fetal loss in ap syndrome placental spiral arteries narrowing intimal thickening acute...
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Fetal Loss in
AP Syndrome
Placental Spiral ArteriesNarrowing
Intimal thickeningAcute Atherosclerosis
Fibrinoid Necrosis
Normal:Dilated Lumen
Fenestrated EndotheliumAbsent muscularis
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Definition: ‘Complete 360 degree spiral course of umbilical vessels around Wharton jelly’
UCI = Total coils / length of cordStudied by USGNo coiling: 5-6% - Hypocoil: UCI <10th Centile – Hypercoil: UCI: >90th Centile
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UCI: indicator of AN / PN Outcome
Hypocoil predicts PIH – IUGR – Fetal Distress (FH Deceleration) – Low apgar – Meconium stain – Chorioamnionitis – Fetal Death
Pointed out by Edmonds 1954 & Lacro 1987Revisited by Strong et al 1994
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Meta analysis: IUD – Meconium stain – PIH – IUGR - Operative intervention -De Laat et al 2005 Performed alongside Doppler in 2nd Trimester: ‘Best single factor to predict SFD babies’
Sensitivity 79% - Specificity 86% - Pos Pred Value 72% - Neg Pred value 90% - J ultrasound 2001
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Revision of Distance betweenBlades
Improvement in Locking System
Soft Blades with Rubber coating
Fabrication with Lighter Polymers
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• Forceps Blades coated with soft Rubber• RCT: 96 Deliveries ( 51 Soft forceps / 45
Traditional forceps )• Severe Facial Abrasions: 1.9% vs 4.1%• Minimal Marking: 34% vs 61%• Conclusion: better but needs improvement
- Roshan DF et al Int J ObG March 2005
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Computer enhanced Isometric Strength
Testing Unit
Leslie KL et al: Original ResearchObG 2005
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FINDINGS:*Useful tool for Forceps Training*On simulation most candidates used force above preferred range of>45 lbs without Visual Feed back*Improved on Acquisition Trial*Force exerted while Sitting wasMore than while Standing *Males used more Force than females
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John Hopkins Team
Least Forceful way to deliver Baby withShoulder Dystocia
3D Bony Pelvis – Flexible legs – Fetal Mannequin – Mock Uterus withPneumatic Pump – Force sensing Glovesto measure Traction Force – ComputerBased data acquisition system
- Allen et al Am J ObG Jan 2005
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Comparison of Rubin’s, Wood screw & Mc Robert’s
Least Force:R: 6.5 WS: 8.5 McR: 16 lbsStretch of Brachial plexus:R:2.9 WS: 6.9 McR: 7.3 cmExtra space under S Pubis:R & WS: 2cm McR: 1 cm
Rubin’s Technique whereAnterior shoulder is rotated& Fetal spine comesAnterior is the Best!
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Incidence in USA:16% (Adult 30%)3-fold Increase in 20 yearsWeight Gain recommended during Pregnancy: 11.5 – 16 Kg IOM-US10 – 12.5 Kg WHOExcess Weight Gain associated with Obesity in child at 3 yearsStudy of 770 mothers byGilman of Harvard Medical School & 1,90,000 families by Sharma of CDC, Atlanta
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CLOSURE OF PERITONEUMAt Caesarean Section
Cohort study of 173 casesClosure Vs Non closure:Adhesions: 52% vs 73%
Dense Adhesions: 30% vs 45%Conclusion:
Closure protects 5-fold against allAdhesions & 3-fold against dense
AdhesionsPractice of Non closure must be
Questioned?Lyell et al Original Research-
J ObG 2005
RCT: Absorbable Staples for closure of Uterine incision at LSCSStaples made of Copolymer (Polylactic+Polyglycolic acid)
Reduces Op time/Trauma/Blood loss/PO MorbidityAcceptable alternative
Hoskins et al Surg Ob Gyn 1991
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US National Academy of SciencesDeveloped Guidelines for ResearchOn Embryonic Stem cells in April ‘05In the section entitled ‘Inter Species Mixing”Authors concluded that there are valid reasons for creating Chimeras – Living entities composed of both Human & Animal cells!
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French surgeonsDubernard & Devauchelle
French Girl whose Face was mutilated by Dog bite
Finding Recipients easy!But finding dead donors difficult!
Involves challenging intricateSurgery & Immune suppressing drugs
Raises many Ethical issues
How would you like to live with Another person’s Face?
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Katie Holmes
Bought an Ultrasound MachineTo have a peek at his Baby!
Am U/S Society has raisedObjections & Questions the Wisdom of untrained personsPlaying with special equipment!
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