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Sangaletti M, Garzon S, Raffaelli R, D'Alessandro R, Bosco M, Casarin J, Laganà AS, Sibona I, Biban P, Franchi M. The Ex utero intrapartum treatment (EXIT) procedure: case report of a multidisciplinary team approach. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021142. [PMID: 33944827 PMCID: PMC8142784 DOI: 10.23750/abm.v92is1.9964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 12/08/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK The EXIT-to-airway procedure is aimed to provide the time required to secure airways when an extrinsic or intrinsic fetal mass raise concerns about airways control at delivery. Due to the rarity of the procedure, we aim to provide a summary of the appropriate prenatal planning by a multidisciplinary team. METHODS Report of a case of EXIT-to-airway procedure. RESULTS A 30 years-old woman, G2P1 with previous cesarean section, was referred to our Unit at 34 gestational weeks due to a fetal cervical mass of 7cm. An EXIT-to-airways procedure was performed by a multidisciplinary team after accurate preoperative planning and the practice simulations. The partial fetal extraction and the amnioinfusion of pre-heated saline were used to prevent fetal complications. The use of supplemental intravenous anesthesia with remifentanil and better control of uterine tone with nitroglycerin allowed to reduce the exposure to volatile halogen for both the mother and the fetus. The accurate preoperative planning and the practice simulations allowed us to perform the treatment safely in urgency due to the onset of spontaneous labor at 37 weeks and 6 days. CONCLUSIONS The strong cooperation among specialists, accurate prenatal planning, and adopting all the required procedures and precautions are of paramount importance to successfully perform the EXIT-to-airway procedure.
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Affiliation(s)
- Marina Sangaletti
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126 Verona (VR), Italy..
| | - Simone Garzon
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126 Verona (VR), Italy.
| | - Ricciarda Raffaelli
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126 Verona (VR), Italy..
| | - Roberto D'Alessandro
- Department of Anesthesia and Intensive Care, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126 Verona (VR), Italy..
| | - Mariachiara Bosco
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126 Verona (VR), Italy..
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Piazza Biroldi 1, 21100 Varese (VA), Italy..
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Piazza Biroldi 1, 21100 Varese (VA), Italy.
| | - Irene Sibona
- Department of Neonatal and Pediatric Intensive Care, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126 Verona (VR), Italy.
| | - Paolo Biban
- Department of Neonatal and Pediatric Intensive Care, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126 Verona (VR), Italy. .
| | - Massimo Franchi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126 Verona (VR), Italy.
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Dietz HP. Virtual issue on urogynaecology. Aust N Z J Obstet Gynaecol 2020; 59:755-756. [PMID: 31820443 DOI: 10.1111/ajo.13095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/16/2019] [Indexed: 11/29/2022]
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Ellwood DA. Caesarean section births for twins: rational choice, or a non-evidence-based intervention that may cause harm? Med J Aust 2019; 212:70-71. [PMID: 31851374 DOI: 10.5694/mja2.50454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- David A Ellwood
- Griffith University, Gold Coast, QLD.,Gold Coast University Hospital, Gold Coast, QLD
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Hoang Nguyen PT, Binns CW, Vo Van Ha A, Nguyen CL, Khac Chu T, Duong DV, Do DV, Lee AH. Caesarean delivery associated with adverse breastfeeding practices: a prospective cohort study. J OBSTET GYNAECOL 2019; 40:644-648. [PMID: 31483180 DOI: 10.1080/01443615.2019.1647519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Caesarean delivery rates are increasing in many Asian countries. This study investigated the effects of caesarean section on breastfeeding practices from delivery to twelve months postpartum. A prospective cohort study was conducted on 2030 pregnant women recruited from three cities in Vietnam during 2015-2017. The overall caesarean rate was 38.1%. Mothers who underwent caesarean section were more likely to give prelacteal feeds to their infants (adjusted odds ratio (OR) 13.91, 95% confidence interval (CI) 10.52-18.39) and as a result have lower rates of early initiation of breastfeeding (adjusted OR 0.04, 95%CI 0.02-0.05). Having a caesarean section reduced the likelihood of (any, predominant and exclusive) breastfeeding from discharge to 6 months postpartum. After 1 year, the any breastfeeding rate was still lower in the caesarean delivery (70.2%) compared with the vaginal delivery group (72.9%), p = .232. Vietnamese women who give birth by caesarean section need extra support to initiate and maintain breastfeeding.IMPACT STATEMENTWhat is already known on this subject? Early initiation of breastfeeding, and 'exclusive' or 'predominant' breastfeeding rates at discharge are lower in mothers delivering by caesarean section compared to vaginal delivery. Prelacteal feeding rates are higher following caesarean section. However, the association between 'any' breastfeeding duration and caesarean delivery has not been established.What the results of this study add? This study showed that caesarean delivery reduced all breastfeeding rates from discharge to six months and any breastfeeding rate at 12 months postpartum in Vietnamese women.What the implications are of these findings for clinical practice and/or further research? Further breastfeeding interventions are needed during the postpartum period for mothers who deliver by caesarean section.
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Affiliation(s)
- Phung Thi Hoang Nguyen
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,School of Public Health, Curtin University, Perth, Australia
| | - Colin W Binns
- School of Public Health, Curtin University, Perth, Australia
| | - Anh Vo Van Ha
- School of Public Health, Curtin University, Perth, Australia.,Faculty of Public Health, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Cong Luat Nguyen
- School of Public Health, Curtin University, Perth, Australia.,National Immunization Program, National Institute of Hygiene and Epidemiology, Ha Noi, Vietnam
| | - Tan Khac Chu
- School of Public Health, Curtin University, Perth, Australia.,Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Dat Van Duong
- School of Public Health, Curtin University, Perth, Australia
| | - Dung Van Do
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Andy H Lee
- School of Public Health, Curtin University, Perth, Australia
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Stegwee SI, Jordans I, van der Voet LF, van de Ven PM, Ket J, Lambalk CB, de Groot C, Hehenkamp W, Huirne J. Uterine caesarean closure techniques affect ultrasound findings and maternal outcomes: a systematic review and meta-analysis. BJOG 2018; 125:1097-1108. [PMID: 29215795 DOI: 10.1111/1471-0528.15048] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Caesarean section (CS) rates are rising globally. Long-term adverse outcomes after CS might be reduced when the optimal uterine closure technique becomes evident. OBJECTIVE To determine the effect of uterine closure techniques after CS on maternal and ultrasound outcomes. SEARCH STRATEGY Literature search in electronic databases. SELECTION CRITERIA Randomised controlled trials (RCTs) or prospective cohort studies that evaluated uterine closure techniques and reported on ultrasound findings, perioperative or long-term outcomes. DATA COLLECTION AND ANALYSIS Twenty studies (15 053 women) were included in our meta-analyses for various outcomes. We calculated pooled risk ratios (RR) and weighted mean differences (WMD) with 95% CI through random-effect analysis. MAIN RESULTS Residual myometrium thickness (RMT), reported in eight studies (508 women), decreased by 1.26 mm after single- compared with double-layer closure (95% CI -1.93 to -0.58), particularly when locked sutures were used. Healing ratio [RMT/adjacent myometrium thickness (AMT)] decreased after single-layer closure (WMD -7.74%, 95% CI -13.31 to -2.17), particularly in the case of locked sutures. Niche prevalence increased (RR 1.71, 95% CI 1.11-2.62) when the decidua was excluded. Dysmenorrhea occurred more often in the single-layer group (RR 1.23, 95% CI 1.01-1.48), whereas incidence of uterine rupture was similar (RR 1.91, 95% CI 0.63-5.74). CONCLUSION Double-layer unlocked sutures are preferable to single-layer locked sutures regarding RMT, healing ratio and dysmenorrhoea. Excluding the decidua seems to result in higher niche prevalence. As thin residual myometrium or niches may serve as intermediates for gynaecological and reproductive outcomes, future studies should focus on these outcomes. TWEETABLE ABSTRACT: #Uterineclosuretechniques after #caesarean affect #longtermoutcomes.
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Affiliation(s)
- S I Stegwee
- VU University Medical Centre, Department of Obstetrics and Gynaecology, Research Institutes 'ICaR-VU' and 'Reproduction and Development', Amsterdam, the Netherlands
| | - Ipm Jordans
- VU University Medical Centre, Department of Obstetrics and Gynaecology, Research Institutes 'ICaR-VU' and 'Reproduction and Development', Amsterdam, the Netherlands
| | - L F van der Voet
- Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, the Netherlands
| | - P M van de Ven
- Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands
| | - Jcf Ket
- Medical Library, VU University, Amsterdam, the Netherlands
| | - C B Lambalk
- VU University Medical Centre, Department of Obstetrics and Gynaecology, Research Institutes 'ICaR-VU' and 'Reproduction and Development', Amsterdam, the Netherlands
| | - Cjm de Groot
- VU University Medical Centre, Department of Obstetrics and Gynaecology, Research Institutes 'ICaR-VU' and 'Reproduction and Development', Amsterdam, the Netherlands
| | - Wjk Hehenkamp
- VU University Medical Centre, Department of Obstetrics and Gynaecology, Research Institutes 'ICaR-VU' and 'Reproduction and Development', Amsterdam, the Netherlands
| | - Jaf Huirne
- VU University Medical Centre, Department of Obstetrics and Gynaecology, Research Institutes 'ICaR-VU' and 'Reproduction and Development', Amsterdam, the Netherlands
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Farquhar CM, Li Z, Lensen S, McLintock C, Pollock W, Peek MJ, Ellwood D, Knight M, Homer CS, Vaughan G, Wang A, Sullivan E. Incidence, risk factors and perinatal outcomes for placenta accreta in Australia and New Zealand: a case-control study. BMJ Open 2017; 7:e017713. [PMID: 28982832 PMCID: PMC5640005 DOI: 10.1136/bmjopen-2017-017713] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Estimate the incidence of placenta accreta and describe risk factors, clinical practice and perinatal outcomes. DESIGN Case-control study. SETTING Sites in Australia and New Zealand with at least 50 births per year. PARTICIPANTS Cases were women giving birth (≥20 weeks or fetus ≥400 g) who were diagnosed with placenta accreta by antenatal imaging, at operation or by pathology specimens between 2010 and 2012. Controls were two births immediately prior to a case. A total of 295 cases were included and 570 controls. METHODS Data were collected using the Australasian Maternity Outcomes Surveillance System. PRIMARY AND SECONDARY OUTCOME MEASURES Incidence, risk factors (eg, prior caesarean section (CS), maternal age) and clinical outcomes of placenta accreta (eg CS, hysterectomy and death). RESULTS The incidence of placenta accreta was 44.2/100 000 women giving birth (95% CI 39.4 to 49.5); however, this may overestimated due to the case definition used. In primiparous women, an increased odds of placenta accreta was observed in older women (adjusted OR (AOR) women≥40 vs <30: 19.1, 95% CI 4.6 to 80.3) and current multiple birth (AOR: 6.1, 95% CI 1.1 to 34.1). In multiparous women, independent risk factors were prior CS (AOR ≥2 prior sections vs 0: 13.8, 95% CI 7.4 to 26.1) and current placenta praevia (AOR: 36.3, 95% CI 14.0 to 93.7). There were two maternal deaths (case fatality rate 0.7%).Women with placenta accreta were more likely to have a caesarean section (AOR: 4.6, 95% CI 2.7 to 7.6) to be admitted to the intensive care unit (ICU)/high dependency unit (AOR: 46.1, 95% CI 22.3 to 95.4) and to have a hysterectomy (AOR: 209.0, 95% CI 19.9 to 875.0). Babies born to women with placenta accreta were more likely to be preterm, be admitted to neonatal ICU and require resuscitation.
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Affiliation(s)
- Cynthia M Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Zhuoyang Li
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Sarah Lensen
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Claire McLintock
- Department of National Women's Health, Auckland City Hospital, Auckland, New Zealand
| | - Wendy Pollock
- Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne and School of Nursing and Midwifery, Melbourne, Australia
| | - Michael J Peek
- Department of ANU Medical School, Australian National University, Canberra, Australia
| | - David Ellwood
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | | | - Caroline Se Homer
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Geraldine Vaughan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Alex Wang
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Elizabeth Sullivan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Svigos J. Every vaginal delivery must count. Aust N Z J Obstet Gynaecol 2017; 57:E6. [PMID: 28573690 DOI: 10.1111/ajo.12631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- John Svigos
- Women's and Childrens Hospital, North Adelaide, South Australia, Australia
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Lawson G. Natural childbirth ideology is endangering women and babies/Every CS must count. Aust N Z J Obstet Gynaecol 2017; 57:E4. [PMID: 28573695 DOI: 10.1111/ajo.12619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Gerald Lawson
- Obstetrics and Gynaecology, John Hunter Hospital, Newcastle, NSW, Australia
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Dietz HP, Exton L. Response to 'Every CS must count'. Aust N Z J Obstet Gynaecol 2016; 56:556. [PMID: 27914113 DOI: 10.1111/ajo.12569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 10/09/2016] [Indexed: 11/29/2022]
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