Normal Vaginal Delivery Group Research Articles

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.

The Effect of Epidural-Spinal Anesthesia on Labor Outcome and Satisfaction in Parturient Mothers: A Randomized Controlled Trial

Introduction: One of the health system concerns is the use of medications for pain relief during labor and its side effects. Therefore, the aim of this study was to investigate the effect of epiduralspinal anesthesia (combined anesthesia [CA]) on labor outcome and satisfaction in pregnant women. Methods: In this randomized controlled trial study, we included 80 nulliparous women who had been admitted to Fatemieh hospital (Hamadan, Iran) during 2015-2016 due to spontaneous onset of labor. They were randomly assigned into 2 groups of 40, one group with CA versus normal vaginal delivery (NVD) group. Data were collected by using of demographic questionnaire, satisfaction questionnaire, and baby truck scales. Data were analyzed by descriptive and analytical statistics in SPSS version 16.0. Results: Average maternal age (mean ± SD) in the CA group was 26.94 ± 4.34 and in the NVD group was 25.89 ±5.18, respectively. There was a significant difference between the 2 groups in terms of length of second stage of labor (P=0.001), headache (P=0.04), and Apgar score (first minute) (P=0.001). Chi-square test showed a significant difference between the 2 groups in terms of satisfaction with childbirth (P=0.004). Conclusion: In this study, labor pain relief by using the spinal-epidural anesthesia (CA) increased the labor satisfaction. Nevertheless, this approach was associated with some maternal and neonatal complications such as: headaches, length of third stage of labor, and low Apgar score. It seems that the use of this method for painless delivery requires further studies.

Relationship between delivery modes and genitourinary syndrome among postmenopausal women

Objectives: Many postmenopausal women suffer from genitourinary syndrome of menopause (GSM) due to the lack of estrogen. This study aimed to evaluate the relationship between mode of delivery and GSM among postmenopausal women.Methods: We performed a case–control study of women who had had either vaginal delivery or Cesarean section. Data were collected through a sociodemographic questionnaire and a check list for assessing signs and symptoms of GSM. Subjective symptoms of vaginal atrophy (dryness, dyspareunia, itching, burning and paleness), pH of the vagina and maturation index were assessed and recorded. Data were analyzed using the χ2 test and independent t-test.Results: A total of 125 postmenopausal women were recruited (65 with a history of normal vaginal delivery (NVD) and 60 with a history of Cesarean section). Vaginal pH was more commonly lower (pH 5–5.49) in the NVD group (50.8% vs. 40%) (p < 0.001). The maturation index was also better in the NVD group (42.7 ± 6.34 vs. 24.08 ± 8.2) (p < 0.001). All symptoms of vaginal atrophy including paleness, dryness, itching, dyspareunia and burning were significantly less in the NVD group compared to the Cesarean section group (p < 0.05).Conclusion: Postmenopausal women with a history of normal vaginal delivery were less likely to have GSM compared to the women with a history of Cesarean section. Other prospective studies can explore this relationship better.

Intraocular pressure in infants and its association with hormonal changes with vaginal birth versus cesarean section.

To investigate cord arterial blood sample and the relationship between birth stress and intraocular pressure in infants at 5min after delivery. The IOP measurements were taken using Tonopen-Avia tonometer to 158 newborns (158 eyes) at 5th min after birth, in a university hospital. Cord blood was collected within 3min after delivery. Intraocular pressure, gender, gestation period, mode of delivery, and birth weight of newborns were noted from medical records. Sixty-two babies were delivered by normal vaginal delivery (NVD) and 96 by cesarian section (C/S). Mean IOP of NVD and C/S groups were 19.56±3.84 and 17.42±3.50, respectively. There was significant difference of mean IOP between two groups. (p<0.001) There were significant differences between two groups regarding APGAR score (p<0.001) and cord blood adrenaline (p=0.003), noradrenaline (p=0.008), and cortisol (p<0.001) levels. There was no difference between infant corneal thickness measurements (p=0.698). In correlation analyses, there is a strong negative correlation between the labor type and postpartum measurements except corneal thickness. Correlation analyses of the 5th min intraocular pressure of the groups individually revealed significant correlation in the NVD group. The conclusion is that the intraocular pressure of newborn infants was higher in NVD delivery compare to C/S. Blood hormonal changes in different anesthesia types and physical stress was thought as the main reason of this result.

Comparative study of occurrence of postpartum low back and pelvic pain (LBPP) after normal delivery versus caesarean section (CS) following spinal anaesthesia and its rehabilitative management

Introduction and hypothesis: Low back and pelvic pain is very commonly encountered ailment in pregnancy and post-partum in women of childbearing age group. It can account for around half of the women of childbearing age. The pathophysiology of low back pain during pregnancy and postpartum is still poorly understood. Methods: The study was to compare low backache after normal delivery and after caesarean section following spinal anaesthesia, and its persistence after pregnancy. Moreover women were educated to regain the pre-pregnancy state uneventfully. Results: Postpartum backache at 1 month incidence in our study was 49%. Remission of pain occurred in 51% at 1 month and 78% at 6 months in caesarean section group, while in the normal vaginal delivery group 55% at 1 month and 85% in the 6th month had remission of pain. Conclusions: Women who had caesarean section with spinal anaesthesia had more chances to develop low back pain than women with normal vaginal delivery. Pre-pregnancy state can be achieved by supervised exercise regime.

Effect of delivery mode on postpartum neonatal body temperatures

Objective: It is known that general and local anesthesia practices disrupt the delicate balance of thermoregulation center which is already sensitive to very tiny differences of temperatures in a normal subject. We aimed to evaluate and compare the rectal temperatures of newborns born with normal vaginal delivery and cesarean section.Methods: We performed a prospective study of 106 term newborn – 40 born with normal vaginal delivery (group 1) and 66 born with cesarean section [51 spinal anesthesia (group 2), 15 general anesthesia (group 3)]. Only term babies were included in the study. Babies of eclamptic, pre-eclamptic and diabetic mothers and babies with chronic systemic diseases were excluded. Pregnants who underwent elective cesarean section were included in the study. Adolescent pregnants, pregnants with increased risks and pregnants with complicated operations were excluded. Mothers’ temperatures were measured before and after the interventions. Rectal temperatures of the babies were measured immediately after birth.Results: Environmental temperature was maintained at 22–24 °C. Pre-operative mother temperatures were 36.31 ± 0.30 °C in group 1, 36.36 ± 0.26 °C in group 2 and 36.39 ± 0.19 °C in group 3 (p = 0.414). Post-operative mother temperatures were 36.39 ± 0.27 °C in group 1, 36.29 ± 0.31 °C in group 2 and 36.25 ± 0.28 °C in group 3 (p = 0.215). Rectal temperatures of the babies born with normal vaginal delivery were significantly higher than the others. It was lowest in the general anesthesia group (37.5 ± 0.6 °C, 37.2 ± 0.2 °C and 36.8 ± 0.4 °C in group 1, 2 and 3, respectively). The temperature differences between groups were statistically significant p < 0.001).Conclusions: In conclusion, it is worthy to note that temperatures of the newborns can differ according to the delivery mode. Physicians and health professionals that take care of the newborns should be aware of this difference.

Joint Hypermobility in Women with Cesarean Section

Background: Delivery modalities are importantobstetrical issues. Joint hypermobility (JHM) is a common clinical condition with striking female predominance. The aim of the study was to assess JHM in women with cesarean section (CS). Methods: This case control study included 100 women with CS and 100 women with normal vaginal delivery (NVD) matched in age and BMI. Joint mobility was measured by a blinded observer according to Beighton score. Women with joint mobility score ≥ 4 were hypermobile. Results: JHM was significantly less in women with CS than NVD group [8 (24.2%) vs 25 (75.8%), OR (95% CI), P=0.002].Total joint mobility score was significantly less in CS group (111) than in NVD group (197) (p=0.002).Joint mobility score at cut off ≤ 3 had accuracy of 59 %, with positive predictive value 55 % , sensitivity (92%), and specificity (25%). Conclusions: Joint mobility was reduced in women with CS. Joint mobility score at cut off ≤ 3 had moderate accuracy and high sensitivity to diagnose women who may need CS. This may suggest that women with more hypermobile joints may be a prognostic and facilitating factorof spontaneous vaginal birth.

1358 Effect of Mode of Delivery on Mortality and Morbidity in Very Low Birth Weight Neonates with Respiratory Distress Syndrome

Background & Aim:It is known that wet lung syndrome and pulmonary maladaptation are more frequent in infants delivered by cesarean section while the effect of mode of delivery on RDS...

Four‐dimensional sonographic evaluation of avulsion of the levator ani according to delivery mode

To determine the frequency of avulsion of the levator ani muscle in primiparous women according to delivery mode, using introital four-dimensional ultrasonography. We performed a prospective observational study at a tertiary obstetric unit. One hundred and eighty primiparous women were included and divided into three groups: normal vaginal delivery without episiotomy, forceps delivery and Cesarean section groups. Between 40 and 120 days after delivery, four-dimensional ultrasonography was performed in order to evaluate the integrity of the levator ani muscle. The operator was blinded to all clinical data and was not aware of delivery mode. The influence of other variables associated with delivery such as birth weight, body mass index, maternal age and use of epidural anesthesia was also studied. Avulsion of the puborectalis component of the levator ani muscle was detected on ultrasonography in 61.7% of women who had undergone a forceps delivery, compared with 13.3% of those who had had a normal vaginal delivery and 0% of those who had had a Cesarean section. Bilateral avulsion was observed in 12/60 (20.0%) of the forceps group and in 2/60 (3.3%) of the normal vaginal delivery group (P < 0.001). Other variables did not seem to influence prevalence. Forceps delivery is associated with an increased rate of avulsion of the puborectalis component of the levator ani muscle. The effect of forceps use is independent of other delivery-related variables.

Postpartum stress urinary incontinence and associated obstetric factors

To evaluate the effect of cesarean section (CS) and vaginal delivery (VD) on postpartum stress urinary incontinence (SUI) and pelvic floor muscles strength and to find out the correlated obstetric factors and prevention for postpartum SUI. Totally, 788 women, who visited the antenatal clinics, delivered and had the follow-up at 6-8 weeks after delivery in Beijing Obstetrics and Gynecology Hospital in the year of 2008, were enrolled in this study and were divided into 3 groups: CS group (n = 212); normal vaginal delivery (NVD) group (n = 534) and forceps delivery (FD) group (n = 42). Women in the NVD and FD group were merged into one VD group and then divided into SUI and non-SUI group. Information of delivery mode and the correlated obstetric factors were obtained through questionnaires and medical records. Femiscan pelvic floor muscle examine system was applied to measure the pelvic floor muscle strength to understand the relationship between postpartum SUI and pelvic floor muscle strength. (1) Incidence of SUI: the overall proportion of women who complained of urinary incontinence (UI) during pregnancy was 15.4% (121/788), and it was 15.9% (85/534), 11.9% (5/42) and 14.6% (31/212) in the NVD, FD and CS group, respectively (P > 0.05). The overall incidence of postpartum SUI was 17.1% (135/788), and it was 19.1% (102/534), 26.2% (11/42) and 10.4% (22/212) in the NVD, FD and CS group, respectively, with significant difference between the NVD and FD group, and between the CS and NVD group (all P < 0.01). (2) The associated obstetric factors of postpartum SUI: among the VD group, 113 women were in the postpartum SUI group and 463 in the non-SUI group. Univariate analysis and logistic multivariate analysis showed that delivery mode, neonatal birth weight and UI during pregnancy were risk factors of postpartum SUI. CS decreased and higher neonatal birth weight and UI during pregnancy increased the risk of postpartum SUI. In the VD group, neonatal birth weight, forceps delivery and UI during pregnancy increased the incidence of postpartum SUI (P < 0.01), but no correlation was found with labor analgesia, duration of labor, episiotomy, breast feeding, volume of postpartum bleeding, gestational weeks at delivery, induction and pre-pregnant BMI, etc (all P > 0.05). (3) Pelvic floor electromyogram: pelvic floor muscles strength in the CS group was significantly higher than that of the VD group [activity value: (19.7 +/- 9.9) microv vs (14.8 +/- 8.4) microv; work value: (84.5 +/- 37.2) microv vs (78.8 +/- 28.2) microv; peak value: (25.5 +/- 12.5) microv vs (19.7 +/- 11.8) microv, all P < 0.01]. Among women in the VD group, the relaxation value and the ratio of relaxation value over activity value (r/a) in the postpartum SUI group were significantly lower than those in the non-SUI group [relaxation value: (1.7 +/- 1.8) microv vs (3.0 +/- 3.9) microv; r/a ratio: 0.2 +/- 0.2 vs 0.3 +/- 0.5, all P < 0.01]. The r/a ratio in the VD group showed no difference compared to that in the CS group (0.2 +/- 3.5 vs 0.2 +/- 0.2, P > 0.05). Women experienced vaginal delivery, either NVD or FD, have a higher incidence of postpartum SUI than those delivered through CS. UI during pregnancy, forceps delivery and neonatal birth weight are risk factors of postpartum SUI.

Postnatal quality of life in women after normal vaginal delivery and caesarean section

BackgroundCaesarean section might increase the incidence of surgical interventions and problems resulting from hospitalization and thus affecting quality of life in women after delivery. This study aimed to compare quality of life in women after normal delivery and caesarean section.MethodsThis was a prospective study. A sample of women with normal delivery and caesarean section from 5 health care centers in Isfahan, Iran were entered into the study. Quality of life was measured using the SF-36 at two points in time (time 1: 6 to 8 weeks after delivery; time 2: 12 to 14 weeks after delivery). Data were analyzed to compare quality of life in the two study groups.ResultsIn all 100 women were interviewed (50 with normal delivery and 50 with caesarean section). Postnatal quality of life in both groups was improved from time1 to time 2. However, comparing the mean scores between the normal and caesarean delivery groups the results showed that in general the normal vaginal delivery group had a better quality of life for almost all subscales in both assessment times. The differences were significant for vitality (mean score 62.9 vs. 54.4 P = 0.03) and mental health (mean score 75.1 vs. 66.7, P = 0.03) at first assessment and for physical functioning (mean score 88.4 vs. 81.5, P = 0.03) at second evaluation. However, comparing the findings within each group the analysis showed that the normal vaginal delivery group improved more on physical health related quality of life while the caesarean section group improved more on mental health related quality of life.ConclusionAlthough the study did not show a clear cut benefit in favor of either methods of delivery that are normal vaginal delivery or caesarean section, the findings suggest that normal vaginal delivery might lead to a better quality of life especially resulting in a superior physical health. Indeed in the absence of medical indications normal vaginal delivery might be better to be considered as the first priority in term pregnancy.

Interleukin-6 and interleukin-1 receptor antagonist in amniotic fluid and cord blood in patients with pre-term, premature rupture of the membranes

Objective: We investigated the role of interleukin (IL)-6 and IL-1 receptor antagonist (IL-1ra) in pre-term premature rupture of the membranes (PROM). Method: Amniotic fluid samples were collected from 10 patients with pre-term PROM (group 1a), 13 patients undergoing genetic amniocentesis (group 2), seven patients with normal vaginal delivery (group 3a), and 11 patients with elective cesarean section (group 4a). Umbilical venous blood was collected from nine cases of pre-term PROM (group 1b), 19 cases of normal delivery (group 3b) and nine cases of elective cesarean section (group 4b). Results: The concentration of IL-6 in the amniotic fluid in group 1a was significantly higher than in group 2 ( P<0.001), and that in group 3a was significantly higher than in group 4a ( P<0.001). The concentration of IL-1ra in amniotic fluid in group 1a was significantly higher than in group 2 ( P<0.001). The concentrations of IL-6 in umbilical venous blood were not significant among the groups. The concentration of IL-1ra in umbilical venous blood in group 1b was significantly higher than in group 3b ( P<0.05) and group 4b ( P<0.05). Conclusions: High concentrations of amniotic fluid IL-6 present in pre-term PROM, are indicative of intrauterine inflammation, probably due to sub-clinical infection. The high concentrations of IL-1ra in amniotic fluid and umbilical venous blood suggest the possibility that the presence of this anti-inflammatory cytokine serves to prevent the development of overt inflammation.

Umbilical cortisol levels as an indicator of the fetal stress response to assisted vaginal delivery

Objectives: While it is well established that delivery by elective caesarean section is less stressful for the fetus than normal vaginal delivery, little attention has been paid to the effect on the baby of an assisted delivery. Study design: We examined cortisol levels in venous cord blood from seven babies born by forceps, 10 by ventouse extraction, 28 by unassisted normal vaginal delivery, and 12 born by elective caesarean. Paired maternal bloods were taken immediately after delivery. Results: Cord blood cortisol values were significantly different in the different groups (one-way ANOVA, P<0.0001). The forceps group had the highest values and the caesarean group the lowest; both were different from the normal vaginal delivery group ( P=0.019 and P=0.046, respectively). There was no effect of length of labour, or method of pain relief on cortisol levels. Maternal values were similar in the different groups, confirming that the differences observed derived from the fetus. Conclusions: There is increasing evidence that the stress experienced by the fetus or neonate can have long-term effects on the function of the hypothalamic–pituitary–adrenal axis in later life. We speculate that the stress caused by some assisted deliveries may contribute to this.

F72Visualization of anal sphincter disruptions with transperineal three‐dimensional ultrasound following vaginal delivery in primiparous women

ObjectiveTo visualize the anal sphincter disruptions following vaginal delivery in primiparous women using 3D ultrasound to correlate damage to obstetrical factors.MethodsWe have studied prospectively 150 consecutive primiparous women. Axial and sagittal images of the anal sphincter were performed 48 h after vaginal delivery using a 7.5‐MHz convex transducer placed on the perineum (Voluson 530 D Kretz) and repeated in the 30 women with anal sphincter disruption at a median of six months post natally. Obstetrical characteristics were analysed in all cases.ResultsAnal sphincter defect and its location were detected in 30 women (20%). None of the 24 women (16%) who underwent cesarean section had a sphincter disruption even in the 10 women delivered by cesarean section in labor. Head circumference, birth weight, maternal age, the duration of each stage of labor and the duration of active pushing were not significantly related to anal sphincter disruptions after vaginal delivery. Instrumental delivery, epidural analgesia and posterolateral episiotomy were associated with a sphincter defect but the only single independent factor related to the development of sphincter defects was instrumental delivery. The 3D sonography revealed sphincter injuries in 70% of the cases in the forceps delivery group (7 of 10), 13.3% of the cases in the vacuum delivery group (2 of 15) and 9.9% of the cases in the normal vaginal delivery group (10 of 101). 12 women (8%) had anal incontinence of faecal urgency when studied two months after vaginal delivery. The anal function was not altered after cesarean section.ConclusionsTransperineal 3D ultrasound of the anal sphincter is a reliable method for evaluating the anal sphincter. It is quickly performed and well tolerated by patients. Besides forceps delivery, commonly measured delivery variables are not useful predictors of latent anal sphincter injury.

Reactive thrombocytosis after caesarean section and vaginal delivery: implications for maternal thromboembolism and its prevention.

To assess the duration and severity of reactive thrombocytosis after caesarean section and vaginal delivery. A prospective cohort study. A large teaching hospital. Women admitted for delivery at the Leicester Royal Infirmary were recruited into the study. The platelet count was measured before delivery and postnatally on days 3, 8, 12, 16, 20 and 24. Women who had antepartum haemorrhage, postpartum haemorrhage and those delivered by instrumental delivery were excluded from the study. Sixty-five were recruited, and 45 completed the study, 20 of whom were delivered by a normal vaginal delivery and 25 by caesarean section. A random effects model was used to compare platelet counts within and between the two groups to assess the severity and the timing of reactive thrombocytosis. There were no statistically significant differences in booking and pre-delivery platelet counts between the two groups (mean values 248.4 x 10(9)/L and 245 x 10(9)/L in the normal vaginal group and 269.4 x 10(9)/L and 251.6 x 10(9)/L in the caesarean section group, respectively). Postnatally, a rise in the platelet count was noted in the normal vaginal delivery group, reaching statistically significant peak values, compared with booking and pre-delivery at days 8 and 12 of the postnatal period (mean value 365.8 x 10(9)/L; P < 0.001 and 369.4 x 10(9)/L; P < 0.001 respectively). In the caesarean section group, the platelet count was raised to a statistically significant high value, compared with booking and pre-delivery at day 8 of the postnatal period. The platelet count peaked at days 12 and 16 of the postnatal period (mean value 522.5 x 10(9)/L; P < 0.0001 and 526.5 x 10(9)/L; P < 0.0001, respectively) and remained significantly higher than booking and predelivery values for 24 days after the caesarean section. There was a greater rise in the platelet count in the caesarean section group compared with the vaginal delivery group. The platelet counts in the caesarean section group were significantly higher than these in the normal vaginal delivery group from day 12 to day 24 of the postnatal period. A significant rise in platelet count occurred eight to twelve days after normal vaginal delivery and caesarean section. The increase in platelet count continued to rise for 16 days after caesarean section, and it stayed significantly higher for more than 24 days after the delivery.

Do routinely measured delivery variables predict anal sphincter outcome?

Trauma to the anal sphincter is a recognized complication of primiparous childbirth. This damage may be compounded during subsequent deliveries leading to symptoms. Earlier work is inconclusive as to which delivery variables are associated with such damage and may prove useful in predicting its occurrence, thereby allowing the potential for intervention in these later deliveries to protect the traumatized anal sphincter. The purpose of the present study was to determine whether routinely recorded obstetric variables can be correlated to anal sphincter damage in a consecutive series of females. A prospective study was undertaken in a single maternity unit. Patients delivering were assessed before discharge using a symptom questionnaire and endoanal ultrasound. Delivery data were collected prospectively and analyzed statistically to see if a significant difference existed in the presence of an anal sphincter defect. A total of 159 patients were assessed. Endosonography revealed sphincter injuries in 8.7 percent of the normal vaginal delivery group and 83 percent of the forceps delivery group. No correlation was found between head circumference, baby weight, maternal body mass index, epidurals, episiotomy, length of each stage of labor, and duration of active pushing. Forceps delivery was the only factor to be significantly associated with sphincter trauma. Besides forceps delivery, commonly measured delivery variables are not useful predictors of anal sphincter trauma. Normal vaginal deliveries do not warrant routine postnatal anorectal assessment, but this should be routine for all instrument deliveries.

Maternal height as a risk factor for Caesarean section due to failure to progress in labour.

We examined for a regional sample of the New Zealand population, the relationship between maternal height and an increased risk of emergency Caesarean section due to arrested labour, to identify a height below which the risk of Caesarean section increases markedly and to quantify the risk of a Caesarean section for a range of maternal heights. The data of nulliparous singleton pregnancies over the period 1994-1998 was sorted into 2 study groups, one resulting in emergency Caesarean section for arrested labour and the other a group of women who had normal vaginal delivery requiring no intervention. The means and standard deviations of these 2 groups were found and 99% confidence intervals calculated. They were analysed for statistical difference and then a logistical regression calculation tried to identify a height at which the risk of a Caesarean section increased suddenly. There were 81 women in the Caesarean section group and 997 in the normal vaginal delivery group. Mean heights and confidence intervals were 161.0 cm (158.9-163.1) and 164.6 cm (164.0-165.2) respectively. There was a statistically significant difference between these means (p<0.001) but logistic regression analysis showed that risk of Caesarean section increased gradually with decreasing height, and even then did not reach more than 30% risk until a height of less than 140 cm. Low maternal height was associated with increased risk of Caesarean section due to labour arrest. Because the likelihood of having a normal vaginal delivery was still very good (>80 %) at modest degrees of short stature, this risk factor alone is unlikely to affect management. However the combination of other risk factors with maternal height may be of clinical use.

Subsequent obstetric performance related to primary mode of delivery.

To relate subsequent obstetric performance with primary mode of delivery. Postal questionnaire survey of women who delivered their first child five years ago. Huddersfield Royal Infirmary. Women who were delivered of their first baby in 1991: 250 by normal vaginal delivery; 250 by instrumental vaginal delivery; and 250 by caesarean section. Answers to fixed choice questions on fear of future childbirth, number of subsequent children and reasons for no further children. The response rate was 64%. Overall, 222 (46.6%) women were initially frightened about future childbirth. According to mode of delivery: 93 (57.1%) after instrumental vaginal; 79 (47.9%) after caesarean section; and 50 (33.8%) after normal vaginal delivery. Five years after the primary delivery, 99 women (20.8%) were still frightened about future childbirth: instrumental vaginal group 41 (25.2%); caesarean section group 43 (26.1%); and normal vaginal group 15 (10.1%). In the group of women who were delivered by caesarean section 13% more women had not had a second child after five years compared with the normal vaginal delivery group ((P < 0.03, relative risk 1.46 (1.07-1.99)). In the group of women who had a vaginal instrumental delivery 6% more had not had a second child after five years compared with normal vaginal delivery group. Of the women who had no further children, 30% who had caesarean section and 28% vaginal instrumental delivery had involuntary infertility. Caesarean section or vaginal instrumental delivery leaves many mothers frightened about future childbirth. Primary caesarean section and to some extent vaginal instrumental delivery is associated with an increased risk of voluntary and involuntary infertility.