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Iaconianni JA, Balasubramanian S, Grimm MJ, Gonik B, Singh A. Studying the Effects of Shoulder Dystocia and Neonate-Focused Delivery Maneuvers on Brachial Plexus Strain: A Computational Study. J Biomech Eng 2024; 146:021009. [PMID: 38116838 PMCID: PMC10880949 DOI: 10.1115/1.4064313] [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: 05/06/2023] [Revised: 11/02/2023] [Accepted: 11/05/2023] [Indexed: 12/21/2023]
Abstract
The purpose of this computational study was to investigate the effects of neonate-focused clinical delivery maneuvers on brachial plexus (BP) during shoulder dystocia. During shoulder dystocia, the anterior shoulder of the neonate is obstructed behind the symphysis pubis of the maternal pelvis, postdelivery of the neonate's head. This is managed by a series of clinical delivery maneuvers. The goal of this study was to simulate these delivery maneuvers and study their effects on neonatal BP strain. Using madymo models of a maternal pelvis and a 90th-percentile neonate, various delivery maneuvers and positions were simulated including the lithotomy position alone of the maternal pelvis, delivery with the application of various suprapubic pressures (SPPs), neonate in an oblique position, and during posterior arm delivery maneuver. The resulting BP strain (%) along with the required maternal delivery force was reported in these independently simulated scenarios. The lithotomy position alone served as the baseline. Each of the successive maneuvers reported a decrease in the required delivery force and resulting neonatal BP strain. As the applied SPP force increased (three scenarios simulated), the required maternal delivery force and neonatal BP strain decreased. A further decrease in both delivery force and neonatal BP strain was observed in the oblique position, with the lowest delivery force and neonatal BP strain reported during the posterior arm delivery maneuver. Data obtained from the improved computational models in this study enhance our understanding of the effects of clinical maneuvers on neonatal BP strain during complicated birthing scenarios such as shoulder dystocia.
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Affiliation(s)
- Joy A. Iaconianni
- Drexel University, 3120 Market Street, Bossone 713, Philadelphia, PA 19104
| | - Sriram Balasubramanian
- School of Biomedical Engineering, Drexel University, 3120 Market Street, Bossone 713, Philadelphia, PA 19104
| | - Michele J. Grimm
- College of Nanotechnology, Science, and Engineering, University at Albany, 1400 Washington Ave, Albany, NY 12222
| | - Bernard Gonik
- Obstetrics & Gynecology — School of Medicine, Wayne State University, 3990 John R. Street, 7 Brush North, Detroit, MI 48201
| | - Anita Singh
- College of Engineering, Temple University, Engineering Building Room 601, Bioengineering, 1947 N. 12th Street, Philadelphia, PA 19104
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Nogalski Z, Barański W. Pelvic dimensions and occurrence of dystocia in Black-and-White and Holstein-Friesian heifers. Pol J Vet Sci 2023; 26:687-693. [PMID: 38088415 DOI: 10.24425/pjvs.2023.148288] [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] [Indexed: 12/18/2023]
Abstract
The Black-and-White (BW) breed, which until recently had dominated in Europe, was replaced by the Holstein-Friesian (HF) breed. As a result, the incidence of dystocia has increased. Dystocia occurs most frequently in heifers, and it is associated with high calf weight and/or too narrow pelvic openings in heifers. The aim of this study was to evaluate retrospectively the effects of pelvic dimensions and rump angle on calving ease in two cattle breeds. The research was carried out in four barns where BW and HF cattle were used. The course of parturition was evaluated in 317 heifers (BW, n=169; HF, n=148) based on direct observations. Calves were weighed, external and internal pelvic measurements were performed (using the Rice pelvimeter), and rump angle was determined in heifers. Based on the course of parturition, heifers of both breeds were divided into easy calving (EC) and difficult calving (DC) groups. The frequency of DC was 24.3% in HF heifers and 13.1% in BW heifers. In comparison with DC heifers, EC heifers had a larger pelvic area, in particular the internal dimensions of the bony pelvis, and a higher rump angle. In comparison with BW heifers, HF heifers had a smaller rump angle, a narrower pelvis and a lower ratio of pelvic area to calf weight. High dystocia rates in HF heifers could result from a relatively large fetus size and a less preferable pelvic size and rump angle. High variation in the internal pelvic dimensions in HF heifers indicates that the incidence of dystocia can be reduced through selection for a larger pelvic size and the optimal rump angle.
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Affiliation(s)
- Z Nogalski
- Department of Animal Nutrition, Feed Science and Cattle Breeding, Faculty of Animal Bioengineering, University of Warmia and Mazury in Olsztyn, Oczapowskiego 2, 10-719 Olsztyn, Poland
| | - W Barański
- Department of Animal Reproduction with Clinic, Faculty of Veterinary Medicine, University of Warmia and Mazury in Olsztyn, Oczapowskiego 2, 10-719 Olsztyn, Poland
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Chan EHL, Lau SL, Leung TY. Long-term trends in the incidence and management of shoulder dystocia in a tertiary obstetric unit in Hong Kong. Hong Kong Med J 2023; 29:524-531. [PMID: 37704569 DOI: 10.12809/hkmj2210038] [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] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION Because there have been changes in the management of macrosomic pregnancies and shoulder dystocia in the past decade, this study was conducted to compare the incidences of shoulder dystocia and perinatal outcomes between the periods of 2000-2009 and 2010-2019. METHODS This retrospective study was conducted in a tertiary obstetric unit. All cases of shoulder dystocia were identified using the hospital's electronic database. The incidences, maternal and fetal characteristics, obstetric management methods, and perinatal outcomes were compared between the two study periods. RESULTS The overall incidence of shoulder dystocia decreased from 0.23% (134/58 326) in 2000-2009 to 0.16% (108/65 683) in 2010-2019 (P=0.009), mainly because of the overall decline in the proportion of babies with macrosomia (from 3.3% to 2.3%; P<0.001). The improved success rates of the McRoberts' manoeuvre (from 31.3% to 47.2%; P=0.012) and posterior arm extraction (from 52.9% to 92.3%; P=0.042) allowed a greater proportion of affected babies to be delivered within 2 minutes (from 59.0% to 79.6%; P=0.003). These changes led to a significant reduction in the proportion of fetuses with low Apgar scores: <5 at 1 minute of life (from 13.4% to 5.6%; P=0.042) and <7 at 5 minutes of life (from 11.9% to 4.6%; P=0.045). CONCLUSION More proactive management of macrosomic pregnancies and enhanced training in the acute management of shoulder dystocia led to significant improvements in shoulder dystocia incidence and perinatal outcomes from 2000-2009 to 2010-2019.
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Affiliation(s)
- E H L Chan
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - S L Lau
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - T Y Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
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Yu H, Kang X, Sun X. Postoperative dystocia of the gastric bursa after LRYGB: A case report. Medicine (Baltimore) 2023; 102:e35077. [PMID: 37904354 PMCID: PMC10615522 DOI: 10.1097/md.0000000000035077] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/13/2023] [Indexed: 11/01/2023] Open
Abstract
RATIONALE Laparoscopic Roux-en-Y gastric diversion is one of the most widely used surgical procedures for weight reduction and metabolic surgery, which is a hybrid approach to restrict intake and reduce absorption. Despite the successful completion of laparoscopic Roux-en-Y gastric diversion, 10% to 20% of patients still experience regained body mass or other complications. PATIENT CONCERNS The patient had regained weight after all the RYGB surgeries, and after diet and exercise control, the results were not good, so she came to our department for treatment. DIAGNOSES Dilatation of the gastric pouch was observed on iodinated water imaging of the upper gastrointestinal tract and on abdominal CT. INTERVENTIONS We report 2 patients with dilated gastric bursa after RYGB, both female, who underwent gastric diversion revision. OUTCOMES Both patients in this case underwent laparoscopic gastric diversion correction to improve weight rebound. Their quality of life improved significantly after treatment. There were no grade 3/4 treatment-related adverse events during the treatment period. LESSONS The above cases suggest that patients who regain weight after RYGB should routinely undergo preoperative upper gastrointestinal endoscopy and upper gastrointestinal iodine hydrography in order to observe the muscle tone of the patient's gastric bursa and the degree of dilatation of the gastrointestinal anastomosis and consider whether to correct the dilated gastric bursa intraoperatively before converting to LSG.
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Affiliation(s)
- Hang Yu
- Department of General Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
- Department of General Surgery, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China
| | - Xing Kang
- Department of General Surgery, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China
| | - Xitai Sun
- Department of General Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
- Department of General Surgery, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China
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Tsaousioti A, Praxitelous A, Kok A, Kiossis E, Boscos C, Tsousis G. Association between dam and calf measurements with overall and fetopelvic dystocia in Holstein heifers. J DAIRY RES 2023; 90:261-268. [PMID: 37587723 DOI: 10.1017/s0022029923000468] [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] [Indexed: 08/18/2023]
Abstract
We investigated the relationship between dam's pelvic and calf's dimensions with dystocia due to fetopelvic disproportion in the Holstein breed and estimated risk factors and dystocia probability. For this purpose, external pelvic measurements were performed in 402 heifers 15 ± 11 (1-38) days ante-partum and specific conformation measurements were obtained from their calves 1.7 ± 1.2 post-partum. Dystocia was defined as the inability of the heifer to complete parturition spontaneously within 120 min after the appearance of the amnion with normal presentation, position and posture or as having definite obstetrical obstacles within 60 min. Overall and fetopelvic disproportion dystocia incidence was 10.4% and 5.2%, respectively. Heifer measurements mainly influenced overall dystocia, whereas calf conformation was related solely with fetopelvic dystocia. Specifically, heifers with a small pelvis (hip width <49.95 cm, pelvic inlet area <333.2 cm2, pelvic volume <7799.2 cm3) had 2.8 to 3.5 times greater incidence of overall dystocia (19.0-20.8%) compared to heifers with a larger pelvis (incidence of 7.0-7.6%). Regarding calf factors, sex (male calves), body weight, chest circumference and fetlock joint circumference significantly increased the odds of experiencing dystocia due to fetopelvic disproportion compared with female, lighter or smaller calves. In a backward elimination model with independent variables treated as continuous, an area under the ROC curve of 0.66 regarding the prediction of overall dystocia based on heifer pelvic length, and of 0.64 for the prediction of fetopelvic dystocia based on fetlock joint circumference was found. The combination of the two variables in one model improved the ROC area to 0.71 regarding dystocia due to fetopelvic disproportion, reaching acceptable level of discrimination. Our findings indicate that dystocia due to fetopelvic disproportion in heifers is mainly influenced by the fetal side. Additionally, the estimation of pelvic dimensions of the dam before parturition and specific conformation characteristics of the calf during parturition, especially fetlock joint circumference, could aid obstetricians and herdsmen regarding dystocia probability and parturition surveillance.
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Affiliation(s)
- Angeliki Tsaousioti
- Clinic of Farm Animals, Faculty of Veterinary Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Praxitelous
- Clinic of Farm Animals, Faculty of Veterinary Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Akke Kok
- Adaptation Physiology Group, Wageningen University and Research, Wageningen, the Netherlands
| | - Evangelos Kiossis
- Clinic of Farm Animals, Faculty of Veterinary Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Constantinos Boscos
- Clinic of Farm Animals, Faculty of Veterinary Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Tsousis
- Clinic of Farm Animals, Faculty of Veterinary Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Abstract
Abnormally prolonged labor, or labor dystocia, is a common complication of parturition. It is the indication for about half of unplanned cesarean deliveries in low-risk nulliparous women. Reducing the rate of unplanned cesarean birth in the USA has been a public health priority over the last two decades with limited success. Labor dystocia is a complex disorder due to multiple causes with a common clinical outcome of slow cervical dilation and fetal descent. A better understanding of the pathophysiologic mechanisms of labor dystocia could lead to new clinical opportunities to increase the rate of normal vaginal delivery, reduce cesarean birth rates, and improve maternal and neonatal health. We conducted a literature review of the causes and pathophysiologic mechanisms of labor dystocia. We summarize known mechanisms supported by clinical and experimental data and newer hypotheses with less supporting evidence. We review recent data on uterine preparation for labor, uterine contractility, cervical preparation for labor, maternal obesity, cephalopelvic disproportion, fetal malposition, intrauterine infection, and maternal stress. We also describe current clinical approaches to preventing and managing labor dystocia. The variation in pathophysiologic causes of labor dystocia probably limits the utility of current general treatment options. However, treatments targeting specific underlying etiologies could be more effective. We found that the pathophysiologic basis of labor dystocia is under-researched, offering wide opportunities for translational investigation of individualized labor management, particularly regarding uterine metabolism and fetal position. More precise diagnostic tools and individualized therapies for labor dystocia might lead to better outcomes. We conclude that additional knowledge of parturition physiology coupled with rigorous clinical evaluation of novel biologically directed treatments could improve obstetric quality of care.
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Affiliation(s)
- Katherine Kissler
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - K Joseph Hurt
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO, 80045, USA.
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Mailstop 8613, Aurora, CO, 80045, USA.
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Diack B, Pierre F, Gachon B. Impact of fetal manipulation on maternal and neonatal severe morbidity during shoulder dystocia management. Arch Gynecol Obstet 2023; 307:501-509. [PMID: 36149510 DOI: 10.1007/s00404-022-06783-y] [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: 04/25/2022] [Accepted: 08/28/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE There are few data on maternal and neonatal morbidities associated with shoulder dystocia (SD), depending on the use of fetal manipulation (FM). A prior 5-year study was conducted in our center in 2012 for this purpose. Our objective was to compare severe maternal and neonatal morbidities according to FM execution in a larger cohort. METHODS We conducted a retrospective study between 2007 and 2020. SD was considered when additional maneuvers were required to complete a delivery. Severe maternal morbidity was defined as the occurrence of obstetric anal sphincter injury (OASI). Severe neonatal morbidity was defined as Apgar < 7 at 5 min and/or cord arterial pH < 7.1 and/or or a permanent brachial plexus palsy. We studied these data in the FM group compared to the non- FM group. RESULTS FM was associated with increased OASI rates (21.1% vs. 3.8%, OR = 6.72 [2.7-15.8]). We found no significant difference in severe neonatal morbidity. Maternal age > 35 and FM appear to be associated with the occurrence of OASI, with ORa = 13.3 [1.5-121.8] and ORa = 5.3 [2.2-12.8], respectively. FM was the only factor associated with the occurrence of severe neonatal morbidity (ORa = 2.3 [1.1-4.8]. The rate of episiotomy was significantly decreased (20% versus 5% p < 0.05) and there was an increase in the rate of SD managed with FM in our center. CONCLUSION FM is the only factor associated with an increased risk of OASI. In case of failure of non-FM maneuvers, the rapid implementation of FM maneuvers resulted in no difference regarding severe neonatal morbidity.
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Affiliation(s)
- Bineta Diack
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Miletrie, 86000, Poitiers, France.
| | - Fabrice Pierre
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Miletrie, 86000, Poitiers, France
| | - Bertrand Gachon
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Miletrie, 86000, Poitiers, France
- Université de Poitiers, INSERM CIC 1402, CHU de Poitiers, Poitiers, France
- Université de Nantes, EA 4334 MIP, Nantes, France
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Elmas B, Ercan N, Ersak DT, Ozdemir EU, Çelik IH, Tapisiz OL, Akay A, Yucel E, Armangil M, Tekin OM. Risk factors for brachial plexus injury and permanent sequelae due to shoulder dystocia. Niger J Clin Pract 2022; 25:2016-2023. [PMID: 36537460 DOI: 10.4103/njcp.njcp_464_22] [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] [Indexed: 06/17/2023]
Abstract
AIM The primary aim of this study was to determine the risk factors for the occurrence of brachial plexus injury in cases of shoulder dystocia. Secondly, it was aimed to determine the factors affecting the occurrence of permanent sequelae in cases with brachial plexus injury. SUBJECTS AND METHODS ICD-10 codes were scanned from the records of patients who gave birth between 2012 and 2018, and the records of patients with brachial plexus injury and shoulder dystocia were reached. Shoulder dystocia cases with brachial plexus damage were accepted as the study group, and shoulder dystocia cases without brachial plexus damage were considered the control group. Shoulder dystocia patients with brachial plexus injury and without injury were compared for 2-year orthopedics clinic follow-up reports, surgical intervention, permanent sequelae status as well as birth data, maternal characteristics, and maneuvers applied to the management of shoulder dystocia. RESULTS Five hundred sixty births with shoulder dystocia were detected. Brachial plexus injury was observed in 88 of them, and permanent sequelae were detected in 12 of these patients. Maneuvers other than McRobert's (advanced maneuvers) were used more and clavicle fracture was seen more in the group with plexus injury (P < 0.05, P < 0.05, respectively). Logistic regression analysis was performed to determine the risk factors of brachial plexus injury. Brachial plexus injury was observed 4.746 times more in infants who were delivered with advanced maneuvers and 3.58 times more in infants with clavicle fractures at birth. CONCLUSION In patients with shoulder dystocia, the risk of brachial plexus injury increased in deliveries in which advanced maneuvers were used and clavicle fracture occurred.
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Affiliation(s)
- B Elmas
- Department of Gynecology and Obstetrics, University of Health Sciences Ankara City Hospital, Ankara, Nigeria
| | - N Ercan
- Department of Orthopedics and Traumatology, Ankara Training and Research Hospital, Ankara, Nigeria
| | - D T Ersak
- Department of Gynecology and Obstetrics, University of Health Sciences Ankara City Hospital, Ankara, Nigeria
| | - E U Ozdemir
- Department of Gynecology and Obstetrics, University of Health Sciences Ankara City Hospital, Ankara, Nigeria
| | - I H Çelik
- Department of Neonatology, University of Health Sciences Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - O L Tapisiz
- Gynecology and Obstetrics Clinic, Private Güven Hospital, Ankara, Turkey
| | - A Akay
- Department of Gynecology and Obstetrics, University of Health Sciences Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - E Yucel
- Department of Gynecology and Obstetrics, University of Health Sciences Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - M Armangil
- Department of Orthopedics and Traumatology, Division of Hand Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - O M Tekin
- Department of Gynecology and Obstetrics, University of Health Sciences Ankara City Hospital, Ankara, Nigeria
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Linde LE, Rasmussen S, Moster D, Kessler J, Baghestan E, Gissler M, Ebbing C. Risk factors and recurrence of cause-specific postpartum hemorrhage: A population-based study. PLoS One 2022; 17:e0275879. [PMID: 36240210 PMCID: PMC9565392 DOI: 10.1371/journal.pone.0275879] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/23/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To explore risk profiles of the different types of postpartum hemorrhage (PPH >500ml or severe PPH >1500ml) and their recurrence risks in a subsequent delivery. METHODS With data from The Medical Birth Registry of Norway and Statistics Norway we performed a population-based cohort study including all singleton deliveries in Norway from 1967-2017. Multilevel logistic regression was used to calculate odds ratio (OR), with 95% confidence interval (CI), with different PPH types (PPH >500ml or PPH >1500ml (severe PPH) combined with retained placenta, uterine atony, obstetric trauma, dystocia, or undefined cause) as outcomes. RESULT We identified 277 746 PPH cases of a total of 3 003 025 births (9.3%) from 1967 to 2017. Retained placenta (and/or membranes) was most often registered as severe PPH (29.3%). Maternal, fetal, and obstetric characteristics showed different associations with the PPH types. Male sex of the neonate was associated with reduced risk of PPH. This effect was strongest on PPH due to retained placenta (adjusted OR, (aOR): 0.80, 95% CI 0.78-0.82), atony (aOR 0.92, 95% CI: 0.90-0.93) and PPH with undefined cause (aOR 0.96, 95% CI: 0.95-0.97). Previous cesarean section showed a strong association with PPH due to dystocia (aOR of 13.2, 95% CI: 12.5-13.9). Recurrence risks were highest for the same type: PPH associated with dystocia (aOR: 6.8, 95% CI: 6.3-7.4), retained placenta and/or membranes (aOR: 5.9, 95% CI: 5.5-6.4), atony (aOR: 4.0, 95% CI: 3.8-4.2), obstetric trauma (aOR: 3.9, 95% CI: 3.5-4.3) and PPH of undefined cause (aOR: 2.2, 95% CI: 2.1-2.3). CONCLUSION Maternal, fetal and obstetric characteristics had differential effects on types of PPH. Recurrence differed considerably between PPH types. Retained placenta was most frequently registered with severe PPH, and showed strongest effect of sex; delivery of a boy was associated with lower risk of PPH. Previous cesarean increased the risk of PPH due to dystocia.
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Affiliation(s)
| | - Svein Rasmussen
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Dag Moster
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Jörg Kessler
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
| | - Elham Baghestan
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Department of Knowledge Brokers, Helsinki, Finland
- Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden
| | - Cathrine Ebbing
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
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Ulici A, Herdea A, Dragomirescu MC, Lungu CN. Obstetric fractures in caesarean delivery and risk factors as evaluated by paediatric surgeons. International Orthopaedics (SICOT) 2022; 46:2611-2617. [PMID: 35982323 PMCID: PMC9556358 DOI: 10.1007/s00264-022-05547-2] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/08/2022] [Indexed: 12/04/2022]
Abstract
Introduction Obstetric fractures usually occur after complicated births and are sent to paediatric orthopaedics for treatment and follow-up. Clavicle fractures represent the most common orthopaedic birth injury, involving approximately 0.2 to 3.5% of births. Hypotheses Caesarean delivery, elective or necessary, along with the type of presentation, may play a determinant role in the aetiology of obstetric fractures. Materials and methods We chose to do a retrospective study to determine possible risk factors for this type of injury that may manifest in either delivery. Our aim was to deepen our knowledge in order to have a better prediction and a better management of this condition. Data gathered included parity, gestity, type of delivery, presentation, shoulder dystocia, type of fracture, birth weight, and APGAR score. Results We followed 136 patients that were diagnosed with Allman type I clavicle fracture, 32 of them also having brachial plexus birth palsy (BPBP) type 1 (Duchenne-Erb). Natural birth with a pelvic presentation imposes a relative risk of 6.2 of associated pathology compared to cranial presentation. Caesarean delivery and cranial presentation increase the risk of related pathology by 5.04 compared to natural birth. Statistically, pelvic presentation is 5.54 times more likely to develop related pathology than cranial presentation. Type of delivery and presentation correlate with associated pathology of clavicle fractures. Discussion and conclusion Caesarean delivery brings risks for the newborn and should be practiced only when necessary. Predictive modeling in obstetrics in third-trimester evaluations may statistically predict risks of birth complications like fracture and BPBP.
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Affiliation(s)
- Alexandru Ulici
- 11th Department of Pediatric Orthopedics, "Carol Davila" University of Medicine and Pharmacy, Bd. Eroii sanitari nr. 8, 050474, Bucharest, Romania
- Pediatric Orthopedics Department, "Grigore Alexandrescu" Children's Emergency Hospital, 011743, Bucharest, Romania
| | - Alexandru Herdea
- 11th Department of Pediatric Orthopedics, "Carol Davila" University of Medicine and Pharmacy, Bd. Eroii sanitari nr. 8, 050474, Bucharest, Romania.
- Pediatric Orthopedics Department, "Grigore Alexandrescu" Children's Emergency Hospital, 011743, Bucharest, Romania.
| | - Mihai-Codrut Dragomirescu
- Pediatric Orthopedics Department, "Grigore Alexandrescu" Children's Emergency Hospital, 011743, Bucharest, Romania
| | - Claudiu N Lungu
- Department of Surgery, Clinical Country Emergency Hospital Galati, 800008, Galati, Romania
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11
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Wagner SM, Mendez-Figueroa H, Chauhan SP. Interventions to decrease complications after shoulder dystocia: a systematic review and Bayesian meta-analysis: a response. Am J Obstet Gynecol 2022; 226:875-876. [PMID: 35065021 DOI: 10.1016/j.ajog.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Steve M Wagner
- Department of Obstetrics and Gynecology, Alpert Medical School, Brown University, Providence, RI
| | - Hector Mendez-Figueroa
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin St., MSB 3.286, Houston, TX 77030
| | - Suneet P Chauhan
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin St., MSB 3.286, Houston, TX 77030.
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12
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Atashi H, Asaadi A, Hostens M. Association between age at first calving and lactation performance, lactation curve, calving interval, calf birth weight, and dystocia in Holstein dairy cows. PLoS One 2021; 16:e0244825. [PMID: 33395420 PMCID: PMC7781378 DOI: 10.1371/journal.pone.0244825] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/16/2020] [Indexed: 11/18/2022] Open
Abstract
In the present study, records on 115,291 heifers distributed in 113 herds were used to investigate the association between age at the first calving (AFC) and lactation performance, lactation curve, the length of the first calving interval (CI), calf birth weight (CBW), and the incidence of dystocia in Holstein heifers in Iran. Based on the AFC, the heifers were classified into eight classes: AFC of 541 to 690 d, 691 to 720 d, 721 to 750 d, 751 to 780 d, 781 to 810 d, 811 to 840 d, 841 to 900 d, and 901 to 1200 d (AFC1 to AFC8, respectively). Multiple regression mixed models were used to investigate the association between AFC and lactation curve parameters, partial and 305-d lactation performance, 100- and 305-d SCS, and the length of the first calving (CI) interval. The mean (SD) and median AFC across all heifers was 760.2 (74.01) and 750 d, respectively. Of 115,291 heifers included, 28,192 and 7,602 heifers were, respectively, ≤ 720 and > 900 d when calving for the first time. More than 44% of the heifers were at 691 to 750 d (23 to 25 months) of age when calving for the first time. An increased AFC was associated with increased partial and 305-d lactation performance, 100- and 305-d SCS, initial milk yield, milk production at the peak of lactation, upward and downward slopes of the lactation curve. The 305-d fat percentage was associated with AFC; however, there was no association between AFC and 305-d protein percentage. An increased AFC was also associated with decreased milk production persistency, delayed peak time, longer CI, and higher calf birth weight. Compared to heifers calving for the first time between 691 to 780 d (23 to 26 months) of age, both increasing and decreasing AFC were associated with increased risk of dystocia. Controlling AFC is an important management factor in achieving a lower risk of dystocia, higher lactation performance, lower SCS, and shorter length of the calving interval.
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Affiliation(s)
- Hadi Atashi
- Department of Animal Science, Shiraz University, Shiraz, Iran
- * E-mail:
| | - Anise Asaadi
- Department of Clinical Science, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Miel Hostens
- Department of Farm Animal Health, University of Utrecht, Utrecht, The Netherlands
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Thomsen CR, Milidou I, Hvidman L, Khalil MR, Rejnmark L, Uldbjerg N. Vitamin D and the risk of dystocia: A case-control study. PLoS One 2020; 15:e0240406. [PMID: 33052935 PMCID: PMC7556460 DOI: 10.1371/journal.pone.0240406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 09/26/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dystocia is one of the most common causes of cesarean section in nulliparous women. Studies have described the presence of vitamin D receptors in the myometrium, but it is still unclear whether vitamin D affects the contractility of the smooth muscles. We therefore aimed to determine the association between the vitamin D serum level at labor and the risk of dystocia. METHOD We conducted a case-control study between January 2012 and June 2017. Cases were primiparous women, with spontaneous onset of labor, who gave birth by cesarean section due to dystocia. Controls were primiparous women with a spontaneous vaginal delivery. We included 60 women (30 cases and 30 controls) in the analysis. The differences between cases and controls were assessed using chi-squared test for categorical variables and two-sample t-test or unequal t-test for continuous variables, as appropriate, after evaluation of whether they followed the normal distributions. RESULTS The mean serum 25-hydroxyvitamin D concentrations were 53.1nmol/l (95%CI; 45.2 to 60.9) among cases and 69.9nmol/l (95%CI; 57.5 to 82.4) among controls (P = 0.02). The mean plasma parathyroid hormone levels were 2.25 pmol/l and 2.38, respectively (P = 0.57). Even though 78% of all women reported taking a minimum of 10μg/day of vitamin D throughout pregnancy, 43% had vitamin D insufficiency, defined as serum 25-hydroxyvitamin D levels below 50nmol/l. CONCLUSIONS In a Danish group of women having a cesarean section due to dystocia, we found decreased vitamin D levels.
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Affiliation(s)
- Christine Rohr Thomsen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- * E-mail:
| | - Ioanna Milidou
- Department of Pediatrics, Hospitals of West Jutland, Herning, Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Mohammed Rohi Khalil
- Department of Obstetrics and Gynecology, Center Hospital Lillebaelt, Kolding, Denmark
| | - Lars Rejnmark
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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14
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Musaba MW, Ndeezi G, Barageine JK, Weeks A, Nankabirwa V, Wamono F, Semakula D, Tumwine JK, Wandabwa JN. Risk factors for obstructed labour in Eastern Uganda: A case control study. PLoS One 2020; 15:e0228856. [PMID: 32040542 PMCID: PMC7010384 DOI: 10.1371/journal.pone.0228856] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/23/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Obstructed labour (OL) is an important clinical and public health problem because of the associated maternal and perinatal morbidity and mortality. Risk factors for OL and its associated obstetric squeal are usually context specific. No epidemiological study has documented the risk factors for OL in Eastern Uganda. This study was conducted to identify the risk factors for OL in Mbale Hospital. Objective To identify the risk factors for OL in Mbale Regional Referral and Teaching Hospital, Eastern Uganda. Methods We conducted a case control study with 270 cases of women with OL and 270 controls of women without OL. We consecutively enrolled eligible cases between July 2018 and February 2019. For each case, we randomly selected one eligible control admitted in the same 24-hour period. Data was collected using face-to-face interviews and a review of patient notes. Logistic regression was used to identify the risk factors for OL. Results The risk factors for OL were, being a referral from a lower health facility (AOR 6.80, 95% CI: 4.20–11.00), prime parity (AOR 2.15 95% CI: 1.26–3.66) and use of herbal medicines in active labour (AOR 2.72 95% CI: 1.49–4.96). Married participants (AOR 0.59 95% CI: 0.35–0.97) with a delivery plan (AOR 0.56 95% CI: 0.35–0.90) and educated partners (AOR 0.57 95% CI: 0.33–0.98) were less likely to have OL. In the adjusted analysis, there was no association between four or more ANC visits and OL, adjusted odds ratio [(AOR) 0.96 95% CI: 0.57–1.63)]. Conclusions Prime parity, use of herbal medicines in labour and being a referral from a lower health facility were identified as risk factors. Being married with a delivery plan and an educated partner were protective of OL. Increased frequency of ANC attendance was not protective against obstructed labour.
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Affiliation(s)
- Milton W. Musaba
- Department of Obstetrics and Gynaecology, Mbale Regional Referral and Teaching Hospital, Mbale, Uganda
- Department of Obstetrics and Gynaecology, Busitema University Faculty of Health Sciences, Mbale, Uganda
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- * E-mail:
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Justus K. Barageine
- Department of Obstetrics and Gynaecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Africa Centre for Systematic Reviews and Knowledge Translation, Makerere University College of Health Sciences, Kampala, Uganda
| | - Andrew Weeks
- Sanyu Research Unit, University of Liverpool, University of Liverpool/Liverpool Women’s Hospital, Liverpool, England, United Kingdom
| | - Victoria Nankabirwa
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
- Centre for Intervention Science and Maternal Child Health (CISMAC), Centre for International health, University of Bergen, Bergen, Norway
| | - Felix Wamono
- School of Statistics and Planning, College of Business and Management Sciences, Makerere University, Kampala, Uganda
| | - Daniel Semakula
- Africa Centre for Systematic Reviews and Knowledge Translation, Makerere University College of Health Sciences, Kampala, Uganda
| | - James K. Tumwine
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Julius N. Wandabwa
- Department of Obstetrics and Gynaecology, Busitema University Faculty of Health Sciences, Mbale, Uganda
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15
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You T, Yang B, Zhang XT, Ren SY, Bai L, Jiao FJ, Jiang XC, Guan SY, Zhang WT. A possible prediction of dystocia at the time of cesarean delivery: Gluteal muscle contracture, a single center experience from China. Medicine (Baltimore) 2020; 99:e19138. [PMID: 32049835 PMCID: PMC7035071 DOI: 10.1097/md.0000000000019138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/26/2022] Open
Abstract
The study assessed the pelvic dimensions by computed tomography (CT) performed for gluteal muscle contracture women, and evaluated the impact of malformations on several essential obstetric parameters.The CT pelvimetry was retrospectively performed in 25 gluteal muscle contracture women selected consecutively whether they had delivery history or not. Among the pelvic inlet plane, the mid plane and the outlet plane, 12 indicators including the transverse diameter of the pelvic inlet, the conjugate vera, the diagonal conjugate, the biischial diameter, the anteroposterior diameter of the middle pelvis, transverse outlet, the posterior sagittal diameter of outlet, the conjugate of the outlet, the anterior sagittal diameter of the outlet, the curvature and length of the sacrum, the angle of pubic arch were collected.Finally, the mean age of these women was 26.6 ± 5.0 years. Most pelvises had anteroposterior elliptical appearance in inlet and size of the female pelvis. The most statistically different and most clinically significant indicator was the biischial diameter, gluteal muscle contracture women were 95.6 ± 9.3 mm and the normal women from other study were 105.0 ± 7.9 mm, the comparison showed a significant difference (P < .001).Generally, most gluteal muscle contracture women had features of anthropoid pelvis which were quite different from normal Chinese female. These results may serve as a basis for future studies to assess its utility and prognostic value for a safe vaginal delivery in gluteal muscle contracture women.
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Affiliation(s)
- Tian You
- Sports Medicine and Rehabilitation Department, Peking University Shenzhen Hospital
| | - Bei Yang
- Gynecology Department, Shenzhen Nanshan Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Xin-tao Zhang
- Sports Medicine and Rehabilitation Department, Peking University Shenzhen Hospital
| | - Shi-you Ren
- Sports Medicine and Rehabilitation Department, Peking University Shenzhen Hospital
| | - Lu Bai
- Sports Medicine and Rehabilitation Department, Peking University Shenzhen Hospital
| | - Fu-jia Jiao
- Sports Medicine and Rehabilitation Department, Peking University Shenzhen Hospital
| | - Xiao-cheng Jiang
- Sports Medicine and Rehabilitation Department, Peking University Shenzhen Hospital
| | - Si-yao Guan
- Sports Medicine and Rehabilitation Department, Peking University Shenzhen Hospital
| | - Wen-tao Zhang
- Sports Medicine and Rehabilitation Department, Peking University Shenzhen Hospital
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16
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Grillo-Ardila CF, Bautista-Charry AA, Diosa-Restrepo M. Breech presentation delivery care: A review of childbirth semiology, mechanism and care. Rev Colomb Obstet Ginecol 2019; 70:253-265. [PMID: 32142240 DOI: 10.18597/rcog.3345] [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] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 12/27/2019] [Indexed: 11/04/2022]
Abstract
Objective To review the concepts underlying breech presentation delivery as well as the semiology and the obstetric maneuvers contributing to a successful perinatal maternal outcome. Materials and methods Based on a hypothetical scenario to set the stage for a practical approach to the topic, an explanatory paper built on a narrative review is created in order to examine the principles related to diagnosis, mechanism of delivery and maternal care, emphasizing maneuvers to ease fetal extraction. Results Breech presentation delivery must be managed through the vaginal canal when already in the expulsion phase with fetal engagement. For diagnosis and care, it is essential to know the unique semiology and physiology of this condition as well as the obstetric maneuvers to facilitate an uncomplicated delivery. Results The mechanism of childbirth in breech presentation is complex and requires knowledge of its physiology and multiple obstetric maneuvers on the part of the obstetrician as well as the general practitioner, in order to ensure adequate care when there is no other option.
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Affiliation(s)
| | | | - Mariana Diosa-Restrepo
- Residente de tercer año de Obstetricia y Ginecología, Facultad de Medicina, Universidad Nacional de Colombia
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Beta J, Khan N, Fiolna M, Khalil A, Ramadan G, Akolekar R. Maternal and neonatal complications of fetal macrosomia: cohort study. Ultrasound Obstet Gynecol 2019; 54:319-325. [PMID: 30938000 DOI: 10.1002/uog.20278] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 02/01/2019] [Revised: 03/17/2019] [Accepted: 03/25/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To estimate the risks of maternal and neonatal complications in pregnancies with macrosomia. METHODS This was a retrospective cohort study conducted at a large maternity unit in the UK between January 2009 and December 2016. The incidence of maternal and neonatal complications in pregnancies with macrosomia, defined as birth weight (BW) > 4000 g, and in those with severe macrosomia, defined as BW > 4500 g, was compared with that in pregnancies with normal BW (2500-4000 g). Regression analysis was performed to determine odds ratios (ORs) for complications in macrosomic pregnancies compared to those with normal BW. RESULTS The study population of 35 548 pregnancies included 4522 (12.7%) with macrosomia, of which 643 (1.8%) had severe macrosomia, and 31 026 (87.3%) with normal BW. In the macrosomia group, the adjusted OR was 3.1 (95% CI, 2.6-3.6) for Cesarean section for failure to progress, 2.4 (95% CI, 2.0-3.0) for severe postpartum hemorrhage, 2.3 (95% CI, 1.9-2.8) for obstetric anal sphincter injury, 10.4 (95% CI, 8.6-12.6) for shoulder dystocia, 28.5 (95% CI, 8.9-90.7) for obstetric brachial plexus injury, 32.3 (95% CI, 3.8-278.2) for birth fractures and 4.4 (95% CI, 2.2-8.8) for hypoxic-ischemic encephalopathy. The respective values in pregnancies with severe macrosomia were 4.3 (95% CI, 3.1-6.1), 2.9 (95% CI, 1.9-4.4), 3.1 (95% CI, 1.9-5.1), 28.7 (95% CI, 20.8-39.8), 73.9 (95% CI, 15.1-363.2), 87.2 (95% CI, 7.7-985.0) and 13.8 (95% CI, 5.2-36.8). CONCLUSION Macrosomia is associated with serious adverse perinatal outcomes. This study provides accurate estimates of risks to aid in pregnancy management. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J Beta
- Fetal Medicine Unit, Medway Maritime Hospital, Gillingham, UK
| | - N Khan
- Fetal Medicine Unit, Medway Maritime Hospital, Gillingham, UK
| | - M Fiolna
- Fetal Medicine Unit, Medway Maritime Hospital, Gillingham, UK
| | - A Khalil
- Fetal Medicine Unit, Medway Maritime Hospital, Gillingham, UK
| | - G Ramadan
- Oliver Fisher Neonatal Unit, Medway Maritime Hospital, Gillingham, UK
| | - R Akolekar
- Fetal Medicine Unit, Medway Maritime Hospital, Gillingham, UK
- Institute of Medical Sciences, Canterbury Christ Church University, Chatham, UK
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Beta J, Khan N, Khalil A, Fiolna M, Ramadan G, Akolekar R. Maternal and neonatal complications of fetal macrosomia: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2019; 54:308-318. [PMID: 30938004 DOI: 10.1002/uog.20279] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [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: 02/01/2019] [Revised: 03/21/2019] [Accepted: 03/25/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To determine accurate estimates of risks of maternal and neonatal complications in pregnancies with fetal macrosomia by performing a systematic review of the literature and meta-analysis. METHODS A search of MEDLINE, EMBASE, CINAHL and The Cochrane Library was performed to identify relevant studies reporting on maternal and/or neonatal complications in pregnancies with macrosomia having a birth weight (BW) > 4000 g and/or those with birth weight > 4500 g. Prospective and retrospective cohort and population-based studies that provided data regarding both cases and controls were included. Maternal outcomes assessed were emergency Cesarean section (CS), postpartum hemorrhage (PPH) and obstetric anal sphincter injury (OASIS). Neonatal outcomes assessed were shoulder dystocia, obstetric brachial plexus injury (OBPI) and birth fractures. Meta-analysis using a random-effects model was used to estimate weighted pooled estimates of summary statistics (odds ratio (OR) and 95% CI) for each complication, according to birth weight. Heterogeneity between studies was estimated using Cochran's Q, I2 statistic and funnel plots. RESULTS Seventeen studies reporting data on maternal and/or neonatal complications in pregnancy with macrosomia were included. In pregnancies with macrosomia having a BW > 4000 g, there was an increased risk of the maternal complications: emergency CS, PPH and OASIS, which had OR (95% CI) of 1.98 (1.80-2.18), 2.05 (1.90-2.22) and 1.91 (1.56-2.33), respectively. The corresponding values for pregnancies with BW > 4500 g were: 2.55 (2.33-2.78), 3.15 (2.14-4.63) and 2.56 (1.97-3.32). Similarly, in pregnancies with a BW > 4000 g, there was an increased risk of the neonatal complications: shoulder dystocia, OBPI and birth fractures, which had OR (95% CI) of 9.54 (6.76-13.46), 11.03 (7.06-17.23) and 6.43 (3.67-11.28), respectively. The corresponding values for pregnancies with a BW > 4500 g were: 15.64 (11.31-21.64), 19.87 (12.19-32.40) and 8.16 (2.75-24.23). CONCLUSION Macrosomia is associated with serious maternal and neonatal adverse outcomes. This study provides accurate estimates of these risks, which can be used for decisions on pregnancy management. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J Beta
- Fetal Medicine Unit, Medway Maritime Hospital, Gillingham, UK
| | - N Khan
- Fetal Medicine Unit, Medway Maritime Hospital, Gillingham, UK
| | - A Khalil
- Fetal Medicine Unit, Medway Maritime Hospital, Gillingham, UK
| | - M Fiolna
- Fetal Medicine Unit, Medway Maritime Hospital, Gillingham, UK
| | - G Ramadan
- Oliver Fisher Neonatal Unit, Medway Maritime Hospital, Gillingham, UK
| | - R Akolekar
- Fetal Medicine Unit, Medway Maritime Hospital, Gillingham, UK
- Institute of Medical Sciences, Canterbury Christ Church University, Chatham, UK
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Weissbach T, Hag-Yahia N, Ovadia M, Tzadikevitch Geffen K, Weitzner O, Biron-Shental T. Kiwi omnicup handheld versus Mityvac M-style conventional vacuum system: a retrospective observational study. J Matern Fetal Neonatal Med 2018; 31:3178-3182. [PMID: 28793827 DOI: 10.1080/14767058.2017.1366443] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION To improve the choice of vacuum-assisted delivery (VAD) system, we compared the outcomes of Kiwi handheld system and Mityvac M-style conventional system (both use disposable plastic cups). MATERIALS AND METHODS Retrospective observational study with data collection from electronic medical records. The study was conducted at a tertiary medical center, with approximately 7000 deliveries annually. Categorical and continuous variables were analyzed using chi-square test and t-test, respectively. p value < .05 was considered significant. The main outcomes assessed were the overall failure rate of each system, failure rates for occipito-anterior (OA) versus occipito-transverse/occipito-anterior (OT/OP) positions, +1 versus +2 fetal stations, and early maternal/neonatal outcomes. RESULTS During a 10-month period, there were 507 (8.4%) attempted VADs, 36 failed (7.1%), and eight (1.5%) converted to cesarean section. Of these, 364 were Kiwi-assisted and 143 Mityvac-assisted. Background characteristics were similar. The handheld system had more failures overall (9.6 versus 0.7%), at OA (7.6 versus 0.9%), and non-OA positions (17.3% versus none), at +1 (13.25 versus 0.96%) and at +2/3 stations (6.1% versus none), than the conventional system did, respectively. There was a higher rate of early post-partum hemorrhage (15.3 versus 7.4%) in the conventional group. Both systems had similar rates of third/fourth degree perineal tears, shoulder dystocia and adverse neonatal outcomes. CONCLUSIONS Our results suggest more failures with Kiwi compared to Mityvac, overall and at any fetal position/station, without a significant difference in adverse outcome profile.
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Affiliation(s)
- Tal Weissbach
- a Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Nasreen Hag-Yahia
- a Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Michal Ovadia
- a Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Keren Tzadikevitch Geffen
- a Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Omer Weitzner
- a Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Tal Biron-Shental
- a Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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Hsu JY, James KE, Bormann CL, Donahoe PK, Pépin D, Sabatini ME. Müllerian-Inhibiting Substance/Anti-Müllerian Hormone as a Predictor of Preterm Birth in Polycystic Ovary Syndrome. J Clin Endocrinol Metab 2018; 103:4187-4196. [PMID: 30239805 DOI: 10.1210/jc.2018-01320] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 06/18/2018] [Accepted: 09/10/2018] [Indexed: 02/07/2023]
Abstract
CONTEXT There is increasing evidence for Müllerian-inhibiting substance (MIS)/anti-Müllerian hormone (AMH) physiologic activity in the human uterus, so it is relevant to study how MIS/AMH levels impact pregnancy. OBJECTIVE To investigate the association of MIS/AMH levels with the risk of adverse obstetric outcomes. DESIGN Retrospective cohort study. SETTING Academic fertility center. PATIENTS Women who became pregnant through in vitro fertilization between January 2012 and October 2016. Exclusion criteria were: oocyte donation, gestational carrier, multiple gestations, miscarriage before 20 weeks, or medically indicated preterm deliveries. INTERVENTIONS None. MAIN OUTCOME MEASURES There were two primary outcomes, preterm birth and cesarean delivery for arrest of labor. Because MIS/AMH level is highly skewed by certain infertility diagnoses, the preterm birth analysis was stratified by polycystic ovary syndrome (PCOS) diagnosis, and the cesarean delivery for arrest of labor analysis was stratified by diminished ovarian reserve diagnosis. χ2, Mann-Whitney, and t tests were used as appropriate. A P value of <0.05 was considered statistically significant. RESULTS Among women with PCOS, those who delivered prematurely had substantially higher MIS/AMH levels (18 vs 6.4 ng/mL, P = 0.003) than did those who delivered at term. At the highest MIS/AMH values, preterm deliveries predominated; above the 90th percentile in women with PCOS, all deliveries were premature. No effect of MIS/AMH level was observed in women without PCOS. We found no association between MIS/AMH values and cesarean delivery for labor arrest. CONCLUSION In women with PCOS, substantially elevated MIS/AMH levels are significantly associated with preterm birth, suggesting closer follow-up and further studies to elucidate the underlying mechanisms.
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Affiliation(s)
- Jennifer Y Hsu
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Kaitlyn E James
- Deborah Kelly Center for Outcomes Research, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
| | - Charles L Bormann
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Patricia K Donahoe
- Harvard Medical School, Boston, Massachusetts
- Pediatric Surgical Research Laboratories, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - David Pépin
- Harvard Medical School, Boston, Massachusetts
- Pediatric Surgical Research Laboratories, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Mary E Sabatini
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Shrestha D, Baniya S, Khatri RB. Fetal Ascites Mimicking Maternal Ovarian Tumor: A Rare Cause of Obstructed Labour. Kathmandu Univ Med J (KUMJ) 2017; 15:253-255. [PMID: 30353903] [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: 06/08/2023]
Abstract
Fetal ascites has been diagnosed more frequently these days because of routine ultrasound scanning in pregnancy. However as a cause of dystocia in labour, it is very rare. Twenty four years second gravida of 28 weeks 6 days of gestation presented to labour room with preterm obstructed labour. Abdominal examination revealed less readily palpable fetal parts and distantly localized fetal heart sounds. An urgent ultrasound showed huge maternal ovarian cyst. She then underwent emergency cesarean section; delivered a male baby with grossly distended abdomen. However, the ovaries were normal looking. Routine antenatal ultrasounds help in identifying maternal and congenital fetal anomalies. They also guide in planning the most appropriate management. Whenever fetal ascites is diagnosed antenatally, possibility of dystocia in labour should be kept in mind.
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Affiliation(s)
- D Shrestha
- Department of Gynaecology and Obstetrics, Lumbini Medical College and Teaching Hospital, Pravas, Palpa, Nepal
| | - S Baniya
- Department of Gynaecology and Obstetrics, Lumbini Medical College and Teaching Hospital, Pravas, Palpa, Nepal
| | - R B Khatri
- School of Public Health, Faculty of Medicine, The University of Queensland, QLD 4006, Australia
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Mallouli M, Derbel M, Ingrid A, Sahli J, Zedini C, Ajmi T, Mtiraoui A. Associated outcomes to fetal macrosomia: effect of maternal diabetes. Tunis Med 2017; 95:120-125. [PMID: 29424871] [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 Fetal macrosomia is associated with an increased risk of adverse outcomes to both the mother and the infant. AIM To determine maternal and neonatal outcomes associated to fetal macrosomia in diabetic and non- diabetic mothers. METHODS It is a descriptive retrospective study conducted in Tunisia. We included in this study all patients who delivered newborns having a birth weight above 4kg during 2013. Multivariate analysis was performed using binary logistic regression to identify the complications associated to macrosomic pregnancies with diabetes. RESULTS Among the 10186 deliveries registered during the study period, 821 mothers gave birth to macrosomic newborns. The prevalence of macrosomia was 8.1%, and macrosomic newborns who had a birth weight of 4500 g or greater were 1.06%. Macrosomia was significantly higher in males (p <10-3). The rate of cesarean delivery was 47.9%. The most frequent adverse maternal and neonatal outcomes were perineal tears (3.6%), post-partum hemorrhage (0.6%), shoulder dystocia (4.9%) and neonatal intensive care unit admission (7.6%).The proportion of maternal diabetes was 9.3%. Macrosomic pregnancies with diabetes appear to be significantly associated with cesarean delivery (OR=2.22), postpartum hemorrhage (OR=6.69) and neonatal intensive care unit admission (OR=4.18). CONCLUSION Macrosomia increases the risk of maternal and perinatal morbidity particularly when it was associated to maternal diabetes.
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Palatnik A, Grobman WA, Hellendag MG, Janetos TM, Gossett DR, Miller ES. Predictors of shoulder dystocia at the time of operative vaginal delivery. Am J Obstet Gynecol 2016; 215:624.e1-624.e5. [PMID: 27287683 DOI: 10.1016/j.ajog.2016.06.001] [Citation(s) in RCA: 21] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 05/30/2016] [Accepted: 06/01/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND It remains uncertain whether clinical factors known prior to delivery can predict which women are more likely to experience shoulder dystocia in the setting of operative vaginal delivery. OBJECTIVE We sought to identify whether shoulder dystocia can be accurately predicted among women undergoing an operative vaginal delivery. STUDY DESIGN This was a case-control study of women undergoing a low or outlet operative vaginal delivery from 2005 through 2014 in a single tertiary care center. Cases were defined as women who experienced a shoulder dystocia at the time of operative vaginal delivery. Controls consisted of women without a shoulder dystocia at the time of operative vaginal delivery. Variables previously identified to be associated with shoulder dystocia that could be known prior to delivery were abstracted from the medical records. Bivariable analyses and multivariable logistic regression were used to identify factors independently associated with shoulder dystocia. A receiver operating characteristic curve was created to evaluate the predictive value of the model for shoulder dystocia. RESULTS Of the 4080 women who met inclusion criteria, shoulder dystocia occurred in 162 (4.0%) women. In bivariable analysis, maternal age, parity, body mass index, diabetes, chorioamnionitis, arrest disorder as an indication for an operative vaginal delivery, vacuum use, and estimated fetal weight >4 kg were significantly associated with shoulder dystocia. In multivariable analysis, parity, diabetes, chorioamnionitis, arrest disorder as an indication for operative vaginal delivery, vacuum use, and estimated fetal weight >4 kg remained independently associated with shoulder dystocia. The area under the curve for the generated receiver operating characteristic curve was 0.73 (95% confidence interval, 0.69-0.77), demonstrating only a modest ability to predict shoulder dystocia before performing an operative vaginal delivery. CONCLUSION While risk factors for shoulder dystocia at the time of operative vaginal delivery can be identified, reliable prediction of shoulder dystocia in this setting cannot be attained.
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Affiliation(s)
- Anna Palatnik
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - William A Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | - Dana R Gossett
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Furrer R, Schäffer L, Kimmich N, Zimmermann R, Haslinger C. Maternal and fetal outcomes after uterine fundal pressure in spontaneous and assisted vaginal deliveries. J Perinat Med 2016; 44:767-772. [PMID: 26352067 DOI: 10.1515/jpm-2015-0101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 06/29/2015] [Indexed: 11/15/2022]
Abstract
AIM This study aimed to evaluate maternal and fetal outcomes after uterine fundal pressure (UFP) in spontaneous and assisted vaginal deliveries. METHODS In a retrospective cohort study, 9743 singleton term deliveries with cephalic presentation were analyzed from 2004 to 2013. Spontaneous and assisted vaginal deliveries were analyzed separately with and without the application of UFP. Odds ratios were adjusted in a multivariate logistic regression analysis. RESULTS Prevalence of UFP was 8.9% in spontaneous and 12.1% in assisted vaginal deliveries. UFP was associated with a higher incidence of shoulder dystocia in both spontaneous (adjusted odds ratio [adj. OR] 2.44, confidence interval [CI] 95% 1.23-4.84) and assisted vaginal deliveries (adj. OR 6.88 CI 95% 3.50-13.53). Fetal acidosis (arterial umbilical pH<7.2) was seen more often after the application of UFP in spontaneous vaginal deliveries (adj. OR 3.18, CI 95% 2.64-3.82) and assisted vaginal deliveries (adj. OR 1.59 CI 95% 1.17-2.16). The incidence of 5'-Apgar<7 (adj. OR 2.19 CI 95% 1.04-4.6) and 10'-Apgar<7 (adj. OR 3.04 CI 95% 1.17-7.88) was also increased after the application of UFP in spontaneous deliveries. A higher incidence of anal sphincter tears (AST) (adj. OR 46.25 CI 95% 11.78-181.6) in the UFP group of spontaneous deliveries was observed. CONCLUSIONS UFP is associated with increased occurrence of shoulder dystocia and fetal acidosis. In spontaneous deliveries, the risk for lower Apgar scores after 5 and 10 min is increased, as well as the risk for AST.
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Farrar D, Simmonds M, Bryant M, Sheldon TA, Tuffnell D, Golder S, Dunne F, Lawlor DA. Hyperglycaemia and risk of adverse perinatal outcomes: systematic review and meta-analysis. BMJ 2016; 354:i4694. [PMID: 27624087 PMCID: PMC5021824 DOI: 10.1136/bmj.i4694] [Citation(s) in RCA: 211] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To assess the association between maternal glucose concentrations and adverse perinatal outcomes in women without gestational or existing diabetes and to determine whether clear thresholds for identifying women at risk of perinatal outcomes can be identified. DESIGN Systematic review and meta-analysis of prospective cohort studies and control arms of randomised trials. DATA SOURCES Databases including Medline and Embase were searched up to October 2014 and combined with individual participant data from two additional birth cohorts. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies including pregnant women with oral glucose tolerance (OGTT) or challenge (OGCT) test results, with data on at least one adverse perinatal outcome. APPRAISAL AND DATA EXTRACTION Glucose test results were extracted for OGCT (50 g) and OGTT (75 g and 100 g) at fasting and one and two hour post-load timings. Data were extracted on induction of labour; caesarean and instrumental delivery; pregnancy induced hypertension; pre-eclampsia; macrosomia; large for gestational age; preterm birth; birth injury; and neonatal hypoglycaemia. Risk of bias was assessed with a modified version of the critical appraisal skills programme and quality in prognostic studies tools. RESULTS 25 reports from 23 published studies and two individual participant data cohorts were included, with up to 207 172 women (numbers varied by the test and outcome analysed in the meta-analyses). Overall most studies were judged as having a low risk of bias. There were positive linear associations with caesarean section, induction of labour, large for gestational age, macrosomia, and shoulder dystocia for all glucose exposures across the distribution of glucose concentrations. There was no clear evidence of a threshold effect. In general, associations were stronger for fasting concentration than for post-load concentration. For example, the odds ratios for large for gestational age per 1 mmol/L increase of fasting and two hour post-load glucose concentrations (after a 75 g OGTT) were 2.15 (95% confidence interval 1.60 to 2.91) and 1.20 (1.13 to 1.28), respectively. Heterogeneity was low between studies in all analyses. CONCLUSIONS This review and meta-analysis identified a large number of studies in various countries. There was a graded linear association between fasting and post-load glucose concentration across the whole glucose distribution and most adverse perinatal outcomes in women without pre-existing or gestational diabetes. The lack of a clear threshold at which risk increases means that decisions regarding thresholds for diagnosing gestational diabetes are somewhat arbitrary. Research should now investigate the clinical and cost-effectiveness of applying different glucose thresholds for diagnosis of gestational diabetes on perinatal and longer term outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42013004608.
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Affiliation(s)
- Diane Farrar
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford BD9 6RJ, UK Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Mark Simmonds
- Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK
| | - Maria Bryant
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford BD9 6RJ, UK Leeds Institute of Clinical Trials Research, University of Leeds, Leeds LS2 9JT, UK
| | | | | | - Su Golder
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Fidelma Dunne
- Galway Diabetes Research Centre (GDRC) and School of Medicine, National University of Ireland, Republic of Ireland
| | - Debbie A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Bristol BS8 2BN, UK School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
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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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Norris T, Johnson W, Farrar D, Tuffnell D, Wright J, Cameron N. Small-for-gestational age and large-for-gestational age thresholds to predict infants at risk of adverse delivery and neonatal outcomes: are current charts adequate? An observational study from the Born in Bradford cohort. BMJ Open 2015; 5:e006743. [PMID: 25783424 PMCID: PMC4368928 DOI: 10.1136/bmjopen-2014-006743] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Construct an ethnic-specific chart and compare the prediction of adverse outcomes using this chart with the clinically recommended UK-WHO and customised birth weight charts using cut-offs for small-for-gestational age (SGA: birth weight <10th centile) and large-for-gestational age (LGA: birth weight >90th centile). DESIGN Prospective cohort study. SETTING Born in Bradford (BiB) study, UK. PARTICIPANTS 3980 White British and 4448 Pakistani infants with complete data for gestational age, birth weight, ethnicity, maternal height, weight and parity. MAIN OUTCOME MEASURES Prevalence of SGA and LGA, using the three charts and indicators of diagnostic utility (sensitivity, specificity and area under the receiver operating characteristic (AUROC)) of these chart-specific cut-offs to predict delivery and neonatal outcomes and a composite outcome. RESULTS In White British and Pakistani infants, the prevalence of SGA and LGA differed depending on the chart used. Increased risk of SGA was observed when using the UK-WHO and customised charts as opposed to the ethnic-specific chart, while the opposite was apparent when classifying LGA infants. However, the predictive utility of all three charts to identify adverse clinical outcomes was poor, with only the prediction of shoulder dystocia achieving an AUROC>0.62 on all three charts. CONCLUSIONS Despite being recommended in national clinical guidelines, the UK-WHO and customised birth weight charts perform poorly at identifying infants at risk of adverse neonatal outcomes. Being small or large may increase the risk of an adverse outcome; however, size alone is not sensitive or specific enough with current detection to be useful. However, a significant amount of missing data for some of the outcomes may have limited the power needed to determine true associations.
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Affiliation(s)
- T Norris
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - W Johnson
- MRC Unit for Lifelong Health & Ageing, University College London, London, UK
| | - D Farrar
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - D Tuffnell
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford Royal Infirmary, Bradford, UK
| | - J Wright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - N Cameron
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Rusavy Z, Bombieri L, Freeman RM. Procidentia in pregnancy: a systematic review and recommendations for practice. Int Urogynecol J 2015; 26:1103-9. [PMID: 25600351 DOI: 10.1007/s00192-014-2595-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 08/27/2014] [Accepted: 11/27/2014] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse (POP) in pregnancy is a rare condition with decreasing incidence and improved management and outcome world-wide recently. Systematic review of the literature for cases of POP in pregnancy published since 1990 was carried out to identify common factors in presentation, management and outcomes. One case from our own practice was added to the analysis. METHODS An extensive search of the Pubmed/Medline, Scopus and Google Scholar databases was performed to identify all cases of POP in pregnancy since 1990. Published case reports of POP in pregnancy were reviewed and summarized in tables to find similarities in history, course, management and outcome of the pregnancies. RESULTS Of the 43 cases and one case series, 41 case studies were eligible for analysis. Two types of POP in pregnancy were identified: preexisting is less common (14 vs 27 cases), often resolves during pregnancy (5 out of 14) and always recurs after delivery (14 out of 14); acute onset of POP in pregnancy rarely resolves in pregnancy (2 out of 27), but often resolves after delivery (18 out of 27). Most patients were managed with bed rest (20 out of 41), pessary (15 out of 41), manual reduction (6 out of 41) and local treatment (6 out of 41). The most common complications reported include preterm labour (14 out of 41), cervical ulcerations (9 out of 41), infection (3 out of 41) and obstructed labour (4 out of 41). About a half of the women delivered vaginally (22 out of 41), caesarean section due to prolapse was required in 15 cases. CONCLUSIONS Two distinct entities were identified based on similarities regarding onset, course and outcome of POP in pregnancy. Concise recommendations for practice were derived from the analysis of case studies published since 1990.
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Affiliation(s)
- Zdenek Rusavy
- Department of Obstetrics and Gynecology, Faculty of Medicine in Pilsen, Charles University in Prague, Alej Svobody 80, Pilsen, 30460, Czech Republic,
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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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Zhu M, Cai J, Liu S, Huang M, Chen Y, Lai X, Chen Y, Zhao Z, Wu F, Wu D, Miu H, Lai S, Chen G. Relationship between gestational fasting plasma glucose and neonatal birth weight, prenatal blood pressure and dystocia in pregnant Chinese women. Diabetes Metab Res Rev 2014; 30:489-96. [PMID: 24665054 DOI: 10.1002/dmrr.2544] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 09/24/2013] [Revised: 02/25/2014] [Accepted: 02/26/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND Little is known about the optimal cut-off point of fasting plasma glucose for the diagnosis of gestational diabetes mellitus for pregnant Chinese women. This study investigates the relationship between gestational fasting plasma glucose and several variables: neonatal birth weight, prenatal blood pressure and dystocia rate of pregnant women. In this study, we hoped to provide a useful tool to screen gestational diabetes mellitus in pregnant Chinese women. METHODS For 1058 pregnant women enrolled in our hospital at pregnancy weeks 22-30, fasting plasma glucose, neonatal birth weight and prenatal blood pressure, as well as dystocia conditions, were examined. We analysed the correlations between the following: gestational fasting plasma glucose and neonatal birth weight; prenatal blood pressure and gestational fasting plasma glucose as well as dystocia rate and gestational fasting plasma glucose group. RESULTS A modest correlation was observed between gestational fasting plasma glucose and neonatal birth weight (r = 0.093, p = 0.003). The macrosomia rate was smallest when the gestational fasting plasma glucose was in the range 3.51-5.5 mmol/L. Prenatal blood pressure increased linearly with increasing gestational fasting plasma glucose (p = 0.000). There was a significant difference between the dystocia rates in different fasting plasma glucose groups (chi-squared = 13.015, p = 0.043). The results showed that the dystocia rate significantly increased when gestational fasting plasma glucose was >4.9 mmol/L; p = 0.03, OR = 2.156 (95% CI, 1.077-4.318). CONCLUSION We suggest that the optimal range of gestational fasting plasma glucose for pregnant Chinese women is in the range 3.5-4.9 mmol/L.
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Affiliation(s)
- Min Zhu
- Department of Endocrinology, The Second People's Hospital of Fujian province, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
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Harper LM, Caughey AB, Roehl KA, Odibo AO, Cahill AG. Defining an abnormal first stage of labor based on maternal and neonatal outcomes. Am J Obstet Gynecol 2014; 210:536.e1-7. [PMID: 24361789 PMCID: PMC4076788 DOI: 10.1016/j.ajog.2013.12.027] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [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: 09/18/2013] [Revised: 11/12/2013] [Accepted: 12/17/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of the study was to determine the threshold for defining abnormal labor that is associated with adverse maternal and neonatal outcomes. STUDY DESIGN This study consisted of a retrospective cohort of all consecutive women admitted at a gestation of 37.0 weeks or longer from 2004 to 2008 who reached the second stage of labor. The 90th, 95th, and 97th percentiles for progress in the first stage of labor were determined specific for parity and labor onset. Women with a first stage above and below each centile were compared. Maternal outcomes were cesarean delivery in the second stage, operative delivery, prolonged second stage, postpartum hemorrhage, and maternal fever. Neonatal outcomes were a composite of the following: admission to level 2 or 3 nursery, 5 minute Apgar less than 3, shoulder dystocia, arterial cord pH of less than 7.0, and a cord base excess of -12 or less. RESULTS Of the 5030 women, 4534 experienced first stage of less than the 90th percentile, 251 between the 90th and 94th percentiles, 102 between the 95th and 96th percentiles, and 143 at the 97th percentile or greater. Longer labors were associated with an increased risk of a prolonged second stage, maternal fever, the composite neonatal outcome, shoulder dystocia, and admission to a level 2 or 3 nursery (P < .01). Depending on the cutoff used, 29-30 cesarean deliveries would need to be performed to prevent 1 shoulder dystocia. CONCLUSION Although women who experience labor dystocia may ultimately deliver vaginally, a longer first stage of labor is associated with adverse maternal and neonatal outcomes, in particular shoulder dystocia. This risk must be balanced against the risks of cesarean delivery for labor arrest.
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Affiliation(s)
- Lorie M Harper
- Department of Obstetrics and Gynecology, University of Alabama School of Medicine at Birmingham, Birmingham, AL
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
| | - Kimberly A Roehl
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Anthony O Odibo
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Alison G Cahill
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO
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Boujoual M, Madani H, Benhaddou H, Belahcen M. [Conjoined twins at common omphalocele and cloacal exstrophy with sexual ambiguity]. Pan Afr Med J 2014; 17:243. [PMID: 25170387 PMCID: PMC4145272 DOI: 10.11604/pamj.2014.17.243.2418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/29/2013] [Accepted: 10/07/2013] [Indexed: 11/11/2022] Open
Abstract
Les jumeaux conjoints sont considérés comme étant une complication rare et grave des grossesses monozygotes. Le diagnostic anténatal permet de définir avec précision les structures communes, de rechercher une anomalie congénitale associée, d'organiser l´accouchement et la prise en charge néonatale. Nous présentons un cas rare de jumeaux conjoints dont la fusion se situait au niveau d'une omphalocèle commune associée à une extrophie cloacale, ambiguïté sexuelle et pieds bots. Le diagnostic a été méconnu pendant la grossesse, ce qui a engendré une dystocie lors de l'accouchement. L'issue a été fatale malgré une tentative de séparation et des mesures de réanimation. Ce cas illustre la difficulté liée d'une part à la méconnaissance du diagnostic, d'autre part au caractère urgent de la césarienne et de la séparation chirurgicale.
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Affiliation(s)
- Majdouline Boujoual
- Gynécologie Obstétrique, Faculté de Médecine et de Pharmacie Oujda, Université Mohamed I, Maroc
| | - Hamid Madani
- Anesthésie Réanimation, Faculté de Médecine et de Pharmacie Oujda, Université Mohamed I, Maroc
| | - Housain Benhaddou
- Chirurgie Pédiatrique, Faculté de Médecine et de Pharmacie Oujda, Université Mohamed I, Maroc
| | - Mohamed Belahcen
- Chirurgie Pédiatrique, Faculté de Médecine et de Pharmacie Oujda, Université Mohamed I, Maroc
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Burkhardt T, Schmidt M, Kurmanavicius J, Zimmermann R, Schäffer L. Evaluation of fetal anthropometric measures to predict the risk for shoulder dystocia. Ultrasound Obstet Gynecol 2014; 43:77-82. [PMID: 23836579 DOI: 10.1002/uog.12560] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/27/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To evaluate the quality of anthropometric measures to improve the prediction of shoulder dystocia by combining different sonographic biometric parameters. METHODS This was a retrospective cohort study of 12,794 vaginal deliveries with complete sonographic biometry data obtained within 7 days before delivery. Receiver-operating characteristics (ROC) curves of various combinations of the biometric parameters, namely, biparietal diameter (BPD), occipitofrontal diameter (OFD), head circumference, abdominal diameter (AD), abdominal circumference (AC) and femur length were analyzed. The influences of independent risk factors were calculated and their combination used in a predictive model. RESULTS The incidence of shoulder dystocia was 1.14%. Different combinations of sonographic parameters showed comparable ROC curves without advantage for a particular combination. The difference between AD and BPD (AD - BPD) (area under the curve (AUC) = 0.704) revealed a significant increase in risk (odds ratio (OR) 7.6 (95% CI 4.2-13.9), sensitivity 8.2%, specificity 98.8%) at a suggested cut-off ≥ 2.6 cm. However, the positive predictive value (PPV) was low (7.5%). The AC as a single parameter (AUC = 0.732) with a cut-off ≥ 35 cm performed worse (OR 4.6 (95% CI 3.3-6.5), PPV 2.6%). BPD/OFD (a surrogate for fetal cranial shape) was not significantly different between those with and those without shoulder dystocia. The combination of estimated fetal weight, maternal diabetes, gender and AD - BPD provided a reasonable estimate of the individual risk. CONCLUSION Sonographic fetal anthropometric measures appear not to be a useful tool to screen for the risk of shoulder dystocia due to a low PPV. However, AD - BPD appears to be a relevant risk factor. While risk stratification including different known risk factors may aid in counseling, shoulder dystocia cannot effectively be predicted.
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Affiliation(s)
- T Burkhardt
- Department of Obstetrics and Gynecology, University Hospital of Zürich, Zürich, Switzerland
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Paul SP, Heaton PA, Patel K. Breaking it to them gently: fractured clavicle in the newborn. Pract Midwife 2013; 16:31-34. [PMID: 24358598] [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: 06/03/2023]
Abstract
Birth injuries are frequently seen in newborn infants. Clavicular fractures are the most commonly encountered bony injuries seen in clinical practice. The incidence of clavicle fracture ranges from 0.35 per cent to 2.9 per cent of births and remains undetected at the time of discharge from hospital in up to 40 per cent of cases. Clinical suspicion of fractured clavicle may be raised from history (shoulder dystocia) or clinical examination (spongy feeling or crepitus on palpation). This should be confirmed with imaging studies. Parents should have the diagnosis explained and be reassured that healing without residual deformity will occur without any medical intervention. Careful documentation of any confirmed clavicle fracture is important from medico-legal aspects. We present the case of a newborn clavicular fracture associated with shoulder dystocia, following a vaginal birth,.
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Abstract
Fetal macrosomia and maternal diabetes are independent risk factors for shoulder dystocia, an obstetrical emergency that may cause permanent neonatal injury. Randomized trials of glycemic control in pregnancies complicated by gestational diabetes reveal decreased rates of macrosomia and shoulder dystocia among those treated. However, definitions of gestational diabetes vary and a specific glycemic threshold for clinically significant risk reduction remains to be delineated. This review discusses risks associated with gestational diabetes including macrosomia (birth weight above 4000-4500 g) and delivery-related morbidity, specifically, shoulder dystocia. Subsequently, we will review recent randomized trials assessing the impact of glycemic control on these delivery-related morbidities. Finally, we will examine a large observational study that found associations with delivery-related morbidity and hyperglycemia below current diabetic thresholds, observations which may suggest reexamination of current diagnosis guidelines for gestational diabetes.
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Affiliation(s)
- Brett C Young
- Massachusetts General Hospital, Division of Maternal Fetal Medicine, 55 Fruit Street, Founders 4th Floor, Boston, MA 02114, USA.
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Jaggat A, Mencia M, Ali T, Stewart V. A five-year retrospective review of infants with Erb-Duchenne's palsy at a teaching hospital in North Trinidad. W INDIAN MED J 2013; 62:45-47. [PMID: 24171327] [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]
Abstract
Birth injuries are devastating to parents and carers alike. They carry the possibility of residual loss of function to the infant and thus the potential for litigation. The aim of this study was to determine the incidence of Erb-Duchenne's palsy and the identification of any contributing factors. A retrospective review over a five-year period, 2005-2009, was performed and an incidence of 0.94 per 1000 live births was noted. An association between both macrosomia and shoulder dystocia and the development of Erb-Duchenne palsy in the newborn was noted. The authors recommended the use of partograms and improved note documentation in the management of labour.
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Affiliation(s)
- A Jaggat
- The University of the West Indies Office, Bungalow 5, Port-of-Spain General Hospital, Trinidad and Tobago.
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Dane C, Rustemoglu Y, Kiray M, Ozkuvanci U, Tatar Z, Dane B. Vaginal leiomyoma in pregnancy presenting as a prolapsed vaginal mass. Hong Kong Med J 2012; 18:533-535. [PMID: 23223657] [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] Open
Abstract
Vaginal leiomyomas are rare benign solid tumours of the vagina. They can cause mechanical dystocia, which is a common problem in obstetrics leading to serious maternal and perinatal complications. Here we describe a patient with a vaginal leiomyoma diagnosed during the mid-trimester that could have caused dystocia. This 22-year-old woman presented with a vaginal mass and leaking vaginal fluid during pregnancy. On examination, a prolapsed, pedunculated mass, measuring 5 × 3 × 4 cm was detected in the anterior vaginal wall. Via a midline incision, the mass was easily enucleated and removed. Transvaginal surgical enucleation of the vaginal leiomyoma is usually curative and recommended as the initial treatment of choice to prevent for dystocia. Such treatment is indicated when the tumour is a potential obstacle to normal labour.
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Affiliation(s)
- Cem Dane
- Department of Gynecology and Obstetrics, Haseki Training and Research Hospital, Istanbul, Turkey.
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Falavigna M, Schmidt MI, Trujillo J, Alves LF, Wendland ER, Torloni MR, Colagiuri S, Duncan BB. Effectiveness of gestational diabetes treatment: a systematic review with quality of evidence assessment. Diabetes Res Clin Pract 2012; 98:396-405. [PMID: 23031412 DOI: 10.1016/j.diabres.2012.09.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [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: 04/30/2012] [Accepted: 09/04/2012] [Indexed: 12/16/2022]
Abstract
AIMS To evaluate the effectiveness of gestational diabetes (GDM) treatment compared to usual antenatal care, in the prevention of adverse pregnancy outcomes. Additionally, to assess the quality of the evidence to support GDM treatment according to GRADE guidelines. METHODS Fourteen electronic databases and reference lists of relevant literature were searched for articles published from inception to February, 2012. Controlled clinical trials comparing GDM treatment to usual antenatal care were included. Independent extraction of articles was done by two authors using predefined data fields. RESULTS Seven trials involving 3157 women were included. We found high quality evidence that treatment of GDM reduces macrosomia (RR=0.47; 95% CI, 0.34-0.65; NNT=11.4) and large for gestational age birth (RR=0.57; 95% CI, 0.47-0.71; NNT=12.2); moderate quality evidence that treatment reduces preeclampsia (RR=0.61; 95% CI, 0.46-0.81; NNT=21.0) and hypertensive disorders in pregnancy (RR=0.64; 95% CI, 0.51-0.81; NNT=18.1); and low quality evidence that treatment reduces shoulder dystocia (RR=0.41; 95% CI, 0.22-0.76; NNT=48.8). No statistically significant reduction was seen for caesarean section. No increase in small for gestational age or preterm birth was found. CONCLUSIONS Treatment of GDM is effective in reducing macrosomia (high quality evidence), preeclampsia and shoulder dystocia.
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Affiliation(s)
- Maicon Falavigna
- Post Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos n. 2600, Porto Alegre, Brazil.
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Urzaiz Rodríguez E. [The tragedy of vertex delivery occipito-posterior positions. 1955]. Ginecol Obstet Mex 2012; 80:625-629. [PMID: 23243838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Abstract
OBJECTIVE To evaluate whether fetal cranial shape is related to shoulder dystocia. METHODS We compared shoulder dystocia cases (n = 18) with controls (normal vaginal deliveries, n = 18) in a retrospective matched-pairs observational study. Subjects were matched for known maternal and fetal risk factors and then evaluated for fetal biometric differences, which were measured by ultrasound near delivery. We tested multivariable risk models to predict shoulder dystocia by logistic regression. RESULTS Cases had a smaller estimated occipitofrontal diameter (OFD) (P = 0.02) and a larger biparietal diameter/estimated OFD ratio (P = 0.003). A multivariable model including estimated fetal weight, estimated OFD, maternal weight and diabetes mellitus had sensitivity and specificity of 86% and 95%, respectively, and positive and negative likelihood ratios of 18.9 and 0.15, respectively. Estimated OFD significantly increased the predictive value of the model. CONCLUSION A small estimated OFD is a risk factor for shoulder dystocia in the presence of other significant risk factors. A multivariable model including estimated OFD can predict shoulder dystocia in a clinically useful range.
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Affiliation(s)
- M A Belfort
- Baylor College of Medicine, Department of Obstetrics and Gynecology, Houston, TX 77030, USA.
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41
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Erteld E, Wehrend A, Goericke-Pesch S. [Uterine torsion in cattle - frequency, clinical symptoms and theories about the pathogenesis]. Tierarztl Prax Ausg G Grosstiere Nutztiere 2012; 40:167-176. [PMID: 22688740] [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] [Received: 02/01/2012] [Accepted: 04/17/2012] [Indexed: 06/01/2023]
Abstract
UNLABELLED Aim of the present study was to summarize the available literature about the incidence, frequency, clinical symptoms and ideas as to the pathogenesis of uterine torsion in the cow. MATERIALS AND METHODS Analysis of the literature using electronic libraries (Pub Med, Medline), German veterinary medicine journals and obstetrical textbooks. RESULTS Uterine torsion is a very important maternal reason for dystocia as most cases occur during parturition. The post-cervical torsion (combined uterine and vaginal torsion, Torsio uteri and vaginae) is more commonly diagnosed than an intra-cervical or pre-cervical torsion. Torsions to the left occur more frequently than to the right. Clinical symptoms clearly vary depending on the degree of torsion. The frequency in relation to all parturitions is described as between 0.5 and 1%, whereas the percentage of uterine torsions presented to the veterinarian as a reason for dystocia varies between 2.7 and 65%. The pathogenesis of uterine torsion remains unclear; however, general agreement exists that the cow is predisposed to uterine torsion due to its anatomy. It appears that the Brown Swiss is more often affected than other cattle breeds.
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Affiliation(s)
- E Erteld
- Klinik für Geburtshilfe, Gynäkologie und Andrologie der Groß- und Kleintiere mit Tierärztlicher Ambulanz, Justus-Liebig-Universität Gießen, Frankfurter Straße 106, 35392 Gießen
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Udeh R, Mahran MA, Oligbo N. Comparison of perinatal outcomes of shoulder dystocia alleviated by different type and sequence of manoeuvres: a retrospective review. BJOG 2011; 118:1677; author reply 1677-8. [PMID: 22077257 DOI: 10.1111/j.1471-0528.2011.03161.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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43
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Ruis KA, Allen RH, Gurewitsch ED. Severe shoulder dystocia with a small-for-gestationaI-age infant: a case report. J Reprod Med 2011; 56:178-180. [PMID: 21542540] [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: 05/30/2023]
Abstract
BACKGROUND Severe shoulder dystocia is disproportionately associated with large-for-gestational-age infants. CASE A nulliparous patient at 38 weeks' gestation had an uncomplicated antenatal course. Clinical pelvimetry revealed an acute-angle pubic arch but otherwise normal diameters, conjugate and sacral concavity. Pre-pregnancy BMI was 20.8 and she had had a 14-pound (6.4 kg) weight gain. She presented in labor and, with oxytocin augmentation, progressed to full dilation over 6 hours, followed by an 18-minute second stage. Severe shoulder dystocia was encountered, necessitating multiple maneuvers, and was resolved after 2 minutes with delivery of the posterior arm. The healthy infant weighed 2,289 g (< 5th percentile) and exhibited only transient shoulder weakness, which resolved completely within 1 hour of life. With informed consent, CT pelvimetry was performed within 24 hours postpartum for investigative purposes, revealing small pelvic inlet and at-threshold interischial diameter. CONCLUSION Geometric analysis reveals that borderline adequate pelvimetry likely played a significant role in severe shoulder dystocia etiology, even with a small-for-gestational-age infant. We alert obstetric providers to the possibility of severe shoulder dystocia in patients with borderline adequate pelves on clinical examination, even when estimated fetal weight makes cephalopelvic disproportion unlikely.
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Affiliation(s)
- Kristy A Ruis
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland 21287, USA
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Abstract
The primary indication for cesarean section in nulliparous women continues to be clinical diagnoses that fall under the rubric of dystocia. These diagnoses account for approximately two-thirds of all cesareans experienced by otherwise healthy nulliparous women. Contemporary research evidence suggests that this clinical phenomenon is complex and multifactorial. This review explores factors associated with the phenomenon of dystocia in the context of a conceptual model that considers women's physical and psychological characteristics, fetal factors, intrapartum care and interventions, assessments and clinical decision-making of health care providers, the sociopolitical environment, and the social and physical environment of childbirth. Clinical recommendations include emphasis on the maintenance of normal weight and weight gain during pregnancy, delaying the admission of nulliparous women to the hospital until active labor is established, avoiding elective induction for nulliparous women, keeping women well-hydrated and well-fed during labor, providing high-quality supportive care during labor, staying the course with effective treatment when dystocia is encountered, and a renewed emphasis on the psychobehavioral preparation of nulliparous women for the realities of labor.
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Affiliation(s)
- Nancy K Lowe
- Oregon Health & Science University, Portland, OR 97239-2941, USA.
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Chauhan SP, Lynn NN, Sanderson M, Humphries J, Cole JH, Scardo JA. A scoring system for detection of macrosomia and prediction of shoulder dystocia: A disappointment. J Matern Fetal Neonatal Med 2009; 19:699-705. [PMID: 17127493 DOI: 10.1080/14767050600797483] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To develop a scoring system for the detection of a macrosomic fetus (birth weight (BW) >or= 4000 g) and predict shoulder dystocia among large for gestational age fetuses. STUDY DESIGN We retrospectively identified all singletons with accurate gestational age (GA) that were large for GA (abdominal circumference (AC) or estimated fetal weight (EFW) >or= 90% for GA) at >or=37 weeks with delivery within three weeks. The scoring system was: 2 points for biparietal diameter, head circumference, AC, or femur length >or=90% for GA, or if the amniotic fluid index (AFI) was >or=24 cm; for biometric parameters <90% or with AFI <24 cm, 0 points. The predictive values for detection of shoulder dystocia were calculated. RESULTS Of the 225 cohorts that met the inclusion criteria the rate of macrosomia was 39% and among vaginal deliveries (n = 120) shoulder dystocia occurred in 12% (15/120; 95% confidence interval (CI) 7-20%). The sensitivity of EFW >or=4500 g to identify a newborn with shoulder dystocia was 0% (95% CI 0-21%), positive predictive values 0% (95% CI 0-46%), and likelihood ratio of 0. For a macrosomia score >6, the corresponding values were 20% (4-48%), 25% (5-57%) and 2.3. CONCLUSION Though the scoring system can identify macrosomia, it offers no advantage over EFW. The scoring system and EFW are poor predictors of shoulder dystocia.
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Affiliation(s)
- Suneet P Chauhan
- Division of Maternal-Fetal Medicine, Aurora Health Care, West Allis, Wisconsin 53227, USA.
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Chauhan SP, Christian B, Gherman RB, Magann EF, Kaluser CK, Morrison JC. Shoulder dystocia without versus with brachial plexus injury: A case–control study. J Matern Fetal Neonatal Med 2009; 20:313-7. [PMID: 17437239 DOI: 10.1080/14767050601165805] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To delineate factors that differentiate shoulder dystocia with and without brachial plexus injury (BPI). STUDY DESIGN A case-control study culled from an established shoulder dystocia database. Cases of shoulder dystocia-related BPI were identified and matched (1:1) with a control group of shoulder dystocia in which BPI did not result. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. RESULTS From 1980 to 2002, there were 89 978 deliveries with 46 cases of dystocia and BPI. The rate of dystocia with BPI was 0.5 per 1000 births and of permanent BPI, 0.9/10 000 deliveries. The two groups were similar for maternal demographics, diabetes, gestational age, induction, use of epidural, the duration of labor, operative vaginal delivery, rate of macrosomia, and maneuvers used to relieve the dystocia. Fracture of the clavicle occurred significantly less often among those without (2%) vs. with BPI (17%; OR 0.10, 95% CI 0.01, 0.88). CONCLUSIONS Neither antepartum nor intrapartum factors can differentiate the patient who will have shoulder dystocia with vs. without BPI.
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Sunday-Adeoye IM, Okonta P, Twomey D. Symphysiotomy at the Mater Misericordiae Hospital Afikpo, Ebonyi State of Nigeria (1982 – 1999): a review of 1013 cases. J OBSTET GYNAECOL 2009; 24:525-9. [PMID: 15369933 DOI: 10.1080/01443610410001722572] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
One thousand and thirteen (1013) symphysiotomies were performed and 27,477 deliveries were conducted during the period. The symphysiotomy rate in the study period was 3.7%. Fifty-six percent (56%) of the patients who had symphysiotomy were aged 39 years and below, and the mean age was 27.94 +/- 7.16 years. Mothers with maternal age greater than 40 years were at a higher risk for symphysiotomy. Thirty-eight percent (38%) of those who had symphysiotomy were nulliparae, 35% were multiparae, while grandmultiparae accounted for 27%. Cephalopelvic disproportion was the leading indication for symphysiotomy (88%), while arrest of the after-coming head of the breech and previous caesarean section with mild cephalopelvic disproportion were other indications for symphysiotomy. Transient post-operative pelvic and leg pain was the leading maternal complication in the study, while stress incontinence, para urethra/vagina lacerations and vesico-vagina fistula were the other complications highlighted. In the study, 69% of the symphysiotomies performed were for babies with birth weight between 3.0 and 3.9 kg. The record of one maternal death was available and was from massive pulmonary embolism on the third day postpartum. There were 104 perinatal deaths with a perinatal mortality rate of 108.7 per 1000 total births.
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Affiliation(s)
- I M Sunday-Adeoye
- Department of Obstetrics and Gynaecology, Ebonyi State University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
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Khodakarami N, Naji H, Dashti MG, Yazdjerdi M. Woman abuse and pregnancy outcome among women in Khoram Abad, Islamic Republic of Iran. East Mediterr Health J 2009; 15:622-628. [PMID: 19731778] [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: 05/28/2023]
Abstract
We carried out a descriptive analysis on the pregnancy outcome in 313 pregnant women abused, 160 non-abused). Abuse was statistically significantly correlated with mean weight gain during pregnancy, mean frequency of the prenatal care, prolonged labour (dystocia), premature rupture of membrane, low mean birth weight and mean gestational age at birth. Given the high likelihood that a woman will access health care services during her pregnancy, physicians providing prenatal care are in a strategic position to screen for partner abuse.
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Affiliation(s)
- N Khodakarami
- Shahid Beheshti Medical University, Reproductive Health Research Centre and Nurisng Midwifery School, Tehran, Islamic Republic of Iran.
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Was baby's shoulder dystocia caused by dr.? Nurs Law Regan Rep 2008; 49:2. [PMID: 19226867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Abstract
Reviewing the areas of controversy related to the obstetric management of women with GDM, we are unfortunately unable to provide significant refinement of the recommendations agreed upon after the Fourth International Workshop-Conference due to the lack of properly controlled and powered clinical studies in this area since 1997. In the area of the need for antenatal fetal surveillance in women with milder degrees of GDM, we may be able to draw indirect conclusions from ongoing cohort studies that will include large numbers of women. In the area of optimal timing and mode of delivery to avoid fetal injury, large well-controlled prospective studies do not currently exist and are urgently needed. In addition, refinement of fetal and pelvic imaging techniques to more accurately identify the maternal-fetal pairs most likely to benefit from avoiding vaginal delivery, and the more widespread availability of these technologies, may also prove to be of benefit in the obstetric management of women with GDM.
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Affiliation(s)
- Deborah L Conway
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health Science Center-San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA.
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