AlgemeneGezondheid.Org

Pregnancy complications

June 06, 2017

The incidence of preterm birth and low birthweight infants are the most pressing obstetrical issues today, in addition to the malpractice crisis, according to Michael Paidas, M.D., associate professor and director of The Program for Thrombosis and Hemostasis in Women's Health in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale School of Medicine.

Paidas' talk included strategies for diagnosis, management and prevention of adverse pregnancy outcomes. He pointed out the important role of risk assessment with fetal fibronectin and cervical length as strong predictors of preterm birth. He also outlined what legislators can do to improve overall pregnancy outcomes and long-term women's health.

"We know now that complicated pregnancies have long-term consequences for women's health, particularly cardiovascular disease," said Paidas, one of 60 national researchers, health care professionals, state representatives and senators attending the conference. "We need more federal funding to understand this complex set of diseases in order to prevent poor pregnancy outcomes and treat complicated pregnancies."

Paidas added, "The cost of caring for premature infants is over $15 billion in the newborn period alone. The malpractice crisis is limiting the number of physician scientists dedicated to reproductive medicine, and drastically reducing the number of obstetricians to deliver care to our patients."

Women In Government President Susan Crosby said, "Women In Government is excited to bring this important issue to the attention of our legislative members in the Eastern Region. We look forward to continuing our work on pregnancy management and pre-term delivery in the future."

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The survey showed there was still a need for the development of more intensive, effective smoking cessation programmes, particularly focused on younger patients, those with lower levels of education (who the survey found were less likely to stop than those with university education) and those whose disease had first manifested as angina.

Dr Scholte op Reimer said that, in line with current guidelines on cardiovascular disease (CVD) prevention, a doctor's firm advice at the time of diagnosis was the most important factor in starting the quitting process. Many patients succeeded without special programmes, but for those who needed support, there should be a specific plan that is followed through. Nicotine replacement and certain anti-depressants should also be available if necessary.

There may also be a difference, she said, between patients having the general knowledge that smoking is a bad habit, and learning their precise risk as an individual. Individual risk could now be worked out via HeartScore ?? a computer program launched recently by the European Society of Cardiology, aiming at preventing CVD (primary prevention). The program can also calculate how much a person can change his or her risk of fatal CVD within 10 years by stopping smoking.

Another survey ?? EUROASPIRE III ?? is planned to see whether the situation improves. "It was disappointing that there was hardly any change in the five years between the first two surveys. However, we believe that the European guidelines on CVD prevention, tools such as HeartScore and interventions by governments might mean that attitudes will have improved by the time we carry out the next survey," Dr Scholte op Reimer concluded.

doi:10.1093/eurheartj/ehi497 and escardio