Pelvic floor morbidity up to one year after difficult instrumental delivery and caesarean section in the second stage of labor: a cohort study

Background: There is an alarming rise in caesarean section leading to increased adverse outcomes for both the mother and fetus when compared with vaginal delivery. With this increasing caesarean section rate, there is a concerning increase in the rate of second stage caesarean section. This study highlights includes the rate of caesarean deliveries in the second stage of labour, the indications for delivery and the associated maternal morbidity in this cohort of women. Methods: This was a prospective cohort review of all women with a singleton, cephalic fetus at term delivered by caesarean section in the second stage of labor between July, 2016 and December 31, 2017 at government medical college hospital Dharmapuri. The main outcome measures were second stage caesarean section, indications and its maternal morbidity.Results: 250 women underwent caesarean delivery in the advanced labor. Among the 250 patient’s majority of them were in the age group of 21-30 yrs. about 76% of the patients were primigravidae and only the remaining 24% were multigravida. The commonest indications for doing caesarean section in the second stage of labor was cephalo pelvic disproportion and non-reassuring fetal heart rate patterns. The difficult task was delivery of the deeply engaged head, the increased likelihood of intraoperative and post-operative complications.Conclusions: Cesarean sections done in second stage of labor are associated with several intra-operative maternal complications and morbidity.

Download Full-text

Management of prolonged second stage of labor

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20182855 ◽

2018 ◽

Vol 7 (7) ◽

pp. 2527

Author(s):

Sanjay Singh ◽

Uttara Aiyer Kohli ◽

Shakti Vardhan

Keyword(s):

Caesarean Section ◽

Perinatal Morbidity ◽

Management Options ◽

Second Stage Of Labor ◽

Second Stage ◽

Second Stage Of Labour ◽

Definition Of

Second stage of labour has been often neglected leading to increased maternal and perinatal morbidity. Recognising and managing prolonged second stage is a challenge even to an experienced obstetrician. This article reviews the changes in the definition of prolonged second stage over the years. It discusses the causes, recognition and management options along with the difficulties in delivering a patient with prolonged second stage of labour. Though adding an extra hour to the definition of second stage in patients may reduce the rate of caesarean section but some studies also show a rise in maternal and perinatal morbidity. Obstetricians are familiarized to the different techniques of delivery of the impacted head. Once diagnosis of prolonged second stage is confirmed, causes should be identified and addressed, and treatment should be individualised, and timing and mode of intervention planned.

Download Full-text

Perineal Body Stretch in the Second Stage of Labor does not Predict Obstetric Trauma or Postpartum Pelvic Floor Function

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2013.12.112 ◽

2014 ◽

Vol 21 (2) ◽

pp. S22

Author(s):

G.C. Dunivan ◽

J. Alldredge ◽

K.V. Meriwether ◽

C. Qualls ◽

L. Leeman ◽

...

Keyword(s):

Pelvic Floor ◽

Perineal Body ◽

Pelvic Floor Function ◽

Second Stage Of Labor ◽

Obstetric Trauma ◽

Second Stage ◽

Floor Function

Download Full-text

Duration of the Second Stage of Labor and the Risk of Pelvic Floor Dysfunction among Primiparous Women One to Two Years Postpartum

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2017.08.154 ◽

2017 ◽

Vol 24 (7) ◽

pp. S99

Author(s):

K. Babaran ◽

M. Aziz ◽

C. Iwanoff ◽

R. Hidalgo ◽

C. Salamon

Keyword(s):

Pelvic Floor ◽

Pelvic Floor Dysfunction ◽

Second Stage Of Labor ◽

Second Stage ◽

Primiparous Women

Download Full-text

Prediction Index of Levator Ani Muscle Avulsion After Vaginal Delivery: An Evidence-Based Appraisal

Advanced Science Letters ◽

10.1166/asl.2018.12689 ◽

2018 ◽

Vol 24 (8) ◽

pp. 6214-6217

Author(s):

Budi Iman Santoso ◽

Adly Nanda Al-Fattah ◽

Raymond Surya ◽

Surrahman Hakim

Keyword(s):

Pelvic Floor ◽

Vaginal Delivery ◽

Pelvic Floor Dysfunction ◽

Levator Ani ◽

Influential Factors ◽

Cochrane Library ◽

Levator Ani Muscle ◽

Second Stage Of Labor ◽

Second Stage ◽

Levator Ani Muscle Avulsion

Pelvic floor dysfunction (PFD) due to vaginal delivery is related to tear of levator ani muscle (LAM) that potentially lead to the impairment of quality of life among women. A number of attempts to predict LAM injury after vaginal delivery had been conducted. This study aims to appraise the accuracy of several prediction index determining LAM injury after vaginal delivery. We conducted a search in Cochrane Library®, Pubmed®, and Medline® with the keywords of “pelvic floor dysfunction” AND “vaginal delivery” AND “prediction.” Critical appraisal determining the validity, importance, and applicability (VIA) was conducted by 2 independent authors. After 6 weeks to 3 months’ duration of follow up, the incidence of LAM avulsion was varied from 15.4% to 35.6% from three studies. Multivariate analysis showed that forceps delivery, OASIS, and active second stage (OR 3.8; 3.1; 1.61; respectively) as the most influential factors for LAM incidence. Maternal age and time spent in active pushing were also contributed to LAM incidence. OASIS and second stage of labor could be used as the most influential components of prediction index for LAM incidence. Prediction indexes for LAM incidence are developed. OASIS and second stage of labor are acknowledged as two most influential variables among three appraised studies.

Download Full-text