TREATMENT OF GRAVID PATIENT SUSTAINING FACIAL FRACTURE UNDER GENERAL ANESTHESIA

Pregnancy is a physiologic condition where the maternal wellbeing imparts on the growth of the fetus. Hence it is important to know the effects of trauma and management of maxillofacial trauma in pregnancy. Hereby we describe a case of mandibular fracture in a pregnant patient who was treated under general anesthesia.

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Emergency obstetrics, gynaecology, and care of the newborn

Oxford Handbook of Pre-hospital Care ◽

10.1093/med/9780198734949.003.0012 ◽

2020 ◽

pp. 659-698

Author(s):

Ian Greaves ◽

Keith Porter

Keyword(s):

Toxic Shock Syndrome ◽

Neonatal Resuscitation ◽

Pregnant Patient ◽

Toxic Shock ◽

Anatomy And Physiology ◽

Normal Birth ◽

Hypertensive Disorders ◽

Trauma In Pregnancy ◽

Term Labour ◽

In Pregnancy

This chapter starts with the anatomy and physiology of pregnancy and the approach to managing a severely ill or injured pregnant patient. It covers taking a history and examination, before describing the management of specific issues. These include shock, ectopic pregnancy, miscarriage, toxic shock syndrome, antepartum haemorrhage, placental abruption, hypertensive disorders (eclampsia and pre-eclampsia), pre-term labour, trauma in pregnancy, and normal labour. The chapter goes on to goes on to describe the retained placenta, abnormal labour, and normal birth. Neonatal resuscitation, and the circumstances in which it should be stopped, are explained.

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424 Advanced gestational age is a predictor of non-completion of sleep apnea testing in pregnancy

SLEEP ◽

10.1093/sleep/zsab072.423 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A168-A168

Author(s):

Mihaela Bazalakova ◽

Abigail Wiedmer ◽

Lauren Rice ◽

Sakshi Bajaj ◽

Natalie Jacobson ◽

...

Keyword(s):

Sleep Apnea ◽

Gestational Age ◽

Retrospective Chart Review ◽

Pregnant Patient ◽

Clinic Visit ◽

Early Screening ◽

Home Sleep Apnea Testing ◽

Living Children ◽

Apnea Testing ◽

In Pregnancy

Abstract Introduction Sleep apnea is emerging as an important and underdiagnosed comorbidity in pregnancy. Screening, diagnosis, and initiation of therapy are all time-sensitive processes during the dynamic progression of gestation. Completion of referral and testing for sleep apnea during pregnancy requires a significant commitment of time and effort on the part of the pregnant patient. We evaluated for predictors of non-completion of sleep apnea testing within our obstetric-sleep referral pipeline, in an effort to inform and optimize future referrals. Methods We performed a retrospective chart-review of 405 pregnant patient referrals for sleep apnea evaluation at the University of Wisconsin-Madison/UnityPoint sleep apnea pregnancy clinic. We used logistic regression analysis to determine predictors of lack of completion of sleep apnea testing. Results The vast majority of referrals (>95%) were triaged directly to home sleep apnea testing with the Alice PDX portable device, rather than a sleep clinic visit. The overall rate of referral non-completion was 59%. Predictors of non-completion of sleep apnea evaluation in our pregnant population included higher gestational age (GA) at referral (1–12 wks GA: 30%, 13–26 wks GA: 31%, and 27–40 wks GA: 57% non-completers, p=0.006) and multiparity with 1 or more living children (65% non-completers if any living children, compared to 45% non-completers if no living children, p=0.002). Age, race, and transportation were not predictors of failure to complete sleep apnea testing. Conclusion We have identified several predictors of pregnant patients’ failure to complete sleep apnea evaluation with objective home sleep apnea testing after referral from obstetrics. Not surprisingly, higher gestational age emerged as a strong negative predictor of referral completion, with >50% of patients referred in the third trimester not completing sleep apnea testing. Early screening and referral for sleep apnea evaluation in pregnancy should be prioritized, given the time-sensitive nature of diagnosis and therapy initiation, and demonstrated reduced completion of referrals in advanced pregnancy. Support (if any) None

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Contemporary Trends in Procedural Volume for Adult Facial Trauma, 1996-2006

Otolaryngology ◽

10.1177/0194599811427825 ◽

2011 ◽

Vol 146 (2) ◽

pp. 226-229 ◽

Cited By ~ 8

Author(s):

Linda N. Lee ◽

Neil Bhattacharyya

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Mandibular Fracture ◽

Facial Trauma ◽

Facial Fracture ◽

National Hospital Discharge Survey ◽

Historical Cohort ◽

Key Indicator ◽

Nasal Fracture ◽

Procedural Volume

Objectives. To determine how rates of operative facial fractures may have changed between 1996 and 2006 and to determine the potential impact of such change on otolaryngology residency surgical key indicator cases. Study Design. Historical cohort study. Setting. Academic medical center. Subjects and Methods. The National Hospital Discharge Survey (NHDS) and National Survey of Ambulatory Surgery (NSAS) 1996 and 2006 cases were reviewed, extracting all cases of adult nasal, malar/zygomatic, maxillary, and mandibular fracture reductions in inpatient and outpatient settings, respectively. Procedure rates for each facial fracture were tabulated and compared between 1996 and 2006. Results. Overall in 1996, there were an estimated 113,041 ± 3740 operative facial fracture repairs performed. Among the 3 key indicator fracture repairs most relevant to otolaryngologists, there were 15,810 ± 2143 open nasal fracture reductions, 9360 ± 1742 open zygomaticomaxillary (ZMC) fracture reductions, and 20,214 ± 2585 open mandibular fracture repairs. Overall in 2006, there were 120,463 ± 7554 total facial fracture procedures, with 11,613 ± 2846 open nasal fracture reductions, 10,216 ± 2881 open ZMC fracture reductions, and 17,965 ± 3171 open mandibular repairs. Comparing cohorts, there was no significant change in number of open nasal, ZMC, or mandibular fracture repairs ( P = .24, P = .58, P = .80, respectively). Conclusion. Facial fracture procedure rates have remained largely stable over the past 10 years. These data have implications for otolaryngology training programs and could help guide resident education in facial trauma.

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