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José García Adánez Marina Navarro LópezCarmen Fernandez Ferrera María Medina DíazNatalia Pagola Limón Oscar Vaquerizo RuizAna Escudero Gomis 《Progresos de Obstetricia y Ginecología》2013
Objective
To review the obstetric and neonatal outcomes of the application of an updated vaginal breech delivery protocol 10 years after this practice had been discontinued.Methods
Breech presentations were referred to a dedicated breech unit at 36 weeks where the external cephalic version was offered. If breech presentation persisted, the patients were selected to undergo attempted vaginal delivery if the following criteria were met: a) estimated fetal weight of 2.500-3.600 g; b) frank or complete breech presentation; c) absence of hyperextension of the fetal head; and d) a clinically adequate pelvis. Intrapartum criteria included: a) progression of labor of ≥ 1 cm/hour in the first hour; b) In the second stage, 90 minutes were allowed for adequate descent of the breech, and 1 hour of active pushing, and c) the availability of an on-call expert.Results
A total of 93 patients showed single live pregnancies in breech presentation after external cephalic version. Sixty-nine patients (73.4%) underwent elective prelabor cesarean delivery, and 24 (26.6%) progressed to attempted vaginal breech delivery, which was successful in 19 (20.1%). Cesarean indications for breech presentation were reduced from 5.7% in 2009 to 2.02% after the application of external cephalic version and vaginal breech delivery (P<.001). We observed no fetal deaths, no Apgar test at 5 minutes of less than 7, no umbilical artery pH of less than 7, and no fetal injuries.Conclusions
. When antepartum and intrapartum criteria are met, vaginal breech delivery is safe. The availability of an on-call expert allows vaginal breech delivery to be safely performed. The combination of external cephalic version and vaginal breech delivery decreases the cesarean rate for breech presentation. 相似文献3.
Francesca M. Russo Elisa Pozzi Francesca Pelizzoni Lyudmyla Todyrenchuk Davide P. Bernasconi Sabrina Cozzolino Patrizia Vergani 《European journal of obstetrics, gynecology, and reproductive biology》2013
Objectives
To estimate the risk of stillbirth in dichorionic and monochorionic twins compared with singletons, and to evaluate the relevant causes of stillbirth in each group.Study design
A retrospective cohort analysis of all pregnancies ≥22 weeks of gestation was performed at a tertiary care center from January 1995 to June 2011. The overall fetal survival and the prospective risk of stillbirth were compared in monochorionic diamniotic (MCDA) twins, dichorionic diamniotic (DCDA) twins, and singletons. Causes of stillbirth were classified using the ReCoDe classification and were compared among the three study groups.Results
A total of 46,200 singletons, 462 MCDA twins and 1108 DCDA twins were included in the study. Both Kaplan–Meier analysis and prospective risk calculation showed that MCDA twins had the highest risk of stillbirth (OR ranging between 13.5 95% CI 8.7–20.7 at 22.0–24.6 weeks and 4.0 95% CI 1.1–13.1 at 31.0–33.6 weeks, compared to singletons), while singletons had the lowest. Main causes of stillbirth were major congenital malformations in singletons (25.1%) and in DCDA twins (75%), and twin–twin transfusion syndrome in MCDA twins (81.5%). When excluding fetuses affected by major congenital anomalies, MCDA twins (p < 0.001) but not DCDA twins (p = 0.2) remained at increased risk for stillbirth compared with singletons.Conclusion
The risk of stillbirth is significantly higher both in MCDA and DCDA twins compared with singletons. Stillbirths are mainly due to twin–twin transfusion syndrome in MCDA twins and major congenital anomalies in DCDA twins. When major congenital anomalies are excluded, DCDA twins have a similar in utero mortality to singletons. 相似文献4.
Tullio Ghi Michela Nanni Luca Pierantoni Federica Bellussi Maria Letizia Bacchi Reggiani Giacomo Faldella Nicola Rizzo 《European journal of obstetrics, gynecology, and reproductive biology》2013
Objective
To compare the rate of neonatal respiratory morbidity in singletons versus twins delivered by pre-labour caesarean section.Study design
Uncomplicated pregnancies delivered by prelabor caesarean section at 34 + 0 to 37 + 6 weeks’ gestation were retrospectively selected. For both singletons and twins caesarean delivery was undertaken electively only after amniocentesis and if the lecithin/sphingomyelin ratio was ≥2. Neonatal respiratory morbidity was compared in twins versus singletons.Results
241 singletons and 100 twin neonates were included. Overall neonatal respiratory morbidity was comparable between the two groups (25/241 (11.7%) versus 7/100 (7%), p = .331). Between 34 + 0 and 36 + 6 weeks, however, the risk was higher among singleton than twins (15/46 (32.6%) versus 6/72 (8.3%), p < .001). At multiple regression, dichorionicity, gestational age at delivery ≥37 weeks and female sex independently decreased the risk of neonatal respiratory morbidity.Conclusion
The risk of neonatal respiratory morbidity after elective caesarean section seems lower among twins, especially prior to 37 + 0 weeks. 相似文献5.
Anne C. Lee Luke C. Mullany Joanne Katz Steven C. LeClerq Ramesh K. Adhikari 《International journal of gynaecology and obstetrics》2011,113(3):199-204
Objective
To assess stillbirth rates and antepartum risk factors in rural Nepal.Methods
Data were collected prospectively during a cluster-randomized, community-based trial in Sarlahi, Nepal, from 2002 to 2006. Multivariate regression modeling was performed to calculate adjusted relative risk estimates.Results
Among 24 531 births, the stillbirth rate was 35.4 per 1000 births (term stillbirth rate 21.2 per 1000 births). Most births occurred at home without a skilled birth attendant. The majority (69%) of intrapartum maternal deaths resulted in stillbirth. The adjusted RR (aRR) of stillbirth was 2.74 among nulliparas and 1.47 among mothers with history of a child death. Mothers above the age of 30 years carried a 1.59-fold higher risk for stillbirth than mothers who were 20-24 years old. The stillbirth risk was lower among households where the father had any formal education (aRR 0.70). Land ownership (aRR 0.85) and Pahadi ethnicity (aRR 0.67; reference: Madhesi ethnicity) were associated with significantly lower risks of stillbirth.Conclusion
Stillbirth rates were high in rural Nepal, with the majority of stillbirths occurring at full-term gestation. Nulliparity, history of prior child loss, maternal age above 30 years, Madhesi ethnicity, and socioeconomic disadvantage were significant risk factors for stillbirth.Clinicaltrials.govNCT00 109616 相似文献6.
Vimla Sharma Gabrielle Colleran Brendan Dineen Marie B. Hession Gloria Avalos John J. Morrison 《European journal of obstetrics, gynecology, and reproductive biology》2009
Objective
To evaluate the effects of maternal age, induction of labour, epidural analgesia and birth weight on mode of delivery in nulliparous women with a singleton pregnancy and cephalic presentation at ≥36 weeks gestation, and to describe how these factors and their influence have changed over a 17-year period from 1989 to 2005.Study design
The study was conducted in the obstetric department of a university teaching hospital in Ireland. Of 45,647 women delivered, 14,867 were nulliparous with a singleton pregnancy and cephalic presentation and undergoing labour at ≥36 weeks gestation, and were included in the study. The main outcome measures were the influence of maternal age, induction of labour, epidural analgesia and birth weight on the mode of delivery. Multinomial logistic regression analysis for type of delivery and the associated explanatory variables and trend analysis of these variables were performed.Results
There was a significant progressive increase in both unplanned abdominal delivery and instrumental vaginal delivery, with advancing maternal age. Induction of labour increased the risk of unplanned abdominal delivery (OR 1.92; 95% CI 1.73–2.14). Epidural analgesia was associated with an increased risk of instrumental vaginal delivery (OR 4.68; 95% CI 4.18–5.25), and unplanned abdominal delivery (OR 2.29; 95% CI 1.98–2.66). Mothers of infants with birth weight ≥4.5 kg were less likely to be delivered by instrumental vaginal delivery (OR 0.60; 95% CI 0.41–0.88), than mothers delivering infants in the 2.50–4.49 kg birth weight category. Between 1989 and 2005 there was a significant increase in maternal age (P = 0.0001), birth weight (P = 0.042) and unplanned abdominal delivery rates (P = 0.0004), and a reduction in instrumental vaginal delivery rates (P = 0.0013).Conclusions
These data demonstrate that the increasing trend of unplanned abdominal delivery in nulliparous women with a singleton pregnancy and cephalic presentation may be partially explained by advancing maternal age, and other obstetric factors also play a significant role. 相似文献7.
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Objective
to examine the evidence in relation to very advanced maternal age (≥45 years) and maternal and perinatal outcomes in high-income countries.Background
this review was conducted against a background of increasing fertility options for women aged ≥=45 years and rising birth rates among this group of women.Methods
established health databases including SCOPUS, MEDLINE, CINAHL, EMBASE and Maternity and Infant Care were searched for journal papers, published 2001–2011, that examined very advanced maternal age (VAMA) and maternal and perinatal outcomes. Further searches were based on references found in located articles. Keywords included a search term for maternal age ≥45 years (very advanced maternal age, pregnancy aged 45 years and older) and a search term for maternal complications (caesarian section, hypertension, pre-eclampsia, gestational diabetes) and/or adverse perinatal outcome (preterm birth, low birth weight, small for gestational age, stillbirth, perinatal death). Of 164 retrieved publications, 10 met inclusion criteria.Data extraction
data were extracted and organised under the following headings: maternal age ≥45 years; maternal characteristics such as parity and use of artificial reproductive technology (ART); and pre-existing maternal conditions, such as diabetes and hypertension. Additional headings included: gestational conditions, such as pre-eclampsia and gestational diabetes (GDM); and perinatal outcomes, including fetal/infant demise; gestational age and weight. Study quality was assessed by using the Critical Appraisal Skills Programme (CASP) guidelines.Findings
this review produced three main findings: (1) increased rates of stillbirth, perinatal death, preterm birth and low birth weight among women ≥45 years; (2) increased rates of pre-existing hypertension and pregnancy complications such as GDM, gestational hypertension (GH), pre-eclampsia and interventions such as caesarian section; and (3) a trend of favourable outcomes, even at extremely advanced maternal age (50–65 years), for healthy women who had been screened to exclude pre-existing disease.Key conclusions
although there is strong evidence of an association between very advanced maternal age and adverse maternal and perinatal outcomes, the absolute rate of stillbirth/perinatal death remains low, at less than 10 per 1000 births in most high-income countries. Therefore, although women in this age group encounter greater pregnancy risk, most will achieve a successful pregnancy outcome. Best outcomes appear to be linked to pre-existing maternal health, and pregnancy care at tertiary centres may also contribute. This information should be used to counsel women aged ≥45 years who are contemplating pregnancy. 相似文献9.
Sylvia M.C. Vijgen Kim E. Boers Brent C. Opmeer Denise Bijlenga Dick J. Bekedam Kitty W.M. Bloemenkamp Karin de Boer Henk A. Bremer Saskia le Cessie Friso M.C. Delemarre Johannes J. Duvekot Tom H.M. Hasaart Anneke Kwee Jan M.M. van Lith Claudia A. van Meir Maria G. van Pampus Joris A.M. van der Post Monique Rijken Frans J.M.E. Roumen Paulien C.M. van der Salm Marc E.A. Spaanderman Christine Willekes Ella J. Wijnen Ben W.J. Mol Sicco A. Scherjon 《European journal of obstetrics, gynecology, and reproductive biology》2013
Objective
Pregnancies complicated by intrauterine growth restriction (IUGR) are at increased risk for neonatal morbidity and mortality. The Dutch nationwide disproportionate intrauterine growth intervention trial at term (DIGITAT trial) showed that induction of labour and expectant monitoring were comparable with respect to composite adverse neonatal outcome and operative delivery. In this study we compare the costs of both strategies.Study design
A cost analysis was performed alongside the DIGITAT trial, which was a randomized controlled trial in which 650 women with a singleton pregnancy with suspected IUGR beyond 36 weeks of pregnancy were allocated to induction or expectant management. Resource utilization was documented by specific items in the case report forms. Unit costs for clinical resources were calculated from the financial reports of participating hospitals. For primary care costs Dutch standardized prices were used. All costs are presented in Euros converted to the year 2009.Results
Antepartum expectant monitoring generated more costs, mainly due to longer antepartum maternal stays in hospital. During delivery and the postpartum stage, induction generated more direct medical costs, due to longer stay in the labour room and longer duration of neonatal high care/medium care admissions. From a health care perspective, both strategies generated comparable costs: on average €7106 per patient for the induction group (N = 321) and €6995 for the expectant management group (N = 329) with a cost difference of €111 (95%CI: €−1296 to 1641).Conclusion
Induction of labour and expectant monitoring in IUGR at term have comparable outcomes immediately after birth in terms of obstetrical outcomes, maternal quality of life and costs. Costs are lower, however, in the expectant monitoring group before 38 weeks of gestation and costs are lower in the induction of labour group after 38 weeks of gestation. So if induction of labour is considered to pre-empt possible stillbirth in suspected IUGR, it is reasonable to delay until 38 weeks, with watchful monitoring. 相似文献10.
María Ramírez Pineda José Luis Dueñas Díez Carlos Bedoya Bergua Juan Polo Padillo 《Progresos de Obstetricia y Ginecología》2009
Objective
To evaluate the usefulness of fetal fibronectin and cervical length in predicting preterm birth in women with preterm uterine contractions.Material and methods
A prospective study was conducted at the Virgen Macarena Hospital in Seville that included 153 pregnant women with suspected preterm labor and intact membranes. Cervical length was measured by transvaginal sonography and a rapid qualitative fibronectin test was performed in the emergency consultation. Women with a negative fibronectin test and cervical length ≥ 30 mm were not hospitalized or treated with tocolytics or corticosteroids.Results
The mean gestational age at diagnosis was 223,02 ± 19,98 days, and 267,52 ± 14,15 days at delivery. Preterm birth < 37 weeks rate was 23% and 7,4% for deliveries < 35 weeks. There is an association between cervical length < 30 mm and birth < 37 weeks (OR, 3,68; 95% CI, 1,53-8,84), and with delivery in the following 14 days (OR, 3,35; 95% CI, 1,30-21,95). With the association of both tests we gain specificity in predicting preterm birth.Conclusion
Cervical length is the test with higher specificity (E) and negative predictive value (VPN) for the prediction of preterm birth in women with symptomatic contractions. 相似文献11.
Asma Basha Zouhair Amarin Freih Abu-Hassan 《International journal of gynaecology and obstetrics》2013
Objective
To assess the incidence and outcome of neonatal long-bone fractures at a tertiary teaching hospital.Methods
A retrospective study of all neonates with long-bone fractures delivered at Jordan University Hospital between January 1, 2000, and December 31, 2010.Results
Among a total of 34 519 live births, 8 neonates had a long-bone fracture (incidence 0.23/1000 live births); of these, 6 had a femur fracture (0.17/1000 live births) and 2 had a humerus fracture (0.05/1000 live births). The route of delivery was emergency cesarean delivery for 6 infants, elective cesarean delivery for 1 infant, and the vaginal route for 1 infant. The mean birth weight was 2723 g. All neonates weighed more than 2200 g and their gestational age was more than 35 weeks, with the exception of 1 neonate born at 31 weeks weighing 1500 g. The mean time interval from birth to fracture diagnosis was 1.5 days. All fractures healed with no residual deformity.Conclusion
Emergency cesarean delivery carries a higher risk of long-bone fracture than vaginal delivery. Prematurity, malpresentation, abnormal lie, and multiple pregnancies may predispose to long-bone fractures. The prognosis of birth-associated long-bone fractures is good. 相似文献12.
Lai-Ling Chan Tsz-Kin Lo Wai-Lam Lau Samuel Lau Bassanio Law Hin-Hung Tsang Wing-Cheong Leung 《International journal of gynaecology and obstetrics》2013
Objective
To determine rates of use and success of second-line therapies for massive primary postpartum hemorrhage (PPH).Methods
A retrospective cohort study was conducted among 91 women who gave birth at Kwong Wah Hospital, Hong Kong, between January 1, 2006, and December 31, 2011. Inclusion criteria were gestational age of at least 24 weeks and massive PPH (defined as blood loss ≥ 1500 mL within 24 hours after birth). Second-line therapies assessed were uterine compression sutures, uterine artery embolization, and balloon tamponade after failure of uterine massage and uterotonic agents to stop bleeding.Results
The rate of massive PPH was 2.65 per 1000 births. Second-line therapies were used among 42 women with PPH, equivalent to a rate of 1.23 per 1000 births. Only 21.4% of the women who received second-line therapies required rescue hysterectomy. A rising trend was observed for the use of second-line therapies, whereas the incidence of rescue hysterectomy and estimated blood loss were found to concomitantly decrease.Conclusion
Increasing use of second-line therapies among women with massive PPH was associated with a decreasing trend for rescue hysterectomy. Obstetricians should, therefore, consider all available interventions to stop PPH, including early use of second-line options. 相似文献13.
Anne-Frederique Minsart Thai-Son N’guyenHirut Dimtsu Rachel RatsimanresyFouad Dada Rachid Ali Hadji 《International journal of gynaecology and obstetrics》2014
Objective
To calculate the prevalence of maternal obesity and to determine the relation between obesity and cesarean delivery in an urban hospital in Djibouti.Methods
In an observational cohort study, all women who had a live birth or stillbirth between October 2012 and November 2013 were considered for inclusion. Body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) was calculated throughout pregnancy, and women with a BMI of at least 30.0 were deemed to be obese. Multivariate logistic regression analyses were used to evaluate the relation between cesarean and obesity.Results
Overall, 100 (24.8%) of 404 women were obese before 14 weeks of pregnancy, as were 112 (25.2%) of 445 before 22 weeks, and 200 (43.2%) of 463 at delivery. Obesity before 22 weeks was associated with a 127% excess risk of cesarean delivery (adjusted odds ratio 2.27; 95% CI 1.07–4.82; P = 0.032). Similar trends were found when the analyses were limited to the subgroup of women without a previous cesarean delivery or primiparae.Conclusion
Prevalence of maternal obesity is high in Djibouti City and is related to an excess risk of cesarean delivery, even after controlling for a range of medical and socioeconomic variables. 相似文献14.
Nathan S. Fox Andrei Rebarber Samantha M. Dunham Daniel H. Saltzman 《The journal of maternal-fetal & neonatal medicine》2013,26(7):593-596
Objective.?To investigate outcomes of twin gestations with advanced maternal age (AMA).Study design.?Historical cohort of twin gestations cared for by a maternal–fetal medicine faculty practice. Outcomes of patients with AMA (70) and non-AMA (75) were compared. AMA was defined as age ≥35. Analysis including mode of delivery, gestational age at delivery and overall complications was performed. Significance was determined using the chi-square test or the Student's t-test.Results.?The Cesarean rate for AMA was significantly greater compared to non-AMA (80.0% vs. 54.7%; p = 0.001). The main reason for the increased rate was uterine dysfunction. The mean gestational age at delivery for AMA was significantly greater than for non-AMA (36.7 weeks vs. 35.4 weeks; p = 0.02). There were no differences in rates of other adverse outcomes including gestational hypertension, pre-eclampsia, gestational diabetes, suspected fetal growth restriction, preterm birth, low birth weight or low birth weight percentiles. This remained true when we compared the 32 women ages ≥40 years to 118 women ages <40 years.Conclusion.?Among twin pregnancies, AMA women are not at an increased risk of adverse pregnancy outcomes, aside from an increased rate of cesarean delivery. 相似文献
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Lucky O. Lawani Okechukwu B. Anozie Paul O. Ezeonu Chukwuemeka A. Iyoke 《International journal of gynaecology and obstetrics》2014
Objective
To evaluate the incidence of, indications for, and outcome of operative vaginal deliveries compared with spontaneous vaginal deliveries in southeast Nigeria.Methods
A retrospective cohort study was conducted involving cases of operative vaginal delivery performed at Ebonyi State University Teaching Hospital over a 10-year period. Data on the procedures were abstracted from the operation notes of the medical records of parturients.Results
An incidence of 4.7% (n = 461) was recorded. The most common indications for vacuum and forceps delivery were prolonged second stage of labor (44.9%) and poor maternal effort (27.8%). The only indication for destructive operation was intrauterine fetal death (3.7%). The risk ratio (RR) for hemorrhage/vulvar hematoma was 1.14 (95% confidence interval [CI], 0.53–2.48) for vacuum-assisted delivery and 5.49 (95% CI, 0.82–36.64) for forceps delivery. The RR for genital laceration was 1.21 (95% CI, 0.44–3.30) for vacuum-assisted delivery and 9.41 (95% CI, 1.33–66.65) for forceps delivery. The risk of fetal scalp bruises and caput succedaneum was higher for operative vaginal delivery than for spontaneous vaginal delivery, with no significant difference in maternal morbidity. The perinatal mortality rate was 0.9 per 1000 live births.Conclusion
Operative vaginal delivery by experienced healthcare providers is associated with good obstetric outcomes with minimal risk. 相似文献16.
Greg A. Pearson Ian Z. MacKenzie 《European journal of obstetrics, gynecology, and reproductive biology》2013
Objective
To determine the range of, and influences on, the incision-delivery interval (IDI) and the impact on neonatal condition at delivery.Study design
Analysis of prospectively collected cohort data from all women delivered by caesarean section over 12 months in an obstetric unit delivering 6000 women per year. Prospective data were collected from clinical records, with factors that influence IDI and relationship to neonatal condition at birth as the main outcome measures.Results
IDI was recorded for 1379 (93%) caesarean sections and ranged between 1 and 37 min; median (IQR) was 6 (5–8) min, and for 3% the interval was longer than 15 min. Category 1 and 2 caesarean sections had shorter IDI than categories 3 and 4 and intrapartum operations had significantly shorter IDI at 5 (3–8) min than antepartum at 7 (5–9) min (P < 0.0001). Factors associated with longer IDI included previous delivery by caesarean section, increased maternal body mass index (BMI), regional anaesthesia, larger neonatal birthweight and technical problems including intraperitoneal adhesions, but did not include fetal malpresentation, multiple pregnancy, grade of surgeon or stage of labour. IDI had no impact on neonatal condition at birth.Conclusions
Prolonged IDI does not adversely affect neonatal outcome, but factors associated with prolonged IDI should be acknowledged when assessing decision-to-delivery interval target times. 相似文献17.
Ashraf F. Nabhan Amr ElhelalyMohamed Elkadi 《International journal of gynaecology and obstetrics》2014
Objective
To assess the effectiveness of prophylactic antibiotics compared with placebo in preventing neonatal and maternal infection-related morbidity associated with prelabor spontaneous rupture of membranes at or beyond 36 weeks of pregnancy.Methods
In the present randomized controlled trial conducted during 2009–2011, 1640 women with prelabor spontaneous rupture of fetal membranes at or beyond 36 weeks of pregnancy were randomly assigned to receive a single dose of prophylactic intravenous antibiotics or placebo on admission to the labor ward of Ain Shams University, Cairo, Egypt. The participants, caregivers, and investigators were blinded to the group assignment. The primary outcome measure was early-onset neonatal sepsis. An intention-to-treat analysis was performed.Results
Early-onset neonatal sepsis occurred in 34 (4.1%) and 24 (2.9%) neonates in the antibiotics and placebo groups, respectively (risk ratio 1.42; 95% confidence interval 0.85–2.37). Maternal infection outcomes were not significantly different between the 2 trial arms.Conclusion
The routine use of prophylactic antibiotics in women with prelabor spontaneous rupture of fetal membranes at or beyond 36 weeks of pregnancy does not reduce the risk of neonatal and maternal infection-related morbidity.Trial registration number: ACTRN12608000501347 相似文献18.
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Jingmei Ma Pan HongJie Fu Li YuHuixia Yang 《International journal of gynaecology and obstetrics》2014
Objective
To determine the proportion of women with advanced maternal age (AMA) undergoing amniocentesis and assess the recommended indication of 35 years or older in China.Methods
Data were retrospectively evaluated from 9641 patients who underwent diagnostic prenatal amniocentesis in Beijing, China, between January 2001 and December 2012. Maternal age, indication for testing, and karyotype data were collected. Patients referred for AMA were stratified in 2 ways: 35–37 years, 38–40 years, and 41 years or older; and indication of AMA alone or combined with other screening. Outcomes and safety performance were compared among the groups.Results
From 2001 to 2012, the annual rate of amniocentesis and the proportion of AMA-related indications increased (P < 0.01). Overall, 82 abnormalities were detected. In the AMA group, the spontaneous abortion rate was 0.5% (22/4748). The positive predictive value (PPV) of AMA alone was 0.5% for women aged 35–37 years. Only among women aged 41 years or older was the PPV of AMA alone better than that of AMA plus other indications (2.3% vs 1.5%, respectively).Conclusion
The PPV of 35 years or older did not offset the risk of spontaneous abortion. AMA alone should not be used as an indication for amniocentesis especially among women aged 35–40 years. 相似文献20.
S. Ortega Marcilla B. Royo ArillaE.L. Tejero Cabrejas R. Savirón CornudellaB. Rodriguez Solanilla S. Castán MateoJ.M. Campillos Maza 《Clínica e investigación en ginecología y obstetricia》2014