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Vincenzo Berghella - One of the best experts on this subject based on the ideXlab platform.
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the effect of transvaginal ultrasound vaginal examination or coitus on fetal fibronectin results individual participant data from 6 cohort studies
American Journal of Obstetrics & Gynecology MFM, 2020Co-Authors: Ariel T Levy, Johanna Quistnelson, Vincenzo BerghellaAbstract:Objective This study aimed to determine whether recent Cervical Manipulation via transvaginal ultrasound, sterile vaginal examination, or coitus affects the accuracy of fetal fibronectin results. Data Sources An electronic search was performed in PubMed, Scopus, Embase, Ovid MEDLINE, ClinicalTrials.gov , Cochrane Library, and CINAHL using a combination of pertinent key words from inception to June 2019. Study Eligibility Criteria We included all observational studies that provided individual-level data on fetal fibronectin results after recent transvaginal ultrasound, sterile vaginal examination, or coitus. Study Appraisal and Synthesis Methods Studies were appraised using the Newcastle-Ottawa Quality Assessment Scale for cohort studies. Individual participant data from the included studies were pooled for each intervention. The primary outcome was agreement between pre- and postManipulation swabs, estimated using proportion agreement and kappa statistics with 95% confidence intervals. Secondary outcomes included frequency in which the fetal fibronectin result changed after Cervical Manipulation and percentage of discordant pairs. Baseline fetal fibronectin swabs were not obtained in studies examining coitus; therefore, the results of these articles were examined separately. Outcome data were combined to estimate the relative risk of a positive qualitative fetal fibronectin result after coitus and differences in the concentration of quantitative fetal fibronectin. Results Of 807 studies identified, 6 were included. Three studies assessed the effect of transvaginal ultrasound (n=346 specimen pairs), 2 of sterile vaginal examination (n=122 specimen pairs), and 2 of coitus (n=262 specimen pairs) on fetal fibronectin results, with 1 study assessing the effect of more than 1 intervention. The proportion agreement between specimen pairs before and after transvaginal ultrasound and sterile vaginal examination was 93.4% (kappa, 0.69; 95% confidence interval, 0.57–0.81) and 88.5% (kappa, 0.69; 95% confidence interval, 0.54–0.84), respectively. For both transvaginal ultrasound and sterile vaginal examination, discordance with a positive preintervention fetal fibronectin and negative postintervention fetal fibronectin occurred more frequently than the converse. Patients reporting coitus within 24 to 48 hours were more likely to have a positive fetal fibronectin result than controls (39.7% vs 7.1%; relative risk, 5.6; 95% confidence interval, 3.0–10.6). Conclusion Cervical Manipulation via transvaginal ultrasound or sterile vaginal examination does not significantly affect fetal fibronectin results; therefore, its use after these exposures is clinically acceptable. Conversely, the use of fetal fibronectin in the setting of recent coitus should continue to be discouraged.
Ariel T Levy - One of the best experts on this subject based on the ideXlab platform.
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the effect of transvaginal ultrasound vaginal examination or coitus on fetal fibronectin results individual participant data from 6 cohort studies
American Journal of Obstetrics & Gynecology MFM, 2020Co-Authors: Ariel T Levy, Johanna Quistnelson, Vincenzo BerghellaAbstract:Objective This study aimed to determine whether recent Cervical Manipulation via transvaginal ultrasound, sterile vaginal examination, or coitus affects the accuracy of fetal fibronectin results. Data Sources An electronic search was performed in PubMed, Scopus, Embase, Ovid MEDLINE, ClinicalTrials.gov , Cochrane Library, and CINAHL using a combination of pertinent key words from inception to June 2019. Study Eligibility Criteria We included all observational studies that provided individual-level data on fetal fibronectin results after recent transvaginal ultrasound, sterile vaginal examination, or coitus. Study Appraisal and Synthesis Methods Studies were appraised using the Newcastle-Ottawa Quality Assessment Scale for cohort studies. Individual participant data from the included studies were pooled for each intervention. The primary outcome was agreement between pre- and postManipulation swabs, estimated using proportion agreement and kappa statistics with 95% confidence intervals. Secondary outcomes included frequency in which the fetal fibronectin result changed after Cervical Manipulation and percentage of discordant pairs. Baseline fetal fibronectin swabs were not obtained in studies examining coitus; therefore, the results of these articles were examined separately. Outcome data were combined to estimate the relative risk of a positive qualitative fetal fibronectin result after coitus and differences in the concentration of quantitative fetal fibronectin. Results Of 807 studies identified, 6 were included. Three studies assessed the effect of transvaginal ultrasound (n=346 specimen pairs), 2 of sterile vaginal examination (n=122 specimen pairs), and 2 of coitus (n=262 specimen pairs) on fetal fibronectin results, with 1 study assessing the effect of more than 1 intervention. The proportion agreement between specimen pairs before and after transvaginal ultrasound and sterile vaginal examination was 93.4% (kappa, 0.69; 95% confidence interval, 0.57–0.81) and 88.5% (kappa, 0.69; 95% confidence interval, 0.54–0.84), respectively. For both transvaginal ultrasound and sterile vaginal examination, discordance with a positive preintervention fetal fibronectin and negative postintervention fetal fibronectin occurred more frequently than the converse. Patients reporting coitus within 24 to 48 hours were more likely to have a positive fetal fibronectin result than controls (39.7% vs 7.1%; relative risk, 5.6; 95% confidence interval, 3.0–10.6). Conclusion Cervical Manipulation via transvaginal ultrasound or sterile vaginal examination does not significantly affect fetal fibronectin results; therefore, its use after these exposures is clinically acceptable. Conversely, the use of fetal fibronectin in the setting of recent coitus should continue to be discouraged.
Johanna Quistnelson - One of the best experts on this subject based on the ideXlab platform.
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the effect of transvaginal ultrasound vaginal examination or coitus on fetal fibronectin results individual participant data from 6 cohort studies
American Journal of Obstetrics & Gynecology MFM, 2020Co-Authors: Ariel T Levy, Johanna Quistnelson, Vincenzo BerghellaAbstract:Objective This study aimed to determine whether recent Cervical Manipulation via transvaginal ultrasound, sterile vaginal examination, or coitus affects the accuracy of fetal fibronectin results. Data Sources An electronic search was performed in PubMed, Scopus, Embase, Ovid MEDLINE, ClinicalTrials.gov , Cochrane Library, and CINAHL using a combination of pertinent key words from inception to June 2019. Study Eligibility Criteria We included all observational studies that provided individual-level data on fetal fibronectin results after recent transvaginal ultrasound, sterile vaginal examination, or coitus. Study Appraisal and Synthesis Methods Studies were appraised using the Newcastle-Ottawa Quality Assessment Scale for cohort studies. Individual participant data from the included studies were pooled for each intervention. The primary outcome was agreement between pre- and postManipulation swabs, estimated using proportion agreement and kappa statistics with 95% confidence intervals. Secondary outcomes included frequency in which the fetal fibronectin result changed after Cervical Manipulation and percentage of discordant pairs. Baseline fetal fibronectin swabs were not obtained in studies examining coitus; therefore, the results of these articles were examined separately. Outcome data were combined to estimate the relative risk of a positive qualitative fetal fibronectin result after coitus and differences in the concentration of quantitative fetal fibronectin. Results Of 807 studies identified, 6 were included. Three studies assessed the effect of transvaginal ultrasound (n=346 specimen pairs), 2 of sterile vaginal examination (n=122 specimen pairs), and 2 of coitus (n=262 specimen pairs) on fetal fibronectin results, with 1 study assessing the effect of more than 1 intervention. The proportion agreement between specimen pairs before and after transvaginal ultrasound and sterile vaginal examination was 93.4% (kappa, 0.69; 95% confidence interval, 0.57–0.81) and 88.5% (kappa, 0.69; 95% confidence interval, 0.54–0.84), respectively. For both transvaginal ultrasound and sterile vaginal examination, discordance with a positive preintervention fetal fibronectin and negative postintervention fetal fibronectin occurred more frequently than the converse. Patients reporting coitus within 24 to 48 hours were more likely to have a positive fetal fibronectin result than controls (39.7% vs 7.1%; relative risk, 5.6; 95% confidence interval, 3.0–10.6). Conclusion Cervical Manipulation via transvaginal ultrasound or sterile vaginal examination does not significantly affect fetal fibronectin results; therefore, its use after these exposures is clinically acceptable. Conversely, the use of fetal fibronectin in the setting of recent coitus should continue to be discouraged.
José Biller - One of the best experts on this subject based on the ideXlab platform.
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Vertebrobasilar dissection and Cervical spine Manipulation A complex pain in the neck.
Neurology, 2003Co-Authors: Linda S. Williams, José BillerAbstract:Chiropractic adjustment and Manipulation are widely used to treat a variety of musculoskeletal complaints. The number of chiropractors in the U.S. is expected to nearly double in this decade,1 and it is estimated that chiropractic visit rates are at least 100 per 100 person-years in the U.S., with nearly 85% of these involving adjustment or Manipulation of the spine.2 As use of chiropractic treatments has increased, so have demands for scientifically rigorous studies examining the risks and benefits of various chiropractic procedures. Prior to 2002, there were at least three randomized trials of Cervical Manipulation for patients with acute neck pain. However, the number of patients in these studies was small, and the quality of the studies, as judged by standardized criteria, was low.3 Recently, a large and well-designed randomized clinical trial showed that Cervical Manipulation (controlled dynamic thrust applied with high-velocity, low-amplitude force) was no better than mobilization (low velocity, variable …
Greg Kawchuk - One of the best experts on this subject based on the ideXlab platform.
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correction the quality of reports on Cervical arterial dissection following Cervical spinal Manipulation
PLOS ONE, 2015Co-Authors: Shari Wynd, Michael Estaway, Sunita Vohra, Greg KawchukAbstract:The authors have found that some of the data contained in this manuscript are categorized inappropriately. Many of the cases included from two case-control studies (Rothwell et al. and Stevinson et al.) should be omitted from the paper’s calculations as they were reported originally as Cervical artery dissection cases in general, but not Cervical artery dissection cases that occurred prior to Cervical Manipulation. The total number of cases where Cervical Manipulation was reported to have occurred prior to the onset of Cervical artery dissection should be reduced from 902 to 322. With this adjustment, the time to onset of symptoms can now be reported to be a smaller percentage of cases (89%) compared to the original paper (93%). Similarly, the percentage of cases that named the involved vessel increased from 71% to 77%. Finally, the percentage of cases reporting the profession of the involved clinician performing the Manipulation decreased from 99% to 80%. Excluding these three variables, the other 15 variables in the paper remain unchanged. This reclassification of cases does not alter the conclusions of the paper.