It is understood a special consent process will be developed by the Australian Government for people under 50 who choose to receive the AZD1222 vaccine. Studies
A study convened by a group of British hematologists on 19 March 2021, just two days after the acknowledgement of the condition, published its finding in The New England Journal of Medicine, establishing case definition criteria. The study included 294 participants who presented with symptoms of thrombocytopenia and thrombosis after receipt of the first dose of the Oxford–AstraZeneca COVID‑19 vaccine, showing an independent association between baseline platelet count and the presence of intracranial hemorrhage. The study established that 85% of the participants effected by the condition were aged younger than 60 years, and that those participants with a history of thrombosis or prothrombotic disorders did not appear to be at increased risk. The study showed an overall mortality rate of 22% and set out plans for additional research to determine the genetic factors that may increase risk of the condition and identify potential therapeutic agents. References
Notes
Footnotes
Further reading
Aleem A, Nadeem AJ (July 2021). "Coronavirus (COVID-19) Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT)". StatPearls. PMID 34033367. Arepally GM, Ortel TL (July 2021). "Vaccine-induced immune thrombotic thrombocytopenia: what we know and do not know". Blood. 138 (4): 293–8. doi:10.1182/blood.2021012152. PMC 8172307. PMID 34323940. Iba T, Levy JH, Warkentin TE (January 2022). "Recognizing Vaccine-Induced Immune Thrombotic Thrombocytopenia". Crit Care Med. 50 (1): e80–e86. doi:10.1097/CCM.0000000000005211. PMC 8670081. PMID 34259661. Schultz NH, Sørvoll IH, Michelsen AE, Munthe LA, Lund-Johansen F, Ahlen MT,  et al. (June 2021).
The uterus continues to try to expel the impacted fetus and as its retraction ring rises, the musculature in the lower segments thins out leading eventually to a uterine rupture and the death of the mother. Impacted shoulder presentations contribute to maternal mortality. Obviously a cesarean section should be performed before the baby has died, but even when the baby has died or impaction has occurred, C/S is the method of choice of delivery, as alternative methods of delivery are potentially too traumatic for the mother. If the baby is preterm or macerated and very small a spontaneous delivery has been observed. History
Prior to the arrival of C/S the fetus usually died during protracted labor and the mothers life was at risk as well due to infection, uterine rupture and bleeding. On occasion, if the baby was macerated and small, it collapsed sufficiently to be delivered. The shoulder presentation was a feared obstetrical complication. In 1690 Justine Siegemundin, a German midwife, published Die Kgl. Preußische und Chur-Brandenburgische Hof-Wehemutter. This treatise for midwives demonstrated abnormal presentations at birth and their management. She was the first to describe a two-handed method of performing an internal rotation of the baby to extract it as a breech (a variation of which is performed today on the second twin, see above) using a sling. The procedure was useful provided the fetus was not impacted. Once the uterus had contracted around the baby tightly, destructive interventions were used to save the life of the mother.