Fetal Trauma Research Articles

Role of FGF21 in Gestational Diabetes Mellitus in a Sample of Egyptian Population

Abstract Background Gestational diabetes (GDM) is defined as carbohydrate intolerance that begins or is first recognized during pregnancy. Gestational diabetes mellitus (GDM) affects approximately 5 to 7% of pregnancies and is associated with increased risk for fetal overgrowth, cesarean delivery, birth trauma, and pre-eclampsia. Objective To investigate serum FGF21 concentrations in a sample of Egyptian patients with GDM as compared with healthy pregnant controls matched for gestational age And its correlation to clinical and biochemical changes (Glucose, insulin, lipids) and fetal wellbeing using obstetric ultrasound to assess fetal size and development of congenital malformation. Methods This cross-sectional study was conducted on 80 participants collected from Obstetrics and Gynecology clinic at Ain Shams University Hospital during the period from November 2019 to March 2021. Results Shows that there is statistically significant increase in FGF21 in female pregnants with GDM as compared to female pregnants without GDM. The high FGF21 level didn’t affect fetal wellbeing. And both groups had normal fetal development with absence of macrosomia and congenital malformation as shown on results of obstetric ultrasound. In addition, there is statistically significant positive correlation between fasting FGF21 level and each of total cholesterol, LDL, HDL and TG (R +ve, P.< 0.05). Conclusion This high level of FGF21 may be FGF21 resistance or compensatory response to the underlying metabolic stress. FGF21 may have reduced an even higher level of blood glucose than the measured one, blood glucose level could have been in the Range of 400-500 mg/dl instead the measured range 200-300 mg/dl. Obstetric ultrasound results revealed normal fetal wellbeing and no change in fetal size nor development of congenital malformation between both groups.

STUDI KASUS: MANUVER MC ROBERT PADA PERTOLONGAN PERSALINAN DENGAN DISTOSIA BAHU

Shoulder dystocia is an obstetric emergency because of the limited time of delivery where the normal value of the time interval for delivery of the head and delivery of the whole body is 24 seconds, but in the case of shoulder dystocia, it lasts 79 seconds resulting in fetal trauma and complications for the mother. Its occurrence is difficult to predict after the head is born, the head is like a turtle and the shoulder delivery is difficult. Mc Robert's Manuver is most effective for front shoulder delivery assistance. One of the factors causing shoulder dystocia is multiparity and maternal power during childbirth. This case study describes the management of midwifery care for Mrs. R, a 31 year old multiparous woman, who experienced shoulder dystocia during labour. Handling efforts carried out by the Mc Robert Manuver method. Case studies use assistive devices in the form of a midwifery care format for mothers giving birth and status sheets or patient documentation and a list of interview questions. Data analysis used is data collection, data interpretation, identification of diagnoses, immediate needs and collaboration, planning, implementation, evaluation and drawing conclusions. The result of the case study is the delivery process with basic assistance in shoulder dystocia using the Mc Robert Manuver method. Health workers must be able to master the skills of emergency delivery assistance in efforts to treat shoulder dystocia.

Trial of labour versus elective caesarean delivery for estimated large for gestational age foetuses after prior caesarean delivery: a multicenter retrospective study

BackgroundLower rates of successful trial of labor after cesarean (TOLAC) in association with fetal macrosomia were previously reported. This study aimed to compare TOLAC to elective caesarean delivery (CD) in women with estimated fetal weight large for gestational age (eLGA) and a prior CD. Primary outcome was to analyse the mode of delivery in case of TOLAC. Secondary outcome was to compare maternal and foetal morbidity.MethodsWe conducted a retrospective, descriptive, multicentric, cohort study in five maternity units between January and December 2020. Inclusion criteria were: women with a single prior CD and eLGA or neonatal weight > 90th percentile with singleton pregnancy and gestational age ≥ 37 weeks. Main outcome measures: rate of vaginal delivery, maternal and fetal morbidity including: shoulder dystocia, neonatal hospitalization, fetal trauma, neonatal acidosis, uterine rupture, 3rd and 4th perineal tears, post-partum hemorrhage, and a need for blood transfusion.ResultsFour hundred forty women met inclusion criteria, including 235 (53.4%) eLGA. 170 (72.3%) had a TOLAC (study group) and 65 (27.7%) an elective CD (control). 117 (68.82%) TOLAC had a vaginal delivery. No significant differences were found between the two groups in the rates of: postpartum haemorrhage, transfusion, Apgar score, neonatal hospitalization, and foetal trauma. Cord lactate was higher in the case of TOLAC (3.2 vs 2.2, p < 0.001). Median fetal weight was 3815 g (3597–4085) vs. 3865 g (3659–4168): p = 0.068 in the study vs. controls group respectively.ConclusionTOLAC for eLGA fetuses is legitimate because there is no difference in maternal–fetal morbidity, and the CD rate is acceptable.

Episiotomy in Modern Obstetrics OR Episiotomy: It's Time to Stop Cutting!

Episiotomy consists of incising the perineum to widen the birth canal. It was historically introduced into medical practice in the 18th century. The purpose of the episiotomy would be to reduce the probability of severe perineal lacerations, while the association with the forceps would minimize the risk of fetal trauma and hypoxia, which was accepted for a long time as an indisputable truth. The use of episiotomy spread enormously after the recommendations of famous obstetricians and began to be used on a larger scale in several countries since the 20th century, although there was no reliable scientific evidence of its effectiveness and safety. In the last decades well-conducted clinical studies on the subject were published and the routine use of episiotomy was questioned. Despite of methodological limitations, the first studies contributed to reduce its practice, including the important participation of women's movements and active childbirth campaigns arguing about the episiotomy use. Current evidence shows that routine episiotomy is not supported in clinical practice and a recent World Health Organization (WHO) guideline strongly recommends against it. However, a lack of knowledge remains as the role of episiotomy in obstetric emergencies and, considering the present evidence, what would be the real benefits for performing an episiotomy. This review aims to show the current state of the art running through the historical background of episiotomy and techniques, analyzing its use worldwide in obstetric practice and discussing the published studies concerning the necessity, the effectiveness, and the consequences of the procedure. Ultimately, regarding the accumulated evidence shown, the authors express their conclusions about the use of episiotomy in obstetric modern practice and the possible strategies to reduce its rates.

The Maternal factors and short term outcomes associated with episiotomy during vaginal delivery at Women and Newborn Hospital , Lusaka, Zambia

Background: An episiotomy is a surgically planned incision on the posterior vaginal wall and perineum performed during the second stage of labour to facilitate the delivery of the neonate. The practice has been used for many decades in the belief that it offers benefit to the mother and the neonate. With the objective of protecting the pelvic floor and preventing fetal trauma, during the birth, its routine use was widely accepted in the past, principally in woman in her first delivery. However, it is not free from complications which include iatrogenic injury to the anal canal, perineal pain and excess bleeding. This study was therefore conducted to explore the short term maternal outcomes and factors associated with episiotomy.&#x0D; &#x0D; Methodology: An unmatched case control study was conducted in postnatal wards of Women and New-born hospital in Lusaka, Zambia between November 2019 and April 2020 with convenient sample for the cases and systematic sample for the controls. A semi-structured interviewer administered questionnaire was used and 102 participants (cases) who had episiotomy performed were recruited while 204(controls) were without episiotomies.&#x0D; &#x0D; Results: A total of 306 (102 are cases and 204 are control) were included. Age was found to be a good predictor of episiotomy in that those younger than 18 years were more than seven times likely to have an episiotomy (AOR=7.65; 95%CI 1.36-18.21; p=0.035). It was also found out that primi gravidas were five times likely to have an episiotomy performed compared to parous women (OR=4.96; 95%CI 2.58-9.52; p&lt;0.001). Out of those delivered by a midwife, 73(28.3%) participants had an episiotomy performed compared to 29(60.4%) delivered by a medical officer. Multivariate regression it was shown that being delivered by a midwife was protective against an episiotomy (OR=0.260; 95%CI 0.14-0.49; p=0.001). Out of the 102 participants who had an episiotomy, only two had third degree tear extension. It was also noted that 99 out of 102 (97%) participants who had an episiotomy experienced post-delivery perineal pain compared to 94 out of 204(46%) of those who had no episiotomies. In univariate analysis, it was found that post-delivery perineal pain was associated with episiotomy (p&lt;0.001). It was further found that those who had an episiotomy performed were about 4 times likely to experience perineal pain post- delivery (OR=3.8; 95%CI 1.2-12.3). The mean blood loss among those who has had no episiotomy was 230mls compared to 270mls among those who had an episiotomy. However, post-delivery blood loss was found to be a poor predictor of an episiotomy (OR=0.998; 95%CI 0.991-1.006; p=0.670).&#x0D; &#x0D; Conclusion: Maternal factors associated with episiotomy included age, parity, method of induction, and the personnel conducting the delivery Short term maternal outcomes of episiotomy were perineal tear extension, excess blood loss and post-delivery perineal pain. It was found that 8.5% of women had undergone an episiotomy done on them. Health professional conducting deliveries should be educated on indications of episiotomy, patient selection during episiotomy and trained on surgical skills to repair episiotomy to reduce morbidity associated the procedure.

The Maternal factors and short term outcomes associated with episiotomy during vaginal delivery at Women and Newborn Hospital , Lusaka, Zambia

Background: An episiotomy is a surgically planned incision on the posterior vaginal wall and perineum performed during the second stage of labour to facilitate the delivery of the neonate. The practice has been used for many decades in the belief that it offers benefit to the mother and the neonate. With the objective of protecting the pelvic floor and preventing fetal trauma, during the birth, its routine use was widely accepted in the past, principally in woman in her first delivery. However, it is not free from complications which include iatrogenic injury to the anal canal, perineal pain and excess bleeding. This study was therefore conducted to explore the short term maternal outcomes and factors associated with episiotomy.&#x0D; Methodology: An unmatched case control study was conducted in postnatal wards of Women and New-born hospital in Lusaka, Zambia between November 2019 and April 2020 with convenient sample for the cases and systematic sample for the controls. A semi-structured interviewer administered questionnaire was used and 102 participants (cases) who had episiotomy performed were recruited while 204(controls) were without episiotomies.&#x0D; Results: A total of 306 (102 are cases and 204 are control) were included. Age was found to be a good predictor of episiotomy in that those younger than 18 years were more than seven times likely to have an episiotomy (AOR=7.65; 95%CI 1.36-18.21; p=0.035). It was also found out that primi gravidas were five times likely to have an episiotomy performed compared to parous women (OR=4.96; 95%CI 2.58-9.52; p&lt;0.001). Out of those delivered by a midwife, 73(28.3%) participants had an episiotomy performed compared to 29(60.4%) delivered by a medical officer. Multivariate regression it was shown that being delivered by a midwife was protective against an episiotomy (OR=0.260; 95%CI 0.14-0.49; p=0.001). Out of the 102 participants who had an episiotomy, only two had third degree tear extension. It was also noted that 99 out of 102 (97%) participants who had an episiotomy experienced post-delivery perineal pain compared to 94 out of 204(46%) of those who had no episiotomies. In univariate analysis, it was found that post-delivery perineal pain was associated with episiotomy (p&lt;0.001). It was further found that those who had an episiotomy performed were about 4 times likely to experience perineal pain post- delivery (OR=3.8; 95%CI 1.2-12.3). The mean blood loss among those who has had no episiotomy was 230mls compared to 270mls among those who had an episiotomy. However, post-delivery blood loss was found to be a poor predictor of an episiotomy (OR=0.998; 95%CI 0.991-1.006; p=0.670).&#x0D; Conclusion: Maternal factors associated with episiotomy included age, parity, method of induction, and the personnel conducting the delivery Short term maternal outcomes of episiotomy were perineal tear extension, excess blood loss and post-delivery perineal pain. It was found that 8.5% of women had undergone an episiotomy done on them. Health professional conducting deliveries should be educated on indications of episiotomy, patient selection during episiotomy and trained on surgical skills to repair episiotomy to reduce morbidity associated the procedure.

Prognosis of fetal macrosomy by fetal weight in the third trimester

Introduction. Fetal macrosomy is associated with the risk of maternal and fetal trauma, shoulder dystocia, increase frequency of cesarean section, and obstetric hemorrhage. Prediction of large fetal size at the antenatal stage remains an urgent issue, definitively unresolved even with the use of modern medical imaging techniques. Materials and Methods. A total of 819 women were examined, of whom 365 (the study group) gave birth to a baby weighing more than 4000 grams, and 454 (the control group) gave birth to a full-term baby within the gestational weight norm. At 32–34 weeks of gestational screening in the third trimester, all women underwent an ultrasound examination followed by calculation of estimated fetal weight using the Hadlock formula. The inclusion criteria were fetal anthropometric data at 32–34 weeks' gestational age within the normal range, i.e. within the 10-90th percentile corridor. Results. There was a difference between the groups, the fetal weight in women in the main group in the third trimester, calculated by the Hadlock formula, was significantly higher and was 2123 grams (Q1; Q3 – 1948; 2278) compared to the control group, in which the weight was 1990 grams (Q1; Q3 – 1844; 2101), p &lt; 0.001. ROC-analysis revealed a low, but statistically significant diagnostic value of this parameter for the prognosis of fetal macrosomia. Discussion. The practical importance of determining the risk of fetal macrosomia cannot be overestimated. Using prognostic methods, it is possible to take measures to prevent maternal and fetal trauma and to prevent perinatal morbidity. Our results show that even the isolated use of the estimated fetal weight estimation by the Hadlock method, performed in a Level III institution, allows us to identify a group of pregnant women at risk for fetal macrosomia with acceptable sensitivity and specificity. The threshold fetal weight at 32–34 weeks is 2032 grams. Obviously, ultrasound at 32–34 weeks remains essential as a selective screening technique, e.g. in the presence of known risk factors for fetal macrosomia. Conclusion. Antenatal 2D ultrasound sonography to determine the risk of fetal oversize fetuses performed as part of third-trimester prenatal screening is a tool for selective screening. The development of integral multifactorial prognostic models of fetal macrosomia based on the calculation of estimated fetal weight using the Hadlock method at 32-34 weeks seems to be a promising direction that will significantly improve the quality of perinatal care.

Environmental Health: Translating Policy Into Action.

Environmental Health: Translating Policy Into Action.

Minimally Invasive Bimanual Fetal Surgery-A Review.

Background: The aim of this review is to discuss experimental and clinical techniques and interventions of fetal surgery which have been performed minimally invasively by the means of a three-port approach for the fetoscope and instruments for the left and right hand of the surgeon (bimanual minimally invasive fetal surgery). Methods: a print and electronic literature search was performed; the titles and abstracts were screened and included reports were reviewed in a two-step approach. First, reports other than minimally invasive fetal surgery were excluded, then a full text review and analysis of the reported data was performed. Results: 17 reports were included. The heterogeneity of the included reports was high. Although reports on human fetoscopic surgical procedures can be found, most of them do not pick out bimanual fetal surgery as a central theme but rather address interventions applying a fetoscope with a working channel for a laser fiber, needle or flexible instrument. Most reports were on experimentation in animal models, the human application of minimally invasive fetoscopic bimanual surgery is rare and has at best been explored for the prenatal treatment of spina bifida. Some reported bimanual fetoscopic procedures were performed on the exteriorized uterus via a maternal laparotomy and can therefore not be classified as being truly minimally invasive. Discussion: our results demonstrate that minimally invasive fetoscopic bimanual surgery is rare, even in animal models, excluding many other techniques and procedures that are loosely termed ‘minimally invasive fetal surgery’ which we suggest to better label as ‘interventions’. Thus, more research on percutaneous minimally invasive bimanual fetoscopic surgery is warranted, with the aim to reduce the maternal, uterine and fetal trauma for correction of congenital malformations.

How a Fetal Elevation Device Assists the Birth of a Neonate With a Deeply Impacted Head in the Pelvis

When a deeply impacted fetal head occurs in the maternal pelvis during a cesarean birth, current practice is for staff to place their hand into the introitus and push up to allow the physician to reach for the neonate’s head with ease. Case reports have described an increased risk of complications with this practice, including increased operative time, increased blood loss, infection, fetal skull trauma, and staff injuries. Costs associated with complications can create a financial systems’ burden and litigation related to maternal or fetal injury.

Early-Onset of Gestational Diabetes vs. Late-Onset: Can We Revamp Pregnancy Outcomes?

We assessed risk factors, antenatal and intrapartum complications associated with early-onset Gestational diabetes mellitus (GDM) in comparison with late-onset GDM. This retrospective study included 161 GDM women having singleton pregnancies, without previous medical disorder and delivered at a tertiary care Hospital in Ha'il City, KSA from Dec 2020 till Jun 2021. Women diagnosed at < 24 weeks of pregnancy were grouped as early-onset GDM (n=71) and those diagnosed at ≥ 24 weeks as late-onset GDM (n=90). Both groups were matched for background variables. Chi-square and binary logistic regression analysis were applied with P-value significance at 0.05. Past history of GDM, macrosomia and stillbirth were significant predictors for early-onset GDM (P value 0.000, 0.002 and 0.040 respectively). Regression analysis showed early-onset GDM significantly increases the risk for recurrent urinary tract infections (AOR 2.35), polyhydramnios (AOR 2.81), reduced fetal movements (AOR 2.13), intrauterine fetal demise (AOR 8.06), macrosomia (AOR 2.16), fetal birth trauma (2.58), low APGAR score at birth (AOR 8.06), and neonatal ICU admissions (AOR 2.65). Rate of preterm birth, hypertensive disorders, labor onset (natural vs. induced) and cesarean section and intrapartum maternal complications were same in both groups. Early-onset GDM significantly increases certain maternal (recurrent urinary tract infections, polyhydramnios and reduced fetal movements) and fetal complications (intrauterine fetal demise, macrosomia fetal birth trauma, low APGAR score at birth and neonatal ICU admissions). Most of these adverse pregnancy outcomes can be prevented through early registration and screening, close follow up, growth ultrasounds, and provision of efficient emergency and neonatal care services.

Makrozomik Fetuslar 38. Gebelik Haftasında Doğurtulabilir Mi?

Objective: Numerous articles have been written on macrosomic fetuses, including the American College of Obstetricians and Gynecologists practice bulletin. However, there is no clear consensus about the time of birth. The aim of this study was to compare the maternal and fetal outcomes of women giving birth at 38+0-38+6 weeks and those with deliveries at ≥39 weeks in pregnancies complicated by fetal macrosomia, and to determine the effect on morbidity and mortality of delivery in the 38th gestational week.Material and Methods: Data of women and their infants born in Kayseri Training and Research Hospital between 01 May 2018 and 31 March 2020 were analyzed retrospectively. The patients included were those with a singleton pregnancy delivered at ≥38 weeks with a birthweight of ≥4000 gr. Demographic data and medical history and birth outcomes of the patients were recorded from the hospital data system. Multiple pregnancies, those with fetal anomalies and births &amp;lt;38 weeks were excluded from the study. The patients were separated into two groups as those who gave birth at 38+0-38+6 gestational weeks (Group 1) and those who gave birth at ≥39 weeks (Group 2).Results: Maternal and/or fetal trauma was found to be statistically significantly higher in nulliparous women with vaginal delivery ≥39 weeks compared to those with vaginal delivery at 38+0-38+6 weeks (p=0.017). No significant difference was observed between the groups in respect of fetal morbidity and mortality.Conclusion: When fetal macrosomia is determined antenatally, rates of fetal and/or maternal trauma can be reduced with delivery planned for the 38th week without increasing fetal morbidity and mortality.

Instruments for assisted vaginal birth.

Instruments for assisted vaginal birth.

Severe brain trauma to the fetus in a car accident: Literature review and a clinical case

Car accidents are the main cause of trauma during pregnancy. Even a non-severe accident is associated with a high risk of injury and unfavorable outcome for the fetus, especially in the event of placental abruption. Major agents leading to a trauma could also include safety belt and safety airbags. Blunt abdominal trauma during a car accident is associated with such type of intrauterine injury as fetal skull fractures and various intracranial hemorrhages. Despite a common viewpoint on relatively high death rates in this population, it is not infrequent that fetal trauma has a favorable outcome without any clinically significant neurological deficiency.The paper presents an analysis of the main outcomes of intrauterine brain injury and associated factors. As an illustration, we describe a case of a car accident related brain injury to a fetus at 38 week of gestation, with skull fracture, brain contusion, and subarachnoidal, epidural and subdural, parenchymal and intraventricular hemorrhages induced by the safety belt, with the mother being virtually uninjured. After treatment, the patient was discharged from the hospital in a satisfactory state, without clinically significant neurological symptoms and signs. A 8-months follow-up of the infant showed some delay in brain maturation manifesting as benign epileptiform discharges of childhood and magnetic resonance imaging patterns.It is highly likely, that the leading factors ensuring a favorable outcome of a intrauterine severe brain trauma (without fatal trauma to the mother and fetus) are as follows: correct obstetric strategy, late gestational age and absence of a massive parenchymal and/or intraventricular bleeding. After the short-term clinical recovery from a severe intrauterine brain trauma and in addition to it, proper follow-up of the child is essential because of a high risk of long-term cerebral and functional abnormalities, mostly paroxysmal, behavioral and cognitive.

Mitigation of Risk and Associated Complications of Diagnostic Amniocentesis during Second Trimester of Pregnancy (15-22 Weeks)

Introduction: Amniocentesis is a procedure in which amniotic fluid is collected from the amniotic cavity for testing or treatment. Amniotic fluid is the fluid that surrounds and protects a baby during pregnancy. Amniotic fluid contains fetal cells and various proteins and provides valuable information about baby's health. Aim: To evaluate the risk and associated complications during diagnostic amniocentesis. Methods: This prospective study was conducted by performing amniocentesis among pregnant ladies of early second trimester at Dhaka CMH, and Aklima General Hospital Limited, Mirpur, Dhaka from July 2016 to June 2019. A total of 50 patients were selected by age of the patient, history of previous pregnancy outcome, parental haemoglobinopathy and few other factors triggered these cases to be put under this study. Results: No major complications have been observed during and after the procedure because of appropriate pre-operative and post-operative management. Conclusion: There are some common and known risks which are associated with amniocentesis like miscarriage, amnionitis, fetal trauma etc. Through skilled execution with the help of real-time ultrasound guidance and proper pre-operative and post-operative care, we can avoid complications and get benefit from amniocentesis. JAFMC Bangladesh. Vol 15, No 1 (June) 2020: 42-45

Exercise and outcomes in macrosomic pregnancies

Objective Pregnancy is generally known to be a period when physical activity is partially or totally restricted to avoid negative outcomes such as miscarriage or premature birth. The aim of this study was to evaluate the effect on maternal and fetal outcomes of exercise in pregnancies complicated by macrosomia. Material and Method In this retrospective study, the data were retrospectively screened of women who gave birth at ≥38 weeks with infant birthweight of ≥4000 gr. The patients were separated into two groups as those who followed an exercise program of walking regularly for 30–60 mins at least 1 day a week throughout pregnancy and those who did not. The maternal and fetal complications were compared between the groups. A total of 252 patients were included in the study as 84 women who exercised during pregnancy and 168 women selected at random in the ratio of 2:1 who did not exercise. Results When the gestational week at birth was examined, a statistically significantly higher rate of patients in the non-exercise group gave birth at ≥40 gestational weeks. Although not at a statistically significant level, maternal and fetal complications were observed more in the non-exercise group. Conclusions The results of this study showed that excessive maternal weight gain was statistically significantly reduced, and although not at a statistically significant level, maternal and fetal trauma were reduced in macrosomic pregnancies with regular exercise. As recommended by ACOG, for pregnant women at risk of macrosomic fetus, exercise of walking for 30–60 mins several days a week will have positive effects on both the mother and infant.

Survey of factors influencing women's selection of the delivery method of their second child in Shanxi Province, China.

Objective:To explore the factors influencing women’s selection of the delivery method of their second child.Methods:A questionnaire survey was administered among 431 women in the age range of interest from January 2015 to January 2017, and the survey results were evaluated and analyzed statistically. The experts evaluating the questionnaire are professionals in the Department of Obstetrics and Gynecology, Heji Hospital Affiliated to Changzhi Medical College.Results:A total of 70.99% of subjects were 28-35 years old. Approximately 82.35% wished to undergo vaginal delivery, and the remaining 17.65% expressed to undergo cesarean delivery. The reasons for cesarean delivery included the following: fetal factors: worry about fetal health (33.33%), birth trauma (12.90%), and fetal macrosomia (38.17%); maternal factors: advanced age (36.56%), inability to bear uterine contraction pains (21.51%), worry about uracratia after vaginal delivery (10.75%), worry about perineum laceration (8.60%) and the impacts on sexual gratification after delivery (5.38%); social factors: faster delivery mode (54.84%), selection of birth time (27.96%), and better planning of maternity leave (17.20%).Conclusion:Most women tend to undergo vaginal delivery. However, due to the influence of age, educational level and other factors, an increasing number of women prefer cesarean delivery. Medical institutions have the responsibility for providing overall and fair medical information to women of childbearing age to help them make informed choices regarding mode of delivery.

Congenital Depressed Skull Fracture Due to Maternal-Fetal Trauma

The fetal head trauma is rare and seen in pregnant road accidents and during extractive maneuvers during childbirth. We have reported a case of congenital depressed skull fracture due to an innocuous fall from her own height of a pregnant of 35 weeks of amenorrhea. The diagnosis was made at birth, by vaginal delivery, by the discovery of a left frontal depressed skull fracture without neurological disorder. A surgical lifting of the drepressed skull fracture was made at the 2nd day of life. Outcome was good marked by a normal psychomotor development.

Adverse gestational events associated with prenatal, perinatal and postnatal variables in the Neonatal ICU

Objective: To analyze whether maternal, obstetric, anthropometric and postnatal variables of neonates admitted to the neonatal intensive care unit (NICU) are different in pregnant women who had adverse gestational events (AGE). In addition, it seeks to analyze whether AGE are predictors of mortality. Methods: Observational, retrospective and quantitative study, with a descriptive and inferential approach based on the medical records of patients seen at the tertiary reference hospital in health located in a municipality in Pará, during 2017. Data were collected to verify the relationship between present and absent AGE. Results: AGE (+) were associated with alcoholism, loss of amniotic fluid, premature labor, breench presentation, increased capillary glycemia and pneumonia. AGE (-) were associated with absent prenatal care, intact amniotic membrane, amniotic fluid with thick meconium and fetal trauma at birth. The other data were not significant. Conclusion: Maternal, obstetric, anthropometric and postnatal variables in neonates admitted to the nicu are associated with AGE (+). The events analyzed did not increase the chances of death.

Implications of Vaginal Instrumental Delivery for Children’s School Achievement: A Population-based Linked Administrative Data Study

(Aust N Z J Obstet Gynaecol. 2019;59:677–683) Instrumental vaginal delivery is a relatively common obstetric procedure in both Australia and the UK, accounting for ∼10% to 13% of deliveries. It is typically performed in cases of prolonged second stage of labor, fetal compromise, or limited ability of the mother to push. While instrumental deliveries are performed when obstetricians believe the benefits outweigh the risks, there are numerous potential side effects for both mother and fetus. These include maternal soft tissue tears and anal and urinary sphincter dysfunction as well as fetal trauma injuries, such as intracranial and subgaleal bleeding, lacerations, and cranial nerve injuries. Researchers have been concerned about the potential long-term neurodevelopmental effects of instrumental vaginal delivery, but previous studies have not adequately compared the development of children who were born via spontaneous vaginal delivery versus those born via instrumental vaginal delivery. This study was conducted to determine whether vacuum extraction, forceps, or normal vaginal deliveries had an effect on academic performance at 8 years of age.