A decade’s experience in primipara, term, singleton, vertex parturients with a sustained low rate of CD

2019 ◽  
Vol 48 (1) ◽  
pp. 27-33 ◽  
Author(s):  
Misgav Rottenstreich ◽  
Meirav Nezer ◽  
Adiel Kahana ◽  
Reut Rotem ◽  
Aharon Tevet ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Vaginal Delivery ◽  
Primary Outcome ◽  
Mode Of Delivery ◽  
Induction Of Labor ◽  
Labor Management ◽  
Sentinel Event ◽  
Low Rate ◽  
Labor Augmentation

AbstractBackgroundCesarean delivery (CD) in primiparas with a term singleton vertex fetus (PTSV) is a sentinel event for the future mode of delivery and determinant of repeat CD risk. We aimed to evaluate the risk factors for primary CD in a population with a decade of sustained low rate of intrapartum CD.MethodsThis was a retrospective single-center cohort study between 2005 and 2014. The primary outcome of the study was the mode of delivery. PTSV who attempted vaginal delivery were identified and categorized according to the mode of delivery: vaginal delivery vs. CD. Risk factors for intrapartum CD adjusted odds ratio (aOR) [95% confidence interval (CI)] in multivariate analysis were reported.ResultsDuring the study, 121,483 deliveries were registered; 26,301 (21.6%) PTSV were admitted in labor, of which 1944 (7.4%) had an intrapartum CD. Significantly in multivariate analysis, this group had a unique risk profile as compared to those who delivered vaginally; non modifiable risks included advanced maternal age: 3.06 (2.16–4.33), P < 0.001; prior multiple (≥3) miscarriages: 1.94 (1.04–3.62), P = 0.04; low (<6) modified admission cervical score: 2.41 (2.07–2.82), P < 0.001; low birth weight (BW): 1.42 (1.00–2.01), P = 0.05 or macrosomia: 2.38 (1.77–3.21), P < 0.001; modifiable risks included induction of labor: 1.79 (1.51–2.13), P < 0.001 and oxytocin labor augmentation: 8.36 (6.84–10.22), P < 0.001.ConclusionIn a population of PTSV with a sustained low risk for intrapartum cesarean maintained by a strict labor management, induction of labor remains a significant and sole potentially modifiable risk factor for CD.

scholarly journals Prevalence and risk factors of persistent stress urinary incontinence at three months postpartum in Indonesian women

2016 ◽  
Vol 25 (3) ◽  
pp. 163-170
Author(s):  
Edy Fakhrizal ◽  
Tyas Priyatini ◽  
Budi I. Santoso ◽  
Junizaf Junizaf ◽  
Fernandi Moegni ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Caesarean Section ◽  
Vaginal Delivery ◽  
Mode Of Delivery ◽  
Primiparous Woman ◽  
Postpartum Stress ◽  
Primiparous Women

Background: Mode of delivery and some certain risk factors have a relationship to postpartum stress urinary incontinence (SUI). For that reason, the objective of this study was to assess the prevalence of postpartum stress urinary incontinence (SUI), the relationship between postpartum SUI and mode of delivery; and the association between SUI and other demographic and obstetric factors.Methods: In this prospective observational cohort study, all primiparous women who were under postpartum care in obstetric and gynecologic ward were recruited. Four hundreds primiparous women with no history of urinary incontinence (UI) who fulfilled the criteria and would like to participate in this study were followed up for three months after delivery. The analysis was done using Stata 12. Bivariate analysis using Chi-square test and multivariate analysis using logistic regression test were done to obtain associated risk factors to postpartum SUI.Results: The prevalence of postpartum SUI was 8.8%. The mode of delivery was significantly associated with postpartum SUI, there were more women who got vaginal delivery that had stress urinary incontinence (14.1%) compared to women caesarean section (7.1%) with OR=2.1 (95% CI=1.05-4.31), this risk increased when vaginal delivery was assisted with vacuum instrument (OR=9.1, 95% CI=3.9-21.6). There was no statistical difference of stress urinary incontinence incidences in patients with emergency or elective caesarean section with OR=0.84 (95% CI=0.28-2.57). Based on multivariate analysis BMI ≥30 kg/m2 at labor, vacuum assisted delivery, birth weight more than 3,360 g, and second stage labor more than 60 minutes appeared to be associated with an increased rate of postpartum SUI.Conclusion: Stress urinary incontinence increased in the early postpartum period of a primiparous woman. Although vaginal delivery increased the risk of postpartum SUI, elective nor emergency caesarean delivery without vaginal delivery id not appear to increase the risk of stress urinary incontinence.

scholarly journals Predictors of Severe Perineal Tear during Delivery in Yenagoa, Southern Nigeria

2021 ◽  
pp. 42-51
Author(s):  
Ikobho Ebenezer Howells ◽  
Isaac Joel Abasi
Keyword(s):  
Multivariate Analysis ◽  
Birth Weight ◽  
Vaginal Delivery ◽  
Anal Sphincter ◽  
Educational Level ◽  
Odds Ratio ◽  
Mode Of Delivery ◽  
Sphincter Injury ◽  
Perineal Tear ◽  
Anal Sphincter Injury

Background:Perineal tear is a very common complication of vaginal delivery, and it is often mild. However, when severe, it could result in torrential life threatening hemorrhage and anal sphincter injury, with fecal incontinence. Objective: The objective of this study is to determine the predictors of severe perineal tear (3rd and 4th degree tear), using mild perineal tear (1st and 2nd degree) as control. It would also determine the rate of perineal tear, and the maternal and fetal demographic risk factor associated with it. Materials and Methods: This was an analytic observational study of 186 women who had perineal tear during vaginal delivery. Out of these, 19 women had severe (3rd and 4th degree) perineal tear, also known as obstetrics anal sphincter injury (OASI). This was compared to 167 women who had mild perineal tear (1st and 2nd degree) during the study period. Maternal demographic information retrieved was maternal age, parity, educational level, and occupation. Obstetrics factors were booking status, gestational age at delivery, mode of delivery, rank of the accoucheur (nurse or doctor), and degree of perineal tear. Fetal demographic data was birth weight and fetal sex. Categorical variables were compared with odds ratio, difference in mean was compared with student’s t-test, and the degree of association for quantitative variables was determined using Pearson’s correlation coefficient. Predictor variables were determined using simple logistic regression, and multivariate analysis. Confidence interval was set at 95%, and statistical significance was set at p value of < 0.05. Results: The prevalence of OASI (3rd and 4th degree perineal tear) in Yenagoa was 1.1%. The significant risk factors were women of younger age, odds ratio = 1.04(0.37, 2.87) with p = 0.04, low parity, odds ratio = 0.20(0.07, 0.55) with p = 0.008, low educational background, odd ratio = 18.9(5.92, 60.81), and birth weight ≥ 4kg, odds ratio = 0.30[0.09, 1.06] with p = 0.04. Using simple liner regression, the most significant predictors for severe perineal tear were mode delivery (r2 = 65.5%), and educational level (r2 = 30.0%). However, on stepwise multivariate analysis, these two factors accounted for 68.5%. Conclusion: The rate of severe perineal tear is relatively low in Yenagoa, Nigeria, and comparable to what obtains in many countries. The most significant predictors were mode of delivery and educational level. Careful selection of the mode of delivery, especially instrumental vaginal deliveries, and women empowerment could minimize the rate in our environment.

Anal Sphincter Injury Associated with Vaginal Twin Delivery

2019 ◽  
Vol 37 (11) ◽  
pp. 1134-1139
Author(s):  
Bobby D. O'Leary ◽  
Tariq Bholah ◽  
Tamara Kalisse ◽  
Mark P. Hehir ◽  
Michael P. Geary
Keyword(s):  
Risk Factors ◽  
Vaginal Delivery ◽  
Anal Sphincter ◽  
Univariate Analysis ◽  
Mode Of Delivery ◽  
Significant Risk ◽  
Sphincter Injury ◽  
Anal Sphincter Injury ◽  
Vaginal Deliveries ◽  
Twin Pregnancies

Abstract Objective Obstetric anal sphincter injury remains the most common cause of fecal incontinence in women, and research in twin pregnancies is sparse. This study aimed to examine risk factors for sphincter injury in twin deliveries over a 10-year period. Study Design This was a retrospective study of twin vaginal deliveries in a tertiary-level hospital over 10 years. We examined the demographics of women who had a vaginal delivery of at least one twin. Logistic regression analysis was used to examine risk factors. Results There were 1,783 (2.1%) twin pregnancies, of which 556 (31%) had a vaginal delivery of at least one twin. Sphincter injury occurred in 1.1% (6/556) women with twins compared with 2.9% (1720/59,944) singleton vaginal deliveries. Women with sphincter injury had more instrumental deliveries (83.3 vs. 27.6%; p = 0.008). On univariate analysis, only instrumental delivery was a significant risk factor (odds ratio: 2.93; p = 0.019). Conclusion Sphincter injury occurs at a lower rate in vaginal twin pregnancies than in singletons. No twin-specific risk factors were identified. Discussion of the risk of sphincter injury should form part of patient counseling with regard to the mode of delivery.

scholarly journals Predictors of mortality in extramural very low birth weight neonates: a prospective observational study

2020 ◽  
Vol 8 (1) ◽  
pp. 107
Author(s):  
Rajkumar M. Meshram ◽  
Ruchi A. Gedam ◽  
Shivangi Garg ◽  
Kalyani S. Kadu ◽  
Madhabika R. Chakraborty ◽  
...  
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Respiratory Distress ◽  
Vaginal Delivery ◽  
Very Low Birth Weight ◽  
Mode Of Delivery ◽  
Home Delivery ◽  
Male Gender ◽  
Independent Risk Factors

Background: Over the past few decades, the burdens of very low birth weight (VLBW) preterm infants are increasing due to advances in obstetrics and perinatal services. Objectives of the study were to assess predictors of mortality of extramural VLBW neonates.Methods: Prospective one year cohort study was undertaken on VLBW neonates fulfilling the inclusion criteria at a tertiary institute. Maternal and neonatal demographic data were analyzed.Results: Male to female ratio was 1.26:1. One hundred and thirty seven (74.9%) neonates had birth weights from 1000-1499 g while 46 (25.1%) had birth weights <1000 g (ELBW) and 90% were preterm. One hundred and sixty five (90.2%) neonates were admitted in early neonatal period. Anaemia was the commonest maternal illness and preeclampsia/eclampsia was the most common obstetric complication. Respiratory distress, temperature instability and lethargy were common clinical presentations. Respiratory distress, sepsis and perinatal asphyxia were common diagnoses on admission. Mortality rate in VLBW neonates was 59.6% and respiratory distress was the commonest cause of death. Male gender (p=0.01), home delivery (p=0.04), vaginal delivery (p=0.05) and positive septic screen (p=0.003) had significantly higher mortality while mode of delivery (aOR 0.27 CI 0.086-0.83 p=0.02) and positive septic screen (aOR 4.0 CI 1.67-9.84 p=0.002) were independent risk factors for mortality.Conclusions: In extramural VLBW neonates, male gender, home delivery, vaginal delivery and positive septic screen had significantly higher mortality whilst mode of delivery and positive septic screen were independent risk factors for mortality.

scholarly journals Prediction of labor outcome by measuring the angle of progression using two dimensional trans-perineal Ultrasound: A prospective cohort study

2021 ◽  
Vol 12 (3) ◽  
pp. 200-204
Author(s):  
Diaa Abdelhalim ◽  
Hussein Abolmakarem ◽  
Mohamed Hassan
Keyword(s):  
Vaginal Delivery ◽  
Primary Outcome ◽  
Mode Of Delivery ◽  
Perineal Ultrasound ◽  
Vaginal Route ◽  
Fetal Head ◽  
Spontaneous Vaginal Delivery ◽  
Non Invasive ◽  
Secondary Outcomes ◽  
Angle Of Progression

Background: Failure of descent due to fetal malposition is one of the most common indications for performing surgical deliveries. It has recently been suggested that trans-perineal intra-partum ultrasonography may be useful in assessing fetal head engagement, position and station as well as it’s reliable, cheap, painless and effective tool. Measuring the ‘angle of progression’ could assist in the obstetrician’s decision regarding mode of delivery. Objectives: The primary outcome is to use the AOP to develop a predictive model for the probability of successful vaginal delivery. Secondary outcomes including assessment of possibly successful VBAC in previous one CS women. Methods: We recruited 500 women in labor. For each woman, a (TPU) was performed to measure the AOP in late first and second stages of labor. We compared AOP between women who delivered fetuses through vaginal route to those who delivered by CS. Results: Through 467 women included in the study, AOP was significantly Higher in spontaneous vaginal delivery group (with cut off 123°±8.5°) as compared with women delivered by vacuum or by CS (113°±10.5°) (P=0.003). The VBAC as another secodary outcome seems to be insignificant. Conclusions: TPU is safe, non-invasive and easily preformed technique which is useful to predict labor outcomes.

scholarly journals Study of pre induction transvaginal ultra-sonographic cervical length and its comparison with bishop score in predicting successful labor induction

2021 ◽  
Vol 10 (6) ◽  
pp. 2335
Author(s):  
Santosh Khajotia ◽  
Madhuri Sharma ◽  
Mool Chand Khichar ◽  
Manoj Gupta ◽  
Kavita Choudhary
Keyword(s):  
Vaginal Delivery ◽  
Prospective Observational Study ◽  
Mode Of Delivery ◽  
Cervical Length ◽  
Labor Induction ◽  
Induction Of Labor ◽  
Bishop Score ◽  
Receiver Operating Characteristic Curves ◽  
Medical College ◽  
Successful Induction

Background: Induction of labor means initiation of uterine contraction, after period of viability by any method (medical, surgical or combined) before spontaneous onset of labor for the purpose of vaginal delivery. The condition of cervix or favorability is important for successful labor induction. Assessment of cervix has been used as a predictor of successful vaginal delivery. Induction of labor carried out in approximately 20% of all pregnancies. Aim and objectives of the current study were to compare the predictive value of trans-vaginal ultra-sonographic measurement of cervical length versus Bishop score prior to induction of labor in predicting the mode of delivery and maternal and fetal outcome.Methods: This prospective observational study was conducted in the department of obstetrics and gynecology, Sardar Patel medical college and associated group of hospitals, Bikaner between February to November 2020. Study group included 100 pregnant women in which induction of labor was performed at 37-42 weeks of gestation.Results: Bishop Score appears to be a better predictor than the cervical length with sensitivity of 1.00 and a specificity of 0.12 compared to 0.52 and 1.00 respectively. In the receiver operating characteristic curves, the cut-off point for the prediction of successful induction taken was 2.6 cm cervical length and >4 for the bishop score.Conclusions: TVS cervical length could be used as alternative to Bishop score for prediction of successful labor induction in the sitting where the appropriate equipment and expertise are available. Bishop score and TVS cervical length both are good predictors of successful induction of labor. 

scholarly journals Risk Factors for Postpartum Maternal Infection Following Spontaneous Vaginal Delivery Complicated by Chorioamnionitis

2020 ◽  
Vol 10 (02) ◽  
pp. e159-e164
Author(s):  
Helen A. Daifotis ◽  
Megan M. Smith ◽  
Anna E. Denoble ◽  
Sarah K. Dotters-Katz
Keyword(s):  
Risk Factors ◽  
Vaginal Delivery ◽  
Primary Outcome ◽  
Perineal Wound ◽  
Antibiotic Use ◽  
Bivariate Statistics ◽  
Spontaneous Vaginal Delivery ◽  
High Risk Women ◽  
Increased Risk ◽  
Perineal Wound Infection

Abstract Objective Guidelines for the management of chorioamnionitis include intrapartum antibiotics, while postpartum antibiotics after spontaneous vaginal delivery (SVD) are reserved high-risk women. Our objective is to describe the incidence of and risk factors for postpartum infection after SVD complicated by chorioamnionitis. Study Design This is a retrospective study of SVDs with clinically diagnosed chorioamnionitis at a single center. The primary outcome was a composite of postpartum infection. Women who developed the primary outcome were compared with those who did not using bivariate statistics. Regression models were developed to estimate adjusted odds of outcomes. Results In this cohort, 346 women underwent SVD complicated by chorioamnionitis. Of these, 23 (6.6%) developed postpartum infections (endometritis n = 7, urinary tract infection/pyelonephritis n = 6, sepsis n = 4, and perineal wound infection n = 6). Receipt of antibiotics intra- or postpartum did not differ between groups, but women with postpartum infections were more likely to deliver prior to 32 weeks (17.4 vs. 4.9%, p = 0.04). When controlling for antibiotic use, delivery at < 32 weeks was associated with 3.8-fold increased (95% confidence interval: 1.07–13.7) odds of postpartum infection. Conclusion Postpartum infections occur in ∼1/15 women delivering vaginally with chorioamnionitis, with those who deliver at < 32 weeks' gestation being at increased risk.

scholarly journals Pre-labor Cesarean delivery or induction of labor in twin gestation

2020 ◽  
Author(s):  
Claire Dougan ◽  
Lara Gotha ◽  
Nir Melamed ◽  
Amir Aviram ◽  
Elizabeth Asztalos ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Vaginal Delivery ◽  
Primary Outcome ◽  
Secondary Analysis ◽  
Neonatal Morbidity ◽  
Induction Of Labor ◽  
Secondary Outcome ◽  
Maternal Outcomes ◽  
Maternal Morbidity And Mortality ◽  
Spontaneous Onset

Abstract BACKGROUND: We aimed to compare neonatal and maternal outcomes of twin gestations without spontaneous onset of labor, which underwent induction of labor or pre-labor cesarean section.METHODS: In the Twin Birth Study (TBS), women at 320/7-386/7 weeks of gestation, in whom the first twin was in cephalic presentation, were randomized to planned vaginal delivery or cesarean section. In this secondary analysis of the TBS we focused on the outcomes of the subset of women who did not have a spontaneous onset of labor. We compared those who had an induction of labor with those who had a pre-labor cesarean section. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity. Secondary outcome was a composite of maternal morbidity and mortality.RESULTS: Of the 2,804 women included in the TBS, a total of 1,347 (48%) women did not have a spontaneous onset of labor: 568 (42%) in the planned vaginal delivery arm and 779 (58%) in the planned cesarean arm. Induction of labor was attempted in 409 (30%), and 938 (70%) had a pre-labor cesarean section. The rate of intrapartum cesarean section in the induction of labor group was 41.3%. The rate of the primary outcome was comparable between the pre-labor cesarean section and induction of labor groups (1.65% vs. 1.97%; p=0.61; OR 0.83; 95% CI 0.43-1.62). The maternal composite outcome was found to be lower with pre-labor cesarean section compared to induction of labor (7.25% vs. 11.25%; p=0.01; OR 0.61; 95% CI 0.41-0.91).CONCLUSION: In women with twin gestation between 320/7-386/7 weeks of gestation with the first twin in cephalic presentation, induction of labor and pre-labor cesarean section have similar neonatal outcomes. Pre-labor cesarean section is associated with favorable maternal outcomes.

scholarly journals Effect of Different Methods of Induction on the Mode of Delivery and Fetal Outcome

2013 ◽  
Vol 26 (2) ◽  
pp. 81-85
Author(s):  
Nabila Aminu Buhari ◽  
Sumayya Lugman Ahmed ◽  
Nastaran Redha Sohrabi ◽  
Hidayat Yetunde Ogunsola ◽  
Riwana B Shaikh ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Vaginal Delivery ◽  
Mode Of Delivery ◽  
Fetal Outcome ◽  
Labor Induction ◽  
Induction Of Labor ◽  
Normal Vaginal Delivery ◽  
College Hospital ◽  
Medical College ◽  
Mean Time

Objectives: To study various methods of induction of labor and their effect on mode of delivery  and fetal outcome.Methods: 104 pregnant women induced in Gulf Medical College hospital from August to   November 2009 were included. Mothers were observed from the start of their induction and  followed up till they were discharged. The methods of induction compared were the use of prostaglandin, oxytocin, prostaglandin and oxytocin combined and artificial rupture of membranes.Results: Out of 104 pregnant women, 86 (89%) had normal vaginal delivery. Of these, 36 (41.9%) were induced with combination of prostaglandin and oxytocin, 32 (37.2%) with prostaglandin, 14 (16.2%) with oxytocin, and 4 (4.6%) with artificial rupture of membranes. 13 (12.5%) mothers delivered through caesarean section of these, 7 (53.8%) mothers were induced with prostaglandin, 3 (23%) with prostaglandin and oxytocin, 2 (15.3%) with oxytocin alone, and 1 (7.7%) with artificial rupture of membranes. Induction of labor with combination of prostaglandin and oxytocin was found to be the most effective method. Duration of labor between primigravidas and multigravidas were significantly different with primigravidas having longer duration of labor with mean time of 12.47 hours while multigravidas had 9.16 hours.Conclusion: Induction of labor with combination of prostaglandin and oxytocin was found to be the most effective method in this study with very good progressing to normal vaginal delivery. Further research is needed on a larger scale to compare other methods of labor induction on parturient to be able to recommend the most effective method of labor induction. DOI: http://dx.doi.org/10.3329/bjog.v26i2.13785 Bangladesh J Obstet Gynaecol, 2011; Vol. 26(2) : 81-85  

scholarly journals Nocturia and others urinary symptoms in three stages of postpartum according mode of delivery

2016 ◽  
Vol 15 (2) ◽  
pp. 175-182
Author(s):  
Priscylla Helouyse Melo Angelo ◽  
Monayane Grazielly Leite Matias ◽  
Maria Aneilma Ribeiro de Azevedo ◽  
Luzinete Medeiros de Almeida ◽  
Maria Thereza Albuquerque Barbosa Cabral Micussi
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Vaginal Delivery ◽  
Postpartum Period ◽  
Prospective Cohort ◽  
Mode Of Delivery ◽  
Urinary Symptoms ◽  
Face To Face ◽  
Three Stages ◽  
First Interview

Introduction: There are risk factors causing urinary symptoms associated with childbirth. The aim was to investigate the presence of urinary symptoms in postpartum. Methods: Prospective cohort study was undertaken. The women were evaluated three times. The first interview was face-to-face at 2 days after the childbirth. At 2 and 8 weeks after delivery, the patients were interviewed by telephone. Results: 132 women were divided into two groups according to the mode of delivery: VG (vaginal delivery group) and CG (cesarean group). The average age of the women was 25.54 (±5.65) years in VG and 25.23 (±5.26) years in CG (p = 0.869). The most frequent symptom in both groups was nocturia. Conclusion: urinary symptoms tend to worsen throughout the postpartum period, regardless of the mode of delivery.

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