Modern Obstetric Practice Research Articles

Knowledge Perception and Utilisation of Labour Analgesia Among Antenatal Clinic Attendees in a Tertiary Centre in Makurdi, North-Central Nigeria

Abstract Background: Labour pain management forms an integral part of modern obstetric practice. Despite the availability of various forms of obstetric analgesia in Nigeria, reports indicate poor knowledge, awareness, and utilisation of labour analgesia among the obstetric population. Objective: To determine the knowledge, perception, utilisation, and factors affecting utilisation of labour analgesia among antenatal clinic attendees at the Federal Medical Centre (FMC), Makurdi. Materials and Methods: This was an analytical cross-sectional study conducted among 421 consecutively consenting antenatal patients in the Department of Obstetrics and Gynaecology at the FMC, Makurdi, between March 1 to July 31, 2023. Data were collected using an interviewer-guided questionnaire, analysed using Statistical Package for Social Sciences (SPSS) version 20.0, and results were presented in textual form and tables. Results: About 47% (199) of the study participants perceived labour pain as the worst possible pain. Only 18.3% (77) of the study participants were knowledgeable about labour analgesia, while just 6.4% (27) of the study participants had ever used it. On multiple logistics regression, the knowledge of labour pain relief (adjusted odd’s ratio [aOR] 0.090, CI = 0.038−0.215, P < 0.001) and mode of previous delivery (aOR 0.292, CI = 0.114−0.750, P < 0.011) were the factors affecting the utilisation of labour analgesia among study participants. Conclusion: There is poor knowledge and utilisation of labour analgesia among antenatal patients. Incorporation of labour analgesia into existing protocols and enhancing health education on labour analgesia as part of antenatal health talks can create awareness of labour analgesia among antenatal patients.

How labor induction methods have evolved throughout history, from the Egyptian era to the present day: evolution, effectiveness, and safety

Induction of labor (IOL) is currently used for one in 10 pregnancies globally. Methods used for induction have shown major changes over time. Medical interventions trace their origins back to ancient civilizations, with evidence suggesting that they began over 5000 years ago in ancient Egypt. During this era, the Egyptians employed natural remedies such as castor oil and date fruits for the IOL. These early practices highlight the rich history and long-standing tradition of using natural substances in medical treatments, laying the foundation for the development of modern obstetric practices. After that, Hippocrates practiced mammary stimulation and mechanical cervical dilatation about 2500 years ago in Greece. Since then, there has been a marked change, especially over the last century, with the development of safer and more effective methods. Mechanical methods were the main method until the early 20th century, which were then substituted by pharmacological methods with more experiments in the mid to late 20th century. Nowadays, effectiveness, safety, cost, and client satisfaction are the main determinants of the methods used. This review summarizes how labor induction practices have evolved from the Egyptian era to the present-day randomized controlled trials and meta-analysis evidence, paying attention to their effectiveness, safety, and future directions.

Comparative Study of Sublingual Misoprostol and Dinoprostone Gel in Labour Induction and Its Implication on Maternal and Neonatal Outcome

Effective and safe induction of labour is crucial in modern obstetric practice. This study aims to compare the efficacy and safety of sublingual misoprostol versus dinoprostone gel in inducing labour. A prospective, randomized controlled trial was conducted at a tertiary care hospital. A total of 828 pregnant women requiring labour induction were randomly assigned to receive either sublingual misoprostol (n=414) or dinoprostone gel (n=414). The primary outcome was the success rate of labour induction, defined as vaginal delivery within 24 hours. Secondary outcomes included the time interval from induction to delivery, incidence of hyperstimulation syndrome, mode of delivery, and maternal and neonatal outcomes. Data were analyzed using SPSS, with statistical significance set at p

A Low Budget Perineal Repair Model

BACKGROUND We designed a low-cost model to prepare junior surgeons for the limited accessibility and visibility of perineal lacerations. This model has advantages over the classical beef tongue model including lower cost, being easier to build, and lasting longer. METHODS To build the model, follow the instructions as described in appendix A. Users were surveyed to compare the model against established simulated formats. RESULTS Each of our models can made in about 5 minutes and costs $2.09 in materials per model. Our model was directly compared to the classical beef tongue model used by many programs to simulate perineal repairs. At our program, it took residents on average 15 minutes to create their beef tongue model and cost $16.50 per model which had to be used immediately and discarded afterwards due to the meat spoiling. Overall, our model was seen as a useful training tool to be used in addition to our current curriculum. It does not require significant preparation to build or use unlike the beef tongue model, and it is sufficiently cheap for medical students and residents to take home. DISCUSSION/CONCLUSION Many medical models are prohibitively expensive for the individual to purchase or are reserved for rare training sessions in a simulation center due to their scarcity. This is an efficient and practical model which accurately demonstrates the limited space and visibility of perineal repairs while also allowing residents to conveniently practice 3rd and 4th degree repairs, which are so infrequent in modern obstetrical practice.

Вплив вітаміну D на мікробіоценоз статевих шляхів у жінок із багатоплідною вагітністю

Insufficiency of vitamin D during pregnancy was and remains one of the urgent problems of modern obstetric practice, which focuses on itself the attention of researchers from different countries. The importance of the issue of multiple pregnancy (МР) is determined by the significant number of complications that may arise during pregnancy, childbirth and the postpartum period. Possessing an immunomodulatory and anti-inflammatory effect, vitamin D ensures not only implantation, placentation, but also the course of the entire multiple pregnancy. Microbiocenosis of the female genital tract is a marker of the overall health of the female body, the issue of its disruption under the influence of vitamin D deficiency is of particular scientific interest. Purpose - to study the peculiarities of the genital tract microbiocenosis in women with multiple pregnancies and vitamin D deficiency. Materials and methods. Were examined 120 pregnant women, 90 of whom had multiple pregnancies and vitamin D deficiency, and were divided into two groups depending on the onset of pregnancy: the Group I consisted of 48 women with multiple births as a result of assisted reproductive technologies, and the Group II consisted of 42 pregnant women with spontaneous multiple births. The control group consisted of 30 healthy women with a singleton pregnancy and a normal level of 25(OH)D. The content of vitamin D in blood serum was studied by the immunoenzymatic method in the first and second trimesters of pregnancy. Microbiocenosis of the vagina of examined pregnant women was studied on the basis of bacterioscopic and bacteriological research. Results. A deviation in the ratio between cocci and bacilli flora was found in the I and II trimesters of pregnancy. The predominance of cocci flora was observed in women with multifertility due to the use of assisted reproductive technologies (55.9%), compared to women of the Group II (22.6%) and the control group (18.4%), which indicates the presence of inflammatory processes caused by vitamin D deficiency in this contingent of pregnant women, both in the first and second trimesters of pregnancy. The high activity of pro-inflammatory cytokines, which activate proteolytic enzymes in the vagina of pregnant women under the influence of vitamin D deficiency, causes the inflammatory process, thereby disrupting the vaginal microbiocenosis of pregnant women with MP. Conclusions. Violations of the microbiocenosis of the genital tract in women with MP in the early stages of pregnancy indicate that vitamin D deficiency plays a leading role in the genesis of inflammatory changes in the vaginal ecosystem. Early detection and timely treatment of vitamin D deficiency will contribute to reducing the number of violations of vaginal microbiocenosis and, as a result, prolongation of multiple pregnancies due to the use of assisted reproductive technologies. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors.

Effect of the “shoulder-up” bundle on the incidence of spontaneous perineal injury after vaginal delivery: comparison of 2 historic cohorts after propensity score matching

Perineal injury following vaginal delivery represents a major cause of long-term maternal morbidity and its prevention is among the priorities of modern Obstetric practice. To investigate whether the systematic implementation of a bundle of maneuvers to prevent perineal injury (i.e. the "shoulder-up" bundle) may reduce the rate of spontaneous perineal tears in women delivering at a single tertiary maternity unit. Single-center retrospective intervention study including all vaginal deliveries between April 1st 2020 and March 31st 2022. On March 1st, 2021, a bundle focused on perineal injury prevention in vaginal deliveries has been implemented and introduced as a standard of care. The "shoulder-up" bundle includes the addition of a hands on technique for the delivery of the posterior shoulder which is slowly lifted up under the direct visualization of the perineal body, immediately after the disengagement of the anterior shoulder. The labor ward staff underwent a dedicated training to acquire expertise on the "shoulder-up" bundle. Little changes in terms of medical and midwifery staffing were recorded during the study period. The incidence of spontaneous 2nd or higher degree perineal tears was compared between the patients who gave birth prior to the clinical implementation of the bundle (Standard care Group) and those who were delivered following the implementation of the bundle (Shoulder-up Group). A 1:1 propensity score matching of the two groups was done for the variables that proved to be independently associated with the perineal outcome. From April 1st 2020 to March 31st 2022, 3671 patients had a vaginal birth at our tertiary care Unit (1786 in the Standard Care group and 1885 in the "Shoulder-up" group) and were enrolled in the study population. Of these 1191 (32.4%) experienced a spontaneous 2nd or higher degree perineal tear; at univariate analysis nulliparity (59.6% vs 39.1%, p<.001), higher gestational age at delivery (39.8 ± 1.28 vs 39.4 ± 1.97 weeks, p<.001), epidural analgesia (40.6% vs 31.2%, p<.001), vacuum assisted delivery (9.6% vs 4.0%, p<.001) and birthweight > 4Kg (11.0% vs 6.3%, p<.001) resulted independently associated with the perineal outcome. Following propensity Score matching for the above cited factors, 1703 patients of either group were compared. A significant increase in the rate of intact perineum (71.0% vs 64.1%, p = 0.014) and a reduction in the incidence of 2nd (27.2% vs 32.9%, p = 0.006) and 3rd-4th degree perineal tears (1.3% vs 3.0%, p<.001) was demonstrated in the "shoulder-up" group. Among the subgroup of patients undergoing vacuum assisted delivery a borderline significant reduction in the OASIs rate (10.4% vs 2.9%, p=0.052) was also observed. Our study showed that the clinical implementation of the "shoulder-up" bundle at vaginal delivery is associated with a significant reduction in the incidence of spontaneous 2nd or higher degree perineal tears.

Knowledge, acceptability and utilization of epidural analgesia in antenatal clinic attendees at UNIOSUN Teaching Hospital (UTH), Osogbo, Osun State

Background/Objective: Labour pain is perceived as the most harrowing and agonizing event of a woman's life. Efforts at reducing the pain and making the event less stressful have predated modern obstetric practice. Epidural analgesia has provided effective pain relief in labour for over three decades. Delivery with epidural analgesia is routine for willing parturients in the developing world, however ignorance, cost as well as lack of qualified personnel has made this to be out of reach of the average Nigerian mother. The aim of this study was to assess level of awareness, acceptability, previous utilization and willingness to utilize epidural analgesia in labour following health education.&#x0D; Subjects/Methods: This cross-sectional study was carried out in the antenatal clinic of UTH, Osogbo. Health education on events of labour and methods of analgesia available was provided to all antenatal clinic attendees between September 2021and March 2022, following which a semi–structured purpose designed, and self- administered questionnaire was administered to 415 of these women who consented to participate in this study.&#x0D; Results: The mean age of the respondents was 32.57± 4.42 years and mean parity of 1.73± 0.96. 70.8% reported that labour pain was severe. 41.7% were aware of epidural analgesia before the health talk. 3.6% of our subjects had utilized epidural in their last confinement. However, only 47.7% expressed a wish to utilize epidural analgesia in labour.&#x0D; Conclusion: Awareness of epidural analgesia in study population was passable at 40% however willingness to utilize it was less than average despite health talk and reassurance by their attending obstetric team.

Чем опасен психологический стресс для беременных и как снизить его влияние на течение беременности и перинатальные исходы

Aim: assess the impact of psycho-emotional stress on the course of pregnancy at various times, as well as consider the possibility of reducing it with the help of vitamin-mineral complexes. Key Points. Pregnant women, like all others, are influenced by a variety of stress factors, and about 30% of them at different stages of gestation realize clinical manifestations of psychological stress. The article considers issue related to the causes of psychological stress before and during pregnancy, identifies the most vulnerable categories of women. Data on the influence of psychological stress on pregnancy outcomes and postnatal development are presented. Attention is paid to modern ideas about the pathogenesis of the damaging effect of psychological stress on various body systems, including the microbiome. Emphasis is placed on the role of an obstetrician-gynecologist as an attending physician in the timely identification of women with signs of psychological stress, in the organization of non-drug care and rational pharmacological support. Pathogenetically justified possibilities of using vitamin and mineral complexes to compensate for the negative effects of psychological stress at the preconception stage and during pregnancy were discussed. Conclusion. Stress before and during pregnancy affects the offspring in the long term, disrupting their physical condition, negatively affecting the functions of the central nervous system. In modern obstetric practice, medical alertness, timely consultation with specialists and the full use of all the possibilities of non-drug and pharmacological support aimed at overcoming anxiety and stress at each stage of gestation will be relevant. Key words: psychological stress, pregnancy, perinatal complications, anemia, vitamin and mineral complexes.

Postpartum Shock Following Vulvovaginal Haematoma, Rare but Keeps Coming: The Complete Case Report

Vulvovaginal haematoma following vagina delivery can cause a serious life-threatening complication including maternal mortality if not promptly diagnosed or properly managed yet, is no more commonly seen, especially in modern obstetric practice due to improvement in quality of care and management in labour with careful observation of mothers in labour ward following delivery.

A second look at intrapartum fetal surveillance and future directions.

Intrapartum fetal surveillance aims to predict significant fetal hypoxia and institute timely intervention to avoid fetal injury, and do so without unnecessary operative delivery of fetuses at no risk of intrapartum hypoxia. However, the configuration and application of current clinical guidelines inadvertently undermine these aims because of persistent failure to incorporate increased understanding of fetal cardiovascular physiology and adaptations to oxygen deprivation, advances in signal acquisition/processing, and related technologies. Consequently, the field on intrapartum fetal surveillance is stuck in rudimentary counts of the fetal R-R intervals and visual assessment of very common, but nonspecific fetal heart decelerations and fetal heart rate variability. The present authors argue that the time has come to move away fromclassifications ofstatic morphological appearances ofFHR decelerations, which do not assist the thinking clinician inunderstanding how the fetus defends itself and compensates for intrapartum hypoxic ischaemic insults or the patterns that suggest progressive loss of compensation. We also reappraise some of the controversial aspects of intrapartum fetal surveillance in modern obstetric practice, the current state of flux in training and certification, and contemplate the future of the field particularly in the context of the emerging role of artificial intelligence.

Labor induction with oxytocin in pregnant rats is not associated with oxidative stress in the fetal brain

Despite the widespread use of oxytocin for induction of labor, mechanistic insights into fetal/neonatal wellbeing are lacking because of the absence of an animal model that recapitulates modern obstetric practice. Here, we create and validate a hi-fidelity pregnant rat model that mirrors labor induction with oxytocin in laboring women. The model consists of an implantable preprogrammed microprocessor-controlled infusion pump that delivers a gradually escalating dose of intravenous oxytocin to induce birth at term gestation. We validated the model with molecular biological experiments on the uterine myometrium and telemetry-supported assessment of changes in intrauterine pressure. Finally, we applied this model to test the hypothesis that labor induction with oxytocin would be associated with oxidative stress in the newborn brain. Analysis of biomarkers of oxidative stress and changes in the expression of associated genes were no different between oxytocin-exposed and saline-treated pups, suggesting that oxytocin-induced labor was not associated with oxidative stress in the developing brain. Collectively, we provide a viable and realistic animal model for labor induction and augmentation with oxytocin that would enable new lines of investigation related to the impact of perinatal oxytocin exposure on the mother-infant dyad.

Translation and Linguistic Validation of the Chinese Version of Angle Labor Pain Questionnaire

Abstract Background: Despite having various choices of labor analgesia in modern obstetric practice, there are limited appropriate instruments to measure labor pain comprehensively. The Angle Labor Pain Questionnaire (A-LPQ) is a new, condition-specific instrument that measures the multidimensional characteristics of labor pain and experiences, yet little information is available on its use in other countries and languages. This study aimed at developing a Chinese version of the A-LPQ questionnaire. Materials and Methods: Two independent certified translators translated the English version of the A-LPQ questionnaire, and reconciliation was performed by discussing the discrepancies with a local coordinator. A third translator performed the backward translation, followed by a review by six clinicians on the reconciled version. A cognitive debriefing was done in five pregnant women during the early stage of labor to collect their feedback. After the proofreading, the final version was tested in 50 pregnant women during their labor. Results: The A-LPQ questionnaire was forward translated and was adjusted to expressive and clinical relevance in a local setting. Minor changes were done after backward translation and clinicians’ review to enable a better understanding. No changes were required during cognitive debriefing, and the subsequent finalization showed that the Chinese version of the A-LPQ questionnaire could be well understood (Difficulty level: 2.3 (SD 3.1); with 0 being fully understand, and 10 being extremely difficult to understand). Conclusion: We successfully performed linguistic validation on the Chinese version of the A-LPQ questionnaire, which is appropriate in measuring the dynamic nature of labor pain in a local Chinese setting.

Indicated Opioids in Pregnancy: Guidance on Providing Comprehensive Care.

In modern obstetric practice, providers will encounter patients for whom opioid use in pregnancy is reasonable or even necessary. A "one-size-fits-all" approach to the counseling and management of such patients is misguided. Understanding indications for ongoing opioid use in pregnancy is essential to patient-centered care. Specifically, recognition of the nuanced differences between opioid dependence and opioid use disorder is crucial for appropriate diagnosis, screening for common concurrent conditions, adequately counseling about individualized maternal and perinatal risks, and accurate documentation of diagnoses and medical decision-making. In this paper, we explore the current typical scenarios in which opioid use in pregnancy may be encountered, ongoing opioid prescribing should be considered, and provide a guide for the obstetric provider to navigate the antepartum, intrapartum, and postpartum periods. KEY POINTS: · Opioid use in pregnant and postpartum individuals is not rare.. · Obstetric providers may elect to assume opioid prescribing.. · Obstetric providers are positioned to optimize outcomes for the mother-infant dyad..

Machine Learning Techniques for Identifying Fetal Risk During Pregnancy

Cardiotocography (CTG) is a biophysical method for assessing fetal condition that primarily relies on the recording and automated analysis of fetal heart activity. The quantitative description of the CTG signals is provided by computerized fetal monitoring systems. Even though effective conclusion generation methods for decision process support are still required to find out the fetal risk such as premature embryo, this proposed method and outcome data can confirm the assessment of the fetal state after birth. Low birth weight is quite possibly the main attribute that significantly depicts an unusual fetal result. These expectations are assessed in a constant experimental decision support system, providing valuable information that can be used to obtain additional information about the fetal state using machine learning techniques. The advancements in modern obstetric practice enabled the use of numerous reliable and robust machine learning approaches in classifying fetal heart rate signals. The Naïve Bayes (NB) classifier, support vector machine (SVM), decision trees (DT), and random forest (RF) are used in the proposed method. To assess these outcomes in the proposed method, some of the metrics such as precision, accuracy, F1 score, recall, sensitivity, logarithmic loss and mean absolute error have been taken. The above mentioned metrics will be helpful to predict the fetal risk.

Преждевременные роды – нерешенная проблема XXI века

The article discusses one of the most significant problems in the modern obstetric practice – preterm labor (PL). The upward trend in PL worldwide is related to an increase number of multiple pregnancies due to in vitro fertilization (IVF). PL is one of the main causes of early neonatal mortality and disability in children, also increases the survival rate of newborns with extremely low birth weight, and therefore it significantly changes the structure of surviving premature infants' morbidity. The greatest threat is represented by the «threshold» stages of the disease, with the development of which the process becomes almost irreversible and requires immediate treatment. To improve the perinatal outcomes of PL, the authors draw attention to two problems: first of them – to understand the mechanism of PL, the second one-to work out tactics that allow to carry out measures that can delay, prevent the distress syndrome, and improve fetal condition at any stage of the disease. Key words: preterm birth, in vitro fertilization, quality of life, retinopathy of prematurity.

Admission cardiotocography: Forecasting perinatal outcome

The Admission test (AT) in high risk pregnancy for continuous monitoring of FHR (fetal heart rate) has become crucial in the modern day obstetric practice. As it senses the presence of fetal intrapartum hypoxia and assist the obstetrician in making decision on the mode of delivery to improve perinatal outcome in high risk pregnancy.A prospective observational study was carried out in 230 pregnant women with high risk pregnancy in KIMS BBSR, Odisha during period of 2018-2020 who were admitted to labor room with gestational age more than 33 weeks for continuous FHR monitoring with CTG (cardiotocography) for 20 minutes.Among 230 patients majority of them were primigravida in age group of 21-25 years. About 39.1% were postdated pregnancy followed by Pregnancy Induced Hypertension (PIH) (21.1%), Premature Rupture of the Membranes (PROM) (10.4%), Bad Obstetric History (BOH) (6.9%), PIH with IUGR (Intrauterine Growth Restriction) (6.5%), IUGR (5.6%), Oligohydramnios (4.3%), Diabetes (3.5%) and Rh negative pregnancy (2.6%). The admission test were normal in (68.7%), suspicious in (21.7%) and pathological in (9.6%). The incidence of fetal distress, meconium stained liqour, NICU (Neonatal Intensive Care Unit) admission and APGAR score less than 7 was significantly higher with pathological AT as compared with suspicious and normal AT.The admission CTG appears to be simple noninvasive tool for screening the high risk pregnancy and prioritizing fetuses and deciding the mode of delivery.

English

BACKGROUND Pregnancy with one prior Caesarean section (CS) constitutes a high-risk group with associated medical and legal implications. The dictum ‘once a Caesarean always a Caesarean’ has now judiciously been replaced with ‘once a Caesarean, trial of labour after selection’ because low transverse uterine incision has much lesser chance of scar rupture. Though vaginal birth after Caesarean (VBAC) or trial of scar (TOS) brings a significant change in modern obstetric practice in terms of lower maternal and perinatal morbidities, apprehension of accidental scar rupture during trial of labour with its undesirable consequences still prevents a good number of obstetricians adopting this process. The purpose of the study was to determine the outcome of pregnancy in relation to mode of delivery, i.e., either elective repeat Caesarean section (ERCS) or vaginal birth after Caesarean (VBAC) with maternal and perinatal complications in each mode. METHODS A hospital based prospective, longitudinal, and observational study of 300 pregnant women with previous one Caesarean delivery attended labour emergency or out-patient department (OPD) at Midnapore Medical College of West Bengal, was carried out, approved by the institutional ethical committee. Gestational age &lt; 37 weeks and &gt; 42 weeks and h\o previous uterine surgery like myomectomy, hysterotomy, classical CS were excluded from the study. Data collected was analysed using statistical package for the social sciences (SPSS) software version 20. Descriptive statistics were used to analyse the continuous and categorical data and expressed in the form of mean and percentage whereas proportions were analysed using chi-square test. A P - value ≤ 0.05 was considered statistically significant. RESULTS Out of 300 pregnancies, 140 subjects were given trial of labour (TOL). Of which 89 subjects (63.6 %) had successful VBAC and 51 subjects (36.4 %) had repeat Caesarean sections. Among 211 subjects of repeat Caesarean section, 53 subjects (25.12 %) had indicated for scar tenderness and 73 subjects (34.59 %) had elective repeat Caesarean section (ERCS) due to protracted or arrested cervical dilatation. Those having previous vaginal delivery (VD), had more incidences of VBAC in present pregnancy than those who had no previous VD (P ≤ 0.005); Maternal morbidity (33.65 % ERCS versus 10.11 % VD group, P ≤ 0.05) and neonatal morbidity (12.3 % ERCS versus 2.46% VD group, P ≤ 0.05) was significantly higher in ERCS group. CONCLUSIONS Trial of labour (TOL) should be given in well-equipped hospital. In carefully selected cases, it is a safe procedure and often rewarding, thus incidence of repeat CS can be reduced. Those who had a history of vaginal delivery, VBAC often successful. KEYWORDS VBAC, Trial of Scar, Elective Repeat Caesarean Section, Trial of Labour

Ayurveda for Modern Obstetrics.

Ayurveda is a system of holistic medicine that integrates health with lifestyle to restore balance and remove disease by resolving the imbalance that causes it. Ayurvedic techniques that support digestion, immunity, vitality, and rejuvenation can help assist women with a healthy conception, pregnancy, delivery, and postpartum. Ayurvedic approaches can help common but bothersome pregnancy symptoms as well as potentially prevent more serious pregnancy complications. Specific techniques, including developing a daily routine and the practice of pranayama to support vitality through breathing exercises are described to help guide modern obstetrical practice.

Incidence of second-stage (fully dilated) cesarean sections and how best to represent it: A multicenter analysis.

To gather multicenter data on the incidence of second-stage cesarean sections and suggest alternative methods by which the data can be represented. Retrospective, observational study over a 12-month study period. Numbers of term, singleton live births were collated from each of six maternity units. Data were separated by mode of delivery-unassisted vaginal birth, assisted (instrumental) vaginal delivery and elective, first-stage, and second-stage cesarean sections. Second-stage cesarean sections were expressed as a proportion of all deliveries, of all laboring women (i.e. excluding elective cesarean sections), and all women who reach full dilatation (i.e. excluding elective and first-stage cesarean sections). Of the 28867 deliveries included in the analysis, 493 of these were second-stage cesarean sections. This represented an incidence of 1.7% of all deliveries, 2.0% of all women in labor, and 2.5% of all women who reach full dilatation. Second-stage cesarean sections continue to be common. Safe delivery of a deeply impacted fetal vertex is essential in modern obstetric practice.

Comparative Characteristics of Pregnancy Course and Labour Outcomes in Pregnant Women, Depending on Observation Conditions and Location of Health Improvement Activities

Recurrent pregnancy loss (RPL) is quite an urgent problem in modern obstetric practice, as it has an important effect on perinatal morbidity and mortality, as well as on women's reproductive health. In the treatment of pregnancy loss, specialists have few attempts, and the doctor is responsible for diagnostic assessment, management and place of treatment. Purpose of study: To compare characteristics of pregnancy course and labour outcomes in pregnant women, depending on observation conditions and location of health improvement activities Materials and methods: Group I included 206 pregnant women, receiving in-patient treatment at the sanatorium; and 147 (group II), who were treated in the pathologic pregnancy department in the maternity hospital, were assigned to the risk group for pregnancy loss. At this, 45 patients in group I and 43 patients in group II 43 were treated for threatened miscarriage. Among women from the risk group of pregnancy loss in more than 70% of cases, a burdened obstetric and gynaecological history was revealed. Pregnant women with threatened pregnancy loss at the sanatorium received a complex therapeutic and preventive treatment, including consultations with a psychotherapist (auto-training), physiotherapy, vitamin therapy, herbal medicine, acupuncture. Pregnant women, belonging only to the risk group for pregnancy loss, received a preventive course of central electrical analgesia (CEA), psychophysiological training and general sanatorium regimen. The therapy was combined with test cardiac monitoring. The therapeutic measures in pathologic pregnancy department in the maternity hospital were limited to bed rest and medical therapy, vitamin therapy, prescription of sedatives and tocolytic therapy. Some pregnant women were treated using physical treatment methods - electric relaxation according to A.Z. Haskin on Amplipulse-4 device. Results: The performed study demonstrates that pregnant women, treated in the sanatorium, were less likely to suffer from gestational toxicosis, threatened miscarriage and anaemia of pregnant women. In women of group I, compared to group II, in a large percentage the delivery was in time and natural. In the pathologic pregnancy department, the following complications were recorded: poor uterine contraction strength and bleeding in the 3rd period. Conclusion: In women with RPL, it is recommended to include a sanatorium stage in the system of specialized care for such patients to prolong pregnancy, normalize psycho-emotional state and reduce the number of postnatal complications.