Second Stage Of Labor
Vincenzo Berghella in Obstetric Evidence Based Guidelines, 2022
Prophylactic intrapartum maternal oxygen should not be used in the second stage of normal labor, since it is associated with more frequent low cord blood pH values (
Cough maneuver is superior to Valsalva maneuver for detecting mild-extent right-to-left shunt
Published in Scandinavian Cardiovascular Journal, 2020
Yun-Xia Zhang, Xiao-Yong Zhang, Qi Zhang
Objective: The purpose of this study was to explore the different provocative maneuvers in detecting right-to-left shunt during contrast transthoracic echocardiography (cTTE). Methods: We evaluated 378 patients for right-to-left shunt detection by cTTE at the quiet respiration, during Valsalva maneuver (blowing into a face mask connected to a sphygmomanometer at 40 mmHg for 10 s), and during cough maneuver, performed in random order, and the degree of right-to-left shunt as the number of microbubbles in the left atrium per frame after each provocative maneuver was recorded. Results: The detection rates of right-to-left shunt for quiet respiration, Valsalva maneuver, and cough maneuver were 16%, 33%, and 38%, respectively (p
Anomalous origin of the left coronary artery from pulmonary artery misdiagnosed as postpartum cardiomyopathy
Published in Baylor University Medical Center Proceedings, 2020
Subash Nepal, Robert L. Carhart, Suhayb Kadura, Stephany Barreto, Indrit Greca
A 30-year-old woman with a history of presumed postpartum cardiomyopathy presented to her primary care physician’s office with crescendo angina and shortness of breath. She was found to be in supraventricular tachycardia, managed with the Valsalva maneuver, and was discharged home without any further workup. She again presented with exertional symptoms. Her electrocardiogram revealed abnormal T waves and her stress test was strongly positive. Cardiac catheterization revealed an absent left coronary ostium and a dilated right coronary artery, with large collaterals supplying the left coronary system; coronary computerized tomography revealed the anomalous origin of the left main coronary artery arising from the posterolateral aspect of the pulmonary artery, highly suggestive of the anomalous origin of the left coronary artery from pulmonary artery (ALCAPA) anomaly (Bland-White-Garland anomaly).
Treatment of Hiccup by Vagal Maneuvers
Published in Journal of the History of the Neurosciences, 2015
A multitude of nonpharmacological interventions to terminate hiccup belong to the public-domain hiccup “mythology” or have been described in the medical literature as case reports. While usually effective in terminating bouts of acute hiccup, they are mostly ineffective in cases of hiccupping that have been present for an extended period. The common denominator of most of these therapeutic maneuvers (some also used to terminate paroxysmal supraventricular tachycardia) is their ability to directly or indirectly increase efferent vagal activity. Among the best known “vagal maneuvers” are the oculo-cardiac reflex (Dagnini-Aschner), the carotid sinus massage, the Valsalva maneuver, stimulation of the ear/auditory canal, ice ingestion, and induction of emesis. This short report provides an overview on hiccups and attempts to identify the lesser known personalities who pioneered its treatment by vagal maneuvers. The recent introduction of electrical vagus nerve stimulation for therapy-resistant hiccup is the ultimate compliment to these pioneers.
Related Knowledge Centers
- Cardiovascular System
- Glottis
- Respiratory System
- Hemodynamics
- Respiratory Function Tests
- Heart Function Tests
- Respiratory Physiological Phenomena