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1.
Medicine (Baltimore) ; 99(7): e19138, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049835

RESUMO

The study assessed the pelvic dimensions by computed tomography (CT) performed for gluteal muscle contracture women, and evaluated the impact of malformations on several essential obstetric parameters.The CT pelvimetry was retrospectively performed in 25 gluteal muscle contracture women selected consecutively whether they had delivery history or not. Among the pelvic inlet plane, the mid plane and the outlet plane, 12 indicators including the transverse diameter of the pelvic inlet, the conjugate vera, the diagonal conjugate, the biischial diameter, the anteroposterior diameter of the middle pelvis, transverse outlet, the posterior sagittal diameter of outlet, the conjugate of the outlet, the anterior sagittal diameter of the outlet, the curvature and length of the sacrum, the angle of pubic arch were collected.Finally, the mean age of these women was 26.6 ±â€Š5.0 years. Most pelvises had anteroposterior elliptical appearance in inlet and size of the female pelvis. The most statistically different and most clinically significant indicator was the biischial diameter, gluteal muscle contracture women were 95.6 ±â€Š9.3 mm and the normal women from other study were 105.0 ±â€Š7.9 mm, the comparison showed a significant difference (P < .001).Generally, most gluteal muscle contracture women had features of anthropoid pelvis which were quite different from normal Chinese female. These results may serve as a basis for future studies to assess its utility and prognostic value for a safe vaginal delivery in gluteal muscle contracture women.


Assuntos
Nádegas/diagnóstico por imagem , Distocia/etiologia , Músculo Esquelético/diagnóstico por imagem , Ossos Pélvicos/diagnóstico por imagem , Adolescente , Adulto , Nádegas/patologia , Nádegas/fisiopatologia , Feminino , Fibrose , Humanos , Músculo Esquelético/fisiopatologia , Ossos Pélvicos/patologia , Gravidez , Síndrome , Adulto Jovem
2.
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
3.
Ultrasound Obstet Gynecol ; 54(3): 319-325, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30938000

RESUMO

OBJECTIVE: To estimate the risks of maternal and neonatal complications in pregnancies with macrosomia. METHODS: This was a retrospective cohort study conducted at a large maternity unit in the UK between January 2009 and December 2016. The incidence of maternal and neonatal complications in pregnancies with macrosomia, defined as birth weight (BW) > 4000 g, and in those with severe macrosomia, defined as BW > 4500 g, was compared with that in pregnancies with normal BW (2500-4000 g). Regression analysis was performed to determine odds ratios (ORs) for complications in macrosomic pregnancies compared to those with normal BW. RESULTS: The study population of 35 548 pregnancies included 4522 (12.7%) with macrosomia, of which 643 (1.8%) had severe macrosomia, and 31 026 (87.3%) with normal BW. In the macrosomia group, the adjusted OR was 3.1 (95% CI, 2.6-3.6) for Cesarean section for failure to progress, 2.4 (95% CI, 2.0-3.0) for severe postpartum hemorrhage, 2.3 (95% CI, 1.9-2.8) for obstetric anal sphincter injury, 10.4 (95% CI, 8.6-12.6) for shoulder dystocia, 28.5 (95% CI, 8.9-90.7) for obstetric brachial plexus injury, 32.3 (95% CI, 3.8-278.2) for birth fractures and 4.4 (95% CI, 2.2-8.8) for hypoxic-ischemic encephalopathy. The respective values in pregnancies with severe macrosomia were 4.3 (95% CI, 3.1-6.1), 2.9 (95% CI, 1.9-4.4), 3.1 (95% CI, 1.9-5.1), 28.7 (95% CI, 20.8-39.8), 73.9 (95% CI, 15.1-363.2), 87.2 (95% CI, 7.7-985.0) and 13.8 (95% CI, 5.2-36.8). CONCLUSION: Macrosomia is associated with serious adverse perinatal outcomes. This study provides accurate estimates of risks to aid in pregnancy management. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Cesárea/estatística & dados numéricos , Distocia/etiologia , Macrossomia Fetal , Hemorragia Pós-Parto/etiologia , Adulto , Feminino , Macrossomia Fetal/fisiopatologia , Humanos , Complicações do Trabalho de Parto , Guias de Prática Clínica como Assunto , Gravidez , Complicações na Gravidez , Estudos Retrospectivos , Medição de Risco
4.
Ultrasound Obstet Gynecol ; 54(3): 308-318, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30938004

RESUMO

OBJECTIVE: To determine accurate estimates of risks of maternal and neonatal complications in pregnancies with fetal macrosomia by performing a systematic review of the literature and meta-analysis. METHODS: A search of MEDLINE, EMBASE, CINAHL and The Cochrane Library was performed to identify relevant studies reporting on maternal and/or neonatal complications in pregnancies with macrosomia having a birth weight (BW) > 4000 g and/or those with birth weight > 4500 g. Prospective and retrospective cohort and population-based studies that provided data regarding both cases and controls were included. Maternal outcomes assessed were emergency Cesarean section (CS), postpartum hemorrhage (PPH) and obstetric anal sphincter injury (OASIS). Neonatal outcomes assessed were shoulder dystocia, obstetric brachial plexus injury (OBPI) and birth fractures. Meta-analysis using a random-effects model was used to estimate weighted pooled estimates of summary statistics (odds ratio (OR) and 95% CI) for each complication, according to birth weight. Heterogeneity between studies was estimated using Cochran's Q, I2 statistic and funnel plots. RESULTS: Seventeen studies reporting data on maternal and/or neonatal complications in pregnancy with macrosomia were included. In pregnancies with macrosomia having a BW > 4000 g, there was an increased risk of the maternal complications: emergency CS, PPH and OASIS, which had OR (95% CI) of 1.98 (1.80-2.18), 2.05 (1.90-2.22) and 1.91 (1.56-2.33), respectively. The corresponding values for pregnancies with BW > 4500 g were: 2.55 (2.33-2.78), 3.15 (2.14-4.63) and 2.56 (1.97-3.32). Similarly, in pregnancies with a BW > 4000 g, there was an increased risk of the neonatal complications: shoulder dystocia, OBPI and birth fractures, which had OR (95% CI) of 9.54 (6.76-13.46), 11.03 (7.06-17.23) and 6.43 (3.67-11.28), respectively. The corresponding values for pregnancies with a BW > 4500 g were: 15.64 (11.31-21.64), 19.87 (12.19-32.40) and 8.16 (2.75-24.23). CONCLUSION: Macrosomia is associated with serious maternal and neonatal adverse outcomes. This study provides accurate estimates of these risks, which can be used for decisions on pregnancy management. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Cesárea/estatística & dados numéricos , Distocia/etiologia , Macrossomia Fetal/complicações , Hemorragia Pós-Parto/etiologia , Complicações na Gravidez/etiologia , Adulto , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido , Gravidez , Estudos Retrospectivos
5.
Rev Colomb Obstet Ginecol ; 70(4): 253-265, 2019 12.
Artigo em Espanhol | MEDLINE | ID: mdl-32142240

RESUMO

OBJECTIVE: To review the concepts underlying breech presentation delivery as well as the semiology and the obstetric maneuvers contributing to a successful perinatal maternal outcome. METHODS: Based on a hypothetical scenario to set the stage for a practical approach to the topic, an explanatory paper built on a narrative review is created in order to examine the principles related to diagnosis, mechanism of delivery and maternal care, emphasizing maneuvers to ease fetal extraction. RESULTS: Breech presentation delivery must be managed through the vaginal canal when already in the expulsion phase with fetal engagement. For diagnosis and care, it is essential to know the unique semiology and physiology of this condition as well as the obstetric maneuvers to facilitate an uncomplicated delivery. CONCLUSIONS: The mechanism of childbirth in breech presentation is complex and requires knowledge of its physiology and multiple obstetric maneuvers on the part of the obstetrician as well as the general practitioner, in order to ensure adequate care when there is no other option.


Assuntos
Apresentação Pélvica , Parto Obstétrico/métodos , Resultado da Gravidez , Distocia/etiologia , Feminino , Humanos , Recém-Nascido , Complicações do Trabalho de Parto/etiologia , Gravidez
6.
Ann Saudi Med ; 38(6): 445-449, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30531180

RESUMO

Placental steroid sulphatase deficiency (SSD) is an X-linked inborn error of metabolism. Congenital X-linked ichthyosis (XLI) is a genetic disorder of keratinisation caused by steroid sulphatase (STS) deficiency, which results in a scaling skin condition in male infants shortly after birth. It may be associated with failed induction of labor and prolonged labor leading to cesarean delivery due to 'cervical dystocia'. We present two cases of congenital ichthyosis. Thorough counselling of women with a previously affected pregnancy during the antenatal period should include discussion about mode of delivery and a critical review of the complexities of prenatal diagnosis in this condition. We propose a clinical management pathway to offer women with a previous pregnancy affected by this rare condition. SIMILAR CASES PUBLISHED: Less than 50 cases reported.


Assuntos
Cesárea/métodos , Deleção Cromossômica , Cromossomos Humanos Par 10/genética , Distocia , Ictiose Ligada ao Cromossomo X , Diagnóstico Pré-Natal/métodos , Adulto , Cardiotocografia/métodos , Distocia/diagnóstico , Distocia/etiologia , Distocia/terapia , Feminino , Testes Genéticos/métodos , Humanos , Ictiose Ligada ao Cromossomo X/diagnóstico , Ictiose Ligada ao Cromossomo X/genética , Ictiose Ligada ao Cromossomo X/terapia , Recém-Nascido , Primeira Fase do Trabalho de Parto , Trabalho de Parto Induzido/métodos , Masculino , Ocitócicos/administração & dosagem , Ocitócicos/efeitos adversos , Ocitocina/administração & dosagem , Ocitocina/efeitos adversos , Gravidez , Resultado da Gravidez , História Reprodutiva , Resultado do Tratamento
7.
J Clin Endocrinol Metab ; 103(11): 4187-4196, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30239805

RESUMO

Context: There is increasing evidence for Müllerian-inhibiting substance (MIS)/anti-Müllerian hormone (AMH) physiologic activity in the human uterus, so it is relevant to study how MIS/AMH levels impact pregnancy. Objective: To investigate the association of MIS/AMH levels with the risk of adverse obstetric outcomes. Design: Retrospective cohort study. Setting: Academic fertility center. Patients: Women who became pregnant through in vitro fertilization between January 2012 and October 2016. Exclusion criteria were: oocyte donation, gestational carrier, multiple gestations, miscarriage before 20 weeks, or medically indicated preterm deliveries. Interventions: None. Main Outcome Measures: There were two primary outcomes, preterm birth and cesarean delivery for arrest of labor. Because MIS/AMH level is highly skewed by certain infertility diagnoses, the preterm birth analysis was stratified by polycystic ovary syndrome (PCOS) diagnosis, and the cesarean delivery for arrest of labor analysis was stratified by diminished ovarian reserve diagnosis. χ2, Mann-Whitney, and t tests were used as appropriate. A P value of <0.05 was considered statistically significant. Results: Among women with PCOS, those who delivered prematurely had substantially higher MIS/AMH levels (18 vs 6.4 ng/mL, P = 0.003) than did those who delivered at term. At the highest MIS/AMH values, preterm deliveries predominated; above the 90th percentile in women with PCOS, all deliveries were premature. No effect of MIS/AMH level was observed in women without PCOS. We found no association between MIS/AMH values and cesarean delivery for labor arrest. Conclusion: In women with PCOS, substantially elevated MIS/AMH levels are significantly associated with preterm birth, suggesting closer follow-up and further studies to elucidate the underlying mechanisms.


Assuntos
Hormônio Antimülleriano/sangue , Cesárea/estatística & dados numéricos , Distocia/diagnóstico , Síndrome do Ovário Policístico/sangue , Nascimento Prematuro/diagnóstico , Adulto , Distocia/sangue , Distocia/etiologia , Distocia/cirurgia , Feminino , Humanos , Recém-Nascido , Síndrome do Ovário Policístico/complicações , Gravidez , Nascimento Prematuro/etiologia , Prognóstico , Estudos Retrospectivos , Inércia Uterina
8.
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
9.
J Matern Fetal Neonatal Med ; 31(23): 3178-3182, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28793827

RESUMO

INTRODUCTION: To improve the choice of vacuum-assisted delivery (VAD) system, we compared the outcomes of Kiwi handheld system and Mityvac M-style conventional system (both use disposable plastic cups). MATERIALS AND METHODS: Retrospective observational study with data collection from electronic medical records. The study was conducted at a tertiary medical center, with approximately 7000 deliveries annually. Categorical and continuous variables were analyzed using chi-square test and t-test, respectively. p value < .05 was considered significant. The main outcomes assessed were the overall failure rate of each system, failure rates for occipito-anterior (OA) versus occipito-transverse/occipito-anterior (OT/OP) positions, +1 versus +2 fetal stations, and early maternal/neonatal outcomes. RESULTS: During a 10-month period, there were 507 (8.4%) attempted VADs, 36 failed (7.1%), and eight (1.5%) converted to cesarean section. Of these, 364 were Kiwi-assisted and 143 Mityvac-assisted. Background characteristics were similar. The handheld system had more failures overall (9.6 versus 0.7%), at OA (7.6 versus 0.9%), and non-OA positions (17.3% versus none), at +1 (13.25 versus 0.96%) and at +2/3 stations (6.1% versus none), than the conventional system did, respectively. There was a higher rate of early post-partum hemorrhage (15.3 versus 7.4%) in the conventional group. Both systems had similar rates of third/fourth degree perineal tears, shoulder dystocia and adverse neonatal outcomes. CONCLUSIONS: Our results suggest more failures with Kiwi compared to Mityvac, overall and at any fetal position/station, without a significant difference in adverse outcome profile.


Assuntos
Falha de Equipamento , Complicações do Trabalho de Parto/terapia , Vácuo-Extração/efeitos adversos , Vácuo-Extração/instrumentação , Adulto , Cesárea/estatística & dados numéricos , Distribuição de Qui-Quadrado , Distocia/etiologia , Feminino , Febre/etiologia , Humanos , Recém-Nascido , Lacerações/etiologia , Tempo de Internação/estatística & dados numéricos , Períneo/lesões , Hemorragia Pós-Parto/etiologia , Gravidez , Estudos Retrospectivos , Couro Cabeludo/lesões , Estatísticas não Paramétricas
10.
Am J Perinatol ; 35(5): 515-520, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29183096

RESUMO

OBJECTIVE: This article aims to compare the composite maternal and neonatal morbidities (CMM and CNM, respectively) between macrosomic (≥4,000 g) and nonmacrosomic (<4,000 g) newborns among women with diabetes mellitus (DM). METHODS: Maternal demographic and peripartum outcome data (N = 1,260) were collected from a retrospective cohort. CMM included chorioamnionitis/endometritis, wound infection, shoulder dystocia, eclampsia, pulmonary edema, admission for hypoglycemia, 3rd/4th degree perineal laceration, and death. CNM included 5-minute Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score of <4, neonatal intensive care unit (NICU) admission, respiratory distress syndrome, mechanical ventilation, intraventricular hemorrhage grade III/IV, necrotizing enterocolitis stage II/III, hypoglycemia, hypocalcemia, bronchopulmonary dysplasia, sepsis, seizures, hyperbilirubinemia, and death. Multivariable Poisson regression models with robust error variance were used to calculate adjusted relative risk (aRR) and 95% confidence interval (CI). RESULTS: The study population consisted of 967 subjects, including 854 (88.3%) nonmacrosomic and 113 (11.7%) macrosomic infants. After adjustment, the risk of CMM was higher among macrosomic deliveries (aRR = 4.08, 95% CI = 2.45-6.80). The risk of CNM was also higher among macrosomic deliveries (aRR = 1.77, 95% CI = 1.39-2.24). Macrosomia was associated with an increased risk in NICU admission, hypoglycemia, and hyperbilirubinemia. CONCLUSION: Among DM deliveries, macrosomia was associated with a fourfold higher risk of CMM and almost twofold higher risk of CNM.


Assuntos
Macrossomia Fetal/epidemiologia , Doenças do Recém-Nascido/epidemiologia , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Complicações do Trabalho de Parto/epidemiologia , Gravidez em Diabéticas/epidemiologia , Adulto , Distocia/etiologia , Feminino , Humanos , Hiperbilirrubinemia/etiologia , Hipoglicemia/etiologia , Recém-Nascido , Troca Materno-Fetal , Morbidade , Análise Multivariada , Gravidez , Análise de Regressão , Estudos Retrospectivos , Texas/epidemiologia , Adulto Jovem
11.
Theriogenology ; 107: 104-108, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29145063

RESUMO

The aim of this study was to report prevalences and causes of dystocias in dairy and beef cattle, in primiparous and multiparous cows, as well as the mortality rate of calves and cows, obtained after 11 years of records across various farms in Italy. On a total of 14,575 records from dairy Italian Friesian cows, beef Romagnola and Marchigiana cows, a prevalence of 5.6% was observed, with a significant higher prevalence in primiparous (p < 0.0001), and dairy cows (p < 0.0001). Dystocias of fetal origin were higher than the ones of maternal origin (p < 0.0001). Dystocia management, performed with manual correction in 96% of the cases, was associated with the 25% of calf mortality and the 11% of maternal mortality. When the combined effects of attitude and parity were assessed in relation to each fetal or maternal dystocia cause, dystocia resolution method and on calf, cow and calf-and-cow mortality, results showed a stronger association of dairy primiparous and multiparous cows than beef cows to several dystocia causes and calf-and-cow mortality. Taken together the results from the present study highlighted, once more, the importance of a correct breeding herd management and genetic selection programmes, especially in dairy cows, as well as the prompt diagnosis and correction of difficult calvings, for the effective management of dystocias aimed to reduce calf mortality.


Assuntos
Doenças dos Bovinos/etiologia , Distocia/veterinária , Criação de Animais Domésticos , Animais , Bovinos , Doenças dos Bovinos/epidemiologia , Doenças dos Bovinos/mortalidade , Distocia/epidemiologia , Distocia/etiologia , Distocia/mortalidade , Feminino , Itália/epidemiologia , Vigilância da População , Gravidez
12.
Res Vet Sci ; 113: 5-12, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28818752

RESUMO

The on-farm mortality of cows in cow-calf herds has a significant influence on the economic efficiency of the farm. It is also an indicator of suboptimal animal health and welfare. The present study analysed the registry data of beef cows in Estonia from the years 2013 to 2015. The datasets incorporated 8084 parturitions of primiparous cows and 21,283 parturitions of 9234 multiparous cows. A Weibull proportional hazard random effect model was used for risk factor analysis, in which the on-farm mortality, including death and euthanasia, was the event of interest. The first 30days post-calving were associated with the highest mortality hazard for primiparous and multiparous cows (including 28.9% and 21.1% of deaths, respectively). In multiparous cows, the lowest mortality hazard was confirmed for animals with parity of three to five, increasing significantly after that. Primiparous cows that did not have a stillborn calf had a significantly higher mortality hazard when calving over 44months of age compared to cows calving younger than 36months. Stillbirth and abortion were significant risk factors for mortality. Cows with dystocia experienced a higher mortality hazard, especially during the first week post-calving. In multiparous cows, a higher herd mean age at first calving was associated with a higher mortality hazard. This study highlights the fact that the early post-partum period and factors associated with calving, such as age at first calving, dystocia, stillbirth and abortion, are critical for beef cow survival.


Assuntos
Aborto Animal/epidemiologia , Doenças dos Bovinos/mortalidade , Distocia/veterinária , Natimorto/veterinária , Aborto Animal/etiologia , Animais , Bovinos , Doenças dos Bovinos/etiologia , Distocia/epidemiologia , Distocia/etiologia , Estônia/epidemiologia , Feminino , Paridade , Gravidez , Fatores de Risco , Natimorto/epidemiologia
13.
Am J Obstet Gynecol ; 217(6): 633-641, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28743440

RESUMO

Fetal malpositions and cephalic malpresentations are well-recognized causes of failure to progress in labor. They frequently require operative delivery, and are associated with an increased probability of fetal and maternal complications. Traditional obstetrics emphasizes the role of digital examinations, but recent studies demonstrated that this approach is inaccurate and intrapartum ultrasound is far more precise. The objective of this review is to summarize the current body of literature and provide recommendations to identify malpositions and cephalic malpresentations with ultrasound. We propose a systematic approach consisting of a combination of transabdominal and transperineal scans and describe the findings that allow an accurate diagnosis of normal and abnormal position, flexion, and synclitism of the fetal head. The management of malpositions and cephalic malpresentation is currently a matter of debate, and individualized depending on the general clinical picture and expertise of the provider. Intrapartum sonography allows a precise diagnosis and therefore offers the best opportunity to design prospective studies with the aim of establishing evidence-based treatment. The article is accompanied by a video that demonstrates the sonographic technique and findings.


Assuntos
Distocia/diagnóstico por imagem , Apresentação no Trabalho de Parto , Complicações do Trabalho de Parto/diagnóstico por imagem , Parto Obstétrico , Distocia/etiologia , Extração Obstétrica , Feminino , Humanos , Gravidez , Ultrassonografia Pré-Natal
15.
Acta Obstet Gynecol Scand ; 96(9): 1063-1069, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28498626

RESUMO

INTRODUCTION: Advanced maternal age is associated with labor dystocia (LD) in nulliparous women. This study investigates the age-related risk of LD in first, second and third births. MATERIAL AND METHODS: All live singleton cephalic births at term (≥ 37 gestational weeks) recorded in the Swedish Medical Birth Register from 1999 to 2011, except elective cesarean sections and fourth births and more, in total 998 675 pregnancies, were included in the study. LD was defined by International Classification of Diseases, version 10 codes (O620, O621, O622, O629, O630, O631 and O639). In each parity group risks of LD at age 25-29 years, 30-34 years, 35-39 years and ≥ 40 years compared with age < 25 years were investigated by logistic regression analyses. Analyses were adjusted for year of delivery, education, country/region of birth, smoking in early pregnancy, maternal height, body mass index, week of gestation, fetal presentation and infant birthweight. RESULTS: Rates of LD were 22.5%, 6.1% and 4% in first, second and third births, respectively. Adjusted odd ratios (OR) for LD increased progressively from the youngest to the oldest age group, irrespective of parity. At age 35-39 years the adjusted OR (95% CI) was approximately doubled compared with age 25 and younger: 2.13 (2.06-2.20) in first birth; 2.05 (1.91-2.19) in second births; and 1.81 (1.49-2.21) in third births. CONCLUSIONS: Maternal age is an independent risk factor for LD in first, second and third births. Although age-related risks by parity are relatively similar, more nulliparous than parous women will be exposed to LD due to the higher rate.


Assuntos
Distocia/epidemiologia , Idade Materna , Paridade , Adulto , Fatores Etários , Distocia/etiologia , Feminino , Humanos , Gravidez , Sistema de Registros , Fatores de Risco , Suécia/epidemiologia , Adulto Jovem
17.
Obstet Gynecol ; 129(4): 693-698, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28333794

RESUMO

OBJECTIVE: To describe delivery management of singleton stillbirths in a population-based, multicenter case series. METHODS: We conducted a retrospective chart review of 611 women with singleton stillbirths at 20 weeks of gestation or greater from March 2006 to September 2008. Medical and delivery information was abstracted from medical records. Both antepartum and intrapartum stillbirths were included; these were analyzed both together and separately. The primary outcome was mode of delivery. Secondary outcomes included induction of labor and indications for cesarean delivery. Indications for cesarean delivery were classified as obstetric (abnormal fetal heart tracing before intrapartum demise, abruption, coagulopathy, uterine rupture, placenta previa, or labor dystocia) or nonobstetric (patient request, repeat cesarean delivery, or not documented). RESULTS: Of the 611 total cases of stillbirth, 93 (15.2%) underwent cesarean delivery, including 43.0% (46/107) of women with prior cesarean delivery and 9.3% (47/504) of women without prior cesarean delivery. No documented obstetric indication was evident for 38.3% (18/47) of primary and 78.3% (36/46) of repeat cesarean deliveries. Labor induction resulted in vaginal delivery for 98.5% (321/326) of women without prior cesarean delivery and 91.1% (41/45) of women with a history of prior cesarean delivery, including two women who had uterine rupture. Among women with a history of prior cesarean delivery who had spontaneous labor, 74.1% (20/27) delivered vaginally, with no cases of uterine rupture. CONCLUSION: Women with stillbirth usually delivered vaginally regardless of whether labor was spontaneous or induced or whether they had a prior cesarean delivery. However, 15% underwent cesarean delivery, often without a documented obstetric indication.


Assuntos
Cesárea , Parto Obstétrico , Distocia/cirurgia , Trabalho de Parto Induzido , Natimorto/epidemiologia , Ruptura Uterina/cirurgia , Adulto , Cesárea/métodos , Cesárea/estatística & dados numéricos , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Demografia , Distocia/etiologia , Feminino , Humanos , Trabalho de Parto Induzido/métodos , Trabalho de Parto Induzido/estatística & dados numéricos , Avaliação de Processos e Resultados em Cuidados de Saúde , Gravidez , Estudos Retrospectivos , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Ruptura Uterina/etiologia
18.
J Med Primatol ; 46(2): 56-58, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28145565

RESUMO

A multiparous Celebes crested macaque presented with dystocia due to foetal macrosomia, causing foetal mortality and hindlimb paresis. After emergency caesarean section, recovery of motor function took 1 month before hindlimbs were weight bearing and 2 months before re-integration with the troop.


Assuntos
Distocia/veterinária , Macrossomia Fetal/veterinária , Macaca , Doenças dos Macacos/etiologia , Atividade Motora , Paresia/veterinária , Comportamento Social , Animais , Animais de Zoológico , Cesárea/efeitos adversos , Cesárea/veterinária , Distocia/etiologia , Feminino , Macrossomia Fetal/complicações , Macrossomia Fetal/mortalidade , Macaca/fisiologia , Doenças dos Macacos/cirurgia , Paresia/etiologia , Gravidez , Recuperação de Função Fisiológica
20.
Vet J ; 219: 49-57, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28093112

RESUMO

Blood gas disturbances, commonly resulting from dystocia, are associated with failed transfer of passive immunity, morbidity and mortality in newborn calves. Modified APGAR scores intended to identify compromised calves are not widely adopted due to lack of practicality and inconsistent associations with blood parameters. The objective of this study was to determine clinical indicators of acidemia in newborn beef calves. Blood parameters at 10 min and 24 h after birth were compared to at-birth clinical examination parameters and calving characteristics in 77 commercial beef calves. There were no associations between heart rate or respiratory rate and blood pH or blood L-lactate concentration (LAC; r < 0.25); however, LAC was highly correlated with blood pH (r, -0.86). Abnormal mucous membrane color (red, white or blue) was associated with increased LAC (P = 0.002) but not decreased blood pH (P = 0.07). Abnormal results for tests of muscle tonicity and reflexes, namely inability to completely withdraw the tongue when pinched and a weak suckle reflex, were associated with decreased blood pH and increased LAC (P <0.05). Calves born to primiparous dams or from an assisted calving also had decreased blood pH and increased LAC (P <0.05). Differences in blood pH between at-birth categories resolved for all parameters by 24 h after birth, except for tongue withdrawal (P= 0.04). In conclusion, traditional APGAR parameters, heart rate, respiratory rate and mucous membrane color were not useful for the identification of acidemic calves; however, tongue withdrawal, calving ease, and parity should be included in such an assessment. Utilizing hand-held LAC meters may be a practical method to quickly identify compromised calves with acidemia in a field setting.


Assuntos
Análise Química do Sangue/veterinária , Gasometria/veterinária , Doenças dos Bovinos/fisiopatologia , Ácido Láctico/sangue , Animais , Animais Recém-Nascidos , Bovinos , Doenças dos Bovinos/etiologia , Distocia/etiologia , Distocia/veterinária , Feminino , Masculino , Gravidez
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