scholarly journals Partogram: an important tool in managing labour!

2021 ◽  
Vol 10 (10) ◽  
pp. 3770
Author(s):  
Swagatha Mukherjee ◽  
Raksha M. ◽  
Malini K. V.
Keyword(s):  
Neonatal Outcome ◽  
Fetal Heart ◽  
Local Population ◽  
Skilled Birth Attendant ◽  
Cervical Dilatation ◽  
Vaginal Examination ◽  
Singleton Pregnancy ◽  
Cephalopelvic Disproportion ◽  
Uterine Contractions ◽  
Vertex Presentation

Background: Various types and designs of partographs are being used at various centers. WHO introduced simplified version of partogram, for the use by skilled birth attendant. Preprinted paper versions of the partograph are availableMethods: 100 antenatal women were selected for study. Patients with vertex presentation and singleton pregnancy were taken. Patients who came late in labour and those with cephalopelvic disproportion were not included in the study. Cervical Dilatation in cms was assessed by per vaginal examination every 2 hourly, fetal Heart Rate every ½ hourly, uterine contractions and maternal pulse measured every ½ hourly, maternal BP and temperature were measured every 4th hourly.Results: Using WHO simplified partogram, characteristics of labour and neonatal outcome was evaluated. Among the 100 women included in the study, 78 required augmentation of labour, here 6 of them crossed the alert line and underwent LSCS. Of the 22 women who did not require augmentation, 4 crossed the alert line and underwent LSCS.We didn’t find any difference in monitoring of labour using simplified version of WHO partogram compared with other partograms, apparently it’s more simpler to plot and easy to understand.Conclusions: An alert line on partogram should be based on lower 10th centile rate of cervical dilatation of the local population. We found this rate as 1cm/hr, which corresponds to the slope of alert lineon standard partogram. Based on this we conclude, simplified partogram is good enough for monitoring labour progress.

Malpresentation, malposition, and cephalopelvic disproportion

2020 ◽  
pp. 395-406
Author(s):  
Deirdre J. Murphy
Keyword(s):  
Early Identification ◽  
Technical Skills ◽  
Operative Delivery ◽  
Cephalopelvic Disproportion ◽  
Obstructed Labour ◽  
Uterine Contractions ◽  
Labour Ward ◽  
Clear Communication ◽  
Vertex Presentation ◽  
Time Of Presentation

Normal labour involves an appropriate-sized fetus in a vertex presentation with a well-flexed head that descends and rotates within the maternal pelvis in response to uterine contractions, delivering in an occipitoanterior position. Abnormal labour occurs when any one or a combination of these factors deviates from normal. It may involve a malpresentation (e.g. face, brow, or breech), a malposition (e.g. occipitoposterior), or cephalopelvic disproportion. The consequences include prolonged labour, obstructed labour, operative vaginal delivery, or caesarean section. Appropriate management requires expertise in clinical assessment, decision-making, and the technical and non-technical skills of operative delivery. A systematic approach is required including an awareness of risk factors for abnormal labour, early identification of deviations from normal, use of preventative strategies where possible, and appropriate intervention when necessary. Good teamwork and clear communication between midwives and obstetricians is essential within a labour ward setting. Timely transfer may be required in a homebirth setting. Particular skills are required in low-resource settings where obstructed labour may be advanced at the time of presentation.

scholarly journals Uterine Tachysystole with Prolonged Deceleration Following Nipple Stimulation for Labor Augmentation

2017 ◽  
Vol 13 (3) ◽  
pp. 268-270
Author(s):  
D.M. Narasimhulu ◽  
L. Zhu
Keyword(s):  
Heart Rate ◽  
Fetal Heart Rate ◽  
Stress Testing ◽  
18Th Century ◽  
Fetal Heart ◽  
Singleton Pregnancy ◽  
Uterine Contractions ◽  
Contraction Stress ◽  
Lateral Positioning ◽  
Labor Augmentation

Breast stimulation for inducing uterine contractions has been reported in the medical literature since the 18th century. The American college of Obstetricians and Gynecologists (ACOG) has described nipple stimulation as a natural and inexpensive nonmedical method for inducing labor.We report on a 37 year old P2 with a singleton pregnancy at 40 weeks gestation who developed tachysystole with a prolonged deceleration after nipple stimulation for augmentation of labor. Initial resuscitative measures, including oxygen by mask, a bolus of intravenous fluids and left lateral positioning, did not restore the fetal heart rate to normal. After the administration of Terbutaline 250 mcg subcutaneously, the tachysystole resolved and the fetal heart rate recovered after five minutes of bradycardia.Most trials of nipple stimulation for induction or augmentation of labor have had small study populations, and no conclusions could be drawn about the safety of nipple stimulation, though its use is widespread. While there have been a few reports of similar complications during nipple stimulation for contraction stress testing, there are no previous reports of tachysystole with sustained bradycardia following nipple stimulation for labor augmentation.In this report, we draw attention to the dangers of nipple stimulation so that providers will be aware of this potential complication.

scholarly journals Birth tears after spontaneous and vacuum-assisted births with different vacuum cup systems – a retrospective cohort study

2020 ◽  
Vol 48 (6) ◽  
pp. 575-581
Author(s):  
Martina Kreft ◽  
Roland Zimmermann ◽  
Nina Kimmich
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Care Center ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Low Grade ◽  
Singleton Pregnancy ◽  
Perineal Tear ◽  
Vertex Presentation

AbstractObjectivesBirth tears are a common complication of vaginal childbirth. We aimed to evaluate the outcomes of birth tears first by comparing the mode of vaginal birth (VB) and then comparing different vacuum cups in instrumental VBs in order to better advise childbearing women and obstetrical professionals.MethodsIn a retrospective cohort study, we analyzed nulliparous and multiparous women with a singleton pregnancy in vertex presentation at ≥37 + 0 gestational weeks who gave birth vaginally at our tertiary care center between 06/2012 and 12/2016. We compared the distribution of tear types in spontaneous births (SBs) vs. vacuum-assisted VBs. We then compared the tear distribution in the vacuum group when using the Kiwi Omnicup or Bird’s anterior metal cup. Outcome parameters were the incidence and distribution of the different tear types dependent on the mode of delivery and type of vacuum cup.ResultsA total of 4549 SBs and 907 VBs were analyzed. Birth tear distribution differed significantly between the birth modes. In 15.2% of women with an SB an episiotomy was performed vs. 58.5% in women with a VB. Any kind of perineal tear was seen in 45.7% after SB and in 32.7% after VB. High-grade obstetric anal sphincter injuries (OASIS) appeared in 1.1% after SB and in 3.1% after VB. No significant changes in tear distribution were found between the two different VB modes.ConclusionsThere were more episiotomies, vaginal tears and OASIS after VB than after SB. In contrast, there were more low-grade perineal and labial tears after SB. No significant differences were found between different vacuum cup systems, just a slight trend toward different tear patterns.

scholarly journals Butorphanol in Labour Analgesia

2018 ◽  
Vol 56 (214) ◽  
pp. 940-944 ◽  
Author(s):  
Jyotsna Yadav ◽  
Mohan Chandra Regmi ◽  
Pritha Basnet ◽  
K.M. Guddy ◽  
Balkrishna Bhattarai ◽  
...  
Keyword(s):  
Neonatal Outcome ◽  
Labour Pain ◽  
Cross Sectional Study ◽  
Labour Analgesia ◽  
Labor Pain ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Fetal Heart Rate Monitoring ◽  
Uterine Contractions ◽  
Pain Scores

Introduction: Labour is the process where uterine contractions lead to expulsion of product of conception through the vagina into the outer world. Labour pain is one of the most severe pains which has ever been evaluated and its fear is one of the reasons women wouldn’t go for natural delivery. Delivery is a painful experience for all of the women except a few of them. The labor pain results from some physiological-psychological causes. Different pharmacological and non-pharmacological methods have been tried for pain relief in labour. The objective of this study is to see the effect of butorphanol injection in labour pain. Methods: It is a descriptive cross-sectional study conducted in B.P. Koirala institute of health sciences. We observed 200 pregnant women meeting the inclusion criteria and giving the informed consent who were on 1 mg butorphanol i.m. at the onset of active stage of labour every 4 hourly and on demand. Pain assessment was done by Numerical Pain analogue scale measured from 1 to 10. Fetal heart rate monitoring was done according to the hospital protocol. Caesarean section was performed for obstetrical indication. Neonatal outcome was evaluated by on duty pediatrician and APGAR score were noted at 1 and 5 min.Results: The pain scores in first, second, third, fourth hour were (8.83±0.773), (9.84±0.544), (9.94±0.338), (9.6±0.298) respectively, where 1st and 2nd hour is statistically significant.Conclusions: Butorphanol is an effective labour analgesia without significant adverse effects on women and the neonatal outcome.

scholarly journals Effect of Intravenous Phloroglucinol Injections upon duration of Active First Stage of Labor

2020 ◽  
Vol 4 (2) ◽  
pp. 69-71
Author(s):  
Bilqees Akhtar Malik ◽  
Ambreen Shabbir ◽  
Zeb-Un-Nisa ◽  
Asma Ambreen
Keyword(s):  
Controlled Trial ◽  
Military Hospital ◽  
Control Group ◽  
Singleton Pregnancy ◽  
Uterine Contractions ◽  
Multiparous Women ◽  
History Of ◽  
Group A ◽  
Group B ◽  
First Stage Of Labor

Objective: In our part of the world poverty and illiteracy has adversely affected our core objective of pregnancy i.e. healthy mother and healthy child. Exploring the role of a routinely used drug in reducing the duration of labor could be a breakthrough. Present study was planned accordingly to evaluate the effect of phloroglucinol (PHL). Materials and Methods: It was a Randomized controlled trial conducted at Department of Obstetrics & Gynecology, Combined Military Hospital, Bahawalpur from January 2019 to June 2019. This study included 60 cases of age 18 to 40 years, having singleton pregnancy and in active first stage of uncomplicated labor. Patients with history of multiple pregnancies, obstetrical and surgical complications and cardiorespiratory diseases were excluded. The cases were placed randomly into Group A & Group B and given intravenous PHL and a placebo respectively. After this, duration of the first stage of labor was recorded in minutes from when there was 3-4 cm cervical dilatation with regular uterine contractions to complete cervical dilation i.e. 10 cm and descent of the presenting fetal part. Results: Mean duration of active first stage of labor in experimental group A (230.20 ± 52.96 minutes) was significantly higher than that of control group B (345.30 ± 50.57 minutes). Conclusion: This study concluded that intravenous PHL has efficiently reduced the duration of active first stage of labor in these randomly selected nulliparous and multiparous women. PHL is a useful drug serving the purpose of a spasmolytic, analgesic and labor augmentation at the same time.

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.

Combined spinal epidural analgesia for labor using sufentanil epidurally versus intrathecally: a retrospective study on the influence on fetal heart trace

2015 ◽  
Vol 43 (4) ◽  
Author(s):  
Nele Everaert ◽  
Marc Coppens ◽  
Peter Vlerick ◽  
Geert Braems ◽  
Patrick Wouters ◽  
...  
Keyword(s):  
Heart Rate ◽  
Retrospective Study ◽  
Epidural Analgesia ◽  
Fetal Heart Rate ◽  
Neonatal Outcome ◽  
Fetal Heart ◽  
Uterine Activity ◽  
Combined Spinal Epidural ◽  
Spinal Epidural ◽  
Intrathecal Space

AbstractWe retrospectively compared a protocol using sufentanil and ropivacaine intrathecally with a protocol in which only ropivacaine was administered intrathecally and sufentanil was used epidurally to evaluate whether banning sufentanil from the intrathecal space results in a decreased incidence of adverse fetal heart rate changes.Some 520 cardiotocographic tracings were examined for changes in fetal heart rate and uterine activity following two different protocols of combined spinal epidural analgesia. Charts were consulted for neonatal and labor outcome.When sufentanil was used epidurally instead of intrathecally, the incidence of adverse changes in fetal heart trace was less, demonstrated by a higher percentage of normal reassuring tracings (74.5% vs. 60.4% when sufentanil was used intrathecally; P=0.007), less tracings showing bradycardia (7.5% vs. 14.1%; P=0.035), and more tracings displaying 3 or more accelerations in fetal heart rate in 45 min (93.5% vs. 83.9%; P=0.003) together with less episodes of tachycardia (3.5% vs. 11.4%; P=0.005). There were no differences in labor and neonatal outcome.Based on fetal heart tracing, it seems favorable to ban sufentanil from the intrathecal compartment.

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