Podcasts about am j obstet gynecol

Play Episode Listen Later Aug 28, 2024 41:00

Following an emergency c-section due to HELLP syndrome in her first pregnancy, Jolene Brink was determined to have a different birthing experience with her second child. Through the support of a knowledgeable medical team and insights gained from her EBB Childbirth Class, she successfully achieved her goal of an unmedicated VBAC with the birth of her son, Guthrie, in 2022. Jolene's journey towards a VBAC was a transformative process of healing, empowerment, and reclaiming her birthing experience, showcasing the importance of advocacy and informed decision-making in maternal healthcare. Resources: Check out Doulas of Duluth to learn from her instructors Cooper Orth and Dana Morrison, and follow them on Instagram! Learn about Jolene's work here! Read The Preeclampsia Foundation's article on HELLP Syndrome Follow the Preeclampsia Foundation on Instagram van Oostwaard, M. F. et al. (2015). "Recurrence of hypertensive disorders of pregnancy: An individual patient data meta-analysis." Am J Obstet Gynecol 212(5): 624.e1-17. https://pubmed.ncbi.nlm.nih.gov/25582098/ Duley, L., et al. (2019). "Antiplatelet agents for preventing pre-eclampsia and its complications." Cochrane Database Syst Rev. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6820858/ Listen to the Evidence on VBAC - EBB 113 EBB Childbirth Class now includes a module all about planning a VBAC! Learn more about the EBB Childbirth class here. For more information about Evidence Based Birth and a crash course on evidence based care, visit www.ebbirth.com. Follow us on Instagram, YouTube, and TikTok! Ready to learn more? Grab an EBB Podcast Listening Guide or read Dr. Dekker's book, "Babies Are Not Pizzas: They're Born, Not Delivered!" If you want to get involved at EBB, join our Professional membership (scholarship options available) and get on the wait list for our EBB Instructor program. Find an EBB Instructor here, and click here to learn more about the EBB Childbirth Class.

REPLAY: EBB 186 – A Positive Pregnancy and Birth Outcome with Multiple High-Risk Labels with EBB Childbirth Class Parent, Angela Jones

The FlightBridgeED Podcast

Play Episode Listen Later Jul 3, 2024 61:56

Today, we're sharing a replay of our podcast episode with EBB Childbirth Class parent, Angela Jones, about having an uncomplicated pregnancy and birth when labeled as high risk. Angela is a macro-level social worker, wife to her husband, Tony, and mom to her son, Allister, and their cats, Pumpernickel and Lion-O. Angela and Tony graduated from the Evidence Based Birth Childbirth Class with EBB instructor, Victoria Michonski. Both Victoria and Heather McCullough, who is also an EBB instructor, were Angela and Tony's doulas for Allister's birth. In today's replay, we talk about Angela's birth story and her experience having an easy, uncomplicated pregnancy and birth despite being labeled as high risk for multiple reasons. We also talk about data birth outcomes for people who have multiple high-risk labels. Three years later, Angela shared this thoughtful update as she reflected on her birth story. Update from Angela: When I am having difficult moments, I sometimes look back at the video of myself giving birth to Allister and feel such peace. Allister turned 3 this year, and recently he has been asking about how he came into this world. My husband and I have been showing him the video of him being born and when he sees it, he looks at me, almost in awe, with a big smile. He now requests to see it at least once per week. Going into my birthing time, I never imagined that I would have 41 hours of active labor. I still credit the EBB course and my amazing doulas with having prepared me well in understanding all of the tools that were available to me when, after 30 hours of not being able to tolerate any food or water, I decided that I wanted to depart from my original birth plan. Getting an epidural allowed me to eat, drink, sleep and then ultimately push my son out gently in the position of my choosing. This was the exact birth experience that I wanted. I still encourage women, especially those who are afraid (in particular, those who are afraid due to multiple "high risk" labels) to not settle for a care team that is anything less than supportive, safe, and empowering. Content note: We talk about ectopic pregnancy, pregnancy losses, high-risk pregnancy complications, and perinatal morbidity. Resources: Learn more about EBB Instructor, Victoria Michonski, here. Follow Victoria on Instagram and Facebook. Learn more about EBB Instructor, Heather McCullough, here. Follow Heather on Instagram and Facebook. Sheen, J. J., Wright, J. D., Goffman, D., et al. (2018). Maternal age and risk for adverse outcomes. Am J Obstet Gynecol. 2018 Oct;219(4):390.e1-390.e15. Click here. For more information about Evidence Based Birth and a crash course on evidence based care, visit www.ebbirth.com. Follow us on Instagram, YouTube, and TikTok! Ready to learn more? Grab an EBB Podcast Listening Guide or read Dr. Dekker's book, "Babies Are Not Pizzas: They're Born, Not Delivered!" If you want to get involved at EBB, join our Professional membership (scholarship options available) and get on the wait list for our EBB Instructor program. Find an EBB Instructor here, and click here to learn more about the EBB Childbirth Class.

Munnhulen - tannroten til alt som er vondt?

Pestpodden

Play Episode Listen Later Oct 16, 2023 31:09

Ruben Dyrhovden er overlege og mikrobiolog som nylig har disputert. Vi snakker om funnene fra doktorgradsarbeidet hans, og munnhulens bakterier. Kanskje er tannhelse viktigere enn vi tror?Referanser:1. Gianos E, Jackson EA, Tejpal A, Aspry K, O'Keefe J, Aggarwal M, et al. Oral health and atherosclerotic cardiovascular disease: A review. Am J Prev Cardiol. 2021;7:100179.2. Labeau SO, Van de Vyver K, Brusselaers N, Vogelaers D, Blot SI. Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis. Lancet Infect Dis. 2011;11(11):845-54.3. Fischer, L. A., Demerath, E., Bittner-Eddy, P. & Costalonga, M. Placental colonization with periodontal pathogens: the potential missing link. Am J Obstet Gynecol 221, 383-392 e3 (2019).4. Blanc, V. et al. Oral bacteria in placental tissues: increased molecular detection in pregnant periodontitis patients. Oral Dis 21, 905–912 (2015).5. Han, Y. W. et al. Term Stillbirth Caused by Oral Fusobacterium nucleatum. Obstetrics Gynecol 115, 442–445 (2010).6. Fardini, Y., Chung, P., Dumm, R., Joshi, N. & Han, Y. W. Transmission of Diverse Oral Bacteria to Murine Placenta: Evidence for the Oral Microbiome as a Potential Source of Intrauterine Infection▿ †. Infect Immun 78, 1789–1796 (2010).7. Han, Y. W. et al. Fusobacterium nucleatum Induces Premature and Term Stillbirths in Pregnant Mice: Implication of Oral Bacteria in Preterm Birth. Infect Immun 72, 2272–2279 (2004). Hosted on Acast. See acast.com/privacy for more information.

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Ep. 118 Hysteropexy vs Hysterectomy for Pelvic Organ Prolapse with Dr. Olivia Chang

BackTable Urology

Play Episode Listen Later Sep 13, 2023 49:14

This week on BackTable Urology, Dr. Suzette Sutherland (University of Washington) and Dr. Olivia Chang (UC Irvine) discuss reasons for uterine preservation and hysteropexy techniques for prolapse repair. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/f2sdAy --- SHOW NOTES First, Suzette and Olivia discuss the value of keeping the uterus in place for women undergoing prolapse repairs, as well as the indications for apical suspension surgery. They also note the historical context of hysterectomy and why it has been the go-to treatment for so long. Next, the doctors discuss the advantages of hysteropexy over hysterectomy for prolapse repair, such as a shorter operative time, less bleeding, and a quicker recovery. The doctors then go into more detail about the best approaches for prolapse repair, like weighing the options of permanent sutures versus delayed absorbable sutures. They also analyze recurrence rates after prolapse surgery, specifically in the anterior compartment. Then, they explore the data on how the choice to keep the uterus in place can stem from a woman's personal and cultural views. Olivia shares about the Value of Uterus questionnaire, a six-question survey instrument that can quantify how a woman values her uterus. It can streamline clinic visits and help to predict whether a woman would choose a uterine-preserving procedure. The doctors note that there is research demonstrating a correlation between valuing the uterus and sexual activity. Finally, Suzette and Olivia contraindications for leaving the uterus in place. They emphasize the importance of assessing for abnormal uterine bleeding and cervical pathology before recommending uterine preservation. They suggest that listeners review the current guidelines around preoperative workup and consider transvaginal ultrasound or endometrial biopsy first. Lastly, they emphasize the importance of symptom and risk stratification and shared decision making when it comes to uterine preservation. --- RESOURCES Chang OH, Walters MD, Yao M, Lapin B. Development and validation of the Value of Uterus instrument and visual analog scale to measure patients' valuation of their uterus. Am J Obstet Gynecol. 2022 Jun 25:S0002-9378(22)00483-5. doi: 10.1016/j.ajog.2022.06.029. Epub ahead of print. PMID: 35764134. https://pubmed.ncbi.nlm.nih.gov/35764134/

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Ep. 32 Hysteropexy vs Hysterectomy for Pelvic Organ Prolapse with Dr. Olivia Chang

BackTable OBGYN

Play Episode Listen Later Sep 13, 2023 49:20

This week on BackTable Urology, Dr. Suzette Sutherland (University of Washington) and Dr. Olivia Chang (UC Irvine) discuss reasons for uterine preservation and hysteropexy techniques for prolapse repair. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/f2sdAy --- SHOW NOTES First, Suzette and Olivia discuss the value of keeping the uterus in place for women undergoing prolapse repairs, as well as the indications for apical suspension surgery. They also note the historical context of hysterectomy and why it has been the go-to treatment for so long. Next, the doctors discuss the advantages of hysteropexy over hysterectomy for prolapse repair, such as a shorter operative time, less bleeding, and a quicker recovery. The doctors then go into more detail about the best approaches for prolapse repair, like weighing the options of permanent sutures versus delayed absorbable sutures. They also analyze recurrence rates after prolapse surgery, specifically in the anterior compartment. Then, they explore the data on how the choice to keep the uterus in place can stem from a woman's personal and cultural views. Olivia shares about the Value of Uterus questionnaire, a six-question survey instrument that can quantify how a woman values her uterus. It can streamline clinic visits and help to predict whether a woman would choose a uterine-preserving procedure. The doctors note that there is research demonstrating a correlation between valuing the uterus and sexual activity. Finally, Suzette and Olivia contraindications for leaving the uterus in place. They emphasize the importance of assessing for abnormal uterine bleeding and cervical pathology before recommending uterine preservation. They suggest that listeners review the current guidelines around preoperative workup and consider transvaginal ultrasound or endometrial biopsy first. Lastly, they emphasize the importance of symptom and risk stratification and shared decision making when it comes to uterine preservation. --- RESOURCES Chang OH, Walters MD, Yao M, Lapin B. Development and validation of the Value of Uterus instrument and visual analog scale to measure patients' valuation of their uterus. Am J Obstet Gynecol. 2022 Jun 25:S0002-9378(22)00483-5. doi: 10.1016/j.ajog.2022.06.029. Epub ahead of print. PMID: 35764134. https://pubmed.ncbi.nlm.nih.gov/35764134/

washington development chang epub uterus pmid hysterectomy pelvic organ prolapse cmes ama pra category am j obstet gynecol

E228: MDCast w/ Dr. Michael Lauria - Severe Postpartum Hemorrhage

Play Episode Listen Later Jul 3, 2023 48:33

This is the first of a special podcast series on obstetric critical care. I am joined on this series by Dr. Elizabeth Garchar, MD, FACOG. She is an OB/GYN and Maternal Fetal Medicine (MFM) specialist who has a special interest in obstetric critical care. She is also unique in that she flies regularly with our critical care transport teams and acts as one of our Assistant Medical Directors for the flight program. So, Dr. Garchar has unique insight into managing this population in transport. This podcast focuses on severe postpartum hemorrhage. We discuss the epidemiology and risk factors as well as the nuances of diagnosis, specifically how blood loss is actually quantified in this setting. We also go through the importance of point-of-care ultrasound to help identify and manage the causes of postpartum hemorrhage. Then, we transition to the discussion of management, focusing on the medical management of uterine atony, and also go over advanced interventions such as uterine packing, balloon tamponade devices, and REBOA. Finally, Dr. Garchar discusses the indication and procedure for emergent hysterectomy as well as the post-procedure management critical care transport crews may have to perform. References Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol. Oct 2017;130(4):e168-e186. doi:10.1097/aog.0000000000002351 Abdel-Aleem H, Singata M, Abdel-Aleem M, Mshweshwe N, Williams X, Hofmeyr GJ. Uterine massage to reduce postpartum hemorrhage after vaginal delivery. Int J Gynaecol Obstet. Oct 2010;111(1):32-6. doi:10.1016/j.ijgo.2010.04.036 Abul A, Al-Naseem A, Althuwaini A, Al-Muhanna A, Clement NS. Safety and efficacy of intrauterine balloon tamponade vs uterine gauze packing in managing postpartum hemorrhage: A systematic review and meta-analysis. AJOG Glob Rep. Feb 2023;3(1):100135. doi:10.1016/j.xagr.2022.100135 Aibar L, Aguilar MT, Puertas A, Valverde M. Bakri balloon for the management of postpartum hemorrhage. Acta Obstet Gynecol Scand. Apr 2013;92(4):465-7. doi:10.1111/j.1600-0412.2012.01497.x Bagga R, Jain V, Kalra J, Chopra S, Gopalan S. Uterovaginal packing with rolled gauze in postpartum hemorrhage. MedGenMed. Feb 13 2004;6(1):50. Borger van der Burg BLS, van Dongen T, Morrison JJ, et al. A systematic review and meta-analysis of the use of resuscitative endovascular balloon occlusion of the aorta in the management of major exsanguination. Eur J Trauma Emerg Surg. Aug 2018;44(4):535-550. doi:10.1007/s00068-018-0959-y Castellini G, Gianola S, Biffi A, et al. Resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with major trauma and uncontrolled haemorrhagic shock: a systematic review with meta-analysis. World J Emerg Surg. Aug 12 2021;16(1):41. doi:10.1186/s13017-021-00386-9 Collaborators WT. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. May 27 2017;389(10084):2105-2116. doi:10.1016/S0140-6736(17)30638-4 Cunningham FG, Nelson DB. Disseminated Intravascular Coagulation Syndromes in Obstetrics. Obstet Gynecol. Nov 2015;126(5):999-1011. doi:10.1097/AOG.0000000000001110 D'Alton M, Rood K, Simhan H, Goffman D. Profile of the Jada(R) System: the vacuum-induced hemorrhage control device for treating abnormal postpartum uterine bleeding and postpartum hemorrhage. Expert Rev Med Devices. Sep 2021;18(9):849-853. doi:10.1080/17434440.2021.1962288 Dildy GA, 3rd. Postpartum hemorrhage: new management options. Clin Obstet Gynecol. Jun 2002;45(2):330-44. doi:10.1097/00003081-200206000-00005 Dueckelmann AM, Hinkson L, Nonnenmacher A, et al. Uterine packing with chitosan-covered gauze compared to balloon tamponade for managing postpartum hemorrhage. Eur J Obstet Gynecol Reprod Biol. Sep 2019;240:151-155. doi:10.1016/j.ejogrb.2019.06.003 Erez O. Disseminated intravascular coagulation in pregnancy: New insights. Thrombosis Update. 2022;6doi:10.1016/j.tru.2021.100083 Erez O, Mastrolia SA, Thachil J. Disseminated intravascular coagulation in pregnancy: insights in pathophysiology, diagnosis and management. Am J Obstet Gynecol. Oct 2015;213(4):452-63. doi:10.1016/j.ajog.2015.03.054 Erez O, Othman M, Rabinovich A, Leron E, Gotsch F, Thachil J. DIC in Pregnancy - Pathophysiology, Clinical Characteristics, Diagnostic Scores, and Treatments. J Blood Med. 2022;13:21-44. doi:10.2147/JBM.S273047 Feng S, Liao Z, Huang H. Effect of prophylactic placement of internal iliac artery balloon catheters on outcomes of women with placenta accreta: an impact study. Anaesthesia. Jul 2017;72(7):853-858. doi:10.1111/anae.13895 Higgins N, Patel SK, Toledo P. Postpartum hemorrhage revisited: new challenges and solutions. Curr Opin Anaesthesiol. Jun 2019;32(3):278-284. doi:10.1097/ACO.0000000000000717 Ji SM, Cho C, Choi G, et al. Successful management of uncontrolled postpartum hemorrhage due to morbidly adherent placenta with Resuscitative endovascular balloon occlusion of the aorta during emergency cesarean section - A case report. Anesth Pain Med (Seoul). Jul 31 2020;15(3):314-318. doi:10.17085/apm.19051 Kellie FJ, Wandabwa JN, Mousa HA, Weeks AD. Mechanical and surgical interventions for treating primary postpartum haemorrhage. Cochrane Database Syst Rev. Jul 1 2020;7(7):CD013663. doi:10.1002/14651858.CD013663 Kogutt BK, Vaught AJ. Postpartum hemorrhage: Blood product management and massive transfusion. Semin Perinatol. Feb 2019;43(1):44-50. doi:10.1053/j.semperi.2018.11.008 Levi M, Toh CH, Thachil J, Watson HG. Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. Br J Haematol. Apr 2009;145(1):24-33. doi:10.1111/j.1365-2141.2009.07600.x Liu C, Gao J, Liu J, et al. Predictors of Failed Intrauterine Balloon Tamponade in the Management of Severe Postpartum Hemorrhage. Front Med (Lausanne). 2021;8:656422. doi:10.3389/fmed.2021.656422 Lohano R, Haq G, Kazi S, Sheikh S. Intrauterine balloon tamponade for the control of postpartum haemorrhage. J Pak Med Assoc. Jan 2016;66(1):22-6. Maier RC. Control of postpartum hemorrhage with uterine packing. Am J Obstet Gynecol. Aug 1993;169(2 Pt 1):317-21; discussion 321-3. doi:10.1016/0002-9378(93)90082-t Makin J, Suarez-Rebling DI, Varma Shivkumar P, Tarimo V, Burke TF. Innovative Uses of Condom Uterine Balloon Tamponade for Postpartum Hemorrhage in India and Tanzania. Case Rep Obstet Gynecol. 2018;2018:4952048. doi:10.1155/2018/4952048 Natarajan A, Alaska Pendleton A, Nelson BD, et al. Provider experiences with improvised uterine balloon tamponade for the management of uncontrolled postpartum hemorrhage in Kenya. Int J Gynaecol Obstet. Nov 2016;135(2):210-213. doi:10.1016/j.ijgo.2016.05.006 Natarajan A, Kamara J, Ahn R, et al. Provider experience of uterine balloon tamponade for the management of postpartum hemorrhage in Sierra Leone. Int J Gynaecol Obstet. Jul 2016;134(1):83-6. doi:10.1016/j.ijgo.2015.10.026 Okoye HC, Nwagha TU, Ugwu AO, et al. Diagnosis and treatment of bbstetrics disseminated intravascular coagulation in resource limited settings. Afr Health Sci. Mar 2022;22(1):183-190. doi:10.4314/ahs.v22i1.24 Ordonez CA, Manzano-Nunez R, Parra MW, et al. Prophylactic use of resuscitative endovascular balloon occlusion of the aorta in women with abnormal placentation: A systematic review, meta-analysis, and case series. J Trauma Acute Care Surg. May 2018;84(5):809-818. doi:10.1097/TA.0000000000001821 Papageorgiou C, Jourdi G, Adjambri E, et al. Disseminated Intravascular Coagulation: An Update on Pathogenesis, Diagnosis, and Therapeutic Strategies. Clin Appl Thromb Hemost. Dec 2018;24(9_suppl):8S-28S. doi:10.1177/1076029618806424 Pingray V, Widmer M, Ciapponi A, et al. Effectiveness of uterine tamponade devices for refractory postpartum haemorrhage after vaginal birth: a systematic review. BJOG. Oct 2021;128(11):1732-1743. doi:10.1111/1471-0528.16819 Quandalle A, Ghesquiere L, Kyheng M, et al. Impact of intrauterine balloon tamponade on emergency peripartum hysterectomy following vaginal delivery. Eur J Obstet Gynecol Reprod Biol. Jan 2021;256:125-129. doi:10.1016/j.ejogrb.2020.10.064 Rattray DD, O'Connell CM, Baskett TF. Acute disseminated intravascular coagulation in obstetrics: a tertiary centre population review (1980 to 2009). J Obstet Gynaecol Can. Apr 2012;34(4):341-347. doi:10.1016/S1701-2163(16)35214-8 Revert M, Rozenberg P, Cottenet J, Quantin C. Intrauterine Balloon Tamponade for Severe Postpartum Hemorrhage. Obstet Gynecol. Jan 2018;131(1):143-149. doi:10.1097/AOG.0000000000002405 Sadek S, Lockey DJ, Lendrum RA, Perkins Z, Price J, Davies GE. Resuscitative endovascular balloon occlusion of the aorta (REBOA) in the pre-hospital setting: An additional resuscitation option for uncontrolled catastrophic haemorrhage. Resuscitation. Oct 2016;107:135-8. doi:10.1016/j.resuscitation.2016.06.029 Schmid BC, Rezniczek GA, Rolf N, Saade G, Gebauer G, Maul H. Uterine packing with chitosan-covered gauze for control of postpartum hemorrhage. Am J Obstet Gynecol. Sep 2013;209(3):225 e1-5. doi:10.1016/j.ajog.2013.05.055 Shimada K, Taniguchi H, Enomoto K, Umeda S, Abe T, Takeuchi I. Hospital transfer for patients with postpartum hemorrhage in Yokohama, Japan: a single-center descriptive study. Acute Med Surg. Jan-Dec 2021;8(1):e716. doi:10.1002/ams2.716 Simpson KR. Update on Evaluation, Prevention, and Management of Postpartum Hemorrhage. MCN Am J Matern Child Nurs. Mar/Apr 2018;43(2):120. doi:10.1097/NMC.0000000000000406 Singer KE, Morris MC, Blakeman C, et al. Can Resuscitative Endovascular Balloon Occlusion of the Aorta Fly? Assessing Aortic Balloon Performance for Aeromedical Evacuation. J Surg Res. Oct 2020;254:390-397. doi:10.1016/j.jss.2020.05.021 Snyder JA, Schuerer DJE, Bochicchio GV, Hoofnagle MH. When REBOA grows wings: Resuscitative endovascular balloon occlusion of the aorta to facilitate aeromedical transport. Trauma Case Rep. Apr 2022;38:100622. doi:10.1016/j.tcr.2022.100622 Soued M, Vivanti AJ, Smiljkovski D, et al. Efficacy of Intra-Uterine Tamponade Balloon in Post-Partum Hemorrhage after Cesarean Delivery: An Impact Study. J Clin Med. Dec 28 2020;10(1)doi:10.3390/jcm10010081 Stensaeth KH, Sovik E, Haig IN, Skomedal E, Jorgensen A. Fluoroscopy-free Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for controlling life threatening postpartum hemorrhage. PLoS One. 2017;12(3):e0174520. doi:10.1371/journal.pone.0174520 Suarez S, Conde-Agudelo A, Borovac-Pinheiro A, et al. Uterine balloon tamponade for the treatment of postpartum hemorrhage: a systematic review and meta-analysis. Am J Obstet Gynecol. Apr 2020;222(4):293 e1-293 e52. doi:10.1016/j.ajog.2019.11.1287 Theron GB, Mpumlwana V. A case series of post-partum haemorrhage managed using Ellavi uterine balloon tamponade in a rural regional hospital. S Afr Fam Pract (2004). May 11 2021;63(1):e1-e4. doi:10.4102/safp.v63i1.5266 Tran QK, Hollis G, Beher R, et al. Transport of Peripartum Patients for Medical Management: Predictors of Any Intervention During Transport. Cureus. Nov 2022;14(11):e31102. doi:10.7759/cureus.31102 Weir R, Lee J, Almroth S, Taylor J. Flying with a Safety Net: Use of REBOA to Enable Safe Transfer to a Level 1 Trauma Center. Journal of Endovascular Resuscitation and Trauma Management. 2022;5(3)doi:10.26676/jevtm.v5i3.214 Wu Q, Liu Z, Zhao X, et al. Outcome of Pregnancies After Balloon Occlusion of the Infrarenal Abdominal Aorta During Caesarean in 230 Patients With Placenta Praevia Accreta. Cardiovasc Intervent Radiol. Nov 2016;39(11):1573-1579. doi:10.1007/s00270-016-1418-y Zeng KW, Ovenell KJ, Alholm Z, Foley MR. Postpartum Hemorrhage Management and Blood Component Therapy. Obstet Gynecol Clin North Am. Sep 2022;49(3):397-421. doi:10.1016/j.ogc.2022.02.001 See omnystudio.com/listener for privacy information.

Die 4 Mythen und Fakten zu Kinderosteopathie

Dynamic Stillness - Der Osteopathie Podcast

Play Episode Listen Later May 4, 2023 15:00

Die 4 Mythen und Fakten zu Kinderosteopathie Heute tauchen wir ein in das Thema Osteopathie für Babys und schauen uns an, was Mythen sind und was wirklich Fakten sind. Als Eltern stehen wir oft vor vielen Entscheidungen, wenn es um die Gesundheit unserer Babys geht, und die Kinderosteopathie ist ein Bereich, der oft von Missverständnissen und Mythen umgeben ist. In dieser Folge werden wir einige gängige Mythen über die Kinderosteopathie ansprechen und sie mit fundierten Fakten und wissenschaftlichen Erkenntnissen widerlegen. Mythos 1: Osteopathie für Babys ist nicht sicher und gefährlich Ein Besuch beim Osteopathen*in mit deinem Kind ist gefährlich  Hayden, C., & Mullinger, B. (2006). A preliminary assessment of the impact of cranial osteopathy for the relief of infantile colic. Complementary Therapies in Clinical Practice, 12(2), 83-90 https://pubmed.ncbi.nlm.nih.gov/16648084/ Mythos 2: Osteopathie für Babys ist nicht wirksam Mythos Nr. 2 über die Kinderosteopathie ist, dass sie nicht wirksam ist und keine nachgewiesenen Vorteile bietet. Hayden, C., & Mullinger, B. (2006). A preliminary assessment of the impact of cranial osteopathy for the relief of infantile colic. Complementary Therapies in Clinical Practice, 12(2), 83-90 https://pubmed.ncbi.nlm.nih.gov/16648084/ Mythos Nr. 3 Osteopathie für Babys ist nur für bestimmte Bedingungen geeignet Tatsächlich kann die Kinderosteopathie jedoch bei einer Vielzahl von Zuständen und Symptomen helfen Quelle: Studie von Hayden C, et al. (2018). Osteopathy for musculoskeletal pain in children: A systematic review of the literature. Manual Therapy, 33, 142-152. https://pubmed.ncbi.nlm.nih.gov/23430598/ Quelle: Studie von Cerritelli F, et al. (2015). Osteopathic manipulative treatment for pediatric conditions: A systematic review. Pediatrics, 135(3), 562-572. https://pubmed.ncbi.nlm.nih.gov/23776117/ Mythos Nr. 4: Osteopathie für Babys ist schmerzhaft. Die Osteopathie bei Säuglingen und Kleinkindern ist eine sanfte Therapieform, die in der Regel nicht schmerzhaft ist. Pizzolorusso, G., Cerritelli, F., D'orazio, M., Cozzolino, V., Renzetti, C., & Barlafante, G. (2013). Osteopathic evaluation of somatic dysfunction and craniosacral strain in preterm vs. term newborns. Evidence-Based Complementary and Alternative Medicine, 2013. https://pubmed.ncbi.nlm.nih.gov/23739757/ . Ausserdem klären wir die häufig gestellte Frage: "Ab welchem Alter kann mein Baby Osteopathie erhalten?" Kostenlose Webinare https://www.stefanrieth.com/webinare/ Der Link zur Ausbildung Deep Touch https://www.stefanrieth.com/ausbildung-2023/ Listen on: Stefanrieth.com: Apple: https://podcasts.apple.com/de/podcast/auftriebskraft/id1331666188 Stitcher; https://www.stitcher.com/show/dynamic-stillness-der-osteopathie-podcast Spotify: https://open.spotify.com/show/6rNJUxu71iwKobqdagKiOq?si=150dd16e6eea4aab Zusätzlich verwendete Quellen: Ceritelli et.al. (2015) - Clinical effectiveness of osteopathic treatment in chronic migraine: 3-Armed randomized controlled trial https://www.researchgate.net/publication/272200443_Clinical_effectiveness_of_osteopathic_treatment_in_chronic_migraine_3-Armed_randomized_controlled_trial Licciardone JC, Buchanan S, Hensel KL, et al. Osteopathic manipulative treatment of back pain and related symptoms during pregnancy: a randomized controlled trial. Am J Obstet Gynecol. 2010;202(1):43.e1-8. doi:10.1016/j.ajog.2009.08.024 https://pubmed.ncbi.nlm.nih.gov/19766977/ Pizzolorusso G, et al. (2017). Osteopathic manipulative treatment in pediatric and neonatal patients: An evidence-based narrative review. https://pubmed.ncbi.nlm.nih.gov/27603533/ https://www.sciencedirect.com/science/article/abs/pii/S1615907122001149 Dein Stefan Rieth, Msc. Ost., D.O. --- Ausschluss von Heilungsversprechen Bitte beachten Sie, dass es sich bei der Osteopathie um nicht wissenschaftlich und/oder schulmedizinisch anerkannte und/oder bewiesene Verfahren handelt und die Wirksamkeit wissenschaftlich und/oder schulmedizinisch nicht anerkannt ist. Besonderer Hinweis zum HWG (Heilmittelwerbegesetz) Aus rechtlichen Gründen weise ich besonders darauf hin, das bei keinem der aufgeführten Therapien- oder Diagnoseverfahren der Eindruck erweckt wird , das hier ein Heilungsversprechen meinerseits zugrunde liegt, bzw. Linderung oder Verbesserung einer Erkrankung garantiert oder versprochen wird. Sollte der Inhalt oder die Aufmachung dieser Seiten fremde Rechte Dritter oder gesetzliche Bestimmungen verletzen, so bitte ich um eine entsprechend kostenfreie Nachricht. Ich werde die zu Recht beanstandeten Passagen unverzüglich entfernen, ohne dass die Einschaltung eines Rechtsbeistandes erforderlich ist. Etwaig ohne vorherige Kontaktaufnahme ausgelöste Kosten jedweder Art werden insgesamt zurückgewiesen. Abmahnungen Keine Abmahnung ohne vorherigen Kontakt. Sollte der Inhalt der Aufmachung meiner Seiten fremde Rechte Dritter oder gesetzliche Bestimmungen verletzen, so bitte ich um eine entsprechende Nachricht ohne Kostennote. Ich garantiere, dass die zu Recht beanstandeten Textpassagen unverzüglich entfernt werde, ohne dass von Ihrer Seite die Einschaltung eines Rechtsbeistandes erforderlich ist. Ferner werde ich von Ihnen ohne vorherige Kontaktaufnahme ausgelösten Kosten vollumfänglich zurückweisen und gegebenenfalls Gegenklage wegen Verletzung vorgenannter Bestimmungen einreichen. Ziel dieses Hinweises ist keine Abmahnung z.B. formlose E-Mail) zu erhalten, sondern nicht mit den Kosten einer anwaltlichen Abmahnung belastet zu werden. Es ist nicht vertretbar, in einem solchen Falle die Notwendigkeit einer anwaltlichen Abmahnung zu bejahen.

spotify art apple stitcher ziel armed gesundheit kontakt clinical entscheidungen bereich seiten recht vorteile kosten fakten msc nachricht sollte ihnen tats pediatrics regel eindruck mythos mythen zus bedingungen falle ost missverst vielzahl notwendigkeit erkenntnissen verfahren verbesserung erkrankung zust verletzung alternative medicine ausserdem babys wirksamkeit clinical practice symptomen therapien ein besuch osteopathy ausschluss passagen kontaktaufnahme ferner kleinkindern bestimmungen manual therapy linderung osteopathie osteopathic abmahnung als eltern therapieform complementary therapies aufmachung osteopathen ihrer seite textpassagen renzetti diagnoseverfahren stefan rieth am j obstet gynecol hinweises kinderosteopathie rechte dritter thema osteopathie kostennote

Ep. 15 The Microbiome with Dr. Ian Fields

BackTable OBGYN

Play Episode Listen Later Feb 23, 2023 51:45

In this episode, Dr. Ian Fields joins Dr. Mark Hoffman at the mic to discuss the role of the microbiome in obstetrical and gynecological conditions. --- SHOW NOTES Dr. Ian Fields completed a fellowship in Female Pelvic Medicine & Reconstructive Surgery and received a Master of Clinical Research degree from Oregon Health & Sciences University. His research focuses on changes in the urinary microbiome and their association with lower urinary tract symptoms. Dr. Fields begins the episode by describing the microbiome as “all of the things outside of our cells that make up the human body,” which includes bacteria, viruses, and fungi. He explains that the microbiome may play a role in how humans maintain states of health, in addition to having large impacts on the pathophysiology or development of disease states. Dr. Fields references the Human Microbiome Project, a United States National Institutes of Health research initiative that was aimed to improve the understanding of microbiota in relation to human health and diseases. The physicians then transition to cover the role of the microbiome, specifically in the field of obstetrics and gynecology. Dr. Fields explains that the most studied condition is bacterial vaginosis. From a urogynecology perspective, he expresses a particular interest in urinary tract disorders, such as urinary incontinence, recurrent urinary tract infections, and interstitial cystitis. Dr. Fields emphasizes to listeners that urine is not sterile. In addition, he highlights how the use of vaginal estrogen increases the presence of lactobacillus within the genital microbiome, and thus is beneficial in the settings of genitourinary syndrome of menopause and recurrent menopause. Dr. Fields concludes the episode by briefly addressing other areas of study regarding the microbiome in the field of obstetrics and gynecology. For example, studies have revealed a link between vaginal microbiota and risk of preterm birth, as well as neonatal gut microbiota and the mode of delivery. Ultimately, Dr. Fields states that the microbiome is an underfunded and understudied aspect of medicine, and he urges listeners to acknowledge the large potential the field has. --- RESOURCES The Human Microbiome Project: https://hmpdacc.org/hmp/overview/ Brubaker L, Nager CW, Richter HE, Visco A, Nygaard I, Barber MD, Schaffer J, Meikle S, Wallace D, Shibata N, Wolfe AJ. Urinary bacteria in adult women with urgency urinary incontinence. Int Urogynecol J. 2014 Sep;25(9):1179-84. Wolfe AJ, Toh E, Shibata N, Rong R, Kenton K, Fitzgerald M, Mueller ER, Schreckenberger P, Dong Q, Nelson DE, Brubaker L. Evidence of uncultivated bacteria in the adult female bladder. J Clin Microbiol. 2012 Apr;50(4):1376-83. Hoffman C, Siddiqui NY, Fields I, Gregory WT, Simon HM, Mooney MA, Wolfe AJ, Karstens L. Species-Level Resolution of Female Bladder Microbiota from 16S rRNA Amplicon Sequencing. mSystems. 2021 Oct 26;6(5):e0051821. Richter HE, Carnes MU, Komesu YM, Lukacz ES, Arya L, Bradley M, Rogers RG, Sung VW, Siddiqui NY, Carper B, Mazloomdoost D, Dinwiddie D, Gantz MG; Eunice Kennedy Shriver National Institute of Child Health and Human Development Pelvic Floor Disorders Network. Association between the urogenital microbiome and surgical treatment response in women undergoing midurethral sling operation for mixed urinary incontinence. Am J Obstet Gynecol. 2022 Jan;226(1):93.e1-93.e15. Fettweis, J.M., Serrano, M.G., Brooks, J.P. et al. The vaginal microbiome and preterm birth. Nat Med 25, 1012–1021 (2019).

health master fields microbiome serrano clinical research child health urinary oregon health reconstructive surgery mark hoffman sciences university female pelvic medicine wallace d human microbiome project am j obstet gynecol

Episode 129: Emergency Contraception

Rio Bravo qWeek

Play Episode Listen Later Feb 17, 2023 15:26

Episode 129: Emergency ContraceptionBailey describes the available methods of emergency contraception in the United States. Written by Bailey Corona, MS4, American University of the Caribbean. Editing by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Definition. Emergency contraception refers to therapy used after intercourse to prevent pregnancy. The need for emergency contraception can happen for many reasons, such as a condom breaking or failure to use contraception. More than 11% of sexually active women in the United States between ages 15 and 44 reports using emergency contraception at least once. With such high demand, a multitude of options has become available to meet these needs. With so many options on the market, it may be difficult to decide which option best fits the needs of each individual, which makes it important for providers to have a clear understanding of the risks and benefits associated with each method. Emergency contraception may be commonly used by young patients as their main contraception method. Let's talk about the types of emergency contraception.Levonorgestrel-only (Plan B®).Levonorge'strel-only emergency contraception is the most popular option on the market today. More commonly known as “Plan-B”, this therapy works because of levonorgestrel's similar make-up to progesterone. Mechanism of action.High levels of progesterone delay follicular development so long as it is administered before the level of luteinizing hormone begin to rise. This gives contraceptive therapy of this class a therapeutic window of 72 hours which is the most limited window of all the methods discussed. Despite this shortcoming, Levonorgestrel contraception remains the most popular option because it can be purchased over the counter without the need of a physician and is available to women of all ages. Additionally, therapy includes only a single 1.5mg dose making noncompliance virtually non-existent. Side effects. Side effects include nausea in 12% of patients and headache in 19% of patients. According to one study, 16% of women reported self-resolving uterine bleeding within the first week after use.Selective progesterone modulators (Ella®).The second most commonly used form of emergency contraception are the selective progesterone receptor modulators or more widely known as Ella®. Mechanism of action.Treatment includes a single 30mg dose of ulipristal acetate, which inhibits follicular rupture even after the luteinizing hormone has begun to rise. Due to this mechanism of action, selective progesterone receptor modulators have a wider therapeutic window of 5 days.Side effects.Side effects resemble that of progesterone-only therapy, significant for nausea and headache. Treatment has 2 major barriers preventing it from being the most widely used. Firstly, efficacy is decreased in women with a BMI greater than 35, and secondly, treatment requires a prescription from a medical professional. Estrogen-progesterone combination.Estrogen-progesterone combination therapy is also a viable option for emergency contraception; however, it is no longer available as a dedicated product but can be made from a variety of oral contraceptives. Its decreased popularity is likely due to its increased incidence of nausea when compared to the other options available.Copper IUD.Lastly, Copper IUDs like Paragard can be used for emergency contraception despite not being FDA-approved for this purpose. Copper IUDs are highly effective if placed within 5 days of intercourse, but studies have shown therapy to be effective up to 10 days after. Mechanism of action.Copper IUDs prevent fertilization by altering sperm viability and oocyte-endometrium interaction. This method is the most invasive as it requires placement by a physician and carries the rare risk of uterine perforation, occurring in around 1/1000 IUD placements. That said, copper IUD placement carries with it the added benefit of continued contraception for 10 years. It is contraindicated, however, in patients with a history of heavy menstrual bleeding. FAQs about emergency contraception:Does increasing the availability of emergency contraception encourage risky sexual behavior?No, according to a systematic review by Maria Rodrigues, there was no significant increase in sexually risky behavior correlated with increased availability of emergency contraception.Rodriguez MI, et al.What is the greatest barrier to emergency contraception use in the United States?Education. A study by Abbott J, et al, interviewed adolescents receiving care in urban emergency rooms. The study showed that only 64% of patients had ever heard of emergency contraception. By educating patients of reproductive age on what options may be available to them it is expected that there would be a decrease in unplanned pregnancies. Additionally, studies like “knowledge of emergency contraception among women aged 18-44 in California” by Foster DG have gone further to establish that women of lower socioeconomic status, foreign birth, or who have not graduated high school also have suboptimal education in emergency contraception.When should someone use emergency contraception?Treatment should begin as soon as possible after unprotected intercourse in order to ensure maximum efficacy. 3 days for Plan B, 5 days for Ella, and 10 days for IUD.How effective is emergency contraception?The answer to this question differs based upon what method a patient decides to useIUDsA systematic review of 42 studies over a 35-year time period reports that pregnancy rates were between 0 and 2%.The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience by Cleland K. et al. Oral regimens have been studied extensively and have shown that ulipristal acetate like Ella® are slightly more effective, showing a pregnancy rate of 1.4% and a rate of 2.2% in levonorgestrel-only pills like Plan B. Ulipristal acetate versus levonorgestrel for emergency contraception: a randomized non-inferiority trial and meta-analysis by Glacier AF.Do patients require follow up after use of emergency contraception?No. Only if there is a delay in the start of normal menses by greater than 1 week or if lower abdominal pain or persistent irregular bleeding develops.___________________Conclusion: Now we conclude episode number 129 “Emergency Contraception.” Bailey explained that a pelvic exam is not needed in most cases before or after emergency contraception. Plan B® is available over the counter, while Ella® is available with a prescription. Copper IUD is not FDA-approved for emergency contraception, but evidence has shown it is an effective method. Dr. Arreaza suggested that, after learning more about emergency contraception, listeners can draw their own conclusions about the ethical dilemma of prescribing it to their patients. This week we thank Hector Arreaza and Bailey Corona. Audio editing by Adrianne Silva.Even without trying, every night, you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you; send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! ____________________Sources:Abbott J, Feldhaus KM, Houry D, Lowenstein SR. Emergency contraception: what do our patients know? Ann Emerg Med. 2004 Mar;43(3):376-81. doi: 10.1016/S019606440301120X. PMID: 14985666. https://pubmed.ncbi.nlm.nih.gov/14985666/.Cleland K, Zhu H, Goldstuck N, Cheng L, Trussell J. The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience. Hum Reprod. 2012 Jul;27(7):1994-2000. doi: 10.1093/humrep/des140. Epub 2012 May 8. PMID: 22570193; PMCID: PMC3619968. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3619968/.“Emergency Contraception.” ACOG, https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2015/09/emergency-contraception.Foster DG, Harper CC, Bley JJ, Mikanda JJ, Induni M, Saviano EC, Stewart FH. Knowledge of emergency contraception among women aged 18 to 44 in California. Am J Obstet Gynecol. 2004 Jul;191(1):150-6. doi: 10.1016/j.ajog.2004.01.004. PMID: 15295356. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3619968/Glasier AF, Cameron ST, Fine PM, Logan SJ, Casale W, Van Horn J, Sogor L, Blithe DL, Scherrer B, Mathe H, Jaspart A, Ulmann A, Gainer E. Ulipristal acetate versus levonorgestrel for emergency contraception: a randomised non-inferiority trial and meta-analysis. Lancet. 2010 Feb 13;375(9714):555-62. doi: 10.1016/S0140-6736(10)60101-8. Epub 2010 Jan 29. Erratum in: Lancet. 2014 Oct 25;384(9953):1504. PMID: 20116841.https://pubmed.ncbi.nlm.nih.gov/20116841/Jayson, Sharon. “5.8M Women Have Used 'Morning after' Pill.” USA Today, Gannett Satellite Information Network, 14 Feb. 2013, https://www.usatoday.com/story/news/nation/2013/02/13/cdc-contraception-emergency-methods/1914673/. Rodriguez MI, Curtis KM, Gaffield ML, Jackson E, Kapp N. Advance supply of emergency contraception: a systematic review. Contraception. 2013 May;87(5):590-601. doi: 10.1016/j.contraception.2012.09.011. Epub 2012 Oct 4. PMID: 23040139. https://pubmed.ncbi.nlm.nih.gov/23040139/.von Hertzen H, Piaggio G, Ding J, Chen J, Song S, Bártfai G, Ng E, Gemzell-Danielsson K, Oyunbileg A, Wu S, Cheng W, Lüdicke F, Pretnar-Darovec A, Kirkman R, Mittal S, Khomassuridze A, Apter D, Peregoudov A; WHO Research Group on Post-ovulatory Methods of Fertility Regulation. Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: a WHO multicentre randomised trial. Lancet. 2002 Dec 7;360(9348):1803-10. doi: 10.1016/S0140-6736(02)11767-3. PMID: 12480356. https://pubmed.ncbi.nlm.nih.gov/12480356/.Royalty-free music used for this episode: “Gushito - Burn Flow." Downloaded on October 13, 2022, from https://www.videvo.net/

EBB 244 - Evidence on Artificial Rupture of Membranes, Assisted Vaginal Delivery, and Internal Monitoring

Just US: Before, Birth, and Beyond

Play Episode Listen Later Nov 2, 2022 35:01

EBB 244: Evidence on Artificial Rupture of Membranes, Assisted Vaginal Delivery, and Internal Monitoring. We are so excited to announce the upcoming release of a new Evidence Based Birth(R) Pocket Guide, all about Interventions! To give you a sneak peek to the Invention Pocket Guide, we are diving into the research and evidence on artificial rupture of membranes, assisted vaginal delivery an internal monitoring. Content note: Discussion of the benefits and risks of these interventions, including forceps and vacuum-assisted deliveries, which can be associated with birthing trauma for birthing people and babies, as well as the risk of mortality. Resources: Make sure you're on the Pocket Guide wait list by going here Amniotomy References: Kawakita, T., Huang, C-C, and Landy, H. J. (2018). Risk Factors for Umbilical Cord Prolapse at the Time of Artificial Rupture of Membranes. AJP Rep 8(2): e89-e94. https://pubmed.ncbi.nlm.nih.gov/29755833/ Simpson, K. R. (2020). Cervical Ripening and Labor Induction and Augmentation, 5th Edition. AWHONN Practice Monograph 24(4): PS1-S41. https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2491-4 Smyth, R. M., Markham, C. & Dowswell, T. (2013). Amniotomy for shortening spontaneous labour. Cochrane Database Syst Rev 6:CD006167. https://pubmed.ncbi.nlm.nih.gov/23780653/ Alfirevic, Z., Keeney, E., Dowswell, T., et al. (2016). Methods to induce labour: a systematic review, network meta-analysis and cost-effectiveness analysis. BJOG 123(9): 1462-1470. https://pubmed.ncbi.nlm.nih.gov/27001034/ de Vaan, M. D. T., ten Eikelder, M. L. G., Jozwiak, M., et al. (2019). Mechanical methods for induction of labour. Cochrane Database of Systematic Reviews 10: CD001233. https://www.cochrane.org/CD001233/PREG_mechanical-methods-induction-labour Simpson, K. R. (2020). Cervical Ripening and Labor Induction and Augmentation, 5th Edition. AWHONN Practice Monograph, 24(4), PS1-S41. https://nwhjournal.org/article/S1751-4851(20)30079-9/abstract Assisted Vaginal Delivery References: NHS article on forceps or vacuum delivery https://www.nhs.uk/pregnancy/labour-and-birth/what-happens/forceps-or-vacuum-delivery/ Bailey, P. E., van Roosmalen, J., Mola, G., et al. (2017). Assisted vaginal delivery in low and middle income countries: an overview. BJOG 124(9): 1335-1344. https://pubmed.ncbi.nlm.nih.gov/28139878/ CDC Wonder Database Feeley, C., Crossland, N., Betran, A. P., et al. (2021). Training and expertise in undertaking assisted vaginal delivery (AVD): a mixed methods systematic review of practitioners views and experiences. Reprod Health 18(1): 92. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8097768/ Crossland, N., Kingdon, C., Balaam, M. C. (2020). Women's, partners' and health care providers' views and experiences of assisted vaginal birth: a systematic mixed methods review. Reprod Health 17:83. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268509/ Hook, C. D., Damos, J. R. (2008). Vacuum-Assisted Vaginal Delivery. Am Fam Physician 78(8): 953-960. https://www.aafp.org/afp/2008/1015/p953.html Tsakiridis, I., Giouleka, S., Mamopoulos, A., et al. (2020). Operative vaginal delivery: a review of four national guidelines. J Perinat Med 48(3): 189-198. https://pubmed.ncbi.nlm.nih.gov/31926101/ Verma, G. L., Spalding, J. J., Wilkinson, M. D., et al. (2021). Instruments for assisted vaginal birth. Cochrane Database Syst Rev. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005455.pub3/full Internal Monitoring References: Euliano, T. Y., Darmanjian, S., Nguyen, M. T., et al. (2017). Monitoring fetal heart rate during labor: A comparison of three methods. J Pregnancy 2017: 8529816. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5368359/ Neilson, J. P. (2015). Fetal electrocardiogram (ECG) for fetal monitoring during labor. Cochrane Database Syst Rev 12: CD000116. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000116.pub5/full Harper, L. M., Shanks, A. L., Tuuli, M. G., et al. (2013). The risks and benefits of internal monitors in laboring patients. Am J Obstet Gynecol 209(1): 38.e1-38.e6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3760973/ Bakker, J. J. H., Verhoeven, C. J. M., Janssen, P. F., et al. (2010). Outcomes after internal versus external tocodynamometry for monitoring labor. N Engl J Med 362(4): 306-13. https://www.nejm.org/doi/10.1056/NEJMoa0902748?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200www.ncbi.nlm.nih.gov Frolova, A. I., Stout, M. J., Carter, E. B., et al. (2021). Internal fetal and uterine monitoring in obese patients and maternal obstetrical outcomes. Am J Obstet Gynecol MFM 3(1): 100282. https://pubmed.ncbi.nlm.nih.gov/33451595/ Bakker, J. J. H., Janssen, P. F., van Halem, K. (2013). Internal versus external tocodynamometry during induced or augmented labor. Cochrane Database Syst Rev 8: CD006947. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006947.pub3/full van Halem, K., Bakker, J. J. H., VerHoeven, C. J., et al. (2011). Does use of an intrauterine catheter during labor increase risk of infection? J Maternal Fetal Neonatal Med 25(4): 415-418. https://www.tandfonline.com/doi/abs/10.3109/14767058.2011.582905 For more information and news about Evidence Based Birth®, visit www.ebbirth.com. Find us on: TikTok Instagram Pinterest Ready to get involved? Check out our Professional membership (including scholarship options) here Find an EBB Instructor here Click here to learn more about the Evidence Based Birth® Childbirth Class.

A conversation about how doctors can join the fight for reproductive health equity

Play Episode Listen Later Aug 30, 2022 22:39

Speaker: Jasmine Johnson, MD, FACOGDescription: In this episode of Just Us, join Cindy McMillan CD(DONA), CBPC, CBE, DBD, NCPSS as she delves into an insightful conversation with Dr. Jazmin Johnson, a self-described maternal health disparities crusader. She is a wife, mom, blogger, MFM Physician with a mission to eliminate inequities. Learn more about how to do so, here with us.Instagram: http://instagram.com/mrsmommymd Twitter: http://twitter.com/JasminRJohnsonIf you liked what you heard please share with your network!We would appreciate if you can provide feedback by filling out the following survey:https://redcap.mahec.net/redcap/surveys/?s=XTM8T3RPNK Show notes:For some extra reading, please check out Dr. Johnson's research:Traylor CS, Johnson JD, Kimmel MC, Manuck TA. Effects of psychological stress on adverse pregnancy outcomes and nonpharmacologic approaches for reduction: an expert review. Am J Obstet Gynecol MFM. 2020 Nov;2(4):100229. doi: 10.1016/j.ajogmf.2020.100229. Epub 2020 Sep 24. PMID: 32995736; PMCID: PMC7513755.Johnson JD, Louis JM. Does race or ethnicity play a role in the origin, pathophysiology, and outcomes of preeclampsia? An expert review of the literature. Am J Obstet Gynecol. 2022 Feb;226(2S):S876-S885. doi: 10.1016/j.ajog.2020.07.038. Epub 2020 Jul 24. PMID: 32717255.Johnson JD, Green CA, Vladutiu CJ, Manuck TA. Racial Disparities in Prematurity Persist among Women of High Socioeconomic Status. Am J Obstet Gynecol MFM. 2020 Aug;2(3):100104. doi: 10.1016/j.ajogmf.2020.100104. Epub 2020 Mar 23. PMID: 33179010; PMCID: PMC7654959.Green CA, Johnson JD, Vladutiu CJ, Manuck TA. The association between maternal and paternal race and preterm birth. Am J Obstet Gynecol MFM. 2021 Jul;3(4):100353. doi: 10.1016/j.ajogmf.2021.100353. Epub 2021 Mar 20. PMID: 33757934; PMCID: PMC8555705.Johnson JD, Asiodu IV, McKenzie CP, Tucker C, Tully KP, Bryant K, Verbiest S, Stuebe AM. Racial and Ethnic Inequities in Postpartum Pain Evaluation and Management. Obstet Gynecol. 2019 Dec;134(6):1155-1162. doi: 10.1097/AOG.0000000000003505. PMID: 31764724.

women conversations doctors management md effects racial health equity reproductive health epub pmid racial disparities cbe just us dbd aog obstet gynecol am j obstet gynecol

Season 2, Episode 10 (Oral minoxidil, Hair Fibers, HCQ in Pregnancy, Teriflunomide-induced Hair Loss, Do it Yourself Haircare, Premature Greying of Hair)

Evidence Based Hair

Play Episode Listen Later Jul 29, 2022 95:36

ORAL MINOXIDIL IN PEDIATRICS Jerjen R et al (starts at 12:33). Low-dose oral minoxidil improves global hair density and length in children with loose anagen hair syndrome. Br J Dermatol. 2021;184(5):977-978. Nicolas-Ruanes et al (starts at 15:33). Low-dose oral minoxidil for treatment of androgenetic alopecia and telogen effluvium in a pediatric population: A descriptive study. J Am Acad Dermatol. 2022 Apr 26; John JM et al (starts at 17:24). Safety and tolerability of low-dose oral minoxidil in adolescents: A retrospective review. J Am Acad Dermatol . 2022 Jul 5;S0190-9622(22)02245-9. HAIR FIBERS AND CAMOUFLAGE Ring and Keller (starts at 25:13). Effect of camouflaging agents on psychologic well-being: A cross-sectional survey of hair loss patients. J Am Acad Dermatol. 2017 Jun;76(6):1186-1189 Babadjouni A et al (starts at 28:15). Patient Satisfaction and Adverse Effects Following the use of Topical Hair Fiber Fillers. Int J Trichology. 2022 May-Jun; 14(3): 97–102 HYDROXYCHLOROQUINE IN PREGNANCY Reynolds JA et al (starts at 34:38). Outcomes of children born to mothers with systemic lupus erythematosus exposed to hydroxychloroquine or azathioprine. Rheumatology (Oxford). 2022 Jun 29: Sperber K et al (starts at 38:25). Systematic review of hydroxychloroquine use in pregnant patients with autoimmune diseases. Pediatr Rheumatol Online J 2009;7:9. Kaplan Y et al (starts at 39:17). Reproductive outcomes following hydroxychloroquine use for autoimmune diseases: a systematic review and meta-analysis. Br J Clin Pharmacol. 2016 May;81(5):835-48. Clowse MEB et al (starts at 40:27). Hydroxychloroquine in the pregnancies of women with lupus: a meta-analysis of individual participant data. Lupus Sci Med. 2022 Mar;9(1):e000651. Huybrechts K et al (starts at 42:37). Hydroxychloroquine early in pregnancy and risk of birth defects. Am J Obstet Gynecol 2021 Mar;224(3):290.e1-290.e22 Huybrechts K et al (starts at 45:20). Hydroxychloroquine early in pregnancy and risk of birth defects: absence of evidence is not the same as evidence of absence. Am J Obstet Gynecol. 2021 May;224(5):549-550. Bérard et al (starts at 46:58). Chloroquine and Hydroxychloroquine Use During Pregnancy and the Risk of Adverse Pregnancy Outcomes Using Real-World Evidence. Front Pharmacol. 2021 Aug 2;12:722511. Howley et al (starts at 47:17). Maternal exposure to hydroxychloroquine and birth defects. Birth Defects Res. 2021 Oct 15;113(17):1245-1256. Andersson et al (starts at 47:34). Fetal safety of chloroquine and hydroxychloroquine use during pregnancy: a nationwide cohort study. Rheumatology (Oxford). 2021 May 14;60(5):2317-2326. TERIFLUNOMIDE INDUCED HAIR LOSS IN MULTIPLE SCLEROSIS Travis LH et al (starts at 53:28). Real-World Observational Evaluation of Hair Thinning in Patients with Multiple Sclerosis Receiving Teriflunomide: Is It an Issue in Clinical Practice? Neurol Ther. 2018 Dec; 7(2): 341–347. Porwal MH et al (starts at 55:41). Alopecia in Multiple Sclerosis Patients Treated with Disease Modifying Therapies. J Cent Nerv Syst Dis. 2022 Jun 23;14:11795735221109674. DO IT YOURSELF LOW-ALLERGEN PRODUCTS Xiong M and Warshaw EM. (starts at 1:05:45) Hair Care Product Hacks: Do It Yourself Alternatives. Dermatitis. 2022 Jun 29. Zirwas M and Moennich J (starts at 1:00:25). Shampoos. Dermatitis. 2009 Mar-Apr;20(2):106-10 Tawfik M, Rodriguez-Homs LG, Alexander T, et al (starts at 1:01:10). Allergen content of best-selling ethnic versus nonethnic shampoos, conditioners, and styling products. Dermatitis 2021;32(2):101–110 https://donovanmedical.com/diy PREMATURE GREYING (EARLY CANITIES) Anggraini et al (starts at 1:08:50). Risk Factors Associated with Premature Hair Greying of Young Adult. Open Access Maced J Med Sci . 2019 Nov 14;7(22):3762-3764. Dawber RP (starts at 1:09:12). Integumentary associations of pernicious anaemia. Br J Dermatol . 1970 Mar;82(3):221-3. Mosley JG and Gibbs AC (starts at 1:09:50). Premature grey hair and hair loss among smokers: a new opportunity for health education? British Medical Journal 1996; 313: 1616. Bhat RM et al (starts at 1:10:21). Epidemiological and investigative study of premature graying of hair in higher secondary and pre-university school children. Int J Trichology. 2013;5:17–21. Chang H-C and Sung C-W (starts at 1:10:35). Association between serum levels of minerals and premature hair graying: a systematic review and meta-analysis. Int J Dermatol. 2020 Oct;59(10):e378-e380. Schnohr P et al (starts at 1:12:35). Longevity and gray hair, baldness, facial wrinkles, and arcus senilis in 13,000 men and women: The Copenhagen city heart study. J Gerontol A Biol Sci Med Sci. 1998;53:M347–50. Schnohr P et al. Gray hair, baldness, and wrinkles in relation to myocardial infarction: the Copenhagen City Heart Study. Am Heart J 1995 Nov;130(5):1003-10. Kocaman SA et al (starts at 1:14:10) . The degree of premature hair graying as an independent risk marker for coronary artery disease: A predictor of biological age rather than chronological age. Anadolu Kardiyol Derg 2012;12:457-63. Paik S et al (starts at 1:14:25). Association Between Premature Hair Greying and Metabolic Risk Factors: A Cross-sectional Study. Acta Derm Venereo. 2018 Aug 29;98(8):748-752. Mahendiratta S et al (starts at 1:15:09). Premature graying of hair: Risk factors, co-morbid conditions, pharmacotherapy and reversal-A systematic review and meta-analysis. Dermatol Ther. 2020 Nov;33(6):e13990. Das S et al (starts at 1:15:51) Cardiovascular risk markers in premature canities. Indian J Dermatol Venereol Leprol. 2022 Jun 30;1-5.

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Ignaz Semmelweis: “El Salvador de las Madres”

LAS PODEROSAS CÉLULAS NK

Play Episode Listen Later Jul 8, 2022 16:49

Kadar N, Romero R, Papp Z. Ignaz Semmelweis: the "Savior of Mothers": On the 200th anniversary of his birth. Am J Obstet Gynecol. 2018 Dec;219(6):519-522. doi: 10.1016/j.ajog.2018.10.036. PMID: 30471890; PMCID: PMC6333090. --- Send in a voice message: https://anchor.fm/las-poderosas-celulas-nk/message

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EP.07 - Chiropratique pédiatrique et périnatalité avec Dre Anne Dolbec, chiropraticienne.

MAX WELLNESS

Play Episode Listen Later Apr 9, 2022 32:30

Aujourd'hui je reçois Dre Anne Dolbec, chiropraticienne membre de l'International Chiropractic Pediatric Association - ayant une pratique axée vers les soins pour enfants, bébés et femmes enceintes. Elle nous parle de son cheminement, de son quotidien en clinique et de son intérêt pour la recherche et l'enseignement.On discute de:✅Son parcours et son expertise clinique✅Chiropratique pour bébés, enfants et mamans✅Quand et Pourquoi consulter à ces stades de vie?✅Conditions fréquemment rencontrées✅En quoi consistent les visites/traitements?✅Recherche et littérature sur le sujet✅Et plus encore!!Bonne écoute! :)Dre Anne Dolbec, chiropraticienne:FB: https://www.facebook.com/drannedolbecClinique: https://www.chirokingsbury.ca/Dr Maxime Lavoie, chiropraticienFB: https://www.facebook.com/MAXWellnessPodcastContenu et site web: https://www.maximelavoie.caLittérature et ressources pertinentes:Fallon J. "The Effect of Chiropractic Treatment on Pregnancy and Labor: A Comprehensive Study." Proceedings of the World Federation of Chiropractic. 1991:24-31.Oswald C, Higgins CC, Assimakopoulos D. "Optimizing Pain Relief During Pregnancy Using Manual Therapy." Canadian Family Physician. 2013 Aug;59(8):841-2.George JW, Skaggs CD, Thompson PA, Nelson DM, Gavard JA, Gross GA. "A Randomized Controlled Trial Comparing a Multimodal Intervention and Standard Obstetrics Care for Low Back and Pelvic Pain in Pregnancy." Am J Obstet Gynecol. 2013 Apr;208(4):295.e1-7. doi: 10.1016/j.ajog.2012.10.869. Epub 2012 Oct 23.Stuber KJ, Wynd S, Weis CA. "Adverse Events from Spinal Manipulation in the Pregnant and Postpartum Periods: A Critical Review of the Literature." Chiropr Man Therap. 2012 Mar 28;20:8. doi: 10.1186/2045-709X-20-8.Marchand AM. Chiropractic care of children from birth to adolescence and classification of reported conditions: an internet cross-sectional survey of 956 European chiropractors. J Manipulative Physiol Ther. 2012;35(5):372–80.Clar C, Tsertsvadze A, Court R, Hundt GL, Clarke A, Sutcliffe P. Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report. Chiropractic manual therapies. 2014;22(1):12.Hawk C, Schneider M, Vallone S, Hewitt E. Best practices for chiropractic care of children: a consensus update. J Manip Physiol Ther. 2016;39:158–68.

Episódio 118: Caso Clínico de Sangramento

Ta de Clinicagem

Play Episode Listen Later Dec 8, 2021 53:51

João e Kaue discutem um caso clínico do Pedro, trazendo os principais pontos na abordagem diagnóstico do paciente sangrando. O que é relevante na anamnese? Hereditário ou adquirido? Como interpretar o coagulograma? Tudo isso nesse episódio! Referências: 1. Dilley A, Drews C, Miller C, et al. von Willebrand disease and other inherited bleeding disorders in women with diagnosed menorrhagia. Obstet Gynecol. 2001;97(4):630–636. 2. Knol HM, Mulder AB, Bogchelman DH, Kluin-Nelemans HC, van der Zee AG, Meijer K. The prevalence of underlying bleeding disorders in patients with heavy menstrual bleeding with and without gynecologic abnormalities. Am J Obstet Gynecol. 2013;209(3):202.e1–202.e7. 3. Neutze D, Roque J. Clinical Evaluation of Bleeding and Bruising in Primary Care. Am Fam Physician. 2016;93(4):279-286. 4. Girolami A, Luzzatto G, Varvarikis C, et al. Main clinical manifestations of a bleeding diathesis: an often disregarded aspect of medical and surgical history taking. Haemophilia 2005; 11:193. 5. Schulman S, Kearon C, Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost 2005; 3:692.

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EBB 186 - A Positive Pregnancy and Birth Outcome with Multiple High-Risk Labels with EBB Childbirth Class Parent, Angela Jones

Play Episode Listen Later Jul 28, 2021 59:39

On today's podcast, we're going to talk with EBB Childbirth Class parent, Angela Jones, about having an uncomplicated pregnancy and birth when labeled as high risk. Angela is a macro-level social worker, wife to her husband, Tony, and mom to her son, Alistair, and their cats, Pumpernickel and Lion-O. Angela and Tony graduated from the Evidence Based Birth Childbirth Class with EBB instructor, Victoria Michonski. Both Victoria and Heather McCullough, who is also an EBB instructor, were Angela and Tony's doulas for Alistair's birth. We talk about Angela's birth story and her experience having an easy, uncomplicated pregnancy and birth despite being labeled as high risk for multiple reasons. We also talk about data birth outcomes for people who have multiple high-risk labels. Content Warning: We talk about ectopic pregnancy, pregnancy losses, high-risk pregnancy complications, and perinatal morbidity. Resources: Learn more about EBB Instructor, Victoria Michonski, here (http://www.vdoula.com/). Follow Victoria on Facebook here (https://www.facebook.com/312doulas/). Learn more about EBB Instructor, Heather McCullough, here (https://www.hmbirth.com/). Follow Heather on Facebook here (https://www.facebook.com/hmbirth). Follow Heather on Instagram here (https://www.instagram.com/hmbirth/). Follow Heather on Twitter here (https://twitter.com/hmbirth). Sheen, J. J., Wright, J. D., Goffman, D., et al. (2018). Maternal age and risk for adverse outcomes. Am J Obstet Gynecol. 2018 Oct;219(4):390.e1-390.e15. Click here. For more information and news about Evidence Based Birth®, visit www.ebbirth.com. Find us on Facebook (https://www.facebook.com/EvidenceBasedBirth/), Instagram (https://www.instagram.com/ebbirth/), and Pinterest (https://www.pinterest.com/ebbirth/). Ready to get involved? Check out our Professional membership (including scholarship options) (https://evidencebasedbirth.com/become-pro-member/). Find an EBB Instructor here (https://evidencebasedbirth.com/find-an-instructor-parents/), and click here (https://evidencebasedbirth.com/childbirth-class/) to learn more about the Evidence Based Birth® Childbirth Class.

16. Prolapse with Jeanice Mitchell

The Pelvic Floor Project

Play Episode Listen Later Jun 28, 2021 53:11

In this episode, I sit down with Jeanice Mitchell from MyPFM to discuss:What prolapse actually is and different typesWhy prolapse is common to experience postpartum Risk factors for prolapseWhat symptoms you may experienceHow a physical therapist can helpOur goal for this episode is to:Help you understand prolapse and make a plan for management so that your fear can take a back seat. Jeanice Mitchell is a physical therapist with advanced training and certifications in women's health, biofeedback, and pelvic health. She began specializing in this area of physical therapy after the birth of her son in 1999. She has seen the profound impact of pelvic floor PT on her own life as well as with countless patients over the years.She started myPFM.com (a non-profit 501(c)(3) organization) in 2018 with the goal of improving global pelvic health awareness and access to resources. The mission of myPFM is “Pelvic Health for All. Everyone. Everywhere. Every Language.” You can find fun, engaging pelvic health content and resources on her website, Instagram and YouTube channels.Special information about episode:Here is the Barber study (30-76% with POP):https://pubmed.ncbi.nlm.nih.gov/27439423/ Here is the PFMT study on the morphological changes:https://pubmed.ncbi.nlm.nih.gov/20093905/Here is the study looking at how common prolapse is:Swift SE, Tate SB, Nicholas J. Correlation of symptoms with degree of pelvic organ support in a general population of women: what is pelvic organ prolapse? Am J Obstet Gynecol. 2003 Aug;189(2):372-7; discussion 377-9. doi: 10.1067/s0002-9378(03)00698-7. PMID: 14520198. Here is the course link for Power Over Prolapse:https://mypfm.mykajabi.com/offers/5CvpRkTiUse code MELISSA50 for 50% off the courseLinks to contact Jeanice:WebsiteInstagramYouTubeThanks for joining me! Here is where you can find more:my online course to walk you through pregnancy, birth prep and postpartum recovery: https://mommyberries.comFollow me on:InstagramFacebookYouTubeSupport the show

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Journal Club 妇产乳腺星期四 Episode 29

Play Episode Listen Later Dec 10, 2020 20:51

FDA 批准一种新型的单抗-药物偶联物治疗乳腺癌JAMA 乳腺癌筛查时，简易乳房MRI与数字乳房合成技术哪一种好？Science子刊能快速诊断癌症的便携式细胞分析仪-CytoPAN曲妥珠单抗-德鲁替康（trastuzumab deruxtecan）曲妥珠单抗-德鲁替康（trastuzumab deruxtecan）是一种HER-2单抗、偶联拓扑异构酶1抑制剂的药物。2019年12月，曲妥珠单抗-德鲁替康（trastuzumab deruxtecan）被FDA批准用于治疗HER2阳性的、经治疗的乳腺癌。《DESTINY-Breast01研究：曲妥珠单抗-德鲁替康经治疗的HER2阳性乳腺癌的2期临床研究》New England Journal of Medicine，2020年2月 (1)这项2部分的、开放标签、单组、多中心、2期研究，评估了184名、HER2阳性的、转移性乳腺癌患者，使用曲妥珠单抗德鲁替康的疗效。研究第一部分，使用了3种不同剂量，以确定推荐剂量；在第二部分中，评估了推荐剂量的有效性和安全性。曲妥珠单抗德鲁替康的推荐剂量为5.4mg/kg。随访11.1个月后，患者的中位缓解时间为14.8个月，中位无进展生存时间为16.4个月。在研究中，最常见的严重不良事件是中性粒细胞计数减少、贫血和恶心。结论：曲妥珠单抗-德鲁替康在HER2阳性的、转移性乳腺癌患者中，显示出持久的抗肿瘤活性。除了恶心和骨髓抑制，治疗组还观察到间质性肺病，因此用药过程中需监测肺部情况。避孕法避孕法主要包括激素避孕和非激素避孕。激素避孕药包括雌-孕激素避孕药和单纯孕激素避孕药；可采用口服、注射、皮下植入剂、透皮贴剂、子宫避孕器或阴道避孕器等方式给药。非激素避孕法主要包括：输卵管阻断、含铜宫内避孕器、避孕套。《回顾性研究：避孕法类型是否影响痤疮的发病率和严重程度》Obstetrics and Gynecology，2020年5月 (2)皮肤科医生常开出复方口服避孕药用于治疗痤疮，这项回顾性队列研究，目的是比较各种避孕法使用1年内，对痤疮的发病率和严重程度的影响。研究共大约337,000名避孕法的新使用者（年龄12～40岁），2%～8%出现新发痤疮，年轻女性的发病率较高。研究发现复方口服避孕药相比，含铜宫内节育器的痤疮发生风险比为1.14，含孕酮的宫内节育器的痤疮风险比1.09，这些女性新发痤疮后的就诊率略高。21,000名患有痤疮病史的女性，使用含铜宫内节育器和含孕酮的节育器后，从外用药转换成口服四环素类抗生素的可能性更高（风险比分别为1.44和1.34）。结论：复方口服避孕药似乎痤疮风险相对较小，各种避孕法之间绝对差异也很小。《回顾性研究：产后即刻行皮下植入依托孕烯植入剂避孕，与静脉血栓栓塞的关系》Obstetrics and Gynecology，2020年6月 (3)来自贝勒大学医学院的研究人员，对分娩后30天内皮下植入依托孕烯植入剂的妇女与未植入的妇女的再入院率进行了比较，旨在明确这种避孕方法是否增加静脉血栓的风险。在338万余名产妇中，排除有静脉血栓栓塞史或抗凝治疗史的产妇，共8369名产妇在分娩住院期间接受了皮下植入避孕。研究发现，依托孕烯避孕的产妇和没有避孕的产妇的静脉血栓栓塞再入院率没有差异；而且糖尿病、血栓性血友病、系统性红斑狼疮和剖宫产的发生率在组间无差异。统计发现，接受避孕植入的产妇更年轻、收入更低、吸烟者更多、高血压、围产期感染或产后出血发生率也较高；在对这些混杂因素进行调整后，静脉血栓栓塞发生率的风险比为1.81，没有统计学差异（95%可信区间0.44 - -7.45）。结论：分娩后立即接受依托孕烯避孕植入物避孕，没有增加静脉血栓发生率。《对照研究：依托孕烯避孕植入物使用者不良出血模式的治疗》Obstetrics and Gynecology，2020年8月 (4)依托孕烯避孕植入物的主要副作用是阴道不规则出血，该研究的目的是评价短程使用他莫西芬是否有效。这个研究的前90天，这是一个双盲、随机、对照试验中，研究纳入112名植入依托孕烯避孕植入物后反复阴道出血的女性，随机双盲入组他莫昔芬10mg bid组或安慰剂组，连续治疗7天。然后，参与者进入下一个90天的开放标签研究，如果需要每30天可以接受最多3个疗程的他莫西芬，在此期间，参与者使用短信记录每天的流血情况。双盲对照期间，他莫西芬组报告在最初90天内阴道连续不出血的天数比安慰剂组少9.8天（P=0.001)；在开放标签阶段，服用他莫西芬的女性得到了类似的疗效。在随机对照期，他莫西芬组参与者的满意度也更高。结论：短疗程的他莫昔芬减少了问题性出血，提高了使用者的满意度。《随机对照研究：新型的宫内节育器的2期临床研究》Obsteteric & Gynecology，2020年4月 (5)这种新型的宫内节育器，支架含有镍钛合金，铜仅位于靠近子宫角和子宫颈内口的位置，含有的铜和镍钛合金的剂量都很小；而且设计时为了方便放置，自带细线。因此，这种宫内节育器可能减少与铜相关的子宫痉挛和出血。在这项为期36个月2期研究中，纳入了286名女性，评价了总共5,640个月经周期的妊娠情况。宫内节育器的平均使用时间为2.7年；37.8%的女性使用该宫内节育器的时间达到36个月。在使用宫内节育器的第1年，每个月经周期的平均出血天数从7.6天（第1个月经周期）减少至5.2天（第13个月经周期）。主要不良反应是出血、疼痛。结论：这种新型的宫内节育器有效性高，且耐受性好。《系统回顾：延长宫内节育器使用时间的有效性和安全性》American Journal of Obstetrics and Gynecology，2020年7月 (6)文章系统地回顾了关于宫内节育器超过批准的有效时间后，是否仍能有效和安全的避孕。研究纳入了2篇关于含铜宫内节育器（批准有效期10年）和4篇关于左炔诺孕酮宫内节育器（批准有效期为5年）的研究。研究发现，左炔诺孕酮宫内节育器在第6和第7年合并妊娠率为0.02/100人年(95%置信区间，0.00-0.29)。超期使用后，每年不良事件发生率、或因不良事件取环的比率为0- 3.7/100。对于含铜宫内节育器，11年和12年的合并妊娠率为0.0/100人年(95%可信区间为0-0.8)；在此期间，不良事件年发生率为0-4.6/100人。结论：左炔诺孕酮宫内节育器和含铜宫内节育器，延长使用的前两年的妊娠率、不良事件率、因副作用取出率都是很低的；但这些数据在数量和质量上都是有限的，不建议推广。乳腺癌的筛查乳腺癌的筛查首先需要对风险进行分层。没有卵巢癌、腹膜癌、乳腺癌个人史或家族史，没有遗传基因突变，10-30岁之间没有接受过胸部放疗的女性属于低危人群；有以上病史的女性属于高危。美国癌症协会建议女性45岁开始接受每年一次的钼靶筛查，55岁以后每两年一次。筛查方式：钼靶是首选，高危女性可使用MRI联合钼靶。《横向研究：简易乳房MRI与数字乳房合成技术在筛查致密乳房女性中乳腺癌的比较》JAMA，2020年2月 (7)乳腺密度高的女性患乳腺癌的风险增加，研究旨在比较简易乳房MRI和数字乳房合成技术对致密乳腺患者的筛查效果。共1516名女性参与了研究，平均年龄54岁。队列中，有17名浸润性乳腺癌和6名原位导管癌。MRI检测出全部17名浸润性乳腺癌和5名原位导管癌；数字合成技术仅检测出7例浸润性乳腺癌和2例原位癌。MRI敏感度为95.7%、特异性为86.7%；数字合成技术灵敏度为39.1%，特异性为97.4%（P=0.001，P

Journal Club 妇产乳腺星期四 Episode 29

Play Episode Listen Later Dec 10, 2020 20:51

FDA 批准一种新型的单抗-药物偶联物治疗乳腺癌JAMA 乳腺癌筛查时，简易乳房MRI与数字乳房合成技术哪一种好？Science子刊能快速诊断癌症的便携式细胞分析仪-CytoPAN曲妥珠单抗-德鲁替康（trastuzumab deruxtecan）曲妥珠单抗-德鲁替康（trastuzumab deruxtecan）是一种HER-2单抗、偶联拓扑异构酶1抑制剂的药物。2019年12月，曲妥珠单抗-德鲁替康（trastuzumab deruxtecan）被FDA批准用于治疗HER2阳性的、经治疗的乳腺癌。《DESTINY-Breast01研究：曲妥珠单抗-德鲁替康经治疗的HER2阳性乳腺癌的2期临床研究》New England Journal of Medicine，2020年2月 (1)这项2部分的、开放标签、单组、多中心、2期研究，评估了184名、HER2阳性的、转移性乳腺癌患者，使用曲妥珠单抗德鲁替康的疗效。研究第一部分，使用了3种不同剂量，以确定推荐剂量；在第二部分中，评估了推荐剂量的有效性和安全性。曲妥珠单抗德鲁替康的推荐剂量为5.4mg/kg。随访11.1个月后，患者的中位缓解时间为14.8个月，中位无进展生存时间为16.4个月。在研究中，最常见的严重不良事件是中性粒细胞计数减少、贫血和恶心。结论：曲妥珠单抗-德鲁替康在HER2阳性的、转移性乳腺癌患者中，显示出持久的抗肿瘤活性。除了恶心和骨髓抑制，治疗组还观察到间质性肺病，因此用药过程中需监测肺部情况。避孕法避孕法主要包括激素避孕和非激素避孕。激素避孕药包括雌-孕激素避孕药和单纯孕激素避孕药；可采用口服、注射、皮下植入剂、透皮贴剂、子宫避孕器或阴道避孕器等方式给药。非激素避孕法主要包括：输卵管阻断、含铜宫内避孕器、避孕套。《回顾性研究：避孕法类型是否影响痤疮的发病率和严重程度》Obstetrics and Gynecology，2020年5月 (2)皮肤科医生常开出复方口服避孕药用于治疗痤疮，这项回顾性队列研究，目的是比较各种避孕法使用1年内，对痤疮的发病率和严重程度的影响。研究共大约337,000名避孕法的新使用者（年龄12～40岁），2%～8%出现新发痤疮，年轻女性的发病率较高。研究发现复方口服避孕药相比，含铜宫内节育器的痤疮发生风险比为1.14，含孕酮的宫内节育器的痤疮风险比1.09，这些女性新发痤疮后的就诊率略高。21,000名患有痤疮病史的女性，使用含铜宫内节育器和含孕酮的节育器后，从外用药转换成口服四环素类抗生素的可能性更高（风险比分别为1.44和1.34）。结论：复方口服避孕药似乎痤疮风险相对较小，各种避孕法之间绝对差异也很小。《回顾性研究：产后即刻行皮下植入依托孕烯植入剂避孕，与静脉血栓栓塞的关系》Obstetrics and Gynecology，2020年6月 (3)来自贝勒大学医学院的研究人员，对分娩后30天内皮下植入依托孕烯植入剂的妇女与未植入的妇女的再入院率进行了比较，旨在明确这种避孕方法是否增加静脉血栓的风险。在338万余名产妇中，排除有静脉血栓栓塞史或抗凝治疗史的产妇，共8369名产妇在分娩住院期间接受了皮下植入避孕。研究发现，依托孕烯避孕的产妇和没有避孕的产妇的静脉血栓栓塞再入院率没有差异；而且糖尿病、血栓性血友病、系统性红斑狼疮和剖宫产的发生率在组间无差异。统计发现，接受避孕植入的产妇更年轻、收入更低、吸烟者更多、高血压、围产期感染或产后出血发生率也较高；在对这些混杂因素进行调整后，静脉血栓栓塞发生率的风险比为1.81，没有统计学差异（95%可信区间0.44 - -7.45）。结论：分娩后立即接受依托孕烯避孕植入物避孕，没有增加静脉血栓发生率。《对照研究：依托孕烯避孕植入物使用者不良出血模式的治疗》Obstetrics and Gynecology，2020年8月 (4)依托孕烯避孕植入物的主要副作用是阴道不规则出血，该研究的目的是评价短程使用他莫西芬是否有效。这个研究的前90天，这是一个双盲、随机、对照试验中，研究纳入112名植入依托孕烯避孕植入物后反复阴道出血的女性，随机双盲入组他莫昔芬10mg bid组或安慰剂组，连续治疗7天。然后，参与者进入下一个90天的开放标签研究，如果需要每30天可以接受最多3个疗程的他莫西芬，在此期间，参与者使用短信记录每天的流血情况。双盲对照期间，他莫西芬组报告在最初90天内阴道连续不出血的天数比安慰剂组少9.8天（P=0.001)；在开放标签阶段，服用他莫西芬的女性得到了类似的疗效。在随机对照期，他莫西芬组参与者的满意度也更高。结论：短疗程的他莫昔芬减少了问题性出血，提高了使用者的满意度。《随机对照研究：新型的宫内节育器的2期临床研究》Obsteteric & Gynecology，2020年4月 (5)这种新型的宫内节育器，支架含有镍钛合金，铜仅位于靠近子宫角和子宫颈内口的位置，含有的铜和镍钛合金的剂量都很小；而且设计时为了方便放置，自带细线。因此，这种宫内节育器可能减少与铜相关的子宫痉挛和出血。在这项为期36个月2期研究中，纳入了286名女性，评价了总共5,640个月经周期的妊娠情况。宫内节育器的平均使用时间为2.7年；37.8%的女性使用该宫内节育器的时间达到36个月。在使用宫内节育器的第1年，每个月经周期的平均出血天数从7.6天（第1个月经周期）减少至5.2天（第13个月经周期）。主要不良反应是出血、疼痛。结论：这种新型的宫内节育器有效性高，且耐受性好。《系统回顾：延长宫内节育器使用时间的有效性和安全性》American Journal of Obstetrics and Gynecology，2020年7月 (6)文章系统地回顾了关于宫内节育器超过批准的有效时间后，是否仍能有效和安全的避孕。研究纳入了2篇关于含铜宫内节育器（批准有效期10年）和4篇关于左炔诺孕酮宫内节育器（批准有效期为5年）的研究。研究发现，左炔诺孕酮宫内节育器在第6和第7年合并妊娠率为0.02/100人年(95%置信区间，0.00-0.29)。超期使用后，每年不良事件发生率、或因不良事件取环的比率为0- 3.7/100。对于含铜宫内节育器，11年和12年的合并妊娠率为0.0/100人年(95%可信区间为0-0.8)；在此期间，不良事件年发生率为0-4.6/100人。结论：左炔诺孕酮宫内节育器和含铜宫内节育器，延长使用的前两年的妊娠率、不良事件率、因副作用取出率都是很低的；但这些数据在数量和质量上都是有限的，不建议推广。乳腺癌的筛查乳腺癌的筛查首先需要对风险进行分层。没有卵巢癌、腹膜癌、乳腺癌个人史或家族史，没有遗传基因突变，10-30岁之间没有接受过胸部放疗的女性属于低危人群；有以上病史的女性属于高危。美国癌症协会建议女性45岁开始接受每年一次的钼靶筛查，55岁以后每两年一次。筛查方式：钼靶是首选，高危女性可使用MRI联合钼靶。《横向研究：简易乳房MRI与数字乳房合成技术在筛查致密乳房女性中乳腺癌的比较》JAMA，2020年2月 (7)乳腺密度高的女性患乳腺癌的风险增加，研究旨在比较简易乳房MRI和数字乳房合成技术对致密乳腺患者的筛查效果。共1516名女性参与了研究，平均年龄54岁。队列中，有17名浸润性乳腺癌和6名原位导管癌。MRI检测出全部17名浸润性乳腺癌和5名原位导管癌；数字合成技术仅检测出7例浸润性乳腺癌和2例原位癌。MRI敏感度为95.7%、特异性为86.7%；数字合成技术灵敏度为39.1%，特异性为97.4%（P=0.001，P

Journal Club 妇产科星期四 Episode 19

Play Episode Listen Later Nov 26, 2020 21:34

FDA 批准HER2酪氨酸激酶抑制剂用于治疗HER2阳性的乳腺癌Lancet 低剂量阿司匹林可以预防初产妇早产？JAMA 男性补充叶酸和锌对精液质量和胎儿活产有影响吗？妥卡替尼（tucatinib）人表皮生长因子受体2 （HER2）阳性的、转移性乳腺癌患者在使用多种HER2靶向药物治疗后，若病情仍出现进展，则治疗选择便很有限。妥卡替尼（tucatinib）是一种口服的、HER2酪氨酸激酶的、高选择性抑制剂。2020年4月，妥卡替尼（tucatinib）被FDA批准用于治疗HER2阳性乳腺癌。《HER2CLIMB研究：妥卡替尼、曲妥珠单抗、卡培他滨治疗HER2阳性转移性乳腺癌的3期临床研究》New England Journal of Medicine，2020年2月 (1)研究纳入HER2阳性的、复发性、转移性乳腺癌患者共480人，在曲妥珠单抗和卡培他滨的联合治疗的基础上，随机联用妥卡替尼或安慰剂。联用妥卡替尼组和安慰剂组中，1年无进展生存率分别为33.1%和12.3%（疾病进展或死亡的风险比为0.54，P

157. Thankful For Well Done Studies & Errors In Lab Values

Questioning Medicine

Play Episode Listen Later Nov 26, 2020 23:06

www.bmj.com/content/368/bmj.m149 No one wants to get pregnant two minutes after having a baby. And also agrees that an IUD is most effective form of conception. However placing IUD after delivering a child seems to be a point of debate as the risk of expulsion seems to be significantly higher immediately post pregnancy In this study titled Averbach SH, Ermias Y, Jeng G, et al. Expulsion of intrauterine devices after postpartum placement by timing of placement, delivery type, and intrauterine device type: a systematic review and meta-analysis. Am J Obstet Gynecol 2020;223:177-188. They looked at the different rates of IUD expulsion postpartum. As you can imagine the rates vary based on if the IUD was placed within 3 minutes of child delivery or 3 weeks after child delivery. There also seemed to be a difference between hormonal IUD (LNG-IUD) compared with a copper T-shaped IUD. Finally there was a difference whether she had a C-section or a vaginal delivery as you can imagine the vaginal delivery was associated with significant less rates of expulsion which is the numbers we are going to talk about going forward as the rates of expulsion following C-section were significantly lower around 0-2%. Brand progesterone IUD are called Skyla, Liletta, Mirena -- but in this study they only included those papers which she used MIRANA. Copper IUD goes by paragard Ultimately the authors looked at 3 different timeframes for placement of the IUD. 1-immediate placement within 10 minutes postpartum, or IUD placement anywhere from 10 minutes postpartum to 72 hours postpartum or early outpatient placement somewhere between 72 hours to 4 weeks postpartum So let’s break them down by timeframe- Those individuals who had an IUD placed immediately following delivery had a 27% exposure rate with Mirena and a 12% exposure rate with ParaGard Those individuals who had an IUD placed not immediately but within the first 72 hours the exposure rate was 37% with the hormonal IUD and 7% for the copper IUD And finally for those women who had an IUD placed in the outpatient setting at some point between 72 hours in 4 weeks there was no expulsion that occurred for either the hormonal or copper IUD. I think the final answer here is for a woman who has a vaginal delivery and would like to have IUD placement following delivery there is almost no way we can justify placing hormonal IUDs within the first 72 hours as the expulsion rate of 30ish percent is way too high to justify. The ideal situation would be IUD placement in the outpatient setting at sometime point between 72 hours in 4 weeks however if you’re patient is insisting on IUD placement while still in the hospital then it appears the best option would be a copper IUD and this likely should be placed as close to discharge as possible because even those individuals who had a copper IUD placed prior to 72 hours still had a 7% exposure rate which seems a little high. If you’re going to use this paper and practice I think important thing to remember is that it was for woman with vaginal deliveries and not for women with C-sections as those individuals had near 0% expulsion rates. The next our article talks about one of the most irritating conditions to treat and of course that is irritable bowel syndrome. In this randomized double-blind placebo controlled trial titled Hamatani T, Fukudo S, Nakada Y, Inada H, Kazumori K, Miwa H. Randomised clinical trial: minesapride vs placebo for irritable bowel syndrome with predominant constipation. Aliment Pharmacol Ther 2020;52(3):430-441. Author still just over 400 patients with a history of severe irritable bowel syndrome predominant constipation who were having less than 3 spontaneous bowel movements per week and randomized them to placebo or minesapride 10 mg, 20 mg, or 40 mg daily for 3 months. The primary endpoint—an increase in one or more complete spontaneous bowel movements and in the end it didn’t matter what dose of minesapride you got because it was no better than placebo. All groups had about a 40% improvement in their rates of spontaneous bowel movement. Irritable bowel is irritating to treat because pooping and bowel movement are so mental. Anxiety and stress and tension can back you up like a hoover damn and then a magical pill even if it is placebo can put you at ease and open the flood gates…running a trial is hard because you need to beat placebo and speaking of things that didn’t beat placebo This paper titled Boesen AP, Boesen MI, Hansen R, et al. Effect of platelet-rich plasma on nonsurgically treated acute achilles tendon ruptures: a randomized, double-blinded prospective study. Am J Sports Med 2020;48(9):2268-2276. Looked to see if platelet rich plasma could be placebo in the treatment of acute Achilles tendon rupture. In this randomized double-blind placebo controlled trial of 40 patient’s with acute Achilles rupture confirmed on ultrasound- All patients were treated with a continuously worn ankle casts that kept the foot plantar flexed for 8 weeks. Every 2 weeks, the researchers lessened the degree of plantarflexion. After 9 weeks, all patients began an ankle rehabilitation program But half were randomized to placebo or and half platelet rich plasma injections. The patient’s were injected every 2 weeks starting within 4 days of the injury they then evaluated patient function via the Achilles tendon total rupture score at the time of removing the cast and then again at 3, 4-1/2, 6, 9, and 12 months after injury. In the end there was no difference between whether patient was randomized to receive platelet rich plasma injections or saline injections. Granted this study was only 40 patient’s and too small to determine differences such as the re-rupture rate but this was a really well done study that I think is hard to refute, they did a lot of things exactly how you want to see them done. For example, None of the patient’s nor providers nor the statistician’s nor the outcome assessors were aware of Whether the patient had received saline or platelet rich plasma. There is only one person who did the injections which was an experience sports medicine physician and injected all patients under ultrasound but this provider had no other influence on the patient’s outcome or care and was also blinded to saline or platelet rich plasma injections as a sheeth was placed over the syringe and the help of the needle. This in all actuality was a very well done trial and methadone neurologically was one of the most sound trials I have read in a long time, if he ever want to read how a method section should be written then he should read this paper. The methods were given in such extreme detail right down to the exact gauge of the needle and to the to the brand of ultrasound machine was used. If you doubt this trial then there is more than enough information in the method section you could easily repeat it in your office tomorrow without any questions. But otherwise said placebo was not nothing placebo is hard to be especially if you’re trying to be treated with platelet rich plasma for an Achilles tendon rupture The man noticed that I said they did a method section really well and if he doesn’t agree with the outcome then you can repeat the study yourself in your clinic. I notice when he comes a cold literature as well as vitamin D literature and other such literature which is borderline terrible those individuals who believe in something so powerful such as mask refuses to believe the outcome of the well done trial regardless of how well the trial was done. However the most important part of the paper size for the results is the method section. If you know exactly what gauge needle, what size syringe, what lab assay, what number years of experience the provider giving the intervention has you can almost do an exact simulation in your office and see if you, with the exact results because sometimes the results very just based on something he would never think of like the laboratory which is no more clearly seen in this article titled Potter JM, Hickman PE, Oakman C, Woods C, Nolan CJ. Strict preanalytical oral glucose tolerance test blood sample handling is essential for diagnosing gestational diabetes mellitus. Diabetes Care 2020;43(7):1438-1441. Which looked at the effect of processing and oral glucose tolerance test with either delayed or early centrifuge protocol. There is a total of just over 12,000 women in this study approximately 7000 women received delayed centrifuge protocol and approximately 5000 women received in early centrifuge protocol. The lumen that had the delayed centrifuge protocol Heather blood collected but then it was sent off to a central laboratory for blood glucose analysis those when that had a early centrifuge protocol underwent the same oral glucose tolerance testing but when they had their blood drawn for analysis but glucose testing was performed immediately. All things being equal they’re really shouldn’t be much of a difference here the results showed that those individuals who had immediate glucose testing rales twice as likely to be diagnosed with gestational diabetes than those individuals with delayed glucose testing Fasting- with fasting there was a difference of 4 mg/dl 1-hour samples 6.1 mg/dL and the two hour measurement was a difference of - 2.8 mg/dL (0.16 mmol/L; 2.3%).. this may sound very small change in the overall glucose but remember the fasting blood glucose concentration is less than 95 so a difference of 4 just based on higher lab processes the blood draw is almost a 5% error in the test.. Likely in the United States for many oral glucose tolerance test we use Accu-Chek monitors however the same question in the same importance and relevant supplies to the calibration and accuracy of the monitor being used. We have a chance grab 2 different brand monitors and check the same person at the exact same time just with different fingers and all certainly you’ll come up with a slight difference in their blood sugar. I’m not surprised by these findings which is a constant reminder that will be due in medicine is small. Nothing is a parachute. Nothing is absolute. I recently heard someone compare a certain intervention to Russian Roulette which implies a 1-6 chance of dying, this is follow-up taking that gives us an over his zealous and heightened sense of our work almost nothing that we do as a number needed to treat of 6 and especially not for death. We have to keep this in mind make sure that our patients are also aware of the inconsistencies in our practice of medicine which is also clearly seen in this paper titled McCormack JP, Holmes DT. Your results may vary: the imprecision of medical measurements. BMJ 2020;368:m149. doi: 10.1136/bmj.m149 Which looked at the variation or error that surrounds laboratory testing. This paper found much of what I mentioned previously on questioning medicine about laboratory findings such as a single HbA1c test result of 6.3% (45 mmol/L) could actually be as low as 5.5% (39 mmol/mol) or as high as 7.1% (51 mmol/mol). The lab findings are thrown off by variability in the analytic or lab process (4.3%), as well as biologic variability meaning the variation in the same person over the course of days caused by physiologic changes. Combined, these challenges to precision can make a single iron, bilirubin, or triglyceride level be inaccurate by as much as 50%. That means you would require at least a 50% change in the levels to be considered valid true actual change and not just a stastical variability. I have put a link to the office calculator as the very first piece of information in this podcast and think everyone should save it to their favorites to either bring up with the patient sitting in clinic or to discuss with your colleagues at the next zoom conference Let’s recap the articles discussed today before this ship set sale in the sea of evidence

Journal Club 妇产科星期四 Episode 19

Play Episode Listen Later Nov 26, 2020 21:34

FDA 批准HER2酪氨酸激酶抑制剂用于治疗HER2阳性的乳腺癌Lancet 低剂量阿司匹林可以预防初产妇早产？JAMA 男性补充叶酸和锌对精液质量和胎儿活产有影响吗？妥卡替尼（tucatinib）人表皮生长因子受体2 （HER2）阳性的、转移性乳腺癌患者在使用多种HER2靶向药物治疗后，若病情仍出现进展，则治疗选择便很有限。妥卡替尼（tucatinib）是一种口服的、HER2酪氨酸激酶的、高选择性抑制剂。2020年4月，妥卡替尼（tucatinib）被FDA批准用于治疗HER2阳性乳腺癌。《HER2CLIMB研究：妥卡替尼、曲妥珠单抗、卡培他滨治疗HER2阳性转移性乳腺癌的3期临床研究》New England Journal of Medicine，2020年2月 (1)研究纳入HER2阳性的、复发性、转移性乳腺癌患者共480人，在曲妥珠单抗和卡培他滨的联合治疗的基础上，随机联用妥卡替尼或安慰剂。联用妥卡替尼组和安慰剂组中，1年无进展生存率分别为33.1%和12.3%（疾病进展或死亡的风险比为0.54，P

Journal Club 内分泌科星期五 Episode 15

Play Episode Listen Later Nov 19, 2020 24:13

FDA 批准治疗Cushing综合征的新药BMJ 妊娠期糖尿病患者16年后的2型糖尿病患病率比对照组高8.5倍Science Advance 可监测血糖、治疗糖网的隐形眼镜奥西卓司他（osilodrostat）奥西卓司他（osilodrostat）是一种新型的口服11‐β‐羟化酶和醛固酮合成酶抑制剂，可以直接阻断肾上腺皮质醇合成。2020年3月，FDA批准奥西卓司他上市，用于治疗库欣综合征，这是FDA批准的首个口服11‐β‐羟化酶抑制剂。《LINC3研究：奥西卓司他治疗库欣氏病的多中心、双盲、随机停药的III期临床试验》Lancet Diabetes Endocrinology，2020年8月 (1)LINC 3研究是一项前瞻性、多中心、开放标签、III期研究，旨在研究奥西卓司对库欣氏病治疗的安全性和有效性。研究共入组137人（平均年龄41岁、3/4为女性、未接受过垂体切除手术或接受过垂体切除手术但未治愈、24小时皮质醇>1.5*ULN）。研究采用双盲随机停药，包括四个期：（1）所有参与者服用开放标签的奥西卓司他直到第12周，每2周调整一次剂量直至30mg bid；（2）第13-24周，继续使用奥西卓司他；（3）26周开始，双盲、随机停药8周；（4）35-48周，所有患者开放标签的奥西卓司他直到研究结束。研究发现在，第34周，与随机停药组29%的患者相比，随机服药组86%的患者保持完全缓解状态。137例患者在第12周后完全缓解，滴度没有上升。结论：每天两次奥西卓司快速降低了平均24小时皮质醇浓度，同时改善了临床症状。2型糖尿病的预防2型糖尿病的高危人群包括：年龄≥45岁，有妊娠期糖尿病病史，BMI≥25kg/m2，一级亲属有糖尿病，久坐的生活方式，高血压高血脂。预防糖尿病的发生主要通过：锻炼和减重，戒烟或服用二甲双胍。其他用于预防的糖尿病的药，如利拉鲁肽、比格列酮、阿卡波糖、维生素D等，尚有争议。《荟萃分析：维生素D对糖尿病发病率的影响》Journal of Clinical Endocrinology and Metabolism，2020年8月 (2)这项荟萃分析的目的是平均25-羟基维生素D（25[OH]D）血液水平低与胰岛素分泌受损、胰岛素抵抗增加和2型糖尿病发病率增加相关。研究者对9项随机对照试验进行了荟萃分析，涵盖43,600名参与者，随访至少一年。在接受较大剂量维生素D（≥1000IU/d）的、糖尿病前期的、人群中，2型糖尿病的发病率较低（相对风险比 0.88），这一结果勉强达到统计学显著性。在接受较小剂量维生素D（

Journal Club 内分泌科星期五 Episode 15

Play Episode Listen Later Nov 19, 2020 24:13

FDA 批准治疗Cushing综合征的新药BMJ 妊娠期糖尿病患者16年后的2型糖尿病患病率比对照组高8.5倍Science Advance 可监测血糖、治疗糖网的隐形眼镜奥西卓司他（osilodrostat）奥西卓司他（osilodrostat）是一种新型的口服11‐β‐羟化酶和醛固酮合成酶抑制剂，可以直接阻断肾上腺皮质醇合成。2020年3月，FDA批准奥西卓司他上市，用于治疗库欣综合征，这是FDA批准的首个口服11‐β‐羟化酶抑制剂。《LINC3研究：奥西卓司他治疗库欣氏病的多中心、双盲、随机停药的III期临床试验》Lancet Diabetes Endocrinology，2020年8月 (1)LINC 3研究是一项前瞻性、多中心、开放标签、III期研究，旨在研究奥西卓司对库欣氏病治疗的安全性和有效性。研究共入组137人（平均年龄41岁、3/4为女性、未接受过垂体切除手术或接受过垂体切除手术但未治愈、24小时皮质醇>1.5*ULN）。研究采用双盲随机停药，包括四个期：（1）所有参与者服用开放标签的奥西卓司他直到第12周，每2周调整一次剂量直至30mg bid；（2）第13-24周，继续使用奥西卓司他；（3）26周开始，双盲、随机停药8周；（4）35-48周，所有患者开放标签的奥西卓司他直到研究结束。研究发现在，第34周，与随机停药组29%的患者相比，随机服药组86%的患者保持完全缓解状态。137例患者在第12周后完全缓解，滴度没有上升。结论：每天两次奥西卓司快速降低了平均24小时皮质醇浓度，同时改善了临床症状。2型糖尿病的预防2型糖尿病的高危人群包括：年龄≥45岁，有妊娠期糖尿病病史，BMI≥25kg/m2，一级亲属有糖尿病，久坐的生活方式，高血压高血脂。预防糖尿病的发生主要通过：锻炼和减重，戒烟或服用二甲双胍。其他用于预防的糖尿病的药，如利拉鲁肽、比格列酮、阿卡波糖、维生素D等，尚有争议。《荟萃分析：维生素D对糖尿病发病率的影响》Journal of Clinical Endocrinology and Metabolism，2020年8月 (2)这项荟萃分析的目的是平均25-羟基维生素D（25[OH]D）血液水平低与胰岛素分泌受损、胰岛素抵抗增加和2型糖尿病发病率增加相关。研究者对9项随机对照试验进行了荟萃分析，涵盖43,600名参与者，随访至少一年。在接受较大剂量维生素D（≥1000IU/d）的、糖尿病前期的、人群中，2型糖尿病的发病率较低（相对风险比 0.88），这一结果勉强达到统计学显著性。在接受较小剂量维生素D（

EBB 153 – Pros and Cons of the Foley and Dilapan-S® for Cervical Ripening During an Induction

Play Episode Listen Later Nov 18, 2020 28:13

In this episode, I will talk about cervical ripening, the Bishop score, and some "mechanical" ways to ripen the cervix. More specifically, we'll talk about the advantages and disadvantages of cervical osmotic dilators (including Dilapan-S®), and using the Foley balloon for cervical ripening. Get on the wait list for the Pocket Guide here: https://evidencebasedbirth.com/pocket-guide-wait-list/ References on Cervical Ripening: Curran, M. (2020). Bishop Score Calculator. Click here. Kolkman, D. G. E., Verhoeven, C. J. M., Brinkhorst, S. J., et al. (2013). Bishop score as a predictor of labor induction success: a systematic review. American Journal of Perinatology, 30(8), 625-30. Click here. Ivars, J., Garabedian, C., Devos, P., et al. (2016). Simplified Bishop score including parity predicts successful induction of labor. Eur J Obstet Gynecol Reprod Biol., 203, 309-314. Click here. References on the Foley: Abdelhakim, A. M. Shareef, M .A., AlAmodi, A. A., et al. (2020). Outpatient versus inpatient balloon catheter insertion for labor induction: A systematic review and meta-analysis of randomized controlled trials. Journal of Gynecology Obstetrics and Human Reproduction, In Press. Click here. Alfirevic, Z., Keeney, E., Dowswell, T., et al. (2016). Methods to induce labour: a systematic review, network meta-analysis and cost-effectiveness analysis. BJOG., 123(9), 1462-1470. Click here. American College of Obstetricians and Gynecologists (2009, Reaffirmed 2019). ACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol.,114(2 Pt 1), 386-397. Click here. de Vaan, M. D. T., ten Eikelder, M. L. G., Jozwiak, M., et al. (2019). Mechanical methods for induction of labour. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD001233. Click here. Dong, S., Khan, M., Hashimi, F., et al. (2020). Inpatient versus outpatient induction of labour: a systematic review and meta-analysis. BMC pregnancy and childbirth, 20(1), 382. Click here. Leduc, D., Biringer, A., Lee, L., et al. (2013). Induction of Labor: SOGC Clinical Practice Guideline. No. 296, 35(9), 840-857. Click here. Liu, X., Wang, Y., Zhang, F., et al. (2019). Double- versus single-balloon catheters for labour induction and cervical ripening: a meta-analysis. BMC pregnancy and childbirth, 19(1), 358. Click here. Simpson, K. R. (2020). Cervical Ripening and Labor Induction and Augmentation, 5th Edition. AWHONN Practice Monograph, 24(4), PS1-S41. Click here. References on Dilapan-S: American College of Obstetricians and Gynecologists (2009, Reaffirmed 2019). ACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol.,114(2 Pt 1), 386-397. Click here. Levine, L. D., Valencia, C. M. and Tolosa, J. E. (2020). Induction of labor in continuing pregnancies. Best Pract Res Clin Obstet Gynaecol., S1521-6934(20), 30079-1. Click here. Gupta, J., Chodankar, R., Baev, O., et al. (2018). Synthetic osmotic dilators in the induction of labour-An international multicentre observational study. Eur J Obstet Gynecol Reprod Biol., 229, 70-75. Click here. Saad, A. F., Villarreal, J., Eid, J., et al. (2019). A randomized controlled trial of Dilapan-S vs Foley balloon for preinduction cervical ripening (DILAFOL trial). Am J Obstet Gynecol., 220(3), 275.e1-275.e9. Click here. For more information and news about Evidence Based Birth®, visit www.ebbirth.com. Find us on Facebook (https://www.facebook.com/EvidenceBasedBirth/), Instagram (https://www.instagram.com/ebbirth/), and Pinterest (https://www.pinterest.com/ebbirth/). Ready to get involved? Check out our Professional membership (including scholarship options) (https://evidencebasedbirth.com/become-pro-member/). Find an EBB Instructor here (https://evidencebasedbirth.com/find-an-instructor-parents/), and click here (https://evidencebasedbirth.com/childbirth-class/) to learn more about the Evidence Based Birth® Childbirth Class.

Journal Club 妇产科星期四 Episode 9

Play Episode Listen Later Nov 13, 2020 25:08

FDA 批准促性腺激素释放激素（GnRH）拮抗剂治疗子宫肌瘤导致的大量子宫出血NEJM 比较子宫动脉栓塞术与子宫肌瘤切除术治疗子宫肌瘤的疗效Cell 在孕妇中利用代谢动力学预测孕周和分娩时间恶拉戈利（elagolix）恶拉戈利（elagolix）是一种口服促性腺激素释放激素（GnRH）拮抗剂，既往用于治疗子宫内膜异位症引起的盆腔疼痛。2020年5月，美国FDA批准恶拉戈利用于治疗绝经前期、子宫肌瘤导致的大量子宫出血。《UF-1和UF-2研究：恶拉戈利治疗子宫肌瘤所致月经过多的治疗方案》New England Journal of Medicine，2020年1月 (1)研究旨在比较恶拉戈利300mg bid（单药治疗或联合雌激素-孕激素反加疗法）对子宫肌瘤的疗效。在两项相同的试验（UF-1和UF-2）中，月经过多（月经失血量＞80 mL）且经超声诊断为子宫肌瘤的总共790名女性（平均年龄42岁）被随机分组，分别接受6个月的恶拉戈利联合反加疗法、恶拉戈利单药治疗或安慰剂治疗。研究者通过收集生理用品的方式量化月经失血量。两项研究6个月后，84%和77%的单药治疗、68.5%和76.5%的恶拉戈利联合反加疗法和9%的安慰剂组达到主要终点（月经量50%）。主要不良反应是潮热和子宫出血，恶拉戈利联合反加治疗组的发生率显著高于安慰剂组。反加治疗法减轻了恶拉戈利的低雌激素效应，腰椎骨密度减少0.76%，低于恶拉戈利单药治疗组2.95%。结论：恶拉戈利单药治疗或联合雌-孕激素反加疗法均有效减轻子宫肌瘤相关的月经过多。恶拉戈利单药治疗与骨密度显著降低相关，反加治疗可以减少这种副作用。子宫肌瘤子宫肌瘤，是女性最常见的盆腔肿瘤，是起源于子宫平滑肌细胞和成纤维细胞的单克隆非癌性肿瘤。主要发生在育龄期妇女，可表现为异常子宫出血、盆腔疼痛/压迫感、生殖功能障碍（不孕或产科并发症）。大多数的子宫肌瘤会在生产后或绝经后自行萎缩；如果子宫肌瘤引起严重症状，则需治疗。对没有生育要求的患者，可行宫腔镜下切除粘膜下肌瘤；雌-孕激素避孕药；释放孕激素的宫内节育器；氨甲环酸；促性腺激素释放激素（GnRH）的激动剂和拮抗剂等。对于有生育要求的患者，药物大多会妨碍受孕，因此治疗首选微创手术切除。《行子宫动脉栓塞术与子宫肌瘤切除术治疗子宫肌瘤的比较》New England Journal of Medicine，2020年7月 (2)对于希望保留子宫、且药物治疗无效的女性，子宫肌瘤切除术和子宫动脉栓塞术是可选治疗方案。这项多中心、随机、开放标签试验，旨在评估症状性子宫肌瘤患者中使用子宫肌瘤切除术和子宫动脉栓塞术的疗效的比较。子宫肌瘤切除术的可选术式包括开腹、腹腔镜或宫腔镜手术。研究共招募了254名女性随机分组：子宫肌瘤切除术组和子宫动脉栓塞术。随访2年时，两组的生活质量评分分别为84.6分和80.0分（P=0.01）。在所有初次手术中，子宫肌瘤切除术组29%的女性和子宫动脉栓塞术组24%的女性发生了围手术期和术后并发症。结论：在有症状的子宫肌瘤患者中，接受子宫肌瘤切除术的女性在2年时的子宫肌瘤相关生活质量优于接受子宫动脉栓塞术的女性。《随机双盲对照试验：术前氨甲环酸减少子宫肌瘤切除术失血》American Journal of Obstetrics and Gynecology，2020年9月(3)氨甲环酸是一种合成赖氨酸衍生物，具有抗纤溶活性，用于其他外科学科，以减少手术期间的失血。本研究旨在探讨早期静脉注射氨甲环酸对子宫肌瘤切除术妇女围手术期出血和输血需求的影响。这项双盲、随机、安慰剂对照试验中，纳入有大出血风险的、症状性子宫肌瘤的女性共60人，随机分入干预组（手术前20分钟静脉注射氨甲环酸15 mg/kg）和安慰剂组（手术前静脉注射生理盐水）。这里有大出血风险定义为：（1）至少1个肌瘤≥10cm，（2）任何1个肌壁内或阔韧带肌瘤≥6cm，和/或（3）手术前影像学检查提示至少有5个肌瘤。患者中53%接受腹腔镜子宫肌瘤切除术，40%接受机器人子宫肌瘤切除术，7%接受采用剖腹手术。氨甲环酸组和安慰剂组中，中位估计失血量分别为200ml和240ml（P=0.88）；中位手术时间没有差异（165min 和 164min），围手术期血红蛋白改变也没有差异（1.00 和 1.1 g/dL）。氨甲环酸组的患者均不需要输血，但安慰剂组有4例需要输血。结论：术前静脉给予氨甲环酸在腹腔镜或机器人肌瘤切除过程中，与减少出血量无关。《术前肠道准备并不能减少子宫切除术后的感染》American Journal of Obstetrics and Gynecology，2020年8月 (4)关于妇科手术前肠道准备的文献很少，在子宫切除术前进行肠道准备主要是借鉴结直肠手术的经验。因此本研究的目的是比较子宫切除术前，与无肠道准备相比，单纯机械性肠准备、单纯口服抗生素或联合使用抗生素是否与手术部位感染或吻合口漏发生率降低有关。研究回顾性的分析了10余年间、共224,687例子宫切除术手术患者的数据。其中良性疾病186,148例、平均45岁，恶性肿瘤38,539例，平均54岁。其中包括腹腔镜/机器人手术、剖腹手术和经阴道手术等不同术式。术前准备包括肠道准备、口服抗生素、两者联合等不同策略。研究人员发现，肠道准备并没有降低手术部位感染、吻合口漏或其他并发症的发病率。在恶性肿瘤、开腹子宫切除术中，肠道准备、口服抗生素或肠道准备联合抗生素等几种策略，与不进行抗生素预防治疗的患者相比，感染发病率没有差异。结论：无论手术方式如何，肠道准备都不能预防手术部位感染或并发症，可以安全省略此步骤。妊娠期高血压妊娠>20周的女性新发高血压，但没有蛋白尿或新发靶器官功能障碍，则诊断为妊娠期高血压。根据2019年美国妇产科医师学会的建议，无论是否有其他表现，收缩压≥ 160mmHg和/或舒张压≥110mmHg，应直接诊断为“重度子痫前期”，即以前所说的“重度妊娠高血压”。更名的原因是，即使没有蛋白尿，妊娠诱发的重度血压升高也可能导致严重的不良事件。若产后≥12周后，血压仍高于正常，诊断为慢性高血压。妊娠期高血压最常用的降压药物包括：甲基多巴、拉贝洛尔、硝苯地平。尚有争议的药物包括：噻嗪类利尿剂、肼屈嗪、可乐定、硝普钠。妊娠期应避免使用的药物包括：ACEI、ARB、直接肾素抑制剂、盐皮质激素。《综述：他汀类药物在预防子痫前期中的作用》American Journal of Obstetrics and Gynecology，2020年8月 (5)子痫前期的确切原因尚不清楚，但普遍认为与胎盘异常释放可溶性抗血管生成因子有关，加之氧化应激和炎症反应的增加，导致母体全身内皮功能障碍。他汀类药物已被证明可以纠正类似的病理生理过程。普伐他汀，在各种临床前期和临床研究中显示，它可以逆转妊娠特异性的血管功能失衡，恢复内皮健康，防止氧化和炎症损伤。人类研究表明普伐他汀具有良好的安全性，而最近的证据不支持他汀类药物致畸的担忧。结论：他汀类药物在子痫前期预防性的使用，仍需大型随机对照研究支持。《荟萃分析：口服降压药对慢性高血压孕妇的疗效和安全性的比较》American Journal of Obstetrics and Gynecology，2020年10月 (6)此荟萃分析的目的是同时比较降压药对患有慢性高血压的孕妇的疗效和安全性。共纳入了22项研究，包括4464名女性。随机对照试验的分析表明，没有任何药物会显著影响先兆子痫的发生率。与安慰剂相比，阿替洛尔与小于胎龄儿（small for gestational age，SGA）的风险增加显著相关（风险比 26.00），而且被列为疗效最差的降压药。严重高血压的发生率在以下药物的干预下显著降低：硝苯地平风险比0.27，甲基多巴风险比0.31，吲哚洛尔风险比0.29，酮舍林风险比0.17。相比而言，严重高血压发生的概率最高的药物包括：速尿、氨氯地平和安慰剂。硝苯地平和甲基多巴能显著降低胎盘早剥率的风险（风险比 0.29和0.23）。各类降压药在剖宫产、围产期死亡、早产和分娩时胎龄方面无显著差异。结论：阿替洛尔与小于胎龄儿的风险显著增加有关。当使用硝苯地平和甲基多巴时，严重高血压的发生率显著降低。尽管在降压药中先兆子痫的风险是相似的，但未来仍需大规模研究为妊娠期降压药的选择和目标血压提供指导。《前瞻性观察队列研究：慢性高血压患者妊娠并发症与妊娠前母体心脏功能和结构有关》American Journal of Obstetrics and Gynecology，2020年9月 (7)约3%的妊娠合并为慢性高血压，这些产妇的分娩并发症发生率可高达25 - 28%。本研究的目的是通过超声心动图，评估妊娠前孕妇的心脏结构和功能，寻找其与分娩并发症以及妊娠前治疗的相关性。这项前瞻性观察队列研究，纳入192名长期接受降压治疗的孕妇，妊娠前改用甲基多巴，并随访至分娩。在192例患者中，出现24例早期并发症（

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Journal Club 妇产科星期四 Episode 9

Play Episode Listen Later Nov 13, 2020 25:08

FDA 批准促性腺激素释放激素（GnRH）拮抗剂治疗子宫肌瘤导致的大量子宫出血NEJM 比较子宫动脉栓塞术与子宫肌瘤切除术治疗子宫肌瘤的疗效Cell 在孕妇中利用代谢动力学预测孕周和分娩时间恶拉戈利（elagolix）恶拉戈利（elagolix）是一种口服促性腺激素释放激素（GnRH）拮抗剂，既往用于治疗子宫内膜异位症引起的盆腔疼痛。2020年5月，美国FDA批准恶拉戈利用于治疗绝经前期、子宫肌瘤导致的大量子宫出血。《UF-1和UF-2研究：恶拉戈利治疗子宫肌瘤所致月经过多的治疗方案》New England Journal of Medicine，2020年1月 (1)研究旨在比较恶拉戈利300mg bid（单药治疗或联合雌激素-孕激素反加疗法）对子宫肌瘤的疗效。在两项相同的试验（UF-1和UF-2）中，月经过多（月经失血量＞80 mL）且经超声诊断为子宫肌瘤的总共790名女性（平均年龄42岁）被随机分组，分别接受6个月的恶拉戈利联合反加疗法、恶拉戈利单药治疗或安慰剂治疗。研究者通过收集生理用品的方式量化月经失血量。两项研究6个月后，84%和77%的单药治疗、68.5%和76.5%的恶拉戈利联合反加疗法和9%的安慰剂组达到主要终点（月经量50%）。主要不良反应是潮热和子宫出血，恶拉戈利联合反加治疗组的发生率显著高于安慰剂组。反加治疗法减轻了恶拉戈利的低雌激素效应，腰椎骨密度减少0.76%，低于恶拉戈利单药治疗组2.95%。结论：恶拉戈利单药治疗或联合雌-孕激素反加疗法均有效减轻子宫肌瘤相关的月经过多。恶拉戈利单药治疗与骨密度显著降低相关，反加治疗可以减少这种副作用。子宫肌瘤子宫肌瘤，是女性最常见的盆腔肿瘤，是起源于子宫平滑肌细胞和成纤维细胞的单克隆非癌性肿瘤。主要发生在育龄期妇女，可表现为异常子宫出血、盆腔疼痛/压迫感、生殖功能障碍（不孕或产科并发症）。大多数的子宫肌瘤会在生产后或绝经后自行萎缩；如果子宫肌瘤引起严重症状，则需治疗。对没有生育要求的患者，可行宫腔镜下切除粘膜下肌瘤；雌-孕激素避孕药；释放孕激素的宫内节育器；氨甲环酸；促性腺激素释放激素（GnRH）的激动剂和拮抗剂等。对于有生育要求的患者，药物大多会妨碍受孕，因此治疗首选微创手术切除。《行子宫动脉栓塞术与子宫肌瘤切除术治疗子宫肌瘤的比较》New England Journal of Medicine，2020年7月 (2)对于希望保留子宫、且药物治疗无效的女性，子宫肌瘤切除术和子宫动脉栓塞术是可选治疗方案。这项多中心、随机、开放标签试验，旨在评估症状性子宫肌瘤患者中使用子宫肌瘤切除术和子宫动脉栓塞术的疗效的比较。子宫肌瘤切除术的可选术式包括开腹、腹腔镜或宫腔镜手术。研究共招募了254名女性随机分组：子宫肌瘤切除术组和子宫动脉栓塞术。随访2年时，两组的生活质量评分分别为84.6分和80.0分（P=0.01）。在所有初次手术中，子宫肌瘤切除术组29%的女性和子宫动脉栓塞术组24%的女性发生了围手术期和术后并发症。结论：在有症状的子宫肌瘤患者中，接受子宫肌瘤切除术的女性在2年时的子宫肌瘤相关生活质量优于接受子宫动脉栓塞术的女性。《随机双盲对照试验：术前氨甲环酸减少子宫肌瘤切除术失血》American Journal of Obstetrics and Gynecology，2020年9月(3)氨甲环酸是一种合成赖氨酸衍生物，具有抗纤溶活性，用于其他外科学科，以减少手术期间的失血。本研究旨在探讨早期静脉注射氨甲环酸对子宫肌瘤切除术妇女围手术期出血和输血需求的影响。这项双盲、随机、安慰剂对照试验中，纳入有大出血风险的、症状性子宫肌瘤的女性共60人，随机分入干预组（手术前20分钟静脉注射氨甲环酸15 mg/kg）和安慰剂组（手术前静脉注射生理盐水）。这里有大出血风险定义为：（1）至少1个肌瘤≥10cm，（2）任何1个肌壁内或阔韧带肌瘤≥6cm，和/或（3）手术前影像学检查提示至少有5个肌瘤。患者中53%接受腹腔镜子宫肌瘤切除术，40%接受机器人子宫肌瘤切除术，7%接受采用剖腹手术。氨甲环酸组和安慰剂组中，中位估计失血量分别为200ml和240ml（P=0.88）；中位手术时间没有差异（165min 和 164min），围手术期血红蛋白改变也没有差异（1.00 和 1.1 g/dL）。氨甲环酸组的患者均不需要输血，但安慰剂组有4例需要输血。结论：术前静脉给予氨甲环酸在腹腔镜或机器人肌瘤切除过程中，与减少出血量无关。《术前肠道准备并不能减少子宫切除术后的感染》American Journal of Obstetrics and Gynecology，2020年8月 (4)关于妇科手术前肠道准备的文献很少，在子宫切除术前进行肠道准备主要是借鉴结直肠手术的经验。因此本研究的目的是比较子宫切除术前，与无肠道准备相比，单纯机械性肠准备、单纯口服抗生素或联合使用抗生素是否与手术部位感染或吻合口漏发生率降低有关。研究回顾性的分析了10余年间、共224,687例子宫切除术手术患者的数据。其中良性疾病186,148例、平均45岁，恶性肿瘤38,539例，平均54岁。其中包括腹腔镜/机器人手术、剖腹手术和经阴道手术等不同术式。术前准备包括肠道准备、口服抗生素、两者联合等不同策略。研究人员发现，肠道准备并没有降低手术部位感染、吻合口漏或其他并发症的发病率。在恶性肿瘤、开腹子宫切除术中，肠道准备、口服抗生素或肠道准备联合抗生素等几种策略，与不进行抗生素预防治疗的患者相比，感染发病率没有差异。结论：无论手术方式如何，肠道准备都不能预防手术部位感染或并发症，可以安全省略此步骤。妊娠期高血压妊娠>20周的女性新发高血压，但没有蛋白尿或新发靶器官功能障碍，则诊断为妊娠期高血压。根据2019年美国妇产科医师学会的建议，无论是否有其他表现，收缩压≥ 160mmHg和/或舒张压≥110mmHg，应直接诊断为“重度子痫前期”，即以前所说的“重度妊娠高血压”。更名的原因是，即使没有蛋白尿，妊娠诱发的重度血压升高也可能导致严重的不良事件。若产后≥12周后，血压仍高于正常，诊断为慢性高血压。妊娠期高血压最常用的降压药物包括：甲基多巴、拉贝洛尔、硝苯地平。尚有争议的药物包括：噻嗪类利尿剂、肼屈嗪、可乐定、硝普钠。妊娠期应避免使用的药物包括：ACEI、ARB、直接肾素抑制剂、盐皮质激素。《综述：他汀类药物在预防子痫前期中的作用》American Journal of Obstetrics and Gynecology，2020年8月 (5)子痫前期的确切原因尚不清楚，但普遍认为与胎盘异常释放可溶性抗血管生成因子有关，加之氧化应激和炎症反应的增加，导致母体全身内皮功能障碍。他汀类药物已被证明可以纠正类似的病理生理过程。普伐他汀，在各种临床前期和临床研究中显示，它可以逆转妊娠特异性的血管功能失衡，恢复内皮健康，防止氧化和炎症损伤。人类研究表明普伐他汀具有良好的安全性，而最近的证据不支持他汀类药物致畸的担忧。结论：他汀类药物在子痫前期预防性的使用，仍需大型随机对照研究支持。《荟萃分析：口服降压药对慢性高血压孕妇的疗效和安全性的比较》American Journal of Obstetrics and Gynecology，2020年10月 (6)此荟萃分析的目的是同时比较降压药对患有慢性高血压的孕妇的疗效和安全性。共纳入了22项研究，包括4464名女性。随机对照试验的分析表明，没有任何药物会显著影响先兆子痫的发生率。与安慰剂相比，阿替洛尔与小于胎龄儿（small for gestational age，SGA）的风险增加显著相关（风险比 26.00），而且被列为疗效最差的降压药。严重高血压的发生率在以下药物的干预下显著降低：硝苯地平风险比0.27，甲基多巴风险比0.31，吲哚洛尔风险比0.29，酮舍林风险比0.17。相比而言，严重高血压发生的概率最高的药物包括：速尿、氨氯地平和安慰剂。硝苯地平和甲基多巴能显著降低胎盘早剥率的风险（风险比 0.29和0.23）。各类降压药在剖宫产、围产期死亡、早产和分娩时胎龄方面无显著差异。结论：阿替洛尔与小于胎龄儿的风险显著增加有关。当使用硝苯地平和甲基多巴时，严重高血压的发生率显著降低。尽管在降压药中先兆子痫的风险是相似的，但未来仍需大规模研究为妊娠期降压药的选择和目标血压提供指导。《前瞻性观察队列研究：慢性高血压患者妊娠并发症与妊娠前母体心脏功能和结构有关》American Journal of Obstetrics and Gynecology，2020年9月 (7)约3%的妊娠合并为慢性高血压，这些产妇的分娩并发症发生率可高达25 - 28%。本研究的目的是通过超声心动图，评估妊娠前孕妇的心脏结构和功能，寻找其与分娩并发症以及妊娠前治疗的相关性。这项前瞻性观察队列研究，纳入192名长期接受降压治疗的孕妇，妊娠前改用甲基多巴，并随访至分娩。在192例患者中，出现24例早期并发症（

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Blood pressure’s threshold in pregnancy, when less is more for mother and baby

EBN podcast

Play Episode Listen Later Aug 27, 2020 9:09

In this podcast, Associate Editor of Evidence-Based Nursing, Lisa Kidd, talks to Laura Austin, who's a Registered Nurse/Midwife working in the Fiona Stanley Hospital, Perth, Australia, and the author of a commentary on original, unpublished research based out of Melbourne. The aim of the research was to determine whether, within Australia, classification of hypertension within pregnancy should be adjusted to reflect the American College of Cardiology’s recent amendment to their guidelines. Read the commentary on the EBN’s website: https://ebn.bmj.com/content/early/2020/08/24/ebnurs-2020-103274 Commentary on: Reddy M, Rolnik DL, Harris K, et al. Challenging the definition of hypertension in pregnancy: a retrospective cohort study. Am J Obstet Gynecol 2020, Jan 16. doi:10.1016/j.ajog.2019.12.272. [Epub ahead of print].

community health australia babies mother online care research practice home melbourne pregnancy nurses challenging commentary nursing visiting perth practitioners american colleges threshold associate editor cardiology blood pressure uti epub appraisal ebn am j obstet gynecol fiona stanley hospital laura austin evidence based nursing

EBB 110 - Inside an Unplanned, Unassisted Home Birth with Parent Sabrina Tran

Play Episode Listen Later Jan 8, 2020 34:06

In this episode, I am joined by Sabrina Tran of Alabama, who recently had a daughter, and took the Evidence Based Birth Childbirth Class with Instructor Traci Weafer. Sabrina, a therapist, is now a stay at home mom. Sabrina had a precipitous - or, extremely fast labor and delivery. She describes it as exciting! Hear her tell her story of how her baby was born before the midwife could make it to her home. I also share the evidence on perineal tearing, and the relationships between tearing, provider experience, and home birth. For more information and news about Evidence Based Birth®, visit www.ebbirth.com. Find us on Facebook, Instagram, and Pinterest. Ready to get involved? Check out our Professional membership (including scholarship options) and our Instructor program. Find an EBB Instructor here, and click here to learn more about the Evidence Based Birth® Childbirth Class. RESOURCES: Click here for great images explaining perineal tears on the Mayo Clinic website. More references: Albers, L. L., Sedler, K. D., Bedrisk, E. J., et al. (2005). Midwifery care measures in the second stage of labor and reduction of genital tract trauma at birth: a randomized trial. J Midwifery Womens Health. 50(5): 365-372. Mizrachi, Y., Leytes, S., Levy, M., et al. (2017). Does midwife experience affect the rate of severe perineal tears? Birth. 44(2): 161-166. Begley, C., Guilliland, K., Dixon, L., et al. (2018). A qualitative exploration of techniques used by expert midwives to preserve the perineum intact. Women Birth. Kopas, M. L. (2014). A review of evidence-based practices for management of the second stage of labor. J Midwifery Womens Health. 59(3):264-76. Shorten, A., Donsante, J. and Shorten, B. (2002). Birth position, accoucheur, and perineal outcomes: informing women about choices for vaginal birth. Birth. 29(1): 18-27. Sandall, J., Soltani, H., Shennan, A., et al. (2013). Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev. (8): CD004667. Hutton, E. K., Cappelletti, A., Reitsma, A. H., et al. (2016). Outcomes associated with planned place of birth among women with low-risk pregnancies. CMAJ. 188(5): E80-E90. Hastings-Tolsma, M., Vincent, D., Emeis, C., et al. (2007). Getting through birth in one piece: protecting the perineum. MCN AM J Matern Child Nurs. 32: 158-64. Landy H. J., Laughon, S. K., Bailit, J. L., et al. (2011). Characteristics associated with severe perineal and cervical lacerations during vaginal delivery. Obstet Gynecol. 117(3): 627-35 Klein, M. C., Gauthier, R. J., Jorgensen, S. H., et al. (1992). Does episiotomy prevent perineal trauma and pelvic floor relaxation? Online J Curr Clin Trials. 10. Klein, M. C., Gauthier, R. J., Robbins, J. M., et al. (1994). Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation. Am J Obstet Gynecol. 171(3): 591-8. Aasheim, V., Nilsen, A. B. V., Reinar, L. M., et al. (2017). Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database of Sys Rev. 6: CD006672 Alliman, J. and Phillippi, J. C. (2016). Maternal Outcomes in Birth Centers: An integrative review of the literature. J Midwifery Womens Health. 61(1): 21-51. Cheyney, M., Bovbjerg, M., Everson, C., et al. (2014). Outcomes of care for 16,924 planned home births in the U.S.: the Midwives Alliance of North America Statistics Project, 2004 to 2009. J Midwifery Womens Health. 59(1): 17-27. Hutton, E. K., Cappelletti, A., Reitsma, A. H., et al. (2016). Outcomes associated with planned place of birth among women with low-risk pregnancies. CMAJ. 188(5): E80-E90. Click here to access the EBB Signature Article, The Evidence on: Waterbirth.

EBB 106 - EBB Conference Series: Nurses and Doulas

Play Episode Listen Later Dec 4, 2019 23:30

This episode is the first in our series of interviews we conducted live from the 2019 Evidence Based Birth Conference - Bringing the Evidence to Life. EBB Instructor and Professional Membership Coordinator Chanté Perryman interviewed several different panels of attendees, hearing from them the most pressing issues in their communities, and how they plan to affect change after being inspired at the conference. This week, we will hear from nurses and doulas: doula Rebecca McKinney, doula Sara Pixton, and labor and delivery nurse Paula Richards. Listen as they highlight some of the challenges faced between the two professions, and how both can work together to support women in labor. After their brief interview, I talk about the research evidence on the challenges of doulas and nurses working together, and offer potential solutions for collaboration! For more information and news about Evidence Based Birth®, visit www.ebbirth.com. Find us on Facebook, Instagram, and Pinterest. Ready to get involved? Check out our Professional membership (including scholarship options) and our Instructor program. Find an EBB Instructor here, and click here to learn more about the Evidence Based Birth® Childbirth Class. RESOURCES: Facebook Group for Doulas and L & D Nurses working collaboratively together: here Goer & Romano (2013). Optimal Care in Childbirth. Classic Day Publishing. Morton & Clift. (2014). Birth Ambassadors. Texas: Praeclarus Press. Bohren, M. A., Hofmeyr, G. J., Sakala, C., et al. (2017). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, Issue 7. Art. No.: CD003766. Bohren, M. A., Berger, B. O., Munthe-Kaas, H., et al. (2019). Perceptions and experiences of labour companionship: a qualitative evidence synthesis. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD012449. Roth, L. M., et al. (2016). “North American Nurses’ and Doulas’ Views of Each Other.”J Obstet Gynecol Neonatal Nurs 45(6):790-800. Veltman (2007). Disruptive behavior in obstetrics: a hidden threat to patient safety. Am J Obstet Gynecol 196(6): 587e1-4, discussion e4-5. Tumblin and Simkin. “Pregnant women’s perceptions of their nurses’ role during labor and delivery” (2001). Birth 28(1): 52-6 Bowers. “Mothers’ experiences of labor support: exploration of qualitative research.” (2002). J Obstet Gynecol Neonatal Nurs 31(6): 742-52. McNiven et al. “Supporting women in labor: a work sampling study of the activities of labor and delivery nurses.” (1992). Birth 19(1): 3-8. Gagnon, Waghorn. “Supportive care by maternity nurses: a work sampling study in an intrapartum unit.” (1996). Birth 23 (1): 1-6. Gale et al. “Measuring nursing support during childbirth. (2001). Am J Matern Cild Nurs 26(5): 264-71 Miltner. “More than support: nursing interventions provided to women in labor.” (2002). J Obstet Gynecol Neonatal Nurs 38(2): 753-61. Barnett. “A new way to measure nursing: Computer timing of nursing time and support of laboring patients.” (2008). Computers, Informatics, Nursing 26(4): 199-206. Evidence Based Birth offers a fantastic cross-professional community in our Professional membership! Get more information here.

"Fertility and Diet" with Audrey Gaskins, PhD

The Whole Health Cure

Play Episode Listen Later Nov 28, 2019 32:41

Audrey Gaskins is an Assistant Professor in the Department of Epidemiology at the Rollins School of Public Health at Emory University. Dr. Gaskins earned her doctoral degree in nutrition and epidemiology from the Harvard School of Public Health in 2014. This training was preceded by a two-year fellowship in the Department of Epidemiology at the Eunice Kennedy Shriver National Institute of Child Health and Human Development and a Bachelor's of Science degree in engineering from Duke University in 2008. Dr. Gaskins's research is aimed at elucidating how environmental, dietary, and lifestyle factors experienced throughout the life course influence a couple's ability to conceive and maintain a healthy pregnancy to term. Over the past decade, she has published over 100 articles on how diet and lifestyle factors affect semen quality, menstrual cycle function, time to pregnancy, miscarriage, and outcomes of assisted reproduction using a variety of population based studies. Her research has been cited over 1,500 times and resulted in numerous awards including multiple NIEHS Top 10 Extramural Science Papers of the Year and the Best New Researcher Award from the International Society of Environmental Epidemiology. In April 2017, Dr. Gaskins received a prestigious 5-year career development award from the National Institute of Environmental Health Sciences to further her research on how exposure to environmental chemicals such as air pollution interact with dietary factors to influence a couple's fertility. In addition to her research endeavors, Dr. Gaskins teaches courses ranging from research methods to nutrition and health and devotes a significant amount of time to mentoring students and fellows at Emory and Emory-affiliated hospitals. She is the current chair of the Nutrition Special Interest Group of the American Society for Reproductive Medicine and on the editorial board for Fertility & Sterility, one of the leading academic journals of reproductive medicine. What does the research say about the recent rise in infertility? What are the dietary and environmental factors contributing to fertility and healthy pregnancy? Dr. Gaskins answers these and many other questions in this interview. Tune in to learn more! Dr. Gaskins profile: https://sph.emory.edu/faculty/profile/index.php?FID=10025 Recent papers by Dr. Gaskins: Gaskins AJ, Chavarro JE. Diet and fertility: a review. Am J Obstet Gynecol. 2018 Apr;218(4):379-389 Gaskins AJ, Nassan FL, Chiu YH, Arvizu M, Williams PL, Keller MG, Souter I, Hauser R, Chavarro JE; EARTH Study Team. Dietary patterns and outcomes of assisted reproduction. Am J Obstet Gynecol. 2019 Jun;220(6):567 Twitter: @audreyjane4

51: Journal Club - February 2019

Play Episode Listen Later Feb 21, 2019 39:39

Dr. Oystein Bergoy joins me to discuss the LaPS Study looking at the effect of Zhang's partograph on cesarean deliveries for labor dystocia. www.obgyn.fm feedback@obgyn.fm The frequency of intrapartum caesarean section use with the WHO partograph versus Zhang’s guideline in the Labour Progression Study (LaPS): a multicentre, cluster-randomised controlled trial Friedman E. The graphic analysis of labor. Am J Obstet Gynecol 1954;68: 1568–75. Zhang J, Troendle JF, Yancey MK. Reassessing the labor curve in nulliparous women. Am J Obstet Gynecol 2002; 187: 824–28. Zhang J, Landy HJ, Branch DW, et al. Contemporary patterns ofspontaneous labor with normal neonatal outcomes. Obstet Gynecol2010; 116: 1281–87.

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36: Journal Club - July 2018

Play Episode Listen Later Jul 12, 2018 42:00

I am joined by minimally invasive gynecologic surgeons Dr. Blaber and Dr. Lian to discuss a paper from the May issue of AJOG. Laparoscopic vs transvaginal cuff closure after total laparoscopic hysterectomy: a randomized trial by the Italian Society of Gynecologic Endoscopy Uccella S, Malzoni M, Cromi A, et al. Laparoscopic vs transvaginal cuff closure after total laparoscopic hysterectomy: a randomized trial by the Italian Society of Gynecologic Endoscopy. Am J Obstet Gynecol 2018;218:500.e1-13.

journal club laparoscopic am j obstet gynecol

29: Journal Club - April 2018

Play Episode Listen Later Apr 20, 2018 32:23

In this episode we discuss the mode of delivery in twin gestation Paper: Schmitz T, Korb D, Battie C, et al. Neonatal morbidity associated with vaginal delivery of noncephalic second twins. Am J Obstet Gynecol 2018;218:449.e1-13. feedback@obgyn.fm Other References: Association Between Planned Cesarean Delivery and Neonatal Mortality and Morbidity in Twin Pregnancies How singleton breech babies at term are born in France: a survey of data from the AUDIPOG network Twin Birth Study: 2-year neurodevelopmental follow-up of the randomized trial of planned cesarean or planned vaginal delivery for twin pregnancy

france neonatal morbidity journal club am j obstet gynecol

020 – Amniotic Fluid Embolism pathophysiology with Assoc Prof Nolan McDonnell

Obsgynaecritcare

Play Episode Listen Later Mar 28, 2018 21:31

Hi Everyone, After last weeks fascinating case discussion, Nolan and I continue with our discussion on amniotic fluid embolism. In this discussion we drill down into some of the current theories and understanding of the pathophysiology, prevalence, risk factors and AMOSS, the Australasian Maternities Outcomes Surveillance System, which has focussed on AFE in Australasia. The exact biological mechanism of AFE is still not fully understood as this is a rare unpredictable condition with no reproducible animal model which makes it exceedingly difficult to study. The knowledge we currently have has been gleaned from descriptions of case reports / case series and the pathophysiology that was observed. Current theories favour the condition to be an immune mediated reaction triggered by maternal exposure to fetal amniotic fluid and that the term "embolism" may be misleading. Listen to our podcast above for some more nuanced discussion on this topic. If anyone has any comments, questions or personal experiences they'd like to share please leave us a comment we'd love hear from you! Roger References AMOSS, the Australasian Maternities Outcomes Surveillance System: https://www.amoss.com.au/ Society for Maternal-Fetal Medicine (SMFM) with the assistance of Pacheco LD, Saade G, et al. Amniotic fluid embolism:diagnosis and management. Am J Obstet Gynecol 2016;Aug;215(2):B16-24. McDonnell NJ, Percival V, Paech MJ.Amniotic fluid embolism: a leading cause of maternal death yet still a medical conundrum. Int J Obstet Anesth. 2013 Nov;22(4):329-36 Listen to last weeks fascinating case of AFE: 019 – Amniotic Fluid Embolism – a case discussion with Assoc Prof Nolan McDonnell

society current mcdonnell australasia pathophysiology afe assoc prof amniotic amoss b16 amniotic fluid embolism am j obstet gynecol

9 - Working Out While Sleep Deprived

Better Daily Shortcast

Play Episode Listen Later Dec 5, 2017 23:08

If you are a parent, then you have been sleep deprived more often than you probably remember (or would like to admit). Heck, many parents I know operate in a cycle of sleep deprivation wherein half of the time they are sleeping decently and the other half is a solid 3-4 hours of interrupted and crappy sleep. Consider this the rule book on how to workout while sleep deprived. When my son was born and put me through the navy seal-style sleep deprivation training, I couldn't find anything helpful out there to guide me in not giving up my workout habit without injuring myself or making the exhaustion worse. Enjoy! And note, whether its the job, familial issues, or the kids that's ruining your sleep, this will not last forever. Hang in there!Citations:http://www.gallup.com/poll/166553/less-recommended-amount-sleep.aspx[ii] Jean-Louis G, Kripke DF, and Ancoli-Israel S. Sleep and quality of well-being. Sleep 23: 1115–1121, 2000.[iii] Slow-wave sleep: a recovery period after exercise CM Shapiro, R Bortz, D Mitchell, P Bartel, and P Jooste Science 11 December 1981: 214 (4526), 1253-1254. [DOI:10.1126/science.7302594][iv] S Taheri. The link between short sleep duration and obesity: we should recommend more sleep to prevent obesity. Arch Dis Child 2006;91:11 881-884 doi:10.1136/adc.2005.093013[v] Ayalon RD1, Friedman F Jr. The effect of sleep deprivation on fine motor coordination in obstetrics and gynecology residents. Am J Obstet Gynecol. 2008 Nov;199(5):576.e1-5. doi: 10.1016/j.ajog.2008.06.080. Epub 2008 Sep 25.[vi] 5. Lehmann M, Baumgartl P, Wiesenack C, Seidel A, Baumann H, et al. Training-overtraining: influence of a defined increase in training volume vs training intensity on performance, catecholamines and some metabolic parameters in experienced middle- and long-distance runners. European journal of applied physiology and occupational physiology. 1992;64:169–177. [PubMed][vii] Kellmann M. Preventing overtraining in athletes in high-intensity sports and stress/recovery monitoring. Scand J Med Sci Sports. 2010;20(Suppl 2):95–102.[viii] Snyder AC. Overtraining and glycogen depletion hypothesis. Med Sci Sports Exerc. 1998;30:1146–1150.[ix] Lehmann M, Dickhuth HH, Gendrisch G, Lazar W, Thum M, et al. Training-overtraining. A prospective, experimental study with experienced middle- and long-distance runners. Int J Sports Med. 1991;12:444–452[x] Swanson DR. Atrial fibrillation in athletes: implicit literature-based connections suggest that overtraining and subsequent inflammation may be a contributory mechanism. Med Hypotheses. 2006;66:1085–1092[xi] Eudi, A. Efficacy and safety of ingredients found in preworkout supplements. American Journal of Health-System Pharmacy April 1, 2013 vol. 70 no. 7 577-588.[xii] Spiegel K, Leproult R, and Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet 354: 1435–1439, 1999.[xiii] Sellwood KL, Brukner P, Williams D, Nicol A, Hinman R. Ice-water immersion and delayed-onset muscle soreness: a randomised controlled trial. Br J Sports Med. 2007;41:392–7.[xiv] http://www.lifetime-weightloss.com/blog/2015/7/14/why-exercise-isnt-enough.htmlBecome a supporter of this podcast: https://www.spreaker.com/podcast/faithful-fitness-by-better-daily--5150768/support.

training european sleep fitness impact ice hang heck preventing efficacy lancet american journal doi epub weightlossjourney overtraining pubmed citations dad life suppl sleep deprived atrial br j sports med med sci sports exerc am j obstet gynecol scand j med sci sports arch dis child

9 - Working Out While Sleep Deprived

Defining Dad Bod

Play Episode Listen Later Dec 5, 2017 23:08

If you are a parent, then you have been sleep deprived more often than you probably remember (or would like to admit). Heck, many parents I know operate in a cycle of sleep deprivation wherein half of the time they are sleeping decently and the other half is a solid 3-4 hours of interrupted and crappy sleep. Consider this the rule book on how to workout while sleep deprived. When my son was born and put me through the navy seal-style sleep deprivation training, I couldn't find anything helpful out there to guide me in not giving up my workout habit without injuring myself or making the exhaustion worse. Enjoy! And note, whether its the job, familial issues, or the kids that's ruining your sleep, this will not last forever. Hang in there!Citations:http://www.gallup.com/poll/166553/less-recommended-amount-sleep.aspx[ii] Jean-Louis G, Kripke DF, and Ancoli-Israel S. Sleep and quality of well-being. Sleep 23: 1115–1121, 2000.[iii] Slow-wave sleep: a recovery period after exercise CM Shapiro, R Bortz, D Mitchell, P Bartel, and P Jooste Science 11 December 1981: 214 (4526), 1253-1254. [DOI:10.1126/science.7302594][iv] S Taheri. The link between short sleep duration and obesity: we should recommend more sleep to prevent obesity. Arch Dis Child 2006;91:11 881-884 doi:10.1136/adc.2005.093013[v] Ayalon RD1, Friedman F Jr. The effect of sleep deprivation on fine motor coordination in obstetrics and gynecology residents. Am J Obstet Gynecol. 2008 Nov;199(5):576.e1-5. doi: 10.1016/j.ajog.2008.06.080. Epub 2008 Sep 25.[vi] 5. Lehmann M, Baumgartl P, Wiesenack C, Seidel A, Baumann H, et al. Training-overtraining: influence of a defined increase in training volume vs training intensity on performance, catecholamines and some metabolic parameters in experienced middle- and long-distance runners. European journal of applied physiology and occupational physiology. 1992;64:169–177. [PubMed][vii] Kellmann M. Preventing overtraining in athletes in high-intensity sports and stress/recovery monitoring. Scand J Med Sci Sports. 2010;20(Suppl 2):95–102.[viii] Snyder AC. Overtraining and glycogen depletion hypothesis. Med Sci Sports Exerc. 1998;30:1146–1150.[ix] Lehmann M, Dickhuth HH, Gendrisch G, Lazar W, Thum M, et al. Training-overtraining. A prospective, experimental study with experienced middle- and long-distance runners. Int J Sports Med. 1991;12:444–452[x] Swanson DR. Atrial fibrillation in athletes: implicit literature-based connections suggest that overtraining and subsequent inflammation may be a contributory mechanism. Med Hypotheses. 2006;66:1085–1092[xi] Eudi, A. Efficacy and safety of ingredients found in preworkout supplements. American Journal of Health-System Pharmacy April 1, 2013 vol. 70 no. 7 577-588.[xii] Spiegel K, Leproult R, and Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet 354: 1435–1439, 1999.[xiii] Sellwood KL, Brukner P, Williams D, Nicol A, Hinman R. Ice-water immersion and delayed-onset muscle soreness: a randomised controlled trial. Br J Sports Med. 2007;41:392–7.[xiv] http://www.lifetime-weightloss.com/blog/2015/7/14/why-exercise-isnt-enough.html

israel training european sleep fitness impact ice hang heck preventing efficacy lancet american journal doi epub dad bods weightlossjourney overtraining pubmed citations dad life suppl sleep deprived atrial br j sports med med sci sports exerc am j obstet gynecol scand j med sci sports arch dis child

9 - Working Out While Sleep Deprived

Defining Dad Bod

Play Episode Listen Later Dec 4, 2017 23:08

If you are a parent, then you have been sleep deprived more often than you probably remember (or would like to admit). Heck, many parents I know operate in a cycle of sleep deprivation wherein half of the time they are sleeping decently and the other half is a solid 3-4 hours of interrupted and crappy sleep. Consider this the rule book on how to workout while sleep deprived. When my son was born and put me through the navy seal-style sleep deprivation training, I couldn't find anything helpful out there to guide me in not giving up my workout habit without injuring myself or making the exhaustion worse. Enjoy! And note, whether its the job, familial issues, or the kids that's ruining your sleep, this will not last forever. Hang in there!Citations:http://www.gallup.com/poll/166553/less-recommended-amount-sleep.aspx[ii] Jean-Louis G, Kripke DF, and Ancoli-Israel S. Sleep and quality of well-being. Sleep 23: 1115–1121, 2000.[iii] Slow-wave sleep: a recovery period after exercise CM Shapiro, R Bortz, D Mitchell, P Bartel, and P Jooste Science 11 December 1981: 214 (4526), 1253-1254. [DOI:10.1126/science.7302594][iv] S Taheri. The link between short sleep duration and obesity: we should recommend more sleep to prevent obesity. Arch Dis Child 2006;91:11 881-884 doi:10.1136/adc.2005.093013[v] Ayalon RD1, Friedman F Jr. The effect of sleep deprivation on fine motor coordination in obstetrics and gynecology residents. Am J Obstet Gynecol. 2008 Nov;199(5):576.e1-5. doi: 10.1016/j.ajog.2008.06.080. Epub 2008 Sep 25.[vi] 5. Lehmann M, Baumgartl P, Wiesenack C, Seidel A, Baumann H, et al. Training-overtraining: influence of a defined increase in training volume vs training intensity on performance, catecholamines and some metabolic parameters in experienced middle- and long-distance runners. European journal of applied physiology and occupational physiology. 1992;64:169–177. [PubMed][vii] Kellmann M. Preventing overtraining in athletes in high-intensity sports and stress/recovery monitoring. Scand J Med Sci Sports. 2010;20(Suppl 2):95–102.[viii] Snyder AC. Overtraining and glycogen depletion hypothesis. Med Sci Sports Exerc. 1998;30:1146–1150.[ix] Lehmann M, Dickhuth HH, Gendrisch G, Lazar W, Thum M, et al. Training-overtraining. A prospective, experimental study with experienced middle- and long-distance runners. Int J Sports Med. 1991;12:444–452[x] Swanson DR. Atrial fibrillation in athletes: implicit literature-based connections suggest that overtraining and subsequent inflammation may be a contributory mechanism. Med Hypotheses. 2006;66:1085–1092[xi] Eudi, A. Efficacy and safety of ingredients found in preworkout supplements. American Journal of Health-System Pharmacy April 1, 2013 vol. 70 no. 7 577-588.[xii] Spiegel K, Leproult R, and Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet 354: 1435–1439, 1999.[xiii] Sellwood KL, Brukner P, Williams D, Nicol A, Hinman R. Ice-water immersion and delayed-onset muscle soreness: a randomised controlled trial. Br J Sports Med. 2007;41:392–7.[xiv] http://www.lifetime-weightloss.com/blog/2015/7/14/why-exercise-isnt-enough.html

israel training european sleep fitness impact ice hang heck preventing efficacy lancet american journal doi epub dad bods weightlossjourney overtraining pubmed citations dad life suppl sleep deprived atrial br j sports med med sci sports exerc am j obstet gynecol scand j med sci sports arch dis child

002 Oxytocin use in labour increases postpartum haemorrhage due to uterine atony

Obsgynaecritcare

Play Episode Listen Later Aug 23, 2017 13:09

https://www.obsgynaecritcare.org/wp-content/uploads/2017/08/Oxytocin-in-labour-increases-PPH.m4a The use of oxytocin to induce or augment labour is an established, commonly used practice that underpins a lot of modern obstetric practice. This technique is a undoubtedly a useful tool which has allowed us to improve maternal and fetal outcomes. For example to induce a timely delivery when maternal illness such as PET occurs or to avoid an operative delivery for a mother when their spontaneous progress in labour is slow. However, like most things in medicine (and life in general) there is no such thing as a "free lunch" and it is perhaps a less well recognised fact that the use of oxytocin in labour - especially at higher doses and for prolonged periods - is associated with an increased risk of postpartum haemorrhage due to uterine atony. Uterine atony is becoming more common in developed countries: The incidence of uterine atony causing postpartum haemorrhage in developed countries has increased markedly in the last 2 decades - one of the important factors contributing to this is thought to be the increased prevalence and use of oxytocin during labour. Lutomski JE1, Byrne BM, Devane D, Greene RA. Increasing trends in atonic postpartum haemorrhage in Ireland: an 11-year population-based cohort study. BJOG. 2012 Feb;119(3):306-14. Epidemiological investigation of a temporal increase in atonic postpartum haemorrhage: a population-based retrospective cohort study. What is the mechanism underlying this phenomenon? Exposure to oxytocin used during labour over time leads to downregulation and desensitisation of the oxytocin receptors on the myometrium. This leads to a decreased response to oxytocin when used after delivery as a uterotonic to prevent PPH.¹ "Fatigued / tired myometrium". Women who are not progressing well and have been in prolonged labour may have a "tired" myometrium (it is a muscle and it tires after prolonged use). These women may often then receive augmentation with oxytocin in an effort to achieve vaginal delivery. The presence of the oxytocin infusion could also be considered a marker of the presence of a "fatigued / tired" uterus in these individuals.² 1. Oxytocin exposure during labor among women with postpartum hemorrhage secondary to uterine atony. Am J Obstet Gynecol 2011; 204: 56.e1-6. 2. Predictors of severity in primary postpartum hemorrhage. Arch Gynecol Obstet. 2015 Dec;292(6):1247-54. Recognise these patients BEFORE delivery. Anticipate and prepare for uterine atony! In Theatre: When patients come from labour ward to theatre for a non elective caesarean during the patient assessment and the team time out specifically enquire about the length of labour & oxytocin use, duration and dose. In Labour Ward: The midwifery and obstetric team should specifically have a discussion regarding their planned management of the third stage in patients on oxytocin infusions. Oxytocin is still the best first line uterotonic but anticipate that it may not be effective. In vitro rat and human studies indicate that oxytocin is less effective in myometrium exposed to oxytocin in labour, but still appears to be more effective than the other uterotonics - at least in vitro anyway.¹ Use oxytocin first but start with your highest recommended dose of oxytocin don't wait until haemorrhage is already well established! At our institution at caesarean delivery I would give a 2-3 unit bolus (and I personally repeat this a few times every few minutes if there is haemodynamic stability) and start the 40u/500ml infusion at 250ml/hr. 1 - Comparative efficacy of uterotonic agents: in vitro contractions in isolated myometrial strips of labouring and non-labouring women. Can J Anaesth. 2014 Sep;61(9):808-18. In the presence of oxytocin receptor downregulation will the other uterotonics still work? The ergot and prostaglandin F2α uterotonic drugs work via different receptors and the...

women ireland exposure labour postpartum increases anticipate recognise oxytocin comparative predictors f2 fatigued uterine epidemiological haemorrhage pph am j obstet gynecol

04: Pelvic Inflammatory Disease - Part 2