Association between obesity and shorter second stage duration in spontaneous vaginal deliveries

Abstract Objective To estimate second stage duration and its effects on labor outcomes in obese versus nonobese nulliparous women. Study Design This was a secondary analysis of a cohort of nulliparous women who presented for labor at term and reached complete cervical dilation. Adjusted relative risks (aRR) were used to estimate the association between obesity and second stage characteristics, composite neonatal morbidity, and composite maternal morbidity. Effect modification of prolonged second stage on the association between obesity and morbidity was assessed by including an interaction term in the regression model. Results Compared with nonobese, obese women were more likely to have a prolonged second stage (aRR: 1.48, 95% CI: 1.18–1.85 for ≥3 hours; aRR: 1.65, 95% CI: 1.18–2.30 for ≥4 hours). Obesity was associated with a higher rate of second stage cesarean (aRR: 1.78, 95% CI: 1.34–2.34) and cesarean delivery for fetal distress (aRR: 2.67, 95% CI: 1.18–3.58). Obesity was also associated with increased rates of neonatal (aRR: 1.38, 95% CI: 1.05–1.80), but not maternal morbidity (aRR: 1.06, 95% CI: 0.90–1.25). Neonatal morbidity risk was not modified by prolonged second stage. Conclusion Obesity is associated with increased risk of neonatal morbidity, which is not modified by prolonged second stage of labor.

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Lumbar Sympathetic Blocks Speed Early and Second Stage Induced Labor in Nulliparous Women

Anesthesiology ◽

10.1097/00000542-199904000-00017 ◽

1999 ◽

Vol 90 (4) ◽

pp. 1039-1046 ◽

Cited By ~ 21

Author(s):

Barbara L. Leighton ◽

Stephen H. Halpern ◽

Donna B. Wilson

Keyword(s):

Epidural Analgesia ◽

Cesarean Delivery ◽

Delivery Mode ◽

Sympathetic Block ◽

Cervical Dilation ◽

Induced Labor ◽

Second Stage ◽

Vaginal Deliveries ◽

Epidural Catheters ◽

Sympathetic Blocks

Background Rapid cervical dilation reportedly accompanies lumbar sympathetic blockade, whereas epidural analgesia is associated with slow labor. The authors compared the effects of initial lumbar sympathetic block with those of epidural analgesia on labor speed and delivery mode in this pilot study. Methods At a hospital not practicing active labor management, full-term nulliparous patients whose labors were induced randomly received initial lumbar sympathetic block or epidural analgesia. The latter patients received 10 ml bupivacaine, 0.125%; 50 microg fentanyl; and 100 microg epinephrine epidurally and sham lumbar sympathetic blocks. Patients to have lumbar sympathetic blocks received 10 ml bupivacaine, 0.5%; 25 microg fentanyl; and 50 microg epinephrine bilaterally and epidural catheters. Subsequently, all patients received epidural analgesia. Results Cervical dilation occurred more quickly (57 vs. 120 min/cm cervical dilation; P = 0.05) during the first 2 h of analgesia in patients having lumbar sympathetic blocks (n = 17) than in patients having epidurals (n = 19). The second stage of labor was briefer in patients having lumbar sympathetic blocks than in those having epidurals (105 vs. 270 min; P < 0.05). Nine patients having lumbar sympathetic block and seven having epidurals delivered spontaneously, whereas seven patients having lumbar sympathetic block and seven having epidurals had instrument-assisted vaginal deliveries. Cesarean delivery for fetal bradycardia occurred in one patient having lumbar sympathetic block. Cesarean delivery for dystocia occurred in five patients having epidurals compared with no patient having lumbar sympathetic block (P = not significant). Visual analog pain scores differed only at 60 min after block. Conclusions Nulliparous parturients having induced labor and receiving initial lumbar sympathetic blocks had faster cervical dilation during the first 2 h of analgesia, shorter second-stage labors, and a trend toward a lower dystocia cesarean delivery rate than did patients having epidural analgesia. The effects of lumbar sympathetic block on labor need to be determined in other patient groups. These results may help define the tocodynamic effects of regional labor analgesia.

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Risk factors for post-partum hemorrhage in patients who underwent operative vaginal delivery in a tertiary care center

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20214066 ◽

2021 ◽

Author(s):

Gayatri Devi Sivasambu ◽

Sujani B. Kempaiah ◽

Urvashi Thukral

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Vaginal Delivery ◽

Post Partum ◽

Tertiary Care ◽

Significant Risk ◽

Post Partum Hemorrhage ◽

Second Stage ◽

Operative Vaginal Delivery ◽

Vaginal Deliveries

Background: Operative vaginal delivery is a timely intervention to cut short second stage labor when imminent delivery is in the interests of mother, fetus, or both. It reduces second stage cesarean section morbidity and uterine scar and its influence on future obstetric career. The possible structural neonatal adverse outcomes due to operative vaginal delivery are well quantified. However, its effects on maternal outcome need to be understood better. In this paper, we study the effect of operative vaginal delivery on maternal post-partum hemorrhage (PPH) and the associated risk factors.Methods: It was a retrospective study carried out for the period July 2016 to July 2020 at Ramaiah Medical College, Bengaluru. Total number of vaginal deliveries in this period were 6318. Out of these, 1020 patients underwent assisted vaginal delivery using vacuum/ forceps/ sequential use of instrument. Blood loss greater than 500 ml is considered PPH for the purpose of this study. 15% of the study population was noted to have PPH. We employ a multivariate logistic regression to identify statistically significant risk factors for PPH in women undergoing operative vaginal delivery.Results: The logistic regression model identifies multiparity, maternal age, neonatal birth weight more than 3.5 kg, application of forceps in women with hypertensive disorders, III-degree tear, cervical tear to significantly increase the risk of PPH in our study population.Conclusions: Certain factors seem to increase the risk of PPH in operative vaginal delivery. The risks and benefits must be weighed properly before use of instruments.

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ASSOCIATION OF PRE-PREGNANCY AND PREGNANCY BODY MASS INDEX WITH LABOR DURATION

Issues of Rehabilitation, Orthopaedics, Neurophysiology and Sport Promotion – IRONS ◽

10.19271/irons-000135-2021-35 ◽

2021 ◽

Vol 35 (35) ◽

pp. 31-39

Author(s):

Angelika Szemraj ◽

Agnieszka Opala-Berdzik

Keyword(s):

Physical Activity ◽

Body Mass Index ◽

Body Mass ◽

Mode Of Delivery ◽

Body Height ◽

Cesarean Sections ◽

Second Stage ◽

Labor Duration ◽

Cesarean Deliveries ◽

Vaginal Deliveries

Introduction Excessive body mass index may have adverse effects on the health of women in their perinatal period. Regular physical activity contributes to body mass control. Aim To determine the association of pre-pregnancy and pregnancy BMIs with labor duration in primi- and multiparas. Also, to determine the proportions of pre-pregnancy BMI > 25 in women after cesarean sections and vaginal deliveries. Material and methods Data of 54 women on a postpartum day 3 to 5 (29 primiparas: 17 after vaginal and 12 after cesarean deliveries; 25 multiparas: 15 after vaginal and 10 after cesarean deliveries). Demographic data collected from the patient’s history included body height, pre-pregnancy and pre-labor body mass, mode of delivery, duration of labor and its second stage, number of deliveries. Pre-pregnancy and pre-labor BMIs were calculated. Results In primiparas, there was a moderate positive correlation between pre-pregnancy and pre-labor BMIs and the labor duration (r = 0.56, p = 0.02; r = 0.65, p = 0.005, respectively). Multiparas did not exhibit a significant correlation between the BMIs and the labor duration (p > 0.05). Neither of the subgroups showed a significant correlation between pre-pregnancy and prelabor BMIs and the duration of the second stage of labor (p > 0.05). Among women after vaginal deliveries, 15.6% had pre-pregnancy BMI > 25; the respective proportion was 22.7% in women after cesarean sections. Conclusions Primiparas with greater pre-pregnancy and pre-labor BMIs were more likely to have a longer labor. The proportion of pre-pregnancy BMI > 25 was higher for cesarean compared to vaginal deliveries. Physical activity should be promoted in women planning pregnancy to help control BMI. Keywords: mirror foot, resection of foot radius, deformation classification

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Second-Stage Duration and Outcomes Among Women Who Labored After a Prior Cesarean Delivery

Obstetrics and Gynecology ◽

10.1097/aog.0000000000002478 ◽

2018 ◽

Vol 131 (3) ◽

pp. 514-522 ◽

Cited By ~ 2

Author(s):

Mark P. Hehir ◽

Dwight J. Rouse ◽

Russell S. Miller ◽

Cande V. Ananth ◽

Jason D. Wright ◽

...

Keyword(s):

Cesarean Delivery ◽

Stage Duration ◽

Second Stage

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Natural Methods to Assist Delivery during the Second Stage of Labour: Part I: Positioning and the Role of Intrapartum Ultrasound

Hellenic Journal of Obstetrics and Gynecology ◽

10.33574/hjog.1928 ◽

2020 ◽

Vol 19 (1) ◽

pp. 1-10

Author(s):

Maria Papamichail ◽

Panos Antsaklis ◽

Marianna Theodora ◽

Michael Syndos ◽

George Daskalakis ◽

...

Keyword(s):

Supine Position ◽

Maternal Satisfaction ◽

Stage Duration ◽

High Importance ◽

Second Stage ◽

Second Stage Of Labour ◽

The Moment ◽

Time To Delivery ◽

Remaining Time

Labour has high importance for every woman’s life but also is the moment when many complications might appear increasing significantly morbidity and mortality. Therefore obstetricians have to help women in labour to give birth to their babies naturally, with the highest satisfaction possible. Western standards suggest that women should experience their partirution in the lithotomy or the supine position. However, upright positions have the potential to reduce second stage of labour and to improve neonatal outcomes. Intrapartum ultrasound using different parameters can predict the remaining time to delivery and therefore to make timely interventions in order to decrease instrumental or caesarean deliveries and postpartum hemorrhage as these are the most important complications met in prolonged second stage of labour. In this review the optimal positioning of the women in labour will be presented. Additionally, the ability of intrapartum to shorting second stage duration and to increase maternal satisfaction concerning childbirth will also mentioned.

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The Fetoplacental Circulation During Parturition: Evidence From Residual Placental Blood Volume

PEDIATRICS ◽

10.1542/peds.54.2.213 ◽

1974 ◽

Vol 54 (2) ◽

pp. 213-216

Author(s):

Joachim G. Klebe ◽

Carl Johan Ingomar

Keyword(s):

Cesarean Section ◽

Blood Volume ◽

Umbilical Cord ◽

Fetal Blood ◽

Vaginal Route ◽

Second Stage Of Labor ◽

Second Stage ◽

Vaginal Deliveries ◽

Placental Blood

The volume of blood left in the fetal part of the placenta after early clamping of the umbilical cord (residual placental blood) was measured in 24 deliveries, and found to be larger among infants born by the vaginal route compared to those born by cesarean section. The result is interpreted as an evidence of a temporary depositing of blood in the placenta during the second stage of labor. As early clamping of the umbilical cord, therefore, among cases of vaginal deliveries, amounts to a blood-letting of about 30 ml of the newborn infant's own blood, it is considered not to be a physiological procedure. The investigation has also demonstrated that the residual placental blood, among cases of vaginally delivered and early clamped infants, fails to represent the intrauterine distribution of the fetoplacental blood volume. Finally, the investigation shows that the placental transfusion, which takes place in late clamped infants, partly originates from previously deposited fetal blood, partly from placental blood. See table in the PDF file. See image in the PDF file. See image in the PDF file.

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