Obstetrics and gynecology最新文献

Background: A modified FAST (Focused Assessment with Sonography for Trauma) examination is increasingly being used in obstetrics as a rapid and low-cost tool to assess postoperative patients with possible intra-abdominal bleeding. The purpose of this study was to evaluate whether a modified FAST examination reliably detects, or excludes, intra-abdominal free fluid in postcesarean delivery obstetric patients when compared with gold-standard imaging, such as computed tomography or magnetic resonance imaging, or intraoperative findings on abdominal re-exploration.

Method: This was a retrospective cohort study of patients who underwent cesarean delivery at a single institution between 2015 and 2020. The primary outcome was presence or absence of abdominal free fluid detected by modified FAST examination that was confirmed on formal imaging or abdominal re-exploration. Positive and negative predictive values, sensitivity, and specificity were calculated for modified FAST examination compared with gold-standard imaging or intraoperative findings on abdominal re-exploration.

Experience: Of the 35 patients with true-positive results, 16 (45.7%) had formal imaging only, 16 (45.7%) had abdominal re-exploration only, and three (8.6%) had both formal imaging and abdominal re-exploration.

Conclusion: Our analysis indicates that a modified FAST examination is a valid test for identifying intra-abdominal free fluid after cesarean delivery and supports its use in clinical decision making in obstetrics.

Objective: We hypothesized that a second- or third-trimester diagnosis of low-lying placenta imparts underappreciated risk for postpartum hemorrhage (PPH) and placenta accreta spectrum (PAS). To quantify this risk and to assess whether it varies by the specific distance of the placenta from the cervical os and low-lying placenta resolution status, we conducted a systematic review and meta-analysis.

Data sources: Systematic searches were conducted in PubMed, ClinicalTrials.gov , EMBASE, and Web of Science from database inception to April 30, 2024.

Methods of study selection: A total of 3,700 results were screened for relevance with the PICO framework: population-singleton pregnancies; intervention-low-lying placenta; comparators-normal placentation; and outcomes-PPH and PAS. Studies published before 2000 were excluded to minimize bias from ultrasound sensitivity.

Tabulation, integration, and results: Twenty-one studies (3,704 patients with low-lying placenta, 2,555 with normal placentation) were included. Data extraction and quality assessment with the Newcastle-Ottawa Scale were performed independently by three reviewers. At any gestational age, low-lying placenta imparted a significant PPH risk (risk ratio [RR] 2.10, 95% CI, 1.02-4.35, P =.05, I2 =0.0%) compared with non-low-lying placenta. The incidence of PPH was 16.0% (95% CI, 10.3-24.1%, I2 =93.3%) in low-lying placenta 1-20 mm compared with 5.8% (95% CI, 3.8-8.8%, I2 =79.9%) in non-low-lying placenta. When parsed by clinically meaningfully strata, a high incidence of PPH persisted with resolved low-lying placenta (resolved: 8%, 95% CI, 4.1-16.3%, I2 =85.0%; unresolved: 29.2%, 95% CI, 19.0-42.0%, I2 =70.5%; non-low-lying placenta: 5.8%, 95% CI, 3.8-8.8%, I2 =79.9%) with no difference in PPH risk at less than 2 cm from the os (low-lying placenta 1-10 mm: 16.6%, 95% CI, 9.2-28.3%, I2 =78.4%; low-lying placenta 11-20 mm: 17.5%, 95% CI, 8.8-31.7%, I2 =92.2%; RR 0.97, 95% CI, 0.67-1.41, P =.84, I2 =0.0%). An important finding is that PAS disorders affected 9.0% (95% CI, 4.7-16.8%, I2 =89.9%) of all low-lying placenta cases.

Conclusion: Antepartum diagnosis of low-lying placenta is associated with a twofold increased risk of PPH compared with normal placentation. The pooled proportions of PPH were 16.6% in the 1-10 mm group and 17.5% in the 11-20 mm low-lying placenta group, with no significant difference. This meta-analysis is the first to quantify the risk of PPH associated with low-lying placenta, emphasizing the need for rigorous monitoring and delivery management of pregnancies with low-lying placenta to mitigate the burden of PPH on maternal morbidity.

Systematic review registration: PROSPERO, CRD42024558043.

Effective communication between physicians and patients is the cornerstone of the patient -physician relationship. Effective communication practices can build positive relationships, enable sharing power, and lead to mutual trust. Moreover, effective patient -physician communication improves patient experiences and health outcomes. The building blocks of relationship-centered communication include acknowledgment of a patient's identity and experiences, clarity of information, patient activation and participation, knowledge-related power and authority, emotional proximity and shared experiences, and managing health care and relational goals. In practical terms, this translates to communication behaviors that demonstrate humility to close the patient -physician relationship distance and achieve effective communication, particularly for marginalized patient populations.

Objective: To evaluate obstetric and perinatal outcomes of pregnancies among patients with osteogenesis imperfecta using the French National Health Insurance Database.

Methods: We conducted a retrospective cohort study. Pregnancies were identified with an algorithm specifically developed for the French National Health Insurance Database to identify delivery stays using a combination of International Classification of Diseases, Tenth Revision (ICD-10) discharge codes and medical procedures. Exposure was osteogenesis imperfecta status based on the occurrence of ICD-10 code Q780 5 years before conception or during pregnancy. Outcomes included pregnancy, delivery, postpartum, and fetal complications based on hospital discharge data and reimbursements of medical procedures, medical devices, and drugs. Multivariable logistic regression analysis was performed, adjusted for multiple pregnancies per participant with generalized estimating equations.

Results: The cohort included 8,850,969 pregnancies (5,823,322 patients) between January 2012 and December 2023. In total, 408 pregnant individuals (4.6/100,000) were identified with osteogenesis imperfecta. Compared with pregnant individuals without osteogenesis imperfecta, pregnant individuals with osteogenesis imperfecta had increased risks of antepartum hemorrhage (adjusted risk ratio [RR] 1.78, 95% CI, 1.01-3.14), chorioamnionitis (adjusted RR 2.79, 95% CI, 1.17-6.64), malpresentation (adjusted RR 1.65, 95% CI, 1.19-2.30), and preterm delivery (adjusted RR 2.11, 95% CI, 1.62-2.74). Cesarean delivery rates were notably higher in pregnant individuals with osteogenesis imperfecta (adjusted RR 2.59, 95% CI, 2.34-2.88), including among nulliparous individuals (adjusted RR 2.50, 95% CI, 2.22-2.81). Osteogenesis imperfecta was associated with major congenital anomalies (adjusted RR 5.04, 95% CI, 3.97-6.39 overall; adjusted RR 1.67, 95% CI, 1.09-2.56 when osteogenesis imperfecta was excluded from the congenital anomaly definition), especially cardiac anomalies. Postpartum analysis indicated no significant increase in fracture rates compared with prepregnancy periods.

Conclusion: In this nationwide cohort study, osteogenesis imperfecta was associated with both maternal and fetal complications. These findings underscore the need for specialized, multidisciplinary management of pregnancies in patients with osteogenesis imperfecta.