Breech Presentation Research Articles

Variations of cervical head entrapment in vaginal breech births: New insights on how to prevent, manage and resolve

This paper presents a novel, systematic way to understand the causes of cervical head entrapment in vaginal breech births, and new insights into management. Three different types of cervical head entrapment are described, with detailed illustrations: unpredictable and potentially catastrophic, manageable, and preventable. The first affects preterm and growth-restricted fetuses. The second involves some degree of uterine prolapse. The third may result from prolonged head entrapment at the pelvic inlet, leaving time for cervical contraction or oedematous entrapment. Traditional and innovative strategies to resolve and prevent this complication are described and illustrated, with suggestions for further research.

Trend analysis of caesarean sections using modified Robson’s classification in a teaching institution in Uttarakhand

ABSTRACT Background: Globally, the rising caesarean section (CS) rate is of great concern as it is associated with increased maternal morbidity and mortality in subsequent pregnancies. It is essential to reanalyze the CS trend and curb the rising menace using a standardized uniform auditing system. This study aimed to analyze and evaluate the trend of CS using Modified Robson’s Ten Group classification system (RTGCS) in a teaching institution in Uttarakhand. Methodology: This cross-sectional study from October 2022 to March 2023 included 260 women undergoing elective or emergency CS. Data on maternal demographics, obstetrics, labour, and fetal outcomes were recorded. Indications for CS were analyzed using modified RTGCS. Results: The overall CS rate for the study period at our hospital was 31.4%. The major contributors to CS were Group 2 (21.5%), Group 10 (21.5%), and Group 5 (20.7%), while Group 6 and Group 8 contributed 10% and 7.6%, respectively. Group 9 had the least share (1%) in the study population. The two main indications for which CS was performed were prior Lower Section Caesarean Section (LSCS) and fetal distress, contributing to 24.6% and 19.2%, respectively. CS for breech presentation was done in 16% of the total cases. Conclusion: Modified RTGCS is an easy and effective method for auditing CS, preventing unnecessary procedures, and improving maternal care. Its implementation is crucial in addressing the increasing prevalence of CS and ensuring better maternal and fetal outcomes.

A Comprehensive Review of the Research Literature on External Cephalic Version (ECV)

External cephalic version (ECV) is an approach to turning a fetus from the breech presentation by external maneuvering of the fetus through the maternal abdominal wall into a cephalic presentation. We conducted a systematic search of the current literature on ECV to provide a comprehensive overview of the procedure and associated success rates, risks, and alternatives to ECV. Tocolytics can improve ECV success, but none of the tocolytics shown to be effective for ECV are currently available in Canada. The factors that can best predict ECV success are low uterine tone (associated with parity or tocolytics), easy palpation of the fetal head, and an unengaged breech. The most common side effect of ECV is transient fetal bradycardia with an incidence of one to six percent of all ECV procedures. The risk of requiring an emergency caesarean section because of ECV appears to be around 0.5% or one in 200 ECV procedures performed. Our review suggested no significant risk of fetal/neonatal mortality or serious morbidity associated with ECV. Few alternative approaches to turning a fetus in the breech presentation have been adequately studied. ECV should be considered for all women with a fetus in the breech presentation at term in the absence of any contraindications to the procedure.

The usefulness of universal ultrasound before hospital discharge for early diagnosing hip dysplasia in Korean neonates with breech presentation in a single center: A retrospective study.

Developmental dysplasia of the hip (DDH) is a broad-spectrum disorder. Early diagnosis and treatment are important for improved prognosis and a lower risk of long-term complications. Selecting high-risk infants is important for the early diagnosis of DDH using ultrasonography; however, there are no standard international guidelines. This study aimed to identify the usefulness of universal ultrasound before hospital discharge in breech-born neonates and proposes selective ultrasound for high-risk patients. A retrospective chart review was conducted to identify breech-born neonates who underwent hip ultrasonography before discharge for the detection of DDH between 2019 and 2023. Patients were categorized into DDH and non-DDH groups according to the ultrasound results. We compared sex, gestational age, birth weight, first-born status, twin pregnancy, associated anomalies, presence of symptoms, physical examination results, and timing of the first hip ultrasound. The medical records of the mothers were reviewed to identify the amount of amniotic fluid and duration of breech presentation. This study included 102 patients, of whom 62 and 40 were assigned to the non-DDH and DDH groups, respectively. Congenital anomalies, positive symptoms, and positive physical examination results were significant risk factors. However, female sex, first-born status, and oligohydramnios were not statistically significant. The duration of breech presentation during pregnancy was not significant. Additionally, the risk of Pavlik harnesses was higher in patients who underwent a positive physical examination. Universal ultrasonography before discharge is not recommended for the early diagnosis of DDH in all breech-born neonates because of the high rate of overdiagnosis. We recommend that ultrasonography be performed in patients with congenital anomalies, except for foot problems, or in those with a positive physical examination conducted by trained specialists.

Maternal and perinatal outcomes in nulliparous women with a booking body mass index exceeding 50 kg/m2.

Women with a body mass index (BMI) >35 kg/m2 carry an increased obstetric risk; however, the experience of the Class IV and above obese nulliparous women is less understood. To describe maternal and perinatal outcomes in nulliparous women of booking BMI > 50 kg/m2. A cohort study of 48 nulliparous women who delivered between 2015 and 2019 in a tertiary hospital and had a booking BMI > 50 kg/m2. Obstetric outcome data was collated via electronic and written patient records. The relationship between mode of delivery and BMI was assessed using direct logistic regression. Multiple pregnancies and severe congenital malformations (n = 3) were excluded. The mean booking BMI was 53.7 kg/m2 (SD 4.05) and mean maternal age was 30.4 years (SD = 5.7). Comorbidities included asthma (43%), essential hypertension (20%) and diabetes (61%). Antenatally, accuracy was compromised in 80% of morphology scans (n = 35). In the perinatal period, 33 women (68.8%) were induced compared to a spontaneous onset of labour in two (4.1%) women. There were nine elective caesarean sections (CS), five of which were for breech presentation. Of those who intended on vaginal delivery (n = 35), 51% (n = 18) had an emergency CS. In these women, the risk of CS increased by a factor of 1.36 for every one point increase in BMI > 50 kg/m2. The average gestational age was 37.5 weeks (SD 2.4) with 14% (n = 6) experiencing preterm deliveries. The incidence of babies born >90th percentile for gestational age was 15 (34%). Increased BMI impairs maternal and perinatal outcomes and significantly increases the risk of emergency CS. BMI > 50 kg/m2 is associated with higher-level interventions and obstetric complications.

Educating Midwives with the World's First Simulator: Madame du Coudray's Eighteenth Century Mannequin

Madam Angelique Marguerite du Coudray (b.1712-d.1769) taught 10,000 midwifery students in 70 cities and towns in France at the command of Kings Louis XV and Louis XVI of France. Her goal was to reduce the high rates of infant mortality in France through careful teaching of the technical, ethical and moral aspects of midwifery to young women around the country. Her course of study included 40 lessons over two months. To enhance her teaching she developed an obstetrical mannequin and wrote six editions of a textbook. Her first mannequin was highly accurate in its anatomical measurements and had many pieces that allowed the student midwife (or physician) to practice normal birth, breech births, complicated births and births at different gestational ages. One of these mannequins is on view at Musée Flaubert et d'histoire de la medicine in Rouen, France. This remarkable midwife leaves an important legacy.

Incidence of risk factors in developmental dysplasia of the hip: a retrospective study on 18,954 cases.

DDH is 1 of the most important causes of childhood disability. A diagnosis of instability can be made in the neonatal period via the Ortolani and Barlow manoeuvres. However, clinical examination, although highly specific, has poor sensitivity as compared to ultrasound. There is controversy between the necessity of universal screening for dysplasia of all newborns or selective screening reserved for those with clinical signs of instability or known risk factors of DDH. To analyse the risk factors of congenital hip dysplasia in a consecutive case series of children referred for diagnosis and treatment of DDH. This was a cross-sectional study on infants consecutively examined between January 2000 and December 2019 at the Marino Ortolani Centre in Ferrara, Italy. The first 3 types on Graf's classification were considered physiological (1A, 1B, 2A+), while the last 6 pathological (2A-, 2B, 2C, 2D, 3, 4). 18,954 infants met the inclusion criteria and were therefore considered eligible for the study. Of these 18,954 infants, 56% (n = 10,629) were females and 44% (n = 8325) were males. According to Graf classification, 34.9% (n = 6621) were 1A, 52.7% (n = 9999) were 1B, 4.0% (n = 753) were 2A+, 2.5% (n = 478) were 2A-, 1.5% (n = 284) were 2B, 1% (n = 196) were 2C, 1.3% (n = 243) were 2D, 1% (n = 193) were 3 and 1.0% (n = 187) were 4. The most significant risk factor was the female gender (OR 5.36; 95% CI, 4.63-6.20) followed by a family history (OR 2.35; 95% CI, 2.08-2.65), then skeletal pathologies (OR 2.04; 95% CI, 1.21-3.42), oligohydramnios (OR 1.75; 95% CI, 1.44-2.13), and finally breech presentation (OR 1.42: 95% CI, 1.27-1.60). Based on our data, family history, musculoskeletal disease, oligohydramnios and breech presentation are the main risk factors for DDH development, as is the female sex.

Caesarean section delivery rates and associated factors in a faith-based referral hospital in Ghana: A retrospective analysis.

The global incidence of caesarean section (CS) deliveries has exceeded the recommended threshold set by the World Health Organization. This development is a matter of public health concern due to the cost involved and the potential health risk to the mother and the neonate. We sought to investigate the prevalence, indications, maternal and neonatal outcomes and determinants of CS in private health facilities in Ghana. A retrospective cross-sectional analysis was conducted using data from women who delivered at the Holy Family Hospital from January to February 2020 using descriptive and inferential statistics, with a significance level set at p<0.05. The prevalence of CS was 28.70%. The primary indications of C/S include previous C/S, foetal distress, breech presentation, pathological CTG and failed induction. Significant associations were found between CS and breech presentation (AOR = 4.60; 95%CI: 1.22-17.38) p<0.024, previous CS history (AOR = 51.72, 95% CI: 11.59-230.70) p<0.00, and neonates referred to NICU (AOR = 3.67, 95% CI: 2.10-6.42) p<0.00. The prevalence of caesarean section (CS) deliveries was higher than the WHO-recommended threshold. Major indications for CS included previous CS, fetal distress, and failed induction. Significant risk factors for CS were previous CS history, breech presentation, and neonates referred to NICU.

The influence of uterine fibroids on adverse outcomes in pregnant women: a meta-analysis

ObjectiveThe objective of the meta-analysis was to determine the influence of uterine fibroids on adverse outcomes, with specific emphasis on multiple or large (≥ 5 cm in diameter) fibroids.Materials and methodsWe searched PubMed, Embase, Web of Science, ClinicalTrials.gov, China National Knowledge Infrastructure (CNKI), and SinoMed databases for eligible studies that investigated the influence of uterine fibroids on adverse outcomes in pregnancy. The pooled risk ratio (RR) of the variables was estimated with fixed effect or random effect models.ResultsTwenty-four studies with 237 509 participants were included. The pooled results showed that fibroids elevated the risk of adverse outcomes, including preterm birth, cesarean delivery, placenta previa, miscarriage, preterm premature rupture of membranes (PPROM), placental abruption, postpartum hemorrhage (PPH), fetal distress, malposition, intrauterine fetal death, low birth weight, breech presentation, and preeclampsia. However, after adjusting for the potential factors, negative effects were only seen for preterm birth, cesarean delivery, placenta previa, placental abruption, PPH, intrauterine fetal death, breech presentation, and preeclampsia. Subgroup analysis showed an association between larger fibroids and significantly elevated risks of breech presentation, PPH, and placenta previa in comparison with small fibroids. Multiple fibroids did not increase the risk of breech presentation, placental abruption, cesarean delivery, PPH, placenta previa, PPROM, preterm birth, and intrauterine growth restriction. Meta-regression analyses indicated that maternal age only affected the relationship between uterine fibroids and preterm birth, and BMI influenced the relationship between uterine fibroids and intrauterine fetal death. Other potential confounding factors had no impact on malposition, fetal distress, PPROM, miscarriage, placenta previa, placental abruption, and PPH.ConclusionThe presence of uterine fibroids poses increased risks of adverse pregnancy and obstetric outcomes. Fibroid size influenced the risk of breech presentation, PPH, and placenta previa, while fibroid numbers had no impact on the risk of these outcomes.

Analysis of caesarean delivery rates using Robson ten group classification system in North West Amhara referral hospitals, Ethiopia, 2022: A cross-sectional study

IntroductionThe cesarean delivery rate has been consistently rising over time and differs among different hospitals. In order to understand the specific factors contributing to this rapid increase beyond the recommended levels, it is necessary to continuously monitor and evaluate cesarean deliveries using the Robson ten-group classification system. Consequently, the objective of this study was to evaluate the rate of cesarean deliveries within each group by employing the Robson ten-group classification system. MethodA cross-sectional study design was conducted in referral hospitals in the North West Amhara region, involving 721 mothers who gave birth between January and February 2022. Participants were selected using systematic random sampling. Data collection involved an interviewer-administered, pretested, semi-structured questionnaire, as well as a review of medical charts. The women were allocated into one of the ten Robson groups. The proportion of each group, the contribution of each group to the total caesarean delivery rate, and the caesarean delivery rate within each group were all calculated. ResultThe overall caesarean delivery rate was 277 (38.3 %). The primary factors contributing to the overall cesarean delivery rate were found to be group 1 (23.9 %), group 5 (21 %), group 3 (11.6 %), and group 10 (11%). The most common indication for caesarean delivery included an abnormal fetal heart rate pattern, the presence of meconium in the amniotic fluid, a history of previous cesarean delivery, fetal-pelvic disproportion, and breech presentation. ConclusionGroup 1, 5, 3, and 10 emerged as the major contributor to the overall cesarean delivery rate. Interestingly, this study also unveiled a significant prevalence of cesarean delivery among low-risk groups. These specific groups warrant further investigation to identify potential factors that can be modified and implement targeted interventions to decrease the cesarean delivery rate. It is crucial to evaluate existing management protocols in the study area.

2D/4D Finger Length Ratio in the Screening of Developmental Dysplasia of the Hip.

To investigate whether there is a relationship between the 2nd finger and 4th finger length measurement ratios and developmental dysplasia of the Hip (DDH). Cross-sectional observational study. Place and Duration of the Study:Department of Orthopaedics and Traumatology, Meram Faculty of Medicine Hospital, Konya, Turkiye, from January 2020 to May 2023. Infants were screened for DDH with Graff method for the ultrasounds of both hips. Lengths of the 2nd and 4th fingers of both hands were measured and recorded. Patients with additional risk factors for developmental dysplasia of the hip (breech birth, family history, oligohydramnios, swaddling) were excluded. Two hundred and fifty-six babies were screened including 55.1% (n = 141) girls and 44.9% (n = 115) boys. Their mean age was 2.51 ± 0.80 months. The average lengths were 31.73 ± 3.05 mm, for the left 2nd finger and 34.26 ± 3.48 mm for the left 4th finger. In the hip USG measurements, the mean alpha angles were 62.91 ± 3.12° for the right hip and, 63.20 ± 3.55° for the left hip. Eighteen (7%) of babies who underwent hip ultrasound (USG) had unilateral or bilateral DDH. Among these cases, 2.7% (n = 7) had right, 2.3% (n = 6) had left, and 2% (n = 5) had bilateral DDH. There was no statistically significant correlation between the ratios of right 2/4 finger lengths and the right alpha angle (rs = 0.051; p = 0.421). There was a statistically positive and statistically significant correlation between the ratios of left 2/4 finger lengths and the left alpha angle (rs = 0.154; p = 0.013). Only the left-hand finger ratio among the parameters in the model had a statistically significant effect on DDH. Therefore, the left hand 2D/4D finger length may be of value in screening for DDH. Developmental dysplasia of the hip, Second to fourth finger digit ratio, Ring finger, Digit ratios.

Statistical Characterisation of Fetal Anatomy in Simple Obstetric Ultrasound Video Sweeps

Background: We present a statistical characterisation of fetal anatomies in obstetric ultrasound video sweeps where the transducer follows a fixed trajectory on the maternal abdomen. Methods: Large-scale, frame-level manual annotations of fetal anatomies (head, spine, abdomen, pelvis, femur) are used to compute common frame-level anatomy detection patterns expected for breech, cephalic, and transverse fetal presentations, with respect to video sweep paths. The patterns, termed statistical heatmaps, quantify the expected anatomies seen in a simple obstetric ultrasound video sweep protocol. In this study, we use a total of 760 unique manual annotations from 365 unique pregnancies. Results: We provide a qualitative interpretation of the heatmaps assessing the transducer sweep paths with respect to different fetal presentations and suggest ways the heatmaps can be applied in computational research (e.g. as a machine learning prior). Conclusions: The heatmap parameters are freely available to other researchers (https://www.github.com/agleed/calopus_statistical_heatmaps).

First Successful Pregnancy After Lung Transplantation in Poland—Case Report

Lung transplantation is well-established treatment for patients with advanced lung dysfunction in cystic fibrosis (CF). Pregnancy in CF lung transplant recipients is feasible, although it still remains challenging for even professionals and demands a multidisciplinary approach. We report the case of pregnancy in a 22-year-old woman after lung transplantation (LTx) due to end-stage respiratory failure in the course of CF. The interval from transplant to conception was 2.5 years. In 2019, orthotopic LTx was performed and a 3-drug immunosuppressive scheme was used-tacrolimus, mycophenolate mofetil, and prednisolone. There were no complications in the postoperative course. In April 2022, the patient was confirmed pregnant. All fetotoxic or teratogenic drugs were discontinued. Throughout the whole pregnancy, the patient was regularly monitored in the transplant and obstetrics centers. Due to the vaginal bleeding and irregular contractions at the 33 weeks of pregnancy, the course of steroids was administered. At 38 weeks and 5 days of gestation, she presented premature rupture of membranes. The caesarean section was performed because of breech presentation of the fetus. A live, term daughter was born and according to the screening test she does not have CF. Currently, 12 months after the delivery, the mother's lung function is good. Getting pregnant and having a safe pregnancy after LTx is possible, but it requires a specialized and individual approach. The patient should be well informed about possible complications and risks including graft failure. The patient's attitude and her cooperation with doctors play a major role.

Role of Dynamic Ultrasound Scan in Detection of Hip Instability and Changing Management Plan

Objectives: To show the vital role of dynamic ultrasound in hip instability screening and review the management plans available for DDH associated with instability with a view to reduce the incidence of complication from delayed diagnosis in our region. Place and Duration of the study: Helena governmental rehabilitation center for children with special needs, Erbil-Iraq, between Nov’21 to Jan’23. Material and Method: This study included 942 infants’ hips presenting with high-risk indicators or a positive clinical examination ranging in age from 6 weeks to 6 months. We performed the ultrasonography using the static Graf technique to determine the DDH Types and then apply the dynamic scan to find stability using Moren-Terjesen’s and Harcke methods. The management approaches were conducted considering both techniques. We used SPSS version 28 along with Chi-square test for data analysis and comparison of proportions. Results: In this retrospective cross-sectional study of 942 hips, the mean age of the infants was 11.9±4.8 weeks with male to female percentage of 46% to 54%. We found a correlation between family history and breech presentation to the dynamic scan stability. In the Graf technique 55% showed the absence of dysplasia while the dynamic scan showed 66% of the hips as normal and 34% as unstable. Further, the significant statistical association (P= 0.001) between the results of dynamic scan stability to the effect on the management plan was also found to advise the change for the unstable hips. Conclusion: It is crucial to apply both static and dynamic scans in the screening of DDH, so that we can reduce the possibility of late detection and elevate the level of diagnostic accuracy. We should follow a strict guideline for the management of all DDH cases (stable and unstable) and change the plan accordingly.

Appropriateness, timeliness and perinatal outcomes of obstetric referrals managed by caesarean section: A prospective observational cohort study

AbstractObjectiveTo evaluate the appropriateness, timeliness and perinatal outcomes of obstetric referrals compared to nonreferrals managed by caesarean section (CS) at a tertiary hospital.MethodsResearch assistants observed and recorded every delivery prospectively. Neonates were followed to discharge or up to 7 days, and outcomes were recorded. Proportions were used to describe baseline characteristics of the groups, and logistic regression was used to determine factors associated with CS in the referral group.ResultsA total of 10 353 deliveries occurred during the study period: 7.4% (768) were referrals and 92.6% (9585) were nonreferrals. The proportion of CS among referrals was 41.5% (319), nonreferrals 22.5% (2152) and overall 23.8% (2471). Compared to nonreferrals, referred women arrived at the second stage of labour with complications, ending up with emergency CS (p &lt; 0.001). Factors associated with CS with odds ratio (OR) in the referral group were previous CS (11.06), abnormal foetal heart rate (4.96), breech presentation (4.61) and thick meconium (3.61). The referral group had higher proportions of stillbirths and neonatal admissions compared to nonreferrals (p &lt; 0.001).ConclusionReferred women arrived late with complications ending with CSs and adverse perinatal outcomes. Earlier identification of complications and timely referral from lower‐level facilities may have the potential to prevent adverse outcomes.

Fetal Outcome in Younger Age Pregnant Female; A Tertiary Care Hospital

Background: The efficacy of Caesarean section in managing breech births surpasses that of a vaginal birth. Risk factors associated with breech presentation include prematurity,recurrent pregnancies, uterine anomalies, and fetal abnormalities. this study aimed toassess fetal outcomes in younger age pregnant female.Materials and Methods:This cross-sectional study was performed in Department of Obstetrics and Gynecology at Mardan Medical Complex, Mardan. The study conducted in 12 months duration from January to December 2020. All data including patients' history,and clinical tests were collected through designed proforma. All recruited patients and fetal were monitor. All data were analyzed through Microsoft excel 2016.Results: Fetal outcomes revealed that out of the total cases, 53.6% found in age group 18-25 years and 46.4% in age 26-33 years. Apgar scores found low in 17.8%, low birth weight fetus observed in 17.8%, birth asphyxia in 32.9%, brachial plexus in 12.5%, andfetal distress in 11.4%.Conclusion: This study highlights that fetal birth issues including low birth weight, birth asphyxia, brachial plexus, and detal distress are common here in our region. It is a crucial to take additional precautions, including vigilant labor monitoring and thorough preparation for infant resuscitation, to mitigate these issues within our local Khyber Pakhtunkhwa community. Awareness of the risks associated with each option can aid in personalized decision-making regarding breech delivery, adding value to the decision-making process. Therefore, the choice of delivery method for breech presentations should be informed by the findings of this study.

Maternal outcomes of planned mode of delivery for term breech in nulliparous women.

To estimate short- and long-term maternal complications in relation to planned mode of term breech delivery in first pregnancy. Register-based cohort study. Denmark. Nulliparous women with singleton breech delivery at term between 1991 and 2018 (n = 30,778). We used data from the Danish national health registries to identify nulliparous women with singleton breech presentation at term and their subsequent pregnancies. We performed logistic regression to compare the risks of maternal complications by planned mode of delivery. All data were proceeded and statistical analyses were performed in SAS 9.4 (SAS Institute Inc. Cary, NC, USA). Postpartum hemorrhage, operative complications, puerperal infections in first pregnancy and uterine rupture, placenta previa, post-partum hemorrhage, hysterectomy and stillbirth in the subsequent two pregnancies. We identified 19,187 with planned cesarean and 9,681 with planned vaginal breech delivery of which 2,970 (30.7%) delivered vaginally. Planned cesarean significantly reduced the risk of postoperative infections (2.4% vs 3.9% adjusted odds ratio (aOR): 0.54 95% confidence interval (CI) 0.44-0.66) and surgical organ lesions (0.06% vs 0.1%; (aOR): 0.29 95% CI 0.11-0.76) compared to planned vaginal breech delivery. Planned cesarean delivery in the first pregnancy was associated with a significantly higher risk of uterine rupture in the subsequent pregnancies but not with risk of postpartum hemorrhage, placenta previa, hysterectomy, or stillbirth. Compared to planned vaginal breech delivery at term, nulliparous women with planned cesarean breech delivery have a significantly reduced risk of postoperative complications but a higher risk of uterine rupture in their subsequent pregnancies.

The Role And Importance Of The Use Of Sımulatıon In Mıdwıfery Educatıon

HHaving an important place in medical education in today's technology age, the practice of simulation has become an indispensable element of midwifery education. Simulation education today is widely applied in many cases such as in obstetrics as evaluation of cervical dilatation, amniocentesis, delivery, breech delivery and management of shoulder dystocia, umbilical cord prolapse, eclampsia, postpartum hemorrhage, first care of the newborn, and maternal cardiac arrest. The simulation application has become an important educational strategy which aims to reveal the health skills with a multidisciplinary approach by creating the real conditions of a situation without taking the possible risks to be encountered, and by providing the person with the experience of that situation in the virtual or artificial environment. The simulation application helps to increase the knowledge and skills of health professionals in the field of obstetrics in order to improve maternal and newborn health and reduce morbidity and mortality rates. The simulation application enables midwifery education to become more comprehensive, resulting in improved patient care and increased patient safety and supports the development of midwifery skills by facilitating students' learning abilities in the intersection of theory and practice. Contrary to traditional methods in education, the application of simulation enables midwifery students to graduate as individuals who act with the approach of a multidisciplinary team, and who are equipped, competent in their field have high self-confidence. The aim of this review is to examine the relevant literature and to reveal the role and importance of the use of simulation in midwifery education.

استكشاف عوامل الخطر والنتائج للأطفال الذين يولدون بوزن منخفض في وحدة العناية المركزة للأطفال الرضع في مستشفى مصراتة - تحليل استرجاعي (2022)

Objective: To examine the characteristics and outcomes of low-birth-weight (LBW) newborns admitted to the NICU at Misurata Teaching Hospital in 2022, and to identify key factors influencing their survival. Patient’s and methods: a retrospective descriptive study included 199 LBW newborns (&lt;2.5kg) admitted to the NICU during the study period. Data were collected from medical records and analyzed using descriptive statistics. Results: Maternal factors: Mothers aged 30-35 years had the highest mortality burden. Clear amniotic fluid was associated with the highest death rate, despite being the most common finding. Gestational age showed a clear inverse relationship with survival, with mortality reaching 100% for infants born before 28 weeks. Low APGAR scores were a significant predictor of mortality. RDS and sepsis were the most common diagnoses, with RDS having the highest mortality rate. Elective caesarean section had the lowest mortality rate, while normal vaginal delivery and urgent C-section had higher rates. Cephalic presentation, though most common, had a higher mortality rate than breech presentation. Conclusion: LBW newborns in Misurata Teaching Hospital faced a complex interplay of maternal, neonatal, and delivery-related factors influencing their survival. Further investigation into maternal factors and individualized delivery management is warranted to improve the prognosis of LBW newborns in this population.

Assisted reproductive technology (ART) is not an independent risk factor for breech presentation among singleton term births in Vienna, Austria.

Assisted reproductive technologies (ARTs) such as in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) are still discussed critically, as there is no consensus on whether these treatments could be the cause of risk factors for obstetric problems such as breech presentation. The aim of this study was to test the association between ART and breech presentation among 11920 singleton term births taking place in Vienna from 2010 to 2020. In this single-centre medical record-based study, data concerning the conception mode (spontaneous versus IVF or ICSI), child presentation, birth mode, newborn sex and size as well as age, height, weight, and reproductive history of the mother were included. Three hundred twenty-six newborns (2.7%) were conceived by IVF or ICSI, and 527 newborns (4.4%) were delivered in breech presentation. Breech presentation occurred in 7.6% of IVF/ICSI children but only in 4.3% of spontaneously conceived children (P = 0.019). ART increased the crude risk of breech presentation significantly (OR = 1.67; 95% CI 1.71 - 2.38). After adjusting for maternal age, height, number of previous births, smoking, and newborn sex, however, ART had no longer a significant impact on the risk of breech presentation. In contrast, breech presentation was significantly associated with higher maternal age as well as a lower number of previous births, but not with ART. This study shows that the adverse outcomes of IVF and ICSI pregnancies may not be due to the ART treatment alone but might also be due to the mostly higher age and lower parity of the mothers using ART.