Assuntos
Triagem de Portadores Genéticos/métodos , Heterozigoto , Síndrome Nefrótica/diagnóstico , Diagnóstico Pré-Natal , alfa-Fetoproteínas/metabolismo , Adulto , Feminino , Testes Genéticos , Idade Gestacional , Humanos , Proteínas de Membrana/genética , Síndrome Nefrótica/sangue , Síndrome Nefrótica/genética , Gravidez , Segundo Trimestre da Gravidez/sangueRESUMO
OBJECTIVE: Although the risk of death from complications of pregnancy in the 20th century has decreased dramatically, several lines of evidence suggest that it has not reached an irreducible minimum. To further reduce pregnancy-related mortality, we must understand which deaths are potentially preventable and the changes needed to prevent them. We sought to identify all pregnancy-related deaths in North Carolina and conduct a comprehensive review examining ways in which the number of these deaths could potentially be reduced. METHODS: The North Carolina Pregnancy-Related Mortality Review Committee reviewed all of the 108 pregnancy-related deaths (women who died during or within 1 year of the end of pregnancy from a complication of pregnancy or its treatment) that occurred in the state in 1995-1999. For each death, the committee determined the cause of death, whether it could have been prevented, and if so, the means by which it might have been prevented. RESULTS: Although overall, 40% of pregnancy-related deaths were potentially preventable, this varied by the cause of death. Almost all deaths due to hemorrhage and complications of chronic diseases were believed to be potentially preventable, whereas none of the deaths due to amniotic fluid embolus, microangiopathic hemolytic syndrome, and cerebrovascular accident were considered preventable. Improved quality of medical care was considered to be the most important factor in preventing these deaths. Among African-American women, 46% of deaths were potentially preventable, compared with 33% of the deaths among white women. CONCLUSION: Despite the decline in pregnancy-related mortality rates, almost one half of these deaths could potentially be prevented, mainly through improved quality of medical care. In-depth review of pregnancy-related deaths can help determine strategies needed to continue making pregnancy safer.
Assuntos
Causas de Morte , Mortalidade Materna/tendências , Complicações na Gravidez/mortalidade , Complicações na Gravidez/prevenção & controle , Prevenção Primária/métodos , Adolescente , Adulto , Fatores Etários , Intervalos de Confiança , Feminino , Humanos , Idade Materna , Distribuição de Poisson , Gravidez , Prevalência , Medição de Risco , Estados UnidosAssuntos
Calcinose/etiologia , Doenças Fetais/virologia , Coração Fetal/diagnóstico por imagem , Herpes Genital/transmissão , Transmissão Vertical de Doenças Infecciosas , Miocardite/diagnóstico por imagem , Miocárdio/patologia , Complicações Infecciosas na Gravidez , Adolescente , Feminino , Morte Fetal/virologia , Coração Fetal/patologia , Coração Fetal/virologia , Humanos , Miocardite/virologia , Gravidez , Ultrassonografia Pré-Natal , alfa-Fetoproteínas/análiseRESUMO
OBJECTIVE: To evaluate the possible role of a novel, minimally invasive approach to the management of abdominal pregnancy. METHODS: We hypothesized that sonographically guided feticide without subsequent laparotomy for removal of the fetus and placenta could minimize potential blood loss and would be a reasonable approach in the care of a patient who had a viable 14.5-week abdominal pregnancy with placental implantation directly over the bifurcation of the left common iliac artery. An extensive MEDLINE literature review revealed 1 case of sonographically guided feticide followed 10 days later by uneventful laparotomy for removal of the fetus and placenta. Thus, we used sonographically guided feticide without subsequent laparotomy for removal of the products of conception. RESULTS: The sonographically guided feticide was uneventful, and the patient had no major postprocedure morbidity; a mild ileus was treated conservatively without the need for nasogastric suctioning. No major postprocedure bleeding was encountered. Human chorionic gonadotropin levels dropped precipitously. During the 1.5 years of postprocedure follow-up, the patient reported no major complications. The gestational sac involuted very slowly; amniotic fluid volume appeared normal at 6 months after the procedure but was diminished at the 9-month postprocedure examination. CONCLUSIONS: In cases of previable intra-abdominal pregnancy, sonographically guided feticide may lessen the risk of extensive hemorrhage that can be associated with exploratory laparotomy. Sonographically guided feticide without subsequent exploratory laparotomy can result in a gradual resorption of the products of conception and an uncomplicated recovery. This treatment option should be considered in the management of this potentially life-threatening condition.