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1.
Adv Exp Med Biol ; 1252: 107-114, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816269

RESUMO

Non-obstetric surgery is needed in 0.75-2% of pregnant women, and safety of anesthesia for mother and child are key points at this time. Some breast diseases need to be approached in a short time interval, and surgery must be performed during pregnancy . In these cases, the technique of anesthesia regarding local, regional or general anesthesia and type of anesthetic medicine are selected based on the extent of the procedure, gestational age, and condition of the mother and child. The ideal timing for any surgery during pregnancy is in the second trimester because the risk of fetal adverse effects as well as preterm labor are lower. However, surgery of breast cancer during pregnancy is performed in any trimester as guided by treatment guidelines and is not deferred based on anesthesia preferences. Various types of anesthesia for breast surgery during pregnancy , preoperative and postoperative considerations are discussed in this chapter.


Assuntos
Anestesia/efeitos adversos , Anestesia/métodos , Anestésicos , Mama/cirurgia , Complicações na Gravidez , Neoplasias da Mama/cirurgia , Feminino , Feto/efeitos dos fármacos , Humanos , Trabalho de Parto Prematuro/induzido quimicamente , Trabalho de Parto Prematuro/etiologia , Trabalho de Parto Prematuro/prevenção & controle , Gravidez , Complicações na Gravidez/induzido quimicamente , Complicações na Gravidez/etiologia , Complicações na Gravidez/prevenção & controle
2.
Restor Neurol Neurosci ; 38(4): 343-354, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32597823

RESUMO

Covid-19 is the acute illness caused by SARS-CoV-2 with initial clinical symptoms such as cough, fever, malaise, headache, and anosmia. After entry into cells, corona viruses (CoV) activate aryl hydrocarbon receptors (AhRs) by an indoleamine 2,3-dioxygenase (IDO1)-independent mechanism, bypassing the IDO1-kynurenine-AhR pathway. The IDO1-kynurenine-AhR signaling pathway is used by multiple viral, microbial and parasitic pathogens to activate AhRs and to establish infections. AhRs enhance their own activity through an IDO1-AhR-IDO1 positive feedback loop prolonging activation induced by pathogens. Direct activation of AhRs by CoV induces immediate and simultaneous up-regulation of diverse AhR-dependent downstream effectors, and this, in turn, results in a "Systemic AhR Activation Syndrome" (SAAS) consisting of inflammation, thromboembolism, and fibrosis, culminating in multiple organ injuries, and death. Activation of AhRs by CoV may lead to diverse sets of phenotypic disease pictures depending on time after infection, overall state of health, hormonal balance, age, gender, comorbidities, but also diet and environmental factors modulating AhRs. We hypothesize that elimination of factors known to up-regulate AhRs, or implementation of measures known to down-regulate AhRs, should decrease severity of infection. Although therapies selectively down-regulating both AhR and IDO1 are currently lacking, medications in clinical use such as dexamethasone may down-regulate both AhR and IDO1 genes, as calcitriol/vitamin D3 may down-regulate the AhR gene, and tocopherol/vitamin E may down-regulate the IDO1 gene. Supplementation of calcitriol should therefore be subjected to epidemiological studies and tested in prospective trials for prevention of CoV infections, as should tocopherol, whereas dexamethasone could be tried in interventional trials. Because lack of physical exercise activates AhRs via the IDO1-kynurenine-AhR signaling pathway increasing risk of infection, physical exercise should be encouraged during quarantines and stay-at-home orders during pandemic outbreaks. Understanding which factors affect gene expression of both AhR and IDO1 may help in designing therapies to prevent and treat humans suffering from Covid-19.


Assuntos
Betacoronavirus/fisiologia , Infecções por Coronavirus/fisiopatologia , Indolamina-Pirrol 2,3,-Dioxigenase/fisiologia , Pandemias , Pneumonia Viral/fisiopatologia , Receptores de Hidrocarboneto Arílico/fisiologia , Poluentes Atmosféricos/efeitos adversos , Calcitriol/uso terapêutico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Dexametasona/uso terapêutico , Exercício Físico , Retroalimentação Fisiológica , Feminino , Fibrose/etiologia , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Indolamina-Pirrol 2,3,-Dioxigenase/biossíntese , Indolamina-Pirrol 2,3,-Dioxigenase/genética , Inflamação/etiologia , Cinurenina/fisiologia , Masculino , Terapia de Alvo Molecular , Insuficiência de Múltiplos Órgãos/etiologia , Trabalho de Parto Prematuro/etiologia , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Gravidez , Complicações Infecciosas na Gravidez/fisiopatologia , Receptores de Hidrocarboneto Arílico/biossíntese , Receptores de Hidrocarboneto Arílico/genética , Transtornos das Sensações/etiologia , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/fisiologia , Tromboembolia/etiologia , Tocoferóis/uso terapêutico
3.
Infez Med ; 28(suppl 1): 46-51, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32532938

RESUMO

BACKGROUND: Since December 2019, coronavirus disease 2019 (COVID-19) has become a major health problem that is spreading all over the world. Several viral infections such as SARS, MERS, and influenza have been associated with adverse pregnancy outcomes. The question arises whether pregnant women are at greater risk of complications related to COVID-19 compared to other people What complications should we expect in the fetuses whose mothers were infected? AIMS: This review aims to provide a summary of studies on symptoms of COVID-19 and the possible risks of COVID-19 among pregnant women, as well as complications in fetuses and neonates whose mothers were infected with COVID-19. METHODS: The included data were provided from Web of Science, Cochrane, PubMed, and Scopus which are extracted from the published studies in English until April 2nd, 2020 that contained data on the risk of COVID-19 in pregnancy. RESULTS: The early symptoms of patients with COVID-19 were fever, cough, dyspnea, myalgia, and fatigue; while production of sputum, headache, hemoptysis, and diarrhea were other symptoms which were less common. There is no evidence of vertical maternal-fetal transmission in pregnant women with COVID-19. CONCLUSIONS: The clinical findings in pregnant women with COVID-19 are not significantly different compared to other patients, and pregnant women with COVID-19 are not at a higher risk of developing critical pneumonia compared to non-pregnant women. Although, there has been no sign of vertical infection in infants, but maternal infection can cause serious problems such as preterm labour and fetal distress.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , Proteína C-Reativa/análise , Infecções por Coronavirus/complicações , Infecções por Coronavirus/transmissão , Tosse/etiologia , Feminino , Sofrimento Fetal/etiologia , Febre/etiologia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido Pequeno para a Idade Gestacional , Transmissão Vertical de Doença Infecciosa , Linfopenia/etiologia , Trabalho de Parto Prematuro/etiologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/transmissão , Gravidez , Complicações na Gravidez/etiologia , Resultado da Gravidez , Síndrome Respiratória Aguda Grave/epidemiologia , Avaliação de Sintomas , Adulto Jovem
4.
Acta Obstet Gynecol Scand ; 99(5): 651-659, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32128786

RESUMO

INTRODUCTION: Previous induced abortions have been associated with adverse birth outcomes. However, only a few studies have considered the possible influence of gestational age at induced abortion. Therefore, this study aimed to identify the impacts of gestational age during prior induced abortion(s) on subsequent births among first-time mothers in Finland. MATERIAL AND METHODS: First-time mothers (n = 418 690) with singleton births between 1996 and 2013 were identified from the Finnish Medical Birth Register and linked to the Abortion Register. Logistic regression analysis was used to estimate the risk (odds ratio [OR] and 95% confidence interval [CI]) of birth outcomes such as prematurity, low birthweight, perinatal death and small for gestational age (SGA). RESULTS: Higher risk was determined for extremely preterm birth (OR 2.28; 95% CI 1.53-3.39) and very low birthweight (OR 1.62; 95% CI 1.22-2.16) in women having had late-induced abortion(s) (≥12 gestational weeks) compared with women having had early-induced abortion(s) (<12 gestational weeks); after adjusting for women's background characteristics, abortion method and interval between the pregnancies. When the analysis was limited to a single abortion, an increased risk was found for extremely preterm birth (OR 1.71; 95% CI 1.02-2.81). Higher risks were found for extremely preterm (OR 4.09; 95% CI 2.05-8.18) and very low birthweight (OR 2.65; 95% CI 1.61-4.35) among women with two or more late-induced abortions compared with those with two or more early-induced abortions. Worse outcomes were seen after a late-induced abortion compared to an early-induced abortion for both medically and surgically induced abortion. CONCLUSIONS: The risk of subsequent adverse birth outcomes is very small if any, but the risk is higher with increasing gestational age at the time of induced abortion. Our study supports reduction of unintended pregnancy and offering abortion services without delay and as early in gestation as possible.


Assuntos
Aborto Induzido/efeitos adversos , Idade Gestacional , Trabalho de Parto Prematuro/etiologia , Resultado da Gravidez/epidemiologia , Aborto Induzido/estatística & dados numéricos , Adulto , Estudos de Coortes , Feminino , Finlândia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido Pequeno para a Idade Gestacional , Morte Perinatal/etiologia , Gravidez , Nascimento Prematuro/etiologia , Sistema de Registros , Fatores de Risco , Adulto Jovem
5.
Artigo em Inglês | MEDLINE | ID: mdl-31936225

RESUMO

Endometriosis may compromise the physiological course of pregnancy. The aim of this prospective observational study was to evaluate whether endometriosis causes a higher prevalence of obstetric and neonatal complications as well as a higher risk of caesarean section and to detect a possible correlation between the presence, type, and location of endometriosis and obstetric complications, previous surgery, and pregnancy outcome, as well as the influence of pregnancy on the course of the disease. We compared two cohorts of women with spontaneous pregnancy, with and without endometriosis. Obstetric and neonatal outcomes, mode of delivery, presence, type, and location of endometriotic lesions and the effect of pregnancy on the disease were analyzed. A total of 425 pregnancies were evaluated: 145 cases and 280 controls. Patients with endometriosis showed a higher incidence of miscarriage, threatened miscarriage, threatened preterm labor, preterm delivery, placental abruption, and a higher incidence of caesarean section. A significant correlation with pregnancy-induced hypertension and preeclampsia was found in the presence of adenomyosis. No difference in fetal outcome was found. One case of hemoperitoneum during pregnancy was observed. Pregnancy in women with endometriosis carries a higher risk of obstetric complications, such as miscarriage, threatened miscarriage, preterm labor, preterm birth, and a higher caesarean section rate. Endometriosis does not seem to influence fetal well-being.


Assuntos
Endometriose/complicações , Complicações na Gravidez/etiologia , Aborto Espontâneo/etiologia , Descolamento Prematuro da Placenta/etiologia , Adulto , Cesárea/estatística & dados numéricos , Feminino , Humanos , Hipertensão Induzida pela Gravidez/etiologia , Recém-Nascido , Trabalho de Parto Prematuro/etiologia , Gravidez , Resultado da Gravidez , Nascimento Prematuro/etiologia , Estudos Prospectivos
6.
JSLS ; 23(3)2019.
Artigo em Inglês | MEDLINE | ID: mdl-31427852

RESUMO

Background: Laparoscopic surgery is safe in pregnancy, but is not without risk. Inadvertent uterine perforation of the gravid uterus is a rare complication. Cases: Three pregnant women had inadvertent uterine perforation during laparoscopic surgery. All patients were counseled regarding the risks of an "incidental fetoscopy" and elected to continue the pregnancy. Two delivered after preterm premature rupture of membranes at 32 and 36 weeks' gestation, and one twin pregnancy delivered at 30 weeks due to preeclampsia. Conclusion: Surgical planning of the gravid patient undergoing laparoscopic surgery should include demarcation of the most superior aspect of the uterine fundus, either via physical examination or, if not conclusive, via preoperative or intraoperative ultrasound.


Assuntos
Apendicectomia/efeitos adversos , Colecistectomia Laparoscópica/efeitos adversos , Complicações Intraoperatórias/etiologia , Laparoscopia/efeitos adversos , Complicações na Gravidez/etiologia , Perfuração Uterina/etiologia , Útero/lesões , Adulto , Apendicite/cirurgia , Cesárea , Feminino , Ruptura Prematura de Membranas Fetais/etiologia , Humanos , Recém-Nascido , Complicações Intraoperatórias/cirurgia , Trabalho de Parto Prematuro/etiologia , Pré-Eclâmpsia/etiologia , Gravidez , Complicações na Gravidez/cirurgia , Resultado da Gravidez , Gravidez Múltipla , Perfuração Uterina/cirurgia
7.
PLoS One ; 14(8): e0219351, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31408465

RESUMO

BACKGROUND: Pelvic inflammatory disease (PID) is an infectious disease that causes tubal occlusion and other pelvic and abdominal adhesions. The incidence of pelvic inflammatory disease (PID) has increased due to the sexually active status of the young population. This leads to a more serious problem and a larger effect than previously observed. However, there have been few studies on this topic in Asian populations. AIM: We aimed to evaluate the risk of preterm labor and/or ectopic pregnancy in Taiwanese women following PID. DESIGN: Using the Taiwan National Health Insurance Database, we designed a retrospective cohort study that included 12- to 55-year-old pregnant women between 2000 and 2010. We selected a 1:3 age-matched control group of non-PID women. The endpoint was any episode of preterm labor or ectopic pregnancy; otherwise, the patients were tracked until 31 December 2010. METHODS: The risk factors for preterm labor or ectopic pregnancy were explored. For cases included from the index date until the end of 2010, we analyzed the risk of incident preterm labor or ectopic pregnancy. With the use of a multivariate Cox proportional hazard regression analysis, we calculated the hazard ratio (HR) with a 95% CI and compared it with that of the control group. RESULTS: This study examined 30,450 patients with PID and 91,350 controls. During the follow-up period, patients in the PID group were more likely to develop preterm labor or ectopic pregnancy than patients in the control group. The cumulative incidence rates for developing preterm labor were 1.84% (561/30,450 individuals) in patients with PID and 1.63% (1492/91,350 individuals) in patients without PID. On the other hand, the cumulative incidence rate for developing ectopic pregnancy in patients with PID was 0.05% (14/30,450 individuals) but was only 0.04% (33/91,350 individuals) in patients without PID. Compared with those without PID, the patients with PID had a 1.864 times (P<0.001) higher risk of developing preterm labor and a 2.121 times (P = 0.003) higher risk of developing ectopic pregnancy. CONCLUSION: Our study provided evidence of an increased risk of preterm labor or ectopic pregnancy in PID patients.


Assuntos
Trabalho de Parto Prematuro/etiologia , Doença Inflamatória Pélvica/complicações , Gravidez Ectópica/etiologia , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Trabalho de Parto Prematuro/epidemiologia , Gravidez , Gravidez Ectópica/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
8.
J Assist Reprod Genet ; 36(9): 1917-1926, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31359234

RESUMO

PURPOSE: Assess the risk of ischemic placental disease (IPD) among in vitro fertilization (IVF; donor and autologous) pregnancies compared with non-IVF pregnancies. METHODS: This was a retrospective cohort study of deliveries from 2000 to 2015 at a tertiary hospital. The exposures, donor, and autologous IVF, were compared with non-IVF pregnancies and donor IVF pregnancies were also compared with autologous IVF pregnancies. The outcome was IPD (preeclampsia, placental abruption, small for gestational age (SGA), or intrauterine fetal demise due to placental insufficiency). We defined SGA as birthweight < 10th percentiles for gestational age and sex. A secondary analysis restricted SGA to < 3rd percentile. RESULTS: Of 69,084 deliveries in this cohort, 262 resulted from donor IVF and 3,501 from autologous IVF. Compared with non-IVF pregnancies, IPD was more common among donor IVF pregnancies (risk ratio (RR) = 2.9; 95% CI 2.5-3.4) and autologous IVF pregnancies (RR = 2.0; 95% CI 1.9-2.1), adjusted for age and parity. IVF pregnancies were more likely to be complicated by preeclampsia (donor RR = 3.8; 95% CI 2.8-5.0 and autologous RR = 2.2; 95% CI 2.0-2.5, adjusted for age, parity, and marital status), placental abruption (donor RR = 3.8; 95% CI 2.1-6.7 and autologous RR = 2.5; 95% CI 2.1-3.1, adjusted for age), and SGA (donor RR = 2.7; 95% CI 2.1-3.4 and autologous RR = 2.0; 95% CI 1.9-2.2, adjusted for age and parity). Results were similar when restricting SGA to < 3rd percentile. CONCLUSION: Pregnancies conceived using donor IVF and autologous IVF were at higher risk of IPD and its associated conditions than non-IVF pregnancies and associations were consistently stronger for donor IVF pregnancies.


Assuntos
Fertilização In Vitro/efeitos adversos , Isquemia/etiologia , Doação de Oócitos/efeitos adversos , Doenças Placentárias/etiologia , Placenta/irrigação sanguínea , Adulto , Estudos de Coortes , Feminino , Fertilização In Vitro/métodos , Fertilização In Vitro/estatística & dados numéricos , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Masculino , Pessoa de Meia-Idade , Trabalho de Parto Prematuro/etiologia , Doação de Oócitos/estatística & dados numéricos , Doenças Placentárias/epidemiologia , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/etiologia , Gravidez , Resultado da Gravidez , Estudos Retrospectivos
9.
J Perinat Med ; 47(6): 637-642, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31287800

RESUMO

Background Sjögren's syndrome (SS) is an autoimmune connective tissue disease affecting the body's moisture-producing glands. Some studies have linked SS to adverse maternal/neonatal outcomes, but sample sizes have tended to be small, with few outcomes examined. The purpose of this study was to evaluate the effect of SS on pregnancy outcomes for mother and neonate using a large dataset. Methods We carried out a retrospective cohort study of women who delivered between 1999 and 2014 using data from the Nationwide Inpatient Sample from the United States. SS categorization is based on ICD-9 coding. Baseline characteristics were compared in both groups and multivariate logistic regression was used to compare maternal and fetal outcomes of pregnancies in women with and without SS. Results The prevalence of SS in our population was 1.34 cases/10,000 births, with the rate increasing over the study period. Women with SS tended to be older, Caucasian and to have pre-existing comorbidities. Births to women with SS were at greater risk of pre-eclampsia [odds ratio (OR) 1.63, 95% confidence interval (CI) 1.34-1.99]; premature rupture of membranes (OR 1.28, 95% CI 1.04-1.57); preterm delivery (OR 1.56, 95% CI 1.34-1.81); cesarean delivery (OR 1.29, 95% CI 1.17-1.41); and venous thromboembolic events (OR 3.71, 95% CI 2.57-5.35). Infants of women with SS were more likely to have intrauterine growth restriction (IUGR) (OR 3.00, 95% CI 2.46-3.65); and congenital malformations (OR 3.26, 95% CI 2.30-4.62). Conclusion SS is a high-risk pregnancy condition associated with significant comorbidities and adverse maternal and fetal outcomes. Women with SS may benefit from increased surveillance during their pregnancies.


Assuntos
Complicações na Gravidez , Síndrome de Sjogren , Adulto , Cesárea/estatística & dados numéricos , Anormalidades Congênitas/epidemiologia , Anormalidades Congênitas/etiologia , Feminino , Retardo do Crescimento Fetal/epidemiologia , Retardo do Crescimento Fetal/etiologia , Ruptura Prematura de Membranas Fetais/epidemiologia , Ruptura Prematura de Membranas Fetais/etiologia , Humanos , Recém-Nascido , Classificação Internacional de Doenças , Trabalho de Parto Prematuro/epidemiologia , Trabalho de Parto Prematuro/etiologia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Gravidez de Alto Risco , Prevalência , Estudos Retrospectivos , Medição de Risco , Síndrome de Sjogren/complicações , Síndrome de Sjogren/diagnóstico , Síndrome de Sjogren/epidemiologia
10.
J Obstet Gynaecol Res ; 45(8): 1466-1471, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31099123

RESUMO

AIM: Prenatal diagnostic testing by chorionic villus sampling (CVS) is sometimes recommended for women with twin pregnancies. However, few studies have compared the outcomes between twins with CVS and control twins without intervention. This study aimed to compare the obstetrical outcomes of CVS in twin pregnancies and those in non-intervention twin pregnancies. METHODS: First-trimester transabdominal CVS was performed on dichorionic-diamniotic twins (n = 54; Group 1) between December 2006 and January 2017 at the Department of Obstetrics and Gynecology at our hospital, and the data were retrospectively analyzed. CVS risks were evaluated by comparing obstetrical outcomes with those of a control population of 155 dichorionic-diamniotic twins without intervention (Group 2). RESULTS: The difference in the overall fetal loss rate (Group 1, 7.4% vs Group 2, 3.9%; P = 0.287) between the two groups was not statistically significant. The miscarriage rate, defined as delivery at <24 gestational weeks, and early preterm delivery, defined as delivery at <34 gestational weeks, were not significant between the groups (miscarriage: Group 1, 5.6% vs Group 2, 3.2%; P = 0.428; early preterm delivery: Group 1, 11.1% vs Group 2, 9.0%; P = 0.788). The mean gestational age at delivery, birth weights and neonatal intensive care unit admission rate were not statistically significant between the groups. Thus, the overall fetal loss rate and obstetrical outcomes of Group 1 were comparable with those of Group 2. CONCLUSION: In conclusion, the overall obstetrical outcomes were not significantly different between twins with CVS and control twins with the advantage of enabling early decision-making about selective feticide in twins with CVS.


Assuntos
Amostra da Vilosidade Coriônica/estatística & dados numéricos , Morte Fetal , Terapia Intensiva Neonatal/estatística & dados numéricos , Trabalho de Parto Prematuro/epidemiologia , Resultado da Gravidez/epidemiologia , Gravidez de Gêmeos , Adulto , Estudos de Casos e Controles , Amostra da Vilosidade Coriônica/efeitos adversos , Doenças em Gêmeos , Feminino , Humanos , Trabalho de Parto Prematuro/etiologia , Gravidez , Primeiro Trimestre da Gravidez , Estudos Retrospectivos
11.
J Korean Med Sci ; 34(12): e105, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30940999

RESUMO

Background: Incidence of whooping cough is increasing in Korea. Since 2011, occurrence among adolescents and adults has risen putting vulnerable neonates at risk. National immunization guidelines now include Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccination during pregnancy and as a cocooning strategy (i.e., vaccinating adults and adolescents in contact with neonates). This study assessed post-marketing Tdap (Boostrix®, GSK, Belgium) vaccine safety in subjects ≥ 10 years. Methods: This open, non-comparative multi-center study was conducted over six years at 10 hospitals in Korea. Subjects received Tdap in normal clinical practice according to local prescribing information. All adverse events (AEs) were recorded, classified as expected or unexpected, and severity and relationship to Tdap were assessed. Results: The analysis included 672 Korean subjects (mean age, 44 years; range, 11-81), 451 were women and 211 were pregnant. Ninety subjects experienced 124 AEs (incidence 13.39%) of which six were serious AEs (SAEs) assessed as not related to vaccination, and 51 were non-SAEs related to vaccination (mostly administration site reactions). Overall 65/124 AEs were unexpected; the most common were 14 constipation, 5 dyspepsia, 4 common cold and 4 premature labor cases. One case of common cold was assessed as possibly related to vaccination. Pregnancy outcome was 'live infant, no apparent congenital anomaly' in 195 subjects (92.42%) or 'lost to follow-up' in 16 subjects. Conclusion: Tdap administration to Korean subjects ≥ 10 years, including pregnant women, for the prevention of diphtheria, tetanus and pertussis was shown to have a well-tolerated safety profile. Trial Registration: ClinicalTrials.gov Identifier: NCT01929291.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/efeitos adversos , Vigilância de Produtos Comercializados , Adolescente , Adulto , Idoso , Criança , Vacinas contra Difteria, Tétano e Coqueluche Acelular/imunologia , Feminino , Gastroenteropatias/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Trabalho de Parto Prematuro/etiologia , Gravidez , Estudos Prospectivos , Prurido/etiologia , República da Coreia , Doenças Respiratórias/etiologia , Tétano/prevenção & controle , Coqueluche/prevenção & controle , Adulto Jovem
12.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(4): 471-474, 2019 Apr 10.
Artigo em Chinês | MEDLINE | ID: mdl-31006211

RESUMO

Objective: To investigate the dose-response relationship between hemoglobin concentration and preterm birth, during pregnancy. Methods: With Zhuang ethnicity, a total of 12 780 pregnant women and their infants that admitted to Wuming、Pingguo、Jingxi、Debao、Longan and Tiandong hospitals, were recruited, in Guangxi Zhuang Autonomous Region, from January 2015 to December 2017. Non-conditional logistic regression method was used to analyze the effect of anemia on preterm birth during pregnancy. Dose-response relationship between hemoglobin concentration and preterm birth was explored, using the restrictive cubic spline model. Results: After excluding 2 053 pregnant women with hypertension or aged 35 years and over, results from the non-conditional logistic regression analysis showed that the risk of preterm birth in the anemia group was 1.29 times (OR=1.29, 95%CI: 1.04-1.59, P=0.019) of the non-anemia group in the first trimester. Data from the restricted cubic sample showed that there appeared nonlinear "L" dose-response relationship between hemoglobin concentration and preterm birth in the first trimester and "U" shape in the third trimester (non-linearity test P<0.001). Conclusion: There appeared nonlinear dose-response relationship between the hemoglobin concentration and preterm birth, both in the first and third trimesters.


Assuntos
Anemia/complicações , Retardo do Crescimento Fetal/epidemiologia , Hemoglobinas/metabolismo , Trabalho de Parto Prematuro/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , China/epidemiologia , Feminino , Retardo do Crescimento Fetal/etiologia , Humanos , Recém-Nascido , Trabalho de Parto Prematuro/etiologia , Gravidez , Complicações Hematológicas na Gravidez , Resultado da Gravidez , Gestantes , Fatores de Risco
13.
Arch Gynecol Obstet ; 299(5): 1275-1282, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30874948

RESUMO

OBJECTIVE: To investigate whether myometrial thickness (MT) to cervical length (CL) ratio could be used in the prediction of preterm birth (PTB) in singleton pregnancies presented with threatened preterm labor (TPL). METHODS: After 48 h of successful tocolysis, MT was measured transabdominally from the fundal, mid-anterior walls and the lower uterine segment (LUS) in 46 pregnancies presented with TPL. MT measurements were divided into CL, individually. The main outcome was PTB before 37 weeks of gestation. RESULTS: The patients were divided into two groups as women delivered ≥ 37 weeks (38.68 ± 1.01 weeks) (n = 25) and those delivered < 37 weeks (34.28 ± 2.53 weeks) (n = 21). The mean ± SD CL in the preterm delivery group was significantly shorter than the term delivery group (23.77 ± 9.23 vs 29.91 ± 7.03 mm, p < 0.05). Fundal, mid-anterior or LUS MT values were similar in both groups. However, in those who delivered preterm, the ratios of fundal MT-to-CL (p = 0.026) and mid-anterior MT-to-CL (p = 0.0085) were significantly different compared to those delivered at term. The optimal cutoff values for CL, fundal MT-to-CL and mid-anterior MT-to-CL ratios in predicting PTB were calculated as 31.1 mm, 0.19 and 0.20, respectively. Fundal MT-to-CL ratio predicted preterm delivery with 71% sensitivity, 72% specificity, 68% positive and 75% negative predictive values. For mid-anterior MT-to-CL ratio, respective values were 76, 76, 73 and 79%. CONCLUSION: Measurement of MT along with CL may offer a promising method in the management of women presented with TPL.


Assuntos
Medida do Comprimento Cervical/efeitos adversos , Trabalho de Parto Prematuro/etiologia , Nascimento Prematuro/patologia , Adulto , Medida do Comprimento Cervical/métodos , Feminino , Humanos , Recém-Nascido , Gravidez , Estudos Prospectivos
14.
Fetal Diagn Ther ; 46(5): 285-295, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30861511

RESUMO

BACKGROUND: Fetal subdural haematoma (SDH) is associated with poor prognosis. OBJECTIVE: The conflicting evidence from the literature presents a challenge in prenatal counselling. We present a case study and systematic review of the literature for the management and outcome of fetal SDH. METHODS: Systematic search of electronic database. RESULTS: A total 45 cases were extracted from 39 papers. Prenatal ultrasonographic features were intracranial echogenicity (42%), lateral ventriculomegaly (38%), presence of an intracranial mass (31%), macrocephaly (24%), midline deviation of cerebral falx (20%), and intracranial fluid collection (11%). Further secondary features were noted including reversed diastolic flow in the middle cerebral artery (11%), echogenic bowel (4%), hydrops fetalis (2%), and elevated middle cerebral artery peak systolic velocity (2%) (all highly likely to be associated with fetal anaemia). The rates of termination of pregnancy, stillbirth, and neonatal death were 18% (8/45), 16% (7/45), and 11% (5/45), respectively. Overall, therefore, the fetal and perinatal mortality was 32% (12/37). Amongst the 24 survivors with available neurological outcome, 42% (10/24) and 58% (14/24) had abnormal and normal neurological outcome, respectively. Underlying aetiology of fetal SDH was not identified in 47% (21/45). Fetal SDH with an identifiable underlying aetiology was the only factor associated with a higher chance of normal neurological outcome when compared to fetal SDH without a detectable cause (78.5 vs. 21.4%, p = 0.035). CONCLUSIONS: Stillbirth and neonatal death occurred in a significant proportion of fetal SDH. 58% of survivors had normal neurological outcome, and better prognosis was seen in SDH with identifiable underlying aetiology.


Assuntos
Ruptura Prematura de Membranas Fetais/etiologia , Hematoma Subdural/diagnóstico por imagem , Imagem por Ressonância Magnética , Trabalho de Parto Prematuro/etiologia , Natimorto , Ultrassonografia Pré-Natal , Adulto , Evolução Fatal , Feminino , Idade Gestacional , Hematoma Subdural/etiologia , Hematoma Subdural/terapia , Humanos , Valor Preditivo dos Testes , Gravidez , Fatores de Risco
15.
Fetal Diagn Ther ; 46(5): 323-332, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30889602

RESUMO

OBJECTIVES: To determine the pulsatility index (PI) in the fetal splenic vein, the main portal vein, the left portal vein, and the ductus venosus with respect to the presence or absence of intra-amniotic inflammation (IAI) in preterm prelabor rupture of membranes (PPROM). METHOD: Women with singleton pregnancies and PPROM, ranging in gestational age from 22+0 to 36+6 weeks, were included. Amniotic fluid samples were obtained by transabdominal amniocentesis and the amniotic fluid level of interleukin-6 (IL-6) was assessed by a point-of-care test. Doppler examination of the selected veins was performed, and the PI was assessed. IAI was defined as amniotic fluid levels of IL-6 ≥745 pg/mL. RESULTS: In total, 42 women were included. Fetuses with IAI compared with those without IAI exhibited a higher PI in the splenic vein (p = 0.005) and the main portal vein (p = 0.05). No differences were observed in the left portal vein PI (p = 0.36) and the ductus venosus PI (p = 0.98). CONCLUSION: IAI was associated with increased fetal splenic vein PI and main portal vein PI in PPROM. The absence of changes in the left portal vein PI and ductus venosus PI supports the local cause of the finding.


Assuntos
Corioamnionite/fisiopatologia , Circulação Hepática , Trabalho de Parto Prematuro/fisiopatologia , Veia Porta/fisiopatologia , Fluxo Pulsátil , Veia Esplênica/fisiopatologia , Adulto , Líquido Amniótico/química , Velocidade do Fluxo Sanguíneo , Corioamnionite/diagnóstico por imagem , Corioamnionite/etiologia , Corioamnionite/metabolismo , Feminino , Idade Gestacional , Humanos , Interleucina-6/análise , Trabalho de Parto Prematuro/diagnóstico por imagem , Trabalho de Parto Prematuro/etiologia , Trabalho de Parto Prematuro/metabolismo , Veia Porta/diagnóstico por imagem , Gravidez , Estudos Prospectivos , Veia Esplênica/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Ultrassonografia Pré-Natal/métodos
16.
J Perinatol ; 39(3): 475-480, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30692614

RESUMO

OBJECTIVE: To determine population-based risks of preterm birth associated with vasa previa. STUDY DESIGN: Included were 945,950 singleton, live birth cesarean deliveries with and without vasa previa (gestational ages 24-41 weeks) in California between 2007 and 2012. Odds ratios (ORs) of preterm birth were estimated using logistic regression. RESULTS: In total, 586 were complicated by vasa previa (0.06%). In total, 369 (63%) of those with vasa previa were delivered <37 weeks, compared with 91,662 (10%) of those without. Odds of extreme and very preterm birth were substantially higher for pregnancies with vasa previa even after controlling for comorbidities known to contribute to prematurity, with ORs of 4.6 (95% confidence interval, CI: 1.7-12.5) and 16.0 (95% CI: 10.3-24.8), respectively. CONCLUSION: Based on these population-based data, most patients with vasa previa are delivered between 32 and 36 weeks gestation; however, a clinically significant portion occur before 32 weeks. These data are helpful in counseling patients with vasa previa regarding prematurity risk.


Assuntos
Cesárea , Lactente Extremamente Prematuro , Trabalho de Parto Prematuro/etiologia , Vasa Previa/diagnóstico por imagem , Vasa Previa/epidemiologia , Adulto , California/epidemiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Modelos Logísticos , Masculino , Análise Multivariada , Gravidez , Diagnóstico Pré-Natal , Estudos Retrospectivos , Ultrassonografia Pré-Natal , Adulto Jovem
17.
Am J Perinatol ; 36(1): 86-89, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30016822

RESUMO

OBJECTIVE: The objective of this study was to examine whether a medically indicated preterm delivery is relatively more likely following longer interdelivery intervals. STUDY DESIGN: This is a case-control study of women with two consecutive deliveries of a live singleton at the same institution between 2005 and 2015, with the subsequent delivery occurring preterm. Preterm deliveries were classified as spontaneous if women delivered following preterm labor, preterm premature rupture of membranes, or placental abruption. Preterm deliveries were classified as medically indicated if women underwent delivery for fetal or maternal medical indications. Interdelivery interval was categorized as < 18, 18 to 59, and 60 months or more. Characteristics of women who had a medically indicated versus spontaneous preterm delivery were compared. RESULTS: Of the 1,276 women, 25.6% had a medically indicated preterm delivery and 74.4% had a spontaneous preterm delivery. Compared with women with an interdelivery interval of 18 to 59 months (of whom 25.7% had a preterm delivery for medical indications), women with a shorter interdelivery interval were less likely (19.3%), while women with a longer interdelivery interval were more likely (37.4%; p = 0.003) to have a medically indicated preterm delivery. This relationship persisted even when accounting for other factors. CONCLUSION: Preterm deliveries are more likely to be medically indicated as the interdelivery interval lengthens.


Assuntos
Intervalo entre Nascimentos/estatística & dados numéricos , Parto Obstétrico , Trabalho de Parto Prematuro , Complicações na Gravidez , Adulto , Estudos de Casos e Controles , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Illinois , Trabalho de Parto Prematuro/epidemiologia , Trabalho de Parto Prematuro/etiologia , Trabalho de Parto Prematuro/terapia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/terapia , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Fatores de Risco
18.
J Perinat Med ; 47(2): 152-160, 2019 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-30352043

RESUMO

Uterine tachysystole (TS) is a potentially significant intrapartum complication seen most commonly in induced or augmented labors but may also occur in women with spontaneous labor. When it occurs, maternal and perinatal complications can arise if not identified and managed promptly by obstetric care providers. Over recent years, new definitions of the condition have facilitated further research into the field, which has been synthesized to inform clinical management guidelines and protocols. We propose a set of recommendations pertaining to TS in line with contemporary evidence and obstetric practice.


Assuntos
Complicações do Trabalho de Parto , Trabalho de Parto Prematuro , Tocólise/métodos , Contração Uterina , Cardiotocografia/métodos , Feminino , Humanos , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/etiologia , Complicações do Trabalho de Parto/fisiopatologia , Complicações do Trabalho de Parto/terapia , Trabalho de Parto Prematuro/etiologia , Trabalho de Parto Prematuro/prevenção & controle , Gravidez , Monitorização Uterina/métodos
19.
Eur J Obstet Gynecol Reprod Biol ; 233: 53-57, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30572188

RESUMO

OBJECTIVES: To study the pregnancy outcomes in women with type 2 diabetes mellitus (T2DM) and to relate these to maternal risk factors. METHODS: We conducted a retrospective study of 419 women with T2DM (index group)- who attended our diabetes in pregnancy clinic at the Hamad Women's Hospital, Doha, between March 2015 and December 2016 -and 1419 normoglycaemic women (control group). RESULTS: Compared with the controls, T2DM women were older (mean age 34.7 ± 6.9 vs 29.6 ± 5.5 years; p < 0.001) and had a higher BMI (34.5 ± 6.7 vs 28.8 ± 6.1 kg/m2; p < 0.001). The incidence of macrosomia, shoulder dystocia and stillbirth were similar in the two groups, while that of pre-term labour, pre-eclampsia, caesarean section (CS), large for gestational age (LGA), neonatal ICU (NICU) admission, and neonatal hypoglycaemia were significantly higher in the T2DM compared to the control group (p < 0.05). Multivariate regression analysis showed that first trimester HbA1C was associated with an increased risk of LGA (OR 1.17; 95% CI [1.01-1.36]), pre-eclampsia (OR 1.26; 95% CI [1.02-1.54]), neonatal hypoglycaemia (OR 1.32; 95% CI 1.10-1.60) and NICU admission (OR 1.32; 95% CI 1.10-1.60). Pre-pregnancy BMI was associated with increased risk of LGA (OR 1.04; 95%CI [1.00-1.08]), macrosomia (OR 1.06; 95%CI [1.00-1.12]) and CS (OR 1.05; 95% CI [1.01-1.09]). Last trimester HbA1c was associated with an increased risk of LGA [OR 1.53, 95% CI [1.13-2.10)] and CS (OR 1.37, 95% CI [1.01-1.87]). CONCLUSION: T2DM is associated with adverse pregnancy outcomes compared to the normal control in Qatar. Maternal obesity and glycaemic control before and during pregnancy are the main determinants of pregnancy outcomes in women with T2DM.


Assuntos
Diabetes Mellitus Tipo 2/fisiopatologia , Hemoglobina A Glicada/administração & dosagem , Gravidez em Diabéticas/fisiopatologia , Adulto , Estudos de Casos e Controles , Cesárea/estatística & dados numéricos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Macrossomia Fetal/epidemiologia , Macrossomia Fetal/etiologia , Ganho de Peso na Gestação , Hemoglobina A Glicada/análise , Humanos , Hipoglicemia/epidemiologia , Hipoglicemia/etiologia , Hipoglicemiantes/uso terapêutico , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/etiologia , Insulina/uso terapêutico , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Metformina/uso terapêutico , Obesidade/complicações , Trabalho de Parto Prematuro/epidemiologia , Trabalho de Parto Prematuro/etiologia , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/etiologia , Gravidez , Gravidez em Diabéticas/tratamento farmacológico , Catar , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
20.
J Matern Fetal Neonatal Med ; 32(4): 527-541, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29020827

RESUMO

OBJECTIVE: The objective of this study is to evaluate the frequency and clinical significance of intra-amniotic inflammation in twin pregnancies with preterm labor and intact membranes. STUDY DESIGN: Amniotic fluid (AF) was retrieved from both sacs in 90 twin gestations with preterm labor and intact membranes (gestational age between 20 and 34 6/7 weeks). Preterm labor was defined as the presence of painful regular uterine contractions, with a frequency of at least 2 every 10 min, requiring hospitalization. Fluid was cultured and assayed for matrix metalloproteinase-8. Intra-amniotic inflammation was defined as an AF matrix metalloproteinase-8 concentration >23 ng/mL. RESULTS: The prevalence of intra-amniotic inflammation for at least 1 amniotic sac was 39% (35/90), while that of proven intra-amniotic infection for at least one amniotic sac was 10% (9/90). Intra-amniotic inflammation without proven microbial invasion of the amniotic cavity was found in 29% (26/90) of the cases. Intra-amniotic inflammation was present in both amniotic sacs for 22 cases, in the presenting amniotic sac for 12 cases, and in the non-presenting amniotic sac for one case. Women with intra-amniotic inflammation observed in at least one amniotic sac and a negative AF culture for microorganisms had a significantly higher rate of adverse pregnancy outcome than those with a negative AF culture and without intra-amniotic inflammation (lower gestational age at birth, shorter amniocentesis-to-delivery interval, and significant neonatal morbidity). Importantly, there was no significant difference in pregnancy outcome between women with intra-amniotic inflammation and a negative AF culture and those with a positive AF culture. CONCLUSION: Intra-amniotic inflammation is present in 39% of twin pregnancies with preterm labor and intact membranes and is a risk factor for impending preterm delivery and adverse outcome, regardless of the presence or absence of bacteria detected using cultivation techniques.


Assuntos
Líquido Amniótico/microbiologia , Corioamnionite/epidemiologia , Metaloproteinase 8 da Matriz/análise , Trabalho de Parto Prematuro/etiologia , Gravidez de Gêmeos , Adulto , Amniocentese , Líquido Amniótico/enzimologia , Análise de Variância , Corioamnionite/microbiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Idade Gestacional , Humanos , Trabalho de Parto Prematuro/diagnóstico , Trabalho de Parto Prematuro/microbiologia , Gravidez , Resultado da Gravidez , Fatores de Risco
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