We studied 510 patients in a retrospective, nonrandomized, comparative survey of vaginal births and repeat caesarean section after one primary caesarean section at the Port Moresby General Hospital. 478 (94%) were allowed a trial of scar (TOS). The most common indications for elective caesarean section in the other 32 patients were cephalopelvic disproportion (CPD) 31%, contracted pelvis 19% and preeclampsia 12.5%. In 41% of patients TOS was terminated by emergency caesarean section. Logistic regression analysis showed that the following were significantly associated with repeat caesarean section after TOS: parity of one, no vaginal birth after the primary caesarean section, narrow obstetric conjugate, birthweight of 2500 g or greater, short stature, high level of the head at admission to the labour ward and region of origin.
Cesarean Section / statistics & ; numerical data Data Collection Delivery, Obstetric - methods Delivery, Obstetric - statistics & ; numerical data ;

OBJECTIVETo establish the value of the resting energy expenditure (REE) in healthy newborns and evaluate relative factors of REE.

METHODSOne hundred and fifty-four healthy newborns (75 boys, 79 girls; birth-weight 2,500-3,999 g) were enrolled in this study. The Apgar score at the 5th minute was equal to or more than 8; the postnatal age was equal to or more than 5 days. The newborns had no apparent defect. The mothers had no history of metabolic and endocrine diseases. REE was measured by Deltatrac II in child canopy mode for 30-45 minutes during asleep or quiet awake status.

RESULTSThe average REE was (201.8 +/- 25.4) kJ/(kg.d), which was significantly lower than the predicted REE by Schofield formula[(226.1 +/- 4.8) kJ/(kg.d), P = 0.000], the predicted REE was 12.04% higher than the measured REE. There were no differences in sex and ways of delivery. The newborns whose birth-weight was between 2,500-2,999 g were measured in two modes: baby and child mode, and the REE values were significantly higher (122.6 +/- 25.0) kJ/(kg.d) and (208.8 +/- 26.4) kJ/(kg.d), respectively (P = 0.000).

CONCLUSIONSThe prediction formula might be improper for calculating the REE in newborn infants. The indirect calorimetry was the better way to know the actual REE of newborns. The authors recommended that in child mode the measurement of REE in newborns would be the indirect calorimetry, and the REE in healthy newborns was (201.8 +/- 25.4) kJ/(kg.d).

Birth Weight ; Calorimetry, Indirect ; methods ; Delivery, Obstetric ; methods ; Energy Metabolism ; physiology ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Male ; Sex Factors

OBJECTIVETo investigate the influence of delayed cord clamping (DCC) on preterm infants with a gestational age of <32 weeks.

METHODSNinety preterm infants with a gestational age of <32 weeks delivered naturally from January to December, 2015 were enrolled and randomly divided into DCC group (46 infants) and immediate cord clamping (ICC) group (44 infants). The routine blood test results, total amount of red blood cell transfusion, blood gas parameters, mean arterial pressure, bilirubin peak, total time of phototherapy, and incidence rates of necrotizing enterocolitis, late-onset sepsis, intracranial hemorrhage, retinopathy, and bronchopulmonary dysplasia were compared between the two groups.

RESULTSCompared with the ICC group, the DCC group had significantly higher levels of hemoglobin, hematocrit, mean arterial pressure, and standard base excess (P<0.05), as well as a significantly lower percentage of preterm infants who underwent volume expansion and dopamine treatment and a significantly lower amount of red blood cell transfusion (P<0.05). The body temperature, pH value, HCO3(-) concentration, serum bilirubin peak, total time of phototherapy, and incidence rates of late-onset sepsis, retinopathy, grade≥2 intracranial hemorrhage, and grade≥2 neonatal necrotizing enterocolitis showed no significant differences between the two groups (P>0.05).

CONCLUSIONSDCC is a safe clinical intervention and can improve the prognosis of preterm infants with a gestational age of <32 weeks.

Constriction ; Delivery, Obstetric ; methods ; Female ; Gestational Age ; Humans ; Infant, Newborn ; blood ; Infant, Premature ; Male ; Time Factors ; Umbilical Cord ; blood supply

This study was designed to assess the effect of inflatable obstetric belts on uterine fundal pressure in the management of the second stage of labor. One hundred twenty-three nulliparas with a singleton cephalic pregnancy at term were randomized. Standard care was performed in the control group, and uterine fundal pressure by the Labor Assister(TM) (Baidy M-420/Curexo, Inc., Seoul, Korea) was utilized in addition to standard care in the active group. The Labor Assister(TM) is an inflatable obstetric belts that synchronized to apply uniform fundal pressure during a uterine contraction. The 62 women in the active group spent less time in the second stage of labor when compared to the 61 women in the control group (41.55+/-30.39 min vs. 62.11+/-35.99 min). There was no significant difference in perinatal outcomes between the two groups. In conclusion, the uterine fundal pressure exerted by the Labor Assistertrade mark reduces the duration of the second stage of labor without attendant complications.
Adult ; Delivery, Obstetric/*methods ; Female ; Humans ; *Labor Stage, Second ; Pregnancy ; Pressure ; Prospective Studies ; Time Factors ; Uterine Contraction

OBJECTIVETo understand the situation of institutional delivery of rural pregnant women in Guangxi Autonomous Region in the period of 1998 - 2003 and to identify the determinants on institutional delivery utilization.

METHODSUsing Andersen's behavioral model as analytical framework and Guangxi databank of the 3rd National Health Service Survey as data source, we described the status of institutional delivery with the rural women having had live birth history in the period of 1998 - 2003 as subjects, while and the univariate analysis and multivariate logistic analysis were done to identify determinants of institutional delivery utilization.

RESULTSAmong a total number of 407 women with live birth history, 39.80 percent of them delivered at the health-care facilities. The rate of institutional delivery increased annually in 1998 - 2003 (P< 0.0001). The proportion of delivery in township health centers increased and the proportion of home delivery decreased by year (P< 0.0001). Results from both univariate and multivariate analysis showed that parity, education background of women, type of drinking water, time needed to get to the nearest healthcare facilities by the most convenient traffic,frequency of prenatal checkup, together with whether or not being advocated on institutional delivery etc. were determinants of delivery utilization. The OR value were 1.749 for multipara, 1.995 for those going to the nearest healthcare facilities by the most convenient traffic in less than 10 minutes, 3.011 for those drinking tap water, 5.435 for those with the education of high school, 29.149 for those with over 5 times in terms of frequency of prenatal checkup and 37.822 for those being advocated on institutional delivery.

CONCLUSIONSocio-economic situation, status of maternal health care and parity made main contribution to institutional delivery and skilled birth attendance for women in rural Guangxi.

China ; Choice Behavior ; Delivery, Obstetric ; methods ; utilization ; Female ; Hospitalization ; statistics & numerical data ; Humans ; Models, Statistical ; Pregnancy ; Rural Population

We have invented a barrel-shape suturing-aid apparatus with a light source on one side and a trapzoid cranny for suturing on the other side. There are many advantages proved by clinical practices in applying the suturing-aid apparatus: 1. to increase the suturing speed and relieve the pains of patients; 2. to avoid the infection of HBV by blood and crossinfection; 3. to improve the illumination condition and avoid no suturing of the hurt tissue.
Delivery, Obstetric ; Equipment Design ; Female ; Humans ; Lacerations ; surgery ; Surgical Staplers ; Surgical Stapling ; instrumentation ; methods ; Vagina ; injuries ; surgery

The purpose of this study was to determine the effect of twin-to-twin delivery interval on umbilical artery acid-base status of the second twin at birth. This was a retrospective cohort study of all live-born twins with measured acid-base status in umbilical arterial blood who were delivered after 34 weeks' gestation from June 2003 to February 2006. Twins with any maternal or fetal complications were excluded. Subjects were divided into two groups based on the mode of delivery of the first twin: normal cephalic vaginal deliveries (n=40) or cesarean deliveries (n=67). The inter-twin differences in umbilical arterial blood pH, PCO2, PO2, and base excess in twin newborns born vaginally were significantly greater than the corresponding differences in those born by cesarean section. A significant positive correlation was found between twin-to-twin delivery interval and inter-twin difference in umbilical arterial blood pH in twin newborns born vaginally. The umbilical arterial blood pH of the second twin was less than 7.0 in 14% (2/14) in cases delivered more than 20 min after the first twin. The umbilical arterial blood gas status of the second twin worsened with increasing twin-to-twin delivery interval, and pathologic fetal acidemia (pH<7.0) might develop in the second twin when the twin-to-twin delivery interval was greater than 20 min.
Umbilical Arteries/*chemistry ; Twins/*blood ; Time Factors ; Statistics ; Retrospective Studies ; Infant, Newborn ; Hydrogen-Ion Concentration ; Humans ; Delivery, Obstetric/*methods ; Cohort Studies ; *Acid-Base Equilibrium

INTRODUCTIONImmediate postpartum haemorrhage (PPH) is the most common cause of maternal mortality worldwide. Most recommendations focus on its prevention and management. Visual estimation of blood loss is widely used for the early detection of PPH, but the most appropriate method remains unclear. This study aimed to compare the efficacy of visual estimation and objective measurement using a sterile under-buttock drape, to determine the volume of postpartum blood loss.

METHODSThis study evaluated patients aged ≥ 18 years with low-risk term pregnancies, who delivered vaginally. Immediately after delivery, a birth attendant inserted the drape under the patient's buttocks. Postpartum blood loss was measured by visual estimation and then compared with objective measurement using the drape. All participants received standard intra- and postpartum care.

RESULTSIn total, 286 patients with term pregnancies were enrolled. There was a significant difference in postpartum blood loss between visual estimation and objective measurement using the under-buttock drape (178.6 ± 133.1 mL vs. 259.0 ± 174.9 mL; p < 0.0001). Regarding accuracy at 100 mL discrete categories of postpartum blood loss, visual estimation was found to be inaccurate, resulting in underestimation, with low correspondence (27.6%) and poor agreement (Cohen's kappa coefficient 0.07; p < 0.05), compared with objective measurement using the drape. Two-thirds of cases of immediate PPH (65.4%) were misdiagnosed using visual estimation.

CONCLUSIONVisual estimation is not optimal for measurement of postpartum blood loss in PPH. This method should be withdrawn from standard obstetric practice and replaced with objective measurement using the sterile under-buttock drape.

Adolescent ; Adult ; Delivery, Obstetric ; instrumentation ; methods ; Early Diagnosis ; Female ; Humans ; Maternal Mortality ; Obstetrics ; Postpartum Hemorrhage ; diagnosis ; Postpartum Period ; Pregnancy ; Prospective Studies ; Reproducibility of Results ; Surgical Drapes ; Young Adult

OBJECTIVETo evaluate the effect of different combined immunoprophylaxis delivery modes on mother to infant transmission of hepatitis B virus (HBV).

METHODSSix hundred and ninety-six relevant literatures were collected by systematic literature search. Meta-analysis was applied to seven selected literatures that met the criteria and to assess the influence on the infant HBV transmission via different delivery patterns by infants combined immunoprophylaxis.

RESULTSA total of 1435 cases from seven studies which met the criteria were included. The positive rate of HBV was 7.34% (61/831) among the 831 infants in the vaginal delivery group and 4.80% (29/604) among the 604 infants in the caesarean section group. There was no statistically difference between the two groups (OR = 0.70, 95%CI: 0.45 - 1.11, Z = 1.52, P = 0.13).

CONCLUSIONThere was no significant effect of delivery modes on infant infectious rate of HBV by infants' passive and active immunization.

Delivery, Obstetric ; methods ; Female ; Hepatitis B ; prevention & control ; transmission ; Hepatitis B Vaccines ; therapeutic use ; Hepatitis B virus ; Humans ; Immunization ; Infant ; Infectious Disease Transmission, Vertical ; prevention & control ; Pregnancy

INTRODUCTION: This study aimed to compare instrumental vaginal deliveries (IDs) and Caesarean sections (CSs) performed at full cervical dilatation, including factors influencing delivery and differences in maternal and neonatal outcomes. METHODS: A retrospective review was conducted of patients who experienced a prolonged second stage of labour at Singapore General Hospital from 2010 to 2012. A comparison between CS and ID was made through analysis of maternal/neonatal characteristics and peripartum outcomes. RESULTS: Of 253 patients who required intervention for a prolonged second stage of labour, 71 (28.1%) underwent CS and 182 (71.9%) underwent ID. 5 (2.0%) of the patients who underwent CS had failed ID. Of the maternal characteristics considered, ethnicity was significantly different. Induction of labour and intrapartum epidural did not influence delivery type. 70.4% of CSs occurred outside office hours, compared with 52.7% of IDs (p = 0.011). CS patients experienced a longer second stage of labour (p < 0.001). Babies born via CS were heavier (p < 0.001), while the ID group had a higher proportion of occipitoanterior presentations (p < 0.001). Estimated maternal blood loss was higher with CSs (p < 0.001), but neonatal outcomes were similar. CONCLUSION More than one in four parturients requiring intervention for a prolonged second stage of labour underwent emergency CS. Low failed instrumentation rates and larger babies in the CS group suggest accurate diagnoses of cephalopelvic disproportion. The higher incidence of CS after hours suggests trainee reluctance to attempt ID. There were no clinically significant differences in maternal and neonatal morbidity.
Adult ; Cesarean Section ; methods ; statistics & numerical data ; Databases, Factual ; Delivery, Obstetric ; Emergency Medical Services ; Extraction, Obstetrical ; methods ; statistics & numerical data ; Female ; Humans ; Labor Stage, First ; Labor Stage, Second ; Obstetrical Forceps ; Pregnancy ; Retrospective Studies ; Risk Factors ; Singapore ; Young Adult