Common Placental Abnormalities Review
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Association Between First Caesarean Delivery and Adverse Outcomes In
Hu et al. BMC Pregnancy and Childbirth (2018) 18:273 https://doi.org/10.1186/s12884-018-1895-x RESEARCHARTICLE Open Access Association between first caesarean delivery and adverse outcomes in subsequent pregnancy: a retrospective cohort study Hong-Tao Hu1†, Jing-Jing Xu1†, Jing Lin1, Cheng Li1, Yan-Ting Wu2, Jian-Zhong Sheng3, Xin-Mei Liu4,5* and He-Feng Huang2,4,5* Abstract Background: Few studies have explored the association between a previous caesarean section (CS) and adverse perinatal outcomes in a subsequent pregnancy, especially in women who underwent a non-indicated CS in their first delivery. We designed this study to compare the perinatal outcomes of a subsequent pregnancy in women who underwent spontaneous vaginal delivery (SVD) or CS in their first delivery. Methods: This retrospective cohort study included women who underwent singleton deliveries at the International Peace Maternity and Child Health Hospital from January 2013 to December 2016. Data on the perinatal outcomes of all the women were extracted from the medical records. Multivariate logistic regression was conducted to assessed the association between CS in the first delivery and adverse perinatal outcomes in the subsequent pregnancy. Results: CS delivery in the subsequent pregnancy was more likely for women who underwent CS in their first birth than for women with previous SVD (97.3% versus 13.2%). CS in the first birth was also associated with a significantly increased risk of adverse outcomes in the subsequent pregnancy, especially in women who underwent a non- indicated CS. Adverse perinatal outcomes included pregnancy-induced hypertension [adjusted odds ratio (OR), 95% confidence interval (CI): 2.20, 1.59–3.05], gestational diabetes mellitus (1.82, 1.57–2.11), gestational anaemia (1.27, 1. -
Managing the Risk of Uterine Rupture During a Trial of Labor After Cesarean Section
Managing the Risk of Uterine Rupture During a Trial of Labor After Cesarean Section By NORCAL Mutual Insurance Company Introduction While a successful vaginal birth after cesarean section (VBAC) is associated with less morbidity and mortality than repeat cesarean section (C-section), an unsuccessful VBAC is associated with a small but significant risk of uterine rupture that can result in death or serious injury to both the mother and the infant.1 When a trial of labor after C-section (TOLAC) ends in uterine rupture, emergency C-section, and the delivery of an infant with brain injuries, there is a good chance that the child’s This article originally appeared in the parents will file a lawsuit, or at least September 2011 issue of Claims Rx. It consider it. It should be noted that has been edited by Drs. Mark Zakowski, a plaintiff’s attorney is supposed to Patricia Dailey and Stephen Jackson prove duty (responsibility of the to meet the educational needs of physicians involved), negligence anesthesiologists, and is reprinted, as (care provided was below the changed, with permission. ©Copyright standard of care) and causation 2011, NORCAL Mutual Insurance Co. (negligence led to the injury) All Rights Reserved. Reproduction as well as injury. However, the permissible with written permission plaintiffs probably won’t focus on and credit. whether the standard of care was met, and their attorney might not either. In these types of cases, the degree of the infant’s brain injuries tends to over- shadow other liability issues. This can carry through to trial because juries are generally biased toward severely brain-injured infants and the parents who must provide for them. -
Managing Complications in Pregnancy and Childbirth Fetal
IMPAC FEtal distress in labour WHO Home | Reproductive Health Home | HRP | What's new | Resources | Contact | Search Department of Reproductive Health and Research (RHR), World Health Organization z Abbreviations Managing Complications in Pregnancy and Childbirth z Index A guide for midwives and doctors z List of diagnoses z MCPC Home Section 2 - Symptoms Clinical principles Rapid initial assessment Fetal distress in labour Talking with women and their families Emotional and psychological support PROBLEMS Emergencies z Abnormal fetal heart rate (less than 100 or more than 180 beats per minute). General care principles Clinical use of blood, blood products and z Thick meconium-stained amniotic fluid. replacement fluids Antibiotic therapy Anaesthesia and analgesia GENERAL MANAGEMENT Operative care principles z Prop up the woman or place her on her left side. Normal Labour and childbirth Newborn care principles z Stop oxytocin if it is being administered. Provider and community linkages ABNORMAL FETAL HEART RATE Symptoms BOX S-7 Abnormal fetal heart rate Shock Vaginal bleeding in early pregnancy z A normal fetal heart rate may slow during a contraction but usually recovers to normal as Vaginal bleeding in later pregnancy and soon as the uterus relaxes. labour z A very slow fetal heart rate in the absence of contractions or persisting after contractions is Vaginal bleeding after childbirth suggestive of fetal distress. Headache, blurred vision, convulsions or loss of consciousness, elevated blood z A rapid fetal heart rate may be a response to maternal fever, drugs causing rapid maternal pressure heart rate (e.g. tocolytic drugs), hypertension or amnionitis. In the absence of a rapid maternal Unsatisfactory progress of Labour heart rate, a rapid fetal heart rate should be considered a sign of fetal distress. -
Gtg-No-20B-Breech-Presentation.Pdf
Guideline No. 20b December 2006 THE MANAGEMENT OF BREECH PRESENTATION This is the third edition of the guideline originally published in 1999 and revised in 2001 under the same title. 1. Purpose and scope The aim of this guideline is to provide up-to-date information on methods of delivery for women with breech presentation. The scope is confined to decision making regarding the route of delivery and choice of various techniques used during delivery. It does not include antenatal or postnatal care. External cephalic version is the topic of a separate RCOG Green-top Guideline No. 20a: ECV and Reducing the Incidence of Breech Presentation. 2. Background The incidence of breech presentation decreases from about 20% at 28 weeks of gestation to 3–4% at term, as most babies turn spontaneously to the cephalic presentation. This appears to be an active process whereby a normally formed and active baby adopts the position of ‘best fit’ in a normal intrauterine space. Persistent breech presentation may be associated with abnormalities of the baby, the amniotic fluid volume, the placental localisation or the uterus. It may be due to an otherwise insignificant factor such as cornual placental position or it may apparently be due to chance. There is higher perinatal mortality and morbidity with breech than cephalic presentation, due principally to prematurity, congenital malformations and birth asphyxia or trauma.1,2 Caesarean section for breech presentation has been suggested as a way of reducing the associated perinatal problems2,3 and in many countries in Northern Europe and North America caesarean section has become the normal mode of breech delivery. -
Skin Eruptions Specific to Pregnancy: an Overview
DOI: 10.1111/tog.12051 Review The Obstetrician & Gynaecologist http://onlinetog.org Skin eruptions specific to pregnancy: an overview a, b Ajaya Maharajan MBBS DGO MRCOG, * Christina Aye BMBCh MA Hons MRCOG, c d Ravi Ratnavel DM(Oxon) FRCP(UK), Ekaterina Burova FRCP CMSc (equ. PhD) aConsultant in Obstetrics and Gynaecology, Luton and Dunstable University Hospital, Lewsey Road, Luton, Bedfordshire LU4 0DZ, UK bST5 in Obstetrics and Gynaecology, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK cConsultant Dermatologist, Buckinghamshire Health Care, Mandeville Road, Aylesbury, Buckinghamshire HP21 8AL, UK dConsultant Dermatologist, Skin Cancer Lead for Bedford Hospital, Bedford Hospital NHS Trust, South Wing, Kempston Road, Bedford MK42 9DJ, UK *Correspondence: Ajaya Maharajan. Email: [email protected] Accepted on 31 January 2013 Key content Learning objectives Pregnancy results in various physiological skin changes. To understand the physiological skin changes in pregnancy. As a consequence, some common dermatoses can present more To identify the skin conditions that require appropriate referral. frequently in pregnant women. In addition, there are a number To be able to take a history, to diagnose the skin eruptions unique to of skin eruptions unique to pregnancy. pregnancy, undertake appropriate investigations and first-line The aetiology of physiological skin changes in pregnancy is management, and understand the criteria for referral to a uncertain but is thought to be due to hormonal and physical dermatologist. changes of pregnancy. Keywords: atopic eruption of pregnancy / intrahepatic cholestasis The four dermatoses of pregnancy are: atopic eruption of pregnancy / pemphigoid gestastionis / polymorphic eruption of of pregnancy, pemphigoid gestationis, polymorphic pregnancy / skin eruptions eruption of pregnancy and intrahepatic cholestasis of pregnancy. -
Cord Prolapse
CLINICAL PRACTICE GUIDELINE CORD PROLAPSE CLINICAL PRACTICE GUIDELINE CORD PROLAPSE Institute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland and the Clinical Strategy and Programmes Division, Health Service Executive Version: 1.0 Publication date: March 2015 Guideline No: 35 Revision date: March 2017 1 CLINICAL PRACTICE GUIDELINE CORD PROLAPSE Table of Contents 1. Revision History ................................................................................ 3 2. Key Recommendations ....................................................................... 3 3. Purpose and Scope ............................................................................ 3 4. Background and Introduction .............................................................. 4 5. Methodology ..................................................................................... 4 6. Clinical Guidelines on Cord Prolapse…… ................................................ 5 7. Hospital Equipment and Facilities ....................................................... 11 8. References ...................................................................................... 11 9. Implementation Strategy .................................................................. 14 10. Qualifying Statement ....................................................................... 14 11. Appendices ..................................................................................... 15 2 CLINICAL PRACTICE GUIDELINE CORD PROLAPSE 1. Revision History Version No. -
High Risk L&D
High Risk L&D, pg 1 of 12 Taking care of patients who have non-reasurring pattern • A non-reassuring pattern is: • no variability • less than 2 accelerations • decelerations • In antepartum setting, you are looking at variable and accelerations • Parameters for 28-32 weeks is different than 32 weeks or greater • What about in labor? • looking for late decels (these are bad) • variability is THE most important thing! • moderate variability shows the CNS is intact • absent variability is no bueno...this would be a big issue if it was moderate before and now has become absent. If pt had medication, then this may not be so much of a concern b/c the meds affects the baby. • minimal may be bad (probably is) • marked is also not good • Category 1: has variablity, maybe a random decel (but most likely none), has accelerations • Category 2: starting to get into a little gray area; physician can proceed forward with usual plan of care; moderate or minimal variability; may have recurring decels (of any type); • Category3 : absent or minimal variability with repetitive late decels; baby is not coping • What’s the first thing you would do if pt had repetitive variable decels? • reposition, increase IV, put Oxygen on mom, call doc (You will reposition b/c the variable decels are d/t cord compression). • You would give O2 if she had decreased variability (according to Dr. Ferguson) • Baby can get late decels from mom lying on her back (so position change), or from having low BP (so give IV bolus). Things you need for precipitous birth • IV • Oxygen • BOA kit (Birth on Arrival kit) What kind of risks are involved with precipitous birth? • Tearing at perineum • Hemorrhage d/t lacerations and such • Pneumothorax (not in boook!). -
Maternal and Fetal Outcomes of Spontaneous Preterm Premature Rupture of Membranes
ORIGINAL CONTRIBUTION Maternal and Fetal Outcomes of Spontaneous Preterm Premature Rupture of Membranes Lee C. Yang, DO; Donald R. Taylor, DO; Howard H. Kaufman, DO; Roderick Hume, MD; Byron Calhoun, MD The authors retrospectively evaluated maternal and fetal reterm premature rupture of membranes (PROM) at outcomes of 73 consecutive singleton pregnancies com- P16 through 26 weeks of gestation complicates approxi- plicated by preterm premature rupture of amniotic mem- mately 1% of pregnancies in the United States and is associ- branes. When preterm labor occurred and fetuses were at ated with significant risk of neonatal morbidity and mor- tality.1,2 a viable gestational age, pregnant patients were managed Perinatal mortality is high if PROM occurs when fetuses aggressively with tocolytic therapy, antenatal corticos- are of previable gestational age. Moretti and Sibai 3 reported teroid injections, and antenatal fetal testing. The mean an overall survival rate of 50% to 70% after delivery at 24 to gestational age at the onset of membrane rupture and 26 weeks of gestation. delivery was 22.1 weeks and 23.8 weeks, respectively. The Although neonatal morbidity remains significant, latency from membrane rupture to delivery ranged despite improvements in neonatal care for extremely pre- from 0 to 83 days with a mean of 8.6 days. Among the mature newborns, neonatal survival has improved over 73 pregnant patients, there were 22 (30.1%) stillbirths and recent years. Fortunato et al2 reported a prolonged latent phase, low infectious morbidity, and good neonatal out- 13 (17.8%) neonatal deaths, resulting in a perinatal death comes when physicians manage these cases aggressively rate of 47.9%. -
Pregnant Woman with Circumvallate Placenta and Suspected Fetal Hypotrophy Caused by Placental Insufficiency: a Case Report
© Copyright by PMWSZ w Opolu e-ISSN 2544-1620 Medical Science Pulse 2020 (14) 4 Case reports Published online: 31 Dec 2020 DOI: 10.5604/01.3001.0014.6735 PREGNANT WOMAN with circumvALLATE PLACENTA AND suspEctED FETAL hypOtrOphy CAusED BY PLACENTAL INsuFFiciENcy: A CASE REPOrt Jadwiga Surówka1 A,B,D–F 1 SSG of Midwifery Care, Jagiellonian University Medical College, • ORCID: 0000-0003-0170-8820 Kraków, Poland 2 A,B,D–F 2 Institute of Nursing and Midwifery, Faculty of Health Sciences, Dorota Matuszyk Jagiellonian University Medical College, Kraków, Poland • ORCID: 0000-0002-3765-6869 A – study design, B – data collection, C – statistical analysis, D – interpretation of data, E – manuscript preparation, F – literature review, G – sourcing of funding ABSTRACT Background: The circumvallate placenta is a rare pathology of the human placenta that occurs in 1–2% of pregnancies. It is characterized by extrachorial placental development, resulting in a ring formation along the edges of the placenta, which leads to efficiency impairment. As a consequence, it causes an intrauter- ine fetal hypotrophy. The fetal hypotrophic pregnancies are classified as high-risk pregnancies, requiring not only intensive monitoring of fetal development but also maternal and fetal care by the highest reference clinical center. Aim of the study: The aim of this study was to analyze the case of a patient with circumvallate placenta and fetal hypotrophy suspicion. Material and methods: The study was based on the case study method. The data was obtained by analyzing medical documentation collected during hospitalization. The patient was interviewed and observed. All of the selected parameters were measured and scaled. -
Fetal Distress Condition Twin-To-Twin Transfusion Syndrome (TTTS)
Fetal Distress Condition Twin-to-Twin Transfusion Syndrome (TTTS) Twice as many babies Description die from TTTS and TTTS or Twin-to-Twin Transfusion Syndrome is a disease of the placenta. It affects other fetal syndromes pregnancies with monochorionic (shared placenta) multiples when blood passes than from SIDS disproportionately from one baby to the other through connecting blood vessels within (Sudden Infant Death their shared placenta. One baby, the recipient twin, gets too much blood overloading his or Syndrome) each year; her cardiovascular system, and may die from heart failure. The other baby, the donor twin yet more people are or stuck twin, does not get enough blood and may die from severe anemia. Left untreated, mortality rates near 100%. aware of SIDS. The cause of TTTS is attributed to unbalanced flow of blood through vascular channels that connect the circulatory systems of each twin via the common placenta. The shunting of blood through the vascular communications leads to a net flow of blood from one twin (the donor) to the other twin (the recipient). The donor twin develops oligohydramnios (low amniotic fluid) and poor fetal growth, while the recipient twin develops polyhydramnios (excess amniotic fluid), heart failure, and hydrops. If left untreated, the pregnancy may be lost due to lack of blood getting to the smaller twin, fluid overload and heart failure in the larger twin, and/or preterm (early) labor leading to miscarriage of the entire pregnancy. Some general treatment approaches consist of using laser energy to seal off the blood vessels that shunt blood between the fetuses. -
Term Pregnancy with Umbilical Cord Prolapse
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Available online at www.sciencedirect.com Taiwanese Journal of Obstetrics & Gynecology 51 (2012) 375e380 www.tjog-online.com Original Article Term pregnancy with umbilical cord prolapse Jian-Pei Huang a,b,*, Chie-Pein Chen a,c, Chih-Ping Chen a,d, Kuo-Gon Wang a,c, Kung-Liahng Wang a,b,d a Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan b Mackay Medicine, Nursing and Management College, Taipei, Taiwan c Division of High Risk Pregnancy, Mackay Memorial Hospital, Taipei, Taiwan d Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan Accepted 10 March 2011 Abstract Objective: To investigate the incidence, management, and perinatal and long-term outcomes of term pregnancies with umbilical cord prolapse (UCP) at Mackay Memorial Hospital, Taipei, from 1998 to 2007. Materials and Methods: For this retrospective study, we reviewed the charts, searched a computerized birth database, and contacted the families by telephone to acquire additional follow-up information. Results: A total of 40 cases of UCP were identified among 40,827 term deliveries, an incidence of 0.1%. Twenty-six cases (65%) were delivered by emergency cesarean section (CS). Of the neonates, 18 had an Apgar score of <7 at 1 minute, 10 of these scores being sustained at 5 minutes after birth, and three infants finally died. Eleven UCPs occurred at the vaginal delivery of a second twin, and nine with malpresentation. All of the infants who had good perinatal outcomes also had good long-term outcomes. -
Coverkids Diagnosis Codes for Pregnancy and Complications of Pregnancy
CoverKids Diagnosis Codes for Pregnancy and Complications of Pregnancy This list is for informational purposes only and is not a binding or definitive list of covered conditions. It is not a guarantee of coverage; coverage depends on the available benefits and eligibility at the time services are rendered. It is for use only with the CoverKids program. When filing claims, providers should use the most accurate codes for the condition being treated – it is fraud against the State of Tennessee and BlueCross BlueShield of Tennessee to intentionally use a code for a covered condition when the treatment provided is for a non- covered condition.