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1.
Medicine (Baltimore) ; 100(22): e26129, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087863

RESUMO

ABSTRACT: Early detection of arterial hypotension during cesarean delivery under spinal anesthesia is important. This study aims to compare the validity of NexfinTM as beat-to-beat noninvasive blood pressure monitoring with conventional intermittent oscillometric measurement of blood pressure during elective cesarean delivery.This open prospective observational bicentric study was performed between January 2013 and December 2015. We simultaneously recorded arterial blood pressure with both techniques in pregnant women undergoing elective cesarean delivery under spinal anesthesia. The primary outcome was a Bland-Altman analysis of systolic blood pressure measurement comparing NexfinTM and a conventional method. The secondary outcomes were the time to detect the first relevant hypotensive episode and the comparison of both devices using a four-quadrant graph.One hundred and seventy-four parturients completed the study, and 2640 pairs of systolic blood pressure measurements were analyzed. Bias was -10 mmHg with upper and lower limits of agreement of -61 and +41 mmHg. In 73.9% of the cases, the two techniques provided the same information (normotension or hypotension), but the conventional method missed 20.8% of measurements, with NexfinTM detecting 16.2% more hypotensive measurements. The median [25-75 percentiles] duration to detect the first hypotensive measurement was 331 [206-480] seconds for NexfinTM and 440 [300-500] s for intermittent oscillometry (P < .001).The agreement between NexfinTM and an intermittent method for the measurement of systolic blood pressure was not in an acceptable range during cesarean delivery, although NexfinTM may detect hypotension earlier than the standard method.Trial registration: Clinicaltrials.gov identifier: NCT01732133; November 22, 2012.


Assuntos
Raquianestesia/efeitos adversos , Determinação da Pressão Arterial/métodos , Cesárea/métodos , Hipotensão/induzido quimicamente , Hipotensão/diagnóstico , Adulto , Índice de Apgar , Pressão Arterial , Determinação da Pressão Arterial/normas , Monitores de Pressão Arterial , Pesos e Medidas Corporais , Feminino , Humanos , Gravidez , Estudos Prospectivos , Reprodutibilidade dos Testes
2.
Medicine (Baltimore) ; 100(18): e25767, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950964

RESUMO

ABSTRACT: To investigate the effect of cervical cerclage or conservative treatment on maternal and neonatal outcomes in singleton gestations with a sonographic short cervix, and further compare the relative treatment value.A retrospective study was conducted among women with singleton gestations who had a short cervical length (<25 mm) determined by ultrasound during the period of 14 to 24 weeks' gestation in our institution. We collected clinical data and grouped the patients according to a previous spontaneous preterm birth (PTB) at <34 weeks of gestation or second trimester loss (STL) and sub-grouped according to treatment option, further comparing the maternal and neonatal outcomes between different groups.In the PTB or STL history cohort, the cerclage group had a later gestational age at delivery (35.3 ±â€Š3.9 weeks vs 31.6 ±â€Š6.7 weeks) and a lower rate of perinatal deaths (2% vs 29.3%) compared with the conservative treatment group. In the non-PTB-STL history cohort, the maternal and neonatal outcomes were not significantly different between the cerclage group and conservative treatment group. More importantly, for patients with a sonographic short cervix who received cervical cerclage, there was no significant difference in the maternal and neonatal outcomes between the non-PTB-STL group and PTB or STL group.For singleton pregnant with a history of spontaneous PTB or STL and a short cervical length (<25 mm), cervical cerclage can significantly improve maternal and neonatal outcomes; however, conservative treatment (less invasive and expensive than cervical cerclage) was more suitable for those pregnant women without a previous PTB and STL history.


Assuntos
Aborto Espontâneo/epidemiologia , Cerclagem Cervical/estatística & dados numéricos , Colo do Útero/anormalidades , Tratamento Conservador/estatística & dados numéricos , Nascimento Prematuro/epidemiologia , Aborto Espontâneo/etiologia , Aborto Espontâneo/prevenção & controle , Adulto , Índice de Apgar , Peso ao Nascer , Cerclagem Cervical/economia , Colo do Útero/diagnóstico por imagem , Colo do Útero/cirurgia , Tratamento Conservador/economia , Feminino , Idade Gestacional , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Morte Perinatal/prevenção & controle , Gravidez , Resultado da Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia
3.
Artigo em Inglês | MEDLINE | ID: mdl-33946326

RESUMO

Neonatal brain injury or neonatal encephalopathy (NE) is a significant morbidity and mortality factor in preterm and full-term newborns. NE has an incidence in the range of 2.5 to 3.5 per 1000 live births carrying a considerable burden for neurological outcomes such as epilepsy, cerebral palsy, cognitive impairments, and hydrocephaly. Many scoring systems based on different risk factor combinations in regression models have been proposed to predict abnormal outcomes. Birthweight, gestational age, Apgar scores, pH, ultrasound and MRI biomarkers, seizures onset, EEG pattern, and seizure duration were the most referred predictors in the literature. Our study proposes a decision-tree approach based on clinical risk factors for abnormal outcomes in newborns with the neurological syndrome to assist in neonatal encephalopathy prognosis as a complementary tool to the acknowledged scoring systems. We retrospectively studied 188 newborns with associated encephalopathy and seizures in the perinatal period. Etiology and abnormal outcomes were assessed through correlations with the risk factors. We computed mean, median, odds ratios values for birth weight, gestational age, 1-min Apgar Score, 5-min Apgar score, seizures onset, and seizures duration monitoring, applying standard statistical methods first. Subsequently, CART (classification and regression trees) and cluster analysis were employed, further adjusting the medians. Out of 188 cases, 84 were associated to abnormal outcomes. The hierarchy on etiology frequencies was dominated by cerebrovascular impairments, metabolic anomalies, and infections. Both preterms and full-terms at risk were bundled in specific categories defined as high-risk 75-100%, intermediate risk 52.9%, and low risk 0-25% after CART algorithm implementation. Cluster analysis illustrated the median values, profiling at a glance the preterm model in high-risk groups and a full-term model in the inter-mediate-risk category. Our study illustrates that, in addition to standard statistics methodologies, decision-tree approaches could provide a first-step tool for the prognosis of the abnormal outcome in newborns with encephalopathy.


Assuntos
Lesões Encefálicas , Epilepsia , Índice de Apgar , Eletroencefalografia , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Estudos Retrospectivos , Convulsões/epidemiologia
4.
BMC Pregnancy Childbirth ; 21(1): 378, 2021 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-34001013

RESUMO

BACKGROUND: Physiological changes during pregnancy put pregnant women at higher risk for COVID-19 complications. The objective of this study was to evaluate clinical and laboratory characteristics and outcomes of 24 COVID-19 pregnant patients and their newborns referred to the Al-Zahra tertiary maternity hospital in Tabriz, Iran. METHODS: Clinical records of 24 COVID-19 confirmed pregnant patients were retrospectively reviewed from10 March 2020 to 15 April 2020. Vertical transition was assessed through neonatal pharyngeal swab samples. The study has been approved by the Tabriz University Medical Ethics Committee (IR.TBZMED.REC.1399.497). RESULTS: There were 24 hospitalized cases with clinical symptoms and confirmed diagnosis of COVID-19. The mean age of cases was 26.5 years; most were nulliparous (54.2%), in their third trimester (62.5%) and were in the type A blood group. Clinical symptoms in order of prevalence were cough, fever, dyspnea, myalgia, anosmia, and diarrhea. Oxygen saturation (SpO2) in 70.8% cases was in the normal range (greater than 93%). The risk of premature labor or abortion in cases showed no increase. 12 cases were in ongoing normal status; on follow up, 11 cases had delivered their babies at term and one had ended in IUFD because of pregnancy-induced hypertension. All delivered babies were healthy. Caesarean section in all cases was performed under obstetric indications or maternal demand, and no relation was found between COVID-19 and Caesarean delivery. Neonatal outcomes according to gestational age in 8 cases out of 11 (72.72%) were desirable; neonatal morbidity and mortality resulted from pregnancy complications. Blood pH in 6 neonates was assessed due to immaturity and NICU admission, all of which were in normal ranges except one case related to HELLP syndrome. There was no evidence of vertical transmission. CONCLUSIONS: Findings suggest that clinical symptoms in pregnancy were similar to non-pregnant women, no rise in risk of premature labor or abortion was seen, and vertical transmission was not observed in none of cases. Lymphopenia was the leading laboratory change. Given asymptomatic cases despite severe forms of infection in pregnancies, we propose screening in all suspected cases. All placentas and newborns should be tested in the field for vertical transmission.


Assuntos
COVID-19/epidemiologia , Hospitalização , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez , Adolescente , Adulto , Índice de Apgar , Peso ao Nascer , Cesárea/estatística & dados numéricos , Parto Obstétrico , Feminino , Humanos , Recém-Nascido , Irã (Geográfico)/epidemiologia , Contagem de Leucócitos , Oxigênio/sangue , Pré-Eclâmpsia , Gravidez , Estudos Retrospectivos , Adulto Jovem
5.
Nutrients ; 13(3)2021 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-33799943

RESUMO

Iodine is an essential micronutrient for the synthesis of thyroid hormones. The proper functioning of the thyroid axis is essential for the normal development of the nervous system, especially in the first trimester of gestation. The aim of the present study was to analyze the perinatal outcomes, anthropometry, and APGAR test scores of newborns and to relate them to maternal thyroid status. A total of 190 newborns participated in the study. No correlation was found between thyroid stimulating hormone (TSH) and maternal ioduria values in the first trimester of gestation with the weight or length of the newborn, or the APGAR score at one minute after birth. However, we found significant differences between the APGAR scores of children whose mothers had an iodine sufficiency level in the first trimester compared to the children of mothers with iodine deficiency. Similarly, the APGAR scores of children whose mothers had a TSH > 4 have significantly better APGAR scores than the children of mothers with a TSH < 4. Likewise, we found significant differences between the measurements of the newborns depending on whether their mothers smoked. The children of mothers who took iodine supplements or iodized salt obtained the highest APGAR score at one and five minutes after birth. It is essential to focus on recommending adequate consumption of iodine supplements and iodized salt prior to gestation and at least during the first trimester to achieve better fetal well-being.


Assuntos
Iodo/análise , Resultado da Gravidez , Primeiro Trimestre da Gravidez/sangue , Primeiro Trimestre da Gravidez/urina , Tireotropina/sangue , Adulto , Antropometria , Índice de Apgar , Suplementos Nutricionais/estatística & dados numéricos , Feminino , Humanos , Hipotireoidismo/sangue , Hipotireoidismo/urina , Recém-Nascido , Iodo/deficiência , Iodo/urina , Fenômenos Fisiológicos da Nutrição Materna , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/urina , Cuidado Pré-Natal/estatística & dados numéricos , Cloreto de Sódio na Dieta/análise , Glândula Tireoide/fisiopatologia
6.
BMC Pregnancy Childbirth ; 21(1): 285, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33836690

RESUMO

BACKGROUND: Routine assessment in (near) term pregnancy is often inaccurate for the identification of fetuses who are mild to moderately compromised due to placental insufficiency and are at risk of adverse outcomes, especially when fetal size is seemingly within normal range for gestational age. Although biometric measurements and cardiotocography are frequently used, it is known that these techniques have low sensitivity and specificity. In clinical practice this diagnostic uncertainty results in considerable 'over treatment' of women with healthy fetuses whilst truly compromised fetuses remain unidentified. The CPR is the ratio of the umbilical artery pulsatility index over the middle cerebral artery pulsatility index. A low CPR reflects fetal redistribution and is thought to be indicative of placental insufficiency independent of actual fetal size, and a marker of adverse outcomes. Its utility as an indicator for delivery in women with reduced fetal movements (RFM) is unknown. The aim of this study is to assess whether expedited delivery of women with RFM identified as high risk on the basis of a low CPR improves neonatal outcomes. Secondary aims include childhood outcomes, maternal obstetric outcomes, and the predictive value of biomarkers for adverse outcomes. METHODS: International multicentre cluster randomised trial of women with singleton pregnancies with RFM at term, randomised to either an open or concealed arm. Only women with an estimated fetal weight ≥ 10th centile, a fetus in cephalic presentation and normal cardiotocograph are eligible and after informed consent the CPR will be measured. Expedited delivery is recommended in women with a low CPR in the open arm. Women in the concealed arm will not have their CPR results revealed and will receive routine clinical care. The intended sample size based on the primary outcome is 2160 patients. The primary outcome is a composite of: stillbirth, neonatal mortality, Apgar score < 7 at 5 min, cord pH < 7.10, emergency delivery for fetal distress, and severe neonatal morbidity. DISCUSSION: The CEPRA trial will identify whether the CPR is a good indicator for delivery in women with perceived reduced fetal movements. TRIAL REGISTRATION: Dutch trial registry (NTR), trial NL7557 . Registered 25 February 2019.


Assuntos
Sofrimento Fetal/prevenção & controle , Movimento Fetal/fisiologia , Trabalho de Parto Induzido/normas , Artéria Cerebral Média/diagnóstico por imagem , Insuficiência Placentária/diagnóstico , Artérias Umbilicais/diagnóstico por imagem , Adulto , Índice de Apgar , Tomada de Decisão Clínica/métodos , Feminino , Sofrimento Fetal/etiologia , Sofrimento Fetal/fisiopatologia , Seguimentos , Humanos , Recém-Nascido , Artéria Cerebral Média/fisiopatologia , Estudos Multicêntricos como Assunto , Mortalidade Perinatal , Insuficiência Placentária/fisiopatologia , Guias de Prática Clínica como Assunto , Valor Preditivo dos Testes , Gravidez , Terceiro Trimestre da Gravidez , Fluxo Pulsátil/fisiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco/métodos , Natimorto , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Pré-Natal , Artérias Umbilicais/fisiopatologia
7.
Int J Mol Sci ; 22(6)2021 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-33806988

RESUMO

The effect of perinatal asphyxia (PA) on oligodendrocyte (OL), neuroinflammation, and cell viability was evaluated in telencephalon of rats at postnatal day (P)1, 7, and 14, a period characterized by a spur of neuronal networking, evaluating the effect of mesenchymal stem cell (MSCs)-treatment. The issue was investigated with a rat model of global PA, mimicking a clinical risk occurring under labor. PA was induced by immersing fetus-containing uterine horns into a water bath for 21 min (AS), using sibling-caesarean-delivered fetuses (CS) as controls. Two hours after delivery, AS and CS neonates were injected with either 5 µL of vehicle (10% plasma) or 5 × 104 MSCs into the lateral ventricle. Samples were assayed for myelin-basic protein (MBP) levels; Olig-1/Olig-2 transcriptional factors; Gglial phenotype; neuroinflammation, and delayed cell death. The main effects were observed at P7, including: (i) A decrease of MBP-immunoreactivity in external capsule, corpus callosum, cingulum, but not in fimbriae of hippocampus; (ii) an increase of Olig-1-mRNA levels; (iii) an increase of IL-6-mRNA, but not in protein levels; (iv) an increase in cell death, including OLs; and (v) MSCs treatment prevented the effect of PA on myelination, OLs number, and cell death. The present findings show that PA induces regional- and developmental-dependent changes on myelination and OLs maturation. Neonatal MSCs treatment improves survival of mature OLs and myelination in telencephalic white matter.


Assuntos
Asfixia/metabolismo , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/metabolismo , Bainha de Mielina/metabolismo , Animais , Animais Recém-Nascidos , Índice de Apgar , Asfixia/etiologia , Biomarcadores , Encéfalo/metabolismo , Encéfalo/patologia , Diferenciação Celular , Sobrevivência Celular , Citocinas/genética , Citocinas/metabolismo , Expressão Gênica , Hipocampo/metabolismo , Hipocampo/patologia , Imuno-Histoquímica , Mediadores da Inflamação , Células-Tronco Mesenquimais/citologia , Bainha de Mielina/patologia , Neuroglia/imunologia , Neuroglia/metabolismo , Oligodendroglia/metabolismo , RNA Mensageiro , Ratos
8.
Med Sci Monit ; 27: e929283, 2021 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-33720924

RESUMO

BACKGROUND We aimed to explore the factors leading to epidural-related maternal fever and the influence of intrapartum fever on neonates. MATERIAL AND METHODS A retrospective analysis was performed on data from pregnant women who received epidural analgesia during labor. The primary aim was to determine the influence of epidural labor analgesia on the incidence of intrapartum fever in pregnant women. The secondary aim was to determine the influence of intrapartum fever on neonates. RESULTS Logistic regression analysis showed that premature rupture of membranes (OR=2.008, 95% CI: 1.551-2.600), vaginal examination performed more than 6 times (OR=1.681, 95% CI: 1.286-2.197), long duration of labor (OR=1.090, 95% CI: 1.063-1.118), and long time from rupture of membranes to delivery (OR=1.048, 95% CI: 1.010-1.087) were all risk factors for intrapartum fever in pregnant women with epidural labor analgesia. Regarding the secondary research outcome, the incidence of intrapartum fever was significantly associated with the number of neonates with Apgar score of 10 delivered from pregnant women with epidural labor analgesia (P<0.05). There was no statistically significant difference in the transfer rate of newborns to the Neonatal Intensive Care Unit (NICU) (P>0.05). CONCLUSIONS Premature rupture of membranes, vaginal examination performed more than 6 times, long duration of labor, and long time from rupture of membranes to delivery are all factors raising the risk of fever during epidural labor analgesia. Although intrapartum fever in the mothers had a significant influence on the number of neonates with Apgar score of 10, it did not affect the outcome of neonates in terms of NICU transfer rate.


Assuntos
Anestesia Epidural/efeitos adversos , Febre/etiologia , Adulto , Índice de Apgar , China , Feminino , Febre/epidemiologia , Febre/fisiopatologia , Humanos , Recém-Nascido , Trabalho de Parto , Complicações do Trabalho de Parto/epidemiologia , Gravidez , Gestantes , Estudos Retrospectivos , Fatores de Risco
9.
Zhongguo Dang Dai Er Ke Za Zhi ; 23(3): 283-287, 2021 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-33691923

RESUMO

A healthy full-term female neonate, aged 3 days and born by vaginal delivery (with a 1-minute Apgar score of 10 and a 5-minute Apgar score of 10), had unexpected cardiac and respiratory arrests in the early morning on day 3 after birth and recovered to spontaneous breathing and heartbeat after a 10-minute resuscitation. The child had poor response and convulsion after resuscitation. Blood gas analysis showed metabolic acidosis, and amplitude-integrated EEG showed a burst-suppression pattern. She was diagnosed with sudden unexpected postnatal collapse but improved after hypothermia and symptomatic/supportive treatment. This article reports the first case of sudden unexpected postnatal collapse in China and summarizes related risk factors, pathophysiological mechanisms, and preventive and treatment measures of this disorder.


Assuntos
Ressuscitação , Índice de Apgar , Criança , Pré-Escolar , China , Feminino , Humanos , Recém-Nascido , Gravidez , Fatores de Risco
10.
Medicine (Baltimore) ; 100(11): e25023, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33725977

RESUMO

ABSTRACT: Pernicious placenta previa (PEPP) is a severe complication of late pregnancy, which might result in adverse maternal-fetal outcome. To explore the application value of placenta accreta score (PAS) for PEPP and its association with maternal-fetal outcome.In this retrospective cohort study, the clinical data of PEPP patients were analyzed. According to the ultrasonic PAS, patients were grouped into 3 groups: scores ≤5, a scores between 6 and 9, and scores ≥10. The clinical data, intraoperative and postoperative outcomes were collected. Receiver operating characteristic (ROC) curves were used to evaluate the performance of PAS in disease severity evaluation. Multivariate logistic and linear regression analysis were performed to assess associations of PAS with intraoperative and postoperative outcomes.A total of 231 patients were enrolled. There were significant differences in intraoperative, postoperative and neonatal outcomes, such as operation time, bladder repair, ICU admission, postoperative hospitalization days, operation complications, Apgar score of newborns in 1 minute and premature delivery among the 3 groups (all P < .05), while the worst outcomes were found in those with a score ≥ 10 (all P < .05). According to ROC curves, scores <5.5, between 5.5 and 7.5, and >7.5 indicated placenta accreta, placenta increta and placenta percreta, respectively. PAS was independently associated with longer time of operation, surgical complications, intraoperative bleeding volume, and postoperative hospitalization days (all P < .05).Placenta accreta score might help with PEPP subtype diagnosis and predict the maternal-fetal outcome of PEPP patients.


Assuntos
Placenta Acreta/diagnóstico , Placenta Prévia/diagnóstico , Índice de Gravidade de Doença , Adulto , Índice de Apgar , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Recém-Nascido , Modelos Logísticos , Duração da Cirurgia , Placenta Acreta/cirurgia , Placenta Prévia/cirurgia , Valor Preditivo dos Testes , Gravidez , Resultado da Gravidez , Curva ROC , Estudos Retrospectivos , Adulto Jovem
11.
BMC Pregnancy Childbirth ; 21(1): 256, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33771115

RESUMO

BACKGROUND: Waterbirth is widely available in English maternity settings for women who are not at increased risk of complications during labour. Immersion in water during labour is associated with a number of maternal benefits. However for birth in water the situation is less clear, with conclusive evidence on safety lacking and little known about the characteristics of women who give birth in water. This retrospective cohort study uses electronic data routinely collected in the course of maternity care in England in 2015-16 to describe the proportion of births recorded as having occurred in water, the characteristics of women who experienced waterbirth and the odds of key maternal and neonatal complications associated with giving birth in water. METHODS: Data were obtained from three population level electronic datasets linked together for the purposes of a national audit of maternity care. The study cohort included women who had no risk factors requiring them to give birth in an obstetric unit according to national guidelines. Multivariate logistic regression models were used to examine maternal (postpartum haemorrhage of 1500mls or more, obstetric anal sphincter injury (OASI)) and neonatal (Apgar score less than 7, neonatal unit admission) outcomes associated with waterbirth. RESULTS: 46,088 low and intermediate risk singleton term spontaneous vaginal births in 35 NHS Trusts in England were included in the analysis cohort. Of these 6264 (13.6%) were recorded as having occurred in water. Waterbirth was more likely in older women up to the age of 40 (adjusted odds ratio (adjOR) for age group 35-39 1.27, 95% confidence interval (1.15,1.41)) and less common in women under 25 (adjOR 18-24 0.76 (0.70, 0.82)), those of higher parity (parity ≥3 adjOR 0.56 (0.47,0.66)) or who were obese (BMI 30-34.9 adjOR 0.77 (0.70,0.85)). Waterbirth was also less likely in black (adjOR 0.42 (0.36, 0.51)) and Asian (adjOR 0.26 (0.23,0.30)) women and in those from areas of increased socioeconomic deprivation (most affluent versus least affluent areas adjOR 0.47 (0.43, 0.52)). There was no association between delivery in water and low Apgar score (adjOR 0.95 (0.66,1.36)) or incidence of OASI (adjOR 1.00 (0.86,1.16)). There was an association between waterbirth and reduced incidence of postpartum haemorrhage (adjOR 0.68 (0.51,0.90)) and neonatal unit admission (adjOR 0.65 (0.53,0.78)). CONCLUSIONS: In this large observational cohort study, there was no association between waterbirth and specific adverse outcomes for either the mother or the baby. There was evidence that white women from higher socioeconomic backgrounds were more likely to be recorded as giving birth in water. Maternity services should focus on ensuring equitable access to waterbirth.


Assuntos
Banhos/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Parto Normal/métodos , Hemorragia Pós-Parto/epidemiologia , Adolescente , Adulto , Fatores Etários , Índice de Apgar , Inglaterra , Feminino , Humanos , Incidência , Recém-Nascido de Baixo Peso , Recém-Nascido , Parto Normal/efeitos adversos , Parto Normal/estatística & dados numéricos , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/prevenção & controle , Gravidez , Estudos Retrospectivos , Fatores Socioeconômicos , Adulto Jovem
12.
Am J Obstet Gynecol ; 224(5): 445-469, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33600780

RESUMO

OBJECTIVE: Brain death (BD) during pregnancy might justify in select cases maternal somatic support to obtain fetal viability and maximize perinatal outcome. This study is a systematic review of the literature on cases of brain death in pregnancy with attempt to prolong pregnancy to assess perinatal outcomes. DATA SOURCES: We performed a systematic review of the literature using Ovid MEDLINE, Scopus, PubMed (including Cochrane database), and CINHAIL from inception to April 2020. STUDY ELIGIBILITY CRITERIA: Relevant articles describing any case report of maternal brain death were identified from the aforementioned databases without any time, language, or study limitations. Studies were deemed eligible for inclusion if they described at least 1 case of maternal brain death. METHODS: Only cases of brain death in pregnancy with maternal somatic support aimed at maximizing perinatal outcome were included. Maternal management strategy, diagnosis, clinical course, fetal monitoring, delivery, and fetal and neonatal outcome data were collected. Mean, range, standard deviation, and percentage calculations were used as applicable. RESULTS: After exclusion, 35 cases of brain death in pregnancy were analyzed. The mean gestational age at diagnosis of brain death was at 20.2±5.3 weeks, and most cases (68%) were associated with maternal intracranial hemorrhage, subarachnoid hemorrhage, and hematoma. The most common maternal complications during the study were infections (69%) (eg, pneumonia, urinary tract infection, sepsis), circulatory instability (63%), diabetes insipidus (56%), thermal variability (41%), and panhypopituitarism (34%). The most common indications for delivery were maternal cardiocirculatory instability (38%) and nonreassuring fetal testing (35%). The mean gestational age at delivery was 27.2±4.7 weeks and differed depending on the gestational age at diagnosis of brain death. Most deliveries (89%) were via cesarean delivery. There were 8 cases (23%) of intrauterine fetal demise in the second trimester of pregnancy (14-25 weeks), and 27 neonates (77%) were born alive. Of the 35 cases of brain in pregnancy, 8 neonates (23%) were described as "healthy" at birth, 15 neonates (43%) had normal longer-term follow-up (>1 month to 8 years; mean, 20.3 months), 2 neonates (6%) had neurologic sequelae (born at 23 and 24 weeks of gestation), and 2 neonates (6%) died (born at 25 and 27 weeks of gestation). Mean birth weight was 1,229 grams, and small for gestational age was present in 17% of neonates. The rate of live birth differed by gestational age at diagnosis of brain death: 50% at <14 weeks, 54.5% at 14 to 19 6/7 weeks, 91.7% at 20 to 23 6/7 weeks, 100% at 24 to 27 6/7 weeks, and 100% at 28 to 31 6/7 weeks. CONCLUSION: In 35 cases of brain death in pregnancy at a mean gestation age of 20 weeks, maternal somatic support aimed at maximizing perinatal outcome lasted for about 7 weeks, with 77% of neonates being born alive and 85% of these infants having a normal outcome at 20 months of life. The data of this study will be helpful in counseling families and practitioners faced with such rare and complex cases.


Assuntos
Morte Encefálica , Complicações na Gravidez/etiologia , Índice de Apgar , Feminino , Morte Fetal , Monitorização Fetal , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Cuidados para Prolongar a Vida , Nascido Vivo , Doenças do Sistema Nervoso/etiologia , Morte Perinatal , Gravidez , Manutenção da Gravidez , Nascimento Prematuro/etiologia
13.
Int J Gynaecol Obstet ; 153(3): 449-456, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33638200

RESUMO

OBJECTIVE: To determine the maternal and neonatal outcomes of pregnant women with COVID-19 infection. METHODS: A cohort study was conducted on 56 pregnant women with COVID-19 and 94 healthy pregnant women during the COVID-19 epidemic in Iran. Two groups were followed until childbirth. Demographic and obstetric information, clinical symptoms, laboratory and radiographic findings of the patients, and maternal and neonatal outcomes of the two groups were gathered by a checklist. Data were analyzed using SPSS version 16. A P value < 0.05 was considered significant. RESULTS: The two groups were similar in terms of maternal age, gravida, parity, and co-morbidities (P > 0.05). The rate of cesarean delivery in the exposed group was higher than that in the control group (P = 0.027; relative risk [RR] =2.23). Pre-eclampsia was seen in 19.8% of the exposed group and 7.4% of the control group (P = 0.037; RR = 2.68). The rate of preterm labor in the exposed group was higher than that in the control group (P = 0.003; RR = 2.70). Fetal distress was seen in 16.1% of the exposed group and 4.3% of the control group (P = 0.016; RR = 3.84). CONCLUSION: Pregnant women with COVID-19 had an increased risk of pre-eclampsia, preterm labor, and cesarean delivery. Their fetal and neonatal outcomes were fetal distress, newborn prematurity, and low Apgar score.


Assuntos
COVID-19/epidemiologia , Sofrimento Fetal/epidemiologia , Trabalho de Parto Prematuro/epidemiologia , Pré-Eclâmpsia/epidemiologia , Complicações na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Índice de Apgar , Cesárea/estatística & dados numéricos , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Irã (Geográfico)/epidemiologia , Gravidez , Estudos Prospectivos , SARS-CoV-2 , Adulto Jovem
14.
BMC Pregnancy Childbirth ; 21(1): 111, 2021 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-33549038

RESUMO

BACKGROUND: Maternal obesity and gestational diabetes (GDM) are commonly encountered during pregnancy. Both conditions are independently associated with unfavorable pregnancy consequences. The objective of this study was to compare the effects of obesity and GDM on birth weight, macrosomia, and other adverse pregnancy outcomes. METHODS: This cohort study involved 531 women with a singleton pregnancy attending the Maternity and Children's Hospital, Medina, Saudi Arabia, between June 2014 and June 2015. Participants underwent a 75-g oral glucose tolerance test between 24 and 28 weeks. The International Association of Diabetes and Pregnancy Study Groups criteria were used for GDM diagnosis. BMI was assessed at the first antenatal visit, and obesity was defined as a BMI ≥30.0 kg/m2. All women were followed up until delivery. Women were divided into 4 groups: non-GDM nonobese (reference group), GDM nonobese, obese non-GDM, and obese GDM. Clinical characteristics and adverse pregnancy outcomes were compared. RESULTS: The mean age and BMI of the participants were 30.5 years and 29.3 kg/m2, respectively. GDM was diagnosed in 50.2% of the participants, and obesity was diagnosed in 47.8% of the participants. Obese women with GDM were the oldest and heaviest among all women. The mean birth weight increased in order among the four groups; it was highest in the infants in the obese GDM group, followed by those in the obese non-GDM, GDM nonobese and reference groups. Obesity and GDM alone or in combination were associated with higher rates of macrosomia and cesarean deliveries than the reference group. Neonatal intensive care unit (NICU) admission was higher in infants in the GDM nonobese and obese GDM groups. The frequency of low Apgar score was significantly higher in infants in the obese GDM group than in infants in the reference group. CONCLUSIONS: Maternal obesity seems to influence birth weight more than GDM, while GDM is associated with a greater risk of admission to the NICU. The combination of both conditions is associated with the greatest risk of adverse pregnancy outcomes.


Assuntos
Peso ao Nascer , Diabetes Gestacional/epidemiologia , Obesidade Materna/epidemiologia , Índice de Apgar , Índice de Massa Corporal , Cesárea , Estudos de Coortes , Feminino , Macrossomia Fetal/epidemiologia , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Admissão do Paciente , Gravidez , Arábia Saudita/epidemiologia
15.
J Obstet Gynaecol Res ; 47(4): 1322-1329, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33496028

RESUMO

AIM: To evaluate whether there is a statistically significant difference between the cord blood gas parameters of pregnancies complicated with preeclampsia and uncomplicated pregnancies and to show whether the amount of proteinuria affects fetal cord blood gas parameters in pregnancies complicated with preeclampsia. METHODS: The study was designed retrospectively. Between 2016 and 2019, the neonatal results and cord blood gas results of 109 pregnant women who were diagnosed with preeclampsia and 75 nonpreeclamptic randomly selected pregnant women were compared. The preeclampsia group was divided into groups according to amount of proteinuria. SPSS 21.0 statistics program was used, and comparative analysis was carried out. RESULTS: The data of the 109 preeclampsia cases and 75 control groups included in the study were compared, and there was no statistical difference between the fetal cord blood gas parameters between the groups (p > 0.05). The median first and fifth minute Apgar scores were found significantly lower in the preeclampsia group compared to the control group (6, 8 and 8, 9, respectively; p < 0.001). Also, the amount of proteinuria does not alter cord blood gas parameters (p > 0.05). CONCLUSION: Preeclampsia poses a risk for the neonatal period as it reduces the neonatal Apgar scores due to the chronic hypoxic process it creates. However, it was observed that the amount of proteinuria, which is one of the diagnostic criteria, did not affect neonatal results on Apgar scores or fetal cord blood gas parameters.


Assuntos
Sangue Fetal , Pré-Eclâmpsia , Proteinúria , Índice de Apgar , Feminino , Sangue Fetal/química , Humanos , Recém-Nascido , Pré-Eclâmpsia/diagnóstico , Gravidez , Estudos Retrospectivos
16.
BMC Pregnancy Childbirth ; 21(1): 36, 2021 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-33413161

RESUMO

BACKGROUND: Fragile and conflict-affected states contribute with more than 60% of the global burden of maternal mortality. There is an alarming need for research exploring maternal health service access and quality and adaptive responses during armed conflict. Taiz Houbane Maternal and Child Health Hospital in Yemen was established during the war as such adaptive response. However, as number of births vastly exceeded the facility's pre-dimensioned capacity, a policy was implemented to restrict admissions. We here assess the restriction's effects on the quality of intrapartum care and birth outcomes. METHODS: A retrospective before and after study was conducted of all women giving birth in a high-volume month pre-restriction (August 2017; n = 1034) and a low-volume month post-restriction (November 2017; n = 436). Birth outcomes were assessed for all births (mode of birth, stillbirths, intra-facility neonatal deaths, and Apgar score < 7). Quality of intrapartum care was assessed by a criterion-based audit of all caesarean sections (n = 108 and n = 82) and of 250 randomly selected vaginal births in each month. RESULTS: Background characteristics of women were comparable between the months. Rates of labour inductions and caesarean sections increased significantly in the low-volume month (14% vs. 22% (relative risk (RR) 0.62, 95% confidence interval (CI) 0.45-0.87) and 11% vs. 19% (RR 0.55, 95% CI 0.42-0.71)). No other care or birth outcome indicators were significantly different. Structural and human resources remained constant throughout, despite differences in patient volume. CONCLUSIONS: Assumptions regarding quality of care in periods of high demand may be misguiding - resilience to maintain quality of care was strong. We recommend health actors to closely monitor changes in quality of care when implementing resource changes; to enable safe care during birth for as many women as possible.


Assuntos
Conflitos Armados , Coeficiente de Natalidade , Acesso aos Serviços de Saúde/organização & administração , Assistência Perinatal/normas , Qualidade da Assistência à Saúde/normas , Adolescente , Adulto , Índice de Apgar , Cesárea/estatística & dados numéricos , Intervalos de Confiança , Estudos Controlados Antes e Depois , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Eficiência Organizacional , Feminino , Humanos , Recém-Nascido , Trabalho de Parto Induzido/estatística & dados numéricos , Avaliação de Processos e Resultados em Cuidados de Saúde , Assistência Perinatal/estatística & dados numéricos , Morte Perinatal , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Natimorto/epidemiologia , Iêmen , Adulto Jovem
17.
BMC Pregnancy Childbirth ; 21(1): 31, 2021 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-33413225

RESUMO

BACKGROUND: Pregnancy associated cancer (PAC) may lead to adverse obstetric and neonatal outcomes. This study aims to assess the association between PACs and adverse perinatal outcomes [i.e. labor induction, iatrogenic delivery, preterm birth, small for gestational age (SGA) newborn, low Apgar score, major malformations, perinatal mortality] in Lombardy, Northern Italy. METHODS: This population-based historic cohort study used the certificate of delivery assistance and the regional healthcare utilization databases of Lombardy Region to identify beneficiaries of National Health Service who delivered between 2008 and 2017. PACs were defined through oncological ICD-9-CM codes reported in the hospital discharge forms. Each woman with PAC was matched to four women randomly selected from those cancer-free (1:4). Log-binomial regression models were fitted to estimate crude and adjusted prevalence ratio (aPR) and the corresponding 95% confidence interval (CI) of each perinatal outcome among PAC and cancer-free women. RESULTS: Out of the 657,968 deliveries, 831 PACs were identified (1.26 per 1000). PAC diagnosed during pregnancy was positively associated with labor induction or planned delivery (aPR=1.80, 95% CI: 1.57-2.07), cesarean section (aPR=1.78, 95% CI: 1.49-2.11) and premature birth (aPR=6.34, 95% CI: 4.59-8.75). No association with obstetric outcomes was found among PAC diagnosed in the post-pregnancy. No association of PAC, neither during pregnancy nor in post-pregnancy was found for SGA (aPR=0.71, 95% CI: 0.36-1.35 and aPR=1.04, 95% CI: 0.78-1.39, respectively), but newborn among PAC women had a lower birth weight (p-value< 0.001). Newborns of women with PAC diagnosed during pregnancy had a higher risk of borderline significance of a low Apgar score (aPR=2.65, 95% CI: 0.96-7.33) as compared to cancer-free women. CONCLUSION: PAC, especially when diagnosed during pregnancy, is associated with iatrogenic preterm delivery, compromising some neonatal heath indicators.


Assuntos
Neoplasias/complicações , Complicações Neoplásicas na Gravidez , Resultado da Gravidez , Adolescente , Adulto , Índice de Apgar , Peso ao Nascer , Cesárea/estatística & dados numéricos , Estudos de Coortes , Intervalos de Confiança , Bases de Dados Factuais , Parto Obstétrico , Feminino , Humanos , Doença Iatrogênica/epidemiologia , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Itália/epidemiologia , Trabalho de Parto Induzido/estatística & dados numéricos , Modelos Lineares , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Período Pós-Parto , Gravidez , Complicações Neoplásicas na Gravidez/diagnóstico , Complicações Neoplásicas na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto Jovem
18.
Anaesthesia ; 76(6): 777-784, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33428221

RESUMO

Hyperbaric bupivacaine spinal anaesthesia remains the gold standard for elective caesarean section, but the resultant clinical effects can be unpredictable. Hyperbaric prilocaine induces shorter motor block but has not previously been studied in the obstetric spinal anaesthesia setting. We aimed to compare duration of motor block after spinal anaesthesia with prilocaine or bupivacaine during elective caesarean section. In this prospective randomised, double-blind study, women with uncomplicated pregnancy undergoing elective caesarean section were eligible for inclusion. Exclusion criteria included: patients aged < 18 years; height < 155 cm or > 175 cm; a desire to breastfeed; or a contra-indication to spinal anaesthesia. Patients were randomly allocated to two groups: the prilocaine group underwent spinal anaesthesia with 60 mg intrathecal prilocaine; and the bupivacaine group received 12.5 mg intrathecal heavy bupivacaine. Both 2.5 µg sufentanil and 100 µg morphine were added to the local anaesthetic agent in both groups. The primary outcome was duration of motor block, which was assessed every 15 min after arriving in the post-anaesthetic care unit. Maternal haemodynamics, APGAR scores, pain scores, patient satisfaction and side-effects were recorded. Fifty patients were included, with 25 randomly allocated to each group. Median (IQR [range]) motor block duration was significantly shorter in the prilocaine group, 158 (125-188 [95-249]) vs. 220 (189-250 [89-302]) min, p < 0.001. Median length of stay in the post-anaesthetic care unit was significantly shorter in the prilocaine group, 135 (120-180 [120-230]) vs. 180 (150-195 [120-240]) min, p = 0.009. There was no difference between groups for: maternal intra-operative hypotension; APGAR score; umbilical cord blood pH; maternal postoperative pain; and patients' or obstetricians' satisfaction. We conclude that hyperbaric prilocaine induces a shorter and more reliable motor block than hyperbaric bupivacaine for women with uncomplicated pregnancy undergoing elective caesarean section.


Assuntos
Anestesia Obstétrica , Raquianestesia , Bupivacaína , Cesárea , Complicações Intraoperatórias/prevenção & controle , Dor Pós-Operatória/prevenção & controle , Prilocaína , Adulto , Período de Recuperação da Anestesia , Anestésicos Locais , Índice de Apgar , Método Duplo-Cego , Procedimentos Cirúrgicos Eletivos , Feminino , França , Humanos , Tempo de Internação/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Gravidez , Estudos Prospectivos
19.
BMC Pregnancy Childbirth ; 21(1): 99, 2021 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-33516193

RESUMO

BACKGROUND: Chorangiosis is a vascular change involving the terminal chorionic villi in the placenta. It results from longstanding, low-grade hypoxia in the placental tissue, and is associated with such conditions as intrauterine growth restriction (IUGR), diabetes, and gestational hypertension in pregnancy. Chorangiosis rarely occurs in normal pregnancies. However, its prevalence is 5-7% of all placentas from infants admitted to newborn intensive care units. The present study was aimed at determining the association of chorangiosis with pregnancy complications and perinatal outcomes. METHODS: In this case-control study, 308 chorangiosis cases were compared with 308 controls (with other diagnoses in pathology) in terms of maternal, placental, prenatal, and neonatal characteristics derived from the medical records of participants retrospectively. R and SPSS version 22 software tools were used, and the statistical significance level was considered 0.05 for all the tests. RESULTS: Preeclampsia, diabetes mellitus, maternal hemoglobin, maternal hematocrit, C/S, oligohydramnios, fetal anomaly, dead neonates, NICU admissions were significantly higher in the chorangiosis group OR = 1.6, 3.98, 1.68, 1.92, 2.1, 4.47, 4.22, 2.9, 2.46, respectively (p-value< 0.05 for all). Amniotic fluid index, birth weight, cord PH amount, 1st, and 5th Apgar score was lower in the chorangiosis group OR = 0.31, 1, 0.097, 0.83, 0.85, respectively (p-value< 0.05 for all). Moreover, fundal placenta, retro placental hemorrhage, perivillous fibrin deposition, calcification, and acute chorioamnionitis were higher in the chorangiosis group OR = 2.1, 11.8, 19.96, 4.05, and 6.38 respectively, (p-value< 0.05). There was a high agreement between the two pathologists, and the power of the study was estimated at 99%. CONCLUSION: Although chorangiosis is an uncommon condition, it is associated with a higher incidence of perinatal and neonatal morbidity and mortality. Therefore, it should be considered an important clinical sign of adverse pregnancy outcomes and should be reported in the pathology evaluation.


Assuntos
Corioamnionite/patologia , Vilosidades Coriônicas/patologia , Doenças Placentárias/patologia , Placenta/patologia , Complicações na Gravidez/patologia , Resultado da Gravidez , Adulto , Índice de Apgar , Estudos de Casos e Controles , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Gravidez , Adulto Jovem
20.
J Pak Med Assoc ; 71(1(A)): 146-149, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33484543

RESUMO

Achondroplasia is a common form of dwarfism occurring in one out of 25,000 of live births. These patients present many problems during pregnancy and at the time of the delivery. The anaesthetist may also face several difficulties for both general and regional anaesthesia. The aim of this case report is to discuss various obstetric and anaesthetic considerations in such patients and ways to manage the difficulties. A 29-year-old woman expecting her first child, with achondroplasia -height of just 3'2'' (98 centimetres) - at 31 weeks of gestation, presented to our OPD for antenatal visit on May 15, 2018. Her successful elective lower segment caesarean section was performed on June 25, 2018 at 37 weeks in view of contracted pelvis under general anaesthesia. A live male baby was delivered, with no complications, good Apgar score and birth weight of 2.7kg. This shows that a woman with a genetic disorder like achondroplasia can become pregnant and deliver a healthy child at term.


Assuntos
Acondroplasia , Anestesia por Condução , Acondroplasia/complicações , Adulto , Anestesia Geral , Índice de Apgar , Cesárea , Criança , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez
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