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International Journal of Women's Health 2024The decision to delivery time is the interval between the decision and the childbirth by emergency caesarean delivery. The Royal College of Obstetricians and...
Decision To Delivery Time and Its Predictors Among Mothers Who Underwent Emergency Cesarean Delivery At Selected Hospitals of Northwest Ethiopia, 2023: Prospective Cohort Study.
BACKGROUND
The decision to delivery time is the interval between the decision and the childbirth by emergency caesarean delivery. The Royal College of Obstetricians and Gynecologists and the American College of Obstetricians and Gynecologists recommend that the decision to delivery time interval is less than 30 min. Additionally, the decision to delivery time varies across institutions and countries.
OBJECTIVE
The aim of this study was to determine the decision to delivery time and its predictors among women who underwent emergency cesarean delivery at selected hospitals of Northwest Ethiopia, 2023.
METHODS
An institutional-based prospective cohort study was conducted at selected hospitals of Northwest Ethiopia, among women who underwent emergency cesarean delivery from November 1 to January 30, 2023. A total of 285 participants were enrolled, and data collected using structured and pre-tested questionnaires. A systematic sampling technique was used. Data were entered into Epi-Data version 4.6 and then exported to STATA 15 for further analysis. The log rank test was utilized to compare group differences. The time is estimated by using the Kaplan-Meier curve and Cox proportional-hazard regression analysis was carried out to determine the predictors.
RESULTS
From 285 participants, 56 (21.8%) women delivered within the recommended 30 min. The overall median survival time was undetermined and the restricted mean survival time was 48.9 min (95% CI: 47.4-50.5). The average decision to delivery time is affected among women who hesitate to accept consent (AHR: 0.17, 95% CI: 0.02-1.25), cord prolapses (AHR: 1.36, 95% CI: 0.46-3.94), rank of surgeon (AHR: 0.42. 95% CI: 0.42-1.08), no free operation room table (AHR: 0.27, 95% CI: 0.28-0.94), regional anesthesia (AHR: 0.56, 95% CI: 0.25-1.28), and use of a bladder flap (AHR: 0.33, 95% CI: 0.16-0.85).
CONCLUSION
Overall decision to delivery times among women who underwent emergency cesarean section at selected hospitals were longer than the recommended time.
PubMed: 38352193
DOI: 10.2147/IJWH.S436755 -
Patent vitellointestinal duct with ileal prolapse in a newborn: A case report and literature review.Medicine Jan 2024Patent vitellointestinal duct is the most common omphalomesenteric duct anomaly to present with symptoms. (Review)
Review
RATIONALE
Patent vitellointestinal duct is the most common omphalomesenteric duct anomaly to present with symptoms.
PATIENT CONCERNS
A 10-day-old child presented with increase in the size of a polypoidal lesion into a large, "Y"-shaped reddish, prolapsing lesion, discharging gaseous, and fecal matter at her umbilicus. A laparoscopic exploration was performed, followed by wedge resection and anastomosis. No complications occurred during postoperative follow-up.
DIAGNOSES
A patent vitellointestinal duct with ileal prolapse.
INTERVENTIONS
The resection of extended intraperitoneal intestinal tube was performed.
OUTCOMES
During the follow-up 3 months after surgery, the umbilical cord of the child healed well after surgery.
LESSONS
Timely surgical treatment can minimize the occurrence of complications, and the overall prognosis is good after surgery.
Topics: Humans; Infant, Newborn; Child; Female; Intestinal Diseases; Intestines; Umbilicus; Digestive System Abnormalities; Vitelline Duct; Prolapse
PubMed: 38241543
DOI: 10.1097/MD.0000000000036919 -
British Journal of Neurosurgery Jan 2024Spinal cerebrospinal fluid (CSF) leaks are common, and their management is heterogeneous. For high-flow leaks, numerous studies advocate for primary dural repair and CSF...
OBJECTIVE
Spinal cerebrospinal fluid (CSF) leaks are common, and their management is heterogeneous. For high-flow leaks, numerous studies advocate for primary dural repair and CSF diversion. The LiquoGuard7® allows automated and precise pressure and volume control, and calculation of patient-specific CSF production rate (prCSF), which is hypothesized to be increased in the context of durotomies and CSF leaks.
METHODS
This single-centre illustrative case series included patients undergoing complex spinal surgery where: 1) a high flow intra-operative and/or post-operative CSF leak was expected and 2) lumbar CSF drainage was performed using a LiquoGuard7®. CSF diversion was tailored to prCSF for each patient, combined with layered spinal wound closure.
RESULTS
Three patients were included, with a variety of pathologies: T7/T8 disc prolapse, T8-T9 meningioma, and T4-T5 metastatic spinal cord compression. The first two patients underwent CSF diversion to prevent post-op CSF leak, whilst the third required this in response to post-op CSF leak. CSF hyperproduction was evident in all cases (mean >/=140ml/hr). With patient-specific CSF diversion regimes, no cases required further intervention for CSF fistulae repair (including for pleural CSF effusion), wound breakdown or infection.
CONCLUSIONS
Patient-specific cerebrospinal fluid drainage may be a useful tool in the management of high-flow intra-operative and post-operative CSF leaks during complex spinal surgery. These systems may reduce post-operative CSF leakage from the wound or into adjacent body cavities. Further larger studies are needed to evaluate the comparative benefits and cost-effectiveness of this approach.
PubMed: 38174716
DOI: 10.1080/02688697.2023.2290101 -
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 -
Ultrasound International Open Jan 2023
PubMed: 38099217
DOI: 10.1055/a-2097-5143 -
Muscle & Nerve Feb 2024We have encountered patients with myasthenia gravis (MG) who exhibited palatal prolapse (PP) during nasal expiration in the supine position while awake. This may be an...
INTRODUCTION/AIMS
We have encountered patients with myasthenia gravis (MG) who exhibited palatal prolapse (PP) during nasal expiration in the supine position while awake. This may be an overlooked cause of dyspnea in MG patients. This study aimed to examine and describe the characteristics of MG patients with PP.
METHODS
We reviewed the medical records of 183 consecutive patients who were diagnosed with MG in our hospital from 2012 to 2021. Thirty-two patients underwent laryngoscopy because of bulbar symptoms. Eight of these patients (25%) exhibited PP on laryngoscopy. Clinical features of these eight patients were retrospectively characterized.
RESULTS
Median age of the eight patients with PP was 70 years. Six were men. Median body mass index was 21.6 kg/m . All patients exhibited PP in the supine position but not the sitting position. Although no patient had abnormal findings on spirometry nor chest computed tomography, six reported dyspnea or difficulty with nasal expiration only in the supine position. PP improved in all four patients who underwent edrophonium testing. All eight patients eventually improved after immunotherapy.
DISCUSSION
PP during nasal expiration may be a cause of dyspnea in MG patients, along with respiratory muscle impairment, lung disease, and vocal cord paralysis. Laryngoscopy in the supine position is required to confirm.
Topics: Aged; Female; Humans; Male; Dyspnea; Edrophonium; Myasthenia Gravis; Respiratory Insufficiency; Retrospective Studies; Vocal Cord Paralysis
PubMed: 38018268
DOI: 10.1002/mus.28009 -
Acta Obstetricia Et Gynecologica... Feb 2024Umbilical cord prolapse (UCP) is a rare but severe obstetric complication in the presence of a rupture of the membranes. Although it is not possible to prevent a...
INTRODUCTION
Umbilical cord prolapse (UCP) is a rare but severe obstetric complication in the presence of a rupture of the membranes. Although it is not possible to prevent a spontaneous rupture of the membranes (SROM), it is possible to prevent an amniotomy, which is a commonly used intervention in labor. This study aimed to explore the incidence and risk factors that are associated with UCP in labor when amniotomy is used vs SROM.
MATERIAL AND METHODS
A retrospective nationwide register study was conducted of all births in Sweden from January 2014 to June 2020 that were included in the Swedish Pregnancy Register (n = 717 336). The main outcome, UCP, was identified in the data by the International Classification of Diseases (ICD-10) diagnosis code O69.0. Multiple binary logistic regression analysis was used to identify the risk factors.
RESULTS
Amniotomy was performed in 230 699 (43.6%) of all pregnancies. A UCP occurred in 293 (0.13%) of these cases. SROM occurred in 298 192 (56.4%) of all cases, of which 352 (0.12%) were complicated by UCP. Risk factors that increased the odds of UCP for both amniotomy and SROM were: higher parity, non-cephalic presentation and an induction of labor. Greater gestational age reduced the odds of UCP. Risk factors associated with only amniotomy were previous cesarean section and the presence of polyhydramnios. Identified risk factors for UCP in labor with SROM were a higher maternal age and maternal origin outside of the EU.
CONCLUSIONS
UCP is a rare complication in Sweden. Beyond confirming the previously recognized risk factors, this study found induction of labor and previous cesarean section to be risk factors in labor when amniotomy is used.
Topics: Pregnancy; Humans; Female; Sweden; Cesarean Section; Amniotomy; Incidence; Rupture, Spontaneous; Retrospective Studies; Labor, Induced; Umbilical Cord; Risk Factors; Fetal Membranes, Premature Rupture; Prolapse
PubMed: 37969005
DOI: 10.1111/aogs.14717 -
World Neurosurgery Jan 2024Minimally invasive spine surgery is rapidly gaining popularity because of its versatile nature. Traditionally, prolapsed disc has been the most common disease targeted...
OBJECTIVE
Minimally invasive spine surgery is rapidly gaining popularity because of its versatile nature. Traditionally, prolapsed disc has been the most common disease targeted using this technique. However, its usefulness for various other diseases has also been shown in studies. We present our experience of using this technique for various spinal diseases apart from prolapsed discs.
METHODS
This is a retrospective study in which patients operated on by a single surgeon from January 2019 to April 2023 were included. Cases that required conversion to open technique were excluded. Intraoperative findings and postoperative courses were obtained from patient records.
RESULTS
A total of 47 patients were included in the study, of whom 29 were male and 18 were female. The various diseases treated comprised intradural extramedullary (IDEM) tumors (n = 23), hypertrophied/ossified ligamentum flavum (n = 9), arachnoid cysts (n = 6), dermoid/epidermoid cysts (n = 4), detethering of cord (n = 3), and posterior cervical decompression for an ossified posterior longitudinal ligament (n = 2). The average duration of surgery was 2.1 ± 1.2 hours and the mean intraoperative blood loss was 138.4 ± 59.1 mL. The mean length of hospital stay was 2.3 ± 0.9 days. Two patients had superficial wound infection and none of the operated patients had cerebrospinal fluid leakage. Re-exploration was not required in any of the operated patients.
CONCLUSIONS
Minimally invasive techniques for dealing with multiple diseases involving the spine are as good as traditional open techniques, with some additional advantages of lesser tissue trauma, early return to work, and so on. However, one must overcome the steep learning curve before adopting them in day-to-day practice.
Topics: Humans; Male; Female; Retrospective Studies; Treatment Outcome; Spine; Spinal Diseases; Minimally Invasive Surgical Procedures; Intervertebral Disc Displacement
PubMed: 37951463
DOI: 10.1016/j.wneu.2023.11.022 -
International Journal of Gynaecology... Mar 2024
Topics: Female; Humans; Pregnancy; Africa South of the Sahara; Incidence; Obstetric Labor Complications; Perinatal Death; Perinatal Mortality; Prolapse; Retrospective Studies; Umbilical Cord
PubMed: 37927143
DOI: 10.1002/ijgo.15233