PubMed · 7848255
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M Shembrey. 1994. 'More information please'.. https://pubmed.ncbi.nlm.nih.gov/7848255/
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In this prospective study, the role of clinical examination and risk factors in the diagnosis of developmental dysplasia of the hip (DDH) was analysed. For this purpose, 376 hips of 188 referred infants with an average age of 3.7 months (range 0-8 months) were clinically and ultrasonographically (Graf method) examined. Infants who had at least one risk factor for DDH had a three times higher occurence rate of DDH than those who didn't have any. Breech presentation and positive family history were the two most common risk factors associated with DDH. The rate of DDH was nearly 16 times higher in the hips with at least one abnormal clinical finding than in the ones without any. Ultrasonographically unstable hips (type IIc-unstable to type IV) were always detected during clinical examination. There was a risk of missing the diagnosis of hips with acetabular dysplasia alone. Limitation of abduction and asymmetry of the skin folds were the two most common clinical findings associated with DDH. Nearly two-thirds of the infants with at least one positive clinical finding and at least one risk factor had either an unilateral or bilateral dysplastic hip. It was concluded that a careful clinical examination was significantly more important than the coexisting risk factors in the detection of DDH.
OBJECTIVE: To evaluate the pregnancy characteristics, methods of delivery, and neonatal outcomes of fetuses affected by osteogenesis imperfecta. METHODS: We reviewed medical records of 1016 individuals whose cells were sent to the University of Washington Collagen Diagnostic Laboratory between 1987 and 1994 for confirmation of diagnoses of osteogenesis imperfecta. Information and neonatal records were available for 167 of those pregnancies. From those we identified method(s) of prenatal detection, delivery method, and neonatal complications, including survival and acquisition of new fractures, and related them to type of delivery. RESULTS: The cesarean delivery rate was 54%, most of them (53%) for nonvertex presentation and fewer than 15% because of an antenatal diagnoses of osteogenesis imperfecta. There was an unusually high rate of breech presentation at term (37%). In infants with nonlethal forms of osteogenesis imperfecta, 24 of 59 (40%) delivered by cesarean and 17 of 53 (32%) delivered vaginally had new fractures (chi(2) =.89; P =.3). Among 55 infants with the most severe form, 24 of 31 delivered by cesarean and 21 of 24 delivered vaginally died within 2 weeks of birth. CONCLUSION: Cesarean delivery did not decrease fracture rates at birth in infants with nonlethal forms of osteogenesis imperfecta nor did it prolong survival for those with lethal forms. Prenatal diagnosis did not influence mode of delivery in most instances. Most cesarean deliveries were done for usual obstetric indications.
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