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Journal of Perinatal Medicine Jul 2023To determine the effect of gestational age at delivery on maternal and neonatal outcomes in preterm prelabor rupture of membranes (PPROM) and assess various predictors...
OBJECTIVES
To determine the effect of gestational age at delivery on maternal and neonatal outcomes in preterm prelabor rupture of membranes (PPROM) and assess various predictors of neonatal and infant mortality in these pregnancies.
METHODS
United States birth data from CDC-National Center for Health Statistics natality database for years 2004-2008 was used to identify singleton pregnancies with PPROM and delivery from 32 0/7 to 36 6/7 weeks. Controls were singletons at 37-40 weeks, without PPROM. Maternal and neonatal complications reported by all states were analyzed along with neonatal outcomes such as chorioamnionitis and hyaline membrane disease, reported by a subgroup of states. OR (95% CI) were calculated after adjusting for preeclampsia, diabetes, chronic hypertension, maternal race, and infant sex.
RESULTS
There were 134,502 PPROM cases and similar number of controls. There was a significant decrease in need for prolonged ventilation, hyaline membrane disease, 5 min Apgar score <7, and NICU admission with advancing gestational age. Placental abruption decreased and chorioamnionitis and cord prolapse were not different between 34 and 37 weeks. We found reductions in early death, neonatal death, and infant mortality with advancing gestational age (p<0.001 for each). Gestational age at delivery was the strongest predictor for early death, neonatal death, and infant mortality in PPROM. These differences persisted after adjusting for antenatal steroid use.
CONCLUSIONS
We provide population-based evidence showing a decrease in neonatal complications and death with advancing gestational age in PPROM. Gestational age at delivery in pregnancies with PPROM is the strongest predictor of mortality risk.
Topics: Infant, Newborn; Infant; Pregnancy; Female; Humans; Chorioamnionitis; Perinatal Death; Hyaline Membrane Disease; Placenta; Fetal Membranes, Premature Rupture; Gestational Age; Retrospective Studies; Pregnancy Outcome
PubMed: 36732494
DOI: 10.1515/jpm-2022-0373 -
American Journal of Obstetrics and... May 2022
Topics: Acidosis; Female; Fetal Diseases; Heart Rate, Fetal; Humans; Pregnancy; Prolapse; Umbilical Cord
PubMed: 34914895
DOI: 10.1016/j.ajog.2021.12.008 -
International Journal of Surgery Case... Jan 2022With the widespread use of laparoscopic inguinal hernia repair, it is known that some clinically evident inguinal hernias lack a peritoneal sac and are referred to as...
INTRODUCTION AND IMPORTANCE
With the widespread use of laparoscopic inguinal hernia repair, it is known that some clinically evident inguinal hernias lack a peritoneal sac and are referred to as "sacless hernias".
PRESENTATION OF CASE
A 61-year-old man presented with a left inguinal bulge. On physical examination, the diagnosis of bilateral inguinal hernias was made, and laparoscopic transabdominal repair was performed. Intraoperatively, the left peritoneal hernia orifice was not identified from the peritoneal cavity and there was only a lipoma. Pressing the lipoma with forceps from inside the peritoneum confirmed the presence of a hernia. The preperitoneal space was opened and the hernia orifice revealed.
DISCUSSION
The terminology and definition of sacless hernias are poorly defined, even though this is not a rare condition. Consistent with Russell's dogma, there are arguments that any prolapse can only be called a hernia if there is an accompanying peritoneal sac. The proportion of patients with sacless hernias and pure cord lipomas are very similar and these conditions are often confused. Detailed and repeated physical examination may distinguish a sacless hernia from a pure lipoma. A watchful waiting strategy is useful and ensures safety.
CONCLUSION
Once the diagnosis of inguinal hernia is made on physical examination, open the preperitoneal cavity if a peritoneal hernia orifice was not identified during laparoscopy.
PubMed: 34902700
DOI: 10.1016/j.ijscr.2021.106667 -
Journal of Gynecology Obstetrics and... Nov 2020Although its role in the prognosis for delivery remains controversial, the type of breech is sometimes taken into account in the decision about mode of delivery.... (Comparative Study)
Comparative Study
BACKGROUND
Although its role in the prognosis for delivery remains controversial, the type of breech is sometimes taken into account in the decision about mode of delivery. Objective of our study was to compare maternal and neonatal morbidity for trial of vaginal delivery according to the type of breech (complete or frank).
MATERIAL AND METHOD
Single-center retrospective study of women with trials of vaginal delivery of a singleton fetus in breech presentation at of after 37 weeks of gestation. Neonatal status was assessed by the composite variable of the Term Breech Trial, first considered alone, and then with the addition of a 5-min Apgar score < 7 or a neonatal arterial pH<7.0.
RESULTS
Of the 495 trials of vaginal delivery during the study period, approximately one third of them were complete breech (35.8 %) and two thirds frank (64.2 %). The frequency of cesareans during labor was similar regardless of the type of breech (16.4 for complete vs 12.6 % for frank, p=0.24), nor did neonatal morbidity differ (1.7 for complete vs 4.1 % for frank, p=0.15). On the other hand, cord prolapse occurred almost exclusively in complete breech presentations (4.5 vs 0.3 %, p<0.01), and prognosis was good in all cases. Complete breech presentations were also associated with more frequent use of forceps to the after-coming head (16.2 vs 9.7 %, p<0.05). Finally, there were non significant difference between the two types of breech concerning severe acidosis but it seemed to have it more in frank breech (2.3 vs 1.2 %, p=0.34).
CONCLUSION
Among women eligible for vaginal delivery, the type of breech presentation (complete or frank) has little influence on delivery maternal and neonatal morbidity. The type of breech need not be taken into account in deciding the route of delivery.
Topics: Adult; Body Mass Index; Breech Presentation; Cesarean Section; Delivery, Obstetric; Female; Gestational Age; Humans; Infant, Newborn; Pregnancy; Pregnancy Outcome; Prognosis; Retrospective Studies
PubMed: 32574703
DOI: 10.1016/j.jogoh.2020.101832 -
Neurology India 2022'White-cord syndrome' is an extremely rare entity following decompression of cervical cord in which post-operative reperfusion injury results in worsening of patient's...
BACKGROUND
'White-cord syndrome' is an extremely rare entity following decompression of cervical cord in which post-operative reperfusion injury results in worsening of patient's neurology and MRI reveals signal changes in spinal cord in absence of cord compression. We wish to report a case of 'white-cord syndrome' following a 'routine' ACDF.
CASE DESCRIPTION
A 39-year-old woman with paresthesias and spastic quadriparesis was found to have C5-C6 PIVD on MRI. ACDF was performed at C5-C6, after which worsening of quadriparesis was noted, for which intravenous high-dose steroids were started. An urgent MRI was done, which revealed findings of white-cord syndrome, without compression on underlying cord. With conservative management, her ASIA grade improved from C to D and the features of white-cord syndrome disappeared on follow-up imaging.
CONCLUSION
It is important for surgeons and patients to be aware of this rare but potentially catastrophic entity as this needs to be discussed while taking consent for surgery.
Topics: Adult; Female; Humans; Cervical Vertebrae; Decompression, Surgical; Diskectomy; Glucocorticoids; Magnetic Resonance Imaging; Paresthesia; Quadriplegia; Reperfusion Injury; Spinal Cord; Spinal Cord Diseases; Spinal Fusion; Syndrome
PubMed: 36412386
DOI: 10.4103/0028-3886.360940 -
American Journal of Obstetrics &... Sep 2021Fetal malpresentation complicates approximately 3% to 4% of all term births. It requires special considerations for delivery and exposes the mother and neonate to...
OBJECTIVE
Fetal malpresentation complicates approximately 3% to 4% of all term births. It requires special considerations for delivery and exposes the mother and neonate to obstetrical interventions and potential adverse outcomes, such as umbilical cord prolapse, head entrapment and birth trauma, hypoxic ischemic encephalopathy, cesarean delivery, and cesarean delivery-related complications. We set out to explore the maternal and fetal factors associated with noncephalic malpresentation at term, with specific interest on the impact of maternal race and ethnicity on fetal malpresentation.
STUDY DESIGN
This was a retrospective analysis of the Centers for Disease Control and Prevention Natality Live Birth database for the years from 2016 through 2018. All term, singleton deliveries for the following racial and ethnic groups were included: non-Hispanic White, non-Hispanic Black, Asian, and Hispanic. Race and ethnicity were assigned based on self-identification and individuals with >1 racial category were excluded from the analysis. Malpresentation was defined as a noncephalic presentation at term and included breech and transverse presentations. The malpresentation group included all noncephalic births and cephalic births that occurred following successful external cephalic version, whereas all other cephalic births served as controls. A multivariable logistic regression analysis was used to assess the rate of malpresentation, with adjustment for potential confounders including maternal age, race and ethnicity, parity, birthweight, fetal malformations, malformations of the central nervous system (CNS), and chromosomal anomalies. The results are displayed as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Statistical significance was set at a P value of <.05. Institutional review board approval was not required because the de-identified data are publicly available through a data use agreement.
RESULTS
There were 9,692,203 term, singleton births during the study period. The malpresentation group included 354,689 births (3.66% of the total). The Table shows the rate of malpresentation for various maternal and fetal factors. We found a substantial racial and ethnic disparity in the malpresentation rates. Non-Hispanic White women had the highest malpresentation risk, whereas non-Hispanic Black women had the lowest risk (3.93% vs 2.81%; aOR, 1.38; 95% CI, 1.36-1.39). Hispanic and Asian women were also at increased risk for malpresentation when compared with non-Hispanic Black women (aOR, 1.30; 95% CI, 1.29-1.32 and aOR, 1.12; 95% CI, 1.10-1.14, respectively). In addition, several maternal and fetal conditions were noted to be associated with an increased risk for malpresentation at term, including older maternal age (aOR, 2.81; 95% CI, 2.74-2.88; for patients >40 years), nulliparity (aOR, 1.50; 95% CI, 1.48-1.51), low birthweight (aOR, 1.80; 95% CI, 1.77-1.83 for birthweight under 2500 g), and fetal malformations of the CNS and chromosomal anomalies (aOR, 3.53; 95% CI, 3.06-4.06 and aOR, 2.32; 95% CI, 2.05-2.63, respectively).
CONCLUSION
Based on a large US population database, we identified several maternal, fetal, and racial and ethnic factors that are associated with an increased rate of noncephalic malpresentation at term. Specifically, fetal CNS malformations, congenital or chromosomal anomalies, advanced maternal age, low birthweight, and nulliparity are risk factors for noncephalic presentation. Interestingly, non-Hispanic White women have the highest risk for malpresentation, whereas non-Hispanic Black women have the lowest risk. Previous publications found that low birthweight, advanced maternal age, nulliparity, and congenital fetal malformations are risk factors for malpresentation. Nonetheless, the current data available on race and ethnicity are sporadic, with limited reports suggesting that sub-Saharan ethnicity is associated with a lower rate of malpresentation and that White race is associated with a higher rate. We present a large-scale, nationwide US-based study to confirm the racial and ethnic disparity regarding malpresentation in the United States. This may be explained by the known variation in the shape of the bony birth canal in different racial and ethnic groups and populations from different geographic locations. Further investigation is needed to explore the racial and ethnic disparity described.
Topics: Adult; Causality; Ethnicity; Female; Humans; Infant, Newborn; Labor Presentation; Maternal Age; Pregnancy; Retrospective Studies; United States
PubMed: 34091061
DOI: 10.1016/j.ajogmf.2021.100405 -
Prehospital Emergency Care 2022Umbilical cord prolapse is an acute obstetric emergency associated with high fetal morbidity and mortality. To avoid poor outcomes, rapid diagnosis with immediate... (Review)
Review
Umbilical cord prolapse is an acute obstetric emergency associated with high fetal morbidity and mortality. To avoid poor outcomes, rapid diagnosis with immediate intervention is required, especially in the prehospital setting where resources are limited. In this case report, we describe a 38-year-old woman with umbilical cord prolapse, with a review of appropriate prehospital maneuvers and treatment.
Topics: Adult; Emergency Medical Services; Female; Humans; Obstetric Labor Complications; Pregnancy; Prolapse; Umbilical Cord
PubMed: 33595425
DOI: 10.1080/10903127.2021.1890285 -
Morphologie : Bulletin de L'Association... Sep 2021Long term survival of animals with major congenital anomalies is very rare. This report documents the 18-month survival of a dog with multiple anomalies including...
Long term survival of animals with major congenital anomalies is very rare. This report documents the 18-month survival of a dog with multiple anomalies including atresia ani. An 18-month-old black Cocker Spaniel bitch was presented for evaluation of prolapsed glands of the third eyelid involving both the eyes. Clinical examination revealed a single perineal opening, fecal matter in the vestibule, distended abdomen, hypoplastic vulva, and the absence of a tail without any neurological deficits. Abdominal contrast radiography revealed a distended colon with fecal stasis, rectovestibular fistula, termination of the rectum as a blind pouch, lumbar scoliosis due to block vertebrae, and the presence of only two hypoplastic coccygeal vertebrae. The case was diagnosed as atresia ani type II with rectovestibular fistula, hypoplastic vulva, lumbar scoliosis, and anury, in the global context of a caudal regression syndrome. The wide aperture fistula, connected to the vestibule, undamaged spinal cord and sacrum without any neurological deficits were the favorable prognostic factors that maintained continence and allowed the dog to survive to adult life with these anomalies. Thus, an appropriate bowel management program and specialty care can improve the quality of life and longevity of this animal.
Topics: Abnormalities, Multiple; Animals; Anus, Imperforate; Dogs; Female; Quality of Life; Rectum
PubMed: 33172785
DOI: 10.1016/j.morpho.2020.10.001 -
Kathmandu University Medical Journal... 2022Background Intrauterine fetal death (IUFD) is a demise occurring at 20 or more weeks of gestation and weight 500 gram or more. Intrauterine fetal death at any point... (Observational Study)
Observational Study
Background Intrauterine fetal death (IUFD) is a demise occurring at 20 or more weeks of gestation and weight 500 gram or more. Intrauterine fetal death at any point during gestation is a traumatic event not only to the patient but also to the care giver. The purpose of this study is to know the risk factors associated with intrauterine fetal death. Objective To determine the factors associated with intrauterine fetal death. Method Prospective observational study was conducted at Paropkar maternity women's hospital, Thapathali, Kathmandu. All the cases with intrauterine fetal death were admitted and delivered in the hospital with period of gestation 20 weeks to term pregnancy. All the relevant data were recorded in pre-designed proforma. The collected data were entered in SPSS 25 version for analysis. Result There was a total 5153 deliveries in three months, with prevalence of 1.2% and intrauterine rate of 12.03 per 1000 births. Out of 50 enrolled cases, 78% (n=50) of patient had not attended antenatal checkup. Majority (n=50; 74%), belonged to age group 21-35 years, 48% of intrauterine fetal death were term pregnancies of 37 to 42 weeks of gestation. Maximum 20% of IUFD, weighed between (1-1.5 kg) (1.5-2 kg) and (2.5-3 kg). Thirty-nine babies were macerated and eleven non-macerated. Pregnancy induced hypertension was most common (26%), followed by ante-partum hemorrhage (8%), hypothyroidism and anemia (6%), meconium stained liquor and cord prolapse (6%), gestational diabetes mellitus, congenital anomalies, chronic hypertension (4%), intrauterine growth restriction and urinary tract infection (2%). Twelve cases underwent cesarean section. Postpartum complications were found in 10 cases; 4 cases had postpartum hemorrhage, 4 had prolonged hospital stay and 2 cases developed hemolysis, elevated liver enzyme, low platelet count (HELLP) syndrome. Conclusion This study concluded that maximum no. of intrauterine fetal death were seen antenatally, as 78% of cases were found macerated. The commonest identified risk factor was pregnancy induced hypertension, followed by ante-partum hemorrhage, anemia, hypothyroidism, which seem to be preventable risk factors of intrauterine fetal death, but still unidentified risk factors are of great challenges for the obstetricians.
Topics: Female; Pregnancy; Humans; Young Adult; Adult; Cesarean Section; Hypertension, Pregnancy-Induced; Fetal Death; Stillbirth; Hospitals; Hemorrhage
PubMed: 37042362
DOI: No ID Found -
Journal of Obstetrics and Gynaecology... Feb 2022The purpose of this study was to better understand obstetric codes requiring rapid response team activation by examining their incidence, indications, team response, and...
OBJECTIVE
The purpose of this study was to better understand obstetric codes requiring rapid response team activation by examining their incidence, indications, team response, and patient outcomes.
METHODS
This was a retrospective study in peripartum women who required activation of the following codes during hospitalization between January 2014 and May 2018: "Code 77 (C77)" (obstetric emergency), "Code Blue (CB)" (cardiopulmonary compromise) or "Code Omega (CO)" (massive transfusion). Hospital database and health records were searched to identify and review cases. Data on code characteristics, resuscitative measures, and maternal and neonatal outcomes were collected.
RESULTS
A total of 147 codes were identified during the study period (C77, 110; CO, 25; CB 12), with an overall incidence of 1 per 203 deliveries (C77, 1:271 deliveries, CO, 1:1194 deliveries; CB, 1:2488 deliveries). Common indications for C77 were cord prolapse (33%) and fetal bradycardia (32%), and for CO and CB, postpartum hemorrhage (84%) and cardiac arrest (42%), respectively. Most codes (67%) occurred after hours. The median decision-to-delivery interval was 8 (interquartile range 5-15) minutes after C77. Emergency cesarean delivery was performed for 57% of obstetric emergencies, and general anesthesia was administered in 63% of cesarean deliveries. Maternal and neonatal mortality rates were 0.68% and 7%, respectively. Major maternal morbidity was seen in 33% of cases. Debrief was documented for 4% of codes.
CONCLUSION
Rapid response team activation was required more commonly in C77 than in CO or CB. Their response time and decision-to-delivery intervals were rapid. Mortality was low; however, one-third of parturients had major morbidities. We suggest closer patient monitoring, immediate availability of resources, and appropriate documentation and debriefing.
Topics: Cesarean Section; Delivery, Obstetric; Emergencies; Female; Hospital Rapid Response Team; Humans; Infant, Newborn; Pregnancy; Retrospective Studies; Tertiary Care Centers
PubMed: 34656770
DOI: 10.1016/j.jogc.2021.09.016