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BMC Medical Education Feb 2024The Advanced Life Support in Obstetrics (ALSO) course is a globally recognized interprofessional training program designed to assist healthcare professionals in...
BACKGROUND
The Advanced Life Support in Obstetrics (ALSO) course is a globally recognized interprofessional training program designed to assist healthcare professionals in acquiring and sustaining the necessary knowledge and skills to handle obstetric emergencies effectively. This survey aimed to assess the use, barriers, and confidence in using the ALSO course guidelines in managing obstetric emergencies in Sudan.
METHODS
This descriptive cross-sectional study involved 103 physicians from the Sudan ALSO group in Sudan. A structured, close-ended questionnaire was distributed electronically to the participants. Data analysis was conducted using Statistical Package of Social Sciences Software version 26.
RESULTS
More than half of the participants were specialists (54.4%). Although all respondents claimed to adhere to the ALSO guidelines for managing shoulder dystocia, a lower percentage followed them for neonatal resuscitation (75.0%) and maternal venous thrombosis management (68.9%). Only 62.1% of participants felt confident performing neonatal resuscitation. The main barriers to implementing the ALSO course guidelines were the respondents' preference for other guidelines and their belief that the guidelines were not applicable in their specific settings.
CONCLUSION
The majority of participants displayed a high level of confidence, indicating a positive perception of the guide's effectiveness. However, there is room for improvement, particularly in areas such as neonatal resuscitation and forceps-assisted births, where confidence levels were lower. Addressing barriers, including the preference for other guidelines and the applicability of the guide in specific settings, is crucial to ensure widespread adoption. Refresher training programs, contextual adaptations, and the integration of guidelines may help overcome these barriers and enhance the overall implementation of the ALSO guide in managing obstetric emergencies in Sudan.
Topics: Pregnancy; Female; Humans; Infant, Newborn; Emergencies; Cross-Sectional Studies; Sudan; Resuscitation; Clinical Competence; Obstetrics
PubMed: 38389049
DOI: 10.1186/s12909-024-05159-x -
AJOG Global Reports Feb 2024Unrecognized diabetes mellitus during pregnancy could pose serious maternal and neonatal complications. A hemoglobin A1c level of ≥6.5% was used to diagnose both...
BACKGROUND
Unrecognized diabetes mellitus during pregnancy could pose serious maternal and neonatal complications. A hemoglobin A1c level of ≥6.5% was used to diagnose both diabetes mellitus in nonpregnant individuals and diabetes in pregnancy. As the hemoglobin A1c level could be influenced by maternal physiological changes, the optimal cutoff in early pregnancy to detect women with diabetes in pregnancy and associated complications remains unclear.
OBJECTIVE
This study aimed to evaluate the diagnostic performance of various hemoglobin A1c levels and the optimal hemoglobin A1c cutoff to identify mothers with diabetes in pregnancy diagnosed by the gold standard 75 g oral glucose tolerance test before 24 weeks of gestation. In addition, the pregnancy and neonatal outcomes were compared using the optimal hemoglobin A1c cutoff.
STUDY DESIGN
A retrospective cohort study was conducted between 2004 and 2019. Women with at least 1 risk factor of gestational diabetes mellitus received an oral glucose tolerance test before 24 weeks of gestation. Terminology of hyperglycemia first detected during pregnancy by oral glucose tolerance test was classified as either diabetes in pregnancy or gestational diabetes mellitus following the World Health Organization's recommendation. Women who met the diagnostic criteria of diabetes in pregnancy and early-onset gestational diabetes mellitus (ie, before 24 weeks of gestation) and had a paired hemoglobin A1c measurement within 4 weeks of their early oral glucose tolerance test were studied. Sensitivity, specificity, and positive and negative predictive values at various hemoglobin A1c cutoffs were calculated for the detection of diabetes in pregnancy. The optimal hemoglobin A1c level was identified from the constructed receiver operating characteristic curves. Multivariate binary logistic regression analyses were performed to calculate the unadjusted and adjusted odds ratios for pregnancy complications.
RESULTS
There were 63,111 deliveries, and 22,949 women underwent an oral glucose tolerance test before 24 weeks of gestation. A total of 157 and 3210 women met the diagnostic criteria of diabetes in pregnancy and early-onset gestational diabetes mellitus using an oral glucose tolerance test, respectively. Only 346 participants had a paired hemoglobin A1c and oral glucose tolerance test measurement (82 cases with diabetes in pregnancy and 264 cases with early-onset gestational diabetes mellitus). The receiver operating characteristic curve identified an optimal hemoglobin A1c cutoff of 5.7% to diagnose diabetes in pregnancy, with a sensitivity of 64.6%, specificity of 81.1%, positive predictive value of 51.5%, and negative predictive value of 88.1%. A hemoglobin A1c cutoff of either 5.9% or 6.5% could miss 47.6% or 73.2% of women with diabetes in pregnancy. In multivariate logistic regression analysis, a hemoglobin A1c level of ≥5.7% increased the risk of maternal insulin use (adjusted odds ratio, 6.69; 95% confidence interval, 3.44-12.99), macrosomia (adjusted odds ratio, 7.43; 95% confidence interval, 1.90-29.00), and shoulder dystocia (adjusted odds ratio, 6.56; 95% confidence interval, 1.161-37.03).
CONCLUSION
The optimal hemoglobin A1c cutoff to detect diabetes in pregnancy diagnosed using an oral glucose tolerance test before 24 weeks of gestation was 5.7%, but this cutoff could not reliably identify diabetes in pregnancy owing to the low sensitivity. However, an early hemoglobin A1c level of ≥5.7% indicated increased risks of pregnancy and neonatal complications.
PubMed: 38362048
DOI: 10.1016/j.xagr.2024.100315 -
International Journal of Nursing... Jan 2024This study aimed to evaluate the effect of case-based learning (CBL) method with virtual reality (VR) simulation technology (CBL-VR) on midwifery laboratory courses.
OBJECTIVE
This study aimed to evaluate the effect of case-based learning (CBL) method with virtual reality (VR) simulation technology (CBL-VR) on midwifery laboratory courses.
METHODS
A quasi-experimental design was employed. A total of 135 midwifery students were recruited from Nursing College of Guilin Medical University in China from September 2020 to January 2022. Intervention group recruited students from the Class of 2019 ( = 59) and control group recruited students from the Class of 2018 ( = 76). The intervention group students received the CBL-VR method based on traditional laboratory teaching, the contents of course included four sections: eutocia (6 class hours), dystocia (6 class hours), umbilical cord prolapse (2 class hours), and neonatal asphyxia and resuscitation (4 class hours), 40 min per class hour. The control group students received the traditional laboratory teaching. Students' academic performance, Self-Directed Learning (SDL) Ability Questionnaire, and the education satisfaction questionnaire were used to evaluate the teaching efficacy between two groups.
RESULTS
After intervention, the intervention group students achieved higher scores than the control group in individual operation ability (90.88 ± 2.14 vs. 89.24 ± 3.15), team operation ability (90.97 ± 2.33 vs. 81.28 ± 5.45), and midwifery case analysis ability (88.64 ± 3.19 vs. 86.70 ± 2.56) ( <0.01). Prior to the implementation of the course, there was no difference in the SDL ability scores between the two groups of students ( > 0.05). However, following the course intervention, the SDL ability scores of the intervention group were higher than those of the control group (94.78 ± 6.59 vs. 88.12 ± 8.36), and the scores in all dimensions of the intervention group were also higher ( < 0.05). Additionally, more than 94% of the students indicated that CBL-VR method developed comprehensive abilities, including independent-study enthusiasm, independent thinking, collaboration, and communication.
CONCLUSION
Using the CBL-VR method in midwifery lab courses improved students' course performance, SDL ability, and comprehensive ability. Students highly recognized the effectiveness of this approach.
PubMed: 38352279
DOI: 10.1016/j.ijnss.2023.12.009 -
Obstetrics and Gynecology International 2024To test the hypothesis that PROMPT reduces permanent brachial plexus palsy and perineal tears.
OBJECTIVE
To test the hypothesis that PROMPT reduces permanent brachial plexus palsy and perineal tears.
DESIGN
A prospective/retrospective cohort study. . Hanover Medical School, Germany. . A self-selected population.
METHODS
The training period is from November 9, 2017, until December 31, 2019; control: January 1, 2004, until November 8, 2017. . Shoulder dystocia, nonpermanent and permanent brachial plexus injuries (BPIs), perineal tears III°/IV°, manual manoeuvres, and asphyxia.
RESULTS
There was a total of 22,640 births, and shoulder dystocia increased from 48/18,031 (0.27%) to 23/4,609 (0.50%) ((=0.017), OR: 1.88, 95% CI: (1.14; 3.09)), whereas BPIs decreased from 7/48 (14.6%) to 1/23 (4.3%) (=0.261). There was 1/7 (14.2%) of permanent BPI before and 0/1 (0%) case after. Perinatal asphyxia increased from 3/48 (6.3%) to 4/23 (17.4%) (=0.23). However, adverse outcomes after one year were zero. McRoberts' manoeuvre increased from 37/48 (77.1%) to 23/23 (100%) ((=0.013), OR: 1.62, 95% CI: (1.33; 1.98)), and internal rotation manoeuvres and manual extraction of the posterior arm from 6/48 (12.5%) to 5/23 (21.7%) (=0.319). Episiotomies decreased from 5,267/18,031 (29.2%) to 836/4,609 (18.1%) (( < 0.001), OR: 0.54, 95% CI: (0.49, 0.58)), whereas perineal tears III°/IV° associated with shoulder dystocia increased from 1/48 (2.1%) to 1/23 (4.8%) (=0.546). Vaginal operative deliveries remained constant (6.5% vs. 7%).
CONCLUSIONS
PROMPT significantly improves the management of shoulder dystocia and decreases permanent brachial plexus injuries but not perineal tears III°/IV°.
PubMed: 38344327
DOI: 10.1155/2024/8712553 -
Veterinary World Dec 2023Mineral deficiencies can lead to dystocia and abnormalities in neonates. Stillbirth of neonatal calves in dairy cows due to dystocia has become an economic problem....
BACKGROUND AND AIM
Mineral deficiencies can lead to dystocia and abnormalities in neonates. Stillbirth of neonatal calves in dairy cows due to dystocia has become an economic problem. Uterine torsion (UT) is a common form of dystocia observed in dairy cows. However, to the best of our knowledge, there have been no reports on the characteristics of serum trace element concentrations in dairy cows with UT. This study aimed to comprehensively measure serum trace element concentrations in dairy cows with UT and dystocia.
MATERIALS AND METHODS
Dairy cows with (n = 15) and without (n = 27) UT and neonates (n = 9 and n = 26, respectively) were included in this study. Blood samples (10 mL) were collected, and serum trace element concentrations were evaluated using inductively coupled plasma mass spectrophotometry.
RESULTS
The mortality rate at birth was significantly higher in calves delivered by cows with UT than those delivered by cows without UT. The odds ratio for mortality rate at birth in dairy cows with UT was 7.85. Serum zinc (Zn) levels were significantly lower in cows with UT than in cows without UT (p = 0.01). The copper: Zn ratio was significantly higher in cows with UT than in cows without torsion (p = 0.05). In contrast, serum Cobalt (Co) concentrations were significantly higher in neonates from cows with UT than in neonates from cows without UT (p = 0.01).
CONCLUSION
Uterine torsion is associated with a high mortality rate at birth and considerable economic losses. Cows with UT had low serum Zn levels, and neonates born to these cows had high serum Co levels.
PubMed: 38328366
DOI: 10.14202/vetworld.2023.2533-2537 -
Heliyon Feb 2024In Ethiopia, , Leptospira Hardjo, and spp are recognized as the primary factors contributing to cattle reproductive issues. A cross-sectional study was conducted in...
In Ethiopia, , Leptospira Hardjo, and spp are recognized as the primary factors contributing to cattle reproductive issues. A cross-sectional study was conducted in southwest Ethiopia from October 2020 to October 2021 to assess the risk of reproductive disorders associated with L. Hardjo, , and spp. Moreover, the study aimed to identify the factors associated with reproductive disorders. Using an indirect ELISA, antibodies against these pathogens were observed in serum samples collected from 461 cattle. We employed multivariable random effect logistic regression analysis to identify potential risk factors associated with reproductive disorders in cattle. The study areas showed a prevalence of 25.16 % (95 % CI: 21.20-29.12) for cattle reproductive disorders. The presence of Leptospira Hardjo (OR = 2.9, 95 % CI: 1.17-4.02) and (OR = 3.0, 1.49-5.94) antibodies was associated to the occurrence of cattle reproductive disorders. Seropositivity to pathogens , , and L. Hardjo, along with co-infection of all three, showed association with cattle abortion. The presence of L. Hardjo seropositivity and co-infection with were related to dystocia in cattle. Cattle with retained fetal membranes were associated with co-infection seropositivity to these pathogens. Additionally, seropositivity was linked to cases of repeated breeding in cattle. Age, breeding practices, and dog access to cattle showed associations with reproductive disorders, with odds ratios of 2.3 (95 % CI: 2.03-4.69), 2.9 (95 % CI: 1.83-4.82), and 6.5 (95 % CI: 1.04-2.53) respectively. This research indicates that , , and Leptospira Hardjo, which are responsible for severe zoonotic diseases, have a substantial negative impact on cattle production by causing reproductive disorders. To address the transmission of these diseases, it is essential to implement effective mitigation strategies and enhance public awareness. Additional investigation is necessary to identify and understand the factors contributing to cattle reproductive disorders in the specified area.
PubMed: 38327482
DOI: 10.1016/j.heliyon.2024.e25558 -
Heliyon Jan 2024To investigate trends and rates of severe perineal trauma (SPT), also known as obstetric anal sphincter injury (OASI), between midwife-led and obstetrician-led care in...
OBJECTIVE
To investigate trends and rates of severe perineal trauma (SPT), also known as obstetric anal sphincter injury (OASI), between midwife-led and obstetrician-led care in the Netherlands, and factors associated with SPT.
METHODS
This nationwide cohort study included registry data from 2000 to 2019 (n = 2,169,950) of spontaneous vaginal births of term, live, cephalic, single infants, without a (previous) caesarean section or assisted vaginal birth.First, trends of SPT and episiotomy were shown. Second, differences in SPT rates between midwife- and obstetrician-led care were assessed. Third, associations of care factors with SPT were examined. Multivariable logistic regression analyses were used to determine which factors were important in the associations. All outcomes were stratified for parity.
RESULTS
Over time, the SPT incidence increased mainly in midwife-led care and episiotomy rates decreased. Compared to midwife-led care, SPT rates were lower in obstetrician-led care among primiparous women (aOR 0.78; 99 % CI 0.74-0.81) and comparable among multiparous women (aOR 1.04; 99 % CI 0.99-1.10). Among women without epidural analgesia, these differences were smaller for primiparous women (aOR 0.88; 99 % CI 0.84-0.92), but the SPT rate was higher in obstetrician-led care among multiparous women (aOR 1.09; 99 % CI 1.03-1.15). Among women without shoulder dystocia, induction, augmentation, and pain medication, SPT rates were comparable among primiparous women, but higher among multiparous women in obstetrician-led care. In midwife-led care, SPT occurred more often among hospital versus home births. In obstetrician-led care, lower SPT incidences were found among births with epidural analgesia and for multiparous women with induction or augmentation.
CONCLUSIONS
Among spontaneous vaginal births, induction, augmentation, and epidural analgesia in obstetrician-led care may be an explanatory factor for the higher incidence of SPT among primiparous women in midwife-led care. More research is needed to explain differences in SPT rates and to understand how SPT can be prevented, while maintaining a high intact perineum rate.
PubMed: 38312656
DOI: 10.1016/j.heliyon.2024.e24609 -
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