Ts Patrelli

Calcium supplementation and prevention of preeclampsia: a meta-analysis

Background: Since the early 1980s, epidemiological evidence has suggested a connection between low calcium intake and preeclampsia The purpose of this meta-analysis is to summarize current evidence regarding calcium supplementation during pregnancy in predicting preeclampsia and associated maternal–fetal complications. Methods: Literature revision of all RCT (random allocation of calcium versus placebo) available in MEDLINE/PUBMED up to 2/29/2012 regarding calcium supplementation during pregnancy for preventing preeclampsia. We used the Mantel-Haenszel’s Method for four subgroup of patients: Adequate calcium intake; Low calcium intake; Low risk of preeclampsia; High risk of preeclampsia. We considered p < 0.05 as significant. Results: There is no consensus in Literature about: (1) the efficacy of calcium supplementation in the prevention of preeclampsia, (2) other/adverse/long-term effects of calcium supplementation in pregnancy. Conclusions: Preeclampsia is likely to be a multifactorial disease. However, inadequate calcium intake represents a factor associated with an increased incidence of hypertensive disease. The results of our meta-analysis demonstrate that the additional intake of calcium during pregnancy is an effective measure to reduce the incidence of preeclampsia, especially in populations at high risk of preeclampsia due to ethnicity, gender, age, high BMI and in those with low baseline calcium intake.

Reply: To PMID 22298867.

To the Editor: My colleagues and I appreciate the letter by Ülker about our article concerning adequate conservative treatment of third-trimester isolated oligohydramnios.1 Certainly, the data of Ülker and Ciçek2 strongly demonstrated that the maternal left lateral decubitus position positively affected the sonographically measured AFI despite the finding that “the AFI increased more rapidly with hydration.”2 In light of the evidence that amniotic fluid measurement is a fundamental means for assessing maternal and fetal well-being and determining the timing and type of delivery, in an era with an emphasis on peripartum ultrasound use, standardization of the amniotic fluid evaluation is mandatory.3 The importance of a correct amniotic fluid measurement is related both to the possibility of improving it by conservative management of idiopathic conditions and to using it as an early predictor of nonreassuring fetal well-being.1 Adjunctively, more recent evidence has indicated that alterations in the amniotic fluid volume could negatively affect delivery outcomes, increasing the rates of surgical and elective/urgent cesarean deliveries and the risk of postpartum hemorrhage.3–6To the Editor: My colleagues and I appreciate the letter by Ülker about our article concerning adequate conservative treatment of third-trimester isolated oligohydramnios.1 Certainly, the data of Ülker and Ciçek2 strongly demonstrated that the maternal left lateral decubitus position positively affected the sonographically measured AFI despite the finding that “the AFI increased more rapidly with hydration.”2 In light of the evidence that amniotic fluid measurement is a fundamental means for assessing maternal and fetal well-being and determining the timing and type of delivery, in an era with an emphasis on peripartum ultrasound use, standardization of the amniotic fluid evaluation is mandatory.3 The importance of a correct amniotic fluid measurement is related both to the possibility of improving it by conservative management of idiopathic conditions and to using it as an early predictor of nonreassuring fetal well-being.1 Adjunctively, more recent evidence has indicated that alterations in the amniotic fluid volume could negatively affect delivery outcomes, increasing the rates of surgical and elective/urgent cesarean deliveries and the risk of postpartum hemorrhage.3–6

Cervicoisthmic Pregnancy Near Cesarean Scar After Oocyte Donation in Premature Ovarian Failure: Literature Review Starting From a Single Case

Objective This study aimed to identify the best management options in decision making in cases of cervicoisthmic and cesarean scar pregnancies and rare forms of ectopic pregnancies with high rates of pregnancy-related morbidity in the first trimester, more commonly associated with assisted reproductive medicine. Materials and Methods We performed a literature review of the description of a case report of a cervicoisthmic pregnancy near a cesarean scar in a premature ovarian failure woman. She obtained pregnancy after ovum donation, hormonal therapy, and in vitro fertilization. The researchers focused on the MEDLINE/PubMed database articles on ectopic pregnancies, particularly on cesarean scar pregnancies, cervical pregnancies, and ectopic pregnancies after in vitro fertilization in English-language journals published from January 1996 to December 2011. Results The conservative or nonconservative options for medical or surgical treatments are disposables. Moreover, in literature, no consensus was found about the best treatment method. Conclusions Obstetricians should pay great attention to a possible cesarean scar pregnancy in patients with risk factors in their medical history. Until now, the rarity of these findings does not allow the definition of a commonly accepted management, so the best personalized approach may be guided by early recognition, close surveillance, and appropriate counseling. Further investigations are necessary to recognize high-risk factors for all ectopic pregnancies and those unique to cesarean scar ectopic pregnancies.