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1.
Artigo em Inglês | MEDLINE | ID: mdl-34574351

RESUMO

Precarious political circumstances can take a mental toll on young people. Adopting a socio-ecological perspective, this study investigated the influence of stress arising from political life events, intrapersonal factors (i.e., meaning in life, resilience), interpersonal factors (i.e., social support, associational social capital), and community factors (i.e., perceived empowerment in the community, perceived opportunities for civic engagement) on the mental health of youth in Hong Kong. Furthermore, it examined the moderating effects of these factors on the relationship between stress arising from political life events and mental health. A cross-sectional quantitative survey with a stratified purposive sampling data collection method was conducted. A total of 1330 secondary school students were recruited for this study. Multiple regression analysis was performed to examine both direct and moderation effects. The results indicate that high stress arising from political life events, low meaningfulness in life, low resilience, low social support, low youth empowerment in the community, and high civic engagement in the community were related to high mental distress. None of the presumed moderators moderated the relationship between stress due to political life events and mental distress. Assessing and addressing stress due to political life events would be potentially important in mental health programs for Hong Kong adolescents in precarious political situations.


Assuntos
Empoderamento , Saúde Mental , Adolescente , Estudos Transversais , Hong Kong/epidemiologia , Humanos , Fatores de Proteção
2.
Obstet Gynecol ; 138(1): 42-50, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34259462

RESUMO

OBJECTIVE: To evaluate maternal and fetal outcomes among women with a single elevated blood pressure before 20 weeks of gestation. METHODS: We conducted a retrospective cohort study of women who delivered at Kaiser Permanente Southern California hospitals between January 1, 2008, and December 31, 2019. Participants were divided into two groups: normotensive (all systolic blood pressures lower than 130 mm Hg and diastolic pressures lower than 80 mm Hg) compared with single elevated blood pressure (single systolic pressure 130 mm Hg or higher, diastolic pressure 80 mm Hg or higher, or both). Women with chronic hypertension were excluded. Maternal comorbidities and maternal and neonatal outcomes were extracted from electronic health records using International Classification of Diseases codes. Adjusted odds ratios (aORs) derived from logistic regression were used to describe the magnitude of association. RESULTS: Of 303,689 women who delivered during the study period, 23% had a single elevated blood pressure. Rates of hypertensive disorders of pregnancy differed between the two groups (10.6% for single elevated blood pressure, 4.5% for normotensive group; aOR 2.06, 95% CI 2.00-2.13), as did iatrogenic preterm delivery (3.7% vs 2.7%, respectively; aOR 1.27, 95% CI 1.21-1.33). DISCUSSION: Women with a single elevated blood pressure before 20 weeks of gestation are at increased risk for hypertensive disorders of pregnancy and iatrogenic preterm delivery.


Assuntos
Pressão Sanguínea , Resultado da Gravidez/epidemiologia , Adulto , California/epidemiologia , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Recém-Nascido , Gravidez , Estudos Retrospectivos
3.
G3 (Bethesda) ; 10(12): 4323-4334, 2020 12 03.
Artigo em Inglês | MEDLINE | ID: mdl-33077477

RESUMO

Stem cells are tightly controlled in vivo Both the balance between self-renewal and differentiation and the rate of proliferation are often regulated by multiple factors. The Caenorhabditis elegans hermaphrodite germ line provides a simple and accessible system for studying stem cells in vivo In this system, GLP-1/Notch activity prevents the differentiation of distal germ cells in response to ligand production from the nearby distal tip cell, thereby supporting a stem cell pool. However, a delay in germline development relative to somatic gonad development can cause a pool of undifferentiated germ cells to persist in response to alternate Notch ligands expressed in the proximal somatic gonad. This pool of undifferentiated germ cells forms a proximal tumor that, in adulthood, blocks the oviduct. This type of "latent niche"-driven proximal tumor is highly penetrant in worms bearing the temperature-sensitive weak gain-of-function mutation glp-1 ( ar202 ) at the restrictive temperature. At the permissive temperature, few worms develop tumors. Nevertheless, several interventions elevate the penetrance of proximal tumor formation at the permissive temperature, including reduced insulin signaling or the ablation of distal-most sheath cells. To systematically identify genetic perturbations that enhance proximal tumor formation, we sought genes that, upon RNAi depletion, elevate the percentage of worms bearing proximal germline tumors in glp-1 ( ar202 ) at the permissive temperature. We identified 43 genes representing a variety of functional classes, the most enriched of which is "translation". Some of these genes also influence the distal germ line, and some are conserved genes for which genetic interactions with Notch were not previously known in this system.


Assuntos
Proteínas de Caenorhabditis elegans , Caenorhabditis elegans , Neoplasias , Receptores Notch , Animais , Caenorhabditis elegans/genética , Caenorhabditis elegans/metabolismo , Proteínas de Caenorhabditis elegans/genética , Proteínas de Caenorhabditis elegans/metabolismo , Células Germinativas/metabolismo , Peptídeo 1 Semelhante ao Glucagon , Fenótipo , Interferência de RNA , Receptores Notch/genética , Receptores Notch/metabolismo
4.
Am J Perinatol ; 37(11): 1110-1114, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32620022

RESUMO

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has created a need for data regarding the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnant women. After implementing universal screening for COVID-19 in women admitted for delivery, we sought to describe the characteristics of COVID-19 in this large cohort of women. STUDY DESIGN: An observational study of women admitted to labor and delivery units in Kaiser Permanente Southern California (KPSC) hospitals between April 6 and May 11, 2020 who were universally offered testing for SARS-CoV-2 infection (n = 3,963). Hospital inpatient and outpatient physician encounter, and laboratory records were used to ascertain universal testing levels, test results, and medical and obstetrical histories. The prevalence of SARS-CoV-2 infection was estimated from the number of women who tested positive during labor per 100 women delivered. RESULTS: Of women delivered during the study period, 3,923 (99.0%) underwent SARS-CoV-2 testing. A total of 17 (0.43%; 95% confidence interval: 0.23-0.63%) women tested positive, and none of them were symptomatic on admission. There was no difference in terms of characteristics between SARS-CoV-2 positive and negative tested women. One woman developed a headache attributed to COVID-19 3 days postpartum. No neonates had a positive test at 24 hours of life. CONCLUSION: The findings suggest that in pregnant women admitted for delivery between April 6 and May 11, 2020 in this large integrated health care system in Southern California, prevalence of SARS-CoV-2 test positive was very low and all patients were asymptomatic on admission. KEY POINTS: · The prevalence of SARS-CoV-2 infection in a large diverse cohort of term pregnant women was 0.43%.. · 99% of women accepted SARS-CoV-2 screening on admission to labor and delivery.. · All women with positive test results were asymptomatic at the time of testing..


Assuntos
Técnicas de Laboratório Clínico , Infecções por Coronavirus , Parto Obstétrico , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Adulto , Infecções Assintomáticas , Betacoronavirus/isolamento & purificação , COVID-19 , Teste para COVID-19 , California/epidemiologia , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez , Prevalência , SARS-CoV-2
5.
Eur J Obstet Gynecol Reprod Biol ; 228: 284-294, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30055509

RESUMO

The aim of this systematic review with meta-analysis was to evaluate the effect on length of labor when patients receive IVF with or without dextrose. Searches were performed in electronic databases from inception of each database to May 2018. Trials comparing intrapartum IVF containing dextrose (i.e. intervention group) with no dextrose or placebo (i.e. control group) were included. Only trials examining low-risk pregnancies in labor at ≥36 weeks were included. Studies were included regardless of oral intake restriction. The primary outcome was the length of total labor from randomization to delivery. The meta-analysis was performed using the random effects model. Sixteen trials (n = 2503 participants) were included in the meta-analysis. Women randomized in the IVF dextrose group did not have a statistically significant different length of total labor from randomization to delivery compared to IVF without dextrose (MD -38.33 min, 95% CI -88.23 to 11.57). IVF with dextrose decreased the length of the first stage (MD -75.81 min, 95% CI -120.67 to -30.95), but there was no change in the second stage. In summary, use of IVF with dextrose during labor in low-risk women at term does not affect total length of labor, but it does shorten the first stage of labor.


Assuntos
Hidratação , Glucose/administração & dosagem , Trabalho de Parto/efeitos dos fármacos , Lactato de Ringer/administração & dosagem , Solução Salina/administração & dosagem , Feminino , Humanos , Infusões Intravenosas , Gravidez
6.
Am J Perinatol ; 35(1): 84-89, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28838010

RESUMO

OBJECTIVE: The aim was to determine the fetal umbilical blood gas effects of supplemental maternal oxygenation compared with room air (RA) during term planned cesarean delivery. METHODS: This is a prospective randomized controlled study of singleton planned cesarean deliveries randomized to receive supplemental oxygen (O2) at 10 L per minute (L/min) via facemask or RA. Umbilical cord gases were collected. The primary outcome was umbilical arterial pH level. Secondary outcomes included umbilical cord values and maternal and neonatal outcomes. Data were expressed as median ± interquartile range (IQR). RESULTS: Seventy subjects in total were enrolled, with 65 subjects available for analysis. The median umbilical arterial pO2 was significantly increased in the supplemental O2 group (18 [13.5-20.5] mm Hg) versus RA group (16 [12-18] mm Hg), p = 0.04). The median umbilical venous pO2 was significantly increased in the supplemental O2 group (32 [26.5-36.0] mm Hg) versus RA group (28.5 [22-34.3] mm Hg), p = 0.04). There were no significant differences with other umbilical blood gas values and composite maternal or neonatal complications. CONCLUSION: Subjects with term singleton gestations receiving O2 at 10 L/min during cesarean delivery compared with RA demonstrated no significant change in umbilical cord pH values. There was a significant increase in umbilical cord arterial and venous O2 levels in those receiving O2.


Assuntos
Anestesia Obstétrica , Cesárea , Oxigenoterapia , Oxigênio/sangue , Cordão Umbilical/química , Adulto , Índice de Apgar , Gasometria , California , Procedimentos Cirúrgicos Eletivos , Feminino , Feto/fisiologia , Humanos , Concentração de Íons de Hidrogênio , Troca Materno-Fetal , Gravidez , Estudos Prospectivos , Nascimento a Termo
7.
J Matern Fetal Neonatal Med ; 31(3): 382-387, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28139946

RESUMO

OBJECTIVE: We sought to describe the prevalence, sociodemographic features, and antenatal/peripartum outcomes of multiple sclerosis (MS) in pregnancy. STUDY DESIGN: A retrospective cohort study was performed using deliveries in California from 2001 to 2009. Cases of MS as well as other morbidities were identified via ICD-9-CM code. Logistic regression was performed to adjust for potential confounders. RESULTS: About 1185 out of 4,424,049 deliveries were complicated by MS. MS prevalence increased with maternal age, with Caucasians comprising a higher proportion of MS subjects. MS subjects were older and more likely to have private insurance. Women with MS were more likely to have preexisting medical conditions such as asthma, chronic hypertension, thyroid disease, or cardiac disease. However, no significant antepartum and peripartum morbidities were found to be increased in patients with MS. Urinary tract infection, cesarean delivery, and induction of labor were slightly increased in MS patients. CONCLUSIONS: MS is a rare condition which is more likely to affect older Caucasian women of higher socioeconomic status and is associated with several preexisting medical conditions. MS, however, does not appear to pose significant increases in adverse pregnancy outcome. This suggests that pregnant patients with MS may likely experience an uneventful pregnancy.


Assuntos
Esclerose Múltipla/epidemiologia , Complicações na Gravidez/epidemiologia , Adolescente , Adulto , California/epidemiologia , Feminino , Humanos , Gravidez , Resultado da Gravidez/epidemiologia , Prevalência , Estudos Retrospectivos , Adulto Jovem
8.
Am J Obstet Gynecol ; 217(2): 208.e1-208.e7, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28322776

RESUMO

BACKGROUND: Prolonged labor has been demonstrated to increase adverse maternal and neonatal outcome. A practice that may decrease the risk of prolonged labor is the modification of fluid intake during labor. OBJECTIVE: Several studies demonstrated that increased hydration in labor as well as addition of dextrose-containing fluids may be associated with a decrease in length of labor. The purpose of our study was to characterize whether high-dose intravenous fluids, standard-dose fluids with dextrose, or high-dose fluids with dextrose show a difference in the duration of labor in nulliparas. STUDY DESIGN: Nulliparous subjects with singletons who presented in active labor were randomized to 1 of 3 groups of intravenous fluids: 250 mL/h of normal saline, 125 mL/h of 5% dextrose in normal saline, or 250 mL/h of 2.5% dextrose in normal saline. The primary outcome was total length of labor from initiation of intravenous fluid in vaginally delivered subjects. Secondary outcomes included cesarean delivery rate and length of second stage of labor, among other maternal and neonatal outcomes. RESULTS: In all, 274 subjects who met inclusion criteria were enrolled. There were no differences in baseline characteristics among the 3 groups. There was no difference in the primary outcome of total length of labor in vaginally delivered subjects among the 3 groups. First stage of labor duration, second stage of labor duration, and cesarean delivery rates were also equivalent. There were no differences identified in other secondary outcomes including clinical chorioamnionitis, postpartum hemorrhage, blood loss, Apgar scores, or neonatal intensive care admission. CONCLUSION: There is no difference in length of labor or delivery outcomes when comparing high-dose intravenous fluids, addition of dextrose, or use of high-dose intravenous fluids with dextrose in nulliparous women who present in active labor.


Assuntos
Hidratação , Glucose/administração & dosagem , Trabalho de Parto/efeitos dos fármacos , Adulto , Método Duplo-Cego , Feminino , Glucose/análise , Glucose/farmacologia , Humanos , Recém-Nascido , Infusões Intravenosas/métodos , Masculino , Paridade , Gravidez , Soluções/administração & dosagem , Soluções/química , Fatores de Tempo
9.
J Matern Fetal Neonatal Med ; 30(14): 1676-1680, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27578238

RESUMO

BACKGROUND: Preterm Premature Rupture of Membranes (PPROM) precedes many deliveries and experts agree with expectant management until 34 weeks gestation. However, there is controversy regarding the gestational age (GA) for administration of corticosteroids. STUDY DESIGN: We performed a retrospective cohort study in the University of California Fetal Consortium (UCfC). We searched available charts of singleton pregnancies with PPROM between 32 and 33 6/7 weeks GA. Outcomes from the groups were analyzed. RESULTS: Of 191 women with PPROM at 32 to 33 6/7 weeks, 150 received corticosteroids. The median GA at admission was earlier for the exposed versus unexposed group (32 4/7 versus 33 0/7 weeks, respectively, p = 0.001). The mean GA at delivery in the exposed was 33 2/7 (32 0/7 to 35 0/7) weeks versus 33 5/7 (32 0/7 to 36 1/7) weeks in the unexposed (p = 0.001). There was no difference in chorioamnionitis or RDS. CONCLUSION: In women with PPROM at 32 to 33 6/7 weeks, our data suggests that corticosteroids are associated with similar outcomes despite earlier GA at delivery and no differences in major morbidities. A larger prospective study is needed to determine if the benefit of corticosteroids outweighs the potential risks in PPROM.


Assuntos
Corticosteroides/administração & dosagem , Ruptura Prematura de Membranas Fetais , Doenças do Prematuro/prevenção & controle , Adolescente , Adulto , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
10.
Diabetes Res Clin Pract ; 118: 98-104, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27351800

RESUMO

OBJECTIVE: To characterize the maternal glycemic response to betamethasone in subjects without diabetes compared to subjects with diabetes. STUDY DESIGN: Blood glucose levels in 22 gravidae without diabetes and 11 gravidae with diabetes were recorded for 48h following betamethasone administration for threatened preterm delivery. Maximum blood glucose value and time to maximum value were compared. Area under the curve calculations were used to express the duration and degree of significant hyperglycemia for individual subjects. These summary measures were then correlated to subject characteristics and laboratory values to determine a risk profile of those subjects without diabetes at risk for significant hyperglycemia. RESULTS: All subjects with diabetes and the majority of those without diabetes had significant hyperglycemia during the study period. Mean maximum blood glucose was higher for those with diabetes (205mg/dL vs. 173mg/dL, p⩽0.01). Mean time to reach the maximum glucose level was similar for both groups. Result of a glucose tolerance test given immediately prior to betamethasone correlated strongly with amount of time spent with hyperglycemia for subjects without diabetes (rho=0.59, p⩽0.01). Morbidly obese subjects spent less time with hyperglycemia than those with lower body mass indices (p=0.03). CONCLUSION: Both subjects with and without diabetes demonstrate significant hyperglycemia after receipt of antenatal betamethasone.


Assuntos
Betametasona/uso terapêutico , Diabetes Gestacional/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Adolescente , Adulto , Betametasona/farmacologia , Glicemia , Diabetes Gestacional/sangue , Feminino , Humanos , Hipoglicemiantes/farmacologia , Recém-Nascido , Gravidez , Resultado do Tratamento , Adulto Jovem
11.
JBRA Assist Reprod ; 19(1): 16-20, 2015 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-27205861

RESUMO

OBJECTIVE: Use of assisted reproductive technology has increased steadily, yet multiple socioeconomic and demographic disparities remain between the general population and those with infertility. Additionally, both mothers and infants experience higher rates of adverse outcomes compared to their non-ART counterparts. METHODS: Using International Classification of Diseases, Ninth Revision (ICD-9) coding, we performed a retrospective review of all ART-conceived deliveries in California in 2009. A total of 551 ART pregnancies were compared to Non-ART pregnancies (n=406,885). RESULTS: The majority of ART deliveries belonged to women of advanced maternal age (AMA) and Caucasian or Asian race. Nearly half of all ART deliveries were multiple gestations. Compared to non-ART deliveries, ART pregnancies were associated with placenta previa, placental abruption, mild preeclampsia, and fetal growth restriction. CONCLUSION: While not powered to detect all outcomes, our study highlights significant racial and ethnic disparities between ART and Non-ART pregnancies.

12.
J Matern Fetal Neonatal Med ; 28(7): 793-8, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-24974876

RESUMO

OBJECTIVE: To describe the incidence, antepartum, intrapartum and postpartum risk factors, and mortality rate of amniotic fluid embolism (AFE). METHODS: We used 2001-2007 California health discharge data to identify cases of AFE by ICD-9 codes. RESULTS: Of 3,556,567 deliveries during the time period, we identified 182 cases of AFE, resulting in a population incidence of 5.1 in 100,000. Twenty-four of the cases resulted in death, giving a case fatality rate of 13.2%. Non-Hispanic blacks had a higher than 2-fold odds of developing AFE. AFE increased significantly with maternal age, most significantly after age 39. Cardiac disease had a nearly 70-fold higher association with AFE, cerebrovascular disorders had a 25-fold higher association, while conditions such as eclampsia, renal disease, placenta previa and polyhydramnios had nearly 7- to 13-fold higher associations. Classical cesarean delivery, abruption placentae, dilation and curettage, and amnioinfusion were all procedures highly associated with AFE. CONCLUSION: Several antepartum and peripartum conditions and procedures are associated with significantly higher risks of amniotic fluid embolism. This information may contribute to a better understanding of the pathophysiology of AFE and potentially help identify those at the highest risk of developing this morbid condition.


Assuntos
Embolia Amniótica/epidemiologia , Adolescente , Adulto , California/epidemiologia , Embolia Amniótica/etiologia , Embolia Amniótica/mortalidade , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
13.
Am J Obstet Gynecol ; 211(6): 641.e1-7, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24912095

RESUMO

OBJECTIVE: The purpose of this study was to assess an early hemoglobin A1c (HgbA1c) value from 5.7-6.4% as an early predictor of progression to gestational diabetes (GDM). STUDY DESIGN: A retrospective cohort study was performed on all women who delivered at a single institution over 2 years who had an early screening HgbA1c test performed at ≤20 weeks of gestation. Women with known preexisting diabetes mellitus or HgbA1c values ≥6.5% were excluded. The primary outcome was GDM development. Secondary outcomes included delivery route, maternal weight gain, birthweight, and neonatal morbidities. Women with an HgbA1c value of 5.7-6.4% were compared with those with an HgbA1c level of <5.7%. RESULTS: Nearly one-third of those patients in the HgbA1c 5.7-6.4% group (27.3%) experience the development of GDM compared with only 8.7% in the HgbA1c <5.7% group (odds ratio, 3.9; 95% confidence level, 2.0-7.7). This 3-fold increase remained significant (adjusted odds ratio, 2.4) after adjustment for age, prepregnancy body mass index, gestational age at HgbA1c collection, gestational age at screening, ethnicity, and method of screening. There were no significant differences in the need for medical treatment, weight gain, delivery route, birthweight, macrosomia, or neonatal morbidities. CONCLUSION: More than 10% of patients in our cohort had an early screening HgbA1c value of 5.7-6.4%. Women in this group have a significantly higher risk of progression to GDM compared with women with normal HgbA1c values and should be considered for closer GDM surveillance and possible intervention.


Assuntos
Peso ao Nascer , Diabetes Gestacional/sangue , Hemoglobina A Glicada/análise , Adulto , Biomarcadores/sangue , Índice de Massa Corporal , Estudos de Coortes , Parto Obstétrico/métodos , Diabetes Gestacional/diagnóstico , Feminino , Idade Gestacional , Teste de Tolerância a Glucose , Humanos , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Razão de Chances , Gravidez , Estudos Retrospectivos , Medição de Risco , Ganho de Peso , Adulto Jovem
14.
J Matern Fetal Neonatal Med ; 27(18): 1886-91, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24635372

RESUMO

OBJECTIVE: To assess trends over time of operative vaginal delivery and compare delivery-related morbidity between vacuum delivery, forceps delivery, or combined use of both in California. METHODS: California ICD-9 discharge data from 2001 to 2007 were used to identify cases of forceps and vacuum delivery. RESULTS: There was a decline in all operative delivery types (9.0% in 2001 to 7.6% in 2007), with the decline in the use of forceps most pronounced (7.26/1000 deliveries in 2001 to 3.85/1000 in 2007). Higher rates of third/fourth degree lacerations, postpartum hemorrhage, manual extraction of placenta, pelvic hematoma requiring evacuation, cervical laceration repair, and thromboembolic events were noted in forceps compared to vacuum deliveries. When both instruments were used, rates of third/fourth degree lacerations and postpartum hemorrhage were increased. Operative delivery failure was highest in combined use compared to forceps or vacuum alone. CONCLUSION: The incidence of operative vaginal delivery in California is declining, with decreasing use of forceps most notable. Several maternal morbidities are increased in forceps and combined deliveries compared to vacuum deliveries. There is a significantly higher risk of failure when two operative delivery methods are employed. These findings may be contributing to the declining willingness of providers to perform operative vaginal delivery.


Assuntos
Traumatismos do Nascimento/epidemiologia , Forceps Obstétrico/efeitos adversos , Vácuo-Extração/efeitos adversos , Adolescente , Adulto , California/epidemiologia , Parto Obstétrico/efeitos adversos , Parto Obstétrico/estatística & dados numéricos , Parto Obstétrico/tendências , Feminino , Humanos , Incidência , Recém-Nascido , Pessoa de Meia-Idade , Morbidade , Hemorragia Pós-Parto/epidemiologia , Gravidez , Estudos Retrospectivos , Vácuo , Vácuo-Extração/instrumentação , Vácuo-Extração/estatística & dados numéricos , Adulto Jovem
15.
Am J Obstet Gynecol ; 211(1): 79.e1-2, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24607750

RESUMO

A 44 year old G4P3 presents with massive hernia recurrence and bowel obstruction. Her symptoms resolve with conservative management, and she is delivered by cesarean section at term with herniorrhaphy performed 10 weeks postpartum.


Assuntos
Hérnia Ventral/diagnóstico por imagem , Obstrução Intestinal/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Complicações na Gravidez/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Feminino , Humanos , Obstrução Intestinal/etiologia , Gravidez , Complicações na Gravidez/etiologia
16.
J Infect Dis ; 209(10): 1573-84, 2014 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-24403553

RESUMO

BACKGROUND: Human cytomegalovirus (HCMV) is the major viral etiology of congenital infection and birth defects. Fetal transmission is high (30%-40%) in primary maternal infection, and symptomatic babies have permanent neurological, hearing, and vision defects. Recurrent infection is infrequently transmitted (2%) and largely asymptomatic. Congenital infection is also associated with intrauterine growth restriction (IUGR). METHODS: To investigate possible underlying HCMV infection in cases of idiopathic IUGR, we studied maternal and cord sera and placentas from 19 pregnancies. Anti-HCMV antibodies, hypoxia-related factors, and cmvIL-10 were measured in sera. Placental biopsy specimens were examined for viral DNA, expression of infected cell proteins, and pathology. RESULTS: Among 7 IUGR cases, we identified 2 primary and 3 recurrent HCMV infections. Virus replicated in glandular epithelium and lymphatic endothelium in the decidua, cytotrophoblasts, and smooth muscle cells in blood vessels of floating villi and the chorion. Large fibrinoids with avascular villi, edema, and inflammation were significantly increased. Detection of viral proteins in the amniotic epithelium indicated transmission in 2 cases of IUGR with primary infection and 3 asymptomatic recurrent infections. CONCLUSIONS: Congenital HCMV infection impairs placental development and functions and should be considered as an underlying cause of IUGR, regardless of virus transmission to the fetus.


Assuntos
Infecções por Citomegalovirus/complicações , Retardo do Crescimento Fetal/virologia , Complicações Infecciosas na Gravidez/patologia , Anticorpos Neutralizantes/sangue , Anticorpos Antivirais/sangue , DNA Viral , Feminino , Humanos , Imunoglobulina G/sangue , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , Projetos Piloto , Gravidez , Testes Sorológicos
17.
J Diabetes Complications ; 28(1): 29-34, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24094665

RESUMO

AIMS: To assess the clinical and demographic differences in patients with pre-gestational diabetes mellitus (PGDM) compared to those with gestational diabetes (GDM). METHODS: Using the 2001-2007 California Health Discharge Database, we identified 22,331 cases of PGDM and 147,097 cases of GDM via ICD-9-CM codes after excluding cases which were missing race or age data or with extremes of age. Data analyzed included demographics, pre-existing medical conditions, antepartum complications, and intrapartum complications. Logistic regression was used to adjust for potential confounders. RESULTS: Both PGDM and GDM incidences increased during the study period. Advancing age was associated with increased prevalence of both diseases. Although Asians were found to have the highest prevalence of GDM, they, along with Caucasians, were found have the lowest prevalence of PGDM. Conditions with increased frequency in PGDM versus GDM included chronic hypertension, renal disease, thyroid dysfunction, fetal CNS malformation, fetal demise, pyelonephritis, and eclampsia. Subjects with PGDM were more likely than those with GDM to have a shoulder dystocia, failed induction of labor, or undergo cesarean delivery. CONCLUSIONS: We have demonstrated clinical morbidities and demographic factors which differ in patients with PGDM compared to patients with GDM. Our findings suggest PGDM to be associated with significantly higher morbidity when compared to GDM. Our findings also suggest that races with the highest tendency for GDM during pregnancy may not necessarily have the highest tendency for PGDM outside of pregnancy.


Assuntos
Diabetes Gestacional/epidemiologia , Gravidez em Diabéticas/epidemiologia , Adolescente , Adulto , California/epidemiologia , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Morbidade , Gravidez , Resultado da Gravidez/epidemiologia , Prevalência , Adulto Jovem
18.
Am J Obstet Gynecol ; 209(3): 229.e1-7, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23727516

RESUMO

OBJECTIVE: We sought to identify trends, demographics, and prepregnancy and peripartum morbidities of eclampsia in California. STUDY DESIGN: We identified cases of eclampsia by International Classification of Diseases, Ninth Revision code using California health discharge data from 2001 through 2007. Cases with missing race/ethnicity as well as age <15 years or >55 years were excluded. Among the remaining cases, patients with eclampsia (n = 1888) were compared against those without (n = 2,768,983). Adjustments were performed for potential confounding variables using logistic regression. Significance was set at P < .05. RESULTS: The incidence of eclampsia decreased over time, from 8.0 cases per 10,000 deliveries in 2001, to 5.6 cases per 10,000 deliveries in 2007 (P < .001). There was a bimodal distribution in age-related risk, with the highest risks at the extremes of age. Non-Hispanic blacks were associated with the highest risk of eclampsia while Asians had the lowest risk. Several antepartum morbidities had increased associations with eclampsia, including preexisting cardiac disease (adjusted odds ratio [OR], 6.84; 95% confidence interval [CI], 5.40-8.66), lupus erythematosus (adjusted OR, 3.68; 95% CI, 1.53-8.86), and twin gestations (adjusted OR, 3.28; 95% CI, 2.70-3.99). Peripartum complications increased in eclampsia included cerebrovascular hemorrhage/disorders (adjusted OR, 112.15; 95% CI, 77.47-162.35), peripartum cardiomyopathy (adjusted OR, 12.88; 95% CI, 6.08-27.25), amniotic fluid embolism (adjusted OR, 11.94; 95% CI, 3.63-39.21), and venous thromboembolism (adjusted OR, 10.71; 95% CI, 5.14-22.32). CONCLUSION: This large population database confirms that there is a decline in eclampsia over time. However, there are extremely morbid complications associated with eclampsia, emphasizing the need for its close monitoring and prevention.


Assuntos
Eclampsia/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Morbidade , Gravidez , Estudos Retrospectivos , Risco
19.
Teach Learn Med ; 22(2): 93-6, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20614372

RESUMO

BACKGROUND: The importance of effective mentoring in career success is universally accepted but has not been well studied in academic medicine. PURPOSES: The purpose was to describe a formal mentoring program of residents by faculty in obstetrics and gynecology and assess professional and educational outcomes. METHODS: In 2006, a formal mentoring program was developed. Faculty and residents were provided instruction. Residents selected their mentors and met regularly. Resident-mentor contracts were signed. Mentors developed corrective plans and monitored residents with problems. Outcomes were measured prospectively. RESULTS: Twenty-five residents and 18 faculty participated. After 2 years, 7 residents (28%) had scientific publications as compared to 10% in the year preceding the mentoring program. Eleven (44%) presented oral or poster presentations, and 17 (68%) were conducting scientific research. Mentors' effectiveness was rated between 4.3 and 4.7 (Likert scale of 1-5). Three of 4 residents in remediation fulfilled their educational requirements. Four residents noted insufficient meeting time. CONCLUSION: A simple but well-organized mentoring system can be an effective means of improving resident learning and enhancing their academic portfolio. Mentoring should be strongly encouraged for residents, especially those with specific deficiencies.


Assuntos
Docentes de Medicina/organização & administração , Ginecologia/educação , Internato e Residência/organização & administração , Relações Interprofissionais , Mentores , Obstetrícia/educação , Centros Médicos Acadêmicos/organização & administração , Adulto , Atitude do Pessoal de Saúde , California , Feminino , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Preceptoria
20.
J Grad Med Educ ; 2(3): 423-9, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21976093

RESUMO

OBJECTIVE: The purpose of this article was to develop and determine the utility of a compliance form in evaluating and teaching the Accreditation Council for Graduate Medical Education competencies of professionalism, practice-based learning and improvement, and systems-based practice. METHODS: In 2006, we introduced a 17-item compliance form in an obstetrics and gynecology residency program. The form prospectively monitored residents on attendance at required activities (5 items), accountability of required obligations (9 items), and completion of assigned projects (3 items). Scores were compared to faculty evaluations of residents, resident status as a contributor or a concerning resident, and to the residents' conflict styles, using the Thomas-Kilmann Conflict MODE Instrument. RESULTS: Our analysis of 18 residents for academic year 2007-2008 showed a mean (standard error of mean) of 577 (65.3) for postgraduate year (PGY)-1, 692 (42.4) for PGY-2, 535 (23.3) for PGY-3, and 651.6 (37.4) for PGY-4. Non-Hispanic white residents had significantly higher scores on compliance, faculty evaluations on interpersonal and communication skills, and competence in systems-based practice. Contributing residents had significantly higher scores on compliance compared with concerning residents. Senior residents had significantly higher accountability scores compared with junior residents, and junior residents had increased project completion scores. Attendance scores increased and accountability scores decreased significantly between the first and second 6 months of the academic year. There were positive correlations between compliance scores with competing and collaborating conflict styles, and significant negative correlations between compliance with avoiding and accommodating conflict styles. CONCLUSIONS: Maintaining a compliance form allows residents and residency programs to focus on issues that affect performance and facilitate assessment of the ACGME competencies. Postgraduate year, behavior, and conflict styles appear to be associated with compliance. A lack of association with faculty evaluations suggests measurement of different perceptions of residents' behavior.

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