Base de dados : MEDLINE
Pesquisa : Paralisia and Obstétrica [Palavras]
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[PMID]:28161491
[Au] Autor:Herisson O; Maurel N; Diop A; Le Chatelier M; Cambon-Binder A; Fitoussi F
[Ad] Endereço:Hôpital Trousseau, Service de chirurgie orthopédique pédiatrique, 26 Avenue du Dr Arnold Netter, 75012 Paris, France. Electronic address: olivierherisson@hotmail.com.
[Ti] Título:Shoulder and elbow kinematics during the Mallet score in obstetrical brachial plexus palsy.
[So] Source:Clin Biomech (Bristol, Avon);43:1-7, 2017 Mar.
[Is] ISSN:1879-1271
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The physical signs of obstetrical brachial plexus palsy range from temporary upper-limb dysfunction to a lifelong impairment and deformity in one arm. The aim of this study was to analyze the kinematics of the upper limb and to evaluate the contribution of glenohumeral and scapulothoracic joints of obstetrical brachial plexus palsy children. METHODS: Six children participated in this study: 2 males and 4 females with a mean age of 11.7years. Three patients had a C5, C6 lesion and 3 had a C5, C6, C7 lesion. They were asked to perform five tasks based on the Mallet scale and the kinematic data were collected using the Fastrak electromagnetic tracking device. FINDINGS: The scapulothoracic protraction and posterior tilt were significantly increased in the involved limb during the hand to mouth task (p=0.006 and p=0.015 respectively). The scapulothoracic Protraction/glenohumeral Elevation ratio was significantly increased in the involved limb during the hand to neck task (p=0.041) and the elevation task (p=0.015). The ratios of scapulothoracic Tilt on the three glenohumeral excursion angles were significantly increased during the hand to mouth task (p≤0.041). The scapulothoracic Mediolateral/glenohumeral Elevation ratio was significantly increased in the involved limb during the elevation task (p=0.038). The glenohumeral elevation excursion was significantly decreased in the involved limb during the hand to neck task (p<0.001) and the elevation task (p=0.0003). INTERPRETATION: This study gives us information about the greater contribution of the scapulothoracic joint to shoulder motion for affected arm of obstetrical brachial plexus palsy patients compared to their unaffected arm. Kinematic analysis could be useful in shoulder motion evaluation during the Mallet score and to evaluate outcomes after surgery.
[Mh] Termos MeSH primário: Neuropatias do Plexo Braquial/fisiopatologia
Articulação do Cotovelo/fisiopatologia
Paralisia Obstétrica/fisiopatologia
Articulação do Ombro/fisiopatologia
[Mh] Termos MeSH secundário: Fenômenos Biomecânicos
Neuropatias do Plexo Braquial/diagnóstico
Criança
Feminino
Seres Humanos
Masculino
Paralisia Obstétrica/diagnóstico
Análise e Desempenho de Tarefas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170206
[St] Status:MEDLINE


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[PMID]:28151819
[Au] Autor:Balki M; Liu S; León JA; Baghirzada L
[Ad] Endereço:From the Departments of *Anesthesia and †Obstetrics & Gynecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; ‡Maternal, Child, and Youth Health, Surveillance and Epidemiology Division, Centre for Chronic Disease Prevention Public Health Agency of Canada, Ottawa; and §Department of Anesthesia, University of Calgary, Alberta Health Services, Calgary, Alberta, Canada.
[Ti] Título:Epidemiology of Cardiac Arrest During Hospitalization for Delivery in Canada: A Nationwide Study.
[So] Source:Anesth Analg;124(3):890-897, 2017 Mar.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Cardiac arrest in pregnancy is a rare and devastating condition with high mortality and morbidity. The objective of this study was to generate information about maternal cardiac arrest in Canada by examining the frequency, temporal incidence, associated conditions, potential etiologies, and survival rates. METHODS: This retrospective population-based study used hospitalization data from the discharge abstract database of the Canadian Institute for Health Information relating to obstetric deliveries in Canada from April 1, 2002, to March 31, 2015. The data were accessed through the Public Health Agency of Canada's (PHAC) Canadian Perinatal Surveillance System. Cases of cardiac arrest were identified using the diagnostic and intervention codes from the International Statistical Classification of Diseases and the Canadian Classification of Health Interventions, respectively. Data on patient demographics, medical and obstetrical conditions, and potential etiologies of cardiac arrest were collected. Multivariable logistic regression analysis was used to identify conditions associated with cardiac arrest. RESULTS: There were 286 cases of maternal cardiac arrest among 3,568,597 hospitalizations for delivery during the 13-year period. A total of 204 (71.3%) women survived to hospital discharge (95% confidence interval, 65.7%-76.5%). There was no significant variation in the incidence of cardiac arrest or survival from arrest over time or across provinces. Among the pre-existing conditions, hypertensive disorders of pregnancy, gestational diabetes, malignancy, and diseases of the respiratory and nervous system were found to be significantly associated with cardiac arrest. Among the obstetrical conditions, placental abnormalities and polyhydramnios were associated with cardiac arrest. The common potential etiologies included postpartum hemorrhage, heart failure, amniotic fluid embolism, and complications of anesthesia. CONCLUSIONS: In this first Canadian study, the incidence of cardiac arrest during pregnancy was found to be 1:12,500 deliveries. The survival rate reported in our study is higher than reported previously in other countries. Our study findings contribute to better inform the development and implementation of policies and programs in an effort to prevent and manage this condition.
[Mh] Termos MeSH primário: Parto Obstétrico/mortalidade
Parada Cardíaca/mortalidade
Mortalidade Hospitalar
Hospitalização
Complicações do Trabalho de Parto/mortalidade
Complicações na Gravidez/mortalidade
[Mh] Termos MeSH secundário: Adulto
Canadá/epidemiologia
Parto Obstétrico/tendências
Feminino
Parada Cardíaca/diagnóstico
Parada Cardíaca/etiologia
Mortalidade Hospitalar/tendências
Hospitalização/tendências
Seres Humanos
Meia-Idade
Complicações do Trabalho de Parto/diagnóstico
Vigilância da População/métodos
Gravidez
Complicações na Gravidez/diagnóstico
Estudos Retrospectivos
Taxa de Sobrevida/tendências
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170714
[Lr] Data última revisão:
170714
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170203
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000001877


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[PMID]:28116954
[Au] Autor:Smith DI; Chiem JL; Burk S; Borovcanin ZC; Tran NH
[Ad] Endereço:1 Department of Anesthesiology and Pain Management, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA.
[Ti] Título:Hemodynamic instability and Horner's syndrome following a labour lumbar neuraxial block: A warning sign of a potentially lethal event?
[So] Source:J R Soc Med;110(6):245-248, 2017 Jun.
[Is] ISSN:1758-1095
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:The development of Horner's syndrome during routine neuraxial anaesthesia suggests anatomic, technical or physiologic variance. Even more importantly, it warrants immediate cessation of the anaesthetic intervention.
[Mh] Termos MeSH primário: Anestesia Epidural/efeitos adversos
Parto Obstétrico/efeitos adversos
Hemodinâmica
Síndrome de Horner/etiologia
Trabalho de Parto
Bloqueio Nervoso/efeitos adversos
Complicações do Trabalho de Parto/etiologia
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Trabalho de Parto Induzido
Região Lombossacral
Gravidez
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170719
[Lr] Data última revisão:
170719
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170125
[St] Status:MEDLINE
[do] DOI:10.1177/0141076816681745


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[PMID]:28059836
[Au] Autor:Sato S; Nakamori E; Kusumoto G; Shigematsu K; Yamaura K
[Ad] Endereço:From the *Department of Anesthesiology, Fukuoka University Hospital, Fukuoka, Japan; and †Operating Rooms, Fukuoka University Hospital, Fukuoka, Japan.
[Ti] Título:Neurally Mediated Syncope During Cesarean Delivery: A Case Report.
[So] Source:A A Case Rep;8(5):96-99, 2017 Mar 01.
[Is] ISSN:2325-7237
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:A 28-year-old woman with preeclampsia at 32 weeks of gestation underwent a cesarean delivery under spinal anesthesia. Administration of nitroglycerin at 200 µg to relax uterine smooth muscles and the application of fundal pressure led to severe bradycardia and loss of consciousness, followed by cardiac arrest. Delivery was completed immediately and recovery was achieved 10 seconds later following cardiopulmonary resuscitation. Neurally mediated syncope was considered the cause of cardiac arrest. Anesthetists should be aware of the potential risk during cesarean delivery following the administration of nitroglycerin, fundal pressure, regional anesthesia, and hypovolemia because of preeclampsia.
[Mh] Termos MeSH primário: Bradicardia/etiologia
Cesárea
Parada Cardíaca/etiologia
Complicações Intraoperatórias
Pré-Eclâmpsia/cirurgia
Pressão
Síncope Vasovagal/complicações
[Mh] Termos MeSH secundário: Adulto
Anestesia Obstétrica
Raquianestesia
Reanimação Cardiopulmonar
Feminino
Parada Cardíaca/terapia
Seres Humanos
Nitroglicerina/uso terapêutico
Gravidez
Fatores de Risco
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
G59M7S0WS3 (Nitroglycerin)
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170309
[Lr] Data última revisão:
170309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170107
[St] Status:MEDLINE
[do] DOI:10.1213/XAA.0000000000000440


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[PMID]:28029180
[Au] Autor:Bin YS; Ford JB; Nicholl MC; Roberts CL
[Ad] Endereço:Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.
[Ti] Título:Long-term childhood outcomes of breech presentation by intended mode of delivery: a population record linkage study.
[So] Source:Acta Obstet Gynecol Scand;96(3):342-351, 2017 Mar.
[Is] ISSN:1600-0412
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: There is a lack of information on long-term outcomes by mode of delivery for term breech presentation. We aimed to compare childhood mortality, cerebral palsy, hospitalizations, developmental, and educational outcomes associated with intended vaginal breech birth (VBB) with planned cesarean section. MATERIAL AND METHODS: Population birth and hospital records from New South Wales, Australia, were used to identify women with non-anomalous pregnancies eligible for VBB during 2001-2012. Intended mode of delivery was inferred from labor onset and management. Death, hospital, and education records were used for follow up until 2014. Cox proportional hazards regression and modified Poisson regression were used for analysis. RESULTS: Of 15 281 women considered eligible for VBB, 7.7% intended VBB, 74.2% planned cesarean section, and intention was uncertain for 18.1%. Intended VBB did not differ from planned cesarean section on infant mortality (Fisher's exact p = 0.55), childhood mortality (Fisher's exact p = 0.50), cerebral palsy (Fisher's exact p = 1.00), hospitalization in the first year of life [adjusted hazard ratio (HR) 1.04; 95% CI 0.90-1.20], hospitalization between the first and sixth birthdays (HR 0.92; 95% CI 0.82-1.04), being developmentally vulnerable [adjusted relative risk (RR) 1.22; 95% CI 0.48-1.69] or having special needs status (RR 0.95; 95% CI 0.48-1.88) when aged 4-6, or scoring more than 1 standard deviation below the mean on tests of reading (RR 1.10; 95% CI 0.87-1.40) and numeracy (RR 1.04; 95% CI 0.81-1.34) when aged 7-9. CONCLUSIONS: Planned VBB confers no additional risks for child health, development or educational achievement compared with planned cesarean section.
[Mh] Termos MeSH primário: Apresentação Pélvica
Paralisia Cerebral/epidemiologia
Parto Obstétrico
[Mh] Termos MeSH secundário: Adulto
Criança
Pré-Escolar
Parto Obstétrico/métodos
Feminino
Seres Humanos
Registro Médico Coordenado
New South Wales/epidemiologia
Gravidez
Resultado da Gravidez
Sistema de Registros
Sobreviventes/estatística & dados numéricos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170403
[Lr] Data última revisão:
170403
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161229
[St] Status:MEDLINE
[do] DOI:10.1111/aogs.13086


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[PMID]:27606502
[Au] Autor:Shen PY; Nidecker AE; Neufeld EA; Lee PS; James MA; Bauer AS
[Ad] Endereço:Department of Radiology, University of California Davis Medical Center, Sacramento, CA.
[Ti] Título:Non-Sedated Rapid Volumetric Proton Density MRI Predicts Neonatal Brachial Plexus Birth Palsy Functional Outcome.
[So] Source:J Neuroimaging;27(2):248-254, 2017 03.
[Is] ISSN:1552-6569
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: The current prognostic biomarker of functional outcome in brachial plexus birth palsy is serial clinical examination throughout the first 6 months of age. This can delay surgical treatment and prolong parental anxiety in neonates who will recover spontaneously. A potentially superior biomarker is a volumetric proton density MRI performed at clinical presentation and within the first 12 weeks of life, providing a high spatial and contrast resolution examination in 4 minutes. METHODS: Nine neonates ranging in age from 4 to 9 weeks who presented with brachial plexus birth palsy were enrolled. All subjects underwent non-sedated 3 Tesla MRI with Cube Proton Density MRI sequence at the same time as their initial clinical visit. Serial clinical examinations were conducted at routine 4 week intervals and the functional performance scores were recorded. MRI findings were divided into pre-ganglionic and post-ganglionic injuries and a radiological scoring system (Shriners Radiological Score) was developed for this study. RESULTS: Proton Density MRI was able to differentiate between pre-ganglionic and post-ganglionic injuries. Radiological scores (Shriners Radiological Score) correlated better with functional performance at 6 months of age (P = .022) than the initial clinical examinations (Active Movement Scale P = .213 and Toronto P = .320). CONCLUSIONS: Rapid non-sedated volumetric Cube Proton Density MRI protocol performed at initial clinical presentation can accurately grade severity of brachial plexus birth palsy injury and predict functional performance at 6 months of age.
[Mh] Termos MeSH primário: Neuropatias do Plexo Braquial/diagnóstico por imagem
Imagem por Ressonância Magnética/métodos
Paralisia Obstétrica/diagnóstico por imagem
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Lactente
Recém-Nascido
Masculino
Prognóstico
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160909
[St] Status:MEDLINE
[do] DOI:10.1111/jon.12389


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[PMID]:27692236
[Au] Autor:Salazard B; Philandrianos C; Tekpa B
[Ad] Endereço:Service de chirurgie plastique Enfants, hôpital Saint-Joseph, 26, boulevard de Louvain, 13008 Marseille, France. Electronic address: dr.salazard@gmail.com.
[Ti] Título:[Palsy of the upper limb: Obstetrical brachial plexus palsy, arthrogryposis, cerebral palsy].
[Ti] Título:Les paralysies du membre supérieur : plexus brachial obstétrical, arthrogrypose, paralysie cérébrale..
[So] Source:Ann Chir Plast Esthet;61(5):613-621, 2016 Oct.
[Is] ISSN:1768-319X
[Cp] País de publicação:France
[La] Idioma:fre
[Ab] Resumo:"Palsy of the upper limb" in children includes various diseases which leads to hypomobility of the member: cerebral palsy, arthrogryposis and obstetrical brachial plexus palsy. These pathologies which differ on brain damage or not, have the same consequences due to the early achievement: negligence, stiffness and deformities. Regular entire clinical examination of the member, an assessment of needs in daily life, knowledge of the social and family environment, are key points for management. In these pathologies, the rehabilitation is an emergency, which began at birth and intensively. Splints and physiotherapy are part of the treatment. Surgery may have a functional goal, hygienic or aesthetic in different situations. The main goals of surgery are to treat: joints stiffness, bones deformities, muscles contractures and spasticity, paresis, ligamentous laxity.
[Mh] Termos MeSH primário: Artrogripose/fisiopatologia
Neuropatias do Plexo Braquial/fisiopatologia
Paralisia Cerebral/fisiopatologia
Extremidade Superior/fisiopatologia
Extremidade Superior/cirurgia
[Mh] Termos MeSH secundário: Artrogripose/cirurgia
Traumatismos do Nascimento/fisiopatologia
Traumatismos do Nascimento/cirurgia
Neuropatias do Plexo Braquial/cirurgia
Paralisia Cerebral/cirurgia
Criança
Seres Humanos
Procedimentos Ortopédicos
Paralisia Obstétrica/fisiopatologia
Paralisia Obstétrica/cirurgia
Extremidade Superior/inervação
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170411
[Lr] Data última revisão:
170411
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161004
[St] Status:MEDLINE


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[PMID]:27590523
[Au] Autor:Zhang L; Graham JH; Feng W; Lewis MW; Zhang X; Kirchner HL
[Ad] Endereço:Division of Anesthesiology, Geisinger Health System, Danville, PA, USA. lzhang1@geisinger.edu.
[Ti] Título:No association of labor epidural analgesia with cerebral palsy in children.
[So] Source:J Anesth;30(6):1008-1013, 2016 Dec.
[Is] ISSN:1438-8359
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Some pregnant women avoid labor epidural analgesia because of their concerns about risk of cerebral palsy in children. Although it is believed that labor epidural does not contribute to cerebral palsy, to our knowledge no study has been published to specifically address this concern. We carried out a retrospective case-control study to investigate whether labor epidural analgesia is associated with cerebral palsy in children. METHODS: This study used data that were collected and entered into the Geisinger electronic health records between January 2004 and January 2013. During this period, 20,929 children were born at Geisinger hospitals. Among them, 50 children were diagnosed with cerebral palsy, and 20 of those were born vaginally. Each of these 20 cerebral palsy children was matched with up to 5 non-cerebral palsy children born at the same hospitals in the same timeframe using propensity scoring methods. Analgesia was classified as epidural (including epidural or combined spinal and epidural) or non-epidural. Conditional logistic regression was used to compare the percentages of deliveries with each analgesia type between the cerebral palsy and non-cerebral palsy groups. RESULTS: In the non-cerebral palsy group, the percentage of patients receiving labor epidural analgesia was 72 %, and in the cerebral palsy group the percentage was 45 %. There was no significant difference between non-cerebral palsy and cerebral palsy groups (odds ratio, 0.57; 95 % confidence interval, 0.14-2.24; p = 0.42). CONCLUSION: We found no association between the use of labor epidural analgesia and the occurrence of cerebral palsy in children.
[Mh] Termos MeSH primário: Analgesia Epidural/métodos
Analgesia Obstétrica/métodos
Paralisia Cerebral/etiologia
Trabalho de Parto
[Mh] Termos MeSH secundário: Adulto
Estudos de Casos e Controles
Parto Obstétrico
Feminino
Seres Humanos
Recém-Nascido
Modelos Logísticos
Masculino
Gravidez
Estudos Retrospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:171011
[Lr] Data última revisão:
171011
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160904
[St] Status:MEDLINE
[do] DOI:10.1007/s00540-016-2244-8


  9 / 994 MEDLINE  
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[PMID]:27461118
[Au] Autor:Patterson JA; Stuart EA; Ford JB
[Ad] Endereço:Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, 2065, Australia. jillian.patterson@sydney.edu.au.
[Ti] Título:Use of propensity score methods to address adverse events associated with the storage time of blood in an obstetric population: a comparison of methods.
[So] Source:BMC Res Notes;9:367, 2016 Jul 26.
[Is] ISSN:1756-0500
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: A recent topic of interest in the blood transfusion literature is the existence of adverse effects of transfusing red cells towards the end of their storage life. This interest has been sparked by conflicting results in observational studies, however a number of methodological difficulties with these studies have been noted. One potential strategy to address these difficulties is the use of propensity scores, of which there are a number of possible methods. This study aims to compare the traditional methods for binary exposures with more recently developed generalised propensity score methods. METHODS: Data were obtained from probabilistically linked hospital, births and blood bank databases for all women giving birth from 23 weeks gestation in New South Wales, Australia, between July 2006 and December 2010 with complete information on the birth admission and blood issued. Analysis was restricted to women who received 1-4 units of red cells. Three different propensity score methods (for binary, ordinal and continuous exposures) were compared, using each of four different approaches to estimating the effect (matching, stratifying, weighting and adjusting by the propensity score). Each method was used to determine the effect of blood storage time on rates of severe morbidity and readmission or transfer. RESULTS: Data were available for 2990 deliveries to women receiving 1-4 units of red cells. The rate of severe maternal morbidity was 3.7 %, and of readmission or transfer was 14.4 %. There was no association between blood storage time and rates of severe morbidity or readmission irrespective of the approach used. There was no single optimal propensity score method; the approaches differed in their ease of implementation and interpretation. CONCLUSIONS: Within an obstetric population, there was no evidence of an increase in adverse events following transfusion of older blood. Propensity score methods provide a useful tool for addressing the question of adverse events with increasing storage time of blood, as these methods avoid many of the pitfalls of previous studies. In particular, generalised propensity scores can be used in situations where the exposure is not binary.
[Mh] Termos MeSH primário: Edema Encefálico/diagnóstico
Parada Cardíaca/diagnóstico
Pontuação de Propensão
Sepse/diagnóstico
Tromboembolia/diagnóstico
Reação Transfusional
[Mh] Termos MeSH secundário: Adulto
Edema Encefálico/etiologia
Edema Encefálico/patologia
Criopreservação
Parto Obstétrico
Feminino
Parada Cardíaca/etiologia
Parada Cardíaca/patologia
Seres Humanos
Modelos Logísticos
Readmissão do Paciente/estatística & dados numéricos
Hemorragia Pós-Parto/patologia
Hemorragia Pós-Parto/terapia
Gravidez
Sepse/etiologia
Sepse/patologia
Tromboembolia/etiologia
Tromboembolia/patologia
Fatores de Tempo
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1701
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160728
[St] Status:MEDLINE
[do] DOI:10.1186/s13104-016-2169-1


  10 / 994 MEDLINE  
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[PMID]:27404120
[Au] Autor:Stock SJ; Bricker L; Norman JE; West HM
[Ad] Endereço:MRC Centre for Reproductive Health, University of Edinburgh Queen's Medical Research Centre, Edinburgh, UK, EH16 4TJ.
[Ti] Título:Immediate versus deferred delivery of the preterm baby with suspected fetal compromise for improving outcomes.
[So] Source:Cochrane Database Syst Rev;7:CD008968, 2016 Jul 12.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Immediate delivery of the preterm fetus with suspected compromise may decrease the risk of damage due to intrauterine hypoxia. However, it may also increase the risks of prematurity. OBJECTIVES: To assess the effects of immediate versus deferred delivery of preterm babies with suspected fetal compromise on neonatal, maternal and long-term outcomes. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 April 2016) and reference lists of retrieved studies. SELECTION CRITERIA: Randomised trials comparing a policy of immediate delivery with deferred delivery or expectant management in preterm fetuses with suspected in utero compromise. Quasi-randomised trials and trials employing a cluster-randomised design were eligible for inclusion but none were identified. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. MAIN RESULTS: We included one trial of 548 women (588 babies) in the review. Women with pregnancies between 24 and 36 weeks' gestation took part. The study took place in 13 European countries, between 1993 and 2001. The difference in the median randomisation to delivery interval between immediate delivery and deferred delivery was four days (median: 0.9 (inter-quartile range (IQR) 0.4 to 1.3) days for immediate delivery, median: 4.9 (IQR 2.0 to 10.8) days in the delay group).There was no clear difference in the primary outcomes of extended perinatal mortality (risk ratio (RR) 1.17, 95% confidence interval (CI) 0.67 to 2.04, one trial, 587 babies, moderate-quality evidence) or the composite outcome of death or disability at or after two years of age (RR 1.22, 95% CI 0.85 to 1.75, one trial, 573 babies, moderate-quality evidence) with immediate delivery compared to deferred delivery. The results for these outcomes are consistent with both appreciable benefit and harm. More babies in the immediate delivery group were ventilated for more than 24 hours (RR 1.54, 95% CI 1.20 to 1.97, one trial, 576 babies). There were no differences between the immediate delivery and deferred delivery groups in any other infant mortality outcome (stillbirth, neonatal mortality, postneonatal mortality > 28 days to discharge), individual neonatal morbidity or markers of neonatal morbidity (cord pH less than 7.00, Apgar less than seven at five minutes, convulsions, interventricular haemorrhage or germinal matrix haemorrhage, necrotising enterocolitis and periventricular leucomalacia or ventriculomegaly).Some important outcomes were not reported, in particular infant admission to neonatal intensive care or special care facility, and respiratory distress syndrome. We were not able to calculate composite rates of serious neonatal morbidity, even though individual morbidities were reported, due to the risk of double counting infants with more than one morbidity.More children in the immediate delivery group had cerebral palsy at or after two years of age (RR 5.88, 95% CI 1.33 to 26.02, one trial, 507 children). There were, however, no differences in neurodevelopment impairment at or after two years (RR 1.72, 95% CI 0.86 to 3.41, one trial, 507 children), death at or after two years of age (RR 1.04, 95% CI 0.66 to 1.63, one trial, 573 children), or death or disability in childhood (six to 13 years of age) (RR 0.82, 95% CI 0.48 to 1.40, one trial, 302 children). More women in the immediate delivery group had caesarean delivery than in the deferred delivery group (RR 1.15, 95% CI 1.07 to 1.24, one trial, 547 women, high-quality evidence). Data were not available on any other maternal outcomes.There were several methodological weaknesses in the included study, and the level of evidence for the primary outcomes was graded high for caesarean section and moderate for extended perinatal mortality and death or disability at or after two years. The evidence was downgraded because the CIs for these outcomes were wide, and were consistent with both appreciable benefit and harm. Bias may have been introduced by several factors: blinding was not possible due to the nature of the intervention, data for childhood follow-up were incomplete due to attrition, and no adjustment was made in the analysis for the non-independence of babies from multiple pregnancies (39 out of 548 pregnancies). This study only included cases of suspected fetal compromise where there was uncertainty whether immediate delivery was indicated, thus results must be interpreted with caution. AUTHORS' CONCLUSIONS: Currently there is insufficient evidence on the benefits and harms of immediate delivery compared with deferred delivery in cases of suspected fetal compromise at preterm gestations to make firm recommendations. There is a lack of trials addressing this question, and limitations of the one included trial means that caution must be used in interpreting and generalising the findings. More research is needed to guide clinical practice.Although the included trial is relatively large, it has insufficient power to detect differences in neonatal mortality. It did not report any maternal outcomes other than mode of delivery, or evaluate maternal satisfaction or economic outcomes. The applicability of the findings is limited by several factors: Women with a wide range of obstetric complications and gestational ages were included, and subgroup analysis is currently limited. Advances in Doppler assessment techniques may diagnose severe compromise more accurately and help make decisions about the timing of delivery. The potential benefits of deferring delivery for longer or shorter periods cannot be presumed.Where there is uncertainty whether or not to deliver a preterm fetus with suspected fetal compromise, there seems to be no benefit to immediate delivery. Deferring delivery until test results worsen or increasing gestation favours delivery may improve the outcomes for mother and baby.There is a need for high-quality randomised controlled trials comparing immediate and deferred delivery where there is suspected fetal compromise at preterm gestations to guide clinical practice. Future trials should report all important outcomes, and should be adequately powered to detect differences in maternal and neonatal morbidity and mortality.
[Mh] Termos MeSH primário: Parto Obstétrico/métodos
Sofrimento Fetal/complicações
Recém-Nascido Prematuro
[Mh] Termos MeSH secundário: Paralisia Cerebral/etiologia
Cesárea/utilização
Parto Obstétrico/efeitos adversos
Feminino
Seres Humanos
Lactente
Mortalidade Infantil
Recém-Nascido
Gravidez
Ensaios Clínicos Controlados Aleatórios como Assunto
Respiração Artificial/utilização
Conduta Expectante
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Em] Mês de entrada:1609
[Cu] Atualização por classe:160802
[Lr] Data última revisão:
160802
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160713
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD008968.pub3



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