Periviable Breech Delivery Decision Analysis

Background/Objective: The optimal mode of delivery (MOD) for malpresentation in periviable deliveries (22-24 weeks), remains a source of debate. Neonatal and maternal complications can arise from both vaginal (VD) and cesarean delivery (CD), and the threat of maternal morbidity extends to subsequent pregnancies. It has been difficult to compare these risks while counseling patients about MOD options, so we sought to create a decision tree that maps probable outcomes associated with breech deliveries at 23- and 24-weeks’ gestation, as well as complications posed for subsequent pregnancies. Methods: An extensive literature review was conducted to identify risk estimates of periviable maternal and neonatal outcomes, along with elective repeat CD (ERCD) and trial of labor after cesarean (TOLAC) for subsequent pregnancies. Probabilities were inputted into TreeAge software, starting with primary maternal health states that may result from CD and VD – “death”, “hysterectomy”, or “no hysterectomy”, followed by the probability of neonatal health states– “death”, “severe morbidity”, or “no severe morbidity”. The likelihood of placenta previa or normal placenta was considered for subsequent pregnancies. We factored in the possibility of ERCD or TOLAC and the associated maternal and neonatal risks for each. Results: Final design of the tree is complete and risk estimates have been inputted. Primary analysis and sensitivity analyses are planned for August 2021. Ultimately, we will also be able to use measured utility values to calculate quality adjusted life years (QALYs) for each health state. Conclusion and Clinical Impact: Whether CD or VD is optimal for breech presentation in periviable delivery is influenced by a complex array of factors, including future reproductive plans and maternal values related to potential neonatal and maternal morbidity and mortality. Quantifying risks associated with each MOD will aid providers in their efforts to help families make informed decisions and reduce morbidity across the reproductive lifespan.

Obstetric fracture of the femur during cesarean section in a preterm baby: A case report

Introduction: Obstetric fractures or Birth fractures are rare events following childbirth. Although fracture of the femur is a relatively uncommon injury, it is the most common fracture of the lower extremity in the newborn. Since evolution of cesarean section rates in Africa, it is one of the most commonly practiced modes of delivery for breech. We described one case of fracture of the femur at cesarean section treated at Adlucem hospital in bonabéri-Douala (Cameroon). Case report: A 2.1 kg male infant was delivered by lower segment cesarean section for breech presentation. Clinical and radiological examination showed shaft fracture of femur with good evolution. Discussion: Fractures of the long bones are associated with cesarean section, breech delivery with assistance and low birth weight. Femoral fractures are the most associated long bones fracture with cesarean section. Conclusion: The clinical and paraclinical diagnosis is simple and the management is mostly non-operative. It is important to explain to the parents and especially to the mother the benignity of the lesion.

Effect of Prenatal Yoga on Changes in Fetal Position in Pregnancy

Based on a preliminary study, there were 18.31% who had a breech delivery, it would result in complications in the baby such as asphyxia, bleeding or soft tissue edema, damage to the medulla oblongata, damage to the cervical spine joints, and even death due to severe asphyxia. determine the effect of Prenatal Yoga on Changes in Fetal Position in Pregnant Women. This type of observational research uses a quasi-experimental design with pre-test and post-pest with control group design. The research was conducted in the city of Kediri. The sample in this study was 32, namely third trimester pregnant women with gestational age > 28 weeks who experienced breech, latitude, and obligate fetal positions which were divided into 2 groups of 16 intervention groups (Prenatal Yoga) and 16 people as controls (pregnancy exercise). The sampling technique used is simple random sampling. Bivariate analysis using Mann Whitney Test. The results obtained are Z = -2.626 and -value 0.009 <0.05 so that Ho is rejected and it can be concluded that there is an effect of Prenatal Yoga on Changes in Fetal Position in Pregnant Women in Kediri City. Yoga exercises to help change the position of the fetus are more focused on providing a wide space in the abdomen, flexing the muscles of the uterus and pelvis. Three movements were used in this study, namely cat cow, downward-facing dog and puffy pose. Suggestions for health workers that prenatal yoga can be a solution and can be applied to help change the position of the fetus from malpresentation to head position.

Incidence and predictors of preterm neonatal mortality at Mbarara Regional Referral Hospital in South Western Uganda

Introduction Preterm neonatal mortality contributes substantially to the high neonatal mortality globally. In Uganda, preterm neonatal mortality accounts for 31% of all neonatal deaths. Previous studies have shown variability in mortality rates by healthcare setting. Also, different predictors influence the risk of neonatal mortality in different populations. Understanding the predictors of preterm neonatal mortality in the low-resource setting where we conducted our study could guide the development of interventions to improve outcomes for preterm neonates. We thus aimed to determine the incidence and predictors of mortality among preterm neonates born at Mbarara Regional Referral Hospital (MRRH) in South Western Uganda. Methods We prospectively enrolled 538 live preterm neonates born at MRRH from October 2019 to September 2020. The neonates were followed up until death or 28 days, whichever occurred first. We used Kaplan Meier survival analysis to describe preterm neonatal mortality and Cox proportional hazards regression to assess predictors of preterm neonatal mortality over a maximum of 28 days of follow up. Results The cumulative incidence of preterm neonatal mortality was 19.8% (95% C.I: 16.7–23.5) at 28 days from birth. Birth asphyxia (adjusted hazard ratio [aHR], 14.80; 95% CI: 5.21 to 42.02), not receiving kangaroo mother care (aHR, 9.50; 95% CI: 5.37 to 16.78), delayed initiation of breastfeeding (aHR, 9.49; 95% CI: 2.84 to 31.68), late antenatal care (ANC) booking (aHR, 1.81 to 2.52; 95% CI: 1.11 to 7.11) and no ANC attendance (aHR, 3.56; 95% CI: 1.51 to 8.43), vaginal breech delivery (aHR, 3.04; 95% CI: 1.37 to 5.18), very preterm births (aHR, 3.17; 95% CI: 1.24 to 8.13), respiratory distress syndrome (RDS) (aHR, 2.50; 95% CI: 1.11 to 5.64) and hypothermia at the time of admission to the neonatal unit (aHR, 1.98; 95% CI: 1.18 to 3.33) increased the risk of preterm neonatal mortality. Attending more than 4 ANC visits (aHR, 0.35; 95% CI: 0.12 to 0.96) reduced the risk of preterm neonatal mortality. Conclusions We observed a high cumulative incidence of mortality among preterm neonates born at a low-resource regional referral hospital in Uganda. The predictors of mortality among preterm neonates were largely modifiable factors occurring in the prenatal, natal and postnatal period (lack of ANC attendance, late ANC booking, vaginal breech delivery, birth asphyxia, respiratory distress syndrome, and hypothermia at the time of admission to the neonatal unit, not receiving kangaroo mother care and delayed initiation of breastfeeding). These findings suggest that investment in and enhancement of ANC attendance, intrapartum care, and the feasible essential newborn care interventions by providing the warm chain through kangaroo mother care, encouraging early initiation of breastfeeding, timely resuscitation for neonates when indicated and therapies reducing the incidence and severity of RDS could improve outcomes among preterm neonates in this setting.

Impact of fetal presentation on neurodevelopmental outcome in a trial of preterm vaginal delivery: a nationwide, population-based record linkage study

Purpose To assess the risk of adverse neurodevelopmental outcomes at the age of four after an attempted vaginal delivery according to the fetal presentation in birth. Methods This retrospective record linkage study evaluated the risks of cerebral palsy, epilepsy, intellectual disability, autism spectrum disorder, attention-deficit/hyperactivity disorder, and speech, visual, and auditory disabilities among preterm children born after an attempted vaginal breech delivery. The control group comprised children born in a cephalic presentation at the same gestational age. This study included 23 803 singleton deliveries at gestational weeks 24 + 0–36 + 6 between 2004 and 2014. Results From 1629 women that underwent a trial of vaginal breech delivery, 1122 (66.3%) were converted to emergency cesarean sections. At extremely preterm and very preterm gestations (weeks 24 + 0—31 + 6), no association between a trial of vaginal breech delivery and neurodevelopmental delay occurred. At gestational weeks 32 + 0—36 + 6, the risks of visual disability (aOR 1.67, CI 1.07—2.60) and autism spectrum disorders (aOR 2.28, CI 1.14—4.56) were increased after an attempted vaginal breech delivery as compared to vaginal cephalic delivery. Conclusion A trial of vaginal breech delivery at extremely preterm and very preterm gestations appears not to increase the risk of adverse neurodevelopmental outcomes at the age of four. In moderate to late preterm births, a trial of vaginal breech delivery was associated with an increased risk of visual impairment and autism spectrum disorders compared to children born in cephalic presentation. A trial of vaginal preterm breech delivery requires distinctive consideration and careful patient selection.

DEVELOPMENTAL DELAY IN 14 MONTH OLD BOY WITH GRADE I MALNUTRITION

When a child does not meet his or her developmental milestones within the predicted time or age, this is referred to as developmental delay. Developmental milestones are activities that certain children master or acquire at specific ages. Head balance, rolling, crawling, driving, and talking are a few examples. The mechanism of growth and the completion of such developmental milestones are referred to as child development. The patient was a 14 months old male child came to the hospital with complaint of inability to sit also he is unable to hold anything in his hand. As narrated by the mother the child was born to G2P1L1A1 mother at 9 months 5 days of gestation. The child has not yet attained gross motor milestone such as rolling over and no sit with support. The child attained immature pincer grasp at 12 months of age and has not attained mature pincer grasp. Social smile was attained at 6 months, stranger anxiety at 12 months and the child has not attained bye-bye. The child was alert to sounds by the age of 9 months .babbles at 10 months and says mama-dada at 12 months. The child is immunized till age. The marriage of the parents was non-consanguineous marriage. The child was born with a weight of 2.5 kg the mother had LSCS and breech delivery. The child did not cry immediately after birth. The child has history of fever after 3 months of delivery. The child is also interpreted as grade 1 mild malnutritious (71-80) %. Developmental delay and grade 1 mild malnutrition. The above study shows that Neck facilitation exercises in prone lying, Ice technique and proper brush technique for neck facilitation improves neck holding. Rolling facilitation in side lying position and proper handling positions helps in attaining milestones such as Rolling over. Facilitation of extension tone with vestibular rehabilitation helps to facilitate extensors. Family plays an important role in the management of such cases all the exercises should be properly explained to them for more improvement. Supporting the child while sitting, for example, might help him or her develop weight shifting, rotation, coordination, and balance.

PERINATAL OUTCOME OF VAGINAL BREECH DELIVERY VERSUS CAESAREAN BREECH DELIVERY

Background: The aim to find out any differences in outcome between vaginal breech delivery and cesarean breech delivery in our setup Methods: Data were collected from record book of Department of Gynecology and obstetrics. Data of 100 patients were analysed among which 36 underwent vaginal delivery for breech and 64 underwent cesarean breech delivery Results: Binary logistic regression was used to compare outcome among different groups. In our study only 5.56% of newborn delivered by vaginal route were admitted to NCU vs. 12.50% in cesarean group which was significant (odds ratio=0.07, P=0.01) Conclusion: Keywords: LSCS, Breech, NICU

External cephalic version at 38 weeks’ gestation at a specialized German single center

Introduction Cesarean section (CS) rates are increasing worldwide. One constant indication is the breech presentation at term. By offering external cephalic version (ECV) and vaginal breech delivery CS rates can be further reduced. Objective This study aimed to analyze the ECV at 38 weeks of gestation with the associate uptake rate, predicting factors, success rate, and complications at a tertiary healthcare provider in Germany specializing in vaginal breech delivery. Methods We conducted a prospective cohort study with retrospective data acquisition. All women with a singleton fetus in breech presentation presenting after 34 weeks of gestation for counseling between 2013 and 2017 were included. ECV impact factors were analyzed using logistic regression. Results A total of 1,598 women presented for breech birth planning. ECV was performed on 353 patients. The overall success rate was 22.4%. A later week of gestation (odds ratio [OR] 1.69), an abundant amniotic fluid index (AFI score) (OR 5.74), fundal (OR 3.78) and anterior (OR 0.39) placental location, and an oblique lie (OR 9.08) were significantly associated with successful ECV in our population. No major complications were observed. The overall vaginal delivery rates could be increased to approximately 14% with ECV. Conclusion The demand for alternative birth modes other than CS for breech birth is high in the area of Frankfurt, Germany. Our study offers evidence of the safety of ECV at 38 weeks. Centers with expertise in vaginal breech delivery and ECV can reduce CS-rates. To further establish vaginal breech delivery and ECV as alternate options, the required knowledge and skill should be implemented in the revised curricula.