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Journal of Surgery and Trauma
In the name of GOD Journal of Birjand University of Medical Surgery and trauma Sciences & Health Services 2345-4873ISSN 2015; Vol. 3; Supplement Issue 2 Publisher: Deputy Editor: Birjand University of Medical Sciences & Health Seyyed Amir Vejdan, Assistant Professor of General Services Surgery, Birjand University of Medical Sciences Director-in-Charge: Managing Editor: Ahmad Amouzeshi, Assistant Professor of General Zahra Amouzeshi, Instructor of Nursing, Birjand Surgery, Birjand University of Medical Sciences University of Medical Sciences Editor-in-Chief: Journal Expert: Mehran Hiradfar, Associate professor of pediatric Fahime Arabi Ayask, B.Sc. surgeon, Mashhad University of Medical Sciences Editorial Board Ahmad Amouzeshi: Assistant Professor of General Surgery, Birjand University of Medical Sciences, Birjand, Iran; Masoud Pezeshki Rad: Assistant professor Department of Radiology, Mashhad university of Medical Sciences, Mashhad, Iran; Ali Taghizadeh kermani: Assistant professor Department of Radiology, Mashhad university of Medical Sciences, Mashhad, Iran; Ali Jangjo: Assistant Professor of General Surgery, Mashhad University of Medical Sciences, Mashhad, Iran; Sayyed-zia-allah Haghi: Professor of Thoracic-Surgery, Mashhad University of Medical Sciences, Mashhad, Iran; Ramin Sadeghi: Assistant professor Department of Radiology, Mashhad University of Medical Sciences, Mashhad, Iran; Mohsen Aliakbarian: Assistant Professor of General Surgery, Mashhad University of Medical Sciences, Mashhad, Iran; Mohammad Ghaemi: Assistant Professor -
Chapter 12 Vaginal Breech Delivery
FOURTH EDITION OF THE ALARM INTERNATIONAL PROGRAM CHAPTER 12 VAGINAL BREECH DELIVERY Learning Objectives By the end of this chapter, the participant will: 1. List the selection criteria for an anticipated vaginal breech delivery. 2. Recall the appropriate steps and techniques for vaginal breech delivery. 3. Summarize the indications for and describe the procedure of external cephalic version (ECV). Definition When the buttocks or feet of the fetus enter the maternal pelvis before the head, the presentation is termed a breech presentation. Incidence Breech presentation affects 3% to 4% of all pregnant women reaching term; the earlier the gestation the higher the percentage of breech fetuses. Types of Breech Presentations Figure 1 - Frank breech Figure 2 - Complete breech Figure 3 - Footling breech In the frank breech, the legs may be extended against the trunk and the feet lying against the face. When the feet are alongside the buttocks in front of the abdomen, this is referred to as a complete breech. In the footling breech, one or both feet or knees may be prolapsed into the maternal vagina. Significance Breech presentation is associated with an increased frequency of perinatal mortality and morbidity due to prematurity, congenital anomalies (which occur in 6% of all breech presentations), and birth trauma and/or asphyxia. Vaginal Breech Delivery Chapter 12 – Page 1 FOURTH EDITION OF THE ALARM INTERNATIONAL PROGRAM External Cephalic Version External cephalic version (ECV) is a procedure in which a fetus is turned in utero by manipulation of the maternal abdomen from a non-cephalic to cephalic presentation. Diagnosis of non-vertex presentation Performing Leopold’s manoeuvres during each third trimester prenatal visit should enable the health care provider to make diagnosis in the majority of cases. -
Educational Exhibit Posters Chosen by the Annual Scientific Meeting
Educational Exhibit Posters Chosen by the Annual Scientific Meeting Committee In advance of the upcoming annual meeting of the Society of Interventional Radiology in Washington, DC, the program committee wishes to highlight the educational exhibit e-posters that will be presented. The posters were chosen using blinded review. Authors are congratulated for their contributions. Daniel Sze, MD, FSIR Chair, 2017 Annual Meeting Scientific Program Educational Exhibit e-Posters Abstract No. 581 Etiology Technique Used Hepatic artery pseudoaneurysms: a pictorial review of Trauma Falling injury Gelfoam with intraprocedural different scenarios and managements cone-beam 3D CT imaging R. Galuppo Monticelli1, Q. Han1, G. Gabriel1, S. Krohmer1, D. Raissi1 Gunshot injury Coiling Iatrogenic Post cholecystectomy Onyx embolization 1University of Kentucky, Lexington, KY Post biliary drain Coiling PURPOSE: The focus of this educational exhibit is to present a pictorial placement review of the anatomical considerations and management in varied Post ERCP Gelfoam cases of hepatic artery pseudoaneurysms (HAPs) secondary to differ- Tumor Hemorrhage Embozene ent etiologies. Special attention is given to troubleshooting HAPs with Tumor related Post TACE N-Butyl cyanoacrylate varied anatomical presentations. Transplant related Portal hypertension iCAST covered Stent MATERIALS: Hepatic artery pseudoaneurysm (HAP) is an unusual but Idiopathic Otherwise healthy male Coiling with sandwich technique serious complication of acute or chronic injury to the hepatic artery that can potentially be fatal. HAPs are classified as intrahepatic or extrahe- patic. There are many etiologies of HAP formation, including trauma, iat- Abstract No. 582 rogenic, tumor, pancreatitis, inflammatory and idiopathic. Early detection Stenting as a first-line therapy for symptomatic and treatment is critical to decrease morbidity and mortality. -
Computerized Fetal Heart Rate Analysis, Doppler Ultrasound and Biophysical Profile Score in the Prediction of Acid–Base Status of Growth-Restricted Fetuses
Ultrasound Obstet Gynecol 2007; 30: 750–756 Published online 10 August 2007 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/uog.4101 Computerized fetal heart rate analysis, Doppler ultrasound and biophysical profile score in the prediction of acid–base status of growth-restricted fetuses S. TURAN*†, O. M. TURAN*†, C. BERG‡, D. MOYANO†, A. BHIDE§, S. BOWER†, B. THILAGANATHAN§, U. GEMBRUCH‡, K. NICOLAIDES†, C. HARMAN* and A. A. BASCHAT* *Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, Baltimore, MD, USA, †Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital and §Fetal Medicine Unit, St George’s Hospital Medical School, London, UK and ‡Department of Obstetrics and Prenatal Medicine, Friedrich-Wilhelm University, Bonn, Germany KEYWORDS: arterial Doppler; biophysical profile scoring; computerized CTG; cord pH; fetal growth restriction; non-stress test; venous Doppler ABSTRACT patients with an equivocal or normal BPS. Abnormal DV Doppler correctly identified false positives among Objective To investigate the performance of non-stress patients with an abnormal BPS. cCTG reduced the rate test (NST), computerized fetal heart rate analysis (cCTG), of an equivocal BPS from 16% to 7.1% when substituted biophysical profile scoring (BPS) and arterial and venous for the traditional NST. Elevated DV Doppler index and Doppler ultrasound investigation in the prediction of umbilical venous pulsations predicted a low pH with 73% acid–base status in fetal growth restriction. sensitivity and 90% specificity (P = 0.008). Methods Growth-restricted fetuses, defined by abdomi- Conclusion In fetal growth restriction with placental nal circumference < 5th percentile and umbilical artery insufficiency, venous Doppler investigation provides the (UA) pulsatility index > 95th percentile, were tested by best prediction of acid–base status. -
Coding for the OB/GYN Practice Coding Principals
12/4/2013 Coding for the OB/GYN Practice NAMAS 5th Annual Auditing Conference Atlanta, GA December 10, 2013 Peggy Y. Green, CMA(AAMA), CPC, CPMA, CPC‐I Coding Principals • Correct coding implies the selection is – What are we doing? Procedures – Why are we doing it? Diagnosis – Supported by documentation – Consistent with coding guidelines 1 12/4/2013 Coding Principals • Reporting Services – IS there physician work or practice expense? – Can it be supported by an ICD‐9 code? – Is it independent of other procedures/services? – Is there documentation of the service? Billing “Rule” • “Not documented” means “Not done” – “Not documented” “Not billable” • Documentation must support type and level of extent of service reported Code Sets • Key Code sets – HCPCS (includes CPT‐4) – ICD‐9‐CM/ICD‐10‐CM • HCPCS dibdescribes “ht”“what” • ICD‐9 CM describes “why” 2 12/4/2013 Who can bill as a Provider? • Change have been made throughout the CPT manual to clarify who may provide certain services with the addition of the phrase “other qualified healthcare professionals”. • Some codes define that a service is limited to professionals or limited to other entities such as hospitals or home health agencies. Providers • CPT defines a “Physician or other qualified health care professional” as an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable), who performs a professional services within his/her scope of practice and independently reports that professional service. • This is distinct from clinical staff 3 12/4/2013 Providers • Clinical staff members are people who work under the supervision of a physician or other qualified health care professional and who is allowed by law, regulation, and facility policy to perform or assist in the performance of a specified professional service, but who does not individually report that professional service. -
Therapeutic Amnioinfusion in Oligohydramnios During Pregnancy (Excluding Labor)
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Qazi M et al. Int J Reprod Contracept Obstet Gynecol. 2017 Oct;6(10):4577-4582 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20174445 Original Research Article Therapeutic amnioinfusion in oligohydramnios during pregnancy (excluding labor) Mahvish Qazi1, Najmus Saqib2*, Abida Ahmed1, Imran Wagay3 1Department of Obstetrics and Gynecology, SKIMS Soura Srinagar Kashmir, India 2Department of Paediatrics and Neonatology, Government Medical College Jammu, Jammu and Kashmir, India 3Department of Radiodiagnosis, Govt. Medical College Srinagar, Jammu and Kashmir, India Received: 05 August 2017 Accepted: 04 September 2017 *Correspondence: Dr. Najmus Saqib, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Oligohydramnios is a serious complication of pregnancy that is associated with a poor perinatal outcome and complicates 1-5% of pregnancies. The purpose of this study was to evaluate the role of antepartum transabdominal amnioinfusion on amniotic fluid volume/latency period in pregnancies with oligohydramnios. Methods: This study was conducted in the Department of Obstetrics and Gynaecology at Sher-i-Kashmir Institute of Medical Sciences Soura Srinagar. In this study, a total of 54 pregnant women with ultrasonographically diagnosed oligohydramnios i.e. AFI < 5 cm and gestational age of >24 weeks were taken for therapeutic amnioinfusion and its effects on amniotic fluid volume were studied. -
(EXIT), a Resuscitation Option for Intra-Thoracic Foetal Pathologies
Original article SWISS MED WKLY 2007;137:279–285 · www.smw.ch 279 Peer reviewed article Ex utero intrapartum treatment (EXIT), a resuscitation option for intra-thoracic foetal pathologies Christian Kerna, Michel Ange, Moralesb, Barbara Peiryc, Riccardo E. Pfisterc a Anaesthesia, University Hospital Geneva, Switzerland b Gynaecology and Obstetrics, University Hospital Geneva, Switzerland c Paediatrics, University Hospital Geneva, Switzerland Summary The ex utero intrapartum treatment (EXIT) requires a caesarean section that specifically differs procedure is designed to guarantee sufficient oxy- from the traditional caesarean section during genation for a foetus at risk of airway obstruction. which uterine tone is maintained to minimize ma- This is achieved by improving lung ventilation, ternal bleeding. To guarantee foetal oxygenation usually by establishing an airway during caesarean during the EXIT procedure, profound uterine delivery whilst preserving the foetal-placental cir- relaxation is desired. To gain time with optimal culation temporarily. Indications for the EXIT placental oxygenation in order to safely perform an procedure have extended from its original use in airway intervention in a baby at risk of hypoxia may reversing iatrogenic tracheal obstruction in con- require deep inhalation anaesthesia and/or to- genital diaphragmatic hernia to naturally occur- colytic agents. We review the EXIT procedure and ring upper airway obstructions. We report our present a case series from the University Hospital experience with a new and rarely mentioned indi- of Geneva that contrasts with the common indica- cation for the EXIT procedure, intra-thoracic tion for the EXIT procedure usually based on volume expansions. The elaboration of lowest risk upper airway obstruction by its exclusive indica- scenarios through balancing risks with alternative tion for intra-thoracic malformations/diseases. -
Management of Spontaneous Rupture of the Amnion with an Intact Chorion Jenny A
Jacob et al. Obstet Gynecol cases Rev 2015, 2:5 ISSN: 2377-9004 Obstetrics and Gynaecology Cases - Reviews Case Report: Open Access Management of Spontaneous Rupture of the Amnion with an Intact Chorion Jenny A. Jacob1, Norman A. Ginsberg2, Lee P. Shulman2* and Leeber Cohen2 1Albert-Ludwigs-University School of Medicine, Germany 2Northwestern Feinberg School of Medicine, USA *Corresponding author: Prof. Lee P. Shulman MD, 250 E. Superior Street, Prentice Women’s Hospital, Room 05- 2174, Chicago, IL, USA 60611, Tel: 1.312.730.8694, Email: [email protected] weeks‘gestation with an AFI of 1cm. The patient reported no history Abstract of vaginal amniotic fluid leakage. Speculum examination showed Idiopathic severe preterm oligohydamnios as a result of spontaneous no evidence of vaginal pooling. The fetal kidneys were visualized at rupture of the amnion with an intact chorion is a rare event with a the time of the ultrasound and were considered functioning since scarcity of reports found in the literature. We evaluated the impact the fetal bladder was visualized at the time of ultrasound. Chorionic of serial amnioinfusions on this unusual occurrence. This is a follow- villus sampling (CVS) was performed after the 18-week scan and up of a 37-year-old woman with idiopathic severe oligohydramnios diagnosed at 18 weeks of gestation. We performed five serial showed a normal 46,XX complement. amnioinfusions with the purpose of improving fetal lung maturity The patient was informed of the complications accompanied and to prevent Potter anomalad. At 31 weeks‘gestation the patient with oligohydramnios and was offered pregnancy termination. -
Coding for Multiple Ultrasounds by Emily H
Coding for multiple ultrasounds By Emily H. Hill, PA In the June 2004 issue [pp 90-97], I discussed the coding guidelines for reporting multiple surgical procedures. There are also instances in which multiple ultrasounds (U/S) are performed, and they can occur on the same day or in the case of obstetrical U/S, during a single pregnancy. Let's look at the case of Desdemona, who has multiple U/S procedures during her pregnancy. Desdemona, a 29-year-old G4P1-0-2-1, presents at 16 weeks to Dr. Cassio for an U/S to assess gestational age and fetal anatomy. Findings revealed fetal biometric parameters consistent with dates. There were no fetal malformations; however, the stomach was not visualized. She was scheduled for a follow-up U/S in 3 weeks. At 19 weeks, Dr. Cassio performed a follow-up U/S. The stomach was visualized and appeared normal. Later that week, Desdemona was given findings from an abnormal triple screen and referred to Dr. Othello, a maternal-fetal medicine specialist who has substantial training in advanced U/S. Dr. Othello performed a detailed fetal anatomic examination, which showed normal fetal anatomy. The patient opted against a genetic amniocentesis. The remainder of Desdemona's pregnancy was uncomplicated and she delivered a healthy 7 lb, 15 oz female at term. Table 1: CPT codes for multiple ultrasounds 76801 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (<14 weeks 0 days), transabdominal approach; single or first gestation 76802 each additional gestation -
The Fetal Biophysical Profile All Topics Are Updated As New Evidence
2017/4/5 The fetal biophysical profile UpToDate Official reprint from UpToDate® www.uptodate.com ©2017 UpToDate® The fetal biophysical profile Author: Frank A Manning, MD Section Editors: Charles J Lockwood, MD, MHCM, Deborah Levine, MD Deputy Editor: Vanessa A Barss, MD, FACOG All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Mar 2017. | This topic last updated: Dec 07, 2016. INTRODUCTION — The fetal biophysical profile (BPP) is a noninvasive, easily learned and performed procedure for evaluating the fetus for signs of compromise. Ultrasound is used to assess four discrete biophysical parameters: fetal movement, fetal tone, fetal breathing, and amniotic fluid volume. A separate nonstress test of the fetal heart rate can also be performed. Each of the four ultrasound parameters and the nonstress test are given a score of 0 or 2 points (no 1 point), depending upon whether specific criteria are met (table 1). A total score ≥8 implies absence of significant central nervous system hypoxemia/acidemia at the time of testing. A score ≤4 can be a sign of fetal compromise. Ideally, identification of a compromised fetus will enable the provider to perform interventions that prevent adverse fetal sequelae. This topic will review issues related to the BPP. An overview of antenatal fetal surveillance and information on the nonstress test and the contraction stress test are available separately. (See "Overview of antepartum fetal surveillance" and "Nonstress test and contraction stress test".) INDICATIONS — The American College of Obstetricians and Gynecologists recommends antepartum fetal surveillance with tests such as the BPP for pregnancies at increased risk of antepartum fetal demise [1]. -
Biophysical Profile and Modified Biophysical Profile in Predicting the Fetal Outcome
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Vanamala VG et al. Int J Reprod Contracept Obstet Gynecol. 2018 Sep;7(9):3516-3519 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20183374 Original Research Article Biophysical profile and modified biophysical profile in predicting the fetal outcome V. G. Vanamala1, Aruna Rachel1*, Sushil Pakyanadhan2, Sudeep Abraham P.3 1Department of Obstetrics and Gynecology, VRK Womens Medical College and Hospital and Research Centre, Hyderabad, Telangana, India 2Department of Pathology, 3Department of Surgery, Shadan Institute of Medical Sciences, Hyderabad, Telangana, India Received: 18 July 2018 Accepted: 23 July 2018 *Correspondence: Dr. Aruna Rachel, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Baby’s well-being in utero is often done by using a cardiotocograph (CTG) machine, which assesses the baby’s heart beat pattern as well as the mother’s uterine contractions. However, lowered fetal movements sometimes may be fatal for the baby. Thus, the biophysical and the modified biophysical profile have been introduced. Methods: 242 patients with over 34 weeks of gestation and with one or more risk factors were included in the study. After taking the demographic details, the patients were subjected to detailed physical and clinical evaluation. Modified BPP was done on all the patients. -
Biophysical Profile
Texas Tech University Health Sciences Center El Paso Department of Obstetrics and Gynecology Protocol #3 The Biophysical Profile Background The biophysical profile (BPP) is based on the concept that fetal breathing, movement and tone are mediated by neurological pathways and therefore reflect the fetal CNS status at the time of the examination. Amniotic fluid level is a measure of chronic asphyxia or placental function. The addition of the evaluation of the fetal heart rate variability (NST) to the BPP increases the sensitivity for acute status changes. The BPP represents the in-utero APGAR score and has been shown to correlate well with the acid-base status of babies delivered by cesarean section prior to the onset of labor. The earliest signs of fetal acidosis are a nonreactive NST and loss of fetal breathing. A significant inverse correlation between the BPP score and perinatal morbidity and mortality has been documented. BPP ≥ 8/10 accurately predicts normal tissue oxygenation with false negative rate <1% BPP ≤ 6/10 is a relatively accurate predictor of acidemia BPP = 0/10 has near 100% sensitivity for acidemia Administration of antenatal corticosteroids can decrease the BPP score. This effect usually resolves within 48 hours. A. Indications 1. Patients with a nonreactive NST 2. Any patient where further confirmation of fetal well-being is desired 3. The BPP should not be performed before 24 weeks B. Technique 1. The patient is placed into a supine position. 2. The fetus is observed, by ultrasound, for up to 30 minutes. During the 30 minutes, the components of the BPP are sought.