RESUMEN

OBJECTIVE: To describe the epidemiological, clinical, paraclinical, therapeutic and evolutionary characteristics of of peripartum cardiomyopathy (PPCM) in the internal medicine department of the Zinder National Hospital (ZNH). METHODS: This was a descriptive cross-sectional study carried out from 2018 to 2022 at the ZNH Department of Internal Medicine. Included were all patients admitted for PPCM who met National Heart Blood and Lung Institute criteria. The data collected was analyzed using Excel and EPI INFO v7. RESULTS: We had collected 100 cases of PPCM out of a total of 8706 hospitalized patients, i.e. a hospital prevalence of 1.14%. The mean age of the patients was 27.9 years ± 7.4 [17-45]. The majority of patients were from underprivileged social strata (n=64). The risk factors for PMPC found were essentially hot bath (n=66), home birth (n=40), natron porridge (n=35) and multiparity (n=57). Cardiac symptomatology appeared postpartum in 56% of patients. Dyspnea was the main symptom in 98% of cases. The physical signs were dominated by the functional systolic murmur (66%). Three quarters (75%) of the patients had congestive heart failure. Electrocardiographic signs were dominated by left ventricular hypertrophy (n=65). Cardiomegaly was present in 94% of patients. Left ventricular ejection fraction was altered in all patients. Impaired renal function was found in 31% of patients. Management was based on a low-sodium diet tripod, diuretics and converting enzyme inhibitors. Two cases of death were recorded. CONCLUSION: PPCM is common in the Zinder region. It affects young women with several risk factors and is revealed by signs of congestive heart failure. For a better understanding of this still poorly elucidated condition, it is necessary to pursue research efforts.

Asunto(s)

Cardiomiopatías , Periodo Periparto , Complicaciones Cardiovasculares del Embarazo , Humanos , Femenino , Adulto , Estudios Transversales , Embarazo , Cardiomiopatías/epidemiología , Cardiomiopatías/diagnóstico , Cardiomiopatías/etiología , Adulto Joven , Complicaciones Cardiovasculares del Embarazo/epidemiología , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Persona de Mediana Edad , Adolescente , Niger/epidemiología , Factores de Riesgo , Prevalencia , Trastornos Puerperales/epidemiología , Trastornos Puerperales/diagnóstico , Trastornos Puerperales/etiología , Recursos en Salud/estadística & datos numéricos

RESUMEN

PURPOSE: To determine the incidence of covert and overt postpartum urinary retention after vaginal delivery and the associated risk factors for postpartum urinary retention. To determine how well clinical examination by abdominal palpation correlates with ultrasound findings of urinary retention. METHODS: Patients after delivery were screened with ultrasound and examined clinically to check for retention of urine after voiding. RESULTS: A total of 822 of women were recruited in the study of which 86 (10.5%) women had significant post-void residue of urine. 33 (38.4%) had overt retention, while 53 (61.6%) had covert retention. Duration of labour and an increased VAS score were found to be significantly higher among those with urinary retention. Using clinical examination to diagnose postpartum urinary retention had a sensitivity of 66.1%, specificity of 88.6%, positive predictive value of 76.5% and negative predictive value of 82.3%. CONCLUSIONS: Clinical examination by abdominal palpation is not a very sensitive test in diagnosing PPUR.

Asunto(s)

Palpación , Ultrasonografía , Retención Urinaria , Humanos , Femenino , Retención Urinaria/diagnóstico , Retención Urinaria/epidemiología , Retención Urinaria/etiología , Adulto , Factores de Riesgo , Incidencia , Sensibilidad y Especificidad , Embarazo , Periodo Posparto , Adulto Joven , Valor Predictivo de las Pruebas , Trastornos Puerperales/diagnóstico , Trastornos Puerperales/orina , Trastornos Puerperales/epidemiología , Parto Obstétrico/efectos adversos

RESUMEN

INTRODUCTION AND HYPOTHESIS: The objective was to study the incidence of urinary incontinence (UI), associated risk factors and quality of life (QOL) in postpartum women. METHODS: A prospective study was conducted with 406 postpartum women at Rajavithi Hospital and followed up over the phone between June 2020 and September 2021. Inclusion criteria were singleton pregnant women aged 18-45 years, and gestational age ≥ 37 weeks. Baseline characteristics (age, body mass index, birthweight, gestational age, parity, delivery type, smoking, and alcohol and caffeine intake) were recorded. UI was defined as a score ≥ 16.7% using the Urogenital Distress Inventory. Incontinence-related QOL was evaluated using the Incontinence Impact Questionnaire: a score of ≥ 70 indicated poor QOL. Outcomes were assessed during the postpartum period at 2 days, 6 weeks, 3 months, and 6 months. Multivariate logistic regression was used to analyze risk factors for UI. RESULTS: The incidence of self-reported UI at 2 days, 6 weeks, 3 months, and 6 months postpartum were 39%, 3%, 1%, and 0% respectively. Caffeine consumption during pregnancy was only a risk factor for UI (adjusted RR 1.61, 95%CI 1.27-2.05, p < 0.001) after adjusting for age, BMI, birthweight, parity, delivery type, alcohol, smoking, and pelvic floor exercise. Three women with UI had poor QOL, whereas all women without UI reported a good QOL. CONCLUSION: In our study sample, urinary incontinence was found in one-third of women during the early postpartum period, but for most women symptoms improved with the first 6 weeks and all resolved at 6 months. In this study, caffeine consumption during pregnancy was the only risk factor for UI.

Asunto(s)

Calidad de Vida , Incontinencia Urinaria , Humanos , Femenino , Adulto , Estudios Prospectivos , Incidencia , Incontinencia Urinaria/epidemiología , Incontinencia Urinaria/etiología , Factores de Riesgo , Adulto Joven , Embarazo , Periodo Posparto , Cafeína/efectos adversos , India/epidemiología , Trastornos Puerperales/epidemiología , Trastornos Puerperales/etiología , Adolescente , Persona de Mediana Edad

RESUMEN

OBJECTIVE: The aim was to develop a predictive tool for anticipating postpartum endometritis occurrences and to devise strategies for prevention and control. METHODS: Employing a retrospective approach, the baseline data of 200 women diagnosed with postpartum endometritis in a tertiary maternity hospital in Zhejiang Province, spanning from February 2020 to September 2022, was examined. Simultaneously, the baseline data of 1,000 women without endometritis during the same period were explored with a 1:5 ratio. Subsequently, 1,200 women were randomly allocated into a training group dataset and a test group dataset, adhering to a 7:3 split. The selection of risk factors for postpartum endometritis involved employing random forests, lasso regression, and traditional univariate and multifactor logistic regression on the training group dataset. A nomogram was then constructed based on these factors. The model's performance was assessed using the area under the curve (AUC), calculated through plotting the receiver operating characteristic (ROC) curve. Additionally, the Brier score was employed to evaluate the model with a calibration curve. To gauge the utility of the nomogram, a clinical impact curve (CIC) analysis was conducted. This comprehensive approach not only involved identifying risk factors but also included a visual representation (nomogram) and thorough evaluation metrics, ensuring a robust tool for predicting, preventing, and controlling postpartum endometritis. RESULTS: In the multivariate analysis, six factors were identified as being associated with the occurrence of maternal endometritis in the postpartum period. These factors include the number of negative finger tests (OR: 1.159; 95%CI: 1.091-1.233; P < 0.05), postpartum hemorrhage (1.003; 1.002-1.005; P < 0.05), pre-eclampsia (9.769; 4.64-21.155; P < 0.05), maternity methods (2.083; 1.187-3.7; P < 0.001), prenatal reproductive tract culture (2.219; 1.411-3.47; P < 0.05), and uterine exploration (0.441; 0.233-0.803; P < 0.001).A nomogram was then constructed based on these factors, and its predictive performance was assessed using the area under the curve (AUC). The results in both the training group data (AUC: 0.803) and the test group data (AUC: 0.788) demonstrated a good predictive value. The clinical impact curve (CIC) further highlighted the clinical utility of the nomogram. CONCLUSION: The development of an individualized nomogram for postpartum endometritis infection holds promise for doctors in screening high-risk women, enabling early intervention and ultimately reducing the rate of postpartum endometritis infection. This comprehensive approach, integrating key risk factors and predictive tools, enhances the potential for timely and targeted medical intervention.

Asunto(s)

Endometritis , Nomogramas , Periodo Posparto , Humanos , Femenino , Endometritis/diagnóstico , Endometritis/epidemiología , Adulto , Factores de Riesgo , Estudios Retrospectivos , Embarazo , Curva ROC , Modelos Logísticos , Trastornos Puerperales/diagnóstico , Trastornos Puerperales/epidemiología , Trastornos Puerperales/prevención & control

RESUMEN

BACKGROUND: Postpartum readmissions (PPRs) are an important indicator of maternal postpartum complications and the quality of medical services and are important for reducing medical costs. The present study aimed to investigate the risk factors affecting readmission after delivery in Imam Ali Hospital in Amol, Iran. METHODS: This retrospective cohort study was conducted on the mothers who were readmitted after delivery within 30 days, at Imam Ali Hospital (2019-2023). The demographic and obstetrics characteristics were identified through the registry system. Univariate and multivariate logistic regressions with odds ratios (ORs) and 95% CIs were carried out. To identify the most important variables by machine learning methods, a random forest model was used. The data were analyzed using SPSS 22 software and R (4.1.3) at a significant level of 0.05. RESULTS: Among 13,983 deliveries 164 (1.2%) had readmission after delivery. The most prevalent cause of readmission after delivery was infection (59.7%). The chance of readmission for women who underwent elective cesarean section and women who experienced labor pain onset by induction of labor was twice and 1.5 times greater than that among women who experienced spontaneous labor pain, respectively. Women with pregnancy complications had more than 2 times the chance of readmission. Cesarean section increased the chance of readmission by 2.69 times compared to normal vaginal delivery. CONCLUSION: The method of labor pain onset, mode of delivery, and complications during pregnancy were the most important factors related to readmission after childbirth.

Asunto(s)

Readmisión del Paciente , Humanos , Femenino , Readmisión del Paciente/estadística & datos numéricos , Irán/epidemiología , Embarazo , Factores de Riesgo , Adulto , Estudios Retrospectivos , Periodo Posparto , Cesárea/estadística & datos numéricos , Adulto Joven , Complicaciones del Embarazo/epidemiología , Parto Obstétrico/estadística & datos numéricos , Modelos Logísticos , Trastornos Puerperales/epidemiología

RESUMEN

BACKGROUND: Peripartum cardiomyopathy (PPCM), a form of heart failure with reduced ejection fraction (HFrEF) that occurs during the final month of pregnancy through the first 5 months postpartum, is associated with heightened risk for maternal morbidity and mortality. Stroke is a common complication of HFrEF but there is limited data on the incidence of stroke in PPCM. METHODS: Using statewide, nonfederal administrative data from 2000 to 2015, we analyzed age-adjusted risk of stroke within 3 years after PPCM-associated pregnancies. RESULTS: PPCM was associated with a greater than 4-fold increased risk of pregnancy-related stroke (aHR 4.7, 95% CI: 3.0-7.5). This risk was highest at the time of PPCM diagnosis but remained elevated in the first postpartum year. CONCLUSION: Our findings confirm the strong association between PPCM and stroke, with risk that persists throughout and after the peripartum period.

Asunto(s)

Cardiomiopatías , Periodo Periparto , Complicaciones Cardiovasculares del Embarazo , Accidente Cerebrovascular , Humanos , Femenino , Embarazo , Incidencia , Adulto , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Complicaciones Cardiovasculares del Embarazo/epidemiología , Cardiomiopatías/epidemiología , Cardiomiopatías/fisiopatología , Volumen Sistólico/fisiología , Factores de Riesgo , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/etiología , Trastornos Puerperales/epidemiología , Trastornos Puerperales/etiología , Estudios Retrospectivos

RESUMEN

BACKGROUND: Although peripartum cardiomyopathy (PPCM) is a fatal disease affecting young patients and fetuses, little is known about its recent prognosis and risk factors. This study investigated temporal trends in clinical characteristics and outcomes for PPCM in a nationwide multicenter registry. METHODS AND RESULTS: The study population comprised 340 patients (mean age, 33 years) who were diagnosed with PPCM between January 2000 and September 2022 in 26 tertiary hospitals in South Korea. PPCM was defined as heart failure with left ventricular ejection fraction ≤45% and no previously known cardiac disease. The main study outcomes included time to the first occurrence of all-cause death, heart transplantation, and cardiovascular hospitalization. The diagnosis of PPCM cases increased notably during the study period (P<0.001). However, clinical outcomes showed no significant improvement (all-cause death for 10 years: 0.9% [2000-2010] versus 2.3% [2011-2022], P=0.450; all-cause death and heart transplantation for 10 years: 3.6% [2000-2010] versus 3.0% [2011-2022] P=0.520; all-cause death, heart transplantation, and cardiovascular hospitalization for 10 years: 11.7% [2000-2010] versus 19.8% [2011-2022], P=0.240). High body mass index (hazard ratio [HR], 1.106 [95% CI, 1.024-1.196]; P=0.011), the presence of gestational diabetes (HR, 5.346 [95% CI, 1.778-16.07]; P=0.002), and increased baseline left ventricular end-diastolic dimension (HR, 1.078 [95% CI, 1.002-1.159]; P=0.044) were significant risk factors for poor prognosis. CONCLUSIONS: While the incidence of PPCM has increased over the past 20 years, the prognosis has not improved significantly. Timely management and close follow-up are necessary for high-risk patients with PPCM with high body mass index, gestational diabetes, or large left ventricular end-diastolic dimension.

Asunto(s)

Cardiomiopatías , Periodo Periparto , Complicaciones Cardiovasculares del Embarazo , Sistema de Registros , Humanos , Femenino , Adulto , Embarazo , República de Corea/epidemiología , Cardiomiopatías/epidemiología , Cardiomiopatías/terapia , Cardiomiopatías/fisiopatología , Cardiomiopatías/mortalidad , Complicaciones Cardiovasculares del Embarazo/epidemiología , Complicaciones Cardiovasculares del Embarazo/terapia , Factores de Riesgo , Factores de Tiempo , Trasplante de Corazón/tendencias , Trasplante de Corazón/estadística & datos numéricos , Pronóstico , Función Ventricular Izquierda , Volumen Sistólico , Causas de Muerte/tendencias , Hospitalización/tendencias , Hospitalización/estadística & datos numéricos , Trastornos Puerperales/epidemiología , Trastornos Puerperales/terapia , Trastornos Puerperales/mortalidad , Trastornos Puerperales/fisiopatología , Estudios Retrospectivos , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/terapia , Insuficiencia Cardíaca/fisiopatología , Incidencia

RESUMEN

BACKGROUND AND OBJECTIVES: cardiovascular changes during pregnancy carry greater risk in heart disease. We analyze cardiovascular, obstetric and perinatal adverse effects associated with congenital and acquired heart disease during pregnancy and postpartum. MATERIALS AND METHODS: Cross-sectional and retrospective study, which included the 2017-2023 registry of pregnant or postpartum patients hospitalised with diagnosis of congenital or acquired heart disease. Adverse events (heart failure, stroke, acute pulmonary edema, maternal death, obstetric haemorrhage, prematurity and perinatal death) were compared with the clinical variables and the implemented treatment. RESULTS: 112 patients with a median age of 28 years (range 15-44) were included. Short circuits predominated 28 (25%). Thirty-six patients (32%) were classified in class IV of the modified WHO scale for maternal cardiovascular risk. Heart failure occurred in 39 (34.8%), acute lung edema 12 (10.7%), stroke 2 (1.8%), maternal death 5 (4.5%), obstetric haemorrhage 4 (3.6%), prematurity 50 (44.5%) and perinatal death 6 (5.4%). Shunts were associated with prematurity (adjusted odds ratio 4; 95% CI: 1.5-10, p = 0.006). Peripartum cardiomyopathy represented higher risk of pulmonary edema (adjusted OR 34; 95% CI: 6-194, p = 0.001) and heart failure (adjusted OR 16; 95% CI: 3-84, p = 0.001). An increased risk of obstetric haemorrhage was observed in patients with prosthetic valves (adjusted OR 30; 95% CI: 1.5-616, p = 0.025) and with the use of acetylsalicylic acid (adjusted OR 14; 95% CI: 1.2-16, p = 0.030). Furthermore, the latter was associated with perinatal death (adjusted OR 9; 95% CI: 1.4-68, p = 0.021). CONCLUSIONS: severe complications were found during pregnancy and postpartum in patients with heart disease, which is why preconception evaluation and close surveillance are vital.

Asunto(s)

Cardiopatías , Complicaciones Cardiovasculares del Embarazo , Trastornos Puerperales , Humanos , Femenino , Embarazo , Estudios Retrospectivos , Adulto , Estudios Transversales , Complicaciones Cardiovasculares del Embarazo/epidemiología , Adulto Joven , Adolescente , Trastornos Puerperales/epidemiología , Trastornos Puerperales/etiología , Recién Nacido , Edema Pulmonar/epidemiología , Edema Pulmonar/etiología , Periodo Posparto

RESUMEN

BACKGROUND AND AIMS: Arrhythmic mitral valve prolapse (AMVP) is linked to life-threatening ventricular arrhythmias (VAs), and young women are considered at high risk. Cases of AMVP in women with malignant VA during pregnancy have emerged, but the arrhythmic risk during pregnancy is unknown. The authors aimed to describe features of women with high-risk AMVP who developed malignant VA during the perinatal period and to assess if pregnancy and the postpartum period were associated with a higher risk of malignant VA. METHODS: This retrospective international multi-centre case series included high-risk women with AMVP who experienced malignant VA and at least one pregnancy. Malignant VA included ventricular fibrillation, sustained ventricular tachycardia, or appropriate shock from an implantable cardioverter defibrillator. The authors compared the incidence of malignant VA in non-pregnant periods and perinatal period; the latter defined as occurring during pregnancy and within 6 months after delivery. RESULTS: The authors included 18 women with AMVP from 11 centres. During 7.5 (interquartile range 5.8-16.6) years of follow-up, 37 malignant VAs occurred, of which 18 were pregnancy related occurring in 13 (72%) unique patients. Pregnancy and 6 months after delivery showed increased incidence rate of malignant VA compared to the non-pregnancy period (univariate incidence rate ratio 2.66, 95% confidence interval 1.23-5.76). CONCLUSIONS: The perinatal period could impose increased risk of malignant VA in women with high-risk AMVP. The data may provide general guidance for pre-conception counselling and for nuanced shared decision-making between patients and clinicians.

Asunto(s)

Prolapso de la Válvula Mitral , Complicaciones Cardiovasculares del Embarazo , Humanos , Femenino , Embarazo , Prolapso de la Válvula Mitral/complicaciones , Prolapso de la Válvula Mitral/epidemiología , Estudios Retrospectivos , Adulto , Complicaciones Cardiovasculares del Embarazo/epidemiología , Factores de Riesgo , Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/etiología , Taquicardia Ventricular/epidemiología , Taquicardia Ventricular/etiología , Trastornos Puerperales/epidemiología , Trastornos Puerperales/etiología , Desfibriladores Implantables , Incidencia , Fibrilación Ventricular/epidemiología , Fibrilación Ventricular/etiología , Periodo Posparto

Asunto(s)

Diabetes Gestacional , Hipertensión , Femenino , Humanos , Embarazo , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/fisiopatología , Diabetes Gestacional/epidemiología , Diabetes Gestacional/fisiopatología , Hipertensión/fisiopatología , Hipertensión/epidemiología , Periodo Posparto , Trastornos Puerperales/fisiopatología , Trastornos Puerperales/etiología , Trastornos Puerperales/epidemiología , Salud de la Mujer

RESUMEN

INTRODUCTION: While the exact pathogenesis of peripartum cardiomyopathy, a potentially life-threatening condition, is still unknown, its incidence is rising globally. We sought to understand the differences in outcomes and complications based on age. METHODS: Records from the 2016-2020 National Inpatient Sample were used for our study. The sample consisted of females diagnosed with peripartum cardiomyopathy that required hospitalization care. They were divided into two age-based cohorts: 15-29 years and 30-40 years. We evaluated differences in in-hospital complications between the two groups using multivariable regression. RESULTS: The analysis consisted of 20520 females diagnosed with peripartum cardiomyopathy, of whom 57.3 % were in the 30-40 years cohort and 42.7 % in the 15-29 years group. The prevalence of cardiovascular risk factors such as smoking, obesity, hypertension, diabetes and lipid disorder was higher among women aged 30-40 years (p < 0.01). These patients also demonstrated higher odds of reporting acute ischemic stroke (aOR 1.354, 95 % CI 1.038-1.767, p = 0.026) while having a reduced risk of cardiogenic shock (aOR 0.787, 95 % CI 0.688-0.901, p < 0.01) as compared to those aged 15-29 years during their hospitalisation with PPCM. No statistically significant differences were noted for events of acute kidney injury (aOR 1.074, 95 % CI 0.976-1.182, p = 0.143), acute pulmonary oedema (aOR 1.147, 95 % CI 0.988-1.332, p = 0.071) or in-hospital mortality (aOR 0.978, 95 % CI 0.742-1.290, p = 0.877). CONCLUSION: Peripartum cardiomyopathy is a serious condition that requires appropriate care and management. Our study linked cases of ages 30-40 years with increased odds of acute ischemic stroke but lower odds of cardiogenic shock.

Asunto(s)

Cardiomiopatías , Periodo Periparto , Complicaciones Cardiovasculares del Embarazo , Humanos , Femenino , Adulto , Adolescente , Embarazo , Cardiomiopatías/epidemiología , Adulto Joven , Complicaciones Cardiovasculares del Embarazo/epidemiología , Complicaciones Cardiovasculares del Embarazo/terapia , Factores de Riesgo , Estados Unidos/epidemiología , Factores de Edad , Estudios Retrospectivos , Incidencia , Hospitalización/estadística & datos numéricos , Prevalencia , Trastornos Puerperales/epidemiología , Trastornos Puerperales/etiología , Trastornos Puerperales/terapia , Mortalidad Hospitalaria/tendencias , Choque Cardiogénico/epidemiología , Choque Cardiogénico/etiología , Choque Cardiogénico/terapia

RESUMEN

BACKGROUND: Postpartum hypertension is a major contributor to the rising maternal mortality rates in the United States, with nearly half of maternal deaths occurring after delivery. Previous studies have found evidence that the maximum blood pressure reading during labor and delivery admission can predict readmission; however, the optimal blood pressure to reduce the need for readmissions and additional medical treatment in the postpartum period is not known. OBJECTIVE: This study aimed to investigate the relationship between postpartum blood pressure control at discharge and readmission within the first 6 weeks after delivery. STUDY DESIGN: Data were obtained from Cosmos, an electronic health record-based, Health Insurance Portability and Accountability Act-defined limited dataset that includes more than 1.4 million birth encounters. All birthing parents with blood pressure data after delivery were included. Demographic information, medications, and readmissions were queried from the dataset. Patients were grouped into categories based on blood pressure readings in the 24 hours before discharge (≥160/110, ≥150/100, ≥140/90, ≥130/80, ≥120/80, and <120/80 mm Hg). The readmission rates across these groups were compared. Planned subanalyses included stratification by the use of antihypertensive medications and a sensitivity analysis using the highest blood pressure during admission. Covariates included maternal age, preexisting diabetes mellitus or lupus erythematosus, and body mass index. RESULTS: The analysis included 1,265,766 total birth encounters, 391,781 (30.9%) in the referent group (120/80 mm Hg), 392,592 (31.0%) in the group with <120/80 mm Hg, 249,414 (19.7%) in the group with ≥130/80 mm Hg, 16,125 (1.3%) in the group with ≥140/90 mm Hg, 50,659 (4.0%) in the group with ≥150/100 mm Hg, and 20,196 (1.6%) in the group with ≥160/110 mm Hg. In the first 6 weeks after delivery, readmission rates increased with higher blood pressure readings. More than 5% of postpartum patients with the highest blood pressure readings (≥160/110 mm Hg) were readmitted. These patients were almost 3 times more likely to be readmitted than patients whose highest blood pressure reading fell into the referent group (120/80 mm Hg) (odds ratio [OR], 2.90; 95% confidence interval, 2.69-3.12). Patients with blood pressures of >150/100 mm Hg (odds ratio, 2.72; 95% confidence interval, 2.58-2.87), >140/90 mm Hg (odds ratio, 2.03; 95% confidence interval, 1.95-2.11), and >130/80 mm Hg (odds ratio, 1.43; 95% confidence interval, 1.37-1.49) all had higher odds of readmission, whereas patients with a blood pressure of <120/80 mm Hg had a lower odds of readmission (odds ratio, 0.78; 95% confidence interval, 0.75-0.81). Patients who had higher blood pressures during admission but had improved control in the 24 hours before discharge had lower rates of readmission than those whose blood pressures remained elevated. In all blood pressure categories, patients who received an antihypertensive prescription had higher rates of readmission. CONCLUSION: In this large, national dataset, blood pressure control at discharge and readmission in the postpartum period were significantly correlated. Our data should inform postpartum hypertension treatment goals and the role of remote monitoring programs in improving maternal safety.

Asunto(s)

Antihipertensivos , Presión Sanguínea , Hipertensión , Readmisión del Paciente , Periodo Posparto , Humanos , Readmisión del Paciente/estadística & datos numéricos , Femenino , Adulto , Hipertensión/epidemiología , Hipertensión/tratamiento farmacológico , Hipertensión/fisiopatología , Hipertensión/diagnóstico , Antihipertensivos/uso terapéutico , Embarazo , Presión Sanguínea/fisiología , Periodo Posparto/fisiología , Trastornos Puerperales/epidemiología , Trastornos Puerperales/terapia , Trastornos Puerperales/fisiopatología , Trastornos Puerperales/diagnóstico , Estados Unidos/epidemiología , Estudios Retrospectivos , Adulto Joven , Factores de Riesgo , Alta del Paciente/estadística & datos numéricos

Asunto(s)

Parto Obstétrico , Trastornos del Suelo Pélvico , Humanos , Femenino , Parto Obstétrico/métodos , Parto Obstétrico/estadística & datos numéricos , Embarazo , Trastornos del Suelo Pélvico/epidemiología , Trastornos del Suelo Pélvico/diagnóstico , Trastornos del Suelo Pélvico/fisiopatología , Adulto , Diafragma Pélvico/fisiopatología , Trastornos Puerperales/epidemiología , Trastornos Puerperales/diagnóstico

RESUMEN

OBJECTIVE: To determine the prevalence of pelvic floor dysfunction (PFD) among pregnant women, their clustering and their association with body image disturbance (BID) up to 1 year postpartum. DESIGN: Monocentric prospective cohort study. SETTING: University Hospitals Leuven. POPULATION: Pregnant women attending for pregnancy care, first assessed prior to 14 weeks of gestation and agreeing to follow-up until 1 year postpartum. METHODS: Standardised questionnaires reporting on PFD and BID at 12-14 and 28-32 weeks of gestation, and again at 6-8 weeks and 1 year postpartum. We calculated the prevalence of PFD, how the cases clustered and how the cases correlated with BID using a linear mixed-model analysis. A minimum of 174 women with complete follow-up were required. MAIN OUTCOME MEASURES: The questionnaires used were the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF), St. Mark's Incontinence Score (SMIS), Patient Assessment of Constipation Symptoms (PAC-SYM), Pelvic Organ Prolapse Distress Inventory (POPDI), Pelvic Organ Prolapse/Incontinence Sexual Questionnaire IUGA Revised (PISQ-IR) and the Body Image Disturbance Questionnaire (BIDQ). RESULTS: Out of 208 women, 92.8% reported one or multiple symptoms of PFD at 28-32 weeks of gestation, dropping to 73.6% by 1 year postpartum. The most common symptoms were constipation (65.3% at 28-32 weeks of gestation and 42.8% at 1 year postpartum) and urinary incontinence (56.8% at 28-32 weeks of gestation and 35.1% at 1 year postpartum). After correcting for body mass index, parity and mode of delivery, the severity of BID was associated with the ICIQ-UI SF score (ß = 0.016, range 0.007-0.024), the PAC-SYM score (ß = 0.006, range 0.002-0.011) and the POPDI score (ß = 0.009, range 0.005-0.012), but not with the SMIS score (ß = 0.015, range -0.001 to 0.031) or the PISQ-IR score, in sexually active women. CONCLUSIONS: Urinary incontinence, constipation and symptoms of prolapse have a measurable impact on BID.

Asunto(s)

Imagen Corporal , Trastornos del Suelo Pélvico , Complicaciones del Embarazo , Humanos , Femenino , Embarazo , Estudios Prospectivos , Adulto , Trastornos del Suelo Pélvico/epidemiología , Imagen Corporal/psicología , Estudios de Seguimiento , Encuestas y Cuestionarios , Complicaciones del Embarazo/epidemiología , Prevalencia , Periodo Posparto , Incontinencia Urinaria/epidemiología , Incontinencia Urinaria/psicología , Trastornos Puerperales/epidemiología

RESUMEN

OBJECTIVES: The goal of this study was to identify the risk factors associated with puerperal genital hematoma (PGHA) and analyze the management strategies employed and the resulting maternal outcomes. METHODS: This retrospective cohort study examined the pregnant women delivering vaginally with PGHA in Peking University Third Hospital during January 2002 to December 2021. Exploratory data analysis was performed to assess mean, standard deviation (SD), frequency, percentage and percentiles. Independent-samples t-test was performed for continuous variables. Chi-squared test was performed to compare categorical data. RESULTS: A total of 47 women with PGHA were included, and 94 matched controls were enrolled during the same study period. Compared with the control group, labor induction (34.0% vs. 9.6%, P = 0.000) and episiotomy (66.0% vs. 31.9%, P = 0.000) were more frequently performed in PGHA cases. There was a significantly higher incidence of postpartum hemorrhage (PPH) (53.2% vs. 6.4%, P = 0.000) in PGHA patients than in controls. Compared with the patients with <5 cm hematoma, the proportion of prenatal anemia (25.8% vs. 0.0%, P = 0.027) and the incidence of PPH (67.7% vs. 25.0%, P = 0.005) were significantly higher in patients with ≥5 cm hematoma. In comparison, the active period was significantly shorter (3.1 ± 1.9 vs. 5.1 ± 3.0, P = 0.031) in patients with ≥5 cm hematoma. There were significant differences in perineal pain and swelling (31.3% vs. 67.7%, P = 0.017), vulva hematoma (93.8% vs. 48.4%, P = 0.002) and surgical treatment (62.5% vs. 96.8%, P = 0.002). Nearly half of the patients in the ≥5 cm group underwent secondary suture (41.9% vs. 6.3%, P = 0.011). In patients with PGHA detected after more than 2 h, the body mass index was substantially higher (24.5 ± 4.3 vs. 21.4 ± 2.7, P = 0.011), and the weight gain during pregnancy (14.1 ± 4.3 vs. 11.4 ± 3.5, P = 0.021) was significantly lower. Compared with the patients in PGHA without PPH, age (31.7 ± 4.4 vs. 29.4 ± 2.6, P = 0.033) and newborn birth weight (3367 ± 390 g vs. 3110 ± 419 g, P = 0.045) were considerably higher in PGHA cases with PPH, and the platelet count ([182 ± 44] × 109/L vs. [219 ± 51] × 109/L, P = 0.015) was significantly lower. CONCLUSIONS: Pregnant women who underwent labor induction and episiotomy had a higher incidence of PGHA. The PGHA-related PPH rate is significantly increased. Active surgical treatment is recommended for patients with ≥5 cm hematoma.

Asunto(s)

Hematoma , Hemorragia Posparto , Humanos , Femenino , Estudios Retrospectivos , Hematoma/epidemiología , Hematoma/etiología , Hematoma/terapia , Embarazo , Adulto , China/epidemiología , Factores de Riesgo , Hemorragia Posparto/terapia , Hemorragia Posparto/epidemiología , Centros de Atención Terciaria , Episiotomía/efectos adversos , Episiotomía/estadística & datos numéricos , Enfermedades de los Genitales Femeninos/epidemiología , Enfermedades de los Genitales Femeninos/terapia , Estudios de Casos y Controles , Trastornos Puerperales/terapia , Trastornos Puerperales/epidemiología , Trastornos Puerperales/etiología

RESUMEN

BACKGROUND: Venous thromboembolism accounts for approximately 9% of pregnancy-related deaths in the United States. National guidelines recommend postpartum risk stratification and pharmacologic prophylaxis in at-risk individuals. Knowledge on modern rates of postpartum pharmacologic thromboprophylaxis and its associated risks is limited. OBJECTIVE: This study aimed to describe the rate of, and factors associated with, initiation of postpartum pharmacologic prophylaxis for venous thromboembolism, and to assess associated adverse outcomes. STUDY DESIGN: This was a secondary analysis of a multicenter cohort of individuals delivering on randomly selected days at 17 US hospitals (2019-2020). Medical records were reviewed by trained and certified personnel. Those with an antepartum diagnosis of venous thromboembolism, receiving antepartum anticoagulation, or known SARS-CoV-2 infection were excluded. The primary outcome was use of postpartum pharmacologic thromboprophylaxis. Secondary outcomes included bleeding complications, surgical site infection, hospital readmission, and venous thromboembolism through 6 weeks postpartum. The rate of thromboprophylaxis administration was assessed by mode of delivery, institution, and continuance to the outpatient setting. Multivariable regression models were developed using k-fold cross-validation with stepwise backward elimination to evaluate factors associated with thromboprophylaxis administration. Univariable and multivariable logistic models with propensity score covariate adjustment were performed to assess the association between thromboprophylaxis administration and adverse outcomes. RESULTS: Of 21,114 individuals in the analytical cohort, 11.9% (95% confidence interval, 11.4%-12.3%) received postpartum pharmacologic thromboprophylaxis; the frequency of receipt was 29.8% (95% confidence interval, 28.7%-30.9%) following cesarean and 3.5% (95% confidence interval, 3.2%-3.8%) following vaginal delivery. Institutional rates of prophylaxis varied from 0.21% to 34.8%. Most individuals (83.3%) received thromboprophylaxis only as inpatients. In adjusted analysis, cesarean delivery (adjusted odds ratio, 19.17; 95% confidence interval, 16.70-22.00), hysterectomy (adjusted odds ratio, 15.70; 95% confidence interval, 4.35-56.65), and obesity (adjusted odds ratio, 3.45; 95% confidence interval, 3.02-3.95) were the strongest factors associated with thromboprophylaxis administration. Thromboprophylaxis administration was not associated with surgical site infection (0.9% vs 0.6%; odds ratio, 1.48; 95% confidence interval, 0.80-2.74), bleeding complications (0.2% vs 0.1%; odds ratio, 2.60; 95% confidence interval, 0.99-6.80), or postpartum readmission (0.9% vs 0.3%; adjusted odds ratio, 1.38; 95% confidence interval, 0.68-2.81). The overall rate of venous thromboembolism was 0.06% (95% confidence interval, 0.03%-0.10%) and was higher in those receiving prophylaxis (0.2%) compared with those not receiving prophylaxis (0.04%). CONCLUSION: Approximately 1 in 10 patients received postpartum pharmacologic thromboprophylaxis in this US cohort. Rates of prophylaxis varied widely by institution. Cesarean delivery, hysterectomy, and obesity were predominant factors associated with postpartum thromboprophylaxis administration.

Asunto(s)

Tromboembolia Venosa , Humanos , Femenino , Tromboembolia Venosa/prevención & control , Tromboembolia Venosa/epidemiología , Adulto , Embarazo , Estados Unidos/epidemiología , Anticoagulantes/uso terapéutico , Anticoagulantes/administración & dosificación , Periodo Posparto , Readmisión del Paciente/estadística & datos numéricos , Estudios de Cohortes , Infección de la Herida Quirúrgica/prevención & control , Infección de la Herida Quirúrgica/epidemiología , Cesárea , Hemorragia Posparto/prevención & control , Hemorragia Posparto/epidemiología , Trastornos Puerperales/prevención & control , Trastornos Puerperales/epidemiología , Estudios Retrospectivos

RESUMEN

Peripartum cardiomyopathy (PPCM) remains a significant challenge in maternal health, marked by its unpredictable onset and varied clinical outcomes. With rising incidence rates globally, understanding PPCM is vital for improving maternal care and prognosis. This review aims to consolidate current knowledge on PPCM, highlighting recent advancements in its diagnosis, management, and therapeutic approaches. This comprehensive review delves into the epidemiology of PPCM, underscoring its global impact and demographic variations. We explore the complex etiology of the condition, examining known risk factors and discussing the potential pathophysiological mechanisms, including oxidative stress and hormonal influences. The clinical presentation of PPCM, often similar yet distinct from other forms of cardiomyopathy, is analyzed to aid in differential diagnosis. Diagnostic challenges are addressed, emphasizing the role of advanced imaging and biomarkers. Current management strategies are reviewed, focusing on the absence of disease-specific treatments and the application of general heart failure protocols. The review also discusses the prognosis of PPCM, factors influencing recovery, and the implications for future pregnancies. Finally, we highlight emerging research directions and the urgent need for disease-specific therapies, aiming to provide a roadmap for future studies and improved patient care. This review serves as a crucial resource for clinicians and researchers, contributing to a deeper understanding and better management of PPCM.

Asunto(s)

Cardiomiopatías , Insuficiencia Cardíaca , Complicaciones Cardiovasculares del Embarazo , Trastornos Puerperales , Embarazo , Femenino , Humanos , Periodo Periparto , Cardiomiopatías/diagnóstico , Cardiomiopatías/epidemiología , Cardiomiopatías/etiología , Trastornos Puerperales/diagnóstico , Trastornos Puerperales/epidemiología , Trastornos Puerperales/etiología , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/terapia , Pronóstico , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Complicaciones Cardiovasculares del Embarazo/epidemiología , Complicaciones Cardiovasculares del Embarazo/etiología

RESUMEN

Peripartum cardiomyopathy (PPCM) causes pregnancy-associated heart failure, typically during the last month of pregnancy, and up to 6 months post-partum, in women without known cardiovascular disease. PPCM is a global disease, but with a significant geographical variability within and between countries. Its true incidence in Africa is still unknown because of the lack of a PPCM population-based study. The variability in the epidemiology of PPCM between and within countries could be due to differences in the prevalence of both genetic and non-genetic risk factors. Several risk factors have been implicated in the aetiopathogenesis of PPCM over the years. Majority of patients with PPCM present with symptoms and signs of congestive cardiac failure. Diagnostic work up in PPCM is prompted by strong clinical suspicion, but Echocardiography is the main imaging technique for diagnosis. The management of PPCM involves multiple disciplines - cardiologists, anaesthetists, intensivists, obstetricians, neonatologists, and the prognosis varies widely.

Asunto(s)

Cardiomiopatías , Insuficiencia Cardíaca , Complicaciones Cardiovasculares del Embarazo , Trastornos Puerperales , Embarazo , Humanos , Femenino , Periodo Periparto , Países en Desarrollo , Cardiomiopatías/diagnóstico , Cardiomiopatías/epidemiología , Cardiomiopatías/terapia , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/etiología , Trastornos Puerperales/diagnóstico , Trastornos Puerperales/epidemiología , Trastornos Puerperales/terapia , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Complicaciones Cardiovasculares del Embarazo/epidemiología , Complicaciones Cardiovasculares del Embarazo/terapia

RESUMEN

BACKGROUND: Perinatal mental health disorders (PMHDs) are associated with a myriad of negative outcomes for women, infants, and the rest of the family unit. Understanding the prevalence of these conditions is important to guide prevention and treatment pathways. Indeed, the burden of PMHDs has been studied in many countries, but for Malta, an island with an annual birth rate of 4500 births, this burden is still to be determined. The main objective of this study was to address this gap, determine the prevalence of PMHDs among postpartum women in Malta, and study associated psychosocial determinants for this population. METHODS: A cross-sectional epidemiological study was conducted between March and April 2022 to determine the point prevalence of postpartum PMHDs in Malta. A representative, random sample of 243 postnatal mothers were recruited and screened for mental health issues using a two stage approach incorporating symptom scales and a diagnostic interview. RESULTS: The point prevalence of postnatal PMHDs in Malta, according to a diagnostic interview, was found to be 21.4%. Anxiety disorders were the most prevalent conditions (16.8%), followed by obsessive-compulsive disorder (6.1%) and borderline personality disorder (5.6%), respectively. A higher rate of 32.1% was identified with self-report measures. CONCLUSIONS: PMHDs are highly prevalent, affecting approximately 20% of women in Malta across the first postnatal year. The value of this finding accentuates the need for service availability and the implementation of perinatal mental health screening programs.

Asunto(s)

Trastornos Mentales , Humanos , Femenino , Estudios Transversales , Adulto , Prevalencia , Embarazo , Malta/epidemiología , Trastornos Mentales/epidemiología , Periodo Posparto/psicología , Adulto Joven , Salud Mental , Trastornos Puerperales/epidemiología , Trastornos Puerperales/psicología

RESUMEN

OBJECTIVE: Accurate information on the frequency and prevalence of manic or mixed episodes is important for therapeutic, prognostic, and safety concerns. We aimed to estimate the risk of relapse of manic and mixed episodes after delivery in women with bipolar I disorder or schizoaffective disorder-bipolar type. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive literature search in PubMed, PsycINFO, Embase, and Cochrane databases was carried out on November 17, 2022, using the terms ((bipolar disorder) OR (manic depressive illness)) AND (mania)) AND (postpartum)) AND (recurrence)) AND (relapse). The search was updated on March 29, 2023. Case studies and qualitative analyses were excluded. Twelve studies reporting on 3595 deliveries in 2183 women were included in the quantitative analysis. RESULTS: The overall pooled estimate of postpartum relapse risk was 39% (95% CI = 29, 49; Q(11) = 211.08, p < 0.001; I2 = 96.31%). Among those who had a relapse, the pooled estimate of risk for manic and mixed episodes was 38% (95% CI = 28, 50; Q(11) = 101.17, p < 0.001; I2 = 91.06%). Using data from the nine studies that reported the percentage of medication use during pregnancy, we estimated a meta-regression model with the percent medication use as a continuous explanatory variable. The estimated prevalence of relapse was 58.1% (95% CI, 9.6 to 39.3 to 76.8) for studies with no medication use and 25.9% (95% CI, 10.5-41.3) for studies with 100% medication use. The difference between the two prevalence estimates was statistically significant, z = -2.099, p = 0.0359. CONCLUSIONS: Our findings suggest an overall pooled estimate of postpartum relapse risk of 39%, while the pooled estimate of risk for manic and mixed episodes was 38%. These findings highlight the need to educate patients with bipolar I disorder, and their healthcare professionals about the high risk of relapse of manic or mixed episodes after delivery.

Asunto(s)

Trastorno Bipolar , Manía , Periodo Posparto , Humanos , Trastorno Bipolar/epidemiología , Femenino , Manía/epidemiología , Recurrencia , Embarazo , Trastornos Puerperales/epidemiología , Trastornos Psicóticos/epidemiología