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International Journal of Women's Health 2023Amniotic fluid volumes are tightly regulated, and amniotic fluid derangement can indicate maternal complications or fetal abnormalities. Ultrasound estimate of amniotic... (Review)
Review
Amniotic fluid volumes are tightly regulated, and amniotic fluid derangement can indicate maternal complications or fetal abnormalities. Ultrasound estimate of amniotic fluid provides a tool to evaluate the maternal-fetal-placental interface in real-time. Oligohydramnios and polyhydramnios are associated with adverse maternal and neonatal outcomes. Oligohydramnios is associated with adverse maternal and neonatal outcomes including cesarean delivery, operative vaginal delivery, induction of labor, postpartum hemorrhage, small for gestational age neonate, intrauterine demise, neonatal death, NICU admission, and APGAR less than 7 at. 5 minutes of life Polyhydramnios is associated with adverse outcomes including cesarean delivery, induction of labor, placental abruption, shoulder dystocia, cord prolapse, postpartum hemorrhage, intrauterine fetal demise, NICU admission, neonatal death, APGAR less than 7 at 5 minutes of life, large for gestational age neonate, and respiratory distress syndrome. Therefore, Amniotic fluid should be evaluated when maternal or fetal well-being is in question.
PubMed: 36756186
DOI: 10.2147/IJWH.S378020 -
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 -
PloS One 2023Birth injury is harm that a baby suffers during the entire birth process. It includes both birth asphyxia and birth trauma. In Ethiopia, birth injury has become the...
BACKGROUND
Birth injury is harm that a baby suffers during the entire birth process. It includes both birth asphyxia and birth trauma. In Ethiopia, birth injury has become the leading cause of neonatal morbidity and mortality, accounting around 28%-31.6% of neonatal mortality. The study aimed to assess the prevalence and factors associated with birth injuries among newborns delivered in public hospitals Addis Ababa, Ethiopia, 2021.
METHODS
Institution based cross-sectional study was conducted from February 15th to April 20th, 2021 in selected public hospitals of Addis Ababa, Ethiopia. Random sampling and systematic random sampling were used. Data was entered by using Epi data version 4.0.2 and exported in to SPSS Software version 25 for analysis. Both bivariate and multivariable logistic regressions analyses were used. Finally P-value <0.05 was used to claim statistically significant.
RESULT
The prevalence of birth injury was 24.7%. In the final model, birth asphyxia was significantly associated with the short height of the mothers (AOR = 10.7, 95% CI: 3.59-32.4), intrapartal fetal distress (AOR = 4.74, 95% CI: 1.81-12.4), cord prolapse (AOR = 7.7. 95% CI: 1.45-34.0), tight nuchal cord (AOR = 9.2. 95% CI: 4.9-35.3), birth attended by residents (AOR = 0.19, 95% CI: 0.05-0.68), male sex (AOR = 3.84, 95% CI: 1.30-11.3) and low birth weight (AOR = 5.28, 95% CI: 1.58-17.6). Whereas, birth trauma was significantly associated with gestational diabetic mellitus (AOR = 5.01, 95% CI: 1.38-18.1), prolonged duration of labor (AOR = 3.74, 95% CI: 1.52-9.20), instrumental delivery (AOR = 10.6, 95% CI: 3.45-32.7) and night time birth (AOR = 4.82, 95% CI: 1.84-12.6).
CONCLUSION
The prevalence of birth injury among newborns has continued to increases and become life-threatening issue in the delivery and neonatal intensive care unit in the study area. Therefore, considering the prevailing factors, robust effort has to be made to optimize the quality obstetric care and follow up and emergency obstetrics team has to be strengthened to reduce the prevalence of birth injury.
Topics: Pregnancy; Female; Infant, Newborn; Male; Humans; Ethiopia; Prevalence; Cross-Sectional Studies; Asphyxia; Hospitals, Public; Asphyxia Neonatorum; Birth Injuries
PubMed: 36716337
DOI: 10.1371/journal.pone.0281066 -
Zhongguo Dang Dai Er Ke Za Zhi =... Jan 2023To identify the perinatal risk factors for the occurrence of singleton apparently stillborn infants. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To identify the perinatal risk factors for the occurrence of singleton apparently stillborn infants.
METHODS
This was a case-control study. A total of 154 singleton neonates with gestational age ≥28 weeks and Apgar score of 0-1 who were subsequently successfully resuscitated in the Obstetrics and Gynecology Hospital of Fudan University from January 2006 to December 2015 were enrolled as the case group (apparently stillborn group). A total of 616 singleton infants born from January 2006 to December 2015 (1-minute Apgar score >1) were randomly selected in a 1:4 ratio as the control group. Univariate analysis and multivariate logistic regression were used to analyze the perinatal risk factors for the occurrence of apparently stillborn infants.
RESULTS
The gestational age and birth weight in the apparently stillborn group were significantly lower than those in the control group (<0.05). The incidences of fetal hydrops, cord prolapse, grade III meconium-stained amniotic fluid, placental abruption, breech presentation, severe pre-eclampsia, maternal general anesthesia at delivery, abnormal antenatal fetal heart monitoring and decreased fetal movement were significantly higher in the apparently stillborn group than those in the control group (<0.05). The multivariate logistic analysis showed that the mother had general anesthesia at delivery (=34.520), decreased antenatal fetal movement (=28.168),placental abruption (=15.641), grade III meconium-stained amniotic fluid (=6.365), abnormal antenatal fetal heart monitoring (=5.739), and breech presentation (=2.614) were risk factors for the occurrence of apparently stillborn infants (<0.05), while higher gestational age was a protective factor (=0.686, <0.05).
CONCLUSIONS
Attention needs to be paid to mothers with abnormal prenatal fetal heart monitoring, decreased fetal movement, preterm labor, placental abruption, breech presentation, grade III meconium-stained amniotic fluid, and general anesthesia. Preparations for resuscitation should be done to rescue apparently stillborn infants.
Topics: Female; Humans; Infant; Infant, Newborn; Pregnancy; Abruptio Placentae; Apgar Score; Breech Presentation; Case-Control Studies; Placenta; Pregnancy Complications; Risk Factors; Stillbirth
PubMed: 36655659
DOI: 10.7499/j.issn.1008-8830.2207108 -
Trials Dec 2022Lumbar disc herniation is one of the leading causes of chronic low back pain. Surgery remains the therapy of choice when conservative approaches fail. Full-endoscopic... (Randomized Controlled Trial)
Randomized Controlled Trial
Full-endoscopic versus conventional microsurgical therapy of lumbar disc herniation: a prospective, controlled, single-center, comprehensive cohort trial (FEMT-LDH trial).
BACKGROUND
Lumbar disc herniation is one of the leading causes of chronic low back pain. Surgery remains the therapy of choice when conservative approaches fail. Full-endoscopic approaches represent a promising alternative to the well-established microsurgical technique. However, high-grade evidence comparing these techniques is still scarce.
METHODS
Patients presenting with lumbar disc herniation will be included. The intervention group will obtain full-endoscopic disc decompression, whereas the control group will be treated by microsurgical disc decompression. We will apply a comprehensive cohort study design involving a randomized and a prospective non-randomized study arm. Patients who do not consent to be randomized will be assigned to the non-randomized arm. The primary outcome will be the Oswestry Disability Index (ODI). Secondary outcomes involve the visual analog scale (VAS) of pain and the SF-36 health questionnaire. Furthermore, clinical characteristics including duration of hospital stay, operation time, and complications as well as laboratory markers, such as C-reactive protein, white blood cell counts, and interleukin 6 will be determined and compared.
DISCUSSION
This study will significantly contribute to the current evidence available in the literature by evaluating the outcome of the full-endoscopic technique against the gold standard for lumbar disc herniation in a clinically relevant study setup. Additionally, the study design allows us to include patients not willing to be randomized in a prospective parallel study arm and to evaluate the impact of randomization on outcomes and include. The results could help to improve the future therapy in patients suffering from lumbar disc herniation.
TRIAL REGISTRATION
This study was prospectively registered in The German Clinical Trials Register (DRKS), a German WHO primary registry, under the registration number: DRKS00025786. Registered on July 7, 2021.
Topics: Humans; Intervertebral Disc Displacement; Prospective Studies; Cohort Studies
PubMed: 36476361
DOI: 10.1186/s13063-022-06892-8 -
Diagnostics (Basel, Switzerland) Nov 2022Umbilical cord prolapse can be a life-threatening obstetrical event involving the fetus due to sudden oxygenated blood flow obstruction. These types of events most often...
Umbilical cord prolapse can be a life-threatening obstetrical event involving the fetus due to sudden oxygenated blood flow obstruction. These types of events most often happen in labor and are associated with obstetric maneuvers. Rarely, a clinical examination can diagnose the condition, but the situation is usually detected secondary to an abnormal cardiotocography trace. We present several clinical cases where a CTG trace was used to infer umbilical cord prolapse.
PubMed: 36428904
DOI: 10.3390/diagnostics12112845 -
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 -
Cureus Oct 2022Umbilical cord prolapse with ruptured membranes is an obstetric emergency with management consisting of delivery via emergent cesarean delivery. If the umbilical cord...
Umbilical cord prolapse with ruptured membranes is an obstetric emergency with management consisting of delivery via emergent cesarean delivery. If the umbilical cord prolapses beyond the internal os with intact membranes, there is an opportunity to intervene and reduce the risk of fetal morbidity and mortality. A healthy 30-year-old, gravida 1 para 0 was incidentally found to have a short cervical length at 25 weeks five days on routine anatomy ultrasound evaluation. On evaluation via ultrasound by the maternal-fetal medicine service, the umbilical cord was noted to be prolapsing through the cervix with membranes intact. The cord prolapse with intact membranes resolved after placing the patient in the Trendelenburg position and nifedipine was administered for tocolysis given the uterus was noted to be contracting. For the remainder of the pregnancy, the patient underwent close follow-up and serial ultrasound scans with confirmation of the fetal head as the presenting part. The patient ultimately delivered vaginally at term. Cord prolapse with intact membranes, when identified via ultrasound, can be managed conservatively via Trendelenburg positioning and tocolysis to avoid premature cesarean delivery.
PubMed: 36348877
DOI: 10.7759/cureus.29870 -
Harefuah Mar 2022Poor obstetric consequences of unexpected events in the delivery room, such as a shoulder dystocia and umbilical cord prolapse at birth or severe maternal infection... (Review)
Review
Poor obstetric consequences of unexpected events in the delivery room, such as a shoulder dystocia and umbilical cord prolapse at birth or severe maternal infection cause harm to the mother, the newborn, the extended family and the staff. A vigorous attempt has been made to anticipate or prevent those events and try to deal with them skillfully and quickly in order to reduce the rate of complications. One of the methods to bring about successful treatment of these events is by integrated staff training in the delivery room, that is, joint training of obstetricians, midwives in the field of nursing, and anesthesiologists. The PROMPT (Practical Obstetrics Multi Professional Training) method has proven effective in improving medical outcomes in cases of shoulder dystocia at birth, significantly improving the response rate in birth management with changes in fetal monitoring and reducing the rate of neonates with a low Apgar score at birth. The training method was brought from England and was recently taught by joint teams from two Clalit hospitals. The system trained local "coaches" from the medical staff, whose task would be to bring the training at all stages into the hospitals selected for the task. The training stages, which take place inside the delivery rooms and not in training centers as is customary today, include practicing selected cases with players, using practice dolls, dedicated flow charts and customized action boxes, as well as creating a sharing atmosphere and improving communication among staff members. In the advanced stage, training programs will be prepared for additional delivery rooms and we will be able to monitor and document a change for the better in managing such events in the future.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Delivery Rooms; Emergencies; Shoulder Dystocia; Obstetrics; Shoulder; Delivery, Obstetric
PubMed: 36259405
DOI: No ID Found