Failure Of Descent Research Articles

Prediction of labor outcome by measuring the angle of progression using two dimensional trans-perineal Ultrasound: A prospective cohort study

Background: Failure of descent due to fetal malposition is one of the most common indications for performing surgical deliveries. It has recently been suggested that trans-perineal intra-partum ultrasonography may be useful in assessing fetal head engagement, position and station as well as it’s reliable, cheap, painless and effective tool. Measuring the ‘angle of progression’ could assist in the obstetrician’s decision regarding mode of delivery. Objectives: The primary outcome is to use the AOP to develop a predictive model for the probability of successful vaginal delivery. Secondary outcomes including assessment of possibly successful VBAC in previous one CS women. Methods: We recruited 500 women in labor. For each woman, a (TPU) was performed to measure the AOP in late first and second stages of labor. We compared AOP between women who delivered fetuses through vaginal route to those who delivered by CS. Results: Through 467 women included in the study, AOP was significantly Higher in spontaneous vaginal delivery group (with cut off 123°±8.5°) as compared with women delivered by vacuum or by CS (113°±10.5°) (P=0.003). The VBAC as another secodary outcome seems to be insignificant. Conclusions: TPU is safe, non-invasive and easily preformed technique which is useful to predict labor outcomes.

Hemiagenesis of unilateral lobe of thyroid gland

The thyroid gland begins its development during the 3rd week of gestation from the median endodermal thickening in the floor of the pharynx that later form the median diverticulum. During development, the thyroid gland normally descends to its typical location in front of the pharynx. Failure of descent has been suggested as a cause of thyroid hemiagenesis; however, the compensatory growth of the other lobe suggests a lobulation defect rather than a failure of descent. Abnormalities during the development lead to defective organogenesis or descent, complete or partial absence of the gland with or without ectopic thyroid tissue. Thyroid hemiagenesis is a rare congenital abnormality characterized by the absence or failure to develop one lobe of the thyroid gland with or without the absence of the isthmus. Unilateral thyroid agenesis (thyroid hemiagenesis) is a rare disorder with less than 300 cases currently in the world literature. Here, we report a case of left hemiagenesis of thyroid.

Sub lingual thyroid-a case report

Introduction: A sub lingual thyroid anterior to the hyoid bone which is the only thyroid tissue present in the body is a rare entity. It was found due to failure of descent of the thyroid gland to its normal position. Methods: 13-14 yr. old female presented with symptoms of severe sinusitis. CT scan was used to perform this study. Result: A Sublingual thyroid gland present in front of the hyoid bone is observed and there was complete absence of thyroid gland at normal position. Discussion: Incidence of lingual thyroid gland is reported as 1:100,000. It is manifested more in females.1:7 Ectopic thyroid tissue can occur anywhere from foramen caecum to its normal position i.e.; in front & sides of trachea at the level of 5th, 6th, 7th cervical & 1st thoracic vertebrae in the human body. 70% of patients with lingual thyroid are associated with hypothyroidism and 10% suffer from cretinism. Conclusion: A sublingual thyroid due to failure of descent of the thyroid gland with congenital hypothyroidism. No known pathogenesis is present in this case. Thorough examination with follow up is important. A thyroid profile, hemogram, an x-ray of the neck & thyroid scan has to be done regularly with interval of at least once in 6 months. Unless there is need for emergency surgery, it should not be performed. Patient should be treated symptomatically. There should be hormonal essay done for every child born and treated as early as possible to avoid the consequences. Starting of treatment in patients with congenital problems of hormones can help the patient to lead a normal life. Keywords: Lingual thyroid gland; Foramen caecum; Ectopic; Hypothyroidism; Cretinism

Comment on: ‘Is nuchal cord justified as a cause of obstetrician anxiety?’ by Narang et al.

Considering the literature about effects of nuchal cord on maternal and fetal morbidity, this article is of great importance to obstetricians so, we thank Narang et al. [1], for focusing on a quite frequent but undetermined subject. Most of the studies about this issue have reported conflicting results, mostly stressing on that, nuchal cord does not have an effect on perinatal outcomes [2]. But there are authors who correlated nuchal cord with some degree of hypoxia and even cerebral palsy [3, 4]. The current study seems to have some bias of design about patient selection which may lead to unintended outcomes regarding management of this patient population. The authors report that they have selected the patients with nuchal cord (single or multiple) who could give birth vaginally among 2,000 patients eligible for the study. They also claim that presence of nuchal cord had some statistically significant effects on umbilical artery acid–base status including pH and lactate but non-nuchal cord group had pathological range biochemical derangement [1] possibly regarding the pathologic cut-off for umbilical artery pH as 7.00 which is the most important parameter related with long-term outcomes. But the number of patients who were eligible for the study but delivered with cesarean section was not mentioned. Cesarean section incidence due to nuchal cord has been reported ranging between 11.1 and 35 % [5] and nuchal cord has been reported to be one of the four leading indications for cesarean delivery in the Chinese population [6]. Based on these reports, although nuchal cord is not an indication for cesarean section on its own, causal relationship with other factors such as decreased fetal heart rate variability or failure of descent may result with need of cesarean section. Although delivery is a complex process, the authors seem to eliminate any possible intervening factors which may interfere with the way of delivery and at this point, the number of patients who were referred to cesarean section gains importance as the only possible factor leading to cesarean might be ‘nuchal cord’ or the number of ‘nuchal cords’. This is why we suggest the authors to report about this aspect of the research. Only after then, it may be possible to claim that nuchal cord does not have a significance as a factor intervening with the process of delivery. In conclusion, retrospectively designed population studies up to now [2], reported about the effect of nuchal cord on acid base status of the umbilical artery to some extent, supporting the results of the current study but what we do not know yet is the significance of these effects in long-term for related subjects. This ‘unknown’ makes us reach more cautious conclusions regarding this issue.

Labor analgesia and anesthetic management during emergency cesarean section of parturient with spinal cord injury (SCI)

Labor analgesia and anesthetic management during emergency cesarean section of parturient with spinal cord injury (SCI)

Sprengel's Deformity Associated with Musculoskeletal Dysfunctions and Renal Anomalies: A Case Report

Background. Sprengel's deformity is a rare congenital anomaly of the shoulder girdle. The deformity is due to failure of descent of the scapula in intrauterine life. Case Presentation. We report a case of unilateral Sprengel's deformity associated with several other musculoskeletal and renal disorders consisting of absence of pectoralis major, weakness of trapezius and serratus anterior muscles, one kidney agenesis, and severe hydronephrosis of the other kidney in a 7-year-old boy. Conclusion. Sprengel's deformity can be associated with other musculoskeletal abnormalities and it is much more than a cosmetic problem.

Fluorescence-Guided Minimally Invasive Parathyroidectomy: A Novel Surgical Therapy for Secondary Hyperparathyroidism

Secondary hyperparathyroidism (SHPT) is a severe and frequent complication in patients with advanced chronic kidney disease, characterized by hyperplasia of all parathyroid glands and elevated serum parathyroid hormone levels. When surgery is required to prevent cardiovascular consequences, bone pain, osteoporosis, or even soft-tissue calcifications, detection of the enlarged glands often can be difficult because of their variability in number and location. A novel surgical technique, fluorescence-guided minimally invasive parathyroidectomy, may facilitate intraoperative localization of parathyroid glands. A 52-year-old woman with SHPT underwent minimally invasive videoscopic-assisted parathyroidectomy after photosensitization with aminolevulinic acid (ALA): Under special fluorescence illumination by D-Light (Karl Storz Co, Tuttlingen, Germany), bilateral neck exploration was performed. All enlarged parathyroid glands were identified because of their ALA-induced intense red fluorescence. Such surrounding structures as thyroid, lymph nodes, and soft tissue remained nonfluorescent and could be distinguished easily from parathyroid glands. Total parathyroidectomy with autotransplantation into the sternocleidoid muscle was performed. In patients with SHPT, exploration of all parathyroid glands during surgery is mandatory. However, to date, there is no convincing technical aid for the surgeon to facilitate this procedure. The ALA-induced fluorescence technique represents an innovative visual detection method for intraoperative identification of parathyroid glands. The technique serves as an additional tool requiring only moderate technical and clinical expenditure.

The effect of unilateral experimental cryptorchidism and subsequent orchidopexy upon maturation of the contralateral scrotal testicle of the guinea-pig.

Abstract A study of the contralateral scrotal testicle of the guinea-pig before and after the surgical treatment of unilateral experimental cryptorchidism is described. The contralateral scrotal testicle of the guinea-pig has been found to mature quite normally without any evidence of incomplete development. In man, however, the contralateral scrotal testicle of unilaterally cryptorchid patients often shows incomplete development. The difference in results suggests that in man the unilateral cryptorchid state may be associated with a bilateral testicular abnormality. This bilateral abnormality might be the cause of poor fertility and, if severe, might also be the cause of failure of descent of the cryptorchid testicle.

Cesarean delivery during second-stage labor: Characteristics and diagnostic accuracy

Objective: To characterize dysfunctional labors that lead to cesarean delivery in the second stage and to assess the accuracy of diagnoses of abnormal fetal descent.Methods: Thirty-one patients delivered by cesarean during the second stage because of abnormal labor or presumed cephalopelvic disproportion were studied and compared to 62 control cesarean cases delivered for the same indications in the first stage. The clinical diagnosis of dysfunctional labor that led to the cesarean was compared to the diagnosis made by retrospective analysis of the labor curves.Results: Cases did not differ from controls delivered in the first stage in maternal age, race, parity, gestational age, weight gain, or the frequency of associated medical complications. The newborns were not significantly different in birth weight, ponderal index, sex, or the incidence of low Apgar scores. Among study patients, 94% had a second stage labor dysfunction determined by graphic labor analysis, predominantly arrest of descent (69%) and failure of descent (28%). In 79% of cases a dysfunctional first stage preceded the abnormal second stage. Among these first stage labor abnormalities, 68% were not recognized during the labor.Conclusion: Characteristics of patients delivered by cesarean during the second stage were similar to those delivered before full cervical dilatation. Second stage labor abnormalities were usually preceded by an abnormal first stage. There was considerable inaccuracy in the diagnosis of second stage labor dysfunction.

The Role of the Gubernaculum in Testicular Descent

The proximal and distal attachments of the gubernaculum were severed in neonatal rats to examine their role in testicular descent and their relationship to transection of the genitofemoral nerve, which prevents descent of the testis. In 34 of 82 animals proximal transection of the gubernaculum resulted in descent of the testis. In 18 animals the testis remained in the abdomen but in both groups the processus vaginalis developed, suggesting that failure of descent was accidental and not caused by scrotal maldevelopment. Distal transection resulted in failure of descent and prevented growth of the processus vaginalis in all 27 rats. These results suggest that distal transection of the gubernaculum is equivalent to division of the genitofemoral nerve, which supplies the gubernaculum through its distal attachment. Because denervation of the gubernaculum prevents the effect of androgens on gubernacular differentiation, the results suggest that testosterone acts via the nerve. The putative effect of androgens on the gubernaculum may be mediated indirectly by the central nervous system, rather than directly on the gubernaculum itself.

Early detection of abnormal labor using the Friedman labor graph.

Early recognition and appropriate management of abnormal labor can reduce perinatal mortality and morbidity and lower the cesarean section rate. A simple labor graph devised over 25 years ago and later modified makes labor abnormalities easy to detect; the two main divisions of labor, the latent and active phases, are easily recognized. A prolonged latent phase has no serious effects on mother or fetus, but protraction and arrest disorders of the active phase--eg, protracted cervical dilatation, arrest or failure of descent of the presenting part--may have a deleterious effect. Common causes of a prolonged latent phase include false labor and inappropriate use of analgesia and anesthesia. Fetopelvic disproportion and fetal malposition are common causes of disorders of the active phase.

An analysis of 1,146 cases of internal podalic version and extraction

We find ourselves in the unique position of advocating a procedure which is in disrepute in most of the country and the use of which is declining in our own institution. This report is a continuation of a study made a few years ago when an analysis of 534 patients delivered by internal podalic version and extraction was reported.1 The conclusions at that time were (1) the procedure should not be performed routinely, but (2) that many cases of inertia, failure of descent, transverse arrest, and persistent posterior are best managed by version and extraction. With our series now increased by 612, making a total of 1,146 cases, we wish to evaluate the present status of internal podalic version and extraction and see if our former conclusions are justified. In other words, is internal podalic version and extraction worthy of remaining an integral part of our obstetric armamentarium or should it be discarded like symphysiotomy, pubiotomy, bougie induction of labor, etc.?