26 results on '"Joanna Sichitiu"'
Search Results
2. Maternal outcomes and risk factors for COVID-19 severity among pregnant women
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Manon Vouga, Guillaume Favre, Oscar Martinez-Perez, Leo Pomar, Laura Forcen Acebal, Alejandra Abascal-Saiz, Maria Rosa Vila Hernandez, Najeh Hcini, Véronique Lambert, Gabriel Carles, Joanna Sichitiu, Laurent Salomon, Julien Stirnemann, Yves Ville, Begoña Martinez de Tejada, Anna Goncé, Ameth Hawkins-Villarreal, Karen Castillo, Eduard Gratacos Solsona, Lucas Trigo, Brian Cleary, Michael Geary, Helena Bartels, Feras Al-Kharouf, Fergal Malone, Mary Higgins, Niamh Keating, Susan Knowles, Christophe Poncelet, Carolina Carvalho Ribeiro-do-Valle, Fernanda Surita, Amanda Dantas-Silva, Carolina Borrelli, Adriana Gomes Luz, Javiera Fuenzalida, Jorge Carvajal, Manuel Guerra Canales, Olivia Hernandez, Olga Grechukhina, Albert I. Ko, Uma Reddy, Rita Figueiredo, Marina Moucho, Pedro Viana Pinto, Carmen De Luca, Marco De Santis, Diogo Ayres de Campos, Inês Martins, Charles Garabedian, Damien Subtil, Betania Bohrer, Maria Lucia Da Rocha Oppermann, Maria Celeste Osorio Wender, Lavinia Schuler-Faccini, Maria Teresa Vieira Sanseverino, Camila Giugliani, Luciana Friedrich, Mariana Horn Scherer, Nicolas Mottet, Guillaume Ducarme, Helene Pelerin, Chloe Moreau, Bénédicte Breton, Thibaud Quibel, Patrick Rozenberg, Eric Giannoni, Cristina Granado, Cécile Monod, Doris Mueller, Irene Hoesli, Dirk Bassler, Sandra Heldstab, Nicole Ochsenbein Kölble, Loïc Sentilhes, Melissa Charvet, Jan Deprest, Jute Richter, Lennart Van der Veeken, Béatrice Eggel-Hort, Gaetan Plantefeve, Mohamed Derouich, Albaro José Nieto Calvache, Maria Camila Lopez-Giron, Juan Manuel Burgos-Luna, Maria Fernanda Escobar-Vidarte, Kurt Hecher, Ann-Christin Tallarek, Eran Hadar, Karina Krajden Haratz, Uri Amikam, Gustavo Malinger, Ron Maymon, Yariv Yogev, Leonhard Schäffer, Arnaud Toussaint, Marie-Claude Rossier, Renato Augusto Moreira De Sa, Claudia Grawe, Karoline Aebi-Popp, Anda-Petronela Radan, Luigi Raio, Daniel Surbek, Paul Böckenhoff, Brigitte Strizek, Martin Kaufmann, Andrea Bloch, Michel Boulvain, Silke Johann, Sandra Andrea Heldstab, Monya Todesco Bernasconi, Gaston Grant, Anis Feki, Anne-Claude Muller Brochut, Marylene Giral, Lucie Sedille, Andrea Papadia, Romina Capoccia Brugger, Brigitte Weber, Tina Fischer, Christian Kahlert, Karin Nielsen Saines, Mary Cambou, Panagiotis Kanellos, Xiang Chen, Mingzhu Yin, Annina Haessig, Sandrine Ackermann, David Baud, and Alice Panchaud
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Medicine ,Science - Abstract
Abstract Pregnant women may be at higher risk of severe complications associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to obstetrical complications. We performed a case control study comparing pregnant women with severe coronavirus disease 19 (cases) to pregnant women with a milder form (controls) enrolled in the COVI-Preg international registry cohort between March 24 and July 26, 2020. Risk factors for severity, obstetrical and immediate neonatal outcomes were assessed. A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented with severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9–9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0–7.0] and diabetes [aOR2.2, 95% CI 1.1–4.5]. Pregnant women with severe maternal outcomes were at higher risk of caesarean section [70.7% (n = 53/75)], preterm delivery [62.7% (n = 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n = 31/75)]. In this study, several risk factors for developing severe complications of SARS-CoV-2 infection among pregnant women were identified including pulmonary comorbidities, hypertensive disorders and diabetes. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease.
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- 2021
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3. Using shear wave elastography to assess uterine tonicity after vaginal delivery
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Joanna Sichitiu, Jean-Yves Meuwly, David Baud, and David Desseauve
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Medicine ,Science - Abstract
Abstract This study aims to evaluate the feasibility and clinical interest of shear wave elastography, by quantitatively estimating the baseline stiffness of the myometrium before and after placental expulsion. We conducted a prospective cohort study of women at term, without known risk factors for postpartum hemorrhage, who gave birth via spontaneous labor in our tertiary center. Myometrium tonicity was evaluated based on measurements of shear wave speed (SWS) in the anterior uterine corpus. All data points were collected by a single operator. Measurements were carried out at three different time points: after fetal delivery (T1), after placental delivery (T2) and 30 min after placental delivery (T3). Our primary objective was to assess the feasibility of this new imaging technique. Ten valid SWS measurements obtained at each of the three different time points were considered as a positive primary outcome. Our secondary objectives were to evaluate the difference in median myometrial shear wave velocity between each time point, as well as to determine the correlation between myometrial shear wave velocity and patients’ characteristics. 38 women were recruited during the study period, of whom 34 met the study criteria. 1017 SWS measurements were obtained. The median time to perform measurements was 16 s for one value, and 2 min 56 s for ten. For 11 women (32%) it was not possible to achieve ten SWS at T1 as placental expulsion immediately followed the birth of the newborn. One patient experienced placental retention and only measurements at T1 were performed. For all other patients, we were successfully able to obtain all measures as intended. There was no difference in the mean shear wave speed between the three time points. After adjustments for confounders, we observed a significant correlation for total blood loss (correlation coefficient = − 0.26, p
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- 2021
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4. Conservative Surgical Management of Placenta Accreta Spectrum: A Pragmatic Approach
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Joanna Sichitiu, Zeina El-Tani, Patrice Mathevet, and David Desseauve
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accreta ,conservative management ,creta ,increta ,invasive placenta ,percreta ,placenta accreta spectrum ,uterine preservation ,Surgery ,RD1-811 - Abstract
In the last 30 years, with increasing cesarean section rates, the incidence of the placenta accreta spectrum has also increased. It is estimated that by the year 2020 there will be nearly 9000 cases annually in the United States. Currently, no consensus exists regarding optimal management. Conventional treatment by cesarean–hysterectomy is challenging, with a high maternal morbidity due to massive hemorrhage, and surgical complications such as urinary tract, bowel and pelvic nerve injury, in addition to loss of fertility and its accompanying psychological trauma. Innovative approaches seek to preserve the uterus with the adherent placenta in situ, thus maintaining fertility and potentially reducing hemorrhage and adjacent organ injury. This review reports strategies for conservative treatment of such conditions, based on the current literature.
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- 2021
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5. Comparison of pelvic floor dysfunction 6 years after uncomplicated vaginal versus elective cesarean deliveries: a cross-sectional study
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David Baud, Joanna Sichitiu, Valeria Lombardi, Maud De Rham, Sylvain Meyer, Yvan Vial, and Chahin Achtari
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Medicine ,Science - Abstract
Abstract Clinicians and patients have traditionally believed that elective cesarean section may protect against certain previously ineluctable consequences of labor, including a plethora of urinary, anorectal and sexual dysfunctions. We aimed to evaluate fecal, urinary and sexual symptoms 6 years postpartum, comparing uncomplicated vaginal delivery and elective cesarean delivery, and to assess their impact on quality of life. We conducted a cross-sectional study to compare perineal functional symptomatology between women having singleton elective cesarean deliveries (eCS) and singleton uncomplicated vaginal deliveries (uVD). Women who delivered 6 years before this study were chosen randomly from our hospital database. This database includes demographic, labor, and delivery information, as well as data regarding maternal and neonatal outcomes, all of which is collected at the time of delivery by the obstetrician. Four validated self-administrated questionnaires were sent by post to the participants: the short forms of the Urogenital Distress Inventory, Incontinence Impact Questionnaire, Wexner fecal incontinence scale, and Female Sexual Function Index. Current socio-demographic details, physical characteristics, obstetrical history and mode of delivery at subsequent births were also registered using a self-reported questionnaire. A total of 309 women with uVD and 208 with eCS returned postal questionnaires. The response rate was 49%. Socio-demographic characteristics and fecal incontinence were similar between groups. After eCS, women reported significantly less urgency urinary incontinence (adjusted Relative Risk 0.55; 95% confidence interval 0.34–0.88) and stress incontinence (adjusted Relative Risk 0.53; 95% confidence interval 0.35–0.80) than after uVD. No difference in total Incontinence Impact Questionnaire score was found between both modes of delivery. Lower abdominal or genital pain (adjusted Relative Risk 1.58; 95% confidence interval 1.01–2.49) and pain related to sexual activity (adjusted Relative Risk 2.50; 95% confidence interval 1.19–5.26) were significantly more frequent after eCS than uVD. Six years postpartum, uVD is associated with urinary incontinence, while eCS is associated with sexual and urination pain.
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- 2020
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6. Assessing feasibility and maternal acceptability of a biomechanically-optimized supine birth position: A pilot study.
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Lisa Bouille, Joanna Sichitiu, Julien Favre, and David Desseauve
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Medicine ,Science - Abstract
BackgroundIn order to manage a protracted second stage of labor, "eminence-based" birth positions have been suggested by some healthcare professionals. Recent biomechanical studies have promoted the use of an optimized supine birthing position in this setting. However, uncertainty exists regarding the feasibility of this posture, and its acceptability by women. This pilot study primarily aimed to assess these characteristics.Objective and methodsIn this monocentric prospective study, 20 women with a protracted second stage of labor were asked to maintain a biomechanically-optimized position for at least 20 minutes at full dilatation. This posture is similar to the McRoberts' maneuver. Maintaining the position for 20 minutes or more was considered clinically relevant and indicative of feasibility and acceptability. Satisfaction with the position was assessed using a Visual Analogue Scale (VAS). A sub-group analysis was performed to assess eventual differences between more and less satisfied patients, according to the median of patients' satisfaction scores.ResultsSeventeen patients (85%) maintained the optimized position for at least 20 minutes. The median satisfaction score of these participants was 8 (interquartile range: 1) out of 10. No significant differences were found between the two sub-groups (satisfaction score ConclusionThe optimized position is acceptable and feasible for women experiencing a protracted second stage of labor. Further clinical studies are needed to assess the efficiency of such positions when women undergo an obstructed labor.
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- 2021
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7. Carbetocin for the prevention of post-partum hemorrhage after vaginal birth: a real-world application
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David Baud, David Desseauve, and Joanna Sichitiu
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endocrine system ,medicine.medical_specialty ,Vaginal birth ,Placenta ,Economic shortage ,Placental Retention ,Uterotonic ,Oxytocin ,Pregnancy ,Oxytocics ,Post-partum hemorrhage ,Humans ,Medicine ,Third stage ,business.industry ,Obstetrics ,Postpartum Hemorrhage ,Postpartum Period ,Obstetrics and Gynecology ,humanities ,Pediatrics, Perinatology and Child Health ,Female ,Carbetocin ,business ,Placenta, Retained ,hormones, hormone substitutes, and hormone antagonists ,medicine.drug - Abstract
To compare maternal outcomes using Carbetocin versus Oxytocin for the active management of the third stage of labor, given a temporary national shortage of Oxytocin. We conducted a retrospective observational study on a cohort of 866 women with vaginal deliveries at our center, >36 weeks of gestation, between November 2018 and March 2019. During the shortage period, each woman received a single slow intravenous injection of Carbetocin 100 µg at delivery of the anterior shoulder, rather than Oxytocin 5 UI, as postpartum hemorrhage prophylaxis. 146 (16.9%) patients received Carbetocin versus 720 (83.1%) receiving Oxytocin. The outcomes were rates of postpartum hemorrhage, severe postpartum hemorrhage, and placental retention. Incidence rates of placental retention and postpartum hemorrhage were 4.9% and 9.4% respectively. Placenta retention was significantly more likely following Carbetocin administration (adjusted odds ratio 2.5; 95% confidence interval 1.2–5.0). Postpartum hemorrhage rates were not significantly different (adjusted odds ratio 1.1; 95% confidence interval 0.6–2.1), as were severe postpartum hemorrhage rates (adjusted odds ratio 0.7; 95% confidence interval 0.2–2.2). Carbetocin is as effective as Oxytocin for postpartum hemorrhage prevention. However, we would reserve it for use after placental delivery due to the increased retention rates.
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- 2021
8. Third trimester placentitis: an underreported complication of SARS-CoV-2 infection
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Joanna Sichitiu, Nicolas Bourgon, Tiffany Guilleminot, Bettina Bessieres, Marianne Leruez-Ville, and Yves Ville
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Obstetrics and Gynecology ,General Medicine - Abstract
SARS-CoV-2-related placentitis shows distinctive histologic characteristics, and its impact on perinatal outcomes is increasingly under scrutiny. We present two such cases in the third trimester displaying mild maternal clinical symptoms and associated with maternal coagulopathy, reduced fetal movements, and nonreassuring fetal heart rate tracing. Both cases resulted in emergency cesarean deliveries. Our cases and a review of the literature highlight that SARS-CoV-2 undermines placental function and thus greatly impacts late-term pregnancies, even in the absence of severe systemic disease.
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- 2022
9. Diabetes mellitus, maternal adiposity, and insulin-dependent gestational diabetes are associated with COVID-19 in pregnancy: the INTERCOVID study
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Brenda Eskenazi, Stephen Rauch, Enrico Iurlaro, Robert B. Gunier, Albertina Rego, Michael G. Gravett, Paolo Ivo Cavoretto, Philippe Deruelle, Perla K. García-May, Mohak Mhatre, Mustapha Ado Usman, Mohamed Elbahnasawy, Saturday Etuk, Raffaele Napolitano, Sonia Deantoni, Becky Liu, Federico Prefumo, Valeria Savasi, Patrícia F. Marques, Eric Baafi, Ghulam Zainab, Ricardo Nieto, Berta Serrano, Muhammad Baffah Aminu, Jorge Arturo Cardona-Perez, Rachel Craik, Adele Winsey, Gabriela Tavchioska, Babagana Bako, Daniel Oros, Caroline Benski, Hadiza Galadanci, Mónica Savorani, Manuela Oberto, Loïc Sentilhes, Milagros Risso, Ken Takahashi, Carmen Vecciarelli, Satoru Ikenoue, Anil K. Pandey, Constanza P. Soto Conti, Irene Cetin, Vincent Bizor Nachinab, Ernawati Ernawati, Eduardo A. Duro, Alexey Kholin, Michelle L. Firlit, Sarah Rae Easter, Joanna Sichitiu, Yetunde John-Akinola, Roberto Casale, Hellas Cena, Josephine Agyeman-Duah, Paola Roggero, Ana Langer, Zulfiqar A. Bhutta, Stephen H. Kennedy, Jose Villar, and Aris T. Papageorghiou
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Adult ,obesity ,Adolescent ,body mass index ,Maternal ,Reproductive health and childbirth ,Obesity, Maternal ,Paediatrics and Reproductive Medicine ,COVID-19 Testing ,Pregnancy ,Clinical Research ,COVID-19 ,diabetes mellitus ,gestational diabetes mellitus ,overweight ,pregnancy ,SARS-CoV-2 ,Diabetes Mellitus ,Humans ,Insulin ,Obstetrics & Reproductive Medicine ,Gestational diabetes ,Metabolic and endocrine ,Adiposity ,Nutrition ,Original Research: Obstetrics ,Prevention ,Diabetes ,Pregnancy Outcome ,Obstetrics and Gynecology ,Diabetes, Gestational ,Diabetes Mellitus, Type 1 ,Good Health and Well Being ,Gestational ,Female ,Type 1 - Abstract
Background Among nonpregnant individuals, diabetes mellitus and high body mass index increase the risk of COVID-19 and its severity. Objective This study aimed to determine whether diabetes mellitus and high body mass index are risk factors for COVID-19 in pregnancy and whether gestational diabetes mellitus is associated with COVID-19 diagnosis. Study Design INTERCOVID was a multinational study conducted between March 2020 and February 2021 in 43 institutions from 18 countries, enrolling 2184 pregnant women aged ≥18 years; a total of 2071 women were included in the analyses. For each woman diagnosed with COVID-19, 2 nondiagnosed women delivering or initiating antenatal care at the same institution were also enrolled. The main exposures were preexisting diabetes mellitus, high body mass index (overweight or obesity was defined as a body mass index ≥25 kg/m2), and gestational diabetes mellitus in pregnancy. The main outcome was a confirmed diagnosis of COVID-19 based on a real-time polymerase chain reaction test, antigen test, antibody test, radiological pulmonary findings, or ≥2 predefined COVID-19 symptoms at any time during pregnancy or delivery. Relationships of exposures and COVID-19 diagnosis were assessed using generalized linear models with a Poisson distribution and log link function, with robust standard errors to account for model misspecification. Furthermore, we conducted sensitivity analyses: (1) restricted to those with a real-time polymerase chain reaction test or an antigen test in the last week of pregnancy, (2) restricted to those with a real-time polymerase chain reaction test or an antigen test during the entire pregnancy, (3) generating values for missing data using multiple imputation, and (4) analyses controlling for month of enrollment. In addition, among women who were diagnosed with COVID-19, we examined whether having gestational diabetes mellitus, diabetes mellitus, or high body mass index increased the risk of having symptomatic vs asymptomatic COVID-19. Results COVID-19 was associated with preexisting diabetes mellitus (risk ratio, 1.94; 95% confidence interval, 1.55–2.42), overweight or obesity (risk ratio, 1.20; 95% confidence interval, 1.06–1.37), and gestational diabetes mellitus (risk ratio, 1.21; 95% confidence interval, 0.99–1.46). The gestational diabetes mellitus association was specifically among women requiring insulin, whether they were of normal weight (risk ratio, 1.79; 95% confidence interval, 1.06–3.01) or overweight or obese (risk ratio, 1.77; 95% confidence interval, 1.28–2.45). A somewhat stronger association with COVID-19 diagnosis was observed among women with preexisting diabetes mellitus, whether they were of normal weight (risk ratio, 1.93; 95% confidence interval, 1.18–3.17) or overweight or obese (risk ratio, 2.32; 95% confidence interval, 1.82–2.97). When the sample was restricted to those with a real-time polymerase chain reaction test or an antigen test in the week before delivery or during the entire pregnancy, including missing variables using imputation or controlling for month of enrollment, the observed associations were comparable. Conclusion Diabetes mellitus and overweight or obesity were risk factors for COVID-19 diagnosis in pregnancy, and insulin-dependent gestational diabetes mellitus was associated with the disease. Therefore, it is essential that women with these comorbidities are vaccinated.
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- 2022
10. Prenatal cavum septi pellucidi width and short-term developmental outcome
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Joanna Sichitiu, Kimia Ghannad-Zadeh, Tim Van Mieghem, and Shiri Shinar
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Obstetrics and Gynecology - Published
- 2023
11. Preeclampsia and COVID-19: results from the INTERCOVID prospective longitudinal study
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Roberto Casale, Mohak Mhatre, Gabriela Tavchioska, Jorge Arturo Cardona-Perez, Federico Prefumo, Irene Cetin, LaVone E. Simmons, Constanza P. Soto Conti, Vincent Bizor Nachinab, Brenda Eskenazi, Satoru Ikenoue, Saturday J. Etuk, Albertina Rego, Fatimah Hassan-Hanga, Mustapha Ado Usman, Philippe Deruelle, Loïc Sentilhes, Enrico Ferrazzi, Abimbola Bowale, Aris T. Papageorghiou, Valeria Savasi, Ken Takahashi, Stephen Kennedy, Muhammad Aminu, Rosa Maria Cerbo, Francesca Giuliani, Becky Liu, Rachel Craik, Nerea Maiz, Adele Winsey, Carmen Vecchiarelli, Stephen Rauch, Robert B. Gunier, Daniel Oros, R. Napolitano, Ernawati Ernawati, Anne Caroline Benski, Michelle L. Firlit, Marynéa Silva do Vale, Babagana Bako, Ramachandran Thiruvengadam, Sonia Deantoni, Joanna Sichitiu, Zulfiqar A Bhutta, Ghulam Zainab, Milagros Risso, Eric Baafi, Sherief Abd-Elsalam, Paolo Cavoretto, Jim G Thornton, Sarah Rae Easter, Perla K. García-May, José Villar, Alexey Kholin, Mónica Savorani, Ricardo Nieto, Eduardo Alfredo Duro, Institut Català de la Salut, [Papageorghiou AT] Nuffield Department of Women’s & Reproductive Health, University of Oxford, Women’s Centre, John Radcliffe Hospital, Oxford, United Kingdom. Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom. Department of Obstetrics and Gynaecology, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom. [Deruelle P] Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. [Gunier RB, Rauch S] Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA. [García-May PK] Hospital Regional Lic. Adolfo López Mateos ISSSTE, Mexico City, Mexico. [Mhatre M] Tufts Medical Center, Boston, MA. [Maiz N] Servei d'Obstetrícia, Vall d’Hebron Hospital Universitari, Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus
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Gestational hypertension ,aspirin ,cohort ,gestational hypertension ,hypertension ,hypertensive disorders in pregnancy ,infection ,morbidity ,mortality ,obesity ,overweight ,preeclampsia ,pregnancy ,preterm birth ,proteinuria ,relative risk ,renal disease ,risk ratio ,SARS-CoV 2 ,small for gestational age ,enfermedades de los genitales femeninos y complicaciones del embarazo::complicaciones del embarazo::hipertensión inducida en el embarazo::preeclampsia [ENFERMEDADES] ,Reproductive health and childbirth ,Low Birth Weight and Health of the Newborn ,Cardiovascular ,Otros calificadores::Otros calificadores::/complicaciones [Otros calificadores] ,Pre-Eclampsia ,Risk Factors ,Pregnancy ,Infant Mortality ,virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus [ENFERMEDADES] ,Medicine ,Longitudinal Studies ,Prospective Studies ,Original Research ,COVID-19 (Malaltia) - Complicacions ,Pediatric ,Obstetrics ,Pregnancy Outcome ,Obstetrics and Gynecology ,Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [DISEASES] ,Premature birth ,Preeclàmpsia - Epidemiologia ,Premature Birth ,Female ,Risk assessment ,Adult ,medicine.medical_specialty ,Other subheadings::Other subheadings::Other subheadings::/virology [Other subheadings] ,Lower risk ,Pregnancy-Induced ,Preeclampsia ,Paediatrics and Reproductive Medicine ,Preterm ,Clinical Research ,Humans ,Risk factor ,Obstetrics & Reproductive Medicine ,Otros calificadores::Otros calificadores::Otros calificadores::/virología [Otros calificadores] ,business.industry ,SARS-CoV-2 ,Contraception/Reproduction ,COVID-19 ,Hypertension, Pregnancy-Induced ,Perinatal Period - Conditions Originating in Perinatal Period ,medicine.disease ,Confidence interval ,Pregnancy Complications ,Good Health and Well Being ,Relative risk ,Female Urogenital Diseases and Pregnancy Complications::Pregnancy Complications::Hypertension, Pregnancy-Induced::Pre-Eclampsia [DISEASES] ,business ,Other subheadings::Other subheadings::/complications [Other subheadings] - Abstract
Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Hipertensió gestacional; Preeclampsia Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Hipertension gestacional; Preeclampsia Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Gestational hypertension; Preeclampsia Background It is unclear whether the suggested link between COVID-19 during pregnancy and preeclampsia is an independent association or if these are caused by common risk factors. Objective This study aimed to quantify any independent association between COVID-19 during pregnancy and preeclampsia and to determine the effect of these variables on maternal and neonatal morbidity and mortality. Study Design This was a large, longitudinal, prospective, unmatched diagnosed and not-diagnosed observational study assessing the effect of COVID-19 during pregnancy on mothers and neonates. Two consecutive not-diagnosed women were concomitantly enrolled immediately after each diagnosed woman was identified, at any stage during pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed until hospital discharge using the standardized INTERGROWTH-21 st protocols and electronic data management system. A total of 43 institutions in 18 countries contributed to the study sample. The independent association between the 2 entities was quantified with the risk factors known to be associated with preeclampsia analyzed in each group. The outcomes were compared among women with COVID-19 alone, preeclampsia alone, both conditions, and those without either of the 2 conditions. Results We enrolled 2184 pregnant women; of these, 725 (33.2%) were enrolled in the COVID-19 diagnosed and 1459 (66.8%) in the COVID-19 not-diagnosed groups. Of these women, 123 had preeclampsia of which 59 of 725 (8.1%) were in the COVID-19 diagnosed group and 64 of 1459 (4.4%) were in the not-diagnosed group (risk ratio, 1.86; 95% confidence interval, 1.32–2.61). After adjustment for sociodemographic factors and conditions associated with both COVID-19 and preeclampsia, the risk ratio for preeclampsia remained significant among all women (risk ratio, 1.77; 95% confidence interval, 1.25–2.52) and nulliparous women specifically (risk ratio, 1.89; 95% confidence interval, 1.17–3.05). There was a trend but no statistical significance among parous women (risk ratio, 1.64; 95% confidence interval, 0.99–2.73). The risk ratio for preterm birth for all women diagnosed with COVID-19 and preeclampsia was 4.05 (95% confidence interval, 2.99–5.49) and 6.26 (95% confidence interval, 4.35–9.00) for nulliparous women. Compared with women with neither condition diagnosed, the composite adverse perinatal outcome showed a stepwise increase in the risk ratio for COVID-19 without preeclampsia, preeclampsia without COVID-19, and COVID-19 with preeclampsia (risk ratio, 2.16; 95% confidence interval, 1.63–2.86; risk ratio, 2.53; 95% confidence interval, 1.44–4.45; and risk ratio, 2.84; 95% confidence interval, 1.67–4.82, respectively). Similar findings were found for the composite adverse maternal outcome with risk ratios of 1.76 (95% confidence interval, 1.32–2.35), 2.07 (95% confidence interval, 1.20–3.57), and 2.77 (95% confidence interval, 1.66–4.63). The association between COVID-19 and gestational hypertension and the direction of the effects on preterm birth and adverse perinatal and maternal outcomes, were similar to preeclampsia, but confined to nulliparous women with lower risk ratios. Conclusion COVID-19 during pregnancy is strongly associated with preeclampsia, especially among nulliparous women. This association is independent of any risk factors and preexisting conditions. COVID-19 severity does not seem to be a factor in this association. Both conditions are associated independently of and in an additive fashion with preterm birth, severe perinatal morbidity and mortality, and adverse maternal outcomes. Women with preeclampsia should be considered a particularly vulnerable group with regard to the risks posed by COVID-19. The study was supported by the COVID-19 Research Response Fund from the University of Oxford (Ref 0009083). A.T.P. is supported by the Oxford Partnership Comprehensive Biomedical Research Centre with funding from the National Institute for Health Research (NIHR) Biomedical Research Centre funding scheme. The funding organization had no involvement in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript, and decision to submit the manuscript for publication.
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- 2021
12. Maternal outcomes and risk factors for COVID-19 severity among pregnant women
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Andrea Papadia, Marco De Santis, Brian Cleary, Feras Al-Kharouf, Irene Hoesli, Kurt Hecher, Javiera Fuenzalida, Sandrine Ackermann, Guillaume Favre, Anis Feki, Lucie Sedille, Ameth Hawkins-Villarreal, Lavinia Schuler-Faccini, Chloe Moreau, Carmen De Luca, David Baud, Eduard Gratacos Solsona, Fernanda Garanhani Surita, Andrea Bloch, Silke Johann, Begoña Martinez de Tejada, Karen Castillo, Uri Amikam, Claudia Grawe, Mariana Horn Scherer, Uma M. Reddy, Adriana Gomes Luz, Véronique Lambert, Ron Maymon, Olga Grechukhina, Betania Bohrer, Anda-Petronela Radan, Alejandra Abascal-Saiz, Karin Nielsen Saines, Marie-Claude Rossier, Najeh Hcini, Sandra A. Heldstab, Oscar Martinez-Perez, Martin Kaufmann, Renato Augusto Moreira de sa, Pedro Viana Pinto, Jorge A Carvajal, Cristina Granado, Helena Bartels, Jute Richter, Yves Ville, Inês S. Martins, Melissa Charvet, Mohamed Derouich, Sandra Andrea Heldstab, Anne-Claude Muller Brochut, Gustavo Malinger, Albert I. Ko, Karoline Aebi-Popp, Gabriel Carles, Julien Stirnemann, Carolina Borrelli, Manon Vouga, Guillaume Ducarme, Marylene Giral, Michel Boulvain, Jan Deprest, Mary Catherine Cambou, Maria Celeste Osório Wender, Mingzhu Yin, Susan Knowles, María Fernanda Escobar-Vidarte, Annina Haessig, Xiang Chen, Carolina C. Ribeiro-do-Valle, Gaston Grant, Albaro José Nieto Calvache, Maria Lúcia Rocha Oppermann, Manuel Guerra Canales, Anna Goncé, Monya Todesco Bernasconi, Brigitte Strizek, Tina Fischer, Loïc Sentilhes, Alice Panchaud, Maria Camila Lopez-Giron, Gaetan Plantefeve, Cécile Monod, Laura Forcen Acebal, Marina Moucho, Juan Manuel Burgos-Luna, Brigitte Weber, Charles Garabedian, Amanda Dantas-Silva, Thibaud Quibel, Camila Giugliani, Fergal D. Malone, Patrick Rozenberg, Eran Hadar, Diogo Ayres de Campos, Paul Böckenhoff, Mary Higgins, Rita Figueiredo, Karina Krajden Haratz, Olivia Hernandez, Lennart Van der Veeken, Luigi Raio, N. Kölble, Christian R Kahlert, Arnaud Toussaint, Maria Rosa Vila Hernandez, Luciana Friedrich, Dirk Bassler, Damien Subtil, Béatrice Eggel-Hort, Eric Giannoni, Ann-Christin Tallarek, Joanna Sichitiu, Nicolas Mottet, Panagiotis Kanellos, Bénédicte Breton, Leonhard Schäffer, Léo Pomar, Maria Teresa Vieira Sanseverino, Niamh Keating, Daniel Surbek, Romina Capoccia Brugger, Laurent Salomon, Michael Geary, Christophe Poncelet, Doris Mueller, Helene Pelerin, Yariv Yogev, and Lucas Trigo
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Adult ,Reproductive signs and symptoms ,medicine.medical_specialty ,Neonatal intensive care unit ,Science ,medicine.medical_treatment ,610 Medicine & health ,Disease ,macromolecular substances ,01 natural sciences ,Article ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,360 Social problems & social services ,Respiratory signs and symptoms ,Diabetes mellitus ,Humans ,Medicine ,Caesarean section ,030212 general & internal medicine ,Pregnancy Complications, Infectious ,0101 mathematics ,Clinical microbiology ,Multidisciplinary ,SARS-CoV-2 ,business.industry ,Obstetrics ,010102 general mathematics ,Pregnancy Outcome ,Case-control study ,COVID-19 ,medicine.disease ,Risk factors ,Viral infection ,Premature birth ,Case-Control Studies ,Cohort ,Premature Birth ,Female ,Pregnant Women ,Infection ,business - Abstract
Pregnant women may be at higher risk of severe complications associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to obstetrical complications. We performed a case control study comparing pregnant women with severe coronavirus disease 19 (cases) to pregnant women with a milder form (controls) enrolled in the COVI-Preg international registry cohort between March 24 and July 26, 2020. Risk factors for severity, obstetrical and immediate neonatal outcomes were assessed. A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented with severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9-9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0-7.0] and diabetes [aOR2.2, 95% CI 1.1-4.5]. Pregnant women with severe maternal outcomes were at higher risk of caesarean section [70.7% (n = 53/75)], preterm delivery [62.7% (n = 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n = 31/75)]. In this study, several risk factors for developing severe complications of SARS-CoV-2 infection among pregnant women were identified including pulmonary comorbidities, hypertensive disorders and diabetes. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease. ispartof: SCIENTIFIC REPORTS vol:11 issue:1 ispartof: location:England status: published
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- 2021
13. Using shear wave elastography to assess uterine tonicity after vaginal delivery
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David Desseauve, David Baud, Jean-Yves Meuwly, and Joanna Sichitiu
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Adult ,Reproductive signs and symptoms ,medicine.medical_specialty ,Placental expulsion ,Science ,Placental Retention ,Oxytocin ,Risk Assessment ,Article ,030218 nuclear medicine & medical imaging ,Uterine Contraction ,Uterine Monitoring ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Birth Weight ,Humans ,Prospective Studies ,Time point ,Prospective cohort study ,Fetus ,030219 obstetrics & reproductive medicine ,Multidisciplinary ,business.industry ,Vaginal delivery ,Postpartum Hemorrhage ,Infant, Newborn ,Myometrium ,Delivery, Obstetric ,Cardiology ,Elasticity Imaging Techniques ,Feasibility Studies ,Medicine ,Tonicity ,Female ,Medical imaging ,business - Abstract
This study aims to evaluate the feasibility and clinical interest of shear wave elastography, by quantitatively estimating the baseline stiffness of the myometrium before and after placental expulsion. We conducted a prospective cohort study of women at term, without known risk factors for postpartum hemorrhage, who gave birth via spontaneous labor in our tertiary center. Myometrium tonicity was evaluated based on measurements of shear wave speed (SWS) in the anterior uterine corpus. All data points were collected by a single operator. Measurements were carried out at three different time points: after fetal delivery (T1), after placental delivery (T2) and 30 min after placental delivery (T3). Our primary objective was to assess the feasibility of this new imaging technique. Ten valid SWS measurements obtained at each of the three different time points were considered as a positive primary outcome. Our secondary objectives were to evaluate the difference in median myometrial shear wave velocity between each time point, as well as to determine the correlation between myometrial shear wave velocity and patients’ characteristics. 38 women were recruited during the study period, of whom 34 met the study criteria. 1017 SWS measurements were obtained. The median time to perform measurements was 16 s for one value, and 2 min 56 s for ten. For 11 women (32%) it was not possible to achieve ten SWS at T1 as placental expulsion immediately followed the birth of the newborn. One patient experienced placental retention and only measurements at T1 were performed. For all other patients, we were successfully able to obtain all measures as intended. There was no difference in the mean shear wave speed between the three time points. After adjustments for confounders, we observed a significant correlation for total blood loss (correlation coefficient = − 0.26, p p = 0.03), and newborn weight (correlation coefficient = − 0.08, p = 0.001). It is feasible to assess uterine tonicity by shear wave imaging, after placental expulsion. We did not observe a variance in uterine tonicity between the three time points. Women who had higher blood loss, received more units of oxytocin and/or those with newborns of a higher weight exhibited lower shear wave speed measures.
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- 2021
14. Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection: The INTERCOVID Multinational Cohort Study
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Stephen Rauch, Paolo Cavoretto, Sherief Abd-Elsalam, Philippe Deruelle, Valeria Savasi, Nerea Maiz, Satoru Ikenoue, Irene Cetin, Mohak Mhatre, Muhammad Aminu, Becky Liu, Constanza P. Soto Conti, Robert B. Gunier, Saturday J. Etuk, Eduardo Alfredo Duro, Loïc Sentilhes, Ricardo Nieto, Jagjit S Teji, Federico Prefumo, Yetunde O. John-Akinola, Carola Capelli, Shabina Ariff, Daniel Oros, Ana Langer, Aris T. Papageorghiou, Enrico Ferrazi, Joanna Sichitiu, Vincent Bizor Nachinab, Ernawati Ernawati, Zulfiqar A Bhutta, Roberto Casale, Babagana Bako, Jorge Arturo Cardona-Perez, Sarah Rae Easter, Carmen Vecciarelli, Hellas Cena, Ramachandran Thiruvengadam, Michael G. Gravett, Perla K. García-May, Marynéa Silva do Vale, Mónica Savorani, José Villar, Manuela Oberto, Alexey Kholin, Laura Salazar, Stephen Kennedy, Mustapha Ado Usman, Paola Roggero, Hadiza S Galadanci, and Adejumoke I. Ayede
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medicine.medical_specialty ,Overweight ,Global Health ,Preeclampsia ,law.invention ,COVID-19 Testing ,law ,Pregnancy ,medicine ,Humans ,Pregnancy Complications, Infectious ,Eclampsia ,business.industry ,Obstetrics ,SARS-CoV-2 ,Infant, Newborn ,Obstetrics and Gynecology ,COVID-19 ,Correction ,General Medicine ,medicine.disease ,Intensive care unit ,Survival Rate ,Premature birth ,Relative risk ,Pediatrics, Perinatology and Child Health ,Female ,medicine.symptom ,Morbidity ,business ,Cohort study ,Follow-Up Studies - Abstract
Importance Detailed information about the association of COVID-19 with outcomes in pregnant individuals compared with not-infected pregnant individuals is much needed. Objective To evaluate the risks associated with COVID-19 in pregnancy on maternal and neonatal outcomes compared with not-infected, concomitant pregnant individuals. Design, Setting, and Participants In this cohort study that took place from March to October 2020, involving 43 institutions in 18 countries, 2 unmatched, consecutive, not-infected women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. Exposures COVID-19 in pregnancy determined by laboratory confirmation of COVID-19 and/or radiological pulmonary findings or 2 or more predefined COVID-19 symptoms. Main Outcomes and Measures The primary outcome measures were indices of (maternal and severe neonatal/perinatal) morbidity and mortality; the individual components of these indices were secondary outcomes. Models for these outcomes were adjusted for country, month entering study, maternal age, and history of morbidity. Results A total of 706 pregnant women with COVID-19 diagnosis and 1424 pregnant women without COVID-19 diagnosis were enrolled, all with broadly similar demographic characteristics (mean [SD] age, 30.2 [6.1] years). Overweight early in pregnancy occurred in 323 women (48.6%) with COVID-19 diagnosis and 554 women (40.2%) without. Women with COVID-19 diagnosis were at higher risk for preeclampsia/eclampsia (relative risk [RR], 1.76; 95% CI, 1.27-2.43), severe infections (RR, 3.38; 95% CI, 1.63-7.01), intensive care unit admission (RR, 5.04; 95% CI, 3.13-8.10), maternal mortality (RR, 22.3; 95% CI, 2.88-172), preterm birth (RR, 1.59; 95% CI, 1.30-1.94), medically indicated preterm birth (RR, 1.97; 95% CI, 1.56-2.51), severe neonatal morbidity index (RR, 2.66; 95% CI, 1.69-4.18), and severe perinatal morbidity and mortality index (RR, 2.14; 95% CI, 1.66-2.75). Fever and shortness of breath for any duration was associated with increased risk of severe maternal complications (RR, 2.56; 95% CI, 1.92-3.40) and neonatal complications (RR, 4.97; 95% CI, 2.11-11.69). Asymptomatic women with COVID-19 diagnosis remained at higher risk only for maternal morbidity (RR, 1.24; 95% CI, 1.00-1.54) and preeclampsia (RR, 1.63; 95% CI, 1.01-2.63). Among women who tested positive (98.1% by real-time polymerase chain reaction), 54 (13%) of their neonates tested positive. Cesarean delivery (RR, 2.15; 95% CI, 1.18-3.91) but not breastfeeding (RR, 1.10; 95% CI, 0.66-1.85) was associated with increased risk for neonatal test positivity. Conclusions and Relevance In this multinational cohort study, COVID-19 in pregnancy was associated with consistent and substantial increases in severe maternal morbidity and mortality and neonatal complications when pregnant women with and without COVID-19 diagnosis were compared. The findings should alert pregnant individuals and clinicians to implement strictly all the recommended COVID-19 preventive measures.
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- 2021
15. Comparison of pelvic floor dysfunction 6 years after uncomplicated vaginal versus elective cesarean deliveries: a cross-sectional study
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Maud de Rham, Joanna Sichitiu, Valeria Lombardi, David Baud, Yvan Vial, Sylvain Meyer, and Chahin Achtari
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Adult ,medicine.medical_specialty ,Stress incontinence ,Science ,Urology ,Urinary Incontinence, Stress ,Urinary incontinence ,Pelvic Floor Disorders ,Article ,Pelvic Organ Prolapse ,03 medical and health sciences ,0302 clinical medicine ,Pelvic floor dysfunction ,Pregnancy ,Surveys and Questionnaires ,medicine ,Elective Cesarean Delivery ,Fecal incontinence ,Humans ,030212 general & internal medicine ,Signs and symptoms ,030219 obstetrics & reproductive medicine ,Multidisciplinary ,Obstetrics ,Vaginal delivery ,business.industry ,Cesarean Section ,Postpartum Period ,Pelvic Floor ,medicine.disease ,Delivery, Obstetric ,Confidence interval ,Cross-Sectional Studies ,Urinary Incontinence ,Risk factors ,Relative risk ,Quality of Life ,Medicine ,Female ,medicine.symptom ,business ,Fecal Incontinence - Abstract
Clinicians and patients have traditionally believed that elective cesarean section may protect against certain previously ineluctable consequences of labor, including a plethora of urinary, anorectal and sexual dysfunctions. We aimed to evaluate fecal, urinary and sexual symptoms 6 years postpartum, comparing uncomplicated vaginal delivery and elective cesarean delivery, and to assess their impact on quality of life. We conducted a cross-sectional study to compare perineal functional symptomatology between women having singleton elective cesarean deliveries (eCS) and singleton uncomplicated vaginal deliveries (uVD). Women who delivered 6 years before this study were chosen randomly from our hospital database. This database includes demographic, labor, and delivery information, as well as data regarding maternal and neonatal outcomes, all of which is collected at the time of delivery by the obstetrician. Four validated self-administrated questionnaires were sent by post to the participants: the short forms of the Urogenital Distress Inventory, Incontinence Impact Questionnaire, Wexner fecal incontinence scale, and Female Sexual Function Index. Current socio-demographic details, physical characteristics, obstetrical history and mode of delivery at subsequent births were also registered using a self-reported questionnaire. A total of 309 women with uVD and 208 with eCS returned postal questionnaires. The response rate was 49%. Socio-demographic characteristics and fecal incontinence were similar between groups. After eCS, women reported significantly less urgency urinary incontinence (adjusted Relative Risk 0.55; 95% confidence interval 0.34–0.88) and stress incontinence (adjusted Relative Risk 0.53; 95% confidence interval 0.35–0.80) than after uVD. No difference in total Incontinence Impact Questionnaire score was found between both modes of delivery. Lower abdominal or genital pain (adjusted Relative Risk 1.58; 95% confidence interval 1.01–2.49) and pain related to sexual activity (adjusted Relative Risk 2.50; 95% confidence interval 1.19–5.26) were significantly more frequent after eCS than uVD. Six years postpartum, uVD is associated with urinary incontinence, while eCS is associated with sexual and urination pain.
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- 2020
16. Intrapartum care of women with COVID-19: A practical approach
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Joanna Sichitiu and David Desseauve
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Pneumonia, Viral ,MEDLINE ,Intrapartum care ,Prenatal care ,Article ,Betacoronavirus ,Pregnancy ,Pandemic ,Obstetrics and Gynaecology ,medicine ,Humans ,Pregnancy Complications, Infectious ,Intensive care medicine ,Pandemics ,Coronavirus Infections/therapy ,Female ,Pneumonia, Viral/therapy ,Pregnancy Complications, Infectious/therapy ,Prenatal Care ,biology ,SARS-CoV-2 ,business.industry ,COVID-19 ,Obstetrics and Gynecology ,medicine.disease ,biology.organism_classification ,Pneumonia ,Reproductive Medicine ,Coronavirus Infections ,business - Published
- 2020
17. Antenatal corticosteroid therapy and COVID‐19: Pathophysiological considerations
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Joanna Sichitiu, David Desseauve, and Fadi Fakhouri
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Pneumonia, Viral ,MEDLINE ,Risk Assessment ,Renin-Angiotensin System ,Betacoronavirus ,Fetal Organ Maturity ,Pregnancy ,Pandemic ,Obstetrics and Gynaecology ,medicine ,Humans ,Pregnancy Complications, Infectious ,Intensive care medicine ,Letters to the Editor ,Letter to the Editor ,Glucocorticoids ,Pandemics ,business.industry ,Betacoronavirus/physiology ,Coronavirus Infections/drug therapy ,Coronavirus Infections/metabolism ,Female ,Fetal Organ Maturity/drug effects ,Glucocorticoids/administration & dosage ,Glucocorticoids/adverse effects ,Pneumonia, Viral/drug therapy ,Pneumonia, Viral/metabolism ,Pregnancy Complications, Infectious/drug therapy ,Pregnancy Complications, Infectious/metabolism ,Prenatal Care/methods ,Renin-Angiotensin System/drug effects ,SARS-CoV-2 ,Obstetrics and Gynecology ,COVID-19 ,Prenatal Care ,General Medicine ,Antenatal corticosteroid ,medicine.disease ,Pathophysiology ,Pneumonia ,Risk assessment ,business ,Coronavirus Infections - Published
- 2020
18. Tachysystole and risk of cesarean section after labor induction using misoprostol: A cohort study
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Alice Panchaud, David Desseauve, Yvan Vial, David Baud, and Joanna Sichitiu
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Adult ,medicine.medical_specialty ,Systole ,medicine.medical_treatment ,Uterine contraction ,03 medical and health sciences ,Uterine Contraction ,0302 clinical medicine ,Pregnancy ,Risk Factors ,Oxytocics ,Tachycardia ,Medicine ,Humans ,030212 general & internal medicine ,Labor, Induced ,Poisson Distribution ,Misoprostol ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,Labor, Obstetric ,business.industry ,Obstetrics ,Cesarean Section ,Infant, Newborn ,Pregnancy Outcome ,Obstetrics and Gynecology ,Retrospective cohort study ,Heart Rate, Fetal ,medicine.disease ,Administration, Intravaginal ,Reproductive Medicine ,Labor induction ,Gestation ,Apgar score ,Female ,medicine.symptom ,business ,medicine.drug ,Cohort study - Abstract
Background In western countries, induction of labor is a common obstetrical intervention. Uterine tachysystole frequently manifests after cervical ripening by misoprostol vaginal inserts. Currently, there is insufficient evidence regarding the clinical impact of tachysystole during induction of labor. Therefore, the objective of the current study is to examine if tachysystole is associated with an increased risk of cesarean section following induction of labor by misoprostol vaginal inserts. Methods We conducted a retrospective cohort study of 446 women over 37 weeks of gestation admitted for labor induction by misoprostol vaginal inserts between May 2016 and May 2017. Fetal heart rate and uterine activity tracings were assessed for tachysystole, defined as ≥ 6 contractions per 10 minutes, averaged over a 30-minute window. Univariate analysis was performed by using t-test and Chi-square, comparing demographics, pregnancy characteristics, intrapartum monitoring, mode of delivery, neonatal outcomes (Apgar score < 7 at 5 minutes, umbilical cord artery pH < 7.10, neonatal intensive care unit admission) and maternal outcomes, with regard to the presence of tachysystole. The association between tachysystole and cesarean section was evaluated after adjusting for potential confounders by a modified Poisson regression model, expressed as an adjusted risk ratio and 95% confidence intervals. Results A total of 140 women (31.4%) presented with tachysystole. The median duration of tachysystole was 2 hours 12 minutes. The rate of cesarean section was 25.0% (N=35) among patients with tachysystole and 19.6% (N=60) for those without tachysystole. Presence of tachysystole during induction of labor with misoprostol vaginal inserts was not associated with cesarean section (adjusted risk ratio,1.0; 95% confidence interval, 0.7 to 1.4). Neonatal and maternal outcomes were similar between mothers who did and did not experience tachysystole. Conclusions This study illustrates that tachysystole is not associated with an increased risk of cesarean section after induction of labor by misoprostol vaginal inserts. The impact of excessive uterine activity on the fetal wellbeing defined by the frequency of uterine contraction alone is probably insufficient. Further research on the development of accurate measures of uterine contractility is necessary to better understand its effect on fetal well-being.
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- 2020
19. Maternal and Obstetrical Outcomes in a Cohort of Pregnant Women Tested for SARS-CoV-2: Interim Results of the COVI-Preg International Registry
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Javiera Fuenzalida, Mary Catherine Cambou, Sanseverino Mtv, Lucie Sedille, Abascal A, Feras Al-Kharouf, Ann-Christin Tallarek, Jute Richter, Guillaume Ducarme, Joanna Sichitiu, Anis Feki, Mingzhu Yin, Léo Pomar, Bénédicte Breton, Amanda Dantas-Silva, Luigi Raio, Carolina Borrelli, Dirk Bassler, Tina Fischer, Anna Goncé, Christian R Kahlert, Maria Camila Lopez-Giron, Stiremann J, Veeken LVd, Gaetan Plantefeve, Romina Capoccia Brugger, Claudia Grawe, Garanhani Surita, Mariana Horn Scherer, Arnaud Toussaint, Leonhard Schäffer, Karin Nielsen Saines, Niamh Keating, Karoline Aebi-Popp, Pedro Viana Pinto, Guillaume Favre, Daniel Surbek, Helena Bartels, Manuel Guerra Canales, Christophe Poncelet, Luciana Friedrich, Marie-Claude Rossier, Nicolas Mottet, Melissa Charvet, Anda-Petronela Radan, Najeh Hcini, Marina Moucho, Marylene Giral, Mohamed Derouich, Yves Ville, Oppermann Mldr, Ribeiro-do-Valle F, Andrea Bloch, Laura Forcen Acebal, Brigitte Weber, Fergal D. Malone, Adriana Gomes Luz, Celeste M, Silke Johann, Cristina Granado, David Baud, X. Chen, Hernandez Mrv, Eduard Gratacos Solsona, Karina Krajden Haratz, Manon Vouga, Kurt Hecher, Brigitte Strizek, Karen Castillo, Perez Om, Sandra A. Heldstab, Thibaud Quibel, Lambert, Paul Böckenhoff, Tejada BMd, Laurent Salomon, Michael Geary, Doris Mueller, Helene Pelerin, Lucas Trigo, Betania Bohrer, Gustavo Malinger, Gaston Grant, Loïc Sentilhes, Cécile Monod, sa RAMd, Charles Garabedian, Yariv Yogev, Béatrice Eggel-Hort, Panagiotis Kanellos, Damien Subtil, Martin Kaufmann, Wender O, Albert I. Ko, Brian Cleary, Irene Hoesli, Uma M. Reddy, Anne-Claude Muller Brochut, Susan Knowles, Jan Deprest, Calvache Ajn, Andrea Papadia, Rita Figueiredo, Santis, Carolina Prado de França Carvalho, Campos DAd, Monya Todesco Bernasconi, Lavinia Schuler-Faccini, Eran Hadar, Olivia Hernandez, María Fernanda Escobar-Vidarte, Annina Haessig, Gabriel Carles, Patrick Rozenberg, Hawkins-Villareal A, Alice Panchaud, N. Kölble, Juan Manuel Burgos-Luna, Camila Giugliani, Ron Maymon, Olga Grechukhina, Mary Higgins, Chloe Moreau, Carmen De Luca, and Michel Boulvain
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Pregnancy ,medicine.medical_specialty ,Fetus ,Neonatal intensive care unit ,business.industry ,Obstetrics ,medicine.disease ,Diabetes mellitus ,Cohort ,Pandemic ,Medicine ,Gestation ,Maternal death ,business - Abstract
Background: Pregnant women represent a vulnerable population at higher risk of complications of infectious diseases. Data regarding the consequences of the emerging pandemic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy are scarce. Recent evidence suggests that pregnant women might be at higher risk of severe disease, while exposed fetuses and newborns could suffer from preterm birth, growth restriction and neonatal infections. Methods: We developed an international web registry to allow structured data collection. Pregnant women at any stage during gestation tested for SARS-CoV-2 infection were enrolled. Maternal, obstetrical and neonatal outcomes were recorded. Findings: 1033 pregnant women tested for SARS-CoV-2 were included, among which 926 tested positive and 107 tested negative. Positive pregnant women were at higher risk of severe maternal outcomes compared to negative women [aRR 5.6, 95% CI 1.4-22.7]. Risk factors for severe maternal outcomes among positive women were pulmonary comorbidities [aOR 4.3, 95% CI 1.9-9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0-7.0] and diabetes [aOR2.2, 95% CI 1.1-4.5]. No difference in term of obstetrical and neonatal outcomes were observed between positive and negative women. Positive pregnant women with severe maternal outcomes were at higher risk of cesarean sections [70.7% (n=53/75)], preterm deliveries [62.7% (n= 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n=31/75)]. A positive neonatal SARS-CoV-2 test was observed in 2.9% (n=11/384) of newborns with an available test at birth. Interpretation: Pregnant women, particularly those with associated comorbidities, seem to be at higher risk of severe complications of SARS-CoV-2 infection. Preliminary data regarding obstetrical and neonatal outcomes among women with a mild disease are reassuring. Funding Statement: None. Declaration of Interests: The authors declare that we have no conflicts of interest. Ethics Approval Statement: The study was approved by both the Swiss Ethical Board (CER-VD-2020-00548) and the local ethics boards at each participating center.
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- 2020
20. Maternal Outcomes and Risk Factors for Severity Among Pregnant Women With COVID-19: A Case Control Study From the COVI-Preg International Registry
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Renato Augusto Moreira de sa, Nicolas Mottet, Andrea Bloch, Silke Johann, Alejandra Abascal, Javiera Fuenzalida, Manuel Guerra Canales, Mary Catherine Cambou, Betania Bohrer, David Baud, Eduard Gratacos Solsona, Mary Higgins, Karen Castillo, Martin Kaufmann, Lucie Sedille, Claudia Grawe, Garanhani Surita, Mariana Horn Scherer, Adriana Gomes Luz, Véronique Lambert, Olga Grechukhina, Fergal D. Malone, Karin Nielsen Saines, Helena Bartels, Melissa Charvet, Marylene Giral, Gustavo Malinger, Cristina Granado, Ann-Christin Tallarek, Joanna Sichitiu, Carolina Prado de França Carvalho, Léo Pomar, Oscar Martinez Perez, Albert I. Ko, Bénédicte Breton, Feras Al-Kharouf, Karoline Aebi-Popp, Kurt Hecher, Jorge A Carvajal, Maria Celeste, Xiang Chen, Marina Moucho, Manon Vouga, Lavinia Schuler-Faccini, Gaston Grant, Anna Goncé, Maria Camila Lopez-Giron, Carolina Borrelli, Romina Capoccia Brugger, Maria Lúcia Rocha Oppermann, Loïc Sentilhes, Uma M. Reddy, Sandra Andrea Heldstab, Béatrice Eggel-Hort, Cécile Monod, Brian Cleary, Gabriel Carles, Michel Boulvain, Leonhard Schäffer, Anis Feki, Susan Knowles, Anne-Claude Muller Brochut, Charles Garabedian, Luigi Raio, Maria Teresa Vieira Sanseverino, Niamh Keating, Lucas Trigo, Jute Richter, Patrick Rozenberg, Annina Haessig, Jan Deprest, Christian R Kahlert, Daniel Surbek, Diogo Ayres de Campos, Dirk Bassler, N. Kölble, Lennart Van der Veeken, Arnaud Toussaint, Monya Todesco Bernasconi, Damien Subtil, Laurent Salomon, Michael Geary, Juan Manuel Burgos-Luna, Ameth Hawkins-Villareal, Sandra A. Heldstab, Irene Hoesli, Eran Hadar, Begoña Martinez de Tejada, Guillaume Favre, Doris Mueller, Olivia Hernandez, Marie-Claude Rossier, Rita Figueiredo, Najeh Hcini, Helene Pelerin, Ron Maymon, Yves Ville, Julien Stiremann, Guillaume Ducarme, Mingzhu Yin, Andrea Papadia, Osorio Wender, Yariv Yogev, Thibaud Quibel, Gaetan Plantefeve, Amanda Dantas-Silva, Marco De Santis, Maria Rosa Vila Hernandez, Pedro Viana Pinto, Luciana Friedrich, Paul Böckenhoff, Mohamed Derouich, Brigitte Strizek, Christophe Poncelet, Panagiotis Kanellos, Tina Fischer, Anda-Petronela Radan, Laura Forcen Acebal, Brigitte Weber, Karina Krajden Haratz, Fernanda Ribeiro-do-Valle, Chloe Moreau, Carmen De Luca, María Fernanda Escobar-Vidarte, Albaro José Nieto Calvache, Alice Panchaud, and Camila Giugliani
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Pregnancy ,medicine.medical_specialty ,Neonatal intensive care unit ,Obstetrics ,business.industry ,Case-control study ,Specific risk ,Disease ,medicine.disease ,Intensive care unit ,law.invention ,law ,Diabetes mellitus ,Cohort ,medicine ,business - Abstract
Background: Recent evidence suggests that pregnant women might be at higher risk of severe disease associated with the emerging pandemic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), while exposed fetuses/newborns could suffer from preterm birth, growth restriction and neonatal infections. The magnitude of this increased risk and specific risk factors for severity remains unclear. Methods: We performed a case control study comparing pregnant women with severe coronavirus disease 19 (case) to pregnant women with a milder form (controls) enrolled in COVI-Preg international registry cohort between from March 24 to July 26, 2020. Risk factors for severity, obstetrical, fetal and neonatal outcomes were assessed. Findings: A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented a severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9-9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0-7.0] and diabetes [aOR2.2, 95% CI 1.1-4.5]. Pregnant women with severe maternal outcomes were at higher risk of cesarean sections [70.7% (n=53/75)], preterm deliveries [62.7% (n= 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n=31/75)]. Interpretation: Pregnant women, particularly those with associated comorbidities, seem to be at higher risk of severe complications of SARS-CoV-2 infection. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease; complications include cesarean sections, prematurity and neonatal admission to the intensive care unit. Funding Statement: None. Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: The study was approved by both the Swiss Ethical Board (CER-VD- 2020-00548) and the local ethics boards at each participating center.
- Published
- 2020
21. Obstetrical anal sphincter injuries and symptoms after subsequent deliveries: A 60 patient study
- Author
-
David Desseauve, Julia Deparis, Carine Fradet-Menard, Joanna Sichitiu, Xavier Fritel, Bertrand Gachon, and Fabrice Pierre
- Subjects
Adult ,medicine.medical_specialty ,Anal Canal ,Perineum ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Pregnancy ,Recurrence ,Risk Factors ,Surveys and Questionnaires ,Humans ,Medicine ,Fecal incontinence ,030212 general & internal medicine ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,Pelvic floor ,business.industry ,Obstetrics ,Vaginal delivery ,Incidence ,Obstetrics and Gynecology ,Retrospective cohort study ,Pelvic Floor ,Anal canal ,Delivery, Obstetric ,medicine.disease ,medicine.anatomical_structure ,Reproductive Medicine ,Quality of Life ,Female ,medicine.symptom ,business ,Fecal Incontinence - Abstract
Introduction More than half of women with a history of prior obstetric anal sphincter injuries (OASIS) will have another pregnancy. Currently, little is known concerning post-partum perineal symptoms in cases of a subsequent vaginal delivery. The aim of this study was to assess the frequency of perineal functional symptoms following a vaginal delivery after OASIS while comparing them to patients who did not have a subsequent delivery. Material and method Retrospective cohort study between January 2000 and December 2011. A questionnaire was sent by post to all women who sustained an OASIS at the Poitiers University Hospital, France. Perineal functional symptoms and quality of life were assessed using validated self-administered questionnaires: Female Pelvic Floor Questionnaire, Pescatori anal incontinence score, EuroQoL five-dimension score, and pain visual analogue scale. Results 159 women of 237 contacted (67%) responded to the questionnaire, on average 46 months after the delivery complicated with OASIS. 135 (85%) of women had a 3rd degree laceration and 24% a 4th degree laceration. 99 women (63%) did not have an ensuing delivery since the event (OASIS − No Subsequent Delivery: SD-). 60 women (37%) had a subsequent delivery (OASIS −Subsequent Delivery: SD + ), with 53 (88%) having a vaginal birth. Among these women, 3 (6%) experienced a recurrent OASIS. The mean score for perineal symptoms (FPFQ) was 6.95 in the OASIS-SD (−) group and 7.40 in the OASIS-SD (+) group (p = 0.64). No significant difference in quality of life (EuroQol 5D) was found between the two groups (p = 0.91). Conclusion We did not observe a deterioration of perineal functional symptomatology after vaginal delivery in women with known prior OASIS, compared to women who did not have a subsequent delivery. Even if the risk of occurrence of these lesions is higher in women with history of previous OASIS compared to those without perineal injury, it is still comparable to incidence among primiparous women.
- Published
- 2018
22. Le retour du siège : mise en place d’un protocole d’accouchement par voie basse au CHUV
- Author
-
Kelly Ribeiro, Joanna Sichitiu, Jean-Yves Meuwly, Yvan Vial, David Baud, and David Desseauve
- Subjects
General Medicine - Published
- 2018
23. Conservative Surgical Management of Placenta Accreta Spectrum: A Pragmatic Approach
- Author
-
Patrice Mathevet, Zeina El-Tani, Joanna Sichitiu, and David Desseauve
- Subjects
medicine.medical_specialty ,Placenta accreta ,Urinary system ,media_common.quotation_subject ,Uterus ,Fertility ,Placenta Accreta ,Conservative Treatment ,Hysterectomy ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,medicine ,Humans ,media_common ,business.industry ,Cesarean Section ,General surgery ,Incidence (epidemiology) ,medicine.disease ,Conservative treatment ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Surgery ,Female ,business ,Pelvic nerve ,Psychological trauma - Abstract
In the last 30 years, with increasing cesarean section rates, the incidence of the placenta accreta spectrum has also increased. It is estimated that by the year 2020 there will be nearly 9000 cases annually in the United States. Currently, no consensus exists regarding optimal management. Conventional treatment by cesarean-hysterectomy is challenging, with a high maternal morbidity due to massive hemorrhage, and surgical complications such as urinary tract, bowel and pelvic nerve injury, in addition to loss of fertility and its accompanying psychological trauma. Innovative approaches seek to preserve the uterus with the adherent placenta in situ, thus maintaining fertility and potentially reducing hemorrhage and adjacent organ injury. This review reports strategies for conservative treatment of such conditions, based on the current literature.
- Published
- 2019
24. [The breech comeback : implementation of a vaginal delivery protocol in the CHUV]
- Author
-
Kelly, Ribeiro, Joanna, Sichitiu, Jean-Yves, Meuwly, Yvan, Vial, David, Baud, and David, Desseauve
- Subjects
Cesarean Section ,Pregnancy ,Humans ,Female ,Breech Presentation ,Delivery, Obstetric - Abstract
Choosing between vaginal delivery and caesarean section in cases of breech presentation is still a matter of controversy. In this article, we present the Lausanne University Hospital's protocol following the introduction of an institutional vaginal breech delivery policy. Vaginal breech delivery is a viable alternative to caesarean section in the presence of an experienced obstetrician and rigorous patient-selection criteria.Le choix entre un accouchement par voie basse et une césarienne reste controversé lors de présentation en siège. Nous présentons dans cet article le protocole de la Maternité du Centre hospitalier universitaire vaudois suite à l’introduction d’une politique favorisant les accouchements en siège. L’accouchement par voie basse du siège est désormais une alternative possible à la césarienne en présence d’obstétriciens expérimentés et de critères de sélection rigoureux des patientes.
- Published
- 2018
25. Ten labor ward commandments: reducing the cesarean section rate by one-third
- Author
-
David Baud, David Desseauve, Yvan Vial, and Joanna Sichitiu
- Subjects
medicine.medical_specialty ,Labor, Obstetric ,Cesarean Section ,business.industry ,Public health ,Section (typography) ,Obstetrics and Gynecology ,Delivery, Obstetric ,female genital diseases and pregnancy complications ,Increased risk ,Pregnancy ,Family medicine ,Pediatrics, Perinatology and Child Health ,Humans ,Medicine ,Female ,business ,Developed country ,reproductive and urinary physiology - Abstract
The increased rate of cesarean section in developed countries is a worrying public health issue, due to the increased risk of feto-maternal morbidity and significant health costs accrued. In an att...
- Published
- 2019
26. Should we offer elective induction of labor to nulliparous women at 39 weeks?
- Author
-
David Desseauve and Joanna Sichitiu
- Subjects
medicine.medical_specialty ,Labor, Obstetric ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,Induction of labor ,Cohort Studies ,Text mining ,Elective Surgical Procedures ,Pregnancy ,medicine ,Humans ,Female ,Labor, Induced ,business - Published
- 2019
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