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Obstetric critical care

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https://www.readbyqxmd.com/read/28225422/clinical-updates-in-women-s-health-care-summary-structural-heart-disease-primary-and-preventive-care-review
#1
Tiberio Frisoli, Michele Doughty Voeltz
Reproductive-aged women with structural heart disease who become pregnant as well as postreproductive-aged women with this condition represent a significant proportion of patients seen by obstetrician- gynecologists. Usually, their conditions are complex, and a basic knowledge of the anatomy and physiology of the heart is required. Additionally, understanding the effect of pregnancy on women with structural heart disease is critically important to optimizing maternal and fetal outcomes. This monograph addresses the pathophysiology, signs and symptoms, screening and diagnosis, basic management, and suggested counseling for an obstetric-gynecologic patient with structural heart disease...
March 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28219965/a-public-health-response-to-opioid-use-in-pregnancy
#2
Stephen W Patrick, Davida M Schiff
The use of opioids during pregnancy has grown rapidly in the past decade. As opioid use during pregnancy increased, so did complications from their use, including neonatal abstinence syndrome. Several state governments responded to this increase by prosecuting and incarcerating pregnant women with substance use disorders; however, this approach has no proven benefits for maternal or infant health and may lead to avoidance of prenatal care and a decreased willingness to engage in substance use disorder treatment programs...
February 20, 2017: Pediatrics
https://www.readbyqxmd.com/read/28214925/missed-opportunities-in-neonatal-deaths-in-rwanda-applying-the-three-delays-model-in-a-cross-sectional-analysis-of-neonatal-death
#3
Efua Wilmot, Marcel Yotebieng, Alison Norris, Fidele Ngabo
Objective Administered in a timely manner, current evidence-based interventions could reduce neonatal deaths from infections, intrapartum injuries and complications due to prematurity. The three delays model (delay in seeking care, in arriving at a health facility, and in receiving adequate care), which has been applied to understanding maternal deaths, may be useful for understanding neonatal deaths. We assess the main causes of neonatal deaths in Rwanda and their associated delays. Methods Using a cross-sectional study design, we evaluated data from 2012 from 40 facilities in which babies were delivered...
February 18, 2017: Maternal and Child Health Journal
https://www.readbyqxmd.com/read/28212182/what-s-new-in-obstetric-anesthesia-the-2016-gerard-w-ostheimer-lecture
#4
Philip E Hess
This special article presents potentially important trends and issues affecting the field of obstetric anesthesia drawn from publications in 2015. Both maternal mortality and morbidity in the United States have increased in recent years because, in part, of the changing demographics of the childbearing population. Pregnant women are older and have more pre-existing conditions and complex medical histories. Cardiovascular and noncardiovascular medical diseases now account for half of maternal deaths in the United States...
March 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28192732/reproductive-decisions-after-the-diagnosis-of-amniotic-fluid-embolism
#5
Amirhossein Moaddab, Miranda Klassen, Cynthia D Priester, Elvira H Munoz, Michael A Belfort, Steven L Clark, Gary A Dildy
OBJECTIVE: This study aims to describe the subsequent reproductive outcomes in women who either correctly or incorrectly were diagnosed with amniotic fluid embolism (AFE). STUDY DESIGN: Medical records were obtained, abstracted and reviewed by authors with extensive experience in critical care obstetrics. Telephone interviews of all survivors were conducted to determine obstetrical and contraceptive history. A subgroup underwent further telephone interview to address subsequent reproductive decisions...
January 23, 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/28178063/detecting-pulmonary-edema-in-obstetric-patients-through-point-of-care-lung-ultrasonography
#6
Sarah Pachtman, Seth Koenig, Natalie Meirowitz
BACKGROUND: Point-of-care lung ultrasonography is used in critical care settings for evaluating respiratory symptoms. Lung ultrasonography is sensitive and specific for the diagnosis of pulmonary edema in nonpregnant patients but is not well-studied in pregnancy. TECHNIQUE: Lung ultrasonography was performed using a portable ultrasound machine with a 2- to 5-MHz curvilinear probe that is available on many labor and delivery units. EXPERIENCE: Lung ultrasonography guided management decisions in a case of shortness of breath after induction of labor for preeclampsia and a case of hemolysis, elevated liver enzymes, and low platelet count syndrome complicated by pulmonary edema...
March 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28152539/hyperoxia-and-the-immature-brain
#7
Bettina Reich, Daniela Hoeber, Ivo Bendix, Ursula Felderhoff-Mueser
Despite major advances in obstetrics and neonatal intensive care, preterm infants frequently suffer from neurological impairments in later life. Preterm and also full-term neonates are generally susceptible to injury caused by reactive oxygen species due to the immaturity of endogenous radical scavenging systems. It is well known that high oxygen levels experienced during the critical phase of maturation can profoundly influence developmental processes. Supraphysiological oxygen concentrations used for resuscitation or in the care of critically ill infants are known to have deleterious effects on the developing lung and retina, contributing to the pathophysiology of neonatal diseases like bronchopulmonary dysplasia and retinopathy of prematurity...
February 3, 2017: Developmental Neuroscience
https://www.readbyqxmd.com/read/28029232/severe-maternal-morbidity-requires-regionalistion-of-obstetric-critical-care
#8
Eap Steegers, A J Eggink
No abstract text is available yet for this article.
December 28, 2016: BJOG: An International Journal of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/27997480/health-care-provider-knowledge-and-attitudes-regarding-reporting-diseases-and-events-to-public-health-authorities-in-tennessee
#9
Mary-Margaret A Fill, Rendi Murphree, April C Pettit
CONTEXT: In the United States, state laws require health care providers to report specific diseases and events to public health authorities, a fundamental facet of disease surveillance. However, reporting by providers is often inconsistent, infrequent, and delayed. OBJECTIVE: To examine knowledge, attitudes, and practices regarding provider disease reporting and to understand current barriers to provider disease reporting. DESIGN: A cross-sectional study was conducted via an anonymous, standardized electronic survey...
December 16, 2016: Journal of Public Health Management and Practice: JPHMP
https://www.readbyqxmd.com/read/27942344/acute-care-trauma-surgeon-s-role-in-obstetrical-gynecologic-emergencies-the-obcat-alert
#10
Seong K Lee, Eddy H Carrillo, Andrew Rosenthal, Rafael Sanchez, Chauniqua Kiffin, Dafney L Davare
BACKGROUND: Overwhelming hemorrhage or other intra-abdominal complications may be associated with obstetrical or gynecologic (OB/GYN) procedures and may require the surgical training of an Acute Care/Trauma Surgeon. The OB Critical Assessment Team (OBCAT Alert) was developed at our institution to facilitate a multidisciplinary response to complex OB/GYN cases. We sought to review and characterize the Acute Care/Trauma Surgeon's role in these cases. METHODS: We conducted a retrospective review of all emergency consults during an OB/GYN case at our institution from 2008 to 2015...
2016: World Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27926635/the-obstetrician-gynecologist-s-role-in-detecting-preventing-and-treating-depression
#11
Amritha Bhat, Susan D Reed, Jürgen Unützer
Women are at a higher risk for depression than are men, and this risk is especially pronounced at specific reproductive periods of vulnerability: adolescence, pregnancy, postpartum, and the menopausal transition. Obstetrician-gynecologists are often the health care providers who women consult during these vulnerable periods, usually presenting with conditions or complaints other than depression or anxiety. Presenting symptoms are frequently known comorbidities with depression or are risk factors for depression...
January 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27918157/necrotic-fasciitis-of-the-lateral-muscle-group-of-the-thigh-following-outside-in-transobturatory-tape-procedure
#12
O Dvořák, D Leško, J Kestřánek
OBJECTIVE: Sling procedures are the preferred surgical treatment of stress urinary incontinence (SUI) due to their high success rate and low risk of complications. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, Medical Faculty of Charles University and Faculty Hospital Hradec Kralove. CASE REPORT: Necrotic fasciitis is a rare infectious complication, the mortality of which varies by age and can reach 73% if untreated...
2016: Ceská Gynekologie
https://www.readbyqxmd.com/read/27907898/obstetrical-and-perinatal-outcomes-following-blastocyst-transfer-compared-to-cleavage-transfer-a-systematic-review-and-meta-analysis
#13
W P Martins, C O Nastri, L Rienzi, S Z van der Poel, C R Gracia, C Racowsky
STUDY QUESTION: Is blastocyst transfer safe when compared to cleavage stage embryo transfer regarding obstetric and perinatal outcomes? SUMMARY ANSWER: The clinical equipoise between blastocyst and cleavage stage embryo transfer remains as the evidence associating blastocyst transfer with some adverse perinatal outcomes is of low/very low quality. WHAT IS KNOWN ALREADY: Extended embryo culture to the blastocyst stage provides some theoretical advantages and disadvantages...
November 2016: Human Reproduction
https://www.readbyqxmd.com/read/27895065/social-determinants-and-maternal-exposure-to-intimate-partner-violence-of-obstetric-patients-with-severe-maternal-morbidity-in-the-intensive-care-unit-a-systematic-review-protocol
#14
Beatriz Paulina Ayala Quintanilla, Angela Taft, Susan McDonald, Wendy Pollock, Joel Christian Roque Henriquez
INTRODUCTION: Maternal mortality is a potentially preventable public health issue. Maternal morbidity is increasingly of interest to aid the reduction of maternal mortality. Obstetric patients admitted to the intensive care unit (ICU) are an important part of the global burden of maternal morbidity. Social determinants influence health outcomes of pregnant women. Additionally, intimate partner violence has a great negative impact on women's health and pregnancy outcome. However, little is known about the contextual and social aspects of obstetric patients treated in the ICU...
November 28, 2016: BMJ Open
https://www.readbyqxmd.com/read/27842632/a-cross-sectional-study-of-peripartum-blood-transfusion-in-the-eastern-cape-south-africa
#15
K Van den Berg, E M Bloch, A S Aku, M Mabenge, D V Creel, G J Hofmeyr, E L Murphy
BACKGROUND: Obstetric haemorrhage (OH) remains a major contributor to maternal morbidity and mortality. Blood transfusion is critical in OH management; yet, data on peripartum transfusion are lacking. A pilot study reported high rates of peripartum transfusion in a sample of South African (SA) hospitals, which was independently associated with HIV status. OBJECTIVES: To assess the incidence of peripartum transfusion in a sample of Eastern Cape, SA hospitals to evaluate generalisability of preceding study findings...
November 2, 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
https://www.readbyqxmd.com/read/27826131/preconception-care-education-for-women-with-diabetes-a-systematic-review-of-conventional-and-digital-health-interventions
#16
REVIEW
Chidiebere Hope Nwolise, Nicola Carey, Jill Shawe
BACKGROUND: Worldwide, 199.5 million women have diabetes mellitus (DM). Preconception care (PCC) education starting from adolescence has been recommended as an effective strategy for safeguarding maternal and child health. However, traditional preconception care advice provided by health care professionals (HCPs) within clinic settings is hindered by inadequate resources, suboptimal coverage, and busy clinics. Electronic health (eHealth), which is instrumental in solving problems around scarce health resources, could be of value in overcoming these limitations and be used to improve preconception care and pregnancy outcomes for women with DM...
November 8, 2016: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/27816155/respiratory-considerations-including-airway-and-ventilation-issues-in-critical-care-obstetric-patients
#17
REVIEW
Holly Ende, Dirk Varelmann
Critical care management of the obstetric patient can present unique challenges. Parturients who present with respiratory distress can suffer from a multitude of etiologies, and each diagnosis must be pursued as appropriate to the clinical picture. Normal physiologic changes of pregnancy may obscure the presentation and diagnosis, and irrelevant of the cause, pregnancy may complicate the management of hypoxic and hypercarbic respiratory failure in this patient population. In addition to these concerns, both anticipated and unanticipated difficult airway management, including difficulty ventilating and intubating, are more common during pregnancy and may be encountered during endotracheal tube placement...
December 2016: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/27816150/critical-care-for-the-obstetrician-and-gynecologist-obstetric-hemorrhage-and-disseminated-intravascular-coagulopathy
#18
REVIEW
Arthur Jason Vaught
Obstetric hemorrhage accounts for 5% all deliveries in the United States and accounts for high maternal morbidity and mortality. Many hemorrhages are secondary to uterine atony and are quickly ameliorated with appropriate uterotonic use. However, for a subset of cases, severe hemorrhage may require advanced resuscitative techniques, and innovative procedural and surgical techniques. This article guides a provider through such a resuscitation.
December 2016: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/27811594/effect-of-implementing-a-standardized-shoulder-dystocia-documentation-form-on-quality-of-delivery-notes
#19
Lisa C Zuckerwise, Madison M Hustedt, Heather S Lipkind, Edmund F Funai, Cheryl A Raab, Christian M Pettker
OBJECTIVES: Complete and accurate documentation by the delivering provider in cases of shoulder dystocia is critical for providing clinical information and care to the patient and protecting providers from litigation risks. Standardized forms improve inclusion of certain data elements in the medical record, but the impact on subsequent narrative notes is unknown. We aimed to determine if implementation of a standardized shoulder dystocia documentation form improves obstetric provider written narrative delivery notes...
November 2, 2016: Journal of Patient Safety
https://www.readbyqxmd.com/read/27789310/severe-maternal-morbidity-and-comorbid-risk-in-hospitals-performing-1000-deliveries-per-year
#20
Mark P Hehir, Cande V Ananth, Jason D Wright, Zainab Siddiq, Mary E D'Alton, Alexander M Friedman
BACKGROUND: While research has demonstrated increasing risk for severe maternal morbidity in the United States, risk at lower volume hospitals remains poorly characterized. More than half of all obstetric units in the United States perform <1000 deliveries per year and improving care at these hospitals may be critical to reducing risk nationwide. OBJECTIVE: We sought to characterize maternal risk profiles and severe maternal morbidity at low-volume hospitals in the United States...
October 24, 2016: American Journal of Obstetrics and Gynecology
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