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Neurology India 2022'White-cord syndrome' is an extremely rare entity following decompression of cervical cord in which post-operative reperfusion injury results in worsening of patient's...
BACKGROUND
'White-cord syndrome' is an extremely rare entity following decompression of cervical cord in which post-operative reperfusion injury results in worsening of patient's neurology and MRI reveals signal changes in spinal cord in absence of cord compression. We wish to report a case of 'white-cord syndrome' following a 'routine' ACDF.
CASE DESCRIPTION
A 39-year-old woman with paresthesias and spastic quadriparesis was found to have C5-C6 PIVD on MRI. ACDF was performed at C5-C6, after which worsening of quadriparesis was noted, for which intravenous high-dose steroids were started. An urgent MRI was done, which revealed findings of white-cord syndrome, without compression on underlying cord. With conservative management, her ASIA grade improved from C to D and the features of white-cord syndrome disappeared on follow-up imaging.
CONCLUSION
It is important for surgeons and patients to be aware of this rare but potentially catastrophic entity as this needs to be discussed while taking consent for surgery.
Topics: Adult; Female; Humans; Cervical Vertebrae; Decompression, Surgical; Diskectomy; Glucocorticoids; Magnetic Resonance Imaging; Paresthesia; Quadriplegia; Reperfusion Injury; Spinal Cord; Spinal Cord Diseases; Spinal Fusion; Syndrome
PubMed: 36412386
DOI: 10.4103/0028-3886.360940 -
Cureus Oct 2022Umbilical cord prolapse with ruptured membranes is an obstetric emergency with management consisting of delivery via emergent cesarean delivery. If the umbilical cord...
Umbilical cord prolapse with ruptured membranes is an obstetric emergency with management consisting of delivery via emergent cesarean delivery. If the umbilical cord prolapses beyond the internal os with intact membranes, there is an opportunity to intervene and reduce the risk of fetal morbidity and mortality. A healthy 30-year-old, gravida 1 para 0 was incidentally found to have a short cervical length at 25 weeks five days on routine anatomy ultrasound evaluation. On evaluation via ultrasound by the maternal-fetal medicine service, the umbilical cord was noted to be prolapsing through the cervix with membranes intact. The cord prolapse with intact membranes resolved after placing the patient in the Trendelenburg position and nifedipine was administered for tocolysis given the uterus was noted to be contracting. For the remainder of the pregnancy, the patient underwent close follow-up and serial ultrasound scans with confirmation of the fetal head as the presenting part. The patient ultimately delivered vaginally at term. Cord prolapse with intact membranes, when identified via ultrasound, can be managed conservatively via Trendelenburg positioning and tocolysis to avoid premature cesarean delivery.
PubMed: 36348877
DOI: 10.7759/cureus.29870 -
BMC Pediatrics Oct 2022Globally more than 650,000 newborns died on their first day of life from birth asphyxia. The outcome of an asphyxiated newborn depends on the quality of care they...
Application of Donabedian quality-of-care framework to assess quality of neonatal resuscitation, its outcome, and associated factors among resuscitated newborns at public hospitals of East Wollega zone, Oromia, Western Ethiopia, 2021.
BACKGROUND
Globally more than 650,000 newborns died on their first day of life from birth asphyxia. The outcome of an asphyxiated newborn depends on the quality of care they received at birth. However, the quality of care newborns received at birth may be below the WHO resuscitation standard. The reason for the poor quality of care is unclear. The Donabedian model, according to the World Health Organization (WHO), is an appropriate framework for health care assessment that focuses on improving the quality of care. So this study aims to assess the quality of neonatal resuscitation, outcome, and its associated factors among newborns with birth asphyxia at public hospitals in the East Wollega zone, 2021.
METHODS
An institution-based cross-sectional study was conducted to observe 410 asphyxiated newborns using consecutive sampling methods. Data was gathered using a pretested structured questionnaire and checklist. Epi-data version 3.1 was used to enter data, which was subsequently exported to Statistical Package for Social Sciences version 25 for analysis. A logistic regression model was employed to determine the variables associated with the outcome variable. The adjusted odds ratio with a 95% confidence interval was calculated, and all variables associated with the outcome variable with a p-value less than 0.05 in multivariable analysis were determined to be significant factors for the outcome of resuscitated newborns.
RESULT
A total of 410 asphyxiated newborns were included in this study with a response rate of 97%. From this 87.6% of resuscitated newborns survived. Keeping baby warm [AOR = 6.9; CI (3.1, 15.6)] is associated significantly with increased chances of survival while meconium presence in the airway [AOR = 0.26; CI (0.1, 0.6)], prematurity [AOR = 0.24; CI (0.12, 0.48)], and presence of cord prolapse [AOR = 0.08; CI (0.03, 0.19)] were factors significantly associated with decreased survival of resuscitated newborns at 1 h of life.
CONCLUSION
Newborns who were kept warm were more likely to survive compared to their counterparts. While the presence of meconium in the airway, preterm, and cord prolapse was associated with the decreased survival status of newborns. Facilitating referral linkage in the event of cord prolapse, counseling on early antenatal care initiation to decrease adverse outcomes (prematurity), and neonatal resuscitation refresher training is strongly recommended.
Topics: Infant; Infant, Newborn; Female; Pregnancy; Humans; Resuscitation; Cross-Sectional Studies; Ethiopia; Asphyxia; Asphyxia Neonatorum; Hospitals, Public; Prolapse
PubMed: 36258182
DOI: 10.1186/s12887-022-03638-y -
The Neuroradiology Journal Jun 2023Neonatal strokes constitute a major cause of pediatric mortality and morbidity. Neuroimaging helps in its diagnosis as well as prognostication. However, advanced... (Review)
Review
Neonatal strokes constitute a major cause of pediatric mortality and morbidity. Neuroimaging helps in its diagnosis as well as prognostication. However, advanced imaging, including magnetic resonance imaging (MRI), carries multiple challenges. Limited data exists in the literature on imaging-based predictors of neurological outcomes in neonatal stroke in the Indian population. In this study, we reviewed our available data on neonatal stroke patients between 2015 and 2020 for clinico-radiological patterns. During this period, 17 neonatal strokes were admitted and the majority were term births with a slight male preponderance. Seizures and encephalopathy were the most common presentation. Multiple maternal risk factors such as gestational diabetes, meconium-stained liquor, APLA syndrome, fever, deranged coagulation profile, oligohydramnios, cord prolapse, and non-progressive labor were seen. Cardiac abnormalities were seen in only less than half of these patients with the most common finding being atrial septal defects (ASD). Transcranial ultrasound was performed in eight neonates and the pick-up rate of ultrasound was poor. MR imaging showed large infarcts in 11 patients. The MCA territory was most commonly involved. Interestingly, five neonates had venous thrombosis with three showing it in addition to arterial thrombosis. Associated ictal, as well as Wallerian changes, were noted in 10. Although large territorial infarcts were the most common pattern, non-contrast MR angiography did not show major vessel occlusion in these cases. Outcomes were fairly good and only three patients had a residual motor deficit at 1 year. No recurrence of stroke was seen in any of the neonates.
Topics: Infant, Newborn; Humans; Male; Child; Tertiary Care Centers; Magnetic Resonance Imaging; Neuroimaging; Stroke; Magnetic Resonance Spectroscopy; Infarction
PubMed: 36170618
DOI: 10.1177/19714009221130488 -
Canine Medicine and Genetics Jun 2022The English Bulldog has risen sharply in popularity over the past decade but its distinctive and extreme conformation is linked to several serious health conditions....
BACKGROUND
The English Bulldog has risen sharply in popularity over the past decade but its distinctive and extreme conformation is linked to several serious health conditions. Using multivariable analysis of anonymised veterinary clinical data from the VetCompass Programme, this study compared the odds of common disorders between English Bulldogs and all remaining dogs in the UK during 2016.
RESULTS
From 905,544 dogs under veterinary care during 2016, the analysis included a random sample of 2,662 English Bulldogs and 22,039 dogs that are not English Bulldogs. English Bulldogs had 2.04 times the odds of diagnosis with ≥ 1 disorder than dogs that are not English Bulldogs (95% confidence interval [CI] 1.85 to 2.25). At a specific-level of diagnostic precision, English Bulldogs had increased odds of 24/43 (55.8%) disorders. These included: skin fold dermatitis (odds ratio [OR] 38.12; 95% CI 26.86 to 54.10), prolapsed nictitating membrane gland (OR 26.79; 95% CI 18.61 to 38.58) and mandibular prognathism (OR 24.32; 95% CI 13.59 to 43.53). Conversely, English Bulldogs had significantly reduced odds of 6/43 (14.0%) disorders. These included: retained deciduous tooth (OR 0.02; 95% CI 0.01 to 0.17), lipoma (OR 0.06; 95% CI 0.01 to 0.40) and periodontal disease (OR 0.23; 95% CI 0.18 to 0.30). At a grouped-level of diagnostic precision, English Bulldogs had significantly increased odds of 17/34 (50.0%) disorders. These included: congenital disorder (OR 7.55; 95% CI 5.29 to 10.76), tail disorder (OR 6.01; 95% CI 3.91 to 9.24) and lower respiratory tract disorder (OR 5.50; 95% CI 4.11 to 7.35). Conversely, English Bulldogs had significantly reduced odds of 3/34 (8.8%) disorders. These were: dental disorder (OR 0.25; 95% CI 0.20 to 0.31), spinal cord disorder (OR 0.31; 95% CI 0.14 to 0.71) and appetite disorder (OR 0.43; 95% CI 0.20 to 0.91).
CONCLUSIONS
These results suggest that the health of English Bulldogs is substantially lower than dogs that are not English Bulldogs and that many predispositions in the breed are driven by the extreme conformation of these dogs. Consequently, immediate redefinition of the breed towards a moderate conformation is strongly advocated to avoid the UK joining the growing list of countries where breeding of English Bulldogs is banned.
PubMed: 35701824
DOI: 10.1186/s40575-022-00118-5 -
Taiwanese Journal of Obstetrics &... May 2022To investigate the incidence of umbilical cord prolapse (UCP) and its influence on infant prognosis in pregnant women with preterm premature rupture of membranes (PPROM).
OBJECTIVE
To investigate the incidence of umbilical cord prolapse (UCP) and its influence on infant prognosis in pregnant women with preterm premature rupture of membranes (PPROM).
MATERIALS AND METHODS
We conducted a retrospective cohort study in a single tertiary perinatal center between 2009 and 2017. Singleton pregnancies with PPROM that occurred between 22 and 33 weeks of gestation were included. Infantile composite adverse outcome consisted of death, severe intraventricular hemorrhage, cystic periventricular leukomalacia, necrotizing enterocolitis, and sepsis before discharge. Infantile outcomes were compared between pregnancies that were complicated by UCP and those that were not.
RESULTS
Out of 208 singleton pregnancies included in the analysis, UCP occurred in 12 (5.8%) cases. The gestational age of pregnancies with UCP was significantly lesser than that of those without UCP. The incidence of infantile composite adverse outcome in patients with UCP was 16.7%, and this was not significantly higher than the incidence in patients without UCP (6.6%, P = 0.21). UCP was not shown to be associated with infantile composite adverse outcome in a multivariate regression model. Gestational age <25 weeks at delivery was significantly associated with infantile composite adverse outcome.
CONCLUSIONS
The incidence of UCP was 5.8% among singleton pregnancies, with PPROM being managed expectantly between 22 and 33 weeks' gestation. Preterm UCP may not be associated with infantile adverse outcomes provided emergency cesarean delivery is available at all time.
Topics: Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Infant; Infant, Newborn; Infant, Premature; Pregnancy; Pregnancy Outcome; Prolapse; Retrospective Studies; Umbilical Cord
PubMed: 35595443
DOI: 10.1016/j.tjog.2022.03.016 -
BMC Pediatrics May 2022Birth asphyxia is the inability of a newborn to start and conserve breathing immediately after birth. Globally, 2.5 million infants die within their first month of life...
BACKGROUND
Birth asphyxia is the inability of a newborn to start and conserve breathing immediately after birth. Globally, 2.5 million infants die within their first month of life every year, contributing nearly 47% of all deaths of children. It is the third cause of neonatal deaths next to infections and preterm birth. Ethiopia is one of the countries with the highest neonatal mortality and high burden of birth asphyxia in the world. The state of birth asphyxia is about 22.52% in Ethiopia, with incidence of 18.0% in East Africa Neonatal mortality incidence ratio was 9.6 deaths per 1000 live births among which 13.5% of neonatal mortality cases were due to birth asphyxia in southern Ethiopia. The effect of birth asphyxia is not only limited to common clinical problems and death; it also has a socio-economic impact on the families. Therefore, this study is aimed to identify determinants of birth asphyxia among newborn live births in public hospitals Southern Ethiopia.
METHODS
An Institution based unmatched case-control study was conducted among newborn live births in public hospitals of Gamo & Gofa zones, with a total sample size of 356 (89 cases and 267 controls, 1:3 case to control ratio) from March 18 to June 18, 2021, after obtaining ethical clearance from Arba Minch University. Cases were selected consecutively and controls were selected by systematic random sampling method. Data were collected using an adapted pretested semi-structured questionnaire through face-to-face interviews and record reviews using an extraction checklist for intrapartum & neonatal-related information. The collected data were entered into Epi data version 4.4 and exported to STATA version 14 for analysis. Finally, bi-variable and multivariable logistic regression analyses were performed to identify determinants of birth asphyxia. Statistical significance was declared at p-value ≤ 0.05 along with corresponding 95% CI of AOR used to declare statistical significance.
RESULTS
Anemia during pregnancy [AOR = 3.87, 95% CI (1.06- 14.09)], breech presentation [AOR = 3.56, 95% CI (1.19-10.65)], meconium stained amniotic fluid [AOR = 6.16, 95% CI (1.95-19.46)], cord prolapse [AOR = 4.69, 95%CI (1.04-21.05)], intrapartum fetal distress [AOR = 9.83, 95% CI (3.82-25.25)] and instrumental delivery [AOR = 5.91, 95% CI (1.51-23.07)] were significantly associated with birth asphyxia.
CONCLUSION
The study revealed that anemia during pregnancy, breech presentation, meconium-stained amniotic fluid, cord prolapse, intrapartum fetal distress, and instrumental delivery were identified as determinants of birth asphyxia. Therefore, health professional and health institutions should give emphasis on care of mother and the newborn in actively detecting and managing asphyxia.
Topics: Asphyxia; Asphyxia Neonatorum; Breech Presentation; Case-Control Studies; Child; Ethiopia; Female; Fetal Distress; Hospitals, Public; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Live Birth; Pregnancy; Premature Birth; Prolapse
PubMed: 35562670
DOI: 10.1186/s12887-022-03342-x -
BMJ Simulation & Technology Enhanced... 2021Umbilical cord prolapse is a rare obstetric emergency requiring rapid coordination of a multidisciplinary team to effect urgent delivery. The decision to delivery...
BACKGROUND
Umbilical cord prolapse is a rare obstetric emergency requiring rapid coordination of a multidisciplinary team to effect urgent delivery. The decision to delivery interval (DDI) is a marker of quality of teamwork. Multidisciplinary team simulation-based training can be used to improve clinical and teamwork performance.
AIM
To assess the DDI for cord prolapse before and after the introduction of simulation-based training at a quaternary maternity unit in Australia.
METHOD
A retrospective, observational cohort study comparing the DDI before and after the introduction of simulation-based training activities. The general linear model was used to estimate the association between DDI and simulation training while adjusting for potential confounders including model of care (public or private) and time of birth (regular or after hours).
RESULTS
After the introduction of simulation training, mean DDI decreased by 4.1 min (difference -4.1, 95% CI -6.2 to -1.9), after adjustment for confounding factors. Despite this, there was no difference in selected neonatal outcomes including Apgar score at 5 min and arterial cord pH.
CONCLUSIONS
The introduction of simulation-based training was associated with a decrease in the DDI in the setting of cord prolapse.
PubMed: 35520957
DOI: 10.1136/bmjstel-2021-000860 -
Anesthesia, Essays and Researches 2021Regional anesthesia (RA), i.e., spinal or epidural anesthesia when performed for lower segment cesarean section (LSCS) provides excellent surgical conditions, avoiding...
INTRODUCTION
Regional anesthesia (RA), i.e., spinal or epidural anesthesia when performed for lower segment cesarean section (LSCS) provides excellent surgical conditions, avoiding manipulation of the maternal airway, maternal satisfaction, and good postoperative analgesia. However, in situations like fetal distress (fetal heart rate abnormalities), obstetric indications (abruption of placenta, antenatal placental bleeding, cord prolapse), maternal refusal for RA, contraindications to neuraxial anesthesia (anticoagulation, coagulopathy), and at times failed RA general anesthesia (GA) is administered. Several studies have demonstrated greater mortality and morbidity when LSCS is done under GA when compared to neuraxial block.
METHODS
After necessary approval, we retrospectively reviewed data over a period of 1 year (January 1, 2020-December 31, 2020) of LSCS under GA versus RA. The aim was to compare immediate postoperative complications, postoperative pulmonary complications up to 4 weeks from the time of elective and emergency LSCS under either RA or GA.
RESULTS
Of the 753 patients who underwent LSCS in one calendar year, there were 272 (36.12%) elective and 481 (63.87%) emergency LSCS. The number of elective LSCS under neuraxial block was 219 (29.09%) and under GA were 53 (7.03%). Emergency LSCS done under neuraxial block were 268 (35.59%) and under GA were 213 (28.28%). There were no adverse pulmonary complications at the end of 4 weeks in either group.
CONCLUSION
RA provides maternal satisfaction and excellent perioperative analgesia in LSCS. Safe GA can be achieved with proper airway planning, if case is attended by at least two anesthesiologist with adequate preoperative fasting, and postoperative monitoring.
PubMed: 35422556
DOI: 10.4103/aer.aer_6_22 -
Geburtshilfe Und Frauenheilkunde Apr 2022According to current guidelines, inpatient management until birth is considered standard in pregnant women with preterm premature rupture of membranes (PPROM). With the...
According to current guidelines, inpatient management until birth is considered standard in pregnant women with preterm premature rupture of membranes (PPROM). With the increasing burden on obstetric departments and the growing importance of satisfaction and right to self-determination in pregnant women, outpatient management in PPROM is a possible alternative to inpatient monitoring. The most important criterion for this approach is to ensure the safety of both the mother and the child. Due to the small number of cases (n = 116), two randomised controlled trials (RCTs) comparing inpatient and outpatient management were unable to draw any conclusions. By 2020, eight retrospective comparative studies (cohort/observational studies) yielded the following outcomes: no significant differences in the rate of maternal complications (e.g., chorioamnionitis, premature placental abruption, umbilical cord prolapse) and in neonatal morbidity, significantly prolonged latency period with higher gestational age at birth, higher birth weight of neonates, and significantly shorter length of stay of preterm infants in neonatal intensive care, shorter hospital stay of pregnant women, and lower treatment costs with outpatient management. Concerns regarding this approach are mainly related to unpredictable complications with the need for rapid obstetric interventions, which cannot be performed in time in an outpatient setting. Prerequisites for outpatient management are the compliance of the expectant mother, the adherence to strict selection criteria and the assurance of adequate monitoring at home. Future research should aim at more accurate risk assessment of obstetric complications through studies with higher case numbers and standardisation of outpatient management under evidence-based criteria.
PubMed: 35392068
DOI: 10.1055/a-1515-2801