Anesthesia-Related Factors Associated with Preterm Labor and Delivery after Open Fetal Surgery

2020 ◽  
pp. 1-8
Author(s):  
Titilopemi A.O. Aina ◽  
Huirong Zhu ◽  
Jonathan Kim ◽  
Kobby A. Wiafe ◽  
Ahmed A. Nassr ◽  
...  
Keyword(s):  
Preterm Delivery ◽  
Preterm Labor ◽  
Diastolic Pressure ◽  
Anesthetic Management ◽  
Fetal Surgery ◽  
In Utero ◽  
Labor And Delivery ◽  
Maternal Complications ◽  
Related Factors ◽  
Increased Risk

<b><i>Background:</i></b> Fetal surgery, such as for meningomyelocele repair, has a clear clinical fetal benefit. In patients who undergo in utero repair of meningomyelocele, for example, there is reduced long-term disease morbidity. However, despite the beneficial effects of early intervention, women who undergo fetal interventions have an increased risk of preterm labor and delivery. Several surgery-related factors have been described but no specific anesthesia-related factors. <b><i>Objective:</i></b> The aim of this study was to determine if any aspects of the perioperative anesthetic management influenced maternal complications following in utero surgery. <b><i>Methods:</i></b> This was a retrospective chart review of the anesthetic management of mothers and fetuses who presented for open and fetoscopic myelomeningocele repair, between 2011 and 2015, at Texas Children’s Fetal Center®. <b><i>Results:</i></b> Forty-six women underwent open or fetoscopic repair of neural tube defects at our institution. We found the maternal heart rate in the postoperative period to be associated with a higher likelihood of preterm labor, but not delivery. The odds of having preterm delivery was higher for nulliparous patients and those with lower intraoperative diastolic pressure. <b><i>Conclusions:</i></b> Our findings confirm what has been previously reported regarding the association of nulliparity with preterm delivery. Additionally, this study highlights the importance of maintaining stable perioperative hemodynamics during the intraoperative and postoperative phases of care for patients undergoing in utero surgery.

scholarly journals Minimally invasive fetal surgery for myelomeningocele: preliminary report from a single center

2019 ◽  
Vol 47 (4) ◽  
pp. E12 ◽  
Author(s):  
Giorgio Carrabba ◽  
Francesco Macchini ◽  
Isabella Fabietti ◽  
Luigi Schisano ◽  
Giulia Meccariello ◽  
...  
Keyword(s):  
Gestational Age ◽  
Fetal Surgery ◽  
Preoperative Assessment ◽  
In Utero ◽  
Maternal Complications ◽  
Preliminary Results ◽  
Neurological Outcomes ◽  
Csf Leakage ◽  
Hindbrain Herniation ◽  
The Mean

OBJECTIVERecent trials have shown the safety and benefits of fetoscopic treatment of myelomeningocele (MMC). The authors’ aim was to report their preliminary results of prenatal fetoscopic treatment of MMC using a biocellulose patch, focusing on neurological outcomes, fetal and maternal complications, neonatal CSF leakage, postnatal hydrocephalus, and radiological outcomes.METHODSPreoperative assessment included clinical examination, ultrasound imaging, and MRI of the fetus. Patients underwent purely fetoscopic in utero MMC repair, followed by postoperative in utero and postnatal MRI. All participants received multidisciplinary follow-up.RESULTSFive pregnant women carrying fetuses affected by MMC signed informed consent for the fetoscopic treatment of the defect. The mean MMC size was 30.4 mm (range 19–49 mm). Defect locations were L1 (2 cases), L5 (2 cases), and L4 (1 case). Hindbrain herniation and ventriculomegaly were documented in all cases. The mean gestational age at surgery was 28.2 weeks (range 27.8–28.8 weeks). Fetoscopic repair was performed in all cases. The mean gestational age at delivery was 33.9 weeks (range 29.3–37.4 weeks). After surgery, reversal of hindbrain herniation was documented in all cases. Three newborns developed signs of hydrocephalus requiring CSF diversion. Neurological outcomes in terms of motor level were favorable in all cases, but a premature newborn died due to CSF infection and sepsis.CONCLUSIONSThe authors’ preliminary results suggest that fetoscopic treatment of MMC is feasible, reproducible, and safe for mothers and their babies. Neurological outcomes were favorable and similar to those in the available literature. As known, prematurity was the greatest complication.

scholarly journals Interleukin-6 in Amniotic Fluid: A Reliable Marker for Adverse Outcomes in Women in Preterm Labor and Intact Membranes

2021 ◽  
pp. 1-8
Author(s):  
Alfredo Leaños-Miranda ◽  
Ana Graciela Nolasco-Leaños ◽  
Reyes Ismael Carrillo-Juárez ◽  
Carlos José Molina-Pérez ◽  
Irma Isordia-Salas ◽  
...  
Keyword(s):  
Amniotic Fluid ◽  
Preterm Delivery ◽  
Interleukin 6 ◽  
Preterm Labor ◽  
Adverse Outcomes ◽  
Morbidity And Mortality ◽  
Perinatal Morbidity ◽  
Increased Risk ◽  
Reliable Marker ◽  
Suitable Marker

<b><i>Introduction:</i></b> Amniotic fluid (AF) interleukin-6 (IL-6) concentration has been associated to preterm delivery and perinatal morbidity and mortality in women with preterm labor and intact membranes. Nevertheless, the clinical significance of this biomarker of intra-amniotic inflammation (IAI) is still unclear due in part to the paucity of large studies. <b><i>Methods:</i></b> AF IL-6 concentrations were determined in 452 consecutive women with preterm labor and intact membranes, categorized into 3 groups: 302 without IAI (IL-6 of &#x3c;2.6 ng/mL), 64 with mild IAI (IL-6 of 2.6–11.2 ng/mL), and 86 with severe IAI (IL-6 of ≥11.3 ng/mL). <b><i>Results:</i></b> The severe IAI group had a short pregnancy duration from amniocentesis to delivery (median 3 days) than in without IAI group (median 45 days); meanwhile, the mild IAI group had a latency that was intermediate to the severe and without IAI groups (median 9.5 days). As compared to women without IAI, women with mild and severe IAI had higher rates of preterm delivery at both &#x3c;34 and &#x3c;37 weeks of gestation and perinatal morbidity and mortality. Furthermore, the risk of various individual adverse outcomes (short latency from amniocentesis to delivery [at ≤3 days, ≤7 days, and ≤14 days], preterm delivery at both &#x3c;34 and &#x3c;37 weeks of gestation, histologic chorioamnionitis, respiratory distress syndrome, and congenital sepsis) was higher in women with severe IAI (OR ≥ 2.8), compared with women without IAI. <b><i>Conclusions:</i></b> AF IL-6 concentrations appear to be suitable marker to assess the degree of IAI and are associated with increased risk of adverse outcomes.

scholarly journals The relationship between lipid profiles in pregnancy and preterm delivery: a systematic review

2018 ◽  
Vol 5 (8) ◽  
pp. 2590-2609
Author(s):  
Zohreh Aghaie ◽  
Sepideh Hajian ◽  
Fatemeh Abdi
Keyword(s):  
Lipid Metabolism ◽  
Preterm Delivery ◽  
Early Pregnancy ◽  
Preterm Labor ◽  
Density Lipoprotein ◽  
Lipid Profiles ◽  
Lipid Levels ◽  
Increased Risk ◽  
The Relationship ◽  
In Pregnancy

Background: High-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride (TG), and total cholesterol (TC) are associated with maternal hormonal changes which can lead to pregnancy complications. High lipid levels during pregnancy may be accompanied by an increased risk of spontaneous preterm labor. The purpose of this review was to determine the relationship between lipid profiles in pregnancy and preterm delivery. Methods: A systematic search was performed in PubMed, EMBASE, Web of Science, Scopus, and Science Direct databases to find cross-sectional, case-control, and cohort studies on the associations between lipid profiles in pregnancy and preterm delivery. The search results were limited to papers published during 2000-2018. The quality of the selected studies was assessed based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Finally, a total of 25 eligible high-quality papers were reviewed. Results: A high maternal TG level in the first trimester of pregnancy was identified as a significant risk factor for preterm delivery. Low TG, HDL-cholesterol (HDL-C) and LDL-cholesterol (LDL-C) levels were uniquely associated with an increased risk of preterm delivery. High TC, TG, and LDL-C levels increased the risk of spontaneous preterm labor. A further association was found between high TG and TC levels and an elevated risk of preterm labor before 34 weeks of gestation. The risk of preterm labor before 34 weeks and during the 34th-37th weeks of gestation increased with increasing TG and TC levels. Moreover, overweight women who had a delivery before 34 weeks exhibited significant increases in TC and LDL concentrations during early pregnancy. Conclusion: Lipid metabolism undergoes complicated changes in pregnancy. Lipid levels (LDL, HDL, TC, and TG) above or below the normal range during pregnancy increase the risk of preterm delivery. Considering the significance of maternal lipid metabolism in the incidence of preterm delivery, lipid profile screening in early pregnancy can largely contribute to the prevention of preterm delivery. Further studies are warranted to meticulously examine the effects of lipid profile on preterm delivery.

scholarly journals Successful Treatment of Preterm Labor in Association with Acute COVID-19 Infection

2020 ◽  
Vol 37 (08) ◽  
pp. 866-868 ◽  
Author(s):  
Paul C. Browne ◽  
Jennifer B. Linfert ◽  
Emilio Perez-Jorge
Keyword(s):  
Case Report ◽  
Preterm Delivery ◽  
Successful Treatment ◽  
Preterm Labor ◽  
Standard Treatment ◽  
Increased Risk ◽  
Key Points ◽  
Novel Coronavirus

Novel coronavirus disease 2019 (COVID-19) infection occurring during pregnancy is associated with an increased risk of preterm delivery. This case report describes successful treatment of preterm labor during acute COVID-19 infection. Standard treatment for preterm labor may allow patients with acute COVID-19 infection to recover without the need for preterm delivery. Key Points

VTE risk assessment in cancer

2016 ◽  
Vol 07 (01) ◽  
pp. 20-25
Author(s):  
I. Pabinger ◽  
C. Ay
Keyword(s):  
Risk Assessment ◽  
Cancer Patients ◽  
Medical Oncology ◽  
Clinical Importance ◽  
Cancer Surgery ◽  
Ambulatory Setting ◽  
Oncology Patients ◽  
Related Factors ◽  
Risk Assessment Models ◽  
Increased Risk

SummaryVenous thromboembolism (VTE) in patients with cancer is associated with an increased morbidity and mortality, and its prevention is of major clinical importance. However, the VTE rates in the cancer population vary between 0.5% - 20%, depending on cancer-, treatment- and patient-related factors. The most important contributors to VTE risk are the tumor entity, stage and certain anticancer treatments. Cancer surgery represents a strong risk factor for VTE, and medical oncology patients are at increased risk of developing VTE, especially when receiving chemotherapy or immunomodulatory drugs. Also biomarkers have been investigated for their usefulness to predict risk of VTE (e.g. elevated leukocyte and platelet counts, soluble P-selectin, D-dimer, etc.). In order to identify cancer patients at high risk of VTE and to improve risk stratification, risk assessment models have been developed, which contain both clinical parameters and biomarkers. While primary thromboprophylaxis with lowmolecular- weight-heparin (LMWH) is recommended postoperatively for a period of up to 4 weeks after major cancer surgery, the evidence is less clear for medical oncology patients. Thromboprophylaxis in hospitalized medical oncology patients is advocated, and is based on results of randomized controlled trials which evaluated the efficacy and safety of LMWH for prevention of VTE in hospitalized medically ill patients. In recent trials the benefit of primary thromboprophylaxis in cancer patients receiving chemotherapy in the ambulatory setting has been investigated. However, at the present stage primary thromboprophylaxis for prevention of VTE in these patients is still a matter of debate and cannot be recommended for all cancer outpatients.

scholarly journals Association between confirmed congenital Zika infection at birth and outcomes up to 3 years of life

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Najeh Hcini ◽  
Yaovi Kugbe ◽  
Zo Hasina Linah Rafalimanana ◽  
Véronique Lambert ◽  
Meredith Mathieu ◽  
...  
Keyword(s):  
Neurological Impairment ◽  
In Utero ◽  
In Utero Exposure ◽  
Zikv Infection ◽  
Neurodevelopmental Delay ◽  
Systematic Testing ◽  
Brain Anomalies ◽  
Increased Risk ◽  
Structural Brain

AbstractLittle is known about the long-term neurological development of children diagnosed with congenital Zika infection at birth. Here, we report the imaging and clinical outcomes up to three years of life of a cohort of 129 children exposed to Zika virus in utero. Eighteen of them (14%) had a laboratory confirmed congenital Zika infection at birth. Infected neonates have a higher risk of adverse neonatal and early infantile outcomes (death, structural brain anomalies or neurologic symptoms) than those who tested negative: 8/18 (44%) vs 4/111 (4%), aRR 10.1 [3.5–29.0]. Neurological impairment, neurosensory alterations or delays in motor acquisition are more common in infants with a congenital Zika infection at birth: 6/15 (40%) vs 5/96 (5%), aRR 6.7 [2.2–20.0]. Finally, infected children also have an increased risk of subspecialty referral for suspected neurodevelopmental delay by three years of life: 7/11 (64%) vs 7/51 (14%), aRR 4.4 [1.9–10.1]. Infected infants without structural brain anomalies also appear to have an increased risk, although to a lesser extent, of neurological abnormalities. It seems paramount to offer systematic testing for congenital ZIKV infection in cases of in utero exposure and adapt counseling based on these results.

Association between Number of Prior Cesareans and Early Preterm Delivery in Women with Abnormal Placentation

2020 ◽  
Author(s):  
Ayamo Oben ◽  
Elizabeth B. Ausbeck ◽  
Melissa N. Gazi ◽  
Akila Subramaniam ◽  
Lorie M. Harper ◽  
...  
Keyword(s):  
Preterm Delivery ◽  
Preterm Labor ◽  
Placenta Previa ◽  
Secondary Analysis ◽  
Blood Products ◽  
Primary Analysis ◽  
Logistic Regression Models ◽  
Placenta Accreta Spectrum ◽  
Nicu Admission ◽  
Early Preterm Birth

Objective Delivery timing at 34 to 36 weeks is nationally recommended for pregnancies complicated by placenta accreta spectrum (PAS). However, it has recently been suggested that those with ≥2 prior cesarean deliveries (CD) and PAS should be delivered earlier than 34 weeks because of a higher risk of unscheduled delivery and complications. We sought to evaluate whether the number of prior CD in women with PAS is associated with early preterm delivery (PTD) (<34 weeks). We also evaluated the same relationship in women with placenta previa alone (without PAS). Study Design This is a secondary analysis of a multicenter and observational study that included women with prior CD (maternal–fetal medicine unit cesarean registry). Women with a diagnosis of PAS (regardless of placenta previa) were included for our primary analysis, and women with known placenta previa (without a component of PAS) were independently analyzed in a second analysis. Two groups of patients from the registry were studied: patients with PAS (regardless of placenta previa) and patients with placenta previa without PAS. The exposure of interest was the number of prior CD: ≥2 CD compared with <2 CD. The primary outcome was PTD <34 weeks. Secondary outcomes included preterm labor requiring hospitalization or tocolysis, transfusion of blood products, composites of maternal and neonatal morbidities, and NICU admission. Outcomes by prior CD number groups were compared in both cohorts. Backward selection was used to identify parsimonious logistic regression models. Results There were 194 women with PAS, 97 (50%) of whom had <2 prior CD and 97 (50%) of whom had ≥2 prior CD. The rate of PTD <34 weeks in women with ≥2 prior CD compared with <2 in the setting of PAS was 23.7 versus 29.9%, p = 0.27; preterm labor requiring hospitalization was 24.7 versus 13.5%; p = 0.05. The rates of plasma transfusion were increased with ≥2 prior CD (29.9 vs. 17.5%, p = 0.04), but there were no differences in transfusion of other products or in composite maternal or neonatal morbidities. After multivariable adjustments, having ≥2 CDs was not associated with PTD <34 weeks in women with PAS (adjusted odds ratio (aOR): 0.73, 95% confidence interval [CI]: 0.39–13.8) despite an association with preterm labor requiring hospitalization (aOR: 2.69; 95% CI: 1.15–6.32). In our second analysis, there were 687 women with placenta previa, 633 (92%) with <2 prior CD, and 54 (8%) with ≥2 prior CD. The rate of PTD <34 weeks with ≥2 CD in the setting of placenta previa was not significantly increased (27.8 vs. 22.1%, aOR: 1.49; 95% CI: 0.77–2.90, p = 0.08); the maternal composite outcome (aOR: 4.85; 95% CI: 2.43–9.67) and transfusion of blood products (aOR: 6.41; 95% CI: 2.30–17.82) were noted to be higher in the group with ≥2 prior CD. Conclusion Women with PAS who have had ≥2 prior CD as compared with women with <2 prior CD did not appear to have a higher risk of complications leading to delivery prior to 34 weeks. As such, considering the associated morbidity with early preterm birth, we would not recommend scheduled delivery prior to 34 weeks in this population. Key Points

scholarly journals Risk Factors for Disability Pension among Young Adults Diagnosed with Attention-deficit Hyperactivity Disorder (ADHD) in Adulthood

2021 ◽  
pp. 108705472110256
Author(s):  
Lingjing Chen ◽  
Ellenor Mittendorfer-Rutz ◽  
Emma Björkenstam ◽  
Syed Rahman ◽  
Klas Gustafsson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Disability Pension ◽  
Cox Regression ◽  
Related Factors ◽  
Adult Age ◽  
Work Related ◽  
Hyperactivity Disorder ◽  
Increased Risk ◽  
Similar Risk

Objective: To investigate risk factors of disability pension (DP) in young adults diagnosed with ADHD in Sweden. Method: In total, 9718 individuals diagnosed with incident ADHD in young adult age (19–29 years) 2006 to 2011, were identified through national registers. They were followed for 5 years and Cox regression models were applied to analyze the DP risk (overall and by sex), associated with socio-demographics, work-related factors, and comorbid disorders. Results: Twenty-one percent of all received DP. Being younger at diagnosis (hazard ratio [HR] = 1.54; 95%confidence interval [CI] 1.39–1.71); low educational level (HR = 1.97; 95%CI 1.60–2.43 for <10 years); work-related factors at baseline (no income from work [HR = 2.64; 95%CI 2.35–2.98] and sickness absence >90 days [HR = 2.48; 95%CI2.17–2.83]); and schizophrenia/psychoses (HR = 2.16; 95%CI 1.66–2.80), autism (HR = 1.87; 95%CI 1.42–2.46), anxiety (HR = 1.34; 95%CI 1.22–1.49) were significantly associated with an increased risk of DP. Similar risk patterns were found in men and women. Conclusion: Work-related factors and comorbid mental disorders need to be highlighted in early vocational rehabilitation for individuals with ADHD.

scholarly journals Iranian midwives’ attitudes and beliefs toward physiological childbirth: a cross-sectional study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Narges Sadeghzadeh ◽  
Leila Amiri-Farahani ◽  
Shima Haghani ◽  
Syedeh Batool Hasanpoor-Azghady
Keyword(s):  
Multiple Linear Regression Model ◽  
Cross Sectional Study ◽  
Attitudes And Beliefs ◽  
Labor And Delivery ◽  
Care Providers ◽  
Sectional Study ◽  
Related Factors ◽  
Cross Sectional ◽  
Significance Level ◽  
Physiological Childbirth

Abstract Background The significant role of midwives in providing labor and delivery care underscores the necessity of the identification of attitudes and beliefs of these groups of maternity care providers toward physiological childbirth. The purpose of the current study was to describe midwives’ attitudes and beliefs toward physiological childbirth and identify its related factors. Methods This cross-sectional study was carried out on 200 midwives working in the labor and delivery wards of selected hospitals in an urban area of Tehran, Iran, through the continuous sampling method from May to July 2018. The data were collected using a two-part demographic characteristic form and Midwives’ Attitudes and Beliefs Questionnaire-Revised toward physiological childbirth. Data analysis was performed in SPSS software (version 25). The significance level was set at P < 0.05. Results The mean score of midwives’ attitudes and beliefs toward physiological childbirth were 119.90 with a standard deviation of 9.30. Moreover, of the different domains of Midwives’ Attitudes and Beliefs Questionnaire-Revised, the women’s experience of birth (78.53) and the medical model conflict (51.05) obtained the highest and lowest scores, respectively. According to the multiple linear regression model analysis, the total mean score of midwives’ attitudes and beliefs toward physiological childbirth was significantly correlated with the level of education and interest in the profession (P < 0.05). Midwives with a master degree obtained higher scores (4.32) in terms of attitudes and beliefs toward physiologic childbirth, compared to those with an associate or bachelor degree. Also, there were 0.09 increases in the attitude and belief score of midwives per one score increase in their interest in the profession. It can be concluded that these two variables explained 16% of the variation in the scores of midwives’ attitudes and beliefs to physiological childbirth. Conclusion The results of this study showed that midwives with higher levels of education and more interest in their profession had more positive attitudes and beliefs toward physiological childbirth. Therefore, it is necessary to motivate midwives to obtain higher levels of education and increase their interest in the profession to promote physiological childbirth.

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