scholarly journals Guidelines and practice recommendations on Obstetric care of pregnant patients with Covid-19 infection: Scoping review.

2020 ◽  
Author(s):  
Wondimu Gudu Jeldu ◽  
Lemi Belay Tolu
Keyword(s):  
Pregnant Women ◽  
Organ Failure ◽  
Scoping Review ◽  
Case Reports ◽  
Obstetric Care ◽  
Professional Associations ◽  
Growth Monitoring ◽  
Practice Recommendations ◽  
Expert Opinions ◽  
Consensus Statements

Abstract Introduction: The Management of pregnant women with Covid-19 infection is usually based on limited evidence from care reports and expert opinions. The aim of this scoping review is to identify available guidelines and practice recommendations on obstetric care of pregnant women with COVID-19.Methods: We searched guideline databases and websites of professional associations and international organizations working on sexual and reproductive health. We looked for guidelines, protocols, consensus statements and practice recommendations on management of pregnant women with COVID-19. Additionally, we searched: MEDLINE, EMBASE and Google Scholar. Data extraction was done by two independent reviewers using a customized tool that was developed to record the key information of the source that’s relevant to the review question.Results: The antenatal care for covid-19 positive mothers should be delayed until they test negative twice. Anatomic scanning may be considered in women who had the infection in the first trimester. Growth monitoring is recommended every 2-4wks. Antenatal corticosteroids can be administered in those women with preterm pregnancy (<34 wks) and mild illness. Low dose Aspirin can be continued safely. Tocolytics, particularly NSAIDs should be used cautiously. Covid-19 infection is not an indication for delivery. Termination is recommended in those with organ failure and in pts with severe respiratory failure. A single, asymptomatic or screen negative birth partner be permitted to stay with the woman. Continuous electronic fetal monitoring in labor is recommended. Cesarean delivery only in those with severe respiratory distress on ventilators & organ failure. Shortening of the second stage is considered in Covid-19 parturients who are on face masks. There are no consistent recommendations on immediate cord clamping and options of breast feeding. Universal isolation of mother from the neonate is not a standard of practice. Postpartum care can be provided with telemedicine.Conclusions: Obstetric care provision for Covid-19 infected mothers is primarily based on limited experience from case reports and expert opinions. Updated guidance for clinical practice are imperative as new scientific evidence emerges.

scholarly journals MANAGEMENT OF ENDOCRINE DISEASE: Fertility, pregnancy and lactation in women with adrenal insufficiency

2018 ◽  
Vol 178 (2) ◽  
pp. R45-R53 ◽  
Author(s):  
Gurpreet Anand ◽  
Felix Beuschlein
Keyword(s):  
Pregnant Women ◽  
Adrenal Insufficiency ◽  
Case Reports ◽  
Obstetric Care ◽  
Normal Pregnancy ◽  
Clinical Situation ◽  
Adrenal Crisis ◽  
Substitution Therapy ◽  
Fetal Outcomes ◽  
Pregnancy And Lactation

With the introduction of hormonal substitution therapy in the 1950s, adrenal insufficiency (AI) has been turned into a manageable disease in pregnant women. In fact, in the light of glucocorticoid replacement therapy and improved obstetric care, it is realistic to expect good maternal and fetal outcomes in patients with AI. However, there are still a number of challenges such as establishing the diagnosis of AI in pregnant women and optimizing the treatment of AI and related comorbidities prior to as well as during pregnancy. Clinical and biochemical diagnoses of a new-onset AI may be challenging because of overlapping symptoms of normal pregnancy as well as pregnancy-induced changes in cortisol values. Physiological changes occurring during pregnancy should be taken into account while adjusting the substitution therapy. The high proportion of reported adrenal crisis in pregnant women with AI highlights persistent problems in this particular clinical situation. Due to the rarity of the disease, there is no prospective data-guiding management of pregnancy in patients with known AI. The aim of this review is to summarize the maternal and fetal outcomes based on recently published case reports in patients with AI and to suggest a practical approach to diagnose and manage AI in pregnancy.

scholarly journals Guidelines and best practice recommendations on contraception and safe abortion care service provision amid COVID-19 pandemic: Scoping review.

2020 ◽  
Author(s):  
Lemi Belay Tolu ◽  
Garumma Tolu Feyissa
Keyword(s):  
Reproductive Health ◽  
Scoping Review ◽  
Service Provision ◽  
Care Service ◽  
Data Extraction ◽  
Assessment Tools ◽  
Safe Abortion ◽  
Practice Recommendations ◽  
Abortion Care ◽  
Consensus Statements

Abstract Introduction: During pandemics there is uncertainty and information overload. Policy makers and health professionals prefer to use summarized evidence of practice recommendations. The aim of this scoping review is therefore to identify available best guidelines, consensus statements, standard of practice and practice recommendations on contraception and safe abortion care service provision during the COVID-19 pandemics.Methods: We searched guideline databases and websites of professional associations and international organizations working on sexual and reproductive health to locate guidelines, protocols, consensus statements and practice recommendations on sexual reproductive health services (SRH) during COVID-19 pandemics. Additionally, we searched: MEDLINE, EMBASE and Google Scholar. We included English records labelled guideline, or recommendation, or consensus, or practice parameter, or position papers on contraception and safe abortion care service practice during the COVID-19 pandemics. Data extraction was done by two independent reviewers using a customized tool that was developed to record the key information of the source that’s relevant to the review question. The difference between the two authors on data extraction was resolved by discussion.Results: Eleven records on safe abortion care and nine records on contraception service were identified. Identified recommendations were categorized into thematic areas. The records addressed approaches to the safe medication and surgical abortion, self-serving family planning and long term and reversible contraception. We haven’t employed any of the quality assessment tools as the pandemic is new clinical entity and evidences are based on expert opinion and limited clinical evidence.Conclusions: Consensus statements and recommendations consistently stated that there should be access to contraception service and safe abortion care during the COVID-19 pandemics with the concerted effort of service re-organization. The practice recommendations focus on innovative ways of service provision to minimize patient and staff exposure to COVID-19 as well as alleviate the burden on the health care system. These include utilizing telemedicine or digital health and community/home-based care or self-care.

scholarly journals A scoping review of worldwide studies evaluating the effects of prehospital time on trauma outcomes

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Alexander F. Bedard ◽  
Lina V. Mata ◽  
Chelsea Dymond ◽  
Fabio Moreira ◽  
Julia Dixon ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Organ Failure ◽  
Scoping Review ◽  
Case Reports ◽  
Prehospital Care ◽  
Morbidity And Mortality ◽  
Main Body ◽  
Trauma Outcomes ◽  
Trauma Registries ◽  
Prehospital Time

Abstract Background Annually, over 1 billion people sustain traumatic injuries, resulting in over 900,000 deaths in Africa and 6 million deaths globally. Timely response, intervention, and transportation in the prehospital setting reduce morbidity and mortality of trauma victims. Our objective was to describe the existing literature evaluating trauma morbidity and mortality outcomes as a function of prehospital care time to identify gaps in literature and inform future investigation. Main body We performed a scoping review of published literature in MEDLINE. Results were limited to English language publications from 2009 to 2020. Included articles reported trauma outcomes and prehospital time. We excluded case reports, reviews, systematic reviews, meta-analyses, comments, editorials, letters, and conference proceedings. In total, 808 articles were identified for title and abstract review. Of those, 96 articles met all inclusion criteria and were fully reviewed. Higher quality studies used data derived from trauma registries. There was a paucity of literature from studies in low- and middle-income countries (LMIC), with only 3 (3%) of articles explicitly including African populations. Mortality was an outcome measure in 93% of articles, predominantly defined as “in-hospital mortality” as opposed to mortality within a specified time frame. Prehospital time was most commonly assessed as crude time from EMS dispatch to arrival at a tertiary trauma center. Few studies evaluated physiologic morbidity outcomes such as multi-organ failure. Conclusion The existing literature disproportionately represents high-income settings and most commonly assessed in-hospital mortality as a function of crude prehospital time. Future studies should focus on how specific prehospital intervals impact morbidity outcomes (e.g., organ failure) and mortality at earlier time points (e.g., 3 or 7 days) to better reflect the effect of early prehospital resuscitation and transport. Trauma registries may be a tool to facilitate such research and may promote higher quality investigations in Africa and LMICs.

Clinical case of periostitis in pregnant women complicated by sepsis

2020 ◽  
pp. 61-63
Author(s):  
S. Sh. Kakvaeva ◽  
M. A. Magomedova ◽  
A. N. Dzhalilova
Keyword(s):  
Pregnant Woman ◽  
Multiple Organ Failure ◽  
Pregnant Women ◽  
Organ Failure ◽  
Clinical Case ◽  
Clinical Observation ◽  
Infectious Agent ◽  
Modern Medicine ◽  
Multiple Organ ◽  
Number Of Patients

One of the most serious problems of modern medicine is sepsis. The number of patients undergoing this complication is 20–30 million (WHO) annually and has no tendency to decrease. Sepsis is characterized by severe multiple organ failure due to a violation of the response of the macroorganism to an infectious agent. Moreover, it is dangerous with high mortality. Sepsis often develops in patients with immunodeficiency conditions, which primarily include pregnant women. The article presents a clinical observation of a case of periostitis in a pregnant woman complicated by a septic state.

Creativity as a Resource for the Development of a Service Enterprise (Through the Example of Event Agencies)

2020 ◽  
Vol 26 (9) ◽  
pp. 957-968
Author(s):  
K. I. Derevyanko ◽  
V. P. Orlovskaya
Keyword(s):  
Scientific Information ◽  
Professional Associations ◽  
Assessment Model ◽  
Professional Activity ◽  
Special Role ◽  
Economic Knowledge ◽  
Creative Activity ◽  
Practical Solution ◽  
Expert Opinions ◽  
Theoretical Conceptualization

Aim. The presented study aims to conduct a comprehensive phenomenological analysis of creativity as a resource for the development of a service enterprise through the example of the creative activity of event agencies. Tasks. The authors examine the phenomenon of creativity and develop a theoretical framework for considering creativity as a resource for the development of a service enterprise through the example of event agencies; identify the indicators of creativity of a service enterprise; develop a scale of creativity of event agencies operating in the modern services market. Methodology. The theoretical and methodological basis of this study includes the works of Russian and foreign scientists and experts in the field of creativity and its use as a resource for the development of service enterprises. The authors use the phenomenological method (to examine the phenomenon of creativity as a whole), comparative (comparison of approaches, ideas, and experience of different countries in the field of creative activity), hermeneutical (interpretation of various aspects related to the analysis of creativity), and systems analysis. To examine the indicators of creativity of event agencies, this study uses quantitative and qualitative analysis of information materials published on the official websites of the examined cities, convention and event agencies, statistics of professional associations of congress and exhibition organizations, including the International Congress and Convention Association (ICCA), as well as other analytical reports, expert opinions, and applied research on the topic. The study analyzes statistics on the number and themes of events held in each city, event infrastructure, the range of provided services, and the level of service. The cities are then comparatively analyzed based on the results of examination of each city, and general conclusions are formulated. Results. The main problem addressed by this study is associated with the concept of “creativity”, its content, degree, limits, and risks. The scientific novelty of the study is predicated upon the insufficient investigation of the problem of creativity as a resource for the development of a service enterprise. This study is one of the first attempts to develop a methodology for comprehensively analyzing the phenomenon of creativity with regard to event agencies. The results obtained during the study are vital for the theoretical conceptualization and practical solution of the problem of creativity in the context of economic knowledge: the key indicators of creativity of an event agency are identified and a creativity assessment model is developed based on the range of possible manifestations of creativity in the professional activity of event agencies. Creativity is analyzed as a resource for the development of a service enterprise through the example of the activity of event agencies. Eight indicators of creativity of an event agency are identified and an assessment scale is developed. The creativity indicators include “fluency”, “flexibility”, “originality”, “elaboration and synthesis”, “redirection”, “redefinition”, “reinitiation”, and “generation”. These eight indicators are incorporated into a creativity scale based on the Likert scale, which makes it possible to assess the degree (level) of creativity of an event agency on a scale of one to ten. As a result, the following problems are solved: the essence of the concept of “creativity” is determined and its main features are identified by analyzing the specific aspects of the modern MICE industry landscape. Scientific information on the topic is analyzed, systematized, and generalized. Russian and foreign experience of using creativity as a resource for the development of a service enterprise is comparatively analyzed. Conclusions. The special role of creativity as a resource for the development of an event agency is revealed, and the indicators of the agency’s creativity are formulated. A creativity scale is developed. The correlation between the competitiveness of a service enterprise and the use of the creative resource in its development is determined. This study is one of the first attempts to develop a methodology for comprehensively analyzing the phenomenon of creativity with regard to event agencies. The results of the study are important for the theoretical conceptualization and practical solution of the problem of creativity in the context of economic knowledge.

scholarly journals Haemostatic and thrombo-embolic complications in pregnant women with COVID-19: a systematic review and critical analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Juliette Servante ◽  
Gill Swallow ◽  
Jim G. Thornton ◽  
Bethan Myers ◽  
Sandhya Munireddy ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Pregnant Women ◽  
Clinical Evidence ◽  
Case Reports ◽  
Standard Form ◽  
Test Results ◽  
Maternal Deaths ◽  
High Clinical Suspicion ◽  
Increased Risk ◽  
Definition Of

Abstract Background As pregnancy is a physiological prothrombotic state, pregnant women may be at increased risk of developing coagulopathic and/or thromboembolic complications associated with COVID-19. Methods Two biomedical databases were searched between September 2019 and June 2020 for case reports and series of pregnant women with a diagnosis of COVID-19 based either on a positive swab or high clinical suspicion where no swab had been performed. Additional registry cases known to the authors were included. Steps were taken to minimise duplicate patients. Information on coagulopathy based on abnormal coagulation test results or clinical evidence of disseminated intravascular coagulation (DIC), and on arterial or venous thrombosis, were extracted using a standard form. If available, detailed laboratory results and information on maternal outcomes were analysed. Results One thousand sixty-three women met the inclusion criteria, of which three (0.28, 95% CI 0.0 to 0.6) had arterial and/or venous thrombosis, seven (0.66, 95% CI 0.17 to 1.1) had DIC, and a further three (0.28, 95% CI 0.0 to 0.6) had coagulopathy without meeting the definition of DIC. Five hundred and thirty-seven women (56%) had been reported as having given birth and 426 (40%) as having an ongoing pregnancy. There were 17 (1.6, 95% CI 0.85 to 2.3) maternal deaths in which DIC was reported as a factor in two. Conclusions Our data suggests that coagulopathy and thromboembolism are both increased in pregnancies affected by COVID-19. Detection of the former may be useful in the identification of women at risk of deterioration.

scholarly journals Opioid-Induced Respiratory Depression in Pediatric Palliative Care Patients with Severe Neurological Impairment—A Scoping Literature Review and Case Reports

Children ◽  
2020 ◽  
Vol 7 (12) ◽  
pp. 312
Author(s):  
Maximilian David Mauritz ◽  
Carola Hasan ◽  
Larissa Alice Dreier ◽  
Pia Schmidt ◽  
Boris Zernikow
Keyword(s):  
Risk Factors ◽  
Palliative Care ◽  
Young Adults ◽  
Scoping Review ◽  
Pediatric Patients ◽  
Case Reports ◽  
Neurological Impairment ◽  
Opioid Therapy ◽  
Pediatric Palliative Care ◽  
Severe Neurological Impairment

Pediatric Palliative Care (PPC) addresses children, adolescents, and young adults with a broad spectrum of underlying diseases. A substantial proportion of these patients have irreversible conditions accompanied by Severe Neurological Impairment (SNI). For the treatment of pain and dyspnea, strong opioids are widely used in PPC. Nonetheless, there is considerable uncertainty regarding the opioid-related side effects in pediatric patients with SNI, particularly concerning Opioid-Induced Respiratory Depression (OIRD). Research on pain and OIRD in pediatric patients with SNI is limited. Using scoping review methodology, we performed a systematic literature search for OIRD in pediatric patients with SNI. Out of n = 521 identified articles, n = 6 studies were included in the review. Most studies examined the effects of short-term intravenous opioid therapy. The incidence of OIRD varied between 0.13% and 4.6%; besides SNI, comorbidities, and polypharmacy were the most relevant risk factors. Additionally, three clinical cases of OIRD in PPC patients receiving oral or transdermal opioids are presented and discussed. The case reports indicate that the risk factors identified in the scoping review also apply to adolescents and young adults with SNI receiving low-dose oral or transdermal opioid therapy. However, the risk of OIRD should never be a barrier to adequate symptom relief. We recommend careful consideration and systematic observation of opioid therapy in this population of patients.

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