A systematic review and a meta-analysis on the incidence of obstetric anal sphincter injuries during vaginal delivery.

AIM: The incidence of obstetric anal sphincter injuries (OASIS) has increased in the past two decades despite improved awareness of the risk factors. This study aimed to define the incidence of OASIS in women with different features (instrumental delivery or other variables). METHODS: A systematic review was conducted on articles reporting the incidence of OASIS. This review aims to examine the association of instrumentation and OASIS by performing a formal systematic review of the published literature. Databases used for the research were MEDLINE, Embase, CINAHL and 'Maternity and infant care' databases. RESULTS: Two independent reviewers screened the selected articles. 2326 duplicates were removed from the total of 4907 articles. The remaining 2581 articles were screened for title and abstract. 1913 articles were excluded due to irrelevance. The remaining 300 were screened as full text. Primiparity associated with the use of forceps were the features associated with the highest incidence of OASIS in the selected articles (19.4%). OASIS in all women had an overall incidence of 3.8%. The incidence of OASIS in all women by geographical region was the highest (6.5%) in North America. CONCLUSIONS: There are various factors that impact on the incidence of OASIS and the combination of some of these, such as the use of forceps in primiparas, resulted in the highest incidence of OASIS. The lack of international consensus is limiting the improvements that can be done to reduce OASIS rates and improve best clinical practice.

[Obstetrical and neonatal prognosis of patients with a history of female genital mutilation]. / Pronostic obstétrical et néonatal des patientes ayant un antécédent de mutilation génitale féminine.

OBJECTIVE: Female genital mutilation (FGM) covers all procedures involving partial or total removal of the external genitalia for non-therapeutic purposes. The period of pregnancy and childbirth is probably more at risk of complications for these women. The main aim of this study was to compare obstetrical, maternal and neonatal outcomes in patients with a history of female genital mutilation with patients without such a history. METHODS: All deliveries taking place between January 2005 and June 2022 at Besançon University Hospital in patients with a history of FGM were included. This group was compared with a randomly selected group of deliveries of patients with no history of FGM. A total of 87 deliveries with a history of FGM were included and compared with 696 deliveries with no history of FGM. RESULTS: There were significantly more instrumental deliveries (27.6% vs. 17.5%, P=0.01), more caesarean sections (23% vs. 14.1%, P=0.01), more episiotomies (9.2% vs. 0.7%, P<0.01), more first-degree perineal tears (30.8% vs. 20.8%, P=0.02), second-degree (13.9% vs. 5.3%, P<0, 01), third-degree (3.1% vs. 0.2%, P=0.02), more anterior perineal tears (23.1% vs. 2.5%, P<0.01), increased duration of pushing efforts (13 min vs. 10 min, P=0.05) and greater blood loss (297 cc vs. 165 cc, P<0.01) in the group with a history of FGM. There was no statistically significant difference in neonatal outcome. CONCLUSION: The obstetrical prognosis of patients with a history of FGM is significantly poorer. Neonatal prognosis remains unchanged.

Fractura craneal deprimida congénita: ¿actitud a seguir? / Congenital depressed skull fracture: The steps to follow?

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Challenges of airway management in a patient with temporomandibular joint ankylosis complicating forceps delivery: a case report / Retos en el tratamiento de las vías respiratorias en una paciente con anquilosis de la articulación temporomandibular complicando el parto con fórceps: reporte de un caso

Ankylosis of the temporomandibular joint following forceps delivery is a rare anomaly. The aetiopathogenesis involves wrongful application of the forceps or forceful closure of the forceps handle against the condyle with haemathrosis, organisation and subsequent ankylosis. Because of the lack of epidemiological data, there is little information about the true incidence and the management of this rare anomaly. The purpose ofthis presentation is to report the challenges encountered in the airway management of a six-year old female with right temporomandibular joint ankylosis following forceps delivery in a private hospital setting.

La anquilosis de la articulacion temporomandibular tras el uso de forceps siguientes es una rara anomalia. La etiopatogenesis implica la aplicacion indebida de los forceps o el cierre forzoso del mango de los forceps contra el condilo con hemartrosis, organizacion y subsiguiente anquilosis. Debido a lafalta de datos epidemiologicos, hay poca informacion acerca de la verdadera incidencia y el tratamiento de esta rara anomalia. El objetivo de esta presentacion es informar los problemas encontrados en el tratamiento de las vias respiratorias de una niha de seis ahos con anquilosis de la articulacion temporomandibular derecha tras de un parto con forceps en el contexto de un hospital privado.

Mecanismos patogénicos de la parálisis braquial congénita: [revisión] / Pathogenic mechanisms of congenital brachial palsy: [review]

Antecedentes: Se define clásicamente a la parálisis braquial congénita como la paresia flácida de una extremidad superior secundaria al estiramiento traumático del plexo braquial durante el parto, en la extracción del hombro anterior, en relación a la distocia de hombro. Numerosas series han reportado la falta de relación entre la parálisis braquial congénita y el estiramiento traumático del plexo braquial durante la distocia de hombro. Objetivo: Realizar una revisión de la literatura para identificar las causas relacionadas con la parálisis braquial congénita. Resultados: Hasta en un 50 por ciento de los casos la parálisis braquial congénita no se asocia a distocia de hombro. Estos casos, son de peor pronóstico, afectan principalmente al hombro posterior y se presentan en recién nacidos de menor peso al nacer, pudiendo presentarse en un parto cesárea. La parálisis braquial congénita no asociada a distocia de hombro reconoce múltiples mecanismos patogénicos como: postura viciosa fetal in útero, tracción del hombro posterior por el promontorio sacro, neoplasias fetales, tumores uterinos, y otras. Conclusión: La parálisis braquial congénita, debe ser entendida como un síndrome, clínicamente caracterizado por parálisis flácida de una de las extremidades superiores detectada en el recién nacido, que responde a diferentes mecanismos patogénicos y de pronóstico variable según el caso.

Background: Classically congenital brachial palsy was defined as a flaccid paresis of the upper limb, secondary to traumatic brachial plexus stretching during delivery of the anterior shoulder in the context of shoulder dystocia. Numerous series have reported the lack of relationship between congenital brachial palsy and traumatic stretching of the brachial plexus during shoulder dystocia, in a significant number of cases. Objective: To review the literature to identify the causes related to congenital brachial palsy. Results: Up to 50 percent of cases of congenital brachial palsy are not associated to shoulder dystocia. These cases, have worse prognosis, mainly affect the posterior shoulder, presents in infants of lower birth weight and may even be in a cesarean delivery. Congenital brachial palsy not associated with shoulder dystocia recognizes multiple pathogenic mechanisms such as: vicious fetal position in utero, traction of the posterior shoulder on the sacral promontory, fetal tumors, uterine tumors, and others. Conclusion: Congenital brachial palsy, should be understood as a syndrome, clinically characterized by flaccid paresis/paralysis of one upper limb detected in the newborn, being the consequence of different pathogenic mechanisms and having variable prognosis.

Fractura de fémur en un neonato / Femur fracture in a neonate

La fractura de fémur es una infrecuente lesión obstétrica, se caracteriza por presentarse por diferentes causas ya sean maternas, obstétricas o del feto. Las manifestaciones clínicas pueden pasar desapercibidas en un primer momento, basándose el diagnostico en la sospecha clínica y confirmándose el diagnostico en la sospecha clínica y confirmándose mediante la radiografía. El tratamiento consisten en la inmovilización de la extremidad durante unas 4 semanas, el pronóstico de la lesión es excelente. Prestamos un caso clínico de una fractura de fémur en un recién nacido por cesárea en una gestación gemelar por presentación podálica del primer gemelo (AU)

Fémur fracture is an infrequent obstetrical injury. It is characterterized to appear for different causes: maternal, obstetrical or fetus related. Clinical manifestations of the injury could be unnoticed at a first moment. Diagnose is based in clinical suspicion and confirmed by x-ray. The treatment consists in the immobilization of the extremity during 4 weeks, prognosis is excellent. We present a clinical case of a femur fracture in a new born by a cesarean in a gemelar gestaction caused by a podalic presentation of the first neonate (AU)

Espátulas de Thierry: maniobra de rotación con rama invertida en posiciones occipito posteriores de la cabeza fetal / Thierry's spatula: rotational manipulation with inverted lever in occipito posterior position of fetal head

La maniobra de rotación con rama invertida de Esátula de Thierry (ET) (1, 2) es descrita y se presentan los resultados en una serie de 54 aplicaciones en pacientes que en el momento del expulsivo presentaban una distocia de posición cefálica posterior persistente. No hubo mortalidad materna ni fetal