The ethics of pregnancy testing
Abstract: Ethical and clinical concerns remain around mandatory pregnancy testing for under 16-year-olds attending for elective procedures. Existing national recommendations state that pregnancy state must be established in all females of reproductive capability. However for this group this is considered discriminatory as they may have capacity and the right to informed consent. In addition the possibility of safeguarding issues, disclosed under-age sexual activity and a newly revealed pregnancy in the presence of parents and guardians as well as the undue harm in attempting to determine pregnancy status when a positive result is extremely unlikely make the situation far from straightforward. Recent guidelines from the Royal College of Paediatrics and Child Health from 2012 attempt to set down a template to overcome these dilemmas and allow institutions to comply with national guidelines.
CONCLUSIONS: Chorioamnionitis and endometritis were the most common causes of sepsis, together accounting for about half of cases. Notable differences were observed in the sensitivity and specificity of sepsis screening tools with the highest to lowest sensitivity being SIRS, MEW, and qSOFA criteria, and the highest to lowest specificity being qSOFA, MEW, and SIRS. Mortality was doubled in the cohort of patients who received antibiotics after>1 hour. Clinicians need to be vigilant to identify cases of peripartum sepsis early in its course and prioritize timely antibiotic therapy. PMID: 31743182 [PubMed - in process]
CONCLUSIONS: Our experience suggested that rapid uptitration of intravenous treprostinil combined with oral sildenafil in the postpartum period may be a safe and effective approach for these very sick parturients with severe pulmonary hypertension. PMID: 31743181 [PubMed - in process]
CONCLUSIONS: Our findings justify the practice of using ≥2 repeated measurements for diagnosing hypertensive disorders of pregnancy. Lower normal blood pressure limits may be below those defining hypotensive shock. Normal heart rates exceed the accepted definitions of both tachy- and bradycardia. Normal temperatures at all times have a more narrow range than previously thought, and the normal range of white blood cell count has outliers exceeding the current definitions of leukocytosis or leukopenia at all times. The normal lower range of hemoglobin was constantly below 10 g/dL, and normal platelet counts were considera...
CONCLUSIONS: Participation at a SAFE-OB course in the Republic of Congo and in Madagascar was associated with personal and organizational changes in practice and sustained improvements in knowledge and skill at 12-18 months. PMID: 31743192 [PubMed - in process]
Authors: PMID: 31743215 [PubMed - in process]
This study investigates the influence of maternal age on birth procedure, gestational age, and rate of interventions during delivery. The influence of maternal parity is also analyzed. Material and Methods Data from the Austrian Register of Births was retrospectively collected and evaluated. The collected data was the data of all singleton live births in Austria between January 1, 2008 and December 31, 2016 (n = 686 272). Multiple births and stillbirths were excluded from the study. Maternal age and parity were analyzed in relation to predefined variables (birth procedure, gestational age, episiotomy in cas...
This article reviews current literature regarding impact of aortic stenosis on pregnancy and anesthesia during noncardiac surgery. There are shortcomings in the scientific evidence. Most of the available studies are observational and often retrospective and therefore there is a great deal of bias. This leads to difficulty in drawing conclusions in terms of how to apply the published information to clinical management.
We present a 24 year old woman, gravida 3, para 1, at 34 weeks’ gestation, who required an urgent caesarean section because of preterm labor and breech presentation.
Rotational thrombo-elastometry (ROTEM ®; Instrumentation LaboratoryTM, Munich, Germany) is a point-of-care visco-elastic test of coagulation that is well established in hepatic and cardiac surgery, obstetrics and trauma.1,2 Women become more hypercoagulable as pregnancy progresses through the three trimesters and this has been measured by both thrombo-elastography and rotational thrombo-elastometry in uncomplicated pregnancies.3 To date there has been a paucity of substantial, well-researched reference ranges for ROTEM® in pregnant labouring and non-labouring women.