Do manual therapies to the perineum during the second stage of labor reduce the incidence of genital tract trauma during vaginal deliveries?

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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Midwifery Care Measures in the Second Stage of Labor and Reduction of Genital Tract Trauma at Birth: A Randomized Trial

Journal of Midwifery & Women s Health ◽

10.1016/j.jmwh.2005.05.012 ◽

2005 ◽

Vol 50 (5) ◽

pp. 365-372 ◽

Cited By ~ 105

Author(s):

Leah L. Albers ◽

Kay D. Sedler ◽

Edward J. Bedrick ◽

Dusty Teaf ◽

Patricia Peralta

Keyword(s):

Randomized Trial ◽

Genital Tract ◽

Midwifery Care ◽

Second Stage Of Labor ◽

Second Stage

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Effect of Antenatal Exercises on Second Stage of Labor Outcomes in Nulliparous Women

Studies on Ethno-Medicine ◽

10.31901/24566772.2020/14.3-4.613 ◽

2020 ◽

Vol 14 (3-4) ◽

Author(s):

Eman Awad

Keyword(s):

Antenatal Care ◽

Neonatal Intensive Care ◽

Randomized Study ◽

Second Stage Of Labor ◽

Second Stage ◽

Nulliparous Women ◽

Vaginal Deliveries ◽

Group B ◽

Routine Antenatal Care ◽

Labor Outcomes

ABSTRACT The second stage of labor (SSL) has often been neglected, leading to birthing complications, perinatal morbidities, and higher rates of cesarean section (CS) in nulliparous women. In this paper, it was aimed to determine the effect of antenatal exercises on labor outcomes in nulliparous women. Two-group posttest-only randomized study. Overall, 60 nulliparous women at their 30th to 32nd weeks of gestation were allocated into two groups randomly. Group (A) received only routine antenatal care and educational instructions till the time of delivery (n=30), while group (B) received the same routine antenatal care and educational instructions in addition to antenatal exercises till the time of delivery (n=30). Comparing both groups revealed that group (B) had a significant increase in the number of spontaneous vaginal deliveries (p<0.05) and a significant decrease in duration of SSL (p<0.05), without any need to admit their neonates to the neonatal intensive care unit (NICU).

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Vacuum Deliveries: A Retrospective Study on Immediate Maternal and Neonatal Outcomes in Western Regional Hospital, Pokhara

Medical Journal of Pokhara Academy of Health Sciences ◽

10.3126/mjpahs.v3i1.31918 ◽

2020 ◽

Vol 3 (1) ◽

pp. 234-238

Author(s):

Deepak Raj Kafle ◽

Prem Raj Pageni

Keyword(s):

Retrospective Study ◽

Vaginal Delivery ◽

Apgar Score ◽

Genital Tract ◽

Neonatal Morbidity ◽

Regional Hospital ◽

Assisted Vaginal Delivery ◽

Second Stage ◽

Vaginal Deliveries ◽

Western Regional

Introduction: The overall rate of operative vaginal delivery is diminishing, but the proportion of operative vaginal deliveries conducted by vacuum is increasing. As forceps assisted delivery requires more skill and has more complications on maternal genital tract, this procedure is being less frequently practiced. By the 1970s, the vacuum extractor virtually replaced forceps for assisted deliveries in most of the countries. Vacuum assisted vaginal delivery reduces maternal as well as neonatal morbidity and mortality in prolonged second stage of labor, non reassuring fetal status and maternal conditions requiring a shortened second stage. Materials and Methods: This was a record based retrospective study of 217 vacuum assisted vaginal deliveries conducted at Western Regional Hospital, Pokhara for a period of one year. Patient’s discharge charts were studied and details of indications for vacuum application, maternal genital tract status, amount of blood loss, postpartum hemorrhage (PPH), birth weight, APGAR score at 1 and 5 minute, Neonatal Intensive Care Unit (NICU) admission and neonatal death (NND) were collected. Descriptive data analysis was done using SPSS program. Results: Out of the 8778 deliveries conducted during the study period, 217 (2.47%) cases were vacuum assisted vaginal deliveries. No significant adverse obstetrics outcomes were noted. Most frequent indication was fetal distress which accounted for 53.9%. Though 3rd/4th degree perineal tears were less, episiotomy rate was higher (69.1%). Regarding neonatal outcomes, mean APGAR score at 5 minute was 7.42 ± 1.11 SD and 12.4% neonates had APGAR score of less than 7 at 5 minute. Conclusion: When standard criteria for vacuum application are met and standard norms are followed, there is no evidence of adverse obstetrics outcomes in vacuum assisted vaginal delivery. Prompt delivery by a skilled clinician in non reassuring fetal cardiac status reduces neonatal morbidity and mortality.

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Operative Vaginal Delivery Is a Safe Option in Women Undergoing a Trial of Labor after Cesarean

American Journal of Perinatology Reports ◽

10.1055/s-0039-1692482 ◽

2019 ◽

Vol 09 (02) ◽

pp. e190-e194

Author(s):

Erin Krizman ◽

Patricia Grzebielski ◽

Kathleen M. Antony ◽

Emmanuel Sampene ◽

Matthew Shanahan ◽

...

Keyword(s):

Vaginal Delivery ◽

Mode Of Delivery ◽

Neonatal Morbidity ◽

Wound Complications ◽

Second Stage Of Labor ◽

Trial Of Labor ◽

Second Stage ◽

Safe Option ◽

Anal Sphincter Laceration ◽

Vaginal Deliveries

Objective To compare outcomes of operative intervention in the second stage of labor during trial of labor after cesarean (TOLAC). Study Design A secondary analysis of the Maternal-Fetal Medicine Units Network cesarean section registry was conducted. Analysis was by first attempted mode of delivery. Results A total of 1,837 met inclusion criteria. Subjects in the operative vaginal groups (OVDs) were more likely to have a prior vaginal delivery (vacuum 34.2%; forceps 34.3%) than the repeat cesarean delivery (RCD) group (22.6%; p < 0.0001). Most OVD attempts were successful (forceps 90.4%; vacuum 92.6%). Neonatal morbidity was not different (12.1% forceps vs. 14.6% vacuum; 14.8% RCD). Maternal morbidity was highest among forceps deliveries (32.3 vs. 24.3% vacuum; 22.0% RCD, p = 0.0001). RCD was associated with surgical injury (2.7 vs. 0.7% forceps; 0% vacuum; p < 0.0001), endometritis (8.4 vs. 3.2% forceps, 1.2% vacuum; p < 0.0001), and wound complications (1.9 vs. 0.4% forceps; 0.3% vacuum; p = 0.006). OVD was associated with anal sphincter laceration (22.7% forceps, 15.5% vacuum; 0% RCD; p = 0.01). Conclusion The success rate of OVD is high in TOLAC with similar outcomes to RCD. Maternal composite outcomes were highest with forceps-assisted vaginal deliveries. However, considering overall morbidity, OVD in the second stage of labor in TOLAC is a reasonable, safe option in selected cases.

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