scholarly journals Breech Presentation: Vaginal Versus Cesarean Delivery, Which Intervention Leads to the Best Outcomes?

2017 ◽  
Vol 30 (6) ◽  
pp. 479 ◽  
Author(s):  
Andreia Fonseca ◽  
Rita Silva ◽  
Inês Rato ◽  
Ana Raquel Neves ◽  
Carla Peixoto ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Vaginal Delivery ◽  
Neonatal Intensive Care ◽  
Elective Cesarean Section ◽  
Apgar Scores ◽  
Nulliparous Women ◽  
Elective Cesarean ◽  
Fetal Trauma

Introduction: The best route of delivery for the term breech fetus is still controversial. We aim to compare maternal and neonatal outcomes between vaginal and cesarean term breech deliveries.Material and Methods: Multicentric retrospective cohort study of singleton term breech fetuses delivered vaginally or by elective cesarean section from January 2012 - October 2014. Primary outcomes were maternal and neonatal morbidity or mortality.Results: Sixty five breech fetuses delivered vaginally were compared to 1262 delivered by elective cesarean. Nulliparous women were more common in the elective cesarean group (69.3% vs 24.6%; p < 0.0001). Gestational age at birth was significantly lower in the vaginal delivery group (38 ± 1 weeks vs 39 ± 0.8 weeks; p = 0.0029) as was birth weight (2928 ± 48.4 g vs 3168 ± 11.3 g; p < 0.0001). Apgar scores below seven on the first and fifth minutes were more likely in the vaginal delivery group (1st minute: 18.5% vs 5.9%; p = 0.0006; OR 3.6 [1.9 - 7.0]; 5th minute: 3.1% vs 0.2%; p = 0.0133; OR 20.0 [2.8 - 144.4]), as was fetal trauma (3.1% vs 0.3%: p = 0.031; OR 9.9 [1.8-55.6]). Neither group had cases of fetal acidemia. Admission to the Neonatal Intensive Care Unit, maternal postpartum hemorrhage and the incidence of other obstetric complications were similar between groups.Discussion: Although vaginal breech delivery was associated with lower Apgar scores and higher incidence of fetal trauma, overall rates of such events were low. Admission to the neonatal intensive care unit and maternal outcomes were similar.Conclusion: Both delivery routes seem equally valid, neither posing high maternal or neonatal complications’ incidence.

scholarly journals Confounders for Neonatal Intensive Care Unit Admission ın Neonates of Mothers with Preeclampsia

2018 ◽  
Vol 24 (3) ◽  
pp. 162
Author(s):  
Cetin Kilicci ◽  
Cigdem Yayla Abide ◽  
Enis Ozkaya ◽  
Evrim Bostancı Ergen ◽  
İlter Yenidede ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Intensive Care Unit Admission ◽  
Neonatal Intensive Care Unit ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Preterm Neonates ◽  
Apgar Scores ◽  
Gestational Age At Delivery

<p><strong>Objective:</strong> The aim of this study was to investigate the effect of some maternal and neonatal clinical parameters on the neonatal intensive care unit admission rates of neonates born to mothers who had preeclampsia. </p><p><strong>Study Design:</strong> Study included 402 singleton pregnant women with preeclampsia who admitted to Maternal-Fetal Medicine Unit of Zeynep Kamil Children and Women’s Health Training and Research Hospital. Pregnancies with uterine rupture, chorioamnionitis and congenital malformations were excluded. Some maternal and neonatal clinical characteristics were assessed to predict neonatal intensive care unit admission.</p><p><strong>Results:</strong> Among 402 neonates, 140 (35%) of them had an indication for neonatal intensive care unit admission, among 140 neonates, 136 (97%) of them were preterm neonates. Comparison of groups with and without neonatal intensive care unit admission indicated significant differences between groups in terms of gestational age, Apgar scores at 1st and 5th minutes, birth weight, some maternal laboratory parameters (Hemoglobin, hematocrit, alanine aminotransferase, aspartate aminotransferase, albumin). In multivariate analysis, among all study population, gestational age at delivery, birth weight and Apgar scores were found to be significantly associated with neonatal intensive care unit admission. On the other hand, in subgroup of term neonates, none of the variables was shown to be associated with neonatal intensive care unit admission.</p><p><strong>Conclusion:</strong> Gestational age at delivery and the birth weight are the main risk factors for neonatal intensive care unit admission of neonates born to mothers who had preeclampsia.</p>

scholarly journals Prenatal and neonatal outcomes of pregnancies diagnosed with fetal single umbilical artery

2021 ◽  
Vol 29 (3) ◽  
pp. 217-224
Author(s):  
Mehmet Obut ◽  
Asya Kalaycı Öncü ◽  
Özge Yücel Çelik ◽  
Arife Akay ◽  
Güliz Özcan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Preterm Delivery ◽  
Neonatal Intensive Care ◽  
Umbilical Artery ◽  
Single Umbilical Artery ◽  
Apgar Scores ◽  
Increased Risk ◽  
Structural Abnormalities

Objective To investigate the associated anomalies and outcomes of fetuses diagnosed as having a single umbilical artery (SUA) which were reported inconsistently in previous studies. Methods The data of 82 pregnancies with fetal SUA, 35 of which were complex, and 47 isolated SUA (iSUA) and 100 pregnancies with fetal double umbilical arteries (DUA) between June 2018 and July 2020 were retrieved. We compared the maternal characteristics, and pregnancy and fetal outcomes of the three groups (iSUA, SUA, and DUA). Results Of 82 fetuses with SUA, 35 had 64 major structural abnormalities. 20 of these 35 fetuses (57.1%) had cardiovascular malformations, 12 (34.2%) had central nervous, 10 (28.5%) had genitourinary, and eight (22.8%) had gastrointestinal system malformations. Isolated SUA was present in SUA. Compared with the 100 DUA fetuses, SUA was a risk for intrauterine growth restriction (IUGR), preterm delivery, Apgar scores of <7, and admission to the neonatal intensive care unit. Having fetal chromosomal or structural abnormalities, was a risk for amnion fluid abnormality, pregnancy termination, intrauterine fetal death, early neonatal death, and a low live birth ratio in SUA cases. Conclusion SUA has an increased rate of fetal structural and chromosomal abnormalities. Among them, the most detected one is cardiac and the second most common one is central nervous system malformations. Pregnancies with fetal SUA have increased risk for IUGR, preterm delivery, low Apgar scores, and admission to the neonatal intensive care unit. The presence of additional structural or chromosomal malformations increases the rate of these adverse pregnancy risks. Thus, these cases warrant dedicated fetal ultrasonographic organ screening and close prenatal follow-up.

Neonatal Resuscitation

2017 ◽  
Author(s):  
Megan Litzau ◽  
Sheryl E Allen
Keyword(s):  
Intensive Care Unit ◽  
Heart Rate ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Neonatal Resuscitation ◽  
Chest Compressions ◽  
Compression Technique ◽  
Apgar Scores ◽  
Successful Resuscitation

The resuscitation of a neonate in the emergency department is an infrequent occurrence. As such, it is imperative that emergency physicians are aware of the resources available at their institution in the event that resuscitation arises. The two mainstays of neonatal resuscitation are respiration and temperature. When resuscitation is required, it is due to a respiratory cause in the majority of neonates. Therefore, if the airway and breathing are managed properly, the heart rate and overall neonatal status will follow suit. Should the neonate’s heart rate continue to be below 60 beats per minute, then he or she will need chest compressions in addition to respiratory support. During the transition from intrauterine life to extrauterine life, neonates stand to lose substantial amounts of heat. Therefore, the temperature of the neonate also needs to be actively managed to prevent the loss of heat. The resuscitation will eventually end in one of two pathways: the termination of efforts or the successful resuscitation of the neonate. If the resuscitation is successful, the proper admission or transfer will need to be arranged for definitive care for the neonate. Figures include the review of fetal and neonatal circulation, proper use of equipment, and proper chest compression technique. Tables include equipment needed, Apgar scores, normal neonatal vital signs, disposition, and neonatal intensive care unit levels. Key words: Apgar scores, fetal circulation, neonatal chest compressions, neonatal circulation, neonatal resuscitation, neonatal intensive care unit levels

scholarly journals Relationship Between Prolonged Second Stage of Labor and Short-Term Neonatal Morbidity: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 17 (21) ◽  
pp. 7762
Author(s):  
Nuria Infante-Torres ◽  
Milagros Molina-Alarcón ◽  
Angel Arias-Arias ◽  
Julián Rodríguez-Almagro ◽  
Antonio Hernández-Martínez
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Apgar Score ◽  
Neonatal Intensive Care ◽  
Neonatal Outcomes ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Nulliparous Women ◽  
Multiparous Women

To evaluate the association between prolonged second stage of labor and the risk of adverse neonatal outcomes with a systematic review and meta-analysis. PubMed, Scopus and EMBASE were searched using the search strategy “Labor Stage, Second” AND (length OR duration OR prolonged OR abnormal OR excessive). Observational studies that examine the relationship between prolonged second stage of labor and neonatal outcomes were selected. Prolonged second stage of labor was defined as 4 h or more in nulliparous women and 3 h or more in multiparous women. The main neonatal outcomes were 5 min Apgar score <7, admission to the Neonatal Intensive Care Unit, neonatal sepsis and neonatal death. Data collection and quality assessment were carried out independently by the three reviewers. Twelve studies were selected including 266,479 women. In nulliparous women, a second stage duration greater than 4 h increased the risk of 5 min Apgar score <7, admission to the Neonatal Intensive Care Unit and neonatal sepsis and intubation. In multiparous women, a second stage of labor greater than 3 h was related to 5 min Apgar score <7, admission to the Neonatal Intensive Care Unit, meconium staining and composite neonatal morbidity. Prolonged second stage of labor increased the risk of 5 min Apgar score <7 and admission to the Neonatal Intensive Care Unit in nulliparous and multiparous women, without increasing the risk of neonatal death. This review demonstrates that prolonged second stage of labor increases the risk of neonatal complications in nulliparous and multiparous women.

The Psychosocial Aspects of Feeding in the Neonatal Intensive Care Unit and Beyond

2019 ◽  
Vol 4 (6) ◽  
pp. 1507-1515
Author(s):  
Lauren L. Madhoun ◽  
Robert Dempster
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Hospital Discharge ◽  
Neonatal Intensive Care ◽  
Oral Feeding ◽  
Medical Attention ◽  
Primary Role ◽  
Speech Language Pathologists ◽  
The Family

Purpose Feeding challenges are common for infants in the neonatal intensive care unit (NICU). While sufficient oral feeding is typically a goal during NICU admission, this can be a long and complicated process for both the infant and the family. Many of the stressors related to feeding persist long after hospital discharge, which results in the parents taking the primary role of navigating the infant's course to ensure continued feeding success. This is in addition to dealing with the psychological impact of having a child requiring increased medical attention and the need to continue to fulfill the demands at home. In this clinical focus article, we examine 3 main areas that impact psychosocial stress among parents with infants in the NICU and following discharge: parenting, feeding, and supports. Implications for speech-language pathologists working with these infants and their families are discussed. A case example is also included to describe the treatment course of an infant and her parents in the NICU and after graduation to demonstrate these points further. Conclusion Speech-language pathologists working with infants in the NICU and following hospital discharge must realize the family context and psychosocial considerations that impact feeding progression. Understanding these factors may improve parental engagement to more effectively tailor treatment approaches to meet the needs of the child and family.

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