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1.
Pan Afr Med J ; 39: 34, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34422157

RESUMO

Introduction: bleeding during and after caesarean section is one of the contributors to maternal mortality and morbidity. Tranexamic acid can be given before surgery to significantly reduce the amount of blood loss during caesarean section. The objective was to evaluate the effectiveness of preoperative tranexamic acid in reducing blood loss during caesarean section at Aminu Kano Teaching Hospital, Kano. Methods: this was a randomized double blind placebo controlled study that was carried out among 244 women who were to have emergency caesarean section between December 2017 and June 2018 and were randomly assigned to the study group or control group. Women in the study group received lg (10mls) of tranexamic acid intravenously while women in the control group received 10ml of normal saline. Oxytocin was administered in the two groups according to protocol. Measurement of blood loss was done immediately after surgery. Postoperative drop in haemoglobin and haematocrit were also determined. Statistical analysis was done using SPSS Version 22. Results: the average intra operative blood loss was 414.0 ml in the study group and 773.8 ml in the control group (t = - 16.18, p ≤ 0.01). Average postoperative haemoglobin was 10.1 g/dl in the study group and 9.5 g/dl in the control group (t = 4.99, p ≤ 0.01). Average postoperative haematocrit was 31.5% in the study group and 29.9% in the control group (t = 4.70, p ≤ 0.01). Conclusion: there was a significant reduction in the blood loss when preoperative tranexamic acid was given to patients who were to undergo emergency caesarean section.


Assuntos
Antifibrinolíticos/administração & dosagem , Perda Sanguínea Cirúrgica/prevenção & controle , Cesárea/métodos , Ácido Tranexâmico/administração & dosagem , Adulto , Método Duplo-Cego , Feminino , Hematócrito , Hemoglobinas , Hospitais de Ensino , Humanos , Nigéria , Hemorragia Pós-Parto/prevenção & controle , Gravidez , Cuidados Pré-Operatórios/métodos , Adulto Jovem
2.
Medicine (Baltimore) ; 100(32): e26845, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397891

RESUMO

RATIONALE: Despite the development of human papillomavirus vaccines and significant improvement in cervical cancer screening over the past few years, cervical cancer remains the fourth most common cancer in women of childbearing age after breast cancer, melanoma, and thyroid cancer. PATIENT CONCERNS: In this case report, the patients are all cervical cancer with stage IB2 and IB3 during pregnancy, the management constitutes a major medical challenge related to the impact of treatment on both maternal and fetal outcomes. Neoadjuvant chemotherapy (NACT) is an innovative option for cervical cancer patients with stage IB2 and IB3 before cesarean delivery and radical hysterectomy, and many chemotherapeutic agents are available, cisplatin plus paclitaxel yielded good maternal and fetal outcomes to the authors' knowledge. DIAGNOSES: Masses were discovered in the cervix of 4 pregnant women with a history of vaginal bleeding. Biopsy examination of the masses revealed cervical carcinoma, which was staged in accordance with the International Federation of Gynecology and Obstetrics (i.e., FIGO) system. INTERVENTIONS: The patients were treated with paclitaxel plus cisplatin, followed by cesarean delivery and radical hysterectomy. OUTCOMES: The 4 patients were treated successfully, with no recurrence during follow-up periods of 14 to 56 months, and all of the children were doing well with no anomalies. LESSONS: Although further data are required, in pregnant women with invasive cervical cancer, NACT with cisplatin plus paclitaxel followed by cesarean delivery and radical hysterectomy was a practical treatment option.


Assuntos
Cisplatino , Histerectomia/métodos , Paclitaxel , Complicações Neoplásicas na Gravidez , Neoplasias do Colo do Útero , Adulto , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Biópsia/métodos , Colo do Útero/patologia , Cesárea/métodos , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Feminino , Humanos , Terapia Neoadjuvante/métodos , Estadiamento de Neoplasias , Paclitaxel/administração & dosagem , Paclitaxel/efeitos adversos , Gravidez , Complicações Neoplásicas na Gravidez/tratamento farmacológico , Complicações Neoplásicas na Gravidez/patologia , Complicações Neoplásicas na Gravidez/cirurgia , Resultado da Gravidez , Resultado do Tratamento , Neoplasias do Colo do Útero/tratamento farmacológico , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia
3.
BMC Pregnancy Childbirth ; 21(1): 587, 2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34445988

RESUMO

BACKGROUND: The coronavirus disease (COVID-19) pandemic has caused ongoing challenges in health services worldwide. Despite the growing body of literature on COVID-19, reports on perinatal care in COVID-19 cases are limited. CASE PRESENTATION: We describe a case of severe acute respiratory distress syndrome (ARDS) in a 36-year-old G5/P2 pregnant woman with morbid obesity, confirmed severe acute respiratory syndrome coronavirus 2 infection, and fulminant respiratory failure. At 28+ 1 gestational weeks, the patient delivered an uninfected newborn. Using ImmunoCAP ISAC® technology, we found no immunoglobulin (Ig) M antibodies, suggesting that no mother-to-child viral transmission occurred during pregnancy or delivery. The maternal respiratory state improved rapidly after delivery; both maternal and neonatal outcomes were encouraging given the early gestational age and fulminant course of respiratory failure in our patient. CONCLUSIONS: The management of ARDS in pregnant women with COVID-19 is complex and requires an individualized, multidisciplinary approach, while considering maternal and fetal outcomes.


Assuntos
COVID-19 , Cesárea/métodos , Pneumonia Viral , Complicações Infecciosas na Gravidez , Nascimento Prematuro , Síndrome do Desconforto Respiratório , SARS-CoV-2/isolamento & purificação , Adulto , COVID-19/complicações , COVID-19/diagnóstico , Feminino , Monitorização Fetal/métodos , Idade Gestacional , Humanos , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/fisiopatologia , Equipe de Assistência ao Paciente/organização & administração , Assistência Perinatal/métodos , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/etiologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/terapia , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/terapia , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório/diagnóstico , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/fisiopatologia , Síndrome do Desconforto Respiratório/terapia , Resultado do Tratamento
4.
Isr Med Assoc J ; 23(7): 408-411, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34251121

RESUMO

BACKGROUND: Our hospital used to perform cesarean delivery under general anesthesia rather than neuraxial anesthesia, mostly because of patient refusal of members of the conservative Bedouin society. According to recommendations implemented by the Israeli Obstetric Anesthesia Society, which were implemented due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, we increased the rate of neuraxial anesthesia among deliveries. OBJECTIVES: To compare the rates of neuraxial anesthesia in our cesarean population before and during SARS-CoV-2 pandemic. METHODS: We included consecutive women undergoing an elective cesarean delivery from two time periods: pre-SARS-CoV-2 pandemic (15 February 2019 to 14 April 2019) and during the SARS-CoV-2 pandemic (15 February 2020 to 15 April 2020). We collected demographic data, details about cesarean delivery, and anesthesia complications. RESULTS: We included 413 parturients undergoing consecutive elective cesarean delivery identified during the study periods: 205 before the SARS-CoV-2 pandemic and 208 during SARS-CoV-2 pandemic. We found a statistically significant difference in neuraxial anesthesia rates between the groups: before the pandemic (92/205, 44.8%) and during (165/208, 79.3%; P < 0.0001). CONCLUSIONS: We demonstrated that patient and provider education about neuraxial anesthesia can increase its utilization. The addition of a trained obstetric anesthesiologist to the team may have facilitated this transition.


Assuntos
Anestesia por Condução , Anestesia Geral , Anestesia Obstétrica , Cesárea , Recusa do Paciente ao Tratamento , Adulto , Anestesia por Condução/métodos , Anestesia por Condução/psicologia , Anestesia por Condução/estatística & dados numéricos , Anestesia Geral/métodos , Anestesia Geral/estatística & dados numéricos , Anestesia Obstétrica/métodos , Anestesia Obstétrica/psicologia , Árabes/psicologia , Árabes/estatística & dados numéricos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Cesárea/métodos , Cesárea/estatística & dados numéricos , Salas de Parto/organização & administração , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Israel/epidemiologia , Inovação Organizacional , Gravidez , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Utilização de Procedimentos e Técnicas/tendências , Estudos Retrospectivos , Recusa do Paciente ao Tratamento/etnologia , Recusa do Paciente ao Tratamento/estatística & dados numéricos
6.
Medicine (Baltimore) ; 100(22): e26129, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087863

RESUMO

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


Assuntos
Raquianestesia/efeitos adversos , Determinação da Pressão Arterial/métodos , Cesárea/métodos , Hipotensão/induzido quimicamente , Hipotensão/diagnóstico , Adulto , Índice de Apgar , Pressão Arterial , Determinação da Pressão Arterial/normas , Monitores de Pressão Arterial , Pesos e Medidas Corporais , Feminino , Humanos , Gravidez , Estudos Prospectivos , Reprodutibilidade dos Testes
7.
Obstet Gynecol Clin North Am ; 48(2): 387-399, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33972073

RESUMO

Macrosomia results from abnormal fetal growth and can lead to serious consequences for the mother and fetus. In cases of suspected macrosomia, patients must be counseled carefully regarding a delivery plan, and Cesarean section should be considered when indicated. Techniques to assess for suspected macrosomia include clinical measurements, ultrasound, and MRI.


Assuntos
Macrossomia Fetal/diagnóstico , Macrossomia Fetal/terapia , Traumatismos do Nascimento/epidemiologia , Cesárea/métodos , Clavícula/lesões , Parto Obstétrico/métodos , Feminino , Desenvolvimento Fetal , Macrossomia Fetal/epidemiologia , Humanos , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Imageamento por Ressonância Magnética/métodos , Masculino , Paralisia do Plexo Braquial Neonatal/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Fatores de Risco , Distocia do Ombro/epidemiologia , Ultrassonografia Pré-Natal/métodos
8.
Medicine (Baltimore) ; 100(14): e25364, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832117

RESUMO

RATIONALE: Although dysgerminomas are relatively uncommon among all ovarian neoplasms, representing for only about 2%, they account for 32.8 percent of malignant ovarian germ cell tumors. Their association with pregnancy is extremely rare; due to the low frequency of occurrence, there are few recommendations regarding pregnancy management; therefore, it is important to discuss and summarize the treatment strategy. PATIENT CONCERNS: We present the case of a 25 years patient, gestation 1, para 1, who was hospitalized in the clinic at 38/39 weeks of gestation at the beginning of labor. Following the ultrasound examination, a hypoechogenic lesion on the uterine fundus was found, suggestive of subterranean fibroid. After caesarean section, right adnexectomy was performed; the histopathological examination revealed, unexpectedly, the diagnosis of dysgerminoma. DIAGNOSES: Dysgerminoma as associated with pregnancy. INTERVENTIONS: Birth by Caesarean section and right adnexectomy. No other medical complications occurred. OUTCOMES: The histopathological and immunohistochemical examinations were consistent with the pure dysgerminoma. Oncology was staged AI, with the monitoring of markers and abdominal and pelvic magnetic resonance imaging at 3, 6, 9, and 12 months. LESSONS: Dysgerminoma is the most common ovarian malignancy associated with pregnancy with a good fetal maternal outcome. If these tumors are discovered accidentally during caesarean section, tumor markers and magnetic resonance imaging scanning should be done postoperatively to plan optimal treatment.


Assuntos
Disgerminoma/diagnóstico , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Ovarianas/patologia , Adulto , Assistência ao Convalescente , Biomarcadores Tumorais/metabolismo , Cesárea/métodos , Disgerminoma/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Neoplasias Embrionárias de Células Germinativas/cirurgia , Neoplasias Ovarianas/cirurgia , Gravidez , Complicações Neoplásicas na Gravidez/patologia , Resultado do Tratamento , Ultrassonografia/métodos
9.
Am J Obstet Gynecol ; 225(2): 128.e1-128.e13, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33894151

RESUMO

OBJECTIVE: Cesarean delivery is the most prevalent surgical procedure worldwide, reaching approximately 29.7 million cases in 2015. It is directly associated with an increased risk of maternal and neonatal morbidity rates in the absence of malpresentation. Several techniques have been investigated, and there is evidence that cephalad-caudad expansion of the uterine incision might be associated with improved maternal outcomes compared with traditional transverse blunt expansion. The purpose of this meta-analysis was to evaluate the impact of cephalad-caudad expansion on adverse maternal outcomes, including intraoperative blood loss, risk of uterine vessel injury, and tearing of the lower uterine segment. DATA SOURCES: We searched Medline, Scopus, the Cochrane Central Register of Controlled Trials, Google Scholar, and Clinicaltrials.gov databases from inception to January 2021. STUDY ELIGIBILITY CRITERIA: Randomized controlled trials that assessed the impact of the cephalad-caudad blunt expansion of the low transverse uterine incision during cesarean delivery rather than those of transverse blunt expansion were selected for inclusion. METHODS: Effect sizes were calculated with the Hartung-Knapp-Sidik-Jonkman random-effects model in R. Trial sequential analysis was performed to evaluate the adequacy of sample sizes. RESULTS: Cephalad-caudad blunt expansion of the uterine incision was associated with a lower prevalence of unintended incision extension (relative risk, 0.62; 95% confidence interval, 0.45-0.86) and uterine vessel injury (relative risk, 0.55; 95% confidence interval 0.41-0.73). However, these complications were not accompanied by the increased need for additional suture placement (relative risk, 0.62; 95% confidence interval, 0.31-4.12) or transfusion rates (relative risk, 0.75; 95% confidence interval, 0.28-2.03). Similarly, the intraoperative duration was comparable with cases treated with transverse blunt expansion (mean difference = -0.45 minutes; 95% confidence interval -2.12 to 1.21) and the risk of intentional incision extension in the form of an inverted T (relative risk, 0.38; 95% confidence interval, 0.09-1.52). Trial sequential analysis revealed that the required sample size was reached in the unintended incision extension and uterine vessel injury outcomes. CONCLUSION: The findings of our study suggested that cephalad-caudad blunt expansion of the uterine incision is superior to transverse expansion in terms of reducing unintended incision extension and uterine vessel injury.


Assuntos
Cesárea/métodos , Histerotomia/métodos , Complicações Intraoperatórias/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Lesões do Sistema Vascular/epidemiologia , Transfusão de Sangue/estatística & dados numéricos , Dissecação/métodos , Feminino , Humanos , Duração da Cirurgia , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Útero/irrigação sanguínea , Útero/cirurgia , Técnicas de Fechamento de Ferimentos/estatística & dados numéricos
11.
Medicine (Baltimore) ; 100(17): e25757, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33907172

RESUMO

ABSTRACT: The purpose of this study was to explore the relevant factors that affect the risk of cesarean scar diverticulum (CSD).A retrospective, case-control study was designed among women with a history of cesarean section (CS) who were admitted in Zhejiang Tongde Hospital from January 2017 to December 2019. Women with missing information were excluded. The basic clinical characteristics and the risk factors for CSD were assessed using univariate analysis and multivariate logistic regression analysis.A total of 216 women were analyzed, including 87 patients with CSD and 129 cases without CSD as control. Significant differences in number of CS, trial of labor (elective or urgent CS), CS interval, uterine position, intraoperative hemorrhage, and dysmenorrhea between CSD group and control group (P < .05). Multivariate logistic regression analysis showed that number of CS, trial of labor, interval of CS, and uterine position were independent risk factors of CSD.In women with a history of CS, multiple cesarean deliveries, elective CS, cesarean interval of less than 5 years, and retroflexed position of the uterus may be associated with an elevated risk of CSD.


Assuntos
Cesárea , Cicatriz , Divertículo , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Estudos de Casos e Controles , Cesárea/efeitos adversos , Cesárea/métodos , Cesárea/estatística & dados numéricos , China , Cicatriz/complicações , Cicatriz/etiologia , Cicatriz/patologia , Divertículo/diagnóstico , Divertículo/epidemiologia , Divertículo/etiologia , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Gravidez , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Prova de Trabalho de Parto , Técnicas de Fechamento de Ferimentos
12.
BMC Pregnancy Childbirth ; 21(1): 323, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33892626

RESUMO

BACKGROUND: Emergency Obstetric Hysterectomy (EOH) is removal of the uterus due to life threatening conditions within the puerperium. This life saving intervention is associated with life threatening complications. In our setting, little is known on EOH. OBJECTIVES: To determine the prevalence, indications and outcomes of emergency obstetric hysterectomy while comparing both postpartum hysterectomy and caesarean hysterectomy. METHODS: A 5-year hospital-based retrospective cohort study involving medical records of patients who underwent emergency obstetric hysterectomies between 1st January 2015 and 31st December 2019, was carried out at the Bafoussam Regional Hospital (BRH) from 1st February 2020 to 30th April 2020. Cases were classified as caesarean hysterectomy (CH) or postpartum hysterectomy (PH). Epidemiological data, indications, and complications of EOH were collected and analyzed in EPI-INFO 7.2.2.1. The chi-squared test was used to compare the two groups, and bivariate analysis was used to identify indicators of adverse outcomes of EOH. Statistical significance was set at p < 0.05. RESULTS: There were 30 cases of emergency obstetric hysterectomy (24 caesarean hysterectomies and 6 postpartum hysterectomies), giving a prevalence rate of 3.75 per 1000 deliveries. The most common indication for CH, was intractable postpartum haemorrhage and uterine rupture (33.33% each), while abnormal placentation (50%) was commonly indicated for PH. Anaemia (both groups) (p = 0.013) and sepsis (PH group only, 33.33%) (p = 0.03) were the most statistically significant complications of EOH respectively. Absence of blood transfusion prior to surgery (p = 0.013) and prolonged surgery lasting 2 or more hours (p = 0.04), were significantly associated with a negative clinical outcome. CONCLUSION: The prevalence of EOH is high. There were no differences in the sociodemographic profile, risk factors and indications of both groups. PH group was more likely to develop sepsis as complication. Lack of blood transfusion prior to surgery and prolonged surgeries were significantly associated to complication. Meticulous care and timely recognition of negative prognostic factors of delivery as well as those of EOH will help improve maternal outcomes of pregnancy.


Assuntos
Cesárea , Parto Obstétrico , Serviços Médicos de Emergência , Histerectomia , Complicações do Trabalho de Parto/epidemiologia , Hemorragia Pós-Parto , Adulto , Camarões/epidemiologia , Cesárea/métodos , Cesárea/estatística & dados numéricos , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Histerectomia/métodos , Histerectomia/estatística & dados numéricos , Hemorragia Pós-Parto/diagnóstico , Hemorragia Pós-Parto/cirurgia , Gravidez , Resultado da Gravidez/epidemiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco
13.
BMC Pregnancy Childbirth ; 21(1): 333, 2021 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-33902486

RESUMO

BACKGROUND: Healthcare costs have substantially increased in recent years, threatening the population health. Obstetric care is a significant contributor to this scenario since it represents 20% of healthcare. The rate of cesarean sections (C-sections) has escalated worldwide. Evidence shows that cesarean delivery is not only more expensive, but it is also linked to poorer maternal and neonatal outcomes. This study assesses which type of delivery is associated with a higher healthcare value in low-risk pregnancies. RESULTS: A total of 9345 deliveries were analyzed. The C-section group had significantly worse rates of breastfeeding in the first hour after delivery (92.57% vs 88.43%, p < 0.001), a higher rate of intensive unit care (ICU) admission both for the mother and the newborn (0.8% vs 0.3%, p = 0.001; 6.7% vs 4.5%, p = 0.0078 respectively), and a higher average cost of hospitalization (BRL14,342.04 vs BRL12,230.03 considering mothers and babies). CONCLUSION: Cesarean deliveries in low-risk pregnancies were associated with a lower value delivery because in addition to being more expensive, they had worse perinatal outcomes.


Assuntos
Cesárea , Parto Obstétrico , Custos de Cuidados de Saúde , Custos Hospitalares/estatística & dados numéricos , Obstetrícia/economia , Adulto , Brasil/epidemiologia , Aleitamento Materno/estatística & dados numéricos , Cesárea/economia , Cesárea/métodos , Cesárea/estatística & dados numéricos , Atenção à Saúde/organização & administração , Atenção à Saúde/tendências , Parto Obstétrico/economia , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Custos de Cuidados de Saúde/tendências , Humanos , Recém-Nascido , Unidades de Terapia Intensiva/estatística & dados numéricos , Avaliação de Processos e Resultados em Cuidados de Saúde/economia , Avaliação de Processos e Resultados em Cuidados de Saúde/estatística & dados numéricos , Gravidez , Medição de Risco
14.
Acta Obstet Gynecol Scand ; 100(7): 1313-1321, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33792924

RESUMO

INTRODUCTION: The aim of this study was to compare vaginal dinoprostone and mechanical methods for induction of labor (IOL) in pregnancies complicated by late fetal growth restriction. MATERIAL AND METHODS: Multicenter, retrospective, cohort study involving six referral centers in Italy and Spain. Inclusion criteria were pregnancies complicated by late fetal growth restriction as defined by Delphi consensus criteria. The primary outcome was the occurrence of uterine tachysystole; secondary outcomes were either cesarean delivery or operative vaginal delivery for non-reassuring fetal status, a composite score of adverse neonatal outcome and admission to neonatal intensive care unit (NICU). Univariate and multivariate logistic regression analysis was used to analyze the data. RESULTS: A total of 571 pregnancies complicated by late fetal growth restriction undergoing IOL (391 with dinoprostone and 180 with mechanical methods) were included in the analysis. The incidence of uterine tachysystole (19.2% vs. 5.6%; p = 0.001) was higher in women undergoing IOL with dinoprostone than in those undergoing IOL with mechanical methods. Similarly, the incidence of cesarean delivery or operative delivery for non-reassuring fetal status (25.6% vs. 17.2%; p = 0.027), composite adverse neonatal outcome (26.1% vs. 16.7%; p = 0.013) and NICU admission (16.9% vs. 5.6%; p < 0.001) was higher in women undergoing IOL with dinoprostone than in those undergoing IOL with mechanical methods. At logistic regression analysis, IOL with mechanical methods was associated with a significantly lower risk of uterine tachysystole (odds ratio 0.26, 95% confidence interval 0.13-0.54; p < 0.001). CONCLUSIONS: In pregnancies complicated by late fetal growth restriction, IOL with mechanical methods is associated with a lower risk of uterine tachysystole, cesarean delivery or operative delivery for non-reassuring fetal status, and adverse neonatal outcome compared with pharmacological methods.


Assuntos
Cateterismo/métodos , Dinoprostona/efeitos adversos , Retardo do Crescimento Fetal/terapia , Trabalho de Parto Induzido/métodos , Ocitócicos/efeitos adversos , Administração Intravaginal , Adulto , Cesárea/métodos , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Itália , Gravidez , Resultado da Gravidez , Espanha , Cateterismo Urinário/métodos
15.
Rev. cuba. anestesiol. reanim ; 20(1): e656, ene.-abr. 2021. graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1156370

RESUMO

Introducción: La hipertensión arterial pulmonar es una enfermedad con una baja incidencia en la gestante, aunque trae consigo una alta mortalidad una vez presentada. Un diagnóstico oportuno y un manejo perioperatorio adecuado minimizan el riesgo de desenlace fatal tanto para la madre como el feto. Objetivo: Describir el comportamiento de la hipertensión arterial pulmonar en la gestante a término y su conducción anestésica. Presentación del caso: Paciente de 23 años, antecedentes de salud, edad gestacional de 35.2 semanas. Luego de presentar dolor de espalda y ardor en el pecho relacionado con el esfuerzo, palpitaciones, disnea y bloqueo de rama derecha en electrocardiograma, se ingresa en UTI con sospecha de tromboembolismo pulmonar, el cual queda descartado tras diagnóstico confirmatorio de hipertensión pulmonar después de realizar angio TAC y ecocardiografía. Se decide realizar cesárea programada bajo técnica regional peridural, sin complicaciones tanto para la madre como el niño. Después de 2 días bajo vigilancia intensiva se traslada a su centro hospitalario de cabecera. Conclusiones: La vía del parto, así como una elección adecuada de la técnica anestésica, puede ser la diferencia entre el éxito y la fatalidad. Las técnicas regionales suelen recomendarse por encima de la técnica de anestesia general siempre que no se presenten contraindicaciones(AU)


Introduction: Pulmonary arterial hypertension is a disease with low incidence in the pregnant woman, although it brings about high mortality once presented. Timely diagnosis and adequate perioeprative management minimize the risk of fatal outcome for both mother and fetus. Objective: To describe pulmonary arterial hypertension and its anesthetic management in the term pregnant woman. Case presentation: 23-year-old female patient, with health history and gestational age of 35.2 weeks. After presenting back pain and chest burning associated with exertion, palpitations, dyspnea and right bundle branch block in the electrocardiogram, the patient was admitted to the intensive care unit with suspected pulmonary thromboembolism, which was ruled out due to the confirmatory diagnosis of pulmonary hypertension after performing computerized tomography angiography and echocardiography. Scheduled cesarean section was decided to be perform using the regional peridural technique, without complications for both the mother and the child. After two days under intensive surveillance, she was transferred to her primary hospital. Conclusions: The route of delivery, as well as an adequate choice of the anesthetic technique, can be the difference between success and fatality. Regional techniques are usually recommended over the general anesthesia technique, as long as there are no contraindications(AU)


Assuntos
Humanos , Feminino , Gravidez , Adulto Jovem , Hipertensão Arterial Pulmonar/complicações , Hipertensão Arterial Pulmonar/diagnóstico por imagem , Anestesia Geral/métodos , Complicações na Gravidez/prevenção & controle , Cesárea/métodos
16.
Acta Obstet Gynecol Scand ; 100 Suppl 1: 41-49, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33713033

RESUMO

INTRODUCTION: Placenta accreta spectrum (PAS) is a condition often resulting in severe maternal morbidity. Scheduled delivery by an experienced team has been shown to improve maternal outcomes; however, the benefits must be weighed against the risk of iatrogenic prematurity. The aim of this study is to investigate the rates of emergency delivery seen for antenatally suspected PAS and compare the resulting outcomes in the 15 referral centers of the International Society for PAS (IS-PAS). MATERIAL AND METHODS: Fifteen centers provided cases between 2008 and 2019. The women included were divided into two groups according to whether they had a planned or an emergency cesarean delivery. Delivery was defined as "planned" when performed at a time and date to suit the team. All the remaining cases were classified as "emergency". Maternal characteristics and neonatal outcomes were compared between the two groups according to gestation at delivery. RESULTS: In all, 356 women were included. Of these, 239 (67%) underwent a planned delivery and 117 (33%) an emergency delivery. Vaginal bleeding was the indication for emergency delivery in 41 of the 117 women (41%). There were no significant differences in terms of blood loss, transfusion rates or major maternal morbidity between planned and emergency deliveries. However, the rate of maternal intensive therapy unit admission was increased with emergency delivery (45% vs 33%, P = .02). Antepartum hemorrhage was the only independent predictor of emergency delivery (aOR: 4.3, 95% confidence interval 2.4-7.7). Emergency delivery due to vaginal bleeding was more frequent with false-positive cases (antenatally suspected but not confirmed as PAS at delivery) and the milder grades of PAS (accreta/increta). The rate of infants experiencing any major neonatal morbidity was 25% at 34+1 to 36+0  weeks and 19% at >36+0  weeks. CONCLUSIONS: Emergency delivery in centers of excellence did not increase blood loss, transfusion rates or maternal morbidity. The single greatest risk factor for emergency delivery was antenatal hemorrhage. When adequate expertise and resources are available, to defer delivery in women with no significant antenatal bleeding and no risk factors for pre-term birth until >36+0  weeks can be considered to improve fetal outcomes. Further studies are needed to investigate this fully.


Assuntos
Cesárea/métodos , Serviços Médicos de Emergência , Hemorragia/cirurgia , Placenta Acreta/cirurgia , Complicações na Gravidez/cirurgia , Adulto , Estudos de Coortes , Bases de Dados Factuais , Europa (Continente) , Feminino , Idade Gestacional , Humanos , Saúde do Lactente , Saúde Materna , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Estados Unidos
17.
Am J Obstet Gynecol ; 225(2): 175.e1-175.e10, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33716074

RESUMO

BACKGROUND: The prevalence of placenta accreta spectrum is rising worldwide. The severe end of the spectrum where the placenta has invaded other organs is fortunately rare, however, few surgical techniques for such a complex hysterectomy have been described in the literature. OBJECTIVE: This study aimed to describe a stepwise, systematic technique for radical cesarean hysterectomy for placenta accreta spectrum to investigate outcomes for women with severe, invasive placenta accreta spectrum who were hysterectomized using this technique. STUDY DESIGN: This was a retrospective cohort study undertaken at a large UK tertiary referral center. A total of 24 cases of elective primary cesarean hysterectomy with a confirmed intrapartum diagnosis of severe percreta (Federation of Gynecology and Obstetrics grades 3b and 3c) were identified between 2011 and 2020. Among those cases, 16 had standard care (surgical technique dependent on surgeon's preference), and 8 had a radical peripartum hysterectomy using the Soleymani-Alazzam-Collins technique as described. Nonparametric testing was used because of sample size. RESULTS: The Soleymani-Alazzam-Collins technique resulted in significantly less blood loss (P=.032), more transverse incisions (P=.009), and less intensive care unit admissions (P=.046). Furthermore, there was no significant difference in theater time. CONCLUSION: The Soleymani-Alazzam-Collins technique demonstrated a significant improvement in outcomes for women with severe placenta accreta spectrum, without increasing surgical time.


Assuntos
Perda Sanguínea Cirúrgica , Cesárea/métodos , Histerectomia/métodos , Unidades de Terapia Intensiva/estatística & dados numéricos , Duração da Cirurgia , Placenta Acreta/cirurgia , Adulto , Feminino , Humanos , Complicações Pós-Operatórias/epidemiologia , Gravidez , Estudos Retrospectivos , Índice de Gravidade de Doença , Oncologia Cirúrgica
18.
BMC Pregnancy Childbirth ; 21(1): 181, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33663429

RESUMO

BACKGROUND: Since maternal mortality is a rare event, maternal near miss has been used as a proxy indicator for measuring maternal health. Maternal near miss (MNM) refers to a woman who nearly died but survived of complications during pregnancy, childbirth or within 42 days of termination of pregnancy. Although study of MNM in Ethiopia is becoming common, it is limited to public facilities leaving private facilities aside. The objective of this study was to assess MNM among women admitted in major private hospitals in eastern Ethiopia. METHODS: An institution based retrospective study was conducted from March 05 to 31, 2020 in two major private hospitals in Harar and Dire Dawa, eastern Ethiopia. The records of all women who were admitted during pregnancy, delivery or within 42 days of termination of pregnancy was reviewed for the presence of MNM criteria as per the sub-Saharan African MNM criteria. Descriptive analysis was done by computing proportion, ratio and means. Factors associated with MNM were assessed using binary logistic regression with adjusted odds ratio (aOR) along with its 95% confidence interval (CI). RESULTS: Of 1214 pregnant or postpartum women receiving care between January 09, 2019 and February 08, 2020, 111 women developed life-threatening conditions: 108 MNM and 3 maternal deaths. In the same period, 1173 live births were registered, resulting in an MNM ratio of 92.1 per 1000 live births. Anemia in the index pregnancy (aOR: 5.03; 95%CI: 3.12-8.13), having chronic hypertension (aOR: 3.13; 95% CI: 1.57-6.26), no antenatal care (aOR: 3.04; 95% CI: 1.58-5.83), being > 35 years old (aOR: 2.29; 95%CI: 1.22-4.29), and previous cesarean section (aOR: 4.48; 95% CI: 2.67-7.53) were significantly associated with MNM. CONCLUSIONS: Close to a tenth of women admitted to major private hospitals in eastern Ethiopia developed MNM. Women with anemia, history of cesarean section, and old age should be prioritized for preventing and managing MNM. Strengthening antenatal care and early screening of chronic conditions including hypertension is essential for preventing MNM.


Assuntos
Cesárea , Hospitais Privados/estatística & dados numéricos , Near Miss/estatística & dados numéricos , Hemorragia Pós-Parto , Complicações na Gravidez , Cuidado Pré-Natal/normas , Adulto , Cesárea/métodos , Cesárea/estatística & dados numéricos , Etiópia/epidemiologia , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Idade Materna , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/terapia , Gravidez , Complicações na Gravidez/mortalidade , Complicações na Gravidez/terapia , Gravidez de Alto Risco , Diagnóstico Pré-Natal/métodos , Melhoria de Qualidade , Estudos Retrospectivos , Medição de Risco
19.
London; National Institute for Health and Care Excellence; Mar. 31, 2021. 44 p.
Monografia em Inglês | BIGG - guias GRADE | ID: biblio-1179030

RESUMO

This guideline covers when to offer caesarean birth, discussion of caesarean birth, procedural aspects of the operation, and care after caesarean birth. It aims to improve the consistency and quality of care for women who are thinking about having a caesarean birth or have had a previous caesarean birth and are pregnant again. The guideline uses the terms 'woman' or 'mother' throughout. These should be taken to include people who do not identify as women but are pregnant or have given birth. The recommendations in this guideline were developed before the COVID-19 pandemic.


Assuntos
Humanos , Feminino , Gravidez , Cesárea/métodos , Cesárea/reabilitação , Tremor por Sensação de Frio , Manejo da Dor , Hipotermia/prevenção & controle
20.
MCN Am J Matern Child Nurs ; 46(2): 97-102, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33630492

RESUMO

BACKGROUND: Intrathecal morphine provides effective analgesia after cesarean birth, yet up to 90% of women who receive it experience excessive itching, an undesirable dose-dependent effect. Pruritis may increase nursing workload, delay breastfeeding, and decrease patient satisfaction. When 0.1 mg spinal morphine is given, pruritis is markedly reduced while analgesia is preserved. PURPOSE: The purpose of this project was to determine possible causes and solutions for pruritus after cesarean birth. METHODS: Anesthesia providers were educated and encouraged to limit spinal morphine to 0.1 mg as a strategy to prevent pruritus. In a repeated measures design, the rate of treatment-required pruritus and opioid consumption were measured 24 hours after surgery. The project included an evaluation of 30 medical records before and 30 medical records after the project intervention. RESULTS: Preintervention rate of treatment-required pruritis was 37%, all received spinal morphine ≥ 1.5 mg. Postintervention rate of treatment-required pruritis was 13% and 57% after spinal morphine 0.1 mg and 0.2 mg, respectively. Opioid consumption was similar between groups. CLINICAL IMPLICATIONS: Mother-baby nurses can have an impact on the practice of anesthesia providers by advocating for evidence-based dosing of intrathecal morphine to reduce the incidence of pruritis while maintaining effective analgesia for women after cesarean birth.


Assuntos
Cesárea/efeitos adversos , Morfina/efeitos adversos , Prurido/prevenção & controle , Adulto , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Cesárea/métodos , Feminino , Hospitais Militares/organização & administração , Hospitais Militares/estatística & dados numéricos , Humanos , Injeções Epidurais/métodos , Injeções Epidurais/normas , Injeções Epidurais/estatística & dados numéricos , Morfina/administração & dosagem , Manejo da Dor/efeitos adversos , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos , Medição da Dor/métodos , Medição da Dor/estatística & dados numéricos , Estudos Retrospectivos
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