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BMC Pregnancy and Childbirth Feb 2024
Correction: Labor dystocia and oxytocin augmentation before or after six centimeters cervical dilatation, in nulliparous women with spontaneous labor, in relation to mode of birth.
PubMed: 38308242
DOI: 10.1186/s12884-024-06292-7 -
International Journal of Surgery Case... Feb 2024Episiotomy is a procedure during vaginal delivery to facilitate a safer delivery. However, it can also have complications including hemorrhage, perineal tears,...
INTRODUCTION
Episiotomy is a procedure during vaginal delivery to facilitate a safer delivery. However, it can also have complications including hemorrhage, perineal tears, infections, and vaginal hematoma which should be managed and monitored carefully.
PRESENTATION OF CASE
A 27-year-old woman with term pregnancy, had a normal vaginal delivery at 39 weeks of gestation, and a large episiotomy was performed due to the estimated neonate weight to prevent shoulder dystocia. She was complicated with a huge pelvic hematoma that was expanded to prerenal space.
DISCUSSION
This complication was managed by conservative therapy, including antibiotic therapy, intensive observation of the patient's situation, and follow-up with a CT scan after consulting with a radiologist. The huge hematoma was reduced.
CONCLUSION
Noninvasive management and close monitoring for pelvic hematoma due to episiotomy in a low-risk patient are successful; however, consulting with radiologists and experts and a multidisciplinary approach should be considered.
PubMed: 38306871
DOI: 10.1016/j.ijscr.2024.109318 -
Women and Birth : Journal of the... May 2024Midwifery led units are rare in Spain. (Observational Study)
Observational Study
PROBLEM
Midwifery led units are rare in Spain.
BACKGROUND
Midwife-Led Care (MLC) is a widely extended model of care and, within this, the alongside midwifery-led units (AMLU) are those hospital-based and located in close connection with obstetric units. In Spain, CL is the first center belonging to the National Health System of these characteristics.
AIM
To evaluate the first year of activity of this pioneering unit.
METHODS
An observational cross-sectional study was carried out to assess maternal and neonatal outcomes of births facilitated at CL by comparing with those births that fulfilled the criteria to be admitted at the AMLU but were assisted at the standard obstetric care unit of the hospital.
FINDINGS
174 (20,3%) women and birthing people decided to give birth at CL, whereas 684 (79,7%) gave birth at the Obstetric Unit of the Hospital. Women assisted at the AMLU had lower intervention rates (episiotomy, epidural analgesia) and a higher rate of breastfeeding practice. There were no statistical differences in maternal outcomes (postpartum hemorrhage, third-or-four-degree laceration) or neonatal outcomes (Apgar< 7 at 5 min; birth weight < 2500 gr; macrosomia; shoulder dystocia, neonatal care transfer).
DISCUSSION
There were differences in transfers from MLU to OU between nulliparous and multiparous; the main reason for transfer is the request for analgesia. Epidural analgesia should be considered when analyzing maternal outcomes.
CONCLUSION
An alongside midwifery-led unit is a safe option with a low incidence of complications. This model of care can be positively implemented at the Public Healthcare System.
Topics: Pregnancy; Infant, Newborn; Child; Female; Humans; Male; Midwifery; Delivery, Obstetric; Cross-Sectional Studies; Spain; Perinatal Care; Hospitals, Public
PubMed: 38296744
DOI: 10.1016/j.wombi.2024.01.003 -
Journal of Animal Science Jan 2024Diets that provide a negative dietary anion cation difference (DCAD) and supplement with a vitamin D metabolite 25-OH-D3 (calcidiol) may increase calcium availability at...
Diets that provide a negative dietary anion cation difference (DCAD) and supplement with a vitamin D metabolite 25-OH-D3 (calcidiol) may increase calcium availability at parturition, and enhance piglet survival and performance. This factorial study assessed the effects of DCAD, calcidiol (50 µg/kg), and parity (parity 1 or >1) and their interactions. Large White and Landrace sows (n = 328), parity 1 to 8 were randomly allocated in blocks to treatment diets from day 103 of gestation until day 3 postfarrow: 1) negative DCAD without calcidiol (negative DCAD + no CA), n = 84, 2) negative DCAD with calcidiol (negative DCAD + CA) n = 84, 3) positive DCAD without calcidiol (negative DCAD + no CA), n = 81, and 4) positive DCAD with calcidiol (positive DCAD + CA), n = 79. Negative DCAD diets were acidified with an anionic feed (2 kg/t) and magnesium sulfate (2 kg/t). All treatment diets contained cholecalciferol at 1,000 IU/kg. Dry sow diets contained 14.8% crude protein (CP), 5.4% crude fiber (CF), 0.8% Ca, and 83 mEq/kg DCAD. Treatment diets 1 and 2 contained 17.5% CP, 7.3% CF, 0.8% Ca, and -2 mEq/kg DCAD. Treatment diets 3 and 4 contained 17.4% CP, 7.4% CF, 0.8% Ca, and 68 mEq/kg DCAD. Before farrowing, all negative DCAD sows had lower urine pH than all sows fed a positive DCAD (5.66 ± 0.05 and 6.29 ± 0.05, respectively; P < 0.01); urinary pH was acidified for both DCAD treatments indicating metabolic acidification. The percentage of sows with stillborn piglets was not affected by DCAD, calcidiol, or parity alone but sows fed the negative DCAD + CA diet had a 28% reduction in odds of stillbirth compared to the negative DCAD + no CA diet and even lesser odds to the positive DCAD + CA diet. At day 1 after farrowing, blood gas, and mineral and metabolite concentrations were consistent with feeding a negative DCAD diet and that negative DCAD diets influence energy metabolism, as indicated by increased glucose, cholesterol, and osteocalcin concentrations and reduced nonesterified free fatty acids and 3-hydroxybutyrate concentrations. In the subsequent litter, total piglets born and born alive (14.7 ± 0.3 and 13.8 ± 0.3 piglets, respectively; P = 0.029) was greater for positive DCAD diets compared to negative DCAD diets; and there was an interaction between DCAD, calcidiol, and parity (P = 0.002). Feeding a negative DCAD diet influenced stillbirth, subsequent litter size, and metabolic responses at farrowing. More studies are needed to define optimal diets prefarrowing for sows.
Topics: Pregnancy; Female; Animals; Swine; Calcifediol; Stillbirth; Lactation; Diet; Dietary Supplements; Anions; Cations; Animal Feed; Swine Diseases
PubMed: 38285624
DOI: 10.1093/jas/skae027 -
Veterinary Journal (London, England :... Apr 2024Schistosoma reflexum (SR) is a lethal congenital syndrome characterized by U-shaped dorsal retroflexion of the spine and exposure of abdominal viscera. SR is usually...
Schistosoma reflexum (SR) is a lethal congenital syndrome characterized by U-shaped dorsal retroflexion of the spine and exposure of abdominal viscera. SR is usually associated with severe dystocia. The syndrome is thought to be inherited as a Mendelian trait. We collected a series of 23 SR-affected calves from four breeds (20 Holstein, one Red Danish, one Limousin, one Romagnola) and performed whole-genome sequencing (WGS). WGS was performed on 51 cattle, including 14 cases with parents (trio-based; Group 1) and nine single cases (solo-based; Group 2). Sequencing-based genome-wide association studies with 20 Holstein cases and 154 controls showed no association (above Bonferroni threshold; P-value<3 ×10). Assuming a monogenic recessive inheritance, no region of shared homozygosity was observed, suggesting heterogeneity. Alternatively, the presence of possible dominant acting de novo mutations were assessed. In Group 1, heterozygous private variants, absent in both parents, were found in seven cases. These involved the ACTL6A, FLNA, GLG1, IQSEC2, MAST3, MBTPS2, and MLLT1 genes. In addition, heterozygous private variants affecting the genes DYNC1LI1, PPP2R2B, SCAF8, SUGP1, and UBP1 were identified in five cases from Group 2. The detected frameshift and missense variants are predicted to cause haploinsufficiency. Each of these 12 affected genes belong to the class of haploinsufficient loss-of-function genes or are involved in embryonic and pre-weaning lethality or are known to be associated with severe malformation syndromes in humans and/or mice. This study presents for the first time a detailed genomic evaluation of bovine SR, suggesting that independent de novo mutations may explain the sporadic occurrence of SR in cattle.
Topics: Humans; Cattle; Animals; Mice; Genome-Wide Association Study; Pedigree; Syndrome; Phenotype; Mutation; Actins; Chromosomal Proteins, Non-Histone; DNA-Binding Proteins; Guanine Nucleotide Exchange Factors; Cytoplasmic Dyneins; Nerve Tissue Proteins; Cattle Diseases; Rodent Diseases
PubMed: 38281659
DOI: 10.1016/j.tvjl.2024.106069 -
Medicina (Kaunas, Lithuania) Jan 2024: Every surgical procedure has the possible risk of complications, and caesarean sections (CSs) are no exception. As CS rates are increasing worldwide, being familiar...
: Every surgical procedure has the possible risk of complications, and caesarean sections (CSs) are no exception. As CS rates are increasing worldwide, being familiar with rare but possible complications has become extremely important. : We present a case of 25-year-old nulliparous patient who came to our hospital with twin pregnancy for a scheduled induction of labour. An urgent CS was performed due to labour dystocia. On the second postoperative day, the patient started to complain about pain in the epigastrium, but initially showed no signs of bowel obstruction, passing gas, and stools, and could tolerate oral intake. After a thorough examination, an early postoperative complication-small-bowel strangulation at the incision site-was diagnosed. Small bowels protruded in between sutured rectus abdominis muscle causing a strangulation which led to re-laparotomy. During the surgery, there was no necrosis of intestines, bowel resection was not needed, and abdominal wall repair was performed. After re-laparotomy, the patient recovered with no further complications. : Although there are discussions about CS techniques, most guidelines recommend leaving rectus muscle unsutured. This case demonstrates a complication which most likely could have been avoided if the rectus muscle had not been re-approximated.
Topics: Pregnancy; Humans; Female; Adult; Cesarean Section; Intestinal Obstruction; Pregnancy, Twin; Dystocia; Postoperative Complications; Surgical Wound
PubMed: 38276068
DOI: 10.3390/medicina60010190 -
European Journal of Obstetrics &... Mar 2024The uterus is a highly innervated organ, and during labor, this innervation is at its highest level. Oxytocinergic fibers play an important role in labor and delivery...
The uterus is a highly innervated organ, and during labor, this innervation is at its highest level. Oxytocinergic fibers play an important role in labor and delivery and, in particular, the Lower Uterine Segment, cervix, and fundus are all controlled by motor neurofibers. Oxytocin is a neurohormone that acts on receptors located on the membrane of the smooth cells of the myometrium. During the stages of labor and delivery, its binding causes myofibers to contract, which enables the fundus of the uterus to act as a mediator. The aim of this study was to investigate the presence of oxytocinergic fibers in prolonged and non-prolonged dystocic delivery in a cohort of 90 patients, evaluated during the first and second stages of labor. Myometrial tissue samples were collected and evaluated by electron microscopy, in order to quantify differences in neurofibers concentrations between the investigated and control cohorts of patients. The authors of this experiment showed that the concentration of oxytocinergic fibers differs between non-prolonged and prolonged dystocic delivery. In particular, in prolonged dystocic delivery, compared to non-prolonged dystocic delivery, there is a lower amount of oxytocin fiber. The increase in oxytocin appeared to be ineffective in patients who experienced prolonged dystocic delivery, since the dystocic labor ended as a result of the altered presence of oxytocinergic fibers detected in this group of patients.
PubMed: 38274243
DOI: 10.1016/j.eurox.2023.100273 -
The Pan African Medical Journal 2023We here report a retrospective analysis of 30 years´ experience with 39 female patients suffering from suburethral diverticula. The average age of patients was 37 years...
We here report a retrospective analysis of 30 years´ experience with 39 female patients suffering from suburethral diverticula. The average age of patients was 37 years of age (24-56 years). The average parity was 2 (1-7); 65% of deliveries were complicated by dystocia, with forceps used in 43% of cases. All patients had a history of urological or gynaecological infections. The revealing symptoms were heterogeneous but recurrent urinary tract infections (26 cases), pollakiuria (23 cases), post-micturition urethral discharge (21 cases), vaginal pain (17 cases) and a sensation of vaginal bulge (15 cases) were mostly reported. Radiological assessment were performed, including intravenous urography, retrograde and micturition urethrography, ultrasound, or MRI. Transvaginal diverticulectomy was the treatment of choice for all patients, with no reported intraoperative complications. At 4 years of follow up outcome was satisfactory. Four patients developed recurrence of diverticulitis. These data provide important information about clinical features, diagnostic results and long-term outcomes of transvaginal diverticulectomy, enabling better management of this rare condition.
Topics: Female; Humans; Adult; Young Adult; Middle Aged; Urethral Diseases; Retrospective Studies; Radiography; Urinary Tract Infections; Diverticulum
PubMed: 38223879
DOI: 10.11604/pamj.2023.46.51.41246 -
JDS Communications Jan 2024Although interest in beef-on-dairy breeding strategies is intensifying, little is actually known of the performance differences between beef-sired male and female...
Although interest in beef-on-dairy breeding strategies is intensifying, little is actually known of the performance differences between beef-sired male and female progeny of dairy cows. The objective was therefore to use a large cross-sectional database of up to 1,389,670 animals to investigate if performance differences existed between male and female progeny generated from beef-on-dairy matings; the focus was on characteristics of interest to both the dairy producer (i.e., gestation length, calving performance, perinatal mortality, and calf sale value) and the beef producer (i.e., slaughter-related traits). While statistical differences existed between both sexes, the observed differences were not always biologically large, with some favoring females (e.g., calving traits and age at slaughter) and some favoring males (i.e., carcass weight). Beef-sired male calves had, on average, a 0.8 d longer gestation than their female counterparts; the sex difference in dairy-sired calves was, on average, 1.1 d, with the advantage to females. The odds of a difficult calving was 2.2 times greater for beef-sired male calves relative to beef-sired female calves; this translated to a difference in predicted probability of dystocia between the sexes of 1.8 percentage units. Male beef-sired calves sold at auctions <42 d of age were worth, on average, €32.40 more than beef-sired female calves. Focusing just on beef-sired progeny, relative to heifer carcasses (mean weight of 280.0 kg), the carcasses of steers (mean weight of 336.9 kg) and bulls (mean weight of 335.4) were 55.4 to 56.9 kg heavier. Based on a 15-point conformation scale, the carcasses of bulls were 1 unit superior to heifers, with the carcasses of the latter being 0.06 units better than steers. Heifers were slaughtered, on average, 79.1 d younger than steers although heifers were slaughtered, on average, 93.8 d older than bulls, the latter generally being finished on a more intensive diet relative to steers and heifers in Ireland. In conclusion, many benefits exist for beef-sired heifer calves in that they had, on average, shorter gestations with less expected assistance required at calving and, although their calf value was less and their carcasses were lighter than their male counterparts, they were slaughtered several months younger than steers.
PubMed: 38223378
DOI: 10.3168/jdsc.2023-0395 -
Experimental and Therapeutic Medicine Jan 2024A prolonged second stage of vaginal delivery increases the risk of shoulder dystocia, unnecessary episiotomies and cesarean sections. However, no standardized method has...
A prolonged second stage of vaginal delivery increases the risk of shoulder dystocia, unnecessary episiotomies and cesarean sections. However, no standardized method has been proposed to tackle this issue. The effects of pelvic floor myofascial manipulation intervention during the second stage of labor in primiparas and its prognostic value in neonatal postpartum outcomes remain unknown. In the present study, a total of 60 primiparas who were expecting a vaginal delivery in the Second Affiliated Hospital of Hainan Medical College (Haikou, China) between October 2021 and January 2022 were selected. These women were randomly assigned to a control group (standard intrapartum care) or an experimental group (pelvic floor myofascial manipulation for 15-20 min during the second stage of labor along with standard intrapartum care) using a random number table, with 28 patients in each group. There was no significant difference in age, gestational time or body mass index between the two groups before delivery, indicating that the baseline data were comparable. The second stage of labor duration, forced breath-holding time and postpartum hemorrhage volume in the experimental group were significantly lower than those in the control group. The pain visual analog scale scores, fatigue scores and neonatal Apgar scores in the experimental group were also significantly lower than those in the control group. The rate of episiotomy in the experimental group was lower than that in the control group, but the difference was not statistically significant. In conclusion, pelvic floor myofascial manipulation intervention during the second stage of labor for primiparas with vaginal delivery can reduce the duration of the second stage of labor, the amount of bleeding during labor and the pain during labor. Meanwhile, it has the potential to improve neonatal outcomes.
PubMed: 38223324
DOI: 10.3892/etm.2023.12292