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RESUMEN El parto vaginal se asocia con un riesgo más alto de daño perineal, incontinencia urinaria y fecal comparado con el parto cesárea. Dicho riesgo aumenta con el parto instrumental (ej. fórceps) y disminuye cuando la posición al momento del parto reduce la compresión sobre el sacro o si el parto ocurre bajo el agua. En otros factores que aumentan el riesgo de incontinencia se incluyen: la gran multiparidad, la duración del trabajo de parto, el peso fetal y tamaño de su cabeza, la edad muy joven al momento del primer parto, la inducción del trabajo de parto, la obesidad, la diabetes, la constipación, el tabaquismo y la historia de incontinencia urinaria o fecal. Factores sociales que se asocian a incontinencia incluyen la falta de educación, malas condiciones de hábitat, trabajo manual intenso, la falta de actividad física y el divorcio.
ABSTRACT Vaginal delivery is associated with a higher risk of perineal injury, and urinary and fecal incontinence as compared with caesarean delivery; The risk is higher in case of operative vaginal delivery and lower if the position at delivery takes the weight off the sacrum or is carried out under water immersion; A number of other factors increase the risk of incontinence, including higher parity, duration of labour, fetal weight or size of fetal head, younger age at first delivery, induction of labour, obesity, diabetes, constipation, smoking and history of urinary or fecal incontinence. Social factors such as lack of education, poor living environment, intense manual labour, the absence of physical exercise and divorce, are also associated with incontinence.
Subject(s)
Humans , Female , Pregnancy , Perineum/injuries , Urinary Incontinence/etiology , Cesarean Section/adverse effects , Delivery, Obstetric/adverse effects , Fecal Incontinence/etiologyABSTRACT
Background: One of the most severe pain experienced by a woman is during child birth. It is imperative to understand the pain transmission for providing labour analgesia. Hemodynamic status in labour fluctuates greatly during uterine contraction and true labour pains. Therefore, pregnant women with cardiovascular disease need epidural anaesthesia during labour depending upon the type of cardiovascular disease. Objective of this study was to assess the impact of labour analgesia and the obstetric outcome and cardiac events during labour.Methods: This is an observational study conducted in 46 pregnant women with cardiovascular disease during the period of January 2019 to December 2019 (12 months).Results: A total of 46 antenatal mother with cardiovascular disease was admitted in the department of obstetrics and gynecology over a period of one year out of which 25 patients who had epidural analgesia during labour and 21 patients who had no epidural analgesia during labour. Cardiovascular events significantly reduced in epidural group (25 patients) and there was no increase in cesarean section in epidural group.Conclusions: The data showed there was significant decrease in cardiovascular events related to arrhythmia hence decreased maternal morbidity and mortality. There was no associated increase in cesarean section rate but slight increase in instrumental vaginal delivery.
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The second stage of labor begins with full dilatation of cervix and ends with delivery of the fetus. In most of the cases the labor progresses uneventfully, without any need of an active intervention but in few cases complications may occur. With passage of time there has been better understanding about second stage of labor, still there are several grey areas yet to be resolved. This review endeavours to scrutinize a variety of care practices including positions, time and type of pushing, use of epidural analgesia, and perineal support techniques etc and discuss evidence based management of second stage of labor. The review was carried out in the period of 1900-2019 by searching in Pub Med, Embase, Scopus, Google scholar, Web of sciences using relevant key words. Reports, articles, fact sheets and official publications of World health Organization (WHO), Ministry of health and family welfare-Govt of India and various other countries were also reviewed.
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Introduction: Providing effective as well as safe analgesiato the parturients in labour is always a concerned for theanaesthesiologists. We conducted this study to compare theanalgesic efficacy and fetomaternal outcome of ropivacaineand bupivacaine at equianalgesic dose with fentanyl in lowdose infusion.Material and Methods: This prospective, single blind studywas carried on 60 nulliparous parturients of ASA grade Iand II, with uncomplicated singleton, term pregnancy. Thepatients were randomly divided into two groups, to receivebolus dose of either 20 ml of 0.075% Ropivacaine and 0.05%Bupivacaine with fentanyl 2 µg/ml in Group RF and GroupBF respectively, followed by infusion at the rate of 10ml/hr.Onset of analgesia, motor block, maternal hemodynamics,mode of delivery and foetal outcome was assessed.Results: Visual Analog Scale (VAS) score < 3 was achievedin 25 min in Group RF as compared to 30 min in Group BF. At30 min, 77% parturients achieved T10 as compared to 50% ingroup BF. Maternal haemodynamics, APGAR score, umbilicalcord blood analysis was comparable in both the groups. Noneof the patients had motor block in both groups. The percentageof instrumental delivery was more in Group RF.Conclusions: The onset of analgesia was faster in Group RFas compared to Group BF. However once the analgesia wasestablished, both the groups had effective and satisfactoryanalgesia throughout the labour with good foetal outcome.The incidence of instrumental delivery was more in Group RF.
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INTRODUCTION@#This study aimed to compare instrumental vaginal deliveries (IDs) and Caesarean sections (CSs) performed at full cervical dilatation, including factors influencing delivery and differences in maternal and neonatal outcomes.@*METHODS@#A retrospective review was conducted of patients who experienced a prolonged second stage of labour at Singapore General Hospital from 2010 to 2012. A comparison between CS and ID was made through analysis of maternal/neonatal characteristics and peripartum outcomes.@*RESULTS@#Of 253 patients who required intervention for a prolonged second stage of labour, 71 (28.1%) underwent CS and 182 (71.9%) underwent ID. 5 (2.0%) of the patients who underwent CS had failed ID. Of the maternal characteristics considered, ethnicity was significantly different. Induction of labour and intrapartum epidural did not influence delivery type. 70.4% of CSs occurred outside office hours, compared with 52.7% of IDs (p = 0.011). CS patients experienced a longer second stage of labour (p < 0.001). Babies born via CS were heavier (p < 0.001), while the ID group had a higher proportion of occipitoanterior presentations (p < 0.001). Estimated maternal blood loss was higher with CSs (p < 0.001), but neonatal outcomes were similar.@*CONCLUSION@#More than one in four parturients requiring intervention for a prolonged second stage of labour underwent emergency CS. Low failed instrumentation rates and larger babies in the CS group suggest accurate diagnoses of cephalopelvic disproportion. The higher incidence of CS after hours suggests trainee reluctance to attempt ID. There were no clinically significant differences in maternal and neonatal morbidity.
Subject(s)
Adult , Female , Humans , Pregnancy , Young Adult , Cesarean Section , Methods , Databases, Factual , Delivery, Obstetric , Emergency Medical Services , Extraction, Obstetrical , Methods , Labor Stage, First , Labor Stage, Second , Obstetrical Forceps , Retrospective Studies , Risk Factors , SingaporeABSTRACT
La presente investigación es un estudio de tipo descriptivo y retrospectivo en pacientes gestantes que se practican una cesárea, en el cual se buscó identificar los factores maternos y fetales que inducen a la práctica de esta intervención quirúrgica y la caracterización socioeconómica de estas mujeres. Los investigadores elaboraron un instrumento el cual fue validado mediante prueba de expertos y la muestra estuvo constituida por 93 gestantes que se sometieron a una cesárea. Las edades en la que las mujeres más se realizan una cesárea es entre los 20 y 22 años, el nivel socioeconómico más frecuente es el estrato 2, el factor materno más encontrado es el de cesárea electiva y la evidencia de infección intrauterina (Toxoplasmosis) es el factor fetal más encontrado
This research is a descriptive and retrospective study in pregnant patients who underwent caesarean section procedure, which looks for identifying maternal and fetal factors that lead to the practice of this surgery and socioeconomic characterization of these women. The researchers developed an instrument which was validated by experts and the test sample consisted of 93 pregnant women who underwent cesarean section. The ages at which women most performed a Caesarean section is between 20 years old and 22 years old, The most frequent socioeconomic status is "estrato 2" , the maternal factor is the elective caesarean and the most common fetal factor is the evidence of intrauterine infection (toxoplasmosis)
Subject(s)
Parturition , PregnancyABSTRACT
Se realizó un estudio retrospectivo de caso control con el objetivo de conocer los resultados perinatales en las adolescentes atendidas en el Hospital "Clodomira Acosta Ferrales" de Ciudad Habana, del 1ro. de enero de 1999 al 31 de marzo de 2000. El grupo de estudio, 184 adolescentes, se comparó con un grupo control representado por las gestantes de 20 a 24 años (n = 439) atendidas en dicho centro en igual periodo de tiempo. Datos referentes como edad gestacional, modo de parto y peso y Apgar del recién nacido, se recogieron en una encuesta habilitada al efecto y se procesaron utilizando el sistema estadístico computadorizado SPSS. Los resultados se exponen en gráficos,y los más relevantes fueron la mayor frecuencia del parto instrumentado y recién nacidos asfícticos entre las adolescentes. Se concluye que a pesar de la atención especializada, el embarazo precoz continúa siendo un factor de riesgo para obtener resultados perinatales desfavorables.
A retrospective case-control study was conducted aimed at knowing the perinatal results among the adolescents attended at “Clodomira Acosta Ferrales”, in Havana City, from January 1st, 1999 to March 31st, 2000. The study group (184 adolescents) was compared with a control group composed of pregnat women aged 20-24 (n = 439) that received attention in this center in the same period of time. Gestational age, mode of delivery, weight and Apgar score of the infant were some of the data collected by a survey done to this end. These data were processed by using the SPSS computerized statistical system. The results were showed in graphs. The most significant were the highest frequency of instrumental delivery and the asphyxial infants among the adolescents. It was concluded that in spite of the specialized care, early pregnancy is still a risk factor for obtaining unfavorable perinatal results.