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PubMed1997

Management and outcomes of posterior fossa subdural hematomas in neonates.

OBJECTIVE: To review and analyze a contemporary series of 15 neonates who were treated for posterior fossa subdural hematomas (PFSDHs) during the era of computed tomography and magnetic resonance imaging. METHODS: A retrospective chart review identified all neonates with PFSDHs for whom neurosurgical consultations were obtained for treatment planning. RESULTS: There were nine male and six female patients. The mean gestational age was 39 weeks. Nine of the 15 mothers of the patients were primiparous. Instrument-assisted delivery (forceps and/or vacuum extractor) was undertaken for seven patients. The mean birth weight of the infants was 3165 g (range, 2160-3930 g). The mean 5-minute Apgar score was 7.5. Symptoms of PFSDH developed within the first 24 hours of life in 13 neonates. The predominant symptoms and signs were failure to thrive, irritability, seizures, apnea, and bradycardia. Lumbar punctures to rule out central nervous system sepsis were performed in six neonates. Hemograms revealed that six neonates were anemic with low hemoglobins, five had low platelets, and four had abnormal prothrombin and/or partial thromboplastin times at the time of diagnosis. Computed tomography established the diagnosis of PFSDH in all cases. Magnetic resonance imaging was performed for two neonates. The median time to diagnosis by imaging studies was 10 hours after birth. Surgical evacuation of the PFSDHs was performed in eight neonates. Seven neonates were followed conservatively with serial imaging studies. There was no mortality in either treatment group. Follow-up ranged from 2 to 10 years, with a mean of 4.5 years. Functional outcome assessment revealed that seven neonates were neurodevelopmentally normal, three were mildly delayed, two were moderately delayed, and three were profoundly delayed. In addition to traumatic causes of the PFSDHs, three neonates were observed to have coagulation disturbances at birth and one was observed at follow-up to have a posterior fossa medulloblastoma that had bled at birth. CONCLUSION: PFSDHs are rare but important lesions to diagnose early in the neonatal period. Surgery can be life-saving when performed in a timely manner for signs and symptoms of brain stem dysfunction. A search for an underlying cause predisposing to a PFSDH may, on occasion, reveal a coagulation disturbance or a neoplasm that will require additional therapeutic considerations.

Birth Injuries↗
PubMed1993

Neglected spinal cord, brain stem and musculoskeletal injuries stemming from birth trauma.

OBJECTIVE: A review of the medical literature was undertaken to determine cause, diagnosis, prognosis, treatment and prevention of injuries resulting from birth trauma. The primary focus was the neonate, though infant, child and adult were also considered because the effects of birth trauma can be life-long. DATA SOURCE: A compilation of case studies and review articles were extracted from numerous "MEDLINE" literature searches. Key Terms included: Birth Trauma, Central Nervous System Injuries, Musculoskeletal Injuries, Stillbirth, Sudden Infant Death Syndrome (SIDS), Cerebral Palsy, Brachial Plexus Palsies (Erb's and Klumpke's), Neonatal-Infantile Respiratory Distress, Obstetric Accidents (Forceps, Vacuum Cup and Cesarean Deliveries), Subluxation, Chiropractic Treatment. American, British, Danish and German studies were included to show the universality of the problem. STUDY SELECTION: Findings were selected on the basis of a clear connection between birth trauma and the resulting symptoms, syndromes and/or death. DATA EXTRACTION: Findings were compiled by studying articles from the literature search. The quality and validity were assessed by corresponding references, method of documentation, number of case studies, length of time over which studies took place and presence of follow-up documentation. DATA SYNTHESIS: Inadequacies and source discrepancies were also included with regard to cause and types of obstetric accidents. CONCLUSION: Birth trauma remains an underpublicized and, therefore, an undertreated problem. There is a need for further documentation and especially more studies directed toward prevention. In the meantime, manual treatment of birth trauma injuries to the neuromusculoskeletal system could be beneficial to many patients not now receiving such treatment, and it is well within the means of current practice in chiropractic and manual medicine.

Adolescent↗
PubMed1992

External ocular trauma in instrumental and normal deliveries.

OBJECTIVE: To compare the occurrence of external ocular trauma in instrumental and normal deliveries. DESIGN: Prospective controlled study. SETTING: University Hospital of Wales, Cardiff. SUBJECTS: 133 babies born consecutively with the use of forceps and 133 control babies born without instrumentation to women matched for parity. INTERVENTIONS: External ocular examination. MAIN OUTCOME MEASURES: The presence within 24 h of birth of corneal oedema, corneal abrasion, conjunctival chemosis, subconjunctival haemorrhage and lid oedema. RESULTS: Lid oedema and multiple minor external ocular trauma occurred in 52 and 22 babies, respectively, in the instrumental delivery group and in 13 and 8 babies, respectively in the control group (P less than 0.001). Corneal abrasion occurred in two babies and corneal oedema in one baby after forceps delivery but in none of the control group. No more serious injuries occurred. All injuries resolved without long term sequelae. CONCLUSION: The frequency of sight threatening corneal trauma in instrumental deliveries is low. Specialist ophthalmic screening of these babies is not justified.

Birth Injuries↗
PubMed2004

A study of quality of life in primigravidae with urinary incontinence.

This study aimed to establish the prevalence and effect of urinary incontinence on quality of life during pregnancy and after parturition. A prospective cohort of primigravidae was recruited. The Kings Health Questionnaire (KHQ) was self-administered antenatally (34 weeks to term) and postnatally (3 months after delivery). Four hundred ninety-two primigravidae were recruited. The prevalence of urinary incontinence was reported as: pre-pregnancy 3.5% (17/492), antenatal 35.6% (175/492), 3-5 days postpartum 13.7% (51/370) and 3 months postnatal 13.0% (47/362). Most women with urinary incontinence experienced an impact on quality of life antenatally (54.3%) and postnatally (71.1%), although those experiencing an impact usually reported it as 'a little' (75.8 and 87.5%). There was a higher prevalence of urinary incontinence after forceps delivery ( p<0.05) but not of greater impairment in quality of life ( p>0.05). Personal and general health deteriorated postnatally ( p<0.05). During pregnancy most women with urinary incontinence experience minimal impact on quality of life. Postnatally, other causes of morbidity may contribute to worsening of general and personal health.

Adult↗
PubMed1990

The effect of delayed pushing in the second stage of labor with continuous lumbar epidural analgesia.

We studied primigravid women in spontaneous labor at term and given epidural analgesia. Two hundred such women giving birth in 1983 were compared with similar groups who gave birth in 1985 and 1987 after the introduction of 'delayed pushing' into our labor ward protocol. Four hundred controls were obtained in 1983 and 1985 by selecting from the labor ward register the next normal primigravid woman in spontaneous labor without epidural analgesia. The assisted delivery rate was significantly higher in all three epidural groups than in the controls (p less than 0.001). Among epidural labors, there was no significant difference between 1983 and 1987 in the incidence of rotational or non-rotational forceps, or of cesarean section. In each epidural group, women who waited more than 60 min were less likely to experience a normal spontaneous delivery than were those who did not (p less than 0.001 in 1983; p = 0.006 in 1985 p = 0.035 in 1987). We conclude that to delay pushing beyond 60 min confers no benefit regarding mode of delivery.

Adult↗
PubMed2003

Mirror-image artifact mimicking epidural hematoma: usefulness of power Doppler sonography.

During sonographic examination, a mirror-like interface can scatter the ultrasound beam, producing mirror-image artifacts. We describe a case of bilateral parietal cephalhematoma in the parietal region of a 2-day-old neonate that mimicked bilateral epidural hematoma on routine sonographic examination. Forceps had been used during delivery, and the neonate had been experiencing episodes of apnea since birth. Gray-scale coronal sonograms showed anechoic structures resembling epidural hematomas in the left and right parietal regions. However, color and power Doppler sonography showed normal vascular findings, thus permitting identification of the mirror-image artifact.

Artifacts↗
PubMed2005

Myasthenia gravis: management issues during pregnancy.

Myasthenia gravis (MG) often affects women in the second and third decades of life, overlapping with the childbearing years. The course of the disease is unpredictable during pregnancy; however, worsening of symptoms occurs more likely during the first trimester and postpartum. MG can be well managed during pregnancy with relatively safe and effective therapies. Anticholinesterase drugs are the mainstay of treatment, when MG symptoms are not satisfactorily controlled, corticosteroids, azathioprine and in some cases cyclosporin A can be used. Until information is available regarding safety, mycophenolate mofetil should be discontinued before pregnancy. Pregnancy should be avoided in women treated with methotrexate because of the risk of causing typical malformations. Plasmapheresis and intravenous immunoglobulins have been successfully used in the treatment of MG crisis during pregnancy. Caesarean section is recommended only for obstetric reasons; forceps delivery and vacuum extraction are sometimes required. Epidural anesthesia is advised to reduce physical and emotional stress. MG during pregnancy can lead to serious life-threatening conditions, including respiratory insufficiency; therefore, intensive checkups by a gynaecologist and a neurologist are necessary. Women with myasthenia gravis should not be discouraged from conceiving; however, they should discuss their plan for pregnancy with their neurologist and their gynaecologist.

Adolescent↗
PubMed2006

[Frey's syndrome: report of three cases with two distinct etiopathogeneses].

Frey's syndrome is characterized by recurrent episodes of facial gustatory flushing and sweating (most frequent in adults) limited to the cutaneous distribution of the auriculotemporal nerve which, when injured, shows abnormal regeneration. The condition is relatively common in adults following nerve injury in parotid surgery but has rarely been reported in children as a sequel of perinatal birth trauma resulting from forceps assisted delivery. We report three patients with the same syndrome and two different causes. Two children had a history of forceps assisted delivery and one adolescent had undergone preauricular lymphadenectomy. This syndrome, which has more often been described by allergists and maxillofacial surgeons than by pediatricians, may pose problems of differential diagnosis with food allergy, leading to unnecessary exclusion diets. In the pediatric age group, Frey's syndrome is self limiting and does not require therapy if the diagnosis is correct.

Adolescent↗
PubMed2003

Osteopathic manipulative treatment in prenatal care: a retrospective case control design study.

The use of osteopathic manipulative treatment (OMT) during pregnancy has a long tradition in osteopathic medicine. A retrospective study was designed to compare a group of women who received prenatal OMT with a matched group that did not receive prenatal OMT. The medical records of 160 women from four cities who received prenatal OMT were reviewed for the occurrence of meconium-stained amniotic fluid, preterm delivery, use of forceps, and cesarean delivery. The randomly selected records of 161 women who were from the same cities, but who did not receive prenatal OMT, were reviewed for the same outcomes. The results of a logistic regression analysis were statistically reliable, chi2 (4, N = 321) = 26.55; P < .001, indicating that the labor and delivery outcomes, as a set, were associated with whether OMT was administered during pregnancy. According to the Wald criterion, prenatal OMT was significantly associated with meconium-stained amniotic fluid (Z = 13.20, P < .001) and preterm delivery (Z = 9.91; P < .01), while the use of forceps was found to be marginally significant (Z = 3.28; P = .07). The case control study found evidence of improved outcomes in labor and delivery for women who received prenatal OMT, compared with women who did not. A prospective study is proposed as the next step in evaluating the effects of prenatal OMT.

Adolescent↗
PubMed2005

Outcomes of labours augmented with oxytocin.

OBJECTIVE: To highlight the differences in mode of delivery between women augmented with intravenous oxytocin because of failure to progress in labour with those who labour without the need for augmentation. STUDY DESIGN: An incidence study over a 5-year-period in a tertiary referral hospital comparing 1097 nulliparous women who were augmented in labour with 2745 nulliparous women who did not need augmentation. Only labours of spontaneous onset in the pregnancies of women at term were studied. The incidence of pregnancy outcomes were assessed by presenting estimates of relative risk (RR) and their 95% confidence intervals (CI). RESULTS: Only 51.1% of women who received augmentation achieved a normal vaginal delivery compared with 76.5% of women who did not need augmentation (RR 0.67; CI 0.63-0.71). Contributory factors to this disparity included a greater number of Caesarean sections (14.4% versus 6.6%; RR 2.18 CI 1.74-2.67), forcep deliveries (12.8% versus 5.3%; RR 2.41 CI 1.93-3.01) and ventouse deliveries (21.7% versus 11.5%; RR 1.89 CI 1.62-2.21) being performed among augmented labours as compared to normal progressive labours. CONCLUSION: Significant improvements in the management of labours which fail to progress are needed if normal vaginal delivery rates are to approach those seen in labours which progress without the need for augmentation.

Adult↗
PubMed1999

A comparison of intermittent and continuous support during labor: a meta-analysis.

Our goal was to contrast the influence of intermittent and continuous support provided by doulas during labor and delivery on 5 childbirth outcomes. Data were aggregated across 11 clinical trials by means of meta-analytic techniques. Continuous support, when compared with no doula support, was significantly associated with shorter labors (weighted mean difference -1.64 hours, 95% confidence interval -2.3 to -.96) and decreased need for the use of any analgesia (odds ratio.64, 95% confidence interval.49 to.85), oxytocin (odds ratio.29, 95% confidence interval.20 to.40), forceps (odds ratio.43, 95% confidence interval.28 to.65), and cesarean sections (odds ratio.49, 95% confidence interval.37 to.65). Intermittent support was not significantly associated with any of the outcomes. Odds ratios differed between the 2 groups of studies for each outcome. Continuous support appears to have a greater beneficial impact on the 5 outcomes than intermittent support. Future clinical trials, however, will need to control for possible confounding influences. Implications for labor management are discussed.

Cesarean Section↗
PubMed1975

[Deliveries in foreign women (author's transl)].

Within four and a half years (between January 1, 1969 and June 30, 1973) there were 6329 deliveries, among them 1217 confinements occurred in foreign women, i.e. proportional 19, 2%. The chi square method was used for the statistical analysis. The incidence of Caesarean Section in foreign women (5, 3%) is significantly higher than in German women (3, 4%). Just so, the incidence of Caesarean Section in wives of foreign workers from Spain and Portugal was significantly higher than in German women; it looks like as if the indication "Pelvic contraction" appears significantly more frequent in parturients of the western part of the mediterranean area than in German women. On the contrary, the indication "fetal distress" is significantly higher in the deliveries of the wives from Greece and Turkey (the eastern part of the mediterranean area). There was no statistical difference in the rate of forceps deliveries and deliveries by vacuum between the German collective (6, 1%) and the foreign collective (7, 5%). Statistically proved, the incidence of the incidence of the indication "fetal distress" in vaginal-operative deliveries of women from Turkey was higher compared to the German collective. Vice versa it turned out that the incidence of the indication "standstill on floor of the pelvis" occurred more often in German parturients than of the collective of Turkey. There was a second statistical method (randomization) to check up if the collectives are comparable; there exists a significant difference between German parturients and women from Turkey: in the German collective are more young and old I.-Parae, in the collective from Turkey you find more Multiparae and more wives in the optimal obstetrical age between 18 and 30 years. The subsequent obstetrical aspects and consequences are discussed. There was no significant difference between foreign and German parturients in further perinatal examinations and parameters.

Adolescent↗
PubMed2006

Cervical neck dislocation associated with the Zavanelli maneuver.

BACKGROUND: In the management of shoulder dystocia, fetal head replacement into the uterus has been advocated should delivery attempts remain unsuccessful. Reports of the Zavanelli maneuver have been remarkably optimistic despite the challenges of the procedure. CASE: A gravida 3 para 2 (two previous vaginal deliveries of more than 4,500-g infants) with gestational diabetes presented at term. Following a low forceps delivery, shoulder dystocia was encountered and was unable to be relieved with standard maneuvers. A cesarean delivery was performed, shoulders disimpacted, and the infant delivered abdominally. A 4,680-g stillborn infant was delivered with radiologic and autopsy evidence of cervical C5-C6 dislocation. CONCLUSION: Despite published reports of high success rates and limited fetal consequences, physicians should be aware of adverse consequences including cervical neck trauma associated with use of the Zavanelli maneuver.

Adult↗
PubMed2005

[Emergency embolization in gynaecological bleeding. Two case reports].

Two patients with gynaecological hemorrhage underwent successfully trans-arterial embolization. The first womanhad an uncontrollable perineal hemorrhage following a delivery with forceps. Angiography showed extravasation of contrast from right and left vaginal artery. Hyperselective embolisation stopped the vaginal bleeding. The second woman had massive hemorrhage following radiotherapy for cervical cancer. Angiography demonstrated extravasation of contrast from both uterine arteries. The bleeding was controlled after hyperselective embolisation. Emergency arterial embolisation is a safe and effective means of control of irrepressible genital hemorrhage.

Adult↗
PubMedDate not supplied

[Clinical aspects and therapy of amniotic fluid embolism. Illustration based on a case report].

A case of amniotic fluid embolism during the delivery of an at term pregnancy is reported. The 34-year old primipara with an unremarkable medical history suddenly suffered from a seizure in the second stage of labor. Shortly prior to this event, a prolonged fetal bradycardia was recorded. After forceps delivery a massive postpartum haemorrhage as the result of a consumption coagulopathy occurred. Immediate resuscitation with artificial ventilation improved the condition of mother and child. The substitution of packed red cells and platelets, fresh frozen plasma and other blood derivates was necessary. Mother and child survived without any physical damage or neurological deficit. Because of the clinical pattern we diagnosed an amniotic fluid embolism.

Adult↗
PubMed1986

Failed forceps.

Among 53 cases of failed forceps occurring in 6524 uncomplicated primiparous deliveries, depression at birth and encephalopathy occurred with similar frequency as when cesarean section was done for failure to progress in the second stage, and birth trauma was no more common than that with successful midforceps delivery. Factors predisposing to or associated with midforceps deliveries or second stage cesarean sections were short mothers, heavy babies, induced or prolonged labors, and fetal distress or meconium release in labor.

Cesarean Section↗
PubMedDate not supplied

Spinal cord transection, cerebral ischaemic and brain-stem injury in a baby following a Kielland's forceps rotation.

A full-term infant suffered a high cervical cord transection after a Kielland 's forceps rotation and extraction. Quadriplegia developed immediately and initial cerebral swelling was followed by atrophy with ventricular dilatation on CT examination. Death occurred at 60 days. At post-mortem complete necrosis of the cervical cord at C2-C3 with old haemorrhage in the meninges was found, with damage to the inferior corpora quadrigemina , the thalamus, striatum, cerebellar and cerebral cortex. The mechanism is discussed briefly.

Adult↗