American journal of perinatology
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This study was performed to determine if cerclage height is associated with spontaneous preterm birth in patients with a history-indicated cerclage. We performed a retrospective cohort study of women with a history-indicated cerclage. Functional cervical length and the cerclage height (distance from cerclage to the external cervical os) were obtained. ⋯ The rates of spontaneous preterm birth <35 weeks were similar between each group: 24, 17, and 10%, respectively ( P = 0.38). Cerclage height is not associated with a reduction in spontaneous preterm birth for women with a history-indicated cerclage. The association between longer cerclage height and decrease in preterm birth was nonsignificant possibly due to the small sample size.
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Review Case Reports
Management of ornithine transcarbamylase deficiency in pregnancy.
Ornithine transcarbamylase (OTC) deficiency is the most common enzymatic deficiency in the urea cycle. In catabolic states, such as the intrapartum and immediate postpartum periods, hyperammonemic comas with permanent neurological damage and death can develop. We report six cases of OTC deficiency during pregnancy managed at our institution and review the literature on OTC deficiency during pregnancy. ⋯ No hyperammonemic episodes occurred, and intensive care unit admissions and hemodialysis were not required. Although risk to women with OTC deficiency during the intra- and postpartum period exists, multidisciplinary management and a coherent plan usually result in successful labor, delivery, and postpartum. A comprehensive plan for patients who develop hyperammonemia is recommended.
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High peak inspiratory pressure (PIP) and tidal volume (V(T)) from manual ventilation are hazardous to the neonatal lung. We investigated the influence of operator training on the extent of applied PIP and V(T) between two manual ventilation devices. We performed a prospective, crossover study of 84 medical professionals using a neonatal mannequin. ⋯ Twenty-five participants (30%) had previous experience with T-piece devices; this correlated significantly with lower PIP and lower V(T) provision ( P > 0.001 for PIP and V(T)). Operator training level and device-specific experience had a significant impact on PIP and V(T) provision when using SI-bags for manual ventilation. For operators with no specific training in manual ventilation, use of T-piece devices is advised to control for excessive PIP and V(T) application.
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The exact role of the Zavanelli maneuver for the management of shoulder dystocia still remains to be defined. None of the previously reported cases in which the Zavanelli maneuver has been employed described impaction of posterior fetal arm. At 40 weeks' gestation, a nulliparous patient with gestational diabetes, who underwent vacuum delivery, delivered an infant with shoulder dystocia. ⋯ The posterior fetal arm was noted to be persistently impacted, so the Zavanelli maneuver was used to deliver an unsuspected macrosomic (4215 g) infant. The newborn, at the age of 3 years, has a right Erb's palsy. The Zavanelli maneuver can be used to alleviate a posterior arm shoulder dystocia, though there may be concomitant neurological injury.
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Trauma in pregnancy remains one of the major contributors to maternal and fetal morbidity and mortality. Potential complications include maternal injury or death, shock, internal hemorrhage, intrauterine fetal demise, direct fetal injury, abruptio placentae, and uterine rupture. The leading causes of obstetric trauma are motor vehicle accidents, falls, assaults, and gunshots, and ensuing injuries are classified as blunt abdominal trauma, pelvic fractures, or penetrating trauma. ⋯ Once maternal stability is established, vigilant evaluation of fetal well-being becomes warranted. Continuous fetal heart monitoring, ultrasonography, computed tomography, open peritoneal lavage, and/or exploratory laparotomy may be indicated in a case of obstetric trauma. In view of the significant impact of trauma on the pregnant woman and her fetus, preventive strategies are paramount.