Risk and Management of Intracerebral Hemorrhage in Patients with Bleeding Disorders

Intracerebral hemorrhage (ICH) is the most dreaded complication, and the main cause of death, in patients with congenital bleeding disorders. ICH can occur in all congenital bleeding disorders, ranging from mild, like some platelet function disorders, to severe disorders such as hemophilia A, which can cause catastrophic hemorrhage. While extremely rare in mild bleeding disorders, ICH is common in severe coagulation factor (F) XIII deficiency. ICH can be spontaneous or trauma-related. Spontaneous ICH occurs more often in adults, while trauma-related ICH is more prevalent in children. Risk factors that can affect the occurrence of ICH include the type of bleeding disorder and its severity, genotype and genetic polymorphisms, type of delivery, and sports and other activities. Patients with hemophilia A; afibrinogenemia; FXIII, FX, and FVII deficiencies; and type 3 von Willebrand disease are more susceptible than those with mild platelet function disorders, FV, FXI, combined FV–FVIII deficiencies, and type 1 von Willebrand disease. Generally, the more severe the disorder, the more likely the occurrence of ICH. Contact sports and activities can provoke ICH, while safe and noncontact sports present more benefit than danger. An important risk factor is stressful delivery, whether it is prolonged or by vacuum extraction. These should be avoided in patients with congenital bleeding disorders. Familiarity with all risk factors of ICH can help prevent occurrence of this diathesis and reduce related morbidity and mortality.

Clinical rationale for the treatment tactics of term patients diagnosed with transient neonatal tachypnoea without parenteral nutrition

Introduction. To analyze the efficacy and safety of treatment tactics for term patients diagnosed with TTN in an ICU without venous access and parenteral nutrition.Materials and methods. The study gives a retrospective analysis of the medical records of 241 ICU patients from January 2020 to March 2021. 83 children meet general criteria for inclusion in the study.Results and Discussion. While comparing the study group and the control group, no significant difference was detected in the incidence of risk factors during pregnancy and childbirth, such as gestational diabetes, ARVI during pregnancy, chorioamnionitis, preeclampsia, and the frequency of a prolonged anhydrous period, the frequency of induced labor, delivery by caesarean section, fetal distress and the use of vacuum extraction. Despite the same initial level of severity of respiratory disorders, when the child was admitted to the ICU, the duration of CPAP therapy was significantly higher in the control group: 7.5 (5.5-12) versus 5 (4-6) hours p = 5×10-5. The average length of hospital stay in the ICU and the total length of hospital stay was significantly higher in the control group (p = 4×10-11 and p = 0.006, respectively), as well as the need for treatment in the Neonatal Pathology unit conditions (p = 0.001).Conclusion. Analyzing the tactics of treating term patients diagnosed with TTN, the study proved that children without venous access require less time for respiratory therapy with CPAP in the NICU, the total duration of hospitalization in the NICU is significantly lower, as well as the need for additional treatment in the Neonatal Pathology unit. The study revealed that the early onset of enteral nutrition and the rapid expansion of the feeding portion, provided with child’s stable health condition, enable to avoid the installation of venous access and the prescription of parenteral nutrition at the ICU stage.

The possibility of introducing a normal pregnancy and delivery in patients with established liver cirrhosis

The management of pregnant women with portal hypertension is challenging. In the second trimester, examinations are performed to identify esophageal varices. There are no clear recommendations regarding the primary prevention of bleeding in case of esophageal varices in pregnant women and management in case of bleeding. There are no recommendations on the preferred mode of delivery (vaginal or caesarean section) for portal hypertension. Since the persistent period is undesirable in the presence of varicose veins, it is recommended, if necessary, to shorten the second stage of labor by applying obstetric forceps or performing vacuum extraction of the fetus. In the presence of obstetric indications, a caesarean section is performed, which is also associated with certain risk; since cirrhosis often has varicose veins of the abdominal wall. In addition there is a tendency to bleed during childbirth, infectious complications, and slow wound healing. Because of possible medical contraindications and difficulty of prenatal management and delivery of patients with established liver cirrhosis, there are many cases of patients concealing their diagnosis when planning pregnancy and visiting a gynecologist, which, undoubtedly, can lead to concomitant complications and serious consequences that threaten the lives of patients. The clearest example of the above is the following patient case.

Prospective assessment of vacuum deliveries from midpelvic station in a tertiary care university hospital: Frequency, failure rates, labor characteristics and maternal and neonatal complications

Background Midpelvic vacuum extractions are controversial due to reports of increased risk of maternal and perinatal morbidity and high failure rates. Prospective studies of attempted midpelvic vacuum outcomes are scarce. Our main aims were to assess frequency, failure rates, labor characteristics, maternal and neonatal complications of attempted midpelvic vacuum deliveries, and to compare labor characteristics and complications between successful and failed midpelvic vacuum deliveries. Study design Clinical data were obtained prospectively from all attempted vacuum deliveries (n = 891) over a one-year period with a total of 6903 births (overall cesarean section rate 18.2% (n = 1258). Student’s t-test, Mann-Whitney U-test or Chi-square test for group differences were used as appropriate. Odds ratios and 95% confidence intervals are given as indicated. The uni- and multivariable analysis were conducted both as a complete case analysis and with a multiple imputation approach. A p-value of <0.05 was considered statistically significant. Results Attempted vacuum extractions from midpelvic station constituted 36.7% (n = 319) of all attempted vacuum extractions (12.9% (n = 891) of all births). Of these 319 midpelvic vacuum extractions, 11.3% (n = 36) failed and final delivery mode was cesarean section in 86.1% (n = 31) and forceps in the remaining 13.9% (n = 5). Successful completion of midpelvic vacuum by 3 pulls or fewer was achieved in 67.1%. There were 3.9% third-degree and no fourth-degree perineal tears. Cup detachments were associated with a significantly increased failure rate (adjusted OR 6.13, 95% CI 2.41–15.56, p< 0.001). Conclusion In our study, attempted midpelvic vacuum deliveries had relatively low failure rate, the majority was successfully completed within three pulls and they proved safe to perform as reflected by a low rate of third-degree perineal tears. We provide data for nuanced counseling of women on vacuum extraction as a second stage delivery option in comparable obstetric management settings with relatively high vacuum delivery rates and low cesarean section rates.

The Revelation of Caput Succedaneum after Instrumental Assisted Deliveries: Exclusively diagnosed on Ultrasonography: Mini Article of Case Series

Vacuum extraction delivery is one of the commonest and routinely available forms of assisted vaginal delivery in tertiary care hospitals. The association of caput succedaneum and mode of deliveries is sparsely discussed in any of the renowned platform. Here we are presenting case series of infants who presented to us with scalp swelling in our ultrasound suite and we diagnosed them as caput succedaneum exclusively on sonography with no need of CT or MRI scanning.