Delivery of a breech baby with the mother in an upright position or on all fours has gained a renewed interest. In these positions, the obstetrician or midwife needs to learn new landmarks and ...maneuvers. A realistic simulation model would be a valuable adjunct for breech on all fours teaching programs.
This article describes the simulation model and training program we have developed to train an interprofessional team to assist breech births when the mother is on all fours. A questionnaire was used to evaluate the realism of the adapted mannequin and the impact of training on the confidence level of the participants.
On a Likert scale of 1 to 5, 92% of participants agreed or strongly agreed that the adapted mannequin used was realistic for training obstetric maneuvers for complicated breech births. After training, their confidence level supporting a breech birth in an upright position rose from an average of 2.5 to 5.7 on a scale of 1 to 10.
Learning the skills for breech deliveries on all fours is made possible by targeted training with this adapted simulation model.
Background
The interaction between pollution and endometriosis is a pressing issue that demands immediate attention. The impact of pollution, particularly air and water pollution, or occupational ...hazards, on hormonal disruption and the initiation of endometriosis remains a major issue.
Objectives
This narrative review aims to delve into the intricate connection between pollution and endometriosis, shedding light on how environmental factors contribute to the onset and severity of this disease and, thus, the possible public health policy implications.
Discussion
Endocrine‐disrupting chemicals (EDCs) in pollutants dysregulate the hormonal balance, contributing to the progression of this major gynaecological disorder. Air pollution, specifically PM2.5 and PAHs, has been associated with an increased risk of endometriosis by enhancing chronic inflammation, oxidative stress, and hormonal imbalances. Chemical contaminants in water and work exposures, including heavy metals, dioxins, and PCBs, disrupt the hormonal regulation and potentially contribute to endometriosis. Mitigating the environmental impact of pollution is required to safeguard women’s reproductive health. This requires a comprehensive approach involving stringent environmental regulations, sustainable practices, responsible waste management, research and innovation, public awareness, and collaboration among stakeholders.
Conclusion
Public health policies have a major role in addressing the interaction between pollution and endometriosis in a long‐term commitment.
Cardiotocography is defined as the recording of fetal heart rate and uterine contractions and is widely used during labor as a screening tool to determine fetal wellbeing. The visual interpretation ...of the cardiotocography signals by the practitioners, following common guidelines, is subject to a high interobserver variability, and the efficiency of cardiotocography monitoring is still debated. Since the 1990s, researchers and practitioners work on designing reliable computer‐aided systems to assist practitioners in cardiotocography interpretation during labor. Several systems are integrated in the monitoring devices, mostly based on the guidelines, but they have not clearly demonstrated yet their usefulness. In the last decade, the availability of large clinical databases as well as the emergence of machine learning and deep learning methods in healthcare has led to a surge of studies applying those methods to cardiotocography signals analysis. The state‐of‐the‐art systems perform well to detect fetal hypoxia when evaluated on retrospective cohorts, but several challenges remain to be tackled before they can be used in clinical practice. First, the development and sharing of large, open and anonymized multicentric databases of perinatal and cardiotocography data during labor is required to build more accurate systems. Also, the systems must produce interpretable indicators along with the prediction of the risk of fetal hypoxia in order to be appropriated and trusted by practitioners. Finally, common standards should be built and agreed on to evaluate and compare those systems on retrospective cohorts and to validate their use in clinical practice.
The use of advanced computerized systems based on the latest machine learning techniques, trained on large databases of cardiotocography data, clinical factors and fetal outcomes, has the potential to successfully assist practitioners in the labor ward and to improve neonatal outcomes.
There is no consensus on an optimal strategy for managing the active phase of the second stage of labor. Intensive pushing could not only reduce pushing duration, but also increase abnormal fetal ...heart rate because of cord compression and reduced placental perfusion and oxygenation resulting from the combination of uterine contractions and maternal expulsive forces. Therefore, it may increase the risk of neonatal acidosis and the need for operative vaginal delivery.
This study aimed to assess the effect of the management encouraging “moderate” pushing vs “intensive” pushing on neonatal morbidity.
This study was a multicenter randomized controlled trial, including nulliparas in the second stage of labor with an epidural and a singleton cephalic fetus at term and with a normal fetal heart rate. Of note, 2 groups were defined: (1) the moderate pushing group, in which women had no time limit on pushing, pushed only twice during each contraction, and observed regular periods without pushing, and (2) the intensive pushing group, in which women pushed 3 times during each contraction and the midwife called an obstetrician after 30 minutes of pushing to discuss operative delivery (standard care). The primary outcome was a composite neonatal morbidity criterion, including umbilical arterial pH of <7.15, base excess of >10 mmol/L, lactate levels of >6 mmol/L, 5-minute Apgar score of <7, and severe neonatal trauma. The secondary outcomes were mode of delivery, episiotomy, obstetrical anal sphincter injuries, postpartum hemorrhage, and maternal satisfaction.
The study included 1710 nulliparous women. The neonatal morbidity rate was 18.9% in the moderate pushing group and 20.6% in the intensive pushing group (P=.38). Pushing duration was longer in the moderate group than in the intensive group (38.8±26.4 vs 28.6±17.0 minutes; P<.001), and its rate of operative delivery was 21.1% in the moderate group compared with 24.8% in the intensive group (P=.08). The episiotomy rate was significantly lower in the moderate pushing group than in the intensive pushing group (13.5% vs 17.8%; P=.02). We found no significant difference for obstetrical anal sphincter injuries, postpartum hemorrhage, or maternal satisfaction.
Moderate pushing has no effect on neonatal morbidity, but it may nonetheless have benefits, as it was associated with a lower episiotomy rate.
Incontinence occurs frequently in the postpartum period. Several theoretical pathophysiological models may underlie the hypothesis that different types of management of the active phase of the second ...stage of labor have different effects on pelvic floor muscles and thus perhaps affect urinary and anal continence.
We aimed to evaluate the impact of "moderate pushing" on the occurrence of urinary or anal incontinence compared to "intensive pushing" and then to determine the factors associated with incontinence at 6 months postpartum.
This was a planned analysis of secondary objectives of the PASST (Phase Active du Second STade) trial, a multicenter randomized controlled trial. PASST included nulliparous women with singleton term pregnancies and epidural analgesia, who were randomly assigned at 8 cm of dilatation to either the intervention group that used “moderate” pushing (pushing only twice during each contraction, resting regularly for one contraction in five without pushing, and no time limit on pushing) or the control group following the usual management of “intensive” pushing (pushing three times during each contraction, with no contractions without pushing, with an obstetrician called to discuss operative delivery after 30 minutes of pushing). Data about continence were collected with validated self-assessment questionnaires at 6 months postpartum. Urinary incontinence was defined by an ICIQ-UI SF (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form) score >0 and anal incontinence by a Wexner Score ≥2. A separate analysis was also performed among the more severely affected women (ICIQ-UI SF ≥6 and Wexner ≥5). Factors associated with incontinence were assessed with univariate and multivariable analyses.
Among 1618 women initially randomized, 890 (55%) returned the complete questionnaire at 6 months. The rate of urinary incontinence was 36.6% in the "moderate” pushing group versus 38.5% in the “intensive” pushing group (RR, 0.95; 95% CI, 0.80-1.13), while the rate of anal incontinence was 32.2% versus 34.6% (RR, 0.93; 95% CI, 0.77-1.12). None of the obstetric factors studied related to the second stage of labor influenced the occurrence of urinary or anal incontinence, except operative vaginal delivery, which increased the risk of anal incontinence (aOR, 1.50; 95% CI, 1.04-2.15).
The results of the PASST trial indicate that neither moderate nor intensive pushing efforts affect the risk of urinary or anal incontinence at 6 months postpartum among women who gave birth under epidural analgesia.
To describe the course over time of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in French women from the beginning of the pandemic until mid-April, the risk profile of ...women with respiratory complications, and short-term pregnancy outcomes.
We collected a case series of pregnant women with COVID-19 in a research network of 33 French maternity units between March 1 and April 14, 2020. All cases of SARS-CoV-2 infection confirmed by a positive result on real-time reverse transcriptase polymerase chain reaction tests of a nasal sample and/or diagnosed by a computed tomography chest scan were included and analyzed. The primary outcome measures were COVID-19 requiring oxygen (oxygen therapy or noninvasive ventilation) and critical COVID-19 (requiring invasive mechanical ventilation or extracorporeal membrane oxygenation, ECMO). Demographic data, baseline comorbidities, and pregnancy outcomes were also collected.
Active cases of COVID-19 increased exponentially during March 1–31, 2020; the numbers fell during April 1–14, after lockdown was imposed on March 17. The shape of the curve of active critical COVID-19 mirrored that of all active cases. By April 14, among the 617 pregnant women with COVID-19, 93 women (15.1 %; 95 %CI 12.3–18.1) had required oxygen therapy and 35 others (5.7 %; 95 %CI 4.0–7.8) had had a critical form of COVID-19. The severity of the disease was associated with age older than 35 years and obesity, as well as preexisting diabetes, previous preeclampsia, and gestational hypertension or preeclampsia. One woman with critical COVID-19 died (0.2 %; 95 %CI 0−0.9). Among the women who gave birth, rates of preterm birth in women with non-severe, oxygen-requiring, and critical COVID-19 were 13/123 (10.6 %), 14/29 (48.3 %), and 23/29 (79.3 %) before 37 weeks and 3/123 (2.4 %), 4/29 (13.8 %), and 14/29 (48.3 %) before 32 weeks, respectively. One neonate (0.5 %; 95 %CI 0.01–2.9) in the critical group died from prematurity.
COVID-19 can be responsible for significant rates of severe acute, potentially deadly, respiratory distress syndromes. The most vulnerable pregnant women, those with comorbidities, may benefit particularly from prevention measures such as a lockdown.
•Eye-protecting devices are crucial to cut off virus transmission via conjunctiva.•3D-printing devices inside hospital setting allows rapid and large-scale manufacture.•An ongoing dialogue in an ...interdisciplinary group allows iterative improvements.
The coronavirus pandemic resulted in a shortage of protective equipment. To meet the request of eye-protecting devices, an interdisciplinary consortium involving practitioners, researchers, engineers and technicians developed and manufactured thousands of inexpensive 3D-printed face shields, inside hospital setting. This action leads to the concept of “concurrent, agile, and rapid engineering”.
The management of foreign body aspirations (FBA) is dreaded by pediatric physicians due to the high risk of respiratory distress and a potential fatal outcome, favored by a lack of experience of ...young specialists. Furthermore, there has been an increasing requirement for low-cost simulation. The aim was to describe the step-by-step manufacturing process and to validate a low-cost, easily home-made training model of pediatric tracheo-bronchial tree (pTBT) for simulation-based training in order to teach young physicians to practice foreign body (FBA) extractions.
A simulator was designed in order to reproduce the physical and esthetic properties of a pTBT. The production cost of a single simulator was estimated. The simulator was then tested by experienced physicians using a rigid bronchoscope. A manufacturing manual of the simulator is hereby presented. A group of 7 experienced pediatric otolaryngologists performed a FBA extraction in the conditions of installation of an operating room.
The result of the survey showed a high fidelity of the simulator in mimicking the biological esthetics and physical properties of a pTBT during a FBA extraction (mean 4.3 ± 0.8).
The total cost of the custom-made simulator is about 20.5 € ($23.4) for the production of the first simulator.
A highly realistic and easily reproducible pediatric tracheo-bronchial tree simulator is presented and can therefore be used during simulation-based training.
•We hereby propose a pediatric tracheo-bronchial tree simulator.•The production of the simulator was designed at low-cost.•The simulator was validated by experienced physicians.•A step-by-step manufacturing manual is presented in this article.
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•Pregnancy should not be contraindicated in women with well-controlled INCPH.•Women should be informed of the risk of liver-related events.•Women should be informed of the high rate ...of miscarriage and preterm birth.•Follow-up should be performed by hepatologists and obstetricians well versed in high-risk pregnancies.
A total of 15% of patients with idiopathic non-cirrhotic portal hypertension (INCPH) are women of childbearing age. We aimed to determine maternal and fetal outcome of pregnancies occurring in women with INCPH.
We retrospectively analyzed the charts of women with INCPH followed in the centers of the VALDIG network, having had ≥1 pregnancy during the follow-up of their liver disease. Data are represented as median (interquartile range).
A total of 24 pregnancies occurred in 16 women within 24 (5–66) months after INCPH diagnosis. Four women had associated partial portal vein thrombosis before pregnancy. At conception, 2 out of the 16 women had detectable ascites and others were asymptomatic. Out of these 24 pregnancies, there were four miscarriages, one ectopic pregnancy, and one medical termination of pregnancy at 20 weeks of gestation. Out of the 18 other pregnancies reaching 20 weeks of gestation (in 14 patients), there were nine preterm and nine term deliveries. All infants were healthy at delivery, but one died at day 1 of unknown cause and one at day 22 of infectious meningitis; both were preterm. Concerning mothers, two had worsening of ascites, two had variceal bleeding despite non-selective betablockers during pregnancy and one developed a main portal vein thrombosis in early postpartum. Genital bleeding occurred in three patients, including two receiving anticoagulation. All 16 women were alive and asymptomatic after a median follow-up of 27 (9–93) months after last delivery.
The overall outcome of women with INCPH who become pregnant is favorable despite a significant incidence of complications related to portal hypertension. Fetal outcome is favorable in most pregnancies reaching 20 weeks of gestation.
About 15% of patients with idiopathic non-cirrhotic portal hypertension are women of childbearing age, who can become pregnant. As available reports on pregnancy in these women are scarce and heterogeneous, it is unclear whether or not pregnancy should be contraindicated in this setting. We provide detailed data showing that, regardless of the associated conditions, the overall outcome of women with idiopathic non-cirrhotic portal hypertension becoming pregnant is good despite a significant incidence of complications related to portal hypertension, and that fetal outcome is favorable in most pregnancies reaching 20 weeks of gestation.
To evaluate the rate of success and practicability of the intrauterine tamponade balloon (ITB) for managing PPH as a fertility-sparing tool. Methods: a five-year retrospective monocentric study in a ...tertiary care center including patients transferred for severe PPH. Results: In 231 patients, the success rate of ITB (n = 57), embolization (n = 58), and medical management (n = 114) was 84.21%, 74.13%, and 76.32%, respectively. Cesarean section during labor did not influence the risk of advanced interventional procedures (AIPs) for patients with ITB (odds ratio OR = 1.08) but did so in patients who were under expectant management in the intensive care (OR = 5.29). In the AIP subgroup of the ITB group, hemostasis was significantly deteriorated. Prothrombin time <50% (OR = 11.5), fibrinogen <2 g/L (OR = 6.88), and >4 red blood cells units (RBCs) transfused (OR = 17.2) were associated with a significantly higher risk of failure. Blood loss in the AIP patients in the embolization group was significantly higher. Patients requiring >4 units of RBCs were 22.9 times more likely to have an AIP (p = .0001). Conclusion: Compared with uterine embolization and medical management, ITB use in a tertiary care center was associated with lower risk of undergoing AIP, but further prospective study is required to confirm this.
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