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Gao Q, Jiang H, Jia M, Xiong J. Acute puerperal uterine inversion with successful manual transvaginal repositioning: A case report. Medicine (Baltimore) 2024; 103:e37986. [PMID: 38669392 PMCID: PMC11049735 DOI: 10.1097/md.0000000000037986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
RATIONALE Uterine inversion is a rare medical condition that is categorized as puerperal and nonpuerperal. Repositioning of uterine involution can be done manually or surgically, the latter of which involves abdominal manipulation and disruption of the integrity of the uterine wall, which can lead to complications for the patient in subsequent pregnancies, such as uterine rupture. PATIENT CONCERNS We report a case of acute puerperal uterine inversion that was manually repositioned transvaginally. An ultrasonogram and reset schematic were also presented. A 23-year-old woman (gravida 1 para 0) was admitted to the hospital with a full-term pregnancy. DIAGNOSES In the postpartum period, we found placental adhesions and uterine inversion into the uterine cavity, which was confirmed by bedside ultrasound. INTERVENTIONS AND OUTCOMES We administered analgesic, relieving uterine spasms, and antishock therapy along with manual stripping of the placenta and ultrasound-guided uterine repositioning. After successful repositioning the patient vaginal bleeding decreased rapidly and she was discharged 3 days after delivery. LESSONS Early recognition, antishock therapy and prompt repositioning are key in the management of puerperal uterine inversion. We hope that this case will enable clinicians to better visualize the ultrasound imaging of uterine inversion and the process of manual repositioning.
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Affiliation(s)
- Qianqian Gao
- Departments of Obstetrics, Weifang People’s Hospital, First Affiliated Hospital of Weifang Medical College, Weifang, Shandong, China
| | - Hong Jiang
- Departments of Obstetrics, Weifang People’s Hospital, First Affiliated Hospital of Weifang Medical College, Weifang, Shandong, China
| | - Mengmeng Jia
- Departments of Obstetrics, Weifang People’s Hospital, First Affiliated Hospital of Weifang Medical College, Weifang, Shandong, China
| | - Jinqiu Xiong
- Departments of General Surgery, Weifang People’s Hospital, First Affiliated Hospital of Weifang Medical College, Weifang, Shandong, China
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Nieto-Tous M, Diaz-Martinez A, De-Arriba-García M, Roca-Prats A, Monfort-Beltrán S, Ivañez-Muñoz M, Alberola-Rubio J, Perales A, Monfort-Ortiz R. GESTACOVID Project: Psychological and Perinatal Effects in Spanish Pregnant Women Subjected to Strict Confinement Due to the COVID-19 Pandemic and Their Evolution during De-Escalation. J Clin Med 2023; 13:248. [PMID: 38202254 PMCID: PMC10779534 DOI: 10.3390/jcm13010248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
The lockdown and de-escalation process following the COVID-19 pandemic led to a period of new normality. This study aimed to assess the confinement impact on the mental health of peripartum women, as their psychological well-being may be particularly vulnerable and thus affect their offspring's development. A cross-sectional epidemiological study was conducted among women who gave birth during strict confinement (G0) and the new normality period (G1), in which a self-administered paper-based questionnaire assessed 15 contextual factors and the General Health Questionnaire-12 (GHQ-12). For each item, it was verified whether the positive screening rate differed in each confinement phase, and a risk factor study was conducted. For G0, significantly higher positive screening and preterm birth rates were observed in the positive screening group. In the case of G1, maternal age (>35 years), decreased physical activity, and normal weight were found to be protective factors against distress. This study underscores the heightened mental health risk for postpartum women during major psychosocial upheavals (war, economic crisis, natural disasters, or pandemics), along with their resilience as the positive screening rate decreases with the new normality. Findings encourage adopting strategies to identify high-risk women and promote effective measures, such as promoting physical activity.
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Affiliation(s)
- Mar Nieto-Tous
- Departmento de Obstetricia y Ginecología, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (R.M.-O.)
| | - Alba Diaz-Martinez
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain
| | | | - Alba Roca-Prats
- Departmento de Obstetricia y Ginecología, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (R.M.-O.)
| | - Sara Monfort-Beltrán
- Departmento de Obstetricia y Ginecología, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (R.M.-O.)
| | - María Ivañez-Muñoz
- Departmento de Obstetricia y Ginecología, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (R.M.-O.)
| | - José Alberola-Rubio
- Instituto de Investigación Sanitaria La Fe de Valencia, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Alfredo Perales
- Departmento de Obstetricia y Ginecología, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (R.M.-O.)
- Departamento de Pediatría, Obstetricia y Ginecología, Facultad de Medicina, Universitat de València, 46010 Valencia, Spain
| | - Rogelio Monfort-Ortiz
- Departmento de Obstetricia y Ginecología, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (R.M.-O.)
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Acharya N, Acharya S, Shukla S, Potdar J, Waghe T, Kabra R. Acute Onset Postpartum Pleural Effusion: A Near-Miss Maternal Case Due to Scrub Typhus Infection. Cureus 2023; 15:e35142. [PMID: 36949983 PMCID: PMC10027019 DOI: 10.7759/cureus.35142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/18/2023] [Indexed: 02/20/2023] Open
Abstract
A 32-year-old puerperal patient developed acute onset breathlessness and fever on the third postoperative day. On evaluation, the patient was diagnosed to have scrub typhus pneumonia without any characteristic eschar. The condition was associated with pleural effusion, and it was drained. Azithromycin was used as the drug of choice due to the peripartum status of this patient. The patient improved due to early detection and multidisciplinary timely care. The safe outcome of this near-miss case suggests that fever profile workup, especially in scrub typhus endemic areas, should include scrub typhus testing even if classical signs are absent in the peripartum period.
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Affiliation(s)
- Neema Acharya
- Department of Obstetrics and Gynaecology, Datta Meghe Institute of Health and Education Research (DMIHER), Wardha, IND
| | - Sourya Acharya
- Department of Medicine, Datta Meghe Institute of Health and Education Research (DMIHER), Wardha, IND
| | - Samarth Shukla
- Department of Pathology, Datta Meghe Institute of Health and Education Research (DMIHER), Wardha, IND
| | - Jyotsana Potdar
- Department of Obstetrics and Gynaecology, Datta Meghe Institute of Health and Education Research (DMIHER), Wardha, IND
| | - Tejal Waghe
- Department of Obstetrics and Gynaecology, Datta Meghe Institute of Health and Education Research (DMIHER), Wardha, IND
| | - Ruchita Kabra
- Department of Medicine, Datta Meghe Institute of Health and Education Research (DMIHER), Wardha, IND
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Ferguson SM, Arbona D, Furiato A. Postpartum Ovarian Vein Thrombosis: Case Report. Clin Pract Cases Emerg Med 2022; 6:141-145. [PMID: 35701363 PMCID: PMC9197755 DOI: 10.5811/cpcem.2022.1.53749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 01/10/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Postpartum ovarian vein thrombosis (POVT) is an uncommon diagnosis that may lead to morbidity or mortality if unrecognized. CASE REPORT This report discusses a single case of POVT in a community hospital, along with the treatment and clinical course. CONCLUSION The mechanism is believed to be right-sided clot formation provoked by anatomical and hormonal changes of gestation. Diagnosis is challenging as most patients are previously healthy and symptoms are often vague. Although the differential is broad, modern imaging is sensitive and specific for diagnosis. Prompt treatment with broad-spectrum antibiotics and anticoagulation may reduce morbidity, and prognosis following treatment is excellent.
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Pêgo-Fernandes PM, Scalabrini A, Hajjar LA, da Costa PB, Kalil R, Jatene FB. Use of CentriMag for refractory cardiogenic shock in a puerperal woman: case report. SAO PAULO MED J 2021; 139:412-415. [PMID: 33978133 PMCID: PMC9615594 DOI: 10.1590/1516-3180.2020.0775.18022021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/18/2021] [Indexed: 11/22/2022] Open
Abstract
CONTEXT Heart failure in Brazil is a major public health problem and, even with advances in treatment, it still presents high morbidity and mortality. As a treatment option, mechanical circulatory assist devices (MCADs) have greatly increased in importance over the last decade. CASE REPORT This report concerns a case of refractory cardiogenic shock due to acute myocarditis in a 35-year-old puerperal female patient who presented with retrosternal pain, fatigue and dyspnea. At the hospital, she was diagnosed with myocarditis. There was no improvement in perfusion even after receiving dobutamine, intra-aortic balloon passage (IAB) and venoarterial extracorporeal membrane oxygenation (VA-ECMO). Therefore, it was decided to implant a MCAD (CentriMag). During hospitalization, recovery from the bi-ventricular dysfunction was achieved. The CentriMag device was removed 10 days after it had been implanted, and the patient was discharged after another 8 days. The myocarditis was proven to be due to the Coxsackie virus. CONCLUSIONS The decision to implant a MCAD should be individualized, as patient profiles do not always match the indications in the guidelines and protocols. In this study, clinical discussion of the case among the medical and multi-professional teams was essential in order to be able to successfully reverse the patient's severe clinical condition without sequelae, through using a CentriMag implant.
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Affiliation(s)
- Paulo Manuel Pêgo-Fernandes
- MD, PhD. Full Professor, Thoracic Surgery Division, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR; and Cardiothoracic Surgeon, Hospital Sírio Libanês (HSL), São Paulo (SP), Brazil.
| | - Augusto Scalabrini
- MD, PhD. Member of the Scientific Committee, Cardiology Center, Hospital Sírio Libanês (HSL), São Paulo (SP), Brazil; and Associate Professor, Emergency Clinic, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Ludhmila Abrahão Hajjar
- MD, PhD. Medical Supervisor of Cardio-Oncology, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Priscila Berenice da Costa
- PhD. Registered Nurse, Thoracic Surgery Division, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Roberto Kalil
- MD, PhD. Full Professor, Cardiology Division, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR; and General Director of the Cardiology Center, Hospital Sírio Libanês (HSL), São Paulo (SP), Brazil.
| | - Fabio Biscegli Jatene
- MD, PhD. Full Professor, Cardiovascular Surgery Division, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR; and Cardiovascular Surgeon, Hospital Sírio Libanês (HSL), São Paulo (SP), Brazil.
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Abstract
Bilateral facial palsy (BFP) is exceedingly rare, representing only 0.3%-2.0% of facial palsy cases. Unlike unilateral facial palsy, it is often caused by a serious underlying systemic disease and therefore warrants urgent medical intervention. The differential diagnosis is broad, and detailed history, physical examination, and investigations are essential for identifying the etiology. Common acquired causes in existing case series include Lyme disease, Guillain-Barré syndrome, sarcoidosis, trauma, and Bell’s palsy. Palsy that develops rapidly is often caused by trauma, infections, or autoimmune disorders, whereas slow progressive palsy suggests neoplastic diseases. While management varies by etiology, the physician can consider early empiric corticosteroids given their efficacy in numerous differential diagnoses. Antivirals can be considered in those with a strong history of viral prodrome. In this paper, we present the case of a puerperal patient with BFP and discuss its differential diagnosis, diagnostic approach, and management.
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Affiliation(s)
- Alvin Yang
- Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, CAN
| | - Vikram Dalal
- Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, CAN
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de Arriba-García M, Diaz-Martinez A, Monfort-Ortiz R, Roca-Prats A, Monfort-Beltrán S, Ivañez-Muñoz M, Alberola-Rubio J, Perales-Marín A. GESTACOVID project: psychological and perinatal effects in Spanish pregnant women subjected to confinement due to the COVID-19 pandemic. J Matern Fetal Neonatal Med 2021; 35:5665-5671. [PMID: 33615968 DOI: 10.1080/14767058.2021.1888922] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION COVID-19 was declared a pandemic and confinement with movement restriction measures were applied in Spain. Postnatal mental disorders are common but frequently undiagnosed, being a risk period to develop anxiety and depression symptoms. The aim of this study is to evaluate the impact of confinement as depressive and anxiety symptoms in pregnant women (PrW) and puerperal women (PuW) mental health, as well as obstetric and perinatal outcomes during this period. MATERIALS AND METHODS The self-administered survey consists of a total of 28 questions, the first 16 providing contextual information and the following ones corresponding to the GHQ-12 that has been evaluated in a binomial form. A logistic regression model has been used to assess whether the contextual variables acted as a protective or risk factor and its fitting has been represented by a receiver operating curve. RESULTS Of the 754 PrW interviewed, 58.22% were screened positive. Confinement time for these was 54.93 ± 9.75 days. The risk factors that were identified after the refinement have been to have a worse general state of health, to be sadder and to be more nervous. Among the protectors have been found to have a higher Apgar 10 score and induction of labor. The area under the adjusted regression adjustment curve was 0.8056. CONCLUSIONS Our results show a high prevalence of depression and anxiety symptoms with strict confinement measures. PrW and PuW must be considered a risk group to develop mental health disorders during disruption circumstances. Using a mental health screening tool could help to identify a group of patients with more risk and to carry out a careful monitoring to allow adequate management.
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Affiliation(s)
| | - Alba Diaz-Martinez
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain
| | - Rogelio Monfort-Ortiz
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Alba Roca-Prats
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Sara Monfort-Beltrán
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - María Ivañez-Muñoz
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - José Alberola-Rubio
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Alfredo Perales-Marín
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Departamento de Pediatría, Obstetricia y Ginecología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain
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Gupta R, Pokharia P, Daspal U, Ammar H. Laparoscopic treatment of postpartum pre-sacral haematoma. J Minim Access Surg 2021; 17:265-267. [PMID: 33723187 PMCID: PMC8083755 DOI: 10.4103/jmas.jmas_153_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Postpartum retroperitoneal or pelvic haematomas are rare after vaginal delivery. The clinical presentation can vary from being an incidental finding to the development of life-threatening bleeding. Due to their rarity, there are no established guidelines for the management of these postpartum haematomas. The reported treatments vary from watchful observation to emergent laparotomy. We report a case of postpartum pre-sacral haematoma after uneventful vaginal delivery managed successfully by laparoscopic drainage after the failure of conservative treatment.
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Affiliation(s)
- Rahul Gupta
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Pradip Pokharia
- Department of Radiology, Synergy Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Ujjwal Daspal
- Department of Anaesthesia, Synergy Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Houssem Ammar
- Department of Digestive Surgery, Sahloul Hospital, University of Sousse, Sousse, Tunisia
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Rule C, Ashley L, Bergin C. Sonographic findings in acute puerperal endometritis. Australas J Ultrasound Med 2018; 21:234-240. [PMID: 34760528 PMCID: PMC8409861 DOI: 10.1002/ajum.12112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate the reliability of the sonographic subserosal hypoechoic rim sign and endomyometrial junction indistinctness in distinguishing patients with acute puerperal endometritis from other common postpartum complications, particularly those with retained products of conception. METHODS Radiographic coding identified all patients presenting to Auckland City Hospital over a 12-month period between 1 March 2016 and 28 February 2017 who had pelvic ultrasound scans to assess for postpartum complications. Clinical notes were reviewed to identify those patients with a clinical diagnosis of acute endometritis. After exclusion criteria were applied, the ultrasound images of 31 patients with acute endometritis and 31 randomly selected controls from the remaining pool of postpartum patients were randomised and anonymised. Ultrasound images were retrospectively reviewed by two independent radiologists to identify the presence or absence of the hypoechoic subserosal rim and endomyometrial junction indistinctness signs. RESULTS The average sensitivity and specificity for readers identifying the subserosal hypoechoic rim sign in full-term postpartum patients with acute endometritis were 76.9% and 92.1%, respectively. Interobserver reliability was moderate with a kappa value of 0.5. The average sensitivity and specificity for endomyometrial junction indistinctness were 89.0% and 95.2%, respectively, with substantial inter-observer agreement, Kappa 0.7. These signs remained specific but were less frequently observed in postpartum patients scanned during early pregnancy. CONCLUSION We have shown that identifying the subserosal hypoechoic rim and endomyometrial junction indistinctness on ultrasound scans can reliably help to distinguish patients with acute postpartum endometritis from other complications, particularly in full-term postpartum patients.
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Affiliation(s)
- Catherine Rule
- Radiology Department Auckland City Hospital 2 Park Rd Grafton, Auckland 1023 New Zealand
| | - Linda Ashley
- Radiology Department Auckland City Hospital 2 Park Rd Grafton, Auckland 1023 New Zealand
| | - Colleen Bergin
- Radiology Department Auckland City Hospital 2 Park Rd Grafton, Auckland 1023 New Zealand
- Faculty of Medicine and Health Sciences University of Auckland 85 Park Rd Grafton, Auckland 1142 New Zealand
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10
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Gillies R, Ashley L, Bergin C. Sonographic findings in acute puerperal endometritis: The hypoechoic rim sign and endomyometrial junction indistinctness. Australas J Ultrasound Med 2017; 20:123-128. [PMID: 34760483 PMCID: PMC8409814 DOI: 10.1002/ajum.12057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To evaluate the accuracy of the sonographic subserosal hypoechoic rim sign and endomyometrial junctional indistinctness in identifying patients with acute endometritis during the puerperal period. METHODS Radiologic coding identified the ultrasound scans of all patients presenting to Auckland City Hospital between January 2014 and February 2016 who were diagnosed clinically as having acute endometritis during the post-partum or post-abortion period. After exclusion criteria were applied, the ultrasound scans of 31 patients with acute endometritis and 32 healthy controls were randomised and anonymised. Images were reviewed retrospectively by two independent reviewers to identify the presence of these signs. RESULTS The average sensitivity and specificity for readers identifying the subserosal hypoechoic rim sign in patients with acute endometritis were 71% and 92%, respectively. Interobserver reliability was good with an average kappa score of 0.63. Average sensitivity and specificity for endomyometrial junctional indistinctness were 79% and 72%, respectively, with good interobserver correlation (average kappa score 0.65). When both signs were either present or absent together, average sensitivity improved to 80.5% and average specificity was 91.7%. CONCLUSION We describe two new sonographic signs for puerperal endomyometritis that could improve the utility of ultrasound in the accurate and timely diagnosis of this condition.
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Affiliation(s)
- Rohana Gillies
- Radiology DepartmentAuckland City Hospital2 Park RdGraftonAuckland1023New Zealand
| | - Linda Ashley
- Radiology DepartmentAuckland City Hospital2 Park RdGraftonAuckland1023New Zealand
| | - Colleen Bergin
- Faculty of Medicine and Health SciencesUniversity of Auckland85 Park RdGraftonAuckland1142New Zealand
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Iyoke CA, Emegoakor FC, Ezugwu EC, Lawani LO, Ajah LO, Madu JA, Ezegwui HU, Ezugwu FO. Effect of treatment with single total-dose intravenous iron versus daily oral iron(III)-hydroxide polymaltose on moderate puerperal iron-deficiency anemia. Ther Clin Risk Manag 2017; 13:647-653. [PMID: 28761350 PMCID: PMC5493201 DOI: 10.2147/tcrm.s112227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Iron-deficiency anemia is the most common nutritional cause of anemia in pregnancy and is often responsible for puerperal anemia. Puerperal anemia can impair postpartum maternal and neonatal well-being. Objective To determine the effect of treatment of moderate puerperal iron-deficiency anemia using a single intravenous total-dose iron dextran versus daily single dose oral iron(III)-hydroxide polymaltose. Methodology A randomized controlled study in which postpartum women with moderate iron-deficiency anemia were randomized into treatment with either a single total-dose intravenous iron dextran or with daily single doses of oral iron(III)-hydroxide polymaltose tablets for 6 weeks. Effects on hemoglobin concentration using either method were compared at 6 weeks postpartum. Analysis was per protocol using SPSS version 17 for windows. P-values ≤0.05 were considered significant. Results Two hundred eighty-four women were recruited for the study: 142 women received single total dose intravenous infusion of iron dextran while 142 received daily oral iron(III)-hydroxide polymaltose tablets. Approximately 84.0% (237/282) completed the study and were analyzed including 81% (115/142) of those randomized to injectable iron therapy compared to 85.9% (122/142) of those randomized to oral treatment. The proportions of women who had attained hemoglobin concentration of at least 10 g/dL by the 6 weeks postpartum visit did not differ significantly between cases and controls (95.7% vs 94.3%; P=0.73). Similarly, the mean increases in hemoglobin following either therapeutic route were comparable (1.03±0.56 g/dL for intravenous iron and 0.97±0.46 g/dL for the oral group; P=0.42). Conclusion Single total-dose intravenous iron for treatment of puerperal iron-deficiency anemia was as effective as daily single doses of ferric iron tablets. For puerperal patients with iron-deficiency anemia in whom compliance with and tolerability of oral iron are not certain, a single total-dose intravenous iron can be safely offered.
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Affiliation(s)
| | | | | | | | | | | | - Hyginus Uzo Ezegwui
- Department of Obstetrics and Gynaecology, University of Nigeria, Enugu Campus
| | - Frank Okechukwu Ezugwu
- Department of Obstetrics and Gynaecology, College of Medicine, Enugu State University, Enugu, Nigeria
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Omori Y, Yanagisawa K, Sato A, Uchigata Y. The importance of nonstop treatment after delivery for pregnant women with type 2 diabetes. Diabetes Metab Res Rev 2017; 33. [PMID: 27667505 DOI: 10.1002/dmrr.2860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/07/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND There are no reports of very long follow-up studies of pregnant women with type 2 diabetes after delivery. Here we describe cases of Japanese women whom we treated for 20 to 50 years after deliveries to investigate the relationship between blood glucose control and diabetic complications. METHODS In Japan, the prevalence of type 1 diabetes is very low, and we have very few long-term follow-up cases with type 1 diabetes. Therefore, we chose to describe subjects with type 2 diabetes only. We present data on a total of 80 deliveries, 68 cases, treated by one of us (Y.O.) for more than a 50-year period. They are divided into 4 groups based on duration of treatment after delivery: more than 50 years (1 delivery, 1 patient), 40 to 49 years (13 deliveries, 11 patients), 30 to 39 years (19 deliveries, 16 patients), and 20 to 29 years (47 deliveries, 40 patients). Their present average ages in these 4 groups are 77, 72.4, 65.9, and 55.5 years, respectively. Their average HbA1c levels at last visit, in May 2014, are 8.2%, 7.6%.,7.2%, and 8.3%, respectively. RESULTS Despite elevated HbA1c levels, they had relatively few complications: 40% (no retinopathy), 43.8% (simple retinopathy), and 12.5% (treated with photocoagulation); 67.5% (no albuminuria), 26.3% (albuminuria), and 6.3% (treated with renal transplantation or hemodialysis). Therefore, even if glycemic control is not ideal, nonstop treatment of Japanese women for type 2 diabetes after deliveries is effective to prevent diabetic complications. CONCLUSIONS Long-term attention to care of diabetes after pregnancy may be preventive of diabetic complications in other populations as well.
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Affiliation(s)
- Yasue Omori
- Diabetes Center, Ebina General Hospital, Ebina, Japan
| | | | - Asako Sato
- Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan
- Department of Clinical Laboratory, Tokyo Women's Medical University, Tokyo, Japan
| | - Yasuko Uchigata
- Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan
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Hantsoo L, Ward-O’Brien D, Czarkowski KA, Gueorguieva R, Price LH, Epperson CN. A randomized, placebo-controlled, double-blind trial of sertraline for postpartum depression. Psychopharmacology (Berl) 2014; 231:939-48. [PMID: 24173623 PMCID: PMC3945214 DOI: 10.1007/s00213-013-3316-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 10/01/2013] [Indexed: 10/26/2022]
Abstract
RATIONALE Postpartum depression (PMD) occurs in roughly 10 % of postpartum women and negatively impacts the mother and her offspring, but there are few placebo-controlled studies of antidepressant treatment in this population. OBJECTIVE The objective was this study is to compare the selective serotonin reuptake inhibitor (SSRI) sertraline to placebo for treating PMD. METHODS This was a single-center, 6-week, randomized double-blind placebo-controlled trial of sertraline with a 1-week placebo lead-in. The participants (n = 38) were women with depression onset within 3 months of delivery; a subset (n = 27) met strict DSM-IV criteria for PMD (onset within 4 weeks of delivery). The participants were prescribed sertraline 50 mg or placebo daily to a maximum of 200 mg/day. Primary outcome variables were the Hamilton Depression Rating Scale (HAM-D) and Clinical Global Impressions (CGI) scores, which were used to determine the rates of response and remission. RESULTS Sertraline produced a significantly greater response rate (59 %) than placebo (26 %) and a more than twofold increased remission rate (53 % vs. 21 %). Mixed models did not reveal significant group by time effects, although in the subset of women who met the DSM-IV criteria, there was a statistically significant group by time effect for the HAM-D, Hamilton Anxiety Rating Scale (HAM-A), and CGI. CONCLUSIONS Women with PMD are more likely to have a remission of their depression with sertraline treatment, a finding that is more pronounced in women who have onset of depression within 4 weeks of childbirth. These data support the continued use of 4 weeks for the DSM-5 postpartum onset specifier for major depressive disorder.
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Affiliation(s)
- Liisa Hantsoo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA,
| | - Deborah Ward-O’Brien
- Department of Psychiatry, Yale University School of Medicine, 300 George St., New Haven, CT 06511
| | - Kathryn A. Czarkowski
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104,Penn Center for Women’s Behavioral Wellness, 3535 Market St., Philadelphia, PA 19104,Penn Center for the Study of Sex and Gender in Behavioral Health, 3535 Market St., Philadelphia, PA 19104
| | - Ralitza Gueorguieva
- Department of Biostatistics, Yale University Schools of Public Health and Medicine, 60 College St., New Haven, CT 06520
| | - Lawrence H. Price
- Butler Hospital and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 345 Blackstone Blvd, Providence, RI 02906
| | - C. Neill Epperson
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104,Penn Center for Women’s Behavioral Wellness, 3535 Market St., Philadelphia, PA 19104,Penn Center for the Study of Sex and Gender in Behavioral Health, 3535 Market St., Philadelphia, PA 19104,Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104
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14
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Heppelmann M, Krüger L, Leidl S, Bollwein H. Transrectal Doppler sonography of uterine blood flow during the first two weeks after parturition in Simmenthal heifers. J Vet Sci 2013; 14:323-7. [PMID: 23820167 PMCID: PMC3788158 DOI: 10.4142/jvs.2013.14.3.323] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 12/15/2012] [Indexed: 11/21/2022] Open
Abstract
Transrectal Doppler sonography was used to evaluate uterine blood flow during the first two weeks after parturition in six primiparous Simmental cows. The uterine blood flow was evaluated on the day of parturition (Day 0), once daily from Days 1 to 8 and then every other day until Day 14. Blood flow was quantified by determining the diameter (D), the time-averaged maximum velocity (TAMV), the pulsatility index (PI) and the blood flow volume (BFV) of the uterine arteries ipsilateral and contralateral to the formerly pregnant uterine horn. During the first four days after calving D, TAMV and BFV declined (ipsilateral: TAMV 70%, BFV 87%, contralateral: D 47%, BFV 84%; p < 0.05), while PI increased (ipsilateral 158%, contralateral 100%; p < 0.05) distinctly. Between Days 4 and 14 only the ipsilateral D (12%) and the BFV of both arteries (ipsilateral 5%, contralateral 8%) decreased (p < 0.05). Blood flow variables were very strongly correlated with each other (r > ±0.75, p < 0.05), with negative correlations with PI and positive correlations with all other investigated factors. Overall, this study revealed characteristic changes in uterine perfusion during the first two weeks after parturition in cows that were pronounced during the first four days postpartum.
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Affiliation(s)
- Maike Heppelmann
- Clinic for Cattle, University of Veterinary Medicine, Foundation, 30173 Hannover,
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15
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de Lira LQ, Lima MSR, de Medeiros JMS, da Silva IF, Dimenstein R. Correlation of vitamin A nutritional status on alpha-tocopherol in the colostrum of lactating women. Matern Child Nutr 2013; 9:31-40. [PMID: 22099335 PMCID: PMC6860850 DOI: 10.1111/j.1740-8709.2011.00376.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The adequate supply of vitamins A and E to newborns is essential. However, factors such as maternal nutritional status and nutrient interaction may limit its bioavailability. The aim of this study was to establish nutritional status for vitamins A and E and evaluate the correlation of retinol on colostrum alpha-tocopherol in lactating women. A total of 103 lactating women were recruited at a Brazilian public maternity hospital. Fasting serum and colostrum samples were collected in the immediate post-partum. Retinol and alpha-tocopherol levels were determined by high-performance liquid chromatography and nutritional status for these vitamins was defined from specific cut-off points for serum and colostrum. Mean serum and colostrum retinol (1.49 µmol L(-1) , 2.18 µmol L(-1) ) and alpha-tocopherol (26.4 µmol L(-1) , 26.1 µmol L(-1) ) indicated satisfactory biochemical status. However, we found a prevalence of subclinical deficiency of vitamin A and vitamin E in serum (15.5% and 16%) and colostrum (50% and 60%). Lactating women with serum retinol ≥ 1.05 µmol L(-1) showed an inverse correlation between serum retinol and alpha-tocopherol concentration in the colostrum (P = 0.008, r = -0.28). This association was not observed in serum level < 1.05 µmol L(-1) . The nutritional status of lactating women for vitamins A and E was adequate, although there is a risk of subclinical deficiency. The negative correlation of serum retinol on alpha-tocopherol concentration in the colostrum must be carefully evaluated in situations of vitamin A supplementation, because alpha-tocopherol bioavailability in maternal milk may be compromised.
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Affiliation(s)
- Larissa Queiroz de Lira
- Postgraduate Program in Biochemistry and Molecular Biology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Mayara Santa Rosa Lima
- Department of Nutrition, Health Science Center, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Isabelle Ferreira da Silva
- Postgraduate Program in Biochemistry and Molecular Biology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Roberto Dimenstein
- Department of Biochemistry at the Federal University of Rio Grande do Norte, Natal, Brazil
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