scholarly journals Recovery after Nulliparous Birth

2017 ◽  
Vol 127 (4) ◽  
pp. 684-694 ◽  
Author(s):  
Ryu Komatsu ◽  
Brendan Carvalho ◽  
Pamela D. Flood
Keyword(s):  
Cesarean Delivery ◽  
Vaginal Delivery ◽  
Functional Recovery ◽  
Rating Scale ◽  
Area Under The Curve ◽  
The United States ◽  
Opioid Use ◽  
Pain Experience ◽  
Nulliparous Women ◽  
Time Required

Abstract Background The majority of parturients in the United States first return for evaluation by their obstetric practitioner 6 weeks after delivery. As such, there is little granular data on the pain experience, analgesic requirements, and functional recovery during the postpartum period. This prospective observational study was performed to evaluate these factors to provide expectations for patients. Methods A total of 213 nulliparous women were enrolled and assessed daily until they completed 3 outcomes: (1) pain resolution; (2) opioid cessation; and (3) self-assessed functional recovery from delivery. The primary endpoint, pain- and opioid-free functional recovery, was the time required to reach all three of the endpoints. Pain burden was assessed as the area under the curve created by plotting the daily numerical pain rating scale against the days required to attain pain resolution. Times to attain study endpoints after cesarean delivery and vaginal delivery were compared using survival analysis. Results After vaginal delivery, days required for pain and opioid-free functional recovery (median [interquartile range (IQR)]) were 19 [11 to 26], for opioid cessation 0 [0 to 2], termination of all analgesic (including nonsteroidal antiinflammatories and acetaminophen) 11 [5 to 17], and pain resolution 14 [7 to 24]. Achievement of these endpoints after cesarean delivery required 27 [19 to 40], 9 [5 to 12], 16 [11 to 24], and 21 [14 to 27] days, respectively. Conclusions There is clinically significant variability between healthy nulliparous parturients in the pain experience, opioid use, and functional recovery after childbirth following vaginal and cesarean delivery. Recovery to predelivery function is similar after vaginal and cesarean delivery, and approximately half of the variance was explained by pain burden.

scholarly journals Clinical predictive factors for vaginal delivery following induction of labour among pregnant women in Jordan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rawan A. Obeidat ◽  
Mahmoud Almaaitah ◽  
Abeer Ben-Sadon ◽  
Dina Istaiti ◽  
Hasan Rawashdeh ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Pregnant Women ◽  
Cesarean Delivery ◽  
Vaginal Delivery ◽  
Induction Of Labour ◽  
Labour Induction ◽  
Bishop Score ◽  
Nulliparous Women ◽  
Multiparous Women ◽  
The Mean

Abstract Background Induction of labour (IOL) is an important and common clinical procedure in obstetrics. In the current study, we evaluate predictors of vaginal delivery in both nulliparous and multiparous women in north Jordan who were induced with vaginal prostaglandins. Method A prospective study was conducted on 530 pregnant women at King Abdullah University Hospital (KAUH) in north Jordan. All pregnant mothers with singleton live fetuses, who had induction of labour (IOL) between July 2017 and June 2019, were included in the study. Mode of delivery, whether vaginal or caesarean, was the primary outcome. Several maternal and fetal variables were investigated. The safety and benefit of repeated dosage of vaginal prostaglandin E2 (PGE2) tablets, neonatal outcomes and factors that affect duration of labour were also evaluated. Pearson χ2 test was used to investigate the significance of association between categorical variables, while student’s t-test and ANOVA were applied to examine the mean differences between categorical and numerical variables. Linear regression analysis was utilized to study the relation between two continuous variables. A multivariate regression analysis was then performed. Significance level was considered at alpha less than 0.05. Results Nulliparous women (N = 254) had significantly higher cesarean delivery rate (58.7% vs. 17.8%, p < 0.001) and longer duration of labour (16.1 ± 0.74 h vs. 11.0 ± 0.43 h, p < 0.001) than multiparous women (N = 276). In nulliparous women, the rate of vaginal delivery was significantly higher in women with higher Bishop score; the mean Bishop score was 3.47 ± 0.12 in nulliparous women who had vaginal delivery vs. 3.06 ± 0.10 in women who had cesarean delivery (Adjusted odds ratio (AOR) = 1.2, 95% CI: 1.03–1.28, p = 0.03). In multiparous women, the rate of vaginal delivery was significantly higher in women with higher Bishop scores and lower in women with higher body mass index (BMI). The mean Bishop score was 3.97 ± 0.07 in multiparous women who had vaginal delivery vs. 3.56 ± 0.16 in women who had cesarean delivery (AOR = 1.5, 95% CI: 1.1–2.1, p = 0.01). The mean BMI was 30.24 ± 0.28 kg/m2 in multiparous women who had vaginal delivery vs. 32.36 ± 0.73 kg/m2 in women who had cesarean delivery (AOR = 0.89, 95% CI: 0.84–0.96, p = 0.005). 27% of nulliparous women who received more than two PGE2 tablets and 50% of multiparous women who received more than two PGE2 tablets had vaginal delivery with no significant increase in neonatal morbidity. Conclusion Parity and cervical status are the main predictors of successful labour induction. Further studies are required to investigate the benefit of the use of additional doses of vaginal PGE2 above the recommended dose for IOL.

scholarly journals A Prospective Investigation of Cesarean Birth with Total and Truncal Fat Mass in Early Adolescence

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1039-1039
Author(s):  
Lidia Minguez Alarcon ◽  
Sheryl Rifas-Shiman ◽  
Joanne Sordillo ◽  
Izzuddin Aris ◽  
Marie-France Hivert ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Vaginal Delivery ◽  
Fat Mass ◽  
Early Adolescence ◽  
Maternal Age ◽  
The United States ◽  
Delivery Mode ◽  
Linear Regression Models ◽  
Funding Sources ◽  
The Difference

Abstract Objectives Nearly 1.3 million cesarean deliveries are performed each year in the United States, resulting in the birth of one third of all children nationwide. A higher risk of childhood obesity has been observed among children born by cesarean, but this literature is inconsistent. We investigated differences in total and truncal fat mass during early adolescence among offspring born by cesarean compared to those born by vaginal delivery. Methods This prospective study includes adolescents (median age 12.8 years) whose mothers enrolled in while pregnant in Project Viva between 1999 and 2002, and who have been followed since birth. A total of 740 adolescents had available total and truncal fat mass measured using Dual Energy X-Ray Absorptiometry (DXA) at the early adolescent in-person visit. We abstracted delivery mode from electronic medical records. We used multivariable linear regression models to estimate the difference in total and truncal fat mass indices (FMI, kg/m,2) among adolescents born by cesarean compared to those born by vaginal delivery while adjusting for confounders. We used stabilized inverse probability weights to account for censoring. Results Mean (SD) maternal age was 32.2 (5.4) years and pre-pregnancy BMI was 25.0 (5.3) kg/m,2. A total of 157 (21%) of the adolescents were born by cesarean delivery and 51%were female; mean (SD) total and truncal FMI were 6.3 (3.1) and 2.4 (1.5) kg/m,2 respectively. Adolescents born by cesarean vs. vaginal delivery had significantly higher total [β (95% CI) = 0.78 (0.23, 1.33) kg/m,2] and truncal [β (95% CI) = 0.35 (0.08, 0.61) kg/m,2] FMI than those born by vaginal delivery in models adjusted for child age and sex, and maternal age, education and race/ethnicity. These associations were attenuated and no longer statistically significant after further adjusting for maternal pre-pregnancy BMI [β (95% CI) = 0.45 (−0.06, 0.96) kg/m,2 for total and 0.19 (−0.05, 0.44) kg/m,2 for truncal FMI]. Additional adjustment for gestational weight gain, smoking and paternal BMI did not substantially change the results. Conclusions These data suggest that the association between birth by cesarean delivery and adolescent adiposity is largely explained by maternal pre-pregnancy BMI. Funding Sources NIH grants R01HD093761, R01HD034568, R01ES024765, and UH3 OD023286.

Cesarean delivery among women with prolonged labor induction

2016 ◽  
Vol 44 (7) ◽  
Author(s):  
Louise L. Highley ◽  
Rebecca A. Previs ◽  
Sarah K. Dotters-Katz ◽  
Leo R. Brancazio ◽  
Chad A. Grotegut
Keyword(s):  
Cesarean Delivery ◽  
Vaginal Delivery ◽  
Mode Of Delivery ◽  
Labor Induction ◽  
University Hospital ◽  
Delivery Rate ◽  
Multivariate Logistic Regression Model ◽  
Nulliparous Women ◽  
Prolonged Labor ◽  
Cesarean Delivery Rate

AbstractObjective:The objective of this study was to determine characteristics associated with cesarean delivery among women with labor induction lasting over 24 h.Study design:Women with live singleton pregnancies without prior cesarean delivery undergoing a labor induction lasting >24 h between September 2006 and March 2009 at Duke University Hospital were identified. Collected variables were compared between subjects by mode of delivery. A multivariate logistic regression model for the outcome cesarean delivery was constructed separately for nulliparous and parous women.Results:There were 303 women who met inclusion criteria. The overall cesarean delivery rate was 57% (n=172) and remained constant with time (P=0.15, test-for-trend). Nulliparous women having a cesarean delivery were more likely to be obese [adjusted OR (aOR) 2.00; 95% CI 1.05, 3.80] and have a larger fetus [aOR 1.11 (aOR for every 100 g increase in birthweight), 95% CI 1.03, 1.20] compared to those having a vaginal delivery.Conclusion:Increasing BMI and birthweight were independent predictors of cesarean delivery among nulliparous women with prolonged labor induction. Despite this, after 24 h of labor induction, the overall mean cesarean delivery rate remained constant at 57%, and did not change with time. Among women having a vaginal delivery following a prolonged labor induction, we saw high rates of shoulder dystocia, operative vaginal delivery and severe perineal laceration.

Predicting Vaginal Delivery in Nulliparous Women Undergoing Induction of Labor at Term

2017 ◽  
Vol 35 (07) ◽  
pp. 660-668 ◽  
Author(s):  
U. M. Reddy ◽  
C. C. Huang ◽  
T. C. Auguste ◽  
D. Bauer ◽  
R. T. Overcash ◽  
...  
Keyword(s):  
Vaginal Delivery ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Predictive Ability ◽  
Induction Of Labor ◽  
Stepwise Logistic Regression ◽  
Chronic Hypertension ◽  
Stepwise Logistic Regression Analysis ◽  
Maternal Characteristics ◽  
Nulliparous Women

Objective We sought to develop a model to calculate the likelihood of vaginal delivery in nulliparous women undergoing induction at term. Study Design We obtained data from the Consortium on Safe Labor by including nulliparous women with term singleton pregnancies undergoing induction of labor at term. Women with contraindications for vaginal delivery were excluded. A stepwise logistic regression analysis was used to identify the predictors associated with vaginal delivery by considering maternal characteristics and comorbidities and fetal conditions. The receiver operating characteristic curve, with an area under the curve (AUC) was used to assess the accuracy of the model. Results Of 10,591 nulliparous women who underwent induction of labor, 8,202 (77.4%) women had vaginal delivery. Our model identified maternal age, gestational age at delivery, race, maternal height, prepregnancy weight, gestational weight gain, cervical exam on admission (dilation, effacement, and station), chronic hypertension, gestational diabetes, pregestational diabetes, and abruption as significant predictors for successful vaginal delivery. The overall predictive ability of the final model, as measured by the AUC was 0.759 (95% confidence interval, 0.749–0.770). Conclusion We identified independent risk factors that can be used to predict vaginal delivery among nulliparas undergoing induction at term. Our predictor provides women with additional information when considering induction.

Association between Maternal Serum Hormones along the Maternal–Fetal Hypothalamic–Pituitary–Adrenal Axis and Successful Vaginal Delivery Measured Prior to Labor Induction

2020 ◽  
Vol 37 (12) ◽  
pp. 1195-1200
Author(s):  
Chase R. Cawyer ◽  
Elena Lobashevksy ◽  
Glenda Corley-Topham ◽  
Sarah Anderson ◽  
John Owen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cesarean Delivery ◽  
Vaginal Delivery ◽  
Hpa Axis ◽  
Maternal Serum ◽  
Labor Induction ◽  
Vaginal Birth ◽  
Serum Hormones ◽  
Hypothalamic Pituitary Adrenal ◽  
Nulliparous Women

Abstract Objective This study aimed to evaluate if maternal serum hormones along the maternal–fetal hypothalamic–pituitary–adrenal (HPA) axis, when drawn prior to labor induction, differed between women who delivered vaginally and those who underwent cesarean. Study Design This was a prospective observational study at a single perinatal center performed from August 2017 to May 2018. Nulliparous women with uncomplicated singleton pregnancies ≥39 weeks had maternal serum collected prior to induction. Corticotrophin-releasing hormone (CRH) was measured by ELISA; dehydroepiandrosterone sulfate (DHEA-S), cortisol, estriol (E3) estradiol (E2), and progesterone (P4) were measured by chemiluminescent reaction. Mean analyte concentrations as well as three ratios (E2/P4, E3/P4, and E2/E3) were compared between women who had a vaginal versus cesarean delivery. Logistic regression was used to model the relationship between CRH and the odds of vaginal birth. We estimated that a sample size of 66 would have 90% power to detect a 25% difference in mean CRH levels assuming a vaginal:cesarean ratio of 2:1 with a baseline CRH concentration of 140 (standard deviation = 36) pg/mL. Results Of the 88 women who had their serum analyzed, 27 (31%) underwent cesarean. Mean maternal serum CRH levels were similar between the vaginal delivery and cesarean groups (122.6 ± 95.2 vs. 112.3 ± 142.4, p = 0.73). Similarly, there were no significant differences in any other maternal serum analytes or ratios. Logistic regression showed a nonsignificant odds ratio for successful vaginal birth (p = 0.69) even when evaluating only the 16 women who had a cesarean for an arrest disorder (p = 0.08). Conclusion In low-risk nulliparous women undergoing full-term labor induction, there were no differences noted in a broad array of other maternal-fetal HPA-axis hormones between women who had a vaginal or cesarean delivery.

scholarly journals Prediction of vaginal delivery by using intrapartum ultrasound – a prospective cohort study

2019 ◽  
Keyword(s):  
Cohort Study ◽  
Vaginal Delivery ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Demographic Data ◽  
Area Under The Curve ◽  
Operating Characteristics ◽  
Fetal Head ◽  
Nulliparous Women ◽  
First Stage Of Labor

Non-invasive transperineal ultrasound is used to detect the descent of the fetal head by measuring head-perineum distance (HPD) and angle of progression (AP). The aim of the study was to evaluate HPD and AP as predictors of vaginal delivery in the first stage of labor. Methods: A prospective cohort study was made in Riga Maternity Hospital in Latvia in 2016. In the study were included nulliparous women with singleton pregnancies in cephalic presentation. HPD and AP were measured using transperineal ultrasoud. Demographic data, delivery parameters and birth outcomes were collected. Results: Of 36 women enrolled in the study, 26 (72.2%) had a vaginal delivery. The area under the receiver–operating characteristics curve was 0.865 (95% confidence interval (CI) 0.75-0.98) for the prediction of vaginal delivery using HPD as the test variable. The area under the curve was 0.877 (95% CI 0.77-0.99) using AP. All women delivered vaginally, if HPD was ≤40 mm (18 (50%) women). 8 (22.2%) of 18 women with HPD >40 mm delivered vaginally (P<0.001). 21 women of 22 (61.1%) with AP ≥105° delivered vaginally. In the other 14 (38.9%) women with AP <105° 5 delivered vaginally (P<0.001). Conclusions: Both HPD ≤ 40 mm and AP ≥ 105° are predictors for vaginal birth in the first stage of labor.

A Double-Blind, Randomized, Active-Controlled Study for Post-Hemorrhoidectomy Pain Management with Liposome Bupivacaine, a Novel Local Analgesic Formulation

2012 ◽  
Vol 78 (5) ◽  
pp. 574-581 ◽  
Author(s):  
Eric Haas ◽  
Erol Onel ◽  
Howard Miller ◽  
Madhu Ragupathi ◽  
Paul F. White
Keyword(s):  
Rating Scale ◽  
Area Under The Curve ◽  
Numeric Rating Scale ◽  
Controlled Study ◽  
Opioid Use ◽  
Double Blind ◽  
Local Infiltration ◽  
Pain Scores ◽  
Liposome Bupivacaine ◽  
Post Hoc

This randomized, active-controlled study evaluated the extent and duration of analgesia after administration of liposome bupivacaine (LB), a novel formulation of bupivacaine, compared with bupivacaine HCl given via local infiltration in excisional hemorrhoidectomy. One hundred patients were randomly assigned to receive a single dose of bupivacaine HCl 75 mg (0.25% with 1:200,000 epinephrine) or LB 66, 199, or 266 mg upon completion of hemorrhoidectomy. Postoperative pain intensity was assessed using a numeric rating scale at rest to calculate a cumulative pain score (area under the curve). Cumulative pain scores were significantly lower with LB at each study dose ( P < 0.05) compared with bupivacaine HCl 72 hours after surgery. Post hoc analysis showed that mean total postoperative opioid consumption was statistically significantly lower for the LB 266-mg group compared with the bupivacaine HCl group during the 12- to 72-hour postoperative period ( P = 0.019). Median time to first opioid use was 19 hours for LB 266 mg versus 8 hours for bupivacaine HCl ( P = 0.005). Incidence of opioid-related adverse events was 4 per cent for LB 266 mg compared with 35 per cent for bupivacaine HCl ( P = 0.007). Local infiltration with LB resulted in significantly reduced postsurgical pain compared with bupivacaine HCl in patients after hemorrhoidectomy surgery.

scholarly journals Using Activity Trackers to Quantify Postpartum Ambulation

2018 ◽  
Vol 128 (3) ◽  
pp. 598-608 ◽  
Author(s):  
Julia Ma ◽  
Rachel Martin ◽  
Bokman Chan ◽  
Michael Gofeld ◽  
Michael P. Geary ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Vaginal Delivery ◽  
Functional Recovery ◽  
Multimodal Analgesia ◽  
Neuraxial Anesthesia ◽  
Activity Tracker ◽  
Quality Of Recovery ◽  
Pain Scores ◽  
Activity Trackers ◽  
Postpartum Pain

Abstract Background Early postoperative ambulation is associated with enhanced functional recovery, particularly in the postpartum population, but ambulation questionnaires are limited by recall bias. This observational study aims to objectively quantify ambulation after neuraxial anesthesia and analgesia for cesarean delivery and vaginal delivery, respectively, by using activity tracker technology. The hypothesis was that vaginal delivery is associated with greater ambulation during the first 24 h postdelivery, compared to cesarean delivery. Methods Parturients having first/second cesarean delivery under spinal anesthesia or first/second vaginal delivery under epidural analgesia between July 2015 and December 2016 were recruited. Patients with significant comorbidities or postpartum complications were excluded, and participants received standard multimodal analgesia. Mothers were fitted with wrist-worn activity trackers immediately postdelivery, and the trackers were recollected 24 h later. Rest and dynamic postpartum pain scores at 2, 6, 12, 18, and 24 h and quality of recovery (QoR-15) at 12 and 24 h were assessed. Results The study analyzed 173 patients (cesarean delivery: 76; vaginal delivery: 97). Vaginal delivery was associated with greater postpartum ambulation (44%) compared to cesarean delivery, with means ± SD of 1,205 ± 422 and 835 ± 381 steps, respectively, and mean difference (95% CI) of 370 steps (250, 490; P &lt; 0.0001). Although both groups had similar pain scores and opioid consumption (less than 1.0 mg of morphine), vaginal delivery was associated with superior QoR-15 scores, with 9.2 (0.6, 17.8; P = 0.02) and 8.2 (0.1, 16.3; P = 0.045) differences at 12 and 24 h, respectively. Conclusions This study objectively demonstrates that vaginal delivery is associated with greater early ambulation and functional recovery compared to cesarean delivery. It also establishes the feasibility of using activity trackers to evaluate early postoperative ambulation after neuraxial anesthesia and analgesia.

scholarly journals Implementation of Evidence-Based Cervical Ripening Protocol: Outcomes and Next Steps

2020 ◽  
Vol 10 (04) ◽  
pp. e408-e412
Author(s):  
Arthurine Zakama ◽  
Nasim C. Sobhani ◽  
Robyn Lamar ◽  
Melissa G. Rosenstein
Keyword(s):  
Cesarean Delivery ◽  
Vaginal Delivery ◽  
San Francisco ◽  
Management Practices ◽  
Low Dose ◽  
Cervical Ripening ◽  
Evidence Based ◽  
Nulliparous Women ◽  
Before And After ◽  
Time To Delivery

Abstract Objective A prominent randomized controlled trial demonstrated that low-dose misoprostol with the concurrent cervical Foley shortened the median time to delivery when compared with either method alone. Our study aims to address implementation of this protocol and evaluate its impact on time to delivery. Study Design This was a retrospective before-and-after study of nulliparous women who delivered nonanomalous, term, singletons at the University of California San Francisco (UCSF) in two separate 2-year periods before and after changes in UCSF's cervical ripening protocol. The primary outcome was time from first misoprostol dose to delivery. Results A total of 1,496 women met inclusion criteria, with 698 in the preimplementation group and 798 in the postimplementation group. There were no statistically significant differences in time to delivery (29 vs. 30 hours, p = 0.69), rate of cesarean delivery (30 vs. 26%, p = 0.09), or cesarean delivery for fetal indications (11 vs. 8%, p = 0.15) between the groups. Conclusion Implementing evidence-based low-dose misoprostol with the concurrent cervical Foley did not change the time to delivery, time to vaginal-delivery, or likelihood of vaginal delivery in our population. This may be due to differences in labor management practices and incomplete fidelity to the protocol. Real-world effectiveness of these interventions will vary and should be considered when choosing an induction method.

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