-
American Journal of Obstetrics and... May 2023The assessment of labor progress from digital vaginal examination has remained largely unchanged for at least a century, despite the current major advances in maternal... (Review)
Review
The assessment of labor progress from digital vaginal examination has remained largely unchanged for at least a century, despite the current major advances in maternal and perinatal care. Although inconsistently reproducible, the findings from digital vaginal examination are customarily plotted manually on a partogram, which is composed of a graphical representation of labor, together with maternal and fetal observations. The partogram has been developed to aid recognition of failure to labor progress and guide management-specific obstetrical intervention. In the last decade, the use of ultrasound in the delivery room has increased with the advent of more powerful, portable ultrasound machines that have become more readily available for use. Although ultrasound in intrapartum practice is predominantly used for acute management, an ultrasound-based partogram, a sonopartogram, might represent an objective tool for the graphical representation of labor. Demonstrating greater accuracy for fetal head position and more objectivity in the assessment of fetal head station, it could be considered complementary to traditional clinical assessment. The development of the sonopartogram concept would require further undertaking of serial measurements. Advocates of ultrasound will concede that its use has yet to demonstrate a difference in obstetrical and neonatal morbidity in the context of the management of labor and delivery. Taking a step beyond the descriptive graphical representation of labor progress is the question of whether a specific combination of clinical and demographic parameters might be used to inform knowledge of labor outcomes. Intrapartum cesarean deliveries and deliveries assisted by forceps and vacuum are all associated with a heightened risk of maternal and perinatal adverse outcomes. Although these outcomes cannot be precisely predicted, many known risk factors exist. Malposition and high station of the fetal head, short maternal stature, and other factors, such as caput succedaneum, are all implicated in operative delivery; however, the contribution of individual parameters based on clinical and ultrasound assessments has not been quantified. Individualized risk prediction models, including maternal characteristics and ultrasound findings, are increasingly used in women's health-for example, in preeclampsia or trisomy screening. Similarly, intrapartum cesarean delivery models have been developed with good prognostic ability in specifically selected populations. For intrapartum ultrasound to be of prognostic value, robust, externally validated prediction models for labor outcome would inform delivery management and allow shared decision-making with parents.
Topics: Infant, Newborn; Pregnancy; Humans; Female; Ultrasonography, Prenatal; Labor Presentation; Fetus; Prospective Studies; Ultrasonography
PubMed: 37164504
DOI: 10.1016/j.ajog.2022.06.027 -
American Journal of Obstetrics &... Nov 2021The mechanics of labor describe the forces required for fetal descent, and the movements that the fetus must perform to overcome the resistance met by the maternal bony... (Review)
Review
The mechanics of labor describe the forces required for fetal descent, and the movements that the fetus must perform to overcome the resistance met by the maternal bony pelvis and soft tissue. The fetus negotiates the birth canal and rotational movements are necessary for descent. Anglo-American literature lists 7 cardinal movements, namely engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion. German and older English literature lists only 4 rotational movements as the cardinal movements and excludes engagement, descent, and expulsion. We would argue that descent is the main purpose of the uterine powers and cardinal movements, a description of the rotational movements the fetal head and shoulders must perform to obtain descent. Ultrasound offers a historically unique opportunity for noninvasive, dynamic studies of the mechanics of labor. The information gathered by clinical examination and ultrasound should be integrated into clinical decision making.
Topics: Female; Fetus; Head; Humans; Labor Presentation; Movement; Pregnancy; Shoulder
PubMed: 34214716
DOI: 10.1016/j.ajogmf.2021.100436 -
CMAJ : Canadian Medical Association... Mar 2024
Topics: Female; Pregnancy; Humans; Breech Presentation; Fetal Movement
PubMed: 38499301
DOI: 10.1503/cmaj.221264-f -
The Journal of Maternal-fetal &... Dec 2024Since its introduction, assisted reproductive technology (ART) has developed into a common clinical practice around the world; yet it still raises a lot of questions.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Since its introduction, assisted reproductive technology (ART) has developed into a common clinical practice around the world; yet it still raises a lot of questions. Throughout time, many researchers have investigated its association with several obstetric incidences and its consequences on perinatal outcomes. The aim of the current meta-analysis was to estimate the correlation between ART procedures and malpresentation of the fetus in singleton pregnancies.
METHODS
The study was conducted according to the Preferred Reporting Items of Systematic Reviews and Meta-analyses (PRISMA) guidelines and prospectively registered under the PROSPERO database (CRD42023458084). Five databases (Embase, MEDLINE, APA PsycInfo, Global Health, Health Management Information Consortium (HMIC)) and two additional sources were searched from inception to 31 May 2023. Quality of the included studies was assessed using the ROBINS-1 scale, whilst quality of evidence by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. Summative and subgroup data as well as heterogeneity were generated by the Cochrane platform RevMan Web.
RESULTS
Overall, 11 studies were included in the study with a total of 3,360,134 deliveries. Results indicate a higher risk of malpresentation at delivery in fetuses conceived through ART than those conceived naturally (RR: 1.50, (95% confidence interval (CI):1.30, 1.73)). This risk decreased when adjustments for potential confounders were applied (RR = 1.12, 95% CI 1.02, 1.23).
CONCLUSIONS
Based on observational studies, this meta-analysis indicated that singleton pregnancies conceived through ART are associated with higher risk of malpresentation than those conceived naturally, albeit the difference was lower when potential confounders were examined. Thus, future large studies are required to better understand possible reversible and irreversible factors of this relationship.
Topics: Pregnancy; Female; Humans; Reproductive Techniques, Assisted; Fertilization; Labor Presentation; Incidence; Observational Studies as Topic
PubMed: 38316567
DOI: 10.1080/14767058.2024.2313143 -
American Journal of Obstetrics and... Apr 2006A large trial published in 2000 concluded that planned vaginal delivery of term breech births is associated with high neonatal risks. Because the obstetric practices in... (Comparative Study)
Comparative Study
OBJECTIVE
A large trial published in 2000 concluded that planned vaginal delivery of term breech births is associated with high neonatal risks. Because the obstetric practices in that study differed from those in countries where planned vaginal delivery is still common, we conducted an observational prospective study to describe neonatal outcome according to the planned mode of delivery for term breech births in 2 such countries.
STUDY DESIGN
Observational prospective study with an intent-to-treat analysis to compare the groups for which cesarean and vaginal deliveries were planned. Associations between the outcome and planned mode of delivery were controlled for confounding by multivariate analysis. The main outcome measure was a variable that combined fetal and neonatal mortality and severe neonatal morbidity. The study population consisted of 8105 pregnant women delivering singleton fetuses in breech presentation at term in 138 French and 36 Belgian maternity units.
RESULTS
Cesarean delivery was planned for 5579 women (68.8%) and vaginal delivery for 2526 (31.2%). Of the women with planned vaginal deliveries, 1796 delivered vaginally (71.0%). The rate of the combined neonatal outcome measure was low in the overall population (1.59%; 95% CI [1.33-1.89]) and in the planned vaginal delivery group (1.60%; 95% CI [1.14-2.17]). It did not differ significantly between the planned vaginal and cesarean delivery groups (unadjusted odds ratio = 1.10, 95% CI [0.75-1.61]), even after controlling for confounding variables (adjusted odds ratio = 1.40, 95% CI [0.89-2.23]).
CONCLUSION
In places where planned vaginal delivery is a common practice and when strict criteria are met before and during labor, planned vaginal delivery of singleton fetuses in breech presentation at term remains a safe option that can be offered to women.
Topics: Adult; Belgium; Breech Presentation; Cesarean Section; Data Collection; Delivery, Obstetric; Female; France; Humans; Infant, Newborn; Infant, Newborn, Diseases; Pregnancy; Prospective Studies
PubMed: 16580289
DOI: 10.1016/j.ajog.2005.10.817 -
Acta Obstetricia Et Gynecologica... Mar 2019Uncertainty exists regarding the impact of malpresentation on pregnancy outcomes and the optimal mode of delivery in low- and middle-income countries. We sought to...
INTRODUCTION
Uncertainty exists regarding the impact of malpresentation on pregnancy outcomes and the optimal mode of delivery in low- and middle-income countries. We sought to compare outcomes between cephalic and non-cephalic pregnancies.
MATERIAL AND METHODS
Using the NICHD Global Network's prospective, population-based registry of pregnancy outcomes from 2010 to 2016, we studied outcomes in 436 112 singleton pregnancies. Robust Poisson regressions were used to estimate the risk of adverse outcomes associated with malpresentation. We examined rates of cesarean delivery for malpresentation and compared outcomes between cesarean and vaginal delivery by region.
RESULTS
Across all regions, stillbirth and neonatal mortality rates were higher among deliveries with malpresentation. In adjusted analysis, malpresentation was significantly associated with stillbirth (adjusted relative risk [aRR] 4.0, 95% confidence interval [CI] 3.7-4.5) and neonatal mortality (aRR 2.3, 95% CI 2.1-2.6). Women with deliveries complicated by malpresentation had higher rates of morbidity and mortality. Rates of cesarean delivery for malpresentation ranged from 27% to 87% among regions. Compared with cesarean delivery, vaginal delivery for malpresentation was associated with increased maternal risk, especially postpartum hemorrhage (aRR 5.0, 95% CI; 3.6-7.1).
CONCLUSIONS
In a cohort of deliveries in low- and middle-income countries, malpresentation was associated with increased perinatal and maternal risk. Further research is needed to determine the best management of these pregnancies.
Topics: Cesarean Section; Delivery, Obstetric; Developing Countries; Female; Humans; Income; Infant, Newborn; Labor Presentation; Obstetric Labor Complications; Pregnancy; Pregnancy Outcome; Socioeconomic Factors; Term Birth
PubMed: 30414270
DOI: 10.1111/aogs.13502 -
PloS One 2022Occiput-posterior (OP) or occiput-transverse (OT) fetal malposition has a prevalence of 33-58% in the first-stage of labour with 12-22% persisting until delivery....
INTRODUCTION
Occiput-posterior (OP) or occiput-transverse (OT) fetal malposition has a prevalence of 33-58% in the first-stage of labour with 12-22% persisting until delivery. Malposition is associated with significant maternal and neonatal morbidity. Most previous studies report the incidence and adverse maternal and fetal outcomes of persistent fetal malposition in the second stage of labour and do not include outcomes that may be present in the first stage of labour.
AIMS
To assess the incidence and health outcomes for women and their newborn infants of a fetal malposition in the first or second stage of labour.
MATERIALS AND METHODS
A retrospective cohort study of 738 maternity records (randomly selected) from a tertiary hospital in New Zealand. Maternal and neonatal characteristics are described. Outcomes for women with a fetus in an OP or OT position in labour are compared to those for women with a fetus in an occiput-anterior position (OA).
RESULTS
499 (68%) women had an OP/OT positioned fetus and 239 (32%) had an OA positioned fetus on vaginal examination in labour. Women had similar characteristics except a body mass index ≥30 kg/m2 was more common in the OP/OT group. Fetal malposition appears to be more likely in women with a right-sided fetal occiput. Three quarters of OP/OT fetuses rotated anteriorly by birth. Fetal malposition compared to no malposition was associated with oxytocin augmentation, epidural use, a longer first stage of labour, fewer normal vaginal births, and more caesarean sections. Fetal malposition during labour was not associated with adverse neonatal outcomes.
CONCLUSION
Interventions such as maternal posture in the first and second stage of labour could potentially reduce the incidence of malposition and improve health outcomes for mothers.
Topics: Infant, Newborn; Female; Pregnancy; Humans; Male; Oxytocin; Retrospective Studies; Labor Presentation; Cesarean Section; Outcome Assessment, Health Care
PubMed: 36260647
DOI: 10.1371/journal.pone.0276406 -
BMJ Case Reports Oct 2020We report a case of idiopathic spontaneous intraperitoneal haemorrhage (ISIH) in a 31-year-old patient at 37 weeks gestation in her second pregnancy. The patient...
We report a case of idiopathic spontaneous intraperitoneal haemorrhage (ISIH) in a 31-year-old patient at 37 weeks gestation in her second pregnancy. The patient presented to the labour ward with abdominal pain and uterine contractions. The initial complain was of sudden onset, severe sharp pain in left iliac fossa. She started having uterine contractions within 30 min of her presentation. Examination confirmed early labour with a footling breech presentation. Urgent caesarean section was performed that confirmed peritoneal bleeding of unknown origin with safe delivery of the baby. Mother and baby were safely discharged on day 5. 'Abdominal apoplexy' (ISIH), is a rare obstetric emergency with increased risk of fetal and maternal morbidity and mortality. With various clinical presentations as a possibility, diagnosis is challenging. High index of suspicion with prompt management of suspected cases can be pivotal life saving measure for the fetus and mother.
Topics: Adult; Breech Presentation; Female; Hemoperitoneum; Humans; Laparotomy; Pregnancy; Uterine Rupture
PubMed: 33127691
DOI: 10.1136/bcr-2020-235946 -
Ultrasound in Obstetrics & Gynecology :... Aug 2007
Review
Topics: Delivery, Obstetric; Female; Fetal Monitoring; Humans; Labor Onset; Labor Presentation; Palpation; Pregnancy; Pregnancy Complications; Ultrasonography, Prenatal
PubMed: 17659656
DOI: 10.1002/uog.4096