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1.
Isr Med Assoc J ; 22(3): 137-141, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32147976

RESUMO

BACKGROUND: Pregestational diabetes mellitus (PGDM) carries a significantly elevated risk of adverse maternal and fetal outcomes. There is evidence that certain interventions reduce the risk for adverse outcomes. Studies have shown that a multi-disciplinary approach improves pregnancy outcomes in women with PGDM. OBJECTIVES: To determine pregnancy outcomes in women with PGDM using a multi-disciplinary approach. METHODS: We retrospectively reviewed consecutive women with pregestational type 1 and type 2 diabetes who were monitored at a high-risk pregnancy clinic at the Sheba Medical Center. Clinical data were obtained from the medical records. All data related to maternal glucose control and insulin pump function were prospectively recorded on Medtronic CareLink® pro software (Medtronic MiniMed, Northridge, CA). RESULTS: This study comprised 121 neonates from 116 pregnancies of 94 women. In 83% of the pregnancies continuous glucose monitoring (CGM) sensors were applied during a part or all of the pregnancy. Pregnancy outcomes among women who were followed by a multi-disciplinary team before and during pregnancy, and during labor and puerperium resulted in better glucose control (hemoglobin A1c 6.4% vs. 7.8%), lower risk for pregnancy induced hypertension/preeclampsia (7.7% vs. 15.6%), lower birth weight (3212 g vs. 3684 g), and lower rate of large size for gestational age and macrosomia (23.1% vs. 54.2% and 3.3% vs. 28.4%, respectively), compared to data from European cohorts. CONCLUSIONS: The multi-disciplinary approach for treating women with PGDM practiced in the high-risk pregnancy clinic at the Sheba Medical Center resulted in lower rates of macrosomia, LGA, and pregnancy induced hypertension compared to rates reported in the literature.


Assuntos
Diabetes Mellitus/terapia , Complicações na Gravidez/terapia , Cuidado Pré-Natal/métodos , Adulto , Glicemia , Feminino , Macrossomia Fetal/prevenção & controle , Humanos , Hipertensão/prevenção & controle , Recém-Nascido de Baixo Peso , Recém-Nascido , Insulina/uso terapêutico , Israel , Pré-Eclâmpsia/prevenção & controle , Gravidez , Estudos Prospectivos , Estudos Retrospectivos
2.
Isr Med Assoc J ; 22(3): 142-147, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32147977

RESUMO

BACKGROUND: Admission to an intensive care unit (ICU) is an objective marker of severe maternal morbidity (SMM). OBJECTIVES: To determine the prevalence of obstetric ICU admissions in one medical center in Israel and to characterize this population. METHODS: In this retrospective study the files of women coded for pregnancy, birth, or the perinatal period and admission to the ICU were pulled for data extraction (2005-2013). RESULTS: During the study period, 111 women were admitted to the ICU among 120,279 women who delivered babies (0.09%). Their average age was 30 ± 6 years, most were multigravida, a few had undergone fertility treatments, and only 27% had complicated previous pregnancies. Most pregnancies (71.2%) were uneventful prior to admission. ICU admissions were divided equally between direct (usually hemorrhage) and indirect (usually cardiac disease) obstetric causes. CONCLUSIONS: The indications for obstetrics ICU admission correlated with the proximate causes of maternal arrest observed worldwide. While obstetric hemorrhage is often unpredictable, deterioration of heart disease is foreseeable. Attention should be directed specifically toward improving the diagnosis and treatment of maternal heart disease during pregnancy in Israel.


Assuntos
Cuidados Críticos/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Transtornos Puerperais/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Cuidados Críticos/métodos , Feminino , Humanos , Unidades de Terapia Intensiva , Israel/epidemiologia , Cuidado Pós-Natal/métodos , Gravidez , Complicações na Gravidez/terapia , Prevalência , Transtornos Puerperais/terapia , Estudos Retrospectivos , Fatores de Risco
3.
Radiol Clin North Am ; 58(2): 445-462, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32044017

RESUMO

Radiological guided intervention techniques are discussed in obstetric and gynecologic patients. Fallopian tube recanalization, postpartum hemorrhage control, techniques of treating uterine leiomyomas, pelvic congestion treatment, and the use of percutaneous and transvaginal ultrasonography-guided aspirations and biopsy are covered. These techniques use basic radiological interventional skills and show how they are adapted for use in the female pelvis.


Assuntos
Embolização Terapêutica/métodos , Doenças Urogenitais Femininas/diagnóstico por imagem , Doenças Urogenitais Femininas/terapia , Complicações na Gravidez/diagnóstico por imagem , Complicações na Gravidez/terapia , Ultrassonografia de Intervenção/métodos , Feminino , Doenças Urogenitais Femininas/patologia , Ginecologia , Humanos , Biópsia Guiada por Imagem/métodos , Obstetrícia , Gravidez , Complicações na Gravidez/patologia
4.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(1): 36-42, ene. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-186145

RESUMO

Introduction: There is no agreement on the procedures to be used for diagnosis and treatment of gestational thyroid dysfunction. Controversy still exists on the normal range of thyroid-stimulating hormone (TSH) levels and use of gestational hypothyroidism (GH) screening. The aim of this study was to assess diagnosis and treatment of thyroid dysfunction during pregnancy in a group of Spanish hospitals. Study design: This was a retrospective, multicenter study in pregnant females with GH attending Spanish healthcare centers from March 2013 to July 2014. Variables analyzed included diagnosis criteria for GH (availability of universal screening for gestational thyroid disorders and TSH reference values (RVs) by trimester of pregnancy): risk factors for GH, iodine intake from food or supplementation, gestational age (at diagnosis/treatment) and l-thyroxine treatment. Results: Fourteen centers participated in the study. Universal screening was performed in only half of the centers, and only 14% had their own TSH RVs. Overall, 257 pregnant women were enrolled, 53.7% with hypothyroidism (HT) diagnosed before pregnancy (pre-GH) and 46.3% with HT diagnosed during pregnancy (intra-GH). A comparison of intra-GH and pre-GH women showed that intra-GH women made their first visit later (59.7% vs. 75.4% respectively before week 12, p = 0.007) and had more frequently high TSH levels (>2.5 μIU/ml) during the first trimester (94.4% vs. 67.0% respectively, p < 0.001). Conclusions: Our results suggest that GH may be underdiagnosed or inadequately diagnosed in most healthcare centers. These findings suggest the need of improving the current practice in Spain


Introducción: Los procedimientos a seguir para el diagnóstico y tratamiento de la disfunción tiroidea en la gestación no están del todo consensuados. Aún se discute el rango de normalidad de los valores de la hormona estimulante del tiroides (TSH) y el uso de screening para detectar hipotiroidismo gestacional (HG). El objetivo de este estudio es evaluar la forma de diagnóstico y tratamiento de la disfunción tiroidea durante la gestación en un grupo de hospitales de España. Diseño del estudio: Estudio retrospectivo, multicéntrico en mujeres embarazadas con HG atendidas en instituciones sanitarias españolas entre marzo de 2013 y julio de 2014. Las variables analizadas incluyeron criterios diagnósticos de HG (disponibilidad de screening universal para trastornos tiroideos gestacionales y valores de referencia de TSH según el trimestre gestacional); factores de riesgo de HG, ingesta de yodo mediante alimentos o suplementos, edad gestacional (al diagnóstico/tratamiento) y tratamiento con L-tiroxina. Resultados: Participaron un total de 14 centros. Únicamente la mitad de los centros empleaba el screening universal, y solo el 14% tenía valores de referencia de TSH propios. Se incluyeron un total de 257 embarazadas, 53,7% con diagnóstico de hipotiroidismo previo al embarazo (pre-HG) y 46,3% con hipotiroidismo diagnosticado durante el embarazo (intra-HG). Comparando los casos de pre-HG e intra-HG, las mujeres con intra-HG realizaban la primera visita más tarde (antes de la semana 12; 59,7% vs. 75,4% respectivamente, p = 0,007) y tenían más frecuentemente valores elevados de TSH (> 2,5 μUI/ml) durante el primer trimestre (94,4% vs. 67,0% respectivamente, p < 0,001). Conclusiones: Nuestros resultados sugieren que el HG puede estar infradiagnosticado o diagnosticado indebidamente en la mayoría de los centros sanitarios. Estos hallazgos sugieren la necesidad de mejorar la práctica actual en España


Assuntos
Humanos , Feminino , Gravidez , Hipotireoidismo/diagnóstico , Hipotireoidismo/terapia , Complicações na Gravidez/terapia , Fatores de Risco , Hipotireoidismo/complicações , Estudos Retrospectivos , Iodo/uso terapêutico , Suplementos Nutricionais , Idade Gestacional , Tiroxina/uso terapêutico
7.
Chiropr Man Therap ; 27: 62, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31700607

RESUMO

Background: Pelvic girdle pain is a common problem during pregnancy and postpartum with significant personal and societal impact and costs. Studies examining the effectiveness of interventions for pelvic girdle pain measure different outcomes, making it difficult to pool data in meta-analysis in a meaningful and interpretable way to increase the certainty of effect measures. A consensus-based core outcome set for pelvic girdle pain can address this issue. As a first step in developing a core outcome set, it is essential to systematically examine the outcomes measured in existing studies. Objective: The objective of this systematic review was to identify, examine and compare what outcomes are measured and reported, and how outcomes are measured, in intervention studies and systematic reviews of interventions for pelvic girdle pain and for lumbopelvic pain (which includes pelvic girdle pain). Methods: We searched PubMed, Cochrane Library, PEDro and Embase from inception to the 11th May 2018. Two reviewers independently selected studies by title/abstract and by full text screening. Disagreement was resolved through discussion. Outcomes reported and their outcome measurement instruments were extracted and recorded by two reviewers independently. We assessed the quality of reporting with two independent reviewers. The outcomes were grouped into core domains using the OMERACT filter 2.0 framework. Results: A total of 107 studies were included, including 33 studies on pelvic girdle pain and 74 studies on lumbopelvic pain. Forty-six outcomes were reported across all studies, with the highest amount (26/46) in the 'life impact' domain. 'Pain' was the most commonly reported outcome in both pelvic girdle pain and lumbopelvic pain studies. Studies used different instruments to measure the same outcomes, particularly for the outcomes pain, function, disability and quality of life. Conclusions: A wide variety of outcomes and outcome measurements are used in studies on pelvic girdle pain and lumbopelvic pain. The findings of this review will be included in a Delphi survey to reach consensus on a pelvic girdle pain - core outcome set. This core outcome set will allow for more effective comparison between future studies on pelvic girdle pain, allowing for more effective translation of findings to clinical practice. Supplementary information: Supplementary information accompanies this paper at 10.1186/s12998-019-0279-2.


Assuntos
Dor nas Costas/terapia , Dor da Cintura Pélvica/terapia , Complicações na Gravidez/terapia , Adulto , Dor nas Costas/psicologia , Feminino , Humanos , Dor da Cintura Pélvica/psicologia , Período Pós-Parto/psicologia , Gravidez , Qualidade de Vida , Adulto Jovem
8.
Int J Behav Nutr Phys Act ; 16(1): 97, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31675954

RESUMO

BACKGROUND: Behaviour change techniques (BCTs) employed within PA intervention for pregnant women with a healthy body mass index (BMI) have been previously identified, however, these BCTS may differ for other weight profiles during pregnancy. The aim of this current review was to identify and summarise the evidence for effectiveness of PA interventions on PA levels for pregnant women with overweight and obesity, with an emphasis on the BCTs employed. METHODS: A systematic review and meta-analysis of PA intervention studies using the PRISMA statement was conducted. Searches were conducted of eight databases in January 2019. Strict inclusion/exclusion criteria were employed. The validity of each included study was assessed using the Cochrane Collaboration's tool for assessing risk of bias. The primary outcome measure was change in PA levels, subjectively or objectively measured, with physical fitness as a secondary outcome. All intervention descriptions were double coded by two authors using Michie's et al's BCT taxonomy V1. Meta-analyses using random effect models assessed the intervention effects on PA. Other PA outcomes were summarised in a narrative synthesis. RESULTS: From 8389 studies, 19 met the inclusion criteria 13 of which were suitable for inclusion in a meta-analysis. The remaining 6 studies were described narratively due to insufficient data and different outcome measures reported. In the meta-analysis, comparing interventions to a control group, significant increases were found in the intervention group for metabolic equivalent (SMD 0.39 [0.14, 0.64], Z = 3.08 P = 0.002) and physical fitness (VO2 max) (SMD 0.55 [0.34, 0.75], Z = 5.20 P = < 0.001). Of the other six, five studies reported an increase in PA for the intervention group versus the control with the other study reporting a significant decrease for women in their 3rd trimester (p = 0.002). 'Self-monitoring of behaviour' was the most frequently used BCTs (76.5%), with 'social support' being newly identified for this pregnant population with overweight or obesity. CONCLUSIONS: This review identified a slight increase in PA for pregnant women with overweight and obesity participating in interventions. However, due to the high risk of bias of the included studies, the results should be interpreted with caution. PA measures should be carefully selected so that studies can be meaningfully compared and standardised taxonomies should be used so that BCTs can be accurately assessed.


Assuntos
Exercício , Comportamentos Relacionados com a Saúde , Obesidade/terapia , Sobrepeso/terapia , Complicações na Gravidez/terapia , Terapia por Exercício , Feminino , Humanos , Gravidez , Cuidado Pré-Natal
9.
Acta Clin Croat ; 58(Suppl 1): 114-117, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31741569

RESUMO

Medico-legal responsibility in the management of acute or chronic pain in broad sense implies acting by the rules of good clinical practice and reducing the potential treatment side effects and complications that may entail health impairment and possible legal proceedings. Patients with acute or chronic obstetric or nonobstetric pain should be informed on the mode and method of treatment, possible side effects, and effects of drugs or procedures on fetal growth and development (informed consent). The principles of perinatal pharmacology and toxicology should be respected, choosing the mode of treatment associated with the lowest rate of side effects and a minimally invasive procedure (Accordingly, medico-legal responsibility is a professional and deontological category that should be fostered and implemented in line with professional guidelines and safety for both patients and medical staff.).


Assuntos
Dor Aguda/terapia , Dor Crônica/terapia , Responsabilidade Legal , Manejo da Dor , Complicações na Gravidez/terapia , Analgésicos/efeitos adversos , Feminino , Humanos , Consentimento Livre e Esclarecido , Obstetrícia , Manejo da Dor/efeitos adversos , Manejo da Dor/métodos , Educação de Pacientes como Assunto , Gravidez
10.
Pan Afr Med J ; 34: 49, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31762915

RESUMO

Massive and severe epistaxis is an uncommon event in pregnancy. It could be life threatening and could affect the normal pregnancy course. The best management is still on debate; it could be medical, conservative or surgical. Pregnancy termination often is problem solving. Hormonal changes during pregnancy affects nasal physiology. Vaginal delivery, labour induction or cesarean section are all suitable, after hemodynamic stabilization of pregnant woman. We report a case and review the available literature.


Assuntos
Epistaxe/complicações , Nariz/patologia , Complicações na Gravidez/patologia , Adulto , Epistaxe/terapia , Feminino , Humanos , Gravidez , Complicações na Gravidez/terapia , Recidiva , Índice de Gravidade de Doença
11.
BMC Health Serv Res ; 19(1): 851, 2019 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-31747914

RESUMO

BACKGROUND: Over time, the Brazilian health system, a growing country, has been developing to ensure good accessibility to health goods and services. This development is focusing on the principle of universality of access and completeness of health care. In this context, we aimed to evaluate the completeness of care and universality of access for women in their pregnancy and puerperal period in Ceará, Brazil. METHODS: A descriptive, cross-sectional study based on a quantitative approach, using information collected from the database of the regulation system of the state of Ceará and data from the Prenatal Monitoring System. The research population comprised of 1701 women who delivered a baby in an obstetric reference unit in the Health Macro-Region of Cariri, Ceará, Brazil from January to December 2015. RESULTS: There was a high rate of cesarean delivery (49.7%) and a high waiting time for access to high-risk delivery (32.6%) and neonatal intensive care unit (72.9%). There was also a low percentage (41.1%) of pregnant women undergoing an adequate number of prenatal consultations, dental care (20%), educational activities (15%), visits to the maternity ward (0.1%), laboratory tests of the third trimester (29.2%) and puerperal consultation (37.9%). CONCLUSIONS: It was concluded that the Maternal and Child Health Policy, especially the Rede Cegonha, which is still under development, does not ensure access and completeness of care for women during the prenatal, delivery, and puerperal periods, thus violating their reproductive rights. The results of this study allow a critical analysis by the academia and health managers in search of strategies to improve the services of Rede Cegonha in Brazil.


Assuntos
Acesso aos Serviços de Saúde/normas , Serviços de Saúde Materna/normas , Adulto , Brasil , Cesárea/estatística & dados numéricos , Criança , Estudos Transversais , Feminino , Política de Saúde , Humanos , Assistência Médica/normas , Cuidado Pós-Natal/normas , Período Pós-Parto/fisiologia , Gravidez , Complicações na Gravidez/terapia , Gestantes , Cuidado Pré-Natal/normas , Encaminhamento e Consulta , Direitos Sexuais e Reprodutivos/normas , Adulto Jovem
12.
Diabetes Res Clin Pract ; 157: 107876, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31586661

RESUMO

AIMS: To assess outcomes of women in the Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) cohort with gestational diabetes mellitus (GDM) managed by lifestyle modification compared with women without hyperglycaemia in pregnancy. METHODS: Indigenous (n = 97) and Europid (n = 113) women managed by lifestyle modification were compared to women without hyperglycaemia (n = 235). Multivariate linear and logistic regressions assessed whether GDM-lifestyle women had poorer outcomes compared to women without hyperglycaemia. RESULTS: Women with GDM-lifestyle had higher body mass index and lower gestational weight gain than women without hyperglycaemia. On univariate analysis, gestational age at delivery was lower and induction rates were higher in women with GDM-lifestyle than without hyperglycaemia. On multivariable regression, GDM-lifestyle was associated with lower gestational age at delivery (by 0.73 weeks), lower birthweight z-score (by 0.26, p = 0.007), lower likelihood of large for gestational age (LGA) [OR (95% CI): 0.55 (0.28, 1.02), p = 0.059], and greater likelihood of labour induction [2.34 (1.49, 3.66), p < 0.001] than women without hyperglycaemia. CONCLUSION: Women with GDM managed by lifestyle modification had higher induction rates and their offspring had lower birthweight z-scores, with a trend to lower LGA than those without hyperglycaemia in pregnancy. Further studies are indicated to explore reasons for higher induction rates.


Assuntos
Peso ao Nascer/genética , Diabetes Gestacional/terapia , Estilo de Vida , Complicações na Gravidez/terapia , Adolescente , Adulto , Feminino , Humanos , Gravidez , Adulto Jovem
13.
BMC Health Serv Res ; 19(1): 684, 2019 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-31590662

RESUMO

BACKGROUND: This study aimed to assess the quality of antenatal care (ANC) women received in Migori county, Kenya-including both service provision and experience dimensions-and to examine factors associated with each dimension. METHODS: We used survey data collected in 2016 in Migori county from 1031 women aged 15-49 who attended ANC at least once in their most recent pregnancy. ANC quality service provision was measured by nine questions on receipt of recommended ANC services, and experience of care by 18 questions on information, communication, dignity, and facility environment. We summed the responses to the individual items to generate ANC service provision and experience of care scores. We used both linear and logistic regression to examine predictors. RESULTS: The average service provision score was 10.9 (SD = 2.4) out of a total of 16. Most women received some recommended services once, but not at the frequency recommended by the Kenyan Ministry of Health. About 90% had their blood pressure measured, and 78% had a urine test, but only 58 and 14% reported blood pressure monitoring and urine test, respectively, at every visit. Only 16% received an ultrasound at any time during ANC. The average experience score is 27.3 (SD = 8.2) out of a total score of 42, with key gaps demonstrated in communication. About half of women were not educated on pregnancy complications. Also, about one-third did not often understand the purposes of tests and medicines received and did not feel able to ask questions to the health care provider. In multivariate analysis, women who were literate, employed, and who received all their ANC in a health center had higher experiences scores than women who were illiterate (coefficient = 1.52, CI:0.26,2.79), unemployed (coefficient = 2.73, CI:1.46,4.00), and received some ANC from a hospital (coefficient = 1.99, CI: 0.84, 3.14) respectively. The wealthiest women had two times higher odds of receiving an ultrasound than the poorest women (OR = 2.00, CI:1.20,3.33). CONCLUSION: Quality of ANC is suboptimal in both service provision and experience domains, with disparities by demographic and socioeconomic factors and facility type. More efforts are needed to improve quality of ANC and to eliminate the disparities.


Assuntos
Assistência à Saúde/normas , Complicações na Gravidez/terapia , Cuidado Pré-Natal/normas , Qualidade da Assistência à Saúde , Adolescente , Adulto , Feminino , Humanos , Quênia , Modelos Logísticos , Pessoa de Meia-Idade , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Saúde da População Rural , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
14.
Medicine (Baltimore) ; 98(40): e17396, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577749

RESUMO

Oral mifepristone combined with rivanol lactate (rivanol) is commonly used in second-trimester pregnancy termination. However, rivanol is not suitable to premature rupture of membranes and oligohydramnios because amniocentesis is difficult. Mifepristone combined with misoprostol is suitable for the patients with oligohydramnios. In accordance with the misoprostol dosing recommendations by the International Federation of Gynecology and Obstetrics (FIGO), the incidences of uterine rupture and cervical laceration are relatively high in Chinese pregnant women. The aim of our study was to optimize misoprostol dosing regimen in terms of efficacy and safety in Chinese pregnant women.We modified the Bishop Score, and then gave patients low-dose misoprostol according to the modified Bishop score. Based on the amniotic fluid volume (AFV) indicated by type-B ultrasonic instrument, the cases with AFV ≤2 cm receiving low-dose misoprostol combined with mifepristone and the cases with amniocentesis failure followed by receiving low-dose misoprostol combined with mifepristone were enrolled into study group, and the cases with AFV >2 cm receiving rivanol combined with mifepristone were enrolled into control group. The start time of uterine contractions, time of fetal expulsion, birth process, hospital day, successful induced labor rate, complete induced labor rate, and incomplete induced labor rate were observed and compared between the 2 groups.There were significant differences in the start time of uterine contractions, time of fetal expulsion, birth process, and hospital day between the control group and the study group (all P < .05). The successful induced labor rate, complete induced labor rate, and incomplete induced labor rate were also significantly different between the 2 groups (all P < .05).In the induced labor of 16 to 28 weeks pathological pregnancy, low-dose misoprostol can markedly improve the successful induced labor rate and complete induced labor rate, shorten the birth process and hospital day, and decrease uterine curettage rate and uterine rupture risk. Low-dose misoprostol combined with mifepristone is suitable to the induced labor of 16 to 28 weeks pathological pregnancy in Chinese women.


Assuntos
Abortivos não Esteroides/uso terapêutico , Aborto Induzido/métodos , Mifepristona/uso terapêutico , Misoprostol/uso terapêutico , Complicações na Gravidez/terapia , Segundo Trimestre da Gravidez , Abortivos não Esteroides/administração & dosagem , Abortivos não Esteroides/efeitos adversos , Aborto Induzido/efeitos adversos , Adulto , Grupo com Ancestrais do Continente Asiático , China , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Feminino , Humanos , Mifepristona/administração & dosagem , Mifepristona/efeitos adversos , Misoprostol/administração & dosagem , Misoprostol/efeitos adversos , Oligo-Hidrâmnio/terapia , Gravidez , Fatores de Tempo , Ruptura Uterina/prevenção & controle
15.
Artigo em Inglês | MEDLINE | ID: mdl-31569780

RESUMO

AIM: To analyze if non-surgical treatment of periodontitis in a pregnant Caucasian women population can reduce adverse pregnancy outcomes. METHODS AND RESULTS: A parallel randomized clinical trial was designed and approved by the Ethical Committee of Sanitary Area Santiago-Lugo, Spain (registration number: 2016/451). Forty patients with periodontitis stage II grade B were randomly allocated to receive either comprehensive non-surgical periodontal therapy (test group; n = 20) or professional tooth cleaning (control group; n = 20) before 24 gestational weeks. Randomization was computer-generated by the statistic program Epidat v.4.1 and allocation was performed using sealed opaque envelopes. Clinical measurements and peripheral blood samples for biochemical variables were collected at baseline, in the middle of second trimester before non-surgical treatment, and in the third trimester. Microbiological samples were collected in the second and third trimester. A statistically significant reduction was verified in all clinical and microbiological parameters after periodontal treatment in the test group. No significant differences were observed for the rest of the variables, including preterm birth and/or low birth weight. No adverse events related to periodontal treatment were reported. CONCLUSIONS: Non-surgical periodontal treatment in Caucasian patients with periodontitis stage II grade B did not significantly reduce the risk of adverse pregnancy outcomes.


Assuntos
Doenças Periodontais/terapia , Complicações na Gravidez/terapia , Resultado da Gravidez , Adolescente , Adulto , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Recém-Nascido , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Espanha , Resultado do Tratamento , Adulto Jovem
17.
PLoS Med ; 16(9): e1002913, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31550245

RESUMO

BACKGROUND: Policy consensus in high-income countries supports offering pregnant women with previous cesarean section a choice between planning an elective repeat cesarean section (ERCS) or attempting a vaginal birth, known as a planned vaginal birth after previous cesarean (VBAC), provided they do not have contraindications to planned VBAC. However, robust comprehensive information on the associated outcomes to counsel eligible women about this choice is lacking. This study investigated the short-term maternal and perinatal outcomes associated with planned mode of delivery after previous cesarean section among women delivering a term singleton and considered eligible to have a planned VBAC. METHODS AND FINDINGS: A population-based cohort of 74,043 term singleton births in Scotland between 2002 and 2015 to women with one or more previous cesarean sections was conducted using linked Scottish national datasets. Logistic or modified Poisson regression, as appropriate, was used to estimate the effect of planned mode of delivery on maternal and perinatal outcomes adjusted for sociodemographic, maternal medical, and obstetric-related characteristics. A total of 45,579 women gave birth by ERCS, and 28,464 had a planned VBAC, 28.4% of whom went on to have an in-labor nonelective repeat cesarean section. Compared to women delivering by ERCS, those who had a planned VBAC were significantly more likely to have uterine rupture (0.24%, n = 69 versus 0.04%, n = 17, adjusted odds ratio [aOR] 7.3, 95% confidence interval [CI] 3.9-13.9, p < 0.001), a blood transfusion (1.14%, n = 324 versus 0.50%, n = 226, aOR 2.3, 95% CI 1.9-2.8, p < 0.001), puerperal sepsis (0.27%, n = 76 versus 0.17%, n = 78, aOR 1.8, 95% CI 1.3-2.7, p = 0.002), and surgical injury (0.17% versus 0.09%, n = 40, aOR 3.0, 95% CI 1.8-4.8, p < 0.001) and experience adverse perinatal outcomes including perinatal death, admission to a neonatal unit, resuscitation requiring drugs and/or intubation, and an Apgar score < 7 at 5 minutes (7.99%, n = 2,049 versus 6.37%, n = 2,570, aOR 1.6, 95% CI 1.5-1.7, p < 0.001). However, women who had a planned VBAC were more likely than those delivering by ERCS to breastfeed at birth or hospital discharge (63.6%, n = 14,906 versus 54.5%, n = 21,403, adjusted risk ratio [aRR] 1.2, 95% CI 1.1-1.2, p < 0.001) and were more likely to breastfeed at 6-8 weeks postpartum (43.6%, n = 10,496 versus 34.5%, n = 13,556, aRR 1.2, 95% CI 1.2-1.3, p < 0.001). The effect of planned mode of delivery on the mother's risk of having a postnatal stay greater than 5 days, an overnight readmission to hospital within 42 days of birth, and other puerperal infection varied according to whether she had any prior vaginal deliveries and, in the case of length of postnatal stay, also varied according to the number of prior cesarean sections. The study is mainly limited by the potential for residual confounding and misclassification bias. CONCLUSIONS: Among women considered eligible to have a planned VBAC, planned VBAC compared to ERCS is associated with an increased risk of the mother having serious birth-related maternal and perinatal complications. Conversely, planned VBAC is associated with an increased likelihood of breastfeeding, whereas the effect on other maternal outcomes differs according to whether a woman has any prior vaginal deliveries and the number of prior cesarean sections she has had. However, the absolute risk of adverse outcomes is small for either delivery approach. This information can be used to counsel and manage the increasing number of women with previous cesarean section, but more research is needed on longer-term outcomes.


Assuntos
Recesariana/efeitos adversos , Parto , Complicações na Gravidez/epidemiologia , Nascimento Vaginal Após Cesárea/efeitos adversos , Adulto , Aleitamento Materno , Recesariana/mortalidade , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Registro Médico Coordenado , Alta do Paciente , Readmissão do Paciente , Morte Perinatal , Mortalidade Perinatal , Gravidez , Complicações na Gravidez/mortalidade , Complicações na Gravidez/terapia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Escócia/epidemiologia , Fatores de Tempo , Nascimento Vaginal Após Cesárea/mortalidade
18.
MMWR Morb Mortal Wkly Rep ; 68(36): 777-783, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31513558

RESUMO

Since 1999, the rate of opioid use disorder (OUD) has more than quadrupled, from 1.5 per 1,000 delivery hospitalizations to 6.5 (1), with similar increases in incidence of neonatal abstinence syndrome (NAS) observed for infants (from 2.8 per 1,000 live births to 14.4) among Medicaid-insured deliveries (2). CDC's response to the opioid crisis involves strategies to prevent opioid overdoses and related harms by building state capacity and supporting providers, health systems, and payers.* Recognizing systems gaps in provision of perinatal care and services, CDC partnered with the Association of State and Territorial Health Officials (ASTHO) to launch the Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative Learning Community (OMNI LC). OMNI LC supports systems change and capacity building in 12 states.† Qualitative data from participating states were analyzed to identify strategies, barriers, and facilitators for capacity building in state-defined focus areas. Most states focused on strategies to expand access to and coordination of quality services (10 of 12) or increase provider awareness and training (nine of 12). Fewer states focused on data, monitoring, and evaluation (four of 12); financing and coverage (three of 12); or ethical, legal, and social considerations (two of 12). By building capacity to strengthen health systems, state-identified strategies across all focus areas might improve the health trajectory of mothers, infants, and families affected by the U.S. opioid crisis.


Assuntos
Síndrome de Abstinência Neonatal/terapia , Transtornos Relacionados ao Uso de Opioides/terapia , Complicações na Gravidez/terapia , Efeitos Tardios da Exposição Pré-Natal/terapia , Feminino , Humanos , Lactente , Recém-Nascido , Síndrome de Abstinência Neonatal/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Período Pós-Parto , Gravidez , Complicações na Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Estados Unidos/epidemiologia
19.
Matern Child Health J ; 23(12): 1604-1612, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31541375

RESUMO

INTRODUCTION: Nearly half of all women gain above gestational weight gain (GWG) recommendations. This study assessed the feasibility and efficacy of a pilot behavioral intervention on GWG and physical activity behaviors. METHODS: Women (n = 45) 14-20 weeks gestation enrolled in a behavioral intervention. Physicians 'prescribed' the intervention to low risk patients. The intervention included self-monitoring, support, and optional walking groups. Process evaluation measures regarding usage and acceptability of study components were obtained. Physical activity was objectively measured at baseline and 35 weeks. The percentage of participants with appropriate GWG was calculated. Control data was obtained from the same clinic where participants were recruited. RESULTS: Overall, the intervention was acceptable to participants; attrition was low (6.7%), weekly contact was high (87%), and self-monitoring was high (Fitbit worn on 82% of intervention weeks; weekly weighing on 81%). Facebook (40% of weeks) and study website use (19%) was low, as was walking group attendance (7% attended a single group). Participants reported a lack of discussions about the study with their physician. Results showed no significant difference between intervention and control participants in the percentage who gained excess weight (p = 0.37). There was a significant decrease in moderate-to-vigorous physical activity in intervention participants (p < 0.0001). DISCUSSION: Continued efforts for promoting physical activity and appropriate GWG are needed. Although acceptable, the intervention was not efficacious. Trainings for, or input from prenatal healthcare providers on how to best encourage and support patients' engagement in healthy behaviors, such as PA, are warranted.


Assuntos
Terapia Comportamental/métodos , Exercício , Ganho de Peso na Gestação , Comportamentos Relacionados com a Saúde , Obesidade/prevenção & controle , Adolescente , Adulto , Índice de Massa Corporal , Estudos de Viabilidade , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Obesidade/terapia , Projetos Piloto , Gravidez , Complicações na Gravidez/prevenção & controle , Complicações na Gravidez/terapia , Cuidado Pré-Natal/métodos , Saúde Pública , Fatores de Risco , Ganho de Peso , Adulto Jovem
20.
JNMA J Nepal Med Assoc ; 57(216): 133-145, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31477950

RESUMO

Anti-phospholipid Antibody Syndrome or Hugh's syndrome is a heterogeneous disorder, first fully described in 1980s. The syndrome is caused by the presence of specific antibodies against phospholipid binding plasma proteins in the serum of the patient, with or without underlying autoimmune diseases, that causes prolongation of tests of coagulation. High index of clinical suspicion is required for diagnosis of Anti-phospholipid Antibody Syndrome. Stroke or myocardial infarction in young, unprovoked recurrent deep vein thrombosis and recurrent pregnancy loss are typical scenarios where Anti-Phospholipid Antibody Syndrome should be suspected. Presence of non-criteria manifestations like livedo reticularis, skin ulcers, nephropathy, valvular heart disease and thrombocytopenia adds to diagnostic clue for presence of Anti-Phospholipid Antibody Syndrome. Treatment of Anti-Phospholipid Antibody Syndrome has preventive and therapeutic aspects that usually focus on thrombotic and obstetric manifestations of the disease. Therapeutic anti-coagulation with heparin followed by warfarin is required for patients presenting with acute thrombosis. Those with venous thrombosis are given moderate intensity warfarin International Normalized Ratio, 2-3), whereas those with arterial thrombosis or recurrent venous thrombosis even on warfarin are treated with high intensity warfarin (International Normalized Ratio, 3-4). Similarly, anticoagulation with heparin is advised in patients with obstetric Anti-Phospholipid Antibody Syndrome throughout pregnancy and up to six weeks postpartum. Treatment recommendations are still not clear for asymptomatic Anti-Phospholipid Antibody Syndrome positive patients and in those with non-criteria manifestations of the disease. Steroids, intravenous immunoglobulin and immunosuppressant are reported to be effective in severe cases of catastrophic antiphospholid syndrome characterized by rapid small vessel thrombotic involvement of multiple organ systems. Studies are evaluating the efficacy of direct thrombin inhibitors in the management of refractory cases. Keywords: anticoagulants; anti-phospholipid syndrome; obstetric APS; thrombotic APS.


Assuntos
Síndrome Antifosfolipídica/terapia , Trombose/etiologia , Anticorpos Antifosfolipídeos/imunologia , Anticoagulantes/administração & dosagem , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/fisiopatologia , Feminino , Humanos , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/fisiopatologia , Complicações na Gravidez/terapia , Trombose/tratamento farmacológico
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