The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
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J. Matern. Fetal. Neonatal. Med. · Feb 2020
Abdominal computed tomography (CT) scan in the evaluation of refractory puerperal fever: impact on management.
Introduction: Computed tomography (CT) imaging should be employed judiciously, given its cost, use of intravenous contrast, and ionizing radiation. The aim of this study was to determine the clinical benefit of a CT scan in the evaluation of refractory puerperal fever and to identify the appropriate candidates for its use. Methods: This was a retrospective cohort study conducted in a single tertiary care center between January 2007 to April 2017. ⋯ Results of the CT changed clinical management in 93 (39.0%) patients, including: switching antibiotics in 24 (10%) patients, adding low molecular weight heparin for 28 (11.8%) patients, and surgical intervention (laparotomy or drainage insertion) in 41 (17.2%) patients. In the regression model, we didn't find any significant risk factors associated with treatment change following the CT scan. Conclusions: Abdominal and pelvic CT scan in women with refractory puerperal fever has a high clinical yield and lead to a change in management in a substantial number of patients.
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J. Matern. Fetal. Neonatal. Med. · Feb 2020
Efficacy of the NICHD vaginal birth after cesarean delivery calculator: a single center experience.
Objective: As the cesarean delivery rate has risen future pregnancy outcomes are impacted including the decision to undergo a repeat cesarean or a vaginal birth after cesarean (VBAC) in the subsequent pregnancy. A calculator was developed by the maternal fetal medicine units (MFMUs) network in 2007 to estimate the chance of successful VBAC and is used widely. The purpose of this study was to investigate the calculator's validity on our obstetric patient population. ⋯ When stratified by race, we found the calculator to be a better predictor of success in African-American patients, as the calculator appears to underestimate success in white and Hispanic patients. Conclusion: Calculators are helpful to facilitate patient counseling and shared decision-making regarding the patient's choice for VBAC. When providing such counseling, the potential for reduced predicted VBAC success in the mid-decile range with the MFMU calculator should be recognized.
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J. Matern. Fetal. Neonatal. Med. · Jan 2020
Susac syndrome and pregnancy: a relationship to clarify. About two cases and review of the literature.
Background: Susac syndrome is a vasculopathy that affects the central nervous system, mainly the brain parenchyma, retina and inner ear. It affects mainly young women and. Management is based on expert consensus and in pregnant women the treatment is not well established. ⋯ Treatment in pregnancy or puerperium is not well established. Précis: Susac syndrome is a disease that requires a high clinical suspicion, especially in pregnant women. Treatment in pregnancy or puerperium is not well established.
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J. Matern. Fetal. Neonatal. Med. · Jan 2020
Maternal racial and ethnic disparities in glycemic threshold for pharmacotherapy initiation for gestational diabetes.
Objective: To compare the glycemic threshold for pharmacotherapy initiation in women with gestational diabetes (GDM) based on maternal race/ethnicity. Methods: A retrospective cohort study of women with GDM who received pharmacotherapy during pregnancy, in addition to diet and exercise, between 2015 and 2019 in a university center. The primary outcome was percent of elevated capillary blood glucoses (CBGs) prior to pharmacotherapy initiation. ⋯ In univariable analysis, NHB women, Hispanic, and women of other race and ethnicity had higher percent of elevated CBGs prior to pharmacotherapy initiation, compared to NHW women (45.5 ± 22.5% for NHW, 65.2 ± 25.4% for NHB, 58.3 ± 21.7% for Hispanic and 51.6 ± 26.8% for other race and ethnicity, respectively, p < .001). After the adjustment for maternal demographic and clinical factors, maternal race and ethnicity remained to be significantly associated with timing of pharmacotherapy initiation, with women of racial and ethnic minority having a higher percent of elevated CBGs prior to pharmacotherapy initiation (adjusted linear regression coefficient 18.1, 95% CI 11.3-25.0 for NHB, adjusted linear regression coefficient 13.2, 95% CI 5.0-21.4 for Hispanic, and adjusted linear regression coefficient 9.8, 95% CI 2.6-16.9 for women of other race and ethnicity). Conclusion: A significant variation was identified in glycemic threshold for pharmacotherapy initiation in women with GDM across different maternal racial and ethnic groups with minority women starting pharmacotherapy at higher percent of elevated CBGs.
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J. Matern. Fetal. Neonatal. Med. · Jan 2020
Psychosocial and biological paternal role in pregnancy outcomes.
Background: Pregnancy outcomes are affected by many different factors. One of the influential factors on pregnancy outcomes is the male partner as an important person to mother's wellbeing. Objective: The aim of the present study was to investigate the effects of male partner's role including socioeconomic support, emotional support, accompanying pregnant women during prenatal care visits (PNC) and labor, and the level of pregnant women's satisfaction from their partners' support and involvement during pregnancy on pregnancy outcomes. ⋯ Regarding psychosocial exposures, placental abruption was more prevalent in mothers with exposure to verbal aggression versus non-exposed ones (9 versus 2%, odds ratio: 4.0, 95% CI 0.9-24.6, p: .04). Moreover, a weak positive association between neonatal gestational age at birth and quality of mother's participation in PNC visits (r: +0.3, p: .01) as well as mother's satisfaction from father's commitment to PNC visits was found (r: +0.1, p: .03). Conclusion: Male partners may play a key role in pregnant women and fetus's heath.