Malpresentation, malposition, and cephalopelvic disproportion

2020 ◽  
pp. 395-406
Author(s):  
Deirdre J. Murphy
Keyword(s):  
Early Identification ◽  
Technical Skills ◽  
Operative Delivery ◽  
Cephalopelvic Disproportion ◽  
Obstructed Labour ◽  
Uterine Contractions ◽  
Labour Ward ◽  
Clear Communication ◽  
Vertex Presentation ◽  
Time Of Presentation

Normal labour involves an appropriate-sized fetus in a vertex presentation with a well-flexed head that descends and rotates within the maternal pelvis in response to uterine contractions, delivering in an occipitoanterior position. Abnormal labour occurs when any one or a combination of these factors deviates from normal. It may involve a malpresentation (e.g. face, brow, or breech), a malposition (e.g. occipitoposterior), or cephalopelvic disproportion. The consequences include prolonged labour, obstructed labour, operative vaginal delivery, or caesarean section. Appropriate management requires expertise in clinical assessment, decision-making, and the technical and non-technical skills of operative delivery. A systematic approach is required including an awareness of risk factors for abnormal labour, early identification of deviations from normal, use of preventative strategies where possible, and appropriate intervention when necessary. Good teamwork and clear communication between midwives and obstetricians is essential within a labour ward setting. Timely transfer may be required in a homebirth setting. Particular skills are required in low-resource settings where obstructed labour may be advanced at the time of presentation.

scholarly journals Partogram: an important tool in managing labour!

2021 ◽  
Vol 10 (10) ◽  
pp. 3770
Author(s):  
Swagatha Mukherjee ◽  
Raksha M. ◽  
Malini K. V.
Keyword(s):  
Neonatal Outcome ◽  
Fetal Heart ◽  
Local Population ◽  
Skilled Birth Attendant ◽  
Cervical Dilatation ◽  
Vaginal Examination ◽  
Singleton Pregnancy ◽  
Cephalopelvic Disproportion ◽  
Uterine Contractions ◽  
Vertex Presentation

Background: Various types and designs of partographs are being used at various centers. WHO introduced simplified version of partogram, for the use by skilled birth attendant. Preprinted paper versions of the partograph are availableMethods: 100 antenatal women were selected for study. Patients with vertex presentation and singleton pregnancy were taken. Patients who came late in labour and those with cephalopelvic disproportion were not included in the study. Cervical Dilatation in cms was assessed by per vaginal examination every 2 hourly, fetal Heart Rate every ½ hourly, uterine contractions and maternal pulse measured every ½ hourly, maternal BP and temperature were measured every 4th hourly.Results: Using WHO simplified partogram, characteristics of labour and neonatal outcome was evaluated. Among the 100 women included in the study, 78 required augmentation of labour, here 6 of them crossed the alert line and underwent LSCS. Of the 22 women who did not require augmentation, 4 crossed the alert line and underwent LSCS.We didn’t find any difference in monitoring of labour using simplified version of WHO partogram compared with other partograms, apparently it’s more simpler to plot and easy to understand.Conclusions: An alert line on partogram should be based on lower 10th centile rate of cervical dilatation of the local population. We found this rate as 1cm/hr, which corresponds to the slope of alert lineon standard partogram. Based on this we conclude, simplified partogram is good enough for monitoring labour progress.

Maternal outcome in obstructed labour in patients presenting to Nishtar Hospital Multan.

2021 ◽  
Vol 28 (03) ◽  
pp. 377-381
Author(s):  
Sadia Zafar ◽  
Nadia Taj ◽  
Rida Iqbal ◽  
Muhammad Sajjad Masood
Keyword(s):  
Vesicovaginal Fistula ◽  
Postpartum Haemorrhage ◽  
Case Series ◽  
Maternal Outcome ◽  
Bladder Rupture ◽  
Age Group ◽  
Maternal Deaths ◽  
Obstructed Labour ◽  
Maternal Morbidity And Mortality ◽  
Labour Ward

Objective: The objective of the study was to determine the frequency of maternal outcome in obstructed labour. Study Design: Descriptive Case Series. Setting: Labour Ward of Nishtar Hospital Multan, Pakistan. Period: 01-11-2018 to 30-04-2019. Material & Methods: Two hundred and forty two clinically diagnosed cases of obstructed labour admitted in labour ward of Nishtar Hospital Multan were enrolled for the study. Patients were monitored till delivery (vaginal/caesarean section) and complication of pregnancy were assessed till six week postpartum. Outcome variables i.e. complications like sepsis, uterine rupture, bladder rupture, vesicovaginal fistula, postpartum haemorrhage, and mortality was noted. Data was analyzed by using SPSS version 10.0. Results: The majority of women was in age group 20-29 years i.e. 42.97% and were primigravida. Sepsis was the most frequent maternal complication observed i.e. in 22.31% of cases. Postpartum haemorrhage was next in line i.e. in 19.42% of cases. Uterine and bladder rupture was a finding in 16.94% and 7.02% of cases respectively. Vesicovaginal fistula was recorded in 12 (4.95%) patients and there were 1 (4.54%) maternal deaths during the study period. Conclusion: Obstructed labour is an important and preventable cause of both maternal morbidity and mortality and needs to be addressed adequately with provision of better antenatal, intrapartum, and postnatal care.

The ‘occiput-spine angle’: a new sonographic index of fetal head deflexion during first stage of labor as predictor of course of labor and outcome

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hesham Mohammed Fathy ◽  
Ahmed Mohammed Bahaa El-Din ◽  
Haitham Fathy Mohammed ◽  
Mohammed Mahmoud Mohammed Helmy
Keyword(s):  
Maternity Hospital ◽  
Ultra Sound ◽  
Operative Delivery ◽  
Fetal Head ◽  
Obstructed Labor ◽  
Uterine Contractions ◽  
Labor Ward ◽  
Vaginal Deliveries ◽  
Fetal Complications ◽  
First Stage Of Labor

Abstract Background Labor is a physiologic process during which the products of conception (i.e. the fetus, membranes, umbilical cord, and placenta) are expelled outside of the uterus. Labor is achieved with changes in the biochemical connective tissue and with gradual effacement and dilatation of the uterine cervix as a result of rhythmic uterine contractions of sufficient frequency, intensity, and duration. Labor is divided into three stages that include cervical dilatation, fetal delivery and delivery of the placenta. Objective The aims of this study were to quantify the degree of fetal head deflection via the use of Ultrasound during the first stage of labor and to determine whether a parameter derived from ultrasound examination (the occiput-spine angle) has a relationship with the progress of labor, subsequent effect on maternal, fetal complications and rate of cesarean delivery. Methods This is a prospective cohort study which includes a total of 200 women with gestational age 37-42 weeks were assessed in this study in Ain shams Maternity hospital labor ward by 2 dimensional ultra sound. Examinations were performed after a verbal and written consent from the patient with the patient lying in the dorsal supine position. And exclusion of Occiput-posterior position, multigravida, Indication for cesarean, Medical disorder eg hypertension or diabetes, pre labor rupture of membranes to correlate between the Occiput- spine angle (OSA) and the outcome of labor regarding the progress of labor, incidence of cesarean section, maternal and fetal complications. Results This study demonstrates that the sonographic measurement of the angle formed by the fetal occiput and the spine (occiput-spine angle) is feasible and reproducible, the occiput-spine angle in the first stage of labor is positively correlated with the clinically established station and the risk of obstructed labor requiring an operative delivery ie, Occiput-spine angle have been statistically significantly lower in cases underwent operative delivery. Occiput-spine angle had a statistically significant low diagnostic performance in predicting operative delivery. Conclusion The occiput-spine angle in the first stage of labor correlates significantly with the risk of obstructed labor Compared with spontaneous vaginal deliveries, cases that require obstetric intervention demonstrated a smaller occiput-spine angle at a similar station, suggesting diminished flexion of the fetal head. For occiput anterior fetuses, the greater the degree of fetal head deflexion, the greater risk of operative delivery due to labor arrest.

scholarly journals Three-dimensional camera anthropometry to assess risk of cephalopelvic disproportion-related obstructed labour in Ethiopia

2019 ◽  
Vol 9 (5) ◽  
pp. 20190036 ◽  
Author(s):  
Lorenzo Tolentino ◽  
Mahlet Yigeremu ◽  
Sisay Teklu ◽  
Shehab Attia ◽  
Michael Weiler ◽  
...  
Keyword(s):  
False Negative ◽  
Three Dimensional ◽  
False Negative Rate ◽  
Detection Rates ◽  
Cephalopelvic Disproportion ◽  
Obstructed Labour ◽  
Tape Measure ◽  
Negative Rate ◽  
Positive Rate ◽  
Tape Measurement

Cephalopelvic disproportion (CPD)-related obstructed labour requires delivery via Caesarean section (C/S); however, in low-resource settings around the world, facilities with C/S capabilities are often far away. This paper reports three low-cost tools to assess the risk of CPD, well before labour, to provide adequate time for referral and planning for delivery. We performed tape measurement- and three-dimensional (3D) camera-based anthropometry, using two 3D cameras (Kinect and Structure) on primigravida, gestational age ≥ 36 weeks, from Addis Ababa, Ethiopia. Novel risk scores were developed and tested to identify models with the highest predicted area under the receiver-operator characteristic curve (AUC), detection rate (true positive rate at a 5% false-positive rate, FPR) and triage rate (true negative rate at a 0% false-negative rate). For tape measure, Kinect and Structure, the detection rates were 53%, 61% and 64% (at 5% FPR), the triage rates were 30%, 56% and 63%, and the AUCs were 0.871, 0.908 and 0.918, respectively. Detection rates were 77%, 80% and 84% at the maximum J -statistic, which corresponded to FPRs of 10%, 15% and 11%, respectively, for tape measure, Kinect and Structure. Thus, tape measurement anthropometry was a very good predictor and Kinect and Structure anthropometry were excellent predictors of CPD risk.

scholarly journals OXYTOCIN DOSE ANALYSIS OF BREASTMILK PRODUCTION THROUGH INDUCTION LABOR

2019 ◽  
Vol 2 (01) ◽  
pp. 01-03
Author(s):  
Sara Nurmala ◽  
Cantika Zaddana
Keyword(s):  
Breast Milk ◽  
Pregnant Women ◽  
Placenta Previa ◽  
The Body ◽  
Cephalopelvic Disproportion ◽  
Uterine Contractions ◽  
Uterine Muscle ◽  
Natural Hormone ◽  
History Of ◽  
Narrow Pelvis

Breast milk is the only first food that can be consumed by newborns until the age reaches six months. therefore it is very important to know by the mother who is pregnant and will give birth about the importance of breast milk. Oxytocin drugs have similar functions to the natural hormone oxytocin produced by the body. This drug serves to trigger or strengthen the contraction of the uterine muscle. Therefore, oxytocin can be used to stimulate (induce) labor and stop bleeding after childbirth. In addition, this drug can also help stimulate the release of breast milk in breastfeeding mothers. Oxytocin should be avoided by pregnant women who can not give birth normally, for example because it has a narrow pelvis, suffering from placenta previa, or having a too strong uterine contractions. Oxytocin is also prohibited for pregnant women with cephalopelvic disproportion, impaired fetal conditions, uterine damage, or a history of caesarean section. In this study we see whether there is effect of different doses of oxytocin on the quantity of breastmilk produced. oxytocin doses were administered with 3 doses of 5 UI, 10 UI and 15 UI. the dose of oxytocin is administered once per incidence of labor. maternal results obtained by oxytocin induction of 5 UI and 10 UI obtained breastmilk averaging 10 ml in the first 24 hours after delivery. and a mother with oxytocin induction 15 UI received an average breastmilk of 10 ml at 24 hours after delivery.

scholarly journals Early identification of acute heart failure at the time of presentation: do natriuretic peptides make the difference?

2018 ◽  
Vol 5 (3) ◽  
pp. 309-315 ◽  
Author(s):  
Martin Möckel ◽  
Stephan von Haehling ◽  
Jörn O. Vollert ◽  
Jan C. Wiemer ◽  
Stefan D. Anker ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Natriuretic Peptides ◽  
Early Identification ◽  
The Difference ◽  
Time Of Presentation

scholarly journals Measurement of the uterocervical angle for the prediction of preterm birth in symptomatic women

2021 ◽  
Author(s):  
Philipp Wagner ◽  
Jana Schlechtendahl ◽  
Markus Hoopmann ◽  
Natalia Prodan ◽  
Harald Abele ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Gestational Age ◽  
Cervical Length ◽  
University Hospital ◽  
Second Line ◽  
Uterine Contractions ◽  
Gestational Age At Delivery ◽  
The University ◽  
Time Of Presentation ◽  
Singleton Pregnancies

Abstract Purpose To examine if the uterocervical angle (UCA) can be used to predict preterm delivery in women with painful and regular uterine contractions and a cervical length of 25 mm or less. Methods Retrospective study at the perinatal unit of the University Hospital of Tuebingen, Germany. Women with singleton gestation and preterm contractions between 24 + 0 and 33 + 6 weeks’ gestation were included. For the UCA measurement, a line is placed from the internal os to the external os irrespective of whether the cervix is straight or curved. A second line is drawn to delineate the lower uterine segment. The angle between the two lines is the UCA measurement. The measurements were taken on stored images from our database. Results The study consisted of 213 singleton pregnancies. At the time of UCA measurement, median maternal and gestational age was 31.4 years and 29.7 weeks’ gestation. Median gestational age at delivery was 35.3 weeks and the corresponding birth weight 2480 g, respectively. The UCA measurement in women who delivered within 2 days, between 3–7 days and after 7 days was not helpful to distinguish between these three groups [median UCA measurements: 108.5°, 108.0° and 107.3° (Kruskal–Wallis test p = 0.576)]. Uni- and multivariate logistic multiple regression analysis demonstrated that the delivery within 2 days was only dependent on the gestational age and the cervical length at the time of presentation. Conclusion The measurement of UCA is not useful in predicting preterm birth in the subsequent 7 days after an episode of preterm contractions.

A Clinical Study of Twenty-seven Children Exhibiting Functional Hearing Loss

1981 ◽  
Vol 12 (1) ◽  
pp. 26-35 ◽  
Author(s):  
Donald L. McCanna ◽  
Giacinto DeLapa
Keyword(s):  
Hearing Loss ◽  
Clinical Study ◽  
Early Identification ◽  
Behavioral Responses ◽  
Upper Elementary ◽  
Elementary Grades ◽  
Ability Level ◽  
Hearing Problem

This report reviews 27 cases of children exhibiting functional hearing loss. The study reveals that most students were in the upper elementary grades and were predominantly females. These subjects were functioning below their ability level in school and were usually in conflict with school, home, or peers. Tests used were selected on the basis of their helping to provide early identification. The subjects' oral and behavioral responses are presented, as well as ways of resolving the hearing problem. Some helpful counseling techniques are also presented.

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