scholarly journals Twin pregnancy-maternal and fetal complications its association with mode of delivery: a study in a tertiary center

2017 ◽  
Vol 6 (11) ◽  
pp. 5089
Author(s):  
Jupirika E. Pyrbot ◽  
Manika Agarwal
Keyword(s):  
Vaginal Delivery ◽  
Statistical Significance ◽  
Mode Of Delivery ◽  
Tertiary Hospital ◽  
North East India ◽  
North East ◽  
Tertiary Center ◽  
Foetal Outcome ◽  
Nicu Admission ◽  
Twin Pregnancies

Background: Twin pregnancies are associated with many complications. Hence the mode of delivery and its effect on the maternal and foetal outcome is important.Methods: A retrospective study of twin pregnancies carried out from April 2015 to March 2017 in a tertiary hospital in north east, India. The maternal, foetal outcome and the mode of delivery data collected and analysed.Results: A total of 50 twin pregnancies studied. The prevalence of twin was 20/1000 deliveries. Most common age group was 20-29 years with a mean age of 28±5.7 years. A total of 24 (48%) had vaginal delivery and 26 (52%) had LSCS, 2 (4%) had the first twin as vaginal delivery and second twin LSCS. A statistical significance was seen in the mode of delivery of twin pregnancies conceived after ovulation induction, (p<0.05). The most common indication for LSCS was foetal malpresentation (14.58%) followed by foetal distress (12.5%) and elective LSCS (10.42%) on patient’s request. The most common complication was anaemia (28.08%) and PIH (27.08%). In the neonate prematurity was the most common morbidity. There was no association between the mode of delivery and the foetal outcome in the form of Apgar at 5 minutes, NICU admission and perinatal mortality.Conclusions: There is a rise of caesarean delivery in twin pregnancies, maternal request becoming one of the causes. Regular antenatal check-ups of pregnant women with counselling regarding the mode of delivery should be carried out.

scholarly journals Neonatal and Maternal Outcomes in Spontaneously-Conceived Twin Pregnancies According to Mode of Delivery

Folia Medica ◽  
2020 ◽  
Vol 62 (3) ◽  
pp. 468-476
Author(s):  
Samantha Mc Kenzie Stancu ◽  
Manuela Cristina Russu
Keyword(s):  
Neonatal Intensive Care ◽  
Statistical Significance ◽  
Mode Of Delivery ◽  
Statistical Correlation ◽  
P Value ◽  
Maternal Outcomes ◽  
Chi Square ◽  
Chi Square Test ◽  
Nicu Admission ◽  
Twin Pregnancies

Introduction: Appropriate intrapartum conduct in a twin delivery remains a challenging aspect of obstetric practice. The objective of this study was to compare neonatal and maternal outcomes in twin pregnancies according to mode of delivery.&nbsp; Materials and methods: This is a single centre retrospective cohort study of all consecutive spontaneously-conceived twin deliver-ies (&ge; 24 weeks, estimated fetal weight &ge; 500 grams) over a nine-year period between 01/01/2007 - 31/12/2016 at a tertiary-level centre. Neonatal outcomes included survival, APGAR score, prematurity-associated pathology (PAP), admission to the neonatal intensive care unit (NICU) and length of stay (LOS). Maternal outcomes included postpartum complications and LOS. Statistical analysis comprised Chi-square test with subsequent p-value and odds-ratio with 95% confidence interval. Statistical significance was set at p<0.05. Results: A total of 173 consecutive women with spontaneously-conceived twin deliveries were enrolled in this study, 129 (74.6%) women delivered by caesarean section (CS). The success rate of vaginal delivery (VD) was 93.6% (44/47). A strong statistical correlation was identified between CS and NICU admission; 53.2% vs. 1.5% (p=0.0001). Neonatal LOS in the NICU was significantly longer in the CS group. Prematurity-associated pathology (PAP) was noted in 75 pairs of twins (75/173); 61 pairs were delivered by CS, bearing strong statistical significance (p<0.0001). Postpartum complications occurred in 14.7% of CS compared to 13.6% of VDs.&nbsp; Conclusion: Neonates delivered by CS had a higher rate of PAP, NICU admission, lower birth weight and longer LOS. This study showed that VD is safe, especially when the first twin is in cephalic presentation

scholarly journals Induction of Labor using Misoprostol in a Tertiary Hospital in the Southeast of Brazil

2017 ◽  
Vol 39 (10) ◽  
pp. 523-528
Author(s):  
Tácito Silva ◽  
Luciano Borges Júnior ◽  
Luisa Tahan ◽  
Taynná Costa ◽  
Fernanda Magalhães ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Pregnant Women ◽  
Vaginal Delivery ◽  
Stepwise Regression ◽  
Statistical Significance ◽  
Tertiary Hospital ◽  
Labor Induction ◽  
Stepwise Regression Analysis ◽  
Labor Process ◽  
Southeastern Brazil

Purpose To assess cases of labor induction with vaginal 25-µg tablets of misoprostol and maternal outcomes in a tertiary hospital in southeastern Brazil. Methods This was a retrospective cohort study of 412 pregnant women with indication for labor induction. Labor induction was performed with vaginal 25-µg tablets of misoprostol in pregnant women with Bishop scores < 6. Stepwise regression analysis was used to identify the factors present at the beginning of induction that could be used as predictors of successful labor induction. Results A total of 69% of the pregnant women who underwent labor induction progressed to vaginal delivery, and 31% of the women progressed to cesarean section. One or two misoprostol tablets were used in 244 patients (59.2%). Of the 412 patients, 197 (47.8%) required oxytocin later on in the labor process, after induction with misoprostol. The stepwise regression analysis showed that only Bishop scores of 4 and 5 and previous vaginal delivery were independent factors with statistical significance in the prediction of successful vaginal labor induction (β = 0.23, p < 0.001, for a Bishop score of 4 and 5, and β = 0.22, p < 0.001, for previous vaginal delivery). Conclusion Higher Bishop scores and previous vaginal delivery were the best predictors of successful labor induction with vaginal 25-µg tablets of misoprostol.

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.

Urine Incontinence Before and After Delivery in Primipara

2020 ◽  
Vol 2 (2) ◽  
pp. 67-72
Author(s):  
Prezma Shrestha
Keyword(s):  
Risk Factor ◽  
Urinary Incontinence ◽  
Vaginal Delivery ◽  
Muscle Tone ◽  
Mode Of Delivery ◽  
Study Finding ◽  
Antenatal Clinic ◽  
Tertiary Hospital ◽  
Pregnancy And Postpartum ◽  
Perineal Muscle

Introduction: Urinary incontinence is a common condition in pregnancy and postpartum period. It causes discomfort, embarrassment, loss of confidence and self esteem. This study aimed to determine the occurrence of urinary incontinence in pregnant attending antenatal clinic in a tertiary hospital. Methods: A descriptive observational study was conducted to find out occurrence of urinary incontinence in primiparous attending department of obstetrics and gynecology from August 2014 to August 2015 at B.P. Koirala Institute of Health Sciences. Results: The total of 100 primigravida were enrolled in the study. Out of which six had urinary incontinence with mean age of 23 years. Most of them were in the period of gestation group 38–40 weeks. 22% of total were obese with mean BMI of 26.69 kg/m2. Seventy nine patients had vaginal delivery, four had vacuum assisted vaginal delivery and 17 had cesarean section. Age and Body Mass Index (BMI) was not found to be associated with urinary incontinence. Oxford grading for assessment of perineal muscle after delivery showed decline in pelvic muscle tone which was significantly associated with urinary incontinence. However, the mode of delivery, and birth weight of baby was not found to be significant. Conclusion: The study finding suggested that pregnancy acts a risk factor for development of UI although no preference could be drawn regarding the mode of delivery. Our study also concluded antepartum UI as a risk factor for postpartum UI.

scholarly journals Predictors of Caesarean Delivery in Preterm Premature Rupture of Membranes

2019 ◽  
Vol 7 (7) ◽  
pp. 1124-1128 ◽  
Author(s):  
Samantha Mc Kenzie Stancu ◽  
Liran Kobi Ash ◽  
Cynthia Smeding ◽  
Maisa Abdullah Alwan
Keyword(s):  
Vaginal Delivery ◽  
Caesarean Delivery ◽  
Statistical Significance ◽  
Mode Of Delivery ◽  
University Education ◽  
Health Concern ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Preterm Premature Rupture ◽  
Pertinent Data

BACKGROUND: Preterm premature rupture of membranes (P-PROM) exerts a tremendous influence on pregnancy prognosis. Additionally, it is a major public health concern, as the cause of up to 40% of all preterm births. AIM: The objective of this study was to identify predictors of Caesarean Delivery in singleton pregnancies complicated by P-PROM. MATERIALS AND METHODS: This is a retrospective observational study of all consecutive singleton P-PROM deliveries (24-37 weeks) over an 18 months at a tertiary referral centre. Pertinent data was collected comprising demographics, obstetric history, pregnancy-associated pathology and delivery from electronic patient records.  Univariate statistical analysis comprised Odds Ratio, 95% Confidence interval and Chi-square test with subsequent p-value with statistical significance set at p < 0.05. RESULTS: A total of 240 women delivered singletons following P-PROM over an 18-month period. Maternal age ranged between 12-41 years with an average age of 28 ± 6.27 years. Vaginal delivery (VD) was the predominant mode of delivery, accounting for 52.9% (n = 127) of deliveries. The following parameters were identified as predictors of Caesarean Section (CS) in P-PROM: vaginal infection (p = 0.04), previous CS (p < 0.0001), primiparity (p = 0.004), gravidity > 5 (p = 0.009), university education (p = 0.0006) and prenatal care (p < 0.0001). CONCLUSION: The advantage of CS over vaginal delivery is expedited delivery of the distressed fetus, while that of vaginal delivery entails avoiding postoperative morbidity. However, large multicentric randomised-controlled studies are needed to elucidate this dilemma definitively.

scholarly journals Evaluation of Maternal and Fetal Stress Hormones During the Process of Birth

2018 ◽  
Vol 24 (2) ◽  
pp. 65
Author(s):  
Burcu Kisa Karakaya ◽  
Ozlem Moraloglu ◽  
Rahime Bedir Findik ◽  
Necati Hancerliogullari ◽  
Hatice Celik ◽  
...  
Keyword(s):  
Stress Response ◽  
Caesarean Section ◽  
Vaginal Delivery ◽  
Umbilical Cord ◽  
Elective Caesarean Section ◽  
Mode Of Delivery ◽  
Normal Vaginal Delivery ◽  
Singleton Pregnancy ◽  
Beta Endorphin ◽  
Tertiary Center

<p><strong>Objective:</strong> This study aims to determine whether mode of delivery is associated with the endocrine stress response in mother and newborn.</p><p><strong>Study Design:</strong> This prospective observational study was conducted with 86 women with a normal singleton pregnancy who delivered healthy infants between 37 and 41 weeks of gestation in a tertiary center. Study groups included; (1) women undergoing normal vaginal delivery with epidural anesthesia, (2) women undergoing vaginal delivery with immersion in water for pain relief during labor, (3) women delivered through elective caesarean section without labor. After delivery, thyroid stimulating hormone, cortisol, insulin, prolactin and Beta-endorphin levels were measured in maternal and umbilical cord serum and their relationships between modes of delivery were investigated.</p><p><strong>Results:</strong> It was found that the concentrations of cortisol and beta-endorphin after vaginal delivery with immersion in water group in both mothers and infants were higher than other two modes of delivery and these differences were statistically significant. Umbilical cord concentration of cortisol was the lowest in the caesarean section group.</p><p><strong>Conclusions:</strong> Maternal and fetal stress response was found to be associated with the mode of delivery and labor.</p>

scholarly journals Fetomaternal Outcome in Twin Pregnancies: A Retrospective Analysis from a Tertiary Care Centre

2020 ◽  
Author(s):  
Kamlesh Kumari ◽  
Minakshi Misra ◽  
Ambika Jhanwar ◽  
Asha Kumari
Keyword(s):  
Twin Pregnancy ◽  
Preterm Labour ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
P Value ◽  
Maternal Risk ◽  
Antenatal Period ◽  
The Mean ◽  
Twin Pregnancies

Introduction: Twin pregnancies are among the major challenges faced by obstetricians globally. Increased maternal and foetal morbidity is observed with an increase in the incidence of twin pregnancies. Due to elevated rates of complications, a larger number of caesarean sections are performed in twin pregnancies in comparison to singleton gestation. Aim: The study aimed to find out the incidence of twin pregnancy with associated maternal risk factors and foetal outcome in the study population. Materials and Methods: This retrospective observational study was carried out at JNU Hospital and Medical College, Jaipur for a period of 4 years from December 2015 to December 2019. A total of 70 mothers, who presented with twin pregnancy, were included in this study. Data were collected from hospital records regarding maternal age, parity, whether spontaneous or assisted conception, gestational age, pregestational Body Mass Index (BMI) and family history. Details of maternal and foetal complications that occurred during the antenatal period and labour as well as the mode of delivery were collected and analysed. Statistical significance was considered if the p-value was ≤0.05. Qualitative data were represented as rate and proportions, while quantitative data were represented as mean and standard deviation. Results: A total of 70 mothers with twin births, resulting in 140 babies during the 4 years study period were included. A total of 4240 deliveries overall during the study period, gave a twin pregnancy incidence rate of 16.5 in 1000 deliveries. Preterm labour (25.4%), anaemia (26.8%) and hypertension (22.5%) were common problems. The most common indication for caesarean delivery was foetal malpresentation (37.8%) The mean weight of the first twin was 2.12±0.35 kg while the mean weight of the second twin was 1.97±0.30 kg. Among foetal complications, Intrauterine Growth Restriction (IUGR) was seen in 11.4% and birth weight discordance in 21.4% of children. A low Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score was noted in 21.4% of babies, while 12.9% of babies died in the early neonatal period. Conclusion: Maternal complications during twin pregnancy were mainly preterm labour, diabetes, hypertension and anaemia. Caesarean section was the main mode of delivery in this study with significant association with hypertension and preterm labour. Foetal complications were in the majority related to IUGR. More vigilance during the antenatal period and labour is needed for proper selection of mode of delivery. Active foetal surveillance and intervention with appropriate neonatal care can improve fetomaternal outcome.

scholarly journals Outcome of Surgical Induction of Labourin a Combined Military Hospital

2018 ◽  
Vol 44 (1) ◽  
pp. 52-59
Author(s):  
Ismat Ara ◽  
Rokshana Sultana ◽  
SM Solaiman ◽  
MN Sakhawat Hassain
Keyword(s):  
Vaginal Delivery ◽  
Mode Of Delivery ◽  
Induction Of Labour ◽  
Normal Vaginal Delivery ◽  
Military Hospital ◽  
Vacuum Extraction ◽  
Term Pregnancy ◽  
Maternal Complications ◽  
Significant Difference ◽  
Foetal Outcome

Induction of labour is considered justified when the benefits of prompt delivery outweigh the consequences of Caeserian Section (CS). Literature on the effectiveness and safety of surgical induction of labour in term and postdated pregnancy is limited in Bangladesh. This study was aimed to assess the effectiveness and safety of surgical induction of labour in term and postdated pregnancy.This prospective clinical study was conducted in the in-patient Department of Obstetrics and Gynecology, Combined Military Hospital (CMH), Dhaka from July, 2005 to June 2006. A total of 100 pregnant women with term and postdated pregnancy were selected for the study by simple random sampling. The particulars of the patient, detailed menstrual and obstetric history, induction delivery interval, mode of delivery and foetal outcome and maternal complications were recorded. The results were analysed by Statistical Package for Social Science (SPSS) version 16.0.The mean±SD age of the participants was 25.79±6.16 years with a range of 18-38 years. The indication of Induction of labour included term pregnancy (79%) and postdated pregnancy (21%).Normal vaginal delivery was done in 78% cases, CS in 17% cases and vacuum extraction in 5% cases.Ninety three percent babies were born healthy, 6% were asphyxiated, perinatal death 2% and still born 1%. O2 inhalation was needed for 6% babies. Prolonged second stage (7%), post-partum haemorrhage (8%), maternal distress during labour (10%) and manual removal of placenta (12%) were the observed maternal complications.No significant difference was observed between term and post term pregnancy in the term of normal vaginal delivery, vacuum extraction and lower uterine cesarean section.Induction of labour is beneficial for both term and postdated pregnancy with associated complications. Foetal outcome was good and maternal complications were acceptable.Bangladesh Med Res Counc Bull 2018; 44(1):52-58

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