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European Journal of Obstetrics,... Mar 2020Assess the impact of implementation by simple distribution of a "colour code" protocol for emergency caesareans on the course over time of the "decision-delivery... (Observational Study)
Observational Study
OBJECTIVE
Assess the impact of implementation by simple distribution of a "colour code" protocol for emergency caesareans on the course over time of the "decision-delivery interval" (DDI) and neonatal outcome.
DESIGN
Observational study in 26 maternity units of the AURORE perinatal network, conducted between October 1, 2017, and April 30, 2018. Each maternity ward́ was supposed to prospectively include 20 consecutive cases of caesareans performed either as an emergency, that is, as a code orange, or an extreme emergency, that is, code red. We compared the DDIs observed in 2017 to those in 2007 according to the degree of emergency, the maternity unit level of care, and their adherence to the protocol. Neonatal outcome in 2007 and 2017, assessed from laboratory and clinical indicators, was also compared, overall and according to the degree of emergency.
RESULTS
The DDI was significantly lower in 2017 (n = 478) than in 2007 (n = 447), regardless of the degree of emergency and the level of care (p < 0.0001). In 2017, all code red caesareans were performed in less than 15 min in level 3 maternity units compared with 73 % (p = 0.039) in 2007. Fewer than 20 % of the caesareans in the 2007 study period were performed in less than 15 min in level 1 and 2 maternity units. Today, this is the case for 83 % of these caesareans in level 2 units (p < 0.001) and 36 % in level 1 (p = 0.01). In 2017, code orange caesareans were performed in less than 30 min in 96 % of cases in level 3 units, 67 % in level 2, and 33 % in level 1, compared respectively with 67 % (p = 0.015), 25 % (p < 0.0001) and 16 % (p = 0.0003) in 2007. We did not observe any difference in the neonatal outcome between 2007 and 2017 or as a function of the DDI expected based on the caesarean colour code.
CONCLUSION
The implementation of the colour code protocols was associated with an improved DDI and better adherence to the recommendations in all 26 maternity units in this perinatal network.
Topics: Abruptio Placentae; Adult; Certification; Cesarean Section; Clinical Decision-Making; Dystocia; Eclampsia; Emergencies; Extraction, Obstetrical; Female; Fetal Distress; France; Heart Rate, Fetal; Humans; Pre-Eclampsia; Pregnancy; Prolapse; Time-to-Treatment; Umbilical Cord; Uterine Rupture
PubMed: 31927407
DOI: 10.1016/j.ejogrb.2019.12.027 -
Heliyon Feb 2022Birth asphyxia is a condition of impaired gas exchange in newborns when the Apgar score is < 7 in the first 5 min. It accounts 31.6% of all neonatal deaths, and the...
INTRODUCTION
Birth asphyxia is a condition of impaired gas exchange in newborns when the Apgar score is < 7 in the first 5 min. It accounts 31.6% of all neonatal deaths, and the leading causes of neonatal mortality in Ethiopia. Identifying its determinant factors is very important to prevent the problem.Therefore, this study was aimed at identifying the determinant factors of birth asphyxia among newborns at Benishangul Gumuz region hospital.
METHODS AND MATERIALS
The hospital-based unmatched case-control study was done from March 04 to July 16, 2019 in Benishangul Gumuz Region Hospitals. Total sample size is 275 with 69 cases and 206 controls. Newborns with an Apgar score of less than 7 at 5 min were taken as cases, and those with greater or equal to 7 were taken as controls. All asphyxiated newborns were enrolled as cases, where as in every three-step non-asphyxiated newborns were taken as controls. The data was entered into Epi Info 7 and exported to SPSS for analysis. Bivariable logistic regression analysis was used. Those variables with a p-value <0.05 were identified as significant determinants of birth asphyxia.
RESULTS
In the current study, anemia during pregnancy [AOR = 2.95, 95% CI: (1.02, 8.54)], no ANC visit at all [AOR = 4.26, 95% CI: (1.23,14.7)], prolapsed cord [AOR = 4.52, 95% CI: (1.3, 21)], and low birth weight [AOR = 4.1, 95% CI: (1.11, 15.36] were all determinant factors for birth asphyxia.
CONCLUSION
and Recommendations: The identified determinants of birth asphyxia were anemia during pregnancy, no ANC visit at all, prolapsed cord, cesarean birth, and low birth weight.Based on our study, most of identified determinant factors of birth asphyxia were preventable so, policy makers, clinicians, and other stakeholders need to invest their maximum effort on prevention of birth asphyxia.
PubMed: 35198758
DOI: 10.1016/j.heliyon.2022.e08875 -
International Journal of Women's Health 2023We explored the feasibility and safety of external cephalic version (ECV) for cases of breech presentation.
OBJECTIVE
We explored the feasibility and safety of external cephalic version (ECV) for cases of breech presentation.
METHODS
We retrospectively analyzed data from 158 singleton pregnant women with breech presentation at 36 weeks gestation, admitted to Guangzhou Hospital of Integrated Traditional and Western Medicine from January 2018 to March 2022. 42 underwent ECV, categorized as the ECV group, while 116 without ECV comprised the control group. Systematic collection and evaluation of pregnancy outcomes were conducted for both groups.
RESULTS
Within the control group, 16 cases experienced a spontaneous transition to head presentation, among which 14 cases resulted in successful vaginal deliveries. In 2 cases, cesarean deliveries were performed due to fetal macrosomia and persistent posterior occipital presentation. Furthermore, 2 cases of breech presentation in pregnant women were successfully delivered vaginally through breech traction, necessitating an emergency procedure due to the wide opening of the uterus. Within the ECV group, 28 cases were successfully inverted to the cephalic presentation. Among them, 1 case underwent an emergency cesarean delivery due to fetal distress during cephalic delivery, 3 cases required cesarean deliveries due to abnormal labor, and 24 cases were successfully delivered vaginally. The comparative analyses showed that the cesarean section rate (18/42 vs 100/116) and non-cephalic delivery rate (14/42 vs 100/116) in the ECV group were significantly lower than those in the control group ( < 0.001). There was no statistically significant differences between the two groups with respect to the rate of newborns with Apgar score < 7 (1/42 vs 3/116), premature rupture of membrane (3/42 vs 20/116), acute fetal distress (2/42 vs 2/116), and cord prolapse (0/42 vs 1/116) ( > 0.05).
CONCLUSION
ECV can effectively reduce the rate of cesarean delivery and non-cephalic deliveries. However, it but requires strict adherence to indications and continuous monitoring.
PubMed: 38106566
DOI: 10.2147/IJWH.S428946 -
The Australian & New Zealand Journal of... Jun 2023Neonatal hypoxic ischaemic encephalopathy (HIE) is the most common cause of encephalopathy in the neonatal period and carries a high risk of mortality and long-term...
BACKGROUND
Neonatal hypoxic ischaemic encephalopathy (HIE) is the most common cause of encephalopathy in the neonatal period and carries a high risk of mortality and long-term morbidity.
AIM
The aim of this study was to investigate key antecedents of moderate and severe HIE in a large contemporary birth cohort.
METHODS
A retrospective cohort study of births meeting criteria was conducted between 2016 and 2020 at the Mater Mothers' Hospital, Brisbane, Australia. This is a quaternary perinatal centre and Australia's largest maternity hospital. Univariate and multivariate Firth logistic regression were used to account for imbalanced frequency classes between non-HIE and HIE groups. Maternal variables and intrapartum factors were investigated for associations with neonatal moderate and severe HIE.
RESULTS
Overall, 133 of 46 041 (0.29%) infants were diagnosed with HIE: 77 (0.17%) with mild HIE and 56 (0.12%) with moderate/severe HIE. Nulliparity, type 1 diabetes mellitus and maternal intensive care unit admission were associated with increased odds of moderate/severe HIE. Intrapartum risk factors included emergency caesarean birth, emergency caesarean for non-reassuring fetal status or failure to process, intrapartum haemorrhage and an intrapartum sentinel event (shoulder dystocia, cord prolapse, uterine rupture and placental abruption). Neonatal risk factors included male sex, late preterm gestation (35 -36 weeks), Apgar score less than four at 5 min, severe respiratory distress requiring ventilatory support and severe acidosis at birth.
CONCLUSIONS
This cohort study identified a series of potentially modifiable maternal and obstetric risk factors for HIE. Risk factors for HIE do not appear to have changed significantly with evolution in modern obstetric care.
Topics: Infant, Newborn; Infant; Humans; Male; Female; Pregnancy; Cohort Studies; Retrospective Studies; Hypoxia-Ischemia, Brain; Australia; Placenta
PubMed: 36974351
DOI: 10.1111/ajo.13665 -
Geburtshilfe Und Frauenheilkunde Apr 2022According to current guidelines, inpatient management until birth is considered standard in pregnant women with preterm premature rupture of membranes (PPROM). With the...
According to current guidelines, inpatient management until birth is considered standard in pregnant women with preterm premature rupture of membranes (PPROM). With the increasing burden on obstetric departments and the growing importance of satisfaction and right to self-determination in pregnant women, outpatient management in PPROM is a possible alternative to inpatient monitoring. The most important criterion for this approach is to ensure the safety of both the mother and the child. Due to the small number of cases (n = 116), two randomised controlled trials (RCTs) comparing inpatient and outpatient management were unable to draw any conclusions. By 2020, eight retrospective comparative studies (cohort/observational studies) yielded the following outcomes: no significant differences in the rate of maternal complications (e.g., chorioamnionitis, premature placental abruption, umbilical cord prolapse) and in neonatal morbidity, significantly prolonged latency period with higher gestational age at birth, higher birth weight of neonates, and significantly shorter length of stay of preterm infants in neonatal intensive care, shorter hospital stay of pregnant women, and lower treatment costs with outpatient management. Concerns regarding this approach are mainly related to unpredictable complications with the need for rapid obstetric interventions, which cannot be performed in time in an outpatient setting. Prerequisites for outpatient management are the compliance of the expectant mother, the adherence to strict selection criteria and the assurance of adequate monitoring at home. Future research should aim at more accurate risk assessment of obstetric complications through studies with higher case numbers and standardisation of outpatient management under evidence-based criteria.
PubMed: 35392068
DOI: 10.1055/a-1515-2801 -
BMJ Simulation & Technology Enhanced... 2021Umbilical cord prolapse is a rare obstetric emergency requiring rapid coordination of a multidisciplinary team to effect urgent delivery. The decision to delivery...
BACKGROUND
Umbilical cord prolapse is a rare obstetric emergency requiring rapid coordination of a multidisciplinary team to effect urgent delivery. The decision to delivery interval (DDI) is a marker of quality of teamwork. Multidisciplinary team simulation-based training can be used to improve clinical and teamwork performance.
AIM
To assess the DDI for cord prolapse before and after the introduction of simulation-based training at a quaternary maternity unit in Australia.
METHOD
A retrospective, observational cohort study comparing the DDI before and after the introduction of simulation-based training activities. The general linear model was used to estimate the association between DDI and simulation training while adjusting for potential confounders including model of care (public or private) and time of birth (regular or after hours).
RESULTS
After the introduction of simulation training, mean DDI decreased by 4.1 min (difference -4.1, 95% CI -6.2 to -1.9), after adjustment for confounding factors. Despite this, there was no difference in selected neonatal outcomes including Apgar score at 5 min and arterial cord pH.
CONCLUSIONS
The introduction of simulation-based training was associated with a decrease in the DDI in the setting of cord prolapse.
PubMed: 35520957
DOI: 10.1136/bmjstel-2021-000860 -
Journal of Visualized Experiments : JoVE Jun 2020External cephalic version (ECV) is an effective procedure for reducing the number of cesarean sections. To date, there is no video publication showing the methodology of...
External cephalic version (ECV) is an effective procedure for reducing the number of cesarean sections. To date, there is no video publication showing the methodology of this procedure. The main objective is to show how to perform ECV with a specific protocol with tocolysis before the procedure and analgesia. Moreover, we describe and analyze the factors associated with successful ECV, and also compare to deliveries in the general pregnant population. A retrospective and descriptive analysis of ECV carried out at the Hospital Clinico Universitario Virgen de la Arrixaca in Murcia (Spain) between 1/1/2014 and 12/31/2018 was assessed. The latest data available of labor deliveries in the local center, which is the biggest maternity department in Spain, were from 2018. 320 patients were recruited and 3 pregnant women were lost during the study. ECV was carried out at 37±3 weeks gestation. ECV was successful in 82.5% (N=264). 19 complications were reported (5.9%): 8 vaginal bleeding (2.5%), 9 fetal bradycardia (2.8%), 1 preterm rupture of membranes (0.3%) and 1 cord prolapse (0.3%). A previous vaginal delivery increases the success rate of ECV ORadjusted=3.03 (1.62-5.68). Maternal Body Mass Index (BMI) affects the success of ECV ORadjusted=0.94 (0.89-0.99). Patients with BMI>40 kg/m have an ORadjusted=0.09 (0.009-0.89) compared with those with BMI <25 kg/m. If ECV was successful, the cesarean delivery index is 22.2% (17.5-27.6%), the eutocic delivery index is 52.1% (46.1-58.1%) and the instrumented vaginal delivery index is 25.7% (20.7-31.2%). There are no differences in cesarean and eutocic delivery indexes after successful ECV. However, a successful ECV is associated with a 6.29% increase in the instrumented delivery rate (OR=1.63). ECV is an effective procedure to reduce the number of cesarean sections for breech presentations. Maternal BMI and previous vaginal delivery are associated with ECV success. Successful ECV does not modify the usual delivery pattern.
Topics: Adult; Breech Presentation; Cesarean Section; Female; Humans; Infant, Newborn; Pregnancy; Retrospective Studies; Safety; Version, Fetal
PubMed: 32568226
DOI: 10.3791/60636 -
Heliyon Oct 2021To this date, there are 4 systematic reviews and meta-analyses studies about the burden and associated factors of birth asphyxia in Ethiopia. However, findings of these...
BACKGROUND
To this date, there are 4 systematic reviews and meta-analyses studies about the burden and associated factors of birth asphyxia in Ethiopia. However, findings of these studies are inconsistent which is difficult to make use of the findings for preventing birth asphyxia in the country. Therefore, umbrella review of these studies is required to pool the inconsistent findings into a single summary estimate that can be easily referred by the information users in Ethiopia.
METHODS
PubMed, Science direct, web of science, data bases specific to systematic reviews such as the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects were searched for systematic reviews and meta-analyses (SRM) studies on the magnitude and risk factors of perinatal asphyxia in Ethiopia. The methodological quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. The estimates of the included SRM studies on the prevalence and predictors of perinatal asphyxia were pooled and summarized with random-effects meta-analysis models. From checking PROSPERO, this umbrella review wasn't registered.
RESULTS
We included four SRM studies with a total of 49,417 neonates. The summary estimate for prevalence of birth asphyxia was 22.52% (95% CI = 17.01%-28.02%; I = 0.00). From the umbrella review, the reported factors of statistical significance include: maternal illiteracy [AOR = 1.96; 95% CI: 1.44-2.67], primiparity [AOR = 1.29; 95% CI: 1.03-1.62], antepartum hemorrhage [AOR = 3.43; 95% CI: 1.74-6.77], pregnancy induced hypertension [AOR = 4.35; 95% CI: 2.98-6.36], premature rupture of membrane [AOR = 12.27; 95% CI: 2.41, 62.38], prolonged labor [AOR = 3.18; 95% CI: 2.75, 3.60], meconium-stained amniotic fluid [AOR = 5.94; 95% CI: 4.86, 7.03], instrumental delivery [AOR = 3.39; 95% CI: 2.46, 4.32], non-cephalic presentation [AOR = 3.39; 95% CI: 1.53, 5.26], cord prolapse [AOR = 2.95; 95% CI: 1.64, 5.30], labor induction [AOR = 3.69; 95% CI: 2.26-6.01], cesarean section delivery [AOR = 3.62; 95% CI: 3.36, 3.88], low birth weight [AOR = 6.06; 95% CI: 5.13, 6.98] and prematurity [AOR = 3.94; 95% CI: 3.67, 4.21] at 95% CI.
CONCLUSION
This umbrella review revealed high burden of birth asphyxia in Ethiopia. The study also indicated significant risk of birth asphyxia among mothers who were unable to read and write, primiparous mothers, those mothers having antepartum hemorrhage, pregnancy induced hypertension, premature rupture of membrane, prolonged labor, meconium-stained amniotic fluid, instrumental delivery, cesarean section delivery, non-cephalic presentation, cord prolapse and labor induction. Moreover, low birth weight and premature neonates were more vulnerable to birth asphyxia compared to their normal birth weight and term counterparts. Therefore, burden of birth asphyxia should be mitigated through special consideration of these risk mothers and neonates during antenatal care, labor and delivery. Mitigation of the problem demands the collaborative efforts of national, regional and local stakeholders of maternal and neonatal health.
PubMed: 34746456
DOI: 10.1016/j.heliyon.2021.e08128 -
Journal of Personalized Medicine Mar 2023Mucopolysaccharidosis (MPS) is a hereditary disorder arising from lysosomal enzymes deficiency, with glycosaminoglycans (GAGs) storage in connective tissues and bones,...
Mucopolysaccharidosis (MPS) is a hereditary disorder arising from lysosomal enzymes deficiency, with glycosaminoglycans (GAGs) storage in connective tissues and bones, which may compromise the airway. This retrospective study evaluated patients with MPS type IVA with airway obstruction detected via endoscopy and imaging modalities and the effects of surgical interventions based on symptoms. The data of 15 MPS type IVA patients (10 males, 5 females, mean age 17.8 years) were reviewed in detail. Fiberoptic bronchoscopy (FB) was used to distinguish adenotonsillar hypertrophy, prolapsed soft palate, secondary laryngomalacia, vocal cord granulation, cricoid thickness, tracheal stenosis, shape of tracheal lumen, nodular deposition, tracheal kinking, tracheomalacia with rigid tracheal wall, and bronchial collapse. Computed tomography (CT) helped to measure the deformed sternal angle, the cross-sectional area of the trachea, and its narrowest/widest ratio (NW ratio), while angiography with 3D reconstruction delineated tracheal torsion, kinking, or framework damage and external vascular compression of the trachea. The NW ratio correlated negatively with age ( < 0.01), showing that airway obstruction progressed gradually. Various types of airway surgery were performed to correct the respiratory dysfunction. MPS type IVA challenges the management of multifactorial airway obstruction. Preoperative airway evaluation with both FB and CT is strongly suggested to assess both intraluminal and extraluminal factors causing airway obstruction.
PubMed: 36983675
DOI: 10.3390/jpm13030494 -
International Journal of Urology :... Nov 2022To report on the long-term outcomes of vesicostomy in elderly patients with chronic urinary retention.
PURPOSE
To report on the long-term outcomes of vesicostomy in elderly patients with chronic urinary retention.
MATERIALS AND METHODS
We conducted a study of 16 elderly patients with chronic urinary retention who underwent Blocksom vesicostomy between April 2010 and March 2021. Postoperative follow-up was conducted every 3 months to check for abnormal findings, such as stoma outlet obstruction, infection, bleeding, bladder prolapse, and bladder stones. The incidence of these findings and the time until they occurred, as well as the rate of achieving a catheter-free status and the time until catheter reinsertion, were then calculated using the Kaplan-Meier curve.
RESULTS
The mean age (±standard deviation) of patients whose cases were observed was 78.6 (±7.8) years; the oldest patient was 87 years of age. The study population included 14 male patients and 2 female patients, with a higher number of males. The causes of urinary retention included neurogenic bladder in 12 patients (including patients with 3 spinal cord injury), advanced prostate cancer in 2 patients, and iatrogenic urethral stricture in 2 patients. The average follow-up period was 55.7 months. During follow-up, 14 patients (87.5% of the total) achieved a catheter-free status under conditions that required no additional treatment. Complications were observed in 6 cases (37.5%); among them, two cases required reoperation. All complications were observed within 2 years after surgery.
CONCLUSION
Blocksom vesicostomy may become a viable option in the treatment of elderly patients with chronic urinary retention whose symptoms do not improve with medical therapy.
Topics: Humans; Male; Aged; Aged, 80 and over; Cystostomy; Urinary Retention; Urinary Bladder, Neurogenic; Reoperation; Prostatic Neoplasms
PubMed: 35945167
DOI: 10.1111/iju.14999