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Find video protocols related to scientific articles indexed in Pubmed.
Problem based review: the pregnant woman presenting to the AMU with palpitations.
Acute Med
PUBLISHED: 09-18-2014
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Pregnant patients commonly present to the acute medical team with symptoms requiring further investigation. Palpitations are a common reason for presentation on the acute medical take, and most acute physicians will be familiar with the process of investigation. The combination of pregnancy and palpitations raises a broad differential diagnosis and can complicate the management pathway. This problem based review is designed to summarise the key issues which may arise during the management of a typical patient presenting in this way.
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Impact of risk factors on the timing of first postpartum venous thromboembolism: a population-based cohort study from England.
Blood
PUBLISHED: 08-25-2014
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Impact on the timing of first postpartum venous thromboembolism (VTE) for women with specific risk factors is of crucial importance when planning the duration of thromboprophylaxis regimen. We observed this using a large linked primary and secondary care database containing 222?334 pregnancies resulting in live and stillbirth births between 1997 and 2010. We assessed the impact of risk factors on the timing of postpartum VTE in term of absolute rates (ARs) and incidence rate ratios (IRRs) using a Poisson regression model. Women with preeclampsia/eclampsia and postpartum acute systemic infection had the highest risk of VTE during the first 3 weeks postpartum (ARs ?2263/100?000 person-years; IRR ?2.5) and at 4-6 weeks postpartum (AR ?1360; IRR ?3.5). Women with body mass index (BMI) >30 kg/m(2) or those having cesarean delivery also had elevated rates up to 6 weeks (AR ?1425 at 1-3 weeks and ?722 at 4-6 weeks). Women with postpartum hemorrhage or preterm birth, had significantly increased VTE rates only in the first 3 weeks (AR ?1736; IRR ?2). Our findings suggest that the duration of the increased VTE risk after childbirth varies based on the type of risk factors and can extend up to the first 3 to 6 weeks postpartum.
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When should we use diagnostic imaging to investigate for pulmonary embolism in pregnant and postpartum women?
Emerg Med J
PUBLISHED: 07-11-2014
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Pulmonary embolism (PE) is a leading cause of death in pregnancy and postpartum. Clinicians face a difficult choice when deciding whether to use diagnostic imaging to investigate for suspected PE in these patients, between risking potentially catastrophic consequences of missed diagnosis if imaging is withheld and risking unnecessary iatrogenic harm to both mother and fetus if imaging is overused. This paper explores the options for imaging and evidence for the use of clinical features, clinical predictions scores or biomarkers to select pregnant and postpartum women for imaging. It also considers where future research could be most appropriately directed.
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Managing cardiovascular disease during pregnancy: best practice to optimize outcomes.
Future Cardiol
PUBLISHED: 07-01-2014
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Cardiac disease is the most common cause of death in pregnancy in the U.K. Optimal management requires an understanding of the physiological changes of the cardiovascular system during pregnancy, and their impact on existing or developing heart disease. Pregnancy itself is associated with the onset of cardiomyopathy, and a potential risk factor for ischemic heart disease and aortic dissection. Women with valvular disease and aortopathy require regular follow-up in specialized centers, and those requiring long-term anticoagulation face difficult challenges to balance maternal and fetal risks. In the UK, the Confidential Enquiries into maternal deaths and the UK Obstetric Surveillance system are examples of existing systems for identifying clinical risks and provide examples of potential improvements in care.
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Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis.
BMJ
PUBLISHED: 04-17-2014
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To provide an accurate assessment of complications of pregnancy in women with chronic hypertension, including comparison with population pregnancy data (US) to inform pre-pregnancy and antenatal management strategies.
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Drugs and therapeutics, including contraception, for women with heart disease.
Best Pract Res Clin Obstet Gynaecol
PUBLISHED: 03-13-2014
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Cardiac disease remains the leading cause of maternal death in the UK, and data from the Centre for Maternal and Child Enquiries have shown that the numbers of women dying from cardiac disease have steadily increased over the past 30 years. The incidence of acquired heart disease is increasing because of older age at first pregnancy, as well as a higher prevalence of cardiovascular risk factors, such as hypertension, diabetes and obesity. The number of women with congenital heart disease who are of childbearing age is also increasing. Significant cardiovascular changes occur in pregnancy even from an early gestation. This can affect the types and doses of medications used in pregnancy. The main aims of management are to optimise the mother's condition during pregnancy, to monitor for deterioration, and to minimise any additional load on the cardiovascular system from pregnancy, delivery and the postpartum period.
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The effects of recombinant activated factor VII dose on the incidence of thromboembolic events in patients with coagulopathic bleeding.
Thromb. Res.
PUBLISHED: 01-24-2014
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Previous studies have suggested the used of off-label recombinant factor VII (rFVIIa) increases the risk of thromboembolic events, but the effect of the dose of rFVIIa is not well described in the literature.
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Connective tissue disease in pregnancy.
Clin Med
PUBLISHED: 12-04-2013
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Connective tissue diseases (CTD) include a variety of chronic multisystem disorders with a high percentage of autoimmune conditions. Many of these conditions affect women of childbearing age and, therefore, pregnancy poses an important challenge for doctors looking after such women. Knowledge of medication safety, the effect of pregnancy on such diseases and vice versa, together with preconception counselling and multidisciplinary team care, are the basic pillars needed to provide the best obstetric and medical care to these women. In this review, we discuss the management of the most common autoimmune CTD before, during and after pregnancy, along with the most relevant issues regarding appropriate medication.
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Risk of first venous thromboembolism in pregnant women in hospital: population based cohort study from England.
BMJ
PUBLISHED: 11-09-2013
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To examine the potential for preventing venous thromboembolism during and after antepartum hospital admissions in pregnant women.
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Myasthenia in pregnancy: best practice guidelines from a UK multispecialty working group.
J. Neurol. Neurosurg. Psychiatr.
PUBLISHED: 06-11-2013
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A national UK workshop to discuss practical clinical management issues related to pregnancy in women with myasthenia gravis was held in May 2011. The purpose was to develop recommendations to guide general neurologists and obstetricians and facilitate best practice before, during and after pregnancy. The main conclusions were (1) planning should be instituted well in advance of any potential pregnancy to allow time for myasthenic status and drug optimisation; (2) multidisciplinary liaison through the involvement of relevant specialists should occur throughout pregnancy, during delivery and in the neonatal period; (3) provided that their myasthenia is under good control before pregnancy, the majority of women can be reassured that it will remain stable throughout pregnancy and the postpartum months; (4) spontaneous vaginal delivery should be the aim and actively encouraged; (5) those with severe myasthenic weakness need careful, multidisciplinary management with prompt access to specialist advice and facilities; (6) newborn babies born to myasthenic mothers are at risk of transient myasthenic weakness, even if the mothers myasthenia is well-controlled, and should have rapid access to neonatal high-dependency support.
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Persistent antiphospholipid antibodies do not contribute to adverse pregnancy outcomes.
Rheumatology (Oxford)
PUBLISHED: 05-16-2013
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To determine whether women with persistent aPL (>12 weeks apart on at least two separate occasions) without a history of thrombosis or adverse pregnancy outcome had the same adverse pregnancy outcomes as those with obstetric APS or unmatched controls.
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Risk factors for first venous thromboembolism around pregnancy: a population-based cohort study from the United Kingdom.
Blood
PUBLISHED: 04-02-2013
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Knowledge of the absolute risk (AR) for venous thromboembolism (VTE) in women around pregnancy and how potential risk factors modify this risk is crucial in identifying women who would benefit most from thromboprophylaxis. We examined a large primary care database containing 376?154 pregnancies ending in live birth or stillbirth from women aged 15 to 44 years between 1995 and 2009 and assessed the effect of risk factors on the incidence of antepartum and postpartum VTE in terms of ARs and incidence rate ratios (IRR), using Poisson regression. During antepartum, varicose veins, inflammatory bowel disease (IBD), urinary tract infection, and preexisting diabetes were associated with an increased risk for VTE (ARs, ?139/100?000 person-years; IRRs, ?1.8/100?000 person-years). Postpartum, the strongest risk factor was stillbirth (AR, 2444/100?000 person-years; IRR, 6.2/100?000 person-years), followed by medical comorbidities (including varicose veins, IBD, or cardiac disease), a body mass index (BMI) of 30 kg/m(2) or higher, obstetric hemorrhage, preterm delivery, and caesarean section (ARs, ?637/100?000 person-years; IRRs, ?1.9/100?000 person-years). Our findings suggest that VTE risk varies modestly by recognized factors during antepartum; however, women with stillbirths, preterm births, obstetric hemorrhage, caesarean section delivery, medical comorbidities, or a BMI of 30 kg/m(2) or higher are at much higher risk for VTE after delivery. These risk factors should receive careful consideration when assessing the potential need for thromboprophylaxis during the postpartum period.
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Renal disease and hypertension in pregnancy.
Clin Med
PUBLISHED: 03-12-2013
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Because women are becoming pregnant at a later age, hypertension is more commonly encountered in pregnancy. In addition, with increasing numbers of young women living with renal transplants and kidney disease, it is important for physicians to be aware of the effects of pregnancy on these diseases. A multidisciplinary approach is essential to assess and care for pregnant women with kidney disease. Pre-pregnancy counselling should be offered to all women with chronic kidney disease. A review of medication to avoid teratogenicity and optimise the disease prior to conception is the ideal. Pregnancy may be the first medical review for a young woman, who may present with a previously undiagnosed renal problem.
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Breastfeeding and tacrolimus: serial monitoring in breast-fed and bottle-fed infants.
Clin J Am Soc Nephrol
PUBLISHED: 01-24-2013
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Women have traditionally been advised not to breastfeed while taking tacrolimus, based on theoretical risks of neonatal immunosuppression and assumed secretion into breast milk, rather than clinical data suggesting neonatal absorption. The aim of this study was to assess tacrolimus levels in breast milk and neonatal exposure during breastfeeding.
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Risk of first venous thromboembolism in and around pregnancy: a population-based cohort study.
Br. J. Haematol.
PUBLISHED: 12-07-2011
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Knowledge of the absolute and relative risk of venous thromboembolism (VTE) in and around pregnancy would be crucial in identifying when to commence and cease thromboprophylaxis in women who would benefit from such intervention. We addressed this hypothesis using a large prospective primary care database from the United Kingdom, containing details on 972683 women aged 15-44years between 1987 and 2004. Risks of a first VTE during antepartum, postpartum and outside of pregnancy were compared using Poisson regression. The rate of VTE during the third trimester antepartum was six times higher than time outside pregnancy [Incidence Rate Ratio (IRR)=6·1; 95% confidence interval, 4·7-7·9]. In contrast, both the first (IRR=1·6) and second (IRR=2·1) trimesters conferred little increase in risk. The first 6weeks postpartum was associated with a 22-fold increase in risk, with the peak occurring in the first 3weeks. Increased age was found to be associated with VTE during postpartum and outside of pregnancy, but not during antepartum. Our findings of a notably raised risk of VTE persisting for 3?weeks postpartum and of a raised antepartum risk constrained to the third trimester have implications for modifying the current recommendations for VTE prophylaxis in pregnancy and the puerperium.
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Pregnancy and the liver.
Br J Hosp Med (Lond)
PUBLISHED: 11-16-2011
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In pregnancy the liver can be affected by diseases specific to pregnancy as well as unrelated conditions. The possible effect of the disease and its management on both the fetus and mother must be considered. Several physiological changes occur during pregnancy as liver metabolism is altered. Serum protein concentrations fall, with a decrease in serum albumin in part the result of the dilutional effect of an increase in plasma volume. Alanine transaminase and aspartate transaminase levels decrease (Table 1), complicating the diagnosis of disorders involving subtle changes in liver function. Alkaline phosphatase is also produced by the placenta, making this an unreliable marker of liver dysfunction in pregnancy.
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Tinzaparin use in pregnancy: an international, retrospective study of the safety and efficacy profile.
Eur. J. Obstet. Gynecol. Reprod. Biol.
PUBLISHED: 06-01-2011
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This study audited pregnancies where the mother received tinzaparin (at any stage before delivery), with a primary objective of determining the maternal safety of this low molecular weight heparin when administered as treatment and/or prophylaxis; the secondary objective was to audit fetal and neonatal safety in this cohort. Efficacy outcomes were also recorded.
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Pregnancy outcomes in systemic lupus erythematosus with and without previous nephritis.
J. Rheumatol.
PUBLISHED: 06-01-2011
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To compare rates and predictors of pregnancy complications in mothers with systemic lupus erythematosus (SLE) with and without previous nephritis (PN).
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Thromboembolic disorders in obstetrics.
Best Pract Res Clin Obstet Gynaecol
PUBLISHED: 05-24-2011
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Thromboembolic disorders remain a leading cause of maternal mortality in the developed world. The halving of the number of deaths from thromboembolic disorders in the last Confidential Enquiry provides further proof that they are largely preventable. A formal assessment of risk factors (e.g. previous thromboembolic disorders, thrombophilia, obesity) should be made at booking and at the time of delivery, or when intercurrent problems develop or the woman is admitted. Women with risk factors pre-dating pregnancy should be offered pre-pregnancy counselling and planning. Thromboprophylaxis should be instituted as soon as practical, bearing in mind that potentially fatal thromboembolic disorders may occur in the first trimester. All women presenting in pregnancy with new chest symptoms should be thoroughly investigated. Imaging is safe and should not be withheld. Treatment should be started empirically while the investigations are completed. Both prophylaxis and treatment doses should be carefully adjusted to take into account the weight of the woman.
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First-trimester low-dose prednisolone in refractory antiphospholipid antibody-related pregnancy loss.
Blood
PUBLISHED: 04-28-2011
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The objective of this study was to assess pregnancy outcome in women with a history of refractory antiphospholipid antibody-associated pregnancy loss(es) who were treated with early low-dose prednisolone in addition to aspirin and heparin. Eighteen women with antiphospholipid antibodies who had refractory pregnancy loss(es) were given prednisolone (10 mg) from the time of their positive pregnancy test to 14 weeks gestation. Before low-dose prednisolone was given as treatment, 4 (4%) of 97 pregnancies had resulted in live births. Among 23 pregnancies supplemented with prednisolone, 9 women had 14 live births (61%), including 8 uncomplicated pregnancies. The remainder were complicated by preterm delivery, preeclampsia, and/or small-for-gestational-age infants. There were 8 first-trimester miscarriages and 1 ectopic pregnancy. There were no fetal deaths after 10 weeks gestation and no evidence of maternal morbidity. The addition of first-trimester low-dose prednisolone to conventional treatment is worthy of further assessment in the management of refractory antiphospholipid antibody-related pregnancy loss(es), although complications remain elevated.
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Saving Mothers Lives: Reviewing maternal deaths to make motherhood safer: 2006-2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom.
BJOG
PUBLISHED: 03-02-2011
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In the triennium 2006-2008, 261 women in the UK died directly or indirectly related to pregnancy. The overall maternal mortality rate was 11.39 per 100,000 maternities. Direct deaths decreased from 6.24 per 100,000 maternities in 2003-2005 to 4.67 per 100,000 maternities in 2006–2008 (p = 0.02). This decline is predominantly due to the reduction in deaths from thromboembolism and, to a lesser extent, haemorrhage. For the first time there has been a reduction in the inequalities gap, with a significant decrease in maternal mortality rates among those living in the most deprived areas and those in the lowest socio-economic group. Despite a decline in the overall UK maternal mortality rate, there has been an increase in deaths related to genital tract sepsis, particularly from community acquired Group A streptococcal disease. The mortality rate related to sepsis increased from 0.85 deaths per 100,000 maternities in 2003-2005 to 1.13 deaths in 2006-2008, and sepsis is now the most common cause of Direct maternal death. Cardiac disease is the most common cause of Indirect death; the Indirect maternal mortality rate has not changed significantly since 2003-2005. This Confidential Enquiry identified substandard care in 70% of Direct deaths and 55% of Indirect deaths. Many of the identified avoidable factors remain the same as those identified in previous Enquiries. Recommendations for improving care have been developed and are highlighted in this report. Implementing the Top ten recommendations should be prioritised in order to ensure the overall UK maternal mortality rate continues to decline.
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An ethical dilemma: severe ischaemic mitral regurgitation and acute coronary syndrome in a 49-year-old pregnant woman.
Eur J Echocardiogr
PUBLISHED: 11-20-2009
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We report the case of a 49-year-old woman who presented with symptomatic severe mitral regurgitation secondary to previous myocardial infarction. During the work-up for surgery, she was found to be pregnant. This report explores the difficulties and ethical dilemmas encountered dealing with the need for urgent valve surgery and coronary revascularization in association with an unplanned, but wanted pregnancy in an older woman.
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Evans syndrome in pregnancy: a systematic literature review and two new cases.
Eur. J. Obstet. Gynecol. Reprod. Biol.
PUBLISHED: 07-28-2009
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Evans syndrome, the coexistence of immune thrombocytopenia (ITP) with autoimmune haemolytic anaemia (AIHA), is rare in pregnancy, with a few published cases. Concerns about the teratogenic effect of pharmacological agents used in the management of Evans syndrome limit the treatment options in pregnancy. In this paper we performed a systematic review of the literature of all published cases with Evans syndrome in pregnancy and we report two new cases. The review was performed by searching the electronic databases PubMed, EMBASE, Cochrane Library and Google scholar up to the end of December 2008. The selection criteria were Evans syndrome in pregnancy; autoimmune haemolytic anaemia; immune thrombocytopenia. Thirteen papers reporting 14 pregnancies in women with Evans syndrome have been published: 7 papers are written in English. Evans syndrome can be diagnosed with a full blood count, film and Coombs testing. It runs a more benign course in pregnancy than in non-pregnant state (notably neutropenia does not occur) and very often resolves post-delivery. The fetal outcome may be less favourable: a minority of fetuses are affected by transplacental passage of antibody and have a significant morbidity and mortality. With appropriate treatment, women with Evans syndrome can have successful pregnancies, with a good response to conventional treatment. More detailed studies of Evans syndrome in pregnancy, especially of fetal outcome, are required.
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Communication between key stakeholders within a medical home: a qualitative study.
Clin Pediatr (Phila)
PUBLISHED: 05-02-2009
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The objective of this study was to determine perceived benefits, detriments, and barriers to communication between pediatric providers and home visitors. The authors performed a cross-sectional, qualitative study consisting of 3 focus groups with paraprofessional home visitors (n=12), 6 with parents receiving home visiting (n=33), and 4 with pediatric providers whose patients received home visiting (n=19). Emerging themes were generated by an inductive analytic approach. Perceived benefits included home visitors assisting parents with communication, giving providers family information, and reinforcing providers guidance. Detriments included parental concern of sharing confidential information and providers becoming aware of family issues for which they are unprepared to act. Barriers included parental consent, logistics of home visitor-provider communication, and providers lack of knowledge about home visitor programs/roles. Greater coordination between home visitation programs and pediatric providers may strengthen home visiting services and reinforce advice and anticipatory guidance given by providers.
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Association of substance use discussion by pediatric providers with the parent-provider relationship and maternal behavior change.
Clin Pediatr (Phila)
PUBLISHED: 04-10-2009
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A cross-sectional study of data from a randomized, controlled trial was conducted to determine (1) provider and parent attributes associated with discussion of maternal substance use, (2) how substance use discussion related to the parent-provider relationship, and (3) whether discussion was associated with maternal attempts at behavior change. Of the 482 mothers, 34% reported discussing all 3 substance use items (smoking, alcohol, and drug use) with their childs provider. Mothers who discussed smoking were more likely to report discussing alcohol and other drug use (P < .001). Parent-provider relationship scores, measured by a modified version of the Primary Care Assessment Survey, were positively associated with discussion of each substance (P < .001). Discussion of smoking and drug use were significantly associated with attempted behavior change. Our findings suggest that discussion of parental substance use by pediatricians is positively associated with the parent-provider relationship and may lead to behavior change.
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Cardiac disease in pregnancy.
Clin Med
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Cardiac disease is the leading cause of maternal mortality in the UK. The major causes of cardiac deaths in pregnancy include cardiomyopathy, myocardial infarction, ischaemic heart disease and dissection of the thoracic aorta. With increasing numbers of migrant women in the UK, rheumatic heart disease in pregnancy has also re-emerged. Women with uncorrected congenital heart disease and those who have undergone corrective or palliative surgery may have complicated pregnancies. Women with metal prosthetic valves face difficult decisions regarding anticoagulation in pregnancy and have an increased risk of haemorrhage. Not all women with significant heart disease are able to meet the increased physiological demands of pregnancy. The care of pregnant women with heart disease thus requires a multidisciplinary approach, involving obstetricians, cardiologists and anaesthetists. This allows appropriate surveillance of maternal and fetal wellbeing, as well as planning and documentation of the management of elective and emergency delivery. This review discusses common cardiac conditions encountered in pregnancy and their antenatal and intrapartum management.
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Disorganized care: the findings of an iterative, in-depth analysis of surgical morbidity and mortality.
J. Surg. Res.
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Performance improvement driven by the review of surgical morbidity and mortality is often limited to critiques of individual cases with a focus on individual errors. Little attention has been given to an analysis of why a decision seemed right at the time or to lower-level root causes. The application of scientific performance improvement has the potential to bring to light deeper levels of understanding of surgical decision-making, care processes, and physician psychology.
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What is Visualize?

JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

How does it work?

We use abstracts found on PubMed and match them to JoVE videos to create a list of 10 to 30 related methods videos.

Video X seems to be unrelated to Abstract Y...

In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.