Adult ; Delivery, Obstetric ; adverse effects ; Female ; Humans ; Parturition ; Pregnancy ; Pubic Symphysis Diastasis ; diagnostic imaging ; etiology ; Radiography

BACKGROUNDTraumatic damage to fascial and muscular support structures during childbirth may be a major factor of the development of stress urinary incontinence (SUI) and pelvic organ prolapse (POP). The aim of this study was to prospectively investigate the role of different childbirth strategies on POP and SUI.

METHODSA total of 120 selected pregnant women were recruited and divided into two groups: vaginal delivery group (n = 72) and selective cesarean delivery group (n = 48). The women were questioned with SUI sheet and estimated with POP quantification (POP-Q) within 6 - 8 weeks after delivery. The correlations of SUI and results of POP-Q with the strategies of delivery were analyzed. t test, chi(2) test, and the Mann-Witney test were used for statistical analysis.

RESULTSAmong the 120 women, SUI was developed during 29 - 30 gestational weeks in 20 patients (16.6%), of whom 14 (70%) had symptoms of SUI till 6 weeks postpartum. Totally 20 (16.6%) women had SUI symptoms after delivery. The prevalence of postpartum SUI was positively correlated with the occurrence of SUI during 29 - 30 gestational weeks (P < 0.001). In the vaginal delivery group, 100% of the women suffered form urinary prolapse 6 weeks postpartum, while 87.5% of those in the selective cesarean delivery group developed POP (P < 0.01). The percentages of the first- and second-degree urinary prolapse in the vaginal delivery group were 20.8% and 79.2% respectively, which were significantly different from those in the selective cesarean delivery group (64.6% and 22.9%; both P = 0.000).

CONCLUSIONSPregnancy and delivery play an etiologic role in the development of SUI and POP. The onset of SUI during late pregnancy implies a significant risk of postpartum SUI symptoms. The prevalence of POP is significantly higher after vaginal delivery than after cesarean delivery.

Adult ; Cesarean Section ; adverse effects ; Delivery, Obstetric ; adverse effects ; Female ; Humans ; Pelvic Floor ; Prospective Studies ; Urinary Incontinence, Stress ; etiology ; Uterine Prolapse ; etiology

BACKGROUND/AIMS: This study was aimed to analyze the clinical characteristics of patients who developed constipation after radical hysterectomy or delivery and to investigate the results of biofeedback therapy for these patients. METHODS: Thirty-five chronic constipation patients with radical hysterectomy (radical hysterectomy group), 27 chronic constipation patients with delivery (delivery group) and 27 constipation patients with no history of hysterectomy or delivery (control group) were included. Clinical characteristics of these patients, including the results of biofeedback therapy, were analyzed. RESULTS: The delivery group showed higher rates of pelvic floor dyssynergia than the control group (14/27, 52% vs. 6/27, 22%; p<0.05). The prevalence of slow transit constipation was lower in the radical hysterectomy group and delivery group than in the control group (7/35, 20% and 5/27, 19% vs. 12/27, 44%; p<0.05). The prevalence of anatomical abnormalities was not different between the groups. The radical hysterectomy group showed higher rate of obstructive sensation and the delivery group showed higher rate of hard stool and digital maneuvers. The biofeedback therapy was effective in 10 out of 12 patients (91%) among the radical hysterectomy and delivery group. CONCLUSIONS: Radical hysterectomy and delivery seem to induce functional constipation, which may be caused by anorectal dysfunction such as pelvic floor dyssynergia. The biofeedback treatment was effective in functional constipation after radical hysterectomy or delivery.
Adult ; Aged ; Chronic Disease ; Constipation/diagnosis/*etiology/therapy ; Delivery, Obstetric/*adverse effects ; English Abstract ; Female ; Humans ; Hysterectomy/*adverse effects ; Middle Aged

INTRODUCTION: There has been a global decrease in operative vaginal deliveries, with a marked shift towards the vacuum extractor. However, little is known about the trends in operative vaginal delivery in Singapore. METHODS: A retrospective study was conducted on all operative vaginal deliveries performed from 2012 to 2017 at Singapore General Hospital (SGH). Maternal outcomes in terms of postpartum haemorrhage and obstetric anal sphincter injuries were compared between forceps- and vacuum-assisted deliveries. Neonatal outcomes in terms of neonatal intensive care unit (NICU) admission and clinically significant neonatal events were compared. The instrument preference of obstetricians was analysed. RESULTS: A total of 906 consecutive operative vaginal deliveries were included in the study, comprising 461 forceps- and 445 vacuum-assisted deliveries. The rate of operative vaginal delivery was maintained at approximately 10% from 2012 to 2017. Neonatal cephalohematomas were more common after vacuum-assisted deliveries. Other maternal and neonatal outcomes did not differ significantly between the two groups. Clinically significant neonatal events were mostly due to shoulder dystocia, whereas all cases of NICU admissions were not directly related to the mode of delivery. Obstetricians' choice of instrument appeared to reflect personal preference and was not affected by the year of graduation. CONCLUSION The rates of neonatal and maternal morbidity were low at SGH. Overall instrument use of forceps and vacuum was balanced, and proficiency in both was demonstrated by all operators. Operative vaginal delivery remains an essential skill in facilitating safe vaginal delivery, which should be maintained to keep Caesarean section rates in check.
Infant, Newborn ; Pregnancy ; Humans ; Female ; Cesarean Section ; Retrospective Studies ; Vacuum Extraction, Obstetrical/adverse effects* ; Hospitals, General ; Obstetrical Forceps/adverse effects* ; Delivery, Obstetric

BACKGROUNDHemolytic anemia, elevated liver enzymes and low platelet count (HELLP) syndrome is a severe obstetric complication which usually resolves in most patients after delivery.

METHODSWe report a rare case of aggravation of HELLP syndrome after delivery.

RESULTSThe patient underwent the treatment for HELLP syndrome, including glucocorticoid therapy. The symptoms of HELLP syndrome reappeared and became more severe than before the termination of pregnancy. The patient also had severe and persistent hypoproteinemia, hyponatremia and hypocalcemia.

CONCLUSIONSHELLP syndrome is an acute and critical obstetric syndrome which can have heterogeneous presentations and variable prognosis. We should be fully aware of the diverse clinical characteristics of this condition.

Adult ; Anemia, Hemolytic ; diagnosis ; etiology ; Delivery, Obstetric ; adverse effects ; Female ; HELLP Syndrome ; diagnosis ; etiology ; Humans ; Hypocalcemia ; diagnosis ; etiology ; Hyponatremia ; diagnosis ; etiology ; Hypoproteinemia ; diagnosis ; etiology ; Pregnancy ; Young Adult

BACKGROUNDObstetric anal sphincter injuries (OASIS) can cause an adverse impact on women's physical and mental health. There was lack of published data in Chinese population particularly on studying the risk of OASIS for nonrotational outlet forceps. This study was to determine the incidence and risk factors of OASIS.

METHODSThis is a retrospective cohort study carried out in a tertiary referral hospital in Hong Kong. The control group was selected randomly. Univariate and multivariate logistic regression analysis was performed to evaluate the influence of potential risk factors on OASIS. This study reviewed the obstetric records of OASIS women and random control from January 2011 to June 2014. Univariate and multivariate logistic regression analysis was performed to evaluate the influence of potential risk factors on OASIS.

RESULTSOf 15,446 women delivered, 49 had OASIS. The percentage of OASIS increased from 0.3% (2011) to 0.38% (2014). There was an increasing trend of OASIS in attempted spontaneous vaginal delivery without episiotomy (P < 0.01), but it did not increase the OASIS risk (P = 0.46). Univariate analysis of 49 cases and 438 control subjects showed that forceps delivery (odds ratio [OR] =8.73, P < 0.01), prolong second stage of labor (OR = 1.43, P < 0.01) increased the risk for OASIS. In multivariate regression models, only forceps delivery (OR = 6.28, P < 0.01) proved to be independent risk factor.

CONCLUSIONSThe incidence of OASIS in Chinese women was increased after 2012, but still lower than the reported figures in the literature. Outlet forceps delivery could be a possible associated risk factor.

Adult ; Anal Canal ; injuries ; Delivery, Obstetric ; adverse effects ; Female ; Hong Kong ; epidemiology ; Humans ; Incidence ; Lacerations ; epidemiology ; etiology ; Multivariate Analysis ; Obstetric Labor Complications ; epidemiology ; etiology ; Pregnancy ; Retrospective Studies ; Risk Factors

OBJECTIVETo investigate the efficacy of transcutaneous electrical nerve stimulation (TENS) on four specific acupuncture points Hegu (LI4), Neiguan (PC6), Danshu (BL19) and Weishu (BL21) for reducing pain in labor.

METHODSA total of 160 voluntary nulliparous women who were willing to receive TENS for analgesia were assigned to the treatment group after cervical dilation of more than 2 cm. Another 145 matched nullipara were recruited as the control group. Visual analogue scale (VAS) was used to assess the pain before and 0.5 h after the application of TENS. Then, VAS was assessed every one hour until delivery. Percentage of VAS score decreased by > 25% was the primary outcome, the delivery mode and neonatal outcome were measured as secondary outcomes. Adverse reactions were also recorded during TENS.

RESULTSThe percentage of VAS score decreased by > 25% was 68.6% in the TENS treatment group. Maternal delivery mode and neonatal outcomes were not significantly different between the two groups. In addition, the incidence of postpartum hemorrhage in the TENS treatment group was less than the control group (P<0.05). There was no adverse reaction recorded with TENS on acupoints.

CONCLUSIONAs a novel and non-invasive approach, TENS on specific acupoints including Hegu (LI4), Neiguan (PC6), Danshu (BL19) and Weishu (BL21) was an effective method for analgesia in labor.

Acupuncture Points ; Case-Control Studies ; Delivery, Obstetric ; Demography ; Female ; Humans ; Infant, Newborn ; Labor, Obstetric ; blood ; Pain Management ; Pain Measurement ; Postpartum Period ; blood ; Pregnancy ; Time Factors ; Transcutaneous Electric Nerve Stimulation ; adverse effects ; Treatment Outcome

OBJECTIVETo investigate the association between autism and prenatal environmental risk factors.

METHODSA case-control study was conducted among 193 children with autism from the special educational schools and 733 typical development controls matched by age and gender by using questionnaire in Tianjin from 2007 to 2012. Statistical analysis included quick unbiased efficient statistical tree (QUEST) and logistic regression in SPSS 20.0.

RESULTSThere were four predictors by QUEST and the logistic regression analysis, maternal air conditioner use during pregnancy (OR=0.316, 95% CI: 0.215-0.463) was the single first-level node (χ²=50.994, P=0.000); newborn complications (OR=4.277, 95% CI: 2.314-7.908) and paternal consumption of freshwater fish (OR=0.383, 95% CI: 0.256-0.573) were second-layer predictors (χ²=45.248, P=0.000; χ²=24.212, P=0.000); and maternal depression (OR=4.822, 95% CI: 3.047-7.631) was the single third-level predictor (χ²=23.835, P=0.000). The prediction accuracy of the tree was 89.2%.

CONCLUSIONThe air conditioner use during pregnancy and paternal freshwater fish diet might be beneficial for the prevention of autism, while newborn complications and maternal depression might be the risk factors.

Adolescent ; Air Conditioning ; Air Pollution ; adverse effects ; Autistic Disorder ; epidemiology ; etiology ; Case-Control Studies ; Child ; Child, Preschool ; China ; epidemiology ; Delivery, Obstetric ; adverse effects ; methods ; Depression ; complications ; Diet ; Environmental Exposure ; Female ; Humans ; Income ; Logistic Models ; Male ; Maternal Exposure ; Obstetric Labor Complications ; epidemiology ; Paternal Exposure ; Pregnancy ; Prenatal Exposure Delayed Effects ; epidemiology ; Risk Factors ; Surveys and Questionnaires

OBJECTIVETo investigate the clinical efficacy of estrogen in management of postpartum hemorrhage due to uterine atony.

METHODSTotalling 112 puerperants with postpartum hemorrhage due to uterine atony were randomly assigned into 2 groups and received routine managements for uterine atony such as uterine massage and uterotonics administration. The puerperants in one group (n=52) was treated with 4 mg estradiol benzoate injected intramuscularly, and the amount of blood loss 2 h after delivery and between 2 and 24 h after delivery was recorded.

RESULTSThere were significant differences in vaginal blood loss at 2 h after delivery between the 2 groups (P<0.05). The puerperants with estrodiol benzoate treatment had blood loss of 589.6-/+226.4 ml at 2 h and 110.8-/+76.2 ml within 2-24 h after delivery, which were both less than those in the control group (864.5-/+359.5 ml and 161.5-/+98.3 ml, respectively). Postpartum hysterectomy was performed in 3 cases of the control group while none in estradiol benzoate-treated group. In the mothers and neonates, no major adverse effects were observed.

CONCLUSIONEstrogen shows cooperative efficacy with uterotonics in stimulating uterine contraction for managements of postpartum hemorrhage due to uterine atony, and can be of value in clinical application.

Adult ; Delivery, Obstetric ; adverse effects ; Drug Therapy, Combination ; Estradiol ; analogs & derivatives ; therapeutic use ; Female ; Humans ; Oxytocics ; therapeutic use ; Postpartum Hemorrhage ; drug therapy ; etiology ; Pregnancy ; Treatment Outcome ; Uterine Inertia ; drug therapy

PURPOSE: This study was conducted to investigate the effectiveness of pelvic floor muscle exercise using biofeedback and electrical stimulation after normal delivery. METHODS: The subjects of this study were 49 (experimental group: 25, control group: 24) postpartum women who passed 6 weeks after normal delivery without complication of pregnancy, delivery and postpartum. The experimental group was applied to the pelvic muscle enforcement program by biofeedback and electrical stimulation for 30 minutes per session, twice a week for 6 weeks, after then self-exercise of pelvic floor muscle was done 50-60 repetition per session, 3 times a day for 6 weeks. Maximum pressure of pelvic floor muscle contraction (MPPFMC), average pressure of pelvic floor muscle contraction (APPFMC), duration time of pelvic floor muscle contraction (DTPFMC) and the subjective lower urinary symptoms were measured by digital perineometer and Bristol Female Urinary Symptom Questionnaire and compared between two groups prior to trial, at the end of treatment and 6 weeks after treatment. RESULTS: The results of this study indicated that MPPFMC, APPFMC, DTPFMC were significantly increased and subjective lower urinary symptoms were significantly decreased after treatment in the experimental group than in the control group. CONCLUSIONS: This study suggested that the pelvic floor muscle exercise using biofeedback and electrical stimulation might be a safer and more effective program for reinforcing pelvic floor muscle after normal delivery.
Adult ; Analysis of Variance ; Biofeedback (Psychology)/*methods ; Combined Modality Therapy ; Delivery, Obstetric/adverse effects/methods ; Electric Stimulation/*methods ; Exercise Therapy/*methods ; Female ; Humans ; Korea ; Muscle Contraction ; Nursing Evaluation Research ; Parity ; *Pelvic Floor/physiopathology ; Pregnancy ; Puerperal Disorders/etiology/physiopathology/*prevention & control ; Risk Factors ; Treatment Outcome ; Urinary Incontinence, Stress/etiology/physiopathology/*prevention & control ; Urodynamics