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The core beliefs of Lamaze International can be summarized with their Six Healthy Birth Practices. Each is heavily sourced from medical literature to provide sound evidence for the safest possible birth for baby and mother. These six practices are as follows:
1. Healthy Birth Practice 1: Let labor begin on its own
2. Healthy Birth Practice 2: Walk, move around and change positions throughout labor
3. Healthy Birth Practice 3: Bring a loved one, friend or doula for continuous support
4. Healthy Birth Practice 4: Avoid interventions that are not medically necessary
5. Healthy Birth Practice 5: Avoid giving birth on your back and follow your body's urges to push
6. Healthy Birth Practice 6: Keep mother and baby together - It's best for mother, baby and breastfeeding
Each of the above practices include a video, a patient handout, and professional references for medical personnel. The Lamaze Healthy Birth Practices are also available in eleven languages: English, Mandarin, Russian, Spanish, Portuguese, Czech, Polish, Romanian, Greek, Arabic, and Hebrew.
Dr. Lamaze was influenced by childbirth practices in the Soviet Union, which involved breathing and relaxation techniques under the supervision of a ""monitrice"", or midwife. The Lamaze method gained popularity in the United States after Marjorie Karmel wrote about her experiences in her 1959 book "Thank You, Dr. Lamaze", and with the formation of the American Society for Psycho prophylaxis in Obstetrics (ASPO Lamaze). Currently Lamaze International, founded by Karmel and Elisabeth Bing, is the premier childbirth education certifying organization in the world.
Modern Lamaze childbirth classes teach expectant mothers many ways to work with the labor process to reduce the pain associated with childbirth and promote normal (physiological) birth including the first moments after birth. Techniques include allowing labour to begin on its own, movement and positions, massage, aromatherapy, hot and cold packs, breathing techniques, the use of a "birth ball" (yoga or exercise ball), spontaneous pushing, upright positions for labour and birth, breastfeeding techniques, and keeping mother and baby together after childbirth. Each class has a specific curriculum that includes learning about common medical interventions and pain relief such as an epidural in an evidence based, non-biased manner.
The risk of awareness is reduced by avoidance of paralytics unless necessary; careful checking of drugs, doses and equipment; good monitoring, and careful vigilance during the case. The Isolated Forearm Technique (IFT) can be used to monitor consciousness; the technique involves applying a tourniquet to the patient's upper arm before the administration of muscle relaxants, so that the forearm can still be moved consciously. The technique is considered a reference standard by which other means of assessing consciousness can be assessed.
The incidence of anesthesia awareness is higher and has more serious sequelae when muscle relaxants or neuromuscular-blocking drugs are used. This is because without relaxant the patient will move and the anesthesiologist will deepen the anesthesia.
One study has indicated this phenomenon occurs in about 1 or 2 per 1000 patients or 0.13%. There is conflicting data however as another study suggested it is a rare phenomenon, with an incidence of 0.0068% after review of their data from a patient population of 211,842 patients.
Post operative interview by an anesthetist is common practice to elucidate if awareness occurred in the case. If awareness is reported a case review is immediately performed to identify machine, medication, or operator error.
Although the definition is imprecise, it occurs in approximately 0.3-1% of vaginal births.
Management of shoulder dystocia has become a focus point for many obstetrical nursing units in North America. Courses such as the Canadian More-OB program encourage nursing units to do routine drills to prevent delays in delivery which adversely affect both mother and fetus. A common treatment mnemonic is ALARMER
- Ask for help. This involves preparing for the help of an obstetrician, for anesthesia, and for pediatrics for subsequent resuscitation of the infant that may be needed if the methods below fail.
- L hyperflexion (McRoberts' maneuver)
- Anterior shoulder disimpaction (pressure)
- Rubin maneuver
- M delivery of posterior arm
- Episiotomy
- Roll over on all fours
Typically the procedures are performed in the order listed above and the sequence ends whenever a technique is successful. Intentional clavicular fracture is a final attempt at nonoperative vaginal delivery prior to Zavanelli's maneuver or symphysiotomy, both of which are considered extraordinary treatment measures.
Via a photo shown on a Facebook page, the mother of a child previously diagnosed with this condition recognised the symptoms and reported them to the family involved, resulting in an immediate diagnosis that medical professionals had overlooked in all earlier consultations.
Surgical correction is recommended when a constriction ring results in a limb contour deformity, with or without lymphedema.
Audioanalgesia (also known as audio-analgesia) is the relief of pain using white noise or music without using pharmacological agents while doing painful medical procedures such as dental treatments. It was first introduced by Gardner and Licklider in 1959.
There are many studies of this technique in dental, obstetric, and palliative care contexts. The most recent review reports mixed results for effectiveness. This questionable pain management strategy might prove useful in distraction and sensory confusion, but only when combined with actual pain relief medications. There is no research to suggest these dubious results will ever be effective other than as a means of self-distraction. This measure is similar to breathing exercises during cramps before administration of epidurals.
It has also been suggested that music may stimulate the production of endorphins and catecholamines.
CMC OA is diagnosed based on clinical findings and radiologic imaging.
Multiview videofluoroscopy is a radiographic technique, mostly to demonstrate the lateral and posterior wall of the pharynx. This is a questionable technique considering these children undergo radiographic examinations frequently. Also known is that children are more sensitive to radiographic examinations than adults. Most of the time barium is used in multiview videofluoroscopy. Besides the fact that videofluoroscopy provides an overview of the lateral and posterior walls of the pharynx, this technique also provides information about the length and movement of the soft palate, the posterior and the lateral walls.
A limitation of multiview videofluoroscopy is the possibility of misinterpreting certain shapes of gaps and anatomic structures.
The most frequently used diagnostic tools are videofluoroscopy and nasoendoscopy. Some studies conclude that the first step in the process of diagnosis is videofluoroscopy in combination with nasometry. Other studies show a favour for nasoendoscopy. But in general there is no preference for which tool should be used as a standard. Most studies conclude that it is necessary to make an individual decision on which diagnostic tool should be used.
A relatively new approach in the diagnosis is magnetic resonance imaging (MRI), which is noninvasive. MRI uses the property of nuclear magnetic resonance to image nuclei of atoms inside the body. MRI is non-radiographic and therefore can be repeated more often in short periods of time. In addition, different studies show that the MRI is better as a diagnostic tool than videofluoroscopy for visualizing the anatomy of the velopharynx.
On the contrary there are still a few limitations of the MRI. Firstly, artifacts can be shown on the images when the patient moves while imaging. Also artifacts will also be shown if the patient has orthodontic appliances. Secondly, the MRI is limited in children who are claustrophobic.
Furthermore, in the MRI scanner movement of the sphincter leads to artifacts on the images. Therefore, nasoendoscopy is still needed for information about the sphincter’s movement. Finally, the MRI is a more expensive diagnostic tool than the combination of nasoendoscopy and videofluoroscopy.
Because of these limits, MRI is currently not widely used. Overall, MRI is used for a “bird's eye view” of the child in the planning of the operation, but not in the progress of diagnosis.
The highest rate of neurological problems of single suture synostosis are seen in patients with trigonocephaly. Surgery is performed generally before the age of one because of claims of better intellectual outcome. Seemingly surgery does not influence the high incidence of neurodevelopment problems in patients with metopic synostosis. Neurological disorders such as ADHD, ASD, ODD and CD are seen in patients with trigonocephaly. These disorders are usually also associated with decreased IQ. The presence of ADHD, ASD and ODD is higher in cases with an IQ below 85. This is not the case with CD which showed an insignificant increase at an IQ below 85.
Pectus excavatum requires no corrective procedures in mild cases. Treatment of severe cases can involve either invasive or non-invasive techniques or a combination of both. Before an operation proceeds several tests are usually to be performed. These include, but are not limited to, a CT scan, pulmonary function tests, and cardiology exams (such as auscultation and ECGs). After a CT scan is taken, the Haller index is measured. The patient's Haller is calculated by obtaining the ratio of the transverse diameter (the horizontal distance of the inside of the ribcage) and the anteroposterior diameter (the shortest distance between the vertebrae and sternum). A Haller Index of greater than 3.25 is generally considered severe, while normal chest has an index of 2.5. The cardiopulmonary tests are used to determine the lung capacity and to check for heart murmurs.
Besides a physical examination, the physician will need imaging techniques to determine the character of the malformation: gynecologic ultrasonography, pelvic MRI, or hysterosalpingography. A hysterosalpingogram is not considered as useful due to the inability of the technique to evaluate the exterior contour of the uterus and distinguish between a bicornuate and septate uterus.
In addition, laparoscopy and/or hysteroscopy may be indicated.
In some patients the vaginal development may be affected.
The reported incidence of constriction ring syndrome varies from 1/1200 and 1/15000 live births. The prevalence is equally in male and female.
Fetomaternal factors like prematurity, maternal illnes, low birth weight and maternal drug exposure are predisposing factors for the constriction ring syndrome.
No positive relationship between CRS and genetic inheritance has been reported.
Economic uses of sterility include:
- the production of certain kinds of seedless fruit, such as seedless tomato or watermelon (though sterility is not the only available route to fruit seedlessness);
- terminator technology, methods for restricting the use of genetically modified plants by causing second generation seeds to be sterile;
- biological control; for example, trap-neuter-return programs for cats; and the sterile insect technique, in which large numbers of sterile insects are released, which compete with fertile insects for food and mates, thus reducing the population size of subsequent generations, which can be used to fight diseases spread by insect vectors such as malaria in mosquitoes.
To determine whether a client presents with puberphonia, a complete voice assessment including medical and diagnostic evaluations is recommended. These assessments are performed by otorhinolaryngologists and speech-language pathologists.
A behavioural assessment for puberphonia will consist of several types of tasks, and may include:
- Examining for tension in the neck and throat: The clinician will visually examine the area around the larynx to see if the voice box sits high in the throat, and palpate the area to determine whether there is excessive muscular tension.
- Determining the relationship between tension and vocal pitch: The clinician will ask the client to perform warm-up and relaxation exercises such as those listed in the Treatment section below to determine whether the client has access to their modal voice register.
- Establishing vocal range: The clinician will ask the client to produce the lowest and highest pitch that they can, and perform different speaking or singing activities at various pitches.
- Listening for abnormal traits: The clinician will listen for the presence of breathy voice, an indication of speech in the falsetto register, and other distortions of vocal quality.
- Taking aerodynamic measurements: Many individuals with puberphonia may have limited breath support caused by the thoracic or shallow breathing patterns often used to support speech in the falsetto register. These symptoms are assessed using vocal tasks such as maximum phonation time and direct measures of breath support such as glottal airflow and subglottal pressure.
Although prone "functional leg length" is a widely used chiropractic tool in their Activator technique, it is not a recognized anthropometric technique, since legs are usually of unequal length, and measurements in the prone position are not entirely valid estimates of standing X-ray differences. Measurements in the standing position are far more reliable. Another confounding factor is that simply moving the two legs held together and leaning them imperceptibly to one side or the other produces different results.
Clinical measurement of leg length conventionally uses the distance from the anterior superior iliac spine to the medial malleolus. Projectional radiographic measurements of leg length have two main variants:
- Teleroentgenogram, which projects the entirety of both legs at the same time.
- Orthoroentgenogram, which takes separate images of the hip, knee and ankle.
On X-rays, the length of the lower limb can be measured from the proximal end of femoral head to the center of the plafond of the distal tibia.
The use of the so-called Solomon technique or dichorionization in fetoscopic laser therapy for TTTS is proven to be beneficial in preventing post-laser TAPS. With this technique, not only all anastomoses are coagulated but also a line is drawn between those in order to coagulate anastomoses that might not (yet) be visible during fetoscopy. It should be stressed that the success of such a technique is highly dependent on the specific situation. For example, when one of the fetusses obstructs the view on the vascular equator (the part of the placenta where the anastomoses need to be coagulated), complete dichorionization by the Solomon technique might not be possible.
The diagnosis is usually initially made by a combination of physical exam and MRI of the shoulder, which can be done with or without the injection of intraarticular contrast. The presence of contrast allows for better evaluation of the glenoid labrum.
Pectus excavatum is initially suspected from visual examination of the anterior chest. Auscultation of the chest can reveal displaced heart beat and valve prolapse. There can be a heart murmur occurring during systole caused by proximity between the sternum and the pulmonary artery.
Lung sounds are usually clear yet diminished due to decreased base lung capacity.
Many scales have been developed to determine the degree of deformity in the chest wall. Most of these are variants on the distance between the sternum and the spine. One such index is the "Backer ratio" which grades severity of deformity based on the ratio between the diameter of the vertebral body nearest to xiphosternal junction and the distance between the xiphosternal junction and the nearest vertebral body. More recently the "Haller index" has been used based on CT scan measurements. An index over 3.25 is often defined as severe. The Haller index is the ratio between the horizontal distance of the inside of the ribcage and the shortest distance between the vertebrae and sternum.
Chest x-rays are also useful in the diagnosis. The chest x-ray in pectus excavatum can show an opacity in the right lung area that can be mistaken for an infiltrate (such as that seen with pneumonia). Some studies also suggest that the Haller index can be calculated based on chest x-ray as opposed to CT scanning in individuals who have no limitation in their function.
Pectus excavatum is differentiated from other disorders by a series of elimination of signs and symptoms. Pectus carinatum is excluded by the simple observation of a collapsing of the sternum rather than a protrusion. Kyphoscoliosis is excluded by diagnostic imaging of the spine, where in pectus excavatum the spine usually appears normal in structure.
Anesthesia dolorosa or anaesthesia dolorosa or deafferentation pain is pain felt in an area (usually of the face) which is completely numb to touch. The pain is described as constant, burning, aching or severe. It can be a side effect of surgery involving any part of the trigeminal system, and occurs after 1–4% of peripheral surgery for trigeminal neuralgia. No effective medical therapy has yet been found. Several surgical techniques have been tried, with modest or mixed results. The value of surgical interventions is difficult to assess because published studies involve small numbers of mixed patient types and little long term follow-up.
- Gasserian ganglion stimulation is stimulation of the gasserian ganglion with electric pulses from a small generator implanted beneath the skin. There are mixed reports, including some reports of marked, some of moderate and some of no improvement. Further studies of more patients with longer follow-up are required to determine the efficacy of this treatment.
- Deep brain stimulation was found in one review to produce good results in forty-five percent of 106 cases. Though relief may not be permanent, several years of relief may be achieved with this technique.
- Mesencephalotomy is the damaging of the junction of the trigeminal tract and the periaqueductal gray in the brain, and has produced pain relief in a group of patients with cancer pain; but when applied to six anesthesia dolorosa patients, no pain relief was achieved, and the unpleasant sensation was in fact increased.
- Dorsal root entry zone lesioning, damaging the point where sensory nerve fibers meet spinal cord fibers, produced favorable results in some patients and poor results in others, with incidence of ataxia at 40%. Patient numbers were small, follow-up was short and existing evidence does not indicate long term efficacy.
- One surgeon treated thirty-five patients using trigeminal nucleotomy, damaging the nucleus caudalis, and reported 66% "abolition of allodynia and a marked reduction in or (less frequently) complete abolition of deep background pain."
Different stages of TAPS are identified using the criteria as shown in the following tables.