Perinatal outcome and risk factors of precipitate labor in term primipara: an analysis of 381 cases / 浙江大学学报·医学版

OBJECTIVE@#To investigate the perinatal outcome and risk factors of precipitate labor in term primipara.@*METHODS@#A total of 6951 full-term singleton primiparas with cephalic vaginal delivery in Women's Hospital, Zhejiang University School of Medicine from January 2020 to December 2020 were enrolled, among whom 381 cases of precipitate labor were classified as the precipitate labor group and 762 cases of normal labor were randomly selected as the control group. The perinatal outcomes of the two groups were compared, and the risk factors of precipitate labor were analyzed by multivariate logistic regression.@*RESULTS@#The incidence of precipitate labor in full-term, singleton pregnancy and cephalic primiparas was 5.48% (381/6951). The durations of the first and second stages of labor in the precipitate labor group were significantly shorter than that in the control group ( P<0.01); while there was no significant difference in the duration of the third stage of labor between the two groups ( P>0.05). Compared with the control group, the incidence of soft birth canal laceration in the precipitate labor group was increased ( P<0.01). However, there was no significant difference in postpartum hemorrhage and neonatal related perinatal outcomes between the two groups (all P>0.05). Multivariate logistic regression analysis showed that maternal height ( OR=1.038, 95% CI: 1.010-1.067, P<0.01), gestational age at delivery ( OR=0.716, 95% CI: 0.618-0.829, P<0.01), late miscarriage ( OR=1.986, 95% CI: 1.065-3.702, P<0.05), membrane rupture before labor ( OR=1.802, 95% CI: 1.350-2.406, P<0.01), labor induction by transcervical balloon ( OR=3.230, 95% CI: 2.027-5.147, P<0.01), labor induction by propess ( OR=2.332, 95% CI: 1.632-3.334, P<0.01) and labor induction by oxytocin ( OR=0.291, 95% CI: 0.219-0.386, P<0.01) were independently associated with precipitate labor.@*CONCLUSIONS@#The incidence of precipitate labor in full-term, singleton pregnancy was not low. Precipitate labor could lead to a significant increase in perineal laceration. Maternal height, history of late miscarriage, membrane rupture before labor and labor induction by transcervical balloon, labor induction by propess are risk factors, while labor induction by oxytocin and late gestational time of delivery are protective factors for precipitate labor in term primipara.

Maniobra Kristeller, consecuencias físicas y éticas según sus protagonistas / Kristeller Maneuver, physical and ethical consequences according to its central characters

Introducción: La maniobra Kristeller consiste en hacer presión del fondo uterino en el período expulsivo, la segunda etapa del trabajo de parto. Objetivo: Determinar la prevalencia, características de la aplicación de la maniobra Kristeller y consecuencias físicas y éticas en puérperas de un hospital de alta complejidad en Lima, Perú. Métodos: Diseño descriptivo transversal y prospectivo. Se incluyeron 250 puérperas de parto vaginal, con gestación única a término, atendidas en el Hospital Nacional Hipólito Unanue, entre agosto y diciembre de 2016. Se usó cuestionario -Stop Kristeller- realizado por la Asociación Española El parto es nuestro. Se les aplicó un cuestionario validado por expertos a las puérperas durante su estancia. Se realizó análisis descriptivo mostrando los resultados en frecuencias y porcentajes. Resultados: Se evidenció que a 116 de ellas (46,4 por ciento) se les realizó la maniobra Kristeller. Con respecto a las características de la realización de la maniobra 77,6 por ciento refirió que se realizó con las palmas de las manos, más del 70 por ciento refirió que fue entre una y tres veces y 75,9 por ciento señaló que solo una persona la realizó. El 32,8 por ciento reportó haber sufrido desgarro vaginal y 51,7 por ciento refirió que no solicitaron su consentimiento para realizar la maniobra. Conclusiones: Existe elevada prevalencia de la utilización de la maniobra, las características de su aplicación siguen pautas descritas por Samuel Kristeller, entre las consecuencias físicas encontradas están los desgarros perineales superficiales y profundos y en muchos casos las condiciones bioéticas no se cumplieron(AU)

Introduction: The Kristeller maneuver consists in making fundal pressure during the second stage of labor. Objective: To determine the prevalence, characteristics of the application of Kristeller maneuver and the physical and ethical consequences in puerperal women of a highly complex hospital in Lima, Peru. Methods: A cross-sectional and prospective descriptive study was carried out in 250 puerperal women of vaginal delivery, with single gestation at term, assisted at Hipólito Unanue National Hospital, from August to December 2016. This research used the Stop Kristeller questionnaire - prepared by the Spanish Association El parto es nuestro. A questionnaire validated by experts was applied to the puerperal women during their stay. A descriptive analysis was made and the results in frequencies and percentages are shown. Results: It was showed that 116 of them (46.4 percent) underwent Kristeller maneuver. Regarding the characteristics of the maneuver performance, 77.6 percent reported that it was performed with hand palms, more than 70 percent reported that this maneuver was done between one and three times and 75.9 percent indicated that only one person performed it. Vaginal tear was reported in 32.8 percent and 51.7 percent reported their consent to perform the maneuver was not requested. Conclusions: There is high prevalence of the use of this maneuver. The characteristics of its application follow the guidelines described by Samuel Kristeller. Superficial and deep perineal tears are among the physical consequences and in many cases, bioethical conditions were not fulfilled(AU)

O Renascimento do Parto / Birth Reborn

O filme "O Renascimento do Parto" retrata a grave realidade obstétrica mundial e sobretudo brasileira, que se caracteriza por um número alarmante de cesarianas ou de partos com intervenções traumáticas e desnecessá¡rias, em contraponto com o que é sabido e recomendado hoje pela ciência. Tal situação apresenta várias consequências perinatais, psicológicas, sociais, antropológicas e financeiras. Através dos relatos de alguns dos maiores especialistas na área e das mais recentes descobertas cientíicas, questiona-se o modelo obstétrico atual, promove-se uma reflexão acerca do novo paradigma do século XXI e sobre o futuro de uma civilização nascida sem os chamados "hormônios do amor", liberados apenas em condições específicas de trabalho de parto.

Indução do parto em pacientes com cesárea anterior / Labor induction in patients with prior cesarian section

Quando a paciente tem uma cesárea anterior e está indicada a interrupção da gravidez, há duas possibilidades de conduta: a repetição da cesárea ou a indução do parto. A cesárea iterativa ou a indução do parto em pacientes com cesárea anterior apresentam riscos e benefícios. Uma complicação rara e perigosa, relacionada à presença de uma cicatriz uterina, é a ruptura uterina. Isso pode ocorrer antes ou durante o trabalho de parto em pacientes com cesárea anterior. Os riscos associados a uma tentativa de parto vaginal são maiores do que aqueles decorrentes de cesárea iterativa, mas permanecem baixos. Acreditamos que, em locais adequados, a indução do parto vaginal após cesárea é uma opção aceitável para mulheres, sem apresentar contraindicações, e é uma conduta obstétrica recomendável.

When a woman has had a previous cesarean section and is indicated interruption of pregnancy, there are two options for her management: elective repeat cesarean or planned induction of labour. Elective repeat caesarean section and induction of labour for women with a prior caesarean are both associated with risks and benefits. One uncommon, but potentially serious complication associated with a prior uterine surgery, including a previous caesarean section, is uterine rupture. This may occur prior to the onset of labour, or during labour in patients with previous cesarean section. The risk associated with an attempted vaginal delivery is greater than the risk associated with an elective repeated cesarean, but it remains low. We believe that, in the appropriate setting, planned induction of labour after a cesarean is an acceptable option for women without other contraindications, and that vaginal birth after a cesarean remains within the standard of care.

Postpartum hemorrhage: an experience at tertiary care hospital

To determine the frequency, causes and various treatment methods used in for postpartum hemorrhage [PPH] our setup. Descriptive study. This study was conducted in the Department of Obstetrics and Gynecology Unit 1, Liaquat University of Medical and Health Sciences Hyderabad, from June 2007 to April 2008. All women admitted with or developed PPH in hospital after delivery or cesarean section were included. Patients with history of bleeding disorders and those on heparin/warfarin were excluded. Results were analyzed through computer software program SPSS version 11 and percentages were used to describe the data. Total number of obstetric admissions during the study period was 1231. Out of these 118 [9.5%] patients developed PPH. Out of these 118 patients, 98[83%] patients had primary PPH while 20[16.9%] patients had secondary PPH. Seventy five [63.5%] patients were unbooked while 43[36.4%] were booked. Regarding causes of PPH, most common cause was uterine atony in 76[64.4%] cases, followed by perineal and vaginal tears in 41[34.7%] patients and prolonged labor in 29[24.5%]. Uterine massage was done in 76[64.4%] patients, B-Lynch sutures were applied in 6[5%] cases and hysterectomy done in 4[3.3%] patients. Majority of patients developed primary PPH and the commonest cause was uterine atony. PPH was commonly seen in unbooked patients, induced/ augmented labor and grand multiparous women

Towards a safer motherhood.

One hundred cases each, in induced and spontaneous labour, were analysed to compare which group could achieve safer motherhood. It was observed that induced group with controlled labour has many maternal and foetal advantages like undisturbed domestic arrangements, avoidance of fatigue of patients and her relations, short duration of labour and minimal exposure to stress of labour, lower incidence of caesarean section and minimised perinatal morbidity and mortality.

Evacuación uterina con prostaglandina E-1 en el hospital nacional Edgardo Rebagliati Martins / Uterine delivery with prostaglandina E-1 in the Hospital Nacional Edgardo Rebagliati Martins

Se presenta el estudio de 113 casos de paciente tratados con Prostaglandina E-1 para evacuación uterina, realizado en el Departamento de Obstetricia del Hospital Nacional Edgardo Rebagliati Martins del Instituto Peruano de Seguridad Social, entre Enero de 1992 y Diciembre de 1993. El motivo del estudio fue la búsqueda de una alternativa al uso de la Oxitocina para la evacuación uterina, en casos en que estuviera indicado dicho procedimiento por alguna razón médica. Se utilizó la vía oral y, en ocasiones se combinó con la vía vaginal. Los resultados fueron exitosos en 103 casos y frustros en 10 (8.8 por ciento). Los efectos colaterales fueron mínimos. Su manejo por vía oral, la rara presentación de efectos secundarios y el bajo porcentaje de casos frustos, lo constituyen en producto a elegir en el diario manejo de la especialidad; su uso acorta la estancia hospitalaria; puede ser utilizado en grandes multíparas y en pacientes cesareadas anteriores; facilitando el tratamiento quirúrgico complementario.

Influencia do uso da ocitocina para conducao do trabalho de parto sobre vitalidade do recem-nato / Influence of the oxyticin use for conduction of the newborn

Foi realizado um estudo retrospectivo com o objetivo de determinar se o uso da ocitocina influencia de alguma forma o estado de vitalidade do recem-nato. Na Maternidade Darcy Vargas, em Joinville(SC), 300 mulheres foram selecionadas dos prontuarios desta instituicao quanto ao uso ou nao de ocitocina para conducao do trabalho de parto. A proposta de analise projeta-se entre dois grupos que sao o de uso de ocitocina e o de nao uso de ocitocina. As conclusoes sao favoraveis ao uso de ocitocina na conducao do trabalho de parto.

Uterine rupture and labor induction with prostaglandins.

Uterine rupture in patients with labor induction with prostaglandin E2 application though uncommon is a very serious complication and preventable in obstetrics. We reported three cases of spontaneous uterine rupture following induction of labor with intracervical PGE2 gel administration in a dosage of 3-6 mg and two in whom labor was augmented with oxytocin infusion. To avoid such a complication, intracervical PGE2 gel administration should be started with a smaller dose and should augmentation with oxytocin be required careful evaluation and monitoring by a specialist is desirable.

Trabajo de parto inducido o conducido y sus efectos sobre la glicemia neonatal / Induced delivery and its efects on neonatal hypoglycemia

Durante los dos meses que duró el estudio se realizaron 360 nacimientos, 34 de los cuales fueron obtenidos por inducción o conducción. A pesar del tiempo corto del estudio y del reducido tamaño de la muestra, se concluye que el empléo de inducto-conducción del parto, no es un factor preponderante o si se quiere relievante en la producción de alteraciones en los niveles normales de la glicemia del recien nacido. Pero si se observa que hay una relación inversa entre tiempo de inducción y glicemia.

Alteraciones neonatales relacionadas con el uso de oxitocina en la madre durante el trabajo de parto / Neonatal alterations related to the use of oxytocin in the mother during labor

Se realiza un estudio prospectivo en 50 neonatos, los cuales fueron divididos en 2 grupos; un grupo control y un grupo en el cual se usó oxitocina para inducir o acelerar el trabajo de parto. Se informa que se les realizó a todas las pacientes un estudio que incluyó varios parámetros: bilirrubina al nacer y a las 72 horas, osmolaridad plasmática, niveles de sodio sérico, hematócrito, glicemia y fragilidad osmótica eritrocitaria al nacer, así como el porcentaje de pérdida de peso en las primeras 48 horas de nacido. Se utiliza para el análisis estadístico de los datos obtenidos la prueba de la t de Student y los datos se procesaron en una computadora CID 201-B. No se encuentran alteraciones significativas en los recién nacidos por el uso de este medicamento durante la labor de parto