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Shoulder dystocia related fetal neurological injuries: the role of diabetic control

100%

Iffy L., Brimacombe M., Varadi V., Raghuwanshi M., Ganesh V., Raju V.

Open Medicine

2009

vol. 4

issue 1

76-83

The study explores the roles of routine prenatal diabetic screening and control in the occurrence of neurological birth injuries associated with shoulder dystocia. The investigation involved retrospective review of 226 medical records that contained information about the antenatal events in cases that resulted in permanent neonatal injuries following arrest of the shoulders at delivery. Close attention was paid to diabetic screening and management of mothers with evidence of glucose intolerance. Analysis of the records revealed that one-third of all women, including those with predisposing factors, received no diabetic screening during pregnancy. The majority of confirmed diabetic patients were not treated adequately. Among babies of diabetic women, birth weights exceeding 4500 g were about 30-fold more frequent than among those with normal glucose tolerance. The data suggest that universal screening and rigid diabetic control, including mothers with borderline glucose tolerance, are effective measures for the prevention of excessive fetal growth and intrapartum complications deriving from it. If ignored, impaired maternal glucose tolerance may become a major predisposing factor for neurological birth injuries. It appears therefore that with routine screening for diabetic predisposition and effective control of gestational diabetes the risk of fetal damage can be reduced substantially.

Wczesna fizjoterapia dziecka z porażeniem splotu ramiennego typu Erba

72%

Włodarczyk A., Gajewska E.

Neurologia Dziecięca

2018

vol. 27

issue 54

31-35

Erb’s palsy affects more than 70% of cases of children with perinatal brachial plexus injury. The injury manifests itself in significant paresis accompanied by muscular atrophy. Secondary muscular contractures, joint deformities and dysesthesia significantly limit the function of the affected limb, therefore quickly implemented regular rehabilitation is necessary. The aim of the study is to analyze early therapeutic treatment in two patients with Erb’s palsy. Functional evaluation of quantitative and qualitative development was carried out at the age of 3, 5, 9 and 12 months and using the Mallet scale at the age of 1.5 years and 2 years. From the first months of life both girls were subjected to the Vojta method. It has been demonstrated that physiotherapy based on the Vojta method has a positive effect on the recovery of lost functions. What is important in the brachial plexus palsy is the constant monitoring of the progress being made and individual selection of the therapy. The type of palsy, good cooperation with parents and properly applied rehabilitation caused that the functions as well as their quality were rated very highly according to Mallet scale.

Porażenie typu Erba dotyczy ponad 70% przypadków dzieci z okołoporodowym uszkodzeniem splotu ramiennego. Uraz objawia się znacznym niedowładem z towarzyszącymi zanikami mięśni. Wtórnie powstałe przykurcze mięśniowe, deformacje stawowe i zaburzenia czucia istotnie wpływają na ograniczenie funkcji zajętej kończyny, dlatego konieczne jest szybkie wdrożenie regularnej rehabilitacji. Celem pracy jest analiza wczesnego postępowania terapeutycznego u dwóch pacjentów z porażeniem splotu typu Erba. Ocenę funkcjonalną rozwoju ilościowego i jakościowego przeprowadzono w wieku 3,5,9 oraz 12 miesięcy oraz wykorzystując skalę Malleta w wieku 1.5 roku i 2 lat. Od pierwszych miesięcy życia obie dziewczynki rehabilitowano metodą Vojty. Wykazano iż fizjoterapia w oparciu o metodę Vojty ma pozytywny wpływ na powrót utraconych funkcji. W porażeniu splotu barkowego ważna jest stała obserwacja postępów, indywidualne dobranie terapii. Rodzaj porażenia, dobra współpraca z rodzicami oraz prawidłowo prowadzona rehabilitacja spowodowały iż funkcje jak i jakość ich wykonywania oceniono bardzo wysoko w skali Malleta.

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1 Neurologia Dziecięca

1 Open Medicine

1 2018

1 2009

1 Brimacombe M.

1 Gajewska E.

1 Ganesh V.

1 Iffy L.

1 Raghuwanshi M.

1 Raju V.

1 Varadi V.

1 Włodarczyk A.

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Shoulder dystocia related fetal neurological injuries: the role of diabetic control

Wczesna fizjoterapia dziecka z porażeniem splotu ramiennego typu Erba