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1.
Artigo em Inglês | MEDLINE | ID: mdl-34747110

RESUMO

Vulvodynia is debilitating vulvar pain accompanied by dyspareunia (pain with sexual intercourse). Ehlers-Danlos syndromes (EDS) and hypermobility spectrum disorders (HSD) may represent a predisposing factor for vulvodynia given a high rate of dyspareunia in these conditions. We conducted an online survey of women with EDS or HSD to assess rates of dyspareunia and estimate rates of vulvodynia, report rates of comorbid conditions common to EDS or HSD and vulvodynia, and examine rates of conditions contributing to dyspareunia in women with EDS or HSD. Women with EDS or HSD (N = 1,146) recruited via social media were 38.2 ± 11.5 years old, primarily White (94.4%), and resided in the United States (78.5%). 63.7% of participants reported dyspareunia and 50% screened positive for vulvodynia. The rate of comorbid conditions common to EDS or HSD and vulvodynia were: irritable bowel syndrome, 6.5%; fibromyalgia, 40.0%; temporomandibular joint dysfunction, 56.4%; migraine, 6.7%; interstitial cystitis, 1.7%; and mast cell activation syndrome, 10.2%. Participants reporting dyspareunia also reported ovarian cysts, fibroids, or abdominal or pelvic scars, 47.5%; endometriosis, 26.5%; and genital lacerations, 19.3%. Women with EDS or HSD may have a higher rate of vulvodynia (50.0%) than women in the U.S. population at large (8%) and should be assessed for dyspareunia and vulvodynia.

2.
Comput Struct Biotechnol J ; 19: 5126-5139, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34589188

RESUMO

The next frontier in the field of microbiome studies is identification of all microbes present in the microbiome and accurate determination of their abundance such that microbiome profiles can serve as reliable assessments of health or disease status. PCR-based 16S rRNA gene sequencing and metagenome shotgun sequencing technologies are the prevailing approaches used in microbiome analyses. Each poses a number of technical challenges associated with PCR amplification, sample availability, and cost of processing and analysis. In general, results from these two approaches rarely agree completely with each other. Here, we compare these methods utilizing a set of vaginal swab and lavage specimens from a cohort of 42 pregnant women collected for a pilot study exploring the effect of the vaginal microbiome on preterm birth. We generated the microbial community profiles from the sequencing reads of the V3V4 and V4V5 regions of the 16S rRNA gene in the vaginal swab and lavage samples. For a subset of the vaginal samples from 12 subjects, we also performed metagenomic shotgun sequencing analysis and compared the results obtained from the PCR-based sequencing methods. Our findings suggest that sample composition and complexity, particularly at the species level, are major factors that must be considered when analyzing and interpreting microbiome data. Our approach to sequence analysis includes consideration of chimeric reads, by using our chimera-counting BlastBin program, and enables recovery of microbial content information generated during PCR-based sequencing methods, such that the microbial profiles more closely resemble those obtained from metagenomic read-based approaches.

3.
J Midwifery Womens Health ; 65(5): 621-626, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32749063

RESUMO

INTRODUCTION: A calculator estimating likelihood of vaginal birth after cesarean (VBAC) has been promoted by the Society for Maternal-Fetal Medicine, but little is known about how it is used and perceived in practice. Cutoffs for prohibiting labor after cesarean are discouraged by the calculator's developers, but such uses may be widespread. The purpose of this study was to determine how calculators predicting VBAC are used and perceived in midwifery practices. METHODS: Certified nurse-midwives and certified midwives currently providing care for labor after cesarean were surveyed between January 17, 2019, and February 7, 2019. Quantitative and text data were collected regarding the uses and perceptions of calculators among midwives and their colleagues. We compared these findings with midwives' perceptions of their ability to accommodate patient wishes for labor after cesarean. We used descriptive content analysis to evaluate themes occurring in text responses. RESULTS: There were 1305 valid responses. A requirement to use calculator scores for patient counseling was reported by 527 (40.4%) of responding midwives. Over 1 in 5 midwives reported that scores were used to discourage or prohibit labor after cesarean. Almost half reported some or strong disagreement with physician colleagues regarding calculator use. Interprofessional agreement and disagreement centered on how scores are used to direct clinical care or restrict patient options. Calculator scores were used in more than twice as many midwives' practices to discourage rather than encourage labor after cesarean. Descriptive analysis of text revealed 4 themes regarding calculators: inconsistent use, information counseling, informed consent, and influence patient management or options. DISCUSSION: Calculators predicting likelihood of VBAC success are widely used in midwifery settings and are more often used to discourage than to encourage labor after cesarean. Midwives reported both directive and nondirective counseling based on calculator scores.


Assuntos
Enfermeiras Obstétricas , Nascimento Vaginal Após Cesárea/estatística & dados numéricos , Atitude do Pessoal de Saúde , Feminino , Humanos , Trabalho de Parto , Tocologia , Gravidez , Prova de Trabalho de Parto
4.
IEEE Trans Med Imaging ; 39(12): 4425-4435, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32833631

RESUMO

Collagen fibers in biological tissues have a complex 3D organization containing rich information linked to tissue mechanical properties and are affected by mutations that lead to diseases. Quantitative assessment of this 3D collagen fiber organization could help to develop reliable biomechanical models and understand tissue structure-function relationships, which impact diagnosis and treatment of diseases or injuries. While there are advanced techniques for imaging collagen fibers, published methods for quantifying 3D collagen fiber organization have been sparse and give limited structural information which cannot distinguish a wide range of 3D organizations. In this article, we demonstrate an algorithm for quantitative classification of 3D collagen fiber organization. The algorithm first simulates five groups, or classifications, of fiber organization: unidirectional, crimped, disordered, two-fiber family, and helical. These five groups are widespread in natural tissues and are known to affect the tissue's mechanical properties. We use quantitative metrics based on features such as preferred 3D fiber orientation and spherical variance to differentiate each classification in a repeatable manner. We validate our algorithm by applying it to second-harmonic generation images of collagen fibers in tendon and cervix tissue that has been sectioned in specified orientations, and we find strong agreement between classification from simulated data and the physical fiber organization. Our approach provides insight for interpreting 3D fiber organization directly from volumetric images. This algorithm could be applied to other fiber-like structures that are not necessarily made of collagen.


Assuntos
Colágeno , Tendões , Feminino , Humanos , Tendões/diagnóstico por imagem
5.
J Obstet Gynecol Neonatal Nurs ; 49(6): 571-580, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32822648

RESUMO

OBJECTIVE: To describe the perceptions of African American women and health care professionals (HCPs) about factors that likely influence the use of pre-exposure prophylaxis (PrEP) to prevent HIV among African American women. DESIGN: Prospective mixed methods. SETTING: Chicago, IL. PARTICIPANTS: Fifty-eight participants included HCPs (n = 10) and African American women (n = 48). METHODS: Following the six steps of concept mapping, participants identified and rated factors they perceived to influence decisions to use PrEP among African American women. RESULTS: African American women generated a list of statements, and we grouped the statements into eight clusters: access, financial, best benefits, protection, medication, setbacks, network, and fear. HCPs ranked having an HIV-positive partner as the most influential factor that affected African American women's decisions to use PrEP (network cluster). African American women ranked ability to prevent HIV when condom use cannot be negotiated as their top reason (best benefits cluster) for using PrEP. CONCLUSION: African American women wanted to know how they could protect themselves and were open to using PrEP. For African American women considering the use of PrEP, the most influential factors were related to the benefits and accessibility of PrEP. HCPs should know that African American women are not afraid to discuss HIV risk and testing.


Assuntos
Afro-Americanos/psicologia , Infecções por HIV/prevenção & controle , Pessoal de Saúde/psicologia , Percepção , Profilaxia Pré-Exposição/normas , Adulto , Afro-Americanos/estatística & dados numéricos , Fármacos Anti-HIV/normas , Fármacos Anti-HIV/uso terapêutico , Chicago , Feminino , Infecções por HIV/tratamento farmacológico , Pessoal de Saúde/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Profilaxia Pré-Exposição/métodos , Profilaxia Pré-Exposição/estatística & dados numéricos , Estudos Prospectivos
6.
J Ultrasound Med ; 39(8): 1581-1587, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32073680

RESUMO

OBJECTIVES: The aim of this study was to explore the motivations of pregnant women in participating in an ultrasound study and the acceptability of vaginal ultrasound examinations. METHODS: A prospective sample of 270 women were asked one question: "Can you tell me what motivated you to participate in the study?" The data were then analyzed through a qualitative thematic analysis with an inductive approach. In addition to the thematic analysis, quantification of the data was performed to enhance the qualitative result. RESULTS: Through the thematic analysis, 5 themes emerged from the responses of the participants: altruism, research, personal experience, personal benefit, and finding out. All responses were relatively short, and some responses included more than one theme. CONCLUSIONS: Vaginal ultrasound examinations were acceptable to the participants, and pregnant women had many motivations to participate. Regardless of race, ethnicity, or insurance status, the women in our study were altruistic and curious about our research.


Assuntos
Gestantes , Sujeitos da Pesquisa , Feminino , Humanos , Motivação , Gravidez , Estudos Prospectivos , Ultrassonografia
7.
Birth ; 47(2): 220-226, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32003064

RESUMO

BACKGROUND: The cesarean birth rate in the United States is 32%, and there is discussion about the cause of high surgical birth rates. Our purpose was to determine whether mode of birth is influenced by maternal, nurse, and system factors. METHODS: Secondary analysis of a data set of 163 women having postdates labor induction with oxytocin. Kaplan-Meier survival curves were calculated to compare the time for patients to reach an infusion rate of 6 mU/min, consistent with endogenous oxytocin levels in active labor. We used the log-rank test to evaluate survival curve differences. Multiple logistic regression and Cox proportional hazards models were conducted and included covariates that had statistically significant bivariate relationships with the time variable, or were clinically meaningful. RESULTS: The mean time to reach 6 mU/min was longer for women who birthed by cesarean (172.5 minutes) than for women who had vaginal birth (125.0 minutes, P = .024). The mean time to reach 6 mU/min was also longer for women admitted on night shift (147.0 minutes) than day shift (110.2 minutes, P = .018). No maternal characteristics were significantly related to the time to reach a rate of 6 mU/min. CONCLUSIONS: Even during the initial hours of labor induction, it is important that the oxytocin infusion is titrated appropriately to aid women in achieving timely vaginal birth. Intrapartum nurses should receive education about the pharmacokinetics of intravenous oxytocin to understand proper administration of this high-alert medication.


Assuntos
Cesárea/estatística & dados numéricos , Trabalho de Parto Induzido/estatística & dados numéricos , Ocitócicos/administração & dosagem , Ocitocina/administração & dosagem , Adulto , Índice de Massa Corporal , Feminino , Humanos , Estimativa de Kaplan-Meier , Trabalho de Parto , Modelos Logísticos , Obesidade/epidemiologia , Gravidez , Resultado da Gravidez/epidemiologia , Modelos de Riscos Proporcionais , Estados Unidos
8.
Nurs Res ; 69(1): 42-50, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31609900

RESUMO

BACKGROUND: Although prior studies of inpatient maternal mortality in the United States provide data on the overall rate and trend in inpatient maternal mortality, there are no published reports of maternal mortality data stratified by timing of its occurrence across the pregnancy continuum (antepartum, intrapartum, and postpartum). OBJECTIVE: The study objective was to determine whether the maternal mortality rate, trends over time, self-reported race/ethnicity, and associated factors vary based on the timing of the occurrence of death during pregnancy. METHODS: We conducted a cross-sectional analysis of the Nationwide Inpatient Sample database to identify pregnancy-related inpatient stays stratified by timing. Among women in the sample, we determined in-hospital mortality and used International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify comorbidities and behavioral characteristics associated with mortality, including alcohol, drug, and tobacco use. Joinpoint regression was used to calculate rates and trends of in-hospital maternal mortality. RESULTS: During the study period, there were 7,411 inpatient maternal mortalities among an estimated 58,742,179 hospitalizations of women 15-49 years of age. In-hospital maternal mortality rate stratified by race showed that African Americans died at significantly higher rates during antepartum, intrapartum, and postpartum periods compared to hospitalizations for Whites or Hispanics during the same time period. Although the postpartum hospitalization represents only 2% of pregnancy-related hospitalizations among women aged 15-49 years, hospitalization during this time period accounted for 27.2% of all maternal deaths during pregnancy-related hospitalization. DISCUSSION: Most in-hospital maternal mortalities occur after hospital discharge from child birth (postpartum period). Yet, the postpartum period continues to be the time period with the least maternal healthcare surveillance in the pregnancy continuum. African American women experience three times more in-hospital mortality when compared to their White counterparts.


Assuntos
Mortalidade Hospitalar/tendências , Mortalidade Materna/tendências , Complicações na Gravidez/epidemiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Previsões , Humanos , Pessoa de Meia-Idade , Gravidez , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem
9.
Artigo em Inglês | MEDLINE | ID: mdl-31217100

RESUMO

This article evaluated the repeatability and reproducibility (R&R) of quantitative ultrasound (QUS) biomarkers attenuation coefficient (AC) and backscatter coefficient (BSC) in transvaginal QUS reference phantoms for obstetric applications. Five phantoms were scanned by three sonographers according to the scanning protocol. Each sonographer scanned each phantom with four transvaginal transducers of the same model (MC9-4) and three probe cover types (latex cover, nonlatex cover, and no cover). The AC and BSC were estimated by using a reference phantom method. The R&R analysis was performed for the frequency-averaged AC and logBSC (= 10log10BSC) (5.4-5.8 MHz) by using three-factor random effects Analysis of Variance with interaction. The total R&R variabilities for AC and logBSC are small (AC: 0.042-0.065 dB/cm-MHz; logBSC: 0.50-0.68 dB), indicating high measurement precision. These values are small compared to the ranges of AC (0.28-0.99 dB/cm-MHz) and logBSC (-33.16 to -20.35 dB) of the five phantoms. The AC and logBSC biomarkers measured on transvaginal QUS phantoms using the reference phantom method are repeatable, and reproducible between sonographers, transducers, and probe covers.


Assuntos
Ultrassonografia/métodos , Vagina , Feminino , Humanos , Imagens de Fantasmas , Reprodutibilidade dos Testes , Transdutores
10.
Adv Neonatal Care ; 19(4): E12-E21, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30893095

RESUMO

BACKGROUND: Negative outcomes related to prematurity may lead to maternal distress. Mothers of premature/low birth-weight infants report increased posttraumatic stress (50%) and depressive symptoms (63%) compared with mothers of full-term infants. Low-income, minority mothers with greater posttraumatic stress and depression have an increased risk for premature/low birth-weight delivery compared with their white counterparts. Variations in the neuropeptide oxytocin are implicated in lactation, perinatal depression, and maternal behavior. PURPOSE: To examine the associations among posttraumatic stress, depressive symptoms, and oxytocin in a pilot sample of minority mothers with premature/low birth-weight infants in the neonatal intensive care unit (NICU). METHODS: This study employed a descriptive, correlational pilot design of 8 minority, low-income mothers with premature/low birth-weight infants. Participants answered questionnaires pertaining to posttraumatic stress, depression, lactation, and demographics and oxytocin was measured. This is a substudy that added oxytocin values. RESULTS: Four participants had elevated depressive symptoms and 5 supplied their own milk. Women who provided their own milk had lower depressive (t = 3.03, P = .023) and posttraumatic stress (t = 3.39, P = .015) symptoms compared with women not supplying their own milk. Women with elevated posttraumatic stress had higher levels of depressive symptoms (r(8) = 0.8, P = .006) and lower levels of oxytocin (r(8) = 0.77, P = .026). IMPLICATIONS FOR PRACTICE: These results are congruent with previous literature on providing human milk and maternal mental health. In addition, we found a possible relationship between postpartum posttraumatic stress and oxytocin in minority women with premature/low birth-weight infants. NICU nurses should encourage lactation and assess mothers for posttraumatic stress and depressive symptoms. IMPLICATIONS FOR RESEARCH: Research is needed to identify the biologic milieu associated with posttraumatic stress and depression in at-risk mothers.


Assuntos
Aleitamento Materno/psicologia , Depressão/fisiopatologia , Lactação/fisiologia , Ocitocina/fisiologia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Adolescente , Adulto , Depressão/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Terapia Intensiva Neonatal , Meio-Oeste dos Estados Unidos/epidemiologia , Projetos Piloto , Pobreza , Gravidez , Inquéritos e Questionários , Adulto Jovem
11.
Clin Perinatol ; 45(2): 155-163, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29747880

RESUMO

Billions of dollars are spent yearly in perinatal medicine on studies designed to improve outcomes for mothers and their neonates. However, implementing research findings is challenging and imperfect. Strategies for implementation must be multifaceted and comprehensive. These implementation challenges extend to, and are often greater in, translational and basic science research. The purpose of this review is to discuss current challenges in the provision of quality perinatal and neonatal medical care, particularly those related to preterm birth, and provide examples of prematurity-related perinatal quality collaborative initiatives. Finally, the authors review considerations in implementing both clinical and translational/basic science prematurity research.


Assuntos
Assistência Perinatal/métodos , Perinatologia/métodos , Nascimento Prematuro/prevenção & controle , Melhoria de Qualidade , Pesquisa Médica Translacional/métodos , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Nascimento Prematuro/mortalidade
12.
Circ Heart Fail ; 11(1): e004005, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29330153

RESUMO

BACKGROUND: Heart failure (HF) is a leading cause of maternal morbidity and mortality in the United States, but prevalence, correlates, and outcomes of HF-related hospitalization during antepartum, delivery, and postpartum periods remain unknown. The objective was to examine HF prevalence, correlates, and outcomes among pregnancy-related hospitalizations among women 13 to 49 years of age. METHODS AND RESULTS: We used the 2001 to 2011 Nationwide Inpatient Sample. Rates of HF were calculated by patient and hospital characteristics. Survey logistic regression was used to estimate adjusted odds ratios representing the association between HF and each outcome, stratified by antepartum, delivery, and postpartum periods. Joinpoint regression was used to describe temporal trends in HF and in-hospital mortality. Over 50 million pregnancy-related hospitalizations were analyzed. The overall rate of HF was 112 cases per 100 000 pregnancy-related hospitalizations. Although postpartum encounters represented only 1.5% of pregnancy-related hospitalizations, ≈60% of HF cases occurred postpartum, followed by delivery (27.3%) and antepartum (13.2%). Among postpartum hospitalizations, there was a significant 7.1% (95% confidence interval, 4.4-9.8) annual increase in HF from 2001 to 2006, followed by a steady rate through 2011. HF rates among antepartum hospitalizations increased on average 4.9% (95% confidence interval, 3.0-6.8) annually from 2001 to 2011. Women with a diagnosis of HF were more likely to experience adverse maternal outcomes, as reflected by outcome-specific adjusted odds ratios during antepartum (2.7-25), delivery (6-195), and postpartum (1.5-6.6) periods. CONCLUSIONS: HF is associated with increased risk of maternal mortality and morbidities. During hospitalization, high-risk mothers need to be identified and surveillance programs developed before discharge.


Assuntos
Insuficiência Cardíaca/epidemiologia , Complicações na Gravidez/epidemiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Modelos Logísticos , Mortalidade Materna , Pessoa de Meia-Idade , Razão de Chances , Gravidez , Prevalência , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
13.
J Hypertens ; 36(3): 608-618, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29045342

RESUMO

OBJECTIVES: Hypertensive disorders of pregnancy (HDP) represent the most common cause of maternal-fetal morbidity and mortality. Yet, the prevalence and cost of postpartum (42-day) readmission (PPR) among HDP-complicated pregnancies in the United States remains unknown. This study provides national prevalence and cost estimates of HDP, and examine factors associated with potentially preventable PPR following HDP-complicated pregnancies. METHOD: The 2013 and 2014 Nationwide Readmissions Databases were used to investigate HDP and PPR among delivery hospitalizations to women aged 15-49 years. PPR rates, length of stay, and costs were stratified by four HDP subtypes based on timing and severity of their condition. Survey logistic regression was employed to generate adjusted odds ratios for the association between HDP and PPR. RESULT: In 2013 and 2014, there were 6.3 million delivery hospitalizations; 666 506 (10.6%) were complicated by HDP. Annually, HDP was responsible for higher rates of potentially preventable PPR. Among HDP-complicated pregnancies, the 42-day all-cause PPR rate ranged from 2.5% (gestational hypertension) to 4.6% (superimposed preeclampsia/eclampsia). Compared with normotensive pregnancies, HDP resulted in an excess 404 800 hospital days and inpatient care costs of $731 million. Even after controlling for patient-level and hospital-level confounders, all hypertensive subgroups continued to have at least two-fold, statistically significant, increased odds of potentially preventable PPR. CONCLUSION: HDP is associated with increased risk of PPR and substantial medical costs. Preventive efforts should be made to identify women at increased risk of PPR during hospitalization so that transition care intervention can be initiated.


Assuntos
Eclampsia/epidemiologia , Custos Hospitalares/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Vigilância da População , Pré-Eclâmpsia/epidemiologia , Adolescente , Adulto , Eclampsia/economia , Feminino , Humanos , Pessoa de Meia-Idade , Readmissão do Paciente/economia , Período Pós-Parto , Pré-Eclâmpsia/economia , Gravidez , Prevalência , Estados Unidos/epidemiologia , Adulto Jovem
14.
J Obstet Gynecol Neonatal Nurs ; 46(4): 494-507, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28528810

RESUMO

OBJECTIVE: To evaluate whether oxytocin titration for postdates labor induction differs among women who are normal weight, overweight, and obese and whether length of labor and birth method differ by oxytocin titration and body mass index (BMI). DESIGN: Retrospective cohort study. SETTING: U.S. university-affiliated hospital. PARTICIPANTS: Of 280 eligible women, 21 were normal weight, 134 were overweight, and 125 were obese at labor admission. METHODS: Data on women who received oxytocin for postdates induction between January 1, 2013 and June 30, 2013 were extracted from medical records. Oxytocin administration and labor outcomes were compared across BMI groups, controlling for potential confounders. Data were analyzed using χ2, analysis of variance, analysis of covariance, and multiple linear and logistic regression models. RESULTS: Women who were obese received more oxytocin than women who were overweight in the unadjusted analysis of variance (7.50 units compared with 5.92 units, p = .031). Women who were overweight had more minutes between rate changes from initiation to maximum than women who were obese (98.19 minutes compared with 83.39 minutes, p = .038). Length of labor increased with BMI (p = .018), with a mean length of labor for the normal weight group of 13.96 hours (standard deviation = 8.10); for the overweight group, 16.00 hours (standard deviation = 7.54); and for the obese group, 18.30 hours (standard deviation = 8.65). Cesarean rate increased with BMI (p = .001), with 4.8% of normal weight, 33.6% of overweight, and 42.4% of obese women having cesarean births. CONCLUSION: Women who were obese and experienced postdates labor induction received more oxytocin than women who were non-obese and had longer length of labor and greater cesarean rates.


Assuntos
Cesárea/estatística & dados numéricos , Trabalho de Parto Induzido/estatística & dados numéricos , Obesidade/epidemiologia , Ocitócicos/administração & dosagem , Ocitocina/administração & dosagem , Resultado da Gravidez/epidemiologia , Adulto , Índice de Massa Corporal , Estudos de Coortes , Relação Dose-Resposta a Droga , Feminino , Humanos , Trabalho de Parto , Gravidez , Estudos Retrospectivos , Adulto Jovem
15.
J Obstet Gynecol Neonatal Nurs ; 46(1): 148-158, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27836659

RESUMO

OBJECTIVE: To examine iron metabolism during the second and third trimesters in African American women with high-risk pregnancies. DESIGN: Longitudinal pilot study. SETTING: Large, university-based, urban Midwestern U.S. medical center. PARTICIPANTS: Convenience sample of 32 African American women with high-risk pregnancies seeking care at an urban maternal-fetal medicine clinic. METHODS: Nonfasting venous blood was collected in the second and third trimesters to assess iron status, hepcidin, and systemic inflammation. Anthropometric and survey data were obtained via self-report. Descriptive statistics were calculated from these data, and changes in the clinical parameters between the second and third trimesters were evaluated via paired t tests. Associations among demographic, reproductive, anthropometric, inflammatory, and iron-related parameters were also assessed in each trimester. RESULTS: The mean age of participants was 28.3 (± 6.8) years, and mean prepregnancy body mass index was 31.9 (± 10.7) kg/m2. In the longitudinal analysis, significant (p < .05) declines in serum iron, ferritin, transferrin saturation, and C-reactive protein were observed between the second and third trimesters. There was no statistically significant change in hepcidin between trimesters. When using a ferritin level cut-point of less than 15 ng/ml and soluble transferrin receptor level of greater than 28.1 nmol/L, 48% of the participants (14 of 29) were classified with iron deficiency in the third trimester. CONCLUSION: In this pilot study, iron deficiency was prevalent among a small cohort of African American women with high-risk pregnancies. Hepcidin concentrations were greater than previously reported in healthy, pregnant, primarily White women, which suggests decreased iron bioavailability in this high-risk group.


Assuntos
Afro-Americanos/estatística & dados numéricos , Ferritinas/administração & dosagem , Complicações na Gravidez/enfermagem , Terceiro Trimestre da Gravidez , Gravidez de Alto Risco/metabolismo , Oligoelementos/administração & dosagem , Adulto , Feminino , Humanos , Estudos Longitudinais , Estado Nutricional , Projetos Piloto , Gravidez , Cuidado Pré-Natal/métodos , Adulto Jovem
16.
J Obstet Gynecol Neonatal Nurs ; 46(1): 123-134, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27836660

RESUMO

OBJECTIVE: To examine the direct relationship between nutrient intake and cervical remodeling. DESIGN: Longitudinal descriptive design. SETTING: Maternal-fetal medicine clinic in a Midwestern urban city. PARTICIPANTS: Forty-seven pregnant African American women. METHODS: Participants completed the Block brief food frequency questionnaire at 19 to 24 weeks and 27 to 29 weeks gestation and had quantitative ultrasonic attenuation estimates at 19 to 21 weeks, 23 to 25 weeks, 27 to 29 weeks, 31 to 33 weeks, and 35 to 37 weeks gestation. RESULTS: Trajectory mixture models identified two subpopulations within our sample: those at risk (n = 36) and at less risk (n = 11) for premature cervical remodeling. More participants in the less-risk group consumed the dietary reference intake for calcium, vitamin A, folate, vitamin E, zinc, and vitamin D than in the at-risk group. The percentage of participants in the less-risk group who consumed the recommended dietary reference intake for vitamin E was twice the percentage of women in the at-risk group (82% and 44%, respectively; p = .004). Mean intake of calcium was almost 1.3 times more (p = .05) and for zinc was 1.5 times more (p = .04) in the less-risk group than in the at-risk group. CONCLUSION: Practitioners can inform women that certain nutrients, particularly zinc, calcium, and vitamin E, could be important to the health of the cervix and inhibit premature cervical remodeling, which in turn may help prevent preterm birth.


Assuntos
Afro-Americanos , Micronutrientes/administração & dosagem , Nascimento Prematuro/prevenção & controle , Vitaminas/administração & dosagem , Adulto , Cálcio na Dieta/administração & dosagem , Colo do Útero , Feminino , Ácido Fólico/administração & dosagem , Promoção da Saúde/métodos , Humanos , Fenômenos Fisiológicos da Nutrição Materna , Gravidez , Vitamina A/administração & dosagem , Adulto Jovem , Zinco/administração & dosagem
17.
J Midwifery Womens Health ; 62(1): 40-48, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27926797

RESUMO

INTRODUCTION: High rates of cesarean birth are a significant health care quality issue, and birth centers have shown potential to reduce rates of cesarean birth. Measuring this potential is complicated by lack of randomized trials and limited observational comparisons. Cesarean rates vary by provider type, setting, and clinical and nonclinical characteristics of women, but our understanding of these dynamics is incomplete. METHODS: We sought to isolate labor setting from other risk factors in order to assess the effect of birth centers on the odds of cesarean birth. We generated low-risk cohorts admitted in labor to hospitals (n = 2527) and birth centers (n = 8776) using secondary data obtained from the American Association of Birth Centers (AABC). All women received prenatal care in the birth center and midwifery care in labor, but some chose hospital admission for labor. Analysis was intent to treat according to site of admission in spontaneous labor. We used propensity score adjustment and multivariable logistic regression to control for cohort differences and measured effect sizes associated with setting. RESULTS: There was a 37% (adjusted odds ratio [OR], 0.63; 95% confidence interval [CI], 0.50-0.79) to 38% (adjusted OR, 0.62; 95% CI, 0.49-0.79) decreased odds of cesarean in the birth center cohort and a remarkably low overall cesarean rate of less than 5% in both cohorts. DISCUSSION: These findings suggest that low rates of cesarean in birth centers are not attributable to labor setting alone. The entire birth center care model, including prenatal preparation and relationship-based midwifery care, should be studied, promoted, and implemented by policy makers interested in achieving appropriate cesarean rates in the United States.


Assuntos
Centros de Assistência à Gravidez e ao Parto , Cesárea , Hospitais , Adulto , Estudos de Coortes , Feminino , Hospitalização , Humanos , Modelos Logísticos , Serviços de Saúde Materna , Tocologia , Razão de Chances , Gravidez , Fatores de Risco , Estados Unidos , Adulto Jovem
18.
Obstet Gynecol ; 128(4): 880-888, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27607874

RESUMO

OBJECTIVE: To examine the association between pregnancy status and in-hospital mortality after cardiopulmonary resuscitation (CPR) in an inpatient setting. METHODS: We conducted a population-based cross-sectional study using the Nationwide Inpatient Sample databases (2002-2011). International Classification of Diseases, 9th Revision, Clinical Modification codes were used to define cases, comorbidities, and clinical outcomes. Rates of CPR among study groups were calculated by patient and hospital characteristics. Survey logistic regression was used to estimate adjusted odds ratios (ORs) that represent the association between pregnancy status and mortality after CPR. Joinpoint regression was used to describe temporal trends in CPR and mortality rates. RESULTS: During the study period, 5,923 women (13-49 years) received inpatient CPR annually. Cardiopulmonary resuscitation rates increased significantly from 2002 to 2011, by 6.4% and 3.8% annually, for pregnant and nonpregnant women, respectively. In-hospital mortality rates after CPR were lower among pregnant women 49.4% (45.4-53.4) than nonpregnant women 71.1% (70.1-72.2), even after adjusting for confounders (adjusted OR 0.46, 95% confidence interval 0.39-0.56). CONCLUSION: Cardiopulmonary resuscitation in an inpatient pregnant woman is associated with improved survival compared with this procedure in nonpregnant women. Elucidating reasons behind this association could help to improve CPR outcomes in both pregnant and nonpregnant women.


Assuntos
Reanimação Cardiopulmonar/estatística & dados numéricos , Pacientes Internados , Avaliação de Resultados em Cuidados de Saúde , Assistência Perinatal , Complicações Cardiovasculares na Gravidez/terapia , Adolescente , Adulto , Estudos de Casos e Controles , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Complicações Cardiovasculares na Gravidez/mortalidade , Taxa de Sobrevida , Estados Unidos/epidemiologia , Adulto Jovem
19.
Ultrasound Med Biol ; 41(11): 3023-9, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26259887

RESUMO

The purpose of this study was to determine whether cervical ultrasonic attenuation could identify women at risk of spontaneous preterm birth. During pregnancy, women (n = 67) underwent from one to five transvaginal ultrasonic examinations to estimate cervical ultrasonic attenuation and cervical length. Ultrasonic data were obtained with a Zonare ultrasound system with a 5- to 9-MHz endovaginal transducer and processed offline. Cervical ultrasonic attenuation was lower at 17-21 wk of gestation in the SPTB group (1.02 dB/cm-MHz) than in the full-term birth groups (1.34 dB/cm-MHz) (p = 0.04). Cervical length was shorter (3.16 cm) at 22-26 wk in the SPTB group than in the women delivering full term (3.68 cm) (p = 0.004); cervical attenuation was not significantly different at this time point. These findings suggest that low attenuation may be an additional early cervical marker to identify women at risk for SPTB.


Assuntos
Colo do Útero/diagnóstico por imagem , Nascimento Prematuro/diagnóstico por imagem , Ultrassonografia Pré-Natal , Adulto , Feminino , Humanos , Projetos Piloto , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez
20.
Nurs Womens Health ; 19(3): 216-23, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26058904

RESUMO

Adolescents often avoid seeing a health care provider to obtain contraception because they do not want to undergo a pelvic exam and Pap screening for fear of stress, pain or embarrassment. The purpose of this quality improvement project was to study health care workers, attitudes and beliefs about Pap screening and to educate them on the latest evidence-based guidelines, with the hope of ultimately decreasing unnecessary screening. Results showed a modest reduction in the frequency of Pap screening; however, many adolescents continued to undergo unnecessary Pap screening. The reluctance of health care workers to change their practice demonstrates the need for better methods of translating evidence-based guidelines into practice.


Assuntos
Atitude do Pessoal de Saúde , Anticoncepção/tendências , Pessoal de Saúde/psicologia , Programas de Rastreamento/métodos , Teste de Papanicolaou/psicologia , Adolescente , Criança , Humanos , Inquéritos e Questionários , Adulto Jovem
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