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Neto CDRL, Coelho G, Figueiredo EG. A new device to treat ping-pong skull fractures: The hammer puller technique. A comparative analysis using a realistic simulation model. Surg Neurol Int 2024; 15:180. [PMID: 38840613 PMCID: PMC11152529 DOI: 10.25259/sni_141_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/08/2024] [Indexed: 06/07/2024] Open
Abstract
Background This study aims to describe a new surgical technique for the treatment of ping-pong skull fractures and to evaluate its efficacy in a realistic simulation model compared to the dissector elevation technique. Methods A total of 64 fractures were obtained using 16 model units, each with four fractures (two frontal and two parietal). The hammer puller technique was applied for left-sided fractures and the dissector technique for right-sided fractures. The variables evaluated were fracture repair time, fracture volume, fracture corrected volume, and fracture correction percentage. Fractures were separated into groups according to the surgical technique used (hammer or dissector) and the bone fractured (frontal or parietal). Statistical analysis was performed with Jamovi® software (version 2.3) using Student's t-test. Results A complete degree of fracture correction was achieved with both techniques, demonstrating a sufficient performance in the correction of the deformity. The hammer technique was shown to be faster in correcting frontal bone depressions with 20.1 ± 7.8 s compared to 31.3 ± 4.7 s for the dissector technique, P < 0.001. There was no statistically significant difference for parietal applications (P = 0.405). Conclusion This study describes a new minimally invasive surgical technique for the treatment of ping-pong fractures. Comparative analysis showed that both techniques were equally effective but that the hammer puller technique was more efficient than the dissector elevation technique, especially for frontal bone fractures.
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Affiliation(s)
| | - Giselle Coelho
- Department of Neurosurgery, Santa Casa de Misericórdia de São Paulo Hospital, São Paulo, Brazil
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2
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Neonatal subgaleal hemorrhage: twenty years of trends in incidence, associations, and outcomes. J Perinatol 2022; 43:573-577. [PMID: 36307481 DOI: 10.1038/s41372-022-01541-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/05/2022] [Accepted: 10/12/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND In 2011, we reported 38 neonates with subgaleal hemorrhage (SH), relating an increasing incidence. It is unclear whether the incidence in our hospitals continued to rise and which risk factors and outcomes are associated with this condition. DESIGN We retrospectively analyzed every recognized case of SH in our hospitals from the end of our previous report (2010) to the present (2022). We redescribed the incidence, scored severity, tabulated blood products transfused, and recorded outcomes. RESULTS Across 141 months, 191 neonates were diagnosed with SH; 30 after vacuum or forceps. The incidence (one/1815 births) was higher than in our 2011 report (one/7124 births). Also, severe SH (requiring transfusion) was more common (one/10,033 births vs. one/20,950 births previously). Four died (all with severe SH) and 12 had neurodevelopmental impairment. CONCLUSION Recognized cases of SH are increasing in our system without a clear explanation. Adverse outcomes are rare but continue to occur.
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3
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Cohen G, Schreiber H, Shalev Ram H, Ovadia M, Shechter-Maor G, Biron-Shental T. Can We Predict Feto-Maternal Adverse Outcomes of Vacuum Extraction? Geburtshilfe Frauenheilkd 2022; 82:1274-1282. [PMID: 36339635 PMCID: PMC9633228 DOI: 10.1055/a-1904-6025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 07/16/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Vacuum extraction (VE) is an important modality in modern obstetrics, yet sometimes results in maternal or neonatal adverse outcomes, which can cause a lifetime disability. We aimed to characterize potential risk factors for adverse outcomes that in retrospect would have led the physician to avoid the procedure. Materials and Methods Retrospective cohort of 3331 singleton pregnancies, ≥ 34 w delivered by VE. 263 deliveries (7.9%) incurred a VE-related feto-maternal adverse outcome, defined as one or more of the following: 3-4th-degree perineal laceration, subgaleal hematoma, intracranial hemorrhage, shoulder dystocia, clavicular fracture, Erb's palsy or fracture of humerus. 3068 deliveries (92.1%) did not have VE-related adverse outcomes. Both groups were compared to determine potential risk factors for VE adverse outcomes. Results Multivariable regression found seven independent risk factors for VE-related feto-maternal adverse outcomes: Nulliparity - with an odds ratio (OR) of 1.82 (95% CI = 1.11-2.98, p = 0.018), epidural anesthesia (OR 1.99, CI = 1.42-2.80, p < 0.001), Ventouse-Mityvac (VM) cup (OR 1.86, CI = 1.35-2.54, p < 0.001), prolonged second stage as indication for VE (OR 1.54, CI = 1.11-2.15, p = 0.010), cup detachment (OR 1.66, CI = 1.18-2.34, p = 0.004), increasing procedure duration (OR 1.07 for every additional minute, CI = 1.03-1.11, p < 0.001) and increasing neonatal birthweight (OR 3.42 for every additional kg, CI = 2.33-5.02, p < 0.001). Occiput anterior (OA) position was a protective factor (OR 0.62, CI = 0.43-0.89, p = 0.010). Conclusions VE-related adverse outcomes can be correlated to clinical characteristics, such as nulliparity, epidural anesthesia, VM cup, prolonged second stage as indication for VE, cup detachment, prolonged procedure duration and increasing neonatal weight. OA position was a protective factor. This information may assist medical staff to make an informed decision whether to choose VE or cesarean delivery (CD).
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Affiliation(s)
- Gal Cohen
- 37253Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel,58408Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel,Korrespondenzadresse Gal Cohen 37253Meir Medical Center, Department of Obstetrics and GynecologyTchernichovsky
St. 5944281 Kfar SabaIsrael
| | - Hanoch Schreiber
- 37253Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel,58408Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hila Shalev Ram
- 37253Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel,58408Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Ovadia
- 37253Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel,58408Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Shechter-Maor
- 37253Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel,58408Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Biron-Shental
- 37253Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel,58408Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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4
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Whitesel E, Brodsky D. Fluctuant Mass on an Infant's Scalp. Neoreviews 2022; 19:e490-e492. [PMID: 35878402 DOI: 10.1542/neo.19-8-e490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Emily Whitesel
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Dara Brodsky
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA
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5
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Gachon B, Daressy E, Vanhecke J, Juinier Louarn C, Papin S, Pierre F, Fritel X. Cephalic marks and well-being in newborns after operative vaginal delivery. Birth 2022; 49:202-211. [PMID: 34523170 DOI: 10.1111/birt.12588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/27/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To compare the incidence of cephalic marks in newborns exposed to operative vaginal delivery and those who are not. We examined the factors associated with alterations in neonatal well-being and with cephalic mark occurrence. METHODS Prospective study involving singleton term newborns delivered in a cephalic presentation. Newborns in the operative group were matched with newborns born on the same day without instruments required. A cephalic mark was defined as any mark or edema on the newborn's skin between 12 and 72 hours of life. Neonatal well-being was assessed by analgesic consumption, neonatal discomfort (EDIN score of 1 or more), and prolonged hospitalization (4 days or more). We compared the operative and spontaneous groups and determined the relative risk (RR) for cephalic marks. We investigated the factors associated with alterations in neonatal well-being and factors associated with cephalic mark occurrence in the case of operative delivery using multivariate logistic regression analysis. RESULTS A total of 135 newborns were included in each group. The incidence of cephalic marks was higher in the operative group (RR = 13.3 [6.0-29.5]). In case of operative delivery, cephalic marks were associated with neonatal discomfort (adjusted odds ratios [aOR] = 8.2 [2.2-30.6]) and analgesic consumption (aOR = 3.0 [1.2-7.1]). The number of cephalic marks was higher in cases with sequential use of vacuum and forceps (aOR = 3.5 [1.1-11.7]) and forceps only deliveries (aOR = 3.0 [1.1-8.1]) relative to vacuum only deliveries. CONCLUSIONS Operative delivery increases the risk of neonatal cephalic marks, which can negatively affect neonatal well-being.
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Affiliation(s)
- Bertrand Gachon
- Department of Obstetrics and Gynecology, Poitiers University Hospital, Poitiers University, Poitiers, France.,Movement-Interactions-Performance, MIP, Nantes University, Nantes, France.,INSERM CIC 1402, Poitiers University Hospital, Poitiers University, Poitiers, France
| | - Elisa Daressy
- Department of Obstetrics and Gynecology, Poitiers University Hospital, Poitiers University, Poitiers, France.,Poitiers Midwifery School, Poitiers University, Poitiers, France
| | - Johanne Vanhecke
- Department of Obstetrics and Gynecology, Poitiers University Hospital, Poitiers University, Poitiers, France.,Poitiers Midwifery School, Poitiers University, Poitiers, France
| | | | - Sonia Papin
- Poitiers Midwifery School, Poitiers University, Poitiers, France
| | - Fabrice Pierre
- Department of Obstetrics and Gynecology, Poitiers University Hospital, Poitiers University, Poitiers, France
| | - Xavier Fritel
- Department of Obstetrics and Gynecology, Poitiers University Hospital, Poitiers University, Poitiers, France.,INSERM CIC 1402, Poitiers University Hospital, Poitiers University, Poitiers, France.,INSERM, Center for Research in Epidemiology and Population Health (CESP), Gender, Sexuality and Health Team, Paris-Sud University, Orsay, France
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6
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Prediction of neonatal subgaleal hemorrhage using first stage of labor data: a machine-learning based model. J Gynecol Obstet Hum Reprod 2022; 51:102320. [DOI: 10.1016/j.jogoh.2022.102320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/11/2022] [Accepted: 01/16/2022] [Indexed: 11/21/2022]
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7
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Peinado Fabregat MI, Aby JL. Bruising Behind the Ears in a Neonate. J Pediatr 2021; 239:242-243. [PMID: 34303726 DOI: 10.1016/j.jpeds.2021.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Affiliation(s)
| | - Janelle L Aby
- Department of General Pediatrics, Stanford School of Medicine, Palo Alto, CA
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8
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Goordyal D, Anderson J, Alazmani A, Culmer P. An engineering perspective of vacuum assisted delivery devices in obstetrics: A review. Proc Inst Mech Eng H 2021; 235:3-16. [PMID: 32928047 PMCID: PMC7780266 DOI: 10.1177/0954411920956467] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/13/2020] [Indexed: 11/17/2022]
Abstract
Complications during childbirth result in the need for clinicians to use 'assisted delivery' in over 12% of cases (UK). After more than 50 years in clinical practice, vacuum assisted delivery (VAD) devices remain a mainstay in physically assisting child delivery; sometimes preferred over forceps due to their ease of use and reduced maternal morbidity. Despite their popularity and enduring track-record, VAD devices have shown little evidence of innovation or design change since their inception. In addition, evidence on the safety and functionality of VAD devices remains limited but does present opportunities for improvements to reduce adverse clinical outcomes. Consequently in this review we examine the literature and patent landscape surrounding VAD biomechanics, design evolution and performance from an engineering perspective, aiming to collate the limited but valuable information from a disparate field and provide a series of recommendations to inform future research into improved, safer, VAD systems.
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Affiliation(s)
- Dushyant Goordyal
- University of Leeds Faculty of
Engineering, Mechanical Engineering, Leeds, West Yorkshire, UK
| | - John Anderson
- Bradford Teaching Hospitals NHS
Foundation Trust, Bradford, West Yorkshire, UK
| | - Ali Alazmani
- University of Leeds Faculty of
Engineering, Mechanical Engineering, Leeds, West Yorkshire, UK
| | - Peter Culmer
- University of Leeds Faculty of
Engineering, Mechanical Engineering, Leeds, West Yorkshire, UK
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9
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Abstract
Delivery room emergencies due to birth injuries are serious, usually unexpected, and can be distressing situations that necessitate immediate action to reduce neonatal morbidity and prevent neonatal mortality. Birth injuries requiring immediate, urgent care in the delivery room are uncommon, hence knowledge of obstetric risk factors and prenatal conditions linked to birth injury is an important first step in the management of affected neonates. Furthermore, immediate recognition of injury and quick action upon delivery is essential in order to achieve the best possible outcomes. This chapter briefly reviews the known risk factors associated with birth injury, and then discusses the identification and management of specific injuries that may require immediate treatment in the delivery room, or hasty management within hours after birth.
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Affiliation(s)
- Tiffany McKee-Garrett
- Baylor College of Medicine, Department of Pediatrics, Section of Neonatology, Houston, TX, USA.
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10
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Foula MS, Hassan A, AlQurashi A, Alsaihati A, Sharroufna M. Spontaneous subgaleal hematoma in a patient with sickle cell disease: A case report and literature review. Clin Case Rep 2019; 7:2220-2224. [PMID: 31788283 PMCID: PMC6878059 DOI: 10.1002/ccr3.2435] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/15/2019] [Accepted: 08/23/2019] [Indexed: 11/11/2022] Open
Abstract
Sickle cell disease (SCD) is a common hemoglobin disorder with variable clinical manifestations. Spontaneous subgaleal hematoma is rare, with sporadic cases reported in patients with SCD. Most cases resolve with conservative measures. Skull bone infarction should be considered a possible cause of severe acute headache in patients with SCD.
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Affiliation(s)
- Mohammed S. Foula
- Department of SurgeryKing Fahd Hospital of the UniversityImam Abdulrahman Bin Faisal UniversityAl‐KhobarSaudi Arabia
| | - Ali Hassan
- Department of Internal MedicineKing Fahd Hospital of the UniversityImam Abdulrahman Bin Faisal UniversityAl‐KhobarSaudi Arabia
| | - Ahmed AlQurashi
- Department of SurgeryKing Fahd Hospital of the UniversityImam Abdulrahman Bin Faisal UniversityAl‐KhobarSaudi Arabia
| | - Amna Alsaihati
- Department of Internal MedicineKing Fahd Hospital of the UniversityImam Abdulrahman Bin Faisal UniversityAl‐KhobarSaudi Arabia
| | - Mohammed Sharroufna
- Department of SurgeryKing Fahd Hospital of the UniversityImam Abdulrahman Bin Faisal UniversityAl‐KhobarSaudi Arabia
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11
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Encephalopathy in neonates with subgaleal hemorrhage is a key predictor of outcome. Pediatr Res 2019; 86:234-241. [PMID: 30999320 DOI: 10.1038/s41390-019-0400-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/07/2019] [Accepted: 04/06/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Subgaleal hemorrhage (SGH) is reported to be associated with severe hemodynamic instability, coagulopathy, and even mortality. The importance of the presence or absence of neonatal encephalopathy in predicting SGH outcomes has not been explored. The aim of this study was to determine the relationship of clinical encephalopathy to short-term outcomes in neonates with SGH. METHODS Neonates ≥35 weeks gestation, diagnosed radiologically with SGH between 2010 and 2017, were included. Cases were divided into encephalopathic and non-encephalopathic. Demographic, clinical, and outcome data were compared between groups. RESULTS Of 54,048 live births, 56 had SGH, of them 13 (23%) had encephalopathy. When compared to the non-encephalopathic neonates, encephalopathic neonates had lower Apgar scores, lower hemoglobin, lower platelet count, longer neonatal intensive care unit stay, two (15%) deaths, and four (31%) required blood transfusion. No non-encephalopathic infant with SGH died or required blood transfusion. Notably, on magnetic resonance imaging (MRI), a majority of subgaleal collections had either no or minimal blood products. CONCLUSIONS In the absence of encephalopathy, SGH is not associated with adverse short-term outcome. Neurological assessment is likely to identify infants at higher risk for adverse outcome. The absence of MRI signal consistent with blood in subgaleal collection warrants further research.
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12
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Levin G, Elchalal U, Yagel S, Eventov-Friedman S, Ezra Y, Sompolinsky Y, Mankuta D, Rottenstreich A. Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction. Acta Obstet Gynecol Scand 2019; 98:1464-1472. [PMID: 31220332 DOI: 10.1111/aogs.13678] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/14/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Subgaleal hemorrhage (SGH) is a life-threatening neonatal condition that is strongly associated with vacuum assisted delivery (VAD). The factors associated with the development of SGH following VAD are not well-established. We aimed to evaluate the factors associated with the development of SGH following attempted VAD. MATERIAL AND METHODS A retrospective case-control study of women who delivered at a tertiary university-affiliated medical center in Jerusalem, Israel, during 2009-2018. Cases comprised all parturients with singleton pregnancies for whom attempted VAD resulted in neonatal SGH. A control group of VAD attempts was established by matching one-to-one according to gestational age at delivery, parity and year of delivery. Fetal, intrapartum and vacuum procedure characteristics were compared between the groups. RESULTS In all, 313 (89.5%) of the 350 attempted VAD were nulliparous. Baseline maternal and fetal characteristics were similar between the groups except for higher neonatal birthweight in the SGH group. In multivariate logistic regression analysis, only six independent risk factors were significantly associated with the development of SGH: second-stage duration (for each 30-minute increase, adjusted odds ratio [OR] 1.13; 95% confidence intervals [CI] 1.04-1.25; P = .006), presence of meconium-stained amniotic fluid (adjusted OR 2.61; 95% CI 1.52-4.48; P = .001), presence of caput succedaneum (adjusted OR 1.79; 95% CI 1.11-2.88; P = .01), duration of VAD (for each 3-minute increase, adjusted OR 2.04; 95% CI 1.72, 2.38; P < .001), number of dislodgments (adjusted OR 2.38; 95% CI 1.66-3.44; P < .001), and fetal head station (adjusted OR 3.57; 95% CI 1.42-8.33; P = .006). Receiver operating characteristic curves showed that VAD duration of ≥15 minutes had a 96.7% sensitivity and 75.0% specificity in predicting SGH formation, with an area under the curve equal to .849. CONCLUSIONS Vacuum duration, the number of dislodgments, the duration of second stage of delivery, fetal head station, the presence of caput succedaneum and the presence of meconium were found to be independently associated with SGH formation.
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Affiliation(s)
- Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Uriel Elchalal
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Yossef Ezra
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yishay Sompolinsky
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David Mankuta
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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13
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Assad M, Spaight M, Sink D, Martin J. Early recognition and management of fetal head trauma with massive subgaleal hemorrhage. J Neonatal Perinatal Med 2019; 11:433-438. [PMID: 30149468 DOI: 10.3233/npm-17112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Non-obstetrical fetal head injury is an unusual clinical event. While multiple case reports describe motor vehicle collisions resulting in intrauterine fetal skull fractures, management of these injuries has not been emphasized. We report a case of a depressed fetal skull fracture with massive subgaleal and subperiosteal hemorrhage requiring neurosurgical intervention with good clinical outcomes for both mother and infant dyad.
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Affiliation(s)
- M Assad
- Division of Newborn Medicine, Boston Children's Hospital, USA
| | - M Spaight
- Department of Neonatology, Danbury Hospital, Connecticut, USA
| | - D Sink
- Department of Neonatology, Connecticut Children's Medical Center, Connecticut, USA
| | - J Martin
- Department of Neurosurgery, Connecticut Children's Medical Center, Connecticut, USA
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14
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Abstract
OBJECTIVE We aimed to investigate the effect of failed vacuum delivery leading to an emergency cesarean delivery on the long-term pediatric hematologic morbidity of the offspring. STUDY DESIGN In this population-based cohort study, the risk of long-term hematologic morbidity (up to the age of 18 y) was evaluated in children born following successful vacuum vaginal delivery, as compared with that of children born following a failed procedure leading to an emergent cesarean delivery. Multiple pregnancies and fetuses with congenital malformations were excluded. A Kaplan-Meier survival curve was constructed to compare cumulative pediatric hematologic morbidity, and a Cox proportional hazards model was used to control for confounders. RESULTS A total of 7978 neonates met the inclusion criteria. Vacuum delivery was successful in 7733 cases (96.9%), whereas it failed in 245 cases (3.1%). Total hematologic morbidity of the offspring up to 18 years of age was comparable between the groups (1.6% vs. 0.8%, P=0.8). The Kaplan-Meier survival curve showed no difference in the cumulative incidence of total hematologic morbidity (log rank, P=0.22). In the Cox regression model, failed vacuum delivery was not independently associated with long-term hematologic morbidity, as compared with a successful procedure, while adjusting for multiple confounders (adjusted hazards ratio [HR], 1.8; 95% confidence interval, 0.7-5.0; P=0.25). CONCLUSIONS Failed vacuum delivery does not seem to be associated with an increased risk for pediatric hematologic morbidity of the offspring up to 18 years of age.
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15
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Ekéus C, Wrangsell K, Penttinen S, Åberg K. Neonatal complications among 596 infants delivered by vacuum extraction (in relation to characteristics of the extraction). J Matern Fetal Neonatal Med 2017. [DOI: 10.1080/14767058.2017.1344631] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Cecilia Ekéus
- Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Katarina Åberg
- Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Stockholm, Sweden
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16
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Obstetric management in vacuum-extraction deliveries. SEXUAL & REPRODUCTIVE HEALTHCARE 2016; 8:94-9. [PMID: 27179384 DOI: 10.1016/j.srhc.2016.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this observational study was to describe the obstetric management in vacuum extraction (VE) deliveries and to compare these findings to instructions in clinical guidelines on VE. METHODS In 2013, detailed data on management of 600 VE cases were consecutively collected from six different delivery units in Sweden. Each unit also contributed their own clinical VE guideline. RESULTS In total, 93% of the VEs ended with a vaginal delivery while 7% failed and were converted to an emergency cesarean section. In 2.3% extraction time exceeded 20 minutes, and in 6% more than six pulls were used to deliver the fetus. Cup detachment occurred in 14.6%, and fundal pressure was used in 11% of the deliveries. In 2.3%, fetal station was assessed as above the level of the maternal ischial spines. The clinical guidelines on VE varied in scope and content between units, and were often incomplete according to best practice. CONCLUSION The vast majority of the VEs were conducted in accordance with safety recommendations. However, in a few extractions, safety rules were disregarded and more than six pulls or an extraction time of more than 20 minutes were used to complete the delivery.
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17
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Ashwal E, Wertheimer A, Aviram A, Pauzner H, Wiznitzer A, Yogev Y, Hiersch L. The association between fetal head position prior to vacuum extraction and pregnancy outcome. Arch Gynecol Obstet 2015; 293:567-73. [DOI: 10.1007/s00404-015-3884-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 09/04/2015] [Indexed: 11/29/2022]
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18
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Yamada T, Cho K, Morikawa M, Yamada T, Minakami H. Intrapartum risk factors for neonatal encephalopathy leading to cerebral palsy in women without apparent sentinel events. J Obstet Gynaecol Res 2015; 41:1520-5. [DOI: 10.1111/jog.12772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 04/02/2015] [Accepted: 05/03/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Takahiro Yamada
- Department of Perinatal Medicine; Hokkaido University Hospital; Sapporo Japan
| | - Kazutoshi Cho
- Department of Perinatal Medicine; Hokkaido University Hospital; Sapporo Japan
| | - Mamoru Morikawa
- Department of Perinatal Medicine; Hokkaido University Hospital; Sapporo Japan
| | - Takashi Yamada
- Department of Obstetrics and Gynecology; Japan Community Health Care Organization Hokkaido Hospital; Sapporo Japan
| | - Hisanori Minakami
- Department of Perinatal Medicine; Hokkaido University Hospital; Sapporo Japan
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19
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Abstract
This article summarizes the initial assessment of normal newborns and describes a few of the common variations that may occur. These variations require a pediatric provider to reassure anxious new parents and provide follow-up communication with the subsequent primary care provider.
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Affiliation(s)
- Julie R Gooding
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH 43205, USA
| | - Richard E McClead
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH 43205, USA.
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Colditz MJ, Lai MM, Cartwright DW, Colditz PB. Subgaleal haemorrhage in the newborn: A call for early diagnosis and aggressive management. J Paediatr Child Health 2015; 51:140-6. [PMID: 25109786 DOI: 10.1111/jpc.12698] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2014] [Indexed: 11/30/2022]
Abstract
Subgaleal haemorrhage (SGH) is an important cause of preventable morbidity and mortality in the neonate. Its increased prevalence in recent years has coincided with the rise in the number of births assisted by vacuum extraction. Three deaths in Australia within the last 7 years have been the subject of two coronial inquests. Subsequent coronial reports have highlighted that neonatal death from SGH can be prevented if appropriate attention is paid to identification of risk factors, early diagnosis, close observation and aggressive treatment. To prevent unnecessary deaths, all involved in the care of the baby after birth need to be aware of the importance of prompt diagnosis, monitoring and early treatment of SGH.
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Affiliation(s)
- Michael J Colditz
- Perinatal Research Centre, The University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia
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21
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Ekéus C, Högberg U, Norman M. Vacuum assisted birth and risk for cerebral complications in term newborn infants: a population-based cohort study. BMC Pregnancy Childbirth 2014; 14:36. [PMID: 24444326 PMCID: PMC3899386 DOI: 10.1186/1471-2393-14-36] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 01/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have focused on cerebral complications among newborn infants delivered by vacuum extraction (VE). The aim of this study was to determine the risk for intracranial haemorrhage and/or cerebral dysfunction in newborn infants delivered by VE and to compare this risk with that after cesarean section in labour (CS) and spontaneous vaginal delivery, respectively. METHODS Data was obtained from Swedish national registers. In a population-based cohort from 1999 to 2010 including all singleton newborn infants delivered at term after onset of labour by VE (n = 87,150), CS (75,216) or spontaneous vaginal delivery (n = 851,347), we compared the odds for neonatal intracranial haemorrhage, traumatic or non-traumatic, convulsions or encephalopathy. Logistic regressions were used to calculate adjusted (for major risk factors and indication) odds ratios (AOR), using spontaneous vaginal delivery as reference group. RESULTS The rates of traumatic and non-traumatic intracranial hemorrhages were 0.8/10,000 and 3.8/1,000. VE deliveries provided 58% and 31.5% of the traumatic and non-traumatic cases, giving a ten-fold risk [AOR 10.05 (4.67-21.65)] and double risk [AOR 2.23 (1.57-3.16)], respectively. High birth weight and short mother were associated with the highest risks. Infants delivered by CS had no increased risk for intracranial hemorrhages. The risks for convulsions or encephalopathy were similar among infants delivered by VE and CS, exceeding the OR after non-assisted spontaneous vaginal delivery by two-to-three times. CONCLUSION Vacuum assisted delivery is associated with increased risk for neonatal intracranial hemorrhages. Although causality could not be established in this observational study, it is important to be aware of the increased risk of intracranial hemorrhages in VE deliveries, particularly in short women and large infants. The results warrant further studies in decision making and conduct of assisted vaginal delivery.
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Affiliation(s)
- Cecilia Ekéus
- Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Stockholm, Sweden
| | - Ulf Högberg
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden
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22
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Bahl R, Van de Venne M, Macleod M, Strachan B, Murphy DJ. Maternal and neonatal morbidity in relation to the instrument used for mid-cavity rotational operative vaginal delivery: a prospective cohort study. BJOG 2013; 120:1526-32. [DOI: 10.1111/1471-0528.12398] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2013] [Indexed: 11/29/2022]
Affiliation(s)
- R Bahl
- Department of Obstetrics & Gynaecology; St Michael's Hospital; Bristol UK
| | - M Van de Venne
- Department of Obstetrics & Gynaecology; Royal United Hospital; Bath UK
| | - M Macleod
- Division of Maternal and Child Health Sciences; Ninewells Hospital & Medical School; University of Dundee; Dundee UK
| | - B Strachan
- Department of Obstetrics & Gynaecology; St Michael's Hospital; Bristol UK
| | - DJ Murphy
- Academic Department of Obstetrics & Gynaecology; Coombe Women & Infants University Hospital & Trinity College; University of Dublin; Dublin UK
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23
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Linder N, Linder I, Fridman E, Kouadio F, Lubin D, Merlob P, Yogev Y, Melamed N. Birth trauma--risk factors and short-term neonatal outcome. J Matern Fetal Neonatal Med 2013; 26:1491-5. [PMID: 23560503 DOI: 10.3109/14767058.2013.789850] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The ability to predict birth trauma (BT) based on the currently recognized risk factors is limited and there is little information regarding the short-term neonatal outcome following BT. We aimed to identify risk factors for BT and to evaluate the effect of BT on short-term neonatal outcome. METHODS A retrospective, cohort, case-control study of all cases of BT in a single tertiary center (1986-2009). The control group included the two subsequent full-term singleton neonates who did not experienced BT. Short-term neonatal outcome was compared between the groups including Apgar scores, NICU admission, duration of hospitalization and neurologic, respiratory and metabolic morbidity. RESULTS Of the 118 280 singleton full-term newborns delivered during the study period, 2874 were diagnosed with BT (24.3/1000). The most frequent types of BT were scalp injuries (63.9%, 15.5/1000) and clavicular fracture (32.1%, 7.7/1000). The following factors were found to be independent risk factors for BT: instrumental delivery (OR 7.5, 95% CI 6.3-8.9), birth weight, delivery during risk hours, parity, maternal age and neonatal head circumference. Cesarean delivery was the only factor protective of BT (OR 0.2, 95% CI 0.2-0.3). Neonates in the study group had a prolonged length of hospital stay (3.3 versus 2.7 d, p = 0.001), were more likely to be admitted to the NICU (3.9% versus 1.9%, p < 0.001), and had a higher rate of jaundice (11.9% versus 7.1%, p < 0.001) and neurological morbidity (4.7% versus 2.3%, p < 0.001). CONCLUSION Instrumental delivery appears to be responsible for most cases of neonatal BT.
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24
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Responding to traumatic birth: subgaleal hemorrhage, assessment, and management during transport. Adv Neonatal Care 2011; 14 Suppl 5:S11-5. [PMID: 21102174 DOI: 10.1097/anc.0b013e3181fe9a49] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Subgaleal hemorrhage is an uncommon but often fatal complication of a traumatic birth. Careful assessment and monitoring of the infant following birth are necessary to ensure prompt intervention, referral, and improved outcomes. Additional care, planning, and communication are especially important in the transport environment.
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25
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What do you tell the family who asks, 'What went wrong?' The truth and nothing but the truth. J Perinatol 2010; 30:513-6. [PMID: 20539276 DOI: 10.1038/jp.2010.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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26
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Congenital duplication of the superior sagittal sinus and parietal encephalocele after vacuum extraction delivery. Acta Neurochir (Wien) 2010; 152:713-6. [PMID: 19639246 DOI: 10.1007/s00701-009-0470-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Accepted: 07/06/2009] [Indexed: 10/20/2022]
Abstract
A newly-born infant with a congenital dural and bony defect and an associated short-segmented duplication of the superior sagittal sinus suffered from herniation and infarction of parietal brain tissue secondary to vacuum extraction. This ultimately led to the formation of a subgaleal cerebrospinal fluid (CSF) collection. Initial operative closure of the encephalocele was performed by attaching a galeal flap to the periostium surrounding the congenital defect. As the bony defect developed characteristics of a growing fracture later on, dural repair, transplantation of a split-bone flap and, finally, the insertion of a ventriculoperitoneal shunt became necessary. This case affirms that stringent indication and cautious usage of vacuum-assisted delivery is strongly recommended, especially in view of the possibility that undetected congenital cranial, vascular and/or cerebral alterations may be present.
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Abstract
Instrumental vaginal delivery involves the use of the vacuum extractor or obstetric forceps to facilitate delivery of the fetus. It is associated with substantial risk of head injury, including hemorrhage, fractures, and, rarely, brain damage or fetal death. This review article describes the different types, etiology, pathophysiology, risk factors, and clinical features of head trauma after instrumental birth, along with their management and prevention strategies.
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Affiliation(s)
- Stergios K Doumouchtsis
- Department of Obstetrics and Gynaecology, St. George's University of London, Cranmer Terrace, London SW17 0RE, UK.
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30
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Chang HY, Peng CC, Kao HA, Hsu CH, Hung HY, Chang JH. Neonatal subgaleal hemorrhage: clinical presentation, treatment, and predictors of poor prognosis. Pediatr Int 2007; 49:903-7. [PMID: 18045294 DOI: 10.1111/j.1442-200x.2007.02482.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Neonatal subgaleal hemorrhage (SGH) is a rare but potentially lethal medical emergency. The objective of the present retrospective study was to clarify the clinical presentation, management, and factors associated with morbidity and mortality. METHODS The records of all newborns from January 1995 to December 2004 were reviewed for evidence of SGH, based on the presence of a fluctuating hemorrhagic mass that crossed suture lines and extended toward the neck. Characteristics were compared between those with a poor or a good outcome. RESULTS Forty-two newborns with SGH were identified, 77% having had an instrumental delivery. The incidence was 0.6/1000 deliveries and 4.6/1000 vacuum-assisted deliveries. Thirteen patients (31%) had a poor outcome (five died, four had epilepsy, three with severe auditory dysfunction, two with cerebral palsy, and one with renal vein thrombosis). The group with the poor outcome had significantly more patients who had been transferred from other hospitals (P < 0.001). Those with a poor outcome had significantly more hypotension (P < 0.001) and seizures (P < 0.05). Laboratory findings associated with a poor outcome included anemia, coagulopathy, metabolic acidosis, and renal impairment. Other predictors of a poor prognosis included skull bone fracture, the need for pressors, blood transfusion, ventilator support, intensive care unit admission, and a longer hospital stay. CONCLUSIONS SGH may be associated with serious complications and death. The condition must be recognized promptly and monitored closely. Those with poor prognostic factors should be referred for intensive care, treated aggressively, and followed in the long term.
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Affiliation(s)
- Hung-Yang Chang
- Department of Pediatrics, Hsinchu Mackay Memorial Hospital, Hsinchu City, Taiwan.
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31
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Abstract
Operative vaginal delivery has been maligned since the days of W.J. Little with the word "forceps" becoming nearly synonymous with "Birth Injury" and "Cerebral Palsy." However in his presentation to the Obstetrical Society of London in 1861, Little's emphasis was on difficult labors being the culprit in subsequent disabilities in the offspring. Instrumented deliveries in that era were the end result of a long, obstructed labor performed for maternal benefit and to avoid a destructive procedure to the fetus thus allowing a chance at life. If there had been a normal progress in labor, operative assistance for delivery would not have been needed. Thus, was it the instrument or the obstructed labor that led to fetal injury? In this article, we will review what injuries to the fetus and the mother can be directly attributable to the instrument. We will explore the processes of labor, conduct of labor management, and concurrent fetal factors that can modulate the occurrence of birth trauma. Evidence regarding inexperience and improper use as contributing to injury will also be explored.
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Affiliation(s)
- Dena R Towner
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, California 95817, USA.
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32
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Abstract
Subgaleal hemorrhages, although infrequent in the past, are becoming more common with the increased use of vacuum extraction. Bleeding into the large subgaleal space can quickly lead to hypovolemic shock, which can be fatal. Understanding of anatomy, pathophysiology, risk factors, differential diagnosis, and management will assist in early recognition and care of the infant with a subgaleal hemorrhage.
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Affiliation(s)
- Julie Reid
- Integris Baptist Medical Center, NICU, Oklahoma City, OK 73112, USA.
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33
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Chang X, Chedraui P, Ross MG, Hidalgo L, Peñafiel J. Vacuum assisted delivery in Ecuador for prolonged second stage of labor: maternal-neonatal outcome. J Matern Fetal Neonatal Med 2007; 20:381-4. [PMID: 17674241 DOI: 10.1080/14767050701227927] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND In South America, and particularly Ecuador, cesarean section rates have risen markedly over the past five years. The associated increases in maternal morbidity and healthcare costs indicate the need for alternative strategies. Operative vaginal delivery is minimally utilized in Ecuador, as neither vacuum nor forceps have been available. OBJECTIVE As vacuum delivery was recently introduced to our clinical service, we sought to examine our initial experiences (i.e., maternal and neonatal outcome) with operative vaginal delivery for prolonged second stage of labor. METHODS Following an initial educational program at the Enrique C. Sotomayor Obstetrics and Gynecology Hospital, Guayaquil, Ecuador, vacuum extraction cups (Mityvac, Cooper Surgical) were offered to laboring women with term singleton gestations and cephalic presentations no higher than +3 station. Maternal and neonatal data were analyzed. RESULTS During the study period, 100 vacuum applications were performed on laboring women complicated with prolonged second stage of labor. Mean maternal age was 23.8 +/- 6.4 years (range 14-41 years) with 57% of patients nulliparous. Left anterior and right posterior fetal positions were the most frequent (85% and 11%, respectively). Maternal complications included need for blood transfusion (1%), shoulder dystocia (1%) and perineal tears (first degree 6%, second degree 5%). Vaginal delivery was successful in 97% of cases. Among neonates, the average weight was 3149 +/- 410 g, with 10% neonates small for gestational age and 5% large for gestational age. Only 1% of infants presented an Apgar score <7 at 5 min. There were no scalp lacerations, cephalohematomas, or subgaleal bleeds. CONCLUSIONS In this initial observational study, vacuum extraction for prolonged second stage was safe and effective. We propose that the introduction of operative vaginal delivery to developing countries will mitigate rising cesarean section rates.
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Affiliation(s)
- Xavier Chang
- Labor Unit, Enrique C Sotomayor Obstetrics and Gynecology Hospital, Guayaquil, Ecuador
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Ryan TD, Dimmitt RA, Tubbs RS, Roberts OA, Choi H, Loukas M, Blount JP. Contribution of surgical evacuation of a large subgaleal hematoma to the resolution of severe conjugated hyperbilirubinemia in a neonate. Case report. J Neurosurg 2007; 106:131-3. [PMID: 17330539 DOI: 10.3171/ped.2007.106.2.131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Subgaleal hematomas (SGHs) in neonates may result from trauma to the scalp sustained during delivery. In the majority of cases, these lesions will resolve on their own without serious or long-term consequences. The authors report on a case of SGH resulting in hypotension, anemia, coagulopathy, and eventually direct hyperbilirubinemia in a neonate. After several weeks of medical management failed to resolve the hyperbilirubinemia, surgical evacuation of the clot was undertaken and yielded favorable results. The direct bilirubinemia in this case was believed to be the result of an overload of iron to the hepatocytes. It is the authors' contention that the evacuation of the hematoma resulted in a reduction in the amount of iron being presented to the liver for metabolism and significantly contributed to this patient's recovery.
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Affiliation(s)
- Thomas D Ryan
- Medical Scientist Training Program, University of Alabama School of Medicine, Birmingham, USA
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Abstract
PURPOSE OF REVIEW The types, mechanisms and clinical manifestations of head injuries (extracranial, cranial and intracranial) after instrumental delivery are described along with current evidence of their prevention and management. RECENT FINDINGS Asymptomatic subdural hematomas can occur in up to 6.1% of uncomplicated vaginal deliveries. Maternal nulliparity, incorrect placement of vacuum extraction cup and failed vacuum extraction are predisposing factors to subgaleal hemorrhage. Injuries associated with the vacuum devices may be minimized if the recommended limits for a safe traction force are not exceeded. There is no difference in the incidence of scalp trauma between vacuum deliveries by a rigid plastic cup (Omnicup) and the standard, silastic cup. The use of a metal cup may increase the occurrence of head injuries. Protective covers over forceps reduce the rates of neonatal facial abrasions and skin bruises. There is no difference in the incidence of cephalhematoma comparing a sequential operative vaginal delivery and a caesarean section following a failed vacuum delivery. SUMMARY Instrumental vaginal deliveries carry substantial risks. Only practitioners who are adequately trained or are under supervision should undertake instrumental delivery. The mode of intervention needs to be individualized after consideration of the operator's skills and experience and the clinical circumstances.
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Affiliation(s)
- Stergios K Doumouchtsis
- Department of Obstetrics and Gynaecology, St George's Hospital, St George's University of London, London, UK.
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36
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Whitlow BJ, Tamizian O, Ashworth J, Kerry S, Penna LK, Arulkumaran S. Validation of traction force indicator in ventouse devices. Int J Gynaecol Obstet 2005; 90:35-8. [PMID: 15921684 DOI: 10.1016/j.ijgo.2005.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2004] [Revised: 02/24/2005] [Accepted: 03/09/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate whether the traction force indicator in a ventouse device gave an accurate estimation of the force applied. METHODS The study was carried out at the Derby City Hospital. An estimate of measurement errors was made by analyzing the standard deviation of the residuals for 30 Kiwi OmniCup devices (Clinical Innovations, Abingdon, Oxfordshire, England) and a standard industrial spring balance. RESULTS The measurement errors for the traction forces were very small and acceptable for the OmniCup. The overall estimate of measurement errors was 0.45 kg (1.35 lb). CONCLUSION The overall measurement error for the traction force indicator of the OmniCup was found to be very small. Injuries associated the ventouse, such as cephalohematomas and subgaleal hemorrhages, may be minimized if the recommended limits for a safe traction force are not exceeded.
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Affiliation(s)
- B J Whitlow
- Colchester Hospital, Turner Road, Colchester CO4 5JL, UK.
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