Risultati per: FIGO: linee guida sulla gestione dell’emorragia postpartum

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Objective
To evaluate the association between body composition from early pregnancy to 42 days postpartum and postpartum weight retention (PPWR).

Design
This retrospective cohort study was conducted at Chengdu Shuangliu Maternal and Child Health Care Hospital from June 2020 to December 2021.

Setting
The study was conducted in Sichuan Province, southwestern China.

Participants
A total of 673 pregnant women at 6–13 weeks of gestation were included.

Outcome measures
Demographic and health information of participants was collected from the electronic medical record system using a self-designed questionnaire. Body fat percentage (PBF), fat mass (FM), fat-free mass (FFM), lean mass (LM) and protein were measured using bioelectrical impedance analysis. Logistic regression and restricted cubic spline (RCS) analyses were performed to examine the association between body composition and PPWR.

Results
During early pregnancy, compared with the bottom quartile group, women in the top quartile group of PBF and FM levels had a 51% (95% CI 0.24 to 0.99) and 64% (95% CI 0.17 to 0.76) lower risk of PPWR, respectively. For each SD increase in PBF and FM levels, the risk of PPWR decreased by 29% (95% CI 0.55 to 0.91) and 35% (95% CI 0.50 to 0.85), respectively. In contrast, at 42 days postpartum, for each SD increase in PBF, FM, FFM and LM levels, the PPWR risk elevated by 251% (95% CI 2.70 to 4.62), 315% (95% CI 3.15 to 5.57), 56% (95% CI 1.30 to 1.89), and 71% (95% CI 1.42 to 2.09). RCS analysis revealed that PBF and FM levels during early pregnancy were negatively correlated with the risk of PPWR (p-overall

Neglet e l’afasia tra principali problemi lungo termine malattia

Introduction
The primary objective of this trial is to evaluate the effect of replenishing coagulation factor XIII (FXIII) in women with postpartum haemorrhage (PPH) on measured blood loss (MBL). Based on earlier research, we hypothesise that the administration of FXIII leads to a significant reduction in postpartum blood loss.

Methods and analysis
This is a randomised, controlled trial that will allocate eligible patients in the event of a PPH and after receiving tranexamic acid either to the treatment group, receiving FXIII, or to the control group (standard of care). The primary endpoint is the MBL within 24 hours using a standardised method. For the primary analysis, estimation of the OR under a proportional odds assumption is conducted simultaneously for all possible cut-off points. A corresponding estimate, along with a two-sided 95% CI and two-sided p value against the null hypothesis OR=1, is obtained from the Continuous Outcome Logistic Regression model. More than 7000 patients will be screened in order to include a total of 988 eligible patients into the trial. Secondary outcomes include the rate of adverse maternal outcomes related to PPH, the rate of women breastfeeding after PPH and the safety of the administration of FXIII in women with PPH. Dynamics of blood coagulation factors in women with PPH and their association with MBL will be assessed in specific centres. A preliminary overview on costs and potential savings through early treatment of PPH with FXIII is included in the analysis as well as a patient and public involvement report, asking for patients’ personal experience during PPH in the main study centre.

Ethics and dissemination
Ethics approval was granted by the central ethics committee (Kantonale Ethikkommission Zürich/Switzerland) on 16 June 2024, reference number: BASEC 2024-00374. Results will be disseminated via open-access publication in a relevant medical journal.

Trial registration number
ClinicalTrials.gov ID NCT06481995.

Introduction
Excessive bleeding after childbirth (postpartum haemorrhage, PPH) affects 5% of births and causes 75 000 maternal deaths worldwide annually. It is the leading cause of direct maternal deaths globally and continues to be a major cause of mortality in the UK. Oxytocin is the standard first-line treatment for atonic PPH. The PPH rate is increasing, and this may be partially related to the overuse of oxytocics in labour. Laboratory studies on myometrium suggest that repeated use of oxytocics leads to the saturation of oxytocin receptors and reduced therapeutic efficacy of oxytocin. Carboprost (a prostaglandin analogue) is usually reserved for second-line management of atonic PPH. A systematic review comparing the efficacy of carboprost and conventional uterotonics for PPH prophylaxis found that carboprost was associated with less blood loss, but around 15% of women experienced side effects. The study’s aim is to compare intramuscular carboprost with intravenous oxytocin for the initial treatment of PPH. In addition, to assess the cost-effectiveness of both treatments, participants’ views on the two treatments and the consent process.

Methods and analysis
COPE is a double-blind, double-dummy, randomised controlled trial that aims to recruit 2000 women (1:1 allocation, stratified by mode of birth) across 20 hospitals in the UK. Due to the emergency nature of PPH, COPE uses a research without prior consent (RWPC) model. Randomisation and treatment will occur if eligibility criteria are met once bleeding starts. Postnatal consent will be sought for disclosure of identifiable data and continued follow-up. Clinical efficacy outcomes will be collected at 24 and 48 hours or at hospital discharge, if sooner. Questionnaires will also be collected at 24 hours and 4 weeks postrandomisation. Cost-effectiveness will be based on the incremental cost per quality-adjusted life-year, calculated from the perspective of the NHS and personal social services.

Ethics and dissemination
This study has been approved by the Coventry and Warwickshire Research Ethics Committee (REC) (18/WM/0227) and the Health Research Authority. Results will be disseminated via peer-reviewed publications.

Trial registration number
ISRCTN16416766.

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