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Exner F, Caspers R, Kennes LN, Wittenborn J, Kupec T, Stickeler E, Najjari L. Digital Examination vs. 4D Transperineal Ultrasound-Do They Compare in Labour Management? A Pilot Study. Diagnostics (Basel) 2024; 14:293. [PMID: 38337809 PMCID: PMC10854967 DOI: 10.3390/diagnostics14030293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/11/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
The aim was to compare transperineal ultrasound (TPU) with parameters of the Bishop Score during the first stage of labour and evaluate how TPU can contribute towards improving labour management. Digital examination (DE) and TPU were performed on 42 women presenting at the labour ward with regular contractions. TPU measurements included the head-symphysis distance, angle of progression, diameter of the cervical wall, cervical dilation (CD) and cervical length (CL). To examine if TPU can monitor labour progress, correlations of TPU parameters were calculated. Agreement of DE and TPU was examined for CL and CD measurements and for two groups divided into latent (CD < 5 cm) and active stages of labour (CD ≥ 5 cm). TPU parameters indicated a moderate negative correlation of CD and CL (Pearson: r = -0.667; Spearman = -0.611). The other parameters showed a weak to moderate correlation. DE and TPU measurements for CD showed better agreement during the latent stage than during the active stage. The results of the present study add to the growing evidence that TPU may contribute towards an improved labour management, suggesting a combined approach of TPU and DE to monitor the latent first stage of labour and using only DE during the active stage of labour.
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Affiliation(s)
- Friederike Exner
- Department of Gynaecology and Obstetrics, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Rebecca Caspers
- Department of Gynaecology and Obstetrics, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Lieven Nils Kennes
- Department of Economics and Business Administration, Hochschule Stralsund, 18435 Stralsund, Germany
| | - Julia Wittenborn
- Department of Gynaecology and Obstetrics, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Tomás Kupec
- Department of Gynaecology and Obstetrics, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Elmar Stickeler
- Department of Gynaecology and Obstetrics, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Laila Najjari
- Department of Gynaecology and Obstetrics, University Hospital RWTH Aachen, 52074 Aachen, Germany
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Frank Wolf M, Ben-Nun M, Sgayer I, Shnaider O, Aiob A, Odeh M, Bornstein J. The association between acute lower abdominal pain over a previous caesarean scar and uterine rupture. J OBSTET GYNAECOL 2022; 42:1169-1173. [PMID: 35152819 DOI: 10.1080/01443615.2022.2027896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Pregnant women with previous caesarean delivery might suffer from acute lower abdominal pain located at the site of previous caesarean scar (CS). The association between this complaint and uterine rupture (UR) is not fully understood. Therefore, we aimed to examine the risk of UR in women with acute persistent abdominal pain (APAP) over a previous CS and to investigate all the women with UR, with or without APAP and with or without previous CS, in order to determine risk factors, clinical presentation and management. We performed a retrospective analysis on two study groups: women who had APAP over previous CS and women who had UR. We found an incidence of UR in patients with APAP over the previous CS was 0.7%; which doubled the total UR rate among women with previous caesarean in our medical centre (0.35%). Forty percent of the women with APAP over a previous CS had preterm delivery. Twenty percent of the cases of UR occurred in preterm weeks. To conclude, APAP over a previous CS is associated with a doubled risk of UR. Considering this symptom as a preliminary sign of UR might lead to elevated rate of iatrogenic preterm deliveries.Impact statementWhat is already known on this subject? Women with UR may present with abdominal pain which may vary from non-specific mild discomfort to severe acute abdominal pain. Additionally, these women may suffer from acute persistent abdominal pain (APAP) located over the previous caesarean scar. The clinical significance of APAP in these women has not been fully investigated.What do the results of this study add? Lower abdominal pain located at the site of previous CS is associated with a doubled risk of UR. Considering this complaint as a major sign of UR might lead to an elevated rate of iatrogenic preterm deliveries.What are the implications of these findings for clinical practice and/or further research? Further studies are needed to explore whether women with a single complaint of APAP over CS could be managed expectantly and even offered a trial of labour after caesarean delivery (CD).
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Affiliation(s)
- Maya Frank Wolf
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Maayan Ben-Nun
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Inshirah Sgayer
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Oleg Shnaider
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Alaa Aiob
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
| | - Marwan Odeh
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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Buttigieg GG, Micallef-Stafrace K. Shoulder dystocia: Updating some medico-legal issues. Med Leg J 2022; 90:13-16. [PMID: 35156438 DOI: 10.1177/00258172211066364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Shoulder dystocia, or shoulder entrapment at birth, is an obstetrician's nightmare, which not infrequently leads to court litigation with complaints of serious foetal and/or maternal damage. Increasingly, retrospective management scrutiny is extending well beyond second stage birth mechanics and involving all case file entries, history taking, ultrasound scan measurements and haematology profile results, etc. The article highlights some medico-legal issues including the influence of the Montgomery ruling on patient disclosure and subsequent management.
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Affiliation(s)
- George G Buttigieg
- Department of Obstetrics and Gynaecology; Department of Orthopaedics, University of Malta, Trauma and Sport Medicine
| | - Kirill Micallef-Stafrace
- Department of Obstetrics and Gynaecology; Department of Orthopaedics, University of Malta, Trauma and Sport Medicine
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Hoque AM, Hoque ME, Hal GV. Incidence, trends and risk factors for perineal injuries of low-risk pregnant women: Experience from a midwife run obstetric unit, South Africa. Afr J Reprod Health 2021; 25:52-62. [PMID: 37585792 DOI: 10.29063/ajrh2021/v25i4.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Pregnant women experience perineal injuries during childbirth. The objectives of this cross-sectional retrospective study were to estimate the incidence, trends, and risk factors for perineal injuries of women who had childbirths from January 2013 to December 2017. We used logistic regression to identify risk factors for all injuries, episiotomy, and obstetric anal sphincter injury (OASI) measured by odds ratios (OR). A total of 5547 women showed gradual decreases of episiotomy from 17.6% in 2013 to 7.6% in 2017 (p <0.05). Perineal injuries were reduced from 33.3% in 2013 to 28.9% in 2017 (p <0.05). The risk factor for any perineal injury were younger ages, term pregnancy, and nil parity (p,0.05). Advanced gestational age, nil parity, and previous vaginal births were risk factors for episiotomy. However, birth weight of baby was significantly associated with OASI. Episiotomy and overall perineal injury rates were commendable. Training to midwives is needed to improve perineal care and maintain good practices during delivery.
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Affiliation(s)
- Akm M Hoque
- Medical Manager, Kwadabeka Community Health Centre, KwaZulu-Natal, South Africa
| | | | - Guido V Hal
- Social Epidemiology and Health Policy, University of Antwerp Antwerp, Belgium
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Snelders S, van Bergen L, Huisman F. Leprosy and the Colonial Gaze: Comparing the Dutch West and East Indies, 1750-1950. Soc Hist Med 2021; 34:611-631. [PMID: 34084094 PMCID: PMC8162854 DOI: 10.1093/shm/hkz079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This article is looking at colonial governance with regard to leprosy, comparing two settings of the Dutch colonial empire: Suriname and the Dutch East Indies. Whereas segregation became formal policy in Suriname, leprosy sufferers were hardly ever segregated in the Dutch East Indies. We argue that the perceived needs to maintain a healthy labour force and to prevent contamination of white populations were the driving forces behind the difference in response to the disease. Wherever close contact between European planters and a non-European labour force existed together with conditions of forced servitude (either slavery or indentured labour), the Dutch response was to link leprosy to racial inferiority in order to legitimise compulsory segregation. This mainly happened in Suriname. We would like to suggest that forced labour, leprosy and compulsory segregation were connected through the 'colonial gaze', legitimising compulsory segregation of leprosy sufferers who had become useless to the plantation economy.
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Affiliation(s)
- Stephen Snelders
- UMC Utrecht, PO Box 85500 HP Str. 6.131, 3508 GA Utrecht, The Netherlands
| | - Leo van Bergen
- UMC Utrecht, PO Box 85500 HP Str. 6.131, 3508 GA Utrecht, The Netherlands
| | - Frank Huisman
- UMC Utrecht, PO Box 85500 HP Str. 6.131, 3508 GA Utrecht, The Netherlands
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de Vries BS, Mcdonald S, Joseph FA, Morton R, Hyett JA, Phipps H, McGeechan K. Impact of analysis technique on our understanding of the natural history of labour: a simulation study. BJOG 2021; 128:1833-1842. [PMID: 33837643 DOI: 10.1111/1471-0528.16719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the discrepancy between historical and more recent descriptions of the first stage of labour by testing whether the statistical techniques used recently (repeated-measures polynomial and interval-censored regression) were appropriate for detection of periods of rapid acceleration of cervical dilatation as might occur at the time of transition from a latent to an active phase of labour. DESIGN AND SETTING A simulation study using regression techniques. SAMPLE We created a simulated data set for 500 000 labours with clearly defined latent and active phases using the parameters described by Friedman. Additionally, we created a data set comprising 500 000 labours with a progressively increasing rate of cervical dilatation. METHODS Repeated-measures polynomial regression was used to create summary labour curves based on simulated cervical examinations. Interval-censored regression was used to create centimetre-by-centimetre estimates of rates of cervical dilatation and their 95th centiles. MAIN OUTCOME MEASURES Labour summary curves and rates of cervical dilatation. RESULTS Repeated-measures polynomial regression did not detect the rapid acceleration in cervical dilatation (i.e. acceleration phase) and overestimated lengths of labour, especially at smaller cervical dilatations. There was a two-fold overestimation in the mean rate of cervical dilatation from 4 to 6 cm. Interval-censored regression overestimated median transit times, at 4- to 5-cm cervical dilatation or when cervical examinations occurred less frequently than 0.5- to 1.5-hourly. CONCLUSION Repeated-measures polynomial regression and interval-censored regression should not be routinely used to define labour progress because they do not accurately reflect the underlying data. TWEETABLE ABSTRACT Repeated-measures polynomial and interval-censored regression techniques are not appropriate to model first stage of labour.
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Affiliation(s)
- B S de Vries
- Sydney Institute for Women, Children and their Families, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, NSW, Australia
| | - S Mcdonald
- Baymatob Operations Pty Ltd Sydney, Sydney, NSW, Australia
| | - F A Joseph
- RPA Women and Babies Camperdown, Camperdown, NSW, Australia
| | - R Morton
- RPA Women and Babies Camperdown, Camperdown, NSW, Australia
| | - J A Hyett
- Sydney Institute for Women, Children and their Families, Sydney, NSW, Australia
| | - H Phipps
- Sydney Institute for Women, Children and their Families, Sydney, NSW, Australia
| | - K McGeechan
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, NSW, Australia
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van Bavel J, Ravelli A, Abu-Hanna A, Roovers J, Mol BW, de Leeuw JW. Risk factors for the recurrence of obstetrical anal sphincter injury and the role of a mediolateral episiotomy: an analysis of a national registry. BJOG 2020; 127:951-956. [PMID: 32285571 DOI: 10.1111/1471-0528.16263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The assessment of risk factors, including mediolateral episiotomy (MLE), for the recurrence of obstetric anal sphincter injury (rOASI). DESIGN Population-based cohort study. SETTING Data from the nationwide database of the Dutch Perinatal Registry (Perined). POPULATION A cohort of 391 026 women at term, of whom 9943 had an OASI in their first delivery and had a second vaginal delivery of a liveborn infant in cephalic position. METHODS Possible risk factors were tested for statistical significance using univariate and multivariate logistic regression analysis. MAIN OUTCOME MEASURES Rate of rOASI. RESULTS The rate of rOASI was 5.8%. Multivariate analysis identified a birthweight of ≥4000 g (adjusted OR, aOR, 2.1, 95% CI 1.6-2.6) and a duration of second stage of ≥30 minutes (aOR 1.8, 95% CI 1.4-2.3) as statistically significant risk factors for rOASI. Mediolateral episiotomy was associated with a statistically significant lower rate of rOASI in spontaneous vaginal delivery (SVD) (aOR 0.4, 95% CI 0.3-0.5) and in operative vaginal delivery (OVD) (aOR 0.2, 95% CI 0.1-0.5). CONCLUSIONS Women with a history of OASI have a higher rate of OASI in their next delivery. Duration of the second stage of ≥30 minutes and a birthweight of ≥4000 g are significantly associated with an increased rate of rOASI. Mediolateral episiotomy is associated with a significantly lower rate of rOASI in both SVD and OVD. TWEETABLE ABSTRACT Mediolateral episiotomy is associated with a significant lower recurrence rate of OASI in women with an OASI in their first delivery.
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Affiliation(s)
- J van Bavel
- Department of Obstetrics and Gynaecology, Amphia Hospital Breda, Breda, the Netherlands
| | - Acj Ravelli
- Department of Medical Informatics, Academic Medical Centre, Amsterdam, the Netherlands
| | - A Abu-Hanna
- Department of Medical Informatics, Academic Medical Centre, Amsterdam, the Netherlands
| | - Jpwr Roovers
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - J W de Leeuw
- Department of Obstetrics and Gynaecology, Ikazia Hospital, Rotterdam, the Netherlands
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Shenouda C, Wijesooriya A, Toufeili A, Miller MR, Penava D, de Vrijer B. Labour Progression in Obese Women: Are Women With Increased Body Mass Index Having Unnecessary Cesarean Sections? J Obstet Gynaecol Can 2019; 42:293-300. [PMID: 31324481 DOI: 10.1016/j.jogc.2019.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/04/2019] [Accepted: 04/09/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study sought to determine whether obese pregnant women undergo cesarean sections without an adequate trial of labour. This may affect future birth and pregnancy outcomes. METHODS A retrospective analysis was done on 526 parturients at Victoria Hospital in London, Ontario. Women were categorized according to parity and pre-pregnancy body mass index (BMI; normal weight, BMI 18.5-24.9 kg/m2; obese class II, BMI 35.0-39.9 kg/m2; obese class III, BMI ≥40 kg/m2). Patient charts and partograms were reviewed for labour progression (time at cervical dilation), demographics, and infant outcomes (Canadian Task Force Classification II-2). RESULTS Obese class II and III primiparous women required an additional 1.62 and 2.67 hours (P = 0.012), respectively, to reach a dilation of 10 cm compared with their normal weight counterparts; obese class II and III multiparous women required an additional 1.25 and 2.05 hours (P = 0.003), respectively. A higher BMI was associated with increased oxytocin use and infant birth weight in primiparous women. Obese women had less gestational weight gain and required more cervical examinations. Cesarean section rates were low for obese parturients (primiparous, 19%; multiparous, 0.8%) and not significantly different among BMI categories. CONCLUSION This study confirmed published results that labour progresses more slowly as maternal BMI increases. The study was performed in a centre with a specialized BMI pregnancy clinic; thus weight gain adherence, awareness of labour differences, and patient counselling may have contributed to low cesarean section rates. Obstetric care providers should consider differences in maternal BMI in labour progression before undertaking a potentially premature cesarean birth, especially in primiparous women.
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Affiliation(s)
- Caroline Shenouda
- Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, Western University, London, ON
| | | | | | - Michael R Miller
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON; Children's Health Research Institute, London, ON
| | - Debbie Penava
- Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, Western University, London, ON; Children's Health Research Institute, London, ON
| | - Barbra de Vrijer
- Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, Western University, London, ON; Children's Health Research Institute, London, ON.
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