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EFORT Open Reviews Sep 2019The term 'developmental dysplasia of the hip' (DDH) includes a wide spectrum of hip alterations: neonatal instability; acetabular dysplasia; hip subluxation; and true... (Review)
Review
The term 'developmental dysplasia of the hip' (DDH) includes a wide spectrum of hip alterations: neonatal instability; acetabular dysplasia; hip subluxation; and true dislocation of the hip.DDH alters hip biomechanics, overloading the articular cartilage and leading to early osteoarthritis. DDH is the main cause of total hip replacement in young people (about 21% to 29%).Development of the acetabular cavity is determined by the presence of a concentrically reduced femoral head. Hip subluxation or dislocation in a child will cause an inadequate development of the acetabulum during the remaining growth.Clinical screening (instability manoeuvres) should be done universally as a part of the physical examination of the newborn. After two or three months of life, limited hip abduction is the most important clinical sign.Selective ultrasound screening should be performed in any child with abnormal physical examination or in those with high-risk factors (breech presentation and positive family history). Universal ultrasound screening has not demonstrated its utility in diminishing the incidence of late dysplasia.Almost 90% of patients with mild hip instability at birth are resolved spontaneously within the first eight weeks and 96% of pathologic changes observed in echography are resolved spontaneously within the first six weeks of life. However, an Ortolani-positive hip requires immediate treatment.When the hip is dislocated or subluxated, a concentric and stable reduction without forceful abduction needs to be obtained by closed or open means. Pavlik harness is usually the first line of treatment under the age of six months.Hip arthrogram is useful for guiding the decision of performing a closed or open reduction when needed.Acetabular dysplasia improves in the majority due to the stimulus provoked by hip reduction. The best parameter to predict persistent acetabular dysplasia at maturity is the evolution of the acetabular index.Pelvic or femoral osteotomies should be performed when residual acetabular dysplasia is present or in older children when a spontaneous correction after hip reduction is not expected.Avascular necrosis is the most serious complication and is related to: an excessive abduction of the hip; a force closed reduction when obstacles for reduction are present; a maintained dislocated hip within the harness or spica cast; and a surgical open reduction. Cite this article: 2019;4:548-556. DOI: 10.1302/2058-5241.4.180019.
PubMed: 31598333
DOI: 10.1302/2058-5241.4.180019 -
Journal of Global Health Jul 2022Breech presentation delivery approach is a controversial issue in obstetrics. How to cope with breech delivery (vaginal or C-section) has been discussed to find the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Breech presentation delivery approach is a controversial issue in obstetrics. How to cope with breech delivery (vaginal or C-section) has been discussed to find the safest in terms of morbidity. The aim of this study was to assess the risks of foetal and maternal mortality and perinatal morbidity associated with vaginal delivery against elective caesarean in breech presentations, as reported in observational studies.
METHODS
Studies assessing perinatal morbidity and mortality associated with breech presentations births. Cochrane, Medline, Scopus, Embase, Web of Science, and Cuiden databases were consulted. This protocol was registered in PROSPERO CRD42020197598. Selection criteria were: years between 2010 and 2020, in English language, and full-term gestation (37-42 weeks). The methodological quality of the eligible articles was assessed according to the Newcastle-Ottawa scale. Meta-analyses were performed to study each parameter related to neonatal mortality and maternal morbidity.
RESULTS
The meta-analysis included 94 285 births with breech presentation. The relative risk of perinatal mortality was 5.48 (95% confidence interval (CI) = 2.61-11.51) times higher in the vaginal delivery group, 4.12 (95% CI = 2.46-6.89) for birth trauma and 3.33 (95% CI = 1.95-5.67) for Apgar results. Maternal morbidity showed a relative risk 0.30 (95% CI = 0.13-0.67) times higher in the planned caesarean group.
CONCLUSIONS
An increment in the risk of perinatal mortality, birth trauma, and Apgar lower than 7 was identified in planned vaginal delivery. However, the risk of severe maternal morbidity because of complications of a planned caesarean was slightly higher.
Topics: Breech Presentation; Cesarean Section; Delivery, Obstetric; Elective Surgical Procedures; Female; Humans; Infant, Newborn; Observational Studies as Topic; Perinatal Death; Perinatal Mortality; Pregnancy
PubMed: 35976004
DOI: 10.7189/jogh.12.04055 -
Cureus Nov 2022Cord entanglement and conjoined twins are unique complications of monoamniotic monochorionic pregnancy. This case report describes a case of monoamniotic twins'...
Cord entanglement and conjoined twins are unique complications of monoamniotic monochorionic pregnancy. This case report describes a case of monoamniotic twins' intrauterine demise due to lethal cord entanglement. A 26-year-old unbooked primigravida was reported in the emergency labor room at 32 weeks with the complaint of loss of fetal movements since the previous day. On obstetric examination, the uterus appeared enlarged and discordant with the gestational age, multiple fetal parts were felt on palpation, and the pelvic grip was empty. Doppler could not detect any fetal heartbeat. The emergency obstetric sonography scan showed twins, the first in breech and the second in vertex presentation. Fetal heart sound was not found for either of the twins. The patient was counseled, and the decision was taken to terminate the pregnancy by lower-segment cesarean section. During the cesarean to deliver the babies, monochorionic and monoamniotic pregnancy was confirmed.
PubMed: 36349075
DOI: 10.7759/cureus.31047 -
Revista Colombiana de Obstetricia Y... Dec 2019To review the concepts underlying breech presentation delivery as well as the semiology and the obstetric maneuvers contributing to a successful perinatal maternal... (Review)
Review
OBJECTIVE
To review the concepts underlying breech presentation delivery as well as the semiology and the obstetric maneuvers contributing to a successful perinatal maternal outcome.
MATERIALS AND METHODS
Based on a hypothetical scenario to set the stage for a practical approach to the topic, an explanatory paper built on a narrative review is created in order to examine the principles related to diagnosis, mechanism of delivery and maternal care, emphasizing maneuvers to ease fetal extraction.
RESULTS
Breech presentation delivery must be managed through the vaginal canal when already in the expulsion phase with fetal engagement. For diagnosis and care, it is essential to know the unique semiology and physiology of this condition as well as the obstetric maneuvers to facilitate an uncomplicated delivery.
RESULTS
The mechanism of childbirth in breech presentation is complex and requires knowledge of its physiology and multiple obstetric maneuvers on the part of the obstetrician as well as the general practitioner, in order to ensure adequate care when there is no other option.
Topics: Breech Presentation; Delivery, Obstetric; Dystocia; Female; Humans; Infant, Newborn; Obstetric Labor Complications; Pregnancy; Pregnancy Outcome
PubMed: 32142240
DOI: 10.18597/rcog.3345 -
Healthcare (Basel, Switzerland) May 2021Acupuncture-type interventions (such as moxibustion and acupuncture) at Bladder 67 (BL67, Zhiyin point) have been proposed to have positive effects on breech... (Review)
Review
Acupuncture-type interventions (such as moxibustion and acupuncture) at Bladder 67 (BL67, Zhiyin point) have been proposed to have positive effects on breech presentation. The aim of this systematic review and meta-analysis was to evaluate the effectiveness and safety of moxibustion and acupuncture in correcting breech presentation. We searched PubMed, MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Chinese Electronic Periodical Services (CEPS), and databases at ClinicalTrials.gov to identify relevant randomized controlled trials (RCTs). In this study, sixteen RCTs involving 2555 participants were included. Compared to control, moxibustion significantly increased cephalic presentation at birth (RR = 1.39; 95% CI = 1.21-1.58). Moxibustion also seemed to elicit better clinical outcomes in the Asian population (RR = 1.42; 95% CI = 1.21-1.67) than in the non-Asian population (RR = 1.20; 95% CI = 1.01-1.43). The effects of acupuncture on correcting breech presentation after sensitivity analysis were inconsistent relative to control. The effect of moxibustion plus acupuncture was synergistic for correcting breech presentation (RR = 1.53; 95% CI = 1.26-1.86) in one RCT. Our findings suggest that moxibustion therapy has positive effects on correcting breech presentation, especially in the Asian population.
PubMed: 34067379
DOI: 10.3390/healthcare9060619