Percepção sobre o cuidado à perda gestacional: estudo qualitativo com casais brasileiros / Perceptions on pregnancy loss care: a qualitative study with brazilian couples / Percepción sobre la atención a la pérdida del embarazo: estudio cualitativo con parejas brasileñas

Este artigo analisou a percepção e os sentimentos de casais sobre o atendimento recebido nos serviços de saúde acessados em função de perda gestacional (óbito fetal ante e intraparto). O convite para a pesquisa foi divulgado em mídias sociais (Instagram e Facebook). Dos 66 casais que contataram a equipe, 12 participaram do estudo, cuja coleta de dados ocorreu em 2018. Os casais responderam conjuntamente a uma ficha de dados sociodemográficos e uma entrevista semiestruturada, realizada presencialmente (n=4) ou por videochamada (n=8). Os dados foram gravados em áudio e posteriormente transcritos. A Análise Temática indutiva das entrevistas identificou cinco temas: sentimento de impotência, iatrogenia vivida nos serviços, falta de cuidado em saúde mental, não reconhecimento da perda como evento com consequências emocionais negativas, e características do bom atendimento. Os achados demonstraram situações de violência, comunicação deficitária, desvalorização das perdas precoces, falta de suporte para contato com o bebê falecido e rotinas pouco humanizadas, especialmente durante a internação após a perda. Para aprimorar a assistência às famílias enlutadas, sugere-se qualificação profissional, ampliação da visibilidade do tema entre diferentes atores e reorganização dos serviços, considerando uma diretriz clínica para atenção ao luto perinatal, com destaque para o fortalecimento da inserção de equipes de saúde mental no contexto hospitalar.(AU)

This study analyzed couples' perceptions and feelings about pregnancy loss care (ante and intrapartum fetal death). A research invitation was published on social media (Instagram and Facebook) and data collection took place in 2018. Of the 66 couples who contacted the research team, 12 participated in the study by filling a sociodemographic questionnaire and answering a semi-structured interview in person (n=04) or by video call (n=08). All interviews were audio recorded, transcribed, and examined by Inductive Thematic Analysis, which identified five themes: feelings of impotence, iatrogenic experiences in health services, lack of mental health care, not recognizing pregnancy loss as an emotionally overwhelming event, and aspects of good healthcare. Analysis showed experiences of violence, poor communication, devaluation of early losses, lack of support for contact with the deceased baby, and dehumanizing routines, especially during hospitalization after loss. Professional qualification, extended pregnancy loss visibility among different stakeholders, and reorganization of health services are needed to improve the care offered to grieving families, considering a clinical guideline for perinatal grief care with emphasis on strengthening the insertion of mental health teams in the hospital context.(AU)

Este estudio analizó las percepciones y sentimientos de parejas sobre la atención recibida en los servicios de salud a los que accedieron debido a la pérdida del embarazo (muerte fetal ante e intraparto). La invitación al estudio se publicó en las redes sociales (Instagram y Facebook). De las 66 parejas que se contactaron con el equipo, 12 participaron en el estudio, cuya recolección de datos se realizó en 2018. Las parejas respondieron un formulario de datos sociodemográficos y realizaron una entrevista semiestructurada presencialmente (n=4) o por videollamada (n=08). Los datos se grabaron en audio para su posterior transcripción. El análisis temático inductivo identificó cinco temas: Sentimiento de impotencia, experiencias iatrogénicas en los servicios, falta de atención a la salud mental, falta de reconocimiento de la pérdida como un evento con consecuencias emocionales negativas y características de buena atención. Los hallazgos evidenciaron situaciones de violencia, comunicación deficiente, desvalorización de las pérdidas tempranas, falta de apoyo para el contacto con el bebé fallecido y rutinas poco humanizadas, especialmente durante la hospitalización tras la pérdida. Para mejorar la atención a las familias en duelo, se sugiere capacitación profesional, ampliación de la visibilidad del tema entre los diferentes actores y reorganización de los servicios, teniendo en cuenta una guía clínica para la atención del duelo perinatal, enfocada en fortalecer la inserción de los equipos de salud mental en el contexto hospitalario.(AU)

A comparison of antenatal prediction models for vaginal birth after caesarean section

INTRODUCTION@#An antenatal scoring system for vaginal birth after caesarean section (VBAC) categorises patients into a low or high probability of successful vaginal delivery. It enables counselling and preparation before labour starts. The current study aims to evaluate the role of Grobman nomogram and the Kalok scoring system in predicting VBAC success in Singapore.@*METHODS@#This is a retrospective study on patients of gestational age 37 weeks 0 day to 41 weeks 0 day who underwent a trial of labour after 1 caesarean section between September 2016 and September 2017 was conducted. Two scoring systems were used to predict VBAC success, a nomogram by Grobman et al. in 2007 and an additive model by Kalok et al. in 2017.@*RESULTS@#A total of 190 patients underwent a trial of labour after caesarean section, of which 103 (54.2%) were successful. The Kalok scoring system (area under curve [AUC] 0.740) was a better predictive model than Grobman nomogram (AUC 0.664). Patient's age (odds ratio [OR] 0.915, 95% CI [confidence interval] 0.844-0.992), body mass index at booking (OR 0.902, 95% CI 0.845-0.962), and history of successful VBAC (OR 4.755, 95% CI 1.248-18.120) were important factors in predicting VBAC.@*CONCLUSION@#Neither scoring system was perfect in predicting VBAC among local women. Further customisation of the scoring system to replace ethnicity with the 4 races of Singapore can be made to improve its sensitivity. The factors identified in this study serve as a foundation for developing a population-specific antenatal scoring system for Singapore women who wish to have a trial of VBAC.

Outcomes of ‘one-day trial of vaginal delivery of twins’ at 36–37 weeks' gestation in Japan

OBJECTIVE: The lack of obstetricians in Japan has prevented the implementation of a 24–hour delivery monitoring system for high-risk deliveries such as twin vaginal delivery at many obstetric facilities. To examine the outcomes of a 1-day trial of the vaginal delivery of twins at 36–37 weeks' gestation. METHODS: We induced the vaginal delivery of twins at 36–37 weeks' gestation of 256 women who provided consent between January 2007 and December 2016 using the following protocol: 1) administration of 0.5 mg oral prostaglandin E2 every 1 hour (maximum: 1.5 mg) in the morning; 2) intravenous administration of oxytocin and amniotomy in the afternoon; and 3) selection of caesarean delivery when vaginal delivery was not expected by evening. We examined their perinatal outcomes in a chart review. RESULTS: The completion rates of vaginal delivery in total, nulliparous, and multiparous women were 79%, 72%, and 84%, respectively. There were no cases of neonatal asphyxia. The total incidence of neonatal respiratory disorders was 2.1%, but there were no cases of persistent pulmonary hypertension. The total incidence of postpartum hemorrhage requiring transfusion was 2.7%. CONCLUSION: The 1-day planned vaginal delivery of twins at 36–37 weeks' gestation appears valid and safe, and our findings suggest that it can be an option for the delivery of twins.

Obstetric outcome of induction of labor using prostaglandin gel in patients with previous one cesarean section

OBJECTIVE: After globally acceptance of planned vaginal birth after cesarean section (VBAC), the mode of induction is still a matter of debate and requires further discussion. We aimed to study obstetric outcomes in post-cesarean patients undergoing induction of labor with prostaglandin gel compared with patients who developed spontaneous labor pains. METHODS: All patients at 34 weeks or more of gestation with previous one cesarean section eligible for trial of labor after cesarean section admitted in a labor room within one year were divided in 2 groups. Group one consisted of patients who experienced the spontaneous onset of labor pains and group 2 consisted of patients who underwent induction of labor with prostaglandin gel. They were analyzed for maternofetal outcomes. Descriptive statistics, independent sample t-test, and chi-square test were applied using SPSS 20 software for statistical analysis. RESULTS: Both groups were comparable in maternal age, parity, and fetal weight, but different in bishop score, mode of delivery, and neonatal outcome. Admisson bishop score was 6.61±2.51 in group 1 and 3.15±1.27 in group 2 (P<0.005). In the patients who experienced spontaneous labor, 86.82% had successful VBAC. In the patients with induced labor, 64.34% had successful VBAC with an average dose of gel of 1.65±0.75. Both groups had one case each of uterine rupture. The neonatal intensive care unit admission rate was 4.1% in group one and 10.4% in group 2. CONCLUSION: This study reflects that supervised labor induction with prostaglandin gel in previous one cesarean section patients is a safe and effective option.

Risk of Emergency Operations, Adverse Maternal and Neonatal Outcomes according to the Planned Gestational Age for Cesarean Delivery

BACKGROUND: The objective of this study was to assess the risk of emergency cesarean deliveries (CDs) and adverse neonatal/maternal outcomes according to the planned gestational age at delivery (GAD) for elective CD. METHODS: The study population consisted of term singleton pregnant women who were booked for elective CD and were subsequently delivered at term by CD, after excluding cases with a trial of labor. The relationship between the planned GAD, risk of emergency CD prior to planned date, and adverse neonatal/maternal outcomes were determined. RESULTS: The frequency of emergency CD, adverse neonatal and maternal outcomes were 9.5%, 4.5%, and 5.9%, respectively. The risk of emergency CD prior to the planned delivery date increased significantly according to the planned GAD (5.8% at 37 weeks, 8.2% at 38 weeks, 13.6% at 39 weeks, and 26.7% at 40 weeks or more of planned GAD, P = 0.005). Emergency CD was associated with an increased risk of adverse maternal outcomes, whereas the risk of adverse neonatal outcomes did not differ. In the total study population including both cases with elective and emergency CD, the risk of adverse maternal outcomes did not increase according to the planned GAD, and the risk of adverse neonatal outcomes decreased significantly according to the planned GAD. CONCLUSION: The risk of emergency CD increased as the planned GAD increased, but the risk of adverse maternal outcomes did not increase and the risk of adverse neonatal outcomes decreased significantly according to the planned GAD in the total study population including elective/emergency CD.

Risk factors differentiating mild/moderate from severe meconium aspiration syndrome in meconium-stained neonates

OBJECTIVE: The aim of this study was to compare the risk factors associated with mild/moderate meconium aspiration syndrome (MAS) with those associated with severe in meconium-stained term neonates. METHODS: Consecutive singleton term neonates (n=671) with meconium staining at birth from all deliveries (n=14,666) in our institution from January 2006 to December 2012 were included. Both maternal and neonatal variables were examined. Among the study population, for women who underwent the trial of labor (n=644), variables associated with labor were also examined. These variables were compared between the mild/moderate MAS group, the severe MAS group, and the MAS-absent group. RESULTS: MAS developed in 10.6% (71/671) of neonates with meconium staining at birth. Among the neonates with MAS, 81.7% had mild MAS, 5.6% had moderate MAS, and 12.7% had severe MAS. The presence of minimal variability was significantly increased in both the mild/moderate and the severe MAS groups. The frequencies of nulliparity, fetal tachycardia, and intrapartum fever were significantly increased in the mild/moderate MAS group, but not in the severe MAS group. While a longer duration of the second stage of labor was significantly associated with mild/moderate MAS, severe MAS was associated with a shorter duration of the second stage. Notably, low mean cord pH (7.165 [6.850-7.375]) was significantly associated with mild/moderate MAS, but not with severe MAS (7.220 [7.021-7.407]) compared with the absence of MAS (7.268 [7.265-7.271]). CONCLUSION: Our data suggest the development of severe MAS is not simply a linear extension of the same risk factors driving mild/moderate MAS.

Hemorragia postparto por causas diferentes a atonia uterina severa en el Hospital Escuela Universitario de Tegucigalpa / Postpartum hemorrhage due to different causes not owing to severe uterine atony at the Hospital Escuela Universitario in Tegucigalpa

Objetivo: caracterizar los casos de Hemorragia Post-Parto (HPP) que ocurren por etiologías diferentes a la hemorragia por atonía uterina en el Hospital Escuela de Tegucigalpa. Material y métodos: se realizó un estudio descriptivo-transversal, se tomó como población a todas las pacientes que ingresaron al Hospital Escuela por atención de parto vía vaginal, cesárea o ingresadas en el puerperio inmediato durante los meses de junio a diciembre del año 2011. La muestra se tomó de las pacientes complicadas con hemorragia postparto diagnosticadas clínicamente según la clasificación de Benedetti. Se consideró la presencia de factores de riesgo asociados al manejo y complicaciones. Resultados: ocurrieron 10,701 nacimientos y 56 casos de hemorragia postparto poratonía grado I, trauma del canal del parto, retención de tejido o trastornos de la coagulación, con una frecuencia de 0.5% de casos, las causas de hemorragia fueron: 22(39%) casos por trauma del canal del parto, de estos, 17(77%) fueron nacimientos por cesárea; ocurrieron 19(34%) por retención de tejido. Se clasificó la gravedad de la hemorragia que presentaron las pacientes al momento del ingreso en grado III y grado IV, resultando 9 (16%) casos de cada uno. Las complicaciones fueron: coagulopatía, falla renal, sepsis y Síndrome Anémico. La mayoría de las pacientes 45 (80%) presentó gestaciones a término; los factores de riesgo fueron: 13(23%) enfermedad hipertensiva, en 4 (7%) se aumentó la labor del parto con fármacos, la mayoría 30 (54%) no tuvieron factores asociados. El manejo inicial se realizó con reanimación con cristaloides, el uterotónico más utilizado fue la combinación de oxitocina y prostaglandinas en 20 (36%) pacientes, se realizó manejo quirúrgico en 14 (25%) y ocurrieron 3(5%) muertes por complicaciones asociadas a hemorragia. Conclusiones: La causa más frecuente de hemorragia postparto encontrada en la población de estudio fue el trauma del canal del parto; en su mayoría...

Secular trends in trial of labor and associated neonatal mortality and morbidity in the United States, 1995 to 2002 / 中南大学学报(医学版)

OBJECTIVE@#A proportion of elective repeated cesarean sections where a trial of labor in a uterus with a previous scar was not attempted is on the increase. This study aimed to assess how reduced the use of trial of labor has impacted on neonatal outcomes in the United States.@*METHODS@#Pregnant women with one previous cesarean delivery and a singleton live birth of the index pregnancy were abstracted from the 1995 to 2002 birth registration data of the United States. Adjusted odds ratios for adverse neonatal outcomes of trial of labor were estimated by multiple logistic regression models, in overall study subjects and in the two periods with high and low rates of trial of labor.@*RESULTS@#A total of 1833407 eligible subjects were included in the analysis. Rate of trial of labor after one previous cesarean section dropped from 38.5% in 1995 to 15.0% in 2002. No significant change was observed in the patient population profile. Successful vaginal birth after cesarean delivery (VBAC) also declined from 76.6% in 1995 to 66.0% in 2002. A trial of labor after one previous cesarean section was correlated with increased risks of asphyxia-related neonatal death and neonatal morbidity. This risk was even more pronounced in low risk women and in the last study years with the lowest rate of trial of labor.@*CONCLUSION@#The reduced use of trial of labor after one cesarean delivery in recent years in the United States has actually resulted in increased risk of adverse neonatal outcomes associated with a trial of labor.

Prospective study of delivery after previous one caesarean section at king Hussein medical center

To evaluate the mode of delivery and safety of vaginal delivery in women with previous caesarean section at King Hussein Medical Centre. Three hundred thirty women with previous caesarean sections were enrolled into the study. Age, parity and indication for the previous caesarean sections were recorded. All events of labour were also recorded [mode of delivery, apgar scores, birth weight, and duration of oxytocin and prostaglandin use]. Intrapartum and postpartum complications were recorded Analysis of the rate of vaginal delivery was made in relation to parity and the indication for the previous caesarean section. The mean age of women was 29.2 years [19-45]. One hundred and twenty six [38%] were Para 1. Overall, the vaginal delivery rate was 71% Among women who had one previous caesarean section 62% achieved vaginal delivery. Overall 11.8% of women had an elective caesarean section. The highest vaginal delivery rate was in patients who had caesarean section for breech presentation [74%], followed by fetal distress [68%]. Even in women, where the previous caesarean section was due to failed progress, 55% achieved vaginal delivery. There was one case of ruptured uterus in the vaginal delivery group, which resulted in a perinatal mortality. The mean birth weight was 3.168 for the vaginal delivery group and 3.4 kg for the caesarean section group. Trial of labour alter previous caesarean section can be very successful with vaginal delivery rate reaching 62%. Even when the previous caesarean section was due to failed progress, vaginal delivery was achieved in 55% of cases. Although the risks of vaginal delivery were small in our series, these should not be overlooked when making decisions regarding mode of delivery after previous caesarean section

Vaginal birth after cesarean / 대한산부인과학회지

The American College of Obstetricians and Gynecologists (ACOG) has recommended that the most women with one previous cesarean delivery with a low-transverse incision are candidates for vaginal birth after cesarean and should be counseled about VBAC and offered a trial of labor in the hospital which has physicians immediately available to provide emergency care including cesarean section and personnel familiar with the potential complications of a trial of labor who should be vigilant for nonreassuring fetal heart rate patterns and inadequate progress of labor. The safer VBAC will be provided when the physicians and patients are alert about the risk, benefit and disadvantage of VBAC, and when the reasonable management of the labor is performed. The success of VBAC will contribute to prevent unnecessary primary cesarean and reduce the overall cesarean delivery rate.

Vaginal birth after cesarean / 대한산부인과학회지

The American College of Obstetricians and Gynecologists (ACOG) has recommended that the most women with one previous cesarean delivery with a low-transverse incision are candidates for vaginal birth after cesarean and should be counseled about VBAC and offered a trial of labor in the hospital which has physicians immediately available to provide emergency care including cesarean section and personnel familiar with the potential complications of a trial of labor who should be vigilant for nonreassuring fetal heart rate patterns and inadequate progress of labor. The safer VBAC will be provided when the physicians and patients are alert about the risk, benefit and disadvantage of VBAC, and when the reasonable management of the labor is performed. The success of VBAC will contribute to prevent unnecessary primary cesarean and reduce the overall cesarean delivery rate.

Caesarean section rate: current trends

To determine the rate and analyze indications of caesarean section. Observational study. The study was conducted in Obstetrics and Gynaecology Unit four, Sindh Govt Lyari General Hospital attached to Dow University of Health Sciences from April 2005 till March 2006. All pregnant women booked in antenatal clinic and unbooked patients admitted in early labour on whom caesarean section [CS] was performed, were included in the study. The medical records of all patients were examined to study the socio-demographic variables, nature of procedure and the indication of abdominal delivery. The total number of births during study period were 930 of which 186 patients underwent caesarean section which makes 20% caesarean section rate [CSR] in our unit. Out of 186 CS done, 144 were performed in emergency and 42 as elective cases. The mean age was 30 years and the mean parity was 1.9. Primigravidas were 71[39%], multigravidas 75[40%] and grandmultiparas 40[21%]. Commonest indication for caesarean section was repeat caesarean section. Failed progress of labour was the 2nd commonest indication among the 15% of cases. Obstructed labour and fetal distress were indications in 9.6% of cases. Other indications include breech presentation, ante partum hemorrhage, hypertensive disorders, twin pregnancies and transverse lie. The most effective mean to control increasing CSR is the prevention of first caesarean section which could be achieved by adopting the policy of trial of vaginal birth after previous C-section, selective vaginal breech delivery and regular audit of C-section in the department

Evaluation of the factors affecting the success of the trial of vaginal birth and duration of labor in women with previous cesarean section / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to determine which factors influence the likelihood of successful trial of labor, to evaluate the risks of VBAC and to evaluate the criteria of dystocia and the safety of VBAC. METHODS: This retrospective study was peformed based on 61 pregnant women who succeeded VBAC, 37 VBAC failure women, 100 nulliparas and 100 multiparas. RESULTS: In clinical characteristics, the parity, the number of previous cesarean section, gestational age, estimated fetal body weight by ultrasonography, and neonatal body weight had notable differences between the success and the failure group. In obstetric and historical factors, cervical effacement, dilation, and Bishop score at admission, spontaneous labor and method of induction of labor had differences. Among these factors, estimated fetal body weight by ultrasonography, cervical effacement and augmentation of labor using oxytocin were the most prognostic factors affecting the success of VBAC. In VBAC group, the duration of active-phase, second phase and total duration of labor were 313.5, 36.4 and 350.2 minutes, which were significantly shorter than nulliparas, but longer than multiparas. CONCLUSION: The trial of labor after cesarean section will decrease repeat operation, if it is performed under exact understanding of successful prognostic factors and the unique time length of labor. It will contribute to increase advantages for mother and economic benefits.

Neonatal outcome of vertex-vertex and vertex-nonvertex second twin according to the mode of delivery / 대한산부인과학회지

OBJECTIVE: The purposes of this study were to estimate the success rate of vaginal delivery after trial of labor (TOL) and to analyze the neonatal outcome of vertex-vertex (V-V) and vertex-nonvertex (V-NV) second twin according to the mode of delivery. METHODS: We reviewed retrospectively the medical records of V-V and V-NV twin delivered between December 1996 and February 2006. The patients were classified as TOL group and elective cesarean delivery (ECD) group to compare of the neonatal morbidity and mortality in second twin. Neonatal morbidity included intraventricular hemorrhage, respiratory distress syndrome, disseminated intravascular coagulopathy, sepsis, necrotizing enterocolitis, and birth trauma. Student t-test, Mann-Whtiney U test, Pearson's chi-square, and Fisher's exact were performed for the comparison of the neonatal outcome in second twin according to the groups. RESULTS: There are 349 eligible cases within given period. The proportions of TOL and ECD were 49% (n=170) and 51% (n=179), respectively. The success rates of vaginal delivery after TOL were 75% (n=93) in V-V twin and 70% (n=32) in V-NV twin. There were no significant differences in the neonatal outcome between TOL and ECD group. Additionally there were no significant differences in the neonatal outcome between cesarean delivery after the failure of TOL (n=45) and ECD group. CONCLUSION: Our results suggest that TOL in V-V and V-NV twin may be a safe method and can reduce the rate of ECD without adverse effect on neonatal outcome of second twin unless there are other obstetrical indications for cesarean delivery.

A prova de trabalho e a via de parto em primíparas com uma cesárea anterior / Factors associated with mode of delivery among primipara women with one previous cesarean section and undergoing a trial of labor

OBJETIVO: Identificar fatores associados à cesárea em mulheres com um único parto anterior por cesárea e submetidas à prova de trabalho de parto. MÉTODOS: Estudo de corte transversal retrospectivo, incluindo 1746 mulheres com uma cesárea anterior submetidas à prova de trabalho de parto no segundo parto ocorrendo entre 1986 e 1998. Foram excluídos os casos com atual gestação múltipla e/ou com malformações fetais incompatíveis com a vida. Elas foram divididas pelo tipo de parto atual em dois grupos: cesárea (n=731) e parto vaginal após cesárea (PVAC, n=1015). A análise estatística para a identificação de fatores associados ao tipo de parto foi feita por meio do cálculo da razão de prevalência (RP) e IC 95 por cento, sendo feito também o ajuste por idade, excluindo-se os casos com informações ignoradas em cada análise. RESULTADOS: A taxa total de parto vaginal após cesárea foi de 58,1 por cento. Os fatores significativamente associados com parto por cesárea foram: maior idade materna, maior altura uterina (RP 1,5; IC 95 por cento 1,19-1,88), rotura prematura de membranas (1,3; 1,08-1,54), líquido amniótico não claro (1,22; 1,04-1,43) ou com quantidade alterada (1,32; 1,01-1,73), alteração dos batimentos cardíacos fetais (1,96; 1,68-2,28), apresentação não cefálica (2,03; 1,54-2,66), indução do parto (1,74; 1,42-2,11) e ausência de analgesia (2,57; 2,11-3,11). CONCLUSÃO: Os fatores associados ao parto por cesárea foram a maior idade, apresentação não-cefálica, rotura prematura de membranas, fetos grandes, necessidade de indução do trabalho de parto, e sinais de comprometimento da vitalidade fetal.

OBJECTIVE: To identify factors associated with cesarean section in women with only one previous delivery by cesarean section and undergoing a trial of labor. METHODS: A retrospective cross sectional study was performed from 1986 to 1998 including a total of 1746 women with one prior cesarean section and delivering after a trial of labor. Cases with a current twin pregnancy or with malformation incompatible with life were excluded. Women were divided in two groups according to the mode of the second delivery: Cesarean (n=731) or Vaginal Birth After Cesarean (VBAC, n=1015). To identify factors associated to the mode of delivery, the prevalence ratios (PR) and the 95 percentCI for each isolated factor, adjusted according to age, were assessed. In each analysis, cases with missing information were excluded. RESULTS: The total rate of Vaginal Birth After Cesarean was 58.1 percent. The factors significantly associated with cesarean section were: higher maternal age, greater fundal height (PR 1.5; 95 percentCI 1.19-1.88), premature rupture of membranes (1.3; 1.08-1.54), amniotic fluid with an altered aspect (1.22; 1.04-1.43) or volume (1.32; 1.01-1.73), altered fetal heart rate (1.96; 1.68-2.28), non cephalic presentation (2.03; 1.54-2.66), induction of labor (1.74; 1.42-2.11) and no labor analgesia (2.57; 2.11-3.11). CONCLUSION: The factors associated with cesarean section were older age, non-cephalic presentation, premature rupture of membranes, signs of large fetus, the need of induction of labor and signs of compromised fetal wellbeing.

Vaginal birth after one caesarean section: analysis of indicators of success.

A study was carried out among 81 women with previous one caesarean section (CS) done for non-recurrent indications to confirm the efficacy and safety of trial of labour (TOL) and to examine the effect of various factors on the mode of delivery. Singleton term pregnancy, vertex presentation and adequate pelvic capacity were the pre-requisites for case selection. Careful monitoring was done during labour and effect of various factors on the outcome was analysed statistically. Success rate of TOL was 73%. A non-recurrent indication for previous CS, such as malpresentation and foetal distress is associated with higher success rate of vaginal birth after caesarean (VBAC) compared to recurrent indications, such as cephalopelvic disproportion (CPD) and failure to progress (FTP). Prior vaginal birth improves the success rate (87%) of VBAC. Factors like premature rupture of membranes, hypertensive disorders of pregnancy, and post-date pregnancy did not affect the outcome adversely. Rate of emergency CS was 44% in women with floating head foetus, 39% in induction/augmentation group and 43% when birth weight of the foetus was > 3000 g. No maternal/perinatal mortality observed. Maternal/perinatal morbidity was low in cases with successful TOL. Uterine rupture occurred in one woman. There are few absolute contra-indications to attempted VBAC. Though the success rate does vary with different pre-existing factors, the clinician may anticipate greater than 50% chance for success in any individual labour.

Term prelabor rupture of membranes: management and outcome

To review the management of term prelabour rupture of membranes and its outcome. Interventional and descriptive. Military Hospital Rawalpindi from 10th June 2002 to 9th March 2003. 110 patients including both primigravidas and multigravidas with singleton pregnancy having term prelabour rupture of membranes were recruited by convenience sampling. They did not have any other complicating factor. They were managed according to their Bishop's score either expectantly or actively by inducing them. 64.54% of patients went into spontaneous labour within 24 hours and only 35.45% required active intervention. Deliveries by the vaginal route were 89.2% with 61% normal and 28.20% instrumental. Cesarean section rate was 10.90%, higher in those induced and primigravidas as compared to the expectantly managed and multigravidas. Chorioamnionitis was seen in 5.45% cases, 3.6% developed postpartum fever, 1.8% wound infection with no case of endometritis or neonatal mortality. 43.64% neonates were put on antibiotics but significant infection was seen in 5[4.54]% cases. Both active and expectant management are equally effective with a significant percentage delivering vaginally. However the cesarean rate was higher among the actively managed

Prolapso genital incidencia y casuística: Hospital Naval de Guayaquil 1995-2000 / Incidence of genital prolapse and casuistry: Naval Hospital of Guayaquil 1995-2000

El prolapso es motivo frecuente de consulta para en Ginecología y la mayoría de las mujeres que lo padecen sobrepasan los 50 años.Se realizó un estudio retrospectivo, descriptivo y longitudinal desde 1995 al 2000 en el hospital Naval de Guayaquil.El objetivo: Conocer los factores causales más comunes.Comprobar la importancia de la relación entre los antecedentes gineco-obstétricos y el desarrollo del prolapso genital.Identificar el tipo de tratamiento quirúrgico y las complicaciones que se presentaron al momento de la resolución en las pacientes internadas en el hospital Naval de Guayaquil (HOSNAV).Se encontraron 65 casos en el estudio de 6 años, la edad media de presentación fue 57 años 8 meses, se demostró que mientras más se acerquen a la etapa del climaterio, la incidencia de prolapso genital aumenta en forma proporcional. El factor causal que se relaciona al desarrollo de prolapsos es la multiparidad y los partos distócicos.

Prolapse is frequent reason of consultation to the gynecologist and most common in women over 50 years. We carried out a retrospective, descriptive and longitudinal study between the years of 1995 to 2000 in the Naval Hospital of Guayaquil with the objective of finding out the most common risk factors, to check the importance of the relationship between the Gynecologic clinical history and the development of the genital prolapse, and to identify the type of surgical treatment and the complications that were presented.There were 65 cases in the 6 year-old study, the age of presentation was 57 years 8 months, it was demonstrated that while more they come closer to the stage of the climaterium, the incidence of genital prolapse increased. The risk factor that is related to the development of prolapse is the multiparty and the distosic childbirths.

Obstetric out come of cases referred to a tertiary care hospital after trial of labour

Childbirth is a natural process but with its' inherent risk of complications. Skilled birth attendant can provide timely emergency obstetrics services. Objective of this study was to analyze fetomaternal outcome of cases referred to our hospital after trial of labour and to identify factors, which could prevent adverse obstetric outcome. This study was conducted at Obstetrics and Gynae Unit II Sir Ganga Ram hospital, Lahore. One hundred patients who were admitted through emergency after trial of labour by TBA, LHV or doctors at home or private clinics were analyzed for fetomaternal outcome. Out of hundred patients in study group 49 were Primigravida while 10 were grandmulti. About 90% of patients never had any antenatal checkup. Maximum patients [94%] were under care of TBA and LHV. 54 patients had already prolong labour out of which 38 cases were of obstructed labour. Five patients had ruptured uterus. 49 patients were delivered by caesarean section while 29 had forceps delivery. Laparotomy was carried out in four patients due to ruptured uterus out of which two had hysterectomy. There was one maternal death due to ruptured uterus. Post partum hemorrhage occurred in ten patients, while 12 had puerperal pyrexia. Regarding perinatal outcome there were 23 stillbirths, while 45 had Apgar score below 5 at five minutes. Ten babies died in first 12 hours. This study concludes that complications of labour if not timely diagnosed and rectified results in adverse fetomaternal outcome. Provision of skilled birth attendant at doorstep will be an ideal solution