Degree Of Cervical Dilatation Research Articles

Noninvasive factors predicting the maintenance of pregnancy for more than 4 weeks after rescue cerclage in singleton pregnancies with cervical dilatation and prolapsed membrane.

Studies on noninvasive factors and predicting the maintenance of pregnancy, and those comparing the usefulness of these factors with invasive amniotic fluid markers in predicting the maintenance of pregnancy following rescue cerclage, are lacking. Therefore, this study aimed to determine whether C-reactive protein (CRP) levels, White blood cell (WBC) count, absolute neutrophil count (ANC), and platelet-to-lymphocyte ratio (PLR) in maternal blood, which are noninvasive and readily available clinical markers, can predict the maintenance of pregnancy following rescue cerclage in patients with cervical insufficiency (CI). A total of 142 singleton pregnant women (15-28 wk) who underwent rescue cerclage for CI were retrospectively evaluated. The interleukin (IL)-6 concentration in the amniotic fluid; CRP levels, WBC count, ANC, and PLR in the maternal peripheral blood; and degree of cervical dilatation were evaluated before cerclage. The primary outcome was whether the pregnancy was maintained for >4 weeks after rescue cerclage. Among the 142 patients, prolonged pregnancy for >4 weeks following emergent cerclage was observed in 107 (75.35%), while 35 (24.65%) gave birth within 4 weeks. This study demonstrated that the degree of cervical dilatation at diagnosis; WBC count, ANC, and CRP levels in the maternal peripheral blood; and IL-6 concentration in the amniotic fluid significantly differed between the successful and failure groups (all P < .05). The area under the curve (AUC) of the amniotic fluid IL-6 concentration was .795 for the prediction of spontaneous preterm birth within 4 weeks after rescue cerclage. Additionally, the AUC of the CRP level, cervical dilatation, WBC count, ANC, and PLR were .795, .703, .695, .682, and .625, respectively. These findings suggest that the preoperative CRP levels can be considered a useful noninvasive marker comparable to amniotic fluid IL-6 concentration for identifying pregnant women with CI at high risk of spontaneous preterm birth following rescue cerclage.

Refining the Clinical Definition of Active Phase Arrest of Dilation in Nulliparous Women to Consider Degree of Cervical Dilation as Well as Duration of Arrest

(Abstracted from Am J Obstet Gynecol 2021;225:294.e1–294.e14) In the United States, the progression of labor has been substantially slower than reported previously, according to a retrospective observational study by the Consortium on Safe Labor. Yet, the optimal threshold for arrest of dilation that balances the likelihood of vaginal delivery with the risk of adverse maternal and neonatal outcomes is unknown.

VP46.08: The association between the degree of cervical dilatation at physical examination‐indicated cerclage placement and subsequent neonatal outcomes

VP46.08: The association between the degree of cervical dilatation at physical examination‐indicated cerclage placement and subsequent neonatal outcomes

Position and Integrity of Uterine Scar Are Determined by Degree of Cervical Dilatation at Time of Cesarean Section

(Abstracted from Ultrasound Obstet Gynecol 2021;57:466–470) Abnormally invasive placenta (AIP) is a rare and sometimes fatal condition during pregnancy. Abnormally invasive placenta usually is caused by placental implantation over a uterine scar from a previous uterine surgery, most commonly a cesarean section (CS).

Refining the clinical definition of active phase arrest of dilation in nulliparous women to consider degree of cervical dilation as well as duration of arrest

Maternal and neonatal outcomes associated with duration of arrest of dilation beyond 4 hours are not well known. In addition, the current definition of arrest does not consider the degree of cervical dilation (6 cm vs 7 cm vs 8 cm vs 9 cm) when arrest occurs. We sought to examine maternal and neonatal outcomes in nulliparous women who achieved the active phase of labor according to the duration they required to achieve a cervical change of at least 1 cm (<4 hours vs 4-5.9 hours vs ≥6 hours) beginning at 6, 7, 8 and 9 cm. This was a retrospective cohort study of nulliparous women with term singleton cephalic pregnancies in spontaneous or induced active labor (≥6 cm). To evaluate the effect of labor duration on maternal and fetal outcomes at different degrees of cervical dilation, we categorized women based on time intervals they required to achieve a cervical change of at least 1 cm after membrane rupture ("<4 hours," "4-5.9 hours," and "≥6 hours"), and we correlated each time interval with referent cervical dilation status (6 cm, 7 cm, 8 cm, and 9 cm). Maternal and neonatal outcomes were analyzed according to the duration to progress at least 1 cm starting from each degree of cervical dilation. Our primary outcome was a composite of neonatal outcomes, including intensive care unit admission, neonatal death, seizure, ventilator use, birth injury, and neonatal asphyxia. In addition, we examined maternal outcomes. Adjusted odds ratios with 95% confidence intervals were calculated, controlling for predefined covariates. Of 31,505 nulliparous women included in this study, 13,142 (42%), 10,855 (34%), 11,761 (37%), and 17,049 (54%) reached documented cervical dilation of 6, 7, 8, and 9 cm, respectively. At cervical dilation of 6 or 7 cm, the arrest of dilation of <4 hours compared with arrest of dilation of 4 to 5.9 hours was associated with decreased risks of adverse maternal outcomes. When cervical dilation was 8 or 9 cm, arrest of dilation of <4 hours compared with arrest of dilation of 4 to 5.9 hours was associated with decreased risks of adverse maternal and neonatal outcomes. For example, women starting at a cervical dilation of 8 cm who required <4 hours to achieve a cervical change of 1 cm compared with those who required 4 to 5.9 hours had lower rates of cesarean delivery (adjusted odds ratio, 0.40; 95% confidence interval, 0.28-0.55), chorioamnionitis (adjusted odds ratio, 0.42; 95% confidence interval, 0.29-0.60), and the neonatal composite outcome (adjusted odds ratio, 0.51; 95% confidence interval, 0.36-0.72). When cervical dilation is 6 or 7 cm, allowing arrest of dilation of ≥4 hours is reasonable because it was not associated withincreased risks of adverse neonatal outcomes. When cervical dilationis 8 or 9 cm, the benefit of allowing arrest of dilation of ≥4 hours should be balanced against the risk of adverse maternal and neonatal outcomes.

Position and integrity of uterine scar are determined by degree of cervical dilatation at time of Cesarean section.

Abnormal placental invasion is more common after an elective Cesarean delivery, suggesting that prelabor Cesarean section (CS) increases the likelihood of the CS scar being above the internal cervical os and predisposing to a scar pregnancy in the future. The aim of this study was to assess the location and integrity of the CS scar in postpartum women delivered by CS at different stages of labor. This was a prospective cohort study of women at term who underwent a CS for the first time. In all women, cervical dilatation was determined by digital examination at the time of the CS. All patients had a transvaginal ultrasound examination to assess the location of the CS scar in relation to the internal cervical os, as well as the presence of a scar niche. A total of 407 pregnant women were recruited into the study: 103 with cervical dilatation ≤ 2 cm, 261 with cervical dilatation 3-7 cm and 43 with cervical dilatation ≥ 8 cm at the time of the CS. A statistically significant correlation was observed between cervical dilatation at the time of the CS and the position of the CS scar. The scar was positioned in the uterus above the internal cervical os in 97.1% (100/103) of women delivered at a cervical dilatation of 0-2 cm, whereas the scar was located at or below the internal cervical os in 97.7% (42/43) of cases delivered at a cervical dilatation of 8-10 cm (P < 0.001). A uterine-scar defect (niche) was observed in 38.1% (64/168) of women with the scar located above, compared with 18.0% (43/239) of those with the scar situated at or below, the internal cervical os (P < 0.001). Prelabor and early-labor Cesarean delivery are associated with an increased prevalence of a scar in the uterine cavity as well as a scar niche. CS in late labor is associated with the uterine scar being situated in the endocervical canal and with a lower incidence of a niche. The position and integrity of the CS scar after prelabor and early-labor Cesarean delivery explain the predisposition to abnormal placental invasion in subsequent pregnancy. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Induction of labour in mid-trimester pregnancy using double-balloon catheter placement within 12\u2009h versus within 12\u201324\u2009h

BackgroundThis study aims to evaluate the efficacy and safety of the induction of labour in mid-trimester pregnancy using a double-balloon catheter (DBC) within 12 h versus within 12–24 h.MethodsIn this retrospective study, a total of 58 pregnant women at 14 + 0 weeks to 27 + 6 weeks of gestation were enrolled as research subjects, and they underwent the intended termination of pregnancy at our birth centre from January 1, 2017, to June 31, 2019. Based on the duration of DBC, the patients were divided into two groups, namely, the DBC group within 12 h and the DBC group within 12–24 h.ResultsAll 58 cases were successful vaginal deliveries, and no one chose to undergo caesarean section. The success rate of induction (successful abortion of the foetus and placenta without the implementation of dilation and evacuation) was higher in the DBC group within 12–24 h (96.3%, 29/31) than in the DBC group within 12 h (71.0%, 18/27) (p < 0.05). Additionally, the time from DBC removal to delivery in the DBC group within 12–24 h was significantly shorter than that in the DBC group within 12 h (3.0 h versus 17.8 h) (p < 0.05), and the degree of cervical dilation after DBC removal in the DBC group within 12–24 h was larger than that in the DBC group within 12 h (p < 0.05).ConclusionIn the clinic, the placement time of DBC generally lasts for approximately 12 h. However, considering that the cervical condition is immature in the mid-trimester, properly extending the placement time of DBC to 24 h will benefit cervical ripening and reduce the chance of dilation and evacuation.

Intrapartum fetal blood sampling performed at early cervical dilatation and delivery outcomes

Intrapartum fetal blood sampling (FBS) is a fetal well-being diagnostic test for cardiotocogram abnormalities. The aim of this study was to determine whether women who had their first FBS at <4cm cervical dilation had an increased risk of operative delivery (caesarean section, instrumental delivery) compared to those women who had their first FBS≥4cm dilation. Retrospective cohort study involving labouring women who underwent FBS in a tertiary centre between 2015 and 2017. Women who had their first FBS at <4cm dilation were compared to those who had their first FBS at ≥4cm. The primary outcome was operative delivery (caesarean, instrumental delivery); secondary outcomes were neonatal complications. Univariate logistic regression was used to assess the association between degree of cervical dilation at first FBS and study outcomes. Among 591 women, 39 (6.6%) had their first FBS at <4cm cervical dilation. Women in the ≥4cm group were less likely to have a total of ≥2 FBS (P=0.003). There was no difference in the primary outcome between the two groups. Women who had the first FBS at <4cm dilation were twice as likely to have a caesarean section delivery (odds ratio 2.06, 95% confidence interval 1.06-3.98), although 41% had a vaginal birth (instrumental and spontaneous). There were no differences in rates of resuscitation or admission to nursery between groups. Women who had their first FBS<4cm cervical dilation were twice as likely to have a caesarean section compared to women who had their first FBS≥4cm. However, 41% had a vaginal birth, and there were no differences in fetal outcomes.

Moistening the new vaginal misoprostol tablets: does it increase the efficacy of cervical priming before manual vacuum aspiration in first-trimester miscarriage? A randomised clinical trial

Objectives: The primary objective of our study was to ascertain whether moistening the Brazilian formulation of vaginal misoprostol tablets increases cervical dilation before manual vacuum aspiration (MVA), compared with use of dry misoprostol, in first-trimester miscarriage. The secondary objective was to ascertain whether there was any correlation between vaginal pH and the degree of cervical dilation using a moistened or dry misoprostol tablet.Methods: In a single-centre, double-blind, randomised trial, 46 patients with first-trimester miscarriage were randomly allocated to treatment with dry or moistened (with 200 µl distilled water) 2 × 200 μg misoprostol tablets.Results: The median (range) cervical dilation in the wet and dry groups was 8 mm (6–12 mm) and 7 mm (5–10 mm), respectively (p = .06). The median time between misoprostol insertion and carrying out the procedure did not differ between the dry (406 min, range 180–550 min) and wet (448 min, range 180–526 min) groups (p = .1). No correlation was found between vaginal pH and cervical dilation using continuous data (p = .57; r= 0.08; 95% confidence interval −0.02, 0.3) or dichotomous data (pH ≤5/>5; cervical dilation ≥8 mm or <8 mm; p = .8).Conclusion: No difference was observed in cervical dilation between moistened and non-moistened misoprostol use prior to MVA.

FIRST TRIMESTER MISCARRIAGE;

Objectives: This study was conducted to access the efficacy of misoprostol andmanual vacuum aspiration for the management of first trimester miscarriage. Study Design:Descriptive case series. Setting: This study was conducted in obstetrics and gynecologydepartment of Nishtar hospital Multan. Duration of Study: This study was conducted fromMay, 2015 to October 2015. Material and Methods: Sample including 652 women havinggestational age less than 12 weeks with open os of cervix were taken in the study. Femaleswith previous cesarean section, multiple gestation or with history of asthma, ischemic heartdisease, hepatitis, glaucoma, or known allergy to prostaglandins were excluded. Total womenwere divided into two groups. i.e. 326 in misoprostol while 326 in manual vacuum aspirationgroup. Misoprostol group received misoprostol tablet 400μg vaginally at intervals of four hoursdepending on the degree of cervical dilatation and frequency of uterine contractions. A total of 3doses of misoprostol were given. Six hours after the first dose of misoprostol syntocinon infusionwas started. Infusion rate was 2mIU/min. Dose was increased after every 30 minutes at the rateof 1mIU/min to maximum of 8mIU/min. Manual vacuum aspiration group did not receive anyuterotonics and directly underwent manual vacuum aspiration. Patients were asked to revisit 7days after the procedure. Transvaginal ultrasound was done to access endometrial thicknessin the longitudinal view of the uterus at the maximal AP diameter. Efficacy was measuredin the form of complete abortion. Results: In the study, misoprostol group mean age was31.79±4.86 years while age range was 18-40 years. In manual vacuum aspiration group meanage was 32.38±4.86 years. Majority of patients were between 31-35 years in both groups. Meangestational age was 9.89±1.38 weeks in misoprostol group and 9.871±1.22 weeks in manualvacuum aspiration group, while mean dose in misoprostol group was 2.358±0.65. Conclusion:Regarding management of first trimester miscarriage both options including manual vacuumaspiration and 400μg intra vaginal misoprostol can be considered. Both methods are affectivetreatment options, decision that which method be opted should be based on, availability of twomethods and wishes of the patient.

English

Objectives: This study was conducted to access the efficacy of misoprostol andmanual vacuum aspiration for the management of first trimester miscarriage. Study Design:Descriptive case series. Setting: This study was conducted in obstetrics and gynecologydepartment of Nishtar hospital Multan. Duration of Study: This study was conducted fromMay, 2015 to October 2015. Material and Methods: Sample including 652 women havinggestational age less than 12 weeks with open os of cervix were taken in the study. Femaleswith previous cesarean section, multiple gestation or with history of asthma, ischemic heartdisease, hepatitis, glaucoma, or known allergy to prostaglandins were excluded. Total womenwere divided into two groups. i.e. 326 in misoprostol while 326 in manual vacuum aspirationgroup. Misoprostol group received misoprostol tablet 400μg vaginally at intervals of four hoursdepending on the degree of cervical dilatation and frequency of uterine contractions. A total of 3doses of misoprostol were given. Six hours after the first dose of misoprostol syntocinon infusionwas started. Infusion rate was 2mIU/min. Dose was increased after every 30 minutes at the rateof 1mIU/min to maximum of 8mIU/min. Manual vacuum aspiration group did not receive anyuterotonics and directly underwent manual vacuum aspiration. Patients were asked to revisit 7days after the procedure. Transvaginal ultrasound was done to access endometrial thicknessin the longitudinal view of the uterus at the maximal AP diameter. Efficacy was measuredin the form of complete abortion. Results: In the study, misoprostol group mean age was31.79±4.86 years while age range was 18-40 years. In manual vacuum aspiration group meanage was 32.38±4.86 years. Majority of patients were between 31-35 years in both groups. Meangestational age was 9.89±1.38 weeks in misoprostol group and 9.871±1.22 weeks in manualvacuum aspiration group, while mean dose in misoprostol group was 2.358±0.65. Conclusion:Regarding management of first trimester miscarriage both options including manual vacuumaspiration and 400μg intra vaginal misoprostol can be considered. Both methods are affectivetreatment options, decision that which method be opted should be based on, availability of twomethods and wishes of the patient.

Two cervical preparation regimens prior to surgical abortion at 10–14 weeks of gestation: A randomized clinical trial

Background: The aim of the study was to determine whether same-day cervical preparation with an osmotic dilator and misoprostol was as effective and safe as overnight cervical preparation for surgical abortions at 10–14 weeks.Methods: Seventy women seeking surgical abortion at 10–14 weeks were allocated to receive one osmotic dilator 16–17 h or 6–7 h prior to an abortion. All women received misoprostol 400 μg orally 2 h before the abortion.Results: The abortion time of the same-day group was 7.42 ± 1.73 min, and that of the overnight group was 8.00 ± 2.19 min (p = 0.23). The blood loss volume of the same-day group was 20.6 ± 10.6 mL, and that of the overnight group was 16.3 ± 7.0 mL (p = 0.55). The degree of cervical dilation for the same-day group was inferior to the overnight group (p = 0.02).Conclusions: Same-day cervical preparation with misoprostol and an osmotic dilator shortens the hospitalization days, suggesting same-day cervical preparation is safe, effective, and feasible for surgical abortion at 10–14 weeks of gestation.

Risk Factors for Unintended Dural Puncture in Obstetric Patients: A Retrospective Cohort Study.

Unintended dural puncture (UDP) is one of the main risks of epidural analgesia, with a reported incidence of approximately 1.5% among the obstetric population. UDP is associated with maternal adverse outcomes, with the most frequent adverse outcome being postdural puncture headache (PDPH). Our retrospective cohort study objective was to identify demographic and obstetric risk factors that increase the risk of unintentional dural puncture as well as describing the obstetric outcome once a dural puncture has occurred. We retrospectively reviewed all cases of UDPs during attempted vaginal delivery between the years 2004 and 2013 in a single Israeli hospital. Each UDP case was matched with the 2 parturients who received epidural analgesia before and 2 parturients after performed by the same anesthesiologist (control group). Demographic, anesthetic, and obstetric variables were compared between the UDP and control groups. Out of 46,668 epidural procedures, 177 cases of UDPs were documented (0.4%). One hundred seven women (60.5%) developed PDPH, and 38 (35.5%) required an epidural blood patch. In multivariate logistic regression, the degree of cervical dilation in centimeters at the time of epidural insertion was associated with an increased rate of UDP (P < .001). Multiparity was associated with PDPH after UDP (P = .004). Women with UDP had longer length of hospital stay than those without UDP (P < .001). UDP, an uncommon complication, is associated with obstetric factors. Nevertheless, it does not seem to be associated with adverse obstetric outcomes except for prolonged duration of hospital stay.

Effectiveness of emergency cerclage in cervical insufficiency

Objective: To assess the effectiveness of emergency cerclage versus conservative management in improving obstetric and neonatal outcomes in women with clinically evident cervical insufficiency.Methods: Retrospective cohort study conducted on all women with a single viable pregnancy diagnosed with cervical insufficiency between the 14th and 24th gestational week without pPROM, clinical chorioamnionitis, vaginal bleeding, treatment-resistant uterine contractions or life-incompatible fetal anomalies, from January 2009 to December 2014. Obstetric and neonatal outcomes were compared between women who underwent cerclage and those who refused, preferring a conservative therapy.Results: Eighteen women underwent emergency cerclage and 19 were managed with a conservative therapy. Mean gestational age at delivery, time from diagnosis to delivery and rate of term birth were significantly higher in the first cohort. Those variables show a linear inverse correlation with the degree of cervical dilatation, with better outcomes in patients who underwent cerclage with a dilatation lower than 5.0 cm. No difference in mode of delivery were found.Conclusion: Emergency cerclage is a valid therapeutic option between the 14th and 24th gestational week in presence of cervical insufficiency when signs of premature labour or infection are not present, with lower expectations with a dilatation greater than 5 cm.

Pronostic obstétrical de la présentation du siège en cas d’admission en travail avancé

Fear of dystocia during breech delivery brings obstetrical teams to choose elective caesarean sections. However, some patients with breech presentations will be in labour before the date scheduled and caesarean delivery during labour increases maternal morbidity. Therefore, this situation raises the question about the relevance of labour trial for breech presentations admitted in labour. Our study aimed to determine the obstetrical prognosis of breech presentations on admission in the labour ward following their degree of cervical dilation. We conducted an observational retrospective study on 213 single breech presentations at ≥37 gestational weeks that delivered at our level 3 labour ward between1st January 2007 and 30th July 2013. Maternal, obstetrical and neonatal factors were analyzed. The total caesarean rate during labour was 23.4% and significantly less important (P<0.05) in patients with cervical dilation ≥5cm on admission (14% vs. 27%). Apgar scores, cordonal arterial pH and lactates, rate of transfer to intensive care were not significantly different between the two groups. In our study, any patient with a breech presentation at an advanced stage of labour on admission is of very good prognosis, although statistical power is insufficient.

Evaluation of systemic exercise and dietary intervention on promoting natural delivery during the middle and late pregnancy

Objective To investigate the effect of promoting natural delivery by implementing the systemic exercise and diet intervention for obstetric VIP primiparas during the middle and late pregnancy period . Methods From January 2011 to March 2012 , 97 primiparas were chosen as the intervention group in obstetric VIP clinic;at the same time, 274 cases of pregnant women were chosen as the control group from the general antenatal clinic of the hospital .Neither of the two groups of pregnant women had movement contraindication , and they all voluntarily made the decision for vaginal delivery .Pregnant women in the control group only accepted the general out-patient routine prenatal check-up and health guidance;while the pregnant women in the intervention group received the VIP systemic exercise and diet guidance in addition to the outpatient routine prenatal check-up and health guidance .The fetal presentation height before delivery , the degree of cervical dilation, the time of birth process, the amount of postpartum bleeding and the mode of delivery were compared within the two groups.Results The natural birth rate in the intervention group was 70.1%significantly higher than that of 35.8%in control group （χ2 =32.788, P＆lt;0.01）.The descending level of fetal presentation in the intervention group was （ -0.65 ±1.15） cm, which was significantly lower than （ -1.12 ±1.10） cm in the control group （t=2.65, P＆lt;0.01）.The total labor time and the first stage of labor time were （369.10 ± 166.82）min and （334.72 ±165.69） min, respectively, which were significantly shorter than （439.48 ± 177.93）min and （403.06 ±174.67）min in the control group （t=-2.57, -2.53;P＆lt;0.05）.The weight of pregnant women before delivery and that of the neonates were （74.70 ±4.80） kg and （3 489.00 ±66.89） g, respectively, in the intervention group, and were （77.80 ±4.70）kg and （3 680.00 ±54.62）g, respectively, in the control group.The differences were significant （t=1.83, 1.12; P＆lt;0.05）.Conclusions The VIP＆amp;nbsp;clinic provides the pregnant women with systemic exercise intervention and nutritional diet guidance , which result in decreasing the cesarean section rate , increasing the natural delivery rate , effectively shortening the time of labor process and reducing the amount of intrapartum bleeding . Key words: Natural delivery; Pregnant woman; Exercise; Diet intervention; Cesarean section

The feasibility of epidural block for analgesia in labor to reduce the rate of Cesarean section after parturiency

Objective To explore the effect of epidural block for labor analgesia on the rate of Cesarean section after parturiency.Methods We summaried 2,885 pregnant women who gave full-term childbirth in our hospital in the years of 1999 and 2009.We analyzed variation of the rate of epidural block for labor analgesia and Cesarean section.The latter included the variation of the total rate of Cesarean section and of the rate of Cesarean section failing to deliver after parturiency.Results The rate of epidural block for labor analgesia was 17.99％ in 1999 but 51.23％ in 2009.The rate of Cesarean section was 40.80％ in 1999 but 27.81％ in 2009.There were significant differences in the rates of epidural block for labor analgesia and Cesarean section between the two years( P＜ 0.001 ).The rate of Cesarean section failing to deliver after parturiency was 6.78％ in 1999 and 3.78％ in 2009,with a significant difference ( P＜ 0.05 ).The average time to parturiency to Cesarean section and the average degree of cervical dilatation were both increased.The average time to parturiency to Cesarean section was ( 164.11 ± 55.35 ) minutes and the dilation degree was ( 5.3 ± 2.05 ) cm in 1999 while it was ( 284.50 ± 84.66 ) minutes and ( 7.0 ± 1.83 ) cm in 2009,respectively; there was a significant difference between the two years ( P ＜ 0.05 ).The rates of ephalic dystocia and Cesarean section because of social factors were decreased after epidural block for labor analgesia.Conclusions Epidural block for labor analgesia can decrease the rates of Cesarean section and cephalic dystocia. Key words: Epidural block for labor analgesia; Rate of Cesarean section; Rate of Cesarean section after parturiency

Minimising the risk of accidental dural puncture with epidural analgesia for labour: a retrospective review of risk factors

BackgroundAccidental dural puncture has a quoted incidence of between 0.19% and 3.6% of obstetric epidurals and is associated with significant morbidity. We set out to determine possible factors associated with an increased risk of accidental dural puncture. MethodsWe performed a retrospective review of 18385 epidurals, performed over a 15-year period. Factors analysed were: time of day of insertion, loss-of-resistance technique, maternal position, cervical dilatation, grade of anaesthetist and depth to the epidural space. ResultsUsing univariate analyses we found no association between the risk of accidental dural puncture and the following variables: time of day of insertion (P=0.71), loss-of-resistance technique (P=0.22), maternal position for insertion (P=0.83), degree of cervical dilatation (P=0.41) and grade of anaesthetist performing the epidural (P=0.34). Conversely, we found that the risk of accidental dural puncture increased with increasing depth to the epidural space. This was confirmed using a logistic regression analysis, from which it was estimated that, for every 1-cm increase in depth, the risk of accidental dural puncture increased by approximately 19% (P=0.019; 95% CI for OR: 1.029–1.38). ConclusionWe conclude that the risk of accidental dural puncture increases with increasing depth to the epidural space. We suggest further study is required to correlate this risk with increasing body mass index.

The risk of intra-amniotic infection, inflammation and histologic chorioamnionitis in term pregnant women with intact membranes and labor

Objective A previous study has demonstrated that term labor is associated with an increased risk of microbial invasion of the amniotic cavity, intra-amniotic inflammation and histologic chorioamnionitis. This study was performed to determine when the risk of intra-amniotic infection, inflammation and histologic chorioamnionitis begins to increase during the course of labor. Study design Amniotic fluid (AF) was obtained from 926 term singleton pregnant women with intact membranes during cesarean section. AF was cultured for aerobic, anaerobic bacteria and genital mycoplasmas. An AF white blood cell (WBC) count was determined. Patients were divided into five groups according to the absence or presence of regular uterine contractions and the degree of cervical dilatation. Intra-amniotic inflammation was defined as an AF WBC ≥19/mm 3. Histologic chorioamnionitis was defined as the presence of acute inflammatory changes in the extra-placental membranes or the chorionic plate of the placenta, and funisitis was diagnosed in the presence of neutrophil infiltration into the umbilical vessel walls or Wharton’s jelly. Results (1) The more advanced the cervical dilatation, the greater the risk of intra-amniotic infection and/or inflammation and histologic chorioamnionitis; (2) The risk of intra-amniotic infection and/or inflammation increased after the cervix began to dilate (7.8% in group 1 [without regular uterine contractions] vs. 18.3% in group 2 [regular uterine contractions and cervical dilation ≤1 cm], p < 0.01); (3) however, histologic chorioamnionitis was significantly more common in women in group 3 than in group 2 (4.2% in group 2 [regular uterine contractions and cervical dilatation ≤1 cm] vs. 23.1% in group 3 [regular uterine contractions and a cervical dilatation of 2–3 cm], p < 0.05). Conclusions The risk of intra-amniotic infection and/or inflammation increases after the cervix begins to dilate and that of histologic chorioamnionitis increases after the cervix dilates 2 cm in term pregnant women with regular uterine contractions with intact membranes.

Association between ultrasound‐based assessment of fetal head station and clinically assessed cervical dilatation

To describe the association between ultrasound-based determination of fetal head station and clinical assessment of cervical dilatation during active labor. From 427 women with singleton uncomplicated term pregnancies we obtained, during the active phase of labor, 907 pairs of measurements. Fetal head station and position were determined using the LaborPro system, based on position tracking and ultrasound imaging technology, and degree of cervical dilatation was determined by digital vaginal examination. The association between them was analyzed. The overall correlation between cervical dilatation and fetal head station was 0.64 (P < 0.001). Complete dilatation was observed in 78% of women with fetal head engagement, and in all women with a fetal head station of + 1.5 or more. There is good association between non-invasive ultrasound-based determination of fetal head station and clinically assessed cervical dilatation.