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Hani K Atrash - One of the best experts on this subject based on the ideXlab platform.
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magnitude of maternal morbidity during labor and delivery united states 1993 1997
Obstetrical & Gynecological Survey, 2003Co-Authors: Isabella Danel, Cynthia J Berg, Christopher H Johnson, Hani K AtrashAbstract:Up until recently, maternal mortality has been the only outcome indicator of maternal health in the United States. Establishing priorities and planning effective interventions will require a knowledge of morbidity as well. This study analyzed National Hospital Discharge Survey data for women giving birth between 1993 and 1997. Morbidity was defined as any condition that adversely affects a woman's physical status during childbirth beyond what is expected from normal delivery. The sample included 154,000 women having vaginal and cesarean deliveries. In all, 30.7% of the study population had an Obstetric Complication, a preexisting medical condition, or both, and 43% had some form of maternal morbidity. The rate of morbidity associated with vaginal delivery was 21.2%; with cesarean delivery it was 9.5%. The most common Obstetric Complications were third- and fourth-degree lacerations, other trauma such as cervical laceration and pelvic trauma, preeclampsia/eclampsia, gestational diabetes, genitourinary infection, postpartum hemorrhage, and amnionitis. The most prevalent preexisting medical condition was chronic hypertension. These statistics indicate that maternal morbidity occurs frequently during delivery and often is preventable. The prevalence of any particular type of morbidity might be low but the total burden of morbidity is high. Only 57% of women in this survey were totally free of morbidity. Close monitoring of maternal morbidity is very important for measuring the effects of policies designed to limit maternal illness and death.
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magnitude of maternal morbidity during labor and delivery united states 1993 1997
American Journal of Public Health, 2003Co-Authors: Isabella Danel, Cynthia J Berg, Christopher H Johnson, Hani K AtrashAbstract:Objectives. This study sought to determine the prevalence of maternal morbidity during labor and delivery in the United States. Methods. Analyses focused on National Hospital Discharge Survey data available for women giving birth between 1993 and 1997. Results. The prevalence of specific types of maternal morbidity was low, but the burden of overall morbidity was high. Forty-three percent of women experienced some type of morbidity during their delivery hospitalization. Thirty-one percent (1.2 million women) had at least 1 Obstetric Complication or at least 1 preexisting medical condition. Conclusions. Maternal morbidity during delivery is frequent and often preventable. Reducing maternal morbidity is a national health objective, and its monitoring is key to improving maternal health.
Isabella Danel - One of the best experts on this subject based on the ideXlab platform.
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magnitude of maternal morbidity during labor and delivery united states 1993 1997
Obstetrical & Gynecological Survey, 2003Co-Authors: Isabella Danel, Cynthia J Berg, Christopher H Johnson, Hani K AtrashAbstract:Up until recently, maternal mortality has been the only outcome indicator of maternal health in the United States. Establishing priorities and planning effective interventions will require a knowledge of morbidity as well. This study analyzed National Hospital Discharge Survey data for women giving birth between 1993 and 1997. Morbidity was defined as any condition that adversely affects a woman's physical status during childbirth beyond what is expected from normal delivery. The sample included 154,000 women having vaginal and cesarean deliveries. In all, 30.7% of the study population had an Obstetric Complication, a preexisting medical condition, or both, and 43% had some form of maternal morbidity. The rate of morbidity associated with vaginal delivery was 21.2%; with cesarean delivery it was 9.5%. The most common Obstetric Complications were third- and fourth-degree lacerations, other trauma such as cervical laceration and pelvic trauma, preeclampsia/eclampsia, gestational diabetes, genitourinary infection, postpartum hemorrhage, and amnionitis. The most prevalent preexisting medical condition was chronic hypertension. These statistics indicate that maternal morbidity occurs frequently during delivery and often is preventable. The prevalence of any particular type of morbidity might be low but the total burden of morbidity is high. Only 57% of women in this survey were totally free of morbidity. Close monitoring of maternal morbidity is very important for measuring the effects of policies designed to limit maternal illness and death.
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magnitude of maternal morbidity during labor and delivery united states 1993 1997
American Journal of Public Health, 2003Co-Authors: Isabella Danel, Cynthia J Berg, Christopher H Johnson, Hani K AtrashAbstract:Objectives. This study sought to determine the prevalence of maternal morbidity during labor and delivery in the United States. Methods. Analyses focused on National Hospital Discharge Survey data available for women giving birth between 1993 and 1997. Results. The prevalence of specific types of maternal morbidity was low, but the burden of overall morbidity was high. Forty-three percent of women experienced some type of morbidity during their delivery hospitalization. Thirty-one percent (1.2 million women) had at least 1 Obstetric Complication or at least 1 preexisting medical condition. Conclusions. Maternal morbidity during delivery is frequent and often preventable. Reducing maternal morbidity is a national health objective, and its monitoring is key to improving maternal health.
Mercedes Jourdain - One of the best experts on this subject based on the ideXlab platform.
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renal cortical necrosis in postpartum hemorrhage a case series
American Journal of Kidney Diseases, 2016Co-Authors: Marie Frimat, M Decambron, Celine Lebas, Anissa Moktefi, Viviane Gnemmi, Benedicte Sautenet, D. Subtil, Francois Glowacki, Laurent Lemaître, Mercedes JourdainAbstract:Background Pregnancy-related renal cortical necrosis may lead to end-stage renal disease. Although this Obstetric Complication had virtually disappeared in high-income countries, we have noted new cases in France over the past few years, all following postpartum hemorrhage. Study Design Case series. Setting & Participants We retrospectively identified 18 patients from 5 French nephrology departments who developed renal cortical necrosis following postpartum hemorrhage in 2009 to 2013. Outcomes Obstetric and renal features, therapeutic measures, and kidney disease outcome were studied. Results All patients had a severe postpartum hemorrhage (mean blood loss, 2.6±1.1 [SD] L). Hemodynamic instability and disseminated intravascular coagulation were reported in 5 and 11 patients, respectively. All developed rapid onset of acute kidney injury and required hemodialysis. Diagnosis of renal cortical necrosis was performed 4 to 33 days following delivery. At 6 months postpartum, 8 patients remained dialysis dependent and none recovered normal kidney function. The length of exposure to tranexamic acid treatment was significantly more prolonged in women whose estimated glomerular filtration rate remained Limitations Retrospective study; small sample size. Conclusions In the setting of gravid endothelium, the conjunction of disseminated intravascular coagulation with the life-saving use of procoagulant and antifibrinolytic agents (recently implemented in France in a postpartum hemorrhage treatment algorithm) may give rise to a risk for uncontrolled clotting in the renal cortex and hence irreversible partial or diffuse cortical necrosis.
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original investigation renal cortical necrosis in postpartum hemorrhage a case series
2016Co-Authors: Marie Frimat, M Decambron, Celine Lebas, Anissa Moktefi, Viviane Gnemmi, Benedicte Sautenet, Mercedes Jourdain, D. Subtil, Laurent Lemaître, Agnes RigouzzoAbstract:Background: Pregnancy-related renal cortical necrosis may lead to end-stage renal disease. Although this Obstetric Complication had virtually disappeared in high-income countries, we have noted new cases in France over the past few years, all following postpartum hemorrhage. Study Design: Case series. Setting & Participants: We retrospectively identified 18 patients from 5 French nephrology departments who developed renal cortical necrosis following postpartum hemorrhage in 2009 to 2013. Outcomes: Obstetric and renal features, therapeutic measures, and kidney disease outcome were studied. Results: All patients had a severe postpartum hemorrhage (mean blood loss, 2.6 6 1.1 [SD] L). Hemodynamic instability and disseminated intravascular coagulation were reported in 5 and 11 patients, respectively. All developed rapid onset of acute kidney injury and required hemodialysis. Diagnosis of renal cortical necrosis was performed 4 to 33 days following delivery. At 6 months postpartum, 8 patients remained dialysis dependent and none recovered normal kidney function. The length of exposure to tranexamic acid treatment was significantly more prolonged in women whose estimated glomerular filtration rate remained ,15 mL/min/ 1.73 m 2 (7.1 6 4.8 vs 2.9 6 2.4 hours; P 5 0.03). Limitations: Retrospective study; small sample size. Conclusions: In the setting of gravid endothelium, the conjunction of disseminated intravascular coagulation with the life-saving use of procoagulant and antifibrinolytic agents (recently implemented in France in a postpartum hemorrhage treatment algorithm) may give rise to a risk for uncontrolled clotting in the renal cortex and hence irreversible partial or diffuse cortical necrosis. Am J Kidney Dis. 68(1):50-57. a 2016 by the National Kidney Foundation, Inc.
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Renal Cortical Necrosis in Postpartum Hemorrhage: A Case Series
American Journal of Kidney Diseases: The Official Journal of the National Kidney Foundation, 2016Co-Authors: Marie Frimat, M Decambron, Celine Lebas, Anissa Moktefi, Viviane Gnemmi, Benedicte Sautenet, D. Subtil, Francois Glowacki, Laurent Lemaître, Mercedes JourdainAbstract:BACKGROUND: Pregnancy-related renal cortical necrosis may lead to end-stage renal disease. Although this Obstetric Complication had virtually disappeared in high-income countries, we have noted new cases in France over the past few years, all following postpartum hemorrhage. STUDY DESIGN: Case series. SETTING & PARTICIPANTS: We retrospectively identified 18 patients from 5 French nephrology departments who developed renal cortical necrosis following postpartum hemorrhage in 2009 to~2013. OUTCOMES: Obstetric and renal features, therapeutic measures, and kidney disease outcome were studied. RESULTS: All patients had a severe postpartum hemorrhage (mean blood loss, 2.6±1.1 [SD] L). Hemodynamic instability and disseminated intravascular coagulation were reported in 5 and 11 patients, respectively. All developed rapid onset of acute kidney injury and required hemodialysis. Diagnosis of renal cortical necrosis was performed 4 to 33 days following delivery. At 6 months postpartum, 8 patients remained dialysis dependent and none recovered normal kidney function. The length of exposure to tranexamic acid treatment was significantly more prolonged in women whose estimated glomerular filtration rate remained~
Francisco Capani - One of the best experts on this subject based on the ideXlab platform.
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palmitoylethanolamide ameliorates hippocampal damage and behavioral dysfunction after perinatal asphyxia in the immature rat brain
Frontiers in Neuroscience, 2018Co-Authors: María Inés Herrera, Francisco Capani, Lucas Udovin, Nicolas Torourrego, Carlos F Kusnier, Juan Pablo LuacesAbstract:Perinatal asphyxia (PA) is an Obstetric Complication associated with an impaired gas exchange. This health problem continues to be a determinant of neonatal mortality and neurodevelopmental disorders. Palmitoylethanolamide (PEA) has exerted neuroprotection in several models of brain injury and neurodegeneration. We aimed at evaluating the potential neuroprotective role of PEA in an experimental model, which induces PA in the immature rat brain. PA was induced by placing Sprague Dawley newborn rats in a water bath at 37 °C for 19 minutes. Rat pups were subjected to treatment with PEA (10 mg/kg) within the first hour of life. Modifications in the hippocampus were analyzed with conventional electron microscopy, immunohistochemistry (for NeuN, pNF-H/M, MAP-2 and GFAP) and western blot (for pNF H/M, MAP-2 and GFAP). Behavior was also studied throughout Open Field(OF) Test, Passive Avoidance (PA) Task and Elevated Plus Maze (EPM) Test. After one month of the PA insult, we observed neuronal nucleus degeneration in CA1 using electron microscopy. Immunohistochemistry revealed a significant increase in pNF-H/M and decrease in MAP-2 in CA1 reactive area. These changes were also observed when analyzing the level of expression of these markers by western blot. Vertical exploration impairments and anxiety-related behaviors were encountered in the OF and EPM tests. PEA treatment attenuated PA-induced hippocampal damage and its corresponding behavioral alterations. These results contribute to the elucidation of PEA neuroprotective role after PA and the future establishment of therapeutic strategies for the developing brain.
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Could Perinatal Asphyxia Induce a Synaptopathy? New Highlights from an Experimental Model.
Neural plasticity, 2017Co-Authors: María Inés Herrera, Matilde Otero-losada, Lucas Udovin, Carlos Federico Kusnier, Rodolfo Alberto Kölliker-frers, Wanderley De Souza, Francisco CapaniAbstract:Birth asphyxia also termed perinatal asphyxia is an Obstetric Complication that strongly affects brain structure and function. Central nervous system is highly susceptible to oxidative damage caused by perinatal asphyxia while activation and maturity of the proper pathways are relevant to avoiding abnormal neural development. Perinatal asphyxia is associated with high morbimortality in term and preterm neonates. Although several studies have demonstrated a variety of biochemical and molecular pathways involved in perinatal asphyxia physiopathology, little is known about the synaptic alterations induced by perinatal asphyxia. Nearly 25% of the newborns who survive perinatal asphyxia develop neurological disorders such as cerebral palsy and certain neurodevelopmental and learning disabilities where synaptic connectivity disturbances may be involved. Accordingly, here we review and discuss the association of possible synaptic dysfunction with perinatal asphyxia on the basis of updated evidence from an experimental model.
Beth Cowan - One of the best experts on this subject based on the ideXlab platform.
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Obstetric fistula: a preventable tragedy.
Journal of midwifery & women's health, 2005Co-Authors: Suellen Miller, Felicia Lester, Monique Webster, Beth CowanAbstract:Obstetric fistula disables millions of women and girls in developing countries, primarily in sub-Saharan Africa and South Asia. The United Nations Population Fund (UNFPA) recently launched a global campaign to end fistula, labeling this condition a preventable and treatable tragedy. Obstetric fistula overwhelmingly results from obstructed labor, which occurs in cases of cephalopelvic disproportion and malpresentation. Cephalopelvic disproportion often complicates deliveries in young, primiparous women of low gynecologic age. Social factors, including young age at marriage and malnutrition of girl children, can also contribute to cephalopelvic disproportion. These social etiologies must be addressed by prevention campaigns. Direct prevention of fistula can occur during delivery when skilled providers identify women and girls at risk for Obstetric fistula and link them with innovative interventions, such as Fistula Prevention Centers, through which they can more readily access emergency Obstetric care, and by setting strict time limits for laboring at home without progress. Community-based programs, such as the Tostan program in West Africa, use social education to prevent fistula. Moreover, effective surgical techniques for fistula repair are available in some settings and should be expanded to reach those in need. Midwives can play a key role in the prevention and treatment of this tragic Obstetric Complication.
