Delivery Complications Research Articles

Deciduous Teeth Hypomineralisation and Perinatal Risk Factors.

Hypomineralisation defects with demarcated opacities are also observed in the deciduous dentition and have been found to be a predictive factor for hypomineralisation defects in the permanent dentition. Deciduous molar hypomineralisation (DMH) represents a qualitative enamel defect primarily afflicting deciduous second molars, albeit its presence is not limited solely to deciduous second molars, as it can manifest in deciduous canines and first molars. Thus, the presence of demarcated hypomineralisation defects in deciduous teeth could be called as deciduous teeth hypomineralisation. Clinically, these defects are characterized by demarcated opacities, posteruptive enamel breakdown, atypical caries lesions, and atypical restorations. The accurate diagnosis of DMH continues to present a clinical challenge, and the reported prevalence of this defect exhibits notable variability across different countries. Its precise etiology remains elusive; however, there is a prevailing suspicion that events occurring during the prenatal, perinatal, or early postnatal periods, particularly those unfolding during the perinatal phase, are intricately linked to DMH development. Factors such as delivery complications, neonatal complications, prematurity, and low birth weight have been associated with DMH. Notably, there exists a possibility that, the more health-related events occur during this critical period, the greater the likelihood of a child presenting with this enamel defect. Nevertheless, the establishment of these associations warrants further investigation through prospective studies. Acquiring knowledge regarding the factors associated with this defect holds paramount importance for effective diagnosis, guidance for families with affected children, and the formulation of strategies to mitigate the incidence of these contributory factors.

Spontaneous bladder rupture: a case report of a rare complication of normal vaginal delivery

Background: Spontaneous bladder rupture (SBR) is defined as the presence of rupture without any antecedent trauma. It is usually due to underlying bladder pathology. Bladder rupture during labor or the postpartum period is extremely rare. Case Presentation: A 29-year-old gravida 2 Para 1 + 0 had an uneventful labor and a vacuum was used to assist the delivery. Seven days later, she was presented to the emergency department (ED) complaining of inability to urinate and abdominal pain. An immediate ultrasound scan (US) showed free fluid in the abdomen and pelvis. Due to her unstable condition, she was admitted to the ICU. The diagnosis of bladder rupture was made based on a CT cystogram showing contrast leaking from the posterior surface of the dome of the bladder. The patient was successfully managed conservatively by indwelling Foley's catheter and peritoneal drainage. Conclusion: Post-partum females with an acute abdomen associated with anuria, high blood urea nitrogen (BUN), and elevated serum creatinine should be investigated and treated emergently as SBR. Conservative management might be a successful option under the right conditions for the treatment of intra-peritoneal bladder rupture.

Влияние новой коронавирусной инфекции на течение беременности и родов у женщин

Currently, there are contradictory views of scientists on the impact of a novel coronavirus infection on the health of women of reproductive age, pregnancy and labor, in particular, against the background of changes in the homeostasis system. This issue requires the study and analysis of clinical observations of patients who have undergone COVID-19 in the unified system of mother-placenta-fetus-newborn for timely correction of the detected disorders and optimization of medical care. Objective. To determine the possible risks of complications of pregnancy and delivery in pregnant women who had a new coronavirus infection before and during pregnancy. Patients and Methods. We examined 485 women, 156 of whom had SARS-CoV-2-associated viral infection during pregnancy, 139 women before the onset of pregnancy, and 190 pregnant women without COVID-19. Data on the somatic health of the patients, the course of pregnancy and labor were obtained from the individual medical records of pregnant and postpartum women (Form No 111/u-20 and No 096/1u-20). The duration of follow-up ranged from 4 to 8 months. Pregnant women were examined within the decreed time frame, according to the Clinical Recommendations of the Russian Society of Obstetricians and Gynecologists supported by the Scientific and Practical Council of the Ministry of Health of the Russian Federation 2020–2023, with informed consent. The results of the study were processed using the application program package TIBCO STATISTICA (USA) for personal computer. When analyzing conjugation tables, Pearson's χ2 test was used to assess the statistical significance of differences between two relative indices. Data in groups were considered statistically significant at p < 0.05 or statistically highly significant at p < 0.001. Results. Iron deficiency, allergic diseases, and gastrointestinal pathology were the most frequent in the observed women, with statistically significantly fewer COVID-19-uninfected women. Pregnant women with new coronavirus infection in the 3rd trimester had a high incidence of pre-eclampsia, threatened abortion, and prescription of hormonal medications (p < 0.001). Pregnant women who underwent COVID-19 in the 2nd trimester had fetal growth retardation and threatened abortion (p < 0.05). The frequency of high D-dimer values in 3rd trimester pregnant women who had a new coronavirus infection was statistically significantly different compared to uninfected women (p < 0.05). Conclusion. The development of a complex of pregravidar preparation, including timely diagnosis of different strains of this infection in non-pregnant and pregnant women, dynamic observation for timely correction of detected homeostasis disorders and optimization of care in the unified system of mother-placenta-fetus-newborn. Key words: pregnant women, novel coronavirus infection, COVID-19

927 The impact of cup size on complications in vacuum-assisted deliveries: A retrospective case-control matching analysis

927 The impact of cup size on complications in vacuum-assisted deliveries: A retrospective case-control matching analysis

Study of Maternal Serum Ischemia-modified Albumin and Ischemia-modified Albumin Ratio in Uncomplicated and Complicated Pregnancy

Abstract Introduction: The maternal and fetal outcomes are poorer in pregnancies associated with obstetric complications. A newly recognized marker of hypoxia, serum ischemia-modified albumin (IMA), which serves as an early predictive marker of myocardial infarction in the emergency department, is now being studied in obstetric complications of pregnancy. Aims and Objectives: (1) To study the levels of maternal serum IMA in the early 2nd trimester (12–20 weeks) to predict the occurrence of uncomplicated and complicated pregnancy post 20 weeks of gestation. (2) To evaluate the IMR ratio (IMAR) (serum IMA-to-human serum albumin ratio) and its significance in the obstetric complications of pregnancy. Methodology: This prospective cohort study was conducted on 150 antenatal women with gestational age from 12 to 20 weeks. A complete detailed history of all participants was taken and they were followed up to the time of delivery for the specific complications (i.e., pregnancy-induced hypertension [PIH], preeclampsia, eclampsia, and gestational diabetes in mother and stillbirth, preterm birth, and fetal growth restriction [FGR] in the fetus) that developed during pregnancy. IMA levels and IMA ratio were obtained and correlated with the development of the defined complications of pregnancy. The data were recorded, tabulated, and subjected to statistical analysis. Results: A significant relationship between IMA value and the incidence of PIH, preeclampsia, and eclampsia and between IMAR value and the incidence of preeclampsia and eclampsia was seen among the study population (P < 0.05). We observed that IMA and IMAR values were higher in women who did not have any fetal complications than in women who had fetal complications, namely, stillbirth, preterm birth, and FGR. However, this difference was not significant (P > 0.05). Conclusion: Serum IMA and IMAR levels were higher in women with PIH, preeclampsia, and eclampsia. The most common pregnancy outcome was small for gestation age. No significant link was found between serum IMA levels or IMAR and the severity of eclampsia, gestational diabetes, stillbirth, preterm, and FGR.

Exploring COVID-19 vaccine adverse events among pregnant women: a cross-sectional study, 2022.

Clear and trustworthy information is crucial to improving public acceptance of COVID-19 vaccinations, especially among pregnant women. Given the increased risk of severe viral pneumonia in pregnant women, it is critical to foster confidence in the vaccine's safety and understand any potential adverse events (AEs). So, we did this study in Jeddah, Saudi Arabia (SA), from March to May 2022 to compare women who did not get any doses of the COVID-19 vaccine during pregnancy (Group A) to women who did get at least one dose during pregnancy (Group B) regarding (1) the frequency, types, AEs, and management of its AEs of the COVID-19 vaccination; and (2) exploring pregnancy, delivery, and fetus-related complications (e.g., miscarriage, birth defects, and preterm labor). A cross-sectional study targeted 438 women who gave birth or were pregnant within the previous 8 weeks. Data was collected through face-to-face interviews with skilled nurses in 13 randomly selected primary healthcare facilities, using a validated, well-structured questionnaire that included the Centers for Disease Control (CDC) COVID-19 vaccination-related AEs. We analyzed the collected data using SPSS version 27. Most participants were aged 25 to less than 35 (58.8%), and 287 (61.3%) were university graduates. There was no statistically significant difference among the studied groups regarding demographics. However, women in Group B had a significantly higher rate of abortions, oligohydramnios (24.4%), abnormal placentas (size and location), 103 (42.7%) abnormal fetal growth, 122 (53.7%) problems breastfeeding, blood pressure problems, and more cases of malaise, headaches, chest pain, breathing problems, and sleep problems than women in Group A. After the second and third doses, the confirmed post-vaccination COVID-19 rates in Group B were lower than those in Group A. The COVID-19 vaccine significantly reduces post-vaccination COVID-19. Although COVID-19 vaccine-related AES are prevalent, analgesics and antipyretics effectively treat most of them.

The Vertical Birthing Positions and Their Perinatal Outcomes in Hilly Tribal Home Birth Settings: A Qualitative Observational Study

This study aims to document the cultural significance of vertical birthing positions and knowledge of easing complicated deliveries among the Porja hilly tribal group, Visakhapatnam district, Andhra Pradesh, India. With the purposive sampling method, 31 postpartum mothers were selected on the inclusion criteria of having been given childbirth in the last six months. The socio-demographic profile of the respondents was presented to understand the socio-cultural living conditions. The qualitative data collection involved 31 face-to-face in-depth interviews with postpartum women and two focus group discussions involving six to eight traditional birth attendants (TBAs) on the cultural efficacy of upright positions. Handwritten transcripts of the interviews and conversations were transcribed and coded into themes and categories. Qualitative themes reveal that the pregnant women with anaemia and morbidity conditions had been exposed to maternal distress and foetal distress (breathing problems and loss of consciousness) but had managed by adopting immediate alternative vertical birthing positions with the suggestion of TBAs. The findings suggest that vertical birth positions are age-old childbirth customs which have been adopted as as a priority option by labouring women, especially in socio-economically disadvantaged societies where medical facilities are unavailable.

438 Complicated deliveries increase neonatal failure rates of the first Otoacoustic Emissions Hearing Test

438 Complicated deliveries increase neonatal failure rates of the first Otoacoustic Emissions Hearing Test

Term delivery through Partial Annular Cervical Tear in a Multigravida with history of Genital Prolapse: A Case Report

Injury to the cervix is one of the common complications of pregnancy and delivery, but partial annular tear of the cervix is a rare entity, let alone vaginal delivery through it. A 32-year-old second gravida presented to a tertiary care hospital in Haryana, India in early labour. Her intrapartum course was uneventful. Following delivery of the baby and after-births, a third degree prolapse of the cervix was noted along with partial annular cervical tear of about 10cm involving the posterior cervical lip and 2cm away from the external os. There was mild bleeding from the edges of the tear and it was repaired with intermittent simple suture using 2-0 chromic catgut. On further probing, the patient denied any cervical trauma or surgery in the past but she gave history of something coming down per vaginum on straining for the last two years. She had not taken any treatment for the management of prolapse. She was given prophylactic oral antibiotics for 5 days and was advised Kegel’s exercise during the postpartum period. On discharge, she was stable, the cervical repair appeared healthy and was asked to follow-up after 6 weeks. This case highlights the possibility of cervical tear in patients having genital prolapse during delivery, first such being reported.

Fetal growth analysis from ultrasound videos based on different biometrics using optimal segmentation and hybrid classifier.

Birth defects and their associated deaths, high health and financial costs of maternal care and associated morbidity are major contributors to infant mortality. If permitted by law, prenatal diagnosis allows for intrauterine care, more complicated hospital deliveries, and termination of pregnancy. During pregnancy, a set of measurements is commonly used to monitor the fetal health, including fetal head circumference, crown-rump length, abdominal circumference, and femur length. Because of the intricate interactions between the biological tissues and the US waves mother and fetus, analyzing fetal US images from a specialized perspective is difficult. Artifacts include acoustic shadows, speckle noise, motion blur, and missing borders. The fetus moves quickly, body structures close, and the weeks of pregnancy vary greatly. In this work, we propose a fetal growth analysis through US image of head circumference biometry using optimal segmentation and hybrid classifier. First, we introduce a hybrid whale with oppositional fruit fly optimization (WOFF) algorithm for optimal segmentation of segment fetal head which improves the detection accuracy. Next, an improved U-Net design is utilized for the hidden feature (head circumference biometry) extraction which extracts features from the segmented extraction. Then, we design a modified Boosting arithmetic optimization (MBAO) algorithm for feature optimization to selects optimal best features among multiple features for the reduction of data dimensionality issues. Furthermore, a hybrid deep learning technique called bi-directional LSTM with convolutional neural network (B-LSTM-CNN) for fetal growth analysis to compute the fetus growth and health. Finally, we validate our proposed method through the open benchmark datasets are HC18 (Ultrasound image) and oxford university research archive (ORA-data) (Ultrasound video frames). We compared the simulation results of our proposed algorithm with the existing state-of-art techniques in terms of various metrics.

Single-layer vs double-layer uterine closure during cesarean delivery: 3-year follow-up of a randomized controlled trial (2Close study)

BackgroundThe rising rate of cesarean sections (CS) has led to an increased incidence of long long-term complications, including niche formation in the uterine scar. Niche development is associated with various gynecological complaints and complications in subsequent pregnancies, such as uterine rupture and placenta accreta spectrum disorders. Although uterine closure technique is considered a potential risk factor for niche development, consensus on the optimal technique remains elusive. ObjectiveWe aim to evaluate the effect of single- versus double-layer closure of the uterine incision on live birth rate at a 3-year follow-up with secondary objectives focusing on gynecological, fertility and obstetric outcomes at the same follow-up. Study DesignA multicenter, double-blind, randomized controlled trial was performed at 32 hospitals in the Netherlands. Women ≥18 years undergoing a first CS were randomly assigned (1:1) to receive either single-layer or double-layer closure of the uterine incision. The primary outcome of the long-term follow-up was the live birth rate with secondary outcomes including pregnancy rate, the need for fertility treatment, mode of delivery, and obstetric and gynecologic complications. This trial is registered on the International Clinical Trials Registry Platform www.who.int (NTR5480; trial finished). ResultsBetween 2016 and 2018, the 2Close study randomly assigned 2292 women, with 830/1144 and 818/1148 responding to the 3-year questionnaire in the single-layer and double-layer closure. No differences were observed in live birth rates, also no differences in pregnancy rate, need for fertility treatments, mode of delivery or uterine ruptures in subsequent pregnancies. High rates of gynecological symptoms including spotting (30-32%), dysmenorrhea (47-49%) and sexual dysfunction (FSFI score 23)-are reported in both groups. ConclusionThe study did not demonstrate the superiority of double-layer closure over single-layer closure in terms of reproductive outcomes after a first CS. This challenges the current recommendation favoring double-layer closure, and we propose that surgeons can choose their preferred technique. Furthermore, the high risk of gynecological symptoms after a CS should be discussed with patients.

Maternal age and adverse pregnancy outcomes among Meitei women of Manipur, Northeast India: A cross-sectional study.

The study examines the outcomes of pregnancies conceived at advanced maternal age (AMA) and maternal complications after childbirth among Meitei women of Northeast India. A total of 760 women participants were included in this study and compared among women aged ≥35 years, with a reference group of women aged 20-34 years. Data on obstetric characteristics were collected after obtaining consent. The data were compared using chi-square analysis, and the results were adjusted using a logistic regression model. Decision trees were developed to predict the potential variables associated with preterm delivery and postpartum complication. In the study, 18.95% of AMA women experienced one or more adverse pregnancy outcomes (APOs). Women with AMA are at significantly increased risk of placenta previa (adjusted odds ratio [AOR] = 4.89, 95% confidence interval [CI]: 2.78-8.57), induction of labor (AOR = 3.69, 95%CI: 2.48-5.50), and caesarean section (AOR = 3.42, 95%CI: 2.28-5.12). Moreover, AMA women have a 1.86-2.76 AOR for developing gestational diabetes, pregnancy-induced hypertension, urinary tract infections, preterm delivery, and postpartum complications. Decision tree analysis revealed that AMA and urban residence independently predict preterm delivery and postpartum complications. The study's findings confirm the adverse impact of AMA on pregnancy outcomes and postpartum complications. Such issues should be addressed, and counseling on the risk of AMA should be provided, particularly for those in the high-risk group. Further prospective studies are needed to understand other potential risk factors of APOs and the impact of AMA complications to prevent the associated burden.

Mode of Delivery and Obstetric Complications in the Setting of Prior Uterine Surgery.

This study aimed to evaluate cesarean rates and risk for obstetric complications among deliveries with a history of prior uterine surgery. This serial cross-sectional study analyzed deliveries with and without prior uterine surgery in the 2016-2019 Nationwide Inpatient Sample. Unadjusted and adjusted logistic regression models were performed to assess risk of nontransfusion severe maternal morbidity (SMM) and other obstetric complications based on the presence or absence of prior uterine surgery with unadjusted and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) as measures of association. Adjusted models accounted for demographic, hospital, and delivery factors. Demographics and clinical factors among deliveries with and without a prior history of uterine surgery diagnosis were compared with the chi-square test with p < 0.05 considered statistically significant. Of 14.7 million delivery hospitalization identified, 6,910 (4.7 per 10,000) had a history of uterine surgery and 111,710 (0.76%) experienced SMM. Women with prior uterine surgery were more likely to be older, to be of unknown race or ethnicity, and to have private insurance (p < 0.01 for all). Eighty-five percent of deliveries with prior uterine surgery were performed by cesarean compared with 32% of deliveries without prior uterine surgery (p < 0.01). In adjusted analysis, compared with patients without prior uterine surgery, patients with prior uterine surgery were not at increased risk for SMM (aOR 1.23, 95% CI 0.73-2.07). Evaluating obstetric complications, patients with prior uterine surgery had a decreased risk of postpartum hemorrhage (aOR 0.64, 95% CI 0.43-0.96) and an increased risk of peripartum hysterectomy (aOR 4.12, 95% CI 1.75-9.67), and no difference in other obstetric complications assessed. These findings suggest that current clinical practice results in similar delivery risks among patients with compared with without prior uterine surgery. · Risk for most adverse outcomes is similar among patients with prior uterine surgery.. · Risk for peripartum hysterectomy was higher with prior uterine surgery.. · Risk for SMM was not higher with prior uterine surgery..

Screening for post-traumatic stress disorder following childbirth using the Peritraumatic Distress Inventory

BackgroundPost-traumatic stress disorder (PTSD) following traumatic childbirth may undermine maternal and infant health, but screening for maternal childbirth-related PTSD (CB-PTSD) remains lacking. Acute emotional distress in response to a traumatic experience strongly associates with PTSD. The Peritraumatic Distress Inventory (PDI) assesses acute distress in non-postpartum individuals, but its use to classify women likely to endorse CB-PTSD is unknown. Methods3039 women provided information about their mental health and childbirth experience. They completed the PDI regarding their recent childbirth event, and a PTSD symptom screen to determine CB-PTSD. We employed Exploratory Graph Analysis and bootstrapping to reveal the PDI's factorial structure and optimal cutoff value for CB-PTSD classification. ResultsFactor analysis revealed two strongly correlated stable factors based on a modified version of the PDI: (1) negative emotions and (2) bodily arousal and threat appraisal. A score of 15+ on the modified PDI produced high sensitivity and specificity: 88 % with a positive CB-PTSD screen in the first postpartum months and 93 % with a negative screen. LimitationsIn this cross-sectional study, the PDI was administered at different timepoints postpartum. Future work should examine the PDI's predictive utility for screening women as closely as possible to the time of childbirth, and establish clinical cutoffs in populations after complicated deliveries. ConclusionsBrief self-report screening concerning a woman's emotional reactions to childbirth using our modified PDI tool can detect those likely to endorse CB-PTSD in the early postpartum. This may serve as the initial step of managing symptoms to ultimately prevent chronic manifestations.

Enhancing Perinatal Outcomes in Gestational Diabetes Mellitus: A Midwifery Facilitator Based Approach

Introduction: Gestational diabetes mellitus, or GDM, is a metabolic disorder that affects both expectant mothers and their developing fetuses. It increases the chance of several pregnancy and delivery complications. Babies born to women with gestational diabetes mellitus (GDM) are at risk for perinatal death, fetal macrosomia, low blood sugar, birth trauma, and congenital malformations. This paper explores the possibility of enhancing perinatal outcomes in GDM by applying a midwifery facilitator-based approach. Objectives: This study's primary objective is to assess the impact of a midwife facilitator-based approach on the management of gestational diabetes mellitus (GDM) and its associated complications in expectant mothers and their babies. Our objective is to create a midwifery facilitator approach model that provides recommendations for clinical practice. Methods: A prospective cohort study involving 111 mothers compared standard care with care led by midwives. The intervention group was chosen based on their preferences, and they received full support, which included education, lifestyle modifications, and assistance for mothers. A certified diabetes educator led the classes, which covered a variety of subjects like multiple pregnancies, chronic illnesses, and absences. Group 1 comprised 62 mothers who attended classes and follow-ups, while 49 mothers in Group 2 did not attend any of them. Consistency and low turnover were assured. Results: The Midwifery Facilitator-Based Approach, which considers psychological, emotional, and physical factors, fully manages GDM. Strict diabetes management, nutritional counseling, promoting a healthy diet, and aiding in stress reduction are all made possible by these midwives. They empower mothers with GDM to take care of themselves and allow informed decision-making, potentially improving perinatal outcomes and the general well-being of GDM-affected families. Conclusion: A promising strategy for improving perinatal outcomes in GDM is the facilitator-based approach used by midwives. It offers a treatment plan that is holistic in nature, taking into account the relationships between various aspects of health. By integrating midwifery into GDM management, we can enhance mothers' empowerment and comprehension, which will ultimately benefit moms and their infants.

Age and Parity as Risk Factors for Childbirth Complications: A Systematic Review

Maternal deaths result from complications during, after pregnancy and childbirth. Factors affecting maternal mortality in Indonesia are 4 too and 3 too late. The main causes that account for nearly 75% of all maternal deaths are postpartum hemorrhage, infection, high blood pressure during pregnancy, complications from childbirth and unsafe abortion. This study aimed to analyze, synthesize, summarize and compare the results of one study with another on "The Relationship of Age and Parity to the Incidence of Complications of Childbirth. The method used in this study was to search various online data centers namely PubMed, Science Direct, Directory of Open Access Journals, Wiley, Cochrane Library, Google Scholar, Scopus. It was found that advanced maternal age and parity status was associated with an increased risk of delivery or obstetrics complication.

Determinants of Labour Complication in Indonesia (2017 IDHS Data Analysis)

An inconclusive fetal condition, or what is known as fetal distress, is one of the birth complications that needs attention, such as irregular heartbeat, low amniotic fluid and asphyxia. The aim of this study was to determine factors associated with pregnancy complications. This study is an analysis of secondary data from the 2017 IDHS (Indonesian Health Demographic Survey 2017). The design of this research is a cross-sectional studyThe sample in this study had 49,627 inclusion and exclusion criteria. The data was analyzed using logistic regression. the results of this research a relationship between maternal age in the high risk category, maternal education in the low category, parity in the high category, utilization of antenatal care is in the bad category, the use of family planning in the non MKJP category and having pregnancy complications with delivery complications.

Intrapartum transperineal ultrasound: angle of progression to evaluate and predict the mode of delivery and labor progression.

Intrapartum ultrasonography serves as a valuable tool for the objective evaluation of labor progression and effectively identifies underlying factors, such as asynclitism, in cases of abnormal labor progression. Among the various ultrasound measurement techniques, the angle of progression (AOP) demonstrates favorable reproducibility and accuracy in assessing fetal head descent. In the context of abnormal labor, interventions differ across different stages of labor, emphasizing the importance of investigating the utility of AOP according to labor stages in this review article. Pre-labor assessment of AOP can be beneficial in terms of counseling for the timing of induction of labor, while a wider AOP value during the prolonged first stage of labor has demonstrated a positive correlation with successful vaginal delivery and shorter time to delivery. In the second stage of labor, the AOP has exhibited efficacy in predicting the mode of delivery and complicated operative deliveries. Furthermore, it has assisted in predicting the duration of labor, thereby highlighting its potential as a decision-making model for labor progression. However, further research is needed to investigate aspects, such as the determination of cutoff values, of AOP, considering the multifaceted characteristics of labor progression, which are influenced by complex interactions among maternal, fetal, and other contributing factors.

Tenzing 7 delivery catheter with or without a leading microwire for single pass aspiration thrombectomy: A multicenter experience.

Aspiration mechanical thrombectomy traditionally includes use of an inner microcatheter and leading microwire to navigate an aspiration catheter (AC) to the site of occlusion. Early clinical experience suggests that a leading microwire is often not needed with the Tenzing 7 (T7, Route 92 Medical, San Mateo, CA), a soft tapered tip ledge-reducing delivery catheter. This multicenter experience aims to describe AC delivery success in single-pass thrombectomy using T7 with and without a leading microwire. A retrospective review was conducted of consecutive patients who underwent single-pass thrombectomy with T7 at six institutions between 2020 and 2022. We examined the percentage of successful AC delivery, puncture-to-revascularization time, and procedural complication rate. A leading microwire with T7 was used in 19/89 (21%) of patients, and it was not used with T7 in 70/89 (79%) of patients. Successful AC delivery was similar with and without microwires (97% vs. 90%, p = 0.15). Median puncture-to-revascularization times were similar (17 min microwire vs. 16 min no-microwire, p = 0.12). No complications were associated with microwire use; one (1.4%) patient had a T7-related vasospasm resolved with verapamil during thrombectomy without a leading microwire. Differences in complication rates were not statistically significant (p = 0.46). In our real-world clinical experience, leading microwire use was infrequently necessary with the T7 delivery catheter. Successful AC delivery and complication rates were similar with and without microwire use in single-pass T7 thrombectomies. Initial pass with T7 may be performed without use of leading microwire, reserving microwire use for refractory cases or known difficult-to-navigate vasculature.

Neuraxial Anesthesia in Obstetric Patients with Thrombocytopenia: Practice Patterns and Clinical Correlates

Introduction: Thrombocytopenia, (platelets under 150x10 9/L) is observed in 10% of pregnancies with counts below 100x10 9/L seen in 1-2% (Reese et. al, 2018, Gernsheimer, 2012). Neuraxial anesthesia is an effective pain management strategy for vaginal delivery and a safe alternative to general anesthesia for c-section. Although the precise risk of spinal hematoma has not been established in this patient population, it remains a common barrier to neuraxial procedures (Bernstein et. al, 2016). The hematology/maternal fetal medicine clinic (MFM) was created in our academic institution in February 2018 in response to the need to provide multidisciplinary care to patients with hematologic disorders in the context of pregnancy, including those with thrombocytopenia. Objectives: To establish the rate of neuraxial anesthesia in patients with thrombocytopenia seen in the multidisciplinary hematology/MFM clinic in our academic institution between 2018 and 2023 and identify clinical characteristics and practice patterns that affect the ability of this patient cohort to receive neuraxial procedures. Methods: Medical charts from all patients with thrombocytopenia affecting pregnancy evaluated in the hematology/MFM clinic (n=40 patients) were retrospectively reviewed. Baseline demographics, laboratory values, medical interventions (platelets directed treatment, neuraxial anesthesia, delivery route) and delivery outcomes were captured and analyzed using descriptive statistics (Table 1). Results: 40 patients underwent 44 deliveries. 33 (75%) were able to receive neuraxial anesthesia for delivery (15 vaginal and 18 c-section) ( Table 1) The median platelet count at the time of delivery was 105x10 9/L with 30 of 33 of the neuraxial deliveries occurring with platelet counts greater than 70x10 9/L (threshold recommended by the SOAP consensus (Bauer et. al, 2021)). The median platelet count at time of delivery for those who received neuraxial anesthesia was higher than for those who did not receive neuraxial (110x10 9/L vs 77x10 9/L). Rates of platelet directed treatment were similar in all patients independent of whether they received neuraxial anesthesia. Overall patients that did not receive neuraxial anesthesia delivered earlier and many delivered prior to their scheduled date. Despite the hematology/MFM clinic facilitating OB anesthesia consultations, a large proportion of patients were not evaluated prior to admission for delivery. Of the 11 patients that did not receive neuraxial anesthesia, 4 did not desire it, but would have been eligible based on their platelet counts at delivery ( Figure 1). Conclusions: These preliminary results indicate that a multidisciplinary approach can effectively treat thrombocytopenia in pregnant people and enable them to receive desired neuraxial anesthesia. Pre-term labor, precipitous delivery, and medical complications of pregnancy remain challenges to pregnant patients receiving neuraxial anesthesia. Future directions include examining which clinical interventions facilitate neuraxial anesthesia for pregnant patients in a larger population.