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Rei, M., D. Ayres-de-Campos, and J. Bernardes. "Neurological damage arising from intrapartum hypoxia/acidosis." Best Practice & Research Clinical Obstetrics & Gynaecology 30 (January 2016): 79–86. http://dx.doi.org/10.1016/j.bpobgyn.2015.04.011.
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Gunaratne, Shehara Amanthi, Siromi Dilhara Panditharatne, and Edwin Chandraharan. "Prediction of Neonatal Acidosis Based on the Type of Fetal Hypoxia Observed on the Cardiotocograph (CTG)." European Journal of Medical and Health Sciences 4, no. 2 (2022): 8–18. http://dx.doi.org/10.24018/ejmed.2022.4.2.1308.
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Cardiotocograph (CTG) was introduced into clinical practice to promptly recognize the features of intrapartum fetal hypoxic stress, so that timely action could be taken to avoid hypoxic-ischaemic encephalopathy (HIE) and perinatal deaths. However, the current systematic evidence suggests that the introduction of CTG into clinical practice over 50 years has not resulted in improvement in the rates of cerebral palsy or perinatal deaths. This is because most fetuses are able to withstand intrapartum hypoxic stresses without sustaining damage, and if the features of fetal compensatory responses are erroneously considered as “pathological”, “Abnormal” or “Category III” CTG tracing, it would lead to an exponential increase in unnecessary operative interventions without any improvement in perinatal outcomes. Neonatal acidosis at birth, determined by the estimation of pH in the umbilical artery has been considered as a surrogate marker of poor perinatal outcome. This is because significant intrapartum fetal hypoxic stress which leads to fetal decompensation, would lead to the onset of anaerobic metabolism and production of lactic acid in fetal tissues and organs. Entry of lactic acid into the fetal systemic circulation may cause damage to fetal central organs resulting in organ damage and death, and this lactate may lower the pH in the umbilical artery. Understanding the different types of fetal hypoxia on the CTG trace may help practicing clinicians to predict the rate of fall in fetal pH, and therefore, predict the umbilical cord pH at birth. It is important to appreciate that non-hypoxic pathways of fetal compromise such as chorioamnionitis may not be associated with low umbilical arterial pH at birth. Fetal pathophysiological approach to CTG interpretation based on deeper understanding of types of intrapartum hypoxia and features of non-hypoxic pathways of injury may help avoid the onset of neonatal metabolic acidosis and improve perinatal outcomes.
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Maeda, Kazuo. "Intrapartum Hypoxic Damage is detected by Hypoxia Index to Prevent Cerebral Palsy." Obstetrics and Gynecology Research 01, no. 01 (2018): 9–18. http://dx.doi.org/10.26502/ogr.4560002.
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Manapova, R. M. "Assessment of Immune Status Indicators in Children with Consequences of Perinatal CNS Damage and Gastroduodenal Pathology." Effective Pharmacotherapy 16, no. 34 (2020): 6–8. http://dx.doi.org/10.33978/2307-3586-2020-16-34-6-8.
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Intrauterine fetal hypoxia, because of disturbances in the fetoplacental complex, is a pathogenic link in the mechanism of development of cerebral lesions in newborns. The immune system is a universal indicator of all pathological processes occurring in the fetus against the background of chronic placental insufficiency. Therefore, scientific studies devoted to the study of the immune status in children who have undergone intrapartum resuscitation at birth are of great importance
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Ramenghi, L. A., M. Fumagalli, L. Bassi, and F. Mosca. "Encefalopatia ipossico-ischemica perinatale." Rivista di Neuroradiologia 16, no. 3 (2003): 339–44. http://dx.doi.org/10.1177/197140090301600303.
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Hypoxic-ischaemic encephalopathy is one of the clinical expressions of hypoxic-is-chaemic damage in which concomitant hypoxia and ischaemia are responsible for the death of the foetus or neonate, or result in organ impairment with possible long-term sequelae. Neurological deficits are among the most common and severe sequelae, leading to hypoxic-ischaemic encephalopathy whose incidence is between 0.6 and 0.9 per thousand live births in Anglosaxon countries. The following four major and two minor criteria must be present to establish the link between intrapartum hypoxic-ischaemic injury and neurological deficit: metabolic acidosis on umbilical cord sampling, persistent Apgar score of < 5 after the fifth minute, neonatal neurological symptoms, multiorgan involvement, abnormal cardiotocographic tracing, passage of meconium. None of the six criteria alone is diagnostic: the more criteria are present, the more likely the presence of asphyxia. Early electroencephalographic recording may yield useful information for the diagnosis of hypoxic-ischaemic injury to determine the neurological outcome and the diagnosis of convulsions. Neuroradiological investigations will identify and define the extent of cerebral lesions, confirming intrapartum hypoxic-ischaemic damage suspected clinically and yielding additional prognostic information on the basis of the anatomical structures involved.
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Malla, D. S. "EPISIOTOMY : A CHALLENGING OBSTETRIC INTERVENTION." Journal of Nepal Medical Association 42, no. 145 (2003): 54–58. http://dx.doi.org/10.31729/jnma.791.
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ABSTRACTThe professional literatures on the development of widely practiced procedure, episiotomy through theyears from the first publication in 1742 are reviewed. It reveals the change in number of publication as wellas the contributors to the development of perception about episiotomy. So it consisted expression of opinionof doctors initially then the co-workers like nurses and researchers and clients or consumers themselvestoo. It concludes that episiotomies prevent anterior perineal tear but fails to accomplish other benefitstraditionally ascribed to pelvic floor damage and relaxation including its sequel and also protection ofnewboin from intracranial haemorrhage and intrapartum asphyxia. Episiotomy substantially increasematernal blood loss during delivery and risk of anal sphincter damage with their long term morbidity.There is an urgent need to restrict the use of episiotomy in vaginal delivery.Key Words: Episiotomy, Perineal tear, anal sphincter damage.
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Hornbuckle, Janet, and James G. Thornton. "The fetal circulatory response to chronic placental insufficiency and relation to pregnancy outcome." Fetal and Maternal Medicine Review 10, no. 3 (1998): 137–52. http://dx.doi.org/10.1017/s0965539598000321.
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Chronic fetal growth restriction is associated with both increased perinatal mortality and impaired neurodevelopment. Although it is a much more important cause of fetal neurological damage than intrapartum birth asphyxia, it is more difficult to treat, since the main intervention, timed delivery, carries its own risks. Since it is associated with a range of circulatory changes, which may also cause fetal damage, understanding these may improve management. In this article we review these fetal circulatory changes and assess their significance for predicting perinatal and long term neurodevelopmental outcome. We describe the Doppler assessment techniques, their clinical role in prediction of adverse outcome and the pathogenesis of brain injury in the preterm growth restricted fetus.
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Vannucci, Robert C. "Current and Potentially New Management Strategies for Perinatal Hypoxic-Ischemic Encephalopathy." Pediatrics 85, no. 6 (1990): 961–68. http://dx.doi.org/10.1542/peds.85.6.961.
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Given the current dilemma in the brain-oriented therapy of newborn infants sustaining cerebral hypoxia-ischemia, it is not surprising that management strategies vary widely among neonatal intensive care units.9 Thus, there is no uniform standard of care, and it remains for future research to uncover new and effective modes of therapy for the neurologically compromised infant. Prevention, or at least optimal management, of prepartum and intrapartum asphyxia remains the best available means of reducing the incidence and severity of peninatal hypoxic-ischemic brain damage.
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Kim, Kyung Won, and Sunhee Lee. "Childbirth outcomes and perineal damage in women with natural childbirth : a review of medical records in a natural birth center in Korea." Korean Journal of Women Health Nursing 27, no. 4 (2021): 379–87. http://dx.doi.org/10.4069/kjwhn.2021.08.31.
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Purpose:. This study aimed to determine the actual state of childbirth in women with natural childbirth and the degree of damage to the perineum during childbirth. Methods: This retrospective study analyzed the medical records of mothers who had natural childbirth at a hospital in Seoul, Korea in 2018. Data from 358 women with cephalic births at greater than 37 gestational weeks were analyzed. To determine natural childbirth characteristics and the degree of damage to the perineum, descriptive statistics were done using IBM SPSS Statistics version 28.0 for Windows. The difference in the degree of perineal injury according to obstetric characteristics was analyzed using independent t-test and one-way analysis of variance.Results: The mean age was 33.18±3.68 years, and 49.2% were primiparas, while 39% gave birth with a doula. The degree of perineal damage differed by age (F=9.15, p<.001), parity (t=19.13, p<.001), number of births in multiparity (F=3.68, p=.027), previous vaginal delivery in multiparity (F=3.00, p=.032) and birthing posture (F=7.44, p<.001). Having received therapeutic procedures (t=–4.62, p<.001), specifically fluid administration (t=–2.72, p=.007), oxygen supply (t=-–2.76, p=.006) and epidural anesthesia (t=–2.77, p=.006) were statistically significant for perineal damage. There were no differences, however, by gestational period, doula use, body mass index at delivery, baby head circumference, or birth weight. Conclusion: Study findings suggest that support for older women, primiparas, and those who require therapeutic procedures may help to decrease the possibility of perineal damage. As perineal damage was also associated with birthing posture, this should be considered when providing intrapartum nursing care.
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Önalan, Erhan, Şüheda Ataş, and Kübra Oral. "A case of Sheehan Syndrome with chronic diffuse muscle pain and weakness." Medical Science and Discovery 6, no. 11 (2019): 310–12. http://dx.doi.org/10.36472/msd.v6i11.315.
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Objective: Sheehan’s syndrome is pituitary deficiency induced by intrapartum and postpartum hemorrhage and hypovolemia. It is still frequent in underdeveloped and developing countries. Sheehan’s syndrome is one of the reason of empty sella. The symptoms of the syndrome can be seen months to years later depend on the degree of pituitary damage. History of postpartum hemorrhage, failure to lactate and cessation of menses are important clues to the diagnosis. Early diagnosis and appropriate treatment are very important to reduce morbidity and mortality of the patients.
Case: In this study sheehan’s syndrome which led to auto pan-hypopituitarism and developed gradually in a patient with sheehan‘s syndrome which in this case, delivered a baby at home 27 years ago and had severe postpartum hemorrhage will be presented. And this 63-year-old female patient was diagnosed as Sjogren’s syndrome and sheehan syndrome by clinical and laboratory findings for the purpose of further investigation and treatment because of symptoms of fever and anemia
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Garland, S. "68. SEXUALLY TRANSMITTED INFECTIONS [STIs] AND PREGNANCY." Sexual Health 4, no. 4 (2007): 311. http://dx.doi.org/10.1071/shv4n4ab68.
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Routine antenatal screening tests currently recommended in Australasia and endorsed by the Royal Australian and New Zealand College of Obstetrics and Gynaecology (RANZCOG) include rubella, varicella-zoster, group b streptococcus [GBS], asymptomatic bacteriuria, as well as the following STIs: Treponema pallidum (syphilis), Human immunodeficiency virus (HIV), Hepatitis B virus (HBsAg), Chlamydia trachomatis (adolescent pregnancies) and offer of hepatitis C virus (HCV). Infections can infect the foetus or neonate by various routes (intrauterine, intrapartum and /or postnatal) and cause potentially serious disease. Such infections in the mother may be mild or commonly subclinical, yet can result in miscarriage, preterm birth, foetal damage, or even death, depending on the pathogen and stage of pregnancy. Consequently, diagnoses should be made definitively by instituting appropriate laboratory tests to ensure effective treatment and follow-up of the woman and her infant, as well as her contact(s). Specific treatment of the mother, where applicable, can prevent most of the impact on the fetus and newborn. The principles for the use and choice of screening tests are (1) if maternal infection occurs, there is a significant risk of fetal or neonatal infection and damage, or other adverse pregnancy outcome; (2) there are sensitive, specific, and inexpensive screening and confirmatory tests; (3) there is a safe, effective intervention and/or treatment regimen which can reduce morbidity and mortality in the fetus and/or the mother.
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Neeraja, S., Sugathi Parimala, and Naima Fathima. "Study of intrapartum fetal distress with the help of cardiotocography and its correlation with umbilical cord blood sampling." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 9, no. 4 (2020): 1580. http://dx.doi.org/10.18203/2320-1770.ijrcog20201227.
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Background: Even in low risk mothers, fetal acidosis occurs as in high risk groups. Aim of fetal monitoring is to detect early response to intrauterine hypoxia and prevent irreversible neurological damage and death. Objective of this study was to correlate the intrapartum fetal distress with the help of cardiotocography CTG with umbilical cord blood sampling.Methods: A total 100 consecutive patients attending the labor ward were studied. Immediately at birth, before the baby’s first breath and before delivery of the placenta, the umbilical cord blood was collected as per the standard guidelines laid down in the standard textbooks. Fetal acidosis was assessed by umbilical cord arterial blood pH. Fetal acidosis was considered when umbilical artery pH <7.2. Cardiotocography features were used to clinically diagnose fetal distress.Results: Most of the mothers were multigravida. They belonged to the age group of 20-25 years. Only 18% had abnormal CTG. Out of 50 mothers with normal vaginal delivery, all had normal CTG. Out of 43 mothers who were delivered by LSCS, no one had normal CTG, 25 had indeterminate CTG and 18 had abnormal CTG. As CTG became abnormal, proportion of mothers with the thick meconium increased. NICU admission proportion increased as CTG changed from normal to the abnormal. There was a significant association between the abnormal CTG and the umbilical cord blood pH being acidic.Conclusions: CTG is a simple test, easy to perform and can alert obstetrician for necessary interventions in case of an abnormal CTG. It can detect fetal distress in labor thus helping to reduce neonatal morbidity by early intervention in cases of abnormal tracing.
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Iffy, Leslie, Michael Brimacombe, Valeria Varadi, Maya Raghuwanshi, Vijaya Ganesh, and Vijaya Raju. "Shoulder dystocia related fetal neurological injuries: the role of diabetic control." Open Medicine 4, no. 1 (2009): 76–83. http://dx.doi.org/10.2478/s11536-008-0086-y.
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AbstractThe study explores the roles of routine prenatal diabetic screening and control in the occurrence of neurological birth injuries associated with shoulder dystocia. The investigation involved retrospective review of 226 medical records that contained information about the antenatal events in cases that resulted in permanent neonatal injuries following arrest of the shoulders at delivery. Close attention was paid to diabetic screening and management of mothers with evidence of glucose intolerance. Analysis of the records revealed that one-third of all women, including those with predisposing factors, received no diabetic screening during pregnancy. The majority of confirmed diabetic patients were not treated adequately. Among babies of diabetic women, birth weights exceeding 4500 g were about 30-fold more frequent than among those with normal glucose tolerance. The data suggest that universal screening and rigid diabetic control, including mothers with borderline glucose tolerance, are effective measures for the prevention of excessive fetal growth and intrapartum complications deriving from it. If ignored, impaired maternal glucose tolerance may become a major predisposing factor for neurological birth injuries. It appears therefore that with routine screening for diabetic predisposition and effective control of gestational diabetes the risk of fetal damage can be reduced substantially.
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Antsaklis, Aris, Themos Grigoriadis, Sylvia-Christina Mylona, George Giannoulis, and Stavros Athanasiou. "Sonographic Evaluation of Obstetric Anal Injuries." Donald School Journal of Ultrasound in Obstetrics and Gynecology 9, no. 3 (2015): 266–74. http://dx.doi.org/10.5005/jp-journals-10009-1413.
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ABSTRACT Intrapartum damage to the anal sphincter is an important factor in fecal incontinence. Obstetric anal sphincter injuries (OASIS) vary from 1 to 18% of vaginal deliveries, including instrumental deliveries. The severity of anal sphincter injuries vary from superficial lacerations to deep injuries that can extend to the epithelium. Obstetric anal sphincter injuries are associated with both short-term complications (heavy bleeding, difficulties in recovery, increased incidence of infections, increased perineal pain) and long-term complications (rectovaginal fistulae or facal incontinence). A significant number of these anal sphincter injuries can be detected promptly after a good clinical examination, but still that does not exclude the possibility of these women suffering long-term complications. What is more when some of these so called ‘occult tears’ go undetected further increase the morbidity of the woman. Sonography of the perineum and the anal sphincter appears to offer a better diagnosis and detection of these injuries after vaginal delivery, which allows a timely and better treatment with less complications, with endoanal sonography offering the best detection rates so far. How to cite this article Grigoriadis T, Mylona SC, Giannoulis G, Athanasiou S, Antsaklis A. Sonographic Evaluation of Obstetric Anal Injuries. Donald School J Ultrasound Obstet Gynecol 2015;9(3):266-274.
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Aznal, Sharifah Sulaiha, Sivalingam Nalliah, and Tong Wooi Chng. "Revisiting Cerebral Palsy: Pathogenesis and Management." Journal of South Asian Federation of Obstetrics and Gynaecology 8, no. 1 (2016): 57–65. http://dx.doi.org/10.5005/jp-journals-10006-1386.
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ABSTRACT Brain damage in utero and its consequences in neonates especially cerebral palsy (CP), are socially disturbing and psychologically distressing to both patients and carers. The prevalence of CP has not declined considerably despite several preventive measures in obstetric and neonatal care. Current views on the pathogenesis and causal pathways of CP relate to hypoxic-related ischemic events. A series of cascading events trigger the inflammatory processes resulting in gliosis of the white matter when labor and the delivery processes are reviewed. Though animal studies seem to support these concepts several other causes like perinatal infection and prematurity are also strong contributors to its pathogenesis. Multiple gestation and genetic factors may play a role in the etiology. Current management strategies focus on preventive measures during antenatal and intrapartum care. The use of antenatal steroids, magnesium sulfate infusion for cerebral protection and the extensive use of electronic fetal monitoring during labor have been elaborated as deliberate attempts to minimize the impact of any of the possible contributing cause. As CP is still prevalent in pediatric practice and in our community discussing means to improve prognosis of affected children are relevant. How to cite this article Aznal SS, Nalliah S, Chng TW. Revisiting Cerebral Palsy: Pathogenesis and Management. J South Asian Feder Obst Gynae 2016;8(1):57-65.
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Wang, Xiaolan, David W. Carmichael, Ernest B. Cady, et al. "Greater Hypoxia-Induced Cell Death in Prenatal Brain after Bacterial-Endotoxin Pretreatment is not Because of Enhanced Cerebral Energy Depletion: A Chicken Embryo Model of the Intrapartum Response to Hypoxia and Infection." Journal of Cerebral Blood Flow & Metabolism 28, no. 5 (2007): 948–60. http://dx.doi.org/10.1038/sj.jcbfm.9600586.
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Infection is a risk factor for adult stroke and neonatal encephalopathy. We investigated whether exposure to bacterial endotoxin increases hypoxia-induced brain cell death and impairs cerebral metabolic compensatory responses to hypoxia. Prehatching chicken embryos (incubation day 19) were exposed to bacterial lipopolysaccharide (LPS) (3 mg Salmonella typhimurium LPS per egg) or hypoxia (4% ambient O2 for 1 h), alone or in combination with LPS, followed 4 h later by hypoxia. Cerebral cell death and glial activation were assessed histologically. Further, chicken embryo brains were studied by magnetic resonance imaging (MRI) and spectroscopy (MRS) to assess haemodynamic and metabolic responses. In most brain areas, combined LPS/hypoxia resulted in a 30- to 100-fold increase in terminal deoxynucleotidyl transferase dUTP nick end labelling -positive cells, compared to control and single-insult groups. Glial activation correlated with the severity of cell death and was significantly greater in the combined-insult group ( P<0.05). Hypoxia was associated with a 10-fold increase in lactate/ N-acetyl-aspartate (NAA), an ˜20% increase in total creatine/NAA, rapid decreases in T2 and T2+, and a reduction in direction-averaged brain-water diffusion ( Dav) by ˜15%. Liposaccharide pretreatment did not alter the magnitude or timing of these responses, but engendered baseline shifts (increased Cho/NAA, Cr/NAA, and Dav, and reduced T2+). In conclusion, LPS greatly increased hypoxia-induced brain damage in this model and induced changes in baseline haemodynamics and metabolism but did not affect the magnitude of the glycolytic response to hypoxia. The damage-enhancing effects of LPS are not because of additional energy depletion but because of a synergistic toxic component.
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Orel, Vasily I., Michael E. Okhlopkov, Antonina N. Grigor'eva, et al. "Children of the Arctic: dynamics of medico-demographic indicators." Pediatrician (St. Petersburg) 8, no. 6 (2017): 30–37. http://dx.doi.org/10.17816/ped8630-37.
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Maintaining and improving the health of the population, especially children and teenagers, is one of the most important state task, the solution of which allows to ensure the availability of human resources, the country's defense and reproduction of the healthy population. Currently in the Russian Federation, there are negative trends in the health status of children in all age categories: the growing incidence, prevalence of chronic diseases, the presence of morphological abnormalities, high prevalence of risk factors among children, a decrease of quality indicators of children's health. There is a significant change in the pattern of morbidity in childhood, reflected in the increase in the number of chronic and combined forms of disease, the increase in the frequency of intrapartum damage and hereditary pathology, which in turn leads to an increase in the number of children with disabilities. The issues of improving medical care in remote and inaccessible localities are actively discussed on all platforms and meetings of the circumpolar countries of the Union. It is clear that much of the health of the population in the Arctic is determined by the welfare of the country. However, some progress in this direction in recent years and our country. In this regard, it is highly important to assess the dynamics of medico-demographic indicators in the Arctic regions during the implementation of major Russian programs in the field of protection of motherhood and childhood in the Republic of Sakha (Yakutia).
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Patel, Kalpesh, and Radha Rastogi. "A comparative study on feto-maternal outcome in patients with meconium stained liquor versus clear liquor." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 10, no. 11 (2021): 4119. http://dx.doi.org/10.18203/2320-1770.ijrcog20214318.
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Background: Meconium is sterile, thick, black-green, odourless material, formed by accumulation of debris in the fetal intestine. This meconium, when leaks out intra-natally, due to hypoxia, can change the whole scenario, increasing intra-natal foetal risk, morbidity, and possibly causing mortality, depending upon the operative factors. Aims and objectives were to know the perinatal outcome in patients with meconium stained amniotic fluid. To study the complications of meconium stained amniotic fluid in the neonates.Methods: Reverse-transcription polymerase chain reaction (RTPCR) negative women, gestational age >37 weeks with cephalic presentation and singleton pregnancy with meconium stained liquor (grade I, II, and III) after spontaneous or artificial rupture of membranes during labour. Delivery was expedited, when fetal heart rate abnormalities were detected, by safest mode of delivery. The Apgar score of neonates, neonatal intensive care unit (NICU) admission, number of days of hospitalization and birth asphyxia were recorded.Results: A Total 11 patients with pre-eclampsia which presented with meconium stained liquor (MSL). 6 patients with prolonged labour presented with MSL. 8 had thin, 15 had thick MSL and 3 patients of clear liquor. 2 children developed persistent pulmonary hypertension of the newborn (PPHN) in case of MSL group. 25 children required oxygen support and antibiotics after delivery. Mean hospital stay was 2.81 days in MSL and 1.33 days in clear liquor group.Conclusions: Chronic hypoxia is more damaging and dangerous than acute hypoxia, due to longer time it has continued the damage. This can be very effectively achieved by improving the Antenatal care, and intra natal vigilance. Proper monitoring of patients in intrapartum period of following parameters like fetal heart sound, uterine contractions, fetal movements.
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Kleshenko, E. I., and E. V. Shimchenko. "EARLY DIAGNOSTICS OF CONSEQUENCES OF CEREBRAL CIRCULATION DISORDERS IN CHILDREN WITH PERINATAL HYPOXIC BRAIN DAMAGE." Pediatria. Journal named after G.N. Speransky 101, no. 1 (2022): 47–55. http://dx.doi.org/10.24110/0031-403x-2022-101-1-47-55.
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Exposure to hypoxia in the perinatal period leads to significant structural changes in the brain (B), which are reflected in the further neuropsychic development of the child. In this regard, the assessment of the state of brain structures and cerebral circulation in young children using high-tech diagnostic methods is of particular importance. Objective of the study: to analyze the indicators of magnetic resonance imaging (MRI) of B structures for early diagnosis of the consequences of cerebrovascular accident in children who underwent hypoxia in the perinatal period. Materials and methods of research: single-center prospective open non-randomized longitudinal observational uncontrolled study were included in 144 newborns, who were stationed in the intensive care unit and intensive therapy units (ICU) of the Regional Perinatal Center of the Krasnodar Regional Clinical Hospital for severe asphyxia and/or intrauterine hypoxia. Among those included in the study were 76 full-term babies (FTBs) (group 1) and 68 premature newborns (PNs) (group 2). The gestational age (GA) of PNs was 29–37 (32.7±2.6) weeks. The sex composition of the groups (boys/girls) did not differ statistically significantly: n=41/35 – 54%/46% in the 1st group versus n=38/30 – 56%/44% in the 2nd group (p=0.816). All children underwent MRI of the B on 2–10 day of life with the determination of the measurement of diffusion coefficient (DC) in the mode of diffusion-weighted images. Children were observed up to 3 years of age in the follow-up department of the Krasnodar Krai Regional Children's Clinical Hospital. Results: in the PNs group, 35 (51%) GA was 29–32 weeks, in 33 (49%) children – 33–37 weeks. The revealed consequences of hypoxic B damage in children were determined by morphological changes in the nervous tissue and were characterized by objective MRI indicators. Analysis of the data obtained made it possible to identify the ranges of B ADI values, reflecting the subsequent neurological outcome. Further formation of neurological deficits (infantile cerebral palsy, disorders of psychoverbal development, symptomatic epilepsy) was noted in PNs with relatively low DC values 0.69–1.30×10–3mm2/s and 0.64–1.07×10–3mm2/s – for white and gray matter of the large hemispheres of the B, respectively; in PNs with relatively low and relatively high DC values of the white matter of the large hemispheres of the B 1.05–1.24×10–3mm2/s and 1.88–2.00×10–3mm2/s, gray matter of the B cerebral hemispheres 0, 93–1.06×10–3mm2/s and 1.36–1.47×10–3mm2/s. The effect of hypoxia in the intrapartum period was manifested by low DC indices, reflecting manifestations of cerebral ischemia. A significant increase in DC indicators was observed in hypoxic brain damage in the antenatal period and characterized atrophic changes in the nervous tissue. Based on the results of the analysis of B DC indices, reflecting manifestations of cerebral ischemia, statistically significant (p<0.01) direct highly correlated relationships were revealed between the DC indices of the white matter of the cerebral hemispheres and the indices of the DC of the gray matter of the cerebral hemispheres (rxy=0.975), the indices of the DC of the midbrain (rxy=0.714) in FTBs, between the indicators of the DC of the white matter of the cerebral hemispheres and the indicators of the DC of the gray matter (rxy=0.923), the indicators of the DC of the midbrain (rxy=0.787) in the PBs, which indicates the global nature of the hypoxic damage to the B. Conclusions: early diagnosis of cerebrovascular accidents in children using MRI data makes it possible to predict the further neurological outcome of perinatal hypoxic brain injures, contributes to the timely implementation of therapeutic and rehabilitation measures based on an objective assessment of the identified disorders.
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Phelan, Jeffrey, Lisa Korst, Cortney Kirkendall, and Gilbert Martin. "The brain damaged infant and intrapartum fetal death: A comparative study of their intrapartum FHR patterns." American Journal of Obstetrics and Gynecology 193, no. 6 (2005): S103. http://dx.doi.org/10.1016/j.ajog.2005.10.354.
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Nahar, Begum Sharifun, Syeda Afroza, and Zakia Naher. "Risk Factors Analysis in Asphyxiated Newborn and Their Neurological Outcome in Relation to Hypoxic-Ischaemic Encephalopathy." Journal of Paediatric Surgeons of Bangladesh 4, no. 2 (2015): 54–57. http://dx.doi.org/10.3329/jpsb.v4i2.23939.
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Background: Perinatal mortality rate in the developing world is still significantly higher than what obtained in the individualized nation1. Perinatal asphyxia has been established as one of the major causes of these deaths. Perinatal asphyxia is a serious clinical problem world wide. There are various reasons of failure to initiate and sustain breathing immediately after birth. Neurological complication like hypoxic ischaemic encephalopathy (HIE) following damage to the brain is very frequent and commonly seen in asphyxiated newborn .Objective: To find out the risk factors and the hospital outcome with special emphasis on HIE following perinatal asphyxia.Methods: It was a retrospective study on 92 (ninety two) consecutive cases of perinatal asphyxia admitted in the neonatal care unit of Sir Salimullah Medical College and Mitford Hospital during the period of January and February 2011.Results: The results revealed that during the study period the number of perinatal asphyxia in admitted in neonatal care unit was 92 out of 193 i.e. 47.6%. Out of 92 asphyxiated newborn 86% were admitted in first 24 hours of life. Among them 71% were inborn and of male sex. Most of them (69%) were of normal birth weight. Regarding gestational age 56% were term. Fifty one percent were delivered per vaginally. Majority of mothers (79%) received antenatal care. Intrapartum risk factors included premature rupture of membrane (PROM) 19%, prolonged labour 15%, pregnancy induced hypertension 13%, antepartum haemorrhage 13%, preeclampsia and eclampsia 10%, obstructed labour 10%, malpresentation 8%, multiple gestation 8%. 60% mothers had multiparity. Presenting complaints were respiratory distress characterized by tachypnea /chest indrawing (30%), grunting (25%), convulsion (21%), irritability or excessive crying (9%), poor feeding or sucking (8.6%). About neurological complications 45% developed hypoxic ischaemic encephalopathy. Out of 42 HIE cases 60% had grade II encephalopathy. Grade I HIE was found in 26% of cases and 14% cases had grade III or severe encephalopathy. About hospital outcome 58% had hospital stay for minimum 5 days and 63% were discharged after improvement Thirteen percent were discharged on risk bond. 22 cases died during hospitalizationConclusion & Recommendation: The rate of hospital admission of Perinatal asphyxia as well as Neurological complication like hypoxic ischemic encephalopathy (HIE) was very high though majority of mother received antenatal care and affected newborns were inborn. So proper attention and timely intervention as well as resuscitation of newborn delivered in the hospital is essential to prevent the unwanted neurological complication of Perinatal asphyxia like HIE as well as other morbidity and fatality.J. Paediatr. Surg. Bangladesh 4(2): 54-57, 2013 (July)
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Honemeyer, Ulrich, and Amira Talic. "Cerebral Palsy: State of Art." Donald School Journal of Ultrasound in Obstetrics and Gynecology 4, no. 2 (2010): 189–98. http://dx.doi.org/10.5005/jp-journals-10009-1142.
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Abstract Cerebral palsy (CP) is the most common motor disability in childhood. It affects 2 to 2.5 children in 1000 live-births, with 20 to 30 fold increased prevalence in preterm infants. Despite of progress in perinatal care, the prevalence of cerebral palsy did not change in the last 50 years. New knowledge about etiological factors, such as inflammation, elevated level of cytokines, vascular strokes and genetic factors shift the origin of cerebral palsy mostly into antenatal period, making intrapartal damage responsible for less than 10% of cases. CP is becoming increasingly the subject of interdisciplinary research. Fetal neurosonography with a growing number of studies promises better understanding of the normal functional maturation of the human brain which may lead to effective prevention and treatment of cerebral palsy. Advances in 4D ultrasound resulted in development of KANET as tool for detection of abnormal fetal behavior.
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Kuryk, O., and Y. Hodovanets. "ANALYSIS OF RISK FACTORS AND CLINICAL AND PARACLINICAL MANIFESTATIONS OF GASTROINTESTINAL DYSFUNCTION IN NEWBORNS IN PERINATAL PATHOLOGY." Neonatology, surgery and perinatal medicine 12, no. 1(43) (2022): 21–25. http://dx.doi.org/10.24061/2413-4260.xii.1.43.2022.4.
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In recent decades, there has been a worldwide trend toward increasing rates of functional and organic pathology of the gastrointestinal (GI) tract in children. Presently, diseases of digestive organs rank second in frequency among pathologies of the pediatric population after acute respiratory diseases. Development of functional disorders of the gastrointestinal tract in children in the first year of life is mainly caused by anatomic and physiological characteristics of the digestive system, as well as high sensitivity and ease of damage of all its parts. Current literature suggests that children born to mothers during difficult pregnancy or childbirth are at increased risk for developing this pathology.Objective of the study: To determine perinatal risk factors and clinical and paraclinical features of gastrointestinal functional disorders in newborns with perinatal pathology.Materials and methods. The study enrolled 82 full-term infants with severe perinatal pathology, with clinical manifestations of gastrointestinal dysfunction (Group I), and 50 healthy infants (Group II) as a comparison group. Exclusion criteria for the study were: congenital malformations, low birth weight, clinical manifestations of infection. To assess metabolic disorders, a comprehensive assessment of the biochemical blood spectrum with the level of total protein and albumin, total bilirubin and its fractions, glucose, urea and uric acid, cholesterol and triglycerides; activity of AlAT, AsAT, LDH, LF, GGTP. Biochemical studies were performed using a Cormay ACCENT biochemical analyzer (Poland, Cormay reagents).Results and discussion. Disorders of postnatal adaptation of newborns are noted in the conditions of mothers’ somatic disadvantages, implementation of unfavorable factors during pregnancy and labor. Analysis of somatic anamnesis, antenatal and intrapartum problems has made it possible to identify the main causes of neonatal adaptation disorders in the early neonatal period. The most important, taking into account maternal anamneses, in the patients of the main group were: cardiovascular system pathology in 30 (36, 59%) cases, urinary system pathology in 22 (26, 83%) cases, endocrine system pathology in 17 (20, 73%) cases, digestive system pathology in 11 (13, 41%) cases, and respiratory system pathology in 8 (9, 76%) cases; gynecological pathology was diagnosed in 16 (19, 51%). The antenatal period was complicated by: placental dysfunction in 10 (12.20%) cases, hydramnios in 8 (9.76%) cases, fetal distress in 10 (12.20%) cases, and cord entanglement around the neck in 5 (6.10%) cases. Overall, there were 14 (17.07%) cases with a poor obstetric history. Caesarean section was performed in 24 (29.27%) cases, vacuum-assisted delivery in 4 (4.88%) cases.The list of diseases responsible for the severity of the newborn's condition was presented according to the main diagnosis: 66 (80.5%) cases had central nervous system involvement in the form of hypoxic-ischemic lesion/neonatal encephalopathy, 27 (32.9%) cases had severe respiratory distress, 13 (15.9%) cases had moderate asphyxia and 11 (13.4%) cases had severe asphyxia, 10 (12.2%) cases had moderate respiratory distress and 2 (2.4%) cases had hemolytic disease in newborn. All patients of the main group also had concomitant diagnoses. The condition of the main group neonates was characterized by more severe somatic and neurological status disorders, formation of MOD syndrome with the development of signs of food intolerance due to complex disorders of the gastrointestinal system. Complex disorders of food tolerance were observed in 71 (86,59%) children, regurgitation/stasis - in 66 (80,49%) neonates, paresis/weak intestinal peristalsis - in 47 (57,32%) patients, flatus - in 3 (3,66%) cases, meconium retention - in 3 (3.66%) cases, isolated absence of sucking reflex/ wobbly sucking was found in 3 (3.66%) cases, enlargement of liver and spleen - in 1 (1.22%) patient. The complex of serum biochemical studies showed significant dysmetabolic changes, which to some extent explain the pathophysiological mechanisms of gastrointestinal dysfunction. In particular, revealed violations of protein-synthetic function of the liver and delays in the production and excretion of bile, enzyme deficiency and cytolytic syndrome.Conclusions. Disorders of the digestive system in newborns is one of the manifestations of general body dysfunction in conditions of hypoxia with the implementation of unfavorable factors of pregnancy and childbirth in the mother.Clinical signs of food intolerance in newborn infants are regurgitation/stasis, paresis/weak intestinal peristalsis, flatus, meconium retention, absence of sucking reflex/wobbly sucking, enlarged liver and spleen.Complex serum biochemical studies in newborns with gastrointestinal disorders showed impaired protein-synthetic liver function, delayed production and excretion of bile, enzymatic insufficiency and cytolytic syndrome.
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Berardi, A., K. Rossi, F. Cavalleri, et al. "Maternal anaphylaxis and fetal brain damage after intrapartum chemoprophylaxis." Journal of Perinatal Medicine 32, no. 4 (2004). http://dx.doi.org/10.1515/jpm.2004.070.
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Vullings, Rik, and Judith O. E. H. van Laar. "Non-invasive Fetal Electrocardiography for Intrapartum Cardiotocography." Frontiers in Pediatrics 8 (December 9, 2020). http://dx.doi.org/10.3389/fped.2020.599049.
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Fetal monitoring is important to diagnose complications that can occur during pregnancy. If detected timely, these complications might be resolved before they lead to irreversible damage. Current fetal monitoring mainly relies on cardiotocography, the simultaneous registration of fetal heart rate and uterine activity. Unfortunately, the technology to obtain the cardiotocogram has limitations. In current clinical practice the fetal heart rate is obtained via either an invasive scalp electrode, that poses risks and can only be applied during labor and after rupture of the fetal membranes, or via non-invasive Doppler ultrasound technology that is inaccurate and suffers from loss of signal, in particular in women with high body mass, during motion, or in preterm pregnancies. In this study, transabdominal electrophysiological measurements are exploited to provide fetal heart rate non-invasively and in a more reliable manner than Doppler ultrasound. The performance of the fetal heart rate detection is determined by comparing the fetal heart rate to that obtained with an invasive scalp electrode during intrapartum monitoring. The performance is gauged by comparing it to performances mentioned in literature on Doppler ultrasound and on two commercially-available devices that are also based on transabdominal fetal electrocardiography.
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Maeda, Kazuo. "Prevention and treatment of cerebral palsy caused by intrapartum damage with novel hypoxia index." Journal of Stem Cell Research & Therapeutics 4, no. 4 (2018). http://dx.doi.org/10.15406/jsrt.2018.04.00122.
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Maeda, Kazuo, and Masaji Utsu. "Prevention of Intrapartum Brain Damage with Hypoxia Index and the Problem in Preterm Birth." Journal of HIV & Retro Virus 04, no. 01 (2018). http://dx.doi.org/10.21767/2471-9676.100040.
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B, Hakim, Roszaman R, Nor Ziana AW, Che Anuar CY, and Jefri A. "Syringomyelia in Pregnancy- Is Caesarean Section The Best Option For Delivery? - A Case Report." IIUM Medical Journal Malaysia 8, no. 1 (2020). http://dx.doi.org/10.31436/imjm.v8i1.768.
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Syringomyelia is a rare neurological disease, which is characterized by the formation of a cyst in the spinal cord. The aetiology of the disease still remains controversial. The damage to the spinal cord results in headache, weakness, stiffness and numbness on both lower and upper limbs. Only few a cases of syringomyelia in pregnancy have been reported thus far. As such, there is no standard management of intrapartum care.1 We present a case of symptomatic syringomyelia in pregnancy, its management and literature review. The mode of delivery with risks for vaginal route is discussed.
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Offerhaus, Pien, Suze Jans, Chantal Hukkelhoven, Raymond de Vries, and Marianne Nieuwenhuijze. "Women’s characteristics and care outcomes of caseload midwifery care in the Netherlands: a retrospective cohort study." BMC Pregnancy and Childbirth 20, no. 1 (2020). http://dx.doi.org/10.1186/s12884-020-03204-3.
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Abstract Background The maternity care system in the Netherlands is well known for its support of community-based midwifery. However, regular midwifery practices typically do not offer caseload midwifery care – one-to-one continuity of care throughout pregnancy and birth. Because we know very little about the outcomes for women receiving caseload care in the Netherlands, we compared caseload care with regular midwife-led care, looking at maternal and perinatal outcomes, including antenatal and intrapartum referrals to secondary (i.e., obstetrician-led) care. Methods We selected 657 women in caseload care and 1954 matched controls (women in regular midwife-led care) from all women registered in the Dutch Perinatal Registry (Perined) who gave birth in 2015. To be eligible for selection the women had to be in midwife-led antenatal care beyond 28 gestational weeks. Each woman in caseload care was matched with three women in regular midwife-led care, using parity, maternal age, background (Dutch or non-Dutch) and region. These two cohorts were compared for referral rates, mode of birth, and other maternal and perinatal outcomes. Results In caseload midwifery care, 46.9% of women were referred to obstetrician-led care (24.2% antenatally and 22.8% in the intrapartum period). In the matched cohort, 65.7% were referred (37.4% antenatally and 28.3% in the intrapartum period). In caseload care, 84.0% experienced a spontaneous vaginal birth versus 77.0% in regular midwife-led care. These patterns were observed for both nulliparous and multiparous women. Women in caseload care had fewer inductions of labour (13.2% vs 21.0%), more homebirths (39.4% vs 16.1%) and less perineal damage (intact perineum: 41.3% vs 28.2%). The incidence of perinatal mortality and a low Apgar score was low in both groups. Conclusions We found that when compared to regular midwife-led care, caseload midwifery care in the Netherlands is associated with a lower referral rate to obstetrician-led care – both antenatally and in the intrapartum period – and a higher spontaneous vaginal birth rate, with similar perinatal safety. The challenge is to include this model as part of the current effort to improve the quality of Dutch maternity care, making caseload care available and affordable for more women.
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Cannata, David J., Zoe Ireland, Hayley Dickinson, et al. "Maternal creatine supplementation from mid-pregnancy protects the newborn spiny mouse diaphragm from intrapartum hypoxia-induced damage." Pediatric Research, July 2010, 1. http://dx.doi.org/10.1203/pdr.0b013e3181f1c048.
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Pereira, Susana, Caron Ingram, Neerja Gupta, Mandeep Singh, and Edwin Chandraharan. "Recognising Fetal Compromise in the Cardiograph during the Antenatal Period: Pearls and Pitfalls." Asian Journal of Medicine and Health, September 3, 2020, 72–83. http://dx.doi.org/10.9734/ajmah/2020/v18i930238.
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There are several national and international guidelines to aid the interpretation of the cardiotocograph (CTG) trace during labour. These guidelines are based on assessing changes in the fetal heart rate (i.e. cardiograph) in response to mechanical and hypoxic stresses during labour secondary to ongoing frequency, duration and strength of uterine contractions (i.e. tocograph). However, during the antenatal period, uterine contractions are absent, and therefore, these intrapartum CTG guidelines cannot be used to reliably identify fetuses at risk of compromise. Computerised analysis of CTG using the Dawes-Redman Criteria could be used to detect fetal compromise. However, clinicians should be aware of the multiple pathways of fetal damage (i.e. inflammation, infection, intrauterine fetal stroke, chronic fetal anaemia, acute feto-maternal haemorrhage and fetal cardiac or neurological disorders) which can cause changes on the CTG trace which may not be recognised by using CTG guidelines.
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"Use and Abuse of the Apgar Score." Pediatrics 98, no. 1 (1996): 141–42. http://dx.doi.org/10.1542/peds.98.1.141.
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This is a revised statement published jointly with the American College of Obstetricians and Gynecologists that emphasizes the appropriate use of the Apgar Score. The highlights of the statement include: (1) the Apgar Score is useful in assessing the condition of the infant at birth; (2) the Apgar score alone should not be used as evidence that neurologic damage was caused by hypoxia that results in neurologic injury or from inappropriate intrapartum treatment; and (3) an infant who has had "asphyxia" proximate to delivery that is severe enough to result in acute neurologic injury should demonstrate all of the following: (a) profound metabolic or mixed acidemia (pH <7.00) on an umbilical arterial blood sample, if obtained, (b) an Apgar score of 0 to 3 for longer than 5 minutes, (c) neurologic manifestation, eg, seizure, coma, or hypotonia, and (d) evidence of multiorgan dysfunction.
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Castro, Luísa, Maria Loureiro, Teresa S. Henriques, and Inês Nunes. "Systematic Review of Intrapartum Fetal Heart Rate Spectral Analysis and an Application in the Detection of Fetal Acidemia." Frontiers in Pediatrics 9 (August 2, 2021). http://dx.doi.org/10.3389/fped.2021.661400.
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It is fundamental to diagnose fetal acidemia as early as possible, allowing adequate obstetrical interventions to prevent brain damage or perinatal death. The visual analysis of cardiotocography traces has been complemented by computerized methods in order to overcome some of its limitations in the screening of fetal hypoxia/acidemia. Spectral analysis has been proposed by several studies exploring fetal heart rate recordings while referring to a great variety of frequency bands for integrating the power spectrum. In this paper, the main goal was to systematically review the spectral bands reported in intrapartum fetal heart rate studies and to evaluate their performance in detecting fetal acidemia/hypoxia. A total of 176 articles were reviewed, from MEDLINE, and 26 were included for the extraction of frequency bands and other relevant methodological information. An open-access fetal heart rate database was used, with recordings of the last half an hour of labor of 246 fetuses. Four different umbilical artery pH cutoffs were considered for fetuses' classification into acidemic or non-acidemic: 7.05, 7.10, 7.15, and 7.20. The area under the receiver operating characteristic curve (AUROC) was used to quantify the frequency bands' ability to distinguish acidemic fetuses. Bands referring to low frequencies, mainly associated with neural sympathetic activity, were the best at detecting acidemic fetuses, with the more severe definition (pH ≤ 7.05) attaining the highest values for the AUROC. This study shows that the power spectrum analysis of the fetal heart rate is a simple and powerful tool that may become an adjunctive method to CTG, helping healthcare professionals to accurately identify fetuses at risk of intrapartum hypoxia and to implement timely obstetrical interventions to reduce the incidence of related adverse perinatal outcomes.
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Rahmawati, Ai, Bhekti Imansari, Devita Madiuw, Ida Nurhidayah, Pipih Napisah, and Yanti Hermayanti. "MANAGEMENT DISASTER IN MATERNITY AREAS." Journal of Maternity Care and Reproductive Health 2, no. 2 (2019). http://dx.doi.org/10.36780/jmcrh.v2i2.72.
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Indonesia is one of the countries in the world that is often affected by natural disasters. The disaster has broad-impact such as infrastructure damage, loss of material, and impacts on residents who live in the disaster area including pregnant women, postpartum women, and newborns. The impact that often occurs is stress in pregnant women and postpartum. Also, babies born also may have low birth weight and premature. The purpose of this literature study was to review disaster management in the maternity area in various countries. The electronic database included EBSCO hosts, PubMed and google scholar. Keyword for searching articles was "management disaster", " disaster preparedness " and "maternity area". A total of 859 articles were found and only 15 articles were chosen for analysis. Based on the literature analysis, it was found that there was a need to prepare for a disaster situation, especially women and infants in the maternal period (antepartum, intrapartum, postpartum and neonatal care) in Indonesia. Disaster management divide into three periods, first, before a disaster the government should provide a referral hospital to accommodate maternal patients and teams to deal with maternal problems. When the disaster occurred, identification of disaster victims using the triage OB TRAIN. After a disaster, maternal patients may experience stress and depression. Prenatal depression intervention includes interpersonal therapy, music therapy, and maternal relaxation. Preventing postpartum depression in postpartum mothers is done by breastfeeding their child. There is a need for a design disaster management for maternal patients in Indonesia that consist of three periods: pre-disaster, during disasters, post-disaster.Keywords: Management disaster, disaster preparedness, maternity areas
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G.Yu., Spiridenko, Petrov Yu.A., and Bragina T.V. "HUMAN IMMUNODEFICIENCY VIRUS AND PREGNANCY: PATHOMORPHOLOGICAL FEATURES AND OBSTETRIC AND GYNECOLOGICAL TACTICS." "Medical & pharmaceutical journal "Pulse", August 30, 2021, 178–84. http://dx.doi.org/10.26787/nydha-2686-6838-2021-23-8-178-184.
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Currently, due to the increase in the incidence of HIV infection in women of reproductive age, the number of desired pregnancies in such patients has increased. This makes it necessary to study the pathological effect of the human immunodeficiency virus on the placenta, fetus and the female body as a whole. HIV belongs to retroviruses and contributes to the discoordination of a woman's immune mechanisms. Using the gp41 and gp120 glycoproteins, reverse transcriptase, integrase, and protease, the virus destroys CD4 cells and increases the viral load. It founded that the risk of infection of the fetus decreases from 45% to 1% with HIV infection before pregnancy and with antiretroviral therapy throughout its duration. Vertical infection is possible in the intrauterine, intranatal and postnatal periods, the main of which is the period of childbirth-up to 70%. Viral, maternal, placental, fetal, obstetric and neonatal factors contribute to an increased risk of transmission of the pathogen to the fetus. High viral load and antiretroviral therapy lead in the 3rd trimester of pregnancy to the development of chronic placental insufficiency due to the formation of focal and diffuse deciduitis, membranitis, intervillusitis and chorionamnionitis and damage to the hematoplacental barrier. Early diagnosis before 12 weeks of gestation, timely therapy with nucleoside and non-nucleoside reverse transcriptase inhibitors, as well as protease inhibitors during pregnancy, childbirth and in the postpartum period are the main aspects of preventing HIV infection and further disorders of the child's growth and development. The timely choice of the method of delivery, indications and contraindications to delivery through the natural birth canal helps to reduce the risk of infection in a particularly dangerous period - the intrapartum.
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Mor, Matan, Nadav Kugler, Eric Jauniaux, et al. "Impact of the COVID-19 Pandemic on Excess Perinatal Mortality and Morbidity in Israel." American Journal of Perinatology, December 10, 2020. http://dx.doi.org/10.1055/s-0040-1721515.
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Objective The 2020 COVID-19 pandemic has been associated with excess mortality and morbidity in adults and teenagers over 14 years of age, but there is still limited evidence on the direct and indirect impact of the pandemic on pregnancy. We aimed to evaluate the effect of the first wave of the COVID-19 pandemic on obstetrical emergency attendance in a low-risk population and the corresponding perinatal outcomes. Study Design This is a single center retrospective cohort study of all singleton births between February 21 and April 30. Prenatal emergency labor ward admission numbers and obstetric outcomes during the peak of the first COVID-19 pandemic of 2020 in Israel were compared with the combined corresponding periods for the years 2017 to 2019. Results During the 2020 COVID-19 pandemic, the mean number of prenatal emergency labor ward admissions was lower, both by daily count and per woman, in comparison to the combined matching periods in 2017, 2018, and 2019 (48.6 ± 12.2 vs. 57.8 ± 14.4, p < 0.0001 and 1.74 ± 1.1 vs. 1.92 ± 1.2, p < 0.0001, respectively). A significantly (p = 0.0370) higher rate of stillbirth was noted in the study group (0.4%) compared with the control group (0.1%). All study group patients were negative for COVID-19. Gestational age at delivery, rates of premature delivery at <28, 34, and 37 weeks, pregnancy complications, postdate delivery at >40 and 41 weeks, mode of delivery, and numbers of emergency cesarean deliveries were similar in both groups. There was no difference in the intrapartum fetal death rate between the groups. Conclusion The COVID-19 pandemic stay-at-home policy combined with patient fear of contracting the disease in hospital could explain the associated higher rate of stillbirth. This collateral perinatal damage follows a decreased in prenatal emergency labor ward admissions during the first wave of COVID-19 in Israel. Key Points
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Habek, Dubravko, and Anis Cerovac. "A Forensic Aspect of Fetal Shoulder Dystocia." Zeitschrift für Geburtshilfe und Neonatologie, June 23, 2020. http://dx.doi.org/10.1055/a-1192-7254.
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AbstractFetal shoulder dystocia (FSD) is an unpredictable and critical obstetric intrapartum emergency, where an objective problem is the relationship between the mother's pelvis and the child, i. e., an anthropometric disorder of delivery mechanics and dynamics. It is evident that the need to perform other maneuvers indicates the severity of FSD, which in turn correlates with the consequent iatrogenic injury of the fetus and/or mother. FSD is certainly the most controversial forensic obstetric problem, with the most disputes, compensation for damages due to peripartum injury to the child and/or mother, pain suffered, the need for someone else's care, and permanent disability. Suboptimal procedures and inadequate documentation are factors of forensic risk and subsequent litigations. Prevention of FSD is generally not possible, although good antenatal care can sometimes exclude risky cases of FSD, and some rare, chronic intrauterine disorders can result in orthopedic and neurological sequelae, which is especially important in forensic analysis. Because FSD is largely impossible to predict, it must be viewed as an intrapartum acceptable risk. During childbirth, FSD may compromise the safety of the mother and unborn child, therefore education and skills acquisition are necessary for obstetric work. Risk control, proper procedures, and proper documentation, along with good communication with the pregnant women and their families, significantly reduce litigation procedures.