Normal Vaginal Delivery Group Research Articles

Transvaginal Ultrasound Versus Bishop Score in Predicting Labour Dystocia at Full-Term Nullipara Undergoing Labour Induction.

Precise assessment of cervical conditions before labor induction is crucial for predicting the success of normal vaginal delivery. The cervix primary condition has a significant value in determining the succession of induction of labour. Traditionally, assessment of cervix before induction has been based on a cervix digital examination using Bishop's scoring method.This study compares transvaginal ultrasonographic (TVS) cervical assessment with the traditional Bishop score in nulliparous women undergoing labor induction, aiming to evaluate their predictive abilities for labor dystocia. In a prospective observational study of 200 pregnant women at Al Hussein University Hospital between October 2022 and July 2023, cervical length, funneling, and posterior cervical angle were measured using transvaginal ultrasound. The Bishop score was recorded before induction. Statistical analyses, including Student's "t"-test and ROC curve, were conducted using SPSS. 68% delivered via normal vaginal delivery (NVD) and 32% via cesarean section (CS). The NVD group exhibited significantly higher Bishop scores (6.82±1.36 vs 3.70±0.94), lower cervical length (25.46±3.99 vs 37.34±2.09), and higher cervical angle (121.39±5.70 vs 89.01±6.09), than the CS group. ROC curve analysis revealed that a Bishop score ≥4.5 had 89% sensitivity and 87.5% specificity, a cervical angle ≥ 92.5 had 98.5% sensitivity and 95.3% specificity, and a cervical length ≥31.5 had 96.9% sensitivity and 97.1% specificity for predicting NVD. The posterior cervical angle, alongside cervical length, proves to be a more sensitive indicator for predicting labor dystocia during induction compared to the traditional Bishop score.

Effect of prior cesarean delivery on the outcomes of intracytoplasmic sperm injection.

This study was conducted to investigate the impact of previous delivery mode on pregnancy outcomes in patients with secondary infertility after frozen-thawed embryo transfer. This prospective observational study included 140 patients experiencing secondary infertility. Of these, 70 patients had a previous cesarean delivery (CD), while the remaining 70 patients had a previous normal vaginal delivery (NVD). The primary outcome was the implantation rate. The secondary outcomes included rates of clinical pregnancy, chemical pregnancy, miscarriage, and ectopic pregnancy. The comparison of all fertility outcomes between the two groups revealed no statistically significant differences. The implantation rate was 40.4% in the CD group and 41.7% in the NVD group (p=0.842). The clinical pregnancy rate was 50% in the CD group and 49.3% in the NVD group (p=0.932), while the chemical pregnancy rate was 14.6% in the CD group and 19% in the NVD group (p=0.591). The miscarriage rates in the CD and NVD groups were 20% and 17.6%, respectively (p=0.803). One case of tubal ectopic pregnancy occurred in the NVD group (1.4%). The mode of prior delivery did not significantly impact pregnancy outcomes following frozen-thawed embryo transfer.

Predictive value of the trans-perineal three-dimensional ultrasound measurement of the pubic arch angle for vaginal delivery.

Numerous variables are linked to the success of vaginal delivery, including the subpubic arch angle (SPAA) during labor, the importance of which has not yet been fully elucidated. To examine the SPAA distributional characteristics and to ascertain SPAA's ability to predict the type and duration of labor. We determined the SPAA and analyzed the corresponding data. We also evaluated the relationship between the SPAA and the mode of delivery and the duration of labor by regression. The present study comprised a total of 301 pregnant women who had given birth at Beijing Tiantan Hospital of the Capital Medical University between January and December of 2021. Our analysis of 301 pregnant women revealed that the SPAA measured using three-dimensional trans-perineal ultrasound had a minimum angle of 81° and a maximum angle of 122.2°. The angle in the normal vaginal delivery group was greater than that in the labor cesarean group (P = 0.000). The SPAA was a highly significant positive predictor of normal vaginal delivery (P = 0.000) with an area under the curve of 0.782 (P = 0.000; 95%CI: 0.717-0.848). We found the length of the second stage of labor to be positively influenced by the SPAA using linear regression analysis (P = 0.045). The SPAA was a highly significant positive predictor of normal vaginal delivery. The length of the second stage of labor and normal vaginal birth were predicted by SPAA.

The effect of delivery type (vaginal delivery versus cesarean section) on intraocular pressure and retinal nerve fiber layer thickness in healthy women

Introduction: Pregnancy imposes physiological stress and significantly changes human body. This change may have potential effects on visual system. Little is known about pregnancy effects on intraocular pressure (IOP) and glaucoma. Objectives: The present study tended to evaluate and compare the effect of normal vaginal delivery (NVD) versus cesarean section (CS) on IOP and retinal nerve fiber layer thickness (RNFLT) in healthy women. Patients and Methods: Sixty pregnant women participated in this prospective cross-sectional study. The participants were assigned to two groups; the first group consisted of 30 candidates for NVD and the second group of 30 candidates for CS. Then, IOP in three states before delivery, during delivery, and six weeks after delivery then RNFLT were measured and compared by optical coherence tomography (OCT) in two states before delivery and six weeks after delivery. Results: Based on the results, there was no significant difference in the RNFLT in left and right eyes, before and after delivery in the NVD and CS groups (P=0.081 and P=0.090, respectively). Additionally, following the comparison of NVD and SC groups, no significant difference in the RNFLT between two groups was detected (P>0.05). According to IOP measurements in both eyes, IOP during delivery was significantly higher than before and after delivery in NVD group (P=0.05 and P=0.048, respectively) and CS group (P=0.028 and P=0.035, respectively). In addition, IOP in NVD group was higher than CS group in all states, but no statistically significant difference was seen among them (P>0.05). Conclusion: In general, the results showed that delivery type does not significantly affect RNFLT and IOP. It is also possible that an increase in IOP will lead to different results in women with pre-existing glaucoma or risk factors for it. Therefore, in cases with a positive background of glaucoma, specialized examinations and delivery under the supervision of a specialist are recommended.

Retrospective evaluation of outcomes of vaginal birth after caesarean section in a tertiary center: a single-center study from Turkey.

The aim of this study was to evaluate the trial of labor after caesarean (TOLAC) outcomes and determine its reliability by comparing it with elective repeat caesarean delivery (ERCD) and vaginal delivery. For this purpose, the outcomes of patients aged 18-40 years who had 57 TOLACs, 72 vaginal deliveries, and 60 elective caesarean sections in Ankara Koru Hospital between January 1, 2019, and January 1, 2022 were compared. Gestational age was lower in the normal vaginal delivery (NVD) group than in the elective caesarean section and vaginal birth after caesarean delivery (VBAC) groups (p < 0.0005). The birth weight was statistically significantly lower in the NVD group than in the elective caesarean section and VBAC groups (p < 0.0002). No statistically significant correlation was found between the BMI values in all three groups (p < 0.586). There was no statistically significant difference between the groups in terms of pre- and post-natal haemoglobin and APGAR scores (p < 0.575)(p < 0.690)(p < 0.747). The rate of epidural and oxytocin use was higher in the NVD group than in the VBAC group (p < 0.001) (p < 0.037). There was no statistically significant correlation between the birth weights of the infants in the TOLAC group and failed VBAC (p < 0.078). No statistically significant correlation was observed between the use of oxytocin for induction and failed VBAC (p < 0.842). There was no statistically significant correlation between epidural anaesthesia and failed VBAC (p < 0.586). A statistically significant correlation was found between gestational age and caesarean section as a result of a failed VBAC (p < 0.020). The main reason for not preferring TOLAC continues to be uterine rupture. It can be recommended to eligible patients in tertiary centers. Because even when the factors increasing the success of VBAC were excluded, the rate of successful VBAC remained high.

The correlation between postpartum stress disorder and maternal anxiety in different types of delivery (vaginal and cesarean section)

Aim: Post-traumatic stress disorder refers to a person&#8217;s experience of a traumatic event. Traumatic experiences during childbirth can cause postpartum stress in some women. The present study aimed to investigate the correlation between postpartum stress disorder in different types of delivery (normal vaginal delivery and cesarean section) and maternal anxiety. Design: This was a cross-sectional study. Methods: This cross-sectional study was performed on 714 pregnant mothers selected via cluster sampling six-eight weeks after their delivery in selected health centers. The data were collected using Post-Traumatic Stress Disorder Symptom Scale I and the Spielberger State-Trait Anxiety Inventory. The data were then entered into the SPSS 20 software and were analyzed using a chi-square test. The significance level was set as p &lt; 0.05. Results: The results showed that most of the participants in the two groups had medium to low anxiety levels, and the two groups were homogeneous in this regard. However, the mean scores of obvious anxiety (p &lt; 0.0001) and hidden anxiety (p &lt; 0.0001) were significantly higher in the normal vaginal delivery group compared to the cesarean section group. Moreover, post-traumatic stress score was significantly correlated to both obvious anxiety and hidden anxiety in the two study groups. Conclusion: Postpartum stress disorder had a positive relationship with obvious anxiety and hidden anxiety in both study groups. Counseling may be effective in reducing post-traumatic stress disorder in women.

Influence of Pilate Therapy and Conventional Therapy in Post Natal Women with Back Pain

&lt;strong&gt;Background:&lt;/strong&gt; Post-partum period is challenging for every woman. It usually starts from delivery and ends by 42 days. In majority of women, complications like hemorrhage, DVT, pulmonary embolism, edema in hand and ankle joints, puerperal infection, problems in breast feeding, kypho-scoliosis and backache arise. Postnatal low back pain and pelvic pain are common problems in the post-partum period; these could vary from mild problems to disability. The incidence of postnatal LBP is very high from 21% to 82% in the fisco year post-partum. Remission of pain occurred in 51% at 1 month and 78% at 6 months in CS group, while in the normal vaginal delivery group 55% at 1 month and 85% in the 6th month had remission of pain. Reoccurrence of pain is common in postnatal period. Physiotherapy has shown to have influence on various problems arising in post-natal period. Health literature listed out various conventional treatment approaches for back pain which includes exercises, yoga, core stability, walking, running, aquatic exercise and aerobics. Pilate therapy focuses on improving the body’s core and makes it more flexible and stronger. Pilates has been found to be effective in neuromuscular problems. Its effect in post natal women is a research area. Its effect over conventional therapy needs to be evaluated for better patient care. &lt;strong&gt;Method:&lt;/strong&gt; 494 subjects were included according to criteria. Subjects were allotted into two groups. Group A: Pilates and Group B: Conventional. Interventions were given for 6 weeks and changes in Visual Analogue Scale, Modified Schober Test, Manual Muscle Testing, Oswestry Low Back Disability were noted. &lt;strong&gt;Result:&lt;/strong&gt; For pre and post interventional analysis between the groups, student’s t-test was used. The results showed significant improvement with Pilates therapy than conventional training in reducing back pain, increasing abdominal muscle strength and improving quality of life. &lt;strong&gt;Conclusion:&lt;/strong&gt; Pilates therapy reduced back pain than conventional therapy in post natal women.

Prevalence of Post-traumatic Stress Disorder in Women with Normal Vaginal Delivery and Those with Caesarian Section

: Childbirth causes intense emotional arousal that may cause traumatic psychological symptoms in some women. This study investigated the prevalence of post-traumatic stress disorder (PTSD) in women with normal vaginal delivery and those with caesarian section. This was a cross-sectional study conducted in selected health centers affiliated to Shiraz University of Medical Sciences in 2018. The samples included 714 patients (328 vaginal deliveries and 386 cesarean deliveries). Sampling was performed using the convenience sampling method in two cluster stages after selecting the clinic. Mothers were determined to be traumatic in their delivery according to criterion A in the Diagnostic and Statistical Manual of Mental Disorders Version DSM-IV (with four questions). Then, a demographics checklist and a stress disorder questionnaire were filled out for all the mothers after a traumatic delivery through interviews. The prevalence of postpartum stress disorder was higher in the cesarean section group (10.8%) than in the normal vaginal delivery group (10%), but this difference was not significant (P = 0.275). Although the prevalence of PTSD between the two groups was not significant, the prevalence of PTSD was significantly higher in this study than in reports from other countries. This highlights the need for targeted interventions to reduce this disorder.

Human Milk Virome Analysis: Changing Pattern Regarding Mode of Delivery, Birth Weight, and Lactational Stage.

The human milk (HM) microbiota is a significant source of microbes that colonize the infant gut early in life. The aim of this study was to compare transient and mature HM virome compositions, and also possible changes related to the mode of delivery, gestational age, and weight for gestational age. Overall, in the 81 samples analyzed in this study, reads matching bacteriophages accounted for 79.5% (mainly Podoviridae, Myoviridae, and Siphoviridae) of the reads, far more abundant than those classified as eukaryotic viruses (20.5%, mainly Herpesviridae). In the whole study group of transient human milk, the most abundant families were Podoviridae and Myoviridae. In mature human milk, Podoviridae decreased, and Siphoviridae became the most abundant family. Bacteriophages were predominant in transient HM samples (98.4% in the normal spontaneous vaginal delivery group, 92.1% in the premature group, 89.9% in the C-section group, and 68.3% in the large for gestational age group), except in the small for gestational age group (only ~45% bacteriophages in transient HM samples). Bacteriophages were also predominant in mature HM; however, they were lower in mature HM than in transient HM (71.7% in the normal spontaneous vaginal delivery group, 60.8% in the C-section group, 56% in the premature group, and 80.6% in the large for gestational age group). Bacteriophages still represented 45% of mature HM in the small for gestational age group. In the transient HM of the normal spontaneous vaginal delivery group, the most abundant family was Podoviridae; however, in mature HM, Podoviridae became less prominent than Siphoviridae. Myoviridae was predominant in both transient and mature HM in the premature group (all C-section), and Podoviridae was predominant in transient HM, while Siphoviridae and Herpesviridae were predominant in mature HM. In the small for gestational age group, the most abundant taxa in transient HM were the family Herpesviridae and a species of the genus Roseolovirus. Bacteriophages constituted the major component of the HM virome, and we showed changes regarding the lactation period, preterm birth, delivery mode, and birth weight. Early in life, the HM virome may influence the composition of an infant’s gut microbiome, which could have short- and long-term health implications. Further longitudinal mother–newborn pair studies are required to understand the effects of these variations on the composition of the HM and the infant gut virome.

Attitudes of Primary Pregnant Women Toward Preference of Birth Method in Dezful, Iran: A Cross-Sectional Study

Introduction: Choosing the birth method is a major issue for pregnant women that is affected by multifaceted physiological, psychological and socio-cultural factors.&#x0D; Aim(s): The aim research was performed to explore factors influencing pregnant women’s attitude toward birth method.&#x0D; Methods: This is a cross-sectional study on 220 healthy nulliparous pregnant women with uncomplicated pregnancies without any contraindication for vaginal birth in Medical Centers of Dezful, in the south west of Iran. Data collection tool was a questionnaire for factors affecting the choice of delivery method. Differences in attitude were compared between two groups of natural vaginal delivery preference and cesarean delivery preference. Statistical analysis was performed with SPSS Version 16.0 statistic software package. Descriptive statistics were used to report percentages, mean, and standard deviation, and t-test, chi-square were applied to analyze the data.&#x0D; Results: During the study period, 206 primary pregnant women were examined to determine the attitudinal influencing factors the birth method preference. 131 women (64%) chose the natural delivery method and 71 women (36%) chose the cesarean delivery method. In addition, the results showed a statistically significant difference between the two groups regarding the general attitude of the participants towards natural delivery (164.43 in the normal vaginal delivery (NVD) group versus 134.50 in the cesarean section (CS) group (p &lt; 0.001)).&#x0D; Conclusion: There is a direct relationship between the attitude of pregnant women towards vaginal birth and the tendency to normal vaginal delivery and cesarean section. Also, according to the results of the study of 8 components of attitudes, counseling sessions and prenatal training sessions can be identified based on counseling needs and be guided counseling sessions more purposefully.

Effect of Perceived Social Support on Postnatal Depression in Females with Cesarean Section and Normal Vaginal Delivery

Objectives: To assess the association of perceived social support with postnatal depression among puerperal women of Faisalabad, Pakistan.&#x0D; Methods: It was a case-control study carried out during a period of 18 months (1-1-2019 to 30-06-2020). By using purposive sampling technique 284 postpartum women were enrolled from Allied hospital and Children hospital Faisalabad. The postnatal depression was diagnosed with Edinburg Postnatal Depression Scale (EPDS).The Multidimensional Scale of Perceived Social Support (MSPSS) was used to measure the social support that was perceived by women.&#x0D; Results: According to cut-off score ≥13 on EPDS 37.3% women were found depressed while 62.7% women were found non-depressed. The mean EPDS score ± SD was 10.12 ± 6.27 (min score 0; max score 27). The perceived social support from significant other, family and friends was found as significant predictor of postnatal depression. With one-point increase in global perceived social support, the postnatal depression decreased by 0.1 points on EPDS scale (p = 0.03) among women in normal vaginal delivery group, by 0.2 points in cesarean section group (p &lt;0.001) and the postnatal depression decreased by 0.2 points in total sample (p &lt; 0.001).&#x0D; Conclusion: A poor perceived social support from significant other, family and friends is a significant risk factor for postnatal depression among puerperal women.

Angle of progression in women undergoing trial of labor after cesarean section in predicting mode of delivery

Objective To assess the ability of ultrasonic measurement of angle of progression (AOP) in predicting mode of delivery in women undergoing vaginal birth after cesarean section (CS). Background The intrapartum ultrasound measurement of AOP is reliable regardless of the fetal head station assessed manually or the clinician's level of ultrasound experience. Patients and methods A prospective observational study was conducted from March 2019 to January 2020 at Menoufia University Hospital, including 100 patients with a history of previous one CS in spontaneous labor. Patients were followed up, and AOP was measured in them using transperineal ultrasound. Patients were divided into two groups according to mode of delivery as follows: group 1, delivered by CS, and group 2, delivered by normal vaginal delivery (NVD). Results The mean AOP was decreased in CS group (98.20 ± 15.83) than NVD group (112.21 ± 12.66). Additionally, at cutoff point of AOP less than 95 (86°), area under curve was 0.511 (95% confidence interval: 0.264–0.758; P = 0.024), with sensitivity of 71.4%, specificity of 85.5%, and accuracy 81.5%. However, at cutoff point of AOP more than 95 (113°), area under curve was 0.545 (95% confidence interval: 0.412–0.679; P = 0.016), with sensitivity of 85.7%, specificity of 69.4%, and accuracy 93.25%. Conclusions The AOP was significantly decreased in CS group than NVD group. The results prove a vital role for using this angle as a simple and accurate landmark to evaluate station of fetal head and provide a useful predictor for mode of delivery, particularly in patients with planned vaginal birth after cesarean delivery (VBAC).

The effect of mother-infant skin-to-skin contact immediately after birth on exclusive breastfeeding: a systematic review and meta-analysis

In the new millennium, exclusive breastfeeding plays an important role in national and international policies. The effects of mother-infant skin-to-skin contact (SSC) after birth has been investigated in several studies. Given that there has been no overall estimate of this effects, the present study was conducted with the aim of investigating the effects of mother-infant SSC on the rate of exclusive breastfeeding through a systematic review and meta-analysis of randomized controlled trials. In the present study, the databases of Scopus, PubMed, Cochrane, SID, Magiran, IranDoc, and Google Scholar were searched to identify randomized controlled trials that evaluated the effects of mother-infant SSC immediately after birth on the rate of exclusive breastfeeding. The risk of bias and strength of evidence were examined according to the Cochrane Collaboration’s tool and the Grading of Recommendation, Assessment, Development, and Evaluation approach, respectively. The data analysis was performed using Stata software. To assess the publication bias and heterogeneity, Egger’s and Begg’s tests and I2 were used, respectively. In addition, the fixed effects model was employed to perform the meta-analysis. The heterogeneity of the factor of effects in the studies was determined as 16.2% (p<0.303). There was no publication bias among the studies included; the p values of Egger’s and Begg’s tests were 0.168 and 0.386, respectively. The effects of mother-infant SSC on exclusive breastfeeding was statistically significant [odds raito (OR)=2.19; 95% confidence interval (CI): (1.66-2); p<0.001]. The subgroup analysis results in the normal vaginal delivery group included OR=2.45 [95% CI: (1.76-3.35); p<0.001], for the cesarean delivery group the results were OR=1.44 [95% CI: (0.78-2.65); p=0.24], the results for the duration of exclusive breastfeeding as of the discharge time up to 3 months were OR=2.47 [95% CI: (1.76-3.48); p<0.001], and the results for the 3 to 6 months of exclusive breastfeeding were OR=1.71 [95% CI: (1.05-2.78); p=0.030]. The study results showed that mother-infant SSC increased the rate of exclusive breastfeeding. Therefore, this finding could be used by maternal and infant health care providers to develop evidence-based intervention programs.

Evaluate the correlations of maternal systemic ınflammatory markers such as neutrophil to lymphocyte ratio and platelet to lymphocyte ratio with gestation age

Objective: In this study, we aim to study the correlation between the maternal systemic inflammatory markers such as neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) including complete blood count (CBC) variables with gestation age, at the labor of our patients. Materials and Methods: This retrospective study was performed with 1127 patients and their infants. We used the maternal CBC variables analyzed within the last day before active labor. We analyzed the statistical differences between the NLR, PLR, and other CBC variables in terms of gestational age. Results: There was no statistically significant difference between the gestational age with NLR and PLR values, (P = 0.414 and P = 0.341, respectively). When we compare the NLR and PLR values in normal spontaneous vaginal delivery (NSVD) group, no statistically significant difference was found (P = 0.250; P = 0.995, respectively). In correlation analyses, no statistically significant correlation was detected between NLR and PLR with a birth weight of the infant and gestational age (P = 0.132 and P = 0.344, respectively). A linear, negative, weak correlation, and statistically significant correlation was detected between white blood cell count (WBC) with the infant's birth weight and gestational week (P Conclusions: Inflammation plays an important role especially at the beginning of the labor. In our study, we showed no correlation of the NLR and PLR with a gestational week or infant's birth weight at labor. Also, in our research, the NLR and PLR values did not differ statistically among the four groups in terms of the gestational age of delivery with the highest values in the preterm birth (

Relationship between Delivery Type and Jaundice Severity among Newborns Referred to Hospital

Background and Aim: Neonatal jaundice affects one of two newborns around the World and occurs when a baby has a high level of bilirubin in the blood. In recent decades, the cesarean section has increased, accompanied by higher neonatal jaundice risks compared with vaginal delivery. This study aimed to investigate the relationship between the jaundice severity and the delivery type and gender among newborns referred to a Qamar Bani Hashem Hospital in Khoy city (West Azerbaijan Province, Iran). Methods: In this cross-sectional study, we investigated randomly 309 newborns with asymptomatic jaundice, who referred to the hospital, from 2014 to 2018. The results of laboratory tests were recorded for all participating infants. Results: 49.19% of newborns with jaundice were born by cesarean section, and 49.19% were born by vaginal delivery. 141 (45.63%) of babies with jaundice were males, and 168 (54.37%) were females. Mean blood sugar (BS) (p=0.52), urea (p=0.48), creatinine(Cr) (p=0.69), Na (p=0.46), K (p=0.69), Ca (p=0.29), TB (p=0.58) and neonatal weight (p=0.14) within days 3 to 10 were not significantly different between vaginal delivery group and cesarean section group (p>0.05), while direct bilirubin showed significant variations (p<0.05). Mean serum direct bilirubin was 0.22±0.07 mg/dL in the normal vaginal delivery group and 0.25±0.09 mg/dL in the cesarean section group (p<0.05). Also, the level of K (P=0.04) was significantly higher in the male group compared to the female group. Conclusion: Based on our study, there is no significant relationship between the severity of jaundice and the type of delivery and gender in newborns. *Corresponding Author: Haleh Barmaki; Email: Halebarmaki@gmail.com Please cite this article as: Panji M, Behmard V, Varghaiyan Y, Sheikhalishahi ZS, Peyvasteh S, Seyedhashemi E, Zakeri M, Pooyanfar F, Barmaki H. Relationship between Delivery Type and Jaundice Severity among Newborns referred to Hospital. Arch Med Lab Sci. 2019;5(4):8-13. https://doi.org/10.22037/amls.v5i4.32145

Prevalence of obstetric anal sphincter injury following vaginal delivery in primiparous women: a retrospective analysis.

Obstetric anal sphincter injuries (OASIS) may be underdetected in primiparous women. This study evaluated the prevalence of OASIS in primiparous women after normal vaginal delivery or instrumental delivery using endoanal ultrasound (US) during postnatal follow-up. This study retrospectively analysed endoanal US data collected during postnatal follow-up (6-12 months after vaginal delivery) at a tertiary hospital in Hong Kong. Offline analysis to determine the prevalence of OASIS was performed by two researchers who were blinded to the clinical diagnosis. Symptoms of faecal and flatal incontinence were assessed with the Pelvic Floor Distress Inventory. Of 542 women included in the study, 205 had normal vaginal delivery and 337 had instrumental delivery. The prevalence of OASIS detected by endoanal US was 7.8% (95% confidence interval [CI]=4.1%-11.5%) in the normal vaginal delivery group and 5.6% (95% CI=3.1%-8.1%) in the instrumental delivery group. Overall, 82.9% of women with OASIS on endoanal US did not show clinical signs of OASIS. Birth weight was significantly higher in the OASIS group (P=0.012). At 6 to 12 months after delivery, 5.5% of women reported faecal incontinence and 17.9% reported flatal incontinence, but OASIS was not associated with these symptoms. Additional training for midwives and doctors may improve OASIS detection.

Low-risk planned caesarean versus planned vaginal delivery at term: early and late infantile outcomes.

Understanding the impact of delivery mode on neonatal morbidity becomes essential in the context of rising Caesarian delivery rates. We aimed to compare the selected outcomes in neonates born by low-risk planned Caesarian delivery versus planned normal vaginal delivery (NVD). This prospective cohort study examined early, and late neonatal complications among 1071 neonates born through low-risk planned Caesarian delivery and 1367 neonates born through planned NVD, in Fars, Islamic Republic of Iran, during 2012-2014. Gestational age of neonates born through Caesarian delivery was significantly lower than their counterparts in NVD group. Accordingly, babies' birth weights were 3166 (±442.4) grams in Caesarian delivery group and 3213 (±454.8) grams in NVD group. Normal skin colour at birth was more prevalent in the Caesarian delivery group compared to the NVD group (85% vs. 81.3%, P = 0.04). No significant differences were detected between the two groups regarding birth trauma, birth height and head circumference, and developing infection, icterus and convulsion during neonatal period. Also, height and weight at two years of age did not significantly differ in both groups. The results of this study show that neonates born by Caesarian delivery and NVD had the same early and late outcomes.

Prevalence of postpartum depression regarding mode of delivery: a cross-sectional study

Purpose: To explore the prevalence of postpartum depression (PPD), as well as the relationship between delivery mode and postpartum depression among postnatal women utilizing the Arabic validated version of the Edinburgh Postnatal Depression Scale (EPDS).Materials and methods: 412 women with singleton gestation during their 3rd trimester without medical or psychological problems preceding or during pregnancy were included. All pregnant women were asked to fill out the Arabic version of Edinburgh Postnatal Depression Scale. Only women with EPDS score <13 during pregnancy were allowed to complete the study. 370 women were asked to repeat the EPDS at 8 and 16 weeks postnatal. The patients were divided into three groups according to their delivery mode; normal vaginal delivery, emergency or elective caesarian section.Results: Prevalence of postpartum depression was found to be significantly higher in emergency caesarian section group at the 8th and 16th postnatal weeks (25% and 19%, respectively) when compared to elective caesarian section group (21% and 13%, respectively) or normal vaginal delivery group (7% and 1.7%, respectively). The mean score of the EPDS in the normal vaginal delivery group at both assessments was significantly lower than those of the emergency and elective caesarian section groups.Conclusions: There was a strong relation between delivery mode and postpartum depression. Emergency CS showed a stronger correlation than elective caesarian section.

Correlation Between Delivery Mode and Pelvic Organ Prolapse Evaluated by Four-Dimensional Pelvic Floor Ultrasonography.

BackgroundThis study explored symptoms and signs of pelvic organ prolapse (POP) evaluated by 4-dimensional pelvic floor ultrasonography and analyzed the relationship between delivery mode and POP.Material/MethodsA total of 578 women who underwent 4-dimensional transperineal ultrasound were enrolled in this study. Obstetric history together with other clinical information were gathered from clinical questionnaires and gynecologists. Patients were thereafter classified into 4 groups: women with normal vaginal delivery, women with forceps delivery, women with cesarean, and nullipara women. We assessed symptoms and signs of POP among these 4 groups by use of 2 evaluation methods. The first method was clinical assessment applying International Continence Society (ICS) pelvic organ prolapse quantification (POP-Q). The second method was the use of ultrasonography in the quantification of anterior, middle, and posterior compartment prolapse.ResultsNulliparae women exhibited the lowest probability of POP (POP-Q: cystocele of 15.6%, uterine prolapse of 11.1%, rectocele of 20.0%; ultrasound exam: 6.7%, 8.9%, 13.3% in sequence), while women with forceps delivery had the highest probability of POP (POP-Q: 59.6%, 50.8%, 63.2% in sequence; ultrasound exam: 45.6%, 52.6%, 42.1% in sequence). Regarding the correlation between POP and delivery mode, the adjusted odds ratio was 2.40 (95%CI: 1.301~4.590) and 3.20 (95%CI: 1.651~6.121) in the normal vaginal delivery group and forceps group, respectively, compared with the cesarean group.ConclusionsFour-dimensional pelvic floor ultrasonography can be used as a preferred method in evaluating POP. Regarding the relationship between delivery mode and POP, there is a significant correlation between vaginal delivery and POP.

Anal sphincter defects and fecal incontinence 15-24 years after first delivery: a cross-sectional study.

To establish the prevalence of external (EAS) and internal (IAS) anal sphincter defects present 15-24 years after childbirth according to mode of delivery, and their association with development of fecal incontinence (FI). The study additionally aimed to compare the proportion of women with obstetric anal sphincter injuries (OASIS) reported at delivery with the proportion of women with sphincter defect detected on ultrasound 15-24 years later. This was a cross-sectional study including 563 women who delivered their first child between 1990 and 1997. Women responded to a validated questionnaire (Pelvic Floor Distress Inventory) in 2013-2014, from which the proportion of women with FI was recorded. Information about OASIS was obtained from the National Birth Registry. Study participants underwent four-dimensional transperineal ultrasound examination. Defect of EAS or IAS of ≥ 30° in at least four of six slices on tomographic ultrasound was considered a significant defect and was recorded. Four study groups were defined based on mode of delivery of the first child. Women who had delivered only by Cesarean section (CS) constituted the CS group. Women in the normal vaginal delivery (NVD) group had NVD of their first child and subsequent deliveries could be NVD or CS. The forceps delivery (FD) group included women who had FD, NVD or CS after FD of their first born. The vacuum delivery (VD) group included women who had VD, NVD or CS after VD of their first born. Multiple logistic regression was used to calculate adjusted odds ratios (aORs) for comparison of prevalence of an EAS defect following different modes of delivery and to test its association with FI. Fisher's exact test was used to calculate crude odds ratios (ORs) for IAS defects. Defects of EAS and IAS were found after NVD (n = 201) in 10% and 1% of cases, respectively, after FD (n = 144) in 32% and 7% of cases and after VD (n = 120) in 15% and 4% of cases. No defects were found after CS (n = 98). FD was associated with increased risk of EAS defect compared with NVD (aOR = 3.6; 95% CI, 2.0-6.6) and VD (aOR = 3.0; 95% CI, 1.6-5.6) and with increased risk of IAS defect compared with NVD (OR = 7.4; 95% CI, 1.5-70.5). The difference between VD and NVD was not significant for EAS or IAS. FI was reported in 18% of women with an EAS defect, in 29% with an IAS defect and in 8% without a sphincter defect. EAS and IAS defects were associated with increased risk of FI (aOR = 2.5 (95% CI, 1.3-4.9) and OR = 4.2 (95% CI, 1.1-13.5), respectively). Of the ultrasonographic sphincter defects, 80% were not reported as OASIS at first or subsequent deliveries. Anal sphincter defects visualized on transperineal ultrasound 15-24 years after first delivery were associated with FD and development of FI. Ultrasound revealed a high proportion of sphincter defects that were not recorded as OASIS at delivery. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.