Management of Critically Ill Pregnant Patients with COVID-19 Infection in a Rural State

2021 ◽  
Author(s):  
Megan E. Pagan ◽  
Abigail M. Ramseyer ◽  
Dayna D. Whitcombe ◽  
Tucker E. Doiron ◽  
Everett F. Magann ◽  
...  
Keyword(s):  
Adverse Events ◽  
Pregnant Women ◽  
Critically Ill ◽  
Care Center ◽  
Tertiary Care ◽  
Renal Dialysis ◽  
Pregnant Patient ◽  
Icu Length Of Stay ◽  
Institutional Review ◽  
Rural State

Objective There is limited data on the treatment of coronavirus disease 2019 (COVID-19) in pregnancy. Arkansas saw an increase in COVID-19 cases in June 2020. The first critically ill pregnant patient was admitted to our institution on May 21st, 2020. The objective of this study was to evaluate outcomes in critically ill pregnant women with COVID-19 at a single tertiary care center who received remdesivir and convalescent plasma (CCP). Study Design This is a retrospective observational review of critically ill pregnant women with COVID-19 who received remdesivir and CCP. This study was approved by the institutional review board (#261354). Results Seven pregnant patients with COVID-19 were admitted to the intensive care unit (ICU). All received remdesivir and CCP. Six received dexamethasone. The median ICU length of stay (LOS) was 8 days (range 3–17). Patient 1 had multi-organ failure requiring vasopressors, renal dialysis, and had an intrauterine fetal demise. Patients 4 and 6 required mechanical ventilation, were delivered for respiratory distress and were extubated at 2 and 1 days postpartum, respectively. The only common risk factor was obesity. There were no adverse events noted with remdesivir or CCP. Conclusion There is little data regarding the use of remdesivir or CCP for the treatment of COVID-19 in pregnant women. In our cohort, these were well tolerated with no adverse events. Previously reported median ICU LOS in critically ill pregnant women with COVID-19 was 8 days (range 4–15).1 Our study found a similar ICU LOS (8 days; range 3–17). Patient 1 did not receive remdesivir or CCP until transport to our facility on hospital day 3. Excluding patient 1, median ICU LOS was 6.5 days (range 3–9). Our institution's treatment of pregnant women with critical illness with remdesivir, CCP and dexamethasone combined with delivery in select cases has thus far had good outcomes. Key Points

scholarly journals Knowledge and Practices of Pregnant Women regarding Oral Health in A Tertiary Care Hospital in Nepal

2019 ◽  
Vol 57 (217) ◽  
Author(s):  
Neha Gupta ◽  
Manisha Chhetry
Keyword(s):  
Oral Health ◽  
Pregnant Women ◽  
Dental Care ◽  
Dental Health ◽  
Care Center ◽  
Tertiary Care ◽  
Care Hospital ◽  
Perinatal Complications ◽  
Institutional Review ◽  
In Pregnancy

Introduction: Poor dental hygiene has been associated with various perinatal complications in studiesdone worldwide but few studies in Nepal have explored the knowledge of pregnant ladies regardingdental hygiene. The aim of the study was to know the knowledge and practices of pregnant womenregarding oral health in a tertiary care center in Nepal. Methods: A qualitative study was carried out in Nobel Medical College and Teaching Hospital fromJanuary 15, 2018 to June 15, 2018 after approval from the Institutional Review Committee of NobelMedical College. Convenience sampling was done. Fifty pregnant women admitted in antenatalward were interviewed regarding their knowledge of dental care in pregnancy, the common dentalproblems they faced and the treatment taken. A predesigned proforma was used and results wereanalyzed using SPSS version 17. Results: Twenty two (44%) patients reported dental problems during pregnancy. Bleeding gumswas seen in 7 (14%) and toothache in 7 (14%) were commonly reported dental problems. Forty seven(94%) patients acknowledged that routine dental care was needed for health, only 6 (12%) wereaware that poor dental health could affect baby weight. Oral health not seen as priority in 24 (48%)was the main barrier to seeking dental care in pregnancy followed by costs of treatment in 18 (36%)and safety concerns in pregnancy in 8 (16%) cases. Conclusions: Though dental problems were a common occurrence in pregnancy, utilization ofservices was low for the same. The participants reported significant barriers to obtaining dental careincluding lack of knowledge about the importance of maternal oral health and the treatment costs.

scholarly journals Obstetrics outcome in pregnant women with cardiac disease in tertiary care center, Dehradun - India

2019 ◽  
Vol 9 (1) ◽  
pp. 313
Author(s):  
Prachi Singh ◽  
Namrata Saxena ◽  
Vineeta Gupta ◽  
Neeta Bansal ◽  
Yashika Pehal
Keyword(s):  
Heart Disease ◽  
Pregnant Women ◽  
Cardiac Disease ◽  
Care Center ◽  
Tertiary Care ◽  
Disease Patient ◽  
Pregnant Patient ◽  
Fetal Outcome ◽  
Reproductive Age ◽  
Tertiary Care Center

Background: Incidence of heart disease in pregnancy is about 1%. Pregnant patient with cardiac disease can present with lot of challenges for the obstetrician, paediatrician and the cardiologist. With improvement in diagnostic, medical, surgical management, more patient with cardiac diseases especially congenital are able to reach reproductive age. Therefore, still a cardiac disease remains a significant cause of maternal death. Maternal and fetal prognosis both is affected by the care given and the skills used in the treatment of the individual patient. Hospital has resulted in majority of cardiac disease patient being managed in a tertiary care center and this provide an opportunity to report on clinical experiences of pregnancy with cardiac disease, their management and obstetrical outcomes.Methods: This was a retrospective study, with all the patients detailed demographic information, diagnosis, course in the hospital, management, maternal and fetal outcome was obtained from the medical records and files.Results: Incidence of cardiac disease was found to be 0.7%, 47% of pregnant women fell in age group of 26-30 years, 38.2% were primigravida, only 23.53% were booked, and half of them belonged to NYHA II class. 73.5% had Rheumatic heart disease and the most common obstetrics complications were preterm labor and anemia. LSCS was done in 29.4% cases and 38.2% of the newborns were premature.Conclusions: Prematurity anaemia, IUGR, are the common obstetrical complication in pregnant patient with cardiac disease which can be taken care with increased awareness and pre-conceptional counselling especially in patient with congenital heart disease. For optimization of maternal and neonatal outcomes in these patients, dedicated team of obstetrician, fetal medicine specialist, pediatricians, cardiologist and anesthesiologist is the prime requirement.

Prevalence, Correlates and Management of Hyperglycemia in Diabetic Non-critically Ill Patients at a Tertiary Care Center in Lebanon

2019 ◽  
Vol 15 (2) ◽  
pp. 133-140 ◽  
Author(s):  
Ghada El Khoury ◽  
Hanine Mansour ◽  
Wissam K. Kabbara ◽  
Nibal Chamoun ◽  
Nadim Atallah ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Center ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Diabetic Patients

Background: Diabetes Mellitus is a chronic metabolic disease that affects 387 million people around the world. Episodes of hyperglycemia in hospitalized diabetic patients are associated with poor clinical outcomes and increased morbidity and mortality. Therefore, prevention of hyperglycemia is critical to decrease the length of hospital stay and to reduce complications and readmissions. Objective: The study aims to examine the prevalence of hyperglycemia and assess the correlates and management of hyperglycemia in diabetic non-critically ill patients. Methods: The study was conducted on the medical wards of a tertiary care teaching hospital in Lebanon. A retrospective chart review was conducted from January 2014 until September 2015. Diabetic patients admitted to Internal Medicine floors were identified. Descriptive analysis was first carried out, followed by a multivariable analysis to study the correlates of hyperglycemia occurrence. Results: A total of 235 medical charts were reviewed. Seventy percent of participants suffered from hyperglycemia during their hospital stay. The identified significant positive correlates for inpatient hyperglycemia, were the use of insulin sliding scale alone (OR=16.438 ± 6.765-39.941, p=0.001) and the low frequency of glucose monitoring. Measuring glucose every 8 hours (OR= 3.583 ± 1.506-8.524, p=0.004) and/or every 12 hours (OR=7.647 ± 0.704-79.231, p=0.0095) was associated with hyperglycemia. The major factor perceived by nurses as a barrier to successful hyperglycemia management was the lack of knowledge about appropriate insulin use (87.5%). Conclusion: Considerable mismanagement of hyperglycemia in diabetic non-critically ill patients exists; indicating a compelling need for the development and implementation of protocol-driven insulin order forms a comprehensive education plan on the appropriate use of insulin.

scholarly journals Why do pregnant women prefer cesarean birth? A qualitative study in a tertiary care center in Southern Thailand

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chitkasaem Suwanrath ◽  
Sopen Chunuan ◽  
Phawat Matemanosak ◽  
Sutham Pinjaroen
Keyword(s):  
Qualitative Study ◽  
Pregnant Women ◽  
Risk Perceptions ◽  
Care Center ◽  
Tertiary Care ◽  
Cesarean Birth ◽  
Positive Attitudes ◽  
Cesarean Births ◽  
Medical Indications ◽  
Superstitious Beliefs

Abstract Background Increasing worldwide rates of cesarean section are of global concern. In recent years, cesarean births upon maternal request have become a hotly debated issue. Hence, this study aimed to explore maternal reasons for cesarean preference without medical indications. Methods A descriptive qualitative study was conducted, using in-depth interviews with 27 pregnant women who preferred cesarean birth, attending antenatal care in Songklanagarind Hospital from September 2018 to June 2019. Data were analyzed using content analysis. Results Maternal reasons for cesarean preference were classified into six main categories: fear of childbirth, safety concerns related to health risk perceptions, negative previous birth experiences, positive attitudes toward cesarean birth, access to biased information and superstitious beliefs in auspicious birth dates. Most women had more than one reason for opting cesarean birth. Conclusion Several reasons for cesarean birth preference have been elucidated. One striking reason was superstitious beliefs in auspicious birth dates, which are challengable for obstetricians to deal with. Obstetricians should explore the exact reasons why women request cesarean birth in order to prevent or diminish unnecessary cesarean births.

scholarly journals Prevalence and risk factors of anemia among pregnant women attending a high-volume tertiary care center for delivery

2015 ◽  
Vol 16 (4) ◽  
pp. 231-236 ◽  
Author(s):  
Cuneyt Eftal Taner ◽  
Atalay Ekin ◽  
Ulas Solmaz ◽  
Cenk Gezer ◽  
Birgul Cetin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Care Center ◽  
Tertiary Care ◽  
High Volume ◽  
Tertiary Care Center

scholarly journals Maternal Attitude and Knowledge towards Modes of Delivery

2018 ◽  
Vol 16 (2) ◽  
pp. 209-214
Author(s):  
Anshumala Joshi ◽  
Meeta Thapa ◽  
Om Biju Panta
Keyword(s):  
Pregnant Women ◽  
Vaginal Delivery ◽  
Caesarean Delivery ◽  
Care Center ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
College Teaching ◽  
Cross Sectional ◽  
Medical College ◽  
Acceptable Method

Background: Whether a mother should be allowed to choose between the modes of delivery is a matter of concern among practicing obstetricians. This study aims to explore the knowledge of the Nepalese women attending a tertiary care center about the benefits and complications of vaginal and caesarean delivery and their attitude and preference for the method of delivery.Methods: The study was a hospital based cross sectional questionnaire survey conducted in Nepal Medical College teaching Hospital, Jorpati from 1stShrawan 2074 to 31st Ashoj 2074. All pregnant women who were 36 weeks or more in gestation attending the clinic during the study period were included in the study. A questionnaire was made of 10 questions for knowledge assessment regarding mode of delivery consisting of the indications, the possible complications and advantages of vaginal and caesarean delivery. Results: A total of 256 pregnant women participated in the study. The knowledge of the mode of delivery, their benefit and complications was medium to good in approximately 90% of the mothers attending the antenatal OPD. Overall attitude for vaginal delivery was positive in 93% of women and negative or neutral in 6.6%.Overall attitude for caesarean delivery was positive in 24% and negative or neutral in 75.8%.Conclusions: Women in our setup agree that vaginal delivery is a natural and acceptable method of delivery and would prefer to have a vaginal delivery. Keywords: Attitude; knowledge; modes of delivery; women.

scholarly journals Knowledge and Acceptance of Labour Analgesia in Pregnant Women

2018 ◽  
Vol 16 (3) ◽  
pp. 302-306 ◽  
Author(s):  
Mona Sharma ◽  
Saurya Dhungel ◽  
Sujata Niroula ◽  
Manan Karki
Keyword(s):  
Pregnant Women ◽  
Low Income ◽  
Care Center ◽  
Tertiary Care ◽  
College Teaching ◽  
Cross Sectional Study ◽  
Acceptance Rate ◽  
Labour Analgesia ◽  
Low Income Countries ◽  
Cross Sectional

Background: Labour analgesia, though practiced worldwide, is not very popular in low-income countries. The aim of the study was to assess the awareness, attitude, acceptance, and reasons for hindrance of labour analgesia among patients visiting a tertiary care center in the capital cityMethods: It was a cross sectional study conducted in Obstetrics and Gynecology outpatient department of Kathmandu Medical College Teaching Hospital in the month of August 2017. All pregnant patients presenting for antenatal checkup was included. Data was collected based on a questionnaire after informed consent. Statistical analysis was done in SPSS version 20 and results were expressed in frequencies and percentage.Results: Total of 270 pregnant women participated in the study. Out of these forty-four (16.3%) patients were aware about labour analgesia. The acceptance rate was high (72.2%). Majority (84.6%) had no problem with expenditure associated with labour analgesia.Conclusions: Despite low awareness about painless delivery among the antenatal women, the acceptance rate is high.

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