Outcomes before and after Adopting Guidelines for Expectant Management of Severe Preeclampsia

2020 ◽  
Author(s):  
Aalok R. Sanjanwala ◽  
Victoria C. Jauk ◽  
Gabriella D. Cozzi ◽  
David A. Becker ◽  
Lorie M. Harper ◽  
...  
Keyword(s):  
Age Groups ◽  
Perinatal Outcomes ◽  
Expectant Management ◽  
Neonatal Morbidity ◽  
Severe Preeclampsia ◽  
Trend Test ◽  
Chi Square ◽  
Before And After ◽  
Armitage Trend Test ◽  
Student’S T

Objective This study aimed to compare maternal and neonatal outcomes in women with severe preeclampsia before and after implementation of the American College of Obstetricians and Gynecologists (ACOG) taskforce hypertensive guidelines. Study Design Single-center retrospective cohort study of women with severe preeclampsia delivering live nonanomalous singletons 23 to 342/7 weeks from 2013 to 2017. In 2015, the ACOG guidelines for expectant management of severe preeclampsia were implemented at our institution. Based on this, patients were categorized as preguideline (January 2013–December 2015) or postguideline adoption (January 2016–December 2017). Primary outcomes included composite maternal morbidity and composite neonatal morbidity; secondary outcomes included composite components, length of stay, birth weight, and delivery gestational age. Groups were compared with Student's t-test, Chi-square, and Wilcoxon's rank-sum tests; adjusted odds ratios (aOR; 95% confidence intervals [CIs]) were calculated. Yearly composite outcomes were compared using the Cochran–Armitage trend test. We estimated a sample size of 250 per group would provide 80% power at α = 0.05 to detect a 50% reduction in neonatal morbidity from a baseline rate of 21.5%. Results From 2013 to 2017, a total of 543 women with severe preeclampsia were identified: 278 (51%) preguideline and 265 (49%) postguideline. Baseline characteristics were overall similar between groups. There were no significant differences in maternal (aOR = 0.96, 95% CI: 0.6–1.41) or neonatal (aOR = 0.88, 95% CI: 0.61–1.28) composite morbidity between groups. Furthermore, there were no differences in composite maternal or neonatal morbidity over time. Conclusion Perinatal outcomes were similar before and after implementation of severe preeclampsia management guidelines at our institution. Studies to evaluate if benefits are limited to subsets of this population, such as earlier gestational ages, are needed. Key Points

scholarly journals A Randomized, Controlled, Parallel-Group, Trial on the Effects of Melatonin on Fatigue Associated with Breast Cancer and Its Adjuvant Treatments

2021 ◽  
Vol 20 ◽  
pp. 153473542098834
Author(s):  
Abdolazim Sedighi Pashaki ◽  
Kamal Mohammadian ◽  
Saeid Afshar ◽  
Mohammad Hadi Gholami ◽  
Abbas Moradi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Intervention Group ◽  
Chi Square ◽  
Significance Level ◽  
Severe Fatigue ◽  
Before And After ◽  
Brief Fatigue Inventory ◽  
Chi Square Test ◽  
Student’S T

Objective: Fatigue associated with malignant conditions and their treatments is a disabling condition. This trial assessed the anti-fatigue effects of melatonin coadministration during adjuvant treatment of patients with the breast cancer. Material and Methods: Patients with breast cancer were randomly assigned to receive melatonin or placebo during adjuvant chemotherapy and radiotherapy. Thirty-seven patients were randomly enrolled in each group. The mean ages of patients in the intervention and control groups were 50.47 ± 10.79 and 46.05 ± 10.55 years, respectively ( P = .223). The intervention group received oral melatonin (18 mg/day) from 1 week before until 1 month after the adjuvant radiotherapy. The level of fatigue was assessed before and after intervention using Brief Fatigue Inventory (BFI) in both groups. To analyze data, the Student’s t-test and the Chi-square test were used at a significance level of P ≤ .05. Results: The BFI score was similar before the intervention in both groups, however, after the intervention, it was significantly lower in the melatonin group ( P < .001). Moreover, the frequency of severe fatigue in the melatonin group was significantly lower than in the placebo group after intervention (42.1% vs 83.3%, P < .001). Conclusion: Coadministration of melatonin during adjuvant chemotherapy and radiotherapy of women with breast cancer decreased the levels of fatigue associated with the malignant condition and its treatments.

Correlation of bile acids and aspartate-aminotransferase with outcomes in cholestasis of pregnancy

2020 ◽  
Vol 13 (4) ◽  
pp. 513-519
Author(s):  
A.L. Juusela ◽  
L. Cordero ◽  
M. Gimovsky ◽  
M. Nazir
Keyword(s):  
Bile Acid ◽  
Laboratory Data ◽  
Perinatal Outcomes ◽  
Retrospective Chart Review ◽  
Roc Curve Analysis ◽  
Chi Square ◽  
Student’S T ◽  
Nicu Admission ◽  
Cholestasis Of Pregnancy ◽  
Meconium Stained Amniotic Fluid

OBJECTIVE: To identify laboratory data that correlates with poor perinatal outcomes. METHODS: A retrospective chart review of women with intrahepatic cholestasis of pregnancy (ICP), admitted for delivery between January 1, 2013 and December 31, 2017, was performed. Chi-square, student’s t-test, and ANOVA statistical analysis was performed. The receiver-operator characteristic curves were plotted for the prediction of each category of perinatal outcome and the areas under the curves were determined. All p-values were two-sided, and p < 0.05 was considered statistically significant. RESULTS: Analysis of the 61 ICP cases showed no occurrence of the intrauterine fetal demise (IUFD), stillbirth, abruption, or neonatal demise. ROC curve analysis revealed a statistically significant correlation between bile acid and AST levels and perinatal outcomes. A bile acid (BA) level equal to or greater than 37μmol/L strongly predicted spontaneous preterm labor in women affected by ICP with a sensitivity of 100% and specificity of 60.70% (p = 0.002). A BA level equal to or greater than 42μmol/L strongly predicted meconium-stained amniotic fluid with a sensitivity of 85.70% and specificity of 66.70% (p = 0.006). AST levels equal to or greater than 62 IU/L strongly predicted NICU admission with a sensitivity of 81.30% and specificity of 62.20% (p = 0.002). AST levels equal to or greater than 75 IU/L strongly predicted hyperbilirubinemia in the neonates with a sensitivity of 87.50% and specificity of 69.80% (p = 0.001). CONCLUSIONS: There is a statistically significant correlation between elevated BA and elevated AST levels and adverse perinatal outcomes.

scholarly journals Predicting Failure of Non-Invasive Ventilation With RAM Cannula in Bronchiolitis

2021 ◽  
pp. 088506662097964
Author(s):  
Mia Maamari ◽  
Gustavo Nino ◽  
James Bost ◽  
Yao Cheng ◽  
Anthony Sochet ◽  
...  
Keyword(s):  
Bacterial Pneumonia ◽  
Invasive Ventilation ◽  
Chi Square ◽  
Critical Congenital Heart Disease ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Before And After ◽  
Baseline Characteristics ◽  
Student’S T ◽  
Student’S T Test

Introduction: In infants hospitalized for bronchiolitis on non-invasive ventilation (NIV) via the RAM cannula nasal interface, variables predicting subsequent intubation, or NIV non-response, are understudied. We sought to identify predictors of NIV non-response. Methods: We performed a retrospective cohort study in infants admitted for respiratory failure from bronchiolitis placed on NIV in a quaternary children’s hospital. We excluded children with concurrent sepsis, critical congenital heart disease, or with preexisting tracheostomy. The primary outcome was NIV non-response defined as intubation after a trial of NIV. Secondary outcomes were vital sign values before and after NIV initiation, duration of NIV and intubation, and mortality. Primary analyses included Chi-square, Wilcoxon rank-sum, student’s t test, paired analyses, and adjusted and unadjusted logistic regression assessing heart rate (HR) and respiratory rate (RR) before and after NIV initiation. Results: Of 138 infants studied, 34% were non-responders. There were no differences in baseline characteristics of responders and non-responders. HR decreased after NIV initiation in responders (156 [143-156] to149 [141-158], p < 0.01) compared to non-responders (158 [149-166] to 158 [145-171], p = 0.73). RR decreased in responders (50 [43-58] vs 47 [41-54]) and non-responders (52 [48-58] vs 51 [40-55], both p < 0.01). Concurrent bacterial pneumonia (OR 6.06, 95% CI: 2.54-14.51) and persistently elevated HR (OR: 1.04, 95% CI: 1.01-1.07) were associated with NIV non-response. Conclusion: In children with acute bronchiolitis who fail to respond to NIV and require subsequent intubation, we noted associations with persistently elevated HR after NIV initiation and concurrent bacterial pneumonia.

scholarly journals Comparative analysis of perinatal outcomes and birth defects amongst adolescent and older Ugandan mothers: evidence from a hospital-based surveillance database

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Robert Serunjogi ◽  
Linda Barlow-Mosha ◽  
Daniel Mumpe-Mwanja ◽  
Dhelia Williamson ◽  
Diana Valencia ◽  
...  
Keyword(s):  
Birth Outcomes ◽  
Adolescent Mothers ◽  
Birth Defects ◽  
Age Groups ◽  
Perinatal Outcomes ◽  
Sub Saharan Africa ◽  
Adverse Birth Outcomes ◽  
Chi Square ◽  
Increased Risk ◽  
Surveillance Database

Abstract Background Uganda has one of the highest adolescent pregnancy rates in sub-Saharan Africa. We compared the risk of adverse birth outcomes between adolescents (age 12–19 years) and mothers (age 20–34 years) in four urban hospitals. Methods Maternal demographics, HIV status, and birth outcomes of all live births, stillbirths, and spontaneous abortions delivered from August 2015 to December 2018 were extracted from a hospital-based birth defects surveillance database. Differences in the distributions of maternal and infant characteristics by maternal age groups were tested with Pearson’s chi-square. Adjusted odds ratios (aORs) and 95% confidence intervals (CI) were calculated using logistic regression to compare the prevalence of adverse birth outcomes among adolescents to mothers 20–34 years. Results A total of 100,189 births were analyzed, with 11.1% among adolescent mothers and 89.0% among older mothers. Adolescent mothers had an increased risk of preterm delivery (aOR: 1.14; CI 1.06–1.23), low birth weight (aOR: 1.46; CI 1.34–1.59), and early neonatal deaths (aOR: 1.58; CI 1.23–2.02). Newborns of adolescent mothers had an increased risk of major external birth defects (aOR: 1.33; CI 1.02–1.76), specifically, gastroschisis (aOR: 3.20; CI 1.12–9.13) compared to mothers 20–34 years. The difference between the prevalence of gastroschisis among adolescent mothers (7.3 per 10,000 births; 95% CI 3.7–14.3) was statistically significant when compared to mothers 20–34 years (1.6 per 10,000 births; 95% CI 0.9–2.6). Conclusions This study found that adolescent mothers had an increased risk for several adverse birth outcomes compared to mothers 20–34 years, similar to findings in the region and globally. Interventions are needed to improve birth outcomes in this vulnerable population.

scholarly journals Induction of labour at 41 weeks or expectant management until 42 weeks: A systematic review and an individual participant data meta-analysis of randomised trials

PLoS Medicine ◽  
2020 ◽  
Vol 17 (12) ◽  
pp. e1003436
Author(s):  
Mårten Alkmark ◽  
Judit K. J. Keulen ◽  
Joep C. Kortekaas ◽  
Christina Bergh ◽  
Jeroen van Dillen ◽  
...  
Keyword(s):  
Perinatal Outcome ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Perinatal Outcomes ◽  
Expectant Management ◽  
Neonatal Morbidity ◽  
Individual Participant Data ◽  
Nulliparous Women ◽  
Multiparous Women ◽  
Individual Participant

Background The risk of perinatal death and severe neonatal morbidity increases gradually after 41 weeks of pregnancy. Several randomised controlled trials (RCTs) have assessed if induction of labour (IOL) in uncomplicated pregnancies at 41 weeks will improve perinatal outcomes. We performed an individual participant data meta-analysis (IPD-MA) on this subject. Methods and findings We searched PubMed, Excerpta Medica dataBASE (Embase), The Cochrane Library, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and PsycINFO on February 21, 2020 for RCTs comparing IOL at 41 weeks with expectant management until 42 weeks in women with uncomplicated pregnancies. Individual participant data (IPD) were sought from eligible RCTs. Primary outcome was a composite of severe adverse perinatal outcomes: mortality and severe neonatal morbidity. Additional outcomes included neonatal admission, mode of delivery, perineal lacerations, and postpartum haemorrhage. Prespecified subgroup analyses were conducted for parity (nulliparous/multiparous), maternal age (<35/≥35 years), and body mass index (BMI) (<30/≥30). Aggregate data meta-analysis (MA) was performed to include data from RCTs for which IPD was not available. From 89 full-text articles, we identified three eligible RCTs (n = 5,161), and two contributed with IPD (n = 4,561). Baseline characteristics were similar between the groups regarding age, parity, BMI, and higher level of education. IOL resulted overall in a decrease of severe adverse perinatal outcome (0.4% [10/2,281] versus 1.0% [23/2,280]; relative risk [RR] 0.43 [95% confidence interval [CI] 0.21 to 0.91], p-value 0.027, risk difference [RD] −57/10,000 [95% CI −106/10,000 to −8/10,000], I2 0%). The number needed to treat (NNT) was 175 (95% CI 94 to 1,267). Perinatal deaths occurred in one (<0.1%) versus eight (0.4%) pregnancies (Peto odds ratio [OR] 0.21 [95% CI 0.06 to 0.78], p-value 0.019, RD −31/10,000, [95% CI −56/10,000 to −5/10,000], I2 0%, NNT 326, [95% CI 177 to 2,014]) and admission to a neonatal care unit ≥4 days occurred in 1.1% (24/2,280) versus 1.9% (46/2,273), (RR 0.52 [95% CI 0.32 to 0.85], p-value 0.009, RD −97/10,000 [95% CI −169/10,000 to −26/10,000], I2 0%, NNT 103 [95% CI 59 to 385]). There was no difference in the rate of cesarean delivery (10.5% versus 10.7%; RR 0.98, [95% CI 0.83 to 1.16], p-value 0.81) nor in other important perinatal, delivery, and maternal outcomes. MA on aggregate data showed similar results. Prespecified subgroup analyses for the primary outcome showed a significant difference in the treatment effect (p = 0.01 for interaction) for parity, but not for maternal age or BMI. The risk of severe adverse perinatal outcome was decreased for nulliparous women in the IOL group (0.3% [4/1,219] versus 1.6% [20/1,264]; RR 0.20 [95% CI 0.07 to 0.60], p-value 0.004, RD −127/10,000, [95% CI −204/10,000 to −50/10,000], I2 0%, NNT 79 [95% CI 49 to 201]) but not for multiparous women (0.6% [6/1,219] versus 0.3% [3/1,264]; RR 1.59 [95% CI 0.15 to 17.30], p-value 0.35, RD 27/10,000, [95% CI −29/10,000 to 84/10,000], I2 55%). A limitation of this IPD-MA was the risk of overestimation of the effect on perinatal mortality due to early stopping of the largest included trial for safety reasons after the advice of the Data and Safety Monitoring Board. Furthermore, only two RCTs were eligible for the IPD-MA; thus, the possibility to assess severe adverse neonatal outcomes with few events was limited. Conclusions In this study, we found that, overall, IOL at 41 weeks improved perinatal outcome compared with expectant management until 42 weeks without increasing the cesarean delivery rate. This benefit is shown only in nulliparous women, whereas for multiparous women, the incidence of mortality and morbidity was too low to demonstrate any effect. The magnitude of risk reduction of perinatal mortality remains uncertain. Women with pregnancies approaching 41 weeks should be informed on the risk differences according to parity so that they are able to make an informed choice for IOL at 41 weeks or expectant management until 42 weeks. Study Registration: PROSPERO CRD42020163174

scholarly journals Psychotherapy can be effective in prolonging periods free of depression in early senescent

2016 ◽  
Vol 15 (1) ◽  
pp. 118-122
Author(s):  
Vidya Bhagat
Keyword(s):  
Medical Science ◽  
Age Groups ◽  
Sampling Technique ◽  
Age Group ◽  
Chi Square ◽  
Significant Difference ◽  
Before And After ◽  
The Difference ◽  
To Come ◽  
Level Of Significance

Background: The Psychotherapy can be effective in prolonging periods free of depression in early senescent has been focused on the study. People refused medication agreed to come for psychotherapy are treated to get free from their depressive symptom. The main objective of the study was therefore using psychotherapy as a treatment module to stretch time free of depression. Further psycho education to give more information on depression and increase patient flexibility for the combination of anti-depressant with psychotherapy when needed.Methodology: The subjects selected for the study were 60 patients from ‘Nitte Rural Psychiatry Clinic’ Nitte Mangalore Karnataka, India. They were selected by random sampling technique. Medico-Psychological questionnaire for general neuroticism was administered to find out the extent of depression before and after psychotherapy. To find the difference between the age and depression before and after psychotherapy Carl Pearson’s Correlation coefficient method was carried out.Results: The results reveal that a non-significant difference between age groups with extent of depression in different age group of early senescent before and after psychotherapy (Chi-square=1.7913, p>0.05) at the 5 % level of significance and (Chi-square=2.4485, p>0.05) at the 5 % level of significance respectively. Further the Comparison of extent of depression before and after psychotherapy in 50-55, 56-60 age groups and as a total by Wilcoxon matched pairs test has been administered and the result reveals that significant differences between extent of depression before and after psychotherapy in 50-55yrs of age group (Z=2.5205, p<0.05) at the 5 % level of significance, 56-60yrs of age group (Z=2.2014, p<0.05) at the 5 % level of significance. It means that, the significant means that, the significance of 15.7%, 10.5%depression was decreased before and after psychotherapy respectively. A significant difference was observed between extent of depression before and after psychotherapy in 50-60yrs of age group (Z=3. 2958, p<0.05) at the 5 % level of significance. It means that, the significance of 13.0% depression was decreased after psychotherapy.Conclusion: The implication of this study was to develop insight and understanding among the clinicians that importance psychotherapy as treatment of depression.Bangladesh Journal of Medical Science Vol.15(1) 2016 p.118-122

scholarly journals Cervical Cancer Registered in Two Developed Regions from Brazil: Upper Limit of Reachable Results from Opportunistic Screening

2018 ◽  
Vol 40 (06) ◽  
pp. 347-353 ◽  
Author(s):  
Julio Teixeira ◽  
Carlos Maestri ◽  
Helymar Machado ◽  
Luiz Zeferino ◽  
Newton Carvalho
Keyword(s):  
Cervical Cancer ◽  
Screening Program ◽  
Age Groups ◽  
Cancer Registries ◽  
Trend Test ◽  
Opportunistic Screening ◽  
Age Group ◽  
Number Pattern ◽  
Armitage Trend Test ◽  
Histologic Types

Objective The aim of this study was to assess the time trends and pattern of cervical cancer diagnosed in the period from 2001 to 2012 by means of an opportunistic screening program from two developed regions in Brazil. Methods An observational study analyzing 3,364 cancer records (n = 1,646 from Campinas and n = 1,718 from Curitiba region) available in hospital-based cancer registries was done. An additional 1,836 records of CIN3/AIS from the region of Campinas was analyzed. The statistical analysis assessed the pooled data and the data by region considering the year of diagnosis, age-group, cancer stage, and histologic type. The Cochran-Armitage trend test was applied and p-values < 0.05 were considered significant. Results The total annual cervical cancer registered from 2001 to 2012 showed a slight drop (273–244), with an age average of 49.5 y, 13 years over the average for CIN3/AIS (36.8 y). A total of 20.6% of the diagnoses (1.6% under 25 y) were done out of the official screening age-range. The biennial rate of diagnoses by age group for the region of Campinas showed an increase trend for the age groups under 25 y (p = 0.007) and 25 to 44 y (p = 0.003). Stage III was the most recorded for both regions, with an annual average of 43%, without any trend modification. There was an increasing trend for stage I diagnoses in the region of Campinas (p = 0.033). The proportion of glandular histologic types registered had an increased trend over time (p = 0.002), higher for the region of Campinas (21.1% versus 12.5% for the region of Curitiba). Conclusion The number, pattern and trends of cervical cancer cases registered had mild and slow modifications and reflect the limited effectivity of the opportunistic screening program, even in developed places.

scholarly journals Comparative analysis of perinatal outcomes and birth defects amongst adolescent and older Ugandan mothers: Evidence from a hospital-based surveillance database

2021 ◽  
Author(s):  
Robert Serunjogi ◽  
Linda Barlow-Mosha ◽  
Daniel Mumpe-Mwanja ◽  
Dhelia Williamson ◽  
Diana Valencia ◽  
...  
Keyword(s):  
Birth Outcomes ◽  
Adolescent Mothers ◽  
Birth Defects ◽  
Age Groups ◽  
Perinatal Outcomes ◽  
Sub Saharan Africa ◽  
Adverse Birth Outcomes ◽  
Chi Square ◽  
Increased Risk ◽  
Surveillance Database

Abstract Background: Uganda has one of the highest adolescent pregnancy rates in sub-Saharan Africa. We compared the risk of adverse birth outcomes between adolescents (age 12-19 years) and mothers (age 20-34 years) in four urban hospitals.Methods: Maternal demographics, HIV status, and birth outcomes of all live births, stillbirths, and spontaneous abortions delivered from August 2015 to December 2018 were extracted from a hospital-based birth defects surveillance database. Differences in the distributions of maternal and infant characteristics by maternal age groups were tested with Pearson’s chi-square. Adjusted odds ratios (aORs) and 95% Confidence Intervals (CI) were calculated using logistic regression to compare the prevalence of adverse birth outcomes among adolescents to mothers 20-34 years.Results: A total of 100,189 births were analyzed, with 11.1% among adolescent mothers and 89.0% among older mothers. Adolescent mothers had an increased risk of preterm delivery (aOR: 1.14; CI: 1.06-1.23), low birth weight (aOR: 1.46; CI: 1.34-1.59), and early neonatal deaths (aOR: 1.58; CI: 1.23-2.02). Newborns of adolescent mothers had an increased risk of major external birth defects (aOR: 1.33; CI: 1.02-1.76), specifically, gastroschisis (aOR: 3.20; CI: 1.12-9.13) compared to mothers 20-34 years. The difference between the prevalence of gastroschisis among adolescent mothers (7.3 per 10,000 births; 95% CI: 3.7-14.3) was statistically significant when compared to mothers 20-34 years (1.6 per 10,000 births; 95% CI: 0.9-2.6).Conclusions: This study found that adolescent mothers had an increased risk for several adverse birth outcomes compared to mothers 20-34 years, similar to findings in the region and globally. Interventions are needed to improve birth outcomes in this vulnerable population.

Sign in / Sign up

Export Citation Format

Share Document