Risultati per: Linee guida sull’emorragia postpartum

Circulation, Volume 147, Issue 7, Page e76-e91, February 14, 2023. This scientific statement summarizes the available preclinical, epidemiological, and clinical trial evidence that supports the contributions of prepregnancy (and interpregnancy) cardiovascular health to risk of adverse pregnancy outcomes and cardiovascular disease in birthing individuals and offspring. Unfavorable cardiovascular health, as originally defined by the American Heart Association in 2010 and revised in 2022, is prevalent in reproductive-aged individuals. Significant disparities exist in ideal cardiovascular health by race and ethnicity, socioeconomic status, and geography. Because the biological processes leading to adverse pregnancy outcomes begin before conception, interventions focused only during pregnancy may have limited impact on both the pregnant individual and offspring. Therefore, focused attention on the prepregnancy period as a critical life period for optimization of cardiovascular health is needed. This scientific statement applies a life course and intergenerational framework to measure, modify, and monitor prepregnancy cardiovascular health. All clinicians who interact with pregnancy-capable individuals can emphasize optimization of cardiovascular health beginning early in childhood. Clinical trials are needed to investigate prepregnancy interventions to comprehensively target cardiovascular health. Beyond individual-level interventions, community-level interventions must include and engage key stakeholders (eg, community leaders, birthing individuals, families) and target a broad range of antecedent psychosocial and social determinants. In addition, policy-level changes are needed to dismantle structural racism and to improve equitable and high-quality health care delivery because many reproductive-aged individuals have inadequate, fragmented health care before and after pregnancy and between pregnancies (interpregnancy). Leveraging these opportunities to target cardiovascular health has the potential to improve health across the life course and for subsequent generations.

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Objectives
Use of intrauterine balloon tamponades for refractory postpartum haemorrhage (PPH) management has triggered recent debate since effectiveness studies have yielded conflicting results. Implementation research is needed to identify factors influencing successful integration into maternal healthcare packages. The Ellavi uterine balloon tamponade (UBT) (Ellavi) is a new low-cost, preassembled device for treating refractory PPH.

Design
A mixed-methods, prospective, implementation research study examining the adoption, sustainability, fidelity, acceptability and feasibility of introducing a newly registered UBT. Cross-sectional surveys were administered post-training and post-use over 10 months.

Setting
Three Ghanaian (district, regional) and three Kenyan (levels 4–6) healthcare facilities.

Participants
Obstetric staff (n=451) working within participating facilities.

Intervention
PPH management training courses were conducted with obstetric staff.

Primary and secondary outcome measures
Facility measures of adoption, sustainability and fidelity and individual measures of acceptability and feasibility.

Results
All participating hospitals adopted the device during the study period and the majority (52%–62%) of the employed obstetric staff were trained on the Ellavi; sustainability and fidelity to training content were moderate. The Ellavi was suited for this context due to high delivery and PPH burden. Dynamic training curriculums led by local UBT champions and clear instructions on the packaging yielded positive attitudes and perceptions, and high user confidence, resulting in overall high acceptability. Post-training and post-use, ≥79% of the trainees reported that the Ellavi was easy to use. Potential barriers to use included the lack of adjustable drip stands and difficulties calculating bag height according to blood pressure. Overall, the Ellavi can be feasibly integrated into PPH care and was preferred over condom catheters.

Conclusions
The training package and time saving Ellavi design facilitated its adoption, acceptability and feasibility. The Ellavi is appropriate and feasible for use among obstetric staff and can be successfully integrated into the Kenyan and Ghanaian maternal healthcare package.

Trial registration numbers
NCT04502173; NCT05340777.

Stroke, Volume 54, Issue Suppl_1, Page ATMP100-ATMP100, February 1, 2023. Background:Chronic primary headaches (CPHs) are known to increase the risk of stroke in women. However, the effect of a novel headache during pregnancy (G-HA) on the occurrence of subsequent stroke is unknown. In this study, we evaluated the association between G-HA and postpartum stroke in women.Methods:Based on the Korean National Health Insurance Service database, we included consecutive women hospitalized for delivery between 2007 and 2008. G-HA was defined as the novel CPH diagnosed during pregnancy, and was divided into migraine and other CPH groups. Primary outcome was determined any stroke, ischemic stroke, and hemorrhagic stroke that occurred during the identification period from delivery to December 31 2016. All diseases were identified based on data registered in the database using the International Classification of Disease-10thRevision-Clinical Modification codes.Results:A total of 919,810 women were evaluated. In multivariable cox regression analysis, G-HA was significantly associated with postpartum stroke [adjusted hazard ratio (aHR) = 1.65, 95% confidence interval (CI): 1.32-2.06]. The close association between G-HA and postpartum stroke was the strongest with migraine (aHR = 2.32, 95% CI: 1.59-3.40), but it was also statistically significant with other CPHs (aHR = 1.40, 95% CI: 1.07-1.83). According to the stroke subtype, G-HA showed a close correlation with ischemic stroke (aHR = 1.87, 95% CI: 1.45-2.41), but not with hemorrhagic stroke.Conclusions:We demonstrated that G-HA, especially migraines, was associated with postpartum stroke occurrence in women. This close association was evident in ischemic stroke and not hemorrhagic stroke.

Terapie personalizzate, più efficaci in base al tipo di malattia

Introduction
Postpartum haemorrhage (PPH) is the most serious clinical problem of childbirth that contributes significantly to maternal mortality worldwide. This systematic review aims to identify predictors of PPH based on a machine learning (ML) approach.

Methods and analysis
This review adhered to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. The review is scheduled to begin on 10 January 2023 and end on 20 March 2023. The main objective is to identify and summarise the predictive factors associated with PPH and propose an ML-based predictive algorithm. From inception to December 2022, a systematic search of the following electronic databases of peer-reviewed journal articles and online search records will be conducted: Cochrane Central Register, PubMed, EMBASE (via Ovid), Scopus, WOS, IEEE Xplore and the Google Scholar search engine. All studies that meet the following criteria will be considered: (1) they include the general population with a clear definition of the diagnosis of PPH; (2) they include ML models for predicting PPH with a clear description of the ML models; and (3) they demonstrate the performance of the ML models with metrics, including area under the receiver operating characteristic curve, accuracy, precision, sensitivity and specificity. Non-English language papers will be excluded. Data extraction will be performed independently by two investigators. The PROBAST, which includes a total of 20 signallings, will be used as a tool to assess the risk of bias and applicability of each included study.

Ethics and dissemination
Ethical approval is not required, as our review will include published and publicly accessible data. Findings from this review will be disseminated via publication in a peer-review journal.

PROSPERO registration number
The protocol for this review was submitted at PROSPERO with ID number CRD42022354896.

L’Assimefac annuncia la pubblicazione della guida per i medici di medicina generale in merito alla terapia domiciliare del paziente Sars-Cov-2.

Objective
To describe the mental health of perinatal women in five European countries during the third pandemic wave and identify risk factors related to depressive and anxiety symptoms.

Design
A cross-sectional, online survey-based study.

Setting
Belgium, Norway, Switzerland, the Netherlands and the UK, 10 June 2021–22 August 2021.

Participants
Pregnant and up to 3 months postpartum women, older than 18 years of age.

Primary outcome measure
The Edinburgh Depression Scale (EDS) and the Generalised Anxiety Disorder scale (GAD-7) were used to assess mental health status. Univariate and multivariate generalised linear models were performed to identify factors associated with poor mental health.

Results
5210 women participated (including 3411 pregnant and 1799 postpartum women). The prevalence of major depressive symptoms (EDS ≥13) was 16.1% in the pregnancy group and 17.0% in the postpartum . Moderate to severe generalised anxiety symptoms (GAD ≥10) were found among 17.3% of the pregnant and 17.7% of the postpartum women. Risk factors associated with poor mental health included having a pre-existing mental illness, a chronic somatic illness, having had COVID-19 or its symptoms, smoking, unplanned pregnancy and country of residence. Among COVID-19 restrictive measures specific to perinatal care, pregnant and postpartum women were most anxious about not having their partner present at the time of delivery, that their partner had to leave the hospital early and to be separated from their newborn after the delivery.

Conclusion
Approximately one in six pregnant or postpartum women reported major depression or anxiety symptoms during the third wave of the pandemic. These findings suggest a continued need to monitor depression and anxiety in pregnancy and postpartum populations throughout and in the wake of the pandemic. Tailored support and counselling are essential to reduce the burden of the pandemic on perinatal and infant mental health.

Introduction
Non-pharmacological treatments for postpartum depression have been investigated in various systematic reviews, and their efficacy has been evaluated. However, the quality of the evidence as a whole has not been quantified. The quality of this evidence may influence the choice of interventions and even cause misleading clinical decisions. This study aims to provide an objective presentation of the methodological bias and identify treatments supported by solid evidence.

Methods and analysis
For the purpose of conducting systematic reviews and meta-analyses, a comprehensive search of the relevant published literature will be conducted in English databases such as PubMed, Embase, Cochrane Library, PsycINFO and Scopus, as well as in four Chinese databases: the Chinese Biomedical Databases (CBM), Wan fang database, China National Knowledge Infrastructure and VIP Database (VIP). The time of publication will be limited from their inception to 31 May 2022. We will extract the following data from the included literature: title, first author, journal type of included literature, number and sample size, intervention/control measures, outcome indicators and main study outcomes. The Assessment of Multiple Systematic Reviews-2 will be used to measure the quality of the methods. In addition, we will use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to evaluate the quality of the reporting, as well as the Grading of Recommendations Assessment, Development and Evaluation to evaluate the quality of the evidence.

PROSPERO registration number
CRD42021285470.