Prolonged Second Stage Of Labor Research Articles

Demographic Disparities in Brachial Plexus Birth Injury [ID 2683383

INTRODUCTION: Black and Hispanic birthing individuals are at increased risk of delivering an infant with a brachial plexus birth injury (BPBI), but the reasons for these disparities are unclear. We evaluated the association of maternal race/ethnicity with established and suspected risk factors for BPBI to determine if these factors mediate these disparities. METHODS: Institutional review board approval was obtained for this retrospective cohort study of all live births occurring in California-licensed hospitals from 1996 to 2012. Multiple logistic regression was used to model adjusted associations of maternal race and ethnicity with an infant born with BPBI. Causal mediation analyses evaluated established and suspected risk factors for BPBI (obesity, diabetes, gestational diabetes, shoulder dystocia, macrosomia, prolonged second stage of labor, gestational age, post-term, vaginal delivery, insurance status, inadequate prenatal care) as potential mediators of the BPBI–maternal race/ethnicity relationship. RESULTS: The cohort included 6,278,562 births, with 7,762 BPBI. Although Black birthing individuals had an increased risk of obesity (adjusted odds ratio [aOR] 2.48) and diabetes (aOR 1.59) compared to non-Blacks, they had a lower risk of shoulder dystocia (aOR 0.76), macrosomia (aOR 0.60), prolonged second-stage labor (aOR 0.33), precipitous labor (aOR 0.88), and vaginal delivery (aOR 0.79). Blacks had an increased risk of inadequate prenatal care (aOR 1.26) and being underinsured (aOR 1.30). The combination of these factors explained only 16.3% of the increased risk for BPBI in Black people. Findings were similar in Hispanic individuals. CONCLUSION: The increased risk of BPBI in Black and Hispanic individuals is only modestly explained by known risk factors. Prenatal care utilization and socioeconomic factors may play a role.

Risk factors of neonatal stroke from different origins: a systematic review and meta-analysis.

This study provides a succinct overview and comparative analysis of maternal, perinatal, and additional risk factors associated with neonatal cerebral artery ischemic stroke and neonatal hemorrhagic stroke, furnishing critical insights for healthcare practitioners involved in the diagnosis and prevention of neonatal stroke. This research also broadens the conceptual framework for future investigations. • Research indicates that prenatal, perinatal, and neonatal risk factors can elevate the risk of neonatal arterial ischemic stroke (NAIS). However, the risk factors for neonatal cerebral arterial ischemic stroke remain contentious, and those for neonatal hemorrhagic stroke (NHS) and neonatal cerebral venous sinus thrombosis (CVST) are still not well-defined. • This study is the inaugural comprehensive review and meta-analysis encompassing 19 studies that explore maternal, perinatal, and various risk factors linked to neonatal stroke of differing etiologies. Notably, our analysis elucidates eight risk factors associated with NAIS: gestational diabetes mellitus, a history of infertility, placenta previa, postdates, preterm birth, premature rupture of membranes, a prolonged second stage of labor, and chorioamnionitis. Furthermore, we identify six risk factors correlated with NHS: postdates, preterm birth, an abnormal CTG, the method of delivery, male gender, and vaginal delivery. Additionally, our systematic review delineates risk factors associated with CVST.

Effect of type III female genital mutilation on obstetric outcomes: A systematic review and meta-analysis

BackgroundControversial evidence suggests a potential association between female genital mutilation (FGM/C) and adverse obstetric outcomes, with type III FGM/C (infibulation) carrying the greatest risk. The aim of this systematic review and meta-analysis was to assess current rate of adverse obstetric outcomes in women with type III female genital mutilation and cutting (FGM/C; infibulation) delivering across different settings worldwide. MethodsWe searched PubMed, Scopus, Embase, and ClinicalTrials.gov databases from inception to Jan 1, 2023. Studies were selected if they included the main outcome of postpartum haemorrhage (PPH) or secondary outcomes, which included major conditions affecting maternal-neonatal health during labour and delivery. DerSimonian-Laird random effects meta-analysis including pooled effect estimates with corresponding 95 % confidence intervals was performed. Heterogeneity was assessed using the I2 statistic. Meta regression for relevant covariates was performed when data on relevant confounders were available. The Newcastle-Ottawa scale (NOS) was used to assess quality of observational studies. The level of evidence was assessed with the GRADE method. Results14 observational studies including 15,320 type III FGM/C women and 59,347 controls were eligible. The risk for postpartum haemorrhage was significantly increased in type III FGM/C, in the main analysis (OR 1.83, 95 % CI 1.03 to 3.24, I2 = 93 %), in pooling of data adjusted for confounders (aOR 1.76, CI 1.42 to 2.17, I2 = 0 %), and in sensitivity analysis of higher quality studies with NOS≥7 (OR 2.76, CI 1.38 to 5.51, I2 = 95 %). Meta-regression showed that nulliparity was significantly and positively associated with postpartum haemorrhage. Similarly, analysis of data adjusted for confounders showed an increased risk of episiotomy in type III FGM/C (aOR 1.56, CI 1.03 to 2.35, I2 = 52 %). Sensitivity analysis of studies with NOS≥7 revealed a significant increase for episiotomy (OR 7.53, CI 1.19 to 47.54, I2 = 96 %), perineal tears (OR 4.24, CI 1.09 to 16.46, I2 = 66 %), prolonged second stage of labour (OR 5.19, 95 % CI 1.00 to 26.85, I2 = 66 %), and Apgar score less than 7 (OR 4.19, CI 1.64 to 10.70, I2 = 0 %). No difference was found regarding obstetric anal sphincter injuries and mode of delivery in these women. Deinfibulation achieved similar obstetric and neonatal outcomes to women who never had type III FGM. The overall quality of the studies was adequate (median NOS score: 7; IQR: 6–8), the level of evidence, according to the GRADE assessment, was low. ConclusionsThese results consistently show an increased risk of adverse obstetric outcomes in women with FGM/C type III. Infibulation substantially increases the risk for PPH, particularly in nulliparae. Systematic Review registration: PROSPERO CRD42023421993.

Retrospective Case-Control Study of Extended Birth Perineal Tears and Risk Factors.

A perineal tear is a rupture of the skin or muscle between the vagina and anus (perineum). A third-degree tear is one type of extended perineal tear (EPT), and it involves the penetration of the anal sphincter muscle.Another type of EPT is a fourth-degree laceration, which penetrates deeper into the lining of the anus or rectum. The stretching of the perineum during childbirth may result in perineal trauma. Invasive surgical interventions are required for the treatment of EPTs.For this reason, the reduction of their incidence can be achieved by fully comprehending the risk aspects associated with them. The aim of this study is to contribute to the body of knowledge by providing insight into the various risk factors that are associated with extended perineal trauma.By following this path, this study aims to contribute to and advance Saudi Arabia's development of evidence-oriented obstetric care recommendations. The current study is a case-control study where a review of 5000 vaginal delivery records was carried out between March 1, 2018, and March 19, 2023. For the study, cases (n = 71) were female patients who had documented greater than second-degree perineal injury.The control group (n = 238) was randomly chosen from women who had vaginal delivery but with less or equal to a second-degree perineal laceration. For each patient, we reviewed medical and obstetrics records for the following characteristics: age of diagnosis, gestational age, parity, labor induction, second-stage labor duration, mode of delivery, infant birth weight, epidural use and episiotomy indication, healthcare worker (HCW) experience,and APGAR (appearance, pulse, grimace, activity, and respiration) score. From the 5000 births analyzed, the cases were 71 patients (1.42% of 5000 births).The mean age at diagnosis in our sample was (28.05 ± 4.66 years).The study's results showed that the following variables significantly affected the occurrence of EPTs: birth weight, labor durations, parity, HCW experience, and mode of delivery.The odds for tears were 3.69 (95% CI: 0.156-0.469) higher in nulliparous patients relative to multiparous patients. Instrumental deliveries resulted in more tears than non-instrumental deliveries with an odds ratio (OR) of 5.901 (95% CI: 2.443-14.525). This study also found that prolonged second-stage labor seems to be associated with an increased risk of perineal damage. HCW experience was looked at in relation to the increased incidence of EPTs, which showed that midwives had a lower incidence rate than physicians with an ORof 2.25 (95% CI: 1.169-4.366). Epidural usage has also been significantly associated with a lesser incidence of perineal tears, which indicates that using epidural could protect against the occurrence of EPTs. In conclusion,the occurrence of perineal lacerations could be prevented during childbirth by taking preventative measures and having more precise judgments. Epidural was a protective factor in our study against the incidence of extensive perineal tearing.Furthermore, as compared to midwives, our study showed that the majority of EPTS occurred in cases of physicians (residents/consultants). Further research, proper documentation, and the development of evidence-based guidelines are needed to improve perineal care and reduce EPTincidence.

Immediate postpartum anemia and associated factors at shewarobit health facilities, Amhara, Ethiopia, 2022: a cross sectional study

BackgroundImmediate postpartum anemia occurs when the amount of red blood cell count is reduced or hemoglobin concentration is below 10 g/dl in the immediate postpartum. It occurs primarily due to inadequate iron intake before and during pregnancy and blood loss during delivery. The aim of this study is to assess the proportion of immediate postpartum anemia and associated factors among mothers who gave birth at Shewarobit health facilities; in Amhara, Ethiopia.MethodsInstitutional-based cross-sectional study was conducted from June to September 2022. A systematic random sampling method was employed to select the study participants. The data were collected through interviewer-assisted questions. Data were entered into Epi Data software version 4.6.0.4 and exported to SPSS 21 for analysis, and descriptive statistics were computed. Logistic regression was applied, and P-values less than 0.05 were considered statistically significant.ResultsThis study was conducted among 307 study participants and, the proportion of immediate postpartum anemia was 41.4% [95% CI: 36.7–46.6]. Having postpartum hemorrhage [AOR = 4.76, 95% CI: 2.44–9.28], not taking iron and folic acid supplementation [AOR = 6.19, 95% CI: 2.69, 14.22], having a prolonged second stage of labor [AOR = 2.52, 95% CI: 1.16–5.44], and mid-upper arm circumference < 23 cm [AOR = 2.02, 95% CI: 1.11–3.68] were factors significantly associated with immediate postpartum anemia.ConclusionsThe proportion of immediate postpartum anemia was public problem in Shewarobit health facilities. Following the progress of labor using a partograph, closely monitoring and immediate intervention of PPH, and prevent undernutrition during antenatal care is recommended.

Pelvic floor dysfunction after intervention, compared with expectant management, in prolonged second stage of labour: A population-based questionnaire and cohort study.

To investigate the effect of vacuum extraction (VE) or caesarean section (CS), compared with expectant management, on pelvic floor dysfunction (PFD) 1-2 years postpartum in primiparous women with a prolonged second stage of labour. A population-based questionnaire and cohort study. Stockholm, Sweden. A cohort of 1302 primiparous women with a second stage duration of ≥3 h, delivering from December 2017 to November 2018. The 1-year follow-up questionnaire from the Swedish National Perineal Laceration Register was distributed 12-24 months postpartum. Exposure was VE or CS at 3-4 h or 4-5 h, compared with expectant management. Pelvic floor dysfunction was defined as at least weekly symptoms of urinary incontinence, pelvic organ prolapse or a Wexner score of ≥4. The risk of PFD was calculated using Poisson regression with robust variance estimation, presented as crude and adjusted relative risks (RRs and aRRs) with 95% confidence intervals (95% CIs). The implication of obstetric anal sphincter injury (OASI) on pelvic floor disorders was investigated through mediation analysis. In total, 35.1% of women reported PFD. Compared with expectant management, the risk of PFD was increased after VE at 3-4 h (aRR 1.33, 95% CI 1.06-1.65) and 4-5 h (aRR 1.34, 95% CI 1.05-1.70), but remained unchanged after CS. The increased risk after VE was not mediated by OASI. Pelvic floor dysfunction was common in primiparous women after a prolonged second stage, and the risk of PFD increased after VE but was unaffected by CS, compared with expectant management. If a spontaneous vaginal delivery eventually occurred, allowing an extended duration of labour did not increase the risk of PFD.

The Rate of Epidural Analgesia in Labor with Maternal And Neonatal Outcome at Tertiary Hospital in Oman

Objectives: The primary objective is to determine the epidural analgesia rate and its effect on the mode of delivery. The secondary objectives are to assess patient satisfaction, duration of second stage of labour and incidence of maternal, fetal and neonatal outcomes. Methods: A retrospective cohort design utilized in this study, involving all pregnant women received epidural analgesia in labour at Sultan Qaboos University Hospital over 3 years period (March 2020 to March 2023). All data is collected from the delivery register at Delivery ward, SQUH track care system, and epidural record chart. Women’s information remained confidential. All entered data in the SPSS program is stored in a passwordprotected computer. Results: There was a total of 7076 deliveries, out of which 389 received epidural analgesia, with a rate of 5.0% (95% CI: 5.0 – 6.0). Out of 389 deliveries, around half were nulliparous and the other half were multiparous. The rate of spontaneous vaginal delivery constituted 60.7%. On the other hand, instrumental deliveries and LSCS constituted 14.9% and 24.4% respectively. The median and mean (±SD) period of 2nd stage were 24.0 and 38.3±40.1. Only 1% of all included patients had prolonged second stage of labor. The rate of oxytocin use was 54.5%, and around 52.4% of it was among nulliparous. 148 patients (52.5% ) reported full benefit from epidural analgesia use, compared to 6% who reported no benefit. In addition, 12.7% of CTG showed fetal distress and postpartum hemorrhage constituted 6.7% among delivered ladies. The study showed that 10.0% of included ladies suffered one or more of post-partum complications, including fever (n 13, 3.3%), headache (n 10, 2.6%), backache (n 3, 0.8%), hypotension (n 9, 2.3%), urine retention (n 3, 0.8%), pruritus (n 1, 0.3%), and nausea and vomiting (n 1, 0.3%). 6.2% was the rate of NICU admissions among the newborns. Conclusions: The study revealed that 5% was the rate of epidural analgesia usage and spontaneous vaginal delivery was the main mode of delivery. However, the indications for delivery by cesarean section or instruments were not related to epidural analgesia in labour. In addition, there was no significant adverse effect on maternal, fetal and neonatal outcome. Based on that, we need to elaborate more on epidural analgesia awareness and usage in order to be offered. Although some previous reviewed studies reported adverse effects of epidural analgesia on labour outcome. Future researches are recommended including prospective design study, bigger sample size, wider variation and multicenter studies.

Prevalence and Associated Factors of Hemorrhoids and Other Perianal Complications During the Puerperium Among Mothers Who Gave Birth at Debre Tabor Referral Hospital, Debre Tabor, Ethiopia, 2022

Puerperium is defined as the period of six weeks after childbirth during which the mother’s reproductive organs return to their original non-pregnant condition. Perianal problems, including constipation, hemorrhoids, and fissures, are among the most common complications among women during the puerperium, observed in about 30 to 50 percent of women. Considering this great prevalence and the paucity of similar research in Ethiopia, this study was done to assess the prevalence of perianal problems during the puerperium and the risk factors associated with them. METHODS: An institution-based cross-sectional study was conducted from February 1 to April 30, 2022. Quota sampling technique was used to select a total of 191 participants. The data were collected and then entered using EPI DATA version 3.1 and exported to STATA 14 for analysis. Bivariable and multivariable logistic regression analyses were performed. Adjusted odds ratio (AOR) with 95% confidence interval was used as a measure of association. Variables having a P-value &lt; 0.05 from the multivariable analysis were considered to have a significant association with the outcome. RESULTS: The total prevalence of all the perianal problems in the puerperium encountered in this study was 22.5% (43 mothers). The perianal problems encountered were fissure [9.4%], followed by hemorrhoids [7.3%], peri-anal episiotomy infections (4.2%), and peri-anal tears (1.6%). Comparative analysis showed that positive family history, past history of perianal diseases, and prolonged second stage of labor (&gt;50 minutes) showed a higher prevalence in the perianal disease group as compared to the healthy group. A statistically significant relationship was observed between the prevalence of hemorrhoids and a past history of any perianal disease [p=0.04]. A statistically significant relationship was observed between the prevalence of hemorrhoids and parity [p=0.02]. There was also a statistically significant relationship between constipation during pregnancy and the development of hemorrhoids [p=0.01]. CONCLUSION: Anal fissure, hemorrhoids, and perianal episiotomy infections are the most common perianal problems in the postpartum period, causing a significant reduction in the quality of life of those afflicted with them.

Optimizing Management of the Second Stage of Labor: A Multicenter Randomized Controlled Trial.

To review the findings of the Optimizing Management of the Second Stage of Labor randomized controlled trial in the context of prior and subsequent obstetric literature. A multi-database search was performed in addition to a review of the parent trial and secondary studies. Nulliparous patients with neuraxial anesthesia randomized to either immediate or delayed pushing showed no difference in vaginal delivery rates. However, delayed pushing is associated with an increased duration of the second stage and perinatal morbidity. Patients should be appropriately counseled on the timing of second-stage pushing and the risks of prolonged second-stage labor.

Factors associated with low fifth minute Apgar score among newborns delivered at public health facilities of Dilla town, Southern Ethiopia, 2022

ObjectiveThe aim of this study is to identify the associated factors of low fifth minute Apgar scores among newborns in Dilla town public health facilities, southern Ethiopia. MethodsAn institution-based case-control study was conducted in Dilla town public health facilities, Southern Ethiopia. The case and control groups were newborns with fifth minute Apgar score of < 7 and ≥ 7, respectively. The study included 534 participants (178 cases and 356 controls). Data were collected through face-to-face interviews and record reviews. Consecutive and systematic random sampling was used to recruit cases and controls, respectively. Bivariate and multivariate analyses were performed. The degree of association between independent and dependent variables was assessed using adjusted odds ratios (ORs) with 95 % confidence intervals (CIs). Finally, variables with a p-value of < 0.05, were consider that had statistically significant. ResultsIn this study, No antenatal care follow-up [AOR = 1.74, 95 % CI: (1.12, 2.69)], instrumental mode of delivery [AOR = 2.11, 95 % CI: (1.25, 3.56)], non-vertex presentation [AOR = 6.54, 95 % CI: (2.92, 14.65)], prolonged second stage of labor [AOR = 5.63, 95 % CI: (2.45, 12.95)], and gestational hypertension [AOR = 0.45, 95 % CI: (0.22, 0.86)] were significantly associated with a low fifth minute Apgar score. ConclusionsThis study found that no antenatal care follow-up, instrumental mode of delivery, pregnancy-induced hypertension, prolonged second stage of labor, and non-vertex presentation were all independently associated with low fifth-minute Apgar scores. These findings suggest the need for improved maternal and neonatal care during pregnancy, delivery, and the postpartum period to reduce the risk of low Apgar scores and to improve newborn outcomes.

115 Prolonged second stage of labor (P2S) in primipara, and perinatal outcomes

115 Prolonged second stage of labor (P2S) in primipara, and perinatal outcomes

Prolonged second stage of labor in delivery using epidural analgesia is a risk factor for postpartum urinary retention.

To determine the postpartum urinary retention rate and risk factors after delivery using epidural analgesia. This single-center retrospective study targeted 341 women who gave birth after at least 37 weeks of gestation from April to August 2021; from this cohort, 208 patients were examined. The postpartum urinary retention rate was compared between the no epidural analgesia group (n = 107) and epidural analgesia group (n = 101). Subsequently, risk factors for postpartum urinary retention were investigated in the epidural analgesia group. After adjustment by propensity score matching for age, body mass index, being primiparous, and labor induction as covariates, the analysis of the incidence of postpartum urinary retention revealed that the epidural analgesia group exhibited a significantly higher postpartum urinary retention rate than the no epidural analgesia group (30% vs. 11%, p = 0.02). The investigation results regarding risk factors for postpartum urinary retention in the epidural analgesia group obtained through a univariate analysis showed that being primiparous and having a prolonged second stage of labor were significantly correlated with postpartum urinary retention. Multivariate analysis indicated that a prolonged second stage of labor was an independent risk factor for postpartum urinary retention (p = 0.03; odds ratio: 3.18; 95% confidence interval: 1.08-9.77). All patients recovered from postpartum urinary retention by day 4. The postpartum urinary retention rate after delivery using epidural analgesia was 25.7%. In the case of epidural analgesia deliveries, a prolonged second stage of labor was an independent risk factor for postpartum urinary retention.

Associations of High-Sensitive Cardiac Troponin T in Healthy Newborns and Prolonged Second Stage of Labor, Neonatal and Maternal Factors: A Prospective Study

Introduction: High-sensitivity cardiac troponin T (hs-cTnT) is not used routinely as a diagnostic biomarker in newborns. The high precision of hs-cTnT assays increases the ability to determine small differences in cTnT over time and to detect troponin T elevation; thus, we believe that hs-cTnT assays might improve clinical care. We explored the plausible association between hs-cTnT levels (ng/L) in healthy newborns and prolonged second stage of labor, neonatal, and maternal factors. Methods: A prospective study was performed among healthy newborns in the Obstetrics and Gynecology Department at Hillel Yaffe Medical Center in Israel in January–June 2021. The sociodemographic characteristics of the participants, maternal age, gravidity, parity, Pitocin use, epidural analgesia, and neonatal anemia were obtained from the electronic medical records. Gestational age was determined by ultrasound biometric measurements. We classified second-stage labor as normal or prolonged using the WHO guidelines. Samples from umbilical cord blood were drawn using syringes rinsed with anticoagulant by a specialist in pediatrics. The remaining blood was used to determine hs-cTnT levels (ng/L), which was defined as a continuous quantitative variable with the median value and the 25th–75th percentiles. Results: Overall, 184 cord blood samples were performed from healthy newborns (60.6% males) with a median hs-cTnT of 39.03 (25th–75th percentiles = 30.53–54.09) ng/L. A multivariable linear regression model showed no significant association between neonatal anemia and hs-cTnT levels (ng/L) (p = 0.8). Gestational age (B coefficient −4.24, p p = 0.03) were negatively associated with hs-cTnT levels (ng/L), while Pitocin use (B coefficient 6.91, p = 0.04) and prolonged second stage of labor (B coefficient 18.07, p = 0.02) were positively associated with hs-cTnT levels (ng/L). Conclusions: High hs-cTnT levels (ng/L) were documented in the cord blood of healthy newborns. Hs-cTnT levels were positively correlated with a prolonged second stage of labor and Pitocin use and negatively correlated with longer gestational age and higher gravidity. Hs-cTnT may signify labor-related fetal distress. A larger surveillance study is mandatory to establish this correlation and assess for possible prognostic significance of elevated hs-cTnT in this context.

Maternal complications and risk factors associated with assisted vaginal delivery

ObjectiveThis study aimed to elucidate the maternal complications and risk factors linked with assisted vaginal delivery.MethodsWe conducted a retrospective, descriptive analysis of hospital records, identifying 3500 cases of vaginal delivery between 2020 and 2022. Data encompassing demographics, complications from the vaginal delivery including post-partum haemorrhage, birth passage injuries, puerperal infection and other pertinent details were documented. Various critical factors, including the duration of the second stage of labor, maternal anemia, underlying maternal health conditions such as diabetes mellitus and hypertension, neonatal birth weight, maternal weight, the expertise of the attending surgeon, and the timing of deliveries were considered.ResultsThe rates for assisted vacuum and forceps delivery were 6.0% (211/3500 cases) and 0.3% (12/3500), respectively. Postpartum haemorrhage emerged as the predominant complication in vaginal deliveries, with a rate of 7.3% (256/3500; P < 0.001). Notably, postpartum haemorrhage had significant associations with gestational diabetes mellitus class A1 (adjusted odds ratio [AOR] 1.46; 95% confidence interval [CI] 1.01–2.11; P = 0.045), assisted vaginal delivery (AOR 5.11; 95% CI 1.30–20.1; P = 0.020), prolonged second stage of labour (AOR 2.68; 95% CI 1.09–6.58; P = 0.032), elevated maternal weight (71.4 ± 12.2 kg; AOR 1.02; 95% CI 1.01–1.03; P = 0.003) and neonates being large for their gestational age (AOR 3.02; 95% CI 1.23–7.43; P = 0.016).ConclusionsThe primary complication arising from assisted vaginal delivery was postpartum haemorrhage. Associated factors were a prolonged second stage of labour, foetal distress, large-for-gestational-age neonates and elevated maternal weight. Cervical and labial injuries correlated with neonates being large for their gestational age. Notably, puerperal infections were related to maternal anaemia (haematocrit levels < 33%).Clinical trial registrationThai Clinical Trials Registry: 20220126004.

OP01.02: Does fetal occiput position affect the ultrasonographic prediction of vaginal delivery in prolonged second stage of labour?

OP01.02: Does fetal occiput position affect the ultrasonographic prediction of vaginal delivery in prolonged second stage of labour?

Prolonged second stage of labor is associated with persistent urinary retention after forceps delivery: An observational study.

The occurrence of urinary retention is significantly higher in women undergoing forceps-assisted midwifery. However, the majority of these women typically regain the ability to urinate spontaneously within 72 hours after delivery. Instances of persistent urinary retention beyond this timeframe are relatively uncommon and have been rarely documented. This study aimed to investigate the risk factors associated with the persistence of urinary retention after forceps-assisted midwifery. A retrospective analysis was conducted on women who underwent forceps-assisted deliveries at the Obstetrics and Gynecology Hospital of Fudan University (China) between August 1, 2019 and December 1, 2019. The study involved collecting general clinical information of these women. Based on the duration of ureter retention, women who had a retention time >72 hours were categorized into group A, while those with a retention time <72 hours were allocated to group B. After performing analysis on the risk factors of persistent urinary retention following forceps delivery, the t test was utilized for analyzing single factors, while logistic regression analysis was employed for assessing multiple factors. Univariate analysis revealed a significant difference in the duration of the second stage of labor between group A and group B. However, logistic regression analysis did not indicate any significant difference between the 2 groups. Further research is still required to determine whether the association between persistent urinary retention following forceps delivery and prolonged second stage of labor is significant, considering the limited number of cases available for analysis.

ASSOCIATED FACTORS AND IMMEDIATE OUTCOME IN BIRTH ASPHYXIATED TERM NEONATES ADMITTED IN TERTIARY CARE HOSPITAL IN TRIBAL REGION OF INDIA-AN OBSERVATIONAL STUDY

Objectives: The objective is to study the associated risk factors and outcomes of birth asphyxia (BA). Methods: The study involved 240 neonates of both genders who were admitted to the NICU of the Department of Pediatrics at NAMO MERI and SVBCH Hospital. Relevant information such as neonatal information, maternal information, and problems during pregnancy or labor noted and analyzed. Results: Among the cases and controls, the male-to-female ratio was 1.3:1 and 1.09:1, respectively. The incidence of meconium-stained liquor was higher in some cases, and these infants required longer resuscitation compared to controls (p&lt;0.0001). Maternal risk factors such as hypertension, antepartum hemorrhage, and prolonged second stage of labor were significantly associated with BA (p&lt;0.05). In addition, BA was significantly associated with hypoxic-ischemic encephalopathy (HIE), convulsions, and apnea (p&lt;0.05). Top of FormBottom of FormThere was a significant correlation between the duration of resuscitation and the grade of HIE in asphyxiated babies (p&lt;0.05). A severe form of HIE was developed in cases with a longer duration of resuscitation. The duration of resuscitation was longer in patients who were delivered in either a primary health center or home compared to a tertiary care hospital (p&lt;0.05). Conclusion: Effective post-delivery resuscitation, additional basic steps, and training health workers and a skilled person at every birth can help reduce the occurrence of BA and its complications in resource-limited peripheral systems. This study highlights importance of maternal risk factor assessment, prompt resuscitation.

Prolonged second stage of labor: Predictors of adverse maternal and perinatal outcomes in a sub-Saharan setting.

To determine the predictors of adverse maternal and perinatal outcomes among parturients with prolonged second stage of labor. This study isa cross-sectional study of women with prolonged second stage of labor from January 1 to June 30, 2021, in four tertiary hospitals in Ethiopia. Data were collected prospectively using a structured questionnaire. Descriptive statistics were used to analyze baseline characteristics. Bivariate and multivariate logistic regression analyses were applied to determine predictors of adverse maternal and perinatal outcomes. A total of 406 women were included in the study. More than half (25/46, 54%) of the women with a prolonged second stage of 4 h or longer had vaginal delivery, which was lower than the 73% (140/190) of women who had a second stage of 2-3 h and the 63.4% (64/101) of women with a second stage duration of 3-4 h. Duration of second stage of labor was not a predictor of composite adverse maternal outcomes nor was it a predictor of adverse perinatal outcome. Operative vaginal delivery (adjusted odds ratio [aOR] 6.0, 95% confidence interval [CI] 2.41-14.9) and nulliparity (aOR 4.1, 95% CI 1.58-10.41) were predictors of adverse maternal outcome, but nulliparity (aOR 1.8, 95% CI 1.05-3.04) and duration of rupture of membranes greater than 18 h (aOR 2.4, 95% CI 1.21-4.93) were predictors of adverse perinatal outcomes. Under strict fetal and maternal well-being monitoring, women with a prolonged second stage of labor can labor for an additional 2 h (up to a total of 4 h) without increasing adverse maternal and neonatal outcomes.

Maternal and perinatal outcomes of prolonged second stage of labour: a historical cohort study of over 51,000 women

BackgroundProlonged second stage of labour has been associated with adverse maternal and perinatal outcomes. The maximum length of the second stage from full dilatation to birth of the baby remains controversial. Our aim was to determine whether extending second stage of labour was associated with adverse maternal and perinatal outcomes.MethodsA retrospective cohort study was conducted using routinely collected hospital data from 51592 births in Aberdeen Maternity Hospital between 2000 and 2016. The hospital followed the local guidance of allowing second stage of labour to extend by an hour compared to national guidelines since 2008 (nulliparous and parous). The increasing duration of second stage of labour was the exposure. Baseline characteristics, maternal and perinatal outcomes were compared between women who had a second stage labour of (a) ≤ 3 h and (b) > 3 h duration for nulliparous women; and (a) ≤ 2 h or (b) > 2 h for parous women. An additional model was run that treated the duration of second stage of labour as a continuous variable (measured in hours). All the adjusted models accounted for: age, BMI, smoking status, deprivation category, induced birth, epidural, oxytocin, gestational age, baby birthweight, mode of birth and parity (only for the final model).ResultsEach hourly increase in the second stage of labour was associated with an increased risk of obstetric anal sphincter injury (aOR 1.21 95% CI 1.16,1.25), having an episiotomy (aOR 1.48 95% CI 1.45, 1.52) and postpartum haemorrhage (aOR 1.27 95% CI 1.25, 1.30). The rates of caesarean and forceps delivery also increased when second stage duration increased (aOR 2.60 95% CI 2.50, 2.70, and aOR 2.44 95% CI 2.38, 2.51, respectively.) Overall adverse perinatal outcomes were not found to change significantly with duration of second stage on multivariate analysis.ConclusionsAs the duration of second stage of labour increased each hour, the risk of obstetric anal sphincter injuries, episiotomies and PPH increases significantly. Women were over 2 times more likely to have a forceps or caesarean birth. The association between adverse perinatal outcomes and the duration of second stage of labour was less convincing in this study.

The accuracy of the Thompson score in predicting early outcome in neonates with hypoxic ischaemic encephalopathy treated with therapeutic cooling in a tertiary hospital.

Hypoxic ischaemic encephalopathy (HIE) is one of the major contributors to neonatal mortality and morbidity in developing countries. Scarcity of resources limits clinicians in optimally caring for these patients. Optimal utilisation of clinical tools such as the Thompson score (TS) can assist in improving care by classifying the severity of HIE followed by appropriate treatment. The primary objective was to study the correlation of the TS and early neonatal outcomes in infants with HIE who received therapeutic hypothermia (TH). Secondary objectives were to investigate the correlation of blood gas values with the TS, need for resuscitation with TS, target organ damage (TOD) with TS and the most common risk factors associated with HIE in Tembisa Provincial Tertiary Hospital (TPTH). This was a retrospective record review of infants admitted with HIE from January 2018 to August 2019 at the TPTH neonatal unit. Infants had to have successfully completed TH. Ninety-three infants met the inclusion criteria, with 32, 48 and 13 being classified into the mild, moderate and severe categories by TS, respectively. The median length of stay (LOS) was noted to rise with a rising TS, recorded to be 7, 8 and 9 days in the mild, moderate and severe groups, respectively. The mortality rate in the study was calculated to be 2.1%, and there was no significant difference across the groups (p=0.231). A need for antiseizure medication (ASM) on discharge was significantly associated with severe HIE (p=0.028). Hypertension was a frequent chronic illness, noted in 11.3% of the mothers. The most frequent perinatal risk factor was meconium aspiration (50.5%), followed by prolonged second stage of labour (PSSL) (17.2%). A higher TS (severe group) was associated with prolonged resuscitation for >10 minutes (p=0.001) and a need for adrenaline (p=0.008). The frequency of cardiac impairment, liver impairment and clinical seizures increased with a higher TS category (p=0.23, p=0.35 and p=0.51, respectively). On blood gas analysis, a low pH and a high base deficit were associated with severe HIE (p=0.027, p=0.061 respectively). The TS is still a useful clinical tool in the era of TH as it is able to predict some early neonatal outcomes such as LOS and a need for ASM at discharge. It is also able to demonstrate increased frequency of duration of resuscitation and a need for adrenaline in severely encephalopathic infants compared with mild. A high TS is also associated with severe metabolic acidosis and increased frequency of TOD. Maternal hypertension, meconium-stained liquor and PSSL are the common risk factors for HIE at TPTH.