https://www.um.edu.mt/library/oar/handle/123456789/754 2026-09-17T08:27:31Z https://www.um.edu.mt/library/oar/handle/123456789/149198 Title: Factors associated with miscarriage in Maltese women presenting with bleeding in the first trimester Abstract: Background: Women presenting with threatened miscarriage are concerned about the outcome of their pregnancy and obstetricians can offer little help to these women beyond conservative management. In St Luke’s Hospital, Malta, a need was felt to try to identify any possible factors that could aggravate or improve the risk of these women to proceed to complete miscarriage.; Aim: The objective was to identify any factors that could increase or decrease the risk of a threatened miscarriage proceeding to a complete miscarriage.; Patients: All 202 women who presented to the Gynaecology Admission Room at St Luke’s Hospital, Malta with threatened miscarriage between January and June 2004. Women with multiple pregnancies or cervical incompetence were excluded.; Methods: After ethical approval of this observational study, the medical notes of these women were traced and retrospective follow up ascertained whether these women proceeded to a miscarriage or a livebirth. A proforma including a number of parameters that could influence the outcome of these pregnancies in any way was designed and data on these parameters in each of the women was collected. Statistical analyses were carried out using SPSS 15.; Results: Sixty two percent of the women with threatened miscarriage subsequently had a miscarriage. Pain and the amount of blood loss at the time of presentation were significantly associated with a worse prognosis (p<0.001). Menstrual cycle history or smoking status did not have any significant association with the outcome of these women. Treatment of patients with progesterone (dydrogesterone) decreased the risk of subsequent miscarriage (p=0.001). Although aspirin did not have an effect, folate tended to decrease the miscarriage rate (p=0.08). Only 63% of those who miscarried were on folate, as compared to 76% of those who proceeded to livebirth. In addition, the miscarriage group had a highly significantly higher number of previous miscarriages than those who had a live birth (p=0.006).; Conclusion: Pain and moderate to severe bleeding and a history of previous miscarriages are the factors related to an adverse outcome in threatened miscarriage patients. Dydrogesterone appears to have a significant protective effect in these pregnancies while aspirin did not improve the outcome. The effect of folate should be investigated further with a larger cohort. 2007-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/149188 Title: An audit of threatened miscarriage as a predictor of obstetric outcome in Malta Authors: Calleja-Agius, Jean; Brincat, Mark; Jauniaux, Eric; Muttukrishna, Shanthi; Calleja, Neville Abstract: Objective: To investigate prospectively the risk of adverse pregnancy outcome in women presenting with first-trimester threatened miscarriage.; Methods: A retrospective cohort study was performed on women presenting with bleeding during their first trimester at the Gynae Admission Room (St Luke’s Hospital) during 2004. Main outcome measures included gestational age and weight at delivery and incidence of adverse pregnancy outcome. Data were analyzed by univariate and multivariate statistical methods.; Expected results: Women with threatened miscarriage are usually at a higher risk of premature delivery, when compared to normal pregnancies. In addition, they were also at a higher risk of preterm prelabour rupture of membranes. Other outcomes that have been linked to threatened miscarriage in the literature include antepartum haemorrhage, elective caesarian sections, manual removal of placenta, and malpresentation.; Conclusions: This study aims to establish whether, in the Maltese population, patients presenting with a threatened miscarriage during early pregnancy are at a high risk for adverse pregnancy outcome. If so, such patients would qualify for closer surveillance up till delivery. Description: This abstract was also presented at the 31st British International Congress of Obstetrics and Gynaecology, London, July 2007. 2006-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/149187 Title: Understanding the pathophysiology of threatened miscarriage Abstract: Introduction: Threatened miscarriage (TM) is defined as a history of vaginal bleeding in early pregnancy in the presence of a closed cervix and with ultrasonic evidence of an intrauterine gestational sac and the confirmation of a fetal heartbeat. TM is the most common complication of ongoing pregnancy, occurring in around 30% of pregnant women, and it is associated with a risk of full miscarriage of 10-14%. The aim of our study was to measure circulating and intracellular levels of T helper-1 (Th-1) and T helper-2 (Th-2) cytokines in women presenting with TM and evaluate their relationship with subsequent miscarriage. 2012-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/149185 Title: Diagnostic accuracy of D-dimer for splanchnic vein thrombosis : a systematic review and meta- analysis Authors: Attard, Laura Maria; Vella, Kevin; Riva, Nicoletta; Calleja-Agius, Jean; Gatt, Alexander; Squizzato, Alessandro Abstract: Background : D- dimer is included in the diagnostic algorithm for deep vein thrombosis of the lower limbs and pulmonary embolism. However, its role for the diagnosis of splanchnic vein thrombosis (SVT) is still debated, especially considering that several conditions predisposing to SVT are associated with increased D- dimer (malignancy, abdominal surgery, liver cirrhosis).; Aims : To evaluate the accuracy of D- dimer in the diagnosis of SVT by performing a systematic review of the literature and meta- analysis; Methods : The protocol of this systematic review was registered a priori in PROSPERO (CRD42020184300). We performed a bibliographic search within the electronic databases MEDLINE, EMBASE, and CENTRAL up to July 2020, in order to identify all studies which evaluated D- dimer accuracy in patients with suspected SVT. The index test was any D- dimer assay. The reference standard was radiological imaging (abdominal ultrasound, computed tomography, magnetic resonance, angiography) or abdominal surgery. The QUADAS- 2 checklist was used for the risk of bias assessment. We calculated pooled weighted mean specificity/sensitivity and positive/ negative likelihood ratios.; Results : Among the 11 included studies, 9 enrolled only cirrhotic patients (5 of them post- surgery). Risk of bias was high in 9 studies. Only 4 studies tested D- dimer within 24 hours from the reference standard, while 3 studies did not use the D- dimer manufacturers’ cut- off. Overall, mean prevalence of SVT was 34.6% (95% CI, 23.0– 47.2%, I 2 = 95.1%). D- dimer sensitivity was 95.3% (95% CI, 70.0– 99.4%), specificity was 41.6% (95% CI, 15.4– 73.6%). Positive likelihood ratio was 1.63 (95% CI, 0.99– 2.68), negative likelihood ratio was 0.11 (95% CI, 0.02– 0.54). The area under the ROC curve was 0.81 (95% CI, 0.78– 0.84).; Conclusions : This systematic review showed high risk of bias and high heterogeneity in the published literature on this topic. Although D- dimer seems to have high sensitivity also for the diagnosis of SVT, there is strong need for more robust evidence. 2021-01-01T00:00:00Z