No abstract available.
Catecholamines* ; Female ; Labor Stage, Second* ; Parturition* ; Plasma* ; Pregnancy ; Supine Position*

BACKGROUND: Pudendal nerve block is one of the many methods of providing analgesia during the second stage of labor. This study was conducted in a university based tertiary hospital. The efficacy of pudendal nerve block was compared to low spinal anesthesia in patients who delivered vaginally METHODS: Thirty four parturients randomly received either pudendal nerve block (n=17) or low spinal anesthesia (n=17) during the second stage of labor. Those requiring analgesia during the first stage of labor were given a single shot epidural dose using bupivacaine 0.125 percent. No intravenous sedatives or analgesics were given throughout labor and delivery. Pain scores using a visual analog scale of 0.10 were recorded as well as the mean onset, mean duration and mean Apgar scores of the two groups. Complications of either technique were also noted down RESULTS: In pudendal nerve block, the mean pain score was 4.88 compared to 0 (zero) in spinal anesthesia. The pudendal group showed a longer onset, shorter duration of analgesia than the spinal group. The only complications noted were mild hypotension (11.7 percent) and minimal motor block (29.4 percent) seen in the spinal group. The mean Apgar scores of the two groups were greater than 7 and was not significantly different CONCLUSION: Pudendal nerve block is a simple and safe method of providing analgesia. The significant reduction of the pain score to more than half may imply a reduction in the amount of intravenous analgesics and potent sedatives often employed during labor and delivery. (Author)
Human ; Female ; ANESTHESIA, SPINAL ; VAGINAL DELIVERY ; ANALGESIA ; LABOR STAGE, SECOND ; OBSTETRIC DELIVERY

This study was undertaken for the clinical analysis and evaluation on 121 patients with incompetent internal os of the cervix, who were admitted and treated with McDonald operation or Shirodkar operation at the Soonchounhyang Medical Center from January 1991 to December 1995. The results of this study were as follows : 1. The incidence of this IIOC was 1.1% of 11,116 cases of total delivery. 2. The mean age of IIOC was 31.7 years old. 3. The average number of gravida was 3.2. 4. The most common contributary factor was previous history of artificial abortion (51.2 %), and midtrimester abortion (17.4 %), cervical laceration due to previous vaginal delivery (8.3 %) etc. was followed. 5. The success rate of operation was 76 %, and the highest success rate (85.7 %) was reveald with period from 15th weeks to 16th weeks of gestation. 6. When cervical dilatation was abscent or small, the success rate of operation was high. 7. The factors of failed operation were preterm labor (58.7 %), PROM (34.5 %), and PIH, bleeding. 8. The delivery method after operation was vaginal delivery in 83 cases (68.6%) and cesarean section in 38 cases (31.4 %).
Cervix Uteri* ; Cesarean Section ; Female ; Hemorrhage ; Humans ; Incidence ; Labor Stage, First ; Lacerations ; Obstetric Labor, Premature ; Pregnancy ; Pregnancy Trimester, Second

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

Objective: To investigate the perinatal maternal and fetal adverse outcomes of cesarean section in the different duration of the second stage of labor. Methods: A retrospective cohort study was conducted on the clinical data of 154 pregnant women with singleton head pregnancy who underwent cesarean section at different times of the second stage of labor due to maternal and fetal factors in the First Affiliated Hospital of Nanjing Medical University from January 1, 2019 to December 31, 2021. According to the duration of the second stage of labor, they were divided into <2 h group (54 cases), 2-<3 h group (61 cases), and ≥3 h group (39 cases). The general data of pregnant women and neonates, preoperative maternal and neonatal conditions related to labor stages, surgical indications, surgical procedures, and perioperative maternal and neonatal adverse outcomes were compared among the three groups. Results: (1) General Information: there were no significant differences in maternal age, gravidity and parity, proportion of primipara, gestational age at delivery, body mass index before delivery, pregnancy complications, labor analgesia rate and the duration of the first stage of labor among the three groups (all P>0.05). The differences of the gender composition, birth weight and incidence of macrosomia of the three groups were also not statistically significant (all P>0.05). (2) Maternal and fetal status and surgical indications: the incidence of intrapartum fever and type Ⅱ and Ⅲ fetal heart rate monitoring in the <2 h group were higher than those in the 2-<3 h group and the ≥3 h group, and the preoperative fetal head position in the ≥3 h group was lower than that in the 2-<3 h group, with statistically significant differences (all P<0.05). The proportion of cesarean section due to "fetal distress" was 40.7% (22/54) in the <2 h group, which was higher than that in the 2-<3 h group (4.9%, 3/61) and the ≥3 h group (2.6%, 1/39). The proportions of surgical indication of "relative cephalo-pelvic disproportion" were 98.4% (60/61) and 94.9% (37/39) in the 2-<3 h group and ≥3 h group, respectively, and the surgical indication of "fetal head descent arrest" were 41.0% (25/61) and 59.0% (23/39), respectively. Compared with <2 h group [63.0% (34/54), 13.0% (7/54)], the differences were statistically significant (all P<0.05). There were no significant difference in surgical indications between 2-<3 h group and ≥3 h group (all P>0.05). (3) Intraoperative conditions and perioperative complications of cesarean section: the puerperal morbidity rate of <2 h group was 37.0% (20/54), which was higher than those of 2-<3 h group (18.0%, 11/61) and ≥3 h group (7.7%, 3/39), the difference was statistically significant (P<0.05). There were no significant differences in operation time, intraoperative blood loss, incidence of fetal head inlay, uterine incision tear, modified B-Lynch suture for uterine atony, postpartum hemorrhage, perioperative blood transfusion, preoperative hemoglobin (Hb) level, perioperative Hb change, and postoperative hospital stay among the three groups (all P>0.05). (4) Adverse neonatal outcomes: non-hemolytic neonatal hyperbilirubinemia in ≥3 h group was 35.9% (14/39), which was significantly higher than that in <2 h group (13.0%, 7/54; P<0.05). Among the neonates admitted to neonatal intensive care unit (NICU) within 1 week after birth, the proportion of neonates admitted to NICU due to neonatal hyperbilirubinemia in ≥3 h group (15/19) was significantly higher than that in <2 h group (9/17) and 2-<3 h group (10/19), and the differences were statistically significant (all P<0.05). However, there was no significant difference between the <2 h group and the 2-<3 h group (P>0.05). There was no perinatal death in the three groups. Conclusions: The rate of puerperal morbidity is higher in patients who were transferred to cesarean section within 2 hours of the second stage of labor. In the early stage of the second stage of labor, the monitoring of fetal heart rate and amniotic fluid characteristics should be strengthened, especially the presence or absence of prenatal fever. In good maternal and neonatal conditions, conversion to cesarean section after 2 hours of the second stage of labor does not significantly increase the incidence of serious adverse maternal and neonatal outcomes. For the second stage of labor more than 3 hours before cesarean section, it is necessary to strengthen the monitoring of neonatal bilirubin.
Infant, Newborn ; Pregnancy ; Female ; Humans ; Cesarean Section/adverse effects* ; Pregnant Women ; Fetus ; Retrospective Studies ; Labor Stage, Second ; Labor Presentation ; Hyperbilirubinemia, Neonatal/etiology*

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

A retrospective study was conducted to evaluate the clinical outcomes of midtrimester emergency cervical cerclage in patients with painless cervical dilatation with/without prolapsed amniotic sac, including cases of no previous history of cervical incompetence. 10 patients including 1 twin pregnancy were teviewed for study, All had received emergency cervical cerclage with Macdonald operation or Shirodka operation at 18 to 31 weeksgestation. The procedures were carried out without serious complication except for one patient who had received re-operation 3 days after Macdonald operation because of re-protrusion of amniotic sae. The mean procedure to delivery internal was 8.9+/-5.3 (range 1 to 17) weeks. The mean gestational age at delivery was 32.4+/-5.6 (range 22 to 39+6) weeks for the entire group, 36.1+/-2.6 (range 32+4 to 39+6) weeks for the 6 who achived viability, and 27.6+/-5.0 (range 22 to 29+4) weeks for the 3 who died during the neonatal period. 1 died during gestation and was delivered at 33+6 weeksgestation. The mean birthweight was 2181.6+/-971.6 (range 498 to 3500)g for the entire group, and 2712.9+/- 571.5 (range 1860 to 3500)g for the 7 infants who lived until after neonatal period. The total survival rate for 11 babies was 64%. This study demonstrates that midtrimester emergency cervical cerclage for the patients who have dilated cervix with/without prolapsed amniotic sac is valuable method to try in the cases predicted they would lost the baby with conservative treatment only.
Cerclage, Cervical* ; Cervix Uteri* ; Dilatation* ; Emergencies* ; Female ; Gestational Age ; Humans ; Infant ; Labor Stage, First ; Pregnancy ; Pregnancy Trimester, Second ; Pregnancy, Twin ; Retrospective Studies ; Survival Rate

OBJECTIVE: This study was performed to evaluate the effect of cervical cerclage and the clinical characteristics in incompetent internal os of the cervix (IIOC). METHODS: A study was conducted on 170 patients with IIOC, 199 cases of IIOC were admitted and treated with McDonald operation or modified Shirodkar operation at department of Obstetrics and Gynecology Il Sin Christian Hospital from January 1. 1994 to December 31. 1998, of this 14 cases were follow up lost, so 185 cases were analyzed. RESULTS: 1) The incidence of IIOC was 0.43%, 1 in 233 deliveries. 2) The mean age of IIOC patients was 30.54yrs old and the most frequent age group was in 30-34yrs old group (43.78%). 3) The average number of gravida and parity before operation were 4.71 and 1.62. & the success rate of operation was low at high gravida & parity. 4) The predisposing factor was previous history of dilation & curettage (43.75%), Cx. laceration after delivery (6.49%), midtrimester termination (4.32%) etc. 5) The operation methods were McDonald operation (91.35%) and modified Shirodkar operation (8.65%) & the success rate of McDonald operation and modified Shirodkar operation were 85.80% and 87.50%. 6) The successful fetal salvage rate was 85.95% and the highest success rate was 87.50% in 14-16 weeks of gestation group. 7) The more cervix dilate, the more failure occurred. 8) The causes of operation failure were premature rupture of membrane (50.00%), preterm labor (34.62%), FDIU, anomaly, APH etc. 9) The delivery methods after operation were vaginal delivery (65.54%), cesarean delivery (34.46%). CONCLUSION: The 14-16th weeks of gestation group & no cervical dilatation have higher success rate indicating that early diagnosis and appropriate timing of operation is associated with a greater operation success rate.
Causality ; Cerclage, Cervical ; Cervix Uteri* ; Curettage ; Early Diagnosis ; Female ; Follow-Up Studies ; Gynecology ; Humans ; Incidence ; Labor Stage, First ; Lacerations ; Membranes ; Obstetric Labor, Premature ; Obstetrics ; Parity ; Pregnancy ; Pregnancy Trimester, Second ; Rupture

OBJECTIVE: To investigate the clinical effectiveness of emergency cervical cerclage in pregnant women with advanced cervical incompetence in the second trimester. METHODS: This study analyzed retrospectively the pregnancy outcomes of 20 patients who were offered emergency cerclage between June 2000 and April 2004. Group I was defined as the patients cervical dilatation without membrane prolapse. Group II was the patients with membrane prolapse into vagina, who were underwent amniocentesis to decrease intraamniotic pressure. RESULTS: The mean+/-SD gestational age at cerclage was 21.6+/-2.4 weeks (Group I: 21.0+/-2.5, Group II: 22.1+/-2.3). The mean cervical dilatation was 2.5+/-0.9 cm (Group I: 1.8+/-0.5, Group II: 3.2+/-0.8) and mean effacement was 79.0+/-12.9% (Group I: 68.8+/-11.6, Group II: 87.3+/-6.4). The mean interval from cerclage to delivery was 9.4+/-5.3 weeks (Group I: 11.1+/-6.1, Group II: 7.9+/-3.7) and mean gestational age at delivery was 31.0+/-6.0 weeks (Group I: 32.2+/-7.4, Group II: 30.0+/-4.9). The birth weight was 1.9+/-1.1 kg (Group I: 2.4+/-1.4, Group II: 1.6+/-0.8) and the perinatal survival rate was 75% (Group I: 77%, Group II: 73%). Cervix dilatation and effacement were significantly more advanced in group II compared to the group I (p<0.05). However, the duration of pregnancy prolongation and birth weight, gestational age at the delivery were not significantly different between both groups. CONCLUSION: This results suggest that emergency cervical cerclage might be an effective treatment in advanced cervical incompetence, and that the concomitant amniocentesis could help the cerclage in the patients with membrane prolapse.
Amniocentesis ; Birth Weight ; Cerclage, Cervical* ; Cervix Uteri ; Dilatation ; Emergencies* ; Female ; Gestational Age ; Humans ; Labor Stage, First ; Membranes ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, Second ; Pregnant Women ; Prolapse ; Retrospective Studies ; Survival Rate ; Vagina

OBJECTIVE: To evaluate the effect of Mcdonald's cerclage and postoperative care on perinatal outcome in patient with incompetent cervix and bulging fetal membranes. METHODS: In the descriptive study, the charts of 78 patients admitted from 1993 to 1997 with a diagnosis of incompetent cervix and cervical dilatation (3cm) were reviewed, Mcdonald's cerclage rate, predisposing factor, fetal salvage by time, factors of falled operation, delivery type were analyzed. RESULTS: The results of the study were as follows; The incidence of II OC was 0.4% of 18702 case, the mean age was 31.9 years old, the average number of gravida was 2.9, the fetal salvage rate was 83.3%, the predisposing factor was previous history of midtrimester termination(56.4%), dilation and curettage(19.2%), unknown(14.1%) etc, the fetal salvage by time was the highest success rate(88.9%) revealed with period from 14th to 16th weeks of gestation, the factors of falled operation were preterm labor(76.9%), PROM(15.4%), infection(7.7%), and delivery type was vaginal delivery in 36 case(55.4%), cesarean section in 29 case(44.6%). CONCLUSION: We concluded that fetal salvage rate was greatly increased when Mcdonald operation was done from 14th to 16th week of gestation if midtrimester abortion and dilatation and curettage were experienced, Even though we have not compared experimental group with control group, upper part of Mcdonald cerclage, no exposure of suture material, benzol conium dressing, bed rest were increased to fetal salvage rate.
Bandages ; Bed Rest ; Benzene ; Causality ; Cervix Uteri* ; Cesarean Section ; Conium ; Diagnosis ; Dilatation and Curettage ; Extraembryonic Membranes ; Female ; Humans ; Incidence ; Labor Stage, First ; Postoperative Care ; Pregnancy ; Pregnancy Trimester, Second ; Sutures ; Uterine Cervical Incompetence