Friday, 30 August 2019
ISSN 2687-8402 (Online) | Open access journal of archaeology & anthropology | The ISSN Portal
ISSN 2687-8402 (Online) | Open access journal of archaeology & anthropology | The ISSN Portal: ISSN 2687-8402 (Online) | Open access journal of archaeology & anthropology
Tuesday, 27 August 2019
ISSN 2687-8410 (Online) | Archives of clinical case studies | The ISSN Portal
ISSN 2687-8410 (Online) | Archives of clinical case studies | The ISSN Portal: ISSN 2687-8410 (Online) | Archives of clinical case studies
Friday, 23 August 2019
Iris Publishers_World Journal of Gynecology & Womens Health
Steroids Administration at Term in Egypt: Does it become a Routine Practice?
Abstract
Background: Antenatal steroids become a routine daily practice before elective Cesarean deliveries in Egypt. These drugs were recommended only from 24 weeks to 34 weeks of gestation to minimize respiratory morbidities in newborn. Steroids are not without side effects or complications for both the baby and the mother.Objective: To evaluate the evidence regarding the use of antenatal steroids at term prior to scheduled cesarean delivery. Materials and Methods: Reviewing published data in recent ten years since January 2009 till 31, December 2017.
Results: Antenatal steroids were recommended only from 24 weeks to 34 weeks with extension up to 37 weeks of gestation not later to minimize respiratory morbidities in newborn.
Conclusion: Steroids are not without side effects or complications for both the baby and the mother. These drugs should be limited to high risk patients with imminent preterm birth and discouraged before term deliveries till evidence approve its long-term safety.
Keywords: Antenatal steroids; Scheduled; Cesarean delivery; Neonatal; Maternal outcomes
Introduction
Antenatal steroids were mainly given in high risk situations with eminent preterm birth as multiple gestations, cervical incompetence, polyhydramions and patients with history of previous preterm birth. Corticosteroids are of great benefit for normal development and enhancement of lung maturity. Evidence supports the use of steroids in those patients with strong limitation to single course and discouraging multiple weekly courses. Many authors advocate the use of steroids at term before scheduled cesarean delivery, but other institutions disagree with the results and conclusions of these studies [1,2].Discussion
Nowadays, many studies emerged with evidence supporting the use of such drugs before term cesarean delivery ≤ 39 weeks. This practice became a routine daily practice even in gestations beyond 39 weeks. Many researchers advised the use of steroids before term elective cesarean section to reduce respiratory and composite morbidities [3-5].On the other hand, many studies found that exposure of the fetus at term to corticosteroids either by betamethasone or dexamethasone can profoundly affect the development of the neuroendocrine system at term than at any other time in pregnancy duration. These drugs had life-long effects on endocrine system, emotions, affection and cognitive functions. These side effects of corticosteroids are still under continuous investigation and evidence till now didn’t reach to a final conclusion regarding this issue [6,7].
Do exogenous synthetic steroids affect endogenous corticosteroids surge near term? Do they affect the mechanism and initiation of parturition mechanism? Do they affect brain and other organs if they were given prior to delivery? Evidence still had no clear answers to these questions. Debates are still present whether to revise the use of steroids before term cesarean or not [6,7]. Nabhan A et al [8], in their study found that prophylactic antenatal corticosteroid for elective cesarean delivery between 34 and 37 weeks is not effective in improving neonatal outcomes [8]. De Vivo et al, found that wound complications were more in patients who received antenatal steroids before Cesarean section [9].
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ISSN 2641-2020 (Online) | Archives of pharmacy & pharmacology research | The ISSN Portal
ISSN 2641-2020 (Online) | Archives of pharmacy & pharmacology research | The ISSN Portal: ISSN 2641-2020 (Online) | Archives of pharmacy & pharmacology research
Wednesday, 21 August 2019
ISSN 2641-6360 (Online) | World journal of ophthalmology & vision research | The ISSN Portal
ISSN 2641-6360 (Online) | World journal of ophthalmology & vision research | The ISSN Portal: ISSN 2641-6360 (Online) | World journal of ophthalmology & vision research
Thursday, 15 August 2019
Iris Publishers_World Journal of Gynecology & Womens Health
Black Pregnant.2019
In 1986, the CDC established the pregnancy mortality
surveillance system to evaluate clinical issues surrounding
maternal death. At its inception the number of maternal deaths
was noted to be 7.2/100,000; in 2019, three decades later, the rate
has almost tripled-with Black women disproportionately affected,
no matter the socioeconomic status. The cause of this disparity
remains unclear. Extant studies have proposed myriad factors,
inclusive of prenatal infections, lack of prenatal care and medical
co-morbidities, during pregnancy as critical. While these internal
factors are important, what impact do external influences, such as
racism and implicit bias factor into the dismal perinatal outcomes
that are prevalent in 2019? This editorial will explore internal and
external forces impacting perinatal health for women of color.
Policy makers have known for years that racial and ethnic differences in health outcomes exist and multiple agencies like the Federal government have prioritized venues- like Health People 2010- the goal of which was the elimination of racial disparities in health outcomes. The final review of Healthy People 2010 was, while it was an ambitious endeavor, there was a significant lack of progress in reducing health disparities. What it did achieve was the development of more informative models and approaches to measuring disparities which serves as an information foundation for Healthy People 2020.
There are two words that need to be highlighted- difference and disparity- and the question becomes when does a difference become a disparity? There is little consensus on what constitutes a disparity or when a difference between two groups should be given the more charged term disparity. For some, disparity implies an inequity or an injustice, rather than a simple inequality. Determining when a difference becomes a disparity is not measured directly, but rather as a residual or a distinction between two groups, often after other factors might contribute to that difference have been statistically controlled for. Difference vs disparity is quite important when discussing the reproductive disadvantages seen among African American women in this country. Does a difference exist which compounds the disparities noted?
Despite improvements in obstetrical and neonatal care, Black infants and mothers still experience excess mortality. The mortality rate for Black infants is 2.5 x higher than for White infants. Black women have 4x higher pregnancy related mortality and 70% higher hospitalization rates for pregnancy related complications than do White women. Extreme preterm birth, fetal growth restriction and sepsis predominantly account for excess Black neonatal mortality; conversely vascular, hypertensive and infection related complications primarily account for disparity in maternal mortality and morbidity.
There are certain experiences embedded within the social context of African American women’s lives; exposure of lifelong stress, and genetic variables- but when stratified across a socioeconomic continuum-the same poor prenatal outcomes still persist. So, the question becomes are there certain pathophysiologic differences at hand accounting for outcomes?
Genitourinary, and to a lesser extent, non-genitourinary tract infections are implicated in preterm birth. Intrauterine infection seems to be the common denominator to racial disparities regarding preterm birth. Although the exact mechanism hasn’t been fully elucidated, intrauterine infection likely results from ascending lower genital tract infections preceding or shortly following conception. Most types of genitourinary infections, including sexually transmitted diseases like gonorrhea, trichomonas, and chlamydia and non-sexually transmitted infections such as Group B strep, UTI and bacterial vaginosis occur more frequently among Black women. Numerous studies have correlated vaginal infection with BV to the high incidence of preterm birth. There is a compelling body of evidence that racial differences exist in the vaginal flora or the vaginal microbiome of women. A healthy vagina has an abundance of lactobacillus species that work to ward off infectious entities by their production of hydrogen peroxide, lactic acid and bacteriocins- in addition they maintain an acidic vaginal pH. Research in this arena has noted that Black women affected by preterm labor show a shift, or an imbalance, of these helpful bacteria to a more diverse polymicrobial community. This variation allows for an overgrowth of pathogenic bacteria and a resultant change to a more alkaline pH-increasing the risk of ascending intrauterine infection resulting in preterm labor and endometritis in the postpartum period.
For More Information: https://irispublishers.com/wjgwh/fulltext/black-pregnant-2019.ID.000536.php
Policy makers have known for years that racial and ethnic differences in health outcomes exist and multiple agencies like the Federal government have prioritized venues- like Health People 2010- the goal of which was the elimination of racial disparities in health outcomes. The final review of Healthy People 2010 was, while it was an ambitious endeavor, there was a significant lack of progress in reducing health disparities. What it did achieve was the development of more informative models and approaches to measuring disparities which serves as an information foundation for Healthy People 2020.
There are two words that need to be highlighted- difference and disparity- and the question becomes when does a difference become a disparity? There is little consensus on what constitutes a disparity or when a difference between two groups should be given the more charged term disparity. For some, disparity implies an inequity or an injustice, rather than a simple inequality. Determining when a difference becomes a disparity is not measured directly, but rather as a residual or a distinction between two groups, often after other factors might contribute to that difference have been statistically controlled for. Difference vs disparity is quite important when discussing the reproductive disadvantages seen among African American women in this country. Does a difference exist which compounds the disparities noted?
Despite improvements in obstetrical and neonatal care, Black infants and mothers still experience excess mortality. The mortality rate for Black infants is 2.5 x higher than for White infants. Black women have 4x higher pregnancy related mortality and 70% higher hospitalization rates for pregnancy related complications than do White women. Extreme preterm birth, fetal growth restriction and sepsis predominantly account for excess Black neonatal mortality; conversely vascular, hypertensive and infection related complications primarily account for disparity in maternal mortality and morbidity.
There are certain experiences embedded within the social context of African American women’s lives; exposure of lifelong stress, and genetic variables- but when stratified across a socioeconomic continuum-the same poor prenatal outcomes still persist. So, the question becomes are there certain pathophysiologic differences at hand accounting for outcomes?
Genitourinary, and to a lesser extent, non-genitourinary tract infections are implicated in preterm birth. Intrauterine infection seems to be the common denominator to racial disparities regarding preterm birth. Although the exact mechanism hasn’t been fully elucidated, intrauterine infection likely results from ascending lower genital tract infections preceding or shortly following conception. Most types of genitourinary infections, including sexually transmitted diseases like gonorrhea, trichomonas, and chlamydia and non-sexually transmitted infections such as Group B strep, UTI and bacterial vaginosis occur more frequently among Black women. Numerous studies have correlated vaginal infection with BV to the high incidence of preterm birth. There is a compelling body of evidence that racial differences exist in the vaginal flora or the vaginal microbiome of women. A healthy vagina has an abundance of lactobacillus species that work to ward off infectious entities by their production of hydrogen peroxide, lactic acid and bacteriocins- in addition they maintain an acidic vaginal pH. Research in this arena has noted that Black women affected by preterm labor show a shift, or an imbalance, of these helpful bacteria to a more diverse polymicrobial community. This variation allows for an overgrowth of pathogenic bacteria and a resultant change to a more alkaline pH-increasing the risk of ascending intrauterine infection resulting in preterm labor and endometritis in the postpartum period.
For More Open Access Journals in Iris Publishers Please click on:
https://irispublishers.com/
For More Articles in World Journal of Gynecology & Womens Health
https://irispublishers.com/wjgwh/
https://irispublishers.com/
For More Articles in World Journal of Gynecology & Womens Health
https://irispublishers.com/wjgwh/
For More Information: https://irispublishers.com/wjgwh/fulltext/black-pregnant-2019.ID.000536.php
Friday, 9 August 2019
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