1
|
Yinger OS, Jones A, Fallin-Bennett K, Gibbs C, Farr RH. Family-Centered Care for LGBTQ+ Parents of Infants in the Neonatal Intensive Care Unit: An Integrative Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:615. [PMID: 38929195 PMCID: PMC11201882 DOI: 10.3390/children11060615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Having an infant in the Neonatal Intensive Care Unit (NICU) can disrupt parent well-being, the transition to parenthood, and the typical trajectories of infant and child health. For lesbian, gay, bisexual, transgender, queer, or other sexual and gender minority identity (LGBTQ+) parents, this stress may be compounded by health disparities and fear of stigma and discrimination; however, research is lacking about LGBTQ+ parents of infants in the NICU. OBJECTIVES The purpose of this integrative review was to better understand the experiences of LGBTQ+ parents of NICU infants, with a focus on experiences of stigma and discrimination, sources of strength and resilience, and provision of family-centered care. METHOD We searched EBSCOHost, ProQuest, Web of Science, and Google Scholar between 30 May 2023 and 18 September 2023 for empirical studies published in English in peer-reviewed scholarly journals in which LGBTQ+ parents shared their experiences with having infants admitted to the NICU. RESULTS We identified six articles that met inclusion criteria, all of which were qualitative studies that included 12-14 LGBTQ+ parents of NICU infants. CONCLUSIONS LGBTQ+ parents in all studies reported instances of perceived stigma and discrimination while their infants were in the NICU, whereas parents in two studies mentioned strength and resilience, and parents in three studies described elements of family-centered care. There is a need for rigorous research on family-centered NICU care that includes questions about sources of strength and resilience in addition to challenges. We propose that future researchers use community engaged methods to center perspectives of LGBTQ+ parents.
Collapse
Affiliation(s)
- Olivia Swedberg Yinger
- School of Music, College of Fine Arts, University of Kentucky, Lexington, KY 40506, USA;
| | - Aubrey Jones
- College of Social Work, University of Kentucky, Lexington, KY 40506, USA;
| | - Keisa Fallin-Bennett
- Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY 40536, USA;
| | - Chelsea Gibbs
- School of Music, College of Fine Arts, University of Kentucky, Lexington, KY 40506, USA;
| | - Rachel H. Farr
- Department of Psychology, College of Arts and Sciences, University of Kentucky, Lexington, KY 40506, USA;
| |
Collapse
|
2
|
Woodward K, Cornish RP, Gale C, Johnson S, Knight M, Kurinczuk J, Chakkarapani E. Effect of SARS-CoV-2 infection in neonates or in pregnancy on developmental outcomes at 21-24 months (SINEPOST): study protocol for a prospective cohort study. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001571. [PMID: 36645759 PMCID: PMC9485650 DOI: 10.1136/bmjpo-2022-001571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/29/2022] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Exposure to SARS-CoV-2 during pregnancy or in the neonatal period may impact fetal or neonatal brain development either through direct central nervous system infection or indirectly through the adverse effects of viral infection-related inflammation in the mother or newborn infant. This study aims to determine whether there are early neurodevelopmental effects of SARS-CoV-2 infection. METHODS AND ANALYSIS We will conduct a prospective national population-based cohort study of children aged 21-24 months who were born at term (≥37 weeks' gestation) between 1 March 2020 and 28 February 2021 and were either antenatally exposed, neonatally exposed or unexposed (comparison cohort) to SARS-CoV-2. Nationally, hospitals will identify and approach parents of children eligible for inclusion in the antenatally and neonatally exposed cohorts using information from the UK Obstetric Surveillance System (UKOSS) and British Paediatric Surveillance Unit (BPSU) national surveillance studies and will identify and approach eligible children for the comparison cohort through routine birth records. Parents will be asked to complete questionnaires to assess their child's development at 21-24 months of age. Outcome measures comprise the Ages and Stages Questionnaire, Third Edition (ASQ-3), Ages and Stages Questionnaire Social-Emotional, Second Edition (ASQ-SE-2), Liverpool respiratory symptoms questionnaire and questionnaire items to elicit information about healthcare usage. With parental consent, study data will be linked to routine health and education records for future follow-up. Regression models will compare ASQ-3 and ASQ-SE-2 scores and proportions, frequency of respiratory symptoms and healthcare usage between the exposed and comparison cohorts, adjusting for potential confounders. ETHICS AND DISSEMINATION Ethics approval was obtained from the London-Westminster Research Ethics Committee. Findings will be disseminated in scientific conference presentations and peer-reviewed publications. ISRCTN REGISTRATION NUMBER ISRCTN99910769.
Collapse
Affiliation(s)
- Kathryn Woodward
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rosie P Cornish
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Marian Knight
- NHIR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jenny Kurinczuk
- NHIR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ela Chakkarapani
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
3
|
Abdollahpour S, Heydari A, Ebrahimipour H, Faridhoseini F, Khadivzadeh T. Mothering sweetness mixed with the bitterness of death: the lived mothering experience of near-miss mothers. J Psychosom Obstet Gynaecol 2022; 43:128-135. [PMID: 33103539 DOI: 10.1080/0167482x.2020.1832076] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Maternal near miss (MNM) refers to women who survive death as a result of life-threatening obstetric complications or organ system dysfunction during pregnancy, childbirth or postpartum. The aim of the present study was to gain an understanding of mothering experiences in survivors 'mothers due maternal near miss event. MATERIALS AND METHODS Heideggerian hermeneutic phenomenology guided this qualitative study. The study was conducted 1 June and 30 December 2019. The sampling was purposeful with maximum variation of 11 near miss mother that used unstructured face-to-face interview for data collection. Data analyzed using Diekelmann, Allen, and Tanner seven stage thematic analysis approach. FINDINGS Emergent theme was "mothering sweetness mixed with the bitterness of death." The two themes constituting the essence was: "An Angel with Broken Wings" and "Mothering in the Shadow of Death." The subthemes comprised five sub-sub themes which emerged from over 850 meaning units. Data were analyzed using MAXQDA10 software. CONCLUSION Maternal health providers need to know that it is not enough only to focus on saving the mother's physical life. While strengthening the role of mothering is essential element to support near-miss mothers who have experienced difficult physical and psychological conditions. The "beyond numbers" concept, implies that it is not enough only to focus on saving the mother's physical life. Removing barriers in order to achieve to early mothering, can have a significant impact on reducing the psychological burden of MNM events.
Collapse
Affiliation(s)
- Sedigheh Abdollahpour
- Reproductive Health, Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Heydari
- School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hosein Ebrahimipour
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farhad Faridhoseini
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Talat Khadivzadeh
- Reproductive Health, Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
4
|
|
5
|
Byrd TE, Ingram LA, Okpara N. Examination of maternal near-miss experiences in the hospital setting among Black women in the United States. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221133830. [PMID: 36325622 PMCID: PMC9638691 DOI: 10.1177/17455057221133830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 09/17/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The high rate of maternal mortality among Black women in the United States continues to gain attention; yet research has not yet fully illuminated the precursors to these events, most impactful among them being "maternal near misses." A maternal near miss occurs when a woman nearly dies but survives a complication that occurred during pregnancy, childbirth, or within 42 days of termination of pregnancy. Researchers have focused on reviewing patient medical records after sentinel maternal events to help determine major contributors to them; however, qualitative studies with near-miss survivors, especially among Black women, may be a more useful approach. METHODS Using a qualitative methodology, we conducted semi-structured interviews with 12 Black women to explore how they perceived the care provided to them during their near-miss experiences. Our study also employed a phenomenology framework to understand the lived experience of Black women who had a maternal near miss in the context of a hospital setting. RESULTS We interviewed 12 women between October 2020 and March 2021. All participants had a maternal near miss between the years 2010 and 2020 and were aged between 19 and 41 years when they had their near-miss experience. These women identified communication, patient-provider relationship, skills/competency of staff, provider discrimination, systems issues, and emotional distress as major contributors to their experiences. CONCLUSION Maternal near misses serve as a precursor to maternal mortality events. By listening to patients and their families recount their perspectives on what leads up to these near misses, we can unearth valuable lessons that can aid in the development of strategies and interventions to decrease the numbers of pregnancy-related deaths; especially among Black women who suffer disproportionately from maternal morbidity and mortality. Based on these findings, we recommend that hospitals and OB-GYN practices consider the unique predispositions of their Black patients; account for their own personal biases, revisit the near-miss experiences of past patients to keep patients central to care and build rapport between patients and hospital birthing support staff; and center discussions about improvements in care around racist structures and systems.
Collapse
Affiliation(s)
- Tiffany E Byrd
- Department of Health Promotion, Education, and
Behavior, Arnold School of Public Health, University of South Carolina,
Columbia, SC, USA
| | - Lucy A Ingram
- Department of Health Promotion, Education, and
Behavior, Arnold School of Public Health, University of South Carolina,
Columbia, SC, USA
| | - Nkechi Okpara
- Department of Health Promotion, Education, and
Behavior, Arnold School of Public Health, University of South Carolina,
Columbia, SC, USA
| |
Collapse
|
6
|
Abdollahpour S, Heydari A, Ebrahimipour H, Faridhoseini F, Heidarian Miri H, Khadivzadeh T. Postpartum depression in women with maternal near miss: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2021; 35:5489-5495. [PMID: 33588679 DOI: 10.1080/14767058.2021.1885024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND postpartum depression (PPD) is one of the psychological complications of mothers who have experienced severe maternal morbidity/maternal near miss (SMM/MNM) which can adversely affect the wellbeing of mothers, new born infants and other family members, but the risk level in this group is unclear. Therefore, we did a meta-analysis to ascertain the relationship PPD with MNM/SMM. MATERIAL AND METHODS The authors searched relevant studies in databases (Web of Science, PubMed, EMBASE, Clinikalkey, Scopus).The summary odds ratio (OR) along with 95% confidence interval (CI) was calculated by use of random or fixed effects models. RESULTS Four studies were included in qualitative synthesis. The pooled analysis revealed that PPD was significantly associated with an increased risk of MNM/SMM (OR = 1.83; 95% CI 1.37-2.44, p = 0.027). CONCLUSION The results show that the risk of PPD in the MNM mothers are twice as likely as women without MNM. Therefore, more attention should be paid to psychological symptoms such as depression in MNM in order to reduce the long-term burden of maternal morbidity.
Collapse
Affiliation(s)
- Sedigheh Abdollahpour
- Department of Reproductive Health, Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Heydari
- Department of Nursing, School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hosein Ebrahimipour
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farhad Faridhoseini
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Heidarian Miri
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Talat Khadivzadeh
- Department of Reproductive Health, Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
7
|
Kennedy HP, Balaam MC, Dahlen H, Declercq E, de Jonge A, Downe S, Ellwood D, Homer CSE, Sandall J, Vedam S, Wolfe I. The role of midwifery and other international insights for maternity care in the United States: An analysis of four countries. Birth 2020; 47:332-345. [PMID: 33124095 DOI: 10.1111/birt.12504] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/12/2020] [Accepted: 08/24/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND The United States (US) spends more on health care than any other high-resource country. Despite this, their maternal and newborn outcomes are worse than all other countries with similar levels of economic development. Our purpose was to describe maternal and newborn outcomes and organization of care in four high-resource countries (Australia, Canada, the Netherlands, and United Kingdom) with consistently better outcomes and lower health care costs, and to identify opportunities for emulation and improvement in the United States. METHOD We examined resources that described health care organization and financing, provider types, birth settings, national, clinical guidelines, health care policies, surveillance data, and information for consumers. We conducted interviews with country stakeholders representing the disciplines of obstetrics, midwifery, pediatrics, neonatology, epidemiology, sociology, political science, public health, and health services. The results of the analysis were compared and contrasted with the US maternity system. RESULTS The four countries had lower rates of maternal mortality, low birthweight, and newborn and infant death than the United States. Five commonalities were identified as follows: (1) affordable/ accessible health care, (2) a maternity workforce that emphasized midwifery care and interprofessional collaboration, (3) respectful care and maternal autonomy, (4) evidence-based guidelines on place of birth, and (5) national data collections systems. CONCLUSIONS The findings reveal marked differences in the other countries compared to the United States. It is critical to consider the evidence for improved maternal and newborn outcomes with different models of care and to examine US cultural and structural failures that are leading to unacceptable and substandard maternal and infant outcomes.
Collapse
Affiliation(s)
| | - Marie-Clare Balaam
- School of Community Health and Midwifery, Research in Childbirth and Health Unit (REACH) Group, University of Central Lancashire, Lancashire, UK
| | - Hannah Dahlen
- School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia
| | - Eugene Declercq
- Department of Obstetrics & Gynecology, School of Public Health, Boston University, Boston, MA, USA
| | - Ank de Jonge
- Amsterdam University Medical Center, VU University Amsterdam, Amsterdam, The Netherlands.,Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam, The Netherlands
| | - Soo Downe
- School of Community Health and Midwifery, Research in Childbirth and Health Unit (REACH) Group, University of Central Lancashire, Lancashire, UK
| | - David Ellwood
- Department of Obstetrics & Gynaecology, Griffith University School of Medicine, Brisbane, QLD, Australia
| | - Caroline S E Homer
- Burnet Institute, Global Women's & Newborns Working Group, Melbourne, VIC, Australia
| | | | - Saraswathi Vedam
- Birth Place Lab, University of British Columbia, Vancouver, BC, Canada
| | - Ingrid Wolfe
- Kings College London, London, UK.,Children & Young People's Health Partnership, London, UK.,Child Public Health at Evelina London Children's Healthcare, London, UK
| |
Collapse
|
8
|
Abdollahpour S, Heydari A, Ebrahimipour H, Faridhosseini F, Khadivzadeh T. The Needs of Women Who Have Experienced "Maternal Near Miss": A Systematic Review of Literature. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2019; 24:417-427. [PMID: 31772915 PMCID: PMC6875890 DOI: 10.4103/ijnmr.ijnmr_77_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 09/02/2019] [Accepted: 09/16/2019] [Indexed: 12/14/2022]
Abstract
Background: Maternal Near Miss (MNM) event is associated with emotional, psychological, and social effects on women. Determining the needs of women with these experiences is the key to programming for providing high-quality care and reducing its burden. Hence, this study was conducted to determine the needs of women who have experienced MNM. Materials and Methods: In this literature systematic review, to achieve the intended information, articles published in Web of Science and PubMed databases were systematically searched. The search strategy focused on three keywords or phrases: “maternal morbidity“ OR “maternal near miss“ AND “needs.“ Publication date was all relevant articles before 2019, and publication language was restricted to English. Article search was conducted by two independent reviewers. After the primary search, 2140 articles were found. Eventually, 77 articles, including 20 qualitative studies and 57 quantitative studies, were enrolled for final evaluation. Results: According to the results, the needs of these women could be categorized into six groups of “Management and care needs of health system,“ “Educational needs of health system,“ “Follow up and continuity of care at the primary care level,“ “Need to develop a physical, psychological and social of care packages,“ “Social support,“ and “Psychosocial support and counseling.“ Conclusions: The near-miss events change the mothers' living conditions, and therefore, they need to receive special support, given the difficult conditions they are undergoing. It is necessary that a supportive program be designed to follow-up MNM after the discharge to be run by the primary care team.
Collapse
Affiliation(s)
- Sedigheh Abdollahpour
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Heydari
- School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran,, Iran
| | - Hosein Ebrahimipour
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farhad Faridhosseini
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Talat Khadivzadeh
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
9
|
Knight M, Chiocchia V, Partlett C, Rivero-Arias O, Hua X, Bowler U, Gray J, Gray S, Hinshaw K, Khunda A, Moore P, Mottram L, Owino N, Pasupathy D, Sanders J, Sultan AH, Thakar R, Tuffnell D, Linsell L, Juszczak E. Intravenous co-amoxiclav to prevent infection after operative vaginal delivery: the ANODE RCT. Health Technol Assess 2019; 23:1-54. [PMID: 31590702 DOI: 10.3310/hta23540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Sepsis is a leading cause of direct and indirect maternal death in both the UK and globally. All forms of operative delivery are associated with an increased risk of sepsis, and the National Institute for Health and Care Excellence's guidance recommends the use of prophylactic antibiotics at all caesarean deliveries, based on substantial randomised controlled trial evidence of clinical effectiveness. A Cochrane review, updated in 2017 (Liabsuetrakul T, Choobun T, Peeyananjarassri K, Islam QM. Antibiotic prophylaxis for operative vaginal delivery. Cochrane Database Syst Rev 2017;8:CD004455), identified only one small previous trial of prophylactic antibiotics following operative vaginal birth (forceps or ventouse/vacuum extraction) and, given the small study size and extreme result, suggested that further robust evidence is needed. OBJECTIVES To investigate whether or not a single dose of prophylactic antibiotic following operative vaginal birth is clinically effective for preventing confirmed or presumed maternal infection, and to investigate the associated impact on health-care costs. DESIGN A multicentre, randomised, blinded, placebo-controlled trial. SETTING Twenty-seven maternity units in the UK. PARTICIPANTS Women who had an operative vaginal birth at ≥ 36 weeks' gestation, who were not known to be allergic to penicillin or constituents of co-amoxiclav and who had no indication for ongoing antibiotics. INTERVENTIONS A single dose of intravenous co-amoxiclav (1 g of amoxicillin/200 mg of clavulanic acid) or placebo (sterile saline) allocated through sealed, sequentially numbered, indistinguishable packs. MAIN OUTCOME MEASURES Primary outcome - confirmed or suspected infection within 6 weeks of giving birth. Secondary outcomes - severe sepsis, perineal wound infection, perineal pain, use of pain relief, hospital bed stay, hospital/general practitioner visits, need for additional perineal care, dyspareunia, ability to sit comfortably to feed the baby, maternal general health, breastfeeding, wound breakdown, occurrence of anaphylaxis and health-care costs. RESULTS Between March 2016 and June 2018, 3427 women were randomised: 1719 to the antibiotic arm and 1708 to the placebo arm. Seven women withdrew, leaving 1715 women in the antibiotic arm and 1705 in the placebo arm for analysis. Primary outcome data were available for 3225 out of 3420 women (94.3%). Women randomised to the antibiotic arm were significantly less likely to have confirmed or suspected infection within 6 weeks of giving birth (180/1619, 11%) than women randomised to the placebo arm (306/1606, 19%) (relative risk 0.58, 95% confidence interval 0.49 to 0.69). Three serious adverse events were reported: one in the placebo arm and two in the antibiotic arm (one was thought to be causally related to the intervention). LIMITATIONS The follow-up rate achieved for most secondary outcomes was 76%. CONCLUSIONS This trial has shown clear evidence of benefit of a single intravenous dose of prophylactic co-amoxiclav after operative vaginal birth. These results may lead to reconsideration of official policy/guidance. Further analysis of the mechanism of action of this single dose of antibiotic is needed to investigate whether earlier, pre-delivery or repeated administration could be more effective. Until these analyses are completed, there is no indication for administration of more than a single dose of prophylactic antibiotic, or for pre-delivery administration. TRIAL REGISTRATION Current Controlled Trials ISRCTN11166984. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 54. See the National Institute for Health Research Journals Library website for further project information.
Collapse
Affiliation(s)
- Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Virginia Chiocchia
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Christopher Partlett
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Xinyang Hua
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ursula Bowler
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - James Gray
- Department of Microbiology, Birmingham Women's & Children's NHS Foundation Trust, Birmingham, UK
| | - Shan Gray
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kim Hinshaw
- Department of Obstetrics and Gynaecology, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK.,Faculty of Health Sciences, University of Sunderland, Sunderland, UK
| | - Aethele Khunda
- Department of Women's Health, James Cook University Hospital, Middlesbrough, UK
| | - Philip Moore
- Department of Microbiology, Birmingham Women's & Children's NHS Foundation Trust, Birmingham, UK
| | - Linda Mottram
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nelly Owino
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Dharmintra Pasupathy
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, King's Health Partners, London, UK
| | - Julia Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK.,Department of Women's Health, Cardiff and Vale University Health Board, Cardiff, UK
| | - Abdul H Sultan
- Department of Obstetrics and Gynaecology, Croydon University Hospital, Croydon, UK
| | - Ranee Thakar
- Department of Obstetrics and Gynaecology, Croydon University Hospital, Croydon, UK
| | - Derek Tuffnell
- Department of Women's Health, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Louise Linsell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Edmund Juszczak
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| |
Collapse
|
10
|
Pregnancy-Related ICU Admissions From 2008 to 2016 in China: A First Multicenter Report. Crit Care Med 2019; 46:e1002-e1009. [PMID: 30059363 PMCID: PMC6147102 DOI: 10.1097/ccm.0000000000003355] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objectives: To identify the key points for improving severe maternal morbidity by analyzing pregnancy-related ICU admissions in Beijing. Design: This was a retrospective, multicenter cohort study. Setting: Three ICUs in tertiary hospitals in Beijing. Patients: A total of 491 severe maternal cases in any trimester of pregnancy or within 42 days of delivery were reviewed between January 1, 2008, and December 31, 2016. Interventions: None. Measurements and Main Results: Among 491 obstetric ICU admissions (median Sequential Organ Failure Assessment score, 2) out of 87,850 hospital deliveries (a frequency of 5.6 admissions per 1,000 deliveries), the leading diagnoses were postpartum hemorrhage (170; 34.62%), hypertensive disorders of pregnancy (156; 31.77%), and cardio-cerebrovascular diseases (78; 15.9%). Comparing 2008–2011 to 2012–2016, the rates of maternal mortality (2.5% vs 1.9%; p = 0.991) and fetal loss (8.5% vs 8.6%; p = 0.977) did not decrease significantly, whereas the rates of ICU admission (3.05% vs 7.85%; p trends < 0.001) and postpartum hemorrhage (23% vs 38.5%; p = 0.002) increased. Hypertensive disorder (150/156; 96.2% transferred to the ICU postpartum, 24/28 women with fetal loss transferred from lower-level hospitals) was an independent maternal factor associated with fetal loss, and infections were the leading cause of maternal death (6/10) in the ICU. Conclusions: Our study highlights the increasing rate of intensive care admissions for postpartum hemorrhage. Improving prenatal care quality for pregnancy-induced hypertension and sepsis at lower-level hospitals may improve maternal and fetal outcomes. Specifically, providing more effective regional cooperation before transfer and shifting patients who require continuous surveillance but not necessarily intensive care to a transitional ward in a tertiary hospital would provide more ICU beds for more prenatal intensive care for the most complex medical conditions.
Collapse
|
11
|
Lawton BA, Jane MacDonald E, Stanley J, Daniells K, Geller SE. Preventability review of severe maternal morbidity. Acta Obstet Gynecol Scand 2019; 98:515-522. [DOI: 10.1111/aogs.13526] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 12/19/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Beverley A. Lawton
- Center for Women's Health Research; Te Tātai Hauora O Hine Faculty of Health; Victoria University of Wellington; Wellington New Zealand
| | - E. Jane MacDonald
- Center for Women's Health Research; Te Tātai Hauora O Hine Faculty of Health; Victoria University of Wellington; Wellington New Zealand
| | - James Stanley
- Dean's Department; University of Otago; Wellington New Zealand
| | - Karen Daniells
- Hutt Valley District Heath Board; Lower Hutt New Zealand
| | - Stacie E. Geller
- Department of Obstetrics and Gynecology; University of Illinois; Chicago IL USA
| |
Collapse
|
12
|
Lee HJ, Cho HY, Peck MJ, Ki HJ, Moon MJ, Kim HC, Jang SW, Kim YR. Uterine artery embolization versus cesarean hysterectomy in the management of postpartum hemorrhage. MINIM INVASIV THER 2019; 28:351-358. [DOI: 10.1080/13645706.2018.1562943] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Hyun Jung Lee
- Department of Obstetrics and Gynecology, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Hee Young Cho
- Department of Obstetrics and Gynecology, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Min Joo Peck
- Department of Obstetrics and Gynecology, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Hyo Jin Ki
- Department of Obstetrics and Gynecology, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Myoung Jin Moon
- Department of Obstetrics and Gynecology, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Hyeon Chul Kim
- Department of Obstetrics and Gynecology, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Sung Woon Jang
- Department of Obstetrics and Gynecology, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Young Ran Kim
- Department of Obstetrics and Gynecology, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
| |
Collapse
|
13
|
Liu Z, Wang Y, Yan J, Li J, Liu X, Zhang L, Cheng L. Uterine artery embolization versus hysterectomy in the treatment of refractory postpartum hemorrhage: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2018; 33:693-705. [PMID: 30354858 DOI: 10.1080/14767058.2018.1497599] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Introduction: We carried out a systematic review and meta-analysis to assess the safety and effectiveness of uterine artery embolization (UAE) compared with conventional hysterectomy on refractory postpartum hemorrhage (PPH).Methods: We searched PubMed, Embase, Chinese National Knowledge Infrastructure database (CNKI), Cochrane Library, and Wanfang database through October 2017 for randomized controlled trials (RCTs) and observational studies assessing the safety and effectiveness of UAE compared with hysterectomy on refractory PPH. The main outcome measures included the blood loss, operating time, hemostatic effective rate, and length of stay.Results: Six RCTs and nine observational studies were included in the meta-analysis, which involved 1142 women with refractory PPH. The results demonstrated that UAE was more beneficial on refractory PPH compared with hysterectomy using four scales: blood loss (WMD 893.39 mL; 95% CI: -1205.65, -581.13; p < .001); operating time (WMD -37.19 minutes; 95% CI: -44.42, -29.96; p < .001); length of stay (WMD -5.36 days; 95% CI: -5.76, -4.97; p < .001), hemostatic effective rate (OR 1.58, 95% CI: 0.80, 3.12, p = .184) .Conclusions: In the present meta-analysis, the positive findings suggest UAE has beneficial effects on refractory PPH. UAE significantly reduced blood loss, shortened the operating time, and length of stay compared with hysterectomy. And there is no difference between the UAE group and hysterectomy group in hemostatic effective rate. However, those findings should be treated with caution because of heterogeneity and potential biases.
Collapse
Affiliation(s)
- ZhiRong Liu
- Department of General Surgery, Second People's Hospital of Chengdu, Chengdu, China
| | - Yaxuan Wang
- Department of Medical Imaging, Chengdu Medical College, Chengdu, China
| | - Jingxin Yan
- Department of Medical Imaging, Chengdu Medical College, Chengdu, China
| | - Juan Li
- Department of Pathology and Pathophysiology, Chengdu Medical College, Chengdu, China
| | - XinLian Liu
- Department of Pathology and Pathophysiology, Chengdu Medical College, Chengdu, China
| | - LuShun Zhang
- Department of Pathology and Pathophysiology, Chengdu Medical College, Chengdu, China.,Development and Regeneration Key Laboratory of Sichuan Province, Collaborative Innovation Center of Sichuan for Elderly Care and Health, Chengdu Medical College, Chengdu, China
| | - Li Cheng
- School of Basic Medical Sciences, Chengdu Medical College, Chengdu, China
| |
Collapse
|
14
|
Edwards Z, Lucas DN, Gauntlett R. Is training in obstetric critical care adequate? An international comparison. Int J Obstet Anesth 2018; 37:96-105. [PMID: 30482716 DOI: 10.1016/j.ijoa.2018.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 07/17/2018] [Accepted: 08/29/2018] [Indexed: 01/18/2023]
Abstract
Obstetric critical care is an emerging discipline which cuts across speciality boundaries. We have analysed the training curricula in the three major specialities (obstetrics, anaesthesia and intensive care medicine) likely to be involved in the care of the critically-ill obstetric patient, to assess whether it is adequate to ensure effective training on this subject.
Collapse
Affiliation(s)
- Z Edwards
- Department of Anaesthetics, Northwick Park Hospital, Harrow, United Kingdom.
| | - D N Lucas
- Department of Anaesthetics, Northwick Park Hospital, Harrow, United Kingdom
| | - R Gauntlett
- Department of Anaesthetics, Royal Victoria Infirmary, Newcastle, United Kingdom
| |
Collapse
|
15
|
Fan D, Wu S, Ye S, Wang W, Wang L, Fu Y, Zeng M, Liu Y, Guo X, Liu Z. Random placenta margin incision for control hemorrhage during cesarean delivery complicated by complete placenta previa: a prospective cohort study. J Matern Fetal Neonatal Med 2018; 32:3054-3061. [PMID: 29577780 DOI: 10.1080/14767058.2018.1457638] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Introduction: Complete placenta previa (CPP) is one of the most problematic types of abnormal placenta, which is further complicated by placenta accreta or percreta that can unexpectedly lead to catastrophic blood loss, infection, multiple complications, emergency hysterectomy, and even death. The present study aimed to assess the efficacy of random placenta margin incision in controlling intraoperative and total blood loss during cesarean section for CPP women. Methods: A prospective cohort study, including a total of 100 consecutive pregnant women with CPP, was performed at a tertiary university-affiliated medical center between March 2016 and July 2017. All of them underwent random placenta margin incision, and intraoperative and total blood loss were analyzed. Through antenatal diagnosis using color Doppler, women were further divided into abnormally invasive placenta (AIP) and non-AIP groups, and anterior and posterior placenta groups. The protocol was registered with the Clinical Trial Registry under registration number NCT02695069. Results: Mean maternal age and gestational age at delivery were 32.26 ± 5.03 years old and 36.21 ± 2.07 weeks, respectively. Total duration of the surgical procedure time was 52.50 (42.43-64.00) min. Median estimated intraoperation blood loss was 746.43 (544.44-1092.86) ml. Total blood loss was 875.00 (604.50-1196.67) ml, and 38 (38.0%) had post-partum hemorrhage. The change from baseline in the median hemoglobin level was -0.33 (6.00-13.20). No women underwent hysterectomy due to massive hemorrhage during the study period. No women had an intraoperative urinary bladder injury, postoperative wound infection, and required relaparotomy, owing to intra-abdominal bleeding. The median hospitalization time was 5.41 (4.18-7.58) d. Conclusion: The random placenta margin incision may be a potentially valuable surgical procedure to control the volumes of intraoperative and postoperative blood loss and reduce the incidence of postpartum hemorrhage among women with complete placenta previa.
Collapse
Affiliation(s)
- Dazhi Fan
- a Foshan Institute of Fetal Medicine , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China.,b Department of Obstetrics , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China.,c Department of Epidemiology & Biostatistics, School of Public Health , Anhui Medical University , Hefei , China
| | - Shuzhen Wu
- a Foshan Institute of Fetal Medicine , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China.,b Department of Obstetrics , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China
| | - Shaoxin Ye
- a Foshan Institute of Fetal Medicine , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China.,b Department of Obstetrics , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China
| | - Wen Wang
- b Department of Obstetrics , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China
| | - Lijuan Wang
- b Department of Obstetrics , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China
| | - Yao Fu
- b Department of Obstetrics , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China
| | - Meng Zeng
- b Department of Obstetrics , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China
| | - Yan Liu
- b Department of Obstetrics , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China
| | - Xiaoling Guo
- a Foshan Institute of Fetal Medicine , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China.,b Department of Obstetrics , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China
| | - Zhengping Liu
- a Foshan Institute of Fetal Medicine , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China.,b Department of Obstetrics , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China
| |
Collapse
|
16
|
Ayala Quintanilla BP, Pollock WE, McDonald SJ, Taft AJ. Impact of violence against women on severe acute maternal morbidity in the intensive care unit, including neonatal outcomes: a case-control study protocol in a tertiary healthcare facility in Lima, Peru. BMJ Open 2018; 8:e020147. [PMID: 29540421 PMCID: PMC5857655 DOI: 10.1136/bmjopen-2017-020147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 02/12/2018] [Accepted: 02/22/2018] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Preventing and reducing violence against women (VAW) and maternal mortality are Sustainable Development Goals. Worldwide, the maternal mortality ratio has fallen about 44% in the last 25 years, and for one maternal death there are many women affected by severe acute maternal morbidity (SAMM) requiring management in the intensive care unit (ICU). These women represent the most critically ill obstetric patients of the maternal morbidity spectrum and should be studied to complement the review of maternal mortality. VAW has been associated with all-cause maternal deaths, and since many women (30%) endure violence usually exerted by their intimate partners and this abuse can be severe during pregnancy, it is important to determine whether it impacts SAMM. Thus, this study aims to investigate the impact of VAW on SAMM in the ICU. METHODS AND ANALYSIS This will be a prospective case-control study undertaken in a tertiary healthcare facility in Lima-Peru, with a sample size of 109 cases (obstetric patients admitted to the ICU) and 109 controls (obstetric patients not admitted to the ICU selected by systematic random sampling). Data on social determinants, medical and obstetric characteristics, VAW, pregnancy and neonatal outcome will be collected through interviews and by extracting information from the medical records using a pretested form. Main outcome will be VAW rate and neonatal mortality rate between cases and controls. VAW will be assessed by using the WHO instrument. Binary logistic followed by stepwise multivariate regression and goodness of fit test will assess any association between VAW and SAMM. ETHICS AND DISSEMINATION Ethical approval has been granted by the La Trobe University, Melbourne-Australia and the tertiary healthcare facility in Lima-Peru. This research follows the WHO ethical and safety recommendations for research on VAW. Findings will be presented at conferences and published in peer-reviewed journals.
Collapse
Affiliation(s)
- Beatriz Paulina Ayala Quintanilla
- The Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- Mercy Hospital for Women, Melbourne, Victoria, Australia
- Peruvian National Institute of Health, Lima, Peru
| | - Wendy E Pollock
- The Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- Mercy Hospital for Women, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Susan J McDonald
- The Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Angela J Taft
- The Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| |
Collapse
|
17
|
Schaap T, Bloemenkamp K, Deneux-Tharaux C, Knight M, Langhoff-Roos J, Sullivan E, van den Akker T. Defining definitions: a Delphi study to develop a core outcome set for conditions of severe maternal morbidity. BJOG 2017; 126:394-401. [PMID: 28755459 DOI: 10.1111/1471-0528.14833] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Develop a core outcome set of international consensus definitions for severe maternal morbidities. DESIGN Electronic Delphi study. SETTING International. POPULATION Eight expert panels. METHODS All 13 high-income countries represented in the International Network of Obstetric Surveillance Systems (INOSS) nominated five experts per condition of morbidity, who submitted possible definitions. From these suggestions, a steering committee distilled critical components: eclampsia: 23, amniotic fluid embolism: 15, pregnancy-related hysterectomy: 11, severe primary postpartum haemorrhage: 19, uterine rupture: 20, abnormally invasive placentation: 12, spontaneous haemoperitoneum in pregnancy: 16, and cardiac arrest in pregnancy: 10. These components were assessed by the expert panel using a 5-point Likert scale, following which a framework for an encompassing definition was constructed. Possible definitions were evaluated in rounds until a rate of agreement of more than 70% was reached. Expert commentaries were used in each round to improve definitions. MAIN OUTCOME MEASURES Definitions with a rate of agreement of more than 70%. RESULTS The invitation to participate in one or more of eight Delphi processes was accepted by 103 experts from 13 high-income countries. Consensus definitions were developed for all of the conditions. CONCLUSION Consensus definitions for eight morbidity conditions were successfully developed using the Delphi process. These should be used in national registrations and international studies, and should be taken up by the Core Outcomes in Women's and Newborn Health initiative. TWEETABLE ABSTRACT Consensus definitions for eight morbidity conditions were successfully developed using the Delphi process.
Collapse
Affiliation(s)
- T Schaap
- Department of Obstetrics, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - K Bloemenkamp
- Department of Obstetrics, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - C Deneux-Tharaux
- Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - M Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - J Langhoff-Roos
- Department of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - E Sullivan
- Australian Centre for Public and Population Health Research Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - T van den Akker
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.,Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | | |
Collapse
|
18
|
Okada A, Nakamoto O, Komori M, Arimoto H, Rinka H, Nakamura H. Resuscitative endovascular balloon occlusion of the aorta as an adjunct for hemorrhagic shock due to uterine rupture: a case report. Clin Case Rep 2017; 5:1565-1568. [PMID: 29026545 PMCID: PMC5628233 DOI: 10.1002/ccr3.1126] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/08/2017] [Accepted: 07/21/2017] [Indexed: 11/17/2022] Open
Abstract
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a life‐saving procedure used to control bleeding and maintain blood pressure temporarily in traumatic hemorrhagic shock. Uterine rupture and placenta accreta provoke uncontrollable massive hemorrhaging. REBOA may be useful for hemodynamic stabilization to prevent cardiac arrest in high‐risk pregnancy.
Collapse
Affiliation(s)
- Asami Okada
- Department of Obstetrics and Gynecology Osaka City General Hospital 2-13-22 Miyakojimahondori Miyakojima-ku Osaka Japan
| | - Osamu Nakamoto
- Department of Obstetrics and Gynecology Osaka City General Hospital 2-13-22 Miyakojimahondori Miyakojima-ku Osaka Japan
| | - Maya Komori
- Department of Obstetrics and Gynecology Osaka City General Hospital 2-13-22 Miyakojimahondori Miyakojima-ku Osaka Japan
| | - Hideki Arimoto
- Department of Emergency and Critical Care Medical Center Osaka City General Hospital 2-13-22 Miyakojimahondori Miyakojima-ku Osaka Japan
| | - Hiroshi Rinka
- Department of Emergency and Critical Care Medical Center Osaka City General Hospital 2-13-22 Miyakojimahondori Miyakojima-ku Osaka Japan
| | - Hiroaki Nakamura
- Department of Obstetrics and Gynecology Osaka City General Hospital 2-13-22 Miyakojimahondori Miyakojima-ku Osaka Japan
| |
Collapse
|
19
|
|