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1.
Mymensingh Med J ; 33(3): 716-723, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38944712

RESUMEN

The spectrum of indications for primary caesarean section changes with advancing parity. As parity advances more cesarean section are done for maternal rather than fetal indications. The objective of this study was to determine the indications and complications of caesarean section in multiparous women with history of previous vaginal delivery. This cross-sectional descriptive observational study was conducted in Mymensingh Medical College Hospital from January 2019 to June 2019 among 100 purposively selected multiparous women who underwent primary caesarean section. A well-designed, semi-structured questionnaire was used to collect data by face-to-face interview, clinical examinations and laboratory investigations. Data analysis was conducted in SPSS 20.0 version. Majority (74.0%) of the women in this study were in the age group 21-30 years with mean age of 26.3±5.76 years. Majority of the patients were of second gravida (42.0%) followed by third gravida (33.0%). The highest gravida in this study was 6th. Most of the patients were of para 1(44.0%). Highest para in this study was para 5. The most common indication of caesarean section in this study was foetal distress (26.0%). The next common indications were cephalo-pelvic disproportion (22.0%), antepartum haemorrhage (13.0%), mal-presentaion or mal-position (16.0%). Other causes were PROM (8.0%), prolonged labour (6.0%), cord prolapse (2.0%), post-dated pregnancy (4.0%), severe pre-eclampsia (2.0%) and secondary subfertility (1.0%). There was no case of maternal mortality in this study but 15 mothers suffered from various post-operative complications like wound infection (4.0%), UTI (4.0%), puerperal pyrexia (3.0%), postpartum haemorrhage (3.0%) and paralytic ileus (1.0%). Among the babies delivered 97 were live births. Among the 97 live births 11(11.34%) were preterm babies. Among the babies delivered majority (85.0%) was with good APGAR score (7-10). In conclusion it can say that a multiparous women in labour requires the same attention as that of primigravida. A parous women needs good obstetric care to improve maternal and neonatal outcome and still keeping caesarean section to a lower rate.


Asunto(s)
Cesárea , Paridad , Complicaciones Posoperatorias , Centros de Atención Terciaria , Humanos , Femenino , Adulto , Cesárea/estadística & datos numéricos , Cesárea/efectos adversos , Embarazo , Estudios Transversales , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Centros de Atención Terciaria/estadística & datos numéricos , Adulto Joven , Sufrimiento Fetal/cirugía , Sufrimiento Fetal/epidemiología , Desproporción Cefalopelviana/cirugía , Desproporción Cefalopelviana/epidemiología
2.
Eur J Obstet Gynecol Reprod Biol ; 297: 264-266, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38616145

RESUMEN

BACKGROUND: Amniotic banding is a rare condition that can lead to structural limb anomalies, fetal distress and adverse obstetric outcomes. The main hypothesis for its etiology is a rupture of the amniotic membrane in early pregnancy, with the formation of tightly entangling strands around the fetus. These strands can constrict, incise, and subsequently amputate limb parts, the neck or head. More rarely, the amniotic banding can affect the umbilical cord, leading to fetal distress or potential intra-uterine fetal demise. OBJECTIVE: We present a unique case of a 26-week pregnant woman who attended a polyclinical consultation due to reduced fetal movements with concerning cardiotocography (CTG) findings. A review of the literature about amniotic banding of the umbilical cord was conducted as well, identifying diagnostic and interventional options for the obstetrician's practice. STUDY DESIGN: This is a case report, alongside a review of the literature. RESULTS: The CTG indicated fetal distress, prompting an emergency caesarean section (C-section). Upon delivery, the neonate exhibited signs of amniotic band sequence, with distal phalangeal defects on the right hand and severe constriction of the umbilical cord caused by amniotic strands, the latter precipitating fetal hypoxia. Direct ultrasound diagnosis remains a challenge in the absence of limb amputation, yet indirect signs such as distal limb or umbilical doppler flow abnormalities and distal limb edema may be suggestive of amniotic banding. MRI is proposed as an adjuvant diagnostic tool yet does not present a higher detection rate compared to ultrasound. Fetoscopic surgery to perform lysis of the amniotic strands with favorable outcome has been described in literature. CONCLUSION: This case presents the first reported survival of an extremely preterm fetus in hypoxic distress as a cause of amniotic banding of the umbilical cord, with a rare degree of incidental timing. Ultrasound diagnosis remains the gold standard. Obstetrical vigilance is warranted, with fetal rescue proven to be feasible.


Asunto(s)
Síndrome de Bandas Amnióticas , Cesárea , Hipoxia Fetal , Humanos , Femenino , Embarazo , Síndrome de Bandas Amnióticas/cirugía , Adulto , Hipoxia Fetal/etiología , Recién Nacido , Cardiotocografía , Ultrasonografía Prenatal , Sufrimiento Fetal/cirugía , Sufrimiento Fetal/etiología , Cordón Umbilical/cirugía
3.
Sci Rep ; 13(1): 8871, 2023 05 31.
Artículo en Inglés | MEDLINE | ID: mdl-37258595

RESUMEN

A Trial of labor after cesarean section is an attempt to deliver vaginally by a woman who had a previous cesarean delivery and when achieved by a vaginal delivery it is called successful vaginal birth after cesarean section. Vaginal birth after a caesarian section is a preferred method to decrease complications associated with repeated caesarian section delivery for both mother and fetus. It has a higher success rate when the right women are selected for a trial of labor. This study aimed to assess factors associated with successful vaginal birth after one lower uterine transverse cesarean section and to validate the Flamm and Geiger score at the public hospitals of Bahir Dar City, Northwest, Ethiopia, 2021. A health facility-based retrospective cross-sectional study was conducted from March 1 to 15/2021. A medical record review of 408 women charts with a trial of labor after one lower uterine transverse cesarean section from January 1/2020 to December 31/2020 was done and 345 women charts with complete maternal and fetal information were included in the study with a response rate of 84.6%. The data were collected using a structured checklist, entered into Epi data 3.1, and analyzed using SPSS 25.0 version. Logistic regression analyses were done to estimate the crude and adjusted odds ratio with a confidence interval of 95% and a P-value of less than 0.05 considered statistically significant. This study identified that the trial of labor after cesarean section rate was 69.5%, and the success rate of vaginal birth after one lower uterine transverse cesarean section was 35.07%. Of the failed trial of labor, fetal distress (38.9%) and failed progress of labor (32.1%) were the main indications for an emergency cesarean section. The maternal age group of 21-30 years, prior vaginal birth after or before cesarean section, non-recurring indication (fetal distress and malpresentation), ruptured membrane, cervical dilatation ≥ 4 cm, cervical effacement ≥ 50%, and low station (≥ 0) at admission were associated with successful vaginal birth after one lower uterine transverse cesarean section. For the Flamm and Geiger score at a cut point of 5, the sensitivity and specificity were 73.6% and 86.6% respectively. In this study area, the trial of labor after cesarean section rate is encouraging, however, the success rate of vaginal birth after one lower uterine transverse caesarian section was lower. The maternal socio-demographic and obstetric-related factors were significantly associated with successful vaginal birth after one lower transverse caesarian section delivery. This study indicated that when the Flamm and Geiger score increases, the chance of successful vaginal birth after one lower uterine transverse caesarian section also increases. We suggest emphasizing counselling and encouraging the women, as their chance of successful vaginal delivery will be high in the subsequent pregnancy, especially if the indications of primary caesarian section delivery were non-recurring.


Asunto(s)
Rotura Uterina , Parto Vaginal Después de Cesárea , Embarazo , Femenino , Humanos , Adulto Joven , Adulto , Cesárea/efectos adversos , Estudios Retrospectivos , Esfuerzo de Parto , Sufrimiento Fetal/cirugía , Estudios Transversales , Rotura Uterina/epidemiología , Rotura Uterina/etiología , Rotura Uterina/cirugía
4.
BMC Pregnancy Childbirth ; 22(1): 48, 2022 Jan 19.
Artículo en Inglés | MEDLINE | ID: mdl-35045812

RESUMEN

BACKGROUND: The potential protective effect of mediolateral episiotomy for obstetrical anal sphincter injuries (OASIs) remains controversial during operative vaginal delivery because of the difficulties to take into account the risk factors and clinical conditions at delivery; in addition, little is known about the potential benefits of mediolateral episiotomy on neonatal outcomes. The objectives were to investigate the associations between mediolateral episiotomy and both OASIs and neonatal outcomes, using propensity scores. METHODS: We performed a retrospective population-based observational study from a perinatal registry that includes all births in a French region between 2010 and 2017. All nulliparous women with singleton pregnancy delivering by operative vaginal deliveries at 37 weeks gestational age or later were included. Inverse-probability-of-treatment weighting with propensity scores was used to minimize indication bias. OASIs was defined as third and fourth-degree tears according to Royal College of Obstetricians and Gynecologists. Two neonatal outcomes were studied: condition at birth (5-min Apgar score less than 7 and/or umbilical artery pH less than 7.10), and admission to neonatal intensive care unit. RESULTS: The study population consisted of 7589 women; 2880 (38.0%) received mediolateral episiotomy. After applying propensity scores, episiotomy was associated with a lower rate of OASIs in forceps/spatula delivery (2.3 vs 6.8%, Risk Ratio (RR) 0.38, 95% Confidence Interval (CI) 0.28-0.52) and in vacuum delivery (1.3 vs 3.4%, RR 0.27, 95% CI 0.20-0.38) as compared with no episiotomy. Mediolateral episiotomy was associated with better condition at birth in case of forceps/spatula delivery (4.5 vs 8.8%, RR 0.56, 95% CI 0.39-0.81). In cases of fetal distress (40.7%), mediolateral episiotomy was associated with better condition of infant at birth in women who delivered by forceps/spatula (4.2 vs 13.5%, RR 0.52, 95% CI 0.31-0.89). No association was found with neonatal unit admission (RR 0.93, 95% CI 0.50-1.74). CONCLUSIONS: Use of mediolateral episiotomy was associated with a lower rate of OASIs during operative vaginal delivery, and in infants it was associated with better condition at birth following forceps/spatula delivery.


Asunto(s)
Canal Anal/lesiones , Parto Obstétrico/métodos , Episiotomía/efectos adversos , Paridad , Puntaje de Propensión , Puntaje de Apgar , Femenino , Sufrimiento Fetal/cirugía , Francia/epidemiología , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Oportunidad Relativa , Embarazo , Estudios Retrospectivos
5.
JNMA J Nepal Med Assoc ; 59(241): 839-843, 2021 Sep 11.
Artículo en Inglés | MEDLINE | ID: mdl-35199724

RESUMEN

INTRODUCTION: Worldwide there is a tremendous increase in cesarean section rate over the last decades which has been a global public health issue. This study aimed to find out the prevalence of cesarean delivery in a tertiary care center of Nepal. METHODS: A descriptive cross-sectional study was conducted among pregnant women at tertiary care centre from 15th September 2019 to 15th October 2020. Ethical clearance was taken from the Institutional Review Committee (Ref: CMC-IRC/077/078-200). Convenience sampling was done to reach the sample size. Basic demographic data, clinical indications and neonatal outcomes were noted. Data entry was done using Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 3193 total deliveries, cesarean deliveries were 1412 (44.22%) at 95% Confidence Interval (42.49-45.94). Among caesarean deliveries 1086 (76.9%) were emergency cesarean sections. Most common indication for cesarean section was fetal distress (24.9%). Among 1437 newborns, 1428 (99.4%) were live births, 1387 (98.2%) were singleton and 801 (55.7%) were male. Nearly one third 418 (29.1%) neonates required neonatal intensive care unit admission and transient tachypnoea of newborns (44.28% in emergency and 60.46% in elective cesarean delivery) was the most common indication for admission. CONCLUSIONS: The prevalence of cesarean delivery was found to be higher than that recommended by the World Health Organisation. Fetal distress was the leading indication for cesarean deliveries.


Asunto(s)
Cesárea , Sufrimiento Fetal , Estudios Transversales , Femenino , Sufrimiento Fetal/epidemiología , Sufrimiento Fetal/cirugía , Humanos , Recién Nacido , Masculino , Nepal/epidemiología , Embarazo , Centros de Atención Terciaria
6.
Reprod Health ; 17(1): 197, 2020 Dec 17.
Artículo en Inglés | MEDLINE | ID: mdl-33334355

RESUMEN

BACKGROUND: Global caesarean section (CS) rates have raised concern of a potential overuse of the procedure in both high- and low-resource settings. We sought to assess management and outcomes of deliveries with emergency CSs due to fetal distress and prolonged labor at 12 public hospitals in Nepal and determine factors associated with suboptimal CS indications. METHODS: We conducted a cross-sectional study on all deliveries between the 14th of April 2017 and the 17th of October 2018 at 12 public hospitals in Nepal and included all emergency CSs due to fetal distress and prolonged labor. Analysis was conducted using Pearson chi-square test and bivariate and multivariate logistic regression. RESULTS: The total cohort included 104,322 deliveries of which 18,964 (18%) were CSs (13,095 [13%] emergency CSs and 5230 [5.0%] elective CSs). We identified 1806 emergency CSs due to fetal distress and 1322 emergency CSs due to prolonged labor. Among CSs due to fetal distress, only 36% had fetal heart rate monitoring performed according to protocol, and among CSs due to prolonged labor, the partograph was completely filled in only 8.6%. Gestational age < 37 weeks and birth weight < 2500 g were associated with more suboptimal CS indications due to fetal distress (adjusted odds ratio [aOR] 1.4, 95% confidence interval [CI] 1.1-1.8 and aOR 1.7, 95% CI 1.3-2.2 respectively) than those with gestational age > 37 weeks and birth weight > 2500 g. We found no association between suboptimal CS indications and maternal ethnicity or education level. CONCLUSIONS: As fetal heart rate monitoring and partograph are fundamental to diagnose fetal distress and prolonged labor, the inappropriate monitoring proceeding CS decisions disclosed in our study indicate that CSs were performed on suboptimal indications. We call for improved quality of intrapartum monitoring, enhanced documentation in medical records, and structured auditing of CS indications in order to curb the potentially harmful CS trend.


Asunto(s)
Cesárea/estadística & datos numéricos , Sufrimiento Fetal/epidemiología , Complicaciones del Trabajo de Parto/epidemiología , Cesárea/efectos adversos , Estudios Transversales , Femenino , Sufrimiento Fetal/cirugía , Frecuencia Cardíaca Fetal , Hospitales Públicos , Humanos , Lactante , Nepal/epidemiología , Complicaciones del Trabajo de Parto/cirugía , Embarazo , Calidad de la Atención de Salud
7.
Eur J Obstet Gynecol Reprod Biol ; 246: 29-34, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31927407

RESUMEN

OBJECTIVE: Assess the impact of implementation by simple distribution of a "colour code" protocol for emergency caesareans on the course over time of the "decision-delivery interval" (DDI) and neonatal outcome. DESIGN: Observational study in 26 maternity units of the AURORE perinatal network, conducted between October 1, 2017, and April 30, 2018. Each maternity ward́ was supposed to prospectively include 20 consecutive cases of caesareans performed either as an emergency, that is, as a code orange, or an extreme emergency, that is, code red. We compared the DDIs observed in 2017 to those in 2007 according to the degree of emergency, the maternity unit level of care, and their adherence to the protocol. Neonatal outcome in 2007 and 2017, assessed from laboratory and clinical indicators, was also compared, overall and according to the degree of emergency. RESULTS: The DDI was significantly lower in 2017 (n = 478) than in 2007 (n = 447), regardless of the degree of emergency and the level of care (p < 0.0001). In 2017, all code red caesareans were performed in less than 15 min in level 3 maternity units compared with 73 % (p = 0.039) in 2007. Fewer than 20 % of the caesareans in the 2007 study period were performed in less than 15 min in level 1 and 2 maternity units. Today, this is the case for 83 % of these caesareans in level 2 units (p < 0.001) and 36 % in level 1 (p = 0.01). In 2017, code orange caesareans were performed in less than 30 min in 96 % of cases in level 3 units, 67 % in level 2, and 33 % in level 1, compared respectively with 67 % (p = 0.015), 25 % (p < 0.0001) and 16 % (p = 0.0003) in 2007. We did not observe any difference in the neonatal outcome between 2007 and 2017 or as a function of the DDI expected based on the caesarean colour code. CONCLUSION: The implementation of the colour code protocols was associated with an improved DDI and better adherence to the recommendations in all 26 maternity units in this perinatal network.


Asunto(s)
Cesárea/estadística & datos numéricos , Toma de Decisiones Clínicas , Urgencias Médicas , Tiempo de Tratamiento/estadística & datos numéricos , Desprendimiento Prematuro de la Placenta/cirugía , Adulto , Certificación , Distocia/cirugía , Eclampsia/cirugía , Extracción Obstétrica , Femenino , Sufrimiento Fetal/cirugía , Francia , Frecuencia Cardíaca Fetal , Humanos , Preeclampsia/cirugía , Embarazo , Prolapso , Cordón Umbilical , Rotura Uterina/cirugía
8.
Ultrasound Obstet Gynecol ; 55(6): 793-798, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-31343783

RESUMEN

OBJECTIVE: Pregnancies complicated by late-onset fetal growth restriction (FGR) are at increased risk of short- and long-term morbidities. Despite this, identification of cases at higher risk of adverse perinatal outcome, at the time of FGR diagnosis, is challenging. The aims of this study were to elucidate the strength of association between fetoplacental Doppler indices at the time of diagnosis of late-onset FGR and adverse perinatal outcome, and to determine their predictive accuracy. METHODS: This was a prospective study of consecutive singleton pregnancies complicated by late-onset FGR. Late-onset FGR was defined as estimated fetal weight (EFW) or abdominal circumference (AC) < 3rd centile, or EFW or AC < 10th centile and umbilical artery (UA) pulsatility index (PI) > 95th centile or cerebroplacental ratio (CPR) < 5th centile, diagnosed after 32 weeks. EFW, uterine artery PI, UA-PI, fetal middle cerebral artery (MCA) PI, CPR and umbilical vein blood flow normalized for fetal abdominal circumference (UVBF/AC) were recorded at the time of the diagnosis of FGR. Doppler variables were expressed as Z-scores for gestational age. Composite adverse perinatal outcome was defined as the occurrence of at least one of emergency Cesarean section for fetal distress, 5-min Apgar score < 7, umbilical artery pH < 7.10 and neonatal admission to the special care unit. Logistic regression analysis was used to elucidate the strength of association between different ultrasound parameters and composite adverse perinatal outcome, and receiver-operating-characteristics (ROC)-curve analysis was used to determine their predictive accuracy. RESULTS: In total, 243 consecutive singleton pregnancies complicated by late-onset FGR were included. Composite adverse perinatal outcome occurred in 32.5% (95% CI, 26.7-38.8%) of cases. In pregnancies with composite adverse perinatal outcome, compared with those without, mean uterine artery PI Z-score (2.23 ± 1.34 vs 1.88 ± 0.89, P = 0.02) was higher, while Z-scores of UVBF/AC (-1.93 ± 0.88 vs -0.89 ± 0.94, P ≤ 0.0001), MCA-PI (-1.56 ± 0.93 vs -1.22 ± 0.84, P = 0.004) and CPR (-1.89 ± 1.12 vs -1.44 ± 1.02, P = 0.002) were lower. On multivariable logistic regression analysis, Z-scores of mean uterine artery PI (P = 0.04), CPR (P = 0.002) and UVBF/AC (P = 0.001) were associated independently with composite adverse perinatal outcome. UVBF/AC Z-score had an area under the ROC curve (AUC) of 0.723 (95% CI, 0.64-0.80) for composite adverse perinatal outcome, demonstrating better accuracy than that of mean uterine artery PI Z-score (AUC, 0.593; 95% CI, 0.50-0.69) and CPR Z-score (AUC, 0.615; 95% CI, 0.52-0.71). A multiparametric prediction model including Z-scores of MCA-PI, uterine artery PI and UVBF/AC had an AUC of 0.745 (95% CI, 0.66-0.83) for the prediction of composite adverse perinatal outcome. CONCLUSION: While CPR and uterine artery PI assessed at the time of diagnosis are associated independently with composite adverse perinatal outcome in pregnancies complicated by late-onset FGR, their diagnostic performance for composite adverse perinatal outcome is low. UVBF/AC showed better accuracy for prediction of composite adverse perinatal outcome, although its usefulness in clinical practice as a standalone predictor of adverse pregnancy outcome requires further research. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.


Papel de la ecografía Doppler en el momento del diagnóstico de la restricción del crecimiento fetal de aparición tardía para la predicción de resultados perinatales adversos: estudio prospectivo de cohortes OBJETIVO: Los embarazos complicados por la restricción del crecimiento fetal (RCF) de aparición tardía tienen un mayor riesgo de morbilidad a corto y largo plazo. A pesar de ello, es difícil identificar los casos con mayor riesgo de resultados perinatales adversos en el momento del diagnóstico de RCF. Los objetivos de este estudio fueron dilucidar la fortaleza de la asociación entre los índices Doppler fetoplacentarios en el momento del diagnóstico de la RCF de aparición tardía y el resultado perinatal adverso, y determinar su precisión predictiva. MÉTODOS: Este fue un estudio prospectivo de embarazos consecutivos con feto único complicados por una RCF de aparición tardía. La aparición tardía de la RCF se definió como peso estimado del feto (PEF) o circunferencia abdominal (CA) <3er percentil, o PEF o CA <10o percentil junto con índice de pulsatilidad (IP) de la arteria umbilical (AU) >95o percentil, o una relación cerebroplacentaria (RCP) <5o percentil, diagnosticado después de las 32 semanas. El PEF, el IP de la arteria uterina (IP-AU), el IP de la arteria cerebral media fetal (ACM), la RCP y el flujo sanguíneo de la vena umbilical normalizado para la circunferencia abdominal fetal (UVBF/AC, por sus siglas en inglés) se registraron en el momento del diagnóstico de RCF. Las variables Doppler se expresaron como puntuaciones Z para la edad gestacional. El resultado perinatal adverso compuesto se definió como la ocurrencia de al menos una cesárea de emergencia por sufrimiento fetal, test de Apgar a los 5 minutos <7, pH de la arteria umbilical <7,10 y el ingreso a la unidad de cuidados especiales de recién nacidos. Se utilizó el análisis de regresión logística para dilucidar la fortaleza de la asociación entre los diferentes parámetros de la ecografía y el resultado perinatal adverso compuesto, y se empleó el análisis de la curva de características operativas del receptor (ROC, por sus siglas en inglés) para determinar su precisión predictiva. RESULTADOS: En total, se incluyeron 243 embarazos con feto único consecutivos complicados por RCF de aparición tardía. El resultado perinatal adverso compuesto se produjo en el 32,5% (IC 95%, 26,7-38,8%) de los casos. En los embarazos con resultados perinatales adversos compuestos, en comparación con los que no los tuvieron, la puntuación Z del IP de la arteria uterina media (2,23±1,34 vs 1,88±0,89, P=0,02) fue mayor, mientras que las puntuaciones Z de UVBF/AC (-1,93±0,88 vs -0,89±0,94, P≤0,0001), IP-ACM (-1,56±0,93 vs -1,22±0,84, P=0,004) y RCP (-1,89±1,12 vs -1,44±1,02, P=0,002) fueron más bajas. En el análisis de regresión logística multivariable, las puntuaciones Z del IP de la arteria uterina media (P=0,04), RCP (P=0,002) y UVBF/AC (P=0,001) estuvieron asociadas de forma independiente con el resultado perinatal adverso compuesto. La puntuación Z del UVBF/AC tuvo un área bajo la curva (ABC) ROC de 0,723 (IC 95%, 0,64-0,80) para el resultado perinatal adverso compuesto, demostrando una mejor precisión que la de la puntuación Z del IP de la arteria uterina media (ABC, 0,593; IC 95%, 0,50-0,69) y la de la puntuación Z de la RCP (ABC, 0,615; IC 95%, 0,52-0,71). Un modelo de predicción multiparamétrico que incluía las puntuaciones Z del IP-ACM, el IP de la arteria uterina y el UVBF/AC resultó en un ABC de 0,745 (IC 95%, 0,66-0,83) para la predicción de un resultado perinatal adverso compuesto. CONCLUSIÓN: Aunque la RCP y el IP de la arteria uterina evaluados en el momento del diagnóstico están asociados de forma independiente con un resultado perinatal adverso compuesto en embarazos complicados por una RCF de aparición tardía, la eficacia del diagnóstico para el resultado perinatal adverso compuesto es baja. El UVBF/AC mostró una mayor precisión para la predicción de un resultado perinatal adverso compuesto, aunque su utilidad en la práctica clínica como parámetro indicativo independiente del resultado adverso del embarazo requiere más investigación. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.


Asunto(s)
Retardo del Crecimiento Fetal/diagnóstico , Resultado del Embarazo/epidemiología , Ultrasonografía Doppler/estadística & datos numéricos , Ultrasonografía Prenatal/estadística & datos numéricos , Abdomen/embriología , Adulto , Puntaje de Apgar , Cesárea/estadística & datos numéricos , Femenino , Sufrimiento Fetal/embriología , Sufrimiento Fetal/etiología , Sufrimiento Fetal/cirugía , Peso Fetal , Feto/diagnóstico por imagen , Feto/embriología , Edad Gestacional , Humanos , Concentración de Iones de Hidrógeno , Recién Nacido , Cuidado Intensivo Neonatal/estadística & datos numéricos , Modelos Logísticos , Valor Predictivo de las Pruebas , Embarazo , Estudios Prospectivos , Flujo Pulsátil , Curva ROC , Ultrasonografía Doppler/métodos , Ultrasonografía Prenatal/métodos , Arterias Umbilicales/embriología
9.
Fetal Diagn Ther ; 46(1): 75-80, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31238308

RESUMEN

We present a case of prenatal hydrops secondary to congenital high airway obstruction syndrome (CHAOS) that was treated with fetoscopy-assisted needle decompression. A 22-year-old G3P2 woman presented after a 21-week ultrasound demonstrated CHAOS. The fetus developed hydrops at 25 weeks, characterized by abdominal ascites, pericardial effusion, and scalp edema. Fetal MRI showed complete obstruction of the glottis and subglottic airway, suggestive of laryngeal atresia. At 27 weeks, due to the progression of the hydrops, operative fetoscopy was proposed and performed. Fetal laryngoscopy confirmed fusion of the vocal cords and laryngeal atresia. The atretic segment was a solid cartilaginous block, preventing intubation. Using the fetoscope to stabilize the fetal head and neck, we performed ultrasound-guided percutaneous needle drainage of the cervical trachea through the anterior fetal neck. We removed 17 mL of viscous fluid from the lower trachea, resulting in immediate lung decompression. Two weeks later, ultrasound confirmed hydrops resolution. The patient was delivered and tracheostomy performed at 30 weeks via an ex utero intrapartum treatment (EXIT) procedure after progression of preterm labor. At 27 days of life, the infant was stable on minimal ventilator support. To our knowledge, this is the first successful report of an ultrasound-guided percutaneous tracheal decompression through the anterior neck of a fetus with CHAOS secondary to laryngeal atresia.


Asunto(s)
Obstrucción de las Vías Aéreas/cirugía , Hidropesía Fetal/diagnóstico por imagen , Enfermedades de la Laringe/cirugía , Tráquea/diagnóstico por imagen , Obstrucción de las Vías Aéreas/complicaciones , Femenino , Sufrimiento Fetal/complicaciones , Sufrimiento Fetal/diagnóstico por imagen , Sufrimiento Fetal/cirugía , Fetoscopía , Humanos , Lactante , Recién Nacido , Enfermedades de la Laringe/complicaciones , Pulmón/diagnóstico por imagen , Embarazo , Traqueostomía , Ultrasonografía Prenatal
10.
Eur J Obstet Gynecol Reprod Biol ; 238: 12-19, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31082738

RESUMEN

Limited data are available on fetal monitoring during non-obstetric surgery in pregnancy. We performed a systematic review to evaluate the incidence of emergent cesarean delivery performed for non-reassuring fetal heart rate patterns during non-obstetric surgery. Electronic databases were searched from their inception until October 2018 without limit for language. We included studies evaluating at least five cases of intraoperative fetal heart rate monitoring -either with ultrasound or cardiotocography- during non-obstetric surgery in pregnant women at ≥22 weeks of gestation. The primary outcome was the incidence of intraoperative cesarean delivery performed for non-reassuring fetal heart rate monitoring. Non-reassuring fetal heart rate monitoring was defined by attendant personnel, meeting NICHD criteria for category II or III patterns. Data extracted regarded type of study, demographic characteristics, maternal and perinatal outcomes. Statistical analysis was performed for continuous outcomes by calculating mean and standard deviations for appropriate variables. Of 120 studies identified, 4 with 41 cases of intraoperative monitoring met criteria for inclusion and were analyzed. Most (66%) surgeries were indicated for neurological or abdominal maternal issues and were performed under general anesthesia (88%) at a mean gestational age of 28 weeks. Minimal or absent fetal heart variability was noted in most cases and a 10-25 beats per minutes decrease in fetal heart rate baseline was observed in cases with general anesthesia. No intraoperative cesarean deliveries were needed. The incidence of non-reassuring fetal heart rate monitoring was 4.9% (2/41) and were limited to fetal tachycardia during maternal fever. Two (4.9%) cases of non-reassuring fetal heart rate monitoring were noted within the immediate 48 h after surgery, necessitating cesarean delivery. A single case of intrauterine fetal demise occurred four days postoperatively in a woman who had neurosurgery and remained comatose. In conclusion, limited data exist regarding the clinical application of fetal heart rate monitoring at viable gestational ages during non-obstetric surgical procedures. Fetal heart rate monitoring during non-obstetric surgery at ≥22 weeks was not associated with need for intraoperative cesarean delivery, but two (4.9%) cesarean deliveries were performed for non-reassuring fetal heart rate monitoring within 48 h after surgery.


Asunto(s)
Sufrimiento Fetal/diagnóstico , Monitoreo Fetal , Frecuencia Cardíaca Fetal , Monitoreo Intraoperatorio , Cesárea/estadística & datos numéricos , Femenino , Sufrimiento Fetal/cirugía , Humanos , Embarazo
11.
Afr Health Sci ; 19(3): 2660-2669, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32127839

RESUMEN

OBJECTIVE: To explore maternal experience following caesarean section. METHODS: The study was a cross-sectional prospective study involving 250 women. RESULTS: The mean age of the study population was 27.2 ± 5.5 years with fifty-three per cent (53.1%) of the women between the ages of 20-9 years. Majority of the participants (67.1%) were multiparous and 37.4% of the parturient had secondary school education. The majority (67.1%) were in social class 3-5. Emergency caesarean section accounted for 74.5% of the caesarean section and the commonest indication was foetal distress. One hundred and forty-four participants (59.3%) were satisfied with their caesarean section experience which was significantly associated with health care attention and foetal outcome. More than half of the study population would not accept caesarean section when indicated in a future pregnancy. The health care attention [AOR 0.53, 95% CI (0.32, 0.88)] and maternal age [AOR 3.05, 95%CI (1.43, 6.49)] were significant predictors. CONCLUSION: Majority of the women were satisfied with their caesarean section experience which is influenced by the hospital care and foetal outcome. Improvement in maternal caesarean section experience through quality health care is important in increasing uptake when indicated.


Asunto(s)
Cesárea/psicología , Satisfacción del Paciente , Adulto , Factores de Edad , Estudios Transversales , Femenino , Sufrimiento Fetal/cirugía , Humanos , Nigeria , Embarazo , Resultado del Embarazo , Estudios Prospectivos , Centros de Atención Terciaria , Adulto Joven
12.
Ultrasound Obstet Gynecol ; 54(1): 51-57, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30246326

RESUMEN

OBJECTIVE: To compare maternal hemodynamics and perinatal outcome, in pregnancies that do not develop pre-eclampsia (PE) or deliver a small-for-gestational-age (SGA) neonate, between those identified at 11-13 weeks' gestation as being screen positive or negative for preterm PE, by a combination of maternal factors, mean arterial pressure, uterine artery pulsatility index, serum placental growth factor and pregnancy associated plasma protein-A. METHODS: This was a prospective longitudinal cohort study of maternal cardiovascular function, assessed using a bioreactance method, in women undergoing first-trimester screening for PE. Maternal hemodynamics and perinatal outcome were compared between screen-positive and screen-negative women who did not have a medical comorbidity, did not develop PE or pregnancy-induced hypertension and delivered at term a live neonate with birth weight between the 5th and 95th percentiles. A multilevel linear mixed-effects model was used to compare the repeated measures of cardiac variables, controlling for maternal characteristics. RESULTS: The screen-negative group (n = 926) had normal cardiac function changes across gestation, whereas the screen-positive group (n = 170) demonstrated static or reduced cardiac output and stroke volume and higher mean arterial pressure and peripheral vascular resistance with advancing gestation. In the screen-positive group, compared with screen-negative women, birth-weight Z-score was shifted toward lower values, with prevalence of delivery of a neonate below the 35th , 30th or 25th percentile being about 70% higher, and the rate of operative delivery for fetal distress in labor also being higher. CONCLUSION: Women who were screen positive for impaired placentation, even though they did not develop PE or deliver a SGA neonate, had pathological cardiac adaptation in pregnancy and increased risk of adverse perinatal outcome. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.


Asunto(s)
Gasto Cardíaco/fisiología , Retardo del Crecimiento Fetal/diagnóstico , Hemodinámica/fisiología , Preeclampsia/diagnóstico , Adulto , Presión Arterial/fisiología , Peso al Nacer/fisiología , Femenino , Sufrimiento Fetal/cirugía , Retardo del Crecimiento Fetal/fisiopatología , Humanos , Hipertensión Inducida en el Embarazo/fisiopatología , Recién Nacido , Estudios Longitudinales , Mortalidad Perinatal/tendencias , Factor de Crecimiento Placentario/metabolismo , Preeclampsia/fisiopatología , Embarazo , Resultado del Embarazo , Primer Trimestre del Embarazo/metabolismo , Primer Trimestre del Embarazo/fisiología , Proteína Plasmática A Asociada al Embarazo/metabolismo , Estudios Prospectivos , Flujo Pulsátil/fisiología , Arteria Uterina/diagnóstico por imagen , Resistencia Vascular/fisiología
13.
J Obstet Gynaecol Can ; 41(3): 327-337, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30366887

RESUMEN

OBJECTIVE: This study sought to quantify perinatal and maternal morbidity and mortality associated with forceps and vacuum delivery compared with Caesarean delivery in the second stage of labour and to estimate whether these associations differed by pelvic station. METHODS: The investigators conducted a population-based, retrospective cohort study of term singleton deliveries by operative delivery with prolonged second stage of labour in Canada (2003-2013) using national hospitalization data. The primary study outcomes were severe perinatal morbidity and mortality (i.e., seizures, assisted ventilation, severe birth trauma, and perinatal death) and severe maternal morbidity and mortality (i.e., severe postpartum hemorrhage, cardiac complication, and maternal death). Logistic regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) after stratifying by indication (dystocia or fetal distress). The Breslow-Day chi-square test for heterogeneity in ORs was used to test effect modification by pelvic station (outlet, low, or midpelvic). RESULTS: There were 61 106 deliveries included in the study. Among women with dystocia, forceps and vacuum deliveries were associated with higher rates of perinatal morbidity and mortality compared with Caesarean delivery (forceps: aOR 1.56; 95% CI 1.13-2.17; vacuum: aOR 1.44; 95% CI 1.06-1.97). Vacuum delivery was associated with lower rates of maternal morbidity and mortality compared with Caesarean delivery (dystocia: aOR 0.64; 95% CI 0.51-0.81; fetal distress: aOR 0.43; 95% CI 0.32-0.57). Pelvic station did not significantly modify the associations between forceps or vacuum and perinatal or maternal morbidity and mortality. CONCLUSION: Forceps and vacuum delivery is associated with increased rates of severe perinatal morbidity and mortality compared with Caesarean delivery among women with dystocia, whereas vacuum delivery is associated with decreased rates of severe maternal morbidity and mortality.


Asunto(s)
Traumatismos del Nacimiento/epidemiología , Cesárea/efectos adversos , Distocia/cirugía , Sufrimiento Fetal/cirugía , Complicaciones del Trabajo de Parto/epidemiología , Extracción Obstétrica por Aspiración/efectos adversos , Adulto , Traumatismos del Nacimiento/mortalidad , Femenino , Edad Gestacional , Humanos , Segundo Periodo del Trabajo de Parto , Complicaciones del Trabajo de Parto/mortalidad , Forceps Obstétrico , Embarazo , Estudios Retrospectivos , Extracción Obstétrica por Aspiración/instrumentación , Adulto Joven
15.
Am J Case Rep ; 19: 956-961, 2018 Aug 15.
Artículo en Inglés | MEDLINE | ID: mdl-30108198

RESUMEN

BACKGROUND Spontaneous coronary artery dissection is the most common etiology of pregnancy-associated myocardial infarction. It is characterized by high rates of maternal morbidity and mortality and may cause fetal complications and death as well. CASE REPORT A 44-year-old female (G2P1) suffered from pregnancy-related spontaneous coronary artery dissection with dissection of distal left anterior descending coronary artery. The patient was hemodynamically stable and did not required revascularization, but signs of fetal distress were detected and thus an urgent cesarean delivery was performed. This emergency procedure was undertaken in the catheterization laboratory (Cath-Lab) right after coronary angiography, thanks to a multidisciplinary team. Health conditions of the newborn were good. The patient instead suffered from a recurrence of spontaneous coronary artery dissection 6 days later, complicated by left ventricular apical thrombus and epistenocardial pericarditis. The dissection self-healed in 1 month. CONCLUSIONS Careful evaluation of pregnancy-related spontaneous coronary artery dissection is needed to assess and manage both maternal and fetal complications. Under specific circumstances, a cesarean delivery may be required and be even performed in the Cath-Lab after coronary catheterization.


Asunto(s)
Disección Aórtica/diagnóstico por imagen , Cesárea , Aneurisma Coronario/diagnóstico por imagen , Sufrimiento Fetal/cirugía , Complicaciones Cardiovasculares del Embarazo/diagnóstico por imagen , Adulto , Disección Aórtica/complicaciones , Aneurisma Coronario/complicaciones , Angiografía Coronaria , Femenino , Sufrimiento Fetal/etiología , Cardiopatías/etiología , Humanos , Pericarditis/etiología , Embarazo , Recurrencia , Trombosis/etiología
16.
J Neonatal Perinatal Med ; 11(4): 433-438, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30149468

RESUMEN

Non-obstetrical fetal head injury is an unusual clinical event. While multiple case reports describe motor vehicle collisions resulting in intrauterine fetal skull fractures, management of these injuries has not been emphasized. We report a case of a depressed fetal skull fracture with massive subgaleal and subperiosteal hemorrhage requiring neurosurgical intervention with good clinical outcomes for both mother and infant dyad.


Asunto(s)
Craneotomía/métodos , Descompresión Quirúrgica/métodos , Sufrimiento Fetal/cirugía , Procedimientos de Cirugía Plástica/métodos , Lesiones Prenatales/cirugía , Fracturas Craneales/embriología , Accidentes de Tránsito , Adulto , Cesárea , Duramadre/cirugía , Femenino , Sufrimiento Fetal/diagnóstico por imagen , Sufrimiento Fetal/fisiopatología , Edad Gestacional , Humanos , Recién Nacido , Cuidado Intensivo Neonatal , Embarazo , Mujeres Embarazadas , Lesiones Prenatales/diagnóstico por imagen , Lesiones Prenatales/fisiopatología , Fracturas Craneales/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
17.
BMJ Case Rep ; 20182018 Feb 14.
Artículo en Inglés | MEDLINE | ID: mdl-29444799

RESUMEN

We present a case of a 28-year-old woman second gravida with a full-term pregnancy who presented to us in active phase of labour with third degree uterovaginal prolapse complicated by entrapment of fetal head by dystocia of cervix and fetal distress. Patient was immediately shifted to the operation theatre and prompt delivery was conducted by giving Duhrssen's incision on the highly vascular, oedematous prolapsed cervix. The outcome was an alive and healthy male baby. Duhrssen's incision was stitched with minimal blood loss. Postnatal management included antibiotics and daily intravaginal packing. Patient was discharged along with the baby in satisfactory condition.


Asunto(s)
Distocia/cirugía , Prolapso Uterino/cirugía , Adulto , Femenino , Sufrimiento Fetal/cirugía , Humanos , Recién Nacido , Masculino , Embarazo , Resultado del Embarazo , Prolapso Uterino/complicaciones
18.
J Matern Fetal Neonatal Med ; 31(24): 3301-3307, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-28816083

RESUMEN

OBJECTIVE: To stratify apparently low-risk pregnant women into those who are at risk of adverse perinatal outcomes. Appropriate stratification would allow targeted prenatal and intrapartum management. METHODS: This prospective, observational study included normotensive women with appropriately grown, non-anomalous, singleton pregnancies. Participants underwent fortnightly ultrasounds from 36 weeks' gestation and intrapartum and neonatal outcomes were recorded. The association between uterine artery pulsatility index (UtA-PI), the cerebroplacental ratio (CPR) and estimated fetal weight (EFW) were explored along with their screening performance for CS-IFC and CNM. RESULTS: The final cohort included 429 women. As continuous variables, UtA-PI and the CPR were not correlated (rho = -0.05, p = .33). UtA-PI >95th centile and the CPR <10th centile were predictive of CS-IFC and CNM, with the highest sensitivity achieved by their combination (33.3%, 95% CI 11.6-55.1) for a false positive rate (FPR) of 15.8% (12.3-19.3). For CNM, the highest sensitivity (28.4%, 95% CI 18.6-38.2) and corresponding FPR (17.0%, 95% CI 13.0-20.9) was achieved by combining UtA-PI 95th centile, the CPR 10th centile and EFW 10th centile. EFW was the weakest of the three predictors. CONCLUSION: In this population, UtA-PI 95th centile and the CPR 10th centile have modest screening performance for CS-IFC and CNM.


Asunto(s)
Ultrasonografía Prenatal/métodos , Adulto , Cesárea/estadística & datos numéricos , Femenino , Sufrimiento Fetal/diagnóstico por imagen , Sufrimiento Fetal/cirugía , Peso Fetal , Humanos , Tamizaje Masivo , Placenta/diagnóstico por imagen , Embarazo , Resultado del Embarazo , Estudios Prospectivos , Arteria Uterina/diagnóstico por imagen
19.
JNMA J Nepal Med Assoc ; 56(213): 871-874, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-31065123

RESUMEN

INTRODUCTION: Cesarean section is one of the common obstetric procedures done when the childbirth is not anticipated to occur by the normal vaginal delivery. There has been increased rate of cesarean section globally as well as in our country in recent decades. METHODS: This descriptive cross-sectional study has been carried out by reviewing a year of data from maternity ward of Paschimanchal Community Hospital, Prithvi Chowk, Pokhara. The total number of delivery, their modes either vaginal or cesarean, indications for the cesarean section and their outcomes were analyzed. The obtained data was entered and analyzed in Microsoft Excel. RESULTS: Total of 257 cases underwent delivery during the study period and 174 (63.27%) were by cesarean section. Oligohydramnios is the most common indication for cesarean section. Around 25 (14.36%) of the women underwent repeat cesarean section. CONCLUSIONS: The rate of cesarean section was quite high in our study and further studies are recommended for understanding of causes and other associated factors with it.


Asunto(s)
Cesárea/estadística & datos numéricos , Hospitales Comunitarios/estadística & datos numéricos , Desproporción Cefalopelviana/cirugía , Cesárea Repetida/estadística & datos numéricos , Estudios Transversales , Distocia/cirugía , Femenino , Sufrimiento Fetal/cirugía , Humanos , Nepal , Oligohidramnios/cirugía , Embarazo
20.
J Perinat Med ; 46(6): 641-647, 2018 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-29171962

RESUMEN

OBJECTIVES: This study aimed to determine maternal and obstetric factors associated with emergency caesarean section (CS) for non-reassuring foetal status (NRFS). MATERIALS AND METHODS: This was a retrospective analysis of term singleton births between January 2007 and December 2015 at the Mater Mother's Hospital in Brisbane. The study group comprised all cases of emergency CS for NRFS, and the control cohort comprised all other births meeting the inclusion criteria but excluding those in the study cohort. RESULTS: Over the study period, there were 74,177 births fulfilling the inclusion criteria. The overall rate of emergency CS for NRFS was 4.2% (3132/74,177). Multivariate analysis showed that being overweight and obese, Indian and "other" ethnicity, artificial reproductive techniques, smoking, induction of labour and gestation at 39-42 weeks were associated with an increased risk, whereas being underweight, female sex, hypertension and birth without labour conferred a lower risk. CONCLUSION: Many maternal and obstetric factors were associated with emergency CS for NRFS and influenced adverse perinatal outcomes. Recognition of these risk factors could help risk stratify women prior to labour.


Asunto(s)
Cesárea , Sufrimiento Fetal/cirugía , Australia , Índice de Masa Corporal , Cesárea/estadística & datos numéricos , Estudios de Cohortes , Demografía , Urgencias Médicas , Femenino , Edad Gestacional , Humanos , Recién Nacido , Masculino , Análisis Multivariante , Embarazo , Resultado del Embarazo , Estudios Retrospectivos , Factores de Riesgo
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