Cephalic Presentation Research Articles

Covid-19 Pandemisi Sırasında Doğum Şeklinin Robson Sınıflandırma Sistemine Göre Değerlendirilmesi

Aim: To show the change in the rates of vaginal delivery and cesarean section during the Covid-19 Pandemic in Ankara City Hospital. Materials and Method: This cross-sectional study included pregnant women who gave birth between 37 and 42 gestational weeks. Cesarean birth rates for each of the 10 Robson categories, compared between Covid-19 and before Covid-19 groups. Results: 21366 pregnant women were included in the study. The cesarean section rates were examined by dividing the patients who gave birth during covid -19 into two groups those who were infected with covid and those who were not. During the Covid-19 pandemic, women with previous CS (Robson group 5) and the nulliparous women who had spontaneous labor with a cephalic presentation at term (Robson group 1) were the most common contributors to the global CS rate, 21,68% and 6.5%, respectively regardless of being infected with Covid-19. Similarly, Robson group 5 makes the greatest contribution to the overall cesarean section rate (% 21,68) when we evaluate the patients by separating them as covid positive and covid negative. Conclusion: At the beginning of the epidemic higher rates of cesarean section are expected in the group of pregnant women with Covid-19 infection due to our limited knowledge. Although the mother's infection complicates the delivery, the timing and mode of delivery should be individualized according to the clinical condition of the pregnant woman, the week of gestation, and the condition of the fetus.

Evaluation of labor management practices during spontaneous labor

IntroductionIn 2017, the French national authority for health issued national guidelines to support physiologic labor and reduce medical interventions. This study's primary aim was to evaluate the association between the publication of these guidelines and the vaginal delivery rate in a type IIb perinatal center. The secondary objectives were to evaluate the implementation of these guidelines, their association with the duration of labor, and the rates of postpartum hemorrhage and adverse neonatal outcomes. Material and methodsA before-and-after, retrospective, single-center study comparing a "before" group (2016) and an "after" group (2018), one year after the recommendations were published. Women were eligible if they had no prior cesarean delivery and gave birth after 37 weeks of gestation to a singleton fetus in cephalic presentation after spontaneous labor. The analysis was stratified by parity. ResultsOxytocin administration decreased between the two periods (48% vs 35 %, P < 0.0001), as did the frequency of amniotomies (artificial rupture of membranes) (39.5 % vs 27.7 %, P < 0.0001). The duration of labor was significantly prolonged (360 vs 390 min, P < 0.0001), especially in nulliparous women (465 min vs 562 min, P<0.0001). The frequency of vaginal delivery rose between the two periods (94.6 % vs 96 %, P = 0.05), and the postpartum hemorrhage rate fell (6 % vs 4.5 %, P = 0.04). The numbers of neonates with an umbilical artery pH< 7.10 and of neonatal transfers also decreased. ConclusionsThe reduction of active interventions during labor is associated with a longer duration of labor and a decrease in the rates of cesarean births, postpartum hemorrhages, and neonatal transfers.

The association between obesity and the success of trial of labor after cesarean delivery (TOLAC) in women with past vaginal delivery.

To evaluate the effect of overweight (body mass index; BMI 25.0-29.9 kg/m2), and obesity (BMI>30 kg/m2), on the success of trial of labor after cesarean delivery (TOLAC), with consideration of successful past vaginal birth. This retrospective cohort study was performed using electronic database of obstetrics department at a university-affiliated tertiary medical center. All women admitted for TOLAC at 37-42 weeks of gestational age, carrying a singleton live fetus at cephalic presentation, with a single previous low segment transverse cesarean delivery between 1/2015 and 5/2021 were included. Primary outcome was the rate of cesarean delivery during labor, and subgroup analysis was performed for the presence of past vaginal birth. Of the 1200 TOLAC deliveries meeting the inclusion criteria, 61.9 % had BMI in the normal range, 24.6 % were overweight (BMI 25.0-29.9 kg/m2), and 13.4 % were obese (BMI of 30 kg/m2 and over). Using a multivariate analysis, BMI≥30 kg/m2 was associated with increased risk of cesarean delivery compared to normal weight. However, in the subgroup of 292 women with a history of successful vaginal birth BMI did not affect TOLAC success. BMI does not affect the success of TOLAC in women with previous vaginal birth. This information should be considered during patients counselling, in order to achieve a better selection of mode of delivery and higher patients' satisfaction.

Effect of screw angulation on the bending performance of polyaxial locking interfaces: a micro-CT evaluation

Polyaxial locking plates rely on a specific thread-to-thread interface of the screw head and the plate hole. The objective of this study was to evaluate the mechanical performance of single screw interfaces when inserted off-axis and to establish correlations between those parameters and the engagement of the screw head and the plate hole thread. Three polyaxial locking screw systems were inserted into the corresponding plates at various angles (0°, 5°, 10°, and 15° off-axis). The screws were tested until failure. A micro-CT was performed to examine the interface between the plate hole and the screw head. The standard insertion at 0° sustained the greatest maximum bending strength without relocation in the screw hole. Screws inserted at 15° showed a significant reduction in force of up to 44%, 55% and 57%, respectively. Micro-CT analysis of the interface showed a significant loss of thread engagement for off-axis insertion. Polyaxial plates offer additional advantages for off-axis placement of screws. However, this flexibility is related to a significant decrease in both thread engagement and bending strength compared to monoaxial insertion. Regardless the insertion angle, the loss of stability is comparable when screws are placed off-axis. Surgeons are advised to consider off-axis insertion as a salvage option, providing access to better bone stock.

Study of Childbirth with A Single Scar Uterus at the "Major Moussa Diakite" Reference Health Center in Kati, Mali

The management of childbirth in a scarred uterus is one of the most debated subjects in modern obstetrics, due to the considerable increase in caesarean section rates and many other risks of complication such as disunion of the old scar. Objective: To study childbirth with a single scar uterus at the Kati Reference Health Center. Method: This was a prospective cross-sectional study, which ran from 1 January to 31 December 2021. It focused on parturients with a single myometrial scar, a vertex presentation of the foetus, a clinically normal pelvis, a uterine height of less than 36 centimeters, a single foetal pregnancy and an intergenesic interval of more than one year. Results: Out of a total of 2521 deliveries, seventy (70) women met the criteria of our study, or a frequency of 28%. The average age of parturients was 30, with extremes ranging from 18 to 42. Only 20% of our parturients had completed four antenatal consultations. They were carried out in 78.5% of cases by qualified staff. Eight out of ten of our parturients (81.4%) came on their own, and in seven out of ten cases (70.0%) in the active phase of childbirth. Delivery was by natural route in almost seven out of ten cases (65.7%), compared with caesarean section in 34.3% of cases. The indications for caesarean section were dominated by dynamic dystocia (66.7%), followed by failure to engage (12.5%), acute foetal distress (12.5%) and umbilical cord prolapse (8.3%). Previous vaginal delivery prior to caesarean section was associated with a successful uterine test (P=0.019). Maternal complications were haemorrhage due to uterine atony (1 case) and disunion of the old caesarean scar (1 case). We recorded two macerated stillbirths and one case of early neonatal death linked to extreme prematurity, and six cases of neonatal suffering. Conclusion: Childbirth in a scar uterus is a high-risk delivery, and strict adherence to the conditions under which it is carried out is essential to improve the maternal and ....

Prevention of obstetric anal sphincter injuries with perineal support and lateral episiotomy: A historical cohort study.

There are many risk factors for obstetric anal sphincter injury (OASIS) and the interaction between these risk factors is complex and understudied. The many observational studies that have shown a reduction of OASIS rates after implementation of perineal support have short follow-up time. We aimed to study the effect of integration of active perineal support and lateral episiotomy on OASIS rates over a 15-year period and to study interactions between risk factors known before delivery. We performed a historical cohort study over the periods 1999-2006 and 2007-2021 at Stavanger University Hospital, Norway. The main outcome was OASIS rates. Women without a previous cesarean section and a live singleton fetus in cephalic presentation at term were eligible. The department implemented in 2007 the Finnish concept of active perineal protection, which includes support of perineum, control of fetal expulsion, good communication with the mother and observation of perineal stretching. The practice of mediolateral episiotomy was replaced with lateral episiotomy when indicated. We analyzed the OASIS rates in groups with and without episiotomy stratified for delivery mode, fetal position at delivery and for parity, and adjusted for possible confounders (maternal age, gestational age, oxytocin augmentation and epidural analgesia). We observed a long-lasting reduction in OASIS rates from 4.9% to 1.9% and an increase in episiotomy rates from 14.4% to 21.8%. Lateral episiotomy was associated with lower OASIS rates in nulliparous women with instrumental vaginal deliveries and occiput anterior (OA) position; 3.4% vs 10.1% (OR 0.31; 95% CI: 0.24-0.40) and 6.1 vs 13.9% (OR 0.40; 95% CI: 0.19-0.82) in women with occiput posterior (OP) position. Lateral episiotomy was also associated with lower OASIS rates in nulliparous women with spontaneous deliveries and OA position; 2.1% vs 3.2% (OR 0.62; 95% CI: 0.49-0.80). The possible confounders had little confounding effects on the risk of OASIS in groups with and without episiotomy. We observed a long-lasting reduction in OASIS rates after implementation of preventive procedures. Lateral episiotomy was associated with lower OASIS rates in nulliparous women with an instrumental delivery. Special attention should be paid to deliveries with persistent OP position.

Asuhan Kebidanan Komprehensif Pada Ny. F Umur 26 Tahun G2p0a1 Presentasi Bokong Dengan Persalinan Sectio Caesarea Di Wilayah Kerja Puskesmas Bumiayu Kabupaten Brebes Tahun 2023

Breech presentation is a pregnancy with an elongated position og the baby where the fetal head is in the fundus and the buttocks are the lowest part of the fetus and most fetuses can carry out a spontaneous version of cephalic presentation at term. Pregnancies with breech presentation with a total of 229 people (Indonesia health profile, 2020). Based in the results of pregnancy, childbirth, newborn, postpartum and family planning care, there was only a problem during the first pregnancy visit at 34 weeks of gestation, namely breech presentation. The researcher implemented comprehensive midwifery care using Varney dan SOAP documentation. This research aims to enable pregnant women to know and understand the location, prevention and treatment. This research uses a qualititave descriptive method with a case study approach. Data collection uses interview methods, observation, physical examination, supporting examinations, medical records, KIA books and other literature. Conclusions in the research can be concluded that health research can broaden the knowledge of pregnant women and can also understand the importance of the dangers of breech presentation delivery.

Internal manual rotation in intrapartal arrest of fetal head engagement

ObjectiveThe success of internal manual or digital rotation of the head in mechanical dystocia due to malpresentation, malposition or malrotation is presented in this paper on our own clinical material with reference of today's research and clinical recommendations. Study designThrough a retrospective bicentric clinical study, we investigated the success of internal head rotation in two University Clinics for gynecology and obstetrics from year 2017 to 2023. In 152 singleton term (37–42 weeks) in cases of persistens intrapartum arrest of the fetal head. After palpatory and ultrasonographically verified arrest of fetal head engagement, a therapeutic manual (Liepmann) or digital rotation was performed. ResultsIn 152 cases, manual rotation was performed in 108 (71.05 %) and digital rotation in 44 (28.94 %) cases in 73 (48.02 %) primiparous and 79 (51.97 %) multiparous. Intrapartum identification by digital palpation was done in all cases, and the following are: persistent occipital posterior position in 68 (44.73%), persistent deep transverse head presentation in 12 (7.89%), persistent high (longitudinal) occipital presentation in 64 (42.10 %) and persistent anterior asynclitism in 8 (5.26 %) cases. Episiotomy was used in 36 (23.68%) cases. Vacuum extraction was completed in 14 (9.21 %) deliveries, and cesarean section due to unsuccessful internal rotation in 15 (9.8 %) cases (%) without other indication. We did not record any intrapartum complications or cardiotocographic abnormalities. Cervical lacerations were treated with sutures in 4 cases (2.63 %). Successful correction of internal rotation procedure with spontaneous vaginal delivery was found in 80.92 % of cases. If we exclude delivery assisted by vacuum extraction whose indications were fetal hypoxia or dystocia after successful internal head rotation procedure, then the success rate of this method was 90.13 %. ConclusionInternal head rotation is a simple, safe and successful obstetric manual intervention that directly increases the rate of vaginal deliveries after correction of the birth mechanism anomaly and directly reduces the percentage of cesarean section. Manual or digital head rotation is an established midwifery/obstetric skill in several centers which, based on numerous clinical researches and experience, should become protocolized and included in the guidelines of professional associations.

Variations over time in mode of birth and perinatal outcomes in women with one previous cesarean in the Netherlands: A 20-year population-based study.

Globally, cesarean birth rates are rising, and while it can be a lifesaving procedure, cesarean birth is also associated with increased maternal and perinatal risks. This study aims to describe changes over time about the mode of birth and perinatal outcomes in second-pregnancy women with one previous cesarean birth in the Netherlands over the past 20 years. We conducted a nationwide, population-based study using the Dutch perinatal registry. The mode of birth (intended vaginal birth after cesarean (VBAC) compared with planned cesarean birth) was assessed in all women with one previous cesarean birth and no prior vaginal birth who gave birth to a term singleton in cephalic presentation between 2000 and 2019 in the Netherlands (n = 143,146). The reported outcomes include the trend of intended VBAC, VBAC success rate, and adverse perinatal outcomes (perinatal mortality up to 7 days, low Apgar score at 5 min, asphyxia, and neonatal intensive care unit admission ≥24 h). Intended VBAC decreased by 21.5% in women with one previous cesarean birth and no prior vaginal birth, from 77.2% in 2000 to 55.7% in 2019, with a marked deceleration from 2009 onwards. The VBAC success rate dropped gradually, from 71.0% to 65.3%, across the same time period. Overall, the cesarean birth rate (planned and unplanned) increased from 45.2% to 63.6%. Adverse perinatal outcomes were higher in women intending VBAC compared with those planning a cesarean birth. Perinatal mortality initially decreased but remained stable from 2009 onwards, with only minimal differences between both modes of birth. In the Netherlands, the proportion of women intending VBAC after one previous cesarean birth and no prior vaginal birth has decreased markedly. Particularly from 2009 onwards, this decrease was not accompanied by a synchronous reduction in perinatal mortality.

Retrospective Analysis of Pregnancy Outcomes Following External Cephalic Version for Breech Presentation.

We explored the feasibility and safety of external cephalic version (ECV) for cases of breech presentation. We retrospectively analyzed data from 158 singleton pregnant women with breech presentation at 36 weeks gestation, admitted to Guangzhou Hospital of Integrated Traditional and Western Medicine from January 2018 to March 2022. 42 underwent ECV, categorized as the ECV group, while 116 without ECV comprised the control group. Systematic collection and evaluation of pregnancy outcomes were conducted for both groups. Within the control group, 16 cases experienced a spontaneous transition to head presentation, among which 14 cases resulted in successful vaginal deliveries. In 2 cases, cesarean deliveries were performed due to fetal macrosomia and persistent posterior occipital presentation. Furthermore, 2 cases of breech presentation in pregnant women were successfully delivered vaginally through breech traction, necessitating an emergency procedure due to the wide opening of the uterus. Within the ECV group, 28 cases were successfully inverted to the cephalic presentation. Among them, 1 case underwent an emergency cesarean delivery due to fetal distress during cephalic delivery, 3 cases required cesarean deliveries due to abnormal labor, and 24 cases were successfully delivered vaginally. The comparative analyses showed that the cesarean section rate (18/42 vs 100/116) and non-cephalic delivery rate (14/42 vs 100/116) in the ECV group were significantly lower than those in the control group (P < 0.001). There was no statistically significant differences between the two groups with respect to the rate of newborns with Apgar score < 7 (1/42 vs 3/116), premature rupture of membrane (3/42 vs 20/116), acute fetal distress (2/42 vs 2/116), and cord prolapse (0/42 vs 1/116) (P > 0.05). ECV can effectively reduce the rate of cesarean delivery and non-cephalic deliveries. However, it but requires strict adherence to indications and continuous monitoring.

Comparing adverse maternal and perinatal outcomes in primary caesarean delivery during first versus second-stage of labour in Kenya: An institution-based cohort study.

As caesarean delivery rates continue to increase globally, so are the number of second-stage caesarean deliveries. Second-stage caesareans may carry additional risk of complications for both the mother and fetus owing to fetal head impaction into the maternal pelvis and manipulations required for delivery. So far, data on this procedure's outcomes from low resource countries are limited. To compare adverse maternal and perinatal outcomes between second-stage and first-stage of labour intrapartum primary caesarean deliveries over 12 months at a tertiary referral obstetric hospital in Kenya. In a hospital-based cohort study, 222 women with singleton, cephalic presenting fetuses at term gestation who had intrapartum primary caesarean delivery during active labour were recruited post-partum. Second-stage caesarean deliveries (73) were compared to 149 first-stage caesarean deliveries. The proportion of caesarean deliveries in the second-stage of labour was estimated and the adverse maternal and perinatal outcomes were compared. The study was conducted from August 2021 to July 2022 at the Moi Teaching and Referral Hospital, Eldoret. The proportion of second-stage caesarean deliveries among intrapartum primary caesarean deliveries was 4.3% [95% CI: 2.9% - 4.7%]. Compared to first-stage caesarean deliveries, second-stage caesarean deliveries had a significantly higher risk of adverse maternal outcomes (RR 3.272, 95% CI 2.28-4.71, P < 0.001), including intraoperative trauma, atony, blood transfusion, and a postoperative hospital stay of more than three days. Additionally, there was a higher risk of adverse perinatal outcomes (RR 2.748, 95% CI 2.45-4.50, P < 0.001), including increased risk of a 5-min APGAR ≤3, admission to NBU, and neonatal death. An increased risk of adverse maternal and perinatal outcomes is associated with primary second-stage caesarean deliveries compared to primary first-stage caesarean deliveries.

Comparison of the Efficacy and Safety of Sublingual Versus Oral Misoprostol for the Induction of Labor: A Randomized Open-Label Study.

Introduction Misoprostol (prostaglandin E1 analog) is being used for the induction of labor by vaginal, oral, and sublingual routes. Oral misoprostol is the preferred route for induction of labor, but the use of sublingual misoprostol appears promising due to a faster onset of action. This study was done to compare the efficacy and safety of oral and sublingual misoprostol for induction of labor in term pregnancy. Materials and methods One hundred and sixty patients were randomly allocated to one of the two groups to receive 50 micrograms oforal and sublingual misoprostol four hourly for a maximum of six doses. Primigravida at 37-42 weeks of gestation with singleton pregnancy, cephalic presentation, Bishop score (<5), and reassuring fetal heart rate were included in the study. Misoprostol dose was withheldif the active phase of labor was reached or if the cervixwas favorable for amniotomy (Bishop score greater than or equal to eight). The change in the Bishop score with misoprostol was studied along with adverse effects and neonatal outcomes. Results The mean number of 50 mcg misoprostol doses required was significantly less in the sublingual group (2.94±0.97 versus 2.13±0.92; p<0.0001). The rate of change of the mean Bishop score was faster in the sublingual group. After four hours of the first dose, the mean Bishop score changed to 3.52±2.14 versus 4.68±2.34 (p=0.001), and, similarly, after eight hours, it was 10.48±2.59 versus 11.39±2.06, and this difference was statistically significant (p=0.015). The mean induction delivery interval was significantly lower in the sublingual group. The need for labor augmentation, mode of delivery, andadverse effects were similar in both groups. The incidence of meconium-stained liquor and NICU admission was also similar in both groups. Conclusion Sublingmisoprostolstol has a short induction delivery interval and comparable side effects when compared to omisoprostolstol. Sublingmisoprostolstol is recommended for induction of labor at term.

An Externally Validated Model to Predict Prolonged Induction of Labor with an Unfavorable Cervix.

To develop and externally validate a prediction model to calculate the likelihood of prolonged induction of labor (induction start to delivery time > 36 hours). This was a retrospective cohort study of all nulliparous women with singleton pregnancies and vertex presentation at term who underwent induction of labor and had a vaginal delivery at a single academic center. Women with contraindications for vaginal delivery were excluded. Analyses were limited to women with unfavorable cervix (both simplified Bishop score [dilation, station, and effacement: range 0-9] <6 and cervical dilation <3 cm). Prolonged induction of labor was defined as the duration of induction (induction start time to delivery) longer than 36 hours. A backward stepwise logistic regression analysis was used to identify the factors associated with prolonged induction of labor by considering maternal characteristics and comorbidities as well as fetal conditions. The final model was validated using an external dataset of the Consortium on Safe Labor after applying the same inclusion and exclusion criteria. We developed a receiver observer characteristic curve with area under the curve (AUC) in validation cohorts. Of 2,118 women, 364 (17%) had prolonged induction of labor. Factors associated with prolonged induction of labor included body mass index at admission, hypertension, fetal conditions, and epidural. Factors including younger maternal age, prelabor rupture of membranes, and a more favorable simplified Bishop score were associated with a decreased likelihood of prolonged induction of labor. In the external validation cohort, 4,418 women were analyzed, of whom 188 (4%) had prolonged induction of labor. The AUC of the final model was 0.76 (95% confidence interval: 0.73-0.80) for the external validation cohort. The online calculator was created and is available at: https://medstarapps.org/obstetricriskcalculator. Our externally validated model was efficient in predicting prolonged induction of labor with an unfavorable cervix. · The number of inductions of labor at 39 weeks' gestation and beyond has been increasing.. · Our model had a good prediction of prolonged induction of labor.. · An online calculator has been created and available..

Caesarean section rate reduced by a redesigned birthing room. Results of a quality improvement intervention at a hospital in Democratic Republic of Congo

ObjectiveTo evaluate the influence of a new birthing room at a tertiary hospital in eastern Democratic Republic of Congo (DRC), on the caesarean section (CS) rate in women classified as Robson group 1, i.e., nulliparous women at term with spontaneous onset of labour of one foetus in cephalic presentation. MethodAs part of quality improvement interventions, a new birthing room designed to promote person-centredness was constructed at the labour ward at Panzi General Referral Hospital in DRC. In a quasi-experimental study on women classified as Robson 1, a comparison was performed between the group being cared for in the new birthing room and the group being cared for in the general birthing room. The main outcome measure was CS rate. ResultsIn the new person-centred birthing room, the CS rate was 17.1 % versus 28.4 % in women cared for in the general birthing room (p-value 0.001). There was also a higher presence of accompanying persons (p-value < 0.0001) and less use of synthetic oxytocin for the augmentation of labour (p-value 0.024). No difference in fear and childbirth experience was identified between women in the two rooms. ConclusionThe results demonstrate that it is possible, in a low-income country as the Democratic Republic of Congo, to reduce the CS rate in women classified as Robson 1 by adapting the birthing environment to be more person-centred, without compromising other obstetric and neonatal outcomes.

Comparaison des prostaglandines vaginales au misoprostol oral en 2e ligne de maturation cervicale après recours à un ballonnet de dilatation cervicale

ObjectiveTo compare vaginal prostaglandins with oral misoprostol as a second line of cervical ripening after using a cervical balloon catheter. Material and methodsThis is a retrospective monocentric study (Lille, France), according to a “before”/“after” design. The inclusion criteria were a singleton pregnancy, with a fetus in cephalic presentation, a term >37 WA, with a cervix having a Bishop score lower than 6 after a first line of maturation by cervical balloon catheter. Two groups were formed: “before” corresponding to the continuation of maturation by vaginal prostaglandins, from March 2019 to November 2019, and “after”: corresponding to the continuation of maturation by oral misoprostol, from June 2020 to December 2020. The primary outcome was vaginal delivery rate. ResultsOne hundred women were included in each group. The rate of vaginal delivery was similar between the 2 groups (76% vs 81%, p=0.39), as were the times between the start of induction and the birth and between the start of induction and the transition to birth room. There was no difference in the indication for caesarean section, with in particular an identical rate of caesarean sections for induction failure (p=0.52). Subgroup analysis in obese women showed a significantly higher rate of vaginal delivery in the “after” group (OR=4.17;95% CI [1.02;17.07]). ConclusionThe vaginal delivery rate is similar when using vaginal prostaglandins or oral misoprostol as second line cervical ripening after use of a cervical balloon catheter.

The influence of epidural anesthesia in pregnancies with scheduled vaginal breech delivery at term: a hospital-based retrospective analysis

IntroductionEpidural anesthesia is a well-established procedure in obstetrics for pain relief in labor and has been well researched as it comes to cephalic presentation. However, in vaginal intended breech delivery less research has addressed the influence of epidural anesthesia. The Greentop guideline on breech delivery states that there’s little evidence and recommends further evaluation.ObjectiveThe aim of this study was to compare maternal and neonatal outcomes in vaginally intended breech deliveries at term with and without an epidural anesthesia.DesignThis study was a retrospective cohort study.SampleThis study included 2122 women at term with a singleton breech pregnancy from 37 + 0 weeks of pregnancy on and a birth weight of at least 2500 g at the obstetric department of University hospital Frankfurt from January 2007 to December 2018.MethodsNeonatal and maternal outcome was analyzed and compared between women receiving “walking” epidural anesthesia and women without an epidural anesthesia.ResultsFetal morbidity, measured with a modified PREMODA score, showed no significant difference between deliveries with (2.96%) or without (1.79%; p = 0.168) an epidural anesthesia. Cesarean delivery rates were significantly higher in deliveries with an epidural (35 vs. 26.2%, p = 0.0003), but after exclusion of multiparous women, cesarean delivery rates were not significantly different (40.2% cesarean deliveries with an epidural vs. 41.5%, p = 0.717). As compared to no epidurals, epidural anesthesia in vaginal delivery was associated with a significantly higher rate of manual assistance (33.8 versus 52.1%) and a longer duration of birth (223.7 ± 194 versus 516.2 ± 310 min) (both p < 0.0001)".ConclusionEpidural anesthesia can be offered as a safe option for pain relief without increasing neonatal or maternal morbidity and mortality. Nevertheless, it is associated with a longer birth duration and manually assisted delivery.

To study the clinical utility of WHO modified and paperless partograph in the management of labour and its outcome

Early detection of abnormal progress of labour and prevention of prolonged labour significantly improves pregnancy outcomes. Partograph is a simple and important tool which can provide a continuous pictorial overview of labour on a single sheet of paper and is essential to monitor labour. (1) To study the progress of labour using WHO modified partograph in terms of alert line and action line and using paperless partograph in terms of alert and action estimated time of delivery and detect any deviation from normal progress of labour. (2) To evaluate the duration of labour, mode of delivery and perinatal outcome in both the groups.It was a prospective observational study which was conducted over a period of 18months on 200 antenatal patients admitted to the Department of Obstetrics and Gynaecology at Christian Medical College and Hospital, Ludhiana. Antenatal patients with singleton term pregnancy with cephalic presentation in active phase of labour were included in the study. The WHO modified partograph was plotted for 100 cases (Group I) and the paperless partograph was recorded for the other group of 100 patients (Group II) and their outcomes were compared. The p value &amp;#60;0.05 was considered to be significant.In our study we noted that the findings were similar in the WHO modified partograph group and the paperless partograph group in terms of duration of labour, progress of labour, mode of delivery and neonatal outcomes with no statistically significant difference between both the groups.Our study concluded that the paperless partograph is as good as the WHO modified partograph in predicting the labour outcomes and identifying labour abnormalities. The paperless partograph does not need graphical representation and therefore can be adopted as an alternative to the WHO modified partograph in busy labour room settings.

Influence factor analysis and prediction model of successful application of high-volume Foley Catheter for labor induction

BackgroundThis study aimed to establish a clinical-based nomogram for predicting the success rate of high-volume Foley catheterization for labor induction.MethodsThis retrospective study included 1149 full-term pregnant women who received high-volume Foley catheterization for labor induction from January 2019 to December 2021 in Changshu No.1 People’s Hospital. Univariate and multivariate logistic regression analyses were performed, in which the labor induction success was set as dependent variables and the characteristics (including age, height, weight, BMI, gravidity, parity, gestational age, uterine height, abdominal circumference, cervical Bishop score, amniotic fluid index, cephalic presentation, neonatal weight, pregnancy complications, etc.) were set as independent variables. A nomogram scoring model was established based on these risk factors, and a calibration curve was plotted to verify the predictive accuracy of the model.ResultsThe success rate of labor induction was 83.55% (960/1149). Univariate analysis revealed that the risk factors associated with the success rate of high-volume Foley catheterization for labor induction were height, pregnancy, birth, age, weight, BMI, uterine height, abdominal circumference, and hypertension. Multivariate logistic regression analysis showed that age (OR = 0.950; 95% CI: 0.904 ~ 0.998), height (OR = 1.062; 95% CI: 1.026 ~ 1.100), BMI (OR = 0.871; 95% CI: 0.831 ~ 0.913), and parity (OR = 8.007; 95% CI: 4.483 ~ 14.303) were independent risk factors for labor induction success by high-volume Foley catheterization. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve in the prediction model was 0.752 (95% CI 0.716 ~ 0.788). A nomogram was constructed based on the final multivariate analysis with a corrected C-index of 0.748, which indicated that the model was calibrated reasonably.ConclusionFour risk factors were used to construct a nomogram to evaluate the success rate of high-volume Foley catheterization for labor induction. The nomogram provides a visual clinical tool to assist in the selection of the most appropriate mode of labor induction for pregnant women of different risk levels.

Role of Stanya Shodhana Mahakashya in the treatment of Stanyadushti - A Case Report

Background: Breast milk is a prime source of nourishment and immunity of the baby. The concept of “Stanya Dushti” refers to the impact of diet and activities of a mother on quantity and quality. Sushruta describe that the pure milk is cold, clean or free from impurities, whitish yellow or white free from discoloration. If Stanya exhibits abnormalities in its color, smell, taste it will be impure and may be referred to as Dushta. This Stanya can’t provide nourishment and good health to child. Methodology: A 34 years old second gravida patient deliver an alive full term male child of weight 2.82 Kg. extracted as vertex presentation on 19/4/2023 by caesarian section. During breast feeding, she noticed that her milk was blackish in color and her child regurgitate this milk just after feeding, so she stopped breast feeding. On her complaint breast milk culture was advised which was found normal. She was treated with Stanya Shodhanagana Kashya for 3 days in the 20 ml dose BD. Result: Her breast milk appeared white only after 3 days of treatment and baby has not regurgitated milk again. Discussion &amp; Conclusion: Stanya Shodhana Mahakashya includes 10 herbs - Patha, Shunthi, Devdaru, Musta, Murva, Guduchi, Vatsakphal, Kiratatikta, Katurohini &amp; Sariva. Mainly its contents possess Tikta, Katu Rasa which has Deepana Pachan properties thus help in proper function of Agni &amp; facilitate proper Ahara Pachan Kriya. Proper Utpatti of Rasadi Dhatu facilitates adequate Utpatti of Updhatu Stanya. So, it can be concluded that Stanya Shodhanagana Kashya is beneficial in improving the quality of breast milk as its name suggests.

Regulated Expiratory Methods During Childbirth Process: A Randomized Controlled Trial

ObjectivesTo evaluate the impact of a regulated expiratory method (REM) on the childbirth process. MethodsThis was a randomized trial. Study population included all first-time mothers with a spontaneous onset of labour, at an early stage, and a fetus in cephalic presentation with a normal weight for gestational age. The evaluated intervention was REM based on the use of a specific device. The primary outcome was the cesarean delivery rate. Secondary outcomes included first and second stages of labour times, rates of spontaneous and instrumental vaginal births, and pain scores. Subjective qualitative outcomes related to childbirth experience were evaluated via 2 interviews conducted with the parturient and the midwife responsible for her delivery. Intention-to-treat analysis was employed to compare the 2 groups. ResultsThe reduction in primary cesarean rates between the 2 groups was not significant (26.7% in control group vs. 18.3% in intervention group; P = 0.274). However, REM allowed for a significant reduction in second stage (P = 0.039) and pushing effort times (P = 0.003). According to midwives, REM had a significant positive impact on parturients’ breathing (P < 0.0001) and pushing effort intensity (P = 0.041). It facilitated communication with the parturient (P = 0.002). Moreover, the evaluated method had a significant positive impact on patient's childbirth experience. ConclusionsAlthough the reduction in immediate cesarean rates was not significant, REM has the potential to shorten labour duration, improve pain management, and ultimately improve maternal childbirth experience.