Prolonged Second Stage Of Labor Research Articles

Wiedenbach Need for Help and Swanson Caring Model on Nursing Care of Prolonged Second Stage of Labour

The second stage of labour is defined as the period from full dilatation of the cervix to the birth of the baby. Prolonged Second Stage of labour greater than 2 hours in primiparous women and greater than 1 hours in multiparous. Nursing management for women with prolonged second stage of labour is providing nursing care both physical and psychological aspec. Case study focused on Wiedenbach Need for Help and Swanson Caring Model on nursing care of prolonged second stage of labour. Applications of Swanson and Wiedenbach theory are implemented and managed to help problem solving for 5 mothers case with prolonged second stage of labour. Therefore nursing emergency action must be done properly and quickly by using the theory of "Need for help" Wiedenbach. With developing the workings of team work , standard setting or pathway of each area so that in case of emergency measures to help can be optimally

An examination of the factors affecting intestinal wall integrity in newborns at birth

Background: An understanding of the factors that influence intestinal wall integrity during the transition from fetal to neonatal life is important to elucidate and minimize potential contributions to the development of intestinal pathologies in vulnerable newborns.Objective: To assess the factors affecting intestinal wall integrity of late preterm and term newborns at birth.Methods: The concentrations of serum intestinal fatty acid-binding protein (I-FABP) as biomarker of intestinal wall injury, superoxide dismutase (SOD), and glutathione peroxidase (Gpx) as parameters of oxidative stress, and blood gas analyses were measured in the arterial cord blood of 80 newborns, delivered by spontaneous vaginal delivery (labor group) or elective cesarean delivery (non-labor group).Results: Compared with the non-labor group, I-FABP, SOD, and Gpx levels were significantly higher in the labor group. I-FABP concentration was inversely correlated with pH and BE and positively correlated with SOD and Gpx concentrations, second stage of labor duration, and active pushing time.Conclusions: This study demonstrates that oxidative stress at birth and prolonged second stage of labor may lead to the intestinal injury, which is reflected in increased serum concentration of I-FABP.

Vacuum Assisted Vaginal Delivery in Singleton Term Pregnancies: Short Term Maternal and Neonatal Outcome in a Tertiary Hospital of Nepal

Introduction: Other than cesarean delivery, assisted vaginal delivery is an alternative procedure for delivery in emergency obstetrics. Presently, vacuum delivery has gained more popularity than forceps for operative/ assisted vaginal delivery, when and where indicated, with success as well as lesser neonatal and maternal complications. This study was done to estimate the short term maternal and fetal morbidity/mortality due to vacuum assisted vaginal delivery.
 
 Methods: A prospective observational study was conducted at Lumbini Medical College Teaching Hospital from January 2015 to May 2016. One hundred and four pregnant women who had successful vacuum assisted vaginal deliveries were enrolled. Fetal and maternal outcome were assessed.
 
 Results: One hundred and four successful vacuum deliveries (2.9%) were conducted among 3457 deliveries during our study period. Sixty seven (64.4%) were primigravida and most (n=59, 56.7%) parturients were of age group 20-30 years. The commonest (n=65, 62.5%) indication for vacuum application was prolonged second stage of labor. The maternal morbidity variables were: 6.7% (n=7) had genital tract injury, 3.8% (n=4) had primary post-partum hemorrhage, 3.8% (n=4) had urinary retention, 2.8% (n=3) needed blood transfusion. Among neonatal morbidity indicators, 19.2% (n=20) neonates had birth asphyxia, 4.8% (n=5) neonates had cephalohematoma, 0.96% (n=1) had brachial plexus injury. There was one early neonatal death due to meconium aspiration syndrome.
 
 Conclusion: A successful vacuum assisted delivery can be achieved with lesser maternal and neonatal morbidity with timely assessment of labor, skilled operator, and availability of neonatal team.

Comparison between Vacuum and Forceps Extraction to Neonatal outcome on Prolonged Second Stage of Labor

Objective: To assess the effectiveness of vacuum and forceps extraction in prolonged second stage in Dr. Mohammad Hoesin Hospital Palembang.
 
 Methods: A retrospective study for 5 years (2005-2009) by doing a prognostic test on prolonged second stage of labor.
 
 Results: The subject age most commonly ranges from 20 to 35 years (84.8% in the forceps extraction group and 86% in the vacuum group). The common parity was nulliparity (58.1% in the forceps extraction group and 61.58% in the vacuum extraction). In the forceps
 extraction group, 76.7% scores >7 in the 1 minute APGAR score with the mean score of 7.14±1.62, whilst in the vacuum extraction group, 79.1% scores >7 in the 1 minute APGAR score, with the mean score of 7.16±1.78. And in the forceps extraction group, 94.2 scores >7 in the 5 minute APGAR score with mean score of 8.62±1.11, whilst in the vacuum extraction group, 93% scores >7 in the 5 minute APGAR score with the mean score of 8.65±1.08. It is concluded that there is no significant differences on both 1 and 5 minute APGAR scores (p value is 0.713 and 0.755, respectively). Maternal complication of extended
 episiotomy and perineal rupture were found more often in forceps extraction, but with no statistically significant difference (p=0.324).
 
 Conclusion: There is no difference of effectiveness between forceps extraction and vacuum extraction in the case of prolonged second stage. Physicians are free whether to use the vacuum or foceps according to their own desirability and skill.
 [Indones J Obstet Gynecol 2012; 36-1:28-31]
 
 Keywords: forceps extraction, prolonged second stage, vacuum extraction

Prolonged Second Stage of Labor, Maternal Infectious Disease, Urinary Retention and Other Complications in the Early Postpartum Period

(BJOG 2016;123:608–616) A prolonged second stage of labor is known to be associated with increased risk of certain maternal complications, such as infection, urinary retention, hematoma, and ruptured sutures in the early postpartum period. Urinary retention can lead to other adverse consequences for the affected woman, including bladder denervation, detrusor atony, and long-term voiding problems. This current population-based cohort study was undertaken to study the association between prolonged second stage of labor and these early postpartum complications.

Effect of Neuraxial Technique After Inadvertent Dural Puncture on Obstetric Outcomes and Anesthetic Complications

(Int J Obstet Anesth. 2016;25:23–29) Epidural analgesia is a popular technique for labor pain management. A relatively common complication of this procedure is inadvertent dural puncture (IDP), which will lead to postdural puncture headache (PDPH) in some patients. The objective of this current study was to evaluate whether there was a difference in labor outcomes when IDP was managed with insertion of an intrathecal catheter versus resiting of an epidural catheter. The authors hypothesized that patients who received an intrathecal catheter would be less likely to have a prolonged second stage of labor with no difference in cesarean delivery rate compare with patients who had another epidural catheter placed.

Prolonged Second Stage: What Is the Optimal Length?

Prolonged second stage of labor is a clinical dilemma in which controversy exists on whether extending labor in nulliparous women with epidural anesthesia decreases the incidence of cesarean delivery without increasing maternal or neonatal risks. This narrative review was conducted to assess the current literature on management of and risks associated with a prolonged second stage in nulliparous women with epidurals. A review of the current literature was performed to evaluate the incidence of cesarean delivery and the maternal and neonatal outcomes. A total of 11.5% of nulliparous women with epidurals have a prolonged second stage; 80.2% of these women deliver vaginally. There is 1 randomized controlled trial on prolonged second stage in nulliparous women with epidurals. In this study, extending the second stage beyond current guidelines decreased the incidence of cesarean delivery by 55% and did not increase maternal or neonatal risks. Most patients (75.6%) with a prolonged second stage delivered by 5 hours and had a vaginal delivery (80.5%). Women with a fetus in occiput anterior position or who presented in spontaneous labor had decreased risk of cesarean delivery (by 83% and 89%, respectively). Maternal risks include postpartum hemorrhage, chorioamnionitis, and third- and fourth-degree lacerations. Neonatal risks may have a small absolute increase. The change of a vaginal delivery is high (over 80%) beyond 3 hours in the second stage. Maternal and neonatal risks need to be further explored by larger, better-designed retrospective reviews or trials.

A study of patients satisfaction following instrumental deliveries

A study of patient satisfaction following instrumental delivery Introduction Instrumental deliveries are common in the UK with rates between 10 and 13% nationally. Choice of instrument varies but may include ventouse or forceps with rotational instrumental deliveries via manual rotation, rotational ventouse or rotational forceps. However, instrumental deliveries are not without complications, which can confer maternal or neonatal morbidity. Acknowledged complications include vaginal tears, possibly extending to the anal sphincter/mucosa, haemorrhage, infection and is a known risk factor for shoulder dystocia. Fetal complications include subgaleal haematoma, intracranial haemorrhage, facial nerve palsy, cephalhaematoma, neonatal jaundice or retinal haemorrhage. Indications for instrumental delivery may include expedited delivery in fetal compromise, prolonged second stage of labour owing to maternal exhaustion/other reasons or safer delivery in cases where maternal pushing is not advisable. Our unit: We have performed a prospective study between October and December 2015 to investigate patient satisfaction following instrumental deliveries. This was achieved via a proforma with the first part completed by the operating physician and the second part completed by the patient in the first day following delivery. We have, on average, 4000 deliveries in our unit per annum and had 1029 deliveries in the 3-month period. There were 111 instrumental deliveries and we had a return rate of 45% (50). Results: Demographics – in the cohort 35 were primiparous, 15 were multiparous with the majority of women between the ages of 20–30. The fetal head was in the occipito-anterior position in 64% with the remainder either occipito-posterior or occipito-transverse. 46% had forceps delivery, 30% had a ventouse delivery, 18% needed a double instrumental delivery and in only 3 deliveries did the instrumental delivery fail necessitating a second stage caesarean section. The instrumental delivery was performed under a variety of analgesic techniques – 30% local perineal infiltration, 6% pudendal block and 64% regional anaesthesia (epidural or spinal anaesthetic). 30 patients had an episiotomy performed, 7 patients had a third degree tear, 1 patient had a fourth degree tear and 5 patients had major post-partum haemorrhages of >1500 ml. The overall patient satisfaction was high with 94% feeling safe, well informed and that they were treated with respect throughout. 96% were happy they received a good explanation of the procedure including rational, consent and associated risks. 94% felt comfortable throughout with supportive staff. Overall pain scores post procedure was low with only 8% stating they had moderate or severe pain post-natally. 23 of 50 women also added comments with 22 highly positive and only 1 borderline comment, which was regarding explanation by the medical staff as it was an emergency procedure. Conclusion: Overall patient satisfaction in the immediate post-partum period was high despite the aforementioned complication rates.

Risk Factors and Short Term Outcome of Hypoxic Ischemic Encephalopathy in Term Neonates with Perinatal Asphyxia

Objectives: to determine the risk factors and short term outcome (till discharge) of neonates with perinatal asphyxia at RMMCH, Chidambaram. Material and Methods: A prospective (case-control) study was conducted between January 2015 and July 2016 in the Neonatal Intensive Care Unit, Department of Paediatrics, Rajah Muthiah Medical College & Hospital. Venous blood collected from 50 term asphyxiated neonates comprising cases & 50 healthy neonates comprising controls constituted the material for study. Details of mother and baby were collected and compared between cases and controls. Results: There is no statistical significant difference in the age, parity status, gestational age of mother, birth weight and mode of delivery between cases and control newborns. Antepartum risk factors were maternal age of 20 to 25 years, Pre eclampsia (16%), Anemia (8%), primigravidity (58%). Intra partum risk factors were breech presentation (4%), prolonged second stage of labour (44%), meconium staind amniotic fluid (26%) and cord around the neck (6%). Among the babies, 48% had stage 2 HIE& there is statistically positive correlation between stages of HIE & short term outcome with NRBC count. Conclusion: Early identification of high risk mothers and timely referral to tertiary care center can reduce the mortality. Furthermore, there is need to carefully evaluate and monitor the babies with perinatal asphyxia immediately after birth. NRBC count can serve as simple and cost effective test in evaluating perinatal asphyxia thus reducing mortality and morbidity.

Imaging of the pubic arch angle in prolonged second stage of labour with intrapartum translabial 3D ultrasound and its clinical significance

Imaging of the pubic arch angle in prolonged second stage of labour with intrapartum translabial 3D ultrasound and its clinical significance

OC18.05: Correlation between the angle of progression and complicated operative vaginal delivery after prolonged second stage of labour

OC18.05: Correlation between the angle of progression and complicated operative vaginal delivery after prolonged second stage of labour

Nuchal cord complication in male small for gestational age increases fetal distress risk during labor

ObjectiveThis study aimed to evaluate whether a nuchal cord increases the risk of perinatal complications during labor, and whether fetal growth and sex affect the risk of fetal distress. Materials and MethodsMedical records of 1749 women with singleton pregnancies planning a vaginal delivery were enrolled. Patients were divided into two groups according to the presence or absence of a nuchal cord at birth. Multivariate logistic regression analyses, odds ratios (ORs), and 95% confidence intervals (CIs) were used to determine whether the risks of perinatal complications increased in the nuchal cord group. ResultsA nuchal cord is associated with higher risks of Rupture of membranes (ROM) prior to delivery (OR = 1.40, 95% CI: 1.12–1.76, p = 0.0031), need for augmentation during labor (OR = 1.68, 95% CI: 1.27–2.23, p = 0.0003), prolonged second stage of labor (OR = 2.54, 95% CI: 1.55–4.25, p = 0.0002), nonreassuring fetal heart risk during labor (OR = 2.89, 95% CI: 2.18–3.84, p < 0.0001), and instrumental delivery or cesarean delivery (OR = 2.00, 95% CI: 1.55–2.58, p < 0.0001). Fetal distress risk during labor was affected by fetal growth and sex, with male small for gestational age fetuses with a nuchal cord having a significantly higher risk than the control group (OR = 9.77, 95% CI: 3.67–25.79, p < 0.0001), despite there being no significant differences in the neonatal Apgar scores at 1 minute or 5 minutes, or in the need for neonatology between the two groups. ConclusionNuchal cord is associated with perinatal outcomes. Male small for gestational age fetuses with a nuchal cord have a significantly higher risk of fetal distress during labor. Our results suggest that evaluation of fetal sex and body weight is also important in antenatal ultrasonography if a nuchal cord is found.

Recurrent shoulder dystocia: is it predictable?

To examine the course and outcome of deliveries occurring in women who previously experienced shoulder dystocia. In addition, recurrent shoulder dystocia risk factors were assessed. A retrospective cohort analysis comparing all singleton deliveries with and without shoulder dystocia in their preceding delivery was conducted. Independent predictors of recurrent shoulder dystocia were investigated using a multiple logistic regression model. Of the 201,422 deliveries included in the analysis, 307 occurred in women with a previous shoulder dystocia (0.015%). Women with a history of shoulder dystocia were more likely to be older, experienced higher rates of gestational diabetes mellitus, polyhydramnios, prolonged second stage, operative delivery and macrosomia (>4000g) in the following delivery. Previous shoulder dystocia was found to be an independent risk factor for recurrent shoulder dystocia (OR=6.1, 95% CI 3.2-11.8, p value<0.001) in the multivariable regression analysis. Shoulder dystocia is an independent risk factor for recurrent shoulder dystocia. Deliveries in women with a history of shoulder dystocia are characterized by higher rates of operative delivery, prolonged second stage of labor and macrosomia.

Perinatal outcomes of vacuum assisted versus cesarean deliveries for prolonged second stage of delivery at term*

Introduction: To compare perinatal outcomes of interventions for prolonged second stage of labor. Materials and methods: Retrospective cohort study, in a single, university-affiliate, medical center (2007–2014). Eligibility: singleton gestations at term, diagnosed with prolonged second stage of labor and head station of S + 1 and lower. We compared perinatal outcomes of cesarean deliveries (CD) with vacuum assisted deliveries (VAD). Results: Of 62 102 deliveries, 3449 (5.6%) were eligible: 356 (10.3%) underwent CD and 3093 (89.7%) underwent VAD. The rate of five-minute Apgar scores <7 was higher in the CD group as well as rates of NICU admission, neonatal asphyxia and composite neonatal adverse outcome. After adjusting for different confounders, CD was associated with adverse neonatal composite outcome (aOR 1.57, 95% CI 1.21–2.05, p = 0.001) and VAD with cephalhematoma (aOR 4.06, 95% CI 2.64–6.25, p < 0.001). No other differences were found between the groups with regards to other traumatic outcomes. Conclusion: Our data suggests that in deliveries complicated by prolonged second stage, CD yield poorer neonatal outcome than VAD, with no apparent major difference in traumatic composite outcome.

Nulliparous Women in the Second Stage of Labor: Changes in Delivery Outcomes Between 2 Cohorts From 2000 to 2011

Obstet Gynecol. 2015;126:81–86 A prolonged second stage of labor has been associated with increased maternal risk for complications such as puerperal infection, perineal lacerations, and postpartum hemorrhage. It is also associated with neonatal morbidities including admission to the intensive care unit, sepsis, and low Apgar scores. However, ending the second stage of labor based solely on its duration might not be necessary, according to existing research. This retrospective cohort study examined the changes that have occurred over the past decade in both the modes of delivery and the delivery outcomes for women who have not previously given birth.

Neonatal Risk Factor for Seizures in Term Neonate: A Hospital - Based Case Control Study

Background: Assessing the maternal risk factors for seizure in first 72 hours of life in term neonate. Design: Case control study. Setting: Department of Paediatrics, Neonatology unit and Maternity ward tertiary care centre Govt. Medical College, Nagpur. Methods: A 210 cases [Term neonate with seizure within first 72 hours of life] and 210 controls [Term neonate without seizure in first 72 hours of life] were randomly selected as study subject over a period of two year. Primary exposure variables in mothers including age, parity, diabetes mellitus, hypertension, anemia, intrapartum fever, mode of delivery and prolonged second stage of labor were considered in study population. Neonates were carefully examined and observed for seizures and manage accordingly. Results: Maternal diabetes mellitus and anemia were potentially significant in their association with term neonatal seizure while maternal hypertension, intrapartum fever and prolonged second stage of labor were not significantly associated with seizure. Neonates born to diabetic mother, young maternal age, anemic mother and cesarean delivered neonate had 1.97, 0.95, 1.83 and 2.18 time more risk to developed seizure respectively. Conclusion: Early identification and timely intervention of maternal risk factor may reduces the seizure in term neonate.

Total Uterine Necrosis-A Case Report with Review of Literature

The use of compression sutures in cases of massive postpartum haemorrhage uncontrolled by med-ical management gives an option to the women for future child bearing and menstrual function. A case is being reported wherein patient was referred in prolonged second stage of labour with failed forceps and intrapartum fetal demise. Emergency caesarean section was done and Hayman’s sutures were placed for massive atonic PPH with failed medical management. Patient developed subinvolution of uterus with py-operitoneum. Patient refused surgical intervention and later presented with necrosed uterine wall hanging through the introitus. Exploratory laparotomy showed total uterine necrosis with pyoperitoneum. A total hysterectomy with right salpingo-oophorectomy was done. Keywords: postpartum haemorrhage, uterine compression sutures, pyoperitoneum, uterine necrosis

Congenital brachial plexus palsy

Abstract Congenital brachial plexus palsy (CBPP) occurs secondary to traumatic injury to the brachial plexus in the perinatal period. It is a commonly encountered problem on the postnatal wards with the potential for significant morbidity. Previously termed ‘obstetrical brachial plexus palsy', recent evidence suggests that it may occur independently of the actions of the birth attendant in some cases. Significant risk factors include shoulder dystocia, macrosomia, instrumental delivery and prolonged second stage of labour. Prognosis is variable and dependent on the type and level of nerve injury with total plexus palsies having the worst prognosis. Approximately two thirds of patients will have complete and spontaneous recovery by 6 months of age. However in those with residual defects, secondary complications may develop. It is important to diagnose it early and manage appropriately due to the risk of long term neuromuscular dysfunction and deformities in the affected arm in some cases. Management following recognition involves, prompt paediatric review and exclusion of associated injuries such as bony fractures. Urgent and regular physiotherapy input is crucial in preventing complications and monitoring progress. Primary surgical repair may be indicated in cases that do not or are unlikely to recover and prompt and early referral to a specialist centre is recommended in these difficult cases. Secondary surgery may also be indicated in those who develop complications. This review details the pathophysiology, risk factors and classification of CBPP. It suggests a systematic approach to the diagnosis of CBPP and gives a framework for understanding its management and prognosis.

Randomized controlled trial of prolonged second stage: extending the time limit vs usual guidelines

Guidelines for management of the second stage have been proposed since the 1800s and were created largely by expert opinion. Current retrospective data are mixed regarding differences in maternal and neonatal outcomes with a prolonged second stage. There are no randomized controlled trials that have evaluated whether extending the second stage of labor beyond current American College of Obstetricians and Gynecologists recommendations is beneficial. The purpose of this study was to evaluate whether extending the length of labor in nulliparous women with prolonged second stage affects the incidence of cesarean delivery and maternal and neonatal outcomes. We conducted a randomized controlled trial of nulliparous women with singleton gestations at 36 0/7 to 41 6/7 weeks gestation who reached the American College of Obstetricians and Gynecologists definition of prolonged second stage of labor, which is 3 hours with epidural anesthesia or 2 hours without epidural anesthesia. Women were assigned randomly to extended labor for at least 1 additional hour, or to usual labor, which was defined as expedited delivery via cesarean or operative vaginal delivery. The exclusion criteria were intrauterine fetal death, planned cesarean delivery, age <18 years, and suspected major fetal anomaly. Primary outcome was incidence of cesarean delivery. Maternal and neonatal outcomes were compared secondarily. Statistical analysis was done by intention-to-treat. Seventy-eight nulliparous women were assigned randomly. All of the women had epidural anesthesia. Maternal demographics were not significantly different. The incidence of cesarean delivery was 19.5% (n = 8/41 deliveries) in the extended labor group and 43.2% (n = 16/37 deliveries) in the usual labor group (relative risk, 0.45; 95% confidence interval, 0.22-0.93). The number needed-to-treat to prevent 1 cesarean delivery was 4.2. There were no statistically significant differences in maternal or neonatal morbidity outcomes. Extending the length of labor in nulliparous women with singleton gestations, epidural anesthesia, and prolonged second stage decreased the incidence of cesarean delivery by slightly more than one-half, compared with usual guidelines. Maternal or neonatal morbidity were not statistically different between the groups; however, our study was underpowered to detect small, but potentially clinical important, differences.

Correlation of intrapartum translabial ultrasound parameters with computed tomographic 3D reconstruction of the female pelvis.

Intrapartum translabial ultrasound [ITU] can be an objective, reproducible and more reliable method than digital vaginal examination when evaluating fetal head position and station in prolonged second stage of labor. However, two-dimensional (2D) ultrasound is not sufficient to demonstrate the ischial spines and other important "landmarks" of the female pelvis. Therefore, the purpose of this study was to evaluate the distance of the interspinous plane as a parallel line to the infrapubic line in 2D ITU with the help of 3D computed tomography and digital reconstruction. Mean distance between the infrapubic plane and the tip of the ischiadic spine was 32.35 (±4.46) mm. The mean height was 166 (±7) cm; the mean weight was 67.5 (±18.4) kg. Body height and the measured distance were significantly correlated (P=0.025; correlation coefficient of 0.5), whereas body weight was not (P=0.37; correlation coefficient of -0.214). With the present results, clinicians were enabled to transfer the reproducible measurements of the "head station" by ITU to the widespread but observer-depending vaginal examination. Furthermore, ITU can be verified as an objective method in comparison to subjective palpation with the ability to optimize the evaluation of the head station according to bony structures as landmarks in a standardized application.