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2.
Am J Obstet Gynecol ; 227(3): B9-B20, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35850938

RESUMO

Cesarean scar ectopic pregnancy is a complication in which an early pregnancy implants in the scar from a previous cesarean delivery. This condition presents a substantial risk for severe maternal morbidity and mortality because of challenges in securing a prompt diagnosis. Ultrasound is the primary imaging modality for cesarean scar ectopic pregnancy diagnosis, although a correct and timely determination can be difficult. Surgical, medical, and minimally invasive therapies have been described for cesarean scar ectopic pregnancy management, but the optimal treatment is unknown. Patients who decline treatment of a cesarean scar ectopic pregnancy should be counseled regarding the risk for severe morbidity. The following are the Society for Maternal-Fetal Medicine recommendations: we recommend against expectant management of cesarean scar ectopic pregnancy (GRADE 1B); we suggest that operative resection (with transvaginal or laparoscopic approaches when possible) or ultrasound-guided uterine aspiration be considered for the surgical management of cesarean scar ectopic pregnancy and that sharp curettage alone be avoided (GRADE 2C); we suggest intragestational methotrexate for the medical treatment of cesarean scar ectopic pregnancy, with or without other treatment modalities (GRADE 2C); we recommend that systemic methotrexate alone not be used to treat cesarean scar ectopic pregnancy (GRADE 1C); in patients who choose expectant management and continuation of a cesarean scar ectopic pregnancy, we recommend repeated cesarean delivery between 34 0/7 and 35 6/7 weeks of gestation (GRADE 1C); we recommend that patients with a cesarean scar ectopic pregnancy be advised on the risks of another pregnancy and counseled regarding effective contraceptive methods, including long-acting reversible contraception and permanent contraception (GRADE 1C).


Assuntos
Abortivos não Esteroides , Gravidez Ectópica , Abortivos não Esteroides/uso terapêutico , Cicatriz/complicações , Cicatriz/diagnóstico por imagem , Feminino , Humanos , Metotrexato/uso terapêutico , Perinatologia , Gravidez , Gravidez Ectópica/diagnóstico por imagem , Gravidez Ectópica/etiologia , Gravidez Ectópica/terapia
3.
Am J Obstet Gynecol ; 227(2): B24-B27, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35710594

RESUMO

The recently published Chronic Hypertension and Pregnancy study provides important data to inform the management of mild chronic hypertension in pregnancy. The purpose of this statement is to review the results of this trial and provide guidance for the implementation of the study findings. Based on the available evidence, SMFM recommends treatment with antihypertensive therapy for mild chronic hypertension in pregnancy to a goal blood pressure of <140/90 mm Hg. Patients with treated chronic hypertension should continue established antihypertensive therapy during pregnancy or change to a regimen compatible with pregnancy to achieve this treatment goal.


Assuntos
Hipertensão , Complicações Cardiovasculares na Gravidez , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Feminino , Humanos , Perinatologia , Gravidez , Complicações Cardiovasculares na Gravidez/induzido quimicamente , Complicações Cardiovasculares na Gravidez/tratamento farmacológico
4.
Am J Obstet Gynecol ; 227(3): B2-B8, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35644249

RESUMO

Hypertensive disorders of pregnancy are a leading cause of maternal morbidity and mortality. Because postpartum exacerbation of severe hypertension is common, the American College of Obstetricians and Gynecologists recommends that patients with severe hypertension during the childbirth hospitalization be seen within 72 hours after discharge. In this statement, the Society for Maternal-Fetal Medicine proposes a uniform metric reflecting the rate of timely postpartum follow-up of patients with severe hypertension. The metric is designed to be measured using automated calculations based on billing codes derived from claims data. The metric can be used in quality improvement projects to increase the rate of timely follow-up in patients with severe hypertension during the childbirth hospitalization. Suggested steps for implementing such a project are outlined.


Assuntos
Hipertensão Induzida pela Gravidez , Hipertensão , Pré-Eclâmpsia , Feminino , Seguimentos , Humanos , Hipertensão/terapia , Hipertensão Induzida pela Gravidez/terapia , Perinatologia , Período Pós-Parto , Gravidez
6.
Artigo em Inglês | MEDLINE | ID: mdl-35742640

RESUMO

Placental syndromes include pregnancy loss, fetal growth restriction, preeclampsia, preterm delivery, premature rupture of membranes, placental abruption and intrauterine fetal demise. This paper discusses the common etiopathogenesis of those syndromes and the role of angiogenic biomarkers in their development. Pregnancy implantation, placental development and maternal adaptation are complex processes in which fetal and maternal cells interact. The syncytiotrophoblast, trophoblast, uterine natural killer cells and regulatory T cells interfere and interact in all the above-mentioned processes. The proper angioneogenesis and vasculogenesis of the placenta, as well as maternal circulatory adaptation, are dependent on angiogenic factor expression. Insufficient maternal immunotolerance, dysregulation in uterine natural killer or regulatory T cell function, syncytiotrophoblast and trophoblast ischemia and hypoxia or impaired balance in angiogenic factors are all related to the occurrence of placental syndromes. Differences in the time of impairment onset and its intensity and correlation with other dysfunctions result in the development of a specific syndrome. The clinical manifestations in the form of a combination of specific symptoms determine the diagnosis. However, they are just symptoms of an underlying complex trophoblast disorder.


Assuntos
Placenta , Pré-Eclâmpsia , Feminino , Humanos , Recém-Nascido , Perinatologia , Placenta/metabolismo , Placentação , Gravidez , Síndrome
7.
J Perinat Med ; 50(5): 620-624, 2022 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-35599300

RESUMO

OBJECTIVES: To identify when obstetricians would deliver a fetus with antenatal hydronephrosis and normal liquor. Designed as snap-shot survey. Setting: Survey Monkey link. Population/sample were obstetrics and fetal medicine consultants who received the survey link via closed professional forums on the North West Coast Maternity Clinical Network, Facebook, and publicly on Twitter. METHODS: Survey link publicised as above, obstetric consultants were asked at what gestation would they deliver a fetus with antenatal hydronephrosis and normal liquor; and what criteria would they use to make that decision. Main outcome measures were number of years in practice, gestation at delivery, anteroposterior diameter (APD) of renal pelvis. RESULTS: A total of 44/102 respondents (43%) would deliver prior to 40 weeks (median no. of years as consultant 10 years [IQR 5-17]) vs. those who would not (median years as consultant 5.5 [IQR 3-12]). Re APD threshold of delivery: 17 indicated delivery if the APD were 20 mm, 10 if it were 21-30 mm and 16 if it were >30 mm. Re gestation at which they would deliver: 13 indicated 37-38 weeks, 13 indicated 38-39 weeks and 17 indicated 39-40 weeks. Reasons selected for delivery before term were obstetric anxiety n=2, maternal request n=2, maternal anxiety n=2 and concern about fatal renal damage/renal damage n=34. CONCLUSIONS: A surprising number of respondents would consider early delivery of a fetus with hydronephrosis and normal liquor despite the lack of evidence of benefit. The evidence supporting term delivery means that early term delivery is only indicated for obstetric reasons in this scenario.


Assuntos
Hidronefrose , Mídias Sociais , Líquido Amniótico , Parto Obstétrico , Feminino , Humanos , Hidronefrose/diagnóstico por imagem , Pelve Renal , Perinatologia , Gravidez
9.
Am J Obstet Gynecol ; 227(2): B44-B59, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35378098

RESUMO

The Centers for Disease Control and Prevention define social determinants of health as "the conditions in the places where people live, learn, work, and play" that can affect health outcomes. Systemic racism is a root cause of the power and wealth imbalances that affect social determinants of health, creating disproportionate rates of comorbidities and adverse outcomes in the communities of racial and ethnic minority groups. Focusing primarily on disparities between Black and White individuals born in the United States, this document reviews the effects of social determinants of health and systemic racism on reproductive health outcomes and recommends multilevel approaches to mitigate disparities in obstetrical outcomes.


Assuntos
Etnicidade , Grupos Minoritários , Feminino , Disparidades em Assistência à Saúde , Humanos , Perinatologia , Determinantes Sociais da Saúde , Racismo Sistêmico , Estados Unidos
10.
Am J Obstet Gynecol ; 227(2): B2-B10, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35487325

RESUMO

The processes of diagnosis and management involve clinical decision-making. However, decision-making is often affected by cognitive biases that can lead to medical errors. This statement presents a framework of clinical thinking and decision-making and shows how these processes can be bias-prone. We review examples of cognitive bias in obstetrics and introduce debiasing tools and strategies. When an adverse event or near miss is reviewed, the concept of a cognitive autopsy-a root cause analysis of medical decision-making and the potential influence of cognitive biases-is promoted as part of the review process. Finally, areas for future research on cognitive bias in obstetrics are suggested.


Assuntos
Cognição , Erros Médicos , Obstetrícia , Viés , Humanos , Perinatologia , Sociedades Médicas , Estados Unidos
12.
Am J Obstet Gynecol ; 227(2): B28-B43, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35337804

RESUMO

Pregnancy in individuals with a mechanical heart valve has been classified as very high risk because of a substantially increased risk of maternal mortality or severe morbidity. Lifelong therapeutic anticoagulation is a principal component of the medical management of mechanical heart valves to prevent valve thrombosis. Anticoagulation regimens indicated outside of pregnancy for patients with mechanical valves should be continued during pregnancy with the possibility of modifications based on the type of valve, the trimester of pregnancy, individual risk tolerance, and circumstances around the time of delivery. The purpose of this document is to provide recommendations regarding the management of anticoagulation for common cardiac conditions complicating pregnancy, including mechanical heart valves, atrial fibrillation, systolic heart failure, and congenital heart disease.


Assuntos
Complicações Cardiovasculares na Gravidez , Tromboembolia , Anticoagulantes/uso terapêutico , Arritmias Cardíacas , Feminino , Humanos , Perinatologia , Gravidez , Complicações Cardiovasculares na Gravidez/induzido quimicamente , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Complicações Cardiovasculares na Gravidez/prevenção & controle , Tromboembolia/prevenção & controle
13.
Am J Obstet Gynecol ; 227(2): B11-B23, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35339479

RESUMO

Prenatal ultrasound is an indispensable tool used by obstetrical care providers to assist in the everyday care of their pregnant patients. Alongside advancements in imaging, the electronic systems that support this technology have become more advanced. However, it is currently difficult for these individual systems to communicate with each other "out of the box." There is also minimal standardization of the type and format of data transmitted within these systems. Clinicians and system vendors must work collaboratively to create clinical and technical standards to serve as the foundation for increased interoperability among the various systems within each institutional network. Therefore, the Society for Maternal-Fetal Medicine Clinical Informatics Committee established an Ultrasound Electronic Health Record Subcommittee to facilitate collaboration between clinicians, including maternal-fetal medicine subspecialists, and ultrasound network component vendors. Based on the work of this subcommittee, the purpose of this document is to provide: (1) a basic understanding of ultrasound network architecture and capabilities, and (2) best-practice recommendations for electronic health record order design, obstetrical clinical data standards, and billing and coding practices.


Assuntos
Obstetrícia , Perinatologia , Feminino , Humanos , Gravidez , Ultrassonografia
14.
Gynecol Obstet Fertil Senol ; 50(7-8): 542-552, 2022.
Artigo em Francês | MEDLINE | ID: mdl-35288367

RESUMO

Perinatal beliefs contribute to the experience of pregnancy and the process of parenthood. Many of these perinatal beliefs have been perpetuated and evolved over time and throughout the world, exerting their influence on the behavior of pregnant women in interaction with medical recommendations. These beliefs generally offer explanations for gravidic and puerperal phenomena, helping to reduce the uncertainty of parents faced with the biological, psychological and social transitions of pregnancy. But certain beliefs can also be harmful, and alter the maternal experience of pregnancy and postpartum. In this paper, we provide an overview of the beliefs associated with the perinatal period. We successively detail the beliefs concerning fertility, pregnancy, childbirth, and postpartum, specifying the cultural beliefs from other cultures interacting with medical recommendations. Finally, we propose a neurocognitive model of perinatal beliefs generation, and we show the need to know these beliefs to improve care in midwifery, obstetrics, and fetal medicine.


Assuntos
Tocologia , Parto , Parto Obstétrico , Feminino , Humanos , Perinatologia , Período Pós-Parto , Gravidez
15.
Am J Obstet Gynecol ; 227(1): B2-B3, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35337803

RESUMO

The management of pregnancies resulting from in vitro fertilization includes several recommended interventions at various times by various providers. To minimize the chance of errors of omission, the Society for Maternal-Fetal Medicine presents a patient-oriented checklist summarizing the recommended management of such pregnancies.


Assuntos
Lista de Checagem , Perinatologia , Feminino , Fertilização In Vitro , Humanos , Gravidez
16.
Más Vita ; 4(1): 94-103, mar. 2022. tab
Artigo em Espanhol | LILACS, LIVECS | ID: biblio-1372132

RESUMO

Un factor de riesgo obstétrico es una condición médica obstétrica o sociodemográfica que, en una mujer gestante puede ocasionar un aumento en la morbimortalidad que repercute como ya se ha mencionado a nivel materno -fetal con respecto al resto de la población. Objetivo: El objetivo primordial de evaluar el riesgo obstétrico, es poder realizar acciones preventivas que encaminen a evitar complicaciones que comprometan la vida materno fetal. Materiales y Métodos: Investigación cuantitativa documental, retrospectiva de corte transversal descriptivo. La investigación es cuantitativa, porque se obtiene datos los cuales son procesados, documental, porque toma la información de historia clínica que reposa en el área de estadística del centro de Salud Roberto Astudillo. Resultados: Dentro de los factores desencadenantes del alto riesgo obstétrico se encuentra el embarazo gemelar, y los embarazos mal controlados; entendiendo que el Síndrome de Hellp puede ser prevenible si hay un control exhaustivo desde el primer trimestre del embarazo, sobre todo cuando hay antecedentes de preeclampsia. Por otro lado, en los hábitos psicobiológicos se obtuvo una incidencia alta de consumo de café, de medicamentos, de consumo de alcohol y de pacientes con hábitos tabáquicos abandonados en el primer trimestre del embarazo (hábitos tóxicos). Aunque no hay una teoría que determine que el consumo de café influye directamente sobre la tensión arterial, se sabe, que las teofilinas estimulan los receptores B1 y B2 trayendo esto como consecuencia un leve incremento de la frecuencia cardíaca, y por ende un ligero incremento de la presión arterial. Conclusiones: Mantener una política de conducta expectante, generalmente incluye la atención intrahospitalaria con corticoides para la maduración pulmonar fetal, sulfato de magnesio (según sea necesario), antihipertensivos (según sea necesario) y monitoreo fetal y materno cuidadoso para identificar las indicaciones para el parto (por ejemplo, hipertensión no controlada, deterioro del estado de la madre y del feto, incluidos disfunción orgánica y sufrimiento fetal). Como parte de la conducta expectante, debe considerarse el traslado intraútero (antes del parto) a un centro de nivel terciario con capacidad para cuidados intensivos neonatales(AU)


An obstetric risk factor is a medical condition, obstetric or sociodemographic that, in a pregnant woman, can cause a increase in morbidity and mortality that has repercussions, as already mentioned, maternal-fetal level with respect to the rest of the population. Objective: The objective essential to assess the obstetric risk is to be able to carry out preventive actions that lead to avoid complications that compromise maternal and fetal life. Materials and Methods: Documentary quantitative research, retrospective of descriptive cross section. The research is quantitative, because it is obtained data which are processed, documentary because it takes the information from clinical history that rests in the statistics area of ​​the health center Robert Astudillo. Result: Within the triggering factors of the high obstetric risk is found in twin pregnancy, and miscarriages controlled; understanding that Hellp Syndrome can be preventable if there is comprehensive control from the first trimester of pregnancy, especially when there is a history of preeclampsia. On the other hand, in habits psychobiological results, a high incidence of coffee consumption, of drugs, alcohol consumption and patients with smoking habits abandoned in the first trimester of pregnancy (toxic habits). But not there is a theory that determines that coffee consumption directly influences on blood pressure, it is known that theophyllines stimulate B1 receptors and B2 bringing this as a consequence a slight increase in the frequency heart rate, and therefore a slight increase in blood pressure. Conclusions: Maintaining a watchful waiting policy generally includes inpatient care with corticosteroids for fetal lung maturation, magnesium sulfate (as needed), antihypertensives (as needed necessary) and careful fetal and maternal monitoring to identify indications for delivery (eg, uncontrolled hypertension, impaired of the condition of the mother and fetus, including organ dysfunction and distress fetal). As part of watchful waiting, transfer should be considered. intrauterine (before delivery) to a tertiary-level facility with the capacity to neonatal intensive care(AU)


Assuntos
Humanos , Feminino , Gravidez , Complicações na Gravidez , Saúde Materno-Infantil , Parto , Perinatologia , Fatores de Risco
17.
Am J Obstet Gynecol MFM ; 4(3): 100601, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35217235

RESUMO

BACKGROUND: Ultrasound training is a vital component of maternal-fetal medicine fellowships in the United States. Of the 18 months of core clinical training, the American Board of Obstetrics and Gynecology currently requires a minimum of 3 months to be dedicated to ultrasound to be eligible for board certification. However, the experience and degree of hands-on training differ among the fellowship programs and have not been reassessed for nearly a decade. OBJECTIVE: To assess regional heterogeneity in the ultrasound training experience during maternal-fetal medicine fellowship in the United States. STUDY DESIGN: A survey was distributed to postgraduate year (PGY)-6 maternal-fetal medicine fellows registered to attend an annual ultrasound training course before the conference (n=114). For programs with >1 fellow attending (n=39), only 1 of them completed the survey to represent the program. The questions included demographics of the program, ultrasound training structure, the fellows' self-perception of ultrasound capabilities, research, mentorship, and technical aspects of sonography. RESULTS: Seventy two postgraduate year 6 fellows with a wide geographic distribution as follows completed the survey (96% response rate): 10 (14%) from the West, 16 (22%) from the Midwest, 17 (24%) from the South, and 29 (40%) from the Northeast. Respondents undergoing training in the South were less likely to report feeling comfortable performing nuchal translucency and detailed anatomic surveys than those from other regions (nuchal translucency: P=.046; anatomy: P=.011). Most of the respondents reported feeling comfortable performing growth (78%) and umbilical artery Doppler (58%) and feeling uncomfortable with three-dimensional ultrasound, neurosonography, and fetal echocardiography. Respondents in the Northeast were more likely to report feeling comfortable performing chorionic villus sampling (P=.001). There was no difference among fellowship programs in the presence or absence of ultrasound curriculum, bedside teaching, ultrasound-focused research mentorship, or months of ultrasound training. CONCLUSION: Despite the standardization of ultrasound training structure across the United States, there remains regional heterogeneity in fellow self-reported comfort with specific ultrasound techniques and chorionic villus sampling at a midpoint in their fellowship training. The maternal-fetal medicine attending involvement at the bedside did not affect the fellow self-reported comfort with ultrasound surveys. This study highlights the need for further optimization of maternal-fetal medicine fellowship ultrasound training, especially in advanced sonography and diagnostic procedures.


Assuntos
Obstetrícia , Perinatologia , Bolsas de Estudo , Feminino , Humanos , Obstetrícia/educação , Percepção , Gravidez , Diagnóstico Pré-Natal , Estados Unidos
18.
Am J Obstet Gynecol ; 226(6): B2-B10, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35189094

RESUMO

Preterm birth is a leading cause of perinatal morbidity and mortality. Antenatal corticosteroid administration before preterm birth reduces the risks of perinatal death, respiratory morbidity, necrotizing enterocolitis, and intraventricular hemorrhage and reduces the costs of perinatal care. Antenatal corticosteroids are optimally effective when administered within 7 days before preterm birth. However, only 20% to 40% of early preterm infants receive antenatal corticosteroids within 7 days before birth, in part because it is difficult to predict the precise timing of preterm birth. Until 2020, The Joint Commission had a Perinatal Care quality metric measuring the rate of antenatal corticosteroid administration at any time before early preterm birth. This metric incentivized providers to use antenatal corticosteroids liberally. The Joint Commission retired the metric in 2020 after the rate reached more than 97% in The Joint Commission-accredited hospitals. However, the metric did not evaluate whether the timing of antenatal corticosteroid administration was optimal, that is, within 7 days of birth. A 2016 multistakeholder Cooperative Workshop recommended the development of a new quality metric to assess the rate of optimally timed antenatal corticosteroids among early preterm births. In this statement, we outline proposed specifications for such a metric and discuss potential uses, advantages, limitations, and barriers. Furthermore, we propose a balancing metric that tracks the percentage of patients treated with antenatal corticosteroids who ultimately give birth at term. We suggest that the use of these new metrics may incentivize more conservative antenatal corticosteroid timing, which could, in turn, lead to meaningfully improved outcomes for preterm neonates.


Assuntos
Nascimento Prematuro , Corticosteroides/uso terapêutico , Benchmarking , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Perinatologia , Gravidez , Nascimento Prematuro/prevenção & controle
19.
Clin Perinatol ; 49(1): xxi-xxii, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35210013
20.
J Perinat Med ; 50(3): 370-371, 2022 03 28.
Artigo em Inglês | MEDLINE | ID: mdl-35119229
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