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A breech birth is the birth of a baby from a breech presentation. In the breech presentation the baby enters the birth canal with the buttocks or feet first as opposed to the normal head first presentation.
There are either three or four main categories of breech births, depending upon the source:
* Frank breech - the baby's bottom comes first, and his or her legs are flexed at the hip and extended at the knees (with feet near the ears). 65-70% of breech babies are in the frank breech position.
* Complete breech - the baby's hips and knees are flexed so that the baby is sitting crosslegged, with feet beside the bottom.
* Footling breech - one or both feet come first, with the bottom at a higher position. This is rare at term but relatively common with premature fetuses.
* Kneeling breech - the baby is in a kneeling position, with one or both legs extended at the hips and flexed at the knees. This is extremely rare, and is excluded from many classifications.
As in labour with a baby in a normal head-down position, uterine contractions typically occur at regular intervals and gradually cause the cervix to become thinner and to open. In the more common breech presentations, the baby’s bottom (rather than feet or knees) is what is first to descend through the maternal pelvis and emerge from the vagina.
At the beginning of labour, the baby is generally in an oblique position, facing either the right or left side of the mother's back. As the baby's bottom is the same size in the term baby as the baby's head. Descent is thus as for the presenting fetal head and delay in descent is a cardinal sign of possible problems with the delivery of the head.
In order to begin the birth, internal rotation needs to occur. This happens when the mother's pelvic floor muscles cause the baby to turn so that it can be born with one hip directly in front of the other. At this point the baby is facing one of the mother's inner thighs. Then, the shoulders follow the same path as the hips did. At this time the baby usually turns to face the mother's back. Next occurs external rotation, which is when the shoulders emerge as the baby’s head enters the maternal pelvis. The combination of maternal muscle tone and uterine contractions cause the baby’s head to flex, chin to chest. Then the back of the baby's head emerges and finally the face.
Due to the increased pressure during labour and birth, it is normal for the baby's leading hip to be bruised and genitalia to be swollen. Babies who assumed the frank breech position in utero may continue to hold their legs in this position for some days after birth.
Vatche, Minassian, MD, MPH, Chief of Urogynecology, and Sarah Cohen, MD, MPH, Director of the Minimally Invasive Gynecologic Surgery Fellowship Program at Brigham and Women’s Hospital, perform a laparoscopic burch colposuspension, a procedure used to correct stress urinary incontinence.
Stress urinary incontinence is one of the most common types of incontinence and is characterized by urinary leakage during physical activities including coughing, sneezing, exercising, lifting, and laughing. As the condition progresses, it can become severe enough to happen with simple acts such as bending and walking. This condition is due to an anatomic weakness of the bladder neck which typically maintains the seal of urine during activity. Stress incontinence can result from a variety of conditions including vaginal childbirth, aging, menopause and obesity. As this is an anatomic condition, primary treatment may involve pelvic floor exercises and/or minimally invasive surgery.
Learn more about treatment for stress urinary incontinence:
Division of Urogynecology: http://www.brighamandwomens.or....g/Departments_and_Se
Division of Minimally Invasive Gynecologic Surgery: http://www.brighamandwomens.or....g/Departments_and_Se
Video shows another patient on the second day of surgery by Dr. Desarda technique of inguinal hernia repair without mesh.
“Complete cure from groin hernia is now possible with Dr.Desarda's repair technique.......”
Mesh is a foreign body. Therefore, its use in hernia repairs is known to cause all sorts of complications like pain, recurrence, infection etc. We have developed an innovative new technique of inguinal hernia repair without mesh. It uses your own body muscle for repair and gives virtually complete cure from inguinal hernia problem. An undetached strip of the external oblique aponeurosis is stitched on the weak area between the muscle arch and the inguinal ligament to form a new, strong and physiologically dynamic posterior wall that gives protection and prevents re-herniation. Normally patient goes home in a day after surgery and can drive car and go to office in 3-4 days time. This "Dr.Desarda's hernia repair" is now followed in many countries all over the world. We are surprised to see the enquiries from many patients in the developed countries asking for this repair in their country. This is because this operation does not use any foreign body like mesh for repair and therefore there are no complications that are seen in mesh repairs. A visit to Topix or other hernia forums show thousands of posts showing sufferings of many patients due to mesh repairs. But still why surgeons from developed countries are interested in mesh repairs is a big question for us.
Please visit our website for more details: http://herniasurgery.tripod.com Our cell number: +91 9373322178
Care must be taken to prevent stenosis at the anastomotic site. If the diameter of the anastomosis is less than 2 cm, the anastomosis should be taken down and resected. A classic end-to-end anastomosis should be performed to ensure adequate diameter to the intestine. If the posterior wall of the colon has been preserved, care should be taken to close the colostomy prior to opening the peritoneal cavity. This will reduce intraperitoneal contamination from the stoma site. Copious irrigation of the wound should be made prior to primary closure. If gross contamination has occurred, delayed closure of the wound should be considered.
A hematoma is a collection of blood outside of a blood vessel Some causes of hematomas are as pelvic bone fractures, fingernail injuries (subungual), bumps, passing blood clots, blood clot in the leg (DVT), blood cancers, and excessive alcohol use.
Dr. Fizan Abdullah is head of the Division of Pediatric Surgery and vice chair of the Department of Surgery at Ann & Robert H. Lurie Children's Hospital of Chicago. His special interests include Chest wall deformities, pectus excavatum, abdominal wall defects, neonatal surgery, pulmonary and upper airway malformations, congenital diaphragmatic hernia, esophageal and gastrointestinal anomalies, hernia repair, tissue engineering, extracorporeal membrane oxygenation (ECMO), surgical safety protocols and surgical infections.
Learn more at www.luriechildrens.org
When placement of a urethral catheter is contraindicated or unsuccessful, percutaneous suprapubic urinary bladder catheterization is a commonly performed procedure to relieve urinary retention. [1, 2] This topic describes the Catheter over needle technique. The Seldinger technique is described in the Clinical Procedures topic Suprapubic Aspiration.
The dural venous sinuses are spaces between the endosteal and meningeal layers of the dura. They contain venous blood that originates for the most part from the brain or cranial cavity. The sinuses contain an endothelial lining that is continuous into the veins that are connected to them.
Symptoms of serotonin syndrome include a classic triad of mental status changes (eg, anxiety, delirium, confusion, restlessness), autonomic dysregulation (eg, diaphoresis, tachycardia, hypertension, hyperthermia, diarrhea, mydriasis), and neuromuscular hyperactivity (eg, hyperreflexia, tremor, rigidity, myoclonus, ocular clonus). Serotonin syndrome is clinically diagnosed and laboratory tests are used to rule out other etiologies. It usually occurs due to inadvertent interactions between drugs, therapeutic use of multiple serotonergic agents, or serotonergic medication overdose. Treatment involves discontinuation of serotonergic drugs, supportive measures, and sedation with benzodiazepines. In severe cases, a serotonin antagonist (cyproheptadine) may be used.