scholarly journals Evaluation of categories of intrapartum fetal heart rate tracings in pregnancies complicated with fetal growth restriction and its relation to perinatal outcome

2021 ◽  
Vol 10 (3) ◽  
pp. 1128
Author(s):  
Bhavya H. U.
Keyword(s):  
Vaginal Delivery ◽  
Perinatal Outcome ◽  
Neonatal Outcome ◽  
Strong Association ◽  
Active Phase ◽  
Fetal Hypoxia ◽  
Second Stage ◽  
Second Stage Of Labour ◽  
Timely Response ◽  
Normal Outcome

Background: Intrapartum FHR monitoring is widely used during labour as changes in FHR precede brain injury, so timely response to abnormal FHR patterns might be effective in preventing it. There is a strong association between stillbirth and FGR which warrants intensive intrapartum fetal surveillance for optimal perinatal outcome. In this study we aimed to classify intrapartum FHR tracings into different categories in FGR pregnancies and correlate with perinatal outcome.Methods: A total 100 singleton pregnant women >34 weeks gestation with FGR were included in study. FHR tracings were followed throughout first and second stage of labour. FHR tracing were categorized into NICHD 3-tier classification as category I, II and III. Maternal and neonatal outome in each category were analysed.Results: Mean duration of category I tracings was 9.05 hours, category II was 7.66 hours and that of category III was 0.49 hours. During late active phase 25/95 patients with category I FHR tracings had vaginal delivery, 62/95 had category II FHR tracings, of which 95.1% had vaginal delivery and 4.9% had instrumental. 8/95 with category III FHR tracings required caesarean section. All patients with category I tracings had normal neonatal outcome, among patients with category II FHR tracings, 74.6% had normal whereas 25.4% had adverse outcome, all with category III FHR tracings had adverse outcome.Conclusions: Categorizing FHR tracings is helpful to distinguish neonates who are likely to have normal outcome from those who are at risk for fetal hypoxia. When the category II tracings are present, it requires more vigilant monitoring and decision taking.

scholarly journals Reduction of maternal and neonatal harm through prevention of the primary Cesarean section

2016 ◽  
Vol 85 (2) ◽  
pp. 19-21
Author(s):  
Andrew Welton
Keyword(s):  
Cesarean Section ◽  
Vaginal Delivery ◽  
Common Knowledge ◽  
Multiple Pregnancy ◽  
Expectant Management ◽  
Breech Presentation ◽  
Active Phase ◽  
External Cephalic Version ◽  
Second Stage ◽  
Nulliparous Women

While there are clear life-saving indications for Cesarean section (C-section), rates of this procedure have seen a continued rise without a concomitant improvement in maternal or neonatal outcomes. There is some evidence that outcomes may actually be worse for low-risk C-sections versus vaginal delivery. However, this is not necessarily common knowledge for healthcare providers, and therefore, their patients. Measures to safely reduce the C-section rate target management of labour arrest and specific indications for progression to C-section. In the active phase of the first stage of labour, C-section should be considered only in cases of failure to progress after 4 hours of adequate uterine contraction, or 6 hours of inadequate contraction. In the second stage of labour, expectant management of 3 hours of pushing in nulliparous women and 2 hours in multiparous women is safe and appropriate. Furthermore, manual rotation and operative vaginal delivery in the second stage are reasonable alternatives to C-section. Expectant management is also appropriate for certain non-reassuring fetal heart rate tracings. In post-dates pregnancies, induction of labour reduces both rates of C-section and neonatal mortality. Finally, evidence supports the use of external cephalic version in breech presentation as well as a more conservative approach to suspected macrosomia and multiple pregnancy. Taken together, these measures target the most common indications for progression to C-section and can allow us to safely reduce the C-section rate. Educating patients and physicians on the risks of the procedure and reasonable alternatives can improve outcomes for mothers and neonates.

scholarly journals Mifepristone as pre-induction cervical ripening agent: a review article

2019 ◽  
Vol 8 (11) ◽  
pp. 4636
Author(s):  
Nikita . ◽  
Seetesh Ghose ◽  
Setu Rathod
Keyword(s):  
Adverse Effects ◽  
Vaginal Delivery ◽  
Perinatal Outcome ◽  
Neonatal Outcome ◽  
Mode Of Delivery ◽  
Review Article ◽  
Induction Of Labour ◽  
Present Review ◽  
Cervical Ripening ◽  
Successful Induction

Induction of labour after the period of viability by any methods medical, surgical or combined, for the purpose of vaginal delivery. The success of induction, to a great extent, depend upon pre-induction cervical status i.e. cervical ripening. So, ripening of cervix prior to induction i.e. pre-induction cervical ripening is one of the important steps for successful induction of labour. There are different methods for cervical ripening like prostaglandins (PGE). However, use of prostaglandins (PGE) and oxytocin as labour inducing agent has its own adverse effects on maternal and perinatal outcome. So, constant efforts are made for the less use of uterotonins. The present review aims to study the efficacy of oral Mifepristone for improvement in Bishop’s score, requirement of additional uterotonics, induction delivery interval, mode of delivery and neonatal outcome. Electronic databases were searched by using keywords ‘Mifepristone, RU486, PGE2 gel, Cervical ripening, Bishop’s score and Induction of labour’ and eleven articles were found from 2009 to 2018 which fulfils our study criteria and thus they were taken for review. Based on all the studies, Mifepristone appears to be effective cervical ripening in comparison to other agents with significant improvement in Bishop’s score, higher vaginal delivery rate, shorter induction delivery interval and good neonatal outcome.

scholarly journals Comparative study of induced and spontaneous labour in nulliparous women using modified WHO partograph

2020 ◽  
Vol 9 (5) ◽  
pp. 2014
Author(s):  
Kamlesh Yadav ◽  
Monika Ranga ◽  
Ankur Nama
Keyword(s):  
Neonatal Outcome ◽  
Mode Of Delivery ◽  
Active Phase ◽  
Safe Procedure ◽  
Maternal Complications ◽  
Second Stage Of Labour ◽  
Nulliparous Women ◽  
Spontaneous Labour ◽  
Group Rate ◽  
The Mean

Background: Induced or spontaneous labour has implication on the eventual mode of delivery and neonatal outcome. The aim of study is to compare mean duration of labour andmaterno-foetal outcome of induced versus spontaneous labour among nulliparous women using modified WHO partograph.Methods: The study was conducted in nulliparous women coming at term in active phase of labour (with cervical dilatation at least 4 cm) either spontaneous or induced, both labouring women were monitored using modified WHO partograph. Outcomes measures include requirement of augmentation of labour with oxytocin, mean duration of labour, eventual mode of delivery and the materno foetal outcome.Results: A total 100 women were compared in each group. There was no difference in mean age group, BMI, gestational age. More women had spontaneous vaginal delivery among those with spontaneous labour (76% versus 58%) (p=0.033). The mean duration of second stage of labour was significantly more in induced labour (16.25 minutes) than in spontaneous labour (14.60 minutes) (p=0.0212). The mean Apgar scores were comparable in two groups. Induced labour is comparable to spontaneous labour regarding fetomaternal outcomes but with increased rate of caesarean deliveries.Conclusions: Study concluded from our study that in spontaneous group mean duration of labour was less than induced group and most of the patient delivered vaginally. In induced group rate of caesarean was higher and requirement of oxytocin for labour augmentation was also more than spontaneous group. Maternal complications were also found more in induced group than spontaneous group whereas neonatal outcome was similar in both the groups. We observed in our study that induced labour can be a safe procedure among nulliparous women if labour is partographically monitored by WHO modified partograph.

scholarly journals Study of maternal and perinatal outcome of caesarean delivery in late first stage and second stage of labour

2021 ◽  
Vol 10 (4) ◽  
pp. 1503
Author(s):  
Shweta Bhatia ◽  
Vijaya M. Revankar
Keyword(s):  
Perinatal Outcome ◽  
Prospective Observational Study ◽  
Intraoperative Complications ◽  
Perinatal Outcomes ◽  
Perinatal Complications ◽  
Medical College ◽  
Second Stage ◽  
Second Stage Of Labour ◽  
Operative Complications ◽  
Febrile Morbidity

Background: Second-stage caesarean sections are known to be associated with increased maternal and perinatal complications as compared to late first stage caesarean sections. The objective of the study was to evaluate the maternal and perinatal outcome of caesarean deliveries in the late first stage and second stage of labour.Methods: The prospective observational study of caesarean deliveries done in the late first stage (~8 cm of cervical dilatation) and second stage of labour was conducted at Lady Goshen Hospital, Mangalore and Kasturba Medical College Attavar, Mangalore from August 2018 to June 2020. Comparison of maternal and perinatal outcomes were assessed in late first stage and second stages of caesarean delivery.Results: In the present study intraoperative complications such as extensions of uterine incisions, atonic PPH and bladder base injury and post-operative complications like need for blood transfusion, febrile morbidity and prolonged catheterisation were found more in second stage of labour. Perinatal complications such as hyperbilirubinemia and respiratory distress were found to be more in second stage of labour.Conclusions: As caesarean deliveries are increasing, it is better to make an institutional protocol regarding duration of second stage of labour, use of instrumental delivery to guide us about timely intervention (operative vaginal/caesarean) in advanced labour, thereby aiming to reduce the maternal and perinatal complications. 

scholarly journals Fetomaternal outcome in operative vaginal delivery

2021 ◽  
Vol 10 (11) ◽  
pp. 4096
Author(s):  
Jeyamani B. ◽  
Nashreen Dhasleema A.
Keyword(s):  
Vaginal Delivery ◽  
Neonatal Outcome ◽  
Breech Presentation ◽  
P Value ◽  
Perineal Tear ◽  
Cross Sectional ◽  
Second Stage ◽  
Operative Vaginal Delivery ◽  
Vaginal Deliveries ◽  
Assisted Delivery

Background: Operative vaginal deliveries (OVD) were performed with the help of vacuum or forceps in the second stage of labor when mother and foetus condition is threatening. A successful assisted vaginal delivery avoids caesarean section and its associated morbidity and implications for future pregnancy. The aim of the study was to assess the maternal and neonatal outcome of vacuum and forceps assisted vaginal deliveries.Methods: It was a retrospective comparative cross sectional study done in VMKVMCH, Salem in obstetrics and gynecology department, from the period of April to June 2021. All the mothers delivered by operative vaginal delivery were included. Mothers with multiple pregnancies, preterm and breech presentation were excluded. Data collected using patients information sheet and analysis was done using SPSS 23. P value <0.05 was considered significant.Results: The most common age group was 21-25 years of age in both groups and most commonly used in primigravida. The most common indication for forceps assisted delivery in our study was the prolonged second stage labour and in vacuum delivery was poor maternal effort. In our study, common complication noted was extended episiotomy followed by perineal tear in forceps group and vice versa in vacuum group. Cephalhematoma was found to be more common in vacuum and scalp and instrumental injuries were more common in forceps assisted vaginal deliveries.Conclusions: Operative vaginal deliveries helps in improving both maternal and foetal outcomes and reduces the caesarean delivery rate and vacuum significantly reduces maternal trauma than forceps. No difference noted in neonatal outcome. 

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