Caesarean delivery injuries are on the rise, but training and equipment can help

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Newswise — More than 34% of Australian women give birth by caesarean section, and a significant proportion of those occur in late labor, when the fetal head is deep in the mother’s pelvis and can be impactful, so baby childbirth is difficult and poses serious risks for both parties. mother and baby.

It is estimated that about 10% of all emergency caesarean deliveries (CB) result in the baby’s head being in a condition known as an buried infant head (IFH). This makes it difficult for doctors to put their hands under the baby’s head during delivery, leading to longer delivery times.

Recent statistics indicate that the majority of newborns born after IFH are mildly injured, but 2% of these infants die or have lifelong severe injuries. increase. The UK NHS Resolutions Report states that 9% of preventable brain injuries at birth are caused by: Impacted infant head (IFH).

Complications for the mother include increased blood loss, increased risk of infection, damage to the bladder or urinary tract, a torn uterus that needs repair and can cause problems with subsequent pregnancies, and even a hysterectomy etc. Complications in babies include lacerations and bruises to the head and face, skull fractures and bleeding, but eye injuries have also been reported.

A paper on scientific impact has been published. BJOG: International Journal of Obstetrics and Gynecology A report by the Royal College of Obstetricians and Gynecologists and Professor Annette Briley of Flinders University has shown that there has been a significant increase in the number of cases of IFH injury in recent years, and obstetric staff have implemented a variety of approaches, but there is no clear definition or treatment. There is no agreement on training on management of Have a baby during CB.

Approaches to dealing with this obstetric emergency include pushing the baby’s head up with an assistant during birth, having the baby’s feet first, and an inflatable balloon device (fetal pillow) designed to elevate the baby’s head. ) and administering drugs to relax the mother’s womb.

However, this scientific impact paper reviews the available evidence and concludes that there is currently no consensus on the best approach for these dangerous cases.

Various techniques and some equipment have been introduced to assist in the delivery of babies in this situation, but it is up to the mother and baby to decide which one is best, or the needs of the staff managing this emergency. No training has been agreed to date.

Most commonly, an assistant is asked to do push-ups from below, but there is evidence to suggest that reverse tooth extraction may lead to better results. A survey across the UK reported that more than half of obstetric registrants were not confident in performing surgery on the inverted organ, and fewer than one in ten were familiar with the patwardhan technique. increase.

“The purpose of this scientific impact paper is to examine all currently available evidence for the various manipulations and instruments currently used to manage IFH and to present the results to the National Guidelines Alliance (UK). It was to integrate the results into a commissioned systematic review,” said study co-author Dr. Annette Briley, a midwife at Flinders University.

Researchers say important steps need to be taken to improve standards.

• High-quality RCTs with adequate competencies comparing techniques for managing and preventing IFH are needed. (Currently available have significant weaknesses.)
• A widely accepted definition of IFH will facilitate future research and teaching.
• Women and their partners should contribute information to research on language and management of IFH.
• Development and implementation of an evidence-based multidisciplinary educational package will lead to consistent management of this obstetric emergency.
• More research is needed on the effectiveness and cost-effectiveness of fetal pillows

Dr. Briley said the data clearly show a significant increase in the number of late-birth cesarean sections and associated IFH-related injury cases in recent years, and that consistent management of this obstetric emergency can be developed. said further education was needed.

“We review the existing evidence on strategies for identifying, preventing and managing IFH during childbirth and seek to improve outcomes for mothers and babies when this potentially serious complication occurs. We have provided guidance and recommendations, and it is imperative that clinicians use the best evidence to inform,” including the best techniques to reduce the potentially devastating complications associated with IFH. , provides care for women and infants. “

Dr. Briley is also part of the research team developing and evaluating the Tideman Tube, an innovative disposable hollow silicone tube that is inserted to lift a baby’s head. Designed to minimize pressure on the head and reduce suction effects once access is achieved.

“A minimal number of Teidemann tubes are used clinically. needs further research.”

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