A comparison of technicques to disimpact the fetal head on a second stage caesearean simulator

Background The rate of second stage caesarean section (CS) is rising with associated increases in maternal and neonatal morbidity, which may be related to impaction of the fetal head in the maternal pelvis. In the last 10 years, two devices have been developed to aid disimpaction and reduce these risks: the Fetal Pillow (FP) and the Tydeman Tube (TT). The aim of this study was to determine the distance of upward fetal head elevation achieved on a simulator for second stage CS using these two devices, compared to the established technique of per vaginum digital disimpaction by an assistant. Methods We measured elevation of the fetal head achieved with the two devices (TT and FP), compared to digital elevation, on a second stage Caesearean simulator (Desperate Debra ™ set at three levels of severity. Elevation was measured by both a single operator experienced with use of the TT and FP and also multiple assistants with no previous experience of using either device. All measurements were blinded Results The trained user achieved greater elevation of the fetal head at both moderate and high levels of severity with the TT (moderate: 30mm vs 12.5mm p<0.001; most severe: 25mm vs 10mm p<0.001) compared to digital elevation. The FP provided comparable elevation to digital at both settings (moderate: 10 vs 12.5mm p=0.149; severe 10 vs 10mm p=0.44). With untrained users, elevation was also significantly greater with the TT compared to digital elevation (20mm vs 10mm p<0.01). However digital disimpaction was significantly greater than the FP (10mm vs 0mm p<0.0001). Conclusion On a simulator, with trained operators, the TT provided greater fetal head elevation than digital elevation and the FP. The FP achieved similar elevation to the digital technique, especially when the user was trained in the procedure.

Effects of Position on Intracranial Pressure Management in Porcine Traumatic Brain Injury with Hemorrhagic Shock

The head elevation position increased mortality, decreased MAP, and showed no significant change in CePP.

198 Effect of Saccharomyces Cerevisiae Fermentate on Immune Cell Function Following Prolonged Head Elevation in 2-year-old Horses in Training

Horses are often restricted from lowering their heads while being transported, which prevents nasal drainage and triggers upper respiratory tract inflammation. Based on positive outcomes in other species, we hypothesized Saccharomyces cerevisiae fermentate (SCF) would modify this immune response in horses. Two-year-old Quarter Horses (mean ± SEM; initial age 22 ± 0.3 mo and BW 439 ± 3 kg) were randomly assigned to receive SCF (Diamond V, Cedar Rapids, IA; 21 g/d; n = 10) or no supplement (CON; n = 10) added to their diet (60% hay, 40% concentrate) for 60 d. Horses were exercised 4 d/wk for 30–45 min/d at light to moderate intensity. On d 57 horses were tethered with their heads elevated 35 cm above wither height for 12 h to mimic long-distance transport. Whole blood samples were obtained before and up to 72 h after stress induction to evaluate immune cell function. Data were compared using mixed model ANOVA with repeated measures. Serum cortisol (P &lt; 0.01) and blood leukocytes (P &lt; 0.05) were greater after head elevation. Lymphocyte proliferation in response to lipopolysaccharide was lower (P &lt; 0.01) following head elevation but did not differ by treatment. Lymphocyte proliferation in response to concanavalin A exhibited a time × treatment effect (P = 0.05) where it decreased in CON horses after head elevation (P &lt; 0.05) but was unchanged in SCF horses. Neutrophil phagocytosis of Streptococcus equi (a respiratory pathogen) was temporarily reduced (P &lt; 0.05) after head elevation in both treatments. A time × treatment effect (P = 0.05) was observed for phagocytosis-induced oxidative burst, where it increased in SCF (P &lt; 0.01) but did not change in CON horses. These data indicate SCF modified peripheral immune cell activity following a localized mucosal stressor. Whether these responses improve resistance to opportunistic pathogens following transport needs to be determined.

Unilateral Optic Nerve Sheath Fenestration in Idiopathic Intracranial Hypertension: A 6-Month Follow-up Study on Visual Outcome and Prognostic Markers

Loss of vision is a feared consequence of idiopathic intracranial hypertension (IIH). Optic nerve sheath fenestration (ONSF) may be an effective surgical approach to protect visual function in medically refractory IIH. In this study, we evaluate the impact of unilateral superomedial transconjunctival ONSF on bilateral visual outcome using a comprehensive follow-up program. A retrospective chart review of IIH patients who underwent unilateral ONSF between January 2016 and March 2021 was conducted. Patients fulfilling the revised Friedman criteria for IIH and who had exclusively received ONSF as a surgical treatment were included. Main outcomes were visual acuity (VA); perimetric mean deviation (PMD); papilledema grade; and optic nerve head elevation (maxONHE) 1 week, 2 weeks, and 1, 3, and 6 months after surgery. VA (p < 0.05), PMD (p < 0.05), papilledema grade (p < 0.01), and maxOHNE (p < 0.001) were improved after 6 months on both the operated and non-operated eye. Prolonged surgical delay impedes PMD improvement (r = −0.78, p < 0.01), and an increasing opening pressure initiates a greater ganglion cell loss (r = −0.79, p < 0.01). In this small case series, we demonstrate that unilateral superonasal transconjunctival ONSF is a safe procedure with an effect on both eyes. Optic nerve head elevation and PMD are feasible biomarkers for assessing early treatment efficacy after ONSF.

The Differences of Left Lateral and Head Elevation Position toward Heart Rate of Newborns with Asphyxia in the Perinatology Room RSUD Dr. Soediran Mangun Sumarso Wonogiri

BACKGROUND: Asphyxia delivery results in hypoxic-ischemic encephalopathy and multiorgan failure. The organ most affected by hypoxia is the cardiovascular system. Newborns with asphyxia have a lack of oxygen (hypoxia) and have an increased heart rate (tachycardia). Giving baby positions, such as supination position, pronation, right lateral, left lateral, and head elevation, are expected to improve the hemodynamic of newborns with asphyxia. AIM: This study was to determine the difference in effect between left lateral position and the head elevation position on the heart rate of newborns with asphyxia in the perinatology room of RSUD Dr. Soediran Mangun Sumarso Wonogiri. METHODS: This research is a quasi-experimental quantitative study with a pre- and post-test non-equivalent control group design. Sampling using non-probability sampling technique with consecutive sampling. The sample was divided into two groups, namely, the intervention group with 30 respondents who got the left lateral position and the control group with 30 respondents who got the head elevation position. Data analysis was performed using the Statistical Package for the Social Sciences parametric test with paired t-test and independent t-test. RESULTS: The results of paired t-test analysis in the intervention group obtained p = 0.003 (p < 0.05) and in the control group obtained p < 0.001 (p < 0.05), which means that both have a significantly on changes in the heart rate of newborns with asphyxia. The results of the independent t-test analysis obtained p = 0.191 (p < 0.05), which means that there is no significant difference in the heart rate of newborns with asphyxia in the intervention and control groups. CONCLUSION: Both interventions, giving the left lateral position and the head elevation position, have a significantly effect on changes in the heart rate of newborns with asphyxia.