SBAR+R

An acronym for a method of structured  communication used in giving a report on or requesting evaluation of a patient using the following format:

A 5 to 10 second report identifying yourself and location, the patient name, relevant vitals,  a clear statement of the problem or situation, and the severity or urgency  of the situation. 

Your conclusion about what you think the problem is or may be.

Response of the person receiving SBAR acknowledging the problem/situation and request. .

 

Schizencephaly

 A rare developmental birth defect characterized by abnormal gaps or clefts in the cerebral hemispheres of the brain. Schizencephaly is thought to represent a defect in neuronal migration.

Individuals with clefts in only one hemisphere (called unilateral clefts) are often paralyzed on one side of the body, but may have average to near-average intelligence. Babies with clefts in both hemispheres commonly have developmental delays  in speech and language skills, and problems with brain-spinal cord communication. Some may also have an abnormally small head, mental retardation, or partial or complete paralysis. Most will experience seizures. Some individuals may have an excessive accumulation of fluid in the brain (hydrocephalus).

A California study from 1985-2001 found a population prevalence of 1.54/100,000. The same study found an association with young parental age and monozygotic twins. One third of their cases also had a another abnormality such as gastroschisis, bowel atresias, and amniotic band disruption sequence. Their study suggests that schizencephaly has heterogeneous etiologies many of which are vascular disruptive in origin [1].

1. Curry CJ et al. Schizencephaly: Heterogeneous etiologies in a population of 4 million California births. Am J Med Genet A. 2005 Aug 30;137(2):181-9. PMID: 16059942;
2.Online Mendelian Inheritance in Man, OMIM (TM). Johns Hopkins University, Baltimore, MD. MIM Number:269160: 8/20/2008: . World Wide Web URL: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=269160
3. http://www.ninds.nih.gov/disorders/schizencephaly/schizencephaly.htm
4. Granata T et al. Schizencephaly: clinical spectrum, epilepsy, and pathogenesis.J Child Neurol. 2005 Apr;20(4):313-8. Review.  PMID: 15921232

Sepsis

SIRS in the presence of infection.

Sepsis, severe

Sepsis associated with organ dysfunction , hypoperfusion abnormality, or sepsis induced hypotension. Perfusion abnormalities may include, but are not limited to, lactic acidosis, oliguria, or acute alteration of mental status.

Sepsis-induced hypotension

A systolic blood pressure of less than 90 mm Hg or a reduction by 40 mm Hg or more from baseline or a mean arterial pressure less than 65 mmHg in the absence of other causes for hypotension (e.g. cardiogenic shock).

Serum iron (FE)

Shoulder dystocia

An average  head-to-body delivery time more than  60 seconds, or more commonly defined as "a delivery that requires additional obstetric maneuvers following failure of gentle downward traction on the fetal head to effect delivery of the shoulders." Shoulder dystocia is usually caused by  the anterior shoulder becoming stuck behind the mother's pubic bone. Shoulder dystocia less commonly occurs if the posterior shoulder becomes wedged against the sacrum. The incidence of shoulder dystocia is reported to be 0.6 to 1.4 percent.

Single nucelotide polymorphism ( SNP)

A  variation in a single nucleotide of a gene.

Singleton

A pregnancy with only one fetus in the uterus.

SIRS (Systemic Inflammatory Response Syndrome)

The body’s physiological response following a wide variety of insults that includes, but is not limited to, more than one of the following clinical manifestations: (1) hyperthermia or hypothermia, (2) tachycardia, (3) tachypnea, (4) leukocytosis or leukopenia . or normal white blood cell count with >10% bands (5) Altered mental status (6) Hyperglycemia (plasma glucose > 140 mg/dL or 7.7 mmol/L) in the absence of diabetes

Small for gestational age (SGA)

Weight below the 10th percentile for gestational age. Most small for gestational age fetuses are small because of constitutional factors such as female sex or heredity.

Sonogram (Ultrasound, Sacn)

An image or images produced by collecting high frequency sound waves reflected from structures inside the body.

Speculum An instrument used to hold the vagina open

Spina Bifida (Myelomeningocele (meningomyelocele )

1. Gregory ECW, MacDorman MF, Martin JA. Trends in fetal and perinatal mortality in the United States, 2006–2012. NCHS data brief, no 169. Hyattsville, MD: National Center for Health Statistics. 2014. http://www.cdc.gov/nchs/data/databriefs/db169.pdf
2. Management of Stillbirth. ACOG Practice Bulletin No. 102. American College of Obstetricians and Gynecologists. Obstet Gynecol 2009; 113:748–61.PMID: 19300347
3. Stillbirth differences according to regions of origin: an analysis of the German perinatal database, 2004-2007. Reeske A, Kutschmann M, Razum O, Spallek J. BMC Pregnancy Childbirth. 2011 Sep 21;11:63. doi: 10.1186/1471-2393-11-63. PMID: 21936931
4. Maternal, newborn, child and adolescent health http://www.who.int/maternal_child_adolescent/epidemiology/stillbirth/en/

Stress test (Contraction stress test,CST, oxytocin contraction stress test)

A method of testing fetal well-being and in particular the function of the placenta under stress. The study is performed by making a graphical recording of the fetal heart rate using an electronic monitor. The tracing is observed for late decelerations. The test requires three contractions in 10 minutes to be present with the contractions lasting 40 to 60 seconds. If uterine activity is absent then oxytocin is infused or nipple stimulation is used to stimulate mild contractions.  The test is positive if late decelerations are consistent and present with more than 50% of the contractions. The CST is equivocal or suspicious if there are intermittent late decelerations

A positive CST has been has been associated with an increased incidence of intrauterine death, late decelerations in labor, low 5-minute Apgar scores, and intrauterine growth restriction.

Subchorionic hematoma

Succenturiate placenta

One or more accessory placental lobes connected  to the main placenta by blood vessels.  There is an increased risk for postpartum hemorrhage and infection  due to retained placenta with a succenturiate placenta. Sometimes the blood vessels that connect the lobes of the placenta  cross over or near the opening of the cervix leaving the blood vessels vulnerable to rupture. This latter condition is called type II vasa previa
 

Surfactant

Sutures

2. Sutures : The fibrous joints between the skull bones .

Sweeping of Membranes (Membrane stripping)

A procedure where a gloved finger is placed through the cervix and the finger is moved  around to separate the membranes from the uterus. Membrane stripping is also known as "stretch and sweep" . The procedure causes release of prostaglandins , and may reduced the number of post-term pregnancies. One review found that  "Routine use of sweeping of membranes from 38 weeks of pregnancy onwards does not seem to produce clinically important benefits. " [1]

REFERENCES:

1. Bone RC, Balk RACerra F, et al; ACCP/SCCM Consensus Conference Committee, American College of Chest Physicians, Society of Critical Care Medicine. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest. 1992;101(6):1644-1655.
2. Dellinger RP, et. al., Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup.Surviving sepsis campaign: international guidelines for
3.  Marik PE, Lipman J.The definition of septic shock: implications for treatment. Crit Care Resusc. 2007 Mar;9(1):101-3.PMID: 17352674