E-learning modules for Integrated Virtual Learning


    Online Class Day 3

    Share

    ma. cristina arroyo

    Posts : 75
    Join date : 2009-06-24

    Re: Online Class Day 3

    Post  ma. cristina arroyo on Wed 12 Aug 2009, 9:28 pm

    while some are still contemplating their answer for no.3, raiza emphasized the possible emotional reaction the adolescent mother can experience such as shock and denial.

    as for meg, she emphasized the socio-economic outcome such as dropping out of school.

    anymore guys?Smile

    Althea Perez

    Posts : 33
    Join date : 2009-08-11

    Re: Online Class Day 3

    Post  Althea Perez on Wed 12 Aug 2009, 9:26 pm

    Different reactions could be felt by the adolescent mother. Depending if the pregnancy is unplanned or planned is a different story also. The mother if informed appropriately regarding the condition of the baby will be be able to prepare herself with the result. Shocked at first (i think).

    But, according to different studies, birth delivery (whether vaginal or caesarian) could cause a traumatic experience to the mother. To add up with high expectations of birth and physical problems with the baby--> the mother is at high risk of experiencing Postpartum Depression.

    miguela
    Guest

    What are the possible reactions of the mother

    Post  miguela on Wed 12 Aug 2009, 9:20 pm

    This is a case of teenage pregnancy. Being a young mother in an can affect one's education. Teen mothers are more likely to drop out of high school.[6] Recent studies, though, have found that many of these mothers had already dropped out of school prior to becoming pregnant, but those in school at the time of their pregnancy were as likely to graduate as their peers.[citation needed] One study in 2001 found that women who gave birth during their teens completed secondary-level schooling 10-12% as often and pursued post-secondary education 14-29% as often as women who waited until age 30.

    ma. cristina arroyo

    Posts : 75
    Join date : 2009-06-24

    Re: Online Class Day 3

    Post  ma. cristina arroyo on Wed 12 Aug 2009, 9:18 pm

    welcome meg in our discussion! and thanks for your answers. for update, we are now on question no.3:) feel free to answer.

    mfnierra
    Guest

    Adolescent Pregnancy

    Post  mfnierra on Wed 12 Aug 2009, 9:18 pm

    Nice guys. . . I like that about Chiari II, that was a well-informed guess Very Happy

    railibo-
    Guest

    Re: Online Class Day 3

    Post  railibo- on Wed 12 Aug 2009, 9:16 pm

    possible reaction? well i guess she will be at a state of shock and denial. i mean for a 16 year old mother (Still an adolescent, by the way), a situation like this is not an easy thing to accept..

    miguela
    Guest

    answer to q1 and 2

    Post  miguela on Wed 12 Aug 2009, 9:15 pm

    1. What other diagnostic/s test can the nurse practitioner suggest to detect the abnormalities?
    Hydrocephalus may be diagnosed on a routine ultrasound. Hydrocephalus is occasionally associated with chromosomal abnormalities. The perinatologist typically will offer an amniocentesis to look for chromosomal issues. Another test that may be recommended is a fetal MRI. Ultrasound imaging can be limited by the mother's body habitus, the surrounding amniotic fluid and the position of the fetus. Fetal MRI is a non-invasive diagnostic test that produces better images of soft tissue, and bone or dense tissue does not interfere with the image. The biggest limitation of fetal MRI is that the best images are obtained when the fetus stays still.


    2. What do you think will be the best method of delivery in this case? Justify.
    It has been suggested that the method of delivery affects the outcome for fetuses with meningomyelocele, since labor and vaginal birth exert pressure on the damaged tissues, exacerbating the malformation. The records of all infants delivered with meningomyelocele during a 10-year period at two medical institutions were reviewed. Cesarean section was offered to and accepted by all mothers of term fetuses diagnosed prenatally who did not have additional complications. One hundred sixty infants survived the period immediately after birth, of whom 47 were delivered by cesarean section before labor began, 35 were delivered by cesarean section after labor had started, and 78 were delivered vaginally. The difference between the anatomical level of the lesion and its motor (functional) level was greater for the cesarean-before-labor group than for either of the other two groups: this represented considerably enhanced motor function for those delivered before labor began. Infants who underwent labor had more severe degrees of paralysis than those delivered by cesarean section: while 45 percent of the cesarean-before-labor group had no motor loss or losses at the sacral level only (the lowest portion of the spinal cord), this was true of only 16 percent of those who underwent labor. The chance of severe paralysis was more than twice as great for infants exposed to labor than for those in the cesarean-before-labor group. Tests of intellectual performance, carried out up to 24 months of age, did not find differences among the infants according to mode of delivery. Thus, the negative effects of labor appeared confined to motor function. Prenatal diagnosis of meningomyelocele and subsequent delivery by cesarean section is likely to improve motor function for affected children. (Consumer Summary produced by Reliance Medical Information, Inc.)



    author: Hollenbach, Kathryn A., Luthy, David A., Nyberg, David A., Benedetti, Thomas J., Hickok, Durlin E., Wardinsky, Terrence, Shurtleff, David B. Publisher: Massachusetts Medical Society Publication Name: The New England Journal of Medicine

    ma. cristina arroyo

    Posts : 75
    Join date : 2009-06-24

    Re: Online Class Day 3

    Post  ma. cristina arroyo on Wed 12 Aug 2009, 9:08 pm

    thanks loren, can you share us your source though, so that everyone can browse it maybe later.

    anlorrai
    Guest

    Re: Online Class Day 3

    Post  anlorrai on Wed 12 Aug 2009, 9:04 pm

    If the baby will be delivered via NSD complications may arise like respiratory distress, meconium aspiration on the part of the baby.

    ma. cristina arroyo

    Posts : 75
    Join date : 2009-06-24

    Re: Online Class Day 3

    Post  ma. cristina arroyo on Wed 12 Aug 2009, 9:04 pm

    So still there are debates regarding the type of delivery for this case, some researches say that there is no clinical significance between delivery through vagina and cesarean section.

    Problems may arise and the worse scenario is that of a low impacted head, which carries not only a risk to the baby of brain damage, but also a potential fatal risk to the mother from a rupture uterus. (Earl,1899)


    With this, individual risk factors will and must be considered in choosing the type of delivery.


    let's proceed to number 3.

    ara_portillo

    Posts : 74
    Join date : 2009-06-24

    Research findings on the mode of delivery...

    Post  ara_portillo on Wed 12 Aug 2009, 9:03 pm

    >A study of Merill and colleagues in 1998 on the Optimal Route of Delivery for Fetal Meningomyelocele concluded that there is no difference in immediate or long term outcome by route of delivery for the fetus with meningomyelocele.The study made a follow up on the with all fetuses (600 with the said condition) delivered at University if Iowa hospitals between 1971 - 1995. The results showed that there were no significant differences by route of delivery for gestational age of delivery, birth weight, meningomyelocele size, or neonatal mortality (vaginal: 1/22 = 4.5%, cesarean section: 2/17 = 11.8%, P = .82). Also, there was no difference in long-term neurologic outcome as determined by the change in motor level, the change in sensory level, or when comparing the final motor level with the anatomic level.

    The authors concluded that they were not able to show the differences between either immediate or long-term outcome for the infant with isolated meningomyelocele when stratified by route of delivery. It is also suggested that a multicenter randomized trial should be required before the acceptance of cesarean section as the optimal route of delivery for the fetus with meningomyelocele.

    Reference: Merill DC et al. 1998. Optimal Route of Delivery for Fetal Meningomyelocel. American Journal of Obstetrics and Gynecology. 179(1):235-40. Abstract Electronic version available at http://www.ncbi.nlm.nih.gov/pubmed/9704793

    Althea Perez

    Posts : 33
    Join date : 2009-08-11

    Re: Online Class Day 3

    Post  Althea Perez on Wed 12 Aug 2009, 9:02 pm

    As for the myelomeningocele case of the child, we always wonder if the type of birth delivery for patients with myelomeningocele may affect the condition of the child (further aggravate).

    A retrospective cohort study of patients with myelomeningocele followed at the Spinal Dysfunction Program at Alfred I. duPont Hospital for Children in Wilmington, Delaware. Medical records were reviewed for gestational age at delivery, birthweight, anatomical level of lesion, and initial (0-6 months) and long-term (10 years or longer) motor function.

    The conclusion was Elective cesarean delivery, when compared with delivery after trial of labor, was not associated with better motor function or ambulation status in myelomeningocele patients.

    Lewis D, Tolosa JE, Kaufmann M, Goodman M, Farrell C, Berghella V. (2004) Elective cesarean delivery and long-term motor function or ambulation status in infants with meningomyelocele. Obstetrics and Gynecology. Mar;103(3):469-73.

    arch_ang
    Guest

    Re: Online Class Day 3

    Post  arch_ang on Wed 12 Aug 2009, 8:57 pm

    Most often, the size of the hydrocephalic head must be reduced if the head is to pass through the canal. Even with CS, the fluid should be reduced before incising the uterus in order to prevent circumvent dangerous extensions of a low transverse or vertical incision.
    Also, it is to avoid deliberately creating a very long vertical uterine incision.

    Williams Obstetrics 21st edition
    p.465

    railibo-
    Guest

    Re: Online Class Day 3

    Post  railibo- on Wed 12 Aug 2009, 8:56 pm

    Unless she has a really mild case, she will probably need a c-section. The first reason is that in many cases the head is simply too large to fit through the birth canal. and second reason is that a brain that is already under pressure hardly needs to go through the trauma of birth.

    Source: http://www.fetalhydrocephalus.com/hydro/info-pregnancy.aspx

    Althea Perez

    Posts : 33
    Join date : 2009-08-11

    Re: Online Class Day 3

    Post  Althea Perez on Wed 12 Aug 2009, 8:55 pm

    The adoption ratio of cesarean delivery to transvaginal delivery was around 7 to 3 in patients with fetal hydrocephalus, and 2 to 7 in patients with infantile hydrocephalus, respectively, with significant difference between fetal hydrocephalus and infantile hydrocephalus groups (p < 0.001). Clinical outcomes in patients with fetal hydrocephalus was better in those delivered transvaginally than in those by cesarean delivery, although without no statistical significance (p = 0.124) and those in patients with infantile hydrocephalus showed almost no difference between transvaginal and cesarean delivery groups.

    Kouzo Moritake.Diagnosis of congenital hydrocephalus and delivery of its patients in Japan Purchase the full-text article.
    http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T50-4RFKKK5-1&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=978347692&_rerunOrigin=google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=284dcaa8bda3100531f23549e39a22a4

    ma. cristina arroyo

    Posts : 75
    Join date : 2009-06-24

    Re: Online Class Day 3

    Post  ma. cristina arroyo on Wed 12 Aug 2009, 8:53 pm

    loren, complications such as?

    Angel Ve
    Guest

    answer 2

    Post  Angel Ve on Wed 12 Aug 2009, 8:52 pm

    Research on Diagnosis of congenital hydrocephalus and delivery of its patients in Japan showed that the adoption ratio of cesarean delivery to transvaginal delivery was around 7 to 3 in patients with fetal hydrocephalus, and 2 to 7 in patients with infantile hydrocephalus, respectively, with significant difference between fetal hydrocephalus and infantile hydrocephalus groups (p < 0.001). Clinical outcomes in patients with fetal hydrocephalus was better in those delivered transvaginally than in those by cesarean delivery, although without no statistical significance (p = 0.124) and those in patients with infantile hydrocephalus showed almost no difference between transvaginal and cesarean delivery groups.

    Moritake. 2007. Diagnosis of congenital hydrocephalus and delivery of its patients in Japan. Available at: http://www.journals.elsevierhealth.com/periodicals/bradev/article/PIIS0387760407002458/abstract

    jenny c.
    Guest

    Re: Online Class Day 3

    Post  jenny c. on Wed 12 Aug 2009, 8:51 pm

    The adoption ratio of cesarean delivery to transvaginal delivery was around 7 to 3 in patients with fetal hydrocephalus, and 2 to 7 in patients with infantile hydrocephalus, respectively, with significant difference between fetal hydrocephalus and infantile hydrocephalus groups. Clinical outcomes in patients with fetal hydrocephalus was better in those delivered transvaginally than in those by cesarean delivery, although without no statistical significance.

    Kouzo Moritake, Hidemasa Nagai, Noriko Nagasako, Mami Yamasaki, Shizuo Oi and Toshiyuki Hata. (2007). Diagnosis of congenital hydrocephalus and delivery of its patients in Japan.

    anlorrai
    Guest

    Re: Online Class Day 3

    Post  anlorrai on Wed 12 Aug 2009, 8:51 pm

    yes I agree with ms thea. The method of delivery that is applicable is cesarean section because there are alot of complications may arise if the baby will be delivered via NSD.

    ma. cristina arroyo

    Posts : 75
    Join date : 2009-06-24

    Re: Online Class Day 3

    Post  ma. cristina arroyo on Wed 12 Aug 2009, 8:49 pm

    for ara, what do those researches your referring to suggest? Why is CS, accdg to those researches do not provide the best outcome for this case?

    ara_portillo

    Posts : 74
    Join date : 2009-06-24

    for the mode of delivery....

    Post  ara_portillo on Wed 12 Aug 2009, 8:45 pm

    The method of delivery can affect the outcome for fetuses with this condition. Since the characteristics of the condition as reflected in the case is the build up of CSF in the ventricles in the brain that contributes to rising ICP, labor and vaginal birth can exert pressure on the damage tissues, which can exacerbate the condition. This implies that the mode of delivery preferred would be the Caesarean SEction...

    However, some researches suggests that CS is not the optimal route of delivery for fetus with myelomeningocele..

    ma. cristina arroyo

    Posts : 75
    Join date : 2009-06-24

    Re: Online Class Day 3

    Post  ma. cristina arroyo on Wed 12 Aug 2009, 8:45 pm

    amazing! thank you for your best guesses ara and thea. as they say it. the problem could be classified under chiari malformations:



    Chiari II abnormality

    -which is associated with meningomyelocele, anencephaly, and encephalocele, all of which belong to a group of disorders known as neural tube defects. These serious congenital anomalies of the nervous system, which occur during the 1st 4 weeks of gestation, result from faulty formation of the neural tube.

    - the cerebellum been pushed downward into the spinal canal, but so has the fourth ventricle and the medulla (lower portion of the brainstem). This type is generally associated with spina bifida (myelomeningocele)

    we've learned something new today.. let's move on with the second question.

    ma. cristina arroyo

    Posts : 75
    Join date : 2009-06-24

    Re: Online Class Day 3

    Post  ma. cristina arroyo on Wed 12 Aug 2009, 8:40 pm

    thank you angel, raiza, jenny and loren for those inputs.

    so while you are still thinking for the answer to my follow up question, thi is the summary for no.,1 question, the possible diagnostic tests are the following:

    - ultrasound
    -fetal MRI

    Ultrafast fetal MRI is a more anatomically precise modality for prenatal neuroimaging.

    -CT scan
    -amniocentesis
    - AFP

    Althea Perez

    Posts : 33
    Join date : 2009-08-11

    Re: Online Class Day 3

    Post  Althea Perez on Wed 12 Aug 2009, 8:39 pm

    I agree with ara, i have also read that Chiari malformations happen when the indented bony space at the lower rear of the skull, known as the posterior fossa, is smaller than normal, the cerebellum and brainstem can be pushed downward. The resulting pressure on the cerebellum can block the flow of cerebrospinal fluid causing hydrocephalus.

    Chiari II - In this type not only has the cerebellum been pushed downward into the spinal canal, but so has the fourth ventricle and the medulla (lower portion of the brainstem). This type is generally associated with spina bifida (myelomeningocele) which is a condition where the spinal cord does not close properly before birth.

    Department of Neuroradiology, St. Chiara Hospital, Via Roma, 67, I-56100 Pisa, Italy e-mail: rcanapicchi@inpe.unipi.it

    anlorrai
    Guest

    Re: Online Class Day 3

    Post  anlorrai on Wed 12 Aug 2009, 8:36 pm

    Hydrocephalus can be defined broadly as a disturbance of formation, flow, or absorption of cerebrospinal fluid (CSF) that leads to an increase in volume occupied by this fluid in the central nervous system (CNS). This condition also could be termed a hydrodynamic disorder of CSF. Acute hydrocephalus occurs over days, subacute over weeks, and chronic over months or years. Conditions such as cerebral atrophy and focal destructive lesions also lead to an abnormal increase of CSF in CNS. In these situations, loss of cerebral tissue leaves a vacant space that is filled passively with CSF. Such conditions are not the result of a hydrodynamic disorder and therefore are not classified as hydrocephalus. An older misnomer used to describe these conditions was hydrocephalus ex vacuo.

    Hydrocephalus is diagnosed through clinical neurological evaluation and by using cranial imaging techniques such as ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), or pressure-monitoring techniques. A physician selects the appropriate diagnostic tool based on an individual's age, clinical presentation, and the presence of known or suspected abnormalities of the brain or spinal cord.





    hydrocephalus
    Author: Eugenia-Daniela Hord, MD, Instructor, Departments of Anesthesia and Neurology, Massachusetts General Hospital Pain Center, Harvard Medical School
    Contributor Information and Disclosures

    Sponsored content

    Re: Online Class Day 3

    Post  Sponsored content


      Current date/time is Tue 24 Oct 2017, 4:27 am