Cardiac Disease in Pregnancy

2018 ◽  
Vol 29 (3) ◽  
pp. 295-302 ◽  
Author(s):  
Stephanie Martin ◽  
Julie Arafeh
Keyword(s):  
Cardiac Disease ◽  
Management Strategy ◽  
Pregnant Patient ◽  
The United States ◽  
Patient Treatment ◽  
Physiological Changes ◽  
Mortality And Morbidity ◽  
Disease Management Strategy ◽  
Maternal Mortality And Morbidity ◽  
The Impact

In the United States, cardiac disease is a leading contributor to maternal mortality and morbidity. This review addresses the impact of cardiac disease on management of pregnancy and how the physiological changes of pregnancy complicate patient treatment. Approaches to assessing risk in pregnant women with cardiac disease are reviewed. Key elements of a successful disease management strategy are reviewed. Management of cardiac arrest in a pregnant patient is discussed.

Sepsis in obstetrics

2016 ◽  
Author(s):  
Nuala Lucas ◽  
Colleen D. Acosta ◽  
Marian Knight
Keyword(s):  
Pregnant Patient ◽  
Physiological Changes ◽  
Risk Of Infection ◽  
Surviving Sepsis Campaign ◽  
Fetal Demise ◽  
Major Morbidity ◽  
Mortality And Morbidity ◽  
Management Of Complications ◽  
Maternal Mortality And Morbidity ◽  
In Pregnancy

Sepsis in pregnancy and the puerperium remains a significant cause of maternal mortality and morbidity worldwide. Major morbidity arising as a result of obstetric sepsis includes fetal demise, organ failure, chronic pelvic inflammatory disease, chronic pelvic pain, bilateral tubal occlusion, and infertility. Sepsis may arise at any time during pregnancy and the puerperium. Prior to the advent of routine prophylactic antibiotics for caesarean delivery, endometritis used to be a major cause of postpartum infection. Diagnosis can be difficult as the physiological changes of pregnancy can overlap significantly with the pathophysiology of sepsis. The clinician must often rely on a high index of clinical suspicion rather than objective criteria. Women at risk of infection should be identified early in pregnancy. Management of the septic pregnant patient must encompass resuscitation, identification, and treatment of the source of sepsis and management of complications such as hypotension and tissue hypoxia. The Royal College of Obstetricians and Gynaecologists recommend that sepsis should be managed in accordance with the Surviving Sepsis Campaign guidelines. Anaesthetists have broad experience in all the elements required to care for a sick parturient and obstetric anaesthetists are key members of the team required to successfully manage these women.

scholarly journals 910. A Comprehensive, One Year, Hospital-Wide Snapshot of All Serious Infectious Complications in People Who Inject Drugs

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S489-S490
Author(s):  
John T Henderson ◽  
Evelyn Villacorta Cari ◽  
Nicole Leedy ◽  
Alice Thornton ◽  
Donna R Burgess ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
Vertebral Osteomyelitis ◽  
The United States ◽  
Infectious Complications ◽  
Data Set ◽  
Cumulative Impact ◽  
Mortality And Morbidity ◽  
Icu Admission ◽  
Risk Of Death ◽  
The Impact

Abstract Background There has been a dramatic rise in IV drug use (IVDU) and its associated mortality and morbidity, however, the scope of this effect has not been described. Kentucky is at the epicenter of this epidemic and is an ideal place to better understand the health complications of IVDU in order to improve outcomes. Methods All adult in-patient admissions to University of Kentucky hospitals in 2018 with an Infectious Diseases (ID) consult and an ICD 9/10 code associated with IVDU underwent thorough retrospective chart review. Demographic, descriptive, and outcome data were collected and analyzed by standard statistical analysis. Results 390 patients (467 visits) met study criteria. The top illicit substances used were methamphetamine (37.2%), heroin (38.2%), and cocaine (10.3%). While only 4.1% of tested patients were HIV+, 74.2% were HCV antibody positive. Endocarditis (41.1%), vertebral osteomyelitis (20.8%), bacteremia without endocarditis (14.1%), abscess (12.4%), and septic arthritis (10.4%) were the most common infectious complications. The in-patient death rate was 3.0%, and 32.2% of patients were readmitted within the study period. The average length of stay was 26 days. In multivariable analysis, infectious endocarditis was associated with a statistically significant increase in risk of death, ICU admission, and hospital readmission. Although not statistically significant, trends toward mortality and ICU admission were identified for patients with prior endocarditis and methadone was correlated with decreased risk of readmission and ICU stay. FIGURE 1: Reported Substances Used FIGURE 2: Comorbidities FIGURE 3: Types of Severe Infectious Complications Conclusion We report on a novel, comprehensive perspective on the serious infectious complications of IVDU in an attempt to measure its cumulative impact in an unbiased way. This preliminary analysis of a much larger dataset (2008-2019) reveals some sobering statistics about the impact of IVDU in the United States. While it confirms the well accepted mortality and morbidity associated with infective endocarditis and bacteremia, there is a significant unrecognized impact of other infectious etiologies. Additional analysis of this data set will be aimed at identifying key predictive factors in poor outcomes in hopes of mitigating them. Disclosures All Authors: No reported disclosures

scholarly journals Maternal Mortality and Morbidity in the United States: Where Are We Now?

2014 ◽  
Vol 23 (1) ◽  
pp. 3-9 ◽  
Author(s):  
Andreea A. Creanga ◽  
Cynthia J. Berg ◽  
Jean Y. Ko ◽  
Sherry L. Farr ◽  
Van T. Tong ◽  
...  
Keyword(s):  
United States ◽  
Maternal Mortality ◽  
The United States ◽  
Mortality And Morbidity ◽  
Maternal Mortality And Morbidity

scholarly journals Diverse local epidemics reveal the distinct effects of population density, demographics, climate, depletion of susceptibles, and intervention in the first wave of COVID-19 in the United States

2020 ◽  
Author(s):  
Niayesh Afshordi ◽  
Benjamin Holder ◽  
Mohammad Bahrami ◽  
Daniel Lichtblau
Keyword(s):  
United States ◽  
Population Density ◽  
The United States ◽  
Effective Response ◽  
Susceptible Population ◽  
Local Climate ◽  
Climate Conditions ◽  
Mortality And Morbidity ◽  
Social Distancing ◽  
The Impact

The SARS-CoV-2 pandemic has caused significant mortality and morbidity worldwide, sparing almost no community. As the disease will likely remain a threat for years to come, an understanding of the precise influences of human demographics and settlement, as well as the dynamic factors of climate, susceptible depletion, and intervention, on the spread of localized epidemics will be vital for mounting an effective response. We consider the entire set of local epidemics in the United States; a broad selection of demographic, population density, and climate factors; and local mobility data, tracking social distancing interventions, to determine the key factors driving the spread and containment of the virus. Assuming first a linear model for the rate of exponential growth (or decay) in cases/mortality, we find that population-weighted density, humidity, and median age dominate the dynamics of growth and decline, once interventions are accounted for. A focus on distinct metropolitan areas suggests that some locales benefited from the timing of a nearly simultaneous nationwide shutdown, and/or the regional climate conditions in mid-March; while others suffered significant outbreaks prior to intervention. Using a first-principles model of the infection spread, we then develop predictions for the impact of the relaxation of social distancing and local climate conditions. A few regions, where a significant fraction of the population was infected, show evidence that the epidemic has partially resolved via depletion of the susceptible population (i.e., “herd immunity”), while most regions in the United States remain overwhelmingly susceptible. These results will be important for optimal management of intervention strategies, which can be facilitated using our online dashboard.

Review of the Relationships Between Maternal Characteristics and Preterm Breastmilk Immune Components

2011 ◽  
Vol 14 (2) ◽  
pp. 207-216 ◽  
Author(s):  
Shelley Thibeau ◽  
Karen D’Apolito
Keyword(s):  
Preterm Infant ◽  
Necrotizing Enterocolitis ◽  
Nosocomial Infections ◽  
Infant Health ◽  
Immunoglobulin A ◽  
The United States ◽  
Term Infants ◽  
Mortality And Morbidity ◽  
Maternal Characteristics ◽  
The Impact

The immune properties of breastmilk are the most effective preventative means of reducing infant mortality through both passive and active immunity. Breastmilk for term infants has been linked to decreased incidence of respiratory and ear infections and gastrointestinal distress. This protection is even more important for the preterm infant. Prematurity is one of the leading causes of infant death in the United States. Hospitalized infant outcomes associated with consumption of breastmilk are shorter length of stay and decreased incidence of nosocomial infections and necrotizing enterocolitis (NEC). The presence of nosocomial infections and necrotizing enterocolitis increases risk of preterm mortality and morbidity as well as healthcare expenditures. However, breastmilk immunological components such as secretory immunoglobulin A, lactoferrin (LFT), and cytokines provide a framework of immunity that, in conjunction with nutritional support, significantly improves neonatal health. The relationship between maternal characteristics and breastmilk immune properties is central to further the understanding of the impact of breastmilk on preterm infant morbidity and mortality. The purpose of this article is to review the numerous immune components in breastmilk, the moderators of the immune components, and the relevance of these components to preterm/infant health. Exploration of the complexity of breastmilk immune components may direct future development of interventions to improve and sustain the immunological benefits of preterm breastmilk.

scholarly journals A study of pregnancy outcome in patients with cardiac disease

2018 ◽  
Vol 7 (12) ◽  
pp. 5111
Author(s):  
Pradnya D. Kamble ◽  
Amarjeet Kaur Bava
Keyword(s):  
Heart Disease ◽  
Cardiac Disease ◽  
Tertiary Care ◽  
Cardiac Complications ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Mortality And Morbidity ◽  
Lower Segment Caesarean Section ◽  
Maternal Mortality And Morbidity ◽  
Rheumatic Heart

Background: Cardiac disease is a leading cause of maternal mortality and morbidity. Timely diagnosis and appropriate management can significantly improve the maternal and perinatal outcome.Methods: This prospective observational study was performed over a period of 18 months at a tertiary care centre in Mumbai. A total of 100 women with heart disease were included in the study. The subjects were followed up during the antenatal, intrapartum and postpartum period to study the maternal and perinatal outcome.Results: Out of 14791 confinements 100 consenting patients were included in the study. The incidence of heart disease came out to 0.9%. Rheumatic heart disease (RHD) was seen more commonly as compared to congenital heart disease (CHD) and peripartum cardiomyopathy. 64% patients delivered vaginally out of which 8% had instrumental delivery and 28% underwent a lower segment caesarean section (LSCS). 21% patients had cardiac complications like pulmonary edema, arrhythmias, sepsis, DIC etc. and there were 3 maternal mortalities. 58% of the babies were born low birth weight, 90.9% of the babies had an Apgar score of >7. 60% of the babies were born at term whereas 26% had a preterm delivery.Conclusions: Patients of cardiac disease with pregnancy need to be managed at a tertiary care centre by a multidisciplinary team of doctors. Early diagnosis of heart disease and stringent management of complication is of utmost importance. Vaginal delivery is favourable and LSCS should be performed for an obstetric indication. Maternal heart disease leads to an increased incidence of preterm delivery and hence a joint care of neonatologist is mandatory in managing these patients.

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