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1.
Medicine (Baltimore) ; 98(38): e17219, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567979

RESUMO

RATIONALE: Retained placenta accreta is an increasing obstetric problem in recent years, and pulmonary embolism (PE) during pregnancy and the postpartum period is a vital condition, but lack of standard therapy guidelines. This report describes a case of postpartum PE combined with retained placenta accreta. PATIENT CONCERNS: A 27-year-old woman presenting with fever and dyspnea after delivery was admitted to our hospital with retained placenta accreta. DIAGNOSES: The patient was diagnosed with the infection, postpartum PE, and residual placenta. INTERVENTIONS: The antibiotics and low molecular weight heparin were initially started to cure the infection and control PE. Mifepristone was then used to promote the necrosis of residual placenta while long-term use of warfarin was served as continuous anticoagulant therapy. Hysteroscopic resection of retained placenta was not performed until thrombi had been almost disappeared after more than 2 months of anticoagulation therapy. OUTCOMES: The patient's menstruation returned to normal within several weeks after hysteroscopic resection and she completely recovered from PE after 3 months of anticoagulant therapy. LESSONS: Treatment of retained placenta accreta can be postponed when encountering complicated cases, such as postpartum PE. PE in perinatal stage can be managed referring to nonmaternal PE.


Assuntos
Placenta Acreta/terapia , Placenta Retida/terapia , Período Pós-Parto , Embolia Pulmonar/terapia , Adulto , Feminino , Humanos , Placenta Acreta/diagnóstico , Placenta Retida/diagnóstico , Gravidez , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Tomografia Computadorizada por Raios X
2.
Medicine (Baltimore) ; 98(38): e17309, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568016

RESUMO

Pregnancy and inflammatory bowel disease (IBD) are independent risk factors for venous thromboembolism (VTE). Nevertheless, the optimal VTE prevention strategy for women with IBD in pregnancy and postpartum period has not been established yet. We assessed VTE risks during pregnancy and the postpartum period in women with IBD through systematic review and meta-analysis.Systematic searches were conducted in MEDLINE (Ovid), Embase (Ovid), CENTRAL (Ovid), and Web of Science (Tomson Reuters) from the database inception till May 2017 to identify relevant studies reporting the risk of VTE during pregnancy and/or the postpartum period in women with IBD. Random effect meta-analyses were performed to compare VTE-related outcomes between women with IBD and without IBD. Our protocol was registered: CRD 42017060199 in the PROSPERO International prospective register of systematic reviews.In the analysis of 5 studies reviewed, IBD population (n = 17,636) had a significantly increased risk of VTE during pregnancy (pooled risk ratio (RR) 2.13, 95% confidence interval (CI) 1.66-2.73) and postpartum (RR 2.61, 95% CI 1.84-3.69), comparing to the non-IBD population (n = 11,251,778). According to the location of VTE, the risk of deep vein thrombosis increased significantly by RR of 2.74 (95% CI 1.73-4.36) during pregnancy, whilst risk increase of pulmonary embolism was not statistically significant. In the subgroup analysis, the degree of VTE risk was higher in both periods in the UC group than in the CD group, as compared to that in the non-IBD population (UC group, during pregnancy: RR 2.24, 95% CI 1.6-3.11; postpartum period: RR 2.85, 95% CI 1.79-4.52).Significantly increased risks of VTE during pregnancy were found in the women with IBD, according to the periods and type of IBD, which might support a detailed strategy regarding administration of prophylactic anticoagulants to women with IBD.


Assuntos
Doenças Inflamatórias Intestinais/complicações , Período Pós-Parto , Complicações na Gravidez/epidemiologia , Tromboembolia Venosa/etiologia , Feminino , Humanos , Gravidez , Fatores de Risco
3.
N Engl J Med ; 381(14): 1333-1346, 2019 10 03.
Artigo em Inglês | MEDLINE | ID: mdl-31577875

RESUMO

BACKGROUND: The safety, efficacy, and appropriate timing of isoniazid therapy to prevent tuberculosis in pregnant women with human immunodeficiency virus (HIV) infection who are receiving antiretroviral therapy are unknown. METHODS: In this multicenter, double-blind, placebo-controlled, noninferiority trial, we randomly assigned pregnant women with HIV infection to receive isoniazid preventive therapy for 28 weeks, initiated either during pregnancy (immediate group) or at week 12 after delivery (deferred group). Mothers and infants were followed through week 48 after delivery. The primary outcome was a composite of treatment-related maternal adverse events of grade 3 or higher or permanent discontinuation of the trial regimen because of toxic effects. The noninferiority margin was an upper boundary of the 95% confidence interval for the between-group difference in the rate of the primary outcome of less than 5 events per 100 person-years. RESULTS: A total of 956 women were enrolled. A primary outcome event occurred in 72 of 477 women (15.1%) in the immediate group and in 73 of 479 (15.2%) in the deferred group (incidence rate, 15.03 and 14.93 events per 100 person-years, respectively; rate difference, 0.10; 95% confidence interval [CI], -4.77 to 4.98, which met the criterion for noninferiority). Two women in the immediate group and 4 women in the deferred group died (incidence rate, 0.40 and 0.78 per 100 person-years, respectively; rate difference, -0.39; 95% CI, -1.33 to 0.56); all deaths occurred during the postpartum period, and 4 were from liver failure (2 of the women who died from liver failure had received isoniazid [1 in each group]). Tuberculosis developed in 6 women (3 in each group); the incidence rate was 0.60 per 100 person-years in the immediate group and 0.59 per 100 person-years in the deferred group (rate difference, 0.01; 95% CI, -0.94 to 0.96). There was a higher incidence in the immediate group than in the deferred group of an event included in the composite adverse pregnancy outcome (stillbirth or spontaneous abortion, low birth weight in an infant, preterm delivery, or congenital anomalies in an infant) (23.6% vs. 17.0%; difference, 6.7 percentage points; 95% CI, 0.8 to 11.9). CONCLUSIONS: The risks associated with initiation of isoniazid preventive therapy during pregnancy appeared to be greater than those associated with initiation of therapy during the postpartum period. (Funded by the National Institutes of Health; IMPAACT P1078 TB APPRISE ClinicalTrials.gov number, NCT01494038.).


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Antituberculosos/uso terapêutico , Infecções por HIV/tratamento farmacológico , Isoniazida/uso terapêutico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Resultado da Gravidez , Tuberculose/prevenção & controle , Adolescente , Adulto , Antituberculosos/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Isoniazida/efeitos adversos , Testes de Função Hepática , Período Pós-Parto , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Prospectivos , Adulto Jovem
4.
Zhonghua Gan Zang Bing Za Zhi ; 27(8): 638-642, 2019 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-31594083

RESUMO

Objective: To investigate the changes in clinical characteristics and laboratory indexes before and after the termination of pregnancy in patients with acute fatty liver of pregnancy (AFLP). Methods: Patients with acute fatty liver of pregnancy who had been admitted to the Department of Obstetrics and Gynecology at the Second Affiliated Hospital of Chongqing Medical University and Chongqing Municipal People's Hospital of Jiangbei District between 2007 and 2018 were selected. Clinical characteristics and complications during diagnosis and treatment, changes in blood coagulation, liver and kidney function, and postpartum recovery were collected for retrospectively analysis. Results: 54 cases with average gestational age of 35.0±1.7 weeks at third trimester of pregnancy with AFLP were treated. The most common gastrointestinal symptoms were yellow urine, nausea and vomiting. All patients had elevated bilirubin. 90.7% patients had changes in blood coagulation function and 68.5% had elevated serum creatinine. Transaminase levels were dropped rapidly within 1-2 days after the termination of pregnancy. Total bilirubin recovery was slow and partially recovered after 6-8 days. Serum creatinine and BUN increased slightly after delivery, reaching a peak at 3-4 days and then began to deplete. There was slight change in prothrombin time and fibrinogen after delivery, but returned to normal level after 5-6 days. The most common complications were AKI (74.1%), LF (42.6%), PPH (40.7%) and DIC (33.3%). Twenty-three of the 54 cases (42.6%) progressed to acute liver failure. AFLP complicated with ALF course was significantly longer than healthy controls, and the disease severity was significantly increased, with a mortality rate of 17.4% (4/23), and 0 in healthy controls. The difference was statistically significant. Conclusion: Early diagnosis and termination of pregnancy are the key factors to determine the prognosis of pregnant patients with acute fatty liver. Blood coagulation function does not deteriorate after termination of pregnancy and renal function begins to recover after 4 days with slight restoration of liver function. The control of complications is an important factor to determine the prognosis of patients.


Assuntos
Fígado Gorduroso/diagnóstico , Complicações na Gravidez/diagnóstico , Análise do Polimorfismo de Comprimento de Fragmentos Amplificados , Estudos de Casos e Controles , Feminino , Humanos , Período Pós-Parto , Gravidez , Estudos Retrospectivos
5.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 11(5): 1148-1154, out.-dez. 2019. ilus
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1021968

RESUMO

Objetivo: Conhecer como a mulher adolescente vivencia o período gravídico-puerperal. Método: Estudo qualitativo descritivo. As participantes foram 11 puérperas adolescentes. Para coleta de dados utilizou-se a entrevista semiestruturada e o mapa falante. Os dados foram submetidos à análise de conteúdo temática da proposta operativa. Resultados: Revelaram que no início da gestação sentiram insegurança, medo e rejeição; passaram por alguns abandonos e afastamentos; tiveram que reorganizar os planos de vida; os estudos foram adiados; mas, ao final, prevaleceu o sentimento de felicidade ao ter o filho nos braços. Conclusão: conhecer a vivência do período gravídico-puerperal das adolescentes permitiu compreender a importância do profissional de saúde atuar neste contexto e poder contribuir para evolução de uma gestação saudável a partir da compreensão das singularidades das adolescentes


Objective: The study's purpose has been to know how the adolescent woman experience the pregnancypuerperal period. Methods: It is a descriptive study with a qualitative approach. The participants were 11 adolescents who have recently given birth. Data collection took place through a semi-structured interview and the taking map. The data were submitted to thematic content analysis according to the operative proposal. Results: Data have revealed that women felt insecurity, fear and rejection during the initial stages of pregnancy; they faced abandonment; they also had to rearrange their life plans; their studies were put aside and delayed; but, after all, the feeling of happiness by having their children together has prevailed. Conclusion: Experiencing the pregnancy-puerperal period allowed the adolescent women to understand the importance of health professionals participating of this context and being able to contribute to a healthy pregnancy by appreciating the adolescents' specificities


Objetivo: Conocer cómo el adolescente mujer viviendo el periodo grávido puerperal. Método: estudio descriptivo cualitativo. Los participantes eran 11 adolescentes que han dado a luz recientemente. Para datos colección utilizó la entrevista semiestructurada y el mapa. Los datos fueron sometidos a análisis de contenido temático de la propuesta operativa. Resultados: reveló que temprano en el embarazo se sentía inseguridad, temor y rechazo; fue a través de algunas salidas y llegadas; tuvo que reorganizar los planes de vida; los estudios fueron retrasados; pero, al final, prevaleció el sentimiento de felicidad para que el niño en sus brazos. Conclusión: llegar a conocer que la experiencia de los adolescentes el período grávidos permitido entender la importancia puerperal de profesional de la salud actuar en este contexto y ser capaces de contribuir a un embarazo saludable de la comprensión de las singularidades de los adolescentes


Assuntos
Humanos , Feminino , Gravidez , Adolescente , Gravidez na Adolescência/psicologia , Saúde do Adolescente , Período Pós-Parto , Brasil
6.
Cochrane Database Syst Rev ; 9: CD012099, 2019 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-31529625

RESUMO

BACKGROUND: Exclusive breastfeeding is recommended for all infants until six months of age due to the many health benefits for both the mother and infant.Evidence suggests that mothers who are overweight (body mass index (BMI) 25.0 to 29.9 kg/m²) or obese (BMI ≥ 30.0 kg/m²) are less likely to initiate breastfeeding and to breastfeed for a shorter duration. Considering the rising prevalence of overweight and obesity globally and the known benefits of breastfeeding particularly in reducing the long-term risks of obesity and diabetes for infants, establishing effective ways to support and promote breastfeeding in women who are overweight or obese is paramount in achieving the goal of healthier communities. OBJECTIVES: To assess the effectiveness of interventions to support the initiation or continuation of breastfeeding in women who are overweight or obese. SEARCH METHODS: On 23 January 2019 we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP) and reference lists of retrieved trials. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs that compared interventions to support the initiation and continuation of breastfeeding in women who are overweight or obese. Interventions included social support, education, physical support, or any combination of these. Interventions were compared either with each other or against a control group. DATA COLLECTION AND ANALYSIS: We assessed all potential trials identified from the search strategy. Two review authors extracted data from each included trial and assessed risk of bias. We resolved discrepancies through discussion with the third review author. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS: We found no trials comparing one type of support versus another. We included seven RCTs (including one cluster-RCT) involving 831 women. The number of women in each trial ranged from 36 to 226. The trials were conducted in high-income countries: USA (5 trials); Denmark (1 trial) and Australia (1 trial), between 2006 and 2015. Three trials only included women who were obese prior to pregnancy and four trials included both women who were overweight and women who were obese. We judged risk of bias in the included trials to be mixed; only one trial was judged to be low risk of bias for random sequence generation, allocation concealment and attrition bias.Physical breastfeeding support (manual or electric breast pump) versus usual care (no breast pump)Very low-certainty evidence from one small trial (39 women) looking at a physical support intervention (manual or electric breast pump) versus usual care (no pump) means it is unclear whether physical support improves exclusive breastfeeding at four to six weeks (risk ratio (RR) 0.55, 95% confidence interval (CI) 0.20 to 1.51) or any breastfeeding at four to six weeks (RR 0.65, 95% CI 0.41 to 1.03). The trial did not report other important outcomes of interest in this review: non-initiation of breastfeeding, exclusive or any breastfeeding at six months postpartum.Multiple methods of breastfeeding support versus usual care Six trials (involving 792 women) used multiple methods of support including education and social support through telephone or face-to-face contact. One of these trials also provided physical support through providing a breast pump and a baby sling and one trial provided a small gift to the women at each trial visit. Support in the trials was provided by a professional (four trials) or a peer (two trials). One trial provided group support, with the other five trials supporting women individually. One trial (174 women) did not report on any of our main outcomes of interest.We are unclear about the effects of the intervention because we identified very low-certainty evidence for all of the important outcomes in this review: rate of non-initiation of breastfeeding (average RR 1.03, 95% CI 0.07 to 16.11; 3 trials, 380 women); exclusive breastfeeding at four to six weeks (average RR 1.21, 95% CI 0.83 to 1.77; 4 trials, 445 women); any breastfeeding at four to six weeks (average RR 1.04, 95% CI 0.57 to 1.89; 2 trials, 103 women); rate of exclusive breastfeeding at six months postpartum (RR 7.23, 95% CI 0.38 to 137.08; 1 trial, 120 women); and any breastfeeding at six months postpartum (average RR 1.42, 95% CI 1.08 to 1.87; 2 trials, 223 women).The included trials under the above comparisons also reported on some of this review's secondary outcomes but very low-certainty evidence means that we are unclear about the effects of the intervention on those outcomes. AUTHORS' CONCLUSIONS: There is insufficient evidence to assess the effectiveness of physical interventions, or multiple methods of support (social, educational or physical) for supporting the initiation or continuation of breastfeeding in women who are overweight or obese. We found no RCTs comparing one type of support to another type of support. All of our GRADE assessments resulted in very low-certainty evidence, with downgrading decisions based on limitations in trial design (e.g. risk of attrition bias), imprecision, inconsistency. The available trials were mostly of variable quality with small numbers of participants, confounded by poor adherence within both the intervention and control groups.Well designed, adequately powered research is needed to answer questions about the social, educational, physical support, or any combination of these interventions that could potentially help mothers who are overweight or obese to achieve optimal breastfeeding outcomes. We need trials that examine interventions designed specifically for women who are overweight or obese, delivered by people with training about how to overcome some of the challenges these women face when establishing and maintaining breastfeeding. Particular attention could be given to the assessment of antenatal interventions aimed at improving breastfeeding initiation in women with a raised BMI, and not just focusing on recruiting women who have an intention to breastfeed. Given that the majority of current trials were undertaken in the USA, further trials in a diverse range of countries and settings are required. Future trials need to give consideration to the theoretical basis of the intervention using established frameworks to enable replicability by others and to better determine the components of effective interventions.


Assuntos
Aleitamento Materno/psicologia , Promoção da Saúde/métodos , Mães/psicologia , Obesidade , Sobrepeso , Feminino , Humanos , Lactente , Mães/educação , Obesidade/prevenção & controle , Sobrepeso/prevenção & controle , Período Pós-Parto , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo
7.
Psychiatr Danub ; 31(Suppl 3): 338-344, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488750

RESUMO

INTRODUCTION: Mental difficulties are common in the postpartum period. They can manifest in a mild form, but also as serious disorders which need to be treated in a timely manner. The most common psychological problem is "Baby blues" characterized by relatively short duration without consequences and treatment is largely unnecessary. Postpartum depression is characterized by a sense of sadness, loss of interest, insomnia, discomfort, loss of energy, reduced concentration. Postpartum psychosis is the most serious disorder but is also rare and may have serious consequences for the mother and child. Important factors in the postpartum mental problems/difficulties are genetic factors, situation of unwanted pregnancy, a feeling of discomfort with the role of motherhood and sudden hormonal changes. AIM: to investigate the frequency and type of mental problems in postpartum period, as well as possible type of help needed by the women in postpartum period. SUBJECTS AND METHODS: One hundred (112) respondents participated in the survey. The survey was conducted from November to December 2017 through a "google docs" application. The survey was placed on different social networks, and the participation in the survey was voluntary and anonymous. A series of 14 questions with the offered answers was used in the survey. RESULTS: The results of the survey have shown that psychological difficulties and disturbances in the postpartum period to be common problems encountered by almost 50% of women (44.46%). The most common difficulty is Baby blues, followed by postpartum depression and anxiety disorders. Age and the mode of birth did not affect the emergence of changes, while social factors such as family support had a great impact. CONCLUSION: The provision of information to the mothers can help, but inaccurate information can do the opposite. Thus, the role of health care professionals is important for helping mothers in that period to prevent certain difficulties as well as in identifying and referring mothers to seek help in a timely fashion.


Assuntos
Ansiedade/epidemiologia , Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/psicologia , Mães/psicologia , Período Pós-Parto/psicologia , Transtornos Psicóticos/epidemiologia , Ansiedade/psicologia , Criança , Feminino , Humanos , Recém-Nascido , Mães/educação , Gravidez , Gravidez não Desejada/psicologia , Transtornos Psicóticos/psicologia , Inquéritos e Questionários
9.
Bratisl Lek Listy ; 120(9): 673-675, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31475552

RESUMO

OBJECTIVES: This study was conducted to determine the frequency of increased postvoiding residual volumes (PVRV) 3 days after delivery and to examine the associated risk factors. BACKGROUND: Increased PVRV ‒ covert postpartum urinary retention, is an asymptomatic condition with possible long-term adverse effects. While early diagnosis and appropriate management can avoid long­term complications, screening is not routinely performed. By identifying risk factors, we could define the group of patients suitable for screening. MATERIAL AND METHODS: This was a prospective observational study carried out over a 3-month period at the university teaching hospital in Bratislava, Slovakia. All participants underwent ultrasound determination of PVRV while 80 ml and more on day 3 was considered pathological. RESULTS: A total of 429 women were included in the study. The prevalence of covert post-partum urinary retention was 9.2 %. Assisted vaginal delivery (ventouse, forceps) and episiotomy were risk factors for post-partum urinary retention (18.7 % vs 6.1 %; p = 0.0053; 52.1 % vs 35.7 %; p = 0.0483; respectively). CONCLUSION: Our observations confirmed the existence of PVRV of 80 ml and more on day 3 in almost 10% of women who had delivered at our clinic. The results of our study prove that instrumental delivery represents a considerable obstetrical-pediatric risk factor for PVRV. Our data support the need of adopting a risk-factor-based approach to PVRV screening as part of postpartum bladder care (Tab. 2, Fig. 1, Ref. 12).


Assuntos
Período Pós-Parto , Retenção Urinária/epidemiologia , Parto Obstétrico , Feminino , Humanos , Gravidez , Estudos Prospectivos , Fatores de Risco , Eslováquia
10.
MMWR Morb Mortal Wkly Rep ; 68(36): 777-783, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31513558

RESUMO

Since 1999, the rate of opioid use disorder (OUD) has more than quadrupled, from 1.5 per 1,000 delivery hospitalizations to 6.5 (1), with similar increases in incidence of neonatal abstinence syndrome (NAS) observed for infants (from 2.8 per 1,000 live births to 14.4) among Medicaid-insured deliveries (2). CDC's response to the opioid crisis involves strategies to prevent opioid overdoses and related harms by building state capacity and supporting providers, health systems, and payers.* Recognizing systems gaps in provision of perinatal care and services, CDC partnered with the Association of State and Territorial Health Officials (ASTHO) to launch the Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative Learning Community (OMNI LC). OMNI LC supports systems change and capacity building in 12 states.† Qualitative data from participating states were analyzed to identify strategies, barriers, and facilitators for capacity building in state-defined focus areas. Most states focused on strategies to expand access to and coordination of quality services (10 of 12) or increase provider awareness and training (nine of 12). Fewer states focused on data, monitoring, and evaluation (four of 12); financing and coverage (three of 12); or ethical, legal, and social considerations (two of 12). By building capacity to strengthen health systems, state-identified strategies across all focus areas might improve the health trajectory of mothers, infants, and families affected by the U.S. opioid crisis.


Assuntos
Síndrome de Abstinência Neonatal/terapia , Transtornos Relacionados ao Uso de Opioides/terapia , Complicações na Gravidez/terapia , Efeitos Tardios da Exposição Pré-Natal/terapia , Feminino , Humanos , Lactente , Recém-Nascido , Síndrome de Abstinência Neonatal/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Período Pós-Parto , Gravidez , Complicações na Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Estados Unidos/epidemiologia
11.
Rev Saude Publica ; 53: 65, 2019 Sep 02.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31483006

RESUMO

OBJECTIVE: To evaluate whether age group, complications or comorbidities are associated with the length of hospitalization of women undergoing cesarean section. METHODS: A cross-sectional study was carried out between June 2012 and July 2017, with 64,437 women undergoing cesarean section and who did not acquire conditions during their hospital stay. Hospital discharge data were collected from national health institutions, using the Diagnosis-Related Groups system (DRG Brasil®). The DRG referring to cesarean section with additional complications or comorbidities (DRG 765) and cesarean section without complications or associated comorbidities (DRG 766) were included in the initial diagnosis. The influence of age group and comorbidities or complications present at admission on the length of hospital stay was assessed based on the means of the analysis of variance. The size of the effect was verified by Cohen's D, which allows evaluating clinical relevance. The criticality levels were identified using the Duncan test. RESULTS: The longest length of hospital stay was observed in the age group from 15 to 17 years old and among those aged 45 years old or more. The hospital stay of women with complications or comorbidities at the time of admission was also longer. Moreover, it was noted that the increase in criticality level was associated with an increase in the mean length of hospital stay. CONCLUSIONS: The length of hospital stay of women is higher among those belonging to the age group ranging from 15 to 17 years old and for those aged 45 years old or more. The presence of associated comorbidities, such as eclampsia, pre-existing hypertensive disorder with superimposed proteinuria and gestational hypertension (induced by pregnancy) with significant proteinuria increase the length of hospital stay. This study enabled the construction of distinct criticality level profiles based on the combination of age groups and the main comorbidities, which were directly related to the length of hospital stay.


Assuntos
Cesárea/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Brasil , Comorbidade , Estudos Transversais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Período Pós-Parto , Gravidez , Fatores de Risco , Adulto Jovem
12.
Isr Med Assoc J ; 21(7): 464-470, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31507122

RESUMO

BACKGROUND: Rheumatic diseases commonly affect women of childbearing age, when women may be contemplating pregnancy or they discover an unplanned pregnancy. Therefore, specific issues about pregnancy planning and management are commonly encountered in patients during these times. Knowledge of the effect of pregnancy on disease activity is important for counseling. This review summarizes recent data on the course of different rheumatic diseases during pregnancy and the postpartum period. Rheumatoid arthritis and systemic lupus erythematosus are the most commonly investigated diseases. Data are increasing about spondyloarthritis. Sparse data are available for other rheumatic diseases. Despite the differences in these diseases and the various courses these disease take during pregnancy, a common feature is that active maternal disease in the months prior to conception increases the risk of flares during pregnancy, which in turn can lead to adverse pregnancy outcomes. Therefore, maternal and fetal health can be optimized if conception is planned when disease is inactive so that a treatment regimen can be maintained throughout pregnancy.


Assuntos
Complicações na Gravidez/fisiopatologia , Resultado da Gravidez , Doenças Reumáticas/fisiopatologia , Artrite Reumatoide/fisiopatologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/fisiopatologia , Período Pós-Parto , Gravidez
13.
BMC Public Health ; 19(1): 1076, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399027

RESUMO

BACKGROUND: Chronic inflammation contributes to the risk of osteoporosis and fracture. Dietary Inflammatory Index (DII), a novel method appraising the inflammatory potential of diet, has been utilized to examine the association between diet and bone health among postmenopausal women or the elderly. However, its relationship with bone density (BD) in lactating women has not been studied. METHODS: The prospective study was conducted to assess the possible association between DII and maternal BD during lactation. We enrolled 150 lactating women in the cohort. Participants were measured ultrasonic BD as baseline values at 1 month postpartum. After five-month follow up, the participants' BD were measured again. DII scores were calculated from semi-quantitative food frequency questionnaires (FFQ) and divided into tertiles. We compared the differences in the changes of BD at 6 months postpartum without or with adjustment for potential covariates across the tertiles. RESULTS: The women in Q1 of DII scores had less bone mass loss than those in Q2 and Q3 without adjustment for any covariates (p < 0.01); after adjusting demographic characteristics such as BMI (kg/m2) at 6 months postpartum, educational level, metabolic equivalent (MET), daily energy intake (kcal/d), we found that participants in the highest tertile of DII scores had much more bone loss than those in the lowest tertile (p = 0.038). However, in the test for trend, no significant association between DII and the changes of maternal BD at 6 months postpartum was observed. CONCLUSIONS: Chinese lactating women with higher DII scores have more bone mass loss; however significant differences and trends are attenuated and/or disappear depending on covariates and confounders that are taken into account in statistical analysis. The further study should be conducted in larger population to explore whether the significant association between DII and BD exists in Chinese lactating women.


Assuntos
Densidade Óssea/fisiologia , Dieta/efeitos adversos , Inflamação/fisiopatologia , Lactação/fisiologia , Adulto , China , Feminino , Humanos , Estudos Longitudinais , Período Pós-Parto , Estudos Prospectivos
14.
Zhonghua Fu Chan Ke Za Zhi ; 54(8): 522-526, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31461808

RESUMO

Objective: To describe the situation of early stage of pelvic floor function and investigate the effect factors in postpartum women. Methods: A retrospective survey was conducted, and women who did regular examination and gave birth in Peking University People's Hospital and had an annual pelvic floor examination at 6-12 weeks after delivery from Sep. 2012 to Dec. 2017 were interviewed. General information and pelvic floor electrical physiological indexes were collected and analyzed. Results: Totally 5 143 puerpera were included in the study. The normal strength of type Ⅰ muscle was 52.40% (2 695/5 143) and the normal strength of type Ⅱ muscle was 52.69% (2 710/5 143). The abnormal degree of fatigue of type Ⅰ muscle was 55.84% (2 872/5 143) and the abnormal degree of fatigue of typeⅡmuscle was 27.34% (1 406/5 143). Pelvic floor dynamic pressure was (93±37) cmH(2)O (1 cmH(2)O=0.098 kPa). The incidence of stress urinary incontinence (SUI) was 23.49% (1 208/5 143) after delivery and it was as high as 57.58% (95/165) for women who had family history of pelvic floor dysfunction. Family history of pelvic floor dysfunction was the risk factor of the fatigue index of type Ⅰ and type Ⅱ muscle (P<0.05). The incidence of SUI was associated with vaginal delivery and age (≥30 years old) and family history of pelvic floor dysfunction (P<0.01). Conclusions: Pelvic floor electrical physiological indicators are reduced in about half of women in early postpartum stage. Age (≥30 years old) and vaginal delivery and family history of pelvic floor dysfunction are the risk factors.


Assuntos
Distúrbios do Assoalho Pélvico/epidemiologia , Diafragma da Pelve/fisiologia , Incontinência Urinária por Estresse/epidemiologia , Adulto , Feminino , Humanos , Músculo Esquelético , Distúrbios do Assoalho Pélvico/etiologia , Período Pós-Parto , Gravidez , Estudos Retrospectivos , Incontinência Urinária/etiologia
15.
Rev Saude Publica ; 53: 64, 2019 Aug 19.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31432929

RESUMO

OBJECTIVE: To analyze the impact of the Hospital-Acquired Conditions (HAC) in women in the puerperal and pregnancy cycle during length of stay. METHODS: This cross-sectional study was conducted with 113,456 women, between July 2012 and July 2017, in Brazil's national hospitals of the supplementary healthcare networks and philanthropists accredited to the Unified Health System (SUS). Data on hospital discharges were collected using the Diagnosis-Related Groups (DRG Brasil®) system. All DRGs of the major diagnostic category 14 (MDC14), including pregnancy, childbirth and puerperium, were included. The impact of HAC on length of stay was estimated by Student's t-test, and the effect size by Cohen's d, which allows to assess clinical relevance. RESULTS: The most prevalent diagnostic categories related to MDC14 were vaginal and cesarean deliveries without complicating diagnoses, both at institutions accredited to SUS and those for supplementary health care. The prevalence of HAC was 3.8% in supplementary health and 2.5% in SUS. Hospitals providing services to supplementary health care providers had a longer length of stay considering HAC for patients classified as DRG: cesarean section with complications or comorbidities at admission (p < 0.001; Cohen's d = 0.74), cesarean section without complications or comorbidities at admission (p < 0.001, Cohen's d = 0.31), postpartum and post abortion without listed procedure (p < 0.001, Cohen's d = 1.05), and other antepartum diagnoses with medical complications (p < 0.001; Cohen's d = 0.77). CONCLUSIONS: This study showed that the prevalence of HAC was low both in the institutions accredited to attend by SUS and in those of supplementary health; however, its presence contributes to increasing the length of stay in cases of cesarean sections without complications or comorbidities in supplementary health institutions.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Doença Iatrogênica , Tempo de Internação/estatística & dados numéricos , Brasil , Cesárea , Comorbidade , Estudos Transversais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Alta do Paciente/estatística & dados numéricos , Período Pós-Parto , Gravidez
16.
Medicine (Baltimore) ; 98(35): e16456, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464890

RESUMO

Breast milk is recognized and strongly recommended by the World Health Organization (WHO) as the optimal feeding for all babies. Breastfeeding is associated with better nutritional and non-nutritional outcomes when compared to formula feeding, and has proven health benefits to both infants and their mothers. This clinical research is to examine the feasibility and efficacy of Acupoint-Tuina therapy in treating postpartum women who underwent C-sections and suffered from insufficient milk production.The patients in the control group received standard medical care, while the patients in the Tuina group received Tuina therapy during the next 48 hours in addition to standard care, given once daily for 2 days. To evaluate the efficacy of Tuina therapy, patients of both groups were assessed for surface temperature of breasts, volume of breasts, volume of breast milk production, serum PRL level, and uterus recovery at various time points.Tuina therapy significantly increased the milk production when compared to the control group, for as much as 13-fold and 10-fold of that in the control group on the third and fourth postpartum days. In addition, Tuina therapy also significantly increased the full breast enlargement and the serum PRL level change, and decreased the breast surface temperature rise. Last but not the least, Tuina therapy also accelerated the post-surgery recovery of uterus.During the early postpartum days, Tuina therapy increases the milk production and promotes other physiological changes supporting lactation for postpartum women with C-section delivery and insufficient breast milk production. The novel intervention is warranted for further investigation and validation.


Assuntos
Medicina Tradicional Chinesa/métodos , Leite Humano/metabolismo , Período Pós-Parto/sangue , Prolactina/sangue , Pontos de Acupuntura , Adulto , Aleitamento Materno , Cesárea/efeitos adversos , Determinação de Ponto Final , Feminino , Humanos , Lactação , Resultado do Tratamento
17.
Medicine (Baltimore) ; 98(35): e16907, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464923

RESUMO

This study was to investigate the incidence and the risk factors of postpartum stress urinary incontinence (SUI), and the effect of comprehensive care and rehabilitation program (CCRP) on preventing postpartum SUI.In stage I, 479 puerperae were recruited within 1 week postpartum, then the postpartum SUI incidence at 8th week and its risk factors were investigated. In stage II, 240 vaginal delivery puerperae were enrolled within 1 week postpartum and randomly assigned to CCRP group or control group as 1:1 ratio. The postpartum SUI incidence and pelvic floor muscle function indexes were evaluated at 8th week.In stage I, the postpartum SUI incidence was 25.7%, and SUI puerperae presented with higher body mass index (BMI), vaginal delivery rate, newborn weight, and larger newborn head diameter compared with non-SUI puerperae. Besides, the vaginal delivery, the elevated age and BMI were independent risk factors for postpartum SUI. In stage II, the postpartum SUI incidence in CCRP group was decreased compared with control group, and the vaginal resting pressure, vaginal squeezing pressure, and vaginal contraction duration were increased in CCRP group compared to control group at 8th week postpartum.The incidence of postpartum SUI is 25.7%, and the vaginal delivery, increased age, and BMI are independent risk factors for postpartum SUI. More importantly, CCRP strengthens pelvic floor muscle functions and decreases postpartum SUI incidence in puerperae.


Assuntos
Assistência Integral à Saúde/métodos , Transtornos Puerperais/epidemiologia , Transtornos Puerperais/reabilitação , Incontinência Urinária por Estresse/epidemiologia , Incontinência Urinária por Estresse/reabilitação , Adulto , Índice de Massa Corporal , Cesárea/efeitos adversos , Parto Obstétrico/efeitos adversos , Feminino , Educação em Saúde/métodos , Humanos , Incidência , Idade Materna , Diafragma da Pelve/fisiopatologia , Período Pós-Parto , Gravidez , Distribuição Aleatória , Incontinência Urinária por Estresse/etiologia
18.
J Med Life ; 12(2): 178-183, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31406521

RESUMO

Weight gain during pregnancy can be a real risk factor for long-term obesity which has implications in all areas of medicine. This study is designed to assess pregnancy-related weight gain and postpartum weight loss, to identify a possible correlation between weight gain during pregnancy and the risk of obesity in the late postpartum period. The batch comprised 306 women, hospitalized in the Obstetrics and Gynecology Section of the "Nicolae Malaxa" Clinical Hospital between June - November 2017. During this study, we assessed the weight status using the Weight, Body Mass Index, Height, and Abdominal Circumference. These parameters were clinically assessed in three periods pre-pregnancy, early postpartum period, late postpartum period. We also collected data on the evolution of the pregnancy using the anamnesis and the personal pregnancy monitoring sheet. Pregnancy and postpartum period represent a key moment in women's lives in which the risk of obesity is real. Understanding women experiences with weight changes during pregnancy and postpartum period can improve the management of losing weight following pregnancy, avoid long-term weight gain and so reduce the risk for obesity. Also, the correct management of obesity should include the assessment of somatic disorders that may cause major dysfunction, requiring complex rehabilitation programs.


Assuntos
Ganho de Peso na Gestação/fisiologia , Obesidade/complicações , Período Pós-Parto/fisiologia , Perda de Peso , Adolescente , Adulto , Índice de Massa Corporal , Parto Obstétrico , Feminino , Humanos , Gravidez , Estudos Prospectivos , Fatores de Risco , Adulto Jovem
20.
Medicine (Baltimore) ; 98(32): e16779, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393402

RESUMO

BACKGROUND: Magnesium sulfate is the ideal drug for the prevention and treatment of eclampsia. Nevertheless, the best regimen for protection against eclampsia with minimal side effects remains to be established. This study aimed to compare serum magnesium levels during intravenous infusion of magnesium sulfate at 1 gram/hour versus 2 grams/hour as a maintenance dose to prevent eclampsia in pregnant and postpartum women with severe preeclampsia. METHODS: A randomized, triple-blind clinical trial was conducted, comparing serum magnesium levels during the intravenous infusion of magnesium sulfate at 1 gram/hour versus 2 grams/hour as a maintenance dose for the prevention of eclampsia in 62 pregnant and postpartum women with severe preeclampsia, 31 in each group. An intravenous loading dose of 6 grams of magnesium sulfate was administered over 30 minutes in both groups. The patients were then randomized to receive a maintenance dose of either 1 or 2 grams/hour for 24 hours. Primary outcomes consisted of serum magnesium levels at the following time points: baseline, 30 minutes, every 2 hours until the end of the first 6 hours, and every 6 hours thereafter until the termination of magnesium sulfate infusion. Side effects, maternal complications, and neonatal outcomes were the secondary outcomes. RESULTS: Serum magnesium levels were higher in the 2-gram/hour group, with a statistically significant difference from 2 hours after the beginning of the magnesium sulfate infusion (P <.05). Oliguria was the most common complication recorded in both groups, with no significant difference between the 2 regimens (RR 0.88; 95% CI: 0.49-1.56; P = .65). No cases of eclampsia occurred. Side effects were more common in the 2-gram/hour group (RR 1.89; 95% CI: 1.04-3.41; P = .02); however, all were mild. There were no differences between the 2 groups regarding neonatal outcomes, except for admission to neonatal intensive care, which was more frequent in the 1-gram/hour group (25% vs 6.3%; P = .04). CONCLUSION: Magnesium sulfate therapy at the maintenance dose of 1 gram/hour was just as effective as the 2-gram maintenance dose, with fewer side effects.


Assuntos
Eclampsia/prevenção & controle , Sulfato de Magnésio/uso terapêutico , Pré-Eclâmpsia/tratamento farmacológico , Adulto , Esquema de Medicação , Feminino , Humanos , Infusões Intravenosas , Sulfato de Magnésio/administração & dosagem , Sulfato de Magnésio/efeitos adversos , Sulfato de Magnésio/sangue , Período Pós-Parto , Gravidez , Resultado da Gravidez , Adulto Jovem
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