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High Risk Pregnancy. Obstetric Emergencies.

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https://read.qxmd.com/read/30707537/points-pearls-identification-and-management-of-adolescent-gynecologic-emergencies-in-the-emergency-department
#1
Tatyana Vayngortin, Shruti Kant, Bryan Wilson
In the emergency department, gynecologic complaints are common presentations for adolescent girls, who may present with abdominal pain, pelvic pain, vaginal discharge, and vaginal bleeding. The differential diagnosis for these presentations is broad, and further complicated by psychosocial factors, confidentiality concerns, and the need to recognize abuse and sexual assault. This issue provides recommendations for the evaluation and management of obstetric and gynecologic emergencies including infectious, anatomic, and endocrine etiologies...
February 1, 2019: Pediatric Emergency Medicine Practice
https://read.qxmd.com/read/30704451/probiotics-and-vaginal-microecology-fact-or-fancy
#2
Laura Buggio, Edgardo Somigliana, Alessandra Borghi, Paolo Vercellini
BACKGROUND: Probiotics are live microorganisms that, when administered in adequate amounts, should confer a health benefit to the host. Media sources tend to present probiotics as an appealing health promotion method able to prevent or treat a wide variety of clinical conditions. In obstetrics and gynaecology, Lactobacilli species are mainly used to restore the physiologic vaginal microbiota in order to treat bacterial vaginosis and vulvovaginal candidiasis (VVC) and prevent preterm birth...
January 31, 2019: BMC Women's Health
https://read.qxmd.com/read/30688138/twin-pregnancies-treated-with-emergency-or-ultrasound-indicated-cerclage-to-prevent-preterm-births
#3
Malou Barbosa, Rikke Bek Helmig, Lone Hvidman
INTRODUCTION: Multiple gestations are high-risk pregnancies associated with an increased risk of neonatal morbidity and mortality, mainly due to preterm births. Numerous interventions have been attempted in order to delay the time of delivery and subsequently, prevent preterm births in twin gestations. To date, no really effective intervention has been found. Use of cerclage in twin pregnancies has been controversial. Recently, however, small retrospective cohort studies have shown a potentially positive effect with the use of cerclage in twin pregnancies...
January 27, 2019: Journal of Maternal-fetal & Neonatal Medicine
https://read.qxmd.com/read/30676713/identification-and-management-of-adolescent-gynecologic-emergencies-in-the-emergency-department
#4
Tatyana Vayngortin, Shruti Kant
In the emergency department, gynecologic complaints are common presentations for adolescent girls, who may present with abdominal pain, pelvic pain, vaginal discharge, and vaginal bleeding. The differential diagnosis for these presentations is broad, and further complicated by psychosocial factors, confidentiality concerns, and the need to recognize abuse and sexual assault. This issue provides recommendations for the evaluation and management of obstetric and gynecologic emergencies including infectious, anatomic, and endocrine etiologies...
February 2019: Pediatric Emergency Medicine Practice
https://read.qxmd.com/read/30639318/laparoscopic-removal-of-an-abdominal-pregnancy-in-the-pelvic-sidewall
#5
Oshri Barel, Ramy Rahamim Suday, Jonathan Stanleigh, Mordechai Pansky
OBJECTIVE: To present the presentation, diagnosis and management of a patient with abdominal pregnancy and to illustrate the laparoscopic technique in which management was preformed. DESIGN: A descriptive study (Canadian task force level III) approved by our local institutional review board. Consent was given from the patient. SETTING: A university hospital in Ashdod, Israel. PATIENT: On May 15th 2018, a Gravida-3 Para-2, 37-year-old asymptomatic patient was referred to the gynecological emergency department due to a suspected ectopic pregnancy...
January 9, 2019: Journal of Minimally Invasive Gynecology
https://read.qxmd.com/read/30576577/pregnancy-and-zika-the-quest-for-quality-care-and-reproductive-justice
#6
Silvia E Rabionet, Carmen D Zorrilla, Juana I Rivera-Viñas, Yeney Guerra-Sanchez
On February 1, 2016, the World Health Organization (WHO) declared the ZIKV virus outbreak a Public Health Emergency of International Concern (PHEIC). Pregnant women and their infants, are vulnerable to the impact of this vector-borne illness (mosquito) and sexually transmitted viral infection. The uncertainty surrounding the possibility of congenital anomalies due to ZIKV infection during pregnancy bring a renewed debate about the rights of women to control their reproductive decisions. Current strategies, resources and services aimed at prevention priorities fall short of responding to a clear framework regarding sexual reproductive health, rights and justice...
December 2018: Puerto Rico Health Sciences Journal
https://read.qxmd.com/read/30559791/meconium-stained-liquor-and-its-neonatal-outcome
#7
Nadia Mohammad, Taha Jamal, Arjumand Sohaila, Syed Rehan Ali
Objective: To determine the maternal factors and neonatal outcome of pregnancy complicated by meconium stained amniotic fluid. Methods: This one year retrospective study was conducted at the Agha Khan Hospital for Women-Garden Campus, it is a secondary care private teaching hospital. Demographics information included gestational age, gender and birth weight of baby, medical and obstetric complications during pregnancy, mode of delivery, neonatal outcome (Meconium Aspiration Syndrome (MAS) and need for admission in nursery) were recorded on a pre-designed proforma...
November 2018: Pakistan Journal of Medical Sciences Quarterly
https://read.qxmd.com/read/30529257/the-implications-of-high-carbon-monoxide-levels-in-early-pregnancy-for-neonatal-outcomes
#8
Ciara M E Reynolds, Brendan Egan, Rachel A Kennedy, Eimer O'Malley, Sharon R Sheehan, Michael J Turner
OBJECTIVES: The aim of this study was to examine the implications of increased maternal Breath Carbon Monoxide (BCO) levels at the first antenatal visit for subsequent birthweight (BW) and neonatal outcomes. STUDY DESIGN: Secondary analysis of a prospective, observational study. Pregnant women aged ≥18years who understood English were recruited (n=250). However, only women who delivered a normally formed baby weighing ≥500g were analysed (n=234). At the first antenatal visit, a research questionnaire was completed and a BCO test was performed...
November 30, 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://read.qxmd.com/read/30527106/clinical-features-and-outcomes-of-pregnancies-complicated-by-pre-ecplampsia-necessitating-in-utero-transfer
#9
Stephanie E Reilly, Shaun P Brennecke, Jacqui Smith, Michael J Stewart, Rosemarie A Boland
OBJECTIVES: Pre-eclampsia (PE) is associated with significant risks of adverse perinatal outcomes, often necessitating transfer to a higher level of care for specialist perinatal management. In Victoria, Australia, the Paediatric Infant Perinatal Emergency Retrieval (PIPER) coordinates in-utero transfers of high-risk pregnancies. Our objectives were to report the clinical features and outcomes of women referred to PIPER with a primary diagnosis of PE, and subsequently transferred in-utero...
October 2018: Pregnancy Hypertension
https://read.qxmd.com/read/30415799/obstetric-anesthesia-management-of-the-patient-with-cardiac-disease
#10
REVIEW
K W Arendt, K J Lindley
Cardiovascular disease is the leading cause of maternal mortality in much of the developed world. Risk stratification models can predict which patients are at greatest risk for maternal or fetal morbidity or mortality. Particular cardiac diseases hold significant risk of mortality during pregnancy including pulmonary hypertension, aortic aneurysm, left-ventricular outflow tract obstruction, and severe cardiomyopathy. High-risk patients should deliver at high-resource hospitals under the care of experts in cardiology, obstetrics, perinatology, neonatology and anesthesiology...
September 27, 2018: International Journal of Obstetric Anesthesia
https://read.qxmd.com/read/30286267/facilitators-for-maternity-waiting-home-utilisation-at-attat-hospital-a-mixed-methods-study-based-on-45-years-of-experience
#11
Tienke Vermeiden, Rita Schiffer, Jorine Langhorst, Neel Klappe, Wolde Asera, Gashaw Getnet, Jelle Stekelenburg, Thomas van den Akker
OBJECTIVE: To describe facilitators for maternity waiting home (MWH) utilisation from the perspectives of MWH users and health staff. METHODS: Data collection took place over several time frames between March 2014 and January 2018 at Attat Hospital in Ethiopia, using a mixed-methods design. This included seven in-depth interviews with staff and users, three focus group discussions with 28 users and attendants, a structured questionnaire among 244 users, a 2-week observation period and review of annual facility reports...
October 4, 2018: Tropical Medicine & International Health: TM & IH
https://read.qxmd.com/read/30230708/maternal-pre-pregnancy-weight-and-autistic-like-traits-among-offspring-in-the-general-population
#12
Kandice J Varcin, John P Newnham, Andrew J O Whitehouse
There is an emerging body of evidence demonstrating that maternal obesity at the time of conception increases the risk for Autism Spectrum Disorders (ASD) among offspring. We explored whether pre-pregnancy weight was related to autistic-like traits among offspring not diagnosed with ASD. A large sample of women, recruited during the second trimester of pregnancy, had their height measured and reported their pre-pregnancy weight. These measurements were then converted to a Body Mass Index (BMI) using the formula: (weight in kilograms)/(height in metres2 )...
September 19, 2018: Autism Research: Official Journal of the International Society for Autism Research
https://read.qxmd.com/read/30230395/nationwide-content-analysis-of-undergraduate-obstetrics-and-gynaecology-clinical-curricula-in-turkish-medical-schools
#13
Mekin Sezik, Erol Gurpinar, Nese Zayim
The aim was to perform a document content analysis of the subject titles in the undergraduate obstetrics and gynaecology (OG) curricula in Turkish medical schools regarding the National Core Curriculum revised in 2014 (NCC-2014). Two mini-focus group discussions with four voluntary OG faculty members in each session and one of the authors as the moderator were employed within a 1-week time frame to identify the primary (n = 36) and secondary (n = 15) NCC-2014 OG titles that were then compared for the alignment with the curricula of the various medical schools published on their website...
September 19, 2018: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
https://read.qxmd.com/read/30192041/adherence-trajectories-of-buprenorphine-therapy-among-pregnant-women-in-a-large-state-medicaid-program-in-the-united-states
#14
Wei-Hsuan Lo-Ciganic, Julie M Donohue, Joo Yeon Kim, Elizabeth E Krans, Bobby L Jones, David Kelley, Alton E James, Marian P Jarlenski
PURPOSE: Little is known about the longitudinal patterns of buprenorphine adherence among pregnant women with opioid use disorder, especially when late initiation, nonadherence, or early discontinuation of buprenorphine during pregnancy may increase the risk of adverse outcomes. We aimed to identify distinct trajectories of buprenorphine use during pregnancy, and factors associated with these trajectories in Medicaid-enrolled pregnant women. METHODS: A retrospective cohort study included 2361 Pennsylvania Medicaid enrollees aged 15 to 46 having buprenorphine therapy during pregnancy and a live birth between 2008 and 2015...
September 7, 2018: Pharmacoepidemiology and Drug Safety
https://read.qxmd.com/read/30173597/prehypertension-during-pregnancy-and-risk-of-small-for-gestational-age-a-systematic-review-and-meta-analysis
#15
Chunxia Cao, Wei Cai, Xiulong Niu, Jiaxi Fu, Jianmei Ni, Qiong Lei, Jianmin Niu, Xin Zhou, Yuming Li
OBJECTIVE: Emerging evidence shows that high blood pressure (BP) level even below 140/90 mmHg during pregnancy is associated with increased risk for maternal and infant complications. The meta-analysis evaluated the associations between prehypertension (BP 120-139/80-89 mmHg) during pregnancy and the risk of small for gestational age (SGA), as well as the impact of prehypertension on birth weight (BW). METHODS: Databases (PubMed, Embase, and Cochrane Library) were searched for cohort studies with data on prehypertension in pregnancy and adverse obstetrical outcomes, including SGA and/or BW...
September 25, 2018: Journal of Maternal-fetal & Neonatal Medicine
https://read.qxmd.com/read/30074551/headache-in-pregnancy
#16
Matthew S Robbins
PURPOSE OF REVIEW: Headache disorders are extraordinarily common and disproportionately impact women of childbearing age. This article reviews the importance of proper diagnosis, natural history, and management of headache disorders in pregnant and postpartum women. RECENT FINDINGS: Red flags for secondary headache specifically among pregnant women include elevated blood pressure and lack of a previous headache history, as well as a prolonged duration of the headache attack in those with a prior history of migraine...
August 2018: Continuum: Lifelong Learning in Neurology
https://read.qxmd.com/read/30016929/bleeding-complications-and-antithrombotic-treatment-in-264-pregnancies-in-antiphospholipid-syndrome
#17
MULTICENTER STUDY
C M Yelnik, M Lambert, E Drumez, V Le Guern, J-L Bacri, M M Guerra, C A Laskin, D W Branch, L R Sammaritano, N Morel, G Guettrot-Imbert, D Launay, E Hachulla, P-Y Hatron, J E Salmon, N Costedoat-Chalumeau
Purpose The purpose of this study was to evaluate the safety of antithrombotic treatments prescribed during pregnancy in patients with antiphospholipid syndrome (APS). Methods This international, multicenter study included two cohorts of patients: a retrospective French cohort and a prospective US cohort (PROMISSE study). Inclusion criteria were (1) APS (Sydney criteria), (2) live pregnancy at 12 weeks of gestation (WG) with (3) follow-up data until six weeks post-partum. According to APS standard of care, patients were treated with aspirin and/or low-molecular weight heparin (LMWH) at prophylactic (pure obstetric APS) or therapeutic doses (history of thrombosis)...
September 2018: Lupus
https://read.qxmd.com/read/29914780/understanding-the-experiences-of-east-african-immigrant-women-with-gestational-diabetes-mellitus
#18
Fartoon M Siad, Xiao Yang Fang, Maria J Santana, Sonia Butalia, Marilynne A Hebert, Doreen M Rabi
OBJECTIVES: East African (EA) women are a subpopulation who are at very high risk for gestational diabetes (GDM) and poor obstetric outcomes, but little is known about the care experiences of this understudied group. The objective of this study was to document the impact of a diagnosis of GDM and the perceptions of diabetes care among EA immigrant women. METHODS: Semistructured in-depth interviews were conducted with 10 EA immigrant women diagnosed with GDM in Calgary; they were recruited from community and tertiary care settings...
February 2, 2018: Canadian Journal of Diabetes
https://read.qxmd.com/read/29862717/-design-and-application-of-high-risk-pregnancy-monitoring-warning-internet-platform-based-on-internet-of-things
#19
Heqing Lu, Xiaofeng Zhang, Bin Li
Through illustrating the designing of high-risk pregnancy maternal-fetal monitoring system based on the internet of things, this paper introduced the specific application of using wearable medical devices to provide maternal-fetal mobile medical services. With the help of big data and cloud obstetrics platform, the monitoring and warning network was further improved, the level-to-level administration of high-risk pregnancy was realized, the level of perinatal health care was enhanced and the risk of critical emergency of pregnancy decreased...
September 30, 2017: Zhongguo Yi Liao Qi Xie za Zhi, Chinese Journal of Medical Instrumentation
https://read.qxmd.com/read/29847607/reducing-stillbirths-in-ethiopia-results-of-an-intervention-programme
#20
Bernt Lindtjørn, Demissew Mitike, Zillo Zidda, Yaliso Yaya
Previous studies from South Ethiopia have shown that interventions that focus on intrapartum care substantially reduce maternal mortality and there is a need to operationalize health packages that could reduce stillbirths. The aim of this paper is to evaluate if a programme that aimed to improve maternal health, and mainly focusing on strengthening intrapartum care, also would reduce the number of stillbirths, and to estimate if there are other indicators that explains high stillbirth rates. Our study used a "continuum of care" approach and focussed on providing essential antenatal and obstetric services in communities through health extension workers, at antenatal and health facility services...
2018: PloS One
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