Tag: childbirth complications

Understanding the Challenges of a Generally Contracted Pelvis: Exploring Birth Complications and Solutions

JiangRuoan

– Contracted pelvis is rare in developed countries but is still prevalent in some developing countries.
– Contracted pelvis is the major cause of cephalopelvic disproportion, Labour Dystocia, and instrumental delivery.
– Labour Dystocia is the most common complication associated with a contracted pelvis and can lead to increased incidence of perinatal and maternal morbidity and mortality.
– The shape, type, and diameter of the female pelvis determine the course and outcome of labor.
– The pelvis is made up of the sacrum, coccyx, and two os coxae (ischium, ilium, and pubis).
– The pelvic cavity is divided into the true pelvis and false pelvis by the pelvic inlet.
– The pelvic inlet involves three units of the bone pelvis (first sacral segment, iliac and pubis portion).
– The shape of the pelvic inlet depends on the general shape of the pelvis, which can be classified into gynaecoid, android, anthropoid, and platypelloid types.
– The gynaecoid pelvis is the most suitable for a vaginal birth, while the android and platypelloid pelvis types are suboptimal.
– The anteroposterior (or “conjugate”) diameter of the pelvic inlet is important and can be measured as the anatomical conjugate, obstetric conjugate, and diagonal conjugate.
– A contracted pelvis is established when the pelvic inlet at the interaxial dimension is less than 10 cm.
– Developmental, metabolic, traumatic, neoplastic, and lumbar kyphosis factors can contribute to a contracted pelvis.
– Diagnosis methods for contracted pelvis include abdominal examination, pelvimetry (internal and external), and imaging pelvimetry using X-ray, CT, or MRI.
– Complications associated with contracted pelvis include pendulous abdomen, nonengagement, pyelonephritis, prolonged labor, rupture of membranes, cord prolapse, obstructed labor, birth asphyxia, fracture skull, nerve injuries, and intra-amniotic infection.
– The management of contracted pelvis depends on the degree of contraction, with vaginal delivery recommended for minor degree, trial labor for moderate degree, and caesarean section for severe or extreme degree.
– Physiotherapy interventions can be beneficial for minor and moderate contracted pelvis, focusing on postural changes to increase pelvic inlet diameters and aid in labor progress.

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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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Difficult delivery: Understanding the causes, risks, and solutions

JiangRuoan

– Heavier infants weighing 8 pounds and 13 ounces or more may have a difficult delivery and are more prone to birth injuries.
– Premature births before the 37th week of pregnancy have higher rates of birth injuries due to underdeveloped muscles and nervous systems in the child.
– Infants born in abnormal positions, such as head-up, buttocks-first, or breech positions, are more likely to suffer birth injuries.
– Physical injuries during the birth process, such as from the use of forceps or vacuum extraction, can cause serious birth injuries.
– Delayed birth lasting over 18 hours can increase pressure on the infant’s brain and lead to fetal distress, elevated blood pressure, and possible stroke or cardiovascular issues.
– Oxygen deprivation during birth caused by factors like a prolapsed umbilical cord or underdeveloped lungs can result in various injuries to newborns, including severe brain injuries.
– Medical malpractice, such as excessive force or negligence during delivery, can also lead to birth injuries, including brain damage.
– Other causes of birth injuries include improper manipulation of the child’s body during delivery, certain medications, and viral or bacterial infections in the mother or infant during pregnancy.
– A childbirth complication refers to any abnormal condition or event during pregnancy, labor, or delivery that can harm the mother or baby. Obstetric complications cause birth injuries.
– Uterine rupture is the most dangerous complication and can cause major brain damage or death for both the baby and mother.
– Shoulder dystocia is an emergency event during vaginal delivery where the baby’s shoulder becomes stuck in the birth canal, posing a risk of brain injury or death due to oxygen deprivation.
– Excessive force during delivery can cause physical injury to the baby, such as fractured collarbones or nerve damage.
– Prolapse of the umbilical cord can restrict or cut off the baby’s oxygen supply, leading to severe consequences.
– Chorioamnionitis, a bacterial infection in the amniotic fluid and/or fetal membranes, can cause brain injuries and increase the risk of major birth injuries.
– Fetal macrosomia, when undiagnosed, can be dangerous during delivery and increase the risk of the baby getting stuck in the birth canal and experiencing oxygen deprivation.
– Clinical risk factors for pregnancy complications include hypertension, gestational diabetes, breech presentation, multiples, and previous cesarean birth.
– The most commonly listed causes of maternal death in the US include uterine rupture, infection, and heart disease.

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Transverse Arrest: Causes, Symptoms, and LifeSaving Interventions

JiangRuoan

– The study will be conducted in hospitals in Australia that have 2,000 or more deliveries per year.
– The intervention will be performed by experienced obstetricians or midwives.
– The inclusion criteria for the study include being at least 18 years old, having a singleton pregnancy, being at least 37 weeks gestation, planning a vaginal birth, having a cephalic presentation, and having confirmed occiput transverse position.
– The exclusion criteria include clinical suspicion of cephalopelvic disproportion, previous caesarean section, brow or face presentation, pathologic CTG, fetal scalp abnormalities, chorioamnionitis, intrapartum hemorrhage, maternal diabetes, suspected fetal bleeding disorder, and major fetal abnormalities.
– The intervention, called manual rotation, is performed when the woman is at full cervical dilatation and the fetal position is occiput transverse. The technique used will be at the discretion of the operator and may involve applying pressure to the lambdoid suture or flexion and rotation of the fetal head.
– The comparator is the standard practice of waiting until full dilatation is reached before performing any intervention.
– The primary outcome measure is operative delivery (vacuum, forceps, or caesarean section).
– Secondary outcomes include the rate of caesarean section, serious maternal morbidity or mortality, and serious perinatal and neonatal morbidity and mortality.
– Prolonged second stage of labour is defined differently based on parity and use of epidural analgesia.
– Other outcomes measured include length of second stage, time from randomization to delivery, estimated blood loss, perineal or vaginal trauma requiring suturing, length of hospital stay, and outcomes for operative delivery.
– Secondary outcomes assessed include breastfeeding status, satisfaction with birth, depression, health-related quality of life, and pelvic floor function.
– The sample size for the study is 416 participants, based on power calculations and previous studies.
– The study aims to evaluate the effectiveness of manual rotation in reducing adverse outcomes during transverse arrest.
– The primary outcome measure is serious morbidity and/or mortality, which includes factors such as neonatal injury, low Apgar score, abnormal cord pH levels, birth trauma, seizures, ventilation, tube feeding, NICU admission, and neonatal jaundice.
– Data collection will occur at three possible time points: antenatal, latent phase of labor, or active phase of the first stage of labor.
– Informed consent will be obtained, and participants will be informed of the potential risks of manual rotation.
– An ultrasound will be performed at full dilatation, and the fetal position will be confirmed by a second ultrasound.
– The treatment allocation is recorded on a randomization sheet kept by the investigator.
– The findings are recorded by the investigator.
– The data will be stored securely and checked for accuracy.
– The analysis will be done according to specific guidelines and will include variables such as maternal factors, gestation, and neonatal gender.
– Subgroup analyses will also be performed based on different techniques of manual rotation and operator ability.
– A Data and Safety Monitoring Committee has been established to ensure the safety of the trial participants.
– Any adverse events will be reported to this committee, and serious complications will be referred to them as well.
– The study has received approval from the Ethics Review Committee of the Sydney Local Health District in Sydney, Australia, with the protocol number X110410.

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