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

La disfunzionalità dell’adipe si riflette sui tessuti arteriosi, cardiaci e renali e queste interconnessioni rappresentano una sfida importante per il Ssn, ma anche un’opportunità per migliorare la presa in cura dei pazienti con patologie complesse

Rinviato a metà gennaio voto su piano revisione Rete oncologica

Objective
In the puerperium, women with hypertensive disease of pregnancy remain at risk for maternal complications. The antihypertensive agent prescribed antepartum is usually continued postpartum; however, evidence regarding the most effective treatment is lacking. Therefore, we aimed to investigate which antihypertensive agent results in optimal treatment (both effectiveness and safety) of postpartum hypertension.

Design
Systematic review and meta-analysis.

Data sources
MEDLINE (Ovid), Embase.com and CENTRAL were searched through 22 August 2024.

Eligibility criteria
Randomised controlled trials (RCTs) evaluating oral antihypertensives and diuretics in postpartum hypertensive women published after 1990, performing BP measurements in the postpartum period, were identified.

Data extraction and synthesis
Two independent reviewers extracted data and assessed risk of bias. Pooled data were calculated as risk ratio or mean difference using a random effect model.

Results
Fourteen RCTs (1651 women) were included. Seven RCTs compared diuretics with placebo or antihypertensive controlled, two RCTs compared oral antihypertensives with placebo and five RCTs compared labetalol with nifedipine. Pooled data demonstrated a significantly lower BP on day 3 in cases with pre-eclampsia using furosemide (mean difference –4.06, 95% CI –6.81 to –1.31). Furosemide had no significant effect on any of the other outcomes. Faster BP control was observed for labetalol over nifedipine in a single RCT (mean difference 5.20, 95% CI 4.36 to 6.04). No other significant effects were observed.

Conclusions
In this extensive literature review, no medication preference could be stated and a lack of high-quality studies was revealed. Some evidence demonstrates a positive effect on BP control in women with pre-eclampsia using furosemide. Therefore, adding furosemide to initial treatment is considerable. However, antihypertensive preference and furosemide effectiveness should be further researched. We propose a retrospective cohort study using real-life hospital data (from health records), utilising clinical variance in therapeutic strategies currently present.

PROSPERO registration number
CRD42023410765.

Introduction
The intrauterine device (IUD) inserted immediately after delivery is a safe and effective measure for preventing unplanned pregnancies. Despite exhibiting a higher expulsion rate compared with later insertions, it proves cost-effective due to the high rate of continuity of the method. There is still a gap in the literature regarding the optimal strategy for monitoring these patients, whether it should be through clinical examination, ultrasound or both. The aim of this review is to map the available evidence regarding the proper clinical and ultrasound follow-up procedures of IUDs inserted immediately post partum.

Methods and analysis
Using the well-established scoping review methodology outlined by the Joanna Briggs Institute, a five-stage review is outlined: (1) determining the research question, (2) search strategy, (3) inclusion criteria, (4) data extraction and (5) analysis and presentation of the results. The search strategy will be applied to nine databases reflecting empirical and grey literature. A two-step screening process will be used to determine eligibility of articles. To be included in the review, articles must describe how postpartum women (adolescents or adults) who had an IUD inserted immediately after birth (vaginal or caesarean) were followed up. All articles will be independently assessed for eligibility, and data from eligible articles will be extracted and charted using a standardised form. Extracted data will be analysed using narrative and descriptive analyses.

Ethics and dissemination
Ethics approval is not required. The results will be disseminated to the health science community through professional networks, conference presentations and publication in a scientific journal.

Objective
Dose-response analysis of the effect of each additional contact where family planning (FP) was discussed during antenatal, delivery, postnatal or immunisation visits on the uptake of postpartum family planning (PPFP) within 12 months.

Design
A cohort where pregnant women were enrolled and reinterviewed approximately 12 months postpartum. Life table analyses examined differentials in probabilities of adopting contraception over 12 months postpartum by level of exposure to FP counselling. Competing risks regression analysis examined the dose effects in HRs by the number of maternal, newborn or child health (MNCH) contacts where FP was discussed, adjusted for confounding covariates.

Setting
Two Arsi zone woredas: Oromia and Ethiopia.

Participants and measures
722 pregnant women enrolled, and 706 successfully reinterviewed 12 months postpartum about each MNCH contact during pregnancy, delivery and later visits, whether these included any PPFP counselling and PPFP use.

Main results
Two-thirds of the cohort delivered at home. The average number of MNCH contacts women received was 7.6, while the average number where FP was discussed was 2.8. The cumulative probability of PPFP uptake was higher for women who received FP information during at least one MNCH contact, regardless of place of delivery. Each additional MNCH contact where FP was discussed increased the likelihood of PPFP uptake by 14% (95% CI 8% to 20%) or 9% (95% CI 5% to 13%), depending on place of birth. PPFP did not increase with additional contacts without FP information.

Conclusions
While PPFP conversations immediately after a facility birth generated the greatest chance of affecting use, integrating at every visit in the continuum had more impact.

Trial registration number
ClinicalTrials.gov, NCT03585361.

Domani ad Ancona congresso scientifico alla Politecnica Marche

La Regione avvia accertamenti con lo Spallanzani. Per il paese africano la malattia misteriosa “è una grave forma di malaria”, ma per l’Oms non è ancora determinata la causa

Cardiologi, tante potenzialità diagnosi e gestione ma nodi etici

Introduction
The neuraxial morphine has been regarded as the gold standard for postpartum analgesia. However, the recent advancements in patient-controlled analgesia and various regional nerve blocks have led to the implementation of multimodal analgesia strategies, which aim to reduce opioid usage and associated complications while ensuring satisfactory pain relief. The objective of this research is to investigate the optimal dosage of epidural morphine for alleviating moderate and severe pain after caesarean sections in healthy parturients, as well as reducing unnecessary burden of respiratory monitoring resources.

Methods and analysis
The present single-centre randomised controlled pragmatic clinical trial aims to enrol a total of 310 healthy parturients with American Society of Anesthesiologists grade I/II, who are scheduled for caesarean section under combined spinal and epidural anaesthesia at West China Second University Hospital of Sichuan University. The recruitment process has not yet commenced and is anticipated to commence in March 2024, concluding in September 2024. Enrolled patients will be evenly distributed into five groups, namely morphine groups (M1–M4) and the control group (M0). The primary outcome measure is the incidence rate of postoperative use Numerical Rating Scale (NRS) pain score ≥4 points within 24 hours, which will be primarily assessed through bedside follow-up conducted by investigators and patient self-assessment at 2, 4, 6, 8, 12 and 24 hours postoperatively. The secondary outcomes encompass the following: incidence of postoperative NRS score ≥4 within 48 hours, occurrence of SpO2