Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 72
Filtrar
1.
J Phys Chem A ; 126(38): 6617-6627, 2022 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-36126364

RESUMO

This work explores Coulomb explosion (CE) dissociation pathways in multiply charged cations of para-nitrotoluene (PNT), a model compound for nitroaromatic energetic molecules. Experiments using strong-field ionization and mass spectrometry indicate that metastable cations PNT2+ and PNT3+ undergo CE to produce NO2+ and NO+. The experimentally measured kinetic energy release from CE upon formation of NO2+ and NO+ agrees qualitatively with the kinetic energy release predicted by computations of the reaction pathways in PNT2+ and PNT3+ using density functional theory (DFT). Both DFT computations and mass spectrometry identified additional products from CE of highly charged PNTq+ cations with q > 3. The dynamical timescales required for direct CE of PNT2+ and PNT3+ to produce NO2+ were estimated to be 200 and 90 fs, respectively, using ultrafast disruptive probing measurements.

2.
J Phys Chem A ; 124(13): 2530-2536, 2020 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-32149509

RESUMO

Treatment of homo- and heterocyclic aromatic substrates with basic deuterium oxide under near- or supercritical conditions results in rapid base-catalyzed hydrogen-deuterium exchange (HDE) in aromatic and benzylic positions. It has been postulated that HDE follows a simple deprotonation-reprotonation mechanism, but little evidence has been provided to date. This study correlates experimentally observed proton exchanges in n-butylbenzene with ab initio calculations of the acidities and potential energy (PE) profiles. In addition to providing further support for carbanion intermediacy in HDE, these results offer new insights into substrate acidities in near- and supercritical aqueous media and the optimal conditions required for their isotope exchange.

3.
J Phys Chem A ; 124(37): 7427-7438, 2020 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-32841027

RESUMO

Dissociation pathways of singly- and multiply charged gas-phase nitromethane cations were investigated with strong-field laser photoionization mass spectrometry and density functional theory computations. There are multiple isomers of the singly charged nitromethane radical cation, several of which can be accessed by rearrangement of the parent CH3-NO2 structure with low energy barriers. While direct cleavage of the C-N bond from the parent nitromethane cation produces NO2+ and CH3+, rearrangement prior to dissociation accounts for fragmentation products including NO+, CH2OH+, and CH2NO+. Extensive Coulomb explosion in fragment ions observed at high laser intensity indicates that rapid dissociation of multiply charged nitromethane cations produces additional species such as CH2+, H+, and NO22+.  On the basis of analysis of Coulomb explosion in the mass spectral signals and pathway calculations, sufficiently intense laser fields can remove four or more electrons from nitromethane.

4.
J Phys Chem A ; 124(16): 3120-3134, 2020 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-32233368

RESUMO

We report density functional theory computations and photoionization mass spectrometry measurements of aniline and its positively charged ions. The geometrical structures and properties of the neutral and singly, doubly, and triply positively charged aniline are computed using density functional theory with the generalized gradient approximation. At each charge, there are multiple isomers closely spaced in total energy. Whereas the lowest energy states of both neutral and cation have the same topology C6H5-NH2, the dication and trication have the C5NH5-CH2 topology with the nitrogen atom in the meta- and para-positions, respectively. We compute the dissociation pathways of all four charge states to NH or NH+ and NH2 or NH2+, depending on the initial charge of the aniline precursor. Dissociation leading to the formation of NH (from the neutral and cation) and NH+ (from the dication and trication) proceeds through multiple transition states. On the contrary, the dissociation of NH2 (from the neutral and cation) and NH2+ (from the dication and trication) is found to proceed without an activation energy barrier. The trication was found to be stable toward abstraction on NH+ and NH2+ by 0.96 and 0.18 eV, respectively, whereas the proton affinity of the trication is substantially higher, 1.98 eV. The mass spectra of aniline were recorded with 1300 nm, 20 fs pulses over the peak intensity range of 1 × 1013 to 3 × 1014 W cm-2. The analysis of the mass spectra suggests high stability of both dication and trication to fragmentation. The formation of the fragment NH+ and NH2+ ions is found to proceed via Coulomb explosion.

5.
Phys Chem Chem Phys ; 20(6): 4546-4553, 2018 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-29376164

RESUMO

The structure and properties of the Fe8O12Hn clusters (n = 0-18) are computed using the all-electron density functional theory with the generalized gradient approximation for the exchange-correlation potential. The ground state of Fe8O12 is found to be a singlet state having a bi-capped octahedron geometry. Upon hydrogenation, the octahedral framework of Fe is retained in Fe8O12Hn up to n < 7, beyond which point the iron octahedron transforms into a cube. Hydrogen atoms are bound to oxygen atoms up to n = 12, but they bind to the faces of the Fe8 cube when n > 12. The total spin magnetic moment of a Fe8O12Hn cluster is larger than 6 µB for 1 ≤ n ≤ 18, except for n = 8 and 10, where the lowest total energy states are antiferromagnetic singlets. The reason for this deviation from the general behavior in the Fe8O12Hn series is attributed to the collective superexchange phenomenon. Surprisingly, the total spin magnetic moment of a Fe8O12Hn cluster is found to be substantially larger than the total spin magnetic moment of the bare Fe8 cluster when n = 12-18. All of the Fe8O12Hn clusters are stable with respect to an abstraction of a single hydrogen atom but are unstable toward the abstraction of an H2 dimer when n =10 and n = 14-18.

6.
Ann Hematol ; 95(12): 2049-2055, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27623626

RESUMO

Postpartum anemia has been associated with postpartum morbidities, such as depression and poor cognition. However, it is unclear whether postpartum anemia is associated with reduced health-related quality of life. We performed a prospective study to examine the relations between postpartum Hb levels with postpartum health-related quality of life (HRQoL). We collected data from 60 women intending vaginal delivery and assessed HRQoL and maternal fatigue on admission and on the first postpartum day using the RAND 36-Item Short-Form Health Survey (SF-36) and the Multidimensional Fatigue Inventory (MFI), respectively. Maternal Hb levels were measured on admission and on the first postpartum day. We also assessed patients for postpartum depression using the Edinburgh Postpartum Depression Scale (EPDS). We performed unadjusted and multivariate linear regression (adjusting for maternal age, parity, mode of delivery, and race) to assess the associations between postdelivery Hb with each subscale of the SF-36 and MFI. The mean predelivery and postpartum Hb levels were 12.3 (1.2) and 10.8 (1.4) g/dl, respectively. In our unadjusted and adjusted regression analyses, we observed no statistically significant associations between postpartum Hb levels with any SF-36 or MFI subscale (P > 0.05). Based on the EPDS, only one patient was depressed; her postpartum Hb was 11.2 g/dl. Our findings suggest that postpartum Hb levels may not influence HRQoL or fatigue. However, our findings may only apply to women without predelivery anemia, severe blood loss or moderate-to-severe anemia after delivery. Future studies are needed to determine whether postpartum Hb influences HRQoL among women with moderate or severe postpartum anemia.


Assuntos
Parto Obstétrico/tendências , Hemoglobinas/metabolismo , Saúde Materna/tendências , Período Pós-Parto/sangue , Qualidade de Vida , Adulto , Estudos de Coortes , Feminino , Humanos , Período Pós-Parto/psicologia , Gravidez , Estudos Prospectivos , Qualidade de Vida/psicologia
7.
Phys Chem Chem Phys ; 18(40): 27858-27867, 2016 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-27711573

RESUMO

Geometrical and electronic structures of the 3d-metal oxide clusters (FeO)n, (CoO)n, and (NiO)n are computed using density functional theory with the generalized gradient approximation in the range of 1 ≤ n ≤ 10. It is found that the cluster geometries are similar in the (FeO)n and (CoO)n series but noticeably different in the (NiO)n series for several values of n. All of the lowest total energy states are found to possess relatively small spin multiplicities and are either antiferromagnetic or ferrimagnetic except for the states of (NiO)3, (NiO)4, (NiO)9, and (NiO)10, which are ferromagnetic. The computed polarizabilities per atom undergo a steep decrease when compared to the atomic values of the MO monomers (M = Fe, Co, and Ni). Surprisingly, the polarizability does not strongly depend on either M or n in all the considered series when n varies from 3 to 10. The binding energies per atom are the largest in the (FeO)n series, followed by the binding energies of (CoO)n and (NiO)n.

8.
J Phys Chem A ; 119(24): 6483-92, 2015 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-25974113

RESUMO

The electronic and geometrical structures of the neutral Fn and singly negatively charged Fn(-) polyfluorides (n = 3-29) are studied using three levels of theory: density functional theory (DFT) with generalized gradient approximation, hybrid Hartree-Fock-DFT, and hybrid HF-DFT with long-range corrections. For n > 4, each polyfluoride possesses a number of states with different geometries that are closely spaced in total energy. The geometrical structures of the lowest total energy states follow different patterns for the even-n and odd-n Fn(-) anion branches with a preference for higher symmetry geometries. The largest F29(-) anion considered is found to possess Oh symmetry. All the anions beginning with F3(-) are found to possess adiabatic and vertical electron detachment energies exceeding the electron affinities of halogen atoms and are therefore superhalogen anions. Electron affinities, energies of formation, and binding energies show oscillatory behavior as functions of the number n of fluorine atoms. The neutral Fn species are found to be barely stable and are bound by polarization forces. The Fn(-) anions, on the contrary, are quite stable toward the loss of F, F(-), and F2(-), but not to the loss of F2.

9.
J Chem Phys ; 143(4): 044306, 2015 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-26233128

RESUMO

Photoelectron spectra of the Mnn(-) anion clusters (n = 2-16) are obtained by anion photoelectron spectroscopy. The electronic and geometrical structures of the anions are computed using density functional theory with generalized gradient approximation and a basis set of triple-ζ quality. The electronic and geometrical structures of the neutral Mnn clusters have also been computed to estimate the adiabatic electron affinities. The average absolute difference between the computed and experimental vertical detachment energies of an extra electron is about 0.2 eV. Beginning with n = 6, all lowest total energy states of the Mnn(-) anions are ferrimagnetic with the spin multiplicities which do not exceed 8. The computed ionization energies of the neutral Mnn clusters are in good agreement with previously obtained experimental data. According to the results of our computations, the binding energies of Mn atoms are nearly independent on the cluster charge for n > 6 and possess prominent peaks at Mn13 and Mn13(-) in the neutral and anionic series, respectively. The density of states obtained from the results of our computations for the Mnn(-) anion clusters show the metallic character of the anion electronic structures.

10.
J Org Chem ; 78(21): 10776-83, 2013 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-24079374

RESUMO

The first computational study of the rearrangement reactions of oxiranes initiated by lithium dialkylamides is presented. Aside from the well-known carbenoid insertion pathways, both ß-elimination and α-lithiation have been suggested as the exclusive mechanism by which oxiranes react in the presence of organolithium bases. The products of the former are allyl alcohols (and, in some cases, dienes) and are ketones in the case of the latter. The computational studies reported in this work indicate that both mechanisms could be simultaneously operational. In particular, our work shows that the allyl alcohols from ß-elimination are unlikely to undergo 1,3-hydrogen transfer to the vinyl alcohols and thus to the ketones, suggesting that ketones are formed through the opening of the oxirane ring after α-substitution. Elimination of LiOH from the lithiated allyl alcohol is found to result in the diene product. Low activation barriers for ß-elimination are offered as the explanation for the few special cases where the allyl alcohol is the dominant or exclusive product. These findings are consistent with the product distributions observed in several experiments.

11.
J Chem Phys ; 138(16): 164303, 2013 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-23635134

RESUMO

The electronic and geometrical structures of the M12 and M13 clusters where M = Sc, Ti, V, Cr, Mn, Fe, Co, Ni, Cu, and Zn along with their singly negatively and positively charged ions are studied using all-electron density functional theory within the generalized gradient approximation. The geometries corresponding to the lowest total energy states of singly and negatively charged ions of V13, Mn12, Co12, Ni13, Cu13, Zn12, and Zn13 are found to be different from the geometries of the corresponding neutral parents. The computed ionization energies of the neutrals, vertical electron detachment energies from the anions, and energies required to remove a single atom from the M13 and M13(+) clusters are in good agreement with experiment. The change in a total spin magnetic moment of the cation or anion with respect to a total spin magnetic moment of the corresponding neutral is consistent with the one-electron model in most cases, i.e., they differ by ±1.0 µ(B). Exceptions are found only for Sc12(-), Ti12(+), Mn12(-), Mn12(+), Fe12(-), Fe13(+), and Co12(+).


Assuntos
Metais Pesados/química , Teoria Quântica , Estrutura Molecular
12.
J Org Chem ; 77(19): 8605-14, 2012 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-22985313

RESUMO

The first computational investigations of the carbenoid reactions of α-lithiated dimethyl ether (methoxymethyllithium) and the intramolecular and intermolecular reactions of lithiated epoxides with the alkene double bond to yield cyclopropane rings are presented. These reactions represent the full spectrum of known carbenoid pathways to cyclopropanation. The reaction of Li-CH(2)-O-CH(3) with ethylene proceeds exclusively through a two-step carbolithiation pathway, the intramolecular reaction of 1,2-epoxy-5-hexene follows either the carbometalation or a concerted methylene transfer pathway (the former is energetically more favorable), and the reaction of lithiated ethylene oxide (oxiranyllithium) with ethylene, the main focus of this paper, appears to proceed exclusively by the methylene transfer mechanism. In the case of these latter reactions, the free energy of activation for cyclopropanation tends to decrease with the higher aggregation states. Formation of tetramers or higher aggregates is favorable in nonpolar solvents, but in strongly coordinating solvents such as tetrahydrofuran (THF), steric factors appear to limit aggregate sizes to the dimer. In the case of 1,2-epoxy-5-hexene, consideration of competing reaction pathways provide an explanation for the observed product distribution.

13.
Infection ; 40(4): 415-23, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22371234

RESUMO

PURPOSE: To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control strategy including a practice bundle to reduce the rates of central line-associated bloodstream infection (CLAB) in patients hospitalized in pediatric intensive care units (PICUs) of hospitals, which are members of the INICC, from nine cities of five developing countries: Colombia, India, Mexico, Philippines, and Turkey. METHODS: CLAB rates were determined by means of a prospective surveillance study conducted on 1,986 patients hospitalized in nine PICUs, over a period of 12,774 bed-days. The study was divided into two phases. During Phase 1 (baseline period), active surveillance was performed without the implementation of the multi-faceted approach. CLAB rates obtained in Phase 1 were compared with CLAB rates obtained in Phase 2 (intervention period), after implementation of the INICC multidimensional infection control program. RESULTS: During Phase 1, 1,029 central line (CL) days were recorded, and during Phase 2, after implementing the CL care bundle and interventions, we recorded 3,861 CL days. The CLAB rate was 10.7 per 1,000 CL days in Phase 1, and in Phase 2, the CLAB rate decreased to 5.2 per 1,000 CL days (relative risk [RR] 0.48, 95% confidence interval [CI] 0.29-0.94, P = 0.02), showing a reduction of 52% in the CLAB rate. CONCLUSIONS: This study shows that the implementation of a multidimensional infection control strategy was associated with a significant reduction in the CLAB rates in the PICUs of developing countries.


Assuntos
Bacteriemia/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Venoso Central/efeitos adversos , Infecção Hospitalar/epidemiologia , Controle de Infecções/métodos , Unidades de Terapia Intensiva Pediátrica , Adolescente , Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/prevenção & controle , Criança , Pré-Escolar , Infecção Hospitalar/prevenção & controle , Países em Desenvolvimento , Feminino , Humanos , Masculino , Estudos Prospectivos
14.
J Phys Chem A ; 116(41): 10218-28, 2012 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-23039843

RESUMO

The electronic and geometrical structures of the Fe(n), Fe(n)(­), and Fe(n)(+) series (n = 7­20) are studied using all-electron density functional theory with the generalized gradient approximation. Equilibria of the geometrical configurations of the lowest total energy states in all three series are found to be similar except for Fe(9)(­), Fe(9)(+), Fe(10)(­), Fe(10)(+), Fe(15)(­), and Fe(19)(+). Our computed ionization energies of the neutrals, vertical electron detachment energies, and energies of Fe atom abstraction are in good agreement with experiment. It is found that the one-electron model corresponding to the change in the total magnetic moment of ±1.0µ(B) due to either attachment or detachment of an electron is valid in most cases. The exceptions are Fe(4)(+), Fe(10)(­), Fe(10)(+), Fe(12)(­), Fe(13)(+), and Fe(14)(+), where the change in the total magnetic moment is +3µ(B) (Fe(10)(­) and Fe(12)(­)), −3µ(B) (Fe(4)(+), Fe(11)(+), and Fe(14)(+)), and −9µ(B) (Fe(13)(+)). The reason for an anomalously large quenching of the total spin magnetic moment in Fe(13)(+) is explained. Our computed total spin magnetic moments per atom match the recent experimental values within the experimental uncertainty bars.

15.
RSC Adv ; 12(4): 2443-2453, 2022 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-35425236

RESUMO

Extensive piezoresponse force microscopy (PFM) and magnetic force microscopy (MFM) measurements in conjunction with piezoresponse spectroscopy have been carried out on pellets of Bi0.9A0.1FeO2.95 (A = Ba, Ca) and Bi0.9Ba0.05Ca0.05FeO2.95 co-doped ceramic samples in order to characterize their ferroelectric and magnetic nature and correlate the findings with our recent far-infrared spectroscopic studies on these samples. We are able to clearly discern the switching behavior of the 71° and 109° ferroelectric domains as distinct from that of the 180° domains in both pristine and Ba-doped bismuth ferrite samples. While substitution of Ba at the Bi site in bismuth ferrite does not affect the ferroelectric and magnetic properties to a great extent, Ca-doped samples show a decrease in their d 33 values with a concomitant increase in their magnetic behavior. These results are in agreement with the findings from our far-infrared studies.

16.
J Phys Chem A ; 114(32): 8423-33, 2010 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-20666488

RESUMO

This study explores the degree to which GGA, meta-GGA, hybrid GGA, and hybrid meta-GGA functionals of density functional theory (DFT), when used with the 6-31+G(d) basis set, are able to reproduce the MP2/6-31+G(d) structures and energetics of the species involved in the reactions of halomethyllithium carbenoids with ethylene. While many popular DFT functionals have been parametrized and/or benchmarked using various databases, the scarcity of experimental structural and energetic information for organolithium compounds has resulted in their exclusion from these training and test sets. In this work, we first establish a set of practical benchmark reaction energetics against which the performance of DFT methods for larger molecules can be compared. Next, we examine the performance of 13 DFT functionals spanning the second, third, and fourth rungs of the "Jacob's ladder" using 84 molecules and 78 reactions. The main conclusions are (a) the meta-hybrid GGA M06-2X is the best functional among the set for organolithium chemistry, (b) the hybrid GGA PBE1PBE consistently yields equilibrium and transition-state geometries that are very close to the MP2 predictions, and (c) MP2//M06-L or MP2//PBE1PBE model chemistries are excellent low-cost alternatives to the costly MP2. However, this work also showed that the very popular B3LYP functional is a rather poor choice for these systems.

17.
J Phys Condens Matter ; 32(40): 405701, 2020 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-32380489

RESUMO

The spin wave resonances of BiFeO3 ceramics have been followed at low temperature through far-infrared reflectance measurements. Following the scheme of Fishman et al (2015 Phys. Rev. B 92 094422) we have been able to assign all the spin wave modes observed. A complete lifting of the degeneracies of all these modes is seen at 250 K concomitant with the increase in single-ion anisotropy. For the first time, all the spin wave modes have been observed in the infrared spectra of BiFeO3. Correlated changes in the strength and frequencies of spin wave excitations with the reported magnetic transitions at low temperature are observed. A simultaneous increase in anharmonicity of the magnetic cycloid and single-ion anisotropy with decreasing temperature results in a partial suppression of the spin wave excitations. An increase in the magnetoelectric coupling is also observed below 150 K.

18.
J Phys Condens Matter ; 21(3): 036001, 2009 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-21817284

RESUMO

We have synthesized a range of transition-metal-doped BiFeO(3) thin films on conducting silicon substrates using a spin-coating technique from metal-organic precursor solutions. Bismuth, iron and transition-metal-organic solutions were mixed in the appropriate ratios to produce 3% transition-metal-doped samples. X-ray diffraction studies show that the samples annealed in a nitrogen atmosphere crystallize in a rhombohedrally distorted BiFeO(3) structure with no evidence for any ferromagnetic secondary phase formation. We find evidence for the disappearance of the 404 cm(-1) Raman mode for certain dopants indicative of structural distortions. The saturation magnetization of these BiFeO(3) films has been found to increase on doping with transition metal ions, reaching a maximum value of 8.5 emu cm(-3) for the Cr-doped samples. However, leakage current measurements find that the resistivity of the films typically decreases with transition metal doping. We find no evidence for any systematic variation of the electric or magnetic properties of BiFeO(3) depending on the transition metal dopant, suggesting that these properties are determined mainly by extrinsic effects arising from defects or grain boundaries.

19.
Transl Psychiatry ; 7(9): e1239, 2017 09 26.
Artigo em Inglês | MEDLINE | ID: mdl-28949335

RESUMO

Histone acetylation is essential for memory formation and its deregulation contributes to the pathogenesis of Alzheimer's disease. Thus, targeting histone acetylation is discussed as a novel approach to treat dementia. The histone acetylation landscape is shaped by chromatin writer and eraser proteins, while readers link chromatin state to cellular function. Chromatin readers emerged novel drug targets in cancer research but little is known about the manipulation of readers in the adult brain. Here we tested the effect of JQ1-a small-molecule inhibitor of the chromatin readers BRD2, BRD3, BRD4 and BRDT-on brain function and show that JQ1 is able to enhance cognitive performance and long-term potentiation in wild-type animals and in a mouse model for Alzheimer's disease. Systemic administration of JQ1 elicited a hippocampal gene expression program that is associated with ion channel activity, transcription and DNA repair. Our findings suggest that JQ1 could be used as a therapy against dementia and should be further tested in the context of learning and memory.


Assuntos
Azepinas/administração & dosagem , Hipocampo/efeitos dos fármacos , Hipocampo/metabolismo , Potenciação de Longa Duração/efeitos dos fármacos , Memória/efeitos dos fármacos , Proteínas Nucleares/antagonistas & inibidores , Triazóis/administração & dosagem , Doença de Alzheimer/genética , Precursor de Proteína beta-Amiloide/genética , Animais , Comportamento Animal/efeitos dos fármacos , Proteínas Cromossômicas não Histona/antagonistas & inibidores , Expressão Gênica/efeitos dos fármacos , Hipocampo/fisiologia , Masculino , Memória/fisiologia , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Fatores de Transcrição/antagonistas & inibidores
20.
Int J Obstet Anesth ; 31: 27-36, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28676403

RESUMO

BACKGROUND: Compared to vaginal delivery, women undergoing cesarean delivery are at increased risk of postpartum hemorrhage. Management approaches may differ between those undergoing prelabor cesarean delivery compared to intrapartum cesarean delivery. We examined surgical interventions, blood component use, and maternal outcomes among those experiencing severe postpartum hemorrhage within the two distinct cesarean delivery cohorts. METHODS: We performed secondary analyses of data from two cohorts who underwent prelabor cesarean delivery or intrapartum cesarean delivery at a tertiary obstetric center in the United States between 2002 and 2012. Severe postpartum hemorrhage was classified as an estimated blood loss ≥1500mL or receipt of a red blood cell transfusion up to 48h post-cesarean delivery. We examined blood component use, medical and surgical interventions and maternal outcomes. RESULTS: The prelabor cohort comprised 269 women and the intrapartum cohort comprised 278 women. In the prelabor cohort, one third of women received red blood cells intraoperatively or postoperatively, respectively. In the intrapartum cohort, 18% women received red blood cells intraoperatively vs. 44% postoperatively (P<0.001). In the prelabor and intrapartum cohorts, methylergonovine was the most common second-line uterotonic (33% and 43%, respectively). Women undergoing prelabor cesarean delivery had the highest rates of morbidity, with 18% requiring hysterectomy and 16% requiring intensive care admission. CONCLUSION: Our findings provide a snapshot of contemporary transfusion and surgical practices for severe postpartum hemorrhage management during cesarean delivery. To determine optimal transfusion and management practices in this setting, large pragmatic studies are needed.


Assuntos
Cesárea/efeitos adversos , Hemorragia Pós-Parto/terapia , Adulto , Anestesia Obstétrica , Estudos de Coortes , Parto Obstétrico , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Humanos , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/terapia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/cirurgia , Gravidez , Estudos Retrospectivos , Fatores de Risco
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA