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1.
Eur J Obstet Gynecol Reprod Biol ; 255: 190-196, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33147531

RESUMO

OBJECTIVE: We aimed to analyze the changing level of anxiety during COVID-19 pandemic in pregnant women, with and without high-risk indicators separately, in a tertiary care center serving also for COVID-19 patients, in the capital of Turkey. STUDY DESIGN: We designed a case-control and cross-sectional study using surveys. The Spielberger State-Trait Anxiety Scale questionnaire (STAI-T) and Beck Anxiety Inventory (BAI) which were validated in Turkish were given to outpatient women with high-risk pregnancies as study group and normal pregnancies as control group. A total of 446 women were recruited. RESULTS: There was a statistically significant difference between those with and without high-risk pregnancy in terms of Trait-State Anxiety scores with COVID-19 pandemic (p < 0.05). We found an increased prevalence of anxiety during COVID-19 pandemic in high-risk pregnant women comparing to pregnancies with no risk factors (p < 0.05). There was a statistically significant difference between the education level in high-risk pregnant women in terms of anxiety scores (p < 0.05), Beck Anxiety score was highest in high school graduates (42.75). While the level of Trait Anxiety was the highest with pandemic in those with high-risk pregnancy with threatened preterm labor and preterm ruptures of membranes (58.0), those with thrombophilia were the lowest (50.88). The State Anxiety level and Beck Anxiety Score of those with maternal systemic disease were the highest (53.32 and 45.53), while those with thrombophilia were the lowest (46.96 and 40.08). The scores of Trait Anxiety (56.38), State Anxiety (52.14), Beck Anxiety (43.94) were statistically higher during the pandemic in those hospitalized at least once (p < 0.05). CONCLUSION: High-risk pregnant women require routine anxiety and depression screening and psychosocial support during the COVID-19 pandemic. High-risk pregnancy patients have comorbid conditions most of the time, hence they not only at more risk for getting infected, but also have higher anxiety scores because of the stress caused by COVID-19 pandemic.


Assuntos
Ansiedade/epidemiologia , Complicações na Gravidez/epidemiologia , Gravidez de Alto Risco , Gestantes/psicologia , Adulto , Ansiedade/virologia , Estudos de Casos e Controles , Comorbidade , Estudos Transversais , Feminino , Humanos , Pacientes Internados/psicologia , Gravidez , Complicações na Gravidez/psicologia , Complicações na Gravidez/virologia , Prevalência , Escalas de Graduação Psiquiátrica , Turquia/epidemiologia , Adulto Jovem
2.
Arch Esp Urol ; 73(9): 813-818, 2020 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-33144535

RESUMO

OBJECTIVE: The exstrophy-epispadias complex (EEC) ranges from distal epispadias to cloacal exstrophy, with serious repercussions on the quality of life of patients. However, reconstructive surgery offers the opportunity to reach adulthood and consider motherhood.The objective of this work is to assess the uro-gynecological characteristics and the risks that pregnant women have with EEC. MATERIALS AND METHOD: Retrospective study of 50 patients diagnosed with EEC and treated in a reference center for this pathology, born between 1968 and 2000. Their medical records were reviewed and all demographic, pathological and gynecological data were collected. RESULTS: 37 patients have the inclusion criteria and of these 8 achieved 17 pregnancies (90% spontaneous and 10% through IVF). 10 were successful (50% at term) and 7 were abortions, 87.5% of which were in the first trimester. Urinary tract infection (UTI) was the most frequent complication (41.6%) and the most severe was intestinal occlusion. None of the patients presented renal function impairment during the gestation or dilation of the pathological upper urinary tract (UUT). 62.5% of the patients presented genital prolapses after pregnancies, 80% of which were grade III and IV. 87.5% were dry in the follow-up after their pregnancies. CONCLUSION: Pregnancy in the EEC patients is high risk and it is crucial that the follow-up is carried out by a specialized and integrated multidisciplinary team to minimize complications.


Assuntos
Extrofia Vesical , Epispadia , Adulto , Extrofia Vesical/cirurgia , Feminino , Humanos , Gravidez , Gravidez de Alto Risco , Qualidade de Vida , Estudos Retrospectivos
3.
J Perinat Med ; 48(9): 925-930, 2020 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-33035193

RESUMO

Pregnant women may be at risk for more severe manifestations and sequelae of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). At this time, there remain significant evidence gaps to allow for comprehensive counseling of pregnant women and their families, specifically regarding the risks of gestational-age specific maternal outcomes and potential risks of intrauterine or peripartum viral transmission to the fetus or newborn. As maternal fetal medicine providers and consultants, we are uniquely positioned to mitigate the risks associated with maternal infection and to guide the care for infected pregnant women by being able to provide the most current evidence-based recommendations. Such care requires incorporating the rapidly evolving data regarding this virus and its impact on pregnancy, as well as taking a stand to advocate for best scientific and clinical practices to optimize both women's health and public health during this pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Assistência Perinatal/métodos , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Complicações Infecciosas na Gravidez/virologia , Centers for Disease Control and Prevention, U.S. , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Cuidados Críticos/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Transmissão Vertical de Doença Infecciosa , Obstetrícia/métodos , Pandemias , Pneumonia Viral/diagnóstico , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/terapia , Resultado da Gravidez , Gravidez de Alto Risco , Cuidado Pré-Natal/métodos , Estados Unidos
4.
Rev. enferm. Cent.-Oeste Min ; 10(1): 3625, out. 2020.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1140130

RESUMO

Objetivo: compreender as representações sociais e experiências das gestantes que frequentam serviços especializados em gestação de alto risco. Método: estudo qualitativo, realizado com mulheres em assistência pré-natal de um serviço público especializado em Gestação de Cuidados Especiais de um município mineiro de médio porte. A coleta de dados ocorreu, por meio de entrevista semiestruturada na qual se utilizou as noções da Teoria das Representações Sociais e os dados organizados, por meio da Análise Estrutural de Narração, para realizar a interpretação das respostas. Resultado: as representações encontradas estão em torno das ideias relacionadas ao risco presente nas gestações e à experiência vivenciada nos atendimentos realizados nos serviços de referência, emergindo da análise três categorias temáticas: representações relacionadas ao modelo biomédico, representações relacionadas ao medo e representações relacionadas à morte. Conclusão: como consequência desse estudo, foi possível evidenciar que as representações das gestantes de alto risco giraram em torno de sentimentos de medo relacionado à gestação e da morte em decorrência dos agravos da condição de risco, além da valorização do modelo biomédico e do profissional de medicina em detrimento do trabalho em equipe multiprofissional e da promoção da saúde.(AU)


Objective: to understand the social representations and experiences of pregnant women who attend specialized services in high-risk pregnancies. Method: qualitative study carried out with women in prenatal care from a public service specializing in Special Care Gestation in a medium-sized town in Minas Gerais, Brazil. Data collection through a semi-structured interview in which the notions of the Theory of Social Representations and the data organized through the Structural Narration Analysis were used to interpret the responses. Result: the representations are around the ideas related to the risk present in pregnancies and the experience lived in the care provided in reference services, emerging from the analysis three thematic categories: representations related to the biomedical model, representations related to fear and representations related to death. Conclusion: as a result of this study, it was possible to show that the representations of high-risk pregnant women revolved around feelings of fear related to pregnancy and death due to the worsening of the risk condition, in addition to the valorization of the biomedical model and the health professionals in detriment of multiprofessional teamwork and health promotion (AU)


Objetivo: comprender las representaciones sociales y las experiencias de las mujeres embarazadas que asisten a servicios especializados en embarazos de alto riesgo. Método: estudio cualitativo, realizado con mujeres en atención prenatal de un servicio público especializado en gestación de atención especial en una ciudad mediana de Minas Gerais. La recopilación de datos se realizó a través de una entrevista semiestructurada en la que se utilizaron las nociones de la Teoría de las representaciones sociales y los datos organizados a través del Análisis estructural de la narración para interpretar las respuestas. Resultado: las representaciones encontradas giran en torno a las ideas relacionadas con el riesgo presente en los embarazos y la experiencia vivida en la atención prestada en los servicios de referencia, emergiendo del análisis tres categorías temáticas: representaciones relacionadas con el modelo biomédico, representaciones relacionadas con el miedo y representaciones relacionadas con la muerte. Conclusión: Como resultado de este estudio, fue posible mostrar que las representaciones de mujeres embarazadas de alto riesgo giraban en torno a sentimientos de miedo relacionados con el embarazo y la muerte debido al empeoramiento de la condición de riesgo, además de la valorización del modelo biomédico y el profesional de la salud. medicina en detrimento del trabajo en equipo multiprofesional y la promoción de la salud (AU)


Assuntos
Humanos , Feminino , Gravidez , Cuidado Pré-Natal , Enfermagem , Gravidez de Alto Risco
5.
Am J Perinatol ; 37(14): 1411-1416, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32992351

RESUMO

OBJECTIVE: The study aimed to compare the quantitative blood loss (QBL) and hemorrhage-related outcomes of pregnant women with and without a coronavirus disease 2019 (COVID-19) diagnosis. STUDY DESIGN: This retrospective cohort study of all live deliveries at Boston Medical Center between April 1, 2020 and July 22, 2020 compares the outcomes of pregnant women with a laboratory-confirmed COVID-19 positive diagnosis and pregnant women without COVID-19. The primary outcomes are QBL and obstetric hemorrhage. The secondary outcomes analyzed were a maternal composite outcome that consisted of obstetric hemorrhage, telemetry-level (intermediate care unit) or intensive care unit, transfusion, length of stay greater than 5 days, or intraamniotic infection, and individual components of the maternal composite outcome. Groups were compared using Student's t-test, Chi-squared tests, or Fisher's exact. Logistic regression was used to adjust for confounding variables. RESULTS: Of 813 women who delivered a live infant between April 1 and July 22, 2020, 53 women were diagnosed with COVID-19 on admission to the hospital. Women with a COVID-19 diagnosis at their time of delivery were significantly more likely to identify as a race other than white (p = 0.01), to deliver preterm (p = 0.05), to be diagnosed with preeclampsia with severe features (p < 0.01), and to require general anesthesia (p < 0.01). Women diagnosed with COVID-19 did not have a significantly higher QBL (p = 0.64). COVID-19 positive pregnant patients had no increased adjusted odds of obstetric hemorrhage (adjusted odds ratio [aOR]: 0.41, 95% confidence interval [CI]: 0.17-1.04) and no increased adjusted odds of the maternal morbidity composite (aOR: 0.98, 95% CI: 0.50-1.93) when compared with those without a diagnosis of COVID-19. CONCLUSION: Pregnant women with COVID-19 diagnosis do not have increased risk for obstetric hemorrhage, increased QBL or risk of maternal morbidity compared with pregnant women without a COVID-19 diagnosis. Further research is needed to describe the impact of a COVID-19 diagnosis on maternal hematologic physiology and pregnancy outcomes. KEY POINTS: · Information about blood loss associated with peripartum COVID-19 is limited.. · COVID-19 diagnosis is not associated with increase in obstetric hemorrhage.. · COVID-19 diagnosis is not associated with increase in blood loss..


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Hemorragia Pós-Parto/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Adulto , Comorbidade , Feminino , Humanos , Recém-Nascido , Pandemias , Gravidez , Gravidez de Alto Risco , Cuidado Pré-Natal/métodos , Estudos Retrospectivos , Fatores de Risco , Estados Unidos
6.
Nursing (Säo Paulo) ; 23(268): 4646-4653, set.2020.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1145325

RESUMO

Objetivo: Verificar a sexualidade vivenciada por gestantes de alto risco de uma maternidade de alta complexidade. Métodos: Estudo descritivo, exploratório e quantitativo, realizado em uma maternidade de alto risco do município de Recife-PE. 110 gestantes participaram do estudo sendo entrevistadas por meio de um questionário validado e estruturado sobre a sexualidade antes e durante a gestação. Os dados foram analisados descritiva e estatisticamente. Resultados: Maior parte das gestantes tinham entre 25 a 34 anos e 82% nunca conversaram sobre sexo com nenhum profissional de saúde, durante a gravidez. Em relação a nota conferida a variável desejo sexual, a mediana passou de 8,00 (antes da gestação) para 4,00 (durante a gestação) (p:0,001). Conclusão: Verificou-se que durante a gravidez ocorrem diversas alterações na mulher, e dentre elas, a sexualidade pode estar extremamente fragilizada, especialmente em gestantes de alto risco, pois além da gestação se faz presente também alguma condição patológica.(AU)


Objective: To verify the sexuality experienced by high-risk pregnant women in a highly complex maternity hospital. Methods: Descriptive, exploratory and quantitative study, carried out in a high-risk maternity hospital in the city of Recife-PE. 110 pregnant women participated in the study by being interviewed using a validated and structured questionnaire about sexuality before and during pregnancy. The data were analyzed descriptively and statistically. Results: Most pregnant women were between 25 and 34 years old and 82% never talked about sex with any health professional, during pregnancy. Regarding the score given to the variable sexual desire, the median went from 8.00 (before pregnancy) to 4.00 (during pregnancy) (p: 0.001). Conclusion: It was found that during pregnancy several changes occur in women, and among them, sexuality can be extremely fragile, especially in high-risk pregnant women, because in addition to pregnancy there is also some pathological condition.(AU)


Objetivo: Verificar la sexualidad experimentada por mujeres embarazadas de alto riesgo en un hospital de maternidad altamente complejo. Métodos: Estudio descriptivo, exploratorio y cuantitativo, realizado en una maternidad de alto riesgo en la ciudad de Recife-PE. 110 mujeres embarazadas participaron en el estudio al ser entrevistadas utilizando un cuestionario validado y estructurado sobre sexualidad antes y durante el embarazo. Los datos fueron analizados descriptiva y estadísticamente. Resultados: La mayoría de las mujeres embarazadas tenían entre 25 y 34 años y el 82% nunca habló sobre sexo con ningún profesional de la salud durante el embarazo. Con respecto a la puntuación dada a la variable deseo sexual, la mediana pasó de 8.00 (antes del embarazo) a 4.00 (durante el embarazo) (p: 0.001). Conclusión: Se descubrió que durante el embarazo se producen varios cambios en las mujeres, y entre ellos, la sexualidad puede ser extremadamente frágil, especialmente en mujeres embarazadas de alto riesgo, porque además del embarazo también existe una condición patológica.(AU)


Assuntos
Humanos , Feminino , Gravidez , Enfermagem Materno-Infantil , Gravidez de Alto Risco , Sexualidade , Saúde Materna , Fatores de Risco , Maternidades
7.
Obstet Gynecol ; 136(4): 745-755, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925617

RESUMO

OBJECTIVE: To investigate subsequent birth rates, maternal and neonatal outcomes for women with a history of placenta accreta spectrum (placenta accreta, increta, and percreta). METHODS: A population-based record linkage study of women who had a first, second, or third birth in New South Wales from 2003 to 2016 was conducted. Data were obtained from birth and hospital records and death registrations. Women with a history of placenta accreta spectrum were matched to women without, on propensity score and parity, to compare outcomes with women who had similar risk profiles. Modified Poisson regression models were used to calculate adjusted relative risk (aRR) for a range of maternal and neonatal outcomes. RESULTS: We identified recurrent placenta accreta spectrum in 27/570 (4.7%, 95% CI 3.0-6.5%) of second and 9/119 (7.6%, 95% CI 2.8-12.3%) of third pregnancies after placenta accreta spectrum in the preceding birth, with an overall recurrence rate of 38/689 (5.5%, 95% CI 3.9-7.5%, compared with the population prevalence of 25.5/10,000 births (95% CI 24.6-26.4). Subsequent births after placenta accreta spectrum had higher risk of postpartum hemorrhage (aRR 1.51, 95% CI 1.19-1.92), transfusion (aRR 2.13, 95% CI 1.17-3.90), cesarean delivery (aRR 1.19, 95% CI 1.02-1.37), manual removal of placenta (aRR 6.92, 95% CI 3.81-12.55), and preterm birth (aRR 1.43, 95% CI 1.03-1.98), with lower risk of small for gestational age (aRR 0.64, 95% CI 0.43-0.96), compared with similar-risk births. CONCLUSION: Women with a history of placenta accreta spectrum have increased risk of maternal morbidity, preterm birth, and placenta accreta spectrum in the subsequent pregnancy compared with similar-risk women with no previous placenta accreta spectrum, although the absolute risks are generally low. These findings may be used to inform counseling of women on the risks of future pregnancies.


Assuntos
Cesárea , Parto Obstétrico , Histerectomia , Placenta Acreta , Hemorragia Pós-Parto , Nascimento Prematuro , Adulto , Austrália/epidemiologia , Transfusão de Sangue/estatística & dados numéricos , Cesárea/métodos , Cesárea/estatística & dados numéricos , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Histerectomia/métodos , Histerectomia/estatística & dados numéricos , Recém-Nascido , Masculino , Placenta Acreta/epidemiologia , Placenta Acreta/terapia , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/terapia , Gravidez , Resultado da Gravidez/epidemiologia , Gravidez de Alto Risco , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Sistema de Registros/estatística & dados numéricos , História Reprodutiva , Risco Ajustado/métodos , Fatores de Risco
8.
Acta Obstet Gynecol Scand ; 99(11): 1486-1491, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32777082

RESUMO

INTRODUCTION: Emergency cesarean sections (EMCS) are associated with subsequent preterm birth, particularly at full dilation (FDCS), which is a cause of both second trimester miscarriages and early, recurrent spontaneous preterm birth (sPTB). The optimal management for these women in subsequent pregnancies is currently unknown. This study aims to assess efficacy of transvaginal cervical cerclage (TVC) in prevention of preterm birth among women who have had an EMCS followed by a subsequent late miscarriage or sPTB. MATERIAL AND METHODS: A historical cohort study was performed assessing outcomes of women attending the Preterm Surveillance Clinic at St Thomas' Hospital, London, who received TVC, with a history of EMCS (pregnancy A) followed by a sPTB/late miscarriage (pregnancy B) and a subsequent pregnancy (pregnancy C). A historical reference group managed in the same clinic was identified comprising women with any risk factor for sPTB, who required TVC. Incidence of delivery >24 to <30 weeks' gestation was compared with relative risk and 95% confidence intervals (CI). Subgroup analysis was carried out assessing women who had a previous FDCS. RESULTS: 209 women with a previous EMCS during labor (50 with FDCS), followed by sPTB/late miscarriage were identified. 178 progressed beyond 24 weeks; of these, 56 received TVC and formed the study group. 905 high-risk women were identified; of these, 154 received TVC and formed the reference group. Despite TVC treatment, 17/56 (30%) of the study group delivered <30 weeks' gestation compared with 5/154 (3%) of the reference group (RR 9.4, 95% CI 3.6-24.2, P < .001). In the subset of 17 women in the study group with a previous FDCS, followed by sPTB/late miscarriage, 6/17 (35%) delivered <30 weeks' gestation, significantly higher than the reference group (P < .001) but similar to EMCS at less than full dilation (35% vs 28%, P = .596). Overall, 33/72 (46%) women receiving cerclage with prior EMCS had either a mid-trimester loss or delivery <30 weeks. CONCLUSIONS: Transvaginal cervical cerclage appears less effective in preventing preterm birth among pregnant women who have had an EMCS followed by a sPTB/late miscarriage compared with other high-risk women. The lack of efficacy in the subgroup with an FDCS was similar.


Assuntos
Cerclagem Cervical , Cesárea , Nascimento Prematuro/prevenção & controle , Incompetência do Colo do Útero/cirurgia , Aborto Espontâneo , Adulto , Estudos de Coortes , Bases de Dados Factuais , Emergências , Feminino , Humanos , Incidência , Gravidez , Gravidez de Alto Risco , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Fatores de Risco , Resultado do Tratamento , Incompetência do Colo do Útero/etiologia , Incompetência do Colo do Útero/fisiopatologia
9.
Medicine (Baltimore) ; 99(31): e21448, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756164

RESUMO

To investigate the diagnostic performance of ultrasound (US) for pregnant women with previous caesarean section (CS) occurring lower uterine segment (LUS) dehiscence and rupture.107 pregnant women with previous CS and LUS thickness of 1.0 mm or less were recruited, the LUS and myometrium was measured, and US findings suggestive of uterine rupture were compared with findings at laparotomy. The included pregnant women were assigned into 2 groups, including 64 pregnant women had vaginal delivery at full-term and 43 pregnant women underwent repeat CS at preterm.US findings suggestive of uterine rupture and dehiscence occurred in 18 women and 89 women, respectively; ten of them developed uterine rupture, and the incidence of uterine rupture was 9.34% (10/107). The sensitivity, specificity, accuracy, positive, and negative predictive values of US for the evaluation of LUS dehiscence and rupture were 100.0%, 91.8%, 92.5%, 55.6%, and 100.0%, respectively. There was no severe maternal obstetric complication, 1 fetus died, and the other fetuses were born with a 5-minute Apgar score of 7 to 10.US has high sensitivity and specificity for pregnant women with previous CS occurring LUS dehiscence and rupture.


Assuntos
Cesárea/efeitos adversos , Miométrio/diagnóstico por imagem , Ultrassonografia/métodos , Útero/diagnóstico por imagem , Adulto , Estudos de Casos e Controles , Parto Obstétrico/métodos , Parto Obstétrico/tendências , Feminino , Idade Gestacional , Humanos , Incidência , Laparotomia/estatística & dados numéricos , Valor Preditivo dos Testes , Gravidez , Resultado da Gravidez , Gravidez de Alto Risco , Estudos Retrospectivos , Sensibilidade e Especificidade , Deiscência da Ferida Operatória/epidemiologia , Ruptura Uterina/epidemiologia , Útero/patologia
10.
PLoS One ; 15(8): e0237132, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764773

RESUMO

BACKGROUND: The safety of methods of labor induction in women with previous cesarean deliveries is still debated. We investigated perinatal outcomes associated with labor induction among women with a trial of labor after one cesarean delivery. METHODS: This retrospective study included 339 women with a trial of labor after one prior cesarean and a singleton term fetus in cephalic presentation in 2013-2016 in a French maternity unit. Labor induction was performed with oxytocin, artificial rupture of membranes and/or prostaglandin E2, according to the Bishop score. The primary outcome was a composite of uterine rupture, low Apgar score, neonatal resuscitation or admission to a neonatal unit. The secondary outcomes included cesarean delivery after onset of labor, postpartum hemorrhage and maternal hospital stay after delivery. We used logistic regression to estimate odds ratios adjusted (aOR) for potential confounders. RESULTS: In our sample, 67.3% of women had spontaneous labor and 32.7% were induced. More than half of the women received oxytocin during labor regardless of the mode of labor. The proportions of the composite outcome and of cesarean after onset of labor were higher in the induced group compared to the spontaneous group (26.1% vs 15.8%, p = 0.02 and 45.0% vs 27.6%, p<0.01, respectively). There were 9 uterine ruptures (2.6%) and this proportion was higher in the induced group compared to the spontaneous group, although this difference was not statistically significant (3.6% vs 2.2%, p = 0.48). After adjustment, labor induction was associated with higher risks of the composite outcome (aOR = 2.45, 95% CI: 1.29-4.65), cesarean after onset of labor (aOR = 2.06, 95% CI: 1.15-3.68) and maternal hospital stay after delivery ≥6 days (aOR = 6.20, 95% CI: 3.25-11.81). No association was found with postpartum hemorrhage. CONCLUSION: Labor induction after one prior cesarean was associated with a higher risk of adverse perinatal outcome. Nevertheless, the higher proportion of uterine rupture did not differ significantly from that in the spontaneous labor group.


Assuntos
Cesárea/efeitos adversos , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Trabalho de Parto Induzido/efeitos adversos , Ruptura Uterina/epidemiologia , Nascimento Vaginal Após Cesárea/efeitos adversos , Adulto , Índice de Apgar , Dinoprostona/administração & dosagem , Feminino , França/epidemiologia , Humanos , Recém-Nascido , Trabalho de Parto Induzido/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Ocitócicos/administração & dosagem , Ocitócicos/efeitos adversos , Ocitocina/administração & dosagem , Gravidez , Gravidez de Alto Risco , Ressuscitação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Ruptura Uterina/etiologia , Nascimento Vaginal Após Cesárea/métodos , Nascimento Vaginal Após Cesárea/estatística & dados numéricos
11.
Am J Perinatol ; 37(10): 1015-1021, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32604446

RESUMO

OBJECTIVE: Antenatal corticosteroids given prior to preterm deliveries reduce the risk of adverse neonatal outcomes. However, steroid administration in the setting of a viral respiratory infection can worsen maternal outcomes. Therefore, the decision to administer corticosteroids must balance the neonatal benefits with the potential harm to the mother if she is infected with the novel coronavirus disease 2019 (COVID-19). This study aimed to determine the gestational ages for which administering antenatal corticosteroids to women at high risk of preterm labor with concurrent COVID-19 infection results in improved combined maternal and infant outcomes. STUDY DESIGN: A decision-analytic model using TreeAge (2020) software was constructed for a theoretical cohort of hospitalized women with COVID-19 in the United States. All model inputs were derived from the literature. Outcomes included maternal intensive care unit (ICU) admission and death, along with infant outcomes of death, respiratory distress syndrome, intraventricular hemorrhage, and neurodevelopmental delay. Quality-adjusted life years (QALYs) were assessed from the maternal and infant perspectives. Sensitivity analyses were performed to determine if the results were robust over a range of assumptions. RESULTS: In our theoretical cohort of 10,000 women delivering between 24 and 33 weeks of gestation with COVID-19, corticosteroid administration resulted in 2,200 women admitted to the ICU and 110 maternal deaths. No antenatal corticosteroid use resulted in 1,500 ICU admissions and 75 maternal deaths. Overall, we found that corticosteroid administration resulted in higher combined QALYs up to 31 weeks of gestation in all hospitalized patients, and up to 29 weeks of gestation in ICU patients. CONCLUSION: Administration of antenatal corticosteroids at less than 32 weeks of gestation for hospitalized patients and less than 30 weeks of gestation for patients admitted to the ICU resulted in higher combined maternal and infant outcomes compared with expectant management for women at high risk of preterm birth with COVID-19 infection. These results can guide clinicians in their counseling and management of these pregnant women. KEY POINTS: · Antenatal steroids reduce adverse neonatal outcomes.. · Steroids worsen maternal outcomes in COVID-19.. · Steroids given < 32 weeks result in improved outcomes..


Assuntos
Corticosteroides/administração & dosagem , Infecções por Coronavirus/prevenção & controle , Morte Materna/estatística & dados numéricos , Trabalho de Parto Prematuro/tratamento farmacológico , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Resultado da Gravidez , Nascimento Prematuro/prevenção & controle , Corticosteroides/efeitos adversos , Estudos de Coortes , Infecções por Coronavirus/epidemiologia , Técnicas de Apoio para a Decisão , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva , Masculino , Método de Monte Carlo , Trabalho de Parto Prematuro/prevenção & controle , Pneumonia Viral/epidemiologia , Gravidez , Gravidez de Alto Risco , Cuidado Pré-Natal/métodos , Medição de Risco , Estados Unidos
12.
Am J Public Health ; 110(S2): S215-S218, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32663077

RESUMO

A health care system and a Medicaid payer partnered to develop an educational intervention and payment redesign program to improve timely postpartum visits for low-income, high-risk mothers in New York City between April 2015 and October 2016. The timely postpartum visit rate was higher for 363 mothers continuously enrolled in the program than for a control group matched by propensity score (67% [243/363] and 56% [407/726], respectively; P < .001). An innovative partnership between a health care system and Medicaid payer improved access to health care services and community resources for high-risk mothers.


Assuntos
Custo Compartilhado de Seguro/métodos , Medicaid/economia , Cuidado Pós-Natal/estatística & dados numéricos , Adulto , Feminino , Humanos , Programas de Assistência Gerenciada , Motivação , Cidade de Nova Iorque , Educação de Pacientes como Assunto/métodos , Cuidado Pós-Natal/economia , Pobreza , Gravidez , Gravidez de Alto Risco , Centros de Atenção Terciária , Estados Unidos
13.
Br J Radiol ; 93(1114): 20200267, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32706979

RESUMO

OBJECTIVE: To assess accuracy and reproducibility of MRI diagnosis of invasive placentation (IP) in high-risk patients and to evaluate reliability of MRI features. Secondary aim was to evaluate impact of interventional radiology (IR) on delivery outcomes in patients with IP at MRI. METHODS: 26 patients (mean age 36.24 y/o,SD 6.16) with clinical risk-factors and echographic suspicion of IP underwent 1.5 T-MRI. Two readers reviewed images. Gold-standard was histology in hysterectomised patients and obstetric evaluation at delivery for patients with preserved uterus. Accuracy and reproducibility of MRI findings were calculated. RESULTS: Incidence of IP was 50% (13/26) and of PP was 11.54% (3/26). MRI showed 100% sensitivity (95% CI = 75.3-100%) and 92.3% specificity (95% CI = 64.0-100%) in the diagnosis of IP. Gold-standard was histology in 10 cases and obstetric evaluation in 16. MRI findings with higher sensitivity were placental heterogeneity, uterine bulging and black intraplacental bands. Uterine scarring, placental heterogeneity, myometrial interruption and tenting of the bladder showed better specificity. MRI inter-rater agreement with Cohen's K was 1. 11 patients among 14 with MRI diagnosis of IP received IR assistance with positive impact on delivery outcomes in terms of blood loss, red cells count, intense care unit length of stay, days of hospitalisation and risk of being transfused. CONCLUSION: MRI is an accurate and reproducible technique in prenatal diagnosis of IP. MRI helps planning a safe and appropriate delivery eventually assisted by IR, which positively affects foetal and maternal outcomes. ADVANCES IN KNOWLEDGE: The adoption of MRI evaluation in patients with high risk of invasive placentation allows a more accurate diagnosis in terms of both presence of the disease and its extension to or through or even beyond the myometrium. This led to a better dedicated delivery management with eventual adoption of interventional radiology with a global positive effect on foetal and maternal outcomes.


Assuntos
Imagem por Ressonância Magnética Intervencionista/métodos , Imagem por Ressonância Magnética/métodos , Placenta Acreta/diagnóstico por imagem , Gravidez de Alto Risco , Adulto , Feminino , Humanos , Gravidez , Resultado da Gravidez , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Ultrassonografia Pré-Natal
14.
Am J Perinatol ; 37(10): 1066-1069, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32544963

RESUMO

We describe our experience with three pregnant women with novel coronavirus disease 2019 (COVID-19) who required mechanical ventilation. Recent data suggest a mortality of 88% in nonpregnant patients with COVID-19 who require intubation and mechanical ventilation. The three women we report were intubated and mechanically ventilated during pregnancy due to respiratory failure and pneumonia resulting from COVID-19. After several days of ventilation, all three were successfully weaned off mechanical ventilation and extubated, and are continuing their pregnancies with no demonstrable adverse effects. Our experience suggests that the mortality in pregnant women with COVID-19 requiring mechanical ventilation is not necessarily as high as in nonpregnant patients with COVID-19. KEY POINTS: · Coronavirus disease 2019 (COVID-19) is now a pandemic.. · COVID-19 may cause pneumonia or respiratory failure in pregnant women.. · Approximately 5% of women with COVID-19 will develop severe or critical disease.. · Mechanical ventilation in pregnant women may not necessarily result in high mortality rates..


Assuntos
Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Complicações Infecciosas na Gravidez/terapia , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez , Gravidez de Alto Risco , Insuficiência Respiratória/terapia , Adulto , Técnicas de Laboratório Clínico , Infecções por Coronavirus/terapia , Serviço Hospitalar de Emergência , Feminino , Idade Gestacional , Humanos , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Pandemias , Pneumonia Viral/terapia , Gravidez , Respiração Artificial/métodos , Insuficiência Respiratória/etiologia , Medição de Risco , Amostragem
15.
Am J Perinatol ; 37(10): 1038-1043, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32498092

RESUMO

With the coronavirus disease 2019 (COVID-19) pandemic in the United States, a majority of states have instituted "shelter-in-place" policies effectively quarantining individuals-including pregnant persons-in their homes. Given the concern for COVID-19 acquisition in health care settings, pregnant persons with high-risk pregnancies-such as persons living with HIV (PLHIV)-are increasingly investigating the option of a home birth. Although we strongly recommend hospital birth for PLHIV, we discuss our experience and recommendations for counseling and preparation of pregnant PLHIV who may be considering home birth or at risk for unintentional home birth due to the pandemic. We also discuss issues associated with implementing a risk mitigation strategy involving high-risk births occurring at home during a pandemic. KEY POINTS: · Coronavirus disease 2019 pandemic has increased interest in home birth.. · Women living with HIV are pursuing home birth.. · Safe planning is paramount for women living with HIV desiring home birth, despite recommending against the practice..


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por HIV/epidemiologia , Parto Domiciliar/métodos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Resultado da Gravidez , Gravidez de Alto Risco , Adulto , Comorbidade , Infecções por Coronavirus/prevenção & controle , Aconselhamento , Parto Obstétrico/métodos , Feminino , Parto Domiciliar/estatística & dados numéricos , Humanos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Pandemias/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Gravidez , Medição de Risco , Estados Unidos
16.
Am J Perinatol ; 37(10): 1044-1051, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32575140

RESUMO

Pregnant patients with severe acute respiratory syndrome coronavirus 2, the virus responsible for the clinical condition newly described in 2019 as coronavirus disease 2019 (COVID-19) and illness severity to warrant intensive care have a complex disease process that must involve multiple disciplines. Guidelines from various clinical societies, along with direction from local health authorities, must be considered when approaching the care of an obstetric patient with known or suspected COVID-19. With a rapidly changing landscape, a simplified and cohesive perspective using guidance from different clinical society recommendations regarding the critically-ill obstetric patient with COVID-19 is needed. In this article, we synthesize various high-level guidelines of clinical relevance in the management of pregnant patients with severe disease or critical illness due to COVID-19. KEY POINTS: · When caring for severely ill obstetric patients with COVID-19, one must be well versed in the complications that may need to be managed including, but not limited to adult respiratory distress syndrome with need for mechanical ventilation, approach to refractory hypoxemia, hemodynamic shock, and multiorgan system failure.. · Prone positioning can be done safely in gravid patients but requires key areas of support to avoid abdominal compression.. · For the critically ill obstetric patient with COVID-19, the focus should be on supportive care as a bridge to recovery rather than delivery as a solution to recovery..


Assuntos
Infecções por Coronavirus/epidemiologia , Cuidados Críticos/métodos , Parto Obstétrico/métodos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Pneumonia Viral/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , /epidemiologia , Comorbidade , Infecções por Coronavirus/prevenção & controle , Parto Obstétrico/efeitos adversos , Feminino , Humanos , Unidades de Terapia Intensiva , Pandemias/prevenção & controle , Posicionamento do Paciente/métodos , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Resultado da Gravidez , Gravidez de Alto Risco , Medição de Risco , Tromboembolia/prevenção & controle , Adulto Jovem
17.
Rev. inf. cient ; 99(3): 225-232, mayo.-jun. 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1126941

RESUMO

RESUMEN Introducción: El bajo peso al nacer determina más del 75 % de la mortalidad perinatal. Objetivo: Caracterizar factores seleccionados asociados al riesgo de recién nacidos con bajo peso en gestantes del municipio Guanabacoa, en provincia La Habana, Cuba, en el bienio 2018-2019. Método: Se realizó un estudio prospectivo, analítico y de corte longitudinal. La información se obtuvo de las historias clínicas. Las variables medidas fueron: edad y los siguientes factores de riesgo de recién nacidos con bajo peso en las gestantes: hipertensión arterial inducida por el embarazo, síndrome de flujo vaginal, infección del tracto urinario, fumadora, periodo intergenésico corto, prematuro anterior y edemas. Resultados: La media de la edad de las pacientes con recién nacidos bajo peso al nacer fue de 26,7 años de edad (p= 0,00). La proporción de gestantes con los factores de riesgos estudiados fue superior en aquellas con recién nacidos bajo peso (p=0,00), entre estos los más comunes fueron el síndrome de flujo vaginal (73,0 %) y hábito de fumar (43,0 %). Se reveló que los factores con mayor asociación al riesgo de la gestante de un recién nacido con bajo peso fueron el síndrome de flujo vaginal (OR 18,2) y el periodo intergenésico corto (OR 11,6). Conclusiones: La proporción de gestantes con alguno de los factores seleccionados del riesgo de recién nacidos con bajo peso es superior en aquellas con este resultado perinatal.


ABSTRACT Introduction: Low birth weight is a major factor in more than 75% of the perinatal mortality. Objective: To characterize selected factors associated with the risk of low birth weight in pregnancy in the municipality of Guanabacoa, in Havana, Cuba; in the period January 2018 - December 2019. Method: A prospective, analytic, longitudinal evaluation study was carried out, with information gathered from medical records. The main variables measured were: maternal age; along with other risk factors for low birth weight as: pregnancy-induced hypertension, vaginal discharge syndrome, urinary tract infection, smoking, short birth intervals, previous preterm labors and edema. Results: The mean age of the patients with low birth weight newborns was 26.7 years of age (p=0.00). The proportion of pregnant women with risk factors was higher in those with low birth weight (p = 0.00); among those factors, the most common were vaginal discharge syndrome (73.0%) and smoking (43.0%). It was found that the more deeply related factor with the risk of a low birth weight newborn were the vaginal discharge syndrome (OR 18.2) and the short birth intervals (OR 11.6). Conclusions: The proportion of pregnant women with some of the selected risk factors was higher on low birth weight newborn cases.


Assuntos
Humanos , Gravidez , Recém-Nascido de Baixo Peso , Fatores de Risco , Estudos Prospectivos , Estudos Longitudinais , Gravidez de Alto Risco
18.
Acta Obstet Gynecol Scand ; 99(12): 1666-1673, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32575148

RESUMO

INTRODUCTION: Some studies have shown that women with a previous cesarean section, compared with women with a previous vaginal delivery, have an increased risk of retained placenta during a subsequent vaginal delivery. It is unknown whether this is mediated by anterior placental location, when the placenta might cover the uterine scar. The aim of this study was to evaluate whether the increased risk of retained placenta in women with a previous cesarean section is mediated by anterior placental location. MATERIAL AND METHODS: This is a population-based cohort study, with data from the regional population-based Stockholm-Gotland Obstetric Cohort, Sweden, from 2008 to 2014. The overall study population included 49 598 women with a vaginal second delivery, where adequate information about placental location from the second-trimester ultrasound scan was available. For the main analysis, including the 3921 women with a previous cesarean section, we calculated the relative risk of retained placenta in women with an anterior placental location, using women with non-anterior placental locations as reference. Relative risks were calculated as odds ratios (OR) with 95% CI. In a second model, adjustments were made for maternal age, height, country of birth, smoking in early pregnancy, infant sex, and in vitro fertilization. RESULTS: In the overall study population, the rate of retained placenta at the second delivery was 2.0%. The proportion of women with a retained placenta was higher among women with a previous cesarean compared with those with a previous vaginal delivery (3.4% vs 1.9%; P < .0001). In the main analysis, including women with a previous cesarean section, the risk for retained placenta was not increased with anterior compared with non-anterior placental location (OR 0.84, 95% CI 0.60-1.20). Adjustments did not affect the estimates in a significant way. CONCLUSIONS: The increased risk of retained placenta in women with a previous cesarean section is not mediated by anterior placental location.


Assuntos
Placenta Retida , Gravidez de Alto Risco , Medição de Risco/métodos , Nascimento Vaginal Após Cesárea , Adulto , Estudos de Coortes , Feminino , Humanos , Idade Materna , Placenta/diagnóstico por imagem , Placenta Retida/diagnóstico , Placenta Retida/epidemiologia , Placenta Retida/etiologia , Gravidez , Características de Residência , Fatores de Risco , Suécia/epidemiologia , Ultrassonografia Pré-Natal/métodos , Nascimento Vaginal Após Cesárea/efeitos adversos , Nascimento Vaginal Após Cesárea/estatística & dados numéricos
19.
BJOG ; 127(13): 1646-1654, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32536019

RESUMO

OBJECTIVE: To compare the efficacy of two types of progestogen therapy for preventing preterm birth (PTB) and to review the relevant literature. DESIGN: A multicentre, randomised, open-label, equivalence trial and a meta-analysis. SETTING: Tertiary referral hospitals in South Korea. POPULATION: Pregnant women with a history of spontaneous PTB or short cervical length (<25 mm). METHODS: Eligible women were screened and randomised at 16-22 weeks of gestation to receive either 200 mg of vaginal micronised progesterone daily (vaginal group) or an intramuscular injection of 250 mg 17α-hydroxyprogesterone caproate weekly (IM group). Stratified randomisation was carried out according to participating centres and indications for progestogen therapy. This trial was registered at ClinicalTrials.gov (NCT02304237). MAIN OUTCOME MEASURE: Preterm birth (PTB) before 37 weeks of gestation. RESULTS: A total of 266 women were randomly assigned and a total of 247 women (119 and 128 women in the vaginal and IM groups, respectively) were available for the intention-to-treat analysis. Risks of PTB before 37 weeks of gestation did not significantly differ between the two groups (22.7 versus 25.8%, P = 0.571). The difference in PTB risk between the two groups was 3.1% (95% CI -7.6 to 13.8%), which was within the equivalence margin of 15%. The meta-analysis results showed no significant differences in the risk of PTB between the vaginal and IM progestogen treatments. CONCLUSION: Compared with vaginal progesterone, treatment with intramuscular progestin might increase the risk of PTB before 37 weeks of gestation by as much as 13.8%, or reduce the risk by as much as 7.6%, in women with a history of spontaneous PTB or with short cervical length. TWEETABLE ABSTRACT: Vaginal and intramuscular progestogen showed equivalent efficacy for preventing preterm birth before 37 weeks of gestation.


Assuntos
Nascimento Prematuro/prevenção & controle , Progestinas/administração & dosagem , Administração Intravaginal , Adulto , Feminino , Humanos , Injeções Intramusculares , Metanálise como Assunto , Gravidez , Gravidez de Alto Risco
20.
Cent Eur J Public Health ; 28(2): 143-148, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32592560

RESUMO

OBJECTIVE: In most indicators of the way of life, the Roma community is generally different from the majority population and dominant culture. The objective of the study was to describe factors affecting the health of the Roma living in Slovakia, with an emphasis on the sexual and reproductive health of Roma women, and report on the results of analysis of high-risk pregnancies of Roma women in the district of Rimavská Sobota, Slovakia. METHODS: A retrospective study of medical documentation was used. The results were analyzed using the absolute and relative frequencies. Statistical methods were used. RESULTS: A total of 1,256 high-risk pregnancies were analyzed, of which 622 (49.52%) were in Roma women. The average age of Roma respondents was lower by 5 years compared to non-Roma. The age of Roma women at the first pregnancy was statistically significantly lower compared to non-Roma (p < 0.001). The Roma respondents achieved statistically significantly lower levels of education than non-Roma. There was a demonstrably higher number of pregnancies as well as a higher number of artificial and spontaneous abortions per Roma woman. These results were statistically significant. For Roma women, pregnancy began to be risky demonstrably earlier than for non-Roma (p < 0.001). There was a statistically significant difference in attending prenatal counselling. Roma women attended prenatal counselling statistically significantly less frequently than non-Roma (p < 0.001). A significant statistical dependence was found between attending prenatal counselling and the onset of pregnancy problems in Roma women. There was no significant difference in the incidence of other diseases associated with high-risk pregnancy among Roma and non-Roma respondents. CONCLUSION: The findings indicate that Roma women are exposed to health problems in the area of sexual and reproductive health in Slovakia. In the approach to the Roma, it is essential to focus on improving accessibility to health care, prevention, knowledgeableness and effectively preventing, eradicating and strongly penalizing all forms of discrimination in access to health care, especially for Roma women, who are more likely to receive health care.


Assuntos
Aborto Induzido/estatística & dados numéricos , Aborto Espontâneo/etnologia , Gravidez de Alto Risco/etnologia , Cuidado Pré-Natal/estatística & dados numéricos , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Saúde Reprodutiva/etnologia , Roma/etnologia , Adolescente , Adulto , Feminino , Humanos , Paridade , Gravidez , Complicações na Gravidez/etnologia , Estudos Retrospectivos , Fatores de Risco , Eslováquia/epidemiologia , Determinantes Sociais da Saúde , Fatores Socioeconômicos , Adulto Jovem
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