Risk factors for mediolateral episiotomy at a tertiary hospital: a cross-sectional study

SUMMARY OBJECTIVE: The main aim of this study was to assess the associated factors for selective mediolateral episiotomy at a tertiary, academic hospital. METHODS: A retrospective cohort analysis between 2017 and 2019 was performed. The primary outcome was the prevalence of selective mediolateral episiotomy. Independent variables were maternal, intrapartum, and neonatal characteristics. A significance level of 5% was established, and univariate and multivariate analyses with logistic regression models were performed. RESULTS: From 2,761 vaginal deliveries eligible for inclusion during this period, the prevalence of selective mediolateral episiotomy was 18.7%. Univariate analysis has shown that non-white women were protective factors (OR=0.77 [0.63-0.96]; p=0.02) for episiotomy; primiparity (OR=2.61 [2.12-3.21]; p<0.01), number of vaginal examinations between 6-10 repetitions (OR=3.16 [2.48-4.01]; p<0.01) and 11-20 repetitions (OR=5.40 [3.69-7.90]; p<0.01), longer second stage duration (OR=1.01 [1.00-1.02]; p<0.01), and women with gestational age more than 37 weeks were risk factors. Multivariate analysis reported that second stage duration (AOR=1.01 [1.00-1.03]; p<0.01), primiparity (AOR=2.03 [1.34-3.06]; p<0.01), and number of vaginal examinations between 6-10 repetitions (AOR=2.36 [1.50-3.70]; p<0.01) and 11-20 repetitions (AOR=3.29 [1.74-6.20]; p<0.01) were remained as risk factors for selective mediolateral episiotomy. CONCLUSION: A higher number of vaginal examinations during labor (over six repetitions), longer duration of second stage labor, and primiparity were risk factors associated with selective mediolateral episiotomy.

Risk Factors for Intrapartum Cesarean Section Delivery in Low-risk Multiparous Women Following at Least a Prior Vaginal Birth (Robson Classification 3 and 4)

Abstract Objective The aim of the present study was to evaluate the risk factors for cesarean section (C-section) in low-risk multiparous women with a history of vaginal birth. Methods The present retrospective study included low-risk multiparous women with a history of vaginal birth who gave birth at between 37 and 42 gestational weeks. The subjects were divided into 2 groups according to the mode of delivery, as C-section Group and vaginal delivery Group. Risk factors for C-section such as demographic characteristics, ultrasonographic measurements, smoking, weight gain during pregnancy (WGDP), interval time between prior birth, history of macrosomic birth, and cervical dilatation at the admission to the hospital were obtained fromthe charts of the patients. Obstetric and neonatal outcomes were compared between groups. Results The most common C-section indications were fetal distress and macrosomia (33.9% [n=77 and 20.7% [n=47] respectively). A bivariate correlation analysis demonstrated that mothers aged>30 years old (odds ratio [OR]: 2.09; 95% confidence interval [CI]: 1.30-3.34; p=0.002), parity >1 (OR: 1.81; 95%CI: 1.18-2.71; p=0.006), fetal abdominal circumference (FAC) measurement>360mm (OR: 34.20; 95%CI: 8.04 -145.56; p<0.001)) and<345mm (OR: 3.06; 95%CI: 1.88-5; p<0.001), presence of large for gestational age (LGA) fetus (OR: 5.09; 95%CI: 1.35-19.21; p=0.016), premature rupture of membranes (PROM) (OR: 1.52; 95%CI: 1-2.33; p=0.041), and cervical dilatation<5cm at admission (OR: 2.12; 95%CI: 1.34-3.34; p=0.001) were associated with the group requiring a C-section. Conclusion This is the first study evaluating the risk factors for C-section in low-risk multiparous women with a history of vaginal birth according to the Robson classification 3 and 4. Fetal distress and suspected fetal macrosomia constituted most of the Csection indications.

A study of caesarean section at full cervical dilatation

Background: Caesarean sections performed in the second stage of labour are difficult and have many implications on both mother and baby. This study was conducted to analyse fetal and maternal outcome in case of caesarean section at full cervical dilatation.Methods: This prospective study was conducted at one of tertiary care teaching institute for period of 1st August 2019 to 31st January 2020. It includes all women delivered by caesarean section at full cervical dilatation at study institute during study period. Cases were looked for parity, maternal age, gestational age, baby birth weight, indication of cesarean section and associated factors.Results: Out of total 3657 deliveries 1690 were delivered by caesarean section, out of which 65 (3.8%) caesarean sections were conducted at full cervical dilation. The most common indication of caesarean section was deep transverse arrest in 66.15% of cases. The maximum number of cases (69.23%) were seen between the age group of 20 to 25 years. Majority of second stage cesarean section (70.77%) were performed in primi gravida. 80% of caesarean sections at full cervical dilatation were performed after 37 weeks of gestation. 15.38% of patients had anemia, 20% had hypertension, 4.61% had history of previous caesarean section. Baby weight at time of birth was 2.5 to 3.5 kg in 67.70% of cases. 15.38% of patients required blood transfusion.Conclusions: A skilled obstetrician is required to take timely and proper decision in such cases and also to conduct cesarean section at second stage of labour.

Validation of a predictive model for successful vaginal birth after cesarean section / Validación de modelos predictivos para parto vaginal exitoso después de cesárea

Abstract Introduction: A strategy for reducing the number of cesarean sections is to allow vaginal delivery after cesarean section. Objective: To validate two predictive models, Metz and Grobman, for successful vaginal delivery after a cesarean section. Methods: Retrospective cohort study involving women with previous history of a previous segmental cesarean section, single pregnancy ≥37 weeks and cephalic presentation. The proportion of vaginal delivery in all pregnant women was determined, and it was compared with those (women) with successful delivery after cesarean section. Then, there were elaborated the models, and their predictive capacity was determined by curve-receiver-operator. Results: The proportion of successful delivery in pregnant women with a previous cesarean section and indication of vaginal delivery was 85.64%. The observed proportion of birth for each decile predicted in the Grobman model was less than 15%, except for the 91-100% decile, where it was 64.09%; the area under the curve was 0.95. For the Metz model, the actual successful delivery rate was lower than predicted in scores between 4 and 14, and within expected for a score between 15 and 23; the area under the curve was 0.94. Conclusions: The vaginal delivery rate after cesarean was lower than expected according to the predictive models of Grobman and Metz. The implementation of these models in a prospective way can lead to a higher rate of successful birth.

Resumen Introducción: Una estrategia de reducción del número de cesáreas es permitir el parto vaginal después de cesárea. Objetivo: Validar dos modelos predictivos, Metz y Grobman, para el parto vaginal exitoso después de una cesárea. Métodos: Estudio de cohorte retrospectivo con mujeres con antecedente de una cesárea segmentaria previa, embarazo único ≥37 semanas y presentación cefálica . Se determinó la proporción de parto vaginal en todas las gestantes y se comparó con aquellas con parto exitoso después de cesárea, se elaboró los modelos y se determinó la capacidad predictiva de ellos mediante curva-receptor-operador. Resultados: La proporción de parto exitoso en gestantes con cesárea previa e indicación de parto vaginal fue 85.64%. La proporción de parto observado para cada decil predicho en el modelo de Grobman fue inferior al 15%, excepto para el decil 91-100%, en el que fue 64.09%, el área bajo la curva fue 0.95. Para el modelo de Metz, la proporción de parto exitoso real fue menor a lo predicho en puntajes entre 4-14 y dentro de lo esperado para puntaje entre 15-23, con un área bajo la curva de 0.94. Conclusiones: La tasa de parto vaginal después de cesárea fue menor a lo esperado de acuerdo a los modelos predictivos de Grobman y Metz. La implementación de estos modelos en forma prospectiva puede llevar una mayor tasa de parto exitoso.

Camylofin dihydrochloride injection: a drug monograph review

Camylofin dihydrochloride is an anti-spasmodic drug available in India and other Latin American and African countries, for the treatment of abdominal colic and for acceleration of labor. Although, the drug has been in use for over six decades, with multiple citations in academic text books of repute, treatment protocols, and multiple research publications, there is no consolidated published information on the pharmacology and clinical details of camylofin. This drug statement/monograph is an attempt to collate and present scientific information that will come in handy to practicing obstetricians and gynaecologists, as well as other primary care physicians, when treating cases of abdominal colic or managing prolonged labor. Approved clinical indications, clinical pharmacology, dosage, contraindications, precautions, drug interactions, adverse effects, overdose and clinical evidence in different indications are covered herein.

Comparison of Caesarean sections and instrumental deliveries at full cervical dilatation: a retrospective review

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.

Analysis of the effect of abortion of pregnant women with hypertensive disorders of COOK and Dinoprostone Suppositories on the balloon dilatation of the cervix during pregnancy / 中国生化药物杂志

Objective To investigate the effect of pregnant women with hypertensive disorders of COOK cervical dilatation balloon and Dinoprostone Suppositories on the gestation effect and safety of induction.MethodsThe research object from June 2013 to June 2015 in our hospital for pregnant women with hypertensive disorders in pregnancy in 68 cases (all patients with gestational hypertension and mild preeclampsia) were randomLy divided into the observation.Group and control group, 34 cases in each group.The observation group received COOK cervical dilatation balloon induced labor, the control group to implement Dinoprostone Suppositories induction, comparative analysis of observation group and control group, maternal and perinatal situation, mode of delivery, the cervical Bishop score, the degree of pain.Resultsabnormal fetal heart and uterine hyperstimulation, uterine tonic contraction rate of observation group were significantly lower than the control group(P<0.05).The cesarean section rate in the observation group and the control group had no significant difference.After placement, the cervical Bishop score of observation group was significantly higher than that of control group(P<0.05).The pain degree of observation group was significantly lower than that in control group(P<0.05).ConclusionCOOK balloon dilatation of the cervix and Dinoprostone Suppositories, fewer complications, can significantly improve maternal, perinatal and cervical ripening score of Bishop.

Effect of diazepam on maternal mood, cervical dilatation and childbirth outcome in the first stage of labor / 中国生化药物杂志

Objective To investigate the effect of diazepam injection on the degree of cervical dilatation, delivery outcome and negative emotion in the first stage of labor. Methods Retrospective study of 120 cases of maternal birth in our hospital as a study sample. Diazepam was used in the first stage of labor, and 60 cases of women with worse cervical dilatation and negative mood were selected as observation group, the other selected not to use any drug-assisted childbirth, only to take the basis of comfort and other interventions, the clinical symptoms and observation group were similar to 60 cases of maternal were classified as control group. The effects of the two groups intervention on maternal mood, delivery outcome and cervical dilatation were compared. Results The self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores of the observation group were significantly lower than those of the control group at 1h, 12h and 24h after treatment, the difference was statistically significant (P<0.05). Observation group Bishop cervix related degree of cervical dilatation, cervical soft and hard, cervix position, cervical canal disappearance and fetal exposure were significantly higher than those of the control group, the difference was statistically significant (P<0.05). The rate of spontaneous delivery in the observation group (83.33%) was significantly higher than that the control group (56.67%), the difference was statistically significant (P<0.05). There were no statistical differences in the rate of adverse childbirth in the observation group (11.67%) and the control group (10.00%). Conclusion The use of diazepam injection in the first stage of labor can effectively improve the overall maturity of maternal cervix, relieve maternal depression, anxiety and other negative psychological, and drug safety is high, and there was no significant adverse effect on the outcome of their childbirth.

A study on clinical application of intrapartum ultrasound / 中华医学超声杂志（电子版）

Objective To discuss the clinical application of getting the images related to the partogram content using the intrapartum ultrasound. Methods One hundred twenty-three pregnant women who tried vaginal delivery in Huai'an Maternity and Children Hospital were included in this study. Intrapartum ultrasound was performed during the progression of labor every two hours. To obtain the images related to the fetal position by transabdominal or transperineal ultrasound in transverse view, determining the fetal head position; to obtain the images related to the fetal head station by transperineal ultrasound in mid-sagittal and transverse views , measuring the angle of progression (AOP) and the fetal head-perineum distance (HPD); to obtain the images related to the cervical dilatation by transperineal ultrasound in transverse view, measuring the anteroposterior diameter of the cervical dilatation. Results This study included 123 pregnant women, 123 images were obtained related to the fetal position; 122 images of AOP related to the fetal head station were measured; and 123 images of HPD related to the fetal head station were measured; 121 images related to the cervical dilatation, all the images can clearly displayed various ultrasonic markers, which can be used to determine the fetal position, the fetal head station and the cervical dilation. Conclusion Intrapartum ultrasound could get the images related to the partogram content, it could be studied to use in labor.

Clinical Analysis of COOK Cervical Dilatation Balloon for Induced Labor in Full-term Pregnancy / 中国微创外科杂志

Objective To evaluate the efficacy and safety of COOK cervical dilatation balloon for induced labor in full -term pregnancy . Methods There were 98 cases of cervical ripening and induced labor by using COOK balloon from January 2014 to April 2015 ( experimental group ) and 130 cases of cervical ripening and induced labor by using oxytocin from January 2010 to September 2013 ( control group ) .The cervical scores , childbirth way , and adverse reactions were compared between the two groups . Results After the removal of the balloon, the cervical scores in the experimental group increased from (2.38 ±0.70) points to (6.15 ±0.96) points (t=31.412, P =0.000).The rate of vaginal delivery in the experimental group (79.6%, 78/98) was significantly higher than that in the control group [62.3%(81/130),χ2 =7.910, P=0.005].The incidence of chorioamnionitis in the control group was 5.4% (7/130), which was significantly lower than that in the experimental group [18.4% (18/98), χ2 =9.647,P=0.002).The other adverse reactions in two groups had no statistical difference (P >0.05). Conclusions Use of COOK cervical dilation balloon is a safe and effective method to promote cervical ripening .In combination with artificial rupturing membrane or intravenous infusion of oxytocin can improve the success rate of full -term pregnancy induced labor .

Efectividad del tratamiento médico con misoprostol según dosis administrada en aborto retenido menor de 12 semanas / Effectiveness of medical treatment with misoprostol as abortion retained dose administered in less than 12 weeks

Antecedentes: El manejo terapéutico del aborto retenido consiste en evacuar la cavidad uterina espontáneamente o utilizando misoprostol previo al legrado quirúrgico. Objetivo: Evaluar la necesidad de dilatación mecánica post maduración cervical con misoprostol y la tasa de perforación uterina post legrado, utilizando diferentes dosis de misoprostol en pacientes con diagnóstico de aborto retenido menor a 12 semanas. Métodos: Se registraron datos demográficos y ginecológicos de una cohorte retrospectiva de pacientes con diagnóstico de aborto retenido menor a 12 semanas, entre enero de 2008 y diciembre de 2010. Se establecieron 3 grupos de trabajo según la dosis de misoprostol administrada vía vaginal, siendo de 100 (n=131), 200 (n=231) y 400 micrones (n=230), y se observaron las complicaciones asociadas al procedimiento. Resultados: La necesidad de dilatación mecánica fue significativamente mayor en el grupo que recibió 100 micrones de misoprostol al compararlo con el de 200 micrones y 400 micrones (p<0,01). No hubo diferencias estadísticamente significativas entre las que recibieron 200 versus 400 micrones de misoprostol. No hubo diferencias significativas respecto a perforación uterina. Conclusión: En el aborto retenido menor a 12 semanas, la necesidad de dilatación mecánica post maduración cervical, es menor si se utiliza 200 o 400 micrones de misoprostol, sin diferencias en la tasa de perforación uterina.

Background: The therapeutic management of missed abortion consists on evacuating the uterine cavity, spontaneously or by administration of misoprostol previous to curettage. Objectives: Evaluate the need of mechanical dilatation after cervical maturation with misoprostol and the rate of uterine perforation before curettage, using different doses of misoprostol in patients with diagnosis of missed abortion before 12 weeks. Methods: Demographic and gynecologic data were registered of a retrospective cohort of patients with the diagnosis of missed abortion before 12 weeks, between January 2008 and December 2010. Three groups were established according to the dose of misoprostol: 100 (n=131), 200 (n=231) and 400 microns (n=230). Complications associated to the procedure were observed. Results: The need of mechanical dilatation was significant higher for the group with 100 microns of misoprostol in comparison with 200 and 400 microns (p<0.001). There was no statistical significance among who received 200 versus 400 microns of misoprostol. No statistical significance was found for uterine perforation. Conclusion: In the missed abortion before 12 week, the need of mechanical dilatation is lower with 200 or 400 microns of misoprostol, without difference in uterine perforation rate.

Effect of Valethamate Bromide on the First Stage of Labor.

Objectives: This study was undertaken to evaluate the effect of intramuscular valethamate bromide on the duration of labor, rate of cervical dilatation and the effect of the drug on the mother and the fetus. Material and Methods: This was a prospective study conducted in Dept. of Obstetrics and Gynecology at ESIC MC-PGIMSR Bangalore involving 200 women with fullterm pregnancy in active labor. Group A received valethamate bromide intramuscular injection. Group B was control group. Results: There was no significant difference in the parity, mean age of patients and mean duration of gestation in both the groups. But, there was difference in the mode of delivery. Valethamate bromide caused significant decrease in the duration of cervical phase of labor as compared to control group. There was no statistically significant difference in the Apgar score of new borns, and there were no maternal and fetal side effects. Conclusion: Valethamate bromide can be used in the management of labor for reducing the duration of first stage of labor without any untoward effects on mother and fetus.

Comparison of Obstetric Pain, Anxiety, and Cervical Dilatation between Epidural Analgesia and No Analgesia group during Labor Stage I

PURPOSE: This research was done to compare obstetric pain, anxiety and cervical dilatation between an epidural analgesia group and a control group. METHODS: Participants were assigned to the experimental or control group depending on their decisions for pain relief. Subjective / objective obstetric pain, anxiety level and cervical dilatation were measured and ANOVA was used for comparison of groups and paired t-test to make pre-post comparisons. RESULTS: Homogeneity of pain, anxiety and cervical dilatation were assessed at the latent phase. Cervical dilatation was larger in the control group than the experimental group, at both the active and the transitional phase (F=22.9, p<.001; F=39.9, p<.001 respectively). The degree of pain and anxiety were not significantly different between the groups. Within the experimental group, subjective / objective pain and anxiety level were significantly lower postanalgesia compared to pre-analgesia in the active phase. All variables, except for sweating in the objective pain measurement, changed significantly at the transient phase. CONCLUSION: The results of this evidence-based research indicate that epidural analgesia while effective in relieving pain and anxiety may have an adverse effect on the cervix during labor stage I. Epidural analgesia should be used carefully during cervical dilatation in labor stage I.

Emergency cerclage in cervical incompetence / 대한산부인과학회지

Emergency cerclage is the only way to prolong pregnancy for women with advanced cervical dilatation with or without prolapsed membrane. Without cerclage, miscarriage is almost always inevitable. Emergency cerclage should be performed after considering indications, contraindications, benefits and risks. Further researches on advanced operative skill, prognostic factors and postoperative medical treatment will improve the outcome of emergency cerclage.