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American Journal of Obstetrics and... Oct 2015We sought to describe the prevalence of serious maternal complications following early preterm birth by gestational age (GA), delivery route, and type of cesarean...
OBJECTIVE
We sought to describe the prevalence of serious maternal complications following early preterm birth by gestational age (GA), delivery route, and type of cesarean incision.
STUDY DESIGN
Trained personnel abstracted data from maternal and neonatal charts for all deliveries on randomly selected days representing one third of deliveries across 25 US hospitals over 3 years (n = 115,502). All women delivering nonanomalous singletons between 23-33 weeks' gestation were included. Women were excluded for antepartum stillbirth and highly morbid conditions for which route of delivery would not likely impact morbidity including nonreassuring fetal status, cord prolapse, placenta previa, placenta accreta, placental abruption, and severe and unstable maternal conditions (cardiopulmonary collapse, acute respiratory distress syndrome, seizures). Serious maternal complications were defined as: hemorrhage (blood loss ≥1500 mL, blood transfusion, or hysterectomy for hemorrhage), infection (endometritis, wound dehiscence, or wound infection requiring antibiotics, reopening, or unexpected procedure), intensive care unit admission, or death. Delivery route was categorized as classic cesarean delivery (CCD), low transverse cesarean delivery (LTCD), low vertical cesarean delivery (LVCD), and vaginal delivery. Association of delivery route with complications was estimated using multivariable regression models yielding adjusted relative risks (aRR) controlling for maternal age, race, body mass index, hypertension, diabetes, preterm premature rupture of membranes, preterm labor, GA, and hospital of delivery.
RESULTS
Of 2659 women who met criteria for inclusion in this analysis, 8.6% of women experienced serious maternal complications. Complications were associated with GA and were highest between 23-27 weeks of gestation. The frequency of complications was associated with delivery route; compared with 3.5% of vaginal delivery, 23.0% of CCD (aRR, 3.54; 95% confidence interval (CI), 2.29-5.48), 12.1% of LTCD (aRR, 2.59; 95% CI, 1.77-3.77), and 10.3% of LVCD (aRR, 2.27; 95% CI, 0.68-7.55) experienced complications. There was no significant difference in complication rates between CCD and LTCD (aRR, 1.37; 95% CI, 0.95-1.97) or between CCD and LVCD (aRR, 1.56; 95% CI, 0.48-5.07).
CONCLUSION
The risk of maternal complications after early preterm delivery is substantial, particularly in women who undergo cesarean delivery. Obstetricians need to be prepared to manage potential hemorrhage, infection, and intensive care unit admission for early preterm births requiring cesarean delivery.
Topics: Adult; Anti-Bacterial Agents; Blood Transfusion; Cesarean Section; Cohort Studies; Delivery, Obstetric; Endometritis; Female; Gestational Age; Humans; Hysterectomy; Intensive Care Units; Maternal Mortality; Postoperative Complications; Postpartum Hemorrhage; Pregnancy; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Premature Birth; Retrospective Studies; Risk; Surgical Wound Dehiscence; Surgical Wound Infection; Young Adult
PubMed: 26164696
DOI: 10.1016/j.ajog.2015.06.064 -
Ginekologia Polska 2017Analysis of the annual distribution of cesarean sections and indications between 2010 and 2015 in our clinic.
OBJECTIVE
Analysis of the annual distribution of cesarean sections and indications between 2010 and 2015 in our clinic.
MATERIAL AND METHODS
Medical records of 10,437 cesarean section patients from a total number of 24,283 deliveries performed at Department of Obstetrics and Gynecology between 2010-2015 were evaluated retrospectively. The indications for Cesarean section were analyzed and compared based on years.
RESULTS
The lowest cesarean section rate was 18.67% in 2011 and the highest rate was 24.5% in 2013, and the annual rates were close to each other in this 6-year period (p > 0.05). History of uterine surgery was the indication with the highest rate of 49.52%, while fetal distress was the second most frequent with 12.53%; presentation anomalies were observed as the most frequent third indication with 7.55%, and umbilical cord prolapse was the least frequent indication with 0.33%.
CONCLUSIONS
Patient education about normal delivery and providing means for pain control during normal delivery, improvement in physical conditions of the clinics, frequent and regular training of the assisting staff with obstetrics physicians are important to diminish the rates of primary cesarean sections. In addition, a normal delivery after a previous cesarean section must be encouraged.
Topics: Adult; Breech Presentation; Cephalopelvic Disproportion; Cesarean Section; Female; Fetal Distress; Gynecologic Surgical Procedures; Hospitals, Teaching; Humans; Labor Presentation; Obstetrics and Gynecology Department, Hospital; Pregnancy; Prolapse; Retrospective Studies; Turkey; Umbilical Cord; Uterus; Young Adult
PubMed: 28509319
DOI: 10.5603/GP.a2017.0036 -
BMC Pediatrics Oct 2022Globally more than 650,000 newborns died on their first day of life from birth asphyxia. The outcome of an asphyxiated newborn depends on the quality of care they...
Application of Donabedian quality-of-care framework to assess quality of neonatal resuscitation, its outcome, and associated factors among resuscitated newborns at public hospitals of East Wollega zone, Oromia, Western Ethiopia, 2021.
BACKGROUND
Globally more than 650,000 newborns died on their first day of life from birth asphyxia. The outcome of an asphyxiated newborn depends on the quality of care they received at birth. However, the quality of care newborns received at birth may be below the WHO resuscitation standard. The reason for the poor quality of care is unclear. The Donabedian model, according to the World Health Organization (WHO), is an appropriate framework for health care assessment that focuses on improving the quality of care. So this study aims to assess the quality of neonatal resuscitation, outcome, and its associated factors among newborns with birth asphyxia at public hospitals in the East Wollega zone, 2021.
METHODS
An institution-based cross-sectional study was conducted to observe 410 asphyxiated newborns using consecutive sampling methods. Data was gathered using a pretested structured questionnaire and checklist. Epi-data version 3.1 was used to enter data, which was subsequently exported to Statistical Package for Social Sciences version 25 for analysis. A logistic regression model was employed to determine the variables associated with the outcome variable. The adjusted odds ratio with a 95% confidence interval was calculated, and all variables associated with the outcome variable with a p-value less than 0.05 in multivariable analysis were determined to be significant factors for the outcome of resuscitated newborns.
RESULT
A total of 410 asphyxiated newborns were included in this study with a response rate of 97%. From this 87.6% of resuscitated newborns survived. Keeping baby warm [AOR = 6.9; CI (3.1, 15.6)] is associated significantly with increased chances of survival while meconium presence in the airway [AOR = 0.26; CI (0.1, 0.6)], prematurity [AOR = 0.24; CI (0.12, 0.48)], and presence of cord prolapse [AOR = 0.08; CI (0.03, 0.19)] were factors significantly associated with decreased survival of resuscitated newborns at 1 h of life.
CONCLUSION
Newborns who were kept warm were more likely to survive compared to their counterparts. While the presence of meconium in the airway, preterm, and cord prolapse was associated with the decreased survival status of newborns. Facilitating referral linkage in the event of cord prolapse, counseling on early antenatal care initiation to decrease adverse outcomes (prematurity), and neonatal resuscitation refresher training is strongly recommended.
Topics: Infant; Infant, Newborn; Female; Pregnancy; Humans; Resuscitation; Cross-Sectional Studies; Ethiopia; Asphyxia; Asphyxia Neonatorum; Hospitals, Public; Prolapse
PubMed: 36258182
DOI: 10.1186/s12887-022-03638-y -
Medecine Et Sante Tropicales May 2016to describe the mode of delivery and the fetal prognosis for breech presentations in Bobo Dioulasso, Burkina Faso. this prospective, descriptive, cross-sectional study...
to describe the mode of delivery and the fetal prognosis for breech presentations in Bobo Dioulasso, Burkina Faso. this prospective, descriptive, cross-sectional study covered the entire year 2013 and included patients from the city's three principal maternity units. The sample included 184 women who gave birth at term to fetuses in breech presentation and a control group of 368 women with infants in cephalic presentation. Data were collected with standardized case report forms. The analysis was conducted with Epi-Info 3.5.1 software. We used the Chi-square test to compare percentages and the Chi-square test for trend to study the variation in frequencies. Differences were considered significant when P ≤ 0.05. during the study period, the prevalence of breech presentation at term was 1.74%. In the breech group, 55.5% of the women had vaginal deliveries versus 92% in the cephalic group (P = 0.04). The comparative analysis of fetal and neonatal morbidity in the two groups found greater morbidity in the breech group, marked by complications including uterine rupture (P = 0.0045), cord prolapse (P = 0.02), dynamic dystocia (P = 0.001), fetal distress (P = 0.0001), postpartum hemorrhage (P = 0.003), and perinatal death (P = 0.006). vaginal delivery remains the most frequent mode of delivery for breech presentations in Bobo Dioulasso, and perinatal morbidity and mortality are relatively high. Improvement of hospital protocols and staff training for breech deliveries should help to improve this situation.
Topics: Adolescent; Adult; Breech Presentation; Burkina Faso; Cross-Sectional Studies; Female; Humans; Infant, Newborn; Pregnancy; Prognosis; Prospective Studies; Term Birth; Young Adult
PubMed: 27033716
DOI: 10.1684/mst.2015.0467 -
PloS One 2021The effect on neonatal mortality of mode of delivery of a fetus in breech presentation at an extremely preterm gestational age remains controversial. (Comparative Study)
Comparative Study
BACKGROUND
The effect on neonatal mortality of mode of delivery of a fetus in breech presentation at an extremely preterm gestational age remains controversial.
OBJECTIVE
To compare mortality associated with planned vaginal delivery (PVD) of fetuses in breech presentation with that of fetuses in breech presentation with a planned cesarean delivery (PCD).
MATERIAL AND METHODS
Retrospective study reviewing records over a 19-year period in a level 3 university referral center of singleton infants born between 25+0 and 27+6 weeks of gestation, alive on arrival in the delivery room, and weighing at least 500 grams at birth. Infants in the first group were in breech presentation with PVD and the second in breech presentation with PCD. The principal endpoint was neonatal death.
RESULTS
During the study period, we observed 113 breech presentations with PVD, and 80 breech presentations with PCD. Although not significant after adjustment, neonatal mortality in the breech PVD group was more than twice that of the breech PCD group (19.5 vs 7.8%, P = 0.031, ORa = 2.6, 95% CI 0.8-9.3, NNT = 8). This higher neonatal mortality in the breech PVD group was exclusively associated with a higher risk of death in the delivery room (12.4 vs 0.0% P = 0.001, OR not calculable, NNT = 8). In these extremely preterm breech presentations with PVD, neonatal mortality in the delivery room was associated with entrapment of the aftercoming head, cord prolapse, and a short duration of labor.
CONCLUSION
For deliveries between 25+0 and 27+6 weeks' gestation, vaginal delivery in breech presentation is associated with a higher risk of death in the delivery room.
Topics: Adult; Breech Presentation; Cesarean Section; Delivery, Obstetric; Female; Fetus; Gestational Age; Humans; Infant, Newborn; Perinatal Death; Pregnancy; Pregnancy Outcome; Risk Factors
PubMed: 34669715
DOI: 10.1371/journal.pone.0258303 -
BMJ Case Reports May 2021
Topics: Female; Humans; Labor Presentation; Obstetric Labor Complications; Pregnancy; Pregnancy Outcome; Prolapse; Umbilical Cord
PubMed: 33947682
DOI: 10.1136/bcr-2021-243320 -
Medecine Et Sante Tropicales 2015Umbilical cord prolapse is an obstetrical emergency that is life-threatening for the fetus. This retrospective cross-sectional study examined cases of pulsating...
UNLABELLED
Umbilical cord prolapse is an obstetrical emergency that is life-threatening for the fetus. This retrospective cross-sectional study examined cases of pulsating umbilical cord prolapses at our level-3 maternity unit over the past three years and sought to assess their prognosis. Cord prolapse occurred in 0.27% of deliveries. The women's mean age was 28 years, and 51% of the women were multiparous. Cesarean deliveries were performed in 96% of cases. Factors affecting neonatal outcome were the degree of cord prolapse (p = 0.0002981) and the appearance of amniotic fluid (p = 0.004078). The neonatal complications included admission to neonatal intensive care (33%), perinatal asphyxia (31%), prematurity (29%), neonatal infection (4%), and neonatal mortality (10%).
CONCLUSION
The fetus must be delivered rapidly, especially when the umbilical cord drops outside the mother's body and the amniotic fluid is meconial.
Topics: Adult; Cross-Sectional Studies; Female; Hospitals; Humans; Infant, Newborn; Infant, Newborn, Diseases; Madagascar; Pregnancy; Pregnancy Complications; Prognosis; Prolapse; Retrospective Studies; Umbilical Cord
PubMed: 26742556
DOI: 10.1684/mst.2015.0454 -
Cureus Jun 2023We report the case of a 28-year-old patient with a partial placental insertion on an intrauterine adhesion diagnosed at 20 weeks' gestation. The increasing incidence of...
We report the case of a 28-year-old patient with a partial placental insertion on an intrauterine adhesion diagnosed at 20 weeks' gestation. The increasing incidence of intrauterine adhesions during the last decade has been attributed to the rising number of uterine surgeries in the fertile population and better imaging studies facilitating diagnosis. Although uterine adhesions during pregnancy are generally considered benign, the existing evidence is conflicting. The obstetric risks in these patients are unclear, but higher numbers of placental abruption, preterm premature rupture of membranes (PPROM), and cord prolapse have been reported. Thus, a prenatal diagnosis should prompt close feto-maternal observation. Surgical resection should be offered to patients with adhesions found prior to pregnancy.
PubMed: 37404407
DOI: 10.7759/cureus.39878 -
Spinal Cord Series and Cases 2018Retrospective, descriptive study.
STUDY DESIGN
Retrospective, descriptive study.
OBJECTIVE
To describe the epidemiological profile of patients with spinal cord injury (SCI) in Kuwait.
SETTING
Physical Medicine and Rehabilitation Hospital, Kuwait.
METHODS
Review of medical records of 241 adult patients with SCI admitted during the period 2010-2015. The data collected included gender, age, etiology, neurological and vertebral level of injury and American Spinal Injury Association impairment scale (AIS).
RESULTS
There were 155 (64.3%) traumatic SCI (TSCI) and 86 (35.7%) non-traumatic SCI (NTSCI) patients. In TSCI, the male to female ratio was 4.3:1, and in NTSCI it was 1.5:1. Road traffic accident was the most common cause of TSCI (52.9%), followed by fall from height (32.9%). Acute disc prolapse was the most common cause of NTSCI (29.1%), followed by degenerative disc disease (26.7%) and tumors (17.4%). Paraplegia (41.3%) was more common in TSCI, the level of injury being thoracic in 61% of cases. Cauda equina syndrome was the most common presentation in NTSCI (40.7%).
CONCLUSION
Road traffic accident was found to be the main cause of TSCI in Kuwait, whereas acute and degenerative disc lesions were the leading causes in NTSCI. Prevention strategies should be directed toward these causes to reduce the incidence of SCI in Kuwait.
PubMed: 29423312
DOI: 10.1038/s41394-017-0036-5 -
Journal of Medical Case Reports Oct 2020Body stalk anomaly is a generally lethal malformation of the thorax and/or abdomen. It is often associated with limb defects. The intrathoracic and abdominal organs lie...
BACKGROUND
Body stalk anomaly is a generally lethal malformation of the thorax and/or abdomen. It is often associated with limb defects. The intrathoracic and abdominal organs lie outside the abdominal cavity. These are contained within a sac composed of amnioperitoneal membrane attached directly to the placenta. The umbilical cord may be totally absent or extremely shortened. Severe kyphoscoliosis is often present. This case is reported to highlight this rare malformation and its clinical presentation.
CASE PRESENTATION
We present a case of a 27-year-old primigravida Oromo woman who had been amenorrheic for 9 months. She presented with an urge to bear down of 10 hours and passage of liquor of the same duration. The patient was referred from a district primary hospital with a diagnosis of preterm labor and hand prolapse. A lower uterine segment cesarean section was performed at Jimma University Medical Center for an indication of active first stage of labor with nonreassuring fetal heart rate pattern (fetal bradycardia) and hand prolapse to effect an anomalous fetus that had only a rudimentary right lower extremity and liver and intestine found outside the abdominal cavity contained within a sac composed of transparent membrane attached directly to the placenta. The umbilical cord was very short, measuring about 7 cm. The fetus had severe scoliosis. It also had a heartbeat upon extraction, which stopped after 5 minutes of delivery. The placenta and fetal body parts together weighed 2400 g.
CONCLUSION
Termination of pregnancy is usually offered because this abnormality is generally considered lethal. If the pregnancy is continued undetected as in our patient's case, vaginal delivery is recommended, given the highly lethal nature of this anomaly. Good prenatal screening and counseling are recommended for early detection and management.
Topics: Adult; Cesarean Section; Ethiopia; Female; Fetus; Humans; Infant, Newborn; Pregnancy; Prenatal Diagnosis; Ultrasonography, Prenatal
PubMed: 33115503
DOI: 10.1186/s13256-020-02509-3