Fetomaternal outcome in caesarean section at full dilatation

Background: To study indications, intraoperative and postoperative complications and fetomaternal outcome in cesarean sections done at full dilatation.Methods: This is a prospective cross-sectional study which was conducted in the department of obstetrics and gynecology, RNT medical college, Udaipur from November 2018 to April 2019. 100 cases of caesarean sections at full dilatation which were performed during this period were analyzed for indications and maternal and fetal morbidity.Results: Among these 100 cesarean sections, majority of cases were in the age group of 21-30 years (46%), booked and  Primigravida(81%).Most common indications were cephalo-pelvic disproportion (27%) and fetal distress (21%). Most commonly baby was delivered either by vertex (44%) or by Patwardhan (31%). Intraoperative complications were higher in terms of hematuria in 41%, Atonic PPH in 35%, uterine incision extension in 28% of cases. In one case bladder injury was noticed. Increased incidence of post-operative febrile illness and wound infection were noted. 44% baby’s required nursery admission, most commonly due to birth asphyxia (16%) and RDS (11%).Conclusions: Cesarean section in the 2nd stage of labor is associated with significantly increased maternal morbidity, Neonatal morbidity and mortality. So proper monitoring during labor and involvement of skilled obstetrician in decision making and delivery is crucial to minimize fetomaternal complications.

Effect of obesity on the outcome of pregnancy in primigravida patients: an Iraqi experience

Background: A parallel rise in the rate of obesity in women in reproductive age; and cesarean section as outcome of pregnancy is noticed in the last years in our society. It is unknown whether this dual rise is related or not. The impact is more evident on primigravida patients, so authors perform this study to assess the impact of obesity on the outcome of pregnancy in primigravida patients in a major obstetrics hospital.Methods: A prospective controlled study was conducted in Ibn Al-Balady obstetrics hospital. It included 121 primigravida patients who were divided into 3 groups according to WHO BMI categories: normal, overweight, and obese. The mode of delivery of these patients is recorded and was assessed in relation to BMI.Results: About 17% of the patients were obese and they needed more emergency CS as a mode of delivery than normal BMI patients (p<0.01). They also had longer second stage of labor (p<0.01) and delivered babies with higher birth weight that the normal group (p<0.05).Conclusions: Obesity constitutes a growing challenge on the outcome of pregnancy, duration of second stage of labor and baby birth weight in primigravida patients. Women who are getting pregnant for the first time should be advised to lower their BMI as a safety measure to avoid emergency cesarean section.

Retrospective analysis of risk factors for low 1-minute Apgar scores in term neonates

The current study was designed to investigate the perinatal risk factors for low 1-min Apgar scores in term neonates. We retrospectively analyzed the maternal and neonatal clinical data of 10,550 infants who were born through vaginal delivery from 37 weeks 0 days to 41 weeks 6 days of single gestation from January 2013 to July 2018. Because the 1-min Apgar score reflects neonatal status at birth, we analyzed the risk factors for low (score <7) 1-min Apgar scores through logistic regression. Among these 10,550 neonates, 339 (3.2%) had low (score <7) 1-min Apgar scores. Among them, 321 (94.7%) were admitted to the neonatology department for further observation or treatment. Multivariate analysis revealed that educational background, body mass index, gestational age, pathological obstetrics, longer duration of the second stage of labor, forceps delivery or vacuum extraction, neonatal weight, neonatal sex, and meconium-stained amniotic fluid were independent risk factors for 1-min Apgar scores <7. Neonates who had low 1-min Apgar scores were more frequently admitted to the neonatology department for further observation or treatment. Early detection of risk factors and timely intervention to address these factors may improve neonatal outcomes at birth and reduce the rate of admission to the neonatology department.

Effects of the combined therapy of the auricular-point pressure at the free position and the unprotected perineal delivery technique during the second stage of labor in the primiparas / 中国针灸

OBJECTIVE@#To observe the effects of the combined therapy of the auricular-point pressure at the free position and the unprotected perineal delivery technique during the 2nd stage of labor in the primiparas so as to improve the clinical delivery quality.@*METHODS@#A total of 146 primiparas who accepted the natural delivery willingly were collected. According to the visit sequence, they were divided into an observation group (72 cases) and a control group (74 cases). The free position and the unprotected perineal delivery were adopted in combination during the labor in both of the two groups. Additionally, in the observation group, the auricular-point pressure with semen vaccariae was intervened when entering the active phase. The points were pengqiang (TF), zigong (uterus), neishengzhiqi (TF), pizhixia (AT), shenmen (TF), jiaogan (AH), pi (CO) and wei (CO). Each point was pressed for 1 to 2 min each time, repeated once every 10 to 20 min until the end of the 2nd stage of labor. The episiotomy rate, perineal laceration degree, perineal pain degree, the duration of the 2nd labor stage, postpartum hemorrhage, postpartum urine retention and neonatal asphyxia rate were recorded and compared in the primiparas between the two groups.@*RESULTS@#The perineal laceration of the degree Ⅲ and Ⅳ did not occur in the two groups. Compared with the control group, the effect on the perineal laceration was better in the observation group (0.05). In the observation group, the neonatal asphyxia rate was 1.4% (1/72), the postpartum hemorrhage 6.9% (5/72) and the incidence of urine retention 5.6% (4/72), all lower than 10.8% (8/74), 18.9% (14/74) and 17.6% (13/74) in the control group respectively (all <0.05). In the observation group, on the 1st, 2nd and 3rd days after labor, the perineal pain degree and the duration of the 2nd stage of labor were superior to the control group (all <0.001).@*CONCLUSION@#The combined therapy of the auricular-point pressure intervention at the free position and the unprotected perineal delivery technique effectively reduces the episiotomy rate and perineal laceration degree, relieves the perineal pain, reduces the neonatal asphyxia rate and improves the delivery quality during the 2nd stage of labor in the primiparas.

Mueller-Hillis maneuver and angle of progression: Are they correlated? / Manobra de Mueller-Hillis e ângulo de progressão: eles estão correlacionados?

Summary Objective: Mueller-Hillis maneuver (MHM) and angle of progression (AOP) measured by transperineal ultrasound have been used to assess fetal head descent during the second stage of labor. We aimed to assess whether AOP correlates with MHM in the second stage of labor. Method: A prospective observational study including women with singleton pregnancy in the second stage of labor was performed. The AOP was measured immediately after the Mueller-Hillis maneuver. A receiver-operating characteristics (ROC) curve analysis was performed to determine the best discriminatory AOP cut-off for the identification of a positive MHM. A p-value less than 0.05 was considered statistically significant. Results: One hundred and sixty-six (166) women were enrolled in the study and 81.3% (n=135) had a positive MHM. The median AOP was 143º (106º to 210º). The area under the curve for the prediction of a positive maneuver was 0.619 (p=0.040). Derived from the ROC curve, an AOP of 138.5º had the best diagnostic performance for the identification of a positive MHM (specificity of 65% and a sensitivity of 67%). Conclusion: An AOP of 138º seems to be associated with a positive MHM in the second stage of labor.

Resumo Objetivo: A manobra de Mueller-Hillis (MHM) e o ângulo de progressão da apresentação (AOP) medido através de ecografia transperineal têm sido utilizados para avaliar a descida do polo cefálico durante o segundo estágio do trabalho de parto. O objetivo do nosso trabalho foi avaliar se o AOP se correlaciona com a MHM no segundo estágio do trabalho de parto. Método: Conduzimos um estudo observacional e prospectivo. Incluímos mulheres com gravidez unifetal com feto em apresentação cefálica, no segundo estágio do trabalho de parto. O AOP foi medido imediatamente após a manobra de Mueller-Hillis. Foi construída uma curva ROC (receiver-operating characteristics) para determinar o melhor AOP para a identificação de uma manobra positiva. Um valor p inferior a 0,05 foi considerado estatisticamente significativo. Resultados: Cento e sessenta e seis mulheres (166) foram incluídas no estudo, e em 81,3% (n=135) a MHM foi positiva. A mediana do AOP foi de 143º (106º a 210º). A área abaixo da curva para a previsão de uma manobra positiva foi 0,619 (p=0,040). Derivado da curva ROC, um AOP de 138,5º teve o melhor desempenho diagnóstico para a identificação de uma MHM positiva (especificidade de 65% e sensibilidade de 67%). Conclusão: Um AOP de 138º parece estar associado com uma MHM positiva no segundo estágio de trabalho de parto.

Effect of the hand-and-knee position on the second stage of labor under continuous epidural block anesthesia / 现代临床护理

Objective To compare the fetal and maternal outcomes of labor undergoing epidural block anesthesia with and without using hand-and-knee position in the second stage of labor.Methods A total of 1,158 subjects were included in the study.There were 560 subjects in the study group and 598 cases in the control group.All the subjects were divided into study and control group according to the randomized numbers.Both groups underwent epidural block anesthesia and used the same labor way in stage I and stage 3.In the study group,the hand-and-knee position was used for 15～30 minutes combined with uterine contractions and the delivery was done in the lithotomy position.In the control group,the gradidea took the semi-recumbent position with bent knees and bed elevated 40°,combined with uterine contractions until the delivery was done in the lithotomy position.The labor time of stage1,stage2,stage3 and all abor,labor way,perinaueum,complications and newborns were compared.Results The average time of the second stage labor and all labor in the observation group were significantly shorter than those of the control group (P＜0.05).The labor ways in the observation group was better than that of the control group (P＜0.05).The incidence of postpartum urinary retention in the observation group was significantly lower than that of the control group (P＜0.05).The differences of labor time for stage 1,stage2,perinaueum,blood loss rate,newboms' s tomor and neonatal asphyxia between two groups were not statistically significant (P＞0.05).Conclusions Under continuous epidural block anesthesia,the use of the hands-and-knees position in the second stage of labor can reduce the incidence of operative delivery,shorten the labor process,and reduce maternal complications.The method is worthy of promotion.

Comparison of the Maternal and Neonatal Outcomes in Parturients with Abnormal Second Stage of Labor between Forceps Delivery and Emergency Cesarean Section / 昆明医科大学学报

Objective To investigate the influence of forceps delivery or emergency cesarean section on the maternal and infant outcome in pregnant women with abnormal second stage of labor.Methods We retrospectively analyzed the clinical data of 118 parturients with abnormal second stage of labor in the department of obstetrics and gynecology in our hospital from 2013 January to 2015 February.The involved parturients with abnormal second stage of labor received different delivery modes including forceps delivery and emergency cesarean section, and the delivery time and its influence on the maternal and infant outcome were compared.Results The mean delivery time of forceps delivery and emergency cesarean section was (14.8 ± 5.3) and (32.7 ± 12.6) minutes, the difference was significant (P＜0.05).The bleeding probability and the occurrence of severe neonatal asphyxia in the forceps delivery group was obviously lower than that of maternal emergency cesarean section group (P＜0.05).The influence of emergency cesarean section on the newborn severe asphyxia was more serious than forceps delivery (P ＜0.05).There was no statistical difference in the mild asphyxia, facial bruising, scalp hematoma and neonatal pneumonia between the two groups.Conclusion Compared with emergency cesarean section, forceps delivery can protect the safety of mother and child can reduce dystocia risk coefficient for the pregnant women with abnormal second stage of labor.

Research in the pudendal nerve block anesthesia timing during second stage of labor / 中国实用护理杂志

Objective To discuss the influence of pudendal nerve block anesthesia on pain degree and labor course when presentation at different positions during the second stage of labor,in order to find the better anesthesia timing and method to reduce pain,shorten labor,increase maternal comfort to a maximum extent and provide the best service for the maternal.Methods 200 cases of primiparas with fullterm and single-birth were selected and numbered randomly,patients with odd numbers were set to the observation group,patients with even numbers were set to the control group,100 cases in each group.In the observation group,when the presentation reached S+1,1％ lidocaine was used to perform pudendal nerve block anesthesia.In the control group,the pudendal nerve block anesthesia was performed before perineal incision.Results The pain intensity,time of the second labor stage,perineum damage degree between the two groups were statistically different.The observation group with Ⅱ-grade level,Ⅲ-grade level pain were 32 cases less than that of the control group.The perineum incision later crack number in the observation group was 24 cases less than that of the control group.The number of delivery within 1 hour in the second labor process in the observation group was 21 cases more than that in the control group.Conclusions Implementation of bilateral pudendal nerve block anesthesia in the second stage of labor when the presentation reaches S+1 can alleviate childbirth pain,shorten the second stage of labor,reduce the degree of perineal trauma.

Clinical discussion for changing the position of parturient to promote birth process / 中国综合临床

Objective To discuss the effect on promoting the progress of the stage of labor and the natural delivery as the parturient adopts the different delivery position in the first and the second stage of labor. Methods One hundred and fifty-two cases of delivery primiparas of cephalic presentation whose pregnancy was from 37 to 41 weeks were enrolled and divided into two groups randomly. In the observation group (80 cases) ,the free positions of delivery like walking,squating,lateral position,half lying and others could be selected in the first stage of labor, the semi-reclining position was selected in the second stage of labor and the lithotomy position was adopted when the head was visible on vulvae gapping. The parturient in the control group (72 cases) selected the decubitus (alternation between prostration and lateral position) in the first stage of labor and the parturient selected routine lithotomy position of supine position in the second stage of labor. The progress of labor and the comfort of the parturient in the two groups were observed. Results In the observation group, time spent in the first stage and second stage were (361. 83 ± 58. 02) mins and (36. 39 ± 11. 97) mins, and (398.21 ±59. 72) mins in the total birth process, which were significantly shorter than those of (560.85 ± 131. 98)mins and (58.11 ± 15.44) mins, and (618. 96 ± 139. 61) mins, respectively (t = 12. 24,9. 74 and 12. 90, Ps <0. 01). There were 13 and 25 cases experienced tingle in two hours after delivery, and 2 and 10 cases in 12 hs after delivery, in the observation and control group, respectively. The comfort of parturient in the observation group was higher than that in the control group (x2 = 6. 90, P < 0.01; x2 = 5. 28, P < 0. 05)respectively. Conclusion The free position in the first stage of labor and the semi-reclining position in the second stage of labor can shorten the birth process effectively and relieve the discomfort after the delivery.

Application effect of massaging Changqiang acupuncture point during the second labor course / 中国实用护理杂志

Objective To investigate the effect of massaging Changqiang acupuncture point during the second labor course of primiparas. Methods 124 primiparas were randomized into the observation group(63 cases)and the control group (61 cases). In the observation group, after entering the second stage of labor, Changqiang point was massaged upwards by using index finger and middle finger, and at the same time primiparas were guided to hold breath to coordinate with uterine contraction to make effort to the anus point which was massaged. While the control group were directed with routine way of correctly using abdominal pressure during process of uterine contraction in the second stage of labor. Results The lasting time of uterine contraction was significantly longer in the observation group than in the control group, the time of second stage of labor was shorter, and the amount of postpartum hemorrhage in the observation group was less than those in the control group. Conclusions Application of massaging Changqiang acupuncture point could prolonge the time of uterine contraction, advance the progress of second stage of labor, and decreased the amount of postpartum hemorrhage.