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8.
BMC Pregnancy Childbirth ; 23(1): 752, 2023 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-37880671

RESUMO

BACKGROUND: Individuals with an increased body mass index (BMI) (≥ 30 kg/m2) experience higher rates of perinatal mental health disorders than individuals with BMI < 30. Personal experience of decreased control over labor has been associated with the development postpartum mood and anxiety disorders. However, no studies have investigated the association between BMI and experience of control over labor. This study aimed to assess perceived control over labor and compare patients with BMI ≥ 30 to those with BMI < 30. METHODS: We performed a secondary analysis of a cross-sectional study of postpartum patients who delivered at term (37-41 weeks gestation). Postpartum, participants completed the Labour Agentry Scale (LAS), a validated tool to assess perceived control over labor/birth. Demographic, maternal health history and obstetric/neonatal outcomes were abstracted from the patient chart. Bivariate analyses were performed between those with BMI < 30 and those with BMI ≥ 30 using Fisher's exact test. Continuous LAS scores were compared between patients with BMI < 30 and BMI ≥ 30 using Wilcoxon rank-sum tests. Higher LAS scores indicate higher perceived control over labor. Multivariable linear regression was then performed to account for confounding factors identified a priori. RESULTS: There was no difference in LAS between those with BMI ≥ 30 and BMI < 30. When stratified by World Health Organization (WHO) class of BMI, those with BMI ≥ 40 had a significantly lower LAS scores than those with BMI < 30 (147 vs. 163, p = 0.02), however, this finding was no longer significant after controlling for length of labor and cesarean birth. CONCLUSION: Only participants with the highest BMI experienced decreased control over labor, and this finding was no longer significant after controlling for mode of delivery and length of labor. Further research into the experience of birthing people with BMI ≥ 30 is critical to understand the increased risk of perinatal mood disorders among this population.


Assuntos
Trabalho de Parto Induzido , Trabalho de Parto , Gravidez , Recém-Nascido , Feminino , Humanos , Índice de Massa Corporal , Estudos Transversais , Trabalho de Parto Induzido/efeitos adversos , Cesárea
9.
Res Sq ; 2023 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-37502868

RESUMO

Background: Individuals with a body mass index (BMI) of ≥ 30 kg/m2 experience weight stigma when interacting with the healthcare system. There is limited data on how weight stigma impacts patient's experience of obstetric care. This study aims to assess perceived control over the birth process and compare patients with BMI ≥ 30 to those with BMI < 30. Methods: We performed a secondary analysis of a cross-sectional study of term patients. Postpartum, participants completed the Labour Agentry Scale (LAS), a validated tool to assess perceived control over labor/birth. Continuous LAS scores were compared between patients with BMI < 30 and BMI ≥ 30. Results: There was no difference in LAS between those with BMI ≥ 30 and BMI < 30. When stratified by World Health Organization (WHO) class of BMI, those with BMI ≥ 40 had a significantly lower LAS scores than those with BMI < 30 (147 vs. 163, p = 0.02), however, this finding was no longer significant after controlling for length of labor and cesarean birth. Conclusion: Only participants with the highest BMI experienced decreased control over labor, and this finding was no longer significant after controlling for mode of delivery and length of labor. Further research is necessary into how weight stigma influences birthing people's experience.

11.
Am J Perinatol ; 40(16): 1827-1833, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-34775584

RESUMO

OBJECTIVE: Idiopathic polyhydramnios is among the most common etiologies of polyhydramnios. However, conflicting evidence exists regarding the relationship between polyhydramnios and neonatal morbidity. We investigated the association between pregnancies with and without idiopathic polyhydramnios and neonatal morbidity at term. STUDY DESIGN: This is a retrospective cohort study of singleton, term (i.e., ≥370/7 weeks) pregnancies from 2014 to 2018. Pregnancies complicated by fetal anomalies, pregestational diabetes, and multifetal gestation were excluded. Pregnancies complicated by idiopathic polyhydramnios were defined by the deepest vertical pocket (DVP) ≥8 cm or amniotic fluid index (AFI) ≥24 cm after 20 weeks' gestation and were compared with women without polyhydramnios at time of delivery. These groups were matched 1:2 by gestational age within 7 days at delivery and maternal race. The primary outcome was a composite neonatal morbidity (neonatal death, respiratory morbidity, hypoxic-ischemic encephalopathy, therapeutic hypothermia, seizures, and umbilical artery pH < 7.10). Outcomes were compared between pregnancies with and without idiopathic polyhydramnios. Unadjusted and adjusted risk ratios were estimated using multivariable logistic regression. RESULTS: Idiopathic polyhydramnios was diagnosed in 192 pregnancies and were matched to 384 pregnancies without polyhydramnios. After adjustment for obesity, women with pregnancies complicated by idiopathic polyhydramnios had an increased risk of composite neonatal morbidity 21.4 versus 5.5% (adjusted risk ratio [aRR] = 4.0, 95% confidence interval [CI]: 2.3-6.7). Term neonatal respiratory morbidity was the primary driver 20.3 versus 4.2%, (aRR = 4.8, 95% CI: 2.7-8.7) and included higher use of continuous positive airway pressure 19.8 versus 3.4%, p <0.01 and the need for supplemental oxygen at >12 hours of newborn life 6.8 versus 1.8%, p <0.01. CONCLUSION: Idiopathic polyhydramnios is associated with term neonatal respiratory morbidity at delivery and during the subsequent hours of newborn life, compared with pregnancies without idiopathic polyhydramnios. Further studies are needed to minimize neonatal morbidity at term. KEY POINTS: · Idiopathic polyhydramnios is associated with increased risk of neonatal morbidity at term.. · Increasing idiopathic polyhydramnios severity was associated with a trend toward worsening morbidity at term.. · Idiopathic polyhydramnios at term requires respiratory support at delivery and during neonatal care..


Assuntos
Poli-Hidrâmnios , Gravidez , Recém-Nascido , Humanos , Feminino , Poli-Hidrâmnios/epidemiologia , Poli-Hidrâmnios/diagnóstico , Estudos Retrospectivos , Líquido Amniótico , Idade Gestacional , Modelos Logísticos
12.
Obstet Gynecol ; 140(2): 340-341, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35852287
13.
Obstet Gynecol ; 140(2): 342-343, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35852289
16.
J Womens Health (Larchmt) ; 31(8): 1156-1164, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35245092

RESUMO

Background: The impact of neighborhood level factors on glycemic control and pregnancy outcomes is understudied. The primary objective was to determine whether there is an association between glycemic control during pregnancy and level of neighborhood deprivation, defined by area deprivation index (ADI). Materials and Methods: We conducted a retrospective cohort study of women with type 2 diabetes who received care at a tertiary referral center from 2007 to 2017. Patients living in more deprived neighborhoods (ADI >85th national percentile) were compared to those living in less deprived neighborhoods (ADI ≤85th percentile). The primary outcome was change in hemoglobin A1c (HbA1c) over time. Demographic characteristics were compared between groups, and trends in mean A1c through each trimester were tested with repeated measures analysis. Results: Of 237 women meeting study criteria, 93 (39.2%) lived in less deprived (low ADI) and 144 (60.8%) lived in more deprived neighborhoods (high ADI). Women living in more deprived neighborhoods were more likely to be Black (86.8% vs. 53.8%, p < 0.01), less likely to be married (11.3% vs. 31.2%, p < 0.01), and had more severe diabetes (p = 0.05). Both groups achieved significant improvement in HbA1c across each trimester using repeated measures analysis. Those living in more deprived neighborhoods had significantly more improvement in HbA1c from their initial visit to the third trimester compared to those in less deprived neighborhoods, (p = 0.01) such that there was no longer a statistically significant disparity in HbA1c by the third trimester (6.69 ± 0.97 Less deprived vs. 6.95 ± 1.22 more deprived, p = 0.19). Conclusions: Low-income women living in more deprived neighborhoods enter pregnancy with significantly worse glycemic control than those living in less deprived neighborhoods, but the gap in glycemic control largely closes by the end of pregnancy with similar maternal and neonatal outcomes.


Assuntos
Diabetes Mellitus Tipo 2 , Feminino , Hemoglobinas Glicadas , Controle Glicêmico , Humanos , Recém-Nascido , Gravidez , Características de Residência , Estudos Retrospectivos
17.
Obstet Gynecol ; 138(1): 115-118, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34259474

RESUMO

BACKGROUND: Standard treatment for placental site trophoblastic tumor is hysterectomy. This may be unacceptable to women desiring fertility. Cells aberrant in placental site trophoblastic tumor display an ability to invade normal tissue while evading the immune system. CASE: We present a case of a 23-year-old woman with stage I placental site trophoblastic tumor who declined hysterectomy. Tumor assay for program cell death-ligand 1 staining was performed and suggestive of an immune-responsive tumor. The patient initiated intravenous pembrolizumab 200 mg every 2 weeks, and by cycle 3 her ß-hCG level fell to undetectable. She subsequently conceived and went on to have an uncomplicated term vaginal birth after cesarean. At 6 weeks postpartum, she remained without evidence of disease. CONCLUSION: Immunotherapy can eliminate early program cell death-ligand 1-positive placental site trophoblastic tumor with subsequent normal pregnancy.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Tumor Trofoblástico de Localização Placentária/tratamento farmacológico , Neoplasias Uterinas/tratamento farmacológico , Feminino , Humanos , Imunoterapia , Gravidez , Nascimento a Termo , Adulto Jovem
18.
Semin Perinatol ; 44(2): 151213, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31839439

RESUMO

The second stage of labor is defined as the time from complete dilation of the cervix to delivery of the fetus. The objective of this seminar is to provide a contemporary, evidence-based approach to management of the second stage of labor. This seminar reviews background maternal and fetal characteristics that impact the duration of the second stage of labor, the recommended evidence-based management (e.g. immediate pushing, manual rotation, operative vaginal delivery), and the maternal/neonatal morbidity clinicians must consider when deciding between operative delivery and a prolonged second stage of labor.


Assuntos
Parto Obstétrico/métodos , Medicina Baseada em Evidências/métodos , Segunda Fase do Trabalho de Parto , Feminino , Peso Fetal , Humanos , Apresentação no Trabalho de Parto , Obesidade/complicações , Gravidez , Complicações na Gravidez/terapia , Fatores de Tempo
19.
J Perinatol ; 40(1): 56-62, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31578422

RESUMO

OBJECTIVE: Investigate marked variability in fetal heart rate (FHR) patterns before delivery and its association with neonatal morbidity and abnormal arterial cord gases. STUDY DESIGN: Prospective cohort of laboring patients at term. Composite neonatal morbidity (respiratory distress, mechanical ventilation, suspected sepsis, meconium aspiration syndrome, therapeutic hypothermia, hypoxic-ischemic encephalopathy, seizure, and death) and abnormal arterial cord gases (pH < 7.10, lactate ≥ 4 mmol/L, base deficit < -12 mEq/L) were assessed with multivariable logistic regression. RESULT: Three hundred and ninety (4.5%) neonates had marked variability in FHR patterns before delivery. There was no difference in composite neonatal morbidity (aRR 1.22; 95% CI 0.91-1.63), though neonates with marked variability in FHR patterns were more likely to have a respiratory distress (aRR 1.85; 95% CI 1.25-2.70). There was an increased risk of composite abnormal arterial cord gases (aRR 1.66; 95% CI 1.47-1.88). CONCLUSION: Marked variability in FHR patterns was not associated with composite neonatal morbidity but was associated with abnormal arterial cord gases.


Assuntos
Dióxido de Carbono/análise , Sangue Fetal/química , Frequência Cardíaca Fetal/fisiologia , Doenças do Recém-Nascido/epidemiologia , Ácido Láctico/sangue , Bicarbonatos/sangue , Gasometria , Eletrocardiografia , Monitorização Fetal , Humanos , Recém-Nascido , Doenças do Recém-Nascido/mortalidade , Estudos Prospectivos
20.
BMC Cancer ; 18(1): 1041, 2018 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-30367632

RESUMO

BACKGROUND: The oncologic safety of allogeneic blood transfusion in ovarian cancer patients is unknow. We sought to determine the prevalence and oncologic safety of perioperative allogeneic blood transfusion during interval cytoreduction surgery among women receiving neoadjuvant chemotherapy for ovarian cancer. METHODS: We utilized retrospective chart review to identify a cohort of patients undergoing interval cytoreduction at a large academic tertiary referral center. We compared outcomes in patients who were exposed to perioperative blood transfusion compared with patients who were not exposed. Our primary endpoint was progression free survival; our secondary endpoint was overall survival. Baseline clinical characteristics were collected for patients in each group. RESULTS: Sixty-six women were included in the final cohort of women undergoing interval cytoreductive surgery after NACT. A total of 51 women (77%) were exposed to allogeneic perioperative pRBC transfusion. Fifteen women (23%) were not exposed to transfusion. The baseline characteristics were generally well matched. Women who were not exposed to a perioperative blood transfusion were more likely to have a normalized CA125 prior to undergoing cytoreductive surgery. Preoperative hemoglobin concentration was lower in the transfusion group (10.5 g/dLvs 11.5 g/dL, p < 0.009). Perioperative transfusion was not associated with a significant difference in progression free survival (PFS = 7.6 months for transfused, 9.4 months for not transfused; log-rank test p = 0.4617). Similarly, there was no observed difference between groups for overall survival (OS = 23.6 months for transfused, 22.5 months for not transfused; log-rank test p = 0.1723). CONCLUSIONS: Women undergoing neoadjuvant chemotherapy for ovarian cancer are at high risk of exposure to blood transfusion at the time of interval cytoreductive surgery. Future studies will continue to evaluate the safety and impact of transfusion on ovarian cancer survival in this at risk population.


Assuntos
Perda Sanguínea Cirúrgica , Transfusão de Sangue/estatística & dados numéricos , Quimioterapia Adjuvante/efeitos adversos , Procedimentos Cirúrgicos de Citorredução , Terapia Neoadjuvante/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/diagnóstico , Neoplasias/tratamento farmacológico , Período Perioperatório , Estudos Retrospectivos
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