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1.
Medicine (Baltimore) ; 98(50): e18229, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852083

RESUMO

BACKGROUND: The relationships between chorioamnionitis (CA) and neurodevelopmental outcomes in preterm infants remain controversial. The meta-analysis aims to evaluate the associations between CA and neurodevelopmental deficits in preterm infants. METHODS: All studies exploring the associations between CA and neurodevelopmental deficits in preterm infants were retrieved from the following databases: PubMed, Embase, OVID, EBSCO, ProQuest, CDSR, and CENTRAL. The NOS was used to evaluate the quality of the studies, RevMan was adopted to analyze the data. RESULTS: Twelve studies involving 4267 preterm infants were included. The ORs across studies was 0.95 (P = .77, I = 51%) for cognitive deficits, 1.09 (P = .44, I = 10%) for psychomotor deficits, 1.21 (P = .08, I = 25%) for language deficits, 2.34 (P = .02, I = 0%) for performance intelligence quotient impairment and 2.81 (P = .03, I = 0%) for verbal intelligence quotient impairment. Subgroup analyses based on the severity of cognitive deficits indicated that CA might be correlated with severe cognitive deficits (P = .01, I = 0%) but not with mild cognitive deficits (P = .40, I = 19%). In terms of the CA category, clinical CA may be related to overall psychomotor deficits (P = .01, I = 25%) and overall language deficits (P < .00001, I = 23%) other than histological CA. CONCLUSION: In preterm infants, CA might be a risk factor for performance and verbal intelligence quotient impairment and severe cognitive deficits, and clinical CA might be a risk factor for overall psychomotor and language deficits.


Assuntos
Corioamnionite/epidemiologia , Doenças do Prematuro/etiologia , Recém-Nascido Prematuro , Transtornos do Neurodesenvolvimento/etiologia , Feminino , Saúde Global , Humanos , Incidência , Recém-Nascido , Doenças do Prematuro/epidemiologia , Transtornos do Neurodesenvolvimento/epidemiologia , Gravidez , Fatores de Risco
2.
Medicine (Baltimore) ; 98(31): e16665, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374040

RESUMO

BACKGROUND: The aim of this study was to summarize current evidence evaluating the association between antenatal infection and intraventricular hemorrhage (IVH) in preterm infants. MATERIALS AND METHODS: We searched for published articles on antenatal infection and IVH in 3 English (PubMed, the Cochrane Library, and EBSCO) and 3 Chinese (VEIPU, CNKI, and WANFANG) databases on May 19, 2019. In addition, the references of these articles were screened. The included studies had to meet all of the following criteria: preterm infants (<37 weeks); comparing antenatal infection with no infection; the outcomes included IVH (all grades), mild IVH, or sereve IVH; the type of study was randomized controlled trial or cohort study. RESULTS: A total of 23 cohort studies involving 13,605 preterm infants met our inclusion criteria. Antenatal infection increased the risk of IVH (odds ratios ([OR] 2.18, 95% confidence intervals [CI] 1.58-2.99), mild IVH (OR 1.95, 95% CI 1.09-3.49) and severe IVH (OR 2.65, 95% CI 1.52-4.61). For type of antenatal infection, the ORs and 95% CI were as follows: 2.21 (1.60-3.05) for chorioamnionitis, 2.26 (1.55-3.28) for histologic chorioamnionitis, 1.88 (1.22-2.92) for clinical chorioamnionitis, and 1.88 (1.14-3.10) for ureaplasma. CONCLUSIONS: Antenatal infection may increase the risk of developing IVH in the preterm infant. The evidence base is however of low quality and well-designed studies are needed.


Assuntos
Hemorragia Cerebral Intraventricular/epidemiologia , Recém-Nascido Prematuro , Resultado da Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Peso ao Nascer , Corioamnionite/epidemiologia , Feminino , Idade Gestacional , Humanos , Gravidez , Índice de Gravidade de Doença
3.
BMC Pregnancy Childbirth ; 19(1): 317, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31464598

RESUMO

BACKGROUND: Cesarean section rates have been increasing dramatically during the past three decades and surgical site infections are becoming a leading cause of morbidity and mortality among women undergoing cesarean deliveries. However there is lack of sound evidence on both the magnitude of the problem and the associated factors in developing countries including Ethiopia. The purpose of this study was to assess proportion of surgical site infection and associated factors among women undergoing cesarean delivery in Debretabor General Hospital. METHODS: An institution based cross sectional study was conducted from May to December / 2017. All women delivered by cesarean section in Debretabor General Hospital during data collection period were our study population. Data were collected using Pre-tested, semi-structured questionnaire/ data extraction tool and post discharge phone follow up and analyzed using SPSS version 20. Logistic regression model was used to determine the association of independent variables with the outcome variable and odds ratios with 95% confidence interval were used to estimate the strength of the association. RESULTS: Proportion of surgical site infection among cesarean deliveries was about 8% (95%Cl: 5.4, 11.6). Pregnancy induced hypertension (AOR = 4.75, 95%CI: 1.62, 13.92), chorioaminitis (AOR = 4.37, 95%CI: 1.53, 12.50), midline skin incision (AOR = 5.19, 95% CI: 1.87, 14.37 and post-operative hemoglobin less than 11 g/deciliter (AOR = 5.28, 95%CI: 1.97, 14.18) were significantly associated with surgical site infection. CONCLUSIONS: Pregnancy induced hypertension, chorioaminitis, midline skin incision and post-operative hemoglobin of less than 11 g/deciliter were independent factors associated with surgical site infection. Cesarean deliveries with concomitant pregnancy induced hypertension, chorioaminitis and post-operative anemia needs special care and follow up until surgical site infection is ruled out. It is also advisable to reduce generous midline skin incision and better replaced with pfannensteil incision.


Assuntos
Anemia/epidemiologia , Cesárea/métodos , Corioamnionite/epidemiologia , Hipertensão Induzida pela Gravidez/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Hospitais Gerais , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Gravidez , Fatores de Risco , Adulto Jovem
4.
Emerg Infect Dis ; 25(8): 1614-1616, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31310211

RESUMO

We report a case of Sneathia amnii as the causative agent of maternal chorioamnionitis and congenital pneumonia resulting in a late fetal death in Mozambique, with strong supportive postmortem molecular and histopathologic confirmation. This rare, fastidious gram-negative coccobacillus has been reported to infrequently cause abortions, stillbirths, and neonatal infections.


Assuntos
Corioamnionite/diagnóstico , Corioamnionite/microbiologia , Infecções por Fusobacteriaceae/diagnóstico , Infecções por Fusobacteriaceae/microbiologia , Leptotrichia , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/microbiologia , Natimorto , Adulto , Autopsia , Corioamnionite/epidemiologia , Feminino , Infecções por Fusobacteriaceae/epidemiologia , Humanos , Imuno-Histoquímica , Pulmão/microbiologia , Pulmão/patologia , Moçambique/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia
5.
Am J Obstet Gynecol ; 221(2): 144.e1-144.e8, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30904320

RESUMO

BACKGROUND: Preterm premature rupture of membranes complicates 2-3% of pregnancies. Many institutions have advocated for the use of azithromycin instead of erythromycin. This is secondary to national shortages of erythromycin, ease of administration, better side effect profile, and decreased cost of azithromycin as compared with erythromycin. OBJECTIVE: The objective of the study was to evaluate whether there are differences in the latency from preterm premature rupture of membranes to delivery in patients treated with different dosing regimens of azithromycin vs erythromycin. STUDY DESIGN: This is a multicenter, retrospective cohort of women with singleton pregnancies with confirmed rupture of membranes between 230 and 336 weeks from January 2010 to June 2015. Patients were excluded if there was a contraindication to expectant management of preterm premature rupture of membranes. Patients received 1 of 4 antibiotic regimens: (1) azithromycin 1000 mg per os once (azithromycin 1 day group); (2) azithromycin 500 mg per os once, followed by azithromycin 250 mg per os daily for 4 days (azithromycin 5 day group); (3) azithromycin 500 mg intravenously for 2 days, followed by azithromycin 500 mg per os daily for 5 days (azithromycin 7 day group); or (4) erythromycin intravenously for 2 days followed by erythromycin per os for 5 days (erythromycin group). The choice of macrolide was based on institutional policy and/or availability of antibiotics at the time of admission. In addition, all patients received ampicillin intravenously for 2 days followed by amoxicillin per os for 5 days. Primary outcome was latency from diagnosis of rupture of membranes to delivery. Secondary outcomes included clinical and histopathological chorioamnionitis and neonatal outcomes. RESULTS: Four hundred fifty-three patients who met inclusion criteria were identified. Seventy-eight patients received azithromycin for 1 day, 191 patients received azithromycin for 5 days, 52 patients received azithromycin for 7 days, and 132 patients received erythromycin. Women who received the 5 day regimen were younger and less likely to be non-African American, have hypertension, have sexually transmitted infection, or experienced substance abuse. There was no statistical difference in median latency time of azithromycin 1 day (4.9 days, 95% confidence interval, 3.3-6.4), azithromycin 5 days (5.0, 95% confidence interval, 3.9-6.1), or azithromycin 7 days (4.9 days, 95% confidence interval, 2.8-7.0) when compared with erythromycin (5.1 days, 95% confidence interval, 3.9-6.4) after adjusting for demographic variables (P = .99). Clinical chorioamnionitis was not different between groups in the adjusted model. Respiratory distress syndrome was increased in the azithromycin 5 day group vs azithromycin 1 day vs erythromycin (44% vs. 29% and 29%, P = .005, respectively). CONCLUSION: There was no difference in latency to delivery, incidence of chorioamnionitis, or neonatal outcomes when comparing different dosing regimens of the azithromycin with erythromycin, with the exception of respiratory distress syndrome being more common in the 5 day azithromycin group. Azithromycin could be considered as an alternative to erythromycin in the expectant management of preterm premature rupture of membranes if erythromycin is unavailable or contraindicated. There appears to be no additional benefit to an extended course of azithromycin beyond the single-day dosing, but final recommendations on dosing strategies should rely on clinical trials.


Assuntos
Antibacterianos/administração & dosagem , Azitromicina/administração & dosagem , Eritromicina/administração & dosagem , Ruptura Prematura de Membranas Fetais/tratamento farmacológico , Adulto , Amoxicilina/administração & dosagem , Ampicilina/administração & dosagem , Corioamnionite/epidemiologia , Estudos de Coortes , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Tempo de Internação/estatística & dados numéricos , Gravidez , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Estudos Retrospectivos
6.
Am J Obstet Gynecol ; 220(4): 395.e1-395.e12, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30786256

RESUMO

BACKGROUND: Unexpected admissions of term neonates to the neonatal intensive care unit and unexpected postnatal complications have been proposed as neonatal-focused quality metrics for intrapartum care. Previous studies have noted significant variation in overall hospital neonatal intensive care unit admission rates; however, little is known about the influence of obstetric practices on these rates or whether variation among unanticipated admissions in low-risk, term neonates can be attributed to systemic hospital practices. OBJECTIVE: The objective of the study was to examine the relative effects of patient characteristics and intrapartum events on unexpected neonatal intensive care unit admissions and to quantify the between-hospital variation in neonatal intensive care unit admission rates among this group of neonates. STUDY DESIGN: We performed a retrospective cross-sectional study using data collected as part of the Consortium for Safe Labor study. Women who delivered term (≥37 weeks), singleton, nonanomalous, liveborn infants without an a priori risk for neonatal intensive care unit admission were included. The primary outcome was neonatal intensive care unit admission among this population. Multilevel mixed-effect models were used to calculate adjusted odds ratios for demographics (age, race, insurer), pregnancy characteristics (parity, gestational age, tobacco use, birthweight), maternal comorbidities (chronic and pregnancy-induced hypertension), hospital characteristics (delivery volume, hospital and neonatal intensive care unit level, academic affiliation), and intrapartum events (prolonged second stage, induction of labor, trial of labor after cesarean delivery, chorioamnionitis, meconium-stained amniotic fluid, and abruption). Intraclass correlation coefficients were used to estimate the between-hospital variance in a series of hierarchical models. RESULTS: Of the 143,951 infants meeting all patient and hospital inclusion criteria, 7995 (5.6%) were admitted to the neonatal intensive care unit after birth. In the fully adjusted model, the factors associated with the highest odds for neonatal intensive care unit admission included: nulliparity (adjusted odds ratio, 1.62 [95% confidence interval, 1.53-1.71]), large for gestational age (adjusted odds ratio, 1.59 [95% confidence interval, 1.47-1.71]), and small for gestational age (adjusted odds ratio, 1.60 [95% confidence interval, 1.47-1.73]). Induction of labor (adjusted odds ratio, 0.95 [95% confidence interval, 0.89-1.01]) was not associated with increased odds of neonatal intensive care unit admission compared with women who labored spontaneously. The events associated with higher odds of neonatal intensive care unit admission included: prolonged second stage (adjusted odds ratio, 1.66 [95% confidence interval, 1.51-1.83]); chorioamnionitis (adjusted odds ratio, 3.89 [95% confidence interval, 3.42-4.44]), meconium-stained amniotic fluid (adjusted odds ratio, 1.96 [95% confidence interval, 1.82-2.10]), and abruption (adjusted odds ratio, 2.64 [95% confidence interval, 2.16-.21]). Compared with women who did not labor, the odds of neonatal intensive care unit admission were lower for women who labored: adjusted odds ratio, 0.48 (95% confidence interval, 0.45-0.52) for women with no uterine scar and adjusted odds ratio, 0.83 (95% confidence interval, 0.73-0.94) for women with a uterine scar. There was significant variation in neonatal intensive care unit admission rates by hospital, ranging from 2.9% to 11.2%. After accounting for case mix and hospital characteristics, the between-hospital variance was 1.9%, suggesting that little of the variation was explained by the effect of the hospital. CONCLUSION: This study contributes to the currently limited understanding of term, neonatal intensive care unit admission rates as a marker of obstetrical care quality. We demonstrated that significant variation exists in hospital unexpected neonatal intensive care unit admission rates and that certain intrapartum events are associated with an increased risk for neonatal intensive care unit admission after delivery. However, the between-hospital variation was low. Unmeasured confounders and extrinsic factors, such as neonatal intensive care unit bed availability, may limit the ability of unexpected term neonatal intensive care unit admissions to meaningfully reflect obstetrical care quality.


Assuntos
Descolamento Prematuro da Placenta/epidemiologia , Corioamnionite/epidemiologia , Macrossomia Fetal/epidemiologia , Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva Neonatal , Obstetrícia/normas , Qualidade da Assistência à Saúde , Nascimento a Termo , Adulto , Líquido Amniótico , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Trabalho de Parto Induzido/estatística & dados numéricos , Masculino , Mecônio , Paridade , Gravidez , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
7.
PLoS One ; 14(2): e0211484, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30735531

RESUMO

OBJECTIVE: To investigate the impact of different stages of intrauterine inflammation (IUI) on neonatal outcomes, before and after adjusting for gestational age (GA) and other perinatal confounders. METHODS: This was an observational, prospective, single-center cohort study including all eligible neonates with GA < 35 weeks and/or birth weight ≤ 1500 g born at a 3rd level Neonatal Intensive Care Unit between 2011 and 2014. Pathological patterns of placenta, membranes and cord were classified according to Redline's criteria. Multivariable linear and logistic regression models were applied, either including or not GA among the covariates. RESULTS: Of the 807 enrolled neonates, 134 (16.6%) had signs of IUI: among these, 54.5% showed just histological chorioamnionitis (HCA), 25.4% had HCA + funisitis (FUN) stage 1, and 20.1% had HCA + FUN stage 2-3. At univariate analysis, HCA increased the risk for retinopathy of prematurity (ROP) and bronchopulmonary dysplasia, while FUN (any stage) had a deleterious impact on all outcomes investigated. After adjustment for covariates not including GA, HCA was a risk factor only for ROP (OR = 2.8, CI: 1-7.8), while FUN (any stage) was still associated with increased ORs for all outcomes (p <0.01). Upon inclusion of GA in the regression model, the results differed remarkably. HCA was associated with lower risk for mechanical ventilation (OR = 0.3, CI: 0.1-0.7) and need for surfactant (OR = 0.5, CI: 0.2-0.9), while FUN (any stage) worsened clinical conditions at birth (p <0.05), increased the risk for early-onset sepsis (p <0.01), and increased the length of mechanical ventilation (FUN stage 2-3 only, RC = 6.5 days, CI: 2-11). No other outcome was affected. CONCLUSIONS: IUI, especially FUN, negatively impact most neonatal morbidities, but its effect is partially reverted adjusting for GA. Considered that GA is an intermediate variable interposed between prenatal causes of prematurity and outcomes, the appropriateness of adjusting for GA may be questionable.


Assuntos
Doenças do Prematuro/epidemiologia , Doenças Uterinas/complicações , Útero/patologia , Adulto , Displasia Broncopulmonar/epidemiologia , Corioamnionite/epidemiologia , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Inflamação/complicações , Masculino , Gravidez , Análise de Regressão , Retinopatia da Prematuridade/epidemiologia , Fatores de Risco , Doenças Uterinas/patologia
8.
J Gynecol Obstet Hum Reprod ; 48(6): 387-390, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30634003

RESUMO

OBJECTIVE: To asses the efectivity of emergency cerclage in the patients with advance cervical dilatation and prolapsed membranes. MATERIAL METHODS: The patients who have ≥4 cm cervical dilatation with protruding membranes were included in the study. The patients were divided into two groups. Group I was consisted of the patients who had emergency cerclage procedure and group II was consisted of the patients who denied the operation and expectantly managed. The physical examination, pregnancy outcomes and the complications were compared between the groups. The results of the patients with emergency cerclage were analysed. RESULTS: 21 patients were referred with a ≥4 cm cervical dilatation with protruding membranes 33.3% of women with emergency cerclage were delivered within one week from the admission. One patient, who was a grand multiparous (G6P4A1), was delivered a healthy infant at 40 weeks of gestation. The remaining five patients were delivered between 21 and 24 weeks, but all the infants were died due to extreme prematurity.Two patients (22.2%) developed chorioamnionitis that necessitated long hospitalization (14-21 days). In group II (expectant management) 83,3% of the patients were delivered within the 48 h from the admission. There were no case of chorioamnionitis in group II. CONCLUSION: Emergency cervical cerclage is not a rationale option for the patients with an advanced cervical dilation (>4 cm) together with protruding membranes in early second trimester because of the short prolongation time and high complication rate.


Assuntos
Cerclagem Cervical , Tratamento de Emergência , Primeira Fase do Trabalho de Parto/fisiologia , Corioamnionite/epidemiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido Prematuro , Paridade , Gravidez , Resultado da Gravidez , Segundo Trimestre da Gravidez , Nascimento Prematuro/prevenção & controle , Resultado do Tratamento
9.
J Matern Fetal Neonatal Med ; 32(4): 527-541, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29020827

RESUMO

OBJECTIVE: The objective of this study is to evaluate the frequency and clinical significance of intra-amniotic inflammation in twin pregnancies with preterm labor and intact membranes. STUDY DESIGN: Amniotic fluid (AF) was retrieved from both sacs in 90 twin gestations with preterm labor and intact membranes (gestational age between 20 and 34 6/7 weeks). Preterm labor was defined as the presence of painful regular uterine contractions, with a frequency of at least 2 every 10 min, requiring hospitalization. Fluid was cultured and assayed for matrix metalloproteinase-8. Intra-amniotic inflammation was defined as an AF matrix metalloproteinase-8 concentration >23 ng/mL. RESULTS: The prevalence of intra-amniotic inflammation for at least 1 amniotic sac was 39% (35/90), while that of proven intra-amniotic infection for at least one amniotic sac was 10% (9/90). Intra-amniotic inflammation without proven microbial invasion of the amniotic cavity was found in 29% (26/90) of the cases. Intra-amniotic inflammation was present in both amniotic sacs for 22 cases, in the presenting amniotic sac for 12 cases, and in the non-presenting amniotic sac for one case. Women with intra-amniotic inflammation observed in at least one amniotic sac and a negative AF culture for microorganisms had a significantly higher rate of adverse pregnancy outcome than those with a negative AF culture and without intra-amniotic inflammation (lower gestational age at birth, shorter amniocentesis-to-delivery interval, and significant neonatal morbidity). Importantly, there was no significant difference in pregnancy outcome between women with intra-amniotic inflammation and a negative AF culture and those with a positive AF culture. CONCLUSION: Intra-amniotic inflammation is present in 39% of twin pregnancies with preterm labor and intact membranes and is a risk factor for impending preterm delivery and adverse outcome, regardless of the presence or absence of bacteria detected using cultivation techniques.


Assuntos
Líquido Amniótico/microbiologia , Corioamnionite/epidemiologia , Metaloproteinase 8 da Matriz/análise , Trabalho de Parto Prematuro/etiologia , Gravidez de Gêmeos , Adulto , Amniocentese , Líquido Amniótico/enzimologia , Análise de Variância , Corioamnionite/microbiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Idade Gestacional , Humanos , Trabalho de Parto Prematuro/diagnóstico , Trabalho de Parto Prematuro/microbiologia , Gravidez , Resultado da Gravidez , Fatores de Risco
10.
J Matern Fetal Neonatal Med ; 32(2): 271-278, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28936902

RESUMO

OBJECTIVE: To determine the association between maternal obesity and delivery due to chorioamnionitis prior to labor onset, among expectantly managed women with preterm premature rupture of membranes (pPROM). METHODS: This was a secondary analysis of a multicenter randomized trial of magnesium sulfate versus placebo to prevent cerebral palsy or death among offspring of women with anticipated delivery at 24-31-week gestation. After univariable analysis, Cox proportional hazard evaluated the association between maternal obesity and chorioamnionitis, while Laplace regression investigated how obesity affects the gestational age at delivery of the first 20% of women developing the outcome of interest. RESULTS: A total of 164 of the 1942 women with pPROM developed chorioamnionitis prior to labor onset. Obese women had a 60% increased hazard of developing such complication (adjusted HR 1.6, 95%CI 1.1-2.1, p = .008), prompting delivery 1.5 weeks earlier, as the 20th survival percentile was 27.2-week gestation (95%CI 26-28.6) among obese as opposed to 28.8 weeks (95%CI 27.4-30.1) (p = .002) among nonobese women. CONCLUSIONS: Maternal obesity is a risk factor for chorioamnionitis prior to labor onset. Future studies will determine if obesity is important enough to change the management of latency after pPROM according to maternal BMI.


Assuntos
Corioamnionite/epidemiologia , Ruptura Prematura de Membranas Fetais/epidemiologia , Ruptura Prematura de Membranas Fetais/terapia , Obesidade/epidemiologia , Complicações na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Cesárea/estatística & dados numéricos , Corioamnionite/terapia , Feminino , Humanos , Recém-Nascido , Sulfato de Magnésio/uso terapêutico , Obesidade/complicações , Obesidade/terapia , Gravidez , Complicações na Gravidez/terapia , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/terapia , Estudos Retrospectivos , Fatores de Tempo
11.
J Matern Fetal Neonatal Med ; 32(3): 488-492, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28942689

RESUMO

OBJECTIVES: To estimate the incidence of fetal inflammatory response syndrome (FIRS) in preterm neonates and correlate it with immediate and one-year neurodevelopmental outcome. MATERIALS AND METHODS: This prospective observational analytical study, in preterm neonates with gestational age between 26 and 34 weeks was conducted from May 2014 to December 2015 in a tertiary care hospital in South India. FIRS was defined as the presence of either elevated levels of interleukin-6 (IL-6) in cord blood ≥11 pg/ml and/or the placental histopathology showing evidence of fetal inflammatory response. One hundred and twenty neonates were recruited. During delivery 2 ml cord blood for interleukin-6 and placenta were collected and stored appropriately. Based on presence/absence of FIRS (IL-6 in cord blood ≥11 pg/ml and or features of placental fetal inflammation), neonates were grouped into two groups. The neonatal and maternal characteristics between two groups were compared. The short-term outcome parameters during NICU stay and neurodevelopmental outcome at one year of corrected age was compared between groups. RESULTS: Among the 120 infants studied, 19 expired. Out of 101 babies discharged, 87 were followed up till corrected 1 year of age. On examination of placenta and cord blood, 50 neonates had evidence of FIRS (41.6%). So there were 50 neonates in FIRS and 70 in NO-FIRS group. The mean gestational age, birth weight, and gender distribution were comparable between the two groups. Mortality [OR: 2.44 (CI: 1.14-5.26)] and early hypotension [OR: 2.13 (CI: 1.1-4.2)] were significantly higher in the FIRS group. The neurodevelopmental assessment at corrected age of 1 year showed that infants with FIRS had lower mean motor developmental quotient by developmental assessment scale for Indian infants (DASII) [87.6 ± 9.15 versus 93.07 ± 9.3, p < .04]. CONCLUSIONS: FIRS has a significant role on survival and neurodevelopmental outcome of preterm infants.


Assuntos
Doenças Fetais/epidemiologia , Doenças do Prematuro/epidemiologia , Recém-Nascido Prematuro , Resultado da Gravidez/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Adulto , Corioamnionite/epidemiologia , Feminino , Doenças Fetais/diagnóstico , Idade Gestacional , Humanos , Índia/epidemiologia , Recém-Nascido , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/etiologia , Interleucina-6/sangue , Masculino , Gravidez , Prognóstico , Síndrome de Resposta Inflamatória Sistêmica/congênito , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Adulto Jovem
12.
BJOG ; 126(6): 719-727, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30485648

RESUMO

OBJECTIVE: To investigate the association of chorioamnionitis and its duration with adverse maternal outcomes by mode of delivery. DESIGN: A retrospective cohort study. SETTING: Data from the Consortium on Safe Labor Study in the USA (2002-2008). POPULATION: Singleton deliveries at ≥23 weeks of gestation (221 274 assessed deliveries, 62 331 by caesarean section). METHODS: The association of chorioamnionitis, and secondarily the duration of chorioamnionitis estimated from intrapartum antibiotic use, with adverse maternal outcomes was analysed using logistic regression with generalised estimating equations, adjusting for age, parity, race, pregestational diabetes, chronic hypertension, gestational age at delivery, study site and delivery year. Analyses were stratified by vaginal versus caesarean delivery. MAIN OUTCOME MEASURES: The composite adverse maternal outcome included: postpartum transfusion, endometritis, wound/perineal infection/separation, venous thromboembolism, hysterectomy, admission to intensive care unit and/or death. RESULTS: Chorioamnionitis was associated with higher odds of the composite adverse maternal outcome with caesarean delivery (adjusted odds ratio 2.31; 95% CI 1.97-2.71); and the association persisted regardless of whether a woman had a trial of labour, preterm delivery or maternal group B streptococcus colonisation. The most common adverse outcomes after caesarean section were postpartum transfusion (56.0%) and wound/perineal infection or endometritis (38.6%). Chorioamnionitis was not associated with adverse maternal outcomes after vaginal delivery. The duration of chorioamnionitis as the exposure did not alter the association between chorioamnionitis and adverse maternal outcomes. CONCLUSIONS: Chorioamnionitis, but not the estimated duration, was associated with increased odds of adverse maternal outcomes with caesarean delivery. This finding has implications for care programmes to prevent maternal morbidity after a caesarean section complicated by chorioamnionitis. TWEETABLE ABSTRACT: Chorioamnionitis, but not its duration, increases the risk of adverse maternal outcomes with caesarean delivery.


Assuntos
Cesárea , Corioamnionite , Parto Obstétrico , Complicações do Trabalho de Parto/epidemiologia , Adulto , Antibacterianos/uso terapêutico , Cesárea/efeitos adversos , Cesárea/estatística & dados numéricos , Corioamnionite/diagnóstico , Corioamnionite/epidemiologia , Corioamnionite/terapia , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Trabalho de Parto/fisiologia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Fatores de Tempo , Estados Unidos/epidemiologia
13.
Pediatr Dev Pathol ; 22(4): 279-287, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30541420

RESUMO

The objective of this study is to better understand embryonic vitelline vascular remnants in the umbilical cord, to assess their prevalence, to categorize their morphology, and then finally to describe and assess inflammation arising from these structures. During routine placental sign out, the author noted the presence or absence of vitelline vessel remnants for 1 year; when present, he assessed their histologic patterns and noted whether there were neutrophils marginating from the remnants and into the adjacent Wharton's jelly and whether there was any other evidence of amniotic fluid infection in sections of placental disc, membranes, or cord. All cord sections with vitelline vessel remnants were immunostained for CD15 to document any infiltrates, to highlight patterns of infiltration, and to evaluate whether mild cases of umbilical phlebitis were associated with these lesions and were at risk of being missed. Vitelline vessel remnants were present in 4.2% of placentas examined. There were 5 vitelline vessel remnant histologic patterns identified providing insight into the vitelline vessel circulation. Funisitis, primarily neutrophilic, arising from vitelline vessel remnants was present in 70.3% of the 37 cords with vitelline vessel remnants. The presence of vitelline vessel remnant funisitis documents continued active circulation in these vascular structures, and vitelline vessel remnant funisitis was associated with the presence of other placental histological evidence of amniotic fluid infection in 53.8% of cases. The author also reviews normal embryology and the pathology of vitelline vessel remnants.


Assuntos
Líquido Amniótico/microbiologia , Corioamnionite/patologia , Inflamação/patologia , Cordão Umbilical/patologia , Alberta/epidemiologia , Vasos Sanguíneos/embriologia , Vasos Sanguíneos/patologia , Corioamnionite/epidemiologia , Corioamnionite/microbiologia , Feminino , Humanos , Inflamação/microbiologia , Neutrófilos/patologia , Placenta/microbiologia , Placenta/patologia , Gravidez , Estudos Prospectivos , Cordão Umbilical/microbiologia , Ducto Vitelino/patologia
14.
Pediatr Neonatol ; 60(4): 441-446, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30559061

RESUMO

BACKGROUND: Ureaplasma spp. is a known risk factor for bronchopulmonary dysplasia (BPD). However, little is known about the effect of different degrees of maternal Ureaplasma colonization and their adverse outcomes. Hence, the aim of this study was to determine the effects of different degrees of maternal Ureaplasma colonization on BPD. METHODS: A retrospective cohort study of preterm infants delivered at <32 weeks' gestational age (GA) was performed. The infants were divided according to maternal Ureaplasma status as follows: high-colonization (≥104 CCU/ml, UUH), low-colonization (<104 CCU/ml, UUL), and noncolonization (controls). Subgroup analysis according to neonatal respiratory Ureaplasma (n-UU) was also performed to evaluate vertical transmission. RESULTS: In total, 245 infants were included in this study (UUH = 105, UUL = 47, controls = 93). The rates of preterm labor and histological chorioamnionitis were significantly different. The rate of BPD was significantly high in UUH (P = 0.044). The transmission rate of n-UU colonization was 36% in UUH and 32% in UUL (P = 0.609). The rate of BPD was 78% in n-UU (+) of UUH but 43% in n-UU (-) of UUL (P = 0.027). CONCLUSIONS: High-degree colonization of maternal Ureaplasma was associated with preterm labor, histological chorioamnionitis, and neonatal BPD. The incidence of BPD was significantly higher in Ureaplasma-colonized infants born to women with high-degree colonization.


Assuntos
Displasia Broncopulmonar/epidemiologia , Portador Sadio/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Infecções Respiratórias/epidemiologia , Infecções por Ureaplasma/epidemiologia , Doenças Vaginais/epidemiologia , Nitrogênio da Ureia Sanguínea , Displasia Broncopulmonar/microbiologia , Portador Sadio/transmissão , Corioamnionite/epidemiologia , Feminino , Idade Gestacional , Humanos , Incidência , Lactente , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Lactente Extremamente Prematuro , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Transmissão Vertical de Doença Infecciosa , Masculino , Trabalho de Parto Prematuro/epidemiologia , Gravidez , Infecções Respiratórias/microbiologia , Estudos Retrospectivos , Fatores de Risco , Infecções por Ureaplasma/transmissão , Doenças Vaginais/microbiologia
15.
J Matern Fetal Neonatal Med ; 32(20): 3473-3479, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29656690

RESUMO

Objective: To compare maternal blood endotoxin activity (EA) in women with preterm premature rupture of membranes (PPROM) with gestational age (GA) matched controls; to evaluate serial EA till birth in PPROM and its correlation with latency to delivery. Methods: We followed singleton preterm pregnancies from admission with PPROM until birth. Uncomplicated, GA-matched pregnancies served as controls. Demographics, birth and neonatal outcomes were collected. EA (EAA™) was assessed serially in PPROM and at study entry in controls. EA was compared using Mann Whitney and Wilcoxon tests, p value <.05 was considered significant. Results: We recruited 20 cases of PPROM and 20 controls. Demographics were similar between groups. Mean GA of PPROM was 29.0 ± 2.2 weeks and median latency was 7.5 (IQR 14.1) weeks. Median EA at admission following PPROM was significantly elevated over controls (0.43 (0.18) versus 0.36 (0.2); p < .02). Overall there was no difference in median EA at admission and in labor (0.43 (0.18) versus 0.33 (0.21); p = .2) following PPROM. However, on comparing cases with latency to delivery ≤7 days (n = 10) versus >7 days (n = 10), there was a significant drop in EA in the latter group (0.44 (0.2) versus 0.34 (0.2); p < .004). Conclusions: EA in PPROM represents a promising biomarker in predicting the clinical evolution of preterm birth.


Assuntos
Endotoxinas/sangue , Ruptura Prematura de Membranas Fetais/sangue , Adulto , Estudos de Casos e Controles , Corioamnionite/sangue , Corioamnionite/epidemiologia , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Gravidez , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/sangue , Nascimento Prematuro/epidemiologia
16.
Gynecol Obstet Invest ; 84(2): 183-189, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30332669

RESUMO

AIMS: To investigate the risk factors of intra-amniotic infection (IAI) related to induction with single-balloon catheter (SBC). METHODS: A retrospective, case-control study including 58 cases of IAI patients who underwent induction with SBC was conducted in Women's Hospital, School of Medicine, Zhejiang University. For each case, 8 women who delivered during the same month and had no infection after SBC induction were selected for control. RESULTS: Compared with the control group, the IAI group had a higher rate of nulliparity (87.93 vs. 70.69%; p = 0.006), BMI > 30 kg/m2 (29.31 vs. 15.95%; p = 0.011), and amniotic fluid index (AFI) < 8 cm (32.8 vs. 15.1%; p = 0.001). The diameter of cervical dilatation when membranes ruptured in IAI group was smaller than that in the control group (2.0 [1.5] vs. 3.0 [8.0] cm; p < 0.001). Time from start of induction to vaginal delivery was longer than that in the control group (47.0 [19.75] vs. 27.0 [16.0] h; p < 0.001). After logistic regression, the 5 factors associated with IAI for those who underwent SBC induction were nulliparity, BMI > 30 kg/m2, AFI < 8 cm, diameter of cervical dilatation < 3 cm when membranes ruptured and time from start of induction to vaginal delivery of more than 48 h. CONCLUSIONS: Focus on these risk factors could result in earlier prophylaxis so that the incidence of IAI could be reduced.


Assuntos
Cateteres , Corioamnionite/epidemiologia , Trabalho de Parto Induzido/efeitos adversos , Trabalho de Parto Induzido/métodos , Adulto , Líquido Amniótico , Índice de Massa Corporal , Estudos de Casos e Controles , Corioamnionite/etiologia , Parto Obstétrico/métodos , Feminino , Idade Gestacional , Humanos , Paridade , Gravidez , Estudos Retrospectivos , Fatores de Risco
17.
J Perinatol ; 38(12): 1625-1630, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30337732

RESUMO

OBJECTIVE: Identify risk factors for poor perineal outcome after operative vaginal delivery. STUDY DESIGN: A retrospective cohort study was performed including operative vaginal deliveries during 2015 through 2016. RESULTS: Of 529 operative vaginal deliveries, 79 (14.9%) had higher order perineal lacerations and 14 (2.7%) had a wound breakdown. The only significant risk factor for higher order lacerations was chorioamnionitis (aOR 2.2; 95% CI 1.09-4.44). Risk factors for perineal wound breakdown included episiotomy (5.2 vs. 1.2%; p < 0.01), type of operative delivery (5.5% after forceps vs. 1.4% after vacuum; p < 0.01) and postpartum narcotic use. Overall, 9.3% of those using narcotics subsequently had a perineal breakdown as compared to 0.7% (p < 0.01). Narcotic use postpartum remained strongly associated in multivariable logistic regression (aOR 21.29; 95% CI 5.43-83.47). Patients with forceps deliveries, episiotomy, and narcotic use had a 38% risk of breakdown. CONCLUSION: Women at highest risk of perineal wound breakdown benefit from close follow-up.


Assuntos
Corioamnionite/epidemiologia , Lacerações/cirurgia , Complicações do Trabalho de Parto/epidemiologia , Períneo/lesões , Deiscência da Ferida Operatória/epidemiologia , Adulto , Boston/epidemiologia , Parto Obstétrico/efeitos adversos , Episiotomia/efeitos adversos , Extração Obstétrica/efeitos adversos , Feminino , Humanos , Modelos Logísticos , Entorpecentes/efeitos adversos , Período Pós-Parto , Gravidez , Estudos Retrospectivos , Fatores de Risco , Deiscência da Ferida Operatória/etiologia
18.
J Pediatr ; 201: 106-114.e4, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30054165

RESUMO

OBJECTIVE: To assess the epidemiology of blood culture-proven early- (EOS) and late-onset neonatal sepsis (LOS). STUDY DESIGN: All newborn infants admitted to tertiary care neonatal intensive care units in Switzerland and presenting with blood culture-proven sepsis between September 2011 and December 2015 were included in the study. We defined EOS as infection occurring <3 days after birth, and LOS as infection ≥3 days after birth. Infants with LOS were classified as having community-acquired LOS if onset of infection was ≤48 hours after admission, and hospital-acquired LOS, if onset was >48 hours after admission. Incidence was estimated based on the number of livebirths in Switzerland and adjusted for the proportion of admissions at centers participating in the study. RESULTS: We identified 444 episodes of blood culture-proven sepsis in 429 infants; 20% of cases were EOS, 62% hospital-acquired LOS, and 18% community-acquired LOS. The estimated national incidence of EOS, hospital-acquired LOS, and community-acquired LOS was 0.28 (95% CI 0.23-0.35), 0.86 (0.76-0.97), and 0.28 (0.23-0.34) per 1000 livebirths. Compared with EOS, hospital-acquired LOS occurred in infants of lower gestational age and was more frequently associated with comorbidities. Community-acquired LOS was more common in term infants and in male infants. Mortality was 18%, 12%, and 0% in EOS, hospital-acquired LOS, and community-acquired LOS, and was higher in preterm infants, in infants with septic shock, and in those requiring mechanical ventilation. CONCLUSIONS: We report a high burden of sepsis in neonates with considerable mortality and morbidity. EOS, hospital-acquired LOS, and community-acquired LOS affect specific patient subgroups and have distinct clinical presentation, pathogens and outcomes.


Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Infecção Hospitalar/epidemiologia , Sepse Neonatal/epidemiologia , Corioamnionite/epidemiologia , Estudos de Coortes , Infecções Comunitárias Adquiridas/microbiologia , Comorbidade , Infecção Hospitalar/microbiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Masculino , Meningites Bacterianas/epidemiologia , Sepse Neonatal/microbiologia , Gravidez , Respiração Artificial/estatística & dados numéricos , Fatores Sexuais , Suíça/epidemiologia , Infecções Urinárias/epidemiologia
19.
Vaccine ; 36(34): 5173-5179, 2018 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-30031662

RESUMO

BACKGROUND: New Zealand has funded the administration of tetanus, diphtheria and acellular pertussis (Tdap) vaccine during pregnancy to prevent infant pertussis since 2013. The aim of this study was to assess the safety of Tdap vaccine administered to pregnant women as part of a national maternal immunisation programme. METHODS: We conducted a national retrospective observational study using linked administrative New Zealand datasets. The study population consisted of pregnant women eligible to receive funded Tdap vaccination from 28 to 38 weeks gestation in 2013. Primary study outcomes were based on prioritised adverse events for the assessment of vaccine safety in pregnant women, as defined by WHO and Brighton Collaboration taskforces. We examined the effect of Tdap vaccination on prioritised maternal outcomes using Cox proportional hazard models. Adjusted hazard ratios controlled for key confounding variables. RESULTS: In the cohort of 68,550 women eligible to receive funded antenatal Tdap vaccination during 2013, 8178 (11.9%) were vaccinated and 60,372 (88.1%) were unvaccinated. The use of Tdap in pregnancy was not associated with an increase in the rate of primary outcomes, including preterm labour; pre-eclampsia; pre-eclampsia with severe features; eclampsia; gestational hypertension; fetal growth restriction; or post-partum haemorrhage. Tdap also did not increase secondary outcomes, including gestational diabetes mellitus; antenatal bleeding; placental abruption; premature rupture of membranes; preterm delivery; fetal distress; chorioamnionitis; or, maternal fever during or after labour. Lactation disorders was the only secondary maternal outcome with a significantly increased hazard ratio. Tdap vaccine had a protective effect on pre-eclampsia with severe features, preterm labour, preterm delivery, and antenatal bleeding. CONCLUSION: We did not detect any biologically plausible adverse maternal outcomes following Tdap vaccination during pregnancy. This study provides further assurance that Tdap administration during pregnancy is not associated with unexpected safety risks.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/efeitos adversos , Complicações na Gravidez/induzido quimicamente , Vacinação/efeitos adversos , Adulto , Corioamnionite/induzido quimicamente , Corioamnionite/epidemiologia , Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Feminino , Idade Gestacional , Humanos , Hipertensão Induzida pela Gravidez/induzido quimicamente , Hipertensão Induzida pela Gravidez/epidemiologia , Nova Zelândia/epidemiologia , Pré-Eclâmpsia/induzido quimicamente , Pré-Eclâmpsia/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Gestantes , Nascimento Prematuro/induzido quimicamente , Nascimento Prematuro/epidemiologia , Vigilância de Produtos Comercializados , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Vacinação/estatística & dados numéricos , Adulto Jovem
20.
Obstet Gynecol ; 132(1): 107-114, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29889757

RESUMO

OBJECTIVE: To quantify the rate of maternal complications associated with a periviable birth in a contemporary population of live births in the state of Ohio. METHODS: We conducted a population-based retrospective cohort study of all live births in Ohio (2006-2015). Maternal, obstetric, and neonatal characteristics were compared between women who delivered in the periviable period (20-25 weeks of gestation) with those who delivered preterm (26-36 weeks of gestation) and at term (greater than 36 weeks of gestation). Women were also stratified by 3-week gestational age epochs (ie, 20-22, 23-25 weeks of gestation). The primary study outcome was a composite of individual adverse maternal outcomes (chorioamnionitis, blood product transfusion, hysterectomy, unplanned operation, and intensive care unit [ICU] admission). Multivariate logistic regression estimated the relative association of periviable birth with maternal complications. RESULTS: Of 1,457,706 live births in Ohio during the 10-year study period, 6,085 live births (0.4%) occurred during the periviable period (20-25 weeks of gestation). The overall rate of the composite adverse outcome was 17.2%. In multivariate analysis, periviable birth was associated with an increased risk of the composite adverse maternal outcome (adjusted relative risk [RR] 5.8, CI 5.4-6.2) and individual complications including transfusion (adjusted RR 4.4, CI 3.4-5.7), unplanned operative procedure (adjusted RR 2.0, CI 1.7-2.4), unplanned hysterectomy (adjusted RR 7.8, CI 4.6-13.0), uterine rupture (adjusted RR 7.1, CI 3.8-13.4), and ICU admission (adjusted RR 9.6, CI 7.2-12.7) compared with the term cohort. Delivery between 20-22 weeks and 23-25 weeks of gestation was associated with the highest risk of composite adverse outcome. The risk of composite adverse outcome decreased with advancing gestational age stratum. CONCLUSION: Periviable birth is associated with significant maternal morbidity. Nearly one in five women in this cohort had a serious morbidity associated with their periviable delivery.


Assuntos
Complicações do Trabalho de Parto/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Transfusão de Sangue/estatística & dados numéricos , Cesárea/estatística & dados numéricos , Corioamnionite/epidemiologia , Feminino , Idade Gestacional , Humanos , Histerectomia/estatística & dados numéricos , Recém-Nascido , Unidades de Terapia Intensiva , Nascimento Vivo , Modelos Logísticos , Análise Multivariada , Ohio/epidemiologia , Admissão do Paciente/estatística & dados numéricos , Gravidez , Estudos Retrospectivos
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