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1.
Health Policy ; 132: 104823, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37121204

RESUMO

In this study, we examine patient gender bias on the probabilities of both visiting the cardiologist and of being diagnosed with a heart disease. Using data from the Catalan Health Survey, we are able to conclude that there is gender bias both in access and diagnosis for patients with high likelihood of suffering heart issues. Our findings suggest that women have lower probabilities of visiting the cardiologist and of being diagnosed with a heart disease after controlling for risk factor and demographics characteristics.


Assuntos
Doenças Cardiovasculares , Cardiopatias , Humanos , Masculino , Feminino , Sexismo , Espanha/epidemiologia , Fatores Sexuais , Doenças Cardiovasculares/diagnóstico
2.
Pain Res Treat ; 2017: 7425907, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28321335

RESUMO

There are no reliable predictors of response to treatment with capsaicin. Given that capsaicin application causes heat sensation, differences in quantitative thermal testing (QTT) profiles may predict treatment response. The aim of this study was to determine whether different QTT profiles could predict treatment outcomes in patients with localized peripheral neuropathic pain (PeLNP). We obtained from medical records QTT results and treatment outcomes of 55 patients treated between 2010 and 2013. Warm sensation threshold (WST) and heat pain threshold (HPT) values were assessed at baseline at the treatment site and in the asymptomatic, contralateral area. Responders were defined as those who achieved a > 30% decrease in pain lasting > 30 days. Two distinct groups were identified based on differences in QTT profiles. Most patients (27/31; 87.1%) with a homogenous profile were nonresponders. By contrast, more than half of the patients (13/24, 54.2%) with a nonhomogenous profile were responders (p = 0.0028). A nonhomogenous QTT profile appears to be predictive of response to capsaicin. We hypothesize patients with a partial loss of cutaneous nerve fibers or receptors are more likely to respond. By contrast, when severe nerve damage or normal cutaneous sensations are present, the pain is likely due to central sensitization and thus not responsive to capsaicin. Prospective studies with larger patient samples are needed to confirm this hypothesis.

3.
Epilepsy Behav ; 49: 280-5, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26071995

RESUMO

INTRODUCTION: The anti-NMDA receptor (NMDAr) encephalitis-associated syndrome includes neuropsychiatric symptoms, impaired consciousness, seizures, autonomic instability, and hypoventilation. The electroencephalographic (EEG) activity throughout the course of the disease has still not been well documented. We reviewed electroclinical data of patients with NMDAr encephalitis to characterize their EEG and its clinical correlation. MATERIAL AND METHODS: We retrospectively identified 16 patients with NMDAr encephalitis from 8 Spanish medical centers, 15 of whom underwent video-EEG in the acute phase. RESULTS: In 15 patients (11 females, median age: 37.4, range: 14-87 years), seizures occurred in 9 (60%) and status epilepticus (SE) in 5 (33.3%). Magnetic resonance imaging (MRI) was abnormal in 10 (66.6%), and CSF (cerebrospinal fluid) was normal in 3 and abnormal in 12, with positive PCR (polymerase chain reaction) for Mycoplasma pneumoniae (1/15) and herpes simple virus (1/15). An ovarian teratoma was found in 1 patient and other malignancies (small cell lung carcinoma) in 1 patient. The EEG was abnormal in the acute phase in 14/15 (93.3%). Extreme delta brush (EDB) was observed in 5 (33.3%), and the presence of EDB was associated with SE in all cases. Rhythmic delta activity without EDB was observed in 5 (33.3%), while excessive beta activity was present in 4 (26.6%). Extreme delta brush can follow a pattern of well-characterized electroclinical seizures. CONCLUSIONS: Almost invariably, patients with NMDAr encephalitis had abnormal EEG. The presence of EDB, which can follow a pattern of well-characterized electroclinical seizures, in our patients was associated with seizures and SE. These findings suggest that EDB could be an evolutive pattern of an SE in NMDAr encephalitis. This article is part of a Special Issue entitled "Status Epilepticus".


Assuntos
Encefalite Antirreceptor de N-Metil-D-Aspartato/fisiopatologia , Ritmo Delta , Eletroencefalografia , Convulsões/fisiopatologia , Estado Epiléptico/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Encefalite Antirreceptor de N-Metil-D-Aspartato/complicações , Encefalite Antirreceptor de N-Metil-D-Aspartato/etiologia , Anticonvulsivantes/uso terapêutico , Encefalite por Herpes Simples/complicações , Encefalite por Herpes Simples/fisiopatologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Pneumonia por Mycoplasma/complicações , Pneumonia por Mycoplasma/fisiopatologia , Recidiva , Estudos Retrospectivos , Convulsões/líquido cefalorraquidiano , Convulsões/etiologia , Estado Epiléptico/líquido cefalorraquidiano , Estado Epiléptico/etiologia , Adulto Jovem
4.
Acta Neurol Scand ; 129(5): e20-3, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24372179

RESUMO

OBJECTIVE: Most patients with idiopathic generalized epilepsies (IGEs) have good seizure control when on antiepileptic drugs. To analyze prospectively the response to low-dose sodium valproate (VPA) treatment (<1000 mg/day) together with plasma VPA levels in a cohort of patients with IGE. METHODS: Patients with IGE were selected and followed for almost 2 years. In patients on VPA with no seizures in the last year, VPA dose was lowered to <1000 mg/day. Newly diagnosed patients with IGE started treatment on VPA directly on this low dose. RESULTS: Fifty-four patients were included, with juvenile myoclonic epilepsy (JME) in 23 (42.6%), juvenile absence epilepsy (JAE) in 17 (31.5%), and generalized tonic-clonic seizures only (GTCS only) in 14 (25.9%). VPA at low dose was administered to 38 (70%) patients. Mean plasma VPA level was 44.21 mg/l (18-78; SD 15.18). Seizure relapse during the 2-year follow-up was observed in 8 (21%). A reduction in adverse events was observed (P < 0.048). The only factor related to efficacy of VPA at low dose was syndromic diagnosis. Low-dose VPA controlled 92.9% (13) of patients with GTCS only, 78.3% (18) of those with JME, and 29.5% (5) of those with JAE. CONCLUSIONS: Low-dose VPA was a highly effective treatment for the majority of those with JME and GTCS only. The seizures in JAE tended to be more resistant to treatment, usually requiring higher doses of VPA or polytherapy.


Assuntos
Anticonvulsivantes/administração & dosagem , Epilepsia Generalizada/tratamento farmacológico , Ácido Valproico/administração & dosagem , Adulto , Anticonvulsivantes/efeitos adversos , Anticonvulsivantes/sangue , Epilepsia Tipo Ausência/sangue , Epilepsia Tipo Ausência/tratamento farmacológico , Epilepsia Generalizada/sangue , Feminino , Seguimentos , Humanos , Masculino , Epilepsia Mioclônica Juvenil/sangue , Epilepsia Mioclônica Juvenil/tratamento farmacológico , Estudos Prospectivos , Convulsões/sangue , Convulsões/tratamento farmacológico , Resultado do Tratamento , Ácido Valproico/efeitos adversos , Ácido Valproico/sangue
5.
J Perinatol ; 33(10): 763-7, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23867960

RESUMO

OBJECTIVE: Delayed cord clamping has been shown to decrease the need for transfusion in preterm neonates, but may delay resuscitation. The aim of this study was to determine whether umbilical cord milking compared with immediate cord clamping in extremely preterm deliveries reduces the need for neonatal red blood cell transfusion. STUDY DESIGN: Women admitted to a tertiary care center and expected to deliver between 24 to 28 completed weeks of gestation were randomized to cord milking before clamping or immediate cord clamping. The primary outcome was the risk of neonatal transfusion, reported as risk ratio (RR) and 95% confidence interval (CI). RESULT: Of 113 women who were enrolled and randomized, 56 were assigned to cord milking with 36 remaining eligible and completing the study and 57 were assigned to the control group with 39 remaining eligible and completing the study. Albeit not statistically significant, neonates in the cord milking group were less likely to require transfusion compared with those in the control group (RR: 0.86; 95% CI: 0.73 to 1.0). Neonates whose cords were milked had higher hematocrits at birth (P=0.004) and were less likely to develop an intraventricular hemorrhage (P=0.0195). CONCLUSION: Milking the umbilical cord of a preterm neonate is an easy intervention with the potential to improve perinatal outcomes. Our results suggest that milking of the cord increases the neonate's initial hematocrit and may lessen the need for transfusion in the neonatal period. The observed reduction in the incidence of intraventricular hemorrhage may have important long-term implications that warrant further study.


Assuntos
Transfusão de Sangue/estatística & dados numéricos , Lactente Extremamente Prematuro , Cuidado Pós-Natal , Resultado da Gravidez , Cordão Umbilical , Adulto , Transfusão de Sangue/métodos , Hemorragia Cerebral/epidemiologia , Constrição , Feminino , Hematócrito , Humanos , Incidência , Lactente Extremamente Prematuro/fisiologia , Recém-Nascido , Projetos Piloto , Circulação Placentária/fisiologia , Gravidez , Adulto Jovem
10.
J Neurol ; 254(5): 638-45, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17420928

RESUMO

Thermoalgesic sensory deficits in patients with syringomyelia may escape objective documentation with conventional electrophysiological techniques. We examined six patients with radiologically proven centrospinal cavities and patchy thermoalgesic sensory deficits by recording the evoked potentials and the sympathetic sudomotor skin responses (SSR) to laser stimuli. While electrical stimuli to the affected areas induced evoked potentials and SSRs of normal latency and amplitude, CO2 laser stimulation induced absent or abnormally reduced evoked potentials. Also, warmth and heat pain stimulation with a Peltier thermode induced absent or abnormal SSRs when applied over the affected areas but well defined SSRs when applied to the corresponding contralateral areas. Our results reveal the utility of recording the SSR to pain and temperature stimuli over specific body sites to demonstrate impairment of pain and temperature pathways in patients with syringomyelia. Comparison of electrical versus laser and temperature induced SSRs is an objective means to evaluate the selective thermoalgesic sensory deficit in these patients.


Assuntos
Dor , Pele/inervação , Siringomielia/fisiopatologia , Sensação Térmica/fisiologia , Adulto , Idoso , Potenciais Evocados/fisiologia , Potenciais Evocados/efeitos da radiação , Potenciais Somatossensoriais Evocados/fisiologia , Potenciais Somatossensoriais Evocados/efeitos da radiação , Feminino , Lateralidade Funcional , Humanos , Lasers/efeitos adversos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Tempo de Reação/fisiologia , Pele/fisiopatologia , Estatísticas não Paramétricas
11.
Neurosci Lett ; 286(2): 79-82, 2000 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-10825641

RESUMO

The subcortical integrative effects of laser-induced activation of pain ascending tracts were examined in 11 healthy volunteers, aged 22-52 years. Subjects underwent either CO2 laser stimulation at the dorsum of the hand, electrical stimulation of digital nerves at the 3rd finger, or mechanical taps to the first dorsal interosseous space, preceding a blink reflex elicited by a supraorbital nerve electrical stimulus. The percentage inhibition induced in the R2 response of the blink reflex was similar for the three different stimulus modalities, but occurred at a different time interval. Compared to control trials, the R2 response of the test trials was a mean of 23.1% at the interval of 250 ms with laser stimuli, 17.4% at the interval of 100 ms with electrical stimuli to the 3rd finger, and 20.6% at the interval of 90 ms with a mechanical tap to the 1st interosseous space. Activation of pain receptors induces prepulse inhibition of the blink reflex at a delay corresponding to a slowly conducting pathway. The percentage inhibition is similar to that observed with other somatosensory inputs.


Assuntos
Piscadela/fisiologia , Inibição Neural/fisiologia , Nociceptores/citologia , Nociceptores/fisiologia , Dor/fisiopatologia , Formação Reticular/fisiologia , Adulto , Estimulação Elétrica , Feminino , Humanos , Lasers , Masculino , Pessoa de Meia-Idade , Limiar da Dor/fisiologia , Estimulação Física , Tempo de Reação/fisiologia , Formação Reticular/citologia , Tratos Espinotalâmicos/citologia , Tratos Espinotalâmicos/fisiologia , Fatores de Tempo
13.
Diabetes Care ; 21 Suppl 2: B123-30, 1998 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-9704239

RESUMO

The purpose of this pilot study was to perform a cost-identification analysis of care for gestational diabetes mellitus (GDM) by determining the direct costs of the diagnostic procedures and treatment used for the outpatient management of GDM (program input costs) and the direct costs of maternal hospitalization after diagnosis of GDM, delivery of the baby, and newborn care (outcome costs). Reimbursed average charges in the Northern California (NoCal) managed care market in 1996 were used to establish the direct costs, and the direct costs were then applied to the elements of care and pregnancy outcomes of three GDM management programs in NoCal, Southern California (SoCal), and New England (NewEng), using prospectively collected data. Reimbursed amounts for the detailed elements of GDM management (program input costs) are presented in the categories of diagnosis of GDM, diabetes treatment supplies, doctor's office visits, office visits to ancillary providers, and fetal surveillance. Program input costs per patient were $817 for diet-treated and $1,838 for insulin-treated women in NoCal, and were estimated to be $882 for diet-treated and $1,425 for insulin-treated women in NewEng. Program input costs for women requiring insulin treatment who were randomized to premeal or postprandial blood glucose testing (N Engl J Med 333:1237, 1995) in SoCal were estimated to be $3,596 per patient for the premeal group and $3,770 per patient for the postprandial group. Reimbursed amounts for health care expenditures related to pregnancy outcomes are detailed in the categories of hospital and physician charges for maternal antepartum hospitalization ($1,864 for 2 days), vaginal delivery with 50% use of epidural anesthesia ($4,050), cesarean section ($5,932), and neonatal intensive care ($9,130 for 4 days). Outcome costs per patient were $5,792 for diet-treated and $6,462 for insulin-treated women in NoCal. Outcome costs per patient were estimated to be $6,096 for diet-treated and $11,216 for insulin-treated women in NewEng, and $8,013 for the premeal blood glucose group and $7,495 for the postprandial blood glucose group in SoCal (both groups required insulin treatment). Incremental cost-effectiveness of postprandial monitoring in the SoCal controlled trial was $35 per patient in input costs per cesarean section averted and $25 per patient in input costs per neonatal intensive care unit day prevented. The benefit-to-cost ratio of the difference in input and outcome costs was 2.98 in favor of postprandial monitoring in the SoCal study. Cost analysis should be included in clinical trials of the management of GDM.


Assuntos
Diabetes Gestacional/economia , Diabetes Gestacional/terapia , Cesárea/economia , Análise Custo-Benefício , Parto Obstétrico/economia , Diabetes Gestacional/diagnóstico , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/economia , Programas de Rastreamento/economia , Educação de Pacientes como Assunto , Projetos Piloto , Gravidez , Cuidado Pré-Natal/economia , Estados Unidos
14.
Obstet Gynecol ; 91(4): 600-4, 1998 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-9540949

RESUMO

OBJECTIVE: To determine the effect of carbohydrate restriction on perinatal outcome in patients with diet-controlled gestational diabetes mellitus (GDM). METHODS: Women with diet-controlled GDM were divided non-randomly into two groups based on their dietary carbohydrate content: those with low dietary carbohydrate content (below 42%) and those with high dietary carbohydrate content (exceeding 45%). Subjects kept dietary accounts and were followed with daily fasting and postprandial glucose assessments. Subjects also were tested daily for urinary ketones. Glycosylated hemoglobin, mean fasting and postprandial glucose values, incidence of macrosomia and large for gestational age (LGA) infants, cesarean deliveries for cephalopelvic disproportion and macrosomia, and need for insulin therapy were compared between the groups. RESULTS: The two groups were identical in terms of demographic characteristics. Significant reductions in the postprandial glucose values were seen among subjects in the low-carbohydrate group (P < .04). Fewer subjects in the low-carbohydrate group required the addition of insulin for glucose control (P < .047; relative risk [RR] 0.14; 95% confidence interval [CI] 0.02, 1.00). The incidence of LGA infants was significantly lower in the low-carbohydrate group (P < .035; RR 0.22; 95% CI 0.05, 0.91). Subjects in the low carbohydrate group also had a lower rate of cesarean deliveries for cephalopelvic disproportion and macrosomia (P < .037; RR 0.15; 95% CI 0.04, 0.94). CONCLUSION: Carbohydrate restriction in patients with diet-controlled GDM results in improved glycemic control, less need for insulin therapy, a decrease in the incidence LGA infants, and a decrease in cesarean deliveries for cephalopelvic disproportion and macrosomia.


Assuntos
Diabetes Gestacional/dietoterapia , Carboidratos da Dieta/administração & dosagem , Adulto , Glicemia/análise , Cesárea , Diabetes Gestacional/sangue , Feminino , Humanos , Período Pós-Prandial , Gravidez , Resultado do Tratamento
15.
J Perinatol ; 16(2 Pt 1): 103-6, 1996.
Artigo em Inglês | MEDLINE | ID: mdl-8732556

RESUMO

Our hypothesis for this study was that visual cervical assessment is not equivalent to digital assessment in patients with uterine contractions. We compared visual with digital cervical examinations done on 133 gravid women evaluated in the labor and delivery department because of uterine contractions. Patients at 27 weeks' gestation or more, subjectively in early labor, were prospectively entered into the study. Cervical dilatation and effacement were determined by two separate examiners blinded to each other's assessment, one by digital examination and the other by visual examination, in random order no more than 5 minutes apart. Eight of 133 patients were excluded from data analysis because of inability to visualize the cervix during speculum examination. Data analysis was done with correlation coefficient and the Bland and Altman test for agreement of two clinical measurements. Visual examination only underestimated actual cervical dilation by 0.60 cm (95% confidence interval [CI] 0.58 to 0.62 cm) and the limits of agreement were -2.06 cm (95% CI -2.02 to -2.09 cm) to 3.25 cm (95% CI 3.21 to 3.29 cm). Similarly, visual assessment underestimated effacement by 14.2% (95% CI 13.7% to 14.6%) and the limits of agreement were -41.3% (95% CI -40.5% to 42.0%) to 69.9% (95% CI 68.8% to 70.4%). In conclusion, cervical assessment in patients with uterine contractions who are thought to be in labor by visual speculum examination is not equivalent to that by digital examination. This difference seems to only be clinically significant if the cervix is more than 3 cm dilated.


Assuntos
Colo do Útero/fisiologia , Contração Uterina/fisiologia , Monitorização Uterina/métodos , Adulto , Feminino , Humanos , Trabalho de Parto/fisiologia , Gravidez , Estudos Prospectivos , Sensibilidade e Especificidade
16.
Am J Obstet Gynecol ; 173(6): 1878-84, 1995 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-8610780

RESUMO

OBJECTIVE: The objectives of this study were to determine whether insulin autoantibodies are present in umbilical cord blood from normal pregnancies, determine whether cord blood insulin autoantibody levels correlate with respective maternal levels at delivery, determine whether cord blood insulin autoantibody levels are related to cord blood or maternal insulin levels, and to determine what relationship neonatal birth weight has with either cord blood insulin autoantibody and insulin levels or maternal insulin autoantibody and insulin levels. STUDY DESIGN: Paired umbilical cord and maternal serum samples were taken from 70 normal subjects at delivery. Measurements of serum insulin autoantibody (competitive charcoal radiobinding assay) and insulin (radioimmune inhibition assay) levels were performed. Multiple linear regression analysis and paired t tests were used for data analyses. RESULTS: Neonatal insulin autoantibody levels (120 nU/ml) were more than two times higher than maternal levels (49 nU/ml) (p < 0.001). No correlation was observed between neonatal and maternal insulin autoantibody levels (r = 0.14, p = 0.25). A positive correlation of both neonatal and maternal insulin with birth weight was observed (r = 0.28, p < 0.02; and r = 0.36, p < 0.01, respectively). CONCLUSIONS: These results suggest that the insulin autoantibody levels in fetal cord blood are not related to maternal levels in normal uncomplicated pregnancies. In addition, insulin levels in both maternal and neonatal circulations were positively correlated with increased birth weight in the normal pregnancies studied.


Assuntos
Peso ao Nascer , Sangue Fetal/imunologia , Anticorpos Anti-Insulina/sangue , Insulina/sangue , Gravidez/imunologia , Adulto , Glicemia/análise , Feminino , Hispânico ou Latino , Humanos , Recém-Nascido , Masculino , Gravidez/sangue , Gravidez/etnologia
17.
N Engl J Med ; 333(19): 1237-41, 1995 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-7565999

RESUMO

BACKGROUND: The fetuses of women with gestational diabetes mellitus are at risk for macrosomia and its attendant complications. The best method of achieving euglycemia in these women and reducing morbidity in their infants is not known. We compared the efficacy of postprandial and preprandial monitoring in achieving glycemic control in women with gestational diabetes. METHODS: We studied 66 women with gestational diabetes mellitus who required insulin therapy at 30 weeks of gestation or earlier. The women were randomly assigned to have their diabetes managed according to the results of preprandial monitoring or postprandial monitoring (one hour after meals) of blood glucose concentrations. Both groups were also monitored with fasting blood glucose measurements. The goal of insulin therapy was a preprandial value of 60 to 105 mg per deciliter (3.3 to 5.9 mmol per liter) or a postprandial value of less than 140 mg per deciliter (7.8 mmol per liter). Obstetrical data and information on neonatal outcomes were collected. RESULTS: The prepregnancy weight, weight gain during pregnancy, gestational age at the diagnosis of diabetes and at delivery, degree of compliance with therapy, and degree of achievement of target blood glucose concentrations were similar in the two groups. The mean (+/- SD) change in the glycosylated hemoglobin value was greater in the group in which postprandial measurements were used (-3.0 +/- 2.2 percent vs. 0.6 +/- 1.6 percent, P < 0.001) and the infants' birth weight was lower (3469 +/- 668 vs. 3848 +/- 434 g, P = 0.01). Similarly, the infants born to the women in the postprandial-monitoring group had a lower rate of neonatal hypoglycemia (3 percent vs. 21 percent, P = 0.05), were less often large for gestational age (12 percent vs. 42 percent, P = 0.01) and were less often delivered by cesarean section because of cephalopelvic disproportion (12 percent vs. 36 percent, P = 0.04) than those in the preprandial-monitoring group. CONCLUSIONS: Adjustment of insulin therapy in women with gestational diabetes according to the results of postprandial, rather than preprandial, blood glucose values improves glycemic control and decreases the risk of neonatal hypoglycemia, macrosomia, and cesarean delivery.


Assuntos
Automonitorização da Glicemia , Glicemia , Diabetes Gestacional/sangue , Diabetes Gestacional/tratamento farmacológico , Insulina/uso terapêutico , Adulto , Peso ao Nascer , Glicemia/metabolismo , Automonitorização da Glicemia/métodos , Jejum , Feminino , Idade Gestacional , Hemoglobinas Glicadas/metabolismo , Humanos , Recém-Nascido , Cooperação do Paciente , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Aumento de Peso
18.
Am J Perinatol ; 12(4): 294-8, 1995 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-7575840

RESUMO

Chart review of 73 patients with 3.5 cm or more dilation, intact membranes, and regular contractions at less than 36 weeks. Forty-four (group A) received tocolysis with magnesium sulfate, and 13 of the 44 also received indomethacin. Twenty-nine (group B) received no tocolysis. Obstetric and neonatal outcomes were compared. Demographic factors and admission gestational age, cervical dilation, effacement, and uterine activity were similar. Twenty-one of the 44 in group A versus 3 of 29 in group B had delivery delayed by more than 48 hours (p = 0.002). Group A had a lower incidence of severe respiratory distress syndrome; 4 of 48 babies in group A versus 9 of 32 in group B (p = 0.04; RR = 0.47; confidence interval [CI], 0.2, 1.0). Tocolysis in advanced preterm labor delays delivery by more than 48 hours in 50% of patients. The neonatal benefits of aggressive tocolysis in cases with advanced cervical dilation may outweigh the potential maternal risks of tocolysis, particularly in the setting of extreme prematurity. Delay in delivery enabling steroid enhancement of pulmonary maturity reduces the severity of respiratory distress syndrome.


Assuntos
Doenças do Prematuro/prevenção & controle , Trabalho de Parto Prematuro/tratamento farmacológico , Tocólise , Estudos de Coortes , Feminino , Humanos , Indometacina/uso terapêutico , Recém-Nascido , Sulfato de Magnésio/uso terapêutico , Gravidez , Resultado da Gravidez , Síndrome do Desconforto Respiratório do Recém-Nascido/prevenção & controle
19.
Obstet Gynecol Clin North Am ; 22(2): 235-46, 1995 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-7651668

RESUMO

Labor and delivery management of multiple gestations remains controversial. The authors review issues relating to the management of labor and the administration of anesthesia in twin gestations. A comprehensive review of published data pertaining to delivery route planning for twins using fetal presentation, gestational age, and estimated fetal weight is presented. Individualization of intrapartum care in twin gestations is imperative.


Assuntos
Parto Obstétrico , Trabalho de Parto , Gravidez Múltipla , Analgesia Obstétrica , Anestesia Obstétrica , Parto Obstétrico/métodos , Emergências , Feminino , Humanos , Apresentação no Trabalho de Parto , Gravidez , Gêmeos
20.
Am J Obstet Gynecol ; 172(3): 1040-1, 1995 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-7534447

RESUMO

We present a catastrophic case of aplasia cutis congenita from a pregnancy complicated by elevated maternal serum and amniotic fluid alpha-fetoprotein levels and a positive acetylcholinesterase. Delivery occurred at 27 weeks 1 day after premature rupture of membranes with chorioamnionitis. The neonate lacked > 90% of its skin and died.


Assuntos
Displasia Ectodérmica/diagnóstico , Diagnóstico Pré-Natal , alfa-Fetoproteínas/análise , Acetilcolinesterase/análise , Adulto , Líquido Amniótico/química , Líquido Amniótico/enzimologia , Feminino , Humanos , Masculino , Gravidez/sangue
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