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1.
PLoS One ; 15(8): e0237765, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32804960

RESUMO

The failure of the maternal immune system to recognize fetal antigens and vice versa due to MHC similarity between the foal and its dam might result in the lack of placental separation during parturition in mares. The aim of the study was to investigate the influence of MHC similarity between a mare and a foal on the incidence of retained fetal membranes (RFM) in post-partum mares. DNA was sampled from 43 draft mares and their foals. Mares which failed to expel fetal membranes within three hours after foal expulsion were considered the RFM group (n = 14) and mares that expelled fetal membranes during the above period were the control group (n = 29). Nine MHC microsatellites of MHC I and MHC II were amplified for all mares and foals. MHC compatibility and MHC genetic similarity between mares and their foals was determined based on MHC microsatellites. The inbreeding coefficient was also calculated for all horses. The incidence of RFM in the studied population was 33%. Compatibility in MHC I and MHC II did not increase the risk of RFM in the studied population of draft mares (P>0.05). Differences in MHC similarity at the genetic level were not observed between mare-foal pairs in RFM and control group (P>0.05). We suspect that RFM in draft mares may not be associated with MHC similarity between a foal and its dam. Despite the above, draft horses could be genetically predisposed to the disease.


Assuntos
Doenças dos Cavalos/imunologia , Cavalos/imunologia , Endogamia , Complexo Principal de Histocompatibilidade/imunologia , Placenta Retida/veterinária , Animais , Estudos Transversais , Feminino , Técnicas de Genotipagem , Doenças dos Cavalos/epidemiologia , Cavalos/genética , Incidência , Complexo Principal de Histocompatibilidade/genética , Repetições de Microssatélites/genética , Repetições de Microssatélites/imunologia , Placenta Retida/epidemiologia , Placenta Retida/imunologia , Período Pós-Parto , Gravidez
2.
BJOG ; 127(5): 628-634, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31808245

RESUMO

OBJECTIVE: To assess the maternal characteristics and causes associated with refractory postpartum haemorrhage (PPH). DESIGN: Secondary analysis of the WHO CHAMPION trial data. SETTING: Twenty-three hospitals in ten countries. POPULATION: Women from the CHAMPION trial who received uterotonics as first-line treatment of PPH. METHODS: We assessed the association between sociodemographic, pregnancy and childbirth factors and refractory PPH, and compared the causes of PPH between women with refractory PPH and women responsive to first-line PPH treatment. MAIN OUTCOME MEASURES: Maternal characteristics; causes of PPH. RESULTS: Women with labour induced or augmented with uterotonics (adjusted odds ratio [aOR] 1.35; 95% CI 1.07-1.72), with episiotomy or tears requiring suturing (aOR 1.82; 95% CI 1.34-2.48) and who had babies with birthweights ≥3500 g (aOR 1.33; 95% CI 1.04-1.69) showed significantly higher odds of refractory PPH compared with the reference categories in the multivariate analysis adjusted by centre and trial arm. While atony was the sole PPH cause in 53.2% (116/218) of the women in the responsive PPH group, it accounted for only 31.5% (45/143) of the causes in the refractory PPH group. Conversely, tears were the sole cause in 12.8% (28/218) and 28% (40/143) of the responsive PPH and refractory PPH groups, respectively. Placental problems were the sole cause in 11 and 5.6% in the responsive and refractory PPH groups, respectively. CONCLUSION: Women with refractory PPH showed a different pattern of maternal characteristics and PPH causes compared with those with first-line treatment responsive PPH. TWEETABLE ABSTRACT: Women with refractory postpartum haemorrhage are different from those with first-line treatment responsive PPH.


Assuntos
Parto Obstétrico/efeitos adversos , Hemorragia Pós-Parto/etiologia , Adulto , Peso ao Nascer , Colo do Útero/lesões , Episiotomia/estatística & dados numéricos , Feminino , Humanos , Trabalho de Parto Induzido/estatística & dados numéricos , Estudos Multicêntricos como Assunto , Ocitócicos/efeitos adversos , Períneo/lesões , Placenta Retida/epidemiologia , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/terapia , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Inércia Uterina/epidemiologia , Vagina/lesões , Adulto Jovem
3.
Artigo em Alemão | MEDLINE | ID: mdl-31810084

RESUMO

OBJECTIVE: The aim of this study was to analyze data concerning history, clinical course, and prognosis of retained fetal membranes in mares. MATERIAL UND METHODS: Patient records of 121 hospitalized mares with retained placenta were evaluated. In 82 cases, additional blood examinations were performed and analyzed. RESULTS: There was no significant correlation between age, parity or course of parturition and retained placenta. Eighty-one mares (66.9 %) were presented solely with retained fetal membranes, 40 mares (33.1 %) had additional diseases at presentation, most commonly injuries of the labia, followed by perineal tears and lochiometra. During hospitalization 50 mares (41.3 %) developed one or more diseases, most frequently lochiometra (23 mares, 19 %), laminitis (17 mares, 14 %) and thrombophlebitis (11 mares, 9.1 %). Eight mares (6.6 %) were euthanized due to the course of their diesease. Blood examinations revealed a mean leucocyte concentration of 9.8 ± 3.9 G/l at presentation. Mean concentration of serum ionized calcium amounted to 1.5 ± 0.2 mmol/l. There was no statistically significant influence of blood parameters on clinical course or development of additional diseases. CONCLUSION AND CLINICAL RELEVANCE: Retained placenta is a common disorder in the puerperium of the mare. In the presented study, most cases developed additional diseases and in 10 % of the mares, the clinical course led to euthanasia. No risk factors for the occurrence of retained fetal membranes or its clinical course could be identified.


Assuntos
Doenças dos Cavalos/epidemiologia , Placenta Retida/veterinária , Fatores Etários , Animais , Cálcio/sangue , Eutanásia Animal/estatística & dados numéricos , Feminino , Doenças dos Cavalos/sangue , Doenças dos Cavalos/etiologia , Cavalos , Contagem de Leucócitos/veterinária , Paridade , Placenta Retida/sangue , Placenta Retida/epidemiologia , Placenta Retida/etiologia , Gravidez , Prognóstico
4.
Eur J Obstet Gynecol Reprod Biol ; 238: 114-119, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31129559

RESUMO

OBJECTIVE: We studied the incidence of postpartum hemorrhage and manual removal of the placenta and their recurrence rate in a subsequent pregnancy. We hypothesized that the risk of recurrence was dependent on the gestational age at first birth and whether or not a manual removal of the placenta was necessary. Knowledge on this subject can potentially improve counselling, prevention and management in obstetric care for women at risk for PPH or identify women at low risk for recurrence. STUDY DESIGN: This was a retrospective national cohort study consisting of women with two consecutive singleton deliveries between 1999 and 2009 in the Netherlands. A longitudinal linked national cohort with information on subsequent singleton deliveries in the Netherlands was used. Main outcome measures were: postpartum hemorrhage (defined as ≥1000 mL after vaginal delivery or Caesarean section) and manual removal of the placenta. We calculated incidence and recurrence rates of postpartum hemorrhage and manual removal of the placenta for all women and stratified by gestational age. RESULTS: After application of in- and exclusion criteria 359 737 women were studied. A total of 5.4% women experienced postpartum hemorrhage in the first pregnancy and 2.7% of women had a manual removal of the placenta. The risk of postpartum hemorrhage in a subsequent pregnancy was significantly higher in women with a history of postpartum hemorrhage compared to women without a previous postpartum hemorrhage (18% vs 3.9%, adjusted odds ratio 4.5; 95% confidence interval 4.3-4.7). The risk of manual removal of the placenta in the second pregnancy was only 1.4% in women without a previous manual removal compared to 17% of women with a previous manual removal of the placenta. Women with a manual removal of the placenta in the first pregnancy between 32 and 37 weeks were most at risk for recurrence (adjusted odds ratio 8.9; 95% confidence interval 7.2-11). CONCLUSION: Women with a previous delivery complicated by postpartum hemorrhage or manual removal of the placenta are at increased risk for recurrence. The magnitude of this risk is highest in women with deliveries beyond 32 weeks in the first pregnancy.


Assuntos
Placenta Retida/epidemiologia , Hemorragia Pós-Parto/epidemiologia , Adulto , Feminino , Humanos , Incidência , Estudos Longitudinais , Países Baixos/epidemiologia , Gravidez , Recidiva , Estudos Retrospectivos , Adulto Jovem
5.
Eur J Obstet Gynecol Reprod Biol ; 234: 108-111, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30682599

RESUMO

OBJECTIVE: To compare the prevalence of postpartum retained products of conception (RPOC) among parturients with a history of third stage of labor placental complications and parturients without those complications. STUDY DESIGN: All women operated for postpartum RPOC following vaginal delivery by hysteroscopy or suction curettage between January 2013 and December 2017 were included in the study. Their medical records were reviewed for the occurrence of third stage of labor placental complications (including early postpartum hemorrhage treated with uterotonics, manual separation of the placenta, and revision of the uterine cavity for removal of cotyledons). RESULTS: The study cohort included 172 women operated for postpartum RPOC following vaginal delivery by operative hysteroscopy (143 cases, 83.1%) or by suction curettage (29 cases, 16.9%). Third stage of labor placental complications were reported in 65 (37.8%) cases, while 107 (62.2%) women had an uncomplicated third stage of labor. When considering all vaginal deliveries in our institution during the study period, the risk for RPOC was significantly higher among parturients with third stage of labor placental complications compared to those with an uneventful third stage of labor (3.7% versus 0.3%, p < 0.001, Odds ratio = 12.5, 95% confidence interval 9.0-17.3). CONCLUSION: Postpartum RPOC following vaginal delivery were more common in parturients with third stage of labor placental complications. However, the majority of postpartum RPOC cases were diagnosed in women reported to have an uncomplicated third stage of labor. Thus, focused postpartum ultrasound follow-up of women considered at risk for RPOC will not identify all cases.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Terceira Fase do Trabalho de Parto , Complicações do Trabalho de Parto/patologia , Placenta Retida/etiologia , Adulto , Parto Obstétrico/métodos , Feminino , Humanos , Histeroscopia/estatística & dados numéricos , Complicações do Trabalho de Parto/etiologia , Placenta Retida/epidemiologia , Placenta Retida/cirurgia , Gravidez , Estudos Retrospectivos , Fatores de Risco , Curetagem a Vácuo/estatística & dados numéricos , Adulto Jovem
6.
J Matern Fetal Neonatal Med ; 32(3): 384-388, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28891361

RESUMO

PURPOSE: The purpose of this study is to assess risk factors and complications of manual placental removal. MATERIALS AND METHODS: An historical prospective study of all parturients undergoing manual placental removal between 2012 and 2014. Parturients were matched by time of delivery with parturients delivering vaginally with spontaneous placental separation. Multiple gestations, preterm deliveries, incomplete placental separation and uterine malformations were excluded. Delivery characteristics and short-term complications were studied. Telephone questionnaires were conducted to assess the likelihood of invasive procedures performed for retained products of conception (RPOC) up to 12 weeks postpartum. RESULTS: Overall 293 (1.5% of all vaginal deliveries) were complicated by manual placental removal. Independent risk factors included advanced maternal age (odds ratio (OR) 1.08, 95% CI 1.03-1.12), previous manual removal (OR 9.27, 95% CI 3.15-27.31), regional anesthesia (OR 3.49, 95% CI 2.14-5.70), and labor induction (OR 1.80, 95% CI 1.12-2.88). Short-term complications included blood product transfusions (OR 18.26 95% CI 5.37-62.13) and prolonged hospitalization (OR 1.51 95% CI 1.06-2.16). Invasive procedures for removal of RPOC occurred in 12.2% of women in the study groups and in none of the women in the control group (p < .001). CONCLUSIONS: Manual placental removal harbors short- and long-term complications, including a high likelihood of RPOC necessitating further invasive procedures.


Assuntos
Parto Obstétrico/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia , Complicações do Trabalho de Parto/etiologia , Placenta Retida , Placenta/patologia , Período Pós-Parto , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Mãos , Humanos , Recém-Nascido , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/cirurgia , Placenta Retida/epidemiologia , Placenta Retida/etiologia , Placenta Retida/cirurgia , Gravidez , Fatores de Risco
7.
J Obstet Gynaecol Res ; 45(1): 141-147, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30230145

RESUMO

AIM: Our aim is to provide expected outcomes for undergoing manual removal of placenta (MROP) following vaginal delivery in women having an unpredictable adherent placenta (AP). METHODS: The data were obtained from four hospitals in Miyazaki Prefecture, Japan. We used propensity score-matched (1:1) analysis to match women who underwent MROP with women who did not undergo MROP (control). Total blood loss and hemorrhagic rate used as a ratio of women who reached a certain amount of blood loss were compared. Subgroup analysis was undertaken and was dependent on the presence of AP. We found the cut-off value of blood loss for detecting AP. RESULTS: Thirty-seven MROP cases were identified. Total blood loss and hemorrhagic rate differed significantly between MROP cases and controls; 95% of controls had blood loss of 1000 mL or less, whereas for the MROP cases, it was 14%. Fourteen MROP cases were diagnosed with AP. The hemorrhagic rate differed significantly between MROP cases with and without AP (n = 19); 79% of MROP cases without AP had blood loss of 2000 mL or less, whereas for the MROP cases with AP, it was 7%. There were seven incidents of hysterectomy and two of arterial embolization in MROP cases with AP. Through receiver operating characteristic curve analysis, 2035 mL of blood loss was determined to be the optimal cut-off value for detecting AP. CONCLUSION: The incidence of unpredictable AP in MROP cases was as high as 38%. The morbidity of MROP cases with unpredictable AP was severe. MROP should be prohibited in the absence of appropriate hemostatic preparations.


Assuntos
Perda Sanguínea Cirúrgica , Parto Obstétrico/métodos , Placenta Retida/terapia , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Parto Obstétrico/efeitos adversos , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Incidência , Japão/epidemiologia , Placenta Retida/epidemiologia , Gravidez , Estudos Retrospectivos , Adulto Jovem
8.
J Matern Fetal Neonatal Med ; 32(6): 906-909, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29046070

RESUMO

OBJECTIVE: The objective of this study is to compare patient outcomes between planned and emergent cesarean deliveries for placenta previa without morbidly adherent placenta. STUDY DESIGN: All patients with confirmed, persistent placenta previa (without morbidly adherent placentation) who underwent the surgery between January 2010 and April 2016 were included in this retrospective study. Primary outcome was composite maternal morbidity defined as the presence of at least one of the followings: death, red blood cell (RBC) transfusion, hysterectomy, reoperation, hospital stay >7 d, ureteral injury, bowel injury, or cystotomy. RESULTS: Three hundred and four patients with placenta previa were identified during the study period, of whom 154 (50.65%) had an antenatal and 10 (3.28%) had an intraoperative diagnosis of morbidly adherent placenta. One hundred and forty patients met the inclusion criteria. Eighty (57.1%) underwent planned cesarean delivery (planned cesarean delivery (PCD) group), and 60 (42.8%) required emergent cesarean delivery due to uterine contractions and/or bleeding (emergent cesarean delivery (ECD) group). Baseline characteristics were similar between the two groups except for the gestational age at delivery (36.0 weeks (36.0, 37.0) in PCD versus 34.0 weeks (32.0, 36.0) in ECP, p < .001). Composite maternal morbidity was not significantly different between two groups: 11 (18.3%) in ECD and 10 (12.5%) in PCD (p = .35) Conclusions: In our referral tertiary centre, emergent and planned cesarean deliveries for placenta previa without morbidly adherent placenta have similar maternal outcomes. In patients without significant hemorrhage, delivery may be safely deferred until 36-37 weeks.


Assuntos
Cesárea/estatística & dados numéricos , Placenta Prévia/cirurgia , Adulto , Peso ao Nascer , Estudos de Casos e Controles , Cesárea/métodos , Emergências , Feminino , Idade Gestacional , Humanos , Placenta Prévia/epidemiologia , Placenta Retida/epidemiologia , Placenta Retida/cirurgia , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Retrospectivos
9.
Clin Obstet Gynecol ; 61(4): 733-742, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30204619

RESUMO

The placenta accreta spectrum has become an important contributor to severe maternal morbidity. The true incidence is difficult to ascertain, but likely falls near 1/1000 deliveries. This number seems to have increased along with the rate of risk factors. These include placenta previa, previous cesarean section, use of assisted reproductive technologies, uterine surgeries, and advanced maternal age. With increased uterine conservation, previous retained placenta or placenta accreta have become significant risk factors. Understanding placenta accreta spectrum risk factors facilitates patient identification and safe delivery planning. Patients considering elective uterine procedures or delayed childbirth should consider the impact on peripartum morbidity.


Assuntos
Cesárea/estatística & dados numéricos , Idade Materna , Placenta Acreta/epidemiologia , Placenta Prévia/epidemiologia , Placenta Retida/epidemiologia , Técnicas de Reprodução Assistida/estatística & dados numéricos , Feminino , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Humanos , Incidência , Gravidez , Fatores de Risco , Útero/cirurgia
10.
Eur J Obstet Gynecol Reprod Biol ; 228: 180-185, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29980112

RESUMO

INTRODUCTION: Retained placenta (RP) is an obstetric complication of third stage of labour. We aimed to evaluate risk factors for RP and to propose a scoring system in order to predict this potentially fatal disorder. METHODS: This was a retrospective case-control study, comparing women with RP after vaginal delivery (≥ 24 weeks of gestation) and women with regular placental separation. Data were collected from January 2007 to October 2017, in two 2nd level University Hospitals. Eligibility was limited to singleton pregnancies in vertex presentation with no major foetal anomaly. A nomogram was developed to predict RP risk. RESULTS: Among 22,749 women who delivered vaginally, 138 (0.6%) had RP. RP was directly related with previous uterine curettage (OR = 1.92, 95% CI 1.04-3.54, p = 0.04) and labour induction with prostaglandins (OR = 4.29, 95% CI 1.83-10.02, p = 0.001), while vaginal spontaneous delivery (OR = 0.03, 95% CI 0.01-0.15, p = 0.0001) and higher Apgar score at 1 min (OR = 0.5, 95% CI 0.33-0.76, p = 0.001) were inversely related to RP. Our predictive model showed an overall diagnostic accuracy of 0.803. DISCUSSION: RP is associated with several maternal, pregnancy, foetal and placental risk factors. The development of a new scoring system, with a high predictive power, able to identify the risk of RP, could be a useful tool for physicians in order to promptly face this life-threatening condition.


Assuntos
Placenta Retida/epidemiologia , Adulto , Feminino , Humanos , Itália/epidemiologia , Modelos Logísticos , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
11.
Artigo em Inglês | MEDLINE | ID: mdl-29525517

RESUMO

OBJECTIVE: To investigate whether women who were surgically treated for retained products of conception (RPOC) by either suction curettage or hysteroscopy are at risk for recurrent RPOC on their subsequent pregnancies. STUDY DESIGN: Retrospective analysis of 442 women surgically treated for RPOC following delivery or abortion by suction curettage (N = 63, 14.3%) or hysteroscopy (N = 379, 85.7%). Information on subsequent pregnancies and their outcomes was available for 161 (36.4%) women. RESULTS: One or more live births were reported for 150 (93.2%) of the women for whom information on subsequent pregnancies was available. The overall rate of spontaneous abortions was 31/161 (19.3%). Recurrent RPOC were diagnosed in 25 (15.5%) cases, while third stage of labor placental problems (including retained placenta or cotyledons and placenta accreta) were found in 44 (27.3%) cases. Recurrent RPOC was associated with treatment by suction curettage compared with hysteroscopy for the initial RPOC on multivariate logistic regression analysis (Odds Ratio [OR] = 3.6, 95% Confidence Interval [CI]1.3-10.5, p = 0.01) and with the initial RPOC occurring after delivery compared with after abortion (OR = 8.4, 95%CI 1.8-39.5, p = 0.006). CONCLUSION: Women treated for RPOC are at risk for recurrent RPOC and for third stage of labor placental problems on their subsequent pregnancies, especially those who had been managed by suction curettage in comparison with operative hysteroscopy. Clinical and ultrasound follow-up in the early and late postpartum period should be considered in women with a history of RPOC.


Assuntos
Aborto Retido/epidemiologia , Histeroscopia/estatística & dados numéricos , Placenta Retida/epidemiologia , Curetagem a Vácuo/estatística & dados numéricos , Aborto Retido/cirurgia , Adulto , Feminino , Humanos , Israel/epidemiologia , Placenta Retida/cirurgia , Gravidez , Recidiva , Estudos Retrospectivos , Medição de Risco , Adulto Jovem
12.
Am J Perinatol ; 35(10): 931-935, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29528466

RESUMO

OBJECTIVE: The objective of this study was to determine the incidence of morbidly adherent placenta in pregnancies after endometrial ablation. STUDY DESIGN: We performed a retrospective cohort analysis using a large, multiinstitutional deidentified clinical database, IBM EPM: Explore (IBM Corporation, Somers, NY). We identified women who underwent endometrial ablation and had a subsequent delivery between 1999 and 2016. Patients with a delivery and no prior ablation were used as controls. The association between morbidly adherent placenta, ablation, and other known risk factors for morbidly adherent placenta was analyzed using multivariable logistic regression. RESULTS: Of 162,100 reproductive-aged women who underwent endometrial ablation, 2,770 women (1.71%) subsequently had a delivery. The rate of morbidly adherent placenta was 1 in 13.9 pregnancies after ablation compared with 1 in 838.7 pregnancies in the control group (adjusted odds ratio [aOR], 20.22, p < 0.0001). CONCLUSION: Pregnancies that occurred after endometrial ablation were associated with increased rates of morbidly adherent placenta.


Assuntos
Técnicas de Ablação Endometrial/efeitos adversos , Miométrio/patologia , Placenta Acreta/epidemiologia , Placenta Retida/epidemiologia , Placenta/patologia , Adolescente , Adulto , Cesárea/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Humanos , Incidência , Modelos Logísticos , Pessoa de Meia-Idade , Análise Multivariada , Ohio/epidemiologia , Placenta/fisiopatologia , Placenta Acreta/etiologia , Placenta Retida/etiologia , Complicações Pós-Operatórias/etiologia , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Fatores de Risco , Hemorragia Uterina/cirurgia , Adulto Jovem
13.
Pesqui. vet. bras ; 38(1): 1-5, Jan. 2018. tab
Artigo em Português | LILACS, VETINDEX | ID: biblio-895562

RESUMO

Objetivou-se avaliar os efeitos do tipo de parto (eutócico vs. distócico) e do período do ano (chuvoso vs. seco) sobre a prevalência de retenção de placenta (RP) e de endometrite subclínica (ES), verificar a relação entre as duas patologias, e os efeitos dessas sobre a taxa de descarte, o período de serviço (PS) e número de IA/concepção. A RP foi avaliada no primeiro dia pós-parto (DPP). A citologia endometrial foi realizada entre 30 e 80 DPP, considerando positivos casos contendo acima de 5% de neutrófilos. Os dados foram analisados por regressão logística e análise de variância no programa Minitab (P<0,05). A prevalência de RP foi de 14,93% (69/462) e de ES de 27,49% (127/462). Foi detectada tendência de efeito (P=0,10) da RP sobre a prevalência da ES. Partos distócicos aumentaram a prevalência de RP e vacas que pariram nos meses chuvosos tiveram maior prevalência de ES (P<0,05). A RP elevou a taxa de descarte (P<0,05), a duração do período de serviço (P<0,05) e o número de IA por concepção (P<0,05), enquanto a ES não afetou essas variáveis (P>0,05). Conclui-se que a retenção de placenta tende a ser um fator de risco para endometrite subclínica, distocia predispõe à retenção de placenta e partos ocorridos no período chuvoso aumentam os casos de endometrite subclínica. Há um impacto negativo na eficiência reprodutiva de vacas leiteiras mestiças acometidas por retenção de placenta.(AU)


This study aimed to evaluate the effects of type of calving (eutocic vs. dystocic), season of the year (rainy vs. dry) on retained placenta (RP) and subclinical endometritis (SE) prevalence, to verify the relation between these diseases, as well as its effects on culling rate, days open and number of AI/conception. Retention of fetal membranes was recorded on first day postpartum. Endometrial cytology was performed between 30 and 80 days in milk (DIM) and positive cases were considered ≥5% neutrophils. Data were analysed by logistic regression and analysis of variance on Minitab program (P<0.05). The prevalence of RP was 14.93% (69/462) and of SE was 27.49% (127/462). A tendency of effect of RP on SE prevalence was detected (P=0.10). Dystocia increased RP prevalence (P<0.05). Cows that calved during rainy months had greater SE prevalence (P<0.05). RP increased culling rate (P<0.05), calving to conception interval (P<0.05) and number of AI/conception (P<0.05), although SE occurrence did not affect these variables (P>0.05). In conclusion, RP tended to be a risk factor for SE, dystocia is a predisposing factor for RP and calvings that happens during rainy period increases SE. There is a negative impact on reproductive efficiency of crossbred dairy cows that had retained placenta.(AU)


Assuntos
Animais , Feminino , Bovinos , Endometrite/epidemiologia , Endometrite/veterinária , Placenta Retida/epidemiologia , Placenta Retida/veterinária , Estação Seca , Período Pós-Parto , Estação Chuvosa
14.
Eur J Obstet Gynecol Reprod Biol ; 216: 12-17, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28692888

RESUMO

OBJECTIVE: To determine risk factors for retained placenta, and to identify supporting epidemiologic evidence for the three previously-proposed mechanisms: (i) invasive placentation, (ii) placental hypo-perfusion, and (iii) inadequate uterine contractility. DESIGN: A retrospective population-based cohort study. SETTING AND POPULATION: Israeli population in the southern district. METHODS: Data were analyzed from a tertiary hospital database, between 1989 and 2014, using univariate tests and generalized estimating equation (GEE) multivariable models. MAIN OUTCOME MEASURES: Prevalence of retained placenta. RESULTS: The study population included 205,522 vaginal deliveries of which 4.8% (n=9870) were complicated with retained placenta. Previous intra-uterine procedures and placenta-related pregnancy complications were found to be significant risk factors for retained placenta (history of cesarean section aOR=8.82, 95%CI 8.35-9.31; history of curettage aOR=12.80, 95%CI 10.57-15.50; pre-eclampsia aOR=1.25, 95%CI 1.14-1.38; delivery of a small for gestational age neonate aOR=1.08, 95%CI 1.01-1.16; stillbirth aOR=2.34, 95%CI 1.98-2.77). During labour, the risk for retained placenta was increased in presence of arrest of dilatation (aOR=2.03, 95%CI 1.08-3.82) or arrest of descent (aOR=1.55, 95%CI 1.22-1.96). Infections of the uterine cavity during labour were also found to be strongly associated with increased risk of retained placenta (endometritis aOR=2.21, 95%CI 1.64-2.97; chorioamnionitis aOR=3.35, 95% CI 2.78-4.04). CONCLUSIONS: Supporting epidemiologic evidence were found for all three underlying mechanisms. In addition, there is evidence to suggest that intrauterine infection and inflammation may also be a possible pathology associated with retained placenta. TWEETABLE ABSTRACT: Risk factors for retained placenta support previously proposed mechanisms in a large cohort study.


Assuntos
Placenta Retida/etiologia , Insuficiência Placentária/fisiopatologia , Placentação/fisiologia , Contração Uterina/fisiologia , Adulto , Corioamnionite/epidemiologia , Corioamnionite/fisiopatologia , Estudos de Coortes , Feminino , Humanos , Placenta Retida/epidemiologia , Placenta Retida/fisiopatologia , Insuficiência Placentária/epidemiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
15.
Prev Vet Med ; 143: 1-10, 2017 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-28622786

RESUMO

Over the past 175 years, data related to human disease and death have progressed to a summary measure of population health, the Disability-Adjusted Life Year (DALY). As dairies have intensified there has been no equivalent measure of the impact of disease on the productive life and well-being of animals. The development of a disease-adjusted metric requires a consistent set of disability weights that reflect the relative severity of important diseases. The objective of this study was to use an international survey of dairy authorities to derive disability weights for primary disease categories recorded on dairies. National and international dairy health and management authorities were contacted through professional organizations, dairy industry publications and conferences, and industry contacts. Estimates of minimum, most likely, and maximum disability weights were derived for 12 common dairy cow diseases. Survey participants were asked to estimate the impact of each disease on overall health and milk production. Diseases were classified from 1 (minimal adverse effects) to 10 (death). The data was modelled using BetaPERT distributions to demonstrate the variation in these dynamic disease processes, and to identify the most likely aggregated disability weights for each disease classification. A single disability weight was assigned to each disease using the average of the combined medians for the minimum, most likely, and maximum severity scores. A total of 96 respondents provided estimates of disability weights. The final disability weight values resulted in the following order from least to most severe: retained placenta, diarrhea, ketosis, metritis, mastitis, milk fever, lame (hoof only), calving trauma, left displaced abomasum, pneumonia, musculoskeletal injury (leg, hip, back), and right displaced abomasum. The peaks of the probability density functions indicated that for certain disease states such as retained placenta there was a relatively narrow range of expected impact whereas other diseases elicited a wider breadth of impact. This was particularly apparent with respect to calving trauma, lameness and musculoskeletal injury, all of which could be redefined using gradients of severity or accounting for sequelae. These disability weight distributions serve as an initial step in the development of the disease-adjusted lactation (DALact) metric. They will be used to assess the time lost due to dynamic phases of dairy cow diseases and injuries. Prioritizing health interventions based on time expands the discussion of animal health to view profits and losses in light of the quality and length of life.


Assuntos
Doenças dos Bovinos/epidemiologia , Doenças dos Bovinos/patologia , Anos de Vida Ajustados por Qualidade de Vida , Abomaso/anormalidades , Abomaso/patologia , Animais , Bovinos , Indústria de Laticínios , Feminino , Cetose/epidemiologia , Cetose/veterinária , Mastite Bovina/epidemiologia , Placenta Retida/epidemiologia , Placenta Retida/veterinária , Gravidez
16.
J Dairy Sci ; 100(6): 4772-4783, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28434752

RESUMO

The objectives of the current experiment were to evaluate the effects of intrauterine infusion of Escherichia coli lipopolysaccharide (LPS) in cows diagnosed with purulent vaginal discharge (PVD) on intrauterine cell population, resolution of PVD, uterine health, and reproductive performance. Jersey cows (n = 3,084) were examined using the Metricheck device to diagnose PVD at 35 ± 6 d postpartum. Purulent vaginal discharge was defined as the presence of purulent (≥50% pus) discharge detectable in the vagina. Of the 310 cows positive for PVD, 267 cows were enrolled in the current experiment. To ensure proper timing of treatment and collection of samples, only 9 PVD-positive cows were treated per day. Selected cows were balanced at 35 ± 6 d postpartum for lactation number, body condition score, and milk yield and were randomly assigned to receive an intrauterine infusion of 20 mL of phosphate-buffered saline (PBS; control, n = 87), 20 mL of PBS with 150 µg LPS (LPS150, n = 91), or 20 mL of PBS with 300 µg of LPS (LPS300, n = 89). Uterine cytology was performed immediately before treatment and 1, 2, and 7 d after treatment to evaluate the effect of LPS treatment on intrauterine cell population. Cows were examined with the Metricheck device at 7 and 28 d after treatment to evaluate the effects of treatment on resolution of PVD. Reproductive status was recorded up to 200 d postpartum. Cows diagnosed with PVD had greater incidence of twinning, dystocia, retained placenta, and metritis after calving than cows without PVD. Count of polymorphonuclear leukocytes (PMNL) in uterine cytology 1, 2, and 7 d after intrauterine infusion was not statistically different among treatments. From d 0 to 1, however, PMNL count in uterine cytology of PBS cows increased by 5%, whereas the PMNL count in uterine cytology of LPS150 and LPS300 cows increased by 54 and 48%, respectively. Treatment did not affect the likelihood of cows being diagnosed with PVD 7 and 28 d after intrauterine infusion. Cows without PVD and LPS150 cows were more likely to be pregnant after the first postpartum AI than PBS cows. After the second postpartum AI, cows without PVD were more likely to be pregnant than PBS and LPS300 cows. Hazard of pregnancy up to 200 d postpartum was decreased for PBS and LPS300 cows compared with cows without PVD, and it tended to be decreased for LPS150 cows compared with cows without PVD. Intrauterine treatment with 150 µg of E. coli LPS of cows diagnosed with PVD improved likelihood of pregnancy after the first postpartum AI, but further research is needed to elucidate the mechanism by which LPS treatment improved fertility.


Assuntos
Doenças dos Bovinos/terapia , Escherichia coli , Lipopolissacarídeos/administração & dosagem , Reprodução/fisiologia , Descarga Vaginal/veterinária , Animais , Bovinos , Doenças dos Bovinos/diagnóstico , Doenças dos Bovinos/epidemiologia , Distocia/epidemiologia , Distocia/veterinária , Endometrite/epidemiologia , Endometrite/veterinária , Feminino , Lactação , Lipopolissacarídeos/farmacologia , Placenta Retida/epidemiologia , Placenta Retida/veterinária , Período Pós-Parto , Gravidez , Útero/efeitos dos fármacos , Útero/patologia , Descarga Vaginal/diagnóstico , Descarga Vaginal/terapia
17.
J Matern Fetal Neonatal Med ; 30(9): 1006-1009, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27265594

RESUMO

OBJECTIVE: To test the generalizability of previously reported increased risk of reoccurrence of retained placenta in yet another setting. METHODS: In this observational retrospective study we longitudinally followed women who had a vaginal delivery complicated by a partial or complete retained placenta at Edith Wolfson Medical Center between 1 January 2009 and 31 December 2012. The study group included parturient women who had a partial or complete retained placenta after a vaginal delivery (n = 90). The control group included parturient women who did not have a partial or complete retained placenta after a vaginal delivery from the same time period using the same inclusion criteria (n = 90). RESULTS: Retained partial or complete placenta at a previous delivery was found to be an independent risk factor for retained partial or complete placenta in a subsequent delivery (adjusted OR 9.8, 95%CI 1.2 to 80.6, p = 0.032) and for retained partial or complete placenta and/or postpartum hemorrhage in a subsequent delivery (adjusted OR 14.1, 95% CI 1.7 to 111.9, p = 0.012), after controlling for gestational age and induction of labor at previous delivery. CONCLUSION: Retained partial or complete placenta at an index delivery increases the risk of reoccurrence of retained partial or complete placenta in a subsequent delivery.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Placenta Retida/epidemiologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Estudos Longitudinais , Hemorragia Pós-Parto/epidemiologia , Gravidez , Análise de Regressão , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Adulto Jovem
18.
Eur J Obstet Gynecol Reprod Biol ; 207: 56-61, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27825028

RESUMO

BACKGROUND: The incidence of peripartum hysterectomy (PH) shows fifty-fold variation worldwide (0.2-10.5/1000 deliveries) and risk factors include advancing maternal age and parity, previous caesarean section (CS) and abnormal placentation. OBJECTIVES: In this first national study of PH in Ireland, our objectives were threefold: to describe the national trend in PH incidence over 15 years since 1999; to assess risk of PH associated with morbidly adherent placenta (MAP), placenta praevia and postpartum haemorrhage (PPH) during 2005-2013; and to describe the causes, interventions and outcomes of PH cases during 2011-2013. STUDY DESIGN: For the 15-year time-trend analysis, PH cases and denominator data were extracted from Ireland's Hospital In-Patient Enquiry database. Multivariate Poisson regression analysis assessed risk of PH associated with MAP, placenta praevia and PPH. In collaboration with the 20 Irish maternity units we carried out a three-year national clinical audit of severe maternity morbidity. PH was a notifiable morbidity and the audit included detailed review of MOH cases. RESULTS: In 1999-2013 there were 298 PH cases, a rate of 0.32/1000 deliveries. During the period 2005-2013, the PH rate was 50 times higher in deliveries involving PPH, 100 times higher with placenta praevia and 1000 times higher with MAP. During the clinical audit (2011-2013) there were 65 PH cases, a rate of 0.33/1000 deliveries, increasing with advancing age and parity. The reporting of abnormal placentation, primarily the co-occurrence of placenta praevia and MAP, was linked with previous CS. Fifty-six of the 65 cases suffered MOH, most commonly associated with placenta praevia, MAP and uterine atony. Prophylactic and therapeutic uterotonic agents were appropriately used in the majority of cases. CONCLUSIONS: The incidence of PH in Ireland has been consistently low over 15 years, averaging one case every 3000 deliveries. The recognised risk factors of MAP, placenta praevia and PPH were independently associated with PH, with MAP being by far the strongest predictor. The vast majority of PH cases in our clinical audit were associated with MOH. Some deficiencies were noted in antenatal care, in certain elements of treatment and clinical governance protocols but adherence to guidelines was generally high.


Assuntos
Histerectomia , Período Periparto , Placenta Prévia/cirurgia , Placenta Retida/cirurgia , Hemorragia Pós-Parto/prevenção & controle , Padrões de Prática Médica , Inércia Uterina/cirurgia , Cesárea , Auditoria Clínica , Registros Eletrônicos de Saúde , Feminino , Fidelidade a Diretrizes , Humanos , Histerectomia/tendências , Incidência , Irlanda/epidemiologia , Idade Materna , Unidade Hospitalar de Ginecologia e Obstetrícia , Paridade , Placenta Prévia/epidemiologia , Placenta Prévia/fisiopatologia , Placenta Retida/epidemiologia , Placenta Retida/fisiopatologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Hemorragia Pós-Parto/etiologia , Padrões de Prática Médica/tendências , Gravidez , Fatores de Risco , Índice de Gravidade de Doença , Inércia Uterina/epidemiologia , Inércia Uterina/fisiopatologia
19.
Comp Med ; 66(2): 143-9, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27053569

RESUMO

During 1999 through 2014, retained placenta was the most common cause of clinical admission for reproductive complications in breeding colonies of baboons (approximate colony size, 2000 animals), cynomolgus macaques (approximately 1000), and rhesus macaques (approximately 500) at the Southwest National Primate Research Center. Retained placentas occurred in 2.7% of baboons, 3.3% of cynomolgus macaques, and 1.0% of rhesus macaques. Apparent risk factors for retained placenta included stillbirth or abortion and at least one prior cesarean section. There was a significant association between stillbirth and retained placenta in all species. Cesarean sections were performed routinely for baboons to meet research objectives but occurred only as needed for cynomolgus and rhesus macaques. Having had at least one prior cesarean section was an incidence factor for retained placenta in 37.0% of baboons and 4.7% of cynomolgus macaques; none of the rhesus macaques with retained placentas had undergone cesarean section previously. More than 90% of dams with retained placenta returned to a successful reproductive life or assignment to a nonbreeding research protocol. Advances in reproductive management will benefit from prospective studies that capture additional data from all members of a breeding group prior to reproductive complications.


Assuntos
Macaca fascicularis , Macaca mulatta , Papio , Placenta Retida/veterinária , Doenças dos Primatas/epidemiologia , Aborto Induzido/veterinária , Animais , Cesárea/veterinária , Feminino , Incidência , Placenta Retida/epidemiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco , Natimorto/veterinária
20.
Cochrane Database Syst Rev ; (1): CD010845, 2016 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-26816300

RESUMO

BACKGROUND: Oxytocin and prostaglandin are hormones responsible for uterine contraction during the third stage of labour. Receptors in the uterine muscles are stimulated by exogenous or endogenous oxytocin leading to uterine contractions. Nipple stimulation or breastfeeding are stimuli that can lead to the secretion of oxytocin and consequent uterine contractions. Consequently, uterine contractions can reduce bleeding during the third stage of labour. OBJECTIVES: To investigate the effects of breastfeeding or nipple stimulation on postpartum haemorrhage (PPH) during the third stage of labour. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (15 July 2015) and reference lists of retrieved studies. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials comparing breast stimulation, breastfeeding or suckling for PPH in the third stage of labour were selected for this review. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion in terms of risk of bias and independently extracted data. Disagreements were resolved by a third review author. MAIN RESULTS: We included four trials (4608 women), but only two studies contributed data to the review's analyses (n = 4472). The studies contributing data were assessed as of high risk of bias overall. One of these studies was cluster-randomised and conducted in a low-income country and the other study was carried out in a high-income country. All four included studies assessed blood loss in the third stage of labour. Birth attendants estimated blood loss in two trials. The third trial assessed the hematocrit level on the second day postpartum to determine the effect of the bleeding. The fourth study measured PPH ≥ 500 mL. Nipple stimulation versus no treatmentOne study (4385 women) compared the effect of suckling versus no treatment. Blood loss was not measured in 114 women (59 in control group and 55 in suckling group). After excluding twin pregnancies, stillbirths and neonatal deaths, the main analyses for this trial were performed on 4227 vaginal deliveries. In terms of maternal death or severe morbidity, one maternal death occurred in the suckling group due to retained placenta (risk ratio (RR) 3.03, 95% confidence interval (CI) 0.12 to 74.26; one study, participants = 4227; very low quality evidence); severe morbidity was not mentioned. Severe PPH (≥ 1000 mL) was not reported in this study.The incidence of PPH (≥ 500 mL) was similar in the suckling and no treatment groups (RR 0.95, 95% CI 0.77 to 1.16; one study, participants = 4227; moderate quality). There were no group differences between nipple stimulation and no treatment regarding blood loss in the third stage of labour (mean difference (MD) 2.00, 95% CI -7.39 to 11.39; one study, participants = 4227; low quality). The rates of retained placenta were similar (RR 1.01, 95% CI 0.14 to 7.16; one study, participants = 4227; very low quality evidence), as were perinatal deaths (RR 1.06, 95% CI 0.57 to 1.98; one study, participants = 4271; low quality), and maternal readmission to hospital (RR 1.01, 95% CI 0.14 to 7.16; one study, participants = 4227; very low quality). We downgraded the evidence for this comparison for risk of bias concerns in the one included trial (inappropriate analyses for cluster design) and for imprecision (wide CIs crossing the line of no difference and, for some outcomes, few events).Many maternal secondary outcomes (including side effects) were not reported. Similarly, most neonatal secondary outcomes were not reported. Nipple stimulation versus oxytocinAnother study compared the effect of nipple stimulation (via a breast pump) with oxytocin. Eighty-seven women were recruited but only 85 women were analysed. Severe PPH ≥ 1000 mL and maternal death or severe morbidity were not reported.There was no clear effect of nipple stimulation on blood loss (MD 15.00, 95% CI -24.50 to 54.50; one study, participants = 85; low quality evidence), or on postnatal anaemia compared to the oxytocin group (MD -0.40, 95% CI -2.22 to 1.42; one study, participants = 85; low quality evidence). We downgraded evidence for this comparison due to risk of bias concerns in the one included trial (alternate allocation) and for imprecision (wide CIs crossing the line of no difference and small sample size).Many maternal secondary outcomes (including side effects) were not reported, and none of this review's neonatal secondary outcomes were reported. AUTHORS' CONCLUSIONS: None of the included studies reported one of this review's primary outcomes: severe PPH ≥ 1000 mL. Only one study reported on maternal death or severe morbidity. There were limited secondary outcome data for maternal outcomes and very few secondary outcome data for neonatal outcomes.There was no clear differences between nipple stimulation (suckling) versus no treatment in relation to maternal death, the incidence of PPH (≥ 500 mL), blood loss in the third stage of labour, retained placenta, perinatal deaths or maternal readmission to hospital. Whilst these data are based on a single study with a reasonable sample size, the quality of these data are mostly low or very low.There is insufficient evidence to evaluate the effect of nipple stimulation for reducing postpartum haemorrhage during the third stage of labour and more evidence from high-quality studies is needed. Further high-quality studies should recruit adequate sample sizes, assess the impact of nipple stimulation compared to uterotonic agents such as syntometrine and oxytocin, and report on important outcomes such as those listed in this review.


Assuntos
Aleitamento Materno , Terceira Fase do Trabalho de Parto , Mamilos/fisiologia , Ocitocina/metabolismo , Estimulação Física/métodos , Hemorragia Pós-Parto/prevenção & controle , Adulto , Feminino , Hematócrito , Humanos , Incidência , Placenta Retida/epidemiologia , Hemorragia Pós-Parto/epidemiologia , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
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