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Vaginally
Kinds of Vaginally Selected AbstractsDelayed umbilical cord clamping at birth has effects on arterial and venous blood gases and lactate concentrationsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2008N Wiberg Objective, To estimate the influence of delayed umbilical cord clamping at birth on arterial and venous umbilical cord blood gases, bicarbonate (), base excess (BE) and lactate in vigorous newborns. Setting, University hospital. Design, Prospective observational. Sample, Vaginally delivered term newborns. Material and methods, Umbilical cord arterial and venous blood was sampled repeatedly every 45 seconds (T0= time zero; T45= 45 seconds, T90= 90 seconds) until the cord pulsations spontaneously ceased in 66 vigorous singletons with cephalic vaginal delivery at 36,42 weeks. Longitudinal comparisons were performed with the Wilcoxon signed-ranks matched pairs test. Mixed effect models were used to describe the shape of the regression curves. Main outcome measures, Longitudinal changes of umbilical cord blood gases and lactate. Results, In arterial cord blood, there were significant decreases of pH (7.24,7.21), (18.9,18.1 mmol/l) and BE (,4.85 to ,6.14 mmol/l), and significant increases of PaCO2 (7.64,8.07 kPa), PO2 (2.30,2.74 kPa) and lactate (5.3,5.9 mmol/l) from T0 to T90, with the most pronounced changes at T0,T45. Similar changes occurred in venous blood pH (7.32,7.31), (19.54,19.33 mmol/l), BE (,4.93 to ,5.19 mmol/l), PaCO2 (5.69,5.81 kPa) and lactate (5.0,5.3 mmol/l), although the changes were smaller and most pronounced at T45,T90. No significant changes were observed in venous PO2. Conclusion, Persistent cord pulsations and delayed cord clamping at birth result in significantly different measured values of cord blood acid,base parameters. [source] Rupture of a Right Sinus of Valsalva Aneurysm into the Right Ventricle During Vaginal Delivery: A Case ReportECHOCARDIOGRAPHY, Issue 10 2005F.E.S.C., Josip Vincelj M.D., Ph.D. A case is reported of a right sinus of Valsalva aneurysm rupture into the right ventricle during vaginal delivery in a 34-year-old healthy woman in her third pregnancy. Pregnancy was carried to term and a healthy baby was delivered vaginally. On day 7 following vaginal delivery she was admitted to hospital for dyspnea and cough, with clinical signs of severe heart failure. The diagnosis of the right sinus of Valsalva aneurysm rupture into the right ventricle was established by transthoracic and transesophageal echocardiography. Clinical recognition and early echocardiographic diagnosis followed by immediate surgical repair proved lifesaving in our patient. (ECHOCARDIOGRAPHY, Volume 22, November 2005) [source] The optimal mode of delivery for the haemophilia carrier expecting an affected infant is caesarean deliveryHAEMOPHILIA, Issue 3 2010A. H. JAMES Summary., While a majority of affected infants of haemophilia carriers who deliver vaginally do not suffer a head bleed, the outcome of labour cannot be predicted. A planned vaginal delivery puts a woman at risk of an abnormal labour and operative vaginal delivery, both of which predispose to intracranial haemorrhage. Furthermore, vaginal delivery does not eliminate the risk to the haemophilia carrier herself. Overall, maternal morbidity and mortality from planned vaginal delivery are not significantly different from those from planned caesarean delivery. Caesarean delivery is recommended or elected now in conditions other than haemophilia carriage, where the potential benefits are not nearly as great. Additionally, vaginal delivery of the haemophilia carrier poses medical/legal risks if the infant is born with cephalohaematoma or intracranial haemorrhage. Caesarean delivery allows for a planned, controlled delivery. Caesarean delivery reduces the risk of intracranial haemorrhage by an estimated 85% and the risk can be nearly eliminated by performing elective caesarean delivery before labour. Therefore, after a discussion of the maternal and foetal risks with planned vaginal delivery versus planned caesarean delivery, haemophilia carriers should be offered the option of an elective caesarean delivery. [source] Beliefs about the causes of cervical cancer in Botswana: implications for nursingINTERNATIONAL NURSING REVIEW, Issue 4 2009D. M. McFarland rn Background:, Cervical cancer is the most common cause of cancer mortality and morbidity for women in Botswana. Yet, little is known about what women believe to be the causes of the disease. Aim:, This paper presents data on factors women in Botswana believe are responsible for the high incidence of cervical cancer in their country. Data were part of a larger study that explored knowledge and perceptions about cervical cancer and Pap smear screening from the perspectives of the clients and the healthcare providers. Methods:, The study that generated the data included 30 women of all socio-economic levels, recruited by network sampling. The women's ages ranged from 31 to 54 years. Demographic data were analysed descriptively. Individualized interview data were content-analysed. Findings:, The identified causes of cervical cancer were classified as cervical irritants and non-irritants. The most commonly cited cervical irritants were vaginally inserted chemical agents and traditional medicine. Discussions:, Participants identified vaginally inserted chemical substances and traditional medicines as possible explanations for the high incidence of cervical cancer in Botswana. They reported that women used these substances for sexual and hygienic purposes. Although these factors are believed to be the causes of cervical cancer and have not yet been medically acknowledged, verbal reports suggest that their use is problematic. Conclusion:, There is a need for health education and for further research to affirm women's beliefs about the harmful effects of intravaginal agents. [source] The Effect of Ultra Low Dose Epidural Analgesia on Newborn Breastfeeding BehaviorsJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 3 2003RN assistant professor, Sharon Radzyminski PhD, graduate program director Objective: To determine whether a difference in breastfeeding behaviors could be observed between newborns whose mothers received epidural analgesia for labor pain relief and those newborns whose mothers received no pain medication in labor. Design: There were two groups of neonates in this study. One group was born to mothers who received epidural analgesia, and one group was born to mothers who received no pain medication for labor. Both groups were observed for initial breastfeeding behaviors using the Premature Infant Breastfeeding Behavior Scale following birth and at 24 hours. Central nervous system functioning in the newborn was measured with the Neurologic and Adaptive Capacity Score at 2 and 24 hours of age. Setting: A large tertiary hospital in northeast Ohio. Participants: Fifty-six breastfeeding mother-newborn dyads. All mothers were healthy multiparae who gave birth vaginally to normal, full-term, healthy newborns. Main Outcome Measures: Newborns were observed for rooting, latch on, sucking, swallowing, activity state, and neurobehavior. Results: There were no statistically significant differences in breastfeeding behaviors at birth or at 24 hours of age. Conclusion: A possible cause for the lack of significant results may have been the ultra low dose of bupivacaine and fentanyl used in this sample. [source] Sublingual versus vaginal misoprostol for the management of missed abortionJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 3 2010Fateme Davari Tanha Abstract Aim:, To evaluate the efficacy of two routes of misoprostol administration (sublingual and vaginal) for the treatment of missed abortion. Methods:, Two hundred and twenty women with confirmed missed abortion who received 400 µg/6 h misoprostol either sublingually or vaginally, were included in this randomized control trial. All women were admitted to hospital for follow-up care for 2 days. If the pregnancy was not completely evacuated during this time, the patient underwent immediate surgical completion. Efficacy was defined as the percentage of women discharged from the study without the need for surgical intervention. Results:, The effectiveness was high in the sublingual group and statistically different (sublingual 84.5%, vaginal 46.4% P = 0.000 RR = 0.54 95%CI = 0.442,0.681). The groups differed in terms of complications like bleeding (88.2% vs 65.5%), pain (85.5% vs 56.4%), diarrhea (69.1% vs 36.4%) and fever (23.6% vs 13.3%) in the sublingual group versus the vaginal group, but the mean time to expulsion was shorter (9.68 h SD = 5.51 95%CI = 8.61,10.57) in the sublingual group than the vaginal group (16.64 h SD = 14.01 95%CI = 13.8,19.48), P = 0.000. Women in the sublingual group were highly satisfied with the method. Conclusion:, Sublingual misoprostol for the medical management of missed abortion is more effective and more acceptable than the vaginal route. However, it showed more adverse effects. [source] Comparison of maternal and newborn outcomes of Tibetan and Han Chinese delivering in Lhasa, TibetJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 6 2008Suellen Miller Abstract Aim:, To compare maternal and neonatal outcomes of Tibetan and Han Chinese women delivering vaginally at high altitude (3650 meters) in Lhasa, Tibet Autonomous Region, People's Republic of China. Method:, Comparative analysis of data from a prospective observational study of Tibetan (n = 938) and Han Chinese (n = 146) women delivering at three hospitals between January 2004 and May 2005. Results:, Han Chinese women had higher rates of pre-eclampsia/gestational hypertension than Tibetan women, (10.3% vs 5.9%, P = 0.04). There was no difference in rates of postpartum hemorrhage between Tibetan and Han women (12.8% vs 17.1%, P = 0.15). Han newborns weighed significantly less than Tibetan newborns (P < 0.01), and were twice as likely to be small for gestational age, (24.5% vs 11.6%, P < 0.01). Tibetan newborns were less likely to have poor neonatal outcomes than Han newborns (P < 0.01). Conclusion:, In high altitude deliveries in Tibet, adverse outcomes were significantly more common among Han Chinese. [source] Vaginal misoprostol for cervical priming before dilatation and curettage in postmenopausal women: A randomized controlled trialJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 3 2004Soysuwan Bunnasathiansri Abstract Aim: To investigate the efficacy of vaginal misoprostol for cervical priming before dilatation and curettage in postmenopausal women. Methods: Forty-four postmenopausal women with indication for dilatation and curettage were randomly assigned to receive either 400 µg of misoprostol or placebo vaginally 6 h before dilatation and curettage. The main outcome measures were the number of women who required cervical dilatation, cervical width, time taken to dilate to Hegar 6 and other complications. Results: The mean cervical diameter (4.59 millimeters in the misoprostol group vs 4.41 millimeters in the placebo group) was comparable between the two groups. A similar number of women in the misoprostol group and in the placebo group required cervical dilatation (12 vs 16, P = 0.35). The operative times for both groups were similar. The incidence of side-effects was comparable in both groups. There were two uterine perforations in the misoprostol group (2 vs 0). Conclusion: There was no significant benefit from applying 400 µg vaginal misoprostol 6 h prior to dilatation and curettage in postmenopausal women. [source] D-dimer levels during delivery and the postpartumJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 2 2005M. EPINEY Summary.,Background: D-dimer (DD) measurement has proved to be very useful to exclude venous thromboembolism (VTE) in outpatients. However, during pregnancy, the progressive increase as well as the interindividual variations of DD means that in this instance they are of poor value to rule out VTE. Only a few studies have reported measurements of DD levels in the postpartum. Objectives: To measure DD sequentially in the puerperium in order to determine when DD levels return to values obtained in non-pregnant women and can again be used in the exclusion of VTE. Patients and methods: After uncomplicated pregnancies, 150 women delivering at term either vaginally (n = 100) or by cesarean section (n = 50) were included. DD levels were measured immediately following delivery and next at days 1, 3, 10, 30 and 45. Results: There was a marked elevation of DD at delivery, especially when instrumental. All DD measurements were above 500 ng mL,1 at delivery, at day 1 and at day 3 postpartum. A sharp decrease in DD was observed between day 1 and day 3, followed by a slight increase at day 10. At day 30 and day 45, respectively, 79% and 93% of women in the vaginal delivery group and 70% and 83% in the cesarean group had levels below 500 ng mL,1. Bleeding, breastfeeding and heparin prophylaxis did not modify DD levels significantly. Conclusion: Using the Vidas DD new assay, our study provides reference intervals for DD in the postpartum period. Using a cut-off at 500 ng mL,1, DD measurement for ruling out VTE was found to be useful again 4 weeks after delivery. [source] Urinary Bladder Herniation through a Vaginal Tear in a Rottweiller with DystociaJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 3 2000DACVECC, Deborah C. Mandell VMD Summary A four-year old female Rottweiler presented with a 34-hour history of dystocia. Physical examination revealed a purple-black, fluid-filled sac protruding from vulva and suspended by a similar colored stalk. Digital vaginal examination indicated that the stalk of tissue extended up into the cervix and beyond. Due to the grossly necrotic appearance, the stalk of tissue was ligated, and the sac was removed. Three puppies were delivered vaginally, but a subsequent caesarian section was required due to uterine inertia likely secondary to exhaustion. Three more live puppies were delivered via the c-section. Further abdominal exploration revealed a tear in the left vaginal wall, one ligated ureter, and the second ureter free at its distal end and leaking urine into the abdomen. The surgical findings indicated that the bladder, ureters, and urethra had herniated through the vaginal tear and prolapsed through the vulva. [source] Maternal factors associated with the duration of breast feeding in Jeddah, Saudi ArabiaPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 1 2003Sherine Shawky Summary Recently, there has been increasing concern about the decline in breast-feeding pattern in developing countries. The objectives of this study were to document the recent breast-feeding trends in Jeddah during the first year of an infant's life and identify the probable maternal risk factors implicated in breast-feeding cessation. Data were collected from six randomly selected primary health care centres in Jeddah City. All married women with an infant , 12 completed months of age were interviewed, and information on socio-demographic characteristics, breast feeding and contraceptive use were collected. Cox proportional hazard regression model was used to calculate the adjusted odds ratios for the various maternal risk factors related to breast-feeding cessation. A total of 400 women were enrolled in the study. Their mean age at delivery was 28.0 years (SD = 4.1 years). Approximately 40.0% had never attended school, 43.0% had at least five children and 13.8% were smokers. Deliveries by caesarean section were reported by 13.0% of women and contraceptive use by 44.7%, among whom oral contraceptives were the commonest method. Around 94.0% of women ever initially breast fed their infants, and this proportion dropped to 40.0% by the infant's 12th month. Women who delivered by caesarean section (OR = 1.9 [95% CI 1.3, 2.8]P = 0.001) and those who used oral contraceptives (OR = 1.5 [95% CI 1.1, 2.2]P = 0.031) were at higher risk of stopping breast feeding and lower probability of maintaining breast feeding to the 12th month post partum than those who delivered vaginally and did not use oral contraceptives. Breast-feeding practice seems to decline rapidly during the first year of the infant's life. Health care professionals should promote breast-feeding practice as early as the antenatal period. They should also take into consideration the impact of caesarean section deliveries and early oral contraceptive use to avoid their negative impact on breast-feeding practice. [source] Rehospitalisation for neonatal jaundice: risk factors and outcomesPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 4 2001Ann M. Geiger Summary This case,control study sought to determine whether rehospitalisation for jaundice in newborns is associated with the length of hospital stay after birth and to identify risk factors for and outcomes of rehospitalisation for jaundice. It was carried out among women who delivered a normal, term infant vaginally at any of 10 medical centres from 1992 to 1994. Cases were infants rehospitalised with jaundice within 14 days of birth. Controls were randomly selected from normal, term infants delivered vaginally but not rehospitalised within 90 days of birth. Maternal medical records for pregnancy, labour and delivery care, records for all the birth hospitalisations, and rehospitalisations for the cases were abstracted. The length of birth hospitalisation did not differ between case and control infants, whether length was measured as a categorical variable or as a continuous measure (median = 22.8 h for cases and 23.3 h for controls, P = 0.931). Rehospitalisation for jaundice was associated with race/ethnicity, primiparity, preterm birth, breast feeding and suspicion of jaundice during the birth hospitalisation. None of the rehospitalised infants died, were diagnosed with kernicterus or required resuscitation. Attention to risks associated with jaundice rehospitalisation might reduce this undesirable, but not commonly severe, outcome. [source] Management and outcome in prenatally diagnosed sacrococcygeal teratomasPEDIATRICS INTERNATIONAL, Issue 4 2008Tadao Okada Abstract Background: The aim of the present study was to retrospectively determine the clinical factors affecting the outcome after birth in prenatally diagnosed sacrococcygeal teratomas (SCT). Methods: Six cases of prenatal SCT were identified from January 1985 until August 2005. A retrospective review of case-notes and pathological reports was carried out. Clinical data during the perinatal period, operative findings, postoperative complications and follow up were evaluated in the patients with prenatally diagnosed SCT. Results: SCT presented as type I in two neonates and type III in four between 22 and 33 weeks' gestation. Fetal intervention was not performed for any fetus. Five of six were delivered by cesarean section and the other was delivered vaginally due to small tumor size. Patients were born at between 29 and 39 weeks' gestation and weighed from 1840 to 3500 g. All patients with type III SCT presented with related diseases, including bilateral hydronephrosis, neurological deficit of the communicating peroneal nerve such as paralytic talipes equines, bladder or bowel dysfunction, high-output cardiac failure, or fetal hydrops in one of a set of fraternal twins. A baby with high-output cardiac failure and fetal hydrops underwent urgent cesarean section at 29 weeks' gestation and died 8 days after birth despite intensive care due to multi-organ failure. In five cases, surgery was successful with good outcomes maintained at follow-up of between 8 months and 14 years. Conclusions: Detailed ultrasound should be performed to rule out associated anomalies, and determine the presence or absence of hydrops in prenatally diagnosed SCT. Fetal hydrops, orthopedic impairment such as lower extremity weakness and swelling, and urinary incontinence are important clinical factors affecting the outcome after birth in prenatally diagnosed SCT. In particular, the present study indicated that the association of a fraternal twin and fetal hydrops makes it very difficult to treat SCT perinatally. [source] Nucleated red blood cell counts and erythropoietin levels in high-risk neonatesPEDIATRICS INTERNATIONAL, Issue 6 2002Ülfet Vatansever Abstract Background: The presence of increased numbers of nucleated red blood cells (NRBC) and increased levels of erythropoietin (EPO) in the circulation of neonates has been associated with states of relative hypoxia. The aim of this study is to assess the pattern of NRBC counts and EPO levels in a group of high-risk neonates under stress conditions and determine the short-term outcome for these babies by using these parameters. Methods: There were 69 high-risk neonates; 14 intrauterine growth retarded (IUGR), 25 preterm infants, 18 term infants with asphyxia and 12 infants of diabetic mothers. Control groups included healthy, term infants delivered either vaginally (n = 18) or with cesarean section (n = 19). Three blood samples were obtained from each infant within 12 h (initial), 3 days and 7 days after birth to measure NRBC counts and EPO levels. Neonatal and short-term outcomes at 3 and 6 months of age were determined. Results: There was no significant difference among the groups with regard to the initial serum EPO concentrations. The initial NRBC counts were significantly lower in the control groups compared with the study groups (P = 0.002). While there was no significant difference between patients with good and poor outcome in terms of EPO concentrations of initial samples, a significant difference existed in terms of NRBC counts (P = 0.038). Conclusions: Both serum EPO level and NRBC count provide limited clinical benefit in the detection of pathological conditions of the neonatal period, but NRBC count determination seems to be especially helpful in predicting short-term neurodevelopmental outcome. [source] Effects of bathing immediately after birth on early neonatal adaptation and morbidity: A prospective randomized comparative studyPEDIATRICS INTERNATIONAL, Issue 5 2000Yasushi Nako Abstract Objective: Because the risks and benefits of early bathing of newborn infants are not well established, we investigated the effects of bathing immediately after birth on rectal temperature, respiratory rate, heart rate, blood pressure, percutaneous arterial blood oxygen saturation (SpO2) and early neonatal morbidity. Methods: The study was designed as a randomized prospective comparative study in the neonatal care unit of a university hospital. A total of 187 healthy term and near-term newborn infants, who were delivered vaginally without asphyxia, between January and December 1997 were the study subjects. We compared findings in newborns who were bathed 2,5 min after birth (n=95) with those of a control group (n=92) who received dry care instead. Groups were comparable with respect to gestational age, birthweight, male : female ratio, Apgar score and umbilical blood pH. Rectal temperature was measured with an electronic thermometer immediately before the intervention bathing or dry care and at 30 min and 1, 2, 3, 8 and 12 h after birth. Heart rate, respiratory rate, systolic and diastolic blood pressure and SpO2 were measured at 1, 2, 8 and 12 h after birth. The incidence of early neonatal morbidity, including hyperbilirubinemia and gastrointestinal and respiratory problems, was also compared. Results: Rectal temperature changed over time postnatally in both groups (P<0.0001, ANOVA) and there was a significant difference in rectal temperature between groups (P<0.0001, ANOVA). Mean (± SEM) rectal temperature at 30 min after birth (i.e. approximately within 20 min after intervention) was significantly higher in the bathed group than in the control (dry care) group (37.30~0.06 vs 37.00~0.05°C, respectively; P=0.000022). Respiratory rate, heart rate, blood pressure and the ratio of the number of infants with SpO2 90,94% and 95,100% did not differ significantly between the two groups. The incidence of early neonatal morbidity, including vomiting, acute gastric mucosal lesion, polycythemia, need for tube feeding, phototherapy and oxygen therapy, also did not differ between the two groups. Conclusions: Early bathing, minutes after birth, did not appear to adversely affect the adaptation of healthy full-term and near-term newborn infants. [source] Limitations of the Human-PBL-SCID Mouse Model for Vaginal Transmission of HIV-1AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 5 2007Osmond J. D'Cruz Problem SCID mice reconstituted with human peripheral blood lymphocytes (PBL) are amenable to vaginal transmission of HIV-1. We investigated the effectiveness of this model to establish systemic HIV-1 infection. Method of study Eighty progesterone-primed C.B-17 SCID mice were reconstituted with human-PBLs and intravaginally inoculated with CCR5 HIV-1 (BaL or 92BR09) infected human-PBLs in the presence of human semen. After two weeks, viral RNA load in spleen, peritoneal lavage (PL), and serum was quantitated by the nucleic acid sequence-based amplification method. Results In five independent experiments, spleen from 8/60 (13.3%), PL from 7/60 (11.6%), and serum from 16/56 (28.5%) mice were positive for BaL HIV-1 infection. Similarly, spleen from 4/20 (20%), PL from 1/20 (5%) and serum from 5/20 (25%) mice vaginally inoculated with 92BR09-infected human-PBLs were positive for HIV-1. A one-sided power analysis using normal approximation revealed that at 5% significance level, the overall response rate need to increase form 0.29 to 0.9 and 80% of the control groups needs to achieve a response rate between 6/10 and 9/10 to make the assay feasible. Conclusion The incidence of vaginal transmission of CCR5 HIV-1 in the human-PBL-SCID mouse was low and variable, which constitutes a major disadvantage for preclinical evaluation of vaginal microbicides. [source] Hysterectomy trends in Australia , between 2000/01 and 2004/05AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2010Erin L. HILL Background:, Hysterectomy is a major and common surgical procedure that has the potential to provide relief from ongoing gynaecological problems, but is often associated with negative impacts on health and wellbeing. Research indicates that hysterectomy rates and trends vary widely between and within countries; yet little is known about patterns in Australia. Aims:, This research aimed to describe hysterectomy rates and trends in Australia between 2000/01 and 2004/05. Methods:, This repeat cross-sectional study used routinely collected data from all hospitals in Australia. Data on all women admitted to hospital for a hysterectomy were obtained from the National Hospital Morbidity Database (2000/01,2004/05). Data were analysed by calculating population rates for each type of hysterectomy. Incidence rate ratios were calculated to assess changes over time. Results:, Hysterectomy rates in Australia declined from 34.8 per 10 000 women in 2000/01 to 31.2 per 10 000 women in 2004/05. A decline in the incidence rate for abdominal hysterectomy (from 18.7 to 15.1 per 10 000 women) and the incidence rate for concurrent oophorectomy (from 12.4 to 11.3 per 10 000 women) were also observed during this time period. At each point in time, the highest incidence rates for hysterectomy were for women aged 45,54 years. Conclusions:, Hysterectomy rates in Australia are declining over time and currently appear to be lower than most other countries. More hysterectomies are performed vaginally than in Canada, the USA, the UK and Finland and the rate of concurrent oophorectomy is less than that reported in the USA and the UK. [source] Can antenatal education influence how women push in labour?AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2009A Pilot Randomised Controlled Trial on Maternal Antenatal Teaching for Pushing in Second Stage of Labour (PUSH STUDY) Background:, Antenatal education on the physiology of second stage of labour and effective pushing has not been studied in the literature. Anecdotal observation seems to indicate that some nulliparous women are (at least initially) unable to push effectively. A large proportion seem to reflexly contract the levator ani muscle when asked to push which may have the effect of slowing the progress of labour. Aims:, To test the effectiveness of structured antenatal education for pushing in the second stage of labour versus normal care and its impact on delivery outcome. Methods: One hundred nulliparous women between 35 and 37 weeks gestation were randomised. Intervention: Two 15-min structured education sessions, one week apart, utilising observation of the perineum and a vaginal examination to teach correct technique for relaxing the levator ani muscle and effective pushing. Results:, In both groups, 31 of 50 women (62%) delivered vaginally. Instrumental delivery and caesarean section rates did not differ between the two groups (P = 0.78, relative risk = 1). The mean duration of active second stage for the control group was 53.96 min compared with 57.26 min for the intervention group. This difference of 3.3 min was not statistically significant (P = 0.56). Knowledge of women in the intervention group was increased and the majority of women found the educational sessions helpful. Conclusion:, Antenatal teaching to ensure effective maternal pushing in labour did not result in altered obstetric outcomes relative to the control group. However, there was a measurable qualitative effect from the intervention in that women clearly felt the education sessions to be helpful. [source] Transplacental haemorrhage may explain the intrapartum transmission of HIV.AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 6 2008A pilot study uses flow cytometry to quantify maternal red blood cells in infants born vaginally or by caesarean section Intrapartum transmission is epidemiologically important for some viruses such as HIV and hepatitis B virus, but its precise mechanism is unknown. We hypothesised that the ability of elective caesarean section to prevent HIV may be due to prevention of transplacental microtransfusions of blood during labour. Their frequency is not known so we performed a pilot study which showed evidence of transplacental transfusion from mother to fetus in one of ten mother,infant pairs delivering vaginally and none of ten delivering by elective caesarean section. We conclude that transplacental transfusion occurs and is one possible mechanism for the intrapartum transmission of viruses from mother to baby. [source] Infant and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women with "No Indicated Risk," United States, 1998,2001 Birth CohortsBIRTH, Issue 3 2006Marian F. MacDorman PhD ABSTRACT:,Background: The percentage of United States' births delivered by cesarean section has increased rapidly in recent years, even for women considered to be at low risk for a cesarean section. The purpose of this paper is to examine infant and neonatal mortality risks associated with primary cesarean section compared with vaginal delivery for singleton full-term (37,41 weeks' gestation) women with no indicated medical risks or complications. Methods: National linked birth and infant death data for the 1998,2001 birth cohorts (5,762,037 live births and 11,897 infant deaths) were analyzed to assess the risk of infant and neonatal mortality for women with no indicated risk by method of delivery and cause of death. Multivariable logistic regression was used to model neonatal survival probabilities as a function of delivery method, and sociodemographic and medical risk factors. Results: Neonatal mortality rates were higher among infants delivered by cesarean section (1.77 per 1,000 live births) than for those delivered vaginally (0.62). The magnitude of this difference was reduced only moderately on statistical adjustment for demographic and medical factors, and when deaths due to congenital malformations and events with Apgar scores less than 4 were excluded. The cesarean/vaginal mortality differential was widespread, and not confined to a few causes of death. Conclusions: Understanding the causes of these differentials is important, given the rapid growth in the number of primary cesareans without a reported medical indication. (BIRTH 33:3 September 2006) [source] Antenatal Perineal Massage for Reducing Perineal TraumaBIRTH, Issue 2 2006M.M. Beckmann Background:, Perineal trauma following vaginal birth can be associated with significant short- and long-term morbidity. Antenatal perineal massage has been proposed as one method of decreasing the incidence of perineal trauma. Objectives:, To assess the effect of antenatal perineal massage on the incidence of perineal trauma at birth and subsequent morbidity. Search strategy:, We searched the Cochrane Pregnancy and Childbirth Group Trials Register (30 January 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2005), PubMed (1966 to January 2005), EMBASE (1980 to January 2005) and reference lists of relevant articles. Selection criteria:, Randomised and quasi-randomised controlled trials evaluating any described method of antenatal perineal massage undertaken for at least the last four weeks of pregnancy. Data collection and analysis:, Both review authors independently applied the selection criteria, extracted data from the included studies and assessed study quality. We contacted study authors for additional information. Main results:, Three trials (2434 women) comparing digital perineal massage with control were included. All were of good quality. Antenatal perineal massage was associated with an overall reduction in the incidence of trauma requiring suturing (three trials, 2417 women, relative risk (RR) 0.91 (95% confidence interval (CI) 0.86 to 0.96), number needed to treat (NNT) 16 (10 to 39)). This reduction was statistically significant for women without previous vaginal birth only (three trials, 1925 women, RR 0.90 (95% CI 0.84 to 0.96), NNT 14 (9 to 35)). Women who practised perineal massage were less likely to have an episiotomy (three trials, 2417 women, RR 0.85 (95% CI 0.75 to 0.97), NNT 23 (13 to 111)). Again this reduction was statistically significant for women without previous vaginal birth only (three trials, 1925 women, RR 0.85 (95% CI 0.74 to 0.97), NNT 20 (11 to 110)). No differences were seen in the incidence of 1st or 2nd degree perineal tears or 3rd/4th degree perineal trauma. Only women who have previously birthed vaginally reported a statistically significant reduction in the incidence of pain at three months postpartum (one trial, 376 women, RR 0.68 (95% CI 0.50 to 0.91) NNT 13 (7 to 60)). No significant differences were observed in the incidence of instrumental deliveries, sexual satisfaction, or incontinence of urine, faeces or flatus for any women who practised perineal massage compared with those who did not massage. Authors' conclusions:, Antenatal perineal massage reduces the likelihood of perineal trauma (mainly episiotomies) and the reporting of ongoing perineal pain and is generally well accepted by women. As such, women should be made aware of the likely benefit of perineal massage and provided with information on how to massage. *** The preceding report is an Abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464,780X). The Cochrane Database of Systematic Reviews 2006 Issue 1. Copyright © 2006 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. [source] Postpartum Maternal Oxytocin Release by Newborns: Effects of Infant Hand Massage and SuckingBIRTH, Issue 1 2001Ann-Sofi Matthiesen BSc Background:Newborns placed skin-to-skin with their mothers show an inborn sequence of behavior similar to that seen in other mammals. The purpose of this study was to make a detailed exploration of hand movements and sucking behavior in healthy term newborns who were placed skin-to-skin on their mothers' chests, and to study maternal oxytocin release in relation to these behaviors.Methods:Ten vaginally delivered infants whose mothers had not been exposed to maternal analgesia were video-recorded from birth until the first breastfeeding. Video protocols were developed based on observations of the videotapes. Each infant's hand, finger, mouth, and tongue movements, positions of the hand and body, and sucking behavior were assessed every 30 seconds. Maternal blood samples were collected every 15 minutes, and oxytocin levels were analyzed by radioimmunoassay. A statistical test for establishing the relationship between maternal oxytocin levels and infants' hand movements or sucking behavior was developed.Results:Infants used their hands to explore and stimulate their mother's breast in preparation for the first breastfeeding. A coordinated pattern of infant hand and sucking movements was also identified. When the infants were sucking, the massagelike hand movements stopped and started again when the infants made a sucking pause. Periods of increased massagelike hand movements or sucking of the mother's breast were followed by an increase in maternal oxytocin levels (p < 0.005). Conclusions:The findings indicate that the newborns use their hands as well as their mouths to stimulate maternal oxytocin release after birth, which may have significance for uterine contraction, milk ejection, and mother-infant interaction. [source] Influence of mode of delivery on neonatal mortality in the second twin, at and before termBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2008A Herbst Design, To study the association between mode of delivery and neonatal mortality in second twins. To study the association between caesarean delivery and mortality with minimum bias of the indication for the operation, we wanted to compare the outcome of second twins delivered by caesarean due to breech presentation of the sibling with vaginally delivered second twins in uncomplicated pregnancies. Setting, Sweden, 1980,2004 Population, Twins born during 1980,2004 were identified from the Swedish Medical Birth Registry. Twin pairs delivered by caesarean due to breech presentation of the first twin, and vaginally delivered twins with the first twin in cephalic presentation were included. Pregnancies with antepartum complications were excluded. Methods, Odds ratios and 95% CI were calculated using multiple logistic regression analyses, adjusting for year of birth, maternal age, parity and gestational age. Main outcome measures, Neonatal mortality. Results, Compared with second-born twins delivered vaginally, second-born twins delivered by caesarean (for breech presentation of the sibling) had a lower risk of neonatal death (adjusted OR 0.40; 95% CI 0.19,0.83). The decreased risk after caesarean delivery was significant for births before 34 weeks (2.1 versus 9.0%; adjusted OR 0.40; 95% CI 0.17,0.95). After 34 weeks, neonatal mortality was low in both groups (0.1 and 0.2%, respectively), and the difference was not statistically significant (adjusted OR 0.42; 95% CI 0.10,1.79). Conclusions, Neonatal mortality is lower for the second twin after caesarean delivery at birth before 34 weeks. At term, mortality is low irrespective of delivery mode. [source] Quality of life and acceptability of medical versus surgical management of early pregnancy failure,BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2008B Harwood Objective, This study compares quality of life (QOL) and acceptability of medical versus surgical treatment of early pregnancy failure (EPF). Design, A randomised clinical trial of treatment for EPF compared misoprostol vaginally versus vacuum aspiration (VA). Setting, A multisite trial at four US Urban University Hospitals. Population, A total of 652 women with an EPF were randomised to treatment. Methods, Participants completed a daily symptom diary and a questionnaire 2 weeks after treatment. Main outcome measures, The questionnaire assessment included subscales of the Short Form-36 Health Survey Revised for QOL and measures of wellbeing, recovery difficulties, and treatment acceptability. Results, The two groups did not differ in mean scores for QOL except bodily pain; medical treatment was associated with higher levels of bodily pain than VA (P < 0.001). Success of treatment was not related to QOL, but acceptability of the procedure was decreased for medical therapy if unsuccessful (P = 0.003). Type of treatment was not associated with differences in recovery, and the two groups reported similar acceptability except for cramping (P = 0.02), bleeding (P < 0.001), and symptom duration (P = 0.03). Conclusions, Despite reporting greater pain and lower acceptability of treatment-related symptoms, QOL and treatment acceptability were similar for medical and surgical treatment of EPF. Acceptability, but not QOL, was influenced by success or failure of medical management. [source] Risk factors for uterine rupture and neonatal consequences of uterine rupture: a population-based study of successive pregnancies in SwedenBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 10 2007M Kaczmarczyk Objective, Uterine rupture is a rare but a catastrophic event. The aim of the present study was to explore the risk factors for uterine rupture and associated neonatal morbidity and mortality among a cohort of Swedish women attempting vaginal birth in their second delivery. Design, Population-based cohort study. Setting, Sweden. Population, A total of 300 200 Swedish women delivering two single consecutive births between 1983 and 2001. Methods, Swedish population-based registers were used to obtain information concerning demographics, pregnancy and birth characteristics, and neonatal outcomes. Logistic regression was used to analyse potential risk factors for uterine rupture and risk of neonatal mortality associated with uterine rupture. Odds ratios were used to estimate relative risks using 95% CI. Main outcome measure, Uterine rupture and neonatal mortality in the second pregnancy. Results, Compared with women who delivered vaginally in their first birth, women who underwent a caesarean delivery were, during their second delivery, at increased risk of uterine rupture (adjusted OR 41.79; 95% CI 29.73,57.00). Induction of labour, high (,4000 g) birthweight, postterm (,42 weeks) births, high (,35 years) maternal age, and short (,164 cm) maternal stature were also associated with increased risk of uterine rupture. Uterine rupture was associated with a substantially increased risk in neonatal mortality (adjusted OR 65.62; 95% CI 32.60,132.08). Conclusion, The risk of uterine rupture in subsequent deliveries is not only markedly increased among women with a previous caesarean delivery but also influenced by induction of labour, birthweight, gestational age, and maternal characteristics. [source] Poor uterine contractility in obese womenBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2007J Zhang Objective, The aim of the study was to elucidate the reason for the high rate of caesarean section in obese women. We examined the following hypotheses: (1) obese women have a high incidence of complications related to poor uterine contractility,caesarean section for dysfunctional labour and postpartum haemorrhage. 2) The myometrium from obese women has less ability to contract in vitro. Design, First, a clinical retrospective analysis of data from 3913 completed singleton pregnancies was performed. Secondly, in a prospective study the force, frequency and intracellular [Ca2+] flux of spontaneously contracting myometrium were related to the maternal body mass index. Setting, Liverpool Women's Hospital and University of Liverpool. Population, The clinical study involved all women who delivered in one hospital in 2002. The in vitro study myometrial biopsies were obtained from 73 women who had elective caesarean section at term. Results, Maternal obesity carried significant risk of caesarean section in labour that was highest for delay in the first stage of labour (OR 3.54). The increased risk of caesarean section in obese women largely occurred in women with normal- and not with high-birthweight infants. Obese women delivering vaginally had increased risk of prolonged first stage of labour and excessive blood loss. Myometrium from obese women contracted with less force and frequency and had less [Ca2+] flux than that from normal-weight women. Conclusions, We suggest that these findings indicate that obesity may impair the ability of the uterus to contract in labour. [source] A randomised controlled trial of 6 and 12 hourly administration of vaginal misoprostol for second trimester pregnancy terminationBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 9 2005Yongyoth Herabutya Objective To compare the effectiveness of vaginal misoprostol administered 6 or 12 hourly for second trimester pregnancy termination. Design A randomised controlled trial. Setting University teaching hospital. Sample Two hundred and seventy-nine pregnant women at gestations between 14 and 26 weeks undergoing pregnancy termination. Methods Women were randomised to receive 600-,g misoprostol tablets vaginally either every 6 hours or every 12 hours until abortion occurred. Main outcome measures Induction,abortion interval, success rate within 24 and 48 hours and adverse effects. Results There was no significant difference in the median induction to abortion interval 6 hours (16 hours) and 12 hours (16 hours; P= 0.80). The total dose of misoprostol was higher in the 6-hour group (1800 vs 1200 ,g). The cumulative abortion rates within 24 hours were 74% and 67% and within 48 hours 94% and 92%, in the 6- and 12-hour groups, respectively. Fever was more common in the 6-hour group (53%) versus the 12-hour group (31%; P < 0.001). The incidence of nausea, vomiting, diarrhoea, severe bleeding and abdominal pain were similar. Conclusions Misoprostol (600 ,g) administered at 12-hour intervals was associated with fewer adverse effects and was as effective as a 6-hour interval. [source] A randomised double blind trial comparing misoprostol or placebo in the management of early miscarriageBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 8 2005F. Blohm Objectives To study if misoprostol 400 ,g, administered vaginally, increased the successful resolution of early miscarriage compared with placebo. Design Randomised, double blind placebo controlled study. Setting Sahlgrenska University Hospital, Göteborg, Sweden. Sample One hundred and twenty-six women seeking medical attention for early miscarriage. Method Women with a non-viable, first trimester miscarriage were randomised to vaginal administration of misoprostol 400 ,g or placebo. Main outcome measures Main outcome measure was the proportion of successful complete resolution of miscarriage. Secondary outcomes were incidence of infection, bleeding, gastrointestinal side effects, pain, use of analgesics and length of sick leave between groups. Results Sixty-four patients were randomised to misoprostol and 62 to placebo. Eighty-one percent in the misoprostol and 52% in the placebo group had a complete miscarriage within one week of the primary visit (RR 1.57; 95% CI 1.20,2.06). Patients in the misoprostol group reported more pain as assessed on a visual analogue scale (60.4 [31.0] vs 43.8 [37.1] mm; P < 0.007) and required analgesics more often (83%vs 61%, RR 1.35; 95% CI 1.08,1.70). There were no significant differences in the occurrence of gastrointestinal side effects, infection, reduction in haemoglobin or sick leave between the groups. Conclusions Treatment with 400 ,g misoprostol administered vaginally increased the success rate of resolvement of uncomplicated early miscarriages compared with placebo. However, women who received misoprostol experienced more pain and required more analgesics than those who did not. [source] Review of singleton fetal and neonatal deaths associated with cranial trauma and cephalic delivery during a national intrapartum-related confidential enquiryBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2005Fidelma O'Mahony Objective To review delivery details of intrapartum-related fetal and neonatal deaths with singleton cephalic presentation and birthweight of 2500 g or more in which traumatic cranial or cervical spine injury or substantial difficulty at delivery of the head was a dominant feature. Design Review of freestyle summary reports and standard questionnaire responses submitted to the national secretariat for the Confidential Enquiry into Stillbirths and Death in Infancy (CESDI) during the 1994/1995 intrapartum-related mortality enquiry following regional multidisciplinary panel review. Setting United Kingdom. Sample Of the 873 cases of intrapartum-related deaths reported in the 1994,1995 national enquiry, 709 weighed more than 2499 g. Reports from 181 (89 from 1994 and 92 from 1995) with a chance of meeting criteria for cranial or cervical trauma as significant contributors to death were examined in detail. Thirty-seven were judged to meet the criteria stated in the objectives (23 from 1994 and 14 from 1995) and form the basis for this review. Methods Electronic and hand search of CESDI records relating to intrapartum-related deaths. Main outcome measures Intrapartum events and features of care. Results There was evidence of fetal compromise present before birth in 33 of the 37 (89%) study group cases reviewed. One delivery was performed vaginally without instrumentation, and in one there was no attempt at vaginal delivery before caesarean section (CS) in the second stage of labour. Twenty-four cases (65%) were delivered vaginally and 11 (30%) by CS after failure to deliver vaginally with instruments. A single instrument was used in six cases of vaginal delivery (four ventouse and two Kjelland's forceps). At least two separate attempts with different instruments were made in 24 cases. Overall, the ventouse was used in 27 cases and forceps in 29 cases. In six cases, three separate attempts were made with at least two different instruments, all of which included use of ventouse. The grade of operator was recorded in 27 cases. Of these, a consultant obstetrician was present at only one delivery and no consultant was recorded to have made the first attempt to deliver a baby. In six cases, shoulder dystocia was also reported. Conclusions This study suggests a lower incidence of death from difficult cephalic delivery and cranial trauma than previously reported. The CESDI studies were believed to have achieved high levels of ascertainment for all intrapartum-related deaths from which the cases reported here were selected. Strictly applied entry criteria used in this study could have restricted the number of cases considered as could limited in vivo or postmortem investigations and lack of detailed autopsy. When cranial traumatic injury was observed, it was almost always associated with physical difficulty at delivery and the use of instruments. The use of ventouse as the primary or only instrument did not prevent this outcome. Some injuries occurred apparently without evidence of unreasonable force, but poorly judged persistence with attempts at vaginal delivery in the presence of failure to progress or signs of fetal compromise were the main contributory factor regardless of which instruments were used. [source] Outcome of term breech births: 10-year experience at a district general hospitalBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2 2005Poonam Pradhan Objective To review the short and long term outcomes among singleton infants with breech presentation at term delivered in a geographically defined population over a 10-year period. Design Retrospective, cohort study. Setting District General Hospital. Population 1433 term breech infants alive at the onset of labour and born between January 1991 and December 2000. Methods Data abstracted from birth registers, neonatal discharge summaries and the child health database system were used to compare the short and long term outcomes of singleton term breech infants born by two different modes of delivery (prelabour caesarean section and vaginal or caesarean section in labour). Fisher's exact test was used to compare the categorical variables. Main outcome measures Short term outcomes: perinatal mortality, Apgar scores, admission to the neonatal unit, birth trauma and neonatal convulsions. Long term outcomes: deaths during infancy, cerebral palsy, long term morbidity (development of special needs and special educational needs). Results Of 1433 singleton term infants in breech presentation at onset of labour, 881 (61.5%) were delivered vaginally or by caesarean section in labour and 552 (38.5%) were born by prelabour caesarean section. There were three (0.3%) non-malformed perinatal deaths among infants born by vaginal delivery or caesarean section in labour compared with none in the prelabour caesarean section cohort. Compared with infants born by prelabour caesarean section, those delivered vaginally or by caesarean section in labour were significantly more likely to have low 5-minute Apgar scores (0.9%vs 5.9%, P < 0.0001) and require admission to the neonatal unit (1.6%vs 4%, P= 0.0119). However, there was no significant difference in the long term morbidity between the two groups (5.3% in the vaginal/caesarean section in labour group vs 3.8% in the prelabour caesarean group, P= 0.26); no difference in rates of cerebral palsy; and none of the eight infant deaths were related to the mode of delivery. Conclusions Vaginal breech delivery or caesarean section in labour was associated with a small but unequivocal increase in the short term mortality and morbidity. However, the long term outcome was not influenced by the mode of delivery. [source] | ||||||||||||||||||||||||||||