Effect of Frequent Vaginal Saline Lavage On Maternal Infection Prevention During Mechanical Labor Induction

Background: Induction of labor is performed in up to 25% of pregnancies. The major concern in mechanical labor induction is that it increases the chance of infection when a foreign device is introduced into the cervix. The aim of the study is to test the effectiveness of a vagina saline lavage procedure on infection prevention during labor induction by transcervical double balloon catheter.Methods: Enrolled pregnant women were randomly divided into two groups. The control group received standard aseptic vaginal cleansing with 5% betadine solution. In addition to the standard aseptic preparation, the study group received vaginal lavage with 0.9% saline solution before the device placement and once every 4 hours after the insertion. Results: There was no statistical difference in the demographic characteristics or the indications for induction between the two groups (P > 0.1). The final delivery modes and complication rates were not significantly different (P > 0.05) between the two groups, except for the maternal infection rate (P < 0.05). The rate of infection dropped from 10.6% to 2.9% when the frequent vaginal lavage procedure was performed. Conclusions: Excessive vaginal aseptic preparation by saline solution is easy to apply, safe and effective in reducing maternal infection during mechanical labor induction.

Right-to-left Shunt via Iatrogenic Atrial Septal Defect Requiring Emergency Surgical Repair following Cryoballoon Atrial Fibrillation Ablation in a Patient with Arrhythmogenic Right Ventricular Cardiomyopathy

An 81-year-old woman with arrhythmogenic right ventricular cardiomyopathy underwent catheter ablation for atrial fibrillation and atrial flutter. Hypoxemia refractory to the administration of oxygen was seen after transseptal puncture. Transthoracic echocardiography revealed right to left shunt via an iatrogenic atrial septal defect (IASD) that was increased by tricuspid regurgitation flow. Her hypoxemia improved after IASD occlusion with the inflation of a venogram balloon catheter. Emergent surgical IASD closure was successfully performed. IASD after transseptal puncture for atrial fibrillation ablation infrequently causes severe complications that require emergent repair.

Profiling cervical ripening for induction of labour with Foley’s balloon catheter in Ebonyi state, Nigeria: a randomized controlled trial

Background: The ripeness of the cervix is an important prerequisite to a successful labour induction. Use of extra-amniotic Foley catheter is a mechanical method of cervical ripening with proven efficacy. This study compared the difference in efficacy between 30 ml and 60 ml of water for inflation of Foley catheter balloon when used for cervical ripening during induction of labour.Methods: A single-blind randomized controlled study where 260 term pregnant women with intact membranes and unfavourable cervix were selected for induction of labour and randomized into two equal groups (30 ml- and 60 ml- groups) from October, 2019 to July 2020. Each participant had cervical ripening with the catheter bulb inflated with either 30 ml or 60 ml of sterile water (as assigned to the individual). After achieving favourable cervix (BS ≥6), oxytocin titration was commenced and the labour monitored with the outcomes well documented and statistically analysed.Results: Mean duration to favourable Bishop Score significantly reduced in the 60 ml group (10.8 hours±2.99) as against 12.7 hours±10.0 in 30ml group (p=0.038). Mean duration of active phase of labour was significantly reduced in 60 ml group (5.6 hours±2.4) as against 8.4 hours±3.2 in 30 ml group (p=0.010). Caesarean delivery rate was significantly reduced in the 60 ml groups (p=0.027).Conclusions: The use of 60 ml inflated Foley’s balloon catheter when compared with 30mls to ripen the cervix effectively reduced the duration to favourable Bishop Score, duration of the active phase of labour and the rate of Caesarean sections.

Successful delayed endovascular correction of migration of transcatheter aortic valve prosthesis in left ventricle outflow tract: case report

<p>We report the successful endovascular correction of the migration of a transcatheter aortic valve prosthesis in the left ventricle outflow tract (LVOT). A 72-old man was underwent transcatheter aortic valve implantation (TAVI) at Almazov National Medical Research Centre for severe aortic stenosis. During the procedure, the self-expanding prosthesis dislocated 10–12 mm into the LVOT. The frame was optimised with the use of a balloon catheter, and aortic regurgitation I-II degree was achieved. However, on day 17 of hospitalisation, acute heart failure with episodes of asystole occurred as a result of severe paravalvular regurgitation; cardiopulmonary resuscitation was necessary. The prosthesis malpositioning was corrected by traction with endovascular snare devices. The patient was stable during the postprocedural period and discharged on day 31. Dislocation of self-expanding prostheses into the LVOT is a complication specific to TAVI that may quickly aggravate a patient’s condition; therefore, correction of valve malpositioning should be performed as soon as possible. The case reported here in an illustration of successful endovascular correction of dislocation performed with the snare traction technique. This bail-out approach can be used by interventional cardiologists in similar situations.</p><p>Received 27 May 2021. Revised 29 July 2021. Accepted 30 July 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest: </strong>Authors declare no conflict of interest.</p><p><strong>Contribution of the authors<br /> </strong>Literature review: A.D. Gorovaya, D.D. Zubarev, A.A. Prokhorikhin<br /> Drafting the article: A.D. Gorovaya, V.S. Krasnov, A.A. Prokhorikhin<br /> Critical revision of the article: A.D. Gorovaya, M.A. Chernyavskiy, A.A. Prokhorikhin<br /> Surgical treatment: D.D. Zubarev, V.S. Krasnov, A.A. Prokhorikhin<br /> Final approval of the version to be published: A.D. Gorovaya, D.D. Zubarev, V.S. Krasnov, M.A. Chernyavskiy, A.A. Prokhorikhin</p>