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1.
Front Cell Infect Microbiol ; 12: 798738, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35419297

RESUMO

Mixed vaginitis is a complex vaginal dysbiosis that differs from single vaginitis. Vaginitis in the third trimester may lead to adverse maternal and neonatal outcomes. The clinical characteristics, microbiological characteristics, and adverse pregnancy outcomes of mixed vaginitis in late pregnancy are worth studying. Therefore, this study investigated the clinical and microbiological characteristics of vaginitis and adverse pregnancy outcomes of patients with mixed vaginitis. We studied 1,674 women in late pregnancy who attended the Tianjin Medical University General Hospital from November, 2019 to October, 2021. We administered standardized questionnaires, performed vaginal examination and sampling plus microscope examinations, and assessed follow-up pregnancy outcomes. We cultured the vaginal discharge of the patients with mixed vaginitis to isolate pathogens and performed antimicrobial susceptibility tests of the isolated pathogens. For the patients with peripartum infection, we collected a sample to isolate pathogens. Among the 1,674 women, 66 (3.9%) had mixed vaginitis. The independent risk factor for mixed vaginitis in late pregnancy was a history of vaginitis during early and middle pregnancy (OR = 5.637, 95% CI: 3.314-9.580). The signs of vaginal erythema (63.6% vs. 42.0%), yellow discharge (81.8% vs. 59.6%), and malodor (31.8% vs. 18.8%) (P <0.05) were significantly higher in patients with mixed vaginitis than in patients with single vaginitis. Bacterial isolates of the vaginal secretions of patients with mixed bacterial vaginitis were mainly the pathogens of aerobic vaginitis and bacterial vaginosis, such as Gardnerella vaginalis, Streptococcus anginosus, and Staphylococcus epidermidis. Pathogen isolation of the vaginal secretions of patients with mixed fungus and bacteria vaginitis mainly included Candida albicans, followed by S. anginosus, Enterococcus faecalis, Staphylococcus hemolyticus, Staphylococcus aureus, Streptococcus agalactiae and Staphylococcus simulans. Women with mixed vaginitis had an increased incidence and risk of peripartum infections (6.1% vs. 1.4%, P <0.05; OR = 3.985, 95% CI:1.214-13.079). Escherichia coli is the main pathogen that causes peripartum infection. Mixed vaginitis in late pregnancy is characterized by a severe and complex phenotype, complex vaginal dysbiosis, and a long course of vaginal dysbiosis. This can lead to an increased incidence and risk of peripartum infection. Therefore, more attention should be paid to patients with mixed vaginitis in the third trimester of pregnancy.


Assuntos
Vaginite , Vaginose Bacteriana , Vulvovaginite , Estudos Transversais , Disbiose , Escherichia coli , Feminino , Humanos , Masculino , Gravidez , Resultado da Gravidez , Terceiro Trimestre da Gravidez , Vaginite/diagnóstico , Vaginite/epidemiologia , Vaginite/microbiologia , Vaginose Bacteriana/complicações , Vaginose Bacteriana/diagnóstico , Vaginose Bacteriana/epidemiologia
2.
Zhonghua Yu Fang Yi Xue Za Zhi ; 56(3): 270-279, 2022 Mar 06.
Artigo em Chinês | MEDLINE | ID: mdl-35381647

RESUMO

Objective: To investigate the influence and critical windows of prenatal exposure to pyrethroid pesticides (PYRs) on neurodevelopment of 2-year-old children. Methods: The subjects of this study were derived from the Xuanwei Birth Cohort. A total of 482 pregnant women who participated in the rural district of Xuanwei birth cohort from January 2016 to December 2018 were included. Maternal urinary concentrations of PYRs metabolites during 8-12 gestational weeks, 20-23 gestational weeks and 32-35 gestational weeks were measured with ultra high performance liquid chromatography system coupled with a tandem mass spectrometry detector. Child neurodevelopment was evaluated with the Bayley Scales of Infant and Toddler Development-Third Edition at 2 years of age. Multivariate linear regression models and binary logistic regression models were used to assess the association between PYRs exposure during pregnancy and children's neurodevelopment. Results: A total of 360 mother-child pairs had complete data on maternal urinary PYRs metabolites detection and children's neurodevelopment assessment. The detection rate of any one PYRs metabolites during the first, second and third trimester were 93.6% (337/360), 90.8% (327/360) and 94.2% (339/360), respectively. The neurodevelopmental scores of Cognitive, Language, Motor, Social-Emotional, and Adaptive Behavior of 2-year-old children were (102.3±18.9), (100.2±16.3), (102.0±20.3), (107.8±23.3) and (85.8±18.6) points, respectively. After controlling for confounding factors, 4-fluoro-3-phenoxybenzoic acid (4F3PBA, one of PYRs metabolites) exposure in the first trimester reduced Motor (ß=-5.02, 95%CI: -9.08, -0.97) and Adaptive Behavior (ß=-4.12, 95%CI:-7.92, -0.32) scores of 2-year-old children, and increased risk of developmental delay of adaptive behavior (OR=2.07, 95%CI:1.13-3.82). Conclusion: PYRs exposure during the first trimester of pregnancy may affect neurodevelopment of 2-year-old children, and the first trimester may be the critical window.


Assuntos
Praguicidas , Efeitos Tardios da Exposição Pré-Natal , Piretrinas , Desenvolvimento Infantil , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Exposição Materna/efeitos adversos , Praguicidas/efeitos adversos , Gravidez , Terceiro Trimestre da Gravidez , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Piretrinas/efeitos adversos , Piretrinas/metabolismo
3.
Ann Palliat Med ; 11(3): 1048-1057, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35365034

RESUMO

BACKGROUND: There is no study on the impact of anemia on postpartum depression and outcomes in mothers older than 35 years, which makes the nursing of these pregnant women with anemia more difficult. METHODS: We retrospectively collected the demographic and clinical characteristics of pregnant women older than 35 years at conception between August 2014 and December 2019. Hemoglobin less than 110 g/L was defined as anemia. Postpartum depression was assessed according to Edinburgh Postnatal Depression Scale. A subgroup analysis was performed by dividing anemia into mild anemia or moderate and severe anemia. All participants were followed up for at least 3 months postpartum and their pregnancy outcomes were recorded. The existence of postpartum depression was evaluated at 4 weeks postpartum. The risk factors of anemia during the third trimester of pregnancy and the impacts of anemia on postpartum depression and pregnancy outcomes were analyzed using multivariable logistic regression analysis. RESULTS: A total of 519 pregnant older than 35 years women were included in this study, including 281 without anemia and 238 with anemia. No significant difference was found in the incidence of postpartum depression between anemia and non-anemia groups (18.9% vs. 12.8%, P=0.057), while the anemia group had significantly higher incidence of preterm delivery, prolonged labor, and caesarean section. The subgroup analysis found that significantly pregnant women with older age in the moderate or severe anemia subgroup had postpartum depression than those in the mild anemia subgroup (23.2% vs. 12.5%, P=0.038). A higher rate of preterm delivery, prolonged labor, and caesarean section was recorded in the moderate or severe anemia subgroup (8.3% vs. 20.4%, P=0.012; 30.2% vs. 43.0%, P<0.001; 20.8% vs. 40.1%, P=0.002). Moderate or severe anemia, the presence of depression during the first trimester of pregnancy, unplanned pregnancy, and fewer parity were identified as risk factors of postpartum depression in pregnant women older than 35 years with anemia. CONCLUSIONS: Anemia has significant impacts on pregnancy outcomes in pregnant women older than 35 years. Furthermore, moderate and severe anemia will significantly increase the incidence of postpartum depression, which should be corrected at an early stage to minimize its negative effects.


Assuntos
Anemia , Depressão Pós-Parto , Anemia/complicações , Anemia/epidemiologia , Cesárea/efeitos adversos , Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/etiologia , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Terceiro Trimestre da Gravidez , Gestantes , Estudos Retrospectivos
4.
Reprod Health ; 19(1): 87, 2022 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-35366925

RESUMO

BACKGROUND: Both pre-gestational (PGDM) and gestational diabetes mellitus (GDM) make pregnancy complicated. Moreover in the literature GDM and PGDM have been held responsible for respiratory morbidity in newborns. Diaphragm ultrasound (DUS) is a valuable and noninvasive method that provides an opportunity to examine the diaphragmatic morphology and function. This study examined the quality of fetal diaphragmatic contractions in pregnant women complicated with GDM and PGDM. METHODS: A total of 105 volunteers who were separated into three groups; (1) A GDM group (n = 35), (2) a PGDM group (n = 35), and (3) a healthy non-diabetic control group (n = 35). All volunteers with the cephalic presentation and only male fetuses were examined in the 37th week of gestation. This cross sectional and case controlled study was performed at the perinatology clinic of the Erciyes University School of Medicine between 15.01.2020 and 01.08.2021. The thickness of fetal diaphragm (DT), diaphragmatic excursion (DE), diaphragm thickening fraction (DTF) and costodiaphragmatic angle (CDA) was measured and recorded by ultrasound and examined on the video frame during the inspiration and expiration phases of respiration. RESULTS: Especially the PGDM group represented adversely affected diaphragm function parameters. DT inspiration, DT expiration, DE, CDA inspiration and DTF values were significantly different between PGDM and the control group. Neonatal intensive care unit (NICU) admission was high among babies who were born to pregnancies complicated with PGDM or GDM. CONCLUSIONS: The quality of fetal diaphragm movements is affected in pregnancies complicated with GDM and PGDM. The prolonged duration of diabetes may have additional adverse effects on diaphragm morphology and its function.


The percentage of pre-gestational diabetes mellitus (PGDM) in pregnancy is 13­21% and the remaining part of diabetes is gestational diabetes mellitus (GDM). Both of the complications are related to respiratory problems at birth.Until now, it was known that this situation was due to the lack of surfactant, which has a facilitating effect on the participation of the lungs in respiration. However, in this study, the diaphragm of the babies of patients with PGDM and GDM was examined. The thickness of fetal diaphragm, movements and function were evaluated via using ultrasound. As a result, it was determined that the diaphragm movements were impaired and the babies born from these patients needed more pediatric care.This study will open horizon on new studies examining the functional capacity of the diaphragm in the future. In the future, it may be possible to decide which baby will need intensive care by examining the diaphragm.


Assuntos
Diabetes Gestacional , Estudos Transversais , Diabetes Gestacional/diagnóstico por imagem , Diafragma/diagnóstico por imagem , Feminino , Feto , Humanos , Recém-Nascido , Masculino , Gravidez , Terceiro Trimestre da Gravidez
6.
J Cardiothorac Surg ; 17(1): 73, 2022 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-35414028

RESUMO

BACKGROUND: Aortic dissection in pregnancy is a life-threatening event that is associated with high maternal and foetal mortality. Most cases occur during the third trimester of pregnancy, Herein, we describe a case of a pregnant woman with acute type A aortic dissection at 28 weeks of gestation. CASE PRESENTATION: A previously healthy, 24-year-old gravida 2 para 1 woman was brought to the emergency department during at the 28 weeks of gestation and diagnosed with acute type A aortic dissection. Cesarean section was performed with the cardiac surgical team on standby for cardiopulmonary bypass and the patient delivered a baby weighing 1000 g. After the operation, we performed the Beatall procedure and total arch replacement with FET using the deep hypothermic circulatory arrest technique. Both the mother and child survived and recovered well. A review of the literature on antepartum acute aortic dissection during pregnancy is also presented. CONCLUSION: Women should have a comprehensive, systematic physical examination before getting pregnant. Women at high risks of aortic dissection must undergo multidisciplinary evaluation and be counseled before pregnancy, once they become pregnant, their consistent aortic root diameter should be consistently monitored, and their blood pressure strictly controlled.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Procedimentos Cirúrgicos Cardíacos , Complicações Cardiovasculares na Gravidez , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Cesárea , Feminino , Humanos , Recém-Nascido , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/cirurgia , Terceiro Trimestre da Gravidez , Adulto Jovem
7.
Artigo em Inglês | MEDLINE | ID: mdl-35270759

RESUMO

BACKGROUND: The aim of this study was to determine the impact of the COVID-19 pandemic on the levels of physical activity during the third trimester of pregnancy, life satisfaction and stress in women in late pregnancy and early postpartum. METHODS: The study was conducted among 740 patients of maternity wards in Cracow hospitals on days 1-8 postpartum. Patients who were surveyed before the pandemic (December 2019-March 2020) were included in the prepandemic group (PPan: n = 252). The second group of women (COVID 1 group, Cov1: n = 262) was examined in the early stages of the pandemic (May-September 2020). In turn, participants who were surveyed during the population vaccination campaign (June-September 2021) were qualified to the COVID 2 group (Cov2: n = 226). The research tools used were the original questionnaire in addition to standardized questionnaires assessing physical activity in the last trimester of pregnancy (the Pregnancy Physical Activity Questionnaire); previous life satisfaction (the Satisfaction with Life Scale); and stress levels during the last month (the Perceived Stress Scale). RESULTS: During the pandemic, women reduced the level of energy spent on total physical activity; nevertheless, statistically significant differences were found only between the PPan and Cov2 groups (p = 0.001). At the early stages of the pandemic, patients significantly reduced mobility activities (Cov1 vs. PPan: p < 0.001; Cov1 vs. Cov2: p = 0.007), while late in the pandemic they spent less energy on household activities (Cov2 vs. PPan: p = 0.002, Cov2 vs. Cov1: p = 0.002). There were no differences in the levels of stress and life satisfaction. CONCLUSIONS: The COVID-19 pandemic impacted the level of physical activity; however, it did not change levels of perceived stress and life satisfaction in women in late-stage pregnancy and in the early puerperium.


Assuntos
COVID-19 , Pandemias , COVID-19/epidemiologia , Exercício Físico , Feminino , Humanos , Satisfação Pessoal , Período Pós-Parto , Gravidez , Terceiro Trimestre da Gravidez , SARS-CoV-2 , Estresse Psicológico/epidemiologia
8.
BMC Pregnancy Childbirth ; 22(1): 174, 2022 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-35236326

RESUMO

BACKGROUND: Gestational diabetes mellitus (GDM) is defined as impaired glucose tolerance in pregnancy and without a history of diabetes mellitus. While there are limited metabolomic studies involving advanced maternal age in China, we aim to investigate the metabolomic profiling of plasma and urine in pregnancies complicated with GDM aged at 35-40 years at early and late gestation. METHODS: Twenty normal and 20 GDM pregnant participants (≥ 35 years old) were enlisted from the Complex Lipids in Mothers and Babies (CLIMB) study. Maternal plasma and urine collected at the first and third trimester were detected using gas chromatography-mass spectrometry (GC-MS). RESULTS: One hundred sixty-five metabolites and 192 metabolites were found in plasma and urine respectively. Urine metabolomic profiles were incapable to distinguish GDM from controls, in comparison, there were 14 and 39 significantly different plasma metabolites between the two groups in first and third trimester respectively. Especially, by integrating seven metabolites including cysteine, malonic acid, alanine, 11,14-eicosadienoic acid, stearic acid, arachidic acid, and 2-methyloctadecanoic acid using multivariant receiver operating characteristic models, we were capable of discriminating GDM from normal pregnancies with an area under curve of 0.928 at first trimester. CONCLUSION: This study explores metabolomic profiles between GDM and normal pregnancies at the age of 35-40 years longitudinally. Several compounds have the potential to be biomarkers to predict GDM with advanced maternal age. Moreover, the discordant metabolome profiles between the two groups could be useful to understand the etiology of GDM with advanced maternal age.


Assuntos
Diabetes Gestacional/sangue , Diabetes Gestacional/metabolismo , Diabetes Gestacional/urina , Idade Materna , Metaboloma , Adulto , Estudos de Casos e Controles , China/epidemiologia , Feminino , Humanos , Metabolômica/métodos , Plasma/metabolismo , Gravidez , Primeiro Trimestre da Gravidez/metabolismo , Terceiro Trimestre da Gravidez/metabolismo , Estudos Prospectivos , Curva ROC
9.
Medicina (Kaunas) ; 58(3)2022 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-35334508

RESUMO

There is consistent evidence that many of the pregnancy complications that occur late in the second and third trimester can be predicted from an integrated 11-13 weeks visit, where a maternal and fetal assessment are comprehensively performed. The traditional aims of the 11-13 weeks visit have been: establishing fetal viability, chorionicity and dating of the pregnancy, and performing the combined screening test for common chromosomal abnormalities. Recent studies have shown that the first trimester provides important information that may help to predict pregnancy complications, such as preeclampsia and fetal growth restriction, stillbirth, preterm birth, gestational diabetes mellitus and placenta accreta spectrum disorder. The aim of this manuscript is to review the methods available to identify pregnancies at risk for adverse outcomes after screening at 11-13 weeks. Effective screening in the first trimester improves pregnancy outcomes by allowing specific interventions such as administering aspirin and directing patients to specialist clinics for regular monitoring.


Assuntos
Complicações na Gravidez , Nascimento Prematuro , Feminino , Humanos , Recém-Nascido , Gravidez , Complicações na Gravidez/diagnóstico , Resultado da Gravidez , Primeiro Trimestre da Gravidez , Terceiro Trimestre da Gravidez
10.
J Gynecol Obstet Hum Reprod ; 51(4): 102353, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35247609

RESUMO

PURPOSE: To evaluate emotional distress and prenatal attachment throughout a subsequent pregnancy after Termination of Pregnancy (TOP) for fetal abnormality. METHODS: Observational study, in a French Tertiary Maternity. POPULATION: 25 women in a subsequent pregnancy after a medical termination of pregnancy for foetal abnormality, 18-year-old and older. Prenatal Interviews at 20 Gestationnal weeks (GW), 27 GW and 35 GW and Postnatal at 3 months and at each time self-administered questionnaires of anxiety, post-traumatic stress syndrome (PCLS) depressive symptoms (EPDS), prenatal attachment (PAI) and Perinatal Grief Scale (PGS). RESULTS: Pregnancy onset, i.e. before 20 GW, showed increased prevalence of anxiety (16/23, 66.7%), depression (7/23, 30.4%) and post-traumatic stress symptoms (4/16, 25%). Total score on PGS is higher in onset of pregnancy than in the third trimester (p = 0.005). Prenatal attachment was lower during early pregnancy (p = 0.003) and correlated inversely with grief intensity (p = 0.022). During late pregnancy, emotional symptoms decrease, and prenatal attachment stopped increase positively, specifically among women whose foetal abnormality in previous pregnancies were diagnosed late, at an average of 25 GW. CONCLUSION: This research shows the specific dynamics of pregnancies following TOP and highlights the necessity for early prenatal psychological support. One should also pay special attention to prenatal attachment during late pregnancy even after knowing that the fetus is healthy.


Assuntos
Ansiedade , Pesar , Aborto Eugênico/psicologia , Adolescente , Adulto , Ansiedade/epidemiologia , Ansiedade/psicologia , Família , Feminino , Feto/anormalidades , Humanos , Gravidez/psicologia , Terceiro Trimestre da Gravidez , Inquéritos e Questionários
11.
Medicine (Baltimore) ; 101(11)2022 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-35356925

RESUMO

ABSTRACT: To determine the association between soluble FMS-like tyrosine kinase-1 (sFlt-1) and high-sensitivity C-reactive protein (hs-CRP) with maternal and perinatal outcomes in patients with preeclampsia (PE) with severe features.A cohort study was conducted on 100 patients, 60 with PE with severe features, and 40 healthy women in the third trimester of pregnancy. Admission serum levels of sFlt-1 and hs-CRP and clinical and epidemiological parameters were evaluated to quantify the predictive ability of adverse maternal and perinatal outcomes using hierarchical multiple regression and receiver operating characteristic curves.Compared to controls, patients with PE and severe features had significantly higher levels of sFlt-1 but not hs-CRP. sFlt-1 and hs-CRP proved to be reasonable parameters for the prediction of composite adverse maternal outcomes. However, we found no correlation between these 2 biomarkers. PE integrated estimate of risk scores were correlated only with sFlt-1 levels. Regarding fetal outcomes, unlike hs-CRP, sFlt-1 was strongly associated with birth weight and Apgar score < 7 at 5 minutes. Following multivariate analysis, maternal age, previous hypertension, sFlt-1, and hs-CRP levels remained independently associated with composite adverse maternal outcomes.sFlt-1 levels were elevated in patients with PE and severe features. Both sFlt-1 and hs-CRP may predict composite adverse maternal outcomes but do not correlate with each other and differ in perinatal morbidity patterns. These data support the hypothesis that the varied outcomes in PE may result from different pathogenic pathways.


Assuntos
Pré-Eclâmpsia , Biomarcadores , Proteína C-Reativa/metabolismo , Estudos de Coortes , Feminino , Humanos , Fator de Crescimento Placentário , Gravidez , Terceiro Trimestre da Gravidez , Receptor 1 de Fatores de Crescimento do Endotélio Vascular
12.
Drug Alcohol Depend ; 233: 109358, 2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-35247723

RESUMO

BACKGROUND: Maternal cigarette smoking is an important modifiable risk factor for low birth weight in the US. We investigated the maternal nicotine metabolite ratio (NMR; trans-3'-hydroxycotinine/cotinine) - a genetically-informed biomarker of nicotine clearance - as a moderator of links between prenatal cigarette use and birth weight. We also explored the role of race in these associations. METHODS: Participants were 454 pregnant women (Mage = 25 years; 11% Black) who smoked cigarettes and their 537 infants from the Collaborative Perinatal Project. Cigarettes smoked per day were assessed at each prenatal visit; maternal NMR was assayed from third trimester serum. Birth weight was obtained from medical records. Generalized estimating equations were used to evaluate associations between cigarette smoking, NMR, race, and birth weight. RESULTS: NMR moderated continuous associations between cigarettes per day over pregnancy and infant birth weight (p = .025). Among women who smoked at moderate levels (<15 cigarettes per day), those with slower NMR showed ~50-100 g decrements in birth weight versus those with faster NMR., while there were no significant associations between NMR and birth weight among women who smoked 15+ cigarettes per day. Although effects of NMR on birthweight were similar for Black and white women, Black women showed significantly slower NMR (p < .001). CONCLUSIONS: This is the first demonstration that the maternal nicotine metabolism phenotype moderates associations between maternal smoking during pregnancy and birth weight. Infants of women with slower nicotine metabolism - including disproportionate representation of Black women - may be at heightened risk for morbidity from maternal smoking.


Assuntos
Fumar Cigarros , Produtos do Tabaco , Peso ao Nascer , Cotinina , Feminino , Humanos , Nicotina/efeitos adversos , Nicotina/metabolismo , Gravidez , Terceiro Trimestre da Gravidez
13.
AJNR Am J Neuroradiol ; 43(4): 620-626, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35332016

RESUMO

BACKGROUND AND PURPOSE: Single intrauterine fetal death increases the risk of antenatal brain lesions in the surviving twin. We evaluated the prevalence of structural brain lesions, biometry, and diffusivity on routine third trimester MR imaging performed following single intrauterine fetal death. MATERIALS AND METHODS: In a retrospective MR imaging-based cohort study, we compared 29 monochorionic twins complicated with single intrauterine fetal death (14 following laser ablation treatment for twin-to-twin transfusion syndrome, 8 following selective fetal reduction, and 7 spontaneous) with 2 control cohorts (49 singleton fetuses and 28 uncomplicated twin fetuses). All fetuses in the single intrauterine fetal death group underwent fetal brain MR imaging as a routine third trimester evaluation. Structural brain lesions were analyzed. Cerebral biometry and diffusivity were measured and compared. RESULTS: Brain lesions consistent with the evolution of prior ischemic injury were found in 1 of 29 fetuses, not detected by ultrasound. No acute brain infarction, hemorrhage, or cortical abnormalities were found. Supratentorial biometric measurements in the single intrauterine fetal death group were significantly smaller than those in the singleton group, but not significantly different from those in the uncomplicated twin group. There were no significant differences in ADC values of the cerebral hemispheres, basal ganglia, and pons between the single intrauterine fetal death group and either control group. CONCLUSIONS: Although smaller brain biometry was found, normal diffusivity in surviving twins suggests normal parenchymal microstructure. The rate of cerebral structural injury was relatively low in our cohort, arguing against the routine use of fetal brain MR imaging in twin pregnancies complicated with single intrauterine fetal death. Larger prospective studies are necessary to guide appropriate surveillance protocol and parental counseling in twin pregnancies complicated by single intrauterine fetal death.


Assuntos
Lesões Encefálicas , Transfusão Feto-Fetal , Imageamento por Ressonância Magnética , Encéfalo/diagnóstico por imagem , Estudos de Coortes , Feminino , Morte Fetal/etiologia , Transfusão Feto-Fetal/complicações , Transfusão Feto-Fetal/diagnóstico por imagem , Humanos , Neuroimagem , Gravidez , Terceiro Trimestre da Gravidez , Gravidez de Gêmeos , Estudos Prospectivos , Estudos Retrospectivos , Gêmeos Monozigóticos , Ultrassonografia Pré-Natal
14.
Actual. SIDA. infectol ; 30(108): 58-67, 20220000. graf, tab
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1363381

RESUMO

ntroducción: La información sobre la evolución de la infección por COVID-19 en personas gestantes (PG) continúa en desarrollo.Objetivos: Describir la presentación de la infección por Sars-CoV-2 en PG y determinar variables asociadas a mayor gravedad.Materiales y métodos: Estudio observacional retrospectivo. Periodo: 01/03/2020-31/07/2021. Se incluyeron PG con diagnóstico de COVID-19 asistidas en una maternidad de gestión pública: se clasificaron según gravedad y se dividieron en dos grupos: Grup o1 leve y de manejo ambulatorio; Grupo 2 moderado, severo y crítico, con internación. Se analizó la relación entre gravedad y obesidad, DBT, hipertensión inducida por el embarazo (HIE), edad gestacional, edad materna, vacunación antigripal. Recién nacidos (RN) de madres infectadas se estudiaron con PCR para Sars-CoV-2 24-48 hs postnacimiento. Análisis estadístico: Chi-cuadrado o test exacto de Fisher. Significancia= p<0,05. Aprobado porComité Ética Institucional.Resultados: 52 PG con diagnóstico de COVID-19. Edadmediana 29,6 años. Grupo 1: 29 PG (55,5%). Grupo 2: 23 PG(44%), 19 (36,5%) moderados, 2 (4%) severos y 2 (4%) críticos. No hubo fallecimientos maternos ni fetales. Edad gestacional ≥ 28 semanas fue la única variable asociada a mayor gravedad,p=0,00004. 48% de los embarazos finalizaron por cesárea.48/52 RN fueron estudiados con PCR para Sars-CoV-2, siendo 1 (2%) positivo (fue el único RN sintomático).Conclusiones: La infección por COVID-19 en PG se asoció a presentaciones clínicas más graves cuando la infecciónse cursó en el tercer trimestre de gestación y se asociócon mayor incidencia de cesáreas


ntroduction: The information concerning the impact of COVID-19 infection in pregnant people (PP) continues to be established.Aim: to describe the evolution of the Sars-CoV-2 infection in pregnant people and to determine variables associated with clinical severity.Materials and Methods: Retrospective observational study. Period: 01-03-2020 to 31-07-2021. We included PP with diagnosis of COVID-19, assisted in a public maternity hospital. The cases were classified according to clinical severity based on the NIH guidelines. The patients were divided into 2 groups: Group 1: mild (ambulatory manage-ment). Group 2: moderate, severe and critical (requiring hospitalization). The relationship between variables and clinical severity was analyzed. Variables studied: obesity, DBT, gestational hypertension, gestational age, maternal age, influenza vaccination. Newborns of infected mothers were studied with PCR for Sars-CoV-2 24 to 48 hours af-ter birth. Statistical analysis: Chi-square or Fisher's exact test, significance = p <0.05. Study approved by the Institu-tional Ethics Committee.Results: 52 PP with diagnosis of COVID-19 were includ-ed. Median age 29.6 years. 23 patients (44%) required hospitalization and 2 (4%) MRA (mechanical respiratory assistance). 29 (55.5%) were mild, 19 (36.5%) moderate, 2 (4%) severe, and 2 (4%) critical. There were no mater-nal or fetal deaths. Gestational age ≥ 28 weeks was the only variable associated with more severe clinical forms, p = 0.0001. 48% of the pregnancies ended by cesarean section. 48/52 newborns were studied with PCR for Sars-CoV-2, with only 1 (2%) being positive. This was the only symptomatic newborn.Conclusions: In our study, Sars-CoV-2 infection during pregnancy was associated with more severe clinical pre-sentations when the infection occurred in the 3rd trimes-ter of pregnancy. COVID-19 was also associated with a higher incidence of ter


Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto , Complicações na Gravidez/prevenção & controle , Terceiro Trimestre da Gravidez , Índice de Gravidade de Doença , Estudos Retrospectivos , Gestantes , COVID-19/complicações , Obesidade/complicações
15.
PLoS One ; 17(3): e0265124, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35298503

RESUMO

OBJECTIVES: About half of the pregnancies among women living with HIV (WLWH) receiving antiretroviral therapy (ART) in sub-Saharan African countries are reported to be unintended. Unintended pregnancy is associated with late initiation of antenatal care (ANC), and may delay provision of viral load monitoring services, antenatal adherence counselling and support, and other services that promote sustained viral suppression throughout pregnancy. This study examines the association between unsuppressed viral load during the third trimester of pregnancy and unintended pregnancy among women who initiated ART before pregnancy. METHODS: This was an analysis of data from a national antenatal survey conducted at 1 589 public health facilities in South Africa between 1 October and 15 November 2019. Consenting pregnant women aged 15-49 years attending ANC during the survey period were enrolled. Demographic and clinical data were collected through interview and medical record review. Pregnancy intention was assessed using two questions from the London Measure of Unplanned Pregnancy, and responses were categorized as "unintended," "undecided," and "intended." Blood specimens were collected from all women and tested for HIV; and if positive, a viral load test was performed. A survey domain-based poisson regression model examined the association between unsuppressed viral load during the third trimester of pregnancy and unintended pregnancy among women who initiated ART before pregnancy. Viral suppression was defined as viral load <50 copies/mL. RESULTS: Of 10 901 WLWH with viral load data available, 63.3% (95% confidence interval (CI): 62.4%-64.1%) were virally suppressed. Among the 2 681 women (representing 24.1% of all WLWH with viral load data) who initiated ART before pregnancy and were in their third trimester at the time of enrolment, 74.4% (95% CI: 73.0%-75.8%) were virally suppressed. In the same population, the proportion virally suppressed was lower among women whose current pregnancies were unintended (72.1%, 95% CI: 70.1%-74.1%) compared to women whose pregnancies were intended (78.3%, 95% CI: 75.9%-80.5%). In multivariable analyses adjusted for age, gravity, marital status, education, location of facility and syphilis status, unintended pregnancy was associated with unsuppressed viral load during the third trimester (adjusted relative risk: 1.3, 95% CI: 1.1-1.4) among women who initiated ART before pregnancy. CONCLUSION: The identified association between unsuppressed viral load and unintended pregnancy among pregnant women who initiated ART before pregnancy highlights the need to strengthen routine assessment of fertility preferences and provision of contraceptive services to reproductive age WLWH receiving ART.


Assuntos
Infecções por HIV , Complicações Infecciosas na Gravidez , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Masculino , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/epidemiologia , Terceiro Trimestre da Gravidez , Gravidez não Planejada , África do Sul/epidemiologia
16.
Curr Opin Obstet Gynecol ; 34(2): 69-76, 2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-35230991

RESUMO

PURPOSE OF REVIEW: Anemia in pregnancy is associated with increased maternal and neonatal morbidity. There is increasing awareness amongst obstetricians about the need to screen for iron deficiency anemia (IDA), as well as growing literature on diagnosis and treatment. This review aims to summarize causes, consequences, treatment, and evaluation of IDA in pregnancy. RECENT FINDINGS: National guidelines provide varying guidance on diagnosis and treatment of IDA in pregnancy. Serum ferritin is a helpful adjunct for the diagnosis of IDA. Oral iron remains an option for treatment; absorption is improved with every other day dosing and is effective for patients able to tolerate. Emerging studies on modern generations of intravenous (IV) iron demonstrate shorter infusion times and improved safety profiles. Notably, recent UK guidelines provide consideration for universal IV iron supplementation for treatment of anemia beyond 34 weeks of pregnancy. SUMMARY: Iron, in dietary, oral, and IV forms, has been found effective in resolving anemia in pregnancy. Pregnant people with IDA in the third trimester are more likely to benefit from IV iron. Future studies designed and powered to assess maternal and perinatal morbidity indicators and blood transfusion rates can strengthen recommendations.


Assuntos
Feminino , Humanos , Recém-Nascido , Ferro/uso terapêutico , Gravidez , Terceiro Trimestre da Gravidez
17.
Artigo em Inglês | MEDLINE | ID: mdl-35329004

RESUMO

Routine third trimester ultrasonography is increasingly used to screen for fetal growth restriction. However, evidence regarding its cost-effectiveness is lacking. We aimed to evaluate the cost-effectiveness of routine third trimester ultrasonography to reduce adverse perinatal outcomes compared to usual care (selective ultrasonography). An economic evaluation alongside a stepped-wedge cluster-randomized trial was conducted. Via 60 midwifery practices 12,974 Dutch women aged ≥16 years with low-risk pregnancies were enrolled at 22.8 (SD = 2.4) weeks' gestation. All practices provided usual care. At 3, 7, and 10 months a third of the practices were randomized to the intervention strategy providing routine ultrasonography at 28-30 and 34-36 weeks' gestation and usual care. The primary clinical outcome was a dichotomous composite measure of 12 severe adverse perinatal outcomes (SAPO) up to one week postpartum. Information on perinatal care and societal costs was derived from Netherlands Perinatal Registry, hospital records and a survey. Cost-effectiveness analyses revealed no significant differences in SAPO and healthcare and societal costs between the intervention strategy (n = 7026) and usual care (n = 5948). Cost-effectiveness acceptability curves showed that the probability of cost-effectiveness was never higher than 0.6 for all possible ceiling ratios. Adding routine third trimester ultrasonography to usual care is not cost-effective in reducing SAPO.


Assuntos
Retardo do Crescimento Fetal , Ultrassonografia Pré-Natal , Análise Custo-Benefício , Feminino , Humanos , Países Baixos , Gravidez , Terceiro Trimestre da Gravidez , Ultrassonografia
18.
Am J Case Rep ; 23: e934942, 2022 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-35321999

RESUMO

BACKGROUND Fournier's gangrene (FG) is a rapidly progressive necrotizing infection of the perineum. Risk factors include male sex and immunosuppression. Inflammatory bowel disease and pregnancy may alter immune response by complex mechanisms but have rarely been associated with necrotizing infections of the perineum. To the best of our knowledge, only 5 cases of FG in association with IBD have been reported in the literature, and none of them occurred during pregnancy. CASE REPORT We report the case of a young woman with long-standing Crohn's disease in clinical remission with Infliximab monotherapy who developed FG in the third trimester of pregnancy. A cesarean section was undertaken at 35 weeks due to fetal distress, followed by debridement, diverting stoma, and vacuum-assisted therapy. The perineal defect was closed following 4 debridements and vacuum-therapy exchanges with a unilateral medial thigh advancement flap, and a draining seton was placed in the suprasphincteric fistula. The patient was discharged after 28 days and her recovery was unremarkable. The neonate also recovered well. CONCLUSIONS The treatment of FG is multidisciplinary and includes early debridement and intestinal diversion. Perianal pain should not be disregarded, as it may be the initial symptom of severe perianal sepsis in the immunosuppressed. To the best of our knowledge, this is the first case report of FG during pregnancy in a patient with Crohn's disease.


Assuntos
Doença de Crohn , Gangrena de Fournier , Cesárea , Doença de Crohn/complicações , Feminino , Gangrena de Fournier/diagnóstico , Gangrena de Fournier/etiologia , Gangrena de Fournier/terapia , Humanos , Recém-Nascido , Masculino , Períneo , Gravidez , Terceiro Trimestre da Gravidez
19.
Artigo em Inglês | MEDLINE | ID: mdl-35329228

RESUMO

INTRODUCTION: The incidence of twin pregnancy is estimated at 1 per 80 single pregnancies. As the topic of sexual function among women with multiple pregnancy is insufficiently developed, we believe it is appropriate to raise this subject. METHODS: A prospective study was conducted on 100 women during subsequent trimesters of pregnancy. RESULTS: From a group of 100 women, 54 women were primiparous, while 46 women had a history of previous delivery. The mean overall FSFI (female sexual function index) was found to be 24.3 ± 6.1. Mean FSFI was the highest in the first trimester at 25.6. The result decreased successively to 24.8 ± 7 and 22.6 ± 8.4 in the second and third trimesters, respectively. The patient's place of residence had a crucial impact on their FSFI score. The results were considerably higher for residents of small and medium towns or cities-24.4 ± 3.8 and 25.9 ± 4.9, respectively-while for those living in rural areas, the FSFI reached only 21.7 ± 5.4. CONCLUSIONS: The present study shows that the FSFI decreased throughout twin pregnancy. The lowest observed FSFI occurred in the third trimester, while the highest FSFI occurred during the first trimester.


Assuntos
Gravidez de Gêmeos , Comportamento Sexual , Feminino , Humanos , Masculino , Gravidez , Primeiro Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Trimestres da Gravidez , Estudos Prospectivos , Inquéritos e Questionários
20.
Ultrasound Med Biol ; 48(6): 1157-1162, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35300877

RESUMO

SlowflowHD is a new ultrasound Doppler imaging technology that allows visualization of flow within small blood vessels. In this mode, a proprietary algorithm differentiates between low-speed flow and signals attributed to tissue motion so that microvessel vasculature can be examined. Our objectives were to describe the low-velocity Doppler mode principles, to assess the bone thermal index (TIb) safety parameter in obstetric ultrasound scans and to evaluate adherence to professional guidelines. To achieve the latter goals, we retrospectively reviewed prospectively collected ultrasound images and video clips from pregnancy ultrasound scans at >10 wk of gestation over 4 mo. We used a custom-built optical character recognition-based software to automatically identify all images and video clips using this technology and extract the TIb. Overall, a total of 185 ultrasound scans performed by three fetal medicine physicians were included, of which 60, 54 and 71 scans were first-, second- and third-trimester scans, respectively. The mean (highest recorded) TIb values were 0.32 (0.70), 0.23 (0.70) and 0.32 (0.60) in the first, second, and third trimesters, respectively. Thermal index values were within recommended values set by the World Federation for Ultrasound in Medicine and Biology American Institute of Ultrasound in Medicine and British Medical Ultrasound Society in all scans.


Assuntos
Obstetrícia , Feminino , Humanos , Gravidez , Terceiro Trimestre da Gravidez , Estudos Retrospectivos , Ultrassonografia Doppler , Ultrassonografia Pré-Natal/métodos , Estados Unidos
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