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1.
BMJ Case Rep ; 12(9)2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31570361

RESUMO

A 28-year-old woman suffered a traffic accident resulting in severe head injuries with deleterious prognosis. Diagnostics further revealed a hitherto unknown pregnancy, at suspected week 9. Based on the patient's wish to donate organs, brain death protocol confirmed irreversible loss of brain function. Yet, vital pregnancy rendered organ transplantation impossible. Multiple ethical and legal issues arose, from invalidation of established legal care after brain death to the delivery of a healthy child after trauma and long-term critical care. After medicolegal and ethical counselling, pregnancy was sustained, and the goal of organ donation postponed. Critical care focused on foetal homeostasis. At 30+4 weeks, a viable girl was born via assisted vaginal delivery. Postpartal organ donation resulted in heart, kidney and pancreas transplantation. The case emphasises the medical, legal and ethical challenges to combine two apparently diametrical goals: the successful full-term pregnancy and the fulfilment of a patient's wish to donate organs.


Assuntos
Morte Encefálica , Viabilidade Fetal/fisiologia , Cuidados para Prolongar a Vida/ética , Doadores Vivos/ética , Mães , Defesa do Paciente/ética , Cuidado Pré-Natal/ética , Obtenção de Tecidos e Órgãos/ética , Adulto , Diretivas Antecipadas , Aconselhamento , Cuidados Críticos , Feminino , Humanos , Cuidados para Prolongar a Vida/métodos , Direitos do Paciente/ética , Gravidez , Resultado da Gravidez , Cuidado Pré-Natal/métodos
5.
Theriogenology ; 138: 121-126, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31326658

RESUMO

Variable gestation length in the mare poses a challenge for determination of fetal readiness for birth. The objectives of this study were to describe sonographic characteristics of the fetal GI tract in the late gestation mare and identify changes that occur with progressing fetal maturity. Based on these characteristics, a grading scale modeled after the existing human and canine scoring system was developed. Weekly sonographic examination of the fetus by one observer beginning 2-3 weeks prior to a calculated due date of 330 days was performed. Fetal assessment included; presence of stomach rugae, bowel segment definition (uniform echogenic, some defined, clearly defined), bowel segment dilation (none, segmental dilation), intestinal contents (none, mixed echogenicity) and peristalsis (none, occasional, every 3 s, continuous). Based on these characteristics a phase was assigned to the GI tract (1-5). Phase 1 was defined as a uniform echogenic grey area caudal to the diaphragm. The differentiation of Phase 2-5 was based primarily on the frequency of peristalsis, with Phase 2 exhibiting no peristalsis, Phase 3 exhibiting occasional peristalsis, Phase 4 exhibiting peristalsis every 3 s and Phase 5 exhibiting continuous peristalsis. Only data from mares with a normal parturition and healthy foals were included in the statistics (N = 10). Associations amongst sonographic fetal GI characteristics and days prepartum were validated using a simulation-based bootstrap approach with 1000 replicates using Stata 14. Stomach rugae, peristalsis, intestinal contents, tail head relaxation and udder development were all highly correlated with days prepartum. Using a multiple linear regression model, tail head relaxation and peristalsis predicted days prepartum with a 95% CI ±â€¯6 days. The same model predicted days prepartum with a 95% CI ±â€¯4 days when day of gestation, tail head relaxation and peristalsis were included as variables. Based on these findings, characterization of the fetal GI tract could provide valuable information concerning the maturity of the equine fetus. Further studies are needed comparing high risk mares to normal mares before this information could be used with confidence in the clinical setting.


Assuntos
Cavalos , Intestinos/diagnóstico por imagem , Intestinos/embriologia , Ultrassonografia Pré-Natal/veterinária , Animais , Feminino , Desenvolvimento Fetal , Monitorização Fetal/veterinária , Maturidade dos Órgãos Fetais/fisiologia , Viabilidade Fetal , Feto/diagnóstico por imagem , Idade Gestacional , Cavalos/anatomia & histologia , Cavalos/embriologia , Intestinos/anatomia & histologia , Parto , Gravidez , Prognóstico
6.
Midwifery ; 76: 110-117, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31195219

RESUMO

OBJECTIVES: The research team aimed to understand women's lived experiences during pregnancies with poor prognosis following prenatal detection of Fetal Growth Restriction at the limits of viability (FGRLV). METHODS: Qualitative interviews with six women who had attended a specialist service following a prenatal diagnosis of FGRLV were conducted. The interview data were analysed using interpretative phenomenological analysis. FINDINGS: Three superordinate themes alongside thirteen subthemes were identified. Theme 1 described 'a fine line between supportive and unhelpful' care experiences. A second theme of 'understanding the situation and decisions to be made' described how women faced many uncertainties. The final theme of 'parental responsibility' reflected how women imagined their futures to have been, exploring their embodied parental role and connection to their unborn or young child. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Women highlighted the importance of maternal healthcare teams providing clear information and reassurance to them. They also reported that prior experiences were important to them in influencing their perception of that pregnancy. Furthermore, women reflected on their desperation for a positive outcome. Understanding these factors can enable maternal healthcare teams to facilitate informed decision-making and provide individualised emotional support for women. Our findings will enable maternal care teams to better support women in similar clinical situations.


Assuntos
Retardo do Crescimento Fetal/psicologia , Viabilidade Fetal , Gestantes/psicologia , Adulto , Feminino , Humanos , Entrevistas como Assunto/métodos , Acontecimentos que Mudam a Vida , Gravidez , Pesquisa Qualitativa , Medicina Estatal , Reino Unido
7.
Am J Physiol Endocrinol Metab ; 317(2): E261-E268, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31084500

RESUMO

Elucidating the mechanism underlying the transmission of metabolic disease to subsequent generations requires robust preclinical mouse breeding strategies. Western diets rich in fat and carbohydrates are contributing factors in the rise of diabetes and obesity rates worldwide. Therefore, determining the impact of Western diets consumed by parents on offspring and future generations is critical for understanding the perpetuation of these diseases. Specifically, epigenetic regulation and transgenerational inheritance of metabolic disease is an emerging field of study requiring robust murine models. However, a major challenge to transgenerational studies is offspring mortality, exacerbated by maternal stress during pregnancy. Here, we describe a challenge experienced in our metabolic research in Western diet-fed female mice leading to the loss of litters via pup mortality and cannibalism by the mother. Furthermore, our study evaluates various breeding schemes with pregnancy efficiency and refined husbandry techniques to overcome pup mortality and infanticide, to characterize dams' and pups' metabolic characteristics, and to determine the impact on physiology of dams under detailed breeding schemes.


Assuntos
Pesquisa Biomédica/tendências , Cruzamento/métodos , Viabilidade Fetal/fisiologia , Tamanho da Ninhada de Vivíparos/fisiologia , Doenças Metabólicas , Efeitos Tardios da Exposição Pré-Natal , Estresse Fisiológico/fisiologia , Criação de Animais Domésticos/métodos , Criação de Animais Domésticos/tendências , Animais , Pesquisa Biomédica/métodos , Dieta Ocidental , Metabolismo Energético/fisiologia , Epigênese Genética/fisiologia , Feminino , Masculino , Fenômenos Fisiológicos da Nutrição Materna , Doenças Metabólicas/genética , Doenças Metabólicas/mortalidade , Doenças Metabólicas/prevenção & controle , Camundongos , Camundongos Endogâmicos C57BL , Obesidade/etiologia , Obesidade/genética , Obesidade/metabolismo , Gravidez , Complicações na Gravidez/genética , Complicações na Gravidez/metabolismo , Complicações na Gravidez/mortalidade , Efeitos Tardios da Exposição Pré-Natal/genética , Efeitos Tardios da Exposição Pré-Natal/metabolismo , Efeitos Tardios da Exposição Pré-Natal/mortalidade
9.
Artigo em Inglês | MEDLINE | ID: mdl-30870741

RESUMO

In France, the frequency of premature rupture of the membranes (PROM) is 2%-3% before 37 weeks' gestation (level of evidence [LE] 2) and less than 1% before 34 weeks (LE2). Preterm delivery and intrauterine infection are the major complications of preterm PROM (PPROM) (LE2). Prolongation of the latency period is beneficial (LE2). Compared with other causes of preterm delivery, PPROM is associated with a clear excess risk of neonatal morbidity and mortality only in cases of intrauterine infection, which is linked to higher rates of in utero fetal death (LE3), early neonatal infection (LE2), and necrotizing enterocolitis (LE2). The diagnosis of PPROM is principally clinical (professional consensus). Tests to detect IGFBP-1 or PAMG-1 are recommended in cases of uncertainty (professional consensus). Hospitalization is recommended for women diagnosed with PPROM (professional consensus). Adequate evidence does not exist to support recommendations for or against initial tocolysis (Grade C). If tocolysis is prescribed, it should not continue longer than 48 h (Grade C). The administration of antenatal corticosteroids is recommended for fetuses with a gestational age less than 34 weeks (Grade A) and magnesium sulfate if delivery is imminent before 32 weeks (Grade A). The prescription of antibiotic prophylaxis at admission is recommended (Grade A) to reduce neonatal and maternal morbidity (LE1). Amoxicillin, third-generation cephalosporins, and erythromycin (professional consensus) can each be used individually or eythromycin and amoxicillin can be combined (professional consensus) for a period of 7 days (Grade C). Nonetheless, it is acceptable to stop antibiotic prophylaxis when the initial vaginal sample is negative (professional consensus). The following are not recommended for antibiotic prophylaxis: amoxicillin-clavulanic acid (professional consensus), aminoglycosides, glycopeptides, first- or second-generation cephalosporins, clindamycin, or metronidazole (professional consensus). Women who are clinically stable after at least 48 h of hospital monitoring can be managed at home (professional consensus). Monitoring should include checking for clinical and laboratory factors suggestive of intrauterine infection (professional consensus). No guidelines can be issued about the frequency of this monitoring (professional consensus). Adequate evidence does not exist to support a recommendation for or against the routine initiation of antibiotic therapy when the monitoring of an asymptomatic woman produces a single isolated positive result (e.g., elevated CRP, or hyperleukocytosis, or a positive vaginal sample) (professional consensus). In cases of intrauterine infection, the immediate intravenous administration (Grade B) of antibiotic therapy combining a beta-lactam with an aminoglycoside (Grade B) and early delivery of the child are both recommended (Grade A). Cesarean delivery of women with intrauterine infections is reserved for the standard obstetric indications (professional consensus). Expectant management is recommended for uncomplicated PROM before 37 weeks (Grade A), even when a sample is positive for Streptococcus B, as long as antibiotic prophylaxis begins at admission (professional consensus). Oxytocin and prostaglandins are two possible options for the induction of labor in women with PPROM (professional consensus).


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Ruptura Prematura de Membranas Fetais/terapia , Complicações Infecciosas na Gravidez/prevenção & controle , Contraindicações de Procedimentos , Parto Obstétrico , Feminino , Ruptura Prematura de Membranas Fetais/diagnóstico , Ruptura Prematura de Membranas Fetais/epidemiologia , Viabilidade Fetal , França/epidemiologia , Humanos , Recém-Nascido , Gravidez
10.
Am J Obstet Gynecol ; 221(1): 69.e1-69.e17, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30853365

RESUMO

BACKGROUND: Ex vivo uterine environment therapy is an experimental life support platform designed to reduce the risk of morbidity and mortality for extremely preterm infants born at the border of viability (21-24 weeks' gestation). To spare the functionally immature lung, this platform performs gas exchange via a membranous oxygenator connected to the umbilical vessels, and the fetus is submerged in a protective bath of artificial amniotic fluid. We and others have demonstrated the feasibility of extended survival with ex vivo uterine environment therapy therapy in late preterm fetuses; however, there is presently no evidence to show that the use of such a platform can support extremely preterm fetuses, the eventual translational target for therapy of this nature. OBJECTIVE: The objective of the study was to use our ex vivo uterine environment therapy platform to support the healthy maintenance of 600-700 g/95 days gestational age (equivalent to 24 weeks of human gestation) sheep fetuses. Primary outcome measures were as follows: (1) maintenance of key physiological variables; (2) absence of infection; (3) absence of brain injury; and (4) growth and cardiovascular function patterns matching that of noninstrumented, age-matched in utero controls. STUDY DESIGN: Singleton fetuses from 8 ewes underwent surgical delivery at 95 days' gestation (term, 150 days). Fetuses were adapted to ex vivo uterine environment therapy and maintained for 120 hours with real-time monitoring of key physiological variables. Umbilical artery blood samples were regularly collected to assess blood gas data, differential counts, inflammation, and microbial load to exclude infection. Brain injury was evaluated by gross anatomical and histopathological approaches after euthanasia. Nine pregnant control animals were euthanized at 100 days' gestation to allow comparative postmortem analyses. Data were tested for mean differences with an analysis of variance. RESULTS: Seven of 8 ex vivo uterine environment group fetuses (87.5%) completed 120 hours of therapy with key parameters maintained in a normal physiological range. There were no significant intergroup differences (P > .05) in final weight, crown-rump length, and body weight-normalized lung and brain weights at euthanasia compared with controls. There were no biologically significant differences in hematological parameters (total or differential leucocyte counts and plasma concentration of tumor necrosis factor-α and monocyte chemoattractant protein 1) (P > .05). Daily blood cultures were negative for aerobic and anaerobic growth in all ex vivo uterine environment animals. There was no difference in airspace consolidation between control and ex vivo uterine environment animals, and there was no increase in the number of lung cells staining positive for the T-cell marker CD3. There were no increases in interleukin-1, interleukin-6, interleukin-8, tumor necrosis factor-α, and monocyte chemoattractant protein 1 mRNA expression in lung tissues compared with the control group. No cases of intraventricular hemorrhage were observed, and white matter injury was identified in only 1 ex vivo uterine environment fetus. CONCLUSION: For several decades, there has been little improvement in outcomes of extremely preterm infants born at the border of viability. In the present study, we report the use of artificial placenta technology to support, for the first time, extremely preterm ovine fetuses (equivalent to 24 weeks of human gestation) in a stable, growth-normal state for 120 hours. With additional refinement, the data generated by this study may inform a treatment option to improve outcomes for extremely preterm infants.


Assuntos
Órgãos Artificiais , Citocinas/genética , Desenvolvimento Fetal , Placenta , Nascimento Prematuro , Animais , Hemocultura , Gasometria , Encéfalo/crescimento & desenvolvimento , Quimiocina CCL2 , Contagem de Colônia Microbiana , Estatura Cabeça-Cóccix , Citocinas/metabolismo , Feminino , Viabilidade Fetal , Peso Fetal , Idade Gestacional , Inflamação/epidemiologia , Inflamação/genética , Inflamação/metabolismo , Contagem de Leucócitos , Pulmão/crescimento & desenvolvimento , Pulmão/metabolismo , Tamanho do Órgão , Gravidez , RNA Mensageiro/metabolismo , Ovinos , Carneiro Doméstico , Fator de Necrose Tumoral alfa , Artérias Umbilicais
11.
JAMA ; 321(12): 1188-1199, 2019 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-30912837

RESUMO

Importance: Since 2004-2007, national guidelines and recommendations have been developed for the management of extremely preterm births in Sweden. If and how more uniform management has affected infant survival is unknown. Objective: To compare survival of extremely preterm infants born during 2004-2007 with survival of infants born during 2014-2016. Design, Setting and Participants: All births at 22-26 weeks' gestational age (n = 2205) between April 1, 2004, and March 31, 2007, and between January 1, 2014, and December 31, 2016, in Sweden were studied. Prospective data collection was used during 2004-2007. Data were obtained from the Swedish pregnancy, medical birth, and neonatal quality registries during 2014-2016. Exposures: Delivery at 22-26 weeks' gestational age. Main Outcomes and Measures: The primary outcome was infant survival to the age of 1 year. The secondary outcome was 1-year survival among live-born infants who did not have any major neonatal morbidity (specifically, without intraventricular hemorrhage grade 3-4, cystic periventricular leukomalacia, necrotizing enterocolitis, retinopathy of prematurity stage 3-5, or severe bronchopulmonary dysplasia). Results: During 2004-2007, 1009 births (3.3/1000 of all births) occurred at 22-26 weeks' gestational age compared with 1196 births (3.4/1000 of all births) during 2014-2016 (P = .61). One-year survival among live-born infants at 22-26 weeks' gestational age was significantly lower during 2004-2007 (497 of 705 infants [70%]) than during 2014-2016 (711 of 923 infants [77%]) (difference, -7% [95% CI, -11% to -2.2%], P = .003). One-year survival among live-born infants at 22-26 weeks' gestational age and without any major neonatal morbidity was significantly lower during 2004-2007 (226 of 705 infants [32%]) than during 2014-2016 (355 of 923 infants [38%]) (difference, -6% [95% CI, -11% to -1.7%], P = .008). Conclusions and Relevance: Among live births at 22-26 weeks' gestational age in Sweden, 1-year survival improved between 2004-2007 and 2014-2016.


Assuntos
Mortalidade Infantil/tendências , Lactente Extremamente Prematuro , Deficiências do Desenvolvimento/epidemiologia , Feminino , Viabilidade Fetal , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Doenças do Prematuro/epidemiologia , Terapia Intensiva Neonatal , Masculino , Estudos Prospectivos , Natimorto/epidemiologia , Taxa de Sobrevida , Suécia/epidemiologia
12.
Parasite Immunol ; 41(4): e12614, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30703256

RESUMO

AIMS: Malaria in pregnancy (MiP) alters the expression of ATP-binding cassette efflux transporters in maternal and foetal tissues, as well as the placenta. Malaria induces oxidative stress, and pregnancy is associated with arginine deficiency. We hypothesized that reducing oxidative stress during MiP by supplementation with L-arginine, a NO precursor, would attenuate transcriptional changes in a second superfamily of transporters, solute carrier (SLC) transporters, and improve pregnancy outcomes. METHODS AND RESULTS: Pregnant BALB/c mice receiving L-arginine (1.2%) in water, or water alone, were infected with Plasmodium berghei ANKA on gestational day 13 and sacrificed on gestational day 19. Compared to controls, the mRNA of numerous SLC transporters was downregulated in maternal and foetal tissues, as well as in the placentas of infected mice. While supplementation with L-arginine did improve foetal viability, it did not improve the mRNA expression of oxidative stress markers, transporters nor other indices of foetal and maternal health. Moreover, amino acid uptake transporters were downregulated upon infection, which could potentially contribute to decreased foetal birthweight. CONCLUSIONS: Malaria in pregnancy significantly alters the expression of SLC transporters in maternal and foetal tissues as well as the placenta, regardless of L-arginine supplementation. Further studies to investigate methods of reducing oxidative stress in MiP are warranted.


Assuntos
Malária/patologia , Estresse Oxidativo/fisiologia , Placenta/metabolismo , Plasmodium berghei , Proteínas Carreadoras de Solutos/biossíntese , Animais , Arginina/farmacologia , Transporte Biológico , Feminino , Viabilidade Fetal/efeitos dos fármacos , Camundongos , Camundongos Endogâmicos BALB C , Gravidez , Proteínas Carreadoras de Solutos/genética
13.
Am J Obstet Gynecol ; 220(5): 465-468.e1, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30685288

RESUMO

Trauma is a significant contributor to maternal and fetal morbidity and death in the United States. The nature of the evaluation of the pregnant trauma patient is intense and multidisciplinary. Although it invites unique opportunities for collaboration with our surgical colleagues, it also increases the risk of misunderstanding and conflict. We present in this Viewpoint a standardized fetal trauma survey that seamlessly integrates with Advanced Trauma Life Support (American College of Surgeons, Chicago, IL) in an effort to create a more reliable and collaborative experience in the trauma room.


Assuntos
Cuidados de Suporte Avançado de Vida no Trauma/métodos , Viabilidade Fetal , Ultrassonografia Pré-Natal , Ferimentos e Lesões , Feminino , Monitorização Fetal , Frequência Cardíaca Fetal , Humanos , Equipe de Assistência ao Paciente , Gravidez
14.
J Matern Fetal Neonatal Med ; 32(21): 3577-3580, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29681199

RESUMO

Objective: Women who have had a spontaneous periviable delivery are at high risk for recurrent preterm delivery. The objective of our study was to determine interpregnancy interval (IPI) after periviable birth as well as percentage of women taking 17 alpha hydroxyprogesteronecaproate (17OHP-C) after periviable birth. We then examined the association between adherence with a postpartum visit after a periviable birth and IPI as well as receipt of 17OHP-C. Materials and methods: We included all women with a periviable delivery (20-26-week gestation) due to spontaneous preterm birth at Magee Women's Hospital between 2009 and 2014, who had their subsequent delivery at our institution during or before May of 2016. Information on maternal, fetal, and neonatal outcomes was obtained from the Magee Obstetrical Medical and Infant (MOMI) database as well as chart abstraction. We calculated IPI, proportion of women who received 17OHP-C in their next pregnancy, and attendance rates with a postpartum visit. The relationship between attendance with a postpartum visit and IPI, and receipt of 17OHP-C was examined with a logistic regression. Results: During the study period, 361 women had a spontaneous periviable birth. A total of 60 women had a subsequent delivery at Magee Women's Hospital. Only 33/60 (52.5%) presented for a postpartum visit after their periviable delivery. The median IPI for the cohort was 12.5 months (interquartile range: 6.4, 17.5 months) and 21.0% (n = 13) had an IPI less than 6 months. Adherence with the postpartum visit was not associated with an IPI less than 6 months. A total of 18.33% (11 women) did not receive 17OHP-C in their subsequent pregnancy. Women who attended a postpartum visit were much more likely to receive 17OHP-C (p = .001). Conclusions: Many women with a history of a periviable birth do not optimize strategies to reduce their risk of recurrent preterm birth. While attendance with a postpartum visit was associated with greater receipt of 17OHP-C in the subsequent pregnancy, given the overall poor rate of attendance with the postpartum visit in this cohort, novel strategies to counsel women about interpregnancy health are needed.


Assuntos
Intervalo entre Nascimentos , Viabilidade Fetal/fisiologia , Nascimento Prematuro/terapia , Cuidado Pré-Natal/métodos , Caproato de 17 alfa-Hidroxiprogesterona/uso terapêutico , Adulto , Assistência Ambulatorial/estatística & dados numéricos , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Nascimento Vivo/epidemiologia , Cooperação do Paciente/estatística & dados numéricos , Gravidez , Nascimento Prematuro/diagnóstico , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/prevenção & controle , Cuidado Pré-Natal/normas , Cuidado Pré-Natal/estatística & dados numéricos , Terapias em Estudo/métodos , Terapias em Estudo/normas , Adulto Jovem
15.
J Matern Fetal Neonatal Med ; 32(21): 3627-3632, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29685073

RESUMO

Objective: To identify the level of amniotic fluid lactate (AFL), placental growth factor (PLGF), and vascular endothelial growth factor (VEGF) at second trimester amniocentesis, and to compare levels in normal pregnancies with pregnancies ending in a miscarriage, an intrauterine growth restricted fetus (IUGR) or decreased fetal movements. Study design: A prospective cohort study. Amniotic fluid was consecutively collected at amniocentesis in 106 pregnancies. Fetal wellbeing at delivery was evaluated from medical files and compared with the levels of AFL, VEGF, and PLGF at the time of amniocentesis. Results: The median level of AFL was 6.9 mmol/l, VEGF 0.088 pg/ml, and PLGF 0.208 pg/ml. The median levels of AFL in pregnancies ended in miscarriage were significantly higher (10.7 mmol/l) compared to those with a live new-born (6.9 mmol/L, p = .02). The levels of VEGF (p = .2) and PLGF (p = .7) were not affected. In pregnancies with an IUGR, the median level of AFL was higher compared to those with normal fetal growth (p = .003). No differences VEGF (p = .5), but significant lower PLGF were found in IUGR pregnancies (p = .03). Conclusions: Pregnancies ending in a miscarriage or with IUGR had significantly higher median values of AFL but lower values of PLGF in the amniotic fluid at the time of second trimester amniocentesis compared to normal pregnancies.


Assuntos
Líquido Amniótico/metabolismo , Biomarcadores/metabolismo , Feto/fisiologia , Resultado da Gravidez , Segundo Trimestre da Gravidez/metabolismo , Aborto Espontâneo/diagnóstico , Aborto Espontâneo/metabolismo , Adulto , Amniocentese , Líquido Amniótico/química , Biomarcadores/análise , Estudos de Casos e Controles , Feminino , Sofrimento Fetal/diagnóstico , Sofrimento Fetal/metabolismo , Sofrimento Fetal/fisiopatologia , Retardo do Crescimento Fetal/diagnóstico , Retardo do Crescimento Fetal/metabolismo , Movimento Fetal/fisiologia , Viabilidade Fetal , Humanos , Recém-Nascido , Ácido Láctico/análise , Ácido Láctico/metabolismo , Fator de Crescimento Placentário/análise , Fator de Crescimento Placentário/metabolismo , Gravidez , Fator A de Crescimento do Endotélio Vascular/análise , Fator A de Crescimento do Endotélio Vascular/metabolismo
16.
Reprod Sci ; 26(5): 639-648, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-29938606

RESUMO

This study evaluated the repercussions of paternal exposure to radiation on reproduction and offspring in rats, as well as whether treatment with the angiotensin II type 1 (AT1) receptor antagonists telmisartan and losartan has a mitigating effect. Rats were randomly divided into 6 groups: control, radiation, telmisartan, losartan, radiation + telmisartan, and radiation + losartan. A single 5 Gy dose of radiation was administered directly into the scrotum, followed by treatment with telmisartan (12 mg/kg/d) or losartan (34 mg/kg/2 times per day) for 60 days in the groups receiving these medications. The reproductive ability of the test animals was assessed before and after exposure to radiation via fertility tests. The resulting offspring were analyzed for the presence of external and internal anomalies. Ionizing radiation significantly affected the rates of fertility, pre- and postimplantation losses, and implantation. Telmisartan and losartan did not significantly prevent this radiation-induced damage. The frequency of fetal anomalies was similar in offspring produced before and after paternal radiation exposure. Moreover, irradiated rats that received treatments and were able to generate offspring did not produce fetuses with morphological changes; this may represent a possible radioprotective effect AT1 antagonists have on offspring development, although few fetuses survived and were evaluated for malformations. Although the study findings indicate that these medications have a positive effect, further studies with longer treatment periods (extending beyond 1 rat spermatogenic cycle) are needed to determine whether these drugs significantly improve reproductive rates after paternal exposure to radiation, which may also reflect an increase in the number of viable fetuses.


Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/administração & dosagem , Viabilidade Fetal/efeitos da radiação , Losartan/administração & dosagem , Exposição Paterna , Exposição à Radiação/efeitos adversos , Reprodução/efeitos dos fármacos , Reprodução/efeitos da radiação , Telmisartan/administração & dosagem , Animais , Feminino , Masculino , Gravidez , Taxa de Gravidez , Radiação Ionizante , Ratos Wistar
17.
J Matern Fetal Neonatal Med ; 32(5): 820-825, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29103318

RESUMO

OBJECTIVE: To examine prospective parents' perceptions of management options and outcomes in the context of threatened periviable delivery, and the values they apply in making antenatal decisions during this period. STUDY DESIGN: Qualitative analysis of 46 antenatal interviews conducted at three tertiary-care hospitals with 54 prospective parents (40 pregnant women, 14 partners) who had received counseling for threatened periviable delivery (40 cases). RESULTS: Participants most often recalled being involved in resuscitation, cerclage, and delivery mode decisions. Over half (63.0%) desired a shared decision-making role. Most (85.2%) recalled hearing about morbidity and mortality, with many reiterating terms like "brain damage", "disability", and "handicap". The potential for disability influenced decision making to variable degrees. In describing what mattered most, participant spoke of giving their child a "fighting chance"; others voiced concerns about "best interest", a "healthy baby", "pain and suffering", and religious faith. CONCLUSIONS: Our findings underscore the importance of presenting clear information on disability and eliciting the factors that parents deem most important in making decisions about periviable birth.


Assuntos
Tomada de Decisões , Viabilidade Fetal , Pais/psicologia , Feminino , Humanos , Cuidados para Prolongar a Vida/psicologia , Masculino , Gravidez , Pesquisa Qualitativa
18.
J Neonatal Perinatal Med ; 12(1): 87-94, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30373964

RESUMO

BACKGROUND: Guidelines exist for counseling expectant families of infants at periviable gestational ages (22-25 weeks), but it is much more common for neonatologists to counsel families at gestational ages beyond the threshold of viability when several aspects of these guidelines do not apply. We aimed to develop an understanding of what information is shared with mothers at risk of preterm delivery beyond periviability and to evaluate communication skills of our participants. METHODS: We developed a checklist of elements to include in counseling based on a comprehensive literature review. The checklist was divided into an information sharing section and a connect score. The information sharing list was sub-divided into general information and specific complications. Neonatologists engaged in a simulated prenatal counseling session with a standardized patient. Videotaped encounters were then analyzed for checklist elements. RESULTS: Neonatologists all scored well in communication using our tool and two other validated communication tools - the SEGUE and the analytic global OSCE. There was no difference in scoring based on years of experience or level of training. Information sharing from neonatologists more often discussed general information over specific. Neonatologists also focused more on early outcomes over long-term outcomes. Only 12% of neonatologists quoted the correct survival rate for the case. CONCLUSIONS: Neonatologists generally communicate well but share less information specific to prematurity and the long-term sequelae of prematurity. Our tool may be used to test if other interventions improve information sharing or communication.


Assuntos
Aconselhamento/educação , Viabilidade Fetal , Neonatologistas/educação , Neonatologia , Cuidado Pré-Natal , Treinamento por Simulação , Adulto , Tomada de Decisões , Deficiências do Desenvolvimento , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Prematuro , Masculino , Neonatologistas/psicologia , Neonatologia/educação , Relações Médico-Paciente , Gravidez , Cuidado Pré-Natal/psicologia , Gravação em Vídeo
19.
Med Law Rev ; 27(3): 461-481, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30428069

RESUMO

This article seeks to challenge the assumption that it is legitimate to consider the costs of premature babies' future social and educational needs when deciding what treatment, if any, to provide in the neonatal intensive care unit (NICU) . It questions the elision that is made between the claim that a particular treatment is insufficiently cost-effective and the claim that a person will be a burden on the state in the future. It discusses a series of common misunderstandings about how treatment decisions are taken in the NICU and concludes by suggesting that the claim that premature babies are too expensive to treat may depend upon regarding a premature infant as if she were not yet a person, with rights and interests of her own.


Assuntos
Tomada de Decisões/ética , Viabilidade Fetal , Lactente Extremamente Prematuro , Unidades de Terapia Intensiva Neonatal , Suspensão de Tratamento/economia , Temas Bioéticos , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Custos de Cuidados de Saúde , Alocação de Recursos para a Atenção à Saúde , Humanos , Recém-Nascido , Suspensão de Tratamento/ética , Suspensão de Tratamento/legislação & jurisprudência
20.
Rev. ecuat. pediatr ; 19(2): 55-57, diciembre 2018.
Artigo em Espanhol | LILACS | ID: biblio-996449

RESUMO

Introducción. La neonatología del Hospital de los Valles (HDLV) es un centro de referencia de cuarto nivel con atención de pacientes prematuros que presentan un mayor riesgo de morbimortalidad y en quienes aún hay debate sobre la edad gestacional aceptable para aunar esfuerzos en tratamiento y sobrevida. En los Estados Unidos, la tasa de nacimientos prematuros, que había aumentado constantemente durante la década de 1990 y principios de 2000, ha disminuido anualmente durante 7 años y ahora es aproximadamente del 11,39%. La viabilidad humana, definida como la edad gestacional en la que la posibilidad de supervivencia es del 50%, actualmente es de aproximadamente 23 a 24 semanas en los países desarrollados, con una supervivencia de prematuros de 25 semanas superior al 60%. Materiales y Métodos. Es un estudio descriptivo transversal de tipo retrospectivo, en el que se tomó como población a todos los niños nacidos antes de las 28 semanas de gestación atendidos en el Hospital de los Valles desde enero del 2014 a diciembre del 2018, se obtuvieron los datos de la base de datos EpicLatino y de las historias clínicas de los pacientes, Los datos obtenidos fueron ingresados en el programa Excel para su tabulación y análisis. Resultados. Entre enero del 2014 a diciembre del 2018 se registraron 1710 pacientes de los cuales 479 son prematuros y de estos 29 son prematuros extremos. Se registraron 8 fallecimientos 5 de los cuales nacieron fuera de la institución, la edad gestacional más temprana con sobrevida es de 24.5 semanas y el menor peso registrado es de 575 gramos, la morbilidad más comúnmente asociada a la prematurez extrema en orden descendente es enfermedad de membrana hialina, anemia, sepsis y broncodisplasia pulmonar, no hay registro de retinopatía y se reportaron 6 casos de hemorragia intraventricular. El peso promedio de alta es de 2045 gramos, con 16 pacientes enviados a casa con oxigeno domiciliario. Conclusión. La neonatología del HDLV presta atención de cuarto nivel con una sobrevida en pacientes menores de 28 semanas de edad gestacional comparable con otras instituciones a nivel mundial, con una mejor respuesta en pacientes nacidos dentro de la propia institución, es importante que los pacientes que tengan riesgo de nacer a edades gestacionales muy cortas sean derivados oportunamente a instituciones con mayor capacidad resolutiva en bien del paciente y su familia.


is an increased risk of morbidity and mortality and in whom there is still debate about the acceptable gestational age to combine efforts in treatment and survival. In the United States, the rate of premature births, which had steadily increased during the 1990s and early 2000s, has decreased annually for 7 years and now is approximately 11.39%. Human viability, defined as gestational age in which the possibility of survival is 50%, currently is approximately 23 to 24 weeks in developed countries, with a survival of preterm infants of 25 weeks greater than 60% . Materials and methods. This is a cross-sectional, retrospective descriptive study, in which all children born before the 28 weeks of gestation attended at the Hospital de los Valles from January 2014 to December 2018 were taken as a population. EpicLatino database and the patient's medical records. The data obtained were entered into the Excel program for tabulation and analysis. Results Between January 2014 and December 2018, 1710 patients were registered, of whom 479 are premature and of these 29 are premature preterm infants. There were 8 deaths 5 of which were born out of the institution, the earliest gestational age with survival is 24.5 weeks and the lowest recorded weight is 575 grams, the morbidity most commonly associated with extreme prematurity in descending order is disease. hyaline membrane, anemia, sepsis and pulmonary bronchodysplasia, there is no record of retinopathy and 6 cases of intraventricular hemorrhage were reported. The average dischange weight is 2045 grams, with 16 patients sent home with home oxygen. Conclusion. HDLV neonatology provides fourth level care with a survival in patients younger than 28 weeks gestational age comparable with other institutions worldwide, with a better response in patients born within the institution itself, it is important that patients at risk of being born at very short gestational ages are opportunely referred to institutions with greater resolutive capacity for the good of the patient and his family.


Assuntos
Humanos , Recém-Nascido , Indicadores de Morbimortalidade , Viabilidade Fetal , Lactente Extremamente Prematuro , Pesquisa sobre Serviços de Saúde , Terapia Intensiva Neonatal , Idade Gestacional
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