Sacral anatomical interspace landmark for lumbar puncture in pregnancy

Neurology ◽  
2019 ◽  
Vol 94 (6) ◽  
pp. e626-e634
Author(s):  
Carlo Pancaro ◽  
Baskar Rajala ◽  
Christie Vahabzadeh ◽  
Ruth Cassidy ◽  
Thomas T. Klumpner ◽  
...  
Keyword(s):  
Gestational Age ◽  
Tertiary Care ◽  
Lumbar Vertebra ◽  
University Hospital ◽  
Secondary Outcome ◽  
Mechanical Trauma ◽  
Office Visits ◽  
Convenience Sample ◽  
The Third ◽  
In Pregnancy

ObjectiveTo determine whether the sacral anatomical interspace landmark (SAIL) technique is more accurate than the classic intercristal line (ICL) technique in pregnant patients and to assess the percentage of clinical determinations above the third lumbar vertebra.MethodsIn this prospective, randomized, open-label trial, there were 110 singleton pregnant patients with gestational age greater than 37 weeks included. Selection procedure was a convenience sample of pregnant patients who presented for office visits or vaginal or cesarean delivery between March 15 and July 31, 2018, at a single-center obstetric tertiary care university hospital. Both techniques were evaluated by 2 physicians independently assessing each method. Before data collection, we hypothesized that the SAIL technique would be more accurate than the ICL technique in determining the L4-L5 interspace, and that the SAIL technique would produce more estimations below the third lumbar vertebra than the ICL technique. Therefore, the primary outcome was accuracy in identifying the L4-L5 lumbar interspace with SAIL vs ICL. The secondary outcome was difference in clinical assessments above the third lumbar vertebra. Both outcomes were measured via ultrasonography.ResultsPatients were 31 ± 5 years of age (mean ± SD) and had body mass index of 31.8 ± 5.7 kg/m2 and gestational age of 38.8 ± 1.1 weeks. A total of 110 patients were analyzed. SAIL correctly identified the L4-L5 interspace 49% of the time vs 8% using ICL (p < 0.0001). Estimations above L3 were 1% for SAIL vs 31% for ICL (p < 0.0001).ConclusionsOur study shows improved accuracy in identifying intervertebral space using the SAIL technique; this may prevent direct mechanical trauma to the conus medullaris when lumbar punctures are performed in pregnancy.Clinicaltrials.gov identifierNCT03433612.

scholarly journals Use of the Maternal Foetal Triage Index- Addressing the Third Delay in Obstetrics: An Observational Study

2021 ◽  
Author(s):  
Nirzarini Vora ◽  
Nandita Maitra ◽  
Priyam Pandya
Keyword(s):  
Observational Study ◽  
Hospital Stay ◽  
Tertiary Care ◽  
Neonatal Outcomes ◽  
Care Hospital ◽  
Convenience Sample ◽  
The Third ◽  
Resource Setting ◽  
Maternal And Neonatal Outcomes ◽  
A Priority

OBJECTIVE: The Maternal Foetal Triage Index (MFTI), a five-tier scale designed by Ruhl et al (2015) has been evaluated in this study for women attending the triage area of a tertiary hospital, to examine the effect on third delay and maternal and neonatal outcomes. DESIGN: Prospective observational study SETTING: The Labour and Delivery Unit of a tertiary care hospital SAMPLE: A convenience sample of 1000 women METHODS: Assessment included maternal history, baseline vital signs and obstetric examination and categorised the woman as per the MFTI scale. Evaluation of the MFTI score was assessed based on predefined maternal and neonatal outcomes within 24h of attendance. MAIN OUTCOME MEASURES: Flow of patients to triage, presenting complaints, Duration of hospital stay, maternal and neonatal outcomes within 24h of admission. RESULTS: A priority wise distribution of subjects based on their clinical diagnosis was found to be statistically significant for anaemia, previous caesarean, postpartum haemorrhage, miscarriage and hypertensive disorders. Sixty seven percent of the subjects belonged to Priority 3-4 and the mean hospital stay duration varied from 8.26±7.68 days for Priority 1 to 3.82±2.74 days for Priority 4 ((p<0.0001). The average time spent in the triage room was 30±17minutes. A priority wise analysis of maternal and neonatal outcomes based on OBICU and NICU admissions, mortality and stillbirths was found to be significant. CONCLUSION: The MFTI scale significantly reduced the third delay, which is crucial in a high-volume, low resource setting. This also simplified handover, improved documentation and decreased time to secondary healthcare provider assessment. KEYWORDS:obstetrictriage,acuity,thirddelay,maternalmortality

scholarly journals Perspectives on simulation-based training from paediatric healthcare providers in Nigeria: a national survey

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e034029
Author(s):  
Rachel Umoren ◽  
Veronica Chinyere Ezeaka ◽  
Ireti B Fajolu ◽  
Beatrice N Ezenwa ◽  
Patricia Akintan ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Professional Training ◽  
Tertiary Care ◽  
Healthcare Providers ◽  
Secondary Outcome ◽  
Skills Acquisition ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Simulation Based

ObjectivesThe objective of this study was to explore the access to, and perceived utility of, various simulation modalities by in-service healthcare providers in a resource-scarce setting.SettingPaediatric training workshops at a national paediatric conference in Nigeria.ParticipantsAll 200 healthcare workers who attended the workshop sessions were eligible to participate. A total of 161 surveys were completed (response rate 81%).Primary and secondary outcome measuresA paper-based 25-item cross-sectional survey on simulation-based training (SBT) was administered to a convenience sample of healthcare workers from secondary and tertiary healthcare facilities.ResultsRespondents were mostly 31–40 years of age (79, 49%) and women (127, 79%). Consultant physicians (26, 16%) and nurses (56, 35%) were in both general (98, 61%) and subspecialty (56, 35%) practice. Most had 5–10 years of experience (62, 37%) in a tertiary care setting (72, 43%). Exposure to SBT varied by profession with physicians more likely to be exposed to manikin-based (29, 30% physicians vs 12, 19% nurses, p<0.001) or online training (7, 7% physician vs 3, 5% nurses, p<0.05). Despite perceived barriers to SBT, respondents thought that SBT should be expanded for continuing education (84, 88% physician vs 39, 63% nurses, p<0.001), teaching (73, 76% physicians vs 16, 26% nurses, p<0.001) and research (65, 68% physicians vs 14, 23% nurses, p<0.001). If facilities were available, nearly all respondents (92, 98% physicians; 52, 96% nurses) would recommend the use of online simulation for their centre.ConclusionsThe access of healthcare workers to SBT is limited in resource-scarce settings. While acknowledging the challenges, respondents identified many areas in which SBT may be useful, including skills acquisition, skills practice and communication training. Healthcare workers were open to the use of online SBT and expressed the need to expand SBT beyond the current scope for health professional training in Nigeria.

scholarly journals Use of the Maternal Foetal Triage Index: Addressing the Third Delay in Obstetrics

2021 ◽  
Author(s):  
Nirzarini Mukul Vora ◽  
Nandita Krishnakant Maitra
Keyword(s):  
Tertiary Care ◽  
Vital Signs ◽  
High Volume ◽  
Tertiary Hospital ◽  
Neonatal Outcomes ◽  
Care Hospital ◽  
Convenience Sample ◽  
The Third ◽  
Maternal And Neonatal Outcomes ◽  
One Year

Abstract PURPOSE: While several scales have been developed specifically for obstetric triage, the Maternal Foetal Triage Index (MFTI), a five-tier scale designed by Ruhl et al (2015) has been evaluated for women attending the triage area of a tertiary hospital. This study intends to evaluate the effect of MFTI score on third delay and maternal and neonatal outcomes.METHODS: A prospective observational study was conducted over a convenience sample of 1000 subjects who attended the Labour and Delivery Unit of a tertiary care hospital over a period of one year. Assessment included maternal history, baseline vital signs and obstetric examination. The woman was categorised as per the MFTI scale and directed to the appropriate area for further management. Evaluation of the MFTI score was assessed based on predefined maternal and neonatal outcomes within 24h of attendance.RESULTS: A priority wise distribution of subjects based on their clinical diagnosis was found to be statistically significant for anaemia, previous caesarean section, postpartum haemorrhage, miscarriage and hypertensive disorders. Sixty seven percent of the subjects belonged to Priority 3-4 and the mean hospital stay duration varied from 8.26±7.68 days for Priority 1 to 3.82±2.74 days for Priority 4 (p<0.0001). The average time spent in the triage room was 30±17minutes. Maternal and neonatal outcomes were analysed according to priority based on OBICU admissions, mortality, NICU admissions and stillbirths and found to be significant.CONCLUSION: The MFTI scale significantly reduced the third delay, which is crucial in a high-volume, low-resource emergency obstetric setting. This also simplified handover of subjects, improved documentation and decreased time to secondary healthcare provider assessment.

scholarly journals Predictors of very preterm births (born between 23 and 29 weeks’ gestation) at a tertiary care center in Karachi, Pakistan: additional multivariate analyses on data from primary cohort

2019 ◽  
Author(s):  
Mohammad Yakoob
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Multivariate Analyses ◽  
Care Center ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
University Hospital ◽  
Very Preterm ◽  
Antenatal Steroids ◽  
Univariate Analyses

Abstract Objective: Previously, we have published univariate analyses on a cohort of all singleton, very preterm infants (N=101) born between 23 and 29 weeks of gestation during January 01, 1998 to June 30, 2003 at The Aga Khan University Hospital in Karachi, Pakistan. Our main objective was to extend these analyses to multivariate logistic regression models and report Odds Ratios (ORs) for univariate and multivariate analyses. All variables in univariate were included in multivariate models. Results: The survival incidences were 0% at 23, 16.7% at 24, 40.0% at 25, 30.0% at 26, 33.3% at 27, 68.8% at 28 and 83.9% at 29 weeks of gestation. In univariate analyses, gestational age, birth-weight and mode of delivery (Cesarean-section had higher survival compared to vaginal) were statistically significant predictors of survival (P≤0.001 each). Other variables that also included antenatal steroids did not achieve significance. However, in complete-case multivariate analyses, only gestational age (per week) was associated with survival (OR=2.5, 95% CI: 1.1–5.5, P=0.03); birth-weight (per 100 grams) and C-section were not associated-1.2, 0.88–1.6, P=0.26 and 2.4, 0.48–12.2, P=0.28. Antenatal steroid use, maternal age, year of birth, parity, history of preterm delivery, hemoglobin levels, complications and time of birth remained not associated.

scholarly journals Predictors of very preterm births (born between 23 and 29 weeks’ gestation) at a tertiary care center in Karachi, Pakistan: additional multivariate analyses on data from primary cohort

2019 ◽  
Author(s):  
Mohammad Yakoob
Keyword(s):  
Gestational Age ◽  
Multivariate Analyses ◽  
Care Center ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
University Hospital ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Antenatal Steroids ◽  
Univariate Analyses

Abstract Objective: Previously, we have published univariate analyses on a cohort of all singleton very preterm infants (N=101) born between 23 and 29 weeks of gestation during January 01, 1998 to June 30, 2003 at The Aga Khan University Hospital in Karachi, Pakistan. Our main objective was to extend these analyses to multivariate logistic regression models and report Odds Ratios (ORs) for univariate and multivariate analyses. All variables in univariate were included in multivariate models. Results: The survival incidences were 0% at 23, 16.7% at 24, 40.0% at 25, 30.0% at 26, 33.3% at 27, 68.8% at 28 and 83.9% at 29 weeks of gestation. In univariate analyses, gestational age, birth-weight and mode of delivery (Cesarean-section had higher survival compared to vaginal) were statistically significant predictors of survival (P≤0.001 each). Other variables that also included antenatal steroids did not achieve significance. However, in complete case multivariate analyses, only gestational age (per week) was associated with survival (OR=2.5, 95% CI: 1.1–5.5, P=0.03); birthweight and C-section were not associated-1.2, 0.88–1.6, P=0.26 and 2.4, 0.48–12.2, P=0.28. Antenatal steroid use, maternal age, year of birth, parity, history of preterm delivery, hemoglobin levels, complications and time of birth remained not associated.

Maternal Anemia during Pregnancy and Its Association with Preterm Birth

2021 ◽  
Vol 15 (8) ◽  
pp. 2216-2219
Author(s):  
Sumaiya Aziz ◽  
Syeda Najmusahar ◽  
Sohani Anwer ◽  
Nazish Baloch
Keyword(s):  
Preterm Delivery ◽  
Gestational Age ◽  
Tertiary Care ◽  
University Hospital ◽  
P Value ◽  
Care Hospital ◽  
Chi Square ◽  
Maternal Anemia ◽  
Qualitative Variables ◽  
Gestational Age At Delivery

Objective: To determine the association of preterm delivery with maternal anemia in Tertiary Care Hospital, Karachi. Study Design: Prospective cohort study. Study Setting: Study was conducted at Department of Obstetrics and Gynecology of Aga Khan University Hospital Karachi, Pakistan. Duration of Study: Six months from 3rd September, 2018 to 3rd March, 2019. Subjects and Methods: Data was prospectively collected from 90 patients. 45 patients were in the anemic group and 45 patients were in the non anemic group. Quantitative data was presented as simple descriptive statistics giving mean and standard deviation and qualitative variables were presented as frequency and percentages. Effect modifiers were controlled through stratification. Post stratification chi square was applied and p-value of ≤0.05 was considered significant. RR > 1 was considered significant. Results: In the anemic group, mean age of the patient was 28.82±3.65 years, gestational age at delivery was 36.97±2.58 weeks, booking hemoglobin was 9.79±0.84 g/dl, and delivery hemoglobin was found to be 9.73±1.19 g/dl. In the non-anemic group mean age of the patient was 29.57±5.83 years, gestational age at delivery 37.08±1.91 weeks, booking hemoglobin was 10.76±0.99 g/dl and delivery hemoglobin was found to be 10.75±1.12 g/dl. Moreover, frequency distribution of preterm status showed that out of 45 patients in anemic and non-anemic group, 35.6% and 46.7% had preterm status respectively. RR was 0.76. Conclusion: Prematurity is major cause of perinatal mortality. The findings of this study although shows prevalence of preterm delivery in both anemic and non-anemic pregnant women however results were not significant to support our hypothesis. Further research is needed with strategies to address the anemia status of expecting mothers. Key Words: Maternal anemia, preterm, anemia and non-anemic group.

scholarly journals Predictors of very preterm births (born between 23 and 29 weeks’ gestation) at a tertiary care center in Karachi, Pakistan: additional multivariate analyses on data from primary cohort

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Mohammad Yawar Yakoob
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Multivariate Analyses ◽  
Care Center ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
University Hospital ◽  
Very Preterm ◽  
Antenatal Steroids ◽  
Univariate Analyses

Abstract Objective Previously, we have published univariate analyses on a cohort of all singleton, very preterm infants (N = 101) born between 23 and 29 weeks of gestation during January 01, 1998 to June 30, 2003 at The Aga Khan University Hospital in Karachi, Pakistan. Our main objective was to extend these analyses to multivariate logistic regression models and report odds ratios (ORs) for univariate and multivariate analyses. All variables in univariate were included in multivariate models. Results The survival incidences were 0% at 23, 16.7% at 24, 40.0% at 25, 30.0% at 26, 33.3% at 27, 68.8% at 28 and 83.9% at 29 weeks of gestation. In univariate analyses, gestational age, birth-weight and mode of delivery (cesarean-section had higher survival compared to vaginal) were statistically significant predictors of survival (P ≤ 0.001 each). Other variables that also included antenatal steroids did not achieve significance. However, in complete-case multivariate analyses, only gestational age (per week) was associated with survival (OR = 2.5, 95% CI 1.1–5.5, P = 0.03); birth-weight (per 100 g) and C-section were not associated-1.2, 0.88–1.6, P = 0.26 and 2.4, 0.48–12.2, P = 0.28. Antenatal steroid use, maternal age, year of birth, parity, history of preterm delivery, hemoglobin levels, complications and time of birth remained not associated.

Increased serum sulfate in pregnancy: relationship to gestational age.

1985 ◽  
Vol 31 (6) ◽  
pp. 866-867 ◽  
Author(s):  
D E Cole ◽  
L S Baldwin ◽  
L J Stirk
Keyword(s):  
Ion Chromatography ◽  
Gestational Age ◽  
Physiological Process ◽  
Third Trimester ◽  
The Third ◽  
Controlled Flow ◽  
Serum Sulfate ◽  
In Pregnancy ◽  
Inorganic Sulfate

Abstract Controlled-flow ion chromatography has significantly improved the precision with which inorganic sulfate (SO4) can be measured in serum. In this study, we have shown that serum SO4 is increased in pregnancy. The increase appears to follow gestational age, resulting in a 39% higher value by the middle of the third trimester. We suggest that this increase is a natural physiological process, which enhances SO4 availability to the growing fetus and placenta.

scholarly journals Fetomaternal outcomes in pregnancy with different cardiac disease at a tertiary care center in Udaipur

2020 ◽  
Vol 9 (10) ◽  
pp. 3983
Author(s):  
Keerti Chaudhary ◽  
Sangeeta Sen
Keyword(s):  
Heart Disease ◽  
Pregnant Women ◽  
Gestational Age ◽  
Cardiac Disease ◽  
Systolic Function ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Cardiac Complications ◽  
Cardiac Diseases ◽  
In Pregnancy

Background: The incidence of maternal cardiac diseases has an adverse effect on pregnancy outcomes. The present study was done the objective to determine the Incidence and distribution of cardiac disease in pregnant patients, to assess mode of delivery and fetomaternal outcome in pregnancy with heart disease patients.Methods: This was a hospital based prospective observational study that include 65 pregnant women with diagnosed cardiac disease or had symptoms and signs suggestive of cardiac disease during the period from January 2018 to December 2019. Baseline data recorded including age, parity, gestational age, cardiac lesions, New York heart association (NYHA) functional class, use of cardiac medications, thorough clinical examination including chest and cardiovascular auscultation, ECG and echocardiographic assessment of left and right ventricular systolic function. Fetomaternal outcome was analysed in the study.Results: The mean age of the patients was 24.33±2.93 years (ranging from 19-36 years). 34 patients (52.30%) were primigravida. Majority (58.46%) cases were from rural area. Majority patients (70.77%) are present between 37-40 weeks of gestational age. Most of patients had vaginal delivery (64.62%). 43 patients (66.15%) diagnosed with heart disease after pregnancy, while 22 patients (33.85%) are diagnosed before pregnancy for heart disease. Neonatal complications were seen in in 35.38% of patients. Cardiac complications were present in 40% of patients. majority of fetal complications are in nonoperated patients (46.15%).Conclusion: The management of pregnant women with cardiac diseases requires multidisciplinary approach to prevent morbidity and mortality. It is necessary to optimize healthcare facilities to obtain maximum maternal and fetal outcome. 

scholarly journals Risk factors and fetomaternal outcome in pregnancy with thrombocytopenia.

2019 ◽  
Vol 26 (11) ◽  
pp. 1942-1946
Author(s):  
Aasma Naz Qureshi ◽  
Sakina ◽  
Tabinda Taqi ◽  
Hafiza Khatoon ◽  
Irfan Ahmed
Keyword(s):  
Risk Factors ◽  
Platelet Count ◽  
Gestational Age ◽  
Complete Blood Count ◽  
Fetal Outcome ◽  
University Hospital ◽  
Common Finding ◽  
Cross Sectional ◽  
Study Results ◽  
In Pregnancy

Objectives: To find out the risk factors and their effects on mother and fetus in pregnancy with thrombocytopenia. Study Design: Cross sectional study. Setting: Department of Obstetrics and Gynaecology at Liaquat University Hospital Hyderabad. Period: Six months (1st July 2016 to 31st December 2016). Material and Methods: Total 96 patients with gestational age >24 weeks having platelet count below 150X109/L were included in the study. Patients admitted throughout patient clinic department of obstetrics & Gynecology at Liaqat University Hospital. Those patients having platelet count below 150X109/L were registered for study. Proforma filled which include Patients demographics details, gestational age, complete blood count (Having platelet count) other important investigations like coagulation profile (PT, APTT), Ultrasound and LFT noted in proforma SPSS version used for analysis. Descriptive statics were calculated frequency and percentages were drawn for the study. Results: Risk factors related to thrombocytopenia included PIH18 (18.8%), preeclampsia 14(14.6%), eclampsia 10(10.3%), HELLP Syndrome 6(6.3%), Viral Hepatitis 12(12.5%) and in 36(37.5%) no risk factors was found. Maternal complication were placental abruption21 (21.8%) post partam hemorrhage 14(14.6%). 7(7.3%) were transferred to ICU and 02(2.1%) maternal death was seen. Fetal outcome include low Apgar score of <6 in 17(17.7%), low birth weight 16(16.7%) and NICU admission 11(11.5%). Conclusion: Thrombocytopenia is a common finding in pregnancy careful diagnosis is important to distinguish serious causes from mild then to manage mother and fetus appropriately. Thrombocytopenia in pregnancy is associated with adverse maternal and fetal outcome in significant number of pregnant woman.

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