The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
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J. Matern. Fetal. Neonatal. Med. · May 2020
External cephalic version of the non-cephalic presenting twin: a systematic review.
Objective: Decreasing the primary cesarean delivery rate and associated maternal and fetal complications is a priority for obstetric care providers. External cephalic version (ECV) is a procedure recommended for women with singleton pregnancies where the fetus is malpresenting to avoid vaginal breech delivery, which is inherently riskier than cesarean delivery. However, little is known about this procedure in the context of twin gestations. ⋯ Conclusions: ECV is insufficiently studied in twin pregnancy. Based on very limited data, it appears feasible to turn the non-cephalic presenting twin. Additional randomized controlled trials are needed to further evaluate the safety and efficacy of this procedure for a non-cephalic presenting twin.
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J. Matern. Fetal. Neonatal. Med. · May 2020
Antenatal corticosteroids for pregnant women with COVID-19 infection and preterm prelabor rupture of membranes: a decision analysis.
Background: While antenatal corticosteroids are routinely used to decrease adverse neonatal outcomes following preterm delivery, corticosteroids are also associated with worse outcomes in patients with viral respiratory infections. Currently in the setting of the COVID-19 pandemic, it is unclear whether antenatal corticosteroids for infant benefit outweigh the potential harm to a pregnant woman with a COVID-19 infection. Objective: To determine at which gestational ages administering antenatal corticosteroids is the optimal management strategy for hospitalized women with preterm prelabor rupture of membranes (PPROM) who have a COVID-19 infection. ⋯ On sensitivity analyses, we found that with increasing gestational age, the probability which antenatal corticosteroids was the optimal management strategy decreased. Conclusion: Administration of antenatal corticosteroids was an effective management strategy compared to no corticosteroid administration at gestational ages less than 31 weeks. These results provide data for clinicians to utilize when counseling pregnant patients hospitalized with PPROM and have a COVID-19 infection.
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J. Matern. Fetal. Neonatal. Med. · May 2020
Simulation-guided preparations for the management of suspected or confirmed COVID-19 cases in the obstetric emergency theater.
Aims: The coronavirus 2019 infection (COVID-19) global outbreak has resulted in unprecedented pressures on health services, the need to prepare for the worst-case scenario, and the need for health experts to utilize their knowledge and expertise to fight this virus. The simulation training objective of this study was to enhance the neonatal, maternity, and anesthetics teams' preparedness for the management of the emergency delivery of pregnant women with suspected or confirmed COVID-19 infection. Methods: Three clinical simulation training sessions were conducted in March 2020 at the University Hospital Plymouth, Plymouth, UK. ⋯ Suggestions were discussed and recommendations made. The key changes were: first, floor plan adjustment, increase of the clinical area by converting some offices to clinical spaces, and standard operating procedures for transporting patients; second, enhancement of the efficiency of the communication and coordination between the clinical teams; third, availability of extra support for the staff in the Central Delivery Suite (CDS); and fourth, introduction of a neonatal care pathway to manage neonatal resuscitation in such an emergency. Conclusions: Collaboration and joint training between the different clinical teams involved in the care of suspected or confirmed COVID-19 patients was proven to be one of the most effective ways of improving performance.
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J. Matern. Fetal. Neonatal. Med. · May 2020
Introduction of standardized, cumulative quantitative measurement of blood loss into routine maternity care.
Introduction: Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity in the UK. Visual estimation of blood loss is unreliable yet remains common practice. As part of a national quality improvement project to improve care during PPH, standardized, quantitative measurement of blood loss (QBL) for all deliveries was introduced into a tertiary obstetric unit in Cardiff, Wales. ⋯ Discussion: QBL has been shown to be reliable across all maternity settings, with reproducible results in theater and delivery rooms (on the obstetric unit and alongside midwifery-led unit). QBL is moderately correlated with adjusted change in Hb for all volumes of bleeding and gives clinicians more accurate knowledge of blood loss than visual estimation. This low-cost, low-fidelity intervention can influence the timely escalation of clinical care and therefore patient outcome.
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J. Matern. Fetal. Neonatal. Med. · May 2020
Review Case ReportsAmniotic fluid embolism and spontaneous hepatic rupture during uncomplicated pregnancy: a case report and literature review.
Amniotic fluid embolism (AFE) and spontaneous hepatic rupture both are extremely rare complications of pregnancy that can be fatal to mother and/or child. AFE is characterized by a sudden collapse of the cardiovascular system, a change in mental status, and disseminated intravascular coagulation (DIC), occurring immediately during labor, delivery, or postpartum, caused by the inflow of amniotic components into the maternal circulation. Spontaneous hepatic rupture during pregnancy which is most often occurs alongside hypertensive disorders, eclampsia, or HELLP syndrome. ⋯ The lack of typical clinical signs and symptoms resulted to the difficulty of early diagnosis. If AFE and hepatic rupture is highly suspected in a pregnant patient, a collaborative multidisciplinary approach is mandatory. Pregnancy women is simultaneously complicated in amniotic fluid embolism and spontaneous hepatic rupture, similar cases are infrequent in the literature, which is reviewed in this report, explore the pathophysiological changes, we hope that can be helpful for the prevention, diagnosis and treatment of similar cases.