scholarly journals Maternal Morbidity in Vaginal Delivery with or without Episiotomy in Nulliparous Women

2017 ◽  
Vol 16 (2) ◽  
pp. 41-46
Author(s):  
Sumana Thapa ◽  
Indira Acharya ◽  
Meeta Singh ◽  
Josie Baral
Keyword(s):  
Vaginal Delivery ◽  
Maternal Morbidity ◽  
Surgical Repair ◽  
Perineal Laceration ◽  
Perineal Tear ◽  
Second Stage ◽  
Mediolateral Episiotomy ◽  
Obstetrics And Gynaecology ◽  
Nulliparous Women ◽  
Prospective Comparative Study

Introduction: Episiotomy incision is the most common surgical procedure around the globe and in many countries, it became a routine policy. Episiotomy in all women with vaginal delivery has no benefit. Rate of episiotomy varies widely around the globe, while in Nepal all nulliparous and primi-parous hospital deliveries are given routine episiotomy. So, this study aimed to compare the maternal morbidity during first vaginal birth in women with or without episiotomy.Methods: This is a hospital based randomized prospective comparative study conducted in the Obstetrics and Gynaecology department of a teaching hospital. The subjects were divided into episiotomy group and no episiotomy group. Under local anaesthesia mediolateral episiotomy was given in the second stage with crowning of the head in episiotomy group. Nature of morbidity seen were recorded in both the groups immediately after delivery, after 6 hours and after 1 week and compared.Results: In no episiotomy group intact perineum 26.3%, laceration 10.5%, spontaneous perineal tear (first and second degree) 63.1% was observed. Total perineal surgical repair was 81.55%. Intact perineum was high among no episiotomy group. Third degree tear, vulval haematoma, wound gaping, perineal oedema were seen in episiotomy group.Conclusion: Anterior perineal laceration rate was high in no episiotomy group than episiotomy group but overall few morbidities were in no episiotomy group than in episiotomy group. So, episiotomy should not be considered to prevent insignificant anterior perineal lacerations.

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 Obesity, Second Stage Duration, and Labor Outcomes in Nulliparous Women

2019 ◽  
Author(s):  
Antonina I. Frolova ◽  
Nandini Raghuraman ◽  
Molly J. Stout ◽  
Methodius G. Tuuli ◽  
George A. Macones ◽  
...  
Keyword(s):  
Maternal Morbidity ◽  
Secondary Analysis ◽  
Neonatal Morbidity ◽  
Fetal Distress ◽  
Obese Women ◽  
Stage Duration ◽  
Second Stage ◽  
Nulliparous Women ◽  
Increased Risk ◽  
Labor Outcomes

Abstract Objective To estimate second stage duration and its effects on labor outcomes in obese versus nonobese nulliparous women. Study Design This was a secondary analysis of a cohort of nulliparous women who presented for labor at term and reached complete cervical dilation. Adjusted relative risks (aRR) were used to estimate the association between obesity and second stage characteristics, composite neonatal morbidity, and composite maternal morbidity. Effect modification of prolonged second stage on the association between obesity and morbidity was assessed by including an interaction term in the regression model. Results Compared with nonobese, obese women were more likely to have a prolonged second stage (aRR: 1.48, 95% CI: 1.18–1.85 for ≥3 hours; aRR: 1.65, 95% CI: 1.18–2.30 for ≥4 hours). Obesity was associated with a higher rate of second stage cesarean (aRR: 1.78, 95% CI: 1.34–2.34) and cesarean delivery for fetal distress (aRR: 2.67, 95% CI: 1.18–3.58). Obesity was also associated with increased rates of neonatal (aRR: 1.38, 95% CI: 1.05–1.80), but not maternal morbidity (aRR: 1.06, 95% CI: 0.90–1.25). Neonatal morbidity risk was not modified by prolonged second stage. Conclusion Obesity is associated with increased risk of neonatal morbidity, which is not modified by prolonged second stage of labor.

scholarly journals Use of 2D and multislice transperineal ultrasonography to describe the degree of perineal laceration following vaginal delivery

2018 ◽  
Vol 27 (2) ◽  
Author(s):  
Budi I. Santoso ◽  
Suskhan Djusad ◽  
Surahman Hakim ◽  
Fernandi Moegni ◽  
Alfa P. Meutia ◽  
...  
Keyword(s):  
Vaginal Delivery ◽  
Clinical Examination ◽  
Evaluation Method ◽  
Cross Sectional Study ◽  
Perineal Laceration ◽  
Perineal Tear ◽  
Cross Sectional ◽  
Measurement Variation ◽  
The Mean ◽  
Primiparous Women

Background: Perineal tear is the most common complication after vaginal delivery. Pill-rolling test is a widely used clinical evaluation method to determine the degree of perineal tear. However, the evaluation results of anal sphincter complex (ASC) differ between clinical examination and 2D/multislice transperineal ultrasonography (TPUS). This study aims to describe measurement variation between these modalities.Methods: This cross-sectional study was conducted at Cipto Mangunkusumo Hospital from November 2015 to May 2016. Subjects were primiparous women after vaginal delivery. Clinical examination using pill-rolling test was performed to determine the degree of perineal laceration. Suture was conducted accordingly. The subjects were subjected to 2D/multislice TPUS 72 hours after delivery to evaluate the integrity of internal and external anal sphincters. Data were collected and analyzed to determine compatibility between these examinations.Results: Among 70 prospective primiparous women, five were excluded due to unavailability to undergo 2D/multislice TPUS 72 hours after delivery. The mean duration to perform 2D/multislice TPUS was 4.5 minutes, and pain was tolerable during the examination. The compatibility values of clinical examination with 2D and multislice TPUS were 0.98 and 0.93, respectively, with Cohen’s kappa of 0.92 (95% CI 0.81–1.00) and 0.79 (95% CI 0.58–0.99), respectively.Conclusion: Clinical examination is compatible with 2D/multislice TPUS for determining the degree of perineal tear after vaginal delivery.

Angle of Progression on Ultrasound in the Second Stage of Labor and Spontaneous Vaginal Delivery

2017 ◽  
Vol 35 (04) ◽  
pp. 413-420 ◽  
Author(s):  
Caroline Rouse ◽  
David Cantonwine ◽  
Sarah Little ◽  
Thomas McElrath ◽  
Julian Robinson ◽  
...  
Keyword(s):  
Vaginal Delivery ◽  
Prospective Observational Study ◽  
Mode Of Delivery ◽  
Transperineal Ultrasound ◽  
Survival Models ◽  
Spontaneous Vaginal Delivery ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Nulliparous Women ◽  
Angle Of Progression

Objective The objective of this study was to assess the association between the angle of progression (AoP) measured by transperineal ultrasound and mode of delivery and duration of the second stage. Study Design This is a prospective observational study of nulliparous women with a singleton gestation at term in which serial transperineal ultrasound examinations were obtained during the second stage of labor. Multivariable logistic regression and adjusted survival models were used for the analysis. Results A total of 137 patients were included in the analysis and median AoP for the study group was 153 degrees. The adjusted odds ratio (aOR) of requiring an operative delivery was 2.6 times higher for those patients who had an AoP < 153 degrees and the aOR of requiring a cesarean delivery was almost six times higher when compared with those patients who had an AoP ≥ 153 degrees (95% confidence interval [CI]: 1.0, 6.2; p = 0.04; aOR: 5.8, 95% CI: 1.2–28.3; p = 0.03, respectively). Those patients with an AoP < 153 degrees were at a higher hazard of staying pregnant longer (adjusted hazard ratio: 1.8, 95% CI: 1.2–2.8, p = 0.005). Conclusion The AoP has the potential to predict spontaneous vaginal delivery and the duration of the second stage of labor which may be useful in counseling patients and managing their labor.

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. 

scholarly journals Effect of episiotomy on perineal lacerations in spontaneous vertex deliveries

2016 ◽  
Vol 11 (4) ◽  
Author(s):  
Meherun Nisa
Keyword(s):  
Vaginal Delivery ◽  
Local Anaesthesia ◽  
Analytical Study ◽  
Study Groups ◽  
Perineal Laceration ◽  
Cross Sectional ◽  
Fourth Degree ◽  
Mediolateral Episiotomy ◽  
Perineal Tears ◽  
Perineal Lacerations

Objectives: To evaluate the effects of episiotomy on the frequency of perineal lacerations. Design: Cross-Sectional analytical study. Place & duration of study: Department of Gynae Obstetrics unit III. Lady willingdon Hospital Lahore. From April 1994 to March 1996. Patients & methods: 2918 women who delivered vaginally were included in the study. Only right mediolateral episiotomy incision was used in these cases. Local anaesthesia in the form of 2% Lignocain was used in all cases to infiltrate the area before episiotomy cut. The delivery was conducted in most cases by a resident. The rate of perineal lacerations with or without episiotomy in both primiparae and multiparae groups was noted. Results 2918 women of term singleton babies were entered into this study. Episiotomy was performed in 1419 (48.63%) of these women. There were 1095(37.53%) primiparae and 1823 (62.47%) multiparae in the study groups. The rate of episiotomy in primiparae and multiparae were 93.42% and 21.72% respectively. A total of 267 (9.2%) perineal tears were sustained by these women during vaginal delivery . Episiotomy was associated with 151 (10.6%) perineal tears compared to 116(7.7%) without episiotomy. The incidence of fourth degree perineal laceration was 0.4% without episiotomy but increased to 1% with the use of episiotomy. This difference is statistically significant. Conclusion: Episiotomy is not protective against severe perineal lacerations. A selective use of episiotomy is recommended for appropriate indications.

Prediction of spontaneous vaginal delivery in nulliparous women with a prolonged second stage of labor: the value of intrapartum ultrasound

2019 ◽  
Vol 221 (6) ◽  
pp. 642.e1-642.e13 ◽  
Author(s):  
Andrea Dall’Asta ◽  
Laura Angeli ◽  
Bianca Masturzo ◽  
Nicola Volpe ◽  
Giovanni Battista Luca Schera ◽  
...  
Keyword(s):  
Vaginal Delivery ◽  
Spontaneous Vaginal Delivery ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Nulliparous Women

scholarly journals Effectiveness of Perineal Massage in the Second Stage of Labor in Preventing Perineal Trauma

2020 ◽  
pp. 1
Author(s):  
Suleyman Cemil Oglak ◽  
Mehmet Obut
Keyword(s):  
Observational Study ◽  
Perineal Trauma ◽  
Control Group ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Mediolateral Episiotomy ◽  
Perineal Tears ◽  
Nulliparous Women ◽  
Massage Group ◽  
Perineal Massage

<p><strong>OBJECTIVE:</strong> This study was aimed to investigate the effect of perineal massage in the second stage of labor in prevention perineal traumas during childbirth.</p><p><strong>STUDY DESIGN:</strong> This observational study was conducted with 171 nulliparous women delivered by vaginally between January 2017 and May 2019. All the patients managed by the selective episiotomy principle. All the patients were divided into two groups: the perineal massage group and the control group. The perineal massage was performed during the second stage of labor until the baby's head was birth. The control group received routine labor care. In the case of threatening tears in any patient and at the preference of the midwife, mediolateral episiotomy was performed. Following childbirth, the perineum and vagina were examined for perineal tears and episiotomy by the midwives.</p><p><strong>RESULTS:</strong> The length of the second stage of labor was significantly lower in the massage group (36±19 minute) compared with the control group (46±25 minute, p=0.024). Twenty-five women (28.8%) in the massage group had intact perineum after vaginal birth, compared with five (6.0%) in the control group (p=0.003). The rate of first- and second-degree perineal tears are higher in the massage group [28 patients (32.2%) and 9 patients (10.3%), respectively] than in the control group [10 patients (11.9%) and 5 patients (6.0%), respectively, p&lt;0.001]. The incidence of episiotomy was significantly lower in the massage group (25 patients, 28.7%) than in the control group (64 patients, 76.1%, p&lt;0.001). </p><p><strong>CONCLUSION:</strong> Perineal massage should be considered a routine intervention to reduce the incidence of perineal trauma.</p>

scholarly journals Does the length of second stage of labour or second stage caesarean section in nulliparous women increase the risk of preterm birth in subsequent pregnancies?

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Cathy Z. Liu ◽  
Nicole Ho ◽  
Keisuke Tanaka ◽  
Christoph Lehner ◽  
Renuka Sekar ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Caesarean Section ◽  
Vaginal Delivery ◽  
Subsequent Pregnancy ◽  
Second Stage ◽  
Second Stage Of Labour ◽  
Index Pregnancy ◽  
Nulliparous Women ◽  
Increased Risk ◽  
Significant Difference

AbstractShort communicationThis study aimed to investigate the role of prolonged second stage of labour and second stage caesarean section on the risk of spontaneous preterm birth (sPTB) in a subsequent pregnancy.Objectives and MethodsThis was a retrospective cohort study of nulliparous women with two consecutive singleton deliveries between 2014 and 2017 at a tertiary centre. In the vaginal delivery cohort, subsequent pregnancy outcomes for women with a prolonged second stage (>2 h) were compared with those with a normal second stage (≤2 h). In the caesarean delivery cohort, women with a first stage or a second stage were compared with the vaginal delivery cohort. The primary outcome was subsequent sPTB.ResultsA total of 821 women met inclusion criteria, of which 74.8% (614/821) delivered vaginally and 25.2% (207/821) delivered by caesarean section. There was no association between a prolonged second stage in the index pregnancy and subsequent sPTB (aOR 0.70, 95% CI 0.13–3.83, p=0.7). The risk of subsequent sPTB was threefold for those with a second stage caesarean section; however this did not reach statistical significance.ConclusionsA prolonged second stage of labour in the index pregnancy is not associated with an increased risk of subsequent sPTB. A second stage caesarean section in the index pregnancy may be associated with an increased risk of subsequent sPTB, however there was no statistically significant difference. These findings are important for counseling and suggest that the effects of these factors are not clinically significant to justify additional interventions in the subsequent pregnancy.

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