American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Aug 2020
Multicenter StudyPerinatal depressive and anxiety symptoms of pregnant women during the coronavirus disease 2019 outbreak in China.
On January 20, 2020, a new coronavirus epidemic with human-to-human transmission was officially declared by the Chinese government, which caused significant public panic in China. In light of the coronavirus disease 2019 outbreak, pregnant women may be particularly vulnerable and in special need for preventive mental health strategies. Thus far, no reports exist to investigate the mental health response of pregnant women to the coronavirus disease 2019 outbreak. ⋯ Major life-threatening public health events such as the coronavirus disease 2019 outbreak may increase the risk for mental illness among pregnant women, including thoughts of self-harm. Strategies targeting maternal stress and isolation such as effective risk communication and the provision of psychological first aid may be particularly useful to prevent negative outcomes for women and their fetuses.
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Fragmentation of care, wherein a patient is readmitted to a hospital different from the initial point of care, has been shown to be associated with worse patient outcomes in other medical specialties. However, postpartum fragmentation of care has not been well characterized in obstetrics. ⋯ This study of nationwide estimates of postpartum fragmentation found discontinuity of postpartum care was associated with increased risk for severe morbidity, high costs, and long length of stay. Reduction of fragmentation may represent an important goal in overall efforts to improve postpartum care.
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Am. J. Obstet. Gynecol. · Aug 2020
Practice GuidelineSociety for Maternal-Fetal Medicine Consult Series #51: Thromboembolism prophylaxis for cesarean delivery.
Venous thromboembolism is a major cause of maternal morbidity and mortality. The risk of venous thromboembolism is particularly elevated during the postpartum period and especially after cesarean delivery. ⋯ This Consult discusses the different guidelines on prophylaxis of venous thromboembolism after cesarean delivery and provides recommendations based on the available evidence. The recommendations by the Society for Maternal-Fetal Medicine are as follows: (1) we recommend that all women who undergo cesarean delivery receive sequential compression devices starting before surgery and that the compression devices be used continuously until the patient is fully ambulatory (GRADE 1C); (2) we suggest that women with a previous personal history of deep venous thrombosis or pulmonary embolism who undergo cesarean delivery receive both mechanical (starting preoperatively and continuing until ambulatory) and pharmacologic (for 6 weeks postoperatively) prophylaxis (GRADE 2C); (3) we suggest that women with a personal history of an inherited thrombophilia (high-risk or low-risk) but no previous thrombosis who undergo cesarean delivery receive both mechanical (starting preoperatively and continuing until ambulatory) and pharmacologic (for 6 weeks postoperatively) prophylaxis (GRADE 2C); (4) we recommend the use of low-molecular-weight heparin as the preferred thromboprophylactic agent in pregnancy and the postpartum period (GRADE 1C); (5) when pharmacologic thromboprophylaxis is needed in pregnant women with class III obesity, we suggest the use of intermediate doses of enoxaparin (GRADE 2C); and (6) we recommend that each institution develop a patient safety bundle with an institutional protocol for venous thromboembolism prophylaxis among women who undergo cesarean delivery (Best Practice).
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Am. J. Obstet. Gynecol. · Aug 2020
Identification of factors associated with delayed treatment of obstetric hypertensive emergencies.
Obstetric hypertensive emergency is defined as having systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥110 mm Hg, confirmed 15 minutes apart. The American College of Obstetricians and Gynecologists recommends that acute-onset, severe hypertension be treated with first line-therapy (intravenous labetalol, intravenous hydralazine or oral nifedipine) within 60 minutes to reduce risk of maternal morbidity and death. ⋯ Initial blood pressure in the nonsevere range, absence of preeclampsia symptoms, presentation overnight, white race, having complaint of labor symptoms, and increasing gestational age at presentation are barriers that lead to a delay in the treatment of obstetric hypertensive emergency. Quality improvement initiatives that target these barriers should be instituted to improve timely treatment.
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Am. J. Obstet. Gynecol. · Aug 2020
Time trends in placenta-mediated pregnancy complications after assisted reproductive technology in the Nordic countries.
The use of assisted reproductive technology is increasing worldwide and conception after assisted reproduction currently comprises 3%-6% of birth cohorts in the Nordic countries. The risk of placenta-mediated pregnancy complications is greater after assisted reproductive technology compared with spontaneously conceived pregnancies. Whether the excess risk of placenta-mediated pregnancy complications in pregnancies following assisted reproduction has changed over time, is unknown. ⋯ The risk of placenta-mediated pregnancy complications following assisted reproductive technology remains higher compared to spontaneously conceived pregnancies, despite declining rates of multiple pregnancies. For hypertensive disorders in pregnancy and placental abruption, pregnancies after assisted reproduction follow the same time trends as the background population, whereas for placenta previa, risk has increased over time in pregnancies after assisted reproductive technology.