A clinical case of the uterine complete rupture along with the previous scar during pregnancy with atypical clinical features

2021 ◽  
Vol 70 (5) ◽  
pp. 141-146
Author(s):  
Marina N. Mochalova ◽  
Viktor A. Mudrov ◽  
Anastasia Yu. Alexeyeva ◽  
Lyubov A. Kuzmina
Keyword(s):  
Neonatal Intensive Care ◽  
Unusual Case ◽  
Clinical Manifestations ◽  
Pubic Symphysis ◽  
Developmental Care ◽  
Provocation Tests ◽  
Pubic Symphysis Diastasis ◽  
Emergency Cesarean ◽  
Scarred Uterus ◽  
Early Developmental

This article presents an unusual case of rupture of the scarred uterus at 36-37 weeks of gestation. The patient presented with pain in the pubic and hip joint area, growing stronger while her walking, seated and changing position. No clinical manifestations of hemorrhagic shock were observed. External obstetric examination revealed a normotonic uterus and satisfactory fetus condition. Provocation tests were conducted to exclude subluxation of the pubic joint. Pubic symphysis diastasis palpation, long dorsal sacroiliac ligament palpation, P4 test, Patricks test, and the modified Trendelenburg test were negative. Pelvic examination revealed sharp pain in lower uterus segment. Ultrasound scan revealed deformation and thinning of the scar up to 1 mm, and no abnormalities in pubic symphysis. A threatening uterine rupture was diagnosed, and emergency cesarean section was performed. Intraoperative examination showed that the scar located in the lower segment consisted of connective tissue. In addition, there was a 4 5 cm scar defect with the overlying amniotic sac, no hemorrhage being noted. After removing the fetus, scar excision was performed. The uterine defect was repaired with a double layer running-locking suture. The patient was discharged from hospital on day 5 of postpartum period. The infant was exposed in the neonatal intensive care unit to provide an early developmental care.

scholarly journals Circumvallate Placenta: Associated Clinical Manifestations and Complications—A Retrospective Study

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Hanako Taniguchi ◽  
Shigeru Aoki ◽  
Kentaro Sakamaki ◽  
Kentaro Kurasawa ◽  
Mika Okuda ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Neonatal Death ◽  
Vaginal Bleeding ◽  
Neonatal Intensive Care ◽  
Placental Abruption ◽  
Care Center ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Second Trimester ◽  
Emergency Cesarean

Aims.To analyze the pregnancy outcomes of circumvallate placenta retrospectively and to predict circumvallate placenta during pregnancy based on its clinical features.Methods.The pregnancy outcomes of 92 women with circumvallate placenta who delivered live singletons at a tertiary care center between January 2000 and September 2012 were compared with those of 9057 controls.Results.Women with circumvallate placenta were associated with higher incidences of preterm delivery (64.1%), placental abruption (10.9%), emergency cesarean section (45.6%), small-for-gestational age (36.9%), neonatal death (8.9%), neonatal intensive care unit admission (55.4%), and chronic lung disease (33.9%). When vaginal bleeding during the second trimester and premature chemical rupture of membranes (PCROM) were both used as predictive factors for circumvallate placenta, the sensitivity was 28.8% and specificity was 99.9%.Conclusion.With circumvallate placenta, pregnancy outcomes were poor and had characteristic clinical manifestations. In women with both vaginal bleeding and PCROM during pregnancy, circumvallate placenta should be strongly suspected.

Presepsin - New Marker of Sepsis Romanian Neonatal Intensive Care Unit Experience

2019 ◽  
Vol 70 (8) ◽  
pp. 3008-3013
Author(s):  
Silvia Maria Stoicescu ◽  
Ramona Mohora ◽  
Monica Luminos ◽  
Madalina Maria Merisescu ◽  
Gheorghita Jugulete ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Sepsis ◽  
Predictive Value ◽  
Neonatal Intensive Care ◽  
Complete Blood Count ◽  
Clinical Manifestations ◽  
Receiver Operating Curve ◽  
Predictive Values

Difficulties in establishing the onset of neonatal sepsis has directed the medical research in recent years to the possibility of identifying early biological markers of diagnosis. Overdiagnosing neonatal sepsis leads to a higher rate and duration in the usage of antibiotics in the Neonatal Intensive Care Unit (NICU), which in term leads to a rise in bacterial resistance, antibiotherapy complications, duration of hospitalization and costs.Concomitant analysis of CRP (C Reactive Protein), procalcitonin, complete blood count, presepsin in newborn babies with suspicion of early or late neonatal sepsis. Presepsin sensibility and specificity in diagnosing neonatal sepsis. The study group consists of newborns admitted to Polizu Neonatology Clinic between 15th February- 15th July 2017, with suspected neonatal sepsis. We analyzed: clinical manifestations and biochemical markers values used for diagnosis of sepsis, namely the value of CRP, presepsin and procalcitonin on the onset day of the disease and later, according to evolution. CRP values may be influenced by clinical pathology. Procalcitonin values were mainly influenced by the presence of jaundice. Presepsin is the biochemical marker with the fastest predictive values of positive infection. Presepsin can be a useful tool for early diagnosis of neonatal sepsis and can guide the antibiotic treatment. Presepsin value is significantly higher in neonatal sepsis compared to healthy newborns (939 vs 368 ng/mL, p [ 0.0001); area under receiver operating curve (AUC) for presepsine was 0.931 (95% confidence interval 0.86-1.0). PSP has a greater sensibility and specificity compared to classical sepsis markers, CRP and PCT respectively (AUC 0.931 vs 0.857 vs 0.819, p [ 0.001). The cut off value for presepsin was established at 538 ng/mLwith a sensibility of 79.5% and a specificity of 87.2 %. The positive predictive value (PPV) is 83.8 % and negative predictive value (NPV) is 83.3%.

scholarly journals Severe Acute Respiratory Syndrome Coronavirus 2 Placental Infection and Inflammation Leading to Fetal Distress and Neonatal Multi-Organ Failure in an Asymptomatic Woman

2020 ◽  
Author(s):  
Sam Schoenmakers ◽  
Pauline Snijder ◽  
Robert M Verdijk ◽  
Thijs Kuiken ◽  
Sylvia S M Kamphuis ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Vertical Transmission ◽  
Neonatal Intensive Care ◽  
Quantitative Polymerase Chain Reaction ◽  
Antigen Expression ◽  
Fetal Distress ◽  
Adverse Outcomes ◽  
Placental Infection ◽  
Emergency Cesarean ◽  
Increased Risk

Abstract Background In general, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy is not considered to be an increased risk for severe maternal outcomes but has been associated with an increased risk for fetal distress. Maternal-fetal transmission of SARS-CoV-2 was initially deemed uncertain; however, recently a few cases of vertical transmission have been reported. The intrauterine mechanisms, besides direct vertical transmission, leading to the perinatal adverse outcomes are not well understood. Methods Multiple maternal, placental, and neonatal swabs were collected for the detection of SARS-CoV-2 using real-time quantitative polymerase chain reaction (RT-qPCR). Serology of immunoglobulins against SARS-CoV-2 was tested in maternal, umbilical cord, and neonatal blood. Placental examination included immunohistochemical investigation against SARS-CoV-2 antigen expression, with SARS-CoV-2 ribonucleic acid (RNA) in situ hybridization and transmission electron microscopy. Results RT-qPCRs of the oropharynx, maternal blood, vagina, placenta, and urine were all positive over a period of 6 days, while breast milk, feces, and all neonatal samples tested negative. Placental findings showed the presence of SARS-CoV-2 particles with generalized inflammation characterized by histiocytic intervillositis with diffuse perivillous fibrin depositions with damage to the syncytiotrophoblasts. Conclusions Placental infection by SARS-CoV-2 leads to fibrin depositions hampering fetal-maternal gas exchange with resulting fetal distress necessitating a premature emergency cesarean section. Postpartum, the neonate showed a fetal or pediatric inflammatory multisystem-like syndrome with coronary artery ectasia temporarily associated with SARS-CoV-2 for which admittance and care on the neonatal intensive care unit (NICU) were required, despite being negative for SARS-CoV-2. This highlights the need for awareness of adverse fetal and neonatal outcomes during the current coronavirus disease 2019 pandemic, especially considering that the majority of pregnant women appear asymptomatic.

The Effect of Individualized Developmental Care Practices in Preterm Infants

2019 ◽  
Vol 27 (2) ◽  
pp. 97-104
Author(s):  
Dilek Küçük Alemdar ◽  
Sevil İnal
Keyword(s):  
Breast Milk ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Controlled Trial ◽  
Oral Feeding ◽  
Control Group ◽  
Developmental Care ◽  
Significant Difference ◽  
Care Practices ◽  
Maternal Voice

Background: Preterm infants are vulnerable humans requiring much care and attention. They may be exposed to irregular noise, light, and odor in the neonatal intensive care unit for a period of several weeks or months. This study was carried out to determine the effect of individualized developmental care on physiological parameters, growth, and transition to oral feeding in preterm infants. Methods: The study was a randomized controlled trial. The sample comprised premature infants meeting the inclusion criteria. They were randomly assigned to four groups: the maternal voice group, the breast milk odor (BMO) group, the incubator cover (IC) group, and the control group. Results: No statistically significant difference was found between the groups in terms of weight, height, and head circumference at time of discharge. Mean SO2 values were statistically higher in the IC group than the other groups; however, the heart rate and respiratory rate were not statistically different in a significant sense between the groups. The briefest duration of transition to total oral feeding was seen in the BMO group. Conclusion: Individualized developmental care practices based on the results of these interventions are likely to support the care of preterm infants. Breast milk odor may ease the transition to breastfeeding.

scholarly journals PUBIC SYMPHYSIS DIASTASIS IN PREGNANCY AND DELIVERY (REVIEW)

2018 ◽  
Vol 24 (3) ◽  
pp. 145-156
Author(s):  
A. L. Petrushin ◽  
A. V. Pryaluchina
Keyword(s):  
Internal Fixation ◽  
Treatment Options ◽  
Pubic Symphysis ◽  
Lower Limbs ◽  
Sacroiliac Joints ◽  
Pubic Symphysis Diastasis ◽  
Partial Load ◽  
Short Period ◽  
Pregnancy And Delivery ◽  
Symphysis Diastasis

Purpose of the study— to generalize and arrange the data published in scientific literature and to present currentviews on epidemiology, diagnostics and treatment options for pubic symphysis diastasis during pregnancy and delivery. Semeiotic separation wider than 10 mm is considered pubic symphysis diastasis during pregnancy and delivery. Diastasis above 14-25 mm might be associated with ruptures of sacroiliac joints. Frequency of such pathology is reported in the range from 0,03 to 2,8%. Key risk factors of this pathology include multiparity and repeated labor. Symptoms of pubic separation include pain and signs of pelvic instability manifesting immediately after delivery or within a short period of time after the delivery. AP roentgenography is the principal diagnostics method however lately ultrasound exam is done more frequently. Conservative option prevails in treatment of pubic symphysis diastasis. Surgical procedures are recommended in case of separation above 30-50 mm, ruptures of sacroiliac joints, open lesions, failed conservative treatment and urological dysfunction. In such cases preferred option is the internal fixation by plate and screws. Some authors use external fixation. Late-term outcomes of both methods do not demonstrate significant differences. Pain regress after the surgery is observed within 3 weeks to 6 months postoperatively, walking with partial load is restored in 5-14 days, full load on the lower limbs is possible 6 months postoperatively. Indications for removal of implants after internal fixation are not clearly defined. Following surgical treatment of pubic symphysis diastasis the majority of authors incline to subsequent operative delivery.

Individualized Developmental Care in the Neonatal Intensive Care Nursery

2008 ◽  
Vol 17 (3) ◽  
pp. 84-93
Author(s):  
Kathleen A. VandenBerg ◽  
Erin Sundseth Ross
Keyword(s):  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Advanced Practice ◽  
Developmental Care ◽  
Medical Interventions ◽  
Speech Language Pathologist ◽  
Developmentally Supportive Care ◽  
Intensive Care Nursery ◽  
Infant Brain Development

Abstract Advances in medical care have improved the success of medical interventions in treating high-risk and premature infants, but long-term developmental outcomes are less positive. The neonatal intensive care unit (NICU) setting influences infant brain development and organization, as well as the parent-infant relationship. One advanced-practice role for a speech-language pathologist (SLP) is that of a newborn developmental specialist (NDS). The NDS working in the NICU understands the influence of medical, environmental, and caregiving interactions on the neurologic and neurobehavioral organization of the infant. The NICU setting advanced practice skills are grounded in an individualized, developmentally supportive care model, such as the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). Neurodevelopmental assessment focuses on the competence of the infant. The developmental assessment and intervention strategies are individualized to support the infant's own goal strivings. In this framework, interactions with infants become modified to increase competence and organization. The SLP working in the NICU is in a unique position to facilitate communication between the infant and the parent, as well as between the infant and professional caregivers. The SLP can help the parent interpret and respond appropriately to the infant's communication by focusing on non-verbal stress and stability cues, and by planning all interactions with a goal of co-regulation. Interactions with infants and families in this Model in the NICU have beneficial lifelong implications.

The Light Side of Preterm Behavioral Epigenetics

2016 ◽  
pp. 107-127 ◽  
Author(s):  
Livio Provenzi ◽  
Renato Borgatti ◽  
Rosario Montirosso
Keyword(s):  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Protective Effects ◽  
Developmental Care ◽  
Early Human Development ◽  
Related Stress ◽  
The One ◽  
Light Side ◽  
Epigenetic Research ◽  
Early Human

Preterm infants need long-lasting hospitalization in the Neonatal Intensive Care Unit (NICU). On the one hand, the NICU stay constitutes an early adverse experience, due to highly stressful experiences. On the other hand, Developmental Care (DC) interventions, including caregiver engagement, can exert neuro-protective effects for preterm infants. Recent evidence in the field of behavioral epigenetics is revealing the biochemical pathways through which adverse and care experiences are embedded in early human development through epigenetic mechanisms. Nonetheless, the application of behavioral epigenetics to preterm birth and NICU stay is still at its beginning. In the present chapter, insights are provided for the application of behavioral epigenetics to the study of the biochemical underpinnings of NICU-related stress and care, with a specific focus on caregiver engagement. This contribute should be intended as a preliminary roadmap to guide future behavioral epigenetic research on the adverse and protective effects of early NICU care of preterm infants.

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