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1.
Medicine (Baltimore) ; 100(7): e24847, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607856

RESUMO

ABSTRACT: The objective of this study was to evaluate the risk factors, pathogenic bacteria and drug sensitivity of maternal sepsis, and provide evidence for clinical prevention and treatment.A retrospective investigation of pregnant women with full-term maternal sepsis was performed to analyze the risk factors, pathogenic bacteria, and drug sensitivity of maternal sepsis.Univariate analysis showed that temperature, serum procalcitonin (PCT) and C-reactive protein (CRP) at admission, white blood cell count (WBC), PCT, CRP and neutrophilic granulocyte percentage (N%) during fever, premature rupture of membranes (PROM), antibiotic use within 1 week, mode of production, onset and duration of fever, between groups were statistically significant (P < .05). Logistic regression analysis showed that cesarean section was an independent risk factor for sepsis (OR = 11.839, 95%CI: 3.121-44.906). Apparent increase was found in body temperature (OR = 3.664, 95%CI: 1.722-7.795), duration of fever (OR = 1.953, 95%CI: 1.242-3.071), and PCT (OR = 1.080, 95%CI: 1.002-1.163). Also, increasing neutrophil ratio (OR = 1.180, 95%CI: 1.073-1.297) indicated a high possibility of maternal sepsis. The organism Escherichia coli (E. coli) was the most common pathogenic bacteria in the positive blood culture group (90%), and the sensitivity to carbapenems (meropenem and imipenem/cilastatin) was 100%, that to piperacillin-tazobactam and amoxicillin sulbactam was over 90%, and that to ceftazidime was 95%.Cesarean section was an independent risk factor for maternal sepsis in term pregnant women with positive blood culture. Besides, the E. coli was the most common pathogenic bacteria in the positive blood culture group. Antibiotics should be used in time and reasonably when the temperature was significantly increased with elevated PCT and N% after a cesarean section.


Assuntos
Antibacterianos/uso terapêutico , Bactérias/patogenicidade , Hospitalização/estatística & dados numéricos , Complicações Infecciosas na Gravidez/microbiologia , Adulto , Antibacterianos/normas , Bactérias/efeitos dos fármacos , Hemocultura/métodos , Hemocultura/estatística & dados numéricos , Proteína C-Reativa/análise , Estudos de Casos e Controles , Cesárea/estatística & dados numéricos , China/epidemiologia , Escherichia coli/patogenicidade , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Febre , Humanos , Contagem de Leucócitos/métodos , Contagem de Leucócitos/estatística & dados numéricos , Testes de Sensibilidade Microbiana/métodos , Neutrófilos/citologia , Neutrófilos/patologia , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Gestantes , Pró-Calcitonina/sangue , Estudos Retrospectivos , Fatores de Risco
2.
Zhongguo Dang Dai Er Ke Za Zhi ; 23(1): 25-30, 2021 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-33476533

RESUMO

OBJECTIVE: To study the influence of premature rupture of membranes (PROM) on the early prognosis of extremely premature infants, and to provide a basis for the management of extremely premature infants and prenatal consultation. METHODS: A total of 179 extremely premature singleton infants who were born from 2017 to 2019 were enrolled. According to the presence or absence of PROM, they were divided into two groups: PROM group (n=69) and non-PROM group (n=110). A statistical analysis was performed for maternal data and early prognostic indicators. RESULTS: Compared with the non-PROM group, the PROM group had significantly higher incidence rates of earlyonset sepsis and necrotizing enterocolitis (NEC) (P < 0.05) and significantly lower rate of use of pulmonary surfactant and incidence rate of hemodynamically significant patent ductus arteriosus (P < 0.05). The multivariate logistic regression analysis showed that chorioamnionitis was an independent risk factor for early-onset sepsis and NEC (OR=11.062 and 9.437 respectively, P < 0.05), and PROM was an independent protective factor against the use of pulmonary surfactant (OR=0.363, P < 0.05). CONCLUSIONS: PROM increases the incidence rates of early-onset sepsis and NEC in extremely premature infants and does not increase the incidence rates of other adverse outcomes. For pregnant women with PROM at the risk of extremely preterm delivery, prevention of miscarriage and chorioamnionitis is recommended to prolong gestational weeks, reduce the incidence rate of infection, and thus improve the outcome of extremely premature infants.


Assuntos
Corioamnionite , Ruptura Prematura de Membranas Fetais , Enterocolite Necrosante/epidemiologia , Enterocolite Necrosante/etiologia , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Idade Gestacional , Humanos , Lactente , Lactente Extremamente Prematuro , Recém-Nascido , Gravidez , Prognóstico
3.
Artigo em Inglês | MEDLINE | ID: mdl-33466859

RESUMO

This study aims to evaluate the perinatal outcomes of preterm premature rupture of membrane (PPROM) with latency periods at 33 + 0-36 + 6 weeks of gestation. This retrospective case-control study included women with singleton pregnancies who delivered at 33 + 0-36 + 6 weeks at Korea University Ansan Hospital in South Korea between 2006-2019. The maternal and neonatal characteristics were compared between different latency periods (expectant delivery ≥72 h vs. immediate delivery <72 h). Data were compared among 345 women (expectant, n = 39; immediate delivery, n = 306). There was no significant difference in maternal and neonatal morbidities between the groups, despite the younger gestational age in the expectant delivery group. Stratified by gestational weeks, the 34-week infants showed a statistically significant lower exposure to antenatal steroids (73.4% vs. 20.0%, p < 0.001), while the incidence of respiratory distress syndrome (12.8%) and the use of any respiratory support (36.8%) was higher than those in the 33-week infants, without significance. Our study shows that a prolonged latency period (≥72 h) did not increase maternal and neonatal morbidities, and a considerable number of preterm infants immediately delivered at 34 weeks experienced respiratory complications. Expectant management and antenatal corticosteroids should be considered in late preterm infants with PPROM.


Assuntos
Ruptura Prematura de Membranas Fetais , Recém-Nascido Prematuro , Estudos de Casos e Controles , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Gravidez , Resultado da Gravidez/epidemiologia , República da Coreia/epidemiologia , Estudos Retrospectivos
4.
Medicine (Baltimore) ; 99(42): e22748, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080738

RESUMO

To compare clinical features and outcomes between early and late onset of neonatal bacterial meningitis (NBM).Patients were allocated in 2 groups: early onset neonatal bacterial meningitis (ENBM) and late onset neonatal bacterial meningitis (LNBM). Data analysis includes asphyxia at birth, premature rupture of membranes (PROM), amnionitis, amniotic fluid contamination, maternal age, clinical manifestations of the patients, laboratory findings, radiological results, complications related to meningitis, duration of hospitalization and therapeutic effect.There was no difference in gender, birth weight, gestational age, and incidence of asphyxia between 2 groups. The incidence of PROM, chorioamnionitis and amniotic fluid contamination, proportion of small-for-gestational-age infants, convulsions, intracranial hemorrhage, hyperbilirubinemia, and the protein level of cerebrospinal fluid in ENBM group were higher than that in LNBM group (P < .05); the proportion of fever, elevated C-reaction protein and the abnormal of platelet counts in LNBM group was higher than that in ENBM group (P < .05). There was no difference in the incidence of complications and hospitalization time between 2 groups. The rate of effective treatment in LNBM group was significantly higher than that in ENBM group (P < .05).Patients with conditions of amniotic fluid contamination, chorioamnionitis, small-for-gestational-age and PROM might be more prone to develop ENBM and ENBM had worse outcomes than LNBM.


Assuntos
Meningites Bacterianas/epidemiologia , Adulto , Líquido Amniótico , Proteína C-Reativa/análise , Proteínas do Líquido Cefalorraquidiano/análise , China/epidemiologia , Corioamnionite/epidemiologia , Diarreia/epidemiologia , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Mortalidade Hospitalar , Humanos , Hiperbilirrubinemia Neonatal/epidemiologia , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Hemorragias Intracranianas/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Meningites Bacterianas/microbiologia , Meningites Bacterianas/terapia , Contagem de Plaquetas , Gravidez , Complicações na Gravidez/epidemiologia , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Convulsões/epidemiologia , Nascimento a Termo
5.
Arch Gynecol Obstet ; 302(3): 553-567, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32643040

RESUMO

PURPOSE: To analyze the effect of Chlamydia trachomatis (C. trachomatis) on adverse pregnancy outcomes based on the currently available evidence. METHODS: Multiple databases were comprehensively searched from the available date of inception through December 9, 2019. The effect of C. trachomatis on adverse pregnancy outcomes was assessed using pooled odds rations (ORs) and 95% confidence intervals (CIs). Egger's test was used for publication bias. RESULTS: Fifty studies involving 502,141 participants were identified. C. trachomatis infection was found to be associated with preterm birth in antibody detection [OR (95% CI): 1.571 (1.112-2.220), P = 0.010] and high-quality assessment [OR (95% CI): 1.734 (1.295-2.321), P < 0.001], preterm premature rupture of membranes (PPROM) in culture detection [OR (95% CI): 4.339 (1.806-10.424), P = 0.001] and high-quality assessment [OR (95% CI): 2.822 (1.333-5.973), P = 0.007], stillbirth [OR (95% CI): 1.585 (1.219-2.062), P = 0.001], low-birthweight babies [OR (95% CI): 2.205 (1.137-4.274), P = 0.019], and babies small for gestational age [OR (95% CI): 1.193 (1.091-1.305), P < 0.001]. No publication bias was exhibited in miscarriage (P = 0.170), preterm birth (P = 0.303), PPROM (P = 0.341), stillbirth (P = 0.533), and low-birthweight babies (P = 0.535). CONCLUSIONS: C. trachomatis infection during pregnancy is associated with a higher risk of preterm birth, PPROM, stillbirth, low-birthweight babies, and babies small for gestational age.


Assuntos
Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis/isolamento & purificação , Ruptura Prematura de Membranas Fetais/epidemiologia , Trabalho de Parto Prematuro/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Aborto Espontâneo , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/microbiologia , Feminino , Ruptura Prematura de Membranas Fetais/microbiologia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/microbiologia , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Natimorto
6.
Medicine (Baltimore) ; 99(28): e21172, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664156

RESUMO

Preterm birth is the most important cause of neonatal mortality and morbidity worldwide. The aim of this study was to identify factors associated with preterm birth and examine the heterogeneity and interactions between these factors.We collected data from 1607 pregnant women treated at Nanjing Maternity and Child Health Care Hospital in China. The women included in the study were divided into the full-term group and the preterm-birth group. We used t-tests to compare the characteristics of age and body mass index, Chi-square tests for the other variables, and we used the Wald test to calculate the interaction between factors that may affect preterm birth. The heterogeneity test was used to study the relationship between subgroups. Multivariable logistic regression analysis was used to explore the associations between risk factors and preterm birth, which included all risk factors. All tests were 2-tailed, P < 0.05 was considered significant, and 95% confidence intervals were estimated for percentages.There was no statistical difference in basic characteristics such as age between the full-term and preterm groups. We found 6 independent risk factors that were associated with preterm birth (P < .05): preeclampsia (PE), intrahepatic cholestasis, premature rupture of the membranes (PROM), placenta previa, chorioamnionitis, and scarred uterus. Five combinations of these factors were statistically significant (P < .05) in terms of heterogeneity: PE and PROM; placenta previa and polyhydramnios; chorioamnionitis and PE; PROM and maternal body mass index; and PROM and gestational diabetes mellitus. Ultimately, the 2 subgroups that showed interactions were PE and PROM and chorioamnionitis and PE.The interaction between different factors over the course of preterm birth cannot be ignored. When independent risk factors are combined with other diseases, such as PE combined with PROM or chorioamnionitis in this study, it may more likely result in preterm birth. Thus, this situation deserves particular clinical attention.


Assuntos
Corioamnionite/epidemiologia , Diabetes Gestacional/epidemiologia , Ruptura Prematura de Membranas Fetais/epidemiologia , Placenta Prévia/epidemiologia , Nascimento Prematuro/etiologia , Adulto , China/epidemiologia , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Modelos Logísticos , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Fatores de Risco
7.
Arch Gynecol Obstet ; 302(4): 861-871, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32621250

RESUMO

PURPOSE: Preterm birth (PTB) can be categorised according to aetiology into: spontaneous preterm labour (SPL), preterm prelabour rupture of membranes (PPROM), and iatrogenic (iatro) PTB. Outcomes could differ between these groups, which could be of interest in counselling. We aimed to explore differences between aetiologic groups of PTB in maternal demographics, obstetrical characteristics and management, and neonatal outcomes. METHODS: This is a cohort study (2012-2018) in Ghent University Hospital, Belgium, of deliveries from 24 + 0 to 33 + 6 weeks. We compared perinatal demographics, management, and outcomes between the aetiologic types of PTB. Point and interval estimates for differences between aetiologic types were estimated using a Generalised Estimating Equations approach to handle clustering due to multiple gestations. RESULTS: 813 mothers and 987 neonates were included. Prevalences of different aetiologic types of PTB were similar. Maternal BMI was higher in the iatrogenic group (iatro-SPL: + 1.92 kg/m2, 95% CI 1.02, 2.83; iatro-PPROM: + 2.06 kg/m2, 95% CI 1.15, 2.96). There was an inversed sex ratio (0.82, 95% CI 0.65, 1.03), more growth restriction (iatro-SPL: + 22.60%, 95% CI 17.08, 28.13; iatro-PPROM: + 24.64%, 95% CI 19.44, 29.83), and a higher caesarean section rate in the iatrogenic group (iatro-SPL: + 57.23%, 95% CI 50.32, 64.13, iatro-PPROM: + 56.79%, 95% CI 50.20, 63.38) and more patients received at least one complete course of antenatal corticosteroids (iatro-SPL: + 17.60%, 95% CI 10.60, 24.60, iatro-PPROM: + 10.73%, 95% CI 4.52, 16.94). In all types of PTB, adverse neonatal outcomes had a low prevalence, except for respiratory distress syndrome. A composite of adverse neonatal outcome was more prevalent in the SPL- compared to the PPROM group, and there was less intraventricular haemorrhage in the iatrogenic group. CONCLUSION: Additional to gestational age at birth, the aetiology of PTB is associated with neonatal outcome. More data are needed to enable individualised management and counselling in case of threatened PTB. TRIAL REGISTRATION NUMBER: NCT03405116.


Assuntos
Ruptura Prematura de Membranas Fetais/epidemiologia , Trabalho de Parto Prematuro/epidemiologia , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/etiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Bélgica/epidemiologia , Cesárea , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Mães , Gravidez , Gravidez Múltipla , Nascimento Prematuro/epidemiologia , Prevalência
8.
Epidemiol Health ; 42: e2020025, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32422694

RESUMO

OBJECTIVES: The global prevalence of preterm labor is approximately 11.1% of live births. However, preterm labor contributes to 75-80% of neonatal morbidity and mortality. The morbidity experienced by preterm infants may continue to influence their subsequent development, imposing physical, psychological, and economic burdens. Premature rupture of membranes (PROM) is a causal factor that may affect preterm birth. Previous studies have shown an association between PROM and preterm labor, but this association should be investigated in more diverse populations. Therefore, this study was conducted in Cilegon, Indonesia to determine the magnitude of the risk of preterm labor associated with PROM at Cilegon Hospital from July 2014 to December 2015. METHODS: This case-control study used data from patients' medical records. The cases were all mothers who delivered at less than 37 weeks of gestation, while the control population comprised all mothers who delivered at greater or equal to 37 weeks. The data were analyzed using logistic regression. RESULTS: The bivariate analysis yielded an odds ratio (OR) of 2.97 (95% confidence interval [CI], 1.92 to 4.59) before controlling for covariates. The model derived through multiple regression analysis after controlling for education, history of preterm labor, and anemia resulted in an OR of 2.58 (95% CI, 1.68 to 3.98). CONCLUSIONS: Mothers who experience PROM during pregnancy were at a 2.58 times higher risk of preterm labor after controlling for education, history of preterm labor, and anemia.


Assuntos
Ruptura Prematura de Membranas Fetais/epidemiologia , Trabalho de Parto Prematuro/epidemiologia , Estudos de Casos e Controles , Feminino , Humanos , Indonésia/epidemiologia , Gravidez , Fatores de Risco
9.
Lancet Psychiatry ; 7(5): 399-410, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32220288

RESUMO

BACKGROUND: Prenatal and perinatal insults are implicated in the aetiopathogenesis of psychotic disorders but the consistency and magnitude of their associations with psychosis have not been updated for nearly two decades. The aim of this systematic review and meta-analysis was to provide a comprehensive and up-to-date synthesis of the evidence on the association between prenatal or perinatal risk and protective factors and psychotic disorders. METHODS: In this systematic review and meta-analysis, we searched the Web of Science database for articles published up to July 20, 2019. We identified cohort and case-control studies examining the association (odds ratio [OR]) between prenatal and perinatal factors and any International Classification of Diseases (ICD) or Diagnostic and Statistical Manual of Mental Disorders (DSM) non-organic psychotic disorder with a healthy comparison group. Other inclusion criteria were enough data available to do the analyses, and non-overlapping datasets. We excluded reviews, meta-analyses, abstracts or conference proceedings, and articles with overlapping datasets. Data were extracted according to EQUATOR and PRISMA guidelines. Extracted variables included first author, publication year, study type, sample size, type of psychotic diagnosis (non-affective psychoses or schizophrenia-spectrum disorders, affective psychoses) and diagnostic instrument (DSM or ICD and version), the risk or protective factor, and measure of association (primary outcome). We did random-effects pairwise meta-analyses, Q statistics, I2 index, sensitivity analyses, meta-regressions, and assessed study quality and publication bias. The study protocol was registered at PROSPERO, CRD42017079261. FINDINGS: 152 studies relating to 98 risk or protective factors were eligible for analysis. Significant risk factors were: maternal age younger than 20 years (OR 1·17) and 30-34 years (OR 1·05); paternal age younger than 20 years (OR 1·31) and older than 35 years (OR 1·28); any maternal (OR 4·60) or paternal (OR 2·73) psychopathology; maternal psychosis (OR 7·61) and affective disorder (OR 2·26); three or more pregnancies (OR 1·30); herpes simplex 2 (OR 1·35); maternal infections not otherwise specified (NOS; OR 1·27); suboptimal number of antenatal visits (OR 1·83); winter (OR 1·05) and winter to spring (OR 1·05) season of birth in the northern hemisphere; maternal stress NOS (OR 2·40); famine (OR 1·61); any famine or nutritional deficits in pregnancy (OR 1·40); maternal hypertension (OR 1·40); hypoxia (OR 1·63); ruptured (OR 1·86) and premature rupture (OR 2·29) of membranes; polyhydramnios (OR 3·05); definite obstetric complications NOS (OR 1·83); birthweights of less than 2000 g (OR 1·84), less than 2500 g (OR 1·53), or 2500-2999 g (OR 1·23); birth length less than 49 cm (OR 1·17); small for gestational age (OR 1·40); premature birth (OR 1·35), and congenital malformations (OR 2·35). Significant protective factors were maternal ages 20-24 years (OR 0·93) and 25-29 years (OR 0·92), nulliparity (OR 0·91), and birthweights 3500-3999 g (OR 0·90) or more than 4000 g (OR 0·86). The results were corrected for publication biases; sensitivity and meta-regression analyses confirmed the robustness of these findings for most factors. INTERPRETATION: Several prenatal and perinatal factors are associated with the later onset of psychosis. The updated knowledge emerging from this study could refine understanding of psychosis pathogenesis, enhance multivariable risk prediction, and inform preventive strategies. FUNDING: None.


Assuntos
Peso ao Nascer , Anormalidades Congênitas/epidemiologia , Complicações na Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Transtornos Psicóticos/epidemiologia , Adulto , Fome Epidêmica , Feminino , Macrossomia Fetal/epidemiologia , Ruptura Prematura de Membranas Fetais/epidemiologia , Herpes Simples/epidemiologia , Herpesvirus Humano 2 , Humanos , Hipertensão/epidemiologia , Hipóxia/epidemiologia , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Masculino , Desnutrição/epidemiologia , Idade Materna , Transtornos do Humor/epidemiologia , Paridade , Idade Paterna , Poli-Hidrâmnios/epidemiologia , Gravidez , Complicações na Gravidez/psicologia , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Fatores de Proteção , Fatores de Risco , Estações do Ano , Estresse Psicológico/epidemiologia , Adulto Jovem
10.
BJOG ; 127(9): 1090-1099, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32145044

RESUMO

OBJECTIVE: To investigate the association between a history of placental bed disorders and later dementia. DESIGN: Retrospective population-based cohort study. SETTING: Sweden. SAMPLE: All women giving birth in Sweden between 1973 and 1993 (1 128 709). METHODS: Women with and without placental bed disorders (hypertensive disorders of pregnancy including pre-eclampsia, fetal growth restriction, spontaneous preterm labour and birth, preterm premature rupture of membranes, abruptio placenta, late miscarriages) and other pregnancy complications were identified by means of the Swedish Medical Birth Register. International classification of disease was used. Data were linked to other National Registers. Participants were followed up until 2013. The Cox proportional hazards model was used to calculate hazard ratios for women with and without pregnancy complications and were adjusted for possible confounders. MAIN OUTCOME MEASURES: Diagnosis of vascular dementia and non-vascular dementia. RESULTS: Adjusted for cardiovascular disease and socio-demographic factors, an increased risk of vascular dementia was shown in women with previous pregnancy-induced hypertension (Hazard ratio [HR] 1.88, 95% CI 1.32-2.69), pre-eclampsia (HR 1.63, 95% CI 1.23-2.16), spontaneous preterm labour and birth (HR 1.65, 95% CI 1.12-2.42) or preterm premature rupture of membranes (HR 1.60, 95% CI 1.08-2.37). No statistically significant increased risk was seen for other pregnancy complications or non-vascular dementia even though many of the point estimates indicated increased risks. CONCLUSIONS: Women with placental bed disorders have a higher risk for vascular disease. Mechanisms behind the abnormal placentation remain elusive, although maternal constitutional factors, abnormal implantation as well as impaired angiogenesis have been suggested. TWEETABLE ABSTRACT: Placental bed syndromes associated with vascular dementia even after adjusting for cardiovascular disease.


Assuntos
Demência/epidemiologia , Complicações na Gravidez/epidemiologia , Aborto Espontâneo/epidemiologia , Feminino , Retardo do Crescimento Fetal/epidemiologia , Ruptura Prematura de Membranas Fetais/epidemiologia , Humanos , Placenta/irrigação sanguínea , Doenças Placentárias/epidemiologia , Pré-Eclâmpsia/epidemiologia , Gravidez , Nascimento Prematuro/epidemiologia , Modelos de Riscos Proporcionais , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Suécia/epidemiologia
11.
BMC Pregnancy Childbirth ; 20(1): 73, 2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-32013909

RESUMO

BACKGROUND: Gestational diabetes mellitus is a leading medical condition woman encounter during pregnancy with serious short- and long-term consequences for maternal morbidity. However, limited evidence was available on potential impacts of gestational diabetes mellitus using updated international diagnostic criteria on adverse maternal outcomes. Therefore, this study aimed to assess the effects of gestational diabetes mellitus on the risk of adverse maternal outcomes in Northwest Ethiopia. METHODS: A prospective cohort study was conducted among pregnant women followed from pregnancy to delivery. Gestational diabetes mellitus status was determined by using a two-hour 75 g oral glucose tolerance test and based on updated international diagnostic criteria. Multivariable log-binomial model was used to examine the effects of gestational diabetes mellitus on the risk of adverse maternal outcomes. RESULTS: A total of 694 women completed the follow-up and included in the analysis. Women with gestational diabetes mellitus had a higher risk of composite adverse maternal outcome (ARR=1.58, 95% CI: 1.22, 2.04), caesarean delivery (ARR=1.67; 95%: 1.15, 2.44), pregnancy induced hypertension (ARR= 3.32; 95%: 1.55, 7.11), premature rupture of membranes (ARR= 1.83; 95%: 1.02, 3.27), antepartum hemorrhage (ARR= 2.10; 95%: 1.11, 3.98) and postpartum hemorrhage (ARR= 4.85; 95%:2.28, 10.30) compared to women without gestational diabetes mellitus. CONCLUSIONS: Gestational diabetes mellitus increased the risk of adverse maternal outcomes. This implies that maternal care and intervention strategies relating to women with gestational diabetes mellitus should be strengthened.


Assuntos
Diabetes Gestacional/epidemiologia , Saúde Materna , Avaliação de Resultados em Cuidados de Saúde , Adulto , Cesárea , Etiópia/epidemiologia , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Gravidez , Estudos Prospectivos , Risco , Hemorragia Uterina/epidemiologia
12.
Am J Obstet Gynecol ; 223(2): 248.e1-248.e21, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32017922

RESUMO

BACKGROUND: There is controversy about whether the amniotic fluid contains bacteria. With the use of sequencing-based methods, recent studies report that the amniotic fluid is colonized by microorganisms. However, background-contaminating DNA might lead to false-positive findings when such a low microbial biomass sample is examined. OBJECTIVE: The purpose of this study was to determine whether the midtrimester amniotic fluid of patients who subsequently had normal pregnancy outcomes contains a microbial signature. STUDY DESIGN: In this prospective cohort study, 42 amniotic fluid samples were collected from 37 pregnancies (5 twin and 32 singletons) during genetic amniocentesis in the midtrimester. The subsequent pregnancy outcomes of all the participants were followed. Multiple methods were used to detect the presence of microorganisms in this study, which included cultivation, quantitative real-time polymerase chain reaction, and 16S ribosomal RNA gene sequencing. Multiple positive control samples (n=16) served as quality control samples and included 3 adult fecal samples, 4 vaginal swabs, and 9 artificial bacterial communities that were run in parallel with negative control samples (n=12) that included 4 samples from the hospital operating room and 8 samples from the laboratory, to account for background-contaminating DNA during each step of the experiments. RESULTS: No bacteria under anaerobic or aerobic conditions or genital mycoplasmas were cultured from any of the amniotic fluid samples. Quantitative polymerase chain reaction did not reveal greater copy numbers of 16S ribosomal RNA gene in amniotic fluid samples than in negative control samples. 16S Ribosomal RNA gene sequencing did not indicate a significant difference in the microbial richness or community structures between amniotic fluid and negative control samples. CONCLUSION: With multiple methods of microbiologic inquiry, no microorganisms were identified in the midtrimester amniotic fluid of healthy pregnancies with a normal pregnancy outcome.


Assuntos
Líquido Amniótico/microbiologia , Técnicas de Cultura/métodos , Segundo Trimestre da Gravidez , RNA Ribossômico 16S/análise , Reação em Cadeia da Polimerase em Tempo Real/métodos , Adulto , Amniocentese , Líquido Amniótico/imunologia , Corioamnionite/epidemiologia , Estudos de Coortes , Citocinas/análise , Citocinas/imunologia , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Humanos , Gravidez , Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Estudos Prospectivos
14.
BJOG ; 127(5): 537-547, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31912613

RESUMO

BACKGROUND: Physical, psychological and sexual intimate partner violence (IPV) has been described in the literature as different types of IPV experienced by women during pregnancy all over the world. OBJECTIVES: To review and summarise systematically the empirical evidence on the links between IPV during pregnancy and the perinatal health of mothers and fetuses/neonates. SEARCH STRATEGY: MEDLINE (Ovid), CINAHL, Embase, Nursing@ovid (Ovid) and LILACS were searched (2008-2018). SELECTION CRITERIA: Observational studies that examined perinatal health outcomes (i.e. pre-term birth, low birthweight, miscarriage, perinatal death and premature rupture of membranes) in pregnant women exposed to IPV. DATA COLLECTION AND ANALYSIS: Information on study characteristics, type of IPV measured, study design, methodological quality and outcome variable extracted. RESULTS: Fifty studies were included. Twenty-nine analysed undifferentiated IPV (n = 25 489), 34 included physical IPV (n = 7333), 22 analysed psychological IPV (n = 7833) and 18 examined sexual IPV (n = 2388). Fifteen studies were from Asia, 12 from North America and Oceania, and 12 from Central and South America. The studies examined the association between IPV and 39 different perinatal health outcomes. The most frequent outcomes reported were pre-term birth (50%), low birthweight (46%), miscarriage (30%), perinatal death (20%) and premature rupture of membranes (20%). A significant association with perinatal health outcomes was reported by 12 of the studies analysing undifferentiated IPV, 18 physical IPV, six psychological IPV and two sexual IPV. CONCLUSIONS: The relation between IPV and perinatal health outcomes can be seen in different epidemiological designs and countries. In all, 39 different outcomes were identified and 29 were associated with IPV. TWEETABLE ABSTRACT: A variety of poor perinatal health outcomes are associated with psychological, physical and sexual IPV.


Assuntos
Violência por Parceiro Íntimo , Gestantes , Aborto Espontâneo/epidemiologia , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Violência por Parceiro Íntimo/psicologia , Morte Perinatal , Gravidez , Gestantes/psicologia , Nascimento Prematuro/epidemiologia
15.
Sex Transm Infect ; 96(5): 322-329, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31836678

RESUMO

BACKGROUND: Genital chlamydia infection in women is often asymptomatic, but may result in adverse outcomes before and during pregnancy. The purpose of this study was to examine the strength of the relationships between chlamydia infection and different reproductive health outcomes and to assess the certainty of the evidence. METHODS: This review was registered and followed the Cochrane guidelines. We searched three databases to quantitatively examine adverse outcomes associated with chlamydia infection. We included pregnancy and fertility-related outcomes. We performed meta-analyses on different study designs for various adverse outcomes using unadjusted and adjusted analyses. RESULTS: We identified 4730 unique citations and included 107 studies reporting 12 pregnancy and fertility-related outcomes. Sixty-eight studies were conducted in high-income countries, 37 studies were conducted in low-income or middle-income countries, and 2 studies were conducted in both high-income and low-income countries. Chlamydia infection was positively associated with almost all of the 12 included pregnancy and fertility-related adverse outcomes in unadjusted analyses, including stillbirth (OR=5.05, 95% CI 2.95 to 8.65 for case-control studies and risk ratio=1.28, 95% CI 1.09 to 1.51 for cohort studies) and spontaneous abortion (OR=1.30, 95% CI 1.14 to 1.49 for case-control studies and risk ratio=1.47, 95% CI 1.16 to 1.85 for cohort studies). However, there were biases in the design and conduct of individual studies, affecting the certainty of the overall body of evidence. The risk of adverse outcomes associated with chlamydia is higher in low-income and middle-income countries compared with high-income countries. CONCLUSION: Chlamydia is associated with an increased risk of several pregnancy and fertility-related adverse outcomes in unadjusted analyses, especially in low-income and middle-income countries. Further research on how to prevent the sequelae of chlamydia in pregnant women is needed. TRIAL REGISTRATION NUMBER: CRD42017056818.


Assuntos
Infecções por Chlamydia/epidemiologia , Infertilidade Feminina/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Aborto Espontâneo/epidemiologia , Chlamydia trachomatis , Endometrite/epidemiologia , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Trabalho de Parto Prematuro/epidemiologia , Pré-Eclâmpsia/epidemiologia , Gravidez , Gravidez Ectópica/epidemiologia , Nascimento Prematuro/epidemiologia , Infecção Puerperal/epidemiologia , Infecções do Sistema Genital/epidemiologia , Natimorto/epidemiologia
16.
Rev Paul Pediatr ; 38: e2018136, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31778408

RESUMO

OBJECTIVE: To determine maternal and fetal risk factors associated with the birth of late preterm infants in comparison to those born at term. METHODS: A case-control study was carried out in a tertiary center for high-risk pregnancies. For the cases, the study enrolled post-partum mothers and their respective newborns with gestational ages equal or greater than 34 weeks and less than 37 weeks. As controls, the post-partum mothers and their newborns with gestational ages of 37 weeks or greater were selected. The sample was calculated with a ratio of two controls for each case, resulting in 423 patients. Association studies were performed using the chi-square test or Fisher's exact test and logistic regression analysis. RESULTS: The variables associated with late prematurity were inadequate prenatal (Odds Ratio [OR] 1.23; confidence interval of 95% [95%CI] 1.12-1.34; p≤0.001), premature rupture of membranes (OR 4.98; 95%CI 2.66-9.31; p≤0.001), length of hospital stay ≥24 hours until birth (OR 0.18; 95%CI 0.06-0.52; p≤0.001), cesarean section (OR 2.74; 95%CI 1.69-4.44; p≤0.001) and small for gestational age newborn (OR 3.02; 95%CI 1.80-5.05; p≤0.001). CONCLUSIONS: Inadequate prenatal care and membranes' premature rupture were found as factors associated with the late preterm birth. It is important to identify the factors that allow intervention with adequate prenatal care in order to reduce poor outcomes due to late prematurity.


Assuntos
Cesárea/estatística & dados numéricos , Ruptura Prematura de Membranas Fetais/epidemiologia , Doenças do Prematuro/epidemiologia , Nascimento Prematuro/epidemiologia , Cuidado Pré-Natal/métodos , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido Pequeno para a Idade Gestacional , Tempo de Internação/tendências , Gravidez , Gravidez de Alto Risco , Nascimento Prematuro/etiologia , Cuidado Pré-Natal/tendências , Fatores de Risco , Centros de Atenção Terciária , Adulto Jovem
17.
Am J Perinatol ; 37(7): 659-665, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31756763

RESUMO

OBJECTIVE: This article assesses the effect of weekly intramuscular 17α-hydroxyprogesterone caproate (17P) on midtrimester cervical length (CL) in patients with prior spontaneous preterm birth. STUDY DESIGN: Retrospective cohort study of all singletons that underwent CL screening at a single institution from 2011 to 2016. The timing of 17P exposure was assessed. The primary outcome was shortest midtrimester CL. Secondary outcomes included gestational age at delivery, rate of short cervix, cerclage, preterm labor admission, and preterm premature rupture of the membranes (PROM). Multivariable regression analysis was used to model the relationship between 17P exposure and shortest CL, controlling for selected covariates. RESULTS: Of 409 women who underwent screening, 211 received and 198 did not receive 17P prior to the last CL. Rates of short cervix and cerclage were similar between groups. After adjusting for covariates, the shortest CL was significantly shorter in the 17P group. In a secondary analysis, those who received any 17P (n = 293) versus those who did not (n = 116) had higher rates of preterm PROM, preterm labor admission, and cerclage. After controlling for covariates, gestational age at delivery was significantly lower in those receiving 17P. CONCLUSION: In high-risk patients undergoing CL screening for ultrasound-indicated cerclage, 17P did not prevent midtrimester cervical shortening or prolong gestation.


Assuntos
Caproato de 17 alfa-Hidroxiprogesterona/administração & dosagem , Colo do Útero/anatomia & histologia , Nascimento Prematuro/prevenção & controle , Progestinas/administração & dosagem , Adulto , Cerclagem Cervical , Medida do Comprimento Cervical , Colo do Útero/diagnóstico por imagem , Colo do Útero/efeitos dos fármacos , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Ruptura Prematura de Membranas Fetais/prevenção & controle , Idade Gestacional , Humanos , Recém-Nascido , Injeções Intramusculares , Gravidez , Segundo Trimestre da Gravidez , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Falha de Tratamento
18.
J Matern Fetal Neonatal Med ; 33(1): 16-23, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29852806

RESUMO

Objectives: To assess the periodontal condition as a factor associated with adverse perinatal outcomes, premature rupture of membranes (PRM), and preeclampsia in low-income pregnant women treated at public hospitals in Bogotá, Colombia.Methods: Pregnant women with preterm birth (PTB) and low birth weight (LBW) or both conditions (n = 107/428), or only PTB (n = 73/292) or LBW (n = 74/296) or with PRM (n = 98/392) or preeclampsia (n = 76/304) in a ratio of four controls for each case, coming from three hospitals of the public Northern Network of Bogotá, Colombia were studied. Sociodemographic, perinatal adverse outcome history, antenatal care, chronic infections, periodontal condition, threatened abortion, bleeding in the second half of pregnancy, oligohydramnios, diabetes, gestational diabetes, alcohol consumption, hypertension, smoking, alcohol during pregnancy were determined. Logistic regression was conducted to establish factors associated to perinatal adverse outcomes. Multiple correspondence analysis was conducted as secondary analysis.Results: Threatened abortion, absence of antenatal care, hypertension, chronic infections, and periodontal condition were the most important factors associated with perinatal adverse outcomes. The presence of periodontal pockets was associated with LBW OR 2.52 (IC95% 1.36-4.70), PTB OR 2.04 (IC95% 1.10-3.64), PTB-LBW or both OR 2.08 (IC95% 1.18-3.31), PRM OR 2.04 (IC95% 1.17-3.56). Periodontal pockets presence was not associated with preeclampsia. Multiple correspondence analyses showed high correlation between PRM with chronic infection and presence of periodontal pockets.Conclusions: Periodontal condition is a factor independent of other important risk factors for a perinatal adverse outcome and PRM. Prevention of periodontal disease should be included in preconception and prenatal care programs.


Assuntos
Ruptura Prematura de Membranas Fetais/epidemiologia , Doenças Periodontais/epidemiologia , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Estudos de Casos e Controles , Colômbia/epidemiologia , Feminino , Ruptura Prematura de Membranas Fetais/etiologia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças Periodontais/complicações , Pobreza/estatística & dados numéricos , Gravidez , Nascimento Prematuro/etiologia , Cuidado Pré-Natal/estatística & dados numéricos , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
19.
Trop Doct ; 50(1): 8-11, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31726941

RESUMO

Premature rupture of membranes (PROM) is a common problem with controversies in its management. The aim of our study was to find out the prevalence of neonatal complications and their correlation with the latent period in babies born to mothers with PROM at 34-40 weeks of gestation. This prospective cohort study was performed on 200 pregnant women with PROM at or near term. After birth, neonates were screened for sepsis. Other outcome measures included birth asphyxia, stay in the Neonatal Intensive Care Unit (NICU) and neonatal mortality. These were correlated against time spent from PROM. Duration after which risk of neonatal sepsis increased immensely was calculated by ROC. The prevalence of specific neonatal complications was as follows: birth asphyxia (8%); neonatal sepsis (4%); NICU admission (26%); and neonatal mortality (2%). Complications increased with an increasing latent period. Beyond 37 h of latency, the rate of neonatal sepsis increases dramatically. In conclusion, pregnancies with PROM at and near term should not be managed expectantly. All neonates born after 37 h of latent PROM should be stringently evaluated for sepsis.


Assuntos
Ruptura Prematura de Membranas Fetais/epidemiologia , Doenças do Recém-Nascido/epidemiologia , Adulto , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Estudos Prospectivos , Fatores de Tempo
20.
Gynecol Obstet Fertil Senol ; 48(1): 19-23, 2020 01.
Artigo em Francês | MEDLINE | ID: mdl-31669526

RESUMO

OBJECTIVE: To synthesize current knowledge on definition, frequency, morbidity and risk factors related to term prelabor rupture of membranes. METHODS: The MedLine database, the Cochrane Library and French and foreign guidelines from 1980 to 2019 have been consulted. RESULTS: Term rupture of membranes is defined by the rupture of the membranes after 37 weeks of gestation (WG). Term prelabor rupture of membranes is defined by the rupture of membranes prior to the onset of labor after 37 WG. According to unpublished data from the 2016 French National Perinatal Survey, 26,5% of women with singleton pregnancies had a term rupture of membranes before their admission into labor ward. We were not able to assess if those were "prelabor" or not (LE3). Among women admitted with term rupture of membranes, 35,6% were still not in labor 12hours after the rupture i.e. 8,9% of all singleton pregnancies (LE3). Reported rates of term prelabor rupture of membranes vary between 6 and 22% in singleton pregnancies (LE3). Term prelabor rupture of membranes is associated with a risk of fever before (LE3), during (LE3) and after labor (LE3), as well as intrauterine and neonatal infection (LE3). The frequency of these complications in the context of a routine antibiotic prophylaxis is unknown. The expert group chose a delay of 12hours without spontaneous labor to differentiate a physiological situation from a potentially risky situation that could justify a medical intervention (Professional consensus). Risk factors for term prelabor rupture of membranes include history of term prelabor rupture of membranes (LE3), nulliparity (LE3), uterine contractions requiring treatment (LE3) and first trimester bleeding (LE3). CONCLUSION: Data on frequency, risk factors and morbidity of term prelabor rupture of membranes are limited or of poor quality.


Assuntos
Ruptura Prematura de Membranas Fetais/diagnóstico , Ruptura Prematura de Membranas Fetais/epidemiologia , Antibioticoprofilaxia , Feminino , Ruptura Prematura de Membranas Fetais/terapia , Febre , França , Idade Gestacional , Humanos , Infecções , Trabalho de Parto , MEDLINE , Gravidez , Fatores de Risco
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