Caesarean section at full cervical dilatation.

BACKGROUND: Caesarean section at full cervical dilatation has many implications for maternal and neonatal morbidity as well as subsequent pregnancy outcomes. However, increasing trends are reported internationally for second-stage caesarean delivery. OBJECTIVES: To review the rate and indication for a caesarean section at full dilatation over a 5-year period at a tertiary referral obstetric centre in Sydney. MATERIALS AND METHODS: Retrospective cohort review of all women with a singleton, cephalic presenting fetus at ≥37(0)  weeks' gestation delivered by caesarean section in the second stage of labour between 1 January 2009 and 31 December 2013 at Royal Prince Alfred Hospital. Medical records were reviewed, and demographic, maternal and fetal outcome data were obtained. Consultant supervision and documentation standards were recorded. The main outcome measures were the rate of caesarean section at full cervical dilatation, maternal and fetal morbidity. RESULTS: During the study period, 8449/26063 (32.4%) babies were born by caesarean section. Of these surgical births, 476 (5.6%) were performed at full cervical dilatation at >37 weeks' gestation. There was no observed trend over the 5 years. The majority of women delivered by caesarean section at full dilatation were nulliparous and in spontaneous labour. More than half of these women were delivered without a trial of instrumental delivery. Consultant obstetricians were present for 7% of public second-stage caesarean deliveries. CONCLUSION: We report a 5-year experience with caesarean delivery at full dilatation at a tertiary unit. The rate was variable over the 5 years. Secondary outcome measures suggest that consultant supervision is uncommon and documentation standards require improvement.

Chronic pain education delivered with a virtual reality headset in outpatient physical therapy clinics: a multi-site exploratory trial.

OBJECTIVE: Chronic pain is multidimensional, requiring expanded interventions for optimal management. Pain education, mindfulness training, and virtual reality (VR) are showing promise, but barriers remain for implementation by clinicians. The purpose of this study was to explore the experiences with a pain education and mindfulness intervention for patients with chronic low back pain and their treating clinicians. METHODS: This was a prospectively designed exploratory trial registered at ClinicalTrials.gov: NCT04777877. Patients were identified by study staff and consented. Baseline and follow-up questionnaires and surveys were collected with quantitative and qualitative data. Patients viewed five videos explaining key pain concepts and guided imagery nature videos using a VR headset. RESULTS: Twenty patients consented, and 15 patients completed the intervention. Patients and clinicians rated their experiences with the program as excellent; however, concerns were raised related to logistical challenges around use of the VR headset in busy clinic settings. Percentage changes in patient pain knowledge occurred in the desired direction in 8 out of 9 key concepts. CONCLUSIONS: Delivering educational and mindfulness content with a VR headset to patients with chronic low back pain was feasible and acceptable to patients and clinicians. Concerns remain regarding the increased time burden with use of this technology in a busy clinic setting weighed against potential benefits. Alternative delivery methods are needed to reduce logistical challenges and increase patient access to content outside of the clinic setting.

Internal jugular vein thrombosis following ovarian hyperstimulation syndrome.

Two cases of women who developed internal jugular vein (IJV) thrombosis associated with ovarian hyperstimulation syndrome (OHSS) are reported in this article. There are 27 cases of IJV thrombosis associated with in vitro fertilisation (IVF) reported in the literature, and in 78% of cases, this outcome was following OHSS. The hypercoagulable state of OHSS increases the risk of venous thromboembolism, and the IJV appears to have a preponderance in uncommon-site thrombosis.

Idiopathic ovarian vein thrombosis: a rare cause of pelvic pain - case report and review of literature.

Ovarian vein thrombosis is a condition most commonly identified in the puerperium and in association with malignancy, pelvic infections, surgery and thrombophilia. We report a case of idiopathic ovarian vein thrombosis and therefore highlight the importance of considering the diagnosis in women presenting with lower abdominal pain, in whom more common diagnoses cannot be identified.

Spontaneous septostomy in monochorionic diamniotic twins resulting in cord entanglement and fetal demise.

Monoamniotic twins are known to be at risk of cord entanglement, and have an elevated perinatal morbidity and mortality associated with this. We present a case of cord entanglement in a monochorionic diamniotic (MCDA) twin pregnancy thought to be due to spontaneous septostomy. Unfortunately the cord entanglement was detected postpartum, and ultimately resulted in the demise of one of the twins. Literature review reveals this as a recognised, albeit rare, phenomena.