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1.
San Salvador; MINSAL; sept.16, 2020. 12 p. ilus, graf.
Não convencional em Espanhol | LILACS, BIGG - guias GRADE, BISSAL | ID: biblio-1121036

RESUMO

La presente guía se elaboró siguiendo los lineamientos del Manual para la elaboración de guías de la Organización Mundial de la Salud. De forma general, se creó un grupo desarrollador multidisciplinario, compuesto por expertos temáticos, epidemiólogos, metodólogos y pacientes. Con base en la evidencia proveniente de la guía para el uso de uterotónicos para la prevención de hemorragia posparto, se desarrolló una adaptación para el contexto del Sistema Nacional Integrado de Salud de El Salvador. Se incluyó de evidencia local y la contextualización de sus recomendaciones. Las recomendaciones fueron graduadas en un panel de expertos conformado por profesionales en estadística, enfermería, materno infantil y médicos generales y especialistas en las siguientes áreas: ginecología y obstetricia, perinatología, anestesiología, medicina familiar, economía de la salud, epidemiología, además se incluyó la participación de pacientes siguiendo el enfoque Grading of Recommendations, Assessment, Development and Evaluation (GRADE)


This guide was prepared following the guidelines of the Manual for the preparation of guidelines of the World Health Organization. In general, a multidisciplinary development group was created, composed of thematic experts, epidemiologists, methodologists, and patients. Based on the evidence from the guide for the use of uterotonics for the prevention of postpartum hemorrhage, an adaptation was developed for the context of the National Integrated Health System of El Salvador. Local evidence and the contextualization of their recommendations were included. The recommendations were graded by a panel of experts made up of professionals in statistics, nursing, maternal and child health, and general practitioners and specialists in the following areas: gynecology and obstetrics, perinatology, anesthesiology, family medicine, health economics, epidemiology, and it was also included patient participation following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE)


Assuntos
Gravidez , Ocitócicos/uso terapêutico , Hemorragia Pós-Parto/prevenção & controle , Hemorragia Pós-Parto/tratamento farmacológico , Hemorragia Pós-Parto/terapia , Ocitocina/uso terapêutico , Misoprostol/uso terapêutico
2.
BMC Pregnancy Childbirth ; 20(1): 481, 2020 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-32838744

RESUMO

BACKGROUND: The world's understanding of COVID-19 continues to evolve as the scientific community discovers unique presentations of this disease. This case report depicts an unexpected intraoperative coagulopathy during a cesarean section in an otherwise asymptomatic patient who was later found to have COVID-19. This case suggests that there may be a higher risk for intrapartum bleeding in the pregnant, largely asymptomatic COVID-positive patient with more abnormal COVID laboratory values. CASE: The case patient displayed D-Dimer elevations beyond what is typically observed among this hospital's COVID-positive peripartum population and displayed significantly more oozing than expected intraoperatively, despite normal prothrombin time, international normalized ratio, fibrinogen, and platelets. CONCLUSION: There is little published evidence on the association between D-Dimer and coagulopathy among the pregnant population infected with SARS-CoV-2. This case report contributes to the growing body of evidence on the effects of COVID-19 in pregnancy. A clinical picture concerning for intraoperative coagulopathy may be associated with SARS-CoV-2 infection during cesarean sections, and abnormal COVID laboratory tests, particularly D-Dimer, may help identify the patients in which this presentation occurs.


Assuntos
Transtornos da Coagulação Sanguínea/sangue , Perda Sanguínea Cirúrgica , Apresentação Pélvica/cirurgia , Cesárea , Infecções por Coronavirus/sangue , Pneumonia Viral/sangue , Complicações Hematológicas na Gravidez/sangue , Complicações Infecciosas na Gravidez/sangue , Adulto , Antifibrinolíticos/uso terapêutico , Betacoronavirus , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transtornos da Coagulação Sanguínea/metabolismo , Proteína C-Reativa/metabolismo , Cauterização , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/metabolismo , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Fibrinogênio/metabolismo , Hemostasia Cirúrgica , Humanos , Coeficiente Internacional Normatizado , Metilergonovina/uso terapêutico , Oligo-Hidrâmnio , Ocitócicos/uso terapêutico , Ocitocina/uso terapêutico , Pandemias , Contagem de Plaquetas , Pneumonia Viral/diagnóstico , Pneumonia Viral/metabolismo , Gravidez , Complicações Hematológicas na Gravidez/tratamento farmacológico , Complicações Hematológicas na Gravidez/metabolismo , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/metabolismo , Tempo de Protrombina , Ácido Tranexâmico/uso terapêutico , Inércia Uterina/tratamento farmacológico
3.
Lancet ; 396(10253): 770-778, 2020 09 12.
Artigo em Inglês | MEDLINE | ID: mdl-32853559

RESUMO

BACKGROUND: The anti-progesterone drug mifepristone and the prostaglandin misoprostol can be used to treat missed miscarriage. However, it is unclear whether a combination of mifepristone and misoprostol is more effective than administering misoprostol alone. We investigated whether treatment with mifepristone plus misoprostol would result in a higher rate of completion of missed miscarriage compared with misoprostol alone. METHODS: MifeMiso was a multicentre, double-blind, placebo-controlled, randomised trial in 28 UK hospitals. Women were eligible for enrolment if they were aged 16 years and older, diagnosed with a missed miscarriage by pelvic ultrasound scan in the first 14 weeks of pregnancy, chose to have medical management of miscarriage, and were willing and able to give informed consent. Participants were randomly assigned (1:1) to a single dose of oral mifepristone 200 mg or an oral placebo tablet, both followed by a single dose of vaginal, oral, or sublingual misoprostol 800 µg 2 days later. Randomisation was managed via a secure web-based randomisation program, with minimisation to balance study group assignments according to maternal age (<30 years vs ≥30 years), body-mass index (<35 kg/m2vs ≥35 kg/m2), previous parity (nulliparous women vs parous women), gestational age (<70 days vs ≥70 days), amount of bleeding (Pictorial Blood Assessment Chart score; ≤2 vs ≥3), and randomising centre. Participants, clinicians, pharmacists, trial nurses, and midwives were masked to study group assignment throughout the trial. The primary outcome was failure to spontaneously pass the gestational sac within 7 days after random assignment. Primary analyses were done according to intention-to-treat principles. The trial is registered with the ISRCTN registry, ISRCTN17405024. FINDINGS: Between Oct 3, 2017, and July 22, 2019, 2595 women were identified as being eligible for the MifeMiso trial. 711 women were randomly assigned to receive either mifepristone and misoprostol (357 women) or placebo and misoprostol (354 women). 696 (98%) of 711 women had available data for the primary outcome. 59 (17%) of 348 women in the mifepristone plus misoprostol group did not pass the gestational sac spontaneously within 7 days versus 82 (24%) of 348 women in the placebo plus misoprostol group (risk ratio [RR] 0·73, 95% CI 0·54-0·99; p=0·043). 62 (17%) of 355 women in the mifepristone plus misoprostol group required surgical intervention to complete the miscarriage versus 87 (25%) of 353 women in the placebo plus misoprostol group (0·71, 0·53-0·95; p=0·021). We found no difference in incidence of adverse events between the study groups. INTERPRETATION: Treatment with mifepristone plus misoprostol was more effective than misoprostol alone in the management of missed miscarriage. Women with missed miscarriage should be offered mifepristone pretreatment before misoprostol to increase the chance of successful miscarriage management, while reducing the need for miscarriage surgery. FUNDING: UK National Institute for Health Research Health Technology Assessment Programme.


Assuntos
Aborto Retido/tratamento farmacológico , Mifepristona/uso terapêutico , Misoprostol/uso terapêutico , Ocitócicos/uso terapêutico , Adulto , Método Duplo-Cego , Quimioterapia Combinada , Humanos , Resultado do Tratamento
4.
Arch Gynecol Obstet ; 302(3): 579-584, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32617665

RESUMO

PURPOSE: To compare the effectiveness of the Cook vaginal cervical ripening balloon (CCRB) with prostaglandin E2 (PGE2) insert for induction of labor in late pregnancy in primipara. METHODS: We evaluated the effectiveness and safety of induction of labor using the improved Bishop score after CCRB or PGE2 administration, total stage of labor, hours until delivery (hours from placement of CCRB or PGE2 insert to parturition and delivery), delivery rate within 24 h, spontaneous delivery rate, successful induction rate, overstimulation syndrome, urgent delivery rate, pain scores, cesarean section rate, and outcomes related to delivery and perinatal morbidity, such as puerperal infection rate, total cost, satisfaction survey, and so on. RESULTS: The improved Bishop Score and delivery rate within 24 h in the CCRB group were significantly higher than in the PGE2 group. The total stage of labor and hours until delivery in the CCRB group were significantly shorter than that in the PGE2 group. Rate of overstimulation syndrome and pain scores in the CCRB group were significantly lower than in the PGE2 group. Compared with the PGE2 group, the mean duration of hospitalization in the CCRB group was shorter and the total cost was less. No difference in satisfaction between the PGE2 and CCRB groups was observed. CONCLUSIONS: Compared with PGE2, CCRB reduced the total stage of labor, hours until delivery, pain scores, mean length of hospitalization, and total cost. CCRB increased the rate of delivery within 24 h with similar safety and maternal satisfaction compared with PGE2.


Assuntos
Maturidade Cervical , Colo do Útero/efeitos dos fármacos , Dinoprostona/administração & dosagem , Trabalho de Parto Induzido/métodos , Ocitócicos/administração & dosagem , Administração Intravaginal , Adulto , Cesárea/estatística & dados numéricos , China , Dinoprostona/uso terapêutico , Feminino , Humanos , Ocitócicos/uso terapêutico , Gravidez , Resultado do Tratamento , Vagina
5.
J Ayub Med Coll Abbottabad ; 32(2): 198-203, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32583994

RESUMO

BACKGROUND: Uterine myomas are most common non-cancerous tumours in reproductive period. The fertility preserving surgery, i.e., myomectomy as compared to hysterectomy, is associated with massive blood loss due to dissection of huge fibroids making it technically difficult procedure. Misoprostol (a uterotonic) is an effective option amongst different interventions used to reduce intraoperative blood loss during myomectomy. This randomized control trial investigated effectiveness of single dose of rectal misoprostol given preoperatively in reducing intraoperative blood loss during abdominal myomectomy.. METHODS: Fifty Patients undergoing abdominal myomectomy were selected for the study. Twenty-five patients were given 800 micrograms misoprostol per rectally half an hour before surgery while rest received placebo, i.e., control group. Number and weight of surgical packs were recorded both Pre and post operatively to assess blood loss. Preoperative and 24 hrs postoperative haemoglobin was also recorded. Data analysed by SPSS-20. RESULTS: Mean of age, parity and myoma size were not statistically different between the two groups. However intraoperative blood loss (as measured by weighing and counting number of swabs used) and postoperative haemoglobin after 24 hours were significantly different between two groups with p-value <0.01. CONCLUSIONS: Single dose of misoprostol given preoperatively via rectal route is effective in reducing intraoperative blood loss during abdominal myomectomy. Misoprostol must be used in different doses and routes in order to investigate its effectiveness in reducing intraoperative blood loss.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Misoprostol/uso terapêutico , Ocitócicos/uso terapêutico , Miomectomia Uterina/efeitos adversos , Feminino , Humanos , Histerectomia/efeitos adversos , Misoprostol/administração & dosagem , Ocitócicos/administração & dosagem
6.
Arch Gynecol Obstet ; 302(1): 117-125, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32445065

RESUMO

PURPOSE: The aim of our study was to assess the outcomes of a prolonged induction carried out with a second sequential cycle of pharmacological stimulation after unsatisfactory response to a first attempt, and to highlight variables correlated with higher response rates. METHODS: A retrospective study was carried out on 157 women who underwent a two-step labor induction by vaginal prostaglandins followed by a second cycle of prostaglandins or intravenous oxytocin. Outcomes assessed were mode of delivery and maternal and neonatal morbidity. Main variables of pregnancy and delivery were collected to identify factors predicting the mode of delivery. RESULTS: Among 157 patients, 63 (40.1%) achieved a vaginal delivery, whereas 94 (59.9%) underwent Cesarean section, 9 women (5.7%) had postpartum hemorrhage; in 2 cases (1.3%), an Apgar score < 7 at 5 min from birth was reported. Higher risk of Cesarean section was observed with advanced maternal age (OR 1.13 for additional year, CI 1.04-1.22) and nulliparity (OR 8.84, CI 2.69-29.06), whereas the response rates were better in carriers of group B streptococcus colonization (OR 0.38, CI 0.17-0.84) and in women with favorable cervical status after the first stimulation (OR 0.81 for additional point of Bishop score, CI 0.70-0.94). CONCLUSION: Labor induction with two cycles of pharmacological stimulation is a procedure with fairly good success rates and a low risk of maternal and neonatal complications. Factors predicting its success encompass younger age, parity, a positive recto-vaginal swab for group B streptococcus and a favorable cervix following the first cycle of stimulation.


Assuntos
Trabalho de Parto Induzido/métodos , Ocitócicos/uso terapêutico , Adulto , Feminino , Humanos , Ocitócicos/farmacologia , Gravidez , Estudos Retrospectivos
7.
Arch Gynecol Obstet ; 301(6): 1463-1471, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32314015

RESUMO

PURPOSE: This study aimed at investigating the efficacy and safety of dinoprostone 3 mg vaginally prior to levonorgestrel-releasing intrauterine system (LNG-IUS) insertion in women undergoing elective cesarean delivery (CD). METHODS: We conducted a prospective, randomized, double-blinded, placebo-controlled trial at family planning clinic of Cairo University hospitals from August 2019 to January 2020. We included 200 women aged ≥ 18 years who previously delivered by elective CD willing to receive LNG-IUS. Women were randomly assigned with a 1:1 allocation ratio to receive 3 mg vaginal dinoprostone or placebo tablets two hours before LNG-IUS insertion. Our main outcomes were patient-reported pain during insertion and 30 min post-procedure, ease of insertion, satisfaction, duration of insertion, and different side effects. RESULTS: Patient-perceived pain during LNG-IUS insertion was significantly reduced in dinoprostone compared to placebo (4.1 ± 1.7 vs 6.4 ± 1.3; p < 0.001). Dinoprostone reduced pain scores 30 min post-procedure compared to placebo, but the difference was not statistically significant (3.5 ± 1.1 vs 3.7 ± 1.6; p = 0.25). Satisfaction score was higher in dinoprostone compared to placebo (7.9 ± 1.0 vs 5.9 ± 0.8; p < 0.001). The insertion was significantly easier and shorter in dinoprostone than placebo (3.9 ± 1.1 vs 5.9 ± 1.1; p < 0.001) and (5.6 ± 0.9 vs 7.2 ± 0.8; p < 0.001), respectively. Adverse events were not significantly different between both groups. CONCLUSION: Dinoprostone administration 2 h before LNG-IUS insertion in women delivered by elective CD effectively reduced pain during insertion and 30 min post-procedure. Women received dinoprostone had easier and shorter insertion and were more satisfied with tolerable side effects.


Assuntos
Cesárea/métodos , Contraceptivos Hormonais/uso terapêutico , Dinoprostona/uso terapêutico , Dispositivos Intrauterinos Medicados/normas , Levanogestrel/uso terapêutico , Ocitócicos/uso terapêutico , Adulto , Contraceptivos Hormonais/farmacologia , Dinoprostona/farmacologia , Método Duplo-Cego , Feminino , Humanos , Levanogestrel/farmacologia , Ocitócicos/farmacologia , Gravidez , Estudos Prospectivos
8.
Intern Med ; 59(11): 1351-1359, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32132336

RESUMO

Objective The decision to perform medical or mechanical therapy in patients with aborted sudden cardiac death (ASCD) due to coronary spasm is controversial. The Japanese Circulation Society guidelines for the diagnosis and treatment of patients with coronary spastic angina mentioned that implantable cardioverter-defibrillator (ICD) is one option in patients with ASCD due to coronary spasm. We investigated the usefulness of spasm provocation tests under medications in five patients with ASCD due to coronary spasm. Methods We performed the spasm provocation tests under medications in five ASCD patients due to coronary spasm. Pharmacological spasm provocation tests, including five acetylcholine (ACh) tests, two ergonovine (ER) tests, and two ACh added after ER tests, were performed to estimate the effect of medications to suppressing the next fatal spasms. Results ACh tests under medications did not provoke spasm in one patient but did provoke in two patients. In the remaining two patients, neither the ACh test nor the ER test provoked spasm, but the ACh added after ER test induced a focal spasm in one coronary artery. We increased the medication dosage in four patients. An ICD was implanted in two patients, including one with refractory spasm and one with left main trunk spasm. One patient died due to pulseless electrical activity without ventricular fibrillation, while the remaining four patients survived. Conclusion Spasm provocation tests under medication in patients with ASCD due to coronary spasm may be an option when deciding on medical or mechanical therapy.


Assuntos
Vasoespasmo Coronário/terapia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis/normas , Eletrocardiografia/normas , Ergonovina/normas , Ergonovina/uso terapêutico , Injeções Intra-Arteriais/normas , Idoso , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Ocitócicos/normas , Ocitócicos/uso terapêutico , Guias de Prática Clínica como Assunto , Estudos Retrospectivos
9.
Arch Gynecol Obstet ; 301(3): 643-653, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32124015

RESUMO

BACKGROUND: Clinical studies and trials have shown that oxytocin can effectively reduce postpartum bleeding, whether by intramuscular (IM) injection or intravenous (IV) injection. These two methods are widely used in the prevention and treatment for the third stage of childbirth. However, it is unclear whether the subtle differences between the mode of these routes have any effect on maternal outcomes. OBJECTIVES: To systematically evaluate the efficacy and safety of oxytocin administered intramuscularly or intravenously for prophylactic management of the third stage of labor after vaginal birth. METHODS: Computerized retrieval of PubMed, the Cochrane Library, Web of Science, Embase, and ClinicalTrials.gov was conducted to collect randomized controlled trials (RCT) on the effects of IM and IV oxytocin on the third stage of labor. After independent literature screening, data extraction and evaluation of the bias risk of included studies by two evaluators, RevMan 5.3 software was used for a meta-analysis. RESULTS: Six studies with 7734 women were included in this study. Meta-analysis results showed that: the severe postpartum hemorrhage (PPH) rate [risk ratio (RR) 1.54, 95% confidence interval (95% CI) 1.08-2.20, P = 0.02], PPH rate (RR 1.31, 95% CI 1.11-1.55, P = 0.001), incidence of blood transfusion (RR 2.30, 95% CI 1.35-3.93, P = 0.002) and the need of manual removal of placenta (RR 1.44, 95% CI 1.05-1.96, P = 0.02) for IM group were higher than IV group, but there were no significant differences in the use of additional uterotonics (P = 0.31) and the incidence of serious maternal morbidity and adverse effects between two groups. None of the included studies reported maternal death. CONCLUSION: For clinical practice, intravenous injection oxytocin 10 IU may be a good, safe option in the management of the third stage of labor. Medical conditions, available resources, adverse effects, and women' s preferences should also be considered. If an IV line is already in place at delivery, IV administration may be preferable to IM injection.


Assuntos
Terceira Fase do Trabalho de Parto/efeitos dos fármacos , Ocitócicos/uso terapêutico , Ocitocina/administração & dosagem , Ocitocina/uso terapêutico , Administração Intravenosa , Adolescente , Adulto , Feminino , Humanos , Injeções Intramusculares , Pessoa de Meia-Idade , Ocitócicos/farmacologia , Ocitocina/farmacologia , Gravidez , Adulto Jovem
10.
BMC Pregnancy Childbirth ; 20(1): 14, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906889

RESUMO

BACKGROUND: Major obstetric haemorrhage is a leading cause of maternal mortality and accounts for one-third of maternal deaths in of Africa. This study aimed to assess the population-based incidence, causes, management and outcomes of major obstetric haemorrhage and risk factors associated with poor maternal outcome. METHODS: Women with major obstetric haemorrhage who met the WHO maternal near-miss criteria or died in the Metro East region, Cape Town, South Africa, were evaluated from November 2014-November 2015. Major obstetric haemorrhage was defined as haemorrhage in pregnancies of at least 20 weeks' gestation or occurring up to 42 days after birth, and leading to hysterectomy, hypovolaemic shock or blood transfusion of ≥5 units of Packed Red Blood Cells. A logistic regression model was used to analyse associations with poor outcome, defined as major obstetric haemorrhage leading to massive transfusion of ≥8 units of packed red blood cells, hysterectomy or death. RESULTS: The incidence of major obstetric haemorrhage was 3/1000 births, and the incidence of massive transfusion was 4/10.000 births in the Metro East region (32.862 births occurred during the studied time period). Leading causes of haemorrhage were placental abruption 45/119 (37.8%), complications of caesarean section 29/119 (24.4%) and uterine atony 13/119 (10.9%). Therapeutic oxytocin was administered in 98/119 (82.4%) women and hysterectomy performed in 33/119 (27.7%). The median numbers of packed red blood cells and units of Fresh Frozen Plasma transfused were 6 (interquartile range 4-7) and 3 (interquartile range 2-4), ratio 1.7:1. Caesarean section was independently associated with poor maternal outcome: adjusted OR 4.01 [95% CI 1.58, 10.14]. CONCLUSIONS: Assessment of major obstetric haemorrhage using the Maternal Near Miss approach revealed that placental abruption and complications of caesarean section were the major causes of major obstetric haemorrhage. Caesarean section was associated with poor outcome.


Assuntos
Saúde Materna , Near Miss , Hemorragia Pós-Parto/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Descolamento Prematuro da Placenta/epidemiologia , Adulto , Transfusão de Sangue , Cesárea/efeitos adversos , Estudos de Coortes , Feminino , Humanos , Histerectomia , Incidência , Ocitócicos/uso terapêutico , Ocitocina/uso terapêutico , Gravidez , Resultado da Gravidez , Fatores de Risco , África do Sul/epidemiologia , Inércia Uterina/epidemiologia
11.
Biol Res Nurs ; 22(2): 157-168, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31983215

RESUMO

OBJECTIVES: The purpose of this study was to evaluate differences in the metabolic pathways activated in late-pregnancy serum samples among African American women who went on to have term (≥37 weeks) labor induction requiring high total oxytocin doses to complete first-stage labor compared to those in similar women with low-oxytocin labor inductions. STUDY DESIGN: Case-control study (N = 27 women with labor induction with successful cervical ripening: 13 requiring the highest total doses of synthetic oxytocin to progress from 4- to 10-cm cervical dilation and 14 requiring the lowest total doses) with groups balanced on parity and gestational age. Serum samples obtained between 24 and 30 weeks' gestation were analyzed using ultra-high-resolution metabolomics. Differentially expressed metabolites between high-oxytocin induction cases and low-oxytocin induction comparison subjects were evaluated using linear regression with xmsPANDA. Metabolic pathways analysis was conducted using Mummichog Version 2.0, with discriminating metabolites annotated using xMSannotator Version 1.3. RESULTS: Labor processes were similar by group with the exception that cases received over 6 times more oxytocin between 4- and 10-cm cervical dilation than comparison women. Induction requiring high total doses of synthetic oxytocin was associated with late-pregnancy serum levels of metabolites from the linoleate and fatty acid activation pathways in term, African American women. CONCLUSION: Serum levels of several lipid metabolites predicted more complicated labor induction involving higher doses of synthetic oxytocin to complete first-stage labor. Further investigation in larger, more diverse cohorts of women is needed to identify potential targets to prevent failed labor induction.


Assuntos
Afro-Americanos/estatística & dados numéricos , Trabalho de Parto Induzido , Trabalho de Parto/fisiologia , Redes e Vias Metabólicas/efeitos dos fármacos , Redes e Vias Metabólicas/fisiologia , Ocitocina/efeitos adversos , Ocitocina/uso terapêutico , Adulto , Estudos de Casos e Controles , Relação Dose-Resposta a Droga , Feminino , Humanos , Ocitócicos/efeitos adversos , Ocitócicos/uso terapêutico , Gravidez , Gestantes , Estados Unidos , Adulto Jovem
12.
BMC Pregnancy Childbirth ; 20(1): 40, 2020 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-31948415

RESUMO

BACKGROUND: Twin pregnancy has a high risk for developing uterine atony (UA). This study aimed to evaluate efficacy and clinical outcomes of prophylactic compression sutures to treat UA during twin cesarean section (CS). METHODS: All patient records of twin deliveries by CS after gestational age of 24 weeks in a large maternity hospital in South Korea between January 2013 and June 2018 were reviewed. Patients with monochorionic monoamniotic twins were excluded from data analysis. In total, 953 women were eligible for data analysis. RESULTS: Of the 953 patients, compression sutures were applied to 147 cases with postpartum bleeding that were refractory to uterine massage and uterotonics. Out of the 147, two patients (1.4%) proceeded to additional uterine artery ligation to achieve hemostasis, yielding a success rate of 98.6%. The rate of transfusion after the first 24 h of delivery in the suture group was not significantly different from that in the non-suture group, suggesting that both groups achieved hemostasis at an equal rate after the first 24 h of delivery. The difference in the operation time between the two groups was only 8.5 min. The rate of subsequent pregnancy among the patients who received compression sutures was 44.4%. CONCLUSIONS: Overall, our findings suggest that with early and fast implementation of compression sutures, UA can be treated in the setting of twin cesarean delivery without significantly increasing maternal morbidity.


Assuntos
Cesárea/métodos , Ocitócicos/uso terapêutico , Hemorragia Pós-Parto/prevenção & controle , Gravidez de Gêmeos , Técnicas de Sutura , Inércia Uterina/terapia , Adulto , Transfusão de Sangue/estatística & dados numéricos , Dinoprostona/análogos & derivados , Dinoprostona/uso terapêutico , Feminino , Hemostasia Cirúrgica , Humanos , Ocitocina/análogos & derivados , Ocitocina/uso terapêutico , Gravidez , Resultado do Tratamento , Embolização da Artéria Uterina/estatística & dados numéricos
13.
Einstein (Sao Paulo) ; 18: eAO5029, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31721897

RESUMO

OBJECTIVE: To characterize the use of the drug misoprostol for treatment of postpartum hemorrhage in pregnant women. METHODS: A descriptive observational study was carried out with secondary data from pregnant women who used misoprostol to treat postpartum hemorrhage in a reference public maternity, from July 2015 to June 2017. Clinical and sociodemographic profiles of pregnant women, how misoprostol was used and success rate in controling postpartum hemorrhage were characterized. RESULTS: A total of 717 prescriptions of misoprostol were identified. Of these, 10% were for treatment of postpartum hemorrhage. The majority of pregnant women were young adults, married, with complete high school education, white, residing in urban areas, multiparous (68.1%) and 25% had previous cesarean sections. The mean gestational age was 39 weeks and 51.4% had a cesarean section. There was prophylactic use of oxytocin in 47.2% of women. Treatment of postpartum hemorrhage was successful in 84.7% of women. Of these, 79.2% also used oxytocin and 54.2% methylergonovine. Only 13.5% of pregnant women had less than five prenatal visits, and the main cause of postpartum hemorrhage was uterine atony. There were 13 complications after hemorrhage, 15.3% required blood transfusion and there was one case of maternal death. CONCLUSION: Misoprostol showed to be effective and safe for treating postpartum hemorrhage.


Assuntos
Misoprostol/uso terapêutico , Ocitócicos/uso terapêutico , Hemorragia Pós-Parto/tratamento farmacológico , Adulto , Estudos Transversais , Feminino , Idade Gestacional , Humanos , Metilergonovina/uso terapêutico , Ocitocina/uso terapêutico , Gravidez , Adulto Jovem
14.
Arch Womens Ment Health ; 23(3): 317-329, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31385103

RESUMO

Birth experiences can be traumatic and may give rise to PTSD following childbirth (PTSD-FC). Peripartum neurobiological alterations in the oxytocinergic system are highly relevant for postpartum maternal behavioral and affective adaptions like bonding and lactation but are also implicated in the response to traumatic events. Animal models demonstrated that peripartum stress impairs beneficial maternal postpartum behavior. Early postpartum activation of the oxytocinergic system may, however, reverse these effects and thereby prevent adverse long-term consequences for both mother and infant. In this narrative review, we discuss the impact of trauma and PTSD-FC on normal endogenous oxytocinergic system fluctuations in the peripartum period. We also specifically focus on the potential of exogenous oxytocin (OT) to prevent and treat PTSD-FC. No trials of exogenous OT after traumatic childbirth and PTSD-FC were available. Evidence from non-obstetric PTSD samples and from postpartum healthy or depressed samples implies restorative functional neuroanatomic and psychological effects of exogenous OT such as improved PTSD symptoms and better mother-to-infant bonding, decreased limbic activation, and restored responsiveness in dopaminergic reward regions. Adverse effects of intranasal OT on mood and the increased fear processing and reduced top-down control over amygdala activation in women with acute trauma exposure or postpartum depression, however, warrant cautionary use of intranasal OT. Observational and experimental studies into the role of the endogenous and exogenous oxytocinergic system in PTSD-FC are needed and should explore individual and situational circumstances, including level of acute distress, intrapartum exogenous OT exposure, or history of childhood trauma.


Assuntos
Depressão Pós-Parto/tratamento farmacológico , Ocitocina/metabolismo , Parto/psicologia , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Animais , Parto Obstétrico/psicologia , Feminino , Humanos , Comportamento Materno , Camundongos , Ocitócicos/metabolismo , Ocitócicos/uso terapêutico , Ocitocina/uso terapêutico , Período Periparto/psicologia , Período Pós-Parto/psicologia , Gravidez , Ratos
15.
Br J Clin Psychol ; 59(2): 186-207, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31774581

RESUMO

OBJECTIVES: Interpersonal dysfunction is a central feature of borderline personality disorder (BPD), and the neuropeptide oxytocin (OT) has been shown to impact patients' behaviour in numerous ways. Nonverbal signals such as the coordination of body movement (nonverbal synchrony) are associated with the success of interpersonal exchanges and could thus be influenced by features of BPD and by the administration of OT. DESIGN: We explored the effect of intranasal OT (inOT) on nonverbal synchrony in sixteen patients with BPD and fifteen healthy controls (CTL) randomly assigned to two double-blind clinical interviews under inOT and placebo (PL). METHODS: Nonverbal synchrony was assessed by automated video-analyses of subject's and interviewer's body movement. Lagged cross-correlations were used to objectively quantify coordination in dyads. RESULTS: Synchrony was higher than pseudosynchrony (= synchrony expected by chance), and there was a differential effect of inOT between groups: While healthy controls displayed increased synchrony under inOT, patients with BPD showed low levels of synchrony under inOT. Additionally, patient's synchrony was negatively associated with self-reported childhood trauma. CONCLUSIONS: Nonverbal synchrony in clinical interviews is influenced by inOT, and this effect depends on subject's diagnosis. In line with previous research implying positive associations between nonverbal synchrony and relationship quality, inOT led to an increase of synchrony in healthy controls, but not in patients with BPD. Low levels of synchrony under inOT in patients and its association with childhood trauma suggest that additional mechanisms such as rejection sensitivity might mediate BPD patients' nonverbal behaviour. PRACTITIONER POINTS: Intranasal oxytocin (inOT) attenuated nonverbal synchrony - a proxy for relationship quality - in patients with borderline personality disorder (BPD), while it increased nonverbal synchrony in healthy controls (CTL). Available models (rejection sensitivity; social salience) suggest that inOT may alter the way patients with BPD assess social situations, and this alteration is expressed by changes in nonverbal coordination. Patients with BPD display low levels of synchrony which are even below expected pseudosynchrony based on chance. The association between self-reported childhood trauma and lower synchrony in BPD was most evident for patient's imitative behaviour: Under inOT, patients with high scores of childhood trauma refrained from imitating their interview partners. Study limitations include small sample sizes and limited data on the psychological impact of the clinical interviews.


Assuntos
Transtorno da Personalidade Borderline/psicologia , Ocitócicos/uso terapêutico , Ocitocina/uso terapêutico , Adulto , Método Duplo-Cego , Feminino , Humanos , Masculino , Ocitócicos/farmacologia , Ocitocina/farmacologia
16.
Gynecol Obstet Fertil Senol ; 48(1): 15-18, 2020 01.
Artigo em Francês | MEDLINE | ID: mdl-31669527

RESUMO

OBJECTIVE: To determine the management of patients with term prelabor rupture of membranes. METHODS: Synthesis of the literature from the PubMed and Cochrane databases and the recommendations of French and foreign societies and colleges. RESULTS: Term prelabor rupture of membranes is considered a physiological process up to 12hours of rupture (Professional consensus). In case of expectant management and with a low rate of antibiotic prophylaxis, home care compared to hospitalization could be associated with an increase in neonatal infections (LE3), especially in case of group B streptococcus colonization (LE3). Home care is therefore not recommended (Grade C). In the absence of spontaneous labor within 12hours of rupture, antibiotic prophylaxis could reduce the risk of maternal intrauterine infection but not of neonatal infection (LE3). Its use after 12hours of rupture in term prelabor rupture of the membranes is therefore recommended (Grade C). When antibiotic prophylaxis is indicated, intravenous beta-lactams are recommended (Grade C). Induction of labor with oxytocin (LE1), prostaglandin E2 (LE1) or misoprostol (LE1), is associated with shorter rupture of membranes to delivery intervals when compared to expectant management. Compared with expectant management, immediate induction of labor is not associated with lower rates of neonatal infection (LE1), even among women with a positive streptococcus B vaginal swab (LE2). Thus, expectant management can be offered without increasing the risk of neonatal infection (Grade B). Induction of labor is not associated with an increase or decrease in the cesarean delivery rate (LE2), whatever parity (LE2) or Bishop score at admission (LE3). Induction can thus be proposed without increasing the risk of cesarean delivery (Grade B). No induction method (oxytocin, dinoprostone, misoprostol or Foley® catheter) has demonstrated superiority over another, whether to reduce rate of intrauterine or neonatal infection, rate of cesarean delivery or to shorten rupture of membranes to delivery intervals regardless of Bishop's score and parity. CONCLUSION: Term prelabor rupture of membranes is a frequent event. A 12-hour delay without onset of spontaneous labor was chosen to differentiate a physiological condition from a potentially unsafe situation justifying an antibiotic prophylaxis. Expectant management or induction of labor can both be proposed, even in case of positive screening for streptococcus B, depending on the patient's wishes and maternity units' organization (Professional consensus).


Assuntos
Ruptura Prematura de Membranas Fetais/terapia , Antibioticoprofilaxia , Dinoprostona/uso terapêutico , Feminino , França , Humanos , Trabalho de Parto Induzido/métodos , Misoprostol/uso terapêutico , Ocitócicos/uso terapêutico , Ocitocina/uso terapêutico , Gravidez , Infecções Estreptocócicas/diagnóstico , Streptococcus agalactiae , beta-Lactamas/administração & dosagem
17.
San Salvador; Ministerio de Salud; 20200000. 1-83 p.
Monografia em Espanhol | LILACS, BIGG - guias GRADE | ID: biblio-1146852

RESUMO

Objetivo: Proveer recomendaciones para mejorar la calidad del cuidado y desenlaces para mujeres que reciben atención del parto, en relación a la prevención de la hemorragia posparto (HPP) por atonía uterina en El Salvador. Métodos: La presente guía fue desarrollada siguiendo los lineamientos del Manual para la elaboración de guías de la Organización Mundial de la Salud1. De forma general, se creó un grupo para la elaboración con enfoque multidisciplinario compuesto por expertos sobre el tema, epidemiólogos, metodólogos y pacientes. Con base en la evidencia proveniente de la guía para el uso de uterotónicos para la prevención de hemorragia posparto, se desarrolló una adaptación para el contexto del sistema de salud de El Salvador2. Se realizó inclusión de evidencia local y la contextualización de sus recomendaciones. Las recomendaciones fueron graduadas en un panel de expertos conformado por profesionales en estadística, enfermería, materno infantil, médicos generales y especialistas en ginecología y obstetricia, perinatología, anestesiología, medicina familiar, economía de la salud, epidemiología, además se incluyó la participación de pacientes siguiendo el enfoque GRADE. Adicionalmente, la guía fue evaluada por pares temáticos y metodológicos. Todos los participantes del panel y del grupo desarrollador firmaron un formato de conflicto de intereses que analizaron los coordinadores de la guía.


Assuntos
Gravidez , Ocitócicos/uso terapêutico , Hemorragia Pós-Parto/prevenção & controle , Hemorragia Pós-Parto/terapia , Misoprostol/uso terapêutico , Hemorragia Pós-Parto/tratamento farmacológico
18.
Medicine (Baltimore) ; 98(47): e17911, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764790

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of carbetocin for prevention of postpartum hemorrhage in women undergoing vaginal delivery compared with oxytocin. METHODS: We conducted a systemic literature search in PubMed, the Cochrane Library, and Embase without language restrictions from inception of each of database to November 18th, 2018. Randomized controlled trials with outcome measure of blood loss ≥500 ml were eligible if they compared carbetocin with oxytocin to prevent postpartum hemorrhage during the third stage of labor in women undergoing vaginal delivery. RESULTS: This meta-analysis of 5 randomized controlled trials (30,314 women) indicated that there was no significant difference between carbetocin and oxytocin in blood loss ≥500 ml in women undergoing vaginal delivery (relative risks (RRs), 0.52; 95% confidence intervals (CIs), 0.24 to 1.15; P = .11; I = 69%). Sensitivity analyses showed the same results. No significant differences were found in blood loss ≥1000 ml, use of additional uterotonic agents, blood transfusion, uterine massage, flushing, vomiting, abdominal pain, nausea, dizziness, headache, palpitation, itching, and shivering. CONCLUSIONS: This meta-analysis showed that carbetocin was as effective and safe as oxytocin for prevention of postpartum hemorrhage in women undergoing vaginal delivery, and the choice of carbetocin for routine prophylaxis will depend on cost-effectiveness.


Assuntos
Ocitócicos/uso terapêutico , Ocitocina/análogos & derivados , Ocitocina/uso terapêutico , Hemorragia Pós-Parto/prevenção & controle , Parto Obstétrico , Feminino , Humanos , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
19.
Eur J Obstet Gynecol Reprod Biol ; 243: 111-119, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31689673

RESUMO

BACKGROUND: There is great controversy regarding the most effective route for cervical priming before diagnostic or operative hysteroscopy. OBJECTIVE: To evaluate the evidence from published randomized clinical trials (RCTs) about the efficacy and safety of oral vs vaginal misoprostol for cervical priming before hysteroscopy. SEARCH STRATEGY: Electronic databases including PubMed, Cochrane Library, Scopus and Web of Science were searched using the relevant keywords. SELECTION CRITERIA: All RCTs assessing the effect of oral vs vaginal misoprostol before hysteroscopy for cervical priming were considered. One hundred and ten studies were identified, of which eight studies were deemed eligible for this review. DATA COLLECTION AND ANALYSIS: The extracted outcomes were: cervical canal width, ease of dilatation, time for cervical dilatation and adverse effects (nausea, vomiting, diarrhoea, bleeding, fever, abdominal pain/uterine cramping and any complications during the procedure). All statistical analyses were completed using RevMan. MAIN RESULTS: Eight RCTs with 768 patients were included in this meta-analysis. Cervical canal width did not differ significantly between the two routes of misoprostol administration [mean difference -0.25 mm, 95% confidence interval (CI) -0.92-0.42; p = 0.47]. However, the vaginal route was significantly superior to the oral route for reducing the time for cervical dilatation (standardized mean difference 0.17, 95% CI 0.02-0.32; p = 0.03). No significant differences in adverse effects were found between the routes, except for diarrhoea which was significantly less prevalent with vaginal administration of misoprostol (risk ratio 2.48, 95% CI 1.17-5.26; p = 0.02). CONCLUSIONS: Oral and vaginal administration of misoprostol before hysteroscopy were similar in terms of cervical canal width, ease of dilatation and various adverse effects, except that the vaginal route was associated with faster cervical dilatation and lower prevalence of diarrhoea.


Assuntos
Colo do Útero , Histeroscopia/métodos , Misoprostol/administração & dosagem , Ocitócicos/uso terapêutico , Pré-Medicação/métodos , Dor Abdominal/induzido quimicamente , Administração Intravaginal , Administração Oral , Diarreia/induzido quimicamente , Dilatação/métodos , Feminino , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
Eur J Obstet Gynecol Reprod Biol ; 242: 99-102, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31580965

RESUMO

OBJECTIVE: The aim of this study was to compare the effects of oxytocin and ergometrine on the intrinsic contractile parameters of human uterine smooth muscle at term between primiparous and multiparous women. STUDY DESIGN: Myometrial biopsies were obtained from women undergoing planned caesarean section at term. The biopsies were dissected into eight uniform strips and mounted in tissue baths for isometric recording. The strips were challenged with increasing concentrations of oxytocin and ergometrine. Parameters of contractile activity, including mean contractile force (MCF) and maximum amplitude of contractions (MAMP) were recorded and analysed. Results were compared between primiparous (Group 1) and multiparous (Group 2) women. RESULTS: Myometrial biopsies were obtained from n = 11 donors (88 tissue strips), of which n = 5 were Group 1 and n = 6 were Group 2. In relation to oxytocin, the MAMP value observed was significantly greater in Group 2 than in Group 1 (151 ±â€¯18mN vs 67 ±â€¯14mN, P < 0.01). Regarding ergometrine, the MCF response was greater in Group 2 samples (24 ±â€¯10 mN) than that in Group 1 (18 ±â€¯2mN) (P < 0.05). CONCLUSION: Our findings highlight that women in a first pregnancy have a decreased response to both oxytocin and ergometrine in an in vitro setting when compared with women in a subsequent pregnancy, and this may have clinical implications regarding the management of postpartum haemorrhage in this cohort.


Assuntos
Ergonovina/farmacologia , Contração Muscular/efeitos dos fármacos , Miométrio/efeitos dos fármacos , Ocitócicos/farmacologia , Ocitocina/farmacologia , Paridade , Adulto , Ergonovina/uso terapêutico , Feminino , Humanos , Técnicas In Vitro , Ocitócicos/uso terapêutico , Ocitocina/uso terapêutico , Hemorragia Pós-Parto/tratamento farmacológico , Gravidez
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