Delivery In Primigravidae Research Articles

Predictive Value of Bishop Score, Cervical Length and Head–Perineal Distance for the Success of Vaginal Delivery in Primigravida with Premature Rupture of Membrane

Predictive Value of Bishop Score, Cervical Length and Head–Perineal Distance for the Success of Vaginal Delivery in Primigravida with Premature Rupture of Membrane

Maternal Acylcarnitine Disruption as a Potential Predictor of Preterm Birth in Primigravida: A Preliminary Investigation.

Preterm birth, defined as any birth before 37 weeks of completed gestation, poses adverse health risks to both mothers and infants. Despite preterm birth being associated with several risk factors, its relationship to maternal metabolism remains unclear, especially in first-time mothers. Aims of the present study were to identify maternal metabolic disruptions associated with preterm birth and to evaluate their predictive potentials. Blood was collected, and the serum harvested from the mothers of 24 preterm and 42 term births at 28-32 weeks gestation (onset of the 3rd trimester). Serum samples were assayed by untargeted metabolomic analyses via liquid chromatography/mass spectrometry (QTOF-LC/MS). Metabolites were annotated by inputting the observed mass-to-charge ratio into the Human Metabolome Database (HMDB). Analysis of 181 identified metabolites by PLS-DA modeling using SIMCA (v17) showed reasonable separation between the two groups (CV-ANOVA, p = 0.02). Further statistical analysis revealed lower serum levels of various acyl carnitines and amino acid metabolites in preterm mothers. Butenylcarnitine (C4:1), a short-chain acylcarnitine, was found to be the most predictive of preterm birth (AUROC = 0.73, [CI] 0.60-0.86). These observations, in conjuncture with past literature, reveal disruptions in fatty acid oxidation and energy metabolism in preterm primigravida. While these findings require validation, they reflect altered metabolic pathways that may be predictive of preterm delivery in primigravida.

WITHDRAWN: The Effect of Preoperative Intravenous Tranexamic Acid Versus Rectal Misoprostol in Reducing Blood Loss During and After Elective Cesarean Delivery in Primigravida: A Double-Blinded, Randomized, Comparative-Placebo Trial

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Comparison between No and Routine Mediolateral Episiotomy during Delivery in Primigravidae, Regarding Maternal and Neonatal Outcome

Comparison between No and Routine Mediolateral Episiotomy during Delivery in Primigravidae, Regarding Maternal and Neonatal Outcome

Effect of a carbohydrate-rich beverage on rate of cesarean delivery in primigravidae with epidural labor analgesia: a multicenter randomized trial

BackgroundLabor represents a period of significant physical activity. Inefficient energy supply may delay labor process and even lead to cesarean delivery. Herein we investigated whether ingestion of a carbohydrate-rich beverage could reduce cesarean delivery in laboring women with epidural analgesia.MethodsThis multicenter randomized trial was conducted in obstetrician-led maternity units of nine tertiary hospitals in China. Primigravidae with single term cephalic pregnancy who were preparing for vaginal birth under epidural analgesia were randomized to intake a carbohydrate-rich beverage or commercially available low-carbohydrate beverages during labor. The primary outcome was the rate of cesarean delivery. Secondary outcomes included maternal feeling of hunger, assessed with an 11-point scale where 0 indicated no hunger and 10 the most severe hunger, and maternal and neonatal blood glucose after childbirth.ResultsBetween 17 January 2018 and 20 July 2018, 2008 women were enrolled and randomized, 1953 were included in the intention-to-treat analysis. The rate of cesarean delivery did not differ between the two groups (11.3% [111/982] with carbohydrate-rich beverage vs. 10.9% [106/971] with low-carbohydrate beverages; relative risk 1.04, 95% CI 0.81 to 1.33; p = 0.79). Women in the carbohydrate-rich beverage group had lower subjective hunger score (median 3 [interquartile range 2 to 5] vs. 4 [2 to 6]; median difference − 1; 95% CI − 1 to 0; p < 0.01); their neonates had less hypoglycemia (1.0% [10/968] vs. 2.3% [22/956]; relative risk 0.45; 95% CI 0.21 to 0.94; p = 0.03) when compared with those in the low-carbohydrate beverage group. They also had higher rates of maternal hyperglycemia (6.9% [67/965] vs. 1.9% [18/953]; p < 0.01) and neonatal hyperglycemia (9.2% [89/968] vs. 5.8% [55/956]; p < 0.01), but none required special treatment.ConclusionsFor laboring primigravidae with epidural analgesia, ingestion of a carbohydrate-rich beverage compared with low-carbohydrate beverages did not reduce cesarean delivery, but relieved maternal hunger and reduced neonatal hypoglycemia at the expense of increased hyperglycemia of both mothers and neonates. Optimal rate of carbohydrate supplementation remains to be determined.Trial registrationwww.chictr.org.cn; identifier: ChiCTR-IOR-17011994; registered on 14 July 2017.

Frequency of genital tract trauma in primigravida in Tertiary Care Hospital of Quetta.

Genital tract trauma is a common outcome of vaginal birth. These injuries can lead to serious complication like pain, dyspareunia, urinary and fecal incontinence, post-partum hemorrhage and fistulae. Objectives: To determine the frequency of genital tract trauma and its types, following spontaneous vertex delivery in primigravida. Study Design: Cross sectional study. Setting: Department of Obstetrics and Gynecology Unit 4, Bolan Medical Complex Hospital Quetta. Period: From 1st September 2018 to 31st March 2019. Material &amp; Method: A total of 127 Primigravida with vertex presentation were randomly included in the study. Frequency and percentages were calculated for genital tract trauma, type of trauma and episiotomy. Results: Frequency of genital tract trauma was found in 40 patients (31%). Regarding the type of trauma 90% (36/40) had perineal tear and 10% (4/40) had cervical tear. First degree perineal tear was seen in 17(47%), 2nd degree perineal in 18(50%) and one case of 3rd degree perineal tear was seen. Episiotomy was given in 40(32%). Conclusion: It is difficult to reduce the frequency of genital tract trauma after vaginal birth in primigravida, however their avoidance, recognition and management should be crucial for obstetricians. Mediolateral episiotomy appears to be protective against perineal trauma but its use should be restricted.

Effect of Maternal Obesity on Duration of Labor and Mode of Delivery in Primigravida

Effect of Maternal Obesity on Duration of Labor and Mode of Delivery in Primigravida

Factors influencing mode of delivery in primigravida in rural tertiary care hospital

Introduction: This study was done to determine the factors influencing mode of delivery in primigravida. Materials and Methods: A retrospective study was done involving 586 women who delivered at SAH & RC from 1st March 2018 to 31st August 2018. The data collected was categorised based on maternal age, mode of onset of labour, expected foetal weight, colour of liquor, presence of FHR abnormalities and indications for caesarean delivery. Additionally, effect on neonatal outcome was also studied. Results: Of the 586 pregnancies, 60.75% had vaginal delivery. The significant facilitating factors for vaginal delivery were found to be maternal age of 20-25 years(34.81%), spontaneous onset of labour(44.36%), expected foetal weight of 2.5-3.5kg(54.95%), clear liquor(93.00%) and no FHR abnormality. The caesarean section rate was 39.25%, most common indications being failure to progress (34.78%), MSAF(17.83%), FHR abnormalities(10.87%), CPD(10%), maternal request (7.8%), second stage arrest of labour (6.9%) and severe preeclampsia (3.48%). Of the 588 babies delivered, 6 neonatal deaths occurred(1.02%), of which 5 delivered vaginally(83.33%). 4 were due to birth asphyxia and 1 due to severe preeclampsia. 1 was delivered by caesarean section done for MSAF. 2 babies delivered via caesarean section (for second stage arrest) were diagnosed as hypoxic ischemic encephalopathy at the time of discharge. Comparing the outcomes of vaginal delivery and caesarean section, p value of 0.91(significant value p of delivery. Conclusion: The prediction for a woman to undergo vaginal delivery or caesarean section in primigravida depends on various factors other than obstetric factors such as counselling the woman and her family during labour and socioeconomic status. Keywords: Foetal heart rate, Meconium stained amniotic fluid, Cephalo-pelvic disproportion.

Serial profile of flow-mediated dilatation in primigravida for prediction of preeclampsia and gestational hypertension

ABSTRACTObjective: Assessment of endothelial dysfunction for prediction of gestational hypertension/preeclampsia (GH/PE).Methods: Serial assessment of flow-mediated vasodilatation (FMD) of brachial artery was done in first, second, and third trimesters, and within 6 weeks of delivery in primigravida (n = 654). Logistic regression was used to assess the predictive value of FMD for the development of GH/PE.Results: Significant fall in FMD was observed from first trimester to third trimester but decrease in FMD in GH/PE group (57%) was more marked as compared to normal (39%) (p < 0.01). FMD (third trimester) was able to predict the development of GH/PE (OR = 1.303; 95% CI 1.088–1.562; p = 0.004).Conclusions: FMD can be used as a non-invasive marker to predict the development of GH/PE.

Angle of progression in pregnant women before onset of labor in predicting the mode of delivery

Objective The aim of this study was to assess the efficacy of measuring angle of progress in the prediction of the mode of delivery in primigravida between 37 and 40 weeks of gestation. Background Prediction of mode of delivery, particularly identification of pregnant women at risk for cesarean delivery, has the potential to improve pregnancy outcome. Transperineal ultrasound has been suggested to be useful for predicting the mode of delivery. Patients and methods The study included 150 nulliparous women with a gestational age of 37–40 weeks, singleton fetus, and cephalic presentation with intact membranes. None of the women were in labor. We excluded women scheduled for elective cesarean section (CS) for a variety of indications. After history taking and physical examination, patients were subjected to transperineal ultrasound imaging to measure the angle of progression, and the mode of delivery was followed up to test the ability of the measured angle to predict the mode of delivery. Results At a cutoff angle of 93.5°, angle of progression correctly identified cases planned to deliver vaginally with a sensitivity of about 83.6% and a specificity of 88.9%. A statistically significant correlation was found between the angle of progression measured in the antenatal period and the mode of delivery (P Conclusion Translabial ultrasound-converted images to measure the angle of progression in antenatal period accurately predicted the mode of delivery, providing a more scientific basis for assessing labor.

EFFECT OF ACUPRESSURE THERAPY POINT LI 4, SP 6, AND BL 60 ON DURATION OF THE FIRST STAGE OF LABOR IN PRIMIGRAVIDA AND NEWBORN’S APGAR SCORE

Background: The prolonged partus is one of the causes of maternal deaths marked by the slow progress of labor. Induction of labor and caesarean section is a common procedure performed on long-term partus events to end pregnancy. The birth acupressure technique is a complementary method to activate the hormone oxytocin at a certain point to use to soften the cervix and increase contraction.&#x0D; Objective: To examine the effect of acupressure point LI4, SP6 and BL60 on the duration of the first stage of labor and APGAR score of newborns in primigravida.&#x0D; Methods: This research employed a quasi-experimental study with posttest control group design. It was conducted at the Public Health Center of Trauma and Public Health Center of Palaran Samarinda, East Kalimantan, Indonesia. There were 40 respondents selected using purposive sampling, which 20 respondents assigned in the experiment and control group. The duration of the first stage of labor was assessed using partograph and APGAR score was assessed using APGAR score assessment sheets. Mann Whitney test was used for data analysis&#x0D; Results: Findings showed that the duration of the first stage of labor in the experiment group was 187 minutes and in the control group was 307 minutes. Mann Whitney test obtained p-value 0.001 (&lt;0.05), which indicated that there was a statistically significant difference of the duration of the first stage of labor between both groups. However, Mann Whitney test for APGAR score showed p-value 0.114 (&gt;0.05), which indicated that there was no significant difference of APGAR score in the experiment and control group.&#x0D; Conclusion: There was a significant effect of acupressure on the duration of the first stage of labor, but no effect of the APGAR score. Therefore, acupressure may be recommended to shorten the duration of the first stage of delivery in primigravida.

PRIMIGRAVIDA

Objectives: Determine the mode of delivery in primigravida with engagedversus unengaged fetal head with spontaneous onset of labour at term. Study design: Casecontrol study. Setting: Department of Obstetrics and Gynaecology, Lady Aitchison Hospital,Lahore. Duration of Study: Jan 2012 to Dec 2012. Patients and Methods: Two hundredcases were included in this study and divided into two groups (A &amp; B) 100 in each group.Primigravidas presenting with engaged fetal head were included in Group A and thosepresenting with unengaged fetal head were included in Group B. The course of labor in allpatients was recorded on partogram. Partogram was maintained according to departmentalprotocol. Cesarean section was decided if labour failed to progress or fetal head failed todescend after observing as per departmental protocol (12 hours). All patients were studiedin detail with reference to mode of delivery regarding vaginal (spontaneous and instrumental)or cesarean section delivery. Results: Mean age was 23.65+3.72 years in Group-A and24.96+4.12 years in Group-B, 31%(n=31) in Group-A and 38%(n=38) in Group-B between37-39 weeks, 60%(n=60) in group-A and 51%(n=51) in Group-B between 40-41 weeks and9%(n=9) in Group-A and 11%(n=11) in Group-B were with 42 weeks of gestation, mode ofdelivery in primigravida with engaged versus unengaged fetal head with spontaneous onsetof labour at term was compared which showed that 19%(n=19) in Group-A and 39%(n=39)in Group-B were delivered with cesarean section, 65%(n=65) in Group-A and 42%(n=42) inGroup-B were spontaneously delivered vaginally while 16%(n=16) in Group-A and 19%(n=19)in Group-B had assisted vaginal delivery. Conclusion: Cesarean section was more prevalent inunengaged fetal head in primigravida women at term.

Post Pregnancy Severe Spinal Osteoporosis with Multiple Vertebral Fractures and Kyphoscoliosis in a Multigravida: A Rare Case with Management.

Osteoporosis associated with pregnancy and lactation is a less commonly known condition and often overlooked. The prevalence, exact aetiology and its pathogenesis are unknown. It is commonly seen in first three months after delivery in primigravida. It is often undiagnosed because of it not suspected n and X-rays and densitometry are avoided if possible during pregnancy and lactation. If missed, it can lead to osteoporotic fractures and disability. In this paper, we report a case of a 24-year-old multigravida 4 months after pregnancy with multiple vertebral compression fractures and kyphoscoliosis. Her metabolic workup was normal but bone densitometry revealed severe osteoporosis of the dorso-lumbar spine. Immediate weaning and antiresorptives like bisphosphonates and teriparatide are used as first line drugs to manage postpartum spinal osteoporosis. Our patient presented at 4 month lactation and did not want to wean her infant, so she was treated with total contact orthosis and took vitamin D and calcium. The pain was relieved within 3 months but there was no improvement in bone density. After eight months when the infant was weaned, she was treated with teriparatide. After one year of teriparatide therapy, there were no new fractures and densitometry scores improved.

Malaria and gravidity interact to modify maternal haemoglobin concentrations during pregnancy

BackgroundPrimigravidity is one of the main risk factors for both malaria and anaemia. Since the implementation of intermittent preventive treatment (IPTp) in sub-Saharan Africa, the relationship between anaemia and gravidity and its evolution during pregnancy has been little explored. This study aimed to evaluate the impact of gravidity on the variation of haemoglobin during pregnancy according to the timing of gestation.MethodsData from three studies carried out in nearby areas in south Benin (Ouidah, Comé, Allada) between 2005 and 2012 were analysed. At inclusion (first antenatal visit, ANV1) women’s age, area of residence, schooling, gravidity, gestational age, weight and height were recorded. Thick blood smears were performed on ANV1, second visit (ANV2) and at delivery. In Allada, women’s serum ferritin and CRP concentrations were also assessed. The impact of gravidity on maternal haemoglobin (Hb) was analysed using a logistic or linear regression depending on the outcome. The statistical significance was set to P < 0.05.ResultsIn total, data from 3,591 pregnant women were analysed. Both univariate and multivariate analyses showed a constant association between Hb concentrations and gravidity in the three periods of Hb assessment (ANV1, ANV2 and delivery). Mean Hb concentration was significantly lower in primigravidae than in multigravidae at ANV1 (mean difference = -2.4 g/L, CI 95%: [-3.4, -1.4], P < 0.001). Afterwards, there was a significant increase in primigravidae only, with a tendency to reversal between primigravidae and multigravidae, which was confirmed at delivery (mean difference = 2.8 g/L, CI 95%: [1.3, 4.2], P < 0.001). The prevalence of malaria infection was halved between ANV1 and delivery in primigravidae while it decreased by only 38% among multigravidae, who were less prone to malaria infection (prevalence at ANV1, 20% and 10% respectively). Iron deficiency was more common in multigravidae, and it decreased slightly in this group between ANV1 and delivery.ConclusionIn a context of IPTp, Hb levels improved progressively throughout pregnancy in primigravidae, likely as a result of reduction in malaria infection. In multigravidae, the improvement was less perceptible and anaemia was mainly due to iron deficiency.

Prevention of spontaneous preterm birth: the role of sonographic cervical length in identifying patients who may benefit from progesterone treatment

Prevention of spontaneous preterm birth: the role of sonographic cervical length in identifying patients who may benefit from progesterone treatment

What are the implications for the next delivery in primigravidae who have an elective caesarean section for breech presentation?

Objective To determine the mode of the next delivery for primigravid women who have an elective caesarean section for breech presentation. Design Retrospective cohort study. Setting University teaching hospital. Population All primigravid women who had an elective caesarean section for a singleton pregnancy in the years 1992 to 1997 and who delivered their next baby in the hospital before 1999. Methods Review of hospital computerised records. Main outcome measures Mode of delivery and fetal presentation at next delivery. Results Of 194 women who had an elective caesarean section with a breech presentation as a primigravida, 19 (9.8%) had a breech presentation at the time of elective caesarean section for their next baby compared with only two (1.7%) in the 121 women who had an elective caesarean section with a cephalic presentation as a primigravida (RR 5.9 [95% CI 1.4–25.0]). Despite the increased likelihood of another breech presentation, the overall repeat section rate was 43.8% ( n = 85) in women with a previous breech presentation ( n = 194), compared with 61.2% ( n = 74) in women with a previous cephalic presentation ( n = 121) (RR 0.72 [95% CI 0.58–0.89]). Of those women allowed to labour after elective caesarean section as a primigravid, the vaginal birth rate was 109/130 (84%) if the presentation previously was breech compared with 47/69 (68%) if the presentation previously was cephalic (RR 1.2 [95% CI 1.03–1.50]). Conclusions Women who have an elective caesarean section for a breech presentation in their first pregnancy have about a 1 in 10 chance of having an elective caesarean section for a breech presentation in their second pregnancy. Overall, the incidence of repeat caesarean section for their second baby was 43.8%, and of those allowed to labour, 84% achieved a vaginal delivery. These results compared favourably with women who had an elective caesarean section with a cephalic presentation in their first pregnancy. This information is important in advising primigravid women with a breech presentation about longer term implications of elective caesarean section. It also allows healthcare managers to anticipate the resource implications of any changes in clinical practice for women with a breech presentation in their first pregnancy.

Relationship Between the Length of the Perineum and Position of the Anus and Vaginal Delivery in Primigravidae

The aim of the study was to determine perineal length and anal position in primigravidae and to evaluate their effect on vaginal delivery. The distances between the fourchette and each of the center of the anal orifice and the inferior margin of the coccyx were measured in 212 primigravidae with singleton term pregnancies during the first stage of labor. Anal position index was calculated by dividing the first measurement by the second. The mean +/- SD length of perineum was 4.6 +/- 0.9 cm. The mean +/- SD anal position index was 0.49 +/- 0.12. Women with a short perineum (<4 cm) or a small anal position index (<0.42) had significantly higher rates of episiotomy, perineal tears and instrumented delivery. This association was also significant by multiple logistic regression analysis. It was concluded that a short perineum and anterior displacement of the anus were associated with traumatic vaginal delivery in primigravidae.

Parentcraft classes: do they affect outcome in childbirth?

SummaryParentcraft classes are widely available. There has been little objective evidence of their usefulness. We conducted a prospective study to compare the various aspects of labour and delivery in primigravidae who did or did not attend parentcraft classes. Following delivery a record was kept of women's view about parentcraft classes. The results of 155 attenders and 88 non-attenders at parentcraft classes were compared. Non-attenders at parentcraft classes had significantly more admissions to the hospital because of false labour (X2test, P = 0·001). There was no statistical significant difference in attender and non-attender groups in cervical dilatation on admission in labour, use and type of analgesia. length of first and second stage of labour and mode of delivery. Howeter. 145 (93·5 per cent) women who attended parentcraft classes regarded them as useful. The aim of parentcraft classes needs to be defined clearly. This opportunity can be used to explain hospital policies, informaton on risks. be...

Influence of birth weight on the mode of delivery in primigravidae

Influence of birth weight on the mode of delivery in primigravidae

The effect of parity on plasma sodium, potassium, chloride and osmolality levels during pregnancy.

SummaryThe changes in plasma sodium, potassium, chloride and osmolality levels have been examined in primigravidae and multigravidae. Plasma sodium and potassium concentrations decrease significantly from 10 to 28 weeks in multigravidae but not in primigravidae. Both groups show a significant increase in plasma potassium concentration between 28 and 37 weeks, when there is no change in sodium concentration. Plasma sodium and potassium levels rise significantly following delivery in primigravidae but, with multigravidae, only the rise in the latter is statistically significant. There is no change in the plasma levels of chloride and osmolality during normal pregnancy, irrespective of parity; osmolality increases significantly after delivery in each group. The results appear consistent with the hypothesis that the expansion of plasma volume is an important factor in the observed changes.