Relations between fetal head descent and cervical dilatation during individual uterine contractions in the active stage of labor

2009 ◽  
Vol 35 (4) ◽  
pp. 654-659 ◽  
Author(s):  
Ofer Barnea ◽  
Oded Luria ◽  
Ariel Jaffa ◽  
Michael Stark ◽  
Harold E. Fox ◽  
...  
Keyword(s):  
Cervical Dilatation ◽  
Active Stage ◽  
Fetal Head ◽  
Uterine Contractions

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.

The management of labour

2020 ◽  
pp. 331-338
Author(s):  
Devendra Kanagalingam
Keyword(s):  
Active Management ◽  
Cervical Dilatation ◽  
Routine Practice ◽  
Fetal Outcomes ◽  
Uterine Contractions ◽  
Best Management ◽  
Spontaneous Expulsion ◽  
Three Stages

Normal labour is a process of spontaneous expulsion of the fetus, placenta, and membranes at term. This process is initiated by complex endocrine mechanisms that cause uterine contractions which lead to effacement and dilatation of the cervix and descent of the fetus, resulting in delivery. About 10% of women go into labour in the preterm period. The progress is dependent on uterine contractions (power), the size and presentation of the fetus (passenger), and the size of the pelvis (passage). For ease of management, the observed labour is artificially divided into three stages. The partogram is used to manage labour and is where maternal and fetal observations can be plotted in addition to cervical dilatation and descent of the presenting part. The value of active management is still debated but has been adapted in routine practice. More research is needed to decide the best management of labour to optimize the maternal and fetal outcomes.

Effect of Epidural Analgesia with Ambulation on Labor Duration

2001 ◽  
Vol 95 (4) ◽  
pp. 857-861 ◽  
Author(s):  
Manuel C. Vallejo ◽  
Leonard L. Firestone ◽  
Gordon L. Mandell ◽  
Francisco Jaime ◽  
Sandra Makishima ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Randomized Study ◽  
Mode Of Delivery ◽  
Vena Cava ◽  
Cervical Dilatation ◽  
Fetal Head ◽  
Chi Square ◽  
Labor Duration ◽  
Nulliparous Women ◽  
Scale Scores

Background Ambulatory epidural analgesia (AEA) is a popular choice for labor analgesia because ambulation reportedly increases maternal comfort, increases the intensity of uterine contractions, avoids inferior vena cava compression, facilitates fetal head descent, and relaxes the pelvic musculature, all of which can shorten labor. However, the preponderance of evidence suggests that ambulation during labor is not associated with these benefits. The purpose of this study is to determine whether ambulation with AEA decreases labor duration from the time of epidural insertion to complete cervical dilatation. Methods In this prospective, randomized study, 160 nulliparous women with AFA were randomly assigned to one of two groups: AEA with ambulation and AEA without ambulation. AEA blocks were initiated with 15-20 ml ropivacaine (0.07%) plus 100 microg fentanyl, followed by a continuous infusion of 0.07% ropivacaine plus 2 microg/ml fentanyl at 15-20 ml/h. Maternal measured variables included ambulation time, time from epidural insertion to complete dilatation, stage II duration, pain Visual Analogue Scale scores, and mode of delivery. APGAR scores were recorded at 1 and 5 min. Results are expressed as mean +/- SD or median and analyzed using the t test, chi-square, or the Mann-Whitney test at P < or = 0.05. Results The ambulatory group walked 25.0 +/- 23.3 min, sat upright 40.3 +/- 29.7 min, or both. Time from epidural insertion to complete dilatation was 240.9 +/- 146.1 min in the ambulatory group and 211.9 +/- 133.9 min in the nonambulatory group (P = 0.206). Conclusion Ambulatory epidural analgesia with walking or sitting does not shorten labor duration from the time of epidural insertion to complete cervical dilatation.

Randomized controlled trial of elevation of the fetal head with a fetal pillow during cesarean delivery at full cervical dilatation

2016 ◽  
Vol 133 (2) ◽  
pp. 178-182 ◽  
Author(s):  
Subrata L. Seal ◽  
Alok Dey ◽  
Sannyashi C. Barman ◽  
Gourisankar Kamilya ◽  
Joydev Mukherji ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Cesarean Delivery ◽  
Controlled Trial ◽  
Cervical Dilatation ◽  
Fetal Head ◽  
Randomized Controlled

scholarly journals Maternal and foetal outcome in second stage caesarean section: a prospective study

2021 ◽  
Vol 10 (4) ◽  
pp. 1644
Author(s):  
Shuchi Sharma ◽  
Poojan Dogra ◽  
Reena Sharma ◽  
Suraj Bhardwaj
Keyword(s):  
Caesarean Section ◽  
Prospective Study ◽  
Cervical Dilatation ◽  
Bladder Injury ◽  
Fetal Head ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Second Stage Of Labour ◽  
Adjacent Structures ◽  
A Prospective Study

Background: Caesarean section is the most commonly performed abdominal operation in women all over the world. Caesarean sections during the second stage labour accounts for approximately one fourth of all primary caesareans.  Caesarean section at full cervical dilatation is technically difficult and is associated with increased trauma to the lower uterine segment and adjacent structures, as well as increased haemorrhage and infection. Aims and objectives were to determine the indications, maternal and foetal morbidity associated with caesarean section in the second stage of labour.Methods: This prospective study included consecutive 50 cases of caesarean section deliveries conducted in second stage of labor for singleton live pregnancies at term. The data collected in the study was analyzed in terms of maternal demographics, indications of caesarean section, intra-operative and postoperative complications and neonatal outcomes.Results: In our series of 50 deliveries, arrest of descent of fetal head due to malposition was the most common indication of caesarean section accounting for 74% and average procedure time was 45-70 minutes. PPH (62%) was the most common complication. Bladder injury was found in 14% cases. Neonatal outcome variables like APGAR<3 at 5 minutes, respiratory distress and neonatal death were observed in 7, 26 and 2 deliveries respectively.Conclusions: Women undergoing cesarean section in second stage of labour are associated with increased maternal and fetal morbidity. They require special care and hence operation should ideally be performed and supervised by an experienced obstetrician. A proper judgement is required to take a decision for caesarean section at full cervical dilatation.

scholarly journals Factors Influencing Perception of Labor Pain among Parturient Women at Tribhuvan University Teaching Hospital

2013 ◽  
Vol 8 (1) ◽  
pp. 26-30 ◽  
Author(s):  
Isha Shrestha ◽  
N Pradhan ◽  
J Sharma
Keyword(s):  
Teaching Hospital ◽  
Demographic Data ◽  
Labor Pain ◽  
University Teaching ◽  
Cervical Dilatation ◽  
Factors Affecting ◽  
Primary Level ◽  
Uterine Contractions ◽  
Obstetrics And Gynaecology ◽  
Active Labor

Aims: This study was done to understand the severity of labor pain in parturients of Kathmandu and to determine factors affecting it. Methods: A descriptive study was conducted in Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal where 300 term parturientsin active labor (cervical dilatation of 3-5 cm with three uterine contractions in 10 minutes each lasting for ≥ 30 seconds) were analysed for socio-demographic data, clinical profile and pain assessment.Visual analog scale was used for pain assessment. Results: The intensity of labor pain was graded as severe by 32%, moderateby 57% and mild by 11% of parturients.Almost half ofthe parturients in the age group of ≤19years described labor pain as severe as compared to women between 20-34years (30.4%) and ≥35years (20%). Among the nulliparous parturients, 37% described it as severe compared to only 20.7% in≥Para1.In those with≥higher secondary leveleducation, 35.9% described labor pain as severe as compared to those women who had education of ≤primary level(26.9%) and upto secondary level (27.1%). Labor pain was seen to be more severe in advanced labor withmore than half describingit as severe when the cervix was dilated to 5 cm, as compared to only 25.9% and 29.4% of the parturients at 3 and 4cm cervical dilatation respectively. Conclusions: This study concluded that the labor pain was moderate to severe for majority of the parturients.Adolescents, nullipara, patients with higher education and those in advanced laborwere more likely to perceive labor pain of higher intensity. Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 1 / Issue 15 / Jan- June, 2013 / 26-30 DOI: http://dx.doi.org/10.3126/njog.v8i1.8857

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