RESUMEN

BACKGROUND: Shoulder dystocia is an unpredictable obstetric condition with potential long-term neonatal complications. The risk of neonatal injury might be related to the condition itself as well as to the obstetrics maneuvers used for its release. OBJECTIVES: To examine the available evidence to assess current management and possible improvement of outcomes. SEARCH STRATEGY: A comprehensive search of MEDLINE, EMBASE, EMCARE, and The Cochrane Library database was performed, all studies reporting on neonatal outcomes in cases of shoulder dystocia stratified by obstetric maneuvers used for delivery were included. Data abstraction was performed and checked by two independent reviewers. RESULTS: McRoberts maneuver was the least associated with risk of neonatal injury (odds ratio 0.6, 95% confidence interval 0.4-0.9), followed by delivery of posterior arm. CONCLUSION: Delivery of posterior arm might be prioritized in cases of shoulder dystocia after failed McRoberts. Neonatal hypoxic injury correlates with the duration of dystocia rather than the maneuver used.

RESUMEN

Childbirth is a defining moment in anyone's life, and it occurs 140 million times per year. Largely a physiologic process, parturition does come with risks; one mother dies every two minutes. These deaths occur mostly among healthy women, and many are considered preventable. For each death, 20 to 30 mothers experience complications that compromise their short- and long-term health. The risk of birth extends to the newborn, and, in 2020, 2.4 million neonates died, 25% in the first day of life. Hence, intrapartum care is an important priority for society. The American Journal of Obstetrics & Gynecology has devoted two special Supplements in 2023 and 2024 to the clinical aspects of labor at term. This article describes the content of the Supplements and highlights new developments in the induction of labor (a comparison of methods, definition of failed induction, new pharmacologic agents), management of the second stage, the value of intrapartum sonography, new concepts on soft tissue dystocia, optimal care during the third stage, and common complications that account for maternal death, such as infection, hemorrhage, and uterine rupture. All articles are available to subscribers and non-subscribers and have supporting video content to enhance dissemination and improve intrapartum care. Our hope is that no mother suffers because of lack of information.

Asunto(s)

RESUMEN

Trauma during pregnancy is the leading non-obstetric cause of morbidity and mortality, and accounts for five per 1000 fetal deaths. Direct fetal injury due to trauma during pregnancy is rare, and limited information is available about how to optimize fetal outcomes after injury. Early recognition and appropriate management of direct fetal trauma may improve outcomes for the fetus. There are currently no available guidelines to direct management of the injured fetus. We provide a detailed literature review of the management and outcomes of direct fetal injury following blunt and penetrating injury during pregnancy, and describe a suggested initial approach to the injured pregnant patient with a focus on evaluation for fetal injury. We identified 45 reported cases of blunt trauma resulting in direct fetal injury, with 21 surviving past the neonatal period, and 33 of penetrating trauma resulting in direct fetal injury, with 24 surviving past the neonatal period. Prenatal imaging identified fetal injury in 19 cases of blunt trauma and was used to identify bullet location relative to the fetus in 6 cases. These reports were used to develop management algorithms for the injured fetus.

Asunto(s)

RESUMEN

We present a remarkable image of a woman, 24 weeks pregnant, who sustained polytrauma after a high-speed motor vehicle collision. Evaluation revealed traumatic bilateral subdural hematoma in the fetus and an unstable T12-L1 fracture in the patient. The standard of care for her unstable fracture was surgical fixation; however, this was hampered by the desire to continue the pregnancy in the interest of the premature fetus. This case presented a unique additional consideration in the management of the polytrauma neurosurgery patient and underscores the importance of coordinated team work and patient counseling to achieve the optimal patient outcome.

Asunto(s)

RESUMEN

PROBLEM: Exposure to intrauterine inflammation (IUI) has been shown to induce fetal brain injury and increase the risk of acquiring a neurobehavioral disorder. The trafficking of the inflammatory mediator, lipopolysaccharide (LPS), in the pregnant female reproductive tract in the setting of IUI and the precise mechanisms by which inflammation induces fetal brain injury are not fully understood. METHOD OF STUDY: FITC-labeled LPS was utilized to induce IUI on E15, tissues were collected, and fluorescence was visualized via the Spectrum IVIS. Embryo transfer was utilized to create divergent maternal and fetal genotypes. Wild-type (WT) embryos were transferred into TLR4-/- pseudopregnant dams (TLR4-/-mat /WTfet ). On E15, TLR4-/-mat /WTfet dams or their WT controls (WTmat /WTfet ) received an intrauterine injection of LPS or phosphate-buffered saline (PBS). Endotoxin and IL-6 levels were assessed in amniotic fluid, and cytokine expression was measured via QPCR. RESULTS: Lipopolysaccharide trafficked to the uterus, fetal membranes, placenta, and the fetus and was undetectable in other tissues. Endotoxin was present in the amniotic fluid of all animals exposed to LPS. However, the immune response was blunted in TLR4-/-mat /WTfet compared with WT controls. CONCLUSION: Intrauterine administered LPS is capable of accessing the entire feto-placental unit with or without a functional maternal TLR4. Thus, bacteria or bacterial byproducts in the uterus may negatively impact fetal development regardless of the maternal genotype or endotoxin response. Despite the blunted immune response in the TLR4-deficient dams, an inflammatory response is still ignited in the amniotic cavity and may negatively impact the fetus.

Asunto(s)

RESUMEN

Trauma, especially traumatic injuries due to car accidents are one of the causes of maternal and fetal mortality and morbidity during pregnancy. Fetus brain injuries are usually caused fetus death. We herein report a pregnant woman in 28 weeks of gestation. The fetus was found to be normal during in-hospital. At birth, the female neonate demonstrated developmental delay and neurological deficits (hypotonicity). Neuroimaging after birth revealed extreme dilatation of lateral ventricles, hypoplasia and aplasia of the brain. In 4 months, she had multiple morbidities including developmental delay, hypotonia, blindness, oropharyngeal dysphagia and simple partial seizure. Motor and response to stimulation was normal. Appropriate seatbelt usage can protect the fetus from sustaining severe intracranial injuries.

RESUMEN

Background Shoulder dystocia occurs when the fetal head delivers, but the shoulder is lodged behind the pubic symphysis. Training for these emergency deliveries is not optimized, and litigation can occur around a shoulder dystocia delivery. Objective Evaluate the ability of an outside observer to visually estimate the amount of traction applied to the fetal head during simulated deliveries complicated by shoulder dystocia. Study Design Simulated deliveries with an objective measurement of traction were randomly organized for estimation of traction applied. Videos show providers applying a "normal" (75 N) and "excessive" (150 N) amount of force in both a "calm" and "stressed" delivery. Results Fifty participants rated the amount of force applied. Observers estimated traction, on a scale from 1 to 5, higher in the 150-N deliveries as compared with 75-N deliveries ("calm" environment: 3.1 vs. 2.8, p < 0.001; and "stressed" environment: 3.2 vs. 2.8, p < 0.001). Only 15% of observers rated force "above average" or "excessive" in a "calm" environment, as opposed to 30% of observers in the "stressed" environment. Conclusion Observers are not able to determine when "excessive force" is used and are twice as likely to overestimate the force applied to a fetal head when an average amount of force is used and the delivery environment is stressful. Precis Observers are unable to determine when excessive traction is applied to the fetal head during simulated deliveries complicated by shoulder dystocia.

RESUMEN

Injury of a pregnant lady risks both mother and fetus. Various modes of injuries are possible. But arrow injury is not usually heard of in today's world. We have reported a male child delivered with a cut injury on the face. It was caused by a penetrating arrow hitting his mother in her lower abdomen at term. The injury of the baby was repaired successfully.

RESUMEN

Preterm birth (PTB) is the leading cause of childhood mortality in children under 5 and accounts for approximately 11% of births worldwide. Premature babies are at risk of a number of health complications, notably cerebral palsy, but also respiratory and gastrointestinal disorders. Preterm deliveries can be medically indicated/elective procedures or they can occur spontaneously. Spontaneous PTB is commonly associated with intrauterine infection/inflammation. The presence of inflammatory mediators in utero has been associated with fetal injury, particularly affecting the fetal lungs and brain. This review will outline (i) the role of inflammation in term and PTB, (ii) the effect infection/inflammation has on fetal development and (iii) recent strategies to target PTB. Further research is urgently required to develop effective methods for the prevention and treatment of PTB and above all, to reduce fetal injury.

Asunto(s)

RESUMEN

Injuries from lightning strikes are an infrequent occurrence, and are only rarely noted to involve pregnant victims. Only 13 cases of lightning strike in pregnancy have been previously described in the medical literature, along with 7 additional cases discovered within news media reports. This case report presents a novel case of lightning-associated injury in a patient in the third trimester of pregnancy, resulting in fetal ischemic brain injury and long-term morbidity, and reviews the mechanics of lightning strikes along with common injury patterns of which emergency providers should be aware.

Asunto(s)

RESUMEN

OBJECTIVE: The effect of gestational age and other factors that could influence the outcome of an electric shock in pregnancy have not been defined yet. Objective of this study is to provide reliable data on medical issues linked to electric shock in pregnancy. METHODS: Authors consulted the most important scientific databases investigating reactions to electric shock in pregnancy, analyzing mechanism of electric shock, gestational age at the time of injury, the post-shock complications, interval from injury to delivery and fetal and maternal outcome. RESULTS: The spectrum of electrical injuries in pregnancy ranges from transient unpleasant sensation with no effect on the fetus to sudden maternal and fetal death. The clinical presentation of the fetal injury may manifest immediately or even postnataly. Reported outcomes include spontaneous abortion, placental abruption, cardiac arrhythmias, fetal burn and intrauterine fetal death. If the pregnancy is continued, decreased fetal movements and asphyxia, pathological fetal heart patterns, intrauterine fetal growth retardation, damage to the fetal central nervous system and oligoamnios can occur. CONCLUSIONS: More large prospective observational studies are necessary for a proper insight into the expected outcomes of the electric shock in pregnancy as well as for a final definition of monitoring procedures of such pregnancies.

Asunto(s)

RESUMEN

Objectives Data on fetal effects following accidental electric shock during pregnancy are scarce. We report on a case of accidental maternal electric shock associated with benign fetal arrhythmia in a woman at 28 weeks' gestation. Study Design Case report. Results Although electrocution involving low-voltage, low-frequency current has been associated with fatal cardiac arrhythmias and conduction abnormalities, two protective parameters in the present case likely reduced the fetal injury: the dry skin at the site of current entry and the hand-to-hand pathway of current flow. Conclusion Because the pathophysiology of electric injury is altered during pregnancy, assessment of fetal well-being should be prompted no matter how trivial an incident may appear.

RESUMEN

Motor vehicle crashes during pregnancy are the leading cause of traumatic fetal mortality and serious maternal injury morbidity and mortality in the United States, injuring approximately 92,500 pregnant women each year. Little is known about the circumstances surrounding these crash events and the maternal characteristics that may increase women's vulnerability to crash-related injuries during pregnancy. Even less is known about the effects of crashes on fetal outcomes. Crash simulation studies using female anthropomorphic test devices and computational models have been conducted to better understand the mechanisms of maternal and fetal injuries and death resulting from motor vehicle crashes. In addition, several case reports describing maternal and fetal outcomes following crashes have been published in the literature. Only a few population-based studies have explored the association between motor vehicle crashes and adverse maternal and/or fetal outcomes and even fewer have examined the effectiveness of seat belts and/or airbags in reducing the risk of these outcomes. This paper reviews what is presently known about motor vehicle crashes during pregnancy, their effects on maternal and fetal outcomes, and the role of vehicle safety devices and other safety approaches in mitigating the occurrence and severity of maternal crashes and subsequent injuries. In addition, this paper suggests interventions targeted towards the prevention of crashes during pregnancy.

RESUMEN

ANTECEDENTES: Se define trauma al nacimiento las lesiones sufridas por el feto durante el trabajo de parto o expulsión. OBJETIVO: Identificar los factores de riesgo asociados a lesiones originadas durante el nacimiento en recién nacidos. MÉTODO: Estudio casos y controles, realizado en el período de julio/2004 a diciembre/2005, en la División de Ginecología y Obstetricia del Hospital General de Caxias do Sul/ Facultad de Medicina, Universidad de Caxias do Sul, RS, Brasil. Fueron analizadas variables maternas, del parto y fetales, utilizando el programa estadístico SPSS versión 19.0. Los factores que obtuvieron nivel significativo <0,10 en los análisis bivariado fueron insertas en la regresión logística. Se utilizó el modelo de entrada por bloques (block entry) para selección del modelo final de la regresión. RESULTADOS: En el período citado nacieron 2.137 infantes, 26 de ellos (1,2%) sufrieron trauma al nacimiento. La fractura de clavícula fue la lesión más frecuente (n=14; 53,8%), seguida del cefalohematoma (n=5; 19,2%). Las variables gasométricas no presentaron diferencia estadística. En la regresión logística, las únicas variables independientes asociadas a traumatismo al nacimiento fueron parto vaginal (OR-A: 11,08; IC95%: 2,45-49,98; p=0,002) y perímetro torácico >33 cm (OR-A: 3,36; IC95%: 1,35-9,73; p=0,010). CONCLUSIÓN: Los factores de riesgo asociados a lesiones durante el nacimiento involucran el parto vaginal y el perímetro torácico igual o superior a 33cm.

BACKGROUND: Obstetrics injuries can be defined as fetal lesions suffered by the fetus during labor or expulsion. OBJECTIVE: Identify risk factors for fetal birth trauma. METHOD: Case-control study conducted from July 2004 to December 2005. We analyzed maternal and fetal variables using software SPSS 19.0. The variables showing a significance level <0.10 in the bivariate analysis were included in the logistic regression analysis. We used the block entry model for selection of the final regression model. RESULTS: During these period, we identified 2137 births and 26 (1.2%) were related to fetal birth injury. Clavicle fracture was the most frequent injury (n = 14; 53.8%), followed by cephalohematoma (n = 5; 19.2%). Umbilical cord blood gas analysis did not show statistical significance. In the regression analysis of the variables that had significance level <0.10, the only independent variables associated with fetal birth injury were vaginal delivery (OR-A: 11.08; 95%CI: 2.45-49.98; p=0.002) and thorax circumference > 33 cm (OR-A: 3.36; 95%CI: 1.35-9.73; p=0.010). CONCLUSION: The risk factors for fetal birth injury were vaginal delivery and chest circumference equal to or larger than 33 cm. Other variables were not associated with the outcome in discussion.

Asunto(s)

RESUMEN

Introdução: Os tocotraumatismos maternos e fetais, por estarem diretamente vinculados à morbiletalidade, constituem tema importante na área perinatológica. Conhecer a real incidência desse evento torna-se importante para eventuais correções de condutas. O objetivo deste estudo foi identificar a prevalência e os tipos de tocotraumatismos materno e fetal na população usuária de um hospital universitário nível III. Métodos: Estudo de corte transversal, que envolveu gestantes no período de julho/2004 a dezembro/2005. Foram avaliadas variáveis maternas e neonatais. Utilizou-se o programa estatístico SPSS 16.0 para analisar as médias, desvios padrões e percentuais. Resultados: Em 2.137 nascimentos foram identificados 25 casos (1,2%) de tocotraumatismo fetal e 34 (1,6%) de tocotraumatismo materno. Dentre os tocotraumatismos fetais, a via de parto predominante foi a vaginal (88%) e a média da idade materna foi de 25,1±5,8 anos. O peso fetal médio foi de 3.366,4g±696,3g. As lesões leves foram as mais observadas (n=16; 64%). A fratura de clavícula foi o tocotraumatismo mais prevalente, seguido do céfalo-hematoma. Dentre os tocotraumatismos maternos, 33 nascimentos ocorreram via vaginal (97,1%) e a média da idade materna foi de 26,6±7,1 anos. O peso fetal médio foi de 3.152,9g ± 507,8g. As lesões mais observadas foram as de fúrcula vaginal (n=19; 55,9%). Conclusão: Dentre os casos de tocotraumatismo fetal (1,2%), as lesões do tipo leve e superficial foram as mais observadas, prevalecendo a fratura de clavícula. Dentre os casos de tocotraumatismos maternos (1,6%), as lacerações do 1.o e 2.o graus foram as mais prevalentes

Introduction: Because the maternal and fetal birth injuries are directly linked to morbidity/mortality, they are a major theme in the perinatal field. To get to know the real incidence of such events becomes important in order to correct any misconducts. The aim of this study was to determine the prevalence and the types of maternal and fetal birth injuries in the population cared for at a tertiary referral university hospital. Methods: A cross-sectional study involving pregnant women in the Jul/2004-Dec/2005 period. Maternal and neonatal variables were evaluated. Statistical software SPSS 16.0 was used in the analysis of means, standard deviations, and percentages. Results: Of 2.137 births, 25 cases (1.2%) of fetal and 34 (1.6%) cases of maternal birth injuries were reported. Among the fetal birth injuries, vaginal childbirth was the prevailing route of delivery (88%) and the mean maternal age was 25.1±5.8 years. The mean birth weight was 3.366.4g±696.3g. Minor lesions were the most prevalent ones (n=16; 64%). Fracture of the clavicle was the commonest injury, followed by cephalhematoma. Among the maternal birth injuries, 33 were through vaginal childbirth (97.1%) and the mean maternal age was 26.6±7.1 years. The mean birth weight was 3.152.9g±507.8g. The commonest injuries were those to the vaginal furcula (n=19; 55.9%). Conclusion: Among the cases of fetal birth injury (1.2%), minor, superficial lesions were the most frequent ones, with fracture of the clavicle prevailing. Among the maternal birth injuries (1.6%), 1st and 2nd degree lacerations were the most prevalent

Asunto(s)