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Umbilical Cord Prolapse

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141. Down Syndrome (Treatment)

is needed because of the associated risk of cervical spine instability. Preoperative evaluation for anesthesia must include adequate evaluation of the airway and the patient’s neurologic status. Cervical radiography (with flexion and extension views) should be performed when any neurologic deficit suggests spinal-cord compression. During laryngoscopy and intubation, the patient’s head should be maintained in a neutral position, and hyperextension should be avoided. Anticholinergics can be prescribed (...) difficulties that persist through the adolescent years Provide antibiotic prophylaxis during dental and surgical procedures in the presence of mitral valve prolapse Consider bone marrow transplantation if leukemia occurs Discuss sleep apnea, treat airway obstruction medically and surgically. Pay special attention to perioperative modalities because of atlantoaxial instability and problems with the respiratory system Screen for hypothyroidism and diabetes mellitus Manage neurologic problems, including

2014 eMedicine Pediatrics

142. Disorders of the Umbilicus (Treatment)

. (F) Umbilical sinus ending in a fibrous cord attaching to the ileum. (G, H) Omphalomesenteric cyst and sinus without intestinal attachments. Photograph of newborn with intestinal prolapse through a patent omphalomesenteric duct. Both the proximal and distal limbs of the intestine have prolapsed. The umbilicus was explored, the bowel was easily reduced, and the patent duct was excised. The child was discharged from the hospital 2 days later. Anatomic relationship between the umbilicus and its (...) for a small port to perform laparoscopy. The umbilical vein (round ligament), the umbilical arteries (medial umbilical ligaments), and the urachus (median umbilical ligament) can often be identified. Umbilical region viewed from the posterior surface of the abdominal wall of an infant with the umbilical cord attached. UA: Umbilical artery; UV: Umbilical vein; RL: Round ligament (obliterated umbilical vein); UR: Umbilical ring; UL: Umbilical ligament; medial (obliterated umbilical arteries); median

2014 eMedicine Pediatrics

143. Pediatric Urologic Gynecology (Treatment)

bladder with a nonocclusive dressing (eg, plastic food wrap) to protect the bladder plate. To prevent unnecessary trauma, ligating the umbilical cord with silk ties rather than a plastic or metal clamp is best. Some children with bladder exstrophy develop functional bladder capacities, whereas others go on to develop small and poorly compliant bladders. The reason for this is not completely understood. The surgical management of bladder exstrophy involves bladder closure within the first days of life (...) . Skene glands (paraurethral glands) These tubular glands arise from the urethral epithelium and are the counterparts to the male prostatic glands. In females, Skene glands may end up in the urethral meatus and hymen. Cysts (tense, yellow, thin-walled) arising partially within the urethral meatus but mostly external to it may resemble a bulging hymen associated with hydrometrocolpos or a prolapsing ureterocele but are usually separate from the urethral opening. [ , ] Bartholin glands The major

2014 eMedicine Pediatrics

144. Omphalocele and Gastroschisis (Treatment)

defects. Am J Surg . 2017 Jan 6. . Frybova B, Kokesova A, Zemkova D, Mixa V, Vlk R, Rygl M. Quality of life in patients with gastroschisis is comparable with the general population: A questionnaire survey. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub . 2016 Dec 13. . Zajac A, Bogusz B, Soltysiak P, et al. Cosmetic outcomes of sutureless closure in gastroschisis. Eur J Pediatr Surg . 2016 Dec. 26 (6):537-41. . Media Gallery Baby with an intact omphalocele. Baby with an umbilical cord hernia (...) of the urinary collecting system Performance of bilateral orchiopexies Cloacal exstrophy Repair of cloacal exstrophy includes the following: The prolapsed ileum (the "elephant trunk") is reduced. The flayed-open cecum is separated from the central portion of the bifid bladder, and this placode of cecum is tubularized. The bladder halves are approximated and repaired as in bladder exstrophy. Later, the colostomy may be mobilized and anastomosed to the rudimentary hind gut and a stoma created; or an anus

2014 eMedicine Pediatrics

145. Labor and Delivery, Normal Delivery of the Newborn

by uterine stimulation in 14% of patients in the prostaglandin arm, but none of those in the catheter arms, and mean cord arterial pH was lower in the prostaglandin arm (7.25 vs 7.26 in the catheter arms [ P =.050]). [ ] For more information, see article. Previous Next: Contraindications See the list below: While most full-term newborns in the United States are delivered vaginally, vaginal birth is contraindicated in some circumstances, including those described in this section. Cord prolapse When cord (...) prolapse is detected on pelvic examination, the clinician should leave the hand in place, applying pressure against the presenting fetal part to keep it as far out of the pelvis as possible to prevent cord compression. The incidence of cord prolapse is directly proportional to cord length. The treatment is immediate conversion to cesarean delivery. If not treated emergently, cord prolapse is associated with high perinatal mortality. Brow presentation This may convert to face or vertex presentation

2014 eMedicine.com

146. Disorders of the Umbilicus (Overview)

. (C) Fibrous cord attaching ileum to abdominal wall. (D) Intestinal-umbilical fistula. Intestinal mucosa extends to skin surface. (E) Omphalomesenteric cyst arising in a fibrous cord. The cyst may contain intestinal or gastric mucosa. (F) Umbilical sinus ending in a fibrous cord attaching to the ileum. (G, H) Omphalomesenteric cyst and sinus without intestinal attachments. Photograph of newborn with intestinal prolapse through a patent omphalomesenteric duct. Both the proximal and distal limbs (...) the physiologic importance of the umbilicus during development and its importance after birth. During development, the umbilicus functions as a channel that allows blood flow between the placenta and fetus. It also serves an important role in the development of the intestine and the urinary system. After birth, once the umbilical cord falls off, no evidence of these connections should be present. Nevertheless, umbilical disorders are frequently encountered in pediatric surgery. [ ] An understanding

2014 eMedicine Pediatrics

147. Minimal Access Surgery (Treatment)

; this is minimized by using carbon dioxide instead of other gases. This complication has also been reported during insufflation in infants when using an umbiical incision for entry. Inadvertent preperitoneal insufflation in a patient with a patent umbilical vein can lead to devastating consequences [ ] and should be considered when choosing access techniques in patients younger than 1 month. These complications can be minimized with the use of low pressure and warm humidified gas insufflation, slight (...) is typically performed with three stab wounds without trocars. [ ] The average operating time is approximately 15 minutes. Most patients (>90%) are discharged home within 24 hours. The laparoscopic approach is not universally accepted, because similar results can be achieved by means of Ramstedt pyloromyotomy via an umbilical incision. There is some evidence to suggest that the complication rate is lower with the laparoscopic approach. The cosmetic results of laparoscopic pyloromyotomy are superior

2014 eMedicine Pediatrics

148. Mucopolysaccharidosis Type II (Overview)

distribution of the affected substrate and the degree of enzyme deficiency. Dermatan sulfate is found mostly in skin but is also found in blood vessels, heart valves, lungs, and tendons; thus, accumulation of this GAG results in a characteristic skin deposition, myxomatous valvular changes (mitral valve prolapse), and progressive restrictive lung disease. Heparan sulfate is an essential component of nerve cell membranes; therefore, accumulation causes progressive neurological deterioration. Keratan sulfate (...) . Mucopolysaccharidosis type II in females and response to enzyme replacement therapy. Am J Med Genet A . 2012 Feb. 158A(2):450-4. . Meikle PJ, Grasby DJ, Dean CJ, et al. Newborn screening for lysosomal storage disorders. Mol Genet Metab . 2006 Aug. 88(4):307-14. . Vellodi A, Young E, Cooper A, Lidchi V, Winchester B, Wraith JE. Long-term follow-up following bone marrow transplantation for Hunter disease. J Inherit Metab Dis . 1999 Jun. 22(5):638-48. . Mullen CA, Thompson JN, Richard LA, Chan KW. Unrelated umbilical

2014 eMedicine Pediatrics

149. Minimal Access Surgery (Overview)

; this is minimized by using carbon dioxide instead of other gases. This complication has also been reported during insufflation in infants when using an umbiical incision for entry. Inadvertent preperitoneal insufflation in a patient with a patent umbilical vein can lead to devastating consequences [ ] and should be considered when choosing access techniques in patients younger than 1 month. These complications can be minimized with the use of low pressure and warm humidified gas insufflation, slight (...) is typically performed with three stab wounds without trocars. [ ] The average operating time is approximately 15 minutes. Most patients (>90%) are discharged home within 24 hours. The laparoscopic approach is not universally accepted, because similar results can be achieved by means of Ramstedt pyloromyotomy via an umbilical incision. There is some evidence to suggest that the complication rate is lower with the laparoscopic approach. The cosmetic results of laparoscopic pyloromyotomy are superior

2014 eMedicine Pediatrics

150. Evaluation of Fetal Death (Diagnosis)

of a product of human conception, irrespective of the duration of pregnancy and which is not an induced termination of pregnancy. The death is indicated by the fact that after such expulsion or extraction, the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory (...) influence estimates of recurrence and future preconceptional counseling, pregnancy management, prenatal diagnostic procedures, and neonatal management. Many institutions use a selective workup based on clinical findings. For example, when clinical findings strongly suggest a cause for the fetal demise at Santa Clara Valley Medical Center, either no further testing or limited testing is performed. Causes deemed fairly obvious include cord accident (ie, prolapse, entanglement, true knot, tight nuchal cord

2014 eMedicine.com

151. Pregnancy, Breech Delivery (Overview)

, 2015 Author: Philippe H Girerd, MD; Chief Editor: Ronald M Ramus, MD Share Email Print Feedback Close Sections Sections Breech Delivery Overview Background occurs when the fetus presents to the birth canal with buttocks or feet first. This presentation creates a mechanical problem in delivery of the fetus. Next: Pathophysiology The buttocks and feet of the fetus do not provide an effective wedge to dilate the cervix. The umbilical cord may prolapse, and/or the aftercoming head may get trapped (...) . In addition, complications can occur as a result of umbilical cord compression due to the unusual presentation to the maternal pelvis. Increased birth trauma: The inexperienced provider is more likely to pull on the fetus prematurely, and to perform the maneuvers to faciliate delivery incorrectly, increasing the risk of traumatic injury. In addition, as the duration of umbilical cord compression increases, the practitioner may try to deliver the infant more rapidly than advisable, thus increasing

2014 eMedicine Emergency Medicine

152. Pregnancy, Breech Delivery (Diagnosis)

, 2015 Author: Philippe H Girerd, MD; Chief Editor: Ronald M Ramus, MD Share Email Print Feedback Close Sections Sections Breech Delivery Overview Background occurs when the fetus presents to the birth canal with buttocks or feet first. This presentation creates a mechanical problem in delivery of the fetus. Next: Pathophysiology The buttocks and feet of the fetus do not provide an effective wedge to dilate the cervix. The umbilical cord may prolapse, and/or the aftercoming head may get trapped (...) . In addition, complications can occur as a result of umbilical cord compression due to the unusual presentation to the maternal pelvis. Increased birth trauma: The inexperienced provider is more likely to pull on the fetus prematurely, and to perform the maneuvers to faciliate delivery incorrectly, increasing the risk of traumatic injury. In addition, as the duration of umbilical cord compression increases, the practitioner may try to deliver the infant more rapidly than advisable, thus increasing

2014 eMedicine Emergency Medicine

153. Subcutaneous Fat Necrosis of the Newborn (Diagnosis)

, [ ] placenta previa, umbilical cord prolapse, anoxia, seizures, [ ] preeclampsia, maternal cocaine abuse, [ ] gestational diabetes, [ ] maternal use of calcium antagonists during pregnancy, [ ] familial dyslipidemia, and a family history of thrombophilia. [ ] Some evidence implicates a maternal hypercoagulable state such as protein C deficiency and antiphospholipid syndrome. [ ] Local pressure trauma during delivery from forceps, from prolonged labor, and from being large for gestational age (macrosomia

2014 eMedicine.com

154. Congenital Malformations, Larynx

report documented survivors of such lesions. Etiology and pathogenesis Failure of recanalization of the laryngotracheal tube during the third month of gestation leads to laryngeal atresia. Clinical presentation Laryngeal atresia manifests as an acute airway obstruction in the newborn immediately after clamping the umbilical cord. Examination reveals a neonate with severe respiratory distress marked by strong respiratory efforts and inability to inhale air or cry. Without immediate airway management (...) , prenatal tests are not available to help establish this diagnosis because polyhydramnios is absent. Management The management of laryngeal atresia involves immediate tracheotomy at birth. If the diagnosis is anticipated, avoid clamping the umbilical cord until the tracheotomy is secured to maximize oxygenation of the newborn. In patients with fistulas, mask ventilation and esophageal intubation can be used as temporary measures until a tracheotomy is performed. Laryngeal Cysts Epidemiology Laryngeal

2014 eMedicine Surgery

155. Minimal Access Surgery (Follow-up)

; this is minimized by using carbon dioxide instead of other gases. This complication has also been reported during insufflation in infants when using an umbiical incision for entry. Inadvertent preperitoneal insufflation in a patient with a patent umbilical vein can lead to devastating consequences [ ] and should be considered when choosing access techniques in patients younger than 1 month. These complications can be minimized with the use of low pressure and warm humidified gas insufflation, slight (...) is typically performed with three stab wounds without trocars. [ ] The average operating time is approximately 15 minutes. Most patients (>90%) are discharged home within 24 hours. The laparoscopic approach is not universally accepted, because similar results can be achieved by means of Ramstedt pyloromyotomy via an umbilical incision. There is some evidence to suggest that the complication rate is lower with the laparoscopic approach. The cosmetic results of laparoscopic pyloromyotomy are superior

2014 eMedicine Pediatrics

156. Down Syndrome (Follow-up)

is needed because of the associated risk of cervical spine instability. Preoperative evaluation for anesthesia must include adequate evaluation of the airway and the patient’s neurologic status. Cervical radiography (with flexion and extension views) should be performed when any neurologic deficit suggests spinal-cord compression. During laryngoscopy and intubation, the patient’s head should be maintained in a neutral position, and hyperextension should be avoided. Anticholinergics can be prescribed (...) difficulties that persist through the adolescent years Provide antibiotic prophylaxis during dental and surgical procedures in the presence of mitral valve prolapse Consider bone marrow transplantation if leukemia occurs Discuss sleep apnea, treat airway obstruction medically and surgically. Pay special attention to perioperative modalities because of atlantoaxial instability and problems with the respiratory system Screen for hypothyroidism and diabetes mellitus Manage neurologic problems, including

2014 eMedicine Pediatrics

157. Disorders of the Umbilicus (Follow-up)

. (F) Umbilical sinus ending in a fibrous cord attaching to the ileum. (G, H) Omphalomesenteric cyst and sinus without intestinal attachments. Photograph of newborn with intestinal prolapse through a patent omphalomesenteric duct. Both the proximal and distal limbs of the intestine have prolapsed. The umbilicus was explored, the bowel was easily reduced, and the patent duct was excised. The child was discharged from the hospital 2 days later. Anatomic relationship between the umbilicus and its (...) for a small port to perform laparoscopy. The umbilical vein (round ligament), the umbilical arteries (medial umbilical ligaments), and the urachus (median umbilical ligament) can often be identified. Umbilical region viewed from the posterior surface of the abdominal wall of an infant with the umbilical cord attached. UA: Umbilical artery; UV: Umbilical vein; RL: Round ligament (obliterated umbilical vein); UR: Umbilical ring; UL: Umbilical ligament; medial (obliterated umbilical arteries); median

2014 eMedicine Pediatrics

159. Fetal Health Surveillance: Antepartum & Intrapartum Consensus Guideline

to prompt delivery, depending upon the overall clinical situation. (III-C) Recommendation 13: Fetal Scalp Blood Sampling 1. Where facilities and expertise exist, fetal scalp blood sampling for assessment of fetal acid–base status is recommended in women with “atypical/abnormal” fetal heart tracings at gestations > 34 weeks when delivery is not imminent, or if digital fetal scalp stimulation does not result in an acceleratory fetal heart rate response. (III-C) Recommendation 14: Umbilical Cord Blood (...) Gases 1. Ideally, cord blood sampling of both umbilical arterial and umbilical venous blood is recommended for ALL births, for quality assurance and improvement purposes. If only one sample is possible, it should preferably be arterial. (III-B) 2. When risk factors for adverse perinatal outcome exist, or when intervention for fetal indications occurs, sampling of arterial and venous cord gases is strongly recommended. (I-insufficient evidence. See Table 1). Recommendation 15: Fetal Pulse Oximetry 1

2008 British Columbia Perinatal Health Program

160. Nonreassuring Fetal Status

Studies (from Trip Database) Ontology: Fetal Hypoxia (C0349489) Definition (NCI_FDA) Caused by conditions such as inadequate placental function (often abruptio placentae), preeclamptic toxicity, prolapse of the umbilical cord, or complications from anesthetic administration. Definition (NCI) Hypoxia in utero, caused by conditions such as inadequate placental function (often abruptio placentae), preeclamptic toxicity, prolapse of the umbilical cord, or complications from anesthetic administration

2015 FP Notebook

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