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American Journal of Obstetrics and... Jan 2022The risk of venous thromboembolism after delivery is modified by mode of delivery, with the risk of venous thromboembolism being higher after cesarean delivery than...
BACKGROUND
The risk of venous thromboembolism after delivery is modified by mode of delivery, with the risk of venous thromboembolism being higher after cesarean delivery than vaginal delivery. The risk of venous thromboembolism after peripartum hysterectomy is largely unknown.
OBJECTIVE
This study aimed to compare the incidence and risk of venous thromboembolism among women who had and did not have a peripartum hysterectomy. Furthermore, we sought to compare the risk of venous thromboembolism after hysterectomy with other patient, pregnancy, and delivery risk factors known to be associated with venous thromboembolism.
STUDY DESIGN
This was a cross-sectional study of women with delivery encounters identified in the Nationwide Readmissions Database from October 2015 to December 2017. Delivery encounters and all variables of interest were identified using the International Classification of Diseases, Tenth Revision diagnosis and procedure codes. The incidence of venous thromboembolism during delivery and rehospitalizations within 6 weeks after discharge was compared among women who had and did not have a peripartum hysterectomy. Multivariable logistic regressions were used to estimate associations between venous thromboembolism and hysterectomy, adjusted for the following characteristics: maternal age, payer at time of delivery, obesity, hypertension, diabetes mellitus, tobacco use, multifetal gestation, peripartum infection, and peripartum hemorrhage. Similarly, venous thromboembolism risk was compared by mode of delivery, including hysterectomy. Diagnoses that may have been indications for peripartum hysterectomy were identified among patients who underwent a hysterectomy and compared between those who did and did not have venous thromboembolism. Analyses used survey weights to obtain population estimates.
RESULTS
Of the 4,419,037 women with deliveries, 5098 (11.5 per 10,000 deliveries) underwent a hysterectomy. Moreover, 110 patients (215.8 per 10,000 deliveries) were diagnosed with venous thromboembolism after hysterectomy. The risk of venous thromboembolism was significantly higher in women who underwent a hysterectomy than in women who did not have a hysterectomy (unadjusted odds ratio, 25.1 [95% confidence interval, 20.0-31.5]; adjusted odds ratio, 11.2 [95% confidence interval, 8.7-14.5]; P<.001). Comparing the risk of venous thromboembolism by mode of delivery, the unadjusted and adjusted incidences of venous thromboembolism were 6.9 (95% confidence interval, 6.5-7.3) and 7.4 (95% confidence interval, 6.9-7.8) per 10,000 deliveries among women after vaginal delivery without peripartum hysterectomy, 12.5 (95% confidence interval, 11.8-13.1) and 11.3 (95% confidence interval, 10.7-12.0) per 10,000 deliveries after cesarean delivery without hysterectomy; and 217.2 (95% confidence interval, 169.1-265.2) and 96.9 (95% confidence interval 76.9-126.5) per 10,000 deliveries after hysterectomy, regardless of mode of delivery. Of the 110 diagnoses of venous thromboembolism with peripartum hysterectomy, 89 (81%) occurred during delivery admission. Of the remaining 21 cases, 50% occurred within the first 10 days after discharge from delivery, and 75% occurred within 25 days after discharge.
CONCLUSION
These findings have demonstrated that peripartum hysterectomy is associated with a markedly increased risk of venous thromboembolism in the postpartum period, even when controlling for other known risk factors for postpartum thromboembolic events. Here, the incidence of venous thromboembolism after peripartum hysterectomy (2.2%) met some guideline-based risk thresholds for routine thromboprophylaxis, potentially for at least 2 weeks after delivery. Further investigation into the role of routine venous thromboembolism prophylaxis during and after delivery is needed.
Topics: Adult; Cesarean Section; Cross-Sectional Studies; Databases, Factual; Delivery, Obstetric; Female; Humans; Hysterectomy; Incidence; Middle Aged; Peripartum Period; Pregnancy; Prenatal Care; Puerperal Disorders; Risk Factors; Time Factors; United States; Venous Thromboembolism
PubMed: 34224689
DOI: 10.1016/j.ajog.2021.06.091 -
The Primary Care Companion For CNS... Jan 2023Psychosis is a psychiatric emergency that affects up to 1 in 500 women postpartum and can result from various etiologies. We present a case vignette and review of the...
Psychosis is a psychiatric emergency that affects up to 1 in 500 women postpartum and can result from various etiologies. We present a case vignette and review of the relevant literature to highlight the broad differential diagnosis of postpartum psychosis with atypical features. Recommendations for evaluation, diagnosis, and treatment of patients with complex neuropsychiatric symptoms in the postpartum period are discussed. This case of postpartum psychosis with malignant catatonia highlights the role of immunology in the development and treatment of postpartum psychosis and the need for future research to more accurately define the etiology and best tailor treatment.
Topics: Humans; Female; Puerperal Disorders; Psychotic Disorders; Postpartum Period; Catatonia; Diagnosis, Differential
PubMed: 36638535
DOI: 10.4088/PCC.22nr03269 -
Journal of Developmental Origins of... Jun 2021The perinatal period is a vulnerable time for the development of psychopathology, particularly mood and anxiety disorders. In the study of maternal anxiety, important...
The perinatal period is a vulnerable time for the development of psychopathology, particularly mood and anxiety disorders. In the study of maternal anxiety, important questions remain regarding the association between maternal anxiety symptoms and subsequent child outcomes. This study examined the association between depressive and anxiety symptoms, namely social anxiety, panic, and agoraphobia disorder symptoms during the perinatal period and maternal perception of child behavior, specifically different facets of development and temperament. Participants (N = 104) were recruited during pregnancy from a community sample. Participants completed clinician-administered and self-report measures of depressive and anxiety symptoms during the third trimester of pregnancy and at 16 months postpartum; child behavior and temperament outcomes were assessed at 16 months postpartum. Child development areas included gross and fine motor skills, language and problem-solving abilities, and personal/social skills. Child temperament domains included surgency, negative affectivity, and effortful control. Hierarchical multiple regression analyses demonstrated that elevated prenatal social anxiety symptoms significantly predicted more negative maternal report of child behavior across most measured domains. Elevated prenatal social anxiety and panic symptoms predicted more negative maternal report of child effortful control. Depressive and agoraphobia symptoms were not significant predictors of child outcomes. Elevated anxiety symptoms appear to have a distinct association with maternal report of child development and temperament. Considering the relative influence of anxiety symptoms, particularly social anxiety, on maternal report of child behavior and temperament can help to identify potential difficulties early on in mother-child interactions as well as inform interventions for women and their families.
Topics: Anxiety; Child Behavior; Child, Preschool; Female; Humans; Mothers; Pregnancy; Puerperal Disorders; Temperament
PubMed: 32907691
DOI: 10.1017/S2040174420000781 -
Deutsches Arzteblatt International Jan 2022
Topics: Cardiomyopathies; Female; Humans; Peripartum Period; Pregnancy; Pregnancy Complications, Cardiovascular; Puerperal Disorders
PubMed: 35410671
DOI: 10.3238/arztebl.m2022.0031 -
Radiographics : a Review Publication of... Apr 2024Severe obstetric hemorrhage is a leading cause of maternal mortality and morbidity worldwide. Major hemorrhage in the antepartum period presents potential risks for both...
Severe obstetric hemorrhage is a leading cause of maternal mortality and morbidity worldwide. Major hemorrhage in the antepartum period presents potential risks for both the mother and the fetus. Similarly, postpartum hemorrhage (PPH) accounts for up to a quarter of maternal deaths worldwide. Potential causes of severe antepartum hemorrhage that radiologists should be familiar with include placental abruption, placenta previa, placenta accreta spectrum disorders, and vasa previa. Common causes of PPH that the authors discuss include uterine atony, puerperal genital hematomas, uterine rupture and dehiscence, retained products of conception, and vascular anomalies. Bleeding complications unique to or most frequently encountered after cesarean delivery are also enumerated, including entities such as bladder flap hematomas, rectus sheath and subfascial hemorrhage, and infectious complications of endometritis and uterine dehiscence. RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Javitt and Madrazo in this issue.
Topics: Pregnancy; Female; Humans; Postpartum Hemorrhage; Placenta; Cesarean Section; Puerperal Disorders; Hematoma
PubMed: 38547034
DOI: 10.1148/rg.230164 -
Hypertension (Dallas, Tex. : 1979) Jan 2020
Topics: Cardiomyopathies; Early Diagnosis; Female; Humans; Peripartum Period; Puerperal Disorders
PubMed: 31707839
DOI: 10.1161/HYPERTENSIONAHA.119.13742 -
European Journal of Obstetrics,... Mar 2023Secondary postpartum haemorrhage is a significant cause of postnatal morbidity and admission to hospital. It can be managed medically, surgically or with interventional... (Review)
Review
Secondary postpartum haemorrhage is a significant cause of postnatal morbidity and admission to hospital. It can be managed medically, surgically or with interventional radiological techniques, however, there is limited evidence to inform the most appropriate use of these treatments. This review aimed to summarise the existing evidence and evaluate the effectiveness and safety of the management options available for secondary postpartum haemorrhage. MEDLINE, EMBASE, CENTRAL, SCOPUS, Clinicaltrials.gov and ICTRP were searched from conception to August 2021. Eligible studies described the management of participants with secondary postpartum haemorrhage occurring between 24 h and 12 weeks after a pregnancy of at least 20 weeks gestation. All treatment interventions were eligible. Outcomes included reduction of bleeding, hospital admissions, re-presentations to hospital, secondary surgical procedures, blood transfusions, adverse effects of treatment, surgical complications, hysterectomy, ICU admissions, severe morbidity and mortality. The protocol for this review was registered with PROSPERO (ID: CRD42021274146). Eleven studies, describing 834 participants, were eligible for inclusion. Five studies reported outcomes of a single intervention and six studies reported outcomes of more than one treatment modality. Assessed interventions included medical management, surgical procedures, and radiological techniques. Resolution of bleeding was seen in 8.2-84.6 % of participants following medical management, 89.3-100 % following surgical management and 87.5-100 % post transcatheter arterial embolisation. When considering only studies published in the last 30 years, these results are 71.9-73.7 %, 89.3-92.0 % and 87.5-100 % respectively. All included studies were small and retrospective observational in design with poor methodological quality leading to a serious or critical risk of bias. This review has highlighted the deficiencies in evidence for the management of secondary PPH. Future, well designed, prospective studies are needed to provide guidance to clinicians managing this condition.
Topics: Pregnancy; Female; Humans; Postpartum Hemorrhage; Retrospective Studies
PubMed: 36708658
DOI: 10.1016/j.ejogrb.2023.01.023 -
American Journal of Obstetrics &... May 2023Up-to-date data on population-level risk factors for postpartum psychosis is limited, although increasing substance use disorders, psychiatric disorders, autoimmune...
BACKGROUND
Up-to-date data on population-level risk factors for postpartum psychosis is limited, although increasing substance use disorders, psychiatric disorders, autoimmune disorders, and other medical comorbidities in the obstetrical population may be contributing to the increased baseline risk of postpartum psychosis.
OBJECTIVE
This study aimed to determine trends in and risk factors for postpartum psychosis during delivery hospitalizations and postpartum readmissions.
STUDY DESIGN
Analyzing the 2016-2019 Nationwide Readmission Database, this repeated cross-sectional study identified diagnoses of postpartum psychosis during delivery hospitalizations and postpartum readmissions within 60 days of discharge. The relationship among demographic, clinical, and hospital-level factors present at delivery and postpartum psychosis was analyzed with logistic regression models with adjusted odds ratios with 95% confidence intervals as measures of association. Separate models were created for postpartum psychosis diagnoses at delivery and during postpartum readmission. Temporal trends in diagnoses were analyzed with Joinpoint regression to determine the average annual percent change with 95% confidence intervals.
RESULTS
Of 12,334,506 deliveries in the analysis, 13,894 (1.1 per 1000) had a diagnosis of postpartum psychosis during the delivery hospitalization, and 7128 (0.6 per 1000) had a 60-day postpartum readmission with postpartum psychosis. Readmissions with postpartum psychosis increased significantly during the study period (P=.046). Most readmissions with a postpartum psychosis diagnosis occurred in 0 to 10 days (43% of readmissions) or 11 to 20 days (18% of readmissions) after discharge. Clinical factors with the highest adjusted odds for postpartum psychosis readmission included delivery postpartum psychosis (adjusted odds ratio, 5.8; 95% confidence interval, 4.2-8.0), depression disorder (adjusted odds ratio, 3.7; 95% confidence interval, 3.3-4.2), bipolar spectrum disorder (odds ratio, 2.9; 95% confidence interval, 2.3-3.5), and schizophrenia spectrum disorder (adjusted odds ratio, 2.9; 95% confidence interval, 2.1-4.0). In models analyzing postpartum psychosis diagnoses at delivery, risk factors associated with the highest odds included anxiety disorder (adjusted odds ratio, 3.9; 95% confidence interval, 3.5-4.2), schizophrenia spectrum disorder (adjusted odds ratio, 2.5; 95% confidence interval, 1.9-3.4), bipolar disorder (adjusted odds ratio, 1.8; 95% confidence interval, 1.6-2.1), stillbirth (odds ratio, 3.6; 95% confidence interval, 3.1-4.2), and substance use disorder (odds ratio, 1.7; 95% confidence interval, 1.6-1.9). In addition, chronic conditions, such as pregestational diabetes mellitus, obesity, and substance use, were associated with delivery and readmission postpartum psychosis.
CONCLUSION
This study determined that postpartum psychosis is increasing during postpartum readmissions and is associated with a wide range of obstetrical and medical comorbidities. Close follow-up care after delivery for other medical and obstetrical diagnoses may represent an opportunity to identify postpartum psychiatric conditions, including postpartum psychosis.
Topics: Female; Humans; Patient Readmission; Cross-Sectional Studies; Hospitalization; Postpartum Period; Puerperal Disorders; Psychotic Disorders; Substance-Related Disorders
PubMed: 36775196
DOI: 10.1016/j.ajogmf.2023.100905 -
The Journal of Dairy Research May 2020This review deals with the prospects and achievements of individual dairy cow management (IDCM) and the obstacles and difficulties encountered in attempts to... (Review)
Review
This review deals with the prospects and achievements of individual dairy cow management (IDCM) and the obstacles and difficulties encountered in attempts to successfully apply IDCM into routine dairy management. All aspects of dairy farm management, health, reproduction, nutrition and welfare are discussed in relation to IDCM. In addition, new IDCM R&D goals in these management fields are suggested, with practical steps to achieve them. The development of management technologies is spurred by the availability of off-the-shelf sensors and expanded recording capacity, data storage, and computing capabilities, as well as by demands for sustainable dairy production and improved animal wellbeing at a time of increasing herd size and milk production per cow. Management technologies are sought that would enable the full expression of genetic and physiological potential of each cow in the herd, to achieve the dairy operation's economic goals whilst optimizing the animal's wellbeing. Results and conclusions from the literature, as well as practical experience supported by published and unpublished data are analyzed and discussed. The object of these efforts is to identify knowledge and management routine gaps in the practical dairy operation, in order to point out directions and improvements for successful implementation of IDCM in the dairy cows' health, reproduction, nutrition and wellbeing.
Topics: Animal Nutritional Physiological Phenomena; Animal Welfare; Animals; Body Weight; Cattle; Cattle Diseases; Dairying; Eating; Estrus Detection; Female; Health Status; Lactation; Lameness, Animal; Mammary Glands, Animal; Monitoring, Physiologic; Pregnancy; Puerperal Disorders; Reproduction
PubMed: 32431258
DOI: 10.1017/S0022029920000382 -
Revista Da Associacao Medica Brasileira... 2023
Topics: Female; Humans; Psychotic Disorders; Puerperal Disorders
PubMed: 37556644
DOI: 10.1590/1806-9282.2023S125