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Biolaw and Bioethics
Published in Roger Brownsword, Technology, Governance and Respect for the Law, 2023
The principal question in Montgomery was whether a pregnant woman who was a diabetic, and whose pregnancy was regarded as high-risk requiring intensive monitoring, should have been informed that there was a risk of shoulder dystocia and given the option of delivery by Caesarean Section. Instead, as the court narrated the story,11 she was not made aware of this particular risk; the risk eventuated during an attempted vaginal delivery that went horribly wrong; and, as a result, the baby was born with severe disabilities. The lower courts, following the Bolam principle, held that the acts of the consultant obstetrician and gynaecologist, who was by her own admission reluctant to steer women towards a Caesarean Section, were sufficiently supported by medical practice. However, the UK Supreme Court, resoundingly rejecting the Bolam test, held that the relationship between clinicians and patients must be rights-respecting rather than paternalistic and that patients have a right to be informed about their options (together with their relative benefits and risks).
Pediatric Imaging in General Radiography
Published in Christopher M. Hayre, William A. S. Cox, General Radiography, 2020
Allen Corrall, Joanna Fairhurst
This is a birth related injury which can occur several ways, most commonly caused by shoulder dystocia where the baby becomes stuck in the birth canal as one of its shoulder lodges on the mother’s pubic bone and during the associated assisted delivery the head (or trunk in breech birth) is pulled causing nerve damage as the neck is stretched (South & Isaacs, 2012). The neonate presents with upper limb paralysis on the affected side (sometimes both) and the X-ray request will often mention lack of tone in the affected arm. The role of X-ray is to exclude a fractured clavicle or humerus as an alternative cause for paresis. Nerve damage sequelae range from full recovery to a permanent degree of paralysis.
Solutions Using Machine Learning for Diabetes
Published in Punit Gupta, Dinesh Kumar Saini, Rohit Verma, Healthcare Solutions Using Machine Learning and Informatics, 2023
Jabar H. Yousif, Kashif Zia, Durgesh Srivastava
Diabetes affects individuals, families, businesses, and society as a whole. Six Arabic countries are among the ten highest globally for the prevalence of diabetes: Egypt, United Arab Emirates (UAE), Bahrain, Kuwait, Oman, and Saudi Arabia. Dietary modifications and physical activities can prevent all types of diabetes. Typically, health care providers treat diabetes with weight management plans, exercise, self-monitoring of blood glucose, and medication if required. Gestational diabetes is associated with several risks, including hypertensive disorder, Cesarean delivery, preterm birth, and infant shoulder dystocia [17].
Why introducing biomechanical considerations into obstetrical management of women from pregnancy to delivery?
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
The increase rates of cesarean section have led major obstetrical organizations worldwide to issue recommendations. These initiatives have allowed a stabilization but not a decrease in cesarean section rates, suggesting that novel complementary approaches are required. Current recommendations rely mainly on clinical or epidemiological obstetrical research, with little consideration for the biomechanical aspects of labor. Approximatively 30% of emergency cesarean sections are due to dystocia, which is defined as a slow and abnormal progression of labor. Dystocia is mainly a biomechanical complication and emerging hypotheses posit that mobilizing the lumbar-pelvic-thigh complex of women in labor (parturients) could allow better progression of the fetus, and thus reduce the number of emergency cesarean sections. The orientation of the pelvis (pelvic inlet plane) relative to the fetal axis trajectory, the flatness of the lumbar spine and uterine contractions are three of the most critical factors in labor. They are particularly important actors with regard to dystocia because they control the movement of the fetus towards the birth canal. Surprisingly, little has been done to monitor these aspects and understand their exact roles. Recently, it was shown that mobilizing the women’s lumbar-pelvic-thigh complex influences the relative orientation of the pelvis and the lumbar spine flatness, suggesting that dystocia could be addressed by optimal mobilization of the parturients. While promising, further research and technical development are necessary before the concept of optimal lumbarpelvic-thigh complex mobilization could be used in the clinics.