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Documents  Grossesse | enregistrements trouvés : 33

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Purpose of review: Caring for women with epilepsy requires specialized knowledge about potential teratogenicity of antiseizure medications, interactions with hormonal contraception, and pregnancy outcomes.

Recent findings: There has been an improvement in understanding the cognitive outcomes of infants exposed in utero in recent years. Folic acid supplementation helps mitigate the cognitive teratogenicity of antiseizure medications. Recent updates provide reassurance that seizure frequency tends to remain stable throughout pregnancy. There is conflicting evidence about the fecundity impact of epilepsy and antiseizure medications in women with epilepsy.

Summary: Recent research highlights the importance of early counseling about the risks and interactions of contraception, pregnancy, and antiseizure medications. More research is needed to understand fertility in women with epilepsy.
Purpose of review: Caring for women with epilepsy requires specialized knowledge about potential teratogenicity of antiseizure medications, interactions with hormonal contraception, and pregnancy outcomes.

Recent findings: There has been an improvement in understanding the cognitive outcomes of infants exposed in utero in recent years. Folic acid supplementation helps mitigate the cognitive teratogenicity of antiseizure medications. Recent ...

Contraception ; Infertilité ; Grossesse ; Épilepsie

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Purpose: Antibiotics are commonly used during pregnancy. However, physiological changes during pregnancy can affect the pharmacokinetics of drugs, including antibiotics, used during this period. Pharmacokinetic evaluations have shed light on how antibiotics are affected during pregnancy and have influenced dosing recommendations in this context.

Methods: A narrative review was conducted and included reports providing data reflecting drug distribution and exposure in the context of pregnancy.

Results: Pharmacokinetic parameters of antibiotics in pregnancy and transplacental passage of antibiotics are comprehensively presented.

Conclusions: Knowledge about the impact on pharmacokinetics and fetal exposure is especially helpful for complicated or severe infections, including intra-amniotic infection and sepsis in pregnancy, where both mother and fetus are at risk. Further studies are warranted to consolidate the role of therapeutic drug monitoring in complicated or severe infections in pregnant patients.
Purpose: Antibiotics are commonly used during pregnancy. However, physiological changes during pregnancy can affect the pharmacokinetics of drugs, including antibiotics, used during this period. Pharmacokinetic evaluations have shed light on how antibiotics are affected during pregnancy and have influenced dosing recommendations in this context.

Methods: A narrative review was conducted and included reports providing data reflecting drug ...

Grossesse ; Antibiotiques ; Médicaments - Usage

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Ventilatory efficiency can be evaluated using the relationship between minute ventilation (V'E) and the rate of CO2 production (V'CO2). In accordance with the modified alveolar ventilation equation, this relationship is determined by changes in dead space volume (VD) and/or the arterial CO2 tension (PaCO2) equilibrium point. In this review, we summarise the physiological factors that may account for normative ageing and pregnancy induced increases in V'E/V'CO2 during exercise. Evidence suggests that age-related increases in VD and pregnancy-related decreases in the PaCO2 equilibrium point are mechanistically linked to the increased V'E/V'CO2 during exercise. Importantly, the resultant increase in V'E/V'CO2 (ratio or slope), with normal ageing or pregnancy, remains below the critical threshold for prognostic indication in cardiopulmonary disease, is not associated with increased risk of adverse health outcomes, and does not affect the respiratory system's ability to fulfil its primary role of eliminating CO2 and maintaining arterial oxygen saturation during exercise.
Ventilatory efficiency can be evaluated using the relationship between minute ventilation (V'E) and the rate of CO2 production (V'CO2). In accordance with the modified alveolar ventilation equation, this relationship is determined by changes in dead space volume (VD) and/or the arterial CO2 tension (PaCO2) equilibrium point. In this review, we summarise the physiological factors that may account for normative ageing and pregnancy induced ...

Pneumologie ; Vieillissement ; Grossesse

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La SOGC reconnaît le besoin d’orientation au sujet de la vaccination contre la COVID-19 pendant la grossesse et l’allaitement. Nous apprécions la difficulté à laquelle font face les femmes et leurs fournisseurs de soins de santé étant donné l’absence d’essais cliniques pouvant fournir les données probantes nécessaires pour formuler des recommandations sur la vaccination contre la COVID-19 chez les populations enceintes et allaitantes. Les connaissances sur la COVID-19, ses effets sur la grossesse et les données sur la vaccination contre la COVID-19 évoluent rapidement. Les renseignements du présent document sont appelés à changer à mesure que d’autres données probantes deviennent disponibles et s’appliquent actuellement aux vaccins à ARN contre la COVID-19.
La SOGC reconnaît le besoin d’orientation au sujet de la vaccination contre la COVID-19 pendant la grossesse et l’allaitement. Nous apprécions la difficulté à laquelle font face les femmes et leurs fournisseurs de soins de santé étant donné l’absence d’essais cliniques pouvant fournir les données probantes nécessaires pour formuler des recommandations sur la vaccination contre la COVID-19 chez les populations enceintes et allaitantes. Les ...

Coronavirus ; Vaccination ; Grossesse

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Promouvoir l’activité physique prénatale | Septembre 2019 H

Article | KP0_10 (GYN)

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La grossesse est une période remplie de changements physiques et émotionnels, au cours de laquelle la femme enceinte se questionne sur ses habitudes de vie afin de s’assurer de sa santé et de celle de son bébé. Elle a le désir de le protéger en se reposant et en évitant toute situation à risque de préjudice. L’infirmière œuvrant en périnatalité accompagne les femmes enceintes pour les aider à vivre une grossesse saine dans la sérénité, en accord avec leur désir. Cet article présente les nombreux bienfaits d’une pratique régulière d’activité physique pour les femmes enceintes et les recommandations à leur transmettre. Il vise aussi à outiller les infirmières afin de les soutenir dans un mode de vie actif.
La grossesse est une période remplie de changements physiques et émotionnels, au cours de laquelle la femme enceinte se questionne sur ses habitudes de vie afin de s’assurer de sa santé et de celle de son bébé. Elle a le désir de le protéger en se reposant et en évitant toute situation à risque de préjudice. L’infirmière œuvrant en périnatalité accompagne les femmes enceintes pour les aider à vivre une grossesse saine dans la sérénité, en accord ...

Exercice ; Grossesse

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Acute stroke in pregnancy can be devastating. Although neurologists will at some point be involved in the management, most of these patients are likely to first be evaluated by an obstetric care provider. It is, therefore, important for obstetric care providers to have an understanding of the presentation and management of stroke, particularly in the initial period when the window of opportunity for therapy is critical. Once suspected, a head computed tomography (CT) without contrast media should be performed without delay to rule out a hemorrhagic component. Patients presenting within 4.5 hours of symptom onset and with an initial normal head CT scan are candidates for alteplase (tissue plasminogen activator [tPA]). Blood pressure (BP) control is paramount when administering tPA. During pregnancy, we recommend maintaining a BP between 140-160/90-110 mm Hg during tPA treatment. Pregnancy should not be a contraindication for mechanical thrombectomy in carefully selected patients. The use of therapeutic anticoagulation during the acute management of ischemic stroke is not indicated owing to an increased risk of hemorrhagic transformation. Supportive therapy should include aggressive treatment of fever, avoidance of hypotonic maintenance fluids, and maintenance of normal serum sodium levels. Serum glucose levels should be kept between 140 and 180 mg/dL. Antiplatelet agents are indicated for secondary prevention. The management of cerebral venous sinus thrombosis, carotid and vertebral dissections, and reversible cerebral vasoconstrictive disease should overall follow same guidelines as for nonpregnant individuals.
Acute stroke in pregnancy can be devastating. Although neurologists will at some point be involved in the management, most of these patients are likely to first be evaluated by an obstetric care provider. It is, therefore, important for obstetric care providers to have an understanding of the presentation and management of stroke, particularly in the initial period when the window of opportunity for therapy is critical. Once suspected, a head ...

Arrêt cardiaque - Traitement ; Grossesse

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OBJECTIVE: To evaluate the effectiveness of cognitive behavioral therapy for insomnia during pregnancy.

METHODS: Randomized, unmasked, 3-site controlled trial. Participants were randomly allocated to cognitive behavioral therapy for insomnia (a first-line, empirically supported psychosocial intervention that addresses sleep-related behaviors and cognitions) or a control intervention consisting of imagery exercises that paired patient-identified distressing nighttime experiences with patient-identified neutral images. Participants were eligible if they met diagnostic criteria for insomnia disorder and were between 18 and 32 weeks of gestation. Patients were ineligible if they met diagnostic criteria for major psychiatric disorders, including depression, or were receiving nonstudy treatments that could affect sleep (or both). The primary outcome was the Insomnia Severity Index score, a validated brief questionnaire, with scores between 14 and 21 representing clinically meaningful insomnia of moderate severity, scores higher than 21 representing severe insomnia, and scores less than 8 representing no insomnia. Secondary outcomes included remission of insomnia (Insomnia Severity Index score less than 8), objectively measured and self-reported time awake (ie, total wake time), and the Edinburgh Postnatal Depression Scale score. All outcomes were measured weekly. Analysis included 48 participants who did not complete treatment. We estimated that 184 women would be required to have 80% power, with a two-tailed test, to detect a moderate Cohen's d effect size (.5) with [alpha]=.05.

RESULTS: Between May 2013 and April 2017, 194 pregnant women were randomized and 149 completed treatment; 179 with available baseline data (92%) were ultimately analyzed, 89 in the cognitive therapy group and 90 in the control group. Women assigned to cognitive behavioral therapy for insomnia experienced significantly greater reductions in insomnia severity (scores decreased from 15.4+/-4.3 to 8.0+/-5.2 in the cognitive behavioral therapy group vs from 15.9+/-4.4 to 11.2+/-4.9 in the control therapy group [P<.001, d=0.5]). Remission of insomnia (to an Insomnia Severity Index score less than 8) disorder was attained by 64% of women in the cognitive behavioral therapy for insomnia group vs 52% in the control group. Women receiving cognitive behavioral therapy for insomnia experienced faster remission of insomnia disorder, with a median of 31 days vs 48 days in the control therapy (P<.001). Cognitive behavioral therapy for insomnia led to significantly greater reduction in self-reported but not objective total wake time and a small but significantly greater decline in Edinburgh Postnatal Depression Scale scores vs the control group.

CONCLUSION: Cognitive behavioral therapy for insomnia is an effective nonpharmacologic treatment for insomnia during pregnancy.
OBJECTIVE: To evaluate the effectiveness of cognitive behavioral therapy for insomnia during pregnancy.

METHODS: Randomized, unmasked, 3-site controlled trial. Participants were randomly allocated to cognitive behavioral therapy for insomnia (a first-line, empirically supported psychosocial intervention that addresses sleep-related behaviors and cognitions) or a control intervention consisting of imagery exercises that paired patient-identified ...

Insomnie ; Grossesse ; Thérapie cognitive

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OBJECTIVE: To use a large national database to compare composite maternal or neonatal morbidity among low-risk, full-term women.

METHODS: This cohort study, using the U.S. vital statistics datasets (2011-2015), evaluated low-risk nulliparous women with nonanomalous singleton gestations who labored at 39, 40, or 41 weeks of gestation (as reported in completed weeks of gestation; eg, 39 weeks include 39 0/7 to 39 6/7 weeks). The primary outcome, composite neonatal morbidity, included any of the following: Apgar score below 5 at 5 minutes, assisted ventilation longer than 6 hours, seizure, or mortality. The secondary outcome, composite maternal morbidity, included any of the following: intensive care unit admission, blood transfusion, uterine rupture, or unplanned hysterectomy. Multivariable Poisson regression was used to estimate the association between gestational age and morbidity (using adjusted relative risk [aRR] and 95% CI).

RESULTS: Of 19.8 million live births during the study interval, 3.3 million met inclusion criteria: 43.5% were delivered at 39 weeks of gestation, 41.4% at 40 weeks, and 15.1% at 41 weeks. The overall rates of composite neonatal and maternal morbidity were 8.8 and 2.8 per 1,000 live births, respectively. Composite neonatal morbidity was higher for those delivered at 40 (aRR 1.22; 95% CI 1.19-1.25) and 41 (aRR 1.53; 95% CI 1.49-1.58) weeks of gestation when compared with 39 weeks. Composite maternal morbidity was also significantly higher with delivery at 40 (aRR 1.19; 95% CI 1.14-1.25) and 41 weeks of gestation (aRR 1.56; 95% CI 1.47-1.65).

CONCLUSION: Among low-risk nulliparous women, the rate of composite neonatal and maternal morbidity increases, albeit modestly, from 39 through 41 weeks of gestation.
OBJECTIVE: To use a large national database to compare composite maternal or neonatal morbidity among low-risk, full-term women.

METHODS: This cohort study, using the U.S. vital statistics datasets (2011-2015), evaluated low-risk nulliparous women with nonanomalous singleton gestations who labored at 39, 40, or 41 weeks of gestation (as reported in completed weeks of gestation; eg, 39 weeks include 39 0/7 to 39 6/7 weeks). The primary outcome, ...

Néonatologie ; Obstétrique ; Grossesse

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Une grossesse en santé? | 2019-03-08 H

Article (PER, GYN)

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Une grossesse en santé ?. Un article de la revue Nutrition Science en évolution (Nutrition périconceptionnelle et anténatale : prévenir pour grandir en santé) diffusée par la plateforme Érudit.

Nutrition ; Grossesse ; Condition physique des femmes enceintes ; Femmes enceintes - Santé et hygiène

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Physical Activity and Exercise in Pregnancy. | Février 2019 H

Article (GYN)

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L’avènement d’une naissance est un événement d’importance dans la vie d’un homme. Pendant la grossesse de la femme, il s’ouvre à des sensations et à des idées nouvelles qui retentissent sur tout son être. La complexité du travail psychique paternel pendant la grossesse s’apparente à une crise narcissico-objectale, crise identitaire et identificatoire. L’annonce d’une paternité, même si elle constitue un heureux événement, suscite le plus souvent quelques perturbations jusqu’à mobiliser parfois d’intenses angoisses, entraînant des accidents aigus névrotiques graves et psychotiques. Celles-ci dévoilent le vacillement de l’équilibre, la mise à l’épreuve de son fonctionnement psychique et de sa construction, lors de la grossesse de sa compagne.
L’avènement d’une naissance est un événement d’importance dans la vie d’un homme. Pendant la grossesse de la femme, il s’ouvre à des sensations et à des idées nouvelles qui retentissent sur tout son être. La complexité du travail psychique paternel pendant la grossesse s’apparente à une crise narcissico-objectale, crise identitaire et identificatoire. L’annonce d’une paternité, même si elle constitue un heureux événement, suscite le plus souvent ...

Pères et fils ; Grossesse ; Psychopathologie

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