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Спінальну анестезію (СА) виконано в 93 жінок при кесаревому розтині. Показаннями до операції слугували: хвороба оперованої матки, неспроможність рубця на матці, клінічно вузький таз, міопія високого ступеня, вторинна родова слабкість. Як місцевий анестетик для СА використовували 0,5% Лонгокаїн Хеві. Преінфузію виконували Гекотоном — 3–4 мл/кг. З метою оцінки впливу СА на показники центральної гемодинаміки і преінфузію вивчали центральну гемодинаміку, об’єм циркулюючої плазми, об’єм позаклітинної рідини, новонароджених оцінювали за шкалою Апгар. Було встановлено, що внутрішньовенна преінфузія Гекотоном за рахунок поєднання переваг колоїдно-гіперосмолярного компонента швидко викликає перерозподіл рідини з міжклітинного простору у внутрішньосудинний, надійно підтримує волемічний ефект, що дозволяє використовувати менший об’єм розчину для передопераційної підготовки при нейроаксiальнiй анестезії. Застосування Гекотону як преінфузії (3–4 мл/кг) стабілізує гемодинамiчний профіль після виконання СА. У 81 (87,1 %) випадку відзначалася відносно стабільна гемодинаміка, що не потребувала адреноміметичної підтримки, і тільки в 12 (12,9 %) — розвивалася виражена артеріальна гіпотензія, корекцію якої проводили фракційним введенням мезатону.

Cesarean section (CS) refers to the delivery of fetus, placenta, and membrane through an abdominal and uterine incision after 28 completed weeks of gestation. This mode of delivery minimizes both maternal and perinatal morbidity and mortality; however, it is associated with lower but severe neonatal outcomes as compared to vaginal delivery. Thus, the current study was aimed to assess the current status of adverse neonatal outcomes and its contributing factors. A retrospective cross-sectional study was employed from July 2016 to August 2017. The data were collected from records of mothers who gave birth through CS in Arba Minch General Hospital using a structured record review checklist. Simple random sampling technique was used to select records for extracting data. Variables with p-value

Introduction: Birth injuries although inevitable should be avoided to prevent unnecessary neonatal morbidities and mortalities as well as hospital litigations. Aim: To determine the incidence rate, pattern and outcome of birth injuries occurring in the Rivers State University Teaching Hospital. Materials and Methods: An observational prospective study was carried out in the Special Care baby Unit of the hospital. A pre tested proforma was used to collect demographic and pregnancy information from mothers and demographic data, delivery history, type of birth injury and clinical outcome from babies whose parents consented to the study. Results: Thirty-nine of the 5,692 babies delivered during the study period had birth injuries, giving an incidence rate of 6.9 per 1000 live births. The common birth injuries were neurological (26.2%), extracranial (23.8%) and soft tissue injuries (21.4%). Cephalopelvic disproportion (36%), diabetes mellitus in pregnancy (32%) and prolonged labour (20%) were commonly found complications of pregnancy among mothers whose babies had birth injuries. Birth injuries were commoner among males, babies born by normal vaginal delivery and those with birth weights between 2.5-3.9Kg. Neurological injuries were significantly associated with normal vaginal delivery and birth weights of ≥ 4kg while soft tissue injuries were significantly associated with Caesarean section, P value < 0.05. Although majority of them were discharged, mortality rate was 7.7%. Conclusion: Although the incidence of birth injury in this study was low, the morbidity and mortality associated with it are avoidable. Improved antenatal and delivery services are therefore necessary to reduce the incidence of birth injuries. Keywords: Birth injury; Incidence; Pattern; Outcome; Tertiary hospital; Nigeria.

Latar belakang: Makrosomia adalah istilah untuk neonatus yang lahir dengan berat lebih dari 4000 gram atau berada dalam persentil 90 terhadap usia kehamilan. Makrosomia meningkatkan kejadian risiko cedera bagi ibu maupun janin selama proses persalinan. Makrosomia dapat dicegah atau dideteksi lebih awal dengan mengendalikan faktor risiko. Ilustrasi kasus: Pada kasus, makrosomia telah menimbulkan komplikasi berupa intra uterine fetal death. Pasien didiagnosis dengan G3P1A1 hamil 37 minggu inpartu kala I fase aktif dengan ketuban pecah dini 3 jam (di luar), janin tunggal mati, presentasi kepala dan suspek makrosomia. Penatalaksanaan: Pada pasien dilakukan penatalaksanaan berupa partus percobaan. Partus percobaan gagal dan diagnosis disproporsi kepala panggul ditegakkan, maka pada pasien dilakukan sectio caesarea. Pemeriksaan fisik: Dilahirkan bayi laki-laki dengan berat 5400 gram, panjang 62 cm dengan maserasi grade I. Selama operasi, didapatkan warna ketuban hijau kecoklatan dan kental yang menandakan adanya proses hipoksia kronis pada janin yang menyebabkan kematian janin pada kasus ini. Pada pasien ditemukan faktor risiko berupa adanya riwayat melahirkan bayi besar sebelumnya (4100 gram). Kunjungan antenatal jarang dilakukan sehingga berat badan selama hamil tidak termonitor. Diskusi: Laporan kasus ini menunjukkan bahwa makrosomia dapat meningkatkan risiko terjadinya komplikasi bagi ibu dan bayi terutama saat persalinan. Komplikasi dapat dihindari dengan mencegah dan mendiagnosis lebih awal adanya makrosomia dengan mengendalikan faktor risiko. Pengendalian faktor risiko dapat dilakukan dengan kunjungan antenatal yang rutin

Background: Caesarean section is the delivery of the foetus, placenta, and foetal membranes through an incision on the abdominal and uterine walls after the age of foetal viability. It is a life-saving surgical procedure, which has helped reduce maternal and perinatal morbidity and mortality over the years. Objective: To determine the rates, indications, outcomes, and complications of Caesarean section at the Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria. Materials and Methods: This research was carried out at the Department of Obstetrics and Gynaecology, Federal Medical Centre (FMC), Yenagoa, Bayelsa State, South-South, Nigeria between 1st January 2018 and 31st December 2020. It was a retrospective study. Data was retrieved from the labour ward records, delivery register, theatre records, and patients’ folders during the period under review, and entered into a pre-designed proforma. Data were analysed with IBM SPSS version 23.0. Results were presented in frequencies and percentages for categorical variables and mean and standard deviation for continuous variables. Results: About 959 women had Caesarean section (CS) out of 2,263 deliveries, giving a Caesarean section rate of 42.4%. The commonest indication for emergency Caesarean section was cephalopelvic disproportion (36.0%), while that for elective Caesarean section was repeat Caesarean section (19.6%). Conclusion: The Caesarean section rate in our Centre is extremely high, almost three times the acceptable upper limit set by the WHO. Encouraging vaginal birth after Caesarean section as a means to reduce this high rate is recommended as it was noted that previous Caesarean section was a leading indication for surgeries.

Objective: We aimed to compare emergency and elective cesarean patients in our hospital in terms of epidemiological features and maternal morbidity. Material and Methods: We randomly retrospectively reviewed the records of 302 caesarean cases. Demographic features and indications for emergency (group 1) and elective caesarean section (C/S) (group 2) were recorded. The groups were compared in terms of indications and intraoperative and postoperative morbidity. Results: It was found that the mean hematocrit decrease in group 1 was not different from group 2 (5.70 ± 1.16 and 5.62 ± 0.67). When the groups are examined according to cesarean indications; In group 1 patients, fetal distress, cephalopelvic disproportion (CPD), non-progress of labor, abruptio placentae were significantly higher compared to group 2, whereas in group 2 patients the previous 1 C / S and previous 2 C / S indications were significantly higher. Intraoperative hemorrhage and bladder injury were more common in group 1 patients compared to group 2 patients. When the groups are examined according to postoperative maternal complications; In group 1 patients, transfusion, prolonged bladder catheterization, admission to intensive care unite (ICU), was significantly higher compared to group 2. Conclusion: It was found that many intraoperative and postoperative complications were more common in the emergency C/S group. it was also detected that all cases with bladder injuries had previous cesarean sections. Therefore, the presence of experienced personnel in these cases may be important for reducing morbidity due to the increased risk of complications.

Background: Caesarean section (CS) is one of the commonest obstetrics procedure to reduce the risks for mother and fetus when vaginal delivery is not anticipated. The objective of the study was to determine the rate and clinical indication of Caesarean section. Materials and Methods: This was a hospital based descriptive retrospective study done within a time frame of a year (from Shrawan 2075 BS to Ashad 2076 BS; 17 July 2018 to July 16 2019) in Matri Shishu Miteri Hospital, Pokhara, Nepal. The total number of deliveries, their modes of delivery, indication for the Cesarean section, age group, number of parity, period of gestation and type of Caesarean section either elective or emergency were descriptively analyzed. Results: A total of five hundred and eighty eight cases underwent delivery during the study period. Of them 128 (21.76%) cases were delivered by Caesarean section. Analysis revealed that the common age group for the CS patients was between 20-30 years (64.8%) of them 66 (51.6%) cases were primi gravida. Emergency Caesarean section was done for 75(58.6%) cases and elective Caesarean section for 53(41.4%) cases. The most common indication for Caesarean section was found to be previous caesarean section 21% (n=27), cephalopelvic disproportion (CPD) 18% (n=23), fetal distress 18% (n=23), failed induction 14.1% (n=18), breech presentation 10.2 %( n=13), non progress of labor (NPOL) 9.4 %( n=12) and oligohydramnios 7.8% (n=10). Conclusion: Our study revealed that the rate of Caesarean section is higher than that recommended by World Health Organization (WHO), which needed to be 10-15% of the total deliveries. The common indications for Caesarean sections were pervious Caesarean section, fetal distress, CPD, failed induction, breech presentation, non progress of labour (NPOL) and oligohydramnios among others.

Aim Reports on pregnancy and delivery in women with Turner syndrome (TS) in Japan are limited to case reports, and the current situation remains unclear. Therefore, this study aimed to clarify the current situation of pregnancy and delivery in women with TS in Japan. Methods Our study comprised primary and secondary surveys and we included perinatal centers approved by the Ministry of Health, Labor and Welfare. Results A total of 24 cases from 19 facilities were reported, and we obtained individual information for 20 cases from 16 facilities. Of these 20 patients, 13 (65%) had become pregnant via oocyte donation. Three of these patients had received oocyte donation in Japan, while the other 10 had received donations in foreign countries. The other seven patients became pregnant with their own oocyte, with spontaneous menarche. Live babies were delivered by 18 patients, while an induced abortion was required at 18 weeks of gestation in one patient and an intrauterine fetal death from an unknown cause was detected at 38 weeks of gestation in another patient. Cesarean section was performed in 14 patients, with the most frequent indication being cephalopelvic disproportion. The rate of implementation of screening for complications related to TS was low, suggesting insufficient cooperation between facilities responsible for TS treatment, infertility and pregnancy and delivery management. Conclusion To improve pregnancy outcomes in women with TS, improved cooperation between facilities and laws regarding oocyte donation in Japan are needed.

Background: Elderly primigravida is defined as women thirty five years of age or above who is pregnant for the first time. The advancement in the artificial reproductive technology have played an important part in delaying the pregnancy. Maternal age is no longer only important factor in women wishing for conception. Nevertheless the increased fetomaternal complication and consideration as a high risk leading to early intervention among these age group is of concern. Objective: The objective of the study was to find out incidence and to determine fetomaternal outcome in elderly primigravida. Materials and Methods: The study was cross sectional, conducted in Regional Institute of Medical Sciences, Imphal, Manipur over a period of one and half year. Elderly primigravida admitted at term in hospital were studied for fetomaternal outcome. Results: Of 17890 delivery during the study period, 280 were elderly primigravida giving an incidence of 1.8%. Based on inclusion criteria, 166 were enrolled in study. Maternal compilation seen were, Oligohydraminos 6.02%, Gestational hypertension 3.01%, Breech presentation 6.03% , PROM 4.2%, Placenta Praevia 2.4%, Gestational diabetes mellitus 0.6% and Twin gestation 2.4%. Caesarean rate was 67.5% of which 62.5% was done for cephalopelvic disproportion. 5.3% baby was low birth weight. Conclusion: Although fetomaternal complication in Elderly Primigravida is increased, with adequate antenatal care, early recognition of complication and timely intervention, optimum outcome can be expected. Further conclusion drawn from this study is rate of Caesarean section which is of concern and needs to be further assessed. Keywords: Elderly primigravida, Caesarean section, Complications.

Cephalopelvic disproportion (CPD)-related obstructed labor is associated with maternal and neonatal morbidity and mortality. Accurate prediction of whether a primiparous woman is at high risk of an unplanned cesarean delivery would be a major advance in obstetrics.To develop and validate a predictive model assessing the risk of cesarean delivery in primiparous women based on MRI findings.Prospective.A total of 150 primiparous women with clinical findings suggestive of CPD.T1-weighted fast spin-echo sequences, single-shot fast spin-echo (SSFSE) T2-weighted sequences at 1.5 T.Pelvimetry and fetal biometry were assessed independently by two radiologists. A nomogram model combined that the clinical and MRI characteristics was constructed.Univariable and multivariable logistic regression analyses were applied to select independent variables. Receiver operating characteristic (ROC) analysis was performed, and the discrimination of the model was assessed by the area under the curve (AUC). Calibration was assessed by calibration plots. Decision curve analysis was applied to evaluate the net clinical benefit. A P value below 0.05 was considered to be statistically significant.In multivariable modeling, the maternal body mass index (BMI) before delivery, bilateral femoral head distance, obstetric conjugate, fetal head circumference, and fetal abdominal circumference was significantly associated with the likelihood of cesarean delivery. The discrimination calculated as the AUC was 0.838 (95% confidence interval [CI]: 0.774-0.902). The sensitivity and specificity of the nomogram model were 0.787 and 0.764, and the positive predictive and negative predictive values were 0.696 and 0.840, respectively. The model demonstrated satisfactory calibration (calibration slope = 0.945). Moreover, the decision curve analysis proved the superior net benefit of the model compared with each factor included.Our study might provide a nomogram model that could identify primiparous women at risk of cesarean delivery caused by CPD based on MRI measurements.2 TECHNICAL EFFICACY: Stage 2.

Introduction: Cephalopelvic disproportion (CPD) is one of the most common obstetric complications. Since CPD is the disproportion between the fetal head and maternal bony pelvis, evaluation of the head circumference (HC) relative to the maternal bony pelvis may be a useful adjunct to pre-labor CPD evaluation. The aim of the present study was a proof-of-concept evaluation of the ratio between HC and pelvic circumference (PC) as a predictor of CPD. Methods: Of 11,822 deliveries, 104 cases that underwent an abdominopelvic CT for any medical indication and who underwent normal vaginal deliveries (NVDs) (n = 84) or cesarean deliveries (CD) due to CPD (n = 20) were included retrospectively. Maternal pelvis dimensions were reconstructed and neonatal HC, as a proxy for fetal HC, was measured. The correlation between cases of CPD and cephalopelvic circumference index (CPCI), which represents the ratio between the HC and PC in percentage (HC/PC × 100), was evaluated. Results: The mid-pelvis CPCI (MP-CPCI) was larger in CD groups as compared to the NVD group: 103 ± 11 versus 97 ± 8%, respectively (p = 0.0003). In logistic regression analysis, the MP-CPCI was found to be independently associated with CD due to CPD: each 1% increase in MP-CPCI increased the likelihood of CD for CPD by 11% (adjusted odds ratio [aOR] 1.11, 95% CI, 1.03–1.19, p = 0.004). The aOR for CD due to CPD increased incrementally as the MP-CPCI increased, from 3.56 (95% CI, 1.01–12.6) at MP-CPCI of 100 to 5.6 (95% CI, 1.63–19.45) at 105, 21.44 (95% CI, 3.05–150.84) at 110, and 28.88 (95% CI, 2.3–362.27) at MP-CPCI of 115. Conclusions: The MP-CPCI, representing the relative dimensions of the fetal HC and maternal PC, is a simple tool that can potentially distinguish between parturients at lower and higher risk of CPD. Prospective randomized studies are required to evaluate the feasibility of prenatal pelvimetry and MP-CPCI to predict the risk of CPD during labor.

Trial of labor after cesarean section (TOLAC) is an option for women with previous cesarean section. However, few women choose this option because of safety concerns. We evaluate the safety and risks associated with TOLAC and the success rate of vaginal birth after cesarean delivery (VBAC).We reviewed all patients with a history of previous cesarean section that underwent elective repeat cesarean section (ERCS) or TOLAC in a regional teaching hospital from Nov, 2013 to May, 2018. Maternal basic clinical information, intrapartum management, postpartum complications, and neonatal outcomes were analyzed.199 pregnant women with a history of at least one previous cesarean section were enrolled. 156 women received ERCS and 43 women (21.6%) underwent TOLAC, with 37 (86.0%) who underwent successful VBAC. The VBAC rate was 18.6%. Higher success rate was found in women with previous vaginal birth than in women without vaginal birth (100% vs. 81.8%). One case (2.3%) in the VBAC group was complicated with uterine rupture and inevitable neonatal death during second stage of labor. The uterus was repaired without maternal complications. In another case, the newborn's condition was complicated with low APGAR score (7) at birth due to maternal chorioamnionitis. Among indications for previous cesarean section, cephalo-pelvic disproportion (CPD) was associated with TOLAC failure and uterine rupture after VBAC.VBAC is a feasible and safe option. Modes of delivery should be thoroughly discussed when considering TOLAC for women with history of previous cesarean section due to CPD, considering its association with TOLAC failure in second stage of labor.

Background and Aims Super morbid obesity is defined as a body mass index of >50 kg/m2. Complications from anesthesia and overall morbidity and mortality are higher in this population. Neuraxial techniques are the preferred anesthetic techniques for cesarean delivery in obese parturients but can be technically challenging. Methods We present the successful anesthetic management of a super morbidly obese obstetric patient with BMI of 68.3 kg/m2 underwent cesarean section due to Cephalopelvic disproportion at 38 weeks gestation. A 36-year-old parturient, G2P0 with a history of spontaneous first trimester miscarriage and significant medical history of chronic arterial hypertension, limited mobility, obesity-related shortness of breath and fatigue that had been exacerbated by her pregnancy. Results In the operating room after several failures to locate the epidural space with an 8 cm needle, we successfully located it at a depth of 9.5 cm using a 18 gauge 10 cm Tuohy needle, in the low lombar at an estimated L1-L2 interspace, but a 10 cm 24 gauge quincke neddle for the spinal block wasn’t enough. After the placement of the epidural catheter space, we successfully performed the spinal anesthesia at the L3-L4 interspace with a 12 cm 22 gauge and spinal hyperbaric bupivacaine 0.5% and sufentanyl was administer. The surgery was completed uneventfully. Postoperatively the patient was observed and a multimodal analgesia was satisfactorily provided. The patient was discharged home on postoperative day eight without complications. Conclusions It is important to report these cases to support the development of new protocols and more adequate conducts for this population.

Introduction. Cesarean section plays an important role in decreasing the mortality and complications of childbirth in the mother and fetus. But the worrying issue in modern midwifery is the high rate of cesarean section. The current study was done to evaluate the frequency of normal vaginal delivery and cesarean section and the causes of cesarean section in public-private centers and compare it with educational centers in Zahedan in 2016-2017. Materials and methods. This is a descriptive cross-sectional study and a total of 792 deliveries were studied, 300 cases were from university hospitals and 492 from non-university hospitals in Zahedan. SPSS22 software was used for data analysis. Findings. The results disclosed that in university hospitals, 65.3 of the deliveries were normal vaginal delivery and 34.7 were cesarean, and in the non-university hospitals, 44.5 and 55.5 of the deliveries were normal and cesarean deliveries, respectively. There was a significant relationship between the type of delivery and the hospital where the delivery was done (P < 0.001). The most common causes of cesarean section in this study were: previous cesarean section (33.7), fetal distress (14.9), cesarean delivery on maternal request (CDMR) (11.7), delivery failure (11.4), mother's disease (7.4), abnormal fetal placement (6.6), multiparous pregnancy (4.5), problems with the placenta and umbilical cord (4), cephalopelvic disproportion (3.2) and embryonic diseases (2.7). There was no cesarean delivery on maternal request (CDMR) in university hospitals while in non-university hospitals it was 16.1. Conclusion. Generally, the percentage of normal vaginal delivery was higher than that of the cesarean section, but the number of cesarean sections was higher in non-university hospitals than in university hospitals. Also, ethnicity, number of pregnancy, job, education, history of infertility, and awareness of complications were significantly related to the type of delivery.

Propósito: caracterizar los factores epidemiológicos relacionados con el parto en pacientes adolescentes en el Hospital Distrital de Poptún. Material y método: estudio descriptivo retrospectivo, en el período de Enero – Mayo del 2019. Nuestra muestra quedó constituida por 222 pacientes adolescentes, incluyendo variables como edad, paridad, edad gestacional, tipo de parto, causa de cesárea, peso al nacer. Resultados: de las variables estudiadas, la edad de las pacientes que más predominó fue entre los 14 a 16 años de edad, con un total de 144 pacientes para un 65.1%. Según la paridad, las nulíparas fueron 112 pacientes para 50.4 %. Es significativo destacar que casi la mitad de estas pacientes ya tenían antecedentes de un parto y más, siendo adolescentes. La edad gestacional que más incidió fue de 37 a 39 semanas, para un 67.1 %. El tipo de parto que más aportó fue el eutócico con un 62.2%. La causa de cesárea que más incidió fue la Desproporción cefalopélvica con 20 pacientes para un 23.8 %, y cesárea previa con un 13 %. El peso al nacer que más prevaleció fue de3001 a 4000 g con un 50.4 %. Conclusión: El embarazo en adolescentes sigue siendo un problema prevalente en Guatemala.

The vitamin D paradox relates to the lower risk of osteoporosis in people of sub-Saharan African ancestry (Blacks) compared with people of European ancestry (Whites). The paradox implies that for bone health, Blacks require less vitamin D and calcium than Whites do. Why should populations that migrated northward out of Africa have ended up needing more vitamin D than tropical Blacks? Human skin color became lighter away from the tropics to permit greater skin penetration of the UVB light that generates vitamin D. Lack of vitamin D impairs intestinal calcium absorption and limits the amount of calcium that can deposit into the protein matrix of bone, causing rickets or osteomalacia. These can cause cephalopelvic disproportion and death in childbirth. Whiter skin was more fit for reproduction in UV-light restricted environments, but natural selection was also driven by the phenotype of bone per se. Bone formation starts with the deposition of bone-matrix proteins. Mineralization of the matrix happens more slowly, and it stiffens bone. If vitamin D and/or calcium supplies are marginal, larger bones will not be as fully mineralized as smaller bones. For the same amount of mineral, unmineralized or partially mineralized bone is more easily deformed than fully mineralized bone. The evidence leads to the hypothesis that to minimize the soft bone that causes pelvic deformation, a decrease in amount of bone, along with more rapid mineralization of osteoid improved reproductive fitness in Whites. Adaptation of bone biology for reproductive fitness in response to the environmental stress of limited availability of vitamin D and calcium came at the cost of greater risk of osteoporosis later in life.

The World Health Organization recommends the Robson Classification1 as a standard instrument for classifying cesarean section referrals. The aim of this study was to analyze cesarean section referrals in a public normal-risk maternity hospital in Curitiba, capital of Parana, Brazil. This was a retrospective cross-sectional documentary study with a quantitative approach. Data on clinical conditions and obstetric history were collected from medical records of 186 women who underwent cesarean sections, as well as the reasons for their referral, from August 2017 to January 2018. Data were subjected to frequency analyses. The groups with the highest concentration of cesarean sections were: Group 5 (31.2%) of multiparous women with a previous cesarean section, and Groups 2 (26.3%) and 4 (14%), of nulliparous and multiparous women without previous caesarean section, respectively, whose deliveries were induced or the cesarean section occurred before labor began. The main reasons for cesarean sections were related to complications of labor, such as breech presentation and failure to induce labor; maternal conditions such as iterativity and cephalopelvic disproportion; and fetal conditions, in which fetal distress and other associated conditions stood out. The analysis of the contribution of each group in the total number of cesarean sections, associated with the analysis of their reasons recorded in the medical records, provides clinical and legal support to justify or recommend the appropriate indication of this procedure, with a view to safe and good quality obstetric care, centered on women, in their clinical condition and obstetric history, and based on current scientific evidence.

Objectives To provide evidence-based guidelines for safe and effective assisted vaginal birth. Outcomes Prerequisites, indications, contraindications, along with maternal and neonatal morbidity associated with assisted vaginal birth. Evidence Medline database was searched for articles published from January 1, 1985, to February 28, 2018 using the key words "assisted vaginal birth," "instrumental vaginal birth," "operative vaginal delivery," "forceps delivery," "vacuum delivery," "ventouse delivery." The quality of evidence is described using the Evaluation of Evidence criteria outlined in the Report of the Canadian Task Force on Preventive Health Care. Validation These guidelines were approved by the Clinical Practice Obstetrics Committee and the Board of the Society of Obstetricians and Gynaecologists of Canada. Recommendations 1The need for assisted vaginal birth can be reduced by: dedicated and continuous support during labour (I-A), oxytocin augmentation of inadequate labour (I-A), delayed pushing in women with an epidural (I-A), increased time pushing in nulliparous women with an epidural (I-B), as well as optimization of fetal head position through manual rotation (I-A). 2Encouraging safe and effective assisted vaginal birth by experienced and skilled care providers may be a useful strategy to reduce the rate of primary Caesarean delivery (II-2B). 3Safe and effective assisted vaginal birth requires expertise in the chosen method, comprehensive assessment of the clinical situation alongside clear communication with the patient, support people, and health care personnel (III-B). 4Practitioners performing assisted vaginal birth should have the knowledge, skills, and experience necessary to assess the clinical situation, use the selected instrument, and manage complications that may arise from assisted vaginal birth (II-2B). 5Obstetrical trainees should receive comprehensive training in assisted vaginal birth and be deemed competent prior to independent practice (III-B). 6When assisted vaginal birth is deemed to have a higher risk of not being successful, it should be considered a trial of assisted vaginal birth and be conducted in a location where immediate recourse to Caesarean delivery is available (III-B). 7The physician should determine the instrument most suitable to the clinical circumstances and their level of skill. Vacuum and forceps are associated with different short- and long-term benefits and risks. Unsuccessful delivery is more likely with vacuum than forceps (I-A). 8Planned sequential use of instruments is not recommended as it may be associated with an increased risk of perinatal trauma. If an attempted vacuum is unsuccessful, the physician should consider the risks of proceeding to an attempted forceps delivery versus Caesarean section (II-2B). 9Restrictive use of mediolateral episiotomy is supported in assisted vaginal birth (II-2B). 10A debrief should be done with the patient and support people immediately following an attempted or successful assisted vaginal birth. If this is not possible, ideally this should be done prior to hospital discharge and include the indication for assisted vaginal birth, management of any complications, and the prognosis for future deliveries (III-B). 11In a subsequent pregnancy, patients should be encouraged to consider spontaneous vaginal birth. However, care planning should be individualized and patient preference respected (II-3B).

Objective To determine the usefulness of a novel classification of indications for caesarean section (CS) in labour in recognizing differences in clinical practice in different maternity units. Methods Data from the National Perinatal Information System (NPIS) for 2013 and 2014 were used to classify indications for CS in nulliparous women with spontaneous onset of labour at ≥37 weeks with single cephalic foetuses within 14 Slovenian maternity units into foetal distress and different sub-groups of dystocia according to use and dosage of oxytocin. Chi-square test was used for statistical comparison between units (P≤0.05 significant). Results There were 13,572 deliveries and 1,567 (12.0%) CS in nulliparous patients with spontaneous onset of labour at ≥37 weeks with single cephalic foetuses in Slovenia during the study period. Rates of CS in this group of women differed significantly among different maternity units (from 4.1% to 20.9%; P Conclusions It is possible to use NPIS data to retrospectively classify indications for CS. Such classification reveals significant differences among maternity units and could allow for a meaningful analysis of CS rates in different hospitals leading to evidence-based initiatives to decrease the incidence of primary CS.

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.

Tyrimo tikslas. Nustatyti galimas vaisiaus galvos apimties ir gimdymo baigčių sąsajas lietuvių gimdyvių populiacijoje. Tyrimo metodai. Retrospektyvusis kohortinis tyrimas, atliktas Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikų (toliau – Kauno klinikos) Akušerijos ir ginekologijos klinikoje. Į tyrimą įtrauktos pirmą kartą gimdžiusios moterys (n=213), kurioms per septynias dienas iki gimdymo buvo atlikta vaisiaus fetometrija. Rezultatai. Vaisiaus galvos apimtis (VGA) koreliavo su cezario pjūvio operacija (CPO) dėl kliniškai siauro dubens (KSD) (rφ=0,235, p=0,001), tarp vaisiaus masės ir CPO ryšys nenustatytas. Nustatyti CPO dėl KSD rizikos veiksniai: rūkymas nėštumo laikotarpiu (ŠS 2,59; 95 proc. PI 1,05–6,45), užpakalinė pakaušio padėtis (UPP) (ŠS 19,27; 95 proc. PI 4,84–76,74), VGA≥338,8 mm (ŠS 5,98; 95 proc. PI 1,94–18,44). UPP, VGA≥338,8 mm, epidurinės analgezijos derinys turėjo 66,7 proc. teigiamą ir 91,8 proc. neigiamą prognostines vertes CPO dėl KSD. Išvados. Išmatuota 338,8 mm ir didesnė VGA bei užpakalinė vaisiaus galvos pakaušio padėtis gimdymo metu buvo siejamos su padidėjusia skubios CPO dėl KSD rizika.

Introduction The obstetric conjugate represents the shortest anteroposterior diameter of the birth canal and it reflects the capacity of the pelvic inlet to allow the passage and the engagement of the fetal head. The antepartum evaluation of this parameter may be attempted at digital examination to predict the risk of cephalopelvic disproportion, but the accuracy of clinical pelvimetry is notoriously poor. The aim of our study was to describe the sonographic measurement of the obstetric conjugate at transabdominal 2D-ultrasound and to assess its reproducibility. Material and methods This is a prospective cohort study conducted at a tertiary University hospital. A non-consecutive series of pregnant women with uncomplicated singleton pregnancies attending the antenatal clinic for routine booking from 34 weeks of gestation onward were included. The ultrasound probe was longitudinally placed above the level of the symphysis and the interpubic fibrocartilaginous disk was visualized. Then the promontory was identified as the most prominent segment of the sacral vertebral column. The obstetric conjugate was measured as the distance between the inner edge of the interpubic disk and the promontory. The inter- and intraobserver repeatability of this measurement was calculated using the intraclass correlation coefficient (ICC) and the Bland-Altman method. Results In all, 119 women were considered eligible for the study; of these, 111/119 (93.3%) women were included in the analysis with a median gestational age of 36.0 (35.0-37.0) weeks. The mean obstetric conjugate measurement was 11.4 ± 0.93 mm for the first operator and 11.4 ± 0.91 mm for the second operator. The overall interobserver ICC was 0.95 (95% [confidence interval] CI 0.92-0.96) and the overall intraobserver ICC was 0.97 (95% CI 0.96-0.98). Limits of agreement ranged from -0.84 to 0.80 for interobserver measures and from -0.64 to 0.62 for intraobserver measures. The degree of reliability was also analyzed for women with a body mass index ≥30 and for women with a gestational age ≥37 weeks. The inter- and intraobserver ICCs were respectively 0.97 (95% CI 0.90-0.98) and 0.98 (0.95-0.99) in the former group and 0.96 (95% CI 0.93-0.98) and 0.97 (95% CI 0.95-0.98) in the latter group. Conclusions Our study demonstrated that among pregnant women at term gestation, sonographic measurement of the obstetric conjugate is feasible and reproducible.

Background Obstructed labor is a preventable obstetric complication. However, it is an important cause of maternal mortality and morbidity and of adverse outcomes for newborns in resource-limited countries in which undernutrition is common resulting in a small pelvis in which there is no easy access to functioning health facilities with a capacity to carry out operative deliveries. Therefore, this systematic review and meta-analysis aimed to estimate the incidence, causes, and maternofetal outcomes of obstructed labor among mothers who gave birth in Ethiopia. Method for this review, we used the standard PRISMA checklist guideline. Different online databases were used for the review: PubMed, Google Scholar, EMBASE, Cochrane Library, HINARI, AFRO Library Databases, and African Online Journals. Based on the adapted PICO principles, different search terms were applied to achieve and access the essential articles. The search included all published and unpublished observational studies written only in the English language and conducted in Ethiopia. Microsoft Excel 16 was used for data entrance, and Stata version 11.0 (Stata Corporation, College Station, Texas, USA) was used for data analysis. Results I included sixteen (16) primary studies with twenty-eight thousand five hundred ninety-one (28,591) mothers who gave birth in Ethiopia. The pooled incidence of obstructed labor in Ethiopia was 12.93% (95% CI: 10.44–15.42, I2 = 98.0%, p Conclusion This systematic review and meta-analysis showed that the incidence of obstructed labor was high in Ethiopia. Not having antenatal care follow-up, rural residency, and visiting hospitals after 12 h of labor increased the incidence of obstructed labor. The major causes of obstructed labor were cephalo-pelvic disproportion, and malpresentation and malpresentation. Additionally, the commonest complications were sepsis, stillbirth, postpartum hemorrhage, uterine rupture, and maternal death. Thus, promoting antenatal care service utilization, a good referral system, and availing comprehensive obstetric care in nearby health institutions are recommended to prevent the incidence of obstructed labor and its complications.

Introduction: A Decision to Delivery Interval (DDI) of 30 minutes for emergency caesarean section has been widely recommended but there is little evidence to support it. This target may not be practicable in a busy maternity unity and therefore, the anticipated beneficial effect on neonatal outcome requires re-evaluation. Aim: To determine the association between decision-delivery interval and perinatal outcome of emergency caesarean section at Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA) over a period of four years. Materials and Methods: This was a retrospective observational study of the cases in emergency caesarean sections performed at the Department of Obstetrics and Gynaecology, AEFUTHA from 1st January 2012 to 1st January 2016. Hospital records of the women with singleton pregnancy at term who delivered through emergency caesarean sections were retrieved. Data extracted include socio-demographic and obstetric characteristics, duration between decision for caesarean section and intervention, indications for the caesarean section, reasons for delay in DDI, association between booking status and DDI and association of DDI and foetal outcome, APGAR score at 1st and 5th minutes and admission to NICU. Data were analysed with IBM statistics version 20. The p-value 75 minutes and poor perinatal outcome. Efforts should be made to strengthen the health system and improve the quality of care in order to keep DDI within this time limit for improved perinatal health outcome and indices.

The causes and mechanisms of damage to the skull and brain of the fetus under the influence of physical forces during childbirth, due to cephalopelvic disproportion, dystocia in childbirth, malposition, malpresentations, asynclitism, and other causes, are examined. The general patterns that must be considered by the obstetrician to prevent birth injury to the fetus are considered. The degrees and types of configuration (molding) of the fetal head are described. It was shown that as a result of head compression (both during spontaneous delivery and when using obstetric forceps and a vacuum extractor), birth trauma and compression hypoxia occur, and their differences are considered. The correlations between the location of the region of periosteal blood congestion of the skull and the localization of the tentorium cerebelli tears are examined. It is shown that any degree of asynclitism increases the risk of birth trauma.

The pelvis is not only a functional bone but has great importance in obstetrics. Because of bipedal locomotion, the shape and size of the pelvis became more straight. In this situation the only way to delivery large brained fetus is that the fetal head has to perform complex rotation and turning movements (cardinal movements) during the progress in the birth canal. The problem may arise from cephalopelvic disproportion (CPD) that is present when the fetal head is too large to pass through the pelvis. CPD and related obstructed labor is responsible for 2–8% of maternal mortality worldwide and furthermore can cause poor progress of labor and can be indication for operative vaginal delivery (OVD) or primary cesarean section (CS).

Normal labor is identified as regular uterine contractions in addition to dilation and effacement of the cervix. It is necessary to define normal labor in order to delineate when a woman's labor pattern diverges from that observed in most women. Labor irregularities are subdivided into protraction disorders and arrest disorders. Identifying abnormal labor patterns and initiating appropriate interventions is essential because prolonged labor is associated with an increase in perinatal morbidity. The aim of this review was to delineate both normal labor progress and also discuss the current evidence-based diagnosis and treatment of protraction and arrest disorders. Many subtleties go into defining the boundaries of the first and second stages of labor. Historically, the Friedman curve established normal limits; but currently Zhang has advanced these definitions by accounting for current demographical characteristics and practice environments. The most significant variables for defining normal progress of labor are parity and regional anesthesia status. The most common causes of labor abnormalities are uterine inactivity, obesity, cephalopelvic disproportion and fetal malposition. Risks of extending the first and/or second stage of labor include postpartum hemorrhage, intraamniotic infection and potentially an increase in neonatal adverse outcomes. The management of labor disorders consists of oxytocin administration, amniotomy, intrauterine pressure catheter use and shared decision-making regarding proceeding with expectant management, operative vaginal delivery or cesarean delivery after weighing the risks and benefits of each option. The decision to extend the duration of labor is personalized for each mother-baby dyad and should be agreed upon depending on individual maternal and fetal circumstances.

A large brain combined with an upright posture in humans has resulted in a high cephalopelvic proportion and frequently obstructed labor. Fischer and Mitteroecker [B. Fischer, P. Mitteroecker, Proc. Natl. Acad. Sci. U.S.A. 112, 5655-5660 (2015)] proposed that the morphological covariations between the skull and pelvis could have evolved to ameliorate obstructed labor in humans. The availability of quantitative data of such covariation, especially of the fetal skull and maternal pelvis, however, is still scarce. Here, we present direct evidence of morphological covariations between the skull and pelvis using actual mother-fetus dyads during the perinatal period of Macaca mulatta, a species that exhibits cephalopelvic proportions comparable to modern humans. We analyzed the covariation of the three-dimensional morphology of the fetal skull and maternal pelvis using computed tomography-based models. The covariation was mostly observed at the pelvic locations related to the birth canal, and the forms of the birth canal and fetal skull covary in such a way that reduces obstetric difficulties. Therefore, cephalopelvic covariation could have evolved not only in humans, but also in other primate taxa in parallel, or it could have evolved already in the early catarrhines.

Objective To analyze the association between newborn and maternal characteristics and the risk for cesarean section (CS) due to cephalopelvic disproportion (CPD) and non-CPD causes compared to vaginal deliveries (VD) in a sample of infants and mothers from Merida, Yucatan, Mexico. Methods The final sample consisted of 3453 single, live, and term infants born between January 2016 and May 2017 at the Maternal-Infant Hospital in Merida and their mothers (aged ≥19 years). The mode of delivery was established as the dependent variables: (a) VD, (b) CS due to CPD, and (c) non-CPD CS. Independent variables were maternal height and weight, the number of previous VD, newborn weight, and neonatal birthweight (BW) index/maternal height index. A multinomial regression model was used to analyze the association between newborn and maternal characteristics and outcome variable. Results By mode of delivery, 2124 (62%) births corresponded to VD, 1042 (30%) to non-CPDCS, and 287 (8%) to CS due to CPD. Mothers who had CS due to CPD weighed more at the end of their pregnancy and were shorter. Maternal age and weight increased the risk for having CS due to CPD compared to VD and maternal height, and the number of previous VD reduces the risk for experiencing CS due to CPD compared to vaginal births. The relative risk ratio for higher neonatal BW/maternal height index was significant for CS due to CPD and non-CPD CS. Conclusion According to our results from a public hospital in Merida, Mexico, CPD is a result of the interrelation of maternal and fetal size, rather than an independent result of maternal height or BW.

Introducción. La cesárea es una operación reservada inicialmente para casos en los que el parto eutócico puede comprometer la vida de la gestante o del producto. Por diversas razones, se ha aceptado a la cesárea como método de parto de elección, aumentando su frecuencia. La OMS estableció un margen de tasa de cesáreas de 15% para las cesáreas primarias, ya que valores mayores no representan una disminución en la morbimortalidad fetal. Mundialmente se ha evidenciado tasas de hasta 21% (países europeos) y, en el Perú, 36% en el año 2015. Objetivos. Determinar la frecuencia e indicaciones más frecuentes de cesáreas en un hospital público docente de Lima. Métodos. Estudio descriptivo, tipo serie de casos, de pacientes sometidas a cesárea y sus indicaciones. Se incluyó a pacientes sometidas a cesáreas, electivas o de emergencia, desde enero 2013 hasta diciembre 2017. Resultados. La cesárea fue realizada con una frecuencia de 50,2%, siendo las indicaciones más frecuentes una cesárea previa y la desproporción cefalopélvica. Conclusiones. El estudio halló que se superó la tasa de cesáreas recomendada por la OMS. La indicación más frecuente en el período estudiado fue la cesárea previa.

During labor mother and fetus are evaluated at intervals to assess their well-being and determine how the labor is progressing. These assessments require skillful physical diagnosis and the ability to translate the acquired information into meaningful prognostic decision-making. We describe a coordinated approach to the assessment of labor. Graphing of serial measurements of cervical dilatation and fetal station creates “labor curves,” which provide diagnostic and prognostic information. Based on these curves we recognize nine discrete labor abnormalities. Many may be related to insufficient or disordered contractile mechanisms. Several factors are strongly associated with development of labor disorders, including cephalopelvic disproportion, excess analgesia, fetal malpositions, intrauterine infection, and maternal obesity. Clinical cephalopelvimetry involves assessing pelvic traits and predicting their effects on labor. These observations must be integrated with information derived from the labor curves. Exogenous oxytocin is widely used. It has a high therapeutic index, but is easily misused. Oxytocin treatment should be restricted to situations in which its potential benefits clearly outweigh its risks. This requires there be a documented labor dysfunction or a legitimate medical reason to shorten the labor. Normal labor and delivery pose little risk to a healthy fetus; but dysfunctional labors, especially if stimulated excessively by oxytocin or terminated by complex operative vaginal delivery, have the potential for considerable harm. Conscientiously implemented, the approach to the evaluation of labor outlined in this review will result in a reasonable cesarean rate and minimize risks that may accrue from the labor and delivery process.

Background The trend of increasing caesarean deliveries in developed countries over the past three decades is now being observed in sub-Saharan African. This rise might be associated with an increase in the complications that could arise from this surgical intervention. We therefore sought to assess the prevalence, indications and complications of caesarean deliveries in Cameroon. Methods We systematically searched online databases: Medline; Global Health and the CINAHL from 01st January 1966 to 25th July 2019. We reviewed published cohort studies, retrospective register analysis and cross-sectional studies that described cohorts of pregnant women presenting at delivery facilities in Cameroon; and included those that had an estimate of the proportion of women who delivered by caesarean sections. Results There were 126 articles initially identified by the search and 88 articles were retained after removal of duplicates. After screening of the titles and abstracts, and full text review, we identified 16 articles describing 22 cohorts of women presenting for delivery in health facilities in Cameroon. The overall estimate for the prevalence of caesarean deliveries was 9.9% (95% CI: 7.4, 12.8%, I2 = 99.68%, χ2 = 315.9, p Conclusion The rates of caesarean deliveries in Cameroon falls just within the recommended 10–15% range proposed by the World Health Organisation but have however been increasing progressively in the past decades. There is a strong need to assess the various indications of caesarean deliveries in Cameroon in order to curb its associated complications.

In the mid-1980s, the World Health Organization (WHO) proposed a 15% standard for cesarean births...

Objective: The aim of the study was to determine if customized fetal growth charts developed excluding obese and underweight mothers (CC(18.5–25)) are better than customized curves (CC) at identifying pregnancies at risk of perinatal morbidity. Material and Methods: Data from 20,331 infants were used to construct CC and from 11,604 for CC(18.5–25), after excluding the cases with abnormal maternal BMI. The 2 models were applied to 27,507 newborns and the perinatal outcomes were compared between large for gestational age (LGA) or small for gestational age (SGA) according to each model. Logistic regression was used to calculate the OR of outcomes by the group, with gestational age (GA) as covariable. The confidence intervals of pH were calculated by analysis of covariance. Results: The rate of cesarean and cephalopelvic disproportion (CPD) were higher in LGAonly by CC(18.5−25) than in LGAonly by CC. In SGAonly by CC(18.5−25), neonatal intensive care unit (NICU) and perinatal mortality rates were higher than in SGAonly by CC. Adverse outcomes rate was higher in LGAonly by CC(18.5−25) than in LGAonly by CC (21.6%; OR = 1.61, [1.34–193]) vs. (13.5%; OR = 0.84, [0.66–1.07]), and in SGA only by CC(18.5−25) than in SGAonly by CC (9.6%; OR = 1.62, [1.25–2.10] vs. 6.3%; OR = 1.18, [0.85–1.66]). Conclusion: The use of CC(18.5–25) allows a more accurate identification of LGA and SGA infants at risk of perinatal morbidity than conventional CC. This benefit increase and decrease, respectively, with GA.

Objective To evaluate the ability of the pubic arch angle (PAA) as measured by transperineal ultrasonography during labor to predict the delivery type and cephalic pole disengagement mode. Methods The present prospective cross-sectional study included 221 women in singleton-gestational labor ≥ 37 weeks with cephalic fetuses who underwent PAA measurement using transperineal ultrasonography. These measurements were correlated with the delivery type, cephalic pole disengagement mode, and fetal and maternal characteristics. Results Out of the subjects, 153 (69.2%) had spontaneous vaginal delivery, 7 (3.2%) gave birth by forceps, and 61 (27.6%) delivered by cesarean section. For the analysis, deliveries were divided into two groups: vaginal and surgical (forceps and cesarean). The mean PAA was 102 ± 7.5º (range, 79.3-117.7º). No statistically significant difference was observed in delivery type (102.6 ± 7.2º versus 100.8 ± 7.9º, p = 0.105). The occipitoanterior position was seen in 94.1% of the fetuses and the occipitoposterior position in 5.8%. A narrower PAA was found in the group of surgical deliveries (97.9 ± 9.6º versus 102.6 ± 7.3º, p = 0.049). Multivariate regression analysis showed that PAA was a predictive variable for the occurrence of head disengagement in occipital varieties after birth (odds ratio, 0.9; 95% confidence interval, 0.82-0.99; p = 0.026). Conclusion Ultrasonographic measurement of the PAA was not a predictor of delivery type, but was associated with the persistence of occipital varieties after birth. Resumo Objetivo Avaliar a medida do ângulo do arco púbico (AAP) por ultrassonografia transperineal durante trabalho de parto em predizer tipo de parto e modo de desprendimento do polo cefálico. Métodos Um estudo prospectivo transversal foi conduzido com 221 mulheres em trabalho de parto com gestação única ≥ 37 semanas, com fetos em apresentação cefálica, foram submetidas à avaliação ultrassonográfica por via transperineal para aferição do AAP. Correlações com tipo de parto, modo de desprendimento do polo cefálico e características fetais e maternas foram realizadas. Resultados Um total de 153 (69,2%) mulheres apresentaram parto vaginal espontâneo, 7 (3,2%) parto a fórceps e 61 (27,6%) parto cesárea. Para fins de análise, dividiu-se os partos em dois grupos: partos vaginais e cirúrgicos (fórceps e cesáreas). A média do AAP foi 102 ± 7,5º (variação: 79,3-117,7º). Não foi observada significância estatística do AAP em relação ao tipo de parto (102,6 ± 7,2º versus 100,8 ± 7,9º; p = 0,105). Um total de 94,1% dos fetos desprenderam em variedade de posição occipito anterior e 5,8% em occipito posterior. Encontrou-se AAP mais estreitado no grupo de partos cirúrgicos (97,9 ± 9,6º versus 102,6 ± 7,3º; p = 0,049). A análise de regressão multivariada demonstrou que AAP foi uma variável de proteção para a ocorrência de desprendimento da cabeça em variedades occipito posteriores ao nascimento (odds ratio [OR]= 0,9; índice de confiança (IC) 95%: 0,82-0,99; p = 0,026). Conclusão A medida ultrassonográfica do AAP não foi preditora do tipo de parto, porém demonstrou associação com persistência de variedades occipito posteriores ao nascimento.

Background Caesarean section rates have increased worldwide in recent decades. Caesarean section is an essential maternal healthcare service. However, it has both maternal and neonatal adverse outcomes. Therefore this systematic review and meta-analysis aimed to estimate the prevalence, indication, and outcomes of caesarean section in Ethiopia. Methods Twenty three cross-sectional studies with a total population of 36,705 were included. Online databases (PubMed/Medline, Hinari, Web of Science, and Google Scholar) and online university repository was used. All the included papers were extracted and appraised using the standard extraction sheet format and Joanna Briggs Institute respectively. The pooled prevalence of the caesarean section, indications, and outcomes was calculated using the random-effect model. Result The overall pooled prevalence of Caesarean section was 29.55% (95% CI: 25.46–33.65). Caesarean section is associated with both maternal and neonatal complications. Cephalopelvic disproportion [18.13%(95%CI: 12.72–23.53] was the most common indication of Caesarean section followed by non-reassuring fetal heart rate pattern [19.57% (95%CI: 16.06–23.08]. The common neonatal complications following Caesarean section included low APGAR score, perinatal asphyxia, neonatal sepsis, meconium aspiration syndrome, early neonatal death, stillbirth, and prematurity whereas febrile morbidity, surgical site infection, maternal mortality, severe anemia, and postpartum hemorrhage were the most common maternal complications following Caesarean section. Conclusion In this systematic review and meta-analysis, the rate of Cesarean section was high. Cephalopelvic disproportion, low Apgar score, and febrile morbidity were the most common indication of Caesarean section, neonatal outcome and maternal morbidity following Caesarean section respectively. Increasing unjustified Caesarean section deliveries as a way to increase different neonatal and maternal complications, then several interventions needed to target both the education of professionals and the public.

Background: There are growing concerns about the increasing rate of caesarean section (CS) worldwide. Various strategies have been implemented to reduce the proportion of CS to a reasonable level. Most research on medical indications for CS focuses on nationwide evaluations. Comparative research between different countries is sparse. The aim of this study was to evaluate differences in the rate and indications for CS between Japan and Germany in 2012 and 2013. Methods: Comparison of the overall rate and medical indications for CS in two cohort studies from Germany and Japan. We used data from the German Perinatal Survey and the Japan Environment and Children's Study (JECS). Results: We analyzed data of 1 335 150 participants from the German perinatal survey and of 62 533 participants from JECS and found significant differences between the two countries in CS rate (30.6% vs 20.6%) and main medical indications: cephalopelvic disproportion (3.2% vs 1.3%; OR: 2.4 [95% CI: 2.2���2.6]), fetal distress (7.3% vs 2.3%; OR: 3.4 [95%-CI: 3.2���3.6]), and past uterine surgery/repeat CS (8.4% vs 8.8%; OR: 0.9 [95%-CI: 0.9���1]). Conclusion: There are differences in the rate and medical indications for CS between Germany and Japan at the population level. Fetal distress was identified as a medical indication for CS more often Germany than in Japan. Considering the substantial diagnostic uncertainty of electronic fetal monitoring (EFM) as the major indicator for fetal distress, it would seem to be reasonable to rethink CS decision algorithms.

DOI: https://doi.org/10.3126/jkahs.v1i3.24151 Introduction: Providers skilled in emergency obstetric and newborn care (EmONC) services are essential, particularly in countries like Nepal with a high burden of maternal and newborn mortality. So this study aims to find out the status of comprehensive emergency obstetrical and neonatal care (CEmONC) service. Method: A retrospective cross-sectional study was conducted using secondary data sources at maternity ward of KAHS teaching hospital, Jumla. Total 291 women admitted in maternity ward for childbirth were included in the study of six month period of 2075. Sampling technique was census for the study who were admitted for child birth purpose. Cases were selected from the record of the maternity ward. The data was collected by using structured tool. Ethical approval was taken from the ethical review committee of KAHS for ethical clearance. Data was analyzed by using descriptive statistics. Result: There were 291 women admitted in the maternity ward for the purpose of childbirth during six-month period. Among them 224(76.97%) women delivered baby by spontaneous vaginal delivery; 61(20.96%) delivered with C/S and 6(2.06%) were delivered with instrumental delivery. Regarding the indication of 61 cesarean section (C/S) delivery; 22.95% with fetal distress, 16.39% with cephalopelvic disproportion and 11.47% with meconium stained liquor Conclusions: About one third childbirth was done by cesarean section with indication of fetal distress, cephalo-pelvic disproportion and meconium stained liquor in higher proportion. Although CEONC service is effective, the rate of cesarean section can be reduced by providing good quality antenatal care. Keywords: Emergency obstetrical care, Newborn care, Spontaneous vaginal delivery

Aims: To evaluate the maternal and perinatal outcome in adolescent pregnancy,Method: This was a cross-sectional study conducted in Department of Obstetrics and Gynecology, Manipal Teaching Hospital, Pokhara from October 2017 to March 2018 for duration of 6 months.Results: There were total 82 cases of teenage pregnancy in the study duration with incidence of 6% among total deliveries. Majority of cases were of age 19 and were primigravida. Fifty five percent of the cases had normal vaginal delivery and cesarean section accounted for 39% of cases. The major indication for cesarean section was meconium stained liquor (52%) followed by oligohydraminos (15%) and cephalopelvic disproportion (11%). The maternal complication accounted for 59% of total cases. Among them, anaemia was highly prevalent comprising 11% of cases followed by PPROM (9.8%) and hypertensive disorders in pregnancy (8.5%). In perinatal outcome, the incidence of preterm birth was 15.9% and low birth weight was 13.4%. The rate of NICU admission was 2.4% and there was one case of still birth.Conclusion: The study showed that teenage pregnancy is at increased risk of adverse maternal and perinatal outcome. So if we lay an effort for reducing the incidence of teenage pregnancy, we can bring in positive changes in the indicators of maternal and perinatal morbidities.

Aims: The aim of the study was to assess the risk factors for adverse outcomes in pregnancy with obstructed labor.Methods: It was a prospective descriptive study conducted at BP Koirala Institute of Health sciences (BPKIHS).The patients with obstructed labour were managed and followed up until delivery and six weeks postpartum from Jan to Dec 2012.Results: There were 57 (0.6%) cases of obstructed labour out of 9500 deliveries. The main cause was cephalopelvic disproportion in 36 (63.2%). The majority of the cases were from rural areas, low socioeconomic status, non salaried and illiterate. Risk for maternal mortality, peripartum hysterectomy and perinatal mortality as adverse outcomes was significantly associated with low socioeconomic status (AOR 12.5, P=0.02) and literacy status (AOR 21.9, P=0.001). If only the risk of perinatal mortality is taken as an adverse outcome, it is significantly associated with booking status (AOR 7, P=0.001), low socioeconomic status (AOR 9.62, P=0.037) and literacy of the patient (AOR 15, P=0.001). Perinatal mortality rate was 100 per 1000 live births in women with obstructed labour. The case fatality rate was 1.2%.

Objective To investigate the variability in the prevalences of selected birth risks in women of different heights and weights. Methods Data from the German Perinatal Survey of 1998–2000 were analyzed: 503,468 cases contributed to our analysis of the prevalences of selected birth risks specified according to maternal weight groups, 502,562 cases contributed to our analysis according to maternal height groups and 43,928 cases contributed to our analysis of birth risks in women with a body mass index (BMI) of 21–23 kg/m2 but different heights and weights. Data analysis was performed using SPSS version 22. Results Some birth risks varied substantially by maternal height in women with a “normal” BMI of 21–23 kg/m2: the prevalence of post-term birth increased from 8.7% in women with a height of 150 cm to 13.5% in 185 cm tall women, the prevalence of preterm birth decreased from 5.9% (150 cm tall women) to 3.1% (185 cm tall women), a pathologic cardiotocography (CTG) or poor fetal heart sounds on auscultation occurred in 19.4% of the 150 cm tall women but only in 9.2% of 185 cm tall women and cephalopelvic disproportion decreased from 12.3% (150 cm tall women) to 1.2% (185 cm tall women). Analyses of women in different body height and weight groups (without restriction of BMI) likewise showed differences in the prevalences of some birth risks. Conclusion Birth risks may vary by height and weight in women with the same, “normal” BMI. BMI should not be the only way by which the impact of maternal height and weight is assessed with regard to perinatal outcomes such as birth risks.

Background: Caesarean Section is now a common surgical practice during child birth.Objective: The purpose of the present study was to see the indication of emergency caesarean section.Methodology: This descriptive type of cross sectional study was conducted in the Department of Gynaecology & Obstetrics at Dhaka Medical College Hospital during the period from July 2006 to December 2006 for a period of 6 months. The pregnant women who were selected for emergency caesarean section during the mentioned period of study were included as study population. The details of the indication of the caesarean section were recorded.Result: A total number of 100 cases were recruited in this study. Among the all indications of emergency caesarean section history of previous caesarean section was the most common which was found in 25(25.0%) cases. Foetal distress was the second common indication of emergency caesarean section which was 18(18.0%) cases. Obstructed labour was also reported in 11(11.0%) cases. Antepartum haemorrhage (8.0%) was another indication of emergency caesarean section. Considering the hypertensive disorder preeclamptic toxaemia (7.0%), eclampsia (5.0%) and pregnancy induced hypertension (1.0%) were the reported as the indications of emergency caesarean section. Some other indications of emergency caesarean section were recorded which were mal-presentation (7.0%), prolonged labour (6.0%), cephalopelvic disproportion (4.0%) and failed trial labour (4.0%).Conclusion: In conclusion history of previous caesarean section is the most common indication for emergency caesarean section obstructed labour, antepartum haemorrhage as well as foetal distress, malpresentation and cephalopelvic disproportion.Journal of Science Foundation 2017;15(2):36-40

Srisuda Songthamwat, Metha Songthamwat Department of Obstetrics and Gynecology, Udonthani Hospital, Udonthani, Thailand Objective: The aim of this study was to report our clinical experience of applying a uterine flexion suture, which was modified from the B-Lynch uterine compression suture, for treating uterine atony during cesarean section. Materials and methods: This is a retrospective descriptive study describing the use of a new technique, uterine flexion suture, for treating uterine atony during cesarean section. The study period was from January 2009 to December 2017 at Udonthani Hospital, Udonthani, Thailand. Uterine atony during cesarean section was treated by manual compression, intravenous oxytocin, methylergonovine maleate, and prostaglandins and then was observed for 10–15minutes before applying a uterine flexion suture in the failed medical treatment cases. The patients were observed for vaginal bleeding, hematometra, and infection after operation. Uterine ultrasound scan results on days 1, 7, and 30 postoperation were also reviewed. Results: Fifty-seven patients with uterine atony during cesarean delivery received the uterine flexion suture. The mean age of patients was 27.0 (15–44years). Thirty-four patients were primipara. The indications for cesarean section were cephalopelvic disproportion in 27 (47.4%) cases, and previous cesarean section in 11 (19.3%) cases. Neither postoperative excessive bleeding nor hysterectomy was observed. There was no hematometra or serious postoperative complication after surgery. The estimated time for uterine flexion suture is only 2–3minutes and was very easy to perform. Conclusion: Uterine flexion suture technique, which was modified from the B-Lynch suture, was inexpensive, quick, and effective in the treatment of atonic postpartum uterus in women undergoing cesarean section. Keywords: B-Lynch, uterine atony, cesarean section, uterine compression suture, uterine flexion suture

Antecedentes: El síndrome Frey es un conjunto de síntomas que incluyen la sudoración unilateral con enrojecimiento de la región malar y pabellón auricular después de comer o beber algún alimento. Se trata de una lesión del nervio auriculotemporal secundaria a cirugía o infección de las glándulas parotídeas o traumatismo facial.Casos clínicos: Tres niños entre cuatro y dos y medio años de edad: dos niñas y un niño. Presentaban máculas eritematosas unilaterales en la cara que llegaban el pabellón auricular de resolución espontánea, sin erupciones, prurito, angioedema, síntomas gastrointestinales ni respiratorios; su aparición estaba asociada con el consumo de alimentos ácidos y algunos dulces. Se observó la reproducción de los síntomas en el recorrido del nervio aurículo-temporal. Entre sus antecedentes se encontraban nacimiento por cesárea debido a desproporción cefalopélvica (caso 1), nacimiento por parto instrumentado con fórceps (caso 2) y nacimiento por cesárea debido a preeclampsia (caso 3).Conclusiones: A menudo el síndrome de Frey suele ser confundido con alergia alimentaria, ocasionando restricciones innecesarias de la dieta. En los niños suele estar ausente la sudoración debido a la posible inmadurez de las glándulas ecrinas.

Saimiri sciureus is a neotropical primate widely used in research. However, there are still difficulties regarding their reproduction in vivaria due to the high incidence of dystocia. Dystocia in primates can be caused by cephalopelvic disproportion and in Squirrel Monkeys, pregnancy of large fetuses were reported. This paper describes pelvimetry data of adult females and subadults in specimens of Squirrel Monkeys, from a research colony of Para, Brazil. Pelvic radiographs were obtained in ventrodorsal projections and the following measurements were taken: superior bi-iliac diameter (SBID); inferior bi-iliac diameter (IBID); bi-iliac average diameter (BIAD); right diagonal diameter (RDD); left diagonal diameter (LDD); sacro-pubic diameter (SPD); Based on the obtained diameters, the entrance area of the pelvis (EAP) was also calculated. The average values of the pelvic diameters and EAP in adult females were SBID 1.714cm, BIAD 1.957cm, IBID 1.686cm, RDD 2.771cm, LDD 2.764cm, SPD 2.543cm and EAP 3.9056cm2; and subadult females: 1.588cm SBID, 1.850cm BIAD, 1.625cm IBID, 2.50cm RDD, LDD 2.474cm, 1.95cm SPD and 2.8293 cm2 EAP. Saimiri sciureus pelvis is characterized as dolichopelvic. There was statistical significance between the values for adult females and subadults to SBID, BIAD, RDD, LDD, SPD and EAP. The values of SBID and IBID were lower when compared to the published data for the same species. The result found on this paper will serve as a basis for future studies using pelvic measurements and dystocia prediction of neotropical primates and comparison between different vivaria. RESUMO: Saimiri sciureus é uma espécie de primata neotropical muito utilizada como animal de pesquisa. No entanto ainda há dificuldades em biotérios quanto a sua reprodução devido à alta ocorrência de distocia. A distocia em primatas pode ter origem devido à desproporção cefalopélvica, sendo que em macacos-de-cheiro é relatada a gestação de fetos grandes. O presente trabalho descreve dados de pelvimetria em espécimes de macaco-de-cheiro, fêmeas adultas e subadultas provenientes de uma colônia de pesquisa do Pará, Brasil. Foram realizadas radiografias da pelve em projeção ventrodorsal e por meio destas mensurados os diâmetros biilíaco superior (DBIS); diâmetro biíliaco inferior (DBII); diâmetro biilíaco médio (DBIM); diâmetro diagonal direito (DDD); diâmetro diagonal esquerdo (DDE); diâmetro sacro-púbico (DSP); com base nos diâmetros obtidos também foi calculada a área de entrada da pelve (AEP). Os valores médios dos diâmetros pélvicos e da AEP em fêmeas adultas foram: DBIS 1,714cm, DBIM 1,957cm, DBII 1,686cm, DDD 2,771cm, DDE 2,764cm, DSP 2,543cm e AEP 3,9056cm2; e para fêmeas subadultas: 1,588cm DBIS, 1,850cm DBIM, 1,625cm DBII, 2,50cm DDD, 2,474cm DDE, 1,95cm DSP e 2,8293 cm2 AEP. Observou-se que a pelve de Saimiri sciureus é dolicopélvica. Houve diferença estatística significativa entre os valores para fêmeas adultas e subadultas para DBIS, DBIM, DDD, DDE, DSP e AEP. Em comparação com dados da literatura de pelvimetria para S. sciureus observaram-se menores valores de DBIS e DBII. O resultado deste trabalho servirá como base para futuros estudos utilizando-se mensurações pélvicas e predição de distocia em primatas neotropicais e referência para comparação entre S. sciureus de diferentes biotérios.

AIM: This study was done to find out the incidence and to analyse the various indications for caesarean sections at Lumbini Zonal Hospital.MATERIALS & METHODS: This was a hospital based retrospective study done at Lumbini Zonal Hospital, Butwal. The case files of all the women who had caesarean delivery over the period of one year from 2071/4/1 to 2072/3/32 were reviewed. Various indications of caesarean sections were analysed for the incidence, age, parity, elective vs emergency caesareans.RESULTS: Out of 7589 deliveries, 1316 (17.34%) had caesarean section. Most common indications were previous caesarean 275 (20.89%), non progress of labour 245 (18.61%), cephalopelvic disproportion 222 (16.86%), fetal distress 215 (16.33%), etc. Majority of caesarean 1226 (93.16%) was done in the age group of 20-30yrs, primipara 702 (53.34%), and elective caesarean sections 766 (58.2%).CONCLUSION: Caesarean section rate at Lumbini Zonal Hospital was optimal. Most common indication was repeat caesarean. The overall reduction in caesarean section rate can be met through reduction of elective caesarean with the promotion of trial of labour.Study also concludes that there is a relation between working duration and health problems, and the problems increase as the duration at work increases.Journal of Universal College of Medical Sciences, Vol. 5, No, 2, 2017, Page: 31-34

Breast milk is the only first food that can be consumed by newborns until the age reaches six months. therefore it is very important to know by the mother who is pregnant and will give birth about the importance of breast milk. Oxytocin drugs have similar functions to the natural hormone oxytocin produced by the body. This drug serves to trigger or strengthen the contraction of the uterine muscle. Therefore, oxytocin can be used to stimulate (induce) labor and stop bleeding after childbirth. In addition, this drug can also help stimulate the release of breast milk in breastfeeding mothers. Oxytocin should be avoided by pregnant women who can not give birth normally, for example because it has a narrow pelvis, suffering from placenta previa, or having a too strong uterine contractions. Oxytocin is also prohibited for pregnant women with cephalopelvic disproportion, impaired fetal conditions, uterine damage, or a history of caesarean section. In this study we see whether there is effect of different doses of oxytocin on the quantity of breastmilk produced. oxytocin doses were administered with 3 doses of 5 UI, 10 UI and 15 UI. the dose of oxytocin is administered once per incidence of labor. maternal results obtained by oxytocin induction of 5 UI and 10 UI obtained breastmilk averaging 10 ml in the first 24 hours after delivery. and a mother with oxytocin induction 15 UI received an average breastmilk of 10 ml at 24 hours after delivery.