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1.
Radiol Clin North Am ; 58(2): 381-399, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32044013

RESUMO

Placenta is a vital organ that connects the maternal and fetal circulations, allowing exchange of nutrients and gases between the two. In addition to the fetus, placenta is a key component to evaluate during any imaging performed during pregnancy. The most common disease processes involving the placenta include placenta accreta spectrum disorders and placental masses. Several systemic processes such as infection and fetal hydrops can too affect the placenta; however, their imaging features are nonspecific such as placental thickening, heterogeneity, and calcifications. Ultrasound is the first line of imaging during pregnancy, and MR imaging is reserved for problem solving, when there is need for higher anatomic resolution.


Assuntos
Descolamento Prematuro da Placenta/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Placenta Acreta/diagnóstico por imagem , Placenta Prévia/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Feminino , Humanos , Placenta/diagnóstico por imagem , Gravidez
2.
BJOG ; 127(3): 335-342, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31654606

RESUMO

OBJECTIVE: Asian dust is a natural phenomenon in which dust particles are transported from desert areas in China and Mongolia to East Asia. Short-term exposure to Asian dust has been associated with cardiovascular disease through mechanisms such as systemic inflammation. Because inflammation is a potential trigger of placental abruption, exposure may also lead to abruption. We examined whether exposure to Asian dust was associated with abruption. DESIGN: A bi-directional, time-stratified case-crossover design. SETTING AND POPULATION: From the Japan Perinatal Registry Network database, we identified 3014 patients who delivered singleton births in hospitals in nine Japanese prefectures from 2009 to 2014 with a diagnosis of placental abruption. METHODS: Asian dust levels were measured at Light Detection and Ranging monitoring stations, and these measurements were used to define the Asian dust days. As there was no information on the onset day of abruption, we assumed this day was the day before delivery (lag1). MAIN OUTCOME MEASURES: Placental abruption. RESULTS: During the study period, the Asian dust days ranged from 15 to 71 days, depending on the prefecture. The adjusted odds ratio of placental abruption associated with exposure to Asian dust was 1.4 (95% confidence interval = 1.0, 2.0) for cumulative lags of 1-2 days. Even after adjustment for co-pollutant exposures, this association did not change substantially. CONCLUSIONS: In this Japanese multi-area study, exposure to Asian dust was associated with an increased risk of placental abruption. TWEETABLE ABSTRACT: Exposure to environmental factors such as Asian dust may be a trigger of placental abruption.


Assuntos
Descolamento Prematuro da Placenta , Poeira , Monitoramento Ambiental , Exposição por Inalação/efeitos adversos , Descolamento Prematuro da Placenta/diagnóstico , Descolamento Prematuro da Placenta/epidemiologia , Adulto , Estudos Cross-Over , Monitoramento Ambiental/métodos , Monitoramento Ambiental/estatística & dados numéricos , Feminino , Humanos , Sistemas de Informação/estatística & dados numéricos , Japão/epidemiologia , Gravidez , Medição de Risco , Fatores de Risco
3.
BJOG ; 127(3): 343-344, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31724306
4.
Z Geburtshilfe Neonatol ; 223(6): 337-349, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31801168

RESUMO

As far as prehospital but in part also clinical obstetrics is concerned, the acute nature of perinatal emergencies is overshadowed by limited diagnostic and therapeutic options. The need for acute and targeted intervention may result from both maternal and fetal indications. As common in emergency services for pregnant women, prehospital primary assessment and logistics management (e.g., transport time/type, choice of destination) define the prognosis. Non-specific emergencies coincident to pregnancy are to be distinguished from perinatal emergencies caused by expecting a child (hypertensive pregnancy disorders, perinatal bleeding, thrombosis, and embolism). In order to cope with rare and unpredictable emergencies, medical teams profit from standardized algorithms to support a high quality of prehospital care. Extensive information and training concepts are essential. The presented series on obstetric emergencies introduces the required knowledge and skills.


Assuntos
Emergências/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Obstetrícia , Complicações na Gravidez/epidemiologia , Descolamento Prematuro da Placenta , Criança , Embolia Amniótica , Feminino , Humanos , Parto , Placenta Prévia , Pré-Eclâmpsia , Gravidez , Tromboembolia , Inércia Uterina
6.
Ceska Gynekol ; 84(5): 345-350, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31826631

RESUMO

OBJECTIVE: A review of contemporary knowledge about uterine rupture during pregnancy, followed by a case-report of a patient with uterine rupture during pregnancy without an uterine scar. DESIGN: Review and case report. SETTING: Clinic of Obstetrics and Gynecology, University Hospital, Hradec Králové; Department of Gynecology and Obstetrics, Hospital Náchod. CASE REPORT: We present a case of an uterine rupture of a uterus without a scar from previous surgery. A patient in 33. week of pregnancy with stillborn fetus was administred to our hospital. While inducing the labor, the patient showed signes of shock, fetus was no longer present in uterus. An C-section was performed, but the stillborn baby was placed in abdominal cavity, with an abrupted placenta. Large uterine rupture was spotted, therefore a hysterectomy was performed. CONCLUSION: Uterine rupture during pregnancy is an urgent state. The incidency of uterine rupture is rising accordingly with the growing number of C-sections. However, it is important to include uterine rupture into differential diagnostics also in cases with other risk factors. The key to successful diagnosis is ultrasound examination and correct evaluation of clinical state, other imaging methods are less suitable because of time delay. Together with the change of major cause of uterine rupture, the approach to treatment has changed as well. If possible, a uterus-saving procedure is preferred. The aim of this case-report is presentation of a rare case of uterine rupture in an scar-free uterus. It also shows how troublesome diagnostics of uterine ruptures can be.


Assuntos
Histerectomia/métodos , Trabalho de Parto , Ruptura Uterina/cirurgia , Descolamento Prematuro da Placenta , Cesárea , Cicatriz , Feminino , Humanos , Gravidez , Natimorto , Resultado do Tratamento , Ruptura Uterina/etiologia
7.
BJOG ; 126(13): 1577-1586, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31483935

RESUMO

OBJECTIVE: To estimate incidence, trends over time, and risk factors for massive blood transfusions in obstetric patients. A secondary aim was to evaluate transfusion ratios in relation to massive transfusion. DESIGN: Population-based cohort. SETTING: Five hospitals, in the Stockholm County, Sweden, from 1990 to 2011. POPULATION: All women that gave birth in Stockholm county, Sweden, and who received blood transfusions postpartum between 1990 and 2011. METHODS: Data on pregnancies and deliveries from the Swedish National Medical Birth Registry was cross-linked to the Stockholm transfusion database. Massive blood transfusion was defined as the transfusion of ≥10 units of red blood cells from partus through the next day. MAIN OUTCOME MEASURES: Main primary outcome was massive blood transfusion postpartum. RESULTS: Our cohort comprised 517 874 deliveries. Massive blood transfusion occurred in 277 women, for an incidence of 5.3 per 10 000 deliveries, and increased by 30% (P < 0.001) between the first and the second half of the study period. Major risk factors apparent before delivery were abnormal placentation (odds ratio [OR] 41; 95% CI 29.3-58.1), pre-eclampsia/placental abruption (OR 4; 95% CI 2.8-5.6), and previous caesarean delivery (OR 4; 95% CI 3.1-6.0). Risk factors at time of delivery were uterine rupture, atonic uterus, and caesarean delivery (OR 38, 17, and 3, respectively). CONCLUSION: We found an increasing trend in the postpartum rate of massive transfusion. Women with abnormal placentation were found to have the highest increased risk. Improved antenatal awareness of these women at risk might improve management and reduce the rate of massive transfusion. TWEETABLE ABSTRACT: Risk of massive blood transfusion in obstetric patients increases with placental complications and prior caesarean section.


Assuntos
Transfusão de Sangue , Cesárea/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Hemorragia Pós-Parto/epidemiologia , Descolamento Prematuro da Placenta/epidemiologia , Adulto , Transfusão de Sangue/estatística & dados numéricos , Cesárea/efeitos adversos , Parto Obstétrico/efeitos adversos , Feminino , Inquéritos Epidemiológicos , Humanos , Histerectomia/estatística & dados numéricos , Incidência , Placenta Acreta/epidemiologia , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/terapia , Gravidez , Fatores de Risco , Suécia/epidemiologia , Inércia Uterina/epidemiologia , Inércia Uterina/terapia
8.
Environ Int ; 131: 105067, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31376592

RESUMO

BACKGROUND: Pregnant women may be vulnerable to changes in ambient temperature and warming climates. Recent evidence suggests that temperature increases are associated with placental abruption, a risk factor for stillbirth. OBJECTIVES: We investigated the effect of acute exposures to apparent temperature on stillbirths in Harris County, Texas, 2008-2013. METHODS: We conducted a case-crossover study to investigate the association between temperature and stillbirth among 708 women. We used data from the National Climatic Data Center to estimate maternal exposure to daily average apparent temperature over the days (lag days 1 through 6) preceding the stillbirth event. We employed symmetric bidirectional sampling to select six control periods one to three weeks before and after each event and applied conditional logistic regression to examine associations between increases of apparent temperature and stillbirths during the warm season (May-September). We adjusted for fine particulate matter (PM2.5), nitrogen dioxide (NO2) and ozone (O3) and used stratified analysis to examine differences in risk by maternal race/ethnicity. We also examined the association among stillbirths with and without placental abruptions. RESULTS: Independent of air pollutant exposures, a 10 °F increase in apparent temperature in the week preceding delivery (lag days 1 to 6) was positively associated with a 45% (adjusted OR = 1.45, 95% confidence interval (CI): 1.18, 1.77) increase in risk for stillbirth. Risks were elevated for stillbirths occurring in June through August, for Hispanic and non-Hispanic Black women, but not for non-Hispanic Whites. We also observed elevated risks associated with temperature increases in the few days preceding delivery among stillbirths caused by placental abruption, with the risk being highest on lag day 1 (OR = 1.93, 95% CI: 1.15, 3.23). CONCLUSIONS: Independent of maternal ambient air pollutant exposure, we found evidence of an association between apparent temperature increases in the week preceding an event and risk of stillbirth. Risks for stillbirth varied by race/ethnicity. Further, in the first study to evaluate the impact of temperature on a specific complication during pregnancy, the risks were higher among mothers with placental abruption.


Assuntos
Descolamento Prematuro da Placenta/epidemiologia , Natimorto/epidemiologia , Temperatura Ambiente , Adulto , Poluição do Ar/análise , Estudos Cross-Over , Feminino , Humanos , Dióxido de Nitrogênio/análise , Material Particulado/análise , Gravidez , Fatores de Risco , Texas , Tempo (Meteorologia) , Adulto Jovem
9.
Neurology ; 93(12): e1148-e1158, 2019 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-31420459

RESUMO

OBJECTIVE: To test whether abruption during pregnancy is associated with long-term cerebrovascular disease by assessing the incidence and mortality from stroke among women with abruption. METHODS: We designed a population-based prospective cohort study of women who delivered in Denmark from 1978 to 2010. We used data from the National Patient Registry, Causes of Death Registry, and Danish Birth Registry to identify women with abruption, cerebrovascular events, and deaths. The outcomes included deaths resulting from stroke and nonfatal ischemic and hemorrhagic strokes. We fit Cox proportional hazards regression models for stroke outcomes, adjusting for the delivery year, parity, education, and smoking. RESULTS: The median (interquartile range) follow-up in the nonabruption and abruption groups was 15.9 (7.8-23.8) and 16.2 (9.6-23.1) years, respectively, among 828,289 women with 13,231,559 person-years of follow-up. Cerebrovascular mortality rates were 0.8 and 0.5 per 10,000 person-years among women with and without abruption, respectively (hazard ratio [HR] 1.6, 95% confidence interval [CI] 0.9-3.0). Abruption was associated with increased rates of nonfatal ischemic stroke (HR 1.4, 95% CI 1.1-1.7) and hemorrhagic stroke (HR 1.4, 95% CI 1.1-1.9). The association of abruption and stroke was increased with delivery at <34 weeks, when accompanied by ischemic placental disease, and among women with ≥2 abruptions. These associations are less likely to have been affected by unmeasured confounding. CONCLUSION: Abruption is associated with increased risk of cerebrovascular morbidity and mortality. Disruption of the hemostatic system manifesting as ischemia and hemorrhage may indicate shared etiologies between abruption and cerebrovascular complications.


Assuntos
Descolamento Prematuro da Placenta/diagnóstico , Descolamento Prematuro da Placenta/epidemiologia , Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/epidemiologia , Vigilância da População , Adulto , Estudos de Coortes , Dinamarca/epidemiologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Vigilância da População/métodos , Gravidez , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Adulto Jovem
10.
Taiwan J Obstet Gynecol ; 58(4): 454-459, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31307732

RESUMO

The abnormal development of placental vascularization leads to placental insufficiency, which further reduces the nutrient and trace exchange between maternal circulation and fetal circulation. These changes cause maternal and fetal complications. The objective of our systematic review was to explore the effects of maternal smoking on placental vascularization. The eligibility criteria were: articles with experimental, quasi-experimental or observational design, performed on human subjects, that study the association, correlation or causation between maternal smoking and changes in placental vascular network. A total of 33 full-text papers were assessed for eligibility, resulting in 12 original articles that were included in the systematic review. Doppler studies confirm reductions in blood flow velocity waveforms and increase in RI in the uterine, umbilical and fetal middle cerebral arteries. These findings are confirmed by morphometric measurements of fetal capillaries in villi that were shown to be smaller in smoke exposure groups.


Assuntos
Descolamento Prematuro da Placenta/etiologia , Exposição Materna/efeitos adversos , Insuficiência Placentária/diagnóstico por imagem , Resultado da Gravidez , Nascimento Prematuro/etiologia , Fumar/efeitos adversos , Descolamento Prematuro da Placenta/fisiopatologia , Adulto , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Placenta/irrigação sanguínea , Placenta/diagnóstico por imagem , Insuficiência Placentária/fisiopatologia , Gravidez , Nascimento Prematuro/fisiopatologia , Medição de Risco , Ultrassonografia Pré-Natal/métodos
11.
BMC Pregnancy Childbirth ; 19(1): 208, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221123

RESUMO

BACKGROUND: This study aims to determine reported prevalence of hypertensive disorders in pregnancy (HDP) and maternal and neonatal outcomes associated with these disorders among women delivering at selected hospitals across Haiti. METHODS: A retrospective review of 8822 singleton deliveries between January 2012 and December 2014 was conducted at four hospitals in separate Departments across Haiti. Researchers examined the proportion of women with reported HDP (hypertension, preeclampsia, eclampsia) and the association between women with HDP and three neonatal outcomes: low birth weight, preterm birth, and stillbirths; and two maternal outcomes: placental abruption and maternal death in Hôpital Albert Schweitzer (HAS). Odds ratios for associations between HDP and perinatal outcomes at HAS were assessed using logistic regression, adjusting for potential confounders. RESULTS: Of the 8822 singleton births included in the study, 510 (5.8%) had a reported HDP (including 285 (55.9%) preeclampsia, 119 (23.3%) eclampsia, and 106 (20.8%) hypertension). Prevalence of HDP among each hospital was: HAS (13.5%), Hôpital Immaculée Conception des Cayes (HIC) (3.2%), Fort Liberté (4.3%), and Hôpital Sacré Coeur de Milot (HSC) (3.0%). Among women at HAS with HDP, the adjusted odds of having a low birth weight baby was four times that of women without HDP (aOR 4.17, 95% CI 3.19-5.45), more than three times that for stillbirths (aOR 3.51, 95% CI 2.43-5.06), and five times as likely to result in maternal death (aOR 5.13, 95% CI 1.53-17.25). Among the three types of HDP, eclampsia was associated with the greatest odds of adverse events with five times the odds of having a low birth weight baby (aOR 5.00, 95% CI 2.84-8.79), six times the odds for stillbirths (aOR 6.34, 95% CI 3.40-11.82), and more than twelve times as likely to result in maternal death (aOR 12.70, 95% CI 2.33-69.31). CONCLUSIONS: A high prevalence of HDP was found among a cohort of Haitian mothers. HDP was associated with higher rates of adverse maternal and neonatal outcomes in HAS, which is comparable to studies of HDP conducted in high-income countries.


Assuntos
Descolamento Prematuro da Placenta/epidemiologia , Hipertensão Induzida pela Gravidez/epidemiologia , Recém-Nascido de Baixo Peso , Nascimento Prematuro/epidemiologia , Natimorto/epidemiologia , Adulto , Estudos de Casos e Controles , Coleta de Dados , Feminino , Haiti/epidemiologia , Hospitais/estatística & dados numéricos , Humanos , Hipertensão Induzida pela Gravidez/mortalidade , Mortalidade Materna , Vigilância da População , Gravidez , Prevalência , Estudos Retrospectivos , Adulto Jovem
12.
Medicine (Baltimore) ; 98(18): e15472, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045828

RESUMO

INTRODUCTION: Placental abruption (PA) is a serious complication of pregnancy, associated with significant perinatal complications, including intrauterine fetal demise (IUFD). Continuous electronic fetal monitoring (EFM) has been widely applied in China in recent decades. Exploration of potentially PA-specific patterns of EFM contributes to early detection of PA occurrence. PATIENT CONCERNS AND DIAGNOSIS: A 33-year-old woman (gravida 3, para 1) was referred to our hospital at 33 weeks gestation due to non-reassuring fetal heart rate (FHR) pattern, and suffered sudden onset of severe PA and subsequent intrauterine fetal demise. INTERVENTIONS: We analyzed the characteristics of her non-stress tests (NSTs) 1 day and 10 min before the detection of PA, aiming to explore potentially PA-specific patterns of EFM and provide reference for early detection of asymptomatic PA occurrence in obstetric practice. OUTCOMES: Unfavored characteristics of FHR patterns before PA onset are analyzed. CONCLUSION: For those who sense decreased fetal movements (DFMs), a NST and a biophysical profile (BPP) are recommended for exclusion of potential adverse maternal and fetal complications.


Assuntos
Descolamento Prematuro da Placenta/fisiopatologia , Cardiotocografia/métodos , Morte Fetal/etiologia , Adulto , Feminino , Idade Gestacional , Frequência Cardíaca Fetal , Humanos , Gravidez
13.
Paediatr Perinat Epidemiol ; 33(3): 215-222, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31131918

RESUMO

BACKGROUND: Placental abruption is a major determinant of maternal and perinatal morbidity and mortality, often related to asphyxia and preterm birth. However, the impact of abruption on the long-term morbidity of the offspring is less investigated. METHODS: We designed a hospital-based cohort study, in which the incidence of long-term neurology-related hospitalisations of offspring to women with and without placental abruption was assessed. All singleton deliveries between 1991 and 2014 were included in the study. Congenital anomalies, perinatal mortality, and multifetal pregnancies were excluded from the analyses. We compared cumulative morbidity incidence using Kaplan-Meier survival curves and estimated the risk for long-term neurological hospitalisations from Cox proportional hazards models after adjustment for putative including maternal age, parity, hypertensive disorders, pre-gestational and gestational diabetes, gender, ethnicity, and year of birth. RESULTS: Over the 22-year period, 2 202 269 person-years of follow-up, there were 217 910 deliveries of which 0.5% (n = 1003) were complicated with placental abruption. The median (interquartile range) follow-up of children in the abruption and non-abruption groups was 10.3 (4.6, 15.9) and 12.0 (6.3, 16.5) years, respectively. The cumulative incidence of total neurological hospitalisations was comparable between abruption (3.32 per 1000 person-years) and non-abruption (3.16 per 1000 person-years). Abruption was associated with increased rates of cerebral palsy (hazard ratio [HR] 6.71, 95% CI 3.32, 13.58) and developmental disorders (HR 3.36, 95% CI 1.38, 8.13), but not for total neurology-related hospitalisations (HR 1.08, 95% CI 0.78, 1.49). CONCLUSION: Placental abruption is associated with increased rate of cerebral palsy and developmental disorders in the offspring later in life. This study may define risk factors for childhood neuropsychiatric disorders, enabling early diagnosis and intervention in children with such disorders, and perhaps improving their prognosis.


Assuntos
Descolamento Prematuro da Placenta/epidemiologia , Hospitalização/estatística & dados numéricos , Doenças do Sistema Nervoso/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Israel/epidemiologia , Idade Materna , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
14.
Pregnancy Hypertens ; 16: 38-41, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31056158

RESUMO

OBJECTIVE: Expectant management of appropriately selected cases of early pre-eclampsia in a dedicated, tertiary in-patient setting with frequent non-invasive maternal and fetal surveillance, prolongs pregnancy, improves perinatal outcome and mitigates the impact of maternal complications. As the rate of abruptio placentae in a large descriptive study performed nearly 20 years ago was 20%, a study to re-evaluate the rate of abruptio placentae and other maternal complications was performed. STUDY DESIGN: A retrospective study that included all women admitted for expectant management with stable early pre-eclampsia (≥24 and <34 weeks' gestation) was performed at Tygerberg Hospital, a secondary and tertiary referral centre in South Africa over a period of 12 months. MAIN OUTCOME MEASURES: Abruptio placentae and other maternal complications. RESULTS: During the study period, 9137 women were delivered at the study institution. The data of 102 of 106 women admitted for expectant management of early pre-eclampsia were available. Thirty-four (33%) reached the elective delivery threshold of 34 weeks. Seventeen women (17%) experienced ≥1 complication. There were four cases (4%) each with abruptio placentae, HELLP syndrome and renal insufficiency. Three of the cases with abruptio placentae were asymptomatic, only being diagnosed at caesarean section for fetal distress. Nine women developed mild/moderate ascites. There were no admissions to the critical care unit and no deaths. CONCLUSIONS: Abruptio placentae occurred in 4% of women managed expectantly with early pre-eclampsia and was most often asymptomatic before delivery.


Assuntos
Descolamento Prematuro da Placenta/epidemiologia , Pacientes Internados , Pré-Eclâmpsia , Cuidado Pré-Natal , Adulto , Feminino , Humanos , Gravidez , Estudos Retrospectivos , África do Sul/epidemiologia , Centros de Atenção Terciária
16.
J Obstet Gynaecol ; 39(5): 601-605, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30821181

RESUMO

This retrospective study evaluates the effects of a massive postpartum haemorrhage (PPH) on maternal outcomes in an inner-city London hospital. One hundred and eighty-four cases of a massive primary PPH (>2000 mL) were identified over a seven-year period. A sub-group analysis was performed to assess whether 2000-3000 mL blood loss (134 cases) was associated with specific maternal characteristics or reduced adverse outcomes compared with >3000 mL blood loss (50 cases). Bakri balloon tamponade (BBT) was the most frequent form of surgical management in both groups (21 vs. 46%), followed by compression sutures (16.4 vs. 24%), the 'uterine sandwich' technique (6.7 vs. 14%) and the hysterectomy (0 vs. 4%). There were significant differences between these groups in placenta praevia as the cause of blood loss (8 vs. 22%, p = .01), length of stay (4.6 vs. 5.9 d, p = .02), use of BBT (p = <.01) and hysterectomy (p = .03). PPH is associated with premature maternal morbidity and mortality. The incidence is increasing in high income countries despite various guidelines, skills training and identification of risk factors. A prediction and assessment of blood loss remain the very cornerstone for a prompt, effective management. Our study shows that the morbidity is clearly related to the amount of blood loss and highlights the existing variable practices for the management of PPH. Impact statement What is already known on this subject? A postpartum haemorrhage (PPH) remains a common cause of maternal morbidity and mortality. Massive PPH (>2000 mL) rates continue to rise in developed countries. The management of PPH includes the medical treatment followed by surgical methods including the Bakri balloon tamponade (BBT), compression sutures or a hysterectomy. What do the results of this study add? This retrospective study evaluates the effects of a massive PPH (blood loss >2000 mL) on maternal outcomes. One hundred and eighty-four cases of a massive PPH were identified over a seven-year period. Sub-group analysis was performed to assess whether a 2000-3000 mL blood loss was associated with specific maternal characteristics and differences in obstetric practice compared with a >3000 mL blood loss. There were significant differences between these groups in placenta praevia, as the cause of blood loss, the length of stay, the use of BBT and the hysterectomy rates. What are the implications of these findings for clinical practice and/or further research? An early identification of the risk factors of a massive PPH is essential to improve maternal outcomes and is an important part of the antenatal, intrapartum and postpartum period. The prediction and assessment of blood loss remain key for a prompt, effective management. The amount of blood loss is related to adverse maternal outcomes and the management techniques applied. BBT has an essential role to play and should be included as part of the core training in the management of a PPH.


Assuntos
Hemorragia Pós-Parto/cirurgia , Resultado do Tratamento , Descolamento Prematuro da Placenta , Adulto , Índice de Massa Corporal , Feminino , Hospitais Universitários , Humanos , Histerectomia , Londres , Placenta Prévia , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/mortalidade , Gravidez , Estudos Retrospectivos , Técnicas de Sutura , Tamponamento com Balão Uterino/métodos , Inércia Uterina , Ferimentos e Lesões/complicações
17.
Taiwan J Obstet Gynecol ; 58(2): 223-226, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30910143

RESUMO

OBJECTIVE: This study aimed to explore the clinical characteristics and outcomes of placental abruption. MATERIALS AND METHODS: A total of 62 placental abruption cases were collected from the Second Hospital of Jilin University between January 2007 and December 2012. A retrospective study was conducted to explore the risk factors for placental abruption, clinical characteristics, and maternal and fetal outcomes. RESULTS: Risk factors for placental abruption mainly include preeclampsia (39%) and premature rupture of membrane (10%). Abdominal pain (68%) and bleeding (35%) comprise the classical symptoms of placental abruption but the clinical picture varies from asymptomatic, in which the diagnosis is made by inspection of the placenta at delivery, to massive abruption leading to fetal death and severe maternal morbidity. Emergency cesarean section was performed in 45 cases (73%) of placental abruption. Sixty-two placental abruption cases were divided into 2 groups according to whether uteroplacental apoplexy occurred. The incidence of preeclampsia and the duration (time between on-set of clinical symptom and placenta delivery) in the observational group were significantly higher than that of the control group, showing statistical significance (P < 0.01). CONCLUSION: The diagnosis of placental abruption should consider risk factors, symptoms, physical signs, dynamic ultrasound monitoring, and cardiac care. Early diagnosis and treatment can improve maternal and infant prognosis.


Assuntos
Descolamento Prematuro da Placenta/fisiopatologia , Hemorragia Pós-Parto/prevenção & controle , Resultado da Gravidez/epidemiologia , Descolamento Prematuro da Placenta/diagnóstico , Descolamento Prematuro da Placenta/etiologia , Adulto , Estudos de Casos e Controles , Cesárea , Diagnóstico Precoce , Feminino , Ruptura Prematura de Membranas Fetais/diagnóstico , Ruptura Prematura de Membranas Fetais/epidemiologia , Humanos , Incidência , Morte Materna/prevenção & controle , Poli-Hidrâmnios/diagnóstico , Poli-Hidrâmnios/epidemiologia , Hemorragia Pós-Parto/diagnóstico , Hemorragia Pós-Parto/etiologia , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/epidemiologia , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
18.
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
19.
BMC Pregnancy Childbirth ; 19(1): 75, 2019 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-30782144

RESUMO

BACKGROUND: Homocysteine is an intermediate metabolite implicated in the risk of placenta-mediated complications, including preeclampsia, placental abruption, fetal growth restriction, and pregnancy loss. Large cohort and case-control studies have reported inconsistent associations between homocysteine and these complications. The purpose of this study was to investigate whether elevated maternal plasma homocysteine concentration in the early to mid-second trimester is associated with an increased risk of placenta-mediated complications. We examined the following potential moderating factors that may explain discrepancies among previous studies: high-risk pregnancy and the MTHFR 677C>T polymorphism. METHODS: We analyzed data from participants recruited to the Ottawa and Kingston (OaK) Birth Cohort from 2002 to 2009 in Ottawa and Kingston, Canada. The primary outcome was a composite of any placenta-mediated complication, defined as a composite of small for gestational age (SGA) infant, preeclampsia, placental abruption, and pregnancy loss. Secondary outcomes were, individually: SGA infant, preeclampsia, placental abruption, and pregnancy loss. We conducted multivariable logistic regression analyses with homocysteine as the primary continuous exposure, adjusting for gestational age at the time of bloodwork and explanatory maternal characteristics. The functional form, i.e., the shape of the homocysteine association with the outcome was examined using restricted cubic splines and information criteria (Akaike's/Bayesian Information Criterion statistics). Missing data were handled with multiple imputation. RESULTS: 7587 cohort participants were included in the study. Maternal plasma homocysteine concentration was significantly associated (linearly) with an increased risk of both the composite outcome of any placenta-mediated complication (p = 0.0007), SGA (p = 0.0010), severe SGA, and marginally with severe preeclampsia, but not preeclampsia, placental abruption and pregnancy loss. An increase in homocysteine concentration significantly increased the odds of any placenta-mediated complication (odds ratio (OR) for a 5 µmol/L increase: 1.63, 95% Confidence Interval (CI) 1.23-2.16) and SGA (OR 1.76, 95% CI 1.25-2.46). Subgroup analyses indicated some potential for modifying effects of the MTHFR 677C>T genotype and high-risk pregnancy, although the interaction was not statistically significant (high-risk subgroup OR 2.37, 95% CI 1.24-4.53, p-value for interaction =0.14). CONCLUSIONS: Our results suggest an independent effect of early to mid-pregnancy elevated maternal homocysteine on placenta-mediated pregnancy complications.


Assuntos
Aborto Espontâneo/sangue , Descolamento Prematuro da Placenta/sangue , Homocisteína/sangue , Recém-Nascido Pequeno para a Idade Gestacional/sangue , Pré-Eclâmpsia/sangue , Adulto , Canadá , Feminino , Humanos , Recém-Nascido , Testes para Triagem do Soro Materno , Razão de Chances , Placenta/metabolismo , Gravidez , Segundo Trimestre da Gravidez/sangue , Fatores de Risco
20.
PLoS One ; 14(2): e0211114, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30811416

RESUMO

OBJECTIVES: To investigate the incidence of inherited thrombophilias in patients with adverse obstetric outcomes and to compare detection rates of thrombophilias between standard blood tests and a novel genetic test. METHODS: This is a case-control prospective study performed in Hospital Sant Joan de Déu in Barcelona, Spain. Cases had a history of intrauterine growth restriction requiring delivery before 34 weeks gestation, placental abruption before 34 weeks gestation, or severe preeclampsia. Controls had at least two normal, spontaneously conceived pregnancies at term, without complications or no underlying medical disease. At least 3 months after delivery, all case and control women underwent blood collection for standard blood tests for thrombophilias and saliva collection for the genetic test, which enables the diagnosis of 12 hereditary thrombophilias by analyzing genetic variants affecting different points of the blood coagulation cascade. RESULTS: The study included 33 cases and 41 controls. There were no statistically significant differences between cases and controls in the standard blood tests for thrombophilias in plasma or the TiC test for genetic variables. One clinical-genetic model was generated using variables with the lowest P values: ABO, body mass index, C_rs5985, C_rs6025, and protein S. This model exhibited good prediction capacity, with an area under the curve of almost 0.7 (P <0.05), sensitivity of almost 67%, and specificity of 70%. CONCLUSION: Although some association may exist between hypercoagulability and pregnancy outcomes, no significant direct correlation was observed between adverse obstetric outcomes and inherited thrombophilias when analyzed using either standard blood tests or the genetic test. Future studies with a larger sample size are required to create a clinical-genetic model that better discriminates women with a history of adverse pregnancy outcomes and an increased risk of poor outcomes in subsequent pregnancies.


Assuntos
Complicações Hematológicas na Gravidez/genética , Trombofilia/complicações , Trombofilia/genética , Descolamento Prematuro da Placenta/genética , Adulto , Estudos de Casos e Controles , Feminino , Retardo do Crescimento Fetal/genética , Testes Genéticos , Humanos , Incidência , Recém-Nascido , Pessoa de Meia-Idade , Pré-Eclâmpsia/genética , Gravidez , Complicações Hematológicas na Gravidez/diagnóstico , Complicações Hematológicas na Gravidez/epidemiologia , Resultado da Gravidez , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Espanha/epidemiologia , Trombofilia/epidemiologia , Adulto Jovem
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