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1.
Sci Rep ; 11(1): 15324, 2021 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-34321556

RESUMO

The association among sugar sweetened beverages (SSB) consumption, addiction and depression in adults, children and adolescents is widely reported. Dieting patterns during pregnancy is complicated by maternal fetal concerns. Specifically, restrained use of SSB might be potentially a source of perinatal distress. The current study modified diagnostic criteria for Substance Use Disorder (SUD) in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), into SSB-specific questions to assess SSB use tendency. Edinburgh Postpartum Depression Scores (EPDS) is used to assess maternal distress during pregnancy. One hundred and ninety-six consecutive pregnant women receiving antenatal care at Kaohsiung Medical University Hospital were invited to participate in this study. In the first trimester, 46.6% of women had none or 1 DSM-5 symptom, 27.0% had 2-3 symptoms, while 26.4% had ≥ 4 symptoms. The mean numbers of DSM-5 symptoms in each trimester were found to be 2.5 ± 2.25, 2.6 ± 2.45, 2.4 ± 2.43 for the first, second and third trimester, respectively, p = 0.750. While EPDS score showed no difference among DSM-5 symptoms 0-1, 2-3 and ≥ 4 groups in the first trimester (8.1 ± 4.59, 8.4 ± 5.00, 8.8 ± 4.82, p = 0.343), women with ≥ 4 DSM-symptoms was found significantly higher EPDS scores than those with < 4 DSM-symptoms in the second (7.2 ± 4.81, 7.7 ± 4.98, 8.8 ± 4.33, p = 0.030) and third trimester (6.8 ± 5.00, 7.2 ± 4.63, 8.7 ± 5.24, p = 0.019). The relationship remained significant after adjusting for covariates including actual SSB amount consumed (adjusted ß = 0.25 with 95% confident interval (CI) 0.04-0.45 and 0.21 with 95% CI 0.04-0.38 for the second and third trimesters, respectively). Overall, the study is the first to characterize the positive relationship between SSB use tendency and antenatal distress in pregnancy, independent of actual SSB amount consumed. The observational nature of the study design precludes inferences of its underlying socio-psychomotor mechanisms, although restrained SSB use in pregnancy is suspected to contribute. The novel employment of modified SSB-specific DSM-5 scores and EPDS in this setting is feasible and further validation is promising. With better understanding and awareness, pregnant women with increased SSB use tendency should be properly counseled with special attention to their mental state.


Assuntos
Depressão Pós-Parto/diagnóstico , Comportamento Alimentar/psicologia , Trimestres da Gravidez/psicologia , Bebidas Adoçadas com Açúcar/efeitos adversos , Adulto , Depressão Pós-Parto/etiologia , Depressão Pós-Parto/fisiopatologia , Depressão Pós-Parto/psicologia , Feminino , Hospitais , Humanos , Estudos Longitudinais , Período Periparto , Gravidez , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários , Taiwan
2.
Sci Rep ; 11(1): 1584, 2021 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-33452330

RESUMO

The study aims to evaluate the effectiveness of local injection of autologous platelet rich plasma (A-PRP) as a treatment for women suffering from stress urinary incontinence (SUI). In a prospective intervention study, twenty consecutive women suffering from SUI were treated with A-PRP injection at anterior vaginal wall where mid-urethra locates. Self-reported questionnaires were used to measure pre-treatment, 1 month and 6 months post-treatment symptom severity. Secondary outcomes of sexual function and treatment effect sorted by age were analyzed with valid statistical methods. A-PRP is effective in relieving SUI symptoms at both 1 month and 6 months post-treatment without significant adverse reactions reported. It seems to have a trend that treatment success rate with cured and improved symptoms was slightly higher in the younger group, although it did not reach statistical significance (P = 0.07). No significant changes in sexual function before and after the treatment were reported by the patients. This pilot study is the first to report A-PRP treatment effect for SUI in women. The result suggested that A-PRP is a considerable treatment option for mild to moderate SUI cases. It also opens up further research opportunities for A-PRP's clinical applications.


Assuntos
Transfusão de Plaquetas , Plasma Rico em Plaquetas/química , Incontinência Urinária por Estresse/terapia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Índice de Gravidade de Doença , Transplante Autólogo , Resultado do Tratamento , Uretra/patologia , Incontinência Urinária por Estresse/patologia , Urodinâmica , Vagina/patologia
3.
J Formos Med Assoc ; 120(6): 1305-1313, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33472764

RESUMO

BACKGROUND/PURPOSE: To investigate the effects of simulated childbirth on the gene expression of parasympathetic muscarinic, purinergic (P2X), and neurokinin receptors of lower urinary tract in rats. METHODS: In all, twenty-four primiparous pregnant Sprague-Dawley female rats were equally divided into three groups: (1). Control group; 8 rats, (2) intra-vaginal balloon dilation for 2 h group; 8 rats, (3) and for 4 h group; 8 rats. After balloon dilatation for 4 months, all rats were sacrificed. We analyzed the gene expression of parasympathetic muscarinic, purinergic (P2X), and neurokinin receptors by real-time quantitative PCR (q-PCR). We quantified pro-inflammatory cytokines of TNF-α and IL-6 by Enzyme-linked immunosorbent assays (ELISA). The urodynamic parameters and micturition frequency by cystometry (CMG) were recorded. RESULTS: Our results showed that the balloon dilation significantly increased micturition frequency and modified peak micturition pressure compare to those in the control groups. Balloon dilation significantly decreased voiding interval and bladder volume compared to those in the control groups. Gene expressions of M3 muscarinic, P2X3 purinergic receptors, and significantly increased following balloon dilation for 2 hours and 4 hours than those in the control group. In addition, we found that NK1R and NK3R receptors were significantly decreased after balloon dilation compare to control group. The marked increase of TNF-α and IL-6 were also seen in the 2 balloon groups. CONCLUSION: The results of our study suggested that birth trauma may impair the function of urinary tract, this being partly related to the changes in the gene expression of the neurotransmitter receptors of the lower urinary tract.


Assuntos
Bexiga Urinária , Urodinâmica , Animais , Feminino , Expressão Gênica , Gravidez , Ratos , Ratos Sprague-Dawley , Receptores de Neurotransmissores , Micção
4.
Taiwan J Obstet Gynecol ; 59(6): 865-871, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33218403

RESUMO

OBJECTIVE: Clinical outcomes of 500 high-intensity focused ultrasound (HIFU)-treated uterine fibroids and adenomyosis are analyzed and presented. MATERIALS AND METHODS: This is a retrospective cross-sectional analysis from a single tertiary medical center. From April 2015 to October 2018, 546 cases were enrolled for the study. After excluding 46 patients with less than 3 months of follow-up period, there were 404 fibroids, 149 adenomyosis and 53 mixed conditions entered for analysis. The patients' uterine fibroids and adenomyosis were treated by HIFU according to Chongqing Haifu protocol, with 12 cm diameter transducer of focal length 10-16  cm at 0.8 or 1.6 MHz T2-weight MRI imaging was rendered prior to and 3 month post treatment to assess lesion volume change using non-perfusion volume, which was the primary outcome. Secondary outcomes including quality of life, subjective satisfaction, adverse events and pregnancy rate were determined using self-reported questionnaires. The mean follow up period ranged from 3 to 38 months with an average of 21 months. RESULTS: Three months after HIFU-treated uterine fibroids and adenomyosis, the lesion size reduced 40.2% and 46.3%, respectively. Symptoms all improved with better quality of life for the fibroid group, while those with adenomyosis or combined diseases benefit the most from pain control. Serum CA125 decreased significantly for all studied groups, and LDH only showed improvement for fibroids group. Number of adverse events is comparable to Chongqing data (approximately 10.2%), with mostly mild and self-resolving conditions. No permanent sequelae or death was documented. Twelve pregnancies are reported in this cohort. CONCLUSION: HIFU is safe and effective in treating uterine fibroids and adenomyosis. The results are reproducible if standardized treatment schedules are followed. It is a promising treatment alternative with the advantages of precision, non-invasiveness, rapid recovery and readiness for pregnancy.


Assuntos
Adenomiose/cirurgia , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Leiomioma/cirurgia , Neoplasias Uterinas/cirurgia , Adulto , Estudos Transversais , Feminino , Humanos , Imageamento por Ressonância Magnética , Satisfação do Paciente , Gravidez , Taxa de Gravidez , Qualidade de Vida , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do Tratamento
5.
Taiwan J Obstet Gynecol ; 59(4): 590-593, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32653135

RESUMO

OBJECTIVE: The report aims to present a case of endometrial cancer with unusual initial presentation. A literature review is conducted to speculate symptoms presented by endometrial cancer other than vaginal bleeding. CASE REPORT: A 43-year-old, para 1, lean female suffered from copious watery vaginal discharge that was odorless and colorless for 8 months without any signs of abnormal vaginal bleeding. Preliminary surveys in private clinics with per vaginal examination and Papanicolaou smear were normal. Urinary incontinence was mistakenly impressed. When the patient turned to our center for help as symptoms aggravated, transvaginal sonography revealed hydrometra with papillary endometrium lesions. Hysteroscopy survey with endometrial biopsy revealed endometrial adenocarcinoma. CONCLUSION: This is a case of endometrial cancer with unusual presentation. Transvaginal sonography and hysteroscopy are easy and sensitive screening tools that should be readily offered to patients with suspicious symptoms.


Assuntos
Adenocarcinoma/diagnóstico , Neoplasias do Endométrio/diagnóstico , Adenocarcinoma/patologia , Adenocarcinoma/terapia , Adulto , Diagnóstico Diferencial , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/terapia , Feminino , Humanos , Tomografia Computadorizada por Raios X , Ultrassonografia , Incontinência Urinária/diagnóstico , Descarga Vaginal/etiologia
6.
Taiwan J Obstet Gynecol ; 59(4): 594-597, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32653136

RESUMO

OBJECTIVE: Ultrasound-guided high-intensity focused ultrasound (USg-HIFU) has emerged in recent years as the new treatment modality for uterine myomas and adenomyosis with the advantages of being non-invasive, safe and effective. As its utility increases, adverse reactions emerge and deserve clinicians' attention for experience accrual. We herein report a case who suffered from acute renal insufficiency and thrombocytopenia immediately after receiving HIFU for uterine myomas. CASE REPORT: A 38-year-old nulliparous healthy female received HIFU for huge uterine myoma that caused heavy vaginal bleeding and chronic anemia. The procedure went smoothly but the patient immediately suffered from oliguria and dark-colored urine. With conservative management and aggressive hydration, her condition had improved spontaneously after 1 week without leaving any long-term sequelae. Myoma size reduced by 70% 3 months post-treatment and her bleeding problems significantly improved. CONCLUSION: This is the first report of post-HIFU acute renal failure and thrombocytopenia. Thermal injuries, drug toxicity and mechanical obstruction of ureters are some plausible explanations for speculations.


Assuntos
Injúria Renal Aguda/etiologia , Ablação por Ultrassom Focalizado de Alta Intensidade/efeitos adversos , Trombocitopenia/etiologia , Adulto , Feminino , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/terapia , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/terapia
7.
Sci Rep ; 10(1): 6615, 2020 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-32313187

RESUMO

We aim to assess the surgical outcomes of our novel hysteropexy procedure, laparoscopic long mesh surgery (LLMS) with augmented round ligaments. Twenty-five consecutive women with stage II or greater main uterine prolapse defined by the POP quantification staging system were referred for LLMS. Long mesh is a synthetic T-shaped mesh, with the body fixed at the uterine cervix and the two arms fixed along the bilateral round ligaments. The clinical evaluations performed before and 6 months after surgery included pelvic examinations, urodynamic studies, and questionnaires for urinary and sexual symptoms. After a follow-up time of 12 to 24 months, the anatomical reduction rate was 92% (23/25) for the apical compartment. The average operative time was 65.4 ± 28.8 minutes. No major complications were recognized during LLMS. The lower urinary tract symptoms and scores on the questionnaires improved significantly after the surgery, except urgency urinary incontinence and nocturia. Neither voiding nor storage dysfunction was observed after the operations. All of the domains and total Female Sexual Function Index (FSFI) scores of the 15 sexually active women did not differ significantly after LLMS. The results of our study suggest that LLMS is an effective, safe, and time-saving hysteropexy surgery for the treatment of apical prolapse.


Assuntos
Laparoscopia , Preservação de Órgãos , Prolapso de Órgão Pélvico/cirurgia , Ligamentos Redondos/cirurgia , Telas Cirúrgicas , Útero/cirurgia , Feminino , Humanos , Laparoscopia/efeitos adversos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/fisiopatologia , Complicações Pós-Operatórias/etiologia , Ligamentos Redondos/fisiopatologia , Telas Cirúrgicas/efeitos adversos , Inquéritos e Questionários , Urodinâmica , Útero/fisiopatologia
8.
Sci Rep ; 10(1): 5818, 2020 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-32242035

RESUMO

This study aimed to evaluate the therapeutic effects of Low intensity extracorporeal low energy shock wave therapy (LiESWT) on stress urinary incontinence (SUI). The investigation was a single-arm, open-label, multicentre study conducted in Taiwan. 50 female patients with SUI received LiESWT-treated with 0.25 mJ/mm2 intensity, 3000 pulses, and 3 pulses/second, once weekly for 4-weeks (W4) and 8-weeks (W8). The pad test, uroflowmetry, life quality questionnaires, and 3-day urinary diary measurement were performed before and after LiESWT intervention. The results revealed that 8-week of LiESWT treatment meaningfully improved urine leakage (pad test), maximum flow rate, post-voided residual urine, average urine volume, functional bladder capacity, urinary frequency, urgency symptom, and nocturia, which also persisted to show significant improvements at 1-month follow up (F1). Moreover, bothersome questionnaires scores were significantly improved at W4, W8, and F1 as compared to the baseline (W0). These results indicated that 8 weeks of LiESWT attenuated SUI symptoms on physical activity, reduced bladder leaks and overactive bladder (OAB), implying that LiESWT brought significant improvement in the quality of life. (ClinicalTrials.gov number, NCT04059133).


Assuntos
Incontinência Urinária por Estresse/terapia , Adulto , Idoso , Tratamento por Ondas de Choque Extracorpóreas/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Noctúria/fisiopatologia , Qualidade de Vida , Inquéritos e Questionários , Taiwan , Resultado do Tratamento , Bexiga Urinária/fisiopatologia , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Adulto Jovem
9.
Taiwan J Obstet Gynecol ; 59(1): 165-166, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32039790

RESUMO

OBJECTIVE: Urethral prolapse is a rare clinical condition, which has been reported mostly in prepubertal girls; few menopaused and only 5 cases of premenopausal women. Strangulated urethral prolapse is even rarer. CASE REPORT: A 64-year-old woman presented with urinary retention, painful vaginal bleeding and a protruding mass. Pelvic examination revealed a reddish doughnut-shaped mass located at introitus. The patient felt uncomfortable with attempts to reduce the presumed prolapse. Urethral prolapse was impressed and topical estrogen cream was prescribed. However, urethral mucosa became congested and without shrinkage three days later. As a result, simple excision was performed. No recurrence was noted at the time of manuscript submission. CONCLUSION: Most common symptoms of urethral prolapse are vaginal bleeding and visible vaginal mass. Urethral prolapse can be diagnosed primarily by physical examinations. Surgical excision is a good way to treat recurrence or strangulated urethral prolapse with almost no complications and high success rate.


Assuntos
Prolapso de Órgão Pélvico/diagnóstico , Doenças Uretrais/diagnóstico , Retenção Urinária/diagnóstico , Prolapso Uterino/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/complicações , Doenças Uretrais/complicações , Retenção Urinária/etiologia
10.
Taiwan J Obstet Gynecol ; 58(6): 820-826, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31759535

RESUMO

OBJECTIVE: According to World Health Organization's Jungner and Wilson criteria for competent screening programs, routine antenatal ultrasound screening is legit and effective to improve both maternal and perinatal outcomes. Health Promotion Administration, Ministry of Health and Welfare in Taiwan followed expert recommendations and started reimbursing one antenatal ultrasonography around mid-second trimester since 1995. However, medical disputes pertaining to examination results grew, while confusions challenged doctors and patients alike. The aim of this study is to assess current use of antenatal ultrasonography for low-risk pregnancies in Taiwan. Specifically, the indications, test frequencies, test items, methods of payment, obstetricians' opinions on important scan timing and areas to be improved are surveyed and analyzed. An overview of international antenatal ultrasound practice guidelines are examined and compared to enhance the quality of antenatal ultrasound screening in Taiwan. MATERIALS AND METHODS: From December 2015 to December 2016, 925 questionnaires were distributed to all licensed obstetricians registered to Taiwan Association of Obstetrics and Gynecology as well as Taiwan Society of Perinatology. A 10-min self-reporting questionnaire was sent by mail, with stamped return envelopes included. Respondents remained entirely anonymous and disclosed no personal information. Data was collected and analyzed for statistical analysis. RESULTS: Most hospitals are well equipped with ultrasound machines of 3 or more functions. Eighty-eight percent of the obstetricians in Taiwan perform prenatal ultrasonography in every office visit for their patients, mostly free of charge. Scans at gestational age 15-22 weeks, <10 weeks, 11-14 weeks and 28-32 weeks are polled as the most importance in the order of significance. In general, they perceive the one-time antenatal scan offered by the Health Promotion Administration as for general obstetrics scan but not higher-leveled studies. Patient education and doctor-patient communications are opined as the 2 most important aspects to enhance antenatal ultrasound quality. CONCLUSION: This report is the first of its kind in Taiwan. It could potentially serve as guidance for national health policy innovations in maternal and fetal care, such as increasing frequency of scans, specifications of scan timing, indications and consequences as well as patient education about this screening modality.


Assuntos
Doenças Fetais/diagnóstico , Obstetrícia/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Inquéritos e Questionários , Ultrassonografia Pré-Natal/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Masculino , Gravidez , Estudos Retrospectivos , Sociedades Médicas , Taiwan
11.
Sci Rep ; 9(1): 17047, 2019 11 19.
Artigo em Inglês | MEDLINE | ID: mdl-31745119

RESUMO

Uphold transvaginal mesh implantation is an option for treating pelvic organ prolapse (POP). This prospective cohort study aims to evaluate the effect of Uphold transvaginal mesh implantation on female sexual function. 205 women with symptomatic POP were recruited and evaluated pre-operatively and re- evaluated six months post-operatively in terms of anatomical restoration, quality of life influenced by urinary incontinence and female sexual function. 30 women eventually completed the assessments and been statistically evaluated. The main outcome focused on sexual function. In our study, we found that Uphold transvaginal mesh surgery could achieve effective anatomical restoration of POP and better sexual function regardless of concomitant sling surgery.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Qualidade de Vida/psicologia , Comportamento Sexual/psicologia , Disfunções Sexuais Fisiológicas/cirurgia , Incontinência Urinária/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos , Slings Suburetrais , Telas Cirúrgicas , Inquéritos e Questionários , Resultado do Tratamento , Vagina/cirurgia
15.
Taiwan J Obstet Gynecol ; 57(5): 755-759, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30342667

RESUMO

OBJECTIVE: Ruptured cervical varicose veins can cause significant vaginal bleeding during the third trimester of pregnancy. The etiology is not uncommon, yet receives little discussion in current literature. We here report such a case with complete evaluations, managements and follow ups; while analyzing similar cases published. CASE REPORT: A 34-year-old pregnant woman, gravida 1, presented with sudden onset of painless antepartum hemorrhage at 31+5 weeks of gestation. Speculum examination revealed ruptured cervical varicose veins; further evaluations with transvaginal sonography and magnetic resonance imaging were done to study the extensiveness and characteristics of the lesion. The cervical varices spontaneously regressed by postpartum day 4 and no recurrence was observed in the immediate postpartum follow-up period or in the subsequent pregnancy. CONCLUSION: The case is unique for the lack of association with placenta previa. Cervical varicose veins rupture should be considered for painless vaginal bleeding during the third trimester pregnancy.


Assuntos
Colo do Útero/irrigação sanguínea , Placenta Prévia , Hemorragia Uterina/etiologia , Varizes/complicações , Varizes/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Gravidez , Terceiro Trimestre da Gravidez , Ruptura Espontânea , Ultrassonografia Pré-Natal
16.
Sci Rep ; 8(1): 9438, 2018 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-29930249

RESUMO

Hysterectomy is the empirical treatment for female pelvic organ prolapse (POP) without robust evidence to prove its efficacy. Uphold transvaginal mesh (TVM) system is an innovated device with smaller area, superior anterior/apical support with single incision to treat POP. The prospective cohort study aims to evaluate Uphold TVM's performance with or without concomitant hysterectomy. Inclusion criteria specify patients suffering from stage 2 or more anterior/apical prolapse without previous hysterectomy. Exclusion criteria specify those with contraindications to uterine preservation, such as leiomyomas, adenomyosis, endometrial hyperplasia, abnormal uterine bleeding, postmenopausal bleeding, cervical dysplasia, receiving tamoxifen treatment, family history of gynecology cancer, or colon cancer and incapability to be routinely followed. Thirty patients are recruited in the hysterectomy group and 66 patients in the hysteropexy group. The results demonstrate that patients with Uphold mesh only experience longer vaginal length, shorter operation duration, less blood loss and less post-operation pain. The performance in anatomical correction, lower urinary tract symptoms improvement, de novo dyspareunia, urodynamic study parameters and mesh extrusion rates are comparable with or without uterus preservation. The information is useful in pre-operation counseling, when the patient can make an educated choice whether or not to receive concomitant hysterectomy.


Assuntos
Dispareunia/epidemiologia , Histerectomia/métodos , Dor Pós-Operatória/epidemiologia , Prolapso de Órgão Pélvico/cirurgia , Doenças Urológicas/epidemiologia , Idoso , Dispareunia/etiologia , Feminino , Humanos , Histerectomia/efeitos adversos , Histerectomia/instrumentação , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Telas Cirúrgicas/efeitos adversos , Doenças Urológicas/etiologia
17.
Taiwan J Obstet Gynecol ; 57(3): 364-369, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29880166

RESUMO

OBJECTIVE: This study aims to examine the long-term cardiovascular and cerebrovascular risks in a large cohort of women with past history of preeclampsia and/or eclampsia. MATERIALS AND METHODS: This is a retrospective longitudinal study using National Health Insurance Research Database from 1996 to 2010. We identified 1295 women with preeclampsia and eclampsia. The control group was 5180 pregnant women without preeclampsia/eclampsia, who were matched for age and date of delivery. The incidences of diabetes, dyslipidemia, hypertension and cardiovascular events after pregnancy were identified from medical records after the date of delivery to the date of an event or the end of the study. RESULTS: The median follow-up duration was 9.8 years (interquartile 5.1-12.7 years). The incidences of diabetes, dyslipidemia, hypertension, congestive heart failure and cerebrovascular disease events were significantly greater in women with eclampsia or preeclampsia than those in controls. Eclampsia or preeclampsia increased the risk of diabetes, dyslipidemia, hypertension, congestive heart failure and cerebrovascular disease events (hazard ratio [HR] 3.84 and 5.42, P < 0.0001; HR 2.75 and 3.40, P < 0.0001; HR 6.52 and 7.31, P < 0.0001; HR 9.07, P = 0.0060 and 7.39, P < 0.0001; HR 10.71, P < 0.0001 and 3.47, P = 0.0048, respectively). The survival curves for the development of congestive heart failure and cerebrovascular disease in women with eclampsia/preeclampsia and in control differed significantly (Log-rank test P < 0.0001). From the curve, we can find dramatic increases of congestive heart failure and cerebrovascular disease incidences at roughly 3 years and 10 years since the diagnosis of eclampsia/preeclampsia. CONCLUSIONS: Our study revealed that women with a history of preeclampsia/eclampsia were at increased risks for subsequent diagnoses of diabetes, dyslipidemia, hypertension, congestive heart failure and cerebrovascular disease. Preventive counseling, more vigilant screening and management for the modifiable risks should be provided to the affected women. Clinicians should closely monitor these patients in the first three years postpartum and continuously for up to at least a decade.


Assuntos
Transtornos Cerebrovasculares/epidemiologia , Eclampsia/epidemiologia , Insuficiência Cardíaca/epidemiologia , Hipertensão/epidemiologia , Pré-Eclâmpsia/epidemiologia , Adulto , Estudos de Casos e Controles , Bases de Dados Factuais , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Gravidez , Estudos Retrospectivos , Fatores de Risco
18.
Sci Rep ; 8(1): 4872, 2018 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-29559709

RESUMO

To assess whether our novel uterus-sparing procedure- laparoscopic organopexy with non-mesh genital(LONG) suspension is an effective, safe, and timesaving surgery for the treatment of apical prolapse. Forty consecutive women with main uterine prolapse stage II or greater defined by the POP quantification(POP-Q) staging system were referred for LONG procedures at our hospitals. Clinical evaluations before and 6 months after surgery included pelvic examination, urodynamic study, and a personal interview to evaluate urinary and sexual symptoms with overactive bladder symptom score(OABSS), the short forms of Urogenital Distress Inventory(UDI-6) and Incontinence Impact Questionnaire(IIQ-7), and the Female Sexual Function Index(FSFI). After follow-up time of 12 to 30 months, anatomical cure rate was 85%(34/40), and the success rates for apical, anterior, and posterior vaginal prolapse were 95%(38/40), 85%(34/40), and 97.5%(39/40), respectively. Six recurrences of anterior vaginal wall all suffered from significant cystocele (stage3; Ba>+1) preoperatively. The average operative time was 73.1 ± 30.8 minutes. One bladder injury occurred and was recognized during surgery. The dyspareunia domain and total FSFI scores of the twelve sexually-active premenopausal women improved postoperatively in a significant manner (P < 0.05). The results of our study suggest that LONG suspension is an effective and safe uterus-sparing surgery for the treatment of apical prolapse.


Assuntos
Laparoscopia/métodos , Prolapso de Órgão Pélvico/cirurgia , Prolapso Uterino/cirurgia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Período Pós-Operatório , Qualidade de Vida , Comportamento Sexual , Telas Cirúrgicas , Inquéritos e Questionários , Resultado do Tratamento , Bexiga Urinária Hiperativa , Urodinâmica , Útero/cirurgia , Vagina/cirurgia
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