-
BMC Pregnancy and Childbirth Dec 2019It is believed that giving birth in an upright position is beneficial for both mother and the infant for several physiologic reasons. An upright positioning helps the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
It is believed that giving birth in an upright position is beneficial for both mother and the infant for several physiologic reasons. An upright positioning helps the uterus to contract more strongly and efficiently, the baby gets in a better position and thus can pass through the pelvis faster. Upright and lateral positions enables flexibility in the pelvis and facilitates the extension of the outlet. Before implementing a change in birthing positions in our clinics we need to review evidences available and context valid related to duration of second stage of labor and birthing positions. Therefore this review aimed to examine the effect of maternal flexible sacrum birth position on duration of second stage of labor.
METHOD
The research searched articles using bibliographical Databases: Medline/PUBMED, SCOPUS, Google scholar and Google. All study designs were considered while investigating the impact of maternal flexible sacrum birthing positioning in relation duration of second stage of labor. Studies including laboring mothers with normal labor and delivery. A total of 1985 women were included in the reviewed studies. We included both qualitative and quantitative analysis.
RESULTS
We identified 1680 potential citations, of which 8 articles assessed the effect of maternal upright birth positioning on the reduction during the duration of second stage of labor. Two studies were excluded because of incomplete reports for meta analysis. The result suggested a reduction in duration of second stage of labor among women in a flexible sacrum birthing position, with a mean duration from 3.2-34.8. The pooled weighted mean difference with random effect model was 21.118(CI: 11.839-30.396) minutes, with the same significant heterogeneity between the studies (I = 96.8%, p < 000).
CONCLUSION
The second stage duration was reduced in cases of a flexible sacrum birthing position. Even though the reduction in duration varies across studies with considerable heterogeneity, laboring women should be encouraged to choose her comfortable birth position. Researchers who aim to compare different birthing positions should consider study designs which enable women to choose birthing position. PROSPERO REGISTRATION NUMBER: [CRD42019120618].
Topics: Female; Humans; Labor Stage, Second; Parturition; Patient Positioning; Posture; Pregnancy; Sacrum; Time Factors
PubMed: 31801479
DOI: 10.1186/s12884-019-2620-0 -
The Pan African Medical Journal 2018Post-fracture osteolysis of the sacrum is a rare radiological entity mimicking a serious disease. We report the case of a female patient lost to follow-up after biopsy...
Post-fracture osteolysis of the sacrum is a rare radiological entity mimicking a serious disease. We report the case of a female patient lost to follow-up after biopsy indication. She presented again after 4 months. During multi-stage bone registration prior to the biopsy, we noticed a change in the appearance of the lesion, associating a linear image (corresponding to the fracture line) with condensation at the edges. Patient's evolution was good after a period of rest at 6-months follow-up. This study highlights the atypical imaging appearance and the diagnostic difficulties associated with post-fracture osteolysis of the sacrum. The particularity of our patient is that symptoms were masked by disc-related nerve root impingement with right L5 root and that the sacrum osteolysis was unexpectedly discovered on CT scan.
Topics: Female; Follow-Up Studies; Fractures, Bone; Humans; Middle Aged; Osteolysis; Sacrum
PubMed: 30637045
DOI: 10.11604/pamj.2018.30.260.13452 -
World Journal of Gastroenterology Mar 2017To analyze the anatomy of sacral venous plexus flow, the causes of injuries and the methods for controlling presacral hemorrhage during surgery for rectal cancer. (Review)
Review
AIM
To analyze the anatomy of sacral venous plexus flow, the causes of injuries and the methods for controlling presacral hemorrhage during surgery for rectal cancer.
METHODS
A review of the databases MEDLINE and Embase™ was conducted, and relevant scientific articles published between January 1960 and June 2016 were examined. The anatomy of the sacrum and its venous plexus, as well as the factors that influence bleeding, the causes of this complication, and its surgical management were defined.
RESULTS
This is a review of 58 published articles on presacral venous plexus injury during the mobilization of the rectum and on techniques used to treat presacral venous bleeding. Due to the lack of cases published in the literature, there is no consensus on which is the best technique to use if there is presacral bleeding during mobilization in surgery for rectal cancer. This review may provide a tool to help surgeons make decisions regarding how to resolve this serious complication.
CONCLUSION
A series of alternative treatments are described; however, a conventional systematic review in which optimal treatment is identified could not be performed because few cases were analyzed in most publications.
Topics: Blood Loss, Surgical; Decision Making; Electrocoagulation; Hemostasis; Hemostasis, Surgical; Humans; Hydrodynamics; Metals; Pelvis; Prostheses and Implants; Rectal Neoplasms; Rectum; Sacrum; Veins
PubMed: 28321171
DOI: 10.3748/wjg.v23.i9.1712 -
Acta Orthopaedica Feb 2018Background and purpose - The role of pelvic incidence in hip disorders is unclear. Therefore, we undertook a literature review to evaluate the evidence on that role.... (Review)
Review
Background and purpose - The role of pelvic incidence in hip disorders is unclear. Therefore, we undertook a literature review to evaluate the evidence on that role. Methods - A search was carried out on MEDLINE, SCOPUS, CENTRAL, and CINAHL databases. Quantitative analysis was based on comparison with a reference population of asymptomatic subjects. Results - The search resulted in 326 records: 15 studies were analyzed qualitatively and 13 quantitatively. The estimates of pelvic incidence varied more than 10 degrees from 47 (SD 3.7) to 59 (SD 14). 2 studies concluded that higher pelvic incidence might contribute to the development of coxarthrosis while 1 study reported the opposite findings. In 2 studies, lower pelvic incidence was associated with a mixed type of femoroacetabular impingement. We formed a reference population from asymptomatic groups used or cited in the selected studies. The reference comprised 777 persons with pooled average pelvic incidence of 53 (SD 10) degrees. The estimate showed a relatively narrow 95% CI of 52 to 54 degrees. The 95% CIs of only 4 studies did not overlap the CIs of reference: 2 studies on coxarthrosis, 1 on mixed femoroacetabular impingement, and 1 on ankylosing spondylitis Interpretation - We found no strong evidence that pelvic incidence plays any substantial role in hip disorders. Lower pelvic incidence may be associated with the mixed type of femoroacetabular impingement and hip problems amongst patients with ankylosing spondylitis. The evidence on association between pelvic incidence and coxarthrosis remained inconclusive.
Topics: Femur Head; Humans; Osteoarthritis, Hip; Pelvis; Sacrum
PubMed: 28914101
DOI: 10.1080/17453674.2017.1377017 -
Applied Health Economics and Health... Aug 2019Mepilex Border Sacrum and Heel dressings are self-adherent, multilayer foam dressings designed for use on the heel and sacrum aiming to prevent pressure ulcers. The... (Review)
Review
Mepilex Border Sacrum and Heel dressings are self-adherent, multilayer foam dressings designed for use on the heel and sacrum aiming to prevent pressure ulcers. The dressings are used in addition to standard care protocols for pressure ulcer prevention. The National Institute for Health and Care Excellence (NICE) selected Mepilex Border Sacrum and Heel dressings for evaluation. The External Assessment Centre (EAC) critiqued the company's submission. Thirteen studies (four randomised controlled trials and nine nonrandomised comparative studies) were included. The majority of studies compared Mepilex Border Sacrum dressings (plus standard care) with standard care alone. Comparative evidence for Mepilex Border Heel dressings was limited. A meta-analysis indicated a non-statistically significant difference in favour of Mepilex Border Sacrum dressings for pressure ulcer incidence [RR 0.51 (95% CI 0.22-1.18)]. The company produced a de novo cost model, which was critiqued by the EAC. After the EAC updated input parameters, cost savings of £19 per patient compared with standard care alone for pressure ulcer prevention were estimated with Mepilex Border dressings predicted to be cost saving in 57% of iterations. The Medical Technologies Advisory Committee reviewed the evidence and judged that, although Mepilex Border Heel and Sacrum dressings have potential to prevent pressure ulcers in people who are considered to be at risk in acute care settings, further evidence is required to address uncertainties around the claimed benefits of the dressings and the incidence of pressure ulcers in an NHS acute-care setting. After a public consultation, NICE published this as Medical Technology Guidance 40.
Topics: Bandages; Heel; Humans; Pressure Ulcer; Sacrum; Treatment Outcome
PubMed: 30820871
DOI: 10.1007/s40258-019-00465-8 -
Orthopaedics & Traumatology, Surgery &... Feb 2016Sacral fracture and lumbosacral hinge trauma are rare but serious lesions. Neurologic disorder is frequently associated, and nerve release may be required, with... (Review)
Review
Sacral fracture and lumbosacral hinge trauma are rare but serious lesions. Neurologic disorder is frequently associated, and nerve release may be required, with reduction and stabilization of the fracture. Management requires knowing the fracture lines and reduction maneuvers and the fixation techniques that may need to be associated. Three classifications allow these fractures to be well understood: the Roy-Camille classification identifies high transverse fractures and their displacement; the Denis classification identifies vertical fracture line location within the sacrum, which correlates with neurologic risk; and the Tile classification analyzes pelvic ring trauma when associated with the sacral fracture. Treatment, when surgical, requires careful patient positioning, sometimes on an orthopedic table. Reduction maneuvers are founded on the fracture classification. Isolated U-shaped fracture of the sacrum is to be distinguished from sacral fracture associated with pelvic ring lesion. Osteosynthesis may be lumbopelvic or restricted to the pelvic ring (sacroiliac or iliosacral). Open osteosynthesis allows reduction to be finalized by intraoperative maneuvers on the implant, while closed osteosynthesis requires perfect preoperative reduction. Complications are frequent and neurologic recovery is uncertain. Fatigue and osteoporotic fractures show little displacement and are good indications for cementoplasty, either isolated or associated to iliosacral screwing. In lumbosacral hinge trauma, and dislocation in particular, reduction surgery with fixation (usually 360°) is indicated. The present study details the analysis and classification of these fractures, the technical pitfalls of reduction and fixation, and treatment indications.
Topics: Fracture Fixation, Internal; Humans; Joint Dislocations; Joints; Lumbar Vertebrae; Patient Positioning; Pelvic Bones; Sacroiliac Joint; Sacrum; Spinal Fractures
PubMed: 26810715
DOI: 10.1016/j.otsr.2015.12.002 -
Canadian Association of Radiologists... May 2014
Review
Topics: Diagnosis, Differential; Diagnostic Imaging; Humans; Sacrum; Spinal Neoplasms
PubMed: 24125655
DOI: 10.1016/j.carj.2013.05.002 -
Journal of Musculoskeletal & Neuronal... Sep 2022Fatigue sacral fractures (FSFs) are rare and often misdiagnosed. This study presents a series of FSFs and a meticulous literature review. (Review)
Review
OBJECTIVES
Fatigue sacral fractures (FSFs) are rare and often misdiagnosed. This study presents a series of FSFs and a meticulous literature review.
METHODS
The present is an 11-year (2010-2021) retrospective observational study. The characteristics of all adult patients with FSF, including demographics, fracture type, treatment, history of fatigue fracture and imaging were evaluated.
RESULTS
Eight cases (6 females; 75%), suffering from 12 fractures (4 bilateral cases) with mean age=33.4 years were studied. Two patients (25%) had suffered another fatigue fracture in the past. Mean symptoms' duration prior diagnosis was 8.5 weeks, while mean symptoms' duration after diagnosis was 10.75. In most cases (7; 87.5%), MRI revealed the fracture. According to the Kaeding-Miller classification; five fractures (42%) were grade III, four (33%) IV and three (25%) II. All patients were treated conservatively, with rest and analgesics, while three received vitamin D and calcium. One patient, due to delayed union, was commenced on teriparatide.
CONCLUSIONS
FSFs are often misdiagnosed; therefore, they should be included in the differential diagnosis for chronic low back-or-hip pain in athletes. History of other fatigue injuries seems to be a predisposing factor. It is of paramount importance to obtain advanced imaging for identifying a FSF.
Topics: Adult; Female; Fractures, Stress; Humans; Observational Studies as Topic; Retrospective Studies; Sacrum; Spinal Fractures; Teriparatide
PubMed: 36046995
DOI: No ID Found -
American Journal of Biological... Apr 2022Despite the high frequency of segmentation anomalies in the human sacrum, their evolutionary and clinical implications remain controversial. Specifically,...
OBJECTIVES
Despite the high frequency of segmentation anomalies in the human sacrum, their evolutionary and clinical implications remain controversial. Specifically, inconsistencies involving the classification and counting methods obscure accurate assessment of lumbosacral transitional vertebrae. Therefore, we aim to establish more reliable morphological and morphometric methods for differentiating between sacralizations and lumbarizations in clinical and paleontological contexts.
MATERIALS AND METHODS
Using clinical CT data from 145 individuals aged 14-47 years, vertebral counts and the spatial relationship between the sacrum and adjoining bony structures were assessed, while the morphological variation of the sacrum was assessed using geometric morphometrics based on varied landmark configurations.
RESULTS
The prevalence of lumbosacral and sacrococcygeal segmentation anomalies was 40%. Lumbarizations and sacralizations were reliably distinguishable based on the spatial relationship between the iliac crest and the upward or downward trajectory of the linea terminalis on the sacrum. Different craniocaudal orientations of the alae relative to the corpus of the first sacral vertebra were also reflected in the geometric morphometric analyses. The fusion of the coccyx (32%) was frequently coupled with lumbarizations, suggesting that the six-element sacra more often incorporate the coccyx rather than the fifth lumbar vertebra.
CONCLUSIONS
Our approach allowed the consistent identification of segmentation anomalies even in isolated sacra. Additionally, our outcomes either suggest that homeotic border shifts often affect multiple spinal regions in a unidirectional way, or that sacrum length is highly conserved perhaps due to functional constraints. Our results elucidate the potential clinical, biomechanical, and evolutionary significance of lumbosacral transitional vertebrae.
Topics: Humans; Sacrum; Lumbar Vertebrae; Spinal Diseases; Lumbosacral Region; Ilium; Musculoskeletal Abnormalities
PubMed: 36787761
DOI: 10.1002/ajpa.24466 -
Neurology Sep 2013A 23-year-old man with recurrent acute myeloid leukemia (AML) underwent successful reinduction and was judged posttherapy to be in complete remission. Soon thereafter,...
A 23-year-old man with recurrent acute myeloid leukemia (AML) underwent successful reinduction and was judged posttherapy to be in complete remission. Soon thereafter, he complained of pain in his left buttock radiating into his left posterior thigh. Neurologic examination was unremarkable. Radiographic evaluation demonstrated a left S2 lesion suggestive of a nerve sheath tumor (figure 1). An open biopsy was performed that revealed a chloroma pathologically (figure 2), sometimes referred to as a myeloid sarcoma.(1,2) Most chloromas are found in patients with recurrent AML and are overwhelmingly intracranial.(1) Infrequently, chloromas are paraspinal, and in this location present with epidural spinal cord compression.(2) Intraspinal invasion by a chloroma is rare. Systemic evaluation confirmed recurrent AML, for which he was successfully treated with reinduction and whole-body irradiation followed by an allogeneic transplant. He is currently disease-free and neurologically asymptomatic 1 year posttransplant.
Topics: Humans; Magnetic Resonance Imaging; Male; Nerve Sheath Neoplasms; Neurologic Examination; Sacrococcygeal Region; Sacrum; Sarcoma, Myeloid; Spinal Cord Compression; Spinal Neoplasms; Tomography, X-Ray Computed; Young Adult
PubMed: 24019392
DOI: 10.1212/WNL.0b013e3182a43aed