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Best Practice & Research. Clinical... Dec 2022Postpartum haemorrhage (PPH) is one of the most common causes of maternal mortality worldwide. Management of PPH depends on the severity of bleeding. If the bleeding is... (Review)
Review
Postpartum haemorrhage (PPH) is one of the most common causes of maternal mortality worldwide. Management of PPH depends on the severity of bleeding. If the bleeding is severe, aorta compression can reduce bleeding. It should be followed by insertion of two coarse needles for intravenous access and blood sampling for haemoglobin and haemostasis. Further on, monitoring of vital parameters, as well as provision of extra oxygen and warm crystalloids, should be performed. Uterine atony is the most common cause of PPH and local guidelines for uterotonic drug selection should be followed. Patients with ongoing bleeding should immediately receive surgical care for bleeding control. During severe ongoing bleeding, haemostasis care includes early tranexamic acid, transfusion in ratio 4:4:1 (blood:plasma:platelets), and extra fibrinogen intravenously. If not severe PPH, use goal-directed therapy. During general anaesthesia and uterine atony, stop volatile anaesthesia and change to intravenous anaesthesia.
Topics: Female; Humans; Postpartum Hemorrhage; Uterine Inertia; Blood Transfusion; Tranexamic Acid; Hemostatics
PubMed: 36513436
DOI: 10.1016/j.bpa.2022.09.003 -
Polish Journal of Veterinary Sciences Dec 2023The Black-and-White (BW) breed, which until recently had dominated in Europe, was replaced by the Holstein-Friesian (HF) breed. As a result, the incidence of dystocia...
The Black-and-White (BW) breed, which until recently had dominated in Europe, was replaced by the Holstein-Friesian (HF) breed. As a result, the incidence of dystocia has increased. Dystocia occurs most frequently in heifers, and it is associated with high calf weight and/or too narrow pelvic openings in heifers. The aim of this study was to evaluate retrospectively the effects of pelvic dimensions and rump angle on calving ease in two cattle breeds. The research was carried out in four barns where BW and HF cattle were used. The course of parturition was evaluated in 317 heifers (BW, n=169; HF, n=148) based on direct observations. Calves were weighed, external and internal pelvic measurements were performed (using the Rice pelvimeter), and rump angle was determined in heifers. Based on the course of parturition, heifers of both breeds were divided into easy calving (EC) and difficult calving (DC) groups. The frequency of DC was 24.3% in HF heifers and 13.1% in BW heifers. In comparison with DC heifers, EC heifers had a larger pelvic area, in particular the internal dimensions of the bony pelvis, and a higher rump angle. In comparison with BW heifers, HF heifers had a smaller rump angle, a narrower pelvis and a lower ratio of pelvic area to calf weight. High dystocia rates in HF heifers could result from a relatively large fetus size and a less preferable pelvic size and rump angle. High variation in the internal pelvic dimensions in HF heifers indicates that the incidence of dystocia can be reduced through selection for a larger pelvic size and the optimal rump angle.
Topics: Cattle; Pregnancy; Animals; Female; Birth Weight; Retrospective Studies; Pelvis; Dystocia; Parturition; Cattle Diseases
PubMed: 38088415
DOI: 10.24425/pjvs.2023.148288 -
Reproduction in Domestic Animals =... Sep 2023Ultrasonography can be used for canine pregnancy diagnosis, determination of gestational age, assessing foetal maturation and readiness for birth, monitoring high-risk... (Review)
Review
Ultrasonography can be used for canine pregnancy diagnosis, determination of gestational age, assessing foetal maturation and readiness for birth, monitoring high-risk pregnancies, assessing foetal distress, evaluating bitches in dystocia and foetal gender determination. As the quality and resolution of ultrasound machines have improved, the clinician's abilities to utilize ultrasound as an integral part of reproductive evaluation of all aspects of pregnancy have exponentially increased. This paper reviews the use of ultrasonography throughout pregnancy and the advances made in the interpretation of captured images.
Topics: Female; Pregnancy; Animals; Dogs; Dystocia; Fetal Development; Gestational Age; Reproduction; Ultrasonography; Dog Diseases
PubMed: 37724659
DOI: 10.1111/rda.14446 -
Medicina (Kaunas, Lithuania) Mar 2021: Fetal overgrowth is related to many perinatal complications, including stillbirth, cesarean section, maternal and neonatal injuries, and shoulder dystocia. It is... (Review)
Review
: Fetal overgrowth is related to many perinatal complications, including stillbirth, cesarean section, maternal and neonatal injuries, and shoulder dystocia. It is related to maternal diabetes, obesity, and gestational weight gain but also happens in low-risk pregnancies. There is ongoing discussion regarding definitions, methods of detection, and classification. The method used for detection is crucial as it draws a line between those at risk and low-risk popula-tions. : For this narrative review, relevant evidence was identified through PubMed search with one of the general terms (macrosomia, large-for-gestational-age) combined with the outcome of interest. : This review summarizes evidence on the relation of fetal overgrowth with stillbirth, cesarean sections, shoulder dystocia, anal sphincter injury, and hem-orrhage. Customized growth charts help to detect mothers and fetuses at risk of those complica-tions. Relations between fetal overgrowth and diabetes, maternal weight, and gestational weight gain were investigated. : a substantial proportion of complications are an effect of the fetus growing above its potential and should be recognized as a new dangerous condition of Fetal Growth Acceleration.
Topics: Acceleration; Cesarean Section; Diabetes, Gestational; Dystocia; Female; Fetal Macrosomia; Humans; Infant; Infant, Newborn; Pregnancy
PubMed: 33801377
DOI: 10.3390/medicina57030228 -
American Journal of Obstetrics and... Apr 2021Amniotic fluid embolism is a rare syndrome characterized by sudden cardiorespiratory collapse during labor or soon after delivery. Because of its rarity, many...
Amniotic fluid embolism is a rare syndrome characterized by sudden cardiorespiratory collapse during labor or soon after delivery. Because of its rarity, many obstetrical providers have no experience in managing amniotic fluid embolism and may therefore benefit from a cognitive aid such as a checklist. We present a sample checklist for the initial management of amniotic fluid embolism based on standard management guidelines. We also suggest steps that each facility can take to implement the checklist effectively.
Topics: Airway Management; Cesarean Section; Checklist; Disseminated Intravascular Coagulation; Embolism, Amniotic Fluid; Female; Heart Arrest; Humans; Hypertension, Pulmonary; Postpartum Hemorrhage; Pregnancy; Uterine Inertia; Ventricular Dysfunction, Right
PubMed: 33417901
DOI: 10.1016/j.ajog.2021.01.001 -
The Journal of Dairy Research Aug 2023We investigated the relationship between dam's pelvic and calf's dimensions with dystocia due to fetopelvic disproportion in the Holstein breed and estimated risk...
We investigated the relationship between dam's pelvic and calf's dimensions with dystocia due to fetopelvic disproportion in the Holstein breed and estimated risk factors and dystocia probability. For this purpose, external pelvic measurements were performed in 402 heifers 15 ± 11 (1-38) days ante-partum and specific conformation measurements were obtained from their calves 1.7 ± 1.2 post-partum. Dystocia was defined as the inability of the heifer to complete parturition spontaneously within 120 min after the appearance of the amnion with normal presentation, position and posture or as having definite obstetrical obstacles within 60 min. Overall and fetopelvic disproportion dystocia incidence was 10.4% and 5.2%, respectively. Heifer measurements mainly influenced overall dystocia, whereas calf conformation was related solely with fetopelvic dystocia. Specifically, heifers with a small pelvis (hip width <49.95 cm, pelvic inlet area <333.2 cm, pelvic volume <7799.2 cm) had 2.8 to 3.5 times greater incidence of overall dystocia (19.0-20.8%) compared to heifers with a larger pelvis (incidence of 7.0-7.6%). Regarding calf factors, sex (male calves), body weight, chest circumference and fetlock joint circumference significantly increased the odds of experiencing dystocia due to fetopelvic disproportion compared with female, lighter or smaller calves. In a backward elimination model with independent variables treated as continuous, an area under the ROC curve of 0.66 regarding the prediction of overall dystocia based on heifer pelvic length, and of 0.64 for the prediction of fetopelvic dystocia based on fetlock joint circumference was found. The combination of the two variables in one model improved the ROC area to 0.71 regarding dystocia due to fetopelvic disproportion, reaching acceptable level of discrimination. Our findings indicate that dystocia due to fetopelvic disproportion in heifers is mainly influenced by the fetal side. Additionally, the estimation of pelvic dimensions of the dam before parturition and specific conformation characteristics of the calf during parturition, especially fetlock joint circumference, could aid obstetricians and herdsmen regarding dystocia probability and parturition surveillance.
Topics: Pregnancy; Animals; Cattle; Female; Male; Birth Weight; Dystocia; Pelvis; Body Weight; Parturition; Cattle Diseases
PubMed: 37587723
DOI: 10.1017/S0022029923000468 -
American Journal of Obstetrics &... Jul 2021Although the neonatal morbidity associated with shoulder dystocia are well known, the maternal morbidity caused by this obstetrical emergency is infrequently reported. (Observational Study)
Observational Study
BACKGROUND
Although the neonatal morbidity associated with shoulder dystocia are well known, the maternal morbidity caused by this obstetrical emergency is infrequently reported.
OBJECTIVE
This study aimed to assess the composite adverse maternal and neonatal outcomes among vaginal deliveries (at 34 weeks or later) with and without shoulder dystocia.
STUDY DESIGN
This is a secondary analysis of the Consortium of Safe Labor, an observational obstetrical cohort of all vaginal deliveries occurring at 19 hospitals (from 2002-2008) and for which data on the occurrence of shoulder dystocia were available. The composite adverse maternal outcome included third- or fourth-degree perineal laceration, postpartum hemorrhage (>500 cc blood loss for a vaginal delivery and >1000 cc blood loss for cesarean delivery), blood transfusion, chorioamnionitis, endometritis, thromboembolism, admission to intensive care unit, or maternal death. The composite adverse neonatal outcome included an Apgar score of <7 at 5 minutes, a birth injury, neonatal seizure, hypoxic ischemic encephalopathy, or neonatal death. A multivariable Poisson regression was used to estimate the adjusted relative risks with 95% confidence intervals. The area under the receiver operating characteristic curve was constructed to determine if clinical factors would identify shoulder dystocia.
RESULTS
Of the 228,438 women in the overall cohort, 130,008 (59.6%) met the inclusion criteria, and among them, shoulder dystocia was documented in 2159 (1.7%) cases. The rate of composite maternal morbidity was significantly higher among deliveries with shoulder dystocia (14.7%) than without (8.6%; adjusted relative risk, 1.71; 95% confidence interval, 1.64-2.01). The most common maternal morbidity with shoulder dystocia was a third- or fourth-degree laceration (adjusted relative risk, 2.82; 95% confidence interval, 2.39-3.31). The risk of composite neonatal morbidity with shoulder dystocia (12.2%) was also significantly higher than without shoulder dystocia (2.4%) (adjusted relative risk, 5.18; 95% confidence interval, 4.60-5.84). The most common neonatal morbidity was birth injury (adjusted relative risk, 5.39; 95% confidence interval, 4.71-6.17). The area under the curve for maternal characteristics to identify shoulder dystocia was 0.66 and it was 0.67 for intrapartum factors.
CONCLUSION
Although shoulder dystocia is unpredictable, the associated morbidity affects both mothers and newborns. The focus should be on concurrently averting the composite morbidity for the maternal-neonatal dyad with shoulder dystocia.
Topics: Birth Injuries; Cesarean Section; Delivery, Obstetric; Female; Humans; Infant, Newborn; Postpartum Hemorrhage; Pregnancy; Shoulder Dystocia
PubMed: 33757935
DOI: 10.1016/j.ajogmf.2021.100359 -
Tierarztliche Praxis. Ausgabe G,... Oct 2023Dystocia represents a life-threatening condition for mare and foal. Morbidity and mortality rates due to a difficult birth, as well as the influence on fertility of the... (Review)
Review
Dystocia represents a life-threatening condition for mare and foal. Morbidity and mortality rates due to a difficult birth, as well as the influence on fertility of the mare were analyzed, based on a review of publications. This was aggravated by the fact that no standardized diagnostic code was used and that most publications do not clearly describe how extensively the examinations were performed beforehand. Retentio secundinarum is the most common complication caused by dystocia. Other complications are injuries to the soft birth canal and the colon. These occur more frequently after surgical obstetrics than following assisted vaginal deliveries. Performing a fetotomy increases the risk of injury to the birth canal. After a caesarean section, the risk for retained placenta increases significantly. In order to evaluate the possibility of medical progress over time, mortality rates of mare and foal were investigated and divided in surgical and conservative obstetrics within the period of 1970-1990 and 1991-2021. The average maternal mortality rate following caesarean section amounted to 18% in the time period between 1970 and 1990 and 14% between the years from 1991-2021. After fetotomy, the two determined mortality rates amounted to 29% and 10% for the time between 1970 and 1990. In the period 1991-2021, the rate varies between 4% and 44% with an average mortality rate of 14%. Following controlled vaginal delivery, the average mortality rate is 9%. Literary sources were however only available for the current time period and range between 6% and 29%. The morbidity and mortality rate of foals is very high. Following caesarean section on average 53% of foals are dead on delivery, with a range of 13-79% in case reports from the years 1991-2021. The number of dead foals in the context of conservative obstetrics is of a similar scale. Postnatal foal diseases are largely due to intrapartum hypoxia during dystocia and obstetric injury. In consequence of a difficult delivery, mares experience reduced fertility. In numerous cases this however may be compensated by pausing from further breeding in the same year. The number of cases evaluated in this context however remains too small to advocate any recommendations for breeding following incidents of dystocia.
Topics: Animals; Horses; Female; Pregnancy; Cesarean Section; Dystocia; Delivery, Obstetric; Parturition; Morbidity
PubMed: 37956674
DOI: 10.1055/a-2180-2182 -
Journal of Feline Medicine and Surgery Mar 2022Cats are common pets worldwide. Successful breeding of cats starts with the selection of suitable breeding animals, and care should be taken to avoid inbreeding. Keeping... (Review)
Review
PRACTICAL RELEVANCE
Cats are common pets worldwide. Successful breeding of cats starts with the selection of suitable breeding animals, and care should be taken to avoid inbreeding. Keeping cats in smaller groups reduces stress and facilitates management.
CLINICAL CHALLENGES
Breeding cats is challenging in many ways. Group housing is a common scenario, and care should be taken not to have groups that are too large, because of the risk of stress and infectious diseases. Feline pregnancy and parturition both vary in length, which is one reason why it may be challenging to diagnose dystocia. In queens with pyometra, a vaginal discharge may not be evident due to their meticulous cleaning habits.
AUDIENCE
This review is aimed at clinicians in small animal practice, especially those in contact with cat breeders.
PATIENT GROUP
Reproductive emergencies occur in both intentionally and unintentionally bred cats, and more often in young or middle-aged queens. Pyometra tends to be a disease of older queens.
EVIDENCE BASE
Evidence is poor for many conditions in the breeding queen, and information is extrapolated from the dog or based on case reports and case series.
Topics: Animals; Breeding; Cat Diseases; Cats; Communicable Diseases; Dystocia; Female; Pregnancy; Pregnancy Complications; Pyometra; Reproduction
PubMed: 35209770
DOI: 10.1177/1098612X221079708 -
The Medico-legal Journal Mar 2022Shoulder dystocia, or shoulder entrapment at birth, is an obstetrician's nightmare, which not infrequently leads to court litigation with complaints of serious foetal...
Shoulder dystocia, or shoulder entrapment at birth, is an obstetrician's nightmare, which not infrequently leads to court litigation with complaints of serious foetal and/or maternal damage. Increasingly, retrospective management scrutiny is extending well beyond second stage birth mechanics and involving all case file entries, history taking, ultrasound scan measurements and haematology profile results, etc. The article highlights some medico-legal issues including the influence of the ruling on patient disclosure and subsequent management.
Topics: Dystocia; Female; Humans; Infant, Newborn; Pregnancy; Retrospective Studies; Shoulder; Shoulder Dystocia
PubMed: 35156438
DOI: 10.1177/00258172211066364