RESUMEN
BACKGROUND: Acellular pertussis (aP) vaccines replaced whole-cell pertussis (wP) vaccines for the US childhood primary series in 1997. As women primed with aP vaccines enter childbearing age, protection of infants through tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination during pregnancy may be impacted. METHODS: Term infants born to women vaccinated with Tdap during pregnancy were included. Geometric mean concentrations (GMCs) of pertussis-specific immunoglobulin G antibodies (international units per milliliter) in cord blood of infants born to women born after 1997 (aP-primed) were compared with those born to women born before 1992 (wP-primed). RESULTS: 253 and 506 infants born to aP- and wP-primed women, respectively, were included. Compared with wP-primed women, aP-primed women were younger, more likely to be Hispanic or non-Hispanic Black, and had lower-birthweight infants (P < .01 for all). Antibodies against pertussis toxin (PT) and filamentous hemagglutinin (FHA) were lower among infants born to aP-primed vs wP-primed women (PT, 17.3 vs 36.4; GMC ratio, .475; 95% confidence interval [CI], .408-.552 and FHA, 104.6 vs 121.4; GMC ratio, 0.861; 95% CI, .776-.958). No differences were observed for anti-fimbriae or anti-pertactin antibodies. CONCLUSIONS: Transplacental anti-pertussis antibody concentrations in infants of women vaccinated with Tdap during pregnancy differed by type of childhood vaccine the women received. Notably, anti-PT antibody levels, considered most important in preventing severe infant disease, were lower in infants born to aP-primed vs wP-primed women. Maternal Tdap vaccination may confer less protection against pertussis in infants born to aP-primed vs those born to wP-primed women.
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Vacunas contra Difteria, Tétanos y Tos Ferina Acelular , Difteria , Tos Ferina , Embarazo , Lactante , Femenino , Humanos , Anticuerpos Antibacterianos , Vacuna contra la Tos Ferina , Tos Ferina/prevención & control , Toxina del Pertussis , Vacunación , Difteria/prevención & controlRESUMEN
BACKGROUND: Kinetics of Tdap-induced maternally-derived antibodies in infants are poorly understood. Pre-Tdap era data suggest that maternal pertussis antibodies in infants have a half-life of approximately 5-6â¯weeks. METHODS: 34 mother-infant pairs had blood collected before maternal Tdap vaccination, 4â¯weeks later, at delivery (maternal and cord), and at infant ages 3 and 6â¯weeks from June 2014-March 2015. Immunoglobulin G (IgG) to pertussis toxin (PT), filamentous hemagglutinin (FHA), fimbrial proteins (FIM) and pertactin (PRN) was quantified by multiplex luminex assay (IU/ml). Geometric mean concentrations (GMCs) with 95% confidence intervals (C.I.) and half-life of pertussis antibodies were calculated. RESULTS: Tdap was administered to 34 women (mean age 31.1â¯years) at mean gestation 30.7â¯weeks (28-32.7). Mean neonatal gestation was 39.1â¯weeks (36-41.1) and mean birthweight was 3379â¯g (2580-4584). Four weeks post-Tdap vaccination, maternal pertussis-specific IgG GMCs increased ≥4-fold in 59%, 41%, 29% and 44% of women for PT, FHA, FIM and PRN, respectively, and then waned. The transplacental transport ratio of pertussis antibodies was 1.35 for PT, 1.41 for FHA, 1.31 for FIM and 1.36 for PRN. Between birth and age 6â¯weeks, infant serum GMC for PT-specific IgG decreased from 55.1â¯IU/mL (38.6-78.6) to 21.1â¯IU/ml (14.7-30.2), and the proportion of infants with PT levels ≥10â¯IU/ml fell from 97% to 67%. Half-life of pertussis-specific IgG in infants in days was 29.4 (95% CI 27.3-31.7) for PT, 29.8 (95% CI 27.7-32.2) for FHA, 31.2 (95% CI 28.9-33.7) for PRN, and 35.8 (95% CI 30.1-44.3) for FIM. CONCLUSION: The half-life of pertussis-specific antibodies in infants induced by maternal Tdap vaccination (29-36â¯days) is shorter than previously reported. Understanding how the durability of passively-acquired antibodies impacts infant susceptibility to pertussis and response to primary vaccination is critical to refine prevention strategies.
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Vacunas contra Difteria, Tétanos y Tos Ferina Acelular , Difteria , Tétanos , Tos Ferina , Adulto , Anticuerpos Antibacterianos , Niño , Preescolar , Femenino , Humanos , Lactante , Cinética , Madres , Embarazo , Tos Ferina/prevención & controlRESUMEN
OBJECTIVE: To estimate the rate of readmissions for postpartum venous thromboembolism (VTE) during the first 30 days postdelivery between women with and without the immediate postpartum insertion of the etonogestrel contraceptive implant. METHODS: The Nationwide Readmissions Database from 2016 was used to identify women with a singleton delivery, immediate postpartum insertion of the etonogestrel contraceptive implant, and readmission for VTE within 30 days of discharge. Those with a prior history of VTE or anticoagulant therapy were excluded. These women were compared with the number of women readmitted within 30 days for VTE who did not have the contraceptive implant placed during delivery admission. RESULTS: Of 3,387,120 deliveries, 8,369 women underwent etonogestrel contraceptive implant placement during the delivery admission. There was no difference identified in the rate of readmission for VTE between exposed and unexposed women. Of these, seven had received a postpartum etonogestrel contraceptive implant (0.85/1,000; 95% CI 0.22-1.45/1,000 deliveries), compared with 1,192 without an etonogestrel contraceptive implant (0.35/1,000; 95% CI 0.33-0.37/1,000 deliveries); odds ratio (OR) 2.41; 95% CI 0.58-9.89. The rates of diabetes, thrombophilia, systemic lupus erythematosus, and cesarean birth did not differ between groups. Women who underwent etonogestrel contraceptive implant placement were younger and were more likely to have government-sponsored health insurance, a smoking history, hypertension, peripartum infection, or postpartum hemorrhage than women who did not receive an etonogestrel contraceptive implant (P<.001). After adjusting for these confounders, there remained no difference in rates of VTE, adjusted OR 1.81; 95% CI 0.44-7.45. CONCLUSION: The immediate postpartum placement of the etonogestrel contraceptive implant was not associated with an increased rate of VTE; however, our sample size was underpowered to determine no difference.
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Anticoncepción/métodos , Anticonceptivos Femeninos/administración & dosificación , Desogestrel/administración & dosificación , Readmisión del Paciente/estadística & datos numéricos , Tromboembolia Venosa/epidemiología , Adulto , Anticonceptivos Femeninos/uso terapéutico , Bases de Datos Factuales , Desogestrel/uso terapéutico , Implantes de Medicamentos , Femenino , Humanos , Modelos Logísticos , Atención Posnatal , Periodo Posparto , Trastornos Puerperales/epidemiología , Trastornos Puerperales/terapia , Estados Unidos/epidemiología , Tromboembolia Venosa/terapia , Adulto JovenRESUMEN
Coronavirus disease 2019 (COVID-19) has been declared a public health emergency for the entire United States. Providing access to prenatal health care while limiting exposure of both obstetric health care professionals and patients to COVID-19 is challenging. Although reductions in the frequency of prenatal visits and implementation of telehealth interventions provide some options, there still remains a need for patient-health care professional visits. A drive-through prenatal care model was developed in which pregnant women would remain in their automobiles while being assessed by the health care professional, thus reducing potential patient, health care professional, and staff exposure to COVID-19. Drive-through prenatal visits would include key elements that some institutions cannot perform by telehealth encounters, such as blood pressure measurements for evaluation for hypertensive disorders of pregnancy, fetal heart rate assessment, and selected ultrasound-based measurements or observations, as well as face-to-face patient-health care professional interaction, thereby reducing patient anxiety resulting from the reduction in the number of planned clinic visits with an obstetric health care professional as well as fear of virus exposure in the clinic setting. We describe the rapid development of a drive-through prenatal care model that is projected to reduce the number of in-person clinic visits by 33% per patient compared with the traditional prenatal care paradigm, using equipment and supplies that most obstetric clinics in the United States can access.
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Betacoronavirus , Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , Complicaciones Infecciosas del Embarazo/prevención & control , Atención Prenatal/métodos , Telemedicina/métodos , COVID-19 , Infecciones por Coronavirus/virología , Femenino , Humanos , Neumonía Viral/virología , Embarazo , Complicaciones Infecciosas del Embarazo/virología , SARS-CoV-2 , Estados UnidosRESUMEN
OBJECTIVES: Adequate repair is vital to reduce the long-term sequelae of obstetric anal sphincter injuries (OASIS). Sufficient documentation is necessary to reflect the quality of care provided, to guide future management, and to reduce medicolegal liability. With the advent of electronic health records, proper methods of documentation can be more easily disseminated and applied for general use. The objectives of our study were to assess whether documentation of OASIS management is improved by introducing a standardized electronic operative report, determining rates of readmission due to complications, and measuring adherence to practice guidelines. METHODS: A pre- and postintervention study was conducted by auditing electronic charts of patients affected by OASIS at two university-affiliated delivery units throughout the 2016 calendar year. Unit A is a safety-net hospital and unit B is private. A standardized electronic template was created in the electronic health records of both units. The primary outcome was the quality of repair documentation, which was quantified using a scale that included all relevant aspects of the repair. RESULTS: Analyzing both units separately, baseline characteristics including operator training level, episiotomy rate, and operative delivery were similar pre- and postintervention. The quality of documentation measured by the scale score improved significantly postintervention. Proper use of antibiotics and bowel regimen significantly increased after the intervention at both units. CONCLUSIONS: The use of a standardized electronic template for reporting the diagnosis and repair of OASIS improves the thoroughness of documentation and appears to promote the implementation of best practice guidelines.
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Canal Anal/lesiones , Parto Obstétrico/métodos , Documentación/normas , Laceraciones/cirugía , Complicaciones del Trabajo de Parto/cirugía , Mejoramiento de la Calidad , Adolescente , Adulto , Registros Electrónicos de Salud , Femenino , Hospitales Privados , Humanos , Embarazo , Proveedores de Redes de Seguridad , Técnicas de Sutura , Adulto JovenRESUMEN
OBJECTIVE: The purpose of this study was to evaluate role conflict between professional and familial responsibilities among obstetric health care providers during a natural disaster between those required to stay in the hospital versus those who were at home during a catastrophic weather event. METHODS: A survey was used of obstetric attending and resident physicians in the Baylor College of Medicine, Department of Obstetrics and Gynecology following Hurricane Harvey on August 26, 2017. RESULTS: Ninety one of 103 physicians (88%) completed the survey. Survey responses were compared between physicians who worked in the hospital (n = 47) versus those who were at home (n = 44) during the storm and its immediate aftermath. Physicians in the hospital and at home agreed (47% and 48%, respectively, P = 0.94) that professional duties conflicted with family obligations and felt torn (49% and 55%, respectively, P = 0.48) regarding family obligations. A majority of homebound health care providers disagreed with the statement that professional duties override family responsibilities, whereas less than half of in-hospital providers felt the same (68% at-home versus 47% of the hospital-team, P = 0.10). CONCLUSION: As organizations prepare for possible catastrophic situations, institutions must realize that obstetric health care providers will experience role conflict between professional and family responsibilities. (Disaster Med Public Health Preparedness. 2019;13:33-37).
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Ginecología/métodos , Desastres Naturales , Rol Profesional/psicología , Adulto , Actitud del Personal de Salud , Femenino , Humanos , Pautas de la Práctica en Medicina/tendencias , Embarazo , Encuestas y CuestionariosRESUMEN
BACKGROUND: Adverse effects of opioid analgesics and potential for chronic use are limitations in the cesarean setting. Regional anesthesia using transversus abdominis plane (TAP) block post-cesarean delivery may improve analgesia and reduce opioid consumption. Effectiveness of TAP block using liposomal bupivacaine (LB) to reduce post-cesarean pain is unknown. METHODS: We performed a single-center retrospective chart review of patients aged ≥18 years who underwent cesarean delivery with a multimodal pain management protocol with or without TAP block with LB 266 mg. Assessments included postsurgical opioid consumption; area under the curve (AUC) of numeric rating scale pain scores from 0 to 3 days; proportion of opioid-free patients; discharge- and post-anesthesia care unit (PACU)-ready time; times to ambulation, solid food, and bowel movement; hospital length of stay (LOS); and adverse events (AEs). Data were analyzed in the total population and in first- and repeat-cesarean subgroups using Wilcoxon, chi-squared, and Student's t-tests. RESULTS: Of 201 patients, 101 were treated with LB TAP block (LB-TAPB) and 100 without LB-TAPB. Treatment with LB-TAPB vs without LB-TAPB significantly reduced mean post-surgical opioid consumption (total, 47%; first-cesarean, 54%; repeat-cesarean, 42%; P<0.001 each) and mean AUC of pain scores (total, 46%; first-cesarean, 57%; repeat-cesarean, 40%; P<0.001 each). Patients treated with LB-TAPB had significantly shorter mean discharge-ready times (2.9 vs 3.6 days; P=0.006), PACU-ready times (138 vs 163 minutes; P=0.028), and LOS (2.9 vs 3.9 days; P<0.001). LB-TAPB significantly decreased mean times to ambulation and solid food by 39% and 31% (P<0.01 each), respectively, and numerically reduced mean time to bowel movement (26%; P=0.05). Fewer patients treated with LB-TAPB vs without LB-TAPB reported an AE (34% vs 50%; P=0.026). CONCLUSION: These results suggest multimodal pain management incorporating TAP block with LB 266 mg is an effective approach to reducing opioid requirements and improving analgesia post-cesarean delivery.
RESUMEN
Importance: Immunization with tetanus, diphtheria, and acellular pertussis (Tdap) vaccine is recommended in the United States during weeks 27 through 36 of pregnancy to prevent life-threatening infant pertussis. The optimal gestation for immunization to maximize concentrations of neonatal pertussis toxin antibodies is unknown. Objective: To determine pertussis toxin antibody concentrations in cord blood from neonates born to women immunized and unimmunized with Tdap vaccine in pregnancy and optimal gestational age for immunization to maximize concentrations of neonatal antibodies. Design, Setting, and Participants: Prospective, observational, cohort study of term neonates in Houston, Texas (December 2013-March 2014). Exposures: Tdap immunization during weeks 27 through 36 of pregnancy or no Tdap immunization. Main Outcomes and Measures: Primary outcome was geometric mean concentrations (GMCs) of pertussis toxin antibodies in cord blood of Tdap-exposed and Tdap-unexposed neonates and proportions of Tdap-exposed and Tdap-unexposed neonates with pertussis toxin antibody concentrations of 15 IU/mL or higher, 30 IU/mL or higher, and 40 IU/mL or higher, cutoffs representing quantifiable antibodies or levels that may be protective until the infant immunization series begins. Secondary outcome was the optimal gestation for immunization to achieve maximum pertussis toxin antibodies. Results: Six hundred twenty-six pregnancies (mean maternal age, 29.7 years; 41% white, 27% Hispanic, 26% black, 5% Asian, 1% other; mean gestation, 39.4 weeks) were included. Three hundred twelve women received Tdap vaccine at a mean gestation of 31.2 weeks (range, 27.3-36.4); 314 were unimmunized. GMC of neonatal cord pertussis toxin antibodies from the Tdap-exposed group was 47.3 IU/mL (95% CI, 42.1-53.2) compared with 12.9 IU/mL (95% CI, 11.7-14.3) in the Tdap-unexposed group, for a GMC ratio of 3.6 (95% CI, 3.1-4.2; P < .001). More Tdap-exposed than Tdap-unexposed neonates had pertussis toxin antibody concentrations of 15 IU/mL or higher (86% vs 37%; difference, 49% [95% CI, 42%-55%]), 30 IU/mL or higher (72% vs 17%; difference, 55% [95% CI, 49%-61%]), and 40 IU/mL or higher (59% vs 12%; difference, 47% [95% CI, 41%-54%]); P < .001 for each analysis. GMCs of pertussis toxin antibodies were highest when Tdap vaccine was administered during weeks 27 through 30 and declined thereafter, reaching a peak at week 30 (57.3 IU/mL [95% CI, 44.0-74.6]). Conclusions and Relevance: Immunization with Tdap vaccine during the third trimester of pregnancy, compared with no immunization, was associated with higher neonatal concentrations of pertussis toxin antibodies. Immunization early in the third trimester was associated with the highest concentrations.
Asunto(s)
Anticuerpos Antibacterianos/sangre , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/inmunología , Recién Nacido/inmunología , Toxina del Pertussis/inmunología , Tos Ferina/inmunología , Adolescente , Adulto , Femenino , Edad Gestacional , Humanos , Masculino , Embarazo , Tercer Trimestre del Embarazo , Estudios Prospectivos , Tos Ferina/prevención & control , Adulto JovenRESUMEN
OBJECTIVE: Nonmedical exemptions continue to rise because of increasing proportions of vaccine-hesitant parents. The proportion of expectant parents who are vaccine-hesitant is currently unknown. We assessed the prevalence of vaccine hesitancy among expectant parents receiving care at an obstetrics clinic in Houston, Texas. METHODS: We conducted a cross-sectional survey of expectant parents between 12 and 31 weeks gestation who received care at Texas Children's Pavilion for Women between July 2014 and September 2015. Using convenience sampling, participants completed a questionnaire that included questions on demographic items, self-assessed pregnancy risk, receipt of annual influenza vaccine, and the 15-item Parents Attitudes About Childhood Vaccines survey, a validated tool to identify vaccine-hesitant parents. We used multivariable logistic regression to determine the association of demographic characteristics, pregnancy risk, and influenza vaccine receipt with vaccine hesitancy after controlling for variables significant in univariable analyses. RESULTS: Six hundred ten expectant mothers and 38 expectant fathers completed the Parents Attitudes About Childhood Vaccines survey. Overall, 50 of 610 expectant mothers (8.2%; 95% confidence interval [CI], 6.1%-10.7%) were vaccine-hesitant. Expectant mothers were primarily non-Hispanic white, 30 years old or older, and married. The odds of being vaccine-hesitant were 2.2 times greater (95% CI, 1.2-4.1) among expectant mothers with a college level of education or less compared with those with more than a 4-year degree. The odds of being vaccine-hesitant were 7.4 times greater (95% CI, 3.9-14.0) among expectant mothers who do not receive an annual influenza vaccine compared with those who do. CONCLUSIONS: Our findings suggest the need to identify and address vaccine hesitancy among expectant parents before birth.
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Actitud Frente a la Salud , Padre , Madres , Negativa a la Vacunación/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Vacunas contra la Influenza/uso terapéutico , Gripe Humana/prevención & control , Modelos Logísticos , Masculino , Análisis Multivariante , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Embarazo de Alto Riesgo , Mujeres Embarazadas , Prevalencia , Texas , Adulto JovenRESUMEN
The United States experienced a 6.1% annual increase in the maternal death rate from 2000 to 2013. Maternal deaths from hemorrhage and complications of preeclampsia are significant contributors to the maternal death rate. Many of these deaths are preventable. By virtue of their continuous care of laboring patients, active involvement in hospital safety initiatives, and immediate availability, obstetric hospitalists are uniquely positioned to evaluate patients, initiate care, and coordinate a multidisciplinary effort. In cases of significant maternal hemorrhage, hypertensive crisis, and acute pulmonary edema, the availability of an obstetrics hospitalist may facilitate improved patient safety and fewer maternal deaths.
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Ginecología/métodos , Médicos Hospitalarios , Hipertensión Inducida en el Embarazo/mortalidad , Mortalidad Materna/tendencias , Obstetricia/métodos , Preeclampsia/mortalidad , Complicaciones del Embarazo/mortalidad , Protocolos Clínicos , Continuidad de la Atención al Paciente/organización & administración , Femenino , Ginecología/normas , Humanos , Hipertensión Inducida en el Embarazo/prevención & control , Trabajo de Parto , Obstetricia/normas , Seguridad del Paciente , Hemorragia Posparto/mortalidad , Hemorragia Posparto/prevención & control , Preeclampsia/prevención & control , Embarazo , Complicaciones del Embarazo/prevención & control , Embolia Pulmonar/mortalidad , Embolia Pulmonar/prevención & control , Derivación y Consulta , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVES: Tetanus, diphtheria and acellular pertussis (Tdap) and influenza vaccination is recommended during each pregnancy but uptake is suboptimal. We evaluated knowledge and acceptance of vaccination recommendations among pregnant women. METHODS: Prospective, convenience survey of pregnant women presenting for antenatal care at the Pavilion for Women, Texas Children's Hospital, Houston, and their healthcare providers. RESULTS: 796 of 825 (96.5%) of women and 63 of 87 (72.4%) providers completed surveys. Mean age of pregnant women was 30.2 (18-45) years. Self-identified race/ethnicity was 45% white, 26% Hispanic, 13% black, 12% Asian and 4% other. Most women had college degrees (84%) and private health insurance (83%). Mean gestation was 28.5 weeks with 4.8%, 37.8% and 57.4%, in the 1st, 2nd and 3rd trimesters, respectively. Women used various sources for pregnancy information (personal contacts, providers, print, audiovisual and online media) but 89.1% cited a provider as their most trusted source, predominantly (85.8%) their physician. 668 (84%) knew vaccines are recommended during pregnancy, specifically influenza (77%) and Tdap (61%) vaccines. 659 (83%) were willing to receive vaccines if recommended by their physician. Factors impacting vaccination decisions included safety for baby, safety for mother and sufficient information, scoring 4.7, 4.5 and 4.2, respectively, on a 5-point scale; less important were additional visit time (2.6), cost (1.9) or needle phobia (1). Women surveyed in the 3rd trimester showed greater acceptance than those earlier in gestation (87% vs 78%; P0.003). Maternal education, ethnicity, insurance, multiple gestation or history of serious illness in a prior infant did not affect willingness to receive vaccines. CONCLUSIONS: Pregnant women are willing to accept vaccination in pregnancy if recommended by their physician and if sufficient discussion of safety and rationale occurs. Strong physician recommendation, as reported for pediatric vaccination, is essential to optimizing uptake of vaccines during pregnancy.
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Conocimientos, Actitudes y Práctica en Salud , Personal de Salud , Vacunación , Adolescente , Adulto , Cultura , Toma de Decisiones , Femenino , Humanos , Persona de Mediana Edad , Aceptación de la Atención de Salud , Embarazo , Factores de Riesgo , Encuestas y Cuestionarios , Texas , Vacunas/inmunología , Adulto JovenRESUMEN
OBJECTIVES: Tetanus, diphtheria and acellular pertussis (Tdap) vaccine is recommended during each pregnancy, but national uptake is poor. We assessed Tdap uptake in a tertiary referral hospital served by university-affiliated and private obstetrical offices. METHODS: Review of women delivering at Texas Children's Hospital Pavilion for Women, Houston, Texas, during April 2013-June 2014. RESULTS: 6577 deliveries occurred during the study period. Mean maternal age was 29.8 years (range 13-49); race/ethnicity was 43.6% White, 27% Hispanic, 21% Black, 7.1% Asian, and 1.3% other. 252 were multiple gestations; 229 sets of twins, 21 triplets and 2 quadruplets. 3678 (56%) women received Tdap during pregnancy, 249 (3.8%) postpartum and 100 (1.5%) received Tdap pre-conception only. Tdap uptake during pregnancy increased from 36% in April 2013 to a sustained uptake of greater than 61% since November 2013, with increases noted coincidental with presentations highlighting Tdap maternal immunization recommendations at faculty and staff meetings, and the release of the ACOG "toolkit". When antenatal Tdap vaccine was administered, mean gestation at receipt of Tdap was 31.4 weeks and 95% of vaccinated women received Tdap at the recommended gestation interval of 27-36 weeks, 71.6% during the 28-32 week window believed optimal for placental transport and 98.5% at least 7 days before delivery. Of 19 women with two pregnancies during the study period, four (21%) had Tdap during both. Black women were less likely to receive antenatal Tdap than women of other race/ethnicity (41% versus 60%; P<0.001). CONCLUSIONS: Sustained antenatal Tdap uptake rates exceeding 61% were achieved after strategies to increase awareness of recommendations were introduced and 95% of women were immunized at a gestation optimal for efficient maternal antibody placental transport. Further increases in uptake will require system changes such as best practice alerts in electronic medical records.
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Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Vacunación/estadística & datos numéricos , Adolescente , Adulto , Femenino , Humanos , Persona de Mediana Edad , Embarazo , Centros de Atención Terciaria , Texas , Población Urbana , Adulto JovenRESUMEN
Hysterectomy is the most common gynecologic surgical procedure performed in the United States. Although most hysterectomies proceed without incident, complications with serious consequences may occur. This chapter reviews the incidence, predisposing factors, intraoperative risk, diagnosis, and management and prevention of complications of hysterectomy. These include hemorrhage, infection, thromboembolism, injury to viscera, and neuropathy. The prepared surgeon is familiar with anatomy, surgical risk factors, current recommendations for prophylaxis and prevention, as well as modern management of complications of hysterectomy.
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Profilaxis Antibiótica/métodos , Histerectomía/métodos , Complicaciones Posoperatorias/prevención & control , Enfermedades Uterinas/cirugía , Tromboembolia Venosa/prevención & control , Femenino , Fiebre , Tracto Gastrointestinal/lesiones , Humanos , Traumatismos de los Nervios Periféricos/prevención & control , Complicaciones Posoperatorias/terapia , Hemorragia Posoperatoria/prevención & control , Hemorragia Posoperatoria/terapia , Factores de Riesgo , Dehiscencia de la Herida Operatoria/prevención & control , Dehiscencia de la Herida Operatoria/terapia , Infección de la Herida Quirúrgica/prevención & control , Infección de la Herida Quirúrgica/terapia , Sistema Urinario/lesiones , Tromboembolia Venosa/terapiaRESUMEN
Hysteroscopic sterilization is growing in popularity. Nearly 500,000 women have been sterilized using this method, and an increasing number of physicians are now performing this procedure in the office setting. The office setting can provide a cost-effective, convenient, and safe environment for hysteroscopic sterilization. Patients may benefit from avoiding hospital preoperative visits, excessive laboratory evaluation, operating room wait times, and expense associated with hospital care. Physicians may improve productivity through remaining in their office or avoiding operating room delays. This article reviews office-hysteroscopic sterilization with the Essure microinsert system.
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Procedimientos Quirúrgicos Ambulatorios , Anestesia/métodos , Histeroscopía , Visita a Consultorio Médico , Dolor Postoperatorio/prevención & control , Seguridad del Paciente/normas , Esterilización Tubaria , Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Procedimientos Quirúrgicos Ambulatorios/métodos , Procedimientos Quirúrgicos Ambulatorios/normas , Lista de Verificación , Análisis Costo-Beneficio , Femenino , Humanos , Histeroscopía/métodos , Histeroscopía/normas , Selección de Paciente , Guías de Práctica Clínica como Asunto , Cuidados Preoperatorios/métodos , Esterilización Tubaria/efectos adversos , Esterilización Tubaria/instrumentación , Esterilización Tubaria/métodos , Esterilización Tubaria/normasRESUMEN
OBJECTIVE: The study objective is to determine the incidence of methicillin-resistant Staphylococcus aureus (MRSA) in postpartum breast abscesses in two Houston, TX, area hospitals. STUDY DESIGN AND METHODS: This is a retrospective chart review of women hospitalized for postpartum breast abscesses at Woman's Hospital of Texas and Memorial Hermann Hospital between January 1, 2000 and December 31, 2006. Patients were identified by searching admission records for ICD-9 codes related to breast abscesses. Demographic characteristics, medical history, culture results, and pertinent procedures were recorded. Statistical analyses included the Fisher exact test for categorical data and Student's test for continuous variables. RESULTS: Thirty-three postpartum abscesses were identified: 19 from Memorial Hermann Hospital and 14 from Woman's Hospital. MRSA and S. aureus were the only causative bacteria identified. Twelve of the 19 abscesses from Hermann Hospital were MRSA positive (63%), and nine of the 14 from Woman's Hospital were MRSA positive (64%). There were no statistically significant differences among women with MRSA abscesses versus those with S. aureus abscesses in terms of ethnicity, age, time to presentation, parity, insurance, or mode of delivery. Susceptibility patterns were consistent with community-acquired MRSA. CONCLUSIONS: MRSA is a significant pathogen in postpartum breast abscesses in our population, and a high level of suspicion is warranted. Local susceptibility patterns should guide treatment. Empirical treatment of breast abscesses without first obtaining cultures should be discouraged.
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Absceso/epidemiología , Enfermedades de la Mama/epidemiología , Staphylococcus aureus Resistente a Meticilina , Infecciones Estafilocócicas/epidemiología , Absceso/tratamiento farmacológico , Absceso/microbiología , Adolescente , Adulto , Antibacterianos/uso terapéutico , Enfermedades de la Mama/tratamiento farmacológico , Enfermedades de la Mama/microbiología , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/microbiología , Femenino , Humanos , Incidencia , Mastitis/complicaciones , Pruebas de Sensibilidad Microbiana , Estudios Retrospectivos , Infecciones Estafilocócicas/tratamiento farmacológico , Texas/epidemiología , Adulto JovenAsunto(s)
Enterobiasis/diagnóstico , Hemorragia/parasitología , Vagina/parasitología , Enfermedades Vaginales/parasitología , Antinematodos/uso terapéutico , Niño , Enterobiasis/tratamiento farmacológico , Femenino , Humanos , Mebendazol/uso terapéutico , Enfermedades Vaginales/diagnóstico , Enfermedades Vaginales/tratamiento farmacológicoRESUMEN
BACKGROUND: We investigated the impact of unbiased, published, easily accessible brochures on the parental decision about circumcision. METHODS: A total of 190 women who were delivered of healthy male infants at Memorial-Hermann Hospital and Woman's Hospital of Texas from December 1, 1999, to April 30, 2000, were asked to complete a brief demographic self-description and questionnaire regarding their attitudes and beliefs about circumcision. The most recent American Academy of Pediatrics (AAP) brochure about circumcision was then distributed, and subjects completed the questionnaire a second time after reading the brochure. RESULTS: Eighty-five percent of participants opted for circumcision. No woman altered her decision on the basis of information in the AAP brochure. Regardless of parental desire for circumcision, responses to all questions before and after distribution of the AAP brochure were highly correlated. Circumcision status of the father and the parents' education and age were significantly associated with the decision to circumcise. There was no significant association between this decision and marital status, race, or religion. CONCLUSIONS: Parental education about the medical indications and possible risks of circumcision has no impact on the decision-making process about neonatal circumcision.