Delivery-related Trauma Research Articles

Diabetes Mellitus in Pregnancy.

Diabetes mellitus (DM) in pregnancy imposes increased risks for the pregnant person, fetus, and infant, which includes miscarriage, congenital anomalies, accelerated fetal growth, iatrogenic prematurity, preeclampsia, delivery-related trauma, cesarean section, neonatal hypoglycemia, and respiratory distress syndrome. Preconceptual counseling for people with type 1 or type 2 DM who are contemplating pregnancy includes education about these risks, and optimization of glucose control. Fetal screening early in pregnancy in persons with type 1 or type 2 DM allows for early diagnosis and therapy optimization. In addition, screening for gestational DM in the late second trimester is routine given that such pregnancies are also affected. The overall perinatal morbidity and mortality of pregnancies complicated by DM is substantially higher than in the general obstetric population, proportionate to the level of glucose control.

Treatment of persistent post-partum haemorrhage: A case report

Introduction: Postpartum hemorrhage (PPH) is an obstetrical emergency and a major cause of maternal morbidity worldwide. Uterine atony, delivery-related trauma, retained placenta and coagulopathies present the main causes of PPH.

Manifestations of Birth Trauma at the Forensic Pediatric Autopsy

Despite a greatly decreasing incidence of birth injuries over the past several decades with birth trauma currently accounting for less than 2% of neonatal deaths, birth trauma continues to be a significant cause of morbidity and mortality. Birth trauma is usually recognized by obstetricians and pediatricians, particularly when associated with a difficult delivery; therefore many birth injuries are diagnosed and documented in the neonatal period. Other delivery-related trauma may remain clinically silent without premortem identification. The challenge for the pathologist at autopsy is to correlate a history of birth trauma with injuries seen at autopsy, and to interpret injuries existing at death to accurately include or exclude birth trauma as a potential cause. Recognition of the spectrum of birth trauma is important when considering other accidental and nonaccidental mechanisms of injury, particularly in cases of unwitnessed perinatal death following delivery of a concealed pregnancy or in cases of alleged nonaccidental trauma. Discussed here is a general review of birth trauma that may be seen in a forensic setting to aid in interpretation of injuries that can be encountered.

The paracetamol concentration‐effect relation in neonates

We suggested a loading dose (20 mg · kg(-1) ) followed by 10 mg · kg(-1) q6h of intravenous (IV) paracetamol to achieve an effect compartment concentration of 11 mg · l(-1) in neonates. Since there are no pharmacodynamic data to support such an effect compartment concentration, pain scores collected in neonates treated with an IV paracetamol loading dose (20 mg · kg(-1) ) were used to validate this effect compartment concentration. Pain scores (Leuven Neonatal Pain Score, LNPS, 0-14) before and 0.5, 1, 2, 3, 4, 5, and 6 h after IV paracetamol loading dose administration in neonates to whom IV paracetamol was administered as single analgesic (PARANEO, www.clinicaltrials.gov, NCT00969176) were collected. Trends were analyzed using repeated measures anova. An E(max) model with a delayed response compartment was fitted to data using population modeling. Nineteen of 60 neonates included in the PARANEO study received monotherapy with IV paracetamol to treat mild to moderate pain (e.g., alprostadil administration, delivery related trauma). Using repeated measures anova, there was a trend (P = 0.02) for lower pain scores within 30 min after administration, with a slight increase in pain scores from 5 to 6 h. An E(max) model had a maximum effect of 4.15 pain units, an EC(50) of 2.07 mg · l(-1). Equilibration halftime (T(1/2) keo) was 1.58 h. Intravenous paracetamol is effective for moderate pain. An effect compartment concentration of 10 mg · l(-1) (loading dose of 20 mg · kg(-1) ) is associated with a pain score reduction of 3.4 LNPS units. This analysis suggests a similar paracetamol effect compartment concentration in neonates compared to children.

O575 MULTICHANNEL EMG EVALUATION OF ANAL SPHINCTER PRE AND POST VAGINAL DELIVERY: RESULTS OF AN INTERNATIONAL STUDY

Objectives: Recent studies demonstrated that there is a significant correlation between anal sphincter damage during vaginal birth, with or without episiotomy, and subsequent development of anal incontinence in women. Mediolateral episiotomy is usually performed on the right side. Knowledge of the location of the innervation zones (IZs) could avoid to perform episiotomy in innervation regions: this could presumably reduce the incidence of sphincter damage and anal incontinence. The aim of the TASI-2 project was to evaluate the effect of delivery related trauma on the external anal sphincter (EAS) muscle with surface electromyography (EMG). Materials: Five hundred primiparae women participated to the study. Nine clinical partners from five European Countries (Germany, Italy, Latvia, Slovenia, Ukraine) were involved in this multicenter study coordinated by the Lab for Eng. of the Neuromuscular System (LISiN). EMG measurements were performed with a rectal probe including 16 silver electrodes spaced along the circumference. The measurements were performed at the 28th-34th gestational week and 6-8 weeks after delivery. 328 women concluded the experimental protocol. Methods: The subjects were asked to perform a maximal voluntary contraction (MVC) of the EAS for 10s. The innervation zones of single motor units were identified by means of a recently developed surface EMG decomposition algorithm. The know the site and the extension of episiotomy, gynaecologists involved in the study were asked to draw a picture of the episiotomy in a standard form. Results: All episiotomies were performed on right side, except three on the left and three in the midline. In women who underwent mediolateral right episiotomy (82 up to date), a statistically significant reduction of the number of IZs was observed, after delivery, in the right ventral quadrant, corresponding to the side of episiotomy, while women who had Caesarean section did not present any significant change in the innervation pattern. Conclusions: The results of the present study showed that pregnant women could have a fast and reliable clinical test which would provide indications about their sphincter innervation pattern. This information could help the obstetricians to choose which side would be preferable for performing episiotomy if this intervention will be deemed necessary at the time of delivery.

Three‐dimensional ultrasound imaging of the pelvic floor: the effect of parturition on paravaginal support structures

It is assumed that support of the female urethra and bladder is maintained by paraurethral and paravaginal fascial structures, with hypermobility resulting from delivery-related trauma. This study used three-dimensional translabial ultrasound to assess these structures and document peripartal changes. A clinical observational pilot study was performed on 26 nulliparous women recruited in the third trimester of pregnancy. They underwent translabial two- and three-dimensional ultrasound. Twenty-three women were again seen 2-5 months postpartum. The assessor was blinded against two-dimensional ultrasound and delivery data. Vaginal tenting was rated as being present, indeterminate or absent at each of three levels, and was correlated with bladder neck descent (BND) and urethral rotation on Valsalva maneuver. Tenting was visible at all levels in 21 of 26 women antepartally. In three women tenting was absent on one level; in two cases tenting was rated indeterminate. There was no significant difference in BND between women with visible tenting and those without. The BND range for women with intact tenting was 5.4-41.6 mm. Twenty-one of the 26 women were included in the postpartum analysis. Of these, obvious peripartal changes were documented in five. Loss of tenting did not correlate significantly with changes in BND. Most nulliparous women showed evidence of intact paravaginal support structures. Tenting occurred in women with widely varying BND, implying that excess bladder neck mobility may be due to increased fascial compliance. Postnatally, fascial disruption was suspected in a minority of patients only. In some women delivery-related changes may be due to attenuation rather than disruption of structures.