Assisted Delivery Research Articles

The outcome of labour in primigravida with term gestation and unengaged head at onset of labour

Introduction: Primigravida are the group at risk. As Ian Donald has said that “Primigravida is a dark and untrained horse and potential for child bearing is determined by the outcome of labour”. Labour is onset of regular uterine contraction followed by progressive cervical dilatation, effacement and descent of presenting part. Engagement is the first step in the mechanism of labour of a primigravida. Those with unengaged head at onset of labour are considered to be at high risk for operative delivery. Objective: To study the course of labour, need for intervention and fetal outcome in primigravida with unengaged fetal head at term gestation at onset of labour. Methods: A prospective study carried at Dept. of OBG at Rural medical college of Telangana state from July15 to Dec15. Total 120 primigravidas with unengaged head at term and at onset of labour were studied. Detailed history was taken in each case. General, systemic and obstetric examination was done. Ultra sonography was done in all cases and risk factors were ruled out. Cardio tocography (CTG) was done to know the fetal condition, partogram was used to monitor the progress of labour and interventions like augmentation and instrumental delivery. Results: Out of the 120 women, 91 women were in the range of 20-30 yrs, and 29 women were of less than 19 yrs. The mean duration of labour, 1st stage –(7hrs min 30 min to 10hrs 45 min) and 2nd stage (55 min to 110 min) out of total 120 cases 78 cases had vaginal delivery and 42 cases needed caesarean section. Among the 78 cases who delivered vaginally 14 cases had forceps delivery, 6 cases had vaccum assisted delivery and rest of the 58 cases had normal vaginal delivery. 42 cases required emergency LSCS, the commonest indication being failure of progress of labour. APGAR score was recorded at 5 min, 81 cases had APGAR score in the range of (7-10), in 33 babies APGAR score was (4-6),

Continuum of Care in a Maternal, Newborn and Child Health Program in Ghana: Low Completion Rate and Multiple Obstacle Factors.

BackgroundSlow progress has been made in achieving the Millennium Development Goals 4 and 5 in Ghana. Ensuring continuum of care (at least four antenatal visits; skilled birth attendance; postnatal care within 48 hours, at two weeks, and six weeks) for mother and newborn is crucial in helping Ghana achieve these goals and beyond. This study examined the levels and factors associated with continuum of care (CoC) completion among Ghanaian women aged 15–49.MethodsA retrospective cross-sectional survey was conducted among women who experienced live births between January 2011 and April 2013 in three regions of Ghana. In a two-stage random sampling method, 1,500 women with infants were selected and interviewed about maternal and newborn service usage in line with CoC. Multiple logistic regression models were used to assess factors associated with CoC completion.ResultsOnly 8.0% had CoC completion; the greatest gap and contributor to the low CoC was detected between delivery and postnatal care within 48 hours postpartum. About 95% of women had a minimum of four antenatal visits and postnatal care at six weeks postpartum. A total of 75% had skilled assisted delivery and 25% received postnatal care within 48 hours. Factors associated with CoC completion at 95% CI were geographical location (OR = 0.35, CI 0.13–0.39), marital status (OR = 0.45; CI 0.22–0.95), education (OR = 2.71; CI 1.11–6.57), transportation (OR = 1.97; CI 1.07–3.62), and beliefs about childhood illnesses (OR = 0.34; CI0.21–0.61).ConclusionThe continuum of care completion rate is low in the study site. Efforts should focus on increasing postnatal care within 48 hours and overcoming the known obstacles to increasing the continuum of care completion rate.

A newborn with a large mass: vacuum extraction-caused dura lesion.

We report on a newborn with a large, high parieto-frontally located mass after vacuum extraction. Imaging methods revealed a large subcutaneous collection of cerebrospinal fluid and hemorrhage. Traumatic dura lesions should be considered in neonates presenting with a large head lump after assisted delivery with vacuum extraction.

Advances and Challenges of Liposome Assisted Drug Delivery.

The application of liposomes to assist drug delivery has already had a major impact on many biomedical areas. They have been shown to be beneficial for stabilizing therapeutic compounds, overcoming obstacles to cellular and tissue uptake, and improving biodistribution of compounds to target sites in vivo. This enables effective delivery of encapsulated compounds to target sites while minimizing systemic toxicity. Liposomes present as an attractive delivery system due to their flexible physicochemical and biophysical properties, which allow easy manipulation to address different delivery considerations. Despite considerable research in the last 50 years and the plethora of positive results in preclinical studies, the clinical translation of liposome assisted drug delivery platforms has progressed incrementally. In this review, we will discuss the advances in liposome assisted drug delivery, biological challenges that still remain, and current clinical and experimental use of liposomes for biomedical applications. The translational obstacles of liposomal technology will also be presented.

Clinical impact of the disposable ventouse iCup® versus a metallic vacuum cup: a multicenter randomized controlled trial

BackgroundAssisted vaginal delivery by vacuum extraction is frequent. Metallic resterilizible metallic vacuum cups have been routinely used in France. In the last few years a new disposable semi-soft vacuum extraction cup, the iCup, has been introduced. Our objective was to compare maternal and new-born outcomes between this disposable cup and the commonly used Drapier-Faure metallic cup.MethodsThis was a multicenter prospective randomized controlled open clinical trial performed in the maternity units of five university hospitals and one community hospital in France from October 2009 to February 2013. We included consecutive eligible women with a singleton gestation of at least 37 weeks who required vacuum assisted delivery. Women were randomized to vacuum extraction using the iCup or usual Drapier-Faure metallic cup. The primary outcome was a composite criterion including both the risk of cup dysfunction and the most frequent maternal and neonatal harms: the use of other instruments after attempted vacuum extraction, caesarean section after attempted vacuum extraction, three detachments of the cup, caput succedaneum, cephalohaematoma, episiotomy and perineal tears.Results335 women were randomized to the disposable cup and 333 to extraction using the metallic cup. There was no significant difference between the two groups for the primary outcome. However, failed instrumental delivery was more frequent in the disposable cup group, mainly due to detachment: 35.6 % vs 7.1 %, p < 0.0001. Conversely, perineal tears were more frequent in the metallic cup group, especially third or fourth grade perineal tears: 1.7 % versus 5.0 %, p = 0.003. There were no significant differences between the two groups concerning post-partum haemorrhage, transfer to a neonatal intensive care unit (NICU) or serious adverse events.ConclusionsWhile the disposable cup had more detachments and extraction failures than the standard metallic cup, this innovative disposable device had the advantage of fewer perineal injuries.Trial registrationwww.clinicaltrials.gov: NCT01058200 on Jan. 27 2010.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-015-0771-1) contains supplementary material, which is available to authorized users.

Obstetric care of women with female genital mutilation attending a specialized clinic in a tertiary center.

To study the obstetric outcomes of women attending a specialized clinic for women with female genital mutilation (FGM). The medical charts of women with FGM who consecutively attended a specialized clinic between 2010 and 2012 were reviewed retrospectively. The present study focused on women attending for obstetric reasons. The outcome measures were type of delivery, reason for cesarean delivery or assisted delivery, blood loss, episiotomy, perineal tear, duration of the second stage of labor, postpartum complications, weight of the neonate, and Apgar score. Outcomes were compared between women with FGM type III who underwent defibulation, and patients with FGM type I and II. The clinic was attended by 129 women, 84 perinatally. Obstetric outcomes were similar to average outcomes for women without FGM presenting at the same department and in Switzerland generally. Specifically, 20 women had a cesarean delivery. An assisted delivery was performed for 18 patients; among these, only eight had experienced obstructed labor. No statistically significant differences were found for the outcome measures when women with FGM type III were compared to FGM type I and II. Routine obstetric follow-up combined with specialized care for women with FGM, including defibulation, can avoid inappropriate obstetric practices and reduce obstetric complications known to be associated with FGM.

Measurement of subpubic arch angle by three-dimensional transperineal ultrasound and impact on vaginal delivery.

To assess whether antepartum measurement of the subpubic arch angle (SPAA) as a parameter of the bony pelvic outlet can predict vaginal delivery. Between January 2007 and June 2011, 625 nulliparous women with a singleton pregnancy were recruited from the antenatal clinic to be interviewed and have a four-dimensional transperineal ultrasound examination. Ultrasound examinations were performed between 34 and 36 weeks of gestation. Volume ultrasound data were saved for offline analysis, blinded against all other data. The SPAA was measured in the axial plane and logistic regression analysis was used to examine the association between SPAA and outcomes of vaginal delivery vs Cesarean section in the second stage of labor, and normal vs assisted vaginal delivery. The association between SPAA and the duration of second stage of labor was also analyzed. Of the 625 women recruited initially, 14 ultrasound data files could not be retrieved, providing a total of 611 ultrasound images for measurement of SPAA. Complete obstetric and ultrasound data were obtained from 593 patients. Mean SPAA was 109.3° (range, 65.6-131.6°). There was no association between SPAA and the odds of a vaginal delivery (odds ratio, 1.01 (95% CI, 0.97-1.06)). However, there was evidence of an association between SPAA and duration of second stage of labor within the subgroup of women with a normal vaginal delivery (cause-specific hazard ratio, 1.02 (95% CI, 1.01-1.03); P = 0.003). SPAA is not useful for predicting vaginal delivery; however, there is an association between this parameter and the duration of the second stage of labor.

A novel gastroscope intervention mechanism with circumferentially pneumatic-driven clamping function.

Robotic assisted gastroscope delivery could solve various problems like understaffing, radiation and infection risk. The friction rollers commonly used in the few existed systems for traditional flexible endoscope, however, has potential risk of destroying scopes for non-uniform clamping. This research develops a novel gastroscope intervention mechanism (GIM) with a specially designed airbag. It evenly clamps the gastroscope with circumferential uniform pneumatic pressure. The GIM realizes axial and radial motion by means of the relay delivery mode similar to clinician's operation. The critical slipping force at different air pressure was analyzed to provide guidelines for safe intervention. Experiments were performed to evaluate the delivery accuracy and velocity and measure the critical slipping force. The results showed the axial and radial accuracy for delivery are 0.025±0.2mm and -0.03±0.25deg, respectively. The average velocity of 6.00mm·s(-1) and 75 deg·s(-1) were achieved to push/pull and twist the gastroscope. The relationship between the critical slipping force and air pressure could be fitted with a quadratic polynomial.

SU‐E‐T‐797: Variations of Cardiac Dose at Different Respiratory Status in CyberKnife M6â„¢ Treatment Plans for Accelerated Partial Breast Irradiation (APBI)

Purpose:Cyberknife robotic assisted radiation delivery has become a choice for accelerated breast RT, while a slightly increased cardiac dose has been reported. The dose dynamics throughout the respiration cycle has scarcely been explored. This study was designed to investigate the dose changes at each respiratory phase or status during respiration cycle.Methods:Six patients with 4DCT studies and six patients with a pair of free‐breathing and deep breath‐hold CT sets were used for dosimetry comparisons. 4DCT sets were obtained by Siemens™ CT and its respiratory gating system, comprising of 8 phases. Standard APBI plan at 340 cGy was done per fraction per NSABP B‐39/RTOG 0413 and modulated with Cyberknife M6™ on MultiPlan™5.1.2. For the purpose of this study, the tumor volume was outlined in the media‐lower quadrant of the left breast.Results:Except for D5cc in plans with 4DCT, cardiac doses are significantly different between respiratory phases in well inhaled breathing phases, and more significantly in plans with BH CT. Mean cardiac doses in 100% inhalation phase were often found to be 5–15% (p&lt; 0.02) less than those in other phases.Conclusion:Although ineligible cardiac doses are noted in APBI plans using 4D free‐breathing CT and instantaneous free breathing CT series, a reduction in cardiac dose was seen for the well‐inhaled phases. This provides practical guidance for cardiac dose reduction applicable with CK M6 APBR.

Mode of delivery and cranial bleeding in newborns with haemophilia: a systematic review and meta-analysis of the literature.

Cranial bleeding at birth can result in significant neurological morbidity in newborns with haemophilia. The optimum mode of delivery (MOD) of a potentially affected foetus remains controversial. The aim of this review is to ascertain overall incidence of cranial bleeding in newborns with haemophilia compared to the general population and the impact of MOD on rates of intracranial haemorrhage (ICH). An EMBASE/MEDLINE search using key terms revealed the relevant studies. Studies included report the incidence of cranial bleeding by MOD within a newborn population. The heterogenicity across studies was assessed using Cochrane's Q test and I(2) statistic and studies were assigned appropriate weight based on a fixed-effect model. Odds ratio (OR) is the primary effect measure. Newborns with haemophilia are 44 times (95% CI: 34.7-57.1, P < 0.01) more likely to experience symptomatic ICH, and 8 times (95% CI: 5.38-12.6, P < 0.01) more likely to experience extracranial haemorrhage at birth, compared to the general population. In newborns with haemophilia the OR of experiencing ICH are 4.4 (95% CI: 1.46-13.7, P = 0.008) following an assisted vaginal delivery (AVD) and 0.34 (95% CI: 0.14-0.83, P = 0.018) following caesarean section (CS), compared to vaginal delivery. Cranial bleeding occurs with a significantly higher frequency in newborns with haemophilia compared to the general population. In newborns with haemophilia, delivery by a CS is associated with the lowest risk of ICH. AVD significantly increases the risk of ICH and should be avoided.

Basic and comprehensive emergency obstetric and neonatal care in 12 South African health districts.

To assess the functionality of healthcare facilities with respect to providing the signal functions of basic and comprehensive emergency obstetric care in 12 districts. Twelve districts were selected from the 52 districts in South Africa, based on the number of maternal deaths, the institutional maternal mortality ratio and the stillbirth rate for the district. All community health centres (CHCs) and district, regional and tertiary hospitals were visited and detailed information was obtained on the ability of the facility to perform the basic (BEmONC) and comprehensive (CEmONC) emergency obstetric and neonatal care signal functions. Fifty-three CHCs, 63 district hospitals (DHs), 13 regional hospitals and 4 tertiary hospitals were assessed. None of the CHCs could perform all seven BEmONC signal functions; the majority could not give parenteral antibiotics (68%), perform manual removal of the placenta (58%), do an assisted delivery (98%) or perform manual vacuum aspiration of the uterus in a woman with an uncomplicated incomplete miscarriage (96%). Seventeen per cent of CHCs could not bag-and-mask ventilate a neonate. Less than half (48%) of the DHs could perform all nine CEmONC signal functions (81% could perform eight of the nine functions), 24% could not perform caesarean sections, and 30% could not perform assisted deliveries. The ability of the CHCs and district hospitals to perform the signal functions (lifesaving services) of basic and comprehensive emergency obstetric care was poor in many of the districts studied. This implies that safe maternity care was not consistently available at many facilities conducting births.

Bi-modal cancer treatment utilizing therapeutic ultrasound and an engineered therapeutic nanobubble

We developed a bi-modal cancer therapy comprising a sorafenib loaded ultra-sonic responsive nanobubble (SRF-NB) for ultrasonic assisted delivery in hepatocellular carcinoma.

Labor epidural analgesia and the incidence of instrumental assisted delivery

ObjectiveTo assess the influence of labor epidural analgesia on the course of labor and to determine its association with instrumental assisted delivery rate. Materials and methodsA retrospective case–control study was performed during 2007–2011 aiming to identify the relation between epidural analgesia (EA) and instrumental assisted delivery (IAD) rate. All patients in whom instrumental assistance for delivery was applied were allocated into either case (parturients who received EA and had IAD) or control (parturients who did not receive EA but had IAD) groups. Maternal demographic data, pregnancy and delivery characteristics as well as neonatal short-term outcome were studied. ResultsA total of 7675 vaginal deliveries occurred during the study period and 187 (2.43%) patients had IAD. Vacuum extraction was applied to 67 (2.16%) parturients who received EA, and to 120 (2.61%) who did not. The median duration of the first stage of labor was 510min in the EA group as compared to 390min in the control group (P=0.001). The median duration of the second stage of labor among cases and controls was 60 and 40min, respectively (P<0.0005). Cases more often had their labor induced by oxytocin 80.3% as compared to 58.3% among controls (P=0.003). There was no significant association between the use of EA and increased IAD rate (OR=0.81; 95% CI, 0.60–1.09). ConclusionsLabor EA did not increase the incidence of IAD and the risk of adverse neonatal outcomes, but was associated with prolonged first and second stages of labor.

Prophylactic manual rotation for fetal malposition to reduce operative delivery.

Manual rotation is commonly performed to increase the chances of normal vaginal delivery and is perceived to be safe. Manual rotation has the potential to prevent operative delivery and caesarean section, and reduce obstetric and neonatal complications. To assess the effect of prophylactic manual rotation for women with malposition in labour on mode of delivery, and maternal and neonatal outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2014), the Australian and New Zealand Clinical Trials Registry (ANZCTR), ClinicalTrials.gov, Current Controlled Trials and the WHO International Clinical Trials Registry Platform (ICTRP) (all searched 23 February 2014), previous reviews and, references of retrieved studies. Randomised, quasi-randomised or cluster-randomised clinical trials comparing prophylactic manual rotation in labour for fetal malposition versus expectant management, augmentation of labour or operative delivery. We defined prophylactic manual rotation as rotation performed without immediate assisted delivery. Two review authors independently assessed study eligibility and quality, and extracted data. We included only one small pilot study (involving 30 women). The study, which we considered to be at low risk of bias, was conducted in a tertiary referral hospital in Australia, and involved women with cephalic, singleton pregnancies. The primary outcome was operative delivery (instrumental delivery or caesarean section).In the manual rotation group, 13/15 women went on to have an instrumental delivery or caesarean section, whereas in the control group, 12/15 women had an operative delivery. The estimated risk ratio was 1.08 (95% confidence interval 0.79 to 1.49). There were no maternal or fetal mortalities in either groupThere were no clear differences for any of the secondary maternal or neonatal outcomes reported (e.g. perineal trauma, analgesia use duration of labour).In terms of adverse events, there were no reported cases of umbilical cord prolapse or cervical laceration and a single case of a non-reassuring or pathological cardiotocograph during the procedure. Currently, there is insufficient evidence to determine the efficacy of prophylactic manual rotation early in the second stage of labour for prevention of operative delivery. One additional study is ongoing. Further appropriately designed trials are required to determine the efficacy of manual rotation.

Commentary on 'Maternal and child health after assisted vaginal delivery: five-year follow up of a randomised controlled study comparing forceps and ventouse'.

Commentary on 'Maternal and child health after assisted vaginal delivery: five-year follow up of a randomised controlled study comparing forceps and ventouse'.

A new approach for highly accurate, remote temperature probing using magnetic nanoparticles.

In this study, we report on a new approach for remote temperature probing that provides accuracy as good as 0.017°C (0.0055% accuracy) by measuring the magnetisation curve of magnetic nanoparticles. We included here the theoretical model construction and the inverse calculation method, and explored the impact caused by the temperature dependence of the saturation magnetisation and the applied magnetic field range. The reported results are of great significance in the establishment of safer protocols for the hyperthermia therapy and for the thermal assisted drug delivery technology. Likewise, our approach potentially impacts basic science as it provides a robust thermodynamic tool for noninvasive investigation of cell metabolism.

Perosomus elumbis in Danish Holstein cattle

BackgroundPerosomus elumbis (PE) is a congenital defect that has been observed sporadically in Holstein cattle for many years. However, several cases have been reported in recent years and this may indicate an unrecognised spread of a mutant allele in the Holstein population worldwide. Two cases in Danish Holstein calves are reported to provide details on the phenotype.Case presentationTwo full-term Holstein calves were born after assisted delivery due to dystocia with breech presentation. External morphological examination indicated that the lumbar, sacral and coccygeal vertebrae were absent and the abdominal region was just present as a floppy sac covered by skin and enclosing the abdominal organs. The hind limbs were hypoplastic with bilateral symmetric arthrogryposis and muscular atrophy. Radiographs, computed tomography scan and necropsy confirmed these findings. The caudal part of the thoracic spinal cord showed myelodysplasia. A range of abdominal organ malformations were found at necropsy. Inbreeding was not found during genealogical examination, but remote shared ancestors were present in the pedigrees.ConclusionThe addition of these further cases of PE to the in recent years reported record of cases should draw more attention to this defect in the Holstein breed. PE may be an emerging genetic defect in the Holstein population worldwide and cases should be sampled to enable genetic mapping of the gene possibly underlying the disease. PE cases seem to be associated with a high risk of dystocia due to increased rate of breech presentation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12917-014-0227-2) contains supplementary material, which is available to authorized users.

Laser assisted drug delivery: A review of an evolving technology

Topically applied drugs have a relatively low cutaneous bioavailability. This article reviews the existing applications of laser assisted drug delivery, a means by which the permeation of topically applied agents can be enhanced into the skin. The existing literature suggests that lasers are a safe and effective means of enhancing the delivery of topically applied agents through the skin. The types of lasers most commonly studied in regards to drug delivery are the carbon dioxide (CO2 ) and erbium:yttrium-aluminum-garnet (Er:YAG) lasers. Both conventional ablative and fractional ablative modalities have been utilized and are summarized herein. The majority of the existing studies on laser assisted drug delivery have been performed on animal models and additional human studies are needed. Laser assisted drug delivery is an evolving technology with potentially broad clinical applications. Multiple studies demonstrate that laser pretreatment of the skin can increase the permeability and depth of penetration of topically applied drug molecules for both local cutaneous and systemic applications.

Dispersion characteristics of blood during nanoparticle assisted drug delivery process through a permeable microvessel

Nanoparticle assisted drug delivery holds considerable promise as a means of next generation of medicine that allows for the intravascular delivery of drugs and contrast agents. We analyze the dispersion characteristics of blood during a nanoparticle-assisted drug delivery process through a permeable microvessel. The contribution of molecular and convective diffusion is based on Taylor's theory of shear dispersion. The aggregation of red blood cells in blood flowing through small tubes (less than 40μm) leads to the two-phase flow with a core of rouleaux surrounded by a cell-depleted peripheral layer. The core region models as a non-Newtonian Casson fluid and the peripheral region acts as a Newtonian fluid. We investigate the influence of the nanoparticle volume fraction, the permeability of the blood vessel, pressure distribution, yield stress and the radius of the nanoparticle on the effective dispersion. We show that the effective diffusion of the nanoparticles reduces with an increase in nanoparticle volume fraction. The permeability of the blood vessels increases the effective dispersion at the inlet. The present study contributes to the fundamental understanding on how the particulate nature of blood influences nanoparticle delivery, and is of particular significance in nanomedicine design for targeted drug delivery applications.

Incidence and determinants of stillbirth amongst parturients in two hospitals in Southern Nigeria

Background: Fetal death is a major but often overlooked public health issue. Aim: Knowledge of the causes and risk factors will help in designing measures to reduce the burden of fetal death in Nigeria. Materials and Methods: A 5 year descriptive study of all fetal mortality of >28 weeks in Southern Nigeria. Relevant details were extracted from the case notes and the registers in the labor ward, maternity ward, the labor ward theater and the main theater. Statistical Analysis Used: The data was analyzed using Statistical Package for Social Scientist (SPSS PC+) and this consisted of univariate analysis and comparisons of identified relationships. Results: The total number of deliveries from 28 weeks was 25,780 and the number of parturients with fetal mortality after 28 weeks was 157 and therefore the incidence of stillbirth was 0.6% giving a mortality rate of 6.1/1000 total births. However, 148 (85%) case notes of the total fetal deaths were retrieved and formed the study sample. Socio-demographic variables such as extremes of age and parity, unbooked status, unemployment, unmarried, Isoko, Itsekiri and Ijaw ethnic groups and primary level or no formal education were determinants of stillbirth. Others were maternal diabetes mellitus, malaria, hypertension, labor duration >4 h, instrumental or assisted vaginal delivery, gestational age at booking >12 weeks, low birth weight and preterm births. Conclusion: The fetal mortality (stillbirth) rate was low and the determinants were identii¬ed. Public health education, female education and socio-economic empowerment are suggested preventive measures.