RESUMO
OBJECTIVES: To explore the long-term (perceived) consequences of (severe pre-)eclampsia in rural Tanzania. METHODS: Women were traced for this mixed-methods study 6-7 years after the diagnosis of (severe pre-)eclampsia. Demographic and obstetric characteristics were noted, and blood pressure was recorded. Questionnaires were used to assess physical and mental health. The qualitative part consisted of semi-structured interviews (SSI). A reference group consisted of women without hypertensive disorders of pregnancy. RESULTS: Of 74 patients, 25 (34%) were available for follow-up, and 24 were included. Five (20%) had suffered from (pre-)eclampsia twice. Hypertension was more common after (pre-)eclampsia than in the reference group (29% vs. 13%). Thirteen women (56%) had feelings of anxiety and depression, compared to 30% in the reference group. In SSIs, experiences during the index pregnancy were explored, as well as body functions, reproductive life course and limitations in daily functioning, which were shown to be long-lasting. CONCLUSIONS: Women who suffered from (severe pre-)eclampsia may experience long-term sequelae, including hypertension, depression and anxiety. Women lack information about their condition, and some are worried to conceive again. To address their specific needs, a strategy along the continuum of care is needed for women following a complicated pregnancy, starting with a late postnatal care visit 6 weeks after giving birth.
OBJECTIFS: Explorer les conséquences à long terme (perçues) de la (sévère pré-) éclampsie en zone rurale, en Tanzanie. MÉTHODES: Les femmes ont été suivies pour cette étude à méthodes mixtes durant 6 à 7 ans après le diagnostic de (sévère pré-) éclampsie. Les caractéristiques démographiques et obstétriques ont été notées et la pression artérielle a été enregistrée. Des questionnaires ont été utilisés pour évaluer la santé physique et mentale. La partie qualitative consistait en des entretiens semi-structurés (ESS). Un groupe de référence était composé de femmes sans troubles hypertensifs de la grossesse. RÉSULTATS: Sur 74 patientes, 25 (34%) étaient disponibles pour le suivi et 24 ont été incluses. Cinq (20%) avaient souffert de (pré-) éclampsie à deux reprises. L'hypertension était plus fréquente après la (pré-) éclampsie que dans le groupe de référence (29% vs 13%). Treize femmes (56%) avaient des sensations d'anxiété et de dépression, contre 30% dans le groupe de référence. Dans les ESS, les expériences au cours de la grossesse indice ont été explorées, ainsi que les fonctions corporelles, le cours de la vie reproductive et les limitations du fonctionnement quotidien, qui se sont révélées durables. CONCLUSIONS: Les femmes qui ont souffert de (sévère pré-) éclampsie pourraient éprouver des séquelles à long terme, y compris l'hypertension, la dépression et l'anxiété. Les femmes manquent d'informations sur leur état et certaines ont peur de concevoir à nouveau. Pour répondre à leurs besoins spécifiques, une stratégie tout au long du continuum des soins est nécessaire pour les femmes à la suite d'une grossesse compliquée, en commençant par une visite de soins postnatals tardive six semaines après l'accouchement.
Assuntos
Ansiedade/etiologia , Depressão/etiologia , Hipertensão/etiologia , Pré-Eclâmpsia/fisiopatologia , Pré-Eclâmpsia/psicologia , Adulto , Feminino , Humanos , Entrevistas como Assunto , Gravidez , Pesquisa Qualitativa , TanzâniaRESUMO
BACKGROUND: The worldwide incidence of birth by Caesarean Section (CS) is rising. Many births after a previous CS are by repeat surgery, either by an elective CS or after a failed trial of labour. Adhesion formation is associated with increased maternal morbidity in patients with repeat CSs. In spite of large-scale studies the relation between the incidence of adhesion formation and CS surgical technique is unclear. This study aims to assess maternal and neonatal morbidity and mortality after repeat CSs in a rural hospital in a low-income country (LIC) and to analyse the effect of surgical technique on the formation of adhesions. METHODS: A cross-sectional, retrospective medical records study of all women undergoing CS in Ndala Hospital in 2011 and 2012. RESULTS: Of the 3966 births, 450 were by CS (11.3%), of which 321 were 1st CS, 80 2nd CS, 36 3rd CS, 12 4th and one 5th CS (71, 18, 8, 3 and 0.2% respectively). Adhesions were considered to be severe in 56% of second CSs and 64% of third CSs. In 2nd CSs, adhesions were not associated with closure of the peritoneum at 1st CS, but were associated with the prior use of a midline skin incision. There was no increase in maternal morbidity when severe adhesions were present. Adverse neonatal outcome was more prevalent when severe adhesions were present, but this was statistically non-significant (16% vs 6%). CONCLUSIONS: Our results give insight into the practice of repeat CS in our rural hospital. Adhesions after CSs are common and occur more frequently after midline skin incision at 1st CS compared to a transverse incision. Reviewing local data is important to evaluate quality of care and to compare local outcomes to the literature.
Assuntos
Recesariana/efeitos adversos , Hospitais Rurais/estatística & dados numéricos , Aderências Teciduais/epidemiologia , Adulto , Recesariana/métodos , Recesariana/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Tanzânia/epidemiologia , Aderências Teciduais/etiologia , Prova de Trabalho de Parto , Adulto JovemRESUMO
BACKGROUND: Ectopic pregnancy (EP) is a serious complication of early pregnancy. In low-income countries diagnosis of EP is difficult and it is a major contributor to maternal mortality. We aimed to assess and improve the diagnostic process of women with EP. METHODS: We conducted a retrospective medical records study of all women with confirmed EP in Ndala Hospital from 2010 to 2012. We used data on demographics, symptoms, diagnostic procedures, surgical findings, treatment and post-operative status. RESULTS: Six thousand six hundred sixty-two women gave birth in the hospital, and 88 women were diagnosed with EP (incidence 1.3%). Thirty-nine percent of women did not report to be pregnant or to have a history of amenorrhea. On admission in Ndala hospital, a diagnosis of 'suspected EP' was made in less than half (47%) of the cases. Most women had a urine pregnancy test done (sensitivity of 98%). Peritoneal aspiration was done in 42%. The fifty-five women with EP who were diagnosed by ultrasound received a lower mean number of units of blood transfusion and had less often severe anaemia than women who were diagnosed by abdominal aspiration (abdominocentesis). The majority of women (65%) had surgery within 24 h after admission. CONCLUSIONS: Diagnosing EP in a rural hospital in Tanzania is challenging. Often there is a large doctors' delay before the right diagnosis is made. Abdominal aspiration can be useful for rapid diagnosis. A pelvic ultrasound, when available, allows the diagnosis to be made earlier with less intra-abdominal bleeding.
Assuntos
Aborto Induzido/estatística & dados numéricos , Diagnóstico Tardio/estatística & dados numéricos , Gravidez Ectópica/diagnóstico , Gravidez Ectópica/terapia , Diagnóstico Pré-Natal/estatística & dados numéricos , Aborto Induzido/métodos , Adulto , Feminino , Hospitais Rurais/estatística & dados numéricos , Humanos , Incidência , Pobreza/estatística & dados numéricos , Gravidez , Gravidez Ectópica/epidemiologia , Estudos Retrospectivos , Tanzânia/epidemiologiaRESUMO
BACKGROUND: Shared decision-making (SDM) is an important aspect of modern health care. Many studies evaluated different interventions to improve SDM, however, none in an inpatient clinical setting. A tool that has been proven effective in an outpatient department is the three questions intervention. These questions are created for patients to get optimal information from their medical team and to make an informed medical decision. In this study, we evaluated the feasibility and effectiveness of this simple intervention on SDM in the obstetric inpatient department of a university hospital in the Netherlands. METHOD: This is a clinical pilot before and after study, using mixed methods with quantitative and qualitative data collection. The three questions were stated on a card; (i.e. 1) What are my options; 2) What are the possible benefits and harms of those options; 3) How likely are each of those benefits and harms to happen to me?). The study period lasted 6 weeks in which all patients admitted to the obstetric ward were asked to participate in the study. In the first 3 weeks patients did not receive the three questions intervention (pre-intervention group). In the final 3 weeks all patients included received the intervention (intervention group). The main quantitative outcome measure was the level of SDM measured using the SDM-Q9 questionnaire at discharge (range 0-100). In addition, interviews with four patients of the intervention group were conducted and qualitatively analyzed. RESULTS: Thirty-three patients were included in the pre-intervention group, 29 patients in the intervention group. The mean score of the SDM-Q9 in the pre-intervention group was 65.5 (SD 22.83) and in the intervention group 63.2 (SD 20.21), a not statistically significant difference. In the interviews, patients reported the three questions to be very useful. They used the questions mainly as a prompt and encouragement to ask more specific questions. DISCUSSION: No difference in SDM was found between the two groups, possibly because of a small sample size. Yet the intervention appeared to be feasible and simple to use in an inpatient department. Further studies are needed to evaluate the impact of implementation of these three questions on a larger scale.
Assuntos
Informação de Saúde ao Consumidor/métodos , Tomada de Decisões , Parto Obstétrico , Participação do Paciente/métodos , Inquéritos e Questionários , Adulto , Parto Obstétrico/métodos , Parto Obstétrico/psicologia , Parto Obstétrico/normas , Estudos de Viabilidade , Feminino , Humanos , Comportamento de Busca de Informação , Pacientes Internados/psicologia , Países Baixos , Preferência do Paciente , Projetos Piloto , Gravidez , Melhoria de QualidadeRESUMO
The purpose of this study is to explore and quantify perceptions and experiences of women with a traumatic childbirth experience in order to identify areas for prevention and to help midwives and obstetricians improve woman-centered care. A retrospective survey was conducted online among 2192 women with a self-reported traumatic childbirth experience. Women were recruited in March 2016 through social media, including specific parent support groups. They filled out a 35-item questionnaire of which the most important items were (1) self-reported attributions of the trauma and how they believe the traumatic experience could have been prevented (2) by the caregivers or (3) by themselves. The responses most frequently given were (1) Lack and/or loss of control (54.6%), Fear for baby's health/life (49.9%), and High intensity of pain/physical discomfort (47.4%); (2) Communicate/explain (39.1%), Listen to me (more) (36.9%), and Support me (more/better) emotionally/practically (29.8%); and (3) Nothing (37.0%), Ask for (26.9%), or Refuse (16.5%) certain interventions. Primiparous participants chose High intensity of pain/physical discomfort, Long duration of delivery, and Discrepancy between expectations and reality more often and Fear for own health/life, A bad outcome, and Delivery went too fast less often than multiparous participants. Women attribute their traumatic childbirth experience primarily to lack and/or loss of control, issues of communication, and practical/emotional support. They believe that in many cases, their trauma could have been reduced or prevented by better communication and support by their caregiver or if they themselves had asked for or refused interventions.
Assuntos
Parto Obstétrico/psicologia , Dor do Parto/psicologia , Mães/psicologia , Parto/psicologia , Período Pós-Parto/psicologia , Adulto , Medo , Feminino , Humanos , Países Baixos , Percepção , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Preterm birth is a major cause of neonatal mortality, especially in low and middle income countries. Antenatal corticosteroid therapy for foetal maturation could have a significant impact and therefore is often referred to as an important strategy to reduce neonatal mortality. A recently conducted large multinational trial showed that antenatal corticosteroids can have adverse effects in low income countries, but this is likely to depend on the specific setting. In our hospital preterm birth is only recognized in patients with severe maternal disease, due to physician-initiated delivery. Spontaneous preterm births are rarely seen in the hospital and often take place in the community or while on the road to a health facility. OBJECTIVE: To investigate the effects of antenatal corticosteroid therapy in a rural hospital in Tanzania. METHODS: A secondary analysis of a retrospective medical records study of women with severe pre-eclampsia and eclampsia performed in Ndala Hospital between July 2011 and December 2012. We used data on gestational age, birth weight, Apgar score, time between admission and birth, use of corticosteroids and maternal and foetal survival. Ethical clearance was obtained from the directorate of research and publications of the University of Dodoma (ref. UDOM/DRP/346). RESULTS: Thirty-six women with forty live foetuses were analysed. Twelve women (13 neonates) were given corticosteroids and could be compared to 24 women (27 neonates) who did not get corticosteroids. The incidence of fresh stillbirths (antenatal death) was 20 %. The 13 neonates who received corticosteroids had significantly smaller birth weight, longer interval between admission and delivery and poorer outcomes (stillbirth and neonatal death). An analysis of 24 neonates with a birth weight between 1.5 and 2.5 kg showed a trend toward better outcome in neonates who did not receive antenatal corticosteroid therapy. CONCLUSION: Small retrospective studies as these have a low level of evidence, but this study helped to gain more knowledge of local conditions affecting the effectiveness of antenatal corticosteroid therapy in our setting of a small rural hospital. Reliability of estimating gestational age, epidemiology of preterm birth, exposure to infections, foetal monitoring and quality of neonatal care are likely to influence the effect of antenatal corticosteroid therapy. Further larger prospective studies should be conducted to determine the exact preconditions of antenatal corticosteroid therapy in low-income countries. Until that time, the WHO precautions seem reasonable and audits and small observational studies like ours can help in assessing whether a specific hospital is suited for antenatal corticosteroid therapy.
Assuntos
Corticosteroides/efeitos adversos , Eclampsia/tratamento farmacológico , Desenvolvimento Fetal/efeitos dos fármacos , Pré-Eclâmpsia/tratamento farmacológico , Natimorto/epidemiologia , Adulto , Feminino , Hospitais Rurais , Humanos , Incidência , Recém-Nascido , Morte Perinatal/etiologia , Gravidez , Estudos Retrospectivos , Tanzânia , Resultado do TratamentoAssuntos
Avaliação de Resultados em Cuidados de Saúde/normas , Resultado da Gravidez , Sistema de Registros , Projetos de Pesquisa , Entorno do Parto , Feminino , Humanos , Recém-Nascido , Mortalidade Materna , Países Baixos , Avaliação de Resultados em Cuidados de Saúde/métodos , Mortalidade Perinatal , GravidezRESUMO
BACKGROUND: Both induction of labour at 41 weeks and expectant management until 42 weeks are common management strategies in low-risk pregnancy since there is no consensus on the optimal timing of induction in late-term pregnancy for the prevention of adverse outcomes. Our aim was to explore maternal preference for either strategy and the influence on quality of life and maternal anxiety on this preference. METHODS: Obstetrical low-risk women with an uncomplicated pregnancy were eligible when they reached a gestational age of 41 weeks. They were asked to fill in questionnaires on quality of life (EQ6D) and anxiety (STAI-state). Reasons of women's preferences for either induction or expectant management were explored in a semi-structured questionnaire containing open ended questions. RESULTS: Of 782 invited women 604 (77.2%) responded. Induction at 41 weeks was preferred by 44.7% (270/604) women, 42.1% (254/604) preferred expectant management until 42 weeks, while 12.2% (74/604) of women did not have a preference. Women preferring induction reported significantly more problems regarding quality of life and were more anxious than women preferring expectant management (p<0.001). Main reasons for preferring induction of labour were: "safe feeling" (41.2%), "pregnancy taking too long" (35.4%) and "knowing what to expect" (18.6%). For women preferring expectant management, the main reason was "wish to give birth as natural as possible" (80.3%). CONCLUSION: Women's preference for induction of labour or a policy of expectant management in late-term pregnancy is influenced by anxiety, quality of life problems (induction), the presence of a wish for natural birth (expectant management), and a variety of additional reasons. This variation in preferences and motivations suggests that there is room for shared decision making in the management of late-term pregnancy.
Assuntos
Ansiedade/psicologia , Trabalho de Parto Induzido/psicologia , Preferência do Paciente , Gravidez Prolongada/psicologia , Qualidade de Vida , Conduta Expectante , Adulto , Cesárea/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Trabalho de Parto , Gravidez , Adulto JovemRESUMO
OBJECTIVE: To describe the panel audit process and to identify substandard care in selected women from a nationwide prospective cohort study into severe acute maternal morbidity (SAMM) in the Netherlands. DESIGN: Prospective audit of selected women with SAMM. SETTING: Eight audit meetings held throughout the Netherlands. POPULATION: All pregnant women in the Netherlands. METHODS: Before each meeting, SAMM details of selected women were sent to all panel members for individual assessment by completing an audit form. During a subsequent plenary meeting, findings were discussed and substandard care factors as judged by the majority of assessors were scored. MAIN OUTCOME MEASURES: Incidence of substandard care and recommendations for improving the quality of care. RESULTS: Substandard care was identified in 53 of 67 women (79%). Specific recommendations were formulated concerning the procedure of audit and concerning local as well as national management guidelines. CONCLUSION: Our findings reflect SAMM in the Netherlands and substandard care is present in four out of five women. Ongoing audit of women with SAMM is promoted both at local and national level.
Assuntos
Complicações na Gravidez/mortalidade , Cuidado Pré-Natal/normas , Qualidade da Assistência à Saúde , Feminino , Humanos , Mortalidade Materna , Auditoria Médica , Morbidade , Países Baixos/epidemiologia , Projetos Piloto , Gravidez , Estudos ProspectivosRESUMO
An 82-year-old postmenopausal woman presented with severe clinical hyperandrogenism related to testosterone overproduction, possibly as a result of a mucinous cystadenoma. The cystadenoma was successfully removed in toto. The patient was discharged in good health. Plasma testosterone levels normalised 6 weeks after surgery. Ovarian mucinous cystadenomas are a rare cause ofhyperandrogenism.
Assuntos
Cistadenoma/complicações , Neoplasias Ovarianas/complicações , Testosterona/sangue , Virilismo/etiologia , Idoso de 80 Anos ou mais , Cistadenoma/metabolismo , Cistadenoma/cirurgia , Feminino , Humanos , Neoplasias Ovarianas/metabolismo , Neoplasias Ovarianas/cirurgia , Resultado do TratamentoRESUMO
Reducing child and maternal mortality are important UN Millennium Development Goals. The AIDS epidemic, which is targeted in another Millennium Development Goal, has a negative influence on child and maternal health. Although on a mondial level, the influence of HIV/AIDS on child and maternal mortality appears to be slight, HIV/AIDS constitutes a significant factor in Sub-Saharan Africa. In the Netherlands, the introduction of aggressive antiretroviral therapy has reduced the chance of vertical transmission to < 1%. In low-wage countries, financial means and political commitment for similar handling are lacking. Possible strategies for the prevention of vertical transmission for these countries are as follows: multivitamin supplements during pregnancy, prophylaxis against opportune infections with cotrimoxazol, a vaginal douche with chlorhexidine for cases where the membranes have ruptured more than 4 hours previously, and a single dose of nevirapine.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV , Mortalidade Infantil , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Mortalidade Materna , Complicações Infecciosas na Gravidez/prevenção & controle , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/mortalidade , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Síndrome da Imunodeficiência Adquirida/transmissão , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/mortalidade , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Humanos , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/mortalidadeRESUMO
In a pregnant woman presenting with vaginal bleeding and a vaginal tumour, vaginal metastasis ofa trophoblast tumour from a mola pregnancy was diagnosed.
Assuntos
Coriocarcinoma/diagnóstico , Mola Hidatiforme/diagnóstico , Complicações Neoplásicas na Gravidez/diagnóstico , Hemorragia Uterina/etiologia , Neoplasias Uterinas/diagnóstico , Neoplasias Vaginais/diagnóstico , Adulto , Antimetabólitos Antineoplásicos/uso terapêutico , Coriocarcinoma/sangue , Coriocarcinoma/tratamento farmacológico , Coriocarcinoma/patologia , Gonadotropina Coriônica Humana Subunidade beta/sangue , Diagnóstico Diferencial , Feminino , Humanos , Mola Hidatiforme/sangue , Mola Hidatiforme/tratamento farmacológico , Mola Hidatiforme/patologia , Metotrexato/uso terapêutico , Gravidez , Complicações Neoplásicas na Gravidez/sangue , Complicações Neoplásicas na Gravidez/tratamento farmacológico , Complicações Neoplásicas na Gravidez/patologia , Resultado do Tratamento , Hemorragia Uterina/diagnóstico , Neoplasias Uterinas/sangue , Neoplasias Uterinas/tratamento farmacológico , Neoplasias Uterinas/patologia , Neoplasias Vaginais/sangue , Neoplasias Vaginais/tratamento farmacológico , Neoplasias Vaginais/secundárioRESUMO
A randomized 14-day study in vivo compared the response of Plasmodium falciparum malaria to amodiaquine (35 mg/kg) and sulfadoxine-pyrimethamine (sulfadoxine, 25 mg/kg) in symptomatic outpatients at 2 sites in northern and western Kenya during 1993. Of the 239 patients recruited, 181 (76%) completed the study [84 (46%) on amodiaquine and 97 (54%) on sulfadoxine-pyrimethamine]. There were no significant differences in the parasitological, clinical or haematological responses between the 2 drug groups in both areas, with 18.5% resistance to amodiaquine versus 9.5% for sulfadoxine-pyrimethamine in the north and 35.1% against amodiaquine versus 34.5% for sulfadoxine-pyrimethamine in the west. In both sites defervescence was significantly more rapid with amodiaquine (P < 0.05) and true clinical failure (symptomatic illness with recurrent parasitaemia) was unusual (9%). As high-level resistance to chloroquine is widespread, both drugs are valuable alternatives. However, the significantly higher levels of resistance in the west may be a sign of the increased drug pressure in this holoendemic area and send an important warning concerning resistance to sulfadoxine-pyrimethamine.
Assuntos
Amodiaquina/uso terapêutico , Antimaláricos/uso terapêutico , Malária Falciparum/tratamento farmacológico , Pirimetamina/administração & dosagem , Sulfadoxina/administração & dosagem , Criança , Pré-Escolar , Resistência a Medicamentos , Quimioterapia Combinada , Hemoglobinas/análise , Humanos , Lactente , Quênia , Malária Falciparum/sangue , Fatores de TempoRESUMO
A 42-year-old pregnant Namibian woman presented with an abnormal position of the foetus due to intra-abdominal pregnancy.
Assuntos
Gravidez Abdominal/diagnóstico , Adulto , Feminino , Morte Fetal , Hemorragia/etiologia , Humanos , Namíbia , Gravidez , Gravidez Abdominal/cirurgiaRESUMO
OBJECTIVE: aim of this study was to investigate current knowledge and practice regarding AMTSL in midwifery practices and obstetric departments in the Netherlands. DESIGN: web-based and postal questionnaire. SETTING: in August and September 2011 a questionnaire was sent to all midwifery practices and all obstetric departments in the Netherlands. PARTICIPANTS: all midwifery practices (528) and all obstetric departments (91) in the Netherlands. MEASUREMENTS AND FINDINGS: the response was 87.5%. Administering prophylactic uterotonics was seen as a component AMTSL by virtually all respondents; 96.1% of midwives and 98.8% of obstetricians. Cord clamping was found as a component of AMTSL by 87.4% of midwives and by 88.1% of obstetricians. Uterine massage was only seen as a component of AMTSL by 10% of the midwives and 20.2% of the obstetricians. Midwifery practices routinely administer oxytocin in 60.1% of births. Obstetric departments do so in 97.6% (p<0.01). Compared to 1995, the prophylactic use of oxytocin had increased in 2011 both by midwives (10-59.1%) and by obstetricians (55-96.4%) (p<0.01). KEY CONCLUSIONS: prophylactic administration of uterotonics directly after childbirth is perceived as the essential part of AMTSL. The administration of uterotonics has significantly increased in the last decade, but is not standard practice in the low-risk population supervised by midwives. IMPLICATIONS FOR PRACTICE: the evidence for prophylactic administration of uterotonics is convincing for women who are at high risk of PPH. Regarding the lack of evidence of AMTSL to prevent PPH in low risk (home) births, further research concerning low-risk (home) births, supervised by midwives in industrialised countries is indicated. A national guideline containing best practices concerning management of the third stage of labour supervised by midwives, should be composed and implemented.
Assuntos
Parto Obstétrico/métodos , Terceira Fase do Trabalho de Parto/efeitos dos fármacos , Ocitócicos/uso terapêutico , Padrões de Prática em Enfermagem/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Feminino , Inquéritos Epidemiológicos , Humanos , Tocologia , Países Baixos , Gravidez , Inquéritos e QuestionáriosRESUMO
SUMMARY: MR imaging at 7T has a high sensitivity for cerebral microbleed detection. We identified mIP processing conditions with an optimal balance between the number of visually detected microbleeds and the number of sections on 7T MR imaging. Even with optimal mIP processing, the limited size of some of the microbleeds and the susceptibility effects of other adjacent structures were a challenge for visual detection, which led to a modest inter-rater agreement, mainly due to missed microbleeds. Automated lesion-detection techniques may be required to optimally benefit from the increased spatial resolution offered by 7T MR imaging.