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8 results

  • A Simulation Model of Escapable and Non-Escapable Areas from Which Pregnant Women Can Reach Tsunami Evacuation Buildings: The Case in 110 Elementary School Districts in Nagoya City, Aichi, Japan

  • Shoko Miyagawa, Ritsuko Hattori, Kanetoshi Hattori
  • Journal:
    Disaster Medicine and Public Health Preparedness / Volume 17 / 2023
    Published online by Cambridge University Press:
    06 September 2022, e218
    • Article
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      • Open access
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  • Objective:

    The objective of this study was to establish a method for evaluating the possibility of pregnant women evacuating to tsunami evacuation buildings in coastal areas affected by tsunami.

    Methods:

    We used data published by the Japanese government and a general-purpose geographic information system to develop a simulation method for evaluating the possibility of evacuation. The data included the number of pregnant women in each elementary school district, tsunami inundation forecast maps, location information of tsunami evacuation buildings, and the number of ordinary buildings. We used our method to conduct a tsunami evacuation possibility simulation for pregnant women in each elementary school district in 7 wards of Nagoya, Japan.

    Results:

    Dense population areas at low elevations are high-risk areas from which many pregnant women may not be able to evacuate. Districts with evenly distributed tsunami evacuation buildings tend to have a lower risk.

    Conclusions:

    The proposed simulation method was able to determine the risk in elementary school districts in densely populated low-lying areas. However, it is suggested that the risk tends to be estimated higher in school districts where there are differences in elevation and the building distribution is not uniform.

  • Relationship of household cooking salt and eating out on iodine status of pregnant women in environmental iodine-deficient coastal areas of China

  • Zhengyuan Wang, Wei Jin, Zhenni Zhu, Xueying Cui, Qi Song, Zehuan Shi, Chunfeng Wu, Jiajie Zang, Changyi Guo
  • Journal:
    British Journal of Nutrition / Volume 124 / Issue 9 / 14 November 2020
    Published online by Cambridge University Press:
    10 June 2020, pp. 971-978
    Print publication:
    14 November 2020
    • Article
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  • As city residents eat out more frequently, it is unknown that if iodised salt is still required in home cooking. We analysed the relationship of household salt and eating out on urinary iodine concentration (UIC) in pregnant women. A household condiment weighing method was implemented to collect salt data for a week. A household salt sample was collected. A urine sample was taken at the end of the week. Totally, 4640 participants were investigated. The median UIC was 139·1 μg/l in pregnant women and 148·7, 140·0 and 122·9 μg/l in the first, second and third trimesters. Median UIC in the third trimester was lower than in the other trimesters (P < 0·001). The usage rates of iodised (an iodine content ≥ 5·0 mg/kg) and qualified-iodised (an iodine content ≥ 21·0 mg/kg) salt were 73·9 and 59·3 %. The median UIC in the qualified-iodised salt group was higher than in the non-iodised group (P = 0·037). The median UIC in the non-iodised group who did not eat out was lower than in qualified-salt groups who both did and did not eat out (P = 0·007, <0·001). The proportion of qualified-iodised salt used in home cooking is low, but foods eaten out have universal salt iodisation according to the national compulsory policy. Household iodised salt did not play a decisive role in the iodine status of pregnant women. Pregnant women in their third trimester who are not eating out and using non-iodised salt at home require extra iodine.

  • Section 5 - Serious problems related to pregnancy

  • Edited by Marc van de Velde, Helen Scholefield, Lauren A. Plante
  • Book:
    Maternal Critical Care
    Published online:
    05 July 2013
    Print publication:
    04 July 2013, pp 403-471

  • Summary

    The most important risk factor for thrombosis in pregnancy is a history of thrombosis. Although both heparin and warfarin are satisfactory for use postpartum, including in women who are breastfeeding, many women prefer to use low-molecular-weight heparin (LMWH) (with once-daily dosing postpartum) because they have become accustomed to its administration and because they can avoid the monitoring associated with coumarin therapy. With massive life-threatening pulmonary thromboembolism (PE), the pregnant woman needs emergency assessment by a multidisciplinary team of obstetricians, surgeons, and radiologists, who should decide rapidly on appropriate treatment ranging from intravenous unfractionated heparin (UFH) to systemic thrombolysis, catheter thrombolysis or embolectomy, or surgical embolectomy. Women are at an increased risk of venous thromboembolism (VTE), during pregnancy. In anticipation of delivery, surgery, or other invasive procedures, anticoagulation should be manipulated to reduce the risk of bleeding complications while minimizing the risk of thrombosis.

  • Chapter 26 - Neurological disease and neurological catastrophes

  • from Section 4 - The pregnant patient with coexisting disease
  • Edited by Marc van de Velde, Helen Scholefield, Lauren A. Plante
  • Book:
    Maternal Critical Care
    Published online:
    05 July 2013
    Print publication:
    04 July 2013, pp 285-300

  • Summary

    The problems in the pregnant woman are universal: physiological changes during pregnancy lead to a reduction in time from onset of apnea to oxygen desaturation and to an increased likelihood of regurgitation from a full stomach. An antenatal visit allows the airway to be evaluated and discussion to be held with the parturient about the use of invasive monitors, such as invasive arterial blood pressure monitoring and the use of continuous positive airway pressure devices during and after labor and delivery. A recent development in the management of the airway in the obese patient is the use of the so-called ramped position. Perhaps the main factor responsible for a higher incidence of difficulties in airway management is that general anesthesia is generally reserved for extreme obstetric emergencies. The use of supraglottic airways in the management of the obstetric airway is undergoing evaluation.

  • Chapter 15 - Shock

  • from Section 2 - General medical considerations
  • Edited by Marc van de Velde, Helen Scholefield, Lauren A. Plante
  • Book:
    Maternal Critical Care
    Published online:
    05 July 2013
    Print publication:
    04 July 2013, pp 160-173

  • Summary

    Critical care staff caring for the patient and her fetus or newborn also benefit from systematic supports, as they are repeatedly exposed to patient trauma, family crisis, and loss. This chapter reviews the supports that can be provided to both families and staff in these scenarios. When a pregnant woman becomes critically ill, the threats to her health and that of her fetus may necessitate multiple decisions about medical management. Pregnant patients in the ICU who are conscious require the emotional and psychological support needed by any adult with a critical illness. While maternal, fetal, and neonatal mortality rates continue to fall worldwide, there will still be situations where clinicians are unable to save the life of the mother and/or infant. Supporting staff members and enabling them to continue their important work requires a culture which permits expression of emotion, confusion, and conflict.

  • Chapter 4 - Ethics of fetal therapy

  • from Section 1 - General principles
  • Edited by Mark D. Kilby, Anthony Johnson, Baylor College of Medicine, Texas, Dick Oepkes
  • Book:
    Fetal Therapy
    Published online:
    05 February 2013
    Print publication:
    13 December 2012, pp 39-44

  • Summary

    This chapter provides an ethical framework to guide clinical investigation and the translation of its results into clinical practice. It describes the ethical framework for fetal therapy in clinical research as well as in practice. Medical ethics identifies the ethical obligations of physicians and healthcare organizations to patients as well as the obligations of patients. The ethical concept of the fetus as a patient is based on both the ethical principle of beneficence and the ethical principle of respect for the pregnant woman's autonomy. Innovation in fetal therapy research begins with the design of an intervention and its implementation in animal models, followed by a single case and then case series. Three criteria must be satisfied in order to conduct such preliminary investigations in fetal research in an ethically responsible fashion, by taking into account beneficence-based obligations to the fetal patient and beneficence-based obligations to the pregnant woman.

  • Case 80 - Cerebralvasospasm

  • from Section II - Neurocritical care
  • Edited by George A. Mashour, Ehab Farag
  • Book:
    Case Studies in Neuroanesthesia and Neurocritical Care
    Published online:
    03 May 2011
    Print publication:
    03 February 2011, pp 269-271

  • Summary

    Physiologic changes during pregnancy may result in the development or growth of nervous system tumors. Brain tumors tend to become larger during pregnancy due to fluid retention, increased blood volume, and hormonal changes. If the patient is stable, gestational advancement may be permitted into the early second trimester, where surgical management of the tumor can be undertaken. In a patient with worsening symptoms, radiotherapy may be an option to delaying surgery. Patients should be premedicated with a nonparticulate antacid and ranitidine to protect against the sequelae of vomiting and aspiration. Cesarean section in patients with neurologic risk factors. Mechanisms of anesthesia-induced neurotoxicity and selectivity of anesthesia-induced neurodegeneration are actively being investigated. Management of brain tumors in pregnant women is mainly reliant on case reports and inherited wisdom. Therefore, close communication among the neurosurgeon, neuroanesthesiologist, obstetrician, and patient is of paramount importance.