Delivery In Second Stage Research Articles

Prediction of spontaneous vaginal delivery in the prolonged second stage using the delta angle of progression

It is clinically challenging to determine when to intervene in the prolonged second stage. Although individualized prediction of spontaneous vaginal delivery is crucial to avoid maternal and neonatal complications associated with operative deliveries, the approach has not been fully established. We aimed to evaluate the predictability of spontaneous vaginal delivery using the difference in angle of progression between pushing and rest, delta angle of progression, to establish a novel method to predict spontaneous vaginal delivery during the prolonged second stage in nulliparous women with epidural anesthesia. We retrospectively analyzed deliveries of nulliparous women with epidural anesthesia between September 2018 and October 2023. Women were included if their delta angle of progression during the second stage was available. Operative deliveries were defined as the cases that required forceps, vacuum, and cesarean deliveries due to labor arrest. Women requiring operative deliveries due to fetal and maternal concerns, or women with fetal occiput posterior presentation were excluded. The second stage was stratified into the prolonged second stage, the period after 3 hours in the second stage, and the normal second stage, the period from the beginning until the third hour of the second stage. The association of the delta angle of the progression measured during each stage with spontaneous vaginal delivery and operative deliveries was investigated. Furthermore, the predictability of spontaneous vaginal delivery was evaluated by combining the delta and rest angle of progression. A total of 129 women were eligible for analysis. The delta angle of progression measured during the prolonged second stage and normal second stage were significantly larger in women who achieved spontaneous vaginal delivery compared to operative deliveries (p<.001 and p<.05, respectively). During the prolonged second stage, a cutoff of 18.8 derived from the receiver operative characteristic curves in the context of the delta angle of progression predicted the possibility of spontaneous vaginal delivery (sensitivity, 81.8%; specificity, 60.0%; AUC, 0.76). Combining the rest angle of progression (>140) and delta angle of progression (>18.8) also provided quantitative prediction of spontaneous vaginal delivery (sensitivity, 86.7%; specificity, 70.0%; AUC, 0.80). The delta angle of progression alone or in combination with the rest angle of progression can be used to predict spontaneous vaginal delivery in the second stage in nulliparous women with epidural anesthesia. Quantitative analysis of the effect of pushing using the delta angle of progression provides an objective guide to assist with an assessment of labor dystocia in the prolonged second stage on an individualized basis, which may optimize labor management in the prolonged second stage by reducing neonatal and maternal complications related to unnecessary operative deliveries and prolonged second stage of labor.

What's new on female genital mutilation/cutting? Recent findings about urogynecologic complications, psychological issues, and obstetric outcomes.

Female genital mutilation/cutting (FGM/C or FGM) are injuries to the female genital organs for non-medical reasons. Every year, over 4 million girls are at risk of FGM. Complications of this practice are very common and some of them are still under investigation. The purpose of this short narrative review is to highlight and summarize the main ones. Psychologic and psychiatric sequelae, chronic vulvar pain, urogenital symptoms, pelvic organs prolapse, sexual disfunction, cervical dysplasia and infections resulted as chronic sequalae of FGM. Severe pain, excessive bleeding, and tissues swelling are acute consequences of FGM. Rates of caesarean section, time of second stage of delivery, post-partum blood loss (but not major hemorrhage), peri-clitoral and perineal injuries and episiotomy rates are higher in pregnant women with FGM, when compared with those non victims of mutilation. The female genital mutilation practice is often cause of severe urogynecologic, psychologic and obstetrics sequelae. Although several studies have been carried out on FMG complications and treatments, long term sequelae are still very common and deserve major attention and further research.

Umbilical cord clamping time and maternal satisfaction

ObjectiveClamping of the umbilical cord is part of the third stage of delivery. Delayed cord clamping (DCC) is recommended due to its contribution to prevention of anaemia. There is no evidence on the effect of DCC on maternal satisfaction. The aim of this study is to evaluate the effect of different sociodemographic and obstetric factors, including the timing of cord clamping, on maternal satisfaction with the birth experience in our healthcare system. DesignPragmatic non-drug intervention study with simple random assignment of participating mothers (Clinical Trials N°: NCT03624335). SettingA public, university-level hospital in Villarreal city, eastern Spain. ParticipantsChildbearing woman, gestation week between 35 and 42 weeks, with regular medical pregnancy checks, single pregnancy and vaginal delivery (N = 198, 80% of the women recruited). Interventionsumbilical cord clamping within 60 seconds of the birth (Early cord clamping, ECC) versus umbilical cord clamping after pulsation had been ceased (Delayed cord clamping, DCC). MeasurementsBirth satisfaction was measured using the Mackey Childbirth Satisfaction Rating Scale (MCSRS). Additionally, sociodemographic data, degree of knowledge about the moment of clamping and type of breastfeeding data were recorded. The Mann-Whitney and Kruskal-Wallis tests for comparison of the mean of two, three, or more groups, respectively, and Chi-square and Spearman for comparison of two qualitative and quantitative variables, respectively, were used. To determine the weight of each factor of MCSRS, an exploratory factor analysis was carried out using the maximum likelihood method for factor extraction and the varimax method for factor rotation. The adequacy of the factor analysis was checked by mean of Kaiser-Meyer-Olkin test and Bartlett sphericity test. The level of significance was set at a p-value of < 0.05. FindingsThe average degree of satisfaction was 4.55/5 (SD: 0.37). No statistically significant difference was observed between mothers’ satisfaction according to mother level of study or mother's place of birth, while it changed significantly with age (p = 0.0398). Within the obstetric variables, satisfaction was significantly associated with spontaneous amniorrhexis, the duration of the second stage of delivery, and the Apgar value of the newborn at the first minute of life, and was independent of the number of previous pregnancies and deliveries, use of intrapartum oxytocin, epidural analgesia, episiotomy, the weight of the child at birth and type of breastfeeding. Furthermore, there was no relationship between the time of clamping and satisfaction (p = 0.5178). Key ConclusionsMaternal satisfaction with the birth experience varies with the age of the childbearing woman, and some intrapartum factors and the result is not influenced by the time of clamping of the umbilical cord. Therefore, this component of the physiological management of childbirth provides additional benefits for the health of the neonate, without negative consequences on the final perception of the maternal health care received. Implications for practiceIf there are no reasons that justify an early umbilical cord clamping, delaying it brings benefits to the neonate, without negatively affecting the maternal assessment of the experience of childbirth.

Women acceptance of episiotomy procedure before and after receiving educational materials: Pretest posttest study.

ObjectivesEpisiotomy is a frequently performed surgical procedure by obstetricians and midwives during vaginal birth. It is defined as a surgical incision in the perineal area through the second stage of delivery. Therefore, this study aimed to evaluate women’s acceptance toward episiotomy before and after providing education.MethodsA Quasi-experiment pretest posttest study was conducted on a total of 234 patients attending antenatal clinics in Maternity and Children hospital and Heraa General hospital in Makkah during June-August 2021. Participants were personally interviewed and provided with evidence-based information about the procedure then re-evaluated by the investigators. The statistical analysis was carried using Two Tailed Tests. Statistical significance was set on a P value of 0.05 or less.ResultsTotal of 234 participant fulfilling the inclusion criteria were interviewed. Females mean age is 26.2 ± 9.7 years. Exact of 115 (49.1%) women heard about episiotomy. And 79 (33.8%) correctly described it as a surgical incision. Also, 89 (38%) understood that it is not recommended for all, and 109 (46.6%) knew that anesthesia is required. The most reported source of information was internet/ social media (49%; 72), followed by friends/relatives (35.4%; 52). Before education, 112 (47.9%) would accept episiotomy if required which was significantly improved to be among 173 (73.9%) of them after receiving the educational materials.ConclusionDue to the controversial opinions and practices of episiotomy, ensuring patients awareness and understanding is crucial. Providing correct information from trusted sources will help minimizing the chances of receiving inaccurate information from unreliable sources. Therefore, making wrong decisions, and refusing needed episiotomy. Health practitioners should be encouraged to discuss patients’ concerns and correct their misconceptions.

Optimal selling mechanisms with buyer price search

We study optimal dynamic selling mechanisms in a two-stage model where the buyer can search for a better price at the second stage. When this outside price is public, the optimal selling mechanism takes the form of a fixed first-stage price with price matching in the second stage. In contrast, when the outside price is the buyer's private information, the optimal mechanism is a menu of two contracts: a first-stage sale at a higher price with immediate delivery, or a first-stage sale at a lower price with second-stage delivery. Thus the optimal form of search deterrence depends on the observability of the buyer's outside option.

Risk of obstetric anal sphincter injury with fundal pressure in second stage of labor: Transperineal ultrasound study.

Clinical management of the second stage of labor and effectiveness of preventive measures for severe perineal tears are controversial. The aim of this study was to evaluate the effect of using uterine fundal pressure during the second stage of delivery on obstetric anal sphincter injury (OASI), among primiparous women using three-dimensional (3D) transperineal ultrasonography. A total of 73 women who had their first vaginal birth were included in the study, the fundal pressure group included women where the fundal pressure maneuver was applied (n = 37); and the control group included women who delivered spontaneously without fundal pressure (n = 36). Tomographic ultrasound imaging with 3D transperineal assessment was performed within 48 h of delivery, internal anal sphincter (IAS) and external anal sphincter (EAS) defect were determined. Five (13.5%) women in the fundal pressure group, seven (20%) women in the control group had complete EAS defect (p = 0.4). Complete IAS defect was observed in one (2.7%) woman in the fundal pressure group and two (5.7%) women in the control group (p = 0.5).A Half-moon sign was observed in one woman in both groups (p = 0.9). The rate of other signs was similar in both groups. Multivariate regression models revealed that none of age, fetal birth weight, episiotomy, length of the second stage of labor, fundal pressure application status, and number were independent predictors of complete IAS or EAS defect. Fundal pressure with mediolateral episiotomy during the second stage of delivery does not increase the rate of OASI detected with ultrasonography.

Relaparotomy post-cesarean delivery: characteristics and risk factors.

Relaparotomy following cesarean delivery (CD) is performed at a rate of 0.2-1% of CD. The objective of the present study was to identify risk factors for relaparotomy following CD, and to examine whether there is a difference in the risk of relaparotomy between CD performed during different hours of the day. A retrospective study on all CD over 10years compared pregnancies that underwent laparotomy within 1week following CD to those that did not. Sixty-four patients underwent relaparotomy out of 24,239 CDs (0.26%). In univariate analysis, relaparotomy was significantly associated with pregnancies following assisted-reproductive-technologies odds ratio (OR) 95% confidence interval (CI) 3.15 (1.90-5.22), hypertensive disorders of pregnancy OR 3.05 (1.62-5.72), twin pregnancies OR 95% CI 3.78 (2.21-6.48), preterm deliveries OR 95% CI 2.44 (1.46-4.10), placenta previa OR 95% CI 6.41(2.55-16.09) and urgent CD 1.74 (1.06-2.86), especially during the second-stage of labor OR 95% CI 2.73 (1.34-5.54). The time of day of CD did not influence the rate of relaparotomy. In a multivariable-regression analysis, the adjusted odds ratio for relaparotomy was 10.24 in CD due to placenta previa, and 5.28 in CD performed at the second-stage of delivery. At relaparotomy, active bleeding was found in 50 patients (78.1%), nearly half received packed cells, 12.5% developed consumptive coagulopathy, and 17.2% needed hospitalization in the intensive care unit. 6.3% underwent a second relaparotomy, mainly due to bleeding. Placenta previa, and urgent CDs mainly those performed at the second stage of labor are risk factors for relaparotomy after CD.

Outcomes of Operative Vaginal Delivery Managed by Residents Under Supervision and Attending Obstetricians: A Prospective Cross-sectional Study

(Am J Obstet Gynecol. 2019;221:59.e1–59.e15) Operative vaginal delivery is intended to expedite vaginal delivery during a prolonged second stage of delivery or for suspected fetal compromise. While every resident should be proficient with delivery requiring forceps and/or vacuum extractors by the end of their training, these procedures are associated with greater maternal and neonatal morbidity than spontaneous vaginal delivery in the short-term. Obstetricians are at greater litigation risk if neonatal trauma or brachial plexus injury occurs. Therefore, there has been a decrease in operative vaginal deliveries in different parts of the world during the last 2 decades. The United States has seen a decrease from 10% of all births in 1994 to 3% in 2014 for both vacuum and forceps assisted deliveries. This decrease is despite the American College of Obstetricians (ACOG) and the Society for Maternal-Fetal Medicine advocating the use of operative vaginal delivery as a means of reducing cesarean section rates. The aim of this study was to determine the maternal morbidity and neonatal morbidity in a large French observational study of attempted operative vaginal deliveries.

New Delivery Chair for Vaginal Delivery

Objectives: Compared to different upright positions, delivery in recumbent position in bed may increase the likelihood of operative delivery and other delivery complications, and also decrease levels of maternal self-control. A new delivery chair has been developed to facilitate a variety of upright positions during labour. A randomized controlled trial was conducted to evaluate the impact of the delivery chair use on selected obstetrical and neonatal outcomes, compared to traditional recumbent position. Methods: A total of 1477 women with uncomplicated singleton pregnancy ≥ 34 gestational weeks with fetus in vertex presentation were enrolled in the study: 776 in the delivery chair group, and 701 in the control group. Results: An intention-to-treat analysis showed no differences between the groups in any of the outcomes used. Of the women in the delivery chair group, 251 used the chair throughout the second stage. An as-treated analysis was performed between these 251 women and their counterparts in the control group. Women using the delivery chair had a shorter second stage of delivery, fewer episiotomies, and less need for vacuum extraction, with no difference in blood loss or neonatal outcome. However, women using the delivery chair had more third-degree tears (11 cases, or 4.4%, vs. 9 cases, or 1.8%). Conclusion: The novel delivery chair can be safely used for vaginal delivery. More attention should be given to perineal support to prevent perineal tears. There is a need for multicentre trials of the delivery chair using standardized measurements of outcomes, including maternal pain, maternal self-control, and overall satisfaction.

Factors associated with the severity of neonatal subgaleal haemorrhage following vacuum assisted delivery

ObjectiveTo evaluate factors associated with subgaleal hemorrhage (SGH) severity following attempted vacuum-assisted delivery (VAD). Study designThis retrospective cohort study was conducted in a tertiary medical center. The population comprised parturients who delivered at our medical center during 2009–2018, and who underwent attempted VAD with singleton pregnancies that resulted in neonatal SGH formation. SGH severity was classified as mild and non-mild (moderate or severe). The main outcome measures were determinants associated with SGH severity. ResultsAmong 350 neonates with SGH, the degree of severity was non-mild for 48 (13.7%). Compared to the mild group, in the non-mild group, small for gestational age was more common (8.2% vs. 2.6%, p = 0.04). Compared to the mothers in the mild group, in the non-mild group, the proportion with two or more deliveries was lower (0% vs. 7.3%, p = 0.05), gestational diabetes was more common (12.5% vs. 4.6%, p = 0.02), the rate of cervical ripening was higher (27.1% vs. 12.9%, p = 0.02), the duration of the second stage of delivery was longer (mean 177 vs. 152 min, p = 0.04), and the rate of two dislodgments was higher (31.2% vs. 15.2%, p = 0.006). On multivariate analysis, only cervical ripening (adjusted odds ratio [OR]: 2.50; 95% confidence interval [CI]: 1.20–5.26; P = 0.01 and second stage duration (adjusted OR: 1.13; 95% [CI]: 1.00-1.29; P = 0.05) were independently associated with more severe SGH. ConclusionsThe duration of second stage and ripening of the cervix during induction of labor are independently associated with SGH severity following attempted VAD.

The effect of distraction techniques on pain and stress during labor: a randomized controlled clinical trial

BackgroundPain control and the stress associated with labor and delivery are among the most important issues of health care system. Use of distraction techniques during childbirth is reported to reduce pain and stress of labor. However, there is a limited publication that looked on the effect of distraction techniques on labor pain and stress. Thus, the aim of this study was to determine the effect of distraction techniques on labor pain and stress (primary outcomes), fear of childbirth, length of delivery stages, first minute Apgar score and oxytocin consumption (secondary outcomes).MethodsA randomized controlled clinical trial was conducted on 68 pregnant women. Participants were allocated into two groups (intervention and control groups) by blocked randomization. Participants in the intervention group received distraction techniques in four sessions. Questionnaires of Fear of Childbirth (W-DEQ version A) and PSS once were completed before intervention and again at the 36th week for the W-DEQ and in the active phase for the PSS through interviews. The pain was assessed through VAS during active phase per hour. The length of delivery stages was recorded in the partograph chart. Data were analyzed by independent t-test and ANCOVA.ResultsThe mean of perceived stress during labor in the intervention group was significantly less than that of the control group (AMD: -3.2; 95% CI: − 0.8 to − 6.0; P = 0.01). The mean (SD) of pain intensity during labor was less than in the intervention and control groups compare to the control group (6.2 vs 7.5; P < 0.001). There was no significant difference between the two groups in terms of fear of childbirth score (AMD: 5.3; 95% CI: 13.0 to − 6.0; P = − 2.3). Moreover, there was no statistically significant difference between the two groups in terms of the active phase of labor (P = 0.504), second stage of delivery (P = 0.928), total length of delivery (P = 0.520), Apgar score (P = 1.000) and frequency of oxytocin consumption (P = 0.622).ConclusionAccording to the results, distraction techniques can reduce the pain and stress of labor, but further studies by using the distraction techniques are needed to reach a decisive conclusion.Trial registrationIRCT2017042910324N39; Name of registry: Iranian Registry of Clinical Trials; Registered 11 September 2017. URL of registry: https://fa.irct.ir/user/trial/10814/view. Date of enrolment of the first participant to the trial: September 2017.

Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction.

Subgaleal hemorrhage (SGH) is a life-threatening neonatal condition that is strongly associated with vacuum assisted delivery (VAD). The factors associated with the development of SGH following VAD are not well-established. We aimed to evaluate the factors associated with the development of SGH following attempted VAD. A retrospective case-control study of women who delivered at a tertiary university-affiliated medical center in Jerusalem, Israel, during 2009-2018. Cases comprised all parturients with singleton pregnancies for whom attempted VAD resulted in neonatal SGH. A control group of VAD attempts was established by matching one-to-one according to gestational age at delivery, parity and year of delivery. Fetal, intrapartum and vacuum procedure characteristics were compared between the groups. In all, 313 (89.5%) of the 350 attempted VAD were nulliparous. Baseline maternal and fetal characteristics were similar between the groups except for higher neonatal birthweight in the SGH group. In multivariate logistic regression analysis, only six independent risk factors were significantly associated with the development of SGH: second-stage duration (for each 30-minute increase, adjusted odds ratio [OR] 1.13; 95% confidence intervals [CI] 1.04-1.25; P= .006), presence of meconium-stained amniotic fluid (adjusted OR 2.61; 95% CI 1.52-4.48; P= .001), presence of caput succedaneum (adjusted OR 1.79; 95% CI 1.11-2.88; P= .01), duration of VAD (for each 3-minute increase, adjusted OR 2.04; 95% CI 1.72, 2.38; P < .001), number of dislodgments (adjusted OR 2.38; 95% CI 1.66-3.44; P < .001), and fetal head station (adjusted OR 3.57; 95% CI 1.42-8.33; P= .006). Receiver operating characteristic curves showed that VAD duration of ≥15minutes had a 96.7% sensitivity and 75.0% specificity in predicting SGH formation, with an area under the curve equal to .849. Vacuum duration, the number of dislodgments, the duration of second stage of delivery, fetal head station, the presence of caput succedaneum and the presence of meconium were found to be independently associated with SGH formation.

Pregnancy and the eye. Changes in morphology of the cornea and the anterior chamber of the eye in pregnant woman.

The main goal of the study was to determine whether uncomplicated pregnancy and natural labor exert influence on the cornea and the anterior chamber of the eye. The study included 114 eyes of 57 women in age of 21-35 years old. Only patients in the physiological pregnancy and giving natural birth were recruited into study. Prospective observative examination was performed. Patients were diagnosed twice: in 36 HBD and 6 weeks after labor. Using the Scheimpflug camera (Pentacam system) the following parameters were assessed: central corneal thickness (CCT), keratometric parameters: flat (K1) and steep (K2), astigmatism value and axis, anterior chamber depth (ACD), anterior chamber volume (ACV) and anterior chamber angle (ACA). The statistical analysis was carried out in the StatSoft Statistica 13 program. CCT value is greater in the third trimester than in 6th week after the labour. ACD and ACA values are higher in 36 HBD than in the post-partum period but the difference is not statistically important (p > 0.05). K1, K2, cylindrical refraction error, axis of cylindrical refraction error do not change. Authors claim that it is the result from an increase in water retention in the corneal stroma as a response to hormonal changes. The plasticity of the anterior chamber seen before delivery can be a natural adaptive mechanism of the female body, which counteracts the excessive increase in intraocular pressure in the second stage of delivery.

Diabetes and Pregnancy

Diabetes and Pregnancy

Retinal hemorrhages in term newborns – Our experience at tertiary centre

Background: There are very few previous studies regarding ocular screening done in term neonates. Retinal hemorrhages can occur in babies during delivery. Aims: To evaluate the correlation of retinal findings with the duration of second stage of labor in term neonates and mode of delivery. Settings and Design: This was a cross-sectional, observational study done on term newborns in a tertiary care centre. Convenience sampling was done. Subjects and Methods: Neonates were examined in the postnatal ward using handheld slit lamp and indirect ophthalmoscope. Fundus examination was done after dilating the pupils with 0.5% tropicamide and 2.5% phenylephrine eyedrops. Second stage of labor and mode of delivery were noted. Chi-square test and independent sample t-test were used to analyze the data. Results: One hundred and fifty infants were screened, of which 75 (50%) had retinal hemorrhages. Chi-square test showed statistical significance with duration of second stage of labor and occurrence of retinal hemorrhages (P < 0.001). Patients with second stage of labor shorter than 30 minutes of duration were found to have more chances of having retinal hemorrhages. Independent sample t-test used for association between mode of delivery and retinal hemorrhages showed patients born of normal vaginal delivery to have more chances of having hemorrhages (P = 0.006). Chi-square test showed statistical significant association with the presence of hemorrhages and day of evaluation (P < 0.001). Conclusion: Retinal hemorrhages were found to be common in full-term babies whose second stage of delivery was shorter than 30 minutes of duration.

Effectiveness of breathing exercises during the second stage of labor on labor pain and duration: a randomized controlled trial

BackgroundSome research exists on the effect of non-pharmacological approaches for labor pain relief. However, there is limited information about effectiveness of breathing exercises in pregnant women to reduce maternal pain during labor. ObjectiveTo determine whether breathing exercises for pregnant women during the second stage of labor have beneficial effects on maternal pain, duration of labor, and the first-minute Appearance, Pulse, Grimace, Activity and Respiration (APGAR) scores. Design, Setting, Participants and InterventionsThis randomized clinical trial involved 250 pregnant women, who were randomly divided into two groups: intervention group (IG; n = 125) and control group (CG; n = 125). IG received one session breathing exercise training and performed breathing exercises during the second stage of labor versus the CG that did not receive any breathing exercise training. Main Outcome MeasuresThe effects of breathing exercises on maternal pain were determined by Visual Analogue Scale (VAS), duration of the second stage of labor, and the first-minute APGAR scores. ResultsThe mean age of the participants was (23.2 ± 4.2) (range: 18 to 42) years. Both IG and CG had similar baseline characteristics in terms of age, education level, occupation, and smoking (P > 0.05). The mean VAS scores of IG and CG were (88.2 ± 6.3) and (90.5 ± 7.0), respectively (P < 0.001). The duration of the second stage of labor was (369.6 ± 92.0) s for IG and (440.7 ± 142.5) s for CG (P < 0.001). The mean first-minute APGAR scores were (8.84 ± 0.50) for IG and (8.73 ± 0.89) for CG (P > 0.05). ConclusionBased on this study, breathing exercises with deep inhalation and exhalation in pregnant women are effective in reducing the perception of labor pain and shortening the duration of the second stage of delivery. Therefore, we recommend breathing exercises as an effective modality for labor pain management and shortening the duration of labor. Trial RegistrationThis study is registered on the website of ClinicalTrials.gov (www.clinicaltrials.gov) with the number of NCT03066973.

Cesarean delivery in the second stage of labor and the risk of subsequent premature birth

Cesarean delivery is being increasingly used by obstetricians for indicated deliveries in the second stage of labor. Unplanned extension of the uterine incision involving the cervix often occurs with these surgeries. Therefore, we hypothesized that cesarean delivery in the second stage of labor may increase the rate of subsequent spontaneous premature birth. We sought to determine if cesarean delivery in the late first stage of labor or in the second stage of labor increases the risk of a subsequent spontaneous preterm birth. We conducted a retrospective cohort study of matched first and second births from a large Canadian perinatal database. The primary outcomes were spontaneous premature birth <37 and <32 weeks of gestation in the second birth. The exposure was stage of labor and cervical dilation at the time of the first cesarean delivery. The protocol and analysis plan was registered prior to obtaining data at Open Science Foundation. In total, 189,021 paired first and second births were identified. The risk of spontaneous preterm delivery <37 and <32 weeks of gestation in the second birth was increased when the first birth was by cesarean delivery in the second stage of labor (relative risk, 1.57; 95% confidence interval, 1.43-1.73 and relative risk, 2.12; 95% confidence interval, 1.67-2.68, respectively). The risk of perinatal death in the second birth, excluding congenital anomalies, was also correspondingly increased (relative risk, 1.44; 95% confidence interval, 1.05-1.96). Cesarean delivery in second stage of labor was associated with a 2-fold increase in the risk of spontaneous preterm birth <32 weeks of gestation in a subsequent birth. This information may inform management of operative delivery in the second stage.

Tissue oxygen saturation levels from fetus to neonate.

Oxygen saturation during the term of delivery to the first cry, when fetal circulation dynamically changes, has not yet been examined. The aim of this study was therefore to determine whether the continuous measurement of regional tissue oxygen saturation (rSO2 ) from crowning until 5 min after delivery is possible using fetal tissue oximetry with a sensor attached to the examiner's finger. Oxygen saturation levels in fetal cranial tissue between the second stage of delivery to crowning and up to 5 min after delivery were measured using fetal tissue oximetry with a sensor attached to the examiner's finger. Thirty-five deliveries were examined, and oxygen saturation was measured in seven infants from delivery of the head until 5 min after birth. Umbilical cord blood gas was measured in all cases. This clinical test was performed under the permission of the Ethics Committee of Hamamatsu University School of Medicine. Average tissue oxygen saturation in the second stage of delivery and at 5 min after delivery were 50.3 ± 16.3% and 56.8 ± 8.46%, respectively. In cases of continuous measurement, average rSO2 for crowning, immediately after delivery, and the first cry was 32.7 ± 9.5%, 30.0 ± 6.6%, and 31.6 ± 5.5%, respectively. We herein successfully measured oxygen saturation levels in fetal cranial tissue during crowning, delivery of the head, the first cry, and 5 min after delivery using fetal tissue oximetry with a sensor attached to the examiner's finger.

COMPARISON OF WOUND REPAIR OUTCOMES OF CHROMIC CATGUT VERSUS VICRYL SUTURES FOR EPISIOTOMY REPAIR: A CLINICAL TRIAL

AbstractBackground and Aim:A large number of postpartum women suffer from short and long-term complications of episiotomy.The aim of this study was to compare Chromic Catgut and Vicryl Sutures wound healing inpostpartum women.Materials and Methods:This study was a randomized clinical trial. The sample was 102 pregnant women who wererandomly divided into two groups. The episiotomy wound repaired by Chromic Catgut and Vicrylrespectively. 4-6 weeks after delivery both groups were evaluated for wound healing. Woundhealing was evaluated using the scale (REEDA). The reeda scale consisted of 5 items includingredness, edema, ecchymosis, discharge, approximation. The data was analyzed by t-test and Mann-WhitneyEu test.Results:The results showed that the two groups had no significant difference in terms of age, gestationalage, parity, duration of the second stage of delivery, the time between the delivery and repair ofepisiotomy, length of episiotomy repair and education. Reeda scale average score was lower invicryl sutured wounds (p<0.05). The mean scores of redness, edema, ecchymosis and dischargewere also significantly lower in vicryl group. The approximation scores had not significantdifference between the two groups.Conclusions:According to the results of this study it seems that vicry sutures had better outcomes in healing ofepisiotomy wounds.Keywords:Episiotomy; Vicryl; Catgut; Wound Healing

Perinatal outcomes of vacuum assisted versus cesarean deliveries for prolonged second stage of delivery at term*

Introduction: To compare perinatal outcomes of interventions for prolonged second stage of labor. Materials and methods: Retrospective cohort study, in a single, university-affiliate, medical center (2007–2014). Eligibility: singleton gestations at term, diagnosed with prolonged second stage of labor and head station of S + 1 and lower. We compared perinatal outcomes of cesarean deliveries (CD) with vacuum assisted deliveries (VAD). Results: Of 62 102 deliveries, 3449 (5.6%) were eligible: 356 (10.3%) underwent CD and 3093 (89.7%) underwent VAD. The rate of five-minute Apgar scores <7 was higher in the CD group as well as rates of NICU admission, neonatal asphyxia and composite neonatal adverse outcome. After adjusting for different confounders, CD was associated with adverse neonatal composite outcome (aOR 1.57, 95% CI 1.21–2.05, p = 0.001) and VAD with cephalhematoma (aOR 4.06, 95% CI 2.64–6.25, p < 0.001). No other differences were found between the groups with regards to other traumatic outcomes. Conclusion: Our data suggests that in deliveries complicated by prolonged second stage, CD yield poorer neonatal outcome than VAD, with no apparent major difference in traumatic composite outcome.