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Obstetric palsies

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https://www.readbyqxmd.com/read/29137550/reengineering-electronic-fetal-monitoring-interpretation-using-the-fetal-reserve-index-to-anticipate-the-need-for-emergent-operative-delivery
#1
Robert D Eden, Mark I Evans, Shara M Evans, Barry S Schifrin
OBJECTIVE: The near-ubiquitous use of electronic fetal monitoring has failed to lower the rates of both cerebral palsy and emergency operative deliveries (EODs). Its performance metrics have low sensitivity, specificity, and predictive values for both. There are many EODs, but the vast majority have normal outcomes. The EODs, however, cause serious disruption in the delivery suite routine with increased complications, anxiety, and concern for all. METHODS: We developed the fetal reserve index (FRI) as multicomponent algorithm including 4 FHR components (analyzed individually), uterine activity, and maternal, obstetrical, and fetal risk factors to assess risk of cerebral palsy and EOD...
January 1, 2017: Reproductive Sciences
https://www.readbyqxmd.com/read/29134042/direct-nerve-sutures-in-extended-upper-obstetric-brachial-plexus-repair
#2
J Bahm, A Gkotsi, S Bouslama, W El-Kazzi, F Schuind
Background  In rare, selected cases of severe (extended) upper obstetric brachial plexus palsy (OBPP), after supraclavicular exposure and distal mobilization of the traumatized trunks and careful neuroma excision, we decided to perform direct nerve coaptation with tolerable tension and immobilized the affected arm positioned in adduction and 90-degree elbow flexion for three weeks. Objectives  We present our surgical technique and preliminary results in a prospective open patient series, including 22 patients (14 right and 8 left side affected) between 2009 and 2016, operated at a mean age of 8...
January 2017: Journal of Brachial Plexus and Peripheral Nerve Injury
https://www.readbyqxmd.com/read/29092081/novel-findings-in-obstetric-brachial-plexus-palsy-a-study-of-corpus-callosum-volumetry-and-resting-state-functional-magnetic-resonance-imaging-of-sensorimotor-network
#3
Kishore Kislay, Bhagavatula Indira Devi, Dhananjaya Ishwar Bhat, Dhaval Prem Shukla, Arun Kumar Gupta, Rajanikant Panda
BACKGROUND: The response of the brain to obstetric brachial plexus palsy (OBPP) is not clearly understood. We propose that even a peripheral insult at the developmental stage may result in changes in the volume of white matter of the brain, which we studied using corpus callosum volumetry and resting-state functional magnetic resonance imaging (rsfMRI) of sensorimotor network. OBJECTIVE: To study the central neural effects in OBPP. METHODS: We performed an MRI study on a cohort of 14 children who had OBPP and 14 healthy controls...
October 28, 2017: Neurosurgery
https://www.readbyqxmd.com/read/29016426/the-epidemiology-of-brachial-plexus-birth-palsy-in-the-united-states-declining-incidence-and-evolving-risk-factors
#4
Christopher J DeFrancesco, Divya K Shah, Benjamin H Rogers, Apurva S Shah
BACKGROUND: The epidemiology of brachial plexus birth palsy (BPBP) in the United States may be changing over time due to population-level changes in obstetric care. METHODS: The Kids' Inpatient Database from 1997 to 2012 was analyzed. Annual estimates of BPBP incidence and disease determinant distribution were calculated for the general population and the study population with BPBP. Long-term trends were analyzed. A multivariate logistic regression model was used to quantify the risk associated with each determinant...
October 9, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28989239/scarring-of-the-c8-t1-roots-with-partial-avulsion-in-situ-in-total-obstetric-brachial-plexus-palsy
#5
Mohammad M Al-Qattan, Amel A F El-Sayed
BACKGROUND: Primary exploration of the brachial plexus in infants with obstetric palsy may reveal scarring of the lower roots with evidence of partial avulsion-in-situ. As we have been treating this lesion by neurolysis only, we aimed to investigate the recovery of hand function following such approach. METHODS: A series of 14 cases of total obstetric palsy with with evidence of partial avulsion-in-situ of the lower roots were included. All lesions were treated by neurolysis only (with no neurotization of the lower roots)...
2017: European Journal of Plastic Surgery
https://www.readbyqxmd.com/read/28853525/-principles-of-causality-between-peripartum-events-and-cerebral-palsy
#6
REVIEW
Isaac Blickstein
Understanding the intrapartum development of cerebral palsy (CP) may improve obstetrical management, would decrease the incidence of CP, and would help the court in judging whether CP is a result of negligence. In 1999, the Australian task force, and in 2003 the American task force, published their consensus regarding the criteria to establish intrapartum development of CP (recently reaffirmed by the American task force). The rationale is that CP is the end product of a continuum starting with an intrapartum hypoxic event that continues with the birth of an asphyxiated neonate, that exhibit specific neurological manifestations, and ends with a specific type of CP...
August 2017: Harefuah
https://www.readbyqxmd.com/read/28853524/-cerebral-palsy-at-the-age-of-modern-obstetrics-ancient-beliefs-versus-solid-facts
#7
Shali Mazaki-Tovi
For many decades the conventional wisdom was that the sole etiology for cerebral palsy is difficult delivery. The adverse outcome associated with cerebral palsy was intuitively related to complications during labor. The blame, unjustifiably and recklessly, was placed on devoted physicians and midwifes. This wrongful accusation, that one may describe as "scientific blood libel" is unprecedented in medicine. In his article, Professor Blickstein scrupulously revises the scientific evidence connecting birth asphyxia and cerebral palsy and refutes the common belief that the only cause for cerebral palsy is complicated delivery...
August 2017: Harefuah
https://www.readbyqxmd.com/read/28798538/the-outcome-of-primary-brachial-plexus-reconstruction-in-extended-erb-s-obstetric-palsy-when-two-roots-are-available-for-intraplexus-neurotization
#8
Mohammad M Al-Qattan, Amel A F El-Sayed
BACKGROUND: The outcome of primary brachial plexus reconstruction in extended Erb's obstetric palsy with single root avulsion has not been specifically documented in the literature. METHODS: A series of 46 consecutive cases of extended Erb's obstetric palsy with single root avulsion was retrospectively reviewed. The upper and middle trunks were reconstructed with nerve grafts from the available two roots. No nerve transfers were used. The percentage of a satisfactory motor recovery was documented...
2017: European Journal of Plastic Surgery
https://www.readbyqxmd.com/read/28798537/the-outcome-of-primary-brachial-plexus-reconstruction-in-extended-erb-s-obstetric-palsy-when-only-one-root-is-available-for-intraplexus-neurotization
#9
Mohammad M Al-Qattan, Amel Ahmed F El-Sayed
BACKGROUND: A recent review by the International Federation of Societies for Surgery of the Hand showed no studies comparing the results of nerve grafting to distal nerve transfer for primary reconstruction of the brachial plexus in infants with obstetric brachial plexus palsy (OBBP). The aim of this retrospective study is to compare two surgical reconstructive strategies in primary reconstruction of the brachial plexus in extended Erb's obstetric palsy with double root avulsion: one with and one without distal nerve transfer for elbow flexion...
2017: European Journal of Plastic Surgery
https://www.readbyqxmd.com/read/28783492/shoulder-muscle-atrophy-and-its-relation-to-strength-loss-in-obstetrical-brachial-plexus-palsy
#10
Christelle Pons, Frances T Sheehan, Hyun Soo Im, Sylvain Brochard, Katharine E Alter
BACKGROUND: Treatment/prevention of shoulder muscle strength imbalances are major therapeutic goals for children with obstetrical brachial plexus palsy. The study aims were to characterize muscle atrophy in children/adolescents with unilateral obstetrical brachial plexus palsy, to quantify the agonist-antagonist muscle volume balance and the association between muscle volume and strength. METHODS: Eight boys and four girls (age=12.1, standard deviation=3.3) participated in this case-control study...
October 2017: Clinical Biomechanics
https://www.readbyqxmd.com/read/28742216/the-fetuses-at-risk-approach-survival-analysis-from-a-fetal-perspective
#11
K S Joseph, Michael S Kramer
Several phenomena in contemporary perinatology create challenges for analyzing pregnancy outcomes. These include recent increases in iatrogenic delivery at late preterm and early term gestation which are incongruent with the belief that stillbirth and neonatal death risk decrease exponentially with advancing gestational age. Perinatal epidemiologists have also puzzled over the paradox of intersecting birth weight- and gestational age-specific perinatal mortality curves for decades. For example, neonatal mortality rates among preterm infants of women who smoke are substantially lower than neonatal mortality rates among preterm infants of non-smoking women, whereas the reverse pattern occurs at term gestation...
July 25, 2017: Acta Obstetricia et Gynecologica Scandinavica
https://www.readbyqxmd.com/read/28739361/gender-affects-long-term-neurological%C3%A2-outcome-of-neonates
#12
Amir Freud, Eyal Sheiner, Tamar Wainstock, Daniella Landau, Asnat Walfisch
OBJECTIVE: We evaluated the possible association between fetal gender and long-term pediatric neurological morbidity. METHODS: We performed a population-based retrospective cohort analysis comparing the risk of long-term neurological morbidity (up to age 18 years) of children born during the years 1991 to 2013 according to their gender. Neurological morbidity evaluated included hospitalizations in childhood involving pervasive developmental disorder, obstructive sleep apnea, cerebral palsy, epilepsy, and infantile spasms and disorders of eating as recorded in the hospital files...
September 2017: Pediatric Neurology
https://www.readbyqxmd.com/read/28719548/forearm-pronation-osteotomy-for-supination-contracture-secondary-to-obstetrical-brachial-plexus-palsy-a-retrospective-cohort-study
#13
Aharon Z Gladstein, Brant Sachleben, Emily S Ho, Alison Anthony, Howard M Clarke, Sevan Hopyan
BACKGROUND: Obstetrical brachial plexus palsy can lead to fixed forearm supination contracture. Fixed supination may lead to functional deficits as the affected hand cannot be positioned optimally for activities on a desk such as writing and typing, or for using tools including utensils, which require a neutral or pronated forearm. Forearm pronation osteotomy has been used to address this problem, although the functional benefit over nonoperative management has not been clearly defined...
July 17, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28709767/obstetrical-brachial-plexus-palsy
#14
Patricia O'Berry, Mackenzie Brown, Leslie Phillips, Sarah Helen Evans
Obstetrical brachial plexus palsy is a disorder of the peripheral nervous system and occurs in as many as 0.4% of infants born. It is associated with shoulder dystocia, use of mechanical extraction, and macrosomia; it occurs more frequently in infants born by vaginal delivery. The unilateral injury to the brachial plexus complex occurs during the delivery phase as lateral traction is applied to the head to permit shoulder clearance. The infant typically presents in the delivery room with decreased active movements of the affected arm and asymmetrical primitive reflex responses...
July 2017: Current Problems in Pediatric and Adolescent Health Care
https://www.readbyqxmd.com/read/28650063/-obstetric-brachial-plexus-palsy-incidence-monitoring-of-progress-and-prognostic-factors
#15
G Vaquero, A Ramos, J C Martinez, P Valero, N Nunez-Enamorado, R Simon-De Las Heras, A Camacho-Salas
INTRODUCTION: Obstetric brachial plexus palsy is related with shoulder dystocia, and its main risk factor is macrosomia. Its incidence is estimated to be between 0.1 and 6.3 cases per 1,000 live newborn infants. Most cases are resolved but can give rise to permanent functional deficiency, which means that there is an interest to identify possible prognostic factors. PATIENTS AND METHODS: We conducted a descriptive study of newborn infants with obstetric brachial plexus palsy born in our hospital between the years 2011 and 2015...
July 1, 2017: Revista de Neurologia
https://www.readbyqxmd.com/read/28625304/any-news-on-the-postdural-puncture-headache-front
#16
REVIEW
Feyce Peralta, Sarah Devroe
Unintentional dural puncture followed by postdural puncture headache is a well-known complication following neuraxial labor analgesia. Risk factors for the development of postdural puncture headache may be related to the patient's history and characteristics, the neuraxial technique, and obstetrical events. The diagnosis of postdural puncture headache is usually made depending on the clinical presentation (orthostatic headache after a neuraxial procedure). Occasionally, neuroimaging and neurological consultation are warranted...
March 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/28596982/evidence-of-the-effectiveness-of-primary-brachial-plexus-surgery-in-infants-with-obstetric-brachial-plexus-palsy-revisited
#17
Amel A F El-Sayed
A recent systematic review questioned the effectiveness of primary surgery in infants with obstetric brachial plexus palsy. At our center, the indication for primary surgery in infants with upper Erb's obstetric palsy is the lack of active elbow flexion at age 4 months. The current study compares the outcome of motor recovery in 2 groups of infants with upper Erb's palsy: one group (n = 9) treated surgically between age 4 and 5 months, and another group (n = 9) treated conservatively despite the lack of active elbow flexion at age 4 months...
January 2017: Child neurology open
https://www.readbyqxmd.com/read/28591756/the-fetal-reserve-index-re-engineering-the-interpretation-and-responses-to-fetal-heart-rate-patterns
#18
Robert D Eden, Mark I Evans, Shara M Evans, Barry S Schifrin
OBJECTIVE: Electronic fetal monitoring (EFM) correlates poorly with neonatal outcome. We present a new metric: the "Fetal Reserve Index" (FRI), formally incorporating EFM with maternal, obstetrical, fetal risk factors, and excessive uterine activity for assessment of risk for cerebral palsy (CP). METHODS: We performed a retrospective, case-control series of 50 term CP cases with apparent intrapartum neurological injury and 200 controls. All were deemed neurologically normal on admission...
June 8, 2017: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/28574948/five-operations-that-give-the-best-results-after-brachial-plexus-injury
#19
Andrés A Maldonado, Allen T Bishop, Robert J Spinner, Alexander Y Shin
Treatment of brachial plexus injuries has improved slowly over the past 45 years. Changes in strategy, techniques, microsurgical equipment, and technology have expanded the surgical options for reconstructing these life-altering, highly complex injuries. The surgical techniques available include neurolysis, nerve repair, nerve grafting, nerve transfers, tendon transfer, muscle transfer, and other soft- and bony-tissue procedures. In this article, the authors have selected five surgical procedures (i.e., Oberlin procedure, Leechavengvongs procedure, free functional muscle transfer, radial nerve tendon transfers, and C5-C6 nerve grafting in obstetric birth palsy) that have consistently yielded good results in patients who require surgical reconstruction...
September 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28504029/obstetric-brachial-plexus-palsy-a-population-based-retrospective-case-control-study-and-medicolegal-considerations
#20
Simona Zaami, Francesco Paolo Busardò, Fabrizio Signore, Nicola Felici, Vito Briganti, Giovanni Baglio, Enrico Marinelli, Vittorio Fineschi
AIMS: The aim of this study was to examine 24 cases of obstetric brachial plexus palsy (OBPP) in 41,002 deliveries occurred at San Camillo-Forlanini Hospital in Rome, during the period 2000-2012. MATERIALS AND METHODS: A population-based retrospective case-control study was designed and the database of the hospital was searched; for each case, maternal and fetal records were examined and some risk factors were evaluated. RESULTS: A statistically significant association between the 24 cases OBPP and the following risk factors: primiparity (p < ...
May 14, 2017: Journal of Maternal-fetal & Neonatal Medicine
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