ContextThe prevalence of overweight among children and adolescents increased
between 1988 and 2000 The change in blood pressure among children and adolescents
over that time and the role of overweight is unknownObjectiveTo examine trends in systolic and diastolic blood pressure among children
and adolescents between 1988 and 2000Design, Setting, and PopulationTwo serially conducted cross-sectional studies using nationally representative
samples of children and adolescents, aged 8 to 17 years, from the third National
Health and Nutrition Examination Survey (NHANES III) conducted in 1988-1994
(n = 3496) and NHANES 1999-2000 (n = 2086)Main Outcome MeasuresSystolic and diastolic blood pressure levelsResultsIn 1999-2000, the mean (SE) systolic blood pressure was 1060 (03)
mm Hg and diastolic blood pressure was 617 (05) mm Hg After adjustment
for age, mean systolic blood pressure was 16 mm Hg higher among non-Hispanic
black girls (P = 11) and 29 mm Hg higher among
non-Hispanic black boys (P<001) compared with
non-Hispanic whites Among Mexican Americans, girls' systolic blood pressure
was 10 mm Hg higher (P = 21) and boys' was 27
mm Hg higher (P<001) compared with non-Hispanic
whites (P<001) With further adjustment for body
mass index, these differences were attenuated After age, race/ethnicity,
and sex standardization, systolic blood pressure was 14 (95% confidence interval
[CI], 06-22) mm Hg higher (P<001) and diastolic
blood pressure was 33 (95% CI, 21-45) mm Hg higher in 1999-2000 (P<001) compared with 1988-1994 With further adjustment
for differences in the body mass index distribution in 1988-1994 and 1999-2000,
the increase in systolic blood pressure was reduced by 29% and diastolic blood
pressure was reduced by 12%ConclusionsBlood pressure has increased over the past decade among children and
adolescents This increase is partially attributable to an increased prevalence
of overweight

https://jamanetwork.com/journals/jama/articlepdf/198685/joc32581.pdf

Trends in blood pressure among children and adolescents.

Objective To assess the effect of treatment for cervical intraepithelial neoplasia (CIN) on obstetric outcomes and to correlate this with cone depth and comparison group used. Design Systematic review and meta-analysis. Data sources CENTRAL, Medline, Embase from 1948 to April 2016 were searched for studies assessing obstetric outcomes in women with or without previous local cervical treatment. Data extraction and synthesis Independent reviewers extracted the data and performed quality assessment using the Newcastle-Ottawa criteria. Studies were classified according to method and obstetric endpoint. Pooled risk ratios were calculated with a random effect model and inverse variance. Heterogeneity between studies was assessed with I2 statistics. Main outcome measures Obstetric outcomes comprised preterm birth (including spontaneous and threatened), premature rupture of the membranes, chorioamnionitis, mode of delivery, length of labour, induction of delivery, oxytocin use, haemorrhage, analgesia, cervical cerclage, and cervical stenosis. Neonatal outcomes comprised low birth weight, admission to neonatal intensive care, stillbirth, APGAR scores, and perinatal mortality. Results 71 studies were included (6 338 982 participants: 65 082 treated/6 292 563 untreated). Treatment significantly increased the risk of overall ( Conclusions Women with CIN have a higher baseline risk for prematurity. Excisional and ablative treatment further increases that risk. The frequency and severity of adverse sequelae increases with increasing cone depth and is higher for excision than for ablation.

pdf/adverse-obstetric-outcomes-after-local-treatment-for-3zcqwcabfu.pdf

Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth: systematic review and meta-analysis

ContextIt is unclear whether treatments for cervical intraepithelial neoplasia
(CIN) increase the subsequent risk of preterm delivery. Most studies have
lacked sufficient sample size, mixed heterogeneous subtypes of preterm delivery,
and failed to control for confounding factors.ObjectiveTo determine whether cervical laser and loop electrosurgical excision
procedure (LEEP) treatments increase risk of preterm delivery and its subtypes.Design, Setting, and ParticipantsRetrospective cohort study conducted among women evaluated at a colposcopy
clinic serving Auckland, New Zealand (1988-2000), comparing delivery outcomes
of untreated women (n = 426) and those treated (n = 652) with laser conization,
laser ablation, or LEEP. Record linkage using unique health identifiers identified
women who had subsequent deliveries.Main Outcome MeasuresTotal preterm delivery and its subtypes, spontaneous labor and premature
rupture of membranes before 37 weeks' gestation (pPROM).ResultsThe overall rate of preterm delivery was 13.8%. The rate of pPROM was
6.2% and the rate of spontaneous preterm delivery was 3.8%. Analyses showed
no significant increase in risk of total preterm delivery (adjusted relative
risk [aRR], 1.1; 95% confidence interval [CI], 0.8-1.5) or spontaneous preterm
delivery (aRR, 1.3; 95% CI, 0.7-2.6) for any treatment. Risk of pPROM was
significantly increased following treatment with laser conization (aRR, 2.7;
95% CI, 1.3-5.6) or LEEP (aRR, 1.9; 95% CI, 1.0-3.8), but not laser ablation
(aRR, 1.1; 95% CI, 0.5-2.4). Moreover, risk of pPROM and total preterm delivery
increased significantly with increasing height of tissue removed from the
cervix in conization. Women in the highest tertile of cone height (≥1.7
cm) had a greater than 3-fold increase in risk of pPROM compared with untreated
women (aRR, 3.6; 95% CI, 1.8-7.5).ConclusionsLEEP and laser cone treatments were associated with significantly increased
risk of pPROM. Careful consideration should be given to treatment of CIN in
women of reproductive age, especially when treatment might reasonably be delayed
or targeted to high-risk cases.

/pdf/treatment-for-cervical-intraepithelial-neoplasia-and-risk-of-2ucx670l4i.pdf

Treatment for cervical intraepithelial neoplasia and risk of preterm delivery.

Background
The mean age of women undergoing local treatment for pre-invasive cervical disease (cervical intra-epithelial neoplasia; CIN) or early cervical cancer (stage IA1) is around their 30s and similar to the age of women having their first child. Local cervical treatment has been correlated to adverse reproductive morbidity in a subsequent pregnancy, however, published studies and meta-analyses have reached contradictory conclusions.

Objectives
To assess the effect of local cervical treatment for CIN and early cervical cancer on obstetric outcomes (after 24 weeks of gestation) and to correlate these to the cone depth and comparison group used.

Search methods
We searched the following databases: Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library, 2017, Issue 5), MEDLINE (up to June week 4, 2017) and Embase (up to week 26, 2017). In an attempt to identify articles missed by the search or unpublished data, we contacted experts in the field and we handsearched the references of the retrieved articles and conference proceedings.

Selection criteria
We included all studies reporting on obstetric outcomes (more than 24 weeks of gestation) in women with or without a previous local cervical treatment for any grade of CIN or early cervical cancer (stage IA1). Treatment included both excisional and ablative methods. We excluded studies that had no untreated reference population, reported outcomes in women who had undergone treatment during pregnancy or had a high-risk treated or comparison group, or both

Data collection and analysis
We classified studies according to the type of treatment and the obstetric endpoint. Studies were classified according to method and obstetric endpoint. Pooled risk ratios (RR) and 95% confidence intervals (CIs) were calculated using a random-effects model and inverse variance. Inter-study heterogeneity was assessed with I2 statistics. We assessed maternal outcomes that included preterm birth (PTB) (spontaneous and threatened), preterm premature rupture of the membranes (pPROM), chorioamnionitis, mode of delivery, length of labour, induction of delivery, oxytocin use, haemorrhage, analgesia, cervical cerclage and cervical stenosis. The neonatal outcomes included low birth weight (LBW), neonatal intensive care unit (NICU) admission, stillbirth, perinatal mortality and Apgar scores.

Main results
We included 69 studies (6,357,823 pregnancies: 65,098 pregnancies of treated and 6,292,725 pregnancies of untreated women). Many of the studies included only small numbers of women, were of heterogenous design and in their majority retrospective and therefore at high risk of bias. Many outcomes were assessed to be of low or very low quality (GRADE assessment) and therefore results should be interpreted with caution. Women who had treatment were at increased overall risk of preterm birth (PTB) (less than 37 weeks) (10.7% versus 5.4%, RR 1.75, 95% CI 1.57 to 1.96, 59 studies, 5,242,917 participants, very low quality), severe (less than 32 to 34 weeks) (3.5% versus 1.4%, RR 2.25, 95% CI 1.79 to 2.82), 24 studies, 3,793,874 participants, very low quality), and extreme prematurity (less than 28 to 30 weeks) (1.0% versus 0.3%, (RR 2.23, 95% CI 1.55 to 3.22, 8 studies, 3,910,629 participants, very low quality), as compared to women who had no treatment.

The risk of overall prematurity was higher for excisional (excision versus no treatment: 11.2% versus 5.5%, RR 1.87, 95% CI 1.64 to 2.12, 53 studies, 4,599,416 participants) than ablative (ablation versus no treatment: 7.7% versus 4.6%, RR 1.35, 95% CI 1.20 to 1.52, 14 studies, 602,370 participants) treatments and the effect was higher for more radical excisional techniques (less than 37 weeks: cold knife conisation (CKC) (RR 2.70, 95% CI 2.14 to 3.40, 12 studies, 39,102 participants), laser conisation (LC) (RR 2.11, 95% CI 1.26 to 3.54, 9 studies, 1509 participants), large loop excision of the transformation zone (LLETZ) (RR 1.58, 95% CI 1.37 to 1.81, 25 studies, 1,445,104 participants). Repeat treatment multiplied the risk of overall prematurity (repeat versus no treatment: 13.2% versus 4.1%, RR 3.78, 95% CI 2.65 to 5.39, 11 studies, 1,317,284 participants, very low quality). The risk of overall prematurity increased with increasing cone depth (less than 10 mm to 12 mm versus no treatment: 7.1% versus 3.4%, RR 1.54, 95% CI 1.09 to 2.18, 8 studies, 550,929 participants, very low quality; more than 10 mm to 12 mm versus no treatment: 9.8% versus 3.4%, RR 1.93, 95% CI 1.62 to 2.31, 8 studies, 552,711 participants, low quality; more than 15 mm to 17 mm versus no treatment: 10.1 versus 3.4%, RR 2.77, 95% CI 1.95 to 3.93, 4 studies, 544,986 participants, very low quality; 20 mm or more versus no treatment: 10.2% versus 3.4%, RR 4.91, 95% CI 2.06 to 11.68, 3 studies, 543,750 participants, very low quality). The comparison group affected the magnitude of effect that was higher for external, followed by internal comparators and ultimately women with disease, but no treatment. Untreated women with disease and the pre-treatment pregnancies of the women who were treated subsequently had higher risk of overall prematurity than the general population (5.9% versus 5.6%, RR 1.24, 95% CI 1.14 to 1.34, 15 studies, 4,357,998 participants, very low quality).

pPROM (6.1% versus 3.4%, RR 2.36, 95% CI 1.76 to 3.17, 21 studies, 477,011 participants, very low quality), low birth weight (7.9% versus 3.7%, RR 1.81, 95% CI 1.58 to 2.07, 30 studies, 1,348,206 participants, very low quality), NICU admission rate (12.6% versus 8.9%, RR 1.45, 95% CI 1.16 to 1.81, 8 studies, 2557 participants, low quality) and perinatal mortality (0.9% versus 0.7%, RR 1.51, 95% CI 1.13 to 2.03, 23 studies, 1,659,433 participants, low quality) were also increased after treatment.

Authors' conclusions
Women with CIN have a higher baseline risk for prematurity. Excisional and ablative treatment appears to further increases that risk. The frequency and severity of adverse sequelae increases with increasing cone depth and is higher for excision than it is for ablation. However, the results should be interpreted with caution as they were based on low or very low quality (GRADE assessment) observational studies, most of which were retrospective.

/pdf/obstetric-outcomes-after-conservative-treatment-for-cervical-oke9iixkwi.pdf

Obstetric outcomes after conservative treatment for cervical intraepithelial lesions and early invasive disease

The risk of preterm birth following treatment for precancerous changes in the cervix: a systematic review and meta-analysis.

Obstetrical prognosis for carbon dioxide laser conisation of the uterine cervix

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 38 - N° 1 - p. 89-93

Œdème aigu du poumon lors d’une tocolyse par nicardipine chez une grossesse gémellaire : À propos de trois observations

Monoamniotic twin pregnancies are necessarily monochorionic and are defined by the development of two fetuses in a single amniotic cavity. This pregnancy is the result of a division of the egg between the 8th and 13th day after fertilization. The diagnosis can and should be performed during the first trimester of pregnancy. Apart from the small risk of fetal transfusion syndrome, the specificities of these pregnancies are linked to greater risk of perinatal mortality, malformations, prematurity and the persistent risk of entanglement cords until birth. Intensified obstetrical monitoring eventually requiring hospitalization followed by a premature birth around 34 SA is recommended to improve perinatal outcomes with a reduction in prenatal mortality. Reorientation toward a neonatal Level III, the proposal of a systematic course of corticosteroids and elective delivery once lung maturation is achieved are recommended. There is not enough argument to recommend specific delivery mode, although cesarean section is performed by most authors to reduce the funicular risks.

Grossesse monochoriale monoamniotique : diagnostic et prise en charge

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 26 - N° 3 - p. 321

[Monitoring of labor by fetal pulse oximetry in a case of fetal atrial-ventricular block].

Iconography : Surveillance du travail par l'oxymétrie de pouls foetal dans un cas de bloc auriculo-ventriculaire foetal

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