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1.
Isr Med Assoc J ; 22(3): 142-147, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32147977

RESUMO

BACKGROUND: Admission to an intensive care unit (ICU) is an objective marker of severe maternal morbidity (SMM). OBJECTIVES: To determine the prevalence of obstetric ICU admissions in one medical center in Israel and to characterize this population. METHODS: In this retrospective study the files of women coded for pregnancy, birth, or the perinatal period and admission to the ICU were pulled for data extraction (2005-2013). RESULTS: During the study period, 111 women were admitted to the ICU among 120,279 women who delivered babies (0.09%). Their average age was 30 ± 6 years, most were multigravida, a few had undergone fertility treatments, and only 27% had complicated previous pregnancies. Most pregnancies (71.2%) were uneventful prior to admission. ICU admissions were divided equally between direct (usually hemorrhage) and indirect (usually cardiac disease) obstetric causes. CONCLUSIONS: The indications for obstetrics ICU admission correlated with the proximate causes of maternal arrest observed worldwide. While obstetric hemorrhage is often unpredictable, deterioration of heart disease is foreseeable. Attention should be directed specifically toward improving the diagnosis and treatment of maternal heart disease during pregnancy in Israel.


Assuntos
Cuidados Críticos/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Transtornos Puerperais/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Cuidados Críticos/métodos , Feminino , Humanos , Unidades de Terapia Intensiva , Israel/epidemiologia , Cuidado Pós-Natal/métodos , Gravidez , Complicações na Gravidez/terapia , Prevalência , Transtornos Puerperais/terapia , Estudos Retrospectivos , Fatores de Risco
4.
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.
J Manipulative Physiol Ther ; 42(8): 601-607, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31864519

RESUMO

OBJECTIVE: The purpose of this study was to investigate the feasibility of conducting a study examining the influence of individualized rehabilitation and chiropractic treatment, compared with individualized rehabilitation alone, in women with persistent dominating 1-sided pelvic girdle pain (PGP) 3 to 6 months after delivery. METHODS: Women were recruited from an outpatient clinic at Stavanger University Hospital, Norway and in a private chiropractic clinic in Stavanger. Those with persistent, dominating 1-sided PGP were included in this pilot study. Those who met inclusion criteria were randomized into 2 groups, one group received individualized rehabilitation and chiropractic treatment and the other group women received individualized rehabilitation alone. Treatment was measured for 20 weeks. RESULTS: Of 330 consenting women who were recruited who reported pelvic pain during pregnancy, 68 reported PGP or low back pain, and 63 consented to fill in a questionnaire. Forty-seven women underwent a clinical examination 3 to 6 months after delivery. During the examination, the women were diagnosed into subgroups for PGP. After exclusion of the women with low back pain only, a total of 13 women were diagnosed with dominating 1-sided PGP and thus included in this study. Six were randomized to the individualized rehabilitation and chiropractic treatment group and 5 to the individualized rehabilitation alone group. After 20 weeks of intervention, both groups reported improvement in disability and pain, but not in general health status. No serious or long-lasting adverse events were registered after treatment or training. CONCLUSION: We found that a study of this nature is feasible. However, the conditions of patient recruitment need to be considered carefully. We learned that a trial to investigate the effect of chiropractic treatment for PGP pain should include all subgroups of PGP to reach an acceptable sample size.


Assuntos
Dor Crônica/terapia , Terapia por Exercício , Manipulação Quiroprática , Dor da Cintura Pélvica/terapia , Adulto , Terapia Combinada , Avaliação da Deficiência , Feminino , Humanos , Medição da Dor , Projetos Piloto , Gravidez , Complicações na Gravidez , Transtornos Puerperais/terapia
7.
BMC Health Serv Res ; 19(1): 551, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387583

RESUMO

BACKGROUND: During pregnancy, childbirth and puerperium, women receive care from a range of health professionals, particularly midwives. To assess the current situation of maternity care for women with physical disabilities in Austria, this study investigated the perceptions and experiences of health professionals who have provided care for women with disabilities during pregnancy, childbirth and postpartum. METHODS: The viewpoints of the participating health professionals were evaluated by means of semistructured interviews followed by an inductive qualitative content analysis of the interview transcripts, as proposed by Mayring. RESULTS: Four main categories emerged from the inductive content analysis: (i) structural conditions and accessibility, (ii) interprofessional teamwork and cooperation, (iii) action competence, and (iv) diversity-sensitive attitudes. According to the participating health professionals, the structural conditions were frequently not suitable for providing targeted group-oriented care services. Additionally, a shortage of time and staff resources also limited the necessary flexibility of treatment measures in the care of mothers with physical disabilities. The importance of interprofessional teamwork for providing adequate care was highlighted. The health professionals regarded interprofessionalism as an instrument of quality assurance and team meetings as an elementary component of high-quality care. On the other hand, the interviewees perceived a lack of action competence that was attributed to a low number of cases and a corresponding lack of experience and routine. Regarding diversity-sensitive attitudes, it became apparent that the topic of mothers with physical disabilities in care posed challenges to health professionals that influenced their natural handling of the interactions. CONCLUSION: The awareness of one's own attitudes towards diversity, in the perinatal context in particular, influences professional security and sovereignty as well as the quality of care of women with disabilities. There is a need for optimization in the support and care of women with physical disabilities during pregnancy, childbirth and puerperium.


Assuntos
Atitude do Pessoal de Saúde , Pessoas com Deficiência , Pessoal de Saúde/psicologia , Cuidado Pré-Natal/normas , Adolescente , Adulto , Áustria , Feminino , Humanos , Relações Interprofissionais , Pessoa de Meia-Idade , Tocologia , Mães/psicologia , Complicações do Trabalho de Parto/terapia , Gravidez , Complicações na Gravidez/terapia , Transtornos Puerperais/terapia , Pesquisa Qualitativa , Adulto Jovem
8.
Medicine (Baltimore) ; 98(24): e16052, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31192964

RESUMO

RATIONALE: Postpartum deep vein thrombosis is a unique condition in diagnosis and treatment. Rivaroxaban, a novel oral anticoagulant, is indicated for acute deep vein thrombosis, but limited data have been reported for postpartum women. Catheter-directed thrombolysis is a common procedure for treating acute deep vein thrombosis, but it is rarely used for postpartum patients, especially after more than 3 months. PATIENT CONCERNS: A 31-year-old Asian woman suffered from progressive erythematous swelling and local heat of the left lower limb after twin delivery. DIAGNOSES: Venous duplex ultrasound examination showed thrombus formation in the left femoral vein and popliteal vein with reduced compressibility. After standard treatment of novel oral anticoagulant therapy for 4 months, we observed only partial improvement of the symptoms, and the condition deteriorated after her ordinary activities. INTERVENTIONS: Venography was performed and a large amount of thrombus lining from left femoral vein to left iliac vein was noted with total occluded left common iliac vein. After catheter-directed thrombolysis and balloon dilatation, better flow was regained and her symptoms improved completely after procedure. OUTCOMES: During a 1-year follow-up without medication, the patient did not complain about leg swelling, exercise aggravation, or any other post-thrombotic symptoms. LESSONS: Pregnancy seems to be a transient provoking factor for deep vein thrombosis, but it is sometimes refractory even during the postpartum period.Follow-up imaging studies should be encouraged to confirm the vessel condition, particularly for applying down-titration or discontinuation strategies of medication.Catheter-directed thrombolysis could be considered as an alternative method for postpartum iliofemoral deep vein thrombosis. Postpartum women usually have favorable functional status and lower bleeding risk.Rivaroxaban is a favorable choice for deep vein thrombosis, but its use in postpartum women is still controversial, and evidence of its effectiveness is not available. Thus, endovascular intervention can be a relatively safe therapy, in addition to anticoagulation therapy for premenopausal patients with recurrent deep vein thrombosis.


Assuntos
Transtornos Puerperais/terapia , Terapia Trombolítica/métodos , Trombose Venosa/terapia , Adulto , Cateterismo , Feminino , Veia Femoral , Humanos , Veia Ilíaca , Período Pós-Parto , Transtornos Puerperais/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia
9.
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
10.
Asian J Psychiatr ; 43: 57-59, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31085437

RESUMO

Supportive counselling is an important part of the treatment process for perinatal mood disorders in KK Women's and Children's Hospital (KKH). This study aims to investigate the extent to which patients deem each component of supportive counselling important to their treatment and recovery process. Sixty-six patients seen during their pregnancy or postnatal period for anxiety or depressive disorders were surveyed at the point of their discharge. Patients were asked to rate on a four-point scale the importance they attributed to each of thirteen components of supportive counselling practised by the perinatal mental health team at KKH. Patients were also asked to identify the three most important components in their treatment experience. The final two survey questions assessed the effects of the treatment process on patients' perceived partner support and patients' optimism towards motherhood. Results corroborate the importance of building a trusting relationship between treatment providers and patients, providing empathic support while patients learn to accept the changes in their lives and engaging patients' partners in the treatment process. It is recommended that perinatal mental healthcare providers continue to build on the therapeutic effects of empathic understanding and engaging patients' partners in the treatment process.


Assuntos
Transtornos de Ansiedade/terapia , Aconselhamento , Transtorno Depressivo/terapia , Serviços de Saúde Materna , Serviços de Saúde Mental , Preferência do Paciente , Complicações na Gravidez/terapia , Relações Profissional-Paciente , Adulto , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Maternidades , Humanos , Pessoa de Meia-Idade , Gravidez , Transtornos Puerperais/terapia , Singapura , Cônjuges
11.
World Neurosurg ; 128: 434-437, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31121372

RESUMO

BACKGROUND: Venous malformations are classified as slow-flow vascular malformations. Coagulation abnormalities are known to be frequent among patients with venous malformations. We report a case of repeated intracranial hemorrhage after delivery, induced by coagulopathy associated with multiple venous malformations. CASE DESCRIPTION: A 28-year-old woman presented with left chronic subdural hematoma 1 month after successfully giving birth. She had a history of multiple venous malformations around the pubic region and hips. The hematoma was evacuated by burr hole surgery. Three hours later, her level of consciousness rapidly deteriorated and computed tomography showed acute epidural hematoma. The hematoma was removed immediately by craniotomy under general anesthesia. No bleeding points were apparent in the operative field. Continuous bleeding around the dura mater and subdural space were encountered, and hemostasis was not achieved by electrocoagulation. After using fresh frozen plasma, hemostasis was achieved. Level of consciousness and neurologic symptoms improved postoperatively. Magnetic resonance imaging revealed multiple venous malformations in bilateral lower extremities and the pelvis. Disseminated intravascular coagulopathy was diagnosed, and thrombomodulin and blood coagulation factor XIII were administered. She was discharged home without any neurologic deficits. CONCLUSIONS: The delivery activated localized intravascular coagulopathy in the venous malformations and induced chronic subdural hematoma. Surgical interventions then resulted in progression of the coagulopathy to disseminated intravascular coagulopathy, inducing acute epidural hematoma.


Assuntos
Coagulação Intravascular Disseminada/terapia , Fator XIII/uso terapêutico , Hemorragias Intracranianas/cirurgia , Hemorragia Pós-Operatória/terapia , Trombomodulina/uso terapêutico , Malformações Vasculares/diagnóstico por imagem , Adulto , Transtornos da Coagulação Sanguínea/complicações , Transtornos da Coagulação Sanguínea/terapia , Craniotomia , Coagulação Intravascular Disseminada/etiologia , Feminino , Hematoma Epidural Craniano/etiologia , Hematoma Epidural Craniano/cirurgia , Hematoma Subdural Crônico/etiologia , Hematoma Subdural Crônico/cirurgia , Hemostasia Cirúrgica , Humanos , Hemorragias Intracranianas/etiologia , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/diagnóstico por imagem , Pelve/irrigação sanguínea , Plasma , Hemorragia Pós-Operatória/etiologia , Transtornos Puerperais/terapia , Malformações Vasculares/complicações
12.
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
13.
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
14.
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
15.
Obesity (Silver Spring) ; 27(4): 535-541, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30900408

RESUMO

OBJECTIVE: This study aimed to assess the efficacy of a home-based lifestyle intervention delivered through Parents as Teachers (PAT), a national home-visiting organization, designed to minimize excessive weight gain through 12 months post partum in socioeconomically disadvantaged (SED) African American women with overweight or obesity. METHODS: This randomized controlled trial was conducted at a single center as part of the Lifestyle Interventions for Expectant Moms (LIFE-Moms) consortium. Analysis was conducted with 185 SED African American women (BMI 25.0-45.0 kg/m2 at pregnancy onset) retained from an original sample of 267 randomized to standard PAT or PAT+Lifestyle, which embedded lifestyle therapy within standard PAT delivered prenatally and for 12 months post partum. RESULTS: Compared with standard PAT, the PAT+Lifestyle group gained less weight (2.5 kg vs. 5.7 kg; P = 0.01) and were more likely to return to their baseline weight (38.0% vs. 21.5%; P = 0.01) from baseline to 12 months post partum. There were no differences between groups in cardiometabolic outcomes, indices of glycemic control and insulin sensitivity, and plasma lipid profile. The estimated cost of PAT+Lifestyle was $81 more to deliver per family than standard PAT. CONCLUSIONS: PAT+Lifestyle decreases weight gain during pregnancy through 12 months post partum in SED African American women with overweight or obesity at the start of pregnancy with minimal additional cost.


Assuntos
Terapia Comportamental/métodos , Obesidade/terapia , Sobrepeso/terapia , Cuidado Pós-Natal/métodos , Transtornos Puerperais/terapia , Populações Vulneráveis , Ganho de Peso , Adolescente , Adulto , Afro-Americanos , Terapia Comportamental/economia , Glicemia , Peso Corporal , Feminino , Serviços de Assistência Domiciliar , Humanos , Estilo de Vida , Pessoa de Meia-Idade , Período Pós-Parto/fisiologia , Gravidez , Complicações na Gravidez/terapia , Populações Vulneráveis/estatística & dados numéricos , Ganho de Peso/fisiologia , Adulto Jovem
16.
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
17.
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
18.
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
19.
J Obstet Gynaecol Res ; 45(6): 1127-1133, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30788889

RESUMO

AIM: Post-partum hematomas are a serious obstetrical complication. Choosing treatments for post-partum hematomas is difficult, and the application of transcatheter arterial embolization remains unclear. We aimed to clarify the clinical characteristics, identify the treatment indications and create a treatment algorithm for post-partum hematomas. METHODS: Fifty-four patients with post-partum hematomas were enrolled. Hematomas were categorized according to location: upper vaginal, lower vaginal and vulvar. Blood loss, treatment methods and other clinical data were collected from the patients' medical records and analyzed retrospectively. RESULTS: Five, 19 and 30 patients had upper vaginal wall, lower vaginal wall and vulvar hematomas, respectively. All upper vaginal wall hematomas required transcatheter arterial embolization to control bleeding, and the average blood loss was 2473 ± 1689 mL. Most lower vaginal wall hematomas were treated surgically; however, two patients required transcatheter arterial embolization, and the average blood loss in these patients was much higher (2010 ± 1145 mL) than that in patients with lower vaginal wall hematomas (395 ± 316 mL). No patient with vulvar hematomas was treated with transcatheter arterial embolization. Two and four patients with vulvar and lower vaginal wall hematomas, respectively, were managed with observation. CONCLUSION: We created an algorithm for post-partum hematoma management. Post-partum hematoma location should guide treatment selection. Transcatheter arterial embolization should be selected for upper vaginal wall hematomas. Most lower vaginal wall hematomas are treatable with surgery, but transcatheter arterial embolization should be considered for hemostasis in difficult cases. Management with observation may also be possible for lower vaginal wall and vulvar hematomas.


Assuntos
Algoritmos , Embolização Terapêutica/métodos , Procedimentos Cirúrgicos em Ginecologia/métodos , Hematoma/terapia , Complicações do Trabalho de Parto/terapia , Transtornos Puerperais/terapia , Doenças Vaginais/terapia , Doenças da Vulva/terapia , Adulto , Feminino , Hematoma/etiologia , Humanos , Gravidez , Transtornos Puerperais/etiologia , Doenças Vaginais/etiologia , Doenças da Vulva/etiologia
20.
Am J Obstet Gynecol ; 220(4): B2-B10, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30684460

RESUMO

Maternal sepsis is a significant cause of maternal morbidity and mortality and is a preventable cause of maternal death. The purpose of this guideline is to summarize what is known about sepsis and to provide guidance for the management of sepsis in pregnancy and the postpartum period. The following are SMFM recommendations: (1) we recommend that sepsis and septic shock be considered medical emergencies and that treatment and resuscitation begin immediately (GRADE 1B); (2) we recommend that providers consider the diagnosis of sepsis in pregnant patients with otherwise unexplained end-organ damage in the presence of an infectious process, regardless of the presence of fever (GRADE 1B); (3) we recommend that empiric broad-spectrum antibiotics be administered as soon as possible, ideally within 1 hour, in any pregnant woman in whom sepsis is suspected (GRADE 1B); (4) we recommend obtaining cultures (blood, urine, respiratory, and others as indicated) and serum lactate levels in pregnant or postpartum women in whom sepsis is suspected or identified, and early source control should be completed as soon as possible (GRADE 1C); (5) we recommend early administration of 1-2 L of crystalloid solutions in sepsis complicated by hypotension or suspected organ hypoperfusion (GRADE 1C); (6) we recommend the use of norepinephrine as the first-line vasopressor during pregnancy and the postpartum period in sepsis with persistent hypotension and/or hypoperfusion despite fluid resuscitation (GRADE 1C); (7) we recommend against immediate delivery for the sole indication of sepsis and that delivery should be dictated by obstetric indications (GRADE 1B).


Assuntos
Antibacterianos/uso terapêutico , Hidratação/métodos , Hipotensão/terapia , Complicações Infecciosas na Gravidez/terapia , Transtornos Puerperais/terapia , Sepse/terapia , Vasoconstritores/uso terapêutico , Soluções Cristaloides , Técnicas de Cultura , Parto Obstétrico , Feminino , Humanos , Hipotensão/etiologia , Ácido Láctico/sangue , Norepinefrina/uso terapêutico , Guias de Prática Clínica como Assunto , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Transtornos Puerperais/diagnóstico , Ressuscitação , Sepse/diagnóstico , Choque Séptico/diagnóstico , Choque Séptico/terapia
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