RESUMO
Complications associated with cerclage that are commonly described in the existing published reports include injuries to the cervix or bladder, premature rupture of membranes, chorioamnionitis and bleeding. We report an unusual complication of a ureterovaginal fistula formation after the insertion of a McDonald suture.
Assuntos
Cerclagem Cervical/efeitos adversos , Complicações Pós-Operatórias/etiologia , Fístula Urinária/etiologia , Fístula Vaginal/etiologia , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Recesariana , Diagnóstico Diferencial , Quimioterapia Combinada , Feminino , Ruptura Prematura de Membranas Fetais/diagnóstico , Humanos , Infusões Intravenosas , Malásia/etnologia , Nefrostomia Percutânea , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/diagnóstico por imagem , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Singapura , Resultado do Tratamento , Fístula Urinária/complicações , Fístula Urinária/diagnóstico , Fístula Urinária/cirurgia , Infecções Urinárias/complicações , Infecções Urinárias/tratamento farmacológico , Fístula Vaginal/complicações , Fístula Vaginal/diagnóstico , Fístula Vaginal/cirurgiaRESUMO
OBJECTIVE: To determine the impact of the new 2013 World Health Organization (WHO) criteria for gestational diabetes mellitus (GDM) diagnosis on GDM prevalence and pregnancy outcomes in Asian ethnic groups compared to the 1999 WHO criteria. METHODS: A retrospective cohort study included 855 pregnant females of Chinese, Malay, and Asian Indian ethnicity at high risk of GDM who underwent 75-g oral glucose tolerance tests (OGTTs) between July 2008 and June 2010 in a tertiary center in Singapore. GDM prevalence, reclassification, and pregnancy outcomes were determined using the 2013 and 1999 diagnostic cutoffs for fasting and 2-hour postglucose (PG) values. RESULTS: The prevalence of GDM was reduced from 28.8% to 21.1% when the 2013 criteria were used. Overall, 10.2% subjects were reclassified from GDM to normal using the 2013 criteria, and 2.6% were reclassified from normal to GDM, giving a net reclassification rate of 12.8%. Reclassification from GDM to normal was greatest among Chinese, followed by Asian Indians, but the prevalence rate was unchanged among Malays. Babies of mothers who were reclassified from normal to GDM were more likely to have birth weight >95th centile and shoulder dystocia. CONCLUSION: The prevalence of GDM was reduced when the 2013 criteria were used, with the greatest reduction seen among Chinese, followed by Asian Indians. Lowering the fasting cutoff as per the new criteria identified a select group of patients who might benefit from GDM treatment. However, raising the 2-hour PG cutoff would miss a significant number of patients who might potentially benefit from GDM treatment.
Assuntos
Vacinas contra Influenza , Influenza Humana , Complicações Infecciosas na Gravidez , Coqueluche , Gravidez , Feminino , Humanos , Influenza Humana/prevenção & controle , Estudos Transversais , Coqueluche/prevenção & controle , Vacinação , Vacinas contra Influenza/uso terapêutico , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos e Questionários , Complicações Infecciosas na Gravidez/prevenção & controle , Aceitação pelo Paciente de Cuidados de SaúdeRESUMO
[This corrects the article DOI: 10.1186/s13756-015-0086-z.].
RESUMO
BACKGROUND: Outbreaks of emerging infectious diseases have led to guidelines recommending the routine use of N95 respirators for healthcare workers, many of whom are women of childbearing age. The respiratory effects of prolonged respirator use on pregnant women are unclear although there has been no definite evidence of harm from past use. METHODS: We conducted a two-phase controlled clinical study on healthy pregnant women between 27 to 32 weeks gestation. In phase I, energy expenditure corresponding to the workload of routine nursing tasks was determined. In phase II, pulmonary function of 20 subjects was measured whilst at rest and exercising to the predetermined workload while breathing ambient air first, then breathing through N95-mask materials. RESULTS: Exercising at 3 MET while breathing through N95-mask materials reduced mean tidal volume (TV) by 23.0 % (95 % CI -33.5 % to -10.5 %, p < 0.001) and lowered minute ventilation (VE) by 25.8 % (95 % CI -34.2 % to -15.8 %, p < 0.001), with no significant change in breathing frequency compared to breathing ambient air. Volumes of oxygen consumption (VO2) and carbon dioxide expired (VCO2) were also significantly reduced; VO2 by 13.8 % (95 % CI -24.2 % to -3 %, p = 0.013) and VCO2 by 17.7 %, (95 % CI -28.1 % to -8.6 %, p = 0.001). Although no changes in the inspired oxygen and carbon dioxide concentrations were demonstrated, breathing through N95-mask materials during low intensity work (3 MET) reduced expired oxygen concentration by 3.2 % (95 % CI: -4.1 % to -2.2 %, p < 0.001), and increased expired carbon dioxide by 8.9 % (95 % CI: 6.9 % to 13.1 %; p <0.001) suggesting an increase in metabolism. There were however no changes in the maternal and fetal heart rates, finger-tip capillary lactate levels and oxygen saturation and rating of perceived exertion at the work intensity investigated. CONCLUSIONS: Breathing through N95 mask materials have been shown to impede gaseous exchange and impose an additional workload on the metabolic system of pregnant healthcare workers, and this needs to be taken into consideration in guidelines for respirator use. The benefits of using N95 mask to prevent serious emerging infectious diseases should be weighed against potential respiratory consequences associated with extended N95 respirator usage. TRIAL REGISTRATION: The study was registered at clinicaltrials.gov, identifier NCT00265926.