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1.
BJOG ; 128(1): 121-129, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32725713

RESUMO

OBJECTIVE: To evaluate the association between deferred delivery in early-onset pre-eclampsia and offspring outcome and maternal cardiovascular, renal and metabolic function in the postpartum period. DESIGN: Observational study. SETTING: Tertiary referral hospital. POPULATION: Nulliparous women diagnosed with pre-eclampsia before 34 weeks' gestation who participated in a routine postpartum cardiovascular risk assessment programme. Women with hypertension, diabetes mellitus or renal disease prior to pregnancy were excluded. METHODS: Regression analyses were performed to assess the association between pregnancy prolongation and outcome measures. MAIN OUTCOME MEASURES: Offspring outcome and prevalence of deviant maternal cardiovascular, renal and metabolic function. RESULTS: The study population included 564 women with a median pregnancy prolongation of 10 days (interquartile range [IQR] 4-18) who were assessed at on average 8 months (IQR 6-12) postpartum. Pregnancy prolongation after diagnosis resulted in a decrease in infant mortality (adjusted odd ratio [aOR] 0.907, 95% CI 0.852-0.965 per day prolongation). This improvement in offspring outcome was associated with an elevated risk of moderately increased albuminuria (aOR 1.025, 95% CI 1.006-1.045 per day prolongation), but not with aberrant cardiac geometry, cardiac systolic or diastolic dysfunction, persistent hypertension or metabolic syndrome. CONCLUSION: Pregnancy prolongation in early-onset pre-eclampsia is associated with improved offspring outcome and survival. These effects do not appear to be deleterious to short-term maternal cardiovascular and metabolic function but are associated with a modest increase in risk of residual albuminuria. TWEETABLE ABSTRACT: Pregnancy prolongation in pre-eclampsia has only a limited effect on postpartum maternal cardiovascular function.


Assuntos
Pré-Eclâmpsia/prevenção & controle , Gravidez Prolongada , Cuidado Pré-Natal , Transtornos Puerperais/epidemiologia , Adulto , Albuminúria , Feminino , Humanos , Síndrome Metabólica , Países Baixos/epidemiologia , Paridade , Gravidez , Transtornos Puerperais/etiologia , Análise de Regressão , Fatores de Risco
2.
Rev Esp Anestesiol Reanim ; 67(9): 511-515, 2020 11.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33036761

RESUMO

We describe the case of a 24-year-old pregnant woman with no history of note who was admitted with a diagnosis of bilateral pneumonia caused by the new coronavirus. Due to clinical worsening, she required urgent cesarean section with general anaesthesia and intubation for decubitus intolerance. After extubation, she presented altered mental state that required a differential diagnosis of encephalitis/meningitis secondary to SARS-CoV-2. CT and CT-angiography were normal, spinal fluid tests were non-specific, and magnetic resonance imaging reported posterior reversible encephalopathy syndrome (PRES) (due to radiological features suggestive of white matter vasogenic edema affecting the parietal, temporal and occipital lobes, along with altered mental state) secondary to gestational hypertension. Eleven days after the cesarean section the patient began to develop hypertension that required treatment. PRES is associated with certain clinical (headache, altered mental state, visual disturbances and convulsions) and radiological (reversible changes in white substance mainly affecting the parietal, temporal, and occipital lobes) characteristics suggestive of vasogenic oedema In pregnant SARS-CoV-2 patients, the differential diagnosis of hypertension and altered mental state is often extremely complicated because complementary tests can be normal and there is no immediate sign of peripartum hypertension. SARS-CoV-2 genome sequencing in spinal fluid could have provided a definitive diagnosis, but the treatment would not have differed.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Síndrome da Leucoencefalopatia Posterior/etiologia , Complicações Infecciosas na Gravidez , Transtornos Puerperais/etiologia , Técnicas de Laboratório Clínico , Transtornos da Consciência/diagnóstico por imagem , Transtornos da Consciência/etiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética , Pandemias , Pneumonia Viral/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Gravidez , Transtornos Puerperais/diagnóstico por imagem , Adulto Jovem
3.
PLoS One ; 15(8): e0237510, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32810155

RESUMO

Periodontitis is a highly prevalent condition leading to a continuous destruction of tooth-supporting tissues. It increases the risk for various systemic diseases and adverse pregnancy outcomes. Therefore, screening for periodontitis is important. Screening measures can range from self-reported symptoms to clinical full-mouth periodontal examination. The hypothesis of our study was that self-reported parameters and clinical definition perform equally well in identifying periodontitis patients. The aim of this study was to develop, validate its internal consistency, and evaluate a self-reported instrument against periodontal clinical evaluation for diagnosis of periodontitis in a group of postpartum women, as well as to describe their periodontal status and the risk factors associated with periodontal disease. A cross-sectional study on postpartum women was conducted in a tertiary university hospital, from April 2018 to March 2019. Sociodemographic and behavioral data, periodontal clinical parameters, and self-reported periodontal perception were collected. A 16-item questionnaire was developed to obtain information about perceived periodontal alterations and oral hygiene habits. The utility of the questionnaire was tested against a periodontal diagnosis based on a full-mouth periodontal examination. The questionnaire was applied in 215 postpartum women aged 29.16±5.54 years (mean age (y) ± standard deviation) having the following periodontal status: 16 individuals without periodontal disease (7.44%), 32 individuals with gingivitis (14.88%), 19 individuals with mild periodontitis (8.84%), 132 individuals with moderate periodontitis (61.39%), and 16 individuals with severe periodontitis (7.44%). A significant association was observed between oral hygiene score, smoking status, and periodontal conditions (p<0.05). A significant association between the self-reported items related to "gum swelling", "halitosis", "previous periodontal diagnosis" and "previous periodontal treatment" with clinical periodontitis have been identified (p<0.05). Using self-reported questionnaires for detection of periodontal disease was ineffective in our studied population, since self-reported parameters and clinical definition do not appear to perform equally in identifying periodontitis cases. Clinical periodontal examination remains the gold standard for screening. Periodontitis was frequent in our group and the severity was significantly associated with the oral hygiene score and smoking. These results underline the necessity for periodontal clinical examination during pregnancy.


Assuntos
Doenças Periodontais/epidemiologia , Doenças Periodontais/etiologia , Transtornos Puerperais/epidemiologia , Transtornos Puerperais/etiologia , Autorrelato , Adolescente , Adulto , Estudos Transversais , Europa Oriental/epidemiologia , Feminino , Gengivite/epidemiologia , Gengivite/etiologia , Halitose/epidemiologia , Halitose/etiologia , Humanos , Higiene Bucal/estatística & dados numéricos , Periodontite/epidemiologia , Periodontite/etiologia , Período Pós-Parto , Gravidez , Prevalência , Fatores de Risco , Romênia/epidemiologia , Autorrelato/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
5.
Anaesth Crit Care Pain Med ; 39(3): 351-353, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32437961
6.
World Neurosurg ; 139: 215-218, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32304887

RESUMO

BACKGROUND: The American Stroke Association and the European Stroke Organization have established guidelines on cerebral venous thrombosis (CVT); however, questions remain when an individual case does not fall within the inclusion criteria on which these guidelines are based. This is relevant when considering the use of anticoagulation in cases of CVT regarding whether or not associated hemorrhage is present and whether the hemorrhage is currently expanding. CASE DESCRIPTION: A 16-year-old right-handed female G2P2 (gravidity 2 [2 pregnancies] and parity 2 [2 live births after at least 24 weeks) presented 8 days postpartum with complaints of slurred speech, right facial droop, and right upper extremity numbness that had progressed over the course of 4 hours before presentation. On imaging the patient had a CVT with associated hemorrhage progressing in size at serial 6-hour stability computed tomography scans for 24 hours post arrival. At 24 hours the patient went into disseminated intravascular coagulation and demonstrated signs of herniation. The patient underwent an emergency hemicraniectomy along with a right frontal external ventricular drain for intracranial pressure monitoring. Most recently, the patient had a Glasgow Coma Scale score of 15 and had a modified Rankin Scale score of 4 and was ultimately discovered to have antiphospholipid syndrome. CONCLUSIONS: This case of CVT demonstrates the need for critically reading guidelines, as in this case the time to anticoagulation treatment was shorter than in cases included in guideline construction and repeated computed tomography examination demonstrated expansion suggesting it is unsuitable for immediate anticoagulation. Certain cases may fall outside of the study parameters on which guidelines are constructed, and clinicians should be aware of these exceptions.


Assuntos
Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/diagnóstico , Veias Cerebrais/diagnóstico por imagem , Craniectomia Descompressiva/métodos , Coagulação Intravascular Disseminada/diagnóstico , Hemorragias Intracranianas/diagnóstico por imagem , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/terapia , Transtornos Puerperais/diagnóstico por imagem , Transtornos Puerperais/terapia , Adolescente , Síndrome Antifosfolipídica/complicações , Angiografia por Tomografia Computadorizada , Progressão da Doença , Coagulação Intravascular Disseminada/etiologia , Coagulação Intravascular Disseminada/terapia , Feminino , Humanos , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/terapia , Trombose Intracraniana/etiologia , Guias de Prática Clínica como Assunto , Transtornos Puerperais/etiologia , Tomografia Computadorizada por Raios X , Ventriculostomia
7.
Ann Rheum Dis ; 79(7): 929-934, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32299794

RESUMO

OBJECTIVES: Bone marrow oedema (BMO) on MRI of sacroiliac joints (SIJs) represents a hallmark of axial spondyloarthritis (SpA), yet such lesions may also occur under augmented mechanical stress in healthy subjects. We therefore sought to delineate the relationship between pregnancy/delivery and pelvic stress through a prospective study with repeated MRI. Results were matched with maternal, child and birth characteristics. METHODS: Thirty-five women underwent a baseline MRI-SIJ within the first 10 days after giving birth. MRI was repeated after 6 months and, if positive for sacroiliitis according to the Assessment of SpondyloArthritis International Society (ASAS) definition, after 12 months. BMO and structural lesions were scored by three trained readers using the Spondyloarthritis Research Consortium of Canada (SPARCC) method. RESULTS: Seventy-seven per cent of the subjects (27/35) displayed sacroiliac BMO immediately postpartum, 60% fulfilled the ASAS definition of a positive MRI. After 6 months, 46% of the subjects (15/33) still showed BMO, representing 15% (5/33) with a positive MRI. After 12 months, MRI was still positive in 12% of the subjects (4/33). Few structural lesions were detected. Intriguingly, in this study, the presence of BMO was related to a shorter duration of labour and lack of epidural anaesthesia. CONCLUSION: A surprisingly high prevalence of sacroiliac BMO occurs in women immediately postpartum. Our data reveal a need for a waiting period of at least 6 months to perform an MRI-SIJ in postpartum women with back pain. This study also underscores the importance of interpreting MRI-SIJ findings in the appropriate clinical context.


Assuntos
Parto Obstétrico/efeitos adversos , Imagem por Ressonância Magnética/métodos , Transtornos Puerperais/epidemiologia , Sacroileíte/epidemiologia , Adulto , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/etiologia , Doenças da Medula Óssea/diagnóstico por imagem , Doenças da Medula Óssea/epidemiologia , Doenças da Medula Óssea/etiologia , Canadá/epidemiologia , Diagnóstico Diferencial , Edema/diagnóstico por imagem , Edema/epidemiologia , Edema/etiologia , Feminino , Humanos , Parto/fisiologia , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/fisiopatologia , Período Pós-Parto , Gravidez , Prevalência , Estudos Prospectivos , Transtornos Puerperais/diagnóstico por imagem , Transtornos Puerperais/etiologia , Sacroileíte/diagnóstico por imagem , Sacroileíte/etiologia , Estresse Fisiológico
8.
Artigo em Inglês | MEDLINE | ID: mdl-32121561

RESUMO

A birth experience with cesarean section (CS) can be a cause of the development of post-traumatic stress disorder after a cesarean (PTSD-AC) or profile PTSD, for a percentage of women. So far, there is no data on the frequency of PTSD-AC in Greece and this syndrome is often associated with other mental disorders of the postpartum period. The purpose of this research is to associate the kind of CS with PTSD-AC for Greek mothers and the combination of factors that make them less resistant to trauma. A sample of ahundred and sixty-six mothers who gave birth with emergency cesarean section (EMCS) and elective cesarean section (ELCS) at a Greek University hospital have consented to participate in the two phases of the survey, in the 2nd day postpartum and a follow-up in the 6th week postpartum. Medical/demographic data and a life events checklist (LEC-5) with Criterion A and post-traumatic stress checklist (PCL-5) were used to diagnose PTSD and PTSD Profile. Out of166 mothers enrolled, 160 replied to the follow-up (96.4%), ELCS 97 (97%) and EMCS 63 (95%). Twenty (31.7%) EMCS had PTSD and nine (14.3%) had Profile. One (1%) ELCS had PTSD and 4 (4.1%) had Profile. This survey shows a high prevalence rate of PTSD after EMCS with additional risk factors of preterm labor, inclusion in the Neonatal Intensive Care Unit (NICU), a lack of breastfeeding, and a lack of support from the partner.


Assuntos
Cesárea/psicologia , Procedimentos Cirúrgicos Eletivos/psicologia , Emergências/psicologia , Transtornos Puerperais/etiologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Adulto , Cesárea/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Seguimentos , Grécia/epidemiologia , Humanos , Gravidez , Prevalência , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/epidemiologia , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologia
9.
Am J Obstet Gynecol ; 223(3): 427.e1-427.e14, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32112729

RESUMO

BACKGROUND: Stillbirth is a devastating adverse pregnancy outcome that may occur without any obvious reason or may occur in the context of fetal growth restriction, preeclampsia, or other obstetric complications. There is increasing evidence that women who experience stillbirths are at greater risk of long-term cardiovascular disease, but little is known about their risk of chronic kidney disease and end-stage renal disease. We conducted the largest study to date to investigate the subsequent risk of maternal chronic kidney disease and end-stage renal disease following stillbirth. OBJECTIVE: To identify whether pregnancy complicated by stillbirth is associated with subsequent risk of maternal chronic kidney disease and end-stage renal disease, independent of underlying medical or obstetric comorbidities. STUDY DESIGN/METHODS: We conducted a population-based cohort study using nationwide data from the Swedish Medical Birth Register, National Patient Register, and Swedish Renal Register. We included all women who had live births and stillbirths from 1973 to 2012, with follow-up to 2013. Women with preexisting renal disease were excluded. Cox proportional hazard regression models were used to estimate adjusted hazard ratios and 95% confidence intervals for associations between stillbirth and maternal chronic kidney disease and end-stage renal disease respectively. We controlled for maternal age, year of delivery, country of origin, parity, body mass index, smoking, gestational diabetes, preeclampsia, and small for gestational age deliveries. Women who had a history of medical comorbidities, which may predispose to renal disease (prepregnancy cardiovascular disease, hypertension, diabetes, lupus, systemic sclerosis, hemoglobinopathy, or coagulopathy), were excluded from the main analysis and examined separately. RESULTS: There were 1,941,057 unique women who had 3,755,444 singleton pregnancies, followed up over 42,313,758 person-years. The median follow-up time was 20.7 years (interquartile range, 9.9-30.0 years). 13,032 women (0.7%) had at least 1 stillbirth. Women who had experienced at least 1 stillbirth had a greater risk of developing chronic kidney disease (adjusted hazard ratio, 1.26; 95% confidence interval, 1.09-1.45) and end-stage renal disease (adjusted hazard ratio, 2.25; 95% confidence interval, 1.55-3.25) compared with women who only had live births. These associations persisted after removing all stillbirths that occurred in the context of preeclampsia, and small for gestational age or congenital malformations (for chronic kidney disease, adjusted hazard ratio, 1.33; 95% confidence interval, 1.13-1.57; for end-stage renal disease, adjusted hazard ratio, 2.95; 95% confidence interval, CI 1.86-4.68). There was no significant association observed between stillbirth and either chronic kidney disease or end-stage renal disease in women who had preexisting medical comorbidities (chronic kidney disease, adjusted hazard ratio, 1.13; 95% confidence interval, 0.73-1.75 or end-stage renal disease, adjusted hazard ratio, 1.49; 95% confidence interval, 0.78-2.85). CONCLUSION: Women who have a history of stillbirth may be at increased risk of chronic kidney disease and end-stage renal disease compared with women who have only had live births. This association persists independently of preeclampsia, and small for gestational age, maternal smoking, obesity, and medical comorbidities. Further research is required to determine whether affected women would benefit from closer surveillance and follow-up for future renal disease.


Assuntos
Transtornos Puerperais/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Natimorto , Adulto , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Gravidez , Transtornos Puerperais/etiologia , Sistema de Registros , Insuficiência Renal Crônica/etiologia , Fatores de Risco , Suécia/epidemiologia
10.
Anaesthesia ; 75(7): 913-919, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32115697

RESUMO

Serious neurological lesions such as vertebral canal haematoma are rare after obstetric regional analgesia/anaesthesia, but early detection may be crucial to avoid permanent damage. This may be hampered by the variable and sometimes prolonged recovery following 'normal' neuraxial block, such that an underlying lesion may easily be missed. These guidelines make recommendations for the monitoring of recovery from obstetric neuraxial block, and escalation should recovery be delayed or new symptoms develop, with the aim of preventing serious neurological morbidity.


Assuntos
Analgesia Obstétrica/métodos , Anestesia Obstétrica/métodos , Monitorização Neurofisiológica/métodos , Analgesia Epidural/efeitos adversos , Analgesia Epidural/métodos , Analgesia Epidural/normas , Analgesia Obstétrica/efeitos adversos , Analgesia Obstétrica/normas , Período de Recuperação da Anestesia , Anestesia por Condução/efeitos adversos , Anestesia por Condução/métodos , Anestesia por Condução/normas , Anestesia Obstétrica/efeitos adversos , Anestesia Obstétrica/normas , Feminino , Hematoma Epidural Espinal/diagnóstico , Hematoma Epidural Espinal/etiologia , Humanos , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/etiologia , Monitorização Neurofisiológica/normas , Segurança do Paciente , Cuidado Pós-Natal/métodos , Cuidado Pós-Natal/normas , Gravidez , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/etiologia , Fatores de Risco
12.
Eur J Obstet Gynecol Reprod Biol ; 245: 45-50, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31851895

RESUMO

OBJECTIVE: The objective of this study is to estimate the prevalence of dyspareunia and stress urinary incontinence (SUI) during pregnancy and after delivery, in addition to evaluating possible associated risk factors. STUDY DESIGN: A cross-sectional study was conducted in 2016 with the target population being women who had given birth within the previous 12 months (n = 6436) in Galicia (Spain). Information was collected regarding the mother's status 6 months before pregnancy, during pregnancy, at the time of delivery, and at the time of the survey. The prevalence of SUI and dyspareunia were estimated and regression models were performed to identify variables associated with both pathologies. RESULTS: The prevalence of SUI and dyspareunia after delivery were 20.4 % (CI95 %: 19.2-22.0) and 23.4 % (22.3-24.8), respectively. The presence of dyspareunia during pregnancy (adjusted prevalence ratio PR 2.1), breastfeeding (PR 1.2), and having a history of episiotomy (PR 1.3) were all variables associated with the presence of dyspareunia after delivery. SUI after delivery was related to the mother's history of SUI before pregnancy (PR 2.4) and during pregnancy (PR 2.0), as well as having undergone vaginal delivery (PR 2.0). CONCLUSION: Knowing which factors are associated with the manifestation of SUI and dyspareunia in women after delivery is useful for identifying susceptible or "at risk" patients. These variables should be included in the clinical history of every pregnant woman.


Assuntos
Dispareunia/epidemiologia , Complicações na Gravidez/epidemiologia , Transtornos Puerperais/epidemiologia , Incontinência Urinária por Estresse/epidemiologia , Adolescente , Adulto , Estudos Transversais , Parto Obstétrico/efeitos adversos , Dispareunia/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Complicações na Gravidez/etiologia , Prevalência , Transtornos Puerperais/etiologia , Análise de Regressão , Fatores de Risco , Espanha/epidemiologia , Incontinência Urinária por Estresse/etiologia , Adulto Jovem
14.
Am J Perinatol ; 37(4): 398-408, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-30780187

RESUMO

OBJECTIVE: The burden of preeclampsia severity on the health of mothers and infants during the first year after delivery is unclear, given the lack of population-based longitudinal studies in the United States. STUDY DESIGN: We assessed maternal and infant adverse outcomes during the first year after delivery using population-based hospital discharge information merged with vital statistics and birth certificates of 2,021,013 linked maternal-infant births in California. We calculated sampling weights using the National Center for Health Statistics data to adjust for observed differences in maternal characteristics between California and the rest of the United States. Separately, we estimated the association between preeclampsia and gestational age and examined collider bias in models of preeclampsia and maternal and infant adverse outcomes. RESULTS: Compared with women without preeclampsia, women with mild and severe preeclampsia delivered 0.66 weeks (95% confidence interval [CI]: 0.64, 0.68) and 2.74 weeks (95% CI: 2.72, 2.77) earlier, respectively. Mild preeclampsia was associated with an increased risk of having any maternal adverse outcome (relative risk [RR] = 1.95; 95% CI: 1.93, 1.97), as was severe preeclampsia (RR = 2.80; 95% CI: 2.78, 2.82). The risk of an infant adverse outcome was increased for severe preeclampsia (RR = 2.15; 95% CI: 2.14, 2.17) but only marginally for mild preeclampsia (RR = 0.99; 95% CI: 0.98, 1). Collider bias produced an inverse association for mild preeclampsia and attenuated the association for severe preeclampsia in models for any infant adverse outcome. CONCLUSION: Using multiple datasets, we estimated that severe preeclampsia is associated with a higher risk of maternal and infant adverse outcomes compared with mild preeclampsia, including an earlier preterm delivery.


Assuntos
Doenças do Recém-Nascido/etiologia , Pré-Eclâmpsia , Nascimento Prematuro , Transtornos Puerperais/etiologia , Conjuntos de Dados como Assunto , Feminino , Seguimentos , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Gravidez , Complicações na Gravidez , Resultado da Gravidez , Fatores de Risco , Estados Unidos
16.
J Matern Fetal Neonatal Med ; 33(4): 606-611, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29985075

RESUMO

Objective: The objective was to investigate the association between blood loss at delivery and physical and mental fatigue during the first 12 weeks postpartum. We also investigated the association between hemoglobin and postpartum fatigue.Methods: We performed a single center prospective longitudinal study of healthy women with a singleton delivery. Women completed the Multidimensional Fatigue Inventory and Edinburgh Postnatal Depression Scale at 3 and 7 d, 3, 8 and 12 weeks postpartum. The hemoglobin level was measured at inclusion (baseline).Results: A total of 196 women with blood loss at delivery ranging from 100 to 2800 mL were included in the study. At 12 weeks follow-up the response rate was 92% (n = 181). We found a significant association between blood loss and scores of physical and mental fatigue within the first week postpartum. When adjusted for bleeding, hemoglobin measured at inclusion was not associated with fatigue at any given time point.Conclusions: The amount of measured blood loss was significantly associated with increased physical and mental fatigue in the first week postpartum. When adjusted for bleeding, baseline hemoglobin was no longer associated with physical and mental fatigue.


Assuntos
Perda Sanguínea Cirúrgica/estatística & dados numéricos , Parto Obstétrico/efeitos adversos , Fadiga/etiologia , Hemoglobinas/metabolismo , Transtornos Puerperais/etiologia , Adulto , Fadiga/metabolismo , Feminino , Humanos , Estudos Longitudinais , Gravidez , Estudos Prospectivos , Transtornos Puerperais/metabolismo
17.
Am J Perinatol ; 37(4): 436-452, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-30818401

RESUMO

OBJECTIVE: This study aimed to develop a core outcome set of primary outcomes for studies involving cesarean deliveries with infectious morbidity outcomes. STUDY DESIGN: Authors reported primary outcomes from 11 Cochrane systematic reviews (SRs), 12 other SRs, and 327 randomized controlled trials (RCTs). These outcomes were condensed into 20 primary outcome groups. Next, a modified Delphi technique was used to gain consensus on key outcomes. Authors from included SRs were sent a questionnaire consisting of a free response and multiple-choice questions. These data were used to propose a set of core outcomes. RESULTS: The most frequent outcomes in RCTs were composite "infectious outcomes" (24%) with the second most common being endometritis (12%). The most common reported SR outcomes were wound infection (21%) and endometritis (16%). For the Delphi survey free response portion, wound infection (88%) and endometritis (79%) were the most commonly endorsed outcomes. Chosen list outcomes were maternal mortality (83%), wound infection (83%), wound complications (86%), and postpartum endometritis (80%). The proposed final core outcome set for cesarean trials was endometritis (primary outcome), maternal mortality, wound infection, wound complications, febrile morbidity, and neonatal morbidity. CONCLUSION: Utilizing defined core outcomes in all studies of cesarean section can harmonize trial reports and allow data synthesis for meta-analyses.


Assuntos
Cesárea/efeitos adversos , Endometrite/etiologia , Transtornos Puerperais/etiologia , Infecção Puerperal/etiologia , Infecção da Ferida Cirúrgica/etiologia , Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Técnica Delfos , Feminino , Febre/etiologia , Humanos , Recém-Nascido , Masculino , Sepse Neonatal/etiologia , Gravidez , Revisões Sistemáticas como Assunto
18.
Am J Perinatol ; 37(5): 453-460, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31529451

RESUMO

OBJECTIVE: Our primary objective was to identify risk factors for maternal readmission with sepsis. Our secondary objectives were to (1) assess diagnoses and infecting organisms at readmission and (2) compare early (<6 weeks) and late (6 weeks to 9 months postpartum) maternal readmission with sepsis. STUDY DESIGN: We identified our cohort using linked hospital discharge data and birth certificates for California deliveries from 2008 to 2011. Consistent with the 2016 sepsis classification, we defined sepsis as septicemia plus acute organ dysfunction. We compared women with early or late readmission with sepsis to women without readmission with sepsis. RESULTS: Among 1,880,264 women, 494 (0.03%) were readmitted with sepsis, 61% after 6 weeks. Risk factors for readmission with sepsis included preterm birth, hemorrhage, obesity, government-provided insurance, and primary cesarean. For both early and late sepsis readmissions, the most common diagnoses were urinary tract infection and pyelonephritis, and the most frequently identified infecting organism was gram-negative bacteria. Women with early compared with late readmission with sepsis shared similar obstetric characteristics. CONCLUSION: Maternal risk factors for both early and late readmission with sepsis included demographic characteristics, cesarean, hemorrhage, and preterm birth. Risks for sepsis after delivery persist beyond the traditional postpartum period of 6 weeks.


Assuntos
Readmissão do Paciente/estatística & dados numéricos , Transtornos Puerperais/epidemiologia , Sepse/epidemiologia , Adulto , Índice de Massa Corporal , California/epidemiologia , Cesárea/efeitos adversos , Feminino , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/epidemiologia , Humanos , Insuficiência de Múltiplos Órgãos/epidemiologia , Insuficiência de Múltiplos Órgãos/etiologia , Hemorragia Pós-Parto , Nascimento Prematuro , Transtornos Puerperais/etnologia , Transtornos Puerperais/etiologia , Fatores de Risco , Sepse/etnologia , Sepse/etiologia , Fatores Socioeconômicos , Fatores de Tempo
19.
J Perinatol ; 40(1): 25-29, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31462721

RESUMO

OBJECTIVE: To determine the rate, maternal characteristics, timing, and indicators of severe maternal morbidity (SMM) that occurs at postpartum readmission. STUDY DESIGN: Women with a birth in California during 2008-2012 were included in the analysis. Readmissions up to 42 days after delivery were investigated. SMM was defined as presence of any of the 21 indicators defined by ICD-9 codes. RESULTS: Among 2,413,943 women with a birth, SMM at readmission occurred in 4229 women. Of all SMM, 12.1% occurred at readmission. Over half (53.5%) of the readmissions with SMM occurred within the first week after delivery hospitalization. The most common indicators of SMM were blood transfusion, sepsis, and pulmonary edema/acute heart failure. CONCLUSION: Twelve percent of SMM was identified at readmission with the majority occurring within 1 week after discharge from delivery hospitalization. Because early readmission may reflect lack of discharge readiness, there may be opportunities to improve care.


Assuntos
Readmissão do Paciente/estatística & dados numéricos , Transtornos Puerperais/epidemiologia , Doença Aguda , Adulto , Transfusão de Sangue/estatística & dados numéricos , California/epidemiologia , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Gravidez , Complicações na Gravidez , Transtornos Puerperais/etiologia , Edema Pulmonar/epidemiologia
20.
Int Breastfeed J ; 14: 46, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31708997

RESUMO

Background: We aimed to investigate the association of breastfeeding on postpartum glucose levels and lipid profiles in women diagnosed with gestational diabetes mellitus (GDM) and women without GDM. Methods: We performed a secondary analysis of a cohort study of 243 women, 159 women with GDM and 84 normally glucose tolerant women between 2012 and 2017. At approximately 6-10 weeks postpartum, we measured fasting blood glucose and plasma lipid levels. Breastfeeding behaviour was self-defined as exclusive breastfeeding or not exclusive breastfeeding. Results: The mean (SD) glucose in the group of women who breastfed exclusively was 4.6 (0.49) mmol/L, compared to 4.9 (0.58) mmol/L (95% CI 0.45, 0.15, p <  0.001) among women who did not exclusively breastfeed. Among women with GDM, the reduction in fasting glucose in women who were breastfeeding was 0.22 mmol/L (95% CI 0.39, 0.05, p = 0.004), and in women who were not GDM, the reduction was 0.14 mmol/L (95% CI 0.37, 0.09, p = 0.24,). After adjustment for GDM status in pregnancy, maternal body mass index (BMI), maternal age and ethnicity, and exclusive breastfeeding was associated with a decreased fasting glucose of 0.19 (95% CI 0.318, 0.061, p = 0.004). After similar adjustment, there was no significant difference in triglycerides, high density lipoprotein cholesterol or low-density lipoprotein cholesterol between women who were breastfeeding and women who were not breastfeeding. Conclusions: Breastfeeding is associated with a reduction in fasting glucose levels postpartum, but not maternal lipid profile. Breastfeeding may play a role in reducing glucose intolerance in women who have had GDM.


Assuntos
Aleitamento Materno , Diabetes Gestacional , Intolerância à Glucose/etiologia , Adulto , Glicemia , HDL-Colesterol/sangue , Estudos de Coortes , Feminino , Intolerância à Glucose/sangue , Teste de Tolerância a Glucose , Humanos , Recém-Nascido , Gravidez , Cuidado Pré-Natal , Transtornos Puerperais/sangue , Transtornos Puerperais/etiologia , Triglicerídeos/sangue
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