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Background: High spinal block is a serious complication of spinal anesthesia. However, findings regarding its associated risk factors are inconsistent, and no studies have reported a relevant risk prediction score. We aimed to determine the risk prediction score for high spinal block in patients who were induced spinal anesthesia for cesarean delivery. Methods: This retrospective cohort study was conducted at a hospital in Southern Thailand between 2019 and 2020. We recorded demographic characteristics, gestational age (GA), hyperbaric bupivacaine dose, sensory block level, pre- and post-procedure blood pressure, and birth weight. High spinal block was defined as a decrease in pinprick sensation > T4. Risk scores, adjusted odds ratios (OR), and 95% confidence intervals (CI) were determined. Risk scores were derived from the coefficients of the final multivariate logistic regression model. Results: The incidence of high spinal block was 22.4% among the 1003 parturients. Our risk prediction tool for high spinal block had a sensitivity and specificity of 76% and 49%, respectively, and was classified into high (> 21), intermediate (15–21), and low (≤ 14) risk groups. The patient-related predictors were a GA < 35 weeks (OR [95% CI]: 2.31 [1.13, 4.71], score of 8), height < 150 cm (2.21 [1.11, 4.38], score of 8), and post-pregnancy body mass index > 27.5 kg/m2 (2.68 [1.33, 5.41], score of 10). The anesthesia-related predictors were a hyperbaric bupivacaine dose > 11 mg (2.56 [1.34, 4.87], score of 9) and induction by a first-year resident (1.48 [1.05, 2.09], score of 4). The surgery-related predictors were previous cesarean delivery in labor (1.83 [1.2, 2.78], score of 6) and elective cesarean delivery (2.53 [1.57, 4.07], score of 9) compared to indication by cephalopelvic disproportion. The incidence of intraoperative hypotension was significantly higher in the high-block group than in the control group (46% vs. 25%, p < 0.001). Conclusion: The combination of patient- and anesthesia-related predictors played an important role in the intermediate- and high-risk groups for high sensory spinal block. Addressing the modifiable risk factors—a GA < 35 weeks, an optimal dose of bupivacaine, and the experience level of the spinal block performer—could minimize the risk of high spinal block during cesarean delivery. [ABSTRACT FROM AUTHOR]

Objective: To determine if there is a correlation between maternal short stature and neonatal birth weight among women with adverse outcomes related to labor dystocia. Methods: The medical records of singleton deliveries with adverse obstetric outcomes related to labor dystocia during 2014–2020, in a single tertiary center, were reviewed. Outcomes included at least one of the following: cesarean delivery (CD) due to cephalopelvic disproportion (CPD), prolonged second stage, shoulder dystocia, third‐ or fourth‐degree perineal tear. Maternal short stature was defined as height below the 10th centile (short stature group) and normal stature was defined as maternal height between the 10th and 90th centiles (normal stature group). Maternal and neonatal characteristics were compared between the groups. Results: A total of 3295 women were included, among them, 307 in the short stature group (9.3%, height 1.52 ± 0.02 m) and 2988 in the normal stature group (90.7%, height 1.63 ± 0.04 m). Evaluating the entire cohort revealed similar neonatal birth weights comparing the short and normal stature groups. A subgroup analysis of women after CD due to CPD (n = 296) revealed lower neonatal birth weights in the short stature group (n = 31) compared with the normal stature group (n = 265) (3215 ± 411 vs 3484 ± 427 g, P = 0.001, respectively). Multivariable linear regression was performed for women who underwent CD due to CPD. After adjusting for obesity and diabetes mellitus, short stature and nulliparity were found to be independently associated with decreased neonatal birth weight (266 g less for short stature, P = 0.001, and 294 g less for nulliparity, P = 0.001). Conclusions: Among women with short stature, CD due to CPD occurs at lower neonatal birth weights. Synopsis: Cesarean deliveries due to cephalopelvic disproportion occur in lower neonatal birth weights among short‐statured women compared with women with normal stature. [ABSTRACT FROM AUTHOR]

Background: Maternal height has been for long a contributory anthropometric factor that can determine the obstetric outcome. There is always a need of a consistent, reliable, and simple risk indicator which is easy to use for preventing unnecessary complications in a country like India where often antenatal care is provided by dais in rural areas. The background of this research aims to ascertain the relationship between maternal height and mode of delivery based on other intrapartum factors which influence labor and consequent maternal and neonatal outcome. Materials and Methods: All primigravidae at term gestation (>37 weeks) with cephalic presentation on admission to labor suite with no other comorbidities were recruited in the study. Their mode of delivery, maternal outcome, along with neonatal outcome was documented. Results: Out of the 680 patients, 104 patients are considered for the short-stature group (15.29%) who were <150 cm in height. Other group comprised patients who were >150 cm in height, a total of 576 (84.71%). There was a higher incidence of induced labor in the study group (66.35%) and emergency lower-segment cesarean section done due to cephalopelvic disproportion (CPD) (60%) was also higher among the short-stature group. The incidence of normal labor (32.99%) was higher in the tall-stature group. Conclusion: Short height (<150 cm) is an independent risk factor for cesarean delivery due to CPD. Statistical correlation was found between mothers of short stature and babies being born with low birth weight. As labor is influenced by multiple factors, it is fair enough to give a trial of labor for short primigravidae except in uncommon circumstances. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of maternal age on the rate, type (elective or emergency) and indications of caesarean section. Study Design: Cross-sectional study. Setting: Government Maternity Hospital, Peshawar. Period: January 2020 to January 2021. Methods: The normal labor register, which contains data of each, and every delivery conducted in the mentioned hospital, was used to find out total number of caesarean sections during the period of study. All those patients were included in the study who underwent caesarean section during the study period. Total number of caesarean sections was 603 after excluding the patients with ruptured uterus, multiple pregnancies, ectopic pregnancy and cephalopelvic disproportion. Maternal age was noted and compared with the rate of caesarean section. Maternal age was further categorized as <20; 21-25; 26-30; 31-35; 36-40 and >40 years. Results: Among 603 patients, the majority of patients who underwent caesarean section were in 26-30 years age group followed by 21-25 years. When the indications for caesarean section were compared based on the already defined categories of age, a significant difference (p<0.001) was found. Previous caesarean sections were found to be the topmost cause in all age groups while the second common cause was malpresentation. Elective caesarean section rate was found to be significantly higher than emergency ones with p-value<0.001. Conclusion: Our results revealed a greater number of caesarean sections in the younger age group; therefore, it can be concluded that maternal age has no direct effects on the rate, type, and indications of caesarean section. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine maternal and neonatal factors in cesarean deliveries due to dystocia, including cephalopelvic disproportion, latent‐phase prolongation, and fetal malposition or malpresentation. Additionally, we sought to compare the differences between the dystocia subgroups. Method and Materials: This retrospective case–control study included women who delivered between January 2010 and June 2021 after 37 weeks of pregnancy and underwent abdominal‐pelvic CT scans within 5 years before and after delivery. Neonatal factors were extracted from medical charts immediately after delivery. Results: Among the 292 women studied, those with cesarean deliveries for dystocia were older (mean ± SD, 34.2 ± 4.27 vs. 32.2 ± 3.8, p‐value = 0.002), had higher pre‐pregnancy BMI (22.7 ± 3.67 vs. 21.4 ± 3.48, p‐value = 0.012) and term‐BMI (27.4 ± 3.72 vs. 25.9 ± 3.66, p‐value = 0.010), shorter interspinous distance (ISD, the distance between ischial spine) (10.8 ± 0.76 vs. 11.2 ± 0.85 cm, p‐value = 0.003), and longer head circumference (HC) (35 ± 1.47 vs. 34.4 ± 1.36 cm, p‐value = 0.003) compared to those who had vaginal deliveries. Univariate logistic regression for dystocia revealed associations between HC/maternal height and HC/ISD ratios (OR, 2.02 [95% confidence interval, CI, 1.4 ~ 2.92], 12.13 [3.2 ~ 46.04], respectively). Multivariate logistic analysis indicated that maternal age, ISD, and HC were significant factors for dystocia (OR, 1.11 [95% CI, 1.01 ~ 1.21], 0.49 [0.26 ~ 0.91], 1.53 [1.07 ~ 2.19], respectively). The subgroup with latent‐phase prolongation exhibited the lowest birthweight/term‐BMI ratio (124 ± 18.8 vs. 113 ± 10.3 vs. 134 ± 19.1, p‐value = 0.013). Conclusion: The HC/ISD ratio emerged as a crucial predictor of dystocia, suggesting that reducing term‐BMI could potentially mitigate latent‐phase prolongation. Further research assessing the maternal mid‐pelvis during pregnancy and labor is warranted, along with efforts to reduce BMI during pregnancy. [ABSTRACT FROM AUTHOR]

Background/Aims: Gestational Diabetes Mellitus (GDM) is a prevalent medical concern among pregnant women. The study aimed to explore maternal characteristics that could lead to an isolated increase in the 50 g Glucose Challenge Test (GCT) levels and to assess the impact of elevated 50 g GCT levels on fetal and neonatal outcomes. Methods: This retrospective trial included 177 pregnant women and 177 infants. All pregnant women who applied to the antenatal clinic and screened for GDM were included in the study. Patients were divided into two groups: patients with abnormal GCT (50 g levels) but normal 100 g-OGTT results (study group) and those with normal 50 g results (control group). Results: The advanced maternal age (AMA) rate (14.80% vs. 4.80%, p=0.028) and maternal weight measurements at the first pregnancy visit were higher in the study group. The rate of overweighted patients (more than 80 kg at the first pregnancy visit) was higher in the study group (35.20% vs. 5.80%, p<0.001). The rate of fetal macrosomia was higher in the study group (10.20% vs. 0, p<0.05). It was determined that the neonate's head circumference (HC) was larger in the study group (35.15 cm vs. 34.69 cm, p=0.029). Emergent (primary) cesarean section (C/S) rate with cephalopelvic disproportion (CPD) indication was higher in the fetal macrosomia group (p<0.05). The power of the current study was determined as 87% Conclusions: According to the study result, the patients with isolated elevation of the 50 g Glucose Challenge Test are at risk of fetal macrosomia, which increases the risk of C/S. In overweight patients over 35 years old, 75 g OGTT may be more sensitive in detecting glucose metabolism disorders. [ABSTRACT FROM AUTHOR]

(1) Background: The morphology of the pelvic cavity is important for decision-making in obstetrics. This study aimed to estimate the accuracy and reliability of pelvimetry measures obtained when radiologists manually label anatomical landmarks on three-dimensional (3D) pelvic models. A second objective was to design an automatic labeling method. (2) Methods: Three operators segmented 10 computed tomography scans each. Three radiologists then labeled 12 anatomical landmarks on the pelvic models, which allowed for the calculation of 15 pelvimetry measures. Additionally, an automatic labeling method was developed based on a reference pelvic model, including reference anatomical landmarks, matching the individual pelvic models. (3) Results: Heterogeneity among landmarks in radiologists' labeling accuracy was observed, with some landmarks being rarely mislabeled by more than 4 mm and others being frequently mislabeled by 10 mm or more. The propagation to the pelvimetry measures was limited; only one out of the 15 measures reported a median error above 5 mm or 5°, and all measures showed moderate to excellent inter-radiologist reliability. The automatic method outperformed manual labeling. (4) Conclusions: This study confirmed the suitability of pelvimetry measures based on manual labeling of 3D pelvic models. Automatic labeling offers promising perspectives to decrease the demand on radiologists, standardize the labeling, and describe the pelvic cavity in more detail. [ABSTRACT FROM AUTHOR]

Background: Progress in obstetrics has been associated with an increased incidence of cesarean section (CS). Primary CS in a multipara means the first CS performed in woman who has delivered vaginally at least once previously and it is associated with a number of maternal and foetal indications. Objectives: The present research was undertaken to study the incidence and indications of primary CS in multigravida. Method: This prospective observational study was conducted in total 510 booked cases of multigravida reported to antenatal OPD with gestational age >28 weeks and previous vaginal deliveries and no cesarean delivery or any other scar on uterus. Results: Primary CS was performed in 75(14.7%) multigravida women. Majority of cases (48%) with primary CS belonged to 26-30 years age group. The incidence of primary CS in emergency and elective cases was 74.7% and 25.3% respectively. Maternal and fetal indications contributed 44% and 56% of the total cases respectively. Fetal distress (26.7%), malpresentation (18.7%) and failed induction (14.7%) for various co-morbidities were the commonest indications of primary CS. Conclusion: Fetal distress is a major contributor to primary CS in multigravida. Proper antenatal evaluation with early detection and management of high risk cases can reduce the likelyhood of intrapartum fetal distress.

Background: As delays or disorders in early language and communication are the most prevalent symptom in children with disabilities, early screening is crucial to promote prevention, early diagnosis, and intervention. However, to the best of our knowledge, no screening tool is available for the joint assessment of early language and social communication skills in European Portuguese (EP)‐learning children, which is critical for screening, monitoring and enrolment in appropriate early intervention services. Aims: (1) To adapt and validate the EP version of the Communication and Symbolic Behaviour Scales Developmental Profile™ (CSBS DP™) Infant–Toddler Checklist, a parental report for the screening of early language and social communication skills. (2) To conduct a cross‐cultural comparison between the EP adaptation and the original US version. Methods & Procedures: A total of 611 EP‐learning children (ages 6–24 months) were assessed on the CSBS DP Infant–Toddler Checklist. Normative data, psychometric characteristics (i.e., internal consistency and test–retest reliability), and cross‐cultural comparison between the EP and the original version were explored. Outcomes & Results: Internal consistency ranged from good to excellent and the test–retest reliability was excellent. The performance of the EP and US samples matched on almost all scores. However, EP children performed significantly better than their American peers in the Social compositive at 22 months and in the Symbolic composite at 20 months. No further differences were found. Conclusions & Implications: These findings showed that the EP CSBS DP Infant–Toddler Checklist seems to be a reliable screening tool of communicative and symbolic behaviours for EP‐learning children, which can be particularly relevant for decision‐making in clinical practice. WHAT THIS PAPER ADDS: What is already known on the subject: Early communication skills are known to be related to later language outcomes. Thus, screening tools for the early identification of children at risk for language and communication impairments, which may lead to monitoring and early intervention, have the potential to promote better outcomes. However, to the best of our knowledge, no screening tool is available for the assessment of early communication abilities in EP‐learning children. What this paper adds to existing knowledge: This study adapted and validated the EP CSBS DP Infant–Toddler Checklist, the first published parental report checklist for the assessment of early communication skills in EP. It described the psychometric characteristics of the adapted checklist, summarized the newly available normative data for EP‐learning infants and toddlers, and compared the performance of EP‐learning children with the original standardization sample reported for American English. The results demonstrated that this tool is a reliable instrument for the early screening of language, communicative and symbolic behaviours for EP‐learning children between 6 and 24 months of age. What are the potential or actual clinical implications of this work?: Given that early screening is crucial to promote prevention, early diagnosis and intervention, the availability of this tool is particularly relevant for children monitoring and their enrolment in appropriate early intervention services, helping decision‐making in clinical practice, in line with current guidelines regarding early monitoring and intervention to promote and support better outcomes. Thus, the tool and related normative data will be useful for paediatricians, family doctors, primary healthcare providers, developmental psychologists and speech–language therapists, among other professionals in the healthcare and educational fields, concerned with speech, language, and communication development and impairments. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Investigating the correlations between external pelvimetry variables and actual birth canal dimensions has important implications for clinical practice, especially for predicting dystocia. This validation study tests external and internal pelvimetry correlations. METHODS: This single-centered retrospective study included 142 women with records of computed tomography pelvimetry. The correlations between four internal variables (obstetric conjugate, transverse diameters of inlet, midplane, and outlet) and five external variables (intertrochanteric, inter anterosuperior iliac spines, external conjugate, transverse diagonal, and prepubic) were first studied individually. Then, the correlations between each internal variable and the seven external variables were jointly evaluated after adjusting for body mass index. RESULTS: As expected, the external conjugate correlated with the obstetric conjugate (r = .65; p < .01) but only weakly with the transverse outlet (r = .21; p < .05). In the simple correlation analysis, the intertrochanteric measure is also correlated with the transverse inlet (TRi), midplane (TRm), and outlet (TRo; r = .542-.672). The transverse diagonal measure marginally correlated with the TRi (r = .29; p < .01). In the multiple regression models, the intertrochanteric measure is associated with the TRi, TRm, and TRo, while the transverse diagonal is associated with the TRi (B = .27; p = .01). The prepubic diameter was not a predictor of birth canal dimensions in either simple or multiple regression models. CONCLUSION: Our study confirms that the reduction of the birth canal in some dimensions (i.e., obstetric conjugate and transverse diameters) is predictable with external, accessible pelvic diameters (e.g., external conjugate, transverse diagonal, and intertrochanteric). [ABSTRACT FROM AUTHOR]

Aim: to improve the efficiency of predicting a clinically narrow pelvis (СNP) using neural network data analysis and to evaluate its prognostic characteristics.Materials and Мethods. The study was designed as a retrospective non-randomized clinical trial. An analysis of 184 born neonates was carried out: group 1 included 135 female patients whose delivery occurred through the natural birth canal, group 2 – 49 patients whose delivery was complicated by СNP development and ended up with emergency caesarean section. Examination of patients was carried out on the eve of childbirth (1–2 days) and included anamnesis, general and special obstetric examination, including pelvimetry, a clinical assessment of cephalopelvic disproportion was carried out during childbirth. The condition of newborns was assessed using the Apgar scale, height and body weight were measured. Neural network analysis was performed using the built-in Neural Networks module of SPSS Statistics Version 25.0 (IBM, USA).Results. Despite hypothetically important role of anatomically narrowed pelvis in development of cephalopelvic disproportion, no significant inter-group differences were found. Significant parameters (abdominal circumference, uterine fundus height and woman’s weight, fetal head circumference, as well as data on the presence or absence of oligohydramnios and fetal macrosomia) were determined, which were included in the test database to create the basis for training the multilayer perceptron. Out of 135 patients of group 1, the prognosis was negative in 131 (97.0 %), positive in 4 (3.0 %); out of 49 patients in group 2, negative in 0 (0.0 %), positive in 49 (100.0 %). The forecast accuracy of the developed model was 98 % (sensitivity – 100 %, specificity –97 %). The information content of neural network data analysis in СNP predicting is presented in ROC analysis: area under the curve (AUC) = 0.99 (95 % confidence interval = 0.97–1.00). Neonatal anthropometric parameters were significantly higher in group 2 vs. group 1, and the Apgar score at 1 minute was correspondingly lower.Conclusion. The use of neural network analysis of clinical data obtained on the eve of childbirth allows to predict СNP development at sufficient degree of accuracy (98.0 %), which, in the future, after being introduced into clinical practice, will optimize a choice of delivery method in patients at risk (anatomically narrow pelvis, large fetus), reduce emergency caesarean sections and improve birth outcomes.

The obstetrical dilemma describes the competing demands that a bipedally adapted pelvis and a large‐brained neonate place on human childbirth and is the predominant model within which hypotheses about the evolution of the pelvis are framed. I argue the obstetrical dilemma follows the adaptationist program outlined by Gould and Lewontin in 1979 and should be replaced with a new model, the multifactor pelvis. This change will allow thorough consideration of nonadaptive explanations for the evolution of the human pelvis and avoid negative social impacts from considering human childbirth inherently dangerous. First, the atomization of the pelvis into discrete traits is discussed, after which current evidence for both adaptive and nonadaptive hypotheses is evaluated, including childbirth, locomotion, shared genetics with other traits under selection, evolutionary history, genetic drift, and environmental and epigenetic influences on the pelvis. [ABSTRACT FROM AUTHOR]

Abstract Background Magnetic resonance imaging (MRI) provides excellent soft tissue visualisation which may be useful in late pregnancy to predict labour outcome and maternal/neonatal birth trauma. Objective To study if MRI in late pregnancy can predict maternal and neonatal outcomes of labour and birth. Methods Systematic review of studies that performed MRI in late pregnancy or immediately postpartum. Studies were included if they imaged maternal pelvic or neonatal structures and assessed birth outcome. Meta-analysis was not performed due to the heterogeneity of studies. Results Eighteen studies were selected. Twelve studies explored the value of MRI pelvimetry measurement and its utility to predict cephalopelvic disproportion (CPD) and vaginal breech birth. Four explored cervical imaging in predicting time interval to birth. Two imaged women in active labour and assessed mouldability of the fetal skull. No marker of CPD had both high sensitivity and specificity for predicting labour outcome. The fetal pelvic index yielded sensitivities between 59 and 60%, and specificities between 34 to 64%. Similarly, although the sensitivity of the cephalopelvic disproportion index in predicting labour outcome was high (85%), specificity was only 56%. In women with breech presentation, MRI was demonstrated to reduce the rates of emergency caesarean section from 35 to 19%, and allowed better selection of vaginal breech birth. Live birth studies showed that the fetal head undergoes a substantial degree of moulding and deformation during cephalic vaginal birth, which is not considered during pelvimetry. There are conflicting studies on the role of MRI in cervical imaging and predicting time interval to birth. Conclusion MRI is a promising imaging modality to assess aspects of CPD, yet no current marker of CPD accurately predicts labour outcome. With advances in MRI, it is hoped that novel methods can be developed to better identify individuals at risk of obstructed or pathological labour. Its role in exploring fetal head moulding as a marker of CPD should be further explored.

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The active phase of labor begins at various degrees of dilatation when the rate of dilatation transitions from the relatively flat slope of the latent phase to a more rapid slope. No diagnostic manifestations demarcate its onset, other than accelerating dilatation. It ends with apparent slowing of dilatation, a deceleration phase, which is usually short in duration and frequently undetected. Several aberrant labor patterns can be detected during the active phase, including protracted dilatation, arrest of dilatation, prolonged deceleration phase and failure of descent. Underlying factors may include cephalopelvic disproportion, excessive neuraxial block, poor uterine contractility, fetal malpositions, malpresentations, uterine infection, maternal obesity, advanced maternal age and previous cesarean delivery. When an active-phase disorder is identified, cesarean delivery is justifiable if there is compelling clinical evidence of disproportion. A prolonged deceleration disorder is strongly associated with disproportion and second stage abnormalities. Shoulder dystocia may occur if vaginal delivery eventuates. This review discusses several issues raised by the introduction of new clinical practice guidelines for labor management. [ABSTRACT FROM AUTHOR]

Cesarean sections have become the most commonly performed operations around the world. The World Health Organization recommended the use of the Robson classification system as a universal standard to establish a joint control system in healthcare facilities. The aim of this study was to implement the Robson classification for the first time in Greece to identify trends in cesarean births and examine the groups of women who are the main contributors to the increasing rates. Moreover, the indicators for cesarean sections will be evaluated as per the Robson classification. In the sample analysis, we included the records of 8572 women giving birth in one private health facility in Greece. A total of 8572 women gave birth during the study period, of which 5224 (60.9%) were cesarean section births and 3348 (39.1%) were vaginal births. In our study, according to the Robson classification, the largest contributors to the overall CS rate were as follows: (a) nulliparous women with a single cephalic term pregnancy, who were either labor induced or delivered by cesarean section before labor—Group 2 (34.6%); (b) multiparous women with a single cephalic term pregnancy and at least one previous cesarean section—Group 5 (30.7%); (c) women with a single cephalic preterm pregnancy—Group 10 (11.7%); (d) women with multiple pregnancies—Group 8 (7.0%). Our study is expected to assist policymakers in Greece in planning further interventions for each subgroup of women in order to reduce the overall CS rate and unnecessary CSs. [ABSTRACT FROM AUTHOR]

Objectives: Comparative studies of the birth process in humans and other primates have focused on the pelvic inlet. This is a region of birth‐canal constraint in humans, but not in other primates. Thus, the true obstetric differences between humans and other apes remain unknown. This research seeks to document nonhuman ape birth‐canal morphologies and their relationships to critical dimensions of neonates, in order to determine what aspects of human birth are unique. Materials and Methods: Computer‐generated images of the scanned pelves of six extant hominoid species are used to compare entire birth canals as three‐dimensional entities, documenting and analyzing the functionally relevant metrics of the maternal pelvis and the obstetric constraints for each species. Results: The inlet is a poor basis of comparison for evaluating tightness of fit in nonhuman primates, whose birth canal is most constricted at the lower end of the sacrum. Previous studies have overestimated the capaciousness of the nonhuman hominoid birth canal (which appears to be just as tight a fit for the fetal head in hylobatids as it is in Homo sapiens) and also misrepresented it as a simple straight tube. In fact, its cross‐sectional shape changes markedly from inlet to outlet in most hominoids. Conclusion: Nonhuman hominoids exhibit obstetric constraints unlike those seen in modern humans. Human adaptations to maternal‐fetal craniopelvic disproportion are unique owing to the constraints imposed by bipedality, and probably predate the origins of the genus Homo. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate increasing cesarean delivery (CD) rates, their causes, and changes over the years in a Turkish tertiary center using the Robson Ten‐Group Classification System (RTGCS). Methods: Data of deliveries involving birth weight of ≥500 g or ≥24 weeks of gestation period from 2013 to 2020 were retrospectively collected and classified from the hospital digital record system using obstetric concepts and parameters described in the RTGCS. Results: The overall CD rate for all births (69051) from 2013 to 2020 was 55.5%. Groups 3, 5, and 1 were the most represented groups (29.1%, 23.9%, and 19.4%, respectively). The major contributors to the overall CD rate were Groups 5, 2, and 10 (23.8%, 9.9%, and 5.6%, respectively). Groups 2 and 4 (nullipara, multipara, single cephalic at term) had high CD rates associated with high rates of pre‐labor CD (88.9% and 73.3%, respectively). The CD rate was 99.7% in Group 5, which showed recurrent CD, and 67.2% in Group 10. The overall CD rate was 60.8% in 2020 owing to the significant increase in the contributions by Groups 5, 8, and 10. The most common indication for CD was previous CD (46.1%), fetal distress (13.2%), and cephalopelvic disproportion (CPD) (8%). Conclusion: Groups 1, 2, 5, and 10 were the major contributors to the overall CD rate at this tertiary center. To reduce overall CD rates, policies that reduce primary CD and support vaginal delivery after cesarean section should be established. [ABSTRACT FROM AUTHOR]

While a basic understanding of pelvic size and typology is still important for obstetricians, pelvic measurement data for Japanese women are very scarce. To our best knowledge, no large-scale pelvimetry studies of Japanese women have been made for the past 50 years. This study aimed to investigate the accurate size, particularly the obstetric conjugate (OC) and transverse diameter of the pelvic inlet (TD), of modern Japanese women, using three-dimensional (3D) computed tomography (CT), and to obtain their reference values. This retrospective, single-center observational study enrolled Japanese non-pregnant women aged between 20 and 40 years, who underwent pelvic CT examination from 2016 to 2021. CT was performed for various reasons, including acute abdomen, search for cancer metastases, and follow-up of existing disease. However, no cases were taken for pelvic measurements. Pelvimetry was performed retrospectively using a 3D workstation. The OC was measured on a strict lateral view and the TD was measured on an axial-oblique view. Other clinical data, such as age, height, and weight, were also extracted from the medical charts and analyzed. A total of 1,263 patients were enrolled, with the mean age of 32.7 years (standard deviation [SD] 6.2). The mean height, weight, and body mass index were 158.8 cm (SD 5.8), 54.8 kg (SD 11.7), and 21.7 kg/m2 (SD 4.4), respectively. The mean OC length was 127.0 mm (SD 9.5, 95% confidence interval [CI] 126.5–127.5), while the mean TD length was 126.8 mm (SD 7.5, 95% CI 126.4–127.2). Both values were normally distributed. Height was significantly associated with OC (regression coefficient = 0.75 [95% CI 0.66–0.84], p <.001) and TD (regression coefficient = 0.63 [95% CI 0.56–0.70], p <.001). Age showed a weak but statistically significant positive association with TD (regression coefficient = 0.14 [95% CI 0.07–0.20], p <.001) and OC (regression coefficient = −0.10 [95% CI −0.18 to −0.01], p =.026). The 3D CT pelvimetry in 1,263 non-pregnant Japanese women of childbearing age revealed the mean OC and TD of 127.0 mm, and 126.8 mm, which were 11.8 mm and 4.3 mm larger, respectively, than those in the survey in 1972. Our data will be referred to in clinical practice as the standard pelvic measurement values for the Japanese population. [ABSTRACT FROM AUTHOR]

Copyright of Minas Gerais Medical Journal / Revista Médica de Minas Gerais is the property of Associacao Medica de Minas Gerais and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Magnetic resonance imaging (MRI) provides excellent soft tissue visualisation which may be useful in late pregnancy to predict labour outcome and maternal/neonatal birth trauma. Objective: To study if MRI in late pregnancy can predict maternal and neonatal outcomes of labour and birth. Methods: Systematic review of studies that performed MRI in late pregnancy or immediately postpartum. Studies were included if they imaged maternal pelvic or neonatal structures and assessed birth outcome. Meta-analysis was not performed due to the heterogeneity of studies. Results: Eighteen studies were selected. Twelve studies explored the value of MRI pelvimetry measurement and its utility to predict cephalopelvic disproportion (CPD) and vaginal breech birth. Four explored cervical imaging in predicting time interval to birth. Two imaged women in active labour and assessed mouldability of the fetal skull. No marker of CPD had both high sensitivity and specificity for predicting labour outcome. The fetal pelvic index yielded sensitivities between 59 and 60%, and specificities between 34 to 64%. Similarly, although the sensitivity of the cephalopelvic disproportion index in predicting labour outcome was high (85%), specificity was only 56%. In women with breech presentation, MRI was demonstrated to reduce the rates of emergency caesarean section from 35 to 19%, and allowed better selection of vaginal breech birth. Live birth studies showed that the fetal head undergoes a substantial degree of moulding and deformation during cephalic vaginal birth, which is not considered during pelvimetry. There are conflicting studies on the role of MRI in cervical imaging and predicting time interval to birth. Conclusion: MRI is a promising imaging modality to assess aspects of CPD, yet no current marker of CPD accurately predicts labour outcome. With advances in MRI, it is hoped that novel methods can be developed to better identify individuals at risk of obstructed or pathological labour. Its role in exploring fetal head moulding as a marker of CPD should be further explored. [ABSTRACT FROM AUTHOR]

Background: Childbirth is a physiological process with significant medical risk, given that neurological impairment due to the birthing process can occur at any time. Improvements in risk assessment and anticipatory interventions are constantly needed; however, the birthing process is difficult to assess using simple imaging technology because the maternal bony pelvis and fetal skeleton interfere with visualizing the soft tissues. Magnetic resonance imaging (MRI) is a noninvasive technique with no ionizing radiation that can monitor the biomechanics of the birthing process. However, the effective use of this modality requires teamwork and the implementation of the appropriate safeguards to achieve appropriate safety levels. Objective: This study describes a clinically effective and safe method to perform real-time MRI during the birthing process. We reported the experience of our team as part of the IMAGINAITRE study protocol (France), which aimed to better understand the biomechanics of childbirth. Methods: A total of 27 pregnant women were examined with 3D MRI sequences before going into labor using a 1-Tesla open-field MRI. Of these 27 patients, 7 (26%) subsequently had another set of 3D MRI sequences during the second stage of labor. Volumes of 2D images were transformed into finite element 3D reconstructions. Polygonal meshes for each part of the fetal body were used to study fetal head moldability and brain compression. Results: All 7 observed babies showed a sugarloaf skull deformity and brain compression at the middle strait. The fetus showing the greatest degree of molding and brain shape deformation weighed 4525 g and was born spontaneously but also presented with a low Apgar score. In this case, observable brain shape deformation demonstrated that brain compression had occurred, and it was not necessarily well tolerated by the fetus. Depending on fetal head moldability, these observations suggest that cephalopelvic disproportion can result in either obstructed labor or major fetal head molding with brain compression. Conclusions: This study suggests the presence of skull moldability as a confounding factor explaining why MRI, even with the best precision to measure radiological landmarks, fails to accurately predict the modality of childbirth. This introduces the fetal head compliance criterion as a way to better understand cephalopelvic disproportion mechanisms in obstetrics. MRI might be the best imaging technology by which to explore all combined aspects of cephalopelvic disproportion and achieve a better understanding of the underlying mechanisms of fetal head molding and moldability. [ABSTRACT FROM AUTHOR]

OBJECTIVES The aim of our study is to determine the exact timing of the decision to the delivery interval in grade I caesarean sections, the factors contributing to the delays and the indications of those caesarean sections. METHODOLOGY This descriptive(cross-sectional) study is conducted in the Gynae B unit of Khyber Teaching Hospital, Peshawar from 1st April 2020 to 30th September 2020 over a span of 6 months. It is a consecutive non-purposive sampling. All women of any age or parity who underwent an emergency grade I caesarean section were included in the study. Age, gestational age, booking status, obstetrical history, the decision to delivery interval, an indication of caesarean, and mode of anesthesia was noted and entered in predesigned proforma. RESULTS 114 patients underwent grade I caesarean in the study period.61(54%) were 21-30 years age group and 48(42%) were in the 31-40 years age group.26(23%) patients were not delayed.31(27%) got delayed as Operation Theatre table was not available,18(16%) could not arrange Caesarean medication and consumables in time,17(15%) could not provide preop investigations in time, in 13(11%) cases patient’s attendants were not available. Fetal distress was the most common cause (33%) of delayed caesarean sections, followed by previous scars in labour (20%), placenta previa with APH (13%), obstructed labour (12%), placental abruption and CPD in labour in 8% each. Spinal anaesthesia was given in 79% and General anaesthesia was given in 21% of cases. CONCLUSION 26(23%) patients were not delayed and their decision to deliver interval was less than 30 minutes. The decision to the delivery interval in Khyber Teaching Hospital was far longer than recommended. The leading causes are delayed arrangement of the OT table, OT stuff and investigations.

Background: 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. Purpose: To develop and validate a predictive model assessing the risk of cesarean delivery in primiparous women based on MRI findings. Study Type: Prospective. Population: A total of 150 primiparous women with clinical findings suggestive of CPD. Field Strength/Sequence: T1‐weighted fast spin‐echo sequences, single‐shot fast spin‐echo (SSFSE) T2‐weighted sequences at 1.5 T. Assessment: Pelvimetry and fetal biometry were assessed independently by two radiologists. A nomogram model combined that the clinical and MRI characteristics was constructed. Statistical Tests: 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. Results: 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. Data Conclusion: Our study might provide a nomogram model that could identify primiparous women at risk of cesarean delivery caused by CPD based on MRI measurements. Evidence Level: 2 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the association between short stature and cephalo-pelvic disproportion among primigravida women with Pakistani population. METHODOLOGY: A case-control study was carried out after approval of CPSP from November 2018 to May 2019 at Obstetrics and Gynecology department of Jinnah Postgraduate Medical Center, Karachi. The primigravida pregnant women with the gestation age of 37 weeks or above and presented for a normal vaginal delivery with vertex presentation of the fetus and developed cepahalopelvic disproportion during labor was included in this study and primigravida pregnant women having an estimated fetal weight more than 3.5 Kg, patients having physical disability was excluded. A total of 238 primigravida patients fulfilling inclusion and exclusion criteria were selected. Informed consent was taken from each individual participated in this study. The age, height, gestational age, fetal mal-presentation, prolonged Labor, and caesarian delivery parameters were observed within the patients and data were analyzed through SPSS version 19. RESULTS: The 21(17.6%) of patients with cephalopelvic disproportion was short suture in case group and 7(5.9%) in the control group, the results showed the significant association of cephalopelic disproportion with short suture patients. The ratio of caesarian delivery was also higher and a significant p-value was obtained. CONCLUSION: The mothers with cephalopelvic disproportion were independently correlated with a higher rate of short stature and caesarian rate is the highest among the CPS women.

Abstract Background Caesarean sections without medical indication cause substantial maternal and perinatal ill-health, particularly in low-income countries where surgery is often less safe. In presence of adequate labour monitoring and by appropriate use of evidence-based interventions for prolonged first stage of labour, unnecessary caesarean sections can be avoided. We aim to describe the incidence of prolonged first stage of labour and the use of amniotomy and augmentation with oxytocin in a low-resource setting in Malawi. Methods Retrospective analysis of medical records and partographs of all women who gave birth in 2015 and 2016 in a rural mission hospital in Malawi. Primary outcomes were incidence of prolonged first stage of labour based on partograph tracings, caesarean section indications and utilization of amniotomy and oxytocin augmentation. Results Out of 3246 women who gave birth in the study period, 178 (5.2%) crossed the action line in the first stage of labour, of whom 21 (11.8%) received oxytocin to augment labour. In total, 645 women gave birth by caesarean section, of whom 241 (37.4%) with an indication ‘prolonged first stage of labour’. Only 113 (46.9%) of them crossed the action line and in 71/241 (29.5%) membranes were still intact at the start of caesarean section. Excluding the 60 women with prior caesarean sections, 14/181 (7.7%) received oxytocin prior to caesarean section for augmentation of labour. Conclusion The diagnosis prolonged first stage of labour was often made without being evident from labour tracings and two basic obstetric interventions to prevent caesarean section, amniotomy and labour augmentation with oxytocin, were underused.

Copyright of Nursing at the Vanguard / Revista Enfermería a la Vanguardia (REVAN) is the property of Revista Enfermeria a la Vanguardia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Human sexual dimorphism has been widely misunderstood. A large literature has underestimated the effect of differences in body composition and the role of male contest competition for mates. It is often assumed that sexually dimorphic traits reflect a history of sexual selection, but natural selection frequently builds different phenotypes in males and females. The relatively small sex difference in stature (∼7%) and its decrease during human evolution have been widely presumed to indicate decreased male contest competition for mates. However, females likely increased in stature relative to males in order to successfully deliver large-brained neonates through a bipedally-adapted pelvis. Despite the relatively small differences in stature and body mass (∼16%), there are marked sex differences in body composition. Across multiple samples from groups with different nutrition, males typically have 36% more lean body mass, 65% more muscle mass, and 72% more arm muscle than women, yielding parallel sex differences in strength. These sex differences in muscle and strength are comparable to those seen in primates where sexual selection, arising from aggressive male mating competition, has produced high levels of dimorphism. Body fat percentage shows a reverse pattern, with females having ∼1.6 times more than males and depositing that fat in different body regions than males. We argue that these sex differences in adipose arise mainly from natural selection on women to accumulate neurodevelopmental resources. [ABSTRACT FROM AUTHOR]

X-ray pelvimetry is used for evaluation of pelvic inlet generally to diagnose cephalopelvic disproportion (CPD) or contracted inlet. Cesarean section delivery (C/S) is often performed for labor dystocia without CPD or contracted inlet. We examined whether X-ray pelvimetry is useful to decide on mode of delivery in women with dystocia. A total of 1118 pregnant women received X-ray pelvimetry before or during labor. 205 women with cesarean deliveries for indications except for dystocia were excluded. 913 women undergoing induction/augmentation were retrospectively investigated. Obstetrical and maternal variables were analyzed by univariate, multivariate or ROC analysis. Among 913 women, 37 including three with contracted inlet and seven with CPD, gave birth by C/S, whereas 876 gave birth by vaginal delivery. Low maternal height, older age, small obstetrical conjugate, large weight and infant head size were associated with risk of C/S for dystocia. Multivariate analysis revealed that the obstetrical conjugate was an independent variable for risk of C/S. The area under the ROC curve and the optimal cut-off values, respectively, were as follows: obstetrical conjugate: 0.68 and 11.7 cm (odds ratio = 4.27), transverse diameter: 0.59 and 11.4 cm (odds ratio = 1.82), maternal height: 0.70 and 155.5 cm (odds ratio = 4.33), and maternal weight before pregnancy: 0.55 and 49.7 kg (odds ratio = 1.98). The obstetrical conjugate was an independent variable associated with risk of C/S for dystocia. Maternal height was comparable to the conjugate in term of diagnostic ability. Our data suggested that routine X-ray pelvimetry was not beneficial to identify women at risk of C/S for dystocia.

Human sexual dimorphism has been widely misunderstood. A large literature has underestimated the effect of differences in body composition and the role of male contest competition for mates. It is often assumed that sexually dimorphic traits reflect a history of sexual selection, but natural selection frequently builds different phenotypes in males and females. The relatively small sex difference in stature (∼7%) and its decrease during human evolution have been widely presumed to indicate decreased male contest competition for mates. However, females likely increased in stature relative to males in order to successfully deliver large-brained neonates through a bipedally-adapted pelvis. Despite the relatively small differences in stature and body mass (∼16%), there are marked sex differences in body composition. Across multiple samples from groups with different nutrition, males typically have 36% more lean body mass, 65% more muscle mass, and 72% more arm muscle than women, yielding parallel sex differences in strength. These sex differences in muscle and strength are comparable to those seen in primates where sexual selection, arising from aggressive male mating competition, has produced high levels of dimorphism. Body fat percentage shows a reverse pattern, with females having ∼1.6 times more than males and depositing that fat in different body regions than males. We argue that these sex differences in adipose arise mainly from natural selection on women to accumulate neurodevelopmental resources.

Purpose: To determine the proportion of cesarean delivery due to CPD without fulfillment of the criteria for diagnosis. Materials and Methods: The obstetric database, between January 2010 and December 2012, was assessed to identify the records of cesarean delivery due to CPD, and the complete medical records were comprehensively reviewed. The degree of adherence to the guidelines on diagnosis of CPD was determined using the criteria recommended by American Congress of Obstetricians and Gynecologists (ACOG) in 2003 compared with that based on the new ACOG 2014 guidelines. Results: During the study period, 475 women underwent cesarean delivery indicated by CPD. The percentages of cases diagnosed with CPD without fulfilling the criteria recommended by ACOG 2003 and ACOG 2014 were 19.37% (92 cases) and 92.42% (432), respectively. Regarding ACOG 2003, cases with non-adherence to the guidelines were mainly associated with diagnosis in the latent phase (55 cases; 11.58%), missed diagnosis for macrosomia in cases of prelabor cesarean section (25 cases; 5.26%), and unfulfilled criteria for diagnosis in the second stage (7 cases; 1.47%). Conclusion: Approximately 19% based on ACOG 2003 guidelines and 92% based on ACOG 2014 guidelines failed to meet the criteria for diagnosis of CPD, suggesting that strengthening diagnosis may reduce a large number of unnecessary cesarean sections.

Abstract 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.

The dangerous and in some cases life-threatening birth collides with the biogenetic imperative, which implies that reproduction is the ultimate goal of every individual and the force of evolution. The human pelvis is a biological compromise between two functions - bipedal gait and childbirth. Changing gait to bipedal undoubtedly results in severe anatomical remodeling of the pelvis, resulting in pelvic narrowing and the creation of a very specific birth canal, where the fetus is forced to perform complex head movements during the second stage of labor. These anatomical evolutionary changes also play a significant role in increasing the frequency of caesarean sections. There is the increase in cephalopelvic disproportion over the last 30 years from the 3% to 3.7%. With modern obstetrics, we save fetuses that would not survive under the pressure of natural selection. Cesarean section freed mothers (with a narrow pelvis) and fetuses (with a higher birth weight) from selection pressure. Thus, medical interventions can sometimes lead to evolutionary changes that can occur over several decades and not over millennia, and thus can set a new biological trend. Although we are currently experiencing an era of Caserean section, it should only be performed if it is medically necessary. Every effort should be made to provide Caesarean sections only to women who trully require it, rather than trying to reach a specific frequency (10-15%) according to the World Health Organization. [ABSTRACT FROM AUTHOR]

The maternal experience in ancient Southeast Asia has been an area of study not yet addressed in bioarchaeological research due to the challenges associated with evaluating it and the lack of tools available. This study aims to better our knowledge of the maternal experience in ancient Southeast Asia by investigating whether there is a relationship between maternal mortality rates and a known maternal risk factor, stature, which can be estimated from archaeologically derived skeletal remains. This is performed by applying an adapted maternal mortality rate estimator and undertaking analyses based on stature estimates from ancient Southeast Asian archaeological samples. By investigating estimated stature and maternal mortality rates, we are able to look at whether the modern risks associated with pregnancy in short statured females were also seemingly applicable in the past in Southeast Asia. This study identified that, at the population level, a decrease in average stature coincided with an increase in maternal mortality rates. These results emulate modern trends, with shorter statured females being at a higher risk of maternal death and often requiring medical intervention due to complications caused by their short stature and associated small pelvis. These findings contribute to our understanding of the maternal risk associated with short stature in ancient Southeast Asia. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: The presence of sexual dimorphism in the birth canals of anthropoid primates is well documented, and birth canal dimorphism tends to be especially robust among species that give birth to relatively large neonates. However, it is less clear whether birth canal dimorphism is accompanied by dimorphism in parts of the pelvis not directly under selection for birth, particularly including bi‐iliac breadth, biactetabular breadth, lengths of the ischium and ilium, and 3D shape. This study investigates the patterns of dimorphism among anthropoid primates in those parts of the pelvis which do not directly contribute to the bony birth canal, here termed the non‐obstetric pelvis. Methods: 3D landmark data were collected on the bony pelves of 899 anthropoid primates. Specifically, landmark data were collected on parts of the pelvis not thought to be directly involved in selection for parturition, including portions of the posterior and superior ilium, acetabulum, and lateral ischium. Principal components analysis and Euclidean distance matrix analysis were used to ascertain sexual dimorphism in pelvic sizes and shapes within each species. Results: Results show that dimorphism in non‐obstetric pelvic size and shape exists across anthropoids, just as is seen in the birth canal. However, the magnitude of dimorphism in non‐obstetric pelvic shape tends to be greater among anthropoid species that give birth to relatively large neonates compared with those birthing smaller neonates relative to maternal pelvic size. Conclusions: Though all anthropoids included in the study show some degree of sexual dimorphism in non‐obstetric pelvic size and/or shape, species which give birth to large neonates relative to maternal pelvic size have the highest levels of dimorphism in pelvic shape. Moreover, the magnitude of dimorphism in certain parts of the non‐obstetric pelvis mirrors patterns seen in the birth canal. The results of this study are promising for ascertaining pelvic dimorphism and relative neonate size in fossil primates, particularly in fragmentary remains which do not preserve a complete bony birth canal. [ABSTRACT FROM AUTHOR]

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.

Background: Caesarean sections without medical indication cause substantial maternal and perinatal ill-health, particularly in low-income countries where surgery is often less safe. In presence of adequate labour monitoring and by appropriate use of evidence-based interventions for prolonged first stage of labour, unnecessary caesarean sections can be avoided. We aim to describe the incidence of prolonged first stage of labour and the use of amniotomy and augmentation with oxytocin in a low-resource setting in Malawi.Methods: Retrospective analysis of medical records and partographs of all women who gave birth in 2015 and 2016 in a rural mission hospital in Malawi. Primary outcomes were incidence of prolonged first stage of labour based on partograph tracings, caesarean section indications and utilization of amniotomy and oxytocin augmentation.Results: Out of 3246 women who gave birth in the study period, 178 (5.2%) crossed the action line in the first stage of labour, of whom 21 (11.8%) received oxytocin to augment labour. In total, 645 women gave birth by caesarean section, of whom 241 (37.4%) with an indication 'prolonged first stage of labour'. Only 113 (46.9%) of them crossed the action line and in 71/241 (29.5%) membranes were still intact at the start of caesarean section. Excluding the 60 women with prior caesarean sections, 14/181 (7.7%) received oxytocin prior to caesarean section for augmentation of labour.Conclusion: The diagnosis prolonged first stage of labour was often made without being evident from labour tracings and two basic obstetric interventions to prevent caesarean section, amniotomy and labour augmentation with oxytocin, were underused. [ABSTRACT FROM AUTHOR]

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.

OBJECTIVE: To determine the association between short stature and cephalo-pelvic disproportion among primigravida women with Pakistani population. METHODOLOGY: A case-control study was carried out after approval of CPSP from November 2018 to May 2019 at Obstetrics and Gynecology department of Jinnah Postgraduate Medical Center, Karachi. The primigravida pregnant women with the gestation age of 37 weeks or above and presented for a normal vaginal delivery with vertex presentation of the fetus and developed cepahalopelvic disproportion during labor was included in this study and primigravida pregnant women having an estimated fetal weight more than 3.5 Kg, patients having physical disability was excluded. A total of 238 primigravida patients fulfilling inclusion and exclusion criteria were selected. Informed consent was taken from each individual participated in this study. The age, height, gestational age, fetal mal-presentation, prolonged Labor, and caesarian delivery parameters were observed within the patients and data were analyzed through SPSS version 19. RESULTS: The 21(17.6%) of patients with cephalopelvic disproportion was short suture in case group and 7(5.9%) in the control group, the results showed the significant association of cephalopelic disproportion with short suture patients. The ratio of caesarian delivery was also higher and a significant p-value was obtained. CONCLUSION: The mothers with cephalopelvic disproportion were independently correlated with a higher rate of short stature and caesarian rate is the highest among the CPS women. [ABSTRACT FROM AUTHOR]

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 <0.05 were regarded as statistically significant. Results: A total of 638 emergency caesarean sections involving singleton pregnancies at term, 522 (81.8%) of which had complete records and were analysed. The mean age of participants was 27.8±5.1 years, 89.3% were para 1-4 and 55.0% were unbooked. Only 6 (1.1%) of the emergency caesarean sections were performed within the recommended 30 minutes of DDI. The mean DDI was 189±124 minutes with range of 25 minutes to 1220 minutes. Two cases performed within 25 minutes were cases of foetal distress and cord prolapse while only a case of reduced foetal movement was delayed to 1220 minutes. The most common indications for emergency caesarean section were cephalopelvic disproportion 129 (24.7%) and foetal distress 65 (12.5%). The major cause of delay was delay in cross-matching of blood for surgery 136 (26.1%) while delay in giving informed consent contributed 67 (12.8%). There was no correlation between DDI of 75 minutes or above and the 1st minute APGAR score (AOR=2.48, CI=0.86-7.16, p-value=0.09), 5th minute APGAR score (AOR=3.08, CI=1.55-6.11, p-value=0.09), foetal outcome (AOR=0.82, CI=017-3.79, p-value=0.08) and admission to Newborn Intensive Care Unit (NICU) (AOR=2.08, CI=0.77-5.56, p-value=0.14). Conclusion: This study showed that there was no correlation between DDI>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. [ABSTRACT FROM AUTHOR]

Purpose First, to describe a new method of assessing cephalopelvic disproportion by measuring the retropubic tissue thickness (RTT), and second, to determine whether RTT was associated with an eventual delivery by cesarean section. Methods Three-dimensional transperineal ultrasound scans were performed on 129 laboring nulliparous women to obtain 3-dimensional volume datasets for assessing RTT. RTT was measured off-line by three operators (A, B, and C) as the shortest distance between the capsule of the pubic symphysis and the outer border of the fetal skull. The intraoperator repeatability of operator A and the interoperator reproducibility among A, B, and C were determined. The RTT in women who were delivered by cesarean section due to failure to progress was compared to that of women who had a vaginal delivery. Results The intraoperator repeatability for RTT was 1.2 mm. The overall RTT interoperator interclass correlation was 0.97 (0.95-0.98). The RTT in women who had a spontaneous, instrumental, or cesarean delivery was 1.16±0.32 cm, 1.12±0.25 cm, and 0.94±0.25 cm, respectively. Women who were delivered by cesarean section had a significantly smaller RTT than women who had a spontaneous delivery (P=0.008). There was no statistically significant difference in RTT between patients who had a normal vaginal delivery and patients who had an instrumental delivery (P=0.990), or between those who had an instrumental delivery and those who had a cesarean delivery after the Bonferroni correction (P=0.120). Conclusion RTT can be measured with satisfactory intraoperator repeatability and interoperator reproducibility. RTT was significantly smaller in women who eventually had a cesarean delivery than in those who had a vaginal delivery.

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Cephalopelvic disproportion (CPD) is a disparity between the fetal head and maternal pelvis, usually in the absence of fetal or maternal jeopardy. It is a very common complication during labour, and it is associated with a very high caesarean section rate. Delay in intervention could lead to obstructed labour. Short stature, fetal macrosomia and pelvic abnormalities are common risk factors. The aim of this study was to determine the influence of maternal height, age, clinical pelvimetry, and birth weight on cephalopelvic disproportion in the Niger Delta University Teaching Hospital, Bayelsa State. Materials and Methods: This is a retrospective case controlled analysis of 5,205 parturients who received antenatal care, and delivered at the Niger Delta University Teaching Hospital, from January 2010 to December 2015. Of these, 588 patients who had cephalopelvic disproportion were identified. Data concerning their maternal age, parity, height, pelvimetry, gestational age at delivery, and fetal demographic characteristics were collected and analyzed. This was compared to a control group of 588 parturients who were randomly selected among parturients who had spontaneous vaginal delivery (SVD) during the study period. Results: A total of 5,205 women delivered during the period of study, out of these, 588 women had cephalopelvic disproportion, giving a rate of 11.3%. Majority of the women who had CPD were nulliparous (47.6%). Women who were 150.0 cm tall or less were 3 times more likely to have cephalopelvic disproportion in labour than those who were over 150.0cm tall. P = 0.001, Odds Ratio = 3.69 [CI, 2.49 -5.47]. Women who delivered babies with birth weight ≥ 4000 grams had significantly more cephalopelvic disproportion, than those who delivered babies with birth weights of 2501 – 3999 grams. Odds Ratio = 0.22, p = 0.001 [CI, 0.14 -0.33]. There is a significant negative correlation between maternal height and parity with cephalopelvic disproportion. [r = -295, p = 0.001] and [r = -197, p = 0.001] respectively. There is also a significant positive correlation between birth weight and gestational age at deliverywith CPD [r = 0.24, p = 0.001] and [r = 0.149, p = 0.001]. Linear regression analysis of the independent variables reveal that maternal height was the biggest predictor to CPD. Coefficient of determination R2 = 0.089(8.9%), F= 112.2, p = 0.001. Conclusion: Short stature is independently associated with an increased risk of intrapartum caesarean section in Nigerian women. We advocate for an early recourse to caesarean section to avoid undue morbidity.

Abstract Mechanical birth-related injuries to the neonate are declining in incidence with advances in prenatal diagnosis and care. These injuries, however, continue to represent an important source of morbidity and mortality in the affected patient population. In the United States, these injuries are estimated to occur among 2.6% of births. Although more usual in context of existing feto-maternal risk factors, their occurrence can be unpredictable. While often superficial and temporary, functional and cosmetic sequelae, disability or even death can result as a consequence of birth-related injuries. The Agency for Healthcare research and quality (AHRQ) in the USA has developed, through expert consensus, patient safety indicators which include seven types of birth-related injuries including subdural and intracerebral hemorrhage, epicranial subaponeurotic hemorrhage, skeletal injuries, injuries to spine and spinal cord, peripheral and cranial nerve injuries and other types of specified and non-specified birth trauma. Understandably, birth-related injuries are a source of great concern for the parents and clinician. Many of these injuries have imaging manifestations. This article seeks to familiarize the reader with the clinical spectrum, significance and multimodality imaging appearances of neonatal multi-organ birth-related trauma and its sequelae, where applicable. Teaching points • Mechanical trauma related to birth usually occurs with pre-existing feto-maternal risk factors. • Several organ systems can be affected; neurologic, musculoskeletal or visceral injuries can occur. • Injuries can be mild and transient or disabling, even life-threatening. • Imaging plays an important role in injury identification and triage of affected neonates.

Without cesarean delivery, obstructed labor can result in maternal and fetal injuries or even death given a disproportion in size between the fetus and the maternal birth canal. The precise frequency of obstructed labor is difficult to estimate because of the widespread use of cesarean delivery for indications other than proven cephalopelvic disproportion, but it has been estimated that at least 1 million mothers per year are affected by this disorder worldwide. Why is the fit between the fetus and the maternal pelvis so tight? Why did evolution not lead to a greater safety margin, as in other primates? Here we review current research and suggest new hypotheses on the evolution of human childbirth and pelvic morphology. In 1960, Washburn suggested that this obstetrical dilemma arose because the human pelvis is an evolutionary compromise between two functions, bipedal gait and childbirth. However, recent biomechanical and kinematic studies indicate that pelvic width does not considerably affect the efficiency of bipedal gait and thus is unlikely to have constrained the evolution of a wider birth canal. Instead, bipedalism may have primarily constrained the flexibility of the pubic symphysis during pregnancy, which opens much wider in most mammals with large fetuses than in humans. We argue that the birth canal is mainly constrained by the trade-off between 2 pregnancy-related functions: while a narrow pelvis is disadvantageous for childbirth, it offers better support for the weight exerted by the viscera and the large human fetus during the long gestation period. We discuss the implications of this hypothesis for understanding pelvic floor dysfunction. Furthermore, we propose that selection for a narrow pelvis has also acted in males because of the role of pelvic floor musculature in erectile function. Finally, we review the cliff-edge model of obstetric selection to explain why evolution cannot completely eliminate cephalopelvic disproportion. This model also predicts that the regular application of life-saving cesarean delivery has evolutionarily increased rates of cephalopelvic disproportion already. We address how evolutionary models contribute to understanding and decision making in obstetrics and gynecology as well as in devising health care policies. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Adolescent pregnancies are considered medically and socially complicated. The aim of this study is to define the medical and sociodemographic characteristics of adolescent pregnancies in our province and to review the health problems of the babies. METHODS: In this study, records of all cases diagnosed as "pregnancy" in the 10-19 age group who administered to the Department of Obstetrics and Gynaecology between January 1, 2014 and January 2018 and their babies in the Department of Child Health and Diseases were examined retrospectively from the patient files and the electronic system of the hospital. One hundred eight pregnancies and 99 babies were evaluated. Data were presented with descriptive statistics. RESULTS: The mean age of marriage of the pregnant women was 17.01 ± 0.90. Although most of them had education level eight years or more, none of them was employed. Hyperemesis, anemia, cephalopelvic incompatibility were important medical and obstetric problems, 96% of pregnancies resulted in caesarean operation. Adolescent pregnancy rate was below the average in Turkey. Respiratory distress and jaundice were the common problems in newborn period. Respiratory tract infections and anemia in infancy were common health problems. DISCUSSION and CONCLUSION: Increased quality of antenatal care in adolescent pregnancies may decrease medical complications. However, even if the education rate is high, it seems to be preventing active participation in working life. The sensitivity of all parts of society should be increased. Marriage and pregnancy processes should be ensured at the age of individual competence. Thus, social complications may decrease. [ABSTRACT FROM AUTHOR]

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