换季了，快上脱敏保证班

随着年龄的增大．你是不是越来越发现，自己的肌肤开始变得敏感脆弱？以前偶尔才会有的肌肤问题，现在却隔三差五的来烦你，而且时常还会伴有干痒、发红等类似肌肤敏感的状况。     

Obesity and pregnancy complications

Maternal obesity increases the risk of numerous complications of pregnancy, labor, and birth for both mother and neonate, including diabetes and hypertensive disorders. As more women enter pregnancy with a body mass index (BMI) indicative of overweight or obesity, providers of obstetric care should be aware of the implications of this increased BMI on perinatal outcomes as well as become familiar with management options.     

Chronic hypoxia differentially increases glutathione content and gamma-glutamyl cysteine synthetase expression in fetal guinea pig organs

OBJECTIVE: Glutathione is a natural antioxidant in the fetus and adult. We sought to determine whether maternal hypoxia alters glutathione levels in fetal organs as an adaptive response to the reduced oxygenation. STUDY DESIGN: Timed pregnant guinea pigs were housed in either a Plexiglas chamber containing 10.5% O(2) from 46 to 60 days gestation (HPX, n=6) or in room air, as the normoxic control (NMX, n=5). Pregnant guinea pigs were anesthetized at near term ( approximately 60 days, term=65 days) and liver, lungand kidney were excised from anesthetized fetuses and stored frozen (-80 degrees C) prior to sample processing. Using the hypoxia marker, pimonidazole, we measured a hypoxia-induced increase in stained cells of fetal liver compared to no change in either the lung or kidney. To measure the effect of hypoxia among different organs, total glutathione (GSH) content and protein levels of gamma-glutamyl cysteine synthetase (gamma-GCS) were measured from the same organs. RESULTS: Maternal hypoxia increased (P<0.05) total glutathione levels by 121% in the fetal liver but had no effect in either fetal lung or kidney. Chronic hypoxia increased (P<0.05) gamma-GCS protein levels in all three fetal organs studied. CONCLUSION: These results demonstrate that the fetal response to maternal hypoxia may be organ specific. The increase in fetal liver glutathione via upregulation of gamma-GCS may be an important adaptive response to prolonged hypoxic stress.     

Kleihauer-betke testing is important in all cases of maternal trauma

BACKGROUND: In maternal trauma, the Kleihauer-Betke (KB) test has traditionally been used to detect transplacental hemorrhage (TPH), so that Rh-negative women could receive appropriate Rh immune prophylaxis. Reasoning that the magnitude of TPH would reflect uterine injury, we evaluated Kleihauer-Betke testing as an independent predictor of preterm labor (PTL) after maternal trauma. METHODS: Admissions to the Shock Trauma Center, University of Maryland, from January 1996 to January 2002, were reviewed. Of 30,362 trauma patients admitted, 166 were pregnant, and 93 of these underwent electronic fetal monitoring. Their records were abstracted for demographics, injury type, three separate trauma scores, documented uterine contractions, PTL (contractions with progressive cervical change), and serious perinatal complications. In 71 cases, transplacental hemorrhage was assessed by maternal KB test. RESULTS: TPH, defined as KB-positive for greater than 0.01 mL of fetal blood in the maternal circulation, occurred in 46 women. Forty-four had documented contractions (25 had overt PTL) and 2 had no contractions. In 25 women with a negative KB test, none had uterine contractions. All patients with contractions or PTL had positive KB tests. By logistic regression, KB test result was the single risk factor associated with PTL (p < 0.001; likelihood ratio, 20.8 for positive KB test). Compared with other sites, abdominal trauma was associated more often with uterine contractions (p < 0.001), PTL (p = 0.001), and a positive KB test (p < 0.001, chi). None of the trauma scoring systems predicted PTL. CONCLUSION: Kleihauer-Betke testing accurately predicts the risk of preterm labor after maternal trauma. Clinical assessment does not. With a negative KB test, posttrauma electronic fetal monitoring duration may be limited safely. With a positive KB test, the significant risk of PTL mandates detailed monitoring. KB testing has important advantages to all maternal trauma victims, regardless of Rh status.     

Gravid hysterectomy: a decade of experience at an academic referral center

OBJECTIVE: To evaluate the incidence of gravid hysterectomy (GH) and to examine the indications as well as risk factors and complications associated with the procedure at an academic perinatal referral center. STUDY DESIGN: Retrospective chart review of all patients who underwent GH from 1991 to 2001. Demographics, obstetric history, delivery information, complications and outcome were analyzed. RESULTS: There were 34 GHs out of 19,491 deliveries (1.74/1000). The preoperative indications were hemorrhage associated with atony (32.4%), placenta accreta (20.6%) and uncontrolled bleeding (17.6%). Of the patients, 87.5% were parous and 53.1% had previous cesarean section. GH was performed prior to viability in 3. GH followed cesarean delivery in 24 (68.6%). Uterine and/or hypogastric artery ligation were performed in 11 (32.4%). Postoperative complications included surgical re-exploration for recurrent hemorrhage in 5, transfusion of blood products in 30, disseminated intravascular coagulopathy in 15, prolonged (> 24 hours) ventilation in 10 and admission to the SICU for prolonged intensive care in 12. There were 2 maternal deaths (5.9%). A significant rise in GH rate from 1/800 to 1/299 occurred over the past 5 years despite constant cesarean rates (chi2, p < 0.05). CONCLUSION: Rates of GH increased over the period examined. Placenta accreta associated with previous cesarean section is the predominant risk factor for GH.     

Interprofessional management of a complex continuing care patient admitted with 18 pressure ulcers: a case report

Interprofessional practice (IP)--ie, collaborative practice--involves interaction and knowledge-sharing between professionals from different disciplines in order to meet the needs of the patient. This approach to care is well suited to patients with pressure ulcers, whose complex and varying presentations require the monitoring and consultation of an IP team. A 44-year-old man with anoxic brain injury was admitted to a complex continuing care facility with 18 wounds, 17 of which were pressure ulcers. The patient was at high risk for further skin breakdown as a result of immobility, incontinence, impaired cognition, impaired sensation, low body weight, and positioning challenges secondary to contractures and spasticity. Wounds were located primarily around the patient's sacrum, trochanters, feet, and ankles. The care team included a physician, unit manager, clinical nurse educator, nurses, physiotherapist, occupational therapist, registered dietician, and pharmacist, all with varying roles related to wound care. The patient's wife was concerned about his overall health status and wanted to move him out of his room in a wheelchair to spend time with him. Using current best practices, the IP team implemented management strategies that facilitated wheelchair time during family visits; plus, all 18 wounds healed within 15 months of admission. The patient did not develop any new areas of skin breakdown. IP collaboration facilitated the problem-solving needed to meet the complex needs of this patient.     

Shoulder dystocia: using simulation to train providers and teams

Shoulder dystocia is an obstetric emergency that requires immediate recognition and a well-coordinated response. This response must include effective application of the maneuvers proven to relieve the impaction of the fetal shoulder and timely hand-off of the newborn to the neonatology team. The rare frequency of shoulder dystocia, coupled with patient safety concerns and the medico-legal environment, limits the opportunity of providers to learn and practice the management of shoulder dystocia. Training, especially simulation-based training, has been demonstrated to improve the management of shoulder dystocia. This article presents a review of the literature that supports simulation training for shoulder dystocia and provides guidance on creating and implementing shoulder dystocia training.     

Sonography in blunt abdominal trauma: a preliminary progress report.

Evaluation of blunt abdominal trauma is clinically challenging. Diagnostic peritoneal lavage (DPL) and computed tomographic (CT) scanning have become primary diagnostic modalities. We examined the efficacy and role of ultrasonographic (US) studies in the initial abdominal evaluation of blunt trauma patients. Over an 8-month period, patients whose abdominal work-up indicated the need for DPL or CT were evaluated sonographically within the first hour after admission by trauma fellows (PGY-6) with at least 1 hour of theoretical training and 1 hour of practical training. Sonograms considered positive were those showing free peritoneal fluid or organ disruption. Hard copies of the sonograms were evaluated by a staff radiologist without knowledge of the fellows' interpretations or of DPL or CT results. Based on the fellows' interpretation of the real-time sonograms, among the first 163 patients studied were 11 true-positive, 146 true-negative, one false-positive, and five false-negative results. Sixteen patients had intra-abdominal injury documented by DPL, CT, or laparotomy. Ultrasonography was 91% sensitive in detecting the presence of hemoperitoneum. Overall, ultrasonography was 69% sensitive, 99% specific, and 96% accurate in diagnosing abdominal injury. We conclude that emergency sonography on admission can serve as a valuable adjunct to the physical diagnosis of clinically significant hemoperitoneum. It is noninvasive, portable, and accurate in determining the need for further diagnostic/surgical intervention.