BACKGROUND Indirect immunofluorescence (IIF) assays are recommended as the gold standard method for the detection of antinuclear antibodies (ANAs). This study aimed to investigate the reliability of an automated system. METHODS We compared 3745 serum samples using NOVA View archived images with manual analysis via microscopy. A custom cutoff value was established to distinguish ANA titers and was validated in two clinical laboratories. The automatic ANA pattern recognition system was evaluated, and all ANA-positive sera were subjected to two commercial ANA IIF kits to compare the consistency of the pattern interpretation results. For inconsistent patterns, a third ANA IIF testing kit was utilized. RESULTS Agreement of the interpretation of the ANA IIF test using the platform of NOVA View and manual microscopy was 96.9%. The local cutoff value to discriminate ANA titers in four main ANA patterns was calculated based on 1390 serum samples. In our laboratory, the titer prediction accuracy was superior to the preset cutoff in NOVA View (p<0.01); the performance was similar in another laboratory (p=0.11). The automatic pattern recognition accuracies of speckled, homogeneous, centromere, nucleolar and nuclear dot patterns were 62.7%, 57.4%, 92.6%, 30.5% and 27.3%, respectively. The consistency of the pattern interpretation results between INOVA and MBL kits was 95.3%. CONCLUSIONS It is necessary to establish a custom value-added ANA report. However, confirmation of the digital immunofluorescence images by expert technicians was essential, and suspect results of an ANA pattern should be reconfirmed by another commercial ANA IIF kit to achieve more reliable results.

https://www.degruyter.com/downloadpdf/j/cclm.2017.55.issue-12/cclm-2017-0050/cclm-2017-0050.xml

Automated antinuclear immunofluorescence antibody analysis is a reliable approach in routine clinical laboratories.

Background Breech presentation delivery approach is a controversial issue in obstetrics. How to cope with breech delivery (vaginal or C-section) has been discussed to find the safest in terms of morbidity. The aim of this study was to assess the risks of foetal and maternal mortality and perinatal morbidity associated with vaginal delivery against elective caesarean in breech presentations, as reported in observational studies. Methods Studies assessing perinatal morbidity and mortality associated with breech presentations births. Cochrane, Medline, Scopus, Embase, Web of Science, and Cuiden databases were consulted. This protocol was registered in PROSPERO CRD42020197598. Selection criteria were: years between 2010 and 2020, in English language, and full-term gestation (37-42 weeks). The methodological quality of the eligible articles was assessed according to the Newcastle-Ottawa scale. Meta-analyses were performed to study each parameter related to neonatal mortality and maternal morbidity. Results The meta-analysis included 94 285 births with breech presentation. The relative risk of perinatal mortality was 5.48 (95% confidence interval (CI) = 2.61-11.51) times higher in the vaginal delivery group, 4.12 (95% CI = 2.46-6.89) for birth trauma and 3.33 (95% CI = 1.95-5.67) for Apgar results. Maternal morbidity showed a relative risk 0.30 (95% CI = 0.13-0.67) times higher in the planned caesarean group. Conclusions An increment in the risk of perinatal mortality, birth trauma, and Apgar lower than 7 was identified in planned vaginal delivery. However, the risk of severe maternal morbidity because of complications of a planned caesarean was slightly higher.

https://jogh.org/wp-content/uploads/2022/07/jogh-12-04055.pdf

Maternal and fetal risks of planned vaginal breech delivery vs planned caesarean section for term breech birth: A systematic review and meta-analysis

Background . Medical information on the provision of emergency trauma care to newborns with fractures of tubular bones is scarce. Aim . This scientific review aimed to inform children's orthopedic traumatologists regarding the main mechanisms of injury, methods of diagnosis, and treatment of fractures of long tubular bones in newborns. Material and methods . The article presents a systematic analysis of 60 scientific works of domestic and foreign authors on topical aspects of fractures of long tubular bones in newborns from 1986 to 2018. For writing the literature review, we used modern electronic databases of medical information: PubMed, MEDLINE, Ulrich’s Periodicals Directory, DOAJ, Cyberleninka, and еLibrary. Results and discussion . Similarly from the analysis of scientific publications, the main mechanism of fractures of limb segments in newborns is intranatal trauma, in which the child can receive both during birth through the birth canal and during cesarean section. The predisposing factors for obtaining bone fractures are intrauterine osteopenia, congenital diseases of the digestive system, and prematurity. Fractures are diagnosed on the basis of clinical examination and results of ultrasound and X-ray studies of the injured limb. In the treatment of limb bone fractures, both conservative and surgical methods are used. In recent years, a tendency has been clearly observed in scientific publications, highlighting the ever-widening introduction into clinical practice of operational methods for stabilizing fractures of long tubular bones in newborns, including using the techniques of transosseous osteosynthesis. Conclusion . The presented article fills the existing gap of summarizing scientific publications on the treatment of fractures of limbs in newborns.

https://journals.eco-vector.com/turner/article/download/10207/8539

Fractures of long tubular bones in newborns: mechanisms of injuries, methods of diagnosis, and treatment

Antecedentes: Se define trauma al nacimiento las lesiones sufridas por el feto durante el trabajo de parto o expulsion. Objetivo: Identificar los factores de riesgo asociados a lesiones originadas durante el nacimiento en recien nacidos. Metodo: Estudio casos y controles, realizado en el periodo de julio/2004 a diciembre/2005, en la Division de Ginecologia y Obstetricia del Hospital General de Caxias do Sul/ Facultad de Medicina, Universidad de Caxias do Sul, RS, Brasil. Fueron analizadas variables maternas, del parto y fetales, utilizando el programa estadistico SPSS version 19.0. Los factores que obtuvieron nivel significativo 33 cm (OR-A: 3,36; IC95%: 1,35-9,73; p=0,010). Conclusion: Los factores de riesgo asociados a lesiones durante el nacimiento involucran el parto vaginal y el perimetro toracico igual o superior a 33cm.

/pdf/factores-de-riesgo-asociados-a-traumatismo-al-nacimiento-37fr310ry6.pdf

Factores de riesgo asociados a traumatismo al nacimiento

[Per-partum risk factors of neonatal acidemia in planned vaginal delivery for fetuses in breech presentation].

Background/Aim. The optimal method of delivery for breech presentation at term still remains a matter of controversy. This is probably due to the fact that the skills of vaginal breech delivery are being lost. The aim of this study was to examine risk factors: mother's age, parity, labor's duration, estimated neonatal birth weight for the mode of breech presentation delivery at term as well as the influence of the delivery mode on neonatal outcome. Methods. A retrospective study of 401 terms (more than 37 week's gestation) breech deliveries at the Institute of Gynecology and Obstetrics, Belgrade, from 2007 to 2008 was made. The following groups with respect to mode of delivery were included: the group I - vaginal delivery (VD) in 139 patients; the group II - urgent cesarean section (UCS) in 128 patients; and the group III - elective cesarean section (ECS) in 134 patients. Mother's age, parity, duration of VD, neonatal birth weight (BW), the Apgar score at 5th minute, and duration of stay in a neonatal intensive care unit (NICU) vere determined. Neonatal mortality and major neonatal morbidity were compared according to the route of delivery. Fetuses and neonates with hemolytic disease and fetal and neonatal anomalies were excluded from the study. For statistical analyses we performed Student's t test, χ2 likelihood ratio, Kruskall-Wallis test, Mann Whitney test, and ANOVA. Results. The mean age of patients in the group I was 28.29 ± 4.97 years, in the group II 29.68 ± 5.92 years and in the group III 30.06 ± 5.41 years. Difference in mother's age between the group I and III was significant (p = 0.022). In the group III there were 73.9% nuliparous similarly to the gropu II (73.4%). We performed ECS in 54.6% of the nuliparous older than 35 years, and 54.4% multiparous younger than 35 years were delivered by VD. The use of oxytocin for stimulation of vaginal labor was not associated with its duration (p = 0.706). Lowset maneuver was performed in 88.5% of the VD. Mean BW of neonantes was 3189.93 ± 399.42 g in the VD group, 3218.59 ± 517.71 g in the UCS and 3427.99 ± 460.04 g in the ECS group. Neonates of the estimated BW below 2 500 g were delivered by UCS in 5.5% cases, vaginally in 3.6% cases and by ECS in 2.2% cases. Neonates of the estimated BW above 3 500 g were delivered by ECS in 44.8% cases, vaginally in 23.0% cases and by UCS in 30.5% cases. There was a statistically significant difference between the VD and UCS groups (p = 0.004). Neonatal well-being was diagnosed in 75.5% of the neonates in the VD group, in 72.4% of the neonates in the ECS group, and in 65.5% of the neonates in the UCS group. The Apgar score at 5th min ≥ 8 was observed in 96% of the neonates in the VD group, in 97.5% of the neonantes in the ECS group and in 94.5% of the neonantes in the UCS group. In breech presentation, perinatal asphyxia remained increased in the VD group by 9.4% as compared with the UCS group, 5.5% (p = 0.001) and the ECS group, 3.0% (p = 0.016). Neonates stayed in NICU significantly longer after UCS compared with VD or ECS (7.21 ± 10.74 days vs 3.99 ± 1.33 days and 5.34 ± 2.88 days, respectively; p = 0.001 and p = 0.037, respectively). There was no diagnosed intracranial hemorrhage, brachial plexus injury and birth trauma in any groups. Also, there was no early neonatal death. Conclusion. For breech presentation elective cesarean section remains the major delevery method in nuliparous older than 35 years, while vaginal delivery is considered to be the method of choice in younger multiparous with ultrasonographically estimated neonatal birth weight 2 500-3 500 grams.

/pdf/vaginal-delivery-versus-cesarean-section-for-term-breech-3rjt1u68ns.pdf

Vaginal delivery versus cesarean section for term breech delivery

Introduction. Progress of labor in multiparous women usually is not
 accompanied with risk of any kind of birth trauma. Case Outline. We report a
 very rare case of rib fracture in a neonate during vaginal delivery in the
 39/40 week of gestation. The expulsion started spontaneously without any
 manipulation from the obstetrician. Live male newborn was delivered 4650 g.
 in weight, 55 cm long, with head circumference of 39 cm, Apgar score 9. The
 child was immediately examined by the neonatologist. Crepitations were
 palpable over the left hemithorax, and auscultatory on the left side
 inspiratory cracks. Finding was suspicious for rib fracture on the left side
 posteriorly and brachial plexus palsy, while other findings were normal.
 X­ray finding was inconclusive, but suspicious for fracture of the 4th, 5th,
 and 6th left rib posteriorly, without dislocation of bone fragments. There
 were no signs of pneumothorax. Dorsal position of the newborn was considered
 sufficient, accompanied with analgetics. X­ray was scheduled in a week
 because formation of the calus would be the only objective sign of previous
 rib fracture. On the control X­ray fracture lines were clearly visible on the
 3rd, 4th, 5th, 6th and 7th rib posteriorly, without dislocation of bone
 fragments with initial calus formation. The child was discharged from
 hospital in good condition after two weeks, for further outpatient care.
 Conclusion. With timely diagnostics of this very rare intrapartal fracture,
 adequate treatment, dorsal position and close control of clinical condition
 of the newborn, serious and potentially life threatening complications can be
 avoided.

/pdf/diagnosis-and-treatment-of-rib-fracture-during-spontaneous-103ix9rx73.pdf

Diagnosis and treatment of rib fracture during spontaneous vaginal delivery

Ovarian tumors in pregnancy represent a significant issue both in terms of
 diagnostics and therapy. Increased use of the ultrasound in pregnancy in the
 last several decades has contributed to the rise in the number of diagnosed
 asymptomatic adnexal tumors with pregnant women. We present a case of a
 patient treated in our clinic for asymptomatic ovarian tumor, which was
 diagnosed in pregnancy. The patient underwent check-ups every four weeks,
 comprising clinical and sonographical examinations and relevant laboratory
 and tumor marker tests. The course of pregnancy was normal, with no detected
 tumor growth and with the tumor marker levels within the reference range.
 Following an uneventful delivery, she developed abdominal pains during the
 puerperium, and the adnexal torsion was diagnosed intraoperatively. The
 attitudes to treating of adnexal tumors in pregnancy are controversial, and
 there exist no defined treatment protocols. It is, therefore, necessary to
 make an individual evaluation of each case, and the relevant decisions should
 be made with the pregnant woman’s informed consent. The adnexal torsion in
 the presented case can be explained by the size of the tumor as well as the
 progressive reduction of the size of the uterus due to the physical
 involution during puerperium.

/pdf/adnexal-torsion-during-puerperium-as-a-complication-of-1oamtdfo5z.pdf

Adnexal torsion during puerperium as a complication of delayed surgical treatment of ovarian tumor in pregnancy

INTRODUCTION: The influence of glucocorticosteroid therapy on foetal lung maturation is evident but little is known about its effects on parameters of foetal venous circulation. OBJECTIVE: The aim of the study was to assess the influence of direct intramuscular (i.m.) foetal corticosteroid therapy (CST) on parameters of foetal venous circulation which indicates a degree of foetal hypoxia. METHOD: The prospective study was conducted at the Institute of Gynaecology and Obstetrics during 2001. We evaluated the influence of direct i.m. foetal single dose dexamethasone (2 mg/ kg estimated foetal weight by sonographic examination) on foetal ductus venosus (DV) and vena cava inferior (VCI) velocities in 49 foetuses 24 hours before and after therapy. RESULTS: There is positive correlation with the statistical significance in systolic/diastolic ratio (S/D) in DV before and after the corticotherapy r = 0.366; p = 0.018. Reverse flow during contraction of the right atrium in DV was found in 55.6% of foetuses after CST. Reverse flow during the contraction of the right atrium in VCI was found in 3 foetuses before CST and in 4 foetuses after CST. We found positive correlation without statistical significance between the vena cava pre-load indices before and after CST (r = 0.127; p = 0.428). There is positive correlation with the statistical significance between systolic flow in VCI before and after CST (r = 0.478; p = 0.002). CONCLUSION: Corticosteroid therapy influences parameters of foetal venous circulation. Its influence depends on duration of foetal hypoxia. The parameters of foetal venous circulation can be a predictor of the perinatal outcome.

/pdf/the-influence-of-direct-intramuscular-corticosteroid-therapy-pfeqv9lqfx.pdf

The influence of direct intramuscular corticosteroid therapy on parameters of venous circulation in hypoxaemic fetuses

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Papers

Vaginal delivery versus cesarean section for term breech delivery

Diagnosis and treatment of rib fracture during spontaneous vaginal delivery

Adnexal torsion during puerperium as a complication of delayed surgical treatment of ovarian tumor in pregnancy

The influence of direct intramuscular corticosteroid therapy on parameters of venous circulation in hypoxaemic fetuses