Search Results for: FIGO: linee guida sulla gestione dell’emorragia postpartum

Purpose
Pregnant and postpartum women living with HIV in South Africa are at high risk of dropping out of care, particularly after delivery. Population mobility may contribute to disruptions in HIV care, and postpartum women are known to be especially mobile. To improve engagement in HIV care during the peripartum period, we developed CareConekta, a smartphone application (app) that uses GPS coordinates to characterise mobility and allow for real-time intervention. We conducted a randomised controlled pilot study to assess feasibility, acceptability and initial efficacy of the app intervention to improve engagement in HIV care. This cohort profile describes participant enrolment and follow-up, describes the data collected and provides participant characteristics.

Participants
We enrolled 200 pregnant women living with HIV attending routine antenatal care at the Gugulethu Midwife Obstetric Unit in Cape Town, South Africa. Eligible women must have owned smartphones that met the app’s technical requirements. Seven participants were withdrawn near enrolment, leaving 193 in the cohort.

Findings to date
Data were collected from detailed participant questionnaires at enrolment and follow-up (6 months after delivery), as well as GPS data from the app, and medical records. Follow-up is complete; initial analyses have explored smartphone ownership, preferences and patterns of use among women screened for eligibility and those enrolled in the study.

Future plans
Additional planned analyses will characterise mobility in the population using the phone GPS data and participant self-reported data. We will assess the impact of mobility on engagement in care for the mother and infant. We also will describe the acceptability and feasibility of the study, including operational lessons learnt. By linking this cohort to the National Health Laboratory Service National HIV Cohort in South Africa, we will continue to assess engagement in care and mobility outcomes for years to come. Collaborations are welcome.

Trial registration number
NCT03836625.

Introduction
The prevention of child abuse and neglect is an urgent matter given the serious effects persisting into adulthood, and the increased risk of the offspring of abused children being abusive themselves. Intervening as early as possible may prevent abuse that can begin in infancy. Although several systematic reviews have investigated the effects of interventions on populations who are at increased risk for perpetrating child abuse and neglect, few studies have focused on women or interventions that start during perinatal periods. This study aims to describe a systematic review to examine the effects of interventions to prevent child abuse and neglect that begin during pregnancy and immediately after childbirth (less than 1 year). The study will involve performing a systematic review and meta-analysis based on the latest research articles and a broader literature search.

Methods and analysis
The protocol was prepared using the 2015 statement of Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. The review will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The literature search will be performed using the MEDLINE, PsycINFO, Embase and Cochrane Central Register of Controlled Trials databases from inception onward. Randomised controlled trials of interventions that begin during pregnancy or the first year postpartum, designed to prevent child abuse and neglect in families who are at increased risk for these issues, will be included. Data collection, quality assessment and statistical syntheses will be conducted by following the methods in the protocol that are predefined. Any index of child maltreatment will be included as a primary outcome. A meta-analysis and sub-group analyses will be considered based on the characteristics of interventions.

Ethics and dissemination
This study does not require ethical approval. The findings will be presented at conferences and will be submitted to a peer-reviewed journal.

PROSPERO registration number
CRD42021266462.

Introduction
Complementary and alternative therapies (CATs) refer to a diverse range of approaches that can be used as add-on or an alternative to conventional therapies. While a number of individual studies and systematic reviews (SRs) or meta-analyses (MAs) have investigated the effectiveness of specific types of CATs to treat depressive symptoms at specific moments of the perinatal period, an overarching synthesis of the literature is currently lacking. We will conduct an umbrella review of SRs and MAs to assess to which extent CATs are associated with depressive symptoms reduction during pregnancy or after childbirth.

Methods and analysis
We will search a broad set of electronic databases (MEDLINE via Ovid, Embase.com, CINAHL via EBSCOhost, PsycINFO via Ovid, AMED and Google Scholar). We will include SRs with or without MAs meeting the following criteria: (1) the review should focus mostly on individual studies reporting a randomised controlled design; (2) diagnosis should be made during pregnancy or during the post partum using a clinical interview according to DSM or ICD criteria; (3) the reviewed intervention should start during pregnancy or in the first postpartum year and meet the criteria for being considered as CAT. The main outcome will be depressive symptoms reduction during pregnancy or after childbirth. Secondary outcomes will include the remission of depression according to DSM criteria and intervention acceptability. Overlap between reviews will be described, quantified and discussed. We will rate the quality of the included SRs or MAs using the AMSTAR-2 tool. MAs will be performed by using the data from the individual RCT studies included in the SRs or MAs. Sensitivity analyses restricted to studies with a low-moderate risk of bias will be realised. Publication bias will be examined visually by using a funnel plot, and formally using the Egger’s test and test of excess significance.

Ethics and dissemination
We intend to publish the results of the umbrella review in an international peer-reviewed journal. Oral presentations in congresses and internal diffusion through the Rise up-PPD European COST Action network are also planned.

PROSPERO registration number
CRD42021229260.

Realizzato con fondi privati e pubblici, resta gestione pubblica

Circulation, Volume 146, Issue Suppl_1, Page A10067-A10067, November 8, 2022. Introduction:Preeclampsia is associated with cardiovascular disease (CVD), and follow-up in women for CVD prevention is essential. We examined racial differences in follow-up with primary or cardiology care and assessed if social factors modified that association.Methods:We conducted our analysis in an administrative database (Optum’s de-identified Clinformatics® Data Mart) and identified women with preeclampsia diagnosed from 9/2014-9/2019. Odds of a follow-up visit with a primary care provider or cardiologist within 6 months after delivery were compared among Black versus White women using multivariable logistic regression models adjusting for age, comorbidities (by Elixhauser score), income, education, insurance type, and number of adults per household. We examined the effect modification of education and income on follow-up by race. A Cox proportional hazard model was used to compare time to follow-up.Results:Of 22,887 women with a diagnosis of preeclampsia (age 31.7±5.6 years), 2,736 (12.0%) were identified as Black race and 3440 (15.0%) Hispanic. Education, income, and comorbidities differed by race and ethnicity. Black women had lower odds of follow-up with a primary care provider or cardiologist within 6 months after delivery: adjusted odds ratio (aOR) 0.85 [95% confidence interval (CI) 0.78-0.92] compared with White women and were 13% less likely to have follow-up in adjusted time to event models. Hispanic women also had lower odds of follow-up: aOR 0.84 [95% CI 0.78-0.91] and were 12% less likely to have follow-up compared with white women. There was an effect modification of education by race on follow-up (p for interaction=0.001), but not income (p for interaction=0.14).Conclusions:Black and Hispanic women have decreased odds of follow-up with a primary care provider or cardiologist than White women in the 6 months postpartum, a disparity that may be modified by socioeconomic factors. Improving follow-up care for Black women, particularly those with less than a college-level education, may enhance CVD prevention.

Circulation, Volume 146, Issue Suppl_1, Page A11515-A11515, November 8, 2022. Introduction:Peripartum cardiomyopathy (PPCM) is a type of heart failure that presents with systolic dysfunction in the third trimester of pregnancy or early postpartum. Viral myocarditis, genetic predisposition, and hormonal changes are suggested as contributing factors to PPCM. However, the molecular basis of PPCM remained elusive.Hypothesis:Cardiac expression of genes involved in immune system response is dysregulated in PPCM.Methods:We identified women with PPCM and age/race-matched heart donors from a dataset obtained from Myocardial Applied Genomics Network (MAGNet) consortium. Left ventricular (LV) biopsies were taken at the time of heart transplantation. Bulk RNA-seq was performed on LV tissue of patients with PPCM and non-failing heart donors (NF). We used the Human Cell Atlas (HCA) reference database with accession code ERP128138 to investigate cell-specific enrichment of genes.Results:Mean age of study participants was 36.1 years and 33.3% of participants had African American ancestry. We found thatLCN6(Log2(fold_change) = -4.1, p-val = 0.0027) andFCN3(Log2(fold_change) = -3.4, p-val = 0.0042) are downregulated in LV tissue obtained from PPCM compared to NF.LCN6encodes lipocalin-6 andFCN3encodes ficolin-3 which are upstream of the mannose-binding lectin complement pathway. Based on HCA dataset on adult human hearts, we observed thatLCN6andFCN3genes are mainly expressed by endothelial cells.Conclusions:We demonstrated that expression ofLCN6andFCN3genes, which are upstream of the mannose-binding lectin pathway, is decreased in cardiac endothelial cells of individuals withPPCM. Mannose-binding lectin is a soluble pattern recognition receptor that identifies mannose and N-acetylglucosamine residues in a wide variety of pathogens and antigen-antibody complexes and works as an opsonin that facilitates phagocytosis. Our findings suggest the possibility of impaired immune complex clearance in PPCM pathogenesis.

Circulation, Volume 146, Issue Suppl_1, Page A11672-A11672, November 8, 2022. Cardiogenic shock (CS) in the peripartum period is associated with significant morbidity and mortality. Treatment of CS by specialists in high-volume centers is associated with improved outcomes. A healthy 34-year-old pregnant woman underwent planned cesarian section delivery for placenta previa at a community hospital, which was complicated by postpartum hemorrhage treated with methylergonovine, tranexamic acid, and carboprost. One hour later, she was hypertensive, tachycardic, and had a generalized seizure followed by hypoxemia and pulseless electrical activity. She was persistently hypotensive after resuscitation. An echocardiogram (TTE) demonstrated a left ventricular ejection fraction of 25%. She was transferred to our cardiac intensive care unit (CCU) for consideration of mechanical circulatory support (MCS). The patient arrived at the CCU on multiple vasopressors and inotropes. The advanced HF, CCU, and maternal fetal medicine teams assessed the patient on arrival. Bedside right heart catheterization demonstrated right atrial pressure of 6 mmHg, pulmonary arterial pressure of 22/17 mmHg, pulmonary capillary wedge pressure of 10 mmHg, and Fick cardiac index of 2.5 L/min. BP was improving and vasoactive agents were weaned. The bleeding risk of anticoagulation for MCS after postpartum hemorrhage was thought to outweigh the potential benefit of MCS with normal filling pressures and weaning of vasoactive agents, thus MCS was not deployed. An electroencephalogram revealed status epilepticus, and magnetic resonance imaging of the brain was suggestive of posterior reversible encephalopathy syndrome with hemorrhage secondary to cerebral vasospasm. TTE on hospital day 4 showed normalization of biventricular function, and she made a full neurologic recovery and was discharged home on hospital day 15. Given the normalization of cardiac and neurologic function with supportive care only, her shock was attributed to methylergonovine-induced cerebral vasospasm leading to seizures with subsequent respiratory and cardiac arrest and myocardial stunning. This case demonstrates the importance of rapid team-based diagnostic assessment of peripartum patients presenting in suspected CS to appropriately triage the use of MCS.

Circulation, Volume 146, Issue Suppl_1, Page A10087-A10087, November 8, 2022. Introduction:Previous research has shown cognitive decline related to preeclampsia (preE) in women after pregnancy when using neurocognitive assessments; however, it is not known if changes in cognition occur antenatally (e.g., in the third trimester of pregnancy). This pilot study investigated if the cerebrovascular effect of preE can manifest as cognitive decline antenatally.Hypothesis:Pregnant preE women will score lower on cognitive tests in the executive and memory function domains compared with pregnant normotensive women.Methods:This was a prospective observational study in a single institution. We included women more than 28 weeks of gestation with preE or normotension. We excluded women with chronic hypertension, neurologic and developmental disabilities, and current substance use. Neurocognitive test battery included subjective (Everyday Cognition) and objective assessment of executive function (Stroop test, Trail Making), attention and working memory (Digit Span Subtest), and information processing speed (Digit Symbol Substitution) evaluated as z-scores. Baseline characteristics (e.g. pre-pregnancy Body mass index [BMI]) characteristics were collected.Results:We enrolled 1 to 2 women weekly over 4 months. Thirty pregnant women were included (16 preE; 14 normotensive). Those with preE had higher pre-pregnancy BMI, delivered at earlier gestational age and reported higher history of migraines. PreE vs. normotensive women had more memory complaints (p

Circulation, Volume 146, Issue Suppl_1, Page A13230-A13230, November 8, 2022. Introduction:Contemporary data on the prevalence, trends, and outcomes of cardiovascular diseases (CVD) in pregnant patients are limited.Hypothesis:We aimed to analyze the prevalence, trends, and outcomes of CVD and their subtypes in hospitalized pregnant patients in the United States (U.S.).Methods:This retrospective population-based cohort study used the Nationwide Readmission Database to identify all hospitalized pregnant patients from January 1, 2010, to December 31, 2019. Pregnancy-associated hospitalizations were identified, and patients with missing information on the length of stay (LOS) and mortality were excluded. Main outcomes were prevalence and trend of CVD burden in pregnant patients.Results:39,212,104 hospitalized pregnant patients were identified: 4,409,924 with CVD (11.25%) and 34,802,180 without CVD (88.75%). The annual CVD burden increased from 9.49 % in 2010 to 15.54 % in 2019 (p

Circulation, Volume 146, Issue Suppl_1, Page A10035-A10035, November 8, 2022. Overlap between the histopathologic changes of acute rejection and viral myocarditis presents a diagnostic dilemma. A 34 year-old female with a past medical history of postpartum cardiomyopathy and subsequent orthotopic heart transplant in December 2019, presented for routine surveillance heart biopsy seven months post-transplant. Her AlloMap was elevated and AlloSure was uptrending, concerning for rejection. Ten days prior to presentation, she tested positive for COVID-19 via polymerase chain reaction (PCR) testing. Her symptoms were fatigue and mild headache for two weeks prior to diagnosis. She did not seek medical attention for her symptoms and received no COVID-19 specific treatment. Endomyocardial biopsy showed grade 2R acute cellular rejection. Her echocardiogram was unchanged with normal left ventricular ejection fraction and right ventricular function. SARS-CoV-2 levels were measured by PCR of ribonucleic acid (RNA) isolated from the biopsy specimen and were undetectable. The patient was treated with two short courses of high dose prednisone which eventually abated her transplant rejection. The patient remained positive on PCR testing for COVID-19 for the next six months. Chest x-ray and computed tomography for follow up after COVID-19 infection showed no evidence of pulmonary fibrosis or superinfection considering ongoing immunosuppression for rejection. Our patient illustrates a case of concomitant COVID-19 infection and presumed transplant rejection, raising the question of whether the findings seen on immunohistochemistry were truly rejection or instead an elevated immune response due to COVID-19 infection. Given that our patient had a predominance of CD3+ T cells and less CD68+ macrophages (the former being more prominent in acute cellular rejection and the latter being more prominent in COVID-19 myocarditis), we are inclined to believe the former.

Circulation, Volume 146, Issue Suppl_1, Page A13430-A13430, November 8, 2022. Introduction:Preeclampsia (PE) is associated with an increased cardiovascular (CV) risk. Recent data have shown worse left ventricular remodeling and diastolic function in women with PE and persistent hypertension (HTN). To improve our understanding of CV risk after PE, we evaluated the contribution of persistent HTN on arterial health.Methods:We recruited 40 women with PE history and 40 age-matched women with normotensive pregnancies (6 months – 6 years post-partum). We comprehensively evaluated measures of arterial health and hemodynamics with validated technique combining applanation tonometry and transthoracic echocardiography. We compared 3 groups: previous PE with persistent HTN (PE-HTN), previous PE with normalized blood pressure (PE-noHTN) and controls. Associations of PE-HTN with arterial health measures were assessed with multivariable linear regression adjusted for age, BSA, heart rate, diabetes, smoking history, serum creatinine and parity.Results:Eight (20%) of the post-PE women had persistent HTN. Mean age was 35.8 ± 3.9 years, number of pregnancies was 2.4 ± 1.4, and time since last pregnancy was 2.6 ± 1.2 years, and not different across the 3 groups (P