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1.
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
2.
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
3.
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
4.
Isr Med Assoc J ; 9(22): 467-471, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32954690

RESUMO

BACKGROUND: The World Health Organization classified coronavirus disease-19 (COVID-19) as a pandemic and recommends strict restrictions regarding most aspects of daily activities. OBJECTIVES: To evaluate whether the pandemic has changed the prenatal care and pregnancy outcome in pregnant women without COVID-19. METHODS: The authors conducted a cross-sectional study to describe changes in outpatient clinic visits and to compare the rates of cesarean and instrumental deliveries between two periods of time: March-April 2020 (during the COVID-19 outbreak) with March-April of the preceding year, 2019. RESULTS: During the COVID-19 outbreak, visits to obstetric triage, gynecologic triage, high-risk clinic, and ultrasound units decreased by 36.4%, 34.7%, 32.8%, and 18.1%, respectively. The medical center experienced a 17.8% drop in the total number of births (610 births) compared with March and April 2019 (742 births). During the outbreak women were more likely to be nulliparous (33.3% vs. 27.6%, P = 0.02) and present with hypertensive disorders during pregnancy (7.5% vs. 4%, P = 0.005) or gestational diabetes (13% vs. 10%, P = 0.03). More epidural analgesia was used (83.1% vs. 77.1%, P = 0.006). There were more operative vaginal deliveries during the outbreak (16.7% vs. 6.8%, P = 0.01). All other maternal and neonatal outcomes were comparable between the two periods. CONCLUSIONS: The medical facility experienced a major decline in all aspects of the routine obstetrics activities during the time of the pandemic. The higher rate of operative vaginal deliveries among nulliparous may be associated with the pandemic effect on the rate of high-risk patients.


Assuntos
Cesárea/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Parto Obstétrico/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Resultado da Gravidez/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Analgesia Epidural/estatística & dados numéricos , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Surtos de Doenças , Feminino , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Gravidez , Complicações na Gravidez/epidemiologia , Centros de Atenção Terciária
5.
Isr Med Assoc J ; 9(22): 503-509, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32954697

RESUMO

BACKGROUND: The incidence of gestational diabetes mellitus (GDM) is increasing in parallel to the worldwide obesity and type 2 diabetes pandemic. Both GDM and pre-gestational diabetes mellitus (PGDM) are associated with short- and long-term consequences in the offspring. There are few recent studies addressing outcomes of newborns born to women diagnosed with GDM and PGDM in Israel. OBJECTIVES: To assess perinatal complications in offspring of women with GDM and PGDM. METHODS: The authors conducted a single-center retrospective case-control study of outcomes of all newborns whose mothers had been diagnosed with diabetes in pregnancy compared to randomly assigned controls born on the same date, whose mothers had no diabetes. RESULTS: In the study period 2015-2017, 526 mothers diagnosed with GDM or PGDM and their newborn infants were identified. The authors randomly assigned 526 control infants. The rate of women with diabetes in pregnancy was 5.0%. Mothers with GDM and PGDM had higher rates of pre-eclampsia, multiple pregnancies, and preterm deliveries. Mothers with PGDM had significantly higher rates of intrauterine fetal demise (4.3%), congenital anomalies (12.8%), and small-for-gestational-age neonates (10.6%) compared to controls (0%, 3.2%, and 4.2%, respectively, P < 0.001). The risks for preterm or cesarean delivery, large-for-gestational-age neonate, respiratory morbidity, hypoglycemia, and polycythemia were increased in offspring of mothers with diabetes, especially PGDM. CONCLUSIONS: Despite all the advancements in prenatal care, diabetes in pregnancy, both PGDM and GDM, is still associated with significant morbidities and complications in offspring. Better preconception and inter-pregnancy care might reduce these risks.


Assuntos
Diabetes Gestacional/epidemiologia , Doenças do Recém-Nascido/epidemiologia , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , Gravidez em Diabéticas/epidemiologia , Adulto , Estudos de Casos e Controles , Cesárea/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Israel , Masculino , Gravidez , Cuidado Pré-Natal/métodos , Estudos Retrospectivos
6.
S Afr Med J ; 110(8): 747-750, 2020 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-32880299

RESUMO

Broader policy research and debate on the issues related to the planning of National Health Insurance (NHI) in South Africa (SA) need to be complemented by case studies to examine and understand the issues that will have to be dealt with at micro and macro levels. The objective of this article is to use caesarean section (CS) as a case study to examine the health systems challenges that NHI would need to address in order to ensure sustainability. The specific objectives are to: (i) provide an overview of the key clinical considerations related to CS; (ii) assess the CS rates in the SA public and private sectors; and (iii) use a health systems framework to examine the drivers of the differences between the public and private sectors and to identify the challenges that the proposed NHI would need to address on the road to implementation.


Assuntos
Cesárea/estatística & dados numéricos , Programas Nacionais de Saúde , Feminino , Planejamento em Saúde , Humanos , Gravidez , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , África do Sul
7.
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
8.
J Pregnancy ; 2020: 4985693, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32953176

RESUMO

Cervical assessment on the Bishop scale prior to induction of labor (IOL) is one of the strongest prognostic criteria in relation to the success of the procedure. The commonly used preinduction methods are mainly aimed at reducing the percentage of cesarean sections. Our study has analyzed obstetric results of patients who had unripe cervix (Bishop score <7) before IOL and used preinduction (Foley catheter or misoprostol vaginal insert releasing 7 mcg of misoprostol per hour for 24 hours) with obstetric results of patients in whom, due to favourable cervix, only a low-dose infusion of oxytocin was used. We reviewed the medical records of 1010 single pregnancies in whom IOL was performed. We divided the patients into two groups: group A (where preinduction was used) and group B (Bishop score ≥7 points) where preinduction was not used. Patients in group A were more likely to complete the delivery by caesarean section (OR = 4.58, 95% CI 3.22-6.51), and more likely to have events that were indications for operative delivery: unreassuring fetal heart rate trace (OR = 3.29, 95% CI 2.07-5.23) and arrested labor or failed induction (OR = 3.4, 95% CI 2.06-5.62). The groups did not differ in the percentage of vacuum extraction, postpartum haemorrhage, and meconium stained amniotic fluid. In group B, more infants were born with umbilical cord blood pH <7.1 (1.38% vs. 0%), both groups included no deliveries of newborns with Apgar score ≤3 points, the groups did not differ in terms of the percentage of newborns with Apgar score between 4 and 7 at birth (OR = 0.66, 95% CI 0.29-1.49). The immature cervix and the need to use labor preinduction is a risk factor for caesarean section. The necessity of preinduction does not impair neonatological results.


Assuntos
Colo do Útero/fisiologia , Trabalho de Parto Induzido/efeitos adversos , Trabalho de Parto Induzido/métodos , Trabalho de Parto , Adulto , Cesárea/estatística & dados numéricos , Feminino , Humanos , Ocitocina/administração & dosagem , Gravidez , Resultado da Gravidez , Prognóstico , Estudos Retrospectivos , Fatores de Risco
9.
Rev Bras Ginecol Obstet ; 42(9): 562-568, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32992359

RESUMO

OBJECTIVE: The present comprehensive review aims to show the full extent of what is known to date and provide a more thorough view on the effects of SARS-CoV2 in pregnancy. METHODS: Between March 29 and May, 2020, the words COVID-19, SARS-CoV2, COVID-19 and pregnancy, SARS-CoV2 and pregnancy, and SARS and pregnancy were searched in the PubMed and Google Scholar databases; the guidelines from well-known societies and institutions (Royal College of Obstetricians and Gynaecologists [RCOG], American College of Obstetricians and Gynecologists [ACOG], International Society of Ultrasound in Obstetrics & Gynecology [ISUOG], Centers for Disease Control and Prevention [CDC], International Federation of Gynecology and Obstetrics [FIGO]) were also included. CONCLUSION: The COVID-19 outbreak resulted in a pandemic with > 3.3 million cases and 230 thousand deaths until May 2nd. It is caused by the SARS-CoV2 virus and may lead to severe pulmonary infection and multi-organ failure. Past experiences show that unique characteristics in pregnancy make pregnant women more susceptible to complications from viral infections. Yet, this has not been reported with this new virus. There are risk factors that seem to increase morbidity in pregnancy, such as obesity (body mass index [BMI] > 35), asthma and cardiovascular disease. Current reports describe an increased rate of preterm birth and C-section. Vertical transmission is still a possibility, due to a few reported cases of neonatal positive real-time polymerase chain reaction (RT-PCR) in nasal swab, amniotic fluid, and positive immunoglobulin M (IgM) in neonatal blood. Treatments must be weighed in with caution due to the lack of quality trials that prove their effectiveness and safety during pregnancy. Medical staff must use personal protective equipment in handling SARS-CoV2 suspected or positive patients and be alert for respiratory decompensations.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Betacoronavirus/isolamento & purificação , Cesárea/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/transmissão , Feminino , Saúde Global , Humanos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Assistência Perinatal/métodos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Pneumonia Viral/transmissão , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/terapia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/virologia , Fatores de Risco
10.
PLoS One ; 15(9): e0237450, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32898139

RESUMO

INTRODUCTION: Sub-Saharan Africa has low Caesarean (CS) levels, despite a global increase in CS use. In conflict settings, the pattern of CS use is unclear because of scanty data. We aimed to examine the opportunity of using routine facility data to describe the CS use in conflict settings. METHODS: We conducted a facility-based cross-sectional study in 8 health zones (HZ) of South Kivu province in eastern DR Congo. We reviewed patient hospital records, maternity registers and operative protocol books, from January to December 2018. Data on direct conflict fatalities were obtained from the Uppsala Conflict Data Program. Based on conflict intensity and chronicity (expressed as a 6-year cumulative conflict death rate), HZ were classified as unstable (higher conflict death rate), intermediate and stable (lower conflict death rate). To describe the Caesarean section practice, we used the Robson classification system. Based on parity, history of previous CS, onset of labour, foetal lie and presentation, number of neonates and gestational age, the Robson classification categorises deliveries into 10 mutually exclusive groups. We performed a descriptive analysis of the relative contribution of each Robson group to the overall CS rate in the conflict stratum. RESULTS: Among the 29,600 deliveries reported by health facilities, 5,520 (18.6%) were by CS; 5,325 (96.5%) records were reviewed, of which 2,883 (54.1%) could be classified. The overall estimated population CS rate was 6.9%. The proportion of health facility deliveries that occurred in secondary hospitals was much smaller in unstable health zones (22.4%) than in intermediate (40.25) or stable health zones (43.0%). Robson groups 5 (previous CS, single cephalic, ≥ 37 weeks), 1 (nulliparous, single cephalic, ≥ 37 weeks, spontaneous labour) and 3 (multiparous, no previous CS, single cephalic, ≥ 37 weeks, spontaneous labour) were the leading contributors to the overall CS rate; and represented 75% of all CS deliveries. In unstable zones, previous CS (27.1%) and abnormal position of the fetus (breech, transverse lie, 3.3%) were much less frequent than in unstable and intermediate (44.3% and 6.0% respectively) and stable (46.7%and 6.2% respectively). Premature delivery and multiple pregnancy were more prominent Robson groups in unstable zones. CONCLUSION: In South Kivu province, conflict exposure is linked with an uneven estimated CS rate at HZ level with at high-risks women in conflict affected settings likely to have lower access to CS compared to low-risk mothers in stable health zones.


Assuntos
Cesárea , Apresentação no Trabalho de Parto , Paridade , Adulto , Apresentação Pélvica/cirurgia , Cesárea/estatística & dados numéricos , Congo , Estudos Transversais , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Gravidez Múltipla , Nascimento Prematuro/cirurgia , Fatores Socioeconômicos , Adulto Jovem
11.
Eur J Obstet Gynecol Reprod Biol ; 252: 490-501, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32795828

RESUMO

OBJECTIVE: Coronavirus disease 2019 (COVID-19) has become a global pandemic and may adversely affect pregnancy outcomes. We estimated the adverse maternal and neonatal characteristics and outcomes among COVID-19 infected women and determined heterogeneity in the estimates and associated factors. STUDY DESIGNS: PubMed search was performed of confirmed COVID-19 pregnant cases and related outcomes were ascertained prior to July 8, 2020, in this systematic review and meta-analysis. Studies reporting premature birth, low birth weight, COVID-19 infection in neonates, or mode of delivery status were included in the study. Two investigators independently performed searches, assessed quality of eligible studies as per the Cochrane handbook recommendations, extracted and reported data according to PRISMA guidelines. Pooled proportions of maternal and neonatal outcomes were estimated using meta-analyses for studies with varying sample sizes while a systematic review with descriptive data analysis was performed for case report studies. Maternal and neonatal outcomes included C-section, premature birth, low birth weight, adverse pregnancy events and COVID transmission in neonates. RESULTS: A total of 790 COVID-19 positive females and 548 neonates from 61 studies were analyzed. The rates of C-section, premature birth, low birth weight, and adverse pregnancy events were estimated as 72 %, 23 %, 7 %, and 27 % respectively. In the heterogeneity analysis, the rate of C-section was substantially higher in Chinese studies (91 %) compared to the US (40 %) or European (38 %) studies. The rates of preterm birth and adverse pregnancy events were also lowest in the US studies (12 %, 15 %) compared to Chinese (17 %, 21 %), and European studies (19 %, 19 %). In case reports, the rates of C-section, preterm birth, and low birth weight were estimated as 69 %, 56 %, and 35 %, respectively. Adverse pregnancy outcomes were associated with infection acquired at early gestational ages, more symptomatic presentation, myalgia symptom at presentation, and use of oxygen support therapy. CONCLUSIONS: Adverse pregnancy outcomes were prevalent in COVID-19 infected females and varied by location, type, and size of the studies. Regular screening and early detection of COVID-19 in pregnant women may provide more favorable outcomes.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez/epidemiologia , Adulto , Cesárea/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Pandemias , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/virologia , Prevalência
12.
Zhonghua Fu Chan Ke Za Zhi ; 55(7): 450-456, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32842248

RESUMO

Objective: To access the effectiveness and safety of the intrauterine balloon tamponade verse gauze packing combined with temporary abdominal aortic balloon occlusion in the management of placenta accreta spectrum (PAS). Methods: This was an open-label, randomized controlled trial conducted in Nanjing Drum Tower Hospital. The patients suspected with PAS for uterine preservation surgery under the multidisciplinary team care were recruited between Aug 2015 and Jan 2018. When bleeding could not be achieved after fetus delivered, and a temporary abdominal aortic balloon occlusion and the compression sutures as needed, the women were randomly allocated 1∶1 into balloon tamponade (n=81) or gauze packing (n=80) group. The primary outcome was successful bleeding arrests by avoiding second line surgeries. The secondary outcomes included the volume of blood loss during and after cesarean section, the rate of PPH, incidence and amount of blood transfusion, hysterectomy, postpartum pain, ICU admission, need for re-laparotomy, and the length of hospital stay, readmission, and interventional radiology complications. Results: All the women [100% (81/81)] in the balloon group were obtained hemostasis without further intervention, significantly higher than 88% (70/80) in the gauze group (P=0.001). Before uterine tamponade, blood loss were 820 ml (620-1 230) ml and 850 ml (605-1 442) ml, while placenta bed were sutured in 96%(78/81, 77/80) respectively (P>0.05).The proportion of blood loss≥1 000 ml was higher in the gauze group than that in the balloon group (P=0.006). Maternal adverse events involving total blood loss, puerperal morbidity and postpartum pain occurred more frequently in the gauze group (P<0.05). The following outcome showed no statistically significant difference between the two groups: the vascular occlusion time, the dose of radiation, and interventional radiology complication (P>0.05). The median volume infused into the lower and upper balloons is 70 ml (50-100 ml) and 180 ml (100-240 ml). Conclusions: Incrauterine balloon tamponade is as effective as gauze packing in hemostasis following the placenta delivery in PAS. Compared with gauze packing, the uterine balloon tamponade is more effective.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Cesárea/estatística & dados numéricos , Placenta Acreta/terapia , Hemorragia Pós-Parto/prevenção & controle , Tamponamento com Balão Uterino/métodos , Aorta Abdominal , Oclusão com Balão/métodos , Transfusão de Sangue , Cesárea/efeitos adversos , Feminino , Humanos , Histerectomia , Incidência , Placenta Prévia , Gravidez , Estudos Retrospectivos , Resultado do Tratamento
13.
Zhonghua Fu Chan Ke Za Zhi ; 55(7): 457-464, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32842249

RESUMO

Objective: To evaluate the effect of dual-tube epidural segmental injection of lidocaine analgesia on the delivery outcome and maternal and infant complications of persistent posterior occipital position postpartum or lateral occipital position postpartum patients with protracted active phase. Methods: The full and single-term primiparas (n=216, 37 to 42 weeks gestation, 22 to 35 years) diagnosed as persistent posterior or lateral occipital position during the active period were selected from the Department of Obstetrics of Qingdao Municipal Hospital from January 2015 to October 2019. The subjects were randomly assigned into two groups: double-tube epidural block group (n=108) and single-tube epidural block group (n=108), 1% lidocaine was used for epidural analgesia respectively under ultrasound guidance. Senior midwife or obstetricians implement new partogram, and guide women to perform position management, and push or rotate the fetal head in a timely manner. Observation indicators: general condition, the use of non-pharmacological analgesic measures, analgesia related conditions and pain visual analogue scale (VAS) score, delivery-related indicator, cesarean section indication, anesthesia-related indicator, maternal and child complications. Results: (1) General condition: the age, weight, height, gestational age, the ratio of persistent lateral or posterior occipital position, cephalic score, and neonatal birth weight between the two groups of women were not statistically significant (all P>0.05). (2) The use of non-pharmacological analgesic measures: the women's Lamaze breathing method, Doula delivery companionship, percutaneous electrical stimulation, and other measures between two groups were compared, and there were not significant differences (all P>0.05). (3) Analgesia related conditions and VAS scores of women undergoing vaginal delivery: compared with the single-tube epidural block group (n=40), the second-partum time of the women in the double-tube epidural block group (n=59) was significantly shortened [(124±44) vs (86±33) minutes, P<0.01]; after 30 minutes of analgesia (4.4±0.5 vs 0.9±0.5, P<0.01), during forced labor in the second stage of labor (5.7±0.6 vs 1.3±0.4, P<0.01), the VAS scores of pain were also significantly reduced (P<0.01). (4) Labor-related indicators: compared with the single-tube epidural block group, the natural delivery rate (21.3% vs 49.1%) and the delivery experience satisfaction rate (51.9% vs 98.1%) of women in the double-tube epidural block group were significantly increased (all P<0.01), cesarean section rate (63.0% vs 45.4%), instrument assisted rate (15.7% vs 5.6%) decreased significantly (all P<0.05). (5) Cesarean section indications: compared with the single-tube epidural block group, the cesarean section rate caused by prolonged labor or protracted active phase of women in the double-tube epidural block group was significantly reduced (38.0% vs 22.2%; P<0.05), and the fetal distress, intrauterine infection, and social factors caused by cesarean section between the two groups were compared, while the differences were not statistically significant (all P>0.05).(6) Anesthesia related indexes: the block planes of the maternal upper tube administration in the double-tube epidural block group were mostly T7, T8, T9-L2 and L3,While,the block planes in the single-tube epidural block group were mostly T10, T11-S1, S2, S3, and the modified Bromage score were all 0. (7) Maternal and child complications: compared with the single-tube epidural block group, the postpartum hemorrhage rate (18.5% vs 7.4%), the perineal lateral cut rate (20.4% vs 5.6%), the neonatal asphyxia rate (12.0% vs 3.7%), ICU rate of transferred neonates (13.9% vs 4.6%) in the double-tube epidural block group were significantly reduced (all P<0.05). Soft birth canal injury rate, puerperal disease rate and neonatal birth rate between two groups were compared, and there were not statistically significant differences (all P>0.05). Conclusion: Dual-tube epidural segmental injection of lidocaine analgesia could increase the natural delivery rate of women with posterior occipital or lateral occipital position with active stagnation, reduce the rate of cesarean section and the rate of transvaginal instruments, and reduce the complications of mother and child.


Assuntos
Analgesia Epidural/métodos , Analgesia Epidural/estatística & dados numéricos , Analgesia Obstétrica/métodos , Analgesia Obstétrica/estatística & dados numéricos , Anestesia Epidural/métodos , Cesárea/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Trabalho de Parto/efeitos dos fármacos , Lidocaína/administração & dosagem , Adulto , Analgesia Epidural/efeitos adversos , Analgesia Obstétrica/efeitos adversos , Feminino , Humanos , Recém-Nascido , Dor , Gravidez , Resultado da Gravidez , Resultado do Tratamento
14.
Cochrane Database Syst Rev ; 8: CD007372, 2020 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-32852803

RESUMO

BACKGROUND: The setting in which induction of labour takes place (home or inpatient) is likely to have implications for safety, women's experiences and costs. Home induction may be started at home with the subsequent active phase of labour happening either at home or in a healthcare facility (hospital, birth centre, midwifery-led unit). More commonly, home induction starts in a healthcare facility, then the woman goes home to await the start of labour. Inpatient induction takes place in a healthcare facility where the woman stays while awaiting the start of labour. OBJECTIVES: To assess the effects on neonatal and maternal outcomes of third trimester home induction of labour compared with inpatient induction using the same method of induction. SEARCH METHODS: For this update, we searched the Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (31 January 2020)), and reference lists of retrieved studies. SELECTION CRITERIA: Published and unpublished randomised controlled trials (RCTs) in which home and inpatient settings for induction have been compared. We included conference abstracts but excluded quasi-randomised trials and cross-over studies. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study reports for inclusion. Two review authors carried out data extraction and assessment of risk of bias independently. GRADE assessments were checked by a third review author. MAIN RESULTS: We included seven RCTs, six of which provided data on 1610 women and their babies. Studies were undertaken between 1998 and 2015, and all were in high- or upper-middle income countries. Most women were induced for post dates. Three studies reported government funding, one reported no funding and three did not report on their funding source. Most GRADE assessments gave very low-certainty evidence, downgrading mostly for high risk of bias and serious imprecision. 1. Home compared to inpatient induction with vaginal prostaglandin E (PGE) (two RCTs, 1028 women and babies; 1022 providing data). Although women's satisfaction may be slightly better in home settings, the evidence is very uncertain (mean difference (MD) 0.16, 95% confidence interval (CI) -0.02 to 0.34, 1 study, 399 women), very low-certainty evidence. There may be little or no difference between home and inpatient induction for other primary outcomes, with all evidence being very low certainty: - spontaneous vaginal birth (average risk ratio (RR) [aRR] 0.91, 95% CI 0.69 to 1.21, 2 studies, 1022 women, random-effects method); - uterine hyperstimulation (RR 1.19, 95% CI 0.40 to 3.50, 1 study, 821 women); - caesarean birth (RR 1.01, 95% CI 0.81 to 1.28, 2 studies, 1022 women); - neonatal infection (RR 1.29, 95% CI 0.59 to 2.82, 1 study, 821 babies); - admission to neonatal intensive care unit (NICU) (RR 1.20, 95% CI 0.50 to 2.90, 2 studies, 1022 babies). Studies did not report serious neonatal morbidity or mortality. 2. Home compared to inpatient induction with controlled release PGE (one RCT, 299 women and babies providing data). There was no information on whether the questionnaire on women's satisfaction with care used a validated instrument, but the findings presented showed no overall difference in scores. We found little or no difference between the groups for other primary outcomes, all also being very low-certainty evidence: - spontaneous vaginal birth (RR 0.94, 95% CI 0.77 to 1.14, 1 study, 299 women); - uterine hyperstimulation (RR 1.01, 95% CI 0.51 to 1.98, 1 study, 299 women); - caesarean births (RR 0.95, 95% CI 0.64 to 1.42, 1 study, 299 women); - admission to NICU (RR 1.38, 0.57 to 3.34, 1 study, 299 babies). The study did not report on neonatal infection nor serious neonatal morbidity or mortality. 3. Home compared to inpatient induction with balloon or Foley catheter (four RCTs; three studies, 289 women and babies providing data). It was again unclear whether questionnaires reporting women's experiences/satisfaction with care were validated instruments, with one study (48 women, 69% response rate) finding women were similarly satisfied. Home inductions may reduce the number of caesarean births, but the data are also compatible with a slight increase and are of very low-certainty (RR 0.64, 95% CI 0.41 to 1.01, 2 studies, 159 women). There was little or no difference between the groups for other primary outcomes with all being very low-certainty evidence: - spontaneous vaginal birth (RR 1.04, 95% CI 0.54 to 1.98, 1 study, 48 women): - uterine hyperstimulation (RR 0.45, 95% CI 0.03 to 6.79, 1 study, 48 women); - admission to NICU (RR 0.37, 95% CI 0.07 to 1.86, 2 studies, 159 babies). There were no serious neonatal infections nor serious neonatal morbidity or mortality in the one study (involving 48 babies) assessing these outcomes. AUTHORS' CONCLUSIONS: Data on the effectiveness, safety and women's experiences of home versus inpatient induction of labour are limited and of very low-certainty. Given that serious adverse events are likely to be extremely rare, the safety data are more likely to come from very large observational cohort studies rather than relatively small RCTs.


Assuntos
Assistência Ambulatorial/métodos , Maturidade Cervical , Hospitalização , Trabalho de Parto Induzido/métodos , Cateterismo/métodos , Cesárea/estatística & dados numéricos , Preparações de Ação Retardada , Dinoprostona , Feminino , Humanos , Recém-Nascido , Tempo de Internação , Ocitócicos , Segurança do Paciente , Satisfação do Paciente , Gravidez , Resultado da Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
Eur J Obstet Gynecol Reprod Biol ; 252: 559-562, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32732059

RESUMO

OBJECTIVE: To study the effect of COVID-19 on pregnancy and neonatal outcomes. STUDY DESIGN: Prospective cohort study in a large tertiary maternity unit within a university hospital with an average annual birth of over 10,000 births. We prospectively collected and analysed data for a cohort of 23 pregnant patients including singleton and multiple pregnancies tested positive for COVID-19 between February 2020 and April 2020 inclusive to assess the effect of COVID-19 on pregnancy, and neonatal outcomes. RESULTS: Twenty-three pregnant patients tested positive for COVID-19, delivering 20 babies including a set of twins, with four ongoing pregnancies at the time of manuscript submission. 16/23 (70 %) whom tested positive were patients from Asian (Indian sub-continent) background. The severity of the symptoms ranged from mild in 13/23 (65.2 %) of the patients, moderate in 2/23 (8.7 %), and severe in 8/23 (34.8 %). Four out of total 23 COVID-19 pregnant patients (17.4 %) developed severe adult respiratory distress syndrome complications requiring ICU support, one of whom led to maternal death 1/23 (4.3 %). 11/23 (48 %) of the patients had pre-existing co-morbidities, with morbid obesity 5/23 (21.7 %) and diabetes 4/23 (17.4 %) being the more commonly represented. Of the 23 pregnant patients 19 were in their third trimester of pregnancy and delivered; 7/19 (36.8 %) had preterm birth, 3/19 (15.8 %) developed adult respiratory distress syndrome before delivery, and 2/19 (10.5 %) had pre-eclampsia. 16/19 (84 %) of patients delivered by C-section. Out of the 20 new-borns, 18 were singletons with a set of twin. CONCLUSION: COVID-19 is associated with high prevalence of preterm birth, preeclampsia, and caesarean section compared to non-COVID pregnancies. COVID-19 infection was not found in the newborns and none developed severe neonatal complications.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez/epidemiologia , Adulto , Cesárea/estatística & dados numéricos , Infecções por Coronavirus/virologia , Feminino , Humanos , Recém-Nascido , Pandemias , Pneumonia Viral/virologia , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/virologia , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/virologia , Estudos Prospectivos
16.
AORN J ; 112(3): 217-224, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32857402

RESUMO

The novel coronavirus SARS-CoV-2 first appeared in Wuhan, China, in December 2019 and led to the Coronavirus Disease 2019 (COVID-19), which quickly spread globally. Protocols for surgical patients with COVID-19 were lacking, particularly for pregnant women undergoing cesarean deliveries. Perioperative nurses at Tongji Hospital in Wuhan retrospectively analyzed the perioperative nursing process, including OR preparation, intraoperative care, and OR cleanup, for women with COVID-19 undergoing cesarean deliveries. Preparation involved altering the layout of the surgical suite, educating staff members, providing personal protective equipment, and creating new in-house guidelines to help protect personnel and patients. This article describes how perioperative personnel strategized to prevent the transmission of COVID-19 in the OR and presents a multiple-case summary of six pregnant patients with COVID-19 who underwent cesarean deliveries at Tongji Hospital in January and February 2020.


Assuntos
Cesárea/estatística & dados numéricos , Infecções por Coronavirus/terapia , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Assistência Perioperatória/métodos , Pneumonia Viral/terapia , Resultado da Gravidez/epidemiologia , Betacoronavirus , China , Infecções por Coronavirus/cirurgia , Feminino , Humanos , Pandemias , Equipamento de Proteção Individual/estatística & dados numéricos , Pneumonia Viral/cirurgia , Gravidez , Complicações Infecciosas na Gravidez/terapia
17.
S Afr Med J ; 110(5): 374-376, 2020 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-32657720

RESUMO

BACKGROUND: Previous work from KwaZulu-Natal (KZN) Province, South Africa, has suggested that public sector district hospitals are not providing adequate access to surgical care in the form of bellwether operations (caesarean section (CS), open reduction of fractures (ORF) and laparotomy). OBJECTIVES: To review the surgical output of regional and tertiary institutions, to quantify their contribution to providing bellwether procedure coverage for the province. METHODS: Data on bellwether operations conducted at all district, regional, tertiary and central hospitals in the public health sector of KZN for the period 1 July - 31 December 2015 were collected from operating theatre registers. RESULTS: Between 1 July and 31 December 2015, a total of 20 926 CSs, 3 947 laparotomies and 3 098 ORFs were performed in KZN provincial hospitals. This translates to a provincial rate for each bellwether procedure of 192/100 000 (CS), 36/100 000 (laparotomy) and 28/100 000 (ORF). The rate of  bellwether operations across the province during the study period was 256/100 000, with numbers as follows: CSs - 10 542 in district hospitals, 8 712 in regional hospitals, 1 538 in tertiary hospitals and 134 in the central hospital; laparotomies - 235 in district hospitals, 2 314 in regional hospitals, 1 259 in tertiary hospitals and 139 in the central hospital; and ORFs - 196 in district hospitals, 1 660 in regional hospitals, 1 201 in tertiary hospitals and 41 in the central hospital. CONCLUSIONS: Regional and tertiary hospitals are performing the bulk of non-obstetric bellwether operations in KZN. This imbalance has major implications for planning future delivery of surgical care in the province.


Assuntos
Cesárea/estatística & dados numéricos , Laparotomia/estatística & dados numéricos , Redução Aberta/estatística & dados numéricos , Programas Médicos Regionais/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Feminino , Fraturas Ósseas/terapia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais de Distrito/estatística & dados numéricos , Humanos , Gravidez , África do Sul
18.
Medicine (Baltimore) ; 99(28): e20815, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664074

RESUMO

BACKGROUND: The high rate of cesarean section is an important factor affecting breastfeeding in China. To improve the nation's current situation of breastfeeding, promoting breastfeeding in women undergoing cesarean section is essential. OBJECTIVE: To explore the effects of health belief model-based interventions on breastfeeding knowledge, breastfeeding behaviors, and breastfeeding satisfaction of Chinese cesarean women. METHODS: A total of 346 cesarean section women were enrolled in the randomized controlled trial conducted at a center in Chengdu, China, between July 1, 2018 and August 31, 2018. While the control group (n = 173) received conventional breastfeeding guidance only, the intervention group (n = 173) received additional interventions based on the health belief model. Questionnaires were distributed to assess breastfeeding knowledge, breastfeeding behavior, and breastfeeding satisfaction at discharge, 42 days postpartum, and 4 months postpartum, respectively. RESULTS: At discharge from hospital, the breastfeeding knowledge score of the intervention group was higher than that of the control group (Z = -11.753, P < .001). The exclusive breastfeeding rates in the intervention group at the time of discharge, 42 days postpartum, and 4 months postpartum were 67.3%, 60.7%, and 52.9%, respectively, while those of the control group were 41.2%, 41.6%, and 40.4%, respectively. The differences were statistically significant (χ = 23.353, P < .001; χ = 11.853, P < .001; χ = 4.805, P = .03). The breastfeeding satisfaction of the intervention group was also higher than the control group at the time of discharge, 42 days postpartum and 4 months postpartum (t = 4.955, P < .001; t = 3.051, P = .002; Z = -3.801, P < .001). CONCLUSION: The health belief model-based interventions can effectively increase breastfeeding knowledge for Chinese cesarean women and improve their breastfeeding behaviors and breastfeeding satisfaction within 4 months after delivery. CLINICAL TRIAL REGISTRATION: ChiCTR1900026006 .


Assuntos
Aleitamento Materno/psicologia , Cesárea/efeitos adversos , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Adulto , Aleitamento Materno/etnologia , Aleitamento Materno/estatística & dados numéricos , Cesárea/estatística & dados numéricos , China/etnologia , Cultura , Feminino , Humanos , Alta do Paciente/estatística & dados numéricos , Alta do Paciente/tendências , Satisfação do Paciente/etnologia , Satisfação do Paciente/estatística & dados numéricos , Período Pós-Parto/fisiologia , Gravidez , Estudos Prospectivos , Inquéritos e Questionários
20.
Arch Gynecol Obstet ; 302(3): 579-584, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32617665

RESUMO

PURPOSE: To compare the effectiveness of the Cook vaginal cervical ripening balloon (CCRB) with prostaglandin E2 (PGE2) insert for induction of labor in late pregnancy in primipara. METHODS: We evaluated the effectiveness and safety of induction of labor using the improved Bishop score after CCRB or PGE2 administration, total stage of labor, hours until delivery (hours from placement of CCRB or PGE2 insert to parturition and delivery), delivery rate within 24 h, spontaneous delivery rate, successful induction rate, overstimulation syndrome, urgent delivery rate, pain scores, cesarean section rate, and outcomes related to delivery and perinatal morbidity, such as puerperal infection rate, total cost, satisfaction survey, and so on. RESULTS: The improved Bishop Score and delivery rate within 24 h in the CCRB group were significantly higher than in the PGE2 group. The total stage of labor and hours until delivery in the CCRB group were significantly shorter than that in the PGE2 group. Rate of overstimulation syndrome and pain scores in the CCRB group were significantly lower than in the PGE2 group. Compared with the PGE2 group, the mean duration of hospitalization in the CCRB group was shorter and the total cost was less. No difference in satisfaction between the PGE2 and CCRB groups was observed. CONCLUSIONS: Compared with PGE2, CCRB reduced the total stage of labor, hours until delivery, pain scores, mean length of hospitalization, and total cost. CCRB increased the rate of delivery within 24 h with similar safety and maternal satisfaction compared with PGE2.


Assuntos
Maturidade Cervical , Colo do Útero/efeitos dos fármacos , Dinoprostona/administração & dosagem , Trabalho de Parto Induzido/métodos , Ocitócicos/administração & dosagem , Administração Intravaginal , Adulto , Cesárea/estatística & dados numéricos , China , Dinoprostona/uso terapêutico , Feminino , Humanos , Ocitócicos/uso terapêutico , Gravidez , Resultado do Tratamento , Vagina
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