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  1 / 4072 MEDLINE  
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PMID:29182128
Autor:Frik S
Título:Management of birth-associated subtrochanteric femur fractures.
Fonte:Acta Orthop Belg; 82(4):850-853, 2016 Dec.
ISSN:0001-6462
País de publicação:Belgium
Idioma:eng
Resumo:In daily clinical practice most orthopedic surgeons suffer from doubt about treatment of rare injuries. The aim of this study is to enlighten the management of birth related femoral subtrochanteric fractures of neonates. Four birth-related femoral subtrochanteric fractures of neonates were treated and followed up. Difficult caesarian breech delivery seems to be a risk factor. All patients were treated with Pavlik harness and union was achieved by the fourth week. None of the patients suffer any angulation or limb length discrepancy. Adequate management of this type of fractures lead to good results.
Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE


  2 / 4072 MEDLINE  
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PMID:28609352
Autor:O'Grady KM; Power HA; Olson JL; Morhart MJ; Harrop AR; Watt MJ; Chan KM
Endereço:Edmonton and Calgary, Alberta, Canada From the Department of Occupational Therapy, Glenrose Rehabilitation Hospital; the Division of Plastic Surgery, the Department of Pediatrics, Faculty of Medicine, and the Division of Physical Medicine and Rehabilitation, University of Alberta; and the Division of Plastic Surgery, University of Calgary.
Título:Comparing the Efficacy of Triple Nerve Transfers with Nerve Graft Reconstruction in Upper Trunk Obstetric Brachial Plexus Injury.
Fonte:Plast Reconstr Surg; 140(4):747-756, 2017 Oct.
ISSN:1529-4242
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Upper trunk obstetric brachial plexus injury can cause profound shoulder and elbow dysfunction. Although neuroma excision with interpositional sural nerve grafting is the current gold standard, distal nerve transfers have a number of potential advantages. The goal of this study was to compare the clinical outcomes and health care costs between nerve grafting and distal nerve transfers in children with upper trunk obstetric brachial plexus injury. METHODS: In this prospective cohort study, children who underwent triple nerve transfers were followed with the Active Movement Scale for 2 years. Their outcomes were compared to those of children who underwent nerve graft reconstruction. To assess health care use, a cost analysis was also performed. RESULTS: Twelve patients who underwent nerve grafting were compared to 14 patients who underwent triple nerve transfers. Both groups had similar baseline characteristics and showed improved shoulder and elbow function following surgery. However, the nerve transfer group displayed significantly greater improvement in shoulder external rotation and forearm supination 2 years after surgery (p < 0.05). The operative time and length of hospital stay were significantly lower (p < 0.05), and the overall cost was approximately 50 percent less in the nerve transfer group. CONCLUSION: Triple nerve transfer for upper trunk obstetric brachial plexus injury is a feasible option, with better functional shoulder external rotation and forearm supination, faster recovery, and lower cost compared with traditional nerve graft reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
Tipo de publicação: JOURNAL ARTICLE; MULTICENTER STUDY


  3 / 4072 MEDLINE  
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PMID:28602269
Autor:Corkum JP; Kuta V; Tang DT; Bezuhly M
Endereço:Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
Título:Sensory outcomes following brachial plexus birth palsy: A systematic review.
Fonte:J Plast Reconstr Aesthet Surg; 70(8):987-995, 2017 Aug.
ISSN:1878-0539
País de publicação:Netherlands
Idioma:eng
Resumo:BACKGROUND: Brachial plexus birth palsy (BPBP) affects approximately 1.5 in 1000 live births and can lead to significant functional impairment and reduced quality of life. To date, studies have focused on grading motor function and strength to assess patient outcomes, with less attention paid to sensory recovery. The authors aimed to systematically review the current literature on sensory outcomes following BPBP. METHODS: A systematic review of the best evidence available assessing sensory outcomes following BPBP was conducted. Two independent reviewers used a predefined search strategy to query Cochrane, MEDLINE, EMBASE, and Web of Science databases. Articles written in English reporting sensory outcomes in patients with BPBP, such as tactile sensation, pain, and proprioception, were included for review. A kappa score was calculated to ensure reviewer agreement. RESULTS: Twenty-nine reports with 1647 cases were included. Tactile sensation was most frequently assessed (75.9%), followed by pain (44.8%) and proprioception (17.2%). Among all cases included in the analysis, 75.8% of articles were found to have patients with suboptimal results in sensory outcomes. The majority of articles (86.2%) were case series or case reports; no level 1 or 2 evidence studies were identified. CONCLUSION: Sensory outcomes are underreported following BPBP, and significant deficits and neuropathic pain are not uncommon and likely underappreciated in this patient population. The current report underscores the need for prospective studies that look beyond motor recovery alone and evaluate sensory outcomes following BPBP.
Tipo de publicação: JOURNAL ARTICLE; REVIEW


  4 / 4072 MEDLINE  
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PMID:28594775
Autor:Skinner S; Davies-Tuck M; Wallace E; Hodges R
Endereço:Ritchie Centre, Department of Obstetrics and Gynecology, Hudson Institute, Monash University, and Perinatal Services Monash Health, Monash Medical Centre, Clayton, Victoria, Australia.
Título:Perinatal and Maternal Outcomes After Training Residents in Forceps Before Vacuum Instrumental Birth.
Fonte:Obstet Gynecol; 130(1):151-158, 2017 Jul.
ISSN:1873-233X
País de publicação:United States
Idioma:eng
Resumo:OBJECTIVE: To compare the rates of attempted and successful instrumental births, intrapartum cesarean delivery, and subsequent perinatal and maternal morbidity before and after implementing a training intervention to arrest the decline in forceps competency among resident obstetricians. METHODS: This retrospective cohort study examined all attempted instrumental births at Monash Health from 2005 to 2014. We performed an interrupted time-series analysis to compare outcomes of attempted instrumental births in 2005-2009 with those in 2010-2014. RESULTS: There were 72,490 births from 2005 to 2014 at Monash Health, of which 8,789 (12%) were attempted instrumental vaginal births. After the intervention, rates of forceps births increased [autoregressive integrated moving average coefficient (ß) 1.5, 95% confidence interval (CI) 1.03-1.96; P<.001], and vacuum births decreased (ß -1.43, 95% CI -2.5 to -0.37; P<.01). Rates of postpartum hemorrhage decreased (ß -1.3, 95% CI -2.07 to -0.49; P=.002) and epidural use increased (ß 0.03, 95% CI 0.02-0.05; P<.001). There was no change in rates of unsuccessful instrumental births (ß -0.39, 95% CI -3.03 to 2.43; P=.83), intrapartum cesarean delivery (ß -0.29, 95% CI -0.55 to 0.14; P=.24), third- and fourth-degree tears (ß -1.04, 95% CI -3.1 to 1.00; P=.32), or composite neonatal morbidity (ß -0.18, 95% CI -0.38 to 0.02, P=.08). Unsuccessful instrumental births were more likely to be in nulliparous women (P<.001), less likely to have a senior obstetrician present (P<.001), be at later gestation (P<.001), and involved larger birth weight neonates (P<.001). CONCLUSION: A policy of ensuring obstetric forceps competency before beginning vacuum training results in more forceps births, fewer postpartum hemorrhages, and no increase in third- and fourth-degree perineal injuries or episiotomies.
Tipo de publicação: JOURNAL ARTICLE


  5 / 4072 MEDLINE  
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PMID:28584040
Autor:Muraca GM; Sabr Y; Lisonkova S; Skoll A; Brant R; Cundiff GW; Joseph KS
Endereço:School of Population and Public Health (Muraca, Lisonkova, Joseph); Department of Obstetrics & Gynaecology (Muraca, Sabr, Lisonkova, Skoll, Cundiff, Joseph); Department of Statistics (Brant), The University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynaecology (Sabr), King
Título:Perinatal and maternal morbidity and mortality after attempted operative vaginal delivery at midpelvic station.
Fonte:CMAJ; 189(22):E764-E772, 2017 Jun 05.
ISSN:1488-2329
País de publicação:Canada
Idioma:eng
Resumo:BACKGROUND: Increased use of operative vaginal delivery (i.e., forceps or vacuum application), of which 20% occurs at midpelvic station, has been advocated to reduce the rate of cesarean delivery. We aimed to quantify severe perinatal and maternal morbidity and mortality associated with attempted midpelvic operative vaginal delivery. METHODS: We studied all term singleton deliveries in Canada between 2003 and 2013, by attempted midpelvic operative vaginal or cesarean delivery with labour (with and without prolonged second stage). The primary outcomes were composite severe perinatal morbidity and mortality (e.g., convulsions, assisted ventilation, severe birth trauma and perinatal death), and composite severe maternal morbidity and mortality (e.g., severe postpartum hemorrhage, shock, sepsis, cardiac complications, acute renal failure and death). RESULTS: The study population included 187 234 deliveries. Among women with dystocia and prolonged second stage of labour, midpelvic operative vaginal delivery was associated with higher rates of severe perinatal morbidity and mortality compared with cesarean delivery (forceps, adjusted odds ratio [AOR] 1.81, 95% confidence interval [CI] 1.24 to 2.64; vacuum, AOR 1.81, 95% CI 1.17 to 2.80; sequential instruments, AOR 3.19, 95% CI 1.73 to 5.88), especially with higher rates of severe birth trauma. Rates of severe maternal morbidity and mortality were not significantly different after operative vaginal delivery, although rates of obstetric trauma were higher (forceps, AOR 4.51, 95% CI 4.04 to 5.02; vacuum, AOR 2.70, 95% CI 2.35 to 3.09; sequential instruments, AOR 4.24, 95% CI 3.46 to 5.19). Among women with fetal distress, similar associations were seen for severe birth trauma and obstetric trauma, although vacuum was associated with lower rates of severe maternal morbidity and mortality (AOR 0.52, 95% CI 0.33 to 0.80). Associations tended to be stronger among women without a prolonged second stage. INTERPRETATION: Midpelvic operative vaginal delivery is associated with higher rates of severe birth trauma and obstetric trauma, whereas overall rates of severe perinatal and maternal morbidity and mortality vary by indication and operative instrument.
Tipo de publicação: JOURNAL ARTICLE


  6 / 4072 MEDLINE  
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PMID:28489924
Autor:Tempest N; McGuinness N; Lane S; Hapangama DK
Endereço:Liverpool Women's Hospital NHS Foundation Trust, Liverpool, United Kingdom.
Título:Neonatal and maternal outcomes of successful manual rotation to correct malposition of the fetal head; A retrospective and prospective observational study.
Fonte:PLoS One; 12(5):e0176861, 2017.
ISSN:1932-6203
País de publicação:United States
Idioma:eng
Resumo:OBJECTIVE: To evaluate the neonatal and maternal outcomes associated with successful operative vaginal births assisted by manual rotation. DESIGN: Prospective and retrospective observational study. SETTING: Delivery suite in a tertiary referral teaching hospital in England. POPULATION: A cohort of 2,426 consecutive operative births, in the second stage of labour, complicated with malposition of the fetal head during 2006-2013. METHODS: Outcomes of all births successfully assisted by manual rotation followed by direct traction instruments were compared with other methods of operative birth for fetal malposition in the second stage of labour (rotational ventouse, Kielland forceps and caesarean section). MAIN OUTCOME MEASURES: Associated neonatal outcomes (admission to the special care baby unit, low cord pH, low Apgar and shoulder dystocia) and maternal outcomes (massive obstetric haemorrhage (blood loss of >1500ml) and obstetric anal sphincter injury). RESULTS: Births successfully assisted with manual rotation followed by direct traction instruments, resulted in 10% (36/346) of the babies being admitted to the Special Care Baby Unit, 4.9% (17/349) shoulder dystocia, 2% (7/349) massive obstetric haemorrhage and 1.7% (6/349) obstetric anal sphincter injury, similar to other methods of rotational births. CONCLUSIONS: Adverse neonatal and maternal outcomes associated with successful manual rotations followed by direct traction instruments were comparable to traditional methods of operative births. There is an urgent need to standardise the practice (guidance, training) and documentation of manual rotation followed by direct traction instrumental deliveries that will enable assessment of its efficacy and the absolute safety in achieving a vaginal birth.
Tipo de publicação: JOURNAL ARTICLE; OBSERVATIONAL STUDY


  7 / 4072 MEDLINE  
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PMID:28324223
Autor:Salman L; Aviram A; Krispin E; Wiznitzer A; Chen R; Gabbay-Benziv R
Endereço:Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, 49100, Israel.
Título:Adverse neonatal and maternal outcome following vacuum-assisted vaginal delivery: does indication matter?
Fonte:Arch Gynecol Obstet; 295(5):1145-1150, 2017 May.
ISSN:1432-0711
País de publicação:Germany
Idioma:eng
Resumo:PURPOSE: To estimate the impact of indication for vacuum-assisted vaginal delivery on neonatal and maternal adverse outcome. METHODS: Retrospective analysis of women carrying singleton-term pregnancies undergoing vacuum-assisted vaginal delivery in a tertiary hospital (2007-2014). Cohort was stratified by indication: non-reassuring fetal heart rate or prolonged second stage. Primary outcome was adverse neonatal outcome and secondary outcome was maternal morbidity. Logistic regression analysis was utilized to adjust for potential confounders. RESULT: Overall, 4931 women met inclusion criteria. Delivery indication was prolonged second stage in 3143 (64%) cases and non-reassuring fetal heart rate in 1788 (36%). In the non-reassuring fetal heart rate group, there were higher rates of cephalohematoma, low 5-min Apgar-score, and asphyxia. In the prolonged second-stage group, there were higher rates of sepsis and post-partum hemorrhage. Composite neonatal birth trauma and maternal morbidity were higher for vacuum-assisted vaginal delivery following prolonged second stage. Following adjustment for confounders cephalohematoma (aOR 1.21, 95% CI 1.04-1.41), low 5-min Apgar-score (aOR 2.91, 95% CI 1.26-4.67) and asphyxia (aOR 1.81 95% CI 1.35-2.44) remained significant in the non-reassuring fetal heart rate group and neonatal sepsis remained significant for the prolonged second-stage group (aOR 1.77, 95% CI 1.38-2.27), p < 0.05 for all. However, there was no longer difference in the composite birth trauma, other neonatal or maternal morbidity. CONCLUSION: The indication for vacuum-assisted vaginal delivery has an impact on neonatal outcome. While cephalohematoma, low 5' Apgar score, and asphyxia were more common in the non-reassuring fetal heart rate group, neonatal sepsis was more common in cases of prolonged second stage of labor.
Tipo de publicação: JOURNAL ARTICLE


  8 / 4072 MEDLINE  
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PMID:28257459
Autor:Pettersson K; Yousaf K; Ranstam J; Westgren M; Ajne G
Endereço:Obstetrics and gynecology, Karolinska University Hospital, Stockholm, Sweden.
Título:Predictive value of traction force measurement in vacuum extraction: Development of a multivariate prognostic model.
Fonte:PLoS One; 12(3):e0171938, 2017.
ISSN:1932-6203
País de publicação:United States
Idioma:eng
Resumo:OBJECTIVE: To enable early prediction of strong traction force vacuum extraction. DESIGN: Observational cohort. SETTING: Karolinska University Hospital delivery ward, tertiary unit. POPULATION AND SAMPLE SIZE: Term mid and low metal cup vacuum extraction deliveries June 2012-February 2015, n = 277. METHODS: Traction forces during vacuum extraction were collected prospectively using an intelligent handle. Levels of traction force were analysed pairwise by subjective category strong versus non-strong extraction, in order to define an objective predictive value for strong extraction. STATISTICAL ANALYSIS: A logistic regression model based on the shrinkage and selection method lasso was used to identify the predictive capacity of the different traction force variables. PREDICTORS: Total (time force integral, Newton minutes) and peak traction (Newton) force in the first to third pull; difference in traction force between the second and first pull, as well as the third and first pull respectively. Accumulated traction force at the second and third pull. OUTCOME: Subjectively categorized extraction as strong versus non-strong. RESULTS: The prevalence of strong extraction was 26%. Prediction including the first and second pull: AUC 0,85 (CI 0,80-0,90); specificity 0,76; sensitivity 0,87; PPV 0,56; NPV 0,94. Prediction including the first to third pull: AUC 0,86 (CI 0,80-0,91); specificity 0,87; sensitivity 0,70; PPV 0,65; NPV 0,89. CONCLUSION: Traction force measurement during vacuum extraction can help exclude strong category extraction from the second pull. From the third pull, two-thirds of strong extractions can be predicted.
Tipo de publicação: JOURNAL ARTICLE


  9 / 4072 MEDLINE  
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PMID:28253469
Autor:Robson SJ; de Costa CM
Endereço:Centenary Hospital for Women and Children, ANU Medical School, Canberra, ACT stephen.robson@anu.edu.au.
Título:Thirty years of the World Health Organization's target caesarean section rate: time to move on.
Fonte:Med J Aust; 206(4):181-185, 2017 Mar 06.
ISSN:1326-5377
País de publicação:Australia
Idioma:eng
Resumo:It has been 30 years since the World Health Organization first recommended a "maximum" caesarean section (CS) rate of 15%. There are demographic differences across the 194 WHO member countries; recent analyses suggest the optimal global CS rate is almost 20%. Attempts to reduce CS rates in developed countries have not worked. The strongest predictor of caesarean delivery for the first birth of "low risk" women appears to be maternal age; a factor that continues to increase. Most women whose first baby is born by caesarean delivery will have all subsequent children by caesarean delivery. Outcomes that informed the WHO recommendation primarily relate to maternal and perinatal mortality, which are easy to measure. Longer term outcomes, such as pelvic organ prolapse and urinary incontinence, are closely related to mode of birth, and up to 20% of women will undergo surgery for these conditions. Pelvic floor surgery is typically undertaken for older women who are less fit for surgery. Serious complications such as placenta accreta occur with repeat caesarean deliveries, but the odds only reach statistical significance at the third or subsequent caesarean delivery. However, in Australia, parity is falling, and only 20% of women will have more than two births. We should aim to provide CS to women in need and to continue including women in the conversation about the benefits and disadvantages, both short and long term, of birth by caesarean delivery.
Tipo de publicação: JOURNAL ARTICLE


  10 / 4072 MEDLINE  
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PMID:28129290
Autor:Kancherla S; Shue A; Pathan MF; Sylvester CL; Nischal KK
Endereço:*Children's Eye Center, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA; and †Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
Título:Management of Descemet Membrane Detachment After Forceps Birth Injury.
Fonte:Cornea; 36(3):375-376, 2017 Mar.
ISSN:1536-4798
País de publicação:United States
Idioma:eng
Resumo:PURPOSE: To describe the clinical signs of Descemet membrane (DM) detachment due to forceps-related birth injury and its subsequent management using optical coherence tomography. METHODS: Case report. RESULTS: A 3-day-old term infant presented with left eye corneal clouding and a definitive history of traumatic forceps-assisted delivery. Despite topical therapy, corneal clouding persisted, necessitating an examination under anesthesia using ultrasound and handheld optical coherence tomography. This revealed not only a tear in DM but also a large detachment. Injection of air alone failed to achieve apposition of DM to the posterior stroma. Apposition was achieved only after penetration of the overlying cornea with the needle of a 10-0 nylon suture and release of clear viscous fluid. The cornea cleared within the first week and continued in the months to follow. CONCLUSIONS: Prolonged corneal edema should alert the physician to probable DM detachment after forceps-related birth injury. Injecting air alone may not be sufficient to reattach the detached DM.
Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE



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