-
The Cochrane Database of Systematic... Mar 2023Women with a suspected large-for-dates fetus or a fetus with suspected macrosomia (birthweight greater than 4000 g) are at risk of operative birth or caesarean section.... (Review)
Review
BACKGROUND
Women with a suspected large-for-dates fetus or a fetus with suspected macrosomia (birthweight greater than 4000 g) are at risk of operative birth or caesarean section. The baby is also at increased risk of shoulder dystocia and trauma, in particular fractures and brachial plexus injury. Induction of labour may reduce these risks by decreasing the birthweight, but may also lead to longer labours and an increased risk of caesarean section.
OBJECTIVES
To assess the effects of a policy of labour induction at or shortly before term (37 to 40 weeks) for suspected fetal macrosomia on the way of giving birth and maternal or perinatal morbidity.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2016), contacted trial authors and searched reference lists of retrieved studies.
SELECTION CRITERIA
Randomised trials of induction of labour for suspected fetal macrosomia.
DATA COLLECTION AND ANALYSIS
Review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We contacted study authors for additional information. For key outcomes the quality of the evidence was assessed using the GRADE approach.
MAIN RESULTS
We included four trials, involving 1190 women. It was not possible to blind women and staff to the intervention, but for other 'Risk of bias' domains these studies were assessed as being at low or unclear risk of bias. Compared to expectant management, there was no clear effect of induction of labour for suspected macrosomia on the risk of caesarean section (risk ratio (RR) 0.91, 95% confidence interval (CI) 0.76 to 1.09; 1190 women; four trials, moderate-quality evidence) or instrumental delivery (RR 0.86, 95% CI 0.65 to 1.13; 1190 women; four trials, low-quality evidence). Shoulder dystocia (RR 0.60, 95% CI 0.37 to 0.98; 1190 women; four trials, moderate-quality evidence), and fracture (any) (RR 0.20, 95% CI 0.05 to 0.79; 1190 women; four studies, high-quality evidence) were reduced in the induction of labour group. There were no clear differences between groups for brachial plexus injury (two events were reported in the control group in one trial, low-quality evidence). There was no strong evidence of any difference between groups for measures of neonatal asphyxia; low five-minute infant Apgar scores (less than seven) or low arterial cord blood pH (RR 1.51, 95% CI 0.25 to 9.02; 858 infants; two trials, low-quality evidence; and, RR 1.01, 95% CI 0.46 to 2.22; 818 infants; one trial, moderate-quality evidence, respectively). Mean birthweight was lower in the induction group, but there was considerable heterogeneity between studies for this outcome (mean difference (MD) -178.03 g, 95% CI -315.26 to -40.81; 1190 infants; four studies; I = 89%). For outcomes assessed using GRADE, we based our downgrading decisions on high risk of bias from lack of blinding and imprecision of effect estimates.
AUTHORS' CONCLUSIONS
Induction of labour for suspected fetal macrosomia has not been shown to alter the risk of brachial plexus injury, but the power of the included studies to show a difference for such a rare event is limited. Also antenatal estimates of fetal weight are often inaccurate so many women may be worried unnecessarily, and many inductions may not be needed. Nevertheless, induction of labour for suspected fetal macrosomia results in a lower mean birthweight, and fewer birth fractures and shoulder dystocia. The observation of increased use of phototherapy in the largest trial, should also be kept in mind. Findings from trials included in the review suggest that to prevent one fracture it would be necessary to induce labour in 60 women. Since induction of labour does not appear to alter the rate of caesarean delivery or instrumental delivery, it is likely to be popular with many women. In settings where obstetricians can be reasonably confident about their scan assessment of fetal weight, the advantages and disadvantages of induction at or near term for fetuses suspected of being macrosomic should be discussed with parents. Although some parents and doctors may feel the evidence already justifies induction, others may justifiably disagree. Further trials of induction shortly before term for suspected fetal macrosomia are needed. Such trials should concentrate on refining the optimum gestation of induction, and improving the accuracy of the diagnosis of macrosomia.
Topics: Infant; Infant, Newborn; Pregnancy; Female; Humans; Cesarean Section; Fetal Macrosomia; Birth Weight; Shoulder Dystocia; Fetal Weight; Labor, Induced
PubMed: 36884238
DOI: 10.1002/14651858.CD000938.pub3 -
American Journal of Obstetrics and... Mar 2024This tutorial of the intrapartum management of shoulder dystocia uses drawings and videos of simulated and actual deliveries to illustrate the biomechanical principles... (Review)
Review
This tutorial of the intrapartum management of shoulder dystocia uses drawings and videos of simulated and actual deliveries to illustrate the biomechanical principles of specialized delivery maneuvers and examine missteps associated with brachial plexus injury. It is intended to complement haptic, mannequin-based simulation training. Demonstrative explication of each maneuver is accompanied by specific examples of what not to do. Positive (prescriptive) instruction prioritizes early use of direct fetal manipulation and stresses the importance of determining the alignment of the fetal shoulders by direct palpation, and that the biacromial width should be manually adjusted to an oblique orientation within the pelvis-before application of traction to the fetal head, the biacromial width is manually adjusted to an oblique orientation within the pelvis. Negative (proscriptive) instructions includes the following: to avoid more than usual and/or laterally directed traction, to use episiotomy only as a means to gain access to the posterior shoulder and arm, and to use a 2-step procedure in which a 60-second hands-off period ("do not do anything") is inserted between the emergence of the head and any initial attempts at downward traction to allow for spontaneous rotation of the fetal shoulders. The tutorial presents a stepwise approach focused on the delivering clinician's tasks while including the role of assistive techniques, including McRoberts, Gaskin, and Sims positioning, suprapubic pressure, and episiotomy. Video footage of actual deliveries involving shoulder dystocia and permanent brachial plexus injury demonstrates ambiguities in making the diagnosis of shoulder dystocia, risks of improper traction and torsion of the head, and overreliance on repeating maneuvers that prove initially unsuccessful.
Topics: Pregnancy; Female; Humans; Dystocia; Shoulder Dystocia; Shoulder; Episiotomy; Prenatal Care; Delivery, Obstetric
PubMed: 38462247
DOI: 10.1016/j.ajog.2022.03.016 -
Obstetrics and Gynecology Oct 2023To estimate racial and ethnic disparities in type 2 diabetes mellitus after gestational diabetes mellitus (GDM) and to investigate baseline pregnancy clinical and social...
OBJECTIVE
To estimate racial and ethnic disparities in type 2 diabetes mellitus after gestational diabetes mellitus (GDM) and to investigate baseline pregnancy clinical and social or structural characteristics as mediators.
METHODS
We conducted a retrospective cohort of individuals with GDM using linked 2009-2011 New York City birth and hospital data and 2009-2017 New York City A1c Registry data. We ascertained GDM and pregnancy characteristics from birth and hospital records. We classified type 2 diabetes as two hemoglobin A 1c test results of 6.5% or higher. We grouped pregnancy characteristics into clinical (body mass index [BMI], chronic hypertension, gestational hypertension, preeclampsia, preterm delivery, caesarean, breastfeeding, macrosomia, shoulder dystocia) and social or structural (education, Medicaid insurance, prenatal care, and WIC [Special Supplemental Nutrition Program for Women, Infants, and Children] participation). We used Cox proportional hazards models to estimate associations between race and ethnicity and 8-year type 2 diabetes incidence, and we tested mediation of pregnancy characteristics, additionally adjusting for age and nativity (U.S.-born vs foreign-born).
RESULTS
The analytic data set included 22,338 patients with GDM. The 8-year type 2 diabetes incidence was 11.7% overall and 18.5% in Black, 16.8% in South and Southeast Asian, 14.6% in Hispanic, 5.5% in East and Central Asian, and 5.4% in White individuals with adjusted hazard ratios of 4.0 (95% CI 2.4-3.9), 2.9 (95% CI 2.4-3.3), 3.3 (95% CI 2.7-4.2), and 1.0 (95% CI 0.9-1.4) for each group compared with White individuals. Clinical and social or structural pregnancy characteristics explained 9.3% and 23.8% of Black, 31.2% and 24.7% of Hispanic, and 7.6% and 16.3% of South and Southeast Asian compared with White disparities. Associations between education, Medicaid insurance, WIC participation, and BMI and type 2 diabetes incidence were more pronounced among White than Black, Hispanic, and South and Southeast Asian individuals.
CONCLUSION
Population-based racial and ethnic inequities are substantial in type 2 diabetes after GDM. Characteristics at the time of delivery partially explain disparities, creating an opportunity to intervene on life-course cardiometabolic inequities, whereas weak associations of common social or structural measures and BMI in Black, Hispanic and South and Southeast Asian individuals demonstrate the need for greater understanding of how structural racism influences postpartum cardiometabolic risk in these groups.
Topics: Pregnancy; Child; Infant; United States; Infant, Newborn; Humans; Female; Diabetes, Gestational; Diabetes Mellitus, Type 2; Retrospective Studies; Fetal Macrosomia; Hypertension, Pregnancy-Induced
PubMed: 37678923
DOI: 10.1097/AOG.0000000000005324 -
Journal of Personalized Medicine May 2024The term dystocia refers to labor characterized by a slow progression with delayed rates or even pauses in the dilation of the cervix or the descent of the fetus.... (Review)
Review
The term dystocia refers to labor characterized by a slow progression with delayed rates or even pauses in the dilation of the cervix or the descent of the fetus. Dystocia describes the deviation from the limits that define a normal birth and is often used as a synonym for the term pathological birth. Shoulder dystocia, also known as the manual exit of the shoulders during vaginal delivery on cephalic presentation, is defined as the "failure of the shoulders to spontaneously traverse the pelvis after delivery of the fetal head". This means that obstetric interventions are necessary to deliver the fetus's body after the head has been delivered, as gentle traction has failed. Abnormal labor (dystocia) is expressed and represented in partograms or by the prolongation of the latent phase or by slowing and pausing in the phases of cervical dilatation and fetal descent. While partograms are helpful in visualizing the progress of labor, regular use of them has not been shown to enhance obstetric outcomes considerably, and no partogram has been shown to be superior to others in comparative trials. Dystocia can, therefore, appear in any phase of the evolution of childbirth, so it is necessary to simultaneously assess all the factors that may contribute to its abnormal evolution, that is, the forces exerted, the weight, the shape, the presentation and position of the fetus, the integrity and morphology of the pelvis, and its relation to the fetus. When this complication occurs, it can result in an increased incidence of maternal morbidity, as well as an increased incidence of neonatal morbidity and mortality. Although several risk factors are associated with shoulder dystocia, it has proven impossible to recognize individual cases of shoulder dystocia in practice before they occur during labor. Various guidelines have been published for the management of shoulder dystocia, with the primary goal of educating the obstetrician and midwife on the importance of a preplanned sequence of maneuvers, thereby reducing maternal and neonatal morbidity and mortality.
PubMed: 38929807
DOI: 10.3390/jpm14060586 -
Animals : An Open Access Journal From... Oct 2020In this study, we determined the occurrence of reproductive diseases in does on 1373 visited farms in Spain and Portugal, between 1994 and 2019. The retrospective...
In this study, we determined the occurrence of reproductive diseases in does on 1373 visited farms in Spain and Portugal, between 1994 and 2019. The retrospective information obtained was entered in a database classified as follows: apparent infertility (≤70% pregnancy rate), abortions (≥2% of serviced does), high fetal death risk at parturition (≥10%) or dystocia, amongst others. Infertility was the reason for 181 visits. The median of prevalence of apparent infertility in these cases was 35% (minimum to maximum: 25-90%) and the mean, 37.4%. We performed a prospective study to determine risk factors at the individual and farm level, with a second database corresponding to 2014-2019. We carried out pregnancy checks, assessed sanitary status and body condition, and recorded the age of 17,297 rebred lactating does on 142 farms. The median size of the farms was 800 does, and the examined cohorts, 350 does. Predisposing risk factors for infertility were observed: e.g., mastitis had an effect. During the 5-year study, we made a third database with the results from 190,508 does palpated by producers in a subset of 134 farms. In this case, the median of the prevalence of apparent infertility was 14.5% (minimum to maximum: 4.1-50%), which could be considered baseline occurrence when monitoring the theriogenology of rabbit doe farms. Reproductive rhythm was an enabling risk factor: does serviced ≤25 d postpartum were less fertile than at ≥32 d. We made a database with the body condition score (BCS) on a linear scale from 1 (emaciated) to 9 (obese). The pregnancy rate (PR) of underweight and borderline does (4/9) was 73.1%. The PR of overweight and borderline does (6/9) was 82.6% and those classified with a mean BCS (5/9): PR = 79.3%. We may infer that the optimum BCS for reproduction is 6/9, rather than 5/9. Some changes in female rabbit health and husbandry to improve reproductive performance and welfare are highlighted.
PubMed: 33066475
DOI: 10.3390/ani10101873 -
Animals : An Open Access Journal From... Jan 2022The main conditions and diseases considered painful in dairy cows are mastitis, lameness, calving (including dystocia and caesarean section) and metritis. The cattle... (Review)
Review
The main conditions and diseases considered painful in dairy cows are mastitis, lameness, calving (including dystocia and caesarean section) and metritis. The cattle literature reports that deviation from normal daily activity patterns (both increased and/or reduced daily lying time) can be indicative of painful conditions and diseases in cows. This narrative review discusses on how pain due to several health conditions in dairy cows modifies its activity pattern and explores if non-steroidal anti-inflammatory drugs (NSAIDs) are capable of restoring it. Divergent outcomes may differ depending upon the painful cause, the severity and the moment, and consequently its interpretation should be properly explained. For instance, cows with clinical mastitis reduced their time lying and increased the number of lying bouts and stepping due to pain caused by the swollen udder when cows are lying. However, lame cows show longer lying times, with a lower number of lying bouts and longer and more variable lying bouts duration, as compared to non-lame cows. When the relationship between painful disorders and daily activity patterns is studied, factors such as parity, bedding type and severity of disease are important factors to take into consideration. The potential benefits of the NSAIDs treatment in painful health disorders depend upon the type of drug administered, its dosage and administration mode, and the time of administration relative to the painful health disorder. This narrative review can be used as a tool to properly interpret and grade pain in cows through behavioural activity patterns and proposes directions for future investigations.
PubMed: 35049798
DOI: 10.3390/ani12020176 -
BMC Pregnancy and Childbirth Mar 2021Intrauterine inflammation affects short- and long-term neonatal outcomes. Histological chorioamnionitis and funisitis are acute inflammatory responses in the fetal...
BACKGROUND
Intrauterine inflammation affects short- and long-term neonatal outcomes. Histological chorioamnionitis and funisitis are acute inflammatory responses in the fetal membranes and umbilical cord, respectively. Although labor dystocia includes a potential risk of intrauterine inflammation, the risk of histological chorioamnionitis and funisitis of labor dystocia has not been evaluated yet. This study aimed to examine the association between labor dystocia and risk of histological chorioamnionitis and funisitis.
METHODS
In this retrospective cohort study, the cases who underwent histopathological examinations of the placenta and umbilical cord at Fukushima Medical University Hospital, Japan, between 2015 and 2020, were included. From the dataset, the pathological findings of the patients with labor dystocia and spontaneous preterm birth were reviewed. Based on the location of leukocytes, the inflammation in the placenta (histological chorioamnionitis) and umbilical cord (funisitis) was staged as 0-3. Multiple logistic regression analysis was performed to evaluate the risk of histological chorioamnionitis, histological chorioamnionitis stage ≥2, funisitis, and funisitis stage ≥2.
RESULT
Of 317 women who met the study criteria, 83 and 144 women had labor dystocia and spontaneous preterm birth, respectively, and 90 women were included as controls. Labor dystocia was a risk factor for histological chorioamnionitis (adjusted odds ratio, 6.3; 95% confidential interval, 1.9-20.5), histological chorioamnionitis stage ≥2 (adjusted odds ratio, 6.0; 95% confidence interval, 1.7-21.8), funisitis (adjusted odds ratio, 15.4; 95% confidence interval, 2.3-101.3), and funisitis stage ≥2 (adjusted odds ratio, 18.5; 95% confidence interval, 2.5-134.0). Spontaneous preterm birth was also a risk factor for histological chorioamnionitis (adjusted odds ratio, 3.7; 95% confidence interval, 1.7-7.8), histological chorioamnionitis stage ≥2 (adjusted odds ratio, 3.0; 95% confidence interval, 1.2-7.9), and funisitis (adjusted odds ratio, 6.6; 95% confidence interval, 1.4-30.6). However, the adjusted odds ratio was smaller in spontaneous preterm births than in labor dystocia.
CONCLUSION
Labor dystocia is a risk factor for severe histological chorioamnionitis and funisitis. Further studies are required to evaluate the effects of histological chorioamnionitis and funisitis on long-term neonatal outcomes.
Topics: Adult; Chorioamnionitis; Datasets as Topic; Dystocia; Female; Humans; Infant, Newborn; Japan; Placenta; Pregnancy; Premature Birth; Retrospective Studies; Risk Factors; Severity of Illness Index; Tertiary Care Centers; Umbilical Cord
PubMed: 33784970
DOI: 10.1186/s12884-021-03719-3 -
Brazilian Journal of Biology = Revista... 2021Reproductive diseases have been well documented in domestic livestock such as sheep, goat, cattle and pigs. However, there is very little information on these diseases...
Reproductive diseases have been well documented in domestic livestock such as sheep, goat, cattle and pigs. However, there is very little information on these diseases in the agouti (Dasyprocta leporina). The agouti is used for its meat in South America and the Caribbean. More recently, intensive farming of this animal is being practiced in the Neotropics. There is dearth of information on dystocia and vaginal prolapses in the agouti. This document reports on three cases of reproductive diseases in captive reared agoutis in Trinidad and Tobago. The first case was a female agouti weighing approximately 3 kg that was in the last stage of pregnancy, which was found dead in its cage. The vulva of the mother had the protruding hind-limbs of the fetus. Necroscopic evaluation of carcass revealed little fat tissue and the mother had two fetuses in the right horn of the uterus. Each fetus weighed approximately 200 g. The fetuses were well formed with fur, teeth and eyes. The placenta was attached to each fetus. The pathological findings suggested that dystocia resulted from secondary uterine inertia which was the cause of death of the adult female agouti. The second case was that of an adult female agouti weighing 2.5 kg. This female had given birth to an offspring three weeks prior and was observed to have had a vaginal prolapse. Surgery was performed and the prolapsed vagina was placed back into the pelvic cavity. Further to this intervention, the vagina prolapsed twice. Subsequent to the re-insertion of the vaginal tissue the agouti was euthanized. The third case was also that of a dystocia. However, the fetuses weighed 235 g and 165 g respectively and were in normal presentation, posture and positioning. The fetus however was unable to pass via the vagina and was trapped in the pelvic cavity. This caused secondary uterine inertia which was the cause of death. The causes of reproductive diseases in these cases are unknown but the feeding management and space allowance given to the agouti in late gestation may be contributing factors.
Topics: Animals; Caribbean Region; Cattle; Dasyproctidae; Female; Pregnancy; Sheep; South America; Swine; Trinidad and Tobago
PubMed: 34105674
DOI: 10.1590/1519-6984.237869 -
Veterinary World Jun 2022Previous findings regarding the effects of farrowing induction on the farrowing characteristics of sows are controversial. This study aimed to investigate the effects of...
BACKGROUND AND AIM
Previous findings regarding the effects of farrowing induction on the farrowing characteristics of sows are controversial. This study aimed to investigate the effects of farrowing induction on the following characteristics: (1) Proportion of sows that farrowed during working hours, (2) stillbirth rate, (3) number of stillbirths per farrow, (4) dystocia rate per farrow, (5) dystocia rate (the proportion of farrowings that had at least one dystocia event), (6) number of dystocia events per farrow, (6) farrowing duration, (7) birth interval, and (8) birth weight.
MATERIALS AND METHODS
Thirty-eight Landrace x Yorkshire sows were randomly allocated into two groups; the control group and the treatment group. In the control group (n = 18), sows farrowed spontaneously. In the treatment group (n = 20), farrowing was induced approximately 2 days earlier than the herd's average length of gestation (7:00 am on day 114) by injecting cloprostenol into the perivulval region. All sows were supervised throughout their farrowing. We recorded the interval between induction and farrowing; total number of births; number of live, stillborn, and mummified piglet births; number of dystocia events; birth interval; farrowing duration; and birth weight. A generalized linear mixed model, a linear mixed-effects model, the Chi-squared test, and Student's t-test were used to compare outcomes between the two groups.
RESULTS
Farrowing induction did not influence the percentage of sows that farrowed during working hours (7 am-5 pm), stillbirth rate, birth weight, and number of dystocia events per farrow. Farrowing induction led to an increase in birth interval, dystocia rate, dystocia per farrow (p < 0.05) and in addition to the percentage of sows that farrowed on the day following induction (60% vs. 27.8%; p < 0.05).
CONCLUSION
Farrowing induction using a single dose of cloprostenol 2 days before the expected farrowing date can be performed with care to concentrate farrowing into a short interval. This can enhance the optimization of cross-fostering and the practice of an all-in-all-out strategy in the swine breeding industry.
PubMed: 35993062
DOI: 10.14202/vetworld.2022.1535-1540 -
Journal of Midwifery & Women's Health May 2020Labor dystocia is the most common cause of cesarean birth in the United States, yet how dystocia develops during labor remains elusive. Uterine activity monitoring has... (Review)
Review
INTRODUCTION
Labor dystocia is the most common cause of cesarean birth in the United States, yet how dystocia develops during labor remains elusive. Uterine activity monitoring has significant potential for advancing our understanding of labor dystocia. While evaluating contraction frequency and amplitude is a common component of labor dystocia management, the literature describing the relationship between measures of uterine activity and labor dystocia is heterogeneous and has not been synthesized to identify the best methods for use in clinical investigation.
METHODS
We conducted a literature search for original research exploring the relationship between uterine activity and labor dystocia published between 2000 and 2019. Included articles were critically reviewed and synthesized.
RESULTS
Across 11 identified studies, investigators employed 3 different techniques for monitoring uterine activity and 9 different measures were employed. Uterine activity measures, including Montevideo units, uterine electromyography power density spectrum and sample entropy, and the fall-to-rise ratio of contraction shape, detected patterns associated with labor dystocia or cesarean birth.
DISCUSSION
The use of multiple regression with clinical covariates and a uterine activity measure increased the accuracy of predicting cesarean delivery. Uterine electromyography may be especially useful to evaluate labor dystocia phenotypes to differentiate uterine muscle fatigue from understimulation and lead to algorithms for increased precision in the diagnosis of labor dystocia and innovative approaches to treatment.
Topics: Adult; Cesarean Section; Dystocia; Electromyography; Female; Humans; Labor, Obstetric; Obstetric Labor Complications; Pregnancy; Uterus
PubMed: 32478978
DOI: 10.1111/jmwh.13119