Risultati per: Linee guida sull’emorragia postpartum

Curata da Arrigoni, Malafarina e Sani e promossa dalla Cpo

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Circulation, Volume 149, Issue 7, Page e330-e346, February 13, 2024. Adverse pregnancy outcomes are common among pregnant individuals and are associated with long-term risk of cardiovascular disease. Individuals with adverse pregnancy outcomes also have an increased incidence of cardiovascular disease risk factors after delivery. Despite this, evidence-based approaches to managing these patients after pregnancy to reduce cardiovascular disease risk are lacking. In this scientific statement, we review the current evidence on interpregnancy and postpartum preventive strategies, blood pressure management, and lifestyle interventions for optimizing cardiovascular disease using the American Heart Association Life’s Essential 8 framework. Clinical, health system, and community-level interventions can be used to engage postpartum individuals and to reach populations who experience the highest burden of adverse pregnancy outcomes and cardiovascular disease. Future trials are needed to improve screening of subclinical cardiovascular disease in individuals with a history of adverse pregnancy outcomes, before the onset of symptomatic disease. Interventions in the fourth trimester, defined as the 12 weeks after delivery, have great potential to improve cardiovascular health across the life course.

Stroke, Volume 55, Issue Suppl_1, Page A55-A55, February 1, 2024. Introduction:Risk of maternal stroke is higher in patients with preeclampsia (PEC), with the highest risk seen in those with chronic hypertension with superimposed preeclampsia (siPEC). Most strokes occur postpartum. Changes in cerebral autoregulation (CA) could contribute to elevated postpartum stroke risk. We describe CA curves in postpartum patients with no hypertension, PEC and siPEC.Methods:We prospectively recruited postpartum patients with and without PEC and measured 10-minute continuous mean arterial pressure (MAP) and cerebral blood flow velocity (CBFV) with finger plethysmography and transcranial Doppler within 1 week of delivery. We generated polynomial S-curves to derive limits of CA, CA plateaus (defined as slope < 0.15), and mean and minimum slopes between CA limits. We calculated Pearson correlation coefficients (Mx) between normalized MAP and CBVF; Mx > 0.3 indicates high MAP-CBFV correlation, suggesting impaired CA.Results:CA curves were produced from 71 patients (28% normotensive, 42% PEC, 30% siPEC). Group means for MAP were higher in those with PEC and siPEC (normotensive 72 mmHg, PEC 88, siPEC 87 [p=0.001]). CA was preserved in all groups, with Mx nadirs below 0.3 (Figure). The normotensive group demonstrated a wide, flat plateau in the S-curve (minimum slope 0.02). In the PEC group, we observed a narrower and slightly steeper autoregulatory plateau (minimum slope 0.05). The siPEC group displayed the narrowest and steepest plateau (minimum slope 0.15).Conclusion:In conclusion, in our sample of postpartum patients with normotension, PEC and siPEC, we observed a gradient in CA plateau range and slope. Compared with the normotensive group, the PEC and siPEC groups had progressively narrower and steeper CA plateaus, suggesting a more limited CA range and diminished CA efficacy. Future studies should investigate whether sustained MAP outside CA limits contributes to adverse maternal outcomes, particularly in those with siPEC.

Stroke, Volume 55, Issue Suppl_1, Page AWP121-AWP121, February 1, 2024. Objective:Standard adult normative data for transcranial Doppler (TCD)-based cerebral hemodynamic measures, such as mean and peak cerebral blood flow velocity (mCBFV, pCBFV), are used to identify pathological conditions such as postpartum angiopathy. However, little is known about cerebral hemodynamics during the early postpartum period, particularly in patients with preeclampsia (PEC). We characterized cerebral hemodynamics using TCD in the first week postpartum in patients with and without PEC.Methods:We prospectively recruited women with PEC and normotensive pregnant women delivering at an urban academic medical center. We measured CBFV in the bilateral middle cerebral arteries with TCD and calculated systolic mCBFV and pCBFV as well as pulsatility index (PI) and PI-derived noninvasive intracranial pressure (nICP). We compared systolic mCBFV and pCBFV between postpartum women with and without PEC, and historical data from non-pregnant young adult female controls.Results:Subjects were 51 women with PEC, 19 normotensive postpartum women, and 28 non-pregnant historical controls. In the PEC group, median mCBFV was 75.0 cm/s (IQR 65.2-99.1) and median pCBFV was 106.9 cm/s (IQR 92.7-130.8). In the normotensive postpartum group, median mCBFV was 77.1 cm/s (IQR 66.0-92.3) and median pCBFV was 107.9 cm/s (IQR 96.6-127.4). In the non-pregnant female control group, median mCBFV was 62.0 cm/s (IQR 48.5-67.9) and median pCBFV was 83.6 cm/s (IQR 69.3-95.2) (p

Stroke, Volume 55, Issue Suppl_1, Page AWP232-AWP232, February 1, 2024. Background:We evaluate the association of migraine before and during pregnancy with the development of major adverse vascular events (MAVE) during an extended postpartum period of 24 weeks.Methods:We identified pregnant women aged between 12 and 44 years from the state inpatient databases of New York, Florida, Georgia, Maryland, and Washington (2016 – 2019). Patients were followed up for up to 24 weeks postpartum. Patients with migraine (ICD-10 code: G43) before or during pregnancy were considered to have a history of migraine. We fit multivariable logistic regression models to evaluate the association between the history of migraine and the development of MAVE (stroke, acute coronary syndrome, systemic thromboembolism, hypertensive encephalopathy, pulmonary heart disease, or death) up to 24 weeks after delivery. Patients with a history of MAVE before or during pregnancy were excluded. Adjusted odds ratios (aOR) and 95% confidence interval (CI) are reported.Results:Among 1,568,646 eligible participants (mean age [SD]: 29 [5.7] years), 43,840 (2.79%) had a documented history of migraine. Women with a history of migraine (vs. those without a history of migraine) had higher odds of experiencing MAVE (268/43840 [0.61%] vs. 4556/1524806 [0.3%], aOR, 95% CI: 1.47, 1.30 – 1.67). Also, older age (aOR, CI: 1.02, 1.02 – 1.03), smoking during pregnancy (2.14, 1.97 – 2.32), and pre-eclampsia (1.87, 1.72 – 2.03) were independently associated with a higher likelihood of developing postpartum MAVE. Additionally, those with a history of kidney failure (2, 1.76 – 2.27), liver disease (1.32, 1.11 – 1.56), and heart failure (1.59, 1.35 – 1.86) had higher odds of experiencing MAVE. Furthermore, those with a history of hypertension (1.23, 1.13 – 1.33), diabetes (1.30, 1.17 – 1.45), obesity (1.31, 1.22 – 1.41), and coagulopathy (2.36, 2.17 – 2.57) were more likely to experience MAVE.Conclusions:Migraine seems to be independently associated with a higher risk of post-partum MAVE. Further studies are needed to assess the utility of extended workup for evaluating the risk of MAVE among pregnant females with migraines.

Stroke, Volume 55, Issue Suppl_1, Page AWP259-AWP259, February 1, 2024. Background:Stroke is a major cause of maternal morbidity and mortality, but delays in diagnosis are common. We hypothesize that in individuals who are pregnant or within 1 year postpartum (PP), the triad of early PP state (first 6 weeks after delivery), elevated blood pressure (BP), and headache is associated with higher stroke risk.Methods:We conducted a single-institution case-control study. Cases had a maternal stroke (ischemic, hemorrhagic, subarachnoid hemorrhage, or cerebral venous thrombosis) during pregnancy or PP, identified from a stroke registry. Controls were pregnant or PP but without any stroke and admitted for any reason, identified from a cohort of individuals with a high proportion of hypertensive disorders of pregnancy (HDP), a known maternal stroke risk factor. We created multivariable logistic regression models with stepwise backward elimination to evaluate the association between maternal stroke and the triad of (1) early PP; (2) systolic BP ≥140 or diastolic ≥90 mmHg; and (3) headache.Results:We identified 60 cases and 113 controls. Population characteristics are shown in the Table. Cases had a higher proportion of preexisting headache disorders and controls a had higher proportion of HDP. Adjusting for race, HDP, and headache disorder history, stroke risk was higher in those presenting to acute care with the proposed triad than in those without these features (adjusted odds ratio 13.6, 95% confidence interval 3.8-48.5, p

Introduction
Approximately 4%–5% of mothers develop childbirth-related post-traumatic stress disorder (CB-PTSD) and approximately 12.3% of mothers develop some CB-PTSD symptoms (CB-PTSS). To date, there is a dearth of studies on fathers and other coparents. Parental CB-PTSD and CB-PTSS may have a negative impact not only on the parents but also on the infant. Understanding risk and protective factors of CB-PTSD for both parents and its consequences on the family is key to detecting or anticipating it, to developing interventions aimed at reducing its detrimental effects and to supporting parents.

Methods and analysis
This study protocol describes an observational, population-based study, consisting of a longitudinal prospective cohort with online surveys at four time points. The population of interest consist of women, in the third trimester of pregnancy or at 6–12 weeks postpartum, and their partner/coparent, who will give birth or gave birth in the French-speaking part of Switzerland. The target sample size is 300–500 women and a proportional number of partners. The primary outcome of this study is the prevalence of CB-PTSD and CB-PTSS. The secondary outcomes focus on: (1) the impact of CB-PTSD and CB-PTSS on the marital and coparental relationships, the bonding with the infant, parental burnout and healthcare seeking behaviours, (2) the role of the childbirth experience in the development of CB-PTSD and CB-PTSS and (3) the social and economic determinants of CB-PTSD and CB-PTSS.

Ethics and dissemination
Ethical approval was granted by the human research ethics committee of the Canton de Vaud (study number 2022-00284). All study participants signed an informed consent form. Dissemination of results will occur via national and international conferences, in peer-reviewed journals, public conferences and social media.

Trial registration number
NCT05865704.