10 results on '"Borna Poljak"'
Search Results
2. Plasma long-chain omega-3 fatty acid status and risk of recurrent early spontaneous preterm birth: a prospective observational study
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Andrew Sharp, Laura Goodfellow, Ana Alfirevic, Jelena Ivandic, Zarko Alfirevic, Devender Roberts, Jane Harrold, Borna Poljak, Bertram Müller-Myhsok, Angharad Care, Maria Makrides, and Robert A. Gibson
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Adult ,Relative risk reduction ,medicine.medical_specialty ,Population ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Risk Factors ,Fatty Acids, Omega-3 ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Omega 3 fatty acid ,education ,education.field_of_study ,030219 obstetrics & reproductive medicine ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,Prenatal Care ,General Medicine ,Odds ratio ,medicine.disease ,Eicosapentaenoic acid ,United Kingdom ,Dietary Supplements ,Premature Birth ,Term Birth ,Gestation ,Female ,business - Abstract
Introduction A 2018 Cochrane review found that omega-3 supplementation in pregnancy was associated with a risk reduction of early preterm birth of 0.58; prompting calls for universal supplementation. Recent analysis suggests the benefit may be confined to women with a low baseline omega-3 fatty acid status. However, the contemporary omega-3 fatty acid status of pregnant women in the UK is largely unknown. This is particularly pertinent for women with a previous preterm birth, in whom a small relative risk reduction would have a larger reduction of absolute risk. This study aimed to assess the omega-3 fatty acid status of a UK pregnant population and determine the association between the long-chain omega-3 fatty acids and recurrent spontaneous early preterm birth. Material and methods A total of 283 high-risk women with previous early preterm birth were recruited to the prospective observational study in Liverpool, UK. Additionally, 96 pregnant women with previous term births and birth ≥39+0 weeks in the index pregnancy provided a low-risk population sample. Within the high-risk group we assessed the odds ratio of recurrent early preterm birth compared with birth at ≥37+0 weeks of gestation according to plasma eicosapentaenoic acid plus docosahexaenoic acid (EPA+DHA) at 15-22 weeks of gestation. Results Our participants had low EPA+DHA; 62% (143/229) of women with previous preterm birth and 69% (68/96) of the population sample had levels within the lowest two quintiles of a previously published pregnancy cohort. We found no association between long-chain omega-3 status and recurrent early preterm birth (n = 51). The crude odds ratio of a recurrent event was 0.91 (95% CI 0.38-2.15, p = 0.83) for women in the lowest, compared with the highest three quintiles of EPA+DHA. Conclusions In the majority of our participants, levels of long-chain omega-3 were low; within the range that may benefit from supplementation. However, levels showed no association with risk of recurrent early spontaneous preterm birth. This could be because our population levels were too low to show benefit in being omega-3 "replete"; or else omega-3 levels may be of lesser importance in recurrent early preterm birth.
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- 2021
3. Vaginal bacterial load in the second trimester is associated with early preterm birth recurrence: a nested case-control study
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Jhhm van de Wijgert, Jelena Ivandic, Devender Roberts, Angharad Care, Christina Bronowski, Borna Poljak, Alistair C. Darby, Bertram Müller-Myhsok, Ana Alfirevic, Marijn C. Verwijs, Zarko Alfirevic, A C Gill, Laura Goodfellow, and Andrew Sharp
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Adult ,Fetal Membranes, Premature Rupture ,medicine.medical_specialty ,Gestational Age ,Young Adult ,Pregnancy ,RNA, Ribosomal, 16S ,Statistical significance ,Lactobacillus ,Lactobacillus iners ,medicine ,Humans ,Rupture of membranes ,Lactobacillus crispatus ,biology ,business.industry ,Obstetrics ,Microbiota ,Obstetrics and Gynecology ,Odds ratio ,medicine.disease ,biology.organism_classification ,Bacterial Load ,Confidence interval ,Case-Control Studies ,Pregnancy Trimester, Second ,Vagina ,Nested case-control study ,Premature Birth ,Gestation ,Female ,business ,Dysbiosis - Abstract
ObjectiveTo assess the association between vaginal microbiome (VMB) composition and recurrent early spontaneous preterm birth (sPTB)/preterm prelabour rupture of membranes (PPROM).DesignNested case-control study.SettingUK tertiary referral hospital.SampleHigh-risk women with previous sPTB/PPROM +0 weeks gestation who had a recurrence (n=22) or delivered at ≥37+0 weeks without PPROM (n=87).MethodsVaginal swabs collected between 15-22 weeks gestation were analysed by 16S rRNA gene sequencing and 16S quantitative PCR.Main outcome measureRecurrent early sPTB/PPROM.Results28/109 high-risk women had anaerobic vaginal dysbiosis, with the remainder dominated by lactobacilli (L. iners 36/109, L. crispatus 23/109, or other 22/109). VMB type, diversity, and stability were not associated with recurrence. Women with a recurrence, compared to those without, had a higher median vaginal bacterial load (8.64 vs. 7.89 log10 cells/μl, adjusted odds ratio (aOR)=1.90, 95% confidence interval (CI)=1.01-3.56, p=0.047) and estimated Lactobacillus concentration (8.59 vs. 7.48 log10 cells/μl, aOR=2.35, CI=1.20-4.61, p=0.013). A higher recurrence risk was associated with higher median bacterial loads for each VMB type after stratification, although statistical significance was reached only for L. iners-domination (aOR=3.44, CI=1.06-11.15, p=0.040). Women with anaerobic dysbiosis or L. iners-domination had a higher median vaginal bacterial load than women with a VMB dominated by L. crispatus or other lactobacilli (8.54, 7.96, 7.63, and 7.53 log10 cells/μl, respectively).ConclusionsVaginal bacterial load is associated with early sPTB/PPROM recurrence. Domination by lactobacilli other than L. iners may protect women from developing high bacterial loads. Future PTB studies should quantify vaginal bacteria and yeasts.FundingWellbeing of Women, London, UKTweetable abstractIncreased vaginal bacterial load in the second trimester may be associated with recurrent early spontaneous preterm birth.
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- 2021
4. Does serial 3rd trimester ultrasound improve detection of small for gestational age babies: Comparison of screening policies in 2 European maternity units
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Zarko Alfirevic, Umber Agarwal, Borna Poljak, Edina Berberovic, and Vesna Sokol Karadjole
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Pediatrics ,medicine.medical_specialty ,Croatia ,Cost-Benefit Analysis ,Pregnancy Trimester, Third ,Psychological intervention ,Sensitivity and Specificity ,3rd trimester ,Ultrasonography, Prenatal ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Ultrasound screening ,Humans ,Medicine ,030212 general & internal medicine ,Retrospective Studies ,Fetal Growth Retardation ,030219 obstetrics & reproductive medicine ,business.industry ,ultrasound, screening, small for gaestational age baby ,Ultrasound ,Infant, Newborn ,Obstetrics and Gynecology ,Retrospective cohort study ,Preterm Births ,medicine.disease ,United Kingdom ,Reproductive Medicine ,Infant, Small for Gestational Age ,Small for gestational age ,Female ,business - Abstract
The aim of this study was to compare the diagnostic accuracy of routine versus selective small for gestational age babies screening policy using data from two European Maternity Units. Methods for the antenatal detection of small for gestational age babies (SGA) differ between countries. This was a retrospective cohort study from Liverpool Women’s Hospital, UK, that uses selective third trimester sonography and from the University Hospital Centre Zagreb, Croatia, that uses routine third trimester sonography for SGA detection. Screen positive cases were defined as pregnancies with estimated fetal weight (EFW)
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- 2017
5. Diagnostic accuracy of individual antenatal tools for prediction of small-for-gestational age at birth
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Andrew Sharp, Borna Poljak, Richard J. Jackson, Umber Agarwal, and Zarko Alfirevic
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Pregnancy ,medicine.medical_specialty ,Pediatrics ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics ,Birth weight ,Obstetrics and Gynecology ,Diagnostic accuracy ,General Medicine ,medicine.disease ,Likelihood ratios in diagnostic testing ,03 medical and health sciences ,0302 clinical medicine ,Reproductive Medicine ,Chart ,Medicine ,Small for gestational age ,Gestation ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,business ,Prospective cohort study - Abstract
Objective To determine the accuracy of fetal and newborn growth charts for the prediction of small‐for‐gestational age (SGA ) at birth (birth weight
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- 2017
6. Effect of QUiPP prediction algorithm on treatment decisions in women with a previous preterm birth: a prospective cohort study
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Borna Poljak, Jelena Ivandic, Devender Roberts, Andrew Sharp, Laura Goodfellow, Zarko Alfirevic, and Angharad Care
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education.field_of_study ,Fetal fibronectin ,business.industry ,BIOMEDICINA I ZDRAVSTVO. Kliničke medicinske znanosti. Ginekologija i opstetricija ,Population ,BIOMEDICINE AND HEALTHCARE. Clinical Medical Sciences. Gynecology and Obstetrics ,Cervical length ,QUiPP ,preterm birth prevention treatment ,quantitative fetal fibronectin ,Obstetrics and Gynecology ,Tertiary referral hospital ,medicine.disease ,Likelihood ratios in diagnostic testing ,Gestation ,Medicine ,Medical history ,education ,business ,Prospective cohort study ,Algorithm ,Premature rupture of membranes - Abstract
OBJECTIVE:The QUiPP algorithm combines cervical length, quantitative fetal fibronectin (qfFN) and medical history to quantify risk of preterm birth. We assessed the utility of QUiPP to inform preterm birth prevention treatment decisions. DESIGN:A prospective cohort study with a subsequent impact assessment using the QUiPP risk of birth before 34 weeks gestation. SETTING:A UK TERTIARY REFERRAL HOSPITAL: SAMPLE: 119 women with previous spontaneous preterm birth (sPTB) or preterm premature rupture of membranes (PPROM) before 34 weeks gestation. METHODS:Cervical length and qfFN were measured at 19+0 - 23+0 weeks gestation. Clinical management was based on history and cervical length. After birth, clinicians were unblinded to qfFN results and QUiPP analysis was undertaken. MAIN OUTCOME MEASURES:Predictive statistics of QUiPP algorithm using 10% risk of sPTB before 34+0 weeks as treatment threshold. RESULTS:Fifteen of 119 women (13%) had PPROM or sPTB before 34 weeks. Of these 53% (8/15) had QUiPP risk of sPTB before 34+0 weeks above 10%. Applying this treatment threshold in practice would have doubled our treatment rate (20% vs 42%). QUIPP threshold of 10% had positive likelihood ratio (LR) of 1.3 (95% CI 0.76-2.18), and negative LR of 0.8 (95% CI 0.45-1.40) for predicting sPTB before 34+0 weeks. CONCLUSIONS:Use of the QUiPP algorithm in this population may lead to substantial increase in interventions without evidence that currently available treatment options are beneficial for this particular group. This article is protected by copyright. All rights reserved.
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- 2019
7. Cervical pessary for short cervix in high risk pregnant women: 5 years experience in a single centre
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Andrew Sharp, Zarko Alfirevic, Jelena Ivandic, Devender Roberts, Borna Poljak, Angharad Care, and Laura Goodfellow
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Cervical pessary ,Adult ,medicine.medical_specialty ,Pregnancy, High-Risk ,Cervix Uteri ,Single Center ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,medicine ,Humans ,030212 general & internal medicine ,030219 obstetrics & reproductive medicine ,Obstetrics ,business.industry ,Pregnancy Outcome ,Obstetrics and Gynecology ,Pessaries ,Pregnancy Complications ,Single centre ,Short cervix ,Cervical Length Measurement ,Pediatrics, Perinatology and Child Health ,Premature Birth ,Female ,business - Abstract
Purpose: To describe single center clinical experience with cervical pessary used for high-risk pregnant women who also had short cervix. We have focused on the techniques to optimize efficacy and ...
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- 2018
8. Clinical guidelines for prevention and management of preterm birth: a systematic review
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Silvia Mammarella, Borna Poljak, Nancy Medley, and Zarko Alfirevic
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medicine.medical_specialty ,Psychological intervention ,Tocolysis ,03 medical and health sciences ,Magnesium Sulfate ,0302 clinical medicine ,Pregnancy ,Intervention (counseling) ,medicine ,Humans ,Guideline development ,030212 general & internal medicine ,Intensive care medicine ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics and Gynecology ,Prenatal Care ,Guideline ,medicine.disease ,Systematic review ,Premature birth ,Cervical Length Measurement ,Practice Guidelines as Topic ,Premature Birth ,Fetal lung ,Female ,Steroids ,business - Abstract
Background Clinical practice guidelines (CPG) endorse multiple strategies to prevent or manage preterm birth (PTB). Objectives To summarise CPG recommendations for PTB and identify areas of international consensus. Search strategy In May 2017 we searched for all CPG relevant to PTB without language restrictions. Selection criteria CPG were eligible if the following criteria were met: (1) the guideline was published or current from June 2013; (2) the guideline recommended practices for the prevention or management of PTB relevant to our prespecified clinical questions for screening, medications or surgery and other interventions; (3) publications on methods of guideline development for eligible CPG were included to enable quality assessment. Data collection and analysis Two authors classified CPG recommendations relevant to prespecified clinical questions. When more than 70% of CPGs reporting on a topic recommended or rejected an intervention, we regarded this as consensus. We summarised recommendations in tables. Main results We identified 49 guidelines from 16 guideline developers. We found consensus for several clinical practices: cervical length screening for high-risk women; short-term tocolysis; steroids for fetal lung maturation; and magnesium sulphate for fetal neuroprotection. We found discrepant recommendations for progesterone and fibronectin. No guideline identified an effective strategy for women with multiple pregnancy. Conclusions We identified interventions for which there is an international consensus on benefit for PTB. Systematic reviews of CPG using standardised methodology will help avoid duplication and target scarce resources for guideline developers globally. Tweetable abstract International clinical guidelines agree on the benefits and harmful effects of several important interventions to prevent preterm birth.
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- 2018
9. Assessment of the Fetal Neuromotor Development with the New KANET Test
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Aida Salihagić Kadić, Asim Kurjak, Milan Stanojević, Barbara Grubišić-Čabo, Borna Poljak, and Maja Predojević
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Fetus ,medicine.medical_specialty ,Screening test ,business.industry ,Obstetrics ,Clinical value ,Medicine ,Abnormality ,business ,4d ultrasound ,Test (assessment) - Abstract
Development of ultrasound technology, especially four-dimensional (4D) ultrasound, enabled insight into the fetal neuromotor development that is reflected by the repertoire of fetal activities or fetal behavior. Based on that new technology, the Zagreb group proposed a screening test called the Kurjak Antenatal Neurodevelopmental Test (KANET). Over several years, the KANET has been used to assess almost 2000 fetuses. Results are promising, and the test has demonstrated an ability to recognize normal, borderline, and abnormal behavior in fetuses from normal and pathological pregnancies. However, further studies are necessary as well as long-term postnatal monitoring of children who were prenatally evaluated with the KANET in order to determine its clinical value in identification of children with neurological risk.
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- 2016
10. Prenatal diagnosis of sex chromosome aneuploidies and disorders of sex development-a retrospective analysis of 11-year data
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Berivoj Mišković, Tomislav Hafner, Ana Vičić, Feodora Stipoljev, Ivanka Bekavac Vlatković, and Borna Poljak
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Male ,medicine.medical_specialty ,Population ,Disorders of Sex Development ,Aneuploidy ,Turner Syndrome ,Prenatal diagnosis ,Gestational Age ,Ultrasonography, Prenatal ,Complete androgen insensitivity syndrome ,Pregnancy ,Prenatal Diagnosis ,Turner syndrome ,medicine ,Humans ,Disorders of sex development ,Advanced maternal age ,education ,Sex Chromosome Aberrations ,Retrospective Studies ,education.field_of_study ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,Karyotype ,Chromosome ,Diagnosis ,Disorders ,Hygroma ,Prenatal ,Sex ,Turner ,Ultrasound ,medicine.disease ,sex chromosome ,DSD ,disorders of sex development ,aneuploidy ,Karyotyping ,Pediatrics, Perinatology and Child Health ,Female ,business ,Maternal Age - Abstract
Objective: Analysis of prenatally diagnosed sex chromosome aneuploidies and disorders of sex development (DSDs). Methods: This study includes a retrospective data analysis of 46 prenatally detected sex chromosome aneuploidies and one case of 46,XY DSD diagnosed during an 11-year period (2002–2012) at our department. Results: Of the 46 sex chromosome aneuploidies, 29 cases (63.0%) were in the group of a selected population of women according to abnormal first-/second-trimester ultrasound and 17 (37.0%) cases in an unselected population of women who underwent fetal karyotyping because of advanced maternal age. The most common aneuploidy was Turner syndrome in full and mosaic form (50%). Complete androgen insensitivity syndrome was diagnosed in the case of 46,XY DSD. Conclusions: Sex chromosome aneuploidies must be taken into consideration if, in the first or second trimester, abnormalities are revealed on ultrasound, mainly Turner syndrome in full or mosaic form and 47,XYY.
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- 2014
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