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[PMID]:28460079
[Au] Autor:Ehrmann Feldman D; Vinet É; Sylvestre MP; Hazel B; Duffy C; Bérard A; Meshefedjian G; Bernatsky S
[Ad] Endereço:School of Rehabilitation, Faculty of Medicine.
[Ti] Título:Postpartum complications in new mothers with juvenile idiopathic arthritis: a population-based cohort study.
[So] Source:Rheumatology (Oxford);56(8):1378-1385, 2017 Aug 01.
[Is] ISSN:1462-0332
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objective: The aim was to evaluate the prevalence of postpartum complications, including depression, in new mothers who had juvenile idiopathic arthritis (JIA) and to assess whether these differ from mothers who never had JIA. Methods: Our cohort study used data from physician billing and hospitalizations covering Quebec, Canada. We identified females with JIA with a first-time birth between 1 January 1983 and 31 December 2010 and assembled a control cohort of first-time mothers without JIA from the same administrative data, matching 4:1 for date of first birth, maternal age and area of residence. We compared the following postpartum complications: major puerperal infection, anaesthetic complications, postpartum haemorrhage, thromboembolism, obstetrical trauma, complications of obstetrical surgical wounds and maternal depression in the first year after delivery, in the JIA vs non-JIA groups, using bivariate analysis and multiple logistic regression. Results: The mean age at delivery was 24.7 years in the JIA group (n = 1681) and 25.0 years for the non-JIA group (n = 6724). Mothers with JIA were more likely to experience complications attributable to anaesthetic [adjusted risk ratio (aRR) 2.17, 95% CI; 1.05, 4.48], postpartum haemorrhage (aRR = 2.75, 95% CI: 2.42, 3.11) and thromboembolism (aRR = 5.27, 95% CI: 1.83, 15.17) but were at lower risk for obstetrical trauma (aRR = 0.78, 95% CI: 0.64, 0.95) or newly to develop depression in the first year postpartum (aRR = 0.52, 95% CI: 0.40, 0.68). Conclusion: Mothers with JIA appear to be at higher risk for complications attributable to anaesthesia, postpartum haemorrhage and thromboembolism. Prevention strategies for postpartum haemorrhage and thromboembolism may be especially important in this population.
[Mh] Termos MeSH primário: Artrite Juvenil/complicações
Complicações do Trabalho de Parto/etiologia
Transtornos Puerperais/etiologia
[Mh] Termos MeSH secundário: Adulto
Anestesia/efeitos adversos
Estudos de Casos e Controles
Estudos de Coortes
Depressão Pós-Parto/etiologia
Feminino
Seres Humanos
Modelos Logísticos
Hemorragia Pós-Parto/etiologia
Período Pós-Parto
Gravidez
Quebeque
Fatores de Risco
Tromboembolia/etiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1093/rheumatology/kex168


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[PMID]:29287104
[Au] Autor:Jansova M; Kalis V; Rusavy Z; Räisänen S; Lobovsky L; Laine K
[Ad] Endereço:New Technologies-Research Centre, University of West Bohemia, Pilsen, Czech Republic.
[Ti] Título:Fetal head size and effect of manual perineal protection.
[So] Source:PLoS One;12(12):e0189842, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The aim of this study was to evaluate whether a previously identified modification of Viennese method of perineal protection remains most effective for reduction of perineal tension in cases with substantially smaller or larger fetal heads. METHODS: A previously designed finite element model was used to compare perineal tension of different modifications of the Viennese method of perineal protection to "hands-off" technique for three different sizes of the fetal head. Quantity and extent of tension throughout the perineal body during vaginal delivery at the time when the suboccipito-bregmatic circumference passes between the fourchette and the lower margin of the pubis was determined. RESULTS: The order of effectiveness of different modifications of manual perineal protection was similar for all three sizes of fetal head. The reduction of perineal tension was most significant in delivery simulations with larger heads. The final position of fingers 2cm anteriorly from the fourchette (y = +2) consistently remains most effective in reducing the tension. The extent of finger movement along the anterior-posterior (y-axis) contributes to the effectiveness of manual perineal protection. CONCLUSION: Appropriately performed Viennese manual perineal protection seems to reduce the perineal tension regardless of the fetal head size, and thus the method seems to be applicable to reduce risk of perineal trauma for all parturients.
[Mh] Termos MeSH primário: Parto Obstétrico/métodos
Feto/anatomia & histologia
Cabeça/anatomia & histologia
Complicações do Trabalho de Parto/prevenção & controle
Períneo/lesões
[Mh] Termos MeSH secundário: Parto Obstétrico/efeitos adversos
Feminino
Análise de Elementos Finitos
Seres Humanos
Gravidez
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180129
[Lr] Data última revisão:
180129
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171230
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189842


  3 / 13986 MEDLINE  
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[PMID]:29266902
[Au] Autor:Diaz MP; Steen M
[Ti] Título:PERINEAL WOUND CARE: EDUCATION AND TRAINING IN AUSTRALIA.
[So] Source:Aust Nurs Midwifery J;24(8):41, 2017 03.
[Is] ISSN:2202-7114
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:In Australia, approximately 75% of women who have a vaginal birth will sustain some form of perineal trauma (AIHW 2013); and over half of perineal injuries will require suturing.
[Mh] Termos MeSH primário: Instrução por Computador
Enfermeiras Obstétricas/educação
Complicações do Trabalho de Parto/enfermagem
Períneo/lesões
[Mh] Termos MeSH secundário: Austrália
Feminino
Seres Humanos
Períneo/cirurgia
Gravidez
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180118
[Lr] Data última revisão:
180118
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:171222
[St] Status:MEDLINE


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[PMID]:28743440
[Au] Autor:Bellussi F; Ghi T; Youssef A; Salsi G; Giorgetta F; Parma D; Simonazzi G; Pilu G
[Ad] Endereço:Departments of Obstetrics and Gynecology, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy. Electronic address: bellussi.federica@gmail.com.
[Ti] Título:The use of intrapartum ultrasound to diagnose malpositions and cephalic malpresentations.
[So] Source:Am J Obstet Gynecol;217(6):633-641, 2017 12.
[Is] ISSN:1097-6868
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Fetal malpositions and cephalic malpresentations are well-recognized causes of failure to progress in labor. They frequently require operative delivery, and are associated with an increased probability of fetal and maternal complications. Traditional obstetrics emphasizes the role of digital examinations, but recent studies demonstrated that this approach is inaccurate and intrapartum ultrasound is far more precise. The objective of this review is to summarize the current body of literature and provide recommendations to identify malpositions and cephalic malpresentations with ultrasound. We propose a systematic approach consisting of a combination of transabdominal and transperineal scans and describe the findings that allow an accurate diagnosis of normal and abnormal position, flexion, and synclitism of the fetal head. The management of malpositions and cephalic malpresentation is currently a matter of debate, and individualized depending on the general clinical picture and expertise of the provider. Intrapartum sonography allows a precise diagnosis and therefore offers the best opportunity to design prospective studies with the aim of establishing evidence-based treatment. The article is accompanied by a video that demonstrates the sonographic technique and findings.
[Mh] Termos MeSH primário: Distocia/diagnóstico por imagem
Apresentação no Trabalho de Parto
Complicações do Trabalho de Parto/diagnóstico por imagem
[Mh] Termos MeSH secundário: Parto Obstétrico
Distocia/etiologia
Extração Obstétrica
Feminino
Seres Humanos
Gravidez
Ultrassonografia Pré-Natal
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW; VIDEO-AUDIO MEDIA
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180111
[Lr] Data última revisão:
180111
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170727
[St] Status:MEDLINE


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[PMID]:29228050
[Au] Autor:Moinuddin M; Christou A; Hoque DME; Tahsina T; Salam SS; Billah SM; Kuppens L; Matin MZ; Arifeen SE
[Ad] Endereço:Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh.
[Ti] Título:Birth preparedness and complication readiness (BPCR) among pregnant women in hard-to-reach areas in Bangladesh.
[So] Source:PLoS One;12(12):e0189365, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Birth preparedness and complication readiness aims to reduce delays in care seeking, promote skilled birth attendance, and facility deliveries. Little is known about birth preparedness practices among populations living in hard-to-reach areas in Bangladesh. OBJECTIVES: To describe levels of birth preparedness and complication readiness among recently delivered women, identify determinants of being better prepared for birth, and assess the impact of greater birth preparedness on maternal and neonatal health practices. METHODS: A cross-sectional survey with 2,897 recently delivered women was undertaken in 2012 as part of an evaluation trial done in five hard-to-reach districts in rural Bangladesh. Mothers were considered well prepared for birth if they adopted two or more of the four birth preparedness components. Descriptive statistics and multivariable logistic regression were used for analysis. RESULTS: Less than a quarter (24.5%) of women were considered well prepared for birth. Predictors of being well-prepared included: husband's education (OR = 1.3; CI: 1.1-1.7), district of residence, exposure to media in the form of reading a newspaper (OR = 2.2; CI: 1.2-3.9), receiving home visit by a health worker during pregnancy (OR = 1.5; CI: 1.2-1.8), and receiving at least 3 antenatal care visits from a qualified provider (OR = 1.4; CI: 1.0-1.9). Well-prepared women were more likely to deliver at a health facility (OR = 2.4; CI: 1.9-3.1), use a skilled birth attendant (OR = 2.4, CI: 1.9-3.1), practice clean cord care (OR = 1.3, CI: 1.0-1.5), receive post-natal care from a trained provider within two days of birth for themselves (OR = 2.6, CI: 2.0-3.2) or their newborn (OR = 2.6, CI: 2.1-3.3), and seek care for delivery complications (OR = 1.8, CI: 1.3-2.6). CONCLUSION: Greater emphasis on BPCR interventions tailored for hard to reach areas is needed to improve skilled birth attendance, care seeking for complications and essential newborn care and facilitate reductions in maternal and neonatal mortality in low performing districts in Bangladesh.
[Mh] Termos MeSH primário: Parto Obstétrico/psicologia
Complicações do Trabalho de Parto/psicologia
População Rural
[Mh] Termos MeSH secundário: Adolescente
Adulto
Bangladesh
Estudos Transversais
Feminino
Seres Humanos
Meia-Idade
Gravidez
Complicações na Gravidez
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180104
[Lr] Data última revisão:
180104
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171212
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189365


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[PMID]:28076992
[Au] Autor:Zaami S; Montanari Vergallo G; Napoletano S; Signore F; Marinelli E
[Ad] Endereço:a Department of Anatomical, Histological, Forensic and Orthopaedic Sciences , Sapienza University of Rome , Rome , Italy.
[Ti] Título:The issue of delivery room infections in the Italian law. A brief comparative study with English and French jurisprudence.
[So] Source:J Matern Fetal Neonatal Med;31(2):223-227, 2018 Jan.
[Is] ISSN:1476-4954
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Delivery room infections are frequent, and many of them could be avoided through higher standards of care. The authors examine this issue by comparing it to English and French reality. Unlike England, in Italy and France the relationship established between health facility, physician and patient is outlined in a contract. In England, the judges' decisions converge toward a better and higher protection of the patient-the actor-and facilitate the probative task. In case of infections, including those occurring in the delivery room, three issues are evaluated: the hospital's negligent conduct, damages if any and causal nexus. Therefore, the hospital must demonstrate to have taken the appropriate asepsis measures according to current scientific knowledge concerning not only treatment, but also diagnosis, previous activities, surgery and post-surgery. In order to avoid a negative sentence, both physicians and hospital have to demonstrate their correct behavior and that the infection was caused by an unforeseeable event. The authors examine the most significant rulings by the Courts and the Supreme Court. They show that hospitals can avoid being accused of negligence and recklessness only if they can demonstrate to have implemented all the preventive measures provided for in the guidelines or protocols.
[Mh] Termos MeSH primário: Infecção Hospitalar
Salas de Parto/legislação & jurisprudência
Imperícia/legislação & jurisprudência
Complicações do Trabalho de Parto
Médicos/legislação & jurisprudência
Transtornos Puerperais
[Mh] Termos MeSH secundário: Antibacterianos/administração & dosagem
Antibacterianos/uso terapêutico
Feminino
Seres Humanos
Lactente
Mortalidade Infantil
Itália
Legislação Hospitalar
Mortalidade Materna
Gravidez
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171128
[Lr] Data última revisão:
171128
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170113
[St] Status:MEDLINE
[do] DOI:10.1080/14767058.2017.1281243


  7 / 13986 MEDLINE  
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[PMID]:29046273
[Au] Autor:Epidural and Position Trial Collaborative Group
[Ti] Título:Upright versus lying down position in second stage of labour in nulliparous women with low dose epidural: BUMPES randomised controlled trial.
[So] Source:BMJ;359:j4471, 2017 Oct 18.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo: To determine whether being upright in the second stage of labour in nulliparous women with a low dose epidural increases the chance of spontaneous vaginal birth compared with lying down. Multicentre pragmatic individually randomised controlled trial. 41 UK hospital labour wards. 3093 nulliparous women aged 16 or older, at term with a singleton cephalic presentation and in the second stage of labour with epidural analgesia. Women were allocated to an upright or lying down position, using a secure web based randomisation service, stratified by centre, with no masking of participants or clinicians to the trial interventions. The primary outcome was spontaneous vaginal birth. Women were analysed in the groups into which they were randomly allocated, regardless of position recorded at any time during the second stage of labour (excluding women with no valid consent, who withdrew, or who did not reach second stage before delivery). Secondary outcomes included mode of birth, perineal trauma, infant Apgar score <4 at five minutes, admission to a neonatal unit, and longer term included maternal physical and psychological health, incontinence, and infant gross developmental delay.  Between 4 October 2010 and 31 January 2014, 3236 women were randomised and 3093 (95.6%) included in the primary analysis (1556 in the upright group and 1537 in the lying down group). Significantly fewer spontaneous vaginal births occurred in women in the upright group: 35.2% (548/1556) compared with 41.1% (632/1537) in the lying down group (adjusted risk ratio 0.86, 95% confidence interval 0.78 to 0.94). This represents a 5.9% absolute increase in the chance of spontaneous vaginal birth in the lying down group (number needed to treat 17, 95% confidence interval 11 to 40). No evidence of differences was found for most of the secondary maternal, neonatal, or longer term outcomes including instrumental vaginal delivery (adjusted risk ratio 1.08, 99% confidence interval 0.99 to 1.18), obstetric anal sphincter injury (1.27, 0.88 to 1.84), infant Apgar score <4 at five minutes (0.66, 0.06 to 6.88), and maternal faecal incontinence at one year (1.18, 0.61 to 2.28). Evidence shows that lying down in the second stage of labour results in more spontaneous vaginal births in nulliparous women with epidural analgesia, with no apparent disadvantages in relation to short or longer term outcomes for mother or baby. Current Controlled Trials ISRCTN35706297.
[Mh] Termos MeSH primário: Analgesia Obstétrica/métodos
Anestesia Epidural/métodos
Anestésicos/administração & dosagem
Segunda Fase do Trabalho de Parto/fisiologia
Efeitos Adversos de Longa Duração/prevenção & controle
Complicações do Trabalho de Parto/prevenção & controle
Posicionamento do Paciente/métodos
[Mh] Termos MeSH secundário: Adulto
Índice de Apgar
Relação Dose-Resposta a Droga
Feminino
Seres Humanos
Recém-Nascido
Trabalho de Parto/fisiologia
Efeitos Adversos de Longa Duração/diagnóstico
Efeitos Adversos de Longa Duração/etiologia
Complicações do Trabalho de Parto/diagnóstico
Complicações do Trabalho de Parto/etiologia
Paridade/fisiologia
Gravidez
Resultado da Gravidez
Reino Unido
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Anesthetics)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171026
[Lr] Data última revisão:
171026
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171020
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j4471


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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
Seres 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:171011
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002257


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[PMID]:29016494
[Au] Autor:Kuper SG; Sievert RA; Steele R; Biggio JR; Tita AT; Harper LM
[Ad] Endereço:University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama.
[Ti] Título:Maternal and Neonatal Outcomes in Indicated Preterm Births Based on the Intended Mode of Delivery.
[So] Source:Obstet Gynecol;130(5):1143-1151, 2017 Nov.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To compare maternal and neonatal outcomes in women who underwent induction of labor or planned cesarean delivery in indicated preterm births before 34 weeks of gestation. METHODS: We conducted a retrospective cohort study of all indicated singleton preterm births (23-34 weeks of gestation) in a tertiary center from 2011 to 2014. The primary maternal outcome was a composite of early postpartum hemorrhage, blood transfusion, operative complications, postpartum complications, and clinical chorioamnionitis. The primary neonatal outcome was a composite of neonatal death, cardiopulmonary resuscitation in the delivery room, grade 3 or 4 intraventricular hemorrhage, necrotizing enterocolitis, culture-proven sepsis, birth trauma, arterial cord gas pH less than 7 or base excess less than -12, and 5-minute Apgar score 3 or less. Outcomes were compared by intended mode of delivery (induction of labor compared with cesarean) and adjusted for confounders. In secondary analyses, maternal and neonatal outcomes based on the intended mode of delivery were stratified by gestational age (23-27 6/7, 28-31 6/7, and 32-33 6/7 weeks of gestation). RESULTS: Of 629 patients with indicated early preterm births during the study period, 331 (53%) underwent induction of labor, of whom 208 (63%) delivered vaginally. Induction of labor was not associated with an increased risk of the primary maternal (16.3% compared with 19.5%, adjusted odds ratio [OR] 0.8, 95% CI 0.5-1.3) or neonatal composite outcome (14.5% compared with 35.9%, adjusted OR 0.7, 95% CI 0.4-1.1). Analyses stratified by gestational age were consistent with the overall analysis. CONCLUSION: Maternal and neonatal outcomes do not differ based on the intended mode of delivery. Induction of labor should be considered when early preterm birth is indicated.
[Mh] Termos MeSH primário: Cesárea/efeitos adversos
Parto Obstétrico/métodos
Trabalho de Parto Induzido/efeitos adversos
Complicações do Trabalho de Parto/etiologia
Nascimento Prematuro/terapia
[Mh] Termos MeSH secundário: Adulto
Feminino
Idade Gestacional
Seres Humanos
Recém-Nascido
Razão de Chances
Gravidez
Resultado da Gravidez
Estudos Retrospectivos
Resultado do Tratamento
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:171011
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002320


  10 / 13986 MEDLINE  
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[PMID]:28885399
[Au] Autor:Easter SR; Molina RL; Venkatesh KK; Kaimal A; Tuomala R; Riley LE
[Ad] Endereço:Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, the Department of Obstetrics, Gynecology, and Reproductive Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, and the Division of Maternal-Fetal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
[Ti] Título:Clinical Risk Factors Associated With Peripartum Maternal Bacteremia.
[So] Source:Obstet Gynecol;130(4):710-717, 2017 Oct.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate risk factors associated with maternal bacteremia in febrile peripartum women. METHODS: We performed a case-control study of women with fevers occurring between 7 days before and up to 42 days after delivery of viable neonates at two academic hospitals. Women with positive blood cultures were matched with the next two febrile women meeting inclusion criteria with negative blood cultures in the microbiology data without other matching parameters. We compared maternal and neonatal characteristics and outcomes between women in the case group and those in the control group with univariate analysis. We then used logistic regression to examine the association between clinical characteristics and maternal bacteremia. RESULTS: After excluding blood cultures positive only for contaminants, we compared 115 women in the case group with 285 in the control group. Bacteremic women were more likely to experience their initial fever during labor (40.9% compared with 22.8%, P<.01) and more likely to have fever at or above 102°F (62.6% compared with 31.6%, P<.01). These associations persisted in the adjusted analysis: multiparity (adjusted odds ratio [OR] 1.75, 95% CI 1.07-2.87), initial fever during labor (adjusted OR 2.82, 95% CI 1.70-4.70), and fever at or above 102°F (adjusted OR 3.83, 95% CI 2.37-6.19). In an analysis restricted to neonates whose mothers had initial fevers before or in the immediate 24 hours after delivery, neonates born to women in the case group had higher rates of bacteremia compared with those born to women in the control group (9.0% compared with 1.3%, P<.01). Eight of the nine bacteremic neonates born to bacteremic mothers (89%) grew the same organism as his or her mother in blood culture. CONCLUSION: Maternal bacteremia is associated with multiparity, initial fever during labor, and fever at or above 102°F; however, 37.5% of cases of bacteremia occurred in women with maximum fevers below this threshold. Obstetricians should maintain a heightened suspicion for an infectious source of fever in women with these clinical characteristics.
[Mh] Termos MeSH primário: Bacteriemia/microbiologia
Febre/microbiologia
Complicações do Trabalho de Parto/microbiologia
Período Periparto
Infecção Puerperal/microbiologia
[Mh] Termos MeSH secundário: Estudos de Casos e Controles
Feminino
Seres Humanos
Recém-Nascido
Modelos Logísticos
Sepse Neonatal/microbiologia
Razão de Chances
Gravidez
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170929
[Lr] Data última revisão:
170929
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170909
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002266



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