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[PMID]: 29521925
[Au] Autor:Riemenschneider KJ
[Ad] Address:Karen J. Riemenschneider, DNP, RN-BC, CWOCN, CNS, Albany Medical Center, Albany, New York.
[Ti] Title:Prevention of Pressure Injuries in the Operating Room: A Quality Improvement Project.
[So] Source:J Wound Ostomy Continence Nurs;45(2):141-145, 2018 Mar/Apr.
[Is] ISSN:1528-3976
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Prevention of hospital-acquired pressure injuries (HAPIs) remains a crucial clinical challenge especially for those patients undergoing surgery. The purpose of this project was to examine whether a 5-layer silicone foam dressing applied to the sacrum of patients undergoing vascular surgery decreased the occurrence of sacral pressure injuries and to explore participant characteristics associated with the development of operating room (OR)-related pressure injuries. A pre-/postintervention design, quality improvement project in a convenience sample of 81 patients undergoing vascular surgery, in a 700-bed level I trauma acute care setting, in the Northeastern United States. Eighty-one patients undergoing vascular surgery participated in this project. Thirty-seven were in the preintervention group who were identified from the housewide pressure injury prevalence data from May and December 2010 and received standard pressure injury prevention while hospitalized. Forty-four patients in the intervention group were identified from a hospital-based outpatient vascular surgery office and preoperatively received the 5-layer silicone foam dressing in addition to standard care. Data were collected on the third and seventh postoperative days via the electronic medical record and paper medical records. Collected data included age, gender, comorbidities (diabetes, hypertension, peripheral vascular disease and, smoking status), presence of a 5-layer silicone sacral foam dressing, and pressure injury occurrence. Analysis included descriptive statistics, Fisher exact test to compare groups, and logistic regression to identify associated risk factors. More than 50% (n = 19) in the preintervention group developed a hospital-acquired pressure injury while only 1 subject (n = 2%) in the intervention group developed a hospital-acquired pressure injury (P = .000). Findings indicate that, after controlling for age, gender, and other comorbidities, application of a 5-layer silicone sacral foam dressing significantly reduced the likelihood of development of a new pressure injury (OR= 0.04, 95% confidence interval, 0.00-40; P = .006). This pre-/postquality improvement project, using a 5-layer silicone sacral foam dressing in addition to standard operating room pressure injury preventive interventions, for elective vascular surgical cases, resulted in a significant decrease in sacral operating room-related pressure injuries. These findings suggest the effectiveness of a 5-layer silicone foam dressing when added to standard preventive interventions. The findings warrant further investigation of additional preventative interventions in the OR specific to high-risk populations.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Process
[do] DOI:10.1097/WON.0000000000000410

  2 / 10362 MEDLINE  
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[PMID]: 29517454
[Au] Autor:Makungu M; du Plessis WM; Barrows M; Groenewald HB; Koeppel KN
[Ti] Title:RADIOGRAPHIC ABDOMINAL ANATOMY IN CAPTIVE RED PANDAS ( AILURUS FULGENS).
[So] Source:J Zoo Wildl Med;49(1):214-218, 2018 Mar.
[Is] ISSN:1042-7260
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:The red panda ( Ailurus fulgens) is classified as an endangered species by the International Union for Conservation of Nature and Natural Resources. The aim of this study was to describe the normal radiographic abdominal anatomy in red pandas to provide guidance for clinical use. Radiography of the abdomen was performed in nine captive red pandas during their annual health examinations. Seven of nine animals had six lumbar vertebrae. The sacrum consisted mainly (8/9) of three fused segments. Hypaxial muscles were easily seen in animals weighing 5 kg and above. The pylorus was located to the right of the midline and cranially to the fundus in 8/9 individuals. Bunching of small intestine in the right central abdomen occurred in animals weighing 6 kg and above. The spleen was prominent. Knowledge of the normal radiographic abdominal anatomy of red pandas is important in the diagnosis of diseases and in routine health examinations.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Data-Review
[do] DOI:10.1638/2016-0167R2.1

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[PMID]: 29516595
[Au] Autor:Kim JW; Kim HJ; Park YJ; Kang SG; Park JY; Bae JH; Kang SH; Park HS; Moon DG; Cheon J; Lee JG; Kim JJ; Oh MM
[Ad] Address:Department of Urology, Korea University College of Medicine, Seoul, Korea.
[Ti] Title:The effects of a heating pad on anxiety, pain, and distress during urodynamic study in the female patients with stress urinary incontinence.
[So] Source:Neurourol Urodyn;, 2018 Mar 08.
[Is] ISSN:1520-6777
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:AIMS: Although generally well tolerated, a urodynamic study is an unpleasant and stressful procedure for some patients. This study evaluated the effects of a heating pad on anxiety, pain, and distress during urodynamic studies in female patients with stress urinary incontinence. METHODS: A total of 74 female patients with stress urinary incontinence who underwent a urodynamic study between May 2015 and October 2015 were randomized to either the experimental group using a heating pad (n = 37) or control group (n = 37). In the experimental group, a heating pad was applied on the patient's sacrum during the urodynamic study. All patients completed the State-Trait Anxiety Inventory (20-80) before and after the procedure and assessed their degree of pain and distress after the procedure by the visual analog scale (0-10). Systolic and diastolic blood pressure and pulse rate were also checked before and after the procedure. RESULTS: Demographic characteristics, mean age, procedure duration, pre and post-procedural systolic, and diastolic blood pressures, and pulse rate were statistically similar between the experimental and control groups. The mean State-Trait Anxiety Inventory was significantly lower in the experimental group than in the control group (30.9 ± 7.5 vs 42.5 ± 10.1, P < 0.001). The experimental group showed significantly lower pain and distress scores (Visual Analog Scale, 2.7 ± 1.5, 3.0 ± 1.5) compared with the control group (4.0 ± 1.6, 4.7 ± 2.0, both P < 0.001). CONCLUSIONS: Using a heating pad for female patients with stress urinary incontinence during a urodynamic study is a simple, economical, and effective therapy that enhances patient comfort and decreases anxiety, pain, and distress.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher
[do] DOI:10.1002/nau.23326

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[PMID]: 29205969
[Au] Autor:Zhang W
[Ad] Address:Department of Forensic Medicine, National Police University of China, Shenyang 110035, China.
[Ti] Title:[Forensic Analysis of the Characteristics of Pelvic Fracture in 65 Road Traffic Accident Death Cases].
[So] Source:Fa Yi Xue Za Zhi;32(6):428-430, 2016 Dec.
[Is] ISSN:1004-5619
[Cp] Country of publication:China
[La] Language:chi
[Ab] Abstract:OBJECTIVES: To analyze the characteristics and mechanisms of pelvic fractures in the cases of road traffic accident deaths. METHODS: Total 65 cases of road traffic accident deaths with pelvic fracture were collected, and the sites, characteristics and injury mechanisms of pelvic fracture were statistically analyzed. RESULTS: Among the 65 cases of pelvic fracture, 38 cases of dislocation of sacroiliac joint were found, and most combined with pubis symphysis separation or fracture of pubis. In the fractures of pubis, ischium and acetabulum, linear fractures were most common, while comminuted fractures were most common in sacrum and coccyx fractures. There were 54 cases combined with pelvic soft tissue injury, and 8 cases with pelvic organ injury and 44 cases with abdominal organ injury. In the types of pelvic ring injury, 32 cases were separation, 49.32%, followed by compression, 26.15% and only one case was verticality, 1.54%. CONCLUSIONS: Detailed and comprehensive examination of the body and determination of the pelvic fracture type contribute to analyze the mechanisms of injury.
[Mh] MeSH terms primary: Accidents, Traffic
Fractures, Bone/diagnosis
Pelvic Bones/injuries
[Mh] MeSH terms secundary: Acetabulum/injuries
Death
Forensic Pathology
Fractures, Comminuted/diagnosis
Humans
Ischium/injuries
Soft Tissue Injuries/diagnosis
Spinal Fractures/diagnosis
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[Js] Journal subset:IM
[Da] Date of entry for processing:171206
[St] Status:MEDLINE
[do] DOI:10.3969/j.issn.1004-5619.2016.06.008

  5 / 10362 MEDLINE  
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[PMID]: 29509655
[Au] Autor:Joukar A; Shah A; Kiapour A; Vosoughi AS; Duhon B; Agarwal AK; Elgafy H; Ebraheim N; Goel VK
[Ad] Address:Engineering Center for Orthopaedic Research Excellence (E-CORE), University of Toledo, Toledo, Ohio.
[Ti] Title:Gender Specific Sacroiliac Joint Biomechanics During Standing Upright: A Finite Element Study.
[So] Source:Spine (Phila Pa 1976);, 2018 Mar 05.
[Is] ISSN:1528-1159
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:STUDY DESIGN: The comparison of sacroiliac joint (SIJ) angular motions, pelvis ligaments strain, load sharing, and stress distribution across the joint for male and female spine-pelvis-femur models using finite element analysis. OBJECTIVE: To quantify biomechanical parameters at SIJ for all motions for both male and female models. SUMMARY OF BACKGROUND DATA: SIJ has been recognized as a main source of pain in 13% to 30% of patients with low back pain. It is shown that the SIJ rotation and translation in different planes are not exceeding 2° to 3° and 2 mm, respectively. Due to limitation of in vivo and in vitro studies, it is difficult to quantify certain biomechanical parameters such as load-sharing and stress distribution across the joint. Finite element analysis is a useful tool which can be utilized to understand the biomechanics of the SIJ. METHODS: The validated finite element models of a male and a female lumbar spine-pelvis-femur were developed from computer tomography (CT) scans. The models were used to simulate spine physiological motions. The range of motion, ligament strains, load sharing, and stress distribution across the left and right SIJs were compared between male and female models. RESULTS: Motions data at SIJs demonstrated that female model experienced 86% higher mobility in flexion, 264% in extension, 143% in left bending, and 228% in right bending compared with the male model. The stresses and loads on SIJs were higher on the female model compared with the male model. Female model ligaments underwent larger strains compared with the male model ligaments. CONCLUSION: Female SIJ had higher mobility, stresses, loads, and pelvis ligament strains compared with the male SIJ which led to higher stress across the joint, especially on the sacrum under identical loading conditions. This could be a possible reason for higher incidence of SIJ pain and pelvic stress fracture in females. LEVEL OF EVIDENCE: N/A.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180306
[Lr] Last revision date:180306
[St] Status:Publisher
[do] DOI:10.1097/BRS.0000000000002623

  6 / 10362 MEDLINE  
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[PMID]: 29181683
[Au] Autor:Akiyama T; Ogura K; Gokita T; Tsukushi S; Iwata S; Nakamura T; Matsumine A; Yonemoto T; Nishida Y; Saita K; Kawai A; Matsumoto S; Yamaguchi T
[Ad] Address:Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan. toruakiyama827@jichi.ac.jp.
[Ti] Title:Analysis of the Infiltrative Features of Chordoma: The Relationship Between Micro-Skip Metastasis and Postoperative Outcomes.
[So] Source:Ann Surg Oncol;25(4):912-919, 2018 Apr.
[Is] ISSN:1534-4681
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Chordomas are very rare primary malignant bone tumors that arise commonly from the sacrum (50-60%) and clivus (25-35%). Chordomas have a high rate of recurrence. The authors confirmed a unique histologic infiltration pattern of chordomas that resembles a skip-metastatic lesion in normal tissue around tumor, which they named "micro-skip metastasis." This study aimed to examine the correlations between the clinicopathologic features of chordomas, including micro-skip metastasis, and the clinical outcomes, including overall survival, local recurrence-free survival, and distant metastasis-free survival. METHODS: The study analyzed histopathologic and clinical data from patients with sacral chordomas who underwent en bloc resection from July 1991 through July 2014. Cases with a minimum follow-up period shorter than 20 months after resection were excluded. Kaplan-Meier survival analyses with log-rank tests were performed for overall survival, metastasis-free survival, and recurrence-free survival. RESULTS: The study retrospectively reviewed 40 patients. The mean follow-up period was 98.2 months (range 22-297 months). The local recurrence rate was 41.3%. Micro-skip metastases, observed in 17 patients (42.5%), were associated with a significantly increased risk of local recurrence (p = 0.023) but not with overall survival or distant metastasis-free survival. Poorer overall survival was associated with histologic vascular invasion (p = 0.030) and a greater maximum tumor diameter (p = 0.050). CONCLUSIONS: The presence of micro-skip metastasis was associated with a higher rate of local recurrence. The maximum tumor diameter and the presence of histologic vascular invasion were associated with poorer overall survival.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1711
[Cu] Class update date: 180307
[Lr] Last revision date:180307
[St] Status:In-Data-Review
[do] DOI:10.1245/s10434-017-6268-6

  7 / 10362 MEDLINE  
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[PMID]: 29501749
[Au] Autor:Lertudomphonwanit T; Kelly MP; Bridwell KH; Lenke LG; McAnany SJ; Punyarat P; Bryan TP; Buchowski JM; Zebala LP; Sides BA; Steger-May K; Gupta MC
[Ad] Address:Department of Orthopaedic Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand.
[Ti] Title:Rod fracture in adult spinal deformity surgery fused to the sacrum: prevalence, risk factors and impact on health related quality of life in 526 patients.
[So] Source:Spine J;, 2018 Feb 28.
[Is] ISSN:1878-1632
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND CONTEXT: Risk factors associated with rod fracture (RF) following adult spinal deformity (ASD) surgery fused to the sacrum remain debatable and the impact of RF on patient-reported outcomes (PROs) after ASD surgery has not been investigated. PURPOSE: To evaluate the prevalence of and risk factors for RF and determine PROs change associated with RF after ASD surgery fused to the sacrum. STUDY DESIGN/SETTING: Retrospective single-center cohort. PATIENT SAMPLE: Patients undergoing long-construct posterior spinal fusions to the sacrum performed at a single institution by two senior spine surgeons from 2004 to 2014 were included. OUTCOME MEASURES: Patient demographics, radiographic parameters and surgical factors were assessed for risk factors associated with RF. Oswestry Disability Index (ODI) and Scoliosis Research Society-30 (SRS-30) scores were assessed at baseline, 1-year postoperatively and latest follow-up. METHODS: Inclusion criteria were ASD patients age >18 who had ≥5 vertebrae instrumented and fused posteriorly to the sacrum and either development of RF or no development of RF with minimum 2-year follow-up. Patient characteristics, operative data, radiographic parameters and PROs were analyzed at baseline and follow-up. Separate Cox proportional hazard models based on rod material and diameter were used to determine factors associated with RF. RESULTS: Five hundred twenty-six patients (80%) were available for analysis. RF occurred in 97 (18.4%) patients (unilateral RF n=61 [63%]; bilateral RF n=36 [37%]). Risk factors for fracture of 5.5mm cobalt chromium (CC) instrumentation (CC 5.5 model) included preoperative sagittal vertical axis (hazard ratio [HR] 1.07 [95% confidence interval (95%CI) 1.02 to 1.14] per 1-cm increase), preoperative thoracolumbar kyphosis (HR 1.02 [95%CI 1.01 to 1.04] per 1-degree increase) and number of levels fused for patients that received rhBMP-2 <12 mg per level fused (HR, 1.48 [95%CI 1.20 to 1.82] per 1-level increase). 5.5mm CC implants were at a higher risk for fracture than 6.35mm stainless steel (SS) constructs (HR, 8.49 [95%CI 4.26 to 16.89]). The RF group had less overall improvement in SRS Satisfaction (0.93 vs 1.32; p=0.007) and SRS Self-image domain scores (0.72 vs 1.02; p=0.01). The bilateral RF group had less overall improvement in ODI (8.1 vs 15.8; p=0.02), SRS Subscore (0.51 vs 0.85; p=0.03) and SRS Pain domain scores (0.48 vs 0.95; p=0.02) compared to the non-RF group at final follow-up. CONCLUSIONS: The prevalence of all RF after index procedures was 18.4%, 37% for bilateral RF. Greater preoperative sagittal vertical axis, greater preoperative thoracolumbar kyphosis, increased number of vertebrae fused for patients that received rhBMP-2 <12 mg per level fused, and CC 5.5 mm rod were associated with RF. Less improvement in patient satisfaction and self-image was noted in the RF group. Furthermore, bilateral RF significantly affected PROs as measured by ODI and SRS Subscore at final follow-up.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180304
[Lr] Last revision date:180304
[St] Status:Publisher

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[PMID]: 29455036
[Au] Autor:Sindhwani N; Callewaert G; Deprest T; Housmans S; Van Beckevoort D; Deprest J
[Ad] Address:Department of Development and Regeneration, Cluster Organ Systems, Biomedical Sciences, KU Leuven, and Clinical Department Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium; Interdepartmental Centre for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium.
[Ti] Title:Short term post-operative morphing of sacrocolpopexy mesh measured by magnetic resonance imaging.
[So] Source:J Mech Behav Biomed Mater;80:269-276, 2018 Apr.
[Is] ISSN:1878-0180
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:BACKGROUND: Sacrocolpopexy (SC) involves suspension of the vaginal vault or cervix to the sacrum using a mesh. Following insertion, the meshes have been observed to have undergone dimensional changes. OBJECTIVE: To quantify dimensional changes of meshes following implantation and characterize their morphology in-vivo. DESIGN SETTING AND PARTICIPANTS: 24 patients underwent SC using PolyVinyliDeneFluoride mesh loaded with Fe O particles. Tailored anterior and posterior mesh flaps were sutured to the respective vaginal walls, uniting at the apex. The posterior flap continued to the sacrum and was attached there. Meshes were visualized on magnetic resonance (MR) imaging at 12 [3-12] (median [range]) months postoperatively and 3D models of the mesh were generated. Dynamic MR sequences were acquired during valsalva to record mesh mobility. OUTCOME MEASURES: The area of the vagina effectively supported by the mesh (Effective Support Area (ESA)) was calculated. The 3D models' wall thickness map was analyzed to identify the locations of mesh folding. Intraclass correlation (ICC) was calculated to test the reliability of the methods. To measure the laxity and flatness of the mesh, the curvature and the ellipticity of the sacral flap were calculated. RESULTS: The ESA calculation methodology had ICC = 0.97. A reduction of 75.49 [61.55-78.67] % (median [IQR]) in area, 47.64 [38.07-59.81] % in anterior flap, and of 23.95 [10.96-27.21] % in the posterior flap was measured. The mesh appeared thicker near its attachment at the sacral promontory (n = 19) and near the vaginal apex (n = 22). The laxity of the mesh was 1.13 [1.10-1.16] and 60.55 [49.76-76.25] % of the sacral flap was flat. We could not reliably measure mesh mobility (ICC = 0.16). CONCLUSION: A methodology for complete 3D characterization of SC meshes using MR images was presented. After implantation, the supported area is much lower than what is prepared prior to implantation. We propose this happened during the surgery itself.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180305
[Lr] Last revision date:180305
[St] Status:In-Data-Review

  9 / 10362 MEDLINE  
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[PMID]: 29360579
[Au] Autor:Sebaaly A; El Rachkidi R; Grobost P; Burnier M; Labelle H; Roussouly P
[Ad] Address:Department of Orthopedic Surgery, Clinique médico-chirurgicale des Massues, 92 Rue Edmond Locard, 69005 Lyon, France; Faculty of Medicine, Saint Joseph University, Damascus Rd, 1107 2180, Beirut, Lebanon. Electronic address: amersebaaly@hotmail.com.
[Ti] Title:L5 incidence: an important parameter for spinopelvic balance evaluation in high-grade spondylolisthesis.
[So] Source:Spine J;, 2018 Jan 31.
[Is] ISSN:1878-1632
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: In high-grade spondylolisthesis (HGSPL), the pelvic incidence (PI) is not a reliable measurement because of doming of the sacrum. Measurement of L5 incidence (L5I) was described as a tool to measure pelvic morphology in HGSPL and for surgical follow-up. OBJECTIVE: We aimed to evaluate L5I in HGSPL and its relationship to other spinopelvic parameters. STUDY DESIGN: A retrospective study of a cohort of 184 patients with HGSPL was carried out. METHODS: Whole spine radiographs were analyzed for PI, pelvic tilt (PT), sacral slope, lumbar lordosis (LL), L5I, L5 tilt (L5T), L5 slope, lumbosacral kyphosis, and slip percentage. Statistical analysis and correlation were made (Pearson correlation test; p<.05). In accordance to Cohen, statically significant correlation were considered strong if R>0.5, moderate if 0.3
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180304
[Lr] Last revision date:180304
[St] Status:Publisher

  10 / 10362 MEDLINE  
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[PMID]: 29444695
[Au] Autor:Verhaeghe C; Parot-Schinkel E; Bouet PE; Madzou S; Biquard F; Gillard P; Descamps P; Legendre G
[Ad] Address:Department of Obstetrics and Gynecology, Angers University Hospital, 49933, Angers Cedex, France.
[Ti] Title:The impact of manual rotation of the occiput posterior position on spontaneous vaginal delivery rate: study protocol for a randomized clinical trial (RMOS).
[So] Source:Trials;19(1):109, 2018 Feb 14.
[Is] ISSN:1745-6215
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: The frequency of posterior presentations (occiput of the fetus towards the sacrum of the mother) in labor is approximately 20% and, of this, 5% remain posterior until the end of labor. These posterior presentations are associated with higher rates of cesarean section and instrumental delivery. Manual rotation of a posterior position in order to rotate the fetus to an anterior position has been proposed in order to reduce the rate of instrumental fetal delivery. No randomized study has compared the efficacy of this procedure to expectant management. We therefore propose a monocentric, interventional, randomized, prospective study to show the superiority of vaginal delivery rates using the manual rotation of the posterior position at full dilation over expectant management. METHODS: Ultrasound imaging of the presentation will be performed at full dilation on all the singleton pregnancies for which a clinical suspicion of a posterior position was raised at more than 37 weeks' gestation (WG). In the event of an ultrasound confirming a posterior position, the patient will be randomized into an experimental group (manual rotation) or a control group (expectative management with no rotation). For a power of 90% and the hypothesis that vaginal deliveries will increase by 20%, (10% of patients lost to follow-up) 238 patients will need to be included in the study. The primary endpoint will be the rate of spontaneous vaginal deliveries (expected rate without rotation: 60%). The secondary endpoints will be the rate of fetal extractions (cesarean or instrumental) and the maternal and fetal morbidity and mortality rates. The intent-to-treat study will be conducted over 24 months. Recruitment started in February 2017. To achieve the primary objective, we will perform a test comparing the number of spontaneous vaginal deliveries in the two groups using Pearson's chi-squared test (provided that the conditions for using this test are satisfactory in terms of numbers). In the event that this test cannot be performed, we will use Fisher's exact test. DISCUSSION: Given that the efficacy of manual rotation has not been proven with a high level of evidence, the practice of this technique is not systematically recommended by scholarly societies and is, therefore, rarely performed by obstetric gynecologists. If our hypothesis regarding the superiority of manual rotation is confirmed, our study will help change delivery practices in cases of posterior fetal position. An increase in the rates of vaginal delivery will help decrease the short- and long-term rates of morbidity and mortality following cesarean section. Manual rotation is a simple and effective method with a success rate of almost 90%. Several preliminary studies have shown that manual rotation is associated with reduced rates for fetal extraction and maternal complications: Shaffer has shown that the cesarean section rate is lower in patients for whom a manual rotation is performed successfully (2%) with a 9% rate of cesarean sections when manual rotation is performed versus 41% when it is not performed. Le Ray has shown that manual rotation significantly reduces vaginal delivery rates via fetal extraction (23.2% vs 38.7%, p < 0.01). However, manual rotation is not systematically performed due to the absence of proof of its efficacy in retrospective studies and quasi-experimental before/after studies. TRIAL REGISTRATION: ClinicalTrials.gov, Identifier: NCT03009435 . Registered on 30 December 2016.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180301
[Lr] Last revision date:180301
[Cl] Clinical Trial:ClinicalTrial
[St] Status:In-Data-Review
[do] DOI:10.1186/s13063-018-2497-7


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