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2.
J Endocrinol Invest ; 45(11): 2105-2121, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35781790

RESUMO

PURPOSE: Placental weight (PW) has been found to mediate the main effect of maternal BMI on fetal size. Still, the BMI-PW association is poorly understood. Therefore, we aimed to explore potential explanatory variables, including gestational weight gain (GWG), early- and late-pregnancy circulating levels of maternal glucose, insulin, leptin, adiponectin, triglycerides, LDL-C, and HDL-C, and fetal insulin. METHODS: We included two studies of pregnant women from Oslo University Hospital, Norway: the prospective STORK (n = 263) and the cross-sectional 4-vessel method study (4-vessel; n = 165). We used multiple linear regression for data analyses. A non-linear BMI-PW association was observed, which leveled off from BMI25. Therefore, BMI <25 and ≥25 were analyzed separately (n = 170/122 and 93/43 for STORK/4-vessel). Confounding variables included maternal age, parity, and gestational age. RESULTS: PW increased significantly per kg m-2 only among BMI <25 (univariate model's std.ß[p] = 0.233 [0.002] vs. 0.074[0.48]/0.296[0.001] vs. -0.030[0.85] for BMI <25 vs. ≥25 in STORK/4-vessel). Maternal early- but not late-pregnancy insulin and term fetal insulin were associated with PW. The estimated effect of early pregnancy insulin was similar between the BMI groups but statistically significant only among BMI <25 (std.ß[p] = 0.182[0.016] vs. 0.203[0.07] for BMI <25 vs. ≥25). Late pregnancy leptin was inversely associated with PW with a 1.3/1.7-fold greater effect among BMI ≥25 than BMI <25 in the STORK/4-vessel. CONCLUSIONS: The BMI-PW association was non-linear: an association was observed for BMI <25 but not for BMI ≥25. Leptin may be involved in the non-linear association through a placental-adipose tissue interplay. Maternal early pregnancy insulin and fetal insulin at term were associated with PW.


Assuntos
Leptina , Infecções Sexualmente Transmissíveis , Adiponectina , Peso ao Nascer , Índice de Massa Corporal , LDL-Colesterol , Estudos Transversais , Feminino , Glucose , Humanos , Insulina , Placenta , Gravidez , Estudos Prospectivos , Triglicerídeos
3.
BMC Pregnancy Childbirth ; 20(1): 605, 2020 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-33032529

RESUMO

BACKGROUND: Prolonged labor might contribute to a negative birth experience and influence first-time mothers' attitudes towards future pregnancies. Previous studies have not adjusted for possible confounding factors, such as operative delivery, induction and postpartum hemorrhage. We aimed to determine the impact of prolonged labor on birth experience and a wish for cesarean section in subsequent pregnancies. METHODS: A survey including the validated "Childbirth Experience Questionnaire". First-time mothers giving birth between 2012 and 2014 at a Norwegian university hospital participated. Data from deliveries were collected. Regression analysis and thematic content analysis were performed. RESULTS: 459 (71%) women responded. Women with labor duration > 12 h had significantly lower scores on two out of four sub-items of the questionnaire: own capacity (p = 0.040) and perceived safety (p = 0.023). Other factors contributing to a negative experience were: Cesarean section vs vaginal birth: own capacity (p = 0.001) and perceived safety (p = 0.007). Operative vaginal vs spontaneous birth: own capacity (p = 0.001), perceived safety (p < 0.001) and participation (p = 0.047). Induced vs spontaneous start: own capacity (p = 0.039) and participation (p = 0.050). Postpartum hemorrhage ≥500 ml vs < 500 ml: perceived safety (p = 0.002) and participation (p = 0.031). In the unadjusted analysis, prolonged labor more than doubled the risk (odds ratio (OR) 2.66, 95%CI 1.42-4.99) of a subsequent wish for cesarean delivery. However, when adjustments were made for mode of delivery and induction, emergency cesarean section (OR 8.86,95%CI 3.85-20.41) and operative vaginal delivery (OR 3.05, 95%CI 1.46-6.38) remained the only factors significantly increasing the probability of wanting a cesarean section in subsequent pregnancies. The written comments on prolonged labor (n = 46) indicated four main themes: Difficulties gaining access to the labor ward. Being left alone during the unexpectedly long, painful early stage of labor. Stressful operative deliveries and worse pain than imagined. Lack of support and too little or contradictory information from the staff. CONCLUSIONS: Women with prolonged labors are at risk of a negative birth experience. Prolonged labor per se did not predict a wish for a cesarean section in a subsequent pregnancy. However, women with long labors more often experience operative delivery, which is a risk factor of a later wish for a cesarean section.


Assuntos
Cesárea/psicologia , Trabalho de Parto/psicologia , Mães/psicologia , Parto/psicologia , Adulto , Cesárea/estatística & dados numéricos , Comportamento de Escolha , Feminino , Humanos , Mães/estatística & dados numéricos , Noruega , Preferência do Paciente/psicologia , Preferência do Paciente/estatística & dados numéricos , Gravidez , Pesquisa Qualitativa , Inquéritos e Questionários/estatística & dados numéricos , Fatores de Tempo
4.
BMC Pregnancy Childbirth ; 18(1): 76, 2018 03 27.
Artigo em Inglês | MEDLINE | ID: mdl-29587658

RESUMO

BACKGROUND: The use of synthetic oxytocin for augmentation of labor is rapidly increasing worldwide. Hyper-stimulation is the most significant side effect, which may cause fetal distress and operative delivery. We performed an intervention consisting of an educational program and modified guidelines to achieve a more appropriate use of oxytocin. METHODS: This prospective intervention study included 431 first-time mothers at term with spontaneous onset of labor before (October 2012 to May 2013), and 664 after the intervention (April 2014 to April 2015). Our outcomes were prevalence and duration of oxytocin treatment, mode of delivery, indication for operative delivery, episiotomy, anal sphincter tears, bleeding, labor duration, pain relief and the effect of oxytocin on mode of delivery. RESULTS: After the intervention, 52.9% were diagnosed with dystocia, compared with 68.9% before (p < 0.001). Oxytocin was not always used in accordance with the guidelines, but a significant reduction in oxytocin rates from 63.3% to 54.1% (p < 0.001) was obtained. More women without dystocia according to the existing guidelines were augmented after the intervention (18.9% vs 8.4%, p < 0.001). Assessing all labors, the median duration of oxytocin treatment was reduced by 72% (from 90 to 25 min) without increasing the median duration of labor (385 min in both groups). There was a moderate reduction in operative vaginal deliveries from 26.9 to 21.5% (p = 0.04), and dystocia as an indication for these deliveries increased (p = 0.01). There was a moderate increase in caesarean sections from 6.7 to 10.2% (p = 0.05), but no increase in dystocia as an indication for these deliveries. Women receiving oxytocin were more likely to have an operative vaginal birth, even after adjusting for birth weight, epidural analgesia and labor duration, OR: 2.1 (CI 1.1-4.0) before and OR 2.7 (CI 1.6-4.5) after the intervention. CONCLUSIONS: Our intervention led to a significant reduction in the use of oxytocin. However, more than half of the women remained diagnosed with dystocia. Operative vaginal births seem to be associated with oxytocin treatment. Therefore, augmentation with oxytocin should be used with caution and only when medically indicated. Even more modified guidelines for augmentation than the ones applied in this study might be appropriate.


Assuntos
Parto Obstétrico/educação , Distocia/terapia , Medicalização , Tocologia/educação , Ocitócicos/uso terapêutico , Ocitocina/uso terapêutico , Adulto , Parto Obstétrico/normas , Episiotomia/normas , Episiotomia/estatística & dados numéricos , Feminino , Humanos , Trabalho de Parto/efeitos dos fármacos , Tocologia/normas , Parto/efeitos dos fármacos , Gravidez , Estudos Prospectivos
7.
Crit Care Med ; 13(8): 664-7, 1985 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-3926380

RESUMO

We compared the blood culture results obtained either by venipuncture or through an arterial catheter in 51 critically ill patients with 217 clinically suspected episodes of bacteremia. During each episode, three blood culture samples, two arterial and one venous, were drawn within 1 h. One or more cultures were positive in 42 (19%) of the episodes, but there were great discrepancies between the results obtained by the two methods. In only eight cases did both methods give the same microorganism. In eight other episodes, the two arterial cultures were positive while the venous sample was negative, probably indicating a continuous contamination of the catheter system. Pseudomonas aeruginosa and Staphylococcus epidermidis were the two most common microbes. The frequency of positive arterial catheter blood cultures did not increase with the length of catheter use. We conclude that an arterial catheter is not a reliable sampling site for blood cultures and does not replace the conventional venipuncture method.


Assuntos
Sepse/diagnóstico , Adolescente , Adulto , Idoso , Artérias , Sangue/microbiologia , Cateteres de Demora , Cuidados Críticos , Estudos de Avaliação como Assunto , Humanos , Unidades de Terapia Intensiva , Técnicas Microbiológicas , Pessoa de Meia-Idade , Pseudomonas aeruginosa/isolamento & purificação , Streptococcus/isolamento & purificação , Veias
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