Category: Labor and Delivery

Difficult labour: Understanding the challenges and finding solutions

JiangRuoan

The pertinent list related to the keyword “difficult labour” includes:

1. Dystocia refers to complications during labor, such as slow dilation of the cervix, entrapment of fetal shoulders, and prolonged labor.
2. Prolonged labor can lead to risks for both the mother and the baby, including infection, fetal distress, uterine rupture, and hemorrhage.
3. Cesarean delivery is often performed in cases of labor dystocia, but it comes with risks, such as hemorrhage and injury to internal organs.
4. Abnormalities of labor progression are a common cause of primary cesarean delivery.
5. The article discusses the need to reduce cesarean delivery rates for labor dystocia to improve maternal and neonatal outcomes.
6. The article highlights the uncertainty surrounding definitions of different phases of labor and what constitutes “normal” labor.
7. Key questions for the study include delivery outcomes for management of abnormal labor, benefits and harms of interventions, and benefits and harms of different protocols for abnormal labor.
8. Interventions for managing labor include electronic fetal monitoring, intermittent auscultation, delayed or Valsalva pushing in the second stage of labor, and routine amniotomy.
9. Outcomes of interest include cesarean delivery, operative vaginal delivery, infection, hemorrhage, uterine rupture, and neonatal health and developmental abnormalities.
10. The study design includes original data, systematic reviews, RCTs, and observational studies.
11. The article discusses the process of identifying relevant literature, including database searches and manual citation searches.
12. Data collection and analysis will be done using the DistillerSR software program and assessing risk of bias and study quality.
13. The feasibility of a quantitative synthesis and decision analysis will be determined based on available evidence.
14. The strength of evidence will be assessed using domains such as study limitations, consistency, directness, precision, and reporting bias.
15. The article also discusses the process of peer review and disclosure of conflicts of interest in the preparation of the final report.

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The Left Mentoanterior Position: Understanding Fetal Presentation during Labor

JiangRuoan

– Face presentation is a cephalic presentation in which the head is completely extended.
– The incidence of face presentation is about 1 in 300 labours.
– Primary face presentation occurs during pregnancy and may be caused by factors such as anencephaly, loops of the cord around the neck, foetal neck tumors, hypertonicity of neck muscles, dolicocephaly (long antero-posterior diameter of the head), dead or premature foetus, or idiopathic causes.
– Secondary face presentation occurs during labour and may be due to factors such as contracted pelvis, pendulous abdomen, marked lateral obliquity of the uterus, further deflexion of brow or occipito-posterior positions, or other malpresentations such as polyhydramnios and placenta praevia.
– Left mento-anterior (LMA) and right mento-anterior (RMA) are more common positions of face presentation.
– Diagnosis during pregnancy is difficult, but the back is difficult to feel and the limbs may be felt more prominently in mento-anterior position. Ultrasound or X-ray can confirm the diagnosis.
– Diagnosis during labour is done through vaginal examination, which shows identifying features such as supra-orbital ridges, malar processes, nose, mouth, and chin.
– Late in labour, the face may become oedematous (tumefaction), which can be misdiagnosed as a buttock (breech presentation). Differentiating factors include the formation of a triangle with foetal mouth and malar processes as apexes, anus on the same line as ischial tuberosities, feeling of a hard gum through the mouth, and no hard object through the anus.
– The mechanism of labour in mento-anterior position involves descent.
– Engagement by submento-bregmatic diameter: 9.5 cm
– Submental region hinges below the symphysis in flexion position
– Submento-vertical diameter: 11.5 cm
– Biparietal diameter does not pass the plane of pelvic inlet until the chin is below the level of the ischial spines and the face begins to distend the perineum
– In about 2/3 of cases, long anterior rotation of 3/8 circle occurs during mento-posterior position
– In about 1/3 of cases, deep transverse arrest of the face, persistent mento-posterior, or direct mento-posterior occur during mento-posterior position
– Direct mento-posterior cannot be delivered due to obstruction caused by the length of the sacrum and neck
– Management of labour includes excluding foetal anomalies and contracted pelvis
– Spontaneous delivery usually occurs in mento-anterior position during second stage of labour
– Forceps delivery and episiotomy may be indicated in prolonged second stage of labour in mento-anterior position
– Wait for long anterior rotation of 3/8 circle in mento-posterior position during second stage of labour
– Oxytocin is used to compete inertia during this period if there are no contraindications
– Caesarean section is the safest option if long anterior rotation fails or there is foetal or maternal distress
– Manual rotation and forceps extraction or rotation and extraction by Kielland forceps are alternative methods, but are hazardous and not commonly used
– Craniotomy may be performed if the foetus is dead
– Complications may occur, refer to complications of malpresentations and malposition for more information.
– There is an increased risk of trauma to the baby in face presentation, so internal manipulation, vacuum extractors, and manual extraction should be avoided.
– Abnormalities in fetal heart rate are more common in face presentation. Monitoring is crucial during labor.
– Complications of face presentation include prolonged labor, facial trauma, facial edema, skull molding, respiratory distress, spinal cord injury, abnormal fetal heart rate patterns, and low Apgar scores.
– Informed consent should be obtained from the mother, and failure to do so is considered negligence.
– Forceps and oxytocin used during labor can put a baby at risk of complications. Forceps can cause head injuries and oxytocin can deprive the baby of oxygen due to strong contractions.
– Mothers should be given the option of a C-section if facing complications.
– Face presentation babies should be closely monitored and delivered by an experienced physician.
– If negligent practices cause injury to the baby, it can be considered medical malpractice. ABC Law Centers specialize in birth injury cases and offer free legal consultations.

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Understanding Hypertonic Uterine Inertia: Causes, Symptoms, and Solutions

JiangRuoan

List of pertinent details about ‘hypertonic uterine inertia’:

1. Hypertonic uterine inertia is defined as infrequent, weak, and short-duration uterine contractions.
2. The causes of hypertonic uterine inertia are unknown.
3. Factors that may be involved in hypertonic uterine inertia include primigravida (particularly elderly), anemia, nervousness, hormonal deficiencies, improper use of analgesics, uterine overdistension, developmental anomalies, myomas, malpresentations, malpositions, cephalopelvic disproportion, and a full bladder or rectum.
4. Hypertonic uterine inertia can be categorized as primary or secondary inertia.
5. Primary inertia occurs when weak contractions occur from the start of labor.
6. Secondary inertia occurs when contractions may initially be strong but become weak and inadequate to overcome an obstruction.
7. Clinical symptoms of hypertonic uterine inertia include prolonged labor, infrequent and weak contractions, slow cervical dilatation, intact membranes, and little impact on the fetus and mother apart from maternal anxiety.
8. Complications from hypertonic uterine inertia can include retained placenta and postpartum hemorrhage.
9. Diagnosis of hypertonic uterine inertia is done through tocography to measure uterine contractions and examination to detect any abnormalities.
10. Management of hypertonic uterine inertia may include proper management of the first stage of labor, prophylactic antibiotics in prolonged labor, amniotomy, and the use of oxytocin to stimulate contractions.
11. Operative delivery, such as vaginal delivery using forceps or vacuum, or caesarean section, may be necessary in cases of failure of other methods or complications.
12. Hypertonic uterine inertia is more common in primigravidae.
13. Management includes general measures such as analgesics and antispasmodics.
14. Constriction (contraction) ring is a persistent localized spasm of the uterine muscles that typically occurs at the junction of the upper and lower uterine segments.
15. The cause of constriction ring is unknown but may be associated with factors such as malpresentations, improper use of oxytocin, and intrauterine manipulations.
16. Complications of constriction ring can include prolonged first or second stage of labor and retained placenta and postpartum hemorrhage.
17. Two conditions discussed in the article are hypertonic uterine inertia and cervical dystocia.
18. Delivery of the fetus is the only way to relieve hypertonic uterine inertia.
19. Treatment for hypertonic uterine inertia includes excluding malpresentations, malposition, and disproportion, as well as the use of medication such as pethidine or deep general anesthesia and amyl nitrite inhalation.
20. Cervical dystocia is the failure of the cervix to dilate within a reasonable time despite regular uterine contractions.
21. There are two varieties of cervical dystocia: organic and functional dystocia.
22. Complications of cervical dystocia include annular detachment of the cervix, rupture of the uterus, and postpartum hemorrhage.
23. Management of organic dystocia is cesarean section.
24. For functional dystocia, pethidine and antispasmodics may be effective. If medical treatment fails or fetal distress develops, a cesarean section is performed.

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Discover the Fascinating World of Left Occipitotransverse Birth

JiangRuoan

– Left Occiput Anterior (LOA)
– Left Occiput Posterior (LOP)
– Left Occiput Transverse (LOT)
– Occiput Anterior (OA)
– Occiput Posterior (OP)
– Left Mentum Anterior (LMA)
– Right Mentum Anterior (RMA)
– Left Frontum Anterior (LFA)
– Right Frontum Anterior (RFA)
– Right Mentum Posterior (RMP)
– Right Mentum Transverse (RMT)
– Left Mentum Anterior (LMA)
– Left Mentum Posterior (LMP)
– Left Mentum Transverse (LMT)
– Mentum Anterior (MA)
– Mentum Posterior (MP)
– Complete Breech
– Frank Breech
– Single or Double Footling Breech
– Kneeling Breech
– Transverse Position
– Sacrum Anterior
– Sacrum Posterior

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The Persistent Occipitoposterior Position: A Guide to Delivery

JiangRuoan

– Occipito-posterior position is a malposition in which the baby’s back is directed posteriorly during a vertex presentation
– Occipito-posterior position occurs in approximately 10% of labors
– Right occipito-posterior (ROP) is more common than left occipito-posterior (LOP)
– Causes of occipito-posterior position include the shape of the pelvis (anthropoid and android pelvises are common causes), maternal kyphosis, anterior insertion of the placenta, and other malpresentations such as placenta previa, pelvic tumors, pendulous abdomen, polyhydramnios, and multiple pregnancy
– Diagnosis during pregnancy can be done through inspection, palpation, and auscultation
– Complications of occipito-posterior position include premature rupture of membranes, cord presentation and prolapse, prolonged labor, obstructed labor, increased incidence of instrumental and operative delivery, trauma to the genital tract, postpartum hemorrhage, and perinatal mortality
– The persistent occipitoposterior position occurs in about 3% of cases
– Long internal rotation, occurring in about 90% of cases, allows for delivery to proceed as in normal labor
– Direct occipitoposterior position occurs in about 6% of cases and can be managed by spontaneous delivery or with the aid of outlet forceps
– Deep transverse arrest occurs in 1% of cases and requires vacuum extraction or manual rotation and extraction with forceps
– Vacuum extraction can be used for rotation of the head, while manual rotation and extraction with forceps is done under general anesthesia
– Different types of forceps, such as Kielland’s forceps and Barton’s forceps, can be used for rotation and extraction of the head in persistent occipitoposterior position
– The Scanzoni double application method, which is considered hazardous, involves applying forceps twice for rotation and extraction
– If other methods fail, a Caesarean section may be necessary. Other indications for a C-section include contracted pelvis, placenta previa, prolapsed pulsating cord, and elderly primigravida
– Craniotomy may be performed if the fetus is dead
– Vacuum extraction and Caesarean section are the commonly used methods in modern obstetrics for managing persistent occipitoposterior position

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Abnormal Uterine Action 101: Unveiling Causes and Solutions

JiangRuoan

Abnormal uterine action can be classified into two categories: over-efficient uterine action and inefficient uterine action. Over-efficient uterine action includes precipitate labor (lasting less than 3 hours) and excessive contraction and retraction (in the presence of obstruction). Inefficient uterine action includes hypotonic inertia and hypertonic inertia. Other types of abnormal uterine action include constriction (contraction) ring and cervical dystocia.

– Precipitate labor
– Excessive uterine contraction and retraction
– Hypotonic inertia
– Hypertonic inertia
– Constriction (contraction) ring
– Cervical dystocia

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Asphyxia Livida: Unveiling the Ominous Reality of Oxygen Deprivation

JiangRuoan

– The term “asphyxia livida” refers to a form of asphyxia neonatorum. In this condition, the skin appears cyanotic, indicating a lack of oxygen, but the heart functions normally and reflexes are intact.
– Birth asphyxia is a condition where a baby does not receive enough oxygen before, during, or directly after birth.
– It can cause serious complications and even be life-threatening.
– Birth asphyxia is also known as perinatal asphyxia and neonatal asphyxia.
– It can occur just before, during, or after birth.
– Insufficient oxygen supply can cause low levels of oxygen or excess acid in the baby’s blood.
– In mild or moderate cases, babies may fully recover, but in severe cases, it can cause permanent brain and organ damage or be fatal.
– Birth asphyxia rates are lower in developed countries at 2 in 1,000 births.
– In developing countries with limited access to neonatal care, the rate increases up to 10 times.
– Various factors can cause birth asphyxia, including umbilical cord prolapse, compression of the umbilical cord, meconium aspiration syndrome, premature birth, amniotic fluid embolism, uterine rupture, placental separation, infection during labor, prolonged or difficult labor, high or low blood pressure during pregnancy, and anemia in the baby.
– Risk factors for birth asphyxia include the pregnant person’s age between 20 and 25, multiple births, lack of prenatal care, low birth weight, abnormal fetal position, preeclampsia or eclampsia, and a history of birth asphyxia.
– Signs and symptoms of birth asphyxia can occur before, during, or after birth.
– Signs in the baby at birth may include unusual skin tone, silence, low heart rate, weak muscle tone and reflexes, lack of breathing, amniotic fluid stained with meconium, seizures, poor circulation, limpness or lethargy, low blood pressure, lack of urination, and abnormal blood clotting.
– A low Apgar score (between 0 and 3) that lasts for more than 5 minutes can indicate birth asphyxia.
– Immediate treatment can reduce the risk of long-term complications.
– Short-term effects can include acidosis, respiratory distress, high blood pressure, blood clotting problems, and kidney problems.
– Long-term effects of mild-to-moderate asphyxia can include cognitive and behavioral changes, hyperactivity, autism spectrum disorder, attention deficits, low intelligence quotient score, schizophrenia, and psychotic disorders.
– Severe asphyxia can cause intellectual disability, cerebral palsy, epilepsy, sight or hearing impairment.
– Treatment depends on the severity and cause of the asphyxia and may include providing extra oxygen, emergency or cesarean delivery, suctioning fluid from airways, putting the newborn on a respirator, placing the baby in a hyperbaric oxygen tank, and induced hypothermia.
– The article discusses the various treatments and prevention methods for asphyxia livida, a condition that can cause brain damage.
– Treatment options include medication to regulate blood pressure, dialysis to support the kidneys, medication to control seizures, IV nutrition, and the use of a breathing tube with nitric oxide.
– Life support with a heart and lung pump may also be necessary.
– Preventing asphyxia can be challenging, but proper care and monitoring before and after birth are crucial.
– Steps to prevent asphyxia include effective resuscitation, controlling body temperature, having the correct equipment available, ensuring trained healthcare providers are present for every birth, and pre-treatment with certain medications.
– Additionally, treatments like body cooling may be used to prevent complications from asphyxia.

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Physiologic Retraction Ring: An Essential Milestone in Labor

JiangRuoan

The list of relevant terms related to the keyword “physiologic retraction ring” from the given text:

– abdominal ring
– Albl’s ring
– Bandl’s ring
– benzene ring
– Cannon’s ring
– conjunctival ring
– constriction ring
– fibrous ring of heart
– halo ring
– inguinal rings
– Kayser-Fleischer ring
– pathologic retraction ring
– Schwalbe’s ring
– tympanic ring
– umbilical ring
– vascular ring

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