Profound fetal anemia may cause anoxic lesions of the fetal brain that may be diagnosed prenatally. If new onset ventriculomegaly is observed on ultrasonography after in utero transfusion for severe fetal anemia, anoxic lesions could be suspected.
Most pregnancies after IUFD resulted in a live birth; however, adverse obstetric outcomes were more common when the previous stillbirth was due to placental causes.
Background:Neonates with severe hyperbilirubinaemia are at increased risk for neurological morbidity. Risk factors for early onset hyperbilirubinaemia include prematurity, red cell haemolysis and birth trauma. As most neonates are asymptomatic and clinical evaluation in detecting early jaundice limited, clinical practice guidelines at the Royal Women's Hospital recommend a serum bilirubin (SBR) level in the first 24 hours following birth for neonates <35 weeks' gestation. Our audit aims to describe the utility of SBR screening in this population.
AbstractMethod: Eligible neonates born between January and October 2015 were identified from the electronic database of the Royal Women's Hospital. Patient demographic data was collected and cross-referenced with the hospital's online pathology system.
Results:During the study period there were 432 eligible neonates. SBR samples were taken in 348 (80.7%) in the first 24 hours. These neonates had a median (range) gestation of 31.5 (24.1-34.6) weeks and birth weight 1503 (367-3686) grams. Samples were taken at a median (range) time of 12 (birth-24) hours. Phototherapy (PTx) was indicated in 29 (8.3%) and commenced in 19 (5.5%).
Conclusions:Routine SBR testing of neonates <35 weeks' gestation in the first 24-hours of age changes management in only 5% of neonates. Routine blood sampling appears unnecessary and the utility of alternative non-invasive means of measuring bilirubin in this high-risk population should be studied.
Hypothesis / aims of study To evaluate whether the use of a speculum blade modifies the evaluation of pelvic organ prolapse as assessed by dynamic MRI.Study design, materials and methods Women with POP-Q stage II or greater, who were due to undergo genital prolapse surgery, were evaluated using dynamic MRI. The procedure was repeated using the posterior blade of a standard plastic Grave's speculum to successively retract the anterior and posterior vaginal walls. Pelvic organ position, prolapsed compartments, and prolapse degree were evaluated according to the use of a speculum blade Results Twenty seven patients were enrolled in this pilot study. Standard POP-Q was 15% stage II, 59% stage III, and 26% stage IV prolapse. The use of a blade evidenced hidden pelvic prolapsed compartments in 59% (n=16) of cases. For 48% of patients (n=13), the variation of the leading edge of at least one additional prolapsed compartment was diagnosed as more than 20mm. Using a speculum blade, patients were significantly more often diagnosed with POP of more than one compartment (p=0.0015).
Interpretation of resultsThe use of a speculum blade during dynamic MRI modifies the pelvic organ prolapse evaluation in a large proportion of patients who require prolapse surgery.
Concluding messageThe results of this study point to a role for the use of a speculum blade during MRI POP evaluation.
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