Impacted fetal head during second stage Caesarean birth: A prospective observational study

Objective: To determine the incidence of, and complication rates from, impacted fetal head at full dilatation Caesarean birth in the UK, and record what techniques were used.Design: Prospective observational study using the UK Obstetric Surveillance System (UKOSS).Setting: 159 (82%) of the 194 UK hospitals with obstetric units.Population: All women who underwent second stage Caesarean birth in the UK between 1st March and 31st August 2019. Further information was collected on cases where a dis-impaction technique was used, or the operating surgeon experienced ‘difficulty’ in delivering the head.Methods: Prospective observational study.Main outcome measures: Technique(s) used, maternal and neonatal outcomes.Results: 3,518 s stage Caesarean births reported. The surgeon used a dis-impaction technique or reported ‘difficulty’ in 564 (16%) of these. The most common dis-impaction techniques used were manual elevation of the head by an assistant through the vagina (n = 235) and a fetal “pillow” (n = 176).Thirteen babies (2%) died or sustained severe injury. Four babies died (two directly attributable to the impacted fetal head).Conclusions: Difficulty with delivery of the fetal head and the use of dis-impaction techniques during second stage Caesarean sections are common but there is no consensus as to the best method to achieve delivery and in what order

The development of modern imaging techniques to study placentation

This thesis describes the development of three-dimensional power Doppler angiography (3D-PDA) and finally magnetic resonance imaging (MRI) perfusion techniques for the assessment of the human placental blood flow. Assessment of changes in placental blood flow may inform the clinical management of pregnancies complicated by placental dysfunction and allow modification of care with the ultimate aim of improving fetal outcome and maternal health. Ideally this should involve a non-invasive technique. I hypothesised that 3D-PDA would prove to be a reliable tool to quantify placental blood flow and demonstrate reduction in conditions associated with aberrant vascularity such as pre- eclampsia, fetal growth restriction and diabetes. I began by determining the validity of 3D-PDA and whether the 3D vascular indices would change in a predictable manner, by examining their relationship to blood flow in both the myometrium in labour and placental tissue in a phantom model. This work demonstrated that there was a relationship between the 3D vascular indices and flow rates, erythrocyte concentration and depth. The relationship was, however, complex. I then assessed within- and between-observer reliability for both data measurement and acquisition in the placenta at various gestational ages using different measurement techniques depending upon whether the entire placenta could be acquired or not. These experiments revealed variable degrees of reliability and demonstrated that the 3D-PDA whole placental technique before 21 completed weeks' gestation was most reliable. Preliminary experiments testing the reliability of an MRI perfusion technique as a tool to assess placental vascularity in the third trimester are also described in the penultimate chapter. The most reliable 3D-PDA techniques where then used to examine placental vascularity between clinical groups. Between 12 and 21 weeks whole placental FI.fmbv was Significantly higher in the diabetic compared to the normal group [54.48 (SE 0.68); 50.60 (SE 0.54) p=O.OOl] and there was a significant difference across gestation (p=0.003). Between 12 and 32 weeks the stereology within a volume technique demonstrated significant differences in FrVolBV between normal and diabetic subjects (p=0.036) and across gestation (p<O.OOl) and the significant difference occurred between 16 and 32 weeks. Mean FrVolBV was also Significantly lower in subjects with pre-eclampsia 0.107 (SE 0.012) compared to those without 0.139 (0.006); p=0.021.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The obstetric care of asylum seekers and refugee women in the UK

Asylum seekers and refugees are a vulnerable group with regards to pregnancy outcomes and accessing maternity care. Asylum seekers and refugees who are pregnant and living in the UK face medical, sexual and psychosocial challenges, including dispersal late in pregnancy. The health needs of asylum seekers and refugees are complex but similar to other deprived and ethnic minority communities in the UK. Asylum-seeking women are three times more likely to die in childbirth and up to four times more likely to experience postnatal depression than the general population because of a complex combination of physical, psychological, educational, monetary and language problems. Healthcare professionals may not be aware of the legal issues surrounding asylum seekers, and therefore may not provide adequate help and support. Learning objectives To gain knowledge of how to provide good antenatal care for this group of vulnerable women. To be able to describe the medical, sexual and psychosocial issues that face pregnant asylum seekers and refugee women in the UK. To gain awareness of the legal aspects of seeking asylum in the UK and its impact on accessing health care, especially in pregnancy. Ethical issues Should the NHS provide free health care to failed asylum seekers? Is it justified to disperse pregnant women late in the third trimester (up to 36 weeks of gestation) to prevent destitution with consequent fragmentation of care and isolation of the women? Keywords: antenatal care / asylum seeker / complex psychosocial needs / dispersal / refugee health Please cite this paper as: Asif S, Baugh A, Jones NW. The obstetric care of asylum seekers and refugee women in the UK

Antepartum fetal health

Delivery of a healthy full term baby following an uneventful antenatal period occurs in the majority of pregnancies. These are classified as a low-risk pregnancy group. There are, however, some pregnancies that are complicated due to maternal or fetal disease that can increase the risk of perinatal morbidity and mortality. This is classified as a high-risk group. The aim of fetal surveillance is to identify these threatened fetuses with the prospect of altering the timing of delivery to prevent the worst outcome, stillbirth. This article looks at the tools available to assess antenatal fetal health in all pregnancies and their ability to identify the at-risk pregnancies that require extra surveillance to improve outcomes. This article does not address fetal surveillance during labour

Primary cam morphology; bump, burden or bog-standard? : A concept analysis

BACKGROUND: Cam morphology, a distinct bony morphology of the hip, is prevalent in many athletes, and a risk factor for hip-related pain and osteoarthritis. Secondary cam morphology, due to existing or previous hip disease (eg, Legg-Calve-Perthes disease), is well-described. Cam morphology not clearly associated with a disease is a challenging concept for clinicians, scientists and patients. We propose this morphology, which likely develops during skeletal maturation as a physiological response to load, should be referred to as primary cam morphology. The aim of this study was to introduce and clarify the concept of primary cam morphology. DESIGN: We conducted a concept analysis of primary cam morphology using articles that reported risk factors associated with primary cam morphology; we excluded articles on secondary cam morphology. The concept analysis method is a rigorous eight-step process designed to clarify complex 'concepts'; the end product is a precise definition that supports the theoretical basis of the chosen concept. RESULTS: We propose five defining attributes of primary cam morphology-tissue type, size, site, shape and ownership-in a new conceptual and operational definition. Primary cam morphology is a cartilage or bony prominence (bump) of varying size at the femoral head-neck junction, which changes the shape of the femoral head from spherical to aspherical. It often occurs in asymptomatic male athletes in both hips. The cartilage or bone alpha angle (calculated from radiographs, CT or MRI) is the most common method to measure cam morphology. We found inconsistent reporting of primary cam morphology taxonomy, terminology, and how the morphology is operationalised. CONCLUSION: We introduce and clarify primary cam morphology, and propose a new conceptual and operational definition. Several elements of the concept of primary cam morphology remain unclear and contested. Experts need to agree on the new taxonomy, terminology and definition that better reflect the primary cam morphology landscape-a bog-standard bump in most athletic hips, and a possible hip disease burden in a selected few

Primary cam morphology; Bump, burden or bog-standard? A concept analysis

Background Cam morphology, a distinct bony morphology of the hip, is prevalent in many athletes, and a risk factor for hip-related pain and osteoarthritis. Secondary cam morphology, due to existing or previous hip disease (eg, Legg-Calve-Perthes disease), is well-described. Cam morphology not clearly associated with a disease is a challenging concept for clinicians, scientists and patients. We propose this morphology, which likely develops during skeletal maturation as a physiological response to load, should be referred to as primary cam morphology. The aim of this study was to introduce and clarify the concept of primary cam morphology. Design We conducted a concept analysis of primary cam morphology using articles that reported risk factors associated with primary cam morphology; we excluded articles on secondary cam morphology. The concept analysis method is a rigorous eight-step process designed to clarify complex ' concepts'; the end product is a precise definition that supports the theoretical basis of the chosen concept. Results We propose five defining attributes of primary cam morphology-tissue type, size, site, shape and ownership-in a new conceptual and operational definition. Primary cam morphology is a cartilage or bony prominence (bump) of varying size at the femoral head-neck junction, which changes the shape of the femoral head from spherical to aspherical. It often occurs in asymptomatic male athletes in both hips. The cartilage or bone alpha angle (calculated from radiographs, CT or MRI) is the most common method to measure cam morphology. We found inconsistent reporting of primary cam morphology taxonomy, terminology, and how the morphology is operationalised. Conclusion We introduce and clarify primary cam morphology, and propose a new conceptual and operational definition. Several elements of the concept of primary cam morphology remain unclear and contested. Experts need to agree on the new taxonomy, terminology and definition that better reflect the primary cam morphology landscape- A bog-standard bump in most athletic hips, and a possible hip disease burden in a selected few

CEBM COVID-19 PPE Rapid Reviews

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