Breastfeeding Conjoined Twins

The breastfeeding experience of a mother and her preterm conjoined twins is described. Assisting the mother in achieving her breastfeeding goal presented unusual nursing-care problems in securing, positioning, and comforting the twins. This case report emphasizes the individualized support provided to this mother and her infants, which was a critical factor in their breastfeeding success.     

Triplets with Conjoined Twins: A Nigerian Midwife's Case Report

This article is a case report of a spontaneous vaginal delivery of live triplets, which included conjoined twins joined at the buttocks. The birth was conducted by an experienced midwife in a rural maternity in the Anambra State of Nigeria. The case illustrates the difficulties faced by rural Nigerian midwives when patients need referral to larger hospitals. There is a scarcity of diagnostic equipment, medical back-up, and the transportation that could facilitate an effective referral network. In addition, patients are reluctant to leave their home villages to give birth in a far-away hospital. For these reasons, many difficult births take place in rural maternity centers. The successful outcome of this high-risk delivery demonstrates the skill of the local Nigerian midwife, who is frequently faced with unusual complications of childbirth, ones that she must resolve herself.     

Breastfeeding Twins: Guidelines for Success

Background: Although the frequency of twin births has increased in Japan, little information is available about breastfeeding twins. An intervention of breastfeeding support was implemented to promote breastfeeding for mothers of twins and to compare the factors related to breastfed and formula-fed twins. Methods: Eleven Japanese twins-mother pairs received breastfeeding support according to a breastfeeding protocol for twins, and a control group of seven pairs received routine care. Perinatal data were obtained from clinical records for analysis. Results: No significant differences were evident between the two groups in terms of maternal age, gestational age, birthweight, the age at which breastfeeding was initiated, amount of supplementary feeding in hospital, infants' age at discharge, or duration of mothers' hospital stay. At age 3 months, 13 infants in the intervention group were being exclusively breastfed and 9 were almost exclusively breastfed. In the control group 4 infants were almost exclusively and 10 were exclusively formula-fed. The mothers in the intervention group breastfed and expressed milk significantly more frequently than the mothers in the control group during their hospital stay. Conclusions: Mothers of twins face many obstacles in breastfeeding, and health care professionals should offer individualized care and support.     

Breastfeeding Twins and Higher-order Multiples

The benefits of breastfeeding for pre-term and full-term infants are well documented. Breastfeeding facilitates maternal-infant attachment, provides optimal infant nutrition and immunologic protection, and minimizes economic impact. These benefits are multiplied with twins and higher-order multiples, who often are born at risk. Supporting a mother as she initiates and continues to breastfeed one infant requires specific knowledge and skills. Health professionals need additional knowledge and skills if they are to provide appropriate assessment, intervention, and support when a mother breastfeeds twins or higher-order multiples.     

Case Report: Dicephalus Dipus Dibrachius Conjoined Twins Diagnosed Prenatally

In this article, a case of dicephalus dipus dibrachius conjoined twins diagnosed by ultrasonography at the 21st week of gestation, which is the rarest form of symmetrical conjoined twins, is presented. Prenatal ultrasonographic diagnosis criteria of conjoined twins are reviewed.     

Breastfeeding Success With Preterm Quadruplets

Although the incidence of triplet and quadruplet birth has increased in the United States, few research-based guidelines are available for assisting mothers of these multiple births with breastfeeding. The purpose of this case study is to report a successful breastfeeding experience of a mother with preterm quadruplets. The quadruplets were born by cesarean delivery at 34 weeks' gestation and weighed from 1,820 g to 2,240 g. In-hospital breastfeeding experiences were managed by the authors, according to research-based guidelines for breastfeeding preterm neonates and infants. During the first month after discharge of the four newborns, the mother breastfed 12-34 times daily. Mean daily weight gains for the quadruplets during this time varied from 30 g to 54 g, indicative of adequate maternal milk supply. Nurses in maternity and neonatal specialties can apply the findings from this study to similar cases of mothers who want to breastfeed multiple neonates or infants.     

Mode Of Delivery Of Preterm Twins

At one high-risk perinatal centre over a 9-year period, 83.1% (103/124) sets of liveborn twins with gestational ages less than 33 weeks were delivered vaginally. Mortality in vaginal births was 26.7% (55/206), almost double that of Caesarean births of 14.3% (6/42), a non-significant difference. When gestational age discrepancies were corrected, however, the trend favouring survival of Caesarean births disappeared. Furthermore, there were no significant associations between mode of delivery and the condition of the infants at birth, or the presence of respiratory distress in the nursery. Because Caesarean section carries substantial risks for the mother our practice of predominantly vaginal deliveries for preterm twins should continue.     

Getting Enough: Mothers' Concerns About Breastfeeding a Preterm Infant After Discharge

Objective : To describe maternal concerns about breastfeeding a preterm infant in the postdischarge period and to delineate the strategies mothers used in managing these concerns.
Design : Naturalistic inquiry was used.
Setting : A semistructured interview was conducted with the mother in the home 1 month after discharge of the infant.
Participants : Twenty mothers of preterm infants; the infants had been in a level 3 hospital nursery, and the mothers had received individualized breastfeeding support services in the hospital.
Main outcome measures : Three categories of maternal concerns emerged from the data: adequate milk consumption by infants; milk composition; and problems with the mechanics of breastfeeding a preterm infant. Mothers identified strategies for these concerns.
Results : The mothers' main concern was whether infants consumed an adequate volume of milk by breastfeeding alone. Strategies for managing concerns about getting enough included using supplemental and complemental feedings, using ongoing cues to tell that the infant is getting enough, and persevering with breastfeeding.
Conclusions : Mothers of preterm infants have unique concerns about breastfeeding in the postdischarge period and need individualized interventions.     

Transitioning Preterm Infants With Nasogastric Tube Supplementation: Increased Likelihood of Breastfeeding

OBJECTIVE: To compare nasogastric tube and bottle supplementation as two means of transitioning preterm infants to breastfeeding within an established breastfeeding support program. DESIGN: Prospective, randomized controlled trial; mothers and health care providers, who were not blinded. SETTING: Metropolitan private regional perinatal center; 40-bed intensive-care nursery. PARTICIPANTS: Eighty-four preterm breastfed infants whose birth weight was 1,000-2,500 g. MAIN OUTCOME MEASURES: Rates of exclusive and partial breastfeeding at discharge from the intensive-care nursery, and at 3 days, 3 months, and 6 months after discharge. RESULTS: Compared with infants receiving bottle supplements, infants receiving nasogastric tube supplements were more likely to be breastfeeding at discharge and at 3 days, 3 months and 6 months, after adjusting for confounding variables. Odds ratios (confidence intervals = 95%) showed that the group receiving nasogastric supplements was 4.5 times (1.4 to 15) more likely to be breastfed at discharge and 9.4 times more likely to be fully breastfed (3.1 to 28.4). There were significantly fewer apnea and bradycardia episodes in the group receiving nasogastric supplements, although they had more episodes that required stimulation for resolution. Groups were not different with respect to length of hospitalization and infant weight at discharge. CONCLUSIONS: Using nasogastric tube supplementation during transition to oral feedings increases the likelihood of breastfeeding at discharge, 3 days, 3 months, and 6 months. This intervention requires a program with skilled personnel and an environment that allows the mother and infant to be in close physical proximity. Further study should investigate differences in the effects on maternal confidence, imprinting, and suck mechanism when preterm infants are bottle fed and breastfed.     

Establishing Breastfeeding with the Late Preterm Infant in the NICU

ObjectiveTo describe challenges that late preterm infants (LPIs) face with breastfeeding and to provide an overview of current policy statements and practice guidelines that support breastfeeding for LPIs. In addition, we describe current breastfeeding research related to the LPI and combine this research with policies and practice guidelines to provide evidence‐based recommendations to guide practice and future research in the NICU.Data SourcesCumulative Index to Nursing and Allied Health Literature and PubMed databases.Study SelectionPolicies, guidelines, and research relevant to breastfeeding the LPI were selected if they were published between January 1, 2009 and March 1, 2014. All documents were published in English and related to breastfeeding management or breastfeeding outcomes for the LPI.Data ExtractionInformation from articles, policies, and guidelines were chosen for their relevance to breastfeeding the LPI.Data SynthesisPolicy statements and practice guidelines were reviewed to provide an understanding of breastfeeding recommendations for the LPI. Additionally, recent research studies were reviewed and combined with the policy statements and practice guidelines to provide practice recommendations for NICU providers.ConclusionsLPIs require a unique set of interventions for breastfeeding success; though they might be perceived as small, full‐term infants, these infants often have greater challenges with breastfeeding than their term counterparts. Future research should be directed at identifying and testing specific strategies that will best support this at‐risk population. Findings from this article are applicable for the LPI in the NICU as well as other care areas such as special care and transitional nurseries.     

Physiologic Breastfeeding: A Contemporary Approach to Breastfeeding Initiation

Early initiation of breastfeeding has numerous benefits for maternal‐child health. Maternity care providers have been shown to play a significant role in establishing breastfeeding, yet there is limited research about clinical approaches that support breastfeeding initiation in the immediate postpartum. Traditional methods that focused on position and attachment have not demonstrated consistent, positive effects on breastfeeding outcomes. Contemporary approaches to breastfeeding initiation emphasize innate maternal and neonatal breastfeeding abilities and the importance of breastfeeding self‐efficacy, dyad‐centered care, and a supportive breastfeeding environment free from unnecessary interventions. Recommendations for clinical practice for physiologic breastfeeding initiation are provided.     

腹腔弥漫型平滑肌瘤病一例

腹腔弥漫型平滑肌瘤病是一种罕见的特殊类型子宫平滑肌瘤,目前,其发病机制尚不明确,发病率极低,误诊率较高。报道山东大学附属省立医院2021年收治的1例腹腔弥漫型平滑肌瘤病患者,该患者以月经频发伴经量增多为首发症状,术前未明确诊断为腹腔弥漫型平滑肌瘤病,相关辅助检查也无明确指征,术中探查可见多枚平滑肌瘤样结节弥漫生长于腹腔。腹腔弥漫型平滑肌瘤病的病灶可弥漫分布于盆腹腔多器官表面,肉眼较难与腹膜转移癌或胃肠道间质肿瘤相鉴别。另外,在临床表现上,症状多与病灶种植位置有关,无特异性表现。在实际临床实践中,术前检出率极低,为降低误诊率,应对有多次子宫平滑肌瘤复发病史、腹腔镜碎瘤史的患者提高警惕,必要时行盆腹腔磁共振成像完善术前检查。     

Retroperitoneal Ectopic Pregnancy: A Case Report

A retroperitoneal ectopic pregnancy is an extremely rare type of ectopic pregnancy and is difficult to diagnose and treat. Owing to its occult onset, it is life-threatening and often associated with high mortality. A 28-year-old woman was admitted to the emergency department of our hospital owing to soreness of the left lower quadrant of the abdomen and amenorrhea for 60 days. Dilatation and curettage were performed at a local hospital to induce abortion, but no gestational sac was found. Elevated plasma human chorionic gonadotropin levels suggested an ectopic pregnancy. An ultrasound showed an approximately 4.0 cm × 3.0 cm mass in front of the middle and upper poles of the left kidney. The plasma beta–human chorionic gonadotropin level was 99 286.00 mIU/mL. Under laparoscopy, an ovoid mass measuring approximately 4.0 cm × 5.0 cm below the left renal vessels and the abdominal aorta was successfully resected. Methotrexate (50 mg/m²) was locally injected, and the retroperitoneum was sutured. Villi were observed in histopathologic sections. This case report highlights the importance of considering the possibility of a retroperitoneal ectopic pregnancy for patients with abdominal pain. Laparoscopic surgery by an experienced surgeon is the preferred method of treatment for this condition.     

Occult Vaginal Evisceration: A Case Report

BackgroundVaginal evisceration is a rare gynaecologic emergency that necessitates surgical intervention. It may manifest with obvious vaginal rupture, or it may be occult, specifically in patients with chronic pelvic organ prolapse.CaseA 66-year-old woman with a history of bowel cancer and irradiation presented with occult vaginal evisceration. This was discovered during a routine follow-up appointment. It was repaired in two layers with xenograft derived from porcine intestinal mucosa (Surgisis, Cook Medical, Bloomington, IN) interposition and a concomitant colpocleisis. Long-term complications of the procedure included recurrent prolapse, but her vaginal vault evisceration did not recur.ConclusionIn patients with chronic pelvic organ prolapse, especially in those with additional risk factors for poor tissue strength, the possibility of vaginal vault evisceration or dehiscence should be considered. These patients would benefit from close follow-up.