Effectiveness of the fetal pillow to prevent adverse maternal and fetal outcomes at full dilatation cesarean section in routine practice.

INTRODUCTION: The fetal pillow has been suggested to reduce maternal trauma and fetal adverse outcomes when used to disimpact the fetal head at full dilatation cesarean section. MATERIAL AND METHODS: We performed a retrospective cohort study of the use of the fetal pillow device at full dilatation cesarean section between September 2014 and March 2018 at Liverpool Women's Hospital, a large UK teaching hospital. RESULTS: There were 471 cases of full dilatation cesarean section during the study period and 391 were included for the analysis; 170 used the fetal pillow and 221 were delivered without. We did not demonstrate any benefit in the significant maternal outcomes of estimated blood loss >1000 mL or >1500 mL, need for blood transfusion, or duration of hospital stay, from the use of the fetal pillow. We did not demonstrate any improvement in fetal outcome following use of the fetal pillow for arterial pH <7.1, Apgar score <7 at 5 minutes or admission to the neonatal unit. For deliveries undertaken at or below the level of the ischial spines there was likewise no benefit from fetal pillow use, except in a reduced risk of an arterial pH <7.1 (relative risk 0.39, 95% CI 0.20-0.80, P = .01); however, admission to the neonatal unit was unaffected. CONCLUSIONS: This is the largest study to date on the use of the fetal pillow at full dilatation cesarean section. We did not demonstrate any statistically significant benefit from the use of the fetal pillow to prevent any maternal or fetal adverse outcomes at full dilatation cesarean section in routine clinical use. Further randomized studies are required to prove clinical benefit from this device before more widespread use.

Aspects of in vivo endotracheal tube intracuff pressure in cats.

OBJECTIVES: To determine the endotracheal tube cuff pressure produced with two inflation techniques, in two brands of endotracheal tube in cats. To determine the inspiratory pressure which produces an audible leak when the intracuff pressure is 30 cmH2O. STUDY DESIGN: Prospective, clinical, randomized study. ANIMALS: A total of 40 client-owned healthy adult cats. METHODS: Following induction of anaesthesia, endotracheal intubation was performed with a Parker Flex-Tip PFLP (Parker; n = 20) or Flexicare VentiSeal (Flexicare; n = 20) endotracheal tube. For each cat, the endotracheal tube cuff was inflated using two methods, minimum occlusive volume (MOV) and pilot balloon palpation (PBP). Intracuff pressure was recorded. Cuff pressure was then set at 30 cmH2O and the pressure within the breathing system when a manual breath first caused an audible leak was measured. RESULTS: PBP pressure was lower for Parker (36 ± 13 cmH2O) compared with Flexicare (45 ± 13 cmH2O, p = 0.048). MOV pressure was not different between tube types (56 ± 28 versus 66 ± 25 cmH2O for Parker and Flexicare, respectively, p = 0.247). MOV produced a higher pressure than PBP for Parker (56 ± 28 versus 36 ± 13 cmH2O, p = 0.001) and Flexicare (66 ± 25 versus 45 ± 13 cmH2O, p = 0.007). When intracuff pressure was set at 30 cmH2O, 95% of cats did not develop an audible leak until the inspiratory pressure was greater than 10 and 12 cmH2O for Parker and Flexicare tubes, respectively. CONCLUSIONS: PBP produced lower cuff pressures than MOV, although both techniques produced a cuff pressure above that at which mucosal blood flow is believed to be restricted. A cuff pressure of 30 cmH2O may be sufficient to prevent audible leak in most cats if respiratory pressures are kept at 10-12 cmH2O or below. CLINICAL RELEVANCE: To ensure a safe endotracheal tube cuff pressure, use of a specifically designed pressure gauge is recommended.

Hyperreactio luteinalis in pregnancy.

OBJECTIVE: To report a case of hyperreactio luteinalis diagnosed in pregnancy. DESIGN: Case report. SETTING: Teaching hospital. PATIENT(S): A 30-year-old primigravida presenting with painful multicystic ovarian enlargement and subsequent virilizing features. INTERVENTION(S): Conservative management. MAIN OUTCOME MEASURE(S): Successful pregnancy resulting in the live birth of a female infant with no gross abnormalities. RESULT(S): On investigation, she developed elevated serum androgen levels and had sonographically the characteristic "spoke wheel" appearance of hyperreactio luteinalis. The patient was managed symptomatically with normal outcomes and a return postnatally to before pregnancy features. CONCLUSION(S): An uncommon clinical presentation in obstetrics in which conservative management can result in good outcomes.