Objective The objective of this study was to report a multicentric study of nine cases of children presenting with a birth-related spinal
injury.
Materials and methods The medical charts of nine patients identified by a questionnaire sent to the members of the French Society of Paediatric
Orthopaedics (SOFOP) were reviewed.
Conclusions The pregnancy was uneventful in all cases. The fetal presentation was cephalic in three cases, a breech presentation in four
cases, a face presentation in two cases. The lesion involved the cervical spine in six cases. Three patients presenting upper
cervical injuries died before the age of 6 years. The six remaining patients experienced no neurological improvement. These
rare conditions occur during difficult deliveries with abnormal presentations, the most common being a breech presentation
with entrapment of the fetal head. In a child with hypotonia, flaccid quadriplegia or high thoracic paraplegia after a difficult
delivery, a spinal cord injury must be suspected and plain radiographs and magnetic resonance imaging (MRI) must be performed. 相似文献
Of 247 women who were pregnant of one healthy child in breech presentation at term, 13 (5.3%) were delivered by a primary cesarean section. The other 234 (94.7%) were allowed to attempt vaginal birth. In these women, the only factor to determine the possibility of a vaginal delivery was normal progression of labor during the first stage, without secondary arrest or signs of fetal distress. 109 Women (44.1%) were delivered spontaneously according to Bracht, 87 (35.2%) had an assisted breech delivery, and 38 (15.4%) underwent a secondary cesarean section. There were two perinatal deaths (0.8%). One of them was directly related to the trial of labor. Two children with a birth trauma had an uneventful recovery. The 1 min Apgar score in all breech delivery groups was more often lower than in a control group of children, who were born spontaneously at term in vertex presentation. However, the 5 min Apgar score and the mean umbilical artery pH were within normal limits in all groups. The secondary cesarean section rate was inversely related to vaginal parity of the mother, and directly related to the newborns' birth weight. There was no relation between the secondary cesarean section rate and the type of breech presentation. It is concluded, that a trial of labor in carefully selected patients with a child in breech presentation at term is a safe procedure, that can be successfully completed in almost 80% of cases. In retrospect, low vaginal parity and high birth weight of the newborn have a negative influence on normal progression of labor. 相似文献
Objective: Though on average one out of every two external cephalic versions (ECV) fails to rotate the breech fetus, little is known about the outcomes of pregnancies in which ECV is unsuccessful. The objective of the present study is to compare obstetrical and neonatal outcomes following failure of ECV, relative to cases of breech controls without an attempt at ECV.
Study design: We conducted a retrospective, population-based, cohort study using the CDC's Birth Data files from the US for the year 2006. We stratified the cohort according to fetal presentation and ECV status: success, failure, and no ECV (controls). The effect of failure of ECV on the risk of several neonatal and obstetrical outcomes was estimated using logistic regression analysis, adjusting for relevant confounders.
Results: We analyzed a total of 4?273?225 births, out of which 183?323 (4.3%) met inclusion criteria. Relative to breech controls, failed ECV occurred more frequently amongst Caucasian, college-educated, married women bearing a female fetus. Compared to no ECV, failure of ECV was associated with increased odds of PROM (aOR, 1.75; 95% CI, 1.60–1.90), elective cesarean delivery (aOR, 1.53; 95% CI, 1.36–1.72), cesarean delivery in labor (aOR, 1.38; 95% CI, 1.21–1.57), abnormal fetal heart tracing (aOR, 1.78; 95% CI, 1.50–2.11), assisted ventilation at birth (aOR, 1.50; 95% CI, 1.27–1.78), 5-min APGAR scores <7 (aOR, 1.35; 95% CI, 1.20–1.51), and NICU admission (aOR, 1.48; 95% CI, 1.20–1.82). The delayed spontaneous fetal restitution rate was 13%. When stratifying controls with regards to trial of labor status, the increased risk of failed ECV persisted for cesarean delivery, NICU admission, assisted ventilation and abnormal fetal tracing, independently of whether a trial of labor took place.
Conclusion: Relative to breech controls without attempt at ECV, failure of ECV to restitute cephalic presentation appears to be associated with an increased risk of adverse perinatal and obstetrical outcomes. 相似文献
To review our incidence of developmental dysplasia of the hip (DDH) in breech infants referred for ultrasound screening and
to determine if subsequent follow-up radiographs are necessary in these patients with normal clinical and ultrasound examinations. 相似文献
The radiological approach of a child with severe cervical spinal cord injury after a difficult breech delivery is presented. This diagnosis is often missed due to concurrent asphyxia. Ultrasound studies clearly showed the localisation and the extent of the injury. These findings were later confirmed by MRI.Conclusion Ultrasonography is recommended as the initial imaging technique to evaluate possible spinal cord lesions in the neonate. 相似文献
To study the relation of method of delivery to perinatal mortality, we examined information from the deliveries of 1593 breech infants weighing 1000 g or more born in 1976 and 1977. In none of the birthweight groups 1000 g or more was neonatal mortality significantly different between infants delivered vaginally compared with those delivered by cesarean section, although the number of deaths was small. In all the birthweight groups, perinatal mortality was higher in breeches delivered vaginally, but the differences were because all of the infants who died before labor were delivered vaginally. Total mortality (intrapartum plus neonatal deaths) in infants who survived to labor was not significantly different in breech infants delivered by one or the other method at any birthweight. These data suggest that routine cesarean delivery for infants 1000 g or more who are in the breech presentation may not be justified from the standpoint of mortality. 相似文献
OBJECTIVES: To compare maternal and neonatal outcomes of planned vaginal delivery vs. elective cesarean delivery for breech presentation at term. METHODS: Retrospective study of term breech deliveries from January 1997 through December 2000. A group of 128 women for whom vaginal delivery was planned was compared with a group of 122 women who had an elective cesarean delivery with regard to neonatal mortality and morbidity (birth trauma, birth asphyxia, hyperbilirubinemia, and duration of stay in the neonatal intensive care unit) and maternal morbidity (infections, hemorrhage, hysterectomy, deep venous thrombosis, and pulmonary embolism). RESULTS: There was no difference in neonatal mortality and morbidity between the two groups (13.0% vs. 9.4%). There were fewer maternal complications in the planned vaginal group than in the elective cesarean group (5.5% vs. 18%; P<0.01). In the planned vaginal delivery group 70% of multiparas and 85% of grandmultiparas were delivered vaginally compared with 50% of nulliparas. CONCLUSIONS: In breech presentations at term vaginal delivery can be achieved in 85% of grandmultiparas without significant neonatal morbidity. Elective cesarean section is associated with increased maternal morbidity compared with planned vaginal delivery. 相似文献