RESUMEN
Pregnancy is associated with physiologic changes that affect virtually every organ system in the mother. These physiologic changes allow the parturient to support the growing uterus and fetus and to withstand labor and the postpartum course. Because the gravida may require surgery while pregnant, it is important to have an appreciation of these physiologic changes. These maternal adaptive responses have significant implications for anesthetic, operative, and perioperative management.
Asunto(s)
Embarazo/fisiología , Femenino , Homeostasis/fisiología , HumanosRESUMEN
Pregnancy always must be considered when evaluating a female trauma victim of reproductive age. When managing the pregnant trauma victim, one must optimize the well-being of two patients, but the health of the mother is of paramount importance. Rapid assessment, treatment, and transport are critical to optimizing maternal and fetal outcome. Evaluation must be performed with an understanding of the physiologic changes that occur in pregnancy. These changes alter maternal response to trauma and require adaptations to care.
Asunto(s)
Complicaciones del Embarazo/cirugía , Heridas y Lesiones/cirugía , Cuidados Críticos/organización & administración , Urgencias Médicas , Femenino , Humanos , Embarazo/fisiología , Complicaciones del Embarazo/diagnóstico , Lesiones Prenatales/cirugía , Heridas y Lesiones/diagnósticoRESUMEN
Surgical diseases frequently arise in gravid patients, with an estimated 1 in 500 pregnancies requiring nonobstetric surgical intervention. Evaluation and treatment generally are the same as for the nonpregnant patient, but pregnancy may mask some of the typical presenting symptoms, leading to delayed diagnosis. This article highlights some of the more common surgical diseases that may present during pregnancy, including appendicitis, biliary diseases, bowel obstruction, hemorrhoids, inflammatory bowel disease, and malignancies.
Asunto(s)
Complicaciones del Embarazo/cirugía , Apendicitis/cirugía , Femenino , Enfermedades de la Vesícula Biliar/cirugía , Hemorroides/cirugía , Humanos , Enfermedades Intestinales/cirugía , Neoplasias/cirugía , EmbarazoRESUMEN
OBJECTIVE: To determine if elective induction (IND) increases the risk of cesarean delivery compared to expectant management (EM). METHODS: A randomized clinical trial involving women 39 weeks' gestation, according to strict dating criteria, with a Bishop score of 5 or more in nulliparous patients and 4 or more in multiparous patients. The control group was expectantly managed and delivered for obstetric indications, but not later than 42 weeks' gestation. The study had 80% power to detect a three-fold increase in cesarean delivery. RESULTS: One-hundred-and-sixteen patients (45 nulliparous) were randomized to IND and 110 (58 nulliparous) to EM. Demographic characteristics were no different between the groups. The cesarean delivery rate in the IND group was 6.9% (8/116) compared to 7.3% (8/110) in the EM group (p = NS). Rates of cesarean delivery for nulliparous patients randomized to IND compared to EM were also not significantly different: 13.3% (6/45) versus 10.3% (6/58) respectively (p = NS). Neonates delivered of IND patients weighed less than those of the EM group (3459 +/- 347 versus 3604 +/- 438, p = 0.006). CONCLUSION: In women with favorable Bishop scores, elective induction of labor resulted in no increase in cesarean delivery compared to expectant management.
Asunto(s)
Cesárea , Trabajo de Parto Inducido , Trabajo de Parto , Resultado del Embarazo , Adulto , Femenino , Humanos , Paridad , Examen Físico , Embarazo , Tercer Trimestre del EmbarazoRESUMEN
OBJECTIVE: Obesity is epidemic in the United States and the prevalence is increasing. We sought to determine if the prevalence of obesity in women eligible for health care at military treatment facilities, specifically, active duty (AD) women, is increasing similar to national trends. METHODS: Our retrospective cohort study evaluated selected outcomes in women delivering in 1999 and 2006. Women delivering living, singleton, term, nonanomalous neonates in 1999 and 2006 were eligible. Prepregnancy weight and weight gain during pregnancy were compared between the two populations, and data were stratified by AD status, age, and ethnicity. Obstetric outcomes were evaluated based on body mass index (BMI). RESULTS: There were 1,543 and 1,745 mother-infant pairs available, respectively, for analysis. Prepregnancy BMI for all women evaluated increased significantly from 1999 to 2006 (25.0 vs. 25.6, p < 0.05). Prepregnancy BMI increased significantly for AD women between 1999 and 2006 (24.3 vs. 25.4, p < 0.05). The prevalence of overweight and obese women increased from 1999 to 2006 in the population evaluated (41.2% vs.46.2%, respectively), and this was demonstrated among all ethnicities. Obesity was associated with increased adverse obstetric outcomes. CONCLUSION: We demonstrated increasing maternal obesity in a military population over time and associated adverse perinatal outcomes.
Asunto(s)
Índice de Masa Corporal , Personal Militar/estadística & datos numéricos , Obesidad/epidemiología , Complicaciones del Embarazo/epidemiología , Aumento de Peso , Adolescente , Adulto , Femenino , Humanos , Persona de Mediana Edad , Obesidad/etnología , Embarazo , Prevalencia , Estudios Retrospectivos , Estados Unidos/epidemiología , Adulto JovenRESUMEN
Trauma complicates approximately 6-7% of all pregnancies and is associated with significant maternal and fetal morbidity and mortality. While the majority of trauma is minor, it is minor trauma that contributes to the majority of fetal mortality. Since virtually every organ system is affected anatomically and physiologically by pregnancy, it is important for healthcare providers who care for trauma victims to be aware of these changes. While assessment and resuscitation considers the existence of two patients, stabilization of the mother takes priority. Diagnostic and radiologic procedures should be used as indicated, with fetal exposure to radiation limited as much as possible. Management of the pregnant trauma victim requires a multidisciplinary approach in order to optimize outcome for mother and fetus. This review discusses the epidemiology, assessment and treatment of pregnant trauma patients and reviews areas where prevention efforts may be focused.