Cord Avulsion Research Articles

Neonatal Outcomes of Water Delivery versus Land Delivery: A Retrospective Propensity Score Weighted Study.

Recent evidence has shown that water delivery is safe for the mother, but high-quality evidence is not available for the newborn. Therefore, obstetric guidelines do not support it. This retrospective study aimed to contribute to the available evidence on maternal and neonatal outcomes associated with water delivery. Retrospective cohort study from prospectively collected birth registry data from 2015 to 2019. A total of 144 consecutive water deliveries and 265 land deliveries eligible for waterbirth were identified. The inverse probability of treatment weighting (IPTW) method was applied to address for confounders. We identified 144 women who delivered in water (water group) and 265 women who delivered on land (land group). One (0.7%) neonatal death was observed in the water delivery group. After IPTW adjustment, water delivery was significantly associated with a higher risk of maternal fever in puerperium (odds ratio [OR]: 4.98; 95% confidence interval [CI]: 1.86-17.02; p = 0.004), of neonatal cord avulsion (OR: 20.73; 95% CI: 2.63-2,674; p = 0.001), and of positive neonatal C-reactive protein (CRP > 5 mg/L; OR: 2.59; 95% CI: 1.05-7.24; p = 0.039); delivering in water was associated with lower maternal blood loss (mean difference: 110.40 mL; 95% CI: 191.01-29.78; p = 0.007), a lower risk of major (≥1,000 mL) postpartum hemorrhage (OR: 0.96; 95% CI: 0.92-0.99; p = 0.016), lower risk of manual placenta delivery (OR: 0.18; 95% CI: 0.03-0.67; p = 0.008) and curettage (OR: 0.24; 95% CI: 0.08-0.60; p = 0.002), lower use of episiotomy (OR: 0.02; 95% CI: 0-0.12; p < 0.001), and lower risk of neonatal ward admission (OR: 0.35; 95% CI: 0.25-0.48; p < 0.001). The present study showed that differences are present between water and land delivery, and among them is the risk of cord avulsion, a severe and potentially fatal event. In women choosing to deliver in water, a trained staffmust be present and immediate recognition of cord avulsion is key for a prompt management to avoid possible serious complications. · High-quality evidence is not available for neonatal safety of waterbirth; therefore, retrospective studies still represent the main body of evidence.. · Differences are present between water and land delivery, and among them, the increased risk of cord avulsion is a potentially fatal event.. · A trained staff must assist women who chose to deliver in water and cord avulsion must be promptly recognized and managed to avoid severe neonatal complications..

Alternate Birth Strategies.

Community birth is defined as birth that occurs outside the hospital setting. Birthing in a birth center can be safe for certain patient populations. Home birth can also be safe in well-selected patient with a well-established transfer infrastructure should an emergency occur. Unfortunately, many areas of the United States and the world do not have this infrastructure, limiting access to safe community birth. Immersion during labor has been associated with decreased need for epidural and pain medication. Delivery should not occur in water due to concerns for infection and cord avulsion. Umbilical cord non-severance (also called lotus birth) and placentophagy should be counseled against due to well-documented risks without clear benefit. Birth plans and options should be regularly discussed during pregnancy visits.

GENETICALLY CONFIRMED TYPE I LEUKOCYTE ADHESION DEFICIENCY IN A TWO-YEAR-OLD MALE

<h3>Introduction</h3> Leukocyte adhesion deficiency (LAD) type 1 affects about one in a million people world-wide. Presentation typically includes delayed separation of the umbilical cord, neutrophilia, and repeated bacterial infections soon after birth. Here we present a case of a 2-year-old male who presented in respiratory failure later found to have genetically confirmed type 1 LAD. <h3>Case Description</h3> A 2-year-old male in state custody presented to an outside hospital with fever and respiratory distress secondary to croup. Hospital course was complicated by right vocal cord avulsion likely secondary to trauma, difficulty in extubation requiring steroids and tracheostomy, persistent leukocytosis with neutrophilia, and reccuring fevers. He was transferred to our hospital after CD18/CDb11 expression was found to be 0%. We sent primary immunodeficiency genetic testing confirming a pathogenic variant in ITGB2 and 22q22.3 pathogenic deletion which included ITGB2, AIRE and ICOSLG. <h3>Discussion</h3> When given an unclassical and convoluted history, relying on more objective data like laboratory results and physical exam is crucial. Our case was challenging due to a complex social situation making obtaining a good history difficult and inability to examine the patient on initial consultation. History revealed insignificant infection history and no delayed separation of the umbilical cord. Therefore, before being able to examine the patient and obtain genetic testing there was some skepticism of the diagnosis despite supporting flow cytometry. Once the patient arrived at our facility, physical exam revealed wound healing characteristic of LAD, increasing suspicion of the disease. Genetic testing confirmed LAD, as he was hemizygous for a pathogenic variant in ITGB2.

A prospective cohort study comparing neonatal outcomes of waterbirth and land birth in an Australian tertiary maternity unit.

Maternal preference for warm water immersion (WWI) and waterbirth is increasing, but adoption into obstetric guidelines and clinical practice remains limited. Concerns regarding safety and a paucity of evidence have been cited as reasons for the limited adoption and uptake. The aim was to investigate maternal and neonatal outcomes after WWI and/or waterbirth compared with land birth. A prospective cohort study was conducted in an Australian public maternity hospital between 2019 and 2020. Maternal and neonatal outcomes for 1665 women who had a vaginal birth were studied. Primary outcome was admission to the neonatal unit (NNU). Secondary outcomes included neonatal antibiotic administration, maternal intrapartum fever, epidural use and perineal injury. Multivariate logistical regression analyses compared the outcomes between three groups: waterbirth, WWI only and land birth. NNU admissions for a suspected infectious condition were significantly higher in the land birth group (P= 0.035). After accounting for labour duration, epidural use and previous birth mode, no significant difference was detected between groups in the odds of NNU admission (P= 0.167). No babies were admitted to NNU with water inhalation or drowning. Women birthing on land were more likely to be febrile (2 vs 0%; P= 0.007); obstetric anal sphincter injury and postpartum haemorrhage were similar between groups. Regional analgesia use was significantly lower in the WWI group compared to the land birth group (21.02 vs 38.58%; P= <0.001). There was one cord avulsion in the waterbirth group (0.41%). Maternal and neonatal outcomes were similar between groups, with no increased risk evident in the waterbirth and WWI groups.

Systematic review and meta-analysis to examine intrapartum interventions, and maternal and neonatal outcomes following immersion in water during labour and waterbirth

ObjectivesWater immersion during labour using a birth pool to achieve relaxation and pain relief during the first and possibly part of the second stage of labour is an increasingly popular...

Maternal and neonatal outcomes following waterbirth: a cohort study of 17 530 waterbirths and 17 530 propensity score-matched land births.

Investigate maternal and neonatal outcomes following waterbirth. Retrospective cohort study, with propensity score matching to address confounding. Community births, United States. Medical records-based registry data from low-risk births were used to create waterbirth and land birth groups (n = 17 530 each), propensity score-matched on >80 demographic and pregnancy risk covariables. Logistic regression models compared outcomes between the matched waterbirth and land birth groups. Maternal: immediate postpartum transfer to a hospital, any genital tract trauma, severe (3rd/4th degree) trauma, haemorrhage >1000 mL, diagnosed haemorrhage regardless of estimated blood loss, uterine infection, uterine infection requiring hospitalisation, any hospitalisation in the first 6 weeks. Neonatal: umbilical cord avulsion; immediate neonatal transfer to a hospital; respiratory distress syndrome; any hospitalisation, neonatal intensive care unit (NICU) admission, or neonatal infection in the first 6 weeks; and neonatal death. Waterbirth was associated with improved or no difference in outcomes for most measures, including neonatal death (adjusted odds ratio [aOR] 0.56, 95% CI 0.31-1.0), and maternal or neonatal hospitalisation in the first 6 weeks (aOR 0.87, 95% CI 0.81-0.92 and aOR 0.95, 95% CI 0.90-0.99, respectively). Increased morbidity in the waterbirth group was observed for two outcomes only: uterine infection (aOR 1.25, 95% CI 1.05-1.48) (but not hospitalisation for infection) and umbilical cord avulsion (aOR 1.57, 95% CI 1.37-1.82). Our results are concordant with other studies: waterbirth is neither as harmful as some current guidelines suggest, nor as benign as some proponents claim. New study demonstrates #waterbirth is neither as harmful as some current guidelines suggest, nor as benign as some proponents claim. @TheUpliftLab @BovbjergMarit @31415926abc @NICHD_NIH.

The Experience of Land and Water Birth Within the American Association of Birth Centers Perinatal Data Registry, 2012-2017.

Consumer demand for water birth has grown within an environment of professional controversy. Access to nonpharmacologic pain relief through water immersion is limited within hospital settings across the United States due to concerns over safety. The study is a secondary analysis of prospective observational Perinatal Data Registry (PDR) used by American Association of Birth Center members (AABC PDR). All births occurring between 2012 and 2017 in the community setting (home and birth center) were included in the analysis. Descriptive, correlational, and relative risk statistics were used to compare maternal and neonatal outcomes. Of 26 684 women, those giving birth in water had more favorable outcomes including fewer prolonged first- or second-stage labors, fetal heart rate abnormalities, shoulder dystocias, genital lacerations, episiotomies, hemorrhage, or postpartum transfers. Cord avulsion occurred rarely, but it was more common among water births. Newborns born in water were less likely to require transfer to a higher level of care, be admitted to a neonatal intensive care unit, or experience respiratory complication. Among childbearing women of low medical risk, personal preference should drive utilization of nonpharmacologic care practices including water birth. Both land and water births have similar good outcomes within the community setting.

Perinatal Outcomes Associated With Isolated Velamentous Cord Insertion in Singleton and Twin Pregnancies.

To evaluate perinatal outcomes in singleton and twin pregnancies with pathologically confirmed velamentous cord insertion without vasa previa. This retrospective case-control study included all nonanomalous singleton and twin pregnancies with pathologically confirmed velamentous cord insertion delivered in a single institution between January 1, 2005, and July 1, 2015, and having an ultrasound examination by maternal-fetal medicine. For each case, the next 2 consecutive deliveries matched for gestational age at delivery ± 1 week and, in twins, amnionicity and chorionicity served as controls. Primary outcomes included surgical delivery for a nonreassuring intrapartum fetal heart rate tracing, umbilical arterial cord pH of less than 7.2, 5-minute Apgar score of less than 7, birth weight below the 10th percentile, neonatal intensive care unit admission, fetal or neonatal death, and cord avulsion necessitating manual placental extraction. Outcomes were available for 53 singletons with 103 matched controls and 33 twin pregnancies with 65 matched controls. In singletons, velamentous cord insertion was associated with cord pH of less than 7.2 (odds ratio [OR] 3.5; 95% confidence interval [CI], 1.1-11.2; P = .039), 5-minute Apgar score of less than 7 (OR, 5.3; 95% CI, 0.99-28.1; P = .045), and cord avulsion requiring manual placental extraction (7.5% versus 0%; P = .012). Associations were suggested with increased surgical delivery for a nonreassuring intrapartum fetal heart rate tracing (OR, 2.4; 95% CI, 0.9-6.9; P = .14), birth weight below the 10th percentile (OR, 2.1; 95% CI, 0.8-5.9; P = .21), and fetal or neonatal death (3.8% versus 0%; P = .11). Velamentous cord insertions were also associated with placental abruption in singletons (7.5% versus 0%; P = .013). Among twins, velamentous cord insertion was associated with fetal or neonatal death (9.1% versus 0%; P = .036). Isolated confirmed velamentous cord insertion is associated with adverse perinatal outcomes in singleton and twin gestations.

A Model Practice Template for Hydrotherapy in Labor and Birth.

A Model Practice Template for Hydrotherapy in Labor and Birth.

Waterbirth: an integrative analysis of peer-reviewed literature.

Despite a growing body of evidence for waterbirth safety, a myriad of political and cultural issues result in limited use in US hospitals compared to other developed nations. The purpose of this article is to critically analyze the evidence on maternal and neonatal outcomes of waterbirth to help inform evidence-based clinical practice in the United States. A literature search was performed using electronic databases CINAHL, Ovid MEDLINE, PubMed, EMBASE, and PsycINFO. Thirty-eight studies, including 2 randomized controlled trials and 36 observational studies, were reviewed. Studies were conducted in 11 countries, mostly outside the United States. More than 31,000 waterbirths were described. Aggregate results suggest that waterbirth is associated with high levels of maternal satisfaction with pain relief and the experience of childbirth, and may increase the likelihood of an intact perineum. Waterbirth is associated with decreased incidence of episiotomy and severe perineal lacerations, and may contribute to reduced postpartum hemorrhage. Data indicate no difference in maternal or neonatal infection rates or nursery admissions after waterbirth. Neonatal mortality rates are low and similar after waterbirth and uncomplicated conventional birth. The calculated cord avulsion rate is 2.4 per 1000 waterbirths; it is unknown how this compares to conventional birth due to a lack of data that permits direct comparison. The majority of waterbirth research to date is observational and descriptive; thus, reported outcomes do not demonstrate causal associations. However, existing evidence is reassuring. Case-controlled studies have included thousands of women who gave birth underwater without an apparent increase in maternal or neonatal morbidity or mortality. Potential risks associated with waterbirth for women and neonates appear minimal, and outcomes are comparable to those expected in any healthy childbearing population.

Umbilical Cord Avulsion in Waterbirth

Umbilical cord avulsion (or "cord snapping") is often cited as a risk associated with waterbirth. This article discusses a case study in which a cord avulsed during a waterbirth and uses it as a basis to explore the incidence, etiology, and associated risk factors of umbilical cord avulsion. The diagnosis, clinical presentation, and management of cord avulsion in waterbirth is presented along with a thorough review of the literature and relevant professional standards. This article offers recommendations for clinical practice to minimize the risk of a cord avulsion and highlights the need for additional research and provider education to ensure optimal care of women and newborns.

Spinal Cord Avulsion in the Pediatric Population

Spinal cord injury without radiographic abnormality (SCIWORA) is a rare phenomenon, but with advances in imaging and improvements in magnetic resonance imaging more cases are being identified. Even more uncommon is the finding of spinal cord avulsion as a type of SCIWORA with only single case reports in the literature. We present the case reports of 2 patients both experiencing spinal cord avulsion as a type of SCIWORA, secondary to improper lap-belt restraint during a motor vehicle accident.

Destructive operation on dorsal root entry zone (DREZ) for obstinate pain after paraplegia

Objective To explore the methods and curative effect of destructive operation on dorsal root entry zone (DREZ) in treatment of obstinate phantom limb and stamp pain after paraplagia. Method 8 patients who suffered from obstinate phantom pain and stamp pain after paraplegia were performed destructive operation on dorsal root entry zone (DREZ) and followed-up for 3,6 and 12 months after operation, average 6.6 months. Results The pain of 8 patients was alleviated at different levels and 6 patients got absolute alleviation. Conclusions The destructive operation on DREZ is tremendously effective for patients with obstinate phantom limb pain and stamp pain after paraplagia because of spinal cord injure and/or avulsion of roots of spinal cord. It is very crucial to choose the appropriate patients for surgery. Key words: Spinal nerve roots; Pain; intractable; Phantom pain; Stamp pain

PRENATALLY DETECTED ASYMMETRIC INTRAUTERINE GROWTH RETARDATION AND UMBILICAL CORD RUPTURE DURING DELIVERY IN A CHILD WITH MARSHALL-SMITH SYNDROME.

Marshall-Smith syndrome (MSS) is defined as an “overgrowth” multiple congenital anomalies syndrome that presents with advanced bone age, characteristic craniofacial anomalies, failure to thrive, respiratory difficulties, and global developmental delay. We report an 18-month-old girl who presented prenatally with asymmetric intrauterine growth retardation (IUGR) and polyhydramnios. At birth, she was hypoxic with no respiratory effort due to umbilical cord avulsion during delivery. Birth weight was 2.0 kg (10%), birth length was 45 cm (10%), and OFC was 33.5 cm (60%). She had facial features consistent with Melnick-Needles syndrome; however, filamin A gene mutation testing was negative. A tracheostomy was done at 2 weeks due to severe micrognathia. When seen at 18 months, her weight was 7.43 kg (

Myelographic and Enhanced Computed Tomographic Appearance of Acute Traumatic Spinal Cord Avulsion

The neuroradiological findings that revealed spinal cord transection/laceration in 6 patients with acute, blunt spinal trauma are described. Four patients suffered cervical spine injuries, and two had thoracic injuries. Initially, all patients had complete neurological deficit at the level of injury. The deficit improved in only 1 patient. On the basis of clinical history and spinal radiographs, spinal hyperflexion with distraction was the predominant mechanism of injury in our patients. Computed tomography with intrathecal contrast was performed on all patients and was always diagnostic. Visualization of intrathecal contrast material accumulating within the cord or the absence of cord shadow within the contrast column established the diagnosis in all cases. A dural tear was noted in 3 patients. Thoracic myelography was performed in 2 patients and, in both, demonstrated contrast pooling within the spinal cord at the level of the laceration. Magnetic resonance imaging was obtained in 1 patient and revealed an irregular, low-signal-intensity, intramedullary region extending to the cord surface on T1-weighted axial images. The myelographic and enhanced computed tomographic appearances of acute, traumatic spinal cord avulsion/laceration, which have been infrequently reported in the literature, are described.

Myelographic and Enhanced Computed Tomographic Appearance of Acute Traumatic Spinal Cord Avulsion

Myelographic and Enhanced Computed Tomographic Appearance of Acute Traumatic Spinal Cord Avulsion