Efficacy of epidural analgesia during labour and delivery: a comparison between singleton vertex presentation, singleton breech presentation and twin pregnancies

2003 ◽  
Vol 20 (2) ◽  
pp. 164-165
Author(s):  
T. Villevieille ◽  
F. Mercier ◽  
P. E. Shannon ◽  
Y. Auroy ◽  
D. Benhamou
Keyword(s):  
Epidural Analgesia ◽  
Breech Presentation ◽  
Vertex Presentation ◽  
Twin Pregnancies

scholarly journals Evaluation of vaginal birth safety in twin pregnancies with the first twin in cephalic presentation

2021 ◽  
Vol 3 (3) ◽  
pp. 59-63
Author(s):  
Bekir Kahveci ◽  
Mehmet Sukru Budak ◽  
Ihsan Baglı ◽  
Sedat Akgol
Keyword(s):  
Neonatal Mortality ◽  
Vaginal Birth ◽  
Neonatal Outcomes ◽  
Cesarean Birth ◽  
Early Neonatal Mortality ◽  
Mode Of Birth ◽  
Adverse Neonatal Outcomes ◽  
Early Neonatal Mortality Rate ◽  
Vertex Presentation ◽  
Twin Pregnancies

Objective: To evaluate vaginal birth safety by comparing the results of cesarean birth in twin pregnancies with the first twin in vertex presentation. Material and methods: A retrospective cohort study of vertex-presenting twin pregnancies between 32 weeks 0 days and 38 weeks 6 days of gestation was conducted at our hospital from January 2013 to December 2014. The study population was divided according to the mode of birth. The primary outcome was early neonatal mortality, and secondary outcomes related to maternal and perinatal clinical characteristics were analysed between the groups. Results: Of 45,166 births, 1.92% (n = 869) were twin pregnancies. Of the 295 pregnancies meeting the study criteria, 30.16% (n = 89) were in the vaginal birth group, while the remaining 69.84% (n = 206) were in the cesarean birth group. In the vaginal birth group, all the first twins were delivered via vaginal birth, while among the second twins, 82.03% (n = 73) were delivered via vaginal birth, and the remaining 17.97% (n = 16) were delivered via cesarean birth. In the vaginal birth group, the early neonatal mortality rate was 22.4‰ (n = 2), and it was 9.7‰ (n = 2) in the cesarean birth group. All of the deaths occurred in pregnancies under 37 weeks of gestation. Conclusion: The neonatal outcomes between the vaginal birth and cesarean birth groups were similar in term pregnancies with the first in twin vertex presentation, whereas adverse neonatal outcomes were increased in the vaginal birth group in preterm second twin pregnancies.

scholarly journals The Prenatal Diagnosis~ What should we do? What can we do?

2021 ◽  
pp. 1-7
Keyword(s):  
Diaphragmatic Hernia ◽  
Breech Presentation ◽  
Fetal Distress ◽  
Heart Sounds ◽  
Meconium Peritonitis ◽  
Fetal Hydrops ◽  
Abnormal Pregnancy ◽  
Meconium Staining ◽  
Twin Pregnancies ◽  
Bowel Dilatation

Purpose: Prenatal diagnostic accuracy has improved; however, the pediatric surgeon’s role remains unclear. This paper aimed to determine the prenatal diagnoses made and the role of pediatric surgeons. Methods: A 6-year retrospective review of 904 pregnancies managed at our institute was conducted. They were classified as a normal pregnancy (NP, n=194), abnormal pregnancy maternal factor (MF, n=449), or abnormal pregnancy fetal factor (FF, n=261). Results: In the FF group, the identified conditions were twin pregnancies (n=75), intrauterine growth restriction (IUGR) (n=49), breech presentation (n=26), arrested development (n=19), hypoamnion (n=42), fetal distress (n=16), hydramnios (n=10), abnormal heart sounds (n=5), meconium staining (n=5), surface anomaly (n=4), calcification (n=2), fetal hydrops (n=2), fetal death (n=2), bowel dilatation (n=2), abdominal mass (n=1) and diaphragmatic hernia (n=1). Case of twin pregnancies, breech presentation, arrested development, IUGR, hypoamnion, abnormal heart sounds, meconium staining and fetal hydrops did not require surgery. Of the 16 cases of fetal distress, 1 had biliary atresia. Of the 10 cases of hydramnios, 1 had meconium peritonitis. Of the 4 with surface anomalies, 3 had gastroschisis. Of the 2 with calcification, 1 had meconium peritonitis. Of the two fetal deaths, 1 had anal atresia suggesting a chromosomal abnormality. Of the 2 cases of bowel dilatation, 1 had bowel atresia. The abnormal mass was caused by adrenal bleeding. These diagnoses were made at an average of 27.4 gestational weeks; however, 2 cases of gastroschisis, suggesting a body stalk anomaly; diaphragmatic hernia; and brain cysts were diagnosed before 20 weeks and were aborted. After delivery, the mortality rate was 0% in neonates treated by pediatric surgeons and neonatologists. Conclusion: Fetal abnormalities are rare; however, early aggressive management with the cooperation of obstetricians and parents is crucial for pediatric surgeons to minimize the effects of anomalies.

scholarly journals Labour with low dose epidural analgesia: maternal perception and fetal outcome

2018 ◽  
Vol 7 (2) ◽  
pp. 689 ◽  
Author(s):  
Vasudha Sawant ◽  
Archana Kumbhar
Keyword(s):  
Epidural Analgesia ◽  
Apgar Score ◽  
Low Dose ◽  
Mode Of Delivery ◽  
Fetal Outcome ◽  
Natural Phenomenon ◽  
Second Stage ◽  
Second Stage Of Labour ◽  
Significant Difference ◽  
Vertex Presentation

Background: Experiencing labour pains and giving birth to infant is normal physiological process. Though it is a natural phenomenon, it produces severe pain which requires analgesia to relieve pain during labour. The objective of this study was to compare effects of low dose epidural analgesia verses no analgesia during labour on mother and fetus.Methods: Here in this study we have assessed effect of epidural analgesia on mother and fetus. Total we have taken 60 women in age group of 20-26 years with full term pregnancy (37-42 weeks). Those who have entered spontaneous labour with vertex presentation, without any previous uterine surgery, clinically adequate pelvis. We had divided these women in 2 groups, 30 were given epidural analgesia and 30 without any analgesia. Variables recorded were pain score during labour using VAS, duration of labour during each stage, mode of delivery, Apgar score of newborn at 1 minute and 5 minutes.Results: Present study shows that duration of first stage of labour in epidural and non-analgesia group are same. Second stage of labour is prolonged in epidural group than non-analgesia group. Both groups had normal APGAR score. Epidural analgesia is not associated with any change in mode of delivery. Visual analogue scale is good with epidural analgesia.Conclusions: There was no significant difference in first stage of labour in both group. Second stage of labour was slightly prolonged in EA group than control, but it was less than two hours. No harmful neonatal outcome in epidural analgesia.

scholarly journals OASIS: clinical audit in a tertiary care centre

2018 ◽  
Vol 7 (5) ◽  
pp. 1958
Author(s):  
Sruthy Soman ◽  
Sobha S. Nair ◽  
Janani J. N. ◽  
Radhamany K. ◽  
Ann John Kurien
Keyword(s):  
Epidural Analgesia ◽  
Vaginal Delivery ◽  
Anal Sphincter ◽  
Gestational Age ◽  
Rectal Mucosa ◽  
Shoulder Dystocia ◽  
Induction Of Labour ◽  
Normal Vaginal Delivery ◽  
Perineal Tear ◽  
Vertex Presentation

Background: Obstetric anal sphincter injury involves injury to the anal sphincter and rectal mucosa sustained at time of vaginal delivery and can result in significant long-term morbidity. These injuries have been defined as 3rd and 4th degree lacerations that involve disruption of the anal sphincter and rectal mucosa respectively. Objectives of this study were to find out the incidence of obstetrical anal sphincter injuries, to identify the risk factors for of OASIS and the outcome of primary repair in terms of anal incontinence and its associated complications.Methods: We did a descriptive study of OASIS by retrospective analysis of the labour case records. The study period was 1 year between August 2016 to July 2017. Inclusion criteria were singleton pregnancy, vertex presentation, instrumental and normal vaginal delivery. Exclusion criteria were multiple pregnancy, non-vertex presentation and caesarean section. Proforma was developed to capture the age, parity, gestational age in weeks, induction of labour, epidural analgesia, delivery duration, type of episiotomy, instrumentation, shoulder dystocia, occipito posterior position,manual support, weight of the baby, suturing method. Postnatal evaluation after 6 weeks and 6 months for perineal discomfort, pain, incontinence, wound infection, breakdown, fistula were noted. Results: The incidence of OASIS was 1.4%. 81.8% women had 3rd degree perineal and 18.1% had 4th degree perineal tear. The mean age of the patients were 27.9 years, gestational age of 39.45 weeks, 72.7% were primiparous. Induction of labour with prostaglandins was done in 36.36% and Pitocin augmentation for 81.81%. The duration of second 36.36% had 60-89 min and 27.27% had duration more than 90 min. 54.54% had epidural analgesia, 36.36% had shoulder dystocia, 36.36% had instrumental delivery. 72.72% babies had birth weight between 3-3.5 kg, 9% between 3.5-4 kg. Ano vaginal fistula developed in 9%.Conclusions: Appropriate training, anticipating and identifying major degrees of perineal tear helps in reducing the complications. Anovaginal fistula is distressing and disabling the patient and to her near ones.

scholarly journals Spontaneous Version of Fetal Presentation in Twin Pregnancies During Third Trimester: Longitudinal Assessment

2018 ◽  
Vol 21 (3) ◽  
pp. 269-274
Author(s):  
Jeong Woo Park ◽  
Seung Mi Lee ◽  
Hye-Sim Kang ◽  
Soon-Sup Shim ◽  
Jong Kwan Jun
Keyword(s):  
Cohort Study ◽  
Birth Weight ◽  
Gestational Age ◽  
Retrospective Cohort ◽  
Longitudinal Assessment ◽  
Third Trimester ◽  
Study Population ◽  
Vertex Presentation ◽  
Twin Pregnancies ◽  
Second Twin

Little is known about longitudinal changes of the first twin presentation in twin gestations. This is a retrospective cohort study including 411 women who were admitted consecutively and delivered live-born twins at 36 weeks of gestation or more. Longitudinal assessment of the first twin presentation was conducted during gestation and at birth in all cases. Gestational age at antenatal assessment was divided into two intervals: early-third trimester (28–31 weeks) and mid-third trimester (32–35 weeks). Fetal presentation was categorized as vertex or non-vertex. We analyzed change of fetal presentation between antepartum intervals and birth. First twin presentation at early-third trimester had the same presentation at birth in 87.6% (360/411) of the study population. In this ‘no change’ group, vertex presentation was seen in 95.6% (283/296) and non-vertex was seen in 67.0% (77/115) of cases. In total, 96.1% (395/411) of the study population maintained their presentation between mid-third trimester and birth. Vertex presentation was seen in 98.4% (310/315) and non-vertex was seen in 88.5% (85/96) of cases. When comparing vertex with non-vertex, vertex presentation during third trimester was a more reliable predictor of presentation at birth (p < .001). The only factor that contributed significantly to spontaneous version of the first twin during mid-third trimester and birth was a lower birth weight of the first twin compared with the second twin. In conclusion, first twin presentation with vertex during third trimester is not likely to change into non-vertex at birth. We concluded that vertex presentation in twin gestations at early- and mid-third trimester is very predictable. In contrast, a non-vertex first twin presentation is relatively unstable.

Do Breech Presentations in Twins and Singletons Run Different Risks?

1985 ◽  
Vol 34 (3-4) ◽  
pp. 207-211 ◽  
Author(s):  
P. Buekens ◽  
R. Lagasse ◽  
F. Puissant ◽  
F. Leroy
Keyword(s):  
Cesarean Section ◽  
Perinatal Mortality ◽  
Lower Risk ◽  
Breech Presentation ◽  
Fetal Distress ◽  
Mortality Rates ◽  
Apgar Scores ◽  
Significant Difference ◽  
Twin Pregnancies

AbstractWe have compared breech twins and breech single births in a population recorded between 1974 and 1978 in 10 Belgian maternity centers. In 190 twin pregnancies, 38 first and 65 second twins were delivered in breech presentation. These twins were compared to 853 singleton breeches, of which 95 delivered by cesarean section were excluded. Data were stratified according to birthweight. No significant difference between twins and singletons was found in terms of perinatal mortality rates. However, Apgar scores below 7 at 5 minutes were significantly less numerous among first twins than among singletons. Therefore, first twins in breech presentation might be at lower risk of fetal distress. This difference should be taken into account in the management of first twins presenting by the breech.

scholarly journals The effects of epidural analgesia in normal labour

2018 ◽  
Vol 7 (9) ◽  
pp. 3485
Author(s):  
Vallur Swetha Reddy ◽  
U. S. Sabitha ◽  
L. Krishna ◽  
Vimala .
Keyword(s):  
Epidural Analgesia ◽  
Standard Technique ◽  
Epidural Group ◽  
Spontaneous Labour ◽  
Good Pain Relief ◽  
Neonatal Icu ◽  
The Mean ◽  
Vertex Presentation ◽  
Two Stages ◽  
And Control

Background: Epidural analgesia is considered to be gold standard technique for labour analgesia but is claimed to prolong labour. Previous studies have evaluated epidural analgesia versus systemic opioids to no analgesia. The present study evaluated the effect of epidural analgesia on duration of labour compared to no analgesia.Methods: Sixty primigravida with full term-singleton, vertex presentation in spontaneous labour were included in the study. Parturient willing for epidural analgesia were allocated as epidural group (n=30), rest served as control. The intervention in active stage of labour included 10 ml of Inj. Bupivacaine 0.125% and Inj. Fentanyl 100μg and maintenance with infusion of Inj. Bupivacaine 0.125% and Inj. Fentanyl 2μg/ml added at a rate of 6-8 ml/hr. Duration of the first two stages of labour, patient satisfaction, side effects, number of instrumental vaginal/ vacuum-assisted deliveries, and neonatal APGAR score were recorded.Results: The mean duration of first stage of labour was shorter in epidural group (250.17±106.33 minutes) compared with control (302.00±111.99 minutes), (p= 0.071). The mean duration of second stage in epidural group was (18.73±6.82 minutes) compared with control (18.33±14.53 minutes) was not significant (p= 0.892). Although instrumental vaginal delivery rate was greater in the epidural group (6.7%) as compared to control (3.3%), (p=1.000). Pain score (VAPS) varied between1-3 and 4-10 in epidural group and control respectively (p< 0.001). The APGAR scores at 5 min and neonatal ICU admissions were statistically comparable.Conclusions: Epidural analgesia with Bupivacaine and Fentanyl results in good pain relief with undue prolongation of labour.

scholarly journals Turning Foetal Breech Presentation at 32-35 Weeks of Gestational Age by Acupuncture and Moxibustion

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Paolo Brici ◽  
Giovanna Franconi ◽  
Cristina Scatassa ◽  
Elisabetta Fabbri ◽  
Paolo Assirelli
Keyword(s):  
Low Cost ◽  
Breech Presentation ◽  
Normal Pregnancy ◽  
The Self ◽  
Secondary Outcome ◽  
Self Administration ◽  
Natural Childbirth ◽  
Cost Treatment ◽  
Vertex Presentation ◽  
Stimulation Of

Introduction. Foetal breech presentation is an obstetric problem that often leads to caesarean section. Stimulation of the acupoint BL67 by moxibustion may correct breech presentation. Methods. We observed 93 pregnant women in the 32nd-35th week of gestation with normal pregnancy and ultrasound diagnosis of breech presentation. The patients received stimulation of acupoint BL67 by self-administered moxibustion once a day for two weeks and if foetuses still were in breech presentation, moxibustion, and needle in the points BL65 and SI1, lasting 30 minutes, for three days in one week. The main outcome was vaginal birth with vertex presentation at delivery; the secondary outcome was compliance in the self-administration of the moxibustion treatment. Results. We observed cephalic version and natural childbirth in 62.4% of all treated women. The treatment was accepted by 98.9% women (93/94), and compliance was 91.4% (85/93) for self-administered moxibustion and 37.5% (12/32) for moxibustion and needle treatment. Conclusions. On the basis of our results, self-administered home treatment moxibustion followed by moxibustion and needle stimulations may be an effective and low-cost treatment for inducing cephalic version.

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