Clinical Question: Does Medical Evidence Support Routine Oronasopharyngeal Suction at Delivery?

Oronasopharyngeal suction (ONPS) is regularly performed in neonates at delivery in many hospitals across the country today. Although ONPS is a technique that has essentially become habitual for most obstetricians, its theorized usefulness to help promote expeditious lung aeration after delivery by removal of amniotic fluid, meconium, mucus and blood that may otherwise be aspirated by the newborn, is currently not recommended. ONPS can cause vagal stimulation-induced bradycardia and thus hypercapnea, iatrogenic infection due to mucous membrane injury, and development of subsequent neonatal brain injury due to changes in cerebral blood flow regulation, particularly in premature infants. Multiple studies that have been performed comparing routine use of ONPS to no intervention controls indicate that newborns receiving ONPS took a longer time to achieve normal oxygen saturations, caused apneic episodes, and caused disturbances in heart rate (mainly bradycardia) compared to the control groups. Although the ONPS groups revealed no significantly different APGAR scores at 1 and 5 minutes, the ONPS groups took longer than the control group to reach an arterial oxygen saturation greater than or equal to 92% in the first minutes of life. Currently, Neonatal Resuscitation Program guidelines discourage the use of or meconium-stained amniotic fluid and in the absence of obvious obstruction. Furthermore, this manuscript highlights various literature sources revealing that the routine use of ONPS at the time of delivery can cause more harm than good, if any good at all.

Spontaneous Renal Rupture During Pregnancy: A Contemporary Literature Review and Guide to Management.

IMPORTANCE: Spontaneous renal rupture is a rare pregnancy complication, which requires a high index of suspicion for a timely diagnosis to prevent a poor maternal or fetal outcome. OBJECTIVE: This review highlights risk factors, pathophysiology, symptoms, diagnosis, management, and complications of spontaneous renal rupture in pregnancy. EVIDENCE ACQUISITION: A literature search was carried out by research librarians using the PubMed and Web of Science search engines at 2 universities. Fifty cases of spontaneous renal rupture in pregnancy were identified and are the basis of this review. RESULTS: The first case of spontaneous renal rupture in pregnancy was reported in 1947. Rupture occurs more commonly on the right side and during the third trimester. Pain was a reported symptom in every case reviewed. Treatment usually consists of stent or nephrostomy tube placement. Conservative management has been reported. CONCLUSIONS: When diagnosed early and managed appropriately, maternal and fetal outcomes are favorable. Preterm delivery is the most common complication. RELEVANCE: Our aim is to increase the awareness of spontaneous renal rupture in pregnancy and its associated complications in order to improve an accurate diagnosis and maternal and fetal outcomes.