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1.
Medicine (Baltimore) ; 99(42): e22748, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080738

RESUMO

To compare clinical features and outcomes between early and late onset of neonatal bacterial meningitis (NBM).Patients were allocated in 2 groups: early onset neonatal bacterial meningitis (ENBM) and late onset neonatal bacterial meningitis (LNBM). Data analysis includes asphyxia at birth, premature rupture of membranes (PROM), amnionitis, amniotic fluid contamination, maternal age, clinical manifestations of the patients, laboratory findings, radiological results, complications related to meningitis, duration of hospitalization and therapeutic effect.There was no difference in gender, birth weight, gestational age, and incidence of asphyxia between 2 groups. The incidence of PROM, chorioamnionitis and amniotic fluid contamination, proportion of small-for-gestational-age infants, convulsions, intracranial hemorrhage, hyperbilirubinemia, and the protein level of cerebrospinal fluid in ENBM group were higher than that in LNBM group (P < .05); the proportion of fever, elevated C-reaction protein and the abnormal of platelet counts in LNBM group was higher than that in ENBM group (P < .05). There was no difference in the incidence of complications and hospitalization time between 2 groups. The rate of effective treatment in LNBM group was significantly higher than that in ENBM group (P < .05).Patients with conditions of amniotic fluid contamination, chorioamnionitis, small-for-gestational-age and PROM might be more prone to develop ENBM and ENBM had worse outcomes than LNBM.


Assuntos
Meningites Bacterianas/epidemiologia , Adulto , Líquido Amniótico , Proteína C-Reativa/análise , Proteínas do Líquido Cefalorraquidiano/análise , China/epidemiologia , Corioamnionite/epidemiologia , Diarreia/epidemiologia , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Mortalidade Hospitalar , Humanos , Hiperbilirrubinemia Neonatal/epidemiologia , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Hemorragias Intracranianas/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Meningites Bacterianas/microbiologia , Meningites Bacterianas/terapia , Contagem de Plaquetas , Gravidez , Complicações na Gravidez/epidemiologia , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Convulsões/epidemiologia , Nascimento a Termo
2.
BMJ ; 371: m3502, 2020 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028606

RESUMO

OBJECTIVE: To consolidate evidence from systematic reviews and meta-analyses investigating the association between reproductive factors in women of reproductive age and their subsequent risk of cardiovascular disease. DESIGN: Umbrella review. DATA SOURCES: Medline, Embase, and Cochrane databases for systematic reviews and meta-analyses from inception until 31 August 2019. REVIEW METHODS: Two independent reviewers undertook screening, data extraction, and quality appraisal. The population was women of reproductive age. Exposures were fertility related factors and adverse pregnancy outcomes. Outcome was cardiovascular diseases in women, including ischaemic heart disease, heart failure, peripheral arterial disease, and stroke. RESULTS: 32 reviews were included, evaluating multiple risk factors over an average follow-up period of 7-10 years. All except three reviews were of moderate quality. A narrative evidence synthesis with forest plots and tabular presentations was performed. Associations for composite cardiovascular disease were: twofold for pre-eclampsia, stillbirth, and preterm birth; 1.5-1.9-fold for gestational hypertension, placental abruption, gestational diabetes, and premature ovarian insufficiency; and less than 1.5-fold for early menarche, polycystic ovary syndrome, ever parity, and early menopause. A longer length of breastfeeding was associated with a reduced risk of cardiovascular disease. The associations for ischaemic heart disease were twofold or greater for pre-eclampsia, recurrent pre-eclampsia, gestational diabetes, and preterm birth; 1.5-1.9-fold for current use of combined oral contraceptives (oestrogen and progesterone), recurrent miscarriage, premature ovarian insufficiency, and early menopause; and less than 1.5-fold for miscarriage, polycystic ovary syndrome, and menopausal symptoms. For stroke outcomes, the associations were twofold or more for current use of any oral contraceptive (combined oral contraceptives or progesterone only pill), pre-eclampsia, and recurrent pre-eclampsia; 1.5-1.9-fold for current use of combined oral contraceptives, gestational diabetes, and preterm birth; and less than 1.5-fold for polycystic ovary syndrome. The association for heart failure was fourfold for pre-eclampsia. No association was found between cardiovascular disease outcomes and current use of progesterone only contraceptives, use of non-oral hormonal contraceptive agents, or fertility treatment. CONCLUSIONS: From menarche to menopause, reproductive factors were associated with cardiovascular disease in women. In this review, presenting absolute numbers on the scale of the problem was not feasible; however, if these associations are causal, they could account for a large proportion of unexplained risk of cardiovascular disease in women, and the risk might be modifiable. Identifying reproductive risk factors at an early stage in the life of women might facilitate the initiation of strategies to modify potential risks. Policy makers should consider incorporating reproductive risk factors as part of the assessment of cardiovascular risk in clinical guidelines. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019120076.


Assuntos
Doenças Cardiovasculares/epidemiologia , Fertilidade , Complicações na Gravidez/epidemiologia , Saúde Reprodutiva/estatística & dados numéricos , Medição de Risco , Correlação de Dados , Feminino , Humanos , Metanálise como Assunto , Gravidez , Fatores de Risco , Revisões Sistemáticas como Assunto
3.
BMC Med ; 18(1): 330, 2020 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-33070775

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak is evolving rapidly worldwide. However, little is known about the association between pregnant women with COVID-19 and the risk of adverse birth outcomes. METHOD: We conducted a retrospective cohort study based on the Maternal and Child Health Information System (MCHIMS) of Wuhan, China. All pregnant women with singleton live birth recorded by the system between January 13 and March 18, 2020, were included. The adverse birth outcomes were preterm birth, low birth weight, neonatal asphyxia, premature rupture of membrane (PROM), and cesarean section delivery. Multivariate logistic regression was used to evaluate the associations between maternal COVID-19 diagnosis and adverse birth outcomes. RESULTS: Out of 11,078 pregnant women, 65 were confirmed with coronavirus disease 2019 (COVID-19). No deaths occurred from these confirmed cases or their newborns. Compared to pregnant women without COVID-19, pregnant women with a confirmed COVID-19 diagnosis had an increased risk of preterm birth (OR 3.34, 95% CI 1.60-7.00) and cesarean section (OR 3.63, 95% CI 1.95-6.76). There was no statistical difference in low birth weight, neonatal asphyxia, and PROM between the mothers with and without COVID-19. Among these newborns that were born to mothers with confirmed COVID-19, none was tested severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive or had abnormal CT results. Only one had diarrhea and three had a fever. CONCLUSIONS: This population-based cohort study suggests that COVID-19 during the later pregnancy is associated with an increased risk of adverse birth outcomes, including iatrogenic preterm birth and cesarean section delivery. Our data provide little evidence for maternal-fetal vertical transmission of SARS-CoV-2. It is important to monitor the long-term health effects of SARS-CoV-2 infection on pregnant women and their children.


Assuntos
Infecções por Coronavirus/transmissão , Pneumonia Viral/transmissão , Complicações Infecciosas na Gravidez , Adulto , Betacoronavirus , Cesárea , China , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Doenças do Recém-Nascido/etiologia , Modelos Logísticos , Masculino , Pandemias , Gravidez , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Estudos Retrospectivos
4.
J Pregnancy ; 2020: 6153146, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33062334

RESUMO

Introduction: Obstetric danger signs are those signs that a pregnant woman will see or those symptoms that she will feel which indicate that something is going wrong with her or with the pregnancy. Evidence on the prevalence of obstetric danger signs and contributing factors were crucial in designing programs in the global target of reducing maternal morbidity and mortality. Objective: To assess the prevalence of obstetric danger signs during pregnancy and associated factors among mothers in a Shashemene rural district, South Ethiopia. Methods: A community-based cross-sectional study design was conducted among 395 randomly selected women who gave birth in the last six months. A pretested interviewer-administered questionnaire was utilized. Data were cleaned, coded, and entered into Epi data manager version 4.1 and then exported to SPSS version 20. Bivariable and multivariable logistic regression analyses were employed to assess the association between independent variables with the outcome variable. Statistical significance was declared at p < 0.05. Result: One hundred sixty-three (41.3%) of women had a history of obstetric danger signs during pregnancy. The most prevalent obstetric danger signs were vaginal bleeding (15.4%) followed by swelling of the body 12.7% and severe vomiting 5.3%. Women who have less than four times antenatal care visits were 6.7 times more likely to experience obstetric danger signs (AOR 6.7 (95% CI 3.05, 14.85)) compared to those who had antenatal care visit four times and above. Women who have inadequate knowledge of obstetric danger signs were 2.5 times more likely to experience obstetric danger signs during pregnancy (AOR 2.5 (95% CI 1.34, 4.71)), and primigravida women were 6.3 times more likely to have obstetric danger signs during pregnancy (AOR 6.3 (95% CI 2.61, 15.09)) compared to multiparous women. Conclusion: About half of the pregnant mothers have experienced at least one obstetric danger signs. Public health interventions on maternal health should give priority to the prevalent causes of obstetric danger signs, strengthening completion of four antenatal care visits and health education on obstetric danger signs for pregnant mothers at community level especially for primgravid women.


Assuntos
Complicações na Gravidez/epidemiologia , Adolescente , Adulto , Estudos Transversais , Edema/epidemiologia , Edema/etiologia , Edema/prevenção & controle , Etiópia/epidemiologia , Feminino , Número de Gestações , Educação em Saúde , Humanos , Conhecimento , Mortalidade Materna , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/prevenção & controle , Cuidado Pré-Natal/estatística & dados numéricos , Prevalência , Inquéritos e Questionários , Hemorragia Uterina/epidemiologia , Hemorragia Uterina/etiologia , Hemorragia Uterina/prevenção & controle , Vômito/epidemiologia , Vômito/etiologia , Vômito/prevenção & controle , Adulto Jovem
5.
Zhonghua Fu Chan Ke Za Zhi ; 55(10): 673-678, 2020 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-33120478

RESUMO

Objective: To study the correlation between the duration of labor and postpartum hemorrhage. Methods: The delivery data of singleton first-term pregnant women who delivered vaginally at Beijing Obstetrics and Gynecology Hospital from January 1, 2017 to December 31, 2017 were collected, 3 104 cases met inclusion criteria. According to the duration of the first labor (t), they were divided into two groups: t≥8 hours was the observation group, t<8 hours was the control group. In order to ensure the baseline characteristics of the subjects in the two groups were balanced, propensity score matching (PSM) was adopted, with matching ratio 1∶1. Then the observation group was divided into four subgroups: group 8-12 h, group 12-16 h, group 16-20 h, group ≥20 h. According to the presence or absence of labor intervention (oxytocin use, artificial rupture of membranes, labor analgesia), the observation group and control group were divided into non-labor intervention observation group, non-labor intervention control group, labor intervention observation group, and labor intervention control group. The case data of 3 104 subjects were analyzed and the duration of labor and atonic postpartum hemorrhage rate of each subgroup were compared with the control group. Results: The duration of the second stage of labor and the first+second stages of labor in the observation group (median:0.8, 13.3 hours) and its subgroups were both longer than those in the control group (median:0.6, 5.1 hours), with statistically significant differences (all P<0.01). The rate of atonic postpartum hemorrhage in the observation group, group 16-20 h and group ≥20 h were higher than that in the control group [8.0%(124/1 552), 14.3%(41/287), 14.1%(12/85), 4.6%(72/1 552)], with significant statistical differences (all P<0.01). The duration of the second stage of labor and the first+second stages of labor in the observation group were both longer than those in the control group, regardless of the presence or absence of labor intervention, with statistically significant differences (all P<0.01). In both the observation group and the control group, the duration of the first stage of labor, the second stage of labor, and the first+second stages of labor with labor intervention were longer than those of the non-labor intervention, with significant statistical differences (all P<0.01). The rate of atonic postpartum hemorrhage in the observation group with labor intervention [8.7%(110/1 263)] was higher than that in the observation group without labor intervention [4.8%(14/289)], with a statistical difference (P<0.05). Conclusions: With the increase of the duration of the first stage of labor, the rate of atonic postpartum hemorrhage increases. The first stage of labor is closely related to the second stage of labor, and to a certain extent the duration of the second stage of labor increases with the length of the first stage of labor. With the increase of the duration of the first stage of labor, the rate of labor intervention and atonic postpartum hemorrhage also increase, which could serve as a clinical warning that excessive labor intervention may indicate a higher incidence of atonic postpartum hemorrhage.


Assuntos
Parto Obstétrico , Trabalho de Parto , Hemorragia Pós-Parto/epidemiologia , Complicações na Gravidez/epidemiologia , Adulto , Feminino , Humanos , Ocitocina , Hemorragia Pós-Parto/terapia , Gravidez , Complicações na Gravidez/etiologia , Fatores de Risco , Fatores de Tempo , Adulto Jovem
6.
Zhonghua Fu Chan Ke Za Zhi ; 55(10): 685-690, 2020 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-33120480

RESUMO

Objective: To investigate the characteristics of pregnancy with pre-excitation syndrome and its influence on pregnancy outcomes. Methods: A retrospective analysis was made on the clinical data of 62 cases of pregnancy complicated with pre-excitation syndrome in Beijing Anzhen Hospital from Jan. 2008 to Dec. 2008. According to whether there was a supraventricular tachycardia (SVT) in pregnancy, they were divided into two groups. There were 16 pregnant women in the SVT seizure group during pregnancy, and 46 pregnant women in no SVT seizure group, with a multi-disciplinary comprehensive diagnosis and treatment model. SPSS software was used to analyze the data and compare the gestational age, age and weight of the newborn, and then compare the pregnancy outcomes. Results: (1) The total number of deliveries in Beijing Anzhen Hospital during the study period was 21 786, and the patients with pregnancy combined with pre-excitation syndrome account for 0.28% (62/21 786). (2) Totally 44 patients (71%, 44/62) were diagnosed with pre-excitation syndrome before pregnancy, and 18 patients (29%, 18/62) were diagnosed for the first-time during pregnancy. Among patients diagnosed with pre-excitation syndrome before pregnancy, 16 patients (36%, 16/44) had seizures before pregnancy, 28 patients (64%, 28/44) had asymptomatic before pregnancy, and 4 of asymptomatic patients had SVT during pregnancy. (3) Of the 16 pregnant women in the SVT seizure group during pregnancy, 2 patients (2/16) had SVT episodes in the first trimester, 5 patients (5/16) had SVT episodes in the second trimester, 9 patients (9/16) had SVT episodes in the third trimester. In the SVT seizure group, 8 patients (8/16) had SVT episodes before pregnancy, and 8 patients (8/16) had no SVT episodes before pregnancy. There were 46 patients in the SVT seizure-free group during pregnancy, including 9 patients with SVT attacks before pregnancy and 37 patients without SVT before pregnancy. (4) Compared with the pregnant women in the SVT seizure group, the age, weight gained during pregnancy, delivery gestation week, newborn weight, and the time of the first and second labors were not statistically different between the two groups of pregnant women (all P>0.05). However, the total duration of labor in the SVT seizure group during pregnancy was shorter and pre-pregnancy weight was lower (all P<0.05). The rate of cesarean section in pregnant women with SVT attack was 12/16, and the rate of cesarean section in pregnant women without SVT was 50% (23/46; P=0.051). No pregnant woman had an arrhythmia during delivery. Conclusions: SVT episode in patients during pregnancy most occurs in the third trimester. Patients who are asymptomatic before pregnancy may also have SVT during pregnancy. Pre-excitation syndrome patients with SVT attacks during pregnancy increase adverse pregnancy outcomes. Multidisciplinary comprehensive management could effectively control pregnant women with pre-excitation syndrome, effectively reduce the occurrence of serious arrhythmia risk events during pregnancy, so that most patients could get good pregnancy outcomes.


Assuntos
Cesárea/estatística & dados numéricos , Síndromes de Pré-Excitação/diagnóstico , Resultado da Gravidez , China/epidemiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Complicações na Gravidez/epidemiologia , Estudos Retrospectivos
7.
PLoS One ; 15(10): e0233817, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33119603

RESUMO

BACKGROUND: One of the most common medical problems associated with pregnancy is hypertension. Hypertensive disorders of pregnancy (HDP), which has been attributable to abnormal placentation may have adverse effects on both mother and foetus if left unchecked. The objective of this study was to determine the prevalence of this condition and its effect on placental morphology as well as maternal and perinatal outcomes. MATERIALS AND METHODS: This was a prospective case-control study, conducted at Komfo Anokye Teaching Hospital (KATH), Ghana between February 2018 and July 2018. The progression of pregnancy in normotensive and hypertensive pregnant women, and the eventual perinatal outcomes were closely followed. Statistical analysis was performed using IMB-SPSS version 23. Associations were considered significant at p values of ≤ 0.05. RESULTS: From a total of 214 deliveries recorded during the period of study, 84 (39.25%) were hypertensives. Forty four (52%) of the hypertensives had preeclampsia, 28 (33.3%) had gestational hypertension, 6 (7.1%) had eclampsia, 4 (4.8%) had chronic hypertension, and 2 (2.4%) had preeclampsia superimposed on chronic hypertension. The frequency of placental haematoma, placental infarction, and placental calcification in the normotensives were significantly (p = 0.001) lower than that of the hypertensives. The mean placental weight (p = 0.01), placental volume (p = 0.001), placental diameter (p = 0.03), and placental thickness (p = 0.001) of the normotensives were significantly higher than those of the hypertensives. The number of normotensives in whom labour was induced, who had their babies delivered by caesarean section, and who were admitted after they had given birth were significantly (p = 0.001) lower than that of hypertensives who underwent similar procedures. No stillbirths were recorded in the normotensives compared with four in the hypertensives. The number of babies delivered to the normotensives who were admitted to the NICU was significantly (p = 0.001) lower than those delivered by hypertensives. CONCLUSION: There was a high prevalence of hypertensive disorders of pregnancy in the study site. Pregnant women who developed HDP are at a risk of developing placental abnormalities that adversely affected perinatal outcomes. These adverse effects can be curtailed by embarking on a vigorous health education drive.


Assuntos
Hematoma/epidemiologia , Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão/epidemiologia , Doenças Placentárias/epidemiologia , Complicações na Gravidez/epidemiologia , Adulto , Estudos de Casos e Controles , Cesárea/estatística & dados numéricos , Feminino , Gana/epidemiologia , Hospitais de Ensino , Humanos , Hipertensão/complicações , Trabalho de Parto Induzido/estatística & dados numéricos , Idade Materna , Gravidez , Prevalência , Estudos Prospectivos , Adulto Jovem
8.
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
9.
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
10.
BMC Psychol ; 8(1): 99, 2020 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-32962764

RESUMO

BACKGROUND: Pregnancy as a sensitive period of a woman's life can be affected by various psychological factors that can have adverse effects on the woman, her fetus and future baby. Since COVID-19 is a new phenomenon with limited information available, it may have adverse psychological effects on pregnant women. Therefore, this study was conducted to determine the status of depression, stress, anxiety and their predictors in Iranian pregnant women during the outbreak of COVID-19. METHODS: This descriptive-analytical cross-sectional study was performed on 205 pregnant women covered by Tabriz health centers in Iran. The sampling method used was cluster sampling. The data collection tool was the socio-demographic characteristics questionnaire and the DASS-21 (Depression, Anxiety and Stress Scale-21), which were completed online by pregnant women. The general linear model was used to determine the predictive factors of depression, anxiety and stress. RESULTS: The mean (SD) score of depression, stress, and anxiety were 3.91 (3.9), 6.22 (4.25), and 3.79 (3.39), respectively; the score range of 0 to 21. Depression, stress, and anxiety symptoms were observed in 32.7, 32.7, and 43.9% of the participants, respectively, with varying degrees from mild to very severe. Based on the adjusted general linear model, variables of education level, spouse's job and marital life satisfaction were the predictors of depressive symptoms. Variables of spouse's education level, spouse's support, marital life satisfaction and the number of pregnancies were the predictive factors of anxiety symptoms and the variables of spouse's education level, household income sufficiency, spouse's support and marital life satisfaction were predictors of stress symptoms. CONCLUSIONS: Considering the role of marital life satisfaction, high level of spouse's education and income in reducing symptoms of stress, anxiety, and depression in pregnant women in critical situations such as the prevalence of COVID-19, it seems that using strategies to promote marital life satisfaction and socio-economic status can play an effective role in controlling anxiety and reducing stress and depression in pregnant women.


Assuntos
Ansiedade , Infecções por Coronavirus , Depressão , Casamento , Pandemias , Pneumonia Viral , Complicações na Gravidez , Estresse Psicológico , Adulto , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Ansiedade/prevenção & controle , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Estudos Transversais , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/prevenção & controle , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/prevenção & controle , Complicações na Gravidez/psicologia , Prevalência , Escalas de Graduação Psiquiátrica , Fatores de Risco , Fatores Socioeconômicos , Estresse Psicológico/diagnóstico , Estresse Psicológico/epidemiologia , Estresse Psicológico/prevenção & controle
11.
PLoS One ; 15(9): e0238938, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32936823

RESUMO

BACKGROUND: Despite having the high rate of stillbirth in most of the countries of South Asia, there is a lack of synthesized evidence based on factors associated with stillbirth. This study systematically synthesizes the evidence on factors associated with stillbirth in the four selected countries of South Asia. METHODS: This review was conducted using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies that examined factors associated with stillbirth in South Asia were searched using five major electronic search databases including MEDLINE, CINAHL, Embase, PsycINFO, and Scopus, published between January 2000 and December 2019. In the meta-analysis, significant heterogeneity was detected among studies (I2 >50%), and hence a random effect model was used. RESULTS: A total of 20 studies met the inclusion criteria. The pooled rate of stillbirth from the studies in Bangladesh, India, Nepal, and Pakistan was 25.15 per 1000 births. Pregnancy complications, maternal health conditions, fetal complications, lack of antenatal care, and lower Socio Economic Status (SES) were the most common factors associated with stillbirth in countries of South Asia. CONCLUSION: This study confirmed that stillbirth in selected countries of South Asia remains high. To reduce stillbirth, a greater focus needs to be on timely management of preterm labor, maternal hypertension, and provision of financial support for quality antenatal and delivery care. The interventions should be targeted for women living in remote areas, who are less educated and those with low SES.


Assuntos
Complicações na Gravidez/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Natimorto/epidemiologia , Bangladesh/epidemiologia , Feminino , Humanos , Índia/epidemiologia , Recém-Nascido , Masculino , Saúde Materna , Nepal/epidemiologia , Estudos Observacionais como Assunto , Paquistão/epidemiologia , Gravidez , Medição de Risco
12.
Cent Eur J Public Health ; 28(3): 230-236, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32997480

RESUMO

OBJECTIVE: This study aimed to analyze the complications of planned home births treated at healthcare facilities in the Czech Republic. METHODS: This prospective cohort observational study is based on analysis of women hospitalized with complications related to planned home deliveries in the Czech Republic between 2016 and 2017. The data were collected using an online form made accessible to the directors of all maternity hospitals in the Czech Republic. The results were statistically evaluated. RESULTS: We identified 45 complications during planned home deliveries. Complications occurred most often among women living in largely populated cities with higher levels of education. Overall, 40% of patients did not receive routine antenatal care, and 38% of women gave birth after the 41st week of pregnancy. In 60% of cases, no professionals attended the birth. Hospital transfer frequencies were 42% after delivery, 36% at third-stage labour, 11% first-stage labour, 9% second-stage labour, and 2% before delivery. We recorded four neonatal deaths and one severe newborn morbidity. There was one maternal death unrelated to the home-birthing process and six cases of severe maternal haemorrhagic shock requiring intensive care. CONCLUSION: Complications of planned home births occurred more frequently in women living in largely populated cities and with higher education levels. Planned home births were also observed among women who were at a higher risk of complications. Risk factors included nulliparity, postdate pregnancy, and lack of prenatal care. Hospital transfers occurred most often in the third stage of labour and postpartum.


Assuntos
Parto Domiciliar/efeitos adversos , Complicações na Gravidez/epidemiologia , República Tcheca/epidemiologia , Feminino , Humanos , Recém-Nascido , Gravidez , Estudos Prospectivos , Fatores de Risco
13.
S Afr Med J ; 110(7): 667-670, 2020 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-32880345

RESUMO

BACKGROUND: Trauma in pregnancy poses a unique challenge to clinicians. Literature on this topic is limited in South Africa (SA). OBJECTIVES: To review our institution's experience with the management of trauma in pregnancy in a developing-world setting. METHODS: This study was based at Grey's Hospital, Pietermaritzburg, SA. All pregnant patients who were admitted to our institution following trauma between December 2012 and December 2018 were identified from the Hybrid Electronic Medical Registry (HEMR). RESULTS: During the 6-year study period, 2 990 female patients were admitted by the Pietermaritzburg Metropolitan Trauma Service (PMTS), of whom 89 were pregnant. The mean age of these patients was 25.64 (range 17 - 43) years. The mechanism of injury was road traffic crash (RTC) in 39, stab wounds (SW) in 19, assault other than SW or gunshot wounds (GSW) in 19, GSW in 8, snake bite in 5, impalement in 1, dog bite in 1, hanging in 1, sexual assault in 1 and a single case of a patient being hit by a falling object. A subset of patients sustained >1 mechanism of injury. Thirty patients were managed operatively. The mean time of gestation was 19.16 (5 - 36) weeks. Three patients died, and there were 16 fetal deaths (including 3 lost after the mother's death). Forty-five fetuses were recorded as surviving at discharge, while 25 fetal outcomes were not specifically recorded. There were 2 threatened miscarriages and/or patients with vaginal bleeding, 1 positive pregnancy test with no recorded outcome and no premature births as a result of trauma. CONCLUSIONS: Trauma in pregnancy is relatively uncommon and mostly due to a RTC or deliberately inflicted trauma. Fetal outcome is largely dependent on the severity of the maternal injury, with injuries requiring laparotomy leading to a high fetal mortality rate.


Assuntos
Complicações na Gravidez/epidemiologia , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Feminino , Morte Fetal , Humanos , Gravidez , Complicações na Gravidez/cirurgia , África do Sul/epidemiologia , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Centros de Traumatologia , Ferimentos e Lesões/cirurgia , Adulto Jovem
14.
PLoS One ; 15(9): e0238733, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32898189

RESUMO

OBJECTIVE: Define the prevalence of OSA in a population of obese pregnant women. Secondary objectives were to assess its obstetric consequences and define its risk factors in this population. METHODS: This single-center prospective study took place at the Lille University Hospital from 2010 to 2016 and included pregnant women with a body mass index (BMI) > 35 kg/m2. They underwent polysomnography (type 1 sleep testing) between 24 and 32 weeks of gestation to diagnose OSA. Clinical, obstetric, and fetal data were collected monthly and at delivery. We compared the groups with and without OSA and calculated its prevalence. RESULTS: This study included 67 women with a mean BMI of 42.4 ± 6.2 kg/m2. Among them, 29 had OSA, for a prevalence of 43.3% (95% confidence interval, 31.4-55.2); it was mild or moderate in 25 women and severe in 4. Comparison of the two groups showed that women in the OSA group were older (31.9 ± 4.7 years vs 29.5 ± 4.8 years, P = .045), had chronic hypertension more frequently (37.9% vs 7.9%, P = .0027), and had a higher mean BMI (43.8 ± 6.2 kg/m2 vs 41.2 ± 6 kg/m2, P = .045). During pregnancy, they developed gestational diabetes more often (48.3% vs 23.7%, P = .04). No significant differences were observed for any of the other criteria studied. CONCLUSIONS: The prevalence of OSA was high in our study, and women with it developed gestational diabetes during pregnancy more often. No other obstetric complications were observed.


Assuntos
Obesidade/complicações , Complicações na Gravidez/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Feminino , Humanos , Gravidez , Estudos Prospectivos , Fatores de Risco
15.
PLoS One ; 15(9): e0239294, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941502

RESUMO

BACKGROUND AND HYPOTHESIS: The role of smoking as a risk factor for group B streptococcal (GBS) colonization in women during pregnancy has not been previously adequately explored. We hypothesized that women of term or near term neonates who smoked during pregnancy were more likely to have GBS colonization than their non-smoking counterparts. METHODS: The electronic health records (EHRs) of a convenience sample of women delivering in an inner-city university tertiary care center were reviewed. The outcome variable of interest was maternal GBS colonization during pregnancy. The primary independent variable of interest was tobacco smoking during pregnancy, determined from the EHRs by the number of cigarettes smoked during gestation. Descriptive statistics were conducted and categorical data were compared by the Fischer's exact test. Multiple logistic regression analysis was further conducted to determine the independent impact of tobacco smoke exposure on GBS colonization. RESULTS: The prevalence of maternal GBS colonization was 35% among the study population. In the univariate analyses, factors associated with maternal GBS colonization were tobacco smoking during pregnancy (P of trend <0.001), Race (P<0.001), maternal age <20 years (P = 0.006), low birthweight <2500 gm (P = 0.020), maternal drug use (P = 004), and gestational age <37 (P = 0.041). In a multiple logistic regression analysis, tobacco smoking during pregnancy remained the most significant predictor of GBS colonization. Women who smoked during pregnancy were more than twice more likely to be colonized than their non-smoking counterparts (OR = 2.6; 95% CI = 1.5-4.6; p<0.001). Maternal age was the only other significant predictor with younger mothers more than one and a half time more likely to be colonized than their older counterparts (OR = 1.65; 95% CI = 1.02-2.68; P = 0.04). CONCLUSION: The prevalence of GBS colonization in this institution was consistent with recent national rates. Smoking and maternal age were identified as two independent risk factors for GBS colonization during pregnancy. Further studies are needed to confirm these findings.


Assuntos
Complicações na Gravidez/epidemiologia , Fumar/epidemiologia , Infecções Estreptocócicas/epidemiologia , Adulto , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Gravidez , Prevalência , Centros de Atenção Terciária/estatística & dados numéricos , Virginia
16.
Zhonghua Fu Chan Ke Za Zhi ; 55(8): 505-509, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32854473

RESUMO

Objective: To compare the preterm birth rate among different age groups and analyze relative high-risk factors of preterm birth. Methods: A retrospective analysis was conducted on clinical data of single pregnant women ≥28 gestational weeks from January 2013 to May 2019 in the First Affiliated Hospital of Chongqing Medical Hospital. All involved women were divided into three groups according to age, Group 1 (aged<35 years), Group 2 (aged 35-39 years), and Group 3 (aged ≥40 years). The preterm birth rate among 3 groups was compared and their high-risk factors were analyzed. Results: There were 48 288 singleton pregnancies during the study period, of which 3 351 were preterm births, preterm birth rate was 6.94% (3 351/48 288). In Group 1, there were 42 020 women, of which 2 699 were preterm births (6.42%, 2 699/42 020); in Group 2, there were 5 061 women, of which 491 were preterm births (9.70%, 491/5 061); and in Group 3, there were 1 207 women, of which 161 were preterm births (13.34%, 161/1 207). Comparing the spontaneous preterm birth rates among the three groups, Group 1 was the lowest one and Group 3 was the highest one (3.72% vs 4.51% vs 5.88%); comparing the medical preterm birth rates among the three groups, Group 1 also was the lowest one and Group 3 also was the highest one (2.70% vs 5.20% vs 7.46%); the differences were statistically significant (P<0.05). The incidence of spontaneous and medical preterm birth according gestational weeks were compared among three groups and there were no significant differences (P>0.05). Comparing and analyzing the high-risk factors of medical preterm birth, the incidence of intrahepatic cholestasis of pregnancy and fetal distress in Group 1 were higher than those in Group 2 and 3; the incidence of placenta praevia were significantly higher in Group 2 and 3 than that in Group 1; the differences were statistically significant (P<0.05). Conclusions: Maternal age is a significant high-risk factor of both spontaneous preterm birth and medical preterm birth, and the risk of preterm birth increases with age. For medical preterm birth, compared with right-age pregnant women, placenta praevia is the high-risk factor for women in advanced maternal age(AMA), which have great effect on medical preterm birth rate of AMA.


Assuntos
Idade Materna , Complicações na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Distribuição por Idade , Fatores Etários , Colestase Intra-Hepática/epidemiologia , Feminino , Sofrimento Fetal/epidemiologia , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Placenta Prévia/epidemiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco
17.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32817396

RESUMO

BACKGROUND: Severe maternal morbidity (SMM) comprises an array of conditions and procedures denoting an acutely life-threatening pregnancy-related condition. SMM may further compromise fetal well-being. Empirical data are lacking about the relation between SMM and infant mortality. METHODS: This population-based cohort study included 1 892 857 singleton births between 2002 and 2017 in Ontario, Canada, within a universal health care system. The exposure was SMM as an overall construct arising from 23 weeks' gestation up to 42 days after the index delivery. The primary outcome was infant mortality from birth to 365 days. Multivariable modified Poisson regression generated relative risks and 95% confidence intervals (CIs), adjusted for maternal age, income, rurality, world region of origin, diabetes mellitus, and chronic hypertension. RESULTS: Infant mortality occurred among 174 of 19 587 live births with SMM (8.9 per 1000) vs 5289 of 1 865 791 live births without SMM (2.8 per 1000) (an adjusted relative risk of 2.93 [95% CI 2.51-3.41]). Of 19 587 pregnancies with SMM, 4523 (23.1%) had sepsis. Relative to births without SMM, the adjusted odds ratio for infant death from sepsis was 1.95 (95% CI 1.10-3.45) if SMM occurred without maternal sepsis and 6.36 (95% CI 3.50-11.55) if SMM included sepsis. CONCLUSIONS: SMM confers a higher risk of infant death. There is also coupling tendency (concurrent event of interest) between SMM with sepsis and infant death from sepsis. Identification of preventable SMM indicators, as well as the development of strategies to limit their onset or progression, may reduce infant mortality.


Assuntos
Mortalidade Infantil/tendências , Saúde Materna/tendências , Complicações na Gravidez/epidemiologia , Índice de Gravidade de Doença , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Morbidade , Ontário/epidemiologia , Gravidez , Complicações na Gravidez/diagnóstico , Adulto Jovem
18.
Medicine (Baltimore) ; 99(30): e21279, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791708

RESUMO

INTRODUCTION: The article presents a protocol of a cross-sectional study of mental health of pregnant women in relation to the coronavirus disease 19 (COVID-19) pandemic. The primary aim is to compare differences in anxiety and depression scores of pregnant women between countries affected by the COVID-19 pandemic. The secondary aim is to assess demographic, economic, and social aspects affecting maternal anxiety and depression scores among pregnant women worldwide in the time of the COVID-19 pandemic. Finally, we will be able to compare differences in perception of the different aspects of the COVID-19 pandemic (social distancing, restrictions related to delivery) between countries and according to the epidemic status (number of infected patients, number of reported deaths). The comparisons will also be done according to the COVID-19 status of the participants. METHODS AND ANALYSIS: It is a web-based anonymous survey of pregnant women living in countries affected by the COVID-19 pandemic. The survey is comprised of 3 sections:Web-based recruitment for health research has proven to be cost-effective and efficient. At current times with the COVID-19 pandemic, limited resources and social distancing restrictions, performing a mental health study involving pregnant women on a large international scale cannot be safely conducted without involving social-media.The fears of pregnant women fall into 3 categories: the medical condition, the economic status and the organization of daily activity.The study has received approval of the medical ethics committee and has been registered on Clinicaltrials.gov. Results will be published in peer-reviewed journals and made public through all available media.


Assuntos
Ansiedade/psicologia , Infecções por Coronavirus/psicologia , Depressão/psicologia , Pneumonia Viral/psicologia , Complicações Infecciosas na Gravidez/psicologia , Complicações na Gravidez/psicologia , Gestantes/psicologia , Adulto , Ansiedade/epidemiologia , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Gravidez , Complicações na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/virologia , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
19.
Womens Health (Lond) ; 16: 1745506520952006, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32833589

RESUMO

OBJECTIVES: The prevalence of opioid use disorder continues to rise in the United States, with a simultaneous increase in the diagnosis of both opioid use disorder during pregnancy and neonatal opioid withdrawal syndrome. Despite these increases in pregnancy-related care, little is known about hospital policy and policy implementation related to opioid use disorder in pregnancy. In addition, it is unknown whether policies might differ in rural or urban hospitals. To better examine these issues, Minnesota hospitals were surveyed regarding the existence and implementation of policies related to opioid use disorder in pregnancy and whether any policy implementation challenges had been identified. METHODS: From August to December 2017, the research team contacted all Minnesota hospitals that offered obstetric services (n = 82) to survey challenges to implementing policies for opioid use disorder during pregnancy, among other questions. Fifty-nine hospitals had respondents (primarily obstetric department supervisors) who provided information about policy implementation challenges for a 72% response rate. Qualitative responses were analyzed using qualitative description and according to hospital location: metropolitan (urban), micropolitan (rural), or non-core (rural). RESULTS: Ninety-one percent of respondents said that they had pregnancies affected by opioid use disorder at their hospital within the last year. Four major challenges to policy implementation were identified in qualitative responses: (1) provider consensus, (2) patient response to policy, (3) lack of resources, and (4) low frequency of occurrence. All four challenges were more frequently identified by respondents at rural hospitals compared to urban hospitals. CONCLUSION: This study identified challenges in standardizing hospital care for pregnancies affected by opioid use disorder, and these challenges were identified more frequently in rural locations. These non-urban hospitals may require increased state and federal support and funding.


Assuntos
Política de Saúde , Hospitais/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Complicações na Gravidez/epidemiologia , Feminino , Humanos , Minnesota/epidemiologia , Síndrome de Abstinência Neonatal/epidemiologia , Gravidez , Inquéritos e Questionários
20.
J Pregnancy ; 2020: 7864816, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32802511

RESUMO

Hypertensive disorders of pregnancy complicate up to 10% of pregnancies worldwide, constituting one of the most significant causes of maternal morbidity and mortality. Hypertensive disorders, specifically gestational hypertension, chronic hypertension, and preeclampsia, throughout pregnancy are contributors to the top causes of maternal mortality in the United States. Diagnosis of hypertensive disorders throughout pregnancy is challenging, with many disorders often remaining unrecognized or poorly managed during and after pregnancy. Moreover, the research has identified a strong link between the prevalence of maternal hypertensive disorders and racial and ethnic disparities. Factors that influence the prevalence of maternal hypertensive disorders among racially and ethnically diverse women include maternal age, level of education, United States-born status, nonmetropolitan residence, prepregnancy obesity, excess weight gain during pregnancy, and gestational diabetes. Examination of the factors that increase the risk for maternal hypertensive disorders along with the current interventions utilized to manage hypertensive disorders will assist in the identification of gaps in prevention and treatment strategies and implications for future practice. Specific focus will be placed on disparities among racially and ethnically diverse women that increase the risk for maternal hypertensive disorders. This review will serve to promote the development of interventions and strategies that better address and prevent hypertensive disorders throughout a pregnant woman's continuum of care.


Assuntos
Disparidades em Assistência à Saúde/tendências , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/prevenção & controle , Fatores Etários , Grupos de Populações Continentais , Diabetes Gestacional , Escolaridade , Feminino , Humanos , Hipertensão/etnologia , Hipertensão/etiologia , Gravidez , Complicações na Gravidez/etnologia , Complicações na Gravidez/etiologia , Prevalência , Risco , Estados Unidos/epidemiologia , Ganho de Peso
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