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1.
N Z Med J ; 133(1515): 97-103, 2020 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-32438381

RESUMO

The role of the external clinical advisor is critical to the adjudication of complex claims in the processes of the Accident Compensation Corporation (ACC). This is particularly true of claims for treatment injury that occur during birth, which are often very complicated. In most cases external clinical advisors are non-treating doctors, whose opinion strongly guides the hand of ACC. This viewpoint considers the impact of the role of the external clinical advisor by using extracts from an external clinical advisor's report to show how a power imbalance can be enacted in ACC decision making processes. Also considered are the way that the normal checks and balances in the system, particularly those provided by the Health & Disability Commissioner, are bypassed in most cases. Finally, a recommendation is made to potential external clinical advisors to precisely following the standards set by the Medical Council in all cases when writing reports for ACC.


Assuntos
Traumatismos do Nascimento/etiologia , Compensação e Reparação/legislação & jurisprudência , Prova Pericial/normas , Papel do Médico , Lesões Encefálicas/etiologia , Criança , Tomada de Decisões , Prova Pericial/legislação & jurisprudência , Feminino , Transtornos do Crescimento/complicações , Humanos , Doença Iatrogênica , Recém-Nascido , Consentimento Livre e Esclarecido/legislação & jurisprudência , Masculino , Nova Zelândia , Osteocondrodisplasias/complicações , Gravidez , Complicações na Gravidez/etiologia
4.
J Craniofac Surg ; 31(3): e260-e261, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32049914

RESUMO

Inappropriate fusion of the cranial sutures leads to craniosynostosis and the subsequent skull rigidity can cause many developmental and structural problems. Cephalohematoma is a subperiosteal collection of blood commonly associated with birth trauma or instrument-assisted delivery and is one of the most frequently reported fetal injuries in Caesarian section procedures. There have been very few cases reported of patients with both scaphocephaly due to sagittal craniosynostosis and cephalohematoma and no reports of scaphocephaly with bilateral cephalohematoma as of the date of this report. The current literature suggests that the two conditions are potentially associated, either through mechanical pathways involving trauma or through a complex interplay of growth factors. The authors present a case of bilateral cephalohematoma with scaphocephaly secondary to progressive sagittal craniosynostosis.


Assuntos
Traumatismos do Nascimento/cirurgia , Craniossinostoses/cirurgia , Hematoma/cirurgia , Traumatismos do Nascimento/complicações , Craniossinostoses/complicações , Feminino , Hematoma/complicações , Humanos , Recém-Nascido , Masculino , Gravidez , Crânio/cirurgia
5.
Eur J Obstet Gynecol Reprod Biol ; 243: 57-62, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31671293

RESUMO

OBJECTIVES: To establish the incidence of obstetric neonatal brachial plexus and facial nerve injuries in a tertiary maternity hospital in the United Kingdom and to identify associated risk factors with an emphasis on the time of delivery. STUDY DESIGN: From our hospital electronic data bases we identified all live births born between 2000 and 2016 and those neonates who sustained a nerve injury during delivery. We performed a logistic regression analysis linking "facial nerve injury" and "brachial plexus injury" with variables for which we had complete cohort data including "breech", "gestation", "sex", "birthweight", "day of week", "time of delivery", "method of delivery", "singleton/multiple deliveries" and "number of deliveries per day". Significance level was set at 5%. RESULTS: We identified 87,461 live births of which 29 had sustained a facial nerve and 45 a brachial plexus injury. Logistic regression showed a significant positive association between "facial nerve injury" and "forceps delivery" (95% CI: 25-1398), "Ventouse delivery" (95% CI: 1.7-207) and "emergency Caesarean section" (95% CI: 1.7-148) and between "brachial plexus injury "and "birthweight" (95% CI: 1.001-1.003), "forceps delivery" (95% CI: 3.4-14) and "Ventouse delivery" (95% CI: 2.5-13). There was no increased risk for weekend and out of hours deliveries. All babies with a nerve injury made a full recovery. CONCLUSIONS: Our obstetric neonatal nerve injury rate (0.085%) was low with our brachial plexus injury rate (0.051%) being about one third of a historical rate from Ireland (0.15%) and half of the rate recently reported from the United States (0.12%) which could be linked to our staff dealing with many high risk pregnancies. Neonatal birth injury data should be included as a clinical safety marker for delivery units.


Assuntos
Traumatismos do Nascimento/epidemiologia , Neuropatias do Plexo Braquial/epidemiologia , Extração Obstétrica/estatística & dados numéricos , Traumatismos do Nervo Facial/epidemiologia , Adulto , Cesárea/estatística & dados numéricos , Clavícula/lesões , Estudos de Coortes , Parto Obstétrico , Feminino , Fraturas Ósseas/epidemiologia , Maternidades , Humanos , Fraturas do Úmero/epidemiologia , Recém-Nascido , Gravidez , Recuperação de Função Fisiológica , Estudos Retrospectivos , Centros de Atenção Terciária , Vácuo-Extração/estatística & dados numéricos
8.
Iowa Orthop J ; 39(1): 37-43, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413672

RESUMO

Background: Microsurgical reconstruction is indicated for infants with brachial plexus birth palsy (BPBP) that demonstrate limited spontaneous neurological recovery. This investigation defines the demographic, perinatal, and physical examination characteristics leading to microsurgical reconstruction. Methods: Infants enrolled in a prospective multicenter investigation of BPBP were evaluated. Microsurgery was performed at the discretion of the treating provider/center. Inclusion required enrollment prior to six months of age and follow-up evaluation beyond twelve months of age. Demographic, perinatal, and examination characteristics were investigated as possible predictors of microsurgical reconstruction. Toronto Test scores and Hospital for Sick Children Active Movement Scale (AMS) scores were used if obtained prior to three months of age. Univariate and multivariate logistic regression analyses were performed. Results: 365 patients from six regional medical centers met the inclusion criteria. 127 of 365 (35%) underwent microsurgery at a median age of 5.4 months, with microsurgery rates and timing varying significantly by site. Univariate analysis demonstrated that several factors were associated with microsurgery including race, gestational diabetes, neonatal asphyxia, neonatal intensive care unit admission, Horner's syndrome, Toronto Test score, and AMS scores for finger/thumb/wrist flexion, finger/thumb extension, wrist extension, elbow flexion, and elbow extension. In multivariate analysis, four factors independently predicted microsurgical intervention including Horner's syndrome, mean AMS score for finger/thumb/ wrist flexion <4.5, AMS score for wrist extension <4.5, and AMS score for elbow flexion <4.5. In this cohort, microsurgical rates increased as the number of these four factors present increased from zero to four: 0/4 factors = 0%, 1/4 factors = 22%, 2/4 factors = 43%, 3/4 factors = 76%, and 4/4 factors = 93%. Conclusions: In patients with BPBP, early physical examination findings independently predict microsurgical intervention. These factors can be used to provide counseling in early infancy for families regarding injury severity and plan for potential microsurgical intervention.Level of Evidence: Prognostic Level I.


Assuntos
Microcirurgia/métodos , Paralisia do Plexo Braquial Neonatal/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Análise de Variância , Traumatismos do Nascimento/diagnóstico , Traumatismos do Nascimento/cirurgia , Estudos de Coortes , Eletromiografia/métodos , Feminino , Seguimentos , Humanos , Lactente , Modelos Logísticos , Masculino , Análise Multivariada , Paralisia do Plexo Braquial Neonatal/diagnóstico , Exame Físico/métodos , Valor Preditivo dos Testes , Estudos Prospectivos , Recuperação de Função Fisiológica/fisiologia , Índice de Gravidade de Doença , Resultado do Tratamento
9.
Neurourol Urodyn ; 38(8): 2296-2302, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31432558

RESUMO

AIMS: To study possible associations between levator ani muscle (LAM) injury and urinary incontinence (UI) and fecal incontinence (FI) and possible associations between bladder neck descent (BND), urethral funneling, and UI. METHODS: A cross-sectional study of 608 women with first delivery in 1990 to 1997 assessed in 2013 to 2014. The Urinary Distress Inventory (UDI-6) and Colorectal Anal Distress Inventory (CRADI-8) were used to quantify symptoms (range, 0-100). The proportion of women with UI and FI was calculated. LAM injury, BND ≥25 mm, and funneling were diagnosed with transperineal ultrasound. Women with LAM injury, BND, and urethral funneling were compared to those without, using the Mann-Whitney U test (symptom scores) and multiple logistic regression analysis (UI and FI). RESULTS: Four-hundred ninety-three (81%) women had intact LAM and 113 (19%) had LAM injury. They had similar median (range) UDI-6 score 8.3 (0-75) vs 4.2 (0-62.5), P = .35, and CRADI-8 score 6.3 (0-78.1) vs 6.3 (0-62.5), P = .90. Three hundred eleven out of six hundred (52%) women had UI and 65 of 594 (11%) had FI. This was similar for women with intact vs injured LAM; UI 53% vs 49%, P = .67; FI 11% vs 12%, P = .44 and with and without BND; stress UI 42% vs 42%, P = .93; urge UI 29% vs 35%, P = .34. Stress UI was more common in women with urethral funneling (50% vs 40%), odds ratio 1.56 (95% confidence interval: 1.03-2.37), P = .04. CONCLUSION: We found no associations between LAM injury and symptoms of UI and FI 15 to 24 years after the first delivery, but urethral funneling was associated with stress UI.


Assuntos
Traumatismos do Nascimento/complicações , Traumatismos do Nascimento/diagnóstico por imagem , Incontinência Fecal/etiologia , Incontinência Urinária/etiologia , Adulto , Canal Anal/diagnóstico por imagem , Estudos Transversais , Incontinência Fecal/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Paridade , Diafragma da Pelve/diagnóstico por imagem , Gravidez , Ultrassonografia , Uretra/lesões , Obstrução do Colo da Bexiga Urinária/etiologia , Incontinência Urinária/diagnóstico por imagem , Incontinência Urinária de Urgência/etiologia
12.
Ceska Gynekol ; 84(2): 93-98, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31238678

RESUMO

OBJECTIVE: Evaluation of maternal and neonatal outcomes in operative vaginal deliveries in prospective study analysis. DESIGN: Prospective case-control study analysis. SETTING: Prospective analysis of 292 operative vaginal deliveries (VEX, forceps) for the period June 2016 - August 2017 from overall 6056 vaginal deliveries. Type and frequency of maternal and neonatal trauma occurence was observed in connection with using vacuum-assisted delivery and forceps delivery, mainly the cephalohematomas and their complications. Collected data were statistically analysed. RESULTS: In the reported period from overall 6056 deliveries there were 216 vacuumextractions (3.6%) and 72 forceps deliveries (1.2%) performed. Both methods were used in four patients (VEX and forceps). The most frequent trauma in newborns were cephalohematomas. Remarkable cephalohematoma, requiring further observation has occured in 40 newborns (18.5%) after vacuum-assisted delivery and in 5 newborns (6.9%), (p = 0,017) after forceps delivery. Consequential punction of cephalohematoma occured only after vacuumextraction delivery and in 6 newborns (15.0 %). The third degree perineal rupture occured after vacuumextraction in 20 patients (9.3%) and after forceps delivery in 12 patients (16.7%), (p = 0,091). The fourth degree perineal rupture occured only after vacuumextraction and in 1 case (0.5%). CONCLUSION: The vacuumextraction compared with forceps is more likely to be associated with the statistically significant incidence of cephalohematomas and their further treatment. Forceps deliveries compared with vacuumextraction are more likely to be associated with the maternal perineal trauma, but the diference was not statistically significant.


Assuntos
Traumatismos do Nascimento/etiologia , Genitália Feminina/lesões , Hematoma/etiologia , Lacerações/etiologia , Forceps Obstétrico/efeitos adversos , Vácuo-Extração/efeitos adversos , Estudos de Casos e Controles , Parto Obstétrico/métodos , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Estudos Prospectivos
13.
J Pediatr Orthop ; 39(6): 328-334, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31169755

RESUMO

BACKGROUND: In children with brachial plexus birth palsy (BPBP) undergoing tendon transfers to augment shoulder external rotation, it is unclear whether transfer of the latissimus dorsi with its combined latissimus dorsi and teres major (cLT) versus isolated teres major (iTM) tendon transfer yield different outcomes. METHODS: Records of patients with BPBP who underwent shoulder tendon transfers to augment external rotation were retrospectively reviewed. Transfer type (cLT or iTM) was considered indiscriminate by virtue of surgeon preference. Modified Mallet Scale (mMS) and Active Movement Scale scores were recorded. Patients with <12 months' follow-up, C7 or lower palsy, humeral osteotomy, shoulder procedure(s) within 8 months, microsurgery within 1 year, or recurrent glenohumeral subluxation confirmed by postoperative imaging were excluded. Matched cohorts were identified within each tendon transfer group to yield similar preoperative shoulder function and glenohumeral alignment status. Outcomes for all tendon transfers as well as differences between cLT and iTM cohorts were analyzed. RESULTS: Among 121 cLT and 34 iTM transfers, 49 cLT and 14 iTM met the inclusion criteria. Subsequent matching of cohorts yielded 28 patients (14 cLT and 14 iTM). Average age at time of transfer was 3.0±1.4 years. Follow-up averaged 4.1±3.1 years. There were no statistically significant preoperative differences between cohorts, thus matching criteria were validated. Regardless of tendon(s) transferred, mMS external rotation improved (2.2 to 3.5, P<0.001), whereas mMS internal rotation decreased (3.8 to 3.2, P<0.001). When comparing matched cohorts, cLT transfer produced a greater mMS external rotation improvement than iTM (2.1 vs. 1.5, respectively; P=0.025). Loss of midline function (defined as mMS external rotation <3) occurred in 5 (35.7%) cLT and 2 (14.3%) iTM patients. CONCLUSIONS: Both cLT or iTM transfer are effective at augmenting shoulder external rotation in children with C5-C6 BPBP. Furthermore, cLT transfers may yield a larger improvement in external rotation in certain patients. However, both techniques slightly decrease shoulder internal rotation. Given that more total cLT patients lost midline function among matched cohorts, iTM transfer may still be considered when limited midline function is a concern. LEVEL OF EVIDENCE: Level III.


Assuntos
Traumatismos do Nascimento/cirurgia , Neuropatias do Plexo Braquial/cirurgia , Músculo Esquelético/transplante , Articulação do Ombro/cirurgia , Transferência Tendinosa/métodos , Neuropatias do Plexo Braquial/fisiopatologia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Úmero/fisiopatologia , Lactente , Masculino , Músculo Esquelético/fisiopatologia , Osteotomia/métodos , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos
14.
BMC Pregnancy Childbirth ; 19(1): 182, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31117987

RESUMO

BACKGROUND: Traumatic birth experience has undesirable effects on the life of the mother, child, family, and society. The identification of predictive factors can be useful in improving birth experiences among women. This study aimed to assess the prevalence of a traumatic birth experience and identify its predictors among a group primiparous women. METHODS: A cross-sectional study was conducted among 64 health centres in Tabriz, the second largest city in Iran. Cluster sampling was used to recruit 800 eligible women at one to 4 months postpartum. The Persian version of the Childbirth Experience Questionnaire was used to measure the womens' birth experiences. Data were collected through face to face interviews and analysed mainly by multivariable logistic regression. RESULTS: The prevalence of traumatic birth experience was 37% in the study group. The independent predictors of the traumatic birth experience were related to antenatal and intrapartum factors. The antenatal predictor was the lack of exercise during pregnancy (OR = 2.81, CI 1.40-5.63, P = .003) and the intrapartum predictors were the absence of pain relief during labour and birth (OR = 4.24, CI 2.12-8.50, P < .001), and the fear of childbirth (OR = 3.47, CI 1.68-7.19, P < .001). CONCLUSIONS: The findings revealed the high rate of traumatic birth experience among the primimarous women and identified the importance of a woman-centered care where a woman can actively make decision about the care she receives receive during labour and birth.


Assuntos
Traumatismos do Nascimento/epidemiologia , Parto Obstétrico/estatística & dados numéricos , Complicações do Trabalho de Parto/epidemiologia , Adulto , Traumatismos do Nascimento/etiologia , Estudos Transversais , Parto Obstétrico/efeitos adversos , Medo , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Complicações do Trabalho de Parto/etiologia , Paridade , Parto/psicologia , Gravidez , Prevalência , Inquéritos e Questionários
15.
J Pak Med Assoc ; 69(5): 684-689, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31105288

RESUMO

OBJECTIVE: To study the association of maternal, paternal and social factors with intellectual disability in special children.. METHODS: The case-control study was conducted in four schools of Lahore, Pakistan, from September 2014 to September 2015, and comprised intellectually disabled children aged 6-15 years, and an equal number of matching healthy subjects. group. Interviews were conducted with the help of a pre-tested structured questionnaire. SPSS -17 was utilised to analyse the data. RESULTS: Of the 298 participants, 149(50%) each were cases and controls. Overall, there were 83(56%) boys and 66(44%) girls. Significant association of intellectual disability was found with consanguinity (p=0.001), father's educational status (p=0.03), paternal history of mental retardation (p=0.01) and history of delayed cry (p=0.001). Breastfeeding (depicted a protective relationship (p=0.03). CONCLUSIONS: Parental, social, environmental and familial causes contributed to intellectual disability among the subjects.


Assuntos
Asfixia Neonatal/epidemiologia , Traumatismos do Nascimento/epidemiologia , Aleitamento Materno/estatística & dados numéricos , Anormalidades Congênitas/epidemiologia , Consanguinidade , Deficiência Intelectual/epidemiologia , Adolescente , Adulto , Ordem de Nascimento , Estudos de Casos e Controles , Criança , Síndrome de Down/epidemiologia , Status Econômico , Escolaridade , Pai , Feminino , Humanos , Masculino , Idade Materna , Mães , Oxigenoterapia , Paquistão/epidemiologia , Idade Paterna , Fatores de Risco , Escalas de Wechsler , Adulto Jovem
16.
J Shoulder Elbow Surg ; 28(9): 1764-1770, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31043347

RESUMO

BACKGROUND: Contracture of the elbow after obstetric brachial plexus palsy (OBPP) is well known; however, details of the 3-dimensional (3D) morphologic changes in the elbow joint in OBPP have not been clarified. This study aimed to clarify the 3D morphologic changes in the elbow joint by focusing on the distal humerus with flexion contracture in upper OBPP. We tested the hypothesis that the shape of the distal humerus with flexion contracture in upper OBPP is hypoplastic in the trochlea, capitellum, and olecranon fossa. METHODS: We retrospectively studied 20 patients with elbow flexion contracture and residual OBPP. The approximate radius of the distal humerus, the shortest distance between the olecranon and coronoid fossa, and the size of the olecranon fossa were measured and compared between the affected and normal sides using 3D bone models to assess the distal humerus morphology. RESULTS: The average radius of the distal humerus was smaller on the affected side than on the normal side. Furthermore, the average distance between the olecranon and coronoid fossa was greater and the average size of the olecranon fossa was smaller on the affected side than on the normal side. The size of the distal humerus was significantly smaller and the olecranon fossa was significantly shallower on the affected side. CONCLUSIONS: Consistent with our original hypothesis, the distal humerus with flexion contracture in upper OBPP was hypoplastic. The shallow olecranon fossa might prevent full extension of the elbow even though soft tissue contracture release is performed. We recommend evaluation of the morphology of the olecranon fossa to determine the treatment plan for elbow flexion contracture with OBPP.


Assuntos
Traumatismos do Nascimento/complicações , Neuropatias do Plexo Braquial/patologia , Contratura/patologia , Articulação do Cotovelo/patologia , Úmero/patologia , Adolescente , Neuropatias do Plexo Braquial/complicações , Criança , Pré-Escolar , Contratura/etiologia , Articulação do Cotovelo/diagnóstico por imagem , Epífises/diagnóstico por imagem , Epífises/patologia , Feminino , Humanos , Úmero/diagnóstico por imagem , Imageamento Tridimensional , Luxações Articulares , Masculino , Estudos Retrospectivos
17.
Eur J Paediatr Neurol ; 23(4): 621-628, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31078397

RESUMO

BACKGROUND: Early diagnosis of unilateral cerebral palsy is important after asymmetric perinatal brain injury (APBI). Our objective is to estimate the risk of unilateral cerebral palsy (UCP) in infants with APBI during the first months of life using neuroimaging and clinical assessment. PATIENTS AND METHODS: Prognostic multivariable prediction modeling study including 52 infants (27 males), median gestational age 39.3 weeks with APBI from Sweden (n = 33) and the Netherlands (n = 19). INCLUSION CRITERIA: (1) neonatal MRI within one month after term equivalent age (TEA), (2) Hand Assessment for Infants (HAI) between 3.5 and 4.5 months of (corrected) age. UCP was diagnosed ≥24 months of age. Firth regression with cross-validation was used to construct and internally validate the model to estimate the risk for UCP based on the predictors corticospinal tract (CST) and basal ganglia/thalamus (BGT) involvement, contralesional HAI Each hand sum score (EaHS), gestational age and sex. RESULTS: UCP was diagnosed in 18 infants (35%). Infants who developed UCP more often had involvement of the CST and BGT on neonatal MRI and had lower contralesional HAI EaHS compared to those who did not develop UCP. The final model showed excellent accuracy for UCP prediction between 3.5 and 4.5 months (area under the curve, AUC = 0.980; 95% CI 0.95-1.00). CONCLUSIONS: Combining neonatal MRI, the HAI, gestational age and sex accurately identify the prognostic risk of UCP at 3.5-4.5 months in infants with APBI.


Assuntos
Traumatismos do Nascimento/complicações , Paralisia Cerebral/diagnóstico , Paralisia Cerebral/etiologia , Nomogramas , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/etiologia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Imagem por Ressonância Magnética , Masculino , Países Baixos , Neuroimagem/métodos , Gravidez , Suécia
18.
J Neonatal Perinatal Med ; 12(3): 325-331, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30932899

RESUMO

A male newborn born by an atraumatic vaginal frank breech delivery was noted to have normal limb movement at birth. However, at 24 hours the neonate developed paraplegia with no evidence of spinal cord injury on radiographic films. Ultrasound and MRI demonstrated an epidural hematoma at the level of T8 and distal cord edema which extended to the conus medullaris. Delayed onset paraplegia following an atraumatic vaginal breech delivery is unlikely to have been caused by acute traction or torsion at birth. Traction and torsion injuries would present acutely. This infant developed a T8 epidural hematoma which has not been reported in a newborn. The pathophysiology of a spontaneous spinal epidural hematoma (SSEH) in adults is frequently related to increased abdominal/thoracic pressure which results in increased pressure in the highly anastomotic network of thin walled and valve-less vertebral venous plexus (Batson's plexus). Such increase in abdominal/thoracic pressure could occur during a frank breech delivery and result in a slow onset epidural hematoma. This report highlights the importance of considering slow onset epidural hematoma in the differential diagnosis of neonates who develop slow onset paraplegia. If diagnosed quickly, an epidural hematoma represents a potentially treatable etiology by rapid surgical decompression.


Assuntos
Traumatismos do Nascimento/etiologia , Apresentação Pélvica , Hematoma Epidural Espinal/etiologia , Hematoma Subdural Espinal/etiologia , Paraplegia/etiologia , Veias/lesões , Edema/etiologia , Feminino , Humanos , Recém-Nascido , Vértebras Lombares/irrigação sanguínea , Angiografia por Ressonância Magnética , Masculino , Gravidez , Ruptura Espontânea/etiologia
19.
An Pediatr (Barc) ; 91(6): 378-385, 2019 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-30981643

RESUMO

INTRODUCTION: The purpose of this study was to assess the neonatal morbidity and mortality associated with vacuum-assisted vaginal deliveries compared to all other vaginal deliveries, and to identify the associated risk factors. MATERIAL AND METHODS: We conducted a retrospective case-control study in a level iii maternity hospital between 2012 and 2016, including 1,802 vacuum-assisted vaginal deliveries and 2control groups: 1802 spontaneous deliveries and 909 forceps-assisted deliveries. We considered minor complications (soft tissue trauma, cephalohaematoma, jaundice, intensive phototherapy, transient brachial plexus injury) and major complications (hypoxic-ischaemic encephalopathy, intracranial and subgaleal haemorrhage, seizures, cranial fracture, permanent brachial plexus injury), admission to the neonatal intensive care unit and death. RESULTS: The risk of soft tissue trauma (aOR, 2.4; P<.001), cephalohaematoma (aOR, 5.5; P<.001), jaundice (aOR, 4.4; P<.001), intensive phototherapy (aOR, 2.1; P<.001) and transient brachial plexus injury (aOR; 2.1, P=.006) was higher in vacuum deliveries compared to spontaneous deliveries. Admission to the neonatal intensive care unit was also higher in vacuum deliveries compared to spontaneous deliveries (OR, 1.9; P=.001). When we compared vacuum with forceps deliveries, we found a higher risk of soft tissue trauma (OR, 2.1; P=.004), cephalohaematoma (OR, 2.2, P=.046) and jaundice (OR, 1.4; P=.012). Major complications were more frequent in the vacuum group comparing with the control groups, but the difference was not significant. The 2deaths occurred in vacuum deliveries (1.1 per 1000). CONCLUSION: The proportion of minor neonatal complications was higher in the vacuum-assisted delivery group. Although major complications and death were also more frequent, they were uncommon, with no significant differences compared to the other groups. There are obstetrical indications for vacuum delivery, but it should alert to the need to watch for potential neonatal complications.


Assuntos
Traumatismos do Nascimento/epidemiologia , Parto Obstétrico/estatística & dados numéricos , Vácuo-Extração/métodos , Adulto , Traumatismos do Nascimento/fisiopatologia , Estudos de Casos e Controles , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Estudos Retrospectivos , Fatores de Risco , Vácuo-Extração/efeitos adversos
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