scholarly journals Upright kneeling position during second stage of labor: a pilot study

2018 ◽  
Vol 7 (2) ◽  
pp. 401 ◽  
Author(s):  
Anjali Dabral ◽  
Pallavi Pawar ◽  
Rekha Bharti ◽  
Archana Kumari ◽  
Achla Batra ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Mode Of Delivery ◽  
Admission Rate ◽  
North India ◽  
Care Hospital ◽  
Apgar Scores ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Perineal Tears ◽  
Second Stage Of Labour

Background: Women delivering in upright position have shorter labour due to efficient and stronger contractions with faster descent of foetal head. The present study aimed to find out effect of upright kneeling position in the second stage of labour on maternal and foetal outcome and assess patients’ satisfaction.Methods: The study was carried out in a tertiary care hospital of North India from October 2012 to February 2014. Low risk women admitted in early labour were divided into two groups, women delivering in kneeling position and in supine position. The outcome measures studied were, duration of second stage of labour, mode of delivery, 2nd degree perineal tears, Apgar scores at 5 minutes, NICU admission rate and patient satisfaction.Results: The mean duration of second stage of labour in kneeling group was shorter by 14.901 minutes. The rate of vaginal delivery was comparable for both primigravidas and multigravida in kneeling and supine groups, RR: 2.275, 95% CI (0.7872-6.5831) and RR: 1.633, 95% CI (0.393-6.775). Primigravidas had more 2nd degree perineal tears in kneeling group as compared to supine, RR 4.191, 95% CI (1.54 to 11.41). No difference in Apgar scores >7 at 5 minutes was observed in both groups, however, significantly lesser babies in kneeling group were admitted in NICU, RR 0.246, 95% CI (0.079 to 0.761). There was no difference on comparing satisfaction scores of primigravidas and multigravida in both supine and kneeling position.Conclusions: Kneeling position reduces the duration of second stage of labour and NICU admissions.

scholarly journals Exploring caesarean delivery in the second stage of labour at a tertiary care hospital: a retrospective study

2021 ◽  
Vol 10 (10) ◽  
pp. 3929
Author(s):  
Pravinkumar A. Jadav ◽  
Palak M. Dabhi ◽  
Dhruti A. Rathod
Keyword(s):  
Retrospective Study ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Transfusion Rate ◽  
Care Hospital ◽  
Intraoperative Complication ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Second Stage Of Labour

Background: Caesarean section (CS) performed in the second stage of labour has many implications for maternal and neonatal morbidity as well as for subsequent pregnancies. The objectives of this study were to determine the rates of CS at full dilatation, their indications, associated maternal and neonatal complications.Methods: This retrospective study assessed all the women with a singleton fetus in cephalic presentation at term (≥37 weeks) who underwent CS in the second stage of labor between 1 August 2019 and 31 March 2020 at a tertiary care hospital. Maternal demographics, labour and delivery details as well as neonatal outcomes were collected.Results: During the study period, 2124 (36%) babies were born by CS. Of these, 49 (2.3%) were performed in the second stage of labour at ≥37 weeks of gestation. The most common indication of CS was non-descent of head in 38 (77.55%) of cases. The majority of women 38 (77.55%) delivered by CS in the second stage of labor were primiparous. The 27 (55.10%) women were in the age group of 20-25 years. Most common intraoperative complication was blood-stained urine in 20 (40.81%) women. Overall transfusion rate was 18.36%. Maximum number of babies born 44 (89.79%) were having birth weight between 2.5-3.5 kg. Out of 65 babies born, 17 (34.69%) were admitted to neonatal intensive care unit.Conclusions: Formulation of an institutional protocol and training and supervision of trainees to improve the skill of operative vaginal delivery and second stage cesarean is needed.

scholarly journals Obstetric and perinatal outcome of twin pregnancy: a prospective study in a tertiary care hospital in North India

2018 ◽  
Vol 7 (6) ◽  
pp. 2455
Author(s):  
Shivali Bhalla ◽  
Seema Grover Bhatti ◽  
Shalini Devgan
Keyword(s):  
Gestational Age ◽  
Perinatal Outcome ◽  
Twin Pregnancy ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Multiple Pregnancy ◽  
Perinatal Outcomes ◽  
North India ◽  
Care Hospital ◽  
Perinatal Morbidity

Background: Multiple pregnancy constitutes an important portion of high risk pregnancies and is a matter of grave concern to obstetricians and paediatricians owing to maternal and perinatal morbidity and mortality associated to it. Objective of present study was to evaluate maternal and perinatal outcome of twin pregnancy.Methods: This observational study included 50 women with twin pregnancy with gestational age of 26 weeks or more. Maternal and perinatal outcomes were studied.Results: The incidence of twin pregnancy was 2.8 % with maximum incidence in age group of 20 -29 years and in multigravida. Mean gestational age was 34.2 weeks. Vertex - vertex fetal presentation was most common presentation. Most frequent mode of delivery was ceserean section (54%). Preterm labour was most common maternal complication (74%), followed by anaemia (62%). Complications in perinatal period were birth hypoxia (58 %), intrauterine growth restriction (15 %), hyper-bilirubinemia (11%) and neonatal sepsis (10 %). 88% of the newborns were LBW. Perinatal mortality in our study was 17%.Conclusions: Twin pregnancies are associated with significant maternal and perinatal morbidity which is more so for second twin. Effective antenatal care planned delivery and good pediatric facilities help decrease the complications. Managment of twin pregnancy requires multidisciplinary approach and involvement of skilled obstetricians and paediatricians.

scholarly journals Comparison of use of restrictive episiotomy versus routine episiotomy in primigravidae undergoing vaginal birth at a tertiary care hospital

2017 ◽  
Vol 6 (5) ◽  
pp. 1770 ◽  
Author(s):  
Deshwal Venus ◽  
Rao P. S. ◽  
S. Prajwal
Keyword(s):  
Tertiary Care ◽  
Good Evidence ◽  
Labour Induction ◽  
Care Hospital ◽  
Perineal Tear ◽  
Surgical Incision ◽  
Second Stage ◽  
Second Stage Of Labour ◽  
Spontaneous Labour ◽  
Labour Room

Background: Episiotomy is the surgical enlargement of the vaginal orifice by an incision on the perineum during the last part of the second stage of labour or delivery. Episiotomy, incision of the perineum at the time of vaginal childbirth, is a common surgical procedure experienced by women. This study is done to compare use of restrictive episiotomy and routine episiotomy in primigravidae undergoing vaginal birth.Methods: This is a prospective cohort study designed to analyse the outcome of the restrictive use of episiotomy in comparison to routine use of episiotomy. Total 100 primigravidae women reporting to labour room in spontaneous labour/induction of labour were included and two cohorts were formed. Both the cohorts were evaluated during labour, immediate postpartum period and first postnatal day and data was tabulated and analysed.Results: Vaginal and paraurethral tears were noted in 14% primigravidae in the routine episiotomy group and 22.22% in the restrictive episiotomy group with no statistically significant association. Number of cases sustaining perineal tear in restrictive group was 15.55% and extension of episiotomy in the routine group was 26% with no statistically significant association. Requirement of suturing was far less in restrictive group (20%) as compared to routine group (100%), as 64.45% of the patients in restrictive group delivered with an intact perineum. The restrictive use of episiotomy does not prolong the second stage of labour and has requirement of significantly less pain relief compared to the routine group. Complication rate was higher in the routine group and perineal laceration and pain severity, was less in restrictive episiotomy group. However, neonatal complications were similar in the two groups.Conclusions: This study identified fair to good evidence suggesting that immediate outcomes following routine use of episiotomy are no better than those of restrictive use. Indeed, routine use is harmful to the degree that some proportion of women who would have had lesser injury instead had a surgical incision.

scholarly journals Maternal and neonatal outcomes in vacuum assisted births in the government tertiary care hospital in Mandya: a retrospective record-based study

2020 ◽  
Vol 9 (3) ◽  
pp. 965
Author(s):  
Shwetha M. ◽  
Shilpa M. N.
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Vacuum Extraction ◽  
Care Hospital ◽  
Second Stage ◽  
Second Stage Of Labour ◽  
Vaginal Deliveries ◽  
Assisted Delivery ◽  
The Government

Background: Vacuum extraction and forceps are the two options when an instrument is needed to facilitate a vaginal birth. Vacuum extraction has recently gained popularity because of new designs of vacuum cups with reduced risk of injury to the neonate. Vacuum extraction is one of the evidence-based interventions that can prevent complications by shortening the second stage of labour. The present study has been carried out to evaluate the maternal and neonatal morbidity, mortality and failure associated with vacuum assisted vaginal deliveries, at a Government tertiary care hospital in Mandya, Karnataka, India.Methods: The study was a record-based study including a total of 207 women who underwent vaginal assisted delivery in the form of vacuum assisted deliveries in a period of 6 months from January 2019 to June 2019 at the Government tertiary care hospital in Mandya, Karnataka, India. Records of women who had vacuum assisted deliveries and records of their newborn children were accessed.Results: In our study 41.5% of the subjects were in the age group of 21-25 years. Nearly 3/4th (74.4%) of the subjects were primigravida. More than half (54.1%) of the study subjects had to be put under vacuum assisted techniques for delivery because of the prolonged second stage of labour, failure rate was 0.4%. Out of 207 vacuum assisted deliveries maternal complication rate was 8.21%, 17.3% neonates had NICU admission and 14.97% had perinatal complications.Conclusions: Vacuum assisted vaginal delivery is comparatively a better choice in preventing the complications caused due to prolonged second stage of labour thus reducing the cesareans rate. It is a safe alternative to cesareans delivery in rightly chosen case. Vacuum assisted delivery by a skilled person and a proper technique is associated with lesser maternal and neonatal morbidity.

scholarly journals Caesarean Delivery in the Second Stage of Labour at a Tertiary Care Hospital

2018 ◽  
Vol 69 (6) ◽  
pp. 558-560
Author(s):  
Smriti Bhargava ◽  
Nupur Hooja ◽  
Manisha Kala ◽  
Premlata Mital ◽  
Kritika Tulani ◽  
...  
Keyword(s):  
Caesarean Delivery ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Second Stage ◽  
Second Stage Of Labour

scholarly journals A root cause analysis of increasing caesarean section rates in a tertiary care private hospital in North India

2019 ◽  
Vol 8 (11) ◽  
pp. 4531
Author(s):  
Bela Makhija ◽  
Deepika Verma ◽  
Asif Mustafa
Keyword(s):  
Caesarean Section ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Cross Sectional Study ◽  
Cultural Factors ◽  
North India ◽  
New Delhi ◽  
Care Hospital ◽  
Cross Sectional ◽  
Group 2

Background: Increase in the incidence of caesarean section is a matter of concern worldwide. Robson’s criteria which is universally accepted now as a way for calculating caesarean rates takes into account only the obstetrical consideration, however, it is noteworthy that many socioeconomic and cultural factors also have a role to play. This study takes into account both Robson’s criteria and common socio-cultural factors which lead to increased caesarean rates with an attempt to suggest ways to curtail this trend.Methods: The study was a hospital based cross-sectional study at a private tertiary care hospital in New Delhi. 1200 consecutive live births after 34 weeks of gestation were analysed over a period of one year.Results: LSCS was the most common mode of delivery 733 (61.1%). 329 (27.4%) had induced labour of which 260 (76.2%) had LSCS. 333 women had elective LSCS. Rates of CDMR were 185 (25.2%) which is very significant. As per Robson’s criteria maximum number of women (318) were in group 2, of which 226 (71.1%) underwent caesarean section.Conclusions: High caesarean rates can be attributed to a multitude of factors. Robson’s criteria are an effective way for analysis of obstetric indications. Other added factors include comorbidities, CDMR, fear of litigations, etc which were analysed.

scholarly journals Cesarean Section or Instrumental Delivery: The Best Choice for Mode of Delivery during Second Stage of Labor

2020 ◽  
Vol 42 (2) ◽  
pp. 42-46
Author(s):  
Suniti Rawal ◽  
Neeta Katuwal ◽  
Sajana Shrestha
Keyword(s):  
Cesarean Section ◽  
Teenage Pregnancy ◽  
Mode Of Delivery ◽  
Fetal Outcome ◽  
Instrumental Delivery ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Second Stage Of Labour ◽  
Emergency Cesarean ◽  
Associated Risk Factors

Introduction Managing second stage of labour is very crucial. Emergency Cesarean Section (CS) or Instrumental Delivery (ID) is the only choices although complications might occur in both modes of deliveries. The rate of CS is at rise and the fear of failed ID followed by emergency CS with added complications makes the choice more difficult amongst the obstetricians. MethodsA retrospective study done to assess the maternal and fetal outcome in second stage of labour following ID and emergency CS from April 2018 to March 2019 among the pregnant women having completed 34 weeks of gestations and beyond. ResultsOf 4761 deliveries, 2537 (53.2%) were vaginal and 2224 (46.7%) CS, and amongst all, 133 (2.7%) were second stage interventions. Out of 133, 78 had ID, 76 were successful and 2 failed. Fifty seven (2.6%) were second stage CS. Nulliparas (65.8%) needed more ID, teenage pregnancy (6.5%) (p=0.04) and heart disease (18.4%) (p=0.002) were high risk for ID. Complications were more in CS, uterine extensions, (29.8%) (p<0.001), urinary complications, (43.9%) (p<0.001) and blood loss (p<0.001). Neonatal admission too was higher in CS (n=29) and more so due to respiratory distress (16/29). ConclusionDespite of few failed attempted ID, it still proved to be better choice for delivery during second stage, as both maternal and neonatal complications were higher following the second stage CS. Hence, the correct and timely decision for ID addressing the associated risk factors could lead to favorable outcome.

scholarly journals FETO-MATERNAL OUTCOME OF CAESAREAN SECTION DURING SECOND STAGE OF LABOR IN A TERTIARY CARE HOSPITAL: AN OBSERVATIONAL STUDY

2020 ◽  
Vol 4 (11) ◽  
Author(s):  
Ruby Kumari
Keyword(s):  
Caesarean Section ◽  
Observational Study ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Cervical Dilatation ◽  
Care Hospital ◽  
Maternal Complications ◽  
Second Stage ◽  
Second Stage Of Labour ◽  
The Mean

Aim: To highlights the maternal and neonatal outcome of caesarean section in second stage of labour. Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynecology at Government Medical College and Hospital Bettiah, Bihar, India from December 2017 to December  2018. total of 24600 women delivered by caesarean section, 16800 emergency and 7800 elective cases. Of these 400 were at full cervical dilatation, >37 weeks gestation with a singleton fetus in cephalic presentation. All caesarean sections performed at full cervical dilatation over the time period of 1 year at a government hospital were included. Results: Among the 400 patient’s majority of them were in the age group of 20-30 years (72.5%). about 75.5% of the patients were primigravidae and only the remaining 24.5% were multigravida. The commonest indications for doing caesarean section in the second stage of labour were cephalo pelvic disproportion, fetal distress and obstructed labour. Incidence of PPH is 48 out of 400 cases (12%). Post-operative wound infection was seen in 23(5.75%) and Post-operative fever was seen in 70(17.5%) out of 400 cases. There were no cases of maternal deaths reported. The mean operative time was 52.9 min .The mean length of hospital stays was 6.6 days. Mean weight of the babies of the second stage caesarean section was 3.2 kg. Conclusions: Caesarean sections done in second stage of labour are associated with several intra-operative maternal complications and neonatal morbidity. Keywords: Caesarean complications; emergency caesarean section; maternal morbidity; neonatal morbidity

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