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1.
Ann Palliat Med ; 10(8): 8881-8888, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34488375

RESUMO

BACKGROUND: Vaginitis is one of the most common gynecological diseases in women and may severely affect the quality of life in patients. However, very few studies have investigated aerobic vaginitis (AV) in pregnant women, and our study was designed to identify the pathogen profile, clinical importance, and risk factors of AV in pregnancy. METHODS: This was a retrospective cohort study enrolling 685 women who attended our hospital between July 2018 and June 2020. Based on the incidence of AV, enrolled women were divided into an AV group and healthy control group, and demographic and clinical characteristics were retrospectively collected by two independent investigators. Some pathogens of AV were tested using quantitative real-time polymerase chain reaction for higher accuracy. Pregnancy outcomes were also retrospectively collected. Univariable and multivariable logistic regression analysis was used to determine the risk factors of AV incidence and adverse pregnant outcomes. RESULTS: Enrolled women were divided into an AV group of 182 women and healthy control group of 503 women. The proportions of women with a history of cesarean delivery and history of vaginal infection differed between the groups (P=0.002 and <0.001, respectively). The mean gestational week at diagnosis of AV was 22.3±8.6 weeks, and the most common pathogen of AV was Escherichia coli (28.6%). After adjustment using multivariable logistic regression, a history of vaginal infection acted as an important risk factor of AV incidence, while a history of cesarean delivery, college education or above, and being employed could protect pregnant women from AV. In addition, the incidences of preterm birth, premature rupture of membranes, neonatal jaundice, and neonatal infection were much higher in the AV group than in the control group, showing significant difference (P<0.001, <0.001, =0.007, and =0.025). After adjustment using multivariable logistic regression, the incidence of AV and older age were important risk factors of premature rupture of membranes and neonatal infection. CONCLUSIONS: Compared with healthy pregnant women, the presence of AV may increase the incidence of adverse outcomes. More attention should be paid to pregnant women with a history of vaginal infection.


Assuntos
Complicações Infecciosas na Gravidez , Nascimento Prematuro , Vaginite , Vaginose Bacteriana , Idoso , Feminino , Humanos , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez , Gestantes , Qualidade de Vida , Estudos Retrospectivos , Fatores de Risco
2.
JNMA J Nepal Med Assoc ; 59(239): 626-629, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34508511

RESUMO

INTRODUCTION: Vitamin-D deficient pregnant women are more likely to have pregnancy complications like pre-eclampsia, intrauterine growth restriction, diabetes, preterm birth, etc. Associated factors include ethnicity, skin coverall, use of sun protection, overweight, vitamin-D intake, and smoking. The objective of this study is to determine the prevalence of Vitamin-D deficiency among pregnant women in a tertiary level hospital. METHODS: This study descriptive cross-sectional study was conducted at a tertiary care hospital from September 15th, 2020 to November 15th, 2020 where the pregnant women visiting for an antenatal checkup in the first trimester were enrolled. Ethical clearance was taken from the Institutional Review Committee of Kathmandu Medical College (reference no. 1808202003). A convenience sampling method was used. All the data were entered in the Statistical Package of the Social Sciences version 20.0 and analyzed. Point estimate at 90% Confidence Interval was calculated along with frequency and percentage for binary data. RESULTS: Among a total of 47 cases, vitamin-D deficiency was seen in 21 (44.6%) (32.67-56.52 at 90% Confidence Interval). CONCLUSIONS: The prevalence of vitamin-D deficiency was similar to other studies done in similar settings.


Assuntos
Gestantes , Nascimento Prematuro , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Gravidez , Primeiro Trimestre da Gravidez , Nascimento Prematuro/epidemiologia , Centros de Atenção Terciária , Vitamina D , Vitaminas
3.
BMC Public Health ; 21(1): 1610, 2021 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479527

RESUMO

BACKGROUND: Preterm birth is a risk factor for child survival in both the short and long term. In Zimbabwe, the prevalence of preterm birth is rising, and there are growing concerns about the adverse consequences. This study explored the association between intimate partner violence (IPV) during pregnancy and preterm birth in Zimbabwe. METHODS: Using data from the 2015 Zimbabwe Demographic and Health Survey, we applied propensity score matching to estimate the effect of IPV during pregnancy on preterm birth among women of reproductive age (15-49 years). A total of 4833 pregnant women who gave birth during the five years preceding the survey were analysed. RESULTS: We successfully matched 79 women who were exposed to IPV during pregnancy to 372 unexposed during pregnancy. Using the matched sample, the probability of preterm delivery was significantly higher among women who were exposed to IPV during pregnancy than those who were not exposed. The findings showed that 7 out of 79 (8.9%) of women exposed to IPV during pregnancy experienced preterm delivery, and 11 out of 372 (3.0%) of those who were not exposed to IPV during pregnancy experienced preterm delivery. In the urban areas, those exposed to IPV during pregnancy were almost five times more likely to experience preterm delivery (OR = 4.8, 95% CI 2.0-11.6), but the association was not significantly different among women in rural areas. CONCLUSION: The findings showed that women exposed to IPV during pregnancy were at increased risk of preterm birth. Some of the risk factors associated with IPV were urban residence, low economic status and unemployment. Effective policies and programmes are required to address the issue of IPV in Zimbabwe.


Assuntos
Violência por Parceiro Íntimo , Nascimento Prematuro , Adolescente , Adulto , Criança , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Gravidez , Gestantes , Nascimento Prematuro/epidemiologia , Prevalência , Fatores de Risco , Adulto Jovem
4.
BMJ Case Rep ; 14(9)2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34497055

RESUMO

We describe the successful treatment of a 24-week pregnant, 44-year-old woman with COVID-19. Management of this complex case required multidisciplinary collaboration and included prolonged invasive mechanical ventilation and prone positioning. Caesarean section delivery was delayed for 32 days, with no monitored fetal compromise, while stabilising the mother. To our knowledge, this is the longest reported duration of invasive ventilation while pregnant in a patient with COVID-19. COVID-19 has been shown to cause increased disease severity in pregnant women, and certain pregnancy-related physiological adaptations that occur could help explain this association. While COVID-19 has been shown to cause no increased adverse neonatal outcomes, clinicians should be aware that data show increased preterm birth in symptomatic pregnant women, thereby increasing the chance of prematurity-related complications. Further research on COVID-19 in pregnancy is crucial to facilitate better management, and full inclusion of pregnant women in therapeutic clinical trials will help achieve this.


Assuntos
COVID-19 , Nascimento Prematuro , Adulto , Cesárea , Feminino , Feto , Humanos , Recém-Nascido , Gravidez , Gestantes , Respiração Artificial , SARS-CoV-2
5.
BMC Pediatr ; 21(1): 373, 2021 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-34465300

RESUMO

BACKGROUND: Adverse metabolic outcomes later in life have been reported among children or young adults who were born as preterm infants. This study was conducted to examine the impact of very preterm/very low birth weight (VP/VLBW) birth and subsequent growth after hospital discharge on cardiometabolic outcomes such as insulin resistance, fasting glucose, and systolic and diastolic blood pressure (BP) among children at 6-8 years of age. METHODS: This retrospective cohort study included children aged 6-8 years and compared those who were born at < 32 weeks of gestation or weighing < 1,500 g at birth (n = 60) with those born at term (n = 110). Body size, fat mass, BP, glucose, insulin, leptin, adiponectin, and lipid profiles were measured. Weight-for-age z-score changes between discharge and early school-age period were also calculated, and factors associated with BP, fasting glucose, and insulin resistance were analyzed. RESULTS: Children who were born VP/VLBW had significantly lower fat masses, higher systolic BP and diastolic BP, and significantly higher values of fasting glucose, insulin, and homeostatic model assessment of insulin resistance (HOMA-IR), compared to children born at term. VP/VLBW was correlated with HOMA-IR and BPs after adjusting for various factors, including fat mass index and weight-for-age z-score changes. Weight-for-age z-score changes were associated with HOMA-IR, but not with BPs. CONCLUSIONS: Although children aged 6-8 years who were born VP/VLBW showed significantly lower weight and fat mass, they had significantly higher BPs, fasting glucose, HOMA-IR, and leptin levels. The associations of VP/VLBW with cardiometabolic factors were independent of fat mass and weight gain velocity.


Assuntos
Doenças Cardiovasculares , Resistência à Insulina , Nascimento Prematuro , Assistência ao Convalescente , Criança , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Alta do Paciente , Gravidez , Estudos Retrospectivos , Instituições Acadêmicas , Adulto Jovem
6.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 43(4): 551-557, 2021 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-34494525

RESUMO

Objective To explore the performance of mobile health platform for standardized management of pregnant women with gestational diabetes mellitus(GDM). Methods A randomized controlled trial was conducted,in which 295 women with GDM were randomized into two groups(traditional management group and mobile health management group)by a computer-generated sequence.The traditional management group accepted standardized GDM management,and the mobile health management group was supplemented by mobile health management based on the standardized management.The glycemic control rate and the incidences of low birth weight,macrosomia,preterm birth,premature rupture of membranes,postpartum hemorrhage after cesarean section,neonatal asphyxia,malformation,and admission to the neonatal intensive care unit were compared between the two groups. Results The glycemic control rate in mobile health management group was significantly higher than that in the traditional management group [(67.22±22.76)% vs.(60.69±21.28)%,P=0.004].The incidences of low birth weight,macrosomia,preterm birth,premature rupture of membranes,postpartum hemorrhage after cesarean section,neonatal asphyxia,malformation,and admission to the neonatal intensive care unit demonstrated no significant differences between groups(all P > 0.05). Conclusions Mobile health applied in standardized management is conducive to the glycemic control of GDM women,whereas it does not significantly improve the pregnancy outcomes.Due to the short time of intervention,the effects of mobile health on pregnancy outcomes need further study.


Assuntos
Diabetes Gestacional , Nascimento Prematuro , Telemedicina , Cesárea , Diabetes Gestacional/terapia , Feminino , Macrossomia Fetal , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez
7.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 39(4): 464-468, 2021 Aug 01.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-34409804

RESUMO

OBJECTIVES: This study aimed to explore the short-term clinical efficacy and factors influencing low-dose superficial X-ray for treating infantile maxillofacial hemangioma. METHODS: Retrospective analysis was conducted on 161 cases of infants with maxillofacial hemangioma treated with superficial X-ray in the Laser Center of Dermatology Department of Sichuan Provincial People's Hospital from January 2015 to December 2017. Clinical efficacy was analyzed by comparing the photos before and after treatment. Patients were further divided into groups according to different genders, age at the start of treatment, preterm birth or low birth weight, hemangioma site, longest diameter of hemangioma, and type of hemangioma to analyze whether differences existed in clinical efficacy and therapeutic dose between different groups. RESULTS: Twelve months after the end of treatment, the overall cure rate was 93.8%, and the significant efficiency was 97.5%. The clinical efficacy was related to the age of children at the beginning of treatment and the type of hemangioma (P<0.05). The clinical efficacy of children aged less than or equal to 12 months and superficial hemangioma group was better than that of children aged more than 12 months and deep subtype or mixed hemangioma group, respectively. Therapeutic doses associa-ted with hemangioma treatment with diameter, category, age (P<0.05), diameter greater than or equal to 4 cm hemangioma group, the mixed type or deep in the group, the children older than 12 months hemangioma group, respectively, the dia-meter is less than 4 cm hemangioma, superficial hemangioma group and age less than or equal to 12 months hemangioma total treatment group exposure dose is greater. CONCLUSIONS: Low-dose superficial X-ray is safe and effective for the treatment of infantile maxillofacial hemangioma. Age and type of hemangioma at the time of treatment are the factors influencing therapeutic dose and clinical efficacy.


Assuntos
Hemangioma , Nascimento Prematuro , Neoplasias Cutâneas , Criança , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Raios X
9.
Cells ; 10(7)2021 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-34359894

RESUMO

COVID-19 is associated with increased incidence of preterm birth (PTB). We assessed pathways by which SARS-CoV-2 could access the placenta. Placentae, from PTB with or without chorioamnionitis (ChA), or from term pregnancies (n = 12/13/group) were collected. Peripheral blood was collected from healthy pregnant women (n = 6). Second trimester placental explants (16-20 weeks, n = 5/group) were treated with lipopolysaccharide (LPS, to mimic bacterial infection) and ACE2, CCL2, IL-6/8 and TNFα mRNA was assessed. ChA-placentae exhibited increased ACE2 and CCL2 mRNA expression (p < 0.05). LPS increased cytokine and ACE2 mRNA in placental explants. Placental ACE2 protein localized to syncytiotrophoblast, fetal endothelium, extravillous trophoblast and in immune cells-subsets (M1/M2 macrophage and neutrophils) within the villous stroma. Significantly increased numbers of M1 macrophage and neutrophils were present in the ChA-placenta (p < 0.001). Subsets of peripheral immune cells from pregnant women express the ACE2 mRNA and protein. A greater fraction of granulocytes was positive for ACE2 protein expression compared to lymphocytes or monocytes. These data suggest that in pregnancies complicated by ChA, ACE2 positive immune cells in the maternal circulation have the potential to traffic SARS-CoV-2 virus to the placenta and increase the risk of vertical transmission to the placenta/fetus.


Assuntos
Enzima de Conversão de Angiotensina 2/genética , Expressão Gênica , Placenta/metabolismo , Complicações Infecciosas na Gravidez/genética , Nascimento Prematuro/etiologia , Adulto , COVID-19/genética , COVID-19/transmissão , Feminino , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , Linfócitos/metabolismo , Monócitos/metabolismo , Placenta/citologia , Gravidez , Nascimento Prematuro/genética , SARS-CoV-2/isolamento & purificação
10.
BMJ Case Rep ; 14(8)2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404662

RESUMO

Dengue is a mosquito-borne virus that causes an influenza-like illness ranging in severity from asymptomatic to fatal. Dengue in pregnancy has been associated with adverse outcomes including miscarriage, preterm birth and fetal and neonatal death. We present the case of a multiparous woman who presented at 9 weeks' gestation with vaginal bleeding and abdominal cramping after a 1 month stay in Mexico. She was initially diagnosed with miscarriage with plan for outpatient follow-up. She was readmitted 3 days later with fever, retro-orbital pain, arthralgia, rash, pancytopenia and transaminitis and managed with intravenous fluids and acetaminophen. Of note, dengue serology was initially negative but retesting 2 days later was positive. It is imperative that clinicians have heightened suspicion for dengue in pregnant women with history of travel to or residence in a dengue-endemic area and consistent clinical evidence.


Assuntos
Aborto Espontâneo , Dengue , Complicações Infecciosas na Gravidez , Nascimento Prematuro , Animais , Dengue/complicações , Dengue/diagnóstico , Feminino , Humanos , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Viagem
11.
Yonsei Med J ; 62(9): 822-828, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34427068

RESUMO

PURPOSE: Funisitis, inflammation of the umbilical cord, is considered a strong risk factor for adverse neonatal outcomes; however, a clinical definition of funisitis has not been established. In this study, we aimed to determine the clinical significance of funisitis in twin neonates with spontaneous preterm birth. MATERIALS AND METHODS: The study included preterm twin neonates (<35 weeks) delivered after spontaneous preterm labor and/or preterm premature rupture of amniotic membranes. The presence of funisitis was examined in the umbilical cord of each twin. We analyzed the risk of adverse neonatal outcomes according to the presence and absence of funisitis. Adverse neonatal outcomes were defined as the occurrence of neonatal mortality, significant morbidity, or both. RESULTS: Among 474 preterm neonates (237 twin pairs) included in this study, the frequency of funisitis was 6.5% (31 cases). Funisitis was significantly associated with neonatal mortality and adverse neonatal outcomes after adjustment for confounding variables [neonatal mortality, odds ratio (OR) 9.043, 95% confidence interval (CI) 2.620-31.204; adverse neonatal outcome, OR 2.445, 95% CI 1.017-5.875]. The concordance rate of funisitis between the twins was 10.7%, and in the absence of funisitis in one twin, the risk of neonatal mortality or adverse neonatal outcome was not influenced by the presence of funisitis in the other twin. CONCLUSION: The presence of funisitis appears to be associated with an increased risk for adverse neonatal outcomes in twin neonates with spontaneous preterm birth.


Assuntos
Corioamnionite , Nascimento Prematuro , Feminino , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Cordão Umbilical
12.
Artigo em Inglês | MEDLINE | ID: mdl-34444265

RESUMO

(1) Background: There is a continuing discussion concerning the impact of preterm birth on Maternal-Infant bonding with inconsistent results. The large burden of preterm births calls for research to evaluate the impact of it on material psychological outcome in the early postpartum period. Thus, the aim of this study was to evaluate the relationship between maternal postpartum bonding with maternal mental health, socio-demographical factors, and child's characteristics. (2) Methods: A cross-sectional study design was used. In total, 72 women (a mean age of 31.44 years old) of preterm infants (mean gestational age = 33.54; range 24-36) filled out socio-demographic questionnaires, Postpartum Bonding Questionnaire (PBQ), Edinburgh Postpartum Depression Scale (EPDS), Postpartum Depression Screening Scale (PDSS), Generalized Anxiety Disorder Assessment (GAD-7), and Parental Stress Scale (PSS) 1-3 days post-delivery; (3) Results: The results analyses have shown positive correlations between the overall result of maternal postpartum bonding with stress (p < 0.01), maternal educational level (p < 0.01), maternal age (p < 0.05) and the number of children (p < 0.01). However, there were no significant relationships between other investigated variables. The results of linear regression have revelated the important role of the overall scores in experience of stress among mothers (explaining 49% of the variability). The mediating role of maternal stress on maternal postpartum bonding was not found. That relationship of maternal postpartum bonding and maternal stress was not moderated through socio-demographic variables. (4) Conclusions: In this study mothers of prematurely born children had a good level of Maternal-Infant bonding. Maternal stress was found to be a predictor of maternal postpartum bonding among the tested variables. Surprisingly, the study results did not show significant relationships between maternal postpartum bonding and maternal mental health (depression and anxiety).


Assuntos
Saúde Mental , Nascimento Prematuro , Adulto , Criança , Estudos Transversais , Feminino , Humanos , Lactente , Saúde do Lactente , Recém-Nascido , Recém-Nascido Prematuro , Relações Mãe-Filho , Mães , Período Pós-Parto , Gravidez , Inquéritos e Questionários
13.
Artigo em Inglês | MEDLINE | ID: mdl-34444266

RESUMO

Adolescent pregnancy remains a health issue worldwide also in developed countries, since it has been associated with adverse maternal and neonatal outcomes. Some data suggest that very young adolescents have higher risk, likely due to immaturity. Therefore, we aimed to assess the influence of maternal age on complications during gestation and labor in pregnant women between 13 and 19 years of age. In particular, we evaluated the possible association between maternal age and obstetric, fetal and labor complications. This is a retrospective, observational and exploratory study conducted at Hospital Universitario La Paz (HULP, Madrid, Spain). The clinical history of 279 women who delivered between 2013 and 2018 was analyzed. Maternal age and the presence of maternal, fetal and labor complications, as well as risk of postpartum depression and breastfeeding intention, were recorded. General regression models were used to analyze the contribution of maternal age on each complication. The percentage of adolescent pregnancies at HULP between 2013 and 2018 was 0.9%. The risk of all the maternal complications analyzed decreased significantly with every year of age of the mother (hyperemesis, lower back pain, anemia, gestational diabetes mellitus, and threat of premature labor and premature rupture of membranes). Every year of maternal age decreased 0.8-fold [0.8; 0.9] the prevalence of fetal complications and also reduced the risk of C-section, postpartum hemorrhage and obstetrical hysterectomy. Furthermore, higher maternal age increased 1.1-fold [1.0; 1.2] the breastfeeding intention. In conclusion, young adolescents are at higher risk of complications during pregnancy and labor.


Assuntos
Complicações do Trabalho de Parto , Trabalho de Parto Prematuro , Complicações na Gravidez , Gravidez na Adolescência , Nascimento Prematuro , Adolescente , Adulto , Cesárea , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Retrospectivos , Adulto Jovem
14.
BMJ Open ; 11(8): e047770, 2021 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-34362802

RESUMO

OBJECTIVE: To investigate the literature and determine if prematurity has an impact on long-term adverse kidney outcomes. DESIGN: Systematic review. DATA SOURCES: OVID Medline, PubMed, SCOPUS, CINAHL and EMBASE databases were searched for studies relating to the adverse outcomes of prematurity from 1990 to April 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: All articles published between January 1990 and April 2021 that investigated whether premature infants developed long-term adverse renal outcomes were included in this review. Articles must have been human studies and written in English. Case series with less than 20 participants and case studies were excluded. DATA EXTRACTION AND SYNTHESIS: One reviewer completed the database searches. Article selection was performed independently and in a non-blinded manner by both reviewers. Initial screening was by title and abstract. Full texts of remaining articles were reviewed. Articles for which inclusion was unclear were re-reviewed by both reviewers, and a unanimous decision was taken as to whether they should be included. The Newcastle-Ottawa Scale was used for quality assessment of the included articles. RESULTS: The literature search yielded 31 human studies, which investigated the short-term and long-term kidney outcomes of prematurity. These studies were conducted in 17 different countries. The most common outcomes measured were blood pressure (BP) and glomerular filtration rate. Other common outcomes measured included kidney size and mass, proteinuria, albuminuria, chronic kidney disease (CKD) and physical parameters such as height, weight and body mass index. CONCLUSION: Prematurity is likely linked to increased risk of kidney dysfunction and high BP in childhood and into early adulthood. Premature birth conferred a twofold increased risk of CKD and extremely premature birth conferred a threefold increased risk of CKD. However, further larger multicentre studies are needed to draw definitive conclusions on the long-term kidney outcomes of prematurity.


Assuntos
Nascimento Prematuro , Insuficiência Renal Crônica , Adulto , Feminino , Taxa de Filtração Glomerular , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Rim , Gravidez , Insuficiência Renal Crônica/epidemiologia
15.
Zhonghua Fu Chan Ke Za Zhi ; 56(8): 528-536, 2021 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-34420284

RESUMO

Objective: To analyze the clinical data of pregnant women complicated with cardiovascular disease in our center in the past 10 years, and to explore the trend of incidence, clinical diagnosis, and treatment of the disease. Methods: Clinical data of pregnant women with cardiovascular disease who delivered in Beijing Anzhen Hospital, Capital Medical University from 2010 to 2019 were collected and analyzed retrospectively. According to the time of the establishment of multidisciplinary team (MDT) in the center, the pregnant women were divided into the first 5-year group (2010-2014) and the second 5-year group (2015-2019). The general data, the composition of pregnancy complicated with cardiovascular disease and the changes of maternal and infant outcomes of the two groups were analyzed. Results: (1) During 2010-2019, there were 2 267 cases of pregnancy complicated with cardiovascular disease (836 cases in the first 5-year group and 1 431 cases in the second 5-year group), with a total incidence of 10.2% (2 267/22 334). Among all kinds of cardiovascular diseases, arrhythmia (41.0%, 930/2 267) and congenital heart disease (38.2%, 865/2 267) were more common. (2) There were 212 cases (25.4%, 212/836) and 426 cases (29.8%, 426/1 431) classified as Ⅲ or Ⅳ by modified WHO cardiovascular risk classification in the first 5-year group and the second 5-year group, respectively, and the difference was statistically significant (χ²=5.076,P=0.024). Among all kinds of cardiovascular diseases, there were 111 cases (13.3%, 111/836) and 159 cases (11.1%, 159/1 431) with valvular disease in the first 5-year group and the second 5-year group, respectively. The change of the component ratio was -16.5% (the difference was significant when the absolute value of change>10%), showing a significant decreasing trend. Aortic disease was found in 16 cases (1.9%, 16/836) and 56 cases (3.9%, 56/1 431), respectively, with a significant upward trend of 105.3%. (3) The mortality rate of pregnant women with cardiovascular disease was 1.0% (22/2 267), and 1.2% (10/836) and 0.8% (12/1 431) in the first 5-year grouop and the second 5-year group, respectively. There was no significant difference between the two groups (χ²=0.702,P=0.402). ICU occupancy rates in the first 5-year group and the second 5-year group were 25.6% (214/836) and 20.7% (296/1 431), respectively, and the difference between the two groups was statistically significant (χ²=7.306,P=0.007). There were no significant differences in cesarean section rate, mortality rate and incidence of adverse events between the two groups of pregnant women, and there were no significant differences in birth weight, preterm birth rate, mortality rate and asphyxia rate between the two groups of newborns (all P>0.05). Conclusions: Pregnancy complicated with cardiovascular disease is a common cause of adverse obstetric outcomes. There are various types of specific cardiovascular diseases, and the prognosis varies greatly. In recent years, the disease composition ratio has changed, and the severity and complexity of diseases have increased. Hierarchical management, MDT and individual management could improve the treatment level and reduce adverse outcomes.


Assuntos
Doenças Cardiovasculares , Complicações Cardiovasculares na Gravidez , Nascimento Prematuro , Doenças Cardiovasculares/epidemiologia , Cesárea , Feminino , Hospitais , Humanos , Recém-Nascido , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/epidemiologia , Estudos Retrospectivos
16.
Lancet Glob Health ; 9(9): e1226-e1241, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34416213

RESUMO

BACKGROUND: Preterm birth rates have increased significantly worldwide over the past decade. Few epidemiological studies on the incidence of preterm birth and temporal trends are available in China. This study used national monitoring data from China's National Maternal Near Miss Surveillance System (NMNMSS) to estimate the rate of preterm birth and trends between 2012 and 2018 in China and to assess risk factors associated with preterm birth. METHODS: In this observational study, data were sourced from the NMNMSS between Jan 1, 2012, and Dec 31, 2018. Pregnancies with at least one livebirth, with the baby born at 28 weeks of gestation or more or 1000 g or more birthweight were included. We estimated the rates of overall preterm, very preterm (born between 28 and 31 weeks' gestation), moderate preterm (born between 32 and 33 weeks' gestation), and late preterm (born between 34 and 36 weeks' gestation) births in singleton and multiple pregnancies and assessed their trends over time. We used logistic regression analysis to examine the associations between preterm birth and sociodemographic characteristics and obstetric complications, considering the sampling strategy and clustering of births within hospitals. Interrupted time series analysis was used to assess the changes in preterm birth rates during the period of the universal two child policy intervention. FINDINGS: From Jan 1, 2012, to Dec 31, 2018, 9 645 646 women gave birth to at least one live baby, of whom 665 244 (6·1%) were born preterm. In all pregnancies, the overall preterm birth rate increased from 5·9% in 2012 to 6·4% in 2018 (8·8% increase; annual rate of increase [ARI] 1·3 [95% CI 0·6 to 2·1]). Late preterm births (8·8%; ARI 1·5% [0·9 to 2·2]) and very preterm births (13·3%; ARI 1·8% [0·5 to 3·0]) significantly increased from 2012 to 2018, whereas moderate preterm births did not (3·8%; ARI 0·3% [95% CI -0·9 to 1·5]). In singleton pregnancies, the overall preterm birth rate showed a small but significant 6·4% increase (ARI 1·0% [0·4 to 1·7]) over the 7 year period. In multiple pregnancies, the overall preterm birth rate significantly increased from 46·8% in 2012 to 52·7% in 2018 (12·4% increase; ARI 1·9% [1·2 to 2·6]). Compared with women who gave birth in 2012, those who gave birth in 2018 were more likely to be older (aged ≥35 years; 7·4% in 2012 vs 15·9% in 2018), have multiples (1·6% vs 1·9%), have seven or more antenatal visits (50·2% vs 70·7%), and have antepartum complications and medical disease (17·9% vs 35·1%), but they were less likely to deliver via caesarean section (47·5% vs 45·0%). Compared with the baseline period (January, 2012 to June, 2016), a higher increase in preterm birth was observed after the universal two child policy came into effect in July, 2016 (ß=0·034; p=0·03). INTERPRETATION: An increase in preterm births was noted for both singleton and multiple pregnancies between 2012 and 2018 in China. China's strategic investment in maternal and neonatal health has been crucial for the prevention of preterm birth. Due to rapid changes in sociodemographic and obstetric factors related to preterm birth-particularly within the context of the universal two child policy-such as advanced maternal age at delivery, maternal complications, and multiple pregnancies, greater efforts to reduce the burden of preterm birth are urgently needed. FUNDING: National Key R&D Program of China, National Health Commission of the People's Republic of China, China Medical Board, WHO, and UNICEF.


Assuntos
Nascimento Prematuro/epidemiologia , China/epidemiologia , Feminino , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Análise de Séries Temporais Interrompida , Gravidez , Fatores de Risco
17.
Medicina (Kaunas) ; 57(8)2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34441002

RESUMO

Background and Objectives: The ongoing pandemic proved to be a tremendous challenge to all economic layers, healthcare, and people safety. As more than one year elapsed since the beginning of the COVID-19 pandemic, a multitude of medical studies involving the SARS-CoV-2 virus helped researchers and medical practitioners in understanding the effects it has on all sorts of patients until effective vaccines were finally developed and distributed for mass vaccination. Still, the SARS-CoV-2 and its new variants remain a potential threat towards all categories of patients, including a more delicate group represented by pregnant women. Thus, the current study aims to investigate the potential effects on obstetrical outcomes after a positive SARS-CoV-2 infection. Materials and Methods: This single-center prospective cohort study investigated the pregnancy outcomes in a total of 1039 eligible pregnant women between 30 August 2020 and 30 January 2021. Multiple patient characteristics and obstetrical outcomes were tested and analyzed in a multivariate regression model to establish potential risks determined by a COVID-19-positive pregnancy towards the mother and the newborn. Results: In the study sample, there were 938 pregnancies included without COVID-19 and 101 pregnant women identified with a positive COVID-19 infection. COVID-19 was significantly associated with a 2-fold increase in the risk of premature rupture of membranes and 1.5 times higher risk of preterm birth with emergency c-sections and lower APGAR scores. Also, significantly more newborns were given birth prematurely, with lower APGAR scores after the mothers were infected with SARS-CoV-2. Conclusions: A third-trimester infection with SARS-CoV-2 is a significant risk factor for preterm birth via an emergency cesarean section, a premature rupture of membranes, and a lower APGAR score in newborns, as compared with pregnancies where COVID-19 was not identified.


Assuntos
COVID-19 , Complicações Infecciosas na Gravidez , Nascimento Prematuro , Cesárea , Feminino , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , Pandemias , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Estudos Prospectivos , SARS-CoV-2
18.
BMC Pregnancy Childbirth ; 21(1): 587, 2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34445988

RESUMO

BACKGROUND: The coronavirus disease (COVID-19) pandemic has caused ongoing challenges in health services worldwide. Despite the growing body of literature on COVID-19, reports on perinatal care in COVID-19 cases are limited. CASE PRESENTATION: We describe a case of severe acute respiratory distress syndrome (ARDS) in a 36-year-old G5/P2 pregnant woman with morbid obesity, confirmed severe acute respiratory syndrome coronavirus 2 infection, and fulminant respiratory failure. At 28+ 1 gestational weeks, the patient delivered an uninfected newborn. Using ImmunoCAP ISAC® technology, we found no immunoglobulin (Ig) M antibodies, suggesting that no mother-to-child viral transmission occurred during pregnancy or delivery. The maternal respiratory state improved rapidly after delivery; both maternal and neonatal outcomes were encouraging given the early gestational age and fulminant course of respiratory failure in our patient. CONCLUSIONS: The management of ARDS in pregnant women with COVID-19 is complex and requires an individualized, multidisciplinary approach, while considering maternal and fetal outcomes.


Assuntos
COVID-19 , Cesárea/métodos , Pneumonia Viral , Complicações Infecciosas na Gravidez , Nascimento Prematuro , Síndrome do Desconforto Respiratório , SARS-CoV-2/isolamento & purificação , Adulto , COVID-19/complicações , COVID-19/diagnóstico , Feminino , Monitorização Fetal/métodos , Idade Gestacional , Humanos , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/fisiopatologia , Equipe de Assistência ao Paciente/organização & administração , Assistência Perinatal/métodos , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/etiologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/terapia , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/terapia , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório/diagnóstico , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/fisiopatologia , Síndrome do Desconforto Respiratório/terapia , Resultado do Tratamento
19.
BMC Pediatr ; 21(1): 358, 2021 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-34429086

RESUMO

BACKGROUND: Spinal cord compression (SCC) is an uncommon, severe complication of Hodgkin lymphoma (HL), occurring in 0.2% of cases at the onset and in 6% during disease progression. We present a teenager with SCC with clinical onset of HL; her pre-existing neurological abnormalities covered the presence of an epidural mass, which could have misled us. CASE PRESENTATION: A 13-year-old girl presented with a three-month history of lower back pain and degrading ability to walk. She suffered from a chronic gait disorder due to her preterm birth. A magnetic resonance imaging of the spine revealed an epidural mass causing collapse of twelfth thoracic vertebra and thus compression and displacement of the spinal cord. Histological examination with immunohistochemical analysis of the epidural mass demonstrated a classic-type Hodgkin lymphoma. Early pathology-specific treatment allowed to avoid urgent surgery, achieve survival and restore of neurological function. CONCLUSIONS: Children and adolescents with back pain and neurological abnormalities should be prioritized to avoid diagnostic delay resulting in potential loss of neurological function. SCC requires a prompt radiological assessment and an expert multidisciplinary management.


Assuntos
Doença de Hodgkin , Nascimento Prematuro , Compressão da Medula Espinal , Adolescente , Criança , Diagnóstico Tardio , Feminino , Doença de Hodgkin/complicações , Doença de Hodgkin/diagnóstico , Humanos , Recém-Nascido , Gravidez , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Vértebras Torácicas/diagnóstico por imagem
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