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High risk obstetrics

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https://www.readbyqxmd.com/read/29652744/clinical-pearls-part-3-anaesthetic-management-of-abnormally-invasive-placentation
#1
Vinod Patil, Gamunu Ratnayake, Galina Fastovets, D S Wijayatilake
PURPOSE OF REVIEW: Abnormal placentation is a clinical condition seen increasingly in the pregnant population. It is associated with significant morbidity and mortality, which may be mitigated through robust multidisciplinary care for these patients. The role of maternal critical care for these patients has largely been ignored in the literature. RECENT FINDINGS: Advances in pharmacological management of bleeding with recent publications of large multicentre trials in addition to new technologies in the management of massive obstetric haemorrhage (MOH) have revolutionized the management of abnormal placentation...
April 12, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29652240/umbilical-cord-coiling-in-high-risk-pregnancies-associations-with-determinants-of-adverse-birth-outcomes-and-iron-status
#2
Gabrielle K Steinl, Jocelyn S Gandelman, Philip J Katzman, Yuan Ru, Ronnie Guillet, Eva Pressman, Elizabeth M Cooper, Kimberly O O'Brien
Abnormal umbilical cord coiling has been associated with adverse neonatal outcomes, but the etiology of these findings remains poorly characterized. This study was undertaken to examine associations between cord coiling and maternal iron (Fe) status and to identify potential determinants of hypo- and hypercoiling in 2 higher risk obstetric groups: pregnant adolescents (≤18 years, n = 92) and adult women carrying twins (n = 49), triplets (n = 11), or quadruplets (n = 1). Umbilical cords were classified as hypo-, normo-, or hypercoiled using digital photographs to assess gross appearance...
January 1, 2018: Pediatric and Developmental Pathology
https://www.readbyqxmd.com/read/29649980/patterns-of-caesarean-section-in-hiv-infected-and-non-infected-women-in-malawi-is-caesarean-section-used-for-pmtct
#3
Lyson Tenthani, Joep J van Oosterhout, Andreas D Haas, Malango Msukwa, Nozgechi Phiri, Frank Chimbwandira, Kali Tal, Karoline Aebi-Popp, Janne Estill, Olivia Keiser
BACKGROUND: Caesarean section (CS) is not recommended for PMTCT in Malawi HIV Guidelines, contrary to most high-income countries where CS is indicated if viral suppression is sub-optimal pre-delivery. We describe patterns of CS in HIV-infected and uninfected women in Malawi and explored if insight into the use of Elective CS (ECS) for PMTCT could be obtained. METHODS: We used routinely collected data from individual medical records from 17 large health facilities in the central and southern regions of Malawi, from January 2010 to December 2013...
April 12, 2018: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/29649339/pathogenic-factors-associated-with-development-of-disseminated-intravascular-coagulopathy-dic-in-a-tertiary-academic-hospital-in-south-africa
#4
Elizabeth S Mayne, Anthony L H Mayne, Susan J Louw
INTRODUCTION: Disseminated intravascular coagulopathy (DIC) is a thrombotic microangiopathy arising from consumption of both coagulation factors and platelets. DIC is triggered by a number of clinical conditions including severe infection, trauma and obstetric complications. Early diagnosis and treatment of the underlying condition is paramount. A high clinical index of suspicion is needed to ensure that patients at risk of developing DIC are appropriately investigated. METHODS: In order to establish the clinical conditions most frequently associated with DIC, we reviewed all DIC screens received at a tertiary hospital in Johannesburg, South Africa over a 1 year period...
2018: PloS One
https://www.readbyqxmd.com/read/29630017/research-in-obstetric-fistula-addressing-gaps-and-unmet-needs
#5
Rachel Pope
Although obstetric fistula has likely plagued women since the beginning of time, very little research proportionally exists. This article summarizes the most substantial research on the topic and delineates research gaps and future needs. Existing research demonstrates that access to care is the underlying cause of obstetric fistula and that the first attempt at closure holds the highest chance at success, ranging between 84% and 94%. For simple cases, 10 days of a catheter is sufficient, although what constitutes as simple is unclear...
April 6, 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29629841/self-efficacy-and-planning-strategies-can-improve-physical-activity-levels-in-women-with-a-recent-history-of-gestational-diabetes-mellitus
#6
Janani Pinidiyapathirage, Rohan Jayasuriya, N Wah Cheung, Ralf Schwarzer
INTRODUCTION: Regular physical activity can reduce the risk of developing diabetes in high risk populations including in women with gestational diabetes mellitus (GDM). This study applied the Health Action Process Approach (HAPA) to determine the motivational and volitional factors important in increasing physical activity among women with previous GDM. METHODS: Women with GDM receiving obstetric care at a teaching hospital in Sri Lanka were invited to participate in a survey 6-36 months post-delivery...
April 9, 2018: Psychology & Health
https://www.readbyqxmd.com/read/29621911/incidence-and-natural-history-of-preeclampsia-eclampsia-at-the-university-maternity-of-antananarivo-madagascar-high-prevalence-of-the-early-onset-condition
#7
Andriamanetsiarivo Tanjona Ratsiatosika, Eric Razafimanantsoa, Valéry Bruno Andriantoky, Noël Ravoavison, Rakotovao Andrianampanalinarivo Hery, Malik Boukerrou, Silvia Iacobelli, Pierre-Yves Robillard
OBJECTIVES: To investigate the incidence of early - (delivery < 34 weeks) (EOP) versus late-onset (delivery ≥ 34 weeks) (LOP) in Madagascar. STUDY DESIGN: Eight months observational study of all preeclamptic/eclamptic women delivering at the maternity of the University Hospital of Befelatanana, Antananarivo, Madagascar. Sociodemographical and obstetrical risk factors are analysed. RESULTS: Over the study period, we found 142 combined preeclampsia/eclampsia among 4316 births (incidence 3...
April 5, 2018: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29616652/risk-factors-for-in-hospital-maternal-mortality-in-the-region-of-maradi-niger-2008-2010-a-retrospective-study-of-7-regional-maternity-units
#8
Ibrahim Alkassoum, Issifou Djibo, Younsa Hama, A Mohamed Abdoulwahabou, Oumarou Amadou
In the Maradi region, despite multiple efforts to reduce maternal mortality the in-hospital maternal mortality ratio (HMMR) remains high. We sought to determine the factors related to maternal mortality in seven maternity units in this region. A retrospective study reviewed records of deliveries from January, 2008, through December, 2010. Data for all maternal deaths were collected. The Chi2 test was used to determine the significance of differences between groups for the different variables. Statistical significance was defined as P < 0...
February 1, 2018: Médecine et Santé Tropicales
https://www.readbyqxmd.com/read/29616651/knowledge-and-practice-of-togolese-women-concerning-cervical-cancer
#9
S Agbo, H S Bemanana, K M Aziagbenyo, F M Lahaye
OBJECTIVE: To identify the determinants of the knowledge and practice of Togolese women concerning cervical cancer. METHODS: This cross-sectional study with a descriptive and analytical focus took place in Togo during the four-month period from May to August 2016 and surveyed women aged 18 to 60 living in the Lomé municipal area for at least 12 months. Sampling of the intervention zones was based on reasoned choice depending on the availability of health structures in the area...
February 1, 2018: Médecine et Santé Tropicales
https://www.readbyqxmd.com/read/29608674/pharmacist-interventions-in-high-risk-obstetric-inpatient-unit-a-medication-safety-issue
#10
Nice M O Silva, Mariana R Gnatta, Marília B Visacri, Amanda C Ferracini, Priscila G Mazzola, Mary  Parpinelli, Fernanda G Surita
Objectives: The aim of this study was to report number, type and severity of prescribing errors and pharmacist interventions in high-risk pregnant and postpartum women. Design: A prospective cross-sectional, observational study. Setting: A high-risk obstetric inpatient unit of a Women's Hospital in Brazil. Participants: About 1826 electronic prescriptions for 549 women in the high-risk obstetrics inpatient unit were included...
March 28, 2018: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/29606552/sexual-activity-recommendations-in-high-risk-pregnancies-what-is-the-evidence
#11
REVIEW
Sally E MacPhedran
BACKGROUND: While sexual activity in normal, healthy pregnant women is safe, concern regarding elements of the sexual act have led to restrictions in pregnancies experiencing complications that are frequently insufficiently addressed in clinical practice. AIM: To comprehensively review the literature for evidence that supports or refutes specific sexual activity restrictions in high-risk pregnancy conditions. METHODS: A search of PubMed, MEDLINE, Ovid, UpToDate, Google Scholar, and Google for relevant publications related to any aspect of sexual activity affecting high-risk pregnancies complicated by history of pre-term delivery, shortened cervix, presence of cerclage, pre-mature rupture of membranes, placenta abruption, placenta previa, multiple gestation, or history of classical cesarean section was performed...
March 29, 2018: Sexual Medicine Reviews
https://www.readbyqxmd.com/read/29595675/a-12-year-analysis-of-closed-medical-malpractice-claims-of-the-taiwan-civil-court-a-retrospective-study
#12
Chi-Yuan Hwang, Chien-Hung Wu, Fu-Cheng Cheng, Yung-Lin Yen, Kuan-Han Wu
Malpractices lawsuits cause increased physician stress and decreased career satisfaction, which might result in defensive medicine for avoiding litigation. It is, consequently, important to learn experiences from previous malpractice claims. The aim of this study was to examine the epidemiologic factors related to medical malpractice claims, identify specialties at high risk of such claims, and determine clinical which errors tend to lead to medical malpractice lawsuits, by analyzing closed malpractice claims in the civil courts of Taiwan...
March 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29588948/adverse-perinatal-events-treatment-gap-and-positive-family-history-linked-to-the-high-burden-of-active-convulsive-epilepsy-in-uganda-a-population-based-study
#13
Angelina Kakooza-Mwesige, Donald Ndyomugyenyi, George Pariyo, Stefan Swartling Peterson, Paul Michael Waiswa, Edward Galiwango, Eddie Chengo, Rachael Odhiambo, Derrick Ssewanyana, Christian Bottomley, Anthony K Ngugi, Charles R J C Newton
Objective: To determine the prevalence of active convulsive epilepsy (ACE) and describe the clinical characteristics and associated factors among a rural Ugandan population. Methods: The entire population in Iganga/Mayuge Health Demographic Surveillance Site (IM-HDSS) was screened using two questions about seizures during a door-to-door census exercise. Those who screened positive were assessed by a clinician to confirm diagnosis of epilepsy. A case control study with the patients diagnosed with ACE as the cases and age/sex-matched controls in a ratio of 1:1 was conducted...
June 2017: Epilepsia Open
https://www.readbyqxmd.com/read/29587540/risk-of-recurrent-shoulder-dystocia-are-we-any-closer-to-prediction
#14
Shadha Al-Hawash, Clare L Whitehead, Dan Farine
OBJECTIVE: To determine the incidence and risk factors for recurrent shoulder dystocia in women. METHODS: We searched Medline, Pubmed, Embase, and CINAHL for relevant articles in English and French from 1980 to February 2018 that described risks of recurrent shoulder dystocia undergoing a trial of labour in subsequent pregnancies. A total of 684 articles were found, of which 13 were included as they met criteria. We extracted data on study characteristics, incidence of recurrent shoulder dystocia, degree of neonatal injury, and presence of known risk factors...
March 27, 2018: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29578986/acog-committee-opinion-no-733-employment-considerations-during-pregnancy-and-the-postpartum-period
#15
(no author information available yet)
In the United States, it is common for women, including mothers and pregnant women, to work outside the home. Working during pregnancy is generally safe. For those in high-risk occupations or with medically complicated pregnancies, work accommodations often can allow for continued safe employment. The major employment issues concerning pregnant women include pregnancy-related discrimination, work accommodations that allow continued employment, job-protected leave, and wage replacement while on leave. Workplace discrimination related to being pregnant and pregnancy-related harassment, including discrimination in the hiring process, is prohibited by federal and state law...
April 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29578984/acog-committee-opinion-no-733-summary-employment-considerations-during-pregnancy-and-the-postpartum-period
#16
(no author information available yet)
In the United States, it is common for women, including mothers and pregnant women, to work outside the home. Working during pregnancy is generally safe. For those in high-risk occupations or with medically complicated pregnancies, work accommodations often can allow for continued safe employment. The major employment issues concerning pregnant women include pregnancy-related discrimination, work accommodations that allow continued employment, job-protected leave, and wage replacement while on leave. Workplace discrimination related to being pregnant and pregnancy-related harassment, including discrimination in the hiring process, is prohibited by federal and state law...
April 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29577914/the-importance-of-the-learning-process-in-st-analysis-interpretation-and-its-impact-in-improving-clinical-and-neonatal-outcomes
#17
Susanna Timonen, Kaisa Holmberg
BACKGROUND: Intrapartum fetal heart rate (FHR) monitoring was introduced with the goal to reduce fetal hypoxia and deaths. However, continuous FHR monitoring has been shown to have a high sensitivity but also a high false positive rate. To improve specificity, adjunctive technologies have been developed to identify fetuses at risk for intrapartum asphyxia. Intensive research on the value of ST-segment analysis of the fetal electrocardiogram (ECG) as an adjunct to standard electronic fetal monitoring (EFM) in lowering the rates of fetal metabolic acidosis and operative deliveries has been ongoing...
March 22, 2018: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29575202/sonographic-evaluation-of-intra-abdominal-adhesions-during-the-third-trimester-of-pregnancy-a-novel-technique-in-women-undergoing-repeated-cesarean-section
#18
Joel Baron, Dan Tirosh, Salvatore Andrea Mastrolia, Yigal Ben-Haroush, Shoshana Schwartz, Yoav Kerner, Reli Hershkovitz
OBJECTIVES: Intra-abdominal adhesions may result in an increased risk of major complications in case of a repeated cesarean section, such as bladder and bowel injury, hemorrhage, infection, and hysterectomy. In an attempt to predict intra-abdominal adhesions before a repeated cesarean delivery, we suggest the use of a novel technique employing a simple and feasible ultrasound imaging technique. METHODS: The study included pregnant women who underwent one or more cesarean deliveries in their obstetric history and were evaluated during the third trimester of the ongoing pregnancy...
March 25, 2018: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/29575180/sonographic-assessment-of-the-anal-sphincter-after-obstetric-anal-sphincter-injury-oasi-using-transperineal-ultrasound-tpus
#19
EDITORIAL
Vered H Eisenberg, Dan V Valsky, Simcha Yagel
Obstetric anal sphincter injury (OASI) is the most common cause of anal incontinence and ano-rectal symptoms in women1 . Reported rates of anal incontinence following primary repair of OASI range between 15-61%, with a mean of 39%2, 3 . Other possible complications of OASI include perineal pain, dyspareunia, and less commonly, abscess formation, wound breakdown, and rectovaginal fistulae. Symptom onset may occur immediately, several years postpartum, or only late in life when aging of tissues adds to the delivery insult...
March 24, 2018: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/29573218/understanding-environmental-contributions-to-autism-causal-concepts-and-the-state-of-science
#20
REVIEW
Irva Hertz-Picciotto, Rebecca J Schmidt, Paula Krakowiak
The complexity of neurodevelopment, the rapidity of early neurogenesis, and over 100 years of research identifying environmental influences on neurodevelopment serve as backdrop to understanding factors that influence risk and severity of autism spectrum disorder (ASD). This Keynote Lecture, delivered at the May 2016 annual meeting of the International Society for Autism Research, describes concepts of causation, outlines the trajectory of research on nongenetic factors beginning in the 1960s, and briefly reviews the current state of this science...
March 23, 2018: Autism Research: Official Journal of the International Society for Autism Research
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