Abnormal Labor Research Articles

Abnormal labor as a medical and social issue

Abnormal labor is a main cause of obstetric and perinatal complications. Impaired uterine contraction during childbirth is accompanied by an increase in the risk of fetal asphyxia, obstetric bleeding and postpartum inflammatory diseases. The frequency of diagnosed abnormal uterine contractile activity is 10-25%, which, along with the high need for operative delivery, allows for considering abnormal labor as one of the main medical and social issues of the present time. The aim of this study was to consider abnormal labor as a medical and social problem. This was achieved by using an analytical method including carrying out a detailed systematic analysis of modern domestic and foreign literature on abnormal labor. The study used databases such as eLIBRARY.RU, Scopus, PubMed, MEDLINE, ScienceDirect, and Cochrane Library from the creation until July 2021. Abnormal labor is an important medical and social issue that requires the active development of methods to predict and prevent not only violations of uterine contractility, but also their complications.

Technology for predicting abnormal labor

BACKGROUND: Abnormal labor is the most common complication of labor. It occurs in 10-15% cases of labor and is an indication for operative delivery in a third of all cases. Until now, there are no effective ways to predict abnormal labor. Meanwhile, the use of high-tech forecasting methods is not available for a wide range of obstetric institutions in the Russian Federation.
 AIM: The aim of this study was to create a technology for predicting abnormal labor, based on generally available methods of laboratory and instrumental research.
 MATERIALS AND METHODS: Based on the data collected in the Regional Clinical Hospital Perinatal Center, Chita, Russia in 2018-2021, the retrospective analysis of 200 cases of labor was carried out. The total sample was divided into four study groups: 100 women with normal labor activity (group 1), 30 women with uterine inertia (group 2), 30 women with incoordinate uterine activity (group 3), and 50 women with excessive uterine activity (group 4). The groups were comparable in terms of age, anthropometric parameters and extragenital pathology. All women on the eve of labor (1-2 days) underwent general clinical and ultrasound examination. Statistical processing of the results was carried out using the IBM SPSS Statistics version 25.0 software.
 RESULTS: The technology for predicting abnormal labor is implemented based on a multilayer perceptron, with the percentage of incorrect predictions being 21.3%. The structure of the trained neural network included nine input neurons: labor parity, gestational age, leukocyte count, erythrocyte sedimentation rate, total protein concentration, amniotic fluid index, biparietal size, as well as fetal head and abdomen circumference.
 CONCLUSIONS: An integrated approach based on generally available laboratory and instrumental research methods, such as complete blood count and biochemical blood test, as well as ultrasound examination, on the eve of labor allows for predicting the abnormal labor development with an accuracy of up to 70%. The use of this technology in clinical practice will help, in the future, not only to prevent abnormal labor, but also to reduce the incidence of adverse obstetric and perinatal outcomes.

The impact of obesity on maternal-fetal prognosis through a comparative study

Abstract Objectives To clarify the impact of obesity on the course of pregnancy and childbirth by specifying maternal and fetal complications. Materials and Methods This is a comparative case-control study, conducted over a period of two months from February 1 to March 31, 2019, which included patients who gave birth in the Farhat Hached Sousse University Hospital and the Maternity and Neonatology Hospital of Monastir. Patients meeting the inclusion criteria were divided into two groups according to body mass index (BMI) at the end of pregnancy: group I: normal weight 18,5≤ BMI <25 and group II BMI greater than or equal to 30. Results Pregnancies of women in Group II were more frequently complicated by gravidic hypertension 8% against 1%, 3% pre-eclampsia against 0% and gestational diabetes 14% against 3%, as well as infections. In obese patients, there were more labor abnormalities with a 17% vs. 3% cesarean section rate and higher instrumental delivery rate 15% vs. 7%. Post-partum follow-up was marked by the occurrence of infectious maternal complications, anemia with breastfeeding difficulties. The newborns of group II women were born with a lower Apgar score and had more neonatal complications such as trauma 6% versus 0% meconium inhalation 6% versus 2% and hypoglycemia 4% versus 0%. Conclusions Obesity is a serious problem in obstetrics, with adverse effects on the health of the mother and her baby throughout pregnancy, childbirth and post-partum. The management of obese or overweight pregnant women must be early and adapted to each case with close obstetrical surveillance. Key messages Obesity is a serious problem in obstetrics, with adverse effects on the health of the mother and baby. The management of obese or overweight pregnant women must be early.

Influence of the diet's structure on the occurrence of the main gynecological pathologies in the sakhalin population of holstein cows

It was established that the level of metabolic energy and the content of raw fiber in diets significantly affects the milk productivity and the occurrence of reproductive pathologies of cows. With a high level of crude fiber and a lack of metabolic energy in the diet, 12.5 % of cows in the herd were diagnosed with persistent ovarian yellow body. Yellow bodies in the ovaries, as shown by surveys, were most often found 25-30 days after delivery or within the same period of time after infertile insemination, as well as in more distant terms. 23 % of sick cows have a diagnosis "ovarian hypofunction", with impaired growth, development, maturation and timely bursting of the follicles. In some cases, ovarian hypofunction occurred as a result of abnormal labor, untimely start-up and physiological old age of cows. In addition to ovarian pathology, cases of pathological processes in the uterus also led to infertility. Endometritis, as a rule, occurred with inflammation of the uterine mucosa (endometrium). This pathology usually occurred in cases of infection, injuries of the uterine mucosa during pathological childbirth, and retention of the afterbirth. With a low level of raw fiber in the diet and a high content of metabolic energy, the most common cows' pathologies were gynecological diseases in 28 heads (23.3 %). Pathological processes in the ovaries with a high level of metabolic energy in the diet almost completely disappear. Most often, endometritis was diagnosed in sick animals - 98.4 %, associated with infection of the genitals and birth injuries. Studies have shown that blood metabolites, body reserves, and the effectiveness of feeding dairy cows depend on the pH of the environment that occurs when feeding different types of diets. One of the conditions for active fermentation of the substrate is the optimal amount of raw fiber. Pathological processes in the ovaries with a high level of metabolic energy in the diet almost completely disappear.

Dysfunctional labor and hemoperitoneum secondary to an incidentally discovered dysgerminoma: a case report

BackgroundOvarian dysgerminoma, a subtype of malignant germ cell tumor (GCT), is a rare ovarian neoplasm that is infrequently found in the gravid patient. When dysgerminomas do occur in pregnancy, the rapidly growing tumors can have a heterogeneous presentation and lead to peripartum complications and morbidity. Due to the rarity of this condition, diagnostic and therapeutic strategies are not well described in the literature.Case presentationA healthy multigravida with an uncomplicated antenatal history presented for elective induction of labor. She had a protracted labor course, persistently abnormal cervical examinations, and eventually developed a worsening Category II tracing that prompted cesarean birth. Intraoperatively, a 26 cm pelvic mass later identified as a Stage IA dysgerminoma was discovered along with a massive hemoperitoneum. The mass was successfully resected, and the patient remains without recurrence 6 months postoperatively.ConclusionAlthough rare and generally indolent, dysgerminomas can grow rapidly and cause mechanical obstruction of labor and other complications in pregnancy. Pelvic masses, including malignant neoplasms, should be included in as part of a broad differential diagnosis when evaluating even routine intrapartum complications such as abnormal labor progression. Additionally, we demonstrate that adnexal masses can be a source of life-threatening intraabdominal hemorrhage.

Морфофункціональний стан щитоподібної залози в дітей з уродженим гіпотиреозом

Актуальність. Захворювання щитоподібної залози (ЩЗ) займають перше місце серед усієї ендокринної патології і залишаються однією з найбільш складних проблем. Мета: оцінити морфофункціональний стан ЩЗ в дітей із уродженим гіпотиреозом (УГ). Матеріали та методи. Робота заснована на даних обстеження 34 дітей з УГ: ультразвукове дослідження ЩЗ, визначення рівня тиреоїдних гормонів (тиреотропний гормон (ТТГ), вільний тироксин, тиреоглобулін). Статистичний аналіз проводився стандартними методами з використанням пакета програм StatSoft Statistica 6.0 для Microsoft Windows XP. Результати. У 67,6 % випадків діагноз був поставлений за скринінгом на УГ, у 32,4 % — поза скринінгом. У 22 пацієнтів тиреоїдна тканина не візуалізувалася в типовому місці, або сумарний обсяг її був значно менший від норми. У 12 пацієнтів ЩЗ перебувала в типовому місці, а обсяг її відповідав нормі або перевищував її верхню межу. У 55,6 % визначалися кісти (у 56 % — з дистопією ЩЗ, у 44 % випадків — з гіпоплазією ЩЗ). Усі вони розташовані паратрахеально: ліворуч — у 66,7 %, праворуч — у 13,3 %, у 20 % — з обох сторін. Встановлений виражений ступінь тиреоїдної недостатності у пацієнтів із вадами залози, однак при гіпоплазії ЩЗ рівень ТТГ перебував на більш низьких значеннях (р < 0,05) порівняно з дистопією. Обтяжена спадковість переважно за материнською лінією спостерігалася в 11,7 %, майже у третині випадків відзначався обтяжений акушерсько-гінекологічний анамнез, більше ніж у половини матерів були патологічні відхилення родової діяльності, та у 2,1 раза частіше, ніж у загальній популяції, траплялася переношена вагітність. Висновки. Частота вроджених аномалій ЩЗ у дітей із УГ становить 64,7 %, більше ніж у половині випадків визначаються кісти. Виражений ступінь тиреоїдної недостатності зареєстрований у випадках гіпоплазії ЩЗ.

Natural Methods for Relieving Labor Pain and Anxiety during the First Stage among Primigravida Mothers

Labor pain is a universal experience among primigravida during pregnancy. Failure to manage labor pain may lead to abnormal labor. There are many complementary nonpharmacological methods used to cope with labor pain such as back massage and breathing exercises. Aim: To evaluate the effect of natural methods for relieving labor pain and anxiety during the first stage of labor among primigravida mothers. Design: A quasi-experimental design was utilized to accomplish this study. Sample: A Purposive sample included 80 primigravida mothers were recruited and divided into two equal groups as a group (A) refers to the back massage group (n=40) and group (B) which refers to the breathing exercises group (n=40). Setting: The study was applied in the Obstetrics and Gynecology Department at Sohag University Hospital. Three tools were used for data collection (1) A structured interviewing questionnaire, (2) a visual analog pain scale, (3) a State-Trait Anxiety Inventory scale. Results: Revealed that there was a highly significant difference between mean and SD of pretest level and posttest regarding labor pain level in back massage and breathing exercises groups at P=0.001 level. There was a highly significant difference between mean and SD of pretest level and posttest regarding anxiety level in back massage and breathing exercises groups at P=0.001 level. Conclusion: Back massage and breathing exercises were effective in relieving and reducing the intensity of pain and reduce anxiety during the first stage of labor among primigravida mothers. Recommendation: Applying back massage and breathing exercises are recommended to relieve pain and reduce anxiety

Assessment of risk factors of perinatal pathology in women with menstrual function disorders

Objective - to study risk factors for perinatal pathology in women with menstrual dysfunction. Material and methods. The analysis of 207 birth histories of women with menstrual irregularities and charts of newborn babies was carried out. Results. Complications of pregnancy were significantly more often observed in women with menstrual dysfunction: in 72.9% of women against 32.0% in the control group. The main difficulties in childbirth were premature rupture of membranes - 21.5% and abnormalities of labor - 17.8%, and fetal distress - 15.0%. In the control group, the number of complicated deliveries was significantly less -21.0%. Premature babies were born significantly more often in this group - 15.0% and children with health impairment conditions constituted 9.3%.Conclusions. In women with menstrual irregularities, among the complications of pregnancy prevailed: the threat of termination of pregnancy in the first trimester and associated complications, and during childbirth - premature rupture of membranes, abnormalities of labor and fetal distress. Childbirth was often premature, much more often premature babies were born with health impairment conditions at birth.

Current aspects of the progress of labor in healthy women according to the data of the retrospective analysis

Purpose of the work – to study the current aspects of the course of labor in healthy women using retrospective indicators.Material and methods. To study this topic, an analysis of 1.078 births of women who were born on the basis of the maternity ward for pregnant women with obstetric pathology of the State Institution «Institute of Pediatrics,Obstetrics and Gynecology named after acad. O.M. Lukyanova National Academy of Medical Sciences of Ukraine». It was found that of all births, the proportion of first-borns was 602 (55.8 %) women, of whom 451 (41.8 %) were pregnant, and only 86 (8 %) were healthy pregnant women, which we will study in the future.Results. It was found that among 86 births, the frequency of physiological births was 64 %, of which in 47.7 % of cases childbirth was complicated, and pathological – 36 %. The most common complications during childbirth were: premature rupture of membranes (PRPO), episio- and perineotomy, trauma to the birth canal. The causes of pathological childbirth in the examined women were: abnormalities of labor, fetal distress, defect of manure and membranes, clinically narrow pelvis, malposition of the fetus and early postpartum hemorrhage. All children were born alive. It should be noted that all births, where the Apgar score was ≤ 6 points, had no partner support, and the women themselves did not undergo any preparation for childbirth. Conclusions. According to our data, in almost healthy women who gave birth for the first time and had no perinatal loss in the anamnesis, did not undergo prenatal training and did not have partner support during childbirth, the number of complications during childbirth is increasing. Therefore, this group of healthy pregnant women needs more detailed study and analysis, development of prenatal training algorithms to improve perinatal indicators.

Normal labor curve in twin gestation

Failure to progress is one of the leading indications for cesarean delivery in trials of labor in twin gestations. However, assessment of labor progression in twin labors is managed according to singleton labor curves. This study aimed to establish a partogram for twin deliveries that reflects normal and abnormal labor progression and customized labor curves for different subgroups of twin labors. This was a multicenter, retrospective cohort analysis of twin deliveries that were recorded in 3 tertiary medical centers between 2003 and 2017. Eligible parturients were those with twin gestations at ≥34 weeks' gestation with cephalic presentation of the presenting twin and ≥2 cervical examinations during labor. Exclusion criteria were elective cesarean delivery without a trial of labor, major fetal anomalies, and fetal demise. The study group comprised twin gestations, whereas singleton gestations comprised the control group. Statistical analysis was performed using Python 3.7.3 and SPSS, version 27. Categorical variables were analyzed using chi-square tests. Student t test and Mann-Whitney U test were applied to analyze the differences in continuous variables, as appropriate. A total of 1375 twin deliveries and 142,659 singleton deliveries met the inclusion criteria. Duration of the active phase of labor was significantly longer in twin labors than in singleton labors in both nulliparous and multiparous parturients; the 95th percentile duration was 2 hours longer in nulliparous twin labors and >3.5 hours longer in multiparous twin labors than in singleton labors. The cervical dilation progression rate was significantly slower in twin deliveries than in singleton deliveries with a mean rate in twin deliveries of 1.89 cm/h (95th percentile, 0.51 cm/h) and a mean rate of 2.48 cm/h (95th percentile, 0.73 cm/h) in singleton deliveries (P<.001). In addition, epidural use further slowed labor progression in twin deliveries. The second stage of labor was also markedly longer in twin deliveries, both in nulliparous and multiparous women (95th percentile, 3.04 vs 2.83 hours, P=.002). Twin labors are characterized by a slower progression of the active phase and second stage of labor compared with singleton labors in nulliparous and multiparous parturients. Epidural analgesia further slows labor progression in twin labors. Implementation of these findings in clinical management might lower cesarean delivery rates among cases with protracted labor in twin gestations.

Increasing adherence to plotting e-partograph: a quality improvement project in a rural maternity hospital in India

Abnormal prolonged labour and its effects are important contributors to maternal and perinatal mortality and morbidity worldwide. E-partograph is a modern tool for real-time computerised recording of labour data which...

A Dicephalus Parapagus Tribrachius Dipus Conjoined Twins: A case report

Dicephalus parapagus tribrachius dipus conjoined twins are a very rare phenomenon. We present a case of stillborn dicephalus parapagus tribrachius dipus female conjoined twins. The pregnancy was terminated after nine months of amenorrhea by cesarean section for labor abnormality at second stage of labor. It is supposed that with proper early diagnosis, this case should be terminated at first or second trimester of pregnancy.

Progression of the first stage of labour, in low risk nulliparas in a South Asian population: a prospective observational study

We compared the labour pattern in the active phase of labour, defined at 4 cm versus 6 cm cervical dilatation, in a South Asian population. This was a prospective observational study where 500 low risk nulliparous women were recruited. Our aim was to study, the average labour pattern curve of all parturients. Mean duration of the active phase from 4 to 10 cm was 5.12 ± 2.10 hours and from 6 to 10 cm was 2.79 ± 1.72 hours. The 95th percentile values suggests that it takes 5–6 hours to progress from 4 to 6 cm and again 5–6 hours from 6 to 10 cm. The minimum labour progression rate can be as low as 0.5 cm/hour with vaginal delivery (VD) still being achieved. The slope of labour curve steepens after 6 cm, suggesting 6 cm as the onset of the active phase. Allowing labour to continue for a longer period before 6 cm of cervical dilation may reduce the rate of unnecessary intrapartum intervention and caesarean section (CS) for labour dystocia. Impact Statement What is already known on this subject ? Friedman’s definitions of normal labour and abnormal labour are widely accepted in current obstetric practises. Friedman’s normal dilatation rate of 1 cm/h that is universally accepted is becoming questionable in our current obstetric population because of escalating rates of unnecessary labour interventions like oxytocin augmentation and CS. What the results of this study add ? The rule of 1 cm/hour of labour progression cannot be applied to every woman and inappropriate interventions should be withheld until labour progression does falls below 0.5 cm/hour. What the implications are of these findings for clinical practice and/or further research? Six centimetres rather than 4 cm of cervical dilatation is a more appropriate landmark for the start of the active phase. Allowing labour to continue for a longer period before 6 cm of cervical dilation may reduce the rate of unnecessary intrapartum interventions and CS for labour dystocia.

Effect of pre-operative bicarbonate infusion on maternal and perinatal outcomes among women with obstructed labour in Mbale hospital: A double blind randomized controlled trial.

Oral bicarbonate solution is known to improve both maternal and perinatal outcomes among women with abnormal labour (dystocia). Its effectiveness and safety among women with obstructed labour is not known. To determine the effect and safety of a single-dose preoperative infusion of sodium bicarbonate on maternal and fetal blood lactate and clinical outcomes among women with obstructed labour (OL) in Mbale hospital. We conducted a double blind, randomised controlled trial from July 2018 to September 2019. The participants were women with OL at term (≥37 weeks gestation), carrying a singleton pregnancy with no other obstetric emergency, medical comorbidity or laboratory derangements. A total of 477 women with OL were randomized to receive 50ml of 8.4% sodium bicarbonate (238 women) or 50 mL of 0.9% sodium chloride (239 women). In both the intervention and controls arms, each participant was preoperatively given a single dose intravenous bolus. Every participant received 1.5 L of normal saline in one hour as part of standard preoperative care. Our primary outcome was the mean difference in maternal venous blood lactate at one hour between the two arms. The secondary outcomes were umbilical cord blood lactate levels at birth, neonatal sepsis and early neonatal death upto 7 days postnatal, as well as the side effects of sodium bicarbonate, primary postpartum hemorrhage, maternal sepsis and mortality at 14 days postpartum. The median maternal venous lactate was 6.4 (IQR 3.3-12.3) in the intervention and 7.5 (IQR 4.0-15.8) in the control group, with a statistically non-significant median difference of 1.2 mmol/L; p-value = 0.087. Vargha and Delaney effect size was 0.46 (95% CI 0.40-0.51) implying very little if any effect at all. The 4.2g of preoperative intravenous sodium bicarbonate was safe but made little or no difference on blood lactate levels. PACTR201805003364421.

584 Ultrasound measurement of the obstetric conjugate and the relative position of the internal cervical os

The obstetric conjugate (OC) is the shortest anteroposterior pelvic diameter that the fetus must traverse during labor and delivery. Our objective was to assess the reliability of measurement of the OC using ultrasound during pregnancy. We also assessed the reliability of a novel measurement – the shortest distance between the OC and the internal cervical os (OCIO), hypothesized to correlate with labor success. All parturient women aged 18-50 who presented for anatomy ultrasound at our tertiary care medical center were included in the study. Multiple cine clips were obtained in which the pubic symphysis, sacral promontory, and internal cervical os could be seen. Two investigators independently reviewed the cine clips and obtained measurements of the OC and OCIO. Reviewers were blinded to the other’s measurements. Bland-Altman plots and interobserver intraclass correlation coefficients (ICC) were used to calculate interobserver reliability. A two-way mixed-effects model was assessed for calculating intra-class correlation coefficient among the two investigators. Agreement was considered excellent when the ICC was ≥ 0.9. Statistical analysis was performed using the Statistical Package for Social Science version 26.0 (SPSS Inc., Chicago, IL). 45 subjects were recruited for the study and measurements were possible in 37 cases. The mean ± S.D. age was 30 ± 5.3 years, gestational age 19.5 ± 1.6 weeks, and BMI 26.9 ± 6.1 kg/m2. The ICC for measurement of the OC was 0.96 (0.92 to 0.98) and 0.985 (0.97 to 0.99) for measurement of the OCIO. The Bland-Altman plots showed the 95% limits of agreement were -0.69 to 0.83 cm for the OC, and -0.56 to 0.91 for OCIO (Figure). The OC and the OCIO were measured with excellent interobserver reliability. Future studies will examine whether these measurements are associated with labor abnormalities.

793 Determining the human placenta microbiome in patients with type 2 diabetes

Determine the placenta microbiome composition in Type 2 diabetes A prospective cohort study with two groups: Type 2 Diabetes and Control. Eligible patients were enrolled upon admission. Patients ages 18-40 who delivered between 37-41.6 weeks. Maternal data included Hgb A1c, BMI, weight gain, labor abnormalities, and delivery mode. Fetal/neonatal data included congenital defects, growth abnormalities, gestational age, gender, birth weight, apgars, and NICU admission. With sterile technique, the placenta was collected at delivery. Sterile surgical tools were used to collect four cuboidal sections 3-4 cm from cord insertion. Tissue was immediately frozen in liquid nitrogen. Samples were transferred to a -80C freezer on dry ice. RNA extraction was done with E.Z.N.A RNA Extraction kit. NanoDrop was used to ensure appropriate yield. All samples were sent for 16s rRNA sequencing. Composite features include 34 total patients delivering between 37 to 41.6 weeks. Average hemoglobin A1c was 5.69%, ranging from 4.9-8.1%. Average BMI at admission was 36.5, ranging from 26-59. Average weight gain in pregnancy was 23.7 lbs, ranging from 1-67 lbs. 61% of patients delivered vaginally and 39% via cesarean. 70.6% of fetuses were female and 29.4% were male. Average birth weight was 3248g, ranging from 2010g - 4430g. In intergroup analysis, diabetic group had higher Hgb A1c (p-value 0.0025), larger BMI (p-value 0.0168), earlier gestational age (p-value 0.0012), and higher rate of cesarean (p-value 0.0111). No statistically significant difference in APGARs or birth weight. All placentas demonstrated high concentration yields of DNA. Further analysis of the placenta samples for microbial DNA resulted in no yield. The placentas showed no evidence of 16s rRNA gene amplification for a microbiome. Our results indicate no placental microbiome in either cohort. Pre-existing inflammatory conditions, such as Type 2 diabetes, did not significantly alter the placental environment. If placental microbiome does exist, then extremely low biomass may not have significant clinical implications.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

49 Normal Labor Curve in Twin Gestations

Failure to progress is the leading indication for cesarean delivery in trials of labor of twin gestations. However, assessment of labor progression in twin labors is managed according to singleton labor curves. This study aims to establish a partogram for twin deliveries that reflects normal and abnormal labor progress, as well as customized labor curves for different subgroups of twins. A multi-center retrospective cohort analysis of twin deliveries recorded in three tertiary medical centers between the years 2003-2017 was conducted. Eligible parturients were twin gestations ≥34 weeks with cephalic presentation of the presenting twin and ≥2 documented cervical examinations during labor. Exclusion criteria were elective cesarean delivery without trial of labor, major fetal anomalies, and fetal demise. Twin gestations comprised the study group while singletons counterparts formed the comparison group. Statistical analysis was performed with Python 3.7.3. A total of 1,375 twin deliveries and 142,659 singleton deliveries met the inclusion criteria. Parturients with twins used epidural analgesia more frequently (74.2% vs. 54.8%, p<0.001) and underwent more labor inductions (24.2% vs. 15.3%, p<0.001) as compared to singletons. Active phase duration was significantly longer in twins as compared to singletons in both nulliparous and multiparous parturients (p=0.005, p<0.001 respectively) (Figure 1). Epidural use and labor induction further slowed labor progression in twins as compared with singletons (p=0.02, p<0.001 respectively) (Figure 2). Twin labors are characterized by slower progression of the active phase of labor as compared with singletons. Nulliparity, epidural analgesia and induction of labor slow labor progression further. Implementation of these findings to clinical management might lower cesarean delivery rate due to protracted labor in twin gestations.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Features of the second half of pregnancy in women with labor abnormalities

Aim: conduct a systematic analysis of pregnancy development, investigate clinical and laboratory data affecting development of labor abnormalities in women residing in the Belgorod region. Materials and Methods. From 2014 to 2018, 484 women were examined and divided into 2 groups: main group consisted of those who had childbirth complicated with labor abnormalities (n = 344), whereas control group consisted of women lacking complications during delivery (n = 140). The following methods were used in the study: questionnaires, general clinical methods, biochemical blood tests in pregnant and postpartum women, populational statistics as well as methods of standard and multivariate statistics. Results. In the second half of pregnancy in women with labor abnormalities revealed higher rate of moderate preeclampsia (34.30 ± 2.56 % vs. 10.71 ± 2.61%; p &lt; 0.05), polyhydramnios (11.34 ± 1.71 % vs. 5.71 ± 1.96 %; p &lt; 0.05), chronic intrauterine hypoxia (29.6 ± 2.46 % vs. 12.86 ± 2.83 %; p &lt; 0.05), chronic utero-placental insufficiency (60.47 ± 2.64 % vs. 20.00 ± 3.38 %; p &lt; 0.05), sexually transmitted infections (3.78 ± 1.03 % vs. 0.71 ± 0.71 %; p &lt; 0.05), acute respiratory viral infection (8.72 ± 1.52 % vs. 3.57 ± 1.57 %; p &lt; 0.05) as well as a combination of several types of pathology (8.72 ± 1.52 % vs. 13.57 ± 2.89 %; p &lt; 0.05). Laboratory parameters in women with labor abnormalities compared with control antepartum group were noted to have significantly decreased count of red blood cells (3.89 ± 0.38×1012/L vs. 3.99 ± 0.40×1012/L; p = 0.006), eosinophils (0.95 ± 0.69×109/L vs. 1.20 ± 0.67×109/L; p = 0.026) and platelets (226.29 ± 62.71×109/L vs. 245.44 ± 60.32×109/L; p = 0.0003). Blood biochemical parameters in women with labor abnormalities vs. control group were featured with significantly decreased level of bilirubin (6.76 ± 3.16 μmol/L vs. 9.88 ± 3.60 μmol/L; p &lt; 0.05) and alanine aminotransferase (13.94 ± 10.08 U/L vs. 19.41 ± 14.40 U/L; p = 0.004). Analyzing coagulation parameters in the main group showed significantly reduced fibrinogen level (4.30 ± 1.00 g/L) compared with control group (4.71 ± 1.14 g/L; p &lt; 0.05) as well as elevated international normalized ratio (1.07 ± 0.11 vs. 1.03 ± 0.10; p = 0.001). Conclusion. Our study data found that pregnant women with labor abnormalities had altered clinical and laboratory parameters observed as early as in the second half of gestation, which may be used to calculate an individual risk of such labor complication.

Adverse Neonatal Outcome are More Common among Babies Born by Cesarean Section than Naturally Born Babies at Public Hospitals in Eastern Ethiopia: A Comparative Prospective Follow-Up Study at Eastern Ethiopia.

The adverse neonatal outcome is defined as the presence of birth asphyxia, respiratory distress, birth trauma, hypothermia, meconium aspiration syndrome, neonatal intensive care admission, and neonatal death. It is a major concern in developing countries, including Ethiopia. This study tried to identify predictors of adverse neonatal outcomes at selected public hospitals in Eastern Ethiopia. A hospital-based prospective follow-up study was conducted in three public hospitals in Eastern Ethiopia from June to October 2020. A total of 2,246 laboring women and neonates born at the hospitals were enrolled in the study. Data were collected through interviews, observation checklists, and clinical chart review. Reports were presented in relative risks with 95% CIs. The overall magnitude of adverse neonatal outcome was 20.97% (95% CI: 19.33- 22.71%). It was 24.3% for babies born through cesarean section (95% CI: 21.3%, 27.5). The presence of meconium in the amniotic fluid increased the risk for neonates delivered via cesarean section (ARR, 1.52 95% CI; 1.04, 2.22). Among neonates born via vaginal delivery, the risk of adverse neonatal outcome was higher among nullipara women (ARR, 1.42 95% CI; 1.02, 1.99) and among women diagnosed with abnormal labor or pregnancy such as APH, pre-eclampsia, obstructed labor, fetal distress, and mal-presentation at admission (ARR, 1.30 95%CI; 1.01, 1.67). The risk of adverse neonatal outcome was higher among babies born through the cesarian section than those born via vaginal delivery. Abnormal labor or pregnancy and being primiparous increased the risk of adverse neonatal outcome in vaginal delivery.

CURRENT ASPECTS OF DELIVERY IN HEALTHY WOMEN IN ACCORDANCE WITH THE DATA OF RETROSPECTIVE ANALYSIS

The aim: to study the current aspects of the course of labor in healthy women using retrospective indicators. Materials and methods: To study this topic, an analysis of 1,078 births on the basis of the maternity ward for pregnant women with obstetric pathology of the State Institution «IPAG. acad. O.M. Lukyanova National Academy of Medical Sciences of Ukraine». It was found that among all births, the share of first-borns was 602 (55.8 %) women, of whom 451 (41.8 %) were pregnant for the first time, and only 86 (8 %) were healthy pregnant women. Results: It was found that among 86 births the frequency of physiological births was 64%, of which in 47.7% of cases the birth was complicated, and pathological – 36%. The most common complications during childbirth were: premature rupture of membranes (PRPO), episio- and perineotomy, trauma to the birth canal. The main causes of pathological childbirth: abnormalities of labor, fetal distress, defect of the placenta and membranes, clinically narrow pelvis, malposition of the fetus and early postpartum hemorrhage. All children were born alive. It should be noted that all births where the Apgar score was ≤ 6 had no partner support, and the women themselves did not receive any preparation for childbirth. Conclusions: According to our data, in almost healthy women who gave birth for the first time and had no perinatal loss in the anamnesis, did not undergo prenatal training and did not have partner support during childbirth, the number of complications during childbirth is increasing. Therefore, this group of healthy pregnant women needs more detailed study and analysis, development of prenatal training algorithms to improve perinatal indicators.