TO STUDY THE FETO-MATERNAL OUTCOME IN OCCIPITO-POSTERIOR POSITION.

2019 ◽  
Vol 2 (2) ◽  
Author(s):  
Jai K Goel ◽  
Anshu Sharma ◽  
Shashi B Arya ◽  
Mridu Sinha ◽  
Rajni Chaurasia
Keyword(s):  
Cesarean Delivery ◽  
Neonatal Outcome ◽  
Instrumental Delivery ◽  
Study Group ◽  
Second Stage ◽  
Posterior Group ◽  
Anterior Position ◽  
Third Stage ◽  
Anterior Group ◽  
Fetal Position

INTRODUCTION: Childbirth is considered as one of the most rewarding and memorable experience in a woman’s life.Labour is the process that leads to childbirth. Difficult labour characterized by abnormally slow labour progress is known as dystocia. Malposition refers to any position of the vertex other than flexed occipito- anterior one. It is a common obstetric belief that progression of labour is underpinned by fetal position. MATERIAL AND METHODS: 100 term antenatal patients, 50 with occipito-posterior and 50 with occipito-anterior position were included in the study admitted in labour room from December 2015 to March 2017. After recuirtment of patients, detailed history, examination: general physical, per abdominal and per vaginal was done. All patients underwent ultrasonography to confirm the fetal position at the onset of labour. They were then followed up until birth to determine outcome. The primary outcome measures including mode of delivery which was categorized into vaginal delivery, instrumental delivery and Cesarean section, duration of labour and neonatal outcome. RESULTS: Of the total 100 cases, the proportion of vaginal delivery was more in occipito-anterior group (74%) in comparison with occipito-posterior group (42%). 40% patients of occipito-posterior group landed into cesarean delivery against 18% patients of occipito-anterior group. Eight percent patients had face to pubis delivery. The mean duration of labour is prolonged in study group i.e. 473.2±1.84 minutes in first stage, 29.4±7.67 minutes in second stage and 5.70±1.75 minutes in third stage versus i.e. 376.8±1.26 minutes in first stage, 24.79±9.77 minutes in second stage and 5.20±3.22 minutes in third stage of labour of control group. The neonatal outcome was analysed by Apgar score at 1,5 minutes of delivery, presence of caput succedaneum and moulding and found to be comparable in both the groups. CONCLUSION: We found that malposition group showed prolongation of labour in comparison to occipito-anterior position. We found high rate of cesarean delivery in study group because of preference for cesarean over instrumental delivery. Neonatal outcome were comparable in both the groups. We noted few instrumental deliveries owing to the fact that art of instrumental delivery is dying in modern obstetrics.

scholarly journals Maternal and neonatal outcome of births in alongside midwifery units: A cohort study from a tertiary center in Germany

2019 ◽  
Author(s):  
Waltraut Maria Merz ◽  
Laura Tascon-Padron ◽  
Marie-Therese Puth ◽  
Andrea Heep ◽  
Sophia L. Tietjen ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Neonatal Outcome ◽  
Obstetric Care ◽  
Models Of Care ◽  
Low Risk ◽  
Control Group ◽  
Study Group ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Low Risk Women

Abstract Background For healthy women entering birth after uneventful pregnancy, midwife-led models of care have the potential to reduce interventions and increase the vaginal birth rate without compromising the maternal or health of the neonate. In Germany, 98.4% of women are giving birth in consultant-led obstetric units. Alongside midwifery units (AMU) have been established in 2003. We compared the outcome of all births in the AMU at our hospital from 2010 to 2017 with a matched group of low-risk women who gave birth during the same period of time in standard obstetric care. Methods We used a retrospective cohort study design. The study group consists of all women admitted to labor ward who had registered for birth in AMU. For the control group, low-risk women were selected; additionally, matching was performed for parity. Mode of birth, postpartum hemorrhage, and obstetric injury was chosen as primary outcome parameter for the mother. For the neonate, a composite primary outcome (5-minute Apgar <7 or umbilical cord arterial pH < 7.20 or transfer to specialist neonatal care) was defined. Secondary outcomes included epidural analgesia, duration of the second stage of labor, and episiotomy rate. Non-inferiority was assessed, and multiple logistic regression analysis was performed. Results 612 women were admitted for labor in AMU, the control group consisted of 612 women giving birth in standard obstetric care. Women in the study group were on average older and had a higher BMI; birthweight was on average 95 g higher. Except for birth injuries, non-inferiority could be established for the primary outcomes. Secondary outcomes occurred less common in the study group, including a shorter duration of the second stage of labor. Overall, 50.3% of women were transferred to standard obstetric care. Regression analysis revealed effects of parity, age and birthweight on the chance of transfer. Conclusion Our investigation confirms comparable maternal and neonatal outcome with less interventions for women giving birth in AMU at our institution. Currently, obstetric services in Germany are almost exclusively provided by consultant-led units. Our results support the integration of AMU as complementary models of care for low-risk women.

Neonatal outcome of second-stage cesarean delivery versus vacuum extraction among neonates <34 weeks

2020 ◽  
pp. 1-8
Author(s):  
Gabriel Levin ◽  
Amihai Rottenstreich ◽  
Abraham Tsur ◽  
Tal Cahan ◽  
Joshua I. Rosenbloom ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Neonatal Outcome ◽  
Vacuum Extraction ◽  
Second Stage

The Coherence of Mary Barton: Romance, Realism, and Utopia

2015 ◽  
Vol 5 (3) ◽  
pp. 185-200
Author(s):  
Robert Z. Birdwell
Keyword(s):  
Thomas Carlyle ◽  
The Novel ◽  
Second Stage ◽  
The Third ◽  
Third Stage ◽  
Three Stages ◽  
Mode Of Production

Critics have argued that Elizabeth Gaskell's first novel, Mary Barton (1848), is split by a conflict between the modes of realism and romance. But the conflict does not render the novel incoherent, because Gaskell surpasses both modes through a utopian narrative that breaks with the conflict of form and gives coherence to the whole novel. Gaskell not only depicts what Thomas Carlyle called the ‘Condition of England’ in her work but also develops, through three stages, the utopia that will redeem this condition. The first stage is romantic nostalgia, a backward glance at Eden from the countryside surrounding Manchester. The second stage occurs in Manchester, as Gaskell mixes romance with a realistic mode, tracing a utopian drive toward death. The third stage is the utopian break with romantic and realistic accounts of the Condition of England and with the inadequate preceding conceptions of utopia. This third stage transforms narrative modes and figures a new mode of production.

How well do voice-hearing assessment measures capture the positive experiences of individuals?

2019 ◽  
Author(s):  
Lucy Armstrong ◽  
Lorna Hogg ◽  
Pamela Charlotte Jacobsen
Keyword(s):  
Systematic Review ◽  
Lived Experience ◽  
Second Stage ◽  
The Third ◽  
Third Stage ◽  
Hearing Assessment ◽  
Positive Experiences ◽  
Assessment Measures ◽  
Stage 1 ◽  
The Voice

The first stage of this project aims to identify assessment measures which include items on voice-hearing by way of a systematic review. The second stage is the development of a brief framework of categories of positive experiences of voice hearing, using a triangulated approach, drawing on views from both professionals and people with lived experience. The third stage will involve using the framework to identify any positve aspects of voice-hearing included in the voice hearing assessments identified in stage 1.

scholarly journals When the World Breaks Down: A 3-Stage Existential Model of Nihilism in Schizophrenia

2021 ◽  
pp. 1-24
Author(s):  
Philipp Klar ◽  
Georg Northoff
Keyword(s):  
The Self ◽  
First Person ◽  
Second Stage ◽  
Existential Crisis ◽  
Third Stage ◽  
The World ◽  
Third Person ◽  
Pathological Development ◽  
Sense Of Reality ◽  
Intentional Structure

The existential crisis of nihilism in schizophrenia has been reported since the early days of psychiatry. Taking first-person accounts concerning nihilistic experiences of both the self and the world as vantage point, we aim to develop a dynamic existential model of the pathological development of existential nihilism. Since the phenomenology of such a crisis is intrinsically subjective, we especially take the immediate and pre-reflective first-person perspective’s (FPP) experience (instead of objectified symptoms and diagnoses) of schizophrenia into consideration. The hereby developed existential model consists of 3 conceptualized stages that are nested into each other, which defines what we mean by existential. At the same time, the model intrinsically converges with the phenomenological concept of the self-world structure notable inside our existential framework. Regarding the 3 individual stages, we suggest that the onset or first stage of nihilistic pathogenesis is reflected by phenomenological solipsism, that is, a general disruption of the FPP experience. Paradigmatically, this initial disruption contains the well-known crisis of common sense in schizophrenia. The following second stage of epistemological solipsism negatively affects all possible perspectives of experience, that is, the first-, second-, and third-person perspectives of subjectivity. Therefore, within the second stage, solipsism expands from a disruption of immediate and pre-reflective experience (first stage) to a disruption of reflective experience and principal knowledge (second stage), as mirrored in abnormal epistemological limitations of principal knowledge. Finally, the experience of the annihilation of healthy self-consciousness into the ultimate collapse of the individual’s existence defines the third stage. The schizophrenic individual consequently loses her/his vital experience since the intentional structure of consciousness including any sense of reality breaks down. Such a descriptive-interpretative existential model of nihilism in schizophrenia may ultimately serve as input for future psychopathological investigations of nihilism in general, including, for instance, its manifestation in depression.

Second stage expedite delivery of low birth weight neonates: Emergent cesarean delivery versus vacuum assisted delivery

2021 ◽  
Vol 50 (8) ◽  
pp. 102136
Author(s):  
Gabriel Levin ◽  
Amihai Rottenstreich ◽  
Tal Cahan ◽  
David Mankuta ◽  
Simcha Yagel ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Cesarean Delivery ◽  
Second Stage ◽  
Assisted Delivery

scholarly journals A Prospective Study of Posterior (Transpedicular) Approach versus Anterior (Transthoracic/Thoracoabdominal) Approach for Posttraumatic Compression Fracture of Thoracolumbar Vertebra in a Tertiary Care Center: Comparison of Clinical and Radiological Outcomes

2020 ◽  
Author(s):  
Rahul Varshney ◽  
Parthasarathi Datta ◽  
Pulak Deb ◽  
Santanu Ghosh
Keyword(s):  
Prospective Study ◽  
Posterior Approach ◽  
Spinal Injuries ◽  
Anterolateral Approach ◽  
Kyphotic Angle ◽  
Posterior Group ◽  
Thoracoabdominal Approach ◽  
A Prospective Study ◽  
Anterior Group

Abstract Objective The aim of this article was to analyze the clinical and radiological outcomes of transpedicular decompression (posterior approach) and anterolateral approach in patients with traumatic thoracolumbar spinal injuries. Methods  It was a prospective study of patients with fractures of dorsolumbar spine from December 2011 to December 2013. A total of 60 patients with traumatic spinal injuries were admitted during the study period (December 2011–2013), of which 51 cases were finally selected and taken for operations while 3 were eventually lost in follow-up. Twenty patients were operated by anterolateral approach, titanium mesh cage, and fixation with bicortical screws. Twenty-eight patients were treated with posterior approach and transpedicular screw fixation. Clinical and radiographic evaluations were performed on all 48 patients before and after surgery. Results There were 48 patients of thoracolumbar burst fractures with 40 male and 8 female patients. Range of follow-up was from 1 month to 20 months, with a mean of 7.4. Preoperatively in anterior group, 65% of the patients were bed ridden, 20% patients were able to walk with support, and 15% of the patients were able to walk without support. In posterior group, 78.57% patients were bed ridden, 10.71% were able to walk with support, and 10.71% patients were able to walk without support. Kyphotic angle changes were seen in 16 patients out of 18 in anterior group and 20 patients in posterior group out of 25. Out of 18 patients in anterior group, 14 showed reduction in kyphotic angle of 10 to 100 (improvement), with mean improvement of 4.070. In posterior group, 7 patients showed improvement of 10 to 80 (reduction in kyphotic angle) whereas 13 patients showed deterioration of 1 to 120. The mean improvement was 2.140 in 7 patients and mean deterioration was 4.920. No statistical difference was found (p > 0.05) regarding improvement in urinary incontinence during the follow-up period. Conclusion There are significant differences in anterior and posterior approaches in terms of clinical improvement. Compared with posterior approach, the anterolateral approach can reduce fusion segment and well maintain the kyphosis correction. The selection of treatment should be based on clinical and radiological findings, including neurological deficit.

The Origins of the Village Revisited: From Nuclear to Extended Households

2002 ◽  
Vol 67 (3) ◽  
pp. 417-433 ◽  
Author(s):  
Kent V. Flannery
Keyword(s):  
Nuclear Family ◽  
Extended Family ◽  
Near East ◽  
Shared Storage ◽  
Nuclear Families ◽  
Second Stage ◽  
Third Stage ◽  
Two Stages ◽  
Extended Households ◽  
The Village

In Mesoamerica and the Near East, the emergence of the village seems to have involved two stages. In the first stage, individuals were distributed through a series of small circular-to-oval structures, accompanied by communal or “shared” storage features. In the second stage, nuclear families occupied substantial rectangular houses with private storage rooms. Over the last 30 years a wealth of data from the Near East, Egypt, the Trans-Caucasus, India, Africa, and the Southwest U.S. have enriched our understanding of this phenomenon. And in Mesoamerica and the Near East, evidence suggests that nuclear family households eventually gave way to a third stage, one featuring extended family households whose greater labor force made possible extensive multifaceted economies.

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