Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 10 de 10
Filtrar
1.
Ultrasound Obstet Gynecol ; 61(6): 734-739, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36357943

RESUMO

OBJECTIVE: Absent or reversed end-diastolic flow (AREDF) in the umbilical artery (UA) on Doppler is a known phenomenon during fetal interventions, such as fetal open spina bifida (OSB) repair. We aimed to evaluate the clinical importance of these Doppler findings by investigating the impact of UA-AREDF on postoperative, neonatal and 2-year neurodevelopmental outcomes. METHODS: This was a prospective study of pregnancies undergoing fetal OSB repair at the Zurich Center for Fetal Diagnosis and Therapy between 2010 and 2019. The group with UA-AREDF during or immediately after the intervention was compared to the group with normal UA Doppler. Primary endpoint was the FIGO scores of cardiotocography (CTG) 1, 2 and 6 h postoperatively and on day 1 after surgery. Secondary endpoints were the neonatal parameters and 2-year neurodevelopmental outcome assessed using the Bayley Scales of Infant and Toddler Development, Third Edition. RESULTS: Data of 130 patients were analyzed. None of the fetuses had UA-AREDF before OSB repair. Normal UA Doppler was observed in 107 (82%) patients and UA-AREDF was observed in 23 (18%) during or immediately after OSB surgery. UA-AREDF was more often observed after version of the fetus (P = 0.045). Seventeen (13%) cases had absent end-diastolic flow (UA-AEDF) and six (5%) cases had reversed end-diastolic flow (UA-REDF). UA-AREDF disappeared in all 23 cases within the first day after OSB surgery. One-third of all CTGs were restricted in oscillation after surgery, but no significant difference in CTG 1, 2 and 6 h postoperatively or on the first postoperative day was found between the UA-AREDF and normal-Doppler groups (P > 0.05). Gestational age at delivery, UA pH, 5-min Apgar score and birth weight were comparable between the two groups, and there was no difference in the 2-year neurodevelopmental outcome (P > 0.05). The neonatal and 2-year neurodevelopmental outcomes also did not differ significantly between the UA-REDF and UA-AEDF groups. CONCLUSIONS: Postoperative CTG abnormalities occur and recover at a similar rate in fetuses with transitory UA-AREDF and those with normal Doppler during fetal OSB repair. UA-AREDF during fetal OSB repair did not negatively influence postnatal or 2-year neurodevelopmental outcomes. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.


Assuntos
Espinha Bífida Cística , Artérias Umbilicais , Recém-Nascido , Gravidez , Lactente , Feminino , Humanos , Estudos Prospectivos , Artérias Umbilicais/diagnóstico por imagem , Feto , Ultrassonografia Doppler , Idade Gestacional , Espinha Bífida Cística/diagnóstico por imagem , Espinha Bífida Cística/cirurgia , Ultrassonografia Pré-Natal , Retardo do Crescimento Fetal
2.
BJOG ; 128(7): 1184-1191, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33152167

RESUMO

OBJECTIVE: To systematically categorise all maternal and fetal intervention-related complications after open fetal myelomeningocele (fMMC) repair of the first 124 cases operated at the Zurich Centre for Fetal Diagnosis and Therapy. DESIGN: A prospective cohort study. SETTING: Single centre. POPULATION: Mothers and fetuses after fMMC repair. METHODS: Between 2010 and 2019, we collected and entered all maternal complications following fMMC repair into the Clavien-Dindo classification. For fetal complications, a classification system based on the Medical Dictionary for Regulatory Activities terminology of Adverse Events was used including the preterm definitions of the World Health Organization. MAIN OUTCOME MEASURES: Systematic classification of maternal and fetal complications following fMMC repair. RESULTS: Gestational ages at surgery and birth were 25.0 ± 0.8 and 35.4 ± 2.0 weeks, respectively. In 17% of all cases, no maternal complications occurred. Maternal intervention-related complications were observed as follows: 69% grade 1, 36% grade 2, 25% grade 3, 6% grade 4 and 0% grade 5. In 34%, no fetal complications were noted; however, 43% of the fetuses developed a grade 1, 14% a grade 2, 8% a grade 3, 2% a grade 4 and 2% a grade 5 complication. CONCLUSION: This study raises awareness of complications following open fMMC repair; 6% of mothers and 2% of fetuses experienced a severe complication (grade 4) and perinatal death rate of 2% was observed (grade 5). These data are useful for prenatal counselling, they help to improve the system of fetal surgical care, and they allow benchmarking with other centres as well as comparison with fetoscopic approaches. TWEETABLE ABSTRACT: Systematic classification of all maternal and fetal intervention-related complications following open fMMC repair.


Assuntos
Feto/cirurgia , Meningomielocele/cirurgia , Complicações Pós-Operatórias/classificação , Complicações na Gravidez/classificação , Estudos de Coortes , Feminino , Morte Fetal , Idade Gestacional , Humanos , Gravidez , Nascimento Prematuro
3.
BJOG ; 122(1): 80-91, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25209926

RESUMO

OBJECTIVE: To evaluate the effectiveness of 200 mg of daily vaginal natural progesterone to prevent preterm birth in women with preterm labour. DESIGN: Multicentre, randomised, double-blind, placebo-controlled trial. SETTING: Twenty-nine centres in Switzerland and Argentina. POPULATION: A total of 385 women with preterm labour (24(0/7) to 33(6/7) weeks of gestation) treated with acute tocolysis. METHODS: Participants were randomly allocated to either 200 mg daily of self-administered vaginal progesterone or placebo within 48 hours of starting acute tocolysis. MAIN OUTCOME MEASURES: Primary outcome was delivery before 37 weeks of gestation. Secondary outcomes were delivery before 32 and 34 weeks, adverse effects, duration of tocolysis, re-admissions for preterm labour, length of hospital stay, and neonatal morbidity and mortality. The study was ended prematurely based on results of the intermediate analysis. RESULTS: Preterm birth occurred in 42.5% of women in the progesterone group versus 35.5% in the placebo group (relative risk [RR] 1.2; 95% confidence interval [95% CI] 0.93-1.5). Delivery at <32 and <34 weeks did not differ between the two groups (12.9 versus 9.7%; [RR 1.3; 95% CI 0.7-2.5] and 19.7 versus 12.9% [RR 1.5; 95% CI 0.9-2.4], respectively). The duration of tocolysis, hospitalisation, and recurrence of preterm labour were comparable between groups. Neonatal morbidity occurred in 44 (22.8%) cases on progesterone versus 35 (18.8%) cases on placebo (RR: 1.2; 95% CI 0.82-1.8), whereas there were 4 (2%) neonatal deaths in each study group. CONCLUSION: There is no evidence that the daily administration of 200 mg vaginal progesterone decreases preterm birth or improves neonatal outcome in women with preterm labour.


Assuntos
Peso ao Nascer , Trabalho de Parto Prematuro/tratamento farmacológico , Nascimento Prematuro/prevenção & controle , Progesterona/uso terapêutico , Progestinas/uso terapêutico , Administração Intravaginal , Adulto , Índice de Apgar , Método Duplo-Cego , Feminino , Humanos , Indometacina/uso terapêutico , Lactente , Mortalidade Infantil , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Receptores de Ocitocina/antagonistas & inibidores , Tocolíticos/uso terapêutico , Adulto Jovem
4.
Hernia ; 17(4): 521-6, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23543336

RESUMO

PURPOSE: The objective of this study was to investigate the additional burdens in terms of pain, prolongation of surgery and morbidity which is added to elective caesarean section if umbilical hernia suture repair is performed simultaneously. Secondly, patient's satisfaction and hernia recurrence rate were assessed. METHODS: Consecutive women with symptomatic umbilical hernia undergoing internal or external suture repair during elective caesarean were included in this retrospective cohort-control study. Data on post-operative pain, duration of surgery and morbidity of a combined procedure were collected. These patients were matched 1:10 to women undergoing caesarean section only. Additionally, two subgroups were assessed separately: external and internal suture hernia repair. These subgroups were compared for patient's satisfaction, cosmesis, body image and recurrence rate. RESULTS: Fourteen patients with a mean age of 37 years were analysed. Internal suture repair (n = 7) prolonged caesarean section by 20 min (p = 0.001) and external suture repair (n = 7) by 34 min (p < 0.0001). Suture repair did not increase morphine use (0.38 ± 0.2 vs. 0.4 ± 02 mg/kg body weight), had no procedure-related morbidity and prolonged hospitalization by 0.5 days (p = 0.01). At a median follow-up of 37 (5-125) months, two recurrences in each surgical technique, internal and external suture repair, occurred (28 %). Body image and cosmesis score showed a higher level of functioning in internal suture repair (p = 0.02; p = 0.04). DISCUSSION: Despite a high recurrence rate, internal suture repair of a symptomatic umbilical hernia during elective caesarean section should be offered to women if requested. No additional morbidity or scar is added to caesarean section. Internal repair is faster, and cosmetic results are better, additional skin or fascia dissection is avoided, and it seems to be as effective as an external approach. Yet, women must be informed on the high recurrence rate.


Assuntos
Cesárea , Hérnia Umbilical/cirurgia , Herniorrafia/métodos , Dor Pós-Operatória/etiologia , Técnicas de Fechamento de Ferimentos Abdominais , Adulto , Analgésicos Opioides/uso terapêutico , Imagem Corporal , Estudos de Casos e Controles , Cesárea/efeitos adversos , Estética , Feminino , Herniorrafia/efeitos adversos , Humanos , Tempo de Internação , Morfina/uso terapêutico , Duração da Cirurgia , Dor Pós-Operatória/tratamento farmacológico , Satisfação do Paciente , Recidiva , Estudos Retrospectivos , Técnicas de Sutura
6.
Ther Umsch ; 59(12): 641-9, 2002 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-12584951

RESUMO

Prenatal care has significantly reduced perinatal and maternal mortality. Screening for maternal disease allows us to reduce or to prevent an unfavourable fetal or obstetrical outcome. Prenatal care should start with a first preconceptional visit. Folic acid intake is recommended for all reproductive-age women who are capable of becoming pregnant. The fetal nuchal translucency measurement has revolutionized prenatal care as a non-invasive, effective screening for chromosomal abnormalities and other diseases of the fetus. Vertical transmission of infections has to be prevented if possible. As an example caesarean section in combination with antiretroviral therapy reduces the transmission of HIV significantly. Screening for sexually transmitted diseases (STD) remains important as at present the incidence of STD is increasing again. In this short review on prenatal care as it is done in Switzerland, we try to enlighten its most important aspects. For the patients and your own benefit as a physician it is important to follow guidelines, although of course each patient has to be treated individually.


Assuntos
Programas de Rastreamento/tendências , Cuidado Pré-Natal/tendências , Procedimentos Clínicos/normas , Procedimentos Clínicos/tendências , Feminino , Previsões , Humanos , Recém-Nascido , Programas de Rastreamento/normas , Gravidez , Cuidado Pré-Natal/normas , Suíça
8.
Scand Cardiovasc J ; 33(3): 183-6, 1999.
Artigo em Inglês | MEDLINE | ID: mdl-10399809

RESUMO

A case of severe ECG abnormalities occurring during pre-eclampsia is presented. Although these electrocardiographic changes were indicative of severe alterations of coronary flow, neither structural nor functional abnormalities could be documented during subsequent diagnostic workup. The pathogenetic pathways potentially involved in this case including coronary spasms are briefly discussed.


Assuntos
Cesárea , Eletrocardiografia , Pré-Eclâmpsia/complicações , Adulto , Emergências , Feminino , Humanos , Isquemia Miocárdica/complicações , Isquemia Miocárdica/patologia , Isquemia Miocárdica/fisiopatologia , Necrose , Gravidez
10.
Geburtshilfe Frauenheilkd ; 52(9): 539-43, 1992 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-1397956

RESUMO

Between January 1, 1983 and June 30, 1991, 107,420 primiparae were recorded in the Swiss Statistics, which cover approx. 60 hospitals. 573 primiparae were 17 years of age or less (= Group I). The control group consisted of 106,855 primiparae between 18 and 35 years of age (Group II). Comparison of these 2 groups showed the following results: A significantly higher risk in prematurity in Group I. There was no significant difference in perinatal mortality or in birth weight under 2,500 g. A significantly lower rate of caesarean sections and of surgical assisted vaginal deliveries were recorded in Group I.


Assuntos
Morte Fetal , Resultado da Gravidez/epidemiologia , Gravidez na Adolescência/estatística & dados numéricos , Adolescente , Cesárea/estatística & dados numéricos , Extração Obstétrica/estatística & dados numéricos , Feminino , Alemanha/epidemiologia , Humanos , Recém-Nascido , Gravidez , Fatores de Risco
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...