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1.
J Crohns Colitis ; 14(Supplement_3): S807-S814, 2020 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-33085970

RESUMO

The rapid emergence of the novel coronavirus [SARS-CoV2] and the coronavirus disease 2019 [COVID-19] has caused significant global morbidity and mortality. This is particularly concerning for vulnerable groups such as pregnant women with inflammatory bowel disease [IBD]. Care for pregnant IBD patients in itself is a complex issue because of the delicate balance between controlling maternal IBD as well as promoting the health of the unborn child. This often requires continued immunosuppressive maintenance medication or the introduction of new IBD medication during pregnancy. The current global COVID-19 pandemic creates an additional challenge in the management of pregnant IBD patients. In this paper we aimed to answer relevant questions that can be encountered in daily clinical practice when caring for pregnant women with IBD during the current COVID-19 pandemic. PODCAST: This article has an associated podcast which can be accessed at https://academic.oup.com/ecco-jcc/pages/podcast.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Doenças Inflamatórias Intestinais/terapia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Complicações na Gravidez/terapia , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Progressão da Doença , Feminino , Humanos , Imunossupressores/uso terapêutico , Doenças Inflamatórias Intestinais/complicações , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Gravidez , Medição de Risco , Índice de Gravidade de Doença
2.
Ideggyogy Sz ; 73(9-10): 339-344, 2020 Sep 30.
Artigo em Húngaro | MEDLINE | ID: mdl-33035415

RESUMO

Pompe disease is a rare lysosomal storage disease inherited in a recessive manner resulting muscular dystrophy. Due to the lack of the enzyme alpha glucosidase, glycogen accumulates in the cells. In the infantile form of Pompe disease hypotonia and severe cardio-respiratory failure are common leading to death within 2 years if left untreated, while the late-onset form is characterized with limb-girdle and axial muscle weakness accompanied with respiratory dysfunction. Pompe disease has been treated with regular intake of the missing enzyme since 2006, which significantly improved the survival and severity of symptoms in patients of both subtypes. The enzyme replacement therapy (ERT) is safe and well tolerated. However, limited data are available on its use in pregnancy. Our goal is to share our experience and review the literature on the safety of enzyme replacement therapy for Pompe disease during pregnancy and post partum.


Assuntos
Terapia de Reposição de Enzimas/efeitos adversos , Doença de Depósito de Glicogênio Tipo II/terapia , Complicações na Gravidez/terapia , alfa-Glucosidases/uso terapêutico , Feminino , Doença de Depósito de Glicogênio Tipo II/diagnóstico , Humanos , Debilidade Muscular/etiologia , Período Pós-Parto , Gravidez , Resultado da Gravidez , Resultado do Tratamento
3.
Pediatrics ; 146(Suppl 2): S218-S222, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33004643

RESUMO

Data from the past decade have revealed that neonatal mortality represents a growing burden of the under-5 mortality rate. To further reduce these deaths, the focus must expand to include building capacity of the workforce to provide high-quality obstetric and intrapartum care. Obstetric complications, such as hypertensive disorders and obstructed labor, are significant contributors to neonatal morbidity and mortality. A well-prepared workforce with the necessary knowledge, skills, attitudes, and motivation is required to rapidly detect and manage these complications to save both maternal and newborn lives. Traditional off-site, didactic, and lengthy training approaches have not always yielded the desired results. Helping Mothers Survive training was modeled after Helping Babies Breathe and incorporates further evidence-based methodology to deliver training on-site to the entire team of providers, who continue to practice after training with their peers. Research has revealed that significant gains in health outcomes can be reached by using this approach. In the coronavirus disease 2019 era, we must look to translate the best practices of these training programs into a flexible and sustainable model that can be delivered remotely to maintain quality services to women and their newborns.


Assuntos
Pessoal de Saúde/educação , Capacitação em Serviço/organização & administração , Assistência Perinatal/organização & administração , Fortalecimento Institucional , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Serviços de Saúde Materno-Infantil/organização & administração , Assistência Perinatal/normas , Gravidez , Complicações na Gravidez/prevenção & controle , Complicações na Gravidez/terapia
5.
Emerg Med Clin North Am ; 38(4): 903-917, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981625

RESUMO

Care of the critically ill pregnant patient is anxiety-provoking for those unprepared, as the emergency physician must consider not only the welfare of the immediate patient, but of the fetus as well. Familiarity with the physiologic changes of pregnancy and how they affect clinical presentation and management is key. Although some medications may be safer in pregnancy than others, stabilizing the pregnant patient is paramount. Emergency physicians should target pregnancy-specific oxygen and ventilation goals and hemodynamics and should be prepared to perform a perimortem cesarean section, should the mother lose pulses, to increase chances for maternal and fetal survival.


Assuntos
Complicações na Gravidez/terapia , Ressuscitação/métodos , Manuseio das Vias Aéreas , Gasometria , Cesárea , Contraindicações de Medicamentos , Estado Terminal , Serviço Hospitalar de Emergência , Feminino , Monitorização Fetal , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Humanos , Hipnóticos e Sedativos/administração & dosagem , Intubação Intratraqueal , Troca Materno-Fetal , Ventilação não Invasiva , Circulação Placentária , Gravidez/fisiologia , Complicações na Gravidez/diagnóstico , Insuficiência Respiratória/terapia , Choque/terapia
6.
J Clin Endocrinol Metab ; 105(12)2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-32929476

RESUMO

CONTEXT: Invited update on the management of systemic autoimmune Graves disease (GD) and associated Graves orbitopathy (GO). EVIDENCE ACQUISITION: Guidelines, pertinent original articles, systemic reviews, and meta-analyses. EVIDENCE SYNTHESIS: Thyrotropin receptor antibodies (TSH-R-Abs), foremost the stimulatory TSH-R-Abs, are a specific biomarker for GD. Their measurement assists in the differential diagnosis of hyperthyroidism and offers accurate and rapid diagnosis of GD. Thyroid ultrasound is a sensitive imaging tool for GD. Worldwide, thionamides are the favored treatment (12-18 months) of newly diagnosed GD, with methimazole (MMI) as the preferred drug. Patients with persistently high TSH-R-Abs and/or persistent hyperthyroidism at 18 months, or with a relapse after completing a course of MMI, can opt for a definitive therapy with radioactive iodine (RAI) or total thyroidectomy (TX). Continued long-term, low-dose MMI administration is a valuable and safe alternative. Patient choice, both at initial presentation of GD and at recurrence, should be emphasized. Propylthiouracil is preferred to MMI during the first trimester of pregnancy. TX is best performed by a high-volume thyroid surgeon. RAI should be avoided in GD patients with active GO, especially in smokers. Recently, a promising therapy with an anti-insulin-like growth factor-1 monoclonal antibody for patients with active/severe GO was approved by the Food and Drug Administration. COVID-19 infection is a risk factor for poorly controlled hyperthyroidism, which contributes to the infection-related mortality risk. If GO is not severe, systemic steroid treatment should be postponed during COVID-19 while local treatment and preventive measures are offered. CONCLUSIONS: A clear trend towards serological diagnosis and medical treatment of GD has emerged.


Assuntos
Gerenciamento Clínico , Doença de Graves/diagnóstico , Oftalmopatia de Graves/diagnóstico , Hipertireoidismo/diagnóstico , Imunoglobulinas Glândula Tireoide-Estimulantes/sangue , Antitireóideos/uso terapêutico , Biomarcadores/sangue , Diagnóstico Diferencial , Feminino , Doença de Graves/complicações , Doença de Graves/terapia , Oftalmopatia de Graves/etiologia , Oftalmopatia de Graves/terapia , Humanos , Hipertireoidismo/complicações , Hipertireoidismo/terapia , Imunoglobulinas Glândula Tireoide-Estimulantes/imunologia , Radioisótopos do Iodo/uso terapêutico , Masculino , Metimazol/uso terapêutico , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/terapia , Receptores da Tireotropina/imunologia , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/imunologia , Tireoidectomia/métodos , Ultrassonografia
8.
Adv Exp Med Biol ; 1252: 101-105, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816268

RESUMO

During pregnancy and lactation, breast vascularity increases and edema occurs in the breast . As a consequence, rate of complications of breast biopsy and surgery like bleeding, infection, delayed healing and wound dehiscence is expected to be higher. Milk fistula is a rare event that may complicate surgery or needle biopsy of the breast in a breastfeeding woman, or in late stages of pregnancy . Suppression of lactation has been proposed in the literature as both a preventive and a therapeutic step. However, the advantages of nursing for both mother and child are numerous, and the author do not propose it as a preventive measure nor as a must in treatment of milk fistula. Prevention and management of milk fistula are discussed in this chapter.


Assuntos
Mama/cirurgia , Lactação , Complicações na Gravidez , Biópsia por Agulha , Aleitamento Materno , Neoplasias da Mama/cirurgia , Feminino , Fístula/etiologia , Fístula/prevenção & controle , Fístula/terapia , Humanos , Lactente , Leite Humano , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/prevenção & controle , Complicações na Gravidez/terapia
10.
Pediatrics ; 146(Suppl 1): S86-S92, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737239

RESUMO

Criminalization of perinatal substance use disorder and other coercive interventions in pregnancy (such as forced cesarean delivery or involuntary hospitalization for bed rest) directly affect the well-being of children and their families and, potentially, of all women of reproductive capacity. Untenable legal and policy approaches that occasion such incursions not only persist but affect a growing number of women. They are antithetical to healthy pregnancies, healthy children, and healthy families; they have the potential to reduce prenatal care seeking, divert attention and resources away from critical mental health and maternal and child support services, and epigenetically affect maternal and infant bonding. Punitive and coercive interventions contravene long-established guidance by professional associations that advocate for public health approaches and ethical frameworks to guide practice. Harmful policies persist because of motivated reasoning by clinicians, members of the judiciary, and ill-informed legislators who rely on personal experience and anecdote rather than evidence to fashion policy. Compounding the problem are inadequate substance use treatment resources and professional associations that choose not to hold their members accountable for violating their ethical obligations to their patients. Pediatricians must advocate for the cessation of coercive interventions within their institutions and their larger communities. All health care professionals should collaborate at the local, state, and national level to provide policymakers and legislators with data emphasizing the negative effects of punitive and coercive policies aimed at pregnant women and their children.


Assuntos
Bem-Estar da Criança , Coerção , Saúde da Família , Tratamento Involuntário/legislação & jurisprudência , Complicações na Gravidez/terapia , Transtornos Relacionados ao Uso de Substâncias/terapia , Grupo com Ancestrais do Continente Africano , Criança , Maus-Tratos Infantis/legislação & jurisprudência , Feminino , Humanos , Recém-Nascido , Guias de Prática Clínica como Assunto , Gravidez , Complicações na Gravidez/etnologia , Gestantes/etnologia , Cuidado Pré-Natal , Classe Social , Sociedades Médicas , South Carolina , Transtornos Relacionados ao Uso de Substâncias/etnologia , Estados Unidos
12.
Arch Gynecol Obstet ; 302(3): 545-551, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32696241

RESUMO

OBJECTIVE: To investigate the maternal and infant outcomes of full-term pregnant patients in Wuhan, China, who were infected with 2019 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that is responsible for coronavirus disease 2019 (COVID-2019). DESIGN: Retrospective case series. SETTING: The Central Hospitals of Wuhan, Tongji Medical College, Huazhong University of Science and Technology in Wuhan, China. PARTICIPANTS: Twenty one full-term pregnant patients who were admitted to the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, confirmed SARS-CoV-2 infection and COVID-2019 with laboratorial and clinical methods, were reviewed by our medical team, and the data were collected from January 20, 2020 to February 29, 2020. MAIN CLINICAL DATA COLLECTION: Clinical data had been collecting using a standard case report form, such as epidemiological history, clinical manifestations, auxiliary examination of major laboratory and clinic, etc. All the information was collected and confirmed by our medical team. RESULTS: Twenty one full-term pregnant patients were reviewed (median age 29 years), and no patients were admitted to intensive care unit (ICU), and died during the treating progress. According to our review, all the cases were infected by human to human transmission, and the most common symptoms at onset of illness were cough in 17 (80.95%), fatigue in 10 (47.62%), fever in 7 (33.33%), expectoration in 1 (4.76%), and only one patient (4.76%) developed shortness of breath on admission. The median time from exposure to onset of illness was 10 days (interquartile range 7 -2 days), and from onset of symptoms to first hospital admission was 1 day (interquartile range 1-2 days). CONCLUSIONS: As of February 29, 2020, all the patients who were full-term pregnancy combined with COVID-2019 were cured and delivered successfully, and all the newborns were not infected with SARS-CoV-2, and there were no evidence of mother-to-child transmission.


Assuntos
Infecções por Coronavirus/diagnóstico , Coronavirus/isolamento & purificação , Hospitalização/estatística & dados numéricos , Pandemias , Pneumonia Viral/diagnóstico , Complicações na Gravidez/virologia , Adulto , Betacoronavirus , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Tosse/etiologia , Dispneia/etiologia , Fadiga/etiologia , Feminino , Febre/etiologia , Humanos , Recém-Nascido , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Gravidez , Complicações na Gravidez/terapia , Resultado da Gravidez , Estudos Retrospectivos
14.
Cochrane Database Syst Rev ; 7: CD000493, 2020 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-32716060

RESUMO

BACKGROUND: Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder that can develop in pregnancy. It occurs when there is a build-up of bile acids in the maternal blood. It has been linked to adverse maternal and fetal/neonatal outcomes. As the pathophysiology is poorly understood, therapies have been largely empiric. As ICP is an uncommon condition (incidence less than 2% a year), many trials have been small. Synthesis, including recent larger trials, will provide more evidence to guide clinical practice. This review is an update of a review first published in 2001 and last updated in 2013. OBJECTIVES: To assess the effects of pharmacological interventions to treat women with intrahepatic cholestasis of pregnancy, on maternal, fetal and neonatal outcomes. SEARCH METHODS: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (13 December 2019), and reference lists of retrieved studies. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials, including cluster-randomised trials and trials published in abstract form only, that compared any drug with placebo or no treatment, or two drug intervention strategies, for women with a clinical diagnosis of intrahepatic cholestasis of pregnancy. DATA COLLECTION AND ANALYSIS: The review authors independently assessed trials for eligibility and risks of bias. We independently extracted data and checked these for accuracy. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included 26 trials involving 2007 women. They were mostly at unclear to high risk of bias. They assessed nine different pharmacological interventions, resulting in 14 different comparisons. We judged two placebo-controlled trials of ursodeoxycholic acid (UDCA) in 715 women to be at low risk of bias. The ten different pharmacological interventions were: agents believed to detoxify bile acids (UCDA) and S-adenosylmethionine (SAMe); agents used to bind bile acids in the intestine (activated charcoal, guar gum, cholestyramine); Chinese herbal medicines (yinchenghao decoction (YCHD), salvia, Yiganling and Danxioling pill (DXLP)), and agents aimed to reduce bile acid production (dexamethasone) Compared with placebo, UDCA probably results in a small improvement in pruritus score measured on a 100 mm visual analogue scale (VAS) (mean difference (MD) -7.64 points, 95% confidence interval (CI) -9.69 to -5.60 points; 2 trials, 715 women; GRADE moderate certainty), where a score of zero indicates no itch and a score of 100 indicates severe itching. The evidence for fetal distress and stillbirth were uncertain, due to serious limitations in study design and imprecision (risk ratio (RR) 0.70, 95% CI 0.35 to 1.40; 6 trials, 944 women; RR 0.33, 95% CI 0.08 to 1.37; 6 trials, 955 women; GRADE very low certainty). We found very few differences for the other comparisons included in this review. There is insufficient evidence to indicate if SAMe, guar gum, activated charcoal, dexamethasone, cholestyramine, Salvia, Yinchenghao decoction, Danxioling and Yiganling, or Yiganling alone or in combination are effective in treating women with intrahepatic cholestasis of pregnancy. AUTHORS' CONCLUSIONS: When compared with placebo, UDCA administered to women with ICP probably shows a reduction in pruritus. However the size of the effect is small and for most pregnant women and clinicians, the reduction may fall below the minimum clinically worthwhile effect. The evidence was unclear for other adverse fetal outcomes, due to very low-certainty evidence. There is insufficient evidence to indicate that SAMe, guar gum, activated charcoal, dexamethasone, cholestyramine, YCHD, DXLP, Salvia, Yiganling alone or in combination are effective in treating women with cholestasis of pregnancy. There are no trials of the efficacy of topical emollients. Further high-quality trials of other interventions are needed in order to identify effective treatments for maternal itching and preventing adverse perinatal outcomes. It would also be helpful to identify those women who are mostly likely to respond to UDCA (for example, whether bile acid concentrations affect how women with ICP respond to treatment with UDCA).


Assuntos
Colestase/terapia , Complicações na Gravidez/terapia , Prurido/terapia , Carvão Vegetal/uso terapêutico , Colagogos e Coleréticos/uso terapêutico , Colestase/complicações , Resina de Colestiramina/uso terapêutico , Dexametasona/uso terapêutico , Medicamentos de Ervas Chinesas/uso terapêutico , Feminino , Sofrimento Fetal/epidemiologia , Galactanos/uso terapêutico , Glucocorticoides/uso terapêutico , Humanos , Mananas/uso terapêutico , Gomas Vegetais/uso terapêutico , Gravidez , Prurido/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , S-Adenosilmetionina/uso terapêutico , Natimorto/epidemiologia , Ácido Ursodesoxicólico/uso terapêutico
15.
J Clin Nurs ; 29(17-18): 3170-3182, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32563204

RESUMO

AIMS AND OBJECTIVES: To systematically review the efficacy of cognitive behavioural therapy for improving mood in perinatal depression. BACKGROUND: The impact of cognitive behavioural therapy on perinatal depression has been evaluated in various studies, but there is uncertainty about their impact. DESIGN: Systematic review and meta-analysis. METHODS: Nine electronic literature databases were searched to retrieve eligible randomised controlled trials: CNKI, VIP digital database, Chinese Wanfang database, the Cochrane library, PubMed, Web of science, EMBASE, PsycINFO, CINAHL from the inception of the databases up to 15 November 2019. The eligible studies were screened and extracted, and then, the methodological quality was evaluated independently by two researchers. The meta-analyst software (Rev Man 5.3) was used to conduct the meta-analysis. Checklist of Preferred Reporting Items for Systematic Reviews and Meta-analyses has been followed. RESULTS: Thirteen RCTs with 966 participants were included. The results showed that the CBT group was superior to the usual care group in reducing depression symptoms of pregnant women after treatment immediately, and the difference was statistically significant. Similarly, at postpartum (<4 months), the results showed that the CBT group was superior to the usual care group in improving depression symptoms of pregnant women. However, there was no statistical difference at postpartum (>4 months). CONCLUSIONS: Cognitive behavioural therapy can effectively relieve the symptoms of depression at short-term effect. However, its long-term effect need to be verified by further clinical studies. RELEVANCE TO CLINICAL PRACTICE: This meta-analysis suggested that cognitive behavioural therapy should be considered as a complementary programme for patients with perinatal depression. Medical workers could apply cognitive behavioural therapy into daily routine cares for perinatal depression.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Depressão/terapia , Complicações na Gravidez/terapia , Estudos de Casos e Controles , Depressão/psicologia , Feminino , Humanos , Gravidez , Complicações na Gravidez/psicologia
16.
J Dairy Sci ; 103(8): 6798-6809, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32505413

RESUMO

The brown seaweed Ascophyllum nodosum is known to bioaccumulate iodine (I). Previous research showed a linear relationship between A. nodosum meal (ASCO) intake and milk I concentration in dairy cows. Thus, improving milk I concentration by supplementation of ASCO to dairy cows may be a compelling strategy to naturally boost I intake in humans. A sensitivity analysis was conducted to gain insights regarding how different milk I intakes affect the I status of pregnant women relative to the United States Institute of Medicine (US IOM) recommended dietary allowance (RDA; 220 µg/d) and the World Health Organization (WHO) recommended nutrient intake (RNI; 250 µg/d) for I. Four studies in which dairy cows received various amounts of ASCO generated the milk I data set used in the sensitivity analysis. The annual per capita consumption of 2% reduced-fat milk in the United States, converted to daily intake (i.e., 0.26 cup; 1 cup = 236.6 mL), was used as the actual milk intake in the simulations. Five additional milk intake scenarios (2, 3, 4, and 5 times the actual per capita milk consumption and the 3 cups-equivalent recommended by the 2015-2020 Dietary Guidelines for American were also included in the sensitivity analysis with varying milk I concentrations (180, 765, and 483 µg/L). The 180, 765, and 483 µg/L values are milk I concentrations derived from cows not receiving ASCO or fed various amounts of ASCO in the diet or a single level (113 g/d) during the grazing season, respectively. With the actual United States milk per capita consumption of 0.26 cup/d and milk I concentrations of 180, 765, and 483 µg/L, 5.09, 21.7, and 13.6% of the RDA for I for pregnant women were met based on the US IOM, respectively. Similarly, 4.48, 19, and 12% of the RNI for I advised by the WHO was achieved with intake of 0.26 cup/d of milk containing I concentrations of 180, 765, and 483 µg/L, respectively. When 3 cups/d was included in the simulations, 58.2, 247, and 156% (US IOM), and 51.2, 217, and 137% (WHO) of the RDA or RNI for I required by gestating women was satisfied with milk I concentrations of 180, 765, and 483 µg/L, respectively. A regression analysis between I intake and milk I concentration revealed that 103 g/d of ASCO in the diet of dairy cows reached the maximum 500 µg/L threshold of I in milk recommended by the European Food Society Authority. Overall, milk from dairy cows fed ASCO can prevent I deficiency in pregnant women, but the amount of ASCO fed to cows needs to be fine-tuned to avoid excess I in milk. Further research is required to better understand the interactions between goitrogenic compounds from forages and concentrates and milk I concentration in cows fed ASCO. Research to evaluate the concentration of I in retail organic milk should be also conducted because of the high prevalence of ASCO fed in organic dairies in the United States.


Assuntos
Ração Animal , Ascophyllum , Suplementos Nutricionais , Iodo/deficiência , Iodo/metabolismo , Leite/química , Complicações na Gravidez/terapia , Ração Animal/análise , Animais , Bovinos , Suplementos Nutricionais/análise , Feminino , Humanos , Lactação , Estado Nutricional , Gravidez , Estados Unidos
17.
Transl Res ; 225: 20-32, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32554071

RESUMO

Pregnancy associated venous thromboembolism (PA-VTE) is a leading cause of maternal morbidity and mortality worldwide. Despite the availability of international guidance on the prevention, diagnosis and treatment, practice differs between countries and clinical institutions. The evidence base in this area is limited due to the vulnerable population who are affected, with the majority of guidelines deriving their recommendations from experience in surgical and medical venous thromboembolic disease. This review includes best evidence in PA-VTE management, highlighting specific literature which supports current diagnosis, prevention, and treatment strategies. Additionally, we hope to demonstrate emerging trends in the field through discussion of ongoing trials designed to progress towards evidence-based practice in the context of PA-VTE.


Assuntos
Complicações na Gravidez/diagnóstico , Complicações na Gravidez/terapia , Tromboembolia Venosa/complicações , Feminino , Humanos , Gravidez , Complicações na Gravidez/prevenção & controle , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/prevenção & controle , Tromboembolia Venosa/terapia
19.
Complement Ther Med ; 50: 102409, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32444058

RESUMO

BACKGROUND AND PURPOSE: Restless legs syndrome (RLS) is a common sensory-motor disorder among the pregnant women. The aim of this study is to compare the impacts of two methods of immersion of legs in cold and warm water on the RLS symptoms among the pregnant women. METHODS: This randomized clinical trial was conducted on 80 pregnant women with RLS who referred to Taleghani educational-therapy center. After obtaining their informed consent, they were selected by accessible method and randomly allocated into group 1 (warm water) and group 2 (cold water). Group 1 were asked to put their legs in cold water for 10 min every night for 2 weeks. The group 2 put their legs in warm water under the same condition. The severity of RLS was measured before and after the study. Data analysis was conducted using descriptive as well as the analytical statistics such as Chi-square, independent T test, pair T test, Mann-Whitney U, Wilcoxon and covariance. RESULTS: After intervention, mean RLS of the cold water group was11.02 ± 4.93; while this mean was 13.50 ± 4.74 in the warm water group. The difference between the two groups was significant (p = 0.017). Results also revealed that the severity of RLS symptoms at the end of the treatment was different from the beginning of the research in both groups (p = 0.001). The intervention with both warm and cold water declined the RLS symptoms among pregnant women. CONCLUSION: The warm and cold water can be used for this purpose depending on the women's preference. However, this article recommends the cold water for more reducing of symptoms.


Assuntos
Crioterapia/métodos , Hipertermia Induzida/métodos , Complicações na Gravidez/terapia , Síndrome das Pernas Inquietas/terapia , Adulto , Terapia Combinada , Feminino , Humanos , Gravidez , Inquéritos e Questionários
20.
Rev Med Suisse ; 16(695): 1106-1113, 2020 May 27.
Artigo em Francês | MEDLINE | ID: mdl-32462840

RESUMO

Breast cancer is the most frequently diagnosed neoplasm and principal one responsible for most death in women, specially under the age of 40. Hereditary and genetic syndromes are more prevalent among young breast cancer patients and require genetic counseling. Young women also exhibit larger tumors, with more frequent nodal involvement and aggressive features (triple negative, high grade and proliferation rate) than menopausal women. Fertility preservation and pregnancy-associated cancer are issues specific to this age group and need to be addressed accordingly.


Assuntos
Neoplasias da Mama/terapia , Preservação da Fertilidade/métodos , Neoplasias da Mama/genética , Feminino , Aconselhamento Genético , Humanos , Gravidez , Complicações na Gravidez/genética , Complicações na Gravidez/terapia
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