336 research outputs found
Preterm infant outcomes following COVID-19 lockdowns in Melbourne, Australia
Peer reviewedPublisher PD
Effect of telehealth-integrated antenatal care on pregnancy outcomes in Australia : an interrupted time-series analysis
Funding Information: We thank all the staff involved in the implementation and provision of telehealth-integrated antenatal care and the women receiving care who adapted to the many changes during the pandemic.Peer reviewe
Externally validated prediction models for preâeclampsia:systematic review and metaâanalysis
Objective: This systematic review and metaâanalysis aimed to evaluate the performance of existing externally validated prediction models for preâeclampsia (PE) (specifically, anyâonset, earlyâonset, lateâonset and preterm PE). Methods: A systematic search was conducted in five databases (MEDLINE, EMBASE, Emcare, CINAHL and Maternity & Infant Care Database) and using Google Scholar/reference search to identify studies based on the Population, Index prediction model, Comparator, Outcome, Timing and Setting (PICOTS) approach until 20 May 2023. We extracted data using the CHARMS checklist and appraised the risk of bias using the PROBAST tool. A metaâanalysis of discrimination and calibration performance was conducted when appropriate. Results: Twentyâthree studies reported 52 externally validated prediction models for PE (one preterm, 20 anyâonset, 17 earlyâonset and 14 lateâonset PE models). No model had the same set of predictors. Fifteen anyâonset PE models were validated externally once, two were validated twice and three were validated three times, while the Fetal Medicine Foundation (FMF) competingârisks model for preterm PE prediction was validated widely in 16 different settings. The most common predictors were maternal characteristics (prepregnancy body mass index, prior PE, family history of PE, chronic medical conditions and ethnicity) and biomarkers (uterine artery pulsatility index and pregnancyâassociated plasma proteinâA). The FMF model for preterm PE (triple test plus maternal factors) had the best performance, with a pooled area under the receiverâoperatingâcharacteristics curve (AUC) of 0.90 (95% prediction interval (PI), 0.76â0.96), and was well calibrated. The other models generally had poorâtoâgood discrimination performance (median AUC, 0.66 (range, 0.53â0.77)) and were overfitted on external validation. Apart from the FMF model, only two models that were validated multiple times for anyâonset PE prediction, which were based on maternal characteristics only, produced reasonable pooled AUCs of 0.71 (95% PI, 0.66â0.76) and 0.73 (95% PI, 0.55â0.86). Conclusions: Existing externally validated prediction models for anyâ, earlyâ and lateâonset PE have limited discrimination and calibration performance, and include inconsistent input variables. The tripleâtest FMF model had outstanding discrimination performance in predicting preterm PE in numerous settings, but the inclusion of specialized biomarkers may limit feasibility and implementation outside of highâresource settings. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology
Oxyalkylated alcohols phthalates
Polyvinyl chloride (PVC) is used to obtain a wide range of materials for various purposes. High demand of PVC
is explained by possibility to modify polyvinyl chloride and produce broad range of materials with improved properties as
well as to have cost efficient ratio: productivity, available raw materials, saving of natural resources. However, under normal
temperature polyvinyl chloride is brittle and inelastic, that limits the fields of PVC application. The production of basic PVC
compositions is impossible without plasticizers â low-molecular compounds that allow direct regulating physical and
mechanical properties of polymer. Production of plasticizers became one of the most important branch of petrochemical
industry. Recently, however, the range and production of plasticizers have drastically decreased due to the increased cost,
which reduced the competitiveness of plasticized PVC products. Therefore, the expansion of plasticizer variety for PVC is a
strategic task of great practical significance.
The present work describes synthesis methods of esters on the basis of oxyalkylated alcohols suggested as polyvinyl chloride
plasticizers. Physico-chemical properties of synthesized compounds were studied. Conditions for their production with maximum outcome were selected. The results of experiments in which obtained compounds were tested as additives in the plasticization of PVC showed that the obtained samples of cable plastic, adhesive PVC tapes and multi-layered polyvinyl chloride linoleum satisfy all the technical requirements by the main indicators: cable plastic compound â GOST 5960-72 with amendment 1-9; a PVC adhesive tape â Technical Conditions â 2245-001-00203312-2003; multilayered linoleum â GOST 7251-77. According to the experimental results, phthalates of oxyalkylated alcohols possess rather high efficiency as plasticizers of polyvinyl chloride and are recommended for use in the above-mentioned industrial PVC recipe
Aspirin for evidence-based preeclampsia prevention trial: effect of aspirin in prevention of preterm preeclampsia in subgroups of women according to their characteristics and medical and obstetrical history.
Objective: To examine whether there are differences in the effect of aspirin on the incidence of preterm-PE in the ASPRE trial in subgroups defined according to maternal characteristics and medical and obstetrical history.
Study design: This was a secondary analysis of data from the ASPRE trial. In ASPRE women with singleton pregnancies had screening by means of an algorithm that combines maternal factors and biomarkers at 11-13 weeksâ gestation. Those with an estimated risk for preterm-PE of >1 in 100 were invited to
participate in a double-blind trial of aspirin (150 mg/day) vs. placebo from 11 to 14 until 36 weeksâ gestation. Aspirin was associated with a significant reduction in the incidence of preterm-PE with delivery at 90% of the prescribed medication. Results are presented as forest plot with P values for the
interaction effects, group sizes, event counts and estimated odds ratios. We examined whether the test of interaction was significant at the 5% level with a Bonferroni adjustment for multiple comparisons.
Results: There was no evidence of heterogeneity in the aspirin effect in subgroups defined according to maternal characteristics and obstetrical history. In participants with chronic hypertension preterm-PE occurred in 10.2% (5/49) in the aspirin group and in 8.2% (5/61) in the placebo group (adjusted odds ratio 1.29, 95% confidence interval, 0.33 to 5.12); the respective values in those without chronic hypertension were 1.1% (8/749) in the aspirin group and 3.9% (30/761) in the placebo group (adjusted odds ratio 0.27, 95% confidence interval, 0.12 to 0.60). In all participants with adherence of >90% the adjusted odds ratio in the aspirin group was 0.24 (95% CI 0.09 to 0.65), in the subgroup with chronic hypertension it was 2.06 (95% CI 0.40 to 10.71) and in those without chronic hypertension it was 0.05 (95% CI 0.01 to 0.41). For the complete data set the test of interaction was not significant at the 5% level (p=0.055), but in those with adherence >90%, after adjustment for multiple comparisons, the interaction was significant at the 5% level (p=0.0019).
Conclusions: The beneficial effect of aspirin in the prevention of preterm preeclampsia may not apply in pregnancies with chronic hypertension. There was no evidence of heterogeneity in the aspirin effect in subgroups defined according to maternal characteristics and obstetrical history
Prediction of preterm birth with and without preeclampsia using mid-pregnancy immune and growth-related molecular factors and maternal characteristics.
OBJECTIVE:To evaluate if mid-pregnancy immune and growth-related molecular factors predict preterm birth (PTB) with and without (±) preeclampsia. STUDY DESIGN:Included were 400 women with singleton deliveries in California in 2009-2010 (200 PTB and 200 term) divided into training and testing samples at a 2:1 ratio. Sixty-three markers were tested in 15-20 serum samples using multiplex technology. Linear discriminate analysis was used to create a discriminate function. Model performance was assessed using area under the receiver operating characteristic curve (AUC). RESULTS:Twenty-five serum biomarkers along with maternal age <34 years and poverty status identified >80% of women with PTBâ±âpreeclampsia with best performance in women with preterm preeclampsia (AUCâ=â0.889, 95% confidence interval (0.822-0.959) training; 0.883 (0.804-0.963) testing). CONCLUSION:Together with maternal age and poverty status, mid-pregnancy immune and growth factors reliably identified most women who went on to have a PTBâ±âpreeclampsia
Screening for pre-eclampsia by maternal factors and biomarkers at 11-13âweeks' gestation
Objective:
To examine the performance of screening for early-, preterm- and term-preeclampsia (PE) at 11 13 weeksâ gestation by maternal factors and combinations of mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), serum placental growth factor (PLGF) and serum pregnancy associated plasma protein A (PAPP A).
Methods
The data for this study were derived from three previously reported prospective non intervention screening studies at 11+0 â 13+6 weeksâ gestation in a combined total of 61,174 singleton pregnancies, including 1,770 (2.9%) that developed PE. Bayes theorem was used to combine the prior distribution of the gestational age at delivery with PE, obtained from maternal characteristics, with various combinations of biomarker multiple of the median (MoM) values to derive the p patient specific risks of delivery with PE at <37 weeksâ gestation. The performance of such screening was estimated.
Results In pregnancies that develop ed PE , compared to those without PE, the MoM values of UtA-PI and MAP were increased and PAPP A and PLGF were decreased and the deviation from normal was greater for early than late PE for all four biomarkers. Combined screening by maternal factors, UtA-PI, MAP and PLGF predicted 90% of early PE, 75% of preterm PE and 4 1 % of term PE, at screen positive rate of 10%; inclusion of PAPP A did not improve the performance of screening The performance of screening depended on the racial origin of the women; in screening by a combination of maternal factors, MAP, UtA-PI and PLGF and use of the risk cut off of 1 in 10 0 for PE at <37 weeks in Caucasian women, the screen positive rate was 10% and detection rates for early --, preterm and term PE were 88%, 69% and 40%, respectively. With the same
method of screening and risk cut off in women of Afro Caribbean racial origin, the screen positive rate was 34% and detection rates for early --, preterm and term PE were 100%,
92% and 75%, respectively.
Conclusion
Screening by maternal factors and biomarkers at 11-13 weeksâ gestation can identify a high proportion of pregnancies that develop early- and preterm-PE
First Trimester Examination of Fetal Anatomy: Clinical Practice Guideline by the World Association of Perinatal Medicine (WAPM) and the Perinatal Medicine Foundation (PMF)
This recommendation document follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation. We aim to bring together groups and individuals throughout the world for precise standardization to implement the ultrasound evaluation of the fetus in the first trimester of pregnancy and improve the early detection of anomalies and the clinical management of the pregnancy. The aim is to present a document that includes statements and recommendations on the standard evaluation of the fetal anatomy in the first trimester, based on quality evidence in the peer-reviewed literature as well as the experience of perinatal experts around the world.info:eu-repo/semantics/publishedVersio
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