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1.
Am J Perinatol ; 2019 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-30780183

RESUMO

BACKGROUND: Obesity and pregnancy are risk factors for venous thromboembolism (VTE). In nonpregnant individuals, abdominal obesity is associated with venous insufficiency. OBJECTIVE: To compare venous Doppler volume flow and velocity in the lower extremities of obese versus nonobese women. STUDY DESIGN: A prospective cohort study was performed. Duplex ultrasound examined bilateral lower extremity venous flow and velocity (time-averaged mean velocity, TAMV). Flow was analyzed at the superficial femoral (SFV), distal external iliac (DEI), common femoral, profunda femoris, and popliteal veins. Mann-Whitney U-test, Spearman's correlation, and chi-square tests were used, with a significance of p < 0.05. RESULTS: Left SFV TAMV and volume flow were higher in the obese group (5.1 [4.1-5.7] vs. 2.8 [1.7-3.4] cm/second; p < 0.001) and (89 [73-119] vs. 48 [26-62] cm/minute; p = 0.005). Significant differences were noted for right DEI flow (obese 326 [221-833] vs. nonobese 182 [104-355] cm/minute; p = 0.049). The right femoral profunda flow was also higher in obese (49 [40-93] cm/minute) compared with nonobese (31 [22-52] cm/minute; p = 0.041). CONCLUSION: Volume flow and TAMV in the lower extremities of obese gravidas are higher compared with nonobese ones. Thus, the increased risk of VTE among obese pregnant women may not be caused by venous stasis.

2.
Hypertens Pregnancy ; 37(3): 126-130, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30014728

RESUMO

Our objective was to determine if elevated uric acid (UA) is associated with postpartum hypertension (PP HTN) in women without chronic hypertension. This is a secondary analysis of a randomized trial. We compared those with elevated UA to those with normal UA. Logistic regression was conducted to determine the association of elevated UA with PP HTN. Five hundred and fifty-six women met criteria. An UA level ≥ 5.2 mg/dL was associated with immediate PP HTN (adjusted odds ratio 2.44, 95% CI 1.63-3.64). The association was stronger among overweight and obese women. We conclude that hyperuricemia is associated with PP HTN, especially among obese women.


Assuntos
Pressão Sanguínea/fisiologia , Hipertensão/complicações , Hiperuricemia/complicações , Adulto , Feminino , Humanos , Hipertensão/fisiopatologia , Hipertensão/urina , Hiperuricemia/fisiopatologia , Hiperuricemia/urina , Período Pós-Parto , Gravidez , Ácido Úrico/sangue
3.
Am J Obstet Gynecol ; 217(1): 85, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28648694

RESUMO

This article has been removed: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been removed at the request of the Editors-in-Chief and Authors. The original publication reported that univariate analysis showed that a vertical skin incision in obese women undergoing Cesarean delivery was associated with a higher odds ratio for wound complications than a transverse skin incision. Multivariable analyses showed a reversal of the association (i.e. the odds of wound complications were lower in women with a vertical skin incision). However, there was an error in the way the variable was entered in the logistic analysis. Re-analysis with the correct coding of the variable indicates that a transverse skin incision is associated with decreased odds of wound complication compared to a vertical skin incision.

4.
Clin Obstet Gynecol ; 60(1): 161-168, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27906745

RESUMO

Preeclampsia is a multisystem disorder that affects 3% to 5% of pregnant women and remains a significant source of short-term and long-term maternal and neonatal mortality and morbidity. Many professional societies recommend the use of low-dose aspirin to prevent preeclampsia in high-risk women. Owing to the similarities in pathophysiology between preeclampsia and atherosclerotic cardiovascular disease, and the encouraging data from preclinical and pilot clinical studies, pravastatin has been proposed for preventing preeclampsia. However, before statin administration becomes part of routine clinical practice, a large, well-designed, and adequately powered randomized-controlled trial is needed.


Assuntos
Aspirina/administração & dosagem , Fibrinolíticos/administração & dosagem , Pravastatina/administração & dosagem , Pré-Eclâmpsia/prevenção & controle , Feminino , Humanos , Gravidez , Fatores de Risco
6.
Am J Perinatol ; 33(6): 569-76, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-26692201

RESUMO

Objective The objective of this study was to use data from the 20-center beneficial effect of antenatal magnesium sulfate (BEAM) trial to assess the external validity of the Neonatal Research Network (NRN) estimator, a widely employed web-based counseling tool to estimate the probability of an adverse outcome for periviable infants given intensive care. Study Design The probability of different adverse outcomes predicted from the NRN estimator was compared with observed rates at 18 to 22 months for ventilated, nonanomalous infants born at 23 to 25 weeks and assessed in BEAM as in the NRN. Results were assessed using rigorous validation methods for prediction models. Results Among 289 eligible infants, 26% died, 40% died or had profound neurodevelopmental impairment (PNDI), and 71% died or had NDI. The area under the receiver operating characteristic curve was 0.70 (95% confidence interval [CI], 0.63-0.78) for death, 0.64 (95% CI, 0.56-0.71) for death or NDI, and 0.71 (95% CI, 0.65-0.78) for death or PNDI. Observed and predicted rates were somewhat different for death or NDI but quite similar for death and for death or PNDI in different risk groups. Brier scores for accuracy were favorable (0.17-0.22) for all outcomes. Conclusion Our results provide external validation of the NRN estimator for assessing the probability of adverse outcomes at 18 to 22 months for periviable infants given intensive care.


Assuntos
Lactente Extremamente Prematuro , Doenças do Prematuro/mortalidade , Recém-Nascido de muito Baixo Peso , Transtornos do Neurodesenvolvimento/mortalidade , Complicações na Gravidez/epidemiologia , Adulto , Aconselhamento/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Internet , Masculino , Análise Multivariada , National Institute of Child Health and Human Development (U.S.) , Morte Perinatal , Gravidez , Probabilidade , Curva ROC , Análise de Regressão , Taxa de Sobrevida , Estados Unidos , Adulto Jovem
8.
Am J Perinatol ; 32(13): 1251-6, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26023905

RESUMO

OBJECTIVE: The objective of this study was to determine the morbidity of preterm small for gestational age (SGA) infants compared with appropriate for GA (AGA). STUDY DESIGN: This is a secondary analysis of the randomized trial evaluating magnesium sulfate for the prevention of cerebral palsy (CP). We compared outcomes of preterm (< 37 weeks) nonanomalous infants who were SGA (birth weight < 10% for GA) versus AGA (birth weight 10-89% for GA). We compared (1) the parent trial primary outcome, a composite of stillbirth, infant death by 1 year of age, or moderate to severe CP at 2 years of age and (2) composite neonatal morbidity (CNM). RESULTS: Of the 1,948 infants who met inclusion criteria, 95% were AGA and 5% were SGA. The primary outcome was similar (10 and 15%, p = 0.08), as was the CNM (24 and 25%, p = 0.89). Sample size calculations indicate that detection of a one-third higher rate of CNM among SGA compared with AGA infants requires more than 93,900 preterm births; for a one-third difference in moderate to severe CP, more than 1.4 million infants. CONCLUSION: Owing to the prohibitive sample size required, ascertaining a difference in sequela between preterm SGA and AGA infants is possibly unverifiable.


Assuntos
Bloqueadores dos Canais de Cálcio/uso terapêutico , Paralisia Cerebral/prevenção & controle , Retardo do Crescimento Fetal/epidemiologia , Sulfato de Magnésio/uso terapêutico , Estudos de Casos e Controles , Paralisia Cerebral/epidemiologia , Método Duplo-Cego , Feminino , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido Pequeno para a Idade Gestacional , Análise Multivariada , Assistência Perinatal , Gravidez , Análise de Regressão , Resultado do Tratamento
10.
Am J Obstet Gynecol ; 210(4): 319, 2014 04.
Artigo em Inglês | MEDLINE | ID: mdl-24560557

RESUMO

This article has been removed: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been removed at the request of the Editors-in-Chief and Authors. The original publication reported that univariate analysis showed that a vertical skin incision in obese women undergoing Cesarean delivery was associated with a higher odds ratio for wound complications than a transverse skin incision. Multivariable analyses showed a reversal of the association (i.e. the odds of wound complications were lower in women with a vertical skin incision). However, there was an error in the way the variable was entered in the logistic analysis. Re-analysis with the correct coding of the variable indicates that a transverse skin incision is associated with decreased odds of wound complication compared to a vertical skin incision.


Assuntos
Cesárea/métodos , Obesidade Mórbida/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Índice de Massa Corporal , Grupos de Populações Continentais/estatística & dados numéricos , Feminino , Hematoma/epidemiologia , Humanos , Idade Materna , Gravidez , Sistema de Registros , Seroma/epidemiologia , Deiscência da Ferida Operatória/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia
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