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1.
PLoS One ; 19(7): e0306488, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38980883

RESUMO

Given Japan's unique social background, it is critical to understand the current risk factors for postpartum hemorrhage (PPH) to effectively manage the condition, especially among specific groups. Therefore, this study aimed to identify the current risk factors for PPH during planned cesarean section (CS) in Japan. This multicenter retrospective cohort study was conducted in two tertiary maternal-fetal medicine units in Fukushima, Japan and included 1,069 women who underwent planned CS between January 1, 2013, and December 31, 2022. Risk factors for PPH (of > 1000 g and > 1500 g) were assessed using multivariate logistic regression analysis, considering variables such as maternal age, parity, assisted reproductive technology (ART) pregnancy, pre-pregnancy body mass index (BMI), uterine myoma, placenta previa, gestational age at delivery, birth weight categories, and hypertensive disorders of pregnancy (HDP). Multivariate linear regression analyses were conducted to predict estimated blood loss during planned CS. ART pregnancy, a pre-pregnancy BMI of 25.0-29.9 kg/m2, and uterine myoma increased PPH risk at various levels. Maternal smoking increased the risk of >1500 g PPH (adjusted odds ratio: 3.09, 95% confidence interval [CI]: 1.16-8.20). Multivariate linear analysis showed that advanced maternal age (B: 83 g; 95% CI: 27-139 g), ART pregnancy (B: 239 g; 95% CI: 121-357 g), pre-pregnancy BMI of 25.0-29.9 kg/m2 (B: 74 g; 95% CI: 22-167 g), uterine myoma (B: 151 g; 95% CI: 47-256 g), smoking (B: 107 g; 95% CI: 13-200 g), and birth weight > 3,500 g (B: 203 g; 95% CI: 67-338 g) were associated with blood loss during planned CS. Considering a patient's clinical characteristic may help predict bleeding in planned CSs and help improve patient safety.


Assuntos
Cesárea , Hemorragia Pós-Parto , Humanos , Feminino , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/epidemiologia , Cesárea/efeitos adversos , Gravidez , Estudos Retrospectivos , Japão/epidemiologia , Adulto , Fatores de Risco , Idade Materna , Índice de Massa Corporal
2.
Artigo em Inglês | MEDLINE | ID: mdl-38994461

RESUMO

Objective: In Brazil, postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality. Data on the profile of women and risk factors associated with PPH are sparse. This study aimed to describe the profile and management of patients with PPH, and the association of risk factors for PPH with severe maternal outcomes (SMO). Methods: A cross-sectional study was conducted in Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) obstetric intensive care unit (ICU) between January 2012 and March 2020, including patients who gave birth at the hospital and that were admitted with PPH to the ICU. Results: The study included 358 patients, of whom 245 (68.4%) delivered in the IMIP maternity, and 113 (31.6%) in other maternity. The mean age of the patients was 26.7 years, with up to eight years of education (46.1%) and a mean of six prenatal care. Uterine atony (72.9%) was the most common cause, 1.6% estimated blood loss, 2% calculated shock index (SI), 63.9% of patients received hemotransfusion, and 27% underwent hysterectomy. 136 cases of SMO were identified, 35.5% were classified as maternal near miss and 3.0% maternal deaths. Multiparity was associated with SMO as an antepartum risk factor (RR=1.83, 95% CI1.42-2.36). Regarding intrapartum risk factors, abruptio placentae abruption was associated with SMO (RR=2.2 95% CI1.75-2.81). Among those who had hypertension (49.6%) there was a lower risk of developing SMO. Conclusion: The principal factors associated with poor maternal outcome were being multiparous and placental abruption.


Assuntos
Hemorragia Pós-Parto , Humanos , Feminino , Estudos Transversais , Hemorragia Pós-Parto/terapia , Adulto , Gravidez , Fatores de Risco , Brasil/epidemiologia , Unidades de Terapia Intensiva , Adulto Jovem , Descolamento Prematuro da Placenta/epidemiologia , Mortalidade Materna
3.
Artigo em Inglês | MEDLINE | ID: mdl-38994464

RESUMO

Objective: To evaluate the risk factors for postpartum hemorrhage (PPH) according to the Robson Classification in a low-risk maternity hospital. Methods: We conducted retrospective cohort study by analyzing the medical records of pregnant women attended in a low-risk maternity hospital, during from November 2019 to November 2021. Variables analyzed were: maternal age, type of delivery, birth weight, parity, Robson Classification, and causes of PPH. We compared the occurrence of PPH between pregnant women with spontaneous (Groups 1 and 3) and with induction of labor (2a and 4a). Chi-square and Student t-tests were performed. Variables were compared using binary logistic regression. Results: There were 11,935 deliveries during the study period. According to Robson's Classification, 48.2% were classified as 1 and 3 (Group I: 5,750/11,935) and 26.1% as 2a and 4a (Group II: 3,124/11,935). Group II had higher prevalence of PPH than Group I (3.5 vs. 2.7%, p=0.028). Labor induction increased the occurrence of PPH by 18.8% (RR: 1.188, 95% CI: 1.02-1.36, p=0.030). Model including forceps delivery [x2(3)=10.6, OR: 7.26, 95%CI: 3.32-15.84, R2 Nagelkerke: 0.011, p<0.001] and birth weight [x2(4)=59.0, OR: 1.001, 95%CI:1.001-1.001, R2 Nagelkerke: 0.033, p<0.001] was the best for predicting PPH in patients classified as Robson 1, 3, 2a, and 4a. Birth weight was poor predictor of PPH (area under ROC curve: 0.612, p<0.001, 95%CI: 0.572-0.653). Conclusion: Robson Classification 2a and 4a showed the highest rates of postpartum hemorrhage. The model including forceps delivery and birth weight was the best predictor for postpartum hemorrhage in Robson Classification 1, 3, 2a, and 4a.


Assuntos
Maternidades , Hemorragia Pós-Parto , Humanos , Feminino , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/classificação , Hemorragia Pós-Parto/etiologia , Estudos Retrospectivos , Gravidez , Adulto , Fatores de Risco , Maternidades/estatística & dados numéricos , Trabalho de Parto Induzido/efeitos adversos , Trabalho de Parto Induzido/estatística & dados numéricos , Adulto Jovem , Paridade , Peso ao Nascer , Parto Obstétrico/efeitos adversos , Prevalência , Idade Materna
4.
5.
J Obstet Gynaecol ; 44(1): 2380084, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-39016305

RESUMO

Postpartum haemorrhage (PPH) is a leading cause of maternal mortality and morbidity on a global scale. Ethnic background is known to be a determinant of variation in the outcomes of women receiving maternity care across the world. Despite free maternity healthcare in the UK National Health Service, women with an ethnic minority background giving birth have an increased risk of PPH, even when other characteristics of the mother, the baby and the care received are considered. Improving PPH care has significant implications for improving health equity. The underlying causes of ethnic disparities are complex and multifaceted. It requires a deep dive into analysing the unique patient factors that make these women more likely to suffer from a PPH as well as reflecting on the efficacy of intra and postpartum care and prophylactic treatment these women receive.


Assuntos
Etnicidade , Hemorragia Pós-Parto , Humanos , Feminino , Hemorragia Pós-Parto/etnologia , Hemorragia Pós-Parto/etiologia , Fatores de Risco , Gravidez , Etnicidade/estatística & dados numéricos , Reino Unido/epidemiologia , Mortalidade Materna/etnologia , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos
6.
Nutrients ; 16(13)2024 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-38999805

RESUMO

We previously reported that a combined myo-inositol, probiotics, and enriched micronutrient supplement (intervention) taken preconception and in pregnancy reduced postpartum blood loss (PBL) and major postpartum hemorrhage compared with a standard micronutrient supplement (control), as secondary outcomes of the NiPPeR trial. This study aimed to identify the intervention components that may contribute to this effect. Associations of plasma concentrations of myo-inositol and vitamins B2, B6, B12, and D at preconception (before and after supplementation), early (~7-weeks), and late pregnancy (~28-weeks) with PBL were assessed by multiple linear regression, adjusting for site, ethnicity, preconception BMI, parity, and previous cesarean section. Amongst 583 women, a higher concentration of myo-inositol in early pregnancy was associated with a PBL reduction [ßadj -1.26 (95%CI -2.23, -0.29) mL per µmol/L myo-inositol increase, p = 0.011]. Applying this co-efficient to the increase in mean 7-week-myo-inositol concentration of 23.4 µmol/L with the intervention equated to a PBL reduction of 29.5 mL (~8.4% of mean PBL of 350 mL among controls), accounting for 84.3% of the previously reported intervention effect of 35 mL. None of the examined vitamins were associated with PBL. Therefore, myo-inositol may be a key intervention component mediating the PBL reduction. Further work is required to determine the mechanisms involved.


Assuntos
Suplementos Nutricionais , Inositol , Hemorragia Pós-Parto , Humanos , Feminino , Inositol/sangue , Inositol/administração & dosagem , Gravidez , Adulto , Hemorragia Pós-Parto/sangue , Hemorragia Pós-Parto/prevenção & controle , Micronutrientes/sangue , Fenômenos Fisiológicos da Nutrição Materna , Período Pós-Parto/sangue
7.
PLoS One ; 19(6): e0303844, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38861495

RESUMO

Post-partum haemorrhage is among the main causes of (preventable) mortality for women in low-resource settings (LRSs), where, in 2017, the mortality ratio was 462 out of every 100 000 live births, over 10 times higher than for high-resource settings. There are different treatments available for post-partum haemorrhage. The intrauterine balloon tamponade is a medical device that proved to be a simple and cost-effective approach. Currently, there are several balloon tamponades available, with different design and working principles. However, all these devices were designed for high-resource settings, presenting several aspects that could be inappropriate for many lower-income countries. This paper presents the results of a preclinical study aiming at informing the design, prototyping and validation of a 3D-printed intrauterine balloon tamponade concept, contributing towards the United Nation's Sustainable Development Goal 3: Good health and Well-being. Frugal engineering concepts and contextualised design techniques were applied throughout, to define the design requirements and specifications. The performance of the final prototype was validated against the requirements of the UK National Health System (NHS) technical guidelines and relevant literature, measuring the water leak and pressure drop over time, both open air and in a approximate uterus model. The resulting prototype is made up of six components, some of which are easy to retrieve, namely a water bottle, a silicone tube and an ordinary condom, while others can be manufactured locally using 3D printers, namely a modified bottle cap, a flow stopper and a valve for holding the condom in place. Validation testing bore promising results with no water or pressure leak open air, and minimal leaks in the approximate uterus model. This demonstrates that the 3D printed condom-based intrauterine balloon tamponade is performing well against the requirements and, when compared to the state of the art, it could be a more appropriate and more resilient solution to low-resource settings, as it bypasses the challenges in the supply of consumables and presents a greener option based on circular economy.


Assuntos
Desenho de Equipamento , Hemorragia Pós-Parto , Impressão Tridimensional , Tamponamento com Balão Uterino , Feminino , Humanos , Tamponamento com Balão Uterino/instrumentação , Tamponamento com Balão Uterino/métodos , Hemorragia Pós-Parto/terapia , Hemorragia Pós-Parto/prevenção & controle , Preservativos , Gravidez
8.
BMC Womens Health ; 24(1): 349, 2024 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-38886787

RESUMO

Pregnant women in rural Uganda largely rely on medicinal plants for inducing labor, treating postpartum hemorrhage (PPH), and inducing abortion. 90% of the women in both rural and urban Uganda use plants to manage pregnancy symptoms like constipation, heartburn, morning sickness, body aches, nausea, and vomiting. After delivery women continue using plants to manage postpartum complications and for infant care especially herbal baths. This study documented how ethnomedical folklore has been used to aid childbirth, manage postpartum hemorrhage, and induce abortion. METHODS: A cross-sectional ethnobotanical survey was conducted from May - December 2023 in Najjemebe sub-county, Buikwe district. 206 respondents from 12 villages were selected using snowball sampling. Key informants included Traditional Birth Attendants (TBAs) and herbalists. Data was collected using semi-structured questionnaires and focus group discussions. Voucher specimens of the plants were identified and authenticated at Makerere University Herbarium. Data were analyzed using descriptive statistics, Informant Consensus factor (ICF), Use Reports (URs), paired comparisons, and GraphPad Prism® version 9.0.0 software. RESULTS: All respondents (N = 206, 100%), used plants to induce labour, treat PPH, and induce abortion. One hundred four plant species were documented: most cited or preferred were: Hoslundia opposita (N = 109, 53%), Phytolacca dodecandra (N = 72, 35%), and Commelina erecta (N = 47, 23%). The plants belonged to 49 families, Lamiaceae (16.3%) and Fabaceae (14.3%) having the majority of the species. Herbs were 42 (40%) and trees 23 (22%). Oral administration 95(72%) was the commonest, then topical 19 (14.4%) and vaginal 14(10.6%). CONCLUSION: Health surveys revealed that about 27% of deliveries in Uganda take place outside a health facility. Due to the oxytocic effects of plant species reported in this study, they play a triple role of being uterotonics, abortifacients, and treating postpartum haemmorhage. The dilemma lies in the unknown dosages and toxicity levels that could endanger both the mother's and the unborn child's lives. Due to Uganda's high rates of population growth, overall fertility, maternal mortality, and morbidity, policies, and programmes on gendered health provision need to be reevaluated. Integrating herbal medicine into health care systems appears to be a feasible solution.


Assuntos
Medicinas Tradicionais Africanas , Hemorragia Pós-Parto , Humanos , Feminino , Uganda , Estudos Transversais , Adulto , Gravidez , Hemorragia Pós-Parto/tratamento farmacológico , Medicinas Tradicionais Africanas/métodos , Medicinas Tradicionais Africanas/estatística & dados numéricos , Aborto Induzido/métodos , Aborto Induzido/estatística & dados numéricos , Fitoterapia/métodos , Fitoterapia/estatística & dados numéricos , Plantas Medicinais , Pessoa de Meia-Idade , Adulto Jovem , Etnobotânica , Inquéritos e Questionários , Preparações de Plantas/uso terapêutico , Tocologia/estatística & dados numéricos , Masculino
9.
Artigo em Inglês | MEDLINE | ID: mdl-38902107

RESUMO

Postpartum haemorrhage (PPH) and PPH-related deaths are disproportionately higher in low-income countries, with sub-Saharan Africa and Southern Asia accounting for approximately 85% of the global burden of PPH-related maternal deaths. Although PPH-related mortality is directly related to the amount and duration of bleeding, the high maternal death burden in resource-limited countries suggests that a great majority of these deaths would be avoidable with the appropriate resources and effective use of evidence-based interventions. Non-surgical management is often the first-line approach for PPH, but conservative surgical interventions may be required if bleeding persists or if the underlying cause is not responsive to the initial conservative measures. The appropriate interventions should be selected based on the individual's specific circumstances and clinical condition.


Assuntos
Hemorragia Pós-Parto , Humanos , Hemorragia Pós-Parto/terapia , Feminino , Gravidez , Tratamento Conservador/métodos , Países em Desenvolvimento , Mortalidade Materna , Embolização da Artéria Uterina
10.
BMC Med Inform Decis Mak ; 24(1): 166, 2024 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-38872184

RESUMO

BACKGROUND: Cesarean section-induced postpartum hemorrhage (PPH) potentially causes anemia and hypovolemic shock in pregnant women. Hence, it is helpful for obstetricians and anesthesiologists to prepare pre-emptive prevention when predicting PPH occurrence in advance. However, current works on PPH prediction focus on whether PPH occurs rather than assessing PPH amount. To this end, this work studies quantitative PPH prediction with machine learning (ML). METHODS: The study cohort in this paper was selected from individuals with PPH who were hospitalized at Shijiazhuang Obstetrics and Gynecology Hospital from 2020 to 2022. In this study cohort, we built a dataset with 6,144 subjects covering clinical parameters, anesthesia operation records, laboratory examination results, and other information in the electronic medical record system. Based on our built dataset, we exploit six different ML models, including logistic regression, linear regression, gradient boosting, XGBoost, multilayer perceptron, and random forest, to automatically predict the amount of bleeding during cesarean section. Eighty percent of the dataset was used as model training, and 20 % was used for verification. Those ML models are constantly verified and improved by root mean squared error(RMSE) and mean absolute error(MAE). Moreover, we also leverage the importance of permutation and partial dependence plot (PDP) to discuss their feasibility. RESULT: The experiment results show that random forest obtains the highest accuracy for PPH amount prediction compared to other ML methods. Random forest reaches the mean absolute error of 21.7, less than 5.4 % prediction error. It also gains the root mean squared error of 33.75, less than 9.3 % prediction error. On the other hand, the experimental results also disclose indicators that contributed most to PPH prediction, including Ca, hemoglobin, white blood cells, platelets, Na, and K. CONCLUSION: It effectively predicts the amount of PPH during a cesarean section by ML methods, especially random forest. With the above insight, ML predicting PPH amounts provides early warning for clinicians, thus reducing complications and improving cesarean sections' safety. Furthermore, the importance of ML and permutation, complemented by incorporating PDP, promises to provide clinicians with a transparent indication of individual risk prediction.


Assuntos
Cesárea , Aprendizado de Máquina , Hemorragia Pós-Parto , Humanos , Feminino , Cesárea/efeitos adversos , Gravidez , Adulto
11.
J Obstet Gynaecol ; 44(1): 2369664, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38917046

RESUMO

BACKGROUND: The aim is to investigate the risk of short-term maternal morbidity caused by the selective clinical use of episiotomy (rate < 0.02), and to compare the risk of severe perineal tears with the statewide risk. METHODS: In this retrospective cohort study, we investigated the effect of selective episiotomy on the risk of severe perineal tears and blood loss in singleton term deliveries, using propensity scores with inverse probability weighting. RESULTS: This study included 10992 women who delivered vaginally between 2008-2018. Episiotomy was performed in 171 patients (1.55%), three of whom (1.75%) experienced severe perineal tears compared to 156 (1.44%) in the control cohort. The adjusted odds ratio of severe perineal tears was 2.06 (95% confidence interval [CI]: 0.51, 8.19 with 0.3 p value). Multivariate linear regression showed that episiotomy increased blood loss by 96.3 ml (95% CI: 6.4, 186.2 with 0.03 p value). Episiotomy was performed in 23% (95% CI: 0.228, 0.23) of vaginal deliveries in the state of Hessen, with a risk of severe perineal tears of 0.0143 (95% CI: 0.0139, 0.0147) compared to 0.0145 (95% CI: 0.0123, 0.0168) in our entire cohort. CONCLUSIONS: Selective use of episiotomy does not increase the risk of higher-grade perineal tears. However, it may be associated with maternal morbidity in terms of increased blood loss.


An episiotomy is a cut between the vagina and the anus that may be performed by an obstetrician during childbirth and can result in increased blood loss or severe birth tears. In this study, we investigated the risks of both bleeding and severe tears caused by a highly selective local practice of episiotomies below 2% and compared the results with statewide data. The study included 10992 women who delivered between 2008­2018, 171 of whom underwent episiotomies according to the hospital's protocols. Having an episiotomy did not increase the likelihood of severe birthing tears but was associated with an increase in estimated blood loss. Therefore, although highly selective use of episiotomy is unlikely to cause more severe tears, it has the potential to worsen the mother's health by increasing blood loss.


Assuntos
Episiotomia , Complicações do Trabalho de Parto , Períneo , Humanos , Feminino , Episiotomia/efeitos adversos , Episiotomia/estatística & dados numéricos , Estudos Retrospectivos , Gravidez , Adulto , Períneo/lesões , Complicações do Trabalho de Parto/etiologia , Complicações do Trabalho de Parto/epidemiologia , Parto Obstétrico/efeitos adversos , Parto Obstétrico/estatística & dados numéricos , Parto Obstétrico/métodos , Fatores de Risco , Lacerações/etiologia , Lacerações/epidemiologia , Pontuação de Propensão , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/epidemiologia , Adulto Jovem
12.
Front Endocrinol (Lausanne) ; 15: 1280692, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38894748

RESUMO

Background: The prevalence of obesity among women of reproductive age is increasing worldwide, with implications for serious pregnancy complications. Methods: Following PRISMA guidelines, a systematic search was conducted in both Chinese and English databases up to December 30, 2020. Pregnancy complications and outcomes including gestational diabetes mellitus (GDM), gestational hypertension (GHTN), pre-eclampsia, cesarean section (CS), induction of labor (IOL), and postpartum hemorrhage (PPH) were analyzed. Random-effects or fixed-effects models were utilized to calculate the odds ratio (OR) with 95% confidence intervals (CIs). Results: Women with overweight and obesity issues exhibited significantly higher risks of GDM (OR, 2.92, 95%CI, 2.18-2.40 and 3.46, 95%CI, 3.05-3.94, respectively) and GHTN (OR, 2.08, 95%CI, 1.72-2.53 and 3.36, 95%CI, 2.81-4.00, respectively) compared to women of normal weight. Pre-eclampsia was also significantly higher in women with overweight or obesity, with ORs of 1.70 (95%CI, 1.44-2.01) and 2.82 (95%CI, 2.66-3.00), respectively. Additionally, mothers with overweight or obesity issues had significantly higher risks of CS (OR, 1.44, 95%CI, 1.41-1.47, and 2.23, 95%CI, 2.08-2.40), IOL (OR, 1.33, 95%CI, 1.30-1.35 and 1.96, 95%CI, 1.85-2.07), and PPH (OR, 1.67, 95%CI, 1.42-1.96 and 1.88, 95%CI, 1.55-2.29). Conclusion: Women with overweight or obesity issues face increased risks of pregnancy complications and adverse outcomes, indicating dose-dependent effects.


Assuntos
Índice de Massa Corporal , Complicações na Gravidez , Resultado da Gravidez , Humanos , Gravidez , Feminino , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Obesidade/complicações , Obesidade/epidemiologia , Diabetes Gestacional/epidemiologia , Pré-Eclâmpsia/epidemiologia , Cesárea/estatística & dados numéricos , Sobrepeso/complicações , Sobrepeso/epidemiologia , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/etiologia
13.
BMJ Open ; 14(6): e083230, 2024 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-38908838

RESUMO

OBJECTIVE: To identify determinants of puerperal sepsis among postpartum women attending East Shoa Zone public hospitals, Central Ethiopia, 2023. DESIGN AND SETTING: An institutional-based, unmatched case-control study was conducted from 19 June 2023 to 4 September 2023, in East Shoa Zone public hospitals. PARTICIPANTS: 495 postpartum women (100 cases and 395 controls) were selected using systematic sampling techniques. Data were collected through face-to-face interviews and from medical charts using a pretested, structured questionnaire. The AOR with its corresponding 95% CI was used to identify determinant variables. Findings were presented in texts and tables. OUTCOME MEASURES: The medical charts of participants were reviewed to identify those who had developed puerperal sepsis. RESULTS: Anaemia (AOR 6.05; 95% CI 2.57 to 14.26), undernourishment (AOR 4.43; 95% CI 1.96 to 10.01), gestational diabetes mellitus (AOR 3.26; 95% CI 1.22 to 8.74), postpartum haemorrhage (AOR 3.17; 95% CI 1.28 to 7.87), obstructed labour (AOR 2.76; 95% CI 1.17 to 6.52), multiparity (AOR 2.54; 95% CI 1.17 to 5.50), placenta previa (AOR 2.27; 95% CI 1.11 to 4.67) and vaginal examination ≥5 times (AOR 2.19; 95% CI 1.05 to 4.54) were the independent determinants of puerperal sepsis in this study. CONCLUSION: This study found that gestational diabetes mellitus, anaemia, undernourishment, placenta previa, obstructed labour, postpartum haemorrhage and five or more per-vaginal examinations during labour were the determinants of puerperal sepsis. Therefore, it is recommended that obstetric care providers strictly adhere to guidelines on the number of vaginal exams that should be performed throughout labour and that they perform these exams using the appropriate infection-prevention techniques. In addition, they should provide comprehensive health education on nutrition during pregnancy and postnatal periods and the importance of iron supplements.


Assuntos
Hospitais Públicos , Infecção Puerperal , Sepse , Humanos , Feminino , Etiópia/epidemiologia , Estudos de Casos e Controles , Adulto , Sepse/epidemiologia , Gravidez , Infecção Puerperal/epidemiologia , Fatores de Risco , Adulto Jovem , Período Pós-Parto , Hemorragia Pós-Parto/epidemiologia , Anemia/epidemiologia , Adolescente , Diabetes Gestacional/epidemiologia
14.
Nurs Open ; 11(6): e2221, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38923309

RESUMO

AIMS: To establish a comprehensive understanding of the roles of midwives and the challenges they encounter in the prevention, diagnosis and management of postpartum haemorrhage (PPH) following normal vaginal delivery. DESIGN: We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews (PRISMA-ScR) recommendations. METHODS: We considered studies related to the roles of midwives and the challenges they encounter in the prevention, diagnosis and management of PPH during vaginal delivery. We excluded guidelines, consensuses, abstracts of meetings and non-English language studies. Databases, including the Cochrane Library, PubMed, Web of Science, Ovid, Medline, Embase, JBI EBP and BIOSIS Previews, were searched on January 1, 2023, with no time limitations. RESULTS: We included 28 publications. Midwives play important roles in the prevention, diagnosis and management of postpartum haemorrhage during vaginal delivery. In the prevention of PPH, midwives' roles include identifying and managing high-risk factors, managing labour and implementing skin-to-skin contact. In the diagnosis of PPH, midwives' roles include early recognition and blood loss estimation. In the management of PPH, midwives are involved in mobilizing other professional team members, emergency management, investigating causes, enhancing uterine contractions, the repair of perineal tears, arranging transfers and preparation for surgical intervention. However, midwives face substantial challenges, including insufficient knowledge and skills, poor teamwork skills, insufficient resources and the need to deal with their negative emotions. Midwives must improve their knowledge, skills and teamwork abilities. Health care system managers and the government should give full support to midwives. Future research should focus on developing clinical practice guidelines for midwives for preventing, diagnosing and managing postpartum haemorrhage.


Assuntos
Parto Obstétrico , Hemorragia Pós-Parto , Humanos , Hemorragia Pós-Parto/enfermagem , Hemorragia Pós-Parto/prevenção & controle , Hemorragia Pós-Parto/terapia , Feminino , Parto Obstétrico/efeitos adversos , Parto Obstétrico/enfermagem , Gravidez , Tocologia , Enfermeiros Obstétricos
17.
MCN Am J Matern Child Nurs ; 49(4): 219-224, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38926920

RESUMO

PURPOSE: The purpose of this study was to examine the impact of the first year of COVID-19 pandemic on maternal and neonatal outcomes at a large military treatment facility in Southern California. STUDY DESIGN AND METHODS: A retrospective review of maternal and neonatal medical records was conducted between January 1, 2019, and December 31, 2020. Outcomes measured included stillbirth rate, neonatal intensive care unit admission, neonatal death, cesarean birth, and postpartum hemorrhage. RESULTS: A total of 4,425 records were analyzed. Rates of stillbirth between the years did not vary. The neonatal death rate decreased more than 50% in 2020 (p = .149). Cesarean births rose by 2.7% in 2020 (p = .046). Rates of postpartum hemorrhage did not vary between years. CLINICAL IMPLICATIONS: The impact of COVID-19 on maternal and neonatal outcomes at a military treatment facility in the first year of the COVID-19 pandemic provides guidance for optimizing perinatal health care. Vertical transmission of COVID-19 is low and routine testing of asymptomatic neonates of positive mothers may not be necessary. COVID-19 infections should not be an indication for cesarean birth and are not associated with neonatal deaths or NICU admission.


Assuntos
COVID-19 , Hospitais Militares , Natimorto , Humanos , COVID-19/epidemiologia , COVID-19/mortalidade , Feminino , Estudos Retrospectivos , Gravidez , Hospitais Militares/estatística & dados numéricos , Recém-Nascido , Adulto , California/epidemiologia , Natimorto/epidemiologia , Cesárea/estatística & dados numéricos , Resultado da Gravidez/epidemiologia , SARS-CoV-2 , Pandemias , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Unidades de Terapia Intensiva Neonatal/organização & administração , Hemorragia Pós-Parto/epidemiologia
18.
Sci Rep ; 14(1): 13953, 2024 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-38886458

RESUMO

Predicting postpartum hemorrhage (PPH) before delivery is crucial for enhancing patient outcomes, enabling timely transfer and implementation of prophylactic therapies. We attempted to utilize machine learning (ML) using basic pre-labor clinical data and laboratory measurements to predict postpartum Hemoglobin (Hb) in non-complicated singleton pregnancies. The local databases of two academic care centers on patient delivery were incorporated into the current study. Patients with preexisting coagulopathy, traumatic cases, and allogenic blood transfusion were excluded from all analyses. The association of pre-delivery variables with 24-h post-delivery hemoglobin level was evaluated using feature selection with Elastic Net regression and Random Forest algorithms. A suite of ML algorithms was employed to predict post-delivery Hb levels. Out of 2051 pregnant women, 1974 were included in the final analysis. After data pre-processing and redundant variable removal, the top predictors selected via feature selection for predicting post-delivery Hb were parity (B: 0.09 [0.05-0.12]), gestational age, pre-delivery hemoglobin (B:0.83 [0.80-0.85]) and fibrinogen levels (B:0.01 [0.01-0.01]), and pre-labor platelet count (B*1000: 0.77 [0.30-1.23]). Among the trained algorithms, artificial neural network provided the most accurate model (Root mean squared error: 0.62), which was subsequently deployed as a web-based calculator: https://predictivecalculators.shinyapps.io/ANN-HB . The current study shows that ML models could be utilized as accurate predictors of indirect measures of PPH and can be readily incorporated into healthcare systems. Further studies with heterogenous population-based samples may further improve the generalizability of these models.


Assuntos
Algoritmos , Hemoglobinas , Aprendizado de Máquina , Humanos , Feminino , Hemoglobinas/análise , Hemoglobinas/metabolismo , Gravidez , Adulto , Hemorragia Pós-Parto/sangue , Período Pós-Parto/sangue , Parto Obstétrico
19.
J Matern Fetal Neonatal Med ; 37(1): 2369210, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38910114

RESUMO

OBJECTIVE: The current study aims to evaluate the correlation between oxytocin augmentation and postpartum hemorrhage. METHOD: PubMed, Web of Science, and Scopus has been searched for studies assessing the correlation between oxytocin augmentation and postpartum hemorrhage up to January 24, 2024. The search strategy included relevant keywords related to PPH and oxytocin augmentation. The risk of bias assessment was conducted by two reviewers using the Newcastle-Ottawa Scale (NOS). To pool the effects sized of included studies odds ratios (OR) of interest outcome with their 95% confidence interval (CI) were used. RESULTS: Eight studies were included in this meta-analysis. The pooled analysis of the included studies showed a statistically significant association between oxytocin augmentation and increased odds of PPH (pooled odds ratio [OR] = 1.27, 95% confidence interval [CI]: 1.05-1.53; I2 = 84.94%; p = 0.01). Publication bias was assessed using funnel plots, which appeared relatively asymmetrical, indicating significant publication bias. Galbraith plot and trim and fill plot were used for publication bias. Sensitivity analyses were performed by leave one out method. CONCLUSION: This meta-analysis suggests that using oxytocin for labor augmentation is linked to a significant increase in the risk of PPH. It highlights the need for careful monitoring and consideration when using oxytocin, especially in low and middle-income countries where guidelines and supervision are crucial.


Assuntos
Ocitócicos , Ocitocina , Hemorragia Pós-Parto , Humanos , Ocitocina/administração & dosagem , Ocitocina/efeitos adversos , Feminino , Hemorragia Pós-Parto/epidemiologia , Gravidez , Ocitócicos/administração & dosagem , Ocitócicos/efeitos adversos
20.
Hypertens Pregnancy ; 43(1): 2366824, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38864450

RESUMO

This study aimed to establish in vitro hemodilution and resupplementation assays for obstetric hemorrhage in pregnancy-induced hypertension (PIH) and to monitor the coagulation function dynamically using a coagulation and platelet function analyzer. Forty-seven singleton pregnant women were divided into normal (n = 24) and PIH (n = 23) groups. Peripheral blood samples were used to construct the assays, and the activated clotting time (ACT), clotting rate (CR), and platelet function index (PF) were measured. The results showed that the baseline ACT was higher in the PIH group (p < 0.01). Hemodilution assays showed decreased ACT and increased CR and PF, with ACT changes significantly lower in the PIH group (p < 0.05). CR changed most in both groups at lower dilution ratios (35% to 50%), while ACT changed most at a higher dilution ratio (75%). In the resupplementation assay, ACT exhibited the most significant response. The analyzer effectively detected differences between pregnant women with and without PIH. Thus, we need to pay more attention to the changes of ACT in the actual clinical application to assess the coagulation status of parturients.


Assuntos
Coagulação Sanguínea , Hipertensão Induzida pela Gravidez , Testes de Função Plaquetária , Humanos , Feminino , Gravidez , Adulto , Hipertensão Induzida pela Gravidez/sangue , Hipertensão Induzida pela Gravidez/fisiopatologia , Coagulação Sanguínea/fisiologia , Testes de Coagulação Sanguínea , Hemorragia Pós-Parto/sangue , Adulto Jovem
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