Can Ultrasound Performed in Prolonged Second Stage of Labor Predict the Difficulty and Success Rates of Operative Vaginal Delivery?

2015 ◽  
Vol 37 (04) ◽  
pp. 399-404 ◽  
Author(s):  
Y. Gilboa ◽  
O. Moran ◽  
Z. Kivilevitch ◽  
S. Kees ◽  
T. Borkowsky ◽  
...  
Keyword(s):  
Vaginal Delivery ◽  
Success Rates ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Operative Vaginal Delivery

Prolonged Second Stage of Labor and Anal Sphincter Injury in a Contemporary Cohort of Term Nulliparas

2020 ◽  
Author(s):  
Mariam Naqvi ◽  
Elana F. Jaffe ◽  
Ilona T. Goldfarb ◽  
Allison S. Bryant ◽  
Blair J. Wylie ◽  
...  
Keyword(s):  
Vaginal Delivery ◽  
Anal Sphincter ◽  
Sphincter Injury ◽  
Predictive Capacity ◽  
Fourth Degree ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Anal Sphincter Injury ◽  
Operative Vaginal Delivery ◽  
Multivariable Regression

Objective This study aimed to assess whether a prolonged second stage of labor is an independent predictor of obstetric anal sphincter injury (OASI) in a contemporary cohort of nulliparous and term parturients, and to evaluate whether predelivery factors can accurately predict OASI. Study Design This was a nested case-control study within a cohort of consecutive nulliparous term parturients with a singleton gestation who underwent a vaginal delivery at a single institution between January 2014 and January 2015. Cases were defined as women with a third- or fourth-degree laceration at the time of delivery, and controls were women without a third- or fourth-degree laceration. A prolonged second stage was defined as a second stage of ≥3 hours. Univariable and multivariable regression analyses were performed to examine the relationship between prolonged second stage of labor and third- or fourth-degree lacerations. Receiver operator curves were developed to assess the predictive capacity of predelivery information for third- and fourth-degree lacerations. Results Of 1,197 births, 63 women had third- or fourth-degree lacerations (5.3%). With each additional hour of the second stage, the rate of OASI increased, with 2.9% of women with a second stage of <1 hour with OASI, 3.5% between 1 and 2 hours, 5.7% between 2 and 3 hours, 7.8% between 3 and 4 hours, 16.1% between 4 and 5 hours, and 28.6% among women with a second stage length >5 hours (p < 0.001). In multivariable regression analysis, operative vaginal delivery (adjusted odds ratio [aOR] = 5.92, 95% confidence interval [CI]: 3.17–11.07) and a prolonged second stage (aOR = 1.92, 95% CI: 1.06–3.51) were independent predictors of third- and fourth-degree lacerations. A predictive model was developed from these results (area under the curve [AUC] = 0.75, 95% CI: 0.68–0.81). Conclusion Prolonged second stage of labor is a predictor of OASI, after adjustment for operative vaginal delivery. A model using predelivery risk factors has a reasonable prediction of OASI. Key Points

Prediction Index of Levator Ani Muscle Avulsion After Vaginal Delivery: An Evidence-Based Appraisal

2018 ◽  
Vol 24 (8) ◽  
pp. 6214-6217
Author(s):  
Budi Iman Santoso ◽  
Adly Nanda Al-Fattah ◽  
Raymond Surya ◽  
Surrahman Hakim
Keyword(s):  
Pelvic Floor ◽  
Vaginal Delivery ◽  
Pelvic Floor Dysfunction ◽  
Levator Ani ◽  
Influential Factors ◽  
Cochrane Library ◽  
Levator Ani Muscle ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Levator Ani Muscle Avulsion

Pelvic floor dysfunction (PFD) due to vaginal delivery is related to tear of levator ani muscle (LAM) that potentially lead to the impairment of quality of life among women. A number of attempts to predict LAM injury after vaginal delivery had been conducted. This study aims to appraise the accuracy of several prediction index determining LAM injury after vaginal delivery. We conducted a search in Cochrane Library®, Pubmed®, and Medline® with the keywords of “pelvic floor dysfunction” AND “vaginal delivery” AND “prediction.” Critical appraisal determining the validity, importance, and applicability (VIA) was conducted by 2 independent authors. After 6 weeks to 3 months’ duration of follow up, the incidence of LAM avulsion was varied from 15.4% to 35.6% from three studies. Multivariate analysis showed that forceps delivery, OASIS, and active second stage (OR 3.8; 3.1; 1.61; respectively) as the most influential factors for LAM incidence. Maternal age and time spent in active pushing were also contributed to LAM incidence. OASIS and second stage of labor could be used as the most influential components of prediction index for LAM incidence. Prediction indexes for LAM incidence are developed. OASIS and second stage of labor are acknowledged as two most influential variables among three appraised studies.

Influence of Patient-Level Factors on Mode of Delivery among Operative Vaginal Delivery Candidates in Modern Practice

2017 ◽  
Vol 34 (10) ◽  
pp. 0974-0981 ◽  
Author(s):  
Christina Gonzalez ◽  
Amanda Allshouse ◽  
Erick Henry ◽  
Sean Esplin ◽  
Torri Metz
Keyword(s):  
Vaginal Delivery ◽  
Gestational Age ◽  
Maternal Age ◽  
Mode Of Delivery ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Second Stage ◽  
Patient Level ◽  
Operative Vaginal Delivery

Objective We aimed to evaluate which patient-level factors influence mode of delivery among candidates for operative vaginal delivery. Study Design Cross-sectional study of candidates for operative vaginal delivery from 18 hospitals over 8 years. Probabilities of mode of delivery were estimated using hierarchical logistic modeling adjusting for clustering within physician and hospital. Results Total 3,771 (64%) women delivered with forceps, 1,474 (25%) vacuums, and 665 (11%) cesareans. Odds of forceps versus vacuum were higher with induction (OR = 2.16, 95% CI: 1.76–2.65), nulliparity (OR = 2.06, 95% CI: 1.59–2.66), epidural (OR = 2.05, 95% CI: 1.19–3.56), maternal indication (OR = 1.53, 95% CI 1.16–2.02), older maternal age (OR 1.18, 95% CI 1.06–1.31 per 5 years), and longer second stage (OR = 1.10, 95% CI: 1.01–1.20 per hour).Odds of cesarean versus operative vaginal delivery were higher with maternal indication (OR = 9.0, 95% CI: 7.23–11.20), a perinatologist (OR = 2.51, 95% CI: 1.09–5.78), longer second stage (OR = 1.79, 95% CI: 1.65–1.93 per hour), older gestational age (OR = 1.10, 95% CI: 1.01–1.20 per week), and longer labor (OR = 1.02, 95% CI: 1.01–1.04 per hour). Conclusion Patient-level factors influence the decision to proceed with an operative vaginal delivery and the choice of instrument, thereby emphasizing the importance of maintaining availability of both forceps and vacuums.

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

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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