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American Journal of Obstetrics and... Mar 2024Viscoelastic hemostatic assays are point-of-care devices that assess coagulation and fibrinolysis in whole blood samples. These technologies provide numeric and visual... (Review)
Review
Viscoelastic hemostatic assays are point-of-care devices that assess coagulation and fibrinolysis in whole blood samples. These technologies provide numeric and visual information of clot initiation, clot strength, and clot lysis under low-shear conditions, and have been used in a variety of clinical settings and subpopulations, including trauma, cardiac surgery, and obstetrics. Emerging data indicate that these devices are useful for detecting important coagulation defects during major postpartum hemorrhage (especially low plasma fibrinogen concentration [hypofibrinogenemia]) and informing clinical decision-making for blood product use. Data from observational studies suggest that, compared with traditional formulaic approaches to transfusion management, targeted or goal-directed transfusion approaches using data from viscoelastic hemostatic assays are associated with reduced hemorrhage-related morbidity and lower blood product requirement. Viscoelastic hemostatic assays can also be used to identify and treat coagulation defects in patients with inherited or acquired coagulation disorders, such as factor XI deficiency or immune-mediated thrombocytopenia, and to assess hemostatic profiles of patients prescribed anticoagulant medications to mitigate the risk of epidural hematoma after neuraxial anesthesia and postpartum hemorrhage after delivery.
Topics: Pregnancy; Female; Humans; Hemostatics; Postpartum Hemorrhage; Thrombelastography; Hemostasis; Blood Coagulation; Blood Coagulation Disorders
PubMed: 38462250
DOI: 10.1016/j.ajog.2022.09.008 -
European Heart Journal Dec 2023
Topics: Female; Humans; Peripartum Period; Cardiomyopathies; Puerperal Disorders; United Kingdom; Europe
PubMed: 37897344
DOI: 10.1093/eurheartj/ehad724 -
Journal of the American College of... Jul 2023
Topics: Female; Pregnancy; Humans; Peripartum Period; Cardiomyopathies; Puerperal Disorders
PubMed: 37380300
DOI: 10.1016/j.jacc.2023.04.042 -
Journal of the American College of... Jul 2023Long-term maternal outcomes of subsequent pregnancies (SSPs) in patients with peripartum cardiomyopathy (PPCM) have not been analyzed.
BACKGROUND
Long-term maternal outcomes of subsequent pregnancies (SSPs) in patients with peripartum cardiomyopathy (PPCM) have not been analyzed.
OBJECTIVES
The goal of this study was to evaluate the long-term survival of SSPs in women with PPCM.
METHODS
We conducted a retrospective review of 137 PPCMs in the registry. The clinical and echocardiographic findings were compared between the recovery group (RG) and nonrecovery group (NRG), defined as left ventricular ejection fraction ≥50% and <50% after an index of pregnancy, respectively.
RESULTS
Forty-five patients with SSPs were included with a mean age of 27.0 ± 6.1 years, 80% were of African American descent, and 75.6% from a low socioeconomic background. Thirty (66.7%) women were in the RG. Overall, SSPs were associated with a decrease in mean left ventricular ejection fraction from 45.1% ± 13.7% to 41.2% ± 14.5% (P = 0.009). At 5 years, adverse outcomes were significantly higher in the NRG compared with the RG (53.3% vs 20%; P = 0.04), driven by relapse PPCM (53.3% vs 20.0%; P = 0.03). Five-year all-cause mortality was 13.33% in the NRG compared with 3.33% in the RG (P = 0.25). At a median follow-up of 8 years, adverse outcomes and all-cause mortality rates were similar in the NRG and RG (53.3% vs 33.3% [P = 0.20] and 20% vs 20%, respectively).
CONCLUSIONS
Subsequent pregnancies in women with PPCM are associated with adverse events. The normalization of left ventricular function does not guarantee a favorable outcome in the SSPs.
Topics: Adult; Female; Humans; Pregnancy; Young Adult; Black or African American; Cardiomyopathies; Peripartum Period; Puerperal Disorders; Stroke Volume; Ventricular Function, Left
PubMed: 37380299
DOI: 10.1016/j.jacc.2023.04.043 -
Animal Reproduction Science Sep 2023Mastitis is a rare condition that can be diagnosed in female cats of all breeds and ages. It is usually caused by bacterial agents and is frequently encountered... (Review)
Review
Mastitis is a rare condition that can be diagnosed in female cats of all breeds and ages. It is usually caused by bacterial agents and is frequently encountered secondarily in feline mammary fibroepithelial hyperplasia (FEH). If left untreated, it can peril both the queen and her kittens. Therefore, a reliable and quick diagnosis is the primary key to successful treatment. Conventional diagnosis consists of a clinical and ultrasound evaluation of the queen's mammary glands. However, there is a lack of literature specifically focused on mastitis in queens. Consequently, the present review brings forth the existing knowledge regarding mammary gland inflammations in cats, with the goal of improving current clinical evaluation and treatment plans.
Topics: Cats; Animals; Female; Inflammation; Mastitis; Cat Diseases
PubMed: 37586155
DOI: 10.1016/j.anireprosci.2023.107318 -
Obstetrics and Gynecology Dec 2023Preeclampsia is an important risk factor for cardiovascular disease (CVD, including heart disease and stroke) along the life course. However, whether exposure to chronic...
OBJECTIVE
Preeclampsia is an important risk factor for cardiovascular disease (CVD, including heart disease and stroke) along the life course. However, whether exposure to chronic hypertension in pregnancy, in the absence of preeclampsia, is implicated in CVD risk during the immediate postpartum period remains poorly understood. Our objective was to estimate the risk of readmission for CVD complications within the calendar year after delivery for people with chronic hypertension.
METHODS
The Healthcare Cost and Utilization Project's Nationwide Readmission Database (2010-2018) was used to conduct a retrospective cohort study of patients aged 15-54 years. International Classification of Diseases codes were used to identify patients with chronic hypertension and postpartum readmission for CVD complications within 1 year of delivery. People with CVD diagnosed during pregnancy or delivery admission, multiple births, or preeclampsia or eclampsia were excluded. Excess rates of CVD readmission among patients with and without chronic hypertension were estimated. Associations between chronic hypertension and CVD complications were determined from Cox proportional hazards regression models.
RESULTS
Of 27,395,346 delivery hospitalizations that resulted in singleton births, 2.0% of individuals had chronic hypertension (n=544,639). The CVD hospitalization rate among patients with chronic hypertension and normotensive patients was 645 (n=3,791) per 100,000 delivery hospitalizations and 136 (n=37,664) per 100,000 delivery hospitalizations, respectively (rate difference 508, 95% CI 467-549; adjusted hazard ratio 4.11, 95% CI 3.64-4.66). The risk of CVD readmission, in relation to chronic hypertension, persisted for 1 year after delivery.
CONCLUSION
The heightened CVD risk as early as 1 month postpartum in relation to chronic hypertension underscores the need for close monitoring and timely care after delivery to reduce blood pressure and related complications.
Topics: Pregnancy; Female; Humans; Pre-Eclampsia; Patient Readmission; Retrospective Studies; Puerperal Disorders; Postpartum Period; Cardiovascular Diseases; Risk Factors; Hypertension
PubMed: 37917949
DOI: 10.1097/AOG.0000000000005424 -
Tropical Animal Health and Production Dec 2023In the present study, thermal images of the short milking tube of the milking machine representing four udder quarters independently attached to a milking animal, along...
In the present study, thermal images of the short milking tube of the milking machine representing four udder quarters independently attached to a milking animal, along with pre-milking and post-milking udder and teat thermograms, were taken using a hand-held digital infrared thermal camera (DarviDTL007) during morning milking of lactating Murrah buffaloes (n = 132) to assess the mastitis status. California mastitis test (CMT) and somatic cell count (SCC) of milk samples were carried out to screen the udder quarters as healthy, subclinical (SCM), and clinical mastitis (CM). The thermograms revealed an increase (p < 0.05) of 2.19 and 3.72ºC in the mean values of short milking tube (SMT) surface temperature among SCM and CM quarters compared to healthy quarters, respectively. The mean values of udder skin surface temperature (USST) for pre-milking, milking, and post-milking of SCM and CM compared to healthy quarters showed an increase (p < 0.05) of 2.17, 1.96, and 1.61ºC and 3.11, 2.88, and 2.73ºC, respectively. Similarly, compared to healthy quarters, the mean values of teat skin surface temperature (TSST) for pre-milking and post-milking of SCM and CM showed an increase (p < 0.05) of 2.12 and 1.66ºC and 3.07 and 2.45ºC, respectively. Also, CMT and SCC results showed a strong positive correlation (r = 0.68-0.91, p < 0.01) with all the thermographic parameters. Thus, thermograms of SMT alone can be used as an efficient detection tool in assessing SCM among Murrah buffaloes.
Topics: Animals; Female; Buffaloes; Milk; Lactation; Bison; Mastitis
PubMed: 38055070
DOI: 10.1007/s11250-023-03853-4 -
Journal of Affective Disorders Nov 2023There is a need for effective interventions to reduce symptomatology of postpartum depression. The objective of this study was to test whether providing an ergonomic... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
There is a need for effective interventions to reduce symptomatology of postpartum depression. The objective of this study was to test whether providing an ergonomic infant carrier would reduce postpartum depression symptomatology.
METHODS
A randomized two-arm, parallel-group trial with 100 participants was conducted between February 2018 and June 2019 in a low-income community. At 30-weeks' gestation, 50 participants were randomly assigned to receive an ergonomic infant carrier and instructions on proper use (intervention group), and 50 participants were assigned to a waitlist (control group). Participants tracked the extent of their infant carrier use and completed the Edinburgh Postpartum Depression Scale (EPDS) to assess postpartum depression symptomatology at 6-weeks postpartum.
RESULTS
Participants in the intervention group reported using an infant carrier significantly more often than the control group (β = 2.69, SE = 0.347, p < .001, 95 % CI = 2.08-3.41). The intervention group reported fewer depressive symptoms at 6-weeks postpartum than the control group (β = -0.541, p = .042).
LIMITATIONS
The sample size was relatively small and thus our results may not be generalizable to the general population.
CONCLUSION
Infant carrying may be a cost-effective intervention to reduce postpartum depression symptomatology. Large-scale studies are warranted to further examine the efficacy and cost-effectiveness of providing carriers as an intervention to reduce postpartum depression symptomatology.
CLINICAL TRIAL REGISTRATION
Clinicaltrials.gov id: NCT04376021. Data Sharing Statement: Deidentified individual participant data will not be made available because we did not obtain permission to share individual data.
CLINICAL TRIAL REGISTRATION NUMBER
NCT0437602; https://beta.
CLINICALTRIALS
gov/study/NCT04376021.
Topics: Female; Humans; Infant; Depression, Postpartum; Postpartum Period; Psychiatric Status Rating Scales
PubMed: 37586649
DOI: 10.1016/j.jad.2023.08.044 -
Blood Advances Oct 2023Postpartum hemorrhage (PPH) is a leading cause of maternal morbi-mortality. Although obstetric risk factors are well described, the impact of predelivery hematologic and... (Meta-Analysis)
Meta-Analysis
Postpartum hemorrhage (PPH) is a leading cause of maternal morbi-mortality. Although obstetric risk factors are well described, the impact of predelivery hematologic and hemostatic biomarkers remains incompletely understood. In this systematic review, we aimed to summarize the available literature on the association between predelivery hemostatic biomarkers and PPH/severe PPH. Searching MEDLINE, EMBASE, and CENTRAL databases from inception to October 2022, we included observational studies on unselected pregnant women without bleeding disorder reporting on PPH and on predelivery hemostatic biomarkers. Two review authors independently performed title, abstract and full-text screening, upon which quantitative syntheses of studies reporting on the same hemostatic biomarker were conducted, calculating the mean difference (MD) between women with PPH/severe PPH and controls. A search on 18 October 2022 yielded 81 articles fitting our inclusion criteria. The heterogeneity between studies was considerable. With regard to PPH, the estimated average MD in the investigated biomarkers (platelets, fibrinogen, hemoglobin, Ddimer, activated partial thromboplastin time, and prothrombin time) were not statistically significant. Women who developed severe PPH had lower predelivery platelets than controls (MD = -26.0 109/L; 95% confidence interval, -35.8 to -16.1), whereas differences in predelivery fibrinogen concentration (MD = -0.31 g/L; 95% confidence interval, -0.75 to 0.13) and levels of factor XIII or hemoglobin were not statistically significant in women with and without severe PPH. Predelivery platelet counts were, on average, lower in women with severe PPH compared with controls, suggesting the potential usefulness of this biomarker for predicting severe PPH. This trial was registered at the International Prospective Register of Systematic Reviews as CRD42022368075.
Topics: Female; Pregnancy; Humans; Postpartum Hemorrhage; Hemostatics; Hemoglobins; Fibrinogen; Biomarkers
PubMed: 37307172
DOI: 10.1182/bloodadvances.2023010143 -
European Journal of Heart Failure Aug 2023
Topics: Female; Humans; Pregnancy; Heart Failure; Peripartum Period; Cardiomyopathies; Thromboembolism; Puerperal Disorders; Registries; Pregnancy Complications, Cardiovascular
PubMed: 37092321
DOI: 10.1002/ejhf.2871