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Zeitschriftenartikel zum Thema "Breech delivery Fetal presentation"
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Kothapally, Kavitha, Archana Uppu und Vijayalakshmi Gillella. „Study of the obstetric outcome of breech presentation in pregnancy in a tertiary hospital in a rural area in Telangana, India“. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, Nr. 5 (27.04.2017): 2040. http://dx.doi.org/10.18203/2320-1770.ijrcog20171973.
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Background: The present study was undertaken to study the incidence, aetiology and obstetric outcome of breech presentation in pregnancy in a teaching hospital in a rural area.Methods: The present retrospective observational study was conducted in the department of obstetrics and gynaecology at Bhaskar Medical College and Bhaskar General Hospital, Yenkepally, Telangana from May 2014 to March 2017. 50 cases of breech presentation were included in the study. Demographic data like age, parity, gestational age of first detection of breech, aetiological factors of breech, mode of delivery, neonatal outcome were noted from case records.Results: The incidence of breech was 1.4% in pregnancies attending Bhaskar general hospital. 74% were in the age group of 20-24yrs & 20% were in the age group of 25-29yrs. Primis accounted for 62% of the study group. Common etiologies of breech presentation were oligohydramnios (28%) and uterine anomalies (28%). No obvious fetal anomalies were noted. Majority (96%) of cases were delivered by caesarean section for breech associated with oligohydramnios, gestational hypertension, intrauterine fetal growth restriction and preterm. Neonatal outcome was good in breech delivered by caesarean section.Conclusions: Breech delivery is a high risk pregnancy with adverse fetal outcomes during pregnancy and labour. Though caesarean section for breech presentation is not universally recommended, caesarean section can reduce the perinatal mortality and morbidity compared to vaginal birth for term breech pregnancy. Mode of delivery should be decided based on the case and obstetrician’s skill.
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Naz, Samina. „VAGINAL BREECH DELIVERY“. Professional Medical Journal 22, Nr. 08 (10.08.2015): 1024–28. http://dx.doi.org/10.29309/tpmj/2015.22.08.1149.
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Objective: To determine the obstetric and perinatal outcome of pregnancieswith singleton breech presentation, and to scrutinize the causes of increasing incidence ofcesarean section in breech presentation. Design: Analytical Observational study. Place andduration: Department of obstetrics and gynecology Fatima hospital Baqai university campusfrom Jan 2010 to Oct 2011. Patients & Methods: This study includes 135 patients with singletonbreech presentation ≥ 34 weeks of gestation, were analyzed in detail with help of designedperforma. Patients were categorized in three groups. Groups a, who had elective C-section,group b. who underwent emergency caesarean section or had C-section after failed trial ofvaginal delivery and group c. who had vaginal breech delivery. Elective caesarean section wasdone in those cases that had some other indications for carrying out this procedure apart frombreech presentation. Trial of vaginal breech delivery was planned for all multiparous womenexcept those falling in group A. All antepartum fetal demise, twin pregnancies and placentaprevia of major degree were excluded. Results: Of 135 women, 7(5%) underwent prelabourcesarean, and 128(95%), had trial of vaginal delivery, of whom 117(91.5%) delivered vaginally.Significantly more infants weighing> 3.5kg were selected for prelabour and intrapartumcesarean than vaginal delivery. Two neonates had Apgar score< 7 at 5 minutes but both werenormal neurologically. There were no nonanomalous perinatal death and no case of significanttrauma or neurological dysfunction. Two infants died due to lethal anomalies. Conclusion:Trial of vaginal breech delivery in well counselled patients, still taken as an appropriate optionwithout compromising prenatal and maternal outcome. It also decreases the rate of cesareansection.
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Fonseca, Andreia, Rita Silva, Inês Rato, Ana Raquel Neves, Carla Peixoto, Zita Ferraz, Inês Ramalho et al. „Breech Presentation: Vaginal Versus Cesarean Delivery, Which Intervention Leads to the Best Outcomes?“ Acta Médica Portuguesa 30, Nr. 6 (30.06.2017): 479. http://dx.doi.org/10.20344/amp.7920.
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Introduction: The best route of delivery for the term breech fetus is still controversial. We aim to compare maternal and neonatal outcomes between vaginal and cesarean term breech deliveries.Material and Methods: Multicentric retrospective cohort study of singleton term breech fetuses delivered vaginally or by elective cesarean section from January 2012 - October 2014. Primary outcomes were maternal and neonatal morbidity or mortality.Results: Sixty five breech fetuses delivered vaginally were compared to 1262 delivered by elective cesarean. Nulliparous women were more common in the elective cesarean group (69.3% vs 24.6%; p < 0.0001). Gestational age at birth was significantly lower in the vaginal delivery group (38 ± 1 weeks vs 39 ± 0.8 weeks; p = 0.0029) as was birth weight (2928 ± 48.4 g vs 3168 ± 11.3 g; p < 0.0001). Apgar scores below seven on the first and fifth minutes were more likely in the vaginal delivery group (1st minute: 18.5% vs 5.9%; p = 0.0006; OR 3.6 [1.9 - 7.0]; 5th minute: 3.1% vs 0.2%; p = 0.0133; OR 20.0 [2.8 - 144.4]), as was fetal trauma (3.1% vs 0.3%: p = 0.031; OR 9.9 [1.8-55.6]). Neither group had cases of fetal acidemia. Admission to the Neonatal Intensive Care Unit, maternal postpartum hemorrhage and the incidence of other obstetric complications were similar between groups.Discussion: Although vaginal breech delivery was associated with lower Apgar scores and higher incidence of fetal trauma, overall rates of such events were low. Admission to the neonatal intensive care unit and maternal outcomes were similar.Conclusion: Both delivery routes seem equally valid, neither posing high maternal or neonatal complications’ incidence.
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Karning, Rashmi Kumar, Bhanu B. T. und Sarojini. „Mode of delivery and outcome of breech presentation: a prospective observational study in a tertiary centre“. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, Nr. 8 (26.07.2017): 3409. http://dx.doi.org/10.18203/2320-1770.ijrcog20173453.
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Background: Breech presentation is the commonest malpresentation with the incidence of 3-4% at term. This study was done with the objective of studying the mode of delivery in breech presentation and to compare the maternal and fetal outcome in patients delivered vaginally to those delivered by cesarean section.Methods: This prospective observational study was conducted in Vanivilas Hospital, affiliated to Bangalore Medical College and Research Institute, from June 2014 to May 2015. The study group included 509 patients with breech presentation who were studied with respect to their gestational age, birth weight, type of breech, mode of delivery, maternal and perinatal outcome.Results: The incidence of breech presentation was 2.92% (509) among 17454 total deliveries with the incidence of 3.17% in primi and 2.73% in multies. 193 (38%) patients had vaginal breech delivery and 316 (62%) delivered by LSCS. Apgar score of less than 7 at 1 minute was seen with 21.42% of vaginally delivered fetuses and 9.09% of fetuses delivered by cesarean section. The perinatal mortality was 1.6% (8 cases) in vaginal group 0.8% (4 cases) in LSCS group. The short term maternal complications in LSCS group was 7.62% and in vaginal delivery group was 3.09%.Conclusions: The short term maternal morbidity is higher in patients with cesarean section compared to those with vaginal breech delivery. Perinatal outcome is better in babies delivered by cesarean section. Still vaginal breech delivery can be an option for breech babies with proper selection and when conducted by a skilled obstetrician.
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MUKHTAR,, BUSHRA, BUSHRA KHAN und NUZHAT RASHEED. „BREECH PRESENTATION AT TERM;“. Professional Medical Journal 20, Nr. 04 (15.08.2013): 526–29. http://dx.doi.org/10.29309/tpmj/2013.20.04.1027.
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Objective: To compare the fetal outcome of elective cesarean section with elective vaginal birth for Term Breechpresentation in terms of APGAR Score, Respiratory Distress Syndrome, Admission in Neonatology Unit and Neonatal mortality. Design:Quasi experimental study. Setting: Department of Obstetrics & Gynaecololgy Bahawal Victoria Hospital, Bahawalpur. Methods: Total 120cases were included in the study divided into two groups, each having 60 fulfilling the inclusion criteria. Group 'A' had those who deliveredby planned cesarean and Group 'B' comprised those having planned vaginal delivery. Results: It was found that neonatal mortality was3.33 in vaginal and 0 in cesarean group. Mean APGAR Score at 1 and 5 minute was 8.47 and 9.53 in vaginal and 8.58 and 9.62 incesarean group. RDS was more in cesarean (5) than vaginal group (1.6). Admission in Neonatalogy Unit was more in vaginally deliveredgroup (8.33) as compared to the cesarean section group (5). Conclusion: Planned cesarean delivery in breech presentation at term isassociated with a reduction in neonatal mortality and morbidity as compared to the planned vaginal birth.
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Ong, S., und P. McKenna. „Breech presentation. Fetal loss associated with intended vaginal delivery“. Irish Journal of Medical Science 165, Nr. 4 (Oktober 1996): 263–64. http://dx.doi.org/10.1007/bf02943085.
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Sankaran, Suneela Mullakkal, und Jayasree Sukumara Sukumara Pillai. „Retrospective analysis of breech deliveries in tertiary care center“. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 9, Nr. 11 (27.10.2020): 4549. http://dx.doi.org/10.18203/2320-1770.ijrcog20204808.
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Background: Breech presentation is the commonest malpresentation accounting for 3-4% of all deliveries at term. The most common cause for breech presentation is preterm delivery. The safest route of delivery for breech had long been a topic of debate and after the results of term breech trial mode of delivery has become abdominal route even in teaching institutions.Methods: This is a retrospective cross sectional study conducted at department of obstetrics and gynaecology, Government medical college, Kozhikode, for a period of 2 years from 01 January 2016 to 31 December 2017. Mothers with gestational age between 28 weeks to 41 weeks with singleton live fetus with breech presentation who had either vaginal or caesarean delivery were included. The case notes were retrieved from the medical records department.Results: A total of 823 breech deliveries occurred during the study period. Of the total mothers 429 were primies and 394 were multies. Common causes identified were prematurity, intrauterine growth restriction, uterine and fetal anomalies. Mode of delivery was caesarean in more than 80% of cases.Conclusions: Incidence of breech presentation was 3.2% during the study period. Increasing incidence of caesarean delivery is seen in breech presentation. Persistent breech presentation at term is most commonly seen in patients with associated oligamnios, intrauterine growth restriction, and uterine anomalies.
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Mohanraj, Uma, und A. Adhirai. „Study of fetomaternal outcome in various modes of breech delivery in a tertiary care hospital- MGM GH, Trichy“. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 10, Nr. 1 (26.12.2020): 154. http://dx.doi.org/10.18203/2320-1770.ijrcog20205761.
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Background: Aim of the study was to optimize the fetomaternal outcome using different modes of delivery in breech presentation and objective of the study was to optimize the maternal and perinatal outcome in various modes of breech delivery.Methods: Among 150 mothers with different parity and gestational age having singleton breech were studied during May 2019- October 2019 for the period of 6 months at KAPV government medical college. Fetomaternal outcome was compared in various modes of breech delivery during this study period in our institute. This study was a prospective analytical study.Results: Incidence of breech presentation was 3.3% of total deliveries in this institute. Around 4 (26.6%) cases by emergency LSCS, 48 (32%) cases delivered vaginally, 62 (41.3%) cases by elective LSCS. Comparatively, large number of cases were delivered by planned caesarean section in our institute. The maternal and perinatal morbidity and mortality was found to be less in planned caesarean section compared with other modes of delivery in this study.Conclusions: In view of insignificant difference in the fetomaternal outcome balanced decision about mode of delivery on a case by case basis will go a long way in improving both fetal and maternal outcome. Regular drills and conduct of assisted vaginal breech delivery should be pursued in all maternity hospitals.
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Toijonen, Anna E., Seppo T. Heinonen, Mika V. M. Gissler und Georg Macharey. „A comparison of risk factors for breech presentation in preterm and term labor: a nationwide, population-based case–control study“. Archives of Gynecology and Obstetrics 301, Nr. 2 (18.11.2019): 393–403. http://dx.doi.org/10.1007/s00404-019-05385-5.
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Abstract Purpose To determine if the common risks for breech presentation at term labor are also eligible in preterm labor. Methods A Finnish cross-sectional study included 737,788 singleton births (24–42 gestational weeks) during 2004–2014. A multivariable logistic regression analysis was used to calculate the risks of breech presentation. Results The incidence of breech presentation at delivery decreased from 23.5% in pregnancy weeks 24–27 to 2.5% in term pregnancies. In gestational weeks 24–27, preterm premature rupture of membranes was associated with breech presentation. In 28–31 gestational weeks, breech presentation was associated with maternal pre-eclampsia/hypertension, preterm premature rupture of membranes, and fetal birth weight below the tenth percentile. In gestational weeks 32–36, the risks were advanced maternal age, nulliparity, previous cesarean section, preterm premature rupture of membranes, oligohydramnios, birth weight below the tenth percentile, female sex, and congenital anomaly. In term pregnancies, breech presentation was associated with advanced maternal age, nulliparity, maternal hypothyroidism, pre-gestational diabetes, placenta praevia, premature rupture of membranes, oligohydramnios, congenital anomaly, female sex, and birth weight below the tenth percentile. Conclusion Breech presentation in preterm labor is associated with obstetric risk factors compared to cephalic presentation. These risks decrease linearly with the gestational age. In moderate to late preterm delivery, breech presentation is a high-risk state and some obstetric risk factors are yet visible in early preterm delivery. Breech presentation in extremely preterm deliveries has, with the exception of preterm premature rupture of membranes, similar clinical risk profiles as in cephalic presentation.
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Jennewein, Lukas, Dörthe Brüggmann, Kyra Fischer, Florian J. Raimann, Hemma Roswitha Pfeifenberger, Lena Agel, Nadja Zander, Christine Eichbaum und Frank Louwen. „Learning Breech Birth in an Upright Position Is Influenced by Preexisting Experience—A FRABAT Prospective Cohort Study“. Journal of Clinical Medicine 10, Nr. 10 (14.05.2021): 2117. http://dx.doi.org/10.3390/jcm10102117.
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Background: Vaginal breech delivery is becoming an extinct art although national guidelines underline its safety and vaginal breech delivery in an upright position has been shown to be a safe birth mode option. In order to spread clinical knowledge and be able to implement vaginal breech delivery into obstetricians’ daily practice, we need to gather knowledge from facilities who teach specialized obstetrical management. Methods: We performed a prospective cohort study on 140 vaginal deliveries out of breech presentation solely-managed by seven newly-trained physicians and compared fetal outcome as well as rates of manual assistance in respect to preexisting experience. Results: Fetal morbidity rate measured with a modified PREMODA score was not significantly different in three sub-cohorts sorted by preexisting expertise levels of managing obstetricians (experience groups EG, EG0: 2, 5%; EG1: 3, 7.5%; EG2: 1, 1.7%; p = 0.357). Manual assistance rate was significantly higher in EG1 (low experience level in breech delivery and only in dorsal position) compared to EG0 and EG2 (EG1 28, 70%; EG0: 14, 25%; EG2: 21, 35%; p = 0.0008). Conclusions: Our study shows that vaginal breech delivery with newly-trained obstetricians is a safe option whether or not they have advanced preexisting expertise in breech delivery. These data should encourage implementing vaginal breech delivery in clinical routine.
Dissertationen zum Thema "Breech delivery Fetal presentation"
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Bartlett, Doreen Joan. „Early motor development of term breech- and cephalic-presenting infants“. Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/nq22948.pdf.
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Peterson, Caroline. „Psycho-Socio-Cultural Risk Factors for Breech Presentation“. Scholar Commons, 2008. https://scholarcommons.usf.edu/etd/451.
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The Breech Baby Study is a mixed methods study which combines qualitative and quantitative inquiry. This study explores psycho-social-cultural risk factors for breech presentation from an evolutionary perspective. The quantitative component of the study uses Florida birth certificate and Medicaid data sets from 1992-2003 to evaluate the influence of ethnicity and socio-economic status on breech presentation.
Ethnicity and socio-economic status account for less than two percent of the variance of risk factors for breech presentation. The qualitative study includes 114 mothers of breech and cephalic presentation babies who completed the State Trait Personality Inventory and a socio-demographic survey. Of these, 52 mothers of cephalic presentation babies and 23 mothers of breech presentation also participated in an in-depth interview about formative life experiences and peri-conception through delivery.
The primary data analysis found mothers of breech presentation babies exhibit psycho-social-cultural characteristics unlike those found in mothers of cephalic presentation babies. These characteristics include being idealistic, analytical, polished, overextended, and fearful. Mothers of cephalic presentation babies were better equipped to adapt to unexpected situations and to be pragmatic in the face of unresolvable circumstances.
Mothers of breech presentation babies were further separated into two categories. One category is achievement focused woman while the other is non-present focused woman. While both sets of breech presentation mothers were idealistic, the achievement focused mothers were more likely to be analytical, polished, and overextended. In contrast, the non-present focused mothers had a history of abuse and were more likely to have an unresolved pregnancy outcome or to be fearful. Breech presentation is interpreted by attachment theory, evolutionary ecological reproductive theory, and developmental plasticity theory as a fetal strategy to adapt to the intra-uterine relationship environment and an attempt to predict the extra-uterine relationship environment.
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Leeuw, Johannes Philippus de. „Breech presentation vaginal or abdominal delivery? a prospective longitudinal study /“. [Maastricht : Maastricht : Rijksuniversiteit Limburg] ; University Library, Maastricht University [Host], 1989. http://arno.unimaas.nl/show.cgi?fid=5451.
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Arey, Kelly Marie. „Examination of Birth Outcomes with Mode of Delivery for Breech Presentation“. VCU Scholars Compass, 2007. http://hdl.handle.net/10156/1686.
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Grälls, Jenny. „Sätesförlossningar : Handläggning och utfall hos mödrar och barn vid vaginal förlossning och kejsarsnitt“. Thesis, Uppsala universitet, Institutionen för kvinnors och barns hälsa, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-200521.
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Background: The incidence of caesarean section for breech presentation has reached approximately 90 % in Sweden. In many of these cases, by means of specific selection criteria, it would be as safe to plan for vaginal breech delivery. Aim: The objective of this study was to investigate differences in management and to compare maternal and fetal outcomes according to delivery mode of breech presentation; vaginal vs. caesarian section. The study included breech presentation in full term singleton pregnancies at the UppsalaUniversityHospital, Uppsala, Sweden (UAS). Method: The study was based on medical record data with a retrospective, descriptive, comparative design with quantitative approach. The method for data collection was a manual review of patient records using a structured questionnaire. Results: Of the women with children in breech presentation during the period studied, 11 % gave birth vaginally. Mother's wish was the most common cause of caesarean section. The group with caesarean section included more first-time mothers, longer length of stay at the hospital, increased bleeding and need for pain medication, separation from the child, later lactation and earlier introduction of formula. Vaginally delivered mothers had increased incidence of straight urine catheterization postpartum and of infants with lower Apgar scores. Conclusion: This study does not support the suggestion that it would be safer to give birth by caesarean section for breech presentation in cases where the woman at full term meets strict selection criteria. Instead of applying medical criteria, the decision regarding mode of delivery was more often left up to the mother.
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Kader, Rahel. „The obstetric outcome of women who had successful external cephalic version for breech presentation at term“. Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/85562.
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Thesis (MMed)-- Stellenbosch University, 2013.ENGLISH ABSTRACT: AIM: Review outcome of pregnancies following successful external cephalic version (ECV) for breech presentation at term, particularly the caesarian section (CS) rate. ECV is a safe procedure with a minimal cost implication that can reduce non-cephalic presentation at onset of labour at term. The outcome of pregnancies following successful ECV is certainly of interest. A meta analysis of studies done between 1997 and 2004, found that pregnancies after successful ECV at term were not the same as those with spontaneous cephalic presentations and was associated with a CS rate twice that in pregnancies with spontaneous cephalic presentations. The conclusion was that pregnancies after successful ECV should not be considered the same as normal pregnancies. In a matched retrospective analysis of CS risk after successful ECV, done in the USA, it was concluded that CS delivery and operative vaginal delivery rates following successful ECV, were not increased. To date there are no such studies in South Africa. METHODOLGY: A retrospective descriptive study was done to audit all successful ECV’s done at the Fetal Evaluation Clinic (FEC) of Tygerberg Academic Hospital. The electronic data from the FEC was searched for successful ECV patients. The facilities where these patients delivered were identified. The outcome of the pregnancies was determined from patient files and/or the labor registers. The relevant information of each patient was captured. All file reviews and data capturing was done by the principal investigator. RESULTS: A total of 78 patients were included in the study. The median age was 28.7 years with a range from 17 to 40 years, the median parity 1 and the range 0 to 6 and the median body mass index 27.2 and the range 18.2 to 45.0. The method of determining gestational age is known in 71 (91%) patients of whom 37 (52%) had an early ultrasound examination. The median gestational age at ECV was 37 weeks with the inter quartile range 36 to 38 weeks. The median ECV to delivery time was 2 weeks with the inter quartile range 1 to 4 weeks. Higher levels of care were required at time of delivery by 47 (60.3%) patients. Vaginal deliveries occurred in 49 patients and 29 (37.2%) had CS. The most common indications for CS were cephalo pelvic disproportion 8, fetal distress 6, reversion back to breech presentations 4 and other abnormal presentations 4 (2 face presentations and 2 transverse lies). The mean birth weight of the babies was 3360g and the range 2100 to 4655g. On comparing the groups that had vaginal deliveries and CS, only nulliparous patients had a significantly (p=0.02) higher risk for CS. CONCLUSIONS: Following successful ECV all patients need to be carefully followed up for possible reversion to breech presentation or transverse lie. Nulliparous and gravid 2 para 1 patients with a previous CS need to be delivered in hospitals with CS facilities. Further studies are required to assess whether successful ECV results in more face presentations.
AFRIKAANSE OPSOMMING: DOELWIT: Om die uitkoms van swangerskappe na suksesvolle eksterne kefaliese kerings (EKK) vir stuit presentasies op voltyd, spesifiek die keisersnit (KS) insidensie te bepaal. EKK is ‘n veilige prosedure wat teen minimale koste die nie-kefaliese presentasies op voltyd kan verminder. Die uitkoms van swangerskappe na suksesvolle EKK is van belang. ‘n Meta-analise van studies gedoen tussen 1997 en 2004 vind dat swangerskappe na suksesvolle EKK op voltyd nie dieselfde is vergeleke met spontane kefaliese presentasies nie en gepaard gaan met ‘n KS koers tweekeer hoër as dié met spontane kefaliese presentasies op voltyd. Die gevolgtrekking was dat swangerskappe na suksesvolle EKK nie as normale swangerskappe beskou moet word nie. In ‘n gepaarde retrospektiewe ontleding van die KS risiko wat in die VSA gedoen is, word gevind dat die KS en operatiewe vaginale verlossing koerse na suksesvolle EKK, nie verhoog is nie. Tot op hede is daar geen studies hieroor in Suid-Afrika gedoen nie. METODE: ’n Retrospektiewe beskrywende studie is gedoen om all suksesvolle EKK wat by die Fetale Evaluasie Kliniek (FEK) gedoen is te oudit. ‘n Elektroniese data soektog van suksesvolle EKK by die FEK is gedoen. Die instellings waar die pasiënte verlos is, is vasgestel. Die uitkoms van die swangerskappe is bepaal deur pasiënt lêers en/of die kraamregisters na te gaan. Die relevant inligting oor elke pasiënt is versamel. RESULTATE: ‘n Totaal van 78 pasiënte is by die studie ingesluit. Die mediane ouderdom was 28.7 jaar met ‘n reikwydte van 17 tot 40 jaar, die mediane pariteit was 1 met ‘n reikwydte van 0 tot 6 en die mediane liggaamsmassa indeks 27.2 met ‘n reikwydte van 18.2 tot 45.0. Die metode waavolgens swangerskapsduurte bepaal is, was bekend in 71 (91%) van pasiënte, waarvan 37 (52%) vroeë ultraklank ondersoeke gehad het. Die mediane swangerskapsduurte tydens die EKK was 37 weke met die interkwartiele interval 36 tot 38 weke. Die mediane EKK tot verlossing tydsverloop was 2 weke met die interkwartiele interval 1 tot 4 weke. Hoër vlakke van sorg was nodig ten tye van die verlossing by 47 (60.3%) van pasiënte. Van die pasiënte het 49 vaginale verlossings en 29 (37.2%) KS gehad. Die mees algemene indikasies vir KS was skedel-bekken disproporsie 8, fetale nood 6, terugkeer na stuitpresentasie 4 en abnormale presentasies 4 (2 aangesigsliggings en 2 transversliggings). Die gemiddelde geboorte gewig van die babas was 3360g en die reikwydte 2100 tot 4655g. Wanneer die groep wat vaginale verlossing en KS gehad het vergelyk word, het slegs nullipareuse pasiënte ‘n betekenisvolle (p=0.02) hoër risiko vir KS gehad. GEVOLTREKKING: Na suksesvolle EKK moet alle pasiënte noukeurig opgevolg word vir terugkeer na ‘n stuit presentasie of transversligging. Nullipareuse en gravida 2 para 1 pasiënte met ‘n vorige KS moet in hospitale met KS fasiliteite verlos word. Verdere studies is nodig om te bepaal of suksesvolle EKK meer aangesig presentasies tot gevolg het.
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Guittier, Marie-Julia. „Présentation foetale en siège en fin de grossesse : effet des interventions et des attitudes professionnelles sur le vécu des femmes“. Thesis, Université de Lorraine, 2013. http://www.theses.fr/2013LORR0193.
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Contexte : Le management de la présentation foetale en siège est complexe car la littérature scientifique est contrastée. Objectif : Mettre en évidence les effets des attitudes et des interventions professionnelles sur le vécu des femmes. Méthodes : Cinq recherches quantitatives et qualitatives, incluant 311 participantes, ont été menées à la maternité des Hôpitaux Universitaires de Genève. Résultats : Les femmes doivent souvent faire un deuil par anticipation de l'accouchement idéalisé. Elles sont très motivées à tenter de corriger la malposition foetale. 69% des participantes ont recours aux médecines alternatives et complémentaires pour se soigner. 68% des participantes ont qualifié la tentative de version céphalique externe (VCE) de « forte à insupportable. Un accompagnement par hypnose ne réduit pas l'intensité de la douleur, comparé à un accompagnement par une sage-femme (échelle visuelle analogique : 6,0 vs 6,3 /10 respectivement, p=0.25). Pour le choix du mode d'accouchement les femmes ont rapporté des conflits décisionnels majeurs. L'information médicale est souvent perçue en faveur de la césarienne élective. Le sentiment de contrôle, les émotions et les premiers instants avec le nouveau-né sont perçus différemment selon le mode d'accouchement, en défaveur de la césarienne en urgence. Conclusion : Un processus émotionnel et décisionnel inattendu et souvent difficile est associé au diagnostic de siège. Développer des outils d'aide à la décision pour la femme, et des techniques de relation d'aide pour les professionnels faciliteraient ces processus. La prise en charge de la douleur durant la tentative de VCE est indispensableContext: Management of breech remains complex due to divergence of practices and recommendations reported in the literature. Objective: To highlight the effects of health professionals' interventions on women's experiences. Methods: Five research studies qualitative were conducted at the University Hospitals of Geneva, including a total of 311 participants. Two studies used a method with interviews and thematic analysis, two used a quantitative method with a statistical analysis, and one used a mixed methods' design. Results: Breech diagnosis often requires anticipating a disappointment of an idealized childbirth. Women demonstrate a strong motivation to try to turn their fetus. 69% of women use complementary and alternative medicine (CAM) for their treatment. 68% of participants qualified external cephalic version (ECV) as "strong to unbearable". An accompaniment by a hypnotist compared to a midwife did not decrease pain intensity (visual analogic scale: 6.0 vs 6.3/10, respectively; p=.25). For the choice of breech delivery mode, women reported strong decisional conflicts. Medical information is often perceived in favour of a planned caesarean. Feelings of control, emotions and the first moments with the newborn are perceived differently and, notably, negatively in the case of emergency ceasarean section. Conclusion: A difficult emotional and decision-making process is associated with term breech. Use of CAM should be considered by professionals. Developing tools to assist women, and relationship techniques for professionals could facilitate these processes. Reduction of pain during ECV is necessary
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„Quantification of force applied during external cephalic version“. Thesis, 2005. http://library.cuhk.edu.hk/record=b6074169.
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External cephalic version (ECV) involves turning a fetus in utero by manipulation through the maternal abdomen and the uterine wall.Many clinicians and patients, however, still decline ECV in favour of Caesarean section. This could be due to the lack of experience of ECV, and fear of complications or pain during the version.
Summary. The force applied during ECV can be measured and analysed using a customized pair of gloves incorporating piezo-resistive pressure sensors and suitable analytical software. The degree of force required for a successful version is highly variable. Failure of version is not usually due to insufficient force. Uterine tone is the most important factor affecting the degree of force applied during a version attempt. The degree of force applied is associated with the changes in fetal cerebral blood flow after ECV, and the amount of pain perceived by the patients. (Abstract shortened by UMI.)
The lack of information in this area is primarily due to the lack of a suitable device that would allow measurements of the force applied without interfering with the ECV. A suitable device would therefore have to be sufficiently robust so that it could be worn on the hands, durable so that it could be used repeatedly, incorporate multiple individual sensors, each of which is capable of making dynamic and mutually independent measurements during the version procedure.
There is no report in the literature on quantification of the force applied during ECV. It is also unknown whether the degree of force applied is related to the version outcome. In particular, it is unclear whether a failed attempt is related to insufficient force, or whether an increase in force may help to achieve version after a failure. Furthermore, it is also not known if any patients' factors may influence how much force is applied through the operator's hands. Although the chance of successful version could be predicted by some clinical factors, whether these factors may also affect the degree of applied force is not known.
This thesis reports on the design and development of a suitable measuring device fulfilling the requirements described above. In addition, it will test a number of hypotheses relating to the degree of force applied during ECV and clinical feto-maternal parameters and outcomes, in a study cohort of 92 patients.
Leung Tak Yeung.
"April 2005."
Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3717.
Thesis (M.D.)--Chinese University of Hong Kong, 2005.
Includes bibliographical references (p. 155-174).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
School code: 1307.
Bücher zum Thema "Breech delivery Fetal presentation"
1
Keag, Oonagh, und E. Sarah Cooper. Prematurity, multiple gestation, and abnormal presentation. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713333.003.0033.
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Preterm labour is a common cause of neonatal morbidity and mortality. This chapter describes the definition, aetiology, diagnosis, and management of preterm labour and delivery with a focus on tocolytic therapy, the use of antenatal corticosteroids, and of magnesium sulphate. Anaesthesia for preterm delivery is discussed. The section on multiple pregnancy details the recommended antenatal careplan for dichorionic and monochorionic twin pregnancies, the fetal and maternal risks and potential complications, and the management of labour and delivery of twins, as well as the anaesthetist’s role in managing these high-risk pregnancies. There are a number of abnormal presentations managed by obstetricians, including abnormal cephalic presentations such as occiputo-posterior positions, breech, transverse, and compound presentations. This chapter focuses specifically on breech presentation, comparing the evidence for vaginal breech delivery versus planned caesarean delivery. It also discusses external cephalic version and vaginal breech delivery itself.
2
Doumouchtsis, Stergios K., S. Arulkumaran, Eleftheria L. Chrysanthopoulou, Stergios K. Doumouchtsis, Sambit Mukhopadhyay, Kostis I. Nikolopoulos, Christiana Nygaard et al. Intrapartum procedures and complications. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199651382.003.0005.
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This chapter discusses the diagnosis of labour, and describes what to do in the case of cord prolapse, abnormal fetal heart rate patterns in labour, continuous abdominal pain in labour, instrumental delivery for fetal distress in the second stage of labour, shoulder dystocia, acute tocolysis, symphysiotomy and destructive operations, along with twin delivery, breech delivery, abnormal lie or presentation in labour, and anaesthetic complications on the labour ward.
3
(Illustrator), Anthony Craib, Hrsg. Breech Birth. Free Association Books, 2003.
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4
Devlieger, Roland, und Maria-Elisabeth Smet. Obstetric management of labour, delivery, and vaginal birth after caesarean delivery. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713333.003.0012.
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This chapter describes the events surrounding normal and abnormal labour and delivery with particular relevance to the anaesthetist. The first two sections explain the course of a normal labour, delivery, and third stage. Subsequently attention is paid to obstructed labour, delivery, and prolonged third stage. Since induction of labour has become common practice in many pathological conditions, several methods of induction and their complications are then discussed. Next, some basic knowledge about intrapartum fetal monitoring is presented, followed by some specific and potentially complicated situations such as shoulder dystocia, operative vaginal delivery, caesarean delivery, breech delivery, twin birth, and vaginal birth after previous caesarean delivery.
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Medforth, Janet, Linda Ball, Angela Walker, Sue Battersby und Sarah Stables. Fetal emergencies during pregnancy, labour, and postnatally. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198754787.003.0023.
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Neonatal emergencies during pregnancy, labour, birth, and the postnatal period are covered. Blood tests during pregnancy and detecting deviations from the norm are included. Fetal emergencies and their management include: in utero transfer, hypoxia, asphyxia, cord presentation, cord prolapse, vasa/placenta praevia, shoulder dystocia, undiagnosed breech, and neonatal resuscitation. Guidelines for admission to a neonatal intensive care unit (NICU) and current neonatal morbidity and mortality data are included. The management of an intrauterine death or stillbirth is included.
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Fox, Grenville, Nicholas Hoque und Timothy Watts. Antenatal care, obstetrics, and fetal medicine. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198703952.003.0001.
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This chapter contains details of methods used for screening and diagnosis of fetal anomalies using antenatal blood tests, ultrasound scanning, chorionic villous sampling, amniocentesis, and fetal blood sampling. There are sections on pre-existing maternal diseases presenting risks to the fetus including maternal diabetes, systemic lupus erythematosus, thrombocytopenia, and neuromuscular disease, as well as those specific to pregnancy—pre-eclampsia, HELLP syndrome, and eclampsia. Intrauterine growth restriction and monitoring is covered in detail. The increased fetal risks of multiple birth due to twin-to-twin transfusion syndrome and other pregnancy complications are described, with detail on oligohydramnios, polyhydramnios, antepartum haemorrhage, preterm prelabour rupture of membranes, cord prolapse, preterm labour, and breech presentation. Intrapartum fetal assessment using electronic fetal monitoring and fetal blood sampling to diagnose fetal distress is covered to enable health professionals involved in care of the newborn to understand events which may have resulted in a baby born in poor condition.
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Creigh, Peter D., und David N. Herrmann. Charcot-Marie-Tooth Disease and Pregnancy. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190667351.003.0025.
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Charcot-Marie-Tooth neuropathies (CMT) represent the most common hereditary neuropathies and can affect men and women from infancy to adulthood. There are no effective or FDA approved pharmacologic treatments aimed at disease modification for any form of CMT, so the primary focus of clinical care is on symptomatic treatment, maintaining functionality, and limiting secondary injury. CMT does not in general appear to affect a woman’s ability to carry a pregnancy. However, having CMT does increase the risk of delivery related complications (operative delivery, fetal presentation anomalies and postpartum bleeding) and exacerbation of neurologic symptoms during pregnancy is possible. Therefore, understanding the risks and planning appropriately are crucial for all women with CMT considering pregnancy and their health care providers. Overall, with the appropriate medical care, most women with CMT who choose to become pregnant will have an uncomplicated pregnancy and deliver a healthy infant.
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Van Calsteren, Kristel. Chronic maternal infections. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713333.003.0050.
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Pregnant women diagnosed with chronic infections are a worldwide problem. In developed countries, the most frequently encountered are hepatitis B and C, toxoplasmosis, syphilis, herpes simplex, and Cytomegalovirus infections. In developing countries, human immunodeficiency virus and malaria are also seen commonly in pregnant women. Maternal infections are associated with various complications in pregnant women, but also with congenital infections with or without structural anomalies and long-term sequelae, fetal growth restriction, preterm delivery, and perinatal mortality. Moreover, increasing evidence suggests that maternal infection during pregnancy affects the developing immune system of the fetus independently of the vertical transmission of pathogens. This chapter discusses the pathogen characteristics, ways of transmission, clinical presentation, diagnostic options, treatment, and, if relevant, prophylaxis for the most common infections in pregnant women (excluding hepatitis which is discussed elsewhere).
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Kaye, Alan, und Richard Urman, Hrsg. Obstetric Anesthesia Practice. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780190099824.001.0001.
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Obstetrical Anesthesia Procedures provides timely updates in the field of obstetrical anesthesia and provides a concise, up-to-date, evidence-based and richly illustrated book for students, trainees, and practicing clinicians. The book comprehensively covers a robust list of topics focused to improve understanding in the field with emphasis on recent developments in clinical practices, technology, and procedures. This book describes all the essential topics that are required for the practitioner to quickly assess the patient and risk stratify them, decide on the type of analgesic and anesthetic plan that is most appropriate for the patient, its feasibility and safety, provide expert consultation to the other members of the obstetric team, manage anesthesia care and complications, and arrange for advanced care if needed. There are special considerations for pregnant patients undergoing non-obstetric surgery, anesthesia for assisted reproductive technologies, and anesthetic management of operations on placental support. It is also important to develop the skills needed to perform antenatal evaluation of high-risk parturients and understand the physiology of pregnancy and peripartum anesthetic implications of co-existing conditions involving hematologic, cardiac, neurological, renal, endocrine and pulmonary systems. There are also special considerations for parturients with pregnancy-induced hypertension, multiple gestations, abnormal fetal presentation, preterm labor, obstetric hemorrhage, and trauma in pregnancy. There are pharmacologic and non-pharmacologic pain management options for labor, caesarean delivery, and postoperative pain. This includes management of intravenous and oral analgesics, understanding of drug pharmacology and its effect on the mother and the baby, neuraxial techniques (spinal, epidural, combined spinal-epidural) and peripheral nerve blocks.
Buchteile zum Thema "Breech delivery Fetal presentation"
1
Floyd, Randall C., und Martin L. Gimovsky. „Breech presentation“. In Clinical Maternal-Fetal Medicine Online, 14.1–14.10. 2. Aufl. London: CRC Press, 2021. http://dx.doi.org/10.1201/9781003222590-12.
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2
Menakaya, Uche A. „Breech Presentation and Delivery“. In Contemporary Obstetrics and Gynecology for Developing Countries, 193–201. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-75385-6_17.
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3
Baldwin, Andrew, Nina Hjelde, Charlotte Goumalatsou und Gil Myers. „Obstetrics“. In Oxford Handbook of Clinical Specialties, 1–97. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198719021.003.0001.
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This chapter explores obstetrics, including obstetric histories, abdominal examination, physiological changes in pregnancy, pre-pregnancy counselling, the placenta, plasma chemistry in pregnancy, antenatal care, structural abnormalities and ultrasound, screening and diagnosis of aneuploidy, minor symptoms of pregnancy, hyperemesis gravidarum, sickle cell disease in pregnancy, cardiac disease in pregnancy, drugs used in psychiatry and epilepsy, anaemia, HIV in pregnancy and labour, diabetes mellitus in pregnancy, thyroid disease in pregnancy, jaundice in pregnancy, malaria, renal disease in pregnancy, epilepsy, respiratory disease in pregnancy, connective tissue diseases in pregnancy, hypertension in pregnancy, thromboprophylaxis, thrombophilia in pregnancy, venous thromboembolism, infection, group B streptococcus (GBS), abdominal pain in pregnancy, sepsis in pregnancy and the puerperium, fetal monitoring in labour, pre-eclampsia, prematurity, small for gestational age (SGA), postmaturity (prolonged pregnancy), maternal collapse, antepartum haemorrhage, prelabour rupture of membranes at term, normal labour, induction of labour, management of delay in labour, home birth, pain relief in labour, multiple pregnancy, breech presentation and other malpresentations/malpositions, cord prolapse, shoulder dystocia, meconium-stained liquor, operative vaginal delivery, caesarean section (CS), uterine rupture, mendelson’s syndrome, stillbirth (intrauterine fetal death, IUD), postpartum haemorrhage (PPH), retained placenta, uterine inversion, placenta praevia, accreta and increta, DIC and coagulation defects, amniotic fluid embolism, birth injuries, episiotomy and tears, the puerperium, maternal and perinatal mortality.
4
Paily, VP, und Vasanthi Jayaraj. „Breech Presentation“. In Pregnancy at Risk: A Practical Approach to High Risk Pregnancy and Delivery, 618. Jaypee Brothers Medical Publishers (P) Ltd., 2010. http://dx.doi.org/10.5005/jp/books/11140_79.
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5
„Managing Breech Presentation and Transverse Lie“. In Labor and Delivery Care, 151–81. Oxford, UK: Wiley-Blackwell, 2011. http://dx.doi.org/10.1002/9781119971566.ch8.
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6
Obladen, Michael. „Postverta, Agrippa, Caesarea“. In Oxford Textbook of the Newborn, herausgegeben von Michael Obladen, 57–62. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780198854807.003.0009.
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The frequency of breech presentation at term is 3% among singletons. Greek physicians dreaded those births, as they frequently led to the death of mother, infant, or both. In Rome, surviving infants were named Agrippa (born with difficulty), and the goddess Postverta was revered for presiding over breech deliveries. To the antique procedures of embryotomy and hook for the dead infant, the Middle Ages added manoeuvres to turn and extract a living, albeit often traumatized infant. These manoeuvres were associated with asphyxia from cord prolapse or compression, fracture of legs, arms, or clavicles, cerebral haemorrhage, trauma to the cerebellum, tentorium, or pituitary stalk, and with torticollis and arm plexus palsy. The prototype of difficult birth, infants born feet-first were considered dangerous, and were neglected or killed in many cultures. Even after Caesarean section had lost most of its risk, conservative obstetricians still propagated vaginal delivery from breech presentation. Finally, at the beginning of the 21st century, large randomized trials and population-based studies proved that Caesarean delivery was safe for the mother and highly beneficial for the child, making vaginal delivery from breech presentation obsolete.
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Morrison, Samantha, und Hugh Ehrenberg. „Planned Cesarean Section Versus Planned Vaginal Birth for Breech Presentation at Term“. In 50 Studies Every Obstetrician-Gynecologist Should Know, 69–73. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780190947088.003.0013.
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The Term Breech Trial was an international randomized control trial to compare a policy of planned cesarean delivery versus planned vaginal delivery for the singleton term breech fetus. The primary outcome was a composite of perinatal and neonatal mortality and neonatal morbidity. Secondary outcomes were serious maternal morbidity or mortality. The odds of the primary outcome were significantly lower for the planned cesarean section group than for the planned vaginal birth group. This risk reduction was greatest at centers located in industrialized countries with overall low perinatal mortality rates. There were no significant differences in maternal outcomes. The article reviews this hallmark trial and places its findings in context within the current landscape of obstetrics.
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„Management of delivery“. In Tasks for Part 3 MRCOG Clinical Assessment, herausgegeben von Sambit Mukhopadhyay und Medha Sule. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780198757122.003.0017.
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This task assesses the following clinical skills: … ● Patient safety ● Communication with patients and their relatives ● Information gathering ● Applied clinical knowledge … Rebecca Francis is a 34- year- old lady in her second pregnancy. She has had a normal vaginal delivery two years ago. Her pregnancy remained uneventful so far. At 36 weeks, her midwife detected that the baby was in breech presentation and has referred her to the antenatal clinic to discuss further management. You will then be given some information and asked questions by the examiner. You have 10 minutes for this task (+ 2mins initial reading time). Please read instruction to candidate and actor. After the consultation with the actor patient (or in the last two minutes), tell the candidate that Rebecca underwent an unsuccessful ECV and was booked for an elective caesarean at 39 weeks. You performed her caesarean and to your surprise, you delivered a cephalic baby by caesarean section. What should you have done to prevent this? What will you do next to prevent this kind of incidence? What will you explain to Rebecca? Record your overall clinical impression of the candidate for each domain (i.e. should this performance be pass, borderline, or a fail). You are Rebecca Francis, a 34- year- old mother of two- year- old Lucy. You had a straight forward pregnancy and delivery with Lucy. You are currently 36 weeks pregnant. You were seen by your midwife yesterday for a routine check and she found the baby to be in breech position. You were sent to the antenatal clinic and have had a scan confirming that the baby is in breech position. You were told that rest of the scan, including the baby’s measurements, fluid volume around the baby and the position of the placenta are normal. You are healthy. You do not smoke and have had no alcohol in pregnancy. Your pregnancy has progressed without any problems so far. The screening test for the baby showed low risk for Down’s syndrome. Temperament: You think you are mostly a calm, level- headed woman, but you do like to be organised and in control of things.
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Murphy, Deirdre J. „Malpresentation, malposition, and cephalopelvic disproportion“. In Oxford Textbook of Obstetrics and Gynaecology, herausgegeben von Sabaratnam Arulkumaran, William Ledger, Lynette Denny und Stergios Doumouchtsis, 395–406. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198766360.003.0032.
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Normal labour involves an appropriate-sized fetus in a vertex presentation with a well-flexed head that descends and rotates within the maternal pelvis in response to uterine contractions, delivering in an occipitoanterior position. Abnormal labour occurs when any one or a combination of these factors deviates from normal. It may involve a malpresentation (e.g. face, brow, or breech), a malposition (e.g. occipitoposterior), or cephalopelvic disproportion. The consequences include prolonged labour, obstructed labour, operative vaginal delivery, or caesarean section. Appropriate management requires expertise in clinical assessment, decision-making, and the technical and non-technical skills of operative delivery. A systematic approach is required including an awareness of risk factors for abnormal labour, early identification of deviations from normal, use of preventative strategies where possible, and appropriate intervention when necessary. Good teamwork and clear communication between midwives and obstetricians is essential within a labour ward setting. Timely transfer may be required in a homebirth setting. Particular skills are required in low-resource settings where obstructed labour may be advanced at the time of presentation.
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Harries, Sarah. „Anaesthesia and analgesia for specific obstetric indications“. In Obstetric Anaesthesia, 365–410. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780199688524.003.0014.
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Abstract: Specific obstetric conditions and complications require careful consideration by the obstetric anaesthetist before embarking on the required analgesia and anaesthesia management plan. This chapter covers the breadth of obstetric problems which may present on any labour ward, with their definition, the key issues to consider, and a proposed management plan. The following indications are covered in each sub-section; feticide, intrauterine death, abnormal presentation, multiple pregnancies, vaginal delivery after CS, preterm fetus, placenta previa and accreta, controlled rupture of membranes, fetal distress, cord prolapse, placental abruption, instrumental delivery, uterine inversion, EXIT (ex utero intrapartum treatment) procedure, retained placenta, and perineal suturing.
Konferenzberichte zum Thema "Breech delivery Fetal presentation"
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Christiaens, G. C. M. L. „DIAGNOSIS AND MANAGEMENT OF ITP DURING THE PERINATAL PERIOD“. In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1644762.
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Although maternal and perinatal mortality and morbidity in pregnant patients with ITP are lower than previously assumed, they are not negligable. Significant postpartum hemorrhage occurs in 7% of the mothers with ITP. Thrombocytopenia is found in 51% of the newborns born from mothers with ITP and 6% of these have serious bleeding problems. Tests which predict which fetuses are at risk, are not yet available. Thrombocyte counts in a fetal blood sample are falsely low in 40% of cases.A prospective controlled randomized study done in the Netherlands failed to show an effect of antenatal corticosteroid treatment on neonatal platelet counts. Elective caesarean section has not been shown to protect against intracranial bleeding in thrombocytopenic newborns. The choice between vaginal delivery and caesarean section in ITP patients should be made on obstetric grounds with one exception: no other assisted vaginal delivery than the easy outlet forceps should be done. All cases of slow progress of the second stage of labour with insufficient descent should be terminated by caesarean section as well as breech delivery with suboptimal progress. Newborn thrombocyte counts should be done daily during the first week of life, since lowest platelet counts are often found between the 3rd and 5th postpartum day. Newborn thrombocytopenia is transient and does not warrant splenectomy, but can necessitate treatment with corticosteroids and/or high doses of immunoglobulin 6. Current data do not justify to dissuade breastfeeding.The recurrence of neonatal thrombocytopenia in subsequent patients is unknown.
Berichte der Organisationen zum Thema "Breech delivery Fetal presentation"
1
McDonagh, Marian, Andrea C. Skelly, Amy Hermesch, Ellen Tilden, Erika D. Brodt, Tracy Dana, Shaun Ramirez et al. Cervical Ripening in the Outpatient Setting. Agency for Healthcare Research and Quality (AHRQ), März 2021. http://dx.doi.org/10.23970/ahrqepccer238.
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Objectives. To assess the comparative effectiveness and potential harms of cervical ripening in the outpatient setting (vs. inpatient, vs. other outpatient intervention) and of fetal surveillance when a prostaglandin is used for cervical ripening. Data sources. Electronic databases (Ovid® MEDLINE®, Embase®, CINAHL®, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews) to July 2020; reference lists; and a Federal Register notice. Review methods. Using predefined criteria and dual review, we selected randomized controlled trials (RCTs) and cohort studies of cervical ripening comparing prostaglandins and mechanical methods in outpatient versus inpatient settings; one outpatient method versus another (including placebo or expectant management); and different methods/protocols for fetal surveillance in cervical ripening using prostaglandins. When data from similar study designs, populations, and outcomes were available, random effects using profile likelihood meta-analyses were conducted. Inconsistency (using I2) and small sample size bias (publication bias, if ≥10 studies) were assessed. Strength of evidence (SOE) was assessed. All review methods followed Agency for Healthcare Research and Quality Evidence-based Practice Center methods guidance. Results. We included 30 RCTs and 10 cohort studies (73% fair quality) involving 9,618 women. The evidence is most applicable to women aged 25 to 30 years with singleton, vertex presentation and low-risk pregnancies. No studies on fetal surveillance were found. The frequency of cesarean delivery (2 RCTs, 4 cohort studies) or suspected neonatal sepsis (2 RCTs) was not significantly different using outpatient versus inpatient dinoprostone for cervical ripening (SOE: low). In comparisons of outpatient versus inpatient single-balloon catheters (3 RCTs, 2 cohort studies), differences between groups on cesarean delivery, birth trauma (e.g., cephalohematoma), and uterine infection were small and not statistically significant (SOE: low), and while shoulder dystocia occurred less frequently in the outpatient group (1 RCT; 3% vs. 11%), the difference was not statistically significant (SOE: low). In comparing outpatient catheters and inpatient dinoprostone (1 double-balloon and 1 single-balloon RCT), the difference between groups for both cesarean delivery and postpartum hemorrhage was small and not statistically significant (SOE: low). Evidence on other outcomes in these comparisons and for misoprostol, double-balloon catheters, and hygroscopic dilators was insufficient to draw conclusions. In head to head comparisons in the outpatient setting, the frequency of cesarean delivery was not significantly different between 2.5 mg and 5 mg dinoprostone gel, or latex and silicone single-balloon catheters (1 RCT each, SOE: low). Differences between prostaglandins and placebo for cervical ripening were small and not significantly different for cesarean delivery (12 RCTs), shoulder dystocia (3 RCTs), or uterine infection (7 RCTs) (SOE: low). These findings did not change according to the specific prostaglandin, route of administration, study quality, or gestational age. Small, nonsignificant differences in the frequency of cesarean delivery (6 RCTs) and uterine infection (3 RCTs) were also found between dinoprostone and either membrane sweeping or expectant management (SOE: low). These findings did not change according to the specific prostaglandin or study quality. Evidence on other comparisons (e.g., single-balloon catheter vs. dinoprostone) or other outcomes was insufficient. For all comparisons, there was insufficient evidence on other important outcomes such as perinatal mortality and time from admission to vaginal birth. Limitations of the evidence include the quantity, quality, and sample sizes of trials for specific interventions, particularly rare harm outcomes. Conclusions. In women with low-risk pregnancies, the risk of cesarean delivery and fetal, neonatal, or maternal harms using either dinoprostone or single-balloon catheters was not significantly different for cervical ripening in the outpatient versus inpatient setting, and similar when compared with placebo, expectant management, or membrane sweeping in the outpatient setting. This evidence is low strength, and future studies are needed to confirm these findings.