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Medicine Nov 2018We report a rare case of a pregnant woman with cord prolapse, velamentous cord insertion (VCI), and fetal vertex presentation who completed vaginal delivery.
RATIONALE
We report a rare case of a pregnant woman with cord prolapse, velamentous cord insertion (VCI), and fetal vertex presentation who completed vaginal delivery.
PATIENT CONCERNS
Without having undergone regular antepartum examinations, a 31-year-old pregnant woman, gravida 6, para 4, abortion 1, presented at 37 weeks and 3 days of gestation. She had regular labor pain and bloody show.
DIAGNOSES
Cord prolapse during labor and VCI after delivery.
INTERVENTIONS
Per vaginal examination at 11:20 PM revealed a fully dilated cervix. Thirty minutes later, artificial rupture of the membrane was performed, and an overt prolapsed cord approximately 10-cm long was palpated in the vagina. Fetal heartbeat decelerated to 60 bpm. After fundal pushing for some minutes, a female baby weighing 2130 g was delivered at 11:54 PM with a pediatrician on standby. Apgar scores were 7 (0 minute), 9 (5 minutes), and 10 (10 minutes). The placenta weighed 870 g and was delivered 5 minutes later, and VCI was discovered.
OUTCOMES
Her postpartum course was uncomplicated and both the patient and infant were discharged 3 days later.
LESSONS
A pregnant woman with umbilical prolapse, VCI, and a fetal vertex presentation can successfully deliver a baby through the vagina. Factors contributing to the success of the reported vaginal delivery might have been a small fetus, multipara status, and immediate management.
Topics: Adult; Delivery, Obstetric; Female; Fetal Monitoring; Fetus; Heart Rate, Fetal; Humans; Infant, Newborn; Labor Presentation; Placenta Diseases; Pregnancy; Prolapse; Umbilical Cord
PubMed: 30407364
DOI: 10.1097/MD.0000000000013221 -
BMJ Open Nov 2021To estimate how often midwives, specialty trainees and doctors specialised in obstetrics and gynaecology are attending to specific obstetric emergencies or high-risk...
OBJECTIVE
To estimate how often midwives, specialty trainees and doctors specialised in obstetrics and gynaecology are attending to specific obstetric emergencies or high-risk deliveries (obstetric events).
DESIGN
A national cross-sectional study.
SETTING
All hospital labour wards in Denmark.
PARTICIPANTS
Midwives (n=1303), specialty trainees (n=179) and doctors specialised in obstetrics and gynaecology (n=343) working in hospital labour wards (n=21) in Denmark in 2018.
METHODS
Categories of obstetric events comprised of Apgar score <7/5 min, eclampsia, emergency caesarean sections, severe postpartum haemorrhage, shoulder dystocia, umbilical cord prolapse, vaginal breech deliveries, vaginal twin deliveries and vacuum extraction. Data on number of healthcare professionals were obtained through the Danish maternity wards, the Danish Health Authority and the Danish Society of Obstetricians and Gynaecologists. We calculated the time interval between attending each obstetric event by dividing the number of events occurred with the number of healthcare professionals.
OUTCOME MEASURES
The time interval between attending a specific obstetric event.
RESULTS
The average time between experiencing obstetric events ranged from days to years. Emergency caesarean sections, which occur relatively frequent, were attended on average every other month by midwives, every 9 days for specialty trainees and every 17 days by specialist doctors. On average, rare events like eclampsia were experienced by midwives only every 42 years, every 6 years by specialty trainees and every 11 years by specialist doctors.
CONCLUSIONS
Some obstetric events occur extremely rarely, hindering the ability to obtain and maintain the clinical skills to manage them through clinical practice alone. By assessing the frequency of a healthcare professionals attending an obstetric emergency, our study contributes to assessing the need for supplementary educational initiatives and interventions to learn and maintain clinical skills.
Topics: Cross-Sectional Studies; Delivery, Obstetric; Emergencies; Female; Humans; Midwifery; Obstetrics; Pregnancy
PubMed: 34758994
DOI: 10.1136/bmjopen-2021-050790 -
BMJ Open Mar 2019Obstetric anal sphincter injury (OASIS) occurs in 5%-7% of normal deliveries and increases with vacuum extraction (VE) to 12%-14% in nulliparous women in Sweden....
Lateral episiotomy versus no episiotomy to reduce obstetric anal sphincter injury in vacuum-assisted delivery in nulliparous women: study protocol on a randomised controlled trial.
INTRODUCTION
Obstetric anal sphincter injury (OASIS) occurs in 5%-7% of normal deliveries and increases with vacuum extraction (VE) to 12%-14% in nulliparous women in Sweden. Lateral/mediolateral episiotomy may reduce the prevalence of OASIS at VE in nulliparous women. The current use of episiotomy is restrictive. The protective effect and consequences are uncertain. This trial will investigate if lateral episiotomy can reduce the prevalence of OASIS and assess short-term and long-term effects.
METHODS AND ANALYSIS
This is a multicentre randomised controlled trial of lateral episiotomy versus no episiotomy in nulliparous women with a singleton, live fetus, after gestational week 34+0 with indication for VE. A lateral episiotomy of 4 cm is cut at crowning, 1-3 cm from the midline, at a 60° angle. The primary outcome is OASIS by clinical diagnosis analysed according to intention to treat. To demonstrate a 50% reduction in OASIS prevalence (from 12.4% to 6.2%), 710 women will be randomised at a 1:1 ratio. Secondary outcomes are pain, blood loss, other perineal injuries, perineal complications, Apgar score, cord pH and neonatal complications. Web-based questionnaires at baseline, 2 months, 1 and 5 years will be used to assess pain, incontinence, prolapse, sexual function, quality of life and childbirth experience. A subset of women will receive follow-up by pelvic floor sonography and pelvic examination. Mode of delivery and recurrence of OASIS/episiotomy in subsequent pregnancies will be assessed at 5 and 10 years using register data.
ETHICS AND DISSEMINATION
The trial is open for enrolment. The trial has received ethical approval from the Regional Ethical Review Board of Stockholm and full funding from the Swedish Research Council. Women are interested in participation. The predominant restrictive view on episiotomy may limit recruitment. Results are of global interest and will be disseminated in peer-reviewed journals and at international congresses.
TRIAL REGISTRATION NUMBER
NCT02643108; Pre-results.
Topics: Anal Canal; Episiotomy; Female; Humans; Obstetric Labor Complications; Perineum; Pregnancy; Pregnancy Outcome; Randomized Controlled Trials as Topic; Risk Factors; Vacuum Extraction, Obstetrical
PubMed: 30872546
DOI: 10.1136/bmjopen-2018-025050 -
BMC Pregnancy and Childbirth Mar 2023Robert's uterus is a rare congenital anomaly, characterized as an asymmetric septate uterus that has a blind hemicavity with unilateral menstrual fluid retention and a... (Review)
Review
BACKGROUND
Robert's uterus is a rare congenital anomaly, characterized as an asymmetric septate uterus that has a blind hemicavity with unilateral menstrual fluid retention and a unicornuate hemicavity connecting to the cervix unimpededly. Patients with Robert's uterus generally present with menstrual disorders and dysmenorrhea, and some may have reproductive problems as well, including infertility, recurrent miscarriage, preterm labor and obstetric complications. In this case, we describe a successful pregnancy implanted on the obstructed hemicavity and delivered a liveborn girl. Meanwhile, we highlight diagnostic and therapeutic difficulties in patients with atypical symptoms of Robert's uterus.
CASE PRESENTATION
A 30-year-old Chinese primigravida sought for emergency treatment at 26 weeks and 2 days of gestation because of preterm premature rupture of membranes (PPROM). At the age of 19, the patient was misdiagnosed with hyperprolactinemia and pituitary microadenoma for showing symptom of hypomenorrhea and was suspected to have a uterine septum in the first trimester. She was diagnosed with Robert's uterus at 22 weeks of gestation by repetitious prenatal transvaginal ultrasonography, which was subsequently confirmed by magnetic resonance imaging. At 26 weeks and 3 days of gestation, the patient was suspected to have oligohydramnion, irregular uterine contraction, and umbilical cord prolapse, and she expressed a strong will of saving the baby. Emergency cesarean delivery was performed and a small hole, together with several weak spots, was found at the lower and back wall of the septum of the patient. The treatment was effective and both the mother and the infant, who had an extremely low birth weight, were discharged in good health conditions.
CONCLUSIONS
Pregnancy in the blind cavity of Robert's uterus with living neonates is incredibly rare. In our case, the favorable outcome may result from the unusual hole found at the septum, which may play a role in communicating amniotic fluid between the two hemicavities so to keep the neonate alive. we highlight the importance of early diagnosis and pre-pregnancy treatment of this uterine malformation, and the timely termination of pregnancy, for improving birth quality and reducing mortality.
Topics: Adult; Female; Humans; Infant, Newborn; Pregnancy; Dysmenorrhea; Infertility; Pelvis; Urogenital Abnormalities; Uterus; Fetal Membranes, Premature Rupture; Magnetic Resonance Imaging; Ultrasonography
PubMed: 36978042
DOI: 10.1186/s12884-023-05541-5 -
Journal of Rehabilitation Medicine.... 2019To assess and describe the involvement of all speech subsystems, including respiration, phonation, articulation, resonance, and prosody, in an individual with cervical...
OBJECTIVE
To assess and describe the involvement of all speech subsystems, including respiration, phonation, articulation, resonance, and prosody, in an individual with cervical spinal cord injury.
METHODS
Detailed speech and voice assessment was performed that included Frenchay Dysarthria Assessment, cranial nerve examination, voice (per-ceptual and instrumental) and nasometric evalua-tion, and intelligibility and communicative effecti-veness.
RESULTS
Impaired respiratory and phonatory con-trol correlated with the physical impairment of C4 and C5 prolapsed intervertebral disc. Cranial nerve examination indicated nerve IX and XI pathology. Phonatory deficits such as imprecise consonants and mild sibilant distortions were apparent. Voice analysis revealed a hoarse, breathy voice with re-duced loudness and no problems with resonance. Reading and speaking rate was reduced, and over-all a mild reduction in communicative effectiveness was perceived.
CONCLUSION
Assessment of the speech subsystems produced a comprehensive picture of the patient's condition and impairments in one or more areas was identified. Treatment options to improve speech outcomes were provided.
PubMed: 33884123
DOI: 10.2340/20030711-1000022 -
Cureus Oct 2022Umbilical cord prolapse with ruptured membranes is an obstetric emergency with management consisting of delivery via emergent cesarean delivery. If the umbilical cord...
Umbilical cord prolapse with ruptured membranes is an obstetric emergency with management consisting of delivery via emergent cesarean delivery. If the umbilical cord prolapses beyond the internal os with intact membranes, there is an opportunity to intervene and reduce the risk of fetal morbidity and mortality. A healthy 30-year-old, gravida 1 para 0 was incidentally found to have a short cervical length at 25 weeks five days on routine anatomy ultrasound evaluation. On evaluation via ultrasound by the maternal-fetal medicine service, the umbilical cord was noted to be prolapsing through the cervix with membranes intact. The cord prolapse with intact membranes resolved after placing the patient in the Trendelenburg position and nifedipine was administered for tocolysis given the uterus was noted to be contracting. For the remainder of the pregnancy, the patient underwent close follow-up and serial ultrasound scans with confirmation of the fetal head as the presenting part. The patient ultimately delivered vaginally at term. Cord prolapse with intact membranes, when identified via ultrasound, can be managed conservatively via Trendelenburg positioning and tocolysis to avoid premature cesarean delivery.
PubMed: 36348877
DOI: 10.7759/cureus.29870 -
BMJ Open Jun 2021This study aimed to evaluate the success rate of vaginal delivery, the reasons for unplanned caesarean delivery, the rate of umbilical cord prolapse and the risk of...
OBJECTIVE
This study aimed to evaluate the success rate of vaginal delivery, the reasons for unplanned caesarean delivery, the rate of umbilical cord prolapse and the risk of umbilical cord prolapse in twin deliveries.
DESIGN
Retrospective cohort study.
SETTING
Single institution.
PARTICIPANTS
This study included 455 women pregnant with twins (307 dichorionic and 148 monochorionic) who attempted vaginal delivery from January 2009 to August 2018. The following criteria were considered for vaginal delivery: diamniotic twins, cephalic presentation of the first twin, no history of uterine scar, no other indications for caesarean delivery, no major structural abnormality in either twin and no fetal aneuploidy.
RESULTS
The rate of vaginal delivery of both twins was 89.5% (407 of 455), caesarean delivery of both twins was 7.7% (35 of 455) and caesarean delivery of only the second twin was 2.9% (13 of 455). The major reasons for unplanned caesarean delivery were arrest of labour and non-reassuring fetal heart rate pattern. The rate of umbilical cord prolapse in the second twin was 1.8% (8 of 455). Multivariate analysis revealed that abnormal umbilical cord insertion in the second twin (velamentous or marginal) was the only significant factor for umbilical cord prolapse in the second twin (OR, 5.05, 95% CI 1.139 to 22.472, p=0.033).
CONCLUSIONS
Abnormal umbilical cord insertion in the second twin (velamentous or marginal) was a significant factor for umbilical cord prolapse during delivery. Antenatal assessment of the second twin's umbilical cord insertion using ultrasonography would be beneficial.
Topics: Delivery, Obstetric; Female; Humans; Pregnancy; Prolapse; Retrospective Studies; Twins; Umbilical Cord
PubMed: 34135046
DOI: 10.1136/bmjopen-2020-046616 -
Chinese Medical Journal Oct 2017Preterm premature rupture of membrane (PPROM) can lead to serious consequences such as intrauterine infection, prolapse of the umbilical cord, and neonatal respiratory...
BACKGROUND
Preterm premature rupture of membrane (PPROM) can lead to serious consequences such as intrauterine infection, prolapse of the umbilical cord, and neonatal respiratory distress syndrome. Genital infection is a very important risk which closely related with PPROM. The preliminary study only made qualitative research on genital infection, but there was no deep and clear judgment about the effects of pathogenic bacteria. This study was to analyze the association of infections with PPROM in pregnant women in Shaanxi, China, and to establish Bayesian stepwise discriminant analysis to predict the incidence of PPROM.
METHODS
In training group, the 112 pregnant women with PPROM were enrolled in the case subgroup, and 108 normal pregnant women in the control subgroup using an unmatched case-control method. The sociodemographic characteristics of these participants were collected by face-to-face interviews. Vaginal excretions from each participant were sampled at 28-36+6 weeks of pregnancy using a sterile swab. DNA corresponding to Chlamydia trachomatis (CT), Ureaplasma urealyticum (UU), Candida albicans, group B streptococci (GBS), herpes simplex virus-1 (HSV-1), and HSV-2 were detected in each participant by real-time polymerase chain reaction. A model of Bayesian discriminant analysis was established and then verified by a multicenter validation group that included 500 participants in the case subgroup and 500 participants in the control subgroup from five different hospitals in the Shaanxi province, respectively.
RESULTS
The sociological characteristics were not significantly different between the case and control subgroups in both training and validation groups (all P > 0.05). In training group, the infection rates of UU (11.6% vs. 3.7%), CT (17.0% vs. 5.6%), and GBS (22.3% vs. 6.5%) showed statistically different between the case and control subgroups (all P < 0.05), log-transformed quantification of UU, CT, GBS, and HSV-2 showed statistically different between the case and control subgroups (P < 0.05). All etiological agents were introduced into the Bayesian stepwise discriminant model showed that UU, CT, and GBS infections were the main contributors to PPROM, with coefficients of 0.441, 3.347, and 4.126, respectively. The accuracy rates of the Bayesian stepwise discriminant analysis between the case and control subgroup were 84.1% and 86.8% in the training and validation groups, respectively.
CONCLUSIONS
This study established a Bayesian stepwise discriminant model to predict the incidence of PPROM. The UU, CT, and GBS infections were discriminant factors for PPROM according to a Bayesian stepwise discriminant analysis. This model could provide a new method for the early predicting of PPROM in pregnant women.
Topics: Adult; Bayes Theorem; Case-Control Studies; Discriminant Analysis; Female; Fetal Membranes, Premature Rupture; Humans; Pregnancy; Real-Time Polymerase Chain Reaction; Risk Factors; Young Adult
PubMed: 29052561
DOI: 10.4103/0366-6999.216396 -
BMC Pediatrics May 2022Birth asphyxia is the inability of a newborn to start and conserve breathing immediately after birth. Globally, 2.5 million infants die within their first month of life...
BACKGROUND
Birth asphyxia is the inability of a newborn to start and conserve breathing immediately after birth. Globally, 2.5 million infants die within their first month of life every year, contributing nearly 47% of all deaths of children. It is the third cause of neonatal deaths next to infections and preterm birth. Ethiopia is one of the countries with the highest neonatal mortality and high burden of birth asphyxia in the world. The state of birth asphyxia is about 22.52% in Ethiopia, with incidence of 18.0% in East Africa Neonatal mortality incidence ratio was 9.6 deaths per 1000 live births among which 13.5% of neonatal mortality cases were due to birth asphyxia in southern Ethiopia. The effect of birth asphyxia is not only limited to common clinical problems and death; it also has a socio-economic impact on the families. Therefore, this study is aimed to identify determinants of birth asphyxia among newborn live births in public hospitals Southern Ethiopia.
METHODS
An Institution based unmatched case-control study was conducted among newborn live births in public hospitals of Gamo & Gofa zones, with a total sample size of 356 (89 cases and 267 controls, 1:3 case to control ratio) from March 18 to June 18, 2021, after obtaining ethical clearance from Arba Minch University. Cases were selected consecutively and controls were selected by systematic random sampling method. Data were collected using an adapted pretested semi-structured questionnaire through face-to-face interviews and record reviews using an extraction checklist for intrapartum & neonatal-related information. The collected data were entered into Epi data version 4.4 and exported to STATA version 14 for analysis. Finally, bi-variable and multivariable logistic regression analyses were performed to identify determinants of birth asphyxia. Statistical significance was declared at p-value ≤ 0.05 along with corresponding 95% CI of AOR used to declare statistical significance.
RESULTS
Anemia during pregnancy [AOR = 3.87, 95% CI (1.06- 14.09)], breech presentation [AOR = 3.56, 95% CI (1.19-10.65)], meconium stained amniotic fluid [AOR = 6.16, 95% CI (1.95-19.46)], cord prolapse [AOR = 4.69, 95%CI (1.04-21.05)], intrapartum fetal distress [AOR = 9.83, 95% CI (3.82-25.25)] and instrumental delivery [AOR = 5.91, 95% CI (1.51-23.07)] were significantly associated with birth asphyxia.
CONCLUSION
The study revealed that anemia during pregnancy, breech presentation, meconium-stained amniotic fluid, cord prolapse, intrapartum fetal distress, and instrumental delivery were identified as determinants of birth asphyxia. Therefore, health professional and health institutions should give emphasis on care of mother and the newborn in actively detecting and managing asphyxia.
Topics: Asphyxia; Asphyxia Neonatorum; Breech Presentation; Case-Control Studies; Child; Ethiopia; Female; Fetal Distress; Hospitals, Public; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Live Birth; Pregnancy; Premature Birth; Prolapse
PubMed: 35562670
DOI: 10.1186/s12887-022-03342-x -
Malawi Medical Journal : the Journal of... Mar 2021Preventing prolongation of the decision-to-delivery interval (DDI) for emergency caesarean delivery (CD) remains central to improving perinatal health. This study...
BACKGROUND
Preventing prolongation of the decision-to-delivery interval (DDI) for emergency caesarean delivery (CD) remains central to improving perinatal health. This study evaluated the effects of the DDI on perinatal outcome following emergency CD.
METHODS
A prospective cross-sectional study involving 205 consenting women who had emergency CD at a tertiary hospital in Nigeria was conducted. The time-motion documentation of events from decision to delivery was documented; the outcome measures were perinatal morbidity (neonatal resuscitation, 5-minute Apgar score, neonatal intensive admission) and mortality. Data analysis was performed with IBM SPSS Statistics version 20.0, and <0.05 was considered significant.
RESULTS
The overall mean DDI was 233.99±132.61 minutes (range 44-725 minutes); the mean DDI was shortest for cord prolapse (86.25±86.25 minutes) and was shorter for booked participants compared with unbooked participants (207.19±13.88 minutes vs 249.25±12.05 minutes; =0.030) and for general anaesthesia compared with spinal anaesthesia (219.48±128.60 minutes vs 236.19±133.42 minutes; =0.543). All neonatal parameters were significantly worse for unbooked women compared with booked women, including perinatal mortality (10.8% vs 1.3%; =0.012). Neonatal morbidity increased with DDI for clinical indications, UK National Institute of Health and Care Excellence (NICE) and Robson classification for CDs; perinatal mortality was 73.2 per 1000 live births, all were category 1 CDs and all except one occurred with DDI greater than 90 minutes. Severe preeclampsia/eclampsia, obstructed labour and placenta praevia tolerated DDI greater than 90 minutes compared with abruptio placentae and umbilical cord prolapse. However, logistic regression showed no statistical correlation between the DDI and neonatal outcomes.
CONCLUSION
Perinatal morbidity and mortality increased with DDI relative to the clinical urgency but perinatal deaths were increased with DDI greater than 90 minutes. For no category of emergency CD should the DDI exceed 90 minutes, while patient and institutional factors should be addressed to reduce the DDI.
Topics: Adult; Apgar Score; Cesarean Section; Cross-Sectional Studies; Decision Making; Emergency Treatment; Female; Humans; Infant, Newborn; Nigeria; Perinatal Mortality; Physicians; Pregnancy; Pregnancy Outcome; Prospective Studies; Time Factors
PubMed: 34422231
DOI: 10.4314/mmj.v33i1.5