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Cerclage versus vaginal progesterone in low-risk pregnant women with a short cervix 宫颈短的低风险孕妇的环扎术与阴道黄体酮
Pub Date : 2022-04-19 DOI: 10.1080/14767058.2022.2065193
Olivet Martinez, H. Moran, S. Wolff, Charles P. Gibbs, Gene T. Lee, K. Gorman, Angela S. Martin
Abstract Objective To compare vaginal progesterone to cerclage in preventing preterm birth and adverse perinatal outcomes in women with a singleton gestation, incidentally found sonographic cervical length of <15 mm, and no history of preterm birth. Study design A retrospective cohort study was conducted on 68 women who delivered at the University of Kansas Health System with a singleton gestation found to have a cervical length <15 mm on transvaginal ultrasound and no history of preterm birth. Women treated with vaginal progesterone (n = 29) were compared to women who underwent cerclage placement (n = 39). The primary outcome was preterm birth at <34 weeks of gestation. Secondary outcomes include preterm birth at <37 and <28 weeks of gestation and neonatal morbidities. Results Of the 268 patients who had a cervical length of <15 mm on transvaginal ultrasound, 68 participants met inclusion criteria and were included in the final analysis. Twenty-nine participants received vaginal progesterone and 39 participants received cervical cerclage. The average cervical length at initiation of therapy was greater in the progesterone cohort versus cerclage cohort, respectively (10.5 vs. 8.0 mm, p < .01). All other baseline characteristics were similar between groups, including no difference in average gestational age at initiation of therapy (21.6 vs. 21.5 weeks, p = .87). Average latency after therapy did not differ between groups (100 vs. 92.7 days p = .43). The incidence of preterm birth at <37 weeks (OR = 1.49, 95% CI = 0.57–3.93), <34 weeks (OR = 1.47, 95% CI = 0.52–4.18), and <28 weeks (OR = 1.90, 95% CI = 0.45–8.07), did not differ significantly between groups. Additionally, no difference in neonatal morbidity was detected. Conclusion At our institution, we found no difference between vaginal progesterone and cerclage in the average latency period or risk of preterm birth among women with an incidental short cervix of <15 mm and no history of preterm birth, despite the significantly shorter initial cervical length in the cerclage group. These findings suggest either vaginal progesterone or cerclage could be used to reduce the risk of preterm birth among this high-risk population.
摘要目的比较阴道孕酮与阴道环扎术对单胎妊娠、宫颈超声长度<15 mm、无早产史的孕妇预防早产及围产期不良结局的效果。研究设计一项回顾性队列研究对68名在堪萨斯大学卫生系统分娩的单胎妊娠妇女进行了研究,经阴道超声检查发现宫颈长度< 15mm,无早产史。接受阴道孕酮治疗的女性(n = 29)与接受环扎术的女性(n = 39)进行比较。主要结局是妊娠<34周的早产。次要结局包括妊娠<37周和<28周的早产和新生儿发病率。结果经阴道超声检查宫颈长度< 15mm的268例患者中,有68例符合纳入标准,纳入最终分析。29名参与者接受阴道黄体酮治疗,39名参与者接受宫颈环切术。治疗开始时,孕酮组的平均宫颈长度大于环扎组(10.5 mm vs 8.0 mm, p < 0.01)。所有其他基线特征在两组之间相似,包括治疗开始时的平均胎龄无差异(21.6周对21.5周,p = 0.87)。治疗后平均潜伏期在两组间无差异(100天vs. 92.7天p = 0.43)。<37周(OR = 1.49, 95% CI = 0.57-3.93)、<34周(OR = 1.47, 95% CI = 0.52-4.18)和<28周(OR = 1.90, 95% CI = 0.45-8.07)的早产发生率组间无显著差异。此外,没有发现新生儿发病率的差异。结论:在我们的机构,我们发现阴道孕酮和环扎术在意外短宫颈< 15mm且无早产史的妇女中,平均潜伏期和早产风险没有差异,尽管环扎术组的初始宫颈长度明显较短。这些发现表明,阴道黄体酮或环扎术都可以用于降低高危人群的早产风险。
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引用次数: 0
Short-term outcomes of very-low-birth-weight infants born to mothers of advanced and very advanced maternal age 高龄母亲和高龄母亲所生极低出生体重婴儿的短期结局
Pub Date : 2022-04-18 DOI: 10.1080/14767058.2022.2065192
H. Kim, Min Soo Kim, Y. Seo, S. Yum
Abstract Objective To evaluate whether advanced maternal age (35–39 years, AMA)/very advanced maternal age (≥40 years, VAMA) impacts neonatal outcomes of very-low-birth-weight (VLBW) infants. Methods Data of VLBW infants admitted to our unit were reviewed. Demographic findings and neonatal outcomes were compared among maternal age [(<35 years, not advanced maternal age, n = 329), AMA (n = 209), and VAMA (n = 43)] groups. Univariate and multivariate analyses were performed to identify the associated risk factors for neonatal outcomes. Result Mortality and overall morbidities showed no significant intergroup differences, except for massive pulmonary hemorrhage (MPH). Multivariate analysis revealed that AMA/VAMA was not significantly associated with MPH development, while ≥ two doses of surfactant administration was. Higher gestational age and antenatal corticosteroid administration were protective. Conclusion AMA/VAMA is not associated with neonatal mortality and morbidities. Since the proportion of AMA/VAMA mothers is expected to increase, perinatal medicine practitioners should focus on approaches before and immediately after birth of such infants.
摘要目的探讨高龄产妇(35 ~ 39岁,AMA)/高龄产妇(≥40岁,VAMA)对极低出生体重儿(VLBW)新生儿结局的影响。方法回顾我院收治的VLBW患儿资料。比较产妇年龄组(<35岁,非高龄产妇,n = 329)、AMA组(n = 209)和VAMA组(n = 43)的人口统计学结果和新生儿结局。进行单因素和多因素分析以确定新生儿结局的相关危险因素。结果两组间除肺大出血外,死亡率和总发病率无显著差异。多因素分析显示,AMA/VAMA与MPH的发生无显著相关性,而≥2剂量的表面活性剂与MPH的发生有显著相关性。较高的胎龄和产前使用皮质类固醇具有保护作用。结论AMA/VAMA与新生儿死亡率和发病率无关。由于AMA/VAMA母亲的比例预计会增加,围产期医生应该把重点放在这些婴儿出生之前和出生后的方法上。
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引用次数: 1
Delivery timing in dichorionic diamniotic twin pregnancies complicated by preeclampsia: a decision analysis 双绒毛膜双羊膜双胎合并先兆子痫的分娩时机:决策分析
Pub Date : 2022-04-18 DOI: 10.1080/14767058.2022.2053103
Bethany T. Waites, Allison R. Walker, A. Caughey
Abstract Objective To determine the optimal timing of delivery in Dichorionic-diamniotic (DCDA) pregnancies complicated by preeclampsia without severe features. Methods A decision-analytic model was created to compare outcomes of expectant management vs. delivery from 34 to 37w0d. Outcomes included quality-adjusted life years (QALYs), development of severe preeclampsia, maternal mortality, maternal stroke, small for gestational age (SGA) due to fetal growth restriction (FGR) detected antenatally, stillbirth, cerebral palsy (CP), and neonatal mortality. Probabilities, utilities, and life expectancies were derived from the literature. Univariate analysis was used to evaluate the impact of delivery at various gestational ages. Maternal and neonatal outcomes were calculated for a theoretical cohort of 10,000 DCDA pregnancies with preeclampsia. Results The optimal gestational age for delivery was 36w0d when the total QALYs (868,112) were highest. Delivery at 34w0d resulted in the fewest cases of severe preeclampsia, maternal mortality, and maternal stroke (0, 4, and 15 cases per 10,000, respectively). The incidence of each of these adverse outcomes increased with gestational age, with the greatest number of adverse outcomes at 37w0d (2452 cases of severe preeclampsia, eight maternal deaths, and 31 cases of maternal stroke per 10,000). Delivery at 34w0d resulted in the fewest cases of severe preeclampsia (0), maternal stroke (15), maternal mortality (4), stillbirth (0), and SGA (1183). However, this strategy was also associated with most cases of neonatal CP (91) and neonatal mortality (87). Conclusion DCDA twin pregnancies complicated by preeclampsia without severe features appear to have the best outcomes when delivered at 36w0d. Specifically, when compared to delivery at 37w0d, this strategy reduced maternal and neonatal morbidity and mortality.
【摘要】目的探讨双绒毛膜-双羊膜血症(DCDA)妊娠合并子痫前期无严重症状的最佳分娩时机。方法建立决策分析模型,比较34 ~ 37天待产与分娩的结局。结果包括质量调整生命年(QALYs)、重度先兆子痫的发生、孕产妇死亡率、孕产妇卒中、因胎儿生长受限(FGR)导致的胎龄过小(SGA)、死产、脑瘫(CP)和新生儿死亡率。概率、效用和预期寿命均来自文献。采用单因素分析评估不同胎龄分娩的影响。对10000例DCDA妊娠伴有先兆子痫的产妇和新生儿结局进行了理论队列计算。结果最佳胎龄为36龄,总QALYs(868,112)最高。34岁分娩导致严重先兆子痫、产妇死亡率和产妇中风的病例最少(分别为0例、4例和15例/ 10,000)。这些不良后果的发生率随着胎龄的增加而增加,37胎龄时不良后果的发生率最高(每10,000例中有2452例严重先兆子痫,8例产妇死亡和31例产妇中风)。34岁分娩导致的严重先兆子痫(0例)、产妇中风(15例)、产妇死亡(4例)、死产(0例)和SGA(1183例)病例最少。然而,这种策略也与大多数新生儿CP病例(91例)和新生儿死亡率(87例)有关。结论DCDA双胎妊娠合并无严重特征的子痫前期患儿在36龄分娩时预后最佳。具体而言,与37岁分娩相比,该策略降低了孕产妇和新生儿的发病率和死亡率。
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引用次数: 1
Management and outcomes of mild hemophiliacs and hemophilia carriers during pregnancy and peripartum period: a hemophilia treatment center experience in the United States 妊娠期和围产期轻度血友病和血友病携带者的管理和结局:美国血友病治疗中心的经验
Pub Date : 2022-04-12 DOI: 10.1080/14767058.2022.2051699
Hana I Lim, M. Desancho
Abstract Background Pregnancy, peripartum management, and outcomes of mild hemophiliacs and hemophilia carriers in the United States are not well established. Aim To describe the management and outcomes of mild hemophiliacs and hemophilia carriers during assisted conception, pregnancy, peripartum and post-partum period at our hemophilia treatment center (HTC). Methods Retrospective review of electronic medical records of pregnant women with mild hemophilia A or B (Factor VIII [FVIII] or Factor IX [FIX] level <0.4 IU/mL) and hemophilia A and B carriers followed at our HTC from January 2008 to October 2020. Demographics, the reason for diagnosis, FVIII and FIX levels at baseline and third trimester, bleeding phenotype and genotype were obtained. Method of conception, factor replacement, iron supplementation, mode of delivery, type of anesthesia, peripartum complications, and offspring outcomes was recorded. Results There was a total of 18 pregnancies in 12 women (2 with mild hemophilia A, 2 mild hemophilia B, 6 hemophilia A carriers, and 2 hemophilia B carriers). Eleven pregnancies (61%) were conceived naturally and 7 (39%) via in-vitro fertilization (IVF). Eight (44.4%) and 10 (55.6%) pregnancies were vaginal and C-section deliveries, respectively. Neuraxial anesthesia was administered in 17 (94.4%) deliveries without complications. Four pregnancies (22.2%) had bleeding complications, 2 of which were post-partum hemorrhages not requiring transfusion. Conclusion In our case series of pregnant hemophilia carriers and mild hemophiliacs, successful outcomes were achieved with a carefully detailed multidisciplinary-driven approach.
背景:在美国,轻度血友病患者和血友病携带者的妊娠、围产期管理和结局尚未得到很好的确定。目的了解我院血友病治疗中心(HTC)轻度血友病患者及血友病携带者在辅助受孕、妊娠、围生期及产后的处理及结局。方法回顾性分析2008年1月至2020年10月在我院随访的轻度血友病A或B孕妇(因子VIII [FVIII]或因子IX [FIX]水平<0.4 IU/mL)和血友病A、B携带者的电子病历。统计数据、诊断原因、基线和妊娠晚期FVIII和FIX水平、出血表型和基因型。记录妊娠方式、因子替代、补铁、分娩方式、麻醉方式、围生期并发症及子代结局。结果12例妊娠18例,其中轻度a型血友病2例,轻度B型血友病2例,a型血友病携带者6例,B型血友病携带者2例。11例妊娠(61%)为自然妊娠,7例(39%)为体外受精妊娠。经阴道分娩8例(44.4%),剖腹产10例(55.6%)。17例(94.4%)分娩采用轴向麻醉,无并发症。4例妊娠(22.2%)出现出血并发症,其中2例为不需要输血的产后出血。在我们的病例系列中,妊娠血友病携带者和轻度血友病患者,通过仔细详细的多学科驱动方法取得了成功的结果。
{"title":"Management and outcomes of mild hemophiliacs and hemophilia carriers during pregnancy and peripartum period: a hemophilia treatment center experience in the United States","authors":"Hana I Lim, M. Desancho","doi":"10.1080/14767058.2022.2051699","DOIUrl":"https://doi.org/10.1080/14767058.2022.2051699","url":null,"abstract":"Abstract Background Pregnancy, peripartum management, and outcomes of mild hemophiliacs and hemophilia carriers in the United States are not well established. Aim To describe the management and outcomes of mild hemophiliacs and hemophilia carriers during assisted conception, pregnancy, peripartum and post-partum period at our hemophilia treatment center (HTC). Methods Retrospective review of electronic medical records of pregnant women with mild hemophilia A or B (Factor VIII [FVIII] or Factor IX [FIX] level <0.4 IU/mL) and hemophilia A and B carriers followed at our HTC from January 2008 to October 2020. Demographics, the reason for diagnosis, FVIII and FIX levels at baseline and third trimester, bleeding phenotype and genotype were obtained. Method of conception, factor replacement, iron supplementation, mode of delivery, type of anesthesia, peripartum complications, and offspring outcomes was recorded. Results There was a total of 18 pregnancies in 12 women (2 with mild hemophilia A, 2 mild hemophilia B, 6 hemophilia A carriers, and 2 hemophilia B carriers). Eleven pregnancies (61%) were conceived naturally and 7 (39%) via in-vitro fertilization (IVF). Eight (44.4%) and 10 (55.6%) pregnancies were vaginal and C-section deliveries, respectively. Neuraxial anesthesia was administered in 17 (94.4%) deliveries without complications. Four pregnancies (22.2%) had bleeding complications, 2 of which were post-partum hemorrhages not requiring transfusion. Conclusion In our case series of pregnant hemophilia carriers and mild hemophiliacs, successful outcomes were achieved with a carefully detailed multidisciplinary-driven approach.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79855070","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: 1
Fetal surgery for obstructive ureterocele using an ultrasound-guided needle laser ablation technique: a case series 使用超声引导下的针激光消融技术治疗梗阻性输尿管囊肿的胎儿手术:一个病例系列
Pub Date : 2022-04-10 DOI: 10.1080/14767058.2022.2061345
G. Sepúlveda-González, Gabriel Edgar Villagómez-Martínez, T. Arroyo-Lemarroy, J. Hinojosa-Lezama, Esteban Lizárraga-Cepeda, R. Martínez-Portilla
Abstract Introduction Obstructive ureterocele is an intravesical cystic dilation of the distal end of the ureter associated with anhidramnios and dilation of both renal pelvises. Methods This is a case-series of prenatally diagnosed ureterocele. Cases were selected at a third level reference hospital in Monterrey Mexico between 2010 and 2018. Eligible patients for fetal therapy were selected when bilateral hydronephrosis and severe oligohydramnios were found before 26+0 weeks of gestation. The fetal intervention comprised an ultrasound-guided needle laser technique for ureterocele ablation. Results There were six cases of prenatal diagnosed of ureterocele, two cases showed anhidramnios at 23 weeks of gestation and were considered obstructive ureterocele. For these two cases, fetal surgery was performed using laser ablation of the ureterocele through an ultrasound-guided needle. In both, the urinary tract was decompressed, and the volume of amniotic fluid improved allowing to carry both pregnancies until term, one of them vaginally and the other by cesarean section. In the postnatal follow-up of both cases, the first neonate died due to neonatal asphyxia at 48-hours, and the second neonate required removal of the abnormal collecting system. Conclusions The use of ultrasound-guided laser ablation for the decompression of obstructive ureterocele is a safe and feasible technique in extremely premature fetuses that could allow survival of the affected fetus until term. Patients receiving an early prenatal diagnosis of obstructive ureterocele may benefit from fetal therapy to reduce the risk of lung hypoplasia and stillbirth. Established facts Prenatal mortality of bilateral obstructive ureterocele is up to 45%. Only a few techniques have been described for the management of prenatally bilateral obstructive ureterocele; among them, the puncturing of the ureterocele which may require more than one intervention during fetal, laser by fetoscopy which may increase the risk of postoperative complications, and ultrasound-guided laser fulguration which seems to be effective and safe. Novel insights The present is the first description of a case series on ureteroceles comprising two ultrasound-guided laser therapy as an effective treatment for bilateral obstructive ureterocele requiring a single intervention. The use of ultrasound-guided laser in obstructive cases avoids fatality and lung hypoplasia due to severe oligohydramnios. Still, the neonatal prognosis of the affected side at two years of age remains unchanged.
梗阻性输尿管囊肿是输尿管远端膀胱内囊性扩张,伴有双肾盆腔无水和扩张。方法:本文是一组产前诊断为输尿管囊肿的病例。病例选择于2010年至2018年在墨西哥蒙特雷的一家三级参考医院。在妊娠26+0周前发现双侧肾积水和严重羊水过少时,选择符合胎儿治疗条件的患者。胎儿干预包括超声引导下的输尿管囊肿穿刺激光消融技术。结果6例产前诊断为输尿管囊肿,2例妊娠23周无水,考虑输尿管囊肿梗阻性。对于这两个病例,胎儿手术采用激光消融输尿管囊肿通过超声引导针。在这两种情况下,泌尿道都得到了减压,羊水的量也得到了改善,这使得两种妊娠都可以持续到足月,其中一种是顺产,另一种是剖宫产。在两例患儿的产后随访中,第1例患儿48小时因新生儿窒息死亡,第2例患儿需要切除异常收集系统。结论超声引导下激光消融术治疗梗阻性输尿管囊肿是一种安全可行的治疗极早产胎儿的方法,可使胎儿存活至足月。接受早期产前诊断为输尿管梗阻性囊肿的患者可能受益于胎儿治疗,以减少肺发育不全和死产的风险。既定事实双侧输尿管梗阻性囊肿的产前死亡率高达45%。只有少数技术已被描述为管理产前双侧输尿管梗阻性囊肿;其中,输尿管精索穿刺在胎儿期可能需要多次干预,胎儿镜下激光可能增加术后并发症的风险,超声引导激光灼烧是有效和安全的。本文首次描述了输尿管囊肿的病例系列,包括两次超声引导激光治疗,作为双侧输尿管囊肿梗阻性的有效治疗,需要一次干预。超声引导激光治疗梗阻性病例可避免严重羊水过少导致的病死率和肺发育不全。尽管如此,两岁时患侧的新生儿预后仍未改变。
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引用次数: 1
Evaluation of acute kidney injury after surgery for congenital heart disease in neonates: a tertiary hospital experience 评价新生儿先天性心脏病术后急性肾损伤:三级医院经验
Pub Date : 2022-04-05 DOI: 10.1080/14767058.2022.2044774
Ezgi Öktener Anuk, İ. Erdoğan, M. Özkan, E. Baskın, B. Varan, N. Tokel
Abstract Purpose of the article Acute kidney injury (AKI) after cardiac surgery in children with congenital heart disease (CHD) is a serious complication closely associated with high morbidity and mortality. Despite numerous studies on AKI in children, most studies have excluded neonates. We sought to characterize AKI associated with cardiac surgery in neonates, determine its incidence, perioperative and postoperative risk factors, and short-term results. Materials and methods This retrospective study included 177 neonates who were operated on for CHD in our hospital between January 2015 and December 2019. Data of the patients were analyzed according to nKDIGO (neonatal Kidney Disease Improving Global Outcomes) and nRIFLE (neonatal Risk, Injury, Failure, Loss of function, End-stage kidney disease) criteria for evaluating AKI retrospectively. Data of groups with and without AKI were analyzed. Results The average age of 177 neonates were 8.2 ± 6.1 (1–28) days. Twenty-two (12.4%) neonates had CS-AKI defined according to nKDIGO criteria. Four (2.3%) neonates reached nKDIGO stage I, 1 (0.6%) reached stage II, 17 (9.6%) reached stage III. Thirty-eight (21.5%) neonates had CS-AKI defined according to nRIFLE criteria. Twenty-four (13.6%) neonates reached nRIFLE stage risk(R), 6 (3.4%) reached stage injury(I), 8 (4.5%) reached stage failure (F). The incidence of cardiac surgery-associated acute kidney injury (CS-AKI) in neonates was 12.5% and 21.5% for nKDIGO and nRIFLE, respectively. The percentage difference between nKDIGO and nRIFLE for AKI assessment was due to the criteria for nRIFLE stage risk(R) urine output < 1.5 mL/kg/h for 24 h. In both classifications, the duration of cardiopulmonary bypass, operation, inotropic treatment, and mechanical ventilation, length of intensive care unit (ICU), and hospital stay were significantly higher in the AKI group than those without AKI group (p˂.05). The mortality rate in the groups with AKI was found to be significantly higher (p˂.05) than in the groups without AKI. In Kappa analysis, when two classifications were compared according to AKI stages, a significant agreement was found between nKDIGO and nRIFLE classifications (p˂.05) (Kappa: 0.299). Conclusion AKI and mortality rates were similar between groups according to the nKDIGO and nRIFLE criteria. For early prediction of AKI and adverse outcomes, diagnostic reference intervals might be specified in more detail in neonates undergoing cardiac surgery for CHD.
摘要本文目的:先天性心脏病(CHD)患儿心脏手术后急性肾损伤(AKI)是一种严重的并发症,发病率和死亡率高。尽管有大量关于儿童AKI的研究,但大多数研究都将新生儿排除在外。我们试图描述与新生儿心脏手术相关的AKI,确定其发生率、围手术期和术后危险因素以及短期结果。材料与方法回顾性研究2015年1月至2019年12月在我院接受冠心病手术的新生儿177例。根据nKDIGO(新生儿肾脏疾病改善总体结局)和nRIFLE(新生儿风险、损伤、衰竭、功能丧失、终末期肾脏疾病)标准对患者数据进行回顾性分析。分析有AKI组和无AKI组的数据。结果177例新生儿平均年龄为8.2±6.1 (1 ~ 28)d。22例(12.4%)新生儿有根据nKDIGO标准定义的CS-AKI。4例(2.3%)新生儿达到nKDIGO I期,1例(0.6%)达到II期,17例(9.6%)达到III期。38例(21.5%)新生儿有根据nRIFLE标准定义的CS-AKI。24例(13.6%)新生儿达到nRIFLE分期风险(R), 6例(3.4%)达到分期损伤(I), 8例(4.5%)达到分期衰竭(F)。nKDIGO组和nRIFLE组新生儿心脏手术相关急性肾损伤(CS-AKI)发生率分别为12.5%和21.5%。nKDIGO和nRIFLE在AKI评估中的百分比差异是由于nRIFLE分期风险(R) 24h尿量< 1.5 mL/kg/h的标准。在两种分类中,AKI组的体外循环、手术、肌力治疗和机械通气时间、重症监护病房(ICU)时间和住院时间均显著高于无AKI组(p小于0.05)。AKI组的死亡率明显高于无AKI组(p小于0.05)。在Kappa分析中,当根据AKI分期比较两种分类时,发现nKDIGO和nRIFLE分类之间存在显著的一致性(p小于0.05)(Kappa: 0.299)。结论按nKDIGO和nRIFLE标准,两组间AKI和死亡率相似。为了早期预测AKI和不良后果,在接受冠心病心脏手术的新生儿中可能会更详细地规定诊断参考区间。
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引用次数: 1
Gestational weight gain and patterns of breastfeeding among patients with class III obesity III类肥胖患者的妊娠期体重增加和母乳喂养模式
Pub Date : 2022-04-05 DOI: 10.1080/14767058.2022.2060734
A. Darling, L. Gatta, A. Tucker, LaMani D Adkins, Courtney J Mitchell, Emily S. Reiff, S. Dotters-Katz
Abstract Background Maternal obesity is associated with delayed lactogenesis and shorter duration of breastfeeding compared to patients with a normal BMI. Research aim/question We investigated the impact of excessive gestational weight gain, defined as greater than the Institute of Medicine guidelines (>9.1 kg), on the initiation and duration of breastfeeding in patients with class III obesity. Methods Retrospective cohort of patients with body mass index ≥40 in first trimester, delivering a singleton term infant at a tertiary care center between July 2013 and December 2017. Primary outcome was exclusive breastfeeding at discharge and at postpartum visit. Secondary outcomes included any breastfeeding at discharge and postpartum visit, and cessation of breastfeeding by the postpartum visit. Descriptive statistics were used to compare those whose gestational weight gain exceeded (eIOM) versus met (mIOM) Institute of Medicine guidelines. Regression models were performed to adjust for baseline confounding factors. Results Of 294 women included, 117(39.8%) were in the eIOM group. These women were more likely to be primigravida, have a higher delivery BMI, greater delivery blood loss, and have a neonate admitted to the intensive care unit. Exclusive breastfeeding at discharge was not different between eIOM and mIOM (66.7% vs 70.9%, p = .44), nor did eIOM impact likelihood of exclusive breastfeeding at postpartum visit (40.1% vs 34.2%, p = .31). When controlling for confounding factors, breastfeeding at discharge (aOR 1.54 95% CI [0.68–3.49]) or postpartum visit (aOR 0.67[0.31–1.47]) did not differ between eIOM compared to mIOM. Conclusions Among women with class III obesity, excessive gestational weight gain did not impact the rate of exclusive breastfeeding at discharge or postpartum visit.
与BMI正常的孕妇相比,孕妇肥胖与乳糖生成延迟和母乳喂养时间缩短有关。研究目的/问题我们调查了孕期体重增加过多(定义为大于医学研究所指南(>9.1 kg))对III级肥胖患者母乳喂养的开始和持续时间的影响。方法回顾性队列研究2013年7月至2017年12月在三级医疗中心分娩一胎足月婴儿的早期妊娠体重指数≥40的患者。主要结局是出院时和产后随访时的纯母乳喂养。次要结局包括出院和产后访视时是否母乳喂养,以及产后访视时是否停止母乳喂养。描述性统计用于比较妊娠期体重增加超过(eIOM)和达到(mIOM)医学研究所指南的孕妇。采用回归模型调整基线混杂因素。结果294例患者中,eIOM组117例(39.8%)。这些妇女更有可能是初产妇,分娩时BMI指数更高,分娩时失血更多,并且有一个新生儿住进了重症监护室。出院时纯母乳喂养在eIOM和mIOM之间没有差异(66.7% vs 70.9%, p = 0.44), eIOM也没有影响产后访问时纯母乳喂养的可能性(40.1% vs 34.2%, p = 0.31)。在控制混杂因素后,出院时母乳喂养(aOR 1.54 95% CI[0.68-3.49])或产后访问(aOR 0.67[0.31-1.47])在eIOM和mIOM之间没有差异。结论:在III级肥胖妇女中,妊娠期体重过度增加不影响出院时或产后访视时纯母乳喂养率。
{"title":"Gestational weight gain and patterns of breastfeeding among patients with class III obesity","authors":"A. Darling, L. Gatta, A. Tucker, LaMani D Adkins, Courtney J Mitchell, Emily S. Reiff, S. Dotters-Katz","doi":"10.1080/14767058.2022.2060734","DOIUrl":"https://doi.org/10.1080/14767058.2022.2060734","url":null,"abstract":"Abstract Background Maternal obesity is associated with delayed lactogenesis and shorter duration of breastfeeding compared to patients with a normal BMI. Research aim/question We investigated the impact of excessive gestational weight gain, defined as greater than the Institute of Medicine guidelines (>9.1 kg), on the initiation and duration of breastfeeding in patients with class III obesity. Methods Retrospective cohort of patients with body mass index ≥40 in first trimester, delivering a singleton term infant at a tertiary care center between July 2013 and December 2017. Primary outcome was exclusive breastfeeding at discharge and at postpartum visit. Secondary outcomes included any breastfeeding at discharge and postpartum visit, and cessation of breastfeeding by the postpartum visit. Descriptive statistics were used to compare those whose gestational weight gain exceeded (eIOM) versus met (mIOM) Institute of Medicine guidelines. Regression models were performed to adjust for baseline confounding factors. Results Of 294 women included, 117(39.8%) were in the eIOM group. These women were more likely to be primigravida, have a higher delivery BMI, greater delivery blood loss, and have a neonate admitted to the intensive care unit. Exclusive breastfeeding at discharge was not different between eIOM and mIOM (66.7% vs 70.9%, p = .44), nor did eIOM impact likelihood of exclusive breastfeeding at postpartum visit (40.1% vs 34.2%, p = .31). When controlling for confounding factors, breastfeeding at discharge (aOR 1.54 95% CI [0.68–3.49]) or postpartum visit (aOR 0.67[0.31–1.47]) did not differ between eIOM compared to mIOM. Conclusions Among women with class III obesity, excessive gestational weight gain did not impact the rate of exclusive breastfeeding at discharge or postpartum visit.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73192342","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
Functional assessment of atrial M-mode in 3rd trimester in the context of postnatal balloon atrial septostomy in fetuses with simple dextro-transposition of the great arteries 单纯性大动脉右转位胎儿产后球囊房间隔造口术对妊娠晚期心房m型的功能评价
Pub Date : 2022-04-05 DOI: 10.1080/14767058.2022.2061346
Oskar Sylwestrzak, M. Respondek-Liberska
Abstract Objective This study aimed to identify new functional echocardiographic features of fetal foramen ovale (FO) to predict the need of urgent balloon atrial septostomy (BAS) in neonates with simple dextro-transposition of the great arteries (d-TGA). Method Single-center prospective study of fetuses, who had prenatal echocardiographic examination <30 days before delivery and fetal diagnosis of simple d-TGA. The subjects were divided according to the need of BAS within the first 24 h after neonatal birth and before arterial switch operation. We analyzed following parameters: FO diameter, pulmonary venous maximal velocity, new FO flap tracings index analyzed by M-mode echocardiography. Results Out of 130 fetuses, 12 patients were included. Cutoff value of FO index provided maximum sensitivity (100%) and negative predictive value (100%) and cutoff value of FO index multiplied by FO diameter provided maximum specificity (100%) and positive predictive value (100%) in fetuses with fetal d-TGA in predicting need of urgent BAS. Conclusion FO index could potentially be used to predict postnatal haemodynamic stability in fetuses with simple d-TGA. FO index multiplied by FO diameter could potentially be used to predict prenatally the need of urgent BAS following the birth.
目的探讨胎儿卵圆孔(FO)的新功能超声心动图特征,以预测单纯性大动脉右转位(d-TGA)新生儿是否需要紧急气囊房间隔造口术(BAS)。方法对产前超声心动图检查<30天且胎儿诊断为单纯性d-TGA的胎儿进行单中心前瞻性研究。根据新生儿出生后24小时内及动脉转换手术前的BAS需用情况进行分组。通过m型超声心动图分析FO直径、肺静脉最大流速、新FO瓣示踪指标。结果在130例胎儿中,纳入12例。胎儿d-TGA胎儿FO指数临界值在预测紧急BAS需求方面具有最大的敏感性(100%)和阴性预测值(100%),FO指数与FO直径的乘积临界值在预测紧急BAS需求方面具有最大的特异性(100%)和阳性预测值(100%)。结论FO指数可用于预测单纯性d-TGA胎儿的产后血流动力学稳定性。FO指数乘以FO直径可能用于预测产前分娩后是否需要紧急BAS。
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引用次数: 3
Development and evaluation of a novel method “bilirubin color card” for screening of treatable jaundice in neonates: prospective comparative diagnostic study “胆红素色卡”筛查新生儿可治疗黄疸新方法的开发和评价:前瞻性比较诊断研究
Pub Date : 2022-03-29 DOI: 10.1080/14767058.2022.2056442
Ashutosh Kumar Singh, S. Murki, D. Sharma, Venkateshwarlu Vardhelli, S. Subramanian, Abhinav Mekarthi
Abstract Background Various methods of screening or diagnosis of severe hyperbilirubinemia like transcutaneous bilirubinometer and laboratory testing havemethodological or practical limitations. In this perspective, we designed and evaluated an invasive but simple screening Color Card method in rapid assessment of various levels of bilirubin categories. Objective This prospective comparative diagnostic study objectives were to create “Color Card” initially by yellow color shades that fall into 4 bilirubin categories, i.e. TSB up to 7 mg/dl, 7.1 to 12 mg/dl, 12.1 to 18 mg/dl and >18 mg/dl from the samples analyzed by diazo method, and to study its sensitivity and specificity for the diagnosis of moderate or severe hyperbilirubinemia in comparison to total serum bilirubin (TSB) by diazo method. Results Out of total 188 samples obtained, 134 were unique patients. The specificity, negative predictive value and accuracy of the color card for the observations made by observer 1 comparing with lab TSB were >95% for clinically important categories of <7 mg/dl and >18 mg/dl. The overall accuracy of color card in measuring various TSB ranges varied from 75% to 96.8%. The agreement between two observers was 85.6% (Cohen’s kappa co-efficient: 0.61, p-value: .0001) overall and was 92.3%, 86%, 84%, 81.2% for each of the four bilirubin categories in ascending order. Conclusion Bilirubin color card has good accuracy and may be very useful in the low resource settings, especially in the first referral units and community settings, where laboratory TSB estimation is not available easily. However, it requires centrifugation and easier methods of centrifugation will make this method simpler.
背景筛选或诊断严重高胆红素血症的各种方法,如经皮胆红素计和实验室检测都有方法学或实践上的局限性。从这个角度来看,我们设计并评估了一种有创但简单的筛选颜色卡方法,用于快速评估各种胆红素类别水平。目的本前瞻性比较诊断研究的目的是通过重氮法分析的样品中TSB≥7mg /dl、7.1 ~ 12mg /dl、12.1 ~ 18mg /dl和> 18mg /dl 4种胆红素类型的黄色色度初步制作“颜色卡”,并与重氮法检测的血清总胆红素(TSB)进行比较,研究其诊断中重度高胆红素血症的敏感性和特异性。结果188份样本中,134例为特殊患者。对于18 mg/dl的临床重要类别,与实验室TSB相比,观测者1所观察到的颜色卡的特异性、阴性预测值和准确性均>95%。色卡测量各种TSB范围的总体准确度在75% ~ 96.8%之间。两个观察者之间的一致性总体为85.6% (Cohen 's kappa系数:0.61,p值:0.0001),四种胆红素类别的一致性依次为92.3%,86%,84%,81.2%。结论胆红素彩色卡具有良好的准确性,在资源匮乏的情况下,特别是在首次转诊单位和社区环境中,实验室TSB估计不容易获得。然而,它需要离心,更容易的离心方法将使这种方法更简单。
{"title":"Development and evaluation of a novel method “bilirubin color card” for screening of treatable jaundice in neonates: prospective comparative diagnostic study","authors":"Ashutosh Kumar Singh, S. Murki, D. Sharma, Venkateshwarlu Vardhelli, S. Subramanian, Abhinav Mekarthi","doi":"10.1080/14767058.2022.2056442","DOIUrl":"https://doi.org/10.1080/14767058.2022.2056442","url":null,"abstract":"Abstract Background Various methods of screening or diagnosis of severe hyperbilirubinemia like transcutaneous bilirubinometer and laboratory testing havemethodological or practical limitations. In this perspective, we designed and evaluated an invasive but simple screening Color Card method in rapid assessment of various levels of bilirubin categories. Objective This prospective comparative diagnostic study objectives were to create “Color Card” initially by yellow color shades that fall into 4 bilirubin categories, i.e. TSB up to 7 mg/dl, 7.1 to 12 mg/dl, 12.1 to 18 mg/dl and >18 mg/dl from the samples analyzed by diazo method, and to study its sensitivity and specificity for the diagnosis of moderate or severe hyperbilirubinemia in comparison to total serum bilirubin (TSB) by diazo method. Results Out of total 188 samples obtained, 134 were unique patients. The specificity, negative predictive value and accuracy of the color card for the observations made by observer 1 comparing with lab TSB were >95% for clinically important categories of <7 mg/dl and >18 mg/dl. The overall accuracy of color card in measuring various TSB ranges varied from 75% to 96.8%. The agreement between two observers was 85.6% (Cohen’s kappa co-efficient: 0.61, p-value: .0001) overall and was 92.3%, 86%, 84%, 81.2% for each of the four bilirubin categories in ascending order. Conclusion Bilirubin color card has good accuracy and may be very useful in the low resource settings, especially in the first referral units and community settings, where laboratory TSB estimation is not available easily. However, it requires centrifugation and easier methods of centrifugation will make this method simpler.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81715106","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: 2
Soy foods and nuts consumption during early pregnancy are associated with decreased risk of gestational diabetes mellitus: a prospective cohort study 一项前瞻性队列研究表明,妊娠早期食用大豆和坚果可降低妊娠期糖尿病的风险
Pub Date : 2022-03-28 DOI: 10.1080/14767058.2021.2017872
X. Pang, C. Cai, H. Dong, X. Lan, Yi-qi Zhang, D. Bai, Lixin Hao, Hong Sun, Fei Li, G. Zeng
Abstract Aims To study the relationship of soy foods and nuts consumption during early pregnancy with the risk of gestational diabetes mellitus (GDM). Methods This was a prospective observational study conducted in Southwest China. Dietary information was assessed through 3-day 24-h dietary recalls at 6–14 gestational weeks. For soy foods and nuts, non-consumers were used as the reference category and the consumers were categorized into tertiles. GDM was assessed with the 75-g, 2-h oral glucose tolerance test at 24–28 gestational weeks. Log-binomial models were used to assess the effects of soy foods and nuts on GDM. Results Of the 1495 pregnant women, 529 were diagnosed with GDM. Median (IQRs) intakes of soy foods and nuts were 2.9 (0.0, 10.3) and 5.0 (0.0, 15.0) g/d, respectively. Our study found that, compared with the non-consumers, the highest tertile of soy foods intake was associated with a decrease in risk of GDM (RR = 0.73, 95%CI: 0.54–0.99, p = .049). Similarly, compared with the non-consumers, a negative relationship between the highest tertile of nuts intake and GDM risk was identified (RR = 0.65, 95%CI: 0.48–0.89, p = .007). Conclusions Consumption of soy foods and nuts are independently inversely associated with the risk of GDM during early pregnancy.
摘要目的探讨妊娠早期大豆食品和坚果的摄食与妊娠期糖尿病(GDM)风险的关系。方法在中国西南地区进行前瞻性观察性研究。在妊娠6-14周,通过3天24小时的饮食回顾来评估饮食信息。对于大豆食品和坚果,非消费者被用作参考类别,消费者被分为三类。妊娠24-28周采用75 g, 2小时口服葡萄糖耐量试验评估GDM。采用对数二项模型评估大豆食品和坚果对GDM的影响。结果1495例孕妇中,529例确诊为GDM。大豆食品和坚果的中位数(IQRs)摄入量分别为2.9 (0.0,10.3)g/d和5.0 (0.0,15.0)g/d。我们的研究发现,与不食用大豆的人相比,大豆食品摄入量最高的人患GDM的风险降低(RR = 0.73, 95%CI: 0.54-0.99, p = 0.049)。同样,与不食用坚果的人相比,最高坚果摄入量与GDM风险之间存在负相关关系(RR = 0.65, 95%CI: 0.48-0.89, p = 0.007)。结论:大豆食品和坚果的摄入与妊娠早期GDM的风险呈独立负相关。
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引用次数: 1
期刊
The Journal of Maternal-Fetal & Neonatal Medicine
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