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[PMID]:29351327
[Au] Autor:Akbilgic O; Langham MR; Walter AI; Jones TL; Huang EY; Davis RL
[Ad] Endereço:University of Tennessee Health Science Center-Oak Ridge National Laboratory Center for Biomedical Informatics, Memphis, Tennessee, United States of America.
[Ti] Título:A novel risk classification system for 30-day mortality in children undergoing surgery.
[So] Source:PLoS One;13(1):e0191176, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:A simple, objective and accurate way of grouping children undergoing surgery into clinically relevant risk groups is needed. The purpose of this study, is to develop and validate a preoperative risk classification system for postsurgical 30-day mortality for children undergoing a wide variety of operations. The National Surgical Quality Improvement Project-Pediatric participant use file data for calendar years 2012-2014 was analyzed to determine preoperative variables most associated with death within 30 days of operation (D30). Risk groups were created using classification tree analysis based on these preoperative variables. The resulting risk groups were validated using 2015 data, and applied to neonates and higher risk CPT codes to determine validity in high-risk subpopulations. A five-level risk classification was found to be most accurate. The preoperative need for ventilation, oxygen support, inotropic support, sepsis, the need for emergent surgery and a do not resuscitate order defined non-overlapping groups with observed rates of D30 that vary from 0.075% (Very Low Risk) to 38.6% (Very High Risk). When CPT codes where death was never observed are eliminated or when the system is applied to neonates, the groupings remained predictive of death in an ordinal manner.
[Mh] Termos MeSH primário: Mortalidade da Criança
Procedimentos Cirúrgicos Operatórios/mortalidade
[Mh] Termos MeSH secundário: Adolescente
Criança
Pré-Escolar
Comorbidade
Bases de Dados Factuais
Feminino
Mortalidade Hospitalar
Seres Humanos
Lactente
Mortalidade Infantil
Recém-Nascido
Modelos Logísticos
Masculino
Mortalidade Perinatal
Complicações Pós-Operatórias/mortalidade
Complicações Pós-Operatórias/prevenção & controle
Melhoria de Qualidade
Medição de Risco
Fatores de Risco
Fatores de Tempo
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180120
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191176


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Registro de Ensaios Clínicos
Registro de Ensaios Clínicos
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[PMID]:29236628
[Au] Autor:Semrau KEA; Hirschhorn LR; Marx Delaney M; Singh VP; Saurastri R; Sharma N; Tuller DE; Firestone R; Lipsitz S; Dhingra-Kumar N; Kodkany BS; Kumar V; Gawande AA; BetterBirth Trial Group
[Ad] Endereço:From Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Departme
[Ti] Título:Outcomes of a Coaching-Based WHO Safe Childbirth Checklist Program in India.
[So] Source:N Engl J Med;377(24):2313-2324, 2017 12 14.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The prevalence of facility-based childbirth in low-resource settings has increased dramatically during the past two decades, yet gaps in the quality of care persist and mortality remains high. The World Health Organization (WHO) Safe Childbirth Checklist, a quality-improvement tool, promotes systematic adherence to practices that have been associated with improved childbirth outcomes. METHODS: We conducted a matched-pair, cluster-randomized, controlled trial in 60 pairs of facilities across 24 districts of Uttar Pradesh, India, testing the effect of the BetterBirth program, an 8-month coaching-based implementation of the Safe Childbirth Checklist, on a composite outcome of perinatal death, maternal death, or maternal severe complications within 7 days after delivery. Outcomes - assessed 8 to 42 days after delivery - were compared between the intervention group and the control group with adjustment for clustering and matching. We also compared birth attendants' adherence to 18 essential birth practices in 15 matched pairs of facilities at 2 and 12 months after the initiation of the intervention. RESULTS: Of 161,107 eligible women, we enrolled 157,689 (97.9%) and determined 7-day outcomes for 157,145 (99.7%) mother-newborn dyads. Among 4888 observed births, birth attendants' mean practice adherence was significantly higher in the intervention group than in the control group (72.8% vs. 41.7% at 2 months; 61.7% vs. 43.9% at 12 months; P<0.001 for both comparisons). However, there was no significant difference between the trial groups either in the composite primary outcome (15.1% in the intervention group and 15.3% in the control group; relative risk, 0.99; 95% confidence interval, 0.83 to 1.18; P=0.90) or in secondary maternal or perinatal adverse outcomes. CONCLUSIONS: Birth attendants' adherence to essential birth practices was higher in facilities that used the coaching-based WHO Safe Childbirth Checklist program than in those that did not, but maternal and perinatal mortality and maternal morbidity did not differ significantly between the two groups. (Funded by the Bill and Melinda Gates Foundation; Clinical Trials number, NCT02148952 .).
[Mh] Termos MeSH primário: Lista de Checagem
Parto Obstétrico/normas
Tocologia
[Mh] Termos MeSH secundário: Adulto
Lista de Checagem/utilização
Distribuição de Qui-Quadrado
Parto Obstétrico/educação
Feminino
Fidelidade a Diretrizes
Seres Humanos
Índia/epidemiologia
Recém-Nascido
Análise de Intenção de Tratamento
Mortalidade Materna
Tocologia/educação
Avaliação de Resultados (Cuidados de Saúde)
Mortalidade Perinatal
Gravidez
Transtornos Puerperais/epidemiologia
Melhoria de Qualidade
Padrão de Cuidado
Organização Mundial da Saúde
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171214
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMoa1701075


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[PMID]:29255547
[Au] Autor:Munan R; Kakudji Y; Nsambi J; Mukuku O; Maleya A; Kinenkinda X; Kakudji P
[Ad] Endereço:Département de Gynécologie-Obstétrique, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo.
[Ti] Título:[Childbirth among primiparous women in Lubumbashi: maternal and perinatal prognosis].
[Ti] Título:Accouchement chez la primipare à Lubumbashi: pronostic maternel et périnatal..
[So] Source:Pan Afr Med J;28:77, 2017.
[Is] ISSN:1937-8688
[Cp] País de publicação:Uganda
[La] Idioma:fre
[Ab] Resumo:Introduction: Childbirth in primiparous women is associated with many complications and, therefore, primiparous women are considered high risk due to maternal and fetal concerns. This study aims to determine birth rate in primiparous women in our environment, to identify factors associated with delivery by cesarean section and to assess maternal and perinatal morbi-mortality from childbirth in primiparous women living in Lubumbashi. Methods: We conducted a cross-sectional, analytical study of singleton births in 10 referral maternity hospitals in Lubumbashi over the period December 2013-May 2014. Primiparous births were compared to multiparous births. Maternal sociodemographic parameters as well as maternal and perinatal morbi-mortality were analyzed. The odds ratio and its confidence interval were calculated. Threshold significance level was set at p < 0.05. Results: Primiparity rate was 19.9%. Compared to multiparous births, primiparous births were mainly observed in adolescents (OR=11. 27, (7.98-15.91)), in students (OR = 5.61 (3.33-9.45)) and in women living alone (OR=7.62 (4.36-13.30)). Risk factors associated with delivery by cesarean section in primiparous women included obstetric evacuation (OR = 9.69 (4.75-19.74)), the lack of prenatal monitoring (OR=2.57, (1.32-5.01)), size ≤ 150 cm (OR = 2.42 (1.04-5.65)), uterine height > 34 cm (OR = 2.33 (1.32-4.10)) and malpresentation (OR = 6.37 (2.92-13.87)). With regard to maternal prognosis, we observed that high blood pressure (OR = 1.91 (1.32-2.74)), malpresentation (OR = 1.95 (1.16-3.17)), oxytocin use (OR = 2.03 (1.64-2.52)), cesarean section (OR = 2.04 (1.47-2.83)), episiotomy (OR=11.89 (8.61-16.43)) and eclampsia (OR = 4.21 (1.55-11.44)) were significantly associated with primiparity. The rates of low 5th minute Apgar score (OR = 1.55 (1.03-2.32)) and of deaths occurred during early neonatal period (OR=1.80 (1.08-2.98)) were significantly higher in primiparous women than in multiparous women. Conclusion: This study shows that primiparous birth is a problem in Lubumbashi. Hence improvement in mother-child care during primiparous childbirth includes the development of protocols for adequate management of childbirths.
[Mh] Termos MeSH primário: Cesárea/estatística & dados numéricos
Parto Obstétrico/métodos
Idade Materna
Cuidado Pré-Natal/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Estudos Transversais
Parto Obstétrico/estatística & dados numéricos
República Democrática do Congo
Feminino
Maternidades
Seres Humanos
Recém-Nascido
Mortalidade Materna
Paridade
Mortalidade Perinatal
Gravidez
Prognóstico
Fatores de Risco
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171222
[Lr] Data última revisão:
171222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171220
[St] Status:MEDLINE
[do] DOI:10.11604/pamj.2017.28.77.13712


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[PMID]:28904664
[Au] Autor:Koulimaya-Gombet CE; Diouf AA; Diallo M; Dia A; Sène C; Moreau JC; Diouf A
[Ad] Endereço:Centre Hospitalier National de Pikine, Service de Gynécologie et d'Obstétrique, Dakar, Sénégal.
[Ti] Título:[Pregnancy and delivery in patients with a personal history of cesarean section in Dakar: epidemiological, clinical, therapeutic and prognostic aspects].
[Ti] Título:Grossesse et accouchement des patientes ayant un antécédent de césarienne à Dakar: aspects épidémio-cliniques thérapeutiques et pronostiques..
[So] Source:Pan Afr Med J;27:135, 2017.
[Is] ISSN:1937-8688
[Cp] País de publicação:Uganda
[La] Idioma:fre
[Ab] Resumo:The aim of our study was to determine hospitalization rate for vaginal birth after cesarean section in Pikine, to evaluate the quality of the management of pregnant women with previous cesarean section and to determine prognostic factors of the outcome of a trial of scar. We conducted a retrospective study based on medical records and operational protocols of patients who underwent vaginal birth after cesarean section over the period 1 January 2010 - 31 December 2011. We analyzed socio-demographic data, pregnancy follow-up, therapeutic modalities and prognosis. Data were collected and analyzed using Microsoft Office Excel 2007 software and SPSS software 17.0. The frequency of vaginal births after cesarean section was 9.6%. The average age of our patients was 29.4 years. Primiparous women accounted for 54%. Short spacing interval between births was found in 52.6% of cases. Based on the number of cesarean sections, the breakdown was as follows: patients with a history of one previous cesarean section (79.8%), patients with a history of two previous caesarean sections (17.9%) and patients with a history of three previous caesarean sections (2.3%). The number of antenatal consultations performed was greater than or equal to 3 in 79.8% of cases. Patients undergoing evacuation accounted for 54.2% and they were already in labor at the time of admission in 81.7% of cases. Trial of scar was authorized in 177 patients (34.3%) and, at the end of this test, 147 patients (83%) had vaginal birth, of whom 21.7% by vacuum extraction. Cesarean section was performed in 71.4% of cases with 245 emergency cesarean sections and 93 scheduled cesarean sections. A history of vaginal birth was a determining factor in normal delivery (p = 0.0001). There was also a significant relationship between mode of admission and decision to perform a cesarean section (p = 0.0001). Maternal mortality was 0.4%. Perinatal mortality rate was 28.2‰ of live births. We are witnessing a dramatic increase of deliveries after cesarean section in our SONUC Health Centre. The quality of management should be enhanced through a better strategy in preparation for delivery. Trial of scar is a procedure to encourage in order to reduce the rate of iterative cesarean sections.
[Mh] Termos MeSH primário: Cesárea/estatística & dados numéricos
Parto Obstétrico/métodos
Hospitalização/estatística & dados numéricos
Nascimento Vaginal Após Cesárea/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Cicatriz/patologia
Feminino
Seres Humanos
Recém-Nascido
Mortalidade Materna
Meia-Idade
Mortalidade Perinatal
Gravidez
Resultado da Gravidez
Prognóstico
Estudos Retrospectivos
Senegal/epidemiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170915
[St] Status:MEDLINE
[do] DOI:10.11604/pamj.2017.27.135.11924


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[PMID]:28865550
[Au] Autor:Insua MF; Cobo AC; Larreategui Z; Ferrando M; Serra V; Meseguer M
[Ad] Endereço:IVI Valencia, Valencia, Spain.
[Ti] Título:Obstetric and perinatal outcomes of pregnancies conceived with embryos cultured in a time-lapse monitoring system.
[So] Source:Fertil Steril;108(3):498-504, 2017 Sep.
[Is] ISSN:1556-5653
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To compare obstetric and perinatal outcomes of singleton pregnancies resulting from embryos incubated in a time-lapse system (TLS) with those of embryos grown in standard IVF incubators (SI). DESIGN: Retrospective description of a cohort of patients who conceived during a randomized, controlled trial. SETTING: Private university-affiliated IVF center. PATIENT(S): Of 856 randomized patients, 378 gave birth to a live-born infant: 216 of the deliveries originated from embryos incubated in TLS, and 162 deliveries were from embryos cultured in SI. INTERVENTION(S): Embryo incubation and selection in TLS. MAIN OUTCOME MEASURE(S): Delivery and neonatal outcomes. RESULT(S): No significant differences were observed in the baseline characteristics of the study population. The delivery rate was 49.3% (TLS) vs. 40.0% (SI), and multiple deliveries were higher in the TLS group: 31.0% (67 of 216) vs. 24.7% (40 of 162) in the SI group. When singleton pregnancies were analyzed no differences were found between the two groups in the rate of obstetric problems with respect to weeks at delivery: 38.8 (95% confidence interval [CI] 38.4-39.1) (TLS) vs. 39.5 (95% CI 38.0-39.9) (SI); preterm births (<37 weeks): 10.7% (TLS) vs. 12.3% (SI); and very preterm births (<34 weeks): 2.9% (TLS) vs. 3.3% (SI). No statistical differences were found in neonatal outcomes such as birth weight: 3,163 g (95% CI 3,035-3,292 g) (TLS) vs. 3,074 (95% CI 2,913-3,236) (SI); low birth weight (<2,500 g): 12.8% (TLS) vs. 12.3% (SI); very low birth weight (<1,500 g): 2.0% (TLS) vs. 2.4% (SI); or height: 50.3 cm (95% CI 49.6-50.9 cm) (TLS) vs. 49.7 (95% CI 48.9-50.4 cm) (SI). No major malformations or perinatal mortality were found in either of the two groups. CONCLUSION(S): No detrimental effects were observed in obstetric and perinatal outcomes when a time-lapse incubator was used rather than a more widely used conventional incubator. As far as we know this is the first report from a randomized study of the neonatal outcomes of time-lapse monitoring. Our results suggest that this technology is an effective and safe alternative for embryo incubation, though trials of larger numbers of patients are required to further confirm our conclusions. CLINICAL TRIAL REGISTRATION NUMBER: NCT01549262.
[Mh] Termos MeSH primário: Embrião de Mamíferos/citologia
Fertilização In Vitro/estatística & dados numéricos
Incubadoras/estatística & dados numéricos
Infertilidade/epidemiologia
Infertilidade/terapia
Resultado da Gravidez/epidemiologia
Imagem com Lapso de Tempo/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Feminino
Fertilização In Vitro/métodos
Seres Humanos
Meia-Idade
Mortalidade Perinatal
Gravidez
Prevalência
Fatores de Risco
Espanha/epidemiologia
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170929
[Lr] Data última revisão:
170929
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170904
[St] Status:MEDLINE


  6 / 1220 MEDLINE  
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Costa, Maria da Conceiçäo Nascimento
Texto completo SciELO Brasil
Texto completo SciELO Saúde Pública
[PMID]:28832759
[Au] Autor:Nascimento RCS; Costa MDCN; Braga JU; Natividade MSD
[Ad] Endereço:Instituto de Saúde Coletiva. Universidade Federal da Bahia. Salvador, BA, Brasil.
[Ti] Título:Spatial patterns of preventable perinatal mortality in Salvador, Bahia, Brazil.
[So] Source:Rev Saude Publica;51:73, 2017 Aug 17.
[Is] ISSN:1518-8787
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To identify the spatial distribution patterns and areas of higher risk of preventable perinatal mortality in the city of Salvador, State of Bahia, Brazil. METHODS: We carried out a spatial aggregated study in 2007, considering the weighting areas (census tracts contiguous sets) of Salvador, of which the center and north present low life conditions. Data were obtained from national vital statistics systems and the 2010 Census. Addresses of live births and stillbirths were geocoded by weighting area. The spatial distribution of the perinatal mortality rate was analyzed from thematic maps. Spatial dependence was evaluated by the Global and Local Geary's and Moran's Indexes. RESULTS: Crude and smoothed perinatal mortality rates were high in areas situated to the north, west, and in center of Salvador. The smoothed rates in weighting areas ranged from 4.9/1,000 to 22.3/1,000 births. Of all perinatal deaths, 92.1% could have been prevented. We identified spatial dependence for preventable perinatal mortality for care in pregnancy, with neighboring areas with high risk in the north of the city. CONCLUSIONS: The preventability potential of perinatal mortality was high in Salvador, in 2007. The spatial distribution pattern with higher rates in disadvantaged areas of the city suggests the existence of social inequalities in health. The characteristics of the process of urban development of Salvador, which has inadequate prenatal care, possibly influenced the magnitude and spatial distribution pattern of this mortality.
[Mh] Termos MeSH primário: Morte Perinatal/prevenção & controle
Mortalidade Perinatal
Análise Espacial
[Mh] Termos MeSH secundário: Brasil/epidemiologia
Causas de Morte
Parto Obstétrico
Feminino
Seres Humanos
Lactente
Recém-Nascido
Gravidez
Medição de Risco/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170824
[St] Status:MEDLINE


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[PMID]:28770973
[Au] Autor:Yonemoto N; Dowswell T; Nagai S; Mori R
[Ad] Endereço:Department of Epidemiology and Biostatistics, Translational Medical Center, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashimachi, Kodaira, Tokyo, Japan, 187-8553.
[Ti] Título:Schedules for home visits in the early postpartum period.
[So] Source:Cochrane Database Syst Rev;8:CD009326, 2017 08 02.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Maternal complications including psychological and mental health problems and neonatal morbidity have been commonly observed in the postpartum period. Home visits by health professionals or lay supporters in the weeks following the birth may prevent health problems from becoming chronic with long-term effects on women, their babies, and their families. OBJECTIVES: To assess outcomes for women and babies of different home-visiting schedules during the early postpartum period. The review focuses on the frequency of home visits, the duration (when visits ended) and intensity, and on different types of home-visiting interventions. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 January 2013) and reference lists of retrieved articles. SELECTION CRITERIA: Randomised controlled trials (RCTs) (including cluster-RCTs) comparing different types of home-visiting interventions enrolling participants in the early postpartum period (up to 42 days after birth). We excluded studies in which women were enrolled and received an intervention during the antenatal period (even if the intervention continued into the postnatal period) and studies recruiting only women from specific high-risk groups. (e.g. women with alcohol or drug problems). DATA COLLECTION AND ANALYSIS: Study eligibility was assessed by at least two review authors. Data extraction and assessment of risk of bias were carried out independently by at least two review authors. Data were entered into Review Manager software. MAIN RESULTS: We included data from 12 randomised trials with data for more than 11,000 women. The trials were carried out in countries across the world, and in both high- and low-resource settings. In low-resource settings women receiving usual care may have received no additional postnatal care after early hospital discharge.The interventions and control conditions varied considerably across studies with trials focusing on three broad types of comparisons: schedules involving more versus fewer postnatal home visits (five studies), schedules involving different models of care (three studies), and home versus hospital clinic postnatal check-ups (four studies). In all but two of the included studies, postnatal care at home was delivered by healthcare professionals. The aim of all interventions was broadly to assess the wellbeing of mothers and babies, and to provide education and support, although some interventions had more specific aims such as to encourage breastfeeding, or to provide practical support.For most of our outcomes only one or two studies provided data, and overall results were inconsistent.There was no evidence that home visits were associated with improvements in maternal and neonatal mortality, and no consistent evidence that more postnatal visits at home were associated with improvements in maternal health. More intensive schedules of home visits did not appear to improve maternal psychological health and results from two studies suggested that women receiving more visits had higher mean depression scores. The reason for this finding was not clear. In a cluster randomised trial comparing usual care with individualised care by midwives extended up to three months after the birth, the proportions of women with Edinburgh postnatal depression scale (EPDS) scores ≥ 13 at four months was reduced in the individualised care group (RR 0.68, 95% CI 0.53 to 0.86). There was some evidence that postnatal care at home may reduce infant health service utilisation in the weeks following the birth, and that more home visits may encourage more women to exclusively breastfeed their babies. There was some evidence that home visits are associated with increased maternal satisfaction with postnatal care. AUTHORS' CONCLUSIONS: Increasing the number of postnatal home visits may promote infant health and maternal satisfaction and more individualised care may improve outcomes for women, although overall findings in different studies were not consistent. The frequency, timing, duration and intensity of such postnatal care visits should be based upon local and individual needs. Further well designed RCTs evaluating this complex intervention will be required to formulate the optimal package.
[Mh] Termos MeSH primário: Visita Domiciliar
Cuidado Pós-Natal/organização & administração
[Mh] Termos MeSH secundário: Feminino
Visita Domiciliar/estatística & dados numéricos
Seres Humanos
Lactente
Mortalidade Infantil
Recém-Nascido
Mortalidade Materna
Mortalidade Perinatal
Cuidado Pós-Natal/estatística & dados numéricos
Período Pós-Parto
Ensaios Clínicos Controlados Aleatórios como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170920
[Lr] Data última revisão:
170920
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170804
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD009326.pub3


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[PMID]:28639706
[Au] Autor:Brown J; Ceysens G; Boulvain M
[Ad] Endereço:Liggins Institute, The University of Auckland, Park Rd, Grafton, Auckland, New Zealand, 1142.
[Ti] Título:Exercise for pregnant women with gestational diabetes for improving maternal and fetal outcomes.
[So] Source:Cochrane Database Syst Rev;6:CD012202, 2017 06 22.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Gestational diabetes mellitus (GDM) is associated with both short- and long-term complications for the mother and her baby. Exercise interventions may be useful in helping with glycaemic control and improve maternal and infant outcomes.The original review on Exercise for diabetic pregnant women has been split into two new review titles reflecting the role of exercise for pregnant women with gestational diabetes and for pregnant women with pre-existing diabetes. Exercise for pregnant women with gestational diabetes for improving maternal and fetal outcomes (this review) Exercise for pregnant women with pre-existing diabetes for improving maternal and fetal outcomes OBJECTIVES: To evaluate the effects of exercise interventions for improving maternal and fetal outcomes in women with GDM. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (27 August 2016), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (18th August 2016), and reference lists of retrieved studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing an exercise intervention with standard care or another intervention in pregnant women diagnosed with gestational diabetes. Quasi-randomised and cross-over studies, and studies including women with pre-existing type 1 or type 2 diabetes were not eligible for inclusion. DATA COLLECTION AND ANALYSIS: All selection of studies, assessment of trial quality and data extraction was conducted independently by two review authors. Data were checked for accuracy. MAIN RESULTS: We included 11 randomised trials, involving 638 women. The overall risk of bias was judged to be unclear due to lack of methodological detail in the included studies.For the mother, there was no clear evidence of a difference between women in the exercise group and those in the control group for the risk of pre-eclampsia as the measure of hypertensive disorders of pregnancy (risk ratio (RR) 0.31, 95% confidence interval (CI) 0.01 to 7.09; two RCTs, 48 women; low-quality evidence), birth by caesarean section (RR 0.86, 95% CI 0.63 to 1.16; five RCTs, 316 women; I = 0%; moderate-quality evidence), the risk of induction of labour (RR 1.38, 95% CI 0.71 to 2.68; one RCT, 40 women; low-quality evidence) or maternal body mass index at follow-up (postnatal weight retention or return to pre-pregnancy weight) (mean difference (MD) 0.11 kg/m , 95% CI -1.04 to 1.26; three RCTs, 254 women; I = 0%; high-quality evidence). Development of type 2 diabetes, perineal trauma/tearing and postnatal depression were not reported as outcomes in the included studies.For the infant/child/adult, a single small (n = 19) trial reported no perinatal mortality (stillbirth and neonatal mortality) events in either the exercise intervention or control group (low-quality evidence). There was no clear evidence of a difference between groups for a mortality and morbidity composite (variously defined by trials, e.g. perinatal or infant death, shoulder dystocia, bone fracture or nerve palsy) (RR 0.56, 95% CI 0.12 to 2.61; two RCTs, 169 infants; I = 0%; moderate-quality evidence) or neonatal hypoglycaemia (RR 2.00, 95% CI 0.20 to 20.04; one RCT, 34 infants; low-quality evidence). None of the included trials pre-specified large-for-gestational age, adiposity (neonatal/infant, childhood or adulthood), diabetes (childhood or adulthood) or neurosensory disability (neonatal/infant) as trial outcomes.Other maternal outcomes of interest: exercise interventions were associated with both reduced fasting blood glucose concentrations (average standardised mean difference (SMD) -0.59, 95% CI -1.07 to -0.11; four RCTs, 363 women; I = 73%; T = 0.19) and a reduced postprandial blood glucose concentration compared with control interventions (average SMD -0.85, 95% CI -1.15 to -0.55; three RCTs, 344 women; I = 34%; T = 0.03). AUTHORS' CONCLUSIONS: Short- and long-term outcomes of interest for this review were poorly reported. Current evidence is confounded by the large variety of exercise interventions. There was insufficient high-quality evidence to be able to determine any differences between exercise and control groups for our outcomes of interest. For the woman, both fasting and postprandial blood glucose concentrations were reduced compared with the control groups. There are currently insufficient data for us to determine if there are also benefits for the infant. The quality of the evidence in this review ranged from high to low quality and the main reason for downgrading was for risk of bias and imprecision (wide CIs, low event rates and small sample size). Development of type 2 diabetes, perineal trauma/tearing, postnatal depression, large-for-gestational age, adiposity (neonate/infant, childhood or adulthood), diabetes (childhood or adulthood) or neurosensory disability (neonate/infant) were not reported as outcomes in the included studies.Further research is required comparing different types of exercise interventions with control groups or with another exercise intervention that reports on both the short- and long-term outcomes (for both the mother and infant/child) as listed in this review.
[Mh] Termos MeSH primário: Diabetes Gestacional/terapia
Terapia por Exercício/métodos
[Mh] Termos MeSH secundário: Adulto
Índice de Massa Corporal
Cesárea
Distocia/epidemiologia
Feminino
Seres Humanos
Hipoglicemia/epidemiologia
Lactente
Recém-Nascido
Trabalho de Parto Induzido/estatística & dados numéricos
Mortalidade Perinatal
Pré-Eclâmpsia/epidemiologia
Gravidez
Ensaios Clínicos Controlados Aleatórios como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[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:170623
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD012202.pub2


  9 / 1220 MEDLINE  
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[PMID]:28613398
[Au] Autor:Alfirevic Z; Stampalija T; Dowswell T
[Ad] Endereço:Department of Women's and Children's Health, The University of Liverpool, First Floor, Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool, UK, L8 7SS.
[Ti] Título:Fetal and umbilical Doppler ultrasound in high-risk pregnancies.
[So] Source:Cochrane Database Syst Rev;6:CD007529, 2017 06 13.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Abnormal blood flow patterns in fetal circulation detected by Doppler ultrasound may indicate poor fetal prognosis. It is also possible that false positive Doppler ultrasound findings could lead to adverse outcomes from unnecessary interventions, including preterm delivery. OBJECTIVES: The objective of this review was to assess the effects of Doppler ultrasound used to assess fetal well-being in high-risk pregnancies on obstetric care and fetal outcomes. SEARCH METHODS: We updated the search of Cochrane Pregnancy and Childbirth's Trials Register on 31 March 2017 and checked reference lists of retrieved studies. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials of Doppler ultrasound for the investigation of umbilical and fetal vessels waveforms in high-risk pregnancies compared with no Doppler ultrasound. Cluster-randomised trials were eligible for inclusion but none were identified. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. Data entry was checked. We assessed the quality of evidence using the GRADE approach. MAIN RESULTS: Nineteen trials involving 10,667 women were included. Risk of bias in trials was difficult to assess accurately due to incomplete reporting. None of the evidence relating to our main outcomes was graded as high quality. The quality of evidence was downgraded due to missing information on trial methods, imprecision in risk estimates and heterogeneity. Eighteen of these studies compared the use of Doppler ultrasound of the umbilical artery of the unborn baby with no Doppler or with cardiotocography (CTG). One more recent trial compared Doppler examination of other fetal blood vessels (ductus venosus) with computerised CTG.The use of Doppler ultrasound of the umbilical artery in high-risk pregnancy was associated with fewer perinatal deaths (risk ratio (RR) 0.71, 95% confidence interval (CI) 0.52 to 0.98, 16 studies, 10,225 babies, 1.2% versus 1.7 %, number needed to treat (NNT) = 203; 95% CI 103 to 4352, evidence graded moderate). The results for stillbirths were consistent with the overall rate of perinatal deaths, although there was no clear difference between groups for this outcome (RR 0.65, 95% CI 0.41 to 1.04; 15 studies, 9560 babies, evidence graded low). Where Doppler ultrasound was used, there were fewer inductions of labour (average RR 0.89, 95% CI 0.80 to 0.99, 10 studies, 5633 women, random-effects, evidence graded moderate) and fewer caesarean sections (RR 0.90, 95% CI 0.84 to 0.97, 14 studies, 7918 women, evidence graded moderate). There was no comparative long-term follow-up of babies exposed to Doppler ultrasound in pregnancy in women at increased risk of complications.No difference was found in operative vaginal births (RR 0.95, 95% CI 0.80 to 1.14, four studies, 2813 women), nor in Apgar scores less than seven at five minutes (RR 0.92, 95% CI 0.69 to 1.24, seven studies, 6321 babies, evidence graded low). Data for serious neonatal morbidity were not pooled due to high heterogeneity between the three studies that reported it (1098 babies) (evidence graded very low).The use of Doppler to evaluate early and late changes in ductus venosus in early fetal growth restriction was not associated with significant differences in any perinatal death after randomisation. However, there was an improvement in long-term neurological outcome in the cohort of babies in whom the trigger for delivery was either late changes in ductus venosus or abnormalities seen on computerised CTG. AUTHORS' CONCLUSIONS: Current evidence suggests that the use of Doppler ultrasound on the umbilical artery in high-risk pregnancies reduces the risk of perinatal deaths and may result in fewer obstetric interventions. The results should be interpreted with caution, as the evidence is not of high quality. Serial monitoring of Doppler changes in ductus venosus may be beneficial, but more studies of high quality with follow-up including neurological development are needed for evidence to be conclusive.
[Mh] Termos MeSH primário: Monitorização Fetal/métodos
Gravidez de Alto Risco
Ultrassonografia Pré-Natal
Artérias Umbilicais/diagnóstico por imagem
Cordão Umbilical/diagnóstico por imagem
[Mh] Termos MeSH secundário: Cardiotocografia
Cesárea/utilização
Feminino
Seres Humanos
Trabalho de Parto Induzido/utilização
Mortalidade Perinatal
Gravidez
Ensaios Clínicos Controlados Aleatórios como Assunto
Natimorto/epidemiologia
Artérias Umbilicais/fisiopatologia
Cordão Umbilical/irrigação sanguínea
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170824
[Lr] Data última revisão:
170824
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170615
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD007529.pub4


  10 / 1220 MEDLINE  
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[PMID]:28605006
[Au] Autor:Iheozor-Ejiofor Z; Middleton P; Esposito M; Glenny AM
[Ad] Endereço:Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, UK, M13 9PL.
[Ti] Título:Treating periodontal disease for preventing adverse birth outcomes in pregnant women.
[So] Source:Cochrane Database Syst Rev;6:CD005297, 2017 06 12.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Periodontal disease has been linked with a number of conditions, such as cardiovascular disease, stroke, diabetes and adverse pregnancy outcomes, all likely through systemic inflammatory pathways. It is common in women of reproductive age and gum conditions tend to worsen during pregnancy. Some evidence from observational studies suggests that periodontal intervention may reduce adverse pregnancy outcomes. There is need for a comprehensive Cochrane review of randomised trials to assess the effect of periodontal treatment on perinatal and maternal health. OBJECTIVES: To assess the effects of treating periodontal disease in pregnant women in order to prevent or reduce perinatal and maternal morbidity and mortality. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 6 October 2016), Cochrane Pregnancy and Childbirth's Trials Register (to 7 October 2016), the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 9) in the Cochrane Library, MEDLINE Ovid (1946 to 6 October 2016), Embase Ovid (1980 to 6 October 2016), and LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; 1982 to 6 October 2016). ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials on 6 October 2016. We placed no restrictions on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: We included all randomised controlled trials (RCTs) investigating the effects of periodontal treatment in preventing or reducing perinatal and maternal morbidity and mortality. We excluded studies where obstetric outcomes were not reported. DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles and abstracts and extracted data using a prepiloted data extraction form. Missing data were obtained by contacting authors and risk of bias was assessed using Cochrane's 'Risk of bias' tool. Where appropriate, results of comparable trials were pooled and expressed as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI) . The random-effects model was used for pooling except where there was an insufficient number of studies. We assessed the quality of the evidence using GRADE. MAIN RESULTS: There were 15 RCTs (n = 7161 participants) meeting our inclusion criteria. All the included studies were at high risk of bias mostly due to lack of blinding and imbalance in baseline characteristics of participants. The studies recruited pregnant women from prenatal care facilities who had periodontitis (14 studies) or gingivitis (1 study).The two main comparisons were: periodontal treatment versus no treatment during pregnancy and periodontal treatment versus alternative periodontal treatment. The head-to-head comparison between periodontal treatments assessed a more intensive treatment versus a less intensive one.Eleven studies compared periodontal treatment with no treatment during pregnancy. The meta-analysis shows no clear difference in preterm birth < 37 weeks (RR 0.87, 95% CI 0.70 to 1.10; 5671 participants; 11 studies; low-quality evidence) between periodontal treatment and no treatment. There is low-quality evidence that periodontal treatment may reduce low birth weight < 2500 g (9.70% with periodontal treatment versus 12.60% without treatment; RR 0.67, 95% CI 0.48 to 0.95; 3470 participants; 7 studies).It is unclear whether periodontal treatment leads to a difference in preterm birth < 35 weeks (RR 1.19, 95% CI 0.81 to 1.76; 2557 participants; 2 studies; ) and < 32 weeks (RR 1.35, 95% CI 0.78 to 2.32; 2755 participants; 3 studies), low birth weight < 1500 g (RR 0.80, 95% CI 0.38 to 1.70; 2550 participants; 2 studies), perinatal mortality (including fetal and neonatal deaths up to the first 28 days after birth) (RR 0.85, 95% CI 0.51 to 1.43; 5320 participants; 7 studies; very low-quality evidence), and pre-eclampsia (RR 1.10, 95% CI 0.74 to 1.62; 2946 participants; 3 studies; very low-quality evidence). There is no evidence of a difference in small for gestational age (RR 0.97, 95% CI 0.81 to 1.16; 3610 participants; 3 studies; low-quality evidence) when periodontal treatment is compared with no treatment.Four studies compared periodontal treatment with alternative periodontal treatment. Data pooling was not possible due to clinical heterogeneity. The outcomes reported were preterm birth < 37 weeks, preterm birth < 35 weeks, birth weight < 2500 g, birth weight < 1500 g and perinatal mortality (very low-quality evidence). It is unclear whether there is a difference in < 37 weeks, preterm birth < 35 weeks, birth weight < 2500 g, birth weight < 1500 g and perinatal mortality when different periodontal treatments are compared because the quality of evidence is very low.Maternal mortality and adverse effects of the intervention did not occur in any of the studies that reported on either of the outcomes. AUTHORS' CONCLUSIONS: It is not clear if periodontal treatment during pregnancy has an impact on preterm birth (low-quality evidence). There is low-quality evidence that periodontal treatment may reduce low birth weight (< 2500 g), however, our confidence in the effect estimate is limited. There is insufficient evidence to determine which periodontal treatment is better in preventing adverse obstetric outcomes. Future research should aim to report periodontal outcomes alongside obstetric outcomes.
[Mh] Termos MeSH primário: Gengivite/terapia
Doenças Periodontais/terapia
Complicações na Gravidez/terapia
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Recém-Nascido de Baixo Peso
Recém-Nascido
Recém-Nascido Pequeno para a Idade Gestacional
Mortalidade Perinatal
Pré-Eclâmpsia/epidemiologia
Gravidez
Resultado da Gravidez
Nascimento Prematuro/epidemiologia
Nascimento Prematuro/prevenção & controle
Ensaios Clínicos Controlados Aleatórios como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170823
[Lr] Data última revisão:
170823
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170613
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD005297.pub3



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