Introduction: Ex-utero intrapartum treatment has been established as an option for fetal and perinatal surgeons to deliver patients with sacrococcygeal teratomas (SCTs) which are causing significant fetal distress and possible in-utero fetal demise. However, ex-utero intrapartum treatment procedures carry significant maternal risk and morbidity. Herein, we report an alternative technique of Cesarean section to immediate resection (CSIR) for managing high-risk SCTs.
Methods: A retrospective institutional review board-approved review was performed on all SCTs evaluated at our fetal center from May 2014 to September 2020. Demographics; prenatal imaging characteristics; prenatal interventions; and postnatal surgery data including operative time, estimated blood loss, pathology, and outcomes were collected. Outcomes of interest included surveillance serum alpha-fetoprotein levels, imaging surveillance, developmental milestones, and the presence or absence of constipation or fecal incontinence.
Results: A total of 20 patients with prenatal diagnosis of SCT were evaluated. Mothers who transferred their care to another institution after diagnosis were excluded from this study. Twelve neonates underwent standard postnatal resection. Three neonates underwent emergent CSIR for high output cardiac failure, fetal anemia, or concerns for in-utero hemorrhagic rupture. The median (interquartile range) operative time was 231.5 (113) minutes for the standard operative group versus 156 min in the CSIR group. We present three patients who underwent immediate resection after emergent Cesarean section. We report 100% survival for the three consecutive cases.
Conclusions: CSIR is a safe and feasible approach for managing appropriately selected high-risk SCTs with signs of hydrops, fetal distress, or fetal anemia. Despite patient prematurity, we demonstrated 100% survival of three consecutive cases. We suggest that CSIR be considered an option in the management algorithm for high-risk SCTs.
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http://dx.doi.org/10.1016/j.jss.2023.07.021 | DOI Listing |
JAMA Netw Open
December 2024
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Importance: Access to appropriate postpartum care is essential for improving maternal health outcomes and promoting maternal health equity.
Objective: To analyze the impact of the Nurse-Family Partnership (NFP) home visiting program on use of routine and emergency postpartum care.
Design, Setting, And Participants: This study was a secondary analysis of a randomized clinical trial that enrolled eligible participants between 2016 and 2020 to receive NFP or usual care from a South Carolina Medicaid program.
Cureus
November 2024
Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA.
Background: Atrial fibrillation (AF) is rare during pregnancy and current data on the impact of AF during delivery is scarce. In this study, we aim to analyze the impact of AF in patients who underwent delivery via cesarean section (CS), natural spontaneous delivery (NSD), or instrumental delivery (ID).
Methods: This study analyzed discharge data from the National Inpatient Sample (NIS) from 2016 to 2020.
Proc (Bayl Univ Med Cent)
October 2024
Department of Anesthesiology, Baylor Scott & White Medical Center - Temple, Temple, Texas, USA.
Background: We hypothesized that patients who received a lower dose of intrathecal morphine (ITM) would have higher postoperative opioid consumption following cesarean delivery.
Methods: Patients who had cesarean deliveries from February 15, 2022, through February 14, 2024 at Baylor Scott & White Medical Center - Temple with single injection spinal or combined spinal epidural anesthesia who did not have labor epidural anesthesia were included. Morphine milligram equivalent (MME) opioid consumption in the first 24 postoperative hours was recorded along with patient demographic, physical, and clinical characteristics.
J Perinat Med
December 2024
Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany.
Objectives: Planning the mode of delivery of a full-term breech singleton remains a challenging task. The aim of this work is to compare the neonatal and maternal short-term outcomes after planned vaginal delivery and caesarean section and to evaluate the influence of an MRI pelvimetry on the short-term outcomes in order to provide appropriate advice to pregnant women with breech presentation.
Methods: This is a retrospective monocentric analysis of all deliveries with singleton pregnancies from breech presentation >36 + 0 weeks of gestation between 08/2021 and 09/2023.
Int J Gynaecol Obstet
December 2024
Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Objective: To compare adverse neonatal outcomes between trial of vaginal delivery and upfront cesarean delivery for singleton infants born at 24 to 28 weeks of gestation.
Methods: This is a retrospective cohort study that was conducted at a university-affiliated tertiary medical center between 2011 and 2022, involving singleton pregnancies delivered between 24 and 27 weeks of gestation. Participants were divided into two groups based on their intended mode of delivery: a trial of labor (TOL) group and an upfront cesarean delivery (CD) group.
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