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Kong CW, To WWK. Precision of vacuum cup placement and its association with subgaleal hemorrhage and associated morbidity in term neonates. Arch Gynecol Obstet 2024; 309:1411-1419. [PMID: 37017783 DOI: 10.1007/s00404-023-07018-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/20/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE To evaluate whether the precision of vacuum cup placement is associated with failed vacuum extraction(VE), neonatal subgaleal hemorrhage(SGH) and other VE-related birth trauma. METHODS All women with singleton term cephalic fetuses with attempted VE were recruited over a period of 30 months. Neonates were examined immediately after birth and the position of the chignon documented to decide whether the cup position was flexing median or suboptimal. Vigilant neonatal surveillance was performed to look for VE-related trauma, including subgaleal/subdural hemorrhages, skull fractures, scalp lacerations. CT scans of the brain were ordered liberally as clinically indicated. RESULTS The VE rate was 5.89% in the study period. There were 17(4.9%) failures among 345 attempted VEs. Thirty babies suffered from subgaleal/subdural hemorrhages, skull fractures, scalp lacerations or a combination of these, giving an incidence of VE-related birth trauma of 8.7%. Suboptimal cup positions occurred in 31.6%. Logistic regression analysis showed that failed VE was associated with a non-occipital anterior fetal head position (OR 3.5, 95% CI 1.22-10.2), suboptimal vacuum cup placement (OR 4.13, 95% CI 1.38-12.2) and a longer duration of traction (OR 8.79, 95% CI 2.13-36.2); while, VE-related birth trauma was associated with failed VE (OR 3.93, 95% CI 1.08-14.3) and more pulls (OR 4.07, 95% CI 1.98-8.36). CONCLUSION Suboptimal vacuum cup positions were related to failed VE but not to SGH and other vacuum-related birth trauma. While optimal flexed median cup positions should be most desirable mechanically to effect delivery, such a position does not guarantee prevention of SGH.
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Affiliation(s)
- Choi Wah Kong
- Department of Obstetrics and Gynaecology, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Hong Kong, China.
| | - William Wing Kee To
- Department of Obstetrics and Gynaecology, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Hong Kong, China
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Auger N, Wei SQ, Ayoub A, Luu TM. Severe neonatal birth injury: Observational study of associations with operative, cesarean, and spontaneous vaginal delivery. J Obstet Gynaecol Res 2023; 49:2817-2824. [PMID: 37772655 DOI: 10.1111/jog.15801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/16/2023] [Indexed: 09/30/2023]
Abstract
AIM To determine the association of successful and unsuccessful operative vaginal delivery attempts with risk of severe neonatal birth injury. METHODS We conducted a population-based observational study of 1 080 503 births between 2006 and 2019 in Quebec, Canada. The main exposure was operative vaginal delivery with forceps or vacuum, elective or emergency cesarean with or without an operative vaginal attempt, and spontaneous delivery. The outcome was severe birth injury, including intracranial hemorrhage, brain and spinal damage, Erb's paralysis and other brachial plexus injuries, epicranial subaponeurotic hemorrhage, skull and long bone fractures, and liver, spleen, and other neonatal body injuries. We determined the association of delivery mode with risk of severe birth injury using adjusted risk ratios (RR) and 95% confidence intervals (CI). RESULTS A total of 8194 infants (0.8%) had severe birth injuries. Compared with spontaneous delivery, vacuum (RR 2.98, 95% CI 2.80-3.16) and forceps (RR 3.35, 95% CI 3.07-3.66) were both associated with risk of severe injury. Forceps was associated with intracranial hemorrhage (RR 16.4, 95% CI 10.1-26.6) and brain and spinal damage (RR 13.5, 95% CI 5.72-32.0), while vacuum was associated with epicranial subaponeurotic hemorrhage (RR 27.5, 95% CI 20.8-36.4) and skull fractures (RR 2.04, 95% CI 1.86-2.25). Emergency cesarean after an unsuccessful operative attempt was associated with intracranial and epicranial subaponeurotic hemorrhage, but elective and other emergency cesareans were not associated with severe injury. CONCLUSIONS Operative vaginal delivery and unsuccessful operative attempts that result in an emergency cesarean are associated with elevated risks of severe birth injury.
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Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Shu Qin Wei
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada
| | - Aimina Ayoub
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada
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Habek D, Mikuš M, Cerovac A. The proposal of the novel fetal shoulder dystocia graduation: a clinical-based opinion. J Perinat Med 2023; 51:1129-1131. [PMID: 37329307 DOI: 10.1515/jpm-2022-0513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 05/09/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Shoulder dystocia is a peracute mechanical dystocia and a prepartum, usually unpredictable, life-threatening entity with significant forensic implications due to significantly poor perinatal outcome, especially permanent disability or perinatal death. CONTENT To better objectify the graduation and to include other important clinical parameters, we believe it is appropriate to present a proposal for a complete perinatal weighted graduation of shoulder dystocia, based on several years of numerous other and our own clinical and forensic studies and thematic biobibliography. Obstetric maneuvers, neonatal outcome, and maternal outcome are three components, which are evaluated according to the severity of 0-4 proposed components. Thus, the gradation is ultimately in four degrees according to the total score: I. degreee, score 0-3: slightly shoulder dystocia with simple obstetric interventions, but without birth injuries; II. degree, score 4-7: mild shoulder dystocia resolved by external, secondary interventions and minor injuries; III. degree, score 8-10: severe shoulder dystocia with severe peripartum injuries; IV. degree, score 11-12: extremely difficult, severe shoulder dystocia with ultima ratio interventions applied and resulting extremely severe injuries with chronic disability, including perinatal death. SUMMARY As a clinically evaluated graduation, it certainly has an applicable long-term anamnestic and prognostic component for subsequent pregnancies and access to subsequent births, as it includes all relevant components of clinical forensic objectification.
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Affiliation(s)
- Dubravko Habek
- Department of Obstetrics and Gynecology, Clinical Hospital Merkur, Zagreb, Croatia
- School of Medicine, Catholic University of Croatia, Zagreb, Croatia
- Collegium of the Surgical Sciences, Croatian Academy of Medical Sciences, Zagreb, Croatia
| | - Mislav Mikuš
- Department of Obstetrics and Gynecology, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Anis Cerovac
- Department of Gynaecology and Obstetrics, General Hospital Tešanj, Tešanj, Bosnia and Herzegovina
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Manske MC, Wilson MD, Wise BL, James MA, Melnikow J, Hedriana HL, Tancredi DJ. Association of Parity and Previous Birth Outcome With Brachial Plexus Birth Injury Risk. Obstet Gynecol 2023; 142:1217-1225. [PMID: 37797333 PMCID: PMC10592124 DOI: 10.1097/aog.0000000000005394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/20/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To evaluate the association of maternal delivery history with a brachial plexus birth injury risk in subsequent deliveries and to estimate the effect of subsequent delivery method on brachial plexus birth injury risk. METHODS We conducted a retrospective cohort study of all live-birth deliveries occurring in California-licensed hospitals from 1996 to 2012. The primary outcome was recurrent brachial plexus birth injury in a subsequent pregnancy. The exposure was delivery history (parity, shoulder dystocia in a previous delivery, or previously delivering a neonate with brachial plexus birth injury). Multiple logistic regression was used to model adjusted associations of delivery history with brachial plexus birth injury in a subsequent pregnancy. The adjusted risk and adjusted risk difference for brachial plexus birth injury between vaginal and cesarean deliveries in subsequent pregnancies were determined, stratified by delivery history, and the number of cesarean deliveries needed to prevent one brachial plexus birth injury was determined. RESULTS Of 6,286,324 neonates delivered by 4,104,825 individuals, 7,762 (0.12%) were diagnosed with a brachial plexus birth injury. Higher parity was associated with a 5.7% decrease in brachial plexus birth injury risk with each subsequent delivery (adjusted odds ratio [aOR] 0.94, 95% CI 0.92-0.97). Shoulder dystocia or brachial plexus birth injury in a previous delivery was associated with fivefold (0.58% vs 0.11%, aOR 5.39, 95% CI 4.10-7.08) and 17-fold (1.58% vs 0.11%, aOR 17.22, 95% CI 13.31-22.27) increases in brachial plexus birth injury risk, respectively. Among individuals with a history of delivering a neonate with a brachial plexus birth injury, cesarean delivery was associated with a 73.0% decrease in brachial plexus birth injury risk (0.60% vs 2.21%, aOR 0.27, 95% CI 0.13-0.55) compared with an 87.9% decrease in brachial plexus birth injury risk (0.02% vs 0.15%, aOR 0.12, 95% CI 0.10-0.15) in individuals without this history. Among individuals with a history of brachial plexus birth injury, 48.1 cesarean deliveries are needed to prevent one brachial plexus birth injury. CONCLUSIONS Parity, previous shoulder dystocia, and previously delivering a neonate with brachial plexus birth injury are associated with future brachial plexus birth injury risk. These factors are identifiable prenatally and can inform discussions with pregnant individuals regarding brachial plexus birth injury risk and planned mode of delivery.
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Affiliation(s)
- M. Claire Manske
- Assistant Professor, Department of Orthopaedic Surgery, University of California Davis, Sacramento, California, United States
- Department of Orthopaedic Surgery, Shriners Hospitals for Children Northern California, Sacramento, California, United States
| | - Machelle D. Wilson
- Principal Biostatistician, Clinical and Translational Science Center, Department of Public Health Sciences, Division of Biostatistics, University of California Davis, Sacramento, California, United States
| | - Barton L. Wise
- Professor, Department of Internal Medicine, University of California Davis, Sacramento, California, United States
| | - Michelle A. James
- Assistant Professor, Department of Orthopaedic Surgery, University of California Davis, Sacramento, California, United States
- Department of Orthopaedic Surgery, Shriners Hospitals for Children Northern California, Sacramento, California, United States
| | - Joy Melnikow
- Professor Emeritus, Department of Family and Community Medicine, University of California Davis, Sacramento, California, United States
| | - Herman L. Hedriana
- Professor and Chief, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of California Davis, Sacramento, California, United States
| | - Daniel J. Tancredi
- Professor in Residence, Department of Pediatrics, University of California Davis, Sacramento, California, United States
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Chawanpaiboon S, Titapant V, Pooliam J. Maternal complications and risk factors associated with assisted vaginal delivery. BMC Pregnancy Childbirth 2023; 23:756. [PMID: 37884886 PMCID: PMC10601252 DOI: 10.1186/s12884-023-06080-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/20/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVE This study aimed to elucidate the maternal complications and risk factors linked with assisted vaginal delivery. METHODS We conducted a retrospective, descriptive analysis of hospital records, identifying 3500 cases of vaginal delivery between 2020 and 2022. Data encompassing demographics, complications from the vaginal delivery including post-partum haemorrhage, birth passage injuries, puerperal infection and other pertinent details were documented. Various critical factors, including the duration of the second stage of labor, maternal anemia, underlying maternal health conditions such as diabetes mellitus and hypertension, neonatal birth weight, maternal weight, the expertise of the attending surgeon, and the timing of deliveries were considered. RESULTS The rates for assisted vacuum and forceps delivery were 6.0% (211/3500 cases) and 0.3% (12/3500), respectively. Postpartum haemorrhage emerged as the predominant complication in vaginal deliveries, with a rate of 7.3% (256/3500; P < 0.001). Notably, postpartum haemorrhage had significant associations with gestational diabetes mellitus class A1 (adjusted odds ratio [AOR] 1.46; 95% confidence interval [CI] 1.01-2.11; P = 0.045), assisted vaginal delivery (AOR 5.11; 95% CI 1.30-20.1; P = 0.020), prolonged second stage of labour (AOR 2.68; 95% CI 1.09-6.58; P = 0.032), elevated maternal weight (71.4 ± 12.2 kg; AOR 1.02; 95% CI 1.01-1.03; P = 0.003) and neonates being large for their gestational age (AOR 3.02; 95% CI 1.23-7.43; P = 0.016). CONCLUSIONS The primary complication arising from assisted vaginal delivery was postpartum haemorrhage. Associated factors were a prolonged second stage of labour, foetal distress, large-for-gestational-age neonates and elevated maternal weight. Cervical and labial injuries correlated with neonates being large for their gestational age. Notably, puerperal infections were related to maternal anaemia (haematocrit levels < 33%). CLINICAL TRIAL REGISTRATION Thai Clinical Trials Registry: 20220126004.
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Affiliation(s)
- Saifon Chawanpaiboon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
| | - Vitaya Titapant
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Julaporn Pooliam
- Clinical Epidemiological Unit, Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
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Kekki M, Koukkula T, Salonen A, Gissler M, Laivuori H, Huttunen TT, Tihtonen K. Birth injury in breech delivery: a nationwide population-based cohort study in Finland. Arch Gynecol Obstet 2023; 308:1139-1150. [PMID: 36074174 PMCID: PMC10435420 DOI: 10.1007/s00404-022-06772-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/25/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Previous studies have examined the optimal mode of breech delivery extensively, but there is a scarcity of publications focusing on the birth injuries of neonates born in breech presentation. This study aimed to examine birth injury in breech deliveries. METHODS In this retrospective register-based nationwide cohort study, data on birth injuries in vaginal breech deliveries with singleton live births were compared to cesarean section with breech presentation and cephalic vaginal delivery between 2004 and 2017 in Finland. The data were retrieved from the National Medical Birth Register. Primary outcome variables were severe and mild birth injury. Incidences of birth injuries in different gestational ages and birthweights were calculated in different modes of delivery. Crude odds ratios of risk factors for severe birth injury were analyzed. RESULTS In vaginal breech delivery (n = 4344), there were 0.8% of neonates with severe birth injury and 1.5% of neonates with mild birth injury compared to 0.06% and 0.2% in breech cesarean section (n = 16,979) and 0.3% and 1.9% in cephalic vaginal delivery (n = 629,182). Brachial plexus palsy was the most common type of injury in vaginal breech delivery. Increasing gestational age and birthweight had a stronger effect on the risk for injury among cephalic vaginal deliveries than among vaginal breech deliveries. CONCLUSION Birth injuries were rare in vaginal breech deliveries. The incidence of severe birth injury was two times higher in vaginal breech delivery compared to cephalic vaginal delivery. Brachial plexus palsy was the most common type of injury in vaginal breech delivery.
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Affiliation(s)
- Maiju Kekki
- Department of Obstetrics and Gynecology, Tampere University Hospital, Elämänaukio 2, 33520, Tampere, Finland.
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Topias Koukkula
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Anne Salonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Pediatric and Adolescent Surgery, Tampere University Hospital, Tampere, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute and Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
| | - Hannele Laivuori
- Department of Obstetrics and Gynecology, Tampere University Hospital, Elämänaukio 2, 33520, Tampere, Finland
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Tuomas T Huttunen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Tampere University Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Kati Tihtonen
- Department of Obstetrics and Gynecology, Tampere University Hospital, Elämänaukio 2, 33520, Tampere, Finland
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Kong CW, To WWK, Lai THT, Tang EWH, Ho YC, Li KKW. A prospective study on neonatal ophthalmic injuries associated with forceps delivery. J AAPOS 2023; 27:196.e1-196.e5. [PMID: 37453665 DOI: 10.1016/j.jaapos.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/23/2023] [Accepted: 04/28/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Assisted delivery by forceps is needed to expedite vaginal delivery in certain maternal and fetal conditions. The aim of this study was to evaluate the incidence and the extent of ophthalmological injuries in neonates after forceps delivery. METHODS Women with cephalic fetuses delivered vaginally by forceps from July 2020 to June 2022 were recruited prospectively. Ophthalmologists would be consulted when there were signs of external ophthalmic injuries, such as periorbital forceps marks or facial bruising. Demographic data, pregnancy characteristics, delivery details, and perinatal outcomes were evaluated to identify any associated risk factors for neonatal ophthalmological injuries. RESULTS A total of 77 forceps deliveries were performed in the study period, in which 20 cases (26%) required ophthalmological consultations. There were more right or left occipital fetal head positions in the group requiring ophthalmological assessment than those that did not require assessment (35% vs 12.3% [P = 0.023]). The degree of moulding of the fetal head was more marked in the former group (65% vs 28% [P = 0.001]). The overall incidence of detectable ophthalmological lesions was 16.9% (13/77). All ophthalmic injuries were mild, and most resolved with conservative management. CONCLUSIONS In our study cohort, external ophthalmic injuries were common after forceps delivery. We recommended ophthalmological consultation in newborns delivered by forceps with evidence of compressive trauma to rule out serious ophthalmological trauma.
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Affiliation(s)
- Choi Wah Kong
- Department of Obstetrics & Gynaecology, United Christian Hospital, Hong Kong.
| | - William Wing Kee To
- Department of Obstetrics & Gynaecology, United Christian Hospital, Hong Kong
| | | | | | - Yok Chiu Ho
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Hong Kong
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Hildén K, Magnuson A, Hanson U, Simmons D, Fadl H. Trends in pregnancy outcomes for women with gestational diabetes mellitus in Sweden 1998-2012: a nationwide cohort study. Diabet Med 2020; 37:2050-2057. [PMID: 32027045 DOI: 10.1111/dme.14266] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2020] [Indexed: 12/31/2022]
Abstract
AIM To assess whether incidence of maternal and neonatal outcomes for women with or without gestational diabetes mellitus (GDM) have changed over time. METHODS Population-based cohort study in Sweden including all singleton pregnancies over the period 1998-2012. GDM was diagnosed following Diabetic Pregnancy Study Group 1991 criteria. Poisson regression or negative binomial regression was used to model yearly relative change in numbers of cases and incidence of the outcomes with 95% confidence intervals (CI), and yearly absolute change in birthweight z-score. RESULTS The study included 1 455 667 pregnancies. The number of pregnancies increased over time and the overall prevalence of GDM was 1%. For women with GDM there was a significantly decreasing trend in incidence per year for large for gestational age (LGA) (0.986, 95% CI 0.975 to 0.996), birthweight z-score (-0.012, 95% CI -0.017 to -0.007) and birth trauma (0.937, 95% CI 0.907 to 0.968). The trend for small for gestational age (SGA) among women with GDM increased by an odds ratio per year (1.016, 95% CI 1.002 to 1.029). No significant interaction tests for maternal characteristics were found. Trends in outcomes for women without diabetes were similar to those for women with GDM. CONCLUSIONS This study shows that there were improvements in pregnancy outcomes for women with GDM between 1998 and 2012, although the incidence of SGA increased. Improvements followed similar trends in the background population. Inequalities in obstetric outcomes between women with GDM and those without have continued unchanged over 15 years, suggesting that new management strategies are required to reduce this gap.
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Affiliation(s)
- K Hildén
- Department of Obstetrics and Gynaecology, Örebro University, Örebro, Sweden
| | - A Magnuson
- Clinical Epidemiology and Biostatistics, Örebro University, Örebro, Sweden
| | - U Hanson
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - D Simmons
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - H Fadl
- Department of Obstetrics and Gynaecology, Örebro University, Örebro, Sweden
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Yenigül AE, Yenigül NN, Başer E, Özelçi R. A retrospective analysis of risk factors for clavicle fractures in newborns with shoulder dystocia and brachial plexus injury: A single-center experience. Acta Orthop Traumatol Turc 2020; 54:609-613. [PMID: 33423993 DOI: 10.5152/j.aott.2020.19180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We aimed to analyze the risk factors for clavicle fractures in newborns with shoulder dystocia and brachial plexus injury and to determine whether their incidence is associated with local characteristics. METHODS This study was conducted as a retrospective trial between January 2017 and December 2018. Patients with clavicular fracture who were hospitalized in the neonatal intensive care unit of a community hospital were retrospectively analyzed. The clavicular fracture cohort was first divided into two groups and then two subgroups: patients with/without shoulder dystocia and patients with/without a brachial plexus injury. Peripartum and neonatal risk factors of these patients were reviewed using the patient information system. Any additional neurological or musculoskeletal trauma was noted. A multivariate logistic regression analysis was performed to determine independent predictors of shoulder dystocia and brachial plexus injury. RESULTS A total of 46 patients with shoulder dystocia in 25 (54%) and brachial plexus injury in 12 (26%) were included in the study. The birth weight of patients with shoulder dystocia was 4,164.2±412.7 g, and that of patients without was 3,535.8±865.2 g (p=0.003). In 11 of 14 patients (44%) in whom labor was induced and whose infant had a fractured clavicle, the infant also had shoulder dystocia (p=0.029). Brachial plexus injury was found in 8 (66.7%) of 14 infants who were born by induced labor and who had a clavicular fracture (p=0.002). The regression analysis revealed that age and induction of labor were independent risk factors for brachial plexus injury (odds ratio=1.599 and 81.862, respectively). Gestational weight gain (p=0.003) and neonatal birth weight (p=0.047) were also found as independent risk factors for shoulder dystocia. CONCLUSION Evidence from this study has shown that not only birth age or birth weight but also excessive weight gain by mother and induction of labor may increase the risk of clavicula fracture with brachial plexus palsy. Advanced maternal age, multiparity, and deliveries after 39 weeks seem to be risk factors for a clavicular fracture with a brachial plexus injury. LEVEL OF EVIDENCE Level IV, Therapeutic study.
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Affiliation(s)
- Ali Erkan Yenigül
- Department of Orthopedics and Traumatology, Minister of Health Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey
| | - Nefise Nazlı Yenigül
- Department of Obstetrics and Gynecology, University of Health Sciences School of Medicine Şanlıurfa Mehmet Akif İnan Research and Training Hospital, Şanlıurfa, Turkey
| | - Emre Başer
- Department of Obstetrics and Gynecology, Bozok University, School of Medicine, Yozgat, Turkey
| | - Runa Özelçi
- Department of Obstetrics and Gynecology, University of Health Sciences School of Medicine Etlik Zübeyde Hanım Training and Research Hospital, Ankara, Turkey
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Omar N, Kokab F. Intellectual disability among special children and its associated factors: A case control study, Lahore Pakistan. J PAK MED ASSOC 2019; 69:684-689. [PMID: 31105288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To study the association of maternal, paternal and social factors with intellectual disability in special children.. METHODS The case-control study was conducted in four schools of Lahore, Pakistan, from September 2014 to September 2015, and comprised intellectually disabled children aged 6-15 years, and an equal number of matching healthy subjects. group. Interviews were conducted with the help of a pre-tested structured questionnaire. SPSS -17 was utilised to analyse the data. RESULTS Of the 298 participants, 149(50%) each were cases and controls. Overall, there were 83(56%) boys and 66(44%) girls. Significant association of intellectual disability was found with consanguinity (p=0.001), father's educational status (p=0.03), paternal history of mental retardation (p=0.01) and history of delayed cry (p=0.001). Breastfeeding (depicted a protective relationship (p=0.03). CONCLUSIONS Parental, social, environmental and familial causes contributed to intellectual disability among the subjects.
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Affiliation(s)
- Naureen Omar
- Community Health Sciences, FMH College of Medicine and Dentistry, Lahore
| | - Farkhanda Kokab
- Community Health Sciences, Amna Inayat Medical College, Lahore, Pakistan
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11
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Beck CT, Casavant S. Synthesis of Mixed Research on Posttraumatic Stress Related to Traumatic Birth. J Obstet Gynecol Neonatal Nurs 2019; 48:385-397. [PMID: 30958993 DOI: 10.1016/j.jogn.2019.02.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To synthesize mixed-research results (quantitative and qualitative) on posttraumatic stress in women who experienced traumatic births. DATA SOURCES PubMed, Scopus, and PsycINFO databases. STUDY SELECTION Quantitative and qualitative studies were included if they were published in English from January 1, 2009, through December 31, 2018, and focused on posttraumatic stress in the postpartum period related to traumatic childbirth. DATA EXTRACTION The final sample consisted of 59 studies: 4 qualitative and 55 quantitative. Both authors independently appraised each study using the Critical Appraisal Skills Programme. Quantitative studies were synthesized by narrative synthesis and vote counting, and qualitative studies were synthesized by content analysis. DATA SYNTHESIS In the included studies, prevalence rates of elevated posttraumatic stress ranged from 0.8% to 26%. Significant predictors of posttraumatic stress that occurred before childbirth and those that were birth related were identified. Reports of six intervention studies to decrease posttraumatic stress symptoms after traumatic births were included. These interventions focused on postnatal debriefing, expressive writing, online cognitive behavioral therapy, a brief cognitive intervention, and the implementation of the nine instinctive stages of the infant during the first hour after birth. We created four themes from the findings of the qualitative studies: Distressing Symptoms, Detrimental Effect of Posttraumatic Stress on Women's Relationships With Their Infants and Partners, Critical Influence ofSupport, and Debriefing. CONCLUSION When a woman experiences posttraumatic stress related to a traumatic birth, the entire family unit is vulnerable. Findings from quantitative predictor studies can be used to develop an instrument to screen women for risk factors for posttraumatic stress related to birth trauma. Primary interventions are needed to prevent women from experiencing traumatic births.
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Ross MG. Threshold of metabolic acidosis associated with newborn cerebral palsy: medical legal implications. Am J Obstet Gynecol 2019; 220:348-353. [PMID: 30529344 DOI: 10.1016/j.ajog.2018.11.1107] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/30/2018] [Accepted: 11/30/2018] [Indexed: 12/15/2022]
Abstract
Obstetricians and gynecologists belong to 1 of the medical specialties with the highest rate of litigation claims. Among birth injury cases, those cases with cerebral palsy outcomes account for litigation settlements or judgments often in the millions of dollars. In cases of potential perinatal asphyxia, a threshold level of metabolic acidosis (base deficit ≥12 mmol/L) is necessary to attribute neonatal encephalopathy to an intrapartum hypoxic event. With increasing duration or severity of a hypoxic stress resulting in metabolic acidosis, newborn infant umbilical artery base deficit increases. It may be alleged that, as base deficit levels increase beyond 12 mmol/L, there is an increased likelihood and severity of cerebral palsy. As a corollary, it may be claimed that an earlier delivery (by minutes) would reduce the base deficit and prevent or reduce the severity of cerebral palsy. This issue is of relevance to obstetricians as defendants, because retrospective "expert" analysis of cases may suggest that optimal management decisions would have resulted in an earlier delivery. In addressing the association of metabolic acidosis and cerebral palsy, base deficit should be measured as the extracellular component (base deficitextracellular fluid) rather than the commonly used base deficitblood. Studies suggest that, beyond the base deficit threshold of 12 mmol/L, the incidence and severity of cerebral palsy does not significantly increase (until ≥20 mmol/L), although the risk of neonatal death rises markedly. Thus, among most infants with hypoxia-associated neonatal encephalopathy, the occurrence of cerebral palsy is unlikely to be impacted by delivery time variation of few minutes, and this argument should not serve as the basis for medical legal claims.
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Affiliation(s)
- Michael G Ross
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Department of Obstetrics and Gynecology, Geffen School of Medicine at UCLA, Los Angeles, CA.
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Berry DC, Thomas SD, Dorman KF, Ivins AR, de los Angeles Abreu M, Young L, Boggess K. Rationale, design, and methods for the Medical Optimization and Management of Pregnancies with Overt Type 2 Diabetes (MOMPOD) study. BMC Pregnancy Childbirth 2018; 18:488. [PMID: 30541506 PMCID: PMC6292086 DOI: 10.1186/s12884-018-2108-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 11/20/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Annually in the US, over 100,000 pregnant women with overt type 2 diabetes give birth. Strict maternal glycemic control is the key to optimizing infant outcomes. Medical treatment of type 2 diabetes in pregnancy is generally restricted to insulin, as data on the safety and efficacy of oral hypoglycemic agents in pregnancy are limited. However, over one-third of infants born to women with type 2 diabetes experience an adverse outcome, such as premature delivery, large-for-gestational age, hypoglycemia, hyperbilirubinemia, or birth trauma, suggesting that current treatment regimens fall short of optimizing outcomes. Metformin is the pharmacologic treatment of choice for type 2 diabetes outside of pregnancy. Metformin is favored over insulin because it results in less weight gain, fewer hypoglycemic episodes, and is administered orally rather than injected. However, metformin is not typically used for treatment of type 2 diabetes complicating pregnancy, mainly because no large clinical studies have been conducted to examine its use in this context. METHODS/DESIGN This is a randomized double-blind multi-center clinical trial of insulin plus metformin versus insulin plus placebo for the treatment of type 2 diabetes complicating pregnancy. A total of 1200 women with type 2 diabetes will be randomized between 10 weeks 0 days' and 20 weeks 6 days' gestation and followed until 30 days after delivery. Neonate outcomes will be followed until 30 days of age. The primary aim is to compare the effect of insulin and metformin versus insulin and placebo on composite adverse neonatal outcomes, comprising perinatal mortality, preterm delivery, neonatal hypoglycemia, hyperbilirubinemia, large-for-gestational age small for gestational age, low birth weight, and/or birth trauma. Key secondary aims are to compare treatment groups for neonatal fat mass and rate of maternal hypoglycemia. Additional aims are to assess the side effects and safety of insulin and metformin among pregnant women with overt type 2 diabetes and to compare gestational weight gain among women treated with metformin plus insulin versus insulin alone. DISCUSSION Successful completion of this study will result in high-quality, contemporary evidence for management of overt type 2 diabetes complicating pregnancy to improve neonatal outcomes. TRIAL REGISTRATION NCT02932475 (05/17/2016).
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Affiliation(s)
- Diane C. Berry
- The University of North Carolina at Chapel Hill School of Nursing, Campus Box 7460, Chapel Hill, NC 27599-7460 USA
| | - Sonia Davis Thomas
- Department of Biostatistics, University of North Carolina, 137 E Rosemary St Suite 203, Chapel Hill, NC 27514 USA
| | - Karen F. Dorman
- The University of North Carolina at Chapel Hill School of Medicine, Campus Box 7516, Chapel Hill, NC 27599-7516 USA
| | - Amber Rose Ivins
- The University of North Carolina at Chapel Hill School of Medicine, Campus Box 7516, Chapel Hill, NC 27599-7516 USA
| | - Maria de los Angeles Abreu
- Department of Biostatistics, University of North Carolina, 137 E Rosemary St Suite 203, Chapel Hill, NC 27514 USA
| | - Laura Young
- The University of North Carolina at Chapel Hill School of Medicine, Campus Box 7516, Chapel Hill, NC 27599-7516 USA
| | - Kim Boggess
- The University of North Carolina at Chapel Hill School of Medicine, Campus Box 7516, Chapel Hill, NC 27599-7516 USA
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Johansen LT, Braut GS, Andresen JF, Øian P. An evaluation by the Norwegian Health Care Supervision Authorities of events involving death or injuries in maternity care. Acta Obstet Gynecol Scand 2018; 97:1206-1211. [PMID: 29806955 PMCID: PMC6175322 DOI: 10.1111/aogs.13391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/13/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION We aimed to determine how serious adverse events in obstetrics were assessed by supervision authorities. MATERIAL AND METHODS We selected cases investigated by supervision authorities during 2009-2013. We analyzed information about who reported the event, the outcomes of the mother and infant, and whether events resulted from errors at the individual or system level. We also assessed whether the injuries could have been avoided. RESULTS During the study period, there were 303 034 births in Norway, and supervision authorities investigated 338 adverse events in obstetric care. Of these, we studied 207 cases that involved a serious outcome for mother or infant. Five mothers (2.4%) and 88 infants (42.5%) died. Of the 207 events reported to the supervision authorities, patients or relatives reported 65.2%, hospitals reported 39.1%, and others reported 4.3%. In 8.7% of cases, events were reported by more than 1 source. The supervision authority assessments showed that 48.3% of the reported cases involved serious errors in the provision of health care, and a system error was the most common cause. We found that supervision authorities investigated significantly more events in small and medium-sized maternity units than in large units. Eighteen health personnel received reactions; 15 were given a warning, and 3 had their authority limited. We determined that 45.9% of the events were avoidable. CONCLUSIONS The supervision authorities investigated 1 in 1000 births, mainly in response to complaints issued from patients or relatives. System errors were the most common cause of deficiencies in maternity care.
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Affiliation(s)
| | - Geir Sverre Braut
- Stavanger University Hospital and Western Norway University of Applied SciencesStavangerNorway
| | | | - Pål Øian
- Department of Obstetrics and GynecologyFaculty of Health SciencesInstitute of Clinical MedicineThe University Hospital of North NorwayThe Arctic University of NorwayTromsøNorway
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Muraca GM, Lisonkova S, Skoll A, Brant R, Cundiff GW, Sabr Y, Joseph KS. Ecological association between operative vaginal delivery and obstetric and birth trauma. CMAJ 2018; 190:E734-E741. [PMID: 29914910 PMCID: PMC6008188 DOI: 10.1503/cmaj.171076] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Increased use of operative vaginal delivery (use of forceps, vacuum or other device) has been recommended to address high rates of cesarean delivery. We sought to determine the association between rates of operative vaginal delivery and obstetric trauma and severe birth trauma. METHODS We carried out an ecological analysis of term, singleton deliveries in 4 Canadian provinces (2004-2014) using data from the Canadian Institute for Health Information. The primary exposure was mode of delivery. The primary outcomes were obstetric trauma and severe birth trauma. RESULTS Data on 1 938 913 deliveries were analyzed. The rate of obstetric trauma was 7.2% in nulliparous women, and 2.2% and 2.7% among parous women without and with a previous cesarean delivery, respectively, and rates of severe birth trauma were 2.1, 1.7 and 0.7 per 1000, respectively. Each 1% absolute increase in rates of operative vaginal delivery was associated with a higher frequency of obstetric trauma among nulliparous women (adjusted rate ratio [ARR] 1.06, 95% confidence interval [CI] 1.05-1.06), parous women without a previous cesarean delivery (ARR 1.10, 95% CI 1.08-1.13) and parous women with a previous cesarean delivery (ARR 1.11, 95% CI 1.07-1.16). Operative vaginal delivery was associated with more frequent severe birth trauma, but only in nulliparous women (ARR 1.05, 95% CI 1.03-1.07). In nulliparous women, sequential vacuum and forceps instrumentation was associated with the largest increase in obstetric trauma (ARR 1.44, 95% CI 1.35-1.55) and birth trauma (ARR 1.53, 95% CI 1.03-2.27). INTERPRETATION Increases in population rates of operative vaginal delivery are associated with higher population rates of obstetric trauma, and in nulliparous women with severe birth trauma.
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Affiliation(s)
- Giulia M Muraca
- School of Population and Public Health (Muraca, Lisonkova, Joseph); Department of Obstetrics & Gynaecology (Muraca, Lisonkova, Skoll, Cundiff, Sabr, Joseph), University of British Columbia; BC Children's and Women's Hospital and Health Centre (Muraca, Lisonkova, Skoll, Brant, Cundiff, Joseph); Department of Statistics (Brant), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynaecology (Sabr), King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Sarka Lisonkova
- School of Population and Public Health (Muraca, Lisonkova, Joseph); Department of Obstetrics & Gynaecology (Muraca, Lisonkova, Skoll, Cundiff, Sabr, Joseph), University of British Columbia; BC Children's and Women's Hospital and Health Centre (Muraca, Lisonkova, Skoll, Brant, Cundiff, Joseph); Department of Statistics (Brant), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynaecology (Sabr), King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Amanda Skoll
- School of Population and Public Health (Muraca, Lisonkova, Joseph); Department of Obstetrics & Gynaecology (Muraca, Lisonkova, Skoll, Cundiff, Sabr, Joseph), University of British Columbia; BC Children's and Women's Hospital and Health Centre (Muraca, Lisonkova, Skoll, Brant, Cundiff, Joseph); Department of Statistics (Brant), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynaecology (Sabr), King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Rollin Brant
- School of Population and Public Health (Muraca, Lisonkova, Joseph); Department of Obstetrics & Gynaecology (Muraca, Lisonkova, Skoll, Cundiff, Sabr, Joseph), University of British Columbia; BC Children's and Women's Hospital and Health Centre (Muraca, Lisonkova, Skoll, Brant, Cundiff, Joseph); Department of Statistics (Brant), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynaecology (Sabr), King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Geoffrey W Cundiff
- School of Population and Public Health (Muraca, Lisonkova, Joseph); Department of Obstetrics & Gynaecology (Muraca, Lisonkova, Skoll, Cundiff, Sabr, Joseph), University of British Columbia; BC Children's and Women's Hospital and Health Centre (Muraca, Lisonkova, Skoll, Brant, Cundiff, Joseph); Department of Statistics (Brant), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynaecology (Sabr), King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Yasser Sabr
- School of Population and Public Health (Muraca, Lisonkova, Joseph); Department of Obstetrics & Gynaecology (Muraca, Lisonkova, Skoll, Cundiff, Sabr, Joseph), University of British Columbia; BC Children's and Women's Hospital and Health Centre (Muraca, Lisonkova, Skoll, Brant, Cundiff, Joseph); Department of Statistics (Brant), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynaecology (Sabr), King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - K S Joseph
- School of Population and Public Health (Muraca, Lisonkova, Joseph); Department of Obstetrics & Gynaecology (Muraca, Lisonkova, Skoll, Cundiff, Sabr, Joseph), University of British Columbia; BC Children's and Women's Hospital and Health Centre (Muraca, Lisonkova, Skoll, Brant, Cundiff, Joseph); Department of Statistics (Brant), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynaecology (Sabr), King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
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Schmitz T, Korb D, Battie C, Cordier AG, de Carne Carnavalet C, Chauleur C, Equy V, Haddad B, Lemercier D, Poncelet C, Rigonnot L, Goffinet F. Neonatal morbidity associated with vaginal delivery of noncephalic second twins. Am J Obstet Gynecol 2018; 218:449.e1-449.e13. [PMID: 29421604 DOI: 10.1016/j.ajog.2018.01.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/10/2018] [Accepted: 01/10/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Management of noncephalic second twin delivery rests on the results of population-based retrospective studies of twin births that have shown higher neonatal mortality and morbidity for second twins with noncephalic, compared with cephalic, presentations after vaginal delivery of the first twin. Because these studies are flawed by data of questionable validity, do not report the obstetrical practices at delivery, and do not allow collection of potential confounding variables, we performed a national prospective study specially designed to evaluate the management of twins' delivery. OBJECTIVE We sought to assess neonatal mortality and morbidity according to second twin presentation after vaginal birth of the first twin. STUDY DESIGN The Jumeaux Mode d'Accouchement study was a nationwide prospective population-based cohort study of twin deliveries performed in 176 maternity units in France from February 2014 through March 2015. The primary outcome was a composite of intrapartum mortality and neonatal mortality and morbidity. Neonatal outcomes of second twins born ≥32 weeks of gestation after vaginal delivery of the first cephalic or breech twin were compared according to the noncephalic or cephalic second twin presentation. Multivariable logistic regression models controlled for potential confounders. Subgroup analyses were conducted according to the breech or transverse presentation of the noncephalic second twin, and gestational age at delivery, before or after 37 weeks of gestation. RESULTS Among 3903 second twins enrolled in the study, 2384 (61.1%) were in cephalic and 1519 (38.9%) in noncephalic presentations, of whom 999 (25.6%) were in breech and 520 (13.3%) in transverse presentation. Composite neonatal mortality and morbidity did not differ between the noncephalic and cephalic group (47/1519 [3.1%] vs 59/2384 [2.5%]; adjusted odds ratio, 1.23; 95% confidence interval, 0.81-1.85). No significant difference between groups was shown for the primary outcome in subgroup analyses according to type of noncephalic second twin presentation or gestational age at delivery. Cesarean delivery rates for the second twin were lower in the breech than in the cephalic group (14/999 [1.4%] vs 75/2384 [3.1%], P = .003) and lower in the cephalic than in the transverse group (75/2384 [3.1%] vs 35/520 [6.7%], P < .001). CONCLUSION Noncephalic and cephalic second twin presentations after vaginal delivery of the first twin ≥32 weeks of gestation are associated with similar low composite neonatal mortality and morbidity. Vaginal delivery of noncephalic second twin is a reasonable option.
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Affiliation(s)
- Thomas Schmitz
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Service de Gynécologie Obstétrique, Paris, France; Université Paris Diderot, Paris, France; INSERM (Institut National de la Santé Et de la Recherche Médicale), U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Paris, France.
| | - Diane Korb
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Service de Gynécologie Obstétrique, Paris, France; Université Paris Diderot, Paris, France; INSERM (Institut National de la Santé Et de la Recherche Médicale), U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Paris, France
| | - Catherine Battie
- Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Service de Gynécologie Obstétrique, Bron, France
| | - Anne-Gaël Cordier
- Assistance Publique-Hôpitaux de Paris, Hôpital Antoine Béclère, Service de Gynécologie Obstétrique, Paris, France; Université Paris Sud, Le Kremlin Bicêtre, France
| | - Céline de Carne Carnavalet
- Assistance Publique-Hôpitaux de Paris, Hôpital Trousseau, Service de Gynécologie Obstétrique, Paris, France
| | - Céline Chauleur
- CHU (Centre Hospitalo-Universitaire) de Saint-Etienne, Service de Gynécologie Obstétrique, Saint-Etienne, France; Université Jean Monnet, Saint-Etienne, France
| | - Véronique Equy
- CHU de Grenoble, Service de Gynécologie Obstétrique, Grenoble, France
| | - Bassam Haddad
- Centre Hospitalier Intercommunal de Créteil, Service de Gynécologie Obstétrique, Créteil, France; Université Paris Est Créteil, Créteil, France
| | - Delphine Lemercier
- Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Service de Gynécologie Obstétrique, Paris, France
| | - Christophe Poncelet
- Hôpital René Dubos, Service de Gynécologie Obstétrique, Pontoise, France; Université Paris 13, Bobigny, France
| | - Luc Rigonnot
- Centre Hospitalier du Sud Francilien, Service de Gynécologie Obstétrique, Corbeil-Essonnes, France
| | - François Goffinet
- INSERM (Institut National de la Santé Et de la Recherche Médicale), U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Paris, France; Assistance Publique-Hôpitaux de Paris, Maternité Port-Royal, Paris, France; Université René Descartes, Paris, France; DHU Risques et Grossesse, Paris, France
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Wen Q, Muraca GM, Ting J, Coad S, Lim KI, Lisonkova S. Temporal trends in severe maternal and neonatal trauma during childbirth: a population-based observational study. BMJ Open 2018; 8:e020578. [PMID: 29500215 PMCID: PMC5855201 DOI: 10.1136/bmjopen-2017-020578] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/08/2018] [Accepted: 01/31/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Instrumental vaginal delivery is associated with birth trauma to infant and obstetric trauma to mother. As caesarean delivery rates increased during the past decades, the rate of instrumental vaginal delivery declined. We examined concomitant temporal changes in the rates of severe birth trauma and maternal obstetric trauma. DESIGN A retrospective observational study. SETTINGS AND PARTICIPANTS All hospital singleton live births in Washington State, USA, 2004-2013, excluding breech delivery. Severe birth trauma (brain, nerve injury, fractures and other severe birth trauma) and obstetric trauma (third/fourth degree perineal lacerations, cervical/high vaginal lacerations) were identified from hospitalisation data. Pregnancy and delivery characteristics were obtained from birth certificates. Temporal trends were assessed by the Cochran-Armitage test. Logistic regression was used to obtain adjusted ORs (AORs) and 95% CI. RESULTS Overall, 732 818 live births were included. The rate of severe birth trauma declined from 5.3 in 2004 to 4.5 per 1000 live births in 2013 (P<0.001). The decline was observed only in spontaneous vaginal delivery, the rates of fractures and other severe birth trauma declined by 5% and 4% per year, respectively (AOR: 0.95, 95% CI 0.94 to 0.97 and AOR: 0.96, 95% CI 0.93 to 0.99; respectively). The rate of third/fourth degree lacerations declined in spontaneous vaginal delivery from 3.5% to 2.3% (AOR: 0.95; 95% CI 0.94 to 0.95) and in vacuum delivery from 17.3% to 14.5% (AOR: 0.97, 95% CI 0.96 to 0.98). Among women with forceps delivery, these rates declined from 29.8% to 23.4% (AOR: 0.98, 95% CI 0.96 to 1.00). CONCLUSION While the rates of fractures and other birth trauma declined among infants delivered by spontaneous vaginal delivery, the rate of birth trauma remained unchanged in instrumental vaginal delivery and caesarean delivery. Among mothers, the rates of severe perineal lacerations declined, except for women with forceps delivery.
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Affiliation(s)
- Qi Wen
- BC Children's Hospital Research Institute, Children's Hospital, Vancouver, Canada
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, Canada
| | - Giulia M Muraca
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
- Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Joseph Ting
- Department of Pediatrics, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada
| | - Sarah Coad
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
- Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada
| | - Kenneth I Lim
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
- Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada
| | - Sarka Lisonkova
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
- Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Casellas-García G, Cavanilles-Walker JM, Albertí-Fitó G. Clavicular fracture in the newborn: Is fracture location a risk factor for obstetric brachial palsy? J Neonatal Perinatal Med 2018; 11:61-64. [PMID: 29689744 DOI: 10.3233/npm-181728] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The incidence of clavicle fracture in the newborn population ranges from 0.2 to 3.5% with an associated rate of obstetric brachial palsy (OBP) ranging from 4 to 13% . METHODS The aim of this study was to describe the anatomical location of the fracture in the clavicle and its possible correlation with OBP. We retrospectively reviewed all perinatal clavicle fractures diagnosed at our institution over thirteen years. RESULTS A total of 155 clavicle fractures were identified among 23508 live newborns representing an incidence of 0.67% . Fracture location was categorized according to the Allman classification. The most frequent location was the mid-shaft (Allman I) (92.90%), followed by the medial third (Allman III) (5.81%) and finally by the lateral third (Allman II) (1.29%). 17 cases had an associated OBP (10.97%). 13 of these cases (76.47%) involved the medial third, 4 involved the midshaft (23.53%) whilst none of the cases with a clavicle fracture involving the lateral third was associated to OBP. We could determine a significant association between the occurrence of OBP and fracture of the clavicle medial third (Allman type III) (p < 0.05). CONCLUSIONS To the best of our knowledge this is the first study describing the anatomical location of the fracture in the clavicle and its possible association with OBP. A fracture involving the medial clavicle third in a newborn might alert of the possible event of OBP. Nevertheless, more studies with larger samples will be necessary to confirm these results.
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Santos P, Hefele JG, Ritter G, Darden J, Firneno C, Hendrich A. Population-Based Risk Factors for Shoulder Dystocia. J Obstet Gynecol Neonatal Nurs 2017; 47:32-42. [PMID: 29221671 DOI: 10.1016/j.jogn.2017.11.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To re-examine the risk factors for shoulder dystocia given the increasing rates of obesity and diabetes in pregnant women. DESIGN Retrospective observational study. SETTING Five hospitals located in Wisconsin, Florida, Maryland, Michigan, and Alabama. PARTICIPANTS We evaluated 19,236 births that occurred between April 1, 2011, and July 25, 2013. METHODS Data were collected from electronic medical records and used to evaluate the risk of shoulder dystocia. Data were analyzed using a generalized linear mixed model, which controlled for clustering due to site. RESULTS When insulin was prescribed, gestational diabetes was associated with an increased risk of shoulder dystocia (odds ratio = 2.10, 95% confidence interval [1.01, 4.37]); however, no similar association was found with regard to gestational diabetes treated with glycemic agents or through diet. Use of epidural anesthesia was associated with an increased risk for shoulder dystocia (odds ratio = 3.47, 95% confidence interval [2.72, 4.42]). Being Black or Hispanic, being covered by Medicaid or having no insurance, infant gestational age of 41 weeks or greater, and chronic diabetes were other significant risk factors. CONCLUSION With the changing characteristics of pregnant women, labor and birth clinicians care for more pregnant women who have an increased risk for shoulder dystocia. Our findings may help prospectively identify women with the greatest risk.
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Salman L, Aviram A, Krispin E, Wiznitzer A, Chen R, Gabbay-Benziv R. Adverse neonatal and maternal outcome following vacuum-assisted vaginal delivery: does indication matter? Arch Gynecol Obstet 2017; 295:1145-1150. [PMID: 28324223 DOI: 10.1007/s00404-017-4339-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/28/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE To estimate the impact of indication for vacuum-assisted vaginal delivery on neonatal and maternal adverse outcome. METHODS Retrospective analysis of women carrying singleton-term pregnancies undergoing vacuum-assisted vaginal delivery in a tertiary hospital (2007-2014). Cohort was stratified by indication: non-reassuring fetal heart rate or prolonged second stage. Primary outcome was adverse neonatal outcome and secondary outcome was maternal morbidity. Logistic regression analysis was utilized to adjust for potential confounders. RESULT Overall, 4931 women met inclusion criteria. Delivery indication was prolonged second stage in 3143 (64%) cases and non-reassuring fetal heart rate in 1788 (36%). In the non-reassuring fetal heart rate group, there were higher rates of cephalohematoma, low 5-min Apgar-score, and asphyxia. In the prolonged second-stage group, there were higher rates of sepsis and post-partum hemorrhage. Composite neonatal birth trauma and maternal morbidity were higher for vacuum-assisted vaginal delivery following prolonged second stage. Following adjustment for confounders cephalohematoma (aOR 1.21, 95% CI 1.04-1.41), low 5-min Apgar-score (aOR 2.91, 95% CI 1.26-4.67) and asphyxia (aOR 1.81 95% CI 1.35-2.44) remained significant in the non-reassuring fetal heart rate group and neonatal sepsis remained significant for the prolonged second-stage group (aOR 1.77, 95% CI 1.38-2.27), p < 0.05 for all. However, there was no longer difference in the composite birth trauma, other neonatal or maternal morbidity. CONCLUSION The indication for vacuum-assisted vaginal delivery has an impact on neonatal outcome. While cephalohematoma, low 5' Apgar score, and asphyxia were more common in the non-reassuring fetal heart rate group, neonatal sepsis was more common in cases of prolonged second stage of labor.
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Affiliation(s)
- Lina Salman
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Aviram
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Krispin
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Wiznitzer
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rony Chen
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rinat Gabbay-Benziv
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, 49100, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Barsaoui M, Safi H, Said W, Nessib MN. Nerve surgery in obstetric brachial plexus palsy, report of 68 cases. Tunis Med 2017; 95:196-200. [PMID: 29446814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Obstetric brachial plexus palsy aredue to elongation of the brachial plexus during delivery by increasing thedistance between the head and shoulder. The majority of paralysis recoverspontaneously, but in some cases, nerve repair is necessary. The timing of thisnerve surgery and criteria for its indication are topics of discussion in theworld literature.The aim of this study is to askdirections and to evaluate the contribution of nerve surgery in improving theprognosis of this disease. METHODS This is a retrospective study thathas interested 68 cases of obstetric brachial plexus palsy who needs a nerverepair, collected over a 8 year-period (2004 - 2011). We analyzed the musclequotes and evaluate the functions of the shoulder, elbow and hand pre and postoperative. A minimum 12 months'follow-up was observed. RESULTS Seventy-eight patients werecollected, 33 boys and 35 girls with a 62 days mean age at first consultationand a mean birth weight of 4187 grams . The presentation was cephalic in 66 cases. Theright side was interested in 66%. Clinically, we reported 50% of total brachialplexus palsy and 50% of C5-C6 palsy.The mean age at time of surgery was 9 months 10 days. Preoperatively, the shoulder was listed 0 or 1 according to Gilbert classification in 70% of cases in the C5-C6 plasy and 90% of the total brachial palsy. After a mean follow up of 30 months, the rate was respectively 9% and 15%. In 75% of cases of total brachial palsy, the hand was listed 0 according to Raimondi scale, while in postoperative, 65% of cases, the hand was listed 2 and 3 according to Raimondi scale. Nerve rupture was the predominant lesion on the C5 and C6 root while fibrosis was predominant on C7, C8 and T1 roots. We noted 6 complications including respiratory distress. CONCLUSIONS The nerve repair should not beperformed too early or too late. Too soon, we may operate those who can have aspontaneous recovery. Too late, the installation of the degeneration of motorendplates and muscle atrophy render unnecessary nerve repair. The absence ofbiceps clinical recovery in the 6th month of life and the presence of root-wrenching signs represented the absolute surgical indications. Its results areencouraging and improve functional outcome.
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Sienas LE, Hedriana HL, Wiesner S, Pelletreau B, Wilson MD, Shields LE. Decreased rates of shoulder dystocia and brachial plexus injury via an evidence-based practice bundle. Int J Gynaecol Obstet 2017; 136:162-167. [PMID: 28099737 PMCID: PMC5245184 DOI: 10.1002/ijgo.12034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 09/16/2016] [Accepted: 11/03/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate whether a standardized approach to identify pregnant women at risk for shoulder dystocia (SD) is associated with reduced incidence of SD and brachial plexus injury (BPI). METHODS Between 2011 and 2015, prospective data were collected from 29 community-based hospitals in the USA during implementation of an evidence-based practice bundle, including an admission risk assessment, required "timeout" before operative vaginal delivery (OVD), and low-fidelity SD drills. All women with singleton vertex pregnancies admitted for vaginal delivery were included. Rates of SD, BPI, OVD, and cesarean delivery were compared between a baseline period (January 2011-September 2013) and an intervention period (October 2013-June 2015), during which there was a system-wide average bundle compliance of 90%. RESULTS There was a significant reduction in the incidence of SD (17.6%; P=0.028), BPI (28.6%; P=0.018), and OVD (18.0%; P<0.001) after implementation of the evidence-based practice bundle. There was a nonsignificant reduction in primary (P=0.823) and total (P=0.396) cesarean rates, but no association between SD drills and incidence of BPI. CONCLUSION Implementation of a standard evidence-based practice bundle was found to be associated with a significant reduction in the incidence of SD and BPI. Utilization of low-fidelity drills was not associated with a reduction in BPI.
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Affiliation(s)
- Laura E. Sienas
- Department of Obstetrics and Gynecology, University of California Davis, Sacramento, CA, USA
| | - Herman L. Hedriana
- Department of Obstetrics and Gynecology, University of California Davis, Sacramento, CA, USA
- Sacramento Maternal-Fetal Medicine Medical Group, Sacramento, CA, USA
| | | | | | - Machelle D. Wilson
- Department of Obstetrics and Gynecology, University of California Davis, Sacramento, CA, USA
| | - Laurence E. Shields
- Patient Safety, Dignity Health, San Francisco, CA, USA
- Maternal-Fetal Medicine, Marian Regional Medical Center, Santa Maria, CA, USA
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Gudu W, Abdulahi M. LABOR, DELIVERY AND POSTPARTUM COMPLICATIONS IN NULLIPAROUS WOMEN WITH FEMALE GENITAL MUTILATION ADMITTED TO KARAMARA HOSPITAL. Ethiop Med J 2017; 55:11-17. [PMID: 29148634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To assess labor, delivery and postpartum complications in nulliparous women with FGM/C and evaluate the attitude of mothers towards elimination of FGM. METHODS A prospective hospital based study using structured questionnaire was conducted between January to March 2015 at Karamara hospital, Jijiga, Ethiopia. All nulliparous women admitted for labor and delivery were included. Data were collected regarding circumcision status, events of labor, delivery; postpartum and neonatal outcomes as well as attitude of mothers towards elimination of FGM/C. RESULTS Two hundred sixty four (92.0%) of the women had FGM/C with most (93.0%) undergoing Type III FGM. The mean age of the women was 22 yr. Failure to progress in 1st stage and prolonged 2nd stage of labor occurred in 165 (57.0%) and189 (65.6%) of the cases respectively. Caesarean section was performed in 17.0% and instrumental delivery in 23.0%. 64.5% required episiotomies, 83.3% had an anterior episiotomy, 29 % had perineal tears, 25.7%% experienced post-partum hemorrhage and 24% postpartum infection. Among the newborns, there were 6.4% perinatal deaths; 18.8 % low birth weight and 1.5% birth injuries. Almost all complications were more frequently seen in circumcised compared to non-circumcised women. CONCLUSIONS The prevalence of FGM is high and it substantially increases the risk of many maternal complications. Health professionals should be aware of these complications and support/care of women with FGM should be integrated at all levels of reproductive health care provision. Capacity building of responsible health professional should be initiated in the area with intensification of FGM eradication activities.
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Abstract
OBJECTIVE To compare neonatal outcomes (including breastfeeding (BF) initiation) of 170 macrosomic IDM with that of 739 macrosomic nIDM. DESIGN/METHODS Retrospective cohort investigation of all macrosomic infants born consecutively over a four-year period (2008-2011). Macrosomic (birth weight ≥4000 g) IDM included 100 infants whose mothers had gestational diabetes and 70 whose mothers had pregestational diabetes. RESULTS IDM were more likely to be delivered by cesarean to obese women while nIDM were more likely to be delivered vaginally to younger women with a higher level of education. Ethnic distribution (60% white, 20% black, 10% Hispanic and 10% Asian or African) was similar in each group. Forty-nine percent of IDM and 7% of nIDM required NICU admission. Respiratory disorders (mainly TTNB) affected 21% of IDM and 3% of nIDM while hypoglycemia was observed in 36% of IDM and 15% of nIDM. Of the 35 IDM delivered vaginally, 10 were complicated by shoulder dystocia without injury. Conversely, 70 of the 458 nIDM delivered vaginally experienced shoulder dystocia that resulted in 6 limb fractures and 3 brachial plexus injuries. On arrival to labor and delivery, 75% of all women intended to BF; however, at the time of discharge, 65% of women with diabetes and 92% of those without diabetes who intended to BF had initiated BF. CONCLUSIONS Both macrosomic IDM and macrosomic nIDM are at risk for significant morbidities. Macrosomic IDM carry a higher risk for NICU admissions, leading to maternal-infant separation, and lower BF initiation rates.
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Abstract
OBJECTIVE Many protocols diagnose gestational diabetes mellitus (GDM) solely on a 1-hour glucose challenge test (GCT) ≥ 200 mg/dL. However, pregnancy outcomes in these women compared with women diagnosed with a 3-hour glucose tolerance test (GTT) has not been adequately evaluated. We hypothesize that a 1-hour GCT ≥ 200 mg/dL is associated with worse pregnancy outcomes as compared with a GCT 135 to 199 mg/dL with positive GTT. STUDY DESIGN A retrospective cohort of singleton pregnancies complicated by GDM. Maternal outcomes included A2DM, preeclampsia, primary cesarean, and failed trial of labor after cesarean. Perinatal outcomes were large/small for gestational age, shoulder dystocia, and birth injury. Groups were compared with t-test and chi-square test, and logistic regression to adjust for confounders. RESULTS A total of 602 women diagnosed with GDM by 1-hour GCT 135 to 199 mg/dL and confirmatory 3-hour GTT (< 200 group) and 225 women diagnosed with 1-hour GCT ≥ 200 alone (≥ 200) were included. The ≥ 200 group had a higher incidence of preeclampsia (16.4 vs. 10.6%) and shoulder dystocia (3.1 vs. 1.0%). Adjusted odds ratio and 95% confidence interval were 1.80 (1.10-2.94) and 5.10 (1.25-20.76), respectively. CONCLUSION Preeclampsia and shoulder dystocia are more frequent in women with GCT ≥ 200 mg/dL than those with a positive GTT following a GCT of 135 to 199 mg/dL.
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Affiliation(s)
- Nana-Ama Ankumah
- Center of Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alan T N Tita
- Center of Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Joseph R Biggio
- Center of Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lorie M Harper
- Center of Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
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Popowski T, Porcher R, Fort J, Javoise S, Rozenberg P. Influence of ultrasound determination of fetal head position on mode of delivery: a pragmatic randomized trial. Ultrasound Obstet Gynecol 2015; 46:520-525. [PMID: 25583399 DOI: 10.1002/uog.14785] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 01/01/2015] [Accepted: 01/02/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate the influence of ultrasound determination of fetal head position on mode of delivery. METHODS This was a pragmatic open-label randomized controlled trial that included women with a singleton pregnancy in the vertex presentation at ≥ 37 weeks' gestation, cervical dilation ≥ 8 cm and who received epidural anesthesia. Women were assigned randomly to undergo either digital vaginal examination (VE group) or both digital vaginal and ultrasound examinations (VE+US group) to determine fetal head position. When the ultrasound and digital vaginal findings were inconsistent in the VE+US group, the ultrasound result was used for clinical management. The primary outcome assessed was operative delivery (Cesarean or instrumental vaginal delivery), and maternal and fetal morbidity were also assessed. RESULTS The VE and VE+US groups included 959 and 944 women, respectively. The overall rate of operative delivery was significantly higher in the VE+US group than in the VE group: 33.7% vs 27.1%, respectively (relative risk (RR), 1.24 (95% CI, 1.08-1.43)), as was the rate of Cesarean delivery: 7.8% vs 4.9%, respectively (RR, 1.60 (95% CI, 1.12-2.28)). The rate of instrumental vaginal delivery was also higher, albeit not significantly: 25.8% in the VE+US group vs 22.2% in the VE group (RR, 1.16 (95% CI, 0.99-1.37)). Neonatal outcomes did not differ between the two groups. When analysis was restricted to instrumental vaginal deliveries only, maternal and neonatal morbidity outcomes were similar in both groups. CONCLUSION Correction of fetal occiput position, determined initially by digital vaginal examination, using systematic ultrasound examination did not improve management of labor and increased the rate of operative delivery without decreasing maternal and neonatal morbidity.
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Affiliation(s)
- T Popowski
- Department of Obstetrics and Gynecology, Poissy-St-Germain Hospital, Poissy, France
| | - R Porcher
- Department of Biostatistics, Saint-Louis Hospital, UMR-S 717 Paris Diderot University and INSERM, Paris, France
| | - J Fort
- Department of Obstetrics and Gynecology, Poissy-St-Germain Hospital, Poissy, France
| | - S Javoise
- Department of Obstetrics and Gynecology, Poissy-St-Germain Hospital, Poissy, France
| | - P Rozenberg
- Department of Obstetrics and Gynecology, Poissy-St-Germain Hospital, Poissy, France
- EA7285, Versailles Saint-Quentin University (UVSQ), France
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Abstract
OBJECTIVE To describe neonatal complications related to shoulder dystocia. METHODS This systematic evidence review is based on PubMed search, Cochrane library and experts' recommendations. RESULTS The risks of brachial plexus birth injury, clavicle and humeral fracture, perinatal asphyxia, hypoxic-ischemic encephalopathy and perinatal mortality are increased after shoulder dystocia. The medical team should be able to provide neonatal resuscitation in the delivery room in case of perinatal asphyxia following shoulder dystocia, according to national and international guidelines. The initial clinical examination should search for complications such as brachial plexus birth injury or clavicle fracture. CONCLUSION The risk of perinatal complications is increased in newborn after shoulder dystocia. The medical team should be able to manage these complications.
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Affiliation(s)
- E Lopez
- Réanimation néonatale, hôpital Clocheville, CHU de Tours, 49, boulevard Béranger, 37044 Tours cedex 9, France.
| | - B de Courtivron
- Chirurgie orthopédique pédiatrique, hôpital Clocheville, CHU de Tours, 49, boulevard Béranger, 37044 Tours cedex 9, France
| | - E Saliba
- Réanimation néonatale, hôpital Clocheville, CHU de Tours, 49, boulevard Béranger, 37044 Tours cedex 9, France
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Dutta P, Gupta P, Singh P, Modi M, Srinivasan A, Mukherjee S, Rai A, Saini H, Sukhija JS, Bansal R, Bhansali A, Mukherjee KK. Extra-Pituitary Birth Defects May Predict Diagnosis of Congenital Hypopituitarism in a Short Child. J Assoc Physicians India 2015; 63:28-36. [PMID: 27604433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Extra-pituitary birth defect (EPBD) in children with congenital hypopituitarism is largely unknown. OBJECTIVE The study aims to evaluate the incidence and pattern of EPBD in children with congenital hypopituitarism and to evaluate whether it can serve as a clue to diagnose this condition. PATIENTS AND METHODS Retrospective analysis of hospital record of patients of short stature due to various etiology from which patients with congenital hypopituitarism with age ≥18 years were recruited for the analysis. Clinical, hormonal, radiological and ocular electrophysiological studies were done in all patients and all EPBD were noted. RESULTS Twenty seven patients (79%) had multiple pituitary hormone deficiency (MPHD) of which growth hormone was universal followed by gonadotropin (62%), TSH (59%), ACTH (44%) and prolactin (12%). Nineteen patients (56%) had multiple EPBD in various combinations. Twenty three ocular abnormalities were present in 12 patients (35%). Nine patients (26%) had other associated EPBD along with ocular abnormalities while 3 had ocular abnormalities without any other associated birth defect. Skeletal defects were present in 10 patients (29.5%). On the contrary, 5 patients in the EPBD group had total 15 visual defects. The most common abnormality of the visual system were abnormal visual evoke response (VER, 18%), followed by strabismus (15%), visual acuity (VA, 12%), electroretinogram (ERG) and electrooculogram (EOG) 8% each and visual field defect 6%. There was a trend towards early age at presentation with EPBD. CONCLUSIONS Presence of EPBD in a short child is a sensitive marker to diagnose congenital hypopituitarism. Subtle abnormalities of visual pathway without absent septum pellucidum or midline brain defects were common.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Kanchan Kumar Mukherjee
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh
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Parkash A, Haider N, Khoso ZA, Shaikh AS. Frequency, causes and outcome of neonates with respiratory distress admitted to Neonatal Intensive Care Unit, National Institute of Child Health, Karachi. J PAK MED ASSOC 2015; 65:771-775. [PMID: 26160089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To determine the frequency, aetiology and outcome of respiratory distress in neonates in intensive care unit. METHODS The descriptive cross-sectional study was conducted at the Neonatal Intensive Care Unit, National Institute of Child Health, Karachi, from October 2009 to March 2010. It comprised neonates aged day 0 to 28 who were admitted to Neonatal Intensive Care Unit. The neonates were screened first for respiratory distress and presence of one or more signs and symptoms. History, examination and investigations were carried out to find out various aetiologies of respiratory distress. Outcome was measured in terms of discharge and death. Data was analysed using SPSS12. RESULTS Of the 205 neonates in the study, 120(58.6%) were boys and 85(41.4%) were girls The overall mean age was 70.58±110.02 hours and the mean gestational age was 36.32±2.72 weeks while the mean weight was 2.41±2.4kg. Respiratory rate >60/min was found in all (100%) the neonates. In terms of signs and symptoms, 125(60.9%) had grunting, 205(100%) had subcostal retractions and nasal flaring, and 81(40%) had cyanosis. The aetiologies observed were birth asphyxia, sepsis, transient tachypnoea of the newborn, pneumonia, meconium aspiration syndrome and respiratory distress syndrome in 22(10.75%), 37(18.05%), 29(14.1%), 36(17.6%), 34(16.7%) and 47(23.0%) neonates respectively. The incidence of neonates with respiratory distress was 68(33.3%). CONCLUSIONS The frequency of respiratory distress among the neonates was high, while mortality was high in neonates with respiratory distress, especially in pre-term and low birthweight neonates. Early diagnosis and management is important for better outcome.
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Affiliation(s)
- Arit Parkash
- Department of Paediatrics and Child Health, NICH, Karachi
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Abstract
BACKGROUND Reduced cortical gray-matter volume is commonly observed in patients with psychosis. Cortical volume is a composite measure that includes surface area, thickness and gyrification. These three indices show distinct maturational patterns and may be differentially affected by early adverse events. The study goal was to determine the impact of two distinct obstetrical complications (OCs) on cortical morphology. METHOD A detailed birth history and MRI scans were obtained for 36 patients with first-episode psychosis and 16 healthy volunteers. RESULTS Perinatal hypoxia and slow fetal growth were associated with cortical volume (Cohen's d = 0.76 and d = 0.89, respectively) in patients. However, the pattern of associations differed across the three components of cortical volume. Both hypoxia and fetal growth were associated with cortical surface area (d = 0.88 and d = 0.72, respectively), neither of these two OCs was related to cortical thickness, and hypoxia but not fetal growth was associated with gyrification (d = 0.85). No significant associations were found within the control sample. CONCLUSIONS Cortical dysmorphology was associated with OCs. The use of a global measure of cortical morphology or a global measure of OCs obscured important relationships between these measures. Gyrification is complete before 2 years and its strong relationship with hypoxia suggests an early disruption to brain development. Cortical thickness matures later and, consistent with previous research, we found no association between thickness and OCs. Finally, cortical surface area is largely complete by puberty and the present results suggest that events during childhood do not fully compensate for the effects of early disruptive events.
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Affiliation(s)
- G N Smith
- Department of Psychiatry,University of British Columbia,Vancouver,Canada
| | - A E Thornton
- Department of Psychology,Simon Fraser University,Burnaby,Canada
| | - D J Lang
- Department of Radiology,University of British Columbia,Vancouver,Canada
| | - G W MacEwan
- Department of Psychiatry,University of British Columbia,Vancouver,Canada
| | - L C Kopala
- Department of Psychiatry,University of British Columbia,Vancouver,Canada
| | - W Su
- Department of Psychiatry,University of British Columbia,Vancouver,Canada
| | - W G Honer
- Department of Psychiatry,University of British Columbia,Vancouver,Canada
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Adegbola O, Habeebu-Adeyemi FM. Fetal Macrosomia at a Tertiary Care Centre in Lagos, Nigeria. Nig Q J Hosp Med 2015; 25:90-94. [PMID: 27295826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Large babies have attracted immense attention as they present obstetric problems with associated increase in perinatal morbidity and mortality. The major risk of fetal macrosomia is trauma to the fetus and mother during vaginal delivery. OBJECTIVE To compare the outcome of macrosomic babies with babies of normal birth weights. METHODS This was a retrospective comparative study of deliveries over a period of two years from 1 "August 2005 to 31st July 2007. RESULTS There were 198 macrosomic babies (6.9%) out of a total of 2,879 deliveries that occurred within the study period. Majority of the mothers were multiparous; para 2 to 4 (47.5% in the study group and 33.7% in the control group). Emergency Caesarean Section (EMCS) rate in the study group was 44.4% while it was 25.3% in the control group and this was statistically significant (p value <0.001). In this study the maternal injuries in the study group were not significantly higher than the control group. The fetal morbidity and mortality in the study group was significantly higher than the control group both with p values <0.001. CONCLUSION Fetal macrosomia is associated with high morbidity and mortality in this centre, there is a need to identify pregnant women at risk as well as adequate counseling of possible interventions and outcomes.
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Wang X, He Y, Zhong M, Wang Z, Fan S, Liu Z, Fan S, Chen D. [Multicenter analysis of risk factors and clinical characteristics of shoulder dystocia]. Zhonghua Fu Chan Ke Za Zhi 2015; 50:12-16. [PMID: 25877418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To explore the risk factors and clinical characteristics of shoulder dystocia. METHODS The data of 44 580 single pregnancy and full-term head delivery were colleceted in the Third Affiliated Hospital of Guangzhou Medical University, Nanfang Hospital, Shenzhen Nanshan Hospital, Peking University Shenzhen Hospital and Yue Bei People's Hospital from January 2008 to September 2013. Totally 116 cases of shoulder dystocia were defined as the shoulder dystocia group, and the others were in the control group. The clinical data of the two groups were analyzed retrospectively, including the maternal age, maternal height, pre-gestational body mass index, weight gain during pregnancy, gestational weeks, gravidity, parity, fundal height, fetal abdominal perimeter, shoulder dystocia medical history, macrosomia, gestational diabetes mellitus, pre-gestational diabetes mellitus, post-term pregnancy and the condition of labor stages. RESULTS (1) The incidence of shoulder dystocia was 0.260% (116/44 580). The maternal age, pre-gestational body mass index and weight gain during pregnancy in the shoulder dystocia group were higher than those in the control group (all P < 0.01). While the maternal height, gestational weeks, gravidity, parity, fundal height, abdominal circumference in the two groups had no significant difference (all P > 0.05). (2) In the shoulder dystocia group, the incidence of shoulder dystocia medical history (11.21%, 13/116), macrosomia (13.79% , 16/116), pre-gestational diabetes mellitus (7.76% , 9/116), post-term pregnancy (10.34%, 12/116), prolongation of maximum acceleration phase (8.62%, 10/116) and prolongation of second labor stage (7.76%, 9/116) were different from those in the control group[1.43% ( 636/44 464), 1.48% (658/ 44 464), 0.57% ( 252/44 464), 1.15% (513/44 464),0.72% (322/44 464), 0.65% (289/44 464), respectively; all P < 0.05]. (3) Logistic regression analysis showed that the risk factors of shoulder dystocia were maternal age over thirty-five years (OR = 1.116, 95%CI: 1.022-2.445), pre-gestational body mass index more than 27 kg/m(2) (OR = 1.893, 95% CI: 1.358-2.228), weight gain more than 20 kg during pregnancy (OR = 2.031, 95% CI: 1.749-3.231), shoulder dystocia medical history (OR = 2.138, 95%CI:1.564-3.853), macrosomia (OR = 3.276, 95% CI:2.315- 4.638), pre-gestational diabetes mellitus (OR = 3.261, 95% CI:2.237- 4.943), post-term pregnancy (OR = 1.473, 95% CI:1.003-2.721), prolongation of the maximum acceleration phase (OR = 2.022, 95% CI:1.681- 3.732), prolongation of second labor stage(OR = 1.943, 95% CI:1.285- 3.215). CONCLUSION Maternal age over thirty-five years old, pre-gestational body mass index more than 27 kg/m(2), weight gain more than 20 kg during pregnancy, shoulder dystocia medical history, macrosomia, pre-gestational diabetes mellitus, post-term pregnancy, prolongation of the maximum acceleration phase, and prolongation of second labor stage are risk factors and clinical characteristics of shoulder dystocia.
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Affiliation(s)
- Xiaoyi Wang
- Department of Gynecology and Obstetrics, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China
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Li N, Li Q, Chang L, Liu C. [Risk factors and clinical prediction of shoulder dystocia in non-macrosomia]. Zhonghua Fu Chan Ke Za Zhi 2015; 50:17-21. [PMID: 25877419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the risk factors, clinical prediction and intrapartum management of shoulder dystocia in non-macrosomia. METHODS Totally 7 811 cases of vaginal delivery were retrospectively reviewed from Juanary 2009 to December 2013 in Shengjing Hospital. Shoulder dystocia was found in 11 cases (0.14% , 11/7 811), including 1 case of macrosomia and 10 cases of non-macrosomia (shoulder dystocia group). Each non-macrosomia shoulder dystocia case was matched with 10 cases of normal delivery in the same week, which were selected randomly as the control group. The tendency and risk factors of shoulder dystocia in macrosomia and non-macrosomia were analyzed, and the following data between the two groups were compared, including the height of uterus fundus, abdominal circumference of the pregnant woman, the increasing of body mass index (BMI), fetal biparietal diameter (BPD), fetal femur length (FL), duration of every stage of labor, birth weight of the newborn, head circumference and chest circumference of the newborn, Apgar score. RESULTS (1) There were 213 macrosomias among the 7 811 vaginal deliveries, with the incidence of 2.73% (213/7 811). Only 1 shoulder dystocia was macrosomia (0.46%, 1/213); while the other 10 cases were non-macrosomia ( 0.13%, 10/7 598). (2) From 2009 to 2013, the macrosomia happened by 24 cases (2.32%, 24/1 034), 42 cases (3.61%, 42/1 164), 46 cases (2.60%, 46/1 772), 62 cases (3.01%, 62/2 060), 39 cases (2.19%, 39/1781), respectively. The incidence of macrosomia had no significant difference among these 5 years (P > 0.05). The shoulder dystosia occurrence without macrosia in these 5 years were 1 case ( 0.10% , 1/1 034), 3 cases (0.26%, 3/1 164), 2 cases ( 0.11%, 2/1 172), 2 cases (0.10%, 2/2 060), 2 cases ( 0.11%, 1/1 781), respectively. The incidence of shoulder dystocia without macrosomia had no significant difference among these 5 years (P > 0.05). (3) In the should dystocia group, 5 cases were complicated with premature rupture of membrane (5/10), 4 cases were mother≥ 35 years old (4/10), 3 cases were multipara(3/10), 3 cases had gestational diabetes mellitus(3/10), 3 cases were occiput posterior during the first stage of labor (3/10), 3 cases had prolonged second stage of labor (3/10) and 6 cases had routine lateral incision (6/10). In the control group, 3 cases were complicated with premature rupture of membrane(3/10); 1 case was mother≥35 years old (1/10); 2 cases were multipara(2/10), 3 cases had gestational diabetes mellitus (3/10), 1 case had prolonged second stage (1/10) and 7 cases had routine lateral incision (7/10). (4) There were no significant difference in the height of uterus fundus, BMI, BPD, FL, and duration of the first stage of labor between the shoulder dystocia group and the control group (P > 0.05). Compared with the control group, the increasing of BMI [(6.8±3.1) vs (4.8±1.4) kg/m(2)], the time of the second stage of labor[(86±65) vs (38±28) minutes ] and abdominal circumference[(108±8) vs (101±7) cm] were significantly higher in the shoulder dystosia group (P < 0.05). (5) There were significant difference in the chest circumference of the newborn [(34.0±1.6) vs (32.2±1.9) cm ] and the ratio of chest circumference to head circumference of the newborn [(0.99±0.03) vs (0.97±0.03) ] between the two groups (P < 0.05). The 1-minute Apgar score of the newborn (7.4±2.8) was significantly lower than the control group (10.0±0.0) (P < 0.01). Clavicular fracture occurred in 3 newborns and brachial plexus injury occurred in 4 newborns in the shoulder dystosia group. CONCLUSION It is difficult to predict shoulder dystocia in non-macrosomia. Shoulder dystocia of non-macrosomia could be predicted by measurement of the head circumference, chest circumference, the ratio of chest circumference to head circumference by using prenatal ultrasound. The risk factors may complicated with premature rupture of membrane, abnormal occiput position during the first stage of labor and prolonged second stage of labor.
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Affiliation(s)
- Na Li
- Department of Obstetrics and Gynecology, Shengjing Hospital, China Medical University, Shenyang 110004, China
| | - Qiuling Li
- Department of Obstetrics and Gynecology, Shengjing Hospital, China Medical University, Shenyang 110004, China
| | - Liang Chang
- Department of Obstetrics and Gynecology, Shengjing Hospital, China Medical University, Shenyang 110004, China
| | - Caixia Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital, China Medical University, Shenyang 110004, China.
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Butler K, Ramphul M, Dunney C, Farren M, McSweeney A, McNamara K, Murphy DJ. A prospective cohort study of the morbidity associated with operative vaginal deliveries performed by day and at night. BMJ Open 2014; 4:e006291. [PMID: 25354825 PMCID: PMC4216855 DOI: 10.1136/bmjopen-2014-006291] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate maternal and neonatal outcomes associated with operative vaginal deliveries (OVDs) performed by day and at night. DESIGN Prospective cohort study. SETTING Urban maternity unit in Ireland with off-site consultant staff at night. POPULATION All nulliparous women requiring an OVD with a term singleton fetus in a cephalic presentation from February to November 2013. METHODS Delivery outcomes were compared for women who delivered by day (08:00-19:59) or at night (20:00-07:59). MAIN OUTCOME MEASURES The main outcomes included postpartum haemorrhage (PPH), anal sphincter tear and neonatal unit admission. Procedural factors included operator grade, sequential use of instruments and caesarean section. RESULTS Of the 597 women who required an OVD, 296 (50%) delivered at night. Choice of instrument, place of delivery, sequential use of instruments and caesarean section did not differ significantly in relation to time of birth. Mid-grade operators performed less OVDs by day than at night, OR 0.60 (95% CI 0.43 to 0.83), and a consultant supervisor was more frequently present by day, OR 2.26 (95% CI 1.05 to 4.83). Shoulder dystocia occurred more commonly by day, OR 2.57 (95% CI 1.05 to 6.28). The incidence of PPH, anal sphincter tears, neonatal unit admission, fetal acidosis and neonatal trauma was similar by day and at night. The mean decision to delivery intervals were 12.0 and 12.6 min, respectively. CONCLUSIONS There was no evidence of an association between time of OVD and adverse perinatal outcomes despite off-site consultant obstetric support at night.
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Affiliation(s)
- Katherine Butler
- Academic Department of Obstetrics & Gynaecology, Trinity College, University of Dublin, Coombe Women & Infants University Hospital, Cork, Dublin, Republic of Ireland
| | - Meenakshi Ramphul
- Academic Department of Obstetrics & Gynaecology, Trinity College, University of Dublin, Coombe Women & Infants University Hospital, Cork, Dublin, Republic of Ireland
| | - Clare Dunney
- Academic Department of Obstetrics & Gynaecology, Trinity College, University of Dublin, Coombe Women & Infants University Hospital, Cork, Dublin, Republic of Ireland
| | - Maria Farren
- Academic Department of Obstetrics & Gynaecology, Trinity College, University of Dublin, Coombe Women & Infants University Hospital, Cork, Dublin, Republic of Ireland
| | - Aoife McSweeney
- Academic Department of Obstetrics & Gynaecology, Trinity College, University of Dublin, Coombe Women & Infants University Hospital, Cork, Dublin, Republic of Ireland
| | - Karen McNamara
- Academic Department of Obstetrics & Gynaecology, Trinity College, University of Dublin, Coombe Women & Infants University Hospital, Cork, Dublin, Republic of Ireland
| | - Deirdre J Murphy
- Academic Department of Obstetrics & Gynaecology, Trinity College, University of Dublin, Coombe Women & Infants University Hospital, Cork, Dublin, Republic of Ireland
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Åberg K, Norman M, Ekéus C. Preterm birth by vacuum extraction and neonatal outcome: a population-based cohort study. BMC Pregnancy Childbirth 2014; 14:42. [PMID: 24450413 PMCID: PMC3900732 DOI: 10.1186/1471-2393-14-42] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 01/20/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Very few studies have investigated the neonatal outcomes after vacuum extraction delivery (VE) in the preterm period and the results of these studies are inconclusive. The objective of this study was to describe the use of VE for preterm delivery in Sweden and to compare rates of neonatal complications after preterm delivery by VE to those found after cesarean section during labor (CS) or unassisted vaginal delivery (VD). METHODS Data was obtained from Swedish national registers. In a population-based cohort from 1999 to 2010, all live-born, singleton preterm infants in a non-breech presentation at birth, born after onset of labor (either spontaneously, by induction, or by rupture of membranes) by VD, CS, or VE were included, leaving a study population of 40,764 infants. Logistic regression analyses were used to calculate adjusted odds ratios (AOR), using unassisted vaginal delivery as reference group. RESULTS VE was used in 5.7% of the preterm deliveries, with lower rates in earlier gestations. Overall, intracranial hemorrhage (ICH) occurred in 1.51%, extracranial hemorrhage (ECH) in 0.64%, and brachial plexus injury in 0.13% of infants. Infants delivered by VE had higher risks for ICH (AOR = 1.84 (95% CI: 1.09-3.12)), ECH (AOR = 4.48 (95% CI: 2.84-7.07)) and brachial plexus injury (AOR = 6.21 (95% CI: 2.22-17.4)), while infants delivered by CS during labor had no increased risk for these complications, as compared to VD. CONCLUSION While rates of neonatal complications after VE are generally low, higher odds ratios for intra- and extracranial hemorrhages and brachial plexus injuries after VE, compared with other modes of delivery, support a continued cautious use of VE for preterm delivery.
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Affiliation(s)
- Katarina Åberg
- Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Retzius väg 13, 171 77 Stockholm, Sweden
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Ekéus
- Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Stockholm, Sweden
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Uche EO, Emejulu JK, Ekenze SO, Okorie E, Uche NJ. Neonatal head injury unrelated to birth trauma in South-East Nigeria. Niger J Med 2013; 22:274-278. [PMID: 24283083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Neonatal head trauma resulting from causes other than birth trauma has rarely been the focus of many a research theme in the literature. AIM/OBJECTIVE To highlight the occurrence of non-birth trauma related neonatal head injury, and evaluate the causes and outcome of treatment. METHODS A 3 year retrospective review of neonatal patients with head injury from two tertiary hospitals in South-East Nigeria between July 2009 and June 2012 (n-37). Data was collected from patients' birth and medical records. Data was analyzed using the SPSS version 15. RESULT Among the one hundred and seventy-six cases (11.78)% pediatric head injury cases seen, thirty seven (2.48)% occurred in neonatal patients. The most common cause of head injury was fall 22 cases [59.5%]. Children of mothers with low educational qualification were more likely to sustain falls 22 cases (59.5%). Road traffic accident (n = 15) was associated with more severe injuries and poorer outcome. Operative treatment was associated with increased mortality (two of three cases). The mortality rate in our series is 8.10%. CONCLUSION Reduction of neonatal head trauma could be achieved through improved maternal education.
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Affiliation(s)
- E O Uche
- Neurosurgery Unit, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria.
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Hehir MP, Reidy FR, Wilkinson MN, Mahony R. Increasing rates of operative vaginal delivery across two decades: accompanying outcomes and instrument preferences. Eur J Obstet Gynecol Reprod Biol 2013; 171:40-3. [PMID: 23998554 DOI: 10.1016/j.ejogrb.2013.08.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/25/2013] [Accepted: 08/05/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine rates and outcomes of operative vaginal delivery over a 20-year study period and the changing preference for various instruments during this period. STUDY DESIGN This retrospective analysis of prospectively gathered data was carried out at a large tertiary referral center from 1991 to 2010. All cases of operative vaginal delivery during the study period were recorded. The rates of instrumental delivery, as well as neonatal outcomes and instrument preference, were compared for individual 5-year epochs. RESULTS During the study period there were 156,130 deliveries of which 17,841 were operative vaginal deliveries, an incidence of 11.4/100 deliveries and 13.6/100 vaginal deliveries. There was an increase in the rate of operative vaginal delivery across the 20-year period (P < 0.0001; R(2) = 0.85; Slope = 0.42). When individual 5-year epochs were compared, the incidence of instrumental delivery increased from 7.3% (2340/31,937) in the first five years, 1991-1995, to 13.7% (6179/45,177) in the final five years, 2006-2010 (P < 0.0001; OR 2.34, 95% CI = 2.23-2.47). The perinatal mortality rate in cases of instrumental delivery was decreased when these time periods were compared (7.3/1000 (17/2340) vs. 1.8/1000 (11/6179); P = 0.003, OR 0.24, 95% CI = 0.11-0.52). The choice of instrument also varied, with 68.2% (1596/2340) of instrumental deliveries in 1991-1995 being carried out with forceps compared to 32.9% (2033/6179) in 2006-2010 (P < 0.001). CONCLUSION Rates of operative vaginal delivery have increased over the 20-year study period. The rate of perinatal mortality in infants who had an assisted vaginal delivery was decreased in the 5-year epoch at the end of the study compared with the period at the beginning. The rate of forceps delivery has fallen significantly, with vacuum delivery now being the choice of the majority of clinicians.
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Affiliation(s)
- Mark P Hehir
- National Maternity Hospital, Holles St, Dublin, Ireland.
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Murguía-González A, Hernández-Herrera RJ, Nava-Bermea M. [Risk factors of birth obstetric trauma]. Ginecol Obstet Mex 2013; 81:297-303. [PMID: 23837294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The proper prenatal care for pregnant women is crucial to quickly identify risk factors for birth trauma. OBJECTIVE To identify risk factors for neonatal birth trauma. PATIENTS AND METHOD Case-control study that included a patient in the case group for every two controls. The following risk factors were identified: cephalopelvic disproportion, macrosomia, use of forceps, precipitated or prolonged labor, malpresentation, and the most common types of birth trauma. We used descriptive statistics and odds ratios. RESULTS Statistically significant risk factors for birth trauma were: maternal age < or = 20 years (OR = 16) and > or = 30 years (OR = 2.5), first pregnancy (OR = 4.0), cephalopelvic disproportion (OR = 8.3), forceps delivery (OR = 9.4), birth weight greater than 3,800 g (OR = 6.6), and non-cephalic presentation (OR = 8.3). Found birth trauma types were: ecchymosis (40.4%), caput succedaneum (25%), erosion (15.4%), clavicle fracture (5.9%), brachial plexus paralysis (4.7%), inter alia. The perinatal outcome of 79 infants with birth trauma were compared to 158 healthy newborns. CONCLUSION Risk factors associated with birth injuries were: Maternal (age, pregnancy), newborn (weight), and birth care (presentation, instrumentation and pelvic sufficiency).
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Affiliation(s)
- Alejandrina Murguía-González
- Unidad Médica de Alta Especialidad 23, Hospital de Ginecologia y Obstetricia, Instituto Mexicano del Seguro Social, Monterrey, NL
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Ogbemudia AO, Ogbemudia EJ. Emergency caesarean delivery in prolonged obstructed labour as risk factor for obstetric fractures--a case series. Afr J Reprod Health 2012; 16:119-122. [PMID: 23437505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Birth fractures predominantly affect the clavicle, humerus or femur. Brachial plexus injury may co-exist with humeral or clavicular fractures. From January 2002 to December 2010, 8 neonates with fractures after caesarean section were treated under the supervision of the first author following obstructed labour and caesarean delivery. The most classical of the cases is a vertex-presenting neonate who was delivered by caesarean section for obstructed labour in a primipara in whom ipsilateral klumpke's palsy and fractures of the clavicle and humerus were confirmed. Literature review did not consider emergency caesarean delivery as one of the predisposing factors for such birth injuries. This case series, in addition to presenting emergency caesarean section as a predisposing factor for birth injuries, offers to suggest a manoeuvre that may reduce severity and rate of birth injuries in caesarean section for obstructed labour in our environment where obstructed labour is still rife.
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Affiliation(s)
- Alfred O Ogbemudia
- Department of Orthopaedics and Trauma, College of Medical Sciences, University of Benin.
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Ugburo AO, Fadeyibi IO, Oluwole AA, Mofikoya BO, Gbadegesin A, Adegbola O. The epidemiology and management of gynatresia in Lagos, southwest Nigeria. Int J Gynaecol Obstet 2012; 118:231-5. [PMID: 22717415 DOI: 10.1016/j.ijgo.2012.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Revised: 03/30/2012] [Accepted: 05/18/2012] [Indexed: 11/16/2022]
Affiliation(s)
- Andrew O Ugburo
- Department of Surgery, Burns and Plastic Surgery Unit, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Nigeria.
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Mandal D, Manda S, Rakshi A, Dey RP, Biswas SC, Banerjee A. Maternal obesity and pregnancy outcome: a prospective analysis. J Assoc Physicians India 2011; 59:486-489. [PMID: 21887903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To analyze whether the obese women have an increased risk of pregnancy complications and adverse fetal outcome. METHODS The longitudinal prospective study was carried out in the Obst and Gynae department, IPGME and R, Kolkata. The study enrolled 422 pre-pregnant obese women with pregnancy as study population and equal number of non obese pregnant mothers as controls. Body mass index (BMI) was > or = 30.0 kg/m2 and 20-22 kg/m2 in obese and control group respectively. RESULTS In comparison to average weight pregnant women, obese pregnant women were at increased risk of gestational diabetes mellitus (19.43 vs 3.79%; p < 0.001), pregnancy induced hypertension (12.32 vs 2.36%; p < 0.001), pre-eclampsia (8.76 vs 3.31%; p < 0.001), preterm labor in less than 34 week gestation (7.58 vs 3.55%; p < 0.001), cesarean section (36.72 vs 17.53%; p < 0.001), instrumental deliveries (12.32 vs 5.21%; p < 0.001) and postpartum infection morbidities (9.95 vs 3.79%; p < 0.001). These women were more prone to develop overt diabetes (2.36% vs 0) and chronic hypertension (5.21 vs .47% ) in future as well. Neonates of obese women were mostly large for gestational age, macrosomic and they had high incidences of birth injuries, shoulder dystocia, premature deliveries, late fetal deaths and congenital malformations particularly spina bifida, cleft lip, cleft palate and heart defect. CONCLUSION As obesity is considered to be a modifiable risk factor, preconception counseling and creating awareness regarding health risks associated with over weight and obesity should be encouraged.
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Affiliation(s)
- Debasmita Mandal
- Department of Obst and Gynae, IPGME and R, 244 AJC Bose Road, Kolkata-700 020
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Walsh JM, Kandamany N, Ni Shuibhne N, Power H, Murphy JF, O'Herlihy C. Neonatal brachial plexus injury: comparison of incidence and antecedents between 2 decades. Am J Obstet Gynecol 2011; 204:324.e1-6. [PMID: 21345417 DOI: 10.1016/j.ajog.2011.01.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 01/06/2011] [Accepted: 01/13/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We sought to compare the incidence and antecedents of neonatal brachial plexus injury (BPI) in 2 different 5-year epochs a decade apart following the introduction of specific staff training in the management of shoulder dystocia. STUDY DESIGN All infants with BPI were prospectively identified during 2004 through 2008. Injuries were correlated with maternal details and intrapartum events and compared with the earlier series. RESULTS Of 41,828 deliveries during 2004 through 2008, 72 infants with BPI were identified (1.7/1000), compared to 54 cases (1.5/1000) from 1994 through 1998 (P = .4); 9 injuries (12.5%) were persistent from 2004 through 2008, compared with 10 (18.5%) earlier (P = .4). There were no significant differences between the 2 time periods with respect to maternal parity, obesity, or prolonged pregnancy, although the cesarean section rate had increased from 10.7 to 18.4%. CONCLUSION Despite training in the management of shoulder dystocia and a rising institutional cesarean section rate, the incidence of BPI has remained unchanged compared with 10 years earlier.
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Affiliation(s)
- Jennifer M Walsh
- Department of Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
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Foy DiGeronimo T, Hamilton E, Daly MV, Goley RB. Shoulder dystocia: neither predictable nor preventable? not anymore. MD Advis 2011; 4:18-24. [PMID: 21804449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Gilbert WM, Jacoby BN, Xing G, Danielsen B, Smith LH. Adverse obstetric events are associated with significant risk of cerebral palsy. Am J Obstet Gynecol 2010; 203:328.e1-5. [PMID: 20598283 DOI: 10.1016/j.ajog.2010.05.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 02/26/2010] [Accepted: 05/05/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine adverse birth events on the development of cerebral palsy in California. STUDY DESIGN A retrospective population-based study of children with cerebral palsy (as of Nov. 30, 2006), matched to their maternal/infant delivery records (Jan. 1, 1991 to Dec. 31, 2001) was performed. Demographic data and intrapartum events were examined. Six adverse birth-related events were chosen. Children without cerebral palsy were controls. RESULTS There were 7242 children who had cerebral palsy (59% term) and 31.3% had 1 or more of the 6 adverse intrapartum events (12.9% in controls P < .0001). This held for both term (28.3% vs 12.7% controls) and preterm (36.8% vs 15.9%, controls) neonates (both P < .0001). Maternal (15.1% vs 6.6%) and neonatal (0.9% vs 0.1%) infection were increased in cerebral palsy cases (P < .0001). CONCLUSION Almost one-third of children with cerebral palsy had at least 1 adverse birth-related event. Higher rates in the preterm group may partially explain the higher rates of cerebral palsy in this group.
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Affiliation(s)
- William M Gilbert
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, USA
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Akin Y, Cömert S, Turan C, Piçak A, Ağzikuru T, Telatar B. Macrosomic newborns: a 3-year review. Turk J Pediatr 2010; 52:378-383. [PMID: 21043383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The objective of this study was to determine the incidence, perinatal complications and the outcome of macrosomic infants. A retrospective analysis was made of macrosomic deliveries and of those admitted into the Neonatology Unit. A control group of 854 deliveries weighing between 2500-4000 g was randomly composed. The incidence of macrosomic deliveries, stillbirth rates, sex, parity, maternal age, mode of delivery, perinatal complications like birth traumas, hypoglycemia, polycythemia, asphyxia, admission rate into the neonatal intensive care unit (NICU), and outcome were analyzed. Among a total of 11,827 deliveries, 829 (7%) were macrosomic neonates. Statistical analysis showed male predominance (p = 0.0001), a significant increase in cesarean section (p = 0.0001), and higher parity for the macrosomic group (p = 0.0001). The mothers of macrosomic newborns were older (p = 0.0001). The admission frequency of macrosomic deliveries into the NICU was almost two-fold. Birth injuries were found in 53 (6.4%) macrosomic infants, and macrosomic deliveries had a two-fold risk for birth injuries. Statistical analysis showed a significant difference between macrosomics and the control group for the frequency of birth traumas (p = 0.0007), hypoglycemia (p = 0.0001) and polycythemia (p = 0.0006). There were two deaths in macrosomic group versus one among control cases. Regarding the high birth trauma and NICU admission rates of macrosomic infants, it is important to emphasize the significance of prenatal diagnosis of fetal macrosomia and of management of these high-risk pregnancies in tertiary level hospitals.
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Affiliation(s)
- Yasemin Akin
- Department of Pediatrics I, Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
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47
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Lucchini R, Barba G, Giampietro S, Trivelli M, Dito L, De Curtis M. [Macrosomic infants: clinical problems at birth and afterward]. Minerva Pediatr 2010; 62:65-66. [PMID: 21090075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Macrosomic infants (birth weight >4000 g) show increased risk for shoulder dystocia and associated injuries, hypoglycemia and respiratory distress. Higher risk is directly related to neonatal birth weight. High birth weight is also associated with increased risk of developing metabolic syndrome later in life. However the relation between birth weight and later-life metabolic syndrome in not linear, but "U" shaped.
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MESH Headings
- Adult
- Birth Injuries/epidemiology
- Birth Injuries/etiology
- Birth Weight
- Delivery, Obstetric
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/etiology
- Diabetes, Gestational/metabolism
- Disease Susceptibility
- Female
- Fetal Macrosomia/complications
- Fetal Macrosomia/epidemiology
- Humans
- Infant, Low Birth Weight
- Infant, Newborn
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/etiology
- Male
- Meta-Analysis as Topic
- Metabolic Syndrome/epidemiology
- Metabolic Syndrome/etiology
- Obstetric Labor Complications/etiology
- Pregnancy
- Prenatal Exposure Delayed Effects
- Retrospective Studies
- Risk
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Affiliation(s)
- R Lucchini
- Dipartimento di Pediatria, Sapienza-Università di Roma
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48
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Cohain JS. The dangers of planned hospital births. Midwifery Today Int Midwife 2010:30-68. [PMID: 20572620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Hospital birth* has not undergone rigorous scientific scrutiny, yet is commonly believed to be safer than planned homebirth, even for low-risk women. A commonly promoted notion is that there are rare complications, which can arise at birth, making a hospital birth safer for low-risk women. There is no published research to support this notion. Where trained and equipped birth attendants are available, and hospital transfer is closer than 30-45 minutes, a planned, attended homebirth is safer for low-risk women than a planned hospital birth. Currently available published research suggests planning a hospital birth is not safer than planning an attended homebirth for women with one head-down fetus, between 37-42 weeks, no high blood pressure, no previous cesareans and no serious medical conditions that affect pregnancy outcome.
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Alexander JM, Leveno KJ, Hauth JC, Landon MB, Gilbert S, Spong CY, Varner MW, Caritis SN, Meis P, Wapner RJ, Sorokin Y, Miodovnik M, O'Sullivan MJ, Sibai BM, Langer O, Gabbe SG. Failed operative vaginal delivery. Obstet Gynecol 2009; 114:1017-1022. [PMID: 20168101 PMCID: PMC3075422 DOI: 10.1097/aog.0b013e3181bbf3be] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare maternal and neonatal outcomes in women undergoing second-stage cesarean delivery after a trial of operative vaginal delivery with those in women undergoing second-stage cesarean delivery without such an attempt. METHODS This study is a secondary analysis of the women who underwent second-stage cesarean delivery. The maternal outcomes examined included blood transfusion, endometritis, wound complication, anesthesia use, and maternal death. Neonatal outcomes examined included umbilical artery pH less than 7.0, Apgar score of 3 or less at 5 minutes, seizures within 24 hours of birth, hypoxic ischemic encephalopathy, stillbirth, skull fracture, and neonatal death. RESULTS Of 3,189 women who underwent second-stage cesarean delivery, operative vaginal delivery was attempted in 640. Labor characteristics were similar in the two groups, with the exception of the admission-to-delivery time and cesarean indication. Those with an attempted operative vaginal delivery were more likely to undergo cesarean delivery for a nonreassuring fetal heart rate tracing (18.0% compared with 13.9%, P=.01), have a wound complication (2.7% compared with 1.0%, odds ratio [OR] 2.65, 95% confidence interval [CI] 1.43-4.91), and require general anesthesia (8.0% compared with 4.1%, OR 2.05, 95% CI 1.44-2.91). Neonatal outcomes, including umbilical artery pH less than 7.0, Apgar score of 3 or less at 5 minutes, and hypoxic ischemic encephalopathy, were more common for those with an attempted operative vaginal delivery. This was not significant when cases with a nonreassuring fetal heart rate tracing were removed. CONCLUSION Cesarean delivery after an attempt at operative vaginal delivery was not associated with adverse neonatal outcomes in the absence of a nonreassuring fetal heart rate tracing. LEVEL OF EVIDENCE II.
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Affiliation(s)
- James M Alexander
- From the Departments of Obstetrics and Gynecology at the University of Texas Southwestern Medical Center, Dallas, Texas; the University of Alabama at Birmingham, Birmingham, Alabama; the Ohio State University, Columbus, Ohio; the University of Utah, Salt Lake City, Utah; the University of Pittsburgh, Pittsburgh, Pennsylvania; Wake Forest University Health Sciences, Winston-Salem, North Carolina; Thomas Jefferson University, Philadelphia, Pennsylvania; Wayne State University, Detroit, Michigan; the University of Cincinnati, Cincinnati, Ohio; the University of Miami, Miami, Florida; the University of Tennessee, Memphis, Tennessee; the University of Texas Health Science Center at San Antonio, San Antonio, Texas; Vanderbilt University, Nashville, Tennessee; the George Washington University Biostatistics Center, Washington, DC, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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50
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Rijal L, Ansari T, Trikha V, Yadhav CS. Birth injuries in caesarian sections: cases of fracture femur and humerus following caesarian section. Nepal Med Coll J 2009; 11:207-208. [PMID: 20334074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Long bone injuries are less common during caesarian section. Sometimes, they remain unnoticed to the operating surgeon but are frequently noted by attending physician or nurses. The aim of this case study is to remind the surgeon that any forceful extraction may result long bone injuries. So, care should be given during and after delivery to rule out injuries.
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Affiliation(s)
- L Rijal
- Department of Orthopaedic, Manipal College of Medical Sciences, Pokhara, Nepal, India.
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