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PubMedDate not supplied

Syndrome auriculotemporal.

Two cases of auriculotemporal syndrome are presented in two male children that began in the first years of life to present reactions of linear erythema itinerary on the cheeks after eating several foods. The allergologic study with these foods was negative, reproducing the clinical picture after their ingestion.

Cheek↗
PubMed2001

Effects of rectally administered paracetamol on infants delivered by vacuum extraction.

OBJECTIVE: To evaluate whether paracetamol (20 mg/kg rectally) relieves pain in infants delivered by vacuum extraction, and improves clinical condition. METHODS: Prospective, randomised, double-blind, placebo-controlled study. Infants delivered by vacuum extraction were randomised either to the study group (n=61) and given paracetamol or to the control group (n=61) receiving placebo. Pain assessment was performed by a validated pain score and by scoring the clinical condition. Both scores and clinical symptoms in these groups were compared with symptoms in a reference group (n=66) with uncomplicated pregnancy and delivery in vertex position without vacuum extraction. RESULTS: Pain score did not differ between groups; clinical condition in the study group improved only after the first dose. There was a significant difference (P<0.05) in objective clinical symptoms in the vacuum extraction groups, compared to the reference group. CONCLUSION: One dose of paracetamol given to neonates delivered by vacuum extraction significantly improved their clinical condition, but did not result in a significant change in objective pain scores. Subsequent doses of paracetamol did not show any effect on the clinical symptoms or appearance of the neonates studied.

Acetaminophen↗
PubMed2003

Urinary and anal incontinence after vacuum delivery.

OBJECTIVES: To evaluate urinary and fecal incontinence symptoms, and occult anal sphincter defects in women after vacuum and spontaneous vaginal delivery. STUDY DESIGN: In a case-control study, 50 primiparous women delivered by vacuum extraction were compared to 50 women delivered spontaneously. Urinary and anal incontinence symptoms, pelvic floor muscle strength and sphincter defects on endoanal ultrasound were evaluated 6-24 weeks postpartum. RESULTS: New anal incontinence symptoms after childbirth were found in 30% of the vacuum group compared to 34% of the controls, new urinary incontinence symptoms in 28 and 42%, respectively (not significant). After excluding Grade III perineal tear, sonographic sphincter defects were found in 11 (27.5%) after vacuum delivery compared to 4 (10%) after spontaneous delivery (P<0.05, chi(2)-test). CONCLUSION: Anal and urinary incontinence symptoms are frequent after vaginal delivery. Vacuum delivery causes more sonographic sphincter defects but appears to cause no more harm to pelvic floor function than spontaneous vaginal delivery.

Adult↗
PubMed2001

[Posterior fossa hemorrhage in newborns following vaccum extractor delivery].

AIM: To emphasize the risk of posterior fossa hemorrhage in newborns following vacuum extraction. PATIENTS AND METHODS: Over a period of 26 months (September 1996-December 1998), seven patients who underwent delivery with the vacuum extractor had symptoms of brain stem compression, related to posterior fossa hemorrhage. They were referred to the neonatal intensive care unit. Some parameters had been analyzed: gestational period, delivery circumstances, gestational age, parameters of newborn, indications of vacuum extraction and other paraclinical investigations (biological and radiological). RESULTS: Ultrasound scan revealed intracranial hemorrhage in five cases of seven; mean time of diagnosis was 10 hours of age. All patients presented symptoms of brain stem compression. Mean period of follow-up was 22 months: six of seven patients had a normal neurodevelopment. One patient had a cerebellar ataxia, another one a palsy of the IIIrd cranial nerve. CONCLUSION: Analyses of posterior fossa by ultrasound scan should be made for newborns delivered by vacuum extractor, especially if they had symptoms of brain stem compression.

Brain Stem↗
PubMed2002

[Spontaneous abortions of first trimester pregnancy: is uterine aspiration still in line?].

Spontaneous abortions of first trimester pregnancy is a frequent pathology in gynecology (more than 10% of clinical pregnancy). Since the mid of twentieth century, the gold standard of evacuation of spontaneous abortion is manual vacuum aspiration most of the time under general anesthesia. This method is used in France for all miscarriages after 7 weeks' gestation at the sonography (about 40,000 women in 1999) but complications are not rare. The vaginal sonography and new medical management changes the view. We can now use expectative management or medical management with misoprostol and/or mifepristone. We summarise the current literature and propose a randomised multicentric control trial.

Abortifacient Agents↗
PubMed1999

Paracetamol 1 g given rectally at the end of minor gynaecological surgery is not efficacious in reducing postoperative pain.

BACKGROUND: We studied the analgesic effects of 1 g paracetamol given rectally at the end of surgery in a prospective, randomised, double-blind study. METHODS: One hundred and forty ASA I-II women scheduled for elective termination of pregnancy under general anaesthesia were randomly allocated to receive paracetamol or placebo. All patients had standardised anaesthesia with propofol, fentanyl and oxygen in nitrous oxide. Postoperative pain was assessed by VAS score. RESULTS: We could find no difference regarding postoperative pain, need for analgesics or time to discharge between the groups. CONCLUSION: The routine use of 1 g paracetamol given rectally at the end of surgery after termination of pregnancy seems not to be justified.

Abortion, Induced↗
PubMed2004

Herpes simplex virus infection after vacuum-assisted vaginally delivered infants of asymptomatic mothers.

OBJECTIVE: To determine whether vacuum extraction technique is associated with an increased risk of herpes simplex virus (HSV) infection in infants born to asymptomatic mothers. PATIENTS AND METHODS: We reviewed the charts of all infants born at the Edith Wolfson Medical Center and admitted to the hospital's neonatal intensive care unit from January 1999 to June 2002 diagnosed with HSV infection. RESULTS: During the study period, 6953 infants were delivered at our institution and 11 infants had HSV infection. The prevalence of neonatal HSV infection was 1.6 per 1000 live births. In 699 infants, vacuum extraction was used for delivery. Five out of the 11 infants delivered vaginally by vacuum extraction developed HSV infection at the site of the vacuum extractor application. They were born to mothers who were asymptomatic at delivery and had no history of HSV genital infection. HSV type 2 was isolated from the vesicular fluid in all infected infants delivered by vacuum extraction, and none had central nervous system involvement. The prevalence of neonatal HSV infection in vacuum-assisted births was seven per 1000 live births as compared to 0.95 in 1000 in infants delivered vaginally or by cesarean section (p<0.0001). The relative risk of HSV infection in infants born in vacuum-assisted births was 7.45 (95% confidence interval (CI) 1.99 to 27.42, p=0.001). All patients were treated with intravenous acyclovir and no recurrences of HSV infection have been noticed at follow-up. CONCLUSIONS: Laceration of the fetal scalp by vacuum extraction technique may enhance the acquisition and the early appearance of cutaneous infection in infants exposed to HSV shedding in the genital tract of asymptomatic mothers, as the virus gains access through the lacerated scalp.

Female↗
PubMed1998

Maternal anthropometry-based screening and pregnancy outcome: a decision analysis.

OBJECTIVE: To assess the impact of screening and intervention based on maternal height, prepregnancy weight and weight during weeks 16-19 or 24-27 in reducing adverse pregnancy outcomes (IUGR, preterm birth and assisted delivery) in developing country settings. METHODS: Decision analysis based on a recent multicentre WHO collaborative study of maternal anthropometry and pregnancy outcomes and meta-analyses of controlled clinical trials of balanced energy/protein supplementation (for IUGR and preterm birth) and support from caregivers during labour (for assisted delivery). Subjects for the analysis comprised pregnant women from Cali, Colombia (1989, n = 4598); urban and rural Pune, India (1990, n = 4307); and urban and rural Myanmar (1981-82, n = 3542) followed until delivery. RESULTS: Seven to 45% of pregnant women had positive screens, with preventive fractions (PFs) ranging from 0.034 to 0.109 for IUGR, 0.027-0.082 for preterm birth and 0.011-0.105 for assisted delivery. Screening prevention ratios (SPRs = ratios of the number of women treated to the number of cases of adverse outcome prevented) are high in all three study settings for preterm birth and assisted delivery (range 22.8-115.7) and low in settings with a high prevalence of the adverse outcome and high specificity of the anthropometric measure (India for IUGR, range 7.0-8.0). Sensitivity analyses demonstrate a marked linear fall in PF and an exponential rise in the SPR as the relative risk associated with intervention increases (i.e. as the protective benefit of intervention decreases) from 0.60 to 0.95. CONCLUSIONS: A maternal anthropometry-based 'risk approach' is unlikely to result in a major reduction in adverse pregnancy outcomes in developing country settings. For risk-free and inexpensive interventions (e.g. caregiver support during labour), a better strategy would be to forego screening and instead treat all pregnant women.

Anthropometry↗
PubMed1997

Conservative management of tracheal rupture after intubation.

A case is reported of a newborn with tracheal rupture resulting from a complicated delivery requiring vacuum extraction and two attempts at intubation. Despite the severity of the situation the infant was successfully managed conservatively with orotracheal intubation.

Female↗
PubMed2003

Effect of operative delivery in the second stage of labor on breastfeeding success.

BACKGROUND: Operative delivery rates are currently rising in many countries, but the effects of this factor on the initiation and duration of breastfeeding are unclear. The purpose of this study was to evaluate breastfeeding success after instrumental vaginal delivery or cesarean section at full dilatation, and to investigate whether timing of discharge after operative delivery affects breastfeeding rates. METHODS: A prospective cohort study was conducted of 393 women with term, singleton, live, cephalic pregnancies who required delivery in theater during the second stage of labor between February 1999 and February 2000. Postal questionnaires were mailed to participants at 6 weeks and 1 year. Logistic regression models were used to explore the relationships between infant feeding and mode of delivery, controlling for factors previously correlated with breastfeeding success. RESULTS: Rates of exclusive breastfeeding at discharge and 6 weeks postpartum were 70 and 44 percent, respectively. No significant differences occurred when instrumental vaginal delivery was compared with cesarean section, adjusted OR 0.84 (95% CI 0.50, 1.41) and 1.15 (95% CI 0.69, 1.93) respectively. Breastfeeding rates after failed instrumental delivery were similar to those after immediate cesarean section, adjusted OR 0.99 (95% CI 0.72, 1.38) and 1.28 (95% CI 0.91, 1.78). Women who had a longer in-patient stay after cesarean section were more likely to achieve exclusive breastfeeding at hospital discharge (78% vs 66%, p = 0.03). CONCLUSIONS: Method of operative delivery in the second stage of labor does not appear to influence initiation or duration of exclusive breastfeeding. A longer inpatient stay may help cesarean-delivered women to initiate breastfeeding.

Adult↗
PubMed2001

Emergency management of the nonviable intrauterine pregnancy.

Fetal death early in gestation is common. Patients in the first trimester of pregnancy with abdominal pain or vaginal bleeding often present to the emergency department for care. Over the past 20 years, the technology available to confirm or exclude the diagnosis of a nonviable pregnancy has improved dramatically. These improvements have altered the diagnostic approach to these patients and have lead to a change in the terminology used to categorize the pregnancy status. In addition, the therapeutic options available to manage patients with a confirmed nonviable pregnancy have expanded greatly. In this article, we re-evaluate the classification scheme used to categorize patients with first trimester pain or bleeding given the improved technology that is available to the emergency physician today. We discuss the role of ultrasound and biochemical markers in confirming or excluding the diagnosis of a nonviable pregnancy. Finally, we review the therapeutic options, including expectant, surgical as well as medical management that are available once the diagnosis of a nonviable intrauterine pregnancy has been confirmed.

Abdominal Pain↗