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Medwave Nov 2023Obstetric emergencies are critical situations that jeopardize the health of both the mother and the baby during pregnancy or childbirth. This study aimed to validate the... (Review)
Review
Obstetric emergencies are critical situations that jeopardize the health of both the mother and the baby during pregnancy or childbirth. This study aimed to validate the effectiveness of clinical simulation training in managing these situations. We conducted a narrative review of studies published between 2008 and 2022, collected from databases including Scopus, Sciencedirect, PubMed, Springer, Scielo, and Google Scholar. Data from studies that met our inclusion criteria were meticulously gathered and summarized. Our findings strongly emphasize that clinical simulation emerges as a highly effective tool in the training of healthcare professionals. This training translates into substantial improvements in various aspects, including performance, knowledge, confidence, satisfaction, attitudes, self-efficacy, teamwork abilities, and the skills necessary to confront critical obstetric situations such as postpartum hemorrhage, eclampsia, shoulder dystocia, maternal cardiac arrest, umbilical cord prolapse, and cesarean sections. Importantly, this training reduces the inherent risks associated with learning on real patients and aligns with the highest ethical standards. Additionally, our results underscore that interdisciplinary collaboration in the management of obstetric emergencies proves to be an effective strategy for providing comprehensive patient care. However, it is crucial to highlight that, in order to ensure patient safety and promote a teamwork approach, it is imperative for healthcare professionals to receive adequate training and be duly qualified. Although we acknowledge that implementing clinical simulation training can entail significant costs and require substantial resources, we firmly believe that this strategy continues to hold immeasurable value in the education of professionals in this field. Ultimately, we anticipate that future high-quality research will further fortify the evidence base regarding best practices in clinical simulation training for obstetric emergencies, thus contributing to enhanced patient outcomes and the overall quality of healthcare in this critical domain.
Topics: Pregnancy; Female; Humans; Emergencies; Delivery, Obstetric; Simulation Training; Learning; Health Personnel; Clinical Competence
PubMed: 37922430
DOI: 10.5867/medwave.2023.10.2712 -
BMC Anesthesiology Oct 2023Cauda Equina Syndrome (CES) after Combined Spinal-Epidural Anesthesia (CSEA) is a rare disease that most of the time need surgery to relieve spinal cord compression.
BACKGROUND
Cauda Equina Syndrome (CES) after Combined Spinal-Epidural Anesthesia (CSEA) is a rare disease that most of the time need surgery to relieve spinal cord compression.
CASE PRESENTATION
A 34-year-old male patient underwent a procedure for prolapse and hemorrhoids (PPH) under CSEA. Anesthesia and surgery were uneventful. However, the patient gradually experienced urinary retention, lower abdomen and back pain, changes in bowel habits and neurological dysfunction of the lower limbs when the catheter was removed. It was later determined that the patient had Tarlov cyst at the left S1 level in the sacral canal. Finally, the patient completely recovered 20 days after drug conservative therapy onset.
CONCLUSION
This case suggests that CES might occur even after ordinary CSEA. The risk factors are drug neurotoxicity to ropivacaine and Tarlov cyst, which helped to accumulate ropivacaine. The development of ultrasound-guided CSEA and an ultrasound atlas of the spinal canal are required.
Topics: Male; Humans; Adult; Ropivacaine; Cauda Equina Syndrome; Tarlov Cysts; Anesthesia, Spinal; Anesthesia, Epidural
PubMed: 37907852
DOI: 10.1186/s12871-023-02311-w -
Spinal Cord Series and Cases Oct 2023Cervical prolapsed intervertebral disc is one of the common conditions causing cervical myeloradiculopathy. Anterior Cervical Discectomy and Fusion (ACDF) is the...
INTRODUCTION
Cervical prolapsed intervertebral disc is one of the common conditions causing cervical myeloradiculopathy. Anterior Cervical Discectomy and Fusion (ACDF) is the standard line of management for the same. Intradural neurogenic origin tumors are relatively rare and can present with features of myeloradiculopathy. Radiological imaging plays important role in diagnosis of such pathologies.
CASE REPORT
We report a patient with C5-6 cervical disc prolapse that presented with radiculopathy symptoms in the right upper limb, which was refractory to conservative care. He underwent a C5-6 ACDF and reported complete relief from symptoms at 4 weeks. He developed deteriorating symptoms over the next 10 weeks and presented at 14 weeks follow-up with severe myeloradiculopathy symptoms on the left upper limb with upper limb weakness. A fresh MRI identified an intradural extramedullary tumor with cystic changes at the index surgery level. This was treated with tumor excision and histopathology confirmed a diagnosis of schwannoma. Simultaneous presence of cord signal changes with disc herniation obscured the cystic schwannoma which became apparent later on contrast enhanced MRI imaging.
CONCLUSION
Careful review of preoperative imaging and contrast MRI study may help in diagnosing cystic schwannomas with concomitant cervical disc herniations that have cord signal changes.
Topics: Male; Humans; Intervertebral Disc Displacement; Cervical Vertebrae; Intervertebral Disc; Prolapse; Neurilemmoma; Spinal Cord Diseases
PubMed: 37898665
DOI: 10.1038/s41394-023-00609-y -
Case Reports in Women's Health Sep 2023Uterine artery embolization (UAE) is an effective minimally invasive alternative to surgery for the treatment of symptomatic uterine fibroids. Uterine rupture is an...
Uterine artery embolization (UAE) is an effective minimally invasive alternative to surgery for the treatment of symptomatic uterine fibroids. Uterine rupture is an obstetrical emergency that requires early diagnosis and prompt management to improve perinatal and maternal outcomes. A 33-year-old woman at 37 weeks of gestation who had had previous two uncomplicated vaginal deliveries at term presented with abdominal pain and rupture of membranes. The patient had undergone UAE for the management of a large anterior wall uterine fibroid three years prior to conception. Vaginal examination revealed cord prolapse and ultrasound showed negative fetal heart. Intrauterine fetal demise with cord prolapse was diagnosed. After admission the patient developed vaginal bleeding and features of hypovolemic shock. Urgent laparotomy revealed a ruptured uterus with a large hemoperitoneum and dead fetus in the abdominal cavity. Obstetricians should be attentive to the possibility of a spontaneous uterine rupture in pregnant women who have previously undergone UAE for the management of a uterine fibroid.
PubMed: 37829161
DOI: 10.1016/j.crwh.2023.e00551 -
Journal of Gynecology Obstetrics and... Oct 2023Preterm prelabor rupture of membranes (PPROM) is a frequent obstetrical condition with risks of maternal and neonatal morbidity and mortality. Home hospitalization (HH)...
BACKGROUND
Preterm prelabor rupture of membranes (PPROM) is a frequent obstetrical condition with risks of maternal and neonatal morbidity and mortality. Home hospitalization (HH) management is an alternative to conventional hospitalization (CH) which remains controversial, and there has been little study of eligibility criteria.
OBJECTIVE
To study obstetrical and perinatal outcomes of PPROM between 24 and 34 gestational weeks in patients discharged to homecare after 4 days, based on a policy of expanded discharge criteria.
STUDY DESIGN AND SETTING
Retrospective before-and-after study over 10 years in a single French level III perinatal center. In period A (2009-2013), discharge criteria were restrictive and in period B (2015-2019), more extended discharge criteria were adopted. The primary outcome was the incidence of confirmed early-onset neonatal sepsis (EOS).
RESULTS
The proportion of patients discharged to home hospitalization increased from 28/170 (16.5) in period A to 39/114 (34.2) in period B (p < 0.01). Regarding the primary outcome, no statistically significant difference in EOS rates was observed between periods (11/153 (7.1) vs 5/110 (4.5), p = 0.37). The incidence of a composite outcome combining severe perinatal complications (intrauterine fetal demise, placental abruption and cord prolapse) did not significantly increase during period B (7/170 (4.1) vs 4/114 (2.7), p = 0.37). There was no significant difference between the periods for chorioamniotitis (9.41% in period A and 11.4% in period B, p = 0.58).
CONCLUSION
Severe maternal or neonatal complications rates did not increase when criteria for home hospitalization were expanded. Larger, prospective studies are needed to confirm the results of such a strategy.
Topics: Infant, Newborn; Pregnancy; Humans; Female; Retrospective Studies; Placenta; Fetal Membranes, Premature Rupture; Home Care Services
PubMed: 37544361
DOI: 10.1016/j.jogoh.2023.102638 -
CJEM Oct 2023
Topics: Humans; Emergency Service, Hospital; Risk Factors
PubMed: 37436690
DOI: 10.1007/s43678-023-00552-9 -
Surgical Case Reports Jul 2023A few cases of small omphalocele with umbilical evagination of the bladder have been reported. However, its embryology is yet to be elucidated. Only a few reports have...
BACKGROUND
A few cases of small omphalocele with umbilical evagination of the bladder have been reported. However, its embryology is yet to be elucidated. Only a few reports have indicated the existence of urachal anomalies and umbilical cysts related to bladder evagination. The incidence of urachal anomalies at birth is reported to be 1 in 5000-8000 live birth, and urachal aplasia is rare. Herein, we report a rare, novel case of urachal aplasia.
CASE PRESENTATION
We encountered a small omphalocele with bladder evagination associated with urachal aplasia for which the neonate underwent surgery one day after birth. The patient was a one-day-old boy with a prenatally diagnosed omphalocele. A fetal magnetic resonance image (MRI) scan (25 weeks of gestation) revealed a 30 × 33 mm (approximately 1.3 in.) cystic lesion which was suspected to be an umbilical cyst. The baby was born vaginally at 38 weeks, weighing 2956 g. An omphalocele (hernial orifice diameter, 4 cm × 3 cm) with bladder prolapse was recognized. After sac excision, the prolapsed bladder was resected and closed with two-layer sutures. In order to secure sufficient bladder capacity, we estimated the minimum residual volume as 21 ml after bladder plasty. The remaining bladder capacity was confirmed to be 30 ml by injecting a contrast dye and saline into the bladder. The neonate had no associated cardiac urogenital or skeletal anomalies. Postoperative course was uneventful. The patient was regularly followed up for two years after surgery and underwent umbilicoplasty. He had no trouble with urinary function.
CONCLUSION
In this case, we experienced extremely rare condition of a small omphalocele with bladder evagination associated with urachal aplasia and reviewed 7 case reports of anomalies similar to those in the present case. Umbilical cord cysts may be an informative indicator of these symptoms in utero. Therefore, ultrasonography scans should be conducted until delivery, despite the spontaneous disappearance of cord cysts.
PubMed: 37428342
DOI: 10.1186/s40792-023-01710-y -
Journal of Pediatric Surgery Oct 2023Anorectal malformations (ARM) are associated with neurogenic bladder. The traditional surgical ARM repair is a posterior sagittal anorectoplasty (PSARP), which is...
BACKGROUND
Anorectal malformations (ARM) are associated with neurogenic bladder. The traditional surgical ARM repair is a posterior sagittal anorectoplasty (PSARP), which is believed to have a minimal effect on bladder dynamics. However, little is known about the effects of reoperative PSARP (rPSARP) on bladder function. We hypothesized that a high rate of bladder dysfunction existed in this cohort.
METHODS
We performed a retrospective review of ARM patients undergoing rPSARP at a single institution from 2008 to 2015. Only patients with Urology follow-up were included in our analysis. Data was collected regarding original level of ARM, coexisting spinal anomalies and indications for reoperation. We assessed urodynamic variables and bladder management (voiding, CIC or diverted) before and after rPSARP.
RESULTS
A total of 172 patients were identified, of which 85 met inclusion criteria with a median follow-up of 23.9 months (IQR, 5.9-43.8 months). Thirty-six patients had spinal cord anomalies. Indications for rPSARP included mislocation (n = 42), posterior urethral diverticulum (PUD; n = 16), stricture (n = 19) and rectal prolapse (n = 8). Within 1 year following rPSARP, 11 patients (12.9%) had a negative change in bladder management, defined as need for beginning intermittent catheterization or undergoing urinary diversion, which increased to 16 patients (18.8%) at last follow-up. Postoperative bladder management changed in rPSARP patients with mislocation (p < 0.0001) and stricture (p 0.005) but not for rectal prolapse (p 0.143).
CONCLUSIONS
Patients who undergo rPSARP warrant especially close attention for bladder dysfunction as we observed a negative postoperative change in bladder management in 18.8% of our series.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Anorectal Malformations; Urinary Bladder; Rectal Prolapse; Reoperation; Constriction, Pathologic; Rectum; Retrospective Studies; Anal Canal
PubMed: 37217362
DOI: 10.1016/j.jpedsurg.2023.04.015