Balancing anatomical limits and dynamic adaptation: Understanding the determinants of successful vaginal breech delivery.

Introduction. The influence of epidural analgesia on the length of labourremains a source of controversy in literature. Objectives. To see the effect of epidural analgesia on the duration ofactive first stage and second stage of labour. Setting: Obstetric Department of CMH Kharian. Period: From 1 January st2005 to 31 March 2006. Material and methods. One hundred pregnant full term, women were included in the study. stFifty primiparous reporting at full term, half were given epidural analgesia the other half were control. Another fiftymultiparous reporting at full term, twenty five women were given epidural the other twenty five were control. Results.The mean duration of active first stage of labour in primiparous women after 3 – 4 centimeter cervical dilatation was5.10 hrs in the epidural group while it was 6.65 hrs in the control group (p less than 0.001). In the multiparous womenthe mean duration of active first stage of labour after 3 – 4 centimeter cervical dilatation was 2.40 hrs in the epiduralgroup while it was 3.43 hrs in the control group (p less than 0.001). In the primiparous women the mean second stagewas 23.76 minutes in the epidural group, and 37.33 minutes in the control group (p less than 0.001). In the multiparousgroup, the mean second stage was 17.58 minutes in the epidural group, and 22.00 minutes in the control group (p lessthan 0.001). Conclusion. Epidural analgesia decreases the duration of active first stage and second stage of labour.

How should preterm singleton babies in breech presentation be delivered?

Objective: In our part of the world poverty and illiteracy has adversely affected our core objective of pregnancy i.e. healthy mother and healthy child. Exploring the role of a routinely used drug in reducing the duration of labor could be a breakthrough. Present study was planned accordingly to evaluate the effect of phloroglucinol (PHL). Materials and Methods: It was a Randomized controlled trial conducted at Department of Obstetrics & Gynecology, Combined Military Hospital, Bahawalpur from January 2019 to June 2019. This study included 60 cases of age 18 to 40 years, having singleton pregnancy and in active first stage of uncomplicated labor. Patients with history of multiple pregnancies, obstetrical and surgical complications and cardiorespiratory diseases were excluded. The cases were placed randomly into Group A & Group B and given intravenous PHL and a placebo respectively. After this, duration of the first stage of labor was recorded in minutes from when there was 3-4 cm cervical dilatation with regular uterine contractions to complete cervical dilation i.e. 10 cm and descent of the presenting fetal part. Results: Mean duration of active first stage of labor in experimental group A (230.20 ± 52.96 minutes) was significantly higher than that of control group B (345.30 ± 50.57 minutes). Conclusion: This study concluded that intravenous PHL has efficiently reduced the duration of active first stage of labor in these randomly selected nulliparous and multiparous women. PHL is a useful drug serving the purpose of a spasmolytic, analgesic and labor augmentation at the same time.

MRI-based pelvimetric measurements as predictors for a successful vaginal breech delivery in the Frankfurt Breech at term cohort (FRABAT)

The objective of this study was to investigate the effects of obstetric gel application on the length of the first stage of labour and perineal trauma in primiparous women. This randomised controlled trial included 110 primiparous women. Women were randomly assigned to the two groups: lubricant gel group and control group. In the intervention group, during cervical dilatation of 4 cm until complete cervical dilatation, 5 ml of water-soluble lubricant gel was used at each vaginal examination. In the control group, routine care was performed. Mean duration of the total length (p = .025), the first (p = .012), and second stage (p = .022) of labour was significantly shorter in the obstetric gel group than control group. Perineal health was significantly better in the gel-applied pregnant women (p < .001). Using obstetric gel at the beginning of the first stage could shorten the total length, the first and the second stage of labour and could protect perineal health. IMPACT STATEMENT What is already known on this subject? Prolonged labour and perineal injuries are a major problem in natural childbirth for primiparous mothers. What the results of this study add? The first (p = .012), and second stage (p = .022) of labour was significantly shorter in the obstetric gel group than in the control group. Perineal health was significantly better in gel-applied pregnant women (p < .001). Using obstetric gel at the beginning of the first stage could shorten the total length, the first and the second stage of labour and could protect against perineal injury. What the implications are of these findings for clinical practice and/or further research? Obstetrical gel lubricant usage in the first stage of labour during the active phase of nulliparous women could shorten the total length, the first and the second stage of labour and could protect perineal health.

Uterine activity was studied during labor in 36 women who had previous cesarean sections. There was no difference in uterine activity between those delivered vaginally (66%) or those who n...

Intrapartum ultrasound and the choice between assisted vaginal and cesarean delivery

To compare the angle of progression (AoP) and the progression distance (PD) during the early active phase, first stage of labor in term nulliparous women between successful vaginal delivery and cesarean section due to active phase arrest or prolonged second stage of labor groups. A prospective observational study was conducted between July 2019 and May 2020 at the labor room of Siriraj Hospital. Cervical dilatation was assessed by digital examination to ensure an early active phase of labor, and a transperineal ultrasound was performed to measure the angle of progression (AoP) and progression distance (PD). The delivery outcomes were divided into successful vaginal delivery (spontaneous or operative) and cesarean section due to active phase arrest or prolonged second stage of labor. Covariates were documented, including maternal age, maternal body mass index, total weight gain during pregnancy, gestational age, and fetal birth weight. A total of 149 term singleton nulliparous women with vertex presentation were consecutively enrolled. Six women who delivered by cesarean section due to non-reassuring fetal heart rate were excluded. Among 143 women who were eligible for further analysis, 108 (75.5%) pregnant women had successful vaginal delivery, while 35 (24.5%) women had cesarean section. The area under the curve indicated that AoP and PD were associated with a successful vaginal delivery (AUCs of 0.67 for AoP and 0.69 for PD). The optimal cut-off points using AoP were ≥ 90 ° (sensitivity 85.2%, specificity 45.7%) and PD ≥ 0cm (sensitivity 86.1%, specificity 42.9%). AoP and PD using standard 2-dimensional ultrasonography at the early active phase, first stage of labor, demonstrated a modest association with successful vaginal delivery. Further studies are warranted to explore the benefit of AoP and PD in clinical applications.

Most women are satisfied with their delivery experience but the effects of pain relief and different pain relief methods on the birthing experience remain inconsistent. We wanted to evaluate the impact of pain relief on the birthing experience during the first and second stages of labor among primiparous and multiparous women. A total of 2042 parturients (953 primiparous and 1089 multiparous women) completed a questionnaire on the second day after vaginal delivery and, using visual analogue scale (VAS), assessed their experience and satisfaction with their pain management during the first and second stages of labor. The experiences of primiparous and multiparous women were compared, and the factors associated with positive and negative birthing experiences were ascertained. Overall birthing experience was better among multiparous than among primiparous women (VAS 8.6 vs. 8.0; p < 0.001). Reported satisfaction with pain management revealed no significant differences between multiparous and primiparous women during the first stage of labor (VAS 8.2 vs. 8.1) or the second stage of labor (VAS 7.8 vs. 7.7). Some variation was reported in satisfaction with the various pain management methods, epidural and spinal block having the highest ratings during both stages of labor. However, despite differences in satisfaction with pain management, in overall birthing experience, no difference according to pain relief administered was reported among multiparous and only minor differences in primiparous women in the second stage of labor. Those parturients reporting negative birthing experiences (VAS ≤5) reported relatively high satisfaction with pain management during the first stage of labor (medians 8 and 8 in multiparous and primiparous women respectively) while satisfaction with second-stage pain management was clearly lower (respective medians 2 and 5). In a regression model satisfaction with pain management during the second stage of labor varied significantly with birthing experience. The childbirth experience was slightly better among multiparous than among primiparous women, although there were no significant differences regarding satisfaction with pain management according to parity during the first or second stage of labor. Satisfaction with pain relief during the second stage of labor was significantly associated with overall birthing experience.

BackgroundEven if lower vaginal delivery success rates and impaired neonatal short-term outcomes have been reported for primiparous women with breech presentation, vaginal breech delivery remains an option for carefully selected patients. Because Magnetic resonance imaging (MRI) pelvimetry can provide additional information on maternal pelvic morphology, we sought to identify new MRI parameters that predict successful vaginal breech delivery.MethodsIn this retrospective unicentre study, 240 primiparous women with breech presentation at term underwent MRI pelvimetry. For all patients vaginal delivery was planned, according to German guidelines and if the conjugata vera (CV) was ≥12 cm. The patients with uneventful vaginal deliveries and the patients who underwent a secondary caesarean section were compared according to pelvimetric parameters and outcomes. Regression analyses were performed.ResultsIn the vaginal delivery group (n = 162, (67.5%)), the distance between the spinae ischiadicae (interspinous diameter, ISD) was significantly enlarged. The ISD significantly influenced the mode of delivery in the regression analyses. The CV did not significantly differ between the groups. The patients with successful vaginal deliveries were significantly younger than the patients who underwent caesarean section. In the receiver operating characteristic (ROC) analysis, the area under the curve (AUC) for ISD was 67.7% (p<0.001, 95% CI [0.303–0.642]) and was higher considering the mother’s age (AUC = 73.1%, p<0.001, 95% CI [0.662–0.800]). The neonatal short-term outcomes were comparable in both groups.ConclusionThe additional use of ISD may predict successful vaginal breech delivery and may be superior to the CV, which is more commonly used.Trial RegistrationDRKS00009957

PurposeLabor is shorter in multiparous women. However, there are no individualized data on differences in duration of labor for consecutive deliveries in the same parturient.MethodsWe conducted a retrospective data analysis from 2004 to 2021 at the University Hospital of Zurich and included all women with 2 or more vaginal deliveries of a singleton child in cephalic position, between 22 and 42 weeks of gestation. Descriptive statistics were performed with SPSS version 25.0 (IBM, SPSS Inc., USA). The primary endpoint was the ratio between durations of labor stages in consecutive deliveries of the same parturient.ResultsA total of 3344 women with 7066 births (2601 first [P0], 2987 s [P1], 1176 third [P2], and 302 fourth [P3]) were included. The ratio of duration of the active first stage of labor between P1 and P0 was 0.49 (95% CI 0.47–0.51, p < 0.001) meaning that the active first stage of labor was 51% shorter. The second stage of labor with a ratio of 0.26 (95% CI 0.24–0.27, p < 0.001) was 74% shorter in P1 compared to P0. Higher birthweight of the first child led to an even greater decrease in duration of the second stage of labor in P1 compared to P0 (p = 0.003). Neuraxial anesthesia was an independent risk factor for a longer duration of labor, irrespective of parity (p < 0.001). Birthweight and HC of the neonates did not significantly differ between the children born by the same women. However, higher birthweight in of the first child significantly augmented the rate of second stage of labor between P0 and P1 (p = 0.003).DiscussionUp to the third delivery, duration of labor decreased with each consecutive delivery of the same parturient. An individualized assessment of the expected duration of labor in multiparous women should be encouraged.

Severe maternal and neonatal morbidity after attempted operative vaginal delivery

The aim of the study was to determine the influence of intended mode of delivery on neonatal outcome in term breech delivery and to identify risk factors at intended vaginal delivery. Based on register data on all deliveries of non-malformed, singleton fetuses in breech presentation at term (n = 19,476) in Denmark, 1982-92, a review of medical records of all (n = 218) cases with Apgar score < 7 at 5 minutes, including intrapartum and early neonatal deaths and 412 controls, was performed. Planned vaginal delivery was associated with a 15 times greater risk of low Apgar score than elective Caesarean section. Low Apgar score was correlated with duration of second stage of labour, but not with age, parity, birthweight, induction, augmentation or duration of first stage of labour. In conclusion, a pre-labour decision on vaginal delivery was associated with a 15-fold increase in low Apgar score. Prediction of low Apgar score in women selected for vaginal delivery does not seem possible before the second stage of labour.

BackgroundWhen certain conditions are met, a large randomized trial has suggested that for twin pregnancies, vaginal delivery does not increase adverse maternal or neonatal outcomes compared with cesarean section. However, the choice of the delivery mode is sometimes controversial, and policies can vary across different facilities. Identifying factors associated with successful vaginal delivery is important in reducing unnecessary cesarean sections.MethodsWe retrospectively analyzed 370 twin pregnancies delivered after 32 weeks of gestation at our hospital between April 2012 and March 2022, excluding monoamniotic monochorionic twins. Vaginal delivery was offered when the first twin was in cephalic presentation, the estimated fetal weight of each twin was at least 1500 g, and there were no other indications for cesarean section. We compared maternal and fetal factors between successful and failed attempts at vaginal delivery. Notably, we used multivariable logistic regression and the classification and regression tree (CART) method for statistical analyses.ResultsOf the 370 twin pregnancies, 133 women attempted vaginal delivery, and 115 (86.5%) achieved successful vaginal delivery of both twins. Multivariable analysis identified multiparity (adjusted odds ratio 15.29, 95% confidence interval 3.55–65.74; p < 0.001) and younger maternal age (adjusted odds ratio 0.84 per year, 95% confidence interval 0.73–0.96; p = 0.013) as independent predictors of successful vaginal delivery. CART analysis supported these findings, identifying parity as the primary discriminator. Among primiparas, maternal age ≤ 29 years emerged as a cutoff, with younger women having a higher probability of successful vaginal delivery. Univariable comparisons further supported this result.ConclusionsOur findings suggest that multiparous women, regardless of maternal age, and primiparous women aged ≤ 29 years are associated with a high probability of successful vaginal twin delivery.

The duration of labor in spontaneous preterm deliveries: A retrospective observational study in a tertiary Irish maternity hospital