CLINICAL MANAGEMENT OF THE BIRTH IN BREECH PRESENTATION

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Modul de naștere în prezentația pelviană rămâne a fi un subiect controversat, deoarece PP este asociată cu o morbiditate și mortalitate prenatală mai mare. Siguranța nașterii vaginale pelvine constituind principalul punct de controversă. Scopul lucrării. Analiza nașterilor în prezentație pelvină din cadrul SCM „Gheorghe Paladi” între anii 2020-2021. Metode și materiale. Sunt prezentate datele unui studiu retrospectiv, care a inclus analiza nașterilor la pacientele cu prezentația pelvină a fătului. Au fost analizate datele din registrele de naștere a 429 de paciente care au născut între anii 2020-2021 în cadrul SCM „Gh. Paladi”. Rezultate. PP a fătului a fost constatată în 4,4% cazuri. Sarcinile au fost finalizate la 37-40 săptămâni în 80,9% din cazuri iar în 19,1% cazuri nașterile au fost premature. Nașterea a fost finisata prin operație cezariană (OC) urgentă în 59,7%, urmată de OC plană - 33,3% cazuri, pe cale naturală au născut doar 7% din gravide. Printre complicațiile care ar fi influențat poziția intrauterină a fătului au fost: în 12,8% circulara de cordon ombilical, anomalii de dezvoltare a organelor genitale interne depistate în 4,2% de cazuri; oligoamnioza - 3,03%, polihidramnioza - 0,93%, cordon anatomic scurt - 2,1%. Copii cu o greutate mică la naștere până la 2500 g s-au înregistrat în 19,8% cazuri, 22,6% din copii au fost cu o masa cuprinsă între 2500-3000 g, 31% din copii -cu masa între 3000-3500 g, 19,4% din copii – cu masa între 35004000 g, iar feți macrosomi s-au înregistrat în 6,5% de cazuri. Concluzii. Tactica de conduită a PP se stabilește individual, în dependență de factorii materni și fetali. Nașterea vaginală în PP este complicată și doar personalul medical calificat și cu experiență este abilitat în conduita acestor nașteri.Background. The way of delivery in breech presentation (BP) continues to be debated, as BP is associated with higher prenatal morbidity and mortality, mostly related to the mode of birth. The safety of pelvic vaginal birth is the most discussed problem. Objective of the study. Analysis of births in pelvic presentation in Gheorghe Paladi Hospital between 2020-2021 years. Material and Methods. The data of a retrospective study are presented, which included the analysis of births in patients with pelvic presentation of the fetus. The data from the birth registers of 429 patients who gave birth between 2020-2021 Gh. Paladi MCH. Results: BP of the fetus was found in 4.4% of cases. Pregnancies were completed at 37-40 weeks in 80.9% of cases and premature birth - 19.1% of cases. The birth was completed by emergency caesarean section (CS) in 59.7%, followed by planned CS - 33.3% of cases, naturally only 7% of pregnant women gave birth. Complications that would have influenced the intrauterine position of the fetus in 12.8% was circular umbilical cord, abnormalities of development of internal genitals were detected in 4.2% of cases; oligoamniosis - 3.03%, polyhydramniosis - 0.93%, short anatomical cord - 2.1%. 19.8% of children had a low birth weight, up to 2500 g, 22.6% had a mass between 2500-3000 g, 31% - 3000-3500, 19.4% - 3500-4000, macrosome faces - 6.5% of cases. Conclusions: BP’s tactics of conduct are established individually, depending on maternal and fetal factors. Vaginal birth in BP is complicated and only qualified and experienced medical staff are qualified in their conduct

Managementul clinic al nașterilor în prezentația pelvină a fătului

Background. The way of delivery in breech presentation (BP) continues to be debated, as BP is associated with higher prenatal morbidity and mortality, mostly related to the mode of birth. The safety of pelvic vaginal birth is the most discussed problem. Objective of the study. Analysis of births in pelvic presentation in Gheorghe Paladi Hospital between 2020-2021 years. Material and Methods. The data of a retrospective study are presented, which included the analysis of births in patients with pelvic presentation of the fetus. The data from the birth registers of 429 patients who gave birth between 2020-2021 Gh. Paladi MCH. Results: BP of the fetus was found in 4.4% of cases. Pregnancies were completed at 37-40 weeks in 80.9% of cases and premature birth - 19.1% of cases. The birth was completed by emergency caesarean section (CS) in 59.7%, followed by planned CS - 33.3% of cases, naturally only 7% of pregnant women gave birth. Complications that would have influenced the intrauterine position of the fetus in 12.8% was circular umbilical cord, abnormalities of development of internal genitals were detected in 4.2% of cases; oligoamniosis - 3.03%, polyhydramniosis - 0.93%, short anatomical cord - 2.1%. 19.8% of children had a low birth weight, up to 2500 g, 22.6% had a mass between 2500-3000 g, 31% - 3000-3500, 19.4% - 3500-4000, macrosome faces - 6.5% of cases. Conclusions: BP’s tactics of conduct are established individually, depending on maternal and fetal factors. Vaginal birth in BP is complicated and only qualified and experienced medical staff are qualified in their conduct.Introducere. Modul de naștere în prezentația pelviană rămâne a fi un subiect controversat, deoarece PP este asociată cu o morbiditate și mortalitate prenatală mai mare. Siguranța nașterii vaginale pelvine constituind principalul punct de controversă. Scopul lucrării. Analiza nașterilor în prezentație pelvină din cadrul SCM „Gheorghe Paladi” între anii 2020-2021. Metode și materiale. Sunt prezentate datele unui studiu retrospectiv, care a inclus analiza nașterilor la pacientele cu prezentația pelvină a fătului. Au fost analizate datele din registrele de naștere a 429 de paciente care au născut între anii 2020-2021 în cadrul SCM „Gh. Paladi”. Rezultate. PP a fătului a fost constatată în 4,4% cazuri. Sarcinile au fost finalizate la 37-40 săptămâni în 80,9% din cazuri iar în 19,1% cazuri nașterile au fost premature. Nașterea a fost finisata prin operație cezariană (OC) urgentă în 59,7%, urmată de OC plană - 33,3% cazuri, pe cale naturală au născut doar 7% din gravide. Printre complicațiile care ar fi influențat poziția intrauterină a fătului au fost: în 12,8% circulara de cordon ombilical, anomalii de dezvoltare a organelor genitale interne depistate în 4,2% de cazuri; oligoamnioza - 3,03%, polihidramnioza - 0,93%, cordon anatomic scurt - 2,1%. Copii cu o greutate mică la naștere până la 2500 g s-au înregistrat în 19,8% cazuri, 22,6% din copii au fost cu o masa cuprinsă între 2500-3000 g, 31% din copii -cu masa între 3000-3500 g, 19,4% din copii – cu masa între 3500- 4000 g, iar feți macrosomi s-au înregistrat în 6,5% de cazuri. Concluzii. Tactica de conduită a PP se stabilește individual, în dependență de factorii materni și fetali. Nașterea vaginală în PP este complicată și doar personalul medical calificat și cu experiență este abilitat în conduita acestor nașteri

Ultrasonography in thyroid pathology diagnostics

Background. In recent decades, a rejuvenation of the pathology of the thyroid gland has been observed, including thyroid tumors. The pathology of the thyroid gland has been increasing lately in our country, and one of the most valuable, safety, cost-efficient and optimal imaging methods used in thyroid gland examination is the ultrasonography. Material and Methods. Our study was conducted on 92 patients (16 males and 76 females), aged between 1-72 years, with various functional problems of the thyroid gland, which were examined by ultrasonography in the Republican Diagnostic Center, during the period May 2021-January 2022. Results. A series of thyroid diseases, among which the thyroid nodules (44.6%), the colloid cysts (7.6%), the autoimmune pathology (3.2%), and others (4.3%) were revealed. Out of the total number of patients diagnosed with thyroid nodules, 22% were males and 78% were females. Unilateral thyroid nodules were marked out in 65.9% of patients, with a male/female ratio of 18.5%/81.5%. Nodules of the right thyroid lobe were determined in 51.9%, with a male/female ratio of 28.6%/71.4% and nodules of the left thyroid lobe were determined in 48.1%, with a male/female ratio of 7.7%/92.3%. Bilateral nodules were present in 34.1% with a male/female ratio of 21.4%/78.6%. Multiple unilateral nodules were marked out in 19.5%. The morphometric parameters of the anteroposterior dimension of the right lobe (RL) of the thyroid gland varied between 1.03-2.34 cm, with a mean value of 1.66±0.27 cm, and that of the left lobe (LL) varied between 0.87-4.03 cm, with a mean of 1.66±0.37 cm. The transverse dimension of the RL were 0.68-2.03 cm, with a mean of 1.45±0.31 cm, and the transverse dimension of the LL were 0.83-8.6 cm, with a mean of 1.51±0.80 cm. The longitudinal dimension of the RL was 1.60-4.99 cm, with a mean value of 3.69±0.49 cm, and that of the LL was 1.64-4.96 cm, with a mean of 3.59±0.55 cm. The thyroid isthmus values varied between 1.5-6.6 mm, with a mean of 3.03±0.68 mm. Conclusions. Both benign and malignant thyroid gland diseases had a higher rate in females, compared to males. Almost in a half of the examined patients were established thyroid nodules, with a twicehigher prevalence of the unilateral nodules and a slight prevalence of the nodules of the right thyroid lobe

Global Chronic Total Occlusion Crossing Algorithm: JACC State-of-the-Art Review

The authors developed a global chronic total occlusion crossing algorithm following 10 steps: 1) dual angiography; 2) careful angiographic review focusing on proximal cap morphology, occlusion segment, distal vessel quality, and collateral circulation; 3) approaching proximal cap ambiguity using intravascular ultrasound, retrograde, and move-the-cap techniques; 4) approaching poor distal vessel quality using the retrograde approach and bifurcation at the distal cap by use of a dual-lumen catheter and intravascular ultrasound; 5) feasibility of retrograde crossing through grafts and septal and epicardial collateral vessels; 6) antegrade wiring strategies; 7) retrograde approach; 8) changing strategy when failing to achieve progress; 9) considering performing an investment procedure if crossing attempts fail; and 10) stopping when reaching high radiation or contrast dose or in case of long procedural time, occurrence of a serious complication, operator and patient fatigue, or lack of expertise or equipment. This algorithm can improve outcomes and expand discussion, research, and collaboration

Global chronic total occlusion crossing algorithm: JACC state-of-the-art review

The authors developed a global chronic total occlusion crossing algorithm following 10 steps: 1) dual angiography; 2) careful angiographic review focusing on proximal cap morphology, occlusion segment, distal vessel quality, and collateral circulation; 3) approaching proximal cap ambiguity using intravascular ultrasound, retrograde, and move-the-cap techniques; 4) approaching poor distal vessel quality using the retrograde approach and bifurcation at the distal cap by use of a dual-lumen catheter and intravascular ultrasound; 5) feasibility of retrograde crossing through grafts and septal and epicardial collateral vessels; 6) antegrade wiring strategies; 7) retrograde approach; 8) changing strategy when failing to achieve progress; 9) considering performing an investment procedure if crossing attempts fail; and 10) stopping when reaching high radiation or contrast dose or in case of long procedural time, occurrence of a serious complication, operator and patient fatigue, or lack of expertise or equipment. This algorithm can improve outcomes and expand discussion, research, and collaboration