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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 -
Hong Kong Medical Journal = Xianggang... Mar 2001We report on a newborn boy, who was delivered at 26 weeks' gestation by emergency caesarean section because of a prolapsed cord and breech presentation. Grade IV hyaline... (Review)
Review
We report on a newborn boy, who was delivered at 26 weeks' gestation by emergency caesarean section because of a prolapsed cord and breech presentation. Grade IV hyaline membrane disease subsequently developed, for which a surfactant was given. On day 8, there were frequent apnoeic attacks, and on day 30, marked irritability developed, as did intermittent stiffening of all four limbs. The anterior fontanelle was bulging and tense, and the cerebrospinal fluid was found to be turbid. Gram staining of the cerebrospinal fluid and blood revealed Gram-positive bacilli. Subsequent culturing yielded Bacillus cereus, which was sensitive to amikacin and vancomycin. Severe cerebral oedema developed, however, and computed tomography of the brain showed bright cortical sulci, suggestive of meningitis. The baby died on day 37, and post-mortem histological examination of the brain showed extensive liquefactive necrosis with abundant neutrophilic infiltration. Since infection with Bacillus cereus is rapidly fatal, early recognition of infection by this organism is important.
Topics: Bacillus cereus; Humans; Infant, Newborn; Male; Meningoencephalitis
PubMed: 11406681
DOI: No ID Found -
Asian Spine Journal Jun 2016Four patients had C2-3 vertebral fusion and radiologically demonstrated cord compression at C3-4 level related to disc bulge with or without association of osteophytes...
STUDY DESIGN
Four patients had C2-3 vertebral fusion and radiologically demonstrated cord compression at C3-4 level related to disc bulge with or without association of osteophytes and C1-2 posterior facetal dislocation. The outcome of treatment by atlantoaxial and subaxial facetal fixation is discussed.
PURPOSE
The article evaluates the significance of atlantoaxial facetal instability in cases having C2-3 vertebral fusion and cord compression at the level of C3-4 disc.
OVERVIEW OF LITERATURE
C2-3 vertebral fusions are frequently encountered in association with basilar invagination and chornic atlantoaxial dislocations. Even when basilar invagination and atlantoaxial dislocation are not identified by conventional parameters, atlantoaxial instability can be the nodal point of pathogenesis in cases with C2-3 vertebral fusion.
METHODS
Between June 2013 and November 2014 four patients having C2-3 fusion presented with progressive symptoms of myelopathy that were related to cord compression at the level opposite the C3-4 disc space. Further investigations revealed C1-2 posterior facetal dislocation.
RESULTS
All patients were males. Ages ranged from 18 to 50 years (average, 36 years). All patients were treated by atlantoaxial facetal plate and screw, and subaxial single or multi-segmental transarticular screw fixation. Follow-up (average, 15 months) using a recently described clinical grading system and the Japanese Orthopaedic Association scoring system confirmed marked improvement of symptoms.
CONCLUSIONS
Identification and treatment of atlantoaxial facetal instability may be crucial for a successful outcome in cases having C2-3 fusion and high cervical (C3-4) disc related cord compression.
PubMed: 27340520
DOI: 10.4184/asj.2016.10.3.430 -
Journal of Personalized Medicine Mar 2023Mucopolysaccharidosis (MPS) is a hereditary disorder arising from lysosomal enzymes deficiency, with glycosaminoglycans (GAGs) storage in connective tissues and bones,...
Mucopolysaccharidosis (MPS) is a hereditary disorder arising from lysosomal enzymes deficiency, with glycosaminoglycans (GAGs) storage in connective tissues and bones, which may compromise the airway. This retrospective study evaluated patients with MPS type IVA with airway obstruction detected via endoscopy and imaging modalities and the effects of surgical interventions based on symptoms. The data of 15 MPS type IVA patients (10 males, 5 females, mean age 17.8 years) were reviewed in detail. Fiberoptic bronchoscopy (FB) was used to distinguish adenotonsillar hypertrophy, prolapsed soft palate, secondary laryngomalacia, vocal cord granulation, cricoid thickness, tracheal stenosis, shape of tracheal lumen, nodular deposition, tracheal kinking, tracheomalacia with rigid tracheal wall, and bronchial collapse. Computed tomography (CT) helped to measure the deformed sternal angle, the cross-sectional area of the trachea, and its narrowest/widest ratio (NW ratio), while angiography with 3D reconstruction delineated tracheal torsion, kinking, or framework damage and external vascular compression of the trachea. The NW ratio correlated negatively with age ( < 0.01), showing that airway obstruction progressed gradually. Various types of airway surgery were performed to correct the respiratory dysfunction. MPS type IVA challenges the management of multifactorial airway obstruction. Preoperative airway evaluation with both FB and CT is strongly suggested to assess both intraluminal and extraluminal factors causing airway obstruction.
PubMed: 36983675
DOI: 10.3390/jpm13030494 -
European Review For Medical and... Jul 2015Umbilical cord prolapse has a reported prevalence of 0.1-0.6%. In previous studies, risk factors for umbilical prolapse have been identified as multiparity, preterm...
OBJECTIVE
Umbilical cord prolapse has a reported prevalence of 0.1-0.6%. In previous studies, risk factors for umbilical prolapse have been identified as multiparity, preterm delivery, non-vertex presentation, and obstetric manipulation for labor induction. In the present study, we aimed to investigate the risk factors for umbilical cord prolapse and to determine the factors that may relate to neonatal morbidity in these patients.
PATIENTS AND METHODS
This study consisted of recorded cases of umbilical cord prolapse at Dr Zekai Tahir Burak Research and Training Hospital between January 2008 and May 2013. Clinical and demographic data were obtained by reviewing the patients' medical records. Student's t test was performed for parametric variables between groups, and a Chi-square test was performed for nonparametric variables between groups. A logistic regression was performed to investigate the effects of clinical parameters such as gestational age, diagnosis to delivery interval, and fetal presentation on neonatal morbidity.
RESULTS
The patients with umbilical cord prolapse during labor had higher rates of preterm deliveries, low-birth-weight infants, and non-vertex presentations than the control group did. Preterm delivery, non-vertex presentation, presence of polyhydramnios, and spontaneous membrane rupture increased the risk of umbilical cord prolapse significantly. In the regression analysis, gestational age and diagnosis to delivery interval greater than 10 minutes predicted adverse neonatal outcomes independently.
CONCLUSIONS
Umbilical cord prolapse is more common in cases of preterm delivery, non-vertex fetal presentation, and spontaneous rupture of membranes. A diagnosis to delivery interval greater than ten minutes is independently associated with an adverse neonatal outcome.
Topics: Adolescent; Adult; Delivery, Obstetric; Female; Gestational Age; Humans; Infant, Newborn; Labor, Induced; Male; Obstetric Labor Complications; Parity; Perinatal Care; Pregnancy; Pregnancy Outcome; Premature Birth; Prolapse; Retrospective Studies; Risk Factors; Umbilical Cord; Young Adult
PubMed: 26214767
DOI: No ID Found -
BMJ Case Reports Jul 2013A case of a prolapsed patent vitellointestinal duct (PVID) in a 10-day-old neonate who presented with vomiting and poor weight gain with partial intestinal obstruction...
A case of a prolapsed patent vitellointestinal duct (PVID) in a 10-day-old neonate who presented with vomiting and poor weight gain with partial intestinal obstruction and a flower like pink, prolapsing lesion at his umbilicus has been reported. A limited contrast study through the tubular structure confirmed it to be a PVID. He underwent transumbilical exploration and resection and anastomosis uneventfully. Persistence of the vitellointestinal duct as a whole or part of it leads to a wide variety of anomalies-Meckel's diverticulum is the commonest lesion and a PVID is the rarest. Umbilical cord clamping flush with the abdominal wall may convert a Meckel's diverticulum prolapsing in the base of umbilical ring into a PVID. Careful assessment should be made for associated anomalies. Transumbilical exploration gives the best cosmetic and functional results.
Topics: Humans; Infant, Newborn; Intestinal Diseases; Male; Prolapse; Vitelline Duct
PubMed: 23845681
DOI: 10.1136/bcr-2013-010221 -
Asian Journal of Neurosurgery 2019Cervical spondylotic myelopathy is a cervical cord compressive lesion that occurs as a result of the normal degenerative process which may cause magnetic resonance...
INTRODUCTION
Cervical spondylotic myelopathy is a cervical cord compressive lesion that occurs as a result of the normal degenerative process which may cause magnetic resonance imaging (MRI) cord intensity changes that may worsen the clinical outcome even after successful anterior cervical decompression.
OBJECTIVE
To assess the relation between MRI T2 Weighted images (T2 WI) hyperintense cord signal and clinical outcome after anterior cervical discectomy in patients with degenerative cervical disc herniation.
MATERIALS AND METHODS
This is a retrospective observational study that was conducted on twenty-five patients with degenerative cervical disc prolapse associated with MRI T2WI hyperintense cord signal, at the Department of Neurosurgery, Qena University Hospital, South Valley University from August 2014 to December 2016. A complete clinical and radiological evaluation of the patients was done. Anterior cervical discectomy and fusion was done for all patients. Patients were clinically assessed preoperatively and postoperatively at 3, 6, and 12 months using Modified Japanese Orthopedic Association (MJOA) score. Radiographic assessment was done by preoperative and postoperative T2WI MRI. The statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software (version 22.0).
RESULTS
There were 25 patients included in the study; 16 (64%) females and 9 (36%) males. The mean age was 46.89 ± 7.52 standard deviation (SD) years with range from 26 to 64 years, 3 (12%) patients had worsened in the form of postoperative motor power deterioration, and 14 (56%) patients has no improvement and remain as preoperative condition. The remaining 8 (32%) patients had a reported postoperative improvement of symptoms and signs according to MJOA score. The mean follow-up period (in months) was 11 ± 2.34 (SD).
CONCLUSION
The presence of T2W hyperintense signal on preoperative MRI predicts a poor surgical outcome in patients with cervical disc prolapse. The regression of T2W ISI postoperatively correlates with better functional outcomes.
PubMed: 30937019
DOI: 10.4103/ajns.AJNS_262_17 -
Medicine Nov 2018We report a rare case of a pregnant woman with cord prolapse, velamentous cord insertion (VCI), and fetal vertex presentation who completed vaginal delivery.
RATIONALE
We report a rare case of a pregnant woman with cord prolapse, velamentous cord insertion (VCI), and fetal vertex presentation who completed vaginal delivery.
PATIENT CONCERNS
Without having undergone regular antepartum examinations, a 31-year-old pregnant woman, gravida 6, para 4, abortion 1, presented at 37 weeks and 3 days of gestation. She had regular labor pain and bloody show.
DIAGNOSES
Cord prolapse during labor and VCI after delivery.
INTERVENTIONS
Per vaginal examination at 11:20 PM revealed a fully dilated cervix. Thirty minutes later, artificial rupture of the membrane was performed, and an overt prolapsed cord approximately 10-cm long was palpated in the vagina. Fetal heartbeat decelerated to 60 bpm. After fundal pushing for some minutes, a female baby weighing 2130 g was delivered at 11:54 PM with a pediatrician on standby. Apgar scores were 7 (0 minute), 9 (5 minutes), and 10 (10 minutes). The placenta weighed 870 g and was delivered 5 minutes later, and VCI was discovered.
OUTCOMES
Her postpartum course was uncomplicated and both the patient and infant were discharged 3 days later.
LESSONS
A pregnant woman with umbilical prolapse, VCI, and a fetal vertex presentation can successfully deliver a baby through the vagina. Factors contributing to the success of the reported vaginal delivery might have been a small fetus, multipara status, and immediate management.
Topics: Adult; Delivery, Obstetric; Female; Fetal Monitoring; Fetus; Heart Rate, Fetal; Humans; Infant, Newborn; Labor Presentation; Placenta Diseases; Pregnancy; Prolapse; Umbilical Cord
PubMed: 30407364
DOI: 10.1097/MD.0000000000013221 -
BMJ Open Nov 2021To estimate how often midwives, specialty trainees and doctors specialised in obstetrics and gynaecology are attending to specific obstetric emergencies or high-risk...
OBJECTIVE
To estimate how often midwives, specialty trainees and doctors specialised in obstetrics and gynaecology are attending to specific obstetric emergencies or high-risk deliveries (obstetric events).
DESIGN
A national cross-sectional study.
SETTING
All hospital labour wards in Denmark.
PARTICIPANTS
Midwives (n=1303), specialty trainees (n=179) and doctors specialised in obstetrics and gynaecology (n=343) working in hospital labour wards (n=21) in Denmark in 2018.
METHODS
Categories of obstetric events comprised of Apgar score <7/5 min, eclampsia, emergency caesarean sections, severe postpartum haemorrhage, shoulder dystocia, umbilical cord prolapse, vaginal breech deliveries, vaginal twin deliveries and vacuum extraction. Data on number of healthcare professionals were obtained through the Danish maternity wards, the Danish Health Authority and the Danish Society of Obstetricians and Gynaecologists. We calculated the time interval between attending each obstetric event by dividing the number of events occurred with the number of healthcare professionals.
OUTCOME MEASURES
The time interval between attending a specific obstetric event.
RESULTS
The average time between experiencing obstetric events ranged from days to years. Emergency caesarean sections, which occur relatively frequent, were attended on average every other month by midwives, every 9 days for specialty trainees and every 17 days by specialist doctors. On average, rare events like eclampsia were experienced by midwives only every 42 years, every 6 years by specialty trainees and every 11 years by specialist doctors.
CONCLUSIONS
Some obstetric events occur extremely rarely, hindering the ability to obtain and maintain the clinical skills to manage them through clinical practice alone. By assessing the frequency of a healthcare professionals attending an obstetric emergency, our study contributes to assessing the need for supplementary educational initiatives and interventions to learn and maintain clinical skills.
Topics: Cross-Sectional Studies; Delivery, Obstetric; Emergencies; Female; Humans; Midwifery; Obstetrics; Pregnancy
PubMed: 34758994
DOI: 10.1136/bmjopen-2021-050790 -
Journal of Craniovertebral Junction &... 2016For a long time the terms basilar invagination and platybasia were used interchangeably. Basilar invagination has been defined as a prolapse of the vertebral column into...
For a long time the terms basilar invagination and platybasia were used interchangeably. Basilar invagination has been defined as a prolapse of the vertebral column into the spinal cord. Platybasia is defined as an abnormal obtuse angle between the anterior skull base and the clivus. The authors review the existing literature and summarize the historical and modern perspectives in the management of basilar invagination. From radiological curiosities, the subject of basilar invagination is now viewed as eminently treatable. The more pronounced understanding of the subject has taken place in the last three decades when on the basis of understanding of the biomechanical subtleties the treatment paradigm has remarkably altered. From surgery that involved decompression of the region, stabilization and realignment now form the basis of treatment.
PubMed: 36988983
DOI: 10.4103/0974-8237.181856