Papers by Tania T Herrera Rodriguez
Panamerican Journal of Public Health, 2024
Objective. To examine maternal mortality in Panama, analyzing its direct obstetric deaths, indire... more Objective. To examine maternal mortality in Panama, analyzing its direct obstetric deaths, indirect obstetric deaths, and contributory conditions. Methods. This cohort study used publicly available data from the National Institute of Statistics and Census to present a 25-year retrospective analysis of maternal deaths in the Republic of Panama from 1998 to 2022. Public data were sourced from the National Institute of Statistics and Census website of Panama. Relevant codes from the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD) were used. The maternal mortality ratio (MMR) was defined as the number of maternal deaths per 100 000 live births. Trendline reliability with R 2 was performed to analyze the data. Results. A total of 1 026 maternal deaths occurred in Panama from 1998 through 2022, of which 61.2% were attributed to direct obstetric causes; 23.9%, indirect obstetric causes; 13.6%, contributory conditions; and 1.4% were unknown or undetermined. The average MMR was 60.1. The trendline reliability resulted in R 2 = 0.1 (y =-0.5147x + 1094.7), which is not statistically significant but meets the 2030 Sustainable Development Goals. The specific primary causes of direct obstetric deaths were: 12.9% due to postpartum hemorrhage (ICD O72); 9.2%, eclampsia (ICD O15); 6.7%, puerperal sepsis (ICD O85); and 6.3%, pre-eclampsia (ICD O14). For indirect obstetric deaths, the primary causes were: 14.9% due to other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth, and the puerperium (ICD O99); and 7.3%, maternal infectious and parasitic diseases classifiable elsewhere but complicating pregnancy, childbirth, and the puerperium (ICD O98). Conclusions. The findings of this study confirmed that there were substantially more direct obstetric causes (61.2%) than indirect obstetric causes (23.9%), contributory causes (13.6%), or unknown/undetermined causes (1.4%) of maternal mortality, despite being highly preventable. Although Panama is right on track to fulfill the target of 70 MMR by 2030, these results highlight the lack of health care access due to the absence of obstetrician-gynecologists per 100 000 population in indigenous comarcas, where 30.8% of the maternal mortalities occur. Furthermore, the health system in Panama is not immune to pandemics and crises.
American Journal of Obstetrics and Gynecology, 2024
BACKGROUND: A cesarean scar pregnancy is an iatrogenic conse-
quence of a previous cesarean deli... more BACKGROUND: A cesarean scar pregnancy is an iatrogenic conse-
quence of a previous cesarean delivery. The gestational sac implants into a
niche created by the incision of the previous cesarean delivery, and this
carries a substantial risk for major maternal complications. The aim of this
study was to report, analyze, and compare the effectiveness and safety of
different treatments options for cesarean scar pregnancies managed in the
first trimester through a registry.
OBJECTIVE: This study aimed to evaluated the ultrasound findings,
disease behavior, and management of first-trimester cesarean scar
pregnancies.
STUDY DESIGN: We created an international registry of cesarean scar
pregnancy cases to study the ultrasound findings, disease behavior, and
management of cesarean scar pregnancies. The Cesarean Scar Preg-
nancy Registry collects anonymized ultrasound and clinical data of indi-
vidual patients with a cesarean scar pregnancy on a secure, digital
information platform. Cases were uploaded by 31 participating centers
across 19 countries. In this study, we only included live and failing ce-
sarean scar pregnancies (with or without a positive fetal heart beat) that
received active treatment (medical or surgical) before 12þ6 weeks’
gestation to evaluate the effectiveness and safety of the different man-
agement options. Patients managed expectantly were not included in this
study and will be reported separately. Treatment was classified as suc-
cessful if it led to a complete resolution of the pregnancy without the need
for any additional medical interventions.
RESULTS: Between August 29, 2018, and February 28, 2023, we
recorded 460 patients with cesarean scar pregnancies (281 live, 179 failing
cesarean scar pregnancy) who fulfilled the inclusion criteria and were
registered. A total of 270 of 460 (58.7%) patients were managed surgically,
123 of 460 (26.7%) patients underwent medical management, 46 of 460
(10%) patients underwent balloon management, and 21 of 460 (4.6%)
patients received other, less frequently used treatment options. Suction
evacuation was very effective with a success rate of 202 of 221 (91.5%; 95%
confidence interval, 87.8e95.2), whereas systemic methotrexate was least
effective with only 38 of 64 (59.4%; 95% confidence interval, 48.4e70.4)
patients not requiring additional treatment. Overall, surgical treatment of
cesarean scar pregnancies was successful in 236 of 258 (91.5%, 95%
confidence interval, 88.4e94.5) patients and complications were observed
in 24 of 258 patients (9.3%; 95% confidence interval, 6.6e11.9).
CONCLUSION: A cesarean scar pregnancy can be managed effec-
tively in the first trimester of pregnancy in more than 90% of cases with
either suction evacuation, balloon treatment, or surgical excision. The
effectiveness of all treatment options decreases with advancing gesta-
tional age, and cesarean scar pregnancies should be treated as early as
possible after confirmation of the diagnosis. Local medical treatment with
potassium chloride or methotrexate is less efficient and has higher rates of
complications than the other treatment options. Systemic methotrexate
has a substantial risk of failing and a higher complication rate and should
not be recommended as first-line treatment.
Key words: balloon treatment, complications, hemorrhage, hysterec-
tomy, KCl, management, methotrexate, suction evacuatio
Genetics and Clinical Genomics
En las últimas décadas, la medicina prenatal ha incorporado progresivamente diferentes tecnología... more En las últimas décadas, la medicina prenatal ha incorporado progresivamente diferentes tecnologías de diagnóstico que han logrado complementar los métodos existentes. Técnicas citogenéticas tales como el cariotipo han sido complementadas con novedosas técnicas moleculares de alta resolución, permitiendo así identificar cambios genómicos con resolución de nucleótidos individuales. Alguna de estas técnicas incorporada a la evaluación de casos prenatales son el QF-PCR, la hibridación genómica comparativa (arreglo CGH), diferentes métodos de secuenciación masiva paralela, entre otras. Actualmente estas tecnologías moleculares para el diagnóstico prenatal estan siendo implementadas en nuestra región desde en la última década. Todo proceso de implementación trae consigo ventajas y retos intrínsecos de cada tecnología, y el equipo multidisciplinario debe manejar con claridad las indicaciones de su uso y las implicaciones posterior a la generación de resultados. En este trabajo present...
Revista peruana de ginecología y obstetricia, Mar 12, 2024
RESUMEN Introducción. La depresión posparto es una de las complicaciones médicas más comunes, la ... more RESUMEN Introducción. La depresión posparto es una de las complicaciones médicas más comunes, la cual se asocia con resultado perinatal adverso a corto y largo plazo en la madre, el infante y la familia. Objetivo. Describir diversos métodos diagnósticos y diversas terapias utilizadas para el manejo de la depresión posparto y analizar las recomendaciones generadas por las distintas agrupaciones científicas (medicina maternofetal, Colegio Americano de Ginecología y Obstetricia, NICE guidelines, psiquiatría, Pediatría). Metodología. Se crearon diversas estrategias de búsqueda para las bases de datos Medline (vía Pubmed), Scopus, Web of Science, Embase, Cochrane, OVID Psycho, desde el 01 de enero del 2020 al 01 de febrero del 2023, utilizando las palabras clave "postpartum depression", "antidepresivos", "terapia cognitivo conductual", "terapia interpersonal", "mindfulness", vocabulario controlado. Dos investigadores examinaron de forma independiente los títulos y resúmenes de los estudios. Resultados. Alrededor de 14% de las embarazadas desarrollan depresión posparto. Los factores de riesgo más relevantes son antecedente de ansiedad, depresión, antecedentes de tratamiento psiquiátrico, historia de abuso físico, complicaciones médicas posparto. Conclusiones. Una de cada siete pacientes (14%) desarrollaron depresión perinatal. Se debe aplicar herramientas como la Escala de Edimburgo a todas las gestantes en su primera cita de control prenatal, durante el tercer trimestre y en el posparto. Existen diversas terapias seguras que han demostrado reducción de los síntomas y disminución en los niveles de recaída, con pocos efectos secundarios. Palabras clave. Embarazo, Depresión posparto, Farmacoterapia ABSTRACT Introduction: Postpartum depression is one of the most common medical complications associated with adverse short-and long-term perinatal outcome in the mother, infant, and family. Objective: To describe various diagnostic methods and therapies used for the management of postpartum depression and to analyze the recommendations generated by different scientific groups (maternalfetal medicine, American College of Obstetrics and Gynecology, NICE guidelines, psychiatry, pediatrics). Methodology: Different search strategies were used in the databases Medline (via Pubmed), Scopus, Web of Science, Embase, Cochrane, OVID Psycho, from January 01, 2020 to February 01, 2023, using the keywords "postpartum depression", "antidepressants", "cognitive behavioral therapy", "interpersonal therapy", "mindfulness", controlled vocabulary. Two investigators independently reviewed study titles and abstracts. Results: About 14% of pregnant women develop postpartum depression. The most relevant risk factors are a history of anxiety, depression, history of psychiatric treatment, history of physical abuse, postpartum medical complications. Conclusions: One in seven patients (14%) develop perinatal depression. Tools such as the Edinburgh Scale should be applied to all pregnant women at their first prenatal checkup appointment, during the third trimester and in the postpartum period. There are several safe therapies that have demonstrated symptom reduction and decreased levels of relapse, with few side effects.
Ultrasound in Obstetrics & Gynecology, Jun 1, 2017
Frontiers in Medicine, Sep 29, 2022
A and Pereira TV (2022) Diagnostic accuracy of prenatal imaging for the diagnosis of congenital Z... more A and Pereira TV (2022) Diagnostic accuracy of prenatal imaging for the diagnosis of congenital Zika syndrome: Systematic review and meta-analysis.
DOAJ (DOAJ: Directory of Open Access Journals), May 1, 2014
anomalies, but also a nonspecifi c indicator of abnormal development, common to several pathologi... more anomalies, but also a nonspecifi c indicator of abnormal development, common to several pathologic pathways, including an increased risk of miscarriage or fetal death, from 1.6% in those with NT between the 95 th and 99 th percentiles to approximately 20% for values above the 99 th percentile, [5] and a 15-fold increased likelihood of lethal or serious malformation. [6] In the study with the largest sample size to date [7] fetuses with even a minimal increase in NT thickness (greater than the 95 th percentile) had associated adverse perinatal outcomes. Congenital heart disease is the most common of all major birth defects and is responsible for 20% of stillbirths and 30% of neonatal deaths associated with congenital defects. [8,9] Several studies have shown that an enlarged NT is associated with an increased risk of congenital heart disease. Accordingly, NT measurement signifi cantly improves the detection of major cardiac malformations, including duct dependent congenital heart disease. [8-11] The combined data from eight studies on euploid fetuses
Journal of Maternal-fetal & Neonatal Medicine, Jan 12, 2017
Objective: Increasing maternal weight has been shown to predict adverse perinatal outcome, includ... more Objective: Increasing maternal weight has been shown to predict adverse perinatal outcome, including increases in the relative risk of fetal death, stillbirth, neonatal death, perinatal death and infant death. In order to better understand the pathophysiological factors associated with obesity during pregnancy, the role of biomarkers associated with adverse outcomes in obese pregnant women is under investigation. The purpose of this review study was to examine potential biomarkers that could serve as effective screening strategies in obese pregnant women to reduce fetal and neonatal morbidity, as well as maternal morbidity. Methods: Electronic databases (Pubmed, Embase) were searched for previously published research studies that investigated biomarkers associated with perinatal outcomes in obese pregnant women and the putative mechanisms underlying biomarker effects on pregnancy outcomes. Results: It is evident that while several biomarkers predict perinatal complications in obese pregnant women, none fulfill the criteria to be considered clinically useful. Conclusion: There is a critical need for reliable blood-based biomarkers associated with an increased risk of adverse perinatal outcomes in obese pregnant women.
Medicine, case reports and study protocols, Feb 1, 2022
Introduction: We aim to synthesize the best available evidence on the accuracy of prenatal imagin... more Introduction: We aim to synthesize the best available evidence on the accuracy of prenatal imaging for the diagnosis of congenital Zika syndrome due to maternal Zika virus (ZIKV) infection. Specifically, we explored the factors that may influence diagnosis accuracy, such as geographic area, endemicity of ZIKA, operator, gestational age, and type of reference standard used. Methods and analysis Study selection criteria: All types of observational studies were included, that examined pregnant women with ZIKV infection (positive real time polymerase chain reaction or immunoglobulin M (IgM) serological tests and plaque neutralization reduction test). The index tests included prenatal imaging studies (ultrasound and/or magnetic resonance imaging). The reference standard was defined as follows: 1) perinatal death, including stillbirth and neonatal death within the first 48 h of birth, 2) neonatal intensive care unit admission, and 3) composite adverse perinatal outcomes. Case reports will be excluded if they only included fewer than five case. Sources of information: PubMed, Scopus, ISI Web of Science, and Google Scholar will be search from inception to March 2021. Two researchers will independently screen study titles and abstracts for eligibility, followed by full-text assessment. Data extraction will include population, settings, timing, and use of the index test and reference standard used. We will assess the methodological quality of the included studies and a meta-analysis will be performed to estimate summary statistics. Bivariate and hierarchical summary receiver operating characteristic modeling will be used to evaluate the diagnostic performance. The quality of evidence will be assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) metholody. Sources: This systematic review is funded by Secretaria Nacional de Ciencia y Tecnología-Panama. Ethics and dissemination: Ethical approval will not be necessary. Results will be published in a peer review scientific journal.
Revista médica de Panamá, Jan 27, 2023
Introducción: El síndrome de insensibilidad androgénica es un desorden genético y un ti po de tra... more Introducción: El síndrome de insensibilidad androgénica es un desorden genético y un ti po de trastorno del desarrollo sexual. Es la feminización de los genitales externos evalua dos al nacimiento cuando el genotipo es 46, XY. Objetivo: Presentar la clínica, estudios moleculares, ultrasonidos durante el embarazo y del recién nacido con trastorno de diferenciación sexual. Caso Clínico: Femenina de 35 años con tercer embarazo, feto único, con resultado de cri bado genético prenatal no invasivo ampliado de aneuploidías cromosómicas y determina ción del sexo fetal a la semana 11 de gestación con sexo genético masculino, ultrasonido con ángulo del tubérculo genital de menos de 30° indicativo de sexo fenotípico femenino y ecografía postnatal con sexo gonadal masculino. Panel molecular genético con una varian te patogénica para el Gen AR, en hemicigosis, asociado a Síndrome de Insensibilidad An drogénica. Conclusión: La discordancia sexual fenotipogenotipo puede indicar una condición genéti ca, cromosómica o bioquímica subyacente. El manejo conjunto interdisciplinario y el conse jo genético permite el diagnóstico molecular neonatal temprano de la condición.
Clínica e Investigación en Ginecología y Obstetricia, Jul 1, 2021
Abstract Aim The purpose of this study was to establish nuchal translucency reference values in h... more Abstract Aim The purpose of this study was to establish nuchal translucency reference values in healthy foetuses of a population from a single outpatient clinic in Panama. A regression equation was generated for the nuchal translucency median, and compared it to medians from different regions of the world. Methods A cross-sectional retrospective correlational study was conducted to review 904 ultrasound reports from women with a foetus of gestational age between 11 weeks and 13 weeks 6 days, and normal foetuses. Results The crown-rump lengths were between 45 and 84 mm, with a median of 64 mm (IQR = 12). The median nuchal translucency reached a maximum of 1.6 mm (IQR = 0.6). Different percentiles (1st, 5th, 50th, 95th, and 99th) were established for each crown-rump length value. A quadratic equation best represented the relationship between nuchal translucency and crown-rump length between gestational ages of 11 weeks and 13 weeks 6 days. The results were compared with the medians from Glasgow (Foetal Medicine Foundation) FMF original, FMF new, and Sweden, as well as the mean NT from Brazil. Conclusions Reference values are reported for nuchal translucency in the first trimester of single gestations with live foetuses in a Panamanian sample. These results show a non-significant difference between median and centiles in different regions of the world.
Journal of Medical Case Reports, Aug 8, 2020
Background: Twin reversed arterial perfusion sequence is a rare and potentially lethal condition ... more Background: Twin reversed arterial perfusion sequence is a rare and potentially lethal condition affecting approximately 1% of monochorionic twin pregnancies and 1 in 35,000 pregnancies overall. An apparently normal (pump) twin perfuses its severely malformed cotwin with deoxygenated blood via retrograde flow in direct arterioarterial anastomoses between the umbilical arteries of each twin. Fetal intestinal volvulus is a rare condition usually manifesting after birth. We report a unique case of twin reversed arterial perfusion sequence in association with intestinal volvulus in the surviving pump twin. Case presentation: A 32-year-old Hispanic primigravida was referred to our clinic after a fetoscopy procedure of laser photocoagulation of anastomoses at 18 weeks of gestation. Follow up scans in the ex-pump twin revealed dilated bowel loops and a typical "whirlpool sign" at 26 weeks of gestation, and intrauterine intestinal volvulus was suspected. At 29 weeks of gestation, preterm premature rupture of membranes occurred, and an emergency cesarean section was performed. The newborn was diagnosed in the early neonatal period with intestinal perforation. The diagnosis was postnatally confirmed by surgery and histopathology. Conclusions: The type of fetal intervention and late gestational age of the procedure increase the risk of complications. This case alerts health providers to be vigilant in the follow-up of patients with complicated monochorionic pregnancies.
In recent decades, prenatal medicine has progressively incorporated different diagnostic technolo... more In recent decades, prenatal medicine has progressively incorporated different diagnostic technologies that have been able to complement existing methods. Cytogenetic techniques such as karyotyping have been complemented with novel high-resolution molecular techniques, allowing the identification of genomic changes with single nucleotide resolution. Some of these techniques incorporated into the evaluation of prenatal cases are QF-PCR, comparative genomic hybridization (CGH array), different methods of massively parallel sequencing, among others. Currently these molecular technologies for prenatal diagnosis are being implemented in our region since the last decade. Every implementation process brings with it advantages and challenges intrinsic to each technology, and the multidisciplinary team must clearly manage the indications for its use and the implications after the generation of results. In this paper we present some of the considerations by the American College of Genetic and Genomic Medicine and the International Society for Prenatal Diagnosis regarding the indications for these molecular tests and post-test counseling. This will allow the health personnel involved in these tests to implement them effectively, and to obtain a greater benefit for the patient.
Frontiers in Medicine
ObjectiveThe aim of this study was to assess the accuracy of prenatal imaging for the diagnosis o... more ObjectiveThe aim of this study was to assess the accuracy of prenatal imaging for the diagnosis of congenital Zika syndrome.Data sourcesMedline (via Pubmed), PubMed, Scopus, Web of Science, and Google Scholar from inception to March 2022. Two researchers independently screened study titles and abstracts for eligibility.Study eligibility criteriaObservational studies with Zika virus-infected pregnant women were included. The index tests included ultrasound and/or magnetic resonance imaging. The reference standard included (1) Zika infection-related perinatal death, stillbirth, and neonatal death within the first 48 h of birth, (2) neonatal intensive care unit admission, and (3) clinically defined adverse perinatal outcomes.Synthesis methodsWe extracted 2 × 2 contingency tables. Pooled sensitivity and specificity were estimated using the random-effects bivariate model and assessed the summary receiver operating characteristic (ROC) curve. Risk of bias was assessed using QUADAS 2 tool....
Medicine: Case Reports and Study Protocols, 2022
Introduction: We aim to synthesize the best available evidence on the accuracy of prenatal imagin... more Introduction: We aim to synthesize the best available evidence on the accuracy of prenatal imaging for the diagnosis of congenital Zika syndrome due to maternal Zika virus (ZIKV) infection. Specifically, we explored the factors that may influence diagnosis accuracy, such as geographic area, endemicity of ZIKA, operator, gestational age, and type of reference standard used. Methods and analysis Study selection criteria: All types of observational studies were included, that examined pregnant women with ZIKV infection (positive real time polymerase chain reaction or immunoglobulin M (IgM) serological tests and plaque neutralization reduction test). The index tests included prenatal imaging studies (ultrasound and/or magnetic resonance imaging). The reference standard was defined as follows: 1) perinatal death, including stillbirth and neonatal death within the first 48 h of birth, 2) neonatal intensive care unit admission, and 3) composite adverse perinatal outcomes. Case reports will be excluded if they only included fewer than five case. Sources of information: PubMed, Scopus, ISI Web of Science, and Google Scholar will be search from inception to March 2021. Two researchers will independently screen study titles and abstracts for eligibility, followed by full-text assessment. Data extraction will include population, settings, timing, and use of the index test and reference standard used. We will assess the methodological quality of the included studies and a meta-analysis will be performed to estimate summary statistics. Bivariate and hierarchical summary receiver operating characteristic modeling will be used to evaluate the diagnostic performance. The quality of evidence will be assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) metholody. Sources: This systematic review is funded by Secretaria Nacional de Ciencia y Tecnología-Panama. Ethics and dissemination: Ethical approval will not be necessary. Results will be published in a peer review scientific journal.
Medicine Case Reports and Study Protocols, 2022
Introduction: We aim to synthesize the best available evidence on the accuracy of prenatal imagin... more Introduction: We aim to synthesize the best available evidence on the accuracy of prenatal imaging for the diagnosis of congenital Zika syndrome due to maternal Zika virus (ZIKV) infection. Specifically, we explored the factors that may influence diagnosis accuracy, such as geographic area, endemicity of ZIKA, operator, gestational age, and type of reference standard used. Methods and analysis Study selection criteria: All types of observational studies were included, that examined pregnant women with ZIKV infection (positive real time polymerase chain reaction or immunoglobulin M (IgM) serological tests and plaque neutralization reduction test). The index tests included prenatal imaging studies (ultrasound and/or magnetic resonance imaging). The reference standard was defined as follows: 1) perinatal death, including stillbirth and neonatal death within the first 48 h of birth, 2) neonatal intensive care unit admission, and 3) composite adverse perinatal outcomes. Case reports will be excluded if they only included fewer than five case. Sources of information: PubMed, Scopus, ISI Web of Science, and Google Scholar will be search from inception to March 2021. Two researchers will independently screen study titles and abstracts for eligibility, followed by full-text assessment. Data extraction will include population, settings, timing, and use of the index test and reference standard used. We will assess the methodological quality of the included studies and a meta-analysis will be performed to estimate summary statistics. Bivariate and hierarchical summary receiver operating characteristic modeling will be used to evaluate the diagnostic performance. The quality of evidence will be assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) metholody. Sources: This systematic review is funded by Secretaria Nacional de Ciencia y Tecnología-Panama. Ethics and dissemination: Ethical approval will not be necessary. Results will be published in a peer review scientific journal.
Journal of Medical Case Reports, 2020
Background Twin reversed arterial perfusion sequence is a rare and potentially lethal condition a... more Background Twin reversed arterial perfusion sequence is a rare and potentially lethal condition affecting approximately 1% of monochorionic twin pregnancies and 1 in 35,000 pregnancies overall. An apparently normal (pump) twin perfuses its severely malformed cotwin with deoxygenated blood via retrograde flow in direct arterioarterial anastomoses between the umbilical arteries of each twin. Fetal intestinal volvulus is a rare condition usually manifesting after birth. We report a unique case of twin reversed arterial perfusion sequence in association with intestinal volvulus in the surviving pump twin. Case presentation A 32-year-old Hispanic primigravida was referred to our clinic after a fetoscopy procedure of laser photocoagulation of anastomoses at 18 weeks of gestation. Follow up scans in the ex-pump twin revealed dilated bowel loops and a typical “whirlpool sign” at 26 weeks of gestation, and intrauterine intestinal volvulus was suspected. At 29 weeks of gestation, preterm prem...
Revista chilena de enfermedades respiratorias
The Journal of Maternal-Fetal & Neonatal Medicine, 2017
Increasing maternal weight has been shown to predict adverse perinatal outcome, including increas... more Increasing maternal weight has been shown to predict adverse perinatal outcome, including increases in the relative risk of fetal death, stillbirth, neonatal death, perinatal death and infant death. In order to better understand the pathophysiological factors associated with obesity during pregnancy, the role of biomarkers associated with adverse outcomes in obese pregnant women is under investigation. The purpose of this review study was to examine potential biomarkers that could serve as effective screening strategies in obese pregnant women to reduce fetal and neonatal morbidity, as well as maternal morbidity. Electronic databases (Pubmed, Embase) were searched for previously published research studies that investigated biomarkers associated with perinatal outcomes in obese pregnant women and the putative mechanisms underlying biomarker effects on pregnancy outcomes. It is evident that while several biomarkers predict perinatal complications in obese pregnant women, none fulfilled the criteria to be considered clinically useful. There is a critical need for reliable blood-based biomarkers associated with an increased risk of adverse perinatal outcomes in obese pregnant women.
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Papers by Tania T Herrera Rodriguez
quence of a previous cesarean delivery. The gestational sac implants into a
niche created by the incision of the previous cesarean delivery, and this
carries a substantial risk for major maternal complications. The aim of this
study was to report, analyze, and compare the effectiveness and safety of
different treatments options for cesarean scar pregnancies managed in the
first trimester through a registry.
OBJECTIVE: This study aimed to evaluated the ultrasound findings,
disease behavior, and management of first-trimester cesarean scar
pregnancies.
STUDY DESIGN: We created an international registry of cesarean scar
pregnancy cases to study the ultrasound findings, disease behavior, and
management of cesarean scar pregnancies. The Cesarean Scar Preg-
nancy Registry collects anonymized ultrasound and clinical data of indi-
vidual patients with a cesarean scar pregnancy on a secure, digital
information platform. Cases were uploaded by 31 participating centers
across 19 countries. In this study, we only included live and failing ce-
sarean scar pregnancies (with or without a positive fetal heart beat) that
received active treatment (medical or surgical) before 12þ6 weeks’
gestation to evaluate the effectiveness and safety of the different man-
agement options. Patients managed expectantly were not included in this
study and will be reported separately. Treatment was classified as suc-
cessful if it led to a complete resolution of the pregnancy without the need
for any additional medical interventions.
RESULTS: Between August 29, 2018, and February 28, 2023, we
recorded 460 patients with cesarean scar pregnancies (281 live, 179 failing
cesarean scar pregnancy) who fulfilled the inclusion criteria and were
registered. A total of 270 of 460 (58.7%) patients were managed surgically,
123 of 460 (26.7%) patients underwent medical management, 46 of 460
(10%) patients underwent balloon management, and 21 of 460 (4.6%)
patients received other, less frequently used treatment options. Suction
evacuation was very effective with a success rate of 202 of 221 (91.5%; 95%
confidence interval, 87.8e95.2), whereas systemic methotrexate was least
effective with only 38 of 64 (59.4%; 95% confidence interval, 48.4e70.4)
patients not requiring additional treatment. Overall, surgical treatment of
cesarean scar pregnancies was successful in 236 of 258 (91.5%, 95%
confidence interval, 88.4e94.5) patients and complications were observed
in 24 of 258 patients (9.3%; 95% confidence interval, 6.6e11.9).
CONCLUSION: A cesarean scar pregnancy can be managed effec-
tively in the first trimester of pregnancy in more than 90% of cases with
either suction evacuation, balloon treatment, or surgical excision. The
effectiveness of all treatment options decreases with advancing gesta-
tional age, and cesarean scar pregnancies should be treated as early as
possible after confirmation of the diagnosis. Local medical treatment with
potassium chloride or methotrexate is less efficient and has higher rates of
complications than the other treatment options. Systemic methotrexate
has a substantial risk of failing and a higher complication rate and should
not be recommended as first-line treatment.
Key words: balloon treatment, complications, hemorrhage, hysterec-
tomy, KCl, management, methotrexate, suction evacuatio
quence of a previous cesarean delivery. The gestational sac implants into a
niche created by the incision of the previous cesarean delivery, and this
carries a substantial risk for major maternal complications. The aim of this
study was to report, analyze, and compare the effectiveness and safety of
different treatments options for cesarean scar pregnancies managed in the
first trimester through a registry.
OBJECTIVE: This study aimed to evaluated the ultrasound findings,
disease behavior, and management of first-trimester cesarean scar
pregnancies.
STUDY DESIGN: We created an international registry of cesarean scar
pregnancy cases to study the ultrasound findings, disease behavior, and
management of cesarean scar pregnancies. The Cesarean Scar Preg-
nancy Registry collects anonymized ultrasound and clinical data of indi-
vidual patients with a cesarean scar pregnancy on a secure, digital
information platform. Cases were uploaded by 31 participating centers
across 19 countries. In this study, we only included live and failing ce-
sarean scar pregnancies (with or without a positive fetal heart beat) that
received active treatment (medical or surgical) before 12þ6 weeks’
gestation to evaluate the effectiveness and safety of the different man-
agement options. Patients managed expectantly were not included in this
study and will be reported separately. Treatment was classified as suc-
cessful if it led to a complete resolution of the pregnancy without the need
for any additional medical interventions.
RESULTS: Between August 29, 2018, and February 28, 2023, we
recorded 460 patients with cesarean scar pregnancies (281 live, 179 failing
cesarean scar pregnancy) who fulfilled the inclusion criteria and were
registered. A total of 270 of 460 (58.7%) patients were managed surgically,
123 of 460 (26.7%) patients underwent medical management, 46 of 460
(10%) patients underwent balloon management, and 21 of 460 (4.6%)
patients received other, less frequently used treatment options. Suction
evacuation was very effective with a success rate of 202 of 221 (91.5%; 95%
confidence interval, 87.8e95.2), whereas systemic methotrexate was least
effective with only 38 of 64 (59.4%; 95% confidence interval, 48.4e70.4)
patients not requiring additional treatment. Overall, surgical treatment of
cesarean scar pregnancies was successful in 236 of 258 (91.5%, 95%
confidence interval, 88.4e94.5) patients and complications were observed
in 24 of 258 patients (9.3%; 95% confidence interval, 6.6e11.9).
CONCLUSION: A cesarean scar pregnancy can be managed effec-
tively in the first trimester of pregnancy in more than 90% of cases with
either suction evacuation, balloon treatment, or surgical excision. The
effectiveness of all treatment options decreases with advancing gesta-
tional age, and cesarean scar pregnancies should be treated as early as
possible after confirmation of the diagnosis. Local medical treatment with
potassium chloride or methotrexate is less efficient and has higher rates of
complications than the other treatment options. Systemic methotrexate
has a substantial risk of failing and a higher complication rate and should
not be recommended as first-line treatment.
Key words: balloon treatment, complications, hemorrhage, hysterec-
tomy, KCl, management, methotrexate, suction evacuatio