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TheScientificWorldJournal 2021This narrative review addresses resilience and stress during pregnancy, which is part of a broader concept of maternal health. Pregnancy and postpartum are opportune... (Review)
Review
This narrative review addresses resilience and stress during pregnancy, which is part of a broader concept of maternal health. Pregnancy and postpartum are opportune periods for health promotion interventions, especially because the close contact of the women with health professionals. In this way, it can be considered a useful window of opportunity to identify women at higher risk for adverse outcomes. Integrated health is a concept that aims at providing comprehensive care related to the promotion of individuals' physical, mental, and social well-being. In this context, stress during pregnancy has been targeted as a remarkable condition to be addressed whether due to individual issues, social issues, or specific pregnancy issues, since it is directly and indirectly associated with pregnancy complications. Stress is associated with preterm birth, postpartum depression, anxiety, child neurodevelopment, and fetal distress. The way that an individual faces a stressful and adverse situation is called resilience; this reaction is individual, dynamic, and contextual, and it can affect maternal and fetal outcomes. Low resilience has been associated with poorer pregnancy outcomes. The social context of pregnancy can act as a protective or contributory (risk) factor, indicating that environments of high social vulnerability play a negative role in resilience and, consequently, in perceived stress. A given stressor can be enhanced or mitigated depending on the social context that was imposed, as well as it can be interpreted as different degrees of perceived stress and faced with a higher or lower degree of resilience. Understanding these complex mechanisms may be valuable for tackling this matter. Therefore, in the pregnancy-puerperal period, the analysis of the stress-resilience relationship is essential, especially in contexts of greater social vulnerability, and is a health-promoting factor for both the mother and baby.
Topics: Anxiety; Depression, Postpartum; Female; Fetal Distress; Fetus; Humans; Infant, Newborn; Maternal Health; Parturition; Perinatal Care; Pregnancy; Pregnancy Complications; Premature Birth; Resilience, Psychological; Social Vulnerability; Stress, Psychological
PubMed: 34434079
DOI: 10.1155/2021/9512854 -
The Cochrane Database of Systematic... Jul 2020Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder that can develop in pregnancy. It occurs when there is a build-up of bile acids in the maternal blood. It... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder that can develop in pregnancy. It occurs when there is a build-up of bile acids in the maternal blood. It has been linked to adverse maternal and fetal/neonatal outcomes. As the pathophysiology is poorly understood, therapies have been largely empiric. As ICP is an uncommon condition (incidence less than 2% a year), many trials have been small. Synthesis, including recent larger trials, will provide more evidence to guide clinical practice. This review is an update of a review first published in 2001 and last updated in 2013.
OBJECTIVES
To assess the effects of pharmacological interventions to treat women with intrahepatic cholestasis of pregnancy, on maternal, fetal and neonatal outcomes.
SEARCH METHODS
For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (13 December 2019), and reference lists of retrieved studies.
SELECTION CRITERIA
Randomised or quasi-randomised controlled trials, including cluster-randomised trials and trials published in abstract form only, that compared any drug with placebo or no treatment, or two drug intervention strategies, for women with a clinical diagnosis of intrahepatic cholestasis of pregnancy.
DATA COLLECTION AND ANALYSIS
The review authors independently assessed trials for eligibility and risks of bias. We independently extracted data and checked these for accuracy. We assessed the certainty of the evidence using the GRADE approach.
MAIN RESULTS
We included 26 trials involving 2007 women. They were mostly at unclear to high risk of bias. They assessed nine different pharmacological interventions, resulting in 14 different comparisons. We judged two placebo-controlled trials of ursodeoxycholic acid (UDCA) in 715 women to be at low risk of bias. The ten different pharmacological interventions were: agents believed to detoxify bile acids (UCDA) and S-adenosylmethionine (SAMe); agents used to bind bile acids in the intestine (activated charcoal, guar gum, cholestyramine); Chinese herbal medicines (yinchenghao decoction (YCHD), salvia, Yiganling and Danxioling pill (DXLP)), and agents aimed to reduce bile acid production (dexamethasone) Compared with placebo, UDCA probably results in a small improvement in pruritus score measured on a 100 mm visual analogue scale (VAS) (mean difference (MD) -7.64 points, 95% confidence interval (CI) -9.69 to -5.60 points; 2 trials, 715 women; GRADE moderate certainty), where a score of zero indicates no itch and a score of 100 indicates severe itching. The evidence for fetal distress and stillbirth were uncertain, due to serious limitations in study design and imprecision (risk ratio (RR) 0.70, 95% CI 0.35 to 1.40; 6 trials, 944 women; RR 0.33, 95% CI 0.08 to 1.37; 6 trials, 955 women; GRADE very low certainty). We found very few differences for the other comparisons included in this review. There is insufficient evidence to indicate if SAMe, guar gum, activated charcoal, dexamethasone, cholestyramine, Salvia, Yinchenghao decoction, Danxioling and Yiganling, or Yiganling alone or in combination are effective in treating women with intrahepatic cholestasis of pregnancy.
AUTHORS' CONCLUSIONS
When compared with placebo, UDCA administered to women with ICP probably shows a reduction in pruritus. However the size of the effect is small and for most pregnant women and clinicians, the reduction may fall below the minimum clinically worthwhile effect. The evidence was unclear for other adverse fetal outcomes, due to very low-certainty evidence. There is insufficient evidence to indicate that SAMe, guar gum, activated charcoal, dexamethasone, cholestyramine, YCHD, DXLP, Salvia, Yiganling alone or in combination are effective in treating women with cholestasis of pregnancy. There are no trials of the efficacy of topical emollients. Further high-quality trials of other interventions are needed in order to identify effective treatments for maternal itching and preventing adverse perinatal outcomes. It would also be helpful to identify those women who are mostly likely to respond to UDCA (for example, whether bile acid concentrations affect how women with ICP respond to treatment with UDCA).
Topics: Charcoal; Cholagogues and Choleretics; Cholestasis; Cholestyramine Resin; Dexamethasone; Drugs, Chinese Herbal; Female; Fetal Distress; Galactans; Glucocorticoids; Humans; Mannans; Plant Gums; Pregnancy; Pregnancy Complications; Pruritus; Randomized Controlled Trials as Topic; S-Adenosylmethionine; Stillbirth; Ursodeoxycholic Acid
PubMed: 32716060
DOI: 10.1002/14651858.CD000493.pub3 -
The Cochrane Database of Systematic... Jun 2012Piracetam is thought to promote the metabolism of brain cells when they are hypoxic. It has been used to prevent adverse effects of fetal distress. (Review)
Review
BACKGROUND
Piracetam is thought to promote the metabolism of brain cells when they are hypoxic. It has been used to prevent adverse effects of fetal distress.
OBJECTIVES
The objective of this review was to assess the effects of piracetam for suspected fetal distress in labour on method of delivery and perinatal morbidity.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (15 February 2012).
SELECTION CRITERIA
Randomised trials of piracetam compared with placebo or no treatment for suspected fetal distress in labour.
DATA COLLECTION AND ANALYSIS
Both review authors assessed eligibility and trial quality.
MAIN RESULTS
One study of 96 women was included. Piracetam compared with placebo was associated with a trend to reduced need for caesarean section (risk ratio 0.57, 95% confidence interval 0.32 to 1.03). There were no statistically significant differences between the piracetam and placebo group for neonatal morbidity (measured by neonatal respiratory distress) or Apgar score.
AUTHORS' CONCLUSIONS
There is not enough evidence to evaluate the use of piracetam for fetal distress in labour.
Topics: Apgar Score; Cesarean Section; Delivery, Obstetric; Female; Fetal Distress; Humans; Labor, Obstetric; Neuroprotective Agents; Piracetam; Pregnancy; Randomized Controlled Trials as Topic
PubMed: 22696322
DOI: 10.1002/14651858.CD001064.pub2 -
American Family Physician Nov 1998Peripartum emergencies occur in patients with no known risk factors. When the well-being of the fetus is in question, the fetal heart rate pattern may offer etiologic... (Review)
Review
Peripartum emergencies occur in patients with no known risk factors. When the well-being of the fetus is in question, the fetal heart rate pattern may offer etiologic clues. Repetitive late decelerations may signify uteroplacental insufficiency, and a sinusoidal pattern may indicate severe fetal distress. Repetitive variable decelerations suggesting umbilical cord compression may be relieved by amnioinfusion. Regardless of the etiology of the nonreassuring fetal heart pattern, measures to improve fetal oxygenation should be attempted while options for delivery are considered. Massive obstetric hemorrhage requires prompt action. Clinical signs, such as painless bleeding, uterine tenderness and nonreassuring fetal heart patterns, may help to differentiate causes of vaginal bleeding that may or may not require emergency cesarean delivery. The causes of postpartum hemorrhage include uterine atony, vaginal or cervical laceration, and retained placenta. The challenge of managing shoulder dystocia is to effect a rapid delivery while avoiding neonatal and maternal morbidity. The McRoberts maneuver has been shown to be the safest and most successful technique for relieving shoulder dystocia. Eclampsia responds best to magnesium sulfate, supportive care and supplemental hydralazine or labetalol as needed for severe hypertension.
Topics: Algorithms; Decision Trees; Eclampsia; Emergencies; Family Practice; Female; Fetal Distress; Humans; Obstetric Labor Complications; Pregnancy; Risk Factors; Uterine Hemorrhage
PubMed: 9824957
DOI: No ID Found -
Best Practice & Research. Clinical... Jan 2017Identification of the fetus at risk of adverse outcome at term is a challenge to both clinicians and researchers alike. Despite the fact that fetal growth restriction... (Review)
Review
Identification of the fetus at risk of adverse outcome at term is a challenge to both clinicians and researchers alike. Despite the fact that fetal growth restriction (FGR) is a known risk factor for stillbirth, at least two thirds of the stillbirth cases at term are not small for gestational age (SGA) - a commonly used proxy for FGR. However, the majority of SGA fetuses are constitutionally small babies and do not suffer from adverse perinatal outcome. The cerebroplacental ratio (CPR) is emerging as a marker of failure to reach growth potential at term. CPR is an independent predictor of intrapartum fetal distress, admission to the neonatal unit at term, stillbirth, perinatal death and neonatal morbidity. Raised uterine artery Doppler resistance in the third trimester is independently associated with significantly lower birthweight and CPR. The combination of the estimated fetal weight, CPR and uterine Doppler in the third trimester can identify the majority of fetuses at risk of stillbirth.
Topics: Female; Fetal Distress; Fetal Growth Retardation; Fetus; Humans; Infant, Newborn; Infant, Small for Gestational Age; Middle Cerebral Artery; Perinatal Death; Placenta; Pregnancy; Pregnancy Trimester, Third; Risk Assessment; Stillbirth; Ultrasonography, Doppler; Ultrasonography, Prenatal; Umbilical Arteries; Uterine Artery; Uterus
PubMed: 27720309
DOI: 10.1016/j.bpobgyn.2016.09.003 -
The Cochrane Database of Systematic... Dec 2012Maternal oxygen administration has been used in an attempt to lessen fetal distress by increasing the available oxygen from the mother. This has been used for suspected... (Review)
Review
BACKGROUND
Maternal oxygen administration has been used in an attempt to lessen fetal distress by increasing the available oxygen from the mother. This has been used for suspected fetal distress during labour, and prophylactically during the second stage of labour on the assumption that the second stage is a time of high risk for fetal distress.
OBJECTIVES
The objective of this review was to assess the effects of maternal oxygenation for fetal distress during labour and to assess the effects of prophylactic oxygen therapy during the second stage of labour on perinatal outcome.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (22 October 2012) and searched reference lists of retrieved studies.
SELECTION CRITERIA
Randomized trials comparing maternal oxygen administration for fetal distress during labour and prophylactic oxygen administration during the second stage of labour with a control group (dummy or no oxygen therapy).
DATA COLLECTION AND ANALYSIS
Both review authors assessed eligibility and trial quality. Data were extracted, checked and entered into Review Manager software. For dichotomous data, we calculated relative risks (RR) and 95% confidence intervals (CI). For continuous data, we calculated weighted mean differences and 95% CI.
MAIN RESULTS
We located no trials addressing maternal oxygen therapy for fetal distress. We included two trials which addressed prophylactic oxygen administration during labour. Abnormal cord blood pH values (less than 7.2) were recorded significantly more frequently in the oxygenation group than the control group (RR 3.51, 95% CI 1.34 to 9.19). There were no other statistically significant differences between the groups. There were conflicting conclusions on the effect of the duration of oxygen administration on umbilical artery pH values between the two trials.
AUTHORS' CONCLUSIONS
Implications for practice There is not enough evidence to support the use of prophylactic oxygen therapy for women in labour, nor to evaluate its effectiveness for fetal distress.Implications for research In view of the widespread use of oxygen administration during labour and the possibility that it may be ineffective or harmful, there is an urgent need for randomized trials to assess its effects.
Topics: Female; Fetal Distress; Humans; Labor Stage, Second; Oxygen Inhalation Therapy; Pregnancy
PubMed: 23235574
DOI: 10.1002/14651858.CD000136.pub2 -
Acta Obstetricia Et Gynecologica... Jun 2014During the 1970s and 1980s, electronic fetal monitoring and fetal scalp blood sampling were introduced without robust evidence. With a methodical review of the published... (Review)
Review
During the 1970s and 1980s, electronic fetal monitoring and fetal scalp blood sampling were introduced without robust evidence. With a methodical review of the published literature, and using one randomized controlled trial, seven controlled studies, nine randomized studies of various surveillance methods and data from the Danish National Birth Registry, we have assessed the usefulness of fetal scalp blood sampling as a complementary tool to improve the specificity and sensitivity of electronic cardiotocography. Based on heterogeneous studies of modest quality with somewhat inconsistent results, we conclude that fetal scalp blood sampling in conjunction with cardiotocography can reduce the risk of operative delivery. Fetal scalp blood sampling can provide additional information on fetal wellbeing and fetal reserves at a time before decisions are made concerning the need for and timing of operative delivery and the choice of anesthesia, and be an adjunct in the interpretation of cardiotocography patterns.
Topics: Blood Specimen Collection; Cardiotocography; Delivery, Obstetric; Electrocardiography; Female; Fetal Distress; Fetal Monitoring; Humans; Pregnancy; Scalp
PubMed: 24806978
DOI: 10.1111/aogs.12421 -
Ugeskrift For Laeger Sep 2014The specific dermatoses of pregnancy are rare and consist of pemphigoid gestationis (PG), intrahepatic cholestasis of pregnancy (ICP), polymorphic eruption of pregnancy... (Review)
Review
The specific dermatoses of pregnancy are rare and consist of pemphigoid gestationis (PG), intrahepatic cholestasis of pregnancy (ICP), polymorphic eruption of pregnancy and atopic eruption of pregnancy. The dermatoses are characterized by pruritus, and they are important to recognize since PG and ICP increase the risk of prematurity, fetal distress and stillbirth. Diagnosis is based on medical history, morphology, blood sample and biopsy. The dermatoses are treated with respectively ursodeoxycholic acid (in case of ICP) and steroids. Breast-feeding is recommended and induction of labour is not normally indicated.
Topics: Cholestasis, Intrahepatic; Dermatitis, Atopic; Female; Fetal Death; Fetal Distress; Humans; Pemphigoid Gestationis; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Pruritus; Risk Factors
PubMed: 25294508
DOI: No ID Found -
Journal of Healthcare Engineering 2021In order to improve the effective extraction of fetal heart rate and prevent fetal distress in utero, a study of fetal heart rate feature extraction based on wavelet...
In order to improve the effective extraction of fetal heart rate and prevent fetal distress in utero, a study of fetal heart rate feature extraction based on wavelet transform to prevent fetal distress in utero was proposed. This paper adopts a fetal heart rate detection method based on the maximum value of the binary wavelet transform modulus. The method is simulated by the Doppler fetal heart signal obtained from the clinic. Compared with the original curve, the transformed curve can roughly see the change rule of the original signal and identify the peak point of the signal, but due to the large disturbance of the peak point, the influence on the computer processing is also great. The periodicity of the transformed signal is greatly enhanced, making it easier to deal with the computation. A total of 300 pregnant women with full-term fetal heart monitoring from January 2018 to January 2020 were selected as the research subjects and divided into the observation group and the control group. The observation group consisted of 100 patients with abnormal fetal heart monitoring, and the control group consisted of 200 patients with normal fetal heart monitoring. The uterine contractions and fetal heart rate were recorded, and the incidence of fetal distress, cesarean section, neonatal asphyxia, and amniotic fluid and fecal contamination were observed. The incidence of fetal distress, cesarean section, neonatal asphyxia, and amniotic fluid fecal stain in the observation group were significantly higher than those in the control group. Fetal heart monitoring can accurately judge the situation of the fetus in pregnant women and timely diagnose the abnormal fetal heart rate, which has a better effect on the prognosis of perinatal infants and can reduce their mortality. It can effectively solve the problems existing in the autocorrelation algorithm and extract the fetal heart rate more accurately. It is an effective improved scheme of fetal heart rate extraction. It is very helpful in preventing fetal distress in utero.
Topics: Cesarean Section; Female; Fetal Distress; Heart Rate, Fetal; Humans; Infant; Infant, Newborn; Pregnancy; Ultrasonography, Doppler; Wavelet Analysis
PubMed: 34630995
DOI: 10.1155/2021/7608785 -
The Cochrane Database of Systematic... Jun 2012Abdominal decompression was developed as a means of pain relief during labour. It has also been used for complications of pregnancy, and in healthy pregnant women in an... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Abdominal decompression was developed as a means of pain relief during labour. It has also been used for complications of pregnancy, and in healthy pregnant women in an attempt to improve fetal wellbeing and intellectual development.
OBJECTIVES
The objective of this review was to assess the effects of antenatal abdominal decompression for maternal hypertension or impaired fetal growth, on perinatal outcome.
SEARCH METHODS
The Cochrane Pregnancy and Childbirth Group's Trials Register (2 February 2012).
SELECTION CRITERIA
Randomised or quasi-randomised trials comparing abdominal decompression with no decompression in women with pre-eclampsia and/or fetuses thought to be compromised.
DATA COLLECTION AND ANALYSIS
Eligibility and trial quality were assessed by one review author.
MAIN RESULTS
Three studies were included, all with the possibility of containing serious bias. Therapeutic abdominal decompression was associated with the following reductions: persistent pre-eclampsia (relative risk 0.36, 95% confidence interval 0.18 to 0.72); fetal distress in labour (relative risk 0.37, 95% confidence interval 0.19 to 0.71); low birthweight (relative risk 0.50, 95% confidence interval 0.40 to 0.63); Apgar scores less than six at one minute (relative risk 0.26, 95% confidence interval 0.12 to 0.56); and perinatal mortality (relative risk 0.39, 95% confidence interval 0.22 to 0.71).
AUTHORS' CONCLUSIONS
Due to the methodological limitations of the studies, the effects of therapeutic abdominal decompression are not clear. The apparent improvements in birthweight and perinatal mortality warrant further evaluation of abdominal decompression where there is impaired fetal growth and possibly for women with pre-eclampsia.
Topics: Estriol; Female; Fetal Development; Fetal Diseases; Fetal Distress; Humans; Lower Body Negative Pressure; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Randomized Controlled Trials as Topic
PubMed: 22696313
DOI: 10.1002/14651858.CD000004.pub2