DOCSLIB.ORG

A Potent Uterine Relaxant for Internal Podalic Version: Case

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
A Potent Uterine Relaxant for Internal Podalic Version: Case Arch Gynecol Obstet (2009) 280:873–875 DOI 10.1007/s00404-009-1077-1 LETTER TO THE EDITOR Intravenous nitroglycerin: a potent uterine relaxant for internal podalic version: case Manju N. Gandhi · Niraj N. Mahajan · Hemlata R. Iyer · Sneha D. Shirodkar Received: 8 January 2009 / Accepted: 26 March 2009 / Published online: 9 April 2009 © Springer-Verlag 2009 Dear Editor, performed under spinal anesthesia: two cases of intrapar- The uterine-muscle relaxation required for complicated tum external cephalic version, internal intrapartum podalic obstetric situations traditionally has been achieved by use of a version of the second twin, and for the fetal head entrap- potent inhalation anesthetic. However, this procedure exposes ment during vaginal breech delivery [1]. We report a case the obstetric patient with full stomach to unnecessary general of IPV of intrauterine fetal demise (IUFD) in which relaxa- anesthesia, with the attendant risk and potentially lethal com- tion of the uterus was accomplished quickly and safely with plications. Emergent uterine relaxation may be required for the use of IV nitroglycerin. conditions such as retained placenta, uterine inversion, inter- A 30-year-old gravida 4 para 3 at 38 weeks gestation nal podalic version (IPV), and breech extraction. presented in active labor with antepartum hemorrhage since EVective on smooth muscle tissue and a venodilator, 2 h. Ultrasound conWrmed transverse lie, abruption placen- nitroglycerin is a short-acting and a potent uterine relaxant tae and IUFD; and examination revealed 4 cm dilated cer- [1, 2]. Safety, predictability, and ease of intravenous (IV) vix. Her vitals were stable, hematocrit was 28% and administration of this drug have been established, and it has coagulation proWle was normal. She made good progress, attracted the attention of obstetricians. Nitroglycerin is pri- reaching 8 cm cervical dilatation over the next 4 h after marily indicated for the treatment or prevention of angina which she started having hematuria so the decision was pectoris. Nitroglycerin has been used during manual extrac- taken immediately to deliver the fetus by IPV. tion of retained placenta without clinically signiWcant Uterine relaxation was achieved by direct IV nitroglyc- hemodynamic eVects [1] and during replacement of a con- erin bolus 50 mcg along with ketamine hydrochloride tracted, completely prolapsed uterus [1, 2]. Its use as a 30 mg IV for sedation. Infusion of nitroglycerin at the rate tocolytic has been reported in cesarean delivery of twins of 50 mcg/min was started after 1 min of loading dose. When the uterus was relaxed (conWrmed with manual pal- pation), approximately 45 s after bolus, the obstetrician per- formed IPV and breech extraction. The procedure was completed in 4 min and 30 s. The total dose of nitroglycerin M. N. Gandhi · H. R. Iyer was 250 mcg. The placenta delivered spontaneously with Department of Anaesthesiology, B. Y. L. Nair Charitable Hospital, T. N. Medical College, Dr. A. L. Nair road, Bombay 400008, no unusual cord traction. Transabdominal massage of the Maharashtra, India uterus and oxytocin infusion improved uterine tone. The hematocrit had decreased from 28 to 22%. One unit blood N. N. Mahajan · S. D. Shirodkar transfusion was given and she remained stable in the post- Department of Obstetrics and Gynaecology, B. Y. L. Nair Charitable Hospital, T. N. Medical College, partum period. Hematuria was cleared in 2 h postpartum. Dr. A. L. Nair road, Bombay 400008, Maharashtra, India Monitoring consisted of electrocardiogram, SpO2 and non-invasive blood pressure measurement. Hypotension N. N. Mahajan (&) occurred 1 min after nitroglycerin injection, which was nor- 31, Dhaqnvantri Nagar, Sevagram, Wardha 442102, Maharashtra, India malized within 50 s with rapid infusion of crystalloids. The e-mail: [email protected] heart rate increased at the same time to 130 bpm. Side 123 874 Arch Gynecol Obstet (2009) 280:873–875 eVects such as headache and prolonged uterine relaxation may explain why acute administration of nitroglycerin is not were not observed. universally associated with clinically signiWcant hypotension. This case demonstrates the value of small-dose intrave- Side eVects such as headache, prolonged uterine relaxation, nous nitroglycerin, in combination with ketamine hydro- and palpitation were not noted. chloride, for IPV. During obstetric emergencies in vaginal Amyl nitrate is another smooth muscle relaxant, must and cesarean deliveries, there is often a need for rapid and be inhaled, and adverse reactions, particularly orthostatic transient relaxation of the cervix and uterus to allow obstet- hypotension, tachycardia, and a severe throbbing head- ric maneuvres [1]. Uterine relaxation is usually induced by ache are common. The major advantages of nitroglycerin rapid induction of general anesthesia with halogenated over amyl nitrate are those of convenience and accuracy inhalation agents. General anesthesia subjects the parturi- in delivery. Tocolytic agents such as magnesium sulfate ents with full stomachs to the risk of aspiration and and terbutaline have also been used to obtain uterine hypoxia. The concentration of inhalation drug necessary to relaxation. The slower onset of action and the potentially relax the refractory uterus might depress the cardiovascular dangerous side eVects (such as cardiac dysrhythmias and system at a time when hemodynamics is unstable. Keta- hypotension) make their use less desirable. Another mine hydrochloride used in our case is suYcient to sup- advantage of nitroglycerin over these drugs is faster press pain caused by IPV; however, used alone, it does not elimination. Therefore, once the acute problem requiring achieve the uterine relaxation required for the maneuver. uterine relaxation is over, the uterus will contract Because safety, predictability, and ease of administration of adequately. IV nitroglycerin has been Wrmly documented [1], we have In summary, this outcome adds to the mounting evi- used this drug in combination with ketamine hydrochloride dence of the safety and eYcacy of IV-NTG where rapid as sedative and analgesic. Many authors used epidural anal- uterine relaxation is needed. However, data are lacking that gesia instead for IPV [1, 3, 4]. conclusively demonstrate its superiority over other methods In the literature review by Riley et al. [5], they found in any of these settings. Further laboratory and controlled nine reports documenting a total of more than 50 cases clinical studies are needed to determine the eYcacy of where intravenous or sublingual nitroglycerin had been nitroglycerin in obstetric practice. used for uterine relaxation in obstetric emergencies. In most instances the indication for using nitroglycerin was a ConXict of interest statement None. retained placenta (40 cases). In Wve cases there were prob- lems associated with twin deliveries: one case of head References entrapment of the Wrst twin due to poor uterine relaxation at cesarean section, three for IPV, and one for external cepha- 1. Vinatier D, Dufour P, Bérard J (1996) Utilization of intravenous lic version of the second twin. In two other cases, success- nitroglycerin for obstetrical emergencies. Int J Gynaecol Obstet ful correction of uterine inversion was obtained after 55:129–134. doi:10.1016/S0020-7292(96)02754-3 adequate uterine relaxation with IV nitroglycerin. 2. Dayan SS, Schwalbe SS (1996) The use of small-dose intravenous Doses ranging from 50 to 1,000 mcg have been used and nitroglycerin in a case of uterine inversion. Anesth Analg V 82:1091–1093. doi:10.1097/00000539-199605000-00041 found to be e ective and safe [1, 6, 7]. In our case only 3. Dufour P, Vinatier D, Vanderstichèle S et al (1996) Intravenous 250 mcg nitroglycerin was required. The speed with which nitroglycerin for intrapartum internal podalic version of the second uterine relaxation occurred as well as the ease with which non-vertex twin. Eur J Obstet Gynecol Reprod Biol 70:29–32. IPV was carried was impressive when compared with our doi:10.1016/S0301-2115(96)02537-7 4. Dufour P, Vinatier D, Vanderstichele S, Ducloy AS, Depret S, past experiences using volatile anesthetic agents. Also time Monnier JC (1998) Intravenous nitroglycerin for internal podalic reported by several authors [1, 2, 8] for uterine relaxation version of the second twin in transverse lie. Obstet Gynecol was 30–90 seconds which is similar to our case. 92:416–419. doi:10.1016/S0029-7844(98)00231-2 In our case only mild hypotension was noted and it 5. Riley ET, Flanagan B, Cohen SE, Chitkarat U (1996) Intravenous nitroglycerin: a potent uterine relaxant for emergency obstetric seemed clinically unimportant. Concerns about the risk of procedures. Review of literature and report of three cases. Int hypotension following nitroglycerin administration in the J Obstet Anesth 5:264–268. doi:10.1016/S0959-289X(96)80048-3 obstetric setting have so far been unfounded. Several reports 6. Chan AS, Ananthanarayan C, Rolbin SH (1995) Alternating [8–10] suggest that there may be a measurable decrease in nitroglycerin and syntocinon to facilitate uterine exploration and removal of an adherent placenta. Can J Anaesth 42:335– blood pressure after administration of IV nitroglycerin, but it 337 has not been considered clinically signiWcant. Interestingly, 7. Lowenwirt IP, Zauk RM, Handwerker SM (1997) Safety of intra- the vascular eVects of nitroglycerin act predominantly on the venous glyceryl trinitrate in management of retained placenta. venous circulation, where it produces an increase in venous Aust N Z J Obstet Gynaecol 37:20–24. doi:10.1111/j.1479- 828X.1997.tb02212.x capacitance, a fall in venous return and hence a decrease in 8. Peng AT, Gorman RS, Shulman SM, DeMarchis E, Nyunt K, myocardial work. This predilection for the venous circulation Blancato LS (1989) Intravenous nitroglycerin for uterine relaxation 123 Arch Gynecol Obstet (2009) 280:873–875 875 in the postpartum patient with retained placenta. Anesthesiology 10. Greenspoon JS, Kovacic A (1991) Breech extraction facilitated 71:172–173. doi:10.1097/00000542-198907000-00039 by glyceryl trinitrate sublingual spray. Lancet 338:124–125.
Load more

Recommended publications
  • Umbilical Cord Prolapse Guideline
    Umbilical Cord Prolapse Guideline Document Control Title Umbilical Cord Prolapse Guideline Author Author’s job title Specialty Trainee in Obstetrics and Gynaecology Directorate Department Women’s and Children’s Obstetrics and Gynaecology Date Version Status Comment / Changes / Approval Issued 1.0 Mar Final Approved by the Maternity Services Guideline Group in 2011 April 2011. 1.1 Aug Revision Minor amendments by Corporate Governance to 2012 document control report, headers and footers, new table of contents, formatting for document map navigation. 2.0 Feb Final Approved by the Maternity Services Guideline Group in 2016 February 2016. 2.1 Apr Revision Harmonised with Royal Devon & Exeter guideline 2019 3.0 May Final Approved by Maternity Specialist Governance Forum 2019 meeting on 01.05.2019 Main Contact ST1 O&G Tel: Direct Dial– 01271 311806 North Devon District Hospital Raleigh Park Barnstaple Devon EX31 4JB Lead Director Medical Director Superseded Documents Nil Issue Date Review Date Review Cycle May 2019 May 2022 Three years Consulted with the following stakeholders: (list all) Senior obstetricians Senior midwives Senior management team Filename Umbilical Cord Prolapse Guideline v3. 01May 19.doc Policy categories for Trust’s internal Tags for Trust’s internal website (Bob) website (Bob) Cord, accidents, prolapse Maternity Services Maternity Page 1 of 11 Umbilical Cord Prolapse Guideline CONTENTS Document Control .................................................................................................... 1 1. Introduction
    [Show full text]
  • Role of Internal Podalic Version in Developing Countries a Mahendru, O Ogueh, K Gajjar, C Rawat
    The Internet Journal of Gynecology and Obstetrics ISPUB.COM Volume 6 Number 1 Role Of Internal Podalic Version In Developing Countries A Mahendru, O Ogueh, K Gajjar, C Rawat Citation A Mahendru, O Ogueh, K Gajjar, C Rawat. Role Of Internal Podalic Version In Developing Countries. The Internet Journal of Gynecology and Obstetrics. 2005 Volume 6 Number 1. Abstract Objective: To study the role of internal podalic version in the management of undiagnosed transverse lie in labour in developing countries and its place in the management of 2nd twin. Materials and methods: This is a retrospective case series study of 41 cases of internal podalic version from January 1997 to August 2002. The data was collected from the labour ward register and was analysed. Main outcome measures: The primary outcome was analysis of the indications of internal podalic version in developing countries. The secondary outcome was to assess the success and outcome of version and the factors affecting the success of this almost lost art by analysing these cases. Results: There were 41 (15.8%) cases of internal podalic version out of 261 cases of transverse lie. All these cases were undiagnosed transverse lie with intrauterine fetal death in labour. None of these cases had any form of antenatal care. Half of the cases were more than 37 weeks gestation. 31 (76%) cases were with >7cm cervical dilatation. Version resulted into minor complications like 5 cases of cervical tears, 7 cases of para- urethral and vaginal tears. No case of rupture uterus or obstetric shock was reported. There were 2 cases of failure of version one of which was followed by LSCS and the other by vaginal birth following reductive surgery.
    [Show full text]
  • A Guide to Obstetrical Coding Production of This Document Is Made Possible by Financial Contributions from Health Canada and Provincial and Territorial Governments
    ICD-10-CA | CCI A Guide to Obstetrical Coding Production of this document is made possible by financial contributions from Health Canada and provincial and territorial governments. The views expressed herein do not necessarily represent the views of Health Canada or any provincial or territorial government. Unless otherwise indicated, this product uses data provided by Canada’s provinces and territories. All rights reserved. The contents of this publication may be reproduced unaltered, in whole or in part and by any means, solely for non-commercial purposes, provided that the Canadian Institute for Health Information is properly and fully acknowledged as the copyright owner. Any reproduction or use of this publication or its contents for any commercial purpose requires the prior written authorization of the Canadian Institute for Health Information. Reproduction or use that suggests endorsement by, or affiliation with, the Canadian Institute for Health Information is prohibited. For permission or information, please contact CIHI: Canadian Institute for Health Information 495 Richmond Road, Suite 600 Ottawa, Ontario K2A 4H6 Phone: 613-241-7860 Fax: 613-241-8120 www.cihi.ca [email protected] © 2018 Canadian Institute for Health Information Cette publication est aussi disponible en français sous le titre Guide de codification des données en obstétrique. Table of contents About CIHI ................................................................................................................................. 6 Chapter 1: Introduction ..............................................................................................................
    [Show full text]
  • Internal Podalic Version and Extraction : the History, Development, and Modern Day Application
    University of Nebraska Medical Center DigitalCommons@UNMC MD Theses Special Collections 5-1-1964 Internal podalic version and extraction : the history, development, and modern day application Thomas C. Bush University of Nebraska Medical Center This manuscript is historical in nature and may not reflect current medical research and practice. Search PubMed for current research. Follow this and additional works at: https://digitalcommons.unmc.edu/mdtheses Part of the Medical Education Commons Recommended Citation Bush, Thomas C., "Internal podalic version and extraction : the history, development, and modern day application" (1964). MD Theses. 6. https://digitalcommons.unmc.edu/mdtheses/6 This Thesis is brought to you for free and open access by the Special Collections at DigitalCommons@UNMC. It has been accepted for inclusion in MD Theses by an authorized administrator of DigitalCommons@UNMC. For more information, please contact [email protected]. INTEIU~AL PODALIC VERSION ~1) EXTRACTION The History, Development and Modern Day Application Thomas Charles Bush Submitted in Partial Fulfillment for the Degree of Doctor of Medicine College of Medicine, University of Nebraska January 23, 1964 Omaha, Nebraska Index Part I A. Introduction and definition---page 1 B. History and development of internal podalic version--­ pp. 1-3 1) Early practice by Pare and Soranus---pp. 1-2 2) Early publications---page 2 3) Braxton-Hicks method----page 2 4) llO .. case study of' Braxton-Hicks method---page 3 C. Potter's method and contributions pp. 3-6 1) Potter's method---pp. 3-5 2) Potter's results---page 5 a) shortening of labor---page 5 bJ complica~ions and ind~cations page 0 D.
    [Show full text]
  • 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.
    [Show full text]
  • Psycho-Socio-Cultural Risk Factors for Breech Presentation Caroline Peterson University of South Florida
    University of South Florida Scholar Commons Graduate Theses and Dissertations Graduate School 7-2-2008 Psycho-Socio-Cultural Risk Factors for Breech Presentation Caroline Peterson University of South Florida Follow this and additional works at: https://scholarcommons.usf.edu/etd Part of the American Studies Commons Scholar Commons Citation Peterson, Caroline, "Psycho-Socio-Cultural Risk Factors for Breech Presentation" (2008). Graduate Theses and Dissertations. https://scholarcommons.usf.edu/etd/451 This Dissertation is brought to you for free and open access by the Graduate School at Scholar Commons. It has been accepted for inclusion in Graduate Theses and Dissertations by an authorized administrator of Scholar Commons. For more information, please contact [email protected]. Psycho-Socio-Cultural Risk Factors for Breech Presentation by Caroline Peterson A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Department of Anthropology College of Arts and Science University of South Florida Major Professor: Lorena Madrigal, Ph.D. Wendy Nembhard, Ph.D. Nancy Romero-Daza, Ph.D. David Himmelgreen, Ph.D. Getchew Dagne, Ph.D. Date of Approval: July 2, 2008 Keywords: Maternal Fetal Attachment, Evolution, Developmental Plasticity, Logistic Regression, Personality © Copyright 2008, Caroline Peterson Dedication This dissertation is dedicated to all the moms who long for answers about their babys‟ presentation and to the babies who do their best to get here. Acknowledgments A big thank you to the following folks who made this dissertation possible: Jeffrey Roth who convinced ACHA to let me use their Medicaid data then linked it with the birth registry data. David Darr who persuaded the Florida DOH to let me use the birth registry data for free.
    [Show full text]
  • Pretest Obstetrics and Gynecology
    Obstetrics and Gynecology PreTestTM Self-Assessment and Review Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the prod- uct information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. Obstetrics and Gynecology PreTestTM Self-Assessment and Review Twelfth Edition Karen M. Schneider, MD Associate Professor Department of Obstetrics, Gynecology, and Reproductive Sciences University of Texas Houston Medical School Houston, Texas Stephen K. Patrick, MD Residency Program Director Obstetrics and Gynecology The Methodist Health System Dallas Dallas, Texas New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2009 by The McGraw-Hill Companies, Inc.
    [Show full text]
  • Contents More Information
    Cambridge University Press 978-1-108-42170-6 — Eponyms and Names in Obstetrics and Gynaecology, 3rd ed. Thomas F. Baskett Table of Contents More Information Contents Image Credits xv About the Author xvii Preface xix Acknowledgements xx Aburel, Eugen Bogdan 1 Bandl, Ludwig 21 Continuous Epidural Analgesia Bandl’s Contraction Ring Alcock, Benjamin 2 Barcroft, Joseph 22 Alcock’s (Pudendal) Canal Fetal Physiology Aldridge, Albert Herman 2 Bard, Samuel 23 Aldridge Sling First American Obstetric Text Allen, Edgar and Doisy, Edward Adelbert 4 Barker, David James Purslove 24 Oestrogen Barker Hypothesis Apgar, Virginia 5 Barnes, Robert and Neville, Apgar Score William 26 Barnes–Neville Forceps Arias-Stella, Javier 7 Arias-Stella Reaction Barr, Murray Llewellyn 28 Barr Body (Sex Chromatin) Aschheim, Selmar and Zondek, Bernhard 8 Bartholin, Caspar 29 Aschheim–Zondek Pregnancy Test Bartholin’s Glands Asherman, Joseph 10 Barton, Lyman Guy 30 Asherman’s Syndrome Barton’s Forceps Aveling, James Hobson 11 Basset, Antoine 32 Aveling’s Repositor Radical Vulvectomy Ayre, James Ernest 12 Battey, Robert 33 Ayre’s Spatula Battey’s Operation Baer, Karl Ernst Ritter von 14 Baudelocque, Jean-Louis 34 Human Ovum/Germ Layer Theory Baudelocque’s Diameter Baillie, Matthew 15 Behçet, Hulusi 35 Ovarian Dermoid Cyst Behçet’s Syndrome Baird, Dugald 16 Bennewitz, Heinrich Gottleib 36 Birth Control/Perinatal Epidemiology Diabetes in Pregnancy Baldy, John Montgomery and Webster, John Bevis, Douglas Charles Aitchison 38 Clarence 18 Amniocentesis in Rhesus Baldy–Webster Uterine Ventrosuspension Isoimmunisation Ballantyne, John William 20 Bird, Geoffrey Colin 39 Vacuum Extraction Antenatal Care v © in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-1-108-42170-6 — Eponyms and Names in Obstetrics and Gynaecology, 3rd ed.
    [Show full text]
  • Value Set Export
    Copyright 2012 American Medical Association and National Committee for Quality Assurance. All Rights Reserved. Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (the PCPI[TM]) and the National Committee for Quality Assurance (NCQA). These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA, (on behalf of the PCPI) or NCQA. Neither the AMA, NCQA, PCPI nor its members shall be responsible for any use of the Measures. THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND. Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, NCQA, the PCPI and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2011 American Medical Association. LOINC(R) copyright 2004-2011 Regenstrief Institute, Inc.
    [Show full text]
  • Original Article
    DOI: 10.18410/jebmh/2015/728 ORIGINAL ARTICLE A CLINICAL STUDY OF OUTCOME OF LABOUR IN TRANSVERSE LIE Vijayalakshmi B1, Pallavi Purra2 HOW TO CITE THIS ARTICLE: Vijayalakshmi B, Pallavi Purra. “A Clinical Study of Outcome of Labour in Transverse Lie”. Journal of Evidence based Medicine and Healthcare; Volume 2, Issue 34, August 24, 2015; Page: 5232-5239, DOI: 10.18410/jebmh/2015/728 ABSTRACT: Transverse lie complicates approximately 0.5% of birth and may result in neglected or impacted shoulder presentation leading to obstructed labour, rupture uterus and postpartum haemorrhage which may result in death of the mother, if not adequately managed in labour. A prospective observational study done in VIMS Bellary, Karnataka, aim of the study was to know the maternal and fetal outcome, to study caesarean rate, maternal and neonatal complications following caesarean. Objective of the study is to analyse the various modes of outcome of transverse lie to know the fetal and maternal mortality and morbidity, to improve the conditions which decreases these rates and guide us for better management of these cases. Out of 6116 deliveries100 cases were transverse lie during 2year period from April 1999 to January 2001. Out of 100 cases, 76 were caesarean sections, 48 were live births, 7 were neonatal deaths, 45 were still births. Maternal morbidity was 2 cases required subtotal hysterectomy. There were no maternal deaths. Elective caesarean section should be advised in all booked cases with transverse lie at term, after ruling out congenital anomalies of the fetus by anomaly scan. KEYWORDS: Transverse lie, Version, Labor Complications, Maternal outcome and Fetal outcome.
    [Show full text]
  • Place of Internal Podalic Version in Modern Obstetrics
    PLACE OF INTERNAL PODALIC VERSION IN MODERN OBSTETRICS by R. v. BHATT, M.D., D.C.H., and H. B. KoTWAL, M.B., B.S. Introduction Increased safety of anaesthesia, blood transfusion and availability of Till the advent of 19th century in­ potent antibiotic drugs have resulted ternal podalic version was resorted in increased safety of caesarean sec­ to when immediate delivery of the tion even when performed late in foetus was necessary and for every labour and has considerably limited conceivable form of dystocia. In­ the scope of internal podalic version. ternal podalic version till last century It is our impression that the pro­ was the sheet anchor of an obste­ cedure of internal podalic version is trician when faced with an obstetric fast receding into the background. difficulty. An obstetrician of those A resident of today gets very few days felt secure with a leg of the opportunities to see even the opera­ foetus in his hands! The procedure tion of internal podalic version, much of internal podalic version was a less does he get an opportunity to do boon especially when maternal it himself. From the current trends mortality following abdominal deli­ of obstetric practice, it appears that very was formidably high. But this operation may become of histori­ methods, like human beings, grow cal interest only. old, become decrepit and die. The Very few articles have appeared safety ensured to both mother and in recent years on internal podalic foetus as a result of abdominal mode version. The outstanding ones are d delivery has practically replaced by Keetel et al (1952), Townbridge internal podalic version from modern (1950), Apthrop (1950), Amigo obstetrics.
    [Show full text]
  • Multiple Pregnancies V2
    Standard Operational Procedure for the Management of Multiple Pregnancies Prepared by: Miss S Allahdin Version: Version 2 Status: Ratified Effective from: 24th September 2020 Review: 24th September 2023 SOP for the Management of Multiple Pregnancies Page 1 of 13 Version 2 Table A ANTENATAL CARE PLAN FOR WOMEN WITH A MULTIPLE PREGNANCY GESTATION DICHORIONIC TWINS PLAN OF CARE 11-13+6 wks. Arrange Dating scan, confirm Chorionicity, Offer First Trimester screening- or Second Trimester screening if they are a late booker or NT is unavailable- see guidance Appendix 1 Arrange anomaly scan Arrange Consultant led antenatal appointment 11-14 wks. Consultant clinic appointment Complete and follow twin proforma (Table B) ,discuss individualised management plan Routine antenatal check 18-20+6 Anomaly ultrasound scan Arrange follow up scans and antenatal consultant led appointments on a 4 weekly basis starting from 28weeks 28-37 weeks Consultant led antenatal clinic appointments 4 weekly Aim for delivery at 37/40 Ensure proforma for management of multiple pregnancy is followed and complete MONOCHORIONIC TWINS PLAN OF CARE 11-13+6 wks. Dating scan to confirm Chorionicity, complete USG documentation sheet (Table C) Arrange Consultant led antenatal appointment Offer First Trimester screening- or Second Trimester screening if they are a late booker or NT is unavailable- see guidance Appendix 1 Arrange anomaly scan 11-14 wks. Consultant clinic appointment Complete and follow twin proforma (Table B) ,discuss individualised management plan Routine antenatal check Organise 2 weekly consultant led antenatal clinic and ultrasound appointments 14-36 wks. Complete and follow the twin Performa (Table B)-Discuss individualised management plan.
    [Show full text]