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First and Second Stage Labor Management: ACOG Clinical Practice Guideline No. 8. Obstet Gynecol 2024; 143:144-62. [PMID: 38096556 DOI: 10.1097/AOG.0000000000005447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
PURPOSE The purpose of this document is to define labor and labor arrest and provide recommendations for the management of dystocia in the first and second stage of labor and labor arrest. TARGET POPULATION Pregnant individuals in the first or second stage of labor. METHODS This guideline was developed using an a priori protocol in conjunction with a writing team consisting of one maternal-fetal medicine subspecialist appointed by the ACOG Committee on Clinical Practice Guidelines-Obstetrics and two external subject matter experts. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements. RECOMMENDATIONS This Clinical Practice Guideline includes definitions of labor and labor arrest, along with recommendations for the management of dystocia in the first and second stages of labor and labor arrest. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence.
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García-Mejido JA, Martín-Martínez A, González-Diaz E, Fernández-Fernández C, Ortega I, Medina M, Fernández-Corona A, Fernández-Palacín A, Sainz JA. Malmström vacuum or Kielland forceps: which causes more damage to pelvic floor? Ultrasound Obstet Gynecol 2020; 55:257-263. [PMID: 31332857 DOI: 10.1002/uog.20404] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 07/01/2019] [Accepted: 07/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To determine whether differences exist in the rate of levator ani muscle (LAM) avulsion between women who had undergone either Malmström vacuum delivery (MVD) or Kielland forceps delivery (KFD), allowing for potential confounding factors. METHODS This was a prospective observational study of nulliparous women undergoing instrumental delivery using Malmström vacuum extractor or Kielland forceps, at two hospital centers in Spain. Fetal head position (anterior, posterior or transverse) and fetal head station (low or mid) were assessed by ultrasound and digital examination, respectively. Avulsion was defined on tomographic ultrasound imaging as an abnormal insertion of the LAM in the three central slices from the plane of minimal hiatal dimensions. RESULTS In total, 414 patients were included in the study (212 MVD and 202 KFD). We observed a higher rate of LAM avulsion in the KFD group (KFD 49.5% vs MVD 32.5%; P = 0.001). When the results were evaluated according to fetal head position and station, we observed no differences in LAM avulsion. The crude odds ratio (OR) for the difference in avulsion between women in the KFD and MVD groups was 2.03 (95% CI, 1.36-3.03). However, when adjusted for duration of second stage of labor, fetal head circumference and fetal head station, the OR was no longer statistically significant (OR, 2.14 (95% CI, 0.95-4.85); P = 0.068). CONCLUSION When potential confounding factors are taken into account, the rate of LAM avulsion does not differ between women according to whether they have undergone KFD or MVD. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J A García-Mejido
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
- Department of Obstetrics and Gynecology, University of Seville, Seville, Spain
| | - A Martín-Martínez
- Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de Gran Canarias, Gran Canarias, Spain
| | - E González-Diaz
- Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de Leon (CAULE), Leon, Spain
| | - C Fernández-Fernández
- Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de Leon (CAULE), Leon, Spain
| | - I Ortega
- Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de Gran Canarias, Gran Canarias, Spain
| | - M Medina
- Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de Gran Canarias, Gran Canarias, Spain
| | - A Fernández-Corona
- Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de Leon (CAULE), Leon, Spain
| | - A Fernández-Palacín
- Biostatistics Unit, Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain
| | - J A Sainz
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
- Department of Obstetrics and Gynecology, University of Seville, Seville, Spain
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Sainz JA, García-Mejido JA, Aquise A, Borrero C, Bonomi MJ, Fernández-Palacín A. A simple model to predict the complicated operative vaginal deliveries using vacuum or forceps. Am J Obstet Gynecol 2019; 220:193.e1-193.e12. [PMID: 30391443 DOI: 10.1016/j.ajog.2018.10.035] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 10/17/2018] [Accepted: 10/24/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Complicated operative vaginal deliveries are associated with high neonatal morbidity and maternal trauma, especially if the procedure is unsuccessful and a cesarean delivery is needed. The decision to perform an operative vaginal delivery has traditionally been based on a subjective assessment by digital vaginal examination combined with the clinical expertise of the obstetrician. Currently there is no method for objectively quantifying the likelihood of successful delivery. Intrapartum ultrasound has been introduced in clinical practice to help predict the progression and final method of delivery. OBJECTIVE The aim of this study was to compare predictive models for identifying complicated operative vaginal deliveries (vacuum or forceps) based on intrapartum transperineal ultrasound in nulliparous women. STUDY DESIGN We performed a prospective cohort study in nulliparous women at term with singleton pregnancies and full dilatation who underwent intrapartum transperineal ultrasound evaluation prior to operative vaginal delivery. Managing obstetricians were blinded to the ultrasound data. Intrapartum transperineal ultrasound (angle of progression, progression distance, and midline angle) was performed immediately before instrument application, both at rest and concurrently with pushing. Intrapartum evaluation of fetal biometric parameters (estimated fetal weight, head circumference, and biparietal diameter) was also carried out. An operative vaginal delivery was classified as complicated when 1 or more of the following complications occurred: ≥3 tractions needed; third- to fourth-degree perineal tear; severe bleeding during episiotomy repair (decrease of ≥2.5 g/dL in the hemoglobin level); or significant traumatic neonatal lesion (subdural-intracerebral hemorrhage, epicranial subaponeurotic hemorrhage, skeletal injuries, injuries to spine and spinal cord, or peripheral and cranial nerve injuries). Six predictive models were evaluated (information available in Table 2). RESULTS We recruited 84 nulliparous patients, of whom 5 were excluded because of the difficulty of adequately evaluating the biparietal diameter and head circumference. A total of 79 nulliparous patients were studied (47 vacuum deliveries, 32 forceps deliveries) with 13 cases in the occiput-posterior position. We identified 31 cases of complicated operative vaginal deliveries (19 vacuum deliveries and 12 forceps deliveries). No differences were identified in obstetric, neonatal, or intrapartum characteristics between the 2 study groups (operative uncomplicated vaginal delivery vs operative complicated vaginal delivery), with the following exceptions: estimated fetal weight (3243 ± 425 g vs 3565 ± 330 g; P = .001), biparietal diameter (93.2 ± 2.1 vs 95.2 ± 2.3 mm; P = .001), head circumference (336 ± 12 vs 348 ± 6.4 mm; P = .001), sex (female 62.5% vs 29.0%; P = .010), newborn weight (3258 ± 472 g vs 3499 ± 383 g; P = .027), and number of tractions (median, interquartile range) (1 [1-2] vs 4 [3-5]; P < .0005). To predict complicated operative deliveries, all 6 of the studied models presented an area under the receiver-operating characteristics curve between 0.863 and 0.876 (95% confidence intervals, 0.775-0.950 and 0.790-0.963; P < .0005). The results of the study met the criteria of interpretability and parsimony (simplicity), allowing us to identify a binary logistic regression model based on the angle of progression and head circumference; this model has an area under the receiver-operating characteristics curve of 0.876 (95% confidence interval, 0.790-0.963; P < .0005) and a calibration slope B of 0.984 (95% confidence interval, 0.0.726-1.243; P < .0005). CONCLUSION The combination of the angle of progression and the head circumference can predict 87% of complicated operative vaginal deliveries and can be performed in the delivery room.
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Sainz JA, García-Mejido JA, Aquise A, Bonomi MJ, Borrero C, De La Fuente P, Fernández-Palacín A. Intrapartum transperineal ultrasound used to predict cases of complicated operative (vacuum and forceps) deliveries in nulliparous women. Acta Obstet Gynecol Scand 2017; 96:1490-1497. [DOI: 10.1111/aogs.13230] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 09/01/2017] [Indexed: 12/28/2022]
Affiliation(s)
- José A. Sainz
- Department of Obstetrics and Gynecology; Valme University Hospital; Seville Spain
- Department of Obstetrics and Gynecology; University of Seville; Seville Spain
| | | | - Adriana Aquise
- Department of Obstetrics and Gynecology; Valme University Hospital; Seville Spain
| | - María J. Bonomi
- Department of Obstetrics and Gynecology; Valme University Hospital; Seville Spain
| | - Carlota Borrero
- Department of Obstetrics and Gynecology; Valme University Hospital; Seville Spain
| | - Paloma De La Fuente
- Department of Obstetrics and Gynecology; Valme University Hospital; Seville Spain
| | - Ana Fernández-Palacín
- Biostatistics Unit; Department of Preventive Medicine and Public Health; University of Seville; Seville Spain
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Abstract
Operative vaginal birth retains an important role in current obstetric practice. However, there is an increasing trend in the rate of cesarean section in Korea. Surgical delivery is more advantageous than cesarean section, but the rate of operative vaginal delivery is decreasing for various reasons. Furthermore, there is no unified technique for vacuum extraction delivery. In this context, this review was performed to provide details of the necessary conditions, techniques, benefits, and risks of operative vaginal delivery. Future research should focus on overcoming the limitations of operative vaginal delivery.
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Affiliation(s)
- Jihan Jeon
- Department of Obstetrics and Gynecology, Kangwon National University Hospital, School of Medicine Kangwon National University, Chuncheon, Korea
| | - Sunghun Na
- Department of Obstetrics and Gynecology, Kangwon National University Hospital, School of Medicine Kangwon National University, Chuncheon, Korea
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Sainz JA, Fernández-Palacín A, Borrero C, Aquise A, Ramos Z, García-Mejido JA. Intra and interobserver variability of intrapartum transperineal ultrasound measurements with contraction and pushing. J OBSTET GYNAECOL 2017; 38:333-338. [DOI: 10.1080/01443615.2017.1354179] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- José A. Sainz
- Department of Obstetrics and Gynaecology, Valme University Hospital, Seville, Spain
- Department of Obstetrics and Gynaecology, University of Seville, Seville, Spain
| | - Ana Fernández-Palacín
- Biostatistics Unit, Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain
| | - Carlota Borrero
- Department of Obstetrics and Gynaecology, Valme University Hospital, Seville, Spain
| | - Adriana Aquise
- Department of Obstetrics and Gynaecology, Valme University Hospital, Seville, Spain
- Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, London, UK
| | - Zenaida Ramos
- Department of Obstetrics and Gynaecology, Valme University Hospital, Seville, Spain
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Son M, Roy A, Grobman WA. Attempted operative vaginal delivery vs repeat cesarean in the second stage among women undergoing a trial of labor after cesarean delivery. Am J Obstet Gynecol 2017; 216:407.e1-5. [PMID: 28153660 DOI: 10.1016/j.ajog.2017.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/27/2016] [Accepted: 01/13/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND It is not well-characterized whether attempting operative vaginal delivery is a safe and effective alternative among women who undergo a trial of labor after cesarean delivery who are unable to complete second-stage labor with a spontaneous vaginal delivery. OBJECTIVE The purpose of this study was to compare maternal and neonatal outcomes that are associated with attempted operative vaginal delivery with those that are associated with second-stage repeat cesarean delivery without an operative vaginal delivery attempt among women who undergo a trial of labor after cesarean delivery. STUDY DESIGN This is a retrospective secondary analysis of data from Cesarean Registry of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Women who underwent a trial of labor after cesarean delivery who were at least 36 weeks gestation were eligible for analysis if they had a live, singleton, nonanomalous gestation in cephalic presentation and reached second-stage labor (defined as complete cervical dilation) with a fetal station of at least +2. The data for women who had an attempted operative vaginal delivery with either forceps or vacuum were compared with those of women who underwent second stage repeat cesarean delivery without operative vaginal delivery attempt. Outcomes of maternal and neonatal complications were compared between groups with bivariable and multivariable analyses. RESULTS Of 1230 women whose cases were eligible for analysis, 945 women (76.8%) had an attempted operative vaginal delivery. Of those who underwent attempted operative vaginal delivery, 914 women (96.7%) achieved a vaginal delivery. Women who attempted operative vaginal delivery had a lower mean body mass index (30.4±6.0 vs 31.8±5.9 kg/m2; P=.001) and gestational age (39.5±1.3 vs 39.8±1.2 weeks; P=.012) at delivery and were more likely to be of non-Hispanic black race (30.0% vs 22.1%; P=.002), to have had a previous vaginal delivery (34.9% vs 20.4%; P<.001), and to have fetal descent greater than +2 station at complete dilation (55.6% vs 16.8%; P<.001) and were less likely to have chorioamnionitis (6.8% vs 19.3%; P<.001). The frequency of endometritis was significantly lower among women who had an attempted operative vaginal delivery compared with those who had repeat cesarean delivery (2.5% vs 9.1%; P<.001). However, other serious maternal or neonatal adverse outcomes were not statistically different between the groups. These findings persisted after adjustment for potential confounders. CONCLUSION In the setting of a trial of labor after cesarean delivery in the second stage with a fetal station of at least +2, attempted operative vaginal delivery resulted in a vaginal birth after cesarean delivery in most women and was not associated with increased adverse maternal and neonatal outcomes but was associated with a reduced frequency of endometritis compared with repeat cesarean delivery without operative vaginal delivery attempt.
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Antonio Sainz J, Borrero C, Aquise A, García-Mejido JA, Gutierrez L, Fernández-Palacín A. Intrapartum translabial ultrasound with pushing used to predict the difficulty in vacuum-assisted delivery of fetuses in non-occiput posterior position. J Matern Fetal Neonatal Med 2016; 29:3400-5. [DOI: 10.3109/14767058.2015.1130816] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Halscott TL, Reddy UM, Landy HJ, Ramsey PS, Iqbal SN, Huang CC, Grantz KL. Maternal and Neonatal Outcomes by Attempted Mode of Operative Delivery From a Low Station in the Second Stage of Labor. Obstet Gynecol 2015; 126:1265-1272. [PMID: 26551186 PMCID: PMC4683158 DOI: 10.1097/aog.0000000000001156] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate maternal and neonatal outcomes by attempted mode of operative delivery from a low station in the second stage of labor. METHODS Retrospective study of 2,518 women carrying singleton fetuses at 37 weeks of gestation or greater who underwent attempted forceps-assisted delivery, attempted vacuum-assisted vaginal delivery, or cesarean delivery from a low station in the second stage of labor. Primary outcomes were stratified by parity and included a maternal adverse outcome composite (postpartum hemorrhage, transfusion, endometritis, peripartum hysterectomy, or intensive care unit admission) and a neonatal adverse outcome composite (5-minute Apgar score less than 4, respiratory morbidity, neonatal intensive care unit admission, shoulder dystocia, birth trauma, or sepsis). RESULTS In nulliparous patients, the maternal adverse composite was not significantly different between women who underwent attempted forceps (12.1% compared with 10.8%, adjusted odds ratio [OR] 0.77, 95% confidence interval [CI] 0.40-1.34) or vacuum (8.3% compared with 10.8%, adjusted OR 0.68, 95% CI 0.40-1.16) delivery compared with cesarean delivery. Among parous women, the maternal adverse composite was not significantly different with attempted forceps (10.7% compared with 12.5%, adjusted OR 0.40, 95% CI 0.09-1.71) or vacuum (11.3% compared with 12.5%, adjusted OR 0.44, 95% CI 0.11-1.72) compared with cesarean delivery. Compared with neonates delivered by cesarean, the neonatal adverse composite was significantly lower among neonates born to nulliparous women who underwent attempted forceps (9.4% compared with 16.7%, adjusted OR 0.44, 95% CI 0.27-0.72) but not among those who underwent vacuum delivery (11.9% compared with 16.7%, adjusted OR 0.68, 95% CI 0.44-1.04). Among parous women, the neonatal adverse composite was not significantly different after attempted forceps (4.1% compared with 12.5%, adjusted OR 0.28, 95% CI 0.06-1.35) or vacuum (12.5% compared with 12.5%, adjusted OR 1.03, 95% CI 0.28-3.87) compared with cesarean delivery. CONCLUSION A trial of forceps delivery from a low station compared with cesarean delivery was associated with decreased neonatal morbidity among neonates born to nulliparous women. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Torre L Halscott
- Departments of Obstetrics and Gynecology, MedStar Washington Hospital Center and MedStar Georgetown University Hospital, Washington, DC, and the University of Texas Health Sciences Center at San Antonio, San Antonio, Texas; and the Department of Biostatistics and Epidemiology, MedStar Health Research Institute, Hyattsville, Maryland
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Rietveld AL, Kok N, Kazemier BM, de Groot CJM, Teunissen PW. Trial of labor after cesarean: attempted operative vaginal delivery versus emergency repeat cesarean, a prospective national cohort study. J Perinatol 2015; 35:258-62. [PMID: 25474557 DOI: 10.1038/jp.2014.216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 10/21/2014] [Accepted: 10/23/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare neonatal and maternal outcomes of attempted operative vaginal delivery with emergency repeat cesarean in trial of labor after cesarean. STUDY DESIGN Prospective 8-year cohort analysis using the Netherlands Perinatal Registry, including women with one prior cesarean giving birth through operative vaginal delivery or emergency repeat cesarean (n=12860). A multivariate analysis was performed. Odds ratios (OR) and adjusted odds ratios (aOR) were calculated. RESULTS Attempted operative vaginal delivery increases the risk on neonatal birth trauma (aOR 15.0 (5.94 to 38.0)) and postpartum hemorrhage (aOR 2.59 (2.17 to 3.09)), and lowers the risk of wet lung syndrome (aOR 0.53 (0.35 to 0.80)) and neonatal convulsions (aOR 0.47 (0.24 to 0.91)). CONCLUSION We found a highly increased risk of neonatal birth trauma and a moderately increased risk of postpartum hemorrhage but slightly lower risks of wet lung syndrome and neonatal convulsions after attempted operative vaginal delivery compared with emergency repeat cesarean.
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Affiliation(s)
- A L Rietveld
- Department of Obstetrics and Gynecology, VU University Medical Centre, Amsterdam, The Netherlands
| | - N Kok
- Department of Obstetrics and Gynecology, VU University Medical Centre, Amsterdam, The Netherlands
| | - B M Kazemier
- Department of Obstetrics and Gynecology, VU University Medical Centre, Amsterdam, The Netherlands
| | - C J M de Groot
- Department of Obstetrics and Gynecology, VU University Medical Centre, Amsterdam, The Netherlands
| | - P W Teunissen
- Department of Obstetrics and Gynecology, VU University Medical Centre, Amsterdam, The Netherlands
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Sainz JA, Borrero C, Fernández-Palacín A, Aquise A, Valdivieso P, Pastor L, Garrido R. Intrapartum transperineal ultrasound as a predictor of instrumentation difficulty with vacuum-assisted delivery in primiparous women. J Matern Fetal Neonatal Med 2014; 28:2041-7. [DOI: 10.3109/14767058.2014.976547] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- José A. Sainz
- Department of Obstetrics and Gynaecology, Valme University Hospital, Seville, Spain,
- Department of Obstetrics and Gynaecology, University of Seville, Spain, and
| | - Carlota Borrero
- Department of Obstetrics and Gynaecology, Valme University Hospital, Seville, Spain,
| | - Ana Fernández-Palacín
- Department of Preventive Medicine and Public Health, Biostatistics Unit, University of Seville, Spain
| | - Adriana Aquise
- Department of Obstetrics and Gynaecology, Valme University Hospital, Seville, Spain,
| | - Pamela Valdivieso
- Department of Obstetrics and Gynaecology, Valme University Hospital, Seville, Spain,
| | - Luis Pastor
- Department of Obstetrics and Gynaecology, Valme University Hospital, Seville, Spain,
| | - Rogelio Garrido
- Department of Obstetrics and Gynaecology, Valme University Hospital, Seville, Spain,
- Department of Obstetrics and Gynaecology, University of Seville, Spain, and
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Kessous R, Tirosh D, Weintraub AY, Benshalom-Tirosh N, Sergienko R, Sheiner E. Second stage disorders in patients following a previous cesarean section: vacuum versus repeated cesarean section. Arch Gynecol Obstet 2012; 287:1075-9. [DOI: 10.1007/s00404-012-2688-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 12/11/2012] [Indexed: 11/29/2022]
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Liang W, Chikritzhs T. Obstetric conditions and risk of first ever mental health contact during infancy, childhood and adolescence. Midwifery 2012; 28:379-84. [PMID: 21820779 DOI: 10.1016/j.midw.2011.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 05/19/2011] [Accepted: 06/13/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE the main aim of this study was to investigate whether risk of first ever occasion of outpatient or inpatient service for a mental disorder among male children and adolescents may be associated with obstetric conditions. DESIGN, SETTING AND PARTICIPANTS this study was a population-based birth-cohort study of males born between 1980 and 1984 in Western Australia (WA). Males were identified using birth registry records and followed-up over a 19 year period using linked health data available through the Western Australian Data Linkage System. MEASUREMENTS multivariate logistic regression was employed to estimate the risk of first ever mental health contact at different stages of mental development in childhood and adolescence. MAIN FINDINGS vacuum and forceps assisted delivery and emergency caesarean were associated with an increased risk of first ever mental health contact. The risk of first ever mental health contact was similar for spontaneous vaginal delivery and elective caesarean. Although outcomes varied by age group, children with stillborn siblings were at increased risk of first ever mental health contact as were babies with 7-9 Apgar score at 5 mins and those born to mothers with several previous live births. CONCLUSIONS AND IMPLICATIONS vacuum and forceps assisted delivery and/or the pathophysiological causes that lead to these clinical procedures, as well as other obstetric conditions, which may be associated with (asymptomatic) brain injury at birth, which may increase the risk of mental disorders.
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