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1.
Acta Obstet Gynecol Scand ; 99(10): 1403-1410, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32320475

RESUMO

INTRODUCTION: The present study aimed first to investigate the change in prevalence of major levator ani muscle (LAM) defects, also called avulsions, from 6 weeks to 1 year postpartum, and second to assess maternal and obstetric risk factors for having persistent major LAM defects/avulsions at 1 year postpartum. MATERIAL AND METHODS: This is a secondary analysis of data from a prospective cohort study including 300 nulliparous women at 17-19 weeks of gestation. Major LAM defects were diagnosed at 6 weeks and 1 year postpartum using transperineal ultrasonography. We defined persistent major LAM defects as a defect diagnosed both at 6 weeks and 1 year postpartum. Maternal and obstetric data were obtained from the hospital's electronic birth records. Pelvic floor muscle function was measured vaginally by manometer at 21 weeks of gestation. The main outcome measurement was change in prevalence of major LAM defects. Maternal and obstetric risk factors for having persistent major LAM defect were also assessed. RESULTS: Prevalence of major LAM defects was 19.4% at 6 weeks and 10.4% at 1 year postpartum. No new major LAM defects were diagnosed at 1 year postpartum. Persisting major LAM defects were associated with longer second stage of labor (median 74.5 minutes vs median 48.0 minutes, P = .012) and higher neonatal birthweight (mean difference of 232.3 g, 95% confidence interval [CI] 21.5-443.1). Vacuum delivery was independently associated with persistent major LAM defects, adjusted OR 3.0 (95% CI 1.0-9.0). CONCLUSIONS: There was a 50% reduction of sonographically diagnosed major LAM defects from 6 weeks to 1 year postpartum. This finding suggests that assessment of the major LAM 6 weeks postpartum may be too early to diagnose defects/avulsions. Long second stage of labor, high neonatal birthweight and vacuum delivery were associated with persistent major LAM defects/avulsions.


Assuntos
Diafragma da Pelve/diagnóstico por imagem , Diafragma da Pelve/lesões , Período Pós-Parto , Adulto , Peso ao Nascer , Distocia/epidemiologia , Feminino , Humanos , Recém-Nascido , Segunda Fase do Trabalho de Parto , Estudos Longitudinais , Noruega/epidemiologia , Gravidez , Prevalência , Fatores de Risco , Ultrassonografia , Vácuo-Extração/efeitos adversos
2.
Int J Gynaecol Obstet ; 150(1): 64-71, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32301113

RESUMO

OBJECTIVE: To evaluate whether treatment of slow labor progress among term nulliparous women using a 2-hour partograph action line reduces the incidence of prolonged labor versus a 4-hour action line. METHODS: Randomized controlled trial of nulliparous women with a term singleton, non-macrosomic, cephalic fetus in labor attending a university hospital in Nigeria (2008-2015). For labor supervision, women were randomly assigned to the 2-hour (n=320) or 4-hour (n=320) partograph action line group. slow labor progress was treated with oxytocin augmentation The primary outcome was incidence of prolonged labor (>12 hours). Delivery mode, neonatal outcomes, and maternal satisfaction with treatment were secondary outcomes. RESULTS: Prolonged labor rate did not significantly differ between the 2-hour (7/320, 2.2%) and 4-hour (8/320, 2.5%) action line groups. Secondary outcomes did not differ significantly. Oxytocin augmentation to treat slow labor progress was needed for 87 (27.2%) and 61 (19.1%) women in the respective 2- and 4-hour groups (P=0.025). Mean duration of first and second labor stages differed significantly between the groups (P<0.05). CONCLUSION: The 2-hour partograph action line did not reduce incidence of prolonged labor relative to the 4-hour action line. Partograph with a 4-hour action line is recommended for labor supervision in all facilities. CLINICAL TRIAL REGISTRATION: Registered at ClinicalTrials.gov as (https://clinicaltrialsgov/show/NCT02911272).


Assuntos
Distocia/tratamento farmacológico , Trabalho de Parto/efeitos dos fármacos , Ocitocina/uso terapêutico , Adulto , Parto Obstétrico/estatística & dados numéricos , Distocia/epidemiologia , Feminino , Humanos , Nigéria/epidemiologia , Satisfação do Paciente , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Prospectivos , Fatores de Tempo
3.
PLoS One ; 15(2): e0228856, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32040542

RESUMO

INTRODUCTION: Obstructed labour (OL) is an important clinical and public health problem because of the associated maternal and perinatal morbidity and mortality. Risk factors for OL and its associated obstetric squeal are usually context specific. No epidemiological study has documented the risk factors for OL in Eastern Uganda. This study was conducted to identify the risk factors for OL in Mbale Hospital. OBJECTIVE: To identify the risk factors for OL in Mbale Regional Referral and Teaching Hospital, Eastern Uganda. METHODS: We conducted a case control study with 270 cases of women with OL and 270 controls of women without OL. We consecutively enrolled eligible cases between July 2018 and February 2019. For each case, we randomly selected one eligible control admitted in the same 24-hour period. Data was collected using face-to-face interviews and a review of patient notes. Logistic regression was used to identify the risk factors for OL. RESULTS: The risk factors for OL were, being a referral from a lower health facility (AOR 6.80, 95% CI: 4.20-11.00), prime parity (AOR 2.15 95% CI: 1.26-3.66) and use of herbal medicines in active labour (AOR 2.72 95% CI: 1.49-4.96). Married participants (AOR 0.59 95% CI: 0.35-0.97) with a delivery plan (AOR 0.56 95% CI: 0.35-0.90) and educated partners (AOR 0.57 95% CI: 0.33-0.98) were less likely to have OL. In the adjusted analysis, there was no association between four or more ANC visits and OL, adjusted odds ratio [(AOR) 0.96 95% CI: 0.57-1.63)]. CONCLUSIONS: Prime parity, use of herbal medicines in labour and being a referral from a lower health facility were identified as risk factors. Being married with a delivery plan and an educated partner were protective of OL. Increased frequency of ANC attendance was not protective against obstructed labour.


Assuntos
Distocia/epidemiologia , Adulto , Estudos de Casos e Controles , Distocia/etiologia , Feminino , Humanos , Modelos Logísticos , Razão de Chances , Gravidez , Fatores de Risco , Uganda/epidemiologia , Adulto Jovem
4.
J Dairy Sci ; 102(12): 11428-11438, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31548074

RESUMO

The objectives of this study were to evaluate postpartum serum calcium dynamics for different parity groups of dairy cows and to assess whether serum calcium concentration on d 0, 1, and 3 postpartum was associated with the risk of developing acute puerperal metritis (APM). The study took place on a commercial dairy farm in northern Germany and included 4,043 Holstein dairy cows. Calving difficulties, such as dystocia, twins, or stillbirth, were recorded. Blood samples were obtained on d 0, 1, and 3 after calving for analysis of serum calcium concentration. Animals were examined daily for clinical symptoms of retained placenta, APM, mastitis, and displaced abomasum until 10 d in milk. To determine serum calcium dynamics postpartum, we performed repeated-measures ANOVA with first-order autoregressive covariance. A logistic regression model was used to evaluate the association of serum calcium concentration with the risk of developing metritis. Serum calcium concentration was affected by time relative to calving, parity, and APM. Increasing parity negatively affected serum calcium concentration on d 0 and 1. Serum calcium concentration reached its lowest level on d 1 and 3 in multiparous and primiparous cows, respectively. The concentration increased from d 1 to 3 in multiparous cows and decreased from d 0 to 3 in primiparous cows. The association of APM and serum calcium dynamics varied by parity. On d 3, serum calcium concentration was significantly lower in animals with subsequent APM than in those without APM. The overall incidence of APM was 12.0% (primiparous cows, 20.4%; multiparous cows, 8.6%). An association existed between serum calcium concentration on d 3 after calving and APM. Primiparous cows had an odds ratio of 0.12 for serum calcium concentration on d 3, indicating that a primiparous cow with serum calcium concentration of 2.5 mmol/L had a 88% lower chance of developing APM compared with a cow with a concentration of 1.5 mmol/L. Multiparous cows had an odds ratio of 0.34 for serum calcium concentration on d 3, indicating that a multiparous cow with serum calcium concentration of 2.5 mmol/L had a 66% lower chance of developing APM compared with a cow with a concentration of 1.5 mmol/L. Primiparous cows with low serum calcium concentration had the highest predicted probability of developing APM. Our results reveal a dynamic in serum calcium concentration in the first 3 d in milk. Consequently, the day of sampling and the observed risk period for hypocalcemia are important when conducting epidemiological studies to evaluate associations between hypocalcemia and clinical diseases.


Assuntos
Cálcio na Dieta/farmacocinética , Cálcio/sangue , Doenças dos Bovinos/epidemiologia , Distocia/veterinária , Hipocalcemia/veterinária , Leite/química , Placenta Retida/veterinária , Doenças Uterinas/veterinária , Animais , Bovinos , Distocia/epidemiologia , Feminino , Alemanha , Hipocalcemia/epidemiologia , Lactação , Paridade , Período Pós-Parto , Gravidez , Doenças Uterinas/epidemiologia
5.
Acta Obstet Gynecol Scand ; 98(12): 1603-1611, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31329281

RESUMO

INTRODUCTION: Cancer treatment during childhood may lead to late adverse effects, such as reduced musculoskeletal development or vascular, endocrine and pulmonary dysfunction, which in turn may have an adverse effect on later pregnancy and childbirth. The aim of the present study was to investigate pregnancy and obstetric outcomes as well as the offspring's health among childhood and adolescent female cancer survivors. MATERIAL AND METHODS: This register-based study included all women born between 1973 and 1977 diagnosed with cancer in childhood or adolescence (age <21), as well as an age-matched comparison group. A total of 278 female cancer survivors with their first childbirth were included in the study, together with 829 age-matched individuals from the general population. Logistic regression and analysis of variance were used to investigate associations between having been treated for cancer and the outcome variables, adjusting for maternal age, nicotine use and comorbidity. RESULTS: Survivors were more likely to have preeclampsia (adjusted odds ratio [aOR] 3.46, 95% confidence interval [CI] 1.58 to 7.56), undergo induction of labor (aOR 1.66, 95% CI 1.05 to 2.62), suffer labor dystocia (primary labor dystocia aOR 3.54, 95% CI 1.51 to 8.34 and secondary labor dystocia aOR 2.43, 95% CI 1.37 to 4.31), malpresentation of fetus (aOR 2.02, 95% CI 1.12 to 3.65) and imminent fetal asphyxia (aOR 2.55, 95% CI 1.49 to 4.39). In addition, deliveries among survivors were more likely to end with vacuum extraction (aOR 2.53, 95% CI 1.44 to 4.47), with higher risk of clitoral lacerations (aOR 2.18, 95% CI 1.47 to 3.23) and anal sphincter injury (aOR 2.76, 95% CI 1.14 to 6.70) and emergency cesarean section (aOR 2.34 95% CI 1.39 to 3.95). Survivors used pain-reliving methods to a higher extent compared with the comparison group. There was no increased risk of neonate diagnoses and malformations. The results showed that survivors who had been diagnosed with cancer when they were younger than 14 had an increased risk of adverse obstetric outcomes. CONCLUSIONS: The study demonstrates increased risk of pregnancy and childbirth complications among childhood and adolescent cancer survivors. There is a need to optimize perinatal care, especially among survivors who were younger than 14 at time of diagnosis.


Assuntos
Sobreviventes de Câncer/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Distocia/epidemiologia , Lacerações/epidemiologia , Pré-Eclâmpsia/epidemiologia , Adolescente , Adulto , Canal Anal/lesões , Estudos de Casos e Controles , Cesárea/estatística & dados numéricos , Criança , Pré-Escolar , Clitóris/lesões , Feminino , Humanos , Apresentação no Trabalho de Parto , Trabalho de Parto Induzido/estatística & dados numéricos , Gravidez , Sistema de Registros , Suécia/epidemiologia , Vácuo-Extração/estatística & dados numéricos , Adulto Jovem
6.
Pan Afr Med J ; 32: 160, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31303929

RESUMO

Introduction: Vaginismus is a severe dysfunction and a problem which can interfere with woman's and couple's sex life. It may influence the obstetric outcome. This study aims to determine if the clinical features of vaginismus can impact childbirth experience. Methods: We conducted a retrospective multicenter study involving patients affected by primary vaginismus, having given birth to their first child (who had reached term), between 2005 and 2015. Results: Out of 19 patients included in the study, 9 had prolonged pregnancies, 14 had spontaneous labor (including 8 at term), 3 had cesarean section before going into labor and 2 had labor induction. Among the 16 women who experienced labor, 4 had cesarean section, 5 had vaginal delivery with the help of forceps and 7 had spontaneous vaginal delivery. Among the 12 women who had vaginal delivery, 9 underwent episiotomy, 7 had spontaneous perineal tear alone or in combination with episiotomy. No 3rd and 4th degree perineal injury or intact perineum were found. The average birth weight for babies was 3380 g ± 332 (2870 g-3970g, 47th percentile). Conclusion: The rates of labour dystocia and perineal morbidity were significantly high. These data were comparable to most of the data in the literature. It is likely that the psychological and behavioral aspects of vaginismus (fear-avoidance and anxiety-inducing mechanism) have favoured prolonged pregnancies, cesarean sections, mechanical dystocias and perineal injuries. Additional studies are necessary to better identify vaginismus and its obstetrical implications.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Resultado da Gravidez , Gravidez Prolongada/epidemiologia , Vaginismo/complicações , Adulto , Cesárea/estatística & dados numéricos , Distocia/epidemiologia , Episiotomia/estatística & dados numéricos , Feminino , Humanos , Períneo/lesões , Gravidez , Estudos Retrospectivos , Adulto Jovem
7.
J Forensic Leg Med ; 66: 44-49, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31220788

RESUMO

BACKGROUND: Today even low incidence of complications for mothers or neonates during pregnancy, delivery or postpartum is unacceptable to the public and can result in claims because of greater expectation from patients and an increase in media coverage. The present study was conducted to investigate the reasons for medical malpractice claims on maternal and neonatal impairment, which are achieved in Iranian Legal Medicine Organization councils. MATERIALS AND METHODS: The present cross-sectional and retrospective study used convenience sampling to collect data of total claims from 31 provinces archived in the supreme council of the ILMO in 2 years. In this article, the medical malpractice claims on maternal and neonatal impairment during pregnancy, labour, delivery and early postpartum were reported. The data were collected through a validated researcher-made checklist and were analyzed in SPSS 16. RESULTS: Among total of 299 cases of impairment, cerebral palsy (33.34%), Erb's palsy due to shoulder dystocia (24.24%) and Down Syndrome (24.24%) were the main confirmed causes of malpractice for neonatal impairment and Retained Surgical Mass (20.5%), Salpingectomy and/or Oophorectomy Related to EP (17.2%), Hysterectomy (17.2%) and Episiotomy Related complication (17.2%) were the main confirmed causes of malpractice for maternal impairment. CONCLUSION: Considering this fact that medical malpractice was confirmed in a large proportion of some preventable and important complications, therefore, results of this study can be used for developing educational programs for related healthcare providers to prevent those complications.


Assuntos
Parto Obstétrico/efeitos adversos , Imperícia/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Adulto , Neuropatias do Plexo Braquial/epidemiologia , Paralisia Cerebral/epidemiologia , Estudos Transversais , Síndrome de Down/epidemiologia , Distocia/epidemiologia , Feminino , Corpos Estranhos/epidemiologia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Humanos , Recém-Nascido , Irã (Geográfico)/epidemiologia , Enfermeiras Obstétricas/estatística & dados numéricos , Obstetrícia , Gravidez , Estudos Retrospectivos , Amostragem
8.
Taiwan J Obstet Gynecol ; 58(3): 380-384, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31122529

RESUMO

OBJECTIVE: Currently, there is paucity of data on the rate of vaginal deliveries and cesarean section among women in Tibet. In this study, we carried out an observational study of 7365 consecutive pregnant women in Lhasa, Tibet who gave birth at our tertiary care institution between 2012 and 2015. MATERIALS AND METHODS: In this retrospective study, we reviewed the hospital records for demographic data, obstetric history, and the number of vaginal and emergency cesarean section deliveries. The overall and annual rate of vaginal and cesarean section deliveries was calculated. Causes, indications or risks for cesarean section were also analyzed. RESULTS: During the review period, 7365 neonates were delivered at our hospital, including 1690 (23.0%) deliveries via cesarean section. The yearly rate of cesarean section progressively declined from 26.7% in 2012 to 18% in 2015 (P < 0.001). Furthermore, the annual rate of emergency cesarean section declined 53.9%between 2012 and 2015(P < 0.001). Fetal risk factors (39.9%) and maternal risk factors (40.3%) were the major causes of cesarean section in the women. Social factors as a cause of cesarean section fluctuated between 7.9% and 11.1%. CONCLUSION: This study has demonstrated a steady decline in the annual rate of cesarean section in women in Tibet between 2012 and 2015. A decrease in the rate of emergency cesarean section contributed substantially to this decline. Moreover, approximately 10% caesarian sections were performed without clear indications, highlighting the need for strengthening prenatal counseling for pregnant women in Tibet.


Assuntos
Cesárea/estatística & dados numéricos , Distribuição por Idade , Altitude , Distocia/epidemiologia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Sofrimento Fetal/epidemiologia , Humanos , Gravidez , Prevalência , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , Centros de Atenção Terciária/estatística & dados numéricos , Tibet/epidemiologia
9.
Ann Glob Health ; 85(1)2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30951271

RESUMO

BACKGROUND: Abdominal operations account for a majority of surgical volume in low-income countries, yet population-level prevalence data on surgically treatable abdominal conditions are scarce. OBJECTIVE: In this study, our objective was to quantify the burden of surgically treatable abdominal conditions in Uganda. METHODS: In 2014, we administered a two-stage cluster-randomized Surgeons OverSeas Assessment of Surgical Need survey to 4,248 individuals in 105 randomly selected clusters (representing the national population of Uganda). FINDINGS: Of the 4,248 respondents, 185 reported at least one surgically treatable abdominal condition in their lifetime, giving an estimated lifetime prevalence of 3.7% (95% CI: 3.0 to 4.6%). Of those 185 respondents, 76 reported an untreated condition, giving an untreated prevalence of 1.7% (95% CI: 1.3 to 2.3%). Obstructed labor (52.9%) accounted for most of the 238 abdominal conditions reported and was untreated in only 5.6% of reported conditions. In contrast, 73.3% of reported abdominal masses were untreated. CONCLUSIONS: Individuals in Uganda with nonobstetric abdominal surgical conditions are disproportionately undertreated. Major health system investments in obstetric surgical capacity have been beneficial, but our data suggest that further investments should aim at matching overall surgical care capacity with surgical need, rather than focusing on a single operation for obstructed labor.


Assuntos
Traumatismos Abdominais/epidemiologia , Dor Abdominal/epidemiologia , Cesárea/estatística & dados numéricos , Distocia/epidemiologia , Hérnia/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Traumatismos Abdominais/cirurgia , Dor Abdominal/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Países em Desenvolvimento , Distocia/cirurgia , Status Econômico , Medo , Feminino , Acesso aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Herniorrafia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Gravidez , Prevalência , Melhoria de Qualidade , Apoio Social , Transportes , Confiança , Uganda/epidemiologia , Adulto Jovem
10.
Ginekol Pol ; 90(12): 711-716, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31909465

RESUMO

OBJECTIVES: This study analyzed the changes of vaginal forceps delivery rate in Jiading Maternal and Child Health Hospital in the past 10 years in order to provide theoretical reference for reducing the rate of cesarean section and solving cephalic dystocia. MATERIAL AND METHODS: The basic information, delivery means and vaginal forceps indication of 78,811 parturients who gave birth in our hospital between January 1, 2009 to December 31, 2018 were analyzed retrospectively, and statistical analysis was carried out by analysis of variance and Chi-square test. RESULTS: In the past 10 years, there was a significant difference in the rate of vaginal forceps use among different years (p < 0. 05). With 2014 as the turning point, the rate of forceps use increased the fastest, from 0.7% in 2013 to 3.3% in 2016. The main indications of forceps increased use in our hospital from high to low were fetal distress, abnormal occipital position, prolongation of the second stage of labor and shortening of the second stage of labor. And there was significant difference among different years (p < 0.000). Although there was no significant difference among the years of labor forceps use in patients with prolonged second stage of labor and abnormal occipital position (p > 0.05), the proportion of forceps delivery in the second stage of labor was gradually decreased with 2014 as the dividing line. Although there was significant difference among the patients who shortened the second stage of labor (X2 = 23,886, p < 0.01), it ranked fourth all the time. CONCLUSIONS: In the past 10 years, the rate of forceps use has been on the rise. With the implementation of the new stage of labor and painless delivery in 2014, vaginal forceps have become the main means to solve the problem of cephalic dystocia.


Assuntos
Parto Obstétrico , Distocia , Sofrimento Fetal , Forceps Obstétrico , Utilização de Procedimentos e Técnicas , Adulto , China/epidemiologia , Parto Obstétrico/instrumentação , Parto Obstétrico/métodos , Parto Obstétrico/tendências , Distocia/epidemiologia , Distocia/terapia , Feminino , Sofrimento Fetal/epidemiologia , Sofrimento Fetal/terapia , Humanos , Apresentação no Trabalho de Parto , Segunda Fase do Trabalho de Parto , Gravidez , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Utilização de Procedimentos e Técnicas/tendências
11.
J Matern Fetal Neonatal Med ; 32(2): 198-202, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28866958

RESUMO

OBJECTIVE: The objective of this study is to investigate whether an abnormal birthweight at term, either small for gestational age (SGA, < 5th centile for gestational age) or large for gestational age (LGA, > 95th centile for gestational age), is a risk factor for perinatal complications as compared with birthweight appropriate for gestational age (AGA). METHODS: A population-based retrospective cohort analysis of all singleton pregnancies delivered between 1991 and 2014 at Soroka Medical Center. Congenital malformations and multiple pregnancies were excluded. A multivariable generalized estimating equation regression model was used to control for maternal clusters and other confounders. RESULTS: During the study period, 228,242 births met the inclusion criteria, of them 91% were AGA (n = 207,652), 4.7% SGA, and 4.3% LGA. SGA significantly increased the risk for perinatal mortality (aOR 5.6, 95%CI 4.5-6.8) and low 5-min Apgar scores (aOR 2.2, 95%CI 2.0-2.4), while LGA did not. SGA and LGA were both significant risk factors for cesarean delivery. LGA was significantly associated with shoulder dystocia and post-partum hemorrhage (aOR =13.6, 95%CI 10.9-17.0, and aOR 1.7, 95%CI 1.2-2.6, respectively). CONCLUSIONS: Extreme birthweights at term are significantly associated with adverse maternal and neonatal outcomes. As opposed to SGA, LGA is not independently associated with perinatal mortality.


Assuntos
Peso ao Nascer/fisiologia , Macrossomia Fetal/epidemiologia , Recém-Nascido Pequeno para a Idade Gestacional , Resultado da Gravidez/epidemiologia , Adulto , Distocia/epidemiologia , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Mortalidade Perinatal , Gravidez , Estudos Retrospectivos , Nascimento a Termo/fisiologia , Adulto Jovem
12.
JBI Database System Rev Implement Rep ; 17(2): 170-208, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30299344

RESUMO

OBJECTIVE: The objective of this review was to identify, assess and synthesize the best available evidence on the effects of induction prior to post-term on the mother and fetus. Maternal and fetal outcomes after routine labor induction in low-risk pregnancies at 41+0 to 41+6 gestational weeks (prior to post-term) were compared to routine labor induction at 42+0 to 42+6 gestational weeks (post-term). INTRODUCTION: Induction of labor when a pregnancy exceeds 14 days past the estimated due date has long been used as an intervention to prevent adverse fetal and maternal outcomes. Over the last decade, clinical procedures have changed in many countries towards earlier induction. A shift towards earlier inductions may lead to 15-20% more inductions. Given the fact that induction as an intervention can cause harm to both mother and child, it is essential to ensure that the benefits of the change in clinical practice outweigh the harms. INCLUSION CRITERIA: This review included studies with participants with expected low-risk deliveries, where both fetus and mother were considered healthy at inclusion and with no known risks besides the potential risk of the ongoing pregnancy. Included studies evaluated induction at 41+1-6 gestational weeks compared to 42+1-6 gestational weeks. Randomized control trials (n = 2), quasi-experimental trials (n = 2), and cohort studies (n = 3) were included. The primary outcomes of interest were cesarean section, instrumental vaginal delivery, low Apgar score (≤ 7/5 min.), and low pH (< 7.10). Secondary outcomes included additional indicators of fetal or maternal wellbeing related to prolonged pregnancy or induction. METHODS: The following information sources were searched for published and unpublished studies: PubMed, CINAHL, Embase, Scopus, Swemed+, POPLINE; Cochrane, TRIP; Current Controlled Trials; Web of Science, and, for gray literature: MedNar; Google Scholar, ProQuest Nursing & Allied Health Source, and guidelines from the Royal College of Obstetricians and Gynaecologists, and American College of Obstetricians and Gynecologists, according to the published protocol. In addition, OpenGrey and guidelines from the National Institute for Health and Care Excellence, World Health Organization, and Society of Obstetricians and Gynaecologists of Canada were sought. Included papers were assessed by all three reviewers independently using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). The standardized data extraction tool from JBI SUMARI was used. Data were pooled in a statistical meta-analysis model using RevMan 5, when the criteria for meta-analysis were met. Non-pooled results were presented separately. RESULTS: Induction at 41+0-6 gestational weeks compared to 42+0-6 gestational weeks was found to be associated with an increased risk of overall cesarean section (relative risk [RR] = 1.11, 95% confidence interval [CI] 1.09-1.14), cesarean section due to failure to progress (RR = 1.43, 95% CI 1.01-2.01), chorioamnionitis (RR = 1.13, 95% CI 1.05-1.21), labor dystocia (RR = 1.29, 95% CI 1.22-1.37), precipitate labor (RR = 2.75, 95% CI 1.45-5.2), uterine rupture (RR = 1.97, 95% CI 1.54-2.52), pH < 7.10 (RR = 1.9, 95% CI 1.48-2.43), and a decreased risk of oligohydramnios (RR = 0.4, 95% CI 0.24-0.67) and meconium stained amniotic fluid (RR = 0.82, 95% CI 0.75-0.91). Data lacked statistical power to draw conclusions on perinatal death. No differences were seen for postpartum hemorrhage, shoulder dystocia, meconium aspiration, 5-minute Apgar score < 7, or admission to neonatal intensive care unit. A policy of awaiting spontaneous onset of labor until 42+0-6 gestational weeks showed, that approximately 70% went into spontaneous labor. CONCLUSIONS: Induction prior to post-term was associated with few beneficial outcomes and several adverse outcomes. This draws attention to possible iatrogenic effects affecting large numbers of low-risk women in contemporary maternity care. According to the World Health Organization, expected benefits from a medical intervention must outweigh potential harms. Hence, our results do not support the widespread use of routine induction prior to post-term (41+0-6 gestational weeks).


Assuntos
Cesárea/estatística & dados numéricos , Parto Obstétrico/instrumentação , Trabalho de Parto Induzido/efeitos adversos , Serviços de Saúde Materna/normas , Adulto , Índice de Apgar , Estudos de Casos e Controles , Corioamnionite/epidemiologia , Distocia/epidemiologia , Feminino , Feto , Idade Gestacional , Humanos , Recém-Nascido , Trabalho de Parto Induzido/métodos , Trabalho de Parto , Síndrome de Aspiração de Mecônio/epidemiologia , Pessoa de Meia-Idade , Oligo-Hidrâmnio/epidemiologia , Morte Perinatal/prevenção & controle , Gravidez , Resultado da Gravidez , Ruptura Uterina/epidemiologia
13.
J Matern Fetal Neonatal Med ; 32(16): 2674-2679, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29478363

RESUMO

OBJECTIVE: The current study aims to evaluate a simple method for sonographic measurement of the fetal biacromial diameter for prediction of fetal macrosomia in term pregnancy. MATERIALS AND METHODS: The current study was a single center prospective observational study conducted in a tertiary University Hospital from January 2015 to May 2017. We included all consecutive term (37-42 weeks) pregnant women presented to the labor ward for delivery. Ultrasound parameters were measured as biparietal diameter, head circumference, transverse thoracic diameter, mid arm diameter, abdominal circumference, femur length, estimated fetal weight, and amniotic fluid index. The proposed ultrasound formula "Youssef's formula" to measure the fetal biacromial diameter is: [Transverse thoracic diameter +2 × midarm diameter]. The accuracy of proposed formula was compared to the actual biacromial diameter of the newborn after delivery. The primary outcome of the study was accuracy of sonographic measurement of fetal biacromial diameter in prediction of fetal macrosomia in terms of sensitivity and specificity Results: The study included 600 participants; 49 (8.2%) of them delivered a macrosomic neonates and 551 (91.8%) delivered average weight neonates. There was no statistical significant difference between the proposed fetal biacromial diameter measured by ultrasound and the actual neonatal biacromial diameter measured after birth (p = .192). The area under the curve (AUC) for prediction of macrosomia at birth based on the fetal biacromial diameter and the abdominal circumference was 0.987 and 0.989, respectively, on receiver operating characteristic (ROC) curve analysis. Using the biacromial diameter cutoff of 15.4 cm has a PPV for prediction of macrosomia (88.4%) and 96.4% sensitivity with overall accuracy of 97%. Similarly, with the abdominal circumference (AC) cutoff of 35.5 cm, the PPV for prediction of macrosomia (87.7%) and 96.4% sensitivity with overall accuracy of 96.83%. No statistical significant difference between both of them was observed for prediction of fetal macrosomia (p = .841) Conclusions: The sonographic measurement of fetal biacromial diameter seems to be a new simple and accurate method for prediction of fetal macrosomia and shoulder dystocia at birth.


Assuntos
Braço/diagnóstico por imagem , Macrossomia Fetal/diagnóstico , Peso Fetal , Tórax/diagnóstico por imagem , Adulto , Peso ao Nascer , Distocia/diagnóstico , Distocia/epidemiologia , Feminino , Macrossomia Fetal/epidemiologia , Humanos , Valor Preditivo dos Testes , Gravidez , Estudos Prospectivos , Nascimento a Termo , Ultrassonografia Pré-Natal , Adulto Jovem
14.
Acta Vet Hung ; 66(4): 613-624, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30580537

RESUMO

The authors monitored the postpartum period during the first seven weeks after calving at a Holstein-Friesian dairy farm in Hungary. Calvings occurred between 2013 and 2015 in three periods from June to November each year (n = 314). Data were collected from the farm record and ultrasonographic examinations were performed between 22 to 28 and 43 to 49 days in milk (DIM), respectively. The animals were followed until successful artificial insemination (AI), i.e. until becoming pregnant or until culling, but at most at 365 DIM. The prevalence of dystocia, twin calving, stillbirth rate and retained fetal membranes (RFM) was 23.2%, 3.8%, 3.5%, and 34.4%, respectively. Altogether 38.9% of the cows (n = 122) had bacterial complications of involution in the first 49 DIM. The prevalence of Grade 2 clinical (puerperal) metritis (CM) was 20.1% within 5 DIM, 10.5% between 6 to 10 DIM and 13.1% from 11 to 20 DIM, while 9.9% of the cows had clinical endometritis (CEM) between 21 and 28 DIM and 1.3% of the cows between 42 and 49 DIM, respectively. Pyometra was diagnosed in 1% of the cows between 21 and 28 DIM and 0.3% between 42 to 49 DIM, respectively. About 80% (80.6%) of the cows were inseminated at least once (n = 253). The success rate of the first AI was 26.9% (n = 68). Dystocia, twin calving, RFM, CM, CEM and cyclicity had no significant effect on the days between calving and first AI, however, according to the Kaplan-Meier analysis stillbirth significantly increased the number of days from calving to first AI (P = 0.039). According to the Kaplan- Meier analysis dystocia, twin calving, stillbirth, RFM, and cyclicity had no effect on the days open. In cows with CM developed within 5 DIM or with CEM diagnosed between 21 and 28 DIM the number of days open significantly decreased (P = 0.009 and P = 0.007, respectively), which confirms the importance of early diagnosis and treatment of uterine diseases. Similar surveys should be conducted to discover the risk factors for reproductive diseases in order to decrease the reproductive losses in dairy farms.


Assuntos
Doenças dos Bovinos/epidemiologia , Inseminação Artificial/veterinária , Complicações na Gravidez/veterinária , Prenhez , Animais , Bovinos , Doenças dos Bovinos/fisiopatologia , Distocia/epidemiologia , Distocia/fisiopatologia , Distocia/veterinária , Feminino , Hungria/epidemiologia , Incidência , Período Pós-Parto , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/fisiopatologia , Prenhez/fisiologia , Prevalência
15.
J Dairy Sci ; 101(11): 10283-10289, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30197149

RESUMO

Dystocia and perinatal calf mortality cause significant economic losses in the dairy cattle industry. Despite advanced ultrasound examination procedures, there is no reliable method to estimate the birth weight of calves in order to predict, prepartum, the risk of dystocia. The aim of this study was to predict calf birth weight and dystocia based on transrectal ultrasonographic (TRUS) examinations in late-term Holstein heifers and cows. Therefore, TRUS examination was performed on 128 animals that were between 265 and 282 d of gestation to measure the bone thickness of the fetal metacarpus (MC) or metatarsus (MT). Fetal TRUS measurements were successful in 104 cases. Excluding twin deliveries, 97 fetal MC/MT bone thicknesses were measured and the mean (±SD) MC/MT thickness was 2.54 ± 0.37 cm. A novel index, the metacarpal/metatarsal index [MCTI = maternal body weight (kg)/fetal MC or MT thickness (cm)], was also calculated to study its association with calving ease. The average MCTI was 257.3 kg/cm in the studied population. A lower MCTI was associated with the risk of dystocia with an odds ratio of 2.074 that was not significantly different from 1 (95% confidence interval: 0.002-11.104). Fetal presentation, fetal age, fetal sex, body condition score of the dam, age of dam, and intercoxal and interischiadic distances were not related to dystocia. A fair phenotypic correlation (0.226) was found between MC/MT thickness and calf birth weight. The genetic correlation between MC/MT thickness and calf birth weight was 0.235. Our results indicate that late-term measurement of the fetal MC/MT bone thickness by means of TRUS examination augmented with the MCTI may have clinical significance in the prediction of dystocia in Holstein cattle. Because the odds ratio for dystocia based on MCTI determination was not significant, the applied technique should be improved based on further studies on prepartum TRUS examinations combined with dam pelvic measurements.


Assuntos
Doenças dos Bovinos/epidemiologia , Distocia/veterinária , Animais , Animais Recém-Nascidos , Peso ao Nascer , Bovinos , Doenças dos Bovinos/diagnóstico por imagem , Distocia/diagnóstico por imagem , Distocia/epidemiologia , Feminino , Idade Gestacional , Ossos Metacarpais/diagnóstico por imagem , Ossos do Metatarso/diagnóstico por imagem , Razão de Chances , Gravidez , Risco , Ultrassonografia/veterinária
16.
J Pregnancy ; 2018: 4790136, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30174954

RESUMO

To investigate how macrosomia affects foetal-maternal birth outcomes, we conducted a retrospective cohort study of singleton pregnant women who gave birth at gestational age ≥37+0 weeks. The patients were divided into three groups according to birth weight: "macrosomia" group, ≥4500 g, n=285; "upper-normal" group, 3500-4499 g, n=593; and "normal" group, 2500-3499 g, n=495. Foetal-maternal and delivery outcomes were compared among the three groups after adjustment for confounders. Caesarean section was more frequent in the macrosomia group than in upper-normal and normal groups. The duration of labour (p < 0.05) and postpartum care at the hospital (p < 0.001) were the highest in the macrosomia group. Increased birth weight was associated with higher risks of shoulder dystocia (p < 0.001), increased bleeding volume (p < 0.001), and perineal tear (p < 0.05). The Apgar score at 5 minutes (p < 0.05), arterial cord pH (p < 0.001), and partial pressure of O2 (p < 0.05) were lower, while the arterial cord partial pressure of CO2 was higher (p < 0.001), in the macrosomia group. Macrosomia has potentially serious impacts for neonate and mother as a result of a complicated and occasionally traumatic delivery.


Assuntos
Traumatismos do Nascimento/etiologia , Cesárea/estatística & dados numéricos , Distocia/etiologia , Macrossomia Fetal/complicações , Lacerações/etiologia , Hemorragia Pós-Parto/etiologia , Adulto , Traumatismos do Nascimento/epidemiologia , Peso ao Nascer , Distocia/epidemiologia , Feminino , Humanos , Recém-Nascido , Lacerações/epidemiologia , Períneo/lesões , Hemorragia Pós-Parto/epidemiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco
17.
BMC Pregnancy Childbirth ; 18(1): 304, 2018 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-30021565

RESUMO

BACKGROUND: Purpose of this study was to investigate differences between primiparous term pregnancies, one leading to vaginal delivery (VD) and the other to acute cesarean section (CS) due to labor dystocia in the first stage of labor. We particularly wanted to assess the influence of body mass index (BMI) on CS risk. METHODS: A retrospective case-control study in a tertiary delivery unit with 5200 deliveries annually. Cases were 296 term primiparous women whose intended vaginal labor ended in acute CS because of dystocia. Controls were primiparas with successful vaginal delivery VD (n = 302). The data were retrieved from medical records. Multiple logistic regression analyses were used to assess the associations between BMI and covariates on labor dystocia. RESULTS: In the cases ending with acute CS, women were older (OR 1.06 [1.03-1.10]), shorter (OR 0.94 [0.91-0.96]) and more often had a chronic disease (OR 1.60 [1.1-2.29]). In this group fetal malposition (OR 42.0 [19.2-91.9]) and chorioamnionitis (OR 10.9 [5.01-23.6]) were more common, labor was less often in an active phase (OR 3.37 [2.38-4.76]) and the cervix was not as well ripened (1.5 vs. 2.5 cm, OR 0.57 [0.48-0.67] on arrival at the birth unit. BMI was higher in the dystocia group (24.1 vs. 22.6 kg/m2, p < 0.001), and rising maternal pre-pregnancy BMI had a strong association with dystocia risk. If BMI increased by 1 kg/m2, the risk of CS was 10% elevated. Among obese primiparas, premature rupture of membranes, chorioamnionitis and induction of labor were more common. Their labors were less often in an active phase at hospital admission. Severely obese primiparas (BMI ≥ 35 kg/m2) had 4 hours longer labor than normal-weight parturients. CONCLUSIONS: Labor dystocia is a multifactorial phenomenon in which the possibility to ameliorate the condition via medical treatment is limited. Hospital admission at an advanced stage of labor is recommended. Pre-pregnancy weight control in the population at reproductive age is essential, as a high BMI is strongly associated with labor dystocia.


Assuntos
Cesárea , Distocia , Obesidade , Adulto , Índice de Massa Corporal , Estudos de Casos e Controles , Cesárea/métodos , Cesárea/estatística & dados numéricos , Distocia/diagnóstico , Distocia/epidemiologia , Distocia/prevenção & controle , Feminino , Finlândia/epidemiologia , Humanos , Obesidade/diagnóstico , Obesidade/epidemiologia , Paridade , Gravidez , Estudos Retrospectivos , Fatores de Risco
18.
Birth ; 45(4): 358-367, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29851163

RESUMO

BACKGROUND: The timing of hospital admission for women with spontaneous labor onset and the criteria used to assess active labor progress and diagnose labor dystocia may significantly influence women's risk for primary cesarean birth. Our aims were to assess associations of labor status at admission (i.e., preactive or active) and active labor progress (i.e., dystocic or physiologic) with oxytocin augmentation, cesarean birth, and adverse neonatal outcome rates. METHODS: A sample of low-risk, nulliparous women admitted to hospitals for spontaneous labor onset was extracted from the Consortium on Safe Labor (n = 27 077). Binomial logistic regression was used to assess associations between labor classifications and outcomes. RESULTS: At admission, 68.0% of women were in preactive labor and 32.0% were in active labor. Cesarean rates for these groups were 18.0% and 7.2%, respectively (adjusted odds ratio [AOR] 2.69; 95% CI 2.45-2.96). Oxytocin augmentation and adverse neonatal outcomes were more likely for women admitted in preactive labor. Among women admitted in active labor, 9.3% experienced labor dystocia and 90.7% progressed physiologically. Cesarean rates for these groups were 20.4% and 5.9%, respectively (AOR 3.02; 95% CI 2.45-3.73). Nearly half of the cesareans performed for dystocia among women admitted in active labor occurred when cervical dilation was physiologic. Oxytocin augmentation and adverse neonatal outcomes were more likely when active labor was dystocic. CONCLUSIONS: Adoption of evidence-based, standardized approaches for diagnosing active labor onset, assessing labor progress, and diagnosing dystocia may safely decrease oxytocin augmentation and cesarean birth rates in the United States.


Assuntos
Cesárea/estatística & dados numéricos , Distocia/epidemiologia , Complicações do Trabalho de Parto/epidemiologia , Paridade , Adolescente , Adulto , Feminino , Humanos , Primeira Fase do Trabalho de Parto , Modelos Logísticos , Análise Multivariada , Ocitocina/farmacologia , Gravidez , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
19.
BMC Pregnancy Childbirth ; 18(1): 118, 2018 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-29716537

RESUMO

BACKGROUND: The aim of the study was to investigate the accuracy of ultrasound-derived estimated fetal weight (EFW) and to determine its impact on management and outcome of delivery. METHODS: In this single-center cohort analysis, women with a singleton term pregnancy in the beginning stages of labor were included. Women with immediately antepartum EFW (N = 492) were compared to women without ultrasound (N = 515). RESULTS: EFW was correct (deviation from birth weight ≤ 10%) in 72.2% (355/492) of patients with fetal biometry; 19.7% (97/492) were underestimated, and 8.1% (40/492) were overestimated. Newborns with a lower birth weight were more frequently overestimated, and newborns with higher birth weight were more frequently underestimated. The mean difference between EFW and real birth weight was - 114.5 g (standard deviation ±313 g, 95% confidence interval 87.1-142.0). The rate of non-reassuring fetal heart tracing (9.8% vs. 1.9%, P < 0.001) and of caesarean delivery (9.1% vs. 5.0%, P = 0.013) was higher in women with EFW. Overestimation was associated with an increased risk for delivery by caesarean section (odds ratio 2.80; 95% confidence interval 1.2-6.5, P = 0.017). After adjustment, EFW remained associated with increased non-reassuring fetal heart tracing (odds ratio 4.73; 95% confidence interval 2.3-9.6) and caesarean delivery (odds ratio 1.86; 95% confidence interval 1.1-3.1). The incidence of perineal tears of grade 3/4, shoulder dystocia, postnatal depression and neonatal acidosis did not differ between groups. CONCLUSIONS: Antepartum ultrasound-derived EFW does not improve maternal and fetal outcome and is therefore not recommended.


Assuntos
Peso ao Nascer , Parto Obstétrico/estatística & dados numéricos , Peso Fetal , Ultrassonografia , Acidose/epidemiologia , Adulto , Cesárea/estatística & dados numéricos , Estudos de Coortes , Parto Obstétrico/métodos , Depressão Pós-Parto/epidemiologia , Distocia/epidemiologia , Feminino , Sofrimento Fetal/epidemiologia , Humanos , Recém-Nascido , Lacerações/epidemiologia , Períneo/lesões , Período Periparto , Valor Preditivo dos Testes , Gravidez , Adulto Jovem
20.
J Neonatal Perinatal Med ; 11(1): 61-64, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29689744

RESUMO

BACKGROUND: The incidence of clavicle fracture in the newborn population ranges from 0.2 to 3.5% with an associated rate of obstetric brachial palsy (OBP) ranging from 4 to 13% . METHODS: The aim of this study was to describe the anatomical location of the fracture in the clavicle and its possible correlation with OBP. We retrospectively reviewed all perinatal clavicle fractures diagnosed at our institution over thirteen years. RESULTS: A total of 155 clavicle fractures were identified among 23508 live newborns representing an incidence of 0.67% . Fracture location was categorized according to the Allman classification. The most frequent location was the mid-shaft (Allman I) (92.90%), followed by the medial third (Allman III) (5.81%) and finally by the lateral third (Allman II) (1.29%). 17 cases had an associated OBP (10.97%). 13 of these cases (76.47%) involved the medial third, 4 involved the midshaft (23.53%) whilst none of the cases with a clavicle fracture involving the lateral third was associated to OBP. We could determine a significant association between the occurrence of OBP and fracture of the clavicle medial third (Allman type III) (p < 0.05). CONCLUSIONS: To the best of our knowledge this is the first study describing the anatomical location of the fracture in the clavicle and its possible association with OBP. A fracture involving the medial clavicle third in a newborn might alert of the possible event of OBP. Nevertheless, more studies with larger samples will be necessary to confirm these results.


Assuntos
Traumatismos do Nascimento/epidemiologia , Neuropatias do Plexo Braquial/epidemiologia , Clavícula/lesões , Fraturas Ósseas/epidemiologia , Índice de Apgar , Traumatismos do Nascimento/complicações , Neuropatias do Plexo Braquial/etiologia , Diáfises/lesões , Distocia/epidemiologia , Feminino , Fraturas Ósseas/complicações , Humanos , Incidência , Recém-Nascido , Gravidez , Estudos Retrospectivos , Fatores de Risco
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