Introduction: The purpose of this study was to examine the clinical usefulness of postoperative epidural analgesia in patients possessing severe gestational hypertension after Cesarean delivery. Methods: We reviewed t...Introduction: The purpose of this study was to examine the clinical usefulness of postoperative epidural analgesia in patients possessing severe gestational hypertension after Cesarean delivery. Methods: We reviewed the obstetric records of 99 patients possessing severe gestational hypertension undergoing singleton Cesarean delivery at ≥ 22 weeks’ gestation. Thirty patients were received continuous epidural analgesia with 0.2% ropivacaine for pain relief after Cesarean delivery with spinal anesthesia, 69 patients were not received epidural analgesia after Cesarean delivery with spinal anesthesia. Results: During the preoperative period, there were no measurable differences in the diastolic blood pressure between the 2 groups (108 vs± 7 vs. 106 mmHg ± 10 mmHg, p = 0.29). The diastolic blood pressure at 2 and 4 hours after Cesarean section in the epidural analgesia group were significantly lower than those in the non-epidural group (2 hours after Cesarean section: 88 vs ± 13 vs. 95 mmHg ± 8 mmHg, p < 0.01;4 hours after Cesarean section: 92 vs ± 15 vs. 102 mmHg ± 9 mmHg, p < 0.01). Conclusions: The current results indicated that the postoperative epidural analgesia can inhibit the rise in diastolic blood pressure in patients possessing severe gestational hypertension after Cesarean delivery. This electronic document is a “live” template. The various components of your paper [title, text, heads, etc.] are already defined on the style sheet, as illustrated by the portions given in this document.展开更多
BACKGROUND Diabetes rates among pregnant women in the United States have been increasing and are associated with adverse pregnancy outcomes.AIM To investigate differences in birth outcomes(preterm birth,macrosomia,and...BACKGROUND Diabetes rates among pregnant women in the United States have been increasing and are associated with adverse pregnancy outcomes.AIM To investigate differences in birth outcomes(preterm birth,macrosomia,and neonatal death)by diabetes status.METHODS Cross-sectional design,using linked Missouri birth and death certificates(singleton births only),2010 to 2012(n=204057).Exposure was diabetes non-diabetic,pre-pregnancy diabetes-insulin dependent(PD-I),pre-pregnancy diabetes-non-insulin dependent(PD-NI),gestational diabetes-insulin dependent(GD-I),and gestational diabetes-non-insulin dependent(GD-NI).Outcomes included preterm birth,macrosomia,and infant mortality.Confounders included demographic characteristics,adequacy of prenatal care,body mass index,smoking,hypertension,and previous preterm birth.Bivariate and multivariate logistic regression assessed differences in outcomes by diabetes status.RESULTS Women with PD-I,PD-NI,and GD-I remained at a significantly increased odds for preterm birth(aOR 2.87,aOR 1.77,and aOR 1.73,respectively)and having a very large baby[macrosomia](aOR 3.01,aOR 2.12,and aOR 1.96,respectively);in reference to non-diabetic women.Women with GDNI were at a significantly increased risk for macrosomia(aOR1.53),decreased risk for their baby to die before their first birthday(aOR 0.41)and no difference in risk for preterm birth in reference to non-diabetic women.CONCLUSION Diabetes is associated with the poor birth outcomes.Clinical management of diabetes during pregnancy and healthy lifestyle behaviors before pregnancy can reduce the risk for diabetes and poor birth outcomes.展开更多
目的:探讨妊娠合并慢性肾病(CKD)患者不良结局的转归及相关预测因素。方法:选取2022年1月至2023年1月于苏州大学附属第二医院分娩的62例CKD产妇。根据肾小球滤过率(GFR)将62例孕妇分为轻度CKD组(42例)和中重度CKD组(20例),收集两组患者...目的:探讨妊娠合并慢性肾病(CKD)患者不良结局的转归及相关预测因素。方法:选取2022年1月至2023年1月于苏州大学附属第二医院分娩的62例CKD产妇。根据肾小球滤过率(GFR)将62例孕妇分为轻度CKD组(42例)和中重度CKD组(20例),收集两组患者的一般情况,孕中孕晚期和产前实验室检验结果,围产期合并症和并发症,母儿转归情况。将差异有统计学意义的数据置于二元logistic回归方程中分析影响因素的主次关系。结果:孕中期,中重度CKD组患者的尿蛋白定性(2+)百分比明显高于轻度CKD组,差异有统计学意义(35.0%vs 7.1%,P=0.005)。孕晚期中重度CKD组中血肌酐值、尿蛋白定性(2+)比例、血清尿素含量、血清白蛋白量均显著高于轻度CKD组[63.4±11.9 vs 44.3±1.9,P=0.000;45.0%vs 16.7%vs,P=0.044;9.82(4.79,205.830)vs 3.56(2.99,4.19),P=0.024;38.0(33.0,38.7)vs 37.7(35.0,39.6),P=0.001],白蛋白/血肌酐均明显低于轻度CKD组(0.67±0.13 vs 0.90±0.04,P=0.033)。产前,中重度CKD患者检验结果进一步恶化,血肌酐值、人尿蛋白定性(2+)百分比、人尿红细胞定性(2+)百分比、肝酶(谷丙转氨酶,谷草转氨酶)和血清尿酸值均显著高于轻度CKD组,而血清白蛋白量和白蛋白/血肌酐均低于轻度CKD组,差异均有统计学意义(P<0.05)。中重度CKD组患者发生妊娠期高血压疾病风险显著增加。二元logistic分析结果显示,孕中期血肌酐值和孕中期血清白蛋白量(OR=1.214,95%CI为1.029~1.433,P=0.022;OR=0.582,95%CI为0.382~0.886,P=0.012)是预测CKD患者发生妊娠期高血压疾病的主要因素。血清肌酐值与妊娠期高血压疾病呈正相关,血清白蛋白与妊娠期高血压疾病呈负相关。中重度CKD组的新生儿体重远低于轻度CKD组,差异有统计学意义(P=0.007)。结论:中重度CKD患者肝肾功能随着孕周增加呈进行性恶化,且妊娠合并CKD患者易发妊娠期高血压疾病,导致母儿转归不良。因此,在孕期就应建立多学科会诊机制,保障母婴安全。展开更多
文摘Introduction: The purpose of this study was to examine the clinical usefulness of postoperative epidural analgesia in patients possessing severe gestational hypertension after Cesarean delivery. Methods: We reviewed the obstetric records of 99 patients possessing severe gestational hypertension undergoing singleton Cesarean delivery at ≥ 22 weeks’ gestation. Thirty patients were received continuous epidural analgesia with 0.2% ropivacaine for pain relief after Cesarean delivery with spinal anesthesia, 69 patients were not received epidural analgesia after Cesarean delivery with spinal anesthesia. Results: During the preoperative period, there were no measurable differences in the diastolic blood pressure between the 2 groups (108 vs± 7 vs. 106 mmHg ± 10 mmHg, p = 0.29). The diastolic blood pressure at 2 and 4 hours after Cesarean section in the epidural analgesia group were significantly lower than those in the non-epidural group (2 hours after Cesarean section: 88 vs ± 13 vs. 95 mmHg ± 8 mmHg, p < 0.01;4 hours after Cesarean section: 92 vs ± 15 vs. 102 mmHg ± 9 mmHg, p < 0.01). Conclusions: The current results indicated that the postoperative epidural analgesia can inhibit the rise in diastolic blood pressure in patients possessing severe gestational hypertension after Cesarean delivery. This electronic document is a “live” template. The various components of your paper [title, text, heads, etc.] are already defined on the style sheet, as illustrated by the portions given in this document.
文摘BACKGROUND Diabetes rates among pregnant women in the United States have been increasing and are associated with adverse pregnancy outcomes.AIM To investigate differences in birth outcomes(preterm birth,macrosomia,and neonatal death)by diabetes status.METHODS Cross-sectional design,using linked Missouri birth and death certificates(singleton births only),2010 to 2012(n=204057).Exposure was diabetes non-diabetic,pre-pregnancy diabetes-insulin dependent(PD-I),pre-pregnancy diabetes-non-insulin dependent(PD-NI),gestational diabetes-insulin dependent(GD-I),and gestational diabetes-non-insulin dependent(GD-NI).Outcomes included preterm birth,macrosomia,and infant mortality.Confounders included demographic characteristics,adequacy of prenatal care,body mass index,smoking,hypertension,and previous preterm birth.Bivariate and multivariate logistic regression assessed differences in outcomes by diabetes status.RESULTS Women with PD-I,PD-NI,and GD-I remained at a significantly increased odds for preterm birth(aOR 2.87,aOR 1.77,and aOR 1.73,respectively)and having a very large baby[macrosomia](aOR 3.01,aOR 2.12,and aOR 1.96,respectively);in reference to non-diabetic women.Women with GDNI were at a significantly increased risk for macrosomia(aOR1.53),decreased risk for their baby to die before their first birthday(aOR 0.41)and no difference in risk for preterm birth in reference to non-diabetic women.CONCLUSION Diabetes is associated with the poor birth outcomes.Clinical management of diabetes during pregnancy and healthy lifestyle behaviors before pregnancy can reduce the risk for diabetes and poor birth outcomes.
文摘目的:探讨妊娠合并慢性肾病(CKD)患者不良结局的转归及相关预测因素。方法:选取2022年1月至2023年1月于苏州大学附属第二医院分娩的62例CKD产妇。根据肾小球滤过率(GFR)将62例孕妇分为轻度CKD组(42例)和中重度CKD组(20例),收集两组患者的一般情况,孕中孕晚期和产前实验室检验结果,围产期合并症和并发症,母儿转归情况。将差异有统计学意义的数据置于二元logistic回归方程中分析影响因素的主次关系。结果:孕中期,中重度CKD组患者的尿蛋白定性(2+)百分比明显高于轻度CKD组,差异有统计学意义(35.0%vs 7.1%,P=0.005)。孕晚期中重度CKD组中血肌酐值、尿蛋白定性(2+)比例、血清尿素含量、血清白蛋白量均显著高于轻度CKD组[63.4±11.9 vs 44.3±1.9,P=0.000;45.0%vs 16.7%vs,P=0.044;9.82(4.79,205.830)vs 3.56(2.99,4.19),P=0.024;38.0(33.0,38.7)vs 37.7(35.0,39.6),P=0.001],白蛋白/血肌酐均明显低于轻度CKD组(0.67±0.13 vs 0.90±0.04,P=0.033)。产前,中重度CKD患者检验结果进一步恶化,血肌酐值、人尿蛋白定性(2+)百分比、人尿红细胞定性(2+)百分比、肝酶(谷丙转氨酶,谷草转氨酶)和血清尿酸值均显著高于轻度CKD组,而血清白蛋白量和白蛋白/血肌酐均低于轻度CKD组,差异均有统计学意义(P<0.05)。中重度CKD组患者发生妊娠期高血压疾病风险显著增加。二元logistic分析结果显示,孕中期血肌酐值和孕中期血清白蛋白量(OR=1.214,95%CI为1.029~1.433,P=0.022;OR=0.582,95%CI为0.382~0.886,P=0.012)是预测CKD患者发生妊娠期高血压疾病的主要因素。血清肌酐值与妊娠期高血压疾病呈正相关,血清白蛋白与妊娠期高血压疾病呈负相关。中重度CKD组的新生儿体重远低于轻度CKD组,差异有统计学意义(P=0.007)。结论:中重度CKD患者肝肾功能随着孕周增加呈进行性恶化,且妊娠合并CKD患者易发妊娠期高血压疾病,导致母儿转归不良。因此,在孕期就应建立多学科会诊机制,保障母婴安全。
