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1.
Ceska Gynekol ; 86(4): 242-245, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34493048

RESUMO

OBJECTIVE: Description of a case of newborn death after acute caesarean section in 31st week of pregnancy because of mothers syphilitic infection. RESULTS: Fifteen-years-old primigravid woman in 31st week of pregnancy was admitted to a secondary level hospital due to a high risk of preterm labor. The pregnancy was terminated with an acute caesarean section because of pathological cardiotocograph record. The newborn died after 35 min of resuscitation. Blood samples from the umbilical cord and mothers blood taken by her gynecologist were positive for syphilis. In cooperation with a dermatologist, the treatment has been provided and reported to the National Referential Laboratory. The autopsy of the newborn had found severe pneumonia, necrotic lymphadenitis and pyocele. CONCLUSION: The dia-gnosis of congenital syphilis had been determined after the death of a preterm delivered newborn. Resuscitation had no chance to success because of syphilitic damage of the lungs.


Assuntos
Complicações Infecciosas na Gravidez , Sífilis Congênita , Sífilis , Adolescente , Causas de Morte , Cesárea , Feminino , Humanos , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Sífilis/diagnóstico , Sífilis Congênita/diagnóstico
2.
East Mediterr Health J ; 27(8): 826-849, 2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34486719

RESUMO

Background: The increasing trend in unnecessary caesarean sections has caused maternal and neonatal health concerns worldwide. Various medical and non-medical interventions have been designed and implemented to reduce caesarian section overuse. However, their efficacy is questionable. Aims: This study aimed to identify and classify effective interventions to reduce unnecessary caesarian sections. Methods: We searched EMBASE, MEDLINE, Web of Knowledge and Scopus databases for articles, using appropriate search strategies, up to 2 June 2020. Overall, 7951 identified articles were screened and assessed using a valid quality assessment checklist. Finally, 109 eligible studies were included in this review. Thematic content analysis was used to identify and classify the effective interventions. Results: Overall, 188 effective caesarian section reduction measures were identified. They were categorized into 45 actions, 16 intervention groups and 6 WHO building blocks, including "governance and leadership", "financing", "health workforce", "medical products and technologies", "information" and "service delivery". Using qualified and competent staff, intra-partum services, and oversight were the most commonly applied interventions to reduce unnecessary caesarian sections. Conclusions: A taxonomy of effective strategies to reduce unnecessary caesarian sections was developed in this study. A holistic approach is crucial to addressing the new epidemic of unnecessary caesarian section. Multiple interventions based on the underlying causes of caesarian section overuse should be designed and implemented at local and global levels.


Assuntos
Cesárea , Parto , Atenção à Saúde , Feminino , Humanos , Recém-Nascido , Gravidez
3.
J Med Case Rep ; 15(1): 448, 2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34493340

RESUMO

BACKGROUND: Placenta accreta is known to be associated with significant maternal morbidity and mortality-primarily due to intractable bleeding during abortion or delivery at any level of gestation. The complications could be reduced if placenta accreta is suspected in a patient with a history of previous cesarean delivery and the gestational sac/placenta is located at the lower part of the uterus. Then, a proper management plan can be instituted, and complications can be reduced. The diagnosis of placenta accreta in the first trimester of pregnancy is considered uncommon. CASE PRESENTATION: A 34-year-old Malay, gravida 4, para 3, rhesus-negative woman was referred from a private hospital at 13 weeks owing to accreta suspicion for further management. She has a history of three previous lower-segment cesarean sections. She also had per vaginal bleeding in the early first trimester, which is considered to indicate threatened miscarriage. Transabdominal ultrasound revealed features consistent with placenta accreta spectrum. She was counseled for open laparotomy and hysterectomy because of potential major complication if she continued with the pregnancy. Histopathological examination revealed placenta increta. CONCLUSION: A high index of suspicion of placenta previa accreta must be in practice in a patient with a history of previous cesarean deliveries and low-lying placenta upon ultrasound examination during early gestation.


Assuntos
Ameaça de Aborto , Placenta Acreta , Ameaça de Aborto/diagnóstico por imagem , Adulto , Cesárea , Feminino , Humanos , Mães , Placenta Acreta/diagnóstico por imagem , Placenta Acreta/cirurgia , Gravidez , Primeiro Trimestre da Gravidez
4.
BMJ Case Rep ; 14(9)2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34497055

RESUMO

We describe the successful treatment of a 24-week pregnant, 44-year-old woman with COVID-19. Management of this complex case required multidisciplinary collaboration and included prolonged invasive mechanical ventilation and prone positioning. Caesarean section delivery was delayed for 32 days, with no monitored fetal compromise, while stabilising the mother. To our knowledge, this is the longest reported duration of invasive ventilation while pregnant in a patient with COVID-19. COVID-19 has been shown to cause increased disease severity in pregnant women, and certain pregnancy-related physiological adaptations that occur could help explain this association. While COVID-19 has been shown to cause no increased adverse neonatal outcomes, clinicians should be aware that data show increased preterm birth in symptomatic pregnant women, thereby increasing the chance of prematurity-related complications. Further research on COVID-19 in pregnancy is crucial to facilitate better management, and full inclusion of pregnant women in therapeutic clinical trials will help achieve this.


Assuntos
COVID-19 , Nascimento Prematuro , Adulto , Cesárea , Feminino , Feto , Humanos , Recém-Nascido , Gravidez , Gestantes , Respiração Artificial , SARS-CoV-2
5.
Ann Acad Med Singap ; 50(8): 606-612, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34472555

RESUMO

INTRODUCTION: An antenatal scoring system for vaginal birth after caesarean section (VBAC) categorises patients into a low or high probability of successful vaginal delivery. It enables counselling and preparation before labour starts. The current study aims to evaluate the role of Grobman nomogram and the Kalok scoring system in predicting VBAC success in Singapore. METHODS: This is a retrospective study on patients of gestational age 37 weeks 0 day to 41 weeks 0 day who underwent a trial of labour after 1 caesarean section between September 2016 and September 2017 was conducted. Two scoring systems were used to predict VBAC success, a nomogram by Grobman et al. in 2007 and an additive model by Kalok et al. in 2017. RESULTS: A total of 190 patients underwent a trial of labour after caesarean section, of which 103 (54.2%) were successful. The Kalok scoring system (area under curve [AUC] 0.740) was a better predictive model than Grobman nomogram (AUC 0.664). Patient's age (odds ratio [OR] 0.915, 95% CI [confidence interval] 0.844-0.992), body mass index at booking (OR 0.902, 95% CI 0.845-0.962), and history of successful VBAC (OR 4.755, 95% CI 1.248-18.120) were important factors in predicting VBAC. CONCLUSION: Neither scoring system was perfect in predicting VBAC among local women. Further customisation of the scoring system to replace ethnicity with the 4 races of Singapore can be made to improve its sensitivity. The factors identified in this study serve as a foundation for developing a population-specific antenatal scoring system for Singapore women who wish to have a trial of VBAC.


Assuntos
Nascimento Vaginal Após Cesárea , Área Sob a Curva , Cesárea , Feminino , Humanos , Lactente , Gravidez , Estudos Retrospectivos , Prova de Trabalho de Parto
6.
BMJ Case Rep ; 14(9)2021 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493555

RESUMO

We report a case of a previously fit woman who presented at 26 weeks into her fourth pregnancy with a dry cough. Following a nasopharyngeal swab, she was diagnosed with a pertussis infection, and treated with antibiotics. A chest X-ray showed right atrial dilatation and an echocardiogram was scheduled outpatient. However, after re-presenting with worsening cough and dyspnoea, an inpatient echocardiogram was performed which suggested elevated pulmonary pressures with significant tricuspid regurgitation, as confirmed by subsequent cardiac catheterisation. She had an elective caesarean section at 34 weeks and underwent repeat right heart catheterisation which revealed persistent, and likely pre-existing, pulmonary arterial hypertension. This case highlights the importance of thorough assessment of non-obstetric symptoms in pregnancy in formulating alternative differentials, even after a diagnosis has been made, to prevent potentially life-threatening conditions from being missed. It also shows that although often associated, respiratory and cardiac causes may coexist separately.


Assuntos
Hipertensão Pulmonar , Insuficiência da Valva Tricúspide , Coqueluche , Cesárea , Ecocardiografia , Feminino , Humanos , Hipertensão Pulmonar/tratamento farmacológico , Hipertensão Pulmonar/etiologia , Gravidez , Coqueluche/complicações , Coqueluche/diagnóstico , Coqueluche/tratamento farmacológico
7.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 43(4): 551-557, 2021 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-34494525

RESUMO

Objective To explore the performance of mobile health platform for standardized management of pregnant women with gestational diabetes mellitus(GDM). Methods A randomized controlled trial was conducted,in which 295 women with GDM were randomized into two groups(traditional management group and mobile health management group)by a computer-generated sequence.The traditional management group accepted standardized GDM management,and the mobile health management group was supplemented by mobile health management based on the standardized management.The glycemic control rate and the incidences of low birth weight,macrosomia,preterm birth,premature rupture of membranes,postpartum hemorrhage after cesarean section,neonatal asphyxia,malformation,and admission to the neonatal intensive care unit were compared between the two groups. Results The glycemic control rate in mobile health management group was significantly higher than that in the traditional management group [(67.22±22.76)% vs.(60.69±21.28)%,P=0.004].The incidences of low birth weight,macrosomia,preterm birth,premature rupture of membranes,postpartum hemorrhage after cesarean section,neonatal asphyxia,malformation,and admission to the neonatal intensive care unit demonstrated no significant differences between groups(all P > 0.05). Conclusions Mobile health applied in standardized management is conducive to the glycemic control of GDM women,whereas it does not significantly improve the pregnancy outcomes.Due to the short time of intervention,the effects of mobile health on pregnancy outcomes need further study.


Assuntos
Diabetes Gestacional , Nascimento Prematuro , Telemedicina , Cesárea , Diabetes Gestacional/terapia , Feminino , Macrossomia Fetal , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez
8.
Niger Postgrad Med J ; 28(2): 145-147, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34494602

RESUMO

Uterine malformations are often asymptomatic but can be associated with a wide range of reproductive problems. We report a case of uterine fusion defect diagnosed intra-operatively in a 20-year-old primigravida who had elective caesarean section at term on account of breech presentation at term. Intraoperative findings included a cone-shaped uterus with narrowed fundus and the appendages emerging at the fundus and lower uterine segment on the right and left respectively. This is a rare fusion defect and makes a case for review of the existing uterine malformation classification systems, to make it all encompassing.


Assuntos
Apresentação Pélvica , Anormalidades Urogenitais , Adulto , Apresentação Pélvica/cirurgia , Cesárea , Feminino , Humanos , Nigéria , Gravidez , Útero/diagnóstico por imagem , Útero/cirurgia , Adulto Jovem
9.
BMJ Case Rep ; 14(9)2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34531234

RESUMO

We report a case of a 36-year-old gravida 2 para 1 woman at 38 weeks of gestation. A caesarean section was performed for severe pre-eclampsia, intrauterine growth restriction and oligohydramnios. The patient suffered postoperative bleeding, and exploratory laparotomy was performed. Uterine atonia, Couvelaire uterus and left adnexal haematoma were found, requiring a supracervical hysterectomy. As COVID-19 pneumonia and superimposed bacterial infection developed, the patient was mechanically ventilated in the intensive care unit. Remdesivir and meropenem were initially administered, but were changed to levofloxacin and ciprofloxacin following antibiotic sensitivity tests. Blood culture grew Enterococcus galinarum Meanwhile, bleeding of the incisional wound occurred, which was controlled by the cessation of heparin therapy and regular wound care. With intensive monitoring and multidisciplinary management, the patient's condition improved, and she was discharged from the hospital on day 25 from admission.


Assuntos
COVID-19 , Cesárea , Adulto , Feminino , Humanos , Histerectomia , Gravidez , Gestantes , SARS-CoV-2
10.
BMJ Glob Health ; 6(9)2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34470746

RESUMO

INTRODUCTION: The COVID-19 pandemic has disrupted health systems around the world. The objectives of this study are to estimate the overall effect of the pandemic on essential health service use and outcomes in Mexico, describe observed and predicted trends in services over 24 months, and to estimate the number of visits lost through December 2020. METHODS: We used health information system data for January 2019 to December 2020 from the Mexican Institute of Social Security (IMSS), which provides health services for more than half of Mexico's population-65 million people. Our analysis includes nine indicators of service use and three outcome indicators for reproductive, maternal and child health and non-communicable disease services. We used an interrupted time series design and linear generalised estimating equation models to estimate the change in service use and outcomes from April to December 2020. Estimates were expressed using average marginal effects on the risk ratio scale. RESULTS: The study found that across nine health services, an estimated 8.74 million patient visits were lost in Mexico. This included a decline of over two thirds for breast and cervical cancer screenings (79% and 68%, respectively), over half for sick child visits and female contraceptive services, approximately one-third for childhood vaccinations, diabetes, hypertension and antenatal care consultations, and a decline of 10% for deliveries performed at IMSS. In terms of patient outcomes, the proportion of patients with diabetes and hypertension with controlled conditions declined by 22% and 17%, respectively. Caesarean section rate did not change. CONCLUSION: Significant disruptions in health services show that the pandemic has strained the resilience of the Mexican health system and calls for urgent efforts to resume essential services and plan for catching up on missed preventive care even as the COVID-19 crisis continues in Mexico.


Assuntos
COVID-19 , Sistemas de Informação em Saúde , Cesárea , Criança , Feminino , Serviços de Saúde , Humanos , Análise de Séries Temporais Interrompida , México/epidemiologia , Pandemias , Gravidez , SARS-CoV-2
11.
Saudi Med J ; 42(9): 1009-1016, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34470840

RESUMO

OBJECTIVES: To describe the effectiveness of HIV guidelines in prevention of mother-to-child transmission (PMTCT). METHODS: A retrospective review from January 2009 to December 2018 at the King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia. The main outcome measures were characteristics of HIV-exposed patients and transmission rate. RESULTS: A total of 18 HIV-positive mothers and their 26 infants were included. The mean age of mothers at delivery was 31.69 years, and 50% were under 30 years old. All mothers received lifelong ART, except one who was not diagnosed until the 27th week of gestation. Among the mothers, 83% complied with treatment regimens, and 11% had ART resistance. Human immunodeficiency virus polymerase chain reaction (PCR) was undetectable in 19 pregnancies. Seven mothers had opportunistic infections and treatment was immediately initiated. After reviewing the infants' HIV PCR tests, the transmission rates of HIV were 0% for both spontaneous vaginal delivery and cesarean section. CONCLUSION: Many challenges face the efforts to decrease vertical HIV transmission, and a particular focus on the transitions between stages of care is needed. We believe that early screening, counseling, and regular follow-up have contributed to MTCT elimination.


Assuntos
Infecções por HIV , Complicações Infecciosas na Gravidez , Adulto , Cesárea , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Hospitais , Humanos , Lactente , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/prevenção & controle , Estudos Retrospectivos , Arábia Saudita
12.
JNMA J Nepal Med Assoc ; 59(235): 288-291, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-34506448

RESUMO

Cesarean scar pregnancy is a rare form of ectopic pregnancy which may lead to uterine rupture and catastrophic hemorrhage. We report a case of cesarean scar pregnancy in a 35-year-old female with the past history of cesarean section presented with complaints of amenorrhoea for 6 weeks and non-specific  pain. Two Transvaginal sonography was done 48 hours apart which suggested a cesarean scar pregnancy in one and cervical pregnancy on the other. Magnetic Resonace Imaging showed a well-defined cystic lesion of (21x19)mm2 embedded within the previous cesarean scar which confirmed the diagnosis of cesarean scar pregnancy. Laparotomy unveiled uterus around 6 weeks size and a (3x3)cm2 bulge was noted at the site of previous scar in lower uterine segment, where a small incision was given and the gestational sac was removed following which the uterine incision was closed with 2-0 polyglactin suture. High index of suspicion and prompt diagnosis is ofparamount for reducing morbidity and mortality.


Assuntos
Gravidez Ectópica , Ruptura Uterina , Adulto , Cesárea/efeitos adversos , Cicatriz/diagnóstico , Cicatriz/patologia , Feminino , Humanos , Histerotomia , Gravidez , Gravidez Ectópica/diagnóstico por imagem , Gravidez Ectópica/cirurgia , Ruptura Uterina/diagnóstico , Ruptura Uterina/etiologia , Ruptura Uterina/cirurgia
13.
JNMA J Nepal Med Assoc ; 59(234): 220-224, 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-34506454

RESUMO

Pregnancy with uterine myoma increases the risk of abortion, fetal malpresentation, placenta previa, postpartum hemorrhage, hysterectomy and risk to neonate and mother. Caesarian myomectomy is a safe and cost-effective procedure especially when performed by an experienced surgeon only in selected cases. Here, we present our experiences of cesarean myomectomy on ten patients presenting to our center in a period of one year. The most common indications were breech presentation and previous cesarean section. The most common site was anterior, except one which was posterior and the common type is intramural. Despite prophylactic measures, two cases had a postpartum hemorrhage of 2000ml and 700ml, respectively and one even received a blood transfusion. No cases of hysterectomy, neonatal morbidity and mortality were noted in these cases. In our experience, cesarean myomectomy in uterine fibroids has been a safe procedure with limited intraoperative and postoperative complications.


Assuntos
Apresentação Pélvica , Miomectomia Uterina , Neoplasias Uterinas , Cesárea , Feminino , Humanos , Recém-Nascido , Gravidez , Centros de Atenção Terciária , Neoplasias Uterinas/cirurgia
14.
JNMA J Nepal Med Assoc ; 59(237): 473-476, 2021 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-34508423

RESUMO

INTRODUCTION: Postpartum hemorrhage is defined as a blood loss of 500ml or more within 24 hours after birth. It is the leading cause of maternal mortality in low-income countries and the primary cause of nearly one-quarter of all maternal deaths globally. It occurs in up to 18% of total births. Post-dated pregnancy is a high-risk pregnancy with increased maternal morbidity. This study aims to determine the prevalence of postpartum hemorrhage in pregnancy beyond 40 weeks of gestation in a tertiary care hospital. METHODS: A descriptive cross-sectional study was conducted among pregnant women beyond 40 weeks in Dhulikhel hospital from October 2016 to March 2017. The study was conducted after ethical clearance from the hospital research committee (reference number#128/16). The sample size was calculated and convenient sampling was done. Statistical Package for the Social Sciences is used for analysis. Point estimate at 95% confidence interval was calculated along with frequency and percentage for binary data. RESULTS: Out of 465 ladies enrolled in this study postpartum hemorrhage was seen in 6 (1.29%) (95% Confidence Interval = 0.267-2.31), and the mean age was 24.25+4.8. About 346 (74.4%) had a normal delivery, 104 (22.36%) had cesarean section and 15 (3.22%) had instrumental delivery. CONCLUSIONS: Postpartum haemorrhage prevalence is low among the pregnant women beyond 40 weeks compared to the standard study. Postpartum hemorrhage is the common leading cause of maternal mortality. So high-risk cases should be identified and active management should be done to reduce morbidity and mortality.


Assuntos
Hemorragia Pós-Parto , Adulto , Cesárea , Estudos Transversais , Feminino , Humanos , Mortalidade Materna , Hemorragia Pós-Parto/epidemiologia , Gravidez , Centros de Atenção Terciária , Adulto Jovem
15.
JNMA J Nepal Med Assoc ; 59(237): 442-445, 2021 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-34508438

RESUMO

INTRODUCTION: Caesarean delivery on maternal request in absence of any maternal and fetal indications and has become a concerning issue among obstetricians. It seems to be one of the contributory factors of increased cesarean rate all over the world. This study aims to find out the prevalence of cesarean delivery on maternal request among cesarean deliveries in a tertiary care hospital. METHODS: This descriptive cross-sectional study was conducted from November 1st 2019 to February 1st 2020 among women undergoing cesarean section in a tertiary care hospital. The ethical clearance was taken from the Institutional Review Committee of Kathmandu Medical College (reference number: 201120192). Convenient sampling was used. Statistical Package for Social Sciences version 20.0 was used for analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 386 cesarean sections, maternal request was the indication in 72 (18.65%) (95% Confidence Interval = 14.76-22.54) mothers. Among the 72, 38 (52.7%) chose cesarean section for fear of labor pain, 14 (19.4%) for date-of-birth selection, 10 (13.8%) for anxiety of labor pain, because of cord around the neck in four (5.5%), male baby in three (4.1%), to avoid pelvic trauma in two (2.7%), and to go abroad in one (1.3%). CONCLUSIONS: Our study showed a prevalence of cesarean delivery on maternal request higher than other national studies but was similar to the global prevalence. The commonest reasons were fear of labor followed by date-of-birth selection.


Assuntos
Cesárea , Mães , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Gravidez , Prevalência , Centros de Atenção Terciária
16.
JNMA J Nepal Med Assoc ; 59(236): 392-395, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-34508533

RESUMO

INTRODUCTION: Rupture uterus is an obstetric catastrophe with poor maternal and fetal outcome. The objective of the study is to determine the prevalence of rupture uterus in pregnancy. METHODS: This was a descriptive cross sectional study conducted in a tertiary care centre from January 2016 to December 2016 after taking ethical approval (Approval No. F-NMC-510/76/77) from Institutional Review Committee. Convenience sampling method was used. Data were entered in the Microsoft Excel sheet and obtained data was analysed using Statistical Package for Social Sciences version 18 software for central tendency and frequencies. RESULTS: Out of total 1559 deliveries, prevalence of rupture uterus was found to be 12 (0.0077%). Previous lower segment caesarean scar rupture was the most common risk factor noted in 7 (58.3%) cases. A total of seven patients (58.3%) required intensive care unit admission and blood transfusion. Other maternal complications were surgical site infection 2 (16.67%), sepsis 2 (16.67%), paralytic ileus 1 (8.3%), pelvic collection 1 (8.3%) and vesico vaginal fistula 1 (8.3%). Two maternal deaths (16.67%) and perinatal death was noted in 8 (66.66 % ) cases. CONCLUSIONS: Rupture uterus most commonly occurred in scarred uterus. Identification of high risk pregnancy, judicious caesarean section, proper labor monitoring, early diagnosis and prompt management are essential in reducing its occurrences.


Assuntos
Cesárea , Ruptura Uterina , Estudos Transversais , Feminino , Humanos , Gravidez , Resultado da Gravidez , Centros de Atenção Terciária , Ruptura Uterina/diagnóstico , Ruptura Uterina/epidemiologia , Ruptura Uterina/etiologia , Útero
17.
JNMA J Nepal Med Assoc ; 59(236): 380-383, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-34508532

RESUMO

INTRODUCTION: Women who conceive at advance age are at risk of pregnancy complications and adverse foetal outcome. This study aims to find out the prevalence of pregnancy at advance age in a teaching hospital. METHODS: A descriptive cross-sectional study was conducted between October 2019 to August 2020 at department of obstetrics and gynaecology of a tertiary care centre of Nepal, after obtaining ethical clearance from Institutional Review Committee (dated 03/09/2019 with ref no. 266) and informed consent from patient. Convenience sampling was done. All the patient who were ≥35 years and >28 weeks of gestation without any chronic illness were selected. Data and descriptive analysis were done using Statistical Package for the Social Sciences version 16. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. RESULTS: Women aged 35 years and above constituted 104 (5.73%) of the total deliveries of study period. Most were multigravida 72 (69.23%) and 23 (22.12%) had preterm delivery. Rate of caesarean section were higher in advance maternal age 69 (66.35%). Maternal complications such as Hypertensive disorder of pregnancy 9 (8.65%), and mal-presentation 15 (14.42%) were higher among them. Perinatal outcome in form of low birth weight 9 (8.65%) and perinatal death 5 (4.80%) were increased in those women. CONCLUSIONS: From this study, it can be concluded that prevalence of advanced age at pregnancy was lower than study done in developed country but it was similar to study in India and is increasing in Nepal.


Assuntos
Cesárea , Morte Perinatal , Idoso , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Idade Materna , Gravidez , Centros de Atenção Terciária
18.
JNMA J Nepal Med Assoc ; 59(236): 322-326, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-34508541

RESUMO

INTRODUCTION: Cesarean section is a common obstetric procedure which is done to reduce complications in high risk pregnancies. The aim of study was to find out the prevalence of cesarean section in a maternity unit of a tertiary care center. METHODS: A descriptive cross-sectional study was conducted among 497 pregnant women presenting in a maternity unit of a tertiary center of Kathmandu, Nepal over a period of six months from March to August 2017 after taking ethical approval from Institutional Review Committee (Ref. 24). In this study, the prevalence of cesarean section, perinatal outcome, maternal and neonatal complications if any were observed. Data and descriptive analysis were done using Statistical Package for the Social Sciences version 22. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. RESULTS: The prevalence of cesarean section was 171 (34.4%) at 95% Confidence interval (30.2-38.7). Most common indication for cesarean section was fetal distress 53 (31%). The maternal complications developed in 11 (6.4%) among those who delivered via cesarean delivery; Surgical Site Infection being the most common maternal complication. The neonatal intensive care unit admission rate among the newborns via cesarean section delivery was 48 (27.43%) and neonatal sepsis 14 (8%) was most common adverse neonatal outcome. CONCLUSIONS: The cesarean rate at the study center is higher than standard target rate of World Health Organization. Neonatal and maternal adverse outcome in current study were comparable with existing literatures.


Assuntos
Cesárea , Sofrimento Fetal , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Nepal/epidemiologia , Gravidez , Centros de Atenção Terciária
19.
Zhongguo Dang Dai Er Ke Za Zhi ; 23(8): 773-778, 2021 Aug 15.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-34511164

RESUMO

OBJECTIVES: To study the association between cesarean section and sensory integration dysfunction (SID) in preschool children through a prospective cohort study. METHODS: Based on the multicenter mother-infant cohort established by the Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the International Peace Maternity and Child Health Hospital Affiliated to Shanghai Jiao Tong University School of Medicine in 2012, the sensory integration functions (three dimensions: vestibular balance, tactile defensiveness, and proprioception) of 392 preschool children were evaluated by the Chinese Children Sensory Integration Capacity Development Rating Scale in 2017. Births by cesarean section were the exposure factors, and the children born by vaginal delivery were enrolled as controls. A multivariable logistic regression analysis was used to evaluate the association of cesarean section with each dimension of SID. RESULTS: The prevalence rate of SID was 21.9% (86/392) among the preschool children, and the prevalence rates of vestibular balance disorder, tactile over-responsivity, and proprioceptive disorder were 5.9% (23/392), 5.4% (21/392), and 15.1% (59/392) respectively. After adjustment for the confounding factors including maternal age at delivery and maternal educational level and child birth situation, the cesarean section group had a significant increase in the risk of proprioceptive disorder (RR=4.16, 95%CI: 1.41-12.30, P<0.05). The stratified analysis based on sex showed that the boys born by cesarean section had a significantly higher risk of proprioceptive disorder than those born by vaginal delivery (RR=5.75, 95%CI: 1.26-26.40, P<0.05). CONCLUSIONS: Cesarean section can significantly increase the risk of proprioceptive disorder in preschool children, especially in boys.


Assuntos
Cesárea , Parto Obstétrico , Pré-Escolar , China/epidemiologia , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Gravidez , Estudos Prospectivos
20.
BMC Pediatr ; 21(1): 370, 2021 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-34465290

RESUMO

BACKGROUND: Betamimetics have been used for tocolysis extensively in the past, and one of them, ritodrine is widely used in Japan. Various adverse events have been reported for this agent, including newborn hypoglycemia and hypokalemia, as well as maternal hypokalemia and rebound hyperkalemia; however, cases of neonatal rebound hyperkalemia are not described in the literature. CASE PRESENTATION: A male infant born at 36 weeks of gestation by cesarean section at a local maternity clinic suddenly entered cardiopulmonary arrest with ventricular tachycardia and fibrillation due to hyperkalemia (K+, 8.7 mmol/L). No monitoring, examination of blood electrolyte levels, or infusions had been performed prior to this event. Maternal infusion of ritodrine (maximum dose, 170 µg/min) had been performed for 7 weeks prior to cesarean section. After resuscitation combined with calcium gluconate, the infant died at 4 months old due to serious respiratory failure accompanied by acute lung injury following shock. No cause of hyperkalemia other than rebound hyperkalemia associated with ritodrine was identified. CONCLUSIONS: This case report serves as a warning regarding the potential risk of neonatal rebound hyperkalemia in association with maternal long-term ritodrine administration.


Assuntos
Hiperpotassemia , Trabalho de Parto Prematuro , Ritodrina , Tocolíticos , Cesárea , Feminino , Humanos , Hiperpotassemia/induzido quimicamente , Lactente , Recém-Nascido , Masculino , Gravidez , Ritodrina/efeitos adversos , Tocolíticos/efeitos adversos
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