Prevalence and risk factors of overt postpartum urinary retention among primiparous women after vaginal delivery: a case-control study

Background Postpartum urinary retention (PUR) may lead to bladder neuromuscular damage and subsequently voiding dysfunction. However, the literature regarding the incidence of and risk factors for PUR remains unclear. Moreover, previously reported studies are limited to small sample sizes. Thus, this study aimed to assess the incidence of and risk factors for overt PUR after vaginal delivery. Methods This retrospective case-control study included all primiparas who delivered vaginally between July 1, 2017, and June 30, 2019, at our institution. The case group comprised 677 women diagnosed with overt PUR who required catheterisation after delivery. The control group comprised 677 women without overt PUR randomly selected in a 1:1 ratio matched for date of delivery and who delivered immediately after each woman with overt PUR to minimise the impact of variations over time in obstetric practice. Univariate and multivariate logistic regression analyses were performed to investigate the factors associated with overt PUR. Results Of the 12,609 women included in our study, 677 were diagnosed with overt PUR (incidence 5.37%). Univariate analysis identified epidural analgesia, episiotomy, perineal tears, instrument-assisted delivery, duration of labour stage, intrauterine operation, and vulvar oedema as risk factors for PUR. Multivariate logistic regression identified epidural analgesia (odds ratio [OR] = 1.41, 95% confidence interval [CI]: 1.11–1.79, P = 0.005), vulvar oedema (OR = 6.92, 95% CI: 4.65–10.31, P < 0.001), forceps delivery (OR = 8.42, 95% CI: 2.22–31.91, P = 0.002), episiotomy (OR = 1.37, 95% CI: 1.02–1.84, P = 0.035), and second-degree perineal tear (OR = 3.42, 95% CI: 2.37–4.94, P < 0.001) as significant independent risk factors for PUR. Conclusions PUR was highly associated with epidural analgesia, forceps delivery, vulvar oedema, episiotomy, and second-degree perineal tears. More attention should be paid to women at high risk to reduce the incidence of PUR.

Utilizing intrapartum transperineal ultrasound in the second stage of labor to predict the difficulty in operative forceps delivery

Objectives: To assess the predictive value of intrapartum transperineal ultrasound (ITU) measurements, including angle of progression (AOP) and head direction (HD), for the difficulty of forceps delivery in occiput anterior position. Methods: This prospective observational study was conducted among 21 nulliparous women with singleton term pregnancies with an indication for forceps delivery. Two operators performed ITU (AOP and HD) immediately before blade application, both at rest and with concurrently contraction and active pushing. Managing obstetricians were blinded to the ultrasound data. A forceps delivery was classified as “complicated” when one or more of the following situations occurred: three or more tractions, a subjective impression of a difficult traction, failed forceps delivery, a third-degree or higher perineal tear and a significant neonatal lesion. Results: Of 21 cases, we identified 5 cases of complicated forceps deliveries. AOP at rest (AOP1) was 127.67 ± 11.35° in complicated group and 143.68 ± 15.08° in uncomplicated group (P = 0.043); AOP during contraction (AOP2) was 161.44 ± 9.25° versus 179.55 ± 15.81° (P = 0.026). HD at rest (HD1) was 14.81 ± 15.39° versus 20.30 ± 9.81° (P = 0.351); HD during contraction (HD2) was 26.77 ± 14.99° versus 35.97 ± 10.21° (P = 0.131). By calculating the area under the receiver-operating characteristics curve (AUC), the measurements of AOP1 and AOP2 and their combination (Combined prediction score = -28.790 + 0.105*AOP1(°) + 0.094*AOP2(°)) showed significant predictive values for a safe forceps delivery. The AUCs were 81.3% (95CI 58.4%-94.7%), 83.8% (95 CI 61.3%-96.0%) and 92.5% (95%CI 72.3%-99.4%), respectively. The optimal cut-offs were an AOP1 of 127.8° (sensitivity = 81.25%, specificity = 80%), an AOP2 of 171.4° (sensitivity = 75%, specificity = 100%) and a new combined prediction score of 1.376 (sensitivity = 81.25%, specificity = 80%). Conclusions: Using the measurements of AOP1 and AOP2 and their combination can predict a high probability of safe forceps delivery, and such prediction can be helpful for the obstetricians in clinical decision-making.

Clinical Effects of Form-Based Management of Forceps Delivery under Intelligent Medical Model

Background. Forceps delivery is one of the most important measures to facilitate vaginal delivery. It can reduce the rate of first cesarean delivery. Frustratingly, adverse maternal and neonatal outcomes associated with forceps delivery have been frequently reported in recent years. There are two major reasons: one is that the abilities of doctors and midwives in forceps delivery vary from hospital to hospital and the other one is lack of regulations in the management of forceps delivery. In order to improve the success rate of forceps delivery and reduce the incidence of maternal and neonatal complications, we applied form-based management to forceps delivery under an intelligent medical model. The aim of this work is to explore the clinical effects of form-based management of forceps delivery. Methods. Patients with forceps delivery in Maternal and Child Health Hospital Affiliated to Nanchang University were divided into two groups: form-based patients from January 1, 2019, to December 31, 2020, were selected as the study group, while traditional protocol patients from January 1, 2017, to December 31, 2018, were chosen as the control group. Then, we compared the maternal and neonatal outcomes of these two groups. Results. There were significant differences in the maternal and neonatal adverse outcomes such as rate of postpartum hemorrhage, degree of perineal laceration, and incidence of neonatal facial skin abrasions between the two groups, whereas differences in the incidence of asphyxia and intracranial hemorrhage were not significant. Conclusions. Form-based management could help us assess the security of forceps delivery comprehensively, as it could not only improve the success rate of the one-time forceps traction scheme but also reduce the incidence of maternal and neonatal adverse outcomes effectively.

Prevalence of Neonatal Mortality and Its Associated Factor among Neonates Who Admitted In Neonatal Intensive Care Unit At Debre Tabor General Hospital, South Gondar, Amhara, Ethiopia

BackgroundNeonatal mortality is the death of newborn babies from the time of birth to 28 completed days of life which are the most vulnerable time for a child's survival. About one million of them passed away on their first day of life, and more than two thirds (38%) of the deaths were in sub-Saharan Africa where Ethiopia is one of the countries with the highest neonatal mortality in the world which accounts for 29 deaths per 1,000 live births.ObjectiveTo assess the prevalence and associated factors of neonatal mortality among neonates admitted in Debre Tabor General Hospital in South Gondar, Ethiopia.MethodsInstitutional based retrospective cross-sectional study design was conducted from November 1, 2018, up to January 30, 2019, in Debre Tabor General Hospital. A Structured interviewer-administered pre-tested questionnaire was used to collect data. The collected data were entered into Epi data version 4.2 and then exported into SPSS window version 24. Bivariate and multivariate analysis was undertaken and information was presented by using simple frequency tables, graphs, and pie charts.Resultthe prevalence of neonatal mortality was found to be 12.3%. Gestational age group 28–32 weeks (AOR = 9.5, 95% CI: 2.39–37.97), Gestational Age beyond 42 weeks (AOR = 4.6, 95% CI: 6.3–33.8), and forceps delivery (AOR = 0.18, 95% CI: 0.05–0.68) were found to be statistically significant.Conclusion and recommendationNeonatal mortality was higher than the national with independently associated factors of prematurity and post maturity while forceps delivery as a preventive factor. Therefore, this might be essential to the hospital NICU to plan for managing prematurity and post maturity in better quality as well as providing quality ANC and identifying most predisposing factors for prematurity.

COMPARISON OF MATERNAL AND NEONATAL OUTCOME IN FORCEPS VERSUS VENTOUSE ASSISTED VAGINAL DELIVERY IN OBSTETRICS AND GYNAECOLOGY DEPARTMENT OF PMCH, PATNA, BIHAR

Objectives: To compare the maternal and neonatal outcome following ventouse and forceps- assisted vaginal deliveries in singleton term pregnancies. Study Design: A cross-sectional study. Duration and Place of study: It was conducted at the Obstetrics and Gynaecology Department of Patna Medical College and Hospital, Patna, Bihar from May 2020 to December 2020. Patients and Methods: All patients who underwent instrumental vaginal delivery during this period, fulfilling the inclusion criteria were studied. Main maternal outcomes were perineal tears while the main neonatal outcomes were Apgar score at 1 minute and at 5 minutes after birth. Neonatal outcome included record of cephalhematoma, shoulder dystocia and need for admission to NICU. In addition to the above, maternal age, gestational age, parity and booking status were also recorded along with the indication for instrumental vaginal delivery for both ventouse and forceps delivery groups. Data was entered into SPSS-15. Percentages were calculated for all the above variables except maternal age and gestational age for which mean + SD were calculated. Chi -square test was used for qualitative variables to assess any difference between the two groups. P-value of equal to or <0.05 considered to be significant. Results: A total of 80 patients underwent ventouse delivery while 120 patients with forceps delivery were included. Mean maternal ages were 25.7+ 4.33 yrs and 25.05+3.47yrs in ventouse and forceps group respectively. 54(67%) and 95(79.16%) were primiparous in ventouse and forceps group respectively. 35(43.7%) were booked cases in ventouse group while this number was 53(44.2%) in forceps group. Fetal distress was the commonest indication of instrument application in 60(75%) and 108(90%) cases in ventouse and forceps group respectively. 16(20%) and 35(29.16%) neonates had Apgar score of <7 at 1 minute in ventouse and forceps group respectively. Apgar score of <7 at 5 minute was observed in 10(12.5%) of ventouse group while 14(11%) of forceps group. 2.5 % (n=2) and 1.66% (n=2) of neonates had shoulder dystocia in ventouse and forceps group respectively. Cephalhematoma was observed in 4(5%) of ventouse group while it was 1.5% (n=2) in forceps group. 11% (n=9) and 10% (n=12) of neonates admitted to NICU in ventouse and forceps group respectively. No case of maternal 3rd degree perineal tear observed in ventouse group while 3(2.5%) of patients had 3rd degree perineal tears in forceps group. Conclusion: Forceps deliveries are more associated with maternal morbidity while neonatal trauma is commoner among those delivered by vacuum extraction however there seems to be no difference in neonatal admission to NICU.

Prevalence of Neonatal Mortality and Its Associated Factors among Neonates Admitted In Neonatal Intensive Care Unit in Debre Tabor General Hospital, South Gondar, Ethiopia

Neonatal mortality is the death of newborn babies from the time of birth to 28 completed days of life which is the most vulnerable time for a child's survival. About one million of them passed away on their first day of life, and more than two thirds (38%) of the deaths were in sub-Saharan Africa where Ethiopia is one of the countries with the highest neonatal mortality in the world which accounts for 29 deaths per 1,000 live births. Objective: To assess the prevalence and associated factors of neonatal mortality among neonates admitted in Debre Tabor General Hospital in South Gondar, Ethiopia. Methods: Institutional based retrospective cross-sectional study design was conducted from November 1, 2018, up to January 30, 2019, in Debre Tabor General Hospital. A Structured interviewer-administered pre-tested questionnaire was used to collect data. The collected data were entered into Epi data version 4.2 and then exported into SPSS window version 24. Bivariate and multivariate analysis was undertaken and information was presented by using simple frequency tables, graphs, and pie charts. Result: the prevalence of neonatal mortality was found to be 12.3%. Gestational age group 28-32 weeks (AOR=9.5, 95% CI: 2.39-37.97), Gestational Age beyond 42 weeks (AOR=4.6, 95% CI: 6.3-33.8), and forceps delivery (AOR=0.18, 95% CI: 0.05-0.68) were found to be statistically significant. Conclusion and recommendation: Neonatal mortality was higher than the national with independently associated factors of prematurity and post maturity while forceps delivery as a preventive factor. Therefore, this might be essential to the hospital neonatal intensive care unit nurse to plan for managing prematurity and post maturity in better nursing care as well as providing quality ANC and identifying most predisposing factors for prematurity.