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Maternal Outcomes of Placental Abruption With Intrauterine Fetal Death and Delivery Routes: A Nationwide Observational Study 胎盘早破合并宫内胎儿死亡的产妇结局及分娩方式:一项全国性观察研究
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001016040.21838.33
Y. Wada, H. Takahashi, Y. Sasabuchi, R. Usui, M. Ogoyama, H. Suzuki, A. Ohkuchi, H. Fujiwara
(Acta Obstet Gynecol Scand. 2023;102:708–715) Both maternal and neonatal morbidity and mortality are associated with placental abruption (PA), a condition where the placenta prematurely separates from the uterine wall before or during labor. PA and intrauterine fetal death (IUFD) can co-occur, making a delivery more complex as well as high risk, as shown through increased maternal morbidity rates. Worldwide, delivery for mothers with PA and IUFD varies between vaginal delivery (VD) and cesarean delivery (CD), although various sources cite VD as the preferred method. Frequent complications of VD for PA with IUFD includes a longer delivery time, uterine rupture, and substantial blood loss. CD is associated with hemorrhagic shock and hematoma formation due to a greater increase in blood loss. Limited, small-scale studies have been performed comparing VD and CD and the effect on maternal morbidity in cases with IUFD and PA; however, this study uses a large data set to understand the relationship between delivery method and morbidity in cases of PA with IUFD.
(Acta Obstet Gynecol Scand. 2023;102:708-715) 胎盘早剥(PA)是指胎盘在分娩前或分娩过程中过早地与子宫壁分离,产妇和新生儿的发病率和死亡率都与此有关。胎盘早剥和胎儿宫内死亡(IUFD)可能同时发生,从而使分娩变得更加复杂和高风险,这体现在孕产妇发病率的增加上。在世界范围内,患有 PA 和 IUFD 的产妇的分娩方式有阴道分娩(VD)和剖宫产(CD)两种,但各种资料均称阴道分娩是首选方式。PA 合并 IUFD 的 VD 常见并发症包括分娩时间延长、子宫破裂和大量失血。由于失血量增加,CD 与失血性休克和血肿形成有关。目前已进行了有限的小规模研究,比较了VD和CD以及对IUFD和PA产妇发病率的影响;但本研究使用了大量数据来了解IUFD PA产妇的分娩方式与发病率之间的关系。
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引用次数: 0
Gestational Diabetes Mellitus and Labor Analgesia: Nationwide Register‐Based Analysis in Finland 妊娠糖尿病与分娩镇痛:基于芬兰全国登记册的分析
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001015968.12988.9f
I. Kuitunen, S. Vähä-Tuisku, T. Huttunen
(Acta Diabetol. 2022;59:1515–1517) Diabetes mellitus (DM) has an impact on patient analgesia, necessitating higher postoperative analgesia doses. Gestational DM’s (GDM) influence on labor analgesia must be studied better. The National Institute for Health and Care Excellence lacks recommendations. A lone study found increased opioid use postcesarean delivery (CD) in GDM patients, who are generally more obese. Previous analyses revealed minimal differences in labor analgesia based on obesity grade. With rising GDM incidence, understanding its impact on labor analgesia is crucial. Our national-level study aims to compare labor analgesia between GDM and non-GDM patients, addressing this gap in research.
(Acta Diabetol. 2022; 59:1515-1517)糖尿病(DM)对患者的镇痛有影响,因此需要增加术后镇痛剂量。必须更好地研究妊娠糖尿病(GDM)对分娩镇痛的影响。美国国家健康与护理卓越研究所(National Institute for Health and Care Excellence)缺乏相关建议。一项单独的研究发现,GDM 患者在剖宫产(CD)后阿片类药物的使用量增加,因为这些患者通常更加肥胖。之前的分析显示,基于肥胖等级的分娩镇痛差异很小。随着 GDM 发病率的上升,了解其对分娩镇痛的影响至关重要。我们的国家级研究旨在比较 GDM 和非 GDM 患者的分娩镇痛情况,以弥补这一研究空白。
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引用次数: 0
Obstetric Clinical Trial Diversity 产科临床试验多样性
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001015912.47620.ee
J. R. Steinberg, J. DiTosto, B. E. Turner, D.R. Roque, L.M. Yee
(Obstet Gynecol. 2023;142:840–843) Clinical trials are typically considered the highest quality evidence that informs clinical practice; however, there are gaps in reporting patient demographics, as well as in the diversity of groups enrolled in clinical trials. Obstetrics in particular has much to lose from underrepresentation, as there are high-impact racial and ethnic disparities in obstetric care that represent life and death situations for many individuals. This article is a research letter focusing on systemic racism and its impact on Asian American health in obstetrics and gynecology.
(Obstet Gynecol. 2023;142:840-843) 临床试验通常被认为是指导临床实践的最高质量的证据;然而,在报告患者人口统计数据以及参与临床试验的群体多样性方面存在差距。产科尤其会因代表性不足而蒙受巨大损失,因为产科护理中存在着影响巨大的种族和民族差异,这对许多人来说是生死攸关的大事。本文是一封研究信,重点关注系统性种族主义及其对妇产科亚裔美国人健康的影响。
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引用次数: 0
Tranexamic Acid, as an Adjunct to Oxytocin Prophylaxis, in the Prevention of Postpartum Hemorrhage in Women Undergoing Elective Cesarean Section: A Single-Center Double-Blind Randomized Controlled Trial 氨甲环酸作为催产素预防的辅助药物,用于预防择期剖宫产妇女产后出血:单中心双盲随机对照试验
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001016020.37304.ff
S.H. Lee, M.E. Kwek, S. Tagore, A. Wright, C.W. Ku, A. Teong, A. Tan, S.W.C. Lim, D. Yen, C. Ang, R. Sultana, C.H.F. Lim, D. Mathur, M. Mathur
(BJOG. 2023;130(9):1007–1015) Postpartum hemorrhage (PPH) is the main cause of maternal morbidity and mortality worldwide. The World Health Organization (WHO) recommends administration of uterotonics including oxytocin to prevent PPH, but uterotonics alone may not fully prevent PPH from other causes. The World Maternal Antifibrinolytic Trial (WOMAN Trial) reported that tranexamic acid (TXA) reduced PPH-related mortality in PPH cases, and as a result the WHO has included the administration of TXA into their recommendations for PPH treatment. There is speculation about the potential role of prophylactic TXA in preventing PPH.
(BJOG.产后出血(PPH)是全球孕产妇发病和死亡的主要原因。世界卫生组织(WHO)建议使用包括催产素在内的子宫收缩剂来预防 PPH,但仅靠子宫收缩剂可能无法完全预防其他原因引起的 PPH。世界产妇抗纤维蛋白溶解试验(WOMAN 试验)报告称,氨甲环酸(TXA)可降低 PPH 病例中与 PPH 相关的死亡率,因此世界卫生组织已将氨甲环酸纳入 PPH 治疗建议中。有人猜测预防性氨甲环酸在预防 PPH 方面可能发挥的作用。
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引用次数: 0
Clinical Triggers and Vital Signs Influencing Crisis Acknowledgment and Calls for Help by Anesthesiologists: A Simulation-Based Observational Study 影响麻醉医师识别危机和呼救的临床触发因素和生命体征:基于模拟的观察研究
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001016008.59181.d9
L.H. Matern, R. Gardner, J.W. Rudolph, R. Nadelberg, C. Buléon, R.D. Minehart
(J Clin Anesth. 2023;90:111235 |https://doi.org/10.1016/j.jclinane.2023.111235) Swiftly mobilizing resources in perioperative emergencies is crucial for patient survival, with anesthesiologists typically bearing this responsibility. Recognizing the urgency, the call for help is emphasized through formalized “stat” calls. However, the timing of seeking assistance remains subjective, posing a challenge. While empirical evidence highlights blood pressure thresholds indicative of harm, ambiguity surrounds terms like “early” in crisis management. An assumption that anesthesiologists must possess all answers hinders timely collaboration, impacting patient care. Factors affecting crisis acknowledgment, especially in simulated settings, were explored among MOCA course participants. Acknowledgment, a pivotal step in emergency response, was scrutinized alongside potential differences between active participants and observers. This investigation seeks to expose vulnerabilities in ACRM implementation, guiding future studies on crisis management in perioperative settings.
(J Clin Anesth. 2023;90:111235 |https://doi.org/10.1016/j.jclinane.2023.111235)在围术期紧急情况下迅速调动资源对患者的存活至关重要,而麻醉医师通常承担着这一责任。由于认识到紧迫性,通过正式的 "stat "呼叫来强调求助。然而,寻求帮助的时机仍然是主观的,这就带来了挑战。虽然经验证据突出表明血压阈值会造成危害,但危机管理中的 "早期 "等术语却含糊不清。麻醉医师必须掌握所有答案的假设阻碍了及时合作,影响了患者护理。我们在 MOCA 课程参与者中探讨了影响危机确认的因素,尤其是在模拟环境中。确认是应急响应中的关键步骤,与积极参与者和旁观者之间的潜在差异一起被仔细研究。这项调查旨在揭示 ACRM 实施过程中的薄弱环节,为今后围术期环境下的危机管理研究提供指导。
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引用次数: 0
State Public Insurance Coverage Policies and Postpartum Care Among Immigrants 州公共保险覆盖政策与移民产后护理
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001015952.14846.cc
M.W. Steenland, R.E. Fabi, M. Bellerose, A. Desir, M. S. White, L.R. Wherry
(JAMA. 2023;330(3):238–246) While physicians and professional medical organizations advocate for routine postpartum care for adults, some states impose restrictions on public insurance coverage for undocumented immigrants and immigrants granted legal documentation status within the past 5 years. The aim of this study was to investigate the relationship between public insurance coverage and postpartum care among low-income immigrants and to determine the difference in postpartum care receipt between immigrants and nonimmigrants.
(JAMA.2023;330(3):238-246)虽然医生和专业医疗组织提倡对成人进行常规产后护理,但一些州对无证移民和在过去 5 年内获得合法证件身份的移民的公共保险覆盖范围施加了限制。本研究旨在调查公共保险覆盖范围与低收入移民产后护理之间的关系,并确定移民与非移民在接受产后护理方面的差异。
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引用次数: 0
Screening for Hypertensive Disorders of Pregnancy: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force 妊娠期高血压疾病筛查:为美国预防服务工作组提供的最新证据报告和系统回顾
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001015920.48053.30
J. T. Henderson, E. M. Webber, R. G. Thomas, K. K. Vesco
(JAMA. 2023;330:11:1083–1091) The incidence of hypertensive disorders, including pre-eclampsia, during pregnancy has been increasing since the early 1990s, putting more pregnant women and neonates at risk of death or illness. The Black population is affected disproportionately, with the risk of dying of pre-eclampsia 5 times higher for Blacks than for Whites. In 2017, the US Preventive Services Task Force recommended screening pregnant women for pre-eclampsia by taking blood pressure (BP) readings throughout pregnancy at office visits. This systematic review examined different screening protocols to evaluate if some were more effective than others.
(JAMA. 2023;330:11:1083-1091) 自 20 世纪 90 年代初以来,妊娠期高血压疾病(包括先兆子痫)的发病率不断上升,使更多孕妇和新生儿面临死亡或患病的风险。黑人受到的影响尤为严重,黑人死于先兆子痫的风险是白人的 5 倍。2017 年,美国预防服务工作组建议通过在整个孕期的门诊中测量血压(BP)来筛查孕妇是否患有先兆子痫。本系统综述研究了不同的筛查方案,以评估是否有些方案比其他方案更有效。
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引用次数: 0
Management and Outcomes of Pulmonary Artery Hypertension and Eisenmenger Syndrome During Pregnancy: A Prospective Observational Cohort Study 妊娠期肺动脉高压和艾森曼格综合征的管理和结果:前瞻性观察队列研究
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001016068.86521.61
N. Jha, M. B. Divya, A.K. Jha
(BJOG. 2023;130(10):1258–1268) Pregnancies complicated by pulmonary arterial hypertension (PAH) and Eisenmenger syndrome often result in severe maternal and fetal morbidity and mortality. Clinicians often counsel women with these conditions to avoid pregnancy or terminate a pregnancy. Multidisciplinary specialty centers, however, have seen good outcomes in these high-risk women and their babies.
(BJOG.2023;130(10):1258–1268)妊娠并发肺动脉高压(PAH)和艾森曼格综合征通常会导致严重的母体和胎儿发病率和死亡率。临床医生通常会建议患有这些疾病的妇女避免怀孕或终止妊娠。然而,多学科专科中心却为这些高危妇女及其胎儿带来了良好的治疗效果。
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引用次数: 1
The Need for Maternal Critical Care Education, Point-of-Care Ultrasound and Critical Care Echocardiography in Obstetric Anesthesiologists Training 产科麻醉师培训中孕产妇重症监护教育、护理点超声和重症监护超声心动图的必要性
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001015904.76475.e9
C. Padilla, C. Ortner, A. Dennis, L. Zieleskiewicz
(Int J Obstet Anesth 2023;55:103880/https://doi.org/10.1016/j.ijoa.2023.103880/0208-5216/) The rise in complex obstetric cases is a global phenomenon. In high-income countries, medical issues, particularly cardiovascular conditions, contribute to maternal morbidity and mortality, challenging traditional educational and clinical approaches. Obstetric critical care principles warrant standardized education, including ultrasound applications like POCUS for real-time assessment of cardiac, pulmonary, airway, and gastric parameters. Despite the increasing need for maternal critical care, formal certification programs are lacking globally. The United States and the UK lack specific educational standards for maternal critical care in anesthesiology.
(Int J Obstet Anesth 2023;55:103880/https://doi.org/10.1016/j.ijoa.2023.103880/0208-5216/)复杂产科病例的增加是一个全球现象。在高收入国家,医疗问题,尤其是心血管疾病,导致了产妇的发病率和死亡率,对传统的教育和临床方法提出了挑战。产科危重症护理原则需要标准化的教育,包括超声应用,如用于实时评估心、肺、气道和胃参数的 POCUS。尽管孕产妇危重症护理的需求日益增长,但全球范围内却缺乏正规的认证计划。美国和英国在麻醉学方面缺乏孕产妇危重症护理的具体教育标准。
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引用次数: 0
Prenatal Intravenous Magnesium at 30 to 34 Weeks’ Gestation and Neurodevelopmental Outcomes in Offspring: The MAGENTA Randomized Clinical Trial 妊娠 30 至 34 周时的产前静脉注射镁与后代的神经发育结果:MAGENTA 随机临床试验
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001016052.26395.51
C. Crowther, P. Ashwood, P. F. Middleton, A. McPhee, T. Tran, J.E. Harding
(JAMA. 2023;330(7):603–614) Preterm infants have a greater risk of cerebral palsy, a common motor disability for which there is no cure. As such, primary prevention is especially important. The use of magnesium sulfate while pregnant has been shown in randomized clinical trials to be helpful for those at risk of early preterm delivery by improving an infant’s chance of survival without cerebral palsy. As a result, magnesium sulfate is recommended for fetal neuroprotection. However, there is a lack of data surrounding the ideal gestational age for using it prenatally.
(美国医学会杂志。2023;330(7):603-614)早产儿患脑瘫的风险更大,而脑瘫是一种常见的运动障碍,目前尚无根治的方法。因此,初级预防尤为重要。随机临床试验表明,孕妇在怀孕期间服用硫酸镁对有早产风险的孕妇很有帮助,可提高婴儿的存活率,避免出现脑瘫。因此,硫酸镁被推荐用于胎儿神经保护。然而,关于产前使用硫酸镁的理想孕龄还缺乏相关数据。
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引用次数: 0
期刊
Obstetric Anesthesia Digest
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