Pub Date : 2012-11-01DOI: 10.1017/S0965539512000101
E. Bujold, S. Roberge, S. Demers, K. Nicolaides
The prophylactic use of low-dose aspirin for prevention of preeclampsia has been an important research question in obstetrics for the last three decades. In 1979, Crandon and Isherwood observed that nulliparous women who had taken aspirin regularly during pregnancy were less likely to have preeclampsia than women who did not. In 1985, Beaufils et al published the first randomized trial suggesting that 150 mg aspirin and 300 mg dipyridamole daily from 3 months’ gestation onwards decreased the risk of preeclampsia, fetal growth restriction and stillbirth in high-risk women. Subsequently, more than 50 trials have been carried out throughout the world and a meta-analysis of these studies reported that the administration of low-dose aspirin in high-risk pregnancies is associated with a decrease in the rate of preeclampsia by approximately 10%. Consequently, several national professional bodies recommend that high-risk pregnancies should be treated with aspirin (50–150 mg daily).
{"title":"ASPIRIN ADMINISTRATION FOR PREVENTION OF ADVERSE PREGNANCY OUTCOMES","authors":"E. Bujold, S. Roberge, S. Demers, K. Nicolaides","doi":"10.1017/S0965539512000101","DOIUrl":"https://doi.org/10.1017/S0965539512000101","url":null,"abstract":"The prophylactic use of low-dose aspirin for prevention of preeclampsia has been an important research question in obstetrics for the last three decades. In 1979, Crandon and Isherwood observed that nulliparous women who had taken aspirin regularly during pregnancy were less likely to have preeclampsia than women who did not. In 1985, Beaufils et al published the first randomized trial suggesting that 150 mg aspirin and 300 mg dipyridamole daily from 3 months’ gestation onwards decreased the risk of preeclampsia, fetal growth restriction and stillbirth in high-risk women. Subsequently, more than 50 trials have been carried out throughout the world and a meta-analysis of these studies reported that the administration of low-dose aspirin in high-risk pregnancies is associated with a decrease in the rate of preeclampsia by approximately 10%. Consequently, several national professional bodies recommend that high-risk pregnancies should be treated with aspirin (50–150 mg daily).","PeriodicalId":89369,"journal":{"name":"Fetal and maternal medicine review","volume":"23 1","pages":"187-200"},"PeriodicalIF":0.0,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0965539512000101","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56977615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-11-01DOI: 10.1017/S0965539512000113
M. Oladejo, S. Bewley
“Clinical decisions and research programs ultimately depend on the reliable and valid measurement of adherence. Yet, 50 years of research in this field have not provided the data necessary to answer critical measurement questions.”.
{"title":"ADHERENCE IN PREGNANCY: A SYSTEMATIC REVIEW OF THE LITERATURE","authors":"M. Oladejo, S. Bewley","doi":"10.1017/S0965539512000113","DOIUrl":"https://doi.org/10.1017/S0965539512000113","url":null,"abstract":"“Clinical decisions and research programs ultimately depend on the reliable and valid measurement of adherence. Yet, 50 years of research in this field have not provided the data necessary to answer critical measurement questions.”.","PeriodicalId":89369,"journal":{"name":"Fetal and maternal medicine review","volume":"23 1","pages":"201-229"},"PeriodicalIF":0.0,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0965539512000113","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56977746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-11-01DOI: 10.1017/S0965539512000149
C. Windrim, M. Czikk
Acute appendicitis is the most common non-obstetric indication for surgical intervention in pregnancy, complicating 1/500 to 1/2000 deliveries. Due to the anatomical and physiological changes associated with pregnancy, appendicitis may present a diagnostic dilemma, leading to management delays and thus increasing the risk of appendiceal perforation. Many of the common presenting symptoms of appendicitis are common features of normal pregnancy including lower abdominal pain, nausea, vomiting and leukocytosis. Furthermore, the enlarging gravid uterus may displace the appendix to varying degrees thus altering the classic symptom pattern of appendicitis. The often nonspecific presentation in pregnancy may necessitate the utilization of diagnostic imaging to aid in accurate diagnosis. However, the perforated appendix is the most common surgical cause of fetal loss and the time required for any diagnostic aid must be weighed against the increasing risk of perforation caused by delay in surgical intervention.
{"title":"APPENDICITIS IN PREGNANCY","authors":"C. Windrim, M. Czikk","doi":"10.1017/S0965539512000149","DOIUrl":"https://doi.org/10.1017/S0965539512000149","url":null,"abstract":"Acute appendicitis is the most common non-obstetric indication for surgical intervention in pregnancy, complicating 1/500 to 1/2000 deliveries. Due to the anatomical and physiological changes associated with pregnancy, appendicitis may present a diagnostic dilemma, leading to management delays and thus increasing the risk of appendiceal perforation. Many of the common presenting symptoms of appendicitis are common features of normal pregnancy including lower abdominal pain, nausea, vomiting and leukocytosis. Furthermore, the enlarging gravid uterus may displace the appendix to varying degrees thus altering the classic symptom pattern of appendicitis. The often nonspecific presentation in pregnancy may necessitate the utilization of diagnostic imaging to aid in accurate diagnosis. However, the perforated appendix is the most common surgical cause of fetal loss and the time required for any diagnostic aid must be weighed against the increasing risk of perforation caused by delay in surgical intervention.","PeriodicalId":89369,"journal":{"name":"Fetal and maternal medicine review","volume":"23 1","pages":"276-295"},"PeriodicalIF":0.0,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0965539512000149","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56977927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-11-01DOI: 10.1017/S0965539512000095
R. Bromley, A. Wieck, D. Makarova, C. Tower, A. Wood, J. Clayton-Smith
It is estimated that 20% of women experience symptoms of depression during pregnancy and antidepressant medication is prescribed for between 2% and 8% of pregnant women depending on the country of report. In the UK antidepressant prescribing during pregnancy increased fourfold from 1992 to 2006, with Selective Serotonin Reuptake Inhibitors (SSRIs) most often chosen. SSRIs cross the human placenta, with fetal levels varying according to treatment type and are found in amniotic fluid. The significance of prenatal exposure to SSRIs and outcomes in terms of the physical health and the neurodevelopment of the infant and child remainunclear. Several prescribed medications are known to be human teratogens, causing increased prevalence of a range of physical and neurodevelopmental deficits in exposed infants. Research into infant outcomes following prenatal exposure is challenging. Ethical constraints do not permit the most rigorous design for investigation, i.e.randomized double-blind controlled studies. In addition, variations in drug type, timing of exposure, dose, duration of exposure, placental passage and genetic factors all require consideration alongside maternal and infant demographic influences (e.g. maternal illness, socioeconomic status). Furthermore, a specific outcome type may be associated with specific risk variables and require targeted investigation. Maternal depression itself, either directly or indirectly, has been reported to influence obstetric and neonatal outcomes. Although beyond the scope of this review, research often fails to consider fetal exposure to antidepressants. Maternal antenatal depression is an important predictor of postnatal depression which may also impact on infant neurodevelopment. Understanding the risks of maternal depression and its treatment with regard to the development of the child is of paramount importance for clinical decision making. Serotonin is known to play a role in the development and physiology of the central nervous system, the gastrointestinal and the cardiovascular systems. In the fetal brain serotonin modulates different developmental processes including neurogenesis, apoptosis and axon branching and therefore alterations in the serotonin system may directly impact on later neuronal development. The role of serotonin in fetal development raises the possibility that SSRI exposure in utero may predispose to structural birth defects and poorer longer term outcomes, however, to date such a relationship is unclear. This review aims to bring together clinical research that examines the immediate and longer term physical and developmental risks to the child that may be associated with prenatal exposure to SSRIs. The article also examines the methodological issues that may contribute to conflicting findings.
{"title":"FETAL EFFECTS OF SELECTIVE SEROTONIN REUPTAKE INHIBITOR TREATMENT DURING PREGNANCY: IMMEDIATE AND LONGER TERM CHILD OUTCOMES","authors":"R. Bromley, A. Wieck, D. Makarova, C. Tower, A. Wood, J. Clayton-Smith","doi":"10.1017/S0965539512000095","DOIUrl":"https://doi.org/10.1017/S0965539512000095","url":null,"abstract":"It is estimated that 20% of women experience symptoms of depression during pregnancy and antidepressant medication is prescribed for between 2% and 8% of pregnant women depending on the country of report. In the UK antidepressant prescribing during pregnancy increased fourfold from 1992 to 2006, with Selective Serotonin Reuptake Inhibitors (SSRIs) most often chosen. SSRIs cross the human placenta, with fetal levels varying according to treatment type and are found in amniotic fluid. The significance of prenatal exposure to SSRIs and outcomes in terms of the physical health and the neurodevelopment of the infant and child remainunclear.\u0000\u0000Several prescribed medications are known to be human teratogens, causing increased prevalence of a range of physical and neurodevelopmental deficits in exposed infants. Research into infant outcomes following prenatal exposure is challenging. Ethical constraints do not permit the most rigorous design for investigation, i.e.randomized double-blind controlled studies. In addition, variations in drug type, timing of exposure, dose, duration of exposure, placental passage and genetic factors all require consideration alongside maternal and infant demographic influences (e.g. maternal illness, socioeconomic status). Furthermore, a specific outcome type may be associated with specific risk variables and require targeted investigation. Maternal depression itself, either directly or indirectly, has been reported to influence obstetric and neonatal outcomes. Although beyond the scope of this review, research often fails to consider fetal exposure to antidepressants. Maternal antenatal depression is an important predictor of postnatal depression which may also\u0000impact on infant neurodevelopment. Understanding the risks of maternal depression and its treatment with regard to the development of the child is of paramount importance for clinical decision making.\u0000\u0000Serotonin is known to play a role in the development and physiology of the central nervous system, the gastrointestinal and the cardiovascular systems. In the fetal brain serotonin modulates different developmental processes including neurogenesis, apoptosis and axon branching and therefore alterations in the serotonin system may directly impact on later neuronal development. The role of serotonin in fetal development raises the possibility that SSRI exposure in utero may predispose to structural birth defects and poorer longer term outcomes, however, to date such a relationship is unclear.\u0000\u0000This review aims to bring together clinical research that examines the immediate and longer term physical and developmental risks to the child that may be associated with prenatal exposure to SSRIs. The article also examines the methodological issues that may contribute to conflicting findings.","PeriodicalId":89369,"journal":{"name":"Fetal and maternal medicine review","volume":"23 1","pages":"230-275"},"PeriodicalIF":0.0,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0965539512000095","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56977541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-11-01DOI: 10.1017/S0965539512000083
M. Endo, T. Mieghem, E. Eixarch, P. Coppi, G. Naulaers, F. Calenbergh, L. Catte, R. Devlieger, L. Lewi, A. Eggink, K. Nicolaides, E. Gratacós, J. Deprest
The prevalence of neural tube defects (NTD) in Europe is around 9 per 10,000 births making it one of the most frequent congential anomalies affecting the central nervous system. NTD encompass all anomalies that are secondary to failure of closure of the neural tube. In this review, we will first summarize the embryology and some epidemiologic aspects related to NTDs. The review focuses on myelomeningocele (MMC), which is the most common distal closure defect. We will describe the secondary pathologic changes in the central and peripheral nervous system that appear later on in pregnancy and contribute to the condition's morbidity. The postnatal impact of MMC mainly depends on the upper level of the lesion. In Europe, the vast majority of parents with a fetus with prenatally diagnosed NTDs, including MMC, opt for termination of pregnancy, as they are apparently perceived as very debilitating conditions. Animal experiments have shown that prenatal surgery can reverse this sequence. This paved the way for clinical fetal surgery resulting in an apparent improvement in outcome. The results of a recent randomized trial confirmed better outcomes after fetal repair compared to postnatal repair; with follow up for 30 months. This should prompt fetal medicine specialists to reconsider their position towards this condition as well as its prenatal repair. The fetal surgery centre in Leuven did not have a clinical programme for fetal NTD repair until the publication of the MOMS trial. In order to offer this procedure safely and effectively, we allied to a high volume centre willing to share its expertise and assist us in the first procedures. Given the maternal side effects of current open fetal surgical techniques, we have intensified our research programmes to explore minimally invasive alternatives. Below we will describe how we are implementing this.
{"title":"THE PRENATAL MANAGEMENT OF NEURAL TUBE DEFECTS: TIME FOR A RE-APPRAISAL","authors":"M. Endo, T. Mieghem, E. Eixarch, P. Coppi, G. Naulaers, F. Calenbergh, L. Catte, R. Devlieger, L. Lewi, A. Eggink, K. Nicolaides, E. Gratacós, J. Deprest","doi":"10.1017/S0965539512000083","DOIUrl":"https://doi.org/10.1017/S0965539512000083","url":null,"abstract":"The prevalence of neural tube defects (NTD) in Europe is around 9 per 10,000 births making it one of the most frequent congential anomalies affecting the central nervous system. NTD encompass all anomalies that are secondary to failure of closure of the neural tube. In this review, we will first summarize the embryology and some epidemiologic aspects related to NTDs. The review focuses on myelomeningocele (MMC), which is the most common distal closure defect. We will describe the secondary pathologic changes in the central and peripheral nervous system that appear later on in pregnancy and contribute to the condition's morbidity. The postnatal impact of MMC mainly depends on the upper level of the lesion. In Europe, the vast majority of parents with a fetus with prenatally diagnosed NTDs, including MMC, opt for termination of pregnancy, as they are apparently perceived as very debilitating conditions. Animal experiments have shown that prenatal surgery can reverse this sequence. This paved the way for clinical fetal surgery resulting in an apparent improvement in outcome. The results of a recent randomized trial confirmed better outcomes after fetal repair compared to postnatal repair; with follow up for 30 months. This should prompt fetal medicine specialists to reconsider their position towards this condition as well as its prenatal repair. The fetal surgery centre in Leuven did not have a clinical programme for fetal NTD repair until the publication of the MOMS trial. In order to offer this procedure safely and effectively, we allied to a high volume centre willing to share its expertise and assist us in the first procedures. Given the maternal side effects of current open fetal surgical techniques, we have intensified our research programmes to explore minimally invasive alternatives. Below we will describe how we are implementing this.","PeriodicalId":89369,"journal":{"name":"Fetal and maternal medicine review","volume":"23 1","pages":"158-186"},"PeriodicalIF":0.0,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0965539512000083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56977513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-05-01DOI: 10.1017/S096553951200006X
Yanfang Guo, Graeme N. Smith, S. Wen, M. Walker
Preeclampsia (PE) is a multisystem disorder of human pregnancy, affecting about 6% of all pregnancies worldwide, and is one of the leading causes of maternal and infant morbidity and mortality. Despite decades of research into the pathogenesis of this complex disease, the underlying mechanisms remain unclear. As a result, the options for prevention and management of PE are limited. In recent years, there has been a growing body of evidence suggesting that folate deficiency is associated with PE, and folic acid supplementation may reduce the risk of developing PE in certain populations. Folate contributes to cell division and growth, and folate metabolism is involved in a large number of physiological and pathophysiological processes in human development. Sufficient supply of folate is therefore particularly important during pregnancy. Nevertheless, the exact mechanisms of folic acid deficiency increasing the risk of developing PE are still unclear. This article reviews what is understood about the aetiology of PE and the relationship between folate metabolism and PE so as to enhance further discussions on the subject.
{"title":"FOLATE METABOLISM AND PREECLAMPSIA","authors":"Yanfang Guo, Graeme N. Smith, S. Wen, M. Walker","doi":"10.1017/S096553951200006X","DOIUrl":"https://doi.org/10.1017/S096553951200006X","url":null,"abstract":"Preeclampsia (PE) is a multisystem disorder of human pregnancy, affecting about 6% of all pregnancies worldwide, and is one of the leading causes of maternal and infant morbidity and mortality. Despite decades of research into the pathogenesis of this complex disease, the underlying mechanisms remain unclear. As a result, the options for prevention and management of PE are limited. In recent years, there has been a growing body of evidence suggesting that folate deficiency is associated with PE, and folic acid supplementation may reduce the risk of developing PE in certain populations. Folate contributes to cell division and growth, and folate metabolism is involved in a large number of physiological and pathophysiological processes in human development. Sufficient supply of folate is therefore particularly important during pregnancy. Nevertheless, the exact mechanisms of folic acid deficiency increasing the risk of developing PE are still unclear. This article reviews what is understood about the aetiology of PE and the relationship between folate metabolism and PE so as to enhance further discussions on the subject.","PeriodicalId":89369,"journal":{"name":"Fetal and maternal medicine review","volume":"23 1","pages":"131-155"},"PeriodicalIF":0.0,"publicationDate":"2012-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S096553951200006X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56977397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-05-01DOI: 10.1017/S0965539512000071
E. Boyle
It is well recognised that birth before 32 weeks of gestation is associated with substantial neonatal morbidity and mortality and these risks have been extensively reported. The focus of perinatal research for many years has therefore been very preterm and extremely preterm delivery, since the likelihood and severity of adverse neonatal outcomes are highest within this group. In contrast, until recently, more mature preterm infants have been understudied and indeed, almost ignored by researchers.
{"title":"Neonatal outcomes following late preterm birth","authors":"E. Boyle","doi":"10.1017/S0965539512000071","DOIUrl":"https://doi.org/10.1017/S0965539512000071","url":null,"abstract":"It is well recognised that birth before 32 weeks of gestation is associated with substantial neonatal morbidity and mortality and these risks have been extensively reported. The focus of perinatal research for many years has therefore been very preterm and extremely preterm delivery, since the likelihood and severity of adverse neonatal outcomes are highest within this group. In contrast, until recently, more mature preterm infants have been understudied and indeed, almost ignored by researchers.","PeriodicalId":89369,"journal":{"name":"Fetal and maternal medicine review","volume":"23 1","pages":"97-119"},"PeriodicalIF":0.0,"publicationDate":"2012-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0965539512000071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56977412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-05-01DOI: 10.1017/S0965539512000046
F. Plaat, L. Arrandale
Hypoxia in pregnancy is rare, however the anatomical and physiological changes associated with pregnancy may exacerbate hypoxia and hypoxaemia arising from pathological processes. In this review we seek to briefly outline the well recognised changes to the maternal airway and respiratory anatomy and physiology. We will discuss a hierarchical approach to the tests used in differential diagnoses, summarise the physical principles behind commonly used tests and identify pitfalls and considerations in their use in the obstetric population. Some of the more commonly seen pathological states that may cause hypoxia in pregnancy will be discussed.
{"title":"HYPOXIA IN PREGNANCY","authors":"F. Plaat, L. Arrandale","doi":"10.1017/S0965539512000046","DOIUrl":"https://doi.org/10.1017/S0965539512000046","url":null,"abstract":"Hypoxia in pregnancy is rare, however the anatomical and physiological changes associated with pregnancy may exacerbate hypoxia and hypoxaemia arising from pathological processes. In this review we seek to briefly outline the well recognised changes to the maternal airway and respiratory anatomy and physiology. We will discuss a hierarchical approach to the tests used in differential diagnoses, summarise the physical principles behind commonly used tests and identify pitfalls and considerations in their use in the obstetric population. Some of the more commonly seen pathological states that may cause hypoxia in pregnancy will be discussed.","PeriodicalId":89369,"journal":{"name":"Fetal and maternal medicine review","volume":"23 1","pages":"71-96"},"PeriodicalIF":0.0,"publicationDate":"2012-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0965539512000046","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56977325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-05-01DOI: 10.1017/S0965539512000058
C. Chebsey, D. Siassakos, T. Draycott
Umbilical cord prolapse is the descent of the umbilical cord through the cervix alongside (occult) or past (overt) the presenting part in the presence of ruptured membranes. Cord prolapse is a rare obstetric complication, usually requiring immediate delivery of the fetus to reduce neonatal morbidity and mortality. Therefore staff caring for women in labour should train regularly to manage it appropriately, because team training has been demonstrated to improve outcomes.
{"title":"A REVIEW OF UMBILICAL CORD PROLAPSE AND THE INFLUENCE OF TRAINING ON MANAGEMENT","authors":"C. Chebsey, D. Siassakos, T. Draycott","doi":"10.1017/S0965539512000058","DOIUrl":"https://doi.org/10.1017/S0965539512000058","url":null,"abstract":"Umbilical cord prolapse is the descent of the umbilical cord through the cervix alongside (occult) or past (overt) the presenting part in the presence of ruptured membranes. Cord prolapse is a rare obstetric complication, usually requiring immediate delivery of the fetus to reduce neonatal morbidity and mortality. Therefore staff caring for women in labour should train regularly to manage it appropriately, because team training has been demonstrated to improve outcomes.","PeriodicalId":89369,"journal":{"name":"Fetal and maternal medicine review","volume":"23 1","pages":"120-130"},"PeriodicalIF":0.0,"publicationDate":"2012-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0965539512000058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56977334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-02-01DOI: 10.1017/S0965539512000022
M. Cameron
Kielland's forceps have been in obstetric practice for over 80 years but their use causes a wide spectrum of reactions in obstetricians. Those that have been well tutored in their use argue that they are a very effective instrument to achieve vaginal delivery in the malpositioned fetus, avoiding the problems of full cervical dilation caesarean section, with low complications in their hands. These exponents of the instrument argue that the “art” of obstetrics is demonstrated in the use of Kielland's forceps. However, others claim that Kielland's forceps are dangerous with high complication rates and that they should be confined to the obstetric museum. This paper reviews the history of the instrument and its inventor, to consider evidence for its effectiveness and its safety, to briefly consider other methods for delivery of the malpositioned fetus at full cervical dilation and finally to complete the journey by considering the future with particular emphasis on training the new generation of obstetricians.
{"title":"KIELLAND'S FORCEPS: PAST, PRESENT AND FUTURE","authors":"M. Cameron","doi":"10.1017/S0965539512000022","DOIUrl":"https://doi.org/10.1017/S0965539512000022","url":null,"abstract":"Kielland's forceps have been in obstetric practice for over 80 years but their use causes a wide spectrum of reactions in obstetricians. Those that have been well tutored in their use argue that they are a very effective instrument to achieve vaginal delivery in the malpositioned fetus, avoiding the problems of full cervical dilation caesarean section, with low complications in their hands. These exponents of the instrument argue that the “art” of obstetrics is demonstrated in the use of Kielland's forceps. However, others claim that Kielland's forceps are dangerous with high complication rates and that they should be confined to the obstetric museum. This paper reviews the history of the instrument and its inventor, to consider evidence for its effectiveness and its safety, to briefly consider other methods for delivery of the malpositioned fetus at full cervical dilation and finally to complete the journey by considering the future with particular emphasis on training the new generation of obstetricians.","PeriodicalId":89369,"journal":{"name":"Fetal and maternal medicine review","volume":"23 1","pages":"32-51"},"PeriodicalIF":0.0,"publicationDate":"2012-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0965539512000022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56977808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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