Browsing by Author "Poon, Liona C."
Now showing 1 - 3 of 3
- Results Per Page
- Sort Options
Item Does low-dose aspirin initiated before 11 weeks' gestation reduce the rate of preeclampsia?(American Journal of Obstetrics and Gynecology, 2019) Chaemsaithong, Piya; Cuenca Gómez, Diana; Plana, María N.; Gil Mira, María del Mar; Poon, Liona C.OBJECTIVE: DATA: Pre-conception or early administration of low-dose aspirin might improve endometrial growth, placental vascularization and organogenesis. Most studies have evaluated the potential benefit of pre-conception or early administration of low-dose aspirin in women with a history of recurrent pregnancy loss, women who have undergone in vitro fertilization or women with thrombophilia or antiphospholipid syndrome. These women are at an increased risk of placenta-associated complications of pregnancy, including preeclampsia, preterm delivery and fetal growth restriction. STUDY: We performed a systematic review and meta-analysis to evaluate the effect of low-dose aspirin initiated at <11 weeks' gestation on the risk of preeclampsia, gestational hypertension, or any hypertensive disorder of pregnancy. Secondary outcomes included preterm delivery at <37 weeks' gestation and fetal growth restriction. STUDY APPRAISAL AND SYNTHESIS METHODS: We searched in MEDLINE via PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.Gov and the World Health Organization International Clinical Trials Registry Platform (WHO-ICTRP) from 1985 to November 2018. Entry criteria were randomized controlled trials evaluating the effect of aspirin administered at <11 weeks' gestation in preventing preeclampsia and/or hypertensive disorders in pregnancy or improving pregnancy outcomes in women with recurrent miscarriage as compared to placebo or no-treatment and outcome data available or provided by authors for >85% of the study population. Relative risks (RR) with 95% confidence intervals (CI) were calculated for each study and pooled for global analysis as the effect measure. We assessed statistical heterogeneity in each meta-analysis using the Chi2 statistics, I2 and Tau2. Heterogeneity was considered substantial if an I2 was greater than 50% and either the Tau2 was greater than zero, or there was a low P-value (<0.10) in the Chi2 test for heterogeneity. Random-effects meta-analysis, weighted by the size of the studies, was performed to produce an overall summary on aspirin effect for each outcome. Sensitivity analysis by sequential omission of each individual study and by fixed-effects model was performed. Publication bias was not assessed due to the small number of included studies. Statistical analysis was performed using Stata release 14.0 (StataCorp, College Station, TX). RESULTS: The entry criteria were fulfilled by eight randomized controlled trials on a combined total of 1,426 participants. Low-dose aspirin initiated at <11 weeks' gestation was associated with a non-significant reduction in the risk of preeclampsia (RR 0.52; 95% CI: 0.23-1.17, P=0.115), gestational hypertension (RR 0.49; 95% CI: 0.20-1.21; P=0.121) and any hypertensive disorder of pregnancy (RR 0.59; 95% CI 0.33-1.04, P=0.067). Early low-dose aspirin reduced the risk of preterm delivery (RR 0.52; 95% CI: 0.27-0.97, p=0.040) but had no impact on the risk of fetal growth restriction (RR 1.10; 95% CI 0.58-2.07, P=0.775). Except for preterm delivery and any hypertensive disorder of pregnancy, sensitivity analysis demonstrated similar observations; therefore confirming the robustness of the analysis. CONCLUSION: The administration of low-dose aspirin at <11 weeks' gestation in high risk women does not decrease the risk of preeclampsia, gestational hypertension, any hypertensive disorder of pregnancy and fetal growth restriction. However, it might reduce the risk of preterm delivery. Larger randomized controlled trials will be required to substantiate the findings.Item Level of agreement between midwives and obstetricians performing ultrasound examination during labor.(International Journal of Gynecology & Obstetrics, 2024) Fidalgo, Ana M.; Miguel, Raquel; Fernández-Buhigas, Irene; Aguado, Asunción; Cuerva, Marcos J.; Corrales, Elisa; Rolle, Valeria; Santacruz Martín, Belén; Gil Mira, María del Mar; Poon, Liona C.Objective To evaluate the level of agreement between ultrasound measurements to evaluate fetal head position and progress of labor by attending midwives and obstetricians after appropriate training. Methods In this prospective study, women in the first stage of labor giving birth to a single baby in cephalic presentation at our Obstetric Unit between March 2018 and December 2019 were invited to participate; 109 women agreed. Transperineal and transabdominal ultrasound was independently performed by a trained midwife and an obstetrician. Two paired measurements were available for comparisons in 107 cases for the angle of progression (AoP), in 106 cases for the head-to-perineum distance (HPD), in 97 cases for the cervical dilatation (CD), and in 79 cases for the fetal head position. Results We found a good correlation between the AoP measured by obstetricians and midwives (intra-class correlation coefficient [ICC] = 0.85; 95% confidence interval [CI] 0.80–0.89). There was a moderate correlation between the HPD (ICC = 0.75; 95% CI 0.68–0.82). There was a very good correlation between the CD measured (ICC = 0.94; 95% CI 0.91–0.96). There was a very good level of agreement in the classification of the fetal head position (Cohen's κ = 0.89; 95% CI 0.80–0.98). Conclusions Ultrasound assessment of fetal head position and progress of labor can effectively be performed by attending midwives without previous experience in ultrasound.Item Risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic: Results of a web-based multinational cross-sectional study.(International Journal of Gynecology and Obstetrics, 2022) Kajdy, Anna; Martin Arias, Aranzazu; Poon, Liona C.Objective To assess risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic using Mind-COVID, a prospective cross-sectional study that compares outcomes in middle-income economies and high-income economies. Methods A total of 7102 pregnant women from 12 high-income economies and nine middle-income economies were included. The web-based survey used two standardized instruments, General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire–9 (PHQ-9). Result Pregnant women in high-income economies reported higher PHQ-9 (0.18 standard deviation [SD], P < 0.001) and GAD-7 (0.08 SD, P = 0.005) scores than those living in middle-income economies. Multivariate regression analysis showed that increasing PHQ-9 and GAD-7 scales were associated with mental health problems during pregnancy and the need for psychiatric treatment before pregnancy. PHQ-9 was associated with a feeling of burden related to restrictions in social distancing, and access to leisure activities. GAD-7 scores were associated with a pregnancy-related complication, fear of adverse outcomes in children related to COVID-19, and feeling of burden related to finances. Conclusions According to this study, the imposed public health measures and hospital restrictions have left pregnant women more vulnerable during these difficult times. Adequate partner and family support during pregnancy and childbirth can be one of the most important protective factors against anxiety and depression, regardless of national economic status.