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The Orthopedic Clinics of North America Apr 2022Brachial plexus birth injuries (BPBIs) are typically traction type injuries to the newborn that occur during the delivery process. Although the incidence of these... (Review)
Review
Brachial plexus birth injuries (BPBIs) are typically traction type injuries to the newborn that occur during the delivery process. Although the incidence of these injuries has overall decreased from 1.5 to around 0.9 per 1000 live births in the United States over the past 2 decades, these injuries remain common, with incidence holding fairly steady from 2008 to 2014. Shoulder dystocia is the strongest identified risk factor, imparting a 100-fold greater risk. The newborn's shoulder is caught behind the mother's pubic bone, and traction performed on the child during delivery results in injury to the brachial plexus. Other risk factors associated with BPBI include macrosomia (birthweight > 4.5 kg), heavy for gestational age infants, birth hypoxia, gestational diabetes, and forceps or vacuum-assisted delivery. Breech presentation has also been described as a risk factor in the past, but there have been more recent data that challenge this association.
Topics: Birth Injuries; Birth Weight; Brachial Plexus; Child; Diabetes, Gestational; Dystocia; Female; Humans; Infant, Newborn; Pregnancy; United States
PubMed: 35365261
DOI: 10.1016/j.ocl.2021.11.003 -
Ultrasound in Obstetrics & Gynecology :... Sep 2019To determine accurate estimates of risks of maternal and neonatal complications in pregnancies with fetal macrosomia by performing a systematic review of the literature... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To determine accurate estimates of risks of maternal and neonatal complications in pregnancies with fetal macrosomia by performing a systematic review of the literature and meta-analysis.
METHODS
A search of MEDLINE, EMBASE, CINAHL and The Cochrane Library was performed to identify relevant studies reporting on maternal and/or neonatal complications in pregnancies with macrosomia having a birth weight (BW) > 4000 g and/or those with birth weight > 4500 g. Prospective and retrospective cohort and population-based studies that provided data regarding both cases and controls were included. Maternal outcomes assessed were emergency Cesarean section (CS), postpartum hemorrhage (PPH) and obstetric anal sphincter injury (OASIS). Neonatal outcomes assessed were shoulder dystocia, obstetric brachial plexus injury (OBPI) and birth fractures. Meta-analysis using a random-effects model was used to estimate weighted pooled estimates of summary statistics (odds ratio (OR) and 95% CI) for each complication, according to birth weight. Heterogeneity between studies was estimated using Cochran's Q, I statistic and funnel plots.
RESULTS
Seventeen studies reporting data on maternal and/or neonatal complications in pregnancy with macrosomia were included. In pregnancies with macrosomia having a BW > 4000 g, there was an increased risk of the maternal complications: emergency CS, PPH and OASIS, which had OR (95% CI) of 1.98 (1.80-2.18), 2.05 (1.90-2.22) and 1.91 (1.56-2.33), respectively. The corresponding values for pregnancies with BW > 4500 g were: 2.55 (2.33-2.78), 3.15 (2.14-4.63) and 2.56 (1.97-3.32). Similarly, in pregnancies with a BW > 4000 g, there was an increased risk of the neonatal complications: shoulder dystocia, OBPI and birth fractures, which had OR (95% CI) of 9.54 (6.76-13.46), 11.03 (7.06-17.23) and 6.43 (3.67-11.28), respectively. The corresponding values for pregnancies with a BW > 4500 g were: 15.64 (11.31-21.64), 19.87 (12.19-32.40) and 8.16 (2.75-24.23).
CONCLUSION
Macrosomia is associated with serious maternal and neonatal adverse outcomes. This study provides accurate estimates of these risks, which can be used for decisions on pregnancy management. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Topics: Adult; Cesarean Section; Dystocia; Female; Fetal Macrosomia; Humans; Infant, Newborn; Infant, Newborn, Diseases; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications; Retrospective Studies
PubMed: 30938004
DOI: 10.1002/uog.20279 -
The American Journal of Forensic... Sep 2020Serious intrapartum fetal injuries are unfortunate events that confer severe consequences on medical personnel. Most birth traumas are noncritical and resolve for a few...
Serious intrapartum fetal injuries are unfortunate events that confer severe consequences on medical personnel. Most birth traumas are noncritical and resolve for a few days. Permanent effects or fatal outcomes occur infrequently. We report an unusual case of intrapartum complete fetal decapitation. The labor was complicated by shoulder dystocia, with resultant repeated mechanical trauma to the fetal neck and, finally, decapitation. The tragic results of biological processes in human organisms do not automatically confirm medical malpractice. However, there may be grave ethical and forensic outcomes.
Topics: Adult; Birth Injuries; Decapitation; Female; Humans; Infant, Newborn; Labor, Induced; Pregnancy; Shoulder Dystocia; Vacuum Extraction, Obstetrical
PubMed: 32796208
DOI: 10.1097/PAF.0000000000000556 -
Minerva Obstetrics and Gynecology Feb 2021Normal labor is identified as regular uterine contractions in addition to dilation and effacement of the cervix. It is necessary to define normal labor in order to... (Review)
Review
Normal labor is identified as regular uterine contractions in addition to dilation and effacement of the cervix. It is necessary to define normal labor in order to delineate when a woman's labor pattern diverges from that observed in most women. Labor irregularities are subdivided into protraction disorders and arrest disorders. Identifying abnormal labor patterns and initiating appropriate interventions is essential because prolonged labor is associated with an increase in perinatal morbidity. The aim of this review was to delineate both normal labor progress and also discuss the current evidence-based diagnosis and treatment of protraction and arrest disorders. Many subtleties go into defining the boundaries of the first and second stages of labor. Historically, the Friedman curve established normal limits; but currently Zhang has advanced these definitions by accounting for current demographical characteristics and practice environments. The most significant variables for defining normal progress of labor are parity and regional anesthesia status. The most common causes of labor abnormalities are uterine inactivity, obesity, cephalopelvic disproportion and fetal malposition. Risks of extending the first and/or second stage of labor include postpartum hemorrhage, intraamniotic infection and potentially an increase in neonatal adverse outcomes. The management of labor disorders consists of oxytocin administration, amniotomy, intrauterine pressure catheter use and shared decision-making regarding proceeding with expectant management, operative vaginal delivery or cesarean delivery after weighing the risks and benefits of each option. The decision to extend the duration of labor is personalized for each mother-baby dyad and should be agreed upon depending on individual maternal and fetal circumstances.
Topics: Cesarean Section; Dystocia; Female; Humans; Labor, Obstetric; Parity; Pregnancy; Time Factors
PubMed: 32882117
DOI: 10.23736/S2724-606X.20.04644-4 -
Theriogenology Jul 2020Around parturition, a bitch has to cope with various challenges such as hormonal changes, whelping, nursing, milk production, and uterine involution. Monitoring the...
Around parturition, a bitch has to cope with various challenges such as hormonal changes, whelping, nursing, milk production, and uterine involution. Monitoring the health of bitches in this period is essential to detect potential illnesses and dystocia early. In that regard, it is elementary to know the normal progress and parameters during pregnancy, parturition and in the puerperium. Some research has been published in the past 50 years giving insights into hormonal and functional changes and findings including definitions of normal parturition and dystocia or puerperal conditions. However, taking a closer look into the literature reveals that for some issues heterogeneous data and varying conclusion were presented, indicating that further research is required. This paper gives an overview on endocrinology and methods to predict the time of parturition in the dog. Furthermore, the stages and mechanisms of parturition and signs of dystocia and puerperal health monitoring are discussed. Fields in which contradictory data have been published include for example the decline of hematocrit in the second half of pregnancy, the body temperature immediately before and after parturition, the interpretation of ultrasound findings, and the length of the canine puerperium. Even if thresholds are not clear for each parameter, examinations such as regular temperature measurement or ultrasound are important to monitor the bitches' health status. Nevertheless, for the practitioner it is important to know that research findings for some parameters used in daily practice are controversial.
Topics: Animals; Dog Diseases; Dogs; Dystocia; Female; Parturition; Pregnancy
PubMed: 32164993
DOI: 10.1016/j.theriogenology.2020.02.046 -
American Journal of Obstetrics and... Apr 2020To assess the efficacy, effectiveness, and safety of uterine balloon tamponade for treating postpartum hemorrhage. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess the efficacy, effectiveness, and safety of uterine balloon tamponade for treating postpartum hemorrhage.
STUDY DESIGN
We searched electronic databases (from their inception to August 2019) and bibliographies. We included randomized controlled trials, nonrandomized studies, and case series that reported on the efficacy, effectiveness, and/or safety of uterine balloon tamponade in women with postpartum hemorrhage. The primary outcome was the success rate of uterine balloon tamponade for treating postpartum hemorrhage (number of uterine balloon tamponade success cases/total number of women treated with uterine balloon tamponade). For meta-analyses, we calculated pooled success rate for all studies, and relative risk with 95% confidence intervals for studies that included a comparative arm.
RESULTS
Ninety-one studies, including 4729 women, met inclusion criteria (6 randomized trials, 1 cluster randomized trial, 15 nonrandomized studies, and 69 case series). The overall pooled uterine balloon tamponade success rate was 85.9% (95% confidence interval, 83.9-87.9%). The highest success rates corresponded to uterine atony (87.1%) and placenta previa (86.8%), and the lowest to placenta accreta spectrum (66.7%) and retained products of conception (76.8%). The uterine balloon tamponade success rate was lower in cesarean deliveries (81.7%) than in vaginal deliveries (87.0%). A meta-analysis of 2 randomized trials that compared uterine balloon tamponade vs no uterine balloon tamponade in postpartum hemorrhage due to uterine atony after vaginal delivery showed no significant differences between the study groups in the risk of surgical interventions or maternal death (relative risk, 0.59; 95% confidence interval, 0.02-16.69). A meta-analysis of 2 nonrandomized before-and-after studies showed that introduction of uterine balloon tamponade in protocols for managing severe postpartum hemorrhage significantly decreased the use of arterial embolization (relative risk, 0.29; 95% confidence interval, 0.14-0.63). A nonrandomized cluster study reported that use of invasive procedures was significantly lower in the perinatal network that routinely used uterine balloon tamponade than that which did not use uterine balloon tamponade (3.0/1000 vs 5.1/1000; P < .01). A cluster randomized trial reported that the frequency of postpartum hemorrhage-related invasive procedures and/or maternal death was significantly higher after uterine balloon tamponade introduction than before uterine balloon tamponade introduction (11.6/10,000 vs 6.7/10,000; P = .04). Overall, the frequency of complications attributed to uterine balloon tamponade use was low (≤6.5%).
CONCLUSION
Uterine balloon tamponade has a high success rate for treating severe postpartum hemorrhage and appears to be safe. The evidence on uterine balloon tamponade efficacy and effectiveness from randomized and nonrandomized studies is conflicting, with experimental studies suggesting no beneficial effect, in contrast with observational studies. Further research is needed to determine the most effective programmatic and healthcare delivery strategies on uterine balloon tamponade introduction and use.
Topics: Cesarean Section; Female; Humans; Maternal Mortality; Parturition; Placenta Accreta; Placenta Previa; Placenta, Retained; Postpartum Hemorrhage; Pregnancy; Uterine Artery Embolization; Uterine Balloon Tamponade; Uterine Inertia
PubMed: 31917139
DOI: 10.1016/j.ajog.2019.11.1287 -
Best Practice & Research. Clinical... Aug 2020The second stage of labor, from full cervical dilatation to complete birth of the baby or babies, constitutes the time of greatest risk for the baby. Birth attendants at... (Review)
Review
The second stage of labor, from full cervical dilatation to complete birth of the baby or babies, constitutes the time of greatest risk for the baby. Birth attendants at all levels require training in the skills necessary to overcome difficulties that may arise unexpectedly during the second stage, particularly poor progress, shoulder dystocia, and breech birth. The mother should receive emotional support and encouragement to bear down instinctively when she feels the urge to do so, in the position she feels enables her to push most effectively, but not the supine position. The baby's heart rate should be monitored after every second contraction. Recent guidelines such as those of the World Health Organization(WHO) recommend allowing 2-3 h for the second stage of labor. Uterine fundal pressure has not been shown to be effective, and may be dangerous. Choosing between cesarean section and assisted vaginal birth to overcome delayed second stage requires relevant skill and experience.
Topics: Cesarean Section; Dystocia; Female; Heart Rate, Fetal; Humans; Labor Stage, Second; Parturition; Pregnancy
PubMed: 32360366
DOI: 10.1016/j.bpobgyn.2020.03.012 -
Obstetrics and Gynecology Sep 2019
Topics: Female; Humans; Pregnancy; Shoulder; Shoulder Dystocia
PubMed: 31441811
DOI: 10.1097/AOG.0000000000003440 -
JAMA Network Open May 2023Elective induction of labor at 39 weeks of gestation is common. Thus, there is a need to assess maternal labor-related complications and neonatal outcomes associated... (Meta-Analysis)
Meta-Analysis
Comparison of Maternal Labor-Related Complications and Neonatal Outcomes Following Elective Induction of Labor at 39 Weeks of Gestation vs Expectant Management: A Systematic Review and Meta-analysis.
IMPORTANCE
Elective induction of labor at 39 weeks of gestation is common. Thus, there is a need to assess maternal labor-related complications and neonatal outcomes associated with elective induction of labor.
OBJECTIVE
To examine maternal labor-related complications and neonatal outcomes following elective induction of labor at 39 weeks compared with expectant management.
DATA SOURCES
A systematic review of the literature was conducted using the MEDLINE (Ovid), Embase (Ovid), Cochrane Central Library, World Health Organization, and ClinicalTrials.gov databases and registries to search for articles published between database inception and December 8, 2022.
STUDY SELECTION
This systematic review and meta-analysis included randomized clinical trials, cohort studies, and cross-sectional studies reporting perinatal outcomes following induction of labor at 39 weeks vs expectant management.
DATA EXTRACTION AND SYNTHESIS
Two reviewers independently assessed study eligibility, extracted data, and assessed studies for bias. Pooled odds ratios (ORs) and 95% CIs were calculated using a random-effects model. This study is reported per the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guideline, and the protocol was prospectively registered with PROSPERO.
MAIN OUTCOMES AND MEASURES
Maternal outcomes of interest included emergency cesarean section, perineal injury, postpartum hemorrhage, and operative vaginal birth. Neonatal outcomes of interest included admission to the neonatal intensive care unit, low 5-minute Apgar score (<7) after birth, macrosomia, and shoulder dystocia.
RESULTS
Of the 5827 records identified in the search, 14 studies were eligible for inclusion in this review. These studies reported outcomes for 1 625 899 women birthing a singleton pregnancy. Induction of labor at 39 weeks of gestation was associated with a 37% reduced likelihood of third- or fourth-degree perineal injury (OR, 0.63 [95% CI, 0.49-0.81]), in addition to reductions in operative vaginal birth (OR, 0.87 [95% CI, 0.79-0.97]), macrosomia (OR, 0.66 [95% CI, 0.48-0.91]), and low 5-minute Apgar score (OR, 0.62 [95% CI, 0.40-0.96]). Results were similar when confined to multiparous women only, with the addition of a substantial reduction in the likelihood of emergency cesarean section (OR, 0.61 [95% CI, 0.38-0.98]) and no difference in operative vaginal birth (OR, 1.01 [95% CI, 0.84-1.21]). However, among nulliparous women only, induction of labor was associated with an increased likelihood of shoulder dystocia (OR, 1.22 [95% CI, 1.02-1.46]) compared with expectant management.
CONCLUSIONS AND RELEVANCE
In this study, induction of labor at 39 weeks was associated with improved maternal labor-related and neonatal outcomes. However, among nulliparous women, induction of labor was associated with shoulder dystocia. These results suggest that elective induction of labor at 39 weeks may be safe and beneficial for some women; however, potential risks should be discussed with nulliparous women.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Cesarean Section; Fetal Macrosomia; Cross-Sectional Studies; Shoulder Dystocia; Labor, Induced; Labor, Obstetric; Obstetric Labor Complications; Infant, Newborn, Diseases
PubMed: 37171818
DOI: 10.1001/jamanetworkopen.2023.13162