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Bahl R, Hotton E, Crofts J, Draycott T. Assisted vaginal birth in 21st century: current practice and new innovations. Am J Obstet Gynecol 2024; 230:S917-S931. [PMID: 38462263 DOI: 10.1016/j.ajog.2022.12.305] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 03/12/2024]
Abstract
Assisted vaginal birth rates are falling globally with rising cesarean delivery rates. Cesarean delivery is not without consequence, particularly when carried out in the second stage of labor. Cesarean delivery in the second stage is not entirely protective against pelvic floor morbidity and can lead to serious complications in a subsequent pregnancy. It should be acknowledged that the likelihood of morbidity for mother and baby associated with cesarean delivery increases with advancing labor and is greater than spontaneous vaginal birth, irrespective of the method of operative birth in the second stage of labor. In this article, we argue that assisted vaginal birth is a skilled and safe option that should always be considered and be available as an option for women who need assistance in the second stage of labor. Selecting the most appropriate mode of birth at full dilatation requires accurate clinical assessment, supported decision-making, and personalized care with consideration for the woman's preferences. Achieving vaginal birth with the primary instrument is more likely with forceps than with vacuum extraction (risk ratio, 0.58; 95% confidence interval, 0.39-0.88). Midcavity forceps are associated with a greater incidence of obstetric anal sphincter injury (odds ratio, 1.83; 95% confidence interval, 1.32-2.55) but no difference in neonatal Apgar score or umbilical artery pH. The risk for adverse outcomes is minimized when the procedure is conducted by a skilled accoucheur who selects the most appropriate instrument likely to achieve vaginal birth with the primary instrument. Anticipation of potential complications and dynamic decision-making are just as important as the technique for safe instrument use. Good communication with the woman and the birthing partner is vital and there are various recommendations on how to achieve this. There have been recent developments (such as OdonAssist) in device innovation, training, and strategies for implementation at a scale that can provide opportunities for both improved outcomes and reinvigoration of an essential skill that can save mothers' and babies' lives across the world.
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Affiliation(s)
- Rachna Bahl
- Department of Obstetrics and Gynaecology, University Hospitals Bristol National Health Service Trust, Bristol, United Kingdom; Royal College of Obstetricians and Gynaecologists, London, United Kingdom.
| | | | - Joanna Crofts
- Department of Obstetrics and Gynaecology, North Bristol National Health Service Trust, Bristol, United Kingdom
| | - Tim Draycott
- Royal College of Obstetricians and Gynaecologists, London, United Kingdom; Department of Obstetrics and Gynaecology, North Bristol National Health Service Trust, Bristol, United Kingdom
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Muneeba S, Acharya N, Mohammad S, Reddy LS, Gupta A. Unicornuate Uterus and Rudimentary Horn: An Unusual Cause of Recurrent Fetal Malpresentation Identified During a Scheduled Cesarean Delivery. Cureus 2023; 15:e46277. [PMID: 37908913 PMCID: PMC10615386 DOI: 10.7759/cureus.46277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 09/30/2023] [Indexed: 11/02/2023] Open
Abstract
This case report presents a unique clinical scenario involving a 32-year-old woman with a unicornuate uterus and a rudimentary horn, leading to recurrent fetal malpresentation. The patient, gravida 3, para 1, presented at 36 weeks of gestational age with contractions and vaginal bleeding. Clinical evaluation revealed a breech presentation and nonreassuring fetal heart tracings. An emergency cesarean section was performed, during which a unicornuate uterus with a rudimentary horn was identified and fused to the main uterine cavity on the left posterior aspect. The rudimentary horn bore a functional left tube and ovary. The surgical procedure was successful, resulting in the delivery of a healthy baby girl. This case underscores the importance of meticulous preoperative assessment, multidisciplinary collaboration, and informed consent in managing complex uterine anomalies to ensure optimal maternal and fetal outcomes.
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Affiliation(s)
- Shaikh Muneeba
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neema Acharya
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shazia Mohammad
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Lucky S Reddy
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aishwarya Gupta
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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3
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Kissler K, Hurt KJ. The Pathophysiology of Labor Dystocia: Theme with Variations. Reprod Sci 2023; 30:729-742. [PMID: 35817950 PMCID: PMC10388369 DOI: 10.1007/s43032-022-01018-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 06/16/2022] [Indexed: 10/17/2022]
Abstract
Abnormally prolonged labor, or labor dystocia, is a common complication of parturition. It is the indication for about half of unplanned cesarean deliveries in low-risk nulliparous women. Reducing the rate of unplanned cesarean birth in the USA has been a public health priority over the last two decades with limited success. Labor dystocia is a complex disorder due to multiple causes with a common clinical outcome of slow cervical dilation and fetal descent. A better understanding of the pathophysiologic mechanisms of labor dystocia could lead to new clinical opportunities to increase the rate of normal vaginal delivery, reduce cesarean birth rates, and improve maternal and neonatal health. We conducted a literature review of the causes and pathophysiologic mechanisms of labor dystocia. We summarize known mechanisms supported by clinical and experimental data and newer hypotheses with less supporting evidence. We review recent data on uterine preparation for labor, uterine contractility, cervical preparation for labor, maternal obesity, cephalopelvic disproportion, fetal malposition, intrauterine infection, and maternal stress. We also describe current clinical approaches to preventing and managing labor dystocia. The variation in pathophysiologic causes of labor dystocia probably limits the utility of current general treatment options. However, treatments targeting specific underlying etiologies could be more effective. We found that the pathophysiologic basis of labor dystocia is under-researched, offering wide opportunities for translational investigation of individualized labor management, particularly regarding uterine metabolism and fetal position. More precise diagnostic tools and individualized therapies for labor dystocia might lead to better outcomes. We conclude that additional knowledge of parturition physiology coupled with rigorous clinical evaluation of novel biologically directed treatments could improve obstetric quality of care.
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Affiliation(s)
- Katherine Kissler
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - K Joseph Hurt
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO, 80045, USA.
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Mailstop 8613, Aurora, CO, 80045, USA.
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Rahman AE, Perkins J, Hossain AT, Banik G, Jabeen S, Wall S, Arifeen SE. Unpacking cesarean in rural Bangladesh: Who, what, when, and where. Birth 2022; 49:709-718. [PMID: 35347769 DOI: 10.1111/birt.12636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 03/08/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bangladesh has experienced an alarming increase in birth through cesarean over the last decade. In this article, we examine rural Bangladeshi women's reporting of why they underwent cesarean, who proposed the cesarean, and when in the process, the decision for a surgical birth was made. METHODS We conducted a cross-sectional household survey of 2299 women in Kushtia district. Of these, 1233 who gave birth through cesarean completed a supplemental questionnaire. Descriptive statistics were used to report cesarean rates, which were disaggregated by sociodemographic characteristics and by antenatal care contacts with health services. We analyzed women's reported reasons for having a cesarean, when the decision was taken, and who proposed the intervention. FINDINGS Over half (54%) of women gave birth through cesarean. The proportion of cesareans was significantly higher among women with higher educational attainment, higher socioeconomic status, and increased antenatal care during pregnancy, particularly if this care was sought in private facilities (P < .05). Women reported that health service providers primarily proposed the cesarean (73%), followed by family members (21%) and finally, the birthing person themselves (6%). With respect to the reasons for cesarean, 34% of women reported nonmedical reasons (convenience and avoidance of labor pain), and 44% mentioned only medical reasons. Over half of the women reported that the decision to undergo a cesarean was made on the day of birth. CONCLUSIONS Women in rural Bangladesh often report avoidable reasons for cesarean. Better regulation of cesarean services in both public and private health services, as well as improved counseling of women with respect to cesarean indications and their consequences, is recommended.
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Affiliation(s)
- Ahmed Ehsanur Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.,University of Edinburgh, Edinburgh, UK
| | | | | | - Goutom Banik
- Saving Newborn Lives, Save the Children, Dhaka, Bangladesh
| | - Sabrina Jabeen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Steve Wall
- Saving Newborn Lives, Save the Children, Dhaka, Bangladesh
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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5
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McDermott L, Pelecanos A, Krepska A, de Jersey S, Sekar R, Mao D, Lee G, Blackie A, Eley V. Single-centre survey of women reflecting on recent experiences and preferences of oral intake during labour. Aust N Z J Obstet Gynaecol 2022; 62:643-649. [PMID: 35342926 DOI: 10.1111/ajo.13509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Consensus-based recommendations guiding oral intake during labour are lacking. AIMS We surveyed women at a tertiary women's hospital about preferences for and experiences of oral intake during labour, gastrointestinal symptoms during labour and recalled advice about oral intake. MATERIALS AND METHODS Women who experienced labour completed a postpartum survey with responses as free text, yes-no questions and five-point Likert scales. We identified demographic data and risk factors for surgical or anaesthetic intervention at delivery from medical records. We summarised free text comments using conventional content analysis. RESULTS One hundred and forty-nine women completed the survey (47% response rate). Their mean (SD) age was 31 (four) years, birthing at median gestation of 39 weeks (interquartile range: 38-40). One hundred and twenty-two (83%) and 44 (30%) women strongly agreed or agreed they felt like drinking and eating respectively during labour. Ninety women (61%) reported nausea and 47 women (32%) reported vomiting in labour. Forty-one women (28%) did not receive advice on oral intake during labour. Maternal risk factors for surgical intervention were identified in 72 (48%) women and fetal risk factors in 27 (18%) women. Thirty-one women (21%) delivered by emergency caesarean section. CONCLUSION Pregnant women received variable advice regarding oral intake during labour, from variable sources. Most women felt like drinking but not eating during labour. Guidelines on oral intake in labour may be beneficial to women, balancing the preferences of women with risks of surgical intervention.
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Affiliation(s)
- Laura McDermott
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Anita Pelecanos
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Amy Krepska
- Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Susan de Jersey
- Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.,Centre for Clinical Research, and Perinatal Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Renuka Sekar
- Department of Maternal Fetal Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Derek Mao
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Geraldine Lee
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Annika Blackie
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Victoria Eley
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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Fomukong NH, Edwin N, Edgar MML, Nkfusai NC, Ijang YP, Bede F, Shirinde J, Cumber SN. Management of face presentation, face and lip edema in a primary healthcare facility case report, Mbengwi, Cameroon. Pan Afr Med J 2019; 33:292. [PMID: 31692903 PMCID: PMC6815474 DOI: 10.11604/pamj.2019.33.292.18927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/31/2019] [Indexed: 11/23/2022] Open
Abstract
Face presentation is a rare obstetric event and most practitioners will go through their carriers without ever meeting one. Face presentation can be delivered vaginally only if the foetus is in the mentum anterior position. More than half of the cases of face presentation are delivered by caesarean section. Newborn infants with face presentation usually have severe facial oedema, facial bruising or ecchymosis. These syndromic facial features usually resolved within 24-48 hours.
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Affiliation(s)
- Nzozone Henry Fomukong
- Microhealth Global Medical Centre, Mbengwi, Cameroon.,Department of Medicine and Surgery, Faculty of Health Sciences University of Buea, Buea, Cameroon
| | | | - Mandeng Ma Linwa Edgar
- Department of Medicine and Surgery, Faculty of Health Sciences University of Buea, Buea, Cameroon
| | - Ngwayu Claude Nkfusai
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon.,Cameroon Baptist Convention Health Services (CBCHS), Yaoundé, Cameroon
| | - Yunga Patience Ijang
- Department of Public Health, School of Health Sciences, Catholic University of Central Africa, Box 1110, Yaoundé, Cameroon
| | - Fala Bede
- Cameroon Baptist Convention Health Services (CBCHS), Yaoundé, Cameroon
| | - Joyce Shirinde
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria Private Bag X323, Gezina, Pretoria, 0001, Pretoria, South Africa
| | - Samuel Nambile Cumber
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria Private Bag X323, Gezina, Pretoria, 0001, Pretoria, South Africa.,Institute of Medicine, Department of Public Health and Community Medicine (EPSO), University of Gothenburg, Box 414, SE - 405 30 Gothenburg, Sweden.,Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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7
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Monod C, Buechel J, Gisin S, Abo El Ela A, Vogt DR, Hoesli I. Simulation of an impacted fetal head extraction during cesarean section: description of the creation and evaluation of a new training program. J Perinat Med 2019; 47:857-866. [PMID: 31494636 DOI: 10.1515/jpm-2019-0216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 08/14/2019] [Indexed: 11/15/2022]
Abstract
Background Although cesarean sections at full dilatation are increasing, training in delivering a deeply impacted fetal head is lacking among obstetricians. The purpose of the study was to implement and evaluate a theoretical and simulation-based training program for this obstetrical emergency. Methods We developed a training program consisting of a theoretical introduction presenting a clinical algorithm, developed on the basis of the available literature, followed by a simulation session. We used the Kirkpatrick's framework to evaluate the program. A questionnaire was distributed, directly before, immediately and 6 weeks after the training. Self-perceived competencies were evaluated on a 6-point Likert scale. Pre- and post-test differences in the Likert scale were measured with the Wilcoxon signed rank test. Additionally, the training sessions were video recorded and rated with a checklist in relation to how well the algorithm was followed. Results Eleven residents and eight senior physicians took part to the training. More than 40% of participants experienced a comparable situation after the course during clinical work. Their knowledge and self-perceived competencies improved immediately after the training program and 6 weeks later. Major improvements were seen in the awareness of the algorithm and in the confidence in performing the reverse breech extraction (14.3% of the participants felt confident with the maneuver in the pre-training assessment compared with 66.7% 6 week post-training). Conclusion Our theoretical and simulation-based training program was successful in improving knowledge and confidence of the participants in delivering a deeply impacted fetal head during a cesarean section performed at full dilation.
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Affiliation(s)
- Cécile Monod
- Department of Gynecology and Obstetrics, University Hospital Basel, Basel, Switzerland
| | - Johanna Buechel
- Department of Gynecology and Obstetrics, University Hospital Basel, Basel, Switzerland
| | - Stefan Gisin
- Department of Anesthesia, University Hospital Basel and Simulation Center SimBa, Basel, Switzerland
| | - Aisha Abo El Ela
- Department of Gynecology and Obstetrics, University Hospital Basel, Basel, Switzerland
| | - Deborah R Vogt
- Clinical Trial Unit, Department Clinical Research, University Hospital Basel and University Basel, Basel, Switzerland
| | - Irene Hoesli
- Department of Gynecology and Obstetrics, University Hospital Basel, Basel, Switzerland
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8
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Qiu Y, Wu L, Xiao Y, Zhang X. Clinical analysis and classification of placental abruption. J Matern Fetal Neonatal Med 2019; 34:2952-2956. [PMID: 31608779 DOI: 10.1080/14767058.2019.1675625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate the diagnosis, treatment, and maternal and fetal outcomes of placental abruption. MATERIALS AND METHODS We recruited 585 cases of placental abruption from the Women and Children's Hospital Affiliated to Xiamen University between January 2012 and December 2017. Cases were categorized into four groups (class 0-III) according to the clinical guidelines published by the Obstetrics and Gynecology Branch of the Chinese Medical Association. We then compared clinical data and auxiliary examinations across the four groups. RESULTS The differences were statistically significant (p < .01) among the four groups of placental abruption with regard to the incidence of an abnormal ultrasound finding. Positive ultrasound signs were evident in 6.4% of the patients categorized as class 0 and 100.0% of patients categorized as class III. Monitoring showed that fetal heart rate (FHR) was abnormal in class II patients with placental abruption; patients in class III showed no fetal heart sounds. Cesarean section was carried out for 26.6%, 75.1%, 65.2%, and 47.1% of patients in classes 0, I, II, and III, respectively. The rate of cesarean section for classes I and II was the highest, while the lowest rate occurred for class 0. Postpartum hemorrhage occurred in 2.5%, 9.3%, 15.2%, and 29.4% of patients across the four groups, DIC occurred in 0.0%, 1.3%, 2.3%, and 23.5% of cases, and perinatal death occurred in 1.0%, 1.3%, 7.6%, and 100.0% of cases, respectively. The highest incidence of postpartum hemorrhage was in class III (29.4%) and the lowest was in class 0 (2.5%). The highest incidence of DIC was in class III (23.5%) and the lowest was in class 0 (0.0%). The highest incidence of neonatal asphyxia was in class II (34.1%) and the lowest was in class 0 (10.1%). Regarding perinatal death, the highest incidence was in class III (100.0%) and the lowest was in class 0 (1.0%). These data showed significance differences when compared across the four groups of patients (p < .01). CONCLUSIONS We recommend that the diagnosis of placental abruption should consider risk factors, clinical features, FHR monitoring, and dynamic ultrasound monitoring. Early diagnosis and treatment can improve maternal and infant prognosis.
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Affiliation(s)
- Yu Qiu
- Department of Obstetrics and Gynecology, Xiamen Women and Children's Health Hospital & Women and Children's Hospital Affiliated to Xiamen University, Xiamen, PR China
| | - Lixia Wu
- Department of Obstetrics and Gynecology, Xiamen Women and Children's Health Hospital & Women and Children's Hospital Affiliated to Xiamen University, Xiamen, PR China
| | - Yunshan Xiao
- Department of Obstetrics and Gynecology, Xiamen Women and Children's Health Hospital & Women and Children's Hospital Affiliated to Xiamen University, Xiamen, PR China
| | - Xueqin Zhang
- Department of Obstetrics and Gynecology, Xiamen Women and Children's Health Hospital & Women and Children's Hospital Affiliated to Xiamen University, Xiamen, PR China
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9
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Bueno-Lopez V, Fuentelsaz-Gallego C, Casellas-Caro M, Falgueras-Serrano AM, Crespo-Berros S, Silvano-Cocinero AM, Alcaine-Guisado C, Zamoro Fuentes M, Carreras E, Terré-Rull C. Efficiency of the modified Sims maternal position in the rotation of persistent occiput posterior position during labor: A randomized clinical trial. Birth 2018. [PMID: 29537658 DOI: 10.1111/birt.12347] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fetal occiput posterior position in labor is associated with more painful and prolonged labor, and an increase in both maternal and fetal morbidity. The aim of this study is to assess whether the modified Sims position on the side of the fetal spine increases the rotation to occiput anterior position in women with epidural analgesia and a fetus in persistent occiput posterior (POP) position. METHODS This is an open, randomized controlled, clinical trial. One hundred and twenty women in labor with fetuses in POP position were included. The diagnosis was performed through digital vaginal examination and confirmed with an ultrasound scan. Women were randomized into the free position group or the modified Sims on the side of the fetal spine. The primary outcome was rotation to occiput anterior, and secondary outcomes were type of delivery, postpartum perineal condition, perinatal results, and maternal satisfaction. RESULTS In pregnant women undergoing labor in the Sims position, fetuses in POP rotated to occiput anterior in 50.8% of cases, whilst in the free position group, the rotation occurred in 21.7% (P = .001). The rate of vaginal deliveries was higher in the Sims group compared with the free position group (84.7% vs 68.3%, P = .035). DISCUSSION The modified Sims position is a maternal posture intervention efficient in POP rotation, which decreases cesarean delivery rate. It is a simple and noninvasive intervention, reproducible, and well tolerated by pregnant women.
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Affiliation(s)
- Vanessa Bueno-Lopez
- Obstetrics Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Manel Casellas-Caro
- Gynaecology-Obstetrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | | | | | | | - Elena Carreras
- Obstetrics Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carmen Terré-Rull
- Faculty of Medicine and Health Sciences: Nursing School, Hospitalet de Llobregat, Universitat de Barcelona, Barcelona, Spain
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Maskey S, Dwa Y. Predisposing Factors and Outcome of Malpresentations in an Institute. JNMA J Nepal Med Assoc 2018; 56:674-677. [PMID: 30381763 PMCID: PMC8997271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION This study was done to find out the incidence of malpresentation among all deliveries with various types of Malpresentations, its mode of delivery , maternal and fetal predisposing factors with outcome. METHODS This was a cross sectional descriptive study done at KIST Medical College and Teaching Hospital. Review cases of women admitted in labor after 22 weeks with malpresentation was done. Maternal/fetal predisposing factors were recorded. RESULTS Total delivery in study period was 4009 where 101 (2.5%) were of malpresentation. Breech was the commonest malpresentation 83 (82.1%). Assisted vaginal delivery occurred in 16 (15.8%) and 953 (84.2%) caesarian section. Malpresentations was common in primigravida 62 (61.3%). Half (47.2%) cases had one/more predisposing factors, commonest being oligohydramnious 7 (6.9%). Out of 108 babies with malpresentation, 10 had perinatal deaths and 10 had NICU admissions. Congenital anomaly was found in 4 babies. CONCLUSIONS The most common type of malpresentation was breech common in primigravida with oligohydramnios as contributing factor.
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Affiliation(s)
- Smrity Maskey
- Department of Obstetrics and Gynaecology, KIST Medical College and Teaching Hospital, Lalitpur, Nepal
| | - Yam Dwa
- Department of Obstetrics and Gynaecology, KIST Medical College and Teaching Hospital, Lalitpur, Nepal
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11
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12
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The use of intrapartum ultrasound to diagnose malpositions and cephalic malpresentations. Am J Obstet Gynecol 2017; 217:633-641. [PMID: 28743440 DOI: 10.1016/j.ajog.2017.07.025] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 01/21/2023]
Abstract
Fetal malpositions and cephalic malpresentations are well-recognized causes of failure to progress in labor. They frequently require operative delivery, and are associated with an increased probability of fetal and maternal complications. Traditional obstetrics emphasizes the role of digital examinations, but recent studies demonstrated that this approach is inaccurate and intrapartum ultrasound is far more precise. The objective of this review is to summarize the current body of literature and provide recommendations to identify malpositions and cephalic malpresentations with ultrasound. We propose a systematic approach consisting of a combination of transabdominal and transperineal scans and describe the findings that allow an accurate diagnosis of normal and abnormal position, flexion, and synclitism of the fetal head. The management of malpositions and cephalic malpresentation is currently a matter of debate, and individualized depending on the general clinical picture and expertise of the provider. Intrapartum sonography allows a precise diagnosis and therefore offers the best opportunity to design prospective studies with the aim of establishing evidence-based treatment. The article is accompanied by a video that demonstrates the sonographic technique and findings.
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13
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Cornelissen MJ, Söfteland M, Apon I, Ladfors L, Mathijssen IM, Cohen-Overbeek TE, Bonsel GJ, Kölby L. Perinatal complications in patients with unisutural craniosynostosis: An international multicentre retrospective cohort study. J Craniomaxillofac Surg 2017; 45:1809-1814. [DOI: 10.1016/j.jcms.2017.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/05/2017] [Accepted: 08/11/2017] [Indexed: 11/29/2022] Open
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14
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Obstetric outcomes in pregnant women with and without depression: population-based comparison. Sci Rep 2017; 7:13937. [PMID: 29066809 PMCID: PMC5655038 DOI: 10.1038/s41598-017-14266-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 10/06/2017] [Indexed: 12/31/2022] Open
Abstract
This study used insurance claims data to evaluate obstetric outcomes in pregnant women with and without depression because population study for Asian women on the issue is limited. We identified 5,064 women with depression at pregnancy in 2005–2013, and 20,024 pregnant women without depression, frequency matched by age, pregnant year and parity. Obstetric events during pregnancy and deliveries were evaluated. The depression group had more events than comparisons for hyperemesis (39.3 vs. 35.5%), abortion (3.3 vs. 2.6%), malpresentation (12.3 vs. 10.3%), C-section (40.2 vs. 34.6%) and intrauterine fetal demise (0.7 vs. 0.4%); risks of these events were significant for childbearing depressed women, not for the 35+ years subgroup. These incidences were higher in depressed women taking antidepressant than those without the medication, but were significant in childbearing depressed subgroup for hyperemesis and C-section with odds ratios of 1.18 (95% confidence intervals (CI), 1.02–1.36) and 1.29 (95% CI, 1.11–1.49), respectively. Incident preterm and low birth weight births were also higher in the depression group than in comparisons, but weren’t significant. In conclusion, women with depression during pregnancy may develop more adverse events than comparisons and are more likely to have a C-section delivery.
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Ahmed RJ, Gafni A, Hutton EK. The Cost Implications in Ontario, Alberta, and British Columbia of Early Versus Delayed External Cephalic Version in the Early External Cephalic Version 2 (EECV2) Trial. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:235-245.e3. [PMID: 27106193 DOI: 10.1016/j.jogc.2015.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 05/25/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE According to the Early External Cephalic Version (EECV2) Trial, planning external cephalic version (ECV) early in pregnancy results in fewer breech presentations at delivery compared with delayed external cephalic version. A Cochrane review conducted after the EECV2 Trial identified an increase in preterm birth associated with early ECV. We examined whether a policy of routine early ECV (i.e., before 37 weeks' gestation) is more or less costly than a policy of delayed ECV. METHODS We undertook this analysis from the perspective of a third-party payer (Ministry of Health). We applied data, using resources reported in the EECV2 Trial, to the Canadian context using 10 hospital unit costs and 17 physician service/procedure unit costs. The data were derived from the provincial health insurance plan schedule of medical benefits in three Canadian provinces (Ontario, Alberta, and British Columbia). The difference in mean total costs between study groups was tested for each province separately. RESULTS We found that planning early ECV results in higher costs than planning delayed ECV. The mean costs of all physician services/procedures and hospital units for planned ECV compared with delayed ECV were $7997.32 versus $7263.04 in Ontario (P < 0.001), $8162.82 versus $7410.55 in Alberta (P < 0.001), and $8178.92 versus $7417.04 in British Columbia (P < 0.001), respectively. CONCLUSION From the perspective of overall cost, our analyses do not support a policy of routinely planning ECV before 37 weeks' gestation.
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Affiliation(s)
- Rashid J Ahmed
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton ON
| | - Amiram Gafni
- Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton ON
| | - Eileen K Hutton
- Department of Obstetrics and Gynecology (Midwifery), Faculty of Health Sciences, McMaster University, Hamilton ON
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Eggebø TM, Hassan WA, Salvesen KÅ, Torkildsen EA, Østborg TB, Lees CC. Prediction of delivery mode by ultrasound-assessed fetal position in nulliparous women with prolonged first stage of labor. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:606-610. [PMID: 25536955 DOI: 10.1002/uog.14773] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 09/22/2014] [Accepted: 12/16/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To ascertain if fetal head position on transabdominal ultrasound is associated with delivery by Cesarean section in nulliparous women with a prolonged first stage of labor. METHODS This was a prospective observational study performed at Stavanger University Hospital, Norway, and Addenbrooke's Hospital, Cambridge, UK, between January 2012 and April 2013. Nulliparous pregnant women with a singleton cephalic presentation at term and prolonged labor had fetal head position assessed by ultrasound. The main outcome was Cesarean section vs vaginal delivery, and secondary outcomes were association of fetal head position with operative vaginal delivery and duration of remaining time in labor. RESULTS Fetal head position was assessed successfully by ultrasound examination in 142/150 (95%) women. In total, 19/50 (38%) women with a fetus in the occiput posterior (OP) position were delivered by Cesarean section compared with 16/92 (17%) women with a fetus in a non-OP position (P = 0.01). On multivariable logistic regression analysis, the OP position predicted delivery by Cesarean section with an odds ratio (OR) of 2.9 (95% CI, 1.3-6.7; P = 0.01) and induction of labor with an OR of 2.4 (95% CI, 1.0-5.6; P = 0.05). Fetal head position was not associated with operative vaginal delivery or with remaining time in labor. The agreement between a digital and an ultrasound assessment of OP position was poor (Cohen's kappa = 0.19; P = 0.18). CONCLUSION OP fetal head position assessed by transabdominal ultrasound was significantly associated with delivery by Cesarean section.
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Affiliation(s)
- T M Eggebø
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
- National Center for Fetal Medicine, Trondheim University Hospital (St Olavs Hospital), Trondheim, Norway
| | - W A Hassan
- Fetal Medicine Department, Rosie Maternity Hospital, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - K Å Salvesen
- Department of Obstetrics and Gynaecology, Clinical Sciences, Lund University, Lund, Sweden
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - E A Torkildsen
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - T B Østborg
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - C C Lees
- Fetal Medicine Department, Rosie Maternity Hospital, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
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Gold KJ, Mozurkewich EL, Puder KS, Treadwell MC. Maternal complications associated with stillbirth delivery: A cross-sectional analysis. J OBSTET GYNAECOL 2015; 36:208-12. [PMID: 26479679 DOI: 10.3109/01443615.2015.1050646] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study sought to identify delivery complications associated with stillbirth labour and delivery. We conducted a retrospective chart review evaluating stillbirth demographics, pregnancy and maternal risk factors, and complications of labour and delivery. We performed bivariable analysis and multivariable logistic regression to evaluate factors associated with medical complications and variations by race. Our cohort included 543 mothers with stillbirth, of which two-thirds were African-American. We noted high rates of shoulder dystocia, clinical chorioamnionitis, postpartum haemorrhage and retained placenta in women with stillbirths. Thirty-three women (6%) experienced at least one serious maternal complication. Complication rates did not vary by maternal race. Providers who perform obstetrical care should be alert to the high rate of maternal medical complications associated with labour and delivery of a stillbirth foetus.
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Affiliation(s)
- K J Gold
- a Department of Family Medicine and Department of Obstetrics and Gynecology , University of Michigan , US
| | - E L Mozurkewich
- b Department of Obstetrics and Gynecology , University of New Mexico , US
| | - K S Puder
- c Department of Obstetrics and Gynecology , Wayne State University , US
| | - M C Treadwell
- d Department of Obstetrics and Gynecology , University of Michigan , US
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Eggebø TM, Eymundsdottir AE, Østborg TB. Face presentation and persistent deep mentum transverse position diagnosed with three-dimensional ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:490-491. [PMID: 25354447 DOI: 10.1002/uog.14705] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 10/13/2014] [Accepted: 10/13/2014] [Indexed: 06/04/2023]
Affiliation(s)
- T M Eggebø
- National Center for Fetal Medicine, Trondheim University Hospital, (St Olavs Hospital), Trondheim, Norway
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Aiken AR, Aiken CE, Alberry MS, Brockelsby JC, Scott JG. Management of fetal malposition in the second stage of labor: a propensity score analysis. Am J Obstet Gynecol 2015; 212:355.e1-7. [PMID: 25446659 DOI: 10.1016/j.ajog.2014.10.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 08/07/2014] [Accepted: 10/15/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We sought to determine the factors associated with selection of rotational instrumental vs cesarean delivery to manage persistent fetal malposition, and to assess differences in adverse neonatal and maternal outcomes following delivery by rotational instruments vs cesarean delivery. STUDY DESIGN We conducted a retrospective cohort study over a 5-year period in a tertiary United Kingdom obstetrics center. In all, 868 women with vertex-presenting, single, liveborn infants at term with persistent malposition in the second stage of labor were included. Propensity score stratification was used to control for selection bias: the possibility that obstetricians may systematically select more difficult cases for cesarean delivery. Linear and logistic regression models were used to compare maternal and neonatal outcomes for delivery by rotational forceps or ventouse vs cesarean delivery, adjusting for propensity scores. RESULTS Increased likelihood of rotational instrumental delivery was associated with lower maternal age (odds ratio [OR], 0.95; P < .01), lower body mass index (OR, 0.94; P < .001), lower birthweight (OR, 0.95; P < .01), no evidence of fetal compromise at the time of delivery (OR, 0.31; P < .001), delivery during the daytime (OR, 1.45; P < .05), and delivery by a more experienced obstetrician (OR, 7.21; P < .001). Following propensity score stratification, there was no difference by delivery method in the rates of delayed neonatal respiration, reported critical incidents, or low fetal arterial pH. Maternal blood loss was higher in the cesarean group (295.8 ± 48 mL, P < .001). CONCLUSION Rotational instrumental delivery is often regarded as unsafe. However, we find that neonatal outcomes are no worse once selection bias is accounted for, and that the likelihood of severe obstetric hemorrhage is reduced. More widespread training of obstetricians in rotational instrumental delivery should be considered, particularly in light of rising cesarean delivery rates.
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Affiliation(s)
- Abigail R Aiken
- Office of Population Research, Princeton University, Princeton, NJ
| | - Catherine E Aiken
- Department of Obstetrics and Gynecology, University of Cambridge, and National Institute of Health Research Cambridge Comprehensive Biomedical Research Center, England, United Kingdom.
| | - Medhat S Alberry
- Department of Obstetrics and Gynecology, University of Cambridge, and National Institute of Health Research Cambridge Comprehensive Biomedical Research Center, England, United Kingdom
| | - Jeremy C Brockelsby
- Department of Obstetrics and Gynecology, University of Cambridge, and National Institute of Health Research Cambridge Comprehensive Biomedical Research Center, England, United Kingdom
| | - James G Scott
- Red McCombs School of Business and Division of Statistics and Scientific Computation, University of Texas at Austin, Austin, TX
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Hall JG, Aldinger KA, Tanaka KI. Amyoplasia revisited. Am J Med Genet A 2014; 164A:700-30. [DOI: 10.1002/ajmg.a.36395] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 11/14/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Judith G. Hall
- Departments of Medical Genetics and Pediatrics; University of British Columbia and BC Children's Hospital; Vancouver Canada
| | - Kimberly A. Aldinger
- Center for Integrative Brain Research; Seattle Children's Research Institute; Seattle Washington
| | - Kimi I. Tanaka
- Departments of Medical Genetics and Pediatrics; University of British Columbia and BC Children's Hospital; Vancouver Canada
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VERSPYCK ERIC, BISSON VIOLENE, GROMEZ ALEXIS, RESCH BENOIT, DIGUET ALAIN, MARPEAU LOÏC. Prophylactic attempt at manual rotation in brow presentation at full dilatation. Acta Obstet Gynecol Scand 2012; 91:1342-5. [DOI: 10.1111/j.1600-0412.2012.01515.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
The objective of this review was to assess the evidence that supports cesarean delivery for fetal indications. The main fetal reasons for abdominal delivery include abnormal fetal heart rate patterns in labor, malpresentation, fetal macrosomia, multiple gestation, and both functional and structural fetal abnormalities. Although the level of evidence is not as strong as anticipated, there is sufficient support for cesarean delivery when these fetal conditions complicate pregnancy. Efforts to decrease cesarean delivery for fetal indications in the current medicolegal environment will not be easy; however, the development of more sensitive tools to assess fetal well-being in labor and practices to deliver or reduce fetuses in breech presentation at term have the potential for greatest impact on the overall primary cesarean delivery rate.
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Affiliation(s)
- Lynn L Simpson
- Department of Obstetrics and Gynecology, Columbia University Medical Center, NY 10032, USA.
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TORKILDSEN ERIKA, SALVESEN KJELLÅ, VON BRANDIS PHILIP, EGGEBØ TORBJØRNM. Predictive value of ultrasound assessed fetal head position in primiparous women with prolonged first stage of labor. Acta Obstet Gynecol Scand 2012; 91:1300-5. [DOI: 10.1111/j.1600-0412.2012.01503.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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ELVANDER CHARLOTTE, HÖGBERG ULF, EKÉUS CECILIA. The influence of fetal head circumference on labor outcome: a population‐based register study. Acta Obstet Gynecol Scand 2012; 91:470-5. [DOI: 10.1111/j.1600-0412.2012.01358.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- CHARLOTTE ELVANDER
- Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institute, Stockholm
| | - ULF HÖGBERG
- Department of Women's and Children's Health, Uppsala University, Uppsala
- Department of Epidemiology & Global Health, Umeå University, Umeå, Sweden
| | - CECILIA EKÉUS
- Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institute, Stockholm
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