2nd Stage Of Labor Research Articles

Risk Factors for Obstetric Anal Sphincter Injuries among Women Delivering at a Tertiary Hospital in Southwestern Uganda.

Background Obstetric anal sphincter injuries (OASIS) arise from perineal trauma during vaginal delivery and are associated with poor maternal health outcomes. Most OASIS occur in unattended deliveries in resource-limited settings. However, even in facilities where deliveries are attended by skilled personnel, a number of women still get OASIS. Objectives To determine the incidence and risk factors for obstetric anal sphincter injuries among women delivering at Mbarara Regional Referral Hospital (MRRH). Methods We conducted an unmatched hospital-based case control study, with the ratio of cases to controls of 1 : 2 (80 cases and 160 controls). We defined a case as a mother who got a third- or fourth-degree perineal tear after vaginal delivery while the controls recruited were the next two mothers who delivered vaginally without a third- or fourth-degree perineal tear. A questionnaire and participants' medical records review were used to obtain sociodemographic and clinical data. We estimated the incidence of OASIS and performed univariable and multivariable logistic regression to identify the associated risk factors. Results The cumulative incidence for OASIS during the study period was 6.6%. The risk factors for OASIS were 2nd stage of labour ≥1 hour (aOR 6.07, 95%CI 1.86–19.82, p=0.003), having episiotomy performed during labour (aOR 2.57, 95%CI 1.07–6.17, p=0.035), perineum support during delivery (aOR 0.03, 95%CI 0.01–0.12, p < 0.001), and monthly income of >50,000 shillings (aOR 0.09, 95%CI 0.03–0.28, p < 0.001). Conclusions and Recommendations. The risk factors for obstetric anal sphincter injury were prolonged second stage of labour and performing episiotomies during deliveries while higher monthly income and perineum support during delivery were protective. We recommend routine support to the perineum during delivery. Care should be taken in mothers with episiotomies, as they can extend and cause OASIS.

Indications and Adverse Outcomes of Emergency Lower Segment Cesarean Section at 1St and 2Nd Stages of Labor at Al-Elwiya Maternity Teaching Hospital

Background: globally that about 6.2 million unnecessary cesarean sections were done yearly. Oldest surgical operation and it is considered as one of the most commonly performed surgical operations. Objective: To assess the indications and adverse outcomes of emergency lower segment caesarean section at 1st and 2nd stages emergency Caesarean at Al-Elwiya maternity teaching hospital. Patients and method: A prospective cross sectional study conducted for 1 year duration in Al-Elwyia Teaching hospital in the period from the first of Jan. 2018 to the end of Dec. 2018, when 1229 of the women were enrolled. Results: A total of 1229 cesarean sections operations were done in the period of the study, 836 (68%) were 1st stage emergency Caesarean and 393(32%) were in 2nd stage. The most common indications of the caesarean section were the malposition (64.5%). Meconium aspiration Syndrome is the most common perinatal outcome (n=34).Conclusion: The 2nd stage emergency Caesarean shows more maternal and neonatal complications in comparison with 1st stage

Rotation manuelle des variétés postérieures : état des lieux de la littérature en 2019

ObjectiveThe aim of our study was to evaluate the safety and the benefits of manual rotation in the management of Occiput-posterior positions in 2019. MethodsA systematic review of literature was performed using the MEDLINE and COCHRANE LIBRARY databases, in order to identify articles concerning maternal and neonatal outcomes after a manual rotation, through January 2019. Information on study characteristics (review, author, year of publication), population, objectives and main neonatal and maternal outcomes were extracted. ResultsA total of 51 articles were identified and 12 articles were selected for the systematic review. The rate of successful manual rotation were about 47 to 90%. There were more success if systematic manual rotation, multiparity, engagement, spontaneous labour and maternal age<35. The 2nd stage of labour was shorter after an attempt of manual rotation. The randomised controlled trials did not find any statistical difference concerning operative deliveries or neonatal and maternal outcomes. ConclusionThe manual rotation is an obstetrical manoeuvre which must be regulated and only practiced by trained operators. Currently, the state of science is not sufficient to recommend the manual rotation as a systematic practice in 2019.

PENGARUH KEBUGARAN JASMANI TERHADAP LAMA PERSALINAN KALA I DAN II PERSALINAN PADA IBU PRIMIGRAVIDADI BPM KOTA MEDAN TAHUN 2015

Physical fitness of pregnant women who are exercise actively have a better vascularization than those who passively. Physical exercise is a major factor in improving physical fitness, flow capacity of the heart, and obtain a high oxygen during labor (Varney and others 2007, Hamilton 1995, Bobak and others 2005), therefore team authors were interested in researching about physical fitness effectiveness for a long period time in first and second stage of labor in primigravida. Method : this type of research is a Quasi Experiment and Non-Equivalent Control Group, population total are 40 respondents (3rd trimester primigravida) measuring the level of physical fitness (VO max), period of 1st&#x0D; stage, 2nd stage and total period time of labor. Data analysis using T test. Result : from 20&#x0D; respondents of experimental group and 20 groups non-experiment obtained homogeneous data regarding physical fitness and psychological condition. The average time period of 1st stage in experimental group are 387,75 minutes (Sd. 43,54), the average time period of 2nd stage are 27,75 minutes (Sd. 9,66). Total period of labor average 334,50 minutes (Sd. 44,35), while in non- experimental group the period time of 1st stage average 448,75 minutes (Sd. 41,64), 2nd stage 40,00 minutes (Sd. 8,27) and the average of total period are 478,75 minutes (Sd. 82,64). T test in the experimental group and non-experimental group obtained homogeneous data because p value (0,794)&#x0D; &gt; ? (0,005). Period time of 2nd stage p value (0,602) &gt; ? (0,005). The period time of labor not normal, analysist using Mann Whitney test obtained p value (0,00) &lt; ? (0,005). Concluded that there is the influence of maternal physical fitness with period of 1st and 2nd stage of labor and suggested for all&#x0D; pregnant women improving physical fitness with physical exercise using a bicycle ergometer.

Female genital mutilation and obstetric outcome: A cross-sectional comparative study in a tertiary hospital in Abakaliki South East Nigeria.

BackgroundFemale genital mutilation (FGM) is an assault on womanhood.ObjectiveTo compare the obstetric outcome between parturient with genital mutilation with a cohort that has no genital mutilation.Materials and methodsThis cross-sectional prospective study was done in the labour ward of Federal Teaching Hospital Abakaliki between 1st January 2013 and 31st December 2013. The obstetrics outcome of 260 consenting healthy parturients with FGM in the 1st stage of labour was compared with 260 cohorts with no FGM and also in labour. Data were obtained with a structured questionnaire and analysed using IBM SPSS Statistic version 20. Simple percentage odd ratio and Chi-square were used for data analysis at a p-value of < 0.05.ResultsThe mean age and gestational age of the women were 27.9 ± 4.8 years and 38.9 ± 1.5 weeks respectively. Majority of the women, 308 or 77.0%, belonged to social class 4 and 82.0% had Type 2 FGM. More than 90.0% of the women had a vaginal delivery and the 2nd stage of labour lasted more than 2 h in 13.4% of the women (OR = 0.78 95% CI 0.64-0.97). Parturient with FGM had increased odd of perineal tear (OR = 0.76 95% CI 0.63 - 0.91) and episiotomy (OR = 1.69 95% CI 1.17–2.45). The mode of delivery and neonatal Apgar scores were not significantly influenced by the presence of FGM (P > 0.05).ConclusionThe study has shown that FGM in labour increases the odds of developing perineal trauma which may be associated with a host of short- and long-term complications. We recommend continued awareness creation to stop FGM.

152: Impact of recommended changes in management of prolonged second-stage for prevention of the primary cesarean-delivery

In 2014, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine (SMFM) published an Obstetric Care Consensus for safe prevention of the primary cesarean delivery (CD). The objective of our study was to assess whether implementation of the new guidelines in our department,regarding second stage of labor, decreased our primary CD rate safely. A historical cohort study of all women, reaching the 2nd stage of labor, at term, in a single university-affiliated medical center (2010-2017). Following the new ACOG and SMFM guidelines, we changed our departmental definition of 2nd stage arrest of labor from 2 and 1 hour in nulliparous or multiparous women respectively, without epidural, to 3 and 2 hours in nulliparous or multiparous women respectively; with the addition of 1 hour to each group when using epidural analgesia. We compared maternal and neonatal outcomes over three year's periods: 1st period – pre-guidelines (2010-2013) vs. 2nd period – post-guidelines (2014-2017). The primary outcome was CD rate at 2nd stage of labor. 5931 women were included in the study. The CD rate of women in the 2nd stage of labor has increased significantly from 4% in the pre-guidelines period to 5.9% in the post-guidelines period (OR 1.48, 95%CI 1.16-1.89). After a sub-analysis of specific subgroups, the CD rate increase was solely observed in nulliparous women with epidural (6.1% vs. 10.2%, P <0.001). However, the CD rate for arrest of 2nd stage of labor was statistically reduced between the two periods (72.9% vs 59.8%, P <0.05). Maternal and neonatal outcomes did not differ between the 2 periods, apart for increased odds for vaginal operative delivery in the post-guidelines period (10.6% vs. 12.3%; P <0.05) (Table 1). After adjusting for confounders, including: age, parity, birthweight, labor induction, and epidural; we have found no association between the implementation of the new guidelines and a change in CD rate performed at the 2nd stage of labor (aOR 1.25, 95%CI 0.97-1.61). (Table 2) The implementation of the new ACOG and SMFM guidelines was not associated with a reduction in the CD rate performed at the 2nd stage of labor, or a difference in maternal or neonatal outcomes. However, it was associated with an increase in CD rate in nulliparous women with an epidural during the second stage.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Normal Range for Maternal Lactic Acid during Pregnancy and Labor: A Systematic Review and Meta-Analysis of Observational Studies.

This article systematically reviews the literature to establish the normal range of lactic acid in healthy pregnant women. Ovid MEDLINE, Embase.com, and Clinicaltrials.gov were searched to identify studies that reported maternal lactic acid in healthy pregnant women. Pooled aggregate means and two standard deviations for each time period were computed using the inverse variance weighting technique. Analyses were performed separately for 1st, 2nd, and 3rd trimesters, scheduled cesarean delivery, early labor, active labor, 2nd stage of labor, and delivery. Overall, 22 studies met the inclusion criteria. There were 1,193 patients, and 2,008 observations identified. All time periods had maternal venous lactic acid aggregate means and two-standard-deviation ranges less than 4 mmol/L. Outside of labor, all ranges were less than 2 mmol/L. All labor periods had a range higher than 2 mmol/L. While the pooled ranges were less than 4 mmol/L, many individual studies reported ranges > 4 mmol/L during labor. This meta-analysis suggests that venous lactic acid levels can be used as a screening tool in pregnant women just as the test would be used in nonpregnant women, except that elevations may be seen during labor, especially later in labor when there is maximal skeletal muscle contraction.

Combined spinal-epidural block for labor analgesia. Comparative study with continuous epidural block

IntroductionLumbar epidural block is an effective and routinely used technique for labor pain relief, and the combined spinal-epidural block has the benefit of using lower doses of local anesthetics and rapid onset of analgesia. The objective of this study was to evaluate the effectiveness and safety of two anesthetic techniques: combined spinal-epidural block and continuous epidural block in pregnant women for labor analgesia. MethodsEighty patients, ASA II and III, with cephalic presentation and cervical dilation between 5 and 6cm, undergoing labor analgesia, allocated in two groups according to the anesthetic technique: combined spinal-epidural (GI) and continuous epidural (GII). Pain severity before the blockade, time to complete analgesia, degree of motor blockade, time to full cervical dilation, duration of the second stage of labor, pain severity during the 1st and 2nd stage of labor, type of delivery, use of oxytocin during labor, maternal cardiocirculatory and respiratory parameters and adverse events, and neonatal repercussions were recorded. ResultsAt the time of anesthesia, pain severity was similar in both groups. Pain relief was faster in GI (4.5±1.5min) when compared to GII (11.6±4.6min) p=0.01; pain scores in the first and second stages of delivery were lower in GI (0.9±0.3 and 1.8±0.7, respectively) when compared to GII (1.9±0.6 and 2.2±0.5, respectively), with p=0.01 only in the first stage of labor; there was need for local anesthetics supplementation in GII; there were more frequent spontaneous deliveries in GI (80% of patients) than in GII (50%) (p=0.045) and more frequent use of instrumental (p=0.03) in GII (12 patients) compared to GI (4 patients); the frequency of cesarean deliveries was significantly higher (p=0.02) in Group II than in Group I, with 4 cases in GI and 8 cases in GII; absence of maternal cardiocirculatory and respiratory changes and neonatal repercussions; more frequent pruritus in GI (10 patients) and (0 patients in GII) (p=0.02). ConclusionThe combined blockade proved to be effective with better quality of analgesia and greater comfort for pregnant women, constituting a good option for the practice of obstetric analgesia.

Bloqueio combinado raquiperidural para analgesia de parto. Estudo comparativo com bloqueio peridural contínuo

IntroductionLumbar epidural block is an effective and routinely used technique for labor pain relief, and the combined spinal‐epidural block has the benefit of using lower doses of local anesthetics and rapid onset of analgesia. The objective of this study was to evaluate the effectiveness and safety of two anesthetic techniques: combined spinal‐epidural block and continuous epidural block in pregnant women for labor analgesia. MethodsEighty patients, ASA II and III, with cephalic presentation and cervical dilation between 5 and 6 centimeters, undergoing labor analgesia, allocated in two groups according to the anesthetic technique: combined spinal‐epidural (GI) and continuous epidural (GII). Pain severity before the blockade, time to complete analgesia, degree of motor blockade, time to full cervical dilation, duration of the second stage of labor, pain severity during the 1st and 2nd stage of labor, type of delivery, use of oxytocin during labor, maternal cardiocirculatory and respiratory parameters and adverse events, and neonatal repercussions were recorded. ResultsAt the time of anesthesia, pain severity was similar in both groups. Pain relief was faster in GI (4.5±1.5min) when compared to GII (11.6±4.6min) p=0.01; pain scores in the first and second stages of delivery were lower in GI (0.9±0.3 and 1.8±0.7, respectively) when compared to GII (1.9±0.6 and 2.2±0.5, respectively), with p=0.01 only in the first stage of labor; there was need for local anesthetics supplementation in GII; there were more frequent spontaneous deliveries in GI (80% of patients) than in GII (50%) (p=0.045) and more frequent use of instrumental (p=0.03) in GII (12 patients) compared to GI (4 patients); the frequency of cesarean deliveries was significantly higher (p=0.02) in Group II than in Group I, with 4 cases in GI and 8 cases in GII; absence of maternal cardiocirculatory and respiratory changes and neonatal repercussions; more frequent pruritus in GI (10 patients) and (0 patients in GII) (p=0.02). ConclusionThe combined blockade proved to be effective with better quality of analgesia and greater comfort for pregnant women, constituting a good option for the practice of obstetric analgesia.

Perineal length among Vietnamese women

ObjectiveVietnamese clinicians routinely perform episiotomies in the belief that 3rd–4th degree tears may be prevented, based partly on the view that Vietnamese women have a short perineal length that puts them at increased risk of tears. However, there is no evidence to suggest Vietnamese women have a short perineum compared with other populations. We aimed to determine the mean perineal length among Vietnamese women in early labor and in the second stage, and to compare this to findings from similar studies in other populations. Materials and methodsWe undertook an observational study in a tertiary obstetric hospital in Vietnam from October 2014 to June 2015. Pregnant women who presented in early labor with a live singleton cephalic presentation at ≥37 weeks gestation were eligible. Perineal length was measured early in the 1st stage of labor (≤4 cm dilation) and in 2nd stage of labor (10 cm dilation). Mean perineal length was compared to other populations using t-tests. ResultsOf 395 women, 159 (40.3%) were nulliparous and 236 (59.8%) multiparous. Overall the mean perineal length in early labor was 3.4 cm (±0.4), and did not differ by parity. Mean perineal length among Vietnamese women was significantly shorter (P < 0.001) than other populations (means 3.8–4.6 cm). Among 365 women who reached 2nd stage the mean perineal length was 4.3 cm (±0.6). ConclusionThe perception that Vietnamese women have a relatively shorter perineal length appears to have some basis and outcomes reported from episiotomy trials may not be generalizable to Vietnamese women.

Etiological Factors&amp; Clinical Courses of Birth Asphyxia in Rural and Urban Population of Kishanganj District.

Problem statement : perinatal asphyxia, neonatal or birth asphyxia is a medical condition from deprivation of oxygen to a newborn infant long enough during the process to cause physical usually to the brain. And it is almost all neonatal deaths occur in our rural and urban area. Where the majority is delivered at homes with negligible antenatal care and poor prenatal services.Methods: In this collaborative study conducted prospective, descriptive study. As a case of 150 newborn babies and as a control 1190 newborn babies are fulfilled the selection criteria for prenatal and birth asphyxia .Results: Incidence of birth asphyxia in relation to ante partum and intrapartum factors. And shows that mother with complication like eclampsia, APH, PROM, cord accidents, failed progress of labor, obstructive labor &amp; prolong 2nd stage of labor, etc were more likely to deliver asphyxiated baby, and analysis of maternal risk factors for birth asphyxia. Many pathological, biochemical &amp; metabolic changes occurs as a result of birth asphyxia. And the data were analyzed by slandered statistical test, namely, Z test, Chi square test, and uniovariate and ultivariate logistic regression analysis of risk factor.Conclusion: In our study it was observed that, Pregnancy related complication in rural &amp; urban population of Kishanganj district was mostly Eclampsia, pre-eclamptic toxaemia, Oligohydramnios, PROM(M24hr) etc. To prevent birth asphyxia trained personal and neonatal resuscitation equipment should be mandatory in all maternity home/hospital because prevention is the best and be only option to reduce the Pre natal &amp; birth asphyxia.Bangladesh Journal of Medical Science Vol.16(4) 2017 p.554-556

Does a policy of earlier induction affect labour outcomes in women induced for postmaturity? A retrospective analysis in a tertiary hospital in the North of England

Objectivesto investigate whether a change in the management of postmature pregnancy to earlier induction affects the length of labour and the induction process. Secondly, to assess the feasibility of the research process to inform a future larger study. Designa change in management of postmature pregnancy in an NHS hospital in October 2013, from induction at 42 weeks gestation to induction between 41–42 weeks, provided an opportunity to conduct a retrospective analysis. Pre-existing data from the maternity database and casenotes were collected and primary outcomes analysed using the Mann-Whitney test and the Hodges-Lehman confidence interval for differences in medians. Settinga large city based tertiary referral hospital in the North of England. Participants125 women induced before the change in policy were compared with 309 women induced after the change. Measurementsprimary outcomes were length of 1st and 2nd stage of labour, overall length of labour, length of induction to established labour and length of induction to birth. Findingsthe median overall length of labour for women induced at 42 weeks was 6.5hours, while for women induced at 41–42 weeks this was 5.2hours. The difference was not statistically significant (p=0.15, 95% CI for median difference −0.27 to 1.93hours) with a small effect size (Pearson's r=−0.08). The median length of induction to birth was 13.6hours for women induced at 42 weeks and 16.5hours for women induced at 41–42 weeks. This difference was also not statistically significant (p=0.14, 95% CI for median difference −7.25 to 1.20hours) with a small effect size (Pearson's r=−0.13). Key conclusions and implications for practiceThis study demonstrated no statistically significant differences in length of labour and induction following a change in the management of postmature pregnancy to earlier induction. A large study is needed to establish definitively the effects of earlier induction on labour outcomes.

Fetal heart rate monitoring category 3 during the 2nd stage of labor is an independent predictor of fetal acidosis

Objective: To determine whether fetal heart rate (FHR) monitoring categories during the 1st and 2nd stage of labor can predict arterial cord pH <7.2.Materials and methods: A case control study was conducted including 653 consecutive term deliveries (37 weeks gestation and above) that were divided according to fetal pH ≤ 7.2 (n = 315) and fetal pH > 7.2 (n = 338). Deliveries occurred during the year 2013 in tertiary medical center, where arterial cord pH is routinely taken after birth. Intrapartum FHR monitoring categorization was defined according to the ACOG committee guidelines by two obstetricians. Multivariable models were constructed to control for confounders.Results: Variable decelerations, late decelerations and bradycardia during the 1st and 2nd stages of labor were significantly higher in group of deliveries ended in cord pH < 7.2 compared with group of deliveries ended in cord pH > 7.2. A significant association was observed between category 2 and 3 during the 1st stage of labor and pH ≤ 7.2. However, while controlling for FHR category 3 at the 2nd stage of labor, 1st stage categorization lost its association with pH <7.2, and only category 3 during the 2nd stage were noted as an independent risk factor for acidosis.Conclusion: FHR monitoring category 3 during the 2nd stage of labor is an independent predictor of fetal acidosis as expressed by arterial cord pH < 7.2.

An Analysis of Operative Delivery Practices Over 30 Years [11D

INTRODUCTION: The aim of this study was to determine delivery practice changes over the past 30 years for singleton pregnancies as a means to elucidate the underlying causes of the rising cesarean section (c/s) rate over the last several decades. METHODS: Delivery data was collected at a medium-sized teaching hospital in Colorado, averaging 4,690 singleton births/year, over 34 years. The numbers of forceps, vacuums, breeches and c/s were recorded for 79,723 singleton deliveries, from alternating years between 1978 and 2012 with complete records available. RESULTS: C/s done for breech presentation remained largely stable, averaging 3% of all deliveries (range 2.09–3.9%). The rate of operative vaginal delivery significantly decreased from a high of 14.7% in 1978 to 2% in 2010. Pooling the number of all operative deliveries (cesarean and forceps/vacuums combined) for non-breech presentation, the overall rate of deliveries requiring an operative approach remained stable at 27.7% in 1978 and 28% in 2012, (average 25.8%). CONCLUSION: Our data suggests that an even trade-off between operative vaginal deliveries and laboring c/s has occurred during the 2nd stage of labor over the past 30 years. The decrease in operative deliveries and not the decrease in breech vaginal deliveries, accounts for the increase in c/s rates. This decrease in operative deliveries is not surprising and has been demonstrated in other studies. This is presumably due to lack of training and comfort using operative vaginal techniques, as well as concerns for morbidity to both the newborn and the mother.

Maternal Outcome of Prolonged Pregnancy

The probability of a pregnancy terminating in a full-term, healthy live birth is a powerful indicator of the health status of its women, and of the quality of health care available to them during pregnancy and birth. The present study conducted to find out the maternal outcome of prolonged pregnancy. This study carried out in the department of obstetrics, Sir Salimullah Medical College and Mitford Hospital, Dhaka, between the period of February 2003 and December 2003. Patients admitted in labour ward having the history of post dates but not in labour and some were admitted during first stage of labour. Patients who were sure about their Last Menstrual Period (LMP) and those patients who had regular menstrual cycle were included in the study. Total 139 respondents were included in the study. Among them 114 (82.01%) were in the age group of 18 to 29 years and 25 (17.99%) were in the age group of ?30 years. Among the respondents 67 (48.2%) were primi gravida and 72 (51.8%) were multi gravida. Among the respondents 92 (66.2%) were in the 1st stage of labour, 7 (5.0%) were in the 2nd stage of labour and rest 40 (28.8%) were not in labour. Mode of delivery of highest number of respondents was caesarian section (54.0%) followed by normal vaginal delivery (39.7%). Other mode of delivery were ventouse and forceps and they were 07(05.0%) and 2(1.4%) respectively. Out of 75 respondents under gone caesarian section, indication of C/S was fetal distress in 1st stage of labour, prolong 1st stage with maternal distress, failed induction, cephalopelvic disproportion (CPD) and breech presentation with big baby were 32.0%, 25.3%, 24.0%, 16.0% and 2.7% respectively. Maternal morbidity like PPH, UTI, puerperal sepsis and wound infection were 10.0%, 14.40%, 3.60% and 5.70% respectively. In postdated pregnancy maternal morbidity is common finding. It also has more operative interference.J Bangladesh Coll Phys Surg 2014; 32: 66-70

Evaluation of myomectomy during cesarean delivery in patients with uterus myomatosus

Methods: A retrospective cohort study was performed at our hospital between 2002 – 2013. Included were all women undergoing CD with uterine leiomyomas and singleton pregnancies. The CD was performed by a consultant. Excluded were multiple pregnancies, placentation disorders, preeclampsia/HELLP, primary coagulopathies, CD in 2nd stage of labor and CD with additional surgical interventions.

788: Fetal heart rate (FHR) monitoring during the 2nd stage of labor: can categorization predict adverse neonatal outcome while adding specific FHR patterns?

788: Fetal heart rate (FHR) monitoring during the 2nd stage of labor: can categorization predict adverse neonatal outcome while adding specific FHR patterns?

The outcome of midwife-led labor in low-risk women within an obstetric referral unit

Objective: To analyze maternal and neonatal outcomes of midwife-led labor in low-risk women at term.Methods: Prospective observational cohort of 1788 singleton low-risk pregnancies in spontaneous term labor, managed according to a specific midwife-led labor protocol. Primary outcomes were mode of delivery, episiotomy, 3rd–4th degree lacerations, post-partum hemorrhage (PPH), need for blood transfusions, pH and Apgar score and NICU admissions.Results: A total 1754 low-risk women (50.3% of all deliveries) were included in the analysis. Epidural analgesia was performed in 29.8% of cases. The rate of cesarean section was 3.7%. Episiotomy was performed in 17.6% of women. PPH > 1000 ml occurred in 1.7% of cases. 3.2% and 0.3% of the cases had an Apgar score <7 and pH < 7.10, respectively, while 0.3% of the newborns were admitted to NICU. Consultant-led labor was required for emerging risk factors during 1st and 2nd stage of labor in 16.1 and 8.6% of cases, respectively. Although maternal outcome were worse in women with emerging risk factors in labor, while neonatal outcomes were not affected by the presence these complications.Conclusions: In hospital settings, midwife-led labor in low-risk women might unfold its major advantages without additional risks of medicalization for the mother and the neonate.

P17.07: Prospective fetal neck and shoulder visualisation during the second stage of labour and prior to operative vaginal delivery: a feasability study

The vaginal operative delivery (OVD) is a major risk factor for shoulder dystocia. Persistent anteriorposterior orientation of the fetal shoulders is probably not caused by the intervention itself, but may be present immediately before OVD. In contrast to intrapartum ultrasound with translabial - perineal access to objectify the descent of the fetal head, we used a transabdominal access, just cranial of the maternal symphysis, to visualize the orientation of fetal shoulders during pushing period. To evaluate the feasibility of this method we analysed ultrasound examination during the 2nd stage of labour, at levels of + / - 0 with regard to indication and mode of delivery. During the pushing period sonographic visualisation of the following structures have been evaluated: the fetal shoulder, humeral head / humerus longitudinally, if it presented in a sector between 10-2 o'clock, the distance to the adjacent maternal symphysis, representation of neck or orbits. Only cases with all structures identified were analysed. In 25 cases the complete identification of the structures listed above could be accomplished, and thus the orientation of the fetal shoulders could be objectified sonographically. This corresponded in all cases with the further route of delivery (vaginal vs. abdominal). Sonographic visualisation of fetal structures during pushing period can provide the obstetrician with valuable assistance. The identifcation of the orientation of the fetal shoulders just above and adjacent to symphysis could provide important additional information about the expected route of delivery.

Anal Injury in a Neonate due to Artificial Rupture of Membrane.

A 26-year-old primigravida with breech presentation came to the emergency in 2nd stage of labor with meconium stained per vaginal leak. Patient was initially taken to a primary health centre were artificial rupture of membrane was done to augment labor but later referred here since labor did not progress. After an emergency cesarean section, a female baby was delivered who on examination had a hematoma over right buttock, anal laceration, perianal edema, and severe rectal bleeding (Fig. 1). Anal injury during artificial rupture of membrane was suspected. Patient was managed conservatively by anal pack for 24 hours and later local dressings and antibiotics. The edema and hematoma resolved in 1 week (Fig. 2). The child has normal continence.