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1.
BMJ Open ; 11(5): e041566, 2021 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-33952535

RESUMO

OBJECTIVE: To investigate the long-term risk of developing hypertension and cardiovascular disease (CVD) among those women who suffered a postpartum haemorrhage (PPH) compared with those women who did not. DESIGN: Population-based longitudinal open cohort study. SETTING: English primary care (The Health Improvement Network (THIN)) and secondary care (Hospital Episode Statistics (HES)) databases. POPULATION: Women exposed to PPH during the study period matched for age and date of delivery, and unexposed. METHODS: We conducted an open cohort study using linked primary care THIN and HES Databases, from 1 January 1997 to 31 January 2018. A total of 42 327 women were included: 14 109 of them exposed to PPH during the study period and 28 218 matched for age and date of delivery, and unexposed to PPH. HRs for cardiovascular outcomes among women who had and did not have PPH were estimated after controlling for covariates using multivariate Cox regression models. OUTCOME MEASURES: Risk of hypertensive disease, ischaemic heart disease, heart failure, stroke or transient ischaemic attack. RESULTS: During a median follow-up of over 4 years, there was no significant difference in the risk of hypertensive disease after adjustment for covariates (adjusted HR (aHR): 1.03 (95% CI: 0.87 to 1.22); p=0.71). We also did not observe a statistically significant difference in the risk of composite CVD (ischaemic heart disease, heart failure, stroke or transient ischaemic attack) between the exposed and the unexposed cohort (aHR: 0.86 (95% CI: 0.52 to 1.43; p=0.57). CONCLUSION: Over a median follow-up of 4 years, we did not observe an association between PPH and hypertension or CVD.


Assuntos
Doenças Cardiovasculares , Hipertensão , Hemorragia Pós-Parto , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos de Coortes , Feminino , Humanos , Hipertensão/epidemiologia , Estudos Longitudinais , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/etiologia , Gravidez , Fatores de Risco , Atenção Secundária à Saúde
2.
Curr Opin Anaesthesiol ; 34(3): 260-268, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33935172

RESUMO

PURPOSE OF REVIEW: The incidence of placenta accreta spectrum is increasing and it is a leading cause of peripartum hysterectomy and massive postpartum hemorrhage. The purpose of the present article is to provide a contemporary overview of placenta accreta spectrum pertinent to the obstetric anesthesiologist. RECENT FINDINGS: Recent changes in the terminology used to report invasive placentation were proposed to clarify diagnostic criteria and guidelines for use in clinical practice. Reduced morbidity is associated with scheduled preterm delivery in a center of excellence using a multidisciplinary team approach. Neuraxial anesthesia as a primary technique is increasingly being used despite the known risk of major bleeding. The use of viscoelastic testing and endovascular interventions may aid hemostatic resuscitation and improve outcomes. SUMMARY: Accurate diagnosis and early antenatal planning among team members are essential. Obstetric anesthesiologists should be prepared to manage a massive hemorrhage, transfusion, and associated coagulopathy. Increasingly, viscoelastic tests are being used to assess coagulation status and the ability to interpret these results is required to guide the transfusion regimen. Balloon occlusion of the abdominal aorta has been proposed as an intervention that could improve outcomes in women with placenta accreta spectrum, but high-quality safety and efficacy data are lacking.


Assuntos
Anestésicos , Placenta Acreta , Hemorragia Pós-Parto , Cesárea , Feminino , Humanos , Histerectomia/efeitos adversos , Recém-Nascido , Placenta Acreta/diagnóstico , Placenta Acreta/epidemiologia , Placenta Acreta/cirurgia , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/prevenção & controle , Gravidez
3.
BMC Res Notes ; 14(1): 167, 2021 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-33947454

RESUMO

OBJECTIVE: Hospital data are a useful resource for studying pregnancy complications, including bleeding-related conditions, however, the reliability of these data is unclear. This study aims to examine reliability of reporting of bleeding-related conditions, including anaemia, obstetric haemorrhage and blood disorders, and procedures, such as blood transfusion and hysterectomy, in coded hospital records compared with obstetric data from two large tertiary hospitals in New South Wales. RESULTS: There were 36,051 births between 2011 and 2015 included in the analysis. Anaemia and blood disorders were poorly reported in the hospital data, with sensitivity ranging from 2.5% to 24.8% (positive predictive value (PPV) 12.0-82.6%). Reporting of postpartum haemorrhage, transfusion and hysterectomy showed high sensitivity (82.8-96.0%, PPV 78.0-89.6%) while moderate consistency with the obstetric data was observed for other types of obstetric haemorrhage (sensitivity: 41.9-65.1%, PPV: 50.0-56.8%) and placental complications (sensitivity: 68.2-81.3%, PPV: 20.3-72.3%). Our findings suggest that hospital data may be a reliable source of information on postpartum haemorrhage, transfusion and hysterectomy. However, they highlight the need for caution for studies of anaemia and blood disorders, given high rates of uncoded and 'false' cases, and suggest that other sources of data should be sought where possible.


Assuntos
Anemia , Hemorragia Pós-Parto , Anemia/diagnóstico , Anemia/epidemiologia , Austrália , Feminino , Hospitais , Humanos , New South Wales/epidemiologia , Hemorragia Pós-Parto/diagnóstico , Hemorragia Pós-Parto/epidemiologia , Gravidez , Reprodutibilidade dos Testes
4.
BMC Pregnancy Childbirth ; 21(1): 332, 2021 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-33902475

RESUMO

BACKGROUND: Although maternal deaths are rare in developed regions, the morbidity associated with severe postpartum hemorrhage (SPPH) remains a major problem. To determine the prevalence and risk factors of SPPH, we analyzed data of women who gave birth in Guangzhou Medical Centre for Critical Pregnant Women, which received a large quantity of critically ill obstetric patients who were transferred from other hospitals in Southern China. METHODS: In this study, we conducted a retrospective case-control study to determine the prevalence and risk factors for SPPH among a cohort of women who gave birth after 28 weeks of gestation between January 2015 and August 2019. SPPH was defined as an estimated blood loss ≥1000 mL and total blood transfusion≥4 units. Logistic regression analysis was used to identify independent risk factors for SPPH. RESULTS: SPPH was observed in 532 mothers (1.56%) among the total population of 34,178 mothers. Placenta-related problems (55.83%) were the major identified causes of SPPH, while uterine atony without associated retention of placental tissues accounted for 38.91%. The risk factors for SPPH were maternal age < 18 years (adjusted OR [aOR] = 11.52, 95% CI: 1.51-87.62), previous cesarean section (aOR = 2.57, 95% CI: 1.90-3.47), history of postpartum hemorrhage (aOR = 4.94, 95% CI: 2.63-9.29), conception through in vitro fertilization (aOR = 1.78, 95% CI: 1.31-2.43), pre-delivery anemia (aOR = 2.37, 95% CI: 1.88-3.00), stillbirth (aOR = 2.61, 95% CI: 1.02-6.69), prolonged labor (aOR = 5.24, 95% CI: 3.10-8.86), placenta previa (aOR = 9.75, 95% CI: 7.45-12.75), placenta abruption (aOR = 3.85, 95% CI: 1.91-7.76), placenta accrete spectrum (aOR = 8.00, 95% CI: 6.20-10.33), and macrosomia (aOR = 2.30, 95% CI: 1.38-3.83). CONCLUSION: Maternal age < 18 years, previous cesarean section, history of PPH, conception through IVF, pre-delivery anemia, stillbirth, prolonged labor, placenta previa, placental abruption, PAS, and macrosomia were risk factors for SPPH. Extra vigilance during the antenatal and peripartum periods is needed to identify women who have risk factors and enable early intervention to prevent SPPH.


Assuntos
Cesárea/efeitos adversos , Complicações do Trabalho de Parto/epidemiologia , Assistência Perinatal , Hemorragia Pós-Parto , Complicações na Gravidez , China/epidemiologia , Estado Terminal/epidemiologia , Feminino , Idade Gestacional , Necessidades e Demandas de Serviços de Saúde , Humanos , Idade Materna , Assistência Perinatal/métodos , Assistência Perinatal/normas , Hemorragia Pós-Parto/diagnóstico , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/prevenção & controle , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Prevalência , Medição de Risco/métodos , Fatores de Risco , Índice de Gravidade de Doença
5.
BMC Pregnancy Childbirth ; 21(1): 280, 2021 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-33832453

RESUMO

BACKGROUND: We aimed to describe the characteristics and outcomes in pregnant women with liver cirrhosis, and identify the predictors of adverse events of mother and fetus. METHODS: Retrospectively collected mothers with liver cirrhosis in our center from 6/2010 to 6/2019. Women without liver cirrhosis were selected as a control in a 1:2 ratio. The primary assessment was the frequency of maternal and fetal adverse events. The secondary assessment was the adverse events in patients continuing pregnancy or not and the factors to predict the severe adverse events. RESULTS: Of 126 pregnancies enrolled, 29 pregnancies were terminated for worrying disease progression and 97 pregnancies continued. One hundred ninety-four pregnancies without liver cirrhosis were selected as control. At baseline, patients with liver cirrhosis have a lower level of platelet, hemoglobin, prothrombin activity, and a higher level of ALT, total Bilirubin, creatinine. Compared to control, patients with liver cirrhosis had a higher frequency of adverse events, including bleeding gums (7.2%vs. 1.0%), TBA elevation (18.6%vs.3.1%), infection (10.3%vs.0.5%), cesarean section (73.6%vs.49.5%), postpartum hemorrhage (13.8% vs 2.1%), blood transfusion (28.9% vs 2.1%), new ascites or aggravating ascites (6.2% vs.0%), MODS (7.2% vs.0.5%) and intensive care unit admissions (24.1% vs 1.1%). The incidence of severe maternal adverse events was also higher (32.0% vs 1.5%). Women who chose to terminated the pregnancy had less severe adverse events (3.4% vs.32.0%). A higher frequency of fetal/infants' complications was observed in liver cirrhosis population than control, including newborn asphyxia (10.2% vs1.1%), low birth weight infant (13.6% vs. 2.6%). In patients who progressed into the third trimester, multivariable regression analysis demonstrated that severe adverse events were associated with a higher CTP score (OR 2.128, 95% CI [1.002, 4.521], p = 0.049). Wilson's disease related liver cirrhosis has a better prognosis (OR = 0.009, 95% CI [0, 0.763], p = 0.038). CONCLUSIONS: The incidence of the adverse events was significantly increased in pregnancies complicated by cirrhosis. The predictor of severe adverse events is higher CTP score. Wilson's disease induced liver cirrhosis have a better prognosis. Timely termination of pregnancy during the first trimester may avoid the incidence of severe adverse events.


Assuntos
Asfixia Neonatal/epidemiologia , Cesárea/estatística & dados numéricos , Cirrose Hepática/complicações , Hemorragia Pós-Parto/epidemiologia , Complicações na Gravidez , Adulto , Asfixia Neonatal/etiologia , Estudos de Casos e Controles , Feminino , Humanos , Incidência , Recém-Nascido de Baixo Peso , Recém-Nascido , Hemorragia Pós-Parto/etiologia , Gravidez , Resultado da Gravidez , Prognóstico
6.
Medicina (Kaunas) ; 57(3)2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33807607

RESUMO

Background and Objectives: COVID-19, a disease caused by SARS-CoV-2, is a public health emergency. Data on the effect of the virus on pregnancy are limited. Materials and Methods: We carried out a retrospective descriptive study, in order to evaluate the obstetric results on pregnant women in which SARS-CoV-2 was detected through RT-PCR of the nasopharyngeal swab, at admission to the maternity hospital. Results: From 16 March to 31 July 2020, 12 SARS-CoV-2 positive pregnant women have been hospitalized. Eleven were hospitalized for initiation or induction of labor, corresponding to 0.64% of deliveries in the maternity hospital. One pregnant woman was hospitalized for threatened abortion, culminating in a stillbirth at 20 weeks of gestation. Regarding the severity of the disease, nine women were asymptomatic and three had mild illness (two had associated cough and one headache). Three had relevant environmental exposure and a history of contact with infected persons. None had severe or critical illness due to SARS-CoV-2. There were no maternal deaths. The following gestational complications were observed: one stillbirth, one preterm labor, one preterm prelabor rupture of membranes, and one fetal growth restriction. Four deliveries were eutocic, two vacuum-assisted deliveries and five were cesarean sections. The indications for cesarean section were obstetric. Conclusions: SARS-CoV-2 infection was found in a minority of hospitalized pregnant women in this sample. Most are asymptomatic or have mild illness, from gestational complications to highlight stillbirth and preterm birth. There were no cases of vertical transmission by coronavirus.


Assuntos
/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , Cesárea , Tosse/fisiopatologia , Feminino , Retardo do Crescimento Fetal/epidemiologia , Ruptura Prematura de Membranas Fetais/epidemiologia , Cefaleia/fisiopatologia , Hospitalização , Maternidades , Humanos , Trabalho de Parto Induzido , Trabalho de Parto Prematuro/epidemiologia , Portugal/epidemiologia , Hemorragia Pós-Parto/epidemiologia , Gravidez , Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Natimorto/epidemiologia , Vácuo-Extração
7.
Artigo em Inglês | MEDLINE | ID: mdl-33925427

RESUMO

Postpartum hemorrhage (PPH) is a common complication of pregnancy and a global public health concern. Even though PPH risk factors were extensively studied and reported in literature, almost all studies were conducted in non-Asian countries or tertiary care centers. Our study aimed to explore relevant risk factors for PPH among pregnant women who underwent transvaginal delivery at a Thai-Myanmar border community hospital in Northern Thailand. An exploratory nested case-control study was conducted to explore risk factors for PPH. Women who delivered transvaginal births at Maesai hospital from 2014 to 2018 were included. Two PPH definitions were used, which were ≥ 500 mL and 1000 mL of estimated blood loss within 24 h after delivery. Multivariable conditional logistic regression was used to identify significant risk factors for PPH and severe PPH. Of 4774 women with vaginal births, there were 265 (5.55%) PPH cases. Eight factors were identified as independent predictors for PPH and severe PPH: elderly pregnancy, minority groups, nulliparous, previous PPH history, BMI ≥ 35 kg/m2, requiring manual removal of placenta, labor augmentation, and fetal weight > 4000 gm. Apart from clinical factors, particular attention should be given to pregnant women who were minority groups as PPH risk significantly increased in this population.


Assuntos
Hemorragia Pós-Parto , Idoso , Estudos de Casos e Controles , Feminino , Hospitais Comunitários , Humanos , Mianmar/epidemiologia , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/etiologia , Gravidez , Fatores de Risco , Tailândia/epidemiologia
8.
Am J Obstet Gynecol ; 224(5): 512.e1-512.e6, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33689752

RESUMO

BACKGROUND: In the United States, Black women are 3 to 4 times more likely to die from childbirth and have a 2-fold greater risk of maternal morbidity than their White counterparts. This disparity is theorized to be related to differences in access to healthcare or socioeconomic status. Military service members and their dependents are a diverse community and have equal access to healthcare and similar socioeconomic statuses. OBJECTIVE: This study hypothesized that universal access to healthcare, as seen in the military healthcare system, leads to similar rates of maternal morbidity regardless of race or ethnic background. STUDY DESIGN: A retrospective cohort study included data from the inaugural National Perinatal Information Center special report comparing indicators of severe maternal morbidity by race. National Perinatal Information Center data from participating military treatment facilities in the Department of Defense performing more than 1000 deliveries annually from April 1, 2018, to March 31, 2019, were included. Using this convenience data set, Chi-square analyses comparing the percentages of cesarean deliveries, adult intensive care unit admissions, and severe maternal morbidity between Black and White patients were performed. RESULTS: Black women were more likely to deliver via cesarean delivery (31.68% vs 23.58%; P<.0001; odds ratio, 1.5; 95% confidence interval, 1.38-1.63), be admitted to an adult intensive care unit (0.49% vs 0.18%; P=.0026; odds ratio, 2.78; 95% confidence interval, 1.46-5.27), and experience overall severe maternal morbidity (2.66% vs 1.66%; P=.0001; odds ratio, 1.67; 95% confidence interval, 1.3-2.15) even when excluding blood transfusion (0.64% vs 0.32%; P=.0139; odds ratio, 1.99; 95% confidence interval, 1.17-3.36) than their White counterparts. There were no substantial differences between races in overall severe maternal morbidity associated with postpartum hemorrhage even when excluding blood transfusion in this subset. CONCLUSION: Equal access to healthcare and similar socioeconomic statuses in the military healthcare system do not explain the healthcare disparities seen regarding maternal morbidity encountered by Black women having children in the United States. This study identifies healthcare disparities in severe maternal morbidity among active duty service members and their families. Further studies to assess causes such as systemic racism (including implicit and explicit medical biases) and physiological factors are warranted.


Assuntos
Afro-Americanos/estatística & dados numéricos , Cesárea/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Serviços de Saúde Militar/estatística & dados numéricos , Militares/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Transfusão de Sangue/estatística & dados numéricos , Feminino , Disparidades em Assistência à Saúde , Humanos , Unidades de Terapia Intensiva , Admissão do Paciente/estatística & dados numéricos , Hemorragia Pós-Parto/epidemiologia , Gravidez , Estudos Retrospectivos , Estados Unidos/epidemiologia
9.
BMC Pregnancy Childbirth ; 21(1): 181, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33663429

RESUMO

BACKGROUND: Since maternal mortality is a rare event, maternal near miss has been used as a proxy indicator for measuring maternal health. Maternal near miss (MNM) refers to a woman who nearly died but survived of complications during pregnancy, childbirth or within 42 days of termination of pregnancy. Although study of MNM in Ethiopia is becoming common, it is limited to public facilities leaving private facilities aside. The objective of this study was to assess MNM among women admitted in major private hospitals in eastern Ethiopia. METHODS: An institution based retrospective study was conducted from March 05 to 31, 2020 in two major private hospitals in Harar and Dire Dawa, eastern Ethiopia. The records of all women who were admitted during pregnancy, delivery or within 42 days of termination of pregnancy was reviewed for the presence of MNM criteria as per the sub-Saharan African MNM criteria. Descriptive analysis was done by computing proportion, ratio and means. Factors associated with MNM were assessed using binary logistic regression with adjusted odds ratio (aOR) along with its 95% confidence interval (CI). RESULTS: Of 1214 pregnant or postpartum women receiving care between January 09, 2019 and February 08, 2020, 111 women developed life-threatening conditions: 108 MNM and 3 maternal deaths. In the same period, 1173 live births were registered, resulting in an MNM ratio of 92.1 per 1000 live births. Anemia in the index pregnancy (aOR: 5.03; 95%CI: 3.12-8.13), having chronic hypertension (aOR: 3.13; 95% CI: 1.57-6.26), no antenatal care (aOR: 3.04; 95% CI: 1.58-5.83), being > 35 years old (aOR: 2.29; 95%CI: 1.22-4.29), and previous cesarean section (aOR: 4.48; 95% CI: 2.67-7.53) were significantly associated with MNM. CONCLUSIONS: Close to a tenth of women admitted to major private hospitals in eastern Ethiopia developed MNM. Women with anemia, history of cesarean section, and old age should be prioritized for preventing and managing MNM. Strengthening antenatal care and early screening of chronic conditions including hypertension is essential for preventing MNM.


Assuntos
Cesárea , Hospitais Privados/estatística & dados numéricos , Near Miss/estatística & dados numéricos , Hemorragia Pós-Parto , Complicações na Gravidez , Cuidado Pré-Natal/normas , Adulto , Cesárea/métodos , Cesárea/estatística & dados numéricos , Etiópia/epidemiologia , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Idade Materna , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/terapia , Gravidez , Complicações na Gravidez/mortalidade , Complicações na Gravidez/terapia , Gravidez de Alto Risco , Diagnóstico Pré-Natal/métodos , Melhoria de Qualidade , Estudos Retrospectivos , Medição de Risco
10.
Lakartidningen ; 1182021 03 15.
Artigo em Sueco | MEDLINE | ID: mdl-33720382

RESUMO

Postpartum hemorrhage is responsible for one fourth of the maternal mortality worldwide. In high resource countries there is an increasing trend in frequency of postpartum hemorrhage and need of blood transfusions. The reason for this increase is probably multifactorial. Major bleeding requires massive blood transfusion (MT), defined as transfusion of >10 units of erythrocytes within 24 hours. In Sweden the incidence of MT due to obstetric hemorrhage is reported to be 53 per 100 000 deliveries and the majority of the cases are due to placental complications, such as placenta previa and placenta accreta. These placental complications have increased over the past years as a consequence of a higher rate of cesarean deliveries. To reduce the number of deliveries requiring blood transfusion postpartum, prophylactic measures such as identification of women at increased risk, optimizing management of hemorrhage and evaluating the effect of every transfused unit of erythrocytes is important.


Assuntos
Placenta Acreta , Placenta Prévia , Hemorragia Pós-Parto , Transfusão de Sangue , Feminino , Humanos , Histerectomia , Placenta Acreta/cirurgia , Placenta Prévia/cirurgia , Placenta Prévia/terapia , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/terapia , Gravidez , Estudos Retrospectivos , Suécia/epidemiologia
11.
BMC Pregnancy Childbirth ; 21(1): 256, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33771115

RESUMO

BACKGROUND: Waterbirth is widely available in English maternity settings for women who are not at increased risk of complications during labour. Immersion in water during labour is associated with a number of maternal benefits. However for birth in water the situation is less clear, with conclusive evidence on safety lacking and little known about the characteristics of women who give birth in water. This retrospective cohort study uses electronic data routinely collected in the course of maternity care in England in 2015-16 to describe the proportion of births recorded as having occurred in water, the characteristics of women who experienced waterbirth and the odds of key maternal and neonatal complications associated with giving birth in water. METHODS: Data were obtained from three population level electronic datasets linked together for the purposes of a national audit of maternity care. The study cohort included women who had no risk factors requiring them to give birth in an obstetric unit according to national guidelines. Multivariate logistic regression models were used to examine maternal (postpartum haemorrhage of 1500mls or more, obstetric anal sphincter injury (OASI)) and neonatal (Apgar score less than 7, neonatal unit admission) outcomes associated with waterbirth. RESULTS: 46,088 low and intermediate risk singleton term spontaneous vaginal births in 35 NHS Trusts in England were included in the analysis cohort. Of these 6264 (13.6%) were recorded as having occurred in water. Waterbirth was more likely in older women up to the age of 40 (adjusted odds ratio (adjOR) for age group 35-39 1.27, 95% confidence interval (1.15,1.41)) and less common in women under 25 (adjOR 18-24 0.76 (0.70, 0.82)), those of higher parity (parity ≥3 adjOR 0.56 (0.47,0.66)) or who were obese (BMI 30-34.9 adjOR 0.77 (0.70,0.85)). Waterbirth was also less likely in black (adjOR 0.42 (0.36, 0.51)) and Asian (adjOR 0.26 (0.23,0.30)) women and in those from areas of increased socioeconomic deprivation (most affluent versus least affluent areas adjOR 0.47 (0.43, 0.52)). There was no association between delivery in water and low Apgar score (adjOR 0.95 (0.66,1.36)) or incidence of OASI (adjOR 1.00 (0.86,1.16)). There was an association between waterbirth and reduced incidence of postpartum haemorrhage (adjOR 0.68 (0.51,0.90)) and neonatal unit admission (adjOR 0.65 (0.53,0.78)). CONCLUSIONS: In this large observational cohort study, there was no association between waterbirth and specific adverse outcomes for either the mother or the baby. There was evidence that white women from higher socioeconomic backgrounds were more likely to be recorded as giving birth in water. Maternity services should focus on ensuring equitable access to waterbirth.


Assuntos
Banhos/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Parto Normal/métodos , Hemorragia Pós-Parto/epidemiologia , Adolescente , Adulto , Fatores Etários , Índice de Apgar , Inglaterra , Feminino , Humanos , Incidência , Recém-Nascido de Baixo Peso , Recém-Nascido , Parto Normal/efeitos adversos , Parto Normal/estatística & dados numéricos , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/prevenção & controle , Gravidez , Estudos Retrospectivos , Fatores Socioeconômicos , Adulto Jovem
12.
J Psychiatr Res ; 137: 419-425, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33774536

RESUMO

There is a gap in the literature investigating the impact of obstetric complications on subsequent mental ill health outcomes. The aim of this study was to establish the association between post-partum haemorrhage (PPH) and mental ill health. We conducted a retrospective open cohort study utilizing linked primary care (The Health Improvement Network (THIN)) and English secondary care (Hospital Episode Statistics (HES)) databases, from January 1, 1990 to January 31, 2018. A total of 42,327 women were included: 14,109 of them were exposed to PPH during the study period and 28,218 unexposed controls were matched for age and date of delivery. Hazard ratios (HRs) for mental illness among women with and without exposure to PPH were estimated after controlling for covariates. Women who had had PPH were at an increased risk of developing postnatal depression (adjusted HR: 1·10, 95%CI: 1·01-1·21) and post-traumatic stress disorder (PTSD) (adjusted HR: 1·17, 95%CI: 0·73-1·89) compared to women unexposed to PPH. When restricting the follow-up to the first year after childbirth, the adjusted HR for PTSD was 3·44 (95% CI 1·31-9·03). No increase in the overall risk was observed for other mental illnesses, including depression (adjusted HR: 0·94, 95%CI: 0·87-1·01), severe mental illness (adjusted HR: 0·65, 95%CI: 0·40-1·08, p = 0·239) and anxiety (adjusted HR: 0·99, 95%CI: 0·90-1·09). PPH is associated with a significant increase in the risk of developing postnatal depression and PTSD in the first year after delivery. Active monitoring for mental illness should form an integral part of the follow-up in women who suffered a PPH.


Assuntos
Hemorragia Pós-Parto , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Hemorragia Pós-Parto/epidemiologia , Gravidez , Estudos Retrospectivos , Atenção Secundária à Saúde
13.
Med Sci Monit ; 27: e928568, 2021 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-33579890

RESUMO

BACKGROUND Postpartum hemorrhage (PPH), the leading cause of maternal death, is defined as a blood loss >500 mL within 24 h after vaginal delivery or >1000 mL within 24 h after cesarean section. This study aimed to investigate the incidence of PPH and assess its risk factors in pregnant women in Tibet to provide a reference for clinicians in this region. MATERIAL AND METHODS A total of 4796 pregnant women with gestational age ≥28 weeks who were admitted to hospitals in Tibet between December 2010 and December 2016 were involved in this study. Patient sociological and clinical data and pregnancy outcomes were collected. The related risk factors of PPH were analyzed by univariate and multivariable logistic regression. The area under the curve of the receiver operating characteristic curves was used to evaluate the effect of the PPH prediction model. RESULTS PPH occurred in 95 women, with an incidence of 1.98%. The following factors were associated with higher risk for PPH: maternal age ≥35 (odds ratio [OR]=1.96; 95% confidence interval [CI], 1.18-3.27; P=0.010), history of preterm birth (OR=2.66; 95% CI, 1.60-4.42; P<0.001), cesarean section (OR=6.69; 95% CI, 4.30-10.40; P<0.001), neonatal weight >4 kg (OR=3.92; 95% CI, 1.75-8.81; P<0.001) and occurrence of neonatal asphyxia (OR=5.52; 95% CI, 2.22-13.74; P<0.001). CONCLUSIONS Maternal age ≥35, history of preterm birth, cesarean section, newborn weight >4 kg, and neonatal asphyxia were risk factors of PPH, which can help evaluate PPH in Tibet.


Assuntos
Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/prevenção & controle , Resultado da Gravidez/epidemiologia , Adulto , Área Sob a Curva , Cesárea/efeitos adversos , Parto Obstétrico/mortalidade , Parto Obstétrico/tendências , Feminino , Idade Gestacional , Instalações de Saúde , Humanos , Incidência , Lactente , Recém-Nascido , Gravidez , Gestantes , Nascimento Prematuro/etiologia , Fatores de Risco , Tibet/epidemiologia , Adulto Jovem
14.
Medicine (Baltimore) ; 100(3): e23885, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33545955

RESUMO

ABSTRACT: Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and death worldwide. The history of cesarean section and the occurrence of placenta previa were significantly associated with the increase in blood transfusion. Therefore, to prevent PPH, it is important to understand the effect of blood transfusion during cesarean section on postpartum hemorrhage. The purpose of this study is to determine the cause of blood transfusion during cesarean section, especially large amounts of blood transfusion, and to take measures to reduce the blood demand caused by PPH with limited blood supply.This study was a retrospective study of patients who underwent blood transfusion during cesarean section in Qilu Hospital of Shandong University (China) from January 2013 to December 2016. Red blood cell infusion ≥10 U during cesarean section was defined as massive blood transfusion. The study collected the demographics of pregnant women, obstetric characteristics and reasons for blood transfusions, as well as blood components and blood transfusion results. Multivariate regression analysis was performed for evaluating the risk factors of PPN.From 2013 to 2016, a total of 587 patients received blood transfusions during cesarean section. The proportion of women receiving blood transfusion during cesarean section increased (from 3.21% to 7.40%, P < .001). The history of cesarean section (P = .005) and the occurrence of placenta previa were positively correlated with the increase in blood transfusion (P = .016). There were 72 cases of massive blood transfusion, accounting for 12.27% of blood transfusion patients. Among mass blood transfusions, 93.1% of cases had prior cesarean delivery, and placenta previa accounted for 95.8%. 19.4% of patients receiving massive blood transfusions underwent hysterectomy. There was no significant difference in maternal BMI and gestational age between the mass blood transfusion group and the non-mass blood transfusion group.From 2013 to 2016, the demand for blood transfusion, especially the demand for massive blood transfusion, increased. Repeated cesarean section and placental previa combined with uterine scar are positively correlated with increased blood transfusion. Reducing the initial cesarean section should help reduce the massive blood transfusion caused by placenta previa with a history of cesarean section.


Assuntos
Transfusão de Sangue/estatística & dados numéricos , Cesárea , Hemorragia Pós-Parto/prevenção & controle , Cuidado Pré-Natal , Adulto , Perda Sanguínea Cirúrgica , China/epidemiologia , Feminino , Humanos , Período Intraoperatório , Hemorragia Pós-Parto/epidemiologia , Gravidez , Estudos Retrospectivos , Centros de Atenção Terciária , Adulto Jovem
15.
Am J Hematol ; 96(5): 561-570, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33606900

RESUMO

Globally, postpartum hemorrhage (PPH) is the leading cause of maternal death. Women with immune thrombocytopenia (ITP) are at increased risk of developing PPH. Early identification of PPH helps to prevent adverse outcomes, but is underused because clinicians do not have a tool to predict PPH for women with ITP. We therefore conducted a nationwide multicenter retrospective study to develop and validate a prediction model of PPH in patients with ITP. We included 432 pregnant women (677 pregnancies) with primary ITP from 18 academic tertiary centers in China from January 2008 to August 2018. A total of 157 (23.2%) pregnancies experienced PPH. The derivation cohort included 450 pregnancies. For the validation cohort, we included 117 pregnancies in the temporal validation cohort and 110 pregnancies in the geographical validation cohort. We assessed 25 clinical parameters as candidate predictors and used multivariable logistic regression to develop our prediction model. The final model included seven variables and was named MONITOR (maternal complication, WHO bleeding score, antepartum platelet transfusion, placental abnormalities, platelet count, previous uterine surgery, and primiparity). We established an easy-to-use risk heatmap and risk score of PPH based on the seven risk factors. We externally validated this model using both a temporal validation cohort and a geographical validation cohort. The MONITOR model had an AUC of 0.868 (95% CI 0.828-0.909) in internal validation, 0.869 (95% CI 0.802-0.937) in the temporal validation, and 0.811 (95% CI 0.713-0.908) in the geographical validation. Calibration plots demonstrated good agreement between MONITOR-predicted probability and actual observation in both internal validation and external validation. Therefore, we developed and validated a very accurate prediction model for PPH. We hope that the model will contribute to more precise clinical care, decreased adverse outcomes, and better health care resource allocation.


Assuntos
Hemorragia Pós-Parto/etiologia , Complicações Hematológicas na Gravidez , Púrpura Trombocitopênica Idiopática/complicações , Adulto , Área Sob a Curva , China/epidemiologia , Estudos de Coortes , Suscetibilidade a Doenças , Registros Eletrônicos de Saúde , Feminino , Seguimentos , Previsões , Geografia Médica , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Imunossupressores/uso terapêutico , Recém-Nascido , Modelos Logísticos , Modelos Teóricos , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/prevenção & controle , Prednisona/uso terapêutico , Gravidez , Resultado da Gravidez , Prognóstico , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Púrpura Trombocitopênica Idiopática/terapia , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária/estatística & dados numéricos
16.
BMC Pregnancy Childbirth ; 21(1): 126, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33579220

RESUMO

BACKGROUND: To determine the effects of maternal age at first cesarean on maternal complications and adverse outcomes of pregnancy with the second cesarean. METHODS: This was a multicenter, historical, cross-sectional cohort study involving singleton pregnancies ≥28 gestational weeks, with a history of 1 cesarean delivery, and who underwent a second cesarean between January and December 2017 at 11 public tertiary hospitals in 7 provinces of China. We analyzed the effects of maternal age at first cesarean on adverse outcomes of pregnancy in the second cesarean using multivariate logistic regression analysis. RESULTS: The study consisted of 10,206 singleton pregnancies. Women were at first cesarean between 18 and 24, 25-29, 30-34, and ≥ 35 years of age; and numbered 2711, 5524, 1751, and 220 cases, respectively. Maternal age between 18 and 24 years at first cesarean increased the risk of placenta accreta spectrum (aOR, 1.499; 95% CI, 1.12-2.01), placenta previa (aOR, 1.349; 95% CI, 1.07-1.70), intrahepatic cholestasis of pregnancy (aOR, 1.947; 95% CI, 1.24-3.07), postpartum hemorrhage (aOR, 1.505; 95% CI, 1.05-2.16), and blood transfusion (aOR, 1.517; 95% CI, 1.21-1.91) in the second cesarean compared with the reference group (aged 25-29 years). In addition, maternal age ≥ 35 years at first cesarean was a risk factor for premature rupture of membranes (aOR, 1.556; 95% CI, 1.08-2.24), placental abruption (aOR, 6.464, 95% CI, 1.33-31.51), uterine rupture (aOR, 7.952; 95% CI, 1.43-44.10), puerperal infection (aOR, 6.864; 95% CI, 1.95-24.22), neonatal mild asphyxia (aOR, 4.339; 95% CI, 1.53-12.32), severe asphyxia (aOR, 18.439; 95% CI, 1.54-220.95), and admission to a neonatal intensive care unit (aOR, 2.825; 95% CI, 1.54-5.17) compared with the reference group (aged 25-29 years). CONCLUSIONS: Maternal age between 18 and 24 years or advanced maternal age at first cesarean was an independent risk factor for adverse maternal outcomes with the second cesarean. Advanced maternal age at the first cesarean specifically increased adverse neonatal outcomes with the second. Therefore, decisions as to whether to perform a first cesarean at a young or advanced maternal age must be critically evaluated.


Assuntos
Cesárea/efeitos adversos , Idade Materna , Placenta Acreta/epidemiologia , Placenta Prévia/epidemiologia , Hemorragia Pós-Parto/epidemiologia , Nascimento Prematuro/epidemiologia , Adolescente , Adulto , Fatores Etários , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Incidência , Recém-Nascido , Placenta Acreta/etiologia , Placenta Prévia/etiologia , Hemorragia Pós-Parto/etiologia , Gravidez , Resultado da Gravidez , Nascimento Prematuro/etiologia , Risco , Adulto Jovem
17.
J Anesth ; 35(2): 197-205, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33507393

RESUMO

PURPOSE: To explore the relationship of ethnicity and postpartum hemorrhage (PPH) for women who underwent cesarean delivery (CD) and examine the risk factors for PPH in distinct ethnic groups in China. METHODS: We conducted case-control studies with the maternity data from the 11,778 CD cases, in Xinjiang Uygur Autonomous Region. Initially, multivariable logistic regression was used to estimate the disparity of race-ethnicity on the risk of PPH in ethnic Han, Uygur, Hui and Kazakh. Then, we performed case-control studies within two major ethnic groups, identifying the specific risk factors for PPH. RESULTS: Ethnic Uygur were associated with a statistically significant increased odds [adjusted odds ratios (aOR) 2.05; 95% confidence interval (CI) 1.26-3.33] of PPH compared with ethnic Han. For subgroup analyses, in Uygur subgroup, general anesthesia (aOR 7.78; 95% CI 2.31-26.20); placenta previa (aOR 11.18; 95% CI 3.09-40.45); prenatal anemia (aOR 4.84; 95% CI 2.44-9.60); emergency surgery (aOR 4.22; 95% CI 1.95-9.13) were independently associated with PPH. In Han subgroup, general anesthesia (aOR 5.70; 95% CI 1.89-17.26); placenta previa (aOR 20.08; 95% CI 6.35-63.46); multiple pregnancy (aOR 7.21; 95% CI 1.61-32.37); body mass index (aOR 1.19; 95% CI 1.07-1.31) were the risk factors to PPH. CONCLUSION: Uygur have more tendency to PPH compared to Han, and risk factors for PPH in Uygur and Han groups may differ. Knowing these differences may be meaningful when planning interventions and resources for high-risk patients undergoing cesarean delivery, and we need more research aimed at risk factors for PPH.


Assuntos
Hemorragia Pós-Parto , Estudos de Casos e Controles , China/epidemiologia , Grupos Étnicos , Feminino , Humanos , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/etiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco
18.
Eur J Obstet Gynecol Reprod Biol ; 258: 299-303, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33498003

RESUMO

INTRODUCTION: A sudden postpartum hemorrhage (PPH) increase has been subjectively observed during summer 2018 in our level-3 maternity, despite following all official recommendations for PPH care. This observation led us to conduct a morbi-mortality review to understand morbidity increase reasons. METHODS: We conducted a first retrospective comparative cohort study from 2017 to 2018 to compare PPH rates. We conducted a second comparative study to determine the factors that may have led to an increase in PPH. One of the initial hypotheses of increased PPH was related to the weakness of oxytocin, exposed to high outside temperatures. The eight-day delivery records were analyzed, as follow: the high-frequency period of PPH (EXPOSED), the batch replacement of oxytocin (NON EXPOSED), and the same period of the previous year (1 YEAR BEFORE). We studied all known PPH risk factors: preconception, pregnancy, childbirth, and human, climatic, or material organizational factors in this maternity. RESULTS: 322 women were included: 111, 92, and 119 in the EXPOSED, NON EXPOSED, and 1 YEAR BEFORE groups, respectively. Sociodemographic data of the 3 groups were not different. The rate of PPH in the EXPOSED was significantly higher than that of NON EXPOSED, and 1 YEAR BEFORE: 20.7 %, 7.6 %, and 5.8 %, respectively (p = 0.0077). In the multivariate analysis, the reduction in PPH (EXPOSED vs NON EXPOSED) after changing the oxytocin batch was significant (OR 0.38 [0.14-0.91], p = 0.039). CONCLUSION: Changing oxytocin batches during this hot period reduced significantly the PPH rate and maternal morbidity in our experience.


Assuntos
Ocitócicos , Hemorragia Pós-Parto , Estudos de Coortes , Feminino , Humanos , Morbidade , Ocitócicos/efeitos adversos , Ocitocina/efeitos adversos , Hemorragia Pós-Parto/epidemiologia , Gravidez , Estudos Retrospectivos
19.
Eur J Obstet Gynecol Reprod Biol ; 258: 184-188, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33450708

RESUMO

OBJECTIVE: To explore diagnoses of postpartum haemorrhage following vaginal birth, in relation to socio-demographic and obstetrical data from women who gave birth at term, in Sweden, during the years 2005-2015. STUDY DESIGN: A register-based cohort study was carried out, describing and comparing socio-demographic variables, obstetric variables and infant variables in 52 367 cases of diagnosed postpartum haemorrhage compared to 353 569 controls without a postpartum haemorrhage diagnosis. Postpartum hemorrhage was identified in The Swedish Medical Birth Register by ICD-10 code O72. Variables for maternal characteristics were dichotomized and used to calculate odds ratios to find possible explanatory variables for postpartum haemorrhage. RESULTS: Between 2005 and 2015 there was no statistically significant decrease in diagnoses of postpartum haemorrhage after vaginal birth at term. Primiparity was associated with the highest risk and women birthing their fifth or subsequent child were associated with the lowest risk of postpartum hemorrhage. Increased maternal age (> 35 years) and/or obesity (BMI > 30) were associated with higher odds of postpartum haemorrhage. The risk of postpartum hemorrhage was 55 % higher when vaginal birth followed induction as compared to vaginal birth after spontaneous onset. Some of the factors known to be associated with postpartum haemorrhage were poorly documented in The Swedish Medical Birth Register. CONCLUSIONS: Birthing women in a Swedish contemporary setting are, despite efforts to improve care, still at risk of birth being complicated by postpartum haemorrhage. Primiparity, increasing maternal age and/or obesity are found to provoke an increased risk and the reasons for these findings need to be further investigated. However, grand multi-parity did not increase the risk for postpartum hemorrhage. Codes for diagnoses require correct documentation in the birth records: only when local statistics are sound and correctly reported can intrapartum care be improved, and the incidence of postpartum haemorrhage reduced.


Assuntos
Hemorragia Pós-Parto , Adulto , Criança , Estudos de Coortes , Feminino , Humanos , Idade Materna , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/etiologia , Gravidez , Fatores de Risco , Suécia/epidemiologia
20.
Biomed Res Int ; 2021: 6648829, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33490275

RESUMO

Background: Intrauterine balloon tamponade (IUBT) and compression sutures have been widely used in recent years in the management of postpartum hemorrhage (PPH). However, there is scant literature directly comparing the clinical scenarios that led to the discriminant selection of these management modalities and the direct clinical outcomes. The purpose of this study is to compare the patient characteristics and clinical risk factors that led to the use of IUBT and compression sutures in the management of major PPH as well as the immediate outcome in a retrospective cohort. Methods: Patients who had IUBT or compression sutures applied due to major PPH (>1000 ml) from 2014 to 2018 in a single obstetric unit were recruited. The patient characteristics and clinical outcome of the two groups were compared. Results: A total of 67 patients had IUBT and 29 patients had compression sutures applied as the first uterine sparing technique. Apart from more vaginal deliveries (25.4% vs. 3.5%) in the IUBT group compared to compression sutures, there were no significant differences between the two groups in terms of patient characteristics. The IUBT group had a slightly higher blood loss at the start of the uterine sparing procedure (239 ml, p = 0.049) and received more transfusions, despite no differences in the total blood loss, hemogloblin level, incidence of coagulopathy, and intensive care unit admission between the two groups. There was no significant difference in the overall success rate between IUBT and compression sutures to control PPH without additional surgical intervention or hysterectomy (73.1% vs. 55.1%, p = 0.15) or the success rate for PPH due to uterine atony (32.8% vs. 20.7%), though IUBT apparently performed better than compression sutures in cases of placenta praevia (77.3% vs. 16.7%, p = 0.01). Blood loss > 1.5 l at the start of the procedure, presence of placenta accreta, and presence of coagulopathy were found to be significant poor prognostic factors for both procedures to control PPH. Conclusions: There were no dominating patient characteristics that favoured the selection of either IUBT or compression sutures in the management of severe PPH except for the mode of delivery. Both procedures had equally high overall success rates to control PPH, but IUBT performed better in placenta praevia cases as compared to compression sutures.


Assuntos
Hemorragia Pós-Parto , Suturas/estatística & dados numéricos , Tamponamento com Balão Uterino/estatística & dados numéricos , Adulto , Transtornos da Coagulação Sanguínea , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Histerectomia , Placenta Acreta , Complicações Pós-Operatórias , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/cirurgia , Gravidez , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
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