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obstetric trauma

A F Fransen, J van de Ven, E Schuit, Aac van Tetering, B W Mol, S G Oei
OBJECTIVE: To investigate whether simulation-based obstetric team training in a simulation centre improves patient outcome. DESIGN: Multicentre, open, cluster randomised controlled trial. SETTING: Obstetric units in the Netherlands. POPULATION: Women with a singleton pregnancy beyond 24 weeks of gestation. METHODS: Random allocation of obstetric units to a 1-day, multi-professional, simulation-based team training focusing on crew resource management (CRM) in a simulation centre or to no such team training...
October 10, 2016: BJOG: An International Journal of Obstetrics and Gynaecology
Joanna Davies, Rezan Kadir
Management of factor XI (FXI) deficiency in pregnancy is complicated by lack of correlation between FXI level and bleeding risk. Clinicians should be vigilant about the potential for prolonged or excessive bleeding following miscarriage or termination of pregnancy, or postpartum hemorrhage (PPH). A multidisciplinary approach along with an individual care plan is recommended to prevent bleeding complications. Assessment of bleeding history, FXI level, and global tests of hemostasis can aid management decisions regarding hemostatic prophylaxis...
October 3, 2016: Seminars in Thrombosis and Hemostasis
Sarah H Koning, Klaas Hoogenberg, Kirsten A Scheuneman, Mick G Baas, Fleurisca J Korteweg, Krystyna M Sollie, Bertine J Schering, Aren J van Loon, Bruce H R Wolffenbuttel, Paul P van den Berg, Helen L Lutgers
BACKGROUND: To evaluate the neonatal and obstetric outcomes of pregnancies complicated by gestational diabetes mellitus (GDM). Screening and treatment - diet-only versus additional insulin therapy - were based on the 2010 national Dutch guidelines. METHODS: Retrospective study of the electronic medical files of 820 singleton GDM pregnancies treated between January 2011 and September 2014 in a university and non-university hospital. Pregnancy outcomes were compared between regular care treatment regimens -diet-only versus additional insulin therapy- and pregnancy outcomes of the Northern region of the Netherlands served as a reference population...
September 29, 2016: BMC Endocrine Disorders
G Tumusiime, A Was, M A Preston, J N Riesel, S S Ttendo, P G Firth
BACKGROUND: There are little primary data available on the delivery or quality of surgical treatment in rural sub-Saharan African hospitals. To initiate a quality improvement system, we characterized the existing data capture at a Ugandan Regional Referral Hospital. METHODS: We examined the surgical ward admission (January 2008-December/2011) and operating theater logbooks (January 2010-July 2011) at Mbarara Regional Referral Hospital. RESULTS: There were 6346 admissions recorded over three years...
September 22, 2016: World Journal of Surgery
Ngoh C Liew, Gina V Alemany, Pantep Angchaisuksiri, Soo M Bang, Gordon Choi, Deidre A De Silva, Ji M Hong, Limi Lee, Yong J Li, Ganesan N Rajamoney, John Suviraj, Thiam C Tan, Eric Tse, Li T Teo, Julie Jvisperas, Raymond S Wong, Lai H Lee
The Asian venous thromboembolism (VTE) prophylaxis guidelines was first published in 2012. Since its first edition, the Asian Venous Thrombosis Forum (AVTF) working group have updated the Asian VTE epidemiology and reviewed issues that were not addressed in the previous guidelines. The authors noted that the rising incidence of VTE across Asia may be attributable to aging population, dietary changes, and increasing incidence of obesity and diabetes. The new additions in the guideline include role of thrombophilia in VTE, bleeding risk in Asians, individual risk assessment, updates in the prevention of VTE in medically ill, bariatric surgery, cancer, orthopaedic and trauma patients...
September 8, 2016: International Angiology: a Journal of the International Union of Angiology
Howard Berger, Robert Gagnon, Mathew Sermer, Melanie Basso, Hayley Bos, Richard N Brown, Emmanuel Bujold, Stephanie L Cooper, Robert Gagnon, Katy Gouin, N Lynne McLeod, Savas M Menticoglou, William R Mundle, Anne Roggensack, Frank L Sanderson, Jennifer D Walsh
OBJECTIVE: This guideline reviews the evidence relating to the diagnosis and obstetrical management of diabetes in pregnancy. OUTCOMES: The outcomes evaluated were short- and long-term maternal outcomes, including preeclampsia, Caesarean section, future diabetes, and other cardiovascular complications, and fetal outcomes, including congenital anomalies, stillbirth, macrosomia, birth trauma, hypoglycemia, and long-term effects. EVIDENCE: Published literature was retrieved through searches of PubMed and the Cochrane Library using appropriate controlled vocabulary (MeSH terms "diabetes" and "pregnancy")...
July 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Micaela M Esquivel, Tarsicio Uribe-Leitz, Emmanuel Makasa, Kennedy Lishimpi, Peter Mwaba, Kendra Bowman, Thomas G Weiser
Importance: Surgical care is widely unavailable in developing countries; advocates recommend that countries evaluate and report on access to surgical care to improve availability and aid health planners in decision making. Objective: To analyze the infrastructure, capacity, and availability of surgical care in Zambia to inform health policy priorities. Design, Setting, and Participants: In this observational study, all hospitals providing surgical care were identified in cooperation with the Zambian Ministry of Health...
August 31, 2016: JAMA Surgery
J A Garcia-Mejido, Dra L Gutierrez, A Fernandez-Palacín, Dra A Aquise, J A Sainz
OBJECTIVES: To determine the rate of pelvic floor trauma, levator ani muscle (LAM) avulsion as well as the mean difference in levator hiatus area, after normal vaginal deliveries (NVD) and vacuum assisted deliveries (VD), assessed with three-dimensional transperineal ultrasound (3D-TpUS). MATERIALS AND METHODS: Prospective observational study with 151 nulliparous women with NVD or VD at ≥37 weeks between 9-2012 and 6-2013. 3D-TpUS was performed 6 months after every patient's delivery, during which LAM, anteroposterior diameter, transverse diameter and levator hiatus area were assessed...
August 24, 2016: Journal of Maternal-fetal & Neonatal Medicine
Thomas Frieling
Fecal incontinence is defined by the unintentional loss of solid or liquid stool, and anal incontinence includes leakage of gas and / or fecal incontinence. Anal-fecal incontinence is not a diagnosis but a symptom. Many patients hide the problem from their families, friends, and even their doctors. Epidemiologic studies indicate a prevalence between 7-15 %, up to 30 % in hospitals and up to 70 % in longterm care settings. Anal-fecal incontinence causes a significant socio-economic burden. There is no widely accepted approach for classifying anal-fecal incontinence available...
August 2016: Deutsche Medizinische Wochenschrift
Benjamin Lindquist, Matthew C Strehlow, G V Ramana Rao, Jennifer A Newberry
BACKGROUND: Many low- and middle-income countries depend on emergency medical technicians (EMTs), nurses, midwives, and layperson community health workers with limited training to provide a majority of emergency medical, trauma, and obstetric care in the prehospital setting. To improve timely patient care and expand provider scope of practice, nations leverage cellular phones and call centers for real-time online medical direction. However, there exist several barriers to adequate communication that impact the provision of emergency care...
2016: Curēus
Chad D Meyerhoefer, Susan A Sherer, Mary E Deily, Shin-Yi Chou, Lizhong Peng, Tianyan Hu, Marion Nihen, Michael Sheinberg, Donald Levick
OBJECTIVE: To determine the effect of availability of clinical information from an integrated electronic health record system on pregnancy outcomes at the point of care. MATERIALS AND METHODS: We used provider interviews and surveys to evaluate the availability of pregnancy-related clinical information in ambulatory practices and the hospital, and applied multiple regression to determine whether greater clinical information availability is associated with improvements in pregnancy outcomes and changes in care processes...
August 18, 2016: Journal of the American Medical Informatics Association: JAMIA
Sindhu K Srinivas, Dylan S Small, Michelle Macheras, Jesse Y Hsu, Donna Caldwell, Scott Lorch
BACKGROUND: The laborist model of obstetric care represents a change in care delivery with the potential of improving maternal and neonatal outcomes. OBJECTIVE: We evaluated the effectiveness of the laborist model of care compared to the traditional model of obstetric care using specific maternal and neonatal outcome measures. STUDY DESIGN: This is a population cohort study with laborist and non-laborist hospitals matched 1:2 on delivery volume, geography, teaching status and NICU level using data from the National Perinatal Information Center/Quality Analytic Services (NPIC/QAS) database...
August 13, 2016: American Journal of Obstetrics and Gynecology
Micah R Whitson, Paul H Mayo
Point-of-care ultrasonography (POCUS) is a useful imaging technique for the emergency medicine (EM) physician. Because of its growing use in EM, this article will summarize the historical development, the scope of practice, and some evidence supporting the current applications of POCUS in the adult emergency department. Bedside ultrasonography in the emergency department shares clinical applications with critical care ultrasonography, including goal-directed echocardiography, echocardiography during cardiac arrest, thoracic ultrasonography, evaluation for deep vein thrombosis and pulmonary embolism, screening abdominal ultrasonography, ultrasonography in trauma, and guidance of procedures with ultrasonography...
August 15, 2016: Critical Care: the Official Journal of the Critical Care Forum
Stephen S Ttendo, Adam Was, Mark A Preston, Emmanuel Munyarugero, Vanessa B Kerry, Paul G Firth
BACKGROUND: We describe delivery and outcomes of critical care at Mbarara Regional Referral Hospital, a Ugandan secondary referral hospital serving a large, widely dispersed rural population. METHODS: Retrospective observational study of ICU admissions was performed from January 2008 to December 2011. RESULTS: Of 431 admissions, 239 (55.4 %) were female, and 142 (33.2 %) were children (<18 years). The median length of stay was 2 (IQR 1-4) days, with 365 patients (85 %) staying less than 8 days...
August 9, 2016: World Journal of Surgery
Albert Wandaogo, Toussaint Wendlamita Tapsoba, Isso Ouédraogo, Bernadette Béré, S F Ouédraogo, E Bandré
Traumas of the foetus caused by stabbings are rare but actually life-threatening for both the foetus and the mother. We report a case of penetrating chest wound on a baby taken from the obstetrics unit to the paediatric surgical department. His mother was assaulted by his father, a mentally sick person with no appropriate follow-up. The foetus did not show any sign of vital distress. Surgical exploration of the wound has revealed a section of the 10 th rib, a laceration of the pleura and a tearing of the diaphragm...
July 2016: African Journal of Paediatric Surgery: AJPS
Dana R Gossett, Douglas Gilchrist-Scott, Diane B Wayne, Susan E Gerber
OBJECTIVE: To evaluate the association of a forceps simulation training curriculum for obstetrics residents on rates of severe perineal lacerations after forceps deliveries. METHODS: This was a retrospective cohort study. We created a novel simulation curriculum for forceps-assisted vaginal delivery based on the best practices of local experts, and trained all residents beginning in 2013. We then retrospectively reviewed all forceps deliveries performed in the 2...
September 2016: Obstetrics and Gynecology
Vineet V Mishra, Tanvir Tanvir, Sumesh Choudhary, Nilesh Goraniya
Vesicovaginal fistula (VVF) is a devastating social problem. It can either result from obstetric trauma or following gynecological surgeries, malignancy, or radiation. We present a case of a 70-year-old woman who had a VVF following mesh augmentation surgery for anterior compartment prolapse. She required a transvaginal removal of the eroded mesh followed by a transvaginal repair of VVF using a Martius flap, 6 weeks later. Transvaginal removal of mesh is technically feasible and a good approach. Timing and route of surgery should be individualized...
April 2016: Journal of Mid-life Health
Alix Leader-Cramer, Kimberly Kenton, Bhumy Davé, Dana R Gossett, Margaret Mueller, Christina Lewicky-Gaupp
INTRODUCTION: The impact of obstetric perineal trauma on timing of return to intercourse is unclear, although sexual desire is clearly decreased in these women. In addition, studies examining timing of return to intercourse are cross-sectional and therefore cannot delineate potential reasons that patients might delay return to intercourse. AIM: To identify factors associated with delayed return to intercourse after obstetric anal sphincter injuries. METHODS: This was a planned secondary analysis of a prospective cohort study of women sustaining obstetric anal sphincter injuries during delivery of a full-term singleton infant...
October 2016: Journal of Sexual Medicine
Sambeet Patra, Jayakrishnan K Narayana Kurup, Ashwath M Acharya, Anil K Bhat
A 5-year-old child presented to us with weakness of the left upper limb since birth. With the given history of obstetric trauma and limb examination, a diagnosis of birth brachial plexus palsy was made. Brachial plexus exploration along with microsurgery was performed at the same time which included extrinsic neurolysis of the roots and trunks and nerve transfer for better shoulder external rotation and elbow flexion. Both the movements were severely restricted previously due to co-contractures with the shoulder internal rotators and triceps...
2016: BMJ Case Reports
Dawid Szpecht, Dagmara Frydryszak, Norbert Miszczyk, Marta Szymankiewicz, Janusz Gadzinowski
INTRODUCTION: Intraventricular hemorrhage (IVH) is mostly documented in premature infants, and the younger the gestational age, the more often it occurs. IVH is very rarely reported in full-term neonates. CASE REPORT: Retrospective analysis was performed in 35939 full-term neonates, who were born in the Clinical Hospital of Gynecology and Obstetrics at the University of Medical Sciences in Poznań. Clinical data were retrieved from their medical records. We report a case series of 2 term newborns, who developed severe IVH grade 3 and 4 with no evidence of asphyxia, neuroinfection, TORCH infections, coagulation disorders and trombocytopenia, metabolic disorders, arteriovenous malformations, and selected genetic abnormalities (factor V Leiden 1601G > A polymorphism and MTHFR 677C > T; 1298A > C polymorphisms)...
July 8, 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
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