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critical care pregnancy

Angel Paternina-Caicedo, Jezid Miranda, Ghada Bourjeily, Andrew Levinson, Carmelo Dueñas, Camilo Bello Muñoz, José A Rojas-Suarez
BACKGROUND: Every day, about 830 women die worldwide from preventable causes related to pregnancy and childbirth. Obstetric early-warning scores have been proposed as a potential tool to reduce maternal morbidity and mortality, based upon the identification of predetermined abnormal values in the vital signs or laboratory parameters, to generate a rapid and effective medical response. Several early-warning scores have been developed for obstetrical patients, but the majority are the result of a clinical consensus rather than statistical analyses of clinical outcome measures (i...
October 14, 2016: American Journal of Obstetrics and Gynecology
Zehra Ordulu, Tammy Kammin, Harrison Brand, Vamsee Pillalamarri, Claire E Redin, Ryan L Collins, Ian Blumenthal, Carrie Hanscom, Shahrin Pereira, India Bradley, Barbara F Crandall, Pamela Gerrol, Mark A Hayden, Naveed Hussain, Bibi Kanengisser-Pines, Sibel Kantarci, Brynn Levy, Michael J Macera, Fabiola Quintero-Rivera, Erica Spiegel, Blair Stevens, Janet E Ulm, Dorothy Warburton, Louise E Wilkins-Haug, Naomi Yachelevich, James F Gusella, Michael E Talkowski, Cynthia C Morton
In this exciting era of "next-gen cytogenetics," integrating genomic sequencing into the prenatal diagnostic setting is possible within an actionable time frame and can provide precise delineation of balanced chromosomal rearrangements at the nucleotide level. Given the increased risk of congenital abnormalities in newborns with de novo balanced chromosomal rearrangements, comprehensive interpretation of breakpoints could substantially improve prediction of phenotypic outcomes and support perinatal medical care...
October 5, 2016: American Journal of Human Genetics
Amy H Farkas, Sarah Tilstra, Sonya Borrero, Melissa McNeil
BACKGROUND: Internal medicine residents are expected to be able to provide gender-specific care. The objective of this study was to develop a consensus list of core topics and procedural skills in women's health to allow residency program directors to prioritize and standardize educational efforts in women's health. METHODS: We conducted a two-round Delphi of women's health experts. Participants were given a list of topics and asked to: (1) rank each topic based on how important they felt each topic was for internal medicine residents to be proficient in upon graduation, and (2) identify which topics were critical for a women's health curriculum...
October 12, 2016: Journal of Women's Health
John J Mccarthy, Martin H Leamon, Loretta P Finnegan, Catherine Fassbender
Increase in the number of opioid dependent pregnant women delivering babies at risk for neonatal abstinence syndrome (NAS) prompted a General Accountability Office (GAO) report documenting deficits in research and provider knowledge about care of the maternal/fetal unit and the neonate. There are three general sources of dependence: untreated opioid use disorder (OUD), pain management, and medication assisted treatment with methadone or buprenorphine. A survey of methadone patients' experiences when telling a physician of their pregnancy and opioid dependence demonstrated physician confusion about proper care, frequent negative interactions with the mother, and failures to provide appropriate referral...
October 8, 2016: American Journal of Obstetrics and Gynecology
Muhammad Abdul Mabood Khalil, Muhammad Salman Ghazni, Jackson Tan, Nazish Naseer, Muhammad Ashhad Ullah Khalil
Ovarian hyperstimulation syndrome (OHSS) was first described in 1960. It may occur as a complication of gonadotropin hormone therapy during assisted pregnancy or for primary infertility. A 26-year-old female patient with polycystic ovarian syndrome and primary infertility was treated to conceive. She received intravenous gonadotropin-releasing hormone (GnRH) along with follicle-stimulating hormone in an outside private clinic. She presented to the emergency department with abdominal and chest pain, loose stool, vomiting, shortness of breath and decreasing urine output...
May 2016: Case Reports in Gastroenterology
Helen M Ryan, Sumedha Sharma, Laura A Magee, J Mark Ansermino, Karen MacDonell, Beth A Payne, Keith R Walley, Peter von Dadelszen
OBJECTIVE: To assess the performance of the Acute Physiology and Chronic Health Evaluation II (APACHE II) mortality prediction model in pregnant and recently pregnant women receiving critical care in low-, middle-, and high-income countries during the study period (1985-2015), using a structured literature review. DATA SOURCES: Ovid MEDLINE, Embase, Web of Science, and Evidence-Based Medicine Reviews, searched for articles published between 1985 and 2015. STUDY SELECTION: Twenty-five studies (24 publications), of which two were prospective, were included in the analyses...
October 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Jennifer L Marino, Lucy N Lewis, Deborah Bateson, Martha Hickey, S Rachel Skinner
BACKGROUND: Australia's teenage birth rate has fallen to historic lows, but teenage motherhood still occurs and can be challenging for mother and baby. OBJECTIVE: The aim of this article is to review current evidence on the epidemiology and clinical care of teenage pregnancy and parenting, and provide recommendations around management of these young people in Australia. DISCUSSION: Teenage mothers may have experienced family, sexual, and partner violence, family disruption, and socioeconomic disadvantage...
October 2016: Australian Family Physician
L M Yee, A R Goldberger, P M Garcia, E S Miller
OBJECTIVE: To characterize pregnant patients' knowledge, attitudes and preferences regarding antenatal HIV testing for themselves and their sexual partners. STUDY DESIGN: Observational, mixed methods study of HIV-negative pregnant women from a university-based urban clinic. Participants completed an anonymous survey about HIV testing for themselves and their partners. Descriptive statistics, bivariable analyses, multivariable logistic regression and qualitative thematic analysis were utilized...
September 29, 2016: Journal of Perinatology: Official Journal of the California Perinatal Association
S Kukora, N Gollehon, G Weiner, N Laventhal
OBJECTIVE: Neonatologists provide antenatal counseling to support shared decision-making for complicated pregnancies. Poor or ambiguous prognostication can lead to inappropriate treatment and parental distress. We sought to evaluate the accuracy of antenatal prognosticaltion. STUDY DESIGN: A retrospective cohort was assembled from a prospectively populated database of all outpatient neonatology consultations. On the basis of the written consultation, fetuses were characterized by diagnosis groups (multiple anomalies or genetic disorders, single major anomaly and obstetric complications), assigned to five prognostic categories (I=survivable, IIA=uncertain but likely survivable, II=uncertain, IIB=uncertain but likely non-survivable, III non-survivable) and two final outcome categories (fetal demise/in-hospital neonatal death or survival to hospital discharge)...
September 29, 2016: Journal of Perinatology: Official Journal of the California Perinatal Association
Nathaly Quintero-Prigent, Naima Brennetot, Coline Martinot-Lagarde, Malak Fanhy, Frédéric Clavier, Frank Fitoussi, Marion Fiat
Our unit has been providing antenatal consultations for 30 years following the discovery of limb malformation with the fetus. Each of these consultations is specific and carried out by a multi-professional team. It requires a physical and rehabilitation doctor, an orthopedic surgeon, an occupational therapist for upper limb malformation, a physiotherapist for lower malformation and a psychologist. This multidisciplinary consultation is unique because of each pregnancy story, because of each patient life story but also because of the words used by the sonologist when announcing the diagnosis...
September 2016: Annals of Physical and Rehabilitation Medicine
Joshua Amo-Adjei, Derek Anamaale Tuoyire
OBJECTIVES: We analysed the extent of planned, mistimed and unwanted pregnancies and how they predict optimal use of prenatal (timing and number of antenatal) care services in 30 African countries. METHODS: We pooled data from Demographic and Health Surveys conducted in 30 African countries between 2006 and 2015. We described the extent of mistimed and unwanted pregnancies and further used mixed effects logistic and Poisson regression estimation techniques to examine the impacts of planned, mistimed and unwanted pregnancies on the use of prenatal health services...
September 27, 2016: Tropical Medicine & International Health: TM & IH
A Linton, A Golobof, L P Shulman
Perimenopause, or the menopause transition, is a time in a woman's life that bridges her reproductive years through to the non-surgical cessation of ovulation, or menopause. For many women this time is one of changes: changes in gynecological issues, onset of symptoms not experienced in her youth and increasing risks for adverse medical conditions. Despite the clear changes that occur for many women during this time, one critical issue is frequently ignored, namely, that, until the onset of menopause, she is exposed to pregnancy if sexually active, and pregnancy for older reproductive women is fraught with considerable increases in morbidity and mortality compared to younger women...
September 24, 2016: Climacteric: the Journal of the International Menopause Society
(no author information available yet)
Critical care in pregnancy is a field that remains unevenly researched. Although there is a body of evidence to guide many recommendations in critical care, limited research specifically addresses obstetric critical care. The purpose of this document is to review the available evidence, propose strategies for care, and highlight the need for additional research. Much of the review will, of necessity, focus on general principles of critical care, extrapolating where possible to obstetric critical care.
October 2016: Obstetrics and Gynecology
(no author information available yet)
Critical care in pregnancy is a field that remains unevenly researched. Although there is a body of evidence to guide many recommendations in critical care, limited research specifically addresses obstetric critical care. The purpose of this document is to review the available evidence, propose strategies for care, and highlight the need for additional research. Much of the review will, of necessity, focus on general principles of critical care, extrapolating where possible to obstetric critical care.
October 2016: Obstetrics and Gynecology
Helen Hall, Holger Cramer, Tobias Sundberg, Lesley Ward, Jon Adams, Craig Moore, David Sibbritt, Romy Lauche
BACKGROUND: Low back pain and pelvic girth pain are common in pregnancy and women commonly utilize complementary manual therapies such as massage, spinal manipulation, chiropractic, and osteopathy to manage their symptoms. OBJECTIVE: The aim of this systematically review was to critically appraise and synthesize the best available evidence regarding the effectiveness of manual therapies for managing pregnancy-related low back and pelvic pain. METHODS: Seven databases were searched from their inception until April 2015 for randomized controlled trials...
September 2016: Medicine (Baltimore)
V Mishra Vineet, A Goyal Preeti, S Aggarwal Rohina, S Choudhary, Tanvir Tanvir, D Dharaiya Nisarg, A Gaddagi Rashmi
BACKGROUND: Acute kidney injury (AKI) is a clinical syndrome characterized by a sudden decline in glomerular filtration rate leading to decreased excretion of nitrogenous waste products. It continues to be a common problem in developing countries. AIMS: The aim of this study was to understand AKI characteristics in pregnancy and identify the factors related to its unfavorable outcome. STUDY DESIGN: A prospective cross-sectional study. METHODS: This prospective study was conducted between January 2013 and May 2014...
October 2016: Journal of Obstetrics and Gynaecology of India
Aruna Kumar, Neha Agrawal
PURPOSE: Maternal brought in dead are the patient who dies in the need of adequate medical care. These deaths are often not analyzed sincerely as they are not institutional deaths. Our aim is to find out actual life threatening cause of delay leading to death. METHOD: Patients brought dead to casualty were seen by the doctors on duty in Department of Obstetrics and Gynaecology,Gandhi Medical College, Bhopal round the clock. Cause of death was analyzed by verbal autopsy of attendants and referral letter from the institute...
October 2016: Journal of Obstetrics and Gynaecology of India
James Spain, Matthew Rheinboldt
Representing an ascending, sexually spread pyogenic infection of the female genital tract, pelvic inflammatory disease (PID) is a commonly encountered cause for emergency visits and hospitalizations among young and adult female patients. Though gynecologic evaluation and sonography constitute the mainstay of diagnosis, multidetector CT imaging of the abdomen and pelvis is not uncommonly performed, often as the initial imaging modality, due to the frequently vague and indeterminate clinical presentation. As such, knowledge and attenuation to the often subtle early imaging features of PID afford the radiologist a critical chance to direct and expedite appropriate pathways of patient care, minimizing the risk for secondary complications, including infertility, ectopic pregnancy, and enteric adhesions...
September 19, 2016: Emergency Radiology
Radka Wilhelmova, Drahoslava Hruba, Lenka Vesela
BACKGROUND: Health literacy is a critical determinant of women's and children's health and therefore has immense consequences for the health of society as well. Evidence from epidemiological, clinical and experimental studies indicates that unhealthy lifestyles and risky behavioural habits of parents before conception and during pregnancy influence the etiology of various health defects. Decreasing primary risk factors, practicing physical wellness, monitoring physiological markers and preparing for labour, breastfeeding and newborn care should be the main parental responsibilities during the prenatal period...
March 2015: Zdravstveno Varstvo
Ender Gedik, Neslihan Yücel, Taylan Sahin, Erdinc Koca, Yusuf Ziya Colak, Turkan Togal
PURPOSE: The aim was to assess outcomes for pregnancies in which hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome develops and the patient requires transfer for critical care. MATERIALS AND METHODS: The cases of women with HELLP syndrome who delivered at our tertiary center or surrounding hospitals and were admitted to the intensive care between January 2007 and July 2012 were retrospectively analyzed. Results were compared for the surviving and non-surviving patients...
September 6, 2016: Hypertension in Pregnancy
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