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1.
Medicine (Baltimore) ; 98(44): e17741, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689823

RESUMO

OBJECTIVES: We compared the clinical efficacy of contrast-enhanced ultrasound (CEUS) to transvaginal ultrasound (TVS) for diagnosing cesarean scar pregnancy (CSP). METHODS: A total of 485 cases of suspected CSP were recruited from January 2017 to March 2018. All received TVS and CEUS by two sonologists blinded to diagnosis by the other. Diagnostic features of CSP that significantly differed between modalities by univariate analysis (P < .05) were included in a logistic regression model. The sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (-LR), and accuracy (ACC) of CSP diagnosis by TVS and CEUS were compared according to operational and pathological outcomes as the reference standard. RESULTS: There were 220 CSP cases (including 85 cases of type I, 93 of type II, and 42 of type III). The sensitivities of CEUS for detection of types I - III CSP were 94.1%, 92.5%, and 97.6%, respectively, and corresponding sensitivities of TVS were 82.4%, 80.6%, and 95.2%. Compared to TVS, CEUS yielded significantly better overall sensitivity (97.27% vs 88.18%), specificity (96.60% vs 75.47%), +LR (28.60 vs 3.59), -LR (0.03 vs 0.16), and diagnostic ACC (96.9% vs 81.23%) (all P < .001). CONCLUSIONS: CEUS is superior to TVS for detecting cesarean scar pregnancy and distinguishing among CSP types.


Assuntos
Cesárea/efeitos adversos , Cicatriz/complicações , Meios de Contraste , Complicações Pós-Operatórias/diagnóstico por imagem , Gravidez Ectópica/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Feminino , Humanos , Complicações Pós-Operatórias/etiologia , Gravidez , Gravidez Ectópica/etiologia , Estudos Prospectivos , Sensibilidade e Especificidade , Vagina/diagnóstico por imagem
2.
Medicine (Baltimore) ; 98(44): e17742, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689824

RESUMO

Placenta previa and accreta with prior cesarean section is an extremely serious condition that is associated with maternal morbidity and mortality from obstetric hemorrhage. The aim of our study was to evaluate the efficacy and advantages of a novel surgical technique, parallel transverse uterine incisions (PTUI), during conservative cesarean delivery in patients with placenta previa and accreta.This was a retrospective cohort study including 124 pregnant women, who had at least 1 prior cesarean section and were diagnosed with anterior placenta previa and accreta between January 2014 and October 2017. Using the hospital's information system, patients were retrospectively classified into undergoing either the PTUI surgery (Group A) or the ordinary cesarean section (Group B). Surgical outcomes and maternal complications during hospitalization were collected. The results from 2 groups were compared and analyzed statistically. Multivariable regression analyses were further used to assess the effect of PTUI on severe maternal outcomes.Patients who underwent PTUI were not statistically different from patients who underwent the ordinary cesarean section in terms of maternal and infants' characteristics. However, PTUI was associated with remarkably reduced intraoperative blood loss (P = .005), related vaginal blood loss after surgery (P = .026), and transfusion requirement of packed red cells (P = .000), compared to the ordinary cesarean section. Moreover, cesarean hysterectomy (3.3% vs 21.9%; P = .002) and intensive care unit admission (1.7% vs 29.7%; P = .000) were significantly fewer among patients who underwent PTUI. Multivariable regression analyses further showed that the risk of intraoperative hemorrhage (ß = -2343.299, P = .000) and cesarean hysterectomy (odds ratio = 0.027, P = .018) were both significantly decreased by PTUI.PTUI is a novel approach that may significantly reduce maternal complications, while preserving the uterus for patients with anterior placenta previa and accreta.


Assuntos
Cesárea/métodos , Histerectomia/métodos , Histeroscopia/métodos , Tratamentos com Preservação do Órgão/métodos , Placenta Acreta/cirurgia , Placenta Prévia/cirurgia , Hemorragia Pós-Parto/cirurgia , Adulto , Perda Sanguínea Cirúrgica , Transfusão de Sangue/estatística & dados numéricos , Cesárea/efeitos adversos , Feminino , Humanos , Histerectomia/efeitos adversos , Hemorragia Pós-Parto/etiologia , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Útero/cirurgia
3.
Braz J Cardiovasc Surg ; 34(5): 627-629, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31719015

RESUMO

A 27-year-old woman with sudden back pain was transported to our hospital. Abdominal ultrasonography revealed pregnancy of 28 weeks' gestation. Computed tomography demonstrated a type A aortic dissection. Because of progressive fetal deterioration, an emergency cesarean section was forced to perform. The next day, simple hysterectomy followed by an aortic procedure was completed. Valve-sparing aortic replacement and total arch replacement were employed as central operations. The mother and baby are well 9 months postoperatively. Although the strategy for acute type A aortic dissection during pregnancy is controversial, collaborations among neonatologists, obstetricians, and cardiovascular surgeons can ensure mother and infant survival.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Complicações Cardiovasculares na Gravidez/cirurgia , Adulto , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Aórtico/diagnóstico por imagem , Cesárea , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Resultado da Gravidez , Tomografia Computadorizada por Raios X , Resultado do Tratamento
4.
Zhonghua Yi Xue Za Zhi ; 99(42): 3335-3339, 2019 Nov 12.
Artigo em Chinês | MEDLINE | ID: mdl-31715671

RESUMO

Objective: To explore the application value of multiple disciplinary team Enhanced recovery after surgery (MDT-ERAS) in cesarean section and evaluate its health economic benefits. Methods: A total of 572 cases of pregnant women undergoing cesarean section in obstetrics department of Jiaxing Maternity and Child Health Care Hospital from March 2018 to March 2019 were selected and randomly divided into experimental group and control group, 286 cases in each group. The control group was treated with traditional rehabilitation mode, and the experimental group was treated with MDT-ERAS intervention to compare the difference of rehabilitation index and health economics index between the two groups, and to evaluate the application value and health economics benefit of MDT-ERAS. Results: The VAS scores of the two groups at 1 day after operation were higher than those at the time of returning to the ward after operation(1.81±0.40 VS. 1.58±0.39, 3.78±0.89 VS. 3.22±0.83, all P<0.05). The VAS scores at 2 days and 3 days after operation were lower than those at the time of returning to the ward(0.58±0.09 VS. 1.58±0.39, 1.02±0.15 VS. 1.58±0.39; 1.88±0.37 VS. 3.22±0.83, 2.67±0.44 VS. 3.22±0.83, all P<0.05). The VAS scores of the experimental group at each time point after operation were lower than those of the control group(1.58±0.39 VS. 3.22±0.83, 1.81±0.40 VS. 3.78±0.89, 1.02±0.15 VS. 2.67±0.44, 0.58±0.09 VS. 1.88±0.37), and these differences were statistically significant (P<0.05). The anal exhaust time, indwelling catheterization time, first time out of bed and first time eating time of the experimental group were lower than those of the control group, with statistical significance (P<0.05). Postpartum hemorrhage rate and neonatal milk addition rate in the experimental group were significantly lower than those in the control group (all P<0.05). The hospitalization time and hospitalization expenses of the experimental group were lower than those of the control group(all P<0.05), and the health economics benefit of the experimental group was significantly higher than that of the latter (P<0.05). Conclusion: MDT-ERAS can effectively improve the recovery rate of the parturient after cesarean section, ensure the analgesic effect and improve the maternal and infant outcomes, and has higher health and economic benefits, which is worthy of promotion.


Assuntos
Cesárea , Hemorragia Pós-Parto , Feminino , Humanos , Gravidez
5.
Medicine (Baltimore) ; 98(44): e17767, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689838

RESUMO

The aim of this study was to evaluate the efficacy and safety of prophylactic intraoperative bilateral uterine or internal iliac artery embolization in planned cesarean for pernicious placenta previa in the third trimester of pregnancy.The patients with pernicious placenta previa were retrospectively included from January 2011 to May 2018, being divided into embolization group and control group. Intraoperative uterine artery embolization (UAE) or internal iliac artery embolization (IIAE) was undertaken to stop intrapartum and postpartum hemorrhage in embolization group.There were no significant differences on age, pregnancy times, gestational age, neonatal weight, neonatal asphyxia, prenatal bleeding, placental implantation, and mortality between embolization group and control group (P > .05). The amount of intraoperative and postoperative bleeding in embolization group was significantly greater than that in control group (P < .05). However, the hysterectomy rate in the embolization group was significantly lower than that in the control group (P < .05). Two (6.25%, 2/32) cases had undergone the second time embolotherapy after 8 hours of cesarean surgery because of severe vaginal bleeding. One case (3.13%, 1/32) died of diffuse intravascular coagulation because of hemorrhagic shock in embolization group. Transient and self-remitted lumbosacral pain was present in 28 (95%, 28/32) patients and no other severe interventional complications were reported in embolization group. All babies in 2 groups were healthy at half to 5 years' follow-up.The prophylactic intraoperative embolization of bilateral UAE or IIAE may be an effective strategy to treat intractable peripartum hemorrhage and preserve the fertility in patients with pernicious placenta previa.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Cesárea/efeitos adversos , Cuidados Intraoperatórios/métodos , Placenta Prévia/cirurgia , Hemorragia Pós-Parto/prevenção & controle , Embolização da Artéria Uterina/métodos , Adulto , Feminino , Humanos , Artéria Ilíaca/cirurgia , Gravidez , Terceiro Trimestre da Gravidez , Procedimentos Cirúrgicos Profiláticos/métodos , Estudos Retrospectivos , Resultado do Tratamento , Artéria Uterina/cirurgia
6.
Pan Afr Med J ; 33: 216, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692727

RESUMO

The association of myoma and pregnancy is becoming more frequent due to the increasing age of first pregnancy. It may affect the outcome of fertility, pregnancy, labor and peripartum course. A 37 years old patient was referred to our unit for discovering uterine leiomyoma at 37 weeks of pregnancy. Ultrasound screening showed a praevia isthmic leiomyoma measuring 16cm. A caesarean delivery was scheduled and a large interstitial isthmic uterine myoma measuring 25cm was found. Hysterectomy was corporeal. The post-operative and puerperium course was normal.


Assuntos
Leiomioma/diagnóstico por imagem , Complicações Neoplásicas na Gravidez/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Neoplasias Uterinas/diagnóstico por imagem , Adulto , Cesárea , Feminino , Humanos , Histerectomia/métodos , Leiomioma/cirurgia , Gravidez , Neoplasias Uterinas/cirurgia
8.
Am J Forensic Med Pathol ; 40(4): 381-385, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31688048

RESUMO

The authors report on the autopsy case of a 40-year-old primigravida without either coagulation disorders or anticoagulant/antiplatelet therapy, who developed a fatal intracranial subdural hematoma after spinal anesthesia (SA) for elective cesarean delivery for tocophobia.Intracranial subdural hematoma is the most dreaded complication of SA and is often misdiagnosed with postdural puncture headache.In this article, the authors discuss pathophysiological mechanisms and risk factors for the development of an intracranial subdural hematoma after SA and review the pertinent literature.


Assuntos
Raquianestesia/efeitos adversos , Cesárea , Hematoma Subdural Intracraniano/etiologia , Adulto , Morte Encefálica , Feminino , Hematoma Subdural Intracraniano/diagnóstico por imagem , Hematoma Subdural Intracraniano/patologia , Humanos
9.
JAMA ; 322(19): 1869-1876, 2019 11 19.
Artigo em Inglês | MEDLINE | ID: mdl-31742629

RESUMO

Importance: The American College of Obstetricians and Gynecologists recommends a delay in umbilical cord clamping in term neonates for at least 30 to 60 seconds after birth. Most literature supporting this practice is from low-risk vaginal deliveries. There are no published data specific to cesarean delivery. Objective: To compare maternal blood loss with immediate cord clamping vs delayed cord clamping in scheduled cesarean deliveries at term (≥37 weeks). Design, Setting, and Participants: Randomized clinical trial performed at 2 hospitals within a tertiary academic medical center in New York City from October 2017 to February 2018 (follow-up completed March 15, 2018). A total of 113 women undergoing scheduled cesarean delivery of term singleton gestations were included. Interventions: In the immediate cord clamping group (n = 56), cord clamping was within 15 seconds after birth. In the delayed cord clamping group (n = 57), cord clamping was at 60 seconds after birth. Main Outcomes and Measures: The primary outcome was change in maternal hemoglobin level from preoperative to postoperative day 1, which was used as a proxy for maternal blood loss. Secondary outcomes included neonatal hemoglobin level at 24 to 72 hours of life. Results: All of the 113 women who were randomized (mean [SD] age, 32.6 [5.2] years) completed the trial. The mean preoperative hemoglobin level was 12.0 g/dL in the delayed and 11.6 g/dL in the immediate cord clamping group. The mean postoperative day 1 hemoglobin level was 10.1 g/dL in the delayed group and 9.8 g/dL in the immediate group. There was no significant difference in the primary outcome, with a mean hemoglobin change of -1.90 g/dL (95% CI, -2.14 to -1.66) and -1.78 g/dL (95% CI, -2.03 to -1.54) in the delayed and immediate cord clamping groups, respectively (mean difference, 0.12 g/dL [95% CI, -0.22 to 0.46]; P = .49). Of 19 prespecified secondary outcomes analyzed, 15 showed no significant difference. The mean neonatal hemoglobin level, available for 90 neonates (79.6%), was significantly higher with delayed (18.1 g/dL [95% CI, 17.4 to 18.8]) compared with immediate (16.4 g/dL [95% CI, 15.9 to 17.0]) cord clamping (mean difference, 1.67 g/dL [95% CI, 0.75 to 2.59]; P < .001). There was 1 unplanned hysterectomy in each group. Conclusions and Relevance: Among women undergoing scheduled cesarean delivery of term singleton pregnancies, delayed umbilical cord clamping, compared with immediate cord clamping, resulted in no significant difference in the change in maternal hemoglobin level at postoperative day 1. Trial Registration: ClinicalTrials.gov Identifier: NCT03150641.


Assuntos
Cesárea , Constrição , Hemoglobinas/análise , Hemorragia Pós-Operatória/prevenção & controle , Cordão Umbilical , Adulto , Gasometria , Procedimentos Cirúrgicos Eletivos , Feminino , Sangue Fetal/química , Humanos , Concentração de Íons de Hidrogênio , Recém-Nascido/sangue , Masculino , Hemorragia Pós-Operatória/epidemiologia , Gravidez , Nascimento a Termo , Fatores de Tempo
10.
BMJ ; 367: l6131, 2019 11 20.
Artigo em Inglês | MEDLINE | ID: mdl-31748223

RESUMO

OBJECTIVE: To evaluate if induction of labour at 41 weeks improves perinatal and maternal outcomes in women with a low risk pregnancy compared with expectant management and induction of labour at 42 weeks. DESIGN: Multicentre, open label, randomised controlled superiority trial. SETTING: 14 hospitals in Sweden, 2016-18. PARTICIPANTS: 2760 women with a low risk uncomplicated singleton pregnancy randomised (1:1) by the Swedish Pregnancy Register. 1381 women were assigned to the induction group and 1379 were assigned to the expectant management group. INTERVENTIONS: Induction of labour at 41 weeks and expectant management and induction of labour at 42 weeks. MAIN OUTCOME MEASURES: The primary outcome was a composite perinatal outcome including one or more of stillbirth, neonatal mortality, Apgar score less than 7 at five minutes, pH less than 7.00 or metabolic acidosis (pH <7.05 and base deficit >12 mmol/L) in the umbilical artery, hypoxic ischaemic encephalopathy, intracranial haemorrhage, convulsions, meconium aspiration syndrome, mechanical ventilation within 72 hours, or obstetric brachial plexus injury. Primary analysis was by intention to treat. RESULTS: The study was stopped early owing to a significantly higher rate of perinatal mortality in the expectant management group. The composite primary perinatal outcome did not differ between the groups: 2.4% (33/1381) in the induction group and 2.2% (31/1379) in the expectant management group (relative risk 1.06, 95% confidence interval 0.65 to 1.73; P=0.90). No perinatal deaths occurred in the induction group but six (five stillbirths and one early neonatal death) occurred in the expectant management group (P=0.03). The proportion of caesarean delivery, instrumental vaginal delivery, or any major maternal morbidity did not differ between the groups. CONCLUSIONS: This study comparing induction of labour at 41 weeks with expectant management and induction at 42 weeks does not show any significant difference in the primary composite adverse perinatal outcome. However, a reduction of the secondary outcome perinatal mortality is observed without increasing adverse maternal outcomes. Although these results should be interpreted cautiously, induction of labour ought to be offered to women no later than at 41 weeks and could be one (of few) interventions that reduces the rate of stillbirths. TRIAL REGISTRATION: Current Controlled Trials ISRCTN26113652.


Assuntos
Idade Gestacional , Doenças do Recém-Nascido , Trabalho de Parto Induzido , Conduta Expectante/estatística & dados numéricos , Adulto , Cesárea/estatística & dados numéricos , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/etiologia , Análise de Intenção de Tratamento , Trabalho de Parto Induzido/efeitos adversos , Trabalho de Parto Induzido/métodos , Trabalho de Parto Induzido/estatística & dados numéricos , Gravidez , Resultado da Gravidez/epidemiologia , Natimorto/epidemiologia , Suécia/epidemiologia , Nascimento a Termo
11.
Zhonghua Fu Chan Ke Za Zhi ; 54(11): 751-755, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31752458

RESUMO

Objective: To study and analyze the incidence of pelvic organ prolapse (POP) in women who underwent cesarean section. Methods: A cross-sectional study was conducted. The clinical data of the women who underwent regular antepartum examination and cesarean delivery in Peking University People's Hospital from January 2019 to June 2019 were collected, including the cervical dilatation. The incidence of POP was analyzed. Results: (1) A total of 345 women met the inclusion criteria, with cervical dilatation of 0-10 cm before cesarean section, the cervix was not dilatated in 58.6% (202/345) of the women, and the cervix was fully dilatated in 2.9% (10/345) of the women. There were 109 cases of POP stage Ⅰ or above, 13 cases of POP stage Ⅱ, and no stage Ⅲ or Ⅳ. The incidence of POP was 31.6% (109/345). (2) Statistical analysis showed that the cervical dilatation of the POP group was significantly larger than that of the non-prolapse group (median: 1.0 vs 0 cm;Z=-2.227, P=0.026). The risk of POP of vaginal trial-birth transfer to cesarean section was higher than that of elective cesarean section [42.4% (36/85) vs 28.1% (73/260), P=0.014]. However, the further analysis of Spearman correlation between cervical dilatation, elective cesarean section and POP, as well as the receiver operating characteristic curve showed that the correlation and prediction value were poor. Conclusion: Elective cesarean section has a certain protective effect on postpartum prolapse, but the protective effect of vaginal trial-birth transfer to cesarean section on pelvic floor is weakened.


Assuntos
Cesárea/efeitos adversos , Parto Obstétrico/efeitos adversos , Prolapso de Órgão Pélvico/etiologia , Período Pós-Parto , Estudos Transversais , Feminino , Humanos , Prolapso de Órgão Pélvico/epidemiologia , Gravidez
12.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(4): 609-614, 2019 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-31642244

RESUMO

OBJECTIVE: To investigate the effects of individualized intervention on postpartum breast-feeding behavior and satisfaction after cesarean section (CS). METHODS: 341 pregnant women who had cesarean section in West China Second Hospital of Sichuan University from 1st July to 30th August in 2018 were randomly divided into intervention group (171 cases) and control group (170 cases). The participants in experimental group received individualized intervention through the combination of prenatal and postnatal. The participants in control group received routine nursing care. The basic clinical data and breastfeeding information at discharge and day 42 postpartum were compared between the two groups. RESULTS: There were no significant differences in age, ethnicity, anesthesia type, preoperative feeding time between the two groups (P>0.05). At the time of discharge and day 42 postpartum, the rate of exclusive breastfeeding, breastfeeding satisfaction and planned breastfeeding duration in the intervention group were higher than those in the control group (P < 0.05). The incidence and degree of breast distending pain, the incidence of cracked nipples, the times of adding formula milk in 24 h, the rate of using feeding bottle and the incidence of feeding problems were all higher in the control group than those in the intervention group (P < 0.05). The knowledge scores of breastfeeding in both groups were higher at discharge than at admission, and the score was higher in the intervention group than that in the control group at the time of discharge. CONCLUSION: The combination of prenatal and postnatal individualized intervention can significantly improve the knowledge, behavior and satisfaction of breastfeeding.


Assuntos
Aleitamento Materno , Cesárea , Cuidado Pós-Natal , Cuidado Pré-Natal , China , Feminino , Humanos , Satisfação do Paciente , Período Pós-Parto , Gravidez
13.
An Acad Bras Cienc ; 91(3): e20180746, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31576915

RESUMO

The use of ulinastatin for pancreatitis and sepsis have been described. This study was designed to evaluate the effect of ulinastatin on vascular endothelial cell damage and coagulation in pregnant women with severe pre-eclampsia (PE).From October 2015 to November 2017 at Tianjin Central Hospital of gynecology and obstetrics in China. Eighty pregnant women with severe PE, who elected to deliver by cesarean section, were randomly assigned to a control group or an ulinastatin group. The plasma concentration of von Willebrand factor (vWF) and platelet granule membrane protein (GMP-140), platelet count, fibrinogen levels, prothrombin time (PT), and partial prothrombin activation time (APTT) were recorded before combined spinal-epidural anesthesia and 40 min after administration in both groups.Ulinastatin attenuates vascular endothelial cell damage in pregnant women with PE as indicated by decreased plasma concentrations of vWF and prolonged APTT.


Assuntos
Células Endoteliais/efeitos dos fármacos , Glicoproteínas/farmacologia , Pré-Eclâmpsia/tratamento farmacológico , Inibidores da Tripsina/farmacologia , Adulto , Coagulação Sanguínea/efeitos dos fármacos , Cesárea/efeitos adversos , Feminino , Fibrinogênio/análise , Glicoproteínas/uso terapêutico , Humanos , Selectina-P/sangue , Contagem de Plaquetas , Pré-Eclâmpsia/sangue , Gravidez , Tempo de Protrombina , Valores de Referência , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Inibidores da Tripsina/uso terapêutico , Adulto Jovem , Fator de von Willebrand/análise
14.
Rinsho Ketsueki ; 60(9): 1292-1298, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31597855

RESUMO

This paper describes diagnosis, treatment, and control of acute venous thromboembolism (VTE) and antithrombotic prophylactic management during pregnancy and puerperium, especially in women with inherited thrombophilia. VTE is currently one of the three main causes of maternal morbidity in Japan. With approximately 0.05%-0.08% incidence rate per total number of births, it is becoming increasingly comparable with other developed countries. Pregnancy is characterized by high blood clotting potential due to increased coagulation factors, decreased anticoagulant activity, and fibrinolysis. Additionally, unique obstetric risk factors exist, such as cesarean section, prolonged bed rest, obesity, preeclampsia, and dehydration due to hyperemesis. Moreover, notable risk factors for VTE in pregnancy and puerperium for patients with inherited thrombophilia (e.g., deficiencies in antithrombin, protein C, and protein S) and acquired thrombophilia (e.g., antiphospholipid antibodies, history of VTE) have been reported; this study describes inherited thrombophilia in details.


Assuntos
Complicações Hematológicas na Gravidez/diagnóstico , Complicações Hematológicas na Gravidez/terapia , Trombofilia/terapia , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/terapia , Cesárea , Gerenciamento Clínico , Feminino , Humanos , Japão , Gravidez , Fatores de Risco
15.
Rev Prat ; 69(4): 429-431, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-31626501

RESUMO

Chronic pelvic pain in a woman with at least one history of caesarean should lead to the diagnosis of parietal endometrioma on a caesarean section scar, even years after. The most suggestive clinical picture is chronic cyclical pelvic pain located near the caesarean section scar associated with a pelvic wall mass. On clinical examination, this painful nodule is most often palpable. In order to support the diagnosis, it is advisable to perform a parietal ultrasound, preferably during menstruation and during the painful crisis; however, ultrasound lesions may also be typical outside menstrual period. The standard treatment consists of a large surgical resection with healthy margins, under general anesthesia.


Assuntos
Cesárea , Cicatriz , Endometriose , Cesárea/efeitos adversos , Cicatriz/patologia , Endometriose/patologia , Feminino , Humanos , Gravidez , Ultrassonografia
16.
Rev Med Suisse ; 15(668): 1920-1924, 2019 Oct 23.
Artigo em Francês | MEDLINE | ID: mdl-31643152

RESUMO

Both cesarean surgery and induction of labor have become common procedures performed in all labor wards in an attempt to reduce adverse obstetrical and neonatal outcomes. Thus, recent evidence, led by the ARRIVE Trial, demonstrated that elective induction at 39 weeks reduced the rates of cesarean deliveries and of hypertensive disorders of pregnancy. However, some concerns must be addressed, as the benefits of universal policies have to be outweighed with the current circumstances of implementation, the economic impact, the number of procedures needed to effectively reduce complications, and, above all, women's perception towards this approach. Therefore, it would be interesting to explore individualization strategies, instead of general recommendations, to offer personalized care.


Assuntos
Cesárea , Ensaios Clínicos como Assunto , Trabalho de Parto Induzido , Obstetrícia/métodos , Obstetrícia/normas , Cesárea/psicologia , Cesárea/normas , Procedimentos Cirúrgicos Eletivos/psicologia , Procedimentos Cirúrgicos Eletivos/normas , Feminino , Humanos , Trabalho de Parto Induzido/psicologia , Trabalho de Parto Induzido/normas , Gravidez , Resultado da Gravidez
17.
Medicine (Baltimore) ; 98(41): e17542, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593133

RESUMO

BACKGROUND: Patient-controlled intravenous analgesia (PCIA) and patient-controlled epidural analgesia are 2 common methods of maintaining analgesia after cesarean section. In recent years, transversus abdominis plane block (TAPB) has been gradually applied clinically to reduce opioid analgesics and has achieved good results. Therefore, we performed this study to compare the efficacy and side effects of TAPB and PCIA in analgesia after cesarean section. METHODS: One hundred patients who underwent cesarean section were randomly classified into 2 groups. Following surgery, one group underwent ultrasound-guided TAPB and the other group underwent PCIA. Pain intensity according to the visual analog scale (VAS; 0 for no pain and 10 for severe intolerable pain) was assessed at 2, 4, 6, 8, 12, and 24-hour postsurgery in both groups. The postoperative complication rate and patient satisfaction were also measured. RESULTS: No significant differences were found in the VAS scores between the groups (P > .05). However, the incidence of postoperative complications in the TAPB group was significantly lower than that in the PCIA group (P < .05). Furthermore, patient satisfaction in the TAPB group was significantly higher than that in the PCIA group (P < .05). CONCLUSION: This study demonstrated that ultrasound-guided TAPB can achieve the same analgesic effect as PCIA after cesarean section but with even higher patient satisfaction.


Assuntos
Músculos Abdominais/inervação , Analgesia Controlada pelo Paciente/métodos , Cesárea/efeitos adversos , Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção/métodos , Músculos Abdominais/diagnóstico por imagem , Músculos Abdominais/efeitos dos fármacos , Adulto , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Cesárea/métodos , Feminino , Humanos , Incidência , Bloqueio Nervoso/efeitos adversos , Satisfação do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Gravidez , Qualidade de Vida , Escala Visual Analógica
18.
Medicine (Baltimore) ; 98(40): e17366, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577735

RESUMO

This study is designed to clarify the incidence of epidural morphine induced pruritus (EMIP) in Chinese Han and Tibetan parturients after cesarean section (CS) and to identify the correlated risk factors.This is a prospective multicenter observational study. Follow-up evaluations were performed at 3 hours, 6 hours, 12 hours, 24 hours, and 48 hours after morphine administration. The primary outcome was EMIP incidence. Other details were also recorded for risk factor screening.Totally 284 parturients receiving CS were enrolled and 247 completed the study. The overall incidence of EMIP was 18.6% (46 in 247). The onset of pruritus was 5.6 ±â€Š4.8 hours (mean ±â€ŠSD) after morphine administration and the duration of pruritus was 14.0 ±â€Š8.8 hours. Logistic regression models was built with 5 variables, history of allergy, serotonin receptor antagonist administration, I.V. fentanyl administration, epidural morphine volume and VAS pain score. Results of showed that 2 of the variables, history of allergy (P < .001) and serotonin receptor antagonist (P < .05), were significantly correlated with incidence of EMIP.In conclusion, EMIP incidence in our study was 18.6%. Positive medical history of allergy and not using serotonin receptor antagonist were potential risk factors of EMIP development.Trial registration: ChiCTR-OPC-17012345.


Assuntos
Analgésicos Opioides/efeitos adversos , Anestesia Epidural/efeitos adversos , Cesárea/métodos , Morfina/efeitos adversos , Prurido/induzido quimicamente , Adulto , Analgésicos Opioides/uso terapêutico , Grupo com Ancestrais do Continente Asiático , Grupos Étnicos , Feminino , Humanos , Incidência , Morfina/uso terapêutico , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo
19.
Beijing Da Xue Xue Bao Yi Xue Ban ; 51(5): 813-818, 2019 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-31624382

RESUMO

OBJECTIVE: To describe the birth characteristics for Chinese newborns, to assess the feasibility of collecting basic data on maternal and child health, and to conduct relevant epidemiological studies by using mobile terminals. METHODS: From June 2016 to January 2017, pregnant women who delivered in hospitals were recruited in 166 hospitals scattered across 23 provinces of China. The data on their maternal and child health including delivery mode, gestational age and birth weight, were collected by self-administered questionnaires embedded in a mobile application. The incidences or means of cesarean section, preterm birth, birth weight, length and head circumference were calculated and compared with recognized national data, including 2005 Growth Standards for Chinese Children Under 7 Years of Age, 2006 World Health Organization Child Growth Standards and 2014 Chinese Neonatal Birth Weight Standards by Gestational Age. RESULTS: A total of 9 986 women were investigated, among whom those aged ≥35 years accounted for 11.7% and those received well education (college and above) accounted for 70.2%. The rate of cesarean section, preterm delivery, low birth weight and macrosomia were 38.1%, 4.5%, 2.2%, and 7.8%, respectively. The means were (3.33±0.44) kg [male (3.36±0.44) kg, female (3.29±0.43) kg] for birth weight, (50.97±2.32) cm [male (51.04±2.32) cm, female (50.89±2.32) cm] for birth length, and (33.99±1.56) cm [male (34.01±1.57) cm, female (33.97±1.55) cm] for head circumference, respectively. As compared with the national data, the cesarean section rate and birth weights by gestational age for term-born neonates were similar to the latest national data in 2014, while the means of birth weight and length were obviously higher than those of the 2005 Growth Standards for Chinese Children Under 7 Years of Age and 2006 World Health Organization Child Growth Standards. CONCLUSION: As compared with the national data 10 years ago, the mean birth weights for male and female newborns were increased by 40 g and 80 g respectively and mean lengths by 0.6 cm and 1.3 cm, but changes for mean head circumferences were negligible, indicating that the physical health condition for Chinese newborns improved significantly over past 10 years and emerging information technology likely provided a new approach for epidemiological research.


Assuntos
Peso ao Nascer , Cesárea , Idade Gestacional , Adulto , Criança , China , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Resultado da Gravidez , Inquéritos e Questionários
20.
Zhonghua Fu Chan Ke Za Zhi ; 54(10): 660-665, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31648441

RESUMO

Objective: To analyze the pregnancy outcomes of fetal tetralogy of Fallot and to explore its prenatal diagnosis and treatment procedures. Methods: The clinical data of 63 cases of fetal tetralogy of Fallot (62 cases were singleton and 1 case was one of twin) were collected retrospectively from November, 2013 to November, 2017 in Beijing Obstetrics and Gynecology Hospital. Results: (1) Totally, 63 cases out of 46 352 pregnancies were diagnosed fetal tetralogy of Fallot by fetal ultrasonic cardiogram with about 0.136%(63/46 352) occurrence rate, and the mean gestational age was (23±3) weeks. And 50 cases (79%, 50/63) terminated pregnancy by induced labour. (2) Totally, 57 cases (90%,57/63) accepted genetic diagnosis.Eight cases (13%, 8/63) existed chromosome abnormality including 21-trimosy in 6 cases, 18-trisomy in 1 case and 22q11.2 microdeletion syndrome in 1 case; and these 8 cases were determined before 28 gestational weeks. (3) And 13 cases (21%, 13/63) of no fetal genetic abnormality selected to continue pregnancy. Twelve cases underwent full term delivery (5 cases were cesarean section delivery and 7 cases were vaginal delivery). Twelve newborns underwent surgical radical operation on heart malformation and got recovery. One case underwent preterm cesarean section at 35 gestational weeks for one of twin, and the newborn with tetralogy of Fallot was dead. The other the newborns survived and were followed up for tetralogy of Fallot surgery from 1 month to 3 years old after birth and recovered. Conclusions: Fetal tetralogy of Fallot mainly is diagnosed by ultrasonic cardiogram in the second trimester. The gestational age of diagnosis may be as early as 15 gestational weeks. Fetal tetralogy of Fallot with no genetic abnormality could underwent radical heart malformation operation after birth. It is necessary to undergo genetic testing on fetal tetralogy of Fallot and prenatal multidisciplinary counseling as well.


Assuntos
Resultado da Gravidez , Diagnóstico Pré-Natal/métodos , Tetralogia de Fallot/diagnóstico por imagem , Ultrassonografia Pré-Natal , Aorta/diagnóstico por imagem , Aorta/patologia , Cesárea , Feminino , Feto , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Gravidez , Artéria Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Tetralogia de Fallot/diagnóstico
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