Aortic dissection in pregnancy and the postpartum period

Pregnancy-associated aortic dissection (AD) is a rare event, with an incidence of 0.0004% per pregnancy. The work of the Aortic Dissection Collaborative identified pregnancy-associated AD as a high-priority topic, despite its rarity. The Pregnancy Working Group, which included physicians and patient stakeholders, performed a systematic literature review of pregnancy-associated AD from 1960 to 2021 and identified 6,333 articles through PubMed, OVID MEDLINE, Cochrane, Embase, CINAHL and Web of Science. The inclusion criterion was AD in pregnant populations and exclusion criteria were case reports, conference abstracts, and languages other than English. Assessment of full-text articles for eligibility after removal of duplicates from all databases yielded 68 articles to be included in the final review. Topics included were timing of AD in pregnancy, type of AD, and management considerations of pregnancy-associated AD. The Pregnancy Working Group identified gaps in knowledge and future areas of research for pregnancy-associated AD, including clinical management, mental health outcomes post AD, reproductive and genetic counseling, and contraception after AD. Future collaborative projects could be a multicenter, international registry for all pregnancy-associated AD to refine the risk factors, best practice and management of AD in pregnancy. In addition, future mixed methodology studies may be useful to explore social, mental, and emotional factors related to pregnancy-associated AD and to determine support groups’ effect on anxiety and depression related to these events in the pregnancy and postpartum period.     

Histology and histochemistry of the ovary during pregnancy and in the postpartum period.

A study of ovarian histology during pregnancy and the puerperium is presented. The relationship of the findings to both physiological and pathological situations is discussed.     

Maternal sepsis during pregnancy or the postpartum period requiring intensive care admission

BackgroundPrevious studies on severe maternal sepsis during pregnancy or the postpartum period are rare and have focused on septic abortion. Voluntary abortion was legalized in France in 1975. This study was conducted to reassess the characteristics of maternal sepsis that have been managed in a French intensive care unit.MethodsA retrospective study of 66 women admitted to an intensive care unit for sepsis from 1977–2008 was performed. Data on sources of infection, microbial agents and maternal and fetal outcomes were collected. Data from 1977–1992 and 1993–2008 were compared.ResultsOver time, the rate of intensive care admission for maternal sepsis did not change (0.75 episodes per 1000 deliveries in 1977–1992 versus 0.72/1000 in 1993–2008, P = 1.0). The percentage of septic abortions decreased from 14% to 0%, whereas that of antepartum infections increased from 50% to 79% (P < 0.01). The percentage of non-bacterial infections increased from 0% to 19% (P = 0.04), and the percentage of pelvic infections had a tendency to decrease from 54% to 27% (P = 0.06). Pelvic infections were due to enterobacteriaceae (50%), gram-positive cocci (45%), and/or anaerobes (23%). Maternal and fetal mortality rates were 6% and 33%, respectively.ConclusionsOver time, our intensive care unit has seen fewer cases of septic abortion. However, maternal sepsis remained a cause of intensive care admission and both maternal and fetal death. The percentages of antepartum and non-bacterial infections have increased over time. A prospective multicentre study is required to confirm these results and to investigate questions such as the effect of maternal sepsis on long-term fetal outcome.     

Changes in endochondral bone elongation rates during pregnancy and lactation in rats

Summary The rates of endochondral bone elongation during pregnancy and lactation in rats have been studied. The rate of growth at the distal femoral epiphyseal growth plate was measured using fluorescent bone markers. Endochondral growth rates were substantially increased in pregnant animals when compared with age-matched, nonmated controls. There were also increases in growth plate thickness, hypertrophic cell lacunar height, and the calculated rate of cell production during pregnancy. At parturition, this growth trend was reversed and during lactation there were significant decreases in endochondral growth rates. There were also corresponding decreases in growth plate thickness, hypertrophic cell lacunar height, and the calculated rate of cartilage cell production. These results indicate that significant changes occur in maternal endochondral growth rates during the reproductive cycle in rats.     

硬膜外分娩镇痛对产妇产后抑郁的影响

目的 评估硬膜外分娩镇痛(LEA)对产妇产后抑郁(PPD)的影响。方法 选择经阴道分娩的初产妇628例,年龄20～36岁,BMI 20～35 kg/m²,ASAⅡ或Ⅲ级。根据产妇是否接受硬膜外分娩镇痛分为两组：镇痛组(n=322)和非镇痛组(n=306)。记录分娩期间VAS疼痛评分最高值、产程时间、出血量、新生儿1、5 min Apgar评分和新生儿入NICU的发生情况。于分娩前1周和产后2周、6周分别采用爱丁堡产后抑郁量表(EPDS)评估PPD发生情况(EPDS评分≥11分为PPD),采用广泛性焦虑量表(GAD-7)评估产妇焦虑情绪,采用领悟社会支持量表(PSSS)评估产妇感受到的总社会支持度。结果 与非镇痛组比较,镇痛组产妇分娩期间VAS疼痛评分最高值明显降低(P<0.05)。两组产妇第一产程时间、第二产程时间、出血量、新生儿1、5 min Apgar评分、新生儿入NICU比例差异无统计学意义。两组产妇产后2、6周PPD发生率、PSSS高支持状态、GAD-7≥10分差异无统计学意义。结论 初产妇接受LEA不影响产后抑郁的发生风险。     

剖宫产术后不同镇痛方法对产妇泌乳的影响

目的 观察剖宫产术后不同镇痛方法对产妇泌乳的影响.方法 75例剖宫产产妇随机分为硬膜外镇痛组(A组)、静脉镇痛组(B组)和肌注镇痛组(C组),每组25例.观察术后12、24、48 h VAS评分、泌乳情况及血浆泌乳素(PRL)水平.结果 A组和B组镇痛效果明显优于C组(P＜0.05),术后48 h PRL水平也明显高于C组(P＜0.05),且初乳时间明显提前.结论 硬膜外镇痛或静脉镇痛效果优于哌替啶肌注,可提高血浆泌乳素水平,有利于提高母乳喂养成功率.     

Stereological evaluation of the seminiferous tubules of rats after maternal undernutrition during the lactation period

The goal of this study is to evaluate, through stereological methods, some structural aspects of offspring testes whose dams were submitted to protein and energy-restricted diets during the lactation period. At birth, dams were separated into 3 groups: control group (C), receiving a diet with 23% protein; protein-restricted group (PR), receiving a diet with 8% protein; energy-restricted group (ER), receiving a diet with 23% protein in restricted quantities. At weaning, the offspring was anesthetized and perfused with formalin solution. Then, the testes were excised and processed using routine histological methods. Compared to the C group, both PR and ER groups had a significant reduction in the testis weight (PR = 65%, ER = 60%, p < 0.01), in the total area (PR = 23%, ER = 32%, p < 0.01), in the luminal area (PR = 30%, ER = 36%, p < 0.01), in the epithelial area (PR = 21%, ER = 27%, p < 0.01), and in the epithelial height (PR = 17%, ER = 23%, p < 0.01) of the seminiferous tubule. We conclude that maternal malnutrition during lactation leads to structural changes in the testis that could be responsible for future alterations in this organ physiology.     

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近年来 ,麻醉学和外科学领域中一个重要的观念变化就是对围手术期镇痛的高度重视 ,甚至主张将手术后疼痛作为“第五生命体征” ,与血压、心率、呼吸、体温等生命体征同等对待 ,并给予及时治疗。随着疼痛理论、镇痛药物、设备及镇痛技术的不断发展 ,目前已可使病人在无痛和较为舒适的状态下度过术后恢复期。1　围手术期镇痛的必要性围手术期包括术前、术中和术后 3个阶段 ,而手术后疼痛则是围手术期病人的主要痛苦所在。调查发现 ,手术后约 30 %～ 75 %的病人有明显疼痛 ,其中 4 9%为中度疼痛、2 3%为重度疼痛、8%为极重度疼痛。Warfield等…     

Screening and treatment of bacteriuria in pregnancy and postpartum period

The paper gives an overview of today's knowledge of urinary tract infection in pregnancy and different treatment procedures. Three different studies of urinary tract infection (UTI) in pregnancy and the postpartum period are reported. Urinary screening of 1798 pregnant women showed a cumulative frequency of bacteriuria of 4.8%, recurrent infection in one-fifth of the cases, and pyelonephritis in 0.6%. Chlamydial infection was observed as a cause of dysuria in pregnancy. In the postpartum period bladder bacteriuria was demonstrated in 3.7%. The condition persisted in 27%, while short-course treatment had significant effect.Presented at the Zambon Symposium on Bacteriuria in Pregnancy, International Urogynecological Association Annual Meeting, Riva del Garda, Italy, September 13, 1989.     

Effect of pelvic floor muscle exercises in the treatment of urinary incontinence during pregnancy and the postpartum period

Introduction and hypothesis  

The aim of this study was to determine the effectiveness of pelvic floor muscle exercises on urinary incontinence during pregnancy and the postpartum period.     

Breast cancer during pregnancy and lactation

Breast cancer is the most frequently seen cancer in pregnancy and lactation, but the incidence is low, the disease being seen in approximately 0.03% of pregnancies. Only 1% to 2% of breast cancer overall is diagnosed during pregnancy or lactation. There is no evidence to implicate pregnancy or lactation in either the etiology or the progression of breast cancer. Careful breast examination early in the pregnancy is very important to find solid masses that require biopsy before breast engorgement hides them. Therapeutic options vary, depending on the stage of disease and the stage of the pregnancy. Operable disease in the first 6 to 7 months of the pregnancy should be treated by mastectomy, as irradiation is contraindicated. Late in the pregnancy, a lumpectomy and axillary dissection can be done, with irradiation being delayed until after delivery. General anesthesia is safe if the usual precautions are taken to compensate for the physiologic changes induced by pregnancy. Unfortunately, delay in diagnosis is common, and 70% to 89% of patients with operable primary lesions have positive axillary lymph nodes. Late stage appears to be the only reason for the generally worse prognosis in these patients, as stage for stage, they have a course similar to that of nonpregnant patients. Adjuvant chemotherapy can be considered late in the pregnancy but should usually be delayed until after delivery. In patients with locally advanced or metastatic cancer diagnosed early in the pregnancy, for whom both chemotherapy and radiation therapy would normally be recommended, consideration must be given to termination of the pregnancy. There is no evidence that termination of pregnancy improves the outlook for the patients, but it does permit standard aggressive therapy in advanced disease.     

Changes in bone mineral and bone formation rates during pregnancy and lactation in rats

Changes in bone chemistry, cortical bone morphometry, and periosteal and trabecular bone formation rates were determined during pregnancy and lactation in rats. Data were obtained using chemical, static morphometric, and fluorochrome-based histomorphometric methods in pregnant or lactating animals and compared with age-matched, unmated controls. There were significant increases in bone weight, ash weight, calcium content, and femoral cross-sectional area by late pregnancy and decreases in these same parameters during lactation. There were also decreases in bone mass and increases in surface:volume ratios of trabecular bone during lactation. There were increases in femoral periosteal and endosteal perimeters associated with the reproductive cycle. Bone formation and appositional rates at the periosteal and endosteal surfaces were elevated during pregnancy, particularly evident at midpregnancy. Periosteal bone formation rates declined during lactation, but trabecular bone formation rates increased. These results indicate that during pregnancy there are increases in bone formation rates contributing to the increases in skeletal mass. During lactation in rats, reductions in skeletal mass are accompanied by increases in bone turnover, particularly evident in trabecular bone.     

Gastric point-of-care ultrasound (PoCUS) during pregnancy and the postpartum period: a systematic review

Personalised risk assessment of the likelihood of pulmonary aspiration is recommended for pregnant women undergoing general anaesthesia and gastric point-of-care ultrasound (PoCUS) may help to achieve this. Traditionally, risk assessment is based upon adherence to fasting times, but gastric emptying may vary during pregnancy and surgery often needs to be expedited. We systematically reviewed the evidence for gastric PoCUS up to August 2018 in pregnant and postpartum women to determine whether it can identify and quantify stomach contents, provide aspiration risk assessment via qualitative or quantitative means, and determine how gastric emptying is affected by pregnancy. Twenty-two articles comprising 1050 participants were included and studies were classified by qualitative or quantitative findings. The evidence suggests that gastric PoCUS is a reliable and feasible method of imaging the stomach in pregnancy in clinical practice. Qualitative assessment via the Perlas grading system can provide rapid assessment of gastric volume states. If fluid is visible, identification of patients at high risk of pulmonary aspiration requires measurement of antral cross-sectional area. Cut-off values of 608 mm² and 960 mm² are recommended in the semi-recumbent and right lateral semi-recumbent positions, respectively. Validated methods to quantify stomach volumes are available, however their usefulness is currently restricted to research. Gastric PoCUS also provides evidence that gastric emptying of ingested food is delayed by term pregnancy, labour and during the early postpartum period. However, the passage of fluids through the stomach appears unaffected throughout the peripartum period.     

Bone mass changes during pregnancy and lactation in the rat

We examined bone mass changes in the total, axial, and appendicular skeleton as well as in the different subareas of femur and tibia in rats fed on a normal calcium diet. A total of 16 virgin Wistar rats, approximately 5 months of age (270 ± 30 g), were assigned to two groups of eight rats each. One group was mated and, for each pregnant rat, a nonpregnant control rat was studied simultaneously. Weaning was performed when the pups reached 38 ± 3 g body weight. At the beginning (t = 0), on the first day postpartum (t = 22 days), and at weaning (t = 45 days), total skeleton bone mineral content (BMC), area, and bone mineral density (BMD) were determined by dual-energy X-ray absorptiometry (DXA) in vivo under anesthesia. Body weight increased significantly during pregnancy (p < 0.05) and decreased at weaning, whereas control rats showed a slow, gradual increment without reaching a significant difference. During pregnancy, BMC and area of the total skeleton increased significantly in pregnant rats, but the changes in BMD were not different compared with the control group. A completely different pattern was observed between groups during the 23 days of lactation. While the skeleton continued to grow in the control group (BMC and area increased), the total skeleton of lactating rats showed no change in area (size), small decreases in BMC, and a significant decrease in BMD (p < 0.05). Consequently, although BMC and BMD of both groups were similar at the time of delivery, BMC was 12.0% lower and BMD 4.9% lower at the end of lactation in the lactating rats compared with the control group. The contribution of the maternal skeleton to the lactation period was not similar; that is, the areas with the highest trabecular component showed the greater average differences in BMD at the time of weaning (proximal tibia −19.9%, distal femur −12.6%, spine −10.9%) (p < 0.05), compared with relatively minor, nonsignificant losses in areas where cortical bone predominates (distal tibia −5%, middle tibia −5.2%). Our experimental results demonstrated the usefulness of DXA in vivo to visualize changes in BMD during the reproductive cycle of the rat. Moreover, the data confirm that normal pregnancy in the rat appears to exert little influence on bone, whereas lactation induces significant bone loss, mainly in the areas of predominant trabecular bone.     

妇女孕晚期与产褥期母婴连结的关系研究

目的 探讨妇女孕晚期与产褥期母婴连结的现状及二者之间的关系,为促进产后母婴连结提供参考.方法 便利选取387名孕妇,在孕晚期及产褥期产检时分别采用母婴连结量表调查母婴连结状况.结果 研究对象产前母婴连结得分为3(1,4)分,产后为3(2,5)分;母婴连结表现为产前、产后情感缺乏障碍分别有38(8.5％)人、31(8.0...