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[PMID]:29069030
[Au] Autor:Wu VC; Chen TH; Yeh JK; Wu M; Lu CH; Chen SW; Wu KP; Cheng CW; Chang CH; Hung KC; Chern MS; Lin FC; Wen MS
[Ad] Endereço:aDivision of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City bDepartment of Cardiology, Chang Gung Memorial Hospital, Keelung cDivison of Cardiology, Weill Cornell Medical Center, New York, NY dDepartment of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City eDepartment of Rehabilitation, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City fDepartment of Infectious Diseases, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City gDepartment of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City hCollege of Medicine, Chang Gung University, Taoyuan City, Taiwan.
[Ti] Título:Clinical outcomes of peripartum cardiomyopathy: a 15-year nationwide population-based study in Asia.
[So] Source:Medicine (Baltimore);96(43):e8374, 2017 Oct.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Peripartum cardiomyopathy (PPCM) is the development of heart failure during late pregnancy to months postpartum with potential fatal outcome. However, the disease is not well-studied in Asia.We aimed to investigate the epidemiology and clinical outcomes of PPCM in Taiwan.Electronic medical records were retrieved from Taiwan National Health Insurance Research Database from 1997 to 2011. Patients with PPCM were separated into 3 groups based on the timing of diagnosis. Early: PPCM diagnosed first to ninth month of pregnancy. Traditional: PPCM diagnosed last month of pregnancy till fifth month post-delivery. Late: PPCM diagnosed sixth to twelfth month post-delivery. Primary outcomes defined as cardiac death, all-cause mortality, and major adverse cardiovascular events (MACE) within 1 year.A total of 3,506,081 deliveries during 1997 to 2011 were retrieved and 925 patients with PPCM were identified. Overall incidence of PPCM was 1:3,790 during the 15 years. Early, Traditional, and Late group each had 88, 742, and 95 patients. Cardiac death occurred in 31 patients, all-cause mortality in 72 patients, and MACE in 65 patients. Late group had 2- to 3-fold event rates in cardiac death, all-cause mortality, and MACE compared with Early and Traditional groups. Cumulative incidence showed significant differences for cardiac death (P = .0011), all-cause mortality (P = .0031), and MACE (P = .0014) among 3 groups. Multivariate Cox model showed Late group had significantly worse outcomes after adjusted for clinical variables compared with 2 other groups.Our study is the largest national cohort among Asian countries that showed timing of diagnosis of PPCM had different outcomes. Late diagnosis portended significantly increased morbidity and mortality, even after adjusted for clinical variables.
[Mh] Termos MeSH primário: Cardiomiopatias/mortalidade
Insuficiência Cardíaca/mortalidade
Período Periparto/etnologia
Transtornos Puerperais/mortalidade
[Mh] Termos MeSH secundário: Adulto
Cardiomiopatias/complicações
Cardiomiopatias/etnologia
Causas de Morte
Bases de Dados Factuais
Feminino
Insuficiência Cardíaca/etnologia
Insuficiência Cardíaca/etiologia
Humanos
Incidência
Análise Multivariada
Gravidez
Modelos de Riscos Proporcionais
Transtornos Puerperais/etnologia
Transtornos Puerperais/etiologia
Taiwan/epidemiologia
Taiwan/etnologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171025
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008374


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[PMID]:29029903
[Au] Autor:Zhang M; Goyert G; Lim HW
[Ad] Endereço:Department of Dermatology, Henry Ford Hospital, Detroit, Michigan.
[Ti] Título:Folate and phototherapy: What should we inform our patients?
[So] Source:J Am Acad Dermatol;77(5):958-964, 2017 Nov.
[Is] ISSN:1097-6787
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Ultraviolet (UV) degradation of folate has been studied in vitro and in vivo, but comprehensive reviews of the subject and recommendations for supplementing folate are lacking, especially for women of childbearing age, in whom decreases in folate predisposes newborns to neural tube defects. OBJECTIVE: We reviewed the effects of phototherapy on folate and provide a recommendation for women of childbearing age on phototherapy. METHODS: PubMed was searched for in vivo studies comparing folate levels before and after phototherapy. RESULTS: There is no evidence of decreased folate levels after UVA exposure. Decreased folate levels after sun exposure were limited to subjects taking folate supplements. Studies using narrowband UVB showed mixed results, potentially explained by dose-dependent degradation of folate; exposure >40 J/cm cumulatively and >2 J/cm per treatment were associated with 19%-27% decreases in serum folate levels, while lower doses did not affect folate levels. LIMITATIONS: Extensive variability in results from studies and lack of considering confounders. CONCLUSIONS: We recommend all women of childbearing age on phototherapy take 0.8 mg/day of folate supplements, as suggested by current guidelines for women of childbearing age, to reduce the risk of neural tube defects in unplanned pregnancy.
[Mh] Termos MeSH primário: Suplementos Nutricionais
Ácido Fólico/metabolismo
Ácido Fólico/efeitos de radiação
Terapia Ultravioleta/efeitos adversos
[Mh] Termos MeSH secundário: Adulto
Feminino
Ácido Fólico/sangue
Humanos
Defeitos do Tubo Neural/prevenção & controle
Fototerapia/métodos
Gravidez
Resultado do Tratamento
Terapia Ultravioleta/métodos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
935E97BOY8 (Folic Acid)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171014
[St] Status:MEDLINE


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[PMID]:29016515
[Au] Autor:Moniz MH; Gavin LE; Dalton VK
[Ad] Endereço:Department of Obstetrics and Gynecology, the Program on Women's Healthcare Effectiveness Research, and the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
[Ti] Título:Performance Measures for Contraceptive Care: A New Tool to Enhance Access to Contraception.
[So] Source:Obstet Gynecol;130(5):1121-1125, 2017 Nov.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Contraception is an essential health service for reducing unintended pregnancy rates, improving health outcomes, and reducing health care costs. However, contraceptive services may not consistently provide access to the full method mix and to patient-centered care. Improving the quality of contraceptive care is a critical strategy to improve contraceptive use, health outcomes, and the patient experience of care. We here describe the three National Quality Forum-endorsed performance measures for contraceptive care, which are intended to monitor 1) provision of most and moderately effective methods, 2) access to long-acting reversible contraception, and 3) provision of most and moderately effective methods and access to long-acting reversible contraception after childbirth. These contraceptive care measures are designed to ensure that contraceptive care is accessible and offers the full spectrum of methods. Payers, health care systems, public agencies, and researchers could all monitor these performance measures for different populations. We describe the crucial role of clinicians in disseminating and using the contraceptive care performance measures for quality improvement. We describe ongoing efforts to improve contraceptive care quality, including the development of measures to monitor other dimensions of quality such as the safety and patient-centeredness of care. Thirty-eight million women at risk of unintended pregnancy are counting on us to improve the quality of family planning care in the United States and ensure that all women have the resources and tools to make free, informed choices about whether and when to become pregnant.
[Mh] Termos MeSH primário: Comportamento Contraceptivo/estatística & dados numéricos
Anticoncepção/normas
Serviços de Planejamento Familiar/normas
Acesso aos Serviços de Saúde/normas
Assistência Centrada no Paciente/normas
[Mh] Termos MeSH secundário: Anticoncepção/métodos
Anticoncepcionais/uso terapêutico
Serviços de Planejamento Familiar/métodos
Feminino
Humanos
Assistência Centrada no Paciente/métodos
Gravidez
Taxa de Gravidez
Gravidez não Planejada
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Contraceptive Agents)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171010
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002314


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[PMID]:29016514
[Au] Autor:Easter SR; Rosenthal EW; Morton-Eggleston E; Nour N; Tuomala R; Zera CA
[Ad] Endereço:Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Biology, and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
[Ti] Título:Disparities in Care for Publicly Insured Women With Pregestational Diabetes.
[So] Source:Obstet Gynecol;130(5):946-952, 2017 Nov.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To investigate the association among public health insurance, preconception care, and pregnancy outcomes in pregnant women with pregestational diabetes. METHODS: This is a retrospective cohort of pregnant women with pregestational type 1 or type 2 diabetes from 2006 to 2011 in Massachusetts-a state with universal insurance coverage since 2006. Women delivering after 24 weeks of gestation and receiving endocrinology and obstetric care in a multidisciplinary clinic were included. Rates of preconception consultation, our primary outcome of interest, were then compared between publicly and privately insured women. We used univariate analysis followed by logistic regression to compare receipt of preconception consultation and other secondary diabetes care measures and pregnancy outcomes according to insurance status. RESULTS: Fifty-four percent (n=106) of 197 women had public insurance. Publicly insured women were younger (median age 30.4 compared with 35.3 years, P<.01) with lower rates of college education (12.3% compared with 45.1%, P<.01). Women with public insurance were less likely to receive a preconception consult (5.7% compared with 31.9%, P<.01), had lower rates of hemoglobin A1C less than 6% at the onset of pregnancy (37.2% compared with 58.4%, P=.01), and experienced higher rates of pregnancies affected by congenital anomalies (10.4% compared with 2.2%, P=.02) compared with those with private insurance. In adjusted analyses controlling for educational attainment, maternal age, and body mass index, women with public insurance were less likely to receive a preconception consult (adjusted odds ratio [OR] 0.21, 95% CI 0.08-0.58), although the odds of achieving the target hemoglobin A1C (adjusted OR 0.45, 95% CI 0.20-1.02) and congenital anomaly (adjusted OR 2.23, 95% CI 0.37-13.41) were similar after adjustment. CONCLUSION: Despite continuous access to health insurance, publicly insured women were less likely than privately insured women to receive a preconception consult-an evidence-based intervention known to improve pregnancy outcomes. Improving use of preconception care among publicly insured women with diabetes is critical to reducing disparities in outcomes.
[Mh] Termos MeSH primário: Disparidades em Assistência à Saúde/estatística & dados numéricos
Cobertura do Seguro/estatística & dados numéricos
Seguro Saúde/estatística & dados numéricos
Cuidado Pré-Concepcional/estatística & dados numéricos
Gravidez em Diabéticas/terapia
[Mh] Termos MeSH secundário: Adulto
Diabetes Mellitus Tipo 1/sangue
Diabetes Mellitus Tipo 1/complicações
Diabetes Mellitus Tipo 1/terapia
Diabetes Mellitus Tipo 2/sangue
Diabetes Mellitus Tipo 2/complicações
Diabetes Mellitus Tipo 2/terapia
Feminino
Hemoglobina A Glicosilada/análise
Humanos
Modelos Logísticos
Massachusetts
Idade Materna
Razão de Chances
Gravidez
Resultado da Gravidez
Gravidez em Diabéticas/sangue
Gravidez em Diabéticas/etiologia
Estudos Retrospectivos
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Hemoglobin A, Glycosylated); 0 (hemoglobin A1c protein, human)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171010
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002252


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[PMID]:29016513
[Au] Autor:Batra P; Fridman M; Leng M; Gregory KD
[Ad] Endereço:Center for Healthy Communities, School of Medicine, University of California, Riverside, and AMF Consulting, the Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, and the Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Burns Allen Research Institute, Los Angeles, California.
[Ti] Título:Emergency Department Care in the Postpartum Period: California Births, 2009-2011.
[So] Source:Obstet Gynecol;130(5):1073-1081, 2017 Nov.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To use population data to identify patient characteristics associated with a postpartum maternal emergency department visit within 90 days of discharge after birth. METHODS: This retrospective cross-sectional study analyzed linked maternal discharge and emergency department data for all live California births from 2009 to 2011. The primary outcome was at least one emergency department visit within 90 days of hospital discharge after birth. Secondary outcomes included three or more visits within 90 days ("high utilization") and inpatient readmission. Independent variables included demographics (age, race or ethnicity, payer, income) and clinical characteristics (length of stay, antepartum complications, mode of delivery, and severe maternal morbidity at delivery). Multilevel logistic regression identified variables associated study outcomes; we validated the predictive model with a split-sample approach and receiver operating characteristic curve analysis. RESULTS: Of 1,071,232 deliveries included, 88,674 women (8.3%) visited the emergency department at least once in the 90 days after delivery discharge. Emergency department use was significantly associated with Medicaid insurance (adjusted odds ratio [OR] 2.15, 95% CI 2.08-2.21), age younger than 20 years (adjusted OR 2.08, 95% CI 1.98-2.19), severe maternal morbidity at delivery (adjusted OR 1.58, 95% CI 1.49-1.71), antepartum complications (adjusted OR 1.46, 95% CI 1.42-1.50), and cesarean delivery (adjusted OR 1.40, 95% CI 1.37-1.44). Approximately one fifth of visits occurred within 4 days of discharge, and more than half were within 3 weeks. High utilizers comprised 0.5% of the entire sample (5,171 women) and only 1.2% of women presenting for emergency department care were readmitted. Receiver operating curve model analysis using the validation sample supported predictive accuracy for postpartum emergency department use (area under the curve=0.95). CONCLUSION: One in 12 California women visited the emergency department in the first 90 days after postpartum discharge. Women at increased risk for postpartum emergency department use per our validated model (eg, low income, birth complications) may benefit from earlier scheduled postpartum visits.
[Mh] Termos MeSH primário: Parto Obstétrico/efeitos adversos
Serviço Hospitalar de Emergência/estatística & dados numéricos
Tratamento de Emergência/estatística & dados numéricos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos
Transtornos Puerperais/epidemiologia
[Mh] Termos MeSH secundário: Adulto
California/epidemiologia
Estudos Transversais
Tratamento de Emergência/métodos
Feminino
Humanos
Modelos Logísticos
Medicaid/estatística & dados numéricos
Razão de Chances
Alta do Paciente/estatística & dados numéricos
Readmissão do Paciente/estatística & dados numéricos
Período Pós-Parto
Gravidez
Transtornos Puerperais/etiologia
Transtornos Puerperais/terapia
Curva ROC
Estudos Retrospectivos
Fatores de Tempo
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171010
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002269


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[PMID]:29016512
[Au] Autor:Grasch JL; Thompson JL; Newton JM; Zhai AW; Osmundson SS
[Ad] Endereço:Vanderbilt University Medical Center, Nashville, Tennessee.
[Ti] Título:Trial of Labor Compared With Cesarean Delivery in Superobese Women.
[So] Source:Obstet Gynecol;130(5):994-1000, 2017 Nov.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To examine whether labor compared with planned cesarean delivery is associated with increased maternal and neonatal morbidity. METHODS: We conducted a retrospective cohort study of all women with body mass indexes (BMIs) at delivery of 50 or greater delivering a live fetus at 34 weeks of gestation of greater between January 1, 2008, and December 31, 2015. Pregnancies with multiple gestations and major fetal anomalies were excluded. The primary outcome was a composite of maternal and neonatal morbidity and was estimated to be 50% in superobese women based on institutional data. A sample size of 338 women determined the study period and was selected to show a 30% difference in the incidence of the primary outcome between the two groups. Multivariate logistic regression adjusted for potential confounders. RESULTS: There were 344 women with BMIs of 50 or greater who met eligibility criteria, of whom 201 (58%) labored and 143 (42%) underwent planned cesarean delivery. Women who labored were younger, more likely to be nulliparous, and less likely to have pre-existing diabetes. Among women who labored, 45% underwent a cesarean delivery, most commonly for labor arrest (61%) or nonreassuring fetal status (28%). Composite maternal and neonatal morbidity was reduced among women who labored even after adjusting for age, parity, pre-existing diabetes, and prior cesarean delivery (adjusted odds ratio 0.42, 95% CI 0.24-0.75). In the subgroup of women (n=234) who underwent a cesarean delivery, whether planned (n=143) or after labor (n=91), there were no differences in maternal and neonatal morbidity except that severe maternal morbidity was increased in women (n=12) who labored (8.8% compared with 2.1%, relative risk 4.2, 95% CI 1.14-15.4). CONCLUSION: Despite high rates of cesarean delivery in women with superobesity, labor is associated with lower composite maternal and neonatal morbidity. Severe maternal morbidity may be higher in women who require a cesarean delivery after labor.
[Mh] Termos MeSH primário: Cesárea/estatística & dados numéricos
Doenças do Recém-Nascido/epidemiologia
Obesidade Mórbida/complicações
Complicações do Trabalho de Parto/epidemiologia
Prova de Trabalho de Parto
[Mh] Termos MeSH secundário: Adulto
Cesárea/efeitos adversos
Feminino
Humanos
Recém-Nascido
Doenças do Recém-Nascido/etiologia
Morbidade
Complicações do Trabalho de Parto/etiologia
Razão de Chances
Paridade
Gravidez
Resultado da Gravidez
Estudos Retrospectivos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171010
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002257


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[PMID]:29016510
[Au] Autor:Borah BJ; Yao X; Laughlin-Tommaso SK; Heien HC; Stewart EA
[Ad] Endereço:Departments of Health Sciences Research, Obstetrics and Gynecology, and Surgery and the Kern Center for Science of Health Care Delivery, Mayo Clinic, and the Departments of Obstetrics-Gynecology and Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
[Ti] Título:Comparative Effectiveness of Uterine Leiomyoma Procedures Using a Large Insurance Claims Database.
[So] Source:Obstet Gynecol;130(5):1047-1056, 2017 Nov.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To compare risk of reintervention, long-term clinical outcomes, and health care utilization among women who have bulk symptoms from leiomyoma and who underwent the following procedures: hysterectomy, myomectomy, uterine artery embolization, and magnetic resonance-guided, focused ultrasound surgery. METHODS: This was a retrospective analysis of administrative claims from a large U.S. commercial insurance database. Women aged 18-54 years undergoing any of the previously mentioned leiomyoma procedures between 2000 and 2013 were included. We assessed the following outcome measures: risk of reintervention between uterine-sparing procedures, risk of other surgical procedures or complications of the index procedure, 5-year health care utilization, pregnancy rates, and reproductive outcomes. Propensity score matching along with Cox proportional hazard models were used to adjust for differences in baseline characteristics between study cohorts. RESULTS: Among the 135,522 study-eligible women with mean follow-up of 3.4 years, hysterectomy was the most common first-line procedural therapy (111,324 [82.2%]) followed by myomectomy (19,965 [14.7%]), uterine artery embolization (4,186 [3.1%]) and magnetic resonance-guided focused ultrasound surgery (47 [0.0003%]). Small but statistically significant differences were noted for uterine artery embolization and myomectomy in reintervention rate (17.1% compared with 15.0%, P=.02), subsequent hysterectomy rates (13.2% compared with 11.1%, P<.01) and subsequent complications from index procedures (18.1% compared with 24.6%, P<.001). During follow-up, women undergoing myomectomy had lower leiomyoma-related health care utilization, but had higher all-cause outpatient services. Pregnancy rates were 7.5% and 2.2% among myomectomy and uterine artery embolization cohorts, respectively (P<.001) with both cohorts having similar rates of adverse reproductive outcome (69.4%). CONCLUSIONS: Although the overwhelming majority of women having leiomyoma with bulk symptoms underwent hysterectomy as their first treatment procedure, among those undergoing uterine-sparing index procedures, approximately one seventh had a reintervention, and one tenth ended up undergoing hysterectomy during follow-up. Compared with women undergoing myomectomy, women undergoing uterine artery embolization had a higher risk of reintervention, lower risk of subsequent complications, but similar rate of adverse reproductive outcomes.
[Mh] Termos MeSH primário: Histerectomia/estatística & dados numéricos
Leiomioma/cirurgia
Cirurgia Assistida por Computador/estatística & dados numéricos
Embolização da Artéria Uterina/estatística & dados numéricos
Miomectomia Uterina/estatística & dados numéricos
Neoplasias Uterinas/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Pesquisa Comparativa da Efetividade
Bases de Dados Factuais
Feminino
Humanos
Formulário de Reclamação de Seguro/estatística & dados numéricos
Meia-Idade
Tratamentos com Preservação do Órgão/métodos
Tratamentos com Preservação do Órgão/estatística & dados numéricos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos
Gravidez
Taxa de Gravidez
Reoperação/métodos
Reoperação/estatística & dados numéricos
Estudos Retrospectivos
Cirurgia Assistida por Computador/métodos
Resultado do Tratamento
Estados Unidos
Útero/irrigação sanguínea
Útero/cirurgia
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171010
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002331


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[PMID]:29016509
[Au] Autor:Wright E; Audette MC; Ye XY; Keating S; Hoffman B; Lye SJ; Shah PS; Kingdom JC
[Ad] Endereço:Department of Obstetrics & Gynaecology, Maternal-Fetal Medicine Division, the Lunenfeld-Tanenbaum Research Institute, the Maternal-Infant Care Research Centre, the Department of Pediatrics, and the Department of Pathology and Laboratory Medicine at Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
[Ti] Título:Maternal Vascular Malperfusion and Adverse Perinatal Outcomes in Low-Risk Nulliparous Women.
[So] Source:Obstet Gynecol;130(5):1112-1120, 2017 Nov.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate the disease burden of placental maternal vascular malperfusion pathology in a low-risk nulliparous population and test the hypothesis that a multiparameter model in the second trimester can predict maternal vascular malperfusion with high precision. METHODS: A single-center, prospective cohort study was conducted in healthy nulliparous women. Maternal vascular malperfusion disease burden was estimated by incidence, relative risk (RR), and population-attributable risk percent. Maternal risk factors, serum biomarkers, Doppler, and placental morphologic ultrasonography were examined in isolation and in combination for prediction of this placental pathology. RESULTS: The incidence of maternal vascular malperfusion pathology was 8.4% (72/856). Women with pathology had higher risk of preeclampsia (8.33% compared with 1.79%; RR 4.67, 95% CI 1.85-11.77%; population-attributable risk 23.6%, 95% CI 16.9-31.6%), small for gestational age (SGA) (47.22% compared with 9.45%; RR 5.00, 95% CI 3.6-6.93%; population-attributable risk 25.2%, 95% CI 22.1-28.5%), and the composite of adverse outcomes (defined as SGA or preeclampsia) (47.22% compared with 10.59%; RR 4.46, 95% CI 3.25-6.13; population-attributable risk 22.5%, 95% CI 19.8-25.5%). The combination of parameters was superior to individual modalities alone in predicting maternal vascular malperfusion, but achieved only moderate precision (area under the curve 0.77, 95% CI 0.71-0.84). CONCLUSION: One in 12 healthy nulliparous women develop maternal vascular malperfusion placental pathology, and these pregnancies had a 4.5 times higher risk of developing preeclampsia or delivering a SGA neonate compared with those without this pathology. A multiparameter model achieved modest precision to predict placental maternal vascular malperfusion. Importantly, in low-risk pregnancies, maternal vascular malperfusion accounts for one fourth of pregnancy outcomes with SGA or preeclampsia. The low population-attributable risk of this placental pathology for SGA and preeclampsia illustrates the importance of discovering novel associations to reduce the disease burden of these pregnancy complications.
[Mh] Termos MeSH primário: Doenças Placentárias/patologia
Placenta/irrigação sanguínea
Circulação Placentária/fisiologia
[Mh] Termos MeSH secundário: Adulto
Efeitos Psicossociais da Doença
Feminino
Humanos
Incidência
Recém-Nascido
Recém-Nascido Pequeno para a Idade Gestacional
Paridade
Placenta/patologia
Doenças Placentárias/epidemiologia
Doenças Placentárias/etiologia
Pré-Eclâmpsia/etiologia
Gravidez
Resultado da Gravidez
Segundo Trimestre da Gravidez
Estudos Prospectivos
Risco
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171010
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002264


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[PMID]:29016508
[Au] Autor:Smid MC; Dotters-Katz SK; Grace M; Wright ST; Villers MS; Hardy-Fairbanks A; Stamilio DM
[Ad] Endereço:Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and the Health Sciences Library, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa.
[Ti] Título:Prophylactic Negative Pressure Wound Therapy for Obese Women After Cesarean Delivery: A Systematic Review and Meta-analysis.
[So] Source:Obstet Gynecol;130(5):969-978, 2017 Nov.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To summarize available studies on wound complication outcomes after prophylactic negative pressure wound therapy for obese women (body mass index 30 or greater). DATA SOURCES: We conducted a systematic review and meta-analysis using electronic database search (PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Google scholar, and Web of Science), Cochrane, and trial registries including ClinicalTrials.gov. METHODS OF STUDY SELECTION: We conducted an electronic search of research articles from 1966 to January 2017 for randomized controlled trials (RCTs), prospective cohort, and retrospective cohort studies of negative pressure wound therapy compared with standard dressing after cesarean delivery among obese women. Our primary outcome was defined as a composite of wound complication, including wound or surgical site infection, cellulitis, seroma, hematoma, wound disruption, or dehiscence. For cohort studies and RCTs, we performed a descriptive systematic review. For available RCTs, we performed a meta-analysis and pooled risk ratios using a random-effects model. We assessed for heterogeneity using χ test for heterogeneity and I test. We assessed for publication bias using a funnel plot. TABULATION, INTEGRATION, AND RESULTS: Of 10 studies meeting eligibility criteria, five were RCTs and five were cohort studies. Results of cohort studies were varied; however, all had a high potential for selection bias. In the meta-analysis, there was no difference in primary composite outcome among those women with negative pressure wound therapy (16.8%) compared with those who had standard dressing (17.8%) (risk ratio 0.97, 95% CI 0.63-1.49). There was no statistically significant heterogeneity (χ test 4.80, P=.31, I=17%). CONCLUSION: Currently available evidence does not support negative pressure wound therapy use among obese women for cesarean wound complication prevention. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: International prospective register of systematic reviews, 42016033948.
[Mh] Termos MeSH primário: Cesárea/métodos
Tratamento de Ferimentos com Pressão Negativa/métodos
Obesidade/cirurgia
Complicações Pós-Operatórias/prevenção & controle
Complicações na Gravidez/cirurgia
Procedimentos Cirúrgicos Profiláticos/métodos
Ferimento Cirúrgico/terapia
[Mh] Termos MeSH secundário: Adulto
Índice de Massa Corporal
Feminino
Humanos
Obesidade/complicações
Complicações Pós-Operatórias/etiologia
Gravidez
Complicações na Gravidez/etiologia
Ferimento Cirúrgico/etiologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171010
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002259


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[PMID]:29016506
[Au] Autor:Menke MN; King WC; White GE; Gosman GG; Courcoulas AP; Dakin GF; Flum DR; Orcutt MJ; Pomp A; Pories WJ; Purnell JQ; Steffen KJ; Wolfe BM; Yanovski SZ
[Ad] Endereço:University of Pittsburgh School of Medicine, the University of Pittsburgh Graduate School of Public Health, and the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Weill Cornell University Medical Center, New York, New York; the University of Washington, Seattle, Washington; the Neuropsychiatric Research Institute, Fargo, North Dakota; Brody School of Medicine, East Carolina University, Greenville, North Carolina; Oregon Health & Science University, Portland, Oregon; North Dakota State University, Fargo, North Dakota; and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.
[Ti] Título:Contraception and Conception After Bariatric Surgery.
[So] Source:Obstet Gynecol;130(5):979-987, 2017 Nov.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To examine contraceptive practices and conception rates after bariatric surgery. METHODS: The Longitudinal Assessment of Bariatric Surgery-2 is a multicenter, prospective cohort study of adults undergoing first-time bariatric surgery as part of routine clinical care at 10 U.S. hospitals. Recruitment occurred between 2005 and 2009. Participants completed preoperative and annual postsurgical assessments for up to 7 years until January 2015. This report was restricted to women 18-44 years old with no history of menopause, hysterectomy, or estrogen and progesterone therapy. Primary outcomes were self-reported contraceptive practices, overall conception rate, and early (less than 18 months) postsurgical conception. Contraceptive practice (no intercourse, protected intercourse, unprotected intercourse, or tried to conceive) was classified based on the preceding year. Conception rates were determined from self-reported pregnancies. RESULTS: Of 740 eligible women, 710 (95.9%) completed follow-up assessment(s). Median (interquartile range) preoperative age was 34 (30-39) years. In the first postsurgical year, 12.7% (95% CI 9.4-16.0) of women had no intercourse, 40.5% (95% CI 35.6-45.4) had protected intercourse only, 41.5% (95% CI 36.4-46.6) had unprotected intercourse while not trying to conceive, and 4.3% (95% CI 2.4-6.3) tried to conceive. The prevalence of the first three groups did not significantly differ across the 7 years of follow-up (P for all >.05); however, more women tried to conceive in the second year (13.1%, 95% CI 9.3-17.0; P<.001). The conception rate was 53.8 (95% CI 40.0-71.1) per 1,000 woman-years across follow-up (median [interquartile range] 6.5 [5.9-7.0] years); 42.3 (95% CI 30.2-57.6) per 1,000 woman-years in the 18 months after surgery. Age (adjusted relative risk 0.41 [95% CI 0.19-0.89] per 10 years, P=.03), being married or living as married (adjusted relative risk 4.76 [95% CI 2.02-11.21], P<.001), and rating future pregnancy as important preoperatively (adjusted relative risk 8.50 [95% CI 2.92-24.75], P<.001) were associated with early conception. CONCLUSIONS: Postsurgical contraceptive use and conception rates do not reflect recommendations for an 18-month delay in conception after bariatric surgery. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT00465829.
[Mh] Termos MeSH primário: Cirurgia Bariátrica/estatística & dados numéricos
Comportamento Contraceptivo/estatística & dados numéricos
Anticoncepção/estatística & dados numéricos
Fertilização
Obesidade/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Cirurgia Bariátrica/métodos
Anticoncepção/métodos
Feminino
Seguimentos
Humanos
Estudos Longitudinais
Período Pós-Operatório
Gravidez
Taxa de Gravidez
Estudos Prospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171010
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002323



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