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2.
BJOG ; 128(3): 584-592, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33426798

RESUMO

OBJECTIVE: To evaluate the impact of a care bundle (antenatal information to women, manual perineal protection and mediolateral episiotomy when indicated) on obstetric anal sphincter injury (OASI) rates. DESIGN: Multicentre stepped-wedge cluster design. SETTING: Sixteen maternity units located in four regions across England, Scotland and Wales. POPULATION: Women with singleton live births between October 2016 and March 2018. METHODS: Stepwise region by region roll-out every 3 months starting January 2017. The four maternity units in a region started at the same time. Multi-level logistic regression was used to estimate the impact of the care bundle, adjusting for time trend and case-mix factors (age, ethnicity, body mass index, parity, birthweight and mode of birth). MAIN OUTCOME MEASURES: Obstetric anal sphincter injury in singleton live vaginal births. RESULTS: A total of 55 060 singleton live vaginal births were included (79% spontaneous and 21% operative). Median maternal age was 30 years (interquartile range 26-34 years) and 46% of women were primiparous. The OASI rate decreased from 3.3% before to 3.0% after care bundle implementation (adjusted odds ratio 0.80, 95% CI 0.65-0.98, P = 0.03). There was no evidence that the effect of the care bundle differed according to parity (P = 0.77) or mode of birth (P = 0.31). There were no significant changes in caesarean section (P = 0.19) or episiotomy rates (P = 0.16) during the study period. CONCLUSIONS: The implementation of this care bundle reduced OASI rates without affecting caesarean section rates or episiotomy use. These findings demonstrate its potential for reducing perineal trauma during childbirth. TWEETABLE ABSTRACT: OASI Care Bundle reduced severe perineal tear rates without affecting caesarean section rates or episiotomy use.


Assuntos
Parto Obstétrico/normas , Lacerações/epidemiologia , Complicações do Trabalho de Parto/epidemiologia , Melhoria de Qualidade/estatística & dados numéricos , Adulto , Canal Anal/lesões , Cesárea/efeitos adversos , Cesárea/normas , Cesárea/estatística & dados numéricos , Análise por Conglomerados , Parto Obstétrico/efeitos adversos , Parto Obstétrico/estatística & dados numéricos , Inglaterra/epidemiologia , Episiotomia/efeitos adversos , Episiotomia/normas , Episiotomia/estatística & dados numéricos , Feminino , Humanos , Lacerações/prevenção & controle , Modelos Logísticos , Complicações do Trabalho de Parto/prevenção & controle , Períneo/lesões , Gravidez , Projetos de Pesquisa , Fatores de Risco , Escócia/epidemiologia , País de Gales/epidemiologia
3.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 47(4): 168-173, oct.-dic. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-197646

RESUMO

La dispareunia se define como la presencia de dolor persistente o recurrente durante el acto sexual y se considera una de las principales disfunciones sexuales en el posparto. El objetivo de este trabajo es conocer los factores que influyen en la aparición de la dispareunia en el período posparto. En enero de 2018 se llevó a cabo una revisión bibliográfica en las siguientes bases de datos: Medline, PubMed, CINAHL, Web of Science y Scopus. Se obtuvieron un total de 15 artículos tras aplicar los criterios de inclusión y exclusión. Se encontró que la dispareunia posparto tiene como principales factores de riesgo el tipo de parto (siendo mayor en las cesáreas y los partos instrumentales), el trauma perineal y/o la episiotomía y la lactancia materna. La situación psicosocial también puede repercutir en la aparición de esta dolencia


Dyspareunia is defined as the presence of persistent or recurrent pain during sexual intercourse and is considered one of the main postpartum sexual dysfunctions. The aim of this study is to determine the factors that influence the appearance of dyspareunia in the postpartum period. A literature review was conducted in the following databases in January 2018: Medline, PubMed, CINAHL, Web of Science and Scopus. A total of 15 articles were obtained after applying the inclusion and exclusion criteria. The main risk factors in postpartum dyspareunia are the type of delivery (being higher in caesarean sections and instrumental deliveries), perineal trauma and/or episiotomy, and breastfeeding. The psychosocial situation can also affect the appearance of this disorder


Assuntos
Humanos , Feminino , Gravidez , Dispareunia/etiologia , Parto Obstétrico/efeitos adversos , Transtornos Puerperais/fisiopatologia , Parto Obstétrico/métodos , Fatores de Risco , Episiotomia , Inquéritos e Questionários
4.
Medicine (Baltimore) ; 99(46): e22844, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181654

RESUMO

By observing and analyzing the success rate of Tai'an City central hospital TOLAC and VBNC and various indicators after delivery, we make sure whether TOLAC is safe and feasible to be promoted in Tai'an area.Between January and December 2017, data of 144 cases undergoing TOLAC, 152 cases undergoing VBNC, 152 cases undergoing RCS and 142 case undergoing PCS in Tai'an City Central Hospital were retrospectively analyzed. The success rate of vaginal delivery, labor time, 24 hours postpartum hemorrhage, hospital stay, Apgar score of newborns and puerperal morbidity were observed.Primary study outcomes: The success rates of the TOLAC and VBNC groups were 93.06% and 93.42%, respectively, where the difference was not statistically significant (P = .901). Secondary study outcomes: There were no significant differences in labor time (P = .0249), amount of 24 hours postpartum hemorrhage (P = .206), Apgar score of newborns (P = .582), hospital stay (P = .194) and puerperal morbidity (P = .942) between the VBAC group and VBNC group. There were statistically significant differences in amount of 24 hours postpartum hemorrhage (P < .001), hospital stay (P < .001) and puerperal morbidity (P = .018), but no difference in Apgar score of newborns (P = .228) between the VBAC group and RCS group. There were significant differences in operation time (P = .011), amount of 24 hours hemorrhage (P = .001), hospital stay (P = .001) and puerperal morbidity (P = .041), but no significant difference in Apgar score of newborns (P = .300) between the RCS and PCS groups.The TOLAC is as safe and feasible as VBNC, and more favorable to the safety of mother and fetus than RCS in Tai'an area.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Prova de Trabalho de Parto , Nascimento Vaginal Após Cesárea/estatística & dados numéricos , Adulto , Índice de Apgar , Recesariana/estatística & dados numéricos , China/epidemiologia , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Estudos de Viabilidade , Feminino , Humanos , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Masculino , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/etiologia , Gravidez , Estudos Retrospectivos , Vagina , Nascimento Vaginal Após Cesárea/efeitos adversos , Nascimento Vaginal Após Cesárea/métodos
5.
PLoS One ; 15(10): e0239649, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33031397

RESUMO

BACKGROUND: The rate of Caesarean Section (CS) deliveries has shown an alarming rise in recent years. CS is a surgical procedure used when there is apprehension of risk to the life of mother or baby in case of vaginal delivery, but its rates higher than 10-15 per cent are not justifiable. It is well recognised that a CS delivery could have a large number of adverse impacts on women and infants. Several studies, especially in developing countries, have revealed that delivery in private hospitals is one of the most contributing factors in CS deliveries. The present study conceptualises a causal pathway in which the possible risk factors, socio-economic, maternal and pregnancy-related, as well as institutional, influence the chances of CS delivery. It is hypothesised that certain factors would contribute to CS deliveries largely indirectly through the place of delivery, that is, either a public or private institution. METHODS AND FINDINGS: To test the hypotheses, this study analysed 146,280 most recent live births delivered in hospitals during the five years preceding the fourth round of India's National Family Health Survey (NFHS-4), carried out during 2015-2016. The analysis, using generalised structural equation modelling (GSEM), revealed that many exogenous variables considered in the path models influence CS deliveries significantly, directly and/or indirectly through the place of delivery factor. Prominent among these are wealth index and receiving ANC services at only private hospitals; the total effects of these variables are even higher than the direct/total effect of place of delivery. CONCLUSION: From this finding, it could be said that the place of delivery is a proximate determinant of a CS delivery or a mediator of other co-factors. Interventions to curb higher CS deliveries should be focused on improving the quality of public health sectors and on developing protocols for CS deliveries.


Assuntos
Cesárea/estatística & dados numéricos , Hospitais Privados , Adolescente , Adulto , Cesárea/efeitos adversos , Cesárea/tendências , Parto Obstétrico/efeitos adversos , Parto Obstétrico/estatística & dados numéricos , Parto Obstétrico/tendências , Feminino , Inquéritos Epidemiológicos , Hospitais Públicos , Humanos , Índia , Recém-Nascido , Análise de Classes Latentes , Masculino , Pessoa de Meia-Idade , Parto , Gravidez , Probabilidade , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
6.
Curr Opin Anaesthesiol ; 33(6): 793-799, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33002958

RESUMO

PURPOSE OF REVIEW: Recognition of the increasing maternal mortality rate in the United States has been accompanied by intense efforts to improve maternal safety. This article reviews recent advances in maternal safety, highlighting those of particular relevance to anesthesiologists. RECENT FINDINGS: Cardiovascular and other chronic medical conditions contribute to an increasing number of maternal deaths. Anesthetic complications associated with general anesthesia are decreasing, but complications associated with neuraxial techniques persist. Obstetric early warning systems are evolving and hold promise in identifying women at risk for adverse intrapartum events. Postpartum hemorrhage rates are rising, and rigorous evaluation of existing protocols may reveal unrecognized deficiencies. Development of regionalized centers for high-risk maternity care is a promising strategy to match women at risk for adverse events with appropriate resources. Opioids are a growing threat to maternal safety. There is growing evidence for racial inequities and health disparities in maternal morbidity and mortality. SUMMARY: Anesthesiologists play an essential role in ensuring maternal safety. While continued intrapartum vigilance is appropriate, addressing the full spectrum of contributors to maternal mortality, including those with larger roles beyond the immediate peripartum time period, will be essential to ongoing efforts to improve maternal safety.


Assuntos
Analgesia Obstétrica/tendências , Anestesia Obstétrica/tendências , Anestesiologistas/psicologia , Parto Obstétrico/tendências , Mortalidade Materna/tendências , Hemorragia Pós-Parto/prevenção & controle , Analgesia Obstétrica/efeitos adversos , Analgesia Obstétrica/métodos , Anestesia Obstétrica/efeitos adversos , Anestesia Obstétrica/métodos , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Feminino , Humanos , Serviços de Saúde Materna/normas , Erros Médicos/prevenção & controle , Gravidez , Complicações na Gravidez , Estados Unidos
7.
Am J Obstet Gynecol ; 223(5): 709-714, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32888923

RESUMO

Obstetrical perineal and anal sphincter lacerations can be associated with considerable sequelae. The diagnosis of short-term bowel, bladder, and healing problems can be delayed if patients are not seen until the traditional postpartum visit at 4 to 6 weeks. Specialized peripartum clinics create a unique opportunity to collaborate with obstetrical specialists to provide early, individualized care for patients experiencing a variety of pelvic floor issues during pregnancy and in the postpartum period. Although implementation of these clinics requires thoughtful planning and partnering with care providers at all levels in the obstetrics care system, many of the necessary resources are available in routine gynecologic practice. Using a multidisciplinary approach with pelvic floor physical therapists, nurses, advanced practice providers, and other specialists is important for the success of this service line and enhances the level of care provided. Overall, these clinics provide a structured means by which pregnant and postpartum women with pelvic floor symptoms can receive specialized counseling and treatment.


Assuntos
Canal Anal/lesões , Lacerações/terapia , Obstetrícia , Distúrbios do Assoalho Pélvico/terapia , Modalidades de Fisioterapia , Cuidado Pós-Natal/organização & administração , Cuidado Pré-Natal/organização & administração , Parto Obstétrico/efeitos adversos , Dispareunia/terapia , Incontinência Fecal/terapia , Feminino , Humanos , Lacerações/etiologia , Equipe de Assistência ao Paciente , Diafragma da Pelve/lesões , Distúrbios do Assoalho Pélvico/etiologia , Prolapso de Órgão Pélvico/terapia , Dor Pélvica/terapia , Períneo/lesões , Período Periparto , Gravidez , Encaminhamento e Consulta , Incontinência Urinária/terapia
8.
Medicine (Baltimore) ; 99(38): e22354, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957407

RESUMO

BACKGROUND: Childbirth is a complex and special physiological process. Pain often accompanies the whole process of delivery. Long term pain will affect the physiological and psychological of pregnant women, and severe pain will affect the delivery process and the life of maternal and fetal. There are 2 ways to relieve delivery pain: drug analgesia and nonpharmacological analgesia. Nonpharmacological analgesia has less effect on the fetus than drug analgesia and is currently a more popular method for labor analgesia. Due to the lack of randomized trials comparing the efficacy of various nonpharmacological analgesia, it is still difficult to judge the relative efficacy. Therefore, we intend to conduct a network meta-analysis to evaluate the benefit among these nonpharmacological analgesia. METHODS: According to the retrieval strategies, randomized controlled trials on nonpharmacological analgesia delivery will be obtained from China National Knowledge Infrastructure, WanFang,SinoMed, PubMed, Web of science, Embase, and Cochrane Library, regardless of publication date or language. Studies were screened based on inclusion and exclusion criteria, and the Cochrane risk bias assessment tool will be used to evaluate the quality of the literature. The network meta-analysis will be performed in Markov Chain Monte Carlo method and carried out with Stata14 and OpenBUGS14 software. Ultimately, the evidentiary grade for the results will be evaluated. RESULTS: This study will provide more reasonable choice for clinic than the effect of nonpharmacological analgesia in parturient delivery. CONCLUSION: Our findings will provide references for future guidance developing and clinical decision.INPLASY registration number: INPLASY202080097.


Assuntos
Analgesia/métodos , Parto Obstétrico/efeitos adversos , Dor do Parto/terapia , Manejo da Dor/métodos , Feminino , Humanos , Metanálise em Rede , Gravidez , Revisões Sistemáticas como Assunto
9.
Obstet Gynecol ; 136(4): 707-715, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925614

RESUMO

OBJECTIVE: To compare neonatal intensive care unit (NICU) or special care nursery admission for deliveries with water immersion compared with deliveries in the matched control group without water immersion. Secondary outcomes included adverse neonatal diagnoses, maternal infections, and perineal lacerations. METHODS: We conducted a retrospective study using electronic health record data (2014-2018) from two health systems (eight hospitals), with similar clinical eligibility, associated with low risks of intrapartum complications, and implementation policies for waterbirth. The water immersion group included women intending waterbirth. Water immersion was recorded prospectively during delivery. The comparison population were women who met the clinical eligibility criteria for waterbirth but did not experience water immersion during labor. Comparison cases were matched (1:1) using propensity scores. Outcomes were compared using Fischer's exact tests and logistic regression with stratification by stage of water immersion. RESULTS: Of the 583 women with water immersion, 34.1% (199) experienced first-stage water immersion only, 65.9% (384) experienced second-stage immersion, of whom 12.0% (70) exited during second stage, and 53.9% (314) completed delivery in the water. Neonatal intensive care unit or special care nursery admissions were lower for second-stage water immersion deliveries than deliveries in the control group (odds ratio [OR] 0.3, 95% CI 0.2-0.7). Lacerations were lower in the second-stage immersion group (OR 0.5, 95% CI 0.4-0.7). Neonatal intensive care unit or special care nursery admissions and lacerations were not different between the first-stage immersion group and their matched comparisons. Cord avulsions occurred for 0.8% of second-stage water immersion deliveries compared with none in the control groups. Five-minute Apgar score (less than 7), maternal infections, and other adverse outcomes were not significantly different between either the first- or second-stage water immersion groups and their control group. CONCLUSION: Hospital-based deliveries with second-stage water immersion had lower risk of NICU or special care nursery admission and perineal lacerations than matched deliveries in the control group without water immersion.


Assuntos
Parto Obstétrico , Registros Eletrônicos de Saúde/estatística & dados numéricos , Doenças do Recém-Nascido , Lacerações , Parto Normal , Complicações do Trabalho de Parto , Adulto , Índice de Apgar , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/prevenção & controle , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Segunda Fase do Trabalho de Parto , Lacerações/diagnóstico , Lacerações/etiologia , Lacerações/prevenção & controle , Masculino , Minnesota/epidemiologia , Parto Normal/efeitos adversos , Parto Normal/métodos , Parto Normal/estatística & dados numéricos , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/etiologia , Complicações do Trabalho de Parto/prevenção & controle , Períneo/lesões , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Retrospectivos
10.
Obstet Gynecol ; 136(4): 745-755, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925617

RESUMO

OBJECTIVE: To investigate subsequent birth rates, maternal and neonatal outcomes for women with a history of placenta accreta spectrum (placenta accreta, increta, and percreta). METHODS: A population-based record linkage study of women who had a first, second, or third birth in New South Wales from 2003 to 2016 was conducted. Data were obtained from birth and hospital records and death registrations. Women with a history of placenta accreta spectrum were matched to women without, on propensity score and parity, to compare outcomes with women who had similar risk profiles. Modified Poisson regression models were used to calculate adjusted relative risk (aRR) for a range of maternal and neonatal outcomes. RESULTS: We identified recurrent placenta accreta spectrum in 27/570 (4.7%, 95% CI 3.0-6.5%) of second and 9/119 (7.6%, 95% CI 2.8-12.3%) of third pregnancies after placenta accreta spectrum in the preceding birth, with an overall recurrence rate of 38/689 (5.5%, 95% CI 3.9-7.5%, compared with the population prevalence of 25.5/10,000 births (95% CI 24.6-26.4). Subsequent births after placenta accreta spectrum had higher risk of postpartum hemorrhage (aRR 1.51, 95% CI 1.19-1.92), transfusion (aRR 2.13, 95% CI 1.17-3.90), cesarean delivery (aRR 1.19, 95% CI 1.02-1.37), manual removal of placenta (aRR 6.92, 95% CI 3.81-12.55), and preterm birth (aRR 1.43, 95% CI 1.03-1.98), with lower risk of small for gestational age (aRR 0.64, 95% CI 0.43-0.96), compared with similar-risk births. CONCLUSION: Women with a history of placenta accreta spectrum have increased risk of maternal morbidity, preterm birth, and placenta accreta spectrum in the subsequent pregnancy compared with similar-risk women with no previous placenta accreta spectrum, although the absolute risks are generally low. These findings may be used to inform counseling of women on the risks of future pregnancies.


Assuntos
Cesárea , Parto Obstétrico , Histerectomia , Placenta Acreta , Hemorragia Pós-Parto , Nascimento Prematuro , Adulto , Austrália/epidemiologia , Transfusão de Sangue/estatística & dados numéricos , Cesárea/métodos , Cesárea/estatística & dados numéricos , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Histerectomia/métodos , Histerectomia/estatística & dados numéricos , Recém-Nascido , Masculino , Placenta Acreta/epidemiologia , Placenta Acreta/terapia , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/terapia , Gravidez , Resultado da Gravidez/epidemiologia , Gravidez de Alto Risco , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Sistema de Registros/estatística & dados numéricos , História Reprodutiva , Risco Ajustado/métodos , Fatores de Risco
11.
Obstet Gynecol ; 136(4): 725-730, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925630

RESUMO

OBJECTIVE: To analyze the origins and consequences of cases of brachial plexus injuries and their relationship to shoulder dystocia. METHODS: We conducted a retrospective cohort study and identified all neonates with brachial plexus injury delivered at our institution between March 2012 and July 2019. A review was performed of the maternal and neonatal records of each neonate to identify obstetric antecedents, including the occurrence of shoulder dystocia and persistence of the injury. Experience of the delivering clinician was also examined. Statistical analysis was performed with the Fisher exact test, χ test for trends, and two-tailed t tests. RESULTS: Thirty-three cases of brachial plexus injury were identified in 41,525 deliveries (0.08%). Fourteen (42%) of these cases were not associated with shoulder dystocia; three (9%) followed cesarean delivery. Brachial plexus injury without shoulder dystocia was related to the absence of maternal diabetes, lower birth weights, and a longer second stage of labor. Persistent brachial plexus injury at the time of discharge was seen with equal frequency among neonates with (17/19, 89%, 95% CI 0.52-100%) and without shoulder dystocia (10/14, 71%, 95% CI 34-100%), P=.36). Whether brachial plexus injury was transient or persistent after shoulder dystocia was unrelated to the years of experience of the delivering clinician. Despite ongoing training and simulation, the already low incidence of brachial plexus injury did not decrease over time at our institution. CONCLUSION: Brachial plexus injury and shoulder dystocia represent two complications of uterine forces driving a fetus through the maternal pelvis in the presence of disproportion between the passage and the shoulder girdle of the passenger. Either or both of these complications may occur, but often are not causally related.


Assuntos
Cesárea , Parto Obstétrico , Paralisia do Plexo Braquial Neonatal , Distocia do Ombro , Adulto , Causalidade , Cesárea/efeitos adversos , Cesárea/estatística & dados numéricos , Parto Obstétrico/efeitos adversos , Parto Obstétrico/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Masculino , Paralisia do Plexo Braquial Neonatal/epidemiologia , Paralisia do Plexo Braquial Neonatal/etiologia , Paralisia do Plexo Braquial Neonatal/fisiopatologia , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Distocia do Ombro/epidemiologia , Distocia do Ombro/etiologia , Distocia do Ombro/fisiopatologia , Texas/epidemiologia
12.
Br J Clin Psychol ; 59(4): 480-502, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32808684

RESUMO

OBJECTIVES: To investigate whether levels of perfectionism, organization, and intolerance of uncertainty predispose women to more negative birth experiences and post-partum post-traumatic stress symptoms (PTSS). Birth experience was also examined as a potential moderator of the relationship between levels of the personality traits and post-natal PTSS. DESIGN: Prospective survey. METHOD: First-time expectant mothers (N = 10,000) were contacted via Emma's Diary during the perinatal period. At 32-42 weeks' gestation, participants completed measures examining the three personality traits and prenatal mood. At 6-12 weeks' post-partum, instruments assessing childbirth experience, birth trauma, PTSS, and post-natal mood were completed. Data from 418 women were analysed. RESULTS: Higher perfectionism and intolerance of uncertainty were associated with more negative birth appraisals and PTSS. Organization was unrelated to birth experience or PTSS. In a regression, higher intolerance of uncertainty and perfectionism statistically predicted more negative birth appraisals. Only perfectionism predicted PTSS. Birth experience did not moderate the relationship between perfectionism or intolerance of uncertainty and PTSS. CONCLUSIONS: Personality risk factors for negative birth experiences and post-natal PTSS are identifiable prenatally. Maternity care providers could educate women about the unique roles of high perfectionism and intolerance of uncertainty during antenatal birth preparation. PRACTITIONER POINTS: Women who expect themselves to be more perfect or who find it more difficult to cope with uncertainty had more negative experiences of childbirth. Women with higher levels of perfectionism were more likely to experience more symptoms of post-traumatic stress during the early post-natal period. Being more perfectionistic continued to have a more negative effect on women's well-being after birth, regardless of whether they had a positive or negative experience of birth. Integrating these findings into antenatal discussion around birth preferences would increase women's awareness of predisposing and obstetric risk factors that partially explain experiences of unsatisfactory births and post-partum post-traumatic stress.


Assuntos
Ansiedade/psicologia , Parto Obstétrico/psicologia , Serviços de Saúde Materna/organização & administração , Parto/psicologia , Personalidade , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Estresse Psicológico/complicações , Incerteza , Adulto , Parto Obstétrico/efeitos adversos , Parto Obstétrico/normas , Depressão/psicologia , Depressão Pós-Parto/psicologia , Feminino , Humanos , Gravidez , Estudos Prospectivos , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Estresse Psicológico/psicologia , Inquéritos e Questionários
13.
Obstet Gynecol ; 136(2): 394-401, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32649504

RESUMO

OBJECTIVE: To evaluate complications associated with early postpartum therapeutic anticoagulation. METHODS: A multicenter retrospective cohort study was done to evaluate the association between therapeutic anticoagulation postpartum and major complications (hemorrhagic and wound complications). Secondary outcomes included minor complications, risk factors associated with total complications (including the time to therapeutic anticoagulation resumption after delivery) and recurrent thrombotic events within 6 weeks postpartum. RESULTS: From 2003 to 2015, 232 consecutive women were treated with therapeutic anticoagulation within 96 hours postpartum; among those treated, 91 received unfractionated heparin, 138 received low-molecular-weight heparin, and three received other anticoagulants. The primary outcome, a composite of major hemorrhagic complications (requiring transfusion, hospitalization, volume resuscitation, transfer to intensive care unit, or surgery) and major wound complications, occurred in 7 of 83 (8.4%) for cesarean deliveries and 9 of 149 (6.0%) for vaginal deliveries (P=.490). Total complications (including major and minor hemorrhagic and wound complications) occurred in 13 of 83 (15.7%) for cesarean deliveries compared with 9 of 149 (6.0%) for vaginal deliveries (P=.016). When comparing cases associated with and without complications, the median delay before resuming anticoagulation was significantly shorter for both cesarean (12 vs 33 hours, P=.033) and vaginal deliveries (6 vs 19 hours, P=.006). For vaginal deliveries, 8 of 51 (15.7%) women had complications when anticoagulation was started before 9.25 hours postpartum, compared with 1 of 98 (1.0%) when started after 9.25 hours. For cesarean deliveries, 7 of 21 (33.3%) of women experienced complications compared with 6 of 62 (9.7%) if anticoagulation was started before or after 15.1 hours, respectively. Two (0.9%) episodes of venous thromboembolism occurred within 6 weeks postpartum. CONCLUSION: Among postpartum women who received early therapeutic anticoagulation, major complications occurred in 8.4% for cesarean deliveries and 6.0% for vaginal deliveries. Complications were associated with earlier resumption of therapeutic anticoagulation, particularly before 9.25 hours for vaginal deliveries and before 15.1 hours for cesarean deliveries.


Assuntos
Anticoagulantes/efeitos adversos , Hemorragia Pós-Parto/epidemiologia , Adulto , Anticoagulantes/uso terapêutico , Cesárea/efeitos adversos , Parto Obstétrico/efeitos adversos , Feminino , Heparina/efeitos adversos , Heparina/uso terapêutico , Heparina de Baixo Peso Molecular/efeitos adversos , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Complicações do Trabalho de Parto/induzido quimicamente , Complicações do Trabalho de Parto/epidemiologia , Hemorragia Pós-Parto/induzido quimicamente , Gravidez , Estudos Retrospectivos , Fatores de Risco , Tromboembolia Venosa/tratamento farmacológico , Ferimentos e Lesões/induzido quimicamente , Ferimentos e Lesões/epidemiologia , Adulto Jovem
14.
J Pediatr ; 223: 51-56.e1, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32482392

RESUMO

OBJECTIVE: To evaluate changes in cerebral oxygenation, peripheral arterial oxygenation, respiratory status, and administered fraction of inspired oxygen during the first 10 minutes of life in premature infants receiving umbilical cord milking compared with delayed cord clamping (DCC). STUDY DESIGN: Premature infants born at 230/7 to 276/7 weeks of gestation were randomized to umbilical cord milking or DCC. A near infrared spectroscopy sensor, pulse oximeter, and electrocardiogram electrodes were placed. Pulse rate, cerebral tissue oxygenation, peripheral oxygen saturation, airway pressure, and fraction of inspired oxygen were collected for 10 minutes in the delivery room. Longitudinal models were used to compare effects of umbilical cord milking and DCC. RESULTS: Fifty-six infants had cerebral oximetry and advanced monitoring at birth. There was an increased incidence of severe intraventricular hemorrhage in infants who received umbilical cord milking compared with DCC (P = .0211). Longitudinal models suggested that peripheral oxygen saturation was higher in the umbilical cord milking group in the first 4 minutes (P = .0221) and that mean airway pressures were lower in the umbilical cord milking group after the first 7 minutes (P = .0072). No statistical differences were observed for fraction of inspired oxygen, cerebral tissue oxygenation, or heart rates. CONCLUSIONS: The data suggest that the rapid transfer of blood during umbilical cord milking may facilitate lung expansion with improved pulmonary blood flow, but may also increase cerebral blood flow, resulting in severe intraventricular hemorrhage. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03145142.


Assuntos
Circulação Cerebrovascular , Parto Obstétrico/métodos , Hemodinâmica/fisiologia , Pulmão/irrigação sanguínea , Cordão Umbilical/irrigação sanguínea , Adulto , Hemorragia Cerebral Intraventricular/etiologia , Parto Obstétrico/efeitos adversos , Feminino , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Gravidez , Resultado da Gravidez/epidemiologia , Espectroscopia de Luz Próxima ao Infravermelho , Fatores de Tempo
15.
Am J Perinatol ; 37(10): 1022-1030, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32534458

RESUMO

OBJECTIVE: Since its emergence in late 2019, severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), the novel coronavirus that causes novel coronavirus disease 2019 (COVID-19), has spread globally. Within the United States, some of the most affected regions have been New York, and Northern New Jersey. Our objective is to describe the impact of COVID-19 in a large delivery service in Northern New Jersey, including its effects on labor and delivery (L&D), the newborn nursery, and the neonatal intensive care unit (NICU). MATERIALS AND METHODS: Between April 21, 2020 and May 5, 2020, a total of 78 mothers (3.6% of deliveries) were identified by screening history or examination to either be COVID-19 positive or possible positives (persons under investigation). Of the mothers who were tested after admission to L&D, 28% tested positive for SARS-CoV-2. DISCUSSION: Isolation between mother and infant was recommended in 62 cases, either because the mother was positive for SARS-CoV-2 or because the test was still pending. Fifty-four families (87%) agreed to isolation and separation. The majority of infants, 51 (94%), were initially isolated on the newborn nursery. Six needed NICU admission. No infants had clinical evidence of symptomatic COVID-19 infection. Fourteen infants whose mothers were positive for SARS-CoV-2, and who had been separated from the mother at birth were tested for SARS-CoV-2 postnatally. All were negative. RESULTS: COVID-19 posed a significant burden to mothers, infants, and staff over the 5-week study period. The yield from screening mothers for COVID-19 on L&D was high. Most families accepted the need for postnatal isolation and separation of mother and newborn. CONCLUSION: Our study suggests that the transmission of SARS-CoV-2 from mother to her fetus/newborn seems to be uncommon if appropriate separation measures are performed at birth. KEY POINTS: · The yield of targeted testing for SARS-CoV-2, on mothers on Labor and Delivery is high.. · Agreement to separation of mothers and infants to reduce transmission of SARS-CoV-2 was high.. · The incidence of symptomatic COVID-19 in newborns is low, if appropriate separation occurs at birth..


Assuntos
Infecções por Coronavirus/epidemiologia , Parto Obstétrico/métodos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Pneumonia Viral/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Resultado da Gravidez , Centros Médicos Acadêmicos , Doenças Assintomáticas , Técnicas de Laboratório Clínico/estatística & dados numéricos , Estudos de Coortes , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Parto Obstétrico/efeitos adversos , Feminino , Humanos , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Unidades de Terapia Intensiva Neonatal , Trabalho de Parto , Masculino , New Jersey , Berçários para Lactentes , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Estudos Prospectivos
16.
Am J Perinatol ; 37(10): 1044-1051, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32575140

RESUMO

Pregnant patients with severe acute respiratory syndrome coronavirus 2, the virus responsible for the clinical condition newly described in 2019 as coronavirus disease 2019 (COVID-19) and illness severity to warrant intensive care have a complex disease process that must involve multiple disciplines. Guidelines from various clinical societies, along with direction from local health authorities, must be considered when approaching the care of an obstetric patient with known or suspected COVID-19. With a rapidly changing landscape, a simplified and cohesive perspective using guidance from different clinical society recommendations regarding the critically-ill obstetric patient with COVID-19 is needed. In this article, we synthesize various high-level guidelines of clinical relevance in the management of pregnant patients with severe disease or critical illness due to COVID-19. KEY POINTS: · When caring for severely ill obstetric patients with COVID-19, one must be well versed in the complications that may need to be managed including, but not limited to adult respiratory distress syndrome with need for mechanical ventilation, approach to refractory hypoxemia, hemodynamic shock, and multiorgan system failure.. · Prone positioning can be done safely in gravid patients but requires key areas of support to avoid abdominal compression.. · For the critically ill obstetric patient with COVID-19, the focus should be on supportive care as a bridge to recovery rather than delivery as a solution to recovery..


Assuntos
Infecções por Coronavirus/epidemiologia , Cuidados Críticos/métodos , Parto Obstétrico/métodos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Pneumonia Viral/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , /epidemiologia , Comorbidade , Infecções por Coronavirus/prevenção & controle , Parto Obstétrico/efeitos adversos , Feminino , Humanos , Unidades de Terapia Intensiva , Pandemias/prevenção & controle , Posicionamento do Paciente/métodos , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Resultado da Gravidez , Gravidez de Alto Risco , Medição de Risco , Tromboembolia/prevenção & controle , Adulto Jovem
17.
Rev Bras Epidemiol ; 23: e200026, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32401919

RESUMO

OBJECTIVE: To classify the drugs used during childbirth in relation to risks in breastfeeding, by using different sources of information and determining their disagreements. METHODS: Cross-sectional study, within the 2015 Pelotas Birth Cohort. Information about the use of drugs was collected, classified and compared regarding risk according to: 1) Brazil Ministry of Health Manual (MS), 2) World Organization (WHO), 3) Newton and Hale's classification and 4) American Academy of Pediatrics (AAP). RESULTS: A total of 1,409 mothers participated, and they had used 14,673 medicines, with 143 different drugs, of which 28 showed discordant classification with regard to breastfeeding risk. These 28 drugs included the following: morphine (64%), classified by AAP and WHO as compatible and as judicious use use by MS and Newton and Hale; hyoscine (23%), classified as judicious use by MS and compatible (A) by AAP; and metoclopramide (18%), classified as compatible by MS, of effects unknown (D) by AAP, and should be avoided according to WHO. Of the total drugs, 49.7% were classified as compatible during breastfeeding. Almost all women used oxytocin (97.4%), followed by lidocaine (75%), ketoprofen (69%), cephalothin (66%) and diclofenac (65%), which were classified as compatible. CONCLUSION: There was extensive use of drugs by mothers in labor during admission, most of the drugs being classified at the same risk and almost half classified as compatible with breastfeeding. However, there was disagreement between the sources for 19.6% of the drugs analyzed, which could endanger the infant's health or leave doubts about the use of the drug or breastfeeding.


Assuntos
Aleitamento Materno , Parto Obstétrico/efeitos adversos , Uso de Medicamentos/classificação , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Hospitalização , Medição de Risco/métodos , Adolescente , Adulto , Brasil , Contraindicações de Medicamentos , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Leite Humano/efeitos dos fármacos , Mães , Fatores de Risco , Organização Mundial da Saúde , Adulto Jovem
18.
Am J Perinatol ; 37(10): 1055-1060, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32403141

RESUMO

OBJECTIVE: The aim of this study is to summarize currently available evidence on vertical transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). STUDY DESIGN: A systematic review was conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis Statement. RESULTS: A total of 22 studies comprising 83 neonates born to mothers diagnosed with coronavirus disease 2019 were included in the present systematic review. Among these neonates, three were confirmed with SARS-CoV-2 infection at 16, 36, and 72 hours after birth, respectively, by nasopharyngeal swab real-time polymerase chain reaction (RT-PCR) tests; another six had elevated virus-specific antibody levels in serum samples collected after birth, but negative RT-PCR test results. However, without positive RT-PCR tests of amniotic fluid, placenta, or cord blood, there is a lack of virologic evidence for intrauterine vertical transmission. CONCLUSION: There is currently no direct evidence to support intrauterine vertical transmission of SARS-CoV-2. Additional RT-PCR tests on amniotic fluid, placenta, and cord blood are needed to ascertain the possibility of intrauterine vertical transmission. For pregnant women infected during their first and second trimesters, further studies focusing on long-term outcomes are needed. KEY POINTS: · We review neonates of mothers diagnosed with coronavirus disease 2019 detected by RT-PCR.. · No direct virologic evidence of vertical transmission has been reported.. · No evidence that cesarean delivery is safer than vaginal delivery.. · More RT-PCR tests on amniotic fluid, placenta, and cord blood are recommended..


Assuntos
Infecções por Coronavirus/epidemiologia , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez , Cesárea/métodos , Cesárea/estatística & dados numéricos , Infecções por Coronavirus/prevenção & controle , DNA Viral/análise , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Feminino , Humanos , Recém-Nascido , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Reação em Cadeia da Polimerase em Tempo Real/métodos , Medição de Risco
19.
Int J Gynaecol Obstet ; 150(1): 92-97, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32364638

RESUMO

OBJECTIVE: To test for an association between blood loss and time until pushing (TUP) after full cervical dilation in nulliparous women with epidural analgesia. METHODS: A prospective cohort study was performed at the University Hospital of Zurich between October 2015 and November 2016. Included were 228 nulliparous women with singleton pregnancy, planned vaginal delivery after 36 completed weeks of gestation, epidural analgesia, and guided active pushing. TUP was defined as the interval between full cervical dilation and initiation of active pushing. The primary outcome measure was blood loss, assessed by the postpartum decrease in hemoglobin (ΔHb), estimated blood loss, and rate of ΔHb ≥30 g/L. Associations between TUP and primary and secondary maternal and neonatal delivery outcomes were assessed using Spearman correlation, Mann-Whitney U test, Kruskal-Wallis test, or Fisher exact test, as appropriate. RESULTS: Longer TUP correlated significantly with increased ΔHb (ρ=0.142, P=0.033) and higher rates of ΔHb ≥30 g/l (P=0.002). Composite adverse maternal and neonatal outcomes were unaffected. CONCLUSION: On the grounds of increased maternal blood loss, and in contrast to the current International Federation of Gynecology and Obstetrics (FIGO) guideline, delayed active pushing is not recommended in nulliparous women with epidural analgesia.


Assuntos
Analgesia Epidural/efeitos adversos , Analgesia Obstétrica/efeitos adversos , Parto Obstétrico/métodos , Hemorragia Pós-Parto/etiologia , Adulto , Analgesia Obstétrica/métodos , Parto Obstétrico/efeitos adversos , Feminino , Humanos , Período Pós-Parto , Gravidez , Estudos Prospectivos , Fatores de Tempo , Adulto Jovem
20.
Afr J Reprod Health ; 24(1): 121-132, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32358944

RESUMO

In efforts to reduce maternal and neonatal mortality, it is recommended that all pregnant women be counseled on signs of pregnancy related complications and neonatal illness. In resource limited settings, such counselling may be task-shifted to lay health workers. We conducted a community-based cross-sectional survey of community health workers/volunteers in North and East Kamagambo of the Rongo Sub- County of Migori County, Kenya, between January-April 2018. A survey tool was administered through face-to-face interviews to investigate the level of knowledge of obstetric and neonatal danger signs among community health workers in North Kamagambo after one year of participation in the Lwala program, as well as to evaluate baseline knowledge of community health volunteers in East Kamagambo at the beginning of Lwala's expansion and prior to their receiving training from Lwala. The North Kamagambo group identified more danger signs in each category. The percentage of participants with adequate knowledge in the pregnancy, postpartum, and neonatal categories was significantly higher in North Kamagambo than in East Kamagambo. Sixty percent of participants in North Kamagambo knew 3 or more danger signs in 3 or more categories, compared to 24% of participants in East Kamagambo. Location in North Kamagambo (OR 2.526, p=0.03) and a shorter time since most recent training (OR 2.291, p=0.025) were associated with increased knowledge. Our study revealed varying levels of knowledge among two populations of lay health workers. This study highlights the benefit of frequent trainings and placing greater emphasis on identified gaps in knowledge of the labor and postpartum periods.


Assuntos
Competência Clínica , Agentes Comunitários de Saúde/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Complicações do Trabalho de Parto/prevenção & controle , Complicações na Gravidez/prevenção & controle , Adulto , Pesquisa Participativa Baseada na Comunidade , Estudos Transversais , Parto Obstétrico/efeitos adversos , Parto Obstétrico/psicologia , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Entrevistas como Assunto , Quênia , Gravidez , Gestantes , Cuidado Pré-Natal/estatística & dados numéricos , Pesquisa Qualitativa , População Rural/estatística & dados numéricos , Inquéritos e Questionários
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