Emergency Caesarean
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2021 ◽  
Author(s):  
Ankitha Devaraj ◽  
Jamaal Raoof ◽  
Osman Janjua ◽  
Kevin Tsang ◽  
Muhammad Zamir

Objective: Symptomatic vertebral haemangiomas that present during pregnancy are extremely uncommon with few cases reported in literature. Epidural haemangiomas are rarer still with few documented. Methods: In this report, we describe the case of a 22-year-old pregnant patient who presented with apparent loss of foetal movement at 38 weeks’ gestation. Clinical review demonstrated the foetus was well but neurological examination revealed lower limb paresthesia, paresis, and evident uterine hypoesthesia. An MRI scan illustrated a haemangioma in the T1 vertebral body with an epidural component causing cord compression. Results: The management of spinal haemangiomas that present during pregnancy is a complex clinical scenario which requires careful multidisciplinary consideration to determine if surgical intervention is appropriate. In this case, the patient had an emergency caesarean section followed by posterior decompression and laminectomy of the T1 vertebra with excellent post-operative recovery. Conclusion: Gestational increase in the size of vertebral haemangiomas is well documented. We discuss a rare case in which a young pregnant patient presents with an atypical symptom of a vertebral haemangioma (uterine hypoesthesia). This case highlights the importance of prompt imaging in these scenarios and a cohesive multidisciplinary approach in order to provide optimal treatment for the patient.


2021 ◽  
Author(s):  
Dequan Liu ◽  
Xuan Sheng ◽  
Dan Guo ◽  
Houmei Han ◽  
Yang Gao ◽  
...  

Abstract Background The purpose of this research is to explore prenatal ultrasound features and clinical managements of fetal small bowel volvulus. At present, researchers mainly focus on the prenatal ultrasound features of fetal small bowel volvulus, and rarely summarize them in combination with the principles of clinical treatment. Methods 11 cases of fetal small bowel volvulus identified by prenatal ultrasound or neonatal surgery in our institution between January 2019 and January 2021 were included. General characteristics of pregnant women, features of prenatal ultrasound, clinical managements and prognosis of neonates were collected. Finally, prenatal ultrasound features and obstetric managements of fetal volvulus was summarized. Results At the first diagnosis, the whirlpool sign and intestinal dilatation were visualized in 11 cases. 3 cases underwent emergency caesarean because of the disappearance of dilated bowel peristalsis, massive ascites and fetal intrauterine hypoxia. The rest 8 cases were followed up by ultrasound, pregnancy outcomes were four regressed intrauterine spontaneously and delivered at term, two underwent emergency caesarean, one premature and one induced labor. 6 cases underwent neonatal surgery immediately after birth and received favorable outcomes.Conclusions Intestinal distention and the whirlpool sign are important ultrasonic features in the diagnosis of fetal small bowel volvulus. The disappearance of intestinal peristalsis of the volvulus segment, massive ascites and intrauterine hypoxia are the main basis for emergency prenatal clinical intervention.


2021 ◽  
Author(s):  
Nurulhuda binti Ahmad Sani ◽  
Jesrine Hong

2021 ◽  
Vol 10 (40) ◽  
pp. 3538-3542
Author(s):  
Sivasambu Gayatri ◽  
Sujani B. K. ◽  
Urvashi Urvashi ◽  
Priyanka Sinha

BACKGROUND The lower segment caesarean section (LSCS) audit shows an increase in caesarean section rates worldwide. Assisted vaginal delivery and, if needed, emergency caesarean section are options available to the obstetrician to handle challenges in the second stage when spontaneous and safe delivery is not imminent. Judicious use of the instrument as well as continuing medical education in the art of assisted vaginal delivery is a must to achieve the twin goal of containing the surging caesarean section rate as well as bring about a successful and safe assisted vaginal delivery. The objective of this study was to quantify the various morbidities associated with assisted vaginal deliveries among patients in a tertiary care teaching hospital in Bengaluru. METHODS It is a retrospective study carried for four years between July 2016 and June 2020 at Ramaiah Medical College at Bengaluru. The total number of vaginal deliveries was 6318 out of which 1020 had a successful assisted vaginal delivery and were studied in terms of outcomes, maternal and foetal indications and morbidity. RESULTS Out of 1020 assisted vaginal deliveries, 86.96 % were vacuum-assisted, 3.9 % were forceps assisted and 9.11 % were both vacuum and forceps assisted. The success rate of forceps deliveries was more compared to vacuum. No significant maternal and neonatal mortality and morbidity were observed in our study. CONCLUSIONS In this study, vacuum was the most used method of assisted vaginal delivery and was safer for mothers and babies. It is also easier to teach and learn. Forceps delivery was more used in preterm delivery. KEY WORDS Assisted Vaginal Delivery, Vacuum, Forceps, Sequential use of Instruments, Maternal and Neonatal Morbidity.


Author(s):  
Khalilah Alhuda Binti Kamilen ◽  
Mohd Yusran Othman

Intussusception is a well-known cause of intestinal obstruction in children. Its occurrence in fetus as an intrauterine incidence is extremely rare and poses a diagnostic difficulty. Intrauterine intussusception may result in intestinal atresia once the gangrenous segment resorbed. However, a very late occurrence of intussusception just prior to delivery may present as meconium peritonitis. We are reporting a case of premature baby who was born at 35 weeks gestation via emergency caesarean for breech in labour. Routine scan 4 days prior to the delivery showed evidence of fetal ascites. She was born with good Apgar Score and weighed 2.5kg. Subsequently she developed respiratory distress syndrome requiring mechanical ventilation. She passed minimal meconium once after birth then developed progressive abdominal distension and vomiting. Abdominal radiograph on day 4 of life revealed gross pneumoperitoneum and bedside percutaneous drain was inserted to ease the ventilation. Upon exploratory laparotomy, a single ileal perforation was seen 20cm from ileocecal junction with an intussusceptum was seen in the distal bowel. Gross meconium contamination and bowel edema did not favour the option of primary anastomosis, thus stoma was created. Reversal of stoma was performed a month later and she recovered well. Fetus with a complicated intrauterine intussusception may present with fetal ascites and their postnatal clinical and radiological findings need to be carefully assessed for evidence of meconium peritonitis; in which a timely surgical intervention is required to prevent the sequelae of prolonged intraabdominal sepsis in this premature baby.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S18


2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Shaymaa Al Zubaidi ◽  
Taghreed Alhaidari

Abstract Objectives To evaluate the uterotonic effect of carbetocin compared with oxytocin in emergency cesarean delivery in Iraq. Methods A double-blinded randomized noninferiority single center trial. Three-hundred patients were systematically randomized to intravenous bolus injection of 10 IU oxytocin or 100 mcg carbetocin after delivery in a ratio of 2:1. The primary outcome was additional uterotonic use when inadequate uterine tone occur in the first 24 h after delivery. Secondary outcomes include the need for blood transfusion, blood pressure and pulse rate changes within an hour of drugs administration. Noninferiority margins for the relative risks outcomes was 4%. Results Addition uterotonics use was significantly lower in carbetocin group with a risk ratio of 0.36. Carbetocin was superior to oxytocin in reducing the need for additional uterotonic drugs by 12% and non-inferior to oxytocin for blood transfusion 3.5%. Noninferiority was not shown for the outcome of sever blood loss. Miner changes in blood pressure and pulse rate were observed in carbetocin group compared to oxytocin but clinically were not significant. Conclusions Heat stable carbetocin is effective in reducing additional uterotonics use compared to oxytocin without clinically significant change in blood pressure or pulse rate, therefore, can be a potential alternative in Iraq.


Author(s):  
Suher Dafaus ◽  
Amel Morgham ◽  
Nasreen Osman

Background and objective. Preeclampsia is a multisystemic disorder, which involves the placenta, liver, blood, neurological and cardiovascular systems. It is one of the leading causes of maternal and fetal morbidity and mortality. This study aimed at describing the characteristic features for mothers who had severe preeclampsia and to know the complications during puerperium. Methods. A prospective study conducted over a period from February 2009 up to November 2009 involving 100 pre-eclampsia patients admitted and delivered in Aljalaa Maternity Hospital, Tripoli, Libya. Results. The patients mean age was 33.3 +5.9 years. The mean gestational age at admission time was 36.8+3.2 weeks and 64% of them were term. 58% of the patients with severe preeclampsia had a positive family history of chronic hypertension whereas 42% of patients had a previous history of preeclampsia. 40% of patients were primigravida. The mean systolic blood pressure at admission was 164+15.4 mmHg and the mean diastolic pressure was 113+6 mmHg. The common symptoms were headache, abdominal pain, and blurred vision (54%, 37%, and 31% respectively), whereas 9% of the patients presented with the eclamptic fit. The pregnancy in 66% patients ended by caesarean section, 78% of them were emergency caesarean section. The birth weight of 13% of new-borns was less than 1500 grams. Furthermore, 10% diagnosed with intrauterine fetal death (IUFD) antenatally and 9% died after admission to nursery intensive care unit post-delivery. Conclusion. the effects of hypertensive disorder associated with pregnancy could be prevented by close antenatal care particularly for whose had previous history of preeclampsia. In addition; early recognition and adequate treatment, and timely delivery can prevent preeclampsia and will improve maternal and neonatal outcomes.


Author(s):  
Monika Dalal ◽  
Smiti Nanda ◽  
Jagjit S. Dalal ◽  
Samiksha Kaushik ◽  
Meenakshi Chauhan ◽  
...  

Background: Women with previous LSCS often have to make a decision about mode of delivery of their second baby. As the rate of caesarean section is continuously increasing, vaginal birth after caesarean section (VBAC) is a good strategy to decrease caesarean rate. The present study was planned to assess the fetomaternal outcome in pregnancies with previous lower segment caesarean section undergoing trial of scar and to identify the factors, which can influence the outcome of trial of scar.Methods: This was a prospective observational study on 100 patients at a tertiary care institute. Pregnant women with previous LSCS were selected randomly for the study on the basis of the inclusion and exclusion criteria. Each labor monitored closely using a partogram. Decision for repeat emergency caesarean was taken by consultant. All women included in the study were followed through delivery and till discharge.Results: Out of 100 pregnant women 49 % cases had successful VBAC, 50% had emergency caesarean and one patient had laparotomy for rupture uterus. In women, who also had a prior vaginal delivery, 72% delivered vaginally, as compared to 40% of the women who did not undergo prior vaginal delivery (p value=0.003). Women who were in spontaneous labor, 59.21% delivered vaginally, whereas women who were induced, 16.6% delivered vaginally. The rate of perinatal complication was more in the patients who required an emergency CS after a failed trial. Conclusions: Our findings may encourage obstetricians to encourage VBAC in the properly screened ANC patients and decrease the rate of recommending caesarean section.


2021 ◽  
Author(s):  
Rachael Maunder ◽  
Peter Branney

The study examines YouTube video accounts of women's birthing experiences via emergency caesarean section using interpretative phenomenological analysis. Using an interpretivist theoretical perspective and a phenomenological methodology to gain an insight into their sense making during the birth of their child. A search on YouTube using the keywords "emergency c-section", "emergency caesarean section", "birth story emergency c-section" returned videos that matched the first criteria of the study; these were mainly women who had experienced a caesarean. However, the searches returned some elective procedures. A homogeneous sample was achieved by skimming through the videos and matching them with the inclusion criteria specified. Texts were transcribed and coded, then themes were identified across the texts. A screenshot from each text was taken to apply multimodal analysis when interpreting the experiences. Three master themes are discussed: "being medicalised", "experiences with medical staff", and "the experience of feelings"; along with their sub-themes, focussing on how women experienced each theme. The study is limited within its data collection method and analysis; however, it also offers strengths for future research. Future study should include discourse analysis around birth.


2021 ◽  
Vol 8 (3) ◽  
pp. 397-400
Author(s):  
Karishma Sharma ◽  
Somya Saxena ◽  
Rahul Agnihotri

Intestinal obstruction (IO) in pregnancy is rare at 1 in 2500 to 1 in 16709 deliveries with an incidence of 0.001% to 0.003%. Although uncommon, IO in pregnancy carries significant maternal (6%) and fetal (26%) mortality. A 30-year-old, primigravida, at 33weeks 4 days of gestation presented to the emergency obstetrics department of Swaroop Rani Nehru Hospital, Prayagraj, Uttar Pradesh, India with a 2-day history of diffuse abdominal pain, distension and obstipation. The decision of emergency caesarean section was taken and a 2.5kg healthy female baby was delivered. Surgical opinion was sought intraoperatively. Segmental resection and anastomosis, adhesiolysis and appendicectomy was done. Patient discharged on 10 post-operative day along with her baby in satisfactory condition. Diagnosis of SBO can be difficult to make as symptoms are often attributed mistakenly to pregnancy and there can be a reluctance to request plain films owing to the risks of ionising radiation. Both of these factors can lead to a delay in diagnosis and initiating treatment. Clinical suspicion is vital and joint management between surgeons and obstetricians is crucial. In agreement with previous literature reviews regarding the need for prompt laparotomy in most cases of SBO, we recommend that patients with confirmed adhesional obstruction may be managed conservatively in the first instance but with a low threshold for progressing to laparotomy.


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