Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 7 de 7
Filtrar
1.
J Matern Fetal Neonatal Med ; 35(10): 1929-1934, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-32495703

RESUMO

OBJECTIVE: To determine if there is a difference in the maternal and perinatal characteristics and outcomes of women undergoing a medically indicated labor induction and delivering vaginally compared to women in spontaneous labor delivering vaginally. METHODS: This is a planned secondary analysis of previously published data with additional data collected for a case-control design. Maternal and perinatal characteristics and outcomes of women undergoing a medically indicated labor induction of labor and delivering vaginally were compared with the next woman who went into labor spontaneously and delivered vaginally. RESULTS: There were 1097 women in the medically indicated labor group and 1096 women in the spontaneous labor group. The medically indicated induction group was younger (p < .0001), had less women of "other" race (p = .004), were of a lower gravidity and parity (p < .0001), had a lower Bishops' score on admission (p < .0001), had a greater proportion of umbilical arterial cord pH values <7.1 and <7.0 (p < .0001). Additionally, the induction group had longer first and second stages of labor (p < .0001). While the unadjusted rates of post-partum complications and NICU admission were higher in the medically indicated labor induction group, only cord gas pH <7.1 remained statistically significant after adjustment. CONCLUSION: Even with successful vaginal delivery of a medically indicated induction of labor, the risk for adverse outcomes remains elevated.


Assuntos
Parto Obstétrico , Trabalho de Parto , Feminino , Humanos , Trabalho de Parto Induzido/efeitos adversos , Paridade , Parto , Gravidez
2.
Am J Case Rep ; 20: 1888-1891, 2019 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-31844036

RESUMO

BACKGROUND Cancer in pregnancy is extremely rare, and gastric cancers are rarer still. Diagnosis is difficult in pregnancy due to overlapping symptoms with pregnancy such as nausea, pain, anemia, and fatigue. CASE REPORT A 26-year-old G1 woman at 32 weeks gestation with a past medical history of systemic lupus erythematosus presented with new-onset chest pain and shortness of breath. Computed tomography of the chest, electrocardiogram, and echocardiogram were normal. Laboratory evaluation revealed thrombocytopenia, proteinuria of 480 milligrams, and normal complement. She delivered on hospital day 3 due to worsening chest pain. During cesarean delivery, the patient became hypotensive and hypoxic and required intensive care unit admission after a cesarean hysterectomy. On postoperative day 2 she had a pulmonary embolus and was started on therapeutic anticoagulation. She clinically improved until postoperative day 4, when she was found unresponsive with pulseless electrical activity. After 38 minutes of Advanced Cardiac Life Support, death was pronounced. An autopsy was performed and the cause of death found to be complications of multi-organ system involvement of adenocarcinoma with signet ring cell features. Lymphangitic carcinomatosis was noted throughout the lungs. CONCLUSIONS This patient had adenocarcinoma with signet ring cell features and associated lymphangitic carcinomatosis, which led to her postpartum death. Lymphangitic carcinomatosis is associated with an exceedingly poor prognosis, especially in pregnancy.


Assuntos
Adenocarcinoma/complicações , Carcinoma de Células em Anel de Sinete/complicações , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/secundário , Metástase Linfática , Complicações Neoplásicas na Gravidez , Adulto , Dor no Peito , Diagnóstico Diferencial , Dispneia , Evolução Fatal , Feminino , Humanos , Gravidez
3.
J Matern Fetal Neonatal Med ; 29(24): 3930-3, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26953615

RESUMO

OBJECTIVE: The length of the third stage of labor is an important risk factor for postpartum hemorrhage (PPH). Current practice recommends manual placenta removal, if not delivered spontaneously, within 30 min. The review reexamines the evidence to determine the optimal length of the third stage of labor. METHODS: A MEDLINE search that associated the length of the third stage of labor with the risk of PPH was undertaken. RESULTS: A retrospective cohort study revealed the risk of a PPH became significant at 10 min (odds ratio = 2.1, 95% confidence interval: 1.6-2.6), and had doubled by 20 min (odds ratio = 4.3, 95% confidence interval: 3.3-5.5). A receiver operator curve determined the optimal length of the third stage of labor to prevent PPH was 18 min. A follow up randomized controlled trial showed that hemodynamic compromise secondary to a PPH can be reduced with manual placenta removal at 10 compared to 15 min (6.4 versus 19.2%, p = 0.001). CONCLUSION: The time interval of 15 min may be a more appropriate time interval to recommend placental removal to prevent PPH.


Assuntos
Parto Obstétrico/normas , Terceira Fase do Trabalho de Parto/fisiologia , Placenta Retida/terapia , Hemorragia Pós-Parto/prevenção & controle , Intervalos de Confiança , Feminino , Humanos , Razão de Chances , Gravidez , Curva ROC , Fatores de Risco , Fatores de Tempo
4.
J Matern Fetal Neonatal Med ; 29(1): 46-50, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-25385267

RESUMO

OBJECTIVE: Describe a novel system of coordinating the identification and management of fetal anomalies in a rural state, where there is a large proportion of impoverished and Medicaid eligible patients, and centralization of the majority of tertiary care resources. METHODS: The Arkansas Fetal Diagnosis and Management program was initiated to coordinate the care of anomalous fetuses. Data from the beginning of the program (2009) to 2013 was collected and analyzed. The data is reported in a descriptive fashion, to report the outcomes of this program. The specific type and number of anomalies diagnosed and managed were tabulated and analyzed. RESULTS: From 2009 to 2013, data from 1300 pregnancies was collected. From 2009 to 2013, there were 7.9%, 10.9%, 15.0%, 18.6%, and 22.3% of ultrasound referrals with fetal anomalies. The anomalies were grouped by physiologic system, and despite the total numbers increasing each year, the frequency and distribution of anomalies remained constant. CONCLUSIONS: The Arkansas Fetal Diagnosis and Management Program streamlined the coordination of care for pregnancies affected by anomalous fetuses.


Assuntos
Anormalidades Congênitas/epidemiologia , Cuidado Pré-Natal/organização & administração , População Rural/estatística & dados numéricos , Arkansas/epidemiologia , Anormalidades Congênitas/diagnóstico por imagem , Feminino , Humanos , Gravidez , Ultrassonografia
5.
South Med J ; 108(7): 389-92, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26192933

RESUMO

OBJECTIVES: To compare the fetal mortality rate in the Delta counties of a state in the Mississippi Delta region of the United States with that of the non-Delta counties of the same state. METHODS: Hospital discharge data for maternal hospitalizations were linked to fetal death and birth certificates for 2004-2010. Data on maternal characteristics and comorbidities and pregnancy characteristics and outcomes were evaluated. The frequency of characteristics of pregnant women and pregnancy outcomes between Delta and non-Delta areas of the state was compared. RESULTS: There were a total of 248,255 singleton births, of which 35,605 occurred in the Delta counties. Delta patients were more likely to be younger than 20 years old, African American, multigravida, Medicaid recipients, smokers, and not married (P < 0.001) when compared with the non-Delta patients. The overall odds of fetal death within Delta counties are 1.40 times (95% confidence interval [CI] 1.22-1.61) higher than the non-Delta counties, and the odds of fetal death at ≤28 weeks are 1.56 times (95% CI 1.28-1.91) higher. After controlling for maternal age, race/ethnicity, level of prenatal care, and maternal comorbidities, the odds of fetal death remained 1.21 times higher (95% CI 1.05-1.41) and 1.28 times higher at ≤28 weeks' gestational age (95% CI 1.03-1.60). CONCLUSIONS: Fetal mortality is significantly greater in the Delta counties compared with the non-Delta counties, with a 21% increase in the odds of overall fetal death in the Delta counties compared with non-Delta counties and a 28% increase in the odds of fetal death at ≤28 weeks.


Assuntos
Declaração de Nascimento , Atestado de Óbito , Mortalidade Fetal/etnologia , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Cuidado Pré-Natal , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Arkansas/epidemiologia , Estudos de Casos e Controles , Feminino , Idade Gestacional , Disparidades nos Níveis de Saúde , Humanos , Idade Materna , Paridade , Gravidez , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/estatística & dados numéricos , Estudos Retrospectivos , Fatores Socioeconômicos , População Branca/estatística & dados numéricos
6.
Clin Obstet Gynecol ; 56(3): 422-33, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23903374

RESUMO

Telemedicine lends itself to several obstetric applications and is of growing interest in developed and developing nations worldwide. In this article we review current trends and applications within obstetrics practice. We searched electronic databases, March 2010 to September 2012, for telemedicine use studies related to obstetrics. Thirty-four of 101 identified studies are the main focus of review. Other relevant studies published before March 2010 are included. Telemedicine plays an important role as an adjunct to delivery of health care to remote patients with inadequate medical access in this era of limited resources and emphasis on efficient use of those available resources.


Assuntos
Obstetrícia/métodos , Telemedicina/métodos , Depressão Pós-Parto/terapia , Diabetes Gestacional/terapia , Feminino , Monitorização Fetal/métodos , Humanos , Obstetrícia/tendências , Gravidez , Telemedicina/tendências , Ultrassonografia Pré-Natal/métodos
7.
J Matern Fetal Neonatal Med ; 17(6): 417-21, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16009644

RESUMO

Vasoconstriction was observed in the fetal middle cerebral and umbilical arteries by Doppler assessment at 27 weeks gestation in a patient requiring continuous morphine infusion for pain control. Fetal heart tracings were also concerning. Fetal status improved after a change to fentanyl infusion, a shorter acting opioid. Caution is recommended when long-term chronic narcotic infusion is used in pregnancy.


Assuntos
Feto/irrigação sanguínea , Morfina/efeitos adversos , Placenta/irrigação sanguínea , Vasoconstrição/efeitos dos fármacos , Adulto , Analgesia Obstétrica , Feminino , Idade Gestacional , Frequência Cardíaca Fetal , Humanos , Mordeduras e Picadas de Insetos/complicações , Fluxometria por Laser-Doppler , Troca Materno-Fetal , Artéria Cerebral Média/efeitos dos fármacos , Artéria Cerebral Média/embriologia , Morfina/administração & dosagem , Gravidez , Complicações na Gravidez , Artérias Umbilicais/efeitos dos fármacos , Artérias Umbilicais/embriologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...