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Annals of Internal Medicine Dec 2020Maternal mortality and severe maternal morbidity are critical health issues in the United States, with unacceptably high rates and racial, ethnic, and geographic... (Review)
Review
Maternal mortality and severe maternal morbidity are critical health issues in the United States, with unacceptably high rates and racial, ethnic, and geographic disparities. Various factors contribute to these adverse maternal health outcomes, ranging from patient-level to health system-level factors. Furthermore, a majority of pregnancy-related deaths are preventable. This review briefly describes the epidemiology of maternal mortality and severe maternal morbidity in the United States and discusses selected initiatives to reduce maternal mortality and severe maternal morbidity in the areas of data and surveillance; clinical workforce training and patient education; telehealth; comprehensive models and strategies; and clinical guidelines, protocols, and bundles. Related Health Resources and Services Administration initiatives are also described.
Topics: Female; Humans; Maternal Health; Maternal Mortality; Patient Education as Topic; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications; Telemedicine
PubMed: 33253021
DOI: 10.7326/M19-3258 -
Frontiers in Immunology 2020Acute chorioamnionitis is characterized by neutrophilic infiltration and inflammation at the maternal fetal interface. It is a relatively common complication of... (Review)
Review
Acute chorioamnionitis is characterized by neutrophilic infiltration and inflammation at the maternal fetal interface. It is a relatively common complication of pregnancy and can have devastating consequences including preterm labor, maternal infections, fetal infection/inflammation, fetal lung, brain, and gastrointestinal tract injury. In this review, we will discuss current understanding of the pathogenesis, immunobiology, and mechanisms of this condition. Most commonly, acute chorioamnionitis is a result of ascending infection with relatively low-virulence organisms such as the Ureaplasma species. Furthermore, recent vaginal microbiome studies suggest that there is a link between vaginal dysbiosis, vaginal inflammation, and ascending infection. Although less common, microorganisms invading the maternal-fetal interface via hematogenous route (e.g., Zika virus, Cytomegalovirus, and Listeria) can cause placental villitis and severe fetal inflammation and injury. We will provide an overview of the knowledge gleaned from different animal models of acute chorioamnionitis and the role of different immune cells in different maternal-fetal compartments. Lastly, we will discuss how infectious agents can break the maternal tolerance of fetal allograft during pregnancy and highlight the novel future therapeutic approaches.
Topics: Animals; Chorioamnionitis; Dysbiosis; Female; Humans; Infections; Microbiota; Pregnancy; Pregnancy Complications, Infectious; Vagina
PubMed: 32373122
DOI: 10.3389/fimmu.2020.00649 -
Ugeskrift For Laeger Mar 2021Depression is common in pregnant women and is often not treated. It can have major consequences for both mother and child. It is associated with several complications,... (Review)
Review
Depression is common in pregnant women and is often not treated. It can have major consequences for both mother and child. It is associated with several complications, including miscarriages, vaginal bleeding and preterm birth. It is important, that healthcare professionals, who have contact with pregnant women, have knowledge about dealing with pregnant women with depression and its symptoms, as a large proportion of these depressions continue post-partum. In this review, we describe the aetiology, assessment, potential complication, antenatal care and treatment of pregnant women with depression.
Topics: Abortion, Spontaneous; Child; Depression; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications; Premature Birth; Prenatal Care
PubMed: 33734070
DOI: No ID Found -
American Journal of Surgery Jan 2022The personal health and professional impact of physician pregnancy requires further study. We performed a comprehensive scoping review of physician pregnancy to... (Review)
Review
BACKGROUND
The personal health and professional impact of physician pregnancy requires further study. We performed a comprehensive scoping review of physician pregnancy to synthesize and assess the evidence to aid decision-making for relevant stakeholders.
METHODS
A search of 7 databases resulted in 3733 citations. 407 manuscripts were included and scored for evidence level. Data were extracted into themes using template analysis.
RESULTS
Physician pregnancy impacted colleagues through perceived increased workload and resulted in persistent stigmatization and discrimination despite work productivity and academic metrics being independent of pregnancy events. Maternity leave policies were inconsistent and largely unsatisfactory. Women physicians incurred occupational hazard risk and had high rates of childbearing delay, abortion, and fertility treatment; obstetric and fetal complication rates compared to controls are conflicting.
CONCLUSIONS
Comprehensive literature review found that physician pregnancy impacts colleagues, elicits negative perceptions of productivity, and is inadequately addressed by current parental leave policies. Data are poor and insufficient to definitively determine the impact of physician pregnancy on maternal and fetal health. Prospective risk-matched observational studies of physician pregnancy should be pursued.
Topics: Efficiency; Female; Humans; Parental Leave; Physicians, Women; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Surveys and Questionnaires
PubMed: 34315575
DOI: 10.1016/j.amjsurg.2021.07.011 -
Obstetrics and Gynecology Clinics of... Mar 2021Pregnancy confers a substantially increased risk of stroke, especially during the third trimester and until 6 weeks postpartum. Hypertensive disorders of pregnancy and... (Review)
Review
Pregnancy confers a substantially increased risk of stroke, especially during the third trimester and until 6 weeks postpartum. Hypertensive disorders of pregnancy and gestational hypercoagulability are important contributors to obstetric stroke. Preeclampsia and eclampsia confer risk for future cardiovascular disease. Hemorrhagic stroke is the most common type of obstetric stroke. Ischemic stroke can result from cardiomyopathy, paradoxical embolism, posterior reversible encephalopathy, reversible cerebral vasoconstriction syndrome, and dissections. Cerebral venous sinus thrombosis is a frequent complication of pregnancy.
Topics: Aspirin; Brain Diseases; Cardiomyopathies; Cesarean Section; Eclampsia; Embolism, Paradoxical; Female; Hemorrhagic Stroke; Humans; Hypertension, Pregnancy-Induced; Intracranial Thrombosis; Ischemic Stroke; Platelet Aggregation Inhibitors; Postpartum Period; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Cardiovascular; Risk Factors; Stroke
PubMed: 33573791
DOI: 10.1016/j.ogc.2020.11.004 -
Clinical Medicine (London, England) Sep 2021Liver disease in pregnancy can be related to a pre-existing condition (such as autoimmune liver disease) or arise as a consequence of pregnancy. In women with...
Liver disease in pregnancy can be related to a pre-existing condition (such as autoimmune liver disease) or arise as a consequence of pregnancy. In women with pre-existing disease, pre-pregnancy counselling is important to discuss the potential complications that may occur during pregnancy and how best to manage these. Acute fatty liver of pregnancy and HELLP (haemolysis, elevated liver enzymes and low platelets) syndrome are pregnancy-related liver diseases and are considered obstetric emergencies. Women with liver dysfunction need appropriate investigations, including blood tests and imaging. They should be managed as part of a multidisciplinary team with obstetricians, obstetric anaesthetists, specialist midwives, gastroenterologists and obstetric physicians.
Topics: Female; HELLP Syndrome; Humans; Liver; Liver Diseases; Pregnancy; Pregnancy Complications
PubMed: 34507927
DOI: 10.7861/clinmed.2021-0497 -
Clinical Medicine (London, England) Dec 2016The prevalence of medical problems in pregnancy is increasing because of a complex interplay between demographic and lifestyle factors, and developments in modern... (Review)
Review
The prevalence of medical problems in pregnancy is increasing because of a complex interplay between demographic and lifestyle factors, and developments in modern medicine. Maternal mortality and morbidity resulting from treatable medical conditions, such as venous thromboembolism, epilepsy and autoimmune disease, have not decreased in recent years. This is despite a marked decrease in overall maternal mortality. It is vital that all physicians acquire a basic knowledge and understanding of medical problems in pregnancy. This includes prepregnancy measures such as counselling and optimisation of medical therapy, as well as multidisciplinary management throughout pregnancy and the postpartum period. Prompt recognition and treatment of acute and chronic illness is of clear benefit, and most drugs and many radiological investigations may be used in pregnancy.
Topics: Epilepsy; Female; Headache; Humans; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Venous Thromboembolism
PubMed: 27956450
DOI: 10.7861/clinmedicine.16-6-s110 -
Skin Therapy Letter 2014The pregnancy-specific skin disorders are pruritic, inflammatory eruptions. The current classification by Ambros-Rudolph et al. includes four entities: pemphigoid...
The pregnancy-specific skin disorders are pruritic, inflammatory eruptions. The current classification by Ambros-Rudolph et al. includes four entities: pemphigoid gestationis (PG), polymorphic eruption of pregnancy (PEP), atopic eruption of pregnancy (AEP), and intrahepatic cholestasis of pregnancy (ICP). Although these disorders are all characterized by intense pruritus during pregnancy, they can be distinguished by timing, morphology, histopathology, treatment and potential for fetal complications. Diagnosis is made by clinical presentation, histology, and immunofluorescence. PEP and AEP typically resolve without sequelae; however, PG may lead to prematurity and low birth weight, and ICP is associated with an increased risk of prematurity, fetal distress, and intrauterine fetal demise. The potential for serious fetal complications necessitates a thorough evaluation of pregnancy-related pruritus. This article will discuss the skin disorders specific to pregnancy, with a focus on clinical presentation, potential for fetal complications, pathogenesis, diagnosis, and treatment.
Topics: Female; Fetal Diseases; Fluorescent Antibody Technique; Humans; Pregnancy; Pregnancy Complications; Pruritus; Skin Diseases
PubMed: 25405676
DOI: No ID Found -
Ugeskrift For Laeger Nov 2022Intrauterine growth restriction (IUGR) is a potential complication associated with maternal SARS-CoV-2 infection. Danish guidelines recommend ultrasound follow-up from...
Intrauterine growth restriction (IUGR) is a potential complication associated with maternal SARS-CoV-2 infection. Danish guidelines recommend ultrasound follow-up from gestational age (GA) 24+0 in SARS-CoV-2-positive pregnant women who experience reduced fetal movements. This is a case report of severe IUGR (-51%) after maternal infection at GA 22+1 in a healthy unvaccinated 28-year-old woman. Positive PCR-tests for SARS-CoV-2 from placenta and child, along with massive placental inflammatory findings, suggested IUGR caused by maternal infection. This implies that follow-up from earlier GA may be warranted.
Topics: Adult; Female; Humans; Infant, Newborn; Pregnancy; COVID-19; Fetal Growth Retardation; Mothers; Placenta; SARS-CoV-2; Pregnancy Complications, Infectious
PubMed: 36426816
DOI: No ID Found -
Expert Reviews in Molecular Medicine Jun 2022Pregnancy is a complex biological process. The establishment and maintenance of foetal-maternal interface are pivotal events. Decidual immune cells and inflammatory... (Review)
Review
Pregnancy is a complex biological process. The establishment and maintenance of foetal-maternal interface are pivotal events. Decidual immune cells and inflammatory cytokines play indispensable roles in the foetal-maternal interface. The disfunction of decidual immune cells leads to adverse pregnancy outcome. Tumour necrosis factor (TNF)-, a common inflammatory cytokine, has critical roles in different stages of normal pregnancy process. However, the relationship between the disorder of TNF- and adverse pregnancy outcomes, including preeclampsia (PE), intrauterine growth restriction (IUGR), spontaneous abortion (SA), preterm birth and so on, is still indefinite. In this review, we thoroughly reviewed the effect of TNF- disorder on pathological conditions. Moreover, we summarized the reports about the adverse pregnancy outcomes (PE, IUGR, SA and preterm birth) of using anti-TNF- drugs (infliximab, etanercept and adalimumab, certolizumab and golimumab) currently in the clinical studies. Overall, IUGR, SA and preterm birth are the most common adverse pregnancy outcomes of anti-TNF- drugs. Our review may provide insight for the immunological treatment of pregnancy-related complication, and help practitioners make informed decisions based on the current evidences.
Topics: Abortion, Spontaneous; Adalimumab; Cytokines; Female; Fetal Growth Retardation; Humans; Infant, Newborn; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Tumor Necrosis Factor Inhibitors; Tumor Necrosis Factor-alpha
PubMed: 35687009
DOI: 10.1017/erm.2022.18