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Background: Epidural analgesia is the most effective method of pain relief during labour and the only method that provides complete analgesia without maternal or foetal adverse effects. This study aimed to assess the mode of delivery outcomes of labour in women who had received effective epidural analgesia.Methods: After ethical approval, this quasi-experimental study was carried out in Dhaka Medical College Hospital for one year, from July 2021 to June 2022. A total of 100 admitted pregnant women (37 weeks to 41 weeks) in the labour ward were included in the study according to the inclusion and exclusion criteria. Among them, 50 women were in group A (with epidural analgesia), and the other 50 were in group B (without epidural analgesia). A detailed history and thorough clinical examination were carried out on each patient. Data were collected in separate case-record forms and analyzed using SPSS 24.Results: Mean age, gestational age, parity, and body mass index were statistically similar in both group A and B. Normal vaginal delivery rate (86% vs. 90%), instrumental delivery rate (10% vs. 6%), and caesarean section rate (4% vs. 4%) were not significantly different in both groups. Besides, both group A and B had statistically similar APGAR scores at 1st (8.66±0.87 and 8.80±0.83 respectively, p=0.414) and 5th min (9.66±0.68 and 9.74±0.59 respectively, p=0.537).Conclusions: Epidural labour analgesia can be safely recommended as a method of labour analgesia, provided the prerequisites are fulfilled. It has no significant adverse effect on the mode of delivery.
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Background: Mode of delivery is determined by a variety of feto-maternal factors like fetal presentation, maternal age, parity as well as environmental factors such as place of residence, quality of ANC care etc. Aim was to assess if neonatal birth wight (NBW) affected the mode of delivery at a tertiary level maternity hospital in urban Mumbai.Methods: Ours was an observational study having cross sectional design, utilizing data retrieved from hospital records, conducted at Cama and Albless Hospital in Mumbai over 3 months- July 2023 -September 2023. Data regarding maternal parity, age, mode of delivery and neonatal birth weight was compiled in Microsoft Excel 2017 from hospital records after taking Ethics Committee permission for the same.Results: In n=104 live viable term singleton pregnancies observed over 3 months LSCS rate of 25.96% was observed, higher Neonatal birth weight (NBW) was associated with caesarean delivery. 89% of the underweight neonates (<2.5kg) delivered vaginally while 100% of the macrocosmic neonates (>4kg) were delivered by LSCS. Maternal age correlated positively with neonatal weight and parity. Neonatal sex was not associated with mode of delivery or NBW.Conclusions: Mode of delivery is affected by NBW, but not by maternal age or neonatal sex. Mode of delivery in first pregnancy significantly determines mode of delivery in subsequent pregnancies.
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Objective To observe the changes of laboratory blood indexes in patients with intrahepatic cholestasis of pregnancy(ICP),and analyze the value of blood inflammation indexes and liver function indexes in the diagnosis of ICP and the prediction of delivery mode.Methods A total of 251 patients diagnosed with ICP in this hospital from January 2021 to December 2022 were selected as the ICP group,and another 200 healthy pregnant women were selected as the control group.The patients with ICP were further divided into the severe ICP group(n=47)and the mild ICP group(n=204),the vaginal delivery group(n=113)and the cesarean section group(n=138)according to the severity of ICP and delivery mode.Mann-Whitney U test was used for comparison of parameters between groups,and Spearman method was used for correlation analy-sis.Receiver operating characteristic(ROC)curves were used to evaluate the efficacy of laboratory indicators in diagnosing ICP and predicting delivery mode.Results Neutrophil/lymphocyte ratio(NLR)[6.01(4.45,8.37)vs.3.36(4.12,3.51)]and aspartate transaminase(AST)level[20.00(16.00,33.00)U/L vs.15.00(13.00,18.00)U/L]in the ICP group were significantly higher than those in the control group(P＜0.05),and NLR in the severe ICP group was significantly higher than that in the mild ICP group[4.93(3.87,7.35)vs.4.14(3.12,5.17),P＜0.05].Correlation analysis showed that NLR was positively correlated with AST level(r=0.279,P＜0.001)and ICP severity(r=0.139,P=0.028)in patients with ICP.The area under ROC curve(AUC)of NLR combined with AST for ICP diagnosis was 0.882(95％CI:0.851-0.913).In ad-dition,cholinesterase(CHE)[6 020.00(5 499.50,6 703.50)U/L vs.5 341.50(4 651.75,6 259.25)U/L]and prealbumin(PA)[199.00(177.71,225.20)mg/Lvs.169.17(139.18,204.40)mg/L]levels in the va-ginal delivery group were significantly higher than those in the cesarean section group(P＜0.05),and the AUC of CHE combined with PA for predicting vaginal delivery in ICP patients was 0.727(95％CI:0.664-0.789).Conclusion NLR and AST have potential value in the diagnosis of ICP,and CHE and PA have poten-tial value in predicting delivery mode of ICP patients.
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Background: Labour is a natural phenomenon which produces intolerable pain that requires effective methods for pain relief which is often challenging and complex task without regional analgesia. Epidural analgesia is most widely accepted method used to reduce labour pain. Aims and objectives were assessment of epidural analgesia in pain relief during labour, duration of different stages of labour, maternal and foetal outcome.Methods: This study was a prospective observational study conducted at RL Jalappa Hospital, Kolar from January 2020 to June 2021. 40 women admitted for normal vaginal delivery opting labour analgesia were studied. Data collected was entered in Microsoft excel spread sheet and results were analysed.Results: The mean duration of first stage of labour was 153 minutes, mean duration of second stage was 30 minutes, and mean duration of third stage was 12 minutes. During first stage of labour, 20 women (52%) had no pain, 12 women (31%) had mild pain and 6 women (15%) had moderate pain. During second stage of labour, 16 women (42%) had mild pain, 15 women (39%) had no pain and 7 women (18%) had moderate pain. During third stage of labour, 30 women (78.9%) had no pain and 8 women (21%) had mild pain. The mean Apgar score of all babies at 1 minute was 7/10 and 5 minute was 9/10.Conclusions: Epidural analgesia is a safe and effective technique during labour and provides significant pain relief with excellent patient satisfaction.
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Background: Twin pregnancies present significant challenges for obstetricians worldwide. Although they account for a relatively small percentage of global births, their occurrence varies across different regions. The increasing utilization of assisted reproduction techniques and the advancing maternal age contribute to the growing incidence of twin pregnancies. As a result, it is essential to understand the implications and risks associated with multiple gestations. The objective was to determine the burden of twin pregnancies, identify maternal risk factors, assess fetal outcomes, and explore potential associations between these factors.Methods: Data were collected from hospital records, including information on maternal age, parity, method of conception, gestational age, pregestational body mass index (BMI), and family history. Maternal and fetal complications, mode of delivery, and high-risk conditions in the fetuses were documented. Statistical analysis was performed using the Fisher-exact test.Results: The study included 78 twin pregnancies. The majority of women (78.2%) fell within the age range of 21-30 years. The majority of women (70.5%) had a normal pregestational BMI. Preterm births occurred in 24.3% of twin pregnancies. Hypertensive disorders (24.0%) and foetal malpresentation (38.0%) were common indications for cesarean section. Fetal complications included intrauterine growth restriction (11.5%), birth weight discordance (25.0%), early neonatal deaths (14.7%), and low APGAR scores (16.0%).Conclusions: Twin pregnancies present challenges due to the increased risks of maternal complications, preterm birth, and adverse fetal outcomes. The study emphasizes the need for careful management and monitoring of twin pregnancies to improve outcomes.
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Background: Labour is a natural phenomenon which produces intolerable pain that requires effective methods for pain relief which is often challenging and complex task without regional analgesia. Epidural analgesia is most widely accepted method used to reduce labour pain. Aims and objectives were assessment of epidural analgesia in pain relief during labour, duration of different stages of labour, maternal and foetal outcome.Methods: This study was a prospective observational study conducted at RL Jalappa Hospital, Kolar from January 2020 to June 2021. 40 women admitted for normal vaginal delivery opting labour analgesia were studied. Data collected was entered in Microsoft excel spread sheet and results were analysed.Results: The mean duration of first stage of labour was 153 minutes, mean duration of second stage was 30 minutes, and mean duration of third stage was 12 minutes. During first stage of labour, 20 women (52%) had no pain, 12 women (31%) had mild pain and 6 women (15%) had moderate pain. During second stage of labour, 16 women (42%) had mild pain, 15 women (39%) had no pain and 7 women (18%) had moderate pain. During third stage of labour, 30 women (78.9%) had no pain and 8 women (21%) had mild pain. The mean Apgar score of all babies at 1 minute was 7/10 and 5 minute was 9/10.Conclusions: Epidural analgesia is a safe and effective technique during labour and provides significant pain relief with excellent patient satisfaction.
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Background: Twin pregnancies present significant challenges for obstetricians worldwide. Although they account for a relatively small percentage of global births, their occurrence varies across different regions. The increasing utilization of assisted reproduction techniques and the advancing maternal age contribute to the growing incidence of twin pregnancies. As a result, it is essential to understand the implications and risks associated with multiple gestations. The objective was to determine the burden of twin pregnancies, identify maternal risk factors, assess fetal outcomes, and explore potential associations between these factors.Methods: Data were collected from hospital records, including information on maternal age, parity, method of conception, gestational age, pregestational body mass index (BMI), and family history. Maternal and fetal complications, mode of delivery, and high-risk conditions in the fetuses were documented. Statistical analysis was performed using the Fisher-exact test.Results: The study included 78 twin pregnancies. The majority of women (78.2%) fell within the age range of 21-30 years. The majority of women (70.5%) had a normal pregestational BMI. Preterm births occurred in 24.3% of twin pregnancies. Hypertensive disorders (24.0%) and foetal malpresentation (38.0%) were common indications for cesarean section. Fetal complications included intrauterine growth restriction (11.5%), birth weight discordance (25.0%), early neonatal deaths (14.7%), and low APGAR scores (16.0%).Conclusions: Twin pregnancies present challenges due to the increased risks of maternal complications, preterm birth, and adverse fetal outcomes. The study emphasizes the need for careful management and monitoring of twin pregnancies to improve outcomes.
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Background: Information regarding the effects of COVID-19 on pregnancy outcomes evolved rapidly in the recent years. This study aims to present the outcomes in COVID-19 positive pregnant women.Methods: This retrospective cohort study was conducted in a tertiary health care center of Uttarakhand, India from April 2021 to June 2021. The maternal and neonatal data for the included cases were extracted from hospital records and appropriately analysed.Results: The positivity rate of COVID-19 among obstetric population was 7.9% by universal screening protocol. 55.2% participants were in the age group of 25-30 years. Gestation age at presentation ranged from 6 weeks to 41 weeks. 47.3% participants had pre-existing comorbidities. 26.4% study subjects had pregnancy related comorbidities, the most common being gestational diabetes mellitus (14.7%), followed by pre-eclampsia (8.8%). Only 21.1% participants were symptomatic at presentation. Most common presenting symptom was fever (87.5%) followed by breathlessness (62.5%). 7.5% required invasive ventilation and 10.5% cases required intensive care unit (ICU) admission and 76.5% participants underwent caesarean section which was done for obstetric indications only. 3.9% participants died due to COVID-related complications. Nearly 35% neonates were preterm, 29.4% had low birth weight and 24.1% needed neonatal intensive care unit (NICU) admission. Nasopharyngeal swab for COVID reverse transcriptase-polymerase chain reaction (RT-PCR) after 24 hours of birth was negative in all neonates. There were 10 (14.7%) stillbirths.Conclusions: COVID-19 in pregnancy was associated with higher risks of gestational diabetes mellitus, preeclampsia and higher rates of invasive ventilation, ICU admission, caesarean sections, maternal mortality specially in women with pre-existing comorbidities, stillbirths, preterm births and NICU admission.
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Background: The incidence of cardiac diseases in pregnancy ranges from 1 to 3%. Pregnancy in women with heart disease is associated with considerable mortality and morbidity. Thorough prenatal care and team approach involving obstetricians, cardiologists, anaesthesiologists and neonatologists can improve the maternal and fetal outcome in these women. Rheumatic heart disease is still the leading cause of maternal heart disease during pregnancy in developing countries.Methods: Between February 2022 and August 2022, a retrospective research at the RL Jalappa Hospital in Kolar was carried out. Out of 764 deliveries made at the facility throughout the study period, 30 singleton pregnancies complicated with heart disease admitted department of obstetrics and gynaecology at different periods of gestation. The maternal and perinatal outcome was thus noted.Results: Out of 764 deliveries, 30 women were found to have been complicated with heart disease. Overall incidence was 3.9%. Rheumatic heart disease was the most common heart disease seen among them. The most common congenital heart disease present was atrial septal defect (ASD). The most common cause for LSCS was fetal distress. 93.3% of the babies delivered were shifted to NICU, with the most common cause being, preterm and low birth weight. No maternal mortality seen, though 1 neonatal mortality present due to extreme low birth weight.Conclusions: A multidisciplinary team approach including obstetrician, cardiologist, pediatrician and anesthesiologist is needed in the cases of pregnancy with heart disease to determine the mode of delivery, timing of delivery, change in anticoagulant drugs in pregnancy, type of anesthesia, care of neonate, and follow-up of mother for better maternal and fetal outcomes.
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Background: Preeclampsia is new onset hypertension of more than 140/90 mmHg on 2 occasions, 4 hours apart in pregnancy, which occurs after 20 weeks of gestation and frequently near term. If there are other symptoms like as headache, blurred vision from end organ damage, and thrombocytopenia, it is characterized as severe preeclampsia. Regardless of the foetal outcome, treatment for severe preeclampsia is immediate delivery. The goal of the current study is to assess how different delivery methods affect individuals with severe preeclampsia.Methods: It is a retrospective study conducted in RL Jalappa hospital, Kolar from January 2021 to February 2022. Out of 2568 deliveries at our facility throughout the study period, 150 singleton pregnancies complicated by severe preeclampsia delivered at 24-34 weeks of gestation were chosen for the study. Women who had additional obstetric, foetal, or medical difficulties were not included in the study.Results: 110 study participants had an LSCS form of delivery out of the total. Among them, non-reassuring fetal heart rate, obstructed labor, and malpresentation were the most typical indicators for LSCS. The difference between Bishop's score and the mode of delivery was statistically significant. There was no discernible difference between the newborn's APGAR score immediately following delivery and the method of delivery.Conclusions: There are strong chances of a normal vaginal birth if the Bishop score at the time of admission and induction is more than 4.
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Background: Early initiation of breast feeding and feeding exclusively for six months have great implication for the survival, well-being and growth of new borne. Factors such as maternal age, occupation, religion, spouse age, spouse occupation, parity, antenatal care (ANC) attendance, mode of delivery (MOD) and birth order are significantly associated with exclusive breast feeding (EBF) Methodology: The study is a descriptive cross-sectional study conducted among nursing mothers attending child health clinic in General Hospital Bonny, in Bonny Island, Rivers State, Nigeria. All eligible nursing mother who presented at the clinic were enlisted for the study. Enlistment of eligible participants was done on every child welfare clinic day. Data was collected using a pretested, interviewer administered, structured questionnaire which was adapted and prepared in English Language. Categorical data was analyzed using multinomial logistic regression model with statistical significance set at 0.05. Result: Results from this study identified significant association between EBF and some maternal variables such as age, occupation and religion. Spouse age and occupation were significantly associated with EBF. ANC attendance, gestational age, MOD, parity and birth order were also significant variables associated with EBF. Conclusion: Maternal variables such as age, occupation, religion, parity, MOD, ANC attendance including spouse age and occupation significantly influence EBF of new borne.
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Lactancia Materna , Ocupaciones , Paridad , Recién Nacido Pequeño para la Edad Gestacional , Salud Infantil , Lactancia Materna Complementaria , MadresRESUMEN
Objective:To explore the feasibility of prenatal ultrasound in predicting delivery mode of full-term primipara.Methods:The study prospectively enrolled primiparas with gestational age ≥37 weeks, singleton, cephalic and no contraindications to vaginal delivery who underwent routine prenatal examination in the Third Affiliated Hospital of Sun Yat-sen University from September 2020 to February 2021.In addition to routine fetal ultrasound examination, the transperineal ultrasound examination was performed to assess the angle of progression (AOP), head perineum distance (HPD), the angle of pubic arch and the anteroposterior diameter, left and right diameter, area and perimeter of levator ani hiatus of pregnant women in different states were measured; Cervical length (CL) was examined by transvaginal ultrasound. The delivery mode was tracked, and the indicators related to natural delivery were screened out. Receiver operating characteristic (ROC) curve was used to evaluate the effectiveness of relevant indicators in predicting natural delivery.Results:A total of 142 cases were included in this study, including 112 cases of natural delivery and 30 cases of manual intervention delivery. There were no significant differences in age, gestational weeks, biparietal diameter, head circumference, body mass index (BMI) and neonatal weight between the natural delivery group and the manual intervention delivery group (all P>0.05). Multivariate regression analysis showed that AOP was associated with natural delivery( OR=1.048, P=0.008). ROC curve analysis showed that the area under the curve was 0.648 with AOP 96.92° as the node, and the specificity and positive predictive values were 83.33% and 0.909 1 respectively. Conclusions:It is feasible to predict the mode of delivery by prenatal ultrasound in full-term primiparas. AOP is related to the mode of delivery, which can provide more reference information for clinical practice.
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Background: The objective of this study was to analyse the current obstetric practice regarding breech presentation, document the incidence, perinatal outcome and the factors influencing perinatal outcome in breech deliveries.Methods: It was a retrospective observational study including 252 cases of breech presentation during January 2018 to December 2019 in a tertiary teaching institute in Vidarbha region of Maharashtra.Results: Total number of breech deliveries 252 (incidence is 2.5%). Caesarean section for breech presentation 95 (37.6%). With vaginal deliveries the Apgar score at 5 min below 7 were among 48 out of 157 breech deliveries whereas with LSCS it was only amongst 7 out of 95 deliveries. The maximum percentage of perinatal mortality is seen with birth weight below 2000 gm. Maximum mortality is seen prior to 32 weeks and in babies who delivered by vaginal route. Respiratory distress with prematurity and severe birth asphyxia are the common causes of perinatal deaths. Total 32 (12.69%) babies were transferred to NICU. 20.38% of the total vaginal breech deliveries and 5.26% of the total LSCS were transferred to NICU. Out of total 32 NICU admissions 22 are for the preterm babies and babies with birth weight below 2000 gm.Conclusions: The perinatal outcome does not depend only on the mode of delivery, it is also affected by the weight of the baby, its maturity, associated congenital anomalies, equipped neonatal intensive care unit and also substantially on the expertise of the obstetrician and the neonatologist.
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Background: Breech presentation is the commonest of all mal presentations. Vaginal delivery of breech presentation at term is associated with a much higher perinatal mortality and morbidity than that of vertex presentation.Methods: This prospective study was carried out in the department of obstetrics and gynaecology, S. S. G. Hospital, Baroda for a period of six months from 1st May 2019 to 31st October 2019. Out of a total number of 4476 deliveries, 159 were breech pregnancy. It included all the women admitted in labour room or ward who delivered with clinical or ultrasound diagnosis of breech presentation after 20 weeks of gestation.Results: In the present study incidence of breech pregnancy was 3.6%. Authors observed the highest incidence of breech pregnancy in the age group of 20 to 25 years. Maximum (62.9%) cases delivered after 37 weeks of gestation. In our study 62.3% cases were primigravida and 37.7% were multigravida. Majority of cases (77.4%) delivered by caesarean section. Among all the babies born 50.6% were having birth weight of less than 2.5 kg.Conclusions: Authors need to study and analyse all cases of breech pregnancy individually to decide the management and mode of delivery depending on cases to case basis and expertise of the staff available. Delivery of breech foetus should be conducted by experience obstetrician after appropriate consent from pregnant women and her relatives.
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Background: Meconium staining of amniotic fluid (MSAF) is a significant risk factor for the subsequent development of meconium aspiration syndrome (MAS), respiratory distress and eventual respiratory failure in neonates. To learn more about the risk factors and outcomes associated with MSAF, a prospective case control study was conducted. The objective of the study was to study various maternal risk factors associated with MSAF and to study the outcome of neonates born through MASF and to compare the perinatal outcome in patients with thick and thin meconium stained amniotic fluid.Methods: A hospital based prospective case control study was conducted comparing pregnant women with meconium stained (cases) amniotic fluid with pregnant women having clear liquor (control), 200 in each arm. Singleton pregnancies complicated with MASF were included in the cases group on the basis of predefined inclusion criteria. Various risk factors, mode of delivery, outcome of neonates and perinatal outcome in babies born through thick and thin meconium stained amniotic fluid was studied.Results: Out of 200 patients who had MSAF 114 patients (57%) had thick meconium stained liquor while remaining 86 patients (43.00%) had thin meconium stained amniotic fluid. Post-maturity, pregnancy induced hypertension; oligohydramnios and prolonged labor were found to be statistically significant risk factors for MSAF. Nonreactive non-stress test and Need for cesarean section was more common in women with MSAF as compared to women with clear liquor (p <0.05). Common morbidities in neonates were Birth asphyxia (15%) followed by meconium aspiration syndrome (10%) and hypoxic ischemic encephalopathy (15%).Conclusions: Meconium stained amniotic fluid is more commonly associated with post-maturity, pregnancy induced hypertension, oligohydramnios and prolonged labor low APGAR score and higher incidence of birth asphyxia and NICU admissions. Appropriate management of neonates with meconium aspiration syndrome is crucial to prevent neonatal mortality.
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Aims and Objectives: The aim of the study was to study the perinatal outcome of the second twin with respect to mode of delivery.Materials and Methods: Consecutive pregnant women having twin pregnancies beyond 28 weeks of gestation admitted tothe department of the institute during the period from April 2016–May 2017 were included in the study.Results: A total of 50 cases were enrolled in the study. Vaginal, ventouse/forceps, and lower segment cesarean section (LSCS) werethe different modes of delivery consisting of 48%, 2%, and 50% of cases, respectively. Perinatal loss of the second twins was higher inLSCS group consisting of 61.11% of cases. Perinatal loss of the second twins was 100% for monochorionic monoamniotic pregnancieswhereas 33.33% for monochorionic diamniotic and 29.03% for dichorionic diamniotic pregnancies. The delivery time interval of <10 minbetween the first and second twin had the higher second twin perinatal loss, i.e., 37.14% and less poor APGAR score, i.e., 57.14% incomparison to time interval of 10–30 and >30 min groups but statistically insignificant. For second twin, vertex presentation had higherpoor APGAR score compared to non-vertex presentation, i.e., 65.63% versus 55.56%. Poor APGAR score was found to be higher incesarean section, outlet forceps and vaginal mode of deliveries consisting of 60%, 100%, and 62.5%, respectively. In overall, 64% ofsecond twins and 84% of first twins were alive, and the difference had P = 0.034. About 62% of second twins and 34% of first twinswere having poor APGAR score of <7, and the difference had P = 0.005. About 67.44% and 76.92% of second twins were found tobe alive higher in maternal age group of ≥20 years and multigravida group, respectively, having P < 0.05. About 64.52% and 100% ofsecond twins were alive higher in <37 weeks gestational age group and birth weight of second twin ≥2500 kg groups, respectively, withP < 0.05. Second twins were having higher alive in vertex-non-vertex presentation, vaginal mode of delivery for both the twins, DCDAgroup and intertwin delivery interval of 10–30 min groups consisting of 71.43%, 72%, 70.97%, and 77.78%, respectively, with P > 0.05.Conclusion: The perinatal mortality of 2nd twin is higher than that of 1st twin in terms of monochorionic, prematurity, and lowbirth weight. Intensive labor monitoring, safe delivery, and improved neonatal care facilities appear to be the major areas toimprove the perinatal outcome.
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Background: To study the association between cervical favorability at admission and maternal, perinatal outcome. To study the association between mode of delivery and maternal, perinatal outcome in eclampsia.Methods: This was a retrospective cohort study carried out in a tertiary hospital. All women (92) admitted with antepartum eclampsia from April 2015 to April 2016, with >32 weeks gestation, reassuring foetal heart and no other complications were included in the study. They were divided into two cohorts delivery, maternal and perinatal outcomes were compared between the two groups.Results: Group with favourable cervix achieved higher vaginal deliveries. Perinatal mortality and morbidity were significantly higher in patients with unfavourable cervix (mortality 39.6% and 20.5% respectively, p: 0.046: morbidity 25.6% and 7.8% respectively, p: 0.033), more so in vaginal delivery (RR 2.355). However there was no significant difference in maternal morbidity. Higher induction-to-delivery interval was the major contributory factor.Conclusions: Perinatal outcome was worse in patients with unfavourable cervix at induction. This can be attributed to increased induction to delivery time and vaginal route of delivery. Prolonged induction should be avoided in eclampsia.
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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.
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Abstract Objective To access the benefits or harms of an exercise program, based on the current American College of Obstetricians and Gynecologists guidelines, on the mode of delivery, duration and onset of labor. Methods A study performed at the Hospital Senhora da Oliveira between October 2015 and February 2017. This was a quasi-experimental study involving 255 women divided into two groups: an intervention group engaged in a controlled and supervised exercise program during pregnancy (n = 99), and a control group that did not participate in the exercise program (n = 156). Data were collected in two stages: during the 1st trimester biochemical screening (before the beginning of the program), through a written questionnaire, and after delivery, from the medical files of the patients. The significance level in the present study was 5% (p = 0.05). Results The control group had higher odds of induced labor (odds ratio [OR] 2.71; 95% confidence interval [CI]: 1.42-5.17; p = 0.003), when compared with women who underwent the intervention. No differences were found between the groups in instrumental vaginal deliveries, cesarean rate, time until the beginning of the active phase, duration of the active phase, and duration of the second stage of labor. Conclusion The implementation of a controlled and supervised exercise program in pregnancy was associated with significantly lower odds of induced deliveries.
Resumo Objetivo Avaliar o efeito de um programa de exercícios na gravidez (baseado nas recomendações do American College of Obstetricians and Gynecologists) na via, duração e início do trabalho de parto. Métodos Estudo realizado no Hospital Senhora da Oliveira entre outubro de 2015 e fevereiro de 2017. Trata-se de um estudo quasi-experimental com 255 grávidas, divididas em dois grupos: grupo de intervenção, constituído por mulheres que participaram de um programa controlado e supervisionado de exercícios físicos (n = 99), e um grupo de controle, formado por grávidas que não participaram do programa de exercícios (n = 156). Os dados foram colhidos em dois momentos: durante o rastreio bioquímico do primeiro trimestre (antes do início do programa), através de um questionário escrito, e após o parto, através da consulta do processo clínico da paciente. O nível de significância estatística adotado neste projeto foi de 5% (p = 0,05). Resultados O grupo controle apresentou maior probabilidade de indução do trabalho de parto (razão de chances [RC] 2,71; intervalo de confiança [IC] 95%: 1,42-5,17; p = 0,003) quando comparado com o grupo de intervenção. Não foram encontradas diferenças estatisticamente significativas entre os dois grupos em relação à via de parto, tempo até início da fase ativa, duração da fase ativa e duração do segundo estadio do trabalho de parto. Conclusão A implementação de um programa de exercícios controlado e supervisionado na gravidez foi associada a uma probabilidade significativamente menor de indução do trabalho de parto.
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Humanos , Femenino , Embarazo , Adulto , Atención Prenatal/métodos , Trabajo de Parto/fisiología , Terapia por Ejercicio/métodos , Trabajo de Parto Inducido/estadística & datos numéricos , Resultado del Embarazo , Estudios de Casos y ControlesRESUMEN
Objective To explore the choice of re - pregnancy delivery mode after cesarean section. Methods From January 2015 to December 2017,a retrospective study was performed on 576 pregnant women who received re-pregnancy after cesarean section in National Nuclear Corporation 416 Hospital and randomly selected 40 cases of vaginal birth after cesarean delivery(VBAC),40 cases of cesarean section after trial of labor after cesarean delivery(TOLAC) and 40 cases of elective repeat cesarean delivery(ERCD) for comparative analysis.The postpartum hemorrhage,neonatal Apgar score, hospitalization time, hospitalization expenses and complication were compared. Results All the 159 pregnant women chose transvaginal trials and 112 had successful vaginal delivery.The success rate of delivery was 70.4%.Compared with the other two groups,the VBAC group had less postpartum hemorrhage [(172.50 ± 59.86) mL,(281.25 ± 192.05 ) mL, ( 260.00 ± 125.68 ) mL],less average hospital stay [(3.9 ± 0.9)d,(5.7 ± 1.5) d, (4.6 ± 0.7) d] and lower medical expenses [(6 491.79 ± 1 104.78), (11 871.96 ± 1 784.30),(10 724.69 ± 1 843.63 )], and the differences were statistically significant ( F =7. 086,26. 243, 123.488;P=0.001,0.000,0.000).The neonatal Apgar score,incidence rates of complications ( incomplete uterine rupture,postpartum hemorrhage,urinary retention,thrombotic disease and neonatal conversion) had no statistically significant differences between the two groups ( all P>0.05).The TOLAC failed to change to the cesarean section group compared with the ERCD group,the average hospitalization cost was more [(11 871.96 ± 1 784.30) CNY, (10 724.69 ± 1 843.63)CNY],the average hospitalization days was longer [(5.7 ± 1.5) d,(4.6 ± 0.7) d],the difference was statistically significant (P=0.000,0.005).The postpartum hemorrhage volume,neonatal Apgar score, complications had no statistically significant differences between the two groups( all P>0.05).Conclusion It is safe and feasible to perform vaginal trials under close monitoring without vaginal trials. It is safe and feasible to perform vaginal trials under strict monitoring.Even if the vaginal trial fails to change to cesarean section,it will not increase the occurrence of serious complications.Infant outcomes are good.