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The Journal of Maternal-fetal &... Dec 2022Even today, hundreds of thousands of women die or suffer high levels of morbidity associated with childbirth. One of the most common causes is halted labor progress, or... (Review)
Review
Even today, hundreds of thousands of women die or suffer high levels of morbidity associated with childbirth. One of the most common causes is halted labor progress, or labor dystocia. There have been no developments in the diagnosis or treatment of dystocic deliveries since Friedman designed the Partogram in the 1950s. Oxytocin is the only treatment for dystocic labor. Sometimes, oxytocin is a lifesaver for the woman, especially in severe postpartum hemorrhages. At the same time, it is also one of the most overused drugs in obstetric care. This review article is meant to provide a short overview of the current knowledge of uterine metabolism during labor, uterine lactate production, and its association with labor dystocia. The article also intends to reflect new ways of thinking regarding practical recommendations for treating labor dystocia and offer a look at the future of dystocic labor management.
Topics: Pregnancy; Female; Humans; Oxytocin; Amniotic Fluid; Lactic Acid; Cesarean Section; Dystocia; Labor, Obstetric
PubMed: 34758684
DOI: 10.1080/14767058.2021.1946790 -
Theriogenology Sep 2018English bulldogs have been reported to have a high incidence of dystocia and caesarean section is often performed electively in this breed. A narrow pelvic canal is the...
English bulldogs have been reported to have a high incidence of dystocia and caesarean section is often performed electively in this breed. A narrow pelvic canal is the major maternal factor contributing to obstructive dystocia. The objective of this cross-sectional study was to assess the pelvic dimensions of 40 clinically healthy English bulldogs using computed tomography pelvimetry. A control group consisting of 30 non-brachycephalic dogs that underwent pelvic computed tomography was retrospectively collected from the patient archive system. Univariate analysis of variance was used to compare computed tomography pelvimetry of both groups and the effects of weight and gender on the measurements. In addition, ratios were obtained to address pelvic shape differences. A significantly (P = 0.00) smaller pelvic size was found in English bulldogs compared to the control group for all computed tomography measurements: width and length of the pelvis, pelvic inlet and caudal pelvic aperture. The pelvic conformation was significantly different between the groups, English bulldogs had an overall shorter pelvis and pelvic canal and a narrower pelvic outlet. Weight had a significant effect on all measurements whereas gender that only had a significant effect on some (4/11) pelvic dimensions. Our findings prove that English bulldogs have a generally reduced pelvic size as well as a shorter pelvis and narrower pelvic outlet when compared to non-brachycephalic breeds. We suggest that some of our measurements may serve as a baseline for pelvic dimensions in English bulldogs and may be useful for future studies on dystocia in this breed.
Topics: Animals; Body Weight; Cross-Sectional Studies; Dog Diseases; Dogs; Dystocia; Female; Male; Pelvimetry; Pelvis; Pregnancy; Retrospective Studies; Species Specificity; Tomography, X-Ray Computed
PubMed: 29906664
DOI: 10.1016/j.theriogenology.2018.05.025 -
FP Essentials Apr 2018Labor is defined as contractions with cervical change and active labor starts when the cervix is dilated 6 cm. Updated labor curves and definitions should be used to...
Labor is defined as contractions with cervical change and active labor starts when the cervix is dilated 6 cm. Updated labor curves and definitions should be used to define labor dystocia. Oxytocin and amniotomy have important roles in the management of labor dystocia. Structured intermittent fetal monitoring should be considered for women with low-risk pregnancies but continuous electronic fetal monitoring still is used most commonly. Moderate fetal heart rate variability is the most reliable marker of fetal well-being. Epidural analgesia is used in more than half of all births in the United States. It is not associated with an increase in the rate of cesarean deliveries but is associated with a longer second stage of labor. Interventions that may reduce the need for cesarean delivery include use of the new definitions of labor dystocia, a trial of manual rotation of occiput posterior presentations, use of cervical ripening agents for induction of labor with an unfavorable cervix, and encouragement of women with previous cesarean deliveries to attempt vaginal delivery.
Topics: Amniotomy; Analgesia, Epidural; Cesarean Section; Delivery, Obstetric; Dystocia; Female; Fetal Monitoring; Humans; Labor, Obstetric; Oxytocin; Pregnancy; United States
PubMed: 29683307
DOI: No ID Found -
Birth (Berkeley, Calif.) Jun 2022Physiological plateaus (slowing, stalling, pausing) during normal labor and birth have been reported for decades, but have received limited attention in research and... (Review)
Review
BACKGROUND
Physiological plateaus (slowing, stalling, pausing) during normal labor and birth have been reported for decades, but have received limited attention in research and clinical practice. To date, heterogeneous conceptualizations and terminology have impeded effective communication and research in this area, raising concern as to whether some physiological plateaus might be misinterpreted as dystocia. To address this issue, we provide a point of orientation, mapping contemporary concepts, and terminologies of physiological plateaus during normal labor and birth.
METHODS
We conducted a scoping review, considering published and unpublished reports of physiological plateaus, reported in any language, between 1990 and 2021. Database searches of CINAHL, EMBASE, Emcare, MIDIRS, MEDLINE, Scopus, and Open Grey yielded 1,953 records, with an additional 35 reports identified by hand searching. In total, 43 reports from eleven countries were included in this scoping review.
RESULTS
Conceptualizations of physiological plateaus are heterogeneous and can be allocated to six conceptual groups: cervical reversal or recoil, plateaus, lulls during transition, "rest and be thankful" stage, deceleration phase, and latent phases. Across included material, we identified over 60 different terms referring to physiological plateaus. Overall, physiological plateaus are reported across the entire continuum of normal labor and birth.
CONCLUSIONS
Physiological plateaus may be an essential mechanism of self-regulation of the mother-infant dyad, facilitating feto-maternal adaptation and preventing maternal and fetal distress during labor and birth.
Topics: Dystocia; Female; Humans; Labor, Obstetric; Parturition; Pregnancy
PubMed: 34989012
DOI: 10.1111/birt.12607 -
Journal of Pregnancy 2018To investigate how macrosomia affects foetal-maternal birth outcomes, we conducted a retrospective cohort study of singleton pregnant women who gave birth at gestational...
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.
Topics: Adult; Birth Injuries; Birth Weight; Cesarean Section; Dystocia; Female; Fetal Macrosomia; Humans; Infant, Newborn; Lacerations; Perineum; Postpartum Hemorrhage; Pregnancy; Retrospective Studies; Risk Factors
PubMed: 30174954
DOI: 10.1155/2018/4790136 -
European Journal of Obstetrics,... Nov 2021The Zavanelli manoeuvre is often the final resort of the clinician facing undeliverable shoulder dystocia and we present retrospective pooled data comprising 110... (Review)
Review
The Zavanelli manoeuvre is often the final resort of the clinician facing undeliverable shoulder dystocia and we present retrospective pooled data comprising 110 shoulder dystocia cases, 11 impacted breech and 11 locked twin deliveries assessed from ten case series and 38 individual case reports. Although recommended when other external and internal manipulations have failed, we suspect that many clinicians have not had formal training on how to conduct the manoeuvre and may be unfamiliar with the steps involved, leading to a reluctance and delay in initiating this. We describe original descriptions of the manoeuvre, examine its use in intractable shoulder dystocia and illustrate stepwise the cephalic replacement technique. For this review, we have concentrated mainly on the outcomes of the Zavanelli manoeuvre in shoulder dystocia but have also touched on its role in impacted breech and locked twin deliveries. Lastly, we discuss the cognitive load an obstetrician faces when having to make time critical decisions in severe shoulder dystocia and share how other disciplines train and prepare their personnel to manage similar rare and unexpected scenarios.
Topics: Delivery, Obstetric; Dystocia; Female; Humans; Pregnancy; Pregnancy, Twin; Retrospective Studies; Shoulder; Shoulder Dystocia
PubMed: 34592651
DOI: 10.1016/j.ejogrb.2021.09.011 -
American Family Physician Feb 2021
Topics: Emergency Service, Hospital; Female; Humans; Pregnancy; Shoulder; Shoulder Dystocia; Symphysiotomy
PubMed: 33507057
DOI: No ID Found -
BMC Pregnancy and Childbirth May 2022The effects of diagnosing and treating labor dystocia with oxytocin infusion at different cervical dilatations have not been fully evaluated. Therefore, we aimed to...
BACKGROUND
The effects of diagnosing and treating labor dystocia with oxytocin infusion at different cervical dilatations have not been fully evaluated. Therefore, we aimed to examine whether cervical dilatation at diagnosis of dystocia and initiation of oxytocin infusion at different stages of cervical dilatation were associated with mode of birth, obstetric complications and women's birthing experience.
METHODS
A retrospective cohort study, including 588 nulliparous term women with spontaneous onset of labor and dystocia requiring oxytocin augmentation. The study population was divided into three groups according to cervical dilatation at diagnosis of dystocia and initiation of oxytocin-infusion (≤ 5 cm, 6-10 cm, fully dilated) with mode of birth as the primary outcome. Secondary outcomes were obstetrical and neonatal complications and women´s experience of childbirth. Statistical comparison between groups using Chi-square and ANOVA was performed. The risk of operative birth (cesarean section and instrumental birth) was assessed using binary logistic regression with suitable adjustments (maternal age, body mass index and risk assessment on admission to the labor ward).
RESULTS
The cesarean section rate differed between the groups (p < 0.001); 12% in the ≤ 5 cm group, 6% in the 6-10 cm group and 0% in the fully dilated group. There was no increased risk for operative birth in the ≤ 5 cm group compared to the 6-10 cm group, adjusted OR 1.28 95%CI (0.78-2.08). The fully dilated group had a decreased risk of operative birth (adjusted OR 0.48 95%CI (0.27-0.85). The rate of a negative birthing experience was high in all groups (28.5%, 19% and 18%) but was only increased among women in the ≤ 5 cm group compared with the 6-10 cm group, adjusted OR 1.76 95%CI (1.05-2.95).
CONCLUSIONS
Although no difference in the risk of operative birth was found between the ≤ 5 cm and 6-10 cm cervical dilatation-groups, the cesarean section rate was highest in women with dystocia requiring oxytocin augmentation at ≤ 5 cm cervical dilatation. This might indicate that oxytocin augmentation before 6 cm cervical dilatation could be contra-productive in preventing cesarean sections. Further, the increased risk of negative birth experience in the ≤ 5 cm group should be kept in mind to improve labor care.
Topics: Cesarean Section; Dystocia; Female; Humans; Infant, Newborn; Labor Stage, First; Oxytocin; Pregnancy; Retrospective Studies
PubMed: 35562716
DOI: 10.1186/s12884-022-04710-2 -
Scientific Reports Apr 2022A deeper understanding of the risk factors for dystocia and stillbirth could help farmers make decisions about dairy cow management. The objectives of this study were to...
A deeper understanding of the risk factors for dystocia and stillbirth could help farmers make decisions about dairy cow management. The objectives of this study were to investigate cow-level risk factors associated with dystocia and stillbirth in a relatively large sample of dairy cows using multivariable linear regression models. The data consisted of 51,405 calving records of 14,546 Holstein cows from 3 dairy herds in Isfahan Province, Iran, collected between April 2011 and September 2017. To investigate the association between selected blood macro-minerals and the incidence of dystocia and stillbirth, blood samples were collected at the time of parturition from a random subset of these cows, which included 1311 animals. The incidence of dystocia and stillbirths averaged 14.7% and 4.3%, respectively. Results showed that calving year, calving season, dry period length, BCS, parity, calf sex, calf birth weight, twin status, and stillbirth were significantly associated with the incidence of dystocia. According to the Random Forest (RF) classifier, we found that dry period length, calf birth weight, and parity were the most important cow-level risk factors for the incidence of dystocia. Calving year, calving season, parity, twin status, dry period length, calf birth weight, calf sex, and dystocia were significantly associated with the incidence of stillbirths. The most important risk factors identified by the RF classifier for stillbirths were twin status, parity, dry period length, and calf birth weight. Also, interactions between the cow-level risk factors associated with dystocia and stillbirth were identified. The incidence of dystocia was associated with the interactions of twin status × calf birth weight and twin status × stillbirth. According to our analysis, the incidence of stillbirth is caused by interactions among several factors, such as twin status × length of dry period, twin status × calving season, and twin status × parity. The highest incidence of dystocia (21.3%) and stillbirths (5.4%) was observed in hypo-calcemic cows. In conclusion, twin status seems to be a determining factor for the incidence of stillbirths but not for dystocia. Finally, the results of this study may help the dairy industry make management decisions aimed at reducing dystocia and stillbirth rates.
Topics: Animals; Birth Weight; Cattle; Cattle Diseases; Dystocia; Female; Minerals; Parity; Parturition; Pregnancy; Risk Factors; Stillbirth
PubMed: 35396559
DOI: 10.1038/s41598-022-09928-w -
Journal of Obstetrics and Gynaecology :... Dec 2023To establish and verify a model for labour dystocia occurring in the active phase, this study retrospectively analysed the clinical data of primiparas with singleton...
To establish and verify a model for labour dystocia occurring in the active phase, this study retrospectively analysed the clinical data of primiparas with singleton cephalic full-term foetuses, who had delivered after a trial of labour. The Chi-square test, -test, Mann-Whitney U test and multivariate logistic regression analysis were used for statistical analysis. Based on the model a nomogram was established using the R programming language. Multivariate logistic regression analysis showed that the foetal abdominal circumference, premature rupture of membranes (PROM), prolonged latent phase, foetal station and foetal position at the early stage of the active phase were independent factors influencing labour dystocia occurring in the active phase. The established model could effectively and accurately support clinicians in the early identification of labour dystocia to improve maternal and infant outcomes.Impact statement Labour dystocia occurring during the active phase of the first stage, is the most commonly diagnosed as labour aberration. Previous studies have suggested that maternal age, body mass index, macrosomia and abnormal foetal position are the independent risk factors for labour dystocia. However, only the risk factors were reported, and few prediction models were established. This study uses data in the real world to establish a prediction model of full-term singleton primipara with labour dystocia occurring in the active phase by logistic regression analysis. Foetal abdomen circumference, PROM, prolonged latent phase, the foetal station and foetal position at the early stage of the active phase are independent factors influencing labour dystocia that occurs in the active phase. In addition, a nomogram is established as a visual graph to predict the probability of it. The nomogram based on the predictive model discarded complicated calculations and presented an easy visual graph-based method to predict the probability of labour dystocia occurring in the active phase. It helps to introduce interventions that could reduce the CS rate and occurrence of adverse maternal and foetal outcomes to ensure the safety of mothers and infants.
Topics: Female; Pregnancy; Humans; Retrospective Studies; Labor, Obstetric; Dystocia; Maternal Age; Fetal Macrosomia
PubMed: 36789884
DOI: 10.1080/01443615.2023.2174837