A Study to Assess the Effects of Epidural Analgesia and Parenteral Analgesia on Maternal and Neonatal Outcomes Among Parturients Experiencing Slow Progression of Labour: A Comparative Study

Introduction: Epidural analgesia however has been shown to be associated with maternal side effects like hypotension, hyperthermia and prolonged labour which are likely to have adverse effects on the fetal outcome, thus discouraging its use in clinical practice. Neonatal/fetal effect should be one of the most important determinants for choosing ideal analgesia. As there is no study which specifically has looked into the effects of labour analgesia on neonatal outcomes on augmentation of labour, it would be prudent to measure the impact of epidural analgesia in parturients requiring augmentation of labour and its effects on maternal and neonatal outcomes. Materials and Methods: The present study was carried among 60 labouring women with partographic evidence of slow progress of labour requiring augmentation in active phase of labour. The enrolled women were randomly allocated into group 1 in which epidural analgesia was established according to guidelines of department of Anesthesia and intensive care, PGIMER. Patients in group 2 received IM tramadol hydrochloride 1 mg/kg (with max. dose 400 mg / 24 hours) every 4 hours. All the women were monitored for 24 to 48 hours postpartum period for complication like hypotension, motor weakness, urinary retention, sedation, nausea or vomiting, allergy fever. The neonates were followed up till discharge from hospital. Results: Most common maternal complication in epidural group was numbness and in tramadol group was vomiting. All most all (93%) of women in epidural group were satisfied with type of analgesia and more than 77% of women reported it to be excellent. In tramadol group only 41% reported analgesia as fair and good but rest of them were dissatisfied with type of analgesia (p-0.001). Ninety three percent of women in epidural group desired to use it again in next pregnancy as compared to 20% in tramadol group. Urinary retention needing catheterization was similar in both groups. Most of neonates in both the groups had established breast feeding with in 12hrs. There was no difference between the groups in the incidence of neonatal jaundice requiring phototherapy. No neonates in either group required NICU or nursery care. Conclusion: To conclude, our study results suggest epidural analgesia might have edge over narcotic analgesics in dystocia. Neonates are more likely to get benefit. However epidural analgesia might increase second stage complications and vigilant care whenever mother on epidural analgesia is mandatory.

Clinical analysis of low forceps midwifery assistance in persistent occiput posterior dystocia / 中国现代医生

@#Objective To discuss the clinical effect of low forceps midwifery in persistent occiput posterior dystocia.Methods A retrospective analysis of 120 parturients with persistent occiput posterior dystocia were admitted to Yangzhou Maternity and Child Health Care Hospital from October 2020 to March 2023.70 cases with lower uterine cesarean section were in group A.20 cases with lower forceps midwifery were in group B.30 cases with spontaneous deliveries were in group C.Results The postoperative hospitalization time and hospitalization cost of group A were significantly higher than those of group B and group C(P<0.05).In both groups A and B,the intrapartum bleeding volume was higher than that in group C(P<0.05),but there was no significant difference in groups A and B(P>0.05);There was no significant difference in birth canal injury between groups B and C(P>0.05).Neonatal birth injuries were not significantly different among the three groups(P>0.05).Conclusion It's important for us to assist the pregnant woman of persistent occiput posterior dystocia in a natural delivery with proper management.The application of low forceps delivery midwifery can reduce the postoperative hospital stay and hospitalization cost,and does not increase the incidence of birth canal injury and neonatal birth injury.

Prevalence of macrosomic newborn and maternal and neonatal complications in a high-risk maternity

Abstract Objective Evaluate the prevalence of macrosomic newborns (birth weight above 4000 grams) in a high-risk maternity from 2014 to 2019, as well as the maternal characteristics involved, risk factors, mode of delivery and associated outcomes, comparing newborns weighing 4000-4500 grams and those weighing above 4500 grams. Methods This is an observational study, case-control type, carried out by searching for data in hospital's own system and clinical records. The criteria for inclusion in the study were all patients monitored at the service who had newborns with birth weight equal than or greater than 4000 grams in the period from January 2014 to December 2019, being subsequently divided into two subgroups (newborns with 4000 to 4500 grams and newborns above 4500 grams). After being collected, the variables were transcribed into a database, arranged in frequency tables. For treatment and statistical analysis of the data, Excel and R software were used. This tool was used to create graphs and tables that helped in the interpretation of the results. The statistical analysis of the variables collected included both simple descriptive analyzes as well as inferential statistics, with univariate, bivariate and multivariate analysis. Results From 2014 to 2019, 3.3% of deliveries were macrosomic newborns. The average gestational age in the birth was 39.4 weeks. The most common mode of delivery (65%) was cesarean section. Diabetes mellitus was present in 30% of the deliveries studied and glycemic control was absent in most patients. Among the vaginal deliveries, only 6% were instrumented and there was shoulder dystocia in 21% of the cases. The majority (62%) of newborns had some complication, with jaundice (35%) being the most common. Conclusion Birth weight above 4000 grams had a statistically significant impact on the occurrence of neonatal complications, such as hypoglycemia, respiratory distress and 5th minute APGAR less than 7, especially if birth weight was above 4500 grams. Gestational age was also shown to be statistically significant associated with neonatal complications, the lower, the greater the risk. Thus, macrosomia is strongly linked to complications, especially neonatal complications.

Dystocia Due to Secondary Uterine Inertia and its Obstetrical Management- A Case Report

Background: A full-term pregnant Ongole cow was presented to the Large Animal Obstetrical Ward with a history of reduced feed intake, dull and ruptured foetal membranes 24 hours before presentation without progress in parturition. The temperature was within the normal physiological range. Per-vaginal examination revealed second-degree cervical dilation, lack of uterine and abdominal contractions and the vaginal discharges were reddish brown and putrid. Methods: The case was diagnosed as secondary uterine inertia and treated with an intracervical application of misoprostol and intravenous calcium therapy. Results: Three hours after the application of misoprostol and calcium therapy, full dilatation of the cervix was achieved to facilitate the delivery of the dead male emphysematous foetus by traction. Uneventful recovery of the dam was noticed. Conclusion: Usage of misoprostol along with CMC massage and calcium therapy resulted in speedy recovery of dystocia suffering with incomplete cervical dilation.

Distocia de hombros: propuestas de resolución de acuerdo con las diferentes posiciones de parto según la movilidad de la pelvis

Introducción. La distocia de hombros es una complicación del parto vaginal que se produce por dificultad en el parto de los hombros fetales. Puede desencadenarse en forma impredecible e imprevista, por lo que debería ser considerada como riesgo potencial de todo nacimiento. La mayoría de las recomendaciones sobre las maniobras de resolución de distocia de hombros lo hacen desde la posición de litotomía y sin considerar los movimientos intrínsecos de la pelvis durante el parto. Objetivos. Analizar las maniobras de resolución de distocia de hombros a partir del conocimiento de la biomecánica de la pelvis y su relación con los hombros fetales, teniendo en cuenta las diferentes posiciones de parto. Métodos. Revisión bibliográfica no sistematizada. Resultados. Ante la distocia del hombro anterior, si la gestante se encuentra en litotomía podría recomendarse la maniobra de McRoberts con presión suprapúbica seguida de la extracción del brazo posterior. Si la gestante se encuentra en posición vertical, se sugiere pasar a posición de cuatro apoyos y una variante original resultado del análisis de los movimientos de la pelvis llamada 'cuatro apoyos en asimetría'. Esta puede ser realizada desde cualquier posición, no es invasiva y requiere un mínimo de entrenamiento. Conclusiones. La resolución de distocia de hombros no posee un único algoritmo; dependerá del tipo de distocia, la posición de la gestante, el contexto y la mayor o menor habilidad de una maniobra sobre otra. La postura de Gaskin y cuatro apoyos en asimetría debería ser tenida en cuenta antes de realizar maniobras internas para la resolución de la distocia de hombros.

Introduction: Shoulder dystocia is a complication of vaginal delivery caused by a difficulty in delivering the fetal shoulders. It can be triggered in an unpredictable and unplanned manner, so it should be considered as a potential risk for every vaginal birth. Most of the recommendations on shoulder dystocia resolution maneuvers are made from the lithotomy position and without considering the intrinsic movements of the pelvis during labor. Objectives : To analyze the maneuvers for resolving shoulder dystocia based on knowledge of the biomechanics of the pelvis and its relationship with the fetal shoulders, considering the different birthing positions. Methods: Non-systematized bibliographic review. Results : In the case of anterior shoulder dystocia, the McRoberts maneuver with suprapubic pressure followed by extraction of the posterior arm could be recommended for a birthing woman in lithotomy position. If the birthing woman is in an upright position, it is suggested to move to the four-support position and an original variant resulting from the analysis of the biomechanics of the pelvis called 'four-lying in asymmetry'. These maneuvers are non-invasive techniques, require minimal training and resources, and can be performed from any childbirth position. Conclusions : The resolution of shoulder dystocia does not have a single algorithm; it will depend on the type of dystocia, the position of the birthing woman, the context, and the greater or lesser ability of one maneuver over another. Gaskin maneuver and four supports in asymmetry should be considered before performing internal maneuvers for the resolution of shoulder dystocia.

Distocia em tigre d'água-de-orelha-vermelha, Trachemys scripta elegans, wied (1839): relato de caso / Dystocia in red-eared slider, Trachemys scripta elegans, wied (1839): case report / Distocia en tortuga de orejas rojas, Trachemys scripta elegans, wied (1839): reporte de caso

Atualmente muitos répteis se tornaram animais de companhia e são mantidos como pet's exóticos. A espécie Trachemys scripta elegans, Wied (1839) é um animal exótico da América do Norte, sua identificação é realizada pelas marcas avermelhadas encontradas lateralmente a sua cabeça. Na rotina clínica as principais enfermidades que acometem os quelônios são as de origem reprodutiva, como a estase folicular e distocia. O objetivo deste trabalho foi relatar um caso recorrente de distocia em um tigre d'água fêmea, para isso, a anamnese, o histórico da paciente, e seus sinais clínicos, em conjunto com os exames complementares de imagem foram essenciais para se obter diagnóstico definitivo. O tratamento foi realizado com a indução medicamentosa utilizando borogluconato de cálcio, seguida da aplicação de ocitocina, esta trouxe resultados positivos para a eliminação dos ovos. Porém devido ao histórico do paciente, optou-se pela intervenção cirúrgica de ovariossalpingectomia, sendo está a maneira permanente de resolução da patologia. O protocolo terapêutico escolhido proporcionou um resultado satisfatório e bem estar ao animal.(AU)

Currently, many reptiles have become companion animals and are kept as exotic pets. The species Trachemys scripta elegans, Wied (1839) is an exotic animal from North America, and its identification is based on the reddish markings found laterally on its head. In routine clinical practice, the main diseases that affect chelonians are those of reproductive origin, such as follicular stasis and dystocia. The aim of this study was to report a recurrent case of dystocia in a female red-eared slider turtle. For this purpose, the patient's anamnesis, history, and clinical signs, along with complementary imaging exams, were essential to obtain a definitive diagnosis. The treatment involved medical induction using calcium borogluconate, followed by the administration of oxytocin, which yielded positive results in egg elimination. However, due to the patient's history, surgical intervention in the form of ovariosalpingectomy was chosen as the permanent solution to the pathology. The chosen therapeutic protocol provided a satisfactory outcome and improved the animal's well-being.(AU)

Actualmente muchos reptiles se han convertido en animales de compañía y se mantienen como mascotas exóticas. La especie Trachemys scripta elegans, Wied (1839) es un animal exótico de América del Norte, su identificación se realiza por las marcas rojizas que se encuentran lateralmente a su cabeza. En la rutina clínica, las principales enfermedades que afectan a los quelonios son las de origen reproductivo, como la estasis folicular y la distocia. El objetivo de este trabajo fue reportar un caso recurrente de distocia en una hembra de tigre de agua, para ello la anamnesis, la historia de la paciente y sus signos clínicos, junto con los exámenes imagenológicos complementarios fueron fundamentales para obtener un diagnóstico definitivo. El tratamiento se realizó con inducción farmacológica con borogluconato de calcio, seguido de la aplicación de oxitocina, que arrojó resultados positivos con la eliminación de huevos. Sin embargo, debido a los antecedentes de la paciente, se optó por la intervención quirúrgica de ovarialpingectomía, que es la forma definitiva de resolución de la patología. El protocolo terapéutico elegido proporcionó un resultado satisfactorio y bienestar al animal.(AU)

Overcoming Primary Cervical Dystocia with Ayurveda Therapeutic Strategy- Case Study

Background: We report a case of primary cervical dystocia managed successfully with Ayurveda therapy. The classical Ayurveda lexicons comprise detailed descriptions regarding Prasava (labor) and its management based on which the present case was intervened which resulted in achieving progressive improvement in cervical dilatation and achieving normal labor. Case Presentation: The case reported in this study is primigravidae, 25 years’ old visited prasutitantra OPD, NIA hospital with 37.2 weeks gestational age complaining of labor pains. Since her contraction and per vaginal findings were suggestive of onset of labor, she was hospitalized for further monitoring and awaited spontaneous progress of labor. Repeated Per vaginal examination revealed no progress in cervical dilatation even after 28 hours and she was diagnosed with primary cervical dystocia. Intervention of Kebuka taila yonipichu-25ml 2 hourly was made which resulted in remarkable cervical dilatation equivalent to mean standard rate following 3 interventions of yonipichu within 6 hours. Conclusion: The status of the cervix during labor is a significant determinant of mode and ease of labor. Ayurveda therapeutic strategy of Kebuka taila yoni-pichu can effectively prime the cervix due to the Garbhashayaka sankochaka and estrogenic properties of Kebuka and the activation of Ferguson's reflex by Yoni-pichu.

Hydrocephalus, Ankylosis and Brachygnathism in an Non-descript Indigenous Calf: A Case Report

The present finding of a case reports revealed successful management of per-vaginal delivery of an indigenous male calf with multiple congenital anomalies like hydrocephalus, ankylosis and brachygnathism.

Partial Per-Cutaneous Fetotomy and Per-Vaginal Delivery of Emphysematous Foetus in a Sheep

The present communication describes partial percutaneous fetotomy and per-vaginal delivery of emphysematous fetus in non-descript biparous ewe due to delayed approach to veterinarian by owner. It was successfully relieved by fetotomy and obstetrical mutational operations followed by clinical management of the animal.

Reproductive diseases in captive Agoutis (Dasyprocta leporina) / Doenças reprodutivas em cutias em cativeiro (Dasyprocta leporina)

Reproductive diseases have been well documented in domestic livestock such as sheep, goat, cattle and pigs. However, there is very little information on these diseases in the agouti (Dasyprocta leporina). The agouti is used for its meat in South America and the Caribbean. More recently, intensive farming of this animal is being practiced in the Neotropics. There is dearth of information on dystocia and vaginal prolapses in the agouti. This document reports on three cases of reproductive diseases in captive reared agoutis in Trinidad and Tobago. The first case was a female agouti weighing approximately 3 kg that was in the last stage of pregnancy, which was found dead in its cage. The vulva of the mother had the protruding hind-limbs of the fetus. Necroscopic evaluation of carcass revealed little fat tissue and the mother had two fetuses in the right horn of the uterus. Each fetus weighed approximately 200 g. The fetuses were well formed with fur, teeth and eyes. The placenta was attached to each fetus. The pathological findings suggested that dystocia resulted from secondary uterine inertia which was the cause of death of the adult female agouti. The second case was that of an adult female agouti weighing 2.5 kg. This female had given birth to an offspring three weeks prior and was observed to have had a vaginal prolapse. Surgery was performed and the prolapsed vagina was placed back into the pelvic cavity. Further to this intervention, the vagina prolapsed twice. Subsequent to the re-insertion of the vaginal tissue the agouti was euthanized. The third case was also that of a dystocia. However, the fetuses weighed 235 g and 165 g respectively and were in normal presentation, posture and positioning. The fetus however was unable to pass via the vagina and was trapped in the pelvic cavity. This caused secondary uterine inertia which was the cause of death. The causes of reproductive diseases in these cases are unknown but the feeding management and space allowance given to the agouti in late gestation may be contributing factors.

As doenças reprodutivas têm sido bem documentadas em rebanhos domésticos, como ovinos, caprinos, bovinos e suínos. Porém, há muito pouca informação sobre essas doenças na cutia (Dasyprocta leporina). A cutia é usada como carne na América do Sul e no Caribe. Mais recentemente, a criação intensiva desse animal está sendo praticada na região neotropical., Há escassez de informações sobre distocia e prolapsos vaginais na cutia. Este documento relata três casos de doenças reprodutivas em cutias criadas em cativeiro em Trinidad e Tobago. O primeiro caso foi de uma cutia de aproximadamente 3 kg que estava na última fase de gestação, encontrada morta em sua gaiola. A vulva da mãe tinha as patas traseiras salientes do feto. A avaliação necroscópica da carcaça revelou pouco tecido adiposo e a mãe tinha dois fetos no corno direito do útero. Cada feto pesava aproximadamente 200 g. Os fetos eram bem formados com pelos, dentes e olhos. A placenta foi presa a cada feto. Os achados patológicos sugeriram que a distocia resultou de inércia uterina secundária, que foi a causa da morte da cutia adulta. O segundo caso foi o de uma cutia adulta pesando 2,5 kg. Essa fêmea deu à luz uma cria três semanas antes e foi observado que tinha prolapso vaginal., A cirurgia foi realizada e a vagina prolapsada foi colocada de volta na cavidade pélvica. Após essa intervenção, a vagina prolapsou duas vezes. Após a reinserção do tecido vaginal, a cutia foi eutanasiada. O terceiro caso também foi de distocia. No entanto, os fetos pesavam 235 g e 165 g e estavam em apresentação, postura e posicionamento normais. O feto, entretanto, não conseguiu passar pela vagina e ficou preso na cavidade pélvica. Isso causou inércia uterina secundária, que foi a causa da morte. As causas das doenças reprodutivas nesses casos são desconhecidas, mas o manejo da alimentação e o espaço concedido à cutia no final da gestação podem ser fatores contribuintes.

Reproductive diseases in captive Agoutis (Dasyprocta leporina) / Doenças reprodutivas em cutias em cativeiro (Dasyprocta leporina)

Reproductive diseases have been well documented in domestic livestock such as sheep, goat, cattle and pigs. However, there is very little information on these diseases in the agouti (Dasyprocta leporina). The agouti is used for its meat in South America and the Caribbean. More recently, intensive farming of this animal is being practiced in the Neotropics. There is dearth of information on dystocia and vaginal prolapses in the agouti. This document reports on three cases of reproductive diseases in captive reared agoutis in Trinidad and Tobago. The first case was a female agouti weighing approximately 3 kg that was in the last stage of pregnancy, which was found dead in its cage. The vulva of the mother had the protruding hind-limbs of the fetus. Necroscopic evaluation of carcass revealed little fat tissue and the mother had two fetuses in the right horn of the uterus. Each fetus weighed approximately 200 g. The fetuses were well formed with fur, teeth and eyes. The placenta was attached to each fetus. The pathological findings suggested that dystocia resulted from secondary uterine inertia which was the cause of death of the adult female agouti. The second case was that of an adult female agouti weighing 2.5 kg. This female had given birth to an offspring three weeks prior and was observed to have had a vaginal prolapse. Surgery was performed and the prolapsed vagina was placed back into the pelvic cavity. Further to this intervention, the vagina prolapsed twice. Subsequent to the re-insertion of the vaginal tissue the agouti was euthanized. The third case was also that of a dystocia. However, the fetuses weighed 235 g and 165 g respectively and were in normalpresentation, posture and positioning. The fetus however was unable to pass via the vagina and was trapped in the pelvic cavity. This caused secondary uterine inertia which was the cause of death. The causes of reproductive diseases in these cases are unknown but the feeding [...].

As doenças reprodutivas têm sido bem documentadas em rebanhos domésticos, como ovinos, caprinos, bovinos e suínos. Porém, há muito pouca informação sobre essas doenças na cutia (Dasyprocta leporina). A cutia é usada como carne na América do Sul e no Caribe. Mais recentemente, a criação intensiva desse animal está sendo praticada na região neotropical. Há escassez de informações sobre distocia e prolapsos vaginais na cutia. Este documento relata três casos de doenças reprodutivas em cutias criadas em cativeiro em Trinidad e Tobago. O primeiro caso foi de uma cutia de aproximadamente 3 kg que estava na última fase de gestação, encontrada morta em sua gaiola. A vulva da mãe tinha as patas traseiras salientes do feto. A avaliação necroscópica da carcaça revelou pouco tecido adiposo e a mãe tinha dois fetos no corno direito do útero. Cada feto pesava aproximadamente 200 g. Os fetos eram bem formados com pelos, dentes e olhos. A placenta foi presa a cada feto. Os achados patológicos sugeriram que a distocia resultou de inércia uterina secundária, que foi a causa da morte da cutia adulta. O segundo caso foi ode uma cutia adulta pesando 2,5 kg. Essa fêmea deu à luz uma cria três semanas antes e foi observado que tinha prolapso vaginal. A cirurgia foi realizada e a vagina prolapsada foi colocada de volta na cavidade pélvica. Após essa intervenção, a vagina prolapsou duas vezes. Após a reinserção do tecido vaginal, a cutia foi eutanasiada. O terceiro caso também foi de distocia. No entanto, os fetos pesavam 235 g e 165 g e estavam em apresentação, postura e posicionamento normais. O feto, entretanto, não conseguiu passar pela vagina e ficou preso na cavidade pélvica. Isso causou inércia uterina secundária, que foi a causa da morte. As causas das doenças reprodutivas nesses casos são desconhecidas, mas o manejo da alimentação e o espaço concedido à cutia no final da gestação podem ser fatores contribuintes.

Reproductive diseases in captive Agoutis (Dasyprocta leporina)

Abstract Reproductive diseases have been well documented in domestic livestock such as sheep, goat, cattle and pigs. However, there is very little information on these diseases in the agouti (Dasyprocta leporina). The agouti is used for its meat in South America and the Caribbean. More recently, intensive farming of this animal is being practiced in the Neotropics. There is dearth of information on dystocia and vaginal prolapses in the agouti. This document reports on three cases of reproductive diseases in captive reared agoutis in Trinidad and Tobago. The first case was a female agouti weighing approximately 3 kg that was in the last stage of pregnancy, which was found dead in its cage. The vulva of the mother had the protruding hind-limbs of the fetus. Necroscopic evaluation of carcass revealed little fat tissue and the mother had two fetuses in the right horn of the uterus. Each fetus weighed approximately 200 g. The fetuses were well formed with fur, teeth and eyes. The placenta was attached to each fetus. The pathological findings suggested that dystocia resulted from secondary uterine inertia which was the cause of death of the adult female agouti. The second case was that of an adult female agouti weighing 2.5 kg. This female had given birth to an offspring three weeks prior and was observed to have had a vaginal prolapse. Surgery was performed and the prolapsed vagina was placed back into the pelvic cavity. Further to this intervention, the vagina prolapsed twice. Subsequent to the re-insertion of the vaginal tissue the agouti was euthanized. The third case was also that of a dystocia. However, the fetuses weighed 235 g and 165 g respectively and were in normal presentation, posture and positioning. The fetus however was unable to pass via the vagina and was trapped in the pelvic cavity. This caused secondary uterine inertia which was the cause of death. The causes of reproductive diseases in these cases are unknown but the feeding management and space allowance given to the agouti in late gestation may be contributing factors.

Resumo As doenças reprodutivas têm sido bem documentadas em rebanhos domésticos, como ovinos, caprinos, bovinos e suínos. Porém, há muito pouca informação sobre essas doenças na cutia (Dasyprocta leporina). A cutia é usada como carne na América do Sul e no Caribe. Mais recentemente, a criação intensiva desse animal está sendo praticada na região neotropical., Há escassez de informações sobre distocia e prolapsos vaginais na cutia. Este documento relata três casos de doenças reprodutivas em cutias criadas em cativeiro em Trinidad e Tobago. O primeiro caso foi de uma cutia de aproximadamente 3 kg que estava na última fase de gestação, encontrada morta em sua gaiola. A vulva da mãe tinha as patas traseiras salientes do feto. A avaliação necroscópica da carcaça revelou pouco tecido adiposo e a mãe tinha dois fetos no corno direito do útero. Cada feto pesava aproximadamente 200 g. Os fetos eram bem formados com pelos, dentes e olhos. A placenta foi presa a cada feto. Os achados patológicos sugeriram que a distocia resultou de inércia uterina secundária, que foi a causa da morte da cutia adulta. O segundo caso foi o de uma cutia adulta pesando 2,5 kg. Essa fêmea deu à luz uma cria três semanas antes e foi observado que tinha prolapso vaginal., A cirurgia foi realizada e a vagina prolapsada foi colocada de volta na cavidade pélvica. Após essa intervenção, a vagina prolapsou duas vezes. Após a reinserção do tecido vaginal, a cutia foi eutanasiada. O terceiro caso também foi de distocia. No entanto, os fetos pesavam 235 g e 165 g e estavam em apresentação, postura e posicionamento normais. O feto, entretanto, não conseguiu passar pela vagina e ficou preso na cavidade pélvica. Isso causou inércia uterina secundária, que foi a causa da morte. As causas das doenças reprodutivas nesses casos são desconhecidas, mas o manejo da alimentação e o espaço concedido à cutia no final da gestação podem ser fatores contribuintes.

Successful Uterine Detorsion and its Therapeutic Management in a Doe

The present case describes successful uterine detorsion and its therapeutic management in a non-descript goat.

Dystocia due to Twin Fetus in Bovine: A case report

A nondescript cattle was reported to dystocia with twin foetus that cause the impaction of maternal pelvis, after lubrication and obstetrical procedure per vaginal both fetus was expelled live with no complication.

Fascitis necrotizante por Enterococcus gallinarum en una puérpera. Presentación de un caso / Necrotizing fasciitis due to Enterococcus gallinarum in a pospartum patient. Case report

RESUMEN Fundamento: La fascitis necrotizante es una infección que se desarrolla de manera rápida, afecta la piel, tejido celular subcutáneo, fascia superficial y en ocasiones la profunda, en heridas quirúrgicas al producir necrosis hística y severa toxicidad sistémica. Es una afectación sistémica acompañante, que a su vez a ella se asocian factores predisponentes endógenos como: diabetes mellitus, obesidad, alcoholismo, infección por VIH, y exógenos: cirugía ginecobstétrica, inyecciones, traumatismos; por lo que estos pacientes resultan ser enfermos críticos en las unidades de cuidados intensivos, con un curso clínico no uniforme, al llevar a una evolución fulminante cuando corresponde con la variante hiperaguda o fulminante. Objetivo: Describir la presencia de fascitis necrotizante hiperaguda causada por Enterococcus gallinarum, en una puérpera. Reporte de caso: Puérpera que se le practicó parto distócico por cesárea electiva a las 38.3 semanas, a las 24 h presentó manifestaciones generales que se acompañaron de lesiones en la piel; se le realizó cirugía ginecobstétrica, su evolución fue tórpida y falleció por fallo multiorgánico a los 3 días debido a las consecuencias de fascitis necrotizante hiperaguda o fulminante, causada esta por un Enterococcus gallinarum. Conclusiones: La fascitis necrotizante es una enfermedad poco frecuente y mortal si no se trata a tiempo; su diagnóstico resulta difícil en su fase inicial, debido a que casi siempre es clínico. El tratamiento quirúrgico debe ser urgente, combinarse este con antibióticoterapia sistémica, debido al germen causal y la toxicidad que producen.

ABSTRACT Background: Necrotizing fasciitis is an infection that develops rapidly, affecting the skin, subcutaneous cellular tissue, superficial fascia and sometimes deep fascia, in surgical wounds by producing hystenotic necrosis and severe systemic toxicity. It is a supplementary systemic affectation, which in turn is associated with endogenous predisposing factors such as: diabetes mellitus, obesity, alcoholism, HIV infection, and exogenous: gynecobstetric surgery, injections, traumatisms; so these patients are critical patients in intensive care units, with a non-uniform clinical progression, leading to a fulminant evolution when parallel to the hyperacute or fulminant variant. Objective: To describe the presence of hyperacute necrotizing fasciitis caused by Enterococcus gallinarum in a puerperal. Case report: A puerperal who suffered from dystocia delivery by elective cesarean section at 38.3 weeks, at 24 h presented general manifestations accompanied by skin lesions; she underwent gynecobstetric surgery, her evolution was torpid and she died of multiorgan failure after 3 days due to the consequences of hyperacute or fulminant necrotizing fasciitis, caused by Enterococcus gallinarum. Conclusions: Necrotizing fasciitis is a rare and fatal disease if not treated in time; its diagnosis is difficult in its early phase because it is often clinical. Surgical treatment should be urgent and combined with systemic antibiotic therapy due to the causative germ and the toxicity they produce.

Per-vaginal Management of a Fetal Ascites Intended Dystocia in a Cross Breed Cow: A Case Study

This article discussed about a case of per-vaginal management of dystocia in a cross breed cow due to fetal ascites cause. A 3.5 years old cross breed cow was presented at Mobile Veterinary Clinic, Gosaba Block, South 24 Paragans, West Bengal with a history of prolonged labor. The water bag was ruptured but there was no progression of parturition. Per-vaginal examination revealed that the cervix was completely dilated and the fetus was in anterior longitudinal presentation with an extremely distended abdomen. The case was diagnosed as dystocia due to fetal ascites. After epidural anesthesia, the abdominal wall of fetus was punctured with a fetotomy knife and about 5-7 liters of clear straw colored ascitic fluid was evacuated. Finally fetus was removed by gentle traction. Post operative therapy with antibiotics, analgesic, intravenous fluid and multivitamin successfully cured the animal.

Successful C-section of a Non-descriptive Goat to Relieve from Dystocia

Present case study was associated with successful management of a pregnant doe from dystocia by caesarean section. A 1.5 years old pregnant non-descriptive doe was admitted in the TVCC, C.V.A.Sc., Pantnagar, Uttarakhand with a history of complete gestation period and prolonged labor (more than 12 hours). There was protrusion of both fetal forelimbs from the vaginal opening. Gynaecological examination revealed that the fetus was in Nape presentation. The case was diagnosed as dystocia due to abnormal fetal disposition. The animal was subjected to caesarean operation. The operation was performed under light sedation with 0.1 ml of xylazine and regional inverted L- block was also done with 2% Lignocaine. An oblique incision was given at left flank and recovery of one dead male fetus occurred. Post-operative treatment was done with Inj. Amoxicillin-sulbactum @10 mg/kg intramuscularly, Inj. Tribivet® 5 ml intramuscularly, Inj. Chlorpheniramine maleate @0.5 mg/kg intramuscularly, Meloxicum@0.5 mg/kg intramuscularly and NS 250 ml for five days. Local antiseptic dressing and fly repellant spray was advised for every alternative day. The skin suture was removed on 10th day post-surgery.

Obstetric Paralysis: Who is to blame? A systematic literature review / Paralisia obstétrica: De quem é a culpa? Uma revisão sistemática de literatura

Abstract Obstetric palsy is classically defined as the brachial plexus injury due to shoulder dystocia or to maneuvers performed on difficult childbirths. In the last 2 decades, several studies have shown that half of the cases of Obstetric palsy are not associated with shoulder dystocia and have raised other possible etiologies for Obstetric palsy. The purpose of the present study is to collect data from literature reviews, classic articles, sentries, and evidence-based medicine to better understand the events involved in the occurrence of Obstetric palsy. A literature review was conducted in the search engine PubMed (MeSH - Medical Subject Headings) with the following keywords: shoulder dystocia and obstetric palsy, completely open, boundless regarding language or date. Later, the inclusion criterion was defined as revisions. A total of 21 review articles associated with the themes described were found until March 8, 2018. Faced with the best available evidence to date, it is well-demonstrated that Obstetric palsy occurs in uncomplicated deliveries and in cesarean deliveries, and there are multiple factors that can cause it, relativizing the responsibility of obstetricians, nurses, and midwives. The present study aims to break the paradigms that associate Obstetric palsy compulsorily with shoulder dystocia, and that its occurrence necessarily implies negligence, malpractice or recklessness of the team involved.

Resumo A paralisia obstétrica é classicamente definida como a lesão do plexo braquial decorrente da distócia de ombros ou das manobras executadas no parto difícil. Nas 2 últimas décadas, vários estudos comprovaram que metade dos casos de paralisia obstétrica não estão associados à distócia de ombros e levantaram outras possíveis etiologias para a paralisia obstétrica. O objetivo do presente trabalho é colher dados da literatura de revisão, artigos clássicos, sentinelas e da medicina baseada em evidências para compreender melhor os eventos envolvidos na ocorrência de paralisia obstétrica. Foi realizada uma revisão da literatura no motor de busca da PubMed (MeSH - Medical Subject Headings) com as seguintes palavras-chave: shoulder dystocia and obstetric palsy, completamente aberto, sem limites de língua ou data. Posteriormente, definimos como critério de inclusão artigos de revisão. Encontramos 21 artigos de revisão com associação dos temas descritos até 8 de março de 2018. Frente às melhores evidências existentes até o momento, está bem demonstrado que a paralisia obstétrica ocorre em partos não complicados e em partos cesáreos, e são múltiplos os fatores que podem causá-la, relativizando a responsabilidade de médicos obstetras, enfermeiras e parteiras. Procuramos, com o presente estudo, quebrar os paradigmas de que paralisia obstétrica se associa obrigatoriamente à distócia de ombros e que a sua ocorrência necessariamente implica em negligência, imperícia ou imprudência da equipe envolvida.

Maternal-fetal prognosis of obstetric emergencies at the maternity ward of the Mamou regional hospital

Background: Pregnant women may be at risk of unpredictable obstetric complications such as: bleeding, dystocia, acute fetal suffering, pre-eclampsia and eclampsia. This maternal-fetal prognosis of obstetric emergencies is influenced by factors that are most often related to complications that alter the course or outcome of a pregnancy and require prompt care. The objectives of this study are to analyze the factors that influence the maternal-fetal prognosis of obstetric emergencies; determine their frequency, describe the clinical profiles of patients and evaluate the maternal-fetal prognosis.Methods: The study was conducted at the Mamou Regional Hospital. It was a 6-month quantitative, descriptive and analytical study, from July 1st to December 31st, 2016, including all parturient women whose term is greater than or equal to 28 weeks of amenorrhoea.Results: The study covered 377 obstetric emergencies out of a total of 1273 deliveries, or 29.61%. Factors influencing the prognosis were: young age, parity, unfavorable socio-economic conditions and difficult baseline conditions. The main obstetric emergencies recorded were acute fetal suffering, disproportion and narrowed pelvis. The dominant mode of delivery was caesarean section with a frequency of 89.65%. Maternal lethality is 3.44% and fetal lethality is 5.14%.Conclusions: Obstetric emergency is a frequent situation where better management would improve the prognosis of the mother and fetus.

Breech presentation delivery care: A review of childbirth semiology, mechanism and care / Atención del parto con feto en presentación pelviana: revisión de la semiología, el mecanismo y la atención del parto

RESUMEN Objetivo: revisar los conceptos que subyacen al trabajo de parto con feto en presentación pelviana, su semiología y las maniobras obstétricas que facilitan un resultado materno perinatal exitoso. Materiales y métodos: a partir de un caso hipotético que ambienta de manera práctica el tema, se crea un documento explicativo construido a partir de una revisión narrativa, en donde se examinan los preceptos relacionados con el diagnóstico, el mecanismo del parto en presentación pelviana y el manejo intraparto de la gestante, con énfasis en la adecuada ejecución de las maniobras que facilitan la extracción fetal. Resultados: el parto en presentación pelviana debe ser atendido por vía vaginal cuando se encuentra en periodo expulsivo con encajamiento cumplido. Para su diagnóstico y atención es esencial hacer una adecuada identificación de la presentación, así como conocer su fisiología, la indicación y adecuada ejecución de las maniobras obstétricas que facilitan un parto sin complicaciones. Conclusiones: el mecanismo del parto en presentación pelviana es complejo y requiere, cuando no hay otra alternativa para la atención, que tanto el obstetra como el médico general conozcan su fisiología y las múltiples maniobras obstétricas que facilitan obtener buen resultado materno perinatal.

ABSTRACT Objective: To review the concepts underlying breech presentation delivery as well as the semiology and the obstetric maneuvers contributing to a successful perinatal maternal outcome. Materials and methods: Based on a hypothetical scenario to set the stage for a practical approach to the topic, an explanatory paper built on a narrative review is created in order to examine the principles related to diagnosis, mechanism of delivery and maternal care, emphasizing maneuvers to ease fetal extraction. Results: Breech presentation delivery must be managed through the vaginal canal when already in the expulsion phase with fetal engagement. For diagnosis and care, it is essential to know the unique semiology and physiology of this condition as well as the obstetric maneuvers to facilitate an uncomplicated delivery. Conclusions: The mechanism of childbirth in breech presentation is complex and requires knowledge of its physiology and multiple obstetric maneuvers on the part of the obstetrician as well as the general practitioner, in order to ensure adequate care when there is no other option.