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Planned Delivery or Expectant Management for Late Preterm Pre-Eclampsia in Low-Income and Middle-Income Countries (CRADLE-4): A Multicenter, Open-Label, Randomized Controlled Trial 中低收入国家早产子痫前期的计划分娩或预产期管理(CRADLE-4):一项多中心、开放标签、随机对照试验
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001016044.78093.29
A. Beardmore-Gray, N. Vousden, P.T. Seed, B. Vwalika, S. Chinkoyo, V. Sichone, A.B. Kawimbe, U. Charantimath, G. Katageri, M.B. Bellad, L. Lokare, K. Donimath, S. Bidri, S. Goudar, J. Sandall, L.C. Chappell, A.H. Shennan
(Lancet. 2023;402:386–396) Pre-eclampsia is a relatively common condition and poses a disproportionately high risk to women in low-income and middle-income countries where it is a leading cause of maternal morbidity and mortality, estimated to have caused more than 42,000 deaths. The only known treatment is delivery, but there are also risks associated with preterm delivery that can contribute to both maternal and neonatal outcomes. Evidence suggests delivery at 37 weeks optimizes outcomes for both mother and infant, but there is little evidence about delivery in the late preterm gestational period leading up to that, between 34 and 36 and 6/7 weeks. Research in higher income settings has shown that fetal death in these cases is rare, but there are factors in such settings that are unavailable or unrealistic in low-income and middle-income settings. This study aimed to address the gap in knowledge by assessing outcomes related to planned delivery between 34 and 37 weeks in women with pre-eclampsia compared with expectant management during the same gestational period in India and Zambia.
(Lancet. 2023;402:386-396) 子痫前期是一种相对常见的疾病,对低收入和中等收入国家的妇女造成的风险过高,是导致孕产妇发病和死亡的主要原因,估计已造成 42,000 多人死亡。唯一已知的治疗方法是分娩,但早产也有相关风险,会对孕产妇和新生儿的预后产生影响。有证据表明,在 37 周分娩可使母婴的预后达到最佳,但在 37 周之前的晚期早产妊娠期(34 至 36 周和 6/7 周之间)分娩的证据却很少。对高收入地区的研究表明,在这些地区胎儿死亡的情况很少见,但在这些地区存在着一些低收入和中等收入地区不具备或不现实的因素。本研究旨在通过评估印度和赞比亚患有先兆子痫的妇女在34至37周之间计划分娩的结果与同一妊娠期的预产期管理结果的比较,弥补知识上的差距。
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引用次数: 0
Direct Current Cardioversion in Pregnancy: A Multicenter Study 妊娠期直流电心脏起博器:一项多中心研究
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001016064.75927.1c
M. Cauldwell, D. Adamson, K. Bhatia, C. Bhagra, A. Bolger, T. Everett, C. Fox, J. Girling, C. Head, K. English, L. Hudsmith, R. James, M. Johnson, L. MacKiliop, F.M. McAuliffe, G. Mariappa, E. Orchard, M. O'Brien, F. Siddiqui, L. Simpson, M. Simpson, P. Timmons, S. Vause, G. Wander, N. Walker, P. Steer
(BJOG. 2023;130(10):1269–1274) The physiological changes that occur in pregnancy have been associated with new onset and recurrent cardiac arrhythmias. It is common for pregnant patients to experience palpitations in pregnancy, and most of these do not require treatment. However, some arrhythmias require treatment including medications and/or direct current cardioversion (DCCV) to restore the patient’s rhythm. In a recent inquiry into maternal deaths in the United Kingdom (UK), DCCV was not applied consistently and may have resulted in maternal deaths. This study aimed to understand practice surrounding DCCV in the UK, assessing which arrhythmias occurred and how they were treated. In addition, they evaluated outcomes associated with obstetric and neonatal health, including the use of fetal monitoring and whether there were cases where DCCV caused harm to the fetus.
(BJOG.2023;130(10):1269-1274) 妊娠期的生理变化与新发和复发性心律失常有关。妊娠期心悸是孕妇的常见症状,其中大多数不需要治疗。然而,有些心律失常需要治疗,包括药物和/或直流电心律转复术(DCCV)来恢复患者的心律。在最近对英国孕产妇死亡事件的调查中,DCCV 的应用并不一致,可能导致了孕产妇死亡。本研究旨在了解英国围绕 DCCV 的实践,评估发生了哪些心律失常以及如何治疗。此外,他们还评估了与产科和新生儿健康相关的结果,包括胎儿监护的使用情况以及 DCCV 是否对胎儿造成伤害。
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引用次数: 0
Storage of Emergency Airway Equipment on Labor and Delivery Units 产房紧急气道设备的储存
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001015976.49431.15
E.T. Riley, B. Carvalho, G. Abir
(J Clin Anesth. 2022;80:110886 | https://doi.org/10.1016/j.jclinane.2022.110886) The imperative need for an operational and prepared environment in labor and delivery (L&D) units, particularly for emergency cesarean delivery (CD), underscores the requirement for a readily available operating room. This preparedness extends to having emergency airway equipment in a state of readiness for immediate use. In an academic tertiary referral institution, which handles ~4600 deliveries annually (with 70% classified as high-risk patients), emergency airway equipment was initially stored preprepared beneath a towel on the front shelf of each anesthesia machine.
(J Clin Anesth. 2022;80:110886 | https://doi.org/10.1016/j.jclinane.2022.110886) 分娩(L&D)科室亟需一个可操作的准备就绪的环境,尤其是在紧急剖宫产(CD)时,这就强调了对可随时使用的手术室的要求。这种准备工作还包括紧急气道设备的随时可用性。一家学术性三级转诊机构每年处理约 4600 例分娩(其中 70% 被归类为高危患者),该机构最初在每台麻醉机前架的毛巾下面存放了准备就绪的紧急气道设备。
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引用次数: 0
Maternal Morbidity and Mortality Among Patients With Cancer at Time of Delivery 分娩时癌症患者的孕产妇发病率和死亡率
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001016072.85980.10
A.C. Sundermann, J. M. Cate, A.K. Campbell, S.K. Dotters-Katz, E.R. Myers, J.J. Federspiel
(Am J Obstet Gynecol. 2023;229:324.e1–324.e7) Women with a cancer diagnosis during pregnancy face higher maternal morbidity and mortality. Current prenatal care guidelines focus on care coordination between obstetricians and oncologists. But knowing more about the risks these women face during delivery could help clinicians provide better care and improve outcomes.
(Am J Obstet Gynecol. 2023;229:324.e1-324.e7)怀孕期间确诊癌症的妇女面临着更高的孕产妇发病率和死亡率。目前的产前护理指南侧重于产科医生和肿瘤专家之间的护理协调。但是,更多地了解这些妇女在分娩过程中面临的风险有助于临床医生提供更好的护理并改善预后。
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引用次数: 0
Perinatal Outcomes and the Role of Obstetric Anesthesia Interventions 围产期结果和产科麻醉干预的作用
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001015908.87799.94
D.N. Lucas, J. Bamber, S. Quasim
(Lancet 2023;401:2038–2039) This editorial discusses multiple recent studies that investigated perinatal outcomes and the impact of anesthetic interventions. A prior study published in the Lancet in 2022 reported poorer perinatal outcomes for neonates born to Black women compared to those born to White women. Another study examined nearly 450,000 deliveries and found an association between neonatal outcomes (Apgar <7 at 5 min, need for neonatal resuscitation, and neonatal admission to the intensive care unit) and maternal use of epidural analgesia. The authors of this editorial examined their own data regarding the incidence of obstetric anesthetic procedures among different ethnic groups and found that compared to White British women who had vaginal birth, incidence of epidural analgesia among Bangladeshi, Pakistani, Black African, and Black Caribbean women was much lower. They noted that similar disparities can be found in the United States and reiterated the socioeconomic and systemic disparities as one likely cause for poor neonatal outcomes, suggesting that offering equal access to neuraxial analgesia across all populations could lead to improved neonatal outcomes for Black women.
(Lancet 2023;401:2038-2039)这篇社论讨论了近期多项调查围产期结局和麻醉干预影响的研究。2022 年发表在《柳叶刀》上的一项研究报告称,与白人妇女所生的新生儿相比,黑人妇女所生的新生儿围产期预后较差。另一项研究检查了近 45 万例分娩,发现新生儿预后(5 分钟内 Apgar <7、新生儿复苏需求和新生儿入住重症监护室)与产妇使用硬膜外镇痛之间存在关联。这篇社论的作者研究了他们自己关于不同种族群体产科麻醉程序发生率的数据,发现与阴道分娩的英国白人妇女相比,孟加拉、巴基斯坦、非洲黑人和加勒比黑人妇女的硬膜外镇痛发生率要低得多。他们指出,美国也存在类似的差异,并重申社会经济和系统差异可能是新生儿结局不佳的原因之一,建议为所有人群提供平等的神经镇痛机会,从而改善黑人妇女的新生儿结局。
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引用次数: 0
Obstetric Anesthesia Manpower and Service Provision Issues: Introduction and European Perspective 产科麻醉人力和服务提供问题:简介和欧洲视角
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001016104.61333.2d
E. Guasch, A. Ioscovich, N. Brogly, S. Orbach-Zinger, P. Kranke, E. Morau, F. Gilsanz
(Int J Obstet Anesth. 2023;55:103647) The global perspective on obstetric anesthesia emphasizes the critical role of universal health coverage, particularly during the COVID-19 pandemic. The United Nations prioritizes achieving 80% global universal health coverage by 2030, recognizing the substantial gaps in emergency and essential surgical and anesthesia care. The shortage of health care workers, especially in low-income and middle-income countries (LMIC), is evident, focusing on the lack of anesthesia physicians. In Europe, standards for physician anesthesia providers are currently achieved, but concerns persist about workforce challenges. Obstetric anesthesia practices vary globally, and efforts to address shortages include fellowship programs to enhance competency and efficiency. Examples from European countries, such as Israel, demonstrate diverse approaches to training obstetric anesthesiologists, aiming to ensure quality care amid workforce challenges. The Israel Obstetric Anesthesia Society actively contributes to education and training, highlighting the ongoing need for improvement in aligning standards with daily practice.
(Int J Obstet Anesth. 2023; 55:103647)产科麻醉的全球视角强调了全民医保的关键作用,尤其是在 COVID-19 大流行期间。联合国将到 2030 年实现 80% 的全球全民医保作为优先事项,并认识到在急诊和基本手术及麻醉护理方面存在巨大差距。医护人员短缺的问题显而易见,尤其是在中低收入国家(LMIC),重点是麻醉医师的缺乏。在欧洲,麻醉医师的标准目前已经达到,但对劳动力挑战的担忧依然存在。全球的产科麻醉实践各不相同,为解决短缺问题所做的努力包括旨在提高能力和效率的奖学金计划。欧洲国家(如以色列)的例子表明,培训产科麻醉医师的方法多种多样,目的是在劳动力面临挑战的情况下确保护理质量。以色列产科麻醉学会积极推动教育和培训工作,强调在使标准与日常实践相一致方面不断改进的必要性。
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引用次数: 0
Economic Cost of Secondary Postpartum Hemorrhage: A Case-Control Study at a Tertiary Hospital in Australia 继发性产后出血的经济成本:澳大利亚一家三级医院的病例对照研究
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001016032.75207.94
N. Young, J. Quinlivan, R. Fox, J. Anderson, L. Davis, S. Mooney
(Aust N Z J Obstet Gynaecol. 2023;63:308–313) Secondary postpartum hemorrhage (PPH) is excessive vaginal bleeding occurring up to 12 weeks after childbirth. The incidence ranges from 0.2% to 3.0%, usually presenting 1 to 2 weeks postnatally and commonly caused by endometritis and retained products. Despite its impact on health, evidence for managing and understanding its cost burden is lacking compared with primary PPH. Australian public hospitals are subsidized, but reproductive care costs were $8.7B in 2018 to 2019. Effective resource allocation is vital amidst rising health care expenses. Limited evidence guides secondary PPH treatment, potentially leading to multiple presentations and increased costs. Consequences include resuscitation, transfusion, surgery, and hysterectomy, elevating health care expenses. This study sought to analyze the economic impact of secondary PPH.
(Aust N Z J Obstet Gynaecol. 2023; 63:308-313)继发性产后出血(PPH)是指产后 12 周内发生的阴道大量出血。其发生率在 0.2% 到 3.0% 之间,通常在产后 1 到 2 周出现,常见原因是子宫内膜炎和残留产物。尽管它对健康有影响,但与原发性 PPH 相比,管理和了解其成本负担的证据还很缺乏。澳大利亚公立医院有补贴,但 2018 至 2019 年的生殖保健费用高达 87 亿澳元。在医疗费用不断上涨的情况下,有效的资源分配至关重要。指导继发性 PPH 治疗的证据有限,可能导致多次发病和费用增加。其后果包括复苏、输血、手术和子宫切除,从而增加了医疗费用。本研究旨在分析继发性 PPH 的经济影响。
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引用次数: 0
Common Street Drug Names for the Anesthesiologist and Pain Physician 麻醉师和疼痛科医生常用的街头药物名称
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001015936.56586.3c
R.R. Donald, S. Patel, M. Smith, S. Clayton, S. Potru
(Reg Anesth Pain Med. 2023;48(7):365–374) Over the years, many drugs have acquired colloquial “street names” in addition to their official designations. Familiarizing medical professionals, including anesthesiologists, with these slang terms can be crucial for effective patient care. Some drugs are named based on their physical appearance or packaging, which may differ from their clinical labels. This allows drug users and dealers to discuss substances discreetly in everyday conversation. Therefore, having a comprehensive list of street names associated with various drugs is essential for health care providers to ensure patient safety and provide appropriate care.
(Reg Anesth Pain Med.2023;48(7):365-374)多年来,许多药物除了其官方名称外,还获得了一些俗称 "街名"。让包括麻醉医师在内的医疗专业人员熟悉这些俚语对于有效护理患者至关重要。有些药物是根据其外观或包装命名的,这可能与其临床标签不同。这使得吸毒者和毒贩可以在日常交谈中谨慎地讨论药物。因此,医疗服务提供者必须掌握与各种药物相关的街道名称的完整列表,以确保患者安全并提供适当的护理。
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引用次数: 0
Hyperemesis Gravidarum: Associations With Personal and Family History of Nausea 孕吐:与个人和家族恶心病史的关系
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001016004.94884.53
V. Lindström, L. Laitinen, J. Nurmi, M. Koivisto, P. Polo-Kantola
(Acta Obstet Gynecol Scand. 2023;102:1176–1182) Nausea and vomiting are prevalent in early pregnancy, with 3.6% experiencing severe symptoms termed hyperemesis gravidarum (HG). Characterized by early onset, impaired eating, and impactful daily life restrictions, HG leads to dehydration and weight loss, becoming a primary cause for early pregnancy hospitalization. Unfortunately, health care recognition of HG is insufficient, resulting in underdiagnosis and undertreatment. The condition’s multifactorial origins include vestibular, olfactory, hormonal, and gastrointestinal factors. General nausea links to various situations and a family history of HG suggests a genetic component. Research indicates that women with a history of nausea may be more susceptible to HG. Identifying such connections can aid health care professionals in recognizing and managing HG risk.
(Acta Obstet Gynecol Scand. 2023; 102:1176-1182)恶心和呕吐是孕早期的常见症状,3.6%的孕早期妇女会出现孕吐(HG)的严重症状。妊娠剧吐的特点是发病早、进食受阻、日常生活受限,会导致脱水和体重下降,成为孕早期住院治疗的主要原因。遗憾的是,医疗机构对 HG 的认识不足,导致诊断和治疗不足。该病的多因素起源包括前庭、嗅觉、荷尔蒙和胃肠道因素。全身性恶心与各种情况有关,而 HG 家族史则表明有遗传因素。研究表明,有恶心病史的女性可能更容易患 HG。找出这些联系有助于医护人员识别和控制 HG 风险。
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引用次数: 0
Quality of Recovery Following Childbirth: A Prospective, Multicenter Cohort Study 产后恢复的质量:一项前瞻性多中心队列研究
Pub Date : 2024-05-24 DOI: 10.1097/01.aoa.0001016128.61922.e0
J. O'Carroll, L. Zucco, E. Warwick, G. Arbane, S. R. Moonesinghe, K. El-Boghdadly, N. Guo, B. Carvalho, P. Sultan
(Anaesthesia. 2023;78(9):1071–1080) The peripartum period, encompassing childbirth and its aftermath, involves the administration of anesthesia or analgesia to ∼65% of patients, a substantial portion necessitated by urgent surgical interventions. The imperative to enhance surgical recovery and ensure patient satisfaction postpartum is crucial for delivering high-quality clinical care, as it has the potential to positively influence maternal physical and psychological well-being. Despite the escalating focus on postpartum-related research, prior studies on recovery have been predominantly confined to single-center endeavors with limited sample sizes, deploying disparate outcome measures or unvalidated metrics, primarily evaluating inpatient recovery with insufficient scrutiny of outpatient recovery.
(Anaesthesia.围产期包括分娩和分娩后,65% 的患者需要进行麻醉或镇痛,其中很大一部分患者需要进行紧急手术干预。产后必须加强手术恢复并确保患者满意度,这对提供高质量的临床护理至关重要,因为它有可能对产妇的身心健康产生积极影响。尽管人们对产后相关研究的关注度不断提高,但之前关于产后恢复的研究主要局限于样本量有限的单中心研究,采用的结果测量方法各不相同或未经验证,主要评估住院患者的恢复情况,对门诊患者的恢复情况审查不足。
{"title":"Quality of Recovery Following Childbirth: A Prospective, Multicenter Cohort Study","authors":"J. O'Carroll, L. Zucco, E. Warwick, G. Arbane, S. R. Moonesinghe, K. El-Boghdadly, N. Guo, B. Carvalho, P. Sultan","doi":"10.1097/01.aoa.0001016128.61922.e0","DOIUrl":"https://doi.org/10.1097/01.aoa.0001016128.61922.e0","url":null,"abstract":"(Anaesthesia. 2023;78(9):1071–1080)\u0000 The peripartum period, encompassing childbirth and its aftermath, involves the administration of anesthesia or analgesia to ∼65% of patients, a substantial portion necessitated by urgent surgical interventions. The imperative to enhance surgical recovery and ensure patient satisfaction postpartum is crucial for delivering high-quality clinical care, as it has the potential to positively influence maternal physical and psychological well-being. Despite the escalating focus on postpartum-related research, prior studies on recovery have been predominantly confined to single-center endeavors with limited sample sizes, deploying disparate outcome measures or unvalidated metrics, primarily evaluating inpatient recovery with insufficient scrutiny of outpatient recovery.","PeriodicalId":19432,"journal":{"name":"Obstetric Anesthesia Digest","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141099157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Obstetric Anesthesia Digest
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