Assuntos
Neoplasias do Ventrículo Cerebral/cirurgia , Procedimentos Endovasculares/métodos , Hemangioblastoma/cirurgia , Aneurisma Intracraniano/cirurgia , Complicações Cardiovasculares na Gravidez/cirurgia , Complicações Neoplásicas na Gravidez/cirurgia , Adulto , Feminino , Quarto Ventrículo , Humanos , Gravidez , Hemorragia Subaracnóidea/cirurgiaRESUMO
PURPOSE: The aim of this multicentric study is to compare clinical, biophysical and molecular parameters in the prediction of the success of labour induction with prostaglandins. METHODS: We included 115 women, who underwent to labour induction at term with vaginal prostaglandin gel. We evaluated the diagnostic efficiency of endocervical phosphorylated insulin-like growth factor-binding protein (phIGFBP-1), cervicovaginal interleukins 6 (IL-6) and 8 (IL-8). We analyzed the transvaginal sonographic measurement of cervical length. A receiver-operating characteristics (ROC) curve was used to determine the most useful cut-off point. A multivariate logistic regression model was used to analyze the combination of significant predictive variables following univariate analysis. We analyzed all the data searching for the parameters that best predict the beginning of the active phase of labour within 12 h. RESULTS: 36.5 % of the patients delivered within 12 h. The Bishop score was >4 in the 43 % of patients with an active phase. The best cut-off values at ROC curves for cervical length, IL-6 and IL-8 were respectively 22 mm, 5 mg/dl and 20,237 mg/dl. At univariate analysis, all predictors of success, with the exception of IL-6, were significantly associated with the beginning of the active phase. Multivariate analysis of the Bishop score (OR 2.3), phIGFBP-1 test (OR 11.2) and IL-8 (OR 6.6) showed that the variables were independent and therefore useful in combination to predict the success of labour induction. CONCLUSION: The phIGFBP-1 test is a fast and easy test that can be used with Bishop score and IL-8 to reach an high positive predictive value in the prediction of the success of labour induction with prostaglandins.
Assuntos
Início do Trabalho de Parto , Trabalho de Parto Induzido , Gravidez/metabolismo , Prostaglandinas/administração & dosagem , Nascimento a Termo/metabolismo , Adulto , Biomarcadores/metabolismo , Líquidos Corporais/metabolismo , Colo do Útero/diagnóstico por imagem , Feminino , Idade Gestacional , Humanos , Proteína 1 de Ligação a Fator de Crescimento Semelhante à Insulina/metabolismo , Interleucina-6/metabolismo , Interleucina-8/metabolismo , Início do Trabalho de Parto/metabolismo , Análise Multivariada , Razão de Chances , Valor Preditivo dos Testes , Curva ROC , Ultrassonografia , VaginaRESUMO
PURPOSE: The aim of this article is to describe two cases of pulmonary hypertension during pregnancy to highlight the major issues associated with the obstetric and anesthesiological management of such patients who, despite the medical advice, decided to continue their pregnancy and gave birth to healthy babies. METHODS AND RESULTS: In our first case, there has been the need for a general anesthesia because of the detachment of the placenta, whereas in the second case elective surgery under spinal anesthesia was performed, thus avoiding the anesthesiological and surgical problems associated with an emergency. CONCLUSIONS: Pregnancy is contraindicated in case of pulmonary hypertension, a highly morbid disease affecting young women of childbearing age. Therefore, in such cases, a multidisciplinary approach is indispensable to plan optimal treatment for patients who wish to pursue a pregnancy even though their heart disease exposes them to a high level of risk.