Spontaneous uterine rupture of an unscarred uterus in primigravida: case report

A spontaneous rupture of the unscarred uterus in a primigravid patient is extremely rare and is associated with high perinatal and maternal morbidity and mortality. Study report a case of spontaneous rupture of an unscarred uterus at 36 weeks of gestation in a 22-years primigravid woman. Ultrasonography showed posterior low-lying placenta praevia with lower margin touching internal OS. Operative findings during emergent caesarean section revealed e/o 2 L of hemoperitoneum, uterus was bicornuate and pregnancy was in the right horn. There was fundal rupture of right horn measuring approximately 6-7 cm anteroposterior. Incision was taken on the lower part of right horn and placenta was seen on anterior wall. Baby delivered as breech after incising placenta. Postoperative recovery was uneventful. In, conclusion, bicornuate uterus may be an independent risk factor for uterine rupture, which can occur in primigravid patients and at any gestation.

Effectiveness of kinesiotaping and Acu-TENS on maternal and neonatal outcomes in the first stage of labor among primigravidas

Background: The common reason for rise in elective Caesarean Section (CS) rate among primigravidas is maternal request due to labor pain fear. Many non-pharmacological pain relief strategies are available to help women cope with labor pain, providing a positive and satisfactory birth experience. The objective of this study was to evaluate effects of KT and Acu-TENS on maternal and neonatal outcomes in primigravidas.Methods: 40 full-term primigravidas with an age range of 20-40 years were enrolled into the study by convenience sampling method and divided into 2 groups. Group A received KT and Group B received Acu-TENS. Both groups received breathing exercises. Pain assessment at various cervical dilatation levels were carried out for all participants before and after treatment using Visual Analogue Scale (VAS). Duration of active phase in first stage labor, mode of delivery and neonatal well-being were measured following delivery.Results: Group A experienced VAS score reduction significantly more than Group B, p=0.004; <0.05. There was no significant change in active phase duration of first stage labor between Group A and Group B, p=0.319; >0.05. CS rate was increased in Group A [35% (7/20)] than in Group B [25% (5/20)], but neonatal outcomes were not different.Conclusions: This study proves that KT produced significantly better pain relief than Acu-TENS in first stage labor among primigravidas. Acu-TENS showed reduction in active phase duration of first stage labor than KT. Both interventions can safely be used non-invasively for labor pain relief.

The effectiveness of utilizing the Zhang's criteria compared to Friedman's criteria in increasing the rate of successful vaginal delivery among primigravid parturient in a tertiary hospital / Philippine Journal of Obstetrics and Gynecology

Objective@#To determine the effectiveness of utilizing the Zhang's criteria as compared to Friedman's criteria in increasing the rate of successful vaginal delivery among primigravid parturient in a tertiary government hospital. @*Material and Methods@#This is a prospective cohort study conducted in a tertiary hospital. The population consisting of primigravid parturient of any age admitted at term pregnancy with a gestational age between 37 and 42 weeks. Included were singleton pregnancy, with no co-morbidities, vertex position on admission, with intact amniotic membranes, and in active phase of labor (either 4cm or 6cm cervical dilatation), who consulted at the emergency room of the institution. Multigravid patients, those with multiple pregnancy and ruptured membranes were excluded from the study. Two groups of cohorts were recruited based on the internal examination of the principal investigator upon admission. Cohort A is composed of pregnant women admitted at 6cm cervical dilatation fulfilling the Zhang's criteria whereas Cohort B is composed of pregnant women admitted at 4cm cervical dilatation fulfilling the Friedman's criteria. Socio-demographic characteristics were recorded. Their course of labor was monitored; contractions were augmented accordingly if needed. The mode of delivery was noted such as spontaneous vaginal delivery or cesarean section. The neonatal outcome was recorded as to apgar scores obtained for both groups. @*Results@#A greater proportion of parturients were young, single and with normal body mass index. A higher proportion of those under Friedman's group was augmented with oxytocin (100% vs. 53.4%). A greater proportion of those in Zhang's group had successful vaginal delivery (98.2% vs. 81.8%) (p=0.011, OR=18.167, 95% CI: 1.943, 169.867). Parturients under Zhang's group had achieved less hours of active labor. @*Conclusion@#The rate of successful vaginal delivery is significantly different between the two groups. A greater proportion of pregnant women under Zhang's group achieved successful vaginal delivery as compared to Friedman's group.

Conocimiento y práctica sobre lactancia materna de mujeres primigestas derechohabientes de una Unidad de Medicina Familiar / Knowledge and practice about breastfeeding of primigravid women entitled to a Family Medicine Unit

Introducción: la promoción e información a la mujer primigesta sobre la lactancia materna, los beneficios de esta y cómo amamantar correctamente al bebé, mejoran el conocimiento y disminuyen el abandono de la misma. Objetivo: analizar el conocimiento y práctica sobre lactancia materna de mujeres primigestas derechohabientes de una unidad de medicina familiar. Material y métodos: estudio transversal, descriptivo con una muestra de 75 mujeres primigestas de entre 14 y 34 años de edad. Se utilizó el "Cuestionario sobre conocimientos, actitudes y prácticas de la lactancia materna". Se llevó a cabo el análisis con frecuencias simples y porcentajes, medidas de tendencia central (X ± DE), asociación chi cuadrada y prueba exacta de Fisher. Resultados: la edad de las mujeres primigestas fue de 24.88 ± 4.64 años, con predominio de mujeres en el segundo trimestre de embarazo, casadas, con grado de licenciatura, católicas y amas de casa. El nivel de conocimiento fue suficiente en 61.3%, se encontró asociación no significativa entre el nivel de conocimiento, grado académico y ocupación. Conclusión: las mujeres primigestas tienen conocimiento suficiente sobre lactancia materna y sus beneficios. Dicha información es proporcionada principalmente por el personal de enfermería.

Introduction: The promotion and information to the primigravid woman on breastfeeding, the benefits of it and how to breastfeed correctly, improve the knowledge and decreases the abandonment of it. Objective: To analyze knowledge and practice about breastfeeding of primigravid women entitled to a family medicine unit. Methods: A cross-sectional, descriptive study with a sample of 75 primigravid women between 14 and 34 years of age. The "Questionnaire on knowledge, attitudes and practices of breastfeeding" was used. The analysis was carried out with simple frequencies and percentages, measures of central tendency, Chi square association and Fisher's exact test (p < 0.05). Results: The age of the primigravid women was 24.88 ± 4.64 years old, with predominance of women in the second trimester of pregnancy. The level of knowledge was sufficient in 61.3%, a non-significant association was found between the level of knowledge, academic degree and occupation. Conclusion: Primigravid women have sufficient knowledge about breastfeeding and its benefits. This information is provided mainly by the nursing staff.

Obstetrical and Neonatal outcomes of singleton gestations among elderly Filipino primigravids in a tertiary government hospital – A five-year review / Philippine Journal of Obstetrics and Gynecology

Objective@#The elderly primigravid has inherent pregnancy risks which may have deleterious effects on both maternal and fetal outcomes. The purpose of this study is to review the obstetric and neonatal outcomes of singleton gestations among Filipino elderly primigravids who delivered in a tertiary government hospital from January 1, 2012 to December 31, 2016.@*Methods@#This is a retrospective cohort study of including 80 primigravid women aged 35 years and older (study group) and 160 primigravid women aged 20 to 34 years old (control group). Data was collected through review of hospital records, and data processing and analysis were carried out using the software, Stata 13. @*Results@#A total of 24,751 deliveries were attended to for the five-year period covered, giving the elderly primigravids a prevalence of 6.91%, with a mean age of 38 ± 2.63 years (range 35-43). Significantly, more women in the elderly group delivered at less than 36 weeks age of gestation, delivered abdominally, and had a history of infertility and important co-morbid conditions. No significant difference in the neonatal outcomes were noted between the two groups. @*Conclusion@#It can be suggested that there was no noted difference in terms of the maternal and neonatal outcomes between elderly primigravids than otherwise. Nevertheless, inherent differences between the study groups may be clinically important in customizing the management of these women.

Conservative surgery for ruptured ovarian pregnancy in an elderly primigravid

@#<p>Primary ovarian ectopic pregnancy, is one of the rarest forms of ectopic pregnancy. Ovarian ectopic pregnancy may occur with or without the essence of any of the classical risk factors or signs and symptoms. The diagnosis is made often at surgery and required histologic confirmation. This is a case of a primary ovarian pregnancy in a 36-year old elderly primigravida who presented with abdominal pain and subsequently underwent ovarian wedge resection. Diagnosis of ovarian pregnancy was later confirmed using the Spiegelberg criteria. This paper presents a review of literature regarding ovarian pregnancy's clinical presentation, risk factors, and the possibility of a conservative management.</p>

Effectiveness of Benson’s Relaxation Therapy on Reduction of Stress among Primigravid Mothers.

Objectives: The study attempt to assess the effectiveness of Benson’s relaxation therapy on reduction of stress among primigravid mothers attending the outpatient department in a selected hospital at Kannur, with the objectives of evaluating the stress among the primigravid mothers before and after the Benson’s relaxation therapy and to associate the level of stress with selected demographic variables. Methods: A total of 30 primigravid mothers after third month of gestation were selected for the study. The information regarding background data were collected from the primigravid mothers by self-administered rating scale and the level of hemoglobin status was noted from the health records. Selected primigravid mothers were given pretest questionnaire and Benson’s relaxation therapy was administered to all group members for 20 minutes and instructed to continue this for a period of 15 days. Post-test using rating scale was conducted 15 days after the administration of Benson’s relaxation therapy. Result: The result of the study shows that the post-test mean stress score was less than the pre-test mean stress score. The obtained mean difference between the pre-test and post-test regarding stress score was statistically significant. Hence research hypothesis “there will be a significant difference in the stress scores before and after Benson’s relaxation therapy among the primigravid mothers” has been retained. Conclusions: It was inferred that primigravid mothers who practiced Benson’s relaxation therapy had significant decrease in post-test stress score. Also there was significant association with the level of stress and some demographic variables.

Analgesia en primigesta en trabajo de parto con Clorhidrato de Tramadol IM, desde 1 de septiembre de 2013 a 28 de febrero de 2014. Hospital Boliviano Holandés (H.M.B.H.) / Analgesia in primigravida in labor with tramadol hydrochloride IM, from September 1, 2013 to February 28, 2014. Hospital Bolivian Dutch (H.M.B.H.)

Introducción: el trabajo de parto es generalmente un acontecimiento doloroso, 75% de las primigestas en trabajo de parto pueden llegar a presentar dolor intenso asociado con aumento de la presión arterial, el consumo de oxígeno y producen la liberación de catecolaminas que pueden afectar el flujo sanguíneo uterino y comprometer al feto...

Introduction: the labor is usually a painful event; 75% of first time pregnant women in labor could contain intense pain associated with increased blood pressure, oxygen consumption and produce catecholamine release that may affect the flow Uterine blood and engage the fetus...

Postural Changes during First Pregnancy.

Aims: The precise changes in postures of each part of the spine of primigravid women are still ambiguous. This study aimed to find out the spinal curvature and pelvic tilt changes during the first pregnancy. Study Design: Observational longitudinal study (Cohort study). Place and Duration of Study: The study was conducted at a hospital clinic in Iran, between April 2014 and December 2014. Methodology: Thirty primigravid women at the first, second and third trimesters of pregnancy were recruited in this cohort study and their lumbar and thoracic curves changes and pelvic inclination angles were studied and compared with 18 age-BMI matched non-pregnant women. The curves were measured by use of a flexible ruler and the pelvic inclination angle was measured by a pelvic inclinometer device. Before starting the main study, the reliability and repeatability of the measuring tools were confirmed in this study (ICC>0.87). A one-way ANOVA and independent t-test were used for statistical analysis. Results: Marked increased curvature and inclination angles were revealed as pregnancy advanced (P<0.05). The lumbar lordosis significantly increased when the first trimester was compared with the second and third ones. The thoracic curvature showed significantly increased curvature between the first and third and between the second and third trimesters. None of the lumbar or thoracic curve showed significantly difference between the control group and pregnant women during the first trimester of pregnancy. Although ten weeks pregnancy increased lumbar lordosis and thoracic kyphosis (4.2%, 8%, respectively), but it was not significant when compared with no pregnant women. The pelvic inclination angle showed to be more sensitive than spinal curvatures as it showed significant increase within all trimesters and when compared to the control group. Interestingly, it increased nearly 2.5 times more at the end of pregnancy (236%). Conclusion: The present study showed a significant increase in most variables that became higher as the months of pregnancy increased. The results might help clinicians for prescribing suitable exercises or spinal orthoses during pregnancy. More research is recommended in this area in women intending to get pregnant.

Study on the current status of spontaneous abortion of primigravid women in Jiaxing of Zhejiang province, China / 中华流行病学杂志

Objective To study the current status of spontaneous abortion of primigravid women in Jiaxing areas of Zhejiang province of China. Methods We analyzed the data from both perinatal healthcare surveillance program and spontaneous abortion, collected in Jiaxing areas by the Institute of Reproductive and Child Health, Peking University. The study population consisted of 14 769 primigravid women (excluding induced abortion, ectopic pregnancy and molar pregnancy as outcomes) attempting to become pregnant who registered between 1993 and 1995. Results 1454 spontaneous abortion cases were identified, with the spontaneous abortion rate as 9.8% (95% CI:9.3%-10.3%). The mean gestational weeks at pregnancy diagnosis were 7.6±2.1 weeks, the mean gestational weeks at miscarriage were (10.1±3.1) weeks and the incidence of first-trimester (≤12 weeks) spontaneous abortion was 7.3%(95%CI: 6.8%-7.7%), accounting for 73.7% of all the spontaneous abortion cases. A peak for risk of miscarriage was around 8-13 weeks, accounting for 37.7% of all spontaneous abortion. The observed multiple Cox regression model showed that increased spontaneous abortion rates were observed in women with age at pregnancy ≥30, being peasants and with higher education level. Conclusion The spontaneous abortion rate of primigravid women in Jiaxing areas was higher than in other areas of China. The maximum occurrence of spontaneous abortions was during period of 8-13 gestation weeks.