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Acta Obstetricia Et Gynecologica... Jan 2021
Topics: Adult; Female; Humans; Postpartum Hemorrhage; Pregnancy; Suture Techniques; Uterine Inertia
PubMed: 33314064
DOI: 10.1111/aogs.14035 -
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 -
Acta Medica Portuguesa Jan 2022Postpartum haemorrhage is still the main cause of maternal morbidity and mortality. Many treatments are available, but they may threaten fertility potential. As a... (Review)
Review
INTRODUCTION
Postpartum haemorrhage is still the main cause of maternal morbidity and mortality. Many treatments are available, but they may threaten fertility potential. As a uterine sparing procedure, we aimed to review uterine compression sutures in order to better understand when they should represent an appropriate option.
MATERIAL AND METHODS
A comprehensive search in MEDLINE and PubMed databases including the terms 'postpartum haemorrhage' and 'uterine compression sutures' was performed. Results were revised and articles reviewing or presenting case reports of uterine compression sutures to treat postpartum haemorrhage were included.
RESULTS
The first description of uterine compression sutures to control postpartum haemorrhage was published in 1997, by B-Lynch et al. After this publication, many others have reported successful management of postpartum haemorrhage with different suturing techniques. Most of them describe success rates above 75% and the possibility of fertility preservation, with cases of uneventful pregnancy after uterine compression sutures already published. Complications associated with each technique are rare.
DISCUSSION
Reports of use of uterine compression sutures include small series of cases or even single case reports which limits the quality of existing evidence to support one technique over another. Nevertheless, uterine compression sutures are recognized as an effective surgical conservative strategy to control postpartum haemorrhage due to uterine atony and its use is recommended, if possible, prior to hysterectomy.
CONCLUSION
Uterine compression sutures are effective, safe and simple to perform in an emergent situation and preserve fertility potential in cases of postpartum haemorrhage.
Topics: Female; Humans; Postpartum Hemorrhage; Pregnancy; Suture Techniques; Sutures; Uterine Inertia; Uterus
PubMed: 32208130
DOI: 10.20344/amp.11987 -
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 Patient-centered Research... 2023Anecdotally, there are attestations from clinicians of calcium carbonate being used successfully for laboring people experiencing labor dystocia. The goal of this... (Review)
Review
Anecdotally, there are attestations from clinicians of calcium carbonate being used successfully for laboring people experiencing labor dystocia. The goal of this narrative review was to provide a synopsis of pertinent literature on calcium use in obstetrics to explore the potential benefit of calcium carbonate as a simple and low-cost intervention for prevention or treatment of labor dystocia. To answer how calcium and carbonate physiologically contribute to myometrium contractility, we conducted a literature search of English-language peer-reviewed articles, with no year limitation, consisting of the keywords "calcium," "calcium carbonate," "calcium gluconate," "pregnancy," "hemorrhage," and variations of "smooth muscle contractility" and "uterine contractions." Though no overt evidence on calcium carbonate's ability to prevent labor dystocia was identified; relevant information was found regarding smooth muscle contractility, calcium's influence on uterine muscle contractility, and carbonate's potential impact on reducing amniotic fluid lactate levels to restore uterine contractility during labor. Studies reporting the potential effectiveness of calcium gluconate and sodium bicarbonate in preventing labor dystocia offer background, safety information, and rationale for a future randomized control trial to evaluate the ability of calcium carbonate to prevent labor dystocia and reduce rates of cesarean section.
PubMed: 37483561
DOI: 10.17294/2330-0698.2010 -
Journal of Clinical Medicine Mar 2024Recommendations for weight gain during pregnancy are based on pre-pregnancy body mass index (BMI). Pregnancy is a risk factor for excessive weight gain and many... (Review)
Review
Recommendations for weight gain during pregnancy are based on pre-pregnancy body mass index (BMI). Pregnancy is a risk factor for excessive weight gain and many endocrine problems, making it difficult to return to pre-pregnancy weight and increasing the risk of postpartum obesity and, consequently, type 2 diabetes and metabolic syndrome. Both excessive gestational weight gain (EGWG) and obesity are associated with an increased risk of gestational hypertension, pre-eclampsia, gestational diabetes, cesarean section, shoulder dystocia, and neonatal macrosomia. In the long term, EGWG is associated with increased morbidity and mortality, particularly from diabetes, cardiovascular disorders, and some cancers. This study aims to present recommendations from various societies regarding weight gain during pregnancy, dietary guidance, and physical activity. In addition, we discuss the pathophysiology of this complication and the differential diagnosis in pregnant women with EGWG. According to our research, inadequate nutrition might contribute more significantly to the development of EGWG than insufficient physical activity levels in pregnant women. Telehealth systems seem to be a promising direction for future EGWG prevention by motivating women to exercise. Although the importance of adequate pre-pregnancy weight and weight gain during pregnancy is well known, an increasing number of women gain excessive weight during pregnancy.
PubMed: 38592297
DOI: 10.3390/jcm13051461 -
Frontiers in Veterinary Science 2022Dystocia in the canine species is a common problem, and elective cesarean sections (C-sections) have become more frequent in breeds that are at risk. The aim of this...
Dystocia in the canine species is a common problem, and elective cesarean sections (C-sections) have become more frequent in breeds that are at risk. The aim of this study was to evaluate the incidence of C-section and contributing factors and to compare data on elective and emergency C-sections (e.g., regarding stillbirth). Using a questionnaire, a total of 423 bitches of 80 breeds and their 899 litters were included. The mean number of litters per bitch was 2.1 ± 1.1 litters. The overall rate of stillbirth was 6.7%. Of all litters, 194 were born C-sections (21.6%), of which 35 were declared as elective and 159 as emergency due to dystocia. Significantly more C-sections were performed in either small litters (1-2 pups) or large litters (>12 pups) (p < 0.001). Bitches that have had prior C-sections had a 4-fold increase in the risk of successive C-sections (RR = 4.54 (95%CI 2.56-7.70; < 0.001). Furthermore, primiparous bitches of advanced age had a significantly higher incidence of emergency C-sections ( = 0.004). Stillbirth was significantly higher in emergency C-sections compared with that in elective C-sections ( = 0.003). Also, timing of intervention had a significant impact on stillbirth in emergency C-sections ( = 0.025). Within a breed-specific evaluation, significant differences were observed between breeds regarding incidence of C-section and stillbirth. Lesser-known breeds were represented in the population, and the results showed that the Norwich Terrier had the highest (51.6%) and the Gordon Setter had the lowest (4.8%) incidence of C-section ( < 0.001). The inclusion and evaluation of lesser-known breeds regarding incidence of C-section is of importance as it shows that certain breeds without phenotypical traits such as brachycephaly may also have an increased incidence of emergency C-section and stillbirth. We further conclude that more importance may be given to the age at first parturition concerning the occurrence of dystocia and the decision making regarding possible elective C-sections.
PubMed: 36118330
DOI: 10.3389/fvets.2022.934273 -
Sexual & Reproductive Healthcare :... Jun 2023To identify maternal factors associated with labor dystocia in low-risk nulliparous women. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To identify maternal factors associated with labor dystocia in low-risk nulliparous women.
METHODS
MEDLINE, Embase, ClinicalTrials.gov, Cochrane, and CINAHL were searched for intervention studies and observational studies published from January 2000 to January 2022. Low-risk was defined as nulliparous women with a singleton, cephalic birth in spontaneous labor at term. Labor dystocia was defined by national or international criteria or treatment. Countries were restricted to OECD members. Two authors independently screened 11,374 titles and abstracts, extracted data, and assessed risk of bias using the Newcastle-Ottawa Scale. Results were presented narratively and by meta-analysis when compatible.
RESULTS
Seven cohort studies were included. Overall, the certainty of the evidence was moderate. Three studies found that higher maternal age was associated with an increased frequency of labor dystocia (relative risk 1.68; 95% CI 1.43-1.98). Further three studies found that higher maternal BMI was associated with increased frequency of labor dystocia (relative risk 1.20; 95% CI 1.01-1.43). Maternal short stature, fear of childbirth, and high caffeine intake were also associated with an increased frequency of labor dystocia, while maternal physical activity was associated with a decreased frequency.
CONCLUSION
Maternal factors associated with an increased frequency of labor dystocia were mainly maternal age, physical characteristics, and fear of childbirth. Maternal physical activity was associated with a decreased frequency. Intervention studies targeting these maternal factors would need to be initiated before or early in pregnancy to test the causality of the identified factors and labor dystocia.
Topics: Pregnancy; Female; Humans; Cesarean Section; Dystocia; Maternal Age; Delivery, Obstetric; Risk Factors
PubMed: 37210774
DOI: 10.1016/j.srhc.2023.100855