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1.
JAMA Netw Open ; 6(1): e2250661, 2023 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-36633845

RESUMO

Importance: Peripartum suicide attempt is a major psychiatric complication associated with pregnancy, but the risk factors remain largely uncertain. Objective: To identify the demographic characteristics and predisposing risks for peripartum suicide attempts and postpartum depression. Design, Setting, and Participants: This cohort study used retrospective data on pregnant women who delivered children between April 1, 2016, and March 31, 2021, at 712 hospitals in Japan. The nationwide Diagnosis Procedure Combination database was used. Exposures: Psychiatric and nonpsychiatric medical history, age, alcohol and tobacco use, and obstetric complications and procedures. Main Outcomes and Measures: Data on admissions for prepartum suicide attempt and delivery during the same hospital stay and readmissions for depression or suicide attempt within 1 year post partum were collected. Comparisons of prevalence of each study variable were performed, and multivariable logistic regression analyses were used to determine risk factors. Results: From a total of 39 908 649 hospitalization episodes, 804 617 cumulative pregnant women (median [IQR] age at childbirth, 33 [29-36] years) who delivered at the enrolled hospitals were identified, including 1202 who were admitted for suicide attempt and delivery during the same hospital stay and 111 readmitted for suicide attempt within 1 year post partum. Risk factors associated with prepartum suicide attempts included younger age (adjusted odds ratio [aOR], 0.99; 95% CI, 0.98-1.00) and histories of personality disorder (aOR, 10.81; 95% CI, 5.70-20.49), depression (aOR, 3.97; 95% CI, 2.35-6.70), schizophrenia (aOR, 2.89; 95% CI, 1.52-5.50), and adjustment disorder (aOR, 2.66; 95% CI, 1.07-6.58). Risk factors associated with postpartum suicide attempts included younger age (aOR, 0.96; 95% CI, 0.93-1.00), heavy tobacco use (aOR, 23.09; 95% CI, 5.46-97.62), and histories of alcohol use disorder (aOR, 163.54; 95% CI, 28.30-944.95), personality disorder (aOR, 10.28; 95% CI, 3.29-32.10), anxiety disorders (aOR, 8.13; 95% CI, 2.88-22.98), depression (aOR, 7.27; 95% CI, 2.95-17.91), schizophrenia (aOR, 5.77; 95% CI, 2.17-15.38), bipolar disorder (aOR, 3.98; 95% CI, 1.36-11.67), and insomnia (aOR, 3.17; 95% CI, 1.30-7.78). On sensitivity analysis, risk factors associated with postpartum depression after excluding those with prenatal depression included histories of personality disorder, adjustment disorder, bipolar disorder, insomnia, and anxiety disorders. Conclusions and Relevance: The findings of this cohort study suggest that histories of smoking and prenatal psychiatric disorders are potential risk factors for peripartum suicide attempts and may require additional treatment and prevention interventions.


Assuntos
Depressão Pós-Parto , Distúrbios do Início e da Manutenção do Sono , Criança , Humanos , Feminino , Gravidez , Tentativa de Suicídio/psicologia , Depressão Pós-Parto/diagnóstico , Estudos de Coortes , Estudos Retrospectivos , Japão/epidemiologia , Período Periparto , Fatores de Risco
2.
Lancet Glob Health ; 11(2): e287-e295, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36669809

RESUMO

BACKGROUND: Primary postpartum haemorrhage is the principal cause of birth-related maternal mortality in most settings and has remained persistently high in severely resource-constrained countries. We evaluate the impact of an intervention that aims to halve maternal mortality caused by primary postpartum haemorrhage within 2 years, nationwide in Niger. METHODS: In this 72-month longitudinal study, we analysed the effects of a primary postpartum haemorrhage intervention in hospitals and health centres in Niger, using data on maternal birth outcomes assessed and recorded by the facilities' health professionals and reported once per month at the national level. Reported data were monitored, compiled, and analysed by a non-governmental organisation collaborating with the Ministry of Health. All births in all health facilities in which births occurred, nationwide, were included, with no exclusion criteria. After a preintervention survey, brief training, and supplies distribution, Niger implemented a nationwide primary postpartum haemorrhage prevention and three-step treatment strategy using misoprostol, followed if needed by an intrauterine condom tamponade, and a non-inflatable anti-shock garment, with a specific set of organisational public health tools, aiming to reduce primary postpartum haemorrhage mortality. FINDINGS: Among 5 382 488 expected births, 2 254 885 (41·9%) occurred in health facilities, of which information was available on 1 380 779 births from Jan 1, 2015, to Dec 31, 2020, with reporting increasing considerably over time. Primary postpartum mortality decreased from 82 (32·16%; 95% CI 25·58-39·92) of 255 health facility maternal deaths in the 2013 preintervention survey to 146 (9·53%; 8·05-11·21) of 1532 deaths among 343 668 births in 2020. Primary postpartum haemorrhage incidence varied between 1900 (2·10%; 2·01-2·20) of 90 453 births and 4758 (1·47%; 1·43-1·52) of 322 859 births during 2015-20, an annual trend of 0·98 (95% CI 0·97-0·99; p<0·0001). INTERPRETATION: Primary postpartum haemorrhage morbidity and mortality declined rapidly nationwide. Because each treatment technology that was used has shown some efficacy when used alone, a strategic combination of these treatments can reasonably attain outcomes of this magnitude. Niger's strategy warrants testing in other low-income and perhaps some middle-income settings. FUNDING: The Government of Norway, the Government of Niger, the Kavli Trust (Kavlifondet), the InFiL Foundation, and individuals in Norway, the UK, and the USA. TRANSLATION: For the French translation of the abstract see Supplementary Materials section.


Assuntos
Hemorragia Pós-Parto , Feminino , Humanos , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/prevenção & controle , Níger/epidemiologia , Estudos Longitudinais , Período Periparto , Instalações de Saúde
3.
J Matern Fetal Neonatal Med ; 36(1): 2155042, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36514834

RESUMO

OBJECTIVE: Peripartum depression (PPD) is a common mental health complication of pregnancy and increases risk for maternal mortality and poorer outcomes for children. Despite its importance, screening rates vary across organizations and care team members. The goal of the current study was to explore the perspectives from care team members in both behavioral health and acute care settings about how they screen and refer pregnant and post pregnant women for PPD, what training around PPD is currently offered by their organization, and if they could benefit from additional PPD training. METHODS: Data were collected from an online self-report survey of care team members from behavioral health and acute care settings in the US. Questions focused on (1) when/if the care teams had a screening protocol for PPD, (2) beliefs about the efficacy of their organization's PPD screening, identification, and referral process, and (3) if their organization currently offered or needed training around the topic of PPD. RESULTS: A total of 794 care team members in behavioral health and acute care responded to the survey between December 2021 and May 2022. Nearly, all (96.7%) reported having a specific protocol for screening for PPD when they know a patient is pregnant; however, only 69.6% of respondents routinely screen regardless of symptoms being reported by the patient. While 93.3% of the sample believed their organization does a good job screening for and identifying PPD, gaps in the referral processes were described, especially in acute settings. 95.3% of the sample reported their organization currently gives training in screening, identifying, or treating PPD or in the process for establishing outpatient referrals for PPD care for care team members who have direct contact with pregnant patients; however, 96.5% also reported their organization would benefit from additional training in one or more of these areas. CONCLUSION: High rates of self-reported PPD screening and training indicate that care team members in both behavioral health and acute care are aware of the importance of maternal mental health issues. However, other research indicates that high rates of screening may not lead to improved outcomes, and there are still high rates of maternal suicide and suicidal ideation in the US. It is possible that high self-reported screening rates may indicate a false sense of security such that care team members feel the issue is addressed while problems remain. Alternatively, many respondents felt their organizations would benefit from further training, perhaps indicating an awareness of this gap. Care team members in behavioral health and acute care settings should increase collaboration to ensure high rates of screening lead to improved maternal mental health care.


Assuntos
Depressão , Serviços de Saúde Materna , Criança , Humanos , Gravidez , Feminino , Depressão/diagnóstico , Depressão/terapia , Saúde Mental , Período Periparto
4.
Niger J Clin Pract ; 25(12): 1963-1968, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36537451

RESUMO

Background: The relationship between blood pressure (BP) trajectories and outcomes in patients with peripartum cardiomyopathy (PPCM) is not clear. Aim: The study aimed to assess the clinical features and outcomes (all-cause mortality and unrecovered left ventricular [LV] systolic function) of PPCM patients grouped according to their baseline systolic BP (SBP). Patients and Methods: PPCM patients presenting to 14 tertiary hospitals in Nigeria were consecutively recruited between June 2017 and March 2018 and then followed up till March 2019. SBP at first presentation was used to categorize the patients into seven groups: <90, 90-99, 100-109, 110-119, 120-129, 130-139, and ≥140 mmHg. Unrecovered LV systolic function was defined as echocardiographic LV ejection fraction (LVEF) below 55% at the last profiling. Results: Two hundred and twenty-seven patients were recruited and followed up for a median of 18 months. Of these, 4.0% had <90 mmHg, 16.3% had 90-99 mmHg, 24.7% had 100-109 mmHg, 24.7% had 110-119 mmHg, 18.5% had 120-129 mmHg, 7.5% had 130-139 mmHg, and 4.4% had ≥140 mmHg of SBP at presentation. The highest frequency of all-cause mortality was recorded among patients with SBP ≤90 mmHg (30.8%) followed by those with 90-99 mmHg (20.5%) (P = 0.076), while unrecovered LV systolic function did not differ significantly between the groups (P = 0.659). In a Cox proportional regression model for all-cause mortality, SBP <90 mmHg had a hazard ratio (HR) of 4.00 (95% confidence interval [CI] 1.49-10.78, P = 0.006), LVEF had an HR of 0.94 (95% CI 0.91-0.98, P = 0.003, B = 0.06%), and use of angiotensin-converting enzyme or angiotensin receptor and/or ß-receptor blockers had an HR of 1.71 (95% CI 0.93-3.16, P = 0.085). However, SBP was not associated with LV function recovery. Conclusion: In our cohort of PPCM patients, one-fifth was hypotensive at presentation. SBP <90 mmHg at presentation was associated with a four-fold higher risk of all-cause mortality during a median follow-up of 18 months.


Assuntos
Cardiomiopatias , Período Periparto , Humanos , Pressão Sanguínea , Função Ventricular Esquerda , Volume Sistólico
5.
Trop Anim Health Prod ; 55(1): 10, 2022 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-36529815

RESUMO

The aim of this study was to determine the serum levels of folic acid, cobalamin, and indicators of energy metabolism during the peripartum period of ewes submitted to different diets and with or without pregnancy toxemia. Forty Santa Inês ewes were divided into three groups, a group of 20 animals fed only roughage-diet with low energy density (G1), a group of 10 ewes submitted to diet containing roughage and concentrate-diet with high energy density (G2), and a group of 10 ewes with diagnosis of pregnancy toxemia (PT) (G3). In the ewes of groups G1 and G2, blood samples were collected -30, -15, -7 days pre-partum, on the day of partum, and 7, 15, and 30 days postpartum; blood samples from G3 animals were collected during the veterinary clinic care. Significant variations were observed in the plasma concentration of glucose and serum folic acid, cobalamin, fructosamine, NEFA, and ß-hydroxybutyrate in the groups fed diets with different energy levels, with and without PT (P < 0.05). A positive correlation of folic acid and cobalamin was observed with plasma glucose and serum NEFA concentrations, in addition to negative correlation of glucose with NEFA and ß-hydroxybutyrate and positive correlation between the latter biomarkers of energy metabolism. The ewes diagnosed with PT showed higher levels of folic acid, NEFA, and ß-hydroxybutyrate (P < 0.05). Ewes fed diet containing roughage and concentrate present higher serum levels of folic acid, cobalamin, and glucose, in the pre-partum period and in the lactation period. The results obtained contribute to better understanding of the application of blood concentration tests for folic acid and cobalamin in the energy metabolism and in PT in ewes.


Assuntos
Ácidos Graxos não Esterificados , Pré-Eclâmpsia , Ovinos , Feminino , Animais , Gravidez , Ácido 3-Hidroxibutírico , Pré-Eclâmpsia/veterinária , Período Periparto , Vitamina B 12 , Ácido Fólico , Dieta/veterinária , Lactação , Metabolismo Energético , Glucose/metabolismo , Fibras na Dieta
6.
Best Pract Res Clin Anaesthesiol ; 36(3-4): 325-339, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36513428

RESUMO

Postpartum/peripartum hemorrhage (PPH) is an obstetric emergency complicating 1-10% of all deliveries and is a leading cause of maternal mortality and morbidity worldwide. However, the incidence of PPH differs widely according to the definition and criteria used, the way of measuring postpartum blood loss, and the population being studied with the highest numbers in developing countries. Despite all the significant progress in healthcare, the incidence of PPH is rising due to an incomplete implementation of guidelines, resulting in treatment delays and suboptimal care. A consensus clinical definition of PPH is needed to enable awareness, early recognition, and initiation of appropriate intensive treatment. Unfortunately, the most used definition of PPH based on blood loss ≥500 ml after delivery suffers from inaccuracies in blood loss quantification and is not clinically relevant in most cases, as the amount of blood loss does not fully reflect the severity of bleeding.


Assuntos
Período Periparto , Hemorragia Pós-Parto , Gravidez , Feminino , Humanos , Fatores de Risco , Hemorragia Pós-Parto/diagnóstico , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/terapia , Mortalidade Materna , Incidência
7.
Dtsch Med Wochenschr ; 147(23): 1537-1544, 2022 11.
Artigo em Alemão | MEDLINE | ID: mdl-36384155

RESUMO

Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening heart disease, with onset in the last month of pregnancy or in the first months after delivery in previously heart-healthy women. PPCM patients typically present with heart failure due to left ventricular (LV) dysfunction with an LV ejection fraction (EF) < 45 %. In the last years clinical and experimental studies contributed to a better understanding of the pathophysiology and the clinical course of PPCM. In the context of oxidative stress, the nursing hormone prolactin is cleaved into a smaller antiangiogenic and proapoptotic 16k Da form, leading to myocardial dysfunction. In an animal model this can be prevented by treatment with the dopamine agonist bromocriptine, which suppresses prolactin release. This therapeutic approach was confirmed in several clinical studies. Therefore, the current guidelines recommend a treatment consisting of a heart failure treatment according to current guidelines in combination with the dopamine agonist bromocriptine. If the diagnosis is made early and the treatment is started immediately, the prognosis is good compared to other forms of cardiomyopathies, as LV function recovers in most cases.In the acute phase the severity of heart failure differs among PPCM patients. Some patients present with mild forms, whereas some PPCM patients display severely reduced LV function and cardiogenic shock. Especially the latter cases are still challenging, as treatment with ß1-adrenergic receptor agonists is associated with progression of heart failure and a worse cardiac outcome. Therefore, patients with cardiogenic shock complicating PPCM should be treated in centers experienced in mechanical circulatory support in combination with bromocriptine treatment.


Assuntos
Cardiomiopatias , Insuficiência Cardíaca , Complicações Cardiovasculares na Gravidez , Transtornos Puerperais , Disfunção Ventricular Esquerda , Gravidez , Humanos , Animais , Feminino , Período Periparto , Bromocriptina/uso terapêutico , Choque Cardiogênico/etiologia , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Prolactina/uso terapêutico , Agonistas de Dopamina/uso terapêutico , Cardiomiopatias/diagnóstico , Cardiomiopatias/tratamento farmacológico , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/tratamento farmacológico , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia
8.
BMJ Open ; 12(11): e057327, 2022 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-36410814

RESUMO

INTRODUCTION: Complementary and alternative therapies (CATs) refer to a diverse range of approaches that can be used as add-on or an alternative to conventional therapies. While a number of individual studies and systematic reviews (SRs) or meta-analyses (MAs) have investigated the effectiveness of specific types of CATs to treat depressive symptoms at specific moments of the perinatal period, an overarching synthesis of the literature is currently lacking. We will conduct an umbrella review of SRs and MAs to assess to which extent CATs are associated with depressive symptoms reduction during pregnancy or after childbirth. METHODS AND ANALYSIS: We will search a broad set of electronic databases (MEDLINE via Ovid, Embase.com, CINAHL via EBSCOhost, PsycINFO via Ovid, AMED and Google Scholar). We will include SRs with or without MAs meeting the following criteria: (1) the review should focus mostly on individual studies reporting a randomised controlled design; (2) diagnosis should be made during pregnancy or during the post partum using a clinical interview according to DSM or ICD criteria; (3) the reviewed intervention should start during pregnancy or in the first postpartum year and meet the criteria for being considered as CAT. The main outcome will be depressive symptoms reduction during pregnancy or after childbirth. Secondary outcomes will include the remission of depression according to DSM criteria and intervention acceptability. Overlap between reviews will be described, quantified and discussed. We will rate the quality of the included SRs or MAs using the AMSTAR-2 tool. MAs will be performed by using the data from the individual RCT studies included in the SRs or MAs. Sensitivity analyses restricted to studies with a low-moderate risk of bias will be realised. Publication bias will be examined visually by using a funnel plot, and formally using the Egger's test and test of excess significance. ETHICS AND DISSEMINATION: We intend to publish the results of the umbrella review in an international peer-reviewed journal. Oral presentations in congresses and internal diffusion through the Rise up-PPD European COST Action network are also planned. PROSPERO REGISTRATION NUMBER: CRD42021229260.


Assuntos
Terapias Complementares , Período Periparto , Gravidez , Feminino , Humanos , Depressão , Revisões Sistemáticas como Assunto , Período Pós-Parto
9.
BMJ Case Rep ; 15(11)2022 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-36351676

RESUMO

A woman in her early 30s presented herself with acute dyspnoea and elevated D-dimers 5 weeks after delivery of her second child. Echocardiographic findings showed signs of acute left ventricular failure, and an MRI confirmed a non-ischaemic dilated left heart failure compatible with peripartum cardiomyopathy. The antihormonal therapy with bromocriptine during 6 weeks and an intensive heart failure therapy led to an amelioration of the heart function within 3 years, but full recovery was not yet observed.


Assuntos
Cardiomiopatias , Insuficiência Cardíaca , Complicações Cardiovasculares na Gravidez , Transtornos Puerperais , Gravidez , Feminino , Criança , Humanos , Período Periparto , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Resultado do Tratamento , Cardiomiopatias/diagnóstico , Cardiomiopatias/diagnóstico por imagem , Transtornos Puerperais/diagnóstico por imagem , Transtornos Puerperais/tratamento farmacológico , Insuficiência Cardíaca/etiologia , Cardiotônicos
10.
Taiwan J Obstet Gynecol ; 61(6): 999-1003, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36428005

RESUMO

OBJECTIVE: Peripartum cardiomyopathy (PPCM) developed from late pregnancy to five months after delivery. Women with PPCM have the risk of mortality or non-recovered cardiac function. We aimed to investigate women with PPCM in Taiwan. MATERIALS AND METHODS: The retrospective study recruited patients with PPCM from January 2002 to October 2018 in a tertiary center. We evaluated the presentations, onset, associated conditions, maternal and fetal outcomes, follow-up cardiac function, and subsequent pregnancies. The clinical data were compared between antepartum and postpartum-onset of PPCM. RESULTS: Thirty women were identified and seventeen (56.6%) patients were antepartum-onset. The delivery time, ranged from 26 to 40 weeks, was mostly at 35 weeks. Twenty-one patients had cardiac function follow-up and seven (33.3%) were non-recovered in six months. The associated conditions of PPCM included age >30, primiparity, preeclampsia or hypertension, obesity, twin pregnancy, and tocolysis. The maternal characteristics and associated conditions were not significant different, but early preterm (32.8 ± 3.6 vs. 35.5 ± 2.4 weeks, p = 0.042) and lower Apgar scores in one (7 vs. 9, p = 0.002) and 5 min (9 vs. 10, p = 0.005) were observed in the antepartum-onset group. CONCLUSION: In conclusion, PPCM commonly occurred around 35 weeks of gestation, ranged from 26 to 40 weeks. Additionally, there were risks of early preterm and low Apgar scores in women with antepartum-onset of PPCM.


Assuntos
Cardiomiopatias , Transtornos Puerperais , Recém-Nascido , Humanos , Feminino , Gravidez , Período Periparto , Estudos Retrospectivos , Transtornos Puerperais/epidemiologia , Período Pós-Parto
11.
J Am Coll Cardiol ; 80(15): 1465-1476, 2022 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-36202536

RESUMO

BACKGROUND: Chronic hypertension (CHT) is the main risk factor for cardiovascular diseases in women with a history of hypertensive disorders of pregnancy (HDP). OBJECTIVES: This study sought to assess the effectiveness of peripartum screening in predicting CHT after HDP. METHODS: In this longitudinal prospective study, women with HDP underwent peripartum transthoracic echocardiography and were evaluated for CHT (blood pressure ≥140/90 mm Hg or on antihypertensive medication) at least 3 months postpartum. Univariable and multivariable analyses assessed the association between clinical and transthoracic echocardiography data and a postpartum diagnosis of CHT. RESULTS: At a median postpartum follow-up of 124 days (IQR: 103-145 days), 70 (33.2%) of 211 women remained hypertensive. Compared with normotensive women, women with CHT were older (35.5 ± 5.0 years vs 32.9 ± 5.6 years; P = 0.001), were more likely to be Afro-Caribbean (27.1% vs 7.8%; P < 0.0001), had higher body mass index (33.4 ± 5.9 kg/m2 vs 31.2 ± 5.4 kg/m2; P = 0.006), and had higher mean arterial pressure (106.5 ± 8.4 mm Hg vs 103.3 ± 7.0 mm Hg; P = 0.004). Moreover, they showed significantly higher left ventricular mass index (84.0 ± 17.9 g/m2 vs 76.3 ± 14.8 g/m2; P = 0.001), higher relative wall thickness (0.46 ± 0.10 vs 0.40 ± 0.10; P < 0.0001), and lower global longitudinal strain (-15.6% ± 2.7% vs -16.6% ± 2.2%; P = 0.006) than normotensive women. A prediction model combining clinical (maternal age and first trimester mean arterial pressure) and echocardiographic features (left ventricular mass index >75 g/m2, relative wall thickness >0.42, and E/e' ratio >7) showed excellent accuracy in identifying women with persistent hypertension after HDP (area under the curve: 0.85; 95% CI: 0.79-0.90). CONCLUSIONS: This peripartum screening approach might be used to identify women at risk of CHT who would benefit from intensive blood pressure monitoring and pharmacological strategies from the early postpartum period to prevent cardiovascular disease.


Assuntos
Doenças Cardiovasculares , Hipertensão Induzida pela Gravidez , Pré-Eclâmpsia , Anti-Hipertensivos , Feminino , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/epidemiologia , Período Periparto , Período Pós-Parto/fisiologia , Pré-Eclâmpsia/diagnóstico , Gravidez , Estudos Prospectivos
13.
Rinsho Ketsueki ; 63(9): 1223-1232, 2022.
Artigo em Japonês | MEDLINE | ID: mdl-36198548

RESUMO

Hereditary thrombophilia is a condition in which individuals are susceptible to the formation of thrombi due to a hereditary deficiency in the anticoagulant factors antithrombin (AT), protein C, or protein S. The recommendations for peripartum management are as follows: 1) For women with acute venous thromboembolism (VTE) during pregnancy, anticoagulant therapy with a therapeutic dose of unfractionated heparin (UFH) is recommended; 2) For women with a history of VTE, a prophylactic dose of UFH is suggested during pregnancy; 3) For those with AT deficiency, supplementation with an AT preparation in addition to UFH is suggested; 4) For women with no history of VTE, anticoagulant therapy during pregnancy is considered for each thrombophilia type; 5) When anticoagulant therapy consisting of a prophylactic dose of UFH is administered during pregnancy, injection is discontinued with the onset of labor pains in cases of vaginal delivery and 6 hours before the start of delivery in cases of planned delivery or cesarean section; 6) In cases of AT deficiency, regardless of the thrombophilia type, supplementation with AT before and after delivery is suggested; 7) For women with thrombophilia and a history of VTE and for those who receive anticoagulant therapy during pregnancy, postpartum anticoagulant therapy is recommended.


Assuntos
Heparina , Trombofilia , Anticoagulantes/uso terapêutico , Antitrombinas/uso terapêutico , Cesárea , Feminino , Heparina/uso terapêutico , Humanos , Período Periparto , Gravidez , Proteína C , Fatores de Risco , Trombofilia/tratamento farmacológico , Trombofilia/etiologia
15.
Acta Obstet Gynecol Scand ; 101(11): 1197-1206, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36082797

RESUMO

INTRODUCTION: Mother-to-child transmission (MTCT) of the hepatitis B virus (HBV) is a serious public health challenge. Estimating HBV MTCT incidence by region under different prophylaxis regimens is critical to understanding the regional disease burden and prioritizing interventions. This study aimed to calculate HBV MTCT incidence under different prophylaxis regimens globally and regionally and identify the HBV DNA threshold for maternal peripartum antiviral prophylaxis. MATERIAL AND METHODS: This review was registered in advance in PROSPERO (CRD 42019120567). We searched PubMed, Embase, China National Knowledge Infrastructure, ClinicalTrials.gov, and Cochrane Library databases for studies on MTCT in pregnant women with chronic HBV infection from their inception until June 13, 2022. MTCT was defined as hepatitis B surface antigen (HBsAg) or HBV DNA seropositivity in infants aged 6-12 months. We calculated the pooled HBV MTCT incidence using the DerSimonian-Laird random-effects model. RESULTS: Among 300 studies, 3402 of 63 293 infants had HBV due to MTCT. Without prophylaxis regimens, the pooled HBV MTCT incidence was 31.3%, ranging from 0.0% (95% confidence interval [CI] 0.0%-6.0%; European Region) to 46.1% (95% CI 29.7%-63.0%; Western Pacific Region). Following the introduction of the hepatitis B vaccine, the HBV MTCT incidence decreased from 82.9% to 15.9% in HBeAg-positive women and from 10.3% to 2.3% in HBeAg-negative women. Maternal peripartum antiviral treatment alongside infant immunoprophylaxis further decreased MTCT incidence to 0.3% (95% CI 0.1%-0.5%). Despite infant immunoprophylaxis, the incidences of MTCT at maternal HBV DNA levels of <2.30, 2.00-3.29, 3.00-4.29, 4.00-5.29, 5.00-6.29, 6.00-7.29 and ≥7.00 log10  IU/ml were 0.0% (95% CI 0.0%-0.0%), 0.0% (95% CI 0.0%-0.0%), 0.0% (95% CI 0.0%-0.5%), 0.6% (95% CI 0.0%-2.6%), 1.0% (95% CI 0.0%-3.1%), 4.3% (95% CI 1.8%-7.5%), and 9.6% (95% CI 7.0%-12.5%), respectively. CONCLUSIONS: HBV MTCT incidence varies across regions. The Western Pacific Region bears the heaviest burden. Peripartum antiviral prophylaxis plus infant immunoprophylaxis is promising for interrupting HBV MTCT. Regarding the HBV DNA threshold for peripartum antiviral prophylaxis, maternal HBV DNA of 4.00 log10  IU/ml or greater seems justified.


Assuntos
Hepatite B , Complicações Infecciosas na Gravidez , Lactente , Feminino , Gravidez , Humanos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Antígenos de Superfície da Hepatite B/uso terapêutico , Antígenos E da Hepatite B/uso terapêutico , Incidência , Antivirais/uso terapêutico , Vacinas contra Hepatite B , DNA Viral , Período Periparto , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/tratamento farmacológico , Hepatite B/epidemiologia , Hepatite B/prevenção & controle , Hepatite B/tratamento farmacológico , Vírus da Hepatite B/genética
16.
Hypertens Res ; 45(11): 1823-1831, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36109600

RESUMO

We investigated the trends in the proportion of antihypertensive prescriptions listed in the guidelines for pregnant patients and their pregnancy outcomes before and after regulatory actions in Japan. This retrospective cohort study used the Japan Medical Data Center claims data from January 2005 to April 2020. We identified women who had delivered and had hypertensive disorders before childbirth. To evaluate the influence of regulatory actions (label revision in 2011 and guideline updates in 2014), we divided the study period into three terms based on the year of the last menstrual period. We assessed the time trend of the prescription proportion of antihypertensives and conducted multivariable logistic regression analyses to assess the impact of the investigation terms on pregnancy outcomes (preterm birth, cesarean section, emergency cesarean section, and Hemolysis, Elevated Liver enzymes, and Low Platelets syndrome). Among the 13,797 eligible patients, 1739 (12.6%) were treated with oral antihypertensives during pregnancy. Before the policy revisions, the most frequently prescribed antihypertensive medication was methyldopa, but after the label and guideline revisions, nifedipine was the most frequently prescribed. The trend in the prescription proportion of nifedipine increased (P < 0.001) and that of hydralazine decreased (P < 0.001), while those of methyldopa and labetalol showed no significant trend. The adjusted odds ratios for all four pregnancy outcomes showed no significant differences according to the investigation terms. By investigating the three terms before and after the label and guideline revisions, significant changes were identified in the trend of the prescription proportion for pregnant women-an increase in nifedipine and a decrease in hydralazine-but not in pregnancy outcomes.


Assuntos
Hipertensão , Nascimento Prematuro , Feminino , Humanos , Recém-Nascido , Gravidez , Anti-Hipertensivos , Metildopa/uso terapêutico , Nifedipino , Gestantes , Período Periparto , Cesárea , Estudos Retrospectivos , Japão , Nascimento Prematuro/induzido quimicamente , Nascimento Prematuro/tratamento farmacológico , Hipertensão/tratamento farmacológico , Hipertensão/induzido quimicamente , Hidralazina/uso terapêutico , Prescrições de Medicamentos , Resultado da Gravidez
17.
Jt Comm J Qual Patient Saf ; 48(12): 630-634, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36115776

RESUMO

BACKGROUND: Hypertensive disorders of pregnancy are a leading cause of severe maternal morbidity and mortality. National guidelines recommend treatment within 30 to 60 minutes of confirmed severe hypertension to reduce the risk of maternal stroke. The objectives of this study were to quantify the number of patients who did not receive timely treatment of severe hypertension, identify barriers to timely treatment, and evaluate if race/ethnicity was associated with timeliness of treatment. METHODS: The researchers created an automated report to identify women who experienced severe hypertension during the delivery admission. The record for each case was reviewed to determine if treatment was timely (within 30 minutes). The study team compared rates of severe peripartum hypertension and rates of timely vs. not timely treatment by race/ethnicity. RESULTS: There were 12,069 deliveries from April 1, 2019, to March 31, 2021-with 684 (5.7%) women with at least one episode of severe hypertension, of whom 241 (35.2%) did not require treatment, leaving 443 (64.8%) women requiring treatment. A total of 441 women received treatment, with 417 (94.6%) treated in a timely manner. Black, Asian, and Hispanic women were all more likely to experience severe hypertension requiring treatment than white women (10.0%, 8.8%, 7.3% vs. 4.0%, respectively, p < 0.001). However, there was no difference in the in the rates of timely treatment between groups (92.6%, 93.0%, 93.9% vs. 96.3%, respectively, p = 0.59). CONCLUSION: Among patients with severe hypertension, 94.6% were treated in a timely manner, and race/ethnicity was not associated with timeliness of treatment. Provider education at all levels at our institution seems to be effective for timely treatment of severe hypertension and suggests that this process could be beneficial at other institutions.


Assuntos
Hipertensão , Período Periparto , Gravidez , Humanos , Feminino , Masculino , Etnicidade , Hispânico ou Latino , Estudos Retrospectivos
18.
BMJ Open ; 12(9): e061430, 2022 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-36123084

RESUMO

OBJECTIVE: Despite the growing prevalence of obesity among reproductive aged persons in the USA, evidence-based guidelines for peripartum care are lacking. The objective of this scoping review is to identify obesity-related recommendations for peripartum care, evaluate grades of evidence for each recommendation, and identify practical tools (eg, checklists, toolkits, care pathways and bundles) to support their implementation in clinical practice. DATA SOURCES: We searched MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov from inception to December 2020 for eligible studies addressing peripartum care in persons with obesity. STUDY ELIGIBILITY CRITERIA: Inclusion criteria were published evidence-rated recommendations and practical tools for peripartum care of persons with obesity. STUDY APPRAISAL AND SYNTHESIS METHODS: Pairs of independent reviewers extracted data (source, publication year, content and number of recommendations, level and grade of evidence, description of tool) and identified similarities and differences among the articles. RESULTS: Of 18 315 screened articles, 18 were included including 7 articles with evidence-rated recommendations and 11 practical tools (3 checklists, 3 guidelines, 1 care bundle, 1 flowchart, 1 care pathway, 1 care map and 1 protocol). Thirteen of 39 evidence-rated recommendations were based on expert opinion. Recommendations related to surgical antibiotic prophylaxis and subcutaneous tissue closure at caesarean delivery received the highest grade of evidence. Some of the practical tools included a checklist from the USA regarding anticoagulation after caesarean delivery (evidence-supported recommendation), a bundle for surgical site infections after caesarean delivery in Australia (evidence did not support recommendation) and a checklist with content for several aspects of peripartum care from Canada (evidence supported seven of nine definitive recommendations). CONCLUSION: The recommendations for peripartum care for persons with obesity are based on limited evidence and few practical tools for implementation exist. Future work should focus on developing practical tools based on high-quality studies.


Assuntos
Antibioticoprofilaxia , Período Periparto , Adulto , Antibioticoprofilaxia/métodos , Anticoagulantes , Humanos , Obesidade/terapia , Infecção da Ferida Cirúrgica/prevenção & controle
19.
BMC Pregnancy Childbirth ; 22(1): 677, 2022 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-36057572

RESUMO

BACKGROUND: Persistent sinus tachycardia (ST) is frequently encountered during pregnancy and peripartum period and its etiology often remains elusive. We sought to examine the possible association between unexplained persistent ST and obstetric outcomes. METHODS: A case control study was conducted using chart review of women admitted in labor to one of 7 hospitals of Northwell Health between January 2015 to June 2021. After excluding women with structurally abnormal hearts, we identified patients with persistent ST during the peripartum period, defined as a heart rate of more than 100 bpm for more than 48 h. A control group was created by randomly subsampling those who did not meet the inclusion criteria for sinus tachycardia. Obstetric outcomes were measured as mother's length of stay (LOS), pre-term labor (PTL), admission to the neonatal ICU (NICU), and whether she received cesarean-section (CS). RESULTS: Seventy-eight patients with persistent ST were identified, out of 141,769 women admitted for labor throughout the Northwell Health system. 23 patients with ST attributable to infection or hypovolemia from anemia requiring transfusion and 55 with unclear etiology were identified. After adjusting for age and parity, pregnant mothers with ST were 2.35 times more likely to have a CS than those without (95% CI: 1.46-3.81, p = 0.0005) and had 1.38 times the LOS (1.21- 1.56, p < 0.0001). Among mothers with ST, those with unexplained ST were 2.14 times more likely to have a CS (1.22-3.75, p = 0.008). CONCLUSION: Among pregnant patients, patients with ST have higher rates of CS.This association is unclear, however potential mechanisms include catecholamine surge, indolent infection, hormonal fluctuations, and medications. More studies are needed to explore the mechanism of ST in pregnant woman to determine the clinical significance and appropriate management.


Assuntos
Período Periparto , Taquicardia Sinusal , Estudos de Casos e Controles , Cesárea , Feminino , Humanos , Recém-Nascido , Paridade , Gravidez , Taquicardia Sinusal/epidemiologia , Taquicardia Sinusal/etiologia
20.
PLoS One ; 17(9): e0274392, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36084036

RESUMO

The maternal care of cows can influence both the milk production and the performance of their calves, making this a topic of important relevance for the production industry that uses zebu cattle. The aims of this study were to 1) investigate the effects of parity on the behaviors of Gyr cows during the peripartum period; 2) characterize the maternal defensiveness of primiparous and multiparous cows towards handlers during the first handling of their calves; and 3) evaluate the relationships between cows' behaviors at the peripartum period and maternal defensiveness. Thirty-one Gyr cows (primiparous and multiparous), from Empresa de Pesquisa Agropecuária de Minas Gerais (Brazil), were used. The animals were placed in a maternity paddock monitored by video cameras. The behaviors of the animals were collected in four periods: Pre-calving, Post-calving, First handling of calf and Post-handling. Primiparous cows presented more pain signs, reflected in arched spine (P = 0.05), and tended to move more (P = 0.07) than the multiparous in the Pre-calving period. Trends were observed for both Maternal Composite Score (P = 0.06) and Maternal Protective Behavior score (P = 0.06), indicating that both primiparous and multiparous were protective, but only multiparous cows were aggressive toward the caretakers on the first handling of their calves. The most protective cows spent more time eating during the prepartum period (P = 0.03), while the least attentive cows spent more time lying down (P = 0.02) in the prepartum period. The cows who nursed and stimulated their calves more were also calmer (P = 0.02) and more attentive (P = 0.01). In conclusion, the peripartum behaviors of Gyr cows were related to maternal care and maternal defensiveness. Multiparous cows tended to be more aggressive than primiparous cows at the time of the first handling of their calves.


Assuntos
Comportamento Materno , Período Periparto , Animais , Brasil , Bovinos , Feminino , Humanos , Lactação , Leite , Paridade , Gravidez
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