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Pre-Trial Panic
Published in R. Annie Gough, Injury Illustrated, 2020
Shelley was nine months pregnant with her second child. Everything in her pregnancy was typical and normal, although her little boy, Henry, was in breech presentation. A breech baby is upside down in the uterus, his head near Shelley's liver, his little bottom and feet resting in the amniotic sac above the cervix. A standard presentation would place the baby's head closest to the vagina and the feet up by the liver and stomach, where expecting mothers feel kicking up high on their baby bump. Breech presentation is fairly common—one in every 25 live births. Shelley's doctors were very aware of Henry's position and planned accordingly. About a week before Henry's due date, Shelley's water broke. The amniotic sac around the baby within her uterus ruptured. This is the normal precursor to delivery, often the initial sign that contractions will start and it is time to get to the hospital. Shelley was admitted to her scheduled hospital and examined. Her uterine contractions had not started, nor had her cervix begun to dilate. She was placed in a comfortable patient room to rest and wait for the initiation of delivery. Shelley was not on an IV or a monitor of any kind. She was going about somewhat normal daily activities, feeling fairly well, messaging friends on her phone, and doing a little light work on the laptop. A day went by and she did not go into labor. The next day went by and she still had not gone into labor; her cervix had still not dilated.
Twin delivery
Published in Michael S. Marsch, Janet M. Rennie, Phillipa A. Groves, Clinical Protocols in Labour, 2020
Michael S. Marsch, Janet M. Rennie, Phillipa A. Groves
The delivery of the second twin should not be rushed if all is normal. the membranes of the second amniotic sac should not be ruptured until the presenting part is well down the pelvis. the interval between delivery of twins 1 and 2 is usually less than 30 min but may be up to 1 h if the fetal and maternal condition is satisfactory. the planned interval between vaginal deliveries should not be more than 1 h.
Structural Methods in the Study of Development of the Lung
Published in Joan Gil, Models of Lung Disease, 2020
Paul Davies, Daphne deMello, Lynne M. Reid
In the monkey (Macaca fascicularis), maternal amniocentesis was performed either early in gestation (47-64 days) or later (85-95 days; term = 155 days) (Hislop et al., 1984). In the early group, the animals at term had somewhat reduced body weights. When adjusted for body weight, lung volume in both groups was unaffected. In neither group was airway number abnormal. Both early and late amniocentesis, however, reduced total alveolar number, either wholly or in part through a failure to form the normal number of respiratory bronchioli. These effects occurred independently of the volume of fluid removed and, indeed, were apparent even after simple puncture of the amniotic sac. The authors speculated that puncture alone was sufficient to cause leakage and that sealing of the hole by normal repair processes occurred more slowly or less successfully than anticipated.
Impact of prolonged use of adjuvant tocolytics after cervical cerclage on late abortion and premature delivery
Published in Journal of Obstetrics and Gynaecology, 2023
Li-Rong Zhao, Shu-Jing Lu, Qing Liu, Ying-Chun Yu, Li Xiao
Shirodkar cervical cerclage was performed for all the patients. A Mersilk suture was U-shape around the cervix counterclockwise from 11 o’clock. The knot was at 12 o’clock. The patients whose amniotic sac was protruded out of the external orifice of the cervix was placed in a position that their heads lay low and their buttocks were held high. The amniotic sac was disinfected with iodophor and gently placed back into the internal orifice of the cervix by using a cotton ball. After cervical cerclage, antibiotics were administered for five days to prevent infection, and uterine contraction inhibitors (indomethacin, ritodrine, and atosiban) alone, in combination, or magnesium sulphate alone were administered. The type, dosage, and duration of uterine contraction inhibitor administration were determined according to the interval, intensity, and duration of uterine contractions. A cerclage is removed typically around the gestational age of 36–37 weeks. In the majority of our patients, the gestational age was ≥35 weeks with regular contractions or amniotic sac rupture when the cerclage was removed. However, in some patients, the cerclage was removed at the gestational age of <35 weeks when regular contractions were not effectively inhibited or amniotic sac was ruptured.
Prediction model for labour dystocia occurring in the active phase
Published in Journal of Obstetrics and Gynaecology, 2023
Yanqing Liu, Qingquan Gong, Yuhong Yuan, Qi Shi
The premature rupture of membranes before labour is a common complication in obstetrics. The incidence rate is about 2.7%–17.0%. It could lead to premature delivery, foetal distress, infection and dystocia, even fatally threatening the health of the mother and foetus (American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins-Obstetrics 2016). The premature rupture of membranes was often considered a warning sign of dystocia, most of which occurred in those who did not engage in the foetal head. It is caused by the gap between the foetal presentation and pelvis, communication between anterior and posterior amniotic fluid and uneven stress on the anterior amniotic sac. The premature rupture of membranes causes amniotic fluid loss. The uterine wall is close to the carcase and is prone to uncoordinated uterine contraction or blocked rotation of the foetal head, increasing the chance of dystocia (Waters and Mercer 2009).
Fertility-Sparing Surgery Using Knitted TiNi Mesh Implants and Sentinel Lymph Nodes: A 10-Year Experience
Published in Journal of Investigative Surgery, 2021
Alena Chernyshova, Larisa Kolomiets, Timofey Chekalkin, Vladimir Chernov, Ivan Sinilkin, Victor Gunther, Ekaterina Marchenko, Gulsharat Baigonakova, Ji Hoon Kang
Alongside an improvement in the technical aspects and surgical management of the primary tumor and adjacent tissues, the prevention of postoperative complications, reduction in surgical invasiveness and desired reproductive outcomes should come to the fore. It is to be noted that when suggesting sparing-surgery methods, a clear balance must be maintained between ensuring surgical radicality and achieving a functional/reproductive score, which can be the rationale to overall treatment success. A timely and unresolved issue at present is the need to strengthen the anastomosis area and maintain a retentive potential of the lower uterine segment for a subsequent pregnancy in the extremely short or resected cervix. The concerns typically encountered when considering uterine isthmus (isthmicocervical) insufficiency are related to the descent and prolapse of the amniotic sac, predisposing it to infection. In addition, the amniotic sac may protrude through the anastomotic area, leading to further widening with an increased risk of miscarriage.