Maternal obesity and its adverse impact on labor outcome

To study the impact of maternal obesity on the outcome of labour. Al Zahraa University hospital prospective randomized control study. A total of [80] pregnant women were included in this study from April 2009 to March 2010. According to the BMI the patients were classified into two groups. Group [I]: [Control Group]: Included [30] patients with [body mass index] [BMI] ranging from 20 to 25 kg/m[2].Group [II]: [Obese Group]: Included [50] patients with [BMI] ranging from 25 to 30kg/m[2]. Each patient were subjected to full clinical examination [General] Abdominal and pelvic] U/S pelviabdominal examination that is to confirm the inclusion and exclusion criteria of the study. A significant differences was noticed between 2 groups as regard the BMI. The current study showed significant difference in cases subjected to induction of labour with p-value < 0.001. Also significant difference between control group and obese group regarding failed induction, failure to progress 1[st] stage, 2[nd] stage, shoulder dystocia with p-value < 0.01.Case of C.S showed the highest significant diff. with P-value < 0.0001 .In the present study no sig. diff. between cases of both groups as regard 3rd stage complication, 4th stage [PPH] and blood transfusion with P-value 0.658, 0.684 and 0.658 respectively. A high significant diff. between the two groups as regard case of macrosomia, Apgar score < 7 1[st] minute, and birth injury with p-value < 0.01. A significant diff. were showed between the cases of both groups as regard the incubation with p-value > 0.05.No significant diff. were noticed between the 2 groups as regard the cases with Apgar score < 7 at 5 minutes with p-value 0.06. A positive correlation coefficient between the BMI [25-29], [29-33] kg/m[2] with the case of induction of labour, failure to progress 1[st] stage, shoulder dystoca, cesarean section and fetal low Apgar score. While a negative correlation was recorded between the BMI of the control group and all the adverse outcomes. Obesity of the gravid women is a sensitive predictor of the adverse outcome during pregnancy, labour, and post partum. Researches are needed into effective, applicable and acceptable community -based program for obese women planning a pregnancy

Indicações de cesariana baseadas em evidências: parte I / Evidence-based cesarean section indications: part I

No Brasil, as taxas de cesárea variam bastante entre as regiões, principalmente quando se compara a assistência realizada pelo Sistema Único de Saúde (SUS) com a assistência privada. A taxa de cesarianas no setor de saúde suplementar chega próximo de 80%, enquanto no SUS fica próxima de 30%, muito acima do recomendado pela Organização Mundial de Saude (OMS). Realizou-se uma revisão da literatura em busca das melhores evidências disponíveis sobre indicações de cesariana. Analisaram-se as principais indicações de cesárea, como distocia ou falha na progressão do parto, desproporção cefalopélvica, má posição fetal nas variedades de posição posteriores e transversas persistentes, apresentação pélvica, de face e córmica, cesárea anterior, frequência cardíaca fetal não-tranquilizadora, presença de mecônio e centralização fetal. Em nenhuma dessas situações existe indicação absoluta de cesariana, uma vez que mesmo na apresentação córmica o parto normal pode ser tentado, mediante versão cefálica externa (VCE). Nas distocias de progressão, o parto normal pode ser alcançado mediante correção da contratilidade uterina, porém a cesariana encontra-se indicada quando a desproporção cefalopélvica é diagnosticada pelo uso judicioso do partograma. A apresentação pélvica também pode ser corrigida com VCE a termo, mas a via de parto deve ser discutida com a gestante quando a VCE falha ou não é realizada. Embora os riscos relativos neonatais sejam maiores para o parto vaginal, os riscos absolutos são baixos, e a opinião da gestante deve ser considerada

Rates of cesarean in Brazil vary widely among the regions, especially when Single Health System (SUS, acronym in Portuguese) assistance is compared with private clinics. In the supplementary health system the rates of cesarean section are around 80% and in SUS are about 30%, above the rates recommended by World Health Organization (WHO). A literature review was performed searching the best evaluable evidences. The main indications for cesarean section were considered such as dystocia or failure to progress, cephalopelvic disproportion, abnormal fetal positioning in occiput posterior and transverse presentations, breech, face and transverse lie, previous cesarean section, non-reassuring fetal heart rate, meconium and brain-sparing effect. Most of these situations do not represent absolute indications for cesarean section. Even in transverse lie an external cephalic version (ECV) could be tried and a trial of labor can be conducted. When a progress failure occurs, vaginal delivery can be achieved using measures as correction of contractility disorders, although cesarean should be indicated when cephalopelvic disproportion is diagnosed using correctly the partograma. Breech presentation can also be corrected with an ECV at term but the mode of delivery has to be discussed with the patient when ECV fails or it is not performed. Although neonatal relative risks are higher with vaginal delivery, absolute risks are small, and the pregnant women opinion has to be considered

Factor de riesgo para cesárea: un enfoque epidemiológico / Risk factors for cesarea: an epidemiological view

El incremento en la frecuencia de cesáreas notado a partir de la década de los setenta no disminuyó como se esperaba la morbilidad y mortalidad perinatales. Las principales indicaciones de cesárea son distocias, cesárea previa y sufrimiento fetal. En 1998 la frecuencia de cesáreas en nuestro hospital fue de 35 por ciento de los embarazos atendidos. Mediante un estudio de casos y controles se determinaron los factores de riesgo para cesárea en nuestra unidad hospitalaria. Se seleccionaron 165 casos (cesáreas) y 328 controles (partos). Se determinó razón de momios (OR) y fracción atribuible (FA) de los factores de riesgo. Se analizaron los datos mediante X2. Las indicaciones más importantes de cesárea fueron: distocias (39 por ciento, n= 64); cesárea previa (23 por ciento, n=41) y sufrimiento fetal (11 por ciento, n=21). No hubo diferencias significativas en edad, estatura y tiempo de rotura de membranas entre ambos grupos. El antecedente de cesárea confirió mayor riesgo para una nueva intervención quirúgica (OR= 12.7, p= < 0.0001, FA= 92 por ciento). Ser nulípara (OR= 6.6, p < 0.001, FA= 85 por ciento), secundigesta (OR= 1.8, p= 0.002, FA= 19 por ciento) o con antecedente de abortos (OR= 1.8, p= 0.04, FA= 45 por ciento) fueron factores mayormente asociados a cesárea. Concluimos que deben replantearse las indicaciones precisas de esta intervención quirúrgica ,sobre todo en casos de nuliparidad o de cesárea previa para disminuir su elevada frecuencia.

Reduction in the cesarean section rate in nulliparous patients after administration of intravenous propranolol

OBJECTIVE: A preliminary investigation to test the efficacy of intravenous propranolol in reducing the cesarean section rate in nulliparas in active labor and evaluate its effect on neonatal and maternal outcomes. METHODS: Fifty seven nulliparous patients admitted in active labor were randomly divided into two groups: a control group consisting of 23 patients, and a treatment group consisting of 34 patients given 2 mg of propranolol intravenously every 4 hours until delivery. Total length of labor, time from first administration of medication to delivery, incidence of cesarean section, APGAR scores, maternal and fetal morbidity were assessed. RESULTS: A total of 4 cesarean sections were performed in each group (11.7 per cent in the treatment group and 17.3 per cent in the control group). The rate of cesarean section due to dystocia was 6.25 and 13.6 per cent respectively (P = .367). Statistical significance was not reached due to the small number of subjects (students t test analysis). There was no increase in the incidence of low APGAR scores, intensive care unit admissions, abnormal heart rate patterns during labor, cesarean sections for fetal distress or maternal morbidity in the treated group. CONCLUSIONS: Intravenous administration of 2 mg of propranolol every four hours is safe and not associated to increased neonatal or maternal morbidity. A 50 per cent decrease in the incidence of cesarean sections can be documented among nulliparous patients treated with propranolol although the small numbers and overall low incidence of cesarean section in our population (14 per cent) did not permit these differences to reach statistical significance

Espátulas de Thierry: aplicación en primíparas con distocia de posición cefálica fetal: experiencia del servicio en 15 años / Thierry's spatulas: application in primiparas with dystocia of fetal cephalic position: service experience through 15 years

Se presentan los resultados obtenidos en una población de 674 primíparas con posición cefálica fetal distócica resueltas instrumentalmente con espátulas de Thierry (ET) 348 pacientes y 326 con fórceps de Kjelland (FK). Se concluye que en aquellas sometidas a resolución con espátulas hay menor morbilidad materno-fetal que las resueltas con ramas de Fórceps, con significación estadística (p< 0,0001). Se recomienda el adiestramiento en su uso por parte de los médicos en formación en la especialidad