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Cureus Jul 2023Maternal hypotension is a common complication of spinal anesthesia in cesarean section and requires immediate intervention. Phenylephrine is most commonly used as a...
Comparing the Effect of Phenylephrine Bolus and Phenylephrine Infusion for Maintaining Arterial Blood Pressure During Cesarean Delivery Under Spinal Anesthesia: A Randomized Prospective Study.
INTRODUCTION
Maternal hypotension is a common complication of spinal anesthesia in cesarean section and requires immediate intervention. Phenylephrine is most commonly used as a vasopressor agent for the treatment of hypotension due to subarachnoid block. Our aim was to compare the bolus dose of 50 µg of phenylephrine with a fixed infusion at 50 µg.min of phenylephrine for maintaining arterial blood pressure during cesarean delivery.
MATERIALS AND METHOD
This was a prospective, randomized comparative study. One hundred normotensive pregnant females aged 18-35 years, body mass index 18-29kg.m, American Society of Anesthesiologists (ASA) physical status classification II scheduled to undergo cesarean section (elective/emergency) under spinal anesthesia were randomly divided into two groups of 50 each. Group PB received a bolus dose of phenylephrine 50 µg after they developed hypotension i.e., a decrease in systolic blood pressure (SBP) ≥ 20% from the baseline. Similarly, patients in Group PI were administered prophylactic infusion using a syringe pump of phenylephrine 50 µg.min, started just after the administration of subarachnoid block. The phenylephrine infusion was continued either till the delivery of the baby or when SBP rises >20% above the baseline. Parameters like blood pressure, heart rate, and peripheral oxygen saturation were recorded. After the delivery of the baby, the neonatal APGAR score was assessed at one minute and five minutes.
RESULTS
Demographic data were comparable in terms of demographic profile, duration of surgery, and ASA physical status classification between the groups. The heart rate was higher in Group PB compared to Group PI throughout the monitoring period (P<0.001). The fall in mean blood pressure was more in Group PB compared to Group PI till 18 minutes of surgery and was statistically significant (P<0.05). After 18 minutes of surgery, mean blood pressure stabilized and was comparable between the groups. Other variables like APGAR score at one minute and five minutes were comparable between the groups. Bradycardia and hypertension were more common in Group PI whereas hypotension, nausea, and vomiting were more common in group PB.
CONCLUSION
We concluded that during cesarean section under spinal anesthesia, phenylephrine infusion provides better hemodynamic stability and APGAR score during the perioperative period.
PubMed: 37654965
DOI: 10.7759/cureus.42713 -
The Journal of Maternal-fetal &... Dec 2023To compare neonatal outcomes in pregnancies with fetal growth restriction (FGR) by intended delivery mode. This is a retrospective cohort study of singleton pregnancies...
To compare neonatal outcomes in pregnancies with fetal growth restriction (FGR) by intended delivery mode. This is a retrospective cohort study of singleton pregnancies with FGR that were delivered ≥34.0 weeks gestation. Neonatal outcomes were compared according to the intended delivery mode, which the attending obstetrician determined. Of note, none of the subjects had a contraindication to labor. Crude and adjusted odds ratios (ORs) and corresponding confidence intervals (CIs) were calculated logistic regression models to assess the potential association between intended delivery mode and neonatal morbidity defined as a composite outcome (i.e. umbilical artery pH ≤7.1, 5-min Apgar score ≤7, admission to the neonatal intensive care unit, hypoglycemia, intrapartum fetal distress requiring expedited delivery, and perinatal death). A sensitivity analysis excluded intrapartum fetal distress requiring emergency cesarean delivery from the composite outcome since only patients with spontaneous labor or labor induction could meet this criterion. Potential confounders in the adjusted effects models included maternal age, body mass index, hypertensive disorders, diabetes, FGR type (i.e. early or late), and oligohydramnios. Seventy-two (34%) patients had an elective cesarean delivery, 73 (34%) had spontaneous labor and were expected to deliver vaginally, and 67 (32%) underwent labor induction. The composite outcome was observed in 65.3%, 89%, and 88.1% of the groups mentioned above, respectively ( < 0.001). Among patients with spontaneous labor and those scheduled for labor induction, 63% and 47.8% required an emergency cesarean delivery for intrapartum fetal distress. Compared to elective cesarean delivery, spontaneous labor (OR 4.32 [95% CI 1.79, 10.42], = 0.001; aOR 4.85 [95% CI 1.85, 12.66], = 0.001), and labor induction (OR 3.92 [95% CI 1.62, 9.49] = 0.002; aOR 5.29 [95% CI 2.01, 13.87], = 0.001) had higher odds of adverse neonatal outcomes. In this cohort of FGR, delivering at ≥34 weeks of gestation, pregnancies with spontaneous labor, and those that underwent labor induction had higher odds of neonatal morbidity than elective cesarean delivery.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Fetal Growth Retardation; Retrospective Studies; Fetal Distress; Cesarean Section; Labor, Obstetric; Labor, Induced; Gestational Age
PubMed: 38010351
DOI: 10.1080/14767058.2023.2286433 -
Clinical Epigenetics May 2024Adverse neonatal outcomes are a prevailing risk factor for both short- and long-term mortality and morbidity in infants. Given the importance of these outcomes, refining...
Adverse neonatal outcomes are a prevailing risk factor for both short- and long-term mortality and morbidity in infants. Given the importance of these outcomes, refining their assessment is paramount for improving prevention and care. Here we aim to enhance the assessment of these often correlated and multifaceted neonatal outcomes. To achieve this, we employ factor analysis to identify common and unique effects and further confirm these effects using criterion-related validity testing. This validation leverages methylome-wide profiles from neonatal blood. Specifically, we investigate nine neonatal health risk variables, including gestational age, Apgar score, three indicators of body size, jaundice, birth diagnosis, maternal preeclampsia, and maternal age. The methylomic profiles used for this research capture data from nearly all 28 million methylation sites in human blood, derived from the blood spot collected from 333 neonates, within 72 h post-birth. Our factor analysis revealed two common factors, size factor, that captured the shared effects of weight, head size, height, and gestational age and disease factor capturing the orthogonal shared effects of gestational age, combined with jaundice and birth diagnosis. To minimize false positives in the validation studies, validation was limited to variables with significant cumulative association as estimated through an in-sample replication procedure. This screening resulted in that the two common factors and the unique effects for gestational age, jaundice and Apgar were further investigated with full-scale cell-type specific methylome-wide association analyses. Highly significant, cell-type specific, associations were detected for both common effect factors and for Apgar. Gene Ontology analyses revealed multiple significant biologically relevant terms for the five fully investigated neonatal health risk variables. Given the established links between adverse neonatal outcomes and both immediate and long-term health, the distinct factor effects (representing the common and unique effects of the risk variables) and their biological profiles confirmed in our work, suggest their potential role as clinical biomarkers for assessing health risks and enhancing personalized care.
Topics: Humans; Infant, Newborn; Female; DNA Methylation; Genome-Wide Association Study; Epigenome; Pregnancy; Gestational Age; Male; Risk Factors; Infant Health; Apgar Score; Maternal Age; Adult; Epigenesis, Genetic
PubMed: 38778395
DOI: 10.1186/s13148-024-01681-3 -
Thoracic Cancer Apr 2024The surgical Apgar score (SAS) quantifying three intraoperative indexes has been confirmed to be significantly associated with postoperative morbidity and prognosis in...
BACKGROUND
The surgical Apgar score (SAS) quantifying three intraoperative indexes has been confirmed to be significantly associated with postoperative morbidity and prognosis in many surgical specialties. However, there are great limitations in its application for esophageal cancer (EC). This study aimed to assess the predictive capability of esophagectomy SAS (eSAS) in determining postoperative morbidity and overall survival (OS) in EC patients who had undergone neoadjuvant therapy.
METHODS
A retrospective evaluation was conducted on a cohort of 221 patients in which surgery- and tumor-related data were extracted and analyzed. Major morbidity was defined as complications meeting the criteria of Clavien-Dindo classification III or higher during hospitalization. Univariate and multivariate analyses were performed to identify potential risk factors for major morbidity. Kaplan-Meier analysis was utilized to calculate the OS and relapse-free survival (RFS).
RESULTS
The results exhibited that eSAS demonstrated potential predictive value for postoperative morbidity with an optimal cutoff value of 6. The eSAS and diabetes mellitus were two independent risk factors for the major morbidity; however, no correlation between the eSAS and the OS or RFS was detected.
CONCLUSION
The eSAS could be used as a predictor of major morbidity, while it was not correlated with OS and RFS.
Topics: Humans; Infant, Newborn; Esophagectomy; Retrospective Studies; Apgar Score; Neoadjuvant Therapy; Postoperative Complications; Neoplasm Recurrence, Local; Esophageal Neoplasms
PubMed: 38390683
DOI: 10.1111/1759-7714.15246 -
Prilozi (Makedonska Akademija Na... Mar 2024Respiratory distress syndrome (RDS) and hypoxic-ischemic encephalopathy (HIE) are frequent causes of death and disability in neonates. This study included newborns...
Respiratory distress syndrome (RDS) and hypoxic-ischemic encephalopathy (HIE) are frequent causes of death and disability in neonates. This study included newborns between January 2021 and July 2022 at the University Clinic for Gynecology and Obstetrics, Skopje. Up to date criteria for HIE/RDS for term and for preterm infants as well for the severity of HIE/RDS were used in a comprehensive analysis of cranial ultrasonography, neurological status, neonatal infections, Apgar score, bradycardia and hypotension, X-ray of the lungs, FiO2, acid-base status, assisted ventilation and use of surfactant. Three groups were created: HIE with RDS (42 babies), HIE without RDS (30 babies) and RDS without HIE in 38 neonates. All newborns with severe (third) degree of HIE died. Intracranial bleeding was found in 35.7% in the first group and 30% in the second group, and in the third group in 53.3%. The need for surfactant in the HIE group with RDS is 59.5%, and in the RDS group without HIE 84.2%. DIC associated with sepsis was found in 13.1-50% in those groups. In newborns with HIE and bradycardia, the probability of having RDS was on average 3.2 times higher than in those without bradycardia. The application of the surfactant significantly improved the pH, pO2, pCO2, BE and chest X-ray in children with RDS. An Apgar score less than 6 at the fifth minute increases the risk of RDS by 3 times. The metabolic acidosis in the first 24 hours increases the risk of death by 23.6 times. The combination of HIE/ RDS significantly worsens the disease outcome. The use of scoring systems improved the early detection of high risk babies and initiation of early treatment increased the chances for survival without disabilities.
Topics: Infant; Pregnancy; Female; Child; Infant, Newborn; Humans; Infant, Premature; Hypoxia-Ischemia, Brain; Bradycardia; Respiratory Distress Syndrome, Newborn; Pulmonary Surfactants; Surface-Active Agents
PubMed: 38575384
DOI: 10.2478/prilozi-2024-0003 -
Clinical Cardiology Aug 2023Catheter ablation is a rarely used procedure to treat arrhythmias during pregnancy.
BACKGROUND
Catheter ablation is a rarely used procedure to treat arrhythmias during pregnancy.
HYPOTHESIS
In the case of maternal arrhythmia during pregnancy, zero-fluoroscopic catheter ablation is preferable to medical treatment.
METHODS
Between April 2014 and September 2021, we examined the demographic data, procedural parameters, and fetal and maternal outcomes in pregnant women undergoing ablation at the Gottsegen National Cardiovascular Center and University of Pécs Medical School, Heart Institute.
RESULTS
Fourteen procedures (14 electrophysiological studies [EPS], 13 ablations) performed on 13 pregnant women (age 30.3 ± 5.2 years, primipara n = 6) were studied. During EPS, 12 patients had inducible arrhythmias. Atrial tachycardia was confirmed in three, atrioventricular re-entry tachycardia via manifest accessory pathway (AP) in three, and via concealed AP in one case. Atrioventricular nodal re-entry tachycardia was confirmed in three and sustained monomorphic ventricular tachycardia in two cases. Eleven radiofrequency ablation (84.6%) and two cryoablation (15.4%) were performed. The electroanatomical mapping system was used in all cases. Transseptal puncture was performed in two cases (15.4%) due to left lateral APs. The mean procedure time was 76.0±33.0 minutes. All procedures were performed without fluoroscopy. No complications occurred. During the follow-up, arrhythmia-free survival was achieved in all cases, but in two patients, we used antiarrhythmic drugs (AADs) to achieve it. APGAR score was within the normal range in all cases [median (interquartile range), 9.0/10.0 (9.0-10.0/9.3-10.0)].
CONCLUSIONS
Zero-fluoroscopic catheter ablation was an effective and safe treatment option for our 13 pregnant patients. Catheter ablation may have less side effects on fetal development than the use of AADs during pregnancy.
Topics: Humans; Female; Pregnancy; Adult; Pregnant Women; Arrhythmias, Cardiac; Tachycardia, Supraventricular; Tachycardia, Ventricular; Catheter Ablation; Catheters; Treatment Outcome
PubMed: 37408170
DOI: 10.1002/clc.24072 -
Cureus Jul 2023Introduction Gestational diabetes mellitus (GDM) is a major contributor to adverse pregnancy outcomes both in the United States and globally. As the prevalence of...
Introduction Gestational diabetes mellitus (GDM) is a major contributor to adverse pregnancy outcomes both in the United States and globally. As the prevalence of obesity continues to rise, the incidence of GDM is anticipated to increase as well. Despite the significant impact of GDM on maternal and neonatal health, research examining the independent associations between GDM and adverse outcomes remains limited in the U.S. context. Objective This study aims to address this knowledge gap and further elucidate the relationship between GDM and maternal and neonatal health outcomes. Method We performed a retrospective study using data from the United States Vital Statistics Records, encompassing deliveries that occurred between January 2015 and December 2019. Our analysis aimed to establish the independent association between GDM and various adverse maternal and neonatal outcomes. The multivariate analysis incorporated factors such as maternal socioeconomic demographics, preexisting comorbidities, and conditions during pregnancy to account for potential confounders and elucidate the relationship between GDM and the outcomes of interest. Result Between 2015 and 2019, there were 1,212,589 GDM-related deliveries, accounting for 6.3% of the 19,249,237 total deliveries during the study period. Among women with GDM, 46.4% were Non-Hispanic Whites, 11.4% were Non-Hispanic Blacks, 25.7% were Hispanics, and 16.5% belonged to other racial/ethnic groups. The median age of women with GDM was 31 years, with an interquartile range of 27-35 years. The cesarean section rate among these women was 46.5%. GDM was identified as an independent predictor of adverse maternal and neonatal outcomes, including cesarean section (OR=1.40; 95% CI: 1.39-1.40), maternal blood transfusion (OR=1.15; 95% CI: 1.12-1.18), intensive care unit admission (OR=1.16; 95% CI: 1.10-1.21), neonatal intensive care unit admission (OR=1.53; 95% CI: 1.52-1.54), assisted ventilation (OR=1.37; 95% CI: 1.35-1.39), and low 5-minute Apgar score (OR=1.01; 95% CI: 1.00-1.03). Conclusion GDM serves as an independent risk factor for adverse maternal and neonatal outcomes, emphasizing the importance of early detection and management in pregnant women.
PubMed: 37546039
DOI: 10.7759/cureus.41360 -
Neurologia I Neurochirurgia Polska 2024To evaluate the safety of lacosamide (LCM) monotherapy during pregnancy and breastfeeding.
AIM OF THE STUDY
To evaluate the safety of lacosamide (LCM) monotherapy during pregnancy and breastfeeding.
MATERIAL AND METHODS
Patients taking LCM monotherapy treated at the university epilepsy clinic were prospectively followed up during pregnancy, delivery, and breastfeeding. Data on seizure frequency, LCM dosage, pregnancy course, delivery and breastfeeding, birth outcome, congenital malformation, and development of newborns was collected.
RESULTS
Four pregnancies in three patients with refractory focal epilepsy treated with LCM monotherapy were reported. One of these pregnancies ended in a miscarriage during the seventh week of gestation. The average daily LCM dose at the time of conception was 300 mg. Treatment with LCM was continued throughout pregnancy and breastfeeding. The dose of LCM was increased in two pregnancies: in one case following a seizure relapse, and in the other case as a preventive measure to avoid an increase in seizure frequency. Seizure frequency remained stable during pregnancy in two cases. All deliveries were carried out via caesarean section, with an average gestational age at birth of 37.6 weeks. The Apgar score was 10 in all newborns, and no congenital malformations were detected. At the age of 12 months, normal developmental milestones were reached. Infants were breastfed without any complications.
CONCLUSIONS AND CLINICAL IMPLICATIONS
This case series adds to a growing body of evidence suggesting the relative safety of LCM monotherapy throughout pregnancy and breastfeeding.
Topics: Humans; Female; Pregnancy; Lacosamide; Breast Feeding; Adult; Anticonvulsants; Infant, Newborn; Pregnancy Complications; Prospective Studies; Pregnancy Outcome; Acetamides; Epilepsies, Partial
PubMed: 38305480
DOI: 10.5603/pjnns.97120 -
The Journal of Maternal-fetal &... Dec 2023Emergency cesarean section is one of the most critical methods in the treatment of high-risk emergency obstetric cases. The aim of this study was to explore the clinical...
INTRODUCTION
Emergency cesarean section is one of the most critical methods in the treatment of high-risk emergency obstetric cases. The aim of this study was to explore the clinical effect of constructing a Rapid Response Team (RRT) in emergency cesarean section.
METHODS
This is a pre- and post-implementation study. The patients who underwent emergency cesarean section were retrospectively analyzed and divided into an experimental group and a control group. There were 52 patients (June-December 2020) in the control group who underwent routine emergency cesarean section without an RRT, and 51 patients (January-June 2021) in the experimental group who underwent emergency cesarean section with an RRT. The operation time indexes (DOI, decision-to-operating room interval; O-I, operating room-to-incision interval; DII, decision-to-incision interval; I-D, incision-to-delivery interval; DDI, decision-to-delivery interval), DDI pass rate, neonatal Apgar score and maternal complications in the two groups were compared. Moreover, the management time trends (DOI, DII, and DDI) in the experimental group were analyzed.
RESULTS
The DDI, DII, DOI, and O-I of the experimental group were shorter than those of the control group, and the differences were significant ( < 0.05). The DDI pass rate in the experimental group was higher than that in the control group, and the difference was significant ( < 0.01). The 1-min Apgar score of the experimental group was higher than that of the control group ( < 0.05). The key intervals of emergency cesarean section in the experimental group leveled off after approximately 3 to 4 months.
CONCLUSION
In the face of emergency situations, the implementation of an emergency cesarean section RRT can improve delivery intervals for emergency cesarean and would be conducive to maternal and infant safety.
Topics: Infant, Newborn; Pregnancy; Humans; Female; Cesarean Section; Pregnancy Outcome; Retrospective Studies; Hospital Rapid Response Team; Time Factors
PubMed: 37931980
DOI: 10.1080/14767058.2023.2279025 -
BMC Pregnancy and Childbirth Apr 2024Although acetaminophen is widely used in women during pregnancy, its safety has not been clearly stated. The study aimed to investigate the association between...
BACKGROUND
Although acetaminophen is widely used in women during pregnancy, its safety has not been clearly stated. The study aimed to investigate the association between acetaminophen use and adverse pregnancy outcomes in pregnant women in China.
METHODS
We conducted a retrospective cohort study by collecting data on pregnant women who delivered in the Beijing Obstetrics and Gynecology Hospital from January 2018 to September 2023. An acetaminophen use group and a control group were formed based on prenatal exposure to acetaminophen. The pregnancy outcomes that we focused on were stillbirth, miscarriage, preterm birth, APGAR score, birth weight, and congenital disabilities. Pregnant women exposed to acetaminophen were matched to unexposed in a 1:1 ratio with propensity score matching, using the greedy matching macro. SPSS software was used for statistical analysis. Multivariable logistics regression was used to assess the association between acetaminophen use during pregnancy and adverse pregnancy outcomes.
RESULTS
A total of 41,440 pregnant women were included, of whom 501 were exposed to acetaminophen during pregnancy, and 40,939 were not exposed. After the propensity score matching, the acetaminophen use and control groups consisted of 501 pregnant women each. The primary analysis showed that acetaminophen exposure during pregnancy was associated with an increased risk of stillbirth (adjusted OR (aOR) = 2.29, 95% CI, 1.19-4.43), APGAR score < 7 at 1 min (aOR = 3.28, 95% CI, 1.73-6.21), APGAR score < 7 at 5 min (aOR = 3.54, 95% CI, 1.74-7.20), APGAR score < 7 at 10 min (aOR = 3.18, 95% CI, 1.58-6.41), and high birth weight (HBW) (aOR = 1.75, 95% CI, 1.05-2.92). Drug exposure during the first and second trimesters increased the odds of stillbirth, miscarriage, APGAR < 7, and the occurrence of at least one adverse pregnancy outcome. In addition, the frequency of drug use more than two times was associated with a higher risk of preterm birth and APGAR score < 7.
CONCLUSIONS
Exposure to acetaminophen during pregnancy was significantly associated with the occurrence of adverse pregnancy outcomes, particularly exposure in the first and second trimesters and frequency of use more than twice. It is suggested that acetaminophen should be prescribed with caution in pregnant women.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Pregnant Women; Stillbirth; Birth Weight; Premature Birth; Acetaminophen; Retrospective Studies; Abortion, Spontaneous; Propensity Score; Pregnancy Complications; Pregnancy Outcome
PubMed: 38605288
DOI: 10.1186/s12884-024-06480-5