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Instrumental Vaginal Delivery
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Malik Goonewardene, Sanjeewa Padumadasa
The posterior fontanelle should be one fingerbreadth above the plane of the shanks (C). This will ensure that the line of traction is through the flexion point of the fetal skull, which is 3 cm anterior to the posterior fontanelle, resulting in flexion of the vertex, and the presentation of the shortest anteroposterior diameter. If the posterior fontanelle is more than one fingerbreadth above this plane, then it will tend to deflex the fetal head during traction, thus presenting a larger diameter at the maternal pelvis.
Growth and development
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
1.42. The anterior fontanelleusually closes by 3 months of age.is rarely pulsatile.marks the junction of the sagittal and coronal sutures.may not bulge in the presence of meningitis.is usually smaller than the posterior fontanelle.
Paediatrics
Published in Vincent Helyar, Aidan Shaw, The Final FRCR, 2017
This is the premature bony fusion of one or more cranial sutures (normally open until about 18 months, except for the metopic suture). The posterior fontanelle closes at 6 months, whilst the anterior fontanelle closes at 12 months. Presents with a deformed head and raised intracranial pressure, see Figure 5.1.
Medical devices and the pediatric population – a head-to-toe approach
Published in Expert Review of Medical Devices, 2019
Joy H. Samuels-Reid, Judith U. Cope
The head is large relative to the body in infants and young children. The skull is thinner and more flexible. This requires different types of considerations for the pediatric population and age-appropriate medical devices. Head circumference is a significant metric in assessing growth and development of the neonate and infant and is measured across the frontal-occipital prominence, the area of greatest diameter. While head circumference is an indicator for growth and development in the pediatric population, it is not in adults. It is tracked on growth charts during pediatric exams from birth through the first few years. Newborns have greater brain weights in proportion to body weight. The anterior and posterior fontanelles close at different times: the anterior fontanelle is the last to close between 1 to 3 years (the median time is about 13.8 months) and the posterior closes 2–3 months after birth. Depressed fontanelles may indicate dehydration, while bulging fontanelles may indicate swelling in the brain [6]. Early closure of fontanelles may lead to microcephaly, misshapen head and delay in closure may signal hydrocephalus. Cranial sutures close at different rates. It is important that use of devices take into consideration the status of cranial sutures and the stage of growth and development of the skull. If sutures close prematurely, they result in craniosynostosis [7]. Devices such as cranial helmets are often used to correct positional head deformity such as plagiocephaly.
Combination of a negative pressure suction device and endoscope can accurately locate the bleeding site of refractory epistaxis
Published in Acta Oto-Laryngologica, 2021
Xinghong Yin, Xinhai Zhang, Bo Wang, Keliang Li, Maoli Duan
Blood pressure, heart rate, electrocardiographic monitoring, and oxygen saturation were monitored in the local anesthesia operating room. With the patient supine, a conventional disinfectant towel was laid, nasal filler was removed, tetracaine and epinephrine cotton were used to anesthetize and contract the nasal cavity, and systemic examinations were performed under nasal endoscopy. The systematic search of the entire nasal cavity to detect bleeding was always performed in the same order: from anterior to posterior and from upper to lower, especially the following sites: junction of the nasal septum and nasal domain; nasal roof to the upper end of the nasal septum in the olfactory fissure area; junction of the middle nasal meatus and methyl plate of the middle turbinate (horizontal part and vertical part); upper margin of the inferior turbinate near the posterior fontanelle of maxillary sinus; front of the inferior meatus; posterior fornix of inferior meatus; and upper margin of the posterior nostril. Possible bleeding points were explored and, if none were found, the patients were randomly assigned to the negative pressure group (NPG) or control group (CG). For the CG, local selective tamponade was performed on suspected bleeding points during intraoperative exploration. In the NPG, the negative pressure device was applied, and negative pressure was adjusted to 40 kPa. The negative pressure football was placed into the anterior nostril of the affected side, and the patient was asked to press the other nasal alar with one hand to block the nasal cavity on the non-affected side and asked to hold their breath. The nasal cavity on the affected side connecting a negative pressure device form a closed space. then opening the negative pressure device, negative pressure in the nasal cavity is formed . Then, the bleeding site of the nasal cavity could be explored again under nasal endoscopy to accurately locate the bleeding site by following the blood flow at the time. Bleeding was stopped by electrocoagulation using an attractive haemostatic electrode, as shown in Figure 1. If nosebleed could not be induced, the patients underwent selective packing. The methodological protocol is illustrated in Figure 2.