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1.
Rev Med Suisse ; 17(720-1): 38-41, 2021 Jan 13.
Artigo em Francês | MEDLINE | ID: mdl-33443829

RESUMO

In Switzerland, tobacco smoking is a major public health problem, especially among pregnant women. Health problems encountered by pregnant women and their fetuses require specific care to assist smoking cessation. A specific consultation to support smoking cessation during pregnancy was created in May 2019 at the maternity ward of the University Hospitals of Geneva, with the support of the Fondation Privée des Hôpitaux Universitaires de Genève and Carrefour addictionS/CIPRET-Genève. The creation of a network of health professionnals trained in smoking cessation is an important step to support women during their cessation process.


Assuntos
Ginecologia/métodos , Obstetrícia/métodos , Assistência Perinatal/métodos , Complicações na Gravidez/prevenção & controle , Gestantes , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar/métodos , Feminino , Humanos , Gravidez , Suíça
2.
Rev. medica electron ; 42(6): 2659-2673, nov.-dic. 2020.
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1150045

RESUMO

RESUMEN El gran desarrollo del programa materno infantil en Cuba y la gran atención que a este se brinda hace que muchos médicos limitan a la embarazada al reposo y todavía hay muchas mujeres que se enfrentan al parto sin un entrenamiento previo. Por la importancia de este tema en materia de salud materno infantil se realizó esta revisión bibliográfica con el propósito de aumentar el nivel de conocimientos de los profesionales sobre los beneficios de la misma y lograr un trabajo en equipo del personal que integre el programa, para de esta manera, conseguir el máximo beneficio para las madres, bebés y sus familias. Está demostrado que le hace bien a la mujer embarazada y al bebé. Una gestante preparada es una gestante colaboradora. Por tanto, el entrenamiento junto a hábitos sanos de vida conllevara a que la embarazada tenga un parto en las mejores condiciones físicas y psíquicas, para de esta forma lograr un hijo sano, fuerte y una gran gratificación para toda la familia. La participación activa del padre conseguirá mayor armonía familiar (AU).


SUMMARY The great development of the maternal-infantile program in Cuba and the great attention provided to this, leads to the limitation of pregnant women to rest by doctors, and there are still many women facing the childbirth without a previous training. Due to the importance of this topic in the matter of maternal-infantile health, the authors carried out the current bibliographical review with the purpose of increasing the level of the professionals' knowledge about its benefits and of achieving a team work of the staff integrating the program, and that way, to get the maximum benefit for mothers, babies and their families. It is proved that it makes well to pregnant woman and to the baby. A trained pregnant woman is a collaborative pregnant woman. Therefore, training together with healthy life habits leads pregnant women to childbirth in the better physical and health conditions, delivering this way a healthy, strong child and achieving a great gratification for the whole family. The father's active participation will get bigger family harmony (AU).


Assuntos
Humanos , Feminino , Técnicas Psicológicas/normas , Obstetrícia/métodos , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/psicologia , Unidade Hospitalar de Ginecologia e Obstetrícia , Família/psicologia , Estratégia Saúde da Família , Gestantes/psicologia
3.
J Perinat Med ; 48(9): 925-930, 2020 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-33035193

RESUMO

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


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Assistência Perinatal/métodos , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Complicações Infecciosas na Gravidez/virologia , Centers for Disease Control and Prevention, U.S. , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Cuidados Críticos/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Transmissão Vertical de Doença Infecciosa , Obstetrícia/métodos , Pandemias , Pneumonia Viral/diagnóstico , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/terapia , Resultado da Gravidez , Gravidez de Alto Risco , Cuidado Pré-Natal/métodos , Estados Unidos
4.
Obstet Gynecol ; 136(5): 1074, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33093424

RESUMO

Travel is an increasingly common aspect of modern life, and the practicing obstetrician-gynecologist needs a good understanding of the health- and safety-related issues it presents for patients. This monograph examines the environmental data that support individual risk assessment and provides guidance on how to eliminate or mitigate those risks, including recommendations for immunization and chemoprophylaxis for women traveling to areas with endemic infectious disease. Management approaches for travel-related diseases, such as traveler's diarrhea, altitude sickness, and location-specific diseases, are reviewed as are special considerations for pregnant and breastfeeding women and women who are attempting pregnancy. Evaluation and management of the returned traveler also is addressed. The recommendations in this document cite resources available from the United States federal government; therefore, they are applicable to women seeking care in the United States.


Assuntos
Medicina Preventiva/métodos , Atenção Primária à Saúde/métodos , Medicina de Viagem/métodos , Doença Relacionada a Viagens , Saúde da Mulher , Adulto , Feminino , Ginecologia/métodos , Humanos , Obstetrícia/métodos , Gravidez , Viagem , Estados Unidos
5.
Obstet Gynecol ; 136(4): 868-869, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32976376

RESUMO

The primary goal of the initial reproductive health visit is to provide preventive health care services, educational information, and guidance, in addition to problem-focused care. The initial reproductive health visit should take place between the ages of 13 and 15 years. The scope of the initial visit will depend on the patient's concerns, medical history, physical and emotional development, and the level of care the patient is receiving from other health care professionals. All adolescents should have the opportunity to discuss health issues with a health care professional one-on-one, because they may feel uncomfortable talking about these issues in the presence of a parent or guardian, sibling, or intimate partner. Addressing confidentiality concerns is imperative because adolescents in need of health care services are more likely to forego care if there are concerns about confidentiality. Laws regarding confidentiality of care to minors vary by state, and health care professionals should be knowledgeable about current laws for their practice. Taking care to establish secure lines of communication can build trust with the patient and guardian, support continuity of care, ensure adherence to legal statutes, and decrease barriers to services. Obstetrician-gynecologists have the opportunity to serve as educators of parents and guardians about reproductive health issues. Preparing the office environment to include adolescent-friendly and age-appropriate reading materials, intake forms, and educational visual aids can make the general office space more inclusive and accessible. Resources should be provided for both the adolescent patient and the parent or guardian, if possible, at the conclusion of the visit. This Committee Opinion has been updated to include gender neutral terminology throughout the document, counseling topics with direct links to helpful resources, screening tools with direct links, addition of gender and sexuality discussion, and inclusion of trauma-informed care.


Assuntos
Serviços de Saúde do Adolescente , Ginecologia/métodos , Obstetrícia/métodos , Serviços Preventivos de Saúde , Saúde Reprodutiva , Adolescente , Comportamento do Adolescente , Saúde do Adolescente , Serviços de Saúde do Adolescente/ética , Serviços de Saúde do Adolescente/organização & administração , Feminino , Humanos , Serviços Preventivos de Saúde/ética , Serviços Preventivos de Saúde/métodos , Saúde Reprodutiva/educação , Saúde Reprodutiva/ética , Educação Sexual/métodos , Comportamento Sexual , Estados Unidos
6.
Obstet Gynecol ; 136(4): e70-e80, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32976378

RESUMO

The primary goal of the initial reproductive health visit is to provide preventive health care services, educational information, and guidance, in addition to problem-focused care. The initial reproductive health visit should take place between the ages of 13 and 15 years. The scope of the initial visit will depend on the patient's concerns, medical history, physical and emotional development, and the level of care the patient is receiving from other health care professionals. All adolescents should have the opportunity to discuss health issues with a health care professional one-on-one, because they may feel uncomfortable talking about these issues in the presence of a parent or guardian, sibling, or intimate partner. Addressing confidentiality concerns is imperative because adolescents in need of health care services are more likely to forego care if there are concerns about confidentiality. Laws regarding confidentiality of care to minors vary by state, and health care professionals should be knowledgeable about current laws for their practice. Taking care to establish secure lines of communication can build trust with the patient and guardian, support continuity of care, ensure adherence to legal statutes, and decrease barriers to services. Obstetrician-gynecologists have the opportunity to serve as educators of parents and guardians about reproductive health issues. Preparing the office environment to include adolescent-friendly and age-appropriate reading materials, intake forms, and educational visual aids can make the general office space more inclusive and accessible. Resources should be provided for both the adolescent patient and the parent or guardian, if possible, at the conclusion of the visit. This Committee Opinion has been updated to include gender neutral terminology throughout the document, counseling topics with direct links to helpful resources, screening tools with direct links, addition of gender and sexuality discussion, and inclusion of trauma-informed care.


Assuntos
Serviços de Saúde do Adolescente , Ginecologia/métodos , Obstetrícia/métodos , Serviços Preventivos de Saúde , Saúde Reprodutiva , Adolescente , Comportamento do Adolescente , Saúde do Adolescente , Serviços de Saúde do Adolescente/ética , Serviços de Saúde do Adolescente/organização & administração , Confidencialidade/normas , Feminino , Humanos , Planejamento de Assistência ao Paciente , Serviços Preventivos de Saúde/ética , Serviços Preventivos de Saúde/métodos , Saúde Reprodutiva/educação , Saúde Reprodutiva/ética , Educação Sexual/métodos , Comportamento Sexual , Estados Unidos
7.
J Obstet Gynaecol Res ; 46(11): 2237-2241, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32909322

RESUMO

AIM: A nationwide questionnaire survey was performed to evaluate how Japanese Society of Obstetrics and Gynecology (JSOG) members dealt with the coronavirus disease (COVID-19) pandemic during the declared nationwide emergency. METHODS: We sent questionnaires to members of JSOG via official email. Participants answered anonymously using Google forms. RESULTS: Two (0.08%) JSOG members had contracted COVID-19. There was a clear decrease in the number of patients scheduled for operation, not only for malignant but also for benign diseases. A decrease in the number of outpatients for infertility treatment was also observed. Polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 was available in 20.4% of the facilities. Inpatients and outpatients were requested to wear masks, limit the number of contacts and check body temperature when visiting hospitals/clinics. During parturition care, caregivers and physicians wore gloves, masks (other than N-95), face shields and gowns. About 66% and 80% of the facilities decided to transfer pregnant women if they had asymptomatic and symptomatic infection, respectively. Cesarean section was typically chosen as delivery mode in infected women. CONCLUSION: The COVID-19 pandemic provoked significant changes in obstetrics and gynecology practices in Japan. Apparently, nosocomial infections were largely prevented due to these changes, although some of them might not have been necessary.


Assuntos
Infecções por Coronavirus/prevenção & controle , Ginecologia/estatística & dados numéricos , Instalações de Saúde/estatística & dados numéricos , Obstetrícia/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Complicações Infecciosas na Gravidez/prevenção & controle , Betacoronavirus , Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Feminino , Ginecologia/métodos , Humanos , Japão , Obstetrícia/métodos , Pneumonia Viral/diagnóstico , Gravidez , Complicações Infecciosas na Gravidez/virologia
8.
J Perinat Med ; 48(9): 892-899, 2020 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-32892181

RESUMO

The global spread of the SARS-CoV-2 virus during the early months of 2020 was rapid and exposed vulnerabilities in health systems throughout the world. Obstetric SARS-CoV-2 disease was discovered to be largely asymptomatic carriage but included a small rate of severe disease with rapid decompensation in otherwise healthy women. Higher rates of hospitalization, Intensive Care Unit (ICU) admission and intubation, along with higher infection rates in minority and disadvantaged populations have been documented across regions. The operational gymnastics that occurred daily during the Covid-19 emergency needed to be translated to the obstetrics realm, both inpatient and ambulatory. Resources for adaptation to the public health crisis included workforce flexibility, frequent communication of operational and protocol changes for evaluation and management, and application of innovative ideas to meet the demand.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Hospitais/estatística & dados numéricos , Obstetrícia/métodos , Pandemias , Pneumonia Viral/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Cuidados Críticos/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Administração Hospitalar , Humanos , Recém-Nascido , Cidade de Nova Iorque/epidemiologia , Obstetrícia/estatística & dados numéricos , Equipamento de Proteção Individual/estatística & dados numéricos , Admissão e Escalonamento de Pessoal , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/terapia , Capacidade de Resposta ante Emergências/organização & administração , Capacidade de Resposta ante Emergências/estatística & dados numéricos
9.
Int J Gynaecol Obstet ; 151 Suppl 1: 51-56, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32894589

RESUMO

OBJECTIVE: To gain insights from pregnant women and obstetricians on the utility of the FIGO Nutrition Checklist in antenatal practice. METHODS: Women were recruited from the antenatal department of a large tertiary-level university maternity hospital in Dublin, Ireland, between October and December 2019. Participants completed the FIGO Nutrition Checklist before their routine antenatal appointment. Obstetricians and women were encouraged to discuss the FIGO Nutrition Checklist during the clinical visit. Completed FIGO Nutrition Checklists were collected after appointments. Acceptability was assessed through questionnaires. RESULTS: The majority (80.0%) of women answered "No" to at least one diet quality question, indicating a potential nutritional risk. While none of the participating obstetricians routinely discussed nutrition with women, all agreed that using the Checklist encouraged them to address nutrition with pregnant women. Nearly every woman (99.0%) found the Checklist quick to complete; however, all participating obstetricians felt there was not enough time to discuss it in routine practice. Despite this, most obstetricians and pregnant women recommended the FIGO Nutrition Checklist for use. CONCLUSION: The FIGO Nutrition Checklist is acceptable for use in routine antenatal practice in tertiary care settings. It helped identify potentially at-risk women during early pregnancy and facilitated conversations related to optimum diet.


Assuntos
Lista de Checagem/estatística & dados numéricos , Fenômenos Fisiológicos da Nutrição Materna , Cuidado Pré-Natal/métodos , Adulto , Feminino , Humanos , Irlanda , Obstetrícia/métodos , Obstetrícia/estatística & dados numéricos , Relações Médico-Paciente , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Inquéritos e Questionários
11.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 47(3): 118-127, jul.-sept. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-191031

RESUMO

La infección causada por el nuevo coronavirus SARS-CoV-2 (COVID-19) representa actualmente una de las mayores emergencias sanitarias a nivel mundial. La aparición de una nueva infección potencialmente grave y la situación de pandemia actual ha implicado importantes ajustes en la práctica clínica en medicina materno-fetal. Aunque no parece existir una mayor afectación o susceptibilidad al virus de las mujeres embarazadas respecto la población general, existen aspectos específicos ligados a la gestación que deben tenerse en cuenta de cara al diagnóstico y manejo de la COVID-19 en pacientes embarazadas. En el siguiente documento se exponen las recomendaciones y el protocolo de actuación ante la infección por COVID-19 durante el embarazo desarrollado en nuestro centro, basado en la evidencia científica disponible hasta la fecha y las principales recomendaciones internacionales


The severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) disease (COVID-19) has caused a large global outbreak and has had a major impact on health systems and societies worldwide. The generation of knowledge about the disease has occurred almost as fast as its global expansion. Very few studies have reported on the effects of the infection on maternal health, since its onset. The mother and foetus do not seem to be at particularly high risk. Nevertheless, obstetrics and maternal-foetal medicine practice have made profound changes in order to adapt to the pandemic. In addition, there are aspects specific to COVID-19 and gestation that should be known by specialists. In this review an evidenced-based protocol is presented for the management of COVID-19 in pregnancy


Assuntos
Humanos , Masculino , Feminino , Gravidez , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Pneumonia Viral/virologia , Complicações Infecciosas na Gravidez/virologia , Espanha , Escores de Disfunção Orgânica , Obstetrícia/métodos , Período Pós-Parto
12.
J Perinat Med ; 48(9): 874-882, 2020 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-32745072

RESUMO

The Coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pandemic has had a rapid and deadly onset, spreading quickly throughout the world. Pregnant patients have had high mortality rates, perinatal losses, and Intensive Care Unit (ICU) admissions from acute respiratory syndrome Coronavirus (SARS-CoV) and Middle East respiratory syndrome Coronavirus (MERS-CoV) in the past. Potentially, a surge of patients may require hospitalization and ICU care beyond the capacity of the health care system. This article is to provide institutional guidance on how to prepare an obstetric hospital service for a pandemic, mass casualty, or natural disaster by identifying a care model and resources for a large surge of critically ill pregnant patients over a short time. We recommend a series of protocols, education, and simulation training, with a structured and tiered approach to match the needs for the patients, for hospitals specialized in obstetrics.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Cuidados Críticos , Obstetrícia/métodos , Pandemias , Pneumonia Viral/complicações , Complicações Infecciosas na Gravidez/virologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Estado Terminal/terapia , Planejamento em Desastres , Serviços Médicos de Emergência/ética , Serviços Médicos de Emergência/organização & administração , Feminino , Maternidades , Humanos , Admissão e Escalonamento de Pessoal , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Gravidez , Complicações Infecciosas na Gravidez/terapia , Capacidade de Resposta ante Emergências
13.
J Obstet Gynaecol Can ; 42(8): 1017-1020, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32736852

RESUMO

Health care team training and simulation-based education are important for preparing obstetrical services to meet the challenges of the COVID-19 pandemic. Priorities for training are identified in two key areas. First, the impact of infection prevention and control protocols on processes of care (e.g., appropriate and correct use of personal protective equipment, patient transport, preparation for emergency cesarean delivery with the potential for emergency intubation, management of simultaneous obstetric emergencies, delivery in alternate locations in the hospital, potential for increased decision-to-delivery intervals, and communication with patients). And second, the effects of COVID-19 pathophysiology on obstetrical patients (e.g., testing and diagnosis, best use of modified obstetric early warning systems, approach to maternal respiratory compromise, collaboration with critical care teams, and potential need for cardiopulmonary resuscitation). However, such training is more challenging during the COVID-19 pandemic because of the requirements for social distancing. This article outlines strategies (spatial, temporal, video-recording, video-conferencing, and virtual) to effectively engage in health care team training and simulation-based education while maintaining social distancing during the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus , Parto Obstétrico , Controle de Infecções/métodos , Obstetrícia , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Treinamento por Simulação , Desenvolvimento de Pessoal/métodos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Parto Obstétrico/educação , Parto Obstétrico/métodos , Tratamento de Emergência/métodos , Feminino , Humanos , Práticas Interdisciplinares/métodos , Obstetrícia/educação , Obstetrícia/métodos , Pandemias/prevenção & controle , Simulação de Paciente , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Treinamento por Simulação/métodos , Treinamento por Simulação/organização & administração
14.
J Obstet Gynaecol Res ; 46(10): 1967-1971, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32691488

RESUMO

AIM: In Hokkaido, Japan, the number of people suffering from coronavirus disease 2019 (COVID-19) is rapidly increased, and by the end of February 2020, there were already 70 confirmed cases of the disease. We investigated the safety of urgently initiated maternal telemedicine in preventing the spread of the coronavirus infection. METHODS: This retrospective, single-institution study examined maternal telemedicine at the department of obstetrics of the Hokkaido University Hospital from March 4 to April 2, 2020. The physicians remotely examined the pregnant women from their homes using a visual communication system which kept communication confidential, performed prenatal checkup and administered medical care according to their various blood pressures, weights and cardiotocograms. RESULTS: Forty-four pregnant women received a total of 67 telemedicine interventions. Thirty-two pregnant women (73%) had complications, and 22 were primiparas (50%). Telemedicine interventions were provided 19 times at less than 26 weeks of gestation, 43 times between 26 and 36 weeks of gestation and 5 times after 37 weeks of gestation. There was one case with an abnormality diagnosed during the remote prenatal checkups, and the patient was hospitalized on the same day. However, there were no abnormal findings observed in mothers and children during the other 66 remote prenatal checkups and medical care. CONCLUSION: Maternal telemedicine can be safely conducted in pregnant women who are at risk of having an underlying disorder or fetal abnormality 1 month following the start of the attempt. It should be considered as a form of maternal medical care to prevent the spread of COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Cuidado Pré-Natal/métodos , Telemedicina/métodos , Adulto , Estudos de Viabilidade , Feminino , Humanos , Japão/epidemiologia , Obstetrícia/métodos , Gravidez , Complicações Infecciosas na Gravidez/virologia , Estudos Retrospectivos
16.
J Perinat Med ; 48(9): 997-1000, 2020 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-32628638

RESUMO

Since SARS-COV-2 appeared in Wuhan City, China and rapidly spread throughout Europe, a real revolution occurred in the daily routine and in the organization of the entire health system. While non-urgent clinical services have been reduced as far as possible, all kind of specialists turned into COVID-19 specialists. Obstetric assistance cannot be suspended and, at the same time, safety must be guaranteed. In addition, as COVID-19 positive pregnant patients require additional care, some of the clinical habits need to be changed to face emerging needs for a vulnerable but unstoppable kind of patients. We report the management set up in an Obstetrics and Gynecology Unit during the COVID-19 era in a University Hospital in Milan, Italy.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Hospitais Universitários/organização & administração , Obstetrícia/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Parto Obstétrico/métodos , Feminino , Ginecologia/métodos , Ginecologia/organização & administração , Humanos , Itália/epidemiologia , Obstetrícia/métodos , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Cuidado Pós-Natal/métodos , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/virologia , Cuidado Pré-Natal/métodos
17.
J Int Med Res ; 48(7): 300060520939337, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32674650

RESUMO

OBJECTIVE: This study aimed to describe the emergency responses to coronavirus disease 2019 (COVID-19) for pregnant patients at our hospital and their effect on hospital operations and patients' outcomes. METHODS: We developed strategies to prevent hospital-associated transmission of COVID-19 in obstetric care. Infrastructure, including the fever clinic and wards, were modified. Outpatient volume was controlled and screening processes were strictly performed. Verification of the virus was compulsory for non-surgery and non-emergency patients. Emergency operations were performed in a negative pressure theater with surgeons fully protected. Outcomes were analyzed and the patients' characteristics were evaluated. The effect of intervention on depressed and anxious patients was assessed. Data from the first 2 months of 2019 and 2020 were compared. RESULTS: No in-hospital COVID-19 infections occurred in our unit. During the epidemic, patient volume significantly decreased. While major characteristics of patients were similar, a higher prevalence of gestational hypertension was found in 2020 than in 2019. Psychological interventions showed optimistic effects in ameliorating depression and anxiety at the beginning of the COVID-19 pandemic. CONCLUSIONS: Our strategies were effective in preventing in-hospital infection of COVID-19 and reassuring women about the safety of pregnancy. Monitoring and managing psychological issues were necessary during this critical period.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Controle de Infecções , Obstetrícia/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Adulto , Ansiedade/complicações , Temperatura Corporal , China/epidemiologia , Infecções por Coronavirus/psicologia , Depressão/complicações , Feminino , Hospitais , Humanos , Recém-Nascido , Obstetrícia/tendências , Avaliação de Resultados em Cuidados de Saúde , Pacientes Ambulatoriais , Pneumonia Viral/psicologia , Gravidez , Complicações Infecciosas na Gravidez/psicologia , Telemedicina/tendências , Adulto Jovem
18.
Arch Gynecol Obstet ; 302(2): 321-328, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32564129

RESUMO

PURPOSE: Antibiotic treatment during surgical repair of obstetric anal sphincter injuries (OASIS) had been a matter of debate. We aimed to review the available literature regarding the efficacy of metronidazole administration in women undergoing perineal repair following obstetric OASIS. STUDY DESIGN: To identify potentially eligible studies, we searched PubMed, Scopus, Embase and the Cochrane Library from inception to January 13th, 2019.Reference lists of identified studies were searched. No language restrictions were applied. We used a combination of keywords and text words represented by "Metronidazole", "obstetrics", "obstetric anal sphincter injury", "OASIS", "third degree tear", "fourth degree tear", "third degree laceration", "fourth degree laceration", "antibiotic therapy", "perineal damage" and "perineal trauma". Two reviewers independently screened the titles and abstracts of records retrieved from the database searches. Both reviewers recommended studies for the full-text review. Thescreen of full-text articles recommended by at least one reviewer was done independently by the same two reviewers and assessedfor inclusion in the systematic review. Disagreements between reviewers were resolved by consensus. RESULTS: The electronic database search yielded a total of 54,356 results (Fig. 1). After duplicate exclusion 28,154 references remained. Of them, 26 were relevant to the review based on title and abstract screening. None of these articles dealt with the use of metronidazole for the prevention of infections complicating anal sphincter repair in women with OASIS. A Cochrane review addressing antibiotic prophylaxis for patients following OASIS, compared prophylactic antibiotics against placebo or no antibiotics, included only one randomized controlled trial of 147 participants. This study showed that prophylactic antibiotics (not metronidazole) may be helpful to prevent perineal wound complications following OASIS. Fig. 1 Study seection process CONCLUSION: Anaerobic infections potentially complicate wound repair after OASIS. Although scientific societies recommend the use of antibiotics for the prevention of infectious morbidity after OASIS, no study has specifically assessed the role of metronidazole.


Assuntos
Canal Anal/lesões , Antibacterianos/uso terapêutico , Lacerações/etiologia , Metronidazol/uso terapêutico , Períneo/lesões , Infecção dos Ferimentos/prevenção & controle , Ferimentos e Lesões/prevenção & controle , Adulto , Canal Anal/microbiologia , Antibioticoprofilaxia/efeitos adversos , Parto Obstétrico/métodos , Feminino , Humanos , Complicações do Trabalho de Parto/cirurgia , Obstetrícia/métodos , Gravidez , Ferimentos e Lesões/complicações , Ferimentos e Lesões/tratamento farmacológico
19.
Arch Gynecol Obstet ; 301(6): 1377-1382, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32363547

RESUMO

PURPOSE: There is little information on the use of extracorporeal membrane oxygenation (ECMO) in pregnant women. Our objectives are to estimate the use of ECMO in pregnant patients, identify clinical conditions associated with ECMO use, and assess survival rates by the associated condition. METHODS: Using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, we carried out a retrospective cohort study of all delivery admissions in the United States from January 1, 1999, to October 1, 2015. Within the cohort, women who received ECMO therapy were identified using ICD-9 codes and then survival rates among these women were calculated. RESULTS: There were 83 women who underwent ECMO therapy in our cohort of 15,335,205 births, for an overall ECMO use rate of 0.54/100,000 pregnancies. The incidence of ECMO use increased from 0.23/100,000 in 1999 to 2.57/100,000 in 2015. Patients on ECMO were more likely to be older, have a lower income, and have pre-existing medical conditions when compared with the patients not on ECMO. The overall survival rate for the ECMO group was 62.7%. The most common reason for ECMO use was acute respiratory failure. Etiologies associated with the highest survival in those on ECMO were pneumonia and venous thromboembolism, which were found to have survival rates of 75.0% and 81.0%, respectively. CONCLUSION: The incidence of ECMO use in the obstetric population increased over the last decade and a half. Although it carries a limited survival rate within this population, it has proven life-saving for many suffering from complications of pregnancy and delivery.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Obstetrícia/métodos , Adulto , Estudos de Coortes , Oxigenação por Membrana Extracorpórea/mortalidade , Feminino , Humanos , Masculino , Gravidez , Estudos Retrospectivos , Taxa de Sobrevida
20.
Am J Perinatol ; 37(10): 1002-1004, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32438425

RESUMO

OBJECTIVE: This study aimed to report a case series of pregnant women in New York City with confirmed or presumed coronavirus disease (COVID-19) infection. STUDY DESIGN: Beginning March 22, 2020, all pregnant women from one large obstetrical practice in New York City were contacted regularly to inquire about symptoms of COVID-19 (fever, cough, shortness of breath, malaise, anosmia), or sick contacts. A running log was kept of these patients, as well as all patients who underwent COVID-19 testing. For this report, we included every patient with suspected COVID-19 infection, which was defined as at least two symptoms, or a positive COVID-19 nasopharyngeal polymerase chain reaction test. RESULTS: From March 22, 2020 until April 30, 2020, 757 pregnant women in our practice were evaluated and 92 had known or suspected COVID-19 (12.2%, 95% confidence interval [CI]: 10.0-14.7%). Of these 92 women, 33 (36%) had positive COVID-19 test results. Only one woman required hospital admission for 5 days due to COVID-19 (1.1%, 95% CI: 0.2-5.9%). One other woman received home oxygen. No women required mechanical ventilation and there were no maternal deaths. One woman had an unexplained fetal demise at 14 weeks' gestation around the time of her COVID-19 symptoms. Twenty one of the 92 women have delivered, and all were uncomplicated. CONCLUSIONS: Among 92 women with confirmed or presumed COVID-19, the overall morbidity was low. These preliminary results are encouraging for pregnant women during the COVID-19 pandemic. KEY POINTS: · Coronavirus disease (COVID-19) is prevalent in New York City.. · In this case series, COVID-19 in pregnant women had a very low morbidity and no mortality.. · This preliminary data is reassuring for pregnant women at risk of COVID-19..


Assuntos
Doenças Assintomáticas/epidemiologia , Infecções por Coronavirus/prevenção & controle , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Resultado da Gravidez , Adulto , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Estudos de Coortes , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Feminino , Idade Gestacional , Humanos , Controle de Infecções/métodos , Cidade de Nova Iorque , Obstetrícia/métodos , Pneumonia Viral/epidemiologia , Gravidez , Cuidado Pré-Natal/métodos , Estudos Retrospectivos , Medição de Risco
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