Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.468
Filtrar
1.
Medicine (Baltimore) ; 99(11): e19524, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176104

RESUMO

The clinical significance of poor nutritional status in patients with peripartum cardiomyopathy (PPCM) is not clearly understood. Prognostic nutritional index (PNI) is a simple nutritional assessment tool, which was first demonstrated to be valuable in patients with colorectal surgeries. We aimed to investigate the predictive value of PNI in patients with PPCM.A total of 92 patients diagnosed with PPCM were enrolled in this study. PNI was calculated using the following formula: 10 × serum albumin value (g/dL) + 0.005 × total lymphocyte count. The primary endpoint was defined as composite adverse cardiac events that included cardiac death or hospitalization due to worsening heart failure (HF). Cardiac death, hospitalization due to worsening HF, and persistent left ventricular (LV) systolic dysfunction were evaluated, respectively, as secondary endpoints.Primary composite endpoint was higher in the lower PNI group. After adjusting for other risk factors, PNI was found to be as an independent predictor of primary composite endpoint (odds ratio 0.805; 95% confidence interval 0.729-0.888; P < .001). In addition, PNI was significantly associated with secondary endpoints; persistent LV systolic dysfunction as well as cardiac death.This study identified nutritional status assessed by the PNI seems to be a novel predictor of adverse cardiovascular outcomes in patients with PPCM.


Assuntos
Cardiomiopatias/diagnóstico , Estado Nutricional , Diagnóstico Pré-Natal , Transtornos Puerperais/diagnóstico , Adulto , Biomarcadores , Cardiomiopatias/sangue , Cardiomiopatias/mortalidade , Cardiomiopatias/fisiopatologia , Feminino , Humanos , Valor Preditivo dos Testes , Gravidez , Transtornos Puerperais/sangue , Transtornos Puerperais/mortalidade , Transtornos Puerperais/fisiopatologia , Fatores de Risco , Análise de Sobrevida
3.
Lakartidningen ; 1172020 01 24.
Artigo em Sueco | MEDLINE | ID: mdl-31990362

RESUMO

Peripartum cardiomyopathy is defined as heart failure, with ejection fraction less than 45% that presents late during pregnancy or the first five months postpartum. Despite being described first in 1849 by Ritchie the mechanisms behind the disease are still not fully understood. However, oxidative stress during pregnancy and the cleavage of prolactine into its 16 kDa fragment appears to play a role in the pathophysiology of peripartum cardiomyopathy. In addition to optimal therapy for heart failure bromocriptine, an inhibitor of prolactine release, should be considered. Prevalence and prognosis varies geographically. Most often left ventricular ejection fraction is normalized after six months but sometimes the disease is associated with deteriorating heart failure and death. Therefore it is important for health care professionals caring for women in the peripartum period to be aware of the signs and symptoms of the diagnosis.


Assuntos
Cardiomiopatias , Complicações Cardiovasculares na Gravidez , Transtornos Puerperais , Cardiomiopatias/diagnóstico , Cardiomiopatias/terapia , Diagnóstico Tardio , Feminino , Humanos , Período Periparto , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/terapia , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/terapia
6.
Pregnancy Hypertens ; 17: 133-137, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31487630

RESUMO

OBJECTIVES: To determine factors that predict the need for antihypertensive treatment during early postpartum period among women with preeclampsia or gestational hypertension. STUDY DESIGN: Retrospective cohort of 358 women. MAIN OUTCOME MEASURES: Demographic, clinical and laboratory data of 63 women diagnosed with preeclampsia or gestational hypertension during a singleton pregnancy and who needed antihypertensive agents during early postpartum period were compared to 295 who did not. RESULTS: No difference was found between groups regarding age, parity, body mass index, or weight gain (p = 0.95, 0.19, 0.56, and 0.078, respectively). Early onset preeclampsia or gestational hypertension was diagnosed among 28.6% of the women who subsequently needed antihypertensive treatment, as compared to 4.1% who did not (p < 0.001). Antepartum, mean maximum blood pressure in the treated vs. untreated group was 165/109 mmHg vs. 150/100 mmHg, respectively (p = 0.001). Groups did not differ regarding symptoms of preeclampsia (38.7% vs. 31.5%, p = 0.273) or laboratory abnormalities. The group that received antihypertensive treatment during early postpartum period, had more preterm deliveries (p < 0.001) and Cesarean deliveries (p < 0.001), and more received magnesium sulfate during labor (p < 0.001). During the early postpartum period, mean maximum blood pressure was higher among the treated group (167/106 vs. 143/92, p = 0.001), as were symptoms of preeclampsia (p = 0.001). The groups were similar regarding laboratory abnormalities that define preeclampsia. CONCLUSIONS: Early onset preeclampsia or gestational hypertension, severe antepartum hypertension, magnesium sulfate during labor, preterm, and Cesarean delivery might be good predictors of the need for antihypertensive treatment during early postpartum period.


Assuntos
Anti-Hipertensivos/uso terapêutico , Técnicas de Apoio para a Decisão , Hipertensão/tratamento farmacológico , Pré-Eclâmpsia , Diagnóstico Pré-Natal , Transtornos Puerperais/tratamento farmacológico , Adulto , Anti-Hipertensivos/administração & dosagem , Estudos de Coortes , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Hipertensão Induzida pela Gravidez , Período Pós-Parto , Valor Preditivo dos Testes , Gravidez , Cuidado Pré-Natal , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/fisiopatologia , Estudos Retrospectivos
7.
Theriogenology ; 138: 127-136, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31326659

RESUMO

The objective of this study was to improve prediction of the probability of conception in dairy cows with clinical endometritis by means of a combination of examination results. For this purpose, a total of 1386 dairy cows were screened for clinical endometritis and data from 286 cows were collected including the calving history, puerperal or concurrent diseases and cow-specific data (breed, parity, BCS at puerperal control 1 (PC 1 = 22-45 days in milk (DIM)), and daily milk yield). The diagnosis of clinical endometritis was made at PC 1 by vaginal discharge scoring with a Metricheck device on a scale from 1 to 3 (endometritis score (ES) 1 to 3). A detailed clinical and gynecological examination including external inspection, transrectal palpation and ultrasonographic examination of the genital tract (cervix, uterus, and ovaries), vaginoscopy and microbiological analysis of the intrauterine content were performed. All cows with clinical endometritis (n = 286) were treated according to the ovarian findings (corpus luteum, dominant follicle) at PC 1. A second puerperal control was performed 21 ±â€¯1 days later. Data was collected until 200 DIM. The risk factors for ES 3 and their effect on the distribution of ES were determined by the Chi-square test and binary logistic regression. Multivariable implications of a large sum of examination parameters on the pregnancy outcome at different DIM (100, 150 and 200 DIM) were analyzed on the basis of conditional inference trees. The prevalence of clinical endometritis was 28%. The ovarian findings at PC 1 did not have any impact on reproductive performance. Puerperal diseases prior to the study, visible vaginal discharge (VVD) and the presence of Trueperella pyogenes (TP) were associated with an ES 3. The prediction of pregnancy status for all DIM times was dominated significantly by VVD or TP as decisive factors. Cows with VVD or TP had lower conception rates at all DIM times than cows without these findings, but the predictive accuracy was similar for both groups. These results suggest that VVD is a valuable and practical examination parameter, which can be used for pregnancy prediction on farm. Therefore, it might facilitate early breeding decisions in cows with clinical endometritis under farm conditions.


Assuntos
Doenças dos Bovinos/diagnóstico , Endometrite/diagnóstico , Fertilização/fisiologia , Exame Físico/métodos , Reprodução/fisiologia , Animais , Cruzamento , Bovinos , Indústria de Laticínios/métodos , Endometrite/complicações , Feminino , Exame Físico/veterinária , Período Pós-Parto , Gravidez , Taxa de Gravidez , Prognóstico , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/veterinária , História Reprodutiva , Descarga Vaginal/diagnóstico , Descarga Vaginal/veterinária , Medicina Veterinária/métodos
8.
Heart Surg Forum ; 22(3): E180-E182, 2019 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-31237539

RESUMO

BACKGROUND: Cor biloculare, two-chambered heart due to the absence of atrial and ventricular septa, is a rare congenital heart anomaly. For Cor biloculare and other cardiac defects with single ventricle physiology, Glenn anastomosis has been developed as a palliative procedure. Thrombosis secondary to Glenn anastomosis in the patient with Cor biloculare could pose a serious threat to the survival, and has never been reported before. CASE REPORT: We report the case of a 27-year-old patient, with past history of Glenn anastomosis that was performed 7 years ago for the palliation of Cor biloculare. She presented with pulmonary embolism and ischemic stroke simultaneously at 7 days after Cesarean section. Due to her critical status, systemic anticoagulation with low-molecular-weight heparin was started immediately, followed by lifelong warfarin therapy. Pulmonary embolism regressed and neurological symptoms were considerably diminished after the anticoagulation treatment. CONCLUSION: This case illuminates the potential risk of thrombotic events in this patient cohort and demonstrates that anticoagulation therapy is an effective, secure, and appropriate for the management of this disease.


Assuntos
Isquemia Encefálica/etiologia , Técnica de Fontan/efeitos adversos , Cardiopatias Congênitas/cirurgia , Transtornos Puerperais/etiologia , Embolia Pulmonar/etiologia , Acidente Vascular Cerebral/etiologia , Adulto , Anticoagulantes/uso terapêutico , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/terapia , Cesárea , Feminino , Cardiopatias Congênitas/complicações , Humanos , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/terapia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia
9.
Neurol Sci ; 40(9): 1873-1876, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31062190

RESUMO

PURPOSE: To explore the clinical and imaging characteristics and summarize the causes of missed diagnosis of reversible posterior leukoencephalopathy syndrome (RPLS) in eclampsia. METHODS: We collected the data of a total of 45 patients with RPLS who were misdiagnosed initially (27 cases were confirmed and 18 cases were suspicious) out of 804 patients with severe eclampsia who had presented themselves to the Affiliated Hospital of Xuzhou Medical University from January 2014 to December 2016. We summarized the clinical and imaging characteristics of the patients and analyzed the possible causes of the misdiagnosis. RESULTS: Among the 804 patients with eclampsia, 45 were misdiagnosed the first time. Their clinical manifestations included headache (20 cases), epilepsy (13 cases), blurred vision (11 cases), disturbance of consciousness (2 cases), and drowsiness (3 cases). The parietal lobe was involved in 22 cases, the occipital lobe in 15 cases, the frontal lobe in 20 cases, basal ganglia in 9 cases, and the temporal lobe in 8 cases. Low-density lesions were observed on computed tomography (CT) scans. Head magnetic resonance (MR) scans showed hypo-intense lesions on T1-weighted image (T1WI), hyper-intense lesions on the T2-weighted image (T2WI) and fluid-attenuated inversion recovery (FLAIR), iso-intense or slightly hyper-intense lesion on diffusion-weighted imaging (DWI), and slightly hyper-intense or hypo-intense lesion on apparent diffusion coefficient (ADC). CONCLUSION: The incidence of reversible posterior leukoencephalopathy syndrome is extremely high. The clinical features include headache, mental disturbance, seizures, blurred vision, and other neurological symptoms. The lesion area is mainly limited to the parietal and occipital lobes; however, the frontal lobe, basal ganglia, temporal lobe, corpus callosum, and cerebellum can also be involved. The prognosis is good with timely and appropriate treatments.


Assuntos
Eclampsia/diagnóstico , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Síndrome da Leucoencefalopatia Posterior/patologia , Síndrome da Leucoencefalopatia Posterior/fisiopatologia , Adolescente , Adulto , Angiografia Cerebral , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Síndrome da Leucoencefalopatia Posterior/etiologia , Gravidez , Prognóstico , Transtornos Puerperais/diagnóstico , Tomografia Computadorizada por Raios X , Adulto Jovem
10.
Emerg Med Clin North Am ; 37(2): 277-286, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30940372

RESUMO

The period just after delivery is a high-risk period for women with associated morbidity and even mortality. There are large variations in complication rates across various groups in the United States. This article covers complications commonly encountered in the emergency department in late pregnancy and the early postpartum period. It specifically addresses postpartum depression, peripartum cardiomyopathy, and the late pregnant or postpartum patient presenting with headache or neurologic complaints. Emergency physicians should be well versed in common and life-threatening postpartum pathologies.


Assuntos
Complicações na Gravidez/diagnóstico , Terceiro Trimestre da Gravidez , Transtornos Puerperais/diagnóstico , Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/terapia , Serviço Hospitalar de Emergência , Feminino , Cefaleia/complicações , Cefaleia/diagnóstico , Cefaleia/terapia , Humanos , Período Pós-Parto , Gravidez , Complicações na Gravidez/terapia , Transtornos Puerperais/terapia
11.
Emerg Med Clin North Am ; 37(2): 287-300, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30940373

RESUMO

This article covers a high-risk time in a woman's life, the period just after delivery of her baby. There are large variations in complication rates across various groups in the United States. Many women seek care in the emergency department for routine and more serious postpartum pathologies. Emergency physicians should be well versed in common and life-threatening complications of delivery. The specific pathologies discussed in this article include lactation in the emergency department, postpartum hemorrhage, amniotic fluid embolism, endometritis, and mastitis.


Assuntos
Transtornos Puerperais/diagnóstico , Embolia Amniótica/diagnóstico , Embolia Amniótica/terapia , Serviço Hospitalar de Emergência , Endometrite/diagnóstico , Endometrite/terapia , Feminino , Humanos , Transtornos da Lactação/diagnóstico , Transtornos da Lactação/terapia , Mastite/diagnóstico , Mastite/terapia , Hemorragia Pós-Parto/diagnóstico , Hemorragia Pós-Parto/terapia , Gravidez , Transtornos Puerperais/terapia
12.
Dtsch Med Wochenschr ; 144(8): 544-546, 2019 04.
Artigo em Alemão | MEDLINE | ID: mdl-30986862

RESUMO

CLINICAL CASE: We report of a 25 year old woman who presented with acute dysuria. She had a normal vaginal delivery three months earlier. She developed increasing ascites and laboratory findings were indicative for acute renal failure. DIAGNOSIS AND THERAPY: An explorative laparotomy revealed a tiny leak of the urinary bladder that was sutured. CONCLUSION: Spontaneous intraperitoneal bladder rupture is rare and clinically present as ascites and acute renal failure. The evaluation of the cause for atraumatic bladder ruptures may be challenging.


Assuntos
Lesão Renal Aguda/diagnóstico , Ascite/diagnóstico , Transtornos Puerperais/diagnóstico , Bexiga Urinária/lesões , Lesão Renal Aguda/terapia , Adulto , Ascite/terapia , Diagnóstico Diferencial , Feminino , Humanos , Período Pós-Parto , Transtornos Puerperais/terapia , Ruptura
13.
Obstet Gynecol ; 133(5): 975-977, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30969221

RESUMO

BACKGROUND: Obstetricians often feel ill-equipped to address the symptom of breast pain in pregnant and postpartum patients. CASES: In the first case, a 40-year-old woman in the second trimester of pregnancy reported nipple discoloration and severe pain. She was treated with nifedipine, and her symptoms decreased quickly and markedly. In the second case, a 32-year-old woman presented for a routine postpartum visit. She described breast pain and sporadic purple discoloration of the nipples, a finding confirmed on examination. Conservative measures of maintaining warmth were recommended. CONCLUSION: Raynaud phenomenon of the nipple is an underdiagnosed condition affecting women in both the prenatal and postpartum periods. A careful history and physical must be obtained in women presenting with breast pain, because diagnosis and treatment allows breastfeeding continuation and mitigation of symptoms.


Assuntos
Doenças Mamárias/diagnóstico , Nifedipino/uso terapêutico , Mamilos , Diagnóstico Pré-Natal , Transtornos Puerperais/diagnóstico , Doença de Raynaud/diagnóstico , Vasodilatadores/uso terapêutico , Adulto , Doenças Mamárias/complicações , Doenças Mamárias/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Humanos , Dor/etiologia , Gravidez , Transtornos Puerperais/tratamento farmacológico , Doença de Raynaud/complicações , Doença de Raynaud/tratamento farmacológico
14.
S Afr Med J ; 109(3): 186-192, 2019 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-30834877

RESUMO

BACKGROUND: Venous thromboembolism (VTE) is associated with significant morbidity and mortality. Pregnancy and the puerperium are hypercoagulable states and increase the risk of VTE. There is a paucity of South African (SA) data related to use of thromboprophylaxis during pregnancy and the puerperium. OBJECTIVES: To evaluate local practice of VTE risk stratification among SA pregnant women and senior doctors' attitudes to VTE prophylaxis. METHODS: This was a cross-sectional descriptive study of conveniently sampled sites in the private and public health sectors. Patients with confirmed pregnancy and an underlying medical condition were enrolled after giving informed consent. Assessments were made based on the participating doctors' questionnaires and case report forms. In essence, this was a local evaluation of a specific group of patients by a specific group of doctors. RESULTS: Two hundred and twenty patients were enrolled at six sites. In the participating doctors' opinion, 126/220 women assessed (57.2%) were at risk of VTE during pregnancy and the postpartum period (information was missing for 1 woman during the postpartum period). Of the women at risk of VTE, 23/126 (18.3%) were at high risk, 59/126 (46.8%) at moderate risk and 44/126 (34.9%) at low risk. Of the women identified as at risk of VTE, 104/127 (81.9%) received some form of VTE prophylaxis; 94/127 (74.0%) were at risk during pregnancy and 32/126 (25.4%) during the postpartum period. Of those who received pharmacological treatment, 15/15 received low-molecular-weight heparin during pregnancy and before delivery and 87/100 during the puerperium. Thirty-four patients received thromboprophylaxis for only 5 - 10 days after caesarean delivery, and 2 received mechanical thromboprophylaxis during pregnancy. CONCLUSIONS: Doctors participating in the study were generally aware of VTE risk during pregnancy and the puerperium. Pharmacological thromboprophylaxis was the most commonly used intervention to reduce VTE risk. Mechanical thromboprophylaxis was underutilised. Adherence to VTE guidelines, specifically in terms of duration of thromboprophylaxis and its utilisation during pregnancy, was suboptimal.


Assuntos
Anticoagulantes/uso terapêutico , Fidelidade a Diretrizes/estatística & dados numéricos , Heparina de Baixo Peso Molecular/uso terapêutico , Padrões de Prática Médica/estatística & dados numéricos , Complicações Cardiovasculares na Gravidez , Transtornos Puerperais , Tromboembolia Venosa , Adulto , Atitude do Pessoal de Saúde , Competência Clínica , Estudos Transversais , Feminino , Humanos , Trombólise Mecânica/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/etiologia , Complicações Cardiovasculares na Gravidez/terapia , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/etiologia , Transtornos Puerperais/terapia , Medição de Risco , Fatores de Risco , África do Sul , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/terapia
15.
BMC Psychiatry ; 19(1): 94, 2019 03 21.
Artigo em Inglês | MEDLINE | ID: mdl-30898103

RESUMO

BACKGROUND: Unwanted, intrusive thoughts of harm-related to the infant are reported by the vast majority of new mothers, with half of all new mothers reporting unwanted, intrusive thoughts of harming their infant on purpose. Thoughts of intentional harm, in particular, are distressing to women, their partners and the people who care for them. While maternal, unwanted and intrusive thoughts of infant-related harm are known to be associated with obsessive compulsive disorder (OCD) and depression, preliminary evidence suggests that they are not associated with an increased risk of harm to infants. Perinatal care providers and policy makers, as well as new mothers and their partners require evidence-based information in order to respond appropriately to these types of thoughts. The purpose of this research is to address important gaps regarding the (a) prevalence and characteristics of intrusive, unwanted thoughts of baby-related harm, (b) their association (or lack thereof) with child abuse, and (c) the prevalence and course of obsessive-compulsive disorder and depression in the perinatal period. METHODS: Participant were 763 English-speaking women and recruited during pregnancy. In this province-wide study in British Columbia, participants were recruited proportionally from hospitals, city centers and rural communities between January 23, 2014 and September 09, 2016. Participants were administered online questionnaires and diagnostic interviews over the phone at 33-weeks gestation, 7-weeks postpartum and 4-months postpartum. The study assessed intrusive and unwanted thoughts of harm related to the infant, obsessive-compulsive disorder (OCD) and major depressive episode (MDE) disorders and symptomatology, sleep, medical outcomes, parenting attitudes, and infant abuse. DISCUSSION: There is a scarcity of literature concerning maternal unwanted, intrusive, postpartum thoughts of infant-related harm and their relationship to child harming behaviors, OCD and depression. This longitudinal cohort study was designed to build on the existing research base to ensure that policy developers, child protection workers and health-care providers have the guidance they need to respond appropriately to the disclosure of infant-related harm thoughts. Thus, its main goals will be to investigate whether intrusive postpartum thoughts of infant-related harm are a risk factor for child abuse or the development of OCD.


Assuntos
Maus-Tratos Infantis/psicologia , Depressão Pós-Parto/psicologia , Transtorno Depressivo Maior/psicologia , Mães/psicologia , Transtorno Obsessivo-Compulsivo/psicologia , Pensamento , Adulto , Colúmbia Britânica/epidemiologia , Maus-Tratos Infantis/prevenção & controle , Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/terapia , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/terapia , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Transtorno Obsessivo-Compulsivo/epidemiologia , Transtorno Obsessivo-Compulsivo/terapia , Período Pós-Parto/psicologia , Gravidez , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/psicologia , Transtornos Puerperais/terapia , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
16.
Clin Cardiol ; 42(5): 524-529, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30843220

RESUMO

BACKGROUND: There is limited data on electrocardiographic (ECG) abnormalities and their prognostic significance in women with peripartum cardiomyopathy (PPCM). We sought to characterize ECG findings in PPCM and explore the association of ECG findings with myocardial recovery and clinical outcomes. HYPOTHESIS: We hypothesized that ECG indicators of myocardial remodeling would portend worse systolic function and outcomes. METHODS: Standard 12-lead ECGs were obtained at enrollment in the Investigations of Pregnancy-Associated Cardiomyopathy study and analyzed for 88 women. Left ventricular ejection fraction (LVEF) was measured by echocardiography at baseline, 6 months, and 12 months. Women were followed for clinical events (death, mechanical circulatory support, and/or cardiac transplantation) until 1 year. RESULTS: Half of women had an "abnormal" ECG, defined as atrial abnormality, ventricular hypertrophy, ST-segment deviation, and/or bundle branch block. Women with left atrial abnormality (LAA) had lower LVEF at 6 months (44% vs 52%, P = 0.02) and 12 months (46% vs 54%, P = 0.03). LAA also predicted decreased event-free survival at 1 year (76% vs 97%, P = 0.008). Neither left ventricular hypertrophy by ECG nor T-wave abnormalities predicted outcomes. A normal ECG was associated with recovery in LVEF to ≥50% (84% vs 49%, P = 0.001) and event-free survival at 1 year (100% vs 85%, P = 0.01). CONCLUSIONS: ECG abnormalities are common in women with PPCM, but a normal ECG does not rule out the presence of PPCM. LAA predicted lower likelihood of myocardial recovery and event-free survival, and a normal ECG predicted favorable event-free survival.


Assuntos
Potenciais de Ação , Cardiomiopatias/diagnóstico , Eletrocardiografia , Frequência Cardíaca , Período Periparto , Transtornos Puerperais/diagnóstico , Adulto , Cardiomiopatias/mortalidade , Cardiomiopatias/fisiopatologia , Cardiomiopatias/terapia , Feminino , Humanos , América do Norte , Valor Preditivo dos Testes , Gravidez , Intervalo Livre de Progressão , Transtornos Puerperais/mortalidade , Transtornos Puerperais/fisiopatologia , Transtornos Puerperais/terapia , Recuperação de Função Fisiológica , Volume Sistólico , Fatores de Tempo , Função Ventricular Esquerda , Adulto Jovem
17.
Gait Posture ; 70: 196-202, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30897492

RESUMO

BACKGROUND: Anthropometric models are used when body center of mass motion is calculated for assessment of dynamic balance. It is currently unknown how body segments and posture change in the postpartum period. Therefore, this study was conducted to evaluate the longitudinal changes in anthropometry, center of mass, and standing posture postpartum. METHODS: Seventeen pregnant women were tested at nine different times: 16-20 weeks and 36-40 weeks gestation, and then in 4-week intervals from childbirth to 28 weeks postpartum. Anthropometry was measured and then participants conducted a static standing and static laying trial. Force plate data and motion capture data were used in combination with anthropometry to calculate the masses of individual segments and the body center of mass. Change over time was determined through a linear mixed model analysis. RESULTS: Anthropometric changes related to the abdomen or fluid retention during pregnancy immediately regress to early pregnancy levels following childbirth. However, other changes related to breast tissue and fat deposits persist postpartum. As such, masses of different segments affect an anthropometric model for center of mass calculation, and body center of mass changes in the lateral and anterior directions postpartum. Vertical body center of mass position was unaffected. SIGNIFICANCE: Increased postpartum breast mass may be the cause of persistent lordotic curvature changes in the lumbar spine. There is potential that this affects postpartum back pain. Future research should explore how body center of mass changes postpartum for individuals that do not breast feed, and thus may not have significant breast mass postpartum.


Assuntos
Período Pós-Parto/fisiologia , Equilíbrio Postural/fisiologia , Gravidez/fisiologia , Posição Ortostática , Adolescente , Adulto , Antropometria , Composição Corporal , Feminino , Humanos , Modelos Lineares , Estudos Longitudinais , Lordose/diagnóstico , Lordose/etiologia , Pessoa de Meia-Idade , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/etiologia , Coluna Vertebral/fisiologia , Estados Unidos , Adulto Jovem
18.
J Gynecol Obstet Hum Reprod ; 48(6): 431-434, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30905853

RESUMO

Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction (RCVS) are rare neurological disorders with complex physiopathology which is not yet fully understood. We present here the case of a 31-year-old woman with a bi-amniotic bi-chorial pregnancy who developed immediate postpartum eclampsia after vaginal delivery, associated with RCVS and PRES. Although post-partum is a well-known precipitating factors for these diseases, to our knowledge, there are only few similar cases reported with the association of these syndromes. Repeated MRI scans were instrumental in the final diagnosis of RCVS associated with PRES, allowing us to give the patient the appropriate treatment. These two syndromes have similar symptoms but may have different treatments, thus highlighting the importance of a correct diagnosis.


Assuntos
Doenças Arteriais Cerebrais/complicações , Eclampsia/diagnóstico , Síndrome da Leucoencefalopatia Posterior/complicações , Transtornos Puerperais/diagnóstico , Vasoconstrição , Adulto , Doenças Arteriais Cerebrais/diagnóstico , Doenças Arteriais Cerebrais/tratamento farmacológico , Eclampsia/fisiopatologia , Feminino , Cefaleia , Humanos , Nimodipina/uso terapêutico , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Gravidez , Complicações Cardiovasculares na Gravidez/fisiopatologia , Gravidez de Gêmeos , Transtornos Puerperais/tratamento farmacológico , Transtornos Puerperais/fisiopatologia , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico , Síndrome , Vasodilatadores
20.
Neurology ; 92(7): e639-e647, 2019 02 12.
Artigo em Inglês | MEDLINE | ID: mdl-30635475

RESUMO

OBJECTIVE: To develop a method to distinguish reversible cerebral vasoconstriction syndrome (RCVS) from other large/medium-vessel intracranial arteriopathies. METHODS: We identified consecutive patients from our institutional databases admitted in 2013-2017 with newly diagnosed RCVS (n = 30) or non-RCVS arteriopathy (n = 80). Admission clinical and imaging features were compared. Multivariate logistic regression modeling was used to develop a discriminatory score. Score validity was tested in a separate cohort of patients with RCVS and its closest mimic, primary angiitis of the CNS (PACNS). In addition, key variables were used to develop a bedside approach to distinguish RCVS from non-RCVS arteriopathies. RESULTS: The RCVS group had significantly more women, vasoconstrictive triggers, thunderclap headaches, normal brain imaging results, and better outcomes. Beta coefficients from the multivariate regression model yielding the best c-statistic (0.989) were used to develop the RCVS2 score (range -2 to +10; recurrent/single thunderclap headache; carotid artery involvement; vasoconstrictive trigger; sex; subarachnoid hemorrhage). Score ≥5 had 99% specificity and 90% sensitivity for diagnosing RCVS, and score ≤2 had 100% specificity and 85% sensitivity for excluding RCVS. Scores 3-4 had 86% specificity and 10% sensitivity for diagnosing RCVS. The score showed similar performance to distinguish RCVS from PACNS in the validation cohort. A clinical approach based on recurrent thunderclap headaches, trigger and normal brain scans, or convexity subarachnoid hemorrhage correctly diagnosed 25 of 37 patients with RCVS2 scores 3-4 across the derivation and validation cohorts. CONCLUSION: RCVS can be accurately distinguished from other intracranial arteriopathies upon admission, using widely available clinical and imaging features. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that the RCVS2 score accurately distinguishes patients with RCVS from those with other intracranial arteriopathies.


Assuntos
Doenças Arteriais Intracranianas/diagnóstico , Arteriosclerose Intracraniana/diagnóstico , Doença de Moyamoya/diagnóstico , Transtornos Puerperais/diagnóstico , Vasculite do Sistema Nervoso Central/diagnóstico , Adulto , Angiografia Cerebral , Transtornos Cerebrovasculares/diagnóstico , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Feminino , Transtornos da Cefaleia Primários/etiologia , Humanos , Doenças Arteriais Intracranianas/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Hemorragia Subaracnóidea/diagnóstico , Vasoconstrição
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA