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1.
PLoS One ; 15(2): e0229568, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32101584

RESUMO

OBJECTIVE: To determine whether the presence of co-existing sleep-disordered breathing (SDB) is associated with worse perinatal outcomes among women diagnosed with a hypertensive disorder of pregnancy (HDP), compared with normotensive controls. STUDY DESIGN: Women diagnosed with HDP (gestational hypertension or preeclampsia) and BMI- and gestation-matched controls underwent polysomnography in late pregnancy to determine if they had coexisting SDB. Fetal heart rate (FHR) monitoring accompanied the sleep study, and third trimester fetal growth velocity was assessed using ultrasound. Cord blood was taken at delivery to measure key regulators of fetal growth. RESULTS: SDB was diagnosed in 52.5% of the HDP group (n = 40) and 38.1% of the control group (n = 42); p = .19. FHR decelerations were commonly observed during sleep, but the presence of SDB did not increase this risk in either the HDP or control group (HDP group-SDB = 35.3% vs. No SDB = 40.0%, p = 1.0; control group-SDB = 41.7% vs. No SDB = 25.0%, p = .44), nor did SDB affect the total number of decelerations overnight (HDP group-SDB = 2.7 ± 1.0 vs. No SDB = 2.8 ± 2.1, p = .94; control group-SDB = 2.0 ± 0.8 vs. No SDB = 2.0 ± 0.7, p = 1.0). Fetal growth restriction was the strongest predictor of fetal heart rate events during sleep (aOR 5.31 (95% CI 1.26-22.26), p = .02). The presence of SDB also did not adversely affect fetal growth; in fact among women with HDP, SDB was associated with significantly larger customised birthweight centiles (43.2% ± 38.3 vs. 16.2% ± 27.0, p = .015) and fewer growth restricted babies at birth (30% vs. 68.4%, p = .026) compared to HDP women without SDB. There was no impact of SDB on measures of fetal growth for the control group. Cord blood measures of fetal growth did not show any adverse effect among women with SDB, either in the HDP or control group. CONCLUSION: We did not find that the presence of mild SDB worsened fetal acute or longitudinal outcomes, either among women with HDP or BMI-matched normotensive controls. Unexpectedly, we found the presence of SDB conferred a better prognosis in HDP in terms of fetal growth. The fetus has considerable adaptive capacity to withstand in utero hypoxia, which may explain our mostly negative findings. In addition, SDB in this cohort was mostly mild. It may be that fetal sequelae will only be unmasked in the setting of more severe degrees of SDB and/or underlying placental disease.


Assuntos
Hipertensão Induzida pela Gravidez/fisiopatologia , Resultado da Gravidez/epidemiologia , Síndromes da Apneia do Sono/fisiopatologia , Adulto , Austrália , Peso ao Nascer , Estudos de Coortes , Feminino , Desenvolvimento Fetal/fisiologia , Retardo do Crescimento Fetal/metabolismo , Frequência Cardíaca Fetal/fisiologia , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional/metabolismo , Recém-Nascido Pequeno para a Idade Gestacional/fisiologia , Parto/fisiologia , Polissonografia , Pré-Eclâmpsia/fisiopatologia , Gravidez , Complicações na Gravidez/fisiopatologia , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Síndromes da Apneia do Sono/complicações
2.
PLoS One ; 15(2): e0228630, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32027690

RESUMO

OBJECTIVE: The relevance between time-series fetal heart rate (FHR) pattern changes during labor and outcomes such as arterial blood gas data at delivery has not been studied. Using 3-tier and 5-tier classification systems, we studied the relationship between time-series FHR pattern changes before delivery and umbilical artery blood gas data at delivery. METHODS: The subjects were 1,909 low-risk women with vaginal delivery (age: 29.1 ± 4.4 years, parity: 1.7 ± 0.8). FHR patterns were classified by a skilled obstetrician based on each 10 min-segment of the last 60 min before delivery from continuous CTG records in an obstetric clinic. RESULTS: The relationship between each 10 min-segment FHR pattern classification from 60 minutes before delivery and umbilical artery blood pH and base excess (BE) values at delivery changed with time. In the 3-tier classification, mean pH of Category I group in each 10 min-segment was significantly higher than that of Category II group. For Category I groups in each 10-minute segment, its number decreased and its average pH increased as the delivery time approached. In the 5-tier classification, there was the same tendency. About each level group in 10 min-segment, the higher the level, the lower the blood gas values, and mean pH of higher level groups decreased as the delivery time approached. CONCLUSIONS: The relationship between classifications and outcomes was clear at any time from 60 min before delivery in 3- and 5-tier classifications, and the 5-tier classification was more relevant.


Assuntos
Sangue Fetal , Frequência Cardíaca Fetal , Adulto , Gasometria , Parto Obstétrico , Feminino , Monitorização Fetal/métodos , Humanos , Concentração de Íons de Hidrogênio , Trabalho de Parto , Gravidez , Fatores de Tempo , Artérias Umbilicais
4.
Adv Clin Exp Med ; 29(1): 33-44, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31965765

RESUMO

BACKGROUND: Remote pregnancy monitoring is one of the most promising applications of telemedicine; however, the diagnostic value of self-examination using mobile cardiotocography (CTG) devices and remote analysis of the subsequent results has never been properly studied. OBJECTIVES: The study aimed to compare the diagnostic usefulness of CTG self-examination using a mobile device to examination performed by a medical professional using a stationary device; and to evaluate the quality of CTG analysis performed remotely. MATERIAL AND METHODS: Eighty-two pairs of CTG recordings were collected; each pair consisted of a single recording from an examination performed by a midwife using a stationary device, and another recording from an unassisted patient self-examination using a mobile device. Recordings were performed with a maximum time interval of 30 min. Each recording was analyzed twice. Primary analysis included a comparison of the assisted examination evaluated on-site vs the self-examination evaluated remotely in pairs. Secondary analysis was conducted by an independent expert who evaluated the unpaired recordings. Baseline fetal heart rate (BFHR) values were compared independently. RESULTS: We found that patients were more likely to perform inconclusive recordings than experienced midwives; however, the self-examination feasibility was satisfactory. The primary analysis showed 88.4% agreement of the recorded pairs; 11.6% of inconsistent pairs were due to inter-observer variability or medical reasons. The independent expert's analysis showed 97.1% agreement between the assisted and unassisted examinations. Paired t-test for BFHR values showed a statistically significant but clinically negligible mean difference between the 2 devices at 1.75 bpm. CONCLUSIONS: The CTG examinations performed using mobile devices present satisfactory feasibility and equivalent diagnostic value compared to conventional devices, while the remote evaluation of recordings is as reliable as on-site analysis. Remote pregnancy surveillance is safe, effective and may be implemented into everyday obstetric care.


Assuntos
Cardiotocografia , Frequência Cardíaca Fetal , Feminino , Humanos , Variações Dependentes do Observador , Gravidez
6.
Int J Gynaecol Obstet ; 148(2): 145-156, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31646629

RESUMO

BACKGROUND: Using Doppler to improve detection of intrapartum fetal heart rate (FHR) abnormalities coupled with appropriate, timely intrapartum care in low- and middle-income countries (LMIC) can save lives. OBJECTIVE: To review studies using Doppler to improve detection of intrapartum FHR abnormalities and intrapartum care quality in LMIC health facilities. SEARCH STRATEGY: PubMed, Web of Science, Embase, Global Health, and Scopus were searched from inception to October 2018 by combining terms for Doppler, perinatal outcomes, and FHR monitoring. SELECTION CRITERIA: Selected studies compared Doppler and Pinard stethoscope for detecting/monitoring intrapartum FHR, or described provider and maternal preferences for FHR monitoring in LMIC settings. DATA COLLECTION AND ANALYSIS: Two team members independently screened and collected data. Risk of bias was assessed by Cochrane EPOC criteria. RESULTS: Eleven studies from eight countries were included. Doppler was superior at detecting abnormal intrapartum FHR as compared with Pinard stethoscope, but was not associated with improved perinatal outcomes. Using Doppler on admission helped to accurately measure perinatal deaths occurring after facility admission. CONCLUSION: Studies and program learning are needed to translate improved detection of FHR abnormalities to improved case management in LMICs. Doppler should be used to calculate a facility indicator of intrapartum care quality. PROSPERO registration: CRD42019121924.


Assuntos
Cardiotocografia/métodos , Cardiopatias Congênitas/diagnóstico por imagem , Frequência Cardíaca Fetal/fisiologia , Ultrassonografia Doppler , Países em Desenvolvimento , Feminino , Saúde Global , Humanos , Recém-Nascido , Mortalidade Perinatal , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Ultrassonografia Pré-Natal
8.
Arch Gynecol Obstet ; 301(1): 137-142, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31883047

RESUMO

PURPOSE: Phase-rectified signal averaging method (PRSA) represents an analysis method which applied on fetal cardiotocography (CTG) allows the quantification of the speed of fetal heart rate changes. By calculating the average deceleration capacity (ADC) an assessment of the fetal autonomic nervous system (ANS) is possible. The objective of this study was to test its ability to predict perinatal acidosis. METHODS: A case-control study was performed at a University Hospital in Munich. All intrapartum CTG heart rate tracings saved during a 7-year period were considered for analysis. All neonates born with an umbilical arterial blood pH ≤ 7.10 were considered as cases. Controls were defined as healthy fetuses born with a pH ≥ 7.25. The main matching criteria were gestational age at delivery, parity, birth mode, and birth weight percentile. Exclusion criteria were a planned caesarean section, fetal malformations, and multiple pregnancies. ADC and STV were then calculated during the last 60, the last 45, and the last 30 min intervals prior to delivery. RESULTS: Of all stored birth CTG recordings, 227 cases met the inclusion criteria and were studied. ADC was significantly higher in fetuses born with acidemia (4.85 bpm ± 3.0) compared to controls (3.36 bpm ± 2.2). The area under ROC curve was 0.659 (95% CI 0.608-0.710) for ADC and 0.566 (0.512-0.620) for STV (p = 0.013). CONCLUSIONS: This study confirms that the assessment of ADC using PRSA represents a good additional tool for the prediction of acute fetal acidosis during delivery.


Assuntos
Acidose/sangue , Cardiotocografia/métodos , Sangue Fetal/química , Doenças Fetais/diagnóstico , Estudos de Casos e Controles , Feminino , Sangue Fetal/citologia , Doenças Fetais/sangue , Frequência Cardíaca Fetal/fisiologia , Humanos , Masculino , Gravidez
9.
Theriogenology ; 142: 303-309, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31711710

RESUMO

During stage II of parturition, the bovine fetus is at risk of oxygen deficiency caused by insufficient gas exchange between the dam and the fetus. The early detection of this critical condition, followed by assistance at calving, can help to improve the vitality of the newborn calf, or even prevent it from being born dead. By using pulse oximetry, the arterial oxygen saturation, as well as the pulse rate, can be continuously and non-invasively measured. The aim of our study was to identify critical thresholds for the parameters 'arterial oxygen saturation (FSpO2)' and 'pulse rate (PR)' that indicate a severe postnatal risk for calves to suffer from acidosis. FSpO2 and PR from 40 bovine fetuses were recorded during the last 25 min of calving with a commercially available pulse oximeter (Radius-7, Masimo Corporation, Irvine, USA). The calves were tested immediately after birth for acidosis by analyzing their blood with a portable blood gas analyzer (VetScan iStat1, Abaxis Inc., Union City, USA). Retrospectively, the pulsoximetric data were scanned for predefined patterns. The validity of these patterns to predict acidosis in newborn calves was analyzed by using receiver operating characteristics (ROC) curve analyses. In general, PR was a stronger predictive parameter for acidosis than FSpO2, with the greatest area under the curve (AUC) for the PR criteria 'Pulse rate > 120 beats per minute (bpm) for at least 2 min', with an AUC of 0.764, in contrast to an AUC of 0.613 for the best FSpO2 criteria 'FSpO2 < 40% for at least 50% of the measurement'. Further studies should investigate whether vitality after calving can be improved and fetal death rate can be reduced when obstetric assistance is performed as soon as one of these criteria apply to the bovine fetus. For more practical implementation in the field, improvement of the device's hardware would be necessary.


Assuntos
Acidose/diagnóstico , Artérias/química , Doenças Fetais/diagnóstico , Monitorização Fetal , Frequência Cardíaca Fetal , Oximetria , Oxigênio/sangue , Acidose/veterinária , Animais , Animais Recém-Nascidos , Bovinos , Doenças dos Bovinos/diagnóstico , Feminino , Doenças Fetais/veterinária , Monitorização Fetal/métodos , Monitorização Fetal/veterinária , Trabalho de Parto/fisiologia , Masculino , Oximetria/métodos , Oximetria/veterinária , Oxigênio/análise , Valor Preditivo dos Testes , Gravidez , Prognóstico , Troca Gasosa Pulmonar/fisiologia , Reprodutibilidade dos Testes , Estudos Retrospectivos
11.
BMC Pregnancy Childbirth ; 19(1): 501, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842798

RESUMO

BACKGROUND: Maternal heart rate artefact is a signal processing error whereby the fetal heart rate is masked by the maternal pulse, potentially leading to danger by failure to recognize an abnormal fetal heart rate or a pre-existing fetal death. Maternal heart rate artefact may be exacerbated by autocorrelation algorithms in modern fetal monitors due to smooth transitions between maternal and fetal heart rates rather than breaks in the tracing. In response, manufacturers of cardiotocography monitors recommend verifying fetal life prior to monitoring and have developed safeguards including signal ambiguity detection technologies to simultaneously and continuously monitor the maternal and fetal heart rates. However, these safeguards are not emphasized in current cardiotocography clinical practice guidelines, potentially leading to a patient safety gap. METHODS: The United States Food and Drug Administration Manufacturer and User Facility Device Experience database was reviewed for records with event type "Death" for the time period March 31, 2009 to March 31, 2019, in combination with search terms selected to capture all cases reported involving cardiotocography devices. Records were reviewed to determine whether maternal heart rate artefact was probable and/or whether the report contained a recommendation from the device manufacturer regarding maternal heart rate artefact. RESULTS: Forty-seven cases of perinatal mortality were identified with probable maternal heart rate artefact including 14 with antepartum fetal death prior to initiation of cardiotocography, 14 with intrapartum fetal death or neonatal death after initiation of cardiotocography, and 19 where the temporal relationship between initiation of cardiotocography and death cannot be definitively established from the report. In 29 cases, there was a recommendation from the manufacturer regarding diagnosis and/or management of maternal heart rate artefact. CONCLUSIONS: This case series indicates a recurring problem with undetected maternal heart rate artefact leading to perinatal mortality and, in cases of pre-existing fetal death, healthcare provider confusion. In response, manufacturers frequently recommend safeguards which are found in their device's instructions for use but not in major intrapartum cardiotocography guidelines. Cardiotocography guidelines should be updated to include the latest safeguards against the risks of maternal heart rate artefact. An additional file summarizing key points for clinicians is included.


Assuntos
Artefatos , Cardiotocografia/mortalidade , Morte Perinatal/etiologia , Mortalidade Perinatal , Cardiotocografia/métodos , Feminino , Frequência Cardíaca Fetal , Humanos , Recém-Nascido , Gravidez , Processamento de Sinais Assistido por Computador , Estados Unidos/epidemiologia , United States Food and Drug Administration
12.
Tunis Med ; 97(3): 500-503, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31729726

RESUMO

A mother presented with a fetus at 22±1 weeks of gestation with a sustained supraventricular tachycardia  (SVT) at initially 186 beat per minute (bpm). The fetal M-mode echocardiography showed a 1/1 atrio ventricular ratio (with short atrioventricular (AV) interval and a long ventriculo-atrial (VA) interval, suggesting a Persistent junctional reciprocating tachycardia (PJRT) . Upon  initial present no signs of heart failure or hydrops  were noted and treament was initiated with amiodarone and  digoxin . Fetus heart rate slowed  .Postnatal electrocardiogram  Confirmed  the diagnosis of PJRT New born was put on amiodarone and proparonal). Sinus rhythm was rapidly achieved 9 days later .The patient doing well at  10 months of age with maintain of sinus rhythm. Conclusion: our case report illustrates  a particular  form of  JRT   diagnosed  prenatal PJRT  , characterized  by  a good clinical tolerance, its absence of evolution towards cardiomyopathy  and its rapid and unusual response to antiarrhythmics.


Assuntos
Antiarrítmicos/uso terapêutico , Doenças Fetais , Taquicardia Ectópica de Junção/diagnóstico , Taquicardia Ectópica de Junção/tratamento farmacológico , Taquicardia Reciprocante/diagnóstico , Taquicardia Reciprocante/tratamento farmacológico , Adulto , Amiodarona/administração & dosagem , Digoxina/administração & dosagem , Quimioterapia Combinada , Ecocardiografia , Eletrocardiografia , Feminino , Doenças Fetais/diagnóstico , Doenças Fetais/tratamento farmacológico , Idade Gestacional , Frequência Cardíaca Fetal , Humanos , Recém-Nascido , Masculino , Gravidez , Segundo Trimestre da Gravidez/efeitos dos fármacos , Segundo Trimestre da Gravidez/fisiologia , Taquicardia Ectópica de Junção/congênito , Taquicardia Reciprocante/congênito , Ultrassonografia Pré-Natal
13.
Eur J Obstet Gynecol Reprod Biol ; 243: 158-161, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31706055

RESUMO

OBJECTIVE: Early pregnancy models for prediction of GDM have been proposed, mostly using anamnestic and biochemical parameters. The aim of our study was to evaluate the strength of association of first trimester fetal heart rate (FHR) in predicting the development of gestational diabetes (GDM). STUDY DESIGN: We considered in our analysis singleton non-diabetic pregnant women who underwent a first trimester screening at 11-14 weeks. Data on maternal age, BMI, cigarette smoking, NT, FHR, CRL, DV-PVI, ß-hCG and PAPP-A were included in the analysis. Multivariate logistic regression analysis was used to estimate the association between maternal characteristics and first-trimester ultrasound measurements and GDM. We evaluated the efficacy of different models for the prediction of GDM. RESULTS: We considered 603 women, of whom 199 (33%) were subsequently diagnosed with GDM. ROC analysis showed that first trimester FHR was highly predictive of GDM (AUC 0.809, 95% CI 0.769-0.849, p < 0.001). At FPR of 20%, first trimester FHR had a detection rate of 65.2% for GDM (positive likelihood ratio: 3.26; negative likelihood ratio: 0.43), which increased to 89.5% at FPR of 40% (positive likelihood ratio: 2.24; negative likelihood ratio: 0.17). When considering as threshold 162 bpm, FHR showed detection rate of 76.9%, specificity of 67.1% and negative predictive value of 85.5% for GDM. CONCLUSION: This is the first study to highlight the potential role of first trimester FHR as early predictor of GDM. In our cohort, a threshold of 162 bpm has shown high detection rate and NPV for GDM.


Assuntos
Diabetes Gestacional/epidemiologia , Frequência Cardíaca Fetal , Primeiro Trimestre da Gravidez , Adulto , Índice de Massa Corporal , Estatura Cabeça-Cóccix , Feminino , Humanos , Modelos Logísticos , Idade Materna , Análise Multivariada , Medição da Translucência Nucal , Obesidade Materna/epidemiologia , Gravidez , Prognóstico , Fluxo Pulsátil , Fumar/epidemiologia , Veias Umbilicais/diagnóstico por imagem , Veia Cava Inferior/diagnóstico por imagem
14.
BMC Pregnancy Childbirth ; 19(1): 405, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694569

RESUMO

INTRODUCTION: Rates of cesarean section (CS) are increasing and abnormal fetal heart rate tracing and concern about consequent acidosis remain one of the most common indications for primary CS. Umbilical artery (UA) lactate sampling provides clinicians with point of care feedback on CTG interpretation and intrapartum care and may result in altered future practice. MATERIALS AND METHODS: From 3rd March - 12th November 2014 we undertook a before and after study in Pretoria, South Africa, to determine the impact of introducing a clinical package of fetal heart rate monitoring education and prompt feedback with UA cord lactate sampling, using a hand-held meter, on maternal and perinatal outcomes. RESULTS: Nine hundred thirty-six consecutive samples were analyzed (pre n = 374 and post n = 562). There was no difference in mean lactate (4.6 mmol/L [95%CI 4.4-4.8] compared with 4.9 mmol/L [95%CI 4.7-5.1], p = 0.089). Suspected fetal compromise was reduced in the post-intervention period: 30·2% vs 22·1%, aOR 0·71, 95% CI 0·52-0·96, p = 0·027. Cesarean section rates were significantly reduced in the univariate analysis: pre- 40·3% vs post-intervention 31·6% (p = 0·007). This reduction remained significant when adjusted for previous cesarean section, primiparity, maternal HIV infection and preterm birth (aOR 0·72, 95%CI 0·54-0·98, p = 0·035). Neonatal outcomes did not differ between the two groups. CONCLUSION: The introduction of a clinical practice package of fetal heart rate monitoring education combined with routine UA cord lactate sampling has the potential to reduce the cesarean section rate without increasing adverse neonatal outcomes in a low-resource setting.


Assuntos
Cesárea/tendências , Educação de Pós-Graduação em Medicina/métodos , Recursos em Saúde , Frequência Cardíaca Fetal/fisiologia , Ácido Láctico/sangue , Monitorização Fisiológica , Obstetrícia/educação , Adulto , Biomarcadores/sangue , Cesárea/educação , Feminino , Seguimentos , Humanos , Recém-Nascido , Trabalho de Parto , Gravidez , Estudos Retrospectivos , África do Sul , Artérias Umbilicais
15.
Medicine (Baltimore) ; 98(48): e18182, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770271

RESUMO

RATIONALE: Rupture of an unscarred uterus after in vitro fertilization-embryo transfer (IVF-ET) in a primiparous woman is rare. Assisted reproductive technology (ART)-induced rupture of an unscarred uterus is usually attributable to increased dizygotic twinning rates. Salpingectomy can result in cornual scarring and increase the risk of uterine rupture as well as the mortality rate in a subsequent ectopic pregnancy. Here, we present the first reported case of a spontaneous, third-trimester, uterine rupture in a primiparous woman after IVF-ET due to a history of bilateral salpingectomy because of bilateral oviduct and ovarian cysts; the patient did not have an ectopic pregnancy or any cornual or other uterine scarring during this pregnancy after IVF-ET. PATIENT CONCERNS: A 24-year-old woman with a history of IVF-ET and bilateral salpingectomy was admitted to our hospital with unexplained acute upper abdominal pain during the third trimester. DIAGNOSIS: The fetal heart rate was abnormal. Abdominal ultrasonography was negative. Computed tomography revealed a small amount of abdominal and pericardial effusion. Laboratory tests revealed increased white blood cells. A diagnosis of pregnancy complicated by acute abdomen was considered. Emergent exploratory laparotomy revealed a uterine rupture at the right fundus adjacent to the right cornual area. INTERVENTIONS: The patient was successfully managed with simultaneous exploratory laparotomy and lower-segment cesarean section. The rupture site was repaired. OUTCOMES: Two live infants were uneventfully delivered. Follow-up assessments of the mother and the female baby on the 42nd postpartum day yielded normal results. The male infant was diagnosed with left hydronephrosis and required an operation. LESSONS: We conclude that the ART-associated increase in dizygotic twinning rates may be a neglected risk factor for spontaneous rupture of the unscarred uterus, especially in patients who have undergone salpingectomy. Uterine rupture should be considered in a patient with multiple pregnancy following IVF-ET who presents with acute abdominal pain and abnormal fetal heart rate. Timely exploratory laparotomy is the key to a good prognosis.


Assuntos
Dor Abdominal , Cesárea/métodos , Transferência Embrionária , Fertilização In Vitro , Frequência Cardíaca Fetal , Ruptura Espontânea , Ruptura Uterina , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Transferência Embrionária/efeitos adversos , Transferência Embrionária/métodos , Feminino , Fertilização In Vitro/efeitos adversos , Fertilização In Vitro/métodos , Monitorização Fetal/métodos , Humanos , Gravidez , Resultado da Gravidez , Terceiro Trimestre da Gravidez , Gravidez de Gêmeos , Fatores de Risco , Ruptura Espontânea/diagnóstico , Ruptura Espontânea/etiologia , Ruptura Espontânea/cirurgia , Salpingectomia/efeitos adversos , Ruptura Uterina/diagnóstico , Ruptura Uterina/etiologia , Ruptura Uterina/cirurgia , Adulto Jovem
16.
BMC Pregnancy Childbirth ; 19(1): 351, 2019 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-31604456

RESUMO

BACKGROUND: Breast stimulation is performed to self-induce labor. However, there are apparently no reports on hormonal evaluation during stimulation for consecutive days in relation to induction effect. We evaluated the salivary oxytocin level following 3 consecutive days of own breast stimulation for 1 h each day compared with no breast stimulation. METHODS: We used a quasi-experimental design. The participants were low-risk primiparas between 38 and 39 gestational weeks. Eight saliva samples per participant were collected at preintervention and 30, 60, and 75 min postintervention on the first and third days. The primary outcome was change in the salivary oxytocin level on the third day after 3 consecutive days of breast stimulation for 1 h each day compared with no breast stimulation. The secondary outcomes were the rate of spontaneous labor onset and negative events including uterine hyperstimulation and abnormal fetal heart rate. RESULTS: Between February and September 2016, 42 women were enrolled into the intervention group (n = 22) or control group (n = 20). As there were differences in the basal oxytocin levels between the 2 groups, to estimate the change in the oxytocin level from baseline, we used a linear mixed model with a first-order autoregressive (AR1) covariance structure. The dependent variable was change in the oxytocin level from baseline. The independent variables were gestational weeks on the first day of intervention, age, education, rs53576 and rs2254298, group, time point, and interaction of group and time. After Bonferroni correction, the estimated change in the mean oxytocin level at 30 min on the third day was significantly higher in the intervention group (M = 20.2 pg/mL, SE = 26.2) than in the control group (M = - 44.4 pg/mL, SE = 27.3; p = 0.018). There was no significant difference in the rate of spontaneous labor onset. Although there were no adverse events during delivery, uterine tachysystole occurred in 1 case during the intervention. CONCLUSIONS: The estimated change in the mean oxytocin level was significantly higher 30 min after breast stimulation on the third day. Thus, consecutive breast stimulation increased the salivary oxytocin level. Repeated stimulations likely increase the oxytocin level. TRIAL REGISTRATION: UMIN000020797 (University Hospital Medical Information Network; Prospective trial registered: January 29, 2016).


Assuntos
Mama , Ocitocina/metabolismo , Estimulação Física , Adulto , Feminino , Frequência Cardíaca Fetal , Humanos , Início do Trabalho de Parto , Trabalho de Parto , Paridade , Polimorfismo de Nucleotídeo Único , Gravidez , Receptores de Ocitocina/genética , Saliva/química , Contração Uterina
17.
Rev Gaucha Enferm ; 40: e20180419, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31576969

RESUMO

OBJECTIVE: To analyze the adequacy of prenatal care in a Birth Center and the causes associated with maternal and newborn transfers to the hospital. METHODS: Cross-sectional study of the care provided at the only Birth Center in Rio de Janeiro, from 2009 to 2014. Statistical analyzes were based on the χ2 test and Prevalence Ratio (PR). RESULTS: Suitable prenatal care was predominant (42.8%) and there was no association (p = 0.55) with the transfers. Maternal transfer is caused by the ruptured amniotic sac (PR = 2.09, 95% CI 1.62-2.70) and altered fetal heart rates (PR = 3.06, 95% CI, 2.13-4.39). Newborn transfers are associated with the presence of meconium in the amniotic fluid (PR = 2.40, 95% CI 1.30-4.43); Apgar below 7 (PR = 5.33, 95% CI 2.65-10.73); and ventilatory assistance at birth (PR = 9.41, 95% CI 5.52-16.04). CONCLUSION: Complications during intrapartum care are the causes associated with transfers.


Assuntos
Centros de Assistência à Gravidez e ao Parto , Transferência de Pacientes , Cuidado Pré-Natal/normas , Adolescente , Adulto , Âmnio , Líquido Amniótico , Índice de Apgar , Distribuição de Qui-Quadrado , Estudos Transversais , Feminino , Frequência Cardíaca Fetal , Humanos , Recém-Nascido , Mecônio , Mães , Gravidez , Ruptura Espontânea , Adulto Jovem
18.
PLoS One ; 14(10): e0223057, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31574123

RESUMO

Non-invasive fetal electrocardiography (NI-FECG) plays an important role in fetal heart rate (FHR) measurement during the pregnancy. However, despite the large number of methods that have been proposed for adult ECG signal processing, the analysis of NI-FECG remains challenging and largely unexplored. In this study, we propose a prefix tree-based framework, called QRStree, for FHR measurement directly from the abdominal ECG (AECG). The procedure is composed of three stages: Firstly, a preprocessing stage is employed for noise elimination. Secondly, the proposed prefix tree-based method is used for fetal QRS complexes (FQRS) detection. Finally, a correction stage is applied for false positive and false negative correction. The novelty of the framework relies on using the range of FHR to establish the connections between the FQRS. The consecutive FQRS can be considered as strings composed of alphabet items, thus we can use the prefix tree to store them. A vertex of the tree contains an alphabet, thus a path of the tree gives a string. Such that, by storing the connections of the FQRS into the prefix tree structure, the problem of FQRS detection converts to a problem of optimal path selection. Specifically, after selecting the optimal path of the tree, the nodes in the optimal path are collected as detected FQRS. Since the prefix tree can cover every possible combination of the FQRS candidates, it has the potential to reduce the occurrence of miss detections. Results on two different databases show that the proposed method is effective in FHR measurement from single-channel AECG. The focus on single-channel FHR measurement facilitates the long-term monitoring for healthcare at home.


Assuntos
Eletrocardiografia/métodos , Monitorização Fetal , Feto/fisiologia , Frequência Cardíaca Fetal/fisiologia , Bases de Dados Factuais , Feminino , Humanos , Gravidez , Cuidado Pré-Natal , Processamento de Sinais Assistido por Computador
19.
Rev Bras Ginecol Obstet ; 41(9): 531-538, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31546276

RESUMO

OBJETIVO: Determinar o efeito da caminhada em esteira sobre a frequência cardíaca materna (FCM) e parâmetros cardiotocográficos (batimentos cardiofetais basais [BCFs], movimentos ativos fetais [MAFs], número de acelerações e desacelerações e variabilidade de curta [STV] e longa [LTV] duração da frequência cardíaca fetal) em gestantes na 36a semana. MéTODOS: Foi realizado um ensaio clínico não randomizado e aberto com 88 gestantes saudáveis submetidas a caminhada de moderada intensidade na esteira e a cardiotocografia computadoriza em 3 momentos de 20 minutos (antes, durante e após a caminhada). RESULTADOS: A média dos BCFs diminuiu durante a caminhada, retornando a níveis prévios (antes: 137 bpm; durante: 98 bpm; após: 140 bpm; p < 0,001), com bradicardia ocorrendo em 56% dos fetos nos primeiros 10 minutos do exercício, e em 47% após 20 minutos. A bradicardia fetal não foi observada em outros momentos (antes ou depois). As médias da STV e da LTV foram 7,9, 17,0 e 8,0 milissegundos (p < 0,001) e 7,6, 10,7 e 7,6 bpm (p = 0,002) antes, durante e após a caminhada, respectivamente. A média dos números dos MAFs em 1 hora foi 29,9, 22,2 e 45,5, respectivamente, nos três momentos (p < 0,001). Nas mulheres com sobrepeso/obesidade, a média da FCM foi menor (p = 0,02). Após a análise de regressão logística, duas variáveis permaneceram significativamente associadas a bradicardia: aptidão maternal na 28a semana de gravidez (efeito protetor) e peso materno (aumento do risco). CONCLUSãO: Em fetos saudáveis, o exercício físico mostrou-se seguro, uma vez que, embora os BCFs e os MAFs diminuam durante a caminhada na esteira, foi observado um aumento da SVT e da LTV.


Assuntos
Exercício Físico/fisiologia , Feto/fisiologia , Frequência Cardíaca Fetal/fisiologia , Gravidez/fisiologia , Segurança , Adolescente , Adulto , Pressão Sanguínea/fisiologia , Cardiotocografia , Feminino , Humanos , Terceiro Trimestre da Gravidez/fisiologia , Caminhada/fisiologia , Adulto Jovem
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