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1.
Rev Bras Epidemiol ; 23: e200012, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32130400

RESUMO

INTRODUCTION: Syphilis is a sexually transmitted disease, easy to diagnose and treat, but whose incidence is increasing in Brazil. This study estimated the prevalence of the non-performance of serological tests for syphilis during prenatal care, in addition to evaluating its trend and identifying its associated factors in the municipality of Rio Grande, Rio Grande do Sul, Southern Brazil. METHODS: This is a cross-sectional survey that included all pregnant women living in this municipality who gave birth between January 1 and December 31, 2007, 2010, and 2013. A single standardized questionnaire was administered to the mothers within 48 hours of delivery, while they were still in the maternity ward. We used the χ2 test for proportions and linear trend, and Poisson regression with robust adjustment in the multivariate analysis. The effect measure adopted was prevalence ratio (PR). RESULTS: Among the 7,351 mothers who had at least one prenatal visit, the prevalence of non-performance of serological tests for syphilis in the three years studied was 2.9% (95% confidence interval - 95%CI 2.56 - 3.33), with 3.3% (95%CI 2.56 - 3.97) in 2007, 2.8% (95%CI 2.20 - 3.52) in 2010, and 2.7% (95%CI 2.12 - 3.38) in 2013. Black mothers, those with low household income and schooling, and who had few prenatal visits showed higher PR of non-performance of this test. DISCUSSION: The prevalence of non-performance has virtually not changed in the period, and women with high-risk pregnancy showed a greater probability of not undergoing the test. CONCLUSIONS: This municipality needs to reach mothers with lower socioeconomic status, restructure the local health services, and enhance their operationalization to improve the quality of prenatal care.


Assuntos
Cuidado Pré-Natal/métodos , Sorodiagnóstico da Sífilis/estatística & dados numéricos , Sífilis/diagnóstico , Sífilis/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Análise Multivariada , Distribuição de Poisson , Gravidez , Gravidez de Alto Risco , Prevalência , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
2.
Medicine (Baltimore) ; 99(11): e19349, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176056

RESUMO

The visual system was reported to be affected in over half of patients with preeclampsia (PE), though fundus examination was performed only among patients complaining of visual symptoms. Delayed diagnosis and treatment of PE-related retinopathy may lead to permanent visual impairment. Therefore, we hypothesize that some clinical or laboratory parameters could predict severity of retinal damage.The aim of the study was to explore the risk factors for retinopathy in severe preeclampsia (sPE) and investigate pregnancy outcomes with different degrees of retinopathy.This retrospective cohort study included women with sPE who underwent ophthalmoscopy and delivered after admission to West China Second University Hospital, between June 2013 and December 2016. Clinical and laboratory characteristics were retrieved from medical records. Patients confirmed with retinopathy were followed up with telephones. Multiple logistic regression analysis was performed to identify risk factors of PE-related retinopathy.Five hundred thirty-four patients were included, of which 17.6% having stage-1/2 retinopathy, 14.6% having stage-3/4 retinopathy, and 67.8% having normal retina. Compared with patients without retinopathy, patients with stage 3/4 retinopathy were more likely to have preterm-birth and low-birth-weight babies. Significant risk factors for stage 3/4 retinopathy in sPE included severe hypertension (odds ratio [OR] 2.24, 95% confidence interval [CI]: 1.10-4.56), elevated white blood cell (WBC) counts (OR 1.88, 95% CI: 1.05-3.35), decreased platelet counts (OR 2.12, 95% CI: 1.07-4.48), lactate dehydrogenase (LDH) concentration of >800 IU/L (OR 2.31, 95% CI: 1.05-5.06), low hemoglobin (HGB) concentrations of <110 g/L (OR 3.73, 95% CI: 1.21-11.47), 24-hour proteinuria of 2 to 5 g (OR 6.39, 95% CI: 2.84-14.39), and >5 g (OR 8.66, 95% CI: 3.67-20.44).This study confirms the association between retinopathy and preterm-birth and low-birth weight in sPE. The risk factors for severe PE-related retinopathy, including severe hypertension, platelet and WBC count, HGB and LDH concentration, and proteinuria, are associated with the development of retinopathy. Routine and repeated fundus examination is recommended for maternal monitoring in sPE.


Assuntos
Pré-Eclâmpsia/epidemiologia , Resultado da Gravidez , Gravidez de Alto Risco , Doenças Retinianas/epidemiologia , Retinoscopia/métodos , China , Estudos de Coortes , Feminino , Idade Gestacional , Hospitais Universitários , Humanos , Recém-Nascido , Modelos Logísticos , Análise Multivariada , Pré-Eclâmpsia/diagnóstico , Gravidez , Nascimento Prematuro , Doenças Retinianas/diagnóstico , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença
4.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 12: 281-287, jan.-dez. 2020. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1047844

RESUMO

Objetivo: investigar os fatores maternos e perinatais associados aos extremos da idade reprodutiva da mulher em São Luís, Maranhão. Método: trata-se de um estudo transversal, realizado em São Luís/MA, com população de 16.474 mães. Os dados foram coletados no Sinasc disponibilizado pela Secretaria Municipal. Utilizou-se o Teste Qui-quadrado de Pearson e calculou-se a Odds Ratio com nível de significância de α = 0.05. Resultados: verificou-se que as adolescentes apresentaram maior chance de nascimentos prematuros (OR=1,37; p< 0,001 mulheres com idade avançada apresentaram maior risco para baixo peso ao nascer (OR=1,22; p=0,022). Tanto as adolescentes (OR=2,09; p< 0,001) quanto as mães com idade avançada (OR=1,85; p<0,0011) possuem chances aumentadas para realizarem menos que seis consultas de pré-natal. Conclusão: os resultados perinatais, nascimento prematuro, baixo peso ao nascer e a realização de menos de seis consultas pré-natais são elevados nas gestações de adolescentes e mulheres em idade avançada


Objective: to investigate maternal and perinatal factors associated with extremes of women's reproductive age in São Luís, Maranhão. Method: this is a cross-sectional study conducted in São Luís/MA, with a population of 16,474 mothers. The data were collected in the Sinasc provided by the Municipal Health Secretariat. We used the Pearson Chi-square test and calculated the odds ratio with a significance level of α=0.05. Results: it was verified that the adolescents had a higher chance of preterm birth (OR=1.37; p<0,001); Women aged 35 years or older were at increased risk for low birth weight (OR=1.22; p=0.022). Both adolescents (OR=2.09; p<0,001) and older mothers (OR=1.85; p<0,001) have an increased chance to perform less than six prenatal visits. Conclusion: perinatal outcomes, preterm birth, low birth weight and fewer than six prenatal visits are frequent in the pregnancies of adolescents and women of advanced age


Assuntos
Humanos , Feminino , Gravidez , Adulto , Pessoa de Meia-Idade , Complicações na Gravidez/epidemiologia , Cuidado Pré-Natal , Idade Materna , Saúde Materno-Infantil , Fatores de Risco , Gravidez de Alto Risco , Assistência Perinatal
5.
Rev Rene (Online) ; 21: 42198, 2020.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1053134

RESUMO

Objetivo: avaliar os determinantes sociais da saúde de gestantes acompanhadas no pré-natal de alto risco. Métodos: estudo observacional e transversal, realizado com 276 gestantes de alto risco. A coleta deu-se mediante aplicação de questionário estruturado acerca dos determinantes sociais da saúde, além de dados clínicos e obstétricos das mulheres. Os dados foram analisados através do programa estatístico Jamovi®, versão 0.9, e discutidos segundo o Modelo de Dahlgren e Whitehead. Resultados: as condições individuais; o comportamento e estilo de vida; a rede social e comunitária; e a condição de vida, tais como: trabalho, saúde, educação, saneamento básico e habitação podem constituir fator de risco ou de proteção à saúde da gestante. Conclusão: determinantes como idade, raça, tipo de gestação, nível educacional, a situação de moradia e o acesso aos serviços de saúde foram considerados favoráveis à saúde da maioria das gestantes, porém, a prevalência de gravidez não planejada como comportamento desfavorável.(AU)


Assuntos
Cuidado Pré-Natal , Gravidez de Alto Risco , Determinantes Sociais da Saúde
6.
Maturitas ; 128: 17-21, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31561817

RESUMO

Transgender men are assigned female at birth, but self-identify as male. Although some transgender men undergo gender-affirming hormonal treatment and/or surgery that preclude pregnancy, many (if not most) retain their female reproductive organs and, as a result, their capacity to become pregnant. Although the visibility of the transgender community has increased, the exposure of healthcare providers to transgender individuals, especially transgender men during pregnancy, as well as research that addresses evidence-based practice remain limited. In this review, we discuss obstetrical issues for transgender men who are ≥35 years old, termed the "new" advanced paternal age. We review preconception care and focus on fertility issues, the impact of stopping gender-affirming hormonal treatment, and age-appropriate health maintenance. We review antepartum and postpartum care, including labor and delivery, monitoring for perinatal depression, contraception, and chest feeding. Finally, we conclude with suggestions for areas for further research and study.


Assuntos
Identidade de Gênero , Obstetrícia , Idade Paterna , Pessoas Transgênero , Adulto , Aleitamento Materno , Feminino , Humanos , Masculino , Gravidez , Gravidez de Alto Risco , Adulto Jovem
7.
BMC Pregnancy Childbirth ; 19(1): 337, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533649

RESUMO

BACKGROUND: To investigate the trends and changes in the incidence and overall outcome of twin pregnancies in Finland, a retrospective study was conducted with emphasis on maternal complications, covering a 28-year study period. METHODS: All 23,498 twin pregnancies with 46,363 live born and 633 stillborn children in Finland during 1987-2014 were included in the study. Data were collected from the national Medical Birth Register and the Care Register on Hospital Care (Finnish Institute for Health and Welfare, Finland) regarding the parturients' characteristics and incidences of several pregnancy and childbirth complications. The incidences of twin pregnancies and maternal complications during pregnancy and childbirth are the main outcome measures of the study. The results are expressed in percentages, means, medians, ranges and standard deviations (SD), when appropriate. RESULTS: Twins comprised 1.4% of all births in Finland in 1987-2014. Parturients' mean age has remained stable, but the share of over 35 year-old parturients is increasing. The incidences of pre-eclampsia, intrahepatic cholestasis of pregnancy, gestational diabetes and postpartum haemorrhage have risen during the study period. Almost half (44.9%) of twins were born preterm, almost half via Caesarean section (47.1%), and 27.7% of twin labours were induced. CONCLUSIONS: Several pregnancy complications increased during the study period. Advanced maternal age among twin parturients has risen, enhancing the risks for developing complications in a pregnancy already of a high-risk category, and predisposing to preterm delivery. National and international guidelines are necessary to improve the overall outcome of twin pregnancies.


Assuntos
Complicações do Trabalho de Parto , Complicações na Gravidez , Gravidez de Gêmeos/estatística & dados numéricos , Nascimento Prematuro/epidemiologia , Natimorto/epidemiologia , Adulto , Feminino , Finlândia/epidemiologia , Idade Gestacional , Humanos , Recém-Nascido , Idade Materna , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/etiologia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etiologia , Resultado da Gravidez/epidemiologia , Gravidez de Alto Risco , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos
8.
BMC Pregnancy Childbirth ; 19(1): 338, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533655

RESUMO

BACKGROUND: Pregnant women who are at risk of preterm birth are often stressed, anxious and depressed because of worries and fears related to the health of the unborn baby, their own health and uncertainty about the future. Only a few studies have assessed the types of psychological support that would relieve these stress symptoms among women with high-risk pregnancies. The aim of this study was to describe 1) how women at risk of preterm birth experienced an interactive 3/4-dimensional (3/4D) ultrasound examination, and 2) their need for psychological support during the antenatal period. METHODS: This qualitative study was conducted at one university hospital in Finland in 2017. Women with a singleton pregnancy of 26-32 gestational weeks (gwks) were included in the study. The interactive 3/4D ultrasound included a joint observation of the baby, based on the mother's wishes, with an obstetrician and psychologist. After the examination, the experiences were explored with a semi-structured interview. The data was analyzed using inductive thematic analysis. RESULTS: The women enjoyed the fact that the staff were focused on her fetus and genuinely present during the session and also enabled the women to actively participate. Watching the baby and her/his activities made the baby more concrete and relieved their concerns. The need for additional psychological support varied individually. CONCLUSIONS: Interactive ultrasound examination is an interesting way to awaken mental images, increase attachment, and reduce stress. The results imply that an interactive way of jointly looking at the fetus supports pregnant women at risk of preterm birth and may be useful in clinical practice.


Assuntos
Gravidez de Alto Risco/psicologia , Nascimento Prematuro/psicologia , Cuidado Pré-Natal , Estresse Psicológico , Ultrassonografia Pré-Natal , Adulto , Feminino , Finlândia , Idade Gestacional , Humanos , Imagem Tridimensional , Gravidez , Gestantes/psicologia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/psicologia , Pesquisa Qualitativa , Estresse Psicológico/etiologia , Estresse Psicológico/prevenção & controle , Ultrassonografia Pré-Natal/métodos , Ultrassonografia Pré-Natal/psicologia
9.
Hypertension ; 74(5): 1136-1143, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31495279

RESUMO

Clinical end-stage parameters define the pregnancy disorders preeclampsia and fetal growth restriction while classification of the underlying placental dysfunction is missing and urgently needed. Flt-1 (FMS-like tyrosine kinase receptor 1) is the most promising placenta-derived predictive biomarker for preeclampsia. We aimed to classify placental dysfunction in preeclampsia and fetal growth restriction at delivery by metabolic profiling and authenticate the biomarker Flt-1 for placental dysfunction. We studied 143 pregnancies with or without preeclampsia and/or fetal growth restriction delivered by cesarean section. Metabolic placenta profiles were created by high-resolution magic angle spinning nuclear magnetic resonance spectroscopy and the resulting placental phenotypes obtained by hierarchical clustering. Placental Flt-1 expression (membrane-bound and soluble isoforms combined) and maternal serum Flt-1 expression (soluble isoforms) were analyzed by immunohistochemistry and ELISA, respectively. We identified 3 distinct placenta groups by 21 metabolites and diagnostic outcome parameters; normal placentas, moderate placental dysfunction, and severe placental dysfunction. Increased placental Flt-1 was associated with severe placental dysfunction, and increased serum Flt-1 was associated with moderate and severe placental dysfunction. The preeclamptic pregnancies with and without placental dysfunction could be distinguished by 5 metabolites and placental Flt-1. Placental Flt-1 alone could separate normal pregnancies with and without placental dysfunction. In conclusion, metabolomics could classify placental dysfunction and provide information not identified by traditional diagnostics and metabolites with biomarker potential were identified. Flt-1 was confirmed as precision biomarker for placental dysfunction, substantiating its usefulness for identification of high-risk pregnancies for preeclampsia and fetal growth restriction with placental involvement.


Assuntos
Retardo do Crescimento Fetal/sangue , Doenças Placentárias/metabolismo , Fator de Crescimento Placentário/sangue , Pré-Eclâmpsia/sangue , Receptores Proteína Tirosina Quinases/metabolismo , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/metabolismo , Biomarcadores/metabolismo , Estudos de Casos e Controles , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Retardo do Crescimento Fetal/diagnóstico , Hospitais Universitários , Humanos , Modelos Lineares , Metabolômica , Noruega , Doenças Placentárias/diagnóstico , Pré-Eclâmpsia/fisiopatologia , Valor Preditivo dos Testes , Gravidez , Resultado da Gravidez , Gravidez de Alto Risco , Estudos Retrospectivos , Sensibilidade e Especificidade
10.
Rev. Bras. Saúde Mater. Infant. (Online) ; 19(3): 601-609, Jul.-Sept. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1041085

RESUMO

Abstract Objectives: to compare the adverse perinatal outcomes in pregnancies of adolescents and elderly women of public health network. Methods: a cross-sectional study carried out with pregnant women at the extremes of reproductive age according to the classification of the Brazilian Ministry of Health (adolescents those aged ≤19 years and those who were older than 35 years) and their newborns. Socioeconomic data (income, schooling, occupation and marital status), as well as clinical (diseases), anthropometric (maternal BMI) and perinatal (gender, weight, length, Apgar and gestational age) data were collected, and Poisson regression in hierarchical model was performed, with the results in Ratio of Prevalence (PR) and its respective Confidence Interval at 95% (95% CI). Results: when comparing adolescent and elderly women, 38.7% vs 54.6% (PR=0.71, CI=0.54-0.94, p=0.002) were observed, respectively, cesarean deliveries; 37.8% vs 25.2% (PR=0.83, CI=0.58-1.19, p=0.332) preterm births; 16.6% vs 20.5% (RP=1.07, CI=0.78-1.46, p=0.666) births of small infants for gestational age (SGA); 18.0% vs 15.3% (RP=1.01, CI=0.69-1.47, p=0.948) births of large-for-gestational-age newborns (LGA); 32.2% vs 34.7% (RP=1.08, CI=0.82-1.42, p=0.578), low birth weight infants and 28.5% vs 42.9% (RP=1.18, CI=0.91-1.54, p=0.201) with high birth length. Conclusions: When compared with adolescent women, pregnant women of advanced age presented a higher frequency of cesarean deliveries.


Resumo Objetivos: comparar os resultados perinatais adversos em gestações de adolescentes e mulheres em idade avançada de rede pública de saúde. Métodos: estudo transversal realizado com gestantes nos extremos de idade reprodutiva segundo classificação do Ministério da Saúde do Brasil (adolescentes aquelas com idade ≤19 anos e em idade avançada aquelas com idade ≥35 anos) e seus recém-nascidos. Foram coletados dados socioeconômicos (renda, escolaridade, ocupação e situação conjugal), clínicos (presença de doenças), antropométricos (IMC materno) e perinatais (sexo, peso, comprimento, Apgar e idade gestacional), e realizada regressão de Poisson em modelo hie-rarquizado, com resultados em Razão de Prevalência (RP) e respectivo Intervalo de Confiança a 95% (IC95%). Resultados: quando comparadas gestantes adolescentes e aquelas em idade avançada, foram observados, respectivamente: 38,7% vs 54,6% (RP=0,71; IC=0,54-0,94; p=0,002) partos cesarianos; 37,8% vs 25,2% (RP=0,83; IC=0,58-1,19; p=0,332) nascimentos de pré-termos; 16,6% vs 20,5% (RP=1,07; IC=0,78-1,46; p=0,666) nascimentos de recém-nascidos pequenos para idade gestacional; 18,0% vs 15,3% (RP=1,01; IC=0,69-1,47; p=0,948) nascimentos de recém-nascidos grandes para a idade gestacional; 32,2% vs 34,7% (RP=1,08; IC=0,82-1,42; p=0,578)recém-nascidos com baixo peso ao nascer e28,5% vs 42,9% (RP=1,18; IC=0,91-1,54; p=0,201) com comprimento elevado ao nascer. Conclusões: as gestantes em idade avançada quando comparadas com as adolescentes apresentaram maior frequência de partos cesarianos.


Assuntos
Humanos , Feminino , Gravidez , Complicações na Gravidez , Gravidez na Adolescência , Cesárea , Idade Materna , Índice de Apgar , Fatores Socioeconômicos , Brasil , Antropometria , Idade Gestacional , Gravidez de Alto Risco
11.
Sex Reprod Healthc ; 21: 95-101, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31395241

RESUMO

BACKGROUND: Minimising the risks of mortality, morbidities, and the costs associated with preterm birth is reliant on accurate prediction, appropriate decision-making and timely intervention. This study aimed to determine for the first time the decisional and informational requirements of women and clinicians during preterm labour diagnosis and intervention. A secondary objective was to explore their experiences. STUDY DESIGN: A qualitative, interpretive approach was used in three tertiary referral units in England and Scotland. Women with experience of or risk factors for preterm birth and clinicians with experience of caring for women in preterm labour took part in semi-structured interviews individually face-face or via telephone, or in a small focus-group. Data was analysed using a framework approach. RESULTS: Women and clinicians welcomed a more accurate tool for predicting preterm birth. Women wanted to be actively involved in their care, but desired different levels of control over decisions. Communication between women and clinicians influenced women's overall experiences and shaped clinicians' practice. Women found accessing care difficult, due to uncertainty about symptoms and gatekeepers to face-face care. The emotional impact of their experiences influenced family plans and subsequent pregnancies. Women's overall perception of their experience was influenced by their judgement of the care they received. CONCLUSIONS: Decision-making is complex and a tool to more accurately predict preterm birth than is currently available was valued. Further research is warranted to evaluate a tool in clinical practice and to improve services for women with symptoms of preterm labour attempting to gain access to face-face care. Trial Registration ISRCTN: 41598423 and CPMS:31277.


Assuntos
Tomada de Decisão Clínica , Trabalho de Parto Prematuro/diagnóstico , Trabalho de Parto Prematuro/terapia , Comunicação , Emoções , Feminino , Grupos Focais , Ginecologia , Acesso aos Serviços de Saúde , Humanos , Entrevistas como Assunto , Tocologia , Trabalho de Parto Prematuro/psicologia , Obstetrícia , Gravidez , Gravidez de Alto Risco/psicologia , Pesquisa Qualitativa , Medição de Risco
12.
BMC Pregnancy Childbirth ; 19(1): 271, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370813

RESUMO

BACKGROUND: To investigate the association between sociodemographic and obstetric variables and delays in care with maternal near misses (MNMs) and their health indicators. METHODS: A prospective cohort study was conducted at a high-risk maternity hospital in northeastern Brazil from June 2015 to May 2016 that included all pregnant women seen at the maternity hospital during the data collection period and excluded those who had not been discharged at the end of the study or whom we were unable to contact after the 42nd postpartum day for MNM control. We used the MNM criteria recommended by the WHO. Risk ratios (RRs) and their 95% confidence intervals (CIs) were calculated. Hierarchical multiple logistic regression analysis was performed. The p values of all tests were two-tailed, and the significance level was set to 5%. RESULTS: A total of 1094 pregnant women were studied. We identified 682 (62.4%) women without adverse maternal outcomes (WOAMOs) and 412 (37.6%) with adverse maternal outcomes (WAMOs), of whom 352 had potentially life-threatening conditions (PLTCs) (85.4%), including 55 MNM cases (13.3%) and five maternal deaths (1.2%). During the study period, 1002 live births (LBs) were recorded at the maternity hospital, resulting in an MNM ratio of 54.8/1000 LB. The MNM distribution by clinical condition identified hypertension in pregnancy (67.2%), hemorrhage (42.2%) and sepsis (12.7%). In the multivariate analysis, the factors significantly associated with an increased risk of MNM were fewer than six prenatal visits (OR: 3.13; 95% CI: 1.74-5.64) and cesarean section in the current pregnancy (OR: 2.91; 95% CI: 1.45-5.82). CONCLUSIONS: The factors significantly associated with the occurrence of MNM were fewer than six prenatal visits and cesarean section in the current pregnancy. These findings highlight the need for improved quality, an increased number of prenatal visits and the identification of innovative and viable models of labor and delivery care that value normal delivery and decrease the percentage of unnecessary cesarean sections.


Assuntos
Hipertensão Induzida pela Gravidez/epidemiologia , Near Miss/estatística & dados numéricos , Hemorragia Pós-Parto/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Sepse/epidemiologia , Adulto , Brasil/epidemiologia , Cesárea/estatística & dados numéricos , Estudos de Coortes , Feminino , Maternidades , Humanos , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Gravidez de Alto Risco , Cuidado Pré-Natal/estatística & dados numéricos , Estudos Prospectivos , Infecção Puerperal/epidemiologia , Fatores de Risco , Tempo para o Tratamento , Hemorragia Uterina/epidemiologia , Inércia Uterina/epidemiologia , Adulto Jovem
13.
Stud Health Technol Inform ; 264: 778-782, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438030

RESUMO

Hyperglycemia associated with pregnancy has been related to several unfavorable perinatal outcomes, as well as to the increase of incidence on future complications. Thus, the diagnosis of hyperglycemia in the pregnancy-puerperal context should be a global health concern. This article presents the development of a mobile application prototype which informs, imparts accurate diagnosis and provides tools for obstetric telemonitoring in women with pregnancy associated diabetes. After detailed analysis of the proposals for a new diagnostic strategy considering possible scarcity of resources, key elements were selected and inserted into the prototype, in order to cater for the most aspects and make it as thorough as possible. The application has been adapted to the Brazilian reality, however, having adjustments in compliance with international protocols, it has the potential to be used worldwide.


Assuntos
Complicações na Gravidez , Feminino , Humanos , Hiperglicemia , Gravidez , Resultado da Gravidez , Gravidez de Alto Risco
14.
Stud Health Technol Inform ; 264: 1769-1770, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438335

RESUMO

This article describes the development of a prototype application for obstetric telemonitoring of hypertensive syndromes during pregnancy. A workflow was elaborated with the conduct for gestational hypertensive syndromes. Subsequently, prototyping was performed using Balsamiq. The prototype presents daily monitoring of blood pressure, signs and symptoms, displays accompanying charts, and generates alerts when there are changes to more or less the normal values, which are sent to the pregnant woman and the health professional.


Assuntos
Hipertensão , Gravidez de Alto Risco , Pressão Sanguínea , Determinação da Pressão Arterial , Feminino , Humanos , Gravidez , Síndrome
16.
Enferm. clín. (Ed. impr.) ; 29(4): 248-253, jul.-ago. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-182920

RESUMO

Aunque el embarazo se considera un periodo de bienestar y felicidad en la vida de la mujer, en ocasiones estas expectativas se ven alteradas por problemas a nivel materno o fetal, generándose situaciones de vulnerabilidad. La evidencia indica que la ansiedad en el embarazo está fuertemente asociada con resultados maternos e infantiles adversos como depresión posparto, parto prematuro, bajo peso al nacer y problemas de salud y desarrollo mental en la infancia. Por otra parte, se evidencia que las complicaciones obstétricas y perinatales incrementan el riesgo de ansiedad y depresión posparto, y que los niveles de ansiedad aumentan conforme lo hace el riesgo gestacional. Las recomendaciones actuales acerca del cuidado y el tratamiento de los problemas de salud mental en las mujeres durante el embarazo y hasta un año después del parto están dirigidas al reconocimiento, evaluación, cuidado y tratamiento, asegurando la continuidad asistencial. El objetivo de este artículo se centra en el reconocimiento de la ansiedad en la gestante de riesgo, a partir de la definición de casos modelo, con el fin de potenciar el pensamiento crítico tanto en los profesionales sanitarios como en las gestantes y mejorar, de este modo, el cuidado de estas pacientes


Pregnancy is considered a period of well-being and happiness in a woman's life. However, these expectations are occasionally disrupted by maternal and/or foetal problems, and situations of vulnerability develop. The evidence suggests that pregnancy-related anxiety is strongly associated with adverse maternal and child outcomes such as pospartum depression, premature birth, low birth weight, and health and mental development problems in childhood. On the other hand, it is evident that obstetric and perinatal complications increase the risk of pospartum anxiety and depression while anxiety levels increase as the gestational risk increases. Current recommendations about the care and treatment of mental health problems in women during pregnancy and up to one year after delivery are aimed at recognition, evaluation, care and treatment, ensuring continuity of care. The aim of this study was to recognise anxiety in pregnant women at risk, from the definition of model cases, in order to enhance critical thinking in both health professionals and pregnant women and thus improve the care of these patients


Assuntos
Humanos , Feminino , Gravidez , Adulto , Ansiedade/complicações , Ansiedade/diagnóstico , Complicações na Gravidez , Gravidez de Alto Risco , Fatores de Risco , Transtornos de Ansiedade/diagnóstico , Enfermagem Baseada em Evidências , Relações Materno-Fetais , Qualidade da Assistência à Saúde
17.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-LISBR1.1-46668

RESUMO

Medidas preventivas da toxoplasmose as gestantes


Assuntos
Toxoplasmose , Gravidez de Alto Risco
19.
J Perinat Med ; 47(6): 637-642, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31287800

RESUMO

Background Sjögren's syndrome (SS) is an autoimmune connective tissue disease affecting the body's moisture-producing glands. Some studies have linked SS to adverse maternal/neonatal outcomes, but sample sizes have tended to be small, with few outcomes examined. The purpose of this study was to evaluate the effect of SS on pregnancy outcomes for mother and neonate using a large dataset. Methods We carried out a retrospective cohort study of women who delivered between 1999 and 2014 using data from the Nationwide Inpatient Sample from the United States. SS categorization is based on ICD-9 coding. Baseline characteristics were compared in both groups and multivariate logistic regression was used to compare maternal and fetal outcomes of pregnancies in women with and without SS. Results The prevalence of SS in our population was 1.34 cases/10,000 births, with the rate increasing over the study period. Women with SS tended to be older, Caucasian and to have pre-existing comorbidities. Births to women with SS were at greater risk of pre-eclampsia [odds ratio (OR) 1.63, 95% confidence interval (CI) 1.34-1.99]; premature rupture of membranes (OR 1.28, 95% CI 1.04-1.57); preterm delivery (OR 1.56, 95% CI 1.34-1.81); cesarean delivery (OR 1.29, 95% CI 1.17-1.41); and venous thromboembolic events (OR 3.71, 95% CI 2.57-5.35). Infants of women with SS were more likely to have intrauterine growth restriction (IUGR) (OR 3.00, 95% CI 2.46-3.65); and congenital malformations (OR 3.26, 95% CI 2.30-4.62). Conclusion SS is a high-risk pregnancy condition associated with significant comorbidities and adverse maternal and fetal outcomes. Women with SS may benefit from increased surveillance during their pregnancies.


Assuntos
Complicações na Gravidez , Síndrome de Sjogren , Adulto , Cesárea/estatística & dados numéricos , Anormalidades Congênitas/epidemiologia , Anormalidades Congênitas/etiologia , Feminino , Retardo do Crescimento Fetal/epidemiologia , Retardo do Crescimento Fetal/etiologia , Ruptura Prematura de Membranas Fetais/epidemiologia , Ruptura Prematura de Membranas Fetais/etiologia , Humanos , Recém-Nascido , Classificação Internacional de Doenças , Trabalho de Parto Prematuro/epidemiologia , Trabalho de Parto Prematuro/etiologia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Gravidez de Alto Risco , Prevalência , Estudos Retrospectivos , Medição de Risco , Síndrome de Sjogren/complicações , Síndrome de Sjogren/diagnóstico , Síndrome de Sjogren/epidemiologia
20.
BMC Pregnancy Childbirth ; 19(1): 224, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31269904

RESUMO

BACKGROUND: The objective of this survey was to explore the association between pregnancy complications and perinatal outcome from regionally total birth population. METHODS: In this prospectively collected data of complete birth registries from all level I-III hospitals in Huai'an in 2015, perinatal morbidity and mortality in relation to pregnancy complications and perinatal outcome were analyzed using international definitions. The results were compared with that of 2010 survey in the same region. RESULTS: Of 59,424 total births in the hospitals of level I (n = 85), II (16) and III (6), delivery rate was 30.4, 40.1 and 29.5%, and rates of pregnancy complications were 12.9, 9.8 and 21.1% (average 14.1%), with antenatal corticosteroids rate in < 37 gestational weeks being 17.3, 31.0 and 39.9% (mean 36.6%), respectively. The preterm birth rate was 0.6, 2.7 and 9.5% (mean 4.06%), and the composite rate of fetal death, stillbirth, and death immediately after delivery was 0.1, 0.4 and 0.6%, respectively. By multivariable logistic regression analysis, congenital anomalies, low Apgar scores, multi-pregnancy and amniotic fluid contamination were risk factors of adverse perinatal outcomes. Despite a higher rate of pregnancy complications than in 2010 survey, perinatal and neonatal mortality continued to fall, in particular in very preterm births. The high cesarean delivery rate in non-medically indicated cases remained a challenge. CONCLUSIONS: Our regional birth-population data in 2015 revealed a robust and persistent improvement in the perinatal care and management of high risk pregnancies and deliveries, which should enable more studies using similar concept and protocol for vital statistics to verify the reliability and feasibility.


Assuntos
Parto Obstétrico/mortalidade , Assistência Perinatal/tendências , Mortalidade Perinatal/tendências , Complicações na Gravidez/mortalidade , Gravidez de Alto Risco , Adulto , China , Feminino , Humanos , Recém-Nascido , Modelos Logísticos , Gravidez , Sistema de Registros , Fatores de Risco
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