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1.
Rev. esp. anestesiol. reanim ; 67(8): 438-445, oct. 2020. graf
Artigo em Espanhol | IBECS | ID: ibc-193564

RESUMO

La infección por COVID-19 afecta también a las pacientes obstétricas. La atención obstétrica habitual ha continuado a pesar de la pandemia. Existen series de casos de pacientes obstétricas. Parece que las técnicas neuroaxiales son seguras y es importante asegurarse que los bloqueos funcionen correctamente antes de una cesárea. Es por esto que se recomienda que los bloqueos sean realizados por anestesiólogos expertos. La protección y seguridad de los profesionales es un punto fundamental y, en caso de anestesia general, también se recomienda acudir al anestesiólogo más experto. Las pacientes gravemente enfermas deben reconocerse rápida y precozmente, para poder suministrarles el tratamiento adecuado lo antes posible. La susceptibilidad a las trombosis hace que la anticoagulación profiláctica sea prioritaria


COVID-19 infection also affects obstetric patients. Regular obstetric care has continued despite the pandemic. Case series of obstetric patients have been published. Neuroaxial techniques appear to be safe and it is important to obtain the highest possible rate of success of the blocks before a cesarean section. For this reason, it is recommended that the blocks be carried out by senior anesthesiologists. The protection and safety of professionals is a key point and in case of general anesthesia, so it is also recommended to call to the most expert anesthesiologist. Seriously ill patients should be recognized quickly and early, in order to provide them with the appropriate treatment as soon as possible. Susceptibility to thrombosis makes prophylactic anticoagulation a priority


Assuntos
Humanos , Infecções por Coronavirus/epidemiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Vírus da SARS/patogenicidade , Anestesia Obstétrica/métodos , Cesárea/métodos , Gestantes , Pandemias , Complicações Infecciosas na Gravidez/epidemiologia , Complicações do Trabalho de Parto/epidemiologia , Precauções Universais/métodos
2.
BMC Pregnancy Childbirth ; 20(1): 587, 2020 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-33023500

RESUMO

BACKGROUND: There are no published cases of tonic-clonic seizures and posterior bilateral blindness during pregnancy and Severe Acute Respiratory Syndrome (SARS) Coronavirus (COV) 2 (SARS-COV-2) infection. We do not just face new and unknown manifestations, but also how different patient groups are affected by SARS-COV-2 infection, such as pregnant women. Coronavirus Disease 2019 (COVID-19), preeclampsia, eclampsia and posterior reversible leukoencephalopathy share endothelium damage and similar pathophysiology. CASE PRESENTATION: A 35-year-old pregnant woman was admitted for tonic-clonic seizures and SARS-COV-2 infection. She had a normal pregnancy control and no other symptoms before tonic-clonic seizures development. After a Caesarean section (C-section) she developed high blood pressure, and we initiated antihypertensive treatment with labetalol, amlodipine and captopril. Few hours later she developed symptoms of cortical blindness that resolved in 72 h with normal brain computed tomography (CT) angiography. CONCLUSION: The authors conclude that SARS COV-2 infection could promote brain endothelial damage and facilitate neurological complications during pregnancy.


Assuntos
Anti-Hipertensivos/administração & dosagem , Betacoronavirus/isolamento & purificação , Cegueira Cortical , Cesárea/métodos , Infecções por Coronavirus , Eclampsia , Fibrinolíticos/administração & dosagem , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Convulsões , Adulto , Cegueira Cortical/diagnóstico , Cegueira Cortical/virologia , Encéfalo/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Diagnóstico Diferencial , Eclampsia/diagnóstico , Eclampsia/terapia , Eclampsia/virologia , Feminino , Humanos , Exame Neurológico/métodos , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/etiologia , Complicações Infecciosas na Gravidez/fisiopatologia , Resultado da Gravidez , Convulsões/diagnóstico , Convulsões/etiologia , Convulsões/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
3.
Rev Med Liege ; 75(10): 676-681, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-33030845

RESUMO

In Wallonia, almost one fourth of cesarean sections are performed on nulliparous women with vertex nonanomalous singleton gestations who underwent induction of labor. The purpose of this study is to compare maternal and neonatal outcomes with elective induction of labor versus spontaneous onset of labor. Data for all deliveries at CHU de Liège over a two-year period were obtained. Women with vertex nonanomalous singleton gestations who delivered from 3900 to 40+6 weeks were selected. We tested the association of elective induction and operative vaginal delivery, cesarean section, post-partum hemorrhage, episiotomy and perineal lacerations, length of labor, length of stay, 1-min and 5-min APGAR inferior to 7 and admission to neonatal intensive care unit. Length of stay was significantly longer in all induced women. In nulliparous women, there was a 45 % probability of operative vaginal delivery or cesarean section delivery in those who underwent elective induction of labor. In light of these results, it seems that our policy of elective induction of labor in nulliparous women is causing unnecessary and potentially avoidable interventions.


Assuntos
Cesárea , Trabalho de Parto Induzido , Feminino , Humanos , Gravidez , Estudos Retrospectivos
4.
Medicine (Baltimore) ; 99(40): e22442, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019428

RESUMO

Delivery methods during childbirth and their related gut microbiota profiles have important impacts on health later in life, they can contribute to the development of diseases such as obesity, whose highest prevalence rate is found among the Mexican child population. Coincidentally, Mexico has one of the highest global average annual rate increase in cesarean births (C-section). Since Mexico leads the world in childhood obesity, studying the relationship between childbirth delivery methods and gut microbiota profiles in this vulnerable population may be used to identify early risk factors for obesity in other developed and developing countries. The objective of this study is to determine the association between child delivery method and gut microbiota profiles in healthy Mexican newborns.Fecal samples of 57 term infants who participated in a randomized clinical trial in 2013 to study the safety of Agave fructans in newborns, were used in this study. DNA samples were extracted and used to characterize the microbiota composition using high-throughput 16S rRNA gene sequencing. The samples were further divided based on childbirth delivery method, as well as early diet. Gut microbiota profiles were determined and analyzed using cluster analysis followed by multiple correspondence analysis.An unusual high abundance of Proteobacteria was found in the gut microbiota of all Mexican infants studied, regardless of delivery method. Feces from infants born by C-section had low levels of Bacteroidetes, high levels of Firmicutes, especially Clostridium and Enterococcus, and a strikingly high ratio of Firmicutes/Bacteroidetes (F:B). Profiles enriched in Bacteroidetes and low F:B ratios, were strongly associated with vaginal delivery.The profile of gut microbiota associated with feces from Mexican infants born by C-section, may be added to the list of boosting factors for the worrying obesity epidemic in Mexico.


Assuntos
Cesárea/estatística & dados numéricos , Microbioma Gastrointestinal , Obesidade/epidemiologia , Cesárea/efeitos adversos , Fezes/microbiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , México/epidemiologia , Fatores de Risco
5.
Medicine (Baltimore) ; 99(40): e22558, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019467

RESUMO

RATIONALE: During ultrasound prenatal screening, absence of the fetal nasal bone is used as a marker for common aneuploidies in singleton pregnancies. However, its application in multiple pregnancies is less sensitive and more challenging owing to difficulties in obtaining adequate views of the fetal face. PATIENT CONCERNS: A 38-year-old woman with dichorionic-diamniotic (DCDA) pregnancy and a history of in vitro fertilization and embryo transfer was referred to our hospital with the absence of the nasal bone noted on ultrasound images obtained during the second trimester in 1 fetus. DIAGNOSIS: Prenatal sonographic examination revealed the absence of the nasal bone in 1 fetus in the DCDA gestation. Amniocentesis performed on the dual amniotic sacs revealed normal karyotypes for each twin. The absence of the nasal bone was confirmed on a radiograph obtained postnatally in 1 infant. INTERVENTIONS: The mother underwent routine outpatient care according to the gestational age and successfully delivered following lower-segment cesarean section. OUTCOMES: Two live infants were uneventfully delivered. Radiography confirmed the absence of the nasal bone in 1 of the newborns on postnatal day 3. The infants were followed up until 2 years and 9 months of age, which revealed normal appearance and eating and breathing functions. LESSONS: Prenatal diagnosis of the absence of nasal bone in 1 fetus of DCDA pregnancy has rarely been reported. Although a fetus with the absence of the nasal bone in DCDA gestation poses a significant risk of aneuploidy, it is acceptable when the defect is an isolated anomaly after ruling out genetic abnormalities. Appropriate consultation should be provided for these patients.


Assuntos
Fertilização In Vitro/efeitos adversos , Osso Nasal/anormalidades , Diagnóstico Pré-Natal/métodos , Adulto , Amniocentese/métodos , Cesárea/métodos , Transferência Embrionária , Feminino , Feto , Humanos , Osso Nasal/diagnóstico por imagem , Gravidez , Segundo Trimestre da Gravidez , Gravidez Múltipla , Radiografia , Gêmeos Dizigóticos , Ultrassonografia Pré-Natal/métodos
6.
Medicine (Baltimore) ; 99(41): e21214, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031254

RESUMO

RATIONALE: Dysgerminoma is an extraordinarily rare neoplasm arising from the malignant germ cells of the ovary. Early antenatal diagnosis and proper management of the neoplasm to improve maternal-neonatal results are the considerable challenges facing the gyne-oncologist. We summarize the clinical features and discuss treatment strategies of the ovary dysgerminoma (OD). Besides, we also review the literature on OD in PubMed, Web of Science Core Collection, Library of Congress, and LISTA from 1939 to 2019 to evaluate its clinical characteristics, feto-maternal compromise, management, and fertility outcome. PATIENT CONCERNS: A 25-year-old pregnant woman reported lower abdominal pain and vomiting. DIAGNOSIS: The patient was diagnosed as right OD. INTERVENTIONS: She received a cesarean section due to severe abdominal pain, delivered a healthy girl at 38 C 4 weeks of gestation, and accepted fertility-preserving surgery. However, the patient refused chemotherapy postoperatively. OUTCOMES: The patient was followed up 42 days, 3 months, and 6 months after surgery, and no tumor recurrence was observed. LESSONS: OD has non-specificity characteristics, including age, symptoms, image date, and tumor marks. However, these abnormal indicators may provide some evidence for accurate antenatal diagnosis. The management strategies should be considered comprehensively on an individual basis, and fertility-preserving surgery should be carried out in the second trimester if further pregnancy is desired. Adjuvant chemotherapy needs to be applied to the treatment of OD patients with The International Federation of Gynecology and Obstetrics (FIGO) stages II, III, and IV and timely chemotherapy is suggested if there are several weeks before the expected date of delivery. The overall prognosis of OD patients is excellent.


Assuntos
Disgerminoma/diagnóstico , Disgerminoma/cirurgia , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/cirurgia , Adulto , Cesárea , Feminino , Humanos , Gravidez , Resultado da Gravidez
7.
J Med Case Rep ; 14(1): 186, 2020 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-33023635

RESUMO

INTRODUCTION: A novel coronavirus named severe acute respiratory syndrome coronavirus 2, was first reported in Wuhan, China, in December 2019. The virus, known as COVID-19, is recognized as a potentially life-threatening disease by causing severe respiratory disease. Since this virus has not previously been detected in humans, there is a paucity of information regarding its effects on humans. In addition, only limited or no information exists about its impact during pregnancy. CASE PRESENTATION: In the present case study, we report the death of a neonate born to a 32-year-old mother with coronavirus disease 2019 in Ilam, Iran, with Kurdish ethnicity. We report the infection and death of a neonate in Iran with a chest X-ray (CXR) marked abnormality 2 hours after birth demonstrating coronavirus disease 2019 disease. The neonate was born by elective cesarean section, the fetal health was assessed using fetal heart rate and a non-stress test before the birth, and there was no evidence of fetal distress. All the above-mentioned facts and radiographic abnormalities suggested that coronavirus disease 2019 is involved. CONCLUSIONS: In this case study, we report the death of a neonate born to a mother with coronavirus disease 2019, 11 hours after birth. There is a paucity of data on the vertical transmission and the adverse maternal-fetal consequences of this disease, so vertical transmission from mother to child remains to be confirmed.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Cuidados Críticos/métodos , Doenças do Recém-Nascido , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Adulto , Cesárea/métodos , Deterioração Clínica , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/transmissão , Evolução Fatal , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/fisiopatologia , Doenças do Recém-Nascido/terapia , Transmissão Vertical de Doença Infecciosa , Irã (Geográfico) , Triagem Neonatal/métodos , Morte Perinatal , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Pneumonia Viral/transmissão , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/terapia , Respiração Artificial/métodos
8.
Environ Health Prev Med ; 25(1): 60, 2020 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-33038922

RESUMO

BACKGROUND: Improving and maintaining the health of mothers and newborns is indisputably a global priority, especially during a pandemic. This study intends to examine the factors associated with cesarean section (CS) during lockdown time. METHODS: A total of 678 women who just gave birth within 7 days were enrolled from maternal and children hospitals in nine cities of China from April to May 2020. The delivery modes and potential influencing factors were investigated. The subgroup analysis and sensitivity analysis were used to examine the association of CS and risk factors among populations with different characteristics and to control for possible confounding, respectively. RESULTS: The overall rate of cesarean delivery was 37.3%. In multi-variant model, maternal age > 30 years (OR, 95% CI = 1.71, 1.21-2.41), higher pre-gestational BMI (OR, 95% CI = 1.16, 1.10-1.23), living in regions with confirmed COVID-19 cases > 500 (OR, 95% CI = 2.45, 1.74-3.45), and excess gestational weight gain (OR, 95% CI = 1.73, 1.17-2.55) were associated with cesarean delivery. These trends of associations were not changes in sensitivity analysis and subgroup analysis. Cesarean delivery occurred more in women who got more nutrition instruction during the pandemic period in the univariant model; however, this association showed insignificance in the multiple-variant analysis. CONCLUSION: A high cesarean delivery rate was found in uninfected women who experienced lockdown in their third trimester. During the COVID-19 pandemic, more medical support should be provided in severely affected regions to ensure and promote health in pregnancy.


Assuntos
Cesárea/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Adulto , Betacoronavirus , China/epidemiologia , Cidades , Estudos Transversais , Feminino , Humanos , Mães , Pandemias , Gravidez , Fatores de Risco
9.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(9): 1074-1081, 2020.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-33051421

RESUMO

OBJECTIVES: To explore the influence factors for pernicious placenta previa (PPP) with placenta accreta and pregnancy outcomes of different types of PPP. METHODS: A case-control study was conducted to collect 410 PPP patients admitted to a general hospital in Changsha from December 2013 to February 2018. Two hundred and fifty cases of PPP with placenta accreta were treated as a case group, and 160 cases of PPP without placenta accreta were treated as a control group. The relationship between clinical data and placenta accreta was analyzed, and the pregnancy outcomes of PPP was observed according to different types of placenta previa. RESULTS: Logistic regression showed that delivery times were more than 2 (OR=3.221), cesarean section times were more than 2 (OR=3.048), central placenta previa (OR=3.607), placental attachment site (anterior wall) (OR=4.592) were independent risk factors for PPP with placenta accrete (P<0.05). Living in cities (OR=0.614), systematic prenatal examination (OR=0.590) were protective factors (P<0.05). Average intraoperative blood loss, postpartum bleeding rate, hysterectomy rate in the central group were all higher than those in the marginal and low-set group. The incidence rates of ICU transfer, complications, and hospital stay were higher or longer than those in the marginal group (P'<0.008). There was no significant difference in stillbirth rate among the 4 groups (P>0.05). Preterm delivery rate was higher than that of the marginal and low-set group, and the birth weight was lower than that of the low-set group. Apgar score at 1 min and asphyxia rate were lower and higher than those of the other 3 groups, respectively (P'<0.008). CONCLUSIONS: Delivery times (>2), cesarean section times (≥2), central placenta previa, placenta attachment site (anterior wall) are independent risk factors for PPP with placenta accreta. Living in cities, systematic prenatal examination were protective factors. The central PPP is more likely to lead to postpartum hemorrhage, hysterectomy, and increases in the risk of preterm birth, low birth weight as well as asphyxia of fetus, which seriously threatens maternal and fetal life.


Assuntos
Placenta Acreta , Placenta Prévia , Estudos de Casos e Controles , Cesárea , Feminino , Humanos , Recém-Nascido , Placenta Acreta/epidemiologia , Placenta Acreta/cirurgia , Placenta Prévia/epidemiologia , Gravidez , Resultado da Gravidez , Estudos Retrospectivos
10.
Medicine (Baltimore) ; 99(36): e21864, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899016

RESUMO

Spinal anesthesia (SpA) for elective caesarean section (CS) is often accompanied by clinically relevant arterial hypotension. The Bezold-Jarisch reflex, causing postspinal hypotension, has been shown to be antagonized by serotonin type 3 (5-HT3) blockade. Our aim was to assess if routine prophylactic administration of the 5-HT3 antagonist ondansetron (ODS) attenuates postspinal change in maternal blood pressure.Elective CS under SpA were retrospectively analyzed. Eighty parturients having routinely received 8 mg ODS prior to SpA were compared with 80 patients having not (control group).Mean arterial blood pressure significantly decreased from baseline to the postspinal period (P < .0001) without differences in blood pressure decreases between the 2 groups. This also applied to the heart rate. Overall use of cafedrine/theodrenaline was higher in the ODS group (0.8 (0.4-1.6) mL vs 0.8 (0-1.0) mL in the control group, P = .01). APGAR values showed a presumably clinically irrelevant decrease in control group compared with the ODS group.Our results suggest that routine administration of ODS in a dosage of 8 mg does not effectively attenuate postspinal change in maternal blood pressure during CS in our setting. Given the wide variability of anesthetic techniques, only large prospective and randomized multicenter trials will ultimately serve to elucidate this issue.


Assuntos
Anestesia Obstétrica/métodos , Raquianestesia/métodos , Cesárea/métodos , Ondansetron/administração & dosagem , Antagonistas do Receptor 5-HT3 de Serotonina/administração & dosagem , Adulto , Índice de Apgar , Pressão Arterial/efeitos dos fármacos , Estudos de Casos e Controles , Cesárea/efeitos adversos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Recém-Nascido , Gravidez , Estudos Retrospectivos
11.
Ann Ist Super Sanita ; 56(3): 378-389, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32959805

RESUMO

INTRODUCTION: The study was implemented to provide guidance to decision-makers and clinicians by describing hospital care offered to women who gave birth with confirmed SARS-CoV-2 infection. MATERIALS AND METHODS: National population-based prospective cohort study involving all women with confirmed SARS-CoV-2 infection who gave birth between February 25 and April 22, 2020 in any Italian hospital. RESULTS: The incidence rate of confirmed SARS-CoV-2 infection in women who gave birth was 2.1 per 1000 maternities at a national level and 6.9/1000 in the Lombardy Region. Overall one third of the women developed a pneumonia and 49.7% assumed at least one drug against SARS-CoV-2 infection. Caesarean rate was 32.9%, no mothers nor newborns died. Six percent of the infants tested positive for SARS-CoV-2 at birth. CONCLUSIONS: Clinical features and outcomes of COVID-19 in women who gave birth are similar to those described for the general population, most women developing mild to moderate illness.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Corticosteroides/uso terapêutico , Adulto , Cesárea/estatística & dados numéricos , Infecções por Coronavirus/congênito , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/terapia , Infecções por Coronavirus/transmissão , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Maturidade dos Órgãos Fetais/efeitos dos fármacos , Humanos , Incidência , Recém-Nascido , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Itália/epidemiologia , Pulmão/embriologia , Pneumonia Viral/congênito , Pneumonia Viral/terapia , Pneumonia Viral/transmissão , Gravidez , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Utilização de Procedimentos e Técnicas , Estudos Prospectivos , Natimorto/epidemiologia
15.
Medicine (Baltimore) ; 99(35): e21916, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871925

RESUMO

Pernicious placenta previa (PPP) is the main cause of severe obstetric postpartum hemorrhage and hysterectomy and often requires donor blood transfusion. Prophylactic internal iliac artery (IIA) balloon occlusion (BO) combined with cell salvage is increasingly being deployed in parallel transverse uterine incision (PTUI) cesarean section (CS). The aim of this study was to explore the differences in blood management in PTUI CS with or without prophylactic IIA BO and to evaluate the safety and efficacy of cell salvage to reduce the need for donor blood transfusion during PTUI CS.This retrospective study included all women who were diagnosed with PPP and PA and underwent PTUI CS from October 1, 2016, to October 31, 2018. Sixty-four patients were included: 34 underwent prophylactic IIA BO (IIA group), whereas 30 were treated without prophylactic IIA BO (control group). The primary outcome was a composite measure of perioperative blood management outcomes, including the estimated blood loss (EBL), donor blood transfusion, salvaged blood returned, fresh frozen plasma (FFP), pre- and postoperative serum hemoglobin and hematocrit. In addition, the baseline conditions of mother and neonates were compared.EBL was significantly higher in the IIA group compared to the control group (2883.5 mL in the IIA group vs 1868.7 mL in the control group, P = .001). Overall, the donor blood transfusion rate was 23.5% (8/34), averaging 4.2 U, in the IIA group versus 30% (9/30), averaging 3.4 U, in the control group, which were not significantly different. The FFP transfusion rate was 47%, averaging 765.6 mL, in the IIA group versus 20%, averaging 816.7 mL, in the control group. In the IIA group, 97.1% used cell savage and had salvaged blood returned, averaging 954.9 mL. In the control group, 90% had salvaged blood returned, averaging 617.9 mL. No cases of amniotic fluid embolism were observed with leukocyte depletion filters.Prophylactic IIA BO during PTUI CS in women with PPP and PA does not lead to a statistically significant reduction in EBL. Cell salvage was associated with a reduction in the rate of donor blood transfusion during PTUI CS.


Assuntos
Oclusão com Balão/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue/métodos , Cesárea/métodos , Placenta Prévia/cirurgia , Hemorragia Pós-Parto/prevenção & controle , Útero/cirurgia , Adulto , Cesárea/efeitos adversos , Feminino , Humanos , Histerectomia , Artéria Ilíaca , Recuperação de Sangue Operatório , Gravidez , Estudos Retrospectivos
16.
Cochrane Database Syst Rev ; 9: CD011216, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32871021

RESUMO

BACKGROUND: Pain after caesarean sections (CS) can affect the well-being of the mother and her ability with her newborn. Conventional pain-relieving strategies are often underused because of concerns about the adverse maternal and neonatal effects. Complementary alternative therapies (CAM) may offer an alternative for post-CS pain. OBJECTIVES: To assess the effects of CAM for post-caesarean pain. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register, LILACS, PEDro, CAMbase, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) (6 September 2019), and checked the reference lists of retrieved articles. SELECTION CRITERIA: Randomised controlled trials (RCTs), including quasi-RCTs and cluster-RCTs, comparing CAM, alone or associated with other forms of pain relief, versus other treatments or placebo or no treatment, for the treatment of post-CS pain. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, extracted data, assessed risk of bias and assessed the certainty of evidence using GRADE. MAIN RESULTS: We included 37 studies (3076 women) which investigated eight different CAM therapies for post-CS pain relief. There is substantial heterogeneity among the trials. We downgraded the certainty of evidence due to small numbers of women participating in the trials and to risk of bias related to lack of blinding and inadequate reporting of randomisation processes. None of the trials reported pain at six weeks after discharge. Primary outcomes were pain and adverse effects, reported per intervention below. Secondary outcomes included vital signs, rescue analgesic requirement at six weeks after discharge; all of which were poorly reported, not reported, or we are uncertain as to the effect Acupuncture or acupressure We are very uncertain if acupuncture or acupressure (versus no treatment) or acupuncture or acupressure plus analgesia (versus placebo plus analgesia) has any effect on pain because the quality of evidence is very low. Acupuncture or acupressure plus analgesia (versus analgesia) may reduce pain at 12 hours (standardised mean difference (SMD) -0.28, 95% confidence interval (CI) -0.64 to 0.07; 130 women; 2 studies; low-certainty evidence) and 24 hours (SMD -0.63, 95% CI -0.99 to -0.26; 2 studies; 130 women; low-certainty evidence). It is uncertain whether acupuncture or acupressure (versus no treatment) or acupuncture or acupressure plus analgesia (versus analgesia) has any effect on the risk of adverse effects because the quality of evidence is very low. Aromatherapy Aromatherapy plus analgesia may reduce pain when compared with placebo plus analgesia at 12 hours (mean difference (MD) -2.63 visual analogue scale (VAS), 95% CI -3.48 to -1.77; 3 studies; 360 women; low-certainty evidence) and 24 hours (MD -3.38 VAS, 95% CI -3.85 to -2.91; 1 study; 200 women; low-certainty evidence). We are uncertain if aromatherapy plus analgesia has any effect on adverse effects (anxiety) compared with placebo plus analgesia. Electromagnetic therapy Electromagnetic therapy may reduce pain compared with placebo plus analgesia at 12 hours (MD -8.00, 95% CI -11.65 to -4.35; 1 study; 72 women; low-certainty evidence) and 24 hours (MD -13.00 VAS, 95% CI -17.13 to -8.87; 1 study; 72 women; low-certainty evidence). Massage We identified six studies (651 women), five of which were quasi-RCTs, comparing massage (foot and hand) plus analgesia versus analgesia. All the evidence relating to pain, adverse effects (anxiety), vital signs and rescue analgesic requirement was very low-certainty. Music Music plus analgesia may reduce pain when compared with placebo plus analgesia at one hour (SMD -0.84, 95% CI -1.23 to -0.46; participants = 115; studies = 2; I2 = 0%; low-certainty evidence), 24 hours (MD -1.79, 95% CI -2.67 to -0.91; 1 study; 38 women; low-certainty evidence), and also when compared with analgesia at one hour (MD -2.11, 95% CI -3.11 to -1.10; 1 study; 38 women; low-certainty evidence) and at 24 hours (MD -2.69, 95% CI -3.67 to -1.70; 1 study; 38 women; low-certainty evidence). It is uncertain whether music plus analgesia has any effect on adverse effects (anxiety), when compared with placebo plus analgesia because the quality of evidence is very low. Reiki We are uncertain if Reiki plus analgesia compared with analgesia alone has any effect on pain, adverse effects, vital signs or rescue analgesic requirement because the quality of evidence is very low (one study, 90 women). Relaxation Relaxation may reduce pain compared with standard care at 24 hours (MD -0.53 VAS, 95% CI -1.05 to -0.01; 1 study; 60 women; low-certainty evidence). Transcutaneous electrical nerve stimulation TENS (versus no treatment) may reduce pain at one hour (MD -2.26, 95% CI -3.35 to -1.17; 1 study; 40 women; low-certainty evidence). TENS plus analgesia (versus placebo plus analgesia) may reduce pain compared with placebo plus analgesia at one hour (SMD -1.10 VAS, 95% CI -1.37 to -0.82; 3 studies; 238 women; low-certainty evidence) and at 24 hours (MD -0.70 VAS, 95% CI -0.87 to -0.53; 108 women; 1 study; low-certainty evidence). TENS plus analgesia (versus placebo plus analgesia) may reduce heart rate (MD -7.00 bpm, 95% CI -7.63 to -6.37; 108 women; 1 study; low-certainty evidence) and respiratory rate (MD -1.10 brpm, 95% CI -1.26 to -0.94; 108 women; 1 study; low-certainty evidence). We are uncertain if TENS plus analgesia (versus analgesia) has any effect on pain at six hours or 24 hours, or vital signs because the quality of evidence is very low (two studies, 92 women). AUTHORS' CONCLUSIONS: Some CAM therapies may help reduce post-CS pain for up to 24 hours. The evidence on adverse events is too uncertain to make any judgements on safety and we have no evidence about the longer-term effects on pain. Since pain control is the most relevant outcome for post-CS women and their clinicians, it is important that future studies of CAM for post-CS pain measure pain as a primary outcome, preferably as the proportion of participants with at least moderate (30%) or substantial (50%) pain relief. Measuring pain as a dichotomous variable would improve the certainty of evidence and it is easy to understand for non-specialists. Future trials also need to be large enough to detect effects on clinical outcomes; measure other important outcomes as listed lin this review, and use validated scales.


Assuntos
Cesárea/efeitos adversos , Terapias Complementares/métodos , Dor Pós-Operatória/terapia , Acupressão , Analgesia por Acupuntura , Adolescente , Adulto , Analgesia Obstétrica/métodos , Analgésicos/administração & dosagem , Aromaterapia , Viés , Terapia Combinada/métodos , Feminino , Humanos , Massagem , Musicoterapia , Placebos/uso terapêutico , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Terapia de Relaxamento , Toque Terapêutico , Estimulação Elétrica Nervosa Transcutânea , Adulto Jovem
17.
Rinsho Ketsueki ; 61(8): 865-869, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32908047

RESUMO

Acute leukemia (AL) during pregnancy poses a substantial risk to both mothers and fetuses. Treatment for leukemia should be initiated promptly; however, the management of AL in pregnant women and fetuses is usually challenging, especially during the second trimester. Here, we report two cases of AL that developed during the second trimester of pregnancy. In one case, chemotherapy was initiated while continuing the pregnancy; in the second case, a cesarean section was performed prior to chemotherapy initiation. As per current medical records, both infants are thriving without any medical problems. The optimal strategy for the treatment of AL during pregnancy typically includes chemotherapy after delivery. However, if fetal development is not sufficient for ex utero survival, the only alternatives available are the initiation of treatment while continuing the pregnancy or treatment after therapeutic abortion (if it is legally allowed). According to previous studies and as per the results from our first case, the initiation of chemotherapy while sustaining the pregnancy may be an acceptable option if it is conducted with appropriate informed consent. The treatment of AL in the second trimester of pregnancy should be carefully decided, while taking into account the medical, legal, and social aspects, such as gestational weeks, maternal and fetal status, and wishes of the patients and their families.


Assuntos
Leucemia Mieloide Aguda , Complicações Neoplásicas na Gravidez , Doença Aguda , Cesárea , Feminino , Humanos , Gravidez , Segundo Trimestre da Gravidez
18.
BMC Pregnancy Childbirth ; 20(1): 511, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32887569

RESUMO

BACKGROUND: It has been proposed that pregnant women and their fetuses may be particularly at risk for poor outcomes due to the coronavirus (COVID-19) pandemic. From the few case series that are available in the literature, women with high risk pregnancies have been associated with higher morbidity. It has been suggested that pregnancy induced immune responses and cardio-vascular changes can exaggerate the course of the COVID-19 infection. CASE PRESENTATION: A 26-year old Somalian woman (G2P1) presented with a nine-day history of shortness of breath, dry cough, myalgia, nausea, abdominal pain and fever. A nasopharyngeal swab returned positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Her condition rapidly worsened leading to severe liver and coagulation impairment. An emergency Caesarean section was performed at gestational week 32 + 6 after which the patient made a rapid recovery. Severe COVID-19 promptly improved by the termination of the pregnancy or atypical HELLP (Hemolysis, Elevated Liver Enzymes and Low Platelet Count) exacerbated by concomitant COVID-19 infection could not be ruled out. There was no evidence of vertical transmission. CONCLUSIONS: This case adds to the growing body of evidence which raises concerns about the possible negative maternal outcomes of COVID-19 infection during pregnancy and advocates for pregnant women to be recognized as a vulnerable group during the current pandemic.


Assuntos
Transtornos da Coagulação Sanguínea/sangue , Cesárea , Infecções por Coronavirus/sangue , Hepatopatias/sangue , Obesidade Materna , Pneumonia Viral/sangue , Complicações Infecciosas na Gravidez/sangue , Adulto , Antitrombina III/metabolismo , Índice de Apgar , Betacoronavirus , Transtornos da Coagulação Sanguínea/etiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/fisiopatologia , Diagnóstico Diferencial , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Síndrome HELLP/diagnóstico , Humanos , Recém-Nascido , Recém-Nascido Prematuro , L-Lactato Desidrogenase/sangue , Hepatopatias/etiologia , Pulmão/diagnóstico por imagem , Masculino , Pandemias , Tempo de Tromboplastina Parcial , Contagem de Plaquetas , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/fisiopatologia , Gravidez , Complicações Infecciosas na Gravidez/fisiopatologia , Suécia , Tomografia Computadorizada por Raios X
19.
Medicine (Baltimore) ; 99(33): e21714, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872051

RESUMO

Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality, yet it is inconsistently defined, preventing accurate estimation of its incidence and identification of risk factors. Here we began to explore a unified definition of PPH that may be valid for vaginal delivery and cesarean section.Medical records of women who underwent vaginal delivery or cesarean section at our tertiary medical center between January and December 2018 were retrospectively analyzed. Patients who delivered by each route were compared in terms of PPH incidence and risk factors depending on different blood loss cut-off values.A total of 560 vaginal deliveries and 393 cesarean sections were analyzed. Vaginal deliveries were associated with significantly greater blood loss based on change of hemoglobin level, but significantly lower blood loss based on clinical estimation. When PPH was defined as blood loss ≥500 ml based on change of hemoglobin level, its incidence was 57.7% for vaginal deliveries and 28.2% for cesarean sections. The corresponding incidences were 15.4% and 3.3% when PPH was defined as blood loss ≥1000 ml based on change of hemoglobin levels. Independent risk factors for PPH in vaginal deliveries were lateral perineotomy (OR 2.835, 95%CI 1.694-4.743), suturing by a junior physician (OR 3.456, 95%CI 2.005-5.956), and long time from delivery of placenta to return to the recovery room (OR 1.013, 95%CI 1.003-1.022). A risk factor for PPH in cesarean sections was a long time from delivery of the fetus until the end of the operation.PPH is a significantly underestimated obstetric problem, especially in vaginal deliveries. Regardless of delivery route, hemoglobin-based blood loss of 500 ml and 1000 ml may be useful, respectively, as early warning and diagnostic cut-off values.


Assuntos
Cesárea/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Hemorragia Pós-Parto/epidemiologia , Adulto , Cesárea/efeitos adversos , China/epidemiologia , Feminino , Humanos , Incidência , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Hemorragia Pós-Parto/diagnóstico , Hemorragia Pós-Parto/etiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco , Terminologia como Assunto
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