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BACKGROUND: Maternal obesity has risen in the United States in recent decades. OBJECTIVE: This study aimed to evaluate the impact of maternal obesity on the risk for spontaneous preterm delivery and the risk for overall preterm delivery among patients with cervical cerclage placement. STUDY DESIGN: This was a retrospective study in which data from the California Office of Statewide Health Planning and Development linked birth file from 2007 to 2012 were used, yielding a total of 3654 patients with and 2,804,671 patients without cervical cerclage placement. Exclusion criteria included patients with missing information on body mass index, multiple gestation, anomalous pregnancies, and gestations <20 weeks or >42 weeks. Patients in each group were identified and were further categorized based on body mass index with the nonobese group defined as having a body mass index of <30 kg/m2, the obese group defined as having a body mass index of 30 to 40 kg/m2, and the morbidly obese group defined as having a body mass index >40 kg/m2. The risks for overall and spontaneous preterm delivery were compared between patients without obesity and those with obesity or those with morbid obesity patients. The analysis was stratified by cerclage placement. RESULTS: Among patients who underwent cerclage placement, the risk for spontaneous preterm delivery was not significantly different in the obese and morbidly obese group when compared with the nonobese group (24.2% vs 20.6%; adjusted odds ratio, 1.18; 95% confidence interval, 0.97-1.43; and 24.5% vs 20.6%; adjusted odds ratio, 1.12; 0.78-1.62, respectively). However, among patients without cerclage placement, the obese and morbidly obese groups had a higher risk for spontaneous preterm delivery than the nonobese group (5.1% vs 4.4%; adjusted odds ratio, 1.04; 1.02-1.05; and 5.9% vs 4.4%; adjusted odds ratio, 1.03; 1.00-1.07, respectively). The risks for overall preterm delivery at <37 weeks' gestation were higher for the obese and morbidly obese groups than for the nonobese group among patients with cerclage (33.7% vs 28.2%; adjusted odds ratio, 1.23; 1.03-1.46; and 32.1% vs 28.2%; adjusted odds ratio, 1.01; 0.72-1.43, respectively). Similarly, among patients without cerclage placement, the risks for preterm delivery at <37 weeks' gestation were higher for the obese and morbidly obese groups than for the nonobese group (7.9% vs 6.8%; adjusted odds ratio, 1.05; 1.04-1.06; and 9.3% vs 6.8%; adjusted odds ratio, 1.10; 1.08-1.13, respectively). CONCLUSION: Among patients who received a cervical cerclage for the prevention of preterm birth, obesity was not associated with an increased risk for spontaneous preterm delivery. However, it was associated with an overall increased risk for preterm delivery.
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BACKGROUND: Patients with placenta accreta spectrum (PAS) disorders often suffer massive hemorrhage during cesarean hysterectomies (CHyst). A novel strategy to decrease blood loss and minimize perioperative morbidity associated with PAS is utilization of ER-REBOA Catheter intraoperatively. In this study, we explore the use of ER-REBOA Catheter during CHyst with the goal of minimizing perioperative morbidity and packed red blood cell (PRBC) transfusions. METHODS: We conducted a retrospective case-control study at a regional referral center of consecutive patients with PAS undergoing CHyst. The primary outcomes were PRBC transfusions of ≥4 units. Secondary outcomes included surgical intensive care unit admissions, postoperative length of stay (LOS), postoperative ileus, and vascular complication rate. We also explored utilization of manual palpation and omission of precesarean fluoroscopy for resuscitative endovascular balloon occlusion of the aorta (REBOA) placement verification in distal aortic zone 3. RESULTS: 90 patients were included in the study. REBOA and non-REBOA cases were similar in clinicodemographic characteristics. 17.7% of REBOA cases received ≥4 units of PRBC compared with 49.3% of non-REBOA cases (p=0.03). Zero REBOA patients developed postoperative ileus, whereas 18 (25%) non-REBOA patients did (p=0.02). LOS was reduced in the REBOA group. Postplacement fluoroscopy was omitted in all REBOA cases. Two postoperative arterial thrombotic events (2 of 19, 11% of REBOA patients) were identified in the REBOA group, one requiring a thrombectomy (1 of 19, 5%). DISCUSSION: Decrease in blood transfusions of ≥4 units of PRBC is demonstrated when ER-REBOA Catheter is placed in distal aortic zone 3 during CHyst performed for severe PAS disorders. The incidence of postoperative ileus and LOS are reduced in the ER-REBOA Catheter group. Placement and utilization of ER-REBOA Catheter during CHyst may be feasible without fluoroscopy when manual placement verification is performed by an experienced operator. Protocol modifications focusing on reducing thrombotic rate are ongoing. LEVEL OF EVIDENCE: IV.
RESUMO
Chronic hepatitis B is a global health problem affecting approximately 350 million to 400 million individuals worldwide, and mother to child transmission remains the major mode of transmission. Approximately 50% of chronically infected individuals acquire infection, either perinatally or early in childhood, predominantly in areas where hepatitis B virus (HBV) is endemic. Management of HBV in pregnancy presents a unique set of challenges. All infants born of hepatitis B surface antigen-positive mothers should receive postexposure immune prophylaxis with hepatitis B immunoglobulin and HBV vaccination within 24 hours of birth and need close follow-up for the first few years of life.
