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1.
Rev Esc Enferm USP ; 56: e20210470, 2022.
Artigo em Inglês, Português | MEDLINE | ID: mdl-35858012

RESUMO

OBJECTIVE: to identify the risk of depression in pregnancy among pregnant women undergoing follow-up in high-risk prenatal care, to assess the factors associated with higher risk of depression in pregnancy and to compare the risk of depression in each gestational trimester. METHOD: this is a descriptive, correlational, cross-sectional study, conducted with 151 pregnant women in prenatal care in a high-risk pregnancy outpatient clinic at a university hospital in the state of São Paulo, Brazil. Data were collected through an online form. Chi-square and Fisher's exact tests were performed. After the bivariate analysis, the variables were included in the logistic regression model. In the final model, the Odds Ratio was calculated. RESULTS: 118 (78.1%) pregnant women had a higher risk of depression during pregnancy, which was higher in the first trimester, but without statistical significance. The number of pregnancies (OR = 0.32) and marital status (OR = 0.07) remained significantly associated with higher risk of depression during pregnancy as protective factors. CONCLUSION: the results elucidate the importance of screening for depression risk and the significant need to improve access to effective interventions for preventing prenatal depression and promoting mental health.


Assuntos
Depressão , Complicações na Gravidez , Gravidez de Alto Risco , Gravidez , Gestantes , Cuidado Pré-Natal , Brasil/epidemiologia , Estudos Transversais , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/prevenção & controle , Depressão/psicologia , Feminino , Humanos , Programas de Rastreamento , Gravidez/psicologia , Complicações na Gravidez/psicologia , Trimestres da Gravidez/psicologia , Gravidez de Alto Risco/psicologia , Gestantes/psicologia , Cuidado Pré-Natal/psicologia , Fatores de Risco
2.
J Int Med Res ; 50(7): 3000605221106723, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35850546

RESUMO

BACKGROUND: COVID-19 has had a catastrophic effect on the healthcare system. Healthcare quality assessment measures the difference between expected and actual performances to identify gaps in the healthcare system. This study aimed to evaluate the quality of perinatal care for women with high-risk pregnancies (HPR) during the COVID-19 pandemic. MATERIALS AND METHODS: This cross-sectional study enrolled 450 women with HPR from health centers in Ahvaz, Iran, from December 2020 to May 2021, using a multi-stage sampling method. Quality of care was assessed using an observational checklist adapted from Ministry of Health guidelines. Data were analyzed using descriptive and statistical methods. RESULTS: The quality of the assessed aspect in comprehensive health centers and in peripartum, perinatal, and postpartum wards was moderate. The overall score for peripartum care was significantly positively correlated with the length of the retraining period, and the quality of perinatal care was significantly related to the proportion of elective cesarean sections and preterm delivery. CONCLUSION: The development of care practices in health centers in Iran should focus on education and counseling. Practices in peripartum wards should emphasize the use of partographs, physical/mental support, and privacy for mothers, while perinatal wards should focus on timely counseling.


Assuntos
COVID-19 , COVID-19/epidemiologia , Criança , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Irã (Geográfico)/epidemiologia , Pandemias , Assistência Perinatal , Gravidez , Gravidez de Alto Risco
3.
Yonsei Med J ; 63(7): 692-700, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35748081

RESUMO

PURPOSE: Fetal well-being is usually assessed via fetal heart rate (FHR) monitoring during the antepartum period. However, the interpretation of FHR is a complex and subjective process with low reliability. This study developed a machine learning model that can classify fetal cardiotocography results as normal or abnormal. MATERIALS AND METHODS: In total, 17492 fetal cardiotocography results were obtained from Ajou University Hospital and 100 fetal cardiotocography results from Czech Technical University and University Hospital in Brno. Board-certified physicians then reviewed the fetal cardiotocography results and labeled 1456 of them as gold-standard; these results were used to train and validate the model. The remaining results were used to validate the clinical effectiveness of the model with the actual outcome. RESULTS: In a test dataset, our model achieved an area under the receiver operating characteristic curve (AUROC) of 0.89 and area under the precision-recall curve (AUPRC) of 0.73 in an internal validation dataset. An average AUROC of 0.73 and average AUPRC of 0.40 were achieved in the external validation dataset. Fetus abnormality score, as calculated from the continuous fetal cardiotocography results, was significantly associated with actual clinical outcomes [intrauterine growth restriction: odds ratio, 3.626 (p=0.031); Apgar score 1 min: odds ratio, 9.523 (p<0.001), Apgar score 5 min: odds ratio, 11.49 (p=0.001), and fetal distress: odds ratio, 23.09 (p<0.001)]. CONCLUSION: The machine learning model developed in this study showed precision in classifying FHR signals. This suggests that the model can be applied to medical devices as a screening tool for monitoring fetal status.


Assuntos
Cardiotocografia , Frequência Cardíaca Fetal , Cardiotocografia/métodos , Feminino , Feto , Frequência Cardíaca Fetal/fisiologia , Humanos , Aprendizado de Máquina , Gravidez , Gravidez de Alto Risco , Reprodutibilidade dos Testes
4.
BMJ Open Qual ; 11(Suppl 1)2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35714981

RESUMO

Complications can occur anytime during pregnancy and childbirth. Pregnancies associated with high-risk factors have a higher-than-normal risk for fetomaternal complications. Bhagwan Mahavir hospital is a public sector hospital catering to low-risk and high-risk pregnant women (PW) in the labour room (LR)). The obstetrics and gynaecology team observed that at times the LR team failed to identify high-risk pregnancy (HRP) during admission in LR and to manage complications timely and efficiently. Therefore, the team started a quality improvement (QI) project in January 2019 with the aim to admit preidentified HRP in LR from existing 0% to 80% in 3 months.The QI team followed the point-of-care quality improvement methodology to conduct this improvement process. They identified HRP in the outpatient department (OPD) during their antenatal care (ANC) visits, mentioned an HRP number on their ANC cards, and did risk stratification with yellow and red stickers into moderate and severe HRP respectively. Preidentified HRP were attended, admitted and managed on priority in the LR. The team achieved its aim in the ninth week of the QI initiative and sustaining to date. The team also measured and analysed the type of HRP identified in OPD, complications occurring around the process of childbirth in LR, maternal near-miss, maternal death and PW referred out from LR. They observed a 6.5%-point reduction (68.93%) in the median complication rate of major life-threatening complications following this improvement process.This new intervention facilitated the team in early initiation of management of HRP in OPD, their triaging in LR, preparedness towards managing complications, involvement of support staff, PW and their relatives in the patient care, and redistribution of human resources according to priority area. The lessons learnt are generalisable and can be used in other facilities with similar settings.


Assuntos
Gravidez de Alto Risco , Melhoria de Qualidade , Parto Obstétrico , Feminino , Hospitalização , Humanos , Gravidez , Gestantes
5.
BMC Pregnancy Childbirth ; 22(1): 445, 2022 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-35643433

RESUMO

BACKGROUND: High-risk pregnancies require increased health and care resources to reduce the severe perinatal consequences. The adoption of a health-promoting lifestyle and social determinants is an important strategy for achieving the desired outcomes of pregnancy. This study aimed to compare intermediate determinants of social health in low and high-risk pregnant women. METHODS: This unmatched case-control study was performed with a ratio of 1: 2 and 300 pregnant women including 200 healthy and 100 pregnant women with gestational hypertension were included using the available sampling technique. Data were collected using socio-demographic and obstetrics, Health-promoting behaviors, Self-efficacy, Perceived stress, and Social support questionnaires by the self-report method. RESULTS: There was no significant difference in the demographic characteristics between the two groups, except for the spouse's education status. The total score of health-promoting behaviors and social support in the healthy group was significantly higher than women with gestational hypertension. However, the perceived stress in women with gestational hypertension was significantly higher than in the healthy group. In the multivariate analysis, those women with high stress [AOR 1.13, 95% CI (1.08-1.18)] and whose Spouse's Educational status was low [AOR 4.94, 95% CI (1.54-15.81)] had higher odds of gestational hypertension than women who haven't respectively. The development of gestational hypertension was decreased by increasing the score of social support [AOR 0.96, 95% CI (0.93-0.98)]. The results showed that the two variables of social support (ß=0.331) and self-efficacy (ß=0.215) have the greatest impact on the score of health-promotion behaviors, respectively. Based on regression analysis, 21.2% of the health-promotion behaviors changes could be explained by three independent variables. CONCLUSION: Women with gestational hypertension have unhealthier lifestyles. Having a high level of stress is a risk factor for gestational hypertension but Social support has a protective effect on it. Recognizing the risk factors of gestational hypertension could help the determination of high-risk cases and it is important to pay attention to women's psychosocial to create appropriate sources of social support and provide the necessary action to reduce stress.


Assuntos
Hipertensão Induzida pela Gravidez , Gestantes , Estudos de Casos e Controles , Feminino , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Gravidez , Gravidez de Alto Risco , Gestantes/psicologia , Determinantes Sociais da Saúde , Estresse Psicológico/epidemiologia , Estresse Psicológico/etiologia
6.
BMC Psychiatry ; 22(1): 396, 2022 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-35698043

RESUMO

BACKGROUND: High-risk pregnancy causes different responses, including negative emotions, feelings of vulnerability and psychological stress in the mother. The aim of this study was to investigate the effect of individual counseling on the empowerment and the perceived stress of high-risk pregnant mothers. METHODS: This study was a two-group experimental study. The study was performed on 82 high-risk pregnant women hospitalized in Fatemieh Hospital in Hamadan, Iran. Inclusion criteria were high-risk pregnancy, being literate, gestational age 24 to 36 weeks. The samples were divided into experimental and control groups using randomized block design. Data were collected using Cohen's perceived stress scale and Kameda empowerment questionnaires. For the experimental group, four sessions of individual counseling according to GATHER principles (Greet, Ask, Tell, Help, Explain, and Return) were performed for 45-60 minutes for two consecutive weeks. SPSS 25 software was used for data analysis. RESULTS: The mean score of the perceived stress after the intervention in the control and experimental groups were 27.07(5.80) and 25.30(4.95), respectively (P = 0.097). There was a substantial difference in the mean score of empowerment 84.76)9.14) and 88.75 (6.17) (P < 0.001) and different dimensions of empowerment (self-efficacy, Future image, self-esteem, Support and assurance from others) between the control and intervention groups after the intervention. CONCLUSIONS: The findings of this study indicate individual counseling is effective in empowering the mothers with high-risk pregnancy but has no significant effect on their perceived stress.


Assuntos
Mães , Gravidez de Alto Risco , Aconselhamento/métodos , Feminino , Humanos , Lactente , Mães/psicologia , Gravidez , Gestantes , Estresse Psicológico
7.
Obstet Gynecol ; 139(4): 571-578, 2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-35594122

RESUMO

OBJECTIVE: To assess whether an intervention with a multimedia educational tool, compared with routine care, would increase the use of long-acting reversible contraceptives (LARC) at 12 weeks postpartum in individuals with high-risk pregnancies. METHODS: In this single-center randomized trial, we assigned individuals aged 13-50 years with high-risk pregnancies to either a multimedia educational tool or routine care. Participants were included during pregnancy through postpartum day 1. Those randomized to the multimedia educational tool (MET) group were provided a tablet with the preloaded 3-5-minute multimedia presentation (https://prezi.com/view/jpFrXaPnnxuqRkcI3A4a/), which was viewed without the presence of research staff and resent by secure email every 4 weeks if undelivered. The primary outcome was uptake of LARC (implant or intrauterine device) within 12 weeks of delivery. The secondary outcomes included overall use of any method of contraception and composite maternal and neonatal adverse outcomes. A priori estimates indicated that 380 participants were needed to detect a 40% difference in use of LARC (baseline 40%; alpha=0.05, power=0.8, assumed loss to follow-up 20%). Relative risk (RR) and number needed to treat (NNT), along with 95% CIs, were calculated. RESULTS: From July 2020 through December 2020, 536 persons were screened and 380 randomized as follows: 190 for the multimedia educational tool and 190 for routine care. Demographic characteristics were similar between groups. The primary outcome-available for more than 90% of participants-was higher in the MET group (32.4%) than in the routine care (RC) group (20.9%) (RR 1.55; 95% CI 1.09-2.21; NNT nine, with 95% CI 5-42). Overall use of contraception was also higher in the MET group than in the RC group (RR 1.16; 95% CI 1.03-1.32). CONCLUSION: Among individuals with high-risk pregnancies, compared with routine care, use of a multimedia-based educational tool increased the uptake of postpartum LARC by 55%. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT04291040. FUNDING SOURCE: Funded in part by Investigator-Initiated studies of Organon.


Assuntos
Contracepção Reversível de Longo Prazo , Anticoncepção/métodos , Anticoncepcionais , Feminino , Humanos , Recém-Nascido , Multimídia , Período Pós-Parto , Gravidez , Gravidez de Alto Risco
8.
JAMA ; 327(17): 1656-1665, 2022 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-35503346

RESUMO

Importance: Inadequate management of elevated blood pressure (BP) is a significant contributing factor to maternal deaths. Self-monitoring of BP in the general population has been shown to improve the diagnosis and management of hypertension; however, little is known about its use in pregnancy. Objective: To determine whether self-monitoring of BP in higher-risk pregnancies leads to earlier detection of pregnancy hypertension. Design, Setting, and Participants: Unblinded, randomized clinical trial that included 2441 pregnant individuals at higher risk of preeclampsia and recruited at a mean of 20 weeks' gestation from 15 hospital maternity units in England between November 2018 and October 2019. Final follow-up was completed in April 2020. Interventions: Participating individuals were randomized to either BP self-monitoring with telemonitoring (n = 1223) plus usual care or usual antenatal care alone (n = 1218) without access to telemonitored BP. Main Outcomes and Measures: The primary outcome was time to first recorded hypertension measured by a health care professional. Results: Among 2441 participants who were randomized (mean [SD] age, 33 [5.6] years; mean gestation, 20 [1.6] weeks), 2346 (96%) completed the trial. The time from randomization to clinic recording of hypertension was not significantly different between individuals in the self-monitoring group (mean [SD], 104.3 [32.6] days) vs in the usual care group (mean [SD], 106.2 [32.0] days) (mean difference, -1.6 days [95% CI, -8.1 to 4.9]; P = .64). Eighteen serious adverse events were reported during the trial with none judged as related to the intervention (12 [1%] in the self-monitoring group vs 6 [0.5%] in the usual care group). Conclusions and Relevance: Among pregnant individuals at higher risk of preeclampsia, blood pressure self-monitoring with telemonitoring, compared with usual care, did not lead to significantly earlier clinic-based detection of hypertension. Trial Registration: ClinicalTrials.gov Identifier: NCT03334149.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , Hipertensão , Adulto , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial/métodos , Feminino , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Hipertensão Induzida pela Gravidez/diagnóstico , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/etiologia , Gravidez , Gravidez de Alto Risco , Autoteste , Telemetria
10.
Acta Paediatr ; 111(7): 1324-1330, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35429200

RESUMO

AIM: Admitting an infant to a neonatal intensive care unit (NICU) is stressful for parents. A great source of stress is the loss of their desired parental role. This study explores parents' experiences and needs during a high-risk pregnancy in preparation for their role as parents of a preterm infant. METHODS: An exploratory qualitative study was conducted among parents with a preterm infant admitted to two level-III NICUs in the Netherlands. A thematic analysis was performed. RESULTS: Nineteen interviews were conducted with parents of preterm infants (26-34 weeks gestational age). Getting a grip in the middle of chaos was identified as the central theme. In the pre-admission phase, coping with potential preterm parenthood was a theme, with coping strategies as subthemes that changed over time from avoidance to being ready to parent a preterm infant. The theme envisioning the NICU emerged in the NICU admission phase, with subthemes preterm care journey and opportunities for involvement fostering parental empowerment. CONCLUSION: Timing and content of information about a parental role in the NICU should be tailored to the individual expectant parent. A customisable intervention bundle may provide a vision of the NICU and the parents' active role in care.


Assuntos
Recém-Nascido Prematuro , Gravidez de Alto Risco , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Pais , Gravidez , Pesquisa Qualitativa
11.
Placenta ; 122: 46-55, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35430505

RESUMO

INTRODUCTION: The CARP study aims to investigate placental function, cardiac function and fetal growth comprehensively during pregnancy, a time of maximal cardiac stress, to work towards disentangling the complex cardiac and placental interactions presenting in the aetiology of pre-eclampsia as well as predicting maternal Cardiovascular Disease (CVD) risk in later life. BACKGROUND: The involvement of the cardiovascular system in pre-eclampsia, one of the most serious complications of pregnancy, is evident. While the manifestations of pre-eclampsia during pregnancy (high blood pressure, multi-organ disease, and placental dysfunction) resolve after delivery, a lifelong elevated CVD risk remains. METHOD: An assessment including both cardiac and placental Magnetic Resonance Imaging (MRI) optimised for use in pregnancy and bespoke to the expected changes was developed. Simultaneous structural and functional MRI data from the placenta, the heart and the fetus were obtained in a total of 32 pregnant women (gestational ages from 18.1 to 37.5 weeks), including uncomplicated pregnancies and five cases with early onset pre-eclampsia. RESULTS: The achieved comprehensive MR acquisition was able to demonstrate a phenotype associated with pre-eclampsia linking both placental and cardiac factors, reduced mean T2* (p < 0.005), increased heterogeneity (p < 0.005) and a trend towards an increase in cardiac work, larger average mass (109.4 vs 93.65 gr), wall thickness (7.0 vs 6.4 mm), blood pool volume (135.7 vs 127.48 mL) and mass to volume ratio (0.82 vs 0.75). The cardiac output in the controls was, controlling for gestational age, positively correlated with placental volume (p < 0.05). DISCUSSION: The CARP study constitutes the first joint assessment of functional and structural properties of the cardiac system and the placenta during pregnancy. Early indications of cardiac remodelling in pre-eclampsia were demonstrated paving the way for larger studies.


Assuntos
Doenças Cardiovasculares , Carpas , Pré-Eclâmpsia , Animais , Feminino , Humanos , Placenta/diagnóstico por imagem , Pré-Eclâmpsia/diagnóstico por imagem , Gravidez , Gravidez de Alto Risco
12.
Rev Bras Ginecol Obstet ; 44(5): 519-531, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35405757

RESUMO

OBJECTIVE: To provide a survey of relevant literature on umbilical artery Doppler ultrasound use in clinical practice, technical considerations and limitations, and future perspectives. METHODS: Literature searches were conducted in PubMed and Medline, restricted to articles written in English. Additionally, the references of all analyzed studies were searched to obtain necessary information. RESULTS: The use of this technique as a routine surveillance method is only recommended for high-risk pregnancies with impaired placentation. Meta-analyses of randomized trials have established that obstetric management guided by umbilical artery Doppler findings can improve perinatal mortality and morbidity. The values of the indices of Umbilical artery Doppler decrease with advancing gestational age; however, a lack of consensus on reference ranges prevails. CONCLUSION: Important clinical decisions are based on the information obtained with umbilical artery Doppler ultrasound. Future efforts in research are imperative to overcome the current limitations of the technique.


OBJETIVO: Compilar informação relevante proveniente da literatura atual sobre a ultrassonografia Doppler das artérias umbilicais (AUs) na prática clínica, considerações e limitações técnicas e perspectivas futuras. MéTODOS: A pesquisa bibliográfica foi realizada nos bancos de dados PubMed e Medline e restringiu-se a artigos escritos na língua inglesa. Recorreu-se também à bibliografia dos artigos selecionados, quando necessário, para obter informação relevante. RESULTADOS: A utilização desta técnica como método de vigilância de rotina está apenas recomendada em gravidezes de alto risco com disfunção placentar. Metanálises de estudos randomizados mostraram que o seguimento obstétrico baseado nos achados do Doppler da artéria umbilical pode melhorar a mortalidade e a morbilidade perinatal. É consensual que os valores dos índices Doppler da AU decrescem com o avanço da idade gestacional. No entanto, há ainda muita incerteza quanto aos valores de referência. CONCLUSãO: As informações obtidas através da AU Doppler US são a base para muitas decisões clínicas importantes. Trabalhos de investigação nesta área são essenciais para tentar colmatar atuais limitações da técnica.


Assuntos
Ultrassonografia Pré-Natal , Artérias Umbilicais , Feminino , Idade Gestacional , Humanos , Gravidez , Gravidez de Alto Risco , Ultrassonografia Doppler , Ultrassonografia Pré-Natal/métodos , Artérias Umbilicais/diagnóstico por imagem
13.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 49(2): 1-6, Abril - Junio, 2022. tab
Artigo em Espanhol | IBECS | ID: ibc-203199

RESUMO

La preeclampsia es una patología con una importante incidencia a nivel mundial que se encuentra asociada directamente con el 15% de las muertes maternas. Esta se caracteriza usualmente por la presencia de hipertensión y proteinuria, que se manifiestan desde la mitad de la gestación. Los microARN son moléculas de ARN monocatenario que actúan principalmente degradando el ARN mensajero transcrito o inhibiendo la traducción de microARN. Los microARN placentarios ejercen un papel en el crecimiento y función de la placenta, se considera factible su uso potencial como biomarcadores de diagnóstico debido a la capacidad de entrar en la circulación materna y ser detectables en el plasma materno.


Preeclampsia is a disease with a significant incidence worldwide that is directly associated with 15% of maternal deaths. This is usually characterized by the presence of hypertension and proteinuria, which manifests itself from the middle of pregnancy. MicroRNAs are single-stranded RNA molecules that act primarily by degrading transcribed messenger RNA or inhibiting microRNA translation. Placental microRNAs play a role in the growth and function of the placenta, their potential use as diagnostic biomarkers is considered feasible due to the ability to enter the maternal circulation and be detectable in maternal plasma.


Assuntos
Humanos , Feminino , Gravidez , Ciências da Saúde , MicroRNAs , Pré-Eclâmpsia , Biologia Molecular , Manutenção da Gravidez , Gravidez de Alto Risco , Obstetrícia , Hipertensão Induzida pela Gravidez
14.
Rev. Bras. Saúde Mater. Infant. (Online) ; 22(1): 79-86, Jan.-Mar. 2022. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1376213

RESUMO

Abstract Objectives: to compare the intrauterine and postnatal growth of preterm infants according to the Intergrowth-21st and Fenton curves. Methods: study carried out in a maternity hospital, reference in high-risk pregnancy, with preterm infants born in 2018 who were hospitalized in the neonatal units of the institution. Preterm newborns weighed at least twice after birth were included in the sample and those that were syndromic, malformed or presented fluid retention were excluded. Proportions and means were compared using Pearson's chi-square and Student's t tests for paired samples, respectively. The McNemar test was used to compare categorical variables and the Kappa test to verify the degree of agreement between birth weight classifications obtained by the curves. Results: one hundred and fifty three infants with a median gestational age of 34.4 weeks were included. The incidences of the categories of nutritional status at birth did not differ between the curves. There was perfect agreement between the curves, except when newborns born under 33 weeks of gestational age were evaluated, in which case the agreement was substantial. About 21% of the babies classified as small for gestational age (SGA) by Intergrowth-21st were adequate for gestational age (AGA) according to Fenton and, on average, 20% of cases that had postnatal growth restriction (PNGR) according to Fenton standards were categorized as adequate weight by Intergrowth-21st. Postnatal weight classifications obtained by the evaluated curves had perfect agreement. Conclusions: the differences in theclassifications found between the charts reveal the importance of choosing the growth curve for monitoring preterm infants since behaviors based on their diagnoses can impact the life of this population.


Resumo Objetivos: comparar o crescimento intrauterino e pós-natal de prematuros segundo as curvas de Intergrowth-21st e Fenton. Métodos: estudo realizado em uma maternidade de referência em gestação de alto risco com prematuros nascidos em 2018 que ficaram internados nas unidades neonatais da instituição. Foram incluídos os pré-termos pesados em pelo menos dois momentos após o nascimento e excluídos aqueles sindrômicos, malformados ou com retenção hídrica. As proporções e médias foram comparadas a partir dos testes qui-quadrado de Pearson e t de student para amostras emparelhadas, respectivamente. Já o teste de McNemar foi utilizado para comparar as variáveis categóricas e teste Kappa para verificar o grau de concordância entre as classificações de peso ao nascer obtidos pelas curvas. Resultados: foram incluídos 153 lactentes com idade gestacional mediana de 34,4 semanas. As incidências das categorias de estado nutricional ao nascer não diferiram entre as curvas. Houve concordância perfeita entre as mesmas, exceto quando se avaliou os nascidos com menos de 33 semanas, onde a concordância foi substancial. Cerca de 21% dos bebês classificados como pequenos para a idade gestacional (PIG) por Intergrowth-21st foram adequados para idade gestacional (AIG) segundo Fenton e, em média, 20% dos casos que tiveram restrição de crescimento pós-natal (RCPN) de acordo aos padrões de Fenton foram categorizados com peso adequado por Intergrowth-21st. As classificações de peso pós-natal obtidas pelas curvas avaliadas tiveram concordância perfeita. Conclusões: as diferenças de classificação encontradas revelam a importância da escolha da curva de crescimento para monitorização de prematuros visto que, condutas baseadas em seus diagnósticos, podem impactar na vida dessa população.


Assuntos
Humanos , Recém-Nascido , Cuidado Pós-Natal , Peso ao Nascer , Recém-Nascido Prematuro/crescimento & desenvolvimento , Estado Nutricional , Triagem Neonatal , Gráficos de Crescimento , Retardo do Crescimento Fetal , Atenção Terciária à Saúde , Brasil , Unidades de Terapia Intensiva Neonatal , Distribuição de Qui-Quadrado , Idade Gestacional , Gravidez de Alto Risco , Estudo Observacional
15.
BMC Pregnancy Childbirth ; 22(1): 191, 2022 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-35260098

RESUMO

BACKGROUND: The COVID-19 social restrictions have increased the risk for depression compared to the previous period in Italian women with Low-Risk Pregnancy (LRP). lLess is known about the impact of COVID-19 restrictions on High-Risk Pregnancy (HRP). This study aimed: 1) to explore levels of depression in women who become pregnant before and during COVID-19 pandemic, distinguishing between LRP and HRP; 2) to analyze the impact of COVID-19 restrictions on pregnancy experience in LRP and HRP. METHODS: A before-during COVID-19 pandemic cross-sectional study was carried out on 155 pregnant women (Mean age = 34.18), between 23 and 32 weeks of gestation. 77 women were recruited before COVID-19 pandemic (51.9% LRP; 48.1% HRP) and 78 women were recruited during COVID-19 pandemic (51.3% LRP; 48.7% HRP). HRP group was enrolled during hospitalization for high-risk pregnancy. Participants filled out Edinburgh Postnatal Depression Scale. Moreover, only COVID-19 group answered an open-ended question about the impact of restriction on pregnancy experience. RESULTS: HRP women reported higher levels of depressive symptoms than LRP. No difference emerged for COVID (before/during) but an interaction effect between COVID-19 and obstetric condition was found. The qualitative results showed the impact of restrictions on emotions and concerns. CONCLUSION: Respect to the previous period, LRP women during COVID-19 presented an increased risk for depressive symptoms than HRP. The HRP women during COVID-19 seemed to use hospitalization as a resource to find a social support network with other pregnant women and to be reassured on the clinical ongoing of pregnancy.


Assuntos
COVID-19/psicologia , Depressão/psicologia , Gravidez de Alto Risco/psicologia , Gestantes/psicologia , Adulto , Estudos Transversais , Emoções , Feminino , Hospitalização , Humanos , Itália , Pessoa de Meia-Idade , Gravidez/psicologia , Escalas de Graduação Psiquiátrica , Qualidade da Assistência à Saúde , Quarentena/psicologia , SARS-CoV-2
16.
BMC Pregnancy Childbirth ; 22(1): 201, 2022 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-35287618

RESUMO

BACKGROUND: Objective to assess the value of preoperative tranexamic acid (TXA) in reduction of intraoperative and postoperative blood loss in high-risk cesarean delivery (CD). METHODS: A double blind randomized controlled trial included 160 high risk women who underwent elective lower segment CD. They were equally randomized to receive either 1 g of TXA or placebo 15 min before surgery. The primary outcome was Intraoperative blood loss. RESULTS: The estimated blood loss was significantly higher in the placebo group when compared to TXA group (896.81 ± 519.6 vs. 583.23 ± 379.62 ml, P < 0.001). Both postoperative hemoglobin and hematocrit were lower (9.2 ± 1.6 and 27.4 ± 4.1 vs. 10.1 ± 1.2 and 30.1 ± 3.4, P values < 0.001and 0.012 respectively) and their change percentages (15.41 vs. 7.11%, P < 0.001) were higher in the placebo group when compared to TXA one. The need for further ecbolics was higher in placebo group when compared to TXA group (46.25 vs. 13.75%, P < 0.001). CONCLUSION: Preoperative TXA is safe and effective in reducing blood loss during and after high-risk CD. TRIAL REGISTRATION: ClincalTrial.gov ID: NCT03820206 .


Assuntos
Antifibrinolíticos/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Cesárea , Hemorragia Pós-Operatória/prevenção & controle , Ácido Tranexâmico/uso terapêutico , Adulto , Método Duplo-Cego , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Período Pós-Operatório , Gravidez , Gravidez de Alto Risco
17.
BMC Pregnancy Childbirth ; 22(1): 221, 2022 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-35305610

RESUMO

AIM: To establish a model for predicting adverse outcomes in advanced-age pregnant women with preterm preeclampsia in China. METHODS: We retrospectively collected the medical records of 896 pregnant women with preterm preeclampsia who were older than 35 years and delivered at the Affiliated Hospital of Qingdao University from June 2018 to December 2020. The pregnant women were divided into an adverse outcome group and a non-adverse outcome group according to the occurrence of adverse outcomes. The data were divided into a training set and a verification set at a ratio of 8:2. A nomogram model was developed according to a binary logistic regression model created to predict the adverse outcomes in advanced-age pregnant women with preterm preeclampsia. ROC curves and their AUCs were used to evaluate the predictive ability of the model. The model was internally verified by using 1000 bootstrap samples, and a calibration diagram was drawn. RESULTS: Binary logistic regression analysis showed that platelet count (PLT), uric acid (UA), blood urea nitrogen (BUN), prothrombin time (PT), and lactate dehydrogenase (LDH) were the factors that independently influenced adverse outcomes (P < 0.05). The AUCs of the internal and external verification of the model were 0.788 (95% CI: 0.737 ~ 0.764) and 0.742 (95% CI: 0.565 ~ 0.847), respectively. The calibration curve was close to the diagonal. CONCLUSIONS: The model we constructed can accurately predict the risk of adverse outcomes of pregnant women of advanced age with preterm preeclampsia, providing corresponding guidance and serving as a basis for preventing adverse outcomes and improving clinical treatment and maternal and infant prognosis.


Assuntos
Idade Materna , Nomogramas , Pré-Eclâmpsia/patologia , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Adulto , China/epidemiologia , Feminino , Humanos , Gravidez , Gravidez de Alto Risco/etnologia , Prognóstico , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade
18.
J Pak Med Assoc ; 72(2): 357-359, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35320193

RESUMO

Diamond Blackfan Anaemia (DBA) is a rare genetic disorder, affecting red blood cells. Pregnancy in women affected by DBA should be managed as a high-risk pregnancy, as it may trigger the relapse of anaemia, and is associated with both maternal and foetal complications. Corticosteroids are the first line of treatment, but a low threshold for blood transfusion should be considered to correct low haemoglobin in pregnancy. An adequate multidisciplinary input and planning is the key to ensure optimal perinatal outcome. We decided to report this case to highlight the implications of pregnancy on DBA and vice versa, taking into consideration the safest approach for the best possible outcomes for the mother and her baby.


Assuntos
Anemia de Diamond-Blackfan , Anemia , Anemia/complicações , Anemia/terapia , Anemia de Diamond-Blackfan/complicações , Anemia de Diamond-Blackfan/diagnóstico , Anemia de Diamond-Blackfan/terapia , Transfusão de Sangue , Família , Feminino , Humanos , Lactente , Gravidez , Gravidez de Alto Risco
19.
Rev Fac Cien Med Univ Nac Cordoba ; 79(1): 4-9, 2022 03 07.
Artigo em Espanhol | MEDLINE | ID: mdl-35312251

RESUMO

Objectives: The objective of the present study was to analyse the use of 100 g aspirin dose as prevention method for preeclampsia in high risk pregnant patients. Methods: A retrospective cohort study was performed in high risk pregnant patients with a blood pressure protocol, and the use of 100 mg of aspirin vs. its non-use was evaluated in the incidence of PREEC. Estimations between the two groups were performed with and without variable adjustment by means of binary logistic regression models. Results: 633 high risk pregnant patients were evaluated. The average age was 30±7 years old, and 25±8 weeks of pregnancy. 281 women (44.3 %) within this group received aspirin. The total prevalence of PREEC in our sample was 151 pregnant women (23.8 %). Pregnant patients under the aspirin treatment developed less PREEC events (19.2% vs 27.5%, p=0.019); with OR not adjusted 0.62 (IC95% 0.43-0.91 p= 0.017). The risk was similar when it was adjusted by age, preeclampsia history, diabetes mellitus and chronic high blood pressure. (OR adjusted 0.63 IC95% 0.43-0.92 p= 0.017). Conclusions: The use of 100 mg of aspirin a day before the 20th week of pregnancy in high risk pregnant patients decreased the risk of developing PREEC, regardless the age and risk factors.


Objetivos: El objetivo de este estudio fue analizar la utilidad de la dosis de 100 mg de aspirina como medida de prevención para preeclampsia en pacientes embarazadas de alto riesgo. Métodos: Se realizó un estudio de cohorte retrospectivo de embarazadas de alto riesgo en seguimiento con un protocolo de tensión arterial y se evaluó la utilización de aspirina 100 mg vs la no utilización de la misma, en la incidencia de PREEC. Se realizó estimaciones de riesgos entre ambos grupos sin y con ajuste de variables con modelos de regresión logística binaria. Resultados: Fueron evaluadas 633 embarazadas de alto riesgo con promedio de 30±7 años y 25±8 semanas de gestación, de las cuales 281 mujeres (44,3%) recibieron aspirina. La prevalencia total de PREEC en nuestra muestra fue de 151 embarazadas (23,8%). Las embarazadas que estaban ingiriendo aspirina, desarrollaron menos eventos de PREEC (19.2% vs 27.5%, p=0.019); con OR no ajustado 0.62 (IC95% 0.43-0.91 p= 0.017). Siendo este riesgo similar cuando fue ajustado por edad, antecedentes de preeclampsia, diabetes mellitus e hipertensión arterial crónica. (OR ajustado 0.63 IC95% 0.43-0.92 p= 0.017). Conclusiones: La utilización de Aspirina 100 mg por día antes de las 20 semanas de gestación en embarazadas de alto riesgo disminuyó el riesgo de desarrollar PREEC, independientemente de la edad y factores de riesgo.


Assuntos
Aspirina , Pré-Eclâmpsia , Adulto , Argentina , Aspirina/uso terapêutico , Estudos de Coortes , Feminino , Humanos , Pré-Eclâmpsia/tratamento farmacológico , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/prevenção & controle , Gravidez , Gravidez de Alto Risco , Estudos Retrospectivos , Adulto Jovem
20.
Rev Fac Cien Med Univ Nac Cordoba ; 79(1): 10-14, 2022 03 07.
Artigo em Espanhol | MEDLINE | ID: mdl-35312246

RESUMO

Introduction: Teleophthalmology programs have become one of the main tools for the early detection of diabetic retinopathy. Assessing the implementation of these programs is essential to contextualize and understand their effectiveness in different regions. The aim of this study was to evaluate the rate of annual eye examination in people with diabetes before and after implementing a teleophthalmology program in the province of La Pampa (Argentina). Methods: A before-and-after study design was performed, comparing the rate of eye examination performed before and after starting with the Program. The analysis was carried out with a random survey of people with diabetes. People from rural and urban areas of the province were included. The program was implemented only in the rural area, while the urban area has the traditional care system. Results: The annual eye examination rate carried out before and after the implementation of the Program in rural areas improved from 39.3% to 78.6%. Being 22.9% higher than in the urban area. Conclusion: The studied teleophthalmology program achieved a significant increase in eye examinations. These kinds of programs are essential to face blindness due to diabetes in the rural regions of Argentina.


Introducción: Los programas de teleoftalmología se han transformado en una de las principales herramientas para detectar oportunamente la retinopatía diabética. Evaluar la implementación de estos programas es fundamental para contextualizar y comprender su funcionamiento en diferentes regiones. El objetivo de este trabajo fue evaluar la tasa anual de fondo de ojos en personas con diabetes antes y después de implementar un programa de teleoftalmología en la provincia de La Pampa (Argentina). Métodos: Se llevó a cabo un diseño de antes y después, comparando la tasa de fondo de ojos realizado antes y después del comenzar con el Programa. La evaluación se realizó mediante una encuesta aleatoria a personas con diagnóstico de diabetes. Para el análisis se incluyeron personas de la zona rural y urbana de la provincia. El programa fue implementado solamente en la zona rural, mientras que la zona urbana cuenta con el sistema tradicional de atención. Resultados: La tasa anual de fondo de ojos realizado antes y después de la implementación del Programa en áreas rurales paso de un 39,3% a un 78,6%. Siendo superior en un 22,9% al de la zona urbana. Conclusión: El programa de teleoftalmología evaluado logró un aumento significativo en la evaluación del fondo de ojos de las personas con diabetes. Implementar este tipo de programas es fundamental para combatir la ceguera por diabetes en la región rural de la Argentina.


Assuntos
Pré-Eclâmpsia , Complicações na Gravidez , Aspirina/uso terapêutico , Feminino , Humanos , Pré-Eclâmpsia/prevenção & controle , Gravidez , Gravidez de Alto Risco , Fatores de Risco
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