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Operative Delivery (operative + delivery)
Selected AbstractsRecurrent persistent occipito-posterior position in subsequent deliveriesBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2 2004Mikael Gardberg A nine year follow up study of the delivery pattern of 119 women after delivery in the persistent occiput posterior position and their occipito-anterior controls. The studied parameters were: number of deliveries, number of repeated cases of persistent occiput posterior position and operative deliveries. Deliveries in the occipito-posterior position were more common in the study group than in the controls (P= 0.031). Except for this, no statistically significant differences were found between the groups. According to the results, recurrence of the persistent occiput posterior position is common. A history of delivery in the persistent occiput posterior position does not seem to have any major impact on future childbearing. [source] Impact of Collaborative Management and Early Admission in Labor on Method of DeliveryJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 2 2003Debra J. Jackson senior researcher Objective: This study compared the effects of early admission in labor and perinatal care provider on delivery method. Higher spontaneous vaginal delivery rates for certified nurse midwives as compared with physicians have been reported in observational studies and randomized clinical trials. Certified nurse midwives, with their more expectant approach to labor management, would be expected to admit women later in labor than obstetricians. Methods: Prospective cohort study of 2,196 low-risk pregnancies, with singleton, vertex infants admitted in spontaneous labor. Independent and joint effects of perinatal care provider and cervical dilation at admission on delivery method were evaluated. Confounding was addressed using restriction and multiple regression. Results: Fewer (23.4%) women in collaborative care were admitted in early labor (< 4 cm cervical dilation) than women managed by obstetricians (95% CI =,27.6 to ,19.2). Obstetrician care had 9% to 30% fewer spontaneous vaginal deliveries. Women admitted early in labor also had 6% to 34% fewer spontaneous vaginal deliveries. Evaluation of joint effects suggested that interaction between obstetrician provider and earlier admission increased the risk of operative delivery. Conclusion: Later admission in labor (at 4 cm or greater cervical dilation) and management of perinatal care by certified nurse midwives in collaboration with obstetricians increased the rate of spontaneous vaginal delivery in low-risk women. [source] Risk factors for emergency cesarean delivery of the second twin after vaginal delivery of the first twinJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 3 2009Shunji Suzuki Abstract Aim:, A case-control study of twins was performed to identify clinical predictions of emergency cesarean delivery in the second-born twin after vaginal delivery of the first twin. Methods:, The obstetric records were reviewed of all twin vaginal deliveries at the Japanese Red Cross Katsushika Maternity Hospital from 2002 through 2007. Results:, There were 206 vaginal deliveries of first twins at ,33 weeks of gestation. Of these deliveries, nine women (4.4%) underwent an emergency cesarean for the delivery of the second twin. The incidence of cesarean delivery for the second twin was significantly greater in cases with a history of infertility therapy (odds ratio: 5.0, 95% confidence intervals: 1.2,22), gestational age at ,39 weeks (24, 4.7,120), nonvertex presentation (6.2, 1.5,26), operative delivery of the first twin (6.1, 1.5,24) and intertwin delivery time interval >30 min (7.2, 1.7,30). Conclusion:, The most important risk factor of emergency cesarean delivery in the second twin was a gestational age of ,39 weeks. [source] Does a change in obstetric management influence the incidence of traumatic birth lesions in mature, otherwise healthy newborn infants?JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 4 2007Willibald Zeck Abstract Aim:, The incidence of lesions due to birth trauma can be generally regarded as a characteristic of obstetric management; since obstetric management has changed through the years, one might expect a decrease or increase of lesions due to birth trauma in mature newborn infants. Methods:, In a retrospective study, the incidence of lesions due to birth trauma was recorded in the year 2000. In 1989, an identical study had already been carried out in the same department, employing the same criteria. The new findings were compared with the historical data. Results:, In the year 1989 24.6% and in 2000 13.2% showed lesions due to obstetric trauma. The episiotomy rate and lesions due to birth trauma had significantly decreased. A decline regarding the traumas per se was noticed in caput succedaneum traumas, in hematomas due to birth trauma and in clavicle fracture. The cesarean section rate among the study group increased. The cesarean section rate among the traumatized newborns decreased. Conclusion:, Episiotomy does not prevent newborns from traumatic lesions. Gestational age and birthweight have not significantly changed throughout the years; therefore an increase in the cesarean section rate must have contributed to the decrease of birth traumas. Even during abdominal operative delivery, obstetric traumas in newborns do occur. However, an increase in cesarean sections alone can not thoroughly explain the reduction of birth lesion among newborns. Improvement in prenatal diagnostic tools and procedures, respectively, and a goal-oriented use of labor induction might also play a major role. [source] Modelling the likelihood of levator avulsion in a urogynaecological populationAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2010H. P. DIETZ Background:, Avulsion of the puborectalis muscle is a consequence of vaginal childbirth and associated with female pelvic organ prolapse. It can be palpated, although diagnosis by imaging seems more reliable. Aims:, To define the prior probability of avulsion based on history and gynaecological examination, in order to facilitate clinical diagnosis. Methods:, Over 3 years, 983 women had been assessed by 3D ultrasound at a tertiary urogynaecological unit. We analysed our database for predictors of puborectalis avulsion and designed a simplified predictive model with the help of backwards stepwise logistic regression. Results:, The following factors were strongly associated with the diagnosis of avulsion: age at first vaginal delivery, no stress incontinence, vaginal operative delivery, prolapse symptoms, cystocele, uterine prolapse, minimum Oxford grading of muscle strength and side differences in Oxford grading (all P < 0.001). Multivariate logistic regression produced a model that had an adjusted r2 of 37.2%, predicting 81% of cases correctly. Conclusions:, This study was undertaken to define the ,typical' patient suffering from avulsion of the puborectalis muscle, a common childbirth-related injury. Levator defects are most likely in women who had their first child by vaginal operative delivery over the age of 30 years, presenting with symptoms of prolapse without stress incontinence. [source] Does delayed child-bearing increase the risk of levator injury in labour?AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 6 2007Hans P. DIETZ Abstract Background:, Levator trauma is common in parous women. We have recently found a relationship with age at first vaginal delivery in women seen before and after childbirth. Aims:, To examine women presenting with symptoms of pelvic floor disorders for such an association. Methods:, Eight hundred and one women were prospectively seen for an interview, clinical examination (including for levator integrity and function in 789 cases), multichannel urodynamic testing and pelvic floor ultrasound (including 3D imaging in 350 cases). Findings were tested for association with maternal age at first vaginal delivery, parity and operative vaginal delivery using logistic regression. Results:, Mean age was 55.3 years (range 17,90), with 79% complaining of stress urinary incontinence and 28% of symptoms of prolapse. Median vaginal parity was 2 (range 0,12); mean age at first vaginal delivery was 24 (range 14,39). Levator defects were found in 170 women (21.6%), 24% of the vaginally parous. Defects were more common on the right (86%) than left (45%) (P < 0.0001). Women with levator trauma had a higher mean age (25.5 (SD 5.2) vs 23.5 (SD 4.5) years, P < 0.0001). Regression modelling confirmed findings, demonstrating an increase in the odds of levator trauma of approximately 10% for every year of delay in child-bearing. Vaginal operative delivery was associated with a near-doubling of the odds of trauma. Conclusions:, Increased maternal age is a risk factor for intrapartum pelvic floor trauma. The global trend towards delayed child-bearing may result in an increased prevalence of pelvic floor disorders in coming decades. [source] High incidence of obstetric interventions after successful external cephalic versionBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2002Louis Yik-Si Chan Objective To investigate the delivery outcome after successful external cephalic version (ECV). Design Case,control study. Setting University teaching hospital. Population The study group consisted of 279 consecutive singleton deliveries at term over a six-year period, all of which had had successful ECV performed. The control group included 28,447 singleton term deliveries during the same six-year period. Methods Between group differences were compared with the Mann,Whitney U test or Student's t test where appropriate. Odds ratio and 95% confidence interval (CI) were calculated for categorical variables. Main outcome measures Incidence of and indications for obstetric interventions. Results The risk of instrumental delivery and emergency caesarean section was higher in the ECV group (14.3%vs 12.8%; OR 1.4; 95% CI 1.0,2.0, and 23.3%vs 9.4%; OR 3.1; 95% CI 2.3,4.1, respectively). The higher caesarean rate was due to an increase in all major indications, namely, suspected fetal distress, failure to progress in labour and failed induction. The higher incidence of instrumental delivery was mainly due to an increase in prolonged second stage. The odds ratio for operative delivery remained significant after controlling for potential confounding variables. There were also significantly greater frequencies of labour induction (24.0%vs 13.4%; OR 2.0; 95% CI 1.5,2.7) and use of epidural analgesia (20.4%vs 12.4%; OR 1.8; 95% CI 1.4,2.4) by women in the ECV group. The higher induction rate is mainly due to induction for post term, abnormal cardiotocography (CTG) and antepartum haemorrhage (APH) of unknown origin. Conclusion The incidence of operative delivery and other obstetric interventions are higher in pregnancies after successful ECV. Women undergoing ECV should be informed about this higher risk of interventions. [source] Role of proteinuria in defining pre-eclampsia: Clinical outcomes for women and babiesCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 4 2010Charlene E Thornton Summary 1.,The presence of proteinuria is not essential to the diagnosis of pre-eclampsia under many diagnostic consensus statements. The aim of the present study was to assess maternal and perinatal outcomes after proteinuric pre-eclampsia compared with other non-proteinuric disease presentations. 2.,An individual patient data review (n = 670) was undertaken for 2003,2006 at a tertiary referral centre in Sydney (NSW, Australia). Women were diagnosed in accordance with the Australasian Society for the Study of Hypertension in Pregnancy Consensus Statement. Data were analysed with the Chi-squared test, t -tests and non-parametric tests. Statistical significance was set at P < 0.05. 3.,The proteinuric cohort had higher systolic and diastolic blood pressure recordings than the non-proteinuric cohort (160/102 and 149/94 mmHg, respectively; P < 0.001), and were also administered magnesium sulphate more frequently (44 vs 22%, respectively; P < 0.001), delivered at earlier gestation (37 vs 38 weeks, respectively; P < 0.001), required operative delivery more frequently (63 vs 48%, respectively; P < 0.001) and received more antihypertensive medications during the antenatal period (72 vs 57%, respectively; P < 0.001). Acute renal failure and acute pulmonary oedema were rare. Four cases of eclampsia all occurred in non-proteinuric women. The perinatal mortality rate was lower for the offspring of women with proteinuric pre-eclampsia compared with offspring of non-proteinuric women (13/1000 and 31/1000, respectively; P = 0.006). 4.,The results of the present study indicate that the presence of proteinuria denotes a group of women who have higher antenatal blood pressure, who deliver at earlier gestation and require operative delivery more commonly, although it is not an indicator of other markers of maternal morbidity or perinatal mortality. [source] | ||||||||||