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High risk obstetrics

Marcos Augusto Bastos Dias, Rosa Maria Soares Madeira Domingues, Arthur Orlando Corrêa Schilithz, Marcos Nakamura-Pereira, Maria do Carmo Leal
BACKGROUND: The rate of cesarean delivery (CD) in Brazil has increased over the past 40 years. The CD rate in public services is three times above the World Health Organization recommended values. Among strategies to reduce CD, the most important is reduction of primary cesarean. This study aimed to describe factors associated with CD during labor in primiparous women with a single cephalic pregnancy assisted in the Brazilian Public Health System (SUS). METHODS: This study is part of the Birth in Brazil survey, a national hospital-based study of 23,894 postpartum women and their newborns...
October 17, 2016: Reproductive Health
Rosa Maria Soares Madeira Domingues, Marcos Augusto Bastos Dias, Arthur Orlando Corrêa Schilithz, Maria do Carmo Leal
BACKGROUND: Maternal near-miss (MNM) audits are considered a useful approach to improving maternal healthcare. The aim of this study was to evaluate the factors associated with maternal near-miss cases in childbirth and the postpartum period in Brazil. METHODS: The study is based on data from a nationwide hospital-based survey of 23,894 women conducted in 2011-2012. The data are from interviews with mothers during the postpartum period and from hospital medical files...
October 17, 2016: Reproductive Health
Sonia Duarte de Azevedo Bittencourt, Rosa Maria Soares Madeira Domingues, Lenice Gnocchi da Costa Reis, Márcia Melo Ramos, Maria do Carmo Leal
BACKGROUND: In Brazil, hospital childbirth care is available to all, but differences in access and quality of care result in inequalities of maternal health. The objective of this study is to assess the infrastructure and staffing of publicly financed labor and birth care in Brazil and its adequacy according to clinical and obstetric conditions potentially associated with obstetric emergencies. METHODS: Nationwide cross-sectional hospital-based study "Birth in Brazil: national survey into labor and birth" conducted in 2011-2012...
October 17, 2016: Reproductive Health
Lucille Arragain, Myrielle Dupont-Rouzeyrol, Olivia O'Connor, Nathalie Sigur, Jean-Paul Grangeon, Emilie Huguon, Clothilde Dechanet, Cécile Cazorla, Ann-Claire Gourinat, Elodie Descloux
: We investigated 10 mother-newborn pairs and found a 90% rate of dengue virus (DENV) transmission during the perinatal period. Here, we describe DENV kinetics in the sera of newborns before the onset of disease. Of the breast-milk samples analyzed, 75% tested positive for DENV. BACKGROUND: Dengue is the most common mosquito-borne viral disease in humans. With this study, we aimed to investigate the risk of vertical (DENV) transmission during the peripartum period and to describe its viral kinetics in serum and breast milk...
October 19, 2016: Journal of the Pediatric Infectious Diseases Society
Mary McGunigal, Jerry Liu, Tamara Kalir, Manjeet Chadha, Vishal Gupta
OBJECTIVES: High-risk histology including UPSC, CC, and high-grade (G3) endometrioid adenocarcinoma (EAC) have a worse prognosis compared to G1-2 EAC. It is unknown whether G3EAC outcomes are more similar to UPSC/CC or to G1-2 EAC. The purpose of this study was to compare overall survival (OS) among UPSC, CC, and G1-3 EAC, for International Federation of Gynecology and Obstetrics stages I to III. METHODS: The National Cancer Data Base was queried for patients diagnosed with International Federation of Gynecology and Obstetrics (1988 classification) Stage I-III UPSC, CC, and EAC from 1998 to 2012 who underwent surgery as definitive treatment...
October 18, 2016: International Journal of Gynecological Cancer
N V Bashmakova, N B Davydenko, G B Malgina, N V Putilova
AIM: The aim of this research was to have a thorough study of predictors of critical states during pregnancy after assisted reproductive technologies. MATERIALS AND METHODS: A retrospective study of 303 patients with "near-miss," out of which 37 are pregnancy cases after ART (the main group) and 265 are spontaneous pregnancy cases (the control group). RESULTS: Pregnancy after ART constituted 12.3% of all critical states. In the main group (10...
October 2016: Gynecological Endocrinology
Pedro Pallangyo, Isaac Mawenya, Paulina Nicholaus, Henry Mayala, Amida Kalombola, Godwin Sharau, Naiz Majani, Mohamed Janabi
BACKGROUND: Congenital complete heart block is a life-threatening condition which is highly associated with autoimmune and connective tissue disorders. Presence of maternal autoantibodies for associated conditions increases the risk of delivering a child with congenital complete heart block, however, less than a half of all women with such antibodies are symptomatic even after delivery. Mortality rate is highest during the neonatal period (45 %) and about two-thirds of all cases will require permanent pacing at some point in their lives...
October 19, 2016: Journal of Medical Case Reports
Matthew S Payne, Demelza J Ireland, Rory Watts, Elizabeth A Nathan, Lucy L Furfaro, Matthew W Kemp, Jeffrey A Keelan, John P Newnham
BACKGROUND: Detection of Ureaplasma, Mycoplasma and Candida spp. in the vagina during pregnancy has previously been associated with preterm birth (PTB). However, the prevalence of these microorganisms and the associated obstetric risks (likely to be population-specific) have not been determined in Australian women; furthermore, in the case of Ureaplasma spp., very few studies have attempted characterisation at the species level and none have examined genotype/serovar status to further refine risk assessment...
October 18, 2016: BMC Pregnancy and Childbirth
J Hu, P Z Zheng, L R Zhu
OBJECTIVE: To analyze the risk and prognostic of patients with stage IB1 cervical adenocarcinoma. METHODS: The clinical data of 139 patients with stage IB1 cervical adenocarcinoma treated at Department of Gynecology and Obstetrics in Peking University First Hospital from August 1994 to April 2015 were retrospectively reviewed, which included 38 cases of cervical adenocarcinoma and 101 cases of cervical squamous cell carcinoma. A comparison was made between ovarian preserving group and bilateral oophorectomy group, in order to justify the risk and prognosis of ovarian preserving patients...
October 18, 2016: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
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
Xiang Kong, Yan Kong, Fangyuan Zhang, Tingting Wang, Jin Yan
BACKGROUND: Intrahepatic cholestasis of pregnancy (ICP) is a specific pregnancy-related disorder without standard medical therapies. Ursodeoxycholic acid (UDCA) is the most used medicine, but the efficacy and safety of UDCA remain uncertain. Several meta-analyses had been made to assess the effects of UDCA in ICP. However, the samples were not large enough to convince obstetricians to use UDCA. We conducted a meta-analysis to evaluate the effects and safety of UDCA in patients with ICP, which included only randomized controlled trials (RCTs)...
October 2016: Medicine (Baltimore)
Wen Tang, Yi Mu, Xiaohong Li, Yanping Wang, Zheng Liu, Qi Li, Mingrong Li, Robert Scherpbier, Sufang Guo, Xiaona Huang, Leni Kang, Jun Zhu, Juan Liang
OBJECTIVE: This study aimed to identify new evidence about the burden and risk factors of low birthweight (LBW) in China using national facility-based data. METHODS: The association between sociodemographic and obstetric characteristics and LBW was examined using a multilevel model, taking into account the clustering of livebirths within hospitals and multiple gestations per woman. RESULTS: There were 3 915 965 deliveries and 235 247 cases born with LBW, producing a LBW rate of 5...
October 16, 2016: Journal of Maternal-fetal & Neonatal Medicine
Ronald Ching Wan Ma, Maria Ines Schmidt, Wing Hung Tam, Harold David McIntyre, Patrick M Catalano
The global epidemic of obesity has led to an increasing number of obese women of reproductive age. Obesity is associated with reduced fertility, and pregnancies complicated by maternal obesity are associated with adverse outcomes, including increased risk of gestational diabetes, pre-eclampsia, preterm birth, instrumental and caesarean births, infections, and post-partum haemorrhage. The medical and obstetric management of obese women is focused on identifying, addressing, and preventing some of these associated complications, and is a daunting challenge given the high percentage of patients with obesity and few therapeutic options proven to improve outcomes in this population...
October 10, 2016: Lancet Diabetes & Endocrinology
Martha A Monson, Karen J Gibbons, M Sean Esplin, Michael W Varner, Tracy A Manuck
OBJECTIVE: To characterize subsequent pregnancy outcomes among women with a history of previable, preterm prelabor rupture of membranes (PROM) and assess factors associated with recurrent preterm birth. METHODS: This was a retrospective cohort study of women cared for with a history of one or more singleton pregnancy complicated by preterm PROM at less than 24 weeks of gestation between 2002 and 2013 who were cared for in two tertiary care health systems by a single group of maternal-fetal medicine specialists...
October 6, 2016: Obstetrics and Gynecology
Ľubica Argalášová, Ľudmila Ševčíková, Jana Jurkovičová, Jana Babjaková, Etela Janeková, Adrián Totka, Martin Šimko, Michael Weitzman
Environmental tobacco smoke (ETS) is one of the greatest and the most frequent environmental toxic exposures presenting a high risk to children and to their mothers as well. The aim of the study was to find determinants of the household ETS in the sample of pregnant women living in the household with smokers and to assess their physical and mental health. The survey was distributed to women being seen for follow-up at the obstetric/gynecology departments in hospitals and at gynecological out-patient departments in Bratislava, Slovakia...
October 14, 2016: Reviews on Environmental Health
Amy O'Donnell, Catherine McParlin, Stephen C Robson, Fiona Beyer, Eoin Moloney, Andrew Bryant, Jennifer Bradley, Colin Muirhead, Catherine Nelson-Piercy, Dorothy Newbury-Birch, Justine Norman, Emma Simpson, Brian Swallow, Laura Yates, Luke Vale
BACKGROUND: Nausea and vomiting in pregnancy (NVP) affects up to 85% of all women during pregnancy, but for the majority self-management suffices. For the remainder, symptoms are more severe and the most severe form of NVP - hyperemesis gravidarum (HG) - affects 0.3-1.0% of pregnant women. There is no widely accepted point at which NVP becomes HG. OBJECTIVES: This study aimed to determine the relative clinical effectiveness and cost-effectiveness of treatments for NVP and HG...
October 2016: Health Technology Assessment: HTA
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
Péter Mihalicza, György Csákány, Miklós Szabó
INTRODUCTION: Care provision for very low birth weight and very low gestational age newborns requires high level clinical preparedness. Appropriate care and care management reduce mortality. AIM: To present Hungarian and international outcomes and local regional differences characterizing neonatal care in 2006-2008, based on the results of the EuroHOPE study. METHOD: Hungarian data were created by linking the obstetrics registry with the financing database of the Health Insurance Fund...
October 2016: Orvosi Hetilap
Laura Oakley, Nicole Penn, Maria Pipi, Eugene Oteng-Ntim, Pat Doyle
OBJECTIVE: The objective of this study was to investigate whether moderately increased maternal age is associated with obstetric and neonatal outcome in a contemporary population, and to consider the possible role of co-morbidities in explaining any increased risk. STUDY DESIGN: Secondary analysis of routinely collected data from a large maternity unit in London, UK. Data were available on 51,225 singleton deliveries (≥22 weeks) occurring to women aged ≥20 between 2004 and 2012...
2016: PloS One
Louise T Day, Daniel Hruschka, Felicity Mussell, Eva Jeffers, Stacy L Saha, Shafiul Alam
BACKGROUND: Prior studies have shown that using uterotonics to augment or induce labor before arrival at comprehensive Emergency Obstetric and Neonatal Care (CEmONC) settings (henceforth, "outside uterotonics") may contribute to perinatal mortality in low- and middle-income countries. We estimate its effect on perinatal mortality in rural Bangladesh. METHODS: Using hospital records (23986 singleton term births, Jan 1, 2009-Dec 31, 2015) from rural Bangladesh, we use a logistic regression model to estimate the increased risk of perinatal death from uterotonics administered outside a CEmONC facility...
October 6, 2016: Reproductive Health
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