Research progress on the influence of maternal gestational diabetes mellitus on fetal outcomes / 中华实用儿科临床杂志

Gestational diabetes mellitus (GDM) is the most common metabolic disorder during pregnancy, which seriously affects the normal development of the fetus.Blood glucose control during pregnancy is associated not only with recent adverse outcomes such as preterm birth, macrosomia, hypoglycemia, neonatal respiratory distress syndrome, electrolyte disorders, heart malformations and intestinal disorders, but also with long-term results such as conti-nued impaired glucose tolerance, obesity, metabolic syndrome, mental illness and eye disease.Correct understanding of adverse effects of GDM on newborn infants in the short and long term and their related mechanisms as well as timely prevention and treatment measures can significantly improve the outcome of pregnancy.This paper will make a summary of these problems.

La responsabilidad jurídica del médico, conceptos que se debaten entre dos ciencias / The Physician's Legal Responsibility, Debatable Concepts between two Sciences

La exigencia de responsabilidad jurídica a los profesionales de la salud ha experimentado, a pesar de su antigüedad, un auge en las sociedades contemporáneas. En el artículo se reflexiona sobre conceptos médicos y jurídicos que permitan clarificar los presupuestos de intervención del Derecho en el ámbito de la Medicina, en función de la determinación de la responsabilidad médica jurídicamente relevante(AU)

In spite of being demanded since long ago, legal responsibility from health professionals has experienced a boom in contemporary societies. This article reflects on medical and legal concepts that make it possible to clarify the assumptions for involving law in the field of medicine, based on the determination of legally relevant medical responsibility(AU)

Glycemic gap as a predictor of adverse outcomes in patients with Type 2 Diabetes Diagnosed with COVID-19 in a tertiary hospital in Metro Manila: A retrospective cohort study

Background@#Although elevated glucose levels are associated with adverse outcomes in the critically ill, HbA1c-based adjusted glycemic variables have not been extensively utilized as a tool to evaluate patients in the acute critical condition.@*Objective@#This study aims to determine whether glycemic gap can predict adverse outcomes in patients with type 2 diabetes diagnosed with COVID-19.@*Methodology@# A single center and retrospective study of adult patients with type 2 diabetes diagnosed with COVID- 19. Glycemic gap was calculated as the difference between the admission blood glucose and A1c‐derived average glucose. Logistic regression was used to determine association of glycemic gap and several adverse clinical outcomes. A decision curve analysis was used to determine the clinical utility of a clinical decision model based on this cut-off.@*Results@#A total of 150 diabetic patients with COVID-19 were analyzed. Median baseline HbA1c was 7.5% (range 4.79–18.42), while median admitting blood glucose was 196 (range 71–506) mg/dL. From these, computed glycemic gaps ranged from -180.5 to 312.8 mg/dL, with a median of 13.75 mg/dL. On univariate analysis, for every unit increase in glycemic gap, odds of developing ARDS increased five times (cOR 4.798, 95% CI 2.08 to 11.09); odds of developing shock increased four times (cOR 4.48, 95% CI 1.48 to 13.44). No single cut-off value for glycemic gap was able to discriminate patients with favorable outcome from those with adverse outcome. The decision curve analysis graphically shows that glycemic gap has a positive net benefit for threshold risk of 50% or higher.@*Conclusion@#Higher glycemic gaps were significantly associated with increased risk for poor outcomes in diabetic patients with COVID-19. Glycemic gap should be correlated with clinical status and other laboratory parameters to make it a more powerful discriminant among COVID-19 infected patients.

The predictive accuracy of hypoxic scoring for prediction of adverse outcome in neonates born with asphyxia

Background: Birth asphyxia is a major contributor to neonatal mortality. Fetal hypoxia followed by asphyxia is common cause of brain injury in term infants. Hypoxia score has shown to be accurate enough to predict adverse outcome in asphyxiated neonates. But controversies exist regarding predictive accuracy of hypoxia score. So we conducted this study. Objective to assess the predictive accuracy of hypoxic scoring for prediction of adverse outcome in neonates born with asphyxia.Methods: 170 neonates were screed for hypoxia score. Neonates were labelled as positive or negative. Then all neonates were followed-up for 7 days. If neonate died within 7days, then case was confirmed as positive or negative. Data was analysed by using SPSS 20. 2x2 table was developed to calculate sensitivity, specificity, PPV, NPV and predictive accuracy of hypoxia score.Results: The mean Apgar score at birth was 5.01'0.83. The sensitivity of hypoxia score was 87.8%, specificity was 90.9%, PPV was 90%, NPV was 88.9% while predictive accuracy was 89.4% taking actual adverse outcome as gold standard.Conclusions: The predictive accuracy of hypoxia score was high for prediction of adverse outcome in asphyxiated neonates.

The association between mode of action and adverse outcome pathway and its application in risk assessment / 中华预防医学杂志

Risk assessment is a necessary technical means to protect human health and environmental safety. Traditional risk assessment based on toxicity data obtained from animal experiments was difficult to meet the need for risk assessment for a large number of chemicals due to the low throughput, long cycle, high cost and uncertainty of extrapolation to human exposure dose. The proposed risk assessment frameworks, the model of action (MOA) and the adverse outcome pathway (AOP), pointed the way for us to develop new and efficient evaluation methods. In this review, the basic concepts and contents of MOA and AOP, as well as the relationship between them, were introduced. Taking acrylamide (AA) as an example, this review briefly described the application of MOA/AOP framework in chemical risk assessment, so as to provide theoretical guidance for better application of MOA/AOP framework in chemical risk assessment.

The association between mode of action and adverse outcome pathway and its application in risk assessment / 中华预防医学杂志

Risk assessment is a necessary technical means to protect human health and environmental safety. Traditional risk assessment based on toxicity data obtained from animal experiments was difficult to meet the need for risk assessment for a large number of chemicals due to the low throughput, long cycle, high cost and uncertainty of extrapolation to human exposure dose. The proposed risk assessment frameworks, the model of action (MOA) and the adverse outcome pathway (AOP), pointed the way for us to develop new and efficient evaluation methods. In this review, the basic concepts and contents of MOA and AOP, as well as the relationship between them, were introduced. Taking acrylamide (AA) as an example, this review briefly described the application of MOA/AOP framework in chemical risk assessment, so as to provide theoretical guidance for better application of MOA/AOP framework in chemical risk assessment.

A Putative Adverse Outcome Pathway Relevant to Carcinogenicity Induced by Sulfuric Acid in Strong Inorganic Acid Mists

Based on epidemiological studies, an International Agency for Research on Cancer Working Group determined that strong inorganic acid mists containing sulfuric acid are carcinogenic to human even though, sulfuric acid, per se, is not. Accumulative studies indicate that there is a link between chronic occupational exposure to sulfuric acid mists and an increased risk of laryngeal cancer. Unintended, acute exposure to sulfuric acid mists can cause corrosive damage to target tissues depending on the route of exposure. This review compares the toxicity and carcinogenicity of sulfuric acid mists compared to other strong inorganic acid mists. It also examines the routes and duration of exposure (short-term, prolonged, and long-term). In vivo evidence does not support or refute the carcinogenicity of sulfuric inorganic mists even though its co-carcinogenic or promoting potential has been considered. On the basis of existing evidence on sulfuric acid mist toxicity, we suggested a putative adverse outcome pathway (AOP) relevant to carcinogenicity caused by mists containing sulfuric acid. A possible key factor involved in sulfuric acid mist carcinogenesis is the genotoxic effects of low pH since it can increase instability in chromosomes and DNA. A putative AOP for sulfuric acid mist carcinogenicity would help generate better risk assessments and more accurate predictions regarding the risk of developing cancer due to prolonged exposure. Establishing an AOP would also be useful for future studies examining the carcinogenicity of other strong inorganic mists.

Comparing the effects of depression, anxiety, and comorbidity on quality-of-life, adverse outcomes, and medical expenditure in Chinese patients with acute coronary syndrome / 中华医学杂志(英文版)

Background:@#Depression and anxiety have been correlated with elevated risks for quality-of-life (QOL), adverse outcomes, and medical expenditure in patients with acute coronary syndrome (ACS). However, the relevant data are lacking for Chinese ACS populations, especially regarding different effects of major depression, anxiety, and comorbidity. The objective of this study was to evaluate the dynamic changes of depression and/or anxiety over 12 months and examine the effects of depression, anxiety, and comorbidity on QOL, adverse outcomes, and medical expenditure in Chinese patients with ACS.@*Methods:@#For this prospective longitudinal study, a total of 647 patients with ACS were recruited from North China between January 2013 and June 2015. Among them, 531 patients (82.1%) completed 12-month follow-ups. Logistic regression model was utilized for analyzing the association of baseline major depression, anxiety, and comorbidity with 12-month all-cause mortality, cardiovascular events, QOL, and health expenditure.@*Results:@#During a follow-up period of 12 months, 7.3% experienced non-fatal myocardial infarction (MI) and 35.8% cardiac rehospitalization. Baseline comorbidity, rather than major depression/anxiety, strongly predicted poor 12-month QOL as measured by short-form health survey-12 (odds ratio [OR]: 1.77, 95% confidence interval [CI]: 1.22–2.52, P = 0.003). Regarding 12-month non-fatal MI and cardiac re-hospitalization, baseline anxiety (OR: 2.83, 95% CI: 1.33–5.89, P < 0.01; OR: 4.47, 95% CI: 1.50–13.00, P < 0.01), major depression (OR: 2.58, 95% CI: 1.02–6.15, P < 0.05; OR: 5.22, 95% CI: 1.42–17.57, P < 0.03), and comorbidity (OR: 6.33, 95% CI: 2.96–13.79, P < 0.0001, OR: 14.08, 95% CI: 4.99–41.66, P < 0.0001) were all independent predictors, and comorbidity had the highest predictive value. Number of re-hospitalization stay, admission frequency within 12 months and medical expenditure within 2 months were the highest in patients with ACS with comorbidity.@*Conclusions:@#Major depression and anxiety may predict 12-month non-fatal MI and cardiac re-hospitalization. However, comorbidity has the highest predictive value with greater medical expenditure and worse QOL in Chinese patients with ACS. And depression with comorbid anxiety may be a new target of mood status in patients with ACS.

Application of the Adverse Outcome Pathway Framework to Risk Assessment for Predicting Carcinogenicity of Chemicals

As industry develops in modern society, many chemicals are being used. The safety of chemicals is an important issue because humans are constantly exposed to chemicals throughout their daily life. Through a risk assessment, the hazardous human effects of chemicals can be identified. Recently, the adverse outcome pathway (AOP) framework has been used to predict the adverse effects of chemicals. As a conceptual framework for organizing existing biological knowledge, the AOP consists of a molecular initiating event, key events, and an adverse outcome. These independent elements represent biological responses and are connected by key event relationships. This AOP framework provides intuitive hazard identification that can be helpful for carcinogenic risk assessment of chemicals. In this review, we introduce the application of the AOP framework to risk assessment for predicting carcinogenicity of chemicals and illustrate the utility of this approach for cancer prevention.

Use of adverse outcome pathways in chemical toxicity testing: potential advantages and limitations

Amid revolutionary changes in toxicity assessment brought about by increasing regulation of chemicals, adverse outcome pathways (AOPs) have emerged as a useful framework to assess adverse effect of chemicals using molecular level effect, which aid in setting environmental regulation policies. AOPs are biological maps that describe mechanisms linking molecular initiating event to adverse outcomes (AOs) at an individual level. Each AOP consists of a molecular initiating event, key events, and an AO. AOPs use molecular markers to predict endpoints currently used in risk assessment, promote alternatives to animal model-based test methods, and provide scientific explanations for the effects of chemical exposures. Moreover, AOPs enhance certainty in interpreting existing and new information. The application of AOPs in chemical toxicity testing will help shift the existing paradigm of chemical management based on apical endpoints toward active application of in silico and in vitro data.

In vitro method for skin sensitization based on dendritic cell activation / 中国比较医学杂志

Allergy contact dermatitis is a type IV delayed type hypersensitivity that is induced by exogenous compounds and involves many cell types. Traditional animal testing uses guinea pigs or mice as a model. With progress of the adverse outcome pathway(AOP)on skin sensitization, a concept for development of alternative methods based on a molecular initiating event and key events is provided. Dendritic cell(DC)activation plays a key role in the AOP. Many alternative methods have been developed,with several methods validated and accepted as guidance for assays. This paper examines DC screening, characteristics of test parameters, and limitations and applicability of DC-derived methods. Progress on interactions between DCs and other cells, co-culture systems, and the human body-on-a-chip will also be introduced. Altogether,this paper will provide information for optimization of in vitro alternative methods for sensitization detection.

Use of adverse outcome pathways in chemical toxicity testing: potential advantages and limitations

Amid revolutionary changes in toxicity assessment brought about by increasing regulation of chemicals, adverse outcome pathways (AOPs) have emerged as a useful framework to assess adverse effect of chemicals using molecular level effect, which aid in setting environmental regulation policies. AOPs are biological maps that describe mechanisms linking molecular initiating event to adverse outcomes (AOs) at an individual level. Each AOP consists of a molecular initiating event, key events, and an AO. AOPs use molecular markers to predict endpoints currently used in risk assessment, promote alternatives to animal model-based test methods, and provide scientific explanations for the effects of chemical exposures. Moreover, AOPs enhance certainty in interpreting existing and new information. The application of AOPs in chemical toxicity testing will help shift the existing paradigm of chemical management based on apical endpoints toward active application of in silico and in vitro data.

Diferencia entre la concentración de factores angiogénicos en preeclampsia e hipertensión gestacional y su relación con el resultado materno y perinatal / Differences between concentrations of angiogenic factors in preeclampsia and gestational hypertension and their relationship with adverse maternal and perinatal outcome

Resumen OBJETIVO: determinar la relación entre las concentraciones séricas de factores angiogénicos con la severidad de la preeclampsia e hipertensión gestacional y con el resultado materno y perinatal adverso. MATERIALES Y MÉTODOS: estudio transversal y comparativo efectuado en pacientes atendidas entre los meses de septiembre de 2013 y agosto de 2015 en la Unidad Médica de Alta Especialidad. La población de estudio se dividió en cinco grupos: 1) hipertensión gestacional leve, 2) preeclampsia leve, 3) hipertensión gestacional severa, 4) preeclampsia severa y 5) preeclampsia severa complicada. Además, el total de pacientes se analizó según el resultado materno o perinatal adverso. Las concentraciones séricas de sFlt-1, PlGF y su relación sFlt1/PlGF se midieron con electroquimioluminiscencia. RESULTADOS: se estudiaron 196 mujeres con embarazo único ≥ 20 semanas de gestación, con hipertensión gestacional y preeclampsia. Las concentraciones de sFlt-1, PlGF y la relación sFlt1/PlGF fueron significativamente diferentes entre los cinco grupos de estudio (p < 0.001). La diferencia en la concentración de los factores angiogénicos fue más marcada conforme mayor fue la severidad de la enfermedad hipertensiva en el embarazo (p < 0.001). La relación sFlt-1/PIGF fue significativamente mayor en las pacientes con resultado materno o perinatal adverso en comparación con quienes no lo tuvieron (222.5 vs 112.8 y 158.3 vs 53.1, respectivamente) p < 0.001. CONCLUSIÓN: conforme mayor fue la severidad de la enfermedad hipertensiva en el embarazo se observó mayor alteración en la concentración de factores angiogénicos (p < 0.001). Así mismo, la relación sFlt-1/PIG fue mayor en pacientes con resultado materno y perinatal adverso (p < 0.001).

Abstract BACKGROUND: Preeclampsia is a major cause of maternal and fetal morbidity and mortality. The loss of the balance between pro-angiogenic and antiangiogenic factors precedes the clinical presentation of preeclampsia. This alteration is greater in early and severe forms of the disease and shows association to adverse perinatal outcome. OBJECTIVE: To determine the relationship between serum concentrations of angiogenic factors and the severity of preeclampsia and gestational hypertension with the maternal and perinatal outcome. MATERIALS AND METHODS: A cross-sectional comparative study from September 2013 to August 2015 was performed in the Hospital of Gynecology and Obstetrics No. 4 IMSS Luis Castelazo Ayala. A total of 196 patients were analyzed including singleton pregnancies ≥ 20 weeks' gestation diagnosed with preeclampsia and gestational hypertension. The patients were divided in five groups: mild gestational hypertension (n = 46), mild preeclampsia (n = 20), severe gestational hypertension (n = 19), severe preeclampsia (n = 89), and severe complicated preeclampsia (n = 22). Additionally the total patients were divided in two groups: with and without adverse maternal outcome and the second group with and without adverse perinatal outcome. The serum concentration of sFlt-1, PlGF and the respective sFlt1/PLGF ratio were determinate with electrochemiluminescence. The management and timing of the termination of pregnancy was performed based on established guidelines for clinical practice. RESULTS: The serum concentration of sFlt-1, PlGF and the respective sFlt1/PLGF ratio were significant different between the 5 groups analyzed (p < 0.001). Moreover, the difference of the concentrations of angiogenic factors are closely associated with the severity of hypertensive disease of pregnancy (p < 0.001). The sFlt1/PLGF ratio was higher in those with adverse maternal and fetal outcomes compared to those who did not had (222.5 vs 112.8 and 158.3 vs 53.1 respectively) p < 0.001. CONCLUSION: Major alteration was observed in the concentration of angiogenic factors as the greater the severity of hypertensive disease in pregnancy. Likewise, the sFlt-1/PlGF ratio was higher in those with adverse maternal and perinatal outcomes compared to those who did not have. Therefore this relationship has potential use as a biochemical marker of severity and risk stratification.

Combined approaches using adverse outcome pathways and big data to find potential diseases associated with humidifier disinfectant

According to previous survey, about two million of people were expected to suffer from toxic effects due to humidifier disinfectant (HD), regardless of healing or not. Extremely small group are recognized as HDs’ victims. Up to now, previous research tried to focus on interstitial fibrosis on terminal bronchiole because it is specific finding, compared with other diseases. To figure out overall effects from HDs, we recommend adverse outcome pathways (AOPs) as new approach. Reactive oxygen species (ROS) generation, decreased T-cell and pro-inflammatory cytokine release from macrophage could be key events between the exposure to HDs and diseases. ROS generation, decreased cell and pro-inflammatory cytokine release from macrophage could be cause of interstitial fibrosis, pneumonia and many other diseases such as asthma, allergic rhinitis, allergic dermatitis, fetal death, premature baby, autoimmune disease, hepatic toxicity, renal toxicity, cancer, and so on. We predict potential disease candidate by AOPs. We can validate the real risk of the adverse outcome by epidemiologic and toxicologic study using big data such as National Health Insurance data and AOPs knowledge base. Application of these kinds of new methods can find the potential disease list from the exposure to HD.

Combined approaches using adverse outcome pathways and big data to find potential diseasesassociated with humidifier disinfectant

According to previous survey, about two million of people were expected to suffer from toxic effects due to humidifier disinfectant (HD), regardless of healing or not. Extremely small group are recognized as HDs’ victims. Up to now, previous research tried to focus on interstitial fibrosis on terminal bronchiole because it is specific finding, compared with other diseases. To figure out overall effects from HDs, we recommend adverse outcome pathways (AOPs) as new approach. Reactive oxygen species (ROS) generation, decreased T-cell and pro-inflammatory cytokine release from macrophage could be key events between the exposure to HDs and diseases. ROS generation, decreased cell and pro-inflammatory cytokine release from macrophage could be cause of interstitial fibrosis, pneumonia and many other diseases such as asthma, allergic rhinitis, allergic dermatitis, fetal death, premature baby, autoimmune disease, hepatic toxicity, renal toxicity, cancer, and so on. We predict potential disease candidate by AOPs. We can validate the real risk of the adverse outcome by epidemiologic and toxicologic study using big data such as National Health Insurance data and AOPs knowledge base. Application of these kinds of new methods can find the potential disease list from the exposure to HD.

Clinical characteristics of childhood purulent meningitis and its risk factors for adverse prognosis / 中华实用儿科临床杂志

Objective To investigate the clinical characteristics of childhood purulent meningitis (PM)and the risk factors for its adverse outcome.Methods One hundred and nine children with PM were retrospective ana-lyzed,who were admitted to pediatric department in Xijing Hospital of the Fourth Military Medical University from Ja-nuary 2008 to July 201 6.They were divided into 5 age groups,the clinical features were compared among the different age groups.According to Glasgow prognostic score,all cases were then divided into 2 groups,the favorable outcome group and the adverse outcome group.All factors including normal information,disease history,clinical manifestations and laboratory examinations were compared between 2 groups.Results There were 72.5% (79 /1 09 cases)of the pa-tients younger than 3 years old.PMwas prone to spring and winter,and most children with PMhad preceding infection. The major clinical manifestations of PM were fever,convulsions and intracranial hypertension.The clinical manifesta-tions of PMwere different in different age groups,and convulsions were more commonly seen in less than 3 years old children,while headache,vomiting and meningeal stimulation had higher proportion in more than 3 years old children. The single factor analysis showed that there were repeated convulsions after admission (≥3 times),the cerebrospinal fluid (CSF)glucose(≤1 .5 mmol/L),CSF protein(≥1 g/L),CSF /blood glucose ratio and complications were signifi-cantly different between 2 groups(all P 500 ×1 06 /L,blood and CSF cultivate positive rate, co -infection,brain CT/MRI abnormality,electroencephalogram abnormality,treatment and duration of seizure more than 5 minutes were not significantly different(all P >0.05).Multivariate analysis showed that there were repeated convulsions after admission (≥3 times)(OR =27.84,P =0.048),CSF protein(≥1 g/L)(OR =28.44,P =0.027) and low CSF /blood glucose ratio (OR =22.1 5,P =0.041 )were independent risk factors for poor prognosis of PM. Conclusion PMhappens mostly in infantile period,with different clinical manifestations at different ages.The inde-pendent risk factors for poor prognosis were repeated convulsions after admission (≥3 times),CSF protein(≥1 g/L) and low CSF /blood glucose ratio.It indicates that if the high risk factors could be identified early,and then intervened immediately and followed up timely,it will be beneficial to improve the long -term prognosis.

Oxidative stress in perinatal asphyxia in relation to outcome.

Objective. To study the serum levels of oxidative stress markers - malondialdehyde (MDA) and protein carbonyl in babies with perinatal asphyxia and to correlate their levels with the outcome in terms of mortality and neurodevelopmental sequelae. Methods. A group of 40 term AGA (appropriate for gestational age) infants with perinatal asphyxia were selected as cases and same number of healthy babies as controls. Serum levels of oxidative stress markers - malondialdehyde and protein carbonyl were determined in cord blood and at 48 hours of life. Their levels were correlated with the outcome of perinatal asphyxia in terms of mortality and the long term neurological outcome. Results. MDA and protein carbonyl, in cord blood were significantly higher among cases (5.88±1.40 μmol/L and 1.50±0.48 nmol/mg of protein respectively) than controls (3.11±0.82 μmol/L and 0.83±0.19 nmol/mg of protein respectively). Among the cases, MDA and protein carbonyl values at 48 hours of life (7.52 ± 1.06 μmol/L and 2.91 ± 0.62 nmol/mg of protein respectively) were significantly higher than those at birth. MDA at birth and 48 hours was significantly higher among babies who had seizures than those who remained seizure free. These values were also significantly higher in babies who expired as compared to those who survived. Protein carbonyl values though higher in those who had seizures and in those who expired, were not statistically significant from controls. MDA and protein carbonyl at birth and 48 hours were higher in babies with developmental delay but the association was not statistically significant. Conclusions. In hypoxic ischemic encephalopathy (HIE), oxidative stress markers MDA and protein carbonyl are high at birth and rise further at 48 hours and the values correlate with the morbidity and mortality. Therefore, determining the serum levels of oxidative stress markers MDA and protein carbonyl will be of benefit in predicting the outcome in perinatal asphyxia.

A Comparison of Obstetric and Non-obstetric Anesthesia Medical Accidents / 대한마취과학회지

BACKGROUND: Obstetrics departments are unique and medical accidents in obstetric anesthesia may show differences from non-obstetric anesthesia accidents.So we compared both groups in several aspects for the understanding their characters and decreasing their incidence. METHODS: Obstetric anesthesia accidents (n = 30) and non-obstetric anesthesia accidents (n = 106) were compared in 6 categories (patient age, anesthesia method, damaging event, anesthetic care, severity of injury, payment). RESULTS: The most common complications in obstetric anesthesia accidents were maternal death (40%), maternal brain damage (13%), and maternal nerve injury (13%).In contrast, the most common complications in non-obstetric anesthesia accidents were patient death (62%), and patient brain damage (27%). The severity of injury score of obstetric anesthesia adverse outcomes was analogous to that of non-obstetric anesthesia adverse outcomes, but the payment for obstetric accidents was significantly greater than that for non-obstetric accidents. CONCLUSIONS: Obstetric anesthesia accidents revealed distinct medical risk profiles, such as patient age, damaging event, severity of injury, and payment.Special care should be used when anesthetizing younger women and caring for a newborn in obstetric anesthesia.More studies and analyses are necessary to prevent obstetric anesthesia accidents.