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Cureus Apr 2024Hanging is amongst the most commonly used methods of suicide. Multiple findings could be observed in such cases. Knowing the proper mechanism of their occurrence and how...
Hanging is amongst the most commonly used methods of suicide. Multiple findings could be observed in such cases. Knowing the proper mechanism of their occurrence and how to interpret them is of utmost importance in forensic practice to avoid misinterpretation and wrong conclusions. The study aimed to present a case of hanging with putrefactive changes - external and internal findings, signs or prolonged stay in a hanged position, their interpretation, and discussion as part of the routine forensic practice.
PubMed: 38721204
DOI: 10.7759/cureus.57809 -
Acta Obstetricia Et Gynecologica... Jul 2024Maternal and infant mortality rates in Finland are among the lowest in the world, yet preventable obstetric injuries occur every year. The aim of this study was to...
INTRODUCTION
Maternal and infant mortality rates in Finland are among the lowest in the world, yet preventable obstetric injuries occur every year. The aim of this study was to describe obstetric claims, their compensation rates, and temporal trends of claims reported to the Patient Insurance center.
MATERIAL AND METHODS
A nationwide, register-based study was conducted. Data consisted of obstetric claims reported to the Patient Insurance Center between 2012 and 2022. Data analyzed included the year of injury, compensation criteria, maternal age, birth hospital, delivery method, reported causes of injury, and maternal or neonatal injury. The data were analyzed with descriptive statistics and logistic regression models.
RESULTS
A total of n = 849 obstetric claims were filed during the study period, of which n = 224 (26.4%) received compensation. The rate of claims was 0.15%, and the rate of compensation was 0.04% in relation to the total volume of births during the period. Substandard care was the most common (97.3%) criterion for compensation. There was a curvilinear increase in the claims rate and a linear increase in compensation rates from 2013 to 2019. More claims were filed and compensated for cesarean and vacuum-assisted deliveries than for unassisted vaginal deliveries. Delayed delivery (18.7%) and surgical technique failure (10.9%) were the most reported causes of injuries. Retained surgical bodies were the induced cause of injury with the highest rate of compensated claims (86.7%). The most common maternal injury was infection (17.9%) and pain (11.7%). Among neonatal injuries, severe (19.2%) and mild asphyxia (16.6%) were the most frequent. Burn injuries (93.3%) and fetal or neonatal death (60.5%) had the highest rate of compensated claims.
CONCLUSIONS
The study provided new information on substandard care and injuries in obstetric care in Finland. An increasing trend in claims and compensation rates was found. Identifying contributors to substandard care that lead to fetal asphyxia is important for improving obstetric safety. Further analysis of the association of claims and compensation rates with operative deliveries is needed to determine their causality. Frequent review of obstetric claims would be useful in providing more recent data on substandard care and preventable injuries.
Topics: Humans; Finland; Female; Registries; Pregnancy; Adult; Delivery, Obstetric; Infant, Newborn; Compensation and Redress; Birth Injuries
PubMed: 38711236
DOI: 10.1111/aogs.14869 -
South African Family Practice :... Apr 2024Stillbirths are a global public health challenge, predominantly affecting low- and middle-income countries. The causes of most stillbirths are preventable.
BACKGROUND
Stillbirths are a global public health challenge, predominantly affecting low- and middle-income countries. The causes of most stillbirths are preventable.
OBJECTIVES
this study reviewed perinatal clinical audit data from Kgapane Hospital over a 4-year period with a special focus on the factors associated with stillbirths.
METHODS
File audits were done for all stillbirths occurring at Kgapane Hospital and its catchment area from 2018 to 2021. The data from these audits were analysed to identify factors associated with stillbirths.
RESULTS
A total of 392 stillbirths occurred during the study period at Kgapane Hospital and its surrounding clinics, resulting in a stillborn rate of 19.06/1000 births. Of the 392 stillbirths recorded, audits were conducted on 354 of the maternal case records. The five most common causes of stillbirths identified were: hypertensive disorders in pregnancy (HDP) (29.7%), intrauterine growth restriction without HDP (11.6%), birth asphyxia (7.1%), premature labour ( 1000 g) (6.5%) and maternal infections (5.9%) including HIV with unsuppressed VL, intrauterine infection, coronavirus disease (COVID) and syphilis. Modifiable factors that can form the basis of improvement strategies should include training, timeous referral, plus improved resources and staffing.
CONCLUSION
Understanding the causes of stillbirths can guide improvement strategies to reduce this heart-breaking complication of pregnancy.Contribution: Family physicians working in rural hospitals are also responsible for perinatal care. Understanding the factors associated with stillbirths will guide them to develop improvement strategies to reduce these preventable deaths.
Topics: Humans; Stillbirth; Female; Pregnancy; South Africa; Adult; Infant, Newborn; Fetal Growth Retardation; Hypertension, Pregnancy-Induced; Risk Factors; COVID-19; Pregnancy Complications
PubMed: 38708746
DOI: 10.4102/safp.v66i1.5863 -
Epilepsy & Behavior Reports 2024Neonatal seizures can lead to long-term neurodevelopmental problems. This study aims to identify predictors of poor developmental outcomes in neonates with seizures to...
Neonatal seizures can lead to long-term neurodevelopmental problems. This study aims to identify predictors of poor developmental outcomes in neonates with seizures to aid in early intervention and referral for follow-up and rehabilitation. This observational study was conducted in the Department of Neonatology and Institute of Paediatric Neurodisorder and Autism, Bangabandhu Sheikh Mujib Medical University. Among 75 study cases of neonatal seizure, 23 died, and 46 were followed-up at 6 and 9 months after discharge. EEGs were performed on every patient. A comprehensive neurological examination and developmental evaluation were performed using Bayley Scales of Infant and Toddler Development, Third Edition (Bayley III). Three-fourths of neonates were born at term (76.1 %), and over half were male (56.5 %). The majority were appropriate for gestational age (79.7 %) and had an average birth weight of 2607 ± 696 g (±SD). Over half of the neonates (52.2 %) had adverse neurodevelopmental outcomes, with global developmental delay being the most common. Recurrent seizures, the number of anticonvulsants needed to control seizures, and abnormal Electroencephalograms were identified as independent predictors of adverse neurodevelopmental outcomes. The study highlights the need for early referral for follow-up and rehabilitation of neonates with seizures having abnormal electroencephalograms, recurrent seizures and requiring more anticonvulsants to control seizures.
PubMed: 38708367
DOI: 10.1016/j.ebr.2024.100665 -
Heliyon May 2024Neonatal seizures are the most common neurological problem among newborns. To date, scientific studies on the incidence and predictors of neonatal seizures in African...
Incidence and predictors of neonatal seizures among neonates admitted in Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia. A prospective follow-up study.
INTRODUCTION
Neonatal seizures are the most common neurological problem among newborns. To date, scientific studies on the incidence and predictors of neonatal seizures in African countries, including Ethiopia are scarce. Therefore, this study aimed to assess the incidence and predictors of neonatal seizures among neonates admitted to Debre Markos comprehensive Specialized Hospital.
METHODS
An institutional-based prospective follow-up study was conducted i Debre Markos comprehensive specialized hospital from February 1 2022 to January 30, 2023. A systematic random sampling technique was used to select a total of 198 neonates. Data were entered into Epi-Data 4.2 and then exported to STATA version 14.1 for analysis. The Kaplan-Meier survival curve and the log-rank test were computed to explore the descriptive statistics. Variables with a p-value ≤0.2 in bi-variable Cox-regression were selected for multivariable Cox-regression analysis. Finally, a p-value of <0.05 was used to declare the statistical significance of the association with the outcome variable.
RESULTS
The overall incidence rate of neonatal seizures was 35 per 1000 person-day observations. The mean follow-up time for this study was 123.4 h. The cumulative survival probability of neonates' at 0 to 24 and 0-72 h was 89.8 % and 81.71 %, respectively. The statistically significant predictors for the incidence of neonatal seizures were perinatal asphyxia (AHR = 10.95; 95%CI: 4.81, 24.93), subgaleal hemorrhage (AHR = 5.17; 95%CI: 2.09, 12.79), and gestational age <37 weeks (AHR = 4.62; 95%CI: 1.62, 13.22).
CONCLUSIONS
The incidence rate of neonatal seizures in this study was high. Neonates born with gestational age <37 weeks, having perinatal asphyxia, and having subgaleal hemorrhage were statistical predictors for the incidence of neonatal seizures. Thus, healthcare professionals should give special attention to neonates born with gestational age <37 weeks, prevent perinatal asphyxia and subgaleal hemorrhage.
PubMed: 38707374
DOI: 10.1016/j.heliyon.2024.e29999 -
Heliyon May 2024Birth asphyxia is one of the leading causes of neonatal mortality, which accounts for around 24 % of overall neonatal mortality. Neonatal death usually results from...
INTRODUCTION
Birth asphyxia is one of the leading causes of neonatal mortality, which accounts for around 24 % of overall neonatal mortality. Neonatal death usually results from preventable factors. Thus, this study has aimed to identify the determinant factors of birth asphyxia among newborns in South Gondar Zone public hospitals.
METHODS
Institution based unmatched case control study and systematic random sampling technique was conducted in South Gondar zone public hospitals from March October 2021 to May 20/2021. A pretested interviewer administered questionnaire and a data retrieving checklist was used for data collection. Cases were selected if one of the following was present at birth: (gasping, no breathing, or breathing rate of below 30 per minute). Epidata version 4.6 software was used for data entry and bivariate logistic regression and multivariable logistic regression techniques were used for data analysis using SPSS version 23.
RESULT
In this study, Instrumental delivery (AOR = 3.19, 95%CI: 1.23-8.36), labor abnormality (AOR = 3.24, 95%CI: 1.31-8.03), cord prolapse (AOR = 7.06, 95%CI:2.25-22.50),APH (AOR = 4.68,95%CI:2.00-10.95) and preterm birth (AOR = 3.84,95%CI:1.32-11.20) were predictors of birth asphyxia.
CONCLUSION
Labor abnormality, ante-partum hemorrhage, cord prolapse, instrumental delivery and preterm birth were independent predictors of birth asphyxia.
PubMed: 38707282
DOI: 10.1016/j.heliyon.2024.e30093 -
Journal of Multidisciplinary Healthcare 2024This study aimed to create, verify and assess the clinical utility of a prediction model for maternal and neonatal adverse outcomes in pregnant women with hypothyroidism.
PURPOSE
This study aimed to create, verify and assess the clinical utility of a prediction model for maternal and neonatal adverse outcomes in pregnant women with hypothyroidism.
METHODS
A prediction model was developed, and its accuracy was tested using data from a retrospective cohort. The study focused exclusively on female patients diagnosed with hypothyroidism who were admitted to a tertiary hospital. The development and validation cohort comprised individuals who gave birth between 1 October 2020 and 31 December 2022. The primary outcome was a combination of crucial maternal and newborn problems (eg premature births, abortions and neonatal asphyxia). The prediction model was developed using logistic regression. Evaluation of the model's performance was conducted based on its ability to discriminate, calibrate and provide clinical value.
RESULTS
In total, nine variables were chosen to develop the predictive model for adverse maternal and neonatal outcomes during pregnancy with hypothyroidism. The area under the curve of the model for predicting maternal adverse outcomes was 0.845, and that for predicting neonatal adverse outcomes was 0.685. The calibration plots showed good agreement between the nomogram predictions and the actual observations in both the training and validation cohorts. Furthermore, decision curve analysis suggested that the nomograms were clinically useful and had good discriminative power to identify high-risk mother-infant cases.
CONCLUSION
Two models to predict the risk probability of maternal and neonatal adverse outcomes in pregnant women with hypothyroidism were developed and verified to assist physicians in evaluating maternal and neonatal adverse outcomes throughout pregnancy with hypothyroidism and to facilitate decision-making regarding therapy.
PubMed: 38706501
DOI: 10.2147/JMDH.S457818 -
Alternative Therapies in Health and... May 2024To explore the effects of comprehensive nursing combined with thermal insulation measures on the awakening agitation (EA) of cesarean section parturient under general...
OBJECTIVE
To explore the effects of comprehensive nursing combined with thermal insulation measures on the awakening agitation (EA) of cesarean section parturient under general anesthesia and maternal and infant safety.
METHODS
A total of 136 cesarean section parturients under general anesthesia admitted in our hospital from May 2020 to November 2023 were picked as the research objects following the random, double-blind method. All patients have no mental illness and can clearly reflect their physical state. The subjects were randomized into the study group and the control group in accordance with the random number table method, with 68 cases in each group. The control group was intervened with thermal insulation measures, while the study group was intervened with comprehensive nursing combined with thermal insulation measures. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) at different time points were compared. The Ramsay score (RASS), the incidence of EA, and the incidence of shivering were compared. The influence of comprehensive nursing combined with thermal insulation measures on maternal and infant safety and their recovery after the operation was analyzed. The adverse psychological status and postoperative satisfaction of the two groups were statistically analyzed.
RESULTS
SBP, DBP, and MAP in the study group were much higher than those in the control group at the time of skin incision, fetal delivery, and the end of operation (P < .05). Compared with the control group, the study group had much higher RASS, and sharply reduced incidence of EA and shivering (P < .05). The incidence of fetal distress, postpartum hemorrhage, neonatal asphyxia, etc., was significantly lower in the study group than in the control group P < .05). Parturient of the study group had a shorter duration of hospitalization, shorter detention time in the anesthesia monitoring room, and awakening time than the parturient in the control group (P < .05). The SAS and SDS scores of parturient were significantly decreased in the two groups at discharge than before the operation, and a more obvious decrease was found in the study group (P < .01). Postoperative satisfaction of the study group and the control group was 98.53% and 80.88%, respectively, which was markedly higher in the study group than in the control group (P < .05).
CONCLUSION
Comprehensive nursing combined with thermal insulation measures vastly improved the sedation degree of parturient, reduced the incidence of EA and chills, ensured maternal and infant safety, reduced adverse pregnancy outcomes, promoted early recovery of parturient, and enhanced maternal satisfaction. This conclusion provides important guidance for improving clinical practice, emphasizing the key role of comprehensive care in improving surgical outcomes and patient comfort, thereby improving the quality and efficiency of medical services.
PubMed: 38702155
DOI: No ID Found -
AJOG Global Reports May 2024The iPREFACE score may aid in predicting fetal acidemia and neonatal asphyxia in emergency cesarean and vaginal deliveries, which may improve labor management precision...
The iPREFACE score is useful for predicting fetal acidemia: A retrospective cohort study of 113 patients who underwent emergency cesarean section for non-reassuring fetal status during labor.
BACKGROUND
The iPREFACE score may aid in predicting fetal acidemia and neonatal asphyxia in emergency cesarean and vaginal deliveries, which may improve labor management precision in the future.
OBJECTIVE
This study aimed to assess the score use of the iPREFACE as an objective indicator of the need for rapid delivery in cases of repeated abnormal waveforms without concurrent indications for immediate medical intervention during labor.
STUDY DESIGN
This retrospective cohort study was conducted among term (37+ 0 days to 41+6 days) singleton pregnant women who underwent emergency cesarean delivery owing to a nonreassuring fetal status. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-decision of emergency cesarean delivery score, calculated from a 30-minute cardiotocography waveform before the decision to perform emergency cesarean delivery, and the integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of cardiotocography transducer score, calculated from a 30-minute cardiotocography waveform before cardiotocography transducer removal, were employed. The primary outcome was the assessment of the predictive ability of these scores for fetal acidemia, whereas the secondary outcomes were differences in umbilical artery blood gas findings and postnatal outcomes between the 2 groups, divided by the cutoff values of the integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of cardiotocography score.
RESULTS
The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-decision of emergency cesarean delivery and integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of cardiotocography transducer scores demonstrated the capability to predict an umbilical artery blood pH of <7.2. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-decision of emergency cesarean delivery and -removal of cardiotocography transducer score, with cutoff values of 37 and 46 points, respectively, exhibited an area under the receiver operating characteristic curve of 0.82 and 0.87, respectively. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of cardiotocography transducer group with ≥46 points had higher incidence rates of an umbilical cord artery blood pH of <7.2, <7.1, and <7.0 and neonatal intensive care unit admissions for neonatal asphyxia.
CONCLUSION
The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring, derived from cardiotocography during an emergency cesarean delivery, may enable clinicians to predict fetal acidemia in cases of nonreassuring fetal status. Improved prediction of fetal acidemia and facilitation of timely intervention hold promise for enhancing the outcomes of mothers and newborns during childbirth. Prospective studies are warranted to establish precise cutoff values and to validate the clinical application of these scores.
PubMed: 38699222
DOI: 10.1016/j.xagr.2024.100343 -
BMC Pregnancy and Childbirth May 2024The aim of this study is to determine the effectiveness of antenatal corticosteroid in reducing respiratory morbidity in babies born in the late preterm period. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The aim of this study is to determine the effectiveness of antenatal corticosteroid in reducing respiratory morbidity in babies born in the late preterm period.
METHODS
Two hundred and eighty-six pregnant women at risk of having a late preterm delivery were studied. One hundred and forty-three (143) served as the cases and were given 2 doses of 12 mg intramuscular dexamethasone 12 h apart, while 143 served as the controls and were given a similar quantity of placebo. The women were followed up prospectively and data were collected on the pregnant women and their newborns on a standardized form. The neonates were assessed for acute respiratory distress syndrome and transient tachypnea of the newborn based on clinical signs, symptoms, and chest x-ray results (when indicated). The primary outcome was the occurrence of neonatal respiratory morbidity.
RESULTS
The primary outcome occurred in 5 out of 130 infants (3.8%) in the dexamethasone group and 31 out of 122 (25.4%) in the placebo group (P value = 0.000003). Birth asphyxia, neonatal intensive care admission and need for active resuscitation at birth also occurred significantly less frequently in the dexamethasone group (P value 0.004, 0.009, 0.014 respectively). There were no significant group differences in the incidence of neonatal sepsis, neonatal jaundice, hypoglycemia and feeding difficulties.
CONCLUSIONS
Administration of dexamethasone to women at risk for late preterm delivery significantly reduced the rate of neonatal respiratory complications, neonatal intensive care unit admission, and need for active resuscitation at birth.
TRIAL REGISTRATION
PACTR ( www.pactr.org ) Registration Number: PACTR202304579281358. The study was retrospectively registered on April 19, 2023.
Topics: Humans; Female; Dexamethasone; Pregnancy; Infant, Newborn; Respiratory Distress Syndrome, Newborn; Adult; Infant, Premature; Prospective Studies; Glucocorticoids; Premature Birth; Prenatal Care; Transient Tachypnea of the Newborn; Gestational Age
PubMed: 38698318
DOI: 10.1186/s12884-024-06304-6