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First Stage Of Labor
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Birthing balls (also known as Swiss balls) are round exercise balls that women in labor can sit on and perform different movements such as pelvic rotation and rocking back and forth. They are thought to widen the maternal pelvic outlet to assist in progression of labor, while also decreasing pain. A recent systematic review and meta-analysis of seven RCTs that included 533 women demonstrated that the use of a birthing ball versus no birthing ball resulted in no significant difference in the incidence of spontaneous vaginal delivery, cesarean delivery, operative vaginal delivery, or duration of labor. However, it did significantly reduce pain in the active phase of the first stage of labor [22].
Anatomy of the Pelvis
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
Pelvic outlet/inferior pelvic aperture is indented behind by sacrum and coccyx and on the sides by ischial tuberosities. There are three main arcs: anteriorly pubic arch, which is formed by the ischio-pubic rami, greater and lesser sciatic notches between ischial tuberosities laterally and sacrum coccyx posteriorly. These notches are converted into foramina by the vertebropelvic ligaments. With these ligaments intact, the shape of the outlet becomes rhomboidal – anterior limbs being the ischio-pubic rami and posterior limbs being the sacrotuberous ligaments and coccyx in the median plane.
Assisted Vaginal Breech Delivery
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Malik Goonewardene
Again, it is important to let the fetus deliver with its back in an anterolateral direction, along the wider anteroposterior diameter of the pelvic outlet (Figure 25.8). This will allow natural birth mechanisms to take place, thus leading to the safe delivery of the fetus. If the fetus shows any tendency to rotate to sacroposterior position, then this should be managed.
Comparing the pelvis of Tibetan and Chinese Han women in rural areas of China: two population-based studies using coarsened exact matching
Published in Journal of Obstetrics and Gynaecology, 2022
Xiaojing Fan, Zhongliang Zhou, Martyn Stewart, Duolao Wang, Xin Lan, Shaonong Dang, Hong Yan
The pelvic dimension including IS, IC, EC and TO was one method used for assessment of contracted pelvis. Whilst this method was easier to implement, it may ignore other parameters. Factors such as gestational weeks, fat thickness and the posture of women when measuring the distance of the two ischial tuberosity’s inside edge may affect the measurements of EC and TO (Laster 1974). Iida et al. suggested that the contracted pelvis should be defined by measures such as the area of the pelvis inlet and the sacral shape (Iida and Takahashi 1993). When standard obstetric measurements were taken and compared to four additional medieval skeletal samples from Sudan, and to modern American standards for the same obstetric dimensions, the Sudanese Kulubnarti pelvis was smaller in most dimensions (Sibley et al. 1992). Studies had illustrated that the accuracy of clinical evaluation of the pelvic outlet is lower than when compared to X-ray pelvimetry, and the parameters of lesser pelvises could be better measured by an ultrasonic (Floberg et al. 1986; Kramarskii and Krasin 1991). Therefore, further assessments of the pelvis of Tibetan women would be required and caution was needed when estimating or comparing the incidence of contracted pelvis in Tibetan women.
Physiotherapist management of a patient with spastic perineal syndrome and subsequent constipation: a case report
Published in Physiotherapy Theory and Practice, 2021
Shankar Ganesh, Mritunjay Kumar
Isolated defecatory dysfunction can occur in 25% of the persons suffering from constipation (Lembo and Camilleri, 2003). In the normal state, the anorectal angle is maintained by the tonic contraction of the puborectalis muscle and the anal sphincter is closed. During normal defecation smooth muscle relaxation of the anal canal (Sorensen, Lorentzen, Petersen, and Christiansen, 1991) occurs along with the relaxation of puborectalis muscle, straightening out the anorectal angle. In dyssynergic type of constipation, there is a paradoxical contraction of pelvic floor muscles (i.e. puborectalis muscle and external anal sphincter) leading to the significantly impaired ability to expel stool during attempts to defecate (Dailianas et al., 2000). These patients have a functional outlet obstruction related to the neuromuscular dysfunction of the defecation unit and are addressed by other names in the literature such as anismus, pelvic floor dyssynergia, obstructive defecation, paradoxical puborectalis contraction, pelvic outlet obstruction, and spastic pelvic floor or perineal syndrome. In this study, we have used the term dyssynergic defecation (DD) to refer to constipation that occurs as a result of pelvic floor dysfunction. The term functional constipation (FC) has been used where the cause of constipation could not be identified.
Perineal trauma: incidence and its risk factors
Published in Journal of Obstetrics and Gynaecology, 2019
Masoumeh Abedzadeh-Kalahroudi, Ahmad Talebian, Zohreh Sadat, Elaheh Mesdaghinia
Studies show that about 57% of deliveries without an episiotomy are associated with some degree of perineal laceration (McCandlish 2001; Leal et al. 2014), which is similar to the incidence in our study (50.5%). In our study, the incidence of a perineal laceration was 16%. In Ethiopia (Niguse et al. 2016), the rate of a laceration was 13.2%, and in England, 18.8% (Smith et al. 2013). Another study in Kashan during 2007–2009 also reported a incidence of 16.1% (Mesdaghinia et al. 2011), indicating that the episiotomy rate has not decreased in this city during the recent years. Although the episiotomy is used to increase the pelvic outlet, in the prevention of severe perineal tears, to facilitate of childbirth, and for a shorter foetal expulsion time, it is recommended that it should be limited to the high risk deliveries for severe perineal lacerations, severe dystocia of soft tissue, or need to facilitate a delivery in a compromised foetus. Studies show that tears are usually smaller than an episiotomy, and their recovery is faster and easier (Robinson 2016).