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Abstract
OBJECTIVE Adenomyosis is a benign uterine disorder characterized by the invasion of the endometrium within the myometrium, starting from the junctional zone (JZ), the inner hormone dependent layer of the myometrium that plays an important role in sperm transport, implantation and placentation. The resulting histological abnormalities and functional defects may represent the pathogenic substrate for infertility and pregnancy complications. The objective of this paper is to review the literature to evaluate the correlation between inner myometrium alterations and infertility and to assess the role of JZ in the origin of adverse obstetric outcomes of both spontaneous and in vitro fertilization (IVF) pregnancies. METHODS we searched Pubmed for all original and review articles in the English language from January1962 until December 2019, using the MeSH terms of 'adenomyosis', 'junctional zone', combined with 'infertility', 'obstetrical outcomes', 'spontaneous conception', 'in vitro fertilization' and 'classification'. The review was divided into three sections to assess this pathogenic correlation, evaluating also the importance of classification of the disease. RESULTS AND CONCLUSIONS Absent or incomplete remodeling of the JZ can affect uterine peristalsis, alter vascular plasticity of the spiral arteries and activate inflammatory pathways, all related to adverse obstetric outcomes. Despite these observations, there is still limited evidence whether adenomyosis is a cause of infertility. However, it is reasonable to screen patients for adenomyosis, to consider pregnant women with diffuse adenomyosis at high risk of adverse obstetric outcomes, and to evaluate the importance of a noninvasive validated classification in the management of women with adenomyosis.
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Affiliation(s)
- Chiara Barbanti
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Nassir Habib
- Department of Obstetrics and Gynaecology, Beaujon Hospital-University of Paris, Paris, France
| | - Luca Labanca
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Karolina Afors
- Department of Obstetrics and Gynaecology, Whittington Hospital, London, UK
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Andersen SL, Christensen PA, Knøsgaard L, Andersen S, Handberg A, Hansen AB, Vestergaard P. Classification of Thyroid Dysfunction in Pregnant Women Differs by Analytical Method and Type of Thyroid Function Test. J Clin Endocrinol Metab 2020; 105:5896598. [PMID: 32835377 DOI: 10.1210/clinem/dgaa567] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/17/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Physiological alterations challenge the assessment of maternal thyroid function in pregnancy. It remains uncertain how the reference ranges vary by week of pregnancy, and how the classification of disease varies by analytical method and type of thyroid function test. DESIGN Serum samples from Danish pregnant women (n = 6282) were used for the measurement of thyrotropin (TSH), total and free thyroxine (T4), total and free 3,5,3'-triiodothyronine (T3), and T-uptake using "Method A" (Cobas 8000, Roche Diagnostics). TSH and free T4 were also measured using "Method B" (ADVIA Centaur XP, Siemens Healthineers). MAIN OUTCOME MEASURES Pregnancy week- and method-specific reference ranges were established among thyroid antibody-negative women (n = 4612). The reference ranges were used to classify maternal thyroid function, and results were compared by analytical method and type of thyroid function test. RESULTS The reference ranges for TSH showed a gradual decrease during pregnancy weeks 4 to 14, a gradual increase was observed for total T4, total T3, and T-uptake, whereas free T4 and free T3 showed less variation. When TSH and free T4 were used, Method A classified 935 (14.9%) with abnormal thyroid function, Method B a total of 903 (14.4%), and the methods agreed on 554 individuals. When TSH and total T4 were used, 947 (15.1%) were classified with abnormal thyroid function, and classifications by either total T4 or free T4 agreed on 584 individuals. CONCLUSIONS Even when pregnancy week- and method-specific reference ranges were established, the classification of maternal thyroid dysfunction varied considerably by analytical method and type of thyroid function test.
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Affiliation(s)
- Stine Linding Andersen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Biochemistry, Viborg Regional Hospital, Viborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Peter Astrup Christensen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Louise Knøsgaard
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Stig Andersen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Geriatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Aase Handberg
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Annebirthe Bo Hansen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Vestergaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
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Doi L, Williams AJ, Marryat L, Frank J. Cohort study of high maternal body mass index and the risk of adverse pregnancy and delivery outcomes in Scotland. BMJ Open 2020; 10:e026168. [PMID: 32086347 PMCID: PMC7045241 DOI: 10.1136/bmjopen-2018-026168] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/22/2019] [Accepted: 02/05/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To examine the association between high maternal weight status and complications during pregnancy and delivery. SETTING Scotland. PARTICIPANTS Data from 132 899 first-time singleton deliveries in Scotland between 2008 and 2015 were used. Women with overweight and obesity were compared with women with normal weight. Associations between maternal body mass index and complications during pregnancy and delivery were evaluated. OUTCOME MEASURES Gestational diabetes, gestational hypertension, pre-eclampsia, placenta praevia, placental abruption, induction of labour, elective and emergency caesarean sections, pre-term delivery, post-term delivery, low Apgar score, small for gestational age and large for gestational age. RESULTS In the multivariable models controlling for potential confounders, we found that, compared with women with normal weight, the odds of the following outcomes were significantly increased for women with overweight and obesity (overweight adjusted ORs; 95% CI, followed by the same for women with obesity): gestational hypertension (1.61; 1.49 to 1.74), (2.48; 2.30 to 2.68); gestational diabetes (2.14; 1.86 to 2.46), (8.25; 7.33 to 9.30); pre-eclampsia (1.46; 1.32 to 1.63) (2.07; 1.87 to 2.29); labour induction (1.28; 1.23 to 1.33), (1.69; 1.62 to 1.76) and emergency caesarean section (1.82; 1.74 to 1.91), (3.14; 3.00 to 3.29). CONCLUSIONS Women with overweight and obesity in Scotland are at greater odds of adverse pregnancy and delivery outcomes. The odds of these conditions increases with increasing body mass index. Health professionals should be empowered and trained to deliver promising dietary and lifestyle interventions to women at risk of overweight and obesity prior to conception, and control excessive weight gain in pregnancy.
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Affiliation(s)
- Lawrence Doi
- Scottish Collaboration for Public Health Research and Policy, School of Health in Social Science, University of Edinburgh, Doorway 6, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Andrew James Williams
- European Centre for Environmental and Human Health, College of Medicine and Health, University of Exeter, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, TR1 3HD, UK
| | - Louise Marryat
- Farr Institute at Scotland, Nine, Edinburgh BioQuarter, 9 Little France Road, University of Edinburgh, Edinburgh, EH16 4UX, UK
- Centre for Clinical Brain Sciences, Royal Edinburgh Hospital, Kennedy Tower, Morningside Park, University of Edinburgh, Edinburgh, EH10 5HF, UK
| | - John Frank
- Farr Institute at Scotland, Nine, Edinburgh BioQuarter, 9 Little France Road, University of Edinburgh, Edinburgh, EH16 4UX, UK
- Usher Institute of Population Health Sciences and Informatics, Doorway 1, Old Medical School, Teviot Place, University of Edinburgh, Edinburgh, EH8 9AG, UK
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Abstract
BACKGROUND Antiphospholipid syndrome (APS) is a rare heterogenous autoimmune disorder with severe life-threatening complications shown during pregnancy. In this analysis, we aimed to systematically compare the pregnancy outcomes (both maternal and fetal) in patients with APS. METHODS Web of Science, Google Scholar, Medicus, Cochrane Central, Embase, and Medline were searched for relevant English publications. The main inclusion criteria were based on studies that compared pregnancy outcomes in patients with APS vs a control group. Statistical analysis was carried out by the RevMan software version 5.3. This analysis involved dichotomous data, and risk ratios (RR) with 95% confidence intervals (CIs) were used to represent the analysis. RESULTS Eight studies consisting of a total number of 212,954 participants were included. Seven hundred seventy participants were pregnant women with APS and 212,184 participants were assigned to the control group. Pregnancy-induced hypertension was significantly higher in women with APS (RR: 1.81, 95% CI: 1.33 - 2.45; P = .0002). The risks of fetal loss (RR: 1.33, 95% CI: 1.00-1.76; P = .05), abortion (RR: 2.42, 95% CI: 1.46-4.01; P = .0006), thrombosis (RR: 2.83, 95% CI: 1.47-5.44; P = .002), and preterm delivery (RR: 1.89, 95% CI: 1.52-2.35; P = .00001) were also significantly higher in women with APS. However, placental abruption (RR: 1.35, 95% CI: 0.78-2.34; P = .29) and pulmonary embolism were not significantly different (RR: 1.47, 95% CI: 0.11-19.20; P = .77). The risk of neonatal mortality (RR: 3.95, 95% CI: 1.98-7.86; P = .0001), infants small for gestational age (RR: 1.38, 95% CI: 1.04-1.82; P = .02), premature infants (RR: 1.86, 95% CI: 1.52-2.28; P = .0001), and infants who were admitted to neonatal intensive care unit (RR: 3.35, 95% CI: 2.29-4.89; P = .00001) were also significantly higher in women with APS. CONCLUSION This analysis showed APS to be associated with significantly worse pregnancy outcomes when compared to the control group. A significantly higher risk of maternal and fetal complications was observed in this category of patients. Therefore, intense care should be given to pregnant women with APS to monitor unwanted outcomes and allow a successful pregnancy.
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Lin L, Chen YH, Sun W, Gong JJ, Li P, Chen JJ, Yan H, Ren LW, Chen DJ. Risk factors of obstetric admissions to the intensive care unit: An 8-year retrospective study. Medicine (Baltimore) 2019; 98:e14835. [PMID: 30882671 PMCID: PMC6426550 DOI: 10.1097/md.0000000000014835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to identify risk factors among obstetric patients admitted to the intensive care unit (ICU).The study was conducted in Third Affiliated Hospital of Guangzhou Medical University during January 1, 2009 and December 31, 2016. A total of 44,817 pregnant women ≥20 weeks of gestational age were scanned. Demographic characteristics, perinatal outcomes, and risk factors among participants were analyzed.A number of factors (21) were more prevalent in the ICU admission group. The greatest for admission to the ICU occurred with amniotic fluid embolism, heart disease, acute fatty liver, and referral for care. The incidence of postpartum hemorrhage, hysterectomy, organ failure, and method of delivery differed significantly between groups (P < .05). Adverse neonatal outcome differed significantly between groups (P < .05).Complications of pregnancy are risk factors for referral to the ICU and may increase risk for unexpected outcomes among mothers and neonates.
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Grønvik T, Fossgard Sandøy I. Complications associated with adolescent childbearing in Sub-Saharan Africa: A systematic literature review and meta-analysis. PLoS One 2018; 13:e0204327. [PMID: 30256821 PMCID: PMC6157872 DOI: 10.1371/journal.pone.0204327] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 09/06/2018] [Indexed: 11/18/2022] Open
Abstract
Objective To examine whether childbearing before age 18 in Sub-Saharan Africa is associated with increased risk of maternal and child complications through a systematic literature review and meta-analysis. Methods The literature on adolescent pregnancy and associated complications in Sub-Saharan Africa was reviewed. A systematic electronic database search in Medline and Embase identified relevant papers. Studies were eligible for inclusion if they had numeric data on maternal mortality, pre-eclampsia, eclampsia, preterm birth, low birth weight, small for gestational age, stillbirth, neonatal death or perinatal death. We included studies on adolescents aged 17 years or younger, and with a comparison group of adult women aged between 20 and 35 years. The quality of the articles was assessed. Meta-analyses were conducted when there were at least three included studies with minor clinical heterogeneity in population and outcome measures. Results Eighteen studies met our inclusion criteria. There were many studies from Sub-Saharan Africa with data on the age group 15–19 years old, but few studies had separate data on adolescents <18 years old. All included studies were of either moderate or low quality. Adolescents had an increased risk of low birth weight, pre-eclampsia/eclampsia, preterm birth and maternal and perinatal mortality. We found a lower, nonsignificant risk of stillbirth and for small for gestational age babies among the young mothers. Conclusion In this systematic review, the findings indicate that young maternal age is associated with some unfavorable outcomes in Sub-Saharan Africa. High quality observational studies that adjust for sociodemographic factors are lacking.
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Affiliation(s)
- Taran Grønvik
- Centre for International Health, University of Bergen, Bergen, Norway
- * E-mail:
| | - Ingvild Fossgard Sandøy
- Centre for International Health, University of Bergen, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health, University of Bergen, Bergen, Norway
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van der Kooi ALLF, Brewster DH, Wood R, Nowell S, Fischbacher C, van den Heuvel-Eibrink MM, Laven JSE, Wallace WHB, Anderson RA. Perinatal risks in female cancer survivors: A population-based analysis. PLoS One 2018; 13:e0202805. [PMID: 30138451 PMCID: PMC6107257 DOI: 10.1371/journal.pone.0202805] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 08/09/2018] [Indexed: 12/16/2022] Open
Abstract
Background/objectives Advances in cancer management have resulted in improved survival rates, particularly in children and young adults. However, treatment may adversely affect reproductive outcomes among female cancer survivors. The objective of this study was to investigate their risk of adverse perinatal outcomes compared to the general population. Design/methods We performed a population-based analysis, including all female cancer survivors diagnosed before the age of 40 years between 1981 and 2012. Pregnancy and perinatal complications were identified through linkage of the Scottish Cancer Registry with hospital discharge records based on the Community Health Index (CHI) database. We compared 1,629 female cancer survivors with a first ever singleton pregnancy after diagnosis, with controls matched on age, deprivation quintile, and year of cancer diagnosis selected from the general population (n = 8,899). Relative risks and 95%-confidence intervals of perinatal risks were calculated using log-binomial regression. Results Survivors were more likely to give birth before 37 weeks of gestation (relative risk (RR]) 1.32, 95%-CI 1.10–1.59), but did not show an increased risk of low birth weight (<2.5kg: RR 1.15, 95%-CI 0.94–1.39), and were less likely to give birth to offspring small for gestational age (RR 0.81, 95%-CI 0.68–0.98). Operative delivery and postpartum haemorrhage were more common but approached rates in controls with more recent diagnosis. The risk of congenital abnormalities was not increased (RR 1.01, 95%-CI 0.85–1.20). Conclusion Cancer survivors have an increased risk of premature delivery and postpartum haemorrhage, but their offspring are not at increased risk for low birth weight or congenital abnormalities. In recent decades there has been a normalisation of delivery method in cancer survivors, nevertheless careful management remains appropriate particularly for those diagnosed in childhood.
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Affiliation(s)
- Anne-Lotte L. F. van der Kooi
- Department of Obstetrics and Gynecology, Erasmus MC–Sophia Children’s Hospital, Rotterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - David H. Brewster
- Scottish Cancer Registry, Information Services Division, NHS National Services Scotland, Edinburgh, Scotland
| | - Rachael Wood
- Information Services Division, NHS National Services Scotland, Edinburgh, Scotland
| | - Sian Nowell
- eData Research & Innovation Service (eDRIS), Information Services Division, NHS National Services Scotland and Farr Institute Scotland, Edinburgh, Scotland
| | - Colin Fischbacher
- Scottish Cancer Registry, Information Services Division, NHS National Services Scotland, Edinburgh, Scotland
| | | | - Joop S. E. Laven
- Department of Obstetrics and Gynecology, Erasmus MC–Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - W. Hamish B. Wallace
- Department of Oncology and Haematology, Royal Hospital for Sick Children, Sciennes Road, Edinburgh, Scotland
| | - Richard A. Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
- * E-mail:
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Kong X, Kong Y, Zhang F, Wang T, Zhu X. Expression and significance of dendritic cells and Th17/Treg in serum and placental tissues of patients with intrahepatic cholestasis of pregnancy. J Matern Fetal Neonatal Med 2018; 31:901-906. [PMID: 28298162 DOI: 10.1080/14767058.2017.1300652] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 02/24/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Dendritic cells (DCs) are involved in immune system, which can also regulate the differentiation of T helper 17 (Th17) and regulatory T cells (Treg). DCs and Th17/Treg participate in preeclampsia and recurrent spontaneous abortion (RSA), but there is still lack of research in intrahepatic cholestasis of pregnancy (ICP). The aim was to evaluate the expression and significance of CD83+DCs, CD1a+DCs, interleukin-17 (IL-17) and IL-35 in serum and placental tissues of patients with ICP. METHODS Thirty cases of mild ICP, 25 cases of severe ICP were selected, and 30 cases of normal pregnant women were selected as control group. Enzyme-linked immunosorbent assay (ELISA) and immunohistochemistry (IHC) were used to detect the expression of CD83+DCs, CD1a+DCs, IL-17 and IL-35 in serum and placenta tissues, respectively. RESULTS There were more CD83+DCs, IL-17 expressed in placenta from women with ICP than in normal pregnancies, while the number of decidual CD1a+DCs, IL-35 was significantly lower in ICP than in normal pregnant women. The comparison within three groups had statistical difference (p < .05). Serum CD83+DCs and CD1a+DCs levels had no significance. IL-17 was higher in ICP, while IL-35 was lower. CONCLUSIONS DCs are involved in damaging the maternal-fetal immune tolerance by changing the phenotype and mature state, which may affect the differentiation of Th17/Treg to cause ICP.
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Affiliation(s)
- Xiang Kong
- a Department of Obstetrics and Gynecology , Medical College of Yangzhou University , Yangzhou , China
| | - Yan Kong
- a Department of Obstetrics and Gynecology , Medical College of Yangzhou University , Yangzhou , China
| | - Fangyuan Zhang
- a Department of Obstetrics and Gynecology , Medical College of Yangzhou University , Yangzhou , China
| | - Tingting Wang
- a Department of Obstetrics and Gynecology , Medical College of Yangzhou University , Yangzhou , China
| | - Xiaotong Zhu
- a Department of Obstetrics and Gynecology , Medical College of Yangzhou University , Yangzhou , China
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Abstract
China recently instituted a two-child policy in response to its aging population, declining workforce and demographic dividend, and the need to develop asocial economy. Additionally, women generally delay having a second child because of the overwhelming pressure in their lives. With the improvements in assisted fertility technologies in recent years, the number of elderly women attempting to bear children has increased. The quality of woman's eggs and a man's sperm declined dramatically with increasing age, leading to an increased risk of pregnancy-related complications among older women. Therefore, the types of fertility problems experienced by elderly females must be provided with considerable attention by obstetricians. This commentary article focuses on the medical problems faced by older second-child pregnant women. This work discusses their increased rates of infertility, spontaneous abortion, fetal malformation, gestational diabetes, cesarean section, placenta previa, postpartum hemorrhage, postpartum depression, and hypertensive disorders, which complicate pregnancy.
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Affiliation(s)
- Qiang Li
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Dongrui Deng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Rabie N, Magann E, Steelman S, Ounpraseuth S. Oligohydramnios in complicated and uncomplicated pregnancy: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 2017; 49:442-449. [PMID: 27062200 DOI: 10.1002/uog.15929] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/14/2016] [Accepted: 03/24/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate adverse pregnancy outcomes in singleton pregnancies diagnosed with oligohydramnios through a systematic review and meta-analysis of controlled trials. METHODS We searched electronic databases via OVID, EBSCO, Web of Science, Google Scholar and others from 1980 to 2015. Prospective and retrospective studies with a control group were included. Two authors independently reviewed the abstracts from the literature search. Inclusion criteria were: studies in English, singleton pregnancy, normal fetal anatomy, intact membranes and oligohydramnios determined by the amniotic fluid index (AFI) technique. We stratified the meta-analysis into two groups according to risk: high risk including studies of oligohydramnios with comorbid conditions (e.g. hypertension) and low risk including studies of isolated oligohydramnios. RESULTS Fifteen trials met the inclusion criteria. Nine were high-risk and six were low-risk studies, including 8067 and 27 526 women, respectively. Compared with women with normal AFI, those with isolated oligohydramnios had significantly higher rates of an infant with meconium aspiration syndrome (relative risk (RR), 2.83; 95% CI, 1.38-5.77), Cesarean delivery for fetal distress (RR, 2.16; 95% CI, 1.64-2.85) and admission to the neonatal intensive care unit (NICU) (RR, 1.71; 95% CI, 1.20-2.42). Patients with oligohydramnios and comorbidities were more likely to have an infant with low birth weight (RR, 2.35; 95% CI, 1.27-4.34). However, rates of 5-min Apgar score < 7 (RR, 1.85; 95% CI, 0.69-4.96), NICU admission (RR, 2.09; 95% CI, 0.80-5.45), meconium-stained amniotic fluid (RR, 1.32; 95% CI, 0.62-2.81) and Cesarean delivery for fetal distress (RR, 1.65; 95% CI, 0.81-3.36) were similar to those for women with normal AFI. Stillbirth rates were too low to analyze in the meta-analysis. CONCLUSIONS This review helps to delineate which adverse outcomes are increased with oligohydramnios in low-risk pregnancy (NICU admission, Cesarean delivery for fetal distress and meconium aspiration syndrome), but does not provide enough data to determine the optimal timing of delivery in such cases. Oligohydramnios in complicated pregnancy is associated with an increased risk of delivery of an infant with low birth weight, but this may be confounded by the comorbid condition. Therefore, in high-risk pregnancy, management should be dictated by the comorbid condition and not the presence of oligohydramnios. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- N Rabie
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - E Magann
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S Steelman
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S Ounpraseuth
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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12
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Abstract
OBJECTIVE To describe the experience of pregnancy with a chronic illness. DESIGN Qualitative description. SETTING Tertiary Medical Center, Northeast United States. PARTICIPANTS A purposive sample of eight pregnant women with various chronic conditions. METHODS Telephone interviews. RESULTS The participants described their chronic illnesses as deviations from normality and their pregnancies brought them closer to normality. They described pregnancy as a balancing act between the fantasy of being normal and the reality of having a chronic disease. At the same time, women acknowledged the blessings and burdens of physical changes and intense vigilance. Participants also described emotional demands related to the need to be vigilant, additional physiological alternations, and information overload. CONCLUSION Pregnancy may alter chronic illness, increase stress, and create new health care needs for women. In turn, increased stress associated with chronic illness may alter perinatal outcomes. Pregnant women with chronic illness may benefit from interventions aimed at helping them balance the blessings and burdens associated with the symptoms of pregnancy.
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13
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Becks L. ICD-10 readiness: complications of pregnancy. Med Econ 2014; 91:48-49. [PMID: 25509477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Watson HJ, Von Holle A, Hamer RM, Berg CK, Torgersen L, Magnus P, Stoltenberg C, Sullivan P, Reichborn-Kjennerud T, Bulik CM. Remission, continuation and incidence of eating disorders during early pregnancy: a validation study in a population-based birth cohort. Psychol Med 2013; 43:1723-1734. [PMID: 23164164 PMCID: PMC4206832 DOI: 10.1017/s0033291712002516] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND We internally validated previously published rates of remission, continuation and incidence of broadly defined eating disorders during pregnancy in the Norwegian Mother and Child Cohort (MoBa) at the Norwegian Institute of Public Health. METHOD A total of 77 267 pregnant women enrolled at 17 weeks gestation between 2001 and 2009 were split into a training sample (n = 41 243) from the version 2 dataset and a validation sample (n = 36 024) from the version 5 dataset who were not in the original study. Internal validation of original rate models involved fitting a calibration model to compare model parameters between the two samples and bootstrap estimates of bias in the entire version 5 dataset. RESULTS Remission, continuation and incidence estimates remained stable. Pre-pregnancy prevalence estimates in the validation sample were: anorexia nervosa (AN; 0.1%), bulimia nervosa (BN; 1.0%), binge eating disorder (BED; 3.3%) and eating disorder not otherwise specified-purging disorder (EDNOS-P; 0.1%). In early pregnancy, estimates were: BN (0.2%), BED (4.8%) and EDNOS-P (<0.01%). Incident BN and EDNOS-P during pregnancy were rare. The highest rates were for full or partial remission for BN and EDNOS-P and continuation for BED. CONCLUSIONS We validated previously estimated rates of remission, continuation and incidence of eating disorders during pregnancy. Eating disorders, especially BED, during pregnancy were relatively common, occurring in nearly one in every 20 women. Pregnancy was a window of remission from BN but a window of vulnerability for BED. Training to detect eating disorders by obstetricians/gynecologists and interventions to enhance pregnancy and neonatal outcomes warrant attention.
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Affiliation(s)
- Hunna J. Watson
- Centre for Clinical Interventions, Department of Health in Western Australia, Australia
- Eating Disorders Program, Princess Margaret Hospital for Children, Department of Health in Western Australia, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Australia
| | - Ann Von Holle
- Department of Psychiatry, University of North Carolina at Chapel Hill, USA
| | - Robert M. Hamer
- Department of Psychiatry, University of North Carolina at Chapel Hill, USA
| | | | - Leila Torgersen
- Division of Mental Health, Norwegian Institute of Public Health, Norway
| | - Per Magnus
- Division of Epidemiology, Norwegian Institute of Public Health, Norway
| | - Camilla Stoltenberg
- Division of Epidemiology, Norwegian Institute of Public Health, Norway
- Department of Public Health and Primary Health Care, University of Bergen, Norway
| | - Patrick Sullivan
- Department of Psychiatry, University of North Carolina at Chapel Hill, USA
- Department of Genetics, University of North Carolina at Chapel Hill, USA
| | - Ted Reichborn-Kjennerud
- Division of Mental Health, Norwegian Institute of Public Health, Norway
- Department of Psychiatry, University of Oslo, Norway
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, USA
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15
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Karnehed N, Osterlund N, Isaksson AK, Nyman M, Sparre LS, Ljung R. [Wrong diagnostic code makes the follow up of pregnant women's sick leave more difficult]. Lakartidningen 2012; 109:168. [PMID: 22482229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Nina Karnehed
- Inspektionen för socialförsäkringen, Socialstyrelsen.
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Tudjegbe SO, Imarengiaye CO, Sadoh WE. Determinants of paediatrician's presence at Caesarian section. West Afr J Med 2012; 31:24-27. [PMID: 23115092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Paediatricians are required to attend all Caesarian sections, yet most neonates so delivered do not require complex resuscitations necessitating a paediatrician's presence. METHODS All Caesarean sections in the University of Benin Teaching Hospital from January to December 2009 were prospectively studied. The socio-demographic characteristics, indication and type of surgery, and the type of anaesthesia were recorded. Neonatal outcome was assessed with Apgar scores at 1 and 5 minutes and the need for a paediatrician determined. RESULTS There were 431 cases of caesarean section within the period and 326 (75.6%) of these had antenatal care. About three-quarters of the patients had emergency caesarean section. Indications for caesarean section were foetal in 19% and maternal in 81%. Subarachnoid block was the main anaesthetic technique 392/431 (91.0%). Apgar score in 1 min was less than 7 in 172/431 (39.9%) and was severe (< 4) in 26/ 431 (6.0%). Lack of ante natal care (p < 0.05, RR = 1.3, 95% CI = 1.0 - 1.7 ), foetal indications (p < 0.05, RR = 1.4, 95% CI = 1.1 - 1.8), emergency caesarean section (p < 0.05, RR = 1.4, 95% C1 =1.0 -1.8), general anaesthesia (p = 0.0056, RR = 1.6, 95% CI = 1.2 -2.2) and active resuscitation (p < 0.05, RR = 2.5, 95% CI = 2.1 =3.1) were associated with Apgar scores less 7 in 1 minute. CONCLUSION Unbooked status, foetal indication (foetal distress, prematurity, abnormal lie), emergency sections, and general anaesthesia may lead to poor Apgar scores and the need for active resuscitation. These settings justify the paediatrician's presence at Caesarean section.
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MESH Headings
- Adult
- Anesthesia, Obstetrical/adverse effects
- Anesthesia, Obstetrical/methods
- Anesthesia, Obstetrical/statistics & numerical data
- Apgar Score
- Cesarean Section/adverse effects
- Cesarean Section/methods
- Cesarean Section/statistics & numerical data
- Female
- Fetal Distress/diagnosis
- Fetal Distress/epidemiology
- Fetal Distress/prevention & control
- Gestational Age
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/prevention & control
- Male
- Monitoring, Intraoperative/methods
- Monitoring, Intraoperative/statistics & numerical data
- Nigeria/epidemiology
- Patient Care Team/organization & administration
- Pediatrics/methods
- Pediatrics/organization & administration
- Postoperative Complications/diagnosis
- Postoperative Complications/epidemiology
- Postoperative Complications/prevention & control
- Pregnancy
- Pregnancy Complications/classification
- Pregnancy Complications/epidemiology
- Pregnancy Complications/surgery
- Pregnancy Outcome/epidemiology
- Socioeconomic Factors
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Affiliation(s)
- S O Tudjegbe
- Department of Anaesthesiology, University of Benin Teaching Hospital, PMB 1111, Benin City, Nigeria
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17
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Abstract
What is probably the first description of targetoid or iris lesions, as they appear in erythema multiforme (EM), can be found in Thomas Bateman's 1836 textbook "Practical Synopsis of Cutaneous Diseases According to the Arrangement of Dr. Willan." EM was initially described by Bateman and later by von Hebra as an acute self-limiting skin disease, symmetrically distributed on the extremities with typical concentric "targetoid" or "iris" lesions, and often recurrent. Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) were added to this syndrome later. A newer classification has created two disease spectra: EM consisting of EM minor and EM major (or bullous EM), and SJS and TEN. EM minor and EM major are often recurrent, postinfectious (especially after herpes and mycoplasma) disorders with low morbidity and almost no mortality. SJS and TEN are usually severe drug-induced reactions with high morbidity and poor prognosis. The target lesions found in each form of the disease are described and defined. Although the term "target lesion" originated from the description of EM and despite its being the dominant lesion in this disease, it is not pathognomonic for EM, and these lesions can sometimes appear in other diseases. Short descriptions of these other diseases are presented.
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MESH Headings
- Dermatitis, Allergic Contact/classification
- Dermatitis, Allergic Contact/pathology
- Erythema Multiforme/classification
- Erythema Multiforme/history
- Erythema Multiforme/pathology
- Hemangioma/classification
- Hemangioma/pathology
- History, 19th Century
- History, 20th Century
- History, 21st Century
- Humans
- Lupus Erythematosus, Systemic/classification
- Lupus Erythematosus, Systemic/pathology
- Pemphigus/classification
- Pemphigus/pathology
- Pregnancy Complications/classification
- Pregnancy Complications/pathology
- Pruritus/classification
- Pruritus/pathology
- Skin Diseases/classification
- Skin Diseases/history
- Skin Diseases/pathology
- Skin Diseases, Vesiculobullous/classification
- Skin Diseases, Vesiculobullous/pathology
- Syphilis/classification
- Syphilis/pathology
- Vasculitis, Leukocytoclastic, Cutaneous/classification
- Vasculitis, Leukocytoclastic, Cutaneous/pathology
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Affiliation(s)
- Ronni Wolf
- Dermatology Unit, Kaplan Medical Center, 76100 Rechovot, Israel (affiliated to the Hebrew University-Hadassah Medical School, Jerusalem, Israel).
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18
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Fen'kova OG, Fursova AZ, Gusarevich OG. [Perinatal risk factors of congenital glaucoma]. Vestn Oftalmol 2011; 127:47-49. [PMID: 22165101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The aim is to estimate extragenital diseases, course of pregnancy and delivery in mothers of children with congenital glaucoma and to study somatic and neurological status of these children. Extragenital comorbidity was found in 76.3% of studied women. 47.6% of women had burdened obstetric history. In the majority of cases there were complications of the present pregnancy. 30.9% of pregnancies resulted in premature birth. In 69.14% of children comorbidity was revealed. Thus the early diagnosis and treatment of comorbidity are essential in women. Treatment and rehabilitation of children with glaucoma requires multidisciplinary approach including ophthalmologist, neurologist and pediatricians.
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Mulu A, Kassu A, Huruy K, Tegene B, Yitayaw G, Nakamori M, Van Nhien N, Bekele A, Wondimhun Y, Yamamoto S, Ota F. Vitamin A deficiency during pregnancy of HIV infected and non-infected women in tropical settings of Northwest Ethiopia. BMC Public Health 2011; 11:569. [PMID: 21762514 PMCID: PMC3146876 DOI: 10.1186/1471-2458-11-569] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 07/15/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vitamin A deficiency (VAD) is known to be a major public health problem among women of reproductive age in South East Asia and Africa. In Ethiopia, there are no studies conducted on serum vitamin A status of HIV-infected pregnant women. Therefore, the present study was aimed at determining the level of serum vitamin A and VAD among pregnant women with and without HIV infection in tropical settings of Northwest Ethiopia. METHODS In this cross-sectional study, blood samples were collected from 423 pregnant women and from 55 healthy volunteers who visited the University of Gondar Hospital. Serum concentration of vitamin A was measured by high performance liquid chromatography. RESULTS After controlling for total serum protein, albumin and demographic variables, the mean ± SD serum vitamin A in HIV seropositive pregnant women (0.96 ± 0.42 μmol/L) was significantly lower than that in pregnant women without HIV infection (1.10 ± 0.45 μmol/L, P < 0.05). Likewise, the level of serum vitamin A in HIV seropositive non-pregnant women (0.74 ± 0.39) was significantly lower than that in HIV negative non-pregnant women (1.18 ± 0.59 μmol/L, P < 0.004). VAD (serum retinol < 0.7 μmol/L) was observed in 18.4% and 17.7% of HIV infected and uninfected pregnant women, respectively. Forty six percent of non-pregnant women with HIV infection had VAD while only 28% controls were deficient for vitamin A (P = 0.002). CONCLUSION The present study shows that VAD is a major public health problem among pregnant women in the tropical settings of Northwest Ethiopia. Considering the possible implications of VAD during pregnancy, we recommend multivitamin (which has a lower level of vitamin A) supplementation in the care and management of pregnant women with or without HIV infection.
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Affiliation(s)
- Andargachew Mulu
- Department of Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
- Institute of Virology, Faculty of Medicine, University of Leipzig, Johannisallee 30, 04103, Leipzig, Germany
| | - Afework Kassu
- Department of Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Kahsay Huruy
- Department of Medical Laboratory Technology, College of Medicine and Health Sciences, University of Gondar P. O. Box 196, Gondar, Ethiopia
| | - Birhanemeskel Tegene
- Department of Medical Laboratory Technology, College of Medicine and Health Sciences, University of Gondar P. O. Box 196, Gondar, Ethiopia
| | - Gashaw Yitayaw
- Department of Medical Laboratory Technology, College of Medicine and Health Sciences, University of Gondar P. O. Box 196, Gondar, Ethiopia
| | - Masayo Nakamori
- Division of Nutrition and Food Science, Ochanomizu University, Tokyo 112-8610, Japan
| | - Nguyen Van Nhien
- Department of Science and Network Direction, National Institute for Food Control, 15A Phan Huy Chu, Hanoi, Vietnam
| | - Assegedech Bekele
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Yared Wondimhun
- Department of Medicine, Howard University Hospital, Howard University
| | - Shigeru Yamamoto
- International Nutrition, Department of Food and Nutritional Sciences, Graduate School of Human Life Sciences, Jumonji University, 2-1-28 Sugasawa, Niiza-City, Saitama 352-8510, Japan
| | - Fusao Ota
- Department of Preventive Environment and Nutrition, Institute of Health Biosciences, The University of Tokushima, Japan
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20
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Kanas RJ, Kanas SJ. Localized aggressive multiparous periodontitis: a newly documented entity. Gen Dent 2011; 59:292-301. [PMID: 21903569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This article describes a form of localized aggressive periodontitis (LAP) in young multiparous women and denotes this form of periodontitis as localized aggressive multiparous periodontitis (LAMP). The authors retrospectively reviewed six cases of LAP in healthy multiparous women who were followed clinically for more than five years, examining clinical histories, clinical findings, and radiographic features. Age, race, gender, parity, location of attachment loss, rate of attachment loss, and symptoms were recorded. LAMP is characterized by asymmetrical attachment loss along the distal proximal area of the maxillary and/or mandibular first permanent molars in multiparous females with a median age of 27. The mean annual rate of attachment loss in the maxillary first molars was calculated at 0.5 mm. LAMP progresses to involve the mandibular incisors but, unlike LAP, appears to spare the maxillary incisors. The authors suggest that LAMP is a recognizable periodontal disease that can be diagnosed in young, multiparous females via clinical history, periodontal examination, and radiographs. This study presents potential pathogenic pathways and suggests a possible answer to the paradox of why aging women become more edentulous than men despite better overall dental care.
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Affiliation(s)
- Robert J Kanas
- Crittenton Medical Center, Rochester Hills, Michigan, USA
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21
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Sal'kov VN, Levchenkova VD, Lobanova LV, Grishina TG, Sheĭnkman OG. [Visual disorders in children cerebral palsy]. Zh Nevrol Psikhiatr Im S S Korsakova 2011; 111:8-11. [PMID: 21512495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A complex study of 55 patients with children cerebral palsy who complained on visual and eye movement disturbances in the age from 4 to 10 years has been carried out. Main factors in the anamnesis that have negative effect on the organism formation in antenatal and perinatal periods have been analyzed. Most of children had ophthalmologic symptoms (visual acuity decrease, disturbance of pupillary reaction to convergence, disturbance of refraction, refraction strabismus, horizontal nystagmus, restriction of the field of vision, ophtalmoparesis), movement and coordination disorders, mental and speech disorders. Plausibly, the combination of different aversive factors in the antenatal, intranatal and neonatal periods led to the brain lesion, including structures of movement and visual analyzers and their links to other analyzers, that determined the clinical picture of disease.
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22
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Bodnar LM, Siega-Riz AM, Simhan HN, Diesel JC, Abrams B. The impact of exposure misclassification on associations between prepregnancy BMI and adverse pregnancy outcomes. Obesity (Silver Spring) 2010; 18:2184-90. [PMID: 20168307 PMCID: PMC2888636 DOI: 10.1038/oby.2010.25] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Prepregnancy BMI is a widely used marker of maternal nutritional status that relies on maternal self-report of prepregnancy weight and height. Pregravid BMI has been associated with adverse health outcomes for the mother and infant, but the impact of BMI misclassification on measures of effect has not been quantified. The authors applied published probabilistic bias analysis methods to quantify the impact of exposure misclassification bias on well-established associations between self-reported prepregnancy BMI category and five pregnancy outcomes (small for gestational age (SGA) and large for gestational age (LGA) birth, spontaneous preterm birth (sPTB), gestational diabetes mellitus (GDM), and preeclampsia) derived from a hospital-based delivery database in Pittsburgh, PA (2003-2005; n = 18,362). The bias analysis method recreates the data that would have been observed had BMI been correctly classified, assuming given classification parameters. The point estimates derived from the bias analysis account for random error as well as systematic error caused by exposure misclassification bias and additional uncertainty contributed by classification errors. In conventional multivariable logistic regression models, underweight women were at increased risk of SGA and sPTB, and reduced risk of LGA, whereas overweight, obese, and severely obese women had elevated risks of LGA, GDM, and preeclampsia compared with normal-weight women. After applying the probabilistic bias analysis method, adjusted point estimates were attenuated, indicating the conventional estimates were biased away from the null. However, the majority of relations remained readily apparent. This analysis suggests that in this population, associations between self-reported prepregnancy BMI and pregnancy outcomes are slightly overestimated.
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Affiliation(s)
- Lisa M Bodnar
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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23
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Abstract
Logistic regression and spatial analytic techniques are used to model fetal distress risk as a function of maternal exposure to Hurricane Andrew. First, monthly time series compare the proportion of infants born distressed in hurricane affected and unaffected areas. Second, resident births are analyzed in Miami-Dade and Broward counties, before, during, and after Hurricane Andrew. Third, resident births are analyzed in all Florida locales with 100,000 or more persons, comparing exposed and unexposed gravid females. Fourth, resident births are analyzed along Hurricane Andrew's path from southern Florida to northeast Mississippi. Results show that fetal distress risk increases significantly with maternal exposure to Hurricane Andrew in second and third trimesters, adjusting for known risk factors. Distress risk also correlates with the destructive path of Hurricane Andrew, with higher incidences of fetal distress found in areas of highest exposure intensity. Hurricane exposed African-American mothers were more likely to birth distressed infants. The policy implications of in utero costs of natural disaster exposure are discussed.
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Affiliation(s)
- Sammy Zahran
- Center for Disaster and Risk Analysis, Department of Sociology,School of Global Environmental Sustainability, Colorado State University, Fort Collins, CO 80523-1784, USA.
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24
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Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva AD, Hod M, Kitzmiler JL, Lowe LP, McIntyre HD, Oats JJN, Omori Y, Schmidt MI. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010. [PMID: 20190296 DOI: 10.2337/dc10-0719] [Citation(s) in RCA: 1078] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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25
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Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva AD, Hod M, Kitzmiler JL, Lowe LP, McIntyre HD, Oats JJN, Omori Y, Schmidt MI. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33:676-82. [PMID: 20190296 PMCID: PMC2827530 DOI: 10.2337/dc09-1848] [Citation(s) in RCA: 2769] [Impact Index Per Article: 197.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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26
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Durand S. [Weight gain in pregnancy concerning new recommendations]. Perspect Infirm 2010; 7:49. [PMID: 20120178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Suzanne Durand
- Direction du développement et du soutien professionnel de l'OIIQ
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27
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Tembely A, Cissé MC, Ouattara Z, Doumbia D, Sanogo Z, Cissé MA, Samassékou A, Ouattara K. [Contribution to the classification of obstetrical vesicovaginal fistula]. Mali Med 2009; 24:50-52. [PMID: 19666370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
UNLABELLED Our study was made with the C.H.U of the hospital of the Point G in the Service of Urology in Bamako in Mali. It is about a retrospective study in a service which has a dosage unit in load of F.V.V.O on average two hundred patients per annum. We included in our study all the F.V.V.O examined in the service which had an organic assessment. This assessment noted the aspect of the vagina and the topographic situation of the dent. Sometimes the examination of certain patients required a loco-regional anaesthesia and tests with the methylene blue to individualize the dent. CONCLUSION The classification proposed is the result of an experiment on the ground. It is a tool for learning thus enabling him to distinguish from the types of dent with their forecast and from the technical epic to realize.
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Affiliation(s)
- A Tembely
- Service d'Urologie Hopital du Point G, Centre Hospitalier Universitaire, Bamako, Mali.
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Abstract
Identifying the causes of preterm birth has been problematic, in part because of heterogeneous pathways leading to the same event, early delivery. If a risk factor affects only a subset of cases, then studies that address the aggregate outcome will generate diluted measures of association. McElrath et al. (Am J Epidemiol. 2008;168(9):980-989) examined an array of potential influences on very early preterm birth (<28 weeks' gestation) and divided cases on the basis of proximal causes. Through factor analysis, they found empirical support for dividing preterm cases into 2 groups: intrauterine inflammation (preterm labor, preterm membrane rupture, placental abruption, and cervical insufficiency) and abnormal placentation (preeclampsia and intrauterine growth restriction). Replication of this classification in less extreme preterm births is needed, requiring large numbers of preterm births that have been characterized in detail. Nonetheless, this division is worthy of study by using previously collected data to determine whether, in fact, stronger associations are found for these subsets than for preterm birth in the aggregate. Ultimately, the test of the approach is in improving our understanding of etiology, ideally generating stronger, more consistent associations with preterm birth subsets than have been found for preterm birth in the aggregate.
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Affiliation(s)
- David A Savitz
- Department of Community and Preventive Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1057, New York, NY 10029, USA.
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McElrath TF, Hecht JL, Dammann O, Boggess K, Onderdonk A, Markenson G, Harper M, Delpapa E, Allred EN, Leviton A. Pregnancy disorders that lead to delivery before the 28th week of gestation: an epidemiologic approach to classification. Am J Epidemiol 2008; 168:980-9. [PMID: 18756014 DOI: 10.1093/aje/kwn202] [Citation(s) in RCA: 254] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Epidemiologists have grouped the multiple disorders that lead to preterm delivery before the 28th week of gestation in a variety of ways. The authors sought to identify characteristics that would help guide how to classify disorders that lead to such preterm delivery. They enrolled 1,006 women who delivered a liveborn singleton infant of less than 28 weeks' gestation at 14 centers in the United States between 2002 and 2004. Each delivery was classified by presentation: preterm labor (40%), prelabor premature rupture of membranes (23%), preeclampsia (18%), placental abruption (11%), cervical incompetence (5%), and fetal indication/intrauterine growth restriction (3%). Using factor analysis (eigenvalue = 1.73) to compare characteristics identified by standardized interview, chart review, placental histology, and placental microbiology among the presentation groups, the authors found 2 broad patterns. One pattern, characterized by histologic chorioamnionitis and placental microbe recovery, was associated with preterm labor, prelabor premature rupture of membranes, placental abruption, and cervical insufficiency. The other, characterized by a paucity of organisms and inflammation but the presence of histologic features of dysfunctional placentation, was associated with preeclampsia and fetal indication/intrauterine growth restriction. Disorders leading to preterm delivery may be separated into two groups: those associated with intrauterine inflammation and those associated with aberrations of placentation.
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Affiliation(s)
- T F McElrath
- Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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Salihu HM, Lynch O, Alio AP, Liu J. Obesity subtypes and risk of spontaneous versus medically indicated preterm births in singletons and twins. Am J Epidemiol 2008; 168:13-20. [PMID: 18456643 DOI: 10.1093/aje/kwn092] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Using data from the Missouri maternally linked files (1989-1997), the authors examined the association among maternal obesity, obesity subtypes, and spontaneous and medically indicated preterm (<37 weeks) and very preterm (<33 weeks) births in singletons and twins. Adjusted odds ratios were obtained with correction for intracluster correlation. The prevalence of obesity increased by 77% over the study period (p(trend) < 0.001). Obese mothers had a lower risk for spontaneous preterm birth, and this was more pronounced among twins (odds ratio = 0.68, 95% confidence interval: 0.62, 0.75) than singletons (odds ratio = 0.84, 95% confidence interval: 0.82, 0.87). However, this association was present only among obese women who gained less than 0.69 kg/week for singletons and between 0.23 and 0.69 kg/week for twins. By contrast, obese mothers with singleton gestation had about 50% greater odds of medically indicated preterm (odds ratio = 1.46, 95% confidence interval: 1.39, 1.54) and very preterm (odds ratio = 1.49, 95% confidence interval: 1.34, 1.65) births, and the risk increases with ascending severity of obesity (p(trend) < 0.01). For extreme obesity, the risk of medically indicated preterm and very preterm births was almost double that for nonobese women. Similar findings were observed in twins. These data suggest that obesity increases the risk for medically indicated but not spontaneous preterm birth in both singletons and twins.
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Affiliation(s)
- Hamisu M Salihu
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL 33613, USA.
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Abstract
There has been an increase in the number of pregnancies among renal transplant recipients. Our experience included 61 pregnancies in 53 patients from January 1997 to April 2007, with 6 patients having multiple pregnancies. Patients were studied for clinical, obstetrical, and perinatal outcomes. The mean patient age was 24.5 years (range, 19-38). They all received living donor kidneys. The mean transplantation-pregnancy interval was 2.7 years (range, 1.7-5.3 years). Immunosuppressive drugs consisted of cyclosporine (CsA), mycophenolate mofetil (MMF), and prednisolone (pred) in 38 patients (72%); CsA, azathioprine (AZA), plus pred were used in 15 patients (28%). Pregnancy complications were chronic hypertension in 21 patients (40%), anemia in 28 (52.6%), and urinary tract infection in 18 (34%). Twelve patients (22.6%) received blood transfusions. Pre-eclampsia was diagnosed in 14 cases (26.4%) and renal dysfunction in 11 (20.7%) with pre-eclampsia assumed to be the main cause. Three patients (5.6%) had graft losses as a result of hemorrhagic shock, sepsis, and eclampsia. Premature rupture of membranes occurred in 6 cases (11.3%), and preterm delivery occurred in 14 cases (26.4%). Eleven (20.7%) newborns were small for gestational age. One club foot and one large facial hemangioma occurred in 2 infants, respectively. One case of neonatal death was registered as a result of excessive prematurity. One mother died due to sepsis. Cesarean section was performed in 24 patients (45.2%), the main indications being related to hypertension and fetal distress. There were no significant differences between MMF-treated and AZA-treated patients with respect to clinical, obstetrical, and perinatal outcomes. This group of patients was characterized by a wide range of antenatal and perinatal problems that must be managed in specialized tertiary units to achieve the best results. MMF may be as safe as AZA in pregnancy.
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Affiliation(s)
- A Ghafari
- Nephrology Department, Urmia University of Medical Sciences, Emam Hospital, Urmia, Iran.
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Abstract
The desire of reproduction is a true challenge for the physicians in charge of patients with chronic inflammatory disorders such as rheumatoid arthritis or other connective tissue diseases. It requires: 1) the strict evaluation of the potential risks of flare of the rheumatic disease because of the pregnancy; 2) the assessment of risks on pregnancy outcome and fetus development; 3) the management of the different anti-rheumatic agents in order to maintain optimal control of disease activity and avoid any teratogenic problem. Besides this, it clearly appears that inflammatory rheumatic diseases may have an impact on patients' fertility, which may be explained by different mechanisms, physical, psychological, hormonal or immunological. Moreover, some treatments may directly affect fertility, which may justify specific managements in order to preserve gonadic functions.
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Affiliation(s)
- B Fautrel
- Service de rhumatologie, groupe hospitalier de la Pitié-Salpêtrière, université Paris-VI-Pierre-et-Marie-Curie, 83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
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33
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Olesińska M, Wiesik-Szewczyk E, Chwalińska-Sadowska H. [Evaluation of systemic lupus erythematosus activity during pregnancy]. Pol Arch Med Wewn 2007; 117:312-316. [PMID: 17966597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Pregnancy in patients with systemic lupus erythematosus (SLE) is considered a high-risk pregnancy. It is complicated by preeclampsia, premature labour and miscarriage more frequently than in the general population. Improved prognosis depends on low disease activity during conception and on appropriate medical care (SLE activity monitoring, selection of therapy safe for the mother and the developing foetus, advances in neonatology). Because symptoms of physiological pregnancy and SLE exacerbation are similar, their correct interpretation is essential for skin lesions, arthralgias, arterial hypertension or results of laboratory tests: proteinuria, thrombocytopenia or leucopenia observed in the patient. In order to standardise the assessment of SLE activity during pregnancy, scores of this activity are used. In the past, scores validated on non-pregnant populations (including male patients) were used: Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), Systemic Lupus Activity Measure (SLAM), European Consensus Lupus Activity Measurment (ECLAM). Only recently have SLE activity scores been introduced that are specific for pregnant women: Lupus Activity Index In Pregnancy (LAI-P), Systemic Lupus Erythematosus Pregnancy Disease Activity Index (SLEPDAI), modified--Systemic Lupus Activity Measure (m-SLAM) and a visual three-grade score modified--Physician Global Assessment (m-PGA). So far, only scores LAI-P and m-PGA have been validated. According to the LAI-P score, clinical data are divided into 4 groups. Group 1 includes mild clinical symptoms, group 2--symptoms of involvement of internal organs, group 3 pertains to modifications of treatment and group 4 to laboratory parameters. Point values are ascribed to individual parameters depending on their intensity.
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Affiliation(s)
- Marzena Olesińska
- Klinika i Poliklinika Układowych Chorób Tkanki Lacznej, Instytut Reumatologii, Warszawa.
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Kashanizadeh N, Nemati E, Sharifi-Bonab M, Moghani-Lankarani M, Ghazizadeh S, Einollahi B, Lessan-Pezeshki M, Khedmat H. Impact of Pregnancy on the Outcome of Kidney Transplantation. Transplant Proc 2007; 39:1136-8. [PMID: 17524914 DOI: 10.1016/j.transproceed.2007.03.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is still controversy over whether pregnancy adversely affects renal transplantation outcomes. We, thus, compared two groups of kidney transplant recipients in terms of patient survival and allograft function: those who did versus did not conceive posttransplant. METHODS This historical cohort study conducted between 1996 and 2002, divided female kidney transplant recipients of reproductive age into group I (n=86, at least one posttransplant pregnancy) and group II (n=125, no posttransplant pregnancy). The two groups were matched for age, cause of end-stage renal disease (ESRD), treatment protocol, and first creatinine (Cr). All patients received a first transplant and all had a Cr less than 1.5 mg/dL on entry into the study. The subjects were followed for 45.4 +/- 22.0 and 46.3 +/- 19.8 months, respectively (P>.05). Five-year patient and graft survivals and Cr were considered to be the main outcome measures. RESULTS Mean (SD) age in groups I and II was 26.6 +/- 6.6 and 26.9 +/- 8.1 years, respectively (P>.05). Five-year patient and graft survival rates were not significantly different between the study groups. Of the women in group 1, only 9 (10.5%) subjects displayed elevated serum Cr levels (>1.5 mg/dL) at the end of follow-up, while the serum Cr levels in 35 (28%) group II patients were above 1.5 mg/dL (P=.024). CONCLUSION Our results indicates pregnancy did not seem to adversely affect patient and graft survival among kidney transplant recipients. Renal transplantation in stable women of childbearing age should not be a contraindication to pregnancy.
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Affiliation(s)
- N Kashanizadeh
- Nephrology and Urology Research Center (NURC), Baqiyatallah Medical Sciences University, Tehran, Iran
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35
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Deroover Y, Wissing KM, Kirkpatrick C. [Pregnancy after kidney transplantation : the Erasme Hospital experience]. Rev Med Brux 2007; 28:83-90. [PMID: 17561722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Kidney transplantation can restore the fertility of women with chronic renal insufficiency, allowing them to bear children. Yet, pregnancy after renal graft is associated with high maternal and fetal morbidity. The purpose of this case-controlled retrospective study was to evaluate maternal and fetal outcomes of pregnancies in renal transplant recipients, and to compare the results to a control population. We studied 18 pregnancies in 14 renal grafted patients, between 1990 and 2003. Each pregnancy was paired for age, number of pregnancies and parity with 2 controls. The analyses concerned the presence of risk factors at the conception, the outcome of the pregnancy and the occurring of maternal-fetal complications. There were significantly more infections (50 % versus 11 %), anaemia (28 % versus 3 %), caesarean sections (72 % versus 14 %), intrauterin growth restriction (39 % versus 3 %), premature babies (44 % versus 8 %) and small weights at birth (50 % versus 8 %) in the transplanted women and a trend to an increased incidence of hypertensive complications. One baby of a transplanted mother died. No deterioration of renal function nor any maternal death occurred. In conclusion, the rates of maternal-fetal complications in pregnancies after kidney transplantation found in our hospital are similar to those of the literature and in comparison with controls, make them high-risk pregnancies. Nevertheless, by respecting certain criteria, the majority have a successful outcome.
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Affiliation(s)
- Y Deroover
- Service de Gynécologie-Obstétrique, Service de Néphrologie, Dialyse et Transplantation, Hôpital Erasme
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36
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Wittayawarawat W, Liabsuetrakul T, Tassee S. Diagnosis summary and coding of obstetric conditions in the government hospitals in Pattalung Province, the effects of audit and feedback. J Med Assoc Thai 2007; 90:216-23. [PMID: 17375623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE Assess the effects of audit and feedback through a seminar on the obstetric summary and coding system with respect to the International Classification of Diseases, Tenth Revision (ICD-10) and to determine factors associated with the error of summary and coding audit. MATERIAL AND METHOD The medical records of 1,629 and 1,337 women with obstetric conditions admitted to one provincial and nine district hospitals in Pattalung Province, Southern Thailand, were evaluated before and after a seminar, respectively. RESULT The error of coding audit among cases with normal conditions and those with abnormal conditions after the seminar was reduced significantly from 40.7 to 13.0% and from 81.8% to 61.2%, respectively (p < 0.001). A seminar was a significant factor to reduce the errors of summary and coding. In contrast, the incorrect diagnosis summary, abnormal obstetric conditions and the district hospital were significantly associated with the increase of the coding errors. CONCLUSION The audit and feedback was moderately effective on summary and coding audit but the clinical significance of error reduction in abnormal obstetric conditions was marginal, thus intensive intervention, evaluation, and monitoring are necessary.
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Affiliation(s)
- Worapin Wittayawarawat
- Department of Obstetrics & Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
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37
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Abstract
OBJECTIVE To explore the use of Centers for Disease Control and Prevention body mass index percentiles for adolescents to classify adolescents for gestational weight gain recommendations. DESIGN A descriptive study using secondary data analysis. SETTING Memphis, Tennessee. PARTICIPANTS Three hundred forty-seven primiparous Black adolescents, aged 12 to 19 years, who delivered full-term infants. MAIN OUTCOME MEASURES Adult and adolescent body mass index categories, gestational weight gain patterns, and neonatal birthweight. RESULTS Adolescents, especially smaller adolescents, were misclassified when the current Institute of Medicine adult body mass index categories were used to classify them for gestational weight gain when compared to the use of the Centers for Disease Control and Prevention body mass index percentiles for adolescents as a gestational weight gain classification schema. Mean neonatal birthweights were similar no matter which schema was used. A large proportion of adolescents gained more than is recommended by the Institute of Medicine. CONCLUSIONS The current gestational weight gain recommendations based on adult body mass index categories may not be sufficiently specific to attain the best maternal and neonatal outcomes for adolescents. Creation of gestational weight gain recommendations based on the Centers for Disease Control and Prevention body mass index percentiles would potentially assist clinicians in counseling adolescents regarding gestational weight gain.
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Affiliation(s)
- Susan Groth
- clinical nursing in the School of Nursing, University of Rochester, NY..
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38
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Zainur RZ, Loh KY. "Postpartum morbidity--what we can do". Med J Malaysia 2006; 61:651-6. [PMID: 17623974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Postpartum is a crucial period for a mother. During this period a mother is going through the physiological process of uterine involution and at the same time adapting to her new role in the family. Many postpartum complications occur during this period. Among the important obstetric morbidities are postpartum hemorrhage, pregnancy related hypertension, pulmonary embolism and puerperal sepsis. Common surgical complications are wound breakdown, breast abscess and urinary fecal incontinence. Medical conditions such as anemia, headache, backache, constipation and sexual problems may also be present. Unrecognized postpartum disorders can lead to physical discomfort, psychological distress and a poor quality of life for the mothers. Providing quality postnatal care including earlier identification of the problems (correction) and proper intervention will help the mother to achieve full recovery and restore her functional status back to the pre-pregnancy state sooner.
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Affiliation(s)
- R Z Zainur
- Department of Obstetrics & Gynaecology, International Medical University, Seremban, Negeri Sembilan
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39
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Mbele AM, Snyman L, Pattison RC. Impact of the Choice on Termination of Pregnancy Act on maternal morbidity and mortality in the west of Pretoria. S Afr Med J 2006; 96:1196-8. [PMID: 17167707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
AIM To evaluate the impact of the Choice on Termination of Pregnancy Act on maternal morbidity and mortality in the west of Pretoria. SETTING Indigent South Africans managed in two public hospitals in the west of Pretoria. METHOD Data were collected on all abortions (incomplete or induced) treated in the hospitals in the study area in 1997-1998 and 2003-2005. All cases of severe acute maternal morbidity and maternal deaths due to abortion were identified for these time periods. Data exclude referrals from outside the west of Pretoria. OUTCOME MEASURES The case fatality rate (CFR), mortality index (MI) and maternal mortality ratio (MMR) due to abortions. RESULTS In 1997-1998 there were 2 050 abortions, of which 80.2% were regarded as being incomplete, and in 2003-2005 there were 3 999 abortions, of which 42.8% were regarded as incomplete. Twenty-four women who were critically ill due to complications of abortion presented in 1997-1998 (a rate of 3.05/1 000 births), compared with 50 (2.76/1 000 births) in 2003-2005. There were 5 deaths in 1997-1998 (CFR of 2.4/1 000 abortions) compared with 1 death in 2003-2005 (CFR 0.25/1 000 abortions) (p = 0.01, relative risk (RR) 0.1, 95% confidence interval (CI) 0.01 - 0.89). The MI fell from 21.7% to 2.0% (p = 0.02, RR 0.1, 95% CI 0.01 - 0.89). The MMR was 63.6/100 000 births in 1997-1998 compared with 5.54/100 000 in 2003-2005 (p = 0.017, RR 0.09, 95% CI 0.01 - 0.74). CONCLUSION The introduction of the Choice on Termination of Pregnancy Act has been associated with a massive reduction in women presenting with incomplete abortions. The prevalence of critically ill women due to complications of abortion has not changed, but the CFR, MI and MMR have declined significantly.
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Affiliation(s)
- A M Mbele
- Department of Obstetrics and Gynaecology, University of Pretoria, and MRC Maternal and Infant Health Care Strategies Research Unit, South Africa
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Pourrat O, Jollit C, Gombert JM, Boinot C, Pierre F. Clinical relevance of the recent update of the classification criteria for definite antiphospholipid syndrome: an obstetric medicine clinic series of 107 patients. J Thromb Haemost 2006; 4:2276-7. [PMID: 16869832 DOI: 10.1111/j.1538-7836.2006.02142.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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Rosato M, Mwansambo CW, Kazembe PN, Phiri T, Soko QS, Lewycka S, Kunyenge BE, Vergnano S, Osrin D, Newell ML, Costello AMDL. Women's groups' perceptions of maternal health issues in rural Malawi. Lancet 2006; 368:1180-8. [PMID: 17011945 DOI: 10.1016/s0140-6736(06)69475-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Improvements in preventive and care-seeking behaviours to reduce maternal mortality in rural Africa depend on the knowledge and attitudes of women and communities. Surveys have indicated a poor awareness of maternal health problems by individual women. We report the perceptions of women's groups to such issues in the rural Mchinji district of Malawi. METHODS Participatory women's groups in the Mchinji district identified maternal health problems (172 groups, 3171 women) and prioritised problems they considered most important (171 groups, 2833 women). In-depth qualitative data was obtained through six focus-group discussions with the women's groups, three with women's group facilitators, and four interviews with facilitator supervisors. FINDINGS The maternal health problems most commonly identified by more than half the groups were anaemia (87%), malaria (80%), retained placenta (77%), obstructed labour (76%), malpresentation (71%), antepartum and postpartum haemorrhage (70% each), and pre-eclampsia (56%). The five problems prioritised as most important were anaemia (sum of rank score 304), malpresentation (295), retained placenta (277), obstructed labour (276). and postpartum haemorrhage (275). HIV/AIDS and sepsis were identified or prioritised much less because complexity and contextual factors hindered their consideration. INTERPRETATION Rural Malawian women meeting in participatory groups showed a developed awareness of maternal health problems and the concern and motivation to address them. Community mobilisation strategies, such as women's groups, might be effective at reducing maternal mortality because they can draw on the collective capacity in communities to solve problems and make women's voices heard by decision-makers.
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Affiliation(s)
- Mikey Rosato
- Centre for International Health and Development, Institute of Child Health, University College London, UK.
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42
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Zimmermann-Górska I. [Classification criteria for the antiphospholipid syndrome--the next modification]. Pol Arch Med Wewn 2006; 115:396-400. [PMID: 17195350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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43
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Ambros-Rudolph CM, Müllegger RR, Vaughan-Jones SA, Kerl H, Black MM. The specific dermatoses of pregnancy revisited and reclassified: Results of a retrospective two-center study on 505 pregnant patients. J Am Acad Dermatol 2006; 54:395-404. [PMID: 16488288 DOI: 10.1016/j.jaad.2005.12.012] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2005] [Revised: 11/13/2005] [Accepted: 12/04/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVES We sought to evaluate the frequency and clinical characteristics of pruritic dermatoses in pregnancy and to assess a rationalized classification. METHODS Data of 505 pregnant patients seen at two university-based dermatologic hospitals (1994-2004) were retrospectively studied. RESULTS Diagnoses included eczema in pregnancy (49.7%), polymorphic eruption of pregnancy (PEP) (21.6%), pemphigoid gestationis (PG) (4.2%), intrahepatic cholestasis of pregnancy (ICP) (3%), prurigo of pregnancy (0.8%), pruritic folliculitis of pregnancy (0.2%), and miscellaneous dermatoses (20.6%). Eczema in pregnancy, prurigo of pregnancy, and pruritic folliculitis of pregnancy showed considerable overlap and were summarized as atopic eruption of pregnancy (AEP). While PEP, PG, and ICP presented in late pregnancy, AEP started significantly earlier. Primigravidae and multiple gestations were characteristic for PEP, abdominal involvement for PEP and PG, and a history of affected pregnancies for ICP. LIMITATIONS This was a retrospective study. CONCLUSION We propose classifying the dermatoses of pregnancy as PG, PEP, AEP, and ICP. Stereotypic immunofluorescence and laboratory findings are diagnostic of PG and ICP, whereas distinct clinical characteristics facilitate discrimination between PEP and AEP.
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Nasreen SA, Haque MM, Hasan MR. Pregnancy outcome in adolescent and adult - a case comparison study. Mymensingh Med J 2006; 15:15-21. [PMID: 16467756 DOI: 10.3329/mmj.v15i1.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study outlined the consequences of adolescent pregnancy with comparison to adults in Mymensingh Medical College Hospital, Mymensingh. It was a case-comparison study. The study population was the mothers who admitted and delivered at the Obstetrics and Gynaecology ward of hospital during April-June 2003. Sample size was 220 mothers, out of which 110 were primigravidae adolescent mothers and 110 were adults. The study finding showed that adolescents were 2.105 times and 3.679 times more at risk than adults to suffer from anaemia and UTI during pregnancy. Among adolescents 74(67.3%) and in adults 39(35.5%) had obstetric complications during pregnancy and the adolescents were 3.742 times more at risk than the adults. PET and Eclampsia were more common in adolescent than adult mothers. 86(78.2%) adolescents and 36(32.7%) adult mothers had complications before delivery. Pre term labour, Premature rupture of membrane (PROM) and Intra-uterine foetal death (IUD) were more common in adolescents than adult mothers. Stillbirths were more in adolescent mothers 23(20.9%) and adults 11(10.0%). There was more low birth weight (LBW) newborns in adolescents 42(38.2%) than adults 18(16.4%). As a result the adolescents were 3.157 times more likely to give birth to low birth weight babies . The newborns of the adolescent mothers were nearly 2 times more at risk to develop asphyxia neonatorum (p< 0.030, odds ratio=1.806).
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Affiliation(s)
- S A Nasreen
- Community Medicine Department, Mymensingh Medical College
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45
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Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, Derksen RHWM, DE Groot PG, Koike T, Meroni PL, Reber G, Shoenfeld Y, Tincani A, Vlachoyiannopoulos PG, Krilis SA. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006; 4:295-306. [PMID: 16420554 DOI: 10.1111/j.1538-7836.2006.01753.x] [Citation(s) in RCA: 4364] [Impact Index Per Article: 242.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
New clinical, laboratory and experimental insights, since the 1999 publication of the Sapporo preliminary classification criteria for antiphospholipid syndrome (APS), had been addressed at a workshop in Sydney, Australia, before the Eleventh International Congress on antiphospholipid antibodies. In this document, we appraise the existing evidence on clinical and laboratory features of APS addressed during the forum. Based on this, we propose amendments to the Sapporo criteria. We also provide definitions on features of APS that were not included in the updated criteria.
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Affiliation(s)
- S Miyakis
- St George Hospital, University of New South Wales, Sydney, Australia
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Al-Suleiman SA, Qutub HO, Rahman J, Rahman MS. Obstetric admissions to the intensive care unit: a 12-year review. Arch Gynecol Obstet 2006; 274:4-8. [PMID: 16432668 DOI: 10.1007/s00404-004-0721-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2004] [Accepted: 12/01/2004] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective was to ascertain the prevalence, causes and outcome of critically ill obstetric patients admitted to the intensive care unit (ICU). DESIGN The design was a retrospective collection of data. SETTINGS The setting was a multidisciplinary ICU in a University hospital. PATIENTS All obstetric patients admitted to the ICU over a 12-year period from May 1992 to April 2004 were reviewed. METHODS Data collected included demographic characteristics of the patients, pre-existing medical conditions, obstetric complications, invasive procedures required in the ICU and outcome of the patients. RESULTS The incidence of obstetric admissions to the ICU represented 0.22% of all deliveries during the study period. The majority (84.4%) of patients were admitted to the ICU postpartum. Obstetric haemorrhage (32.8%) and pregnancy-induced hypertension (17.2%) were the two main obstetrical reasons for admission. The remainder included medical disorders (37.5%) and other causes (6.2%). Associated major complications included adult respiratory distress syndrome (ARDS) and HELLP (haemolysis, elevated liver enzymes and low platelets) syndrome. The perinatal mortality rate was 20% and the maternal mortality rate 9.4%. CONCLUSIONS A team approach consisting treatment by obstetricians, intensive care specialists and anaesthesiologists provided optimal care for the patients. Improved management strategies for obstetric haemorrhage and hypertension may significantly reduce maternal morbidity.
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Affiliation(s)
- Suleiman A Al-Suleiman
- Department of Obstetrics and Gynaecology, College of Medicine, King Faisal University, Dammam, Saudi Arabia
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47
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Zonenberg A, Leoniak M, Zarzycki W. [The effect of Chernobyl accident on the development of non malignant diseases]. Endokrynol Pol 2006; 57:38-44. [PMID: 16575761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The early medical complications of Chernobyl accident include post radiation disease, which were diagnosed in 134 subjects affected by ionizing radiation. 28 persons died during the first 100 days after the event. The increase occurrence of coronary heart disease, endocrine, haematological, dermatological and other diseases were observed after disaster in the contaminated territories. We also discussed the impact of ionizing radiation from Chernobyl accident on pregnancy and congenital defects occurrence. Changes following the Chernobyl accident, as the inhabitants migration from contaminated regions, political and economic conversions, led to depression, anxiety, and even to "epidemic" of mental diseases. Increased suicide rate, car accidents, alcohol and drug abuse have been observed in this population. Nowadays vegetative neurosis is more often diagnosed in Ukrainian children. Epidemiological studies were conducted on the ionising radiation effect on the health and on the dose of received radiation after Chernobyl accident face numerous problems as the absence of reliable data regarding diseases in the contaminated territories.
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Affiliation(s)
- Anna Zonenberg
- Department of Endocrinology, Diabetology and Internal Medicine, Białystok Medical University, Poland.
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Abstract
OBJECTIVES To determine the rate of autopsy certification of maternal deaths; evaluate concordance and/discordance rates between autopsy and clinical diagnoses of maternal deaths, and to compare these with findings from other parts of the world. DESIGN Retrospective study. SETTING The Lagos University Teaching Hospital (LUTH), Nigeria between January 1989 and December 1998. SUBJECTS Women who died from pregnancy-related complications having been on admission in or having presented as emergencies to LUTH. RESULTS In the study period, 445 maternal deaths were registered in the LUTH mortuary. Autopsies were performed on 371 of these, giving an autopsy rate of 83.37%. Only 230 cases were found suitable for evaluation of concordance and discordance. Two hundred and six of these (89.57%) had related clinical and autopsy diagnoses (concordance) while 24 (10.43%) had completely unrelated diagnoses (discordance). CONCLUSION Adequate investigation of cause of death using the autopsy will assist in accurately determining the sequence of events that result in death and hence provide required statistics for the planning of appropriate interventions.
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Affiliation(s)
- A O Daramola
- Department of Morbid Anatomy, College of Medicine, University of Lagos, Lagos, Nigeria
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49
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Jabiry-Zieniewicz Z, Cyganek A, Luterek K, Bobrowska K, Kamiński P, Ziółkowski J, Zieniewicz K, Krawczyk M. Pregnancy and delivery after liver transplantation. Transplant Proc 2005; 37:1197-200. [PMID: 15848667 DOI: 10.1016/j.transproceed.2005.01.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AIM According to statistics, women constitute one-third of all liver recipients and approximately 75% of female recipients are of reproductive age. Successful liver transplantation in these patients results in the restoration of menstrual function and fertility. The aim of this study was to assess the course of pregnancy and delivery in liver-transplanted women. MATERIALS AND METHODS We retrospectively analyzed data of 138 liver-transplanted women, aged from 18 to 63 years, who underwent regular gynecological evaluations. Among 77 patients of reproductive age, 11 women conceived and delivered babies. RESULTS All patients have successfully delivered. The mean gestation age at delivery was 36.5 weeks. All neonates were delivered in a good state with no congenital abnormalities. Common pregnancy complications were preterm birth, anemia, intrahepatic cholestasis, and infection. In 1 case, graft rejection was observed due to willful discontinuation of immunosuppressive therapy. Two spontaneous vaginal deliveries and 9 caesarean sections were performed. All caesarean sections were performed for obstetrical indications: fetal intrauterine asphyxia (n = 4), breech presentation (n = 2), threatening intrauterine infection (n = 2), and preterm twin delivery (n = 1). CONCLUSION High-risk pregnancies in liver-transplanted women are generally associated with good outcomes, although an increased rate of preterm labor, intrauterine infections, anemia, and cholestasis were observed. Pregnancy did not seem to impair graft function or accelerate rejection in patients receiving immunosuppressive therapy.
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Affiliation(s)
- Z Jabiry-Zieniewicz
- First Department of Obstetrics and Gynecology, The Medical University of Warsaw, Warsaw, Poland
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Munnur U, Karnad DR, Bandi VDP, Lapsia V, Suresh MS, Ramshesh P, Gardner MA, Longmire S, Guntupalli KK. Critically ill obstetric patients in an American and an Indian public hospital: comparison of case-mix, organ dysfunction, intensive care requirements, and outcomes. Intensive Care Med 2005; 31:1087-94. [PMID: 16012807 PMCID: PMC7095210 DOI: 10.1007/s00134-005-2710-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2004] [Accepted: 06/08/2005] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To compare case-mix, health care practices, and outcome in obstetric ICU admissions in inner-city teaching hospitals in economically developed and developing countries. DESIGN Retrospective study. SETTING Ben Taub General Hospital (BTGH), Houston, Texas, and King Edward Memorial Hospital (KEMH), Mumbai, India. PATIENTS Women admitted during pregnancy or 6 weeks postpartum between 1992 and 2001. MEASUREMENTS AND RESULTS Patients from BTGH (n=174) and KEMH (n=754) had comparable age, number of organs affected, incidence of medical disorders (30%), liver dysfunction, and thrombocytopenia. Fewer KEMH patients received prenatal care (27 vs 86%) and came to hospital within 24 h of onset of symptoms (60 vs 90%). They had higher APACHE II scores (median 16 vs 10), greater incidence of neurological (63 vs 36%), renal (50 vs 37%), and cardiovascular dysfunction (39 vs 29%). Severe malaria, viral hepatitis, cerebral venous thrombosis, and poisoning were common medical disorders. The BTGH group had higher incidence of respiratory dysfunction (59 vs 46%) and disseminated intravascular coagulation (40 vs 23%), placental anomalies, HELLP syndrome, chorioamnionitis, peripartum cardiomyopathy, puerperal sepsis, urinary infection, bacteremia, substance abuse, and asthma. More BTGH patients required mechanical ventilation and blood component therapy, whereas more KEMH patients needed dialysis. Of BTGH patients, 78.2% were delivered by cesarean section (vs 15.4%). Maternal (2.3 vs 25%) and fetal (13 vs 51%) mortality were lower in BTGH patients. CONCLUSIONS There were marked differences in medical diseases, organ failure, and intensive care needs. Higher mortality in the Indian ICU may be due to difference in case mix, inadequate prenatal care, delay in reaching hospital, and greater severity of illness.
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Affiliation(s)
- Uma Munnur
- Department of Anesthesiology and Obstetrics, Baylor College of Medicine, Ben Taub General Hospital, Houston, TX USA
| | - Dilip R. Karnad
- Department of Medicine, Medical-Neuro Intensive Care Unit, King Edward Memorial Hospital, 400012 Parel, Mumbai , India
| | - Venkata D. P. Bandi
- Department Of Medicine, Pulmonary and Critical Care Section, Baylor College of Medicine, Ben Taub General Hospital, Houston, TX USA
| | - Vijay Lapsia
- Department of Medicine, Medical-Neuro Intensive Care Unit, King Edward Memorial Hospital, 400012 Parel, Mumbai , India
| | - Maya S. Suresh
- Department of Anesthesiology and Obstetrics, Baylor College of Medicine, Ben Taub General Hospital, Houston, TX USA
| | - Priya Ramshesh
- Department of Medicine, Medical-Neuro Intensive Care Unit, King Edward Memorial Hospital, 400012 Parel, Mumbai , India
| | - Michael A. Gardner
- Department of Anesthesiology and Obstetrics, Baylor College of Medicine, Ben Taub General Hospital, Houston, TX USA
| | - Stephen Longmire
- Department of Anesthesiology and Obstetrics, Baylor College of Medicine, Ben Taub General Hospital, Houston, TX USA
| | - Kalpalatha K. Guntupalli
- Department Of Medicine, Pulmonary and Critical Care Section, Baylor College of Medicine, Ben Taub General Hospital, Houston, TX USA
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