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The Lancet. Neurology Oct 2014Epilepsy is a common neurological disease in tropical countries, particularly in sub-Saharan Africa. Previous work on epilepsy in sub-Saharan Africa has shown that many... (Review)
Review
Epilepsy is a common neurological disease in tropical countries, particularly in sub-Saharan Africa. Previous work on epilepsy in sub-Saharan Africa has shown that many cases are severe, partly a result of some specific causes, that it carries a stigma, and that it is not adequately treated in many cases. Many studies on the epidemiology, aetiology, and management of epilepsy in sub-Saharan Africa have been reported in the past 10 years. The prevalence estimated from door-to-door studies is almost double that in Asia, Europe, and North America. The most commonly implicated risk factors are birth trauma, CNS infections, and traumatic brain injury. About 60% of patients with epilepsy receive no antiepileptic treatment, largely for economic and social reasons. Further epidemiological studies should be a priority to improve understanding of possible risk factors and thereby the prevention of epilepsy in Africa, and action should be taken to improve access to treatment.
Topics: Africa South of the Sahara; Age Distribution; Anticonvulsants; Birth Injuries; Brain Injuries; Central Nervous System Infections; Drug Utilization; Epilepsy; Humans; Incidence; Malnutrition; Prevalence; Risk Factors; Seizures; Seizures, Febrile; Sex Distribution; Socioeconomic Factors
PubMed: 25231525
DOI: 10.1016/S1474-4422(14)70114-0 -
American Journal of Obstetrics &... Jul 2021Although the neonatal morbidity associated with shoulder dystocia are well known, the maternal morbidity caused by this obstetrical emergency is infrequently reported. (Observational Study)
Observational Study
BACKGROUND
Although the neonatal morbidity associated with shoulder dystocia are well known, the maternal morbidity caused by this obstetrical emergency is infrequently reported.
OBJECTIVE
This study aimed to assess the composite adverse maternal and neonatal outcomes among vaginal deliveries (at 34 weeks or later) with and without shoulder dystocia.
STUDY DESIGN
This is a secondary analysis of the Consortium of Safe Labor, an observational obstetrical cohort of all vaginal deliveries occurring at 19 hospitals (from 2002-2008) and for which data on the occurrence of shoulder dystocia were available. The composite adverse maternal outcome included third- or fourth-degree perineal laceration, postpartum hemorrhage (>500 cc blood loss for a vaginal delivery and >1000 cc blood loss for cesarean delivery), blood transfusion, chorioamnionitis, endometritis, thromboembolism, admission to intensive care unit, or maternal death. The composite adverse neonatal outcome included an Apgar score of <7 at 5 minutes, a birth injury, neonatal seizure, hypoxic ischemic encephalopathy, or neonatal death. A multivariable Poisson regression was used to estimate the adjusted relative risks with 95% confidence intervals. The area under the receiver operating characteristic curve was constructed to determine if clinical factors would identify shoulder dystocia.
RESULTS
Of the 228,438 women in the overall cohort, 130,008 (59.6%) met the inclusion criteria, and among them, shoulder dystocia was documented in 2159 (1.7%) cases. The rate of composite maternal morbidity was significantly higher among deliveries with shoulder dystocia (14.7%) than without (8.6%; adjusted relative risk, 1.71; 95% confidence interval, 1.64-2.01). The most common maternal morbidity with shoulder dystocia was a third- or fourth-degree laceration (adjusted relative risk, 2.82; 95% confidence interval, 2.39-3.31). The risk of composite neonatal morbidity with shoulder dystocia (12.2%) was also significantly higher than without shoulder dystocia (2.4%) (adjusted relative risk, 5.18; 95% confidence interval, 4.60-5.84). The most common neonatal morbidity was birth injury (adjusted relative risk, 5.39; 95% confidence interval, 4.71-6.17). The area under the curve for maternal characteristics to identify shoulder dystocia was 0.66 and it was 0.67 for intrapartum factors.
CONCLUSION
Although shoulder dystocia is unpredictable, the associated morbidity affects both mothers and newborns. The focus should be on concurrently averting the composite morbidity for the maternal-neonatal dyad with shoulder dystocia.
Topics: Birth Injuries; Cesarean Section; Delivery, Obstetric; Female; Humans; Infant, Newborn; Postpartum Hemorrhage; Pregnancy; Shoulder Dystocia
PubMed: 33757935
DOI: 10.1016/j.ajogmf.2021.100359 -
Bulletin of the NYU Hospital For Joint... 2011Shoulder deformity remains the most common musculo-skeletal sequela following a brachial plexus birth injury. The natural history of untreated glenohumeral deformity is... (Review)
Review
Shoulder deformity remains the most common musculo-skeletal sequela following a brachial plexus birth injury. The natural history of untreated glenohumeral deformity is one of progression in this unique patient population. In infants and young children with persistent neurological deficits, shoulder dysfunction becomes a major source of morbidity, as these children have extreme difficulty placing the hand in space. The functional limitations due to muscle denervation and the resultant periarticular soft tissue contractures and progressive osseous deformities have been well-characterized. Increasing attention is being given to the glenohumeral dysplasia (GHD) and the associated prevalence of early posterior dislocation of the shoulder in infants with brachial plexus birth injuries. GHD represents a spectrum of findings, including glenoid and humeral head articular incongruities and dysplasia, subluxation, and frank dislocation. This article presents our comprehensive, temporally-based management strategies for the glenohumeral joint deformities in these children utilizing soft tissue and bony reconstructive procedures.
Topics: Birth Injuries; Brachial Plexus; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Joint Deformities, Acquired; Shoulder Joint; Surgical Procedures, Operative
PubMed: 21332437
DOI: No ID Found -
Acta Obstetricia Et Gynecologica... Oct 2019
Topics: Birth Injuries; Checklist; Documentation; Female; Humans; Monitoring, Physiologic; Pregnancy; Video Recording
PubMed: 31538338
DOI: 10.1111/aogs.13660 -
BMJ Open Mar 2024Birth injury is a significant public health problem in Africa, with a high incidence and associated mortality and morbidity. Systematic reviews that indicate the...
INTRODUCTION
Birth injury is a significant public health problem in Africa, with a high incidence and associated mortality and morbidity. Systematic reviews that indicate the incidence, contributing factors and outcomes of birth injury in Africa provide valuable evidence to policy-makers and programme planners for improving prevention and treatment strategies. Therefore, this review is aimed to evaluate the incidence, contributing factors and outcomes of birth injury among newborns in Africa.
METHODS AND ANALYSIS
The data will be searched and extracted from JBI Database, Cochrane Database, MEDLINE/PubMed, CINAHL/EBSCO, EMBASE, PEDro, POPLINE, Proquest, OpenGrey (SIGLE), Google Scholar, Google, APA PsycInfo, Web of Science, Scopus and HINARI. Unpublished studies and grey literature will be searched from different sources. This systematic review will include quantitative observational studies, registry and census data, and experimental studies that report on the prevalence or incidence in Africa from 1 January 1990 to 30 September 2023. The Joanna Briggs Institute (JBI) quality appraisal checklist will be used to select eligible studies. Two researchers will independently appraise and extract the data from included studies and resolve discrepancies through discussion. Heterogeneity will be assessed using forest plots and the I statistic. If substantial heterogeneity is present, a random-effects model will be used to pool the data. Subgroup analyses will be used to explore the potential sources of heterogeneity. Publication bias will be assessed using funnel plots and Egger's regression test. The software package used to conduct the meta-analysis will be JBI SUMARI. An association will be considered significant if the p<0.05.
ETHICS AND DISSEMINATION
Ethical clearance is not needed for this systematic review and the results will be shared with relevant stakeholders to maximise reach and impact.
PROSPERO REGISTRATION NUMBER
CRD42023123637.
Topics: Humans; Infant, Newborn; Incidence; Africa; Prevalence; Birth Injuries; Systematic Reviews as Topic; Meta-Analysis as Topic
PubMed: 38458802
DOI: 10.1136/bmjopen-2023-080262 -
The Cochrane Database of Systematic... Jan 2016Caesarean section involves making an incision in the woman's abdomen and cutting through the uterine muscle. The baby is then delivered through that incision. Difficult... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Caesarean section involves making an incision in the woman's abdomen and cutting through the uterine muscle. The baby is then delivered through that incision. Difficult caesarean birth may result in injury for the infant or complications for the mother. Methods to assist with delivery include vacuum or forceps extraction or manual delivery utilising fundal pressure. Medication that relaxes the uterus (tocolytic medication) may facilitate the birth of the baby at caesarean section. Delivery of the impacted head after prolonged obstructed labour can be associated with significant maternal and neonatal complication; to facilitate delivery of the head the surgeon may utilise either reverse breech extraction or head pushing.
OBJECTIVES
To compare the use of tocolysis (routine or selective use) with no use of tocolysis or placebo and to compare different extraction methods at the time of caesarean section for outcomes of infant birth trauma, maternal complications (particularly postpartum haemorrhage requiring blood transfusion), and long-term measures of infant and childhood morbidity.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2015) and reference lists of retrieved studies.
SELECTION CRITERIA
All published, unpublished, and ongoing randomised controlled trials comparing the use of tocolytic agents (routine or selective) at caesarean section versus no use of tocolytic or placebo at caesarean section to facilitate the birth of the baby. Use of instrument versus manual delivery to facilitate birth of the baby. Reverse breech extraction versus head pushing to facilitate delivery of the deeply impacted fetal head.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.
MAIN RESULTS
Seven randomised controlled trials, involving 582 women undergoing caesarean section were included in this review. The risk of bias of included trials was variable, with some trials not adequately describing allocation or randomisation.Three comparisons were included. 1. Tocolysis versus no tocolysisA single randomised trial involving 97 women was identified and included in the review. Birth trauma was not reported. There were no cases of any maternal side-effect reported in either the nitroglycerin or the placebo group. No other maternal and infant health outcomes were reported. 2. Reverse breech extraction versus head push for the deeply impacted head at full dilation at caesarean section Four randomised trials involving 357 women were identified and included in the review. The primary outcome of birth trauma was reported by three trials and there was no difference between reverse breech extraction and head push for this rare outcome (three studies, 239 women, risk ratio (RR) 1.55, 95% confidence interval (CI) 0.42 to 5.73). Secondary outcomes including endometritis rate (three studies, 285 women, average RR 0.52, 95% CI 0.26 to 1.05, Tau I² = 0.22, I² = 56%), extension of uterine incision (four studies, 357 women, average RR 0.23, 95% CI 0.13 to 0.40), mean blood loss (three studies, 298 women, mean difference (MD) -294.92, 95% CI -493.25 to -96.59; I² = 98%) and neonatal intensive care unit (NICU)/special care nursery (SCN) admission (two studies, 226 babies, average RR 0.53, 95% CI 0.23 to 1.22, Tau I² = 0.27, I² = 74%) were decreased with reverse breech extraction. No differences were observed between groups for many of the other secondary outcomes reported (blood loss > 500 mL; blood transfusion; wound infection; mean hospital stay; average Apgar score).There was significant heterogeneity between the trials for the outcomes mean blood loss, operative time and mean hospital stay, making comparison difficult. However the operation duration was significantly shorter for reverse breech extraction, which may correspond with ease of delivery and therefore, the amount of tissue trauma and therefore, significantly less blood loss. Given the heterogeneity, we cannot define the amount of difference in blood loss, operative time or hospital stay however. 3. Instrument (vacuum or forceps) versus manual extraction at elective caesarean section Two randomised trials involving 128 women were identified and included in the review. Only one trial reported maternal and infant health outcomes as prespecified in this review. This trial reported birth trauma as an outcome but there were no instances of birth trauma in either comparison group. There were no differences found in mean fall in haemoglobin (Hb) between groups (one study, 44 women, MD 0.03, 95% CI -0.53 to 0.59), or in uterine incision extension (one study, 44 women, RR 0.70, 95% CI 0.13 to 3.73).
AUTHORS' CONCLUSIONS
There is currently insufficient information available from randomised trials to support or refute the routine or selective use of tocolytic agents or instrument to facilitate infant birth at the time of difficult caesarean section. There is limited evidence that reverse breech extraction may improve maternal and fetal outcomes, though there was no difference in primary outcome of infant birth trauma. Further randomised controlled trials are needed to answer these questions.
Topics: Birth Injuries; Cesarean Section; Extraction, Obstetrical; Female; Humans; Pregnancy; Randomized Controlled Trials as Topic; Tocolysis; Tocolytic Agents
PubMed: 26827159
DOI: 10.1002/14651858.CD004944.pub3 -
BMJ (Clinical Research Ed.) Oct 2023argue that Canada’s high rates of maternal and neonatal trauma following operative vaginal delivery warrant urgent recognition, transparency, and action
argue that Canada’s high rates of maternal and neonatal trauma following operative vaginal delivery warrant urgent recognition, transparency, and action
Topics: Pregnancy; Infant, Newborn; Female; Humans; Vacuum Extraction, Obstetrical; Infant, Newborn, Diseases; Birth Injuries; Family; Surgical Instruments; Obstetrical Forceps; Delivery, Obstetric; Extraction, Obstetrical; Retrospective Studies
PubMed: 37857419
DOI: 10.1136/bmj-2022-073991 -
American Journal of Obstetrics and... May 2022The intrinsic properties of pelvic soft tissues in women who do and do not sustain birth injuries are likely divergent. However, little is known about this. Rat pelvic...
BACKGROUND
The intrinsic properties of pelvic soft tissues in women who do and do not sustain birth injuries are likely divergent. However, little is known about this. Rat pelvic floor muscles undergo protective pregnancy-induced structural adaptations-sarcomerogenesis and increase in intramuscular collagen content-that protect against birth injury.
OBJECTIVE
We aimed to test the following hypotheses: (1) the increased mechanical load of a gravid uterus drives antepartum adaptations; (2) load-induced changes are sufficient to protect pelvic muscles from birth injury.
STUDY DESIGN
The independent effects of load uncoupled from the hormonal milieu of pregnancy were tested in 3- to 4-month-old Sprague-Dawley rats randomly divided into the following 4 groups, with N of 5 to 14 per group: (1) load/pregnancy hormones (controls), (2) load/pregnancy hormones, (3) reduced load/pregnancy hormones, and (4) load/pregnancy hormones. Mechanical load of a gravid uterus was simulated by weighing uterine horns with beads similar to fetal rat size and weight. A reduced load was achieved by unilateral pregnancy after unilateral uterine horn ligation. To assess the acute and chronic phases required for sarcomerogenesis, the rats were sacrificed at 4 hours or 21 days after bead loading. The coccygeus, iliocaudalis, pubocaudalis, and nonpelvic tibialis anterior musles were harvested for myofiber and sarcomere length measurements. The intramuscular collagen content was assessed using a hydroxyproline assay. An additional 20 load/pregnancy hormones rats underwent vaginal distention to determine whether the load-induced changes are sufficient to protect from mechanical muscle injury in response to parturition-associated strains of various magnitude. The data, compared using 2-way repeated measures analysis of variance followed by pairwise comparisons, are presented as mean±standard error of mean.
RESULTS
An acute increase in load resulted in significant pelvic floor muscle stretch, accompanied by an acute increase in sarcomere length compared with nonloaded control muscles (coccygeus: 2.69±0.03 vs 2.30±0.06 μm, respectively, P<.001; pubocaudalis: 2.71±0.04 vs 2.25±0.03 μm, respectively, P<.0001; and iliocaudalis: 2.80±0.06 vs 2.35±0.04 μm, respectively, P<.0001). After 21 days of sustained load, the sarcomeres returned to operational length in all pelvic muscles (P>.05). However, the myofibers remained significantly longer in the load/pregnancy hormones than the load/pregnancy hormones in coccygeus (13.33±0.94 vs 9.97±0.26 mm, respectively, P<.0001) and pubocaudalis (21.20±0.52 vs 19.52±0.34 mm, respectively, P<.04) and not different from load/pregnancy hormones (12.82±0.30 and 22.53±0.32 mm, respectively, P>.1), indicating that sustained load-induced sarcomerogenesis in these muscles. The intramuscular collagen content in the load/pregnancy hormones group was significantly greater relative to the controls in coccygeus (6.55±0.85 vs 3.11±0.47 μg/mg, respectively, P<.001) and pubocaudalis (5.93±0.79 vs 3.46±0.52 μg/mg, respectively, P<.05) and not different from load/pregnancy hormones (7.45±0.65 and 6.05±0.62 μg/mg, respectively, P>.5). The iliocaudalis required both mechanical and endocrine cues for sarcomerogenesis. The tibialis anterior was not affected by mechanical or endocrine alterations. Despite an equivalent extent of adaptations, load-induced changes were only partially protective against sarcomere hyperelongation.
CONCLUSION
Load induces plasticity of the intrinsic pelvic floor muscle components, which renders protection against mechanical birth injury. The protective effect, which varies between the individual muscles and strain magnitudes, is further augmented by the presence of pregnancy hormones. Maximizing the impact of mechanical load on the pelvic floor muscles during pregnancy, such as with specialized pelvic floor muscle stretching regimens, is a potentially actionable target for augmenting pregnancy-induced adaptations to decrease birth injury in women who may otherwise have incomplete antepartum muscle adaptations.
Topics: Animals; Birth Injuries; Collagen; Female; Hormones; Humans; Pelvic Floor; Pregnancy; Rats; Rats, Sprague-Dawley
PubMed: 34801444
DOI: 10.1016/j.ajog.2021.11.1353 -
CMAJ : Canadian Medical Association... Jan 2022Operative vaginal delivery (OVD) is considered safe if carried out by trained personnel. However, opportunities for training in OVD have declined and, given these shifts...
BACKGROUND
Operative vaginal delivery (OVD) is considered safe if carried out by trained personnel. However, opportunities for training in OVD have declined and, given these shifts in practice, the safety of OVD is unknown. We estimated incidence rates of trauma following OVD in Canada, and quantified variation in trauma rates by instrument, region, level of obstetric care and institutional OVD volume.
METHODS
We conducted a cohort study of all singleton, term deliveries in Canada between April 2013 and March 2019, excluding Quebec. Our main outcome measures were maternal trauma (e.g., obstetric anal sphincter injury, high vaginal lacerations) and neonatal trauma (e.g., subgaleal hemorrhage, brachial plexus injury). We calculated adjusted and stabilized rates of trauma using mixed-effects logistic regression.
RESULTS
Of 1 326 191 deliveries, 38 500 (2.9%) were attempted forceps deliveries and 110 987 (8.4%) were attempted vacuum deliveries. The maternal trauma rate following forceps delivery was 25.3% (95% confidence interval [CI] 24.8%-25.7%) and the neonatal trauma rate was 9.6 (95% CI 8.6-10.6) per 1000 live births. Maternal and neonatal trauma rates following vacuum delivery were 13.2% (95% CI 13.0%-13.4%) and 9.6 (95% CI 9.0-10.2) per 1000 live births, respectively. Maternal trauma rates remained higher with forceps than with vacuum after adjustment for confounders (adjusted rate ratio 1.70, 95% CI 1.65-1.75) and varied by region, but not by level of obstetric care.
INTERPRETATION
In Canada, rates of trauma following OVD are higher than previously reported, irrespective of region, level of obstetric care and volume of OVD among hospitals. These results support a reassessment of OVD safety in Canada.
Topics: Anal Canal; Birth Injuries; Canada; Female; Humans; Incidence; Intracranial Hemorrhages; Lacerations; Neonatal Brachial Plexus Palsy; Obstetric Labor Complications; Obstetrical Forceps; Pelvis; Pregnancy; Skull Fractures; Trauma, Nervous System; Urethra; Urinary Bladder; Vacuum Extraction, Obstetrical; Vagina
PubMed: 35012946
DOI: 10.1503/cmaj.210841 -
Journal of Hand Therapy : Official... 2015Literature review. (Review)
Review
STUDY DESIGN
Literature review.
INTRODUCTION
After perinatal brachial plexus injury (PBPI), clinicians play an important role in injury classification as well as the assessment of recovery and secondary conditions. Early assessment guides the initial plan of care and influences follow-up and long-term outcome.
PURPOSE
To review methods used to assess, classify and monitor the extent and influence of PBPI with an emphasis on guidelines for clinicians.
METHODS
We use The International Classification of Functioning, Disability, and Health (ICF) model to provide a guide to assessment after PBPI for rehabilitation clinicians.
DISCUSSION
With information gained from targeted assessments, clinicians can design interventions to increase the opportunities infants and children have for optimal recovery and to attain skills that allow participation in areas of interest.
Topics: Birth Injuries; Brachial Plexus; Brachial Plexus Neuropathies; Child, Preschool; Humans; Infant; Infant, Newborn
PubMed: 25840493
DOI: 10.1016/j.jht.2015.01.001