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American Journal of Perinatology Apr 2020Our primary objective was to identify risk factors for maternal readmission with sepsis. Our secondary objectives were to (1) assess diagnoses and infecting organisms at... (Comparative Study)
Comparative Study
OBJECTIVE
Our primary objective was to identify risk factors for maternal readmission with sepsis. Our secondary objectives were to (1) assess diagnoses and infecting organisms at readmission and (2) compare early (<6 weeks) and late (6 weeks to 9 months postpartum) maternal readmission with sepsis.
STUDY DESIGN
We identified our cohort using linked hospital discharge data and birth certificates for California deliveries from 2008 to 2011. Consistent with the 2016 sepsis classification, we defined sepsis as septicemia plus acute organ dysfunction. We compared women with early or late readmission with sepsis to women without readmission with sepsis.
RESULTS
Among 1,880,264 women, 494 (0.03%) were readmitted with sepsis, 61% after 6 weeks. Risk factors for readmission with sepsis included preterm birth, hemorrhage, obesity, government-provided insurance, and primary cesarean. For both early and late sepsis readmissions, the most common diagnoses were urinary tract infection and pyelonephritis, and the most frequently identified infecting organism was gram-negative bacteria. Women with early compared with late readmission with sepsis shared similar obstetric characteristics.
CONCLUSION
Maternal risk factors for both early and late readmission with sepsis included demographic characteristics, cesarean, hemorrhage, and preterm birth. Risks for sepsis after delivery persist beyond the traditional postpartum period of 6 weeks.
Topics: Adult; Body Mass Index; California; Cesarean Section; Female; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Multiple Organ Failure; Patient Readmission; Postpartum Hemorrhage; Premature Birth; Puerperal Disorders; Risk Factors; Sepsis; Socioeconomic Factors; Time Factors
PubMed: 31529451
DOI: 10.1055/s-0039-1696721 -
Journal of Pregnancy 2010Peripartum cardiomyopathy (PPCM) is a rare but potentially lethal complication of pregnancy occurring in approximately 1 : 3,000 live births in the United States... (Review)
Review
Peripartum cardiomyopathy (PPCM) is a rare but potentially lethal complication of pregnancy occurring in approximately 1 : 3,000 live births in the United States although some series report a much higher incidence. African-American women are particularly at risk. Diagnosis requires symptoms of heart failure in the last month of pregnancy or within five months of delivery in the absence of recognized cardiac disease prior to pregnancy as well as objective evidence of left ventricular systolic dysfunction. This paper provides an updated, comprehensive review of PPCM, including emerging insights into the etiology of this disorder as well as current treatment options.
Topics: Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Anticoagulants; Cardiomyopathies; Cytokines; Dyspnea; Edema; Electrocardiography; Female; Humans; Natriuretic Peptide, Brain; Pregnancy; Pregnancy Complications, Cardiovascular; Prognosis; Puerperal Disorders; Risk Factors; Stroke Volume; Tachycardia; Troponin T; Ventricular Dysfunction, Left
PubMed: 21490738
DOI: 10.1155/2010/149127 -
The Cochrane Database of Systematic... Oct 2008Mental health conditions arising in the perinatal period, including depression, have the potential to impact negatively on not only the woman but also her partner,... (Review)
Review
BACKGROUND
Mental health conditions arising in the perinatal period, including depression, have the potential to impact negatively on not only the woman but also her partner, infant, and family. The capacity for routine, universal antenatal psychosocial assessment, and thus the potential for reduction of morbidity, is very significant.
OBJECTIVES
To evaluate the impact of antenatal psychosocial assessment on perinatal mental health morbidity.
SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, the Cochrane Depression, Anxiety and Neurosis Group's Trials Register (CCDAN TR-Studies), HSRProj in the National Library of Medicine (USA), and the Current Controlled Trials website: http://www.controlled trials.com/ and the UK National Research Register (last searched March 2008).
SELECTION CRITERIA
Randomised and quasi-randomised controlled trials.
DATA COLLECTION AND ANALYSIS
At least two review authors independently assessed trials for eligibility; they also extracted data from included trials and assessed the trials for potential bias.
MAIN RESULTS
Two trials met criteria for an RCT of antenatal psychosocial assessment. One trial examined the impact of an antenatal tool (ALPHA) on clinician awareness of psychosocial risk, and the capacity of the antenatal ALPHA to predict women with elevated postnatal Edinburgh Depression Scale (EDS) scores, finding a trend towards increased clinician awareness of 'high level' psychosocial risk where the ALPHA intervention had been used (relative risk (RR) 4.61 95% confidence interval (CI) 0.99 to 21.39). No differences between groups were seen for numbers of women with antenatal EDS scores, a score of greater than 9 being identified by ALPHA as of concern for depression (RR 0.69 95% CI 0.35 to 1.38); 139 providers. The other trial reported no differences in EPS scores greater than 12 at 16 weeks postpartum between the intervention (communication about the EDS scores with the woman and her healthcare providers plus a patient information booklet) and the standard care groups (RR 0.86 95% CI 0.61 to 1.21; 371 women).
AUTHORS' CONCLUSIONS
While the use of an antenatal psychosocial assessment may increase the clinician's awareness of psychosocial risk, neither of these small studies provides sufficient evidence that routine antenatal psychosocial assessment by itself leads to improved perinatal mental health outcomes. Further studies with better sample size and statistical power are required to further explore this important public health issue. It will also be important to examine outcomes up to one year postpartum not only for mother, but also infant and family.
Topics: Anxiety Disorders; Depression, Postpartum; Female; Humans; Mental Health; Pregnancy; Prenatal Care; Puerperal Disorders; Randomized Controlled Trials as Topic
PubMed: 18843682
DOI: 10.1002/14651858.CD005124.pub2 -
MCN. the American Journal of Maternal... 2016To study the relation of infant characteristics and home environment on maternal sleep, depression, and fatigue in late postpartum.
PURPOSE
To study the relation of infant characteristics and home environment on maternal sleep, depression, and fatigue in late postpartum.
STUDY DESIGN AND METHODS
Forty-two healthy mother-infant dyads completed a home-based study at infant age 32 weeks. Maternal measures included Patient Reported Outcomes Measurement Information System (PROMIS) sleep and wake disturbance, depression, and fatigue scales. Home regularity was assessed using the Confusion, Hubbub, and Order Scale (CHAOS). Infant sleep and regulation were measured respectively by the Brief Infant Sleep Questionnaire (BISQ) and Infant-Toddler Symptom Checklist (ITSC).
RESULTS
Significant correlations among maternal sleep and wake disturbance, fatigue, and depression were detected (r = .519 to .746, p < .01), but not with infant variables. Home regularity was significantly related with maternal variables (r = .597 to .653, p < .01).
CLINICAL IMPLICATIONS
Regularity of the home environment appears to contribute to maternal sleep, depression, and fatigue. Implications for intervention include establishment of daily routines and household management to improve regularity and consequently improve maternal outcomes.
Topics: Adolescent; Adult; Depression, Postpartum; Fatigue; Female; Humans; Infant; Infant, Newborn; Longitudinal Studies; Maternal-Child Nursing; Mother-Child Relations; Pregnancy; Puerperal Disorders; Sleep Deprivation; Surveys and Questionnaires; Young Adult
PubMed: 26909724
DOI: 10.1097/NMC.0000000000000213 -
Acta Medica Portuguesa 2003The author refers to the main clinical symptoms, diagnosis, treatment and evaluation of the post-partum thyroiditis. Researches can reveal different post-partum...
The author refers to the main clinical symptoms, diagnosis, treatment and evaluation of the post-partum thyroiditis. Researches can reveal different post-partum thyroiditis, considering the diagnosis and screening. Normally the classical presentation of post-partum thyroiditis includes a period of thyrotoxicosis, followed by hypothyroidism and finally thyroid functions in its normal levels. According to some statistic investigation, authors mention that after a period of normal and stable status, hypothyroidism can prevail as a long-term disease.
Topics: Female; Humans; Puerperal Disorders; Thyroiditis
PubMed: 14750284
DOI: No ID Found -
British Medical Journal Dec 1966
Topics: Female; Humans; Pregnancy; Pregnancy Complications; Psychotic Disorders; Puerperal Disorders; United Kingdom
PubMed: 6006109
DOI: No ID Found -
British Medical Journal Mar 1971
Topics: Coronary Disease; Female; Gastrointestinal Hemorrhage; Humans; Hysterectomy; Pessaries; Postoperative Complications; Pregnancy; Puerperal Disorders; Pulmonary Embolism; Uterine Prolapse
PubMed: 5313364
DOI: 10.1136/bmj.1.5748.539 -
Archives of Women's Mental Health Feb 2010Several decades of research have focused on the impact of exposure to postnatal depression on children, while anxiety has been largely overlooked. Estimates of the... (Review)
Review
Several decades of research have focused on the impact of exposure to postnatal depression on children, while anxiety has been largely overlooked. Estimates of the prevalence of postnatal maternal anxiety (PMA) range from 3% to 43%, suggesting PMA may be an important risk factor for adverse outcomes in children. This review summarizes what is known about the effects of PMA exposure on children and makes recommendations for future research. A systematic search of Ovid MEDLINE and PsychINFO through 2008 identified 18 studies that evaluated child outcomes associated with PMA exposure. Identified studies covered three domains: somatic, developmental, and psychological outcomes. The strongest evidence for an adverse effect of PMA exposure is in somatic and psychological outcomes; the evidence for an effect of PMA on child development is inconclusive. Methodological differences among the studies make comparisons difficult and there are a number of common limitations that challenge the validity of these studies.
Topics: Anxiety Disorders; Female; Humans; Mothers; Parturition; Puerperal Disorders
PubMed: 19789953
DOI: 10.1007/s00737-009-0109-y -
Translational Psychiatry Dec 2017Postpartum psychosis (PP) is the most severe psychiatric disorder associated with childbirth. The risk of PP is very high in women with a history of bipolar affective...
Postpartum psychosis (PP) is the most severe psychiatric disorder associated with childbirth. The risk of PP is very high in women with a history of bipolar affective disorder or schizoaffective disorder. However, the neurobiological basis of PP remains poorly understood and no study has evaluated brain structure in women at risk of, or with, PP. We performed a cross-sectional study of 256 women at risk of PP and 21 healthy controls (HC) in the same postpartum period. Among women at risk, 11 who developed a recent episode of PP (PPE) (n = 2 with lifetime bipolar disorder; n = 9 psychotic disorder not otherwise specified) and 15 at risk women who did not develop an episode of PP (NPPE) (n = 10 with lifetime bipolar disorder; n = 1 with schizoaffective disorder; n = 1 with a history of PP in first-degree family member; n = 3 with previous PP). We obtained T1-weighted MRI scans at 3T and examined regional gray matter volumes with voxel-based morphometry and cortical thickness and surface area with Freesurfer. Women with PPE showed smaller anterior cingulate gyrus, superior temporal gyrus and parahippocampal gyrus compared to NPPE women. These regions also showed decreased surface area. Moreover, the NPPE group showed a larger superior and inferior frontal gyrus volume than the HC. These results should be interpreted with caution, as there were between-group differences in terms of duration of illness and interval between delivery and MRI acquisition. Nevertheless, these are the first findings to suggest that MRI can provide information on brain morphology that characterize those women at risk of PP more likely to develop an episode after childbirth.
Topics: Adult; Brain; Cross-Sectional Studies; Female; Humans; Magnetic Resonance Imaging; Psychotic Disorders; Puerperal Disorders; Risk Factors
PubMed: 29249808
DOI: 10.1038/s41398-017-0003-8 -
Journal of Dairy Science Sep 1988The descriptive epidemiology and risk factors were reviewed for six clinical disorders: milk fever, downer cow syndrome, hypomagnesemic tetany, udder edema, left... (Review)
Review
The descriptive epidemiology and risk factors were reviewed for six clinical disorders: milk fever, downer cow syndrome, hypomagnesemic tetany, udder edema, left displaced abomasum, and ketosis. Data were included also from preliminary analyses of a data set from approximately 61,000 Finnish Ayrshire cows. A web of postulated associations among the metabolic disorders and other risks factors (previous lactation diseases and milk yield, calf factors, certain dry period nutritional factors, dystocia, retained placenta, and metritis) was diagrammed.
Topics: Animals; Cattle; Cattle Diseases; Female; Metabolic Diseases; Pregnancy; Puerperal Disorders
PubMed: 3053813
DOI: 10.3168/jds.S0022-0302(88)79845-8