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Caesarean Section
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
In caesareans where difficulties are anticipated, it is essential to plan well. Following are the situations where one must expect difficulties: Pre-labour preterm (less than 32 weeks) caesareans section with malpresentation and decreased amniotic fluid due to rupture of membranes.Free-floating head with placenta previa.Caesarean section for placenta previa.Caesarean for previous two or more caesarean scars.Second stage caesarean section.Caesarean sections for adhesive placental disorders like placenta previa accreta or increta.Caesareans performed for a transverse lie.
Obstetrics: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
Shoulder dystocia occurs in approximately 6/1000 deliveries (1). Aetiological factors include those which exist pre-labour and those which occur or become apparent during labour. Pre-labour factors include previous shoulder dystocia, and recurrence rates are quoted as being between 1% and 16%. Fetal macrosomia is also associated, although it is not necessarily a good predictor, as half of the incidences of shoulder dystocia occur in babies with a birthweight less than 4 kg. Maternal body mass index (BMI) of greater than 30 kg/m2 is also a risk factor. Diabetes mellitus and its association with both macrosomia and high maternal BMI is also a factor (2). Intrapartum factors include induction of labour and prolongation of both first and second stages. The use of oxytocin and a secondary arrest also make shoulder dystocia more likely. All these factors have a low positive predictive value, both singly and in combination, demonstrating that shoulder dystocia is an unpredictable and therefore unpreventable event (2).
The context of birth
Published in Helen Baston, Midwifery, 2020
This is the pre-labour phase, which is variable between individuals. It can start with what are experienced as regular, painful contractions which may last a few hours and then fade away. Other women experience mild, irregular contractions before getting into a more established pattern. During this time the cervix begins to soften and dilate up to 4 cm.
Successful pregnancy and childbirth in a patient with acute lymphoblastic leukaemia after busulfan-based myeloablative conditioning allogeneic haematopoietic stem cell transplantation: a case report
Published in Journal of Obstetrics and Gynaecology, 2020
Chen Zhang, Honglan Zhu, Heng Cui, Xiaohong Chang, Zhaohua Wang
On 14 December, 2016, the third day of her last menstrual period, the patient was placed on Progynova plus Oestriol gel, and dydrogesterone was added on the day of transplantation. On 28 December, three donor frozen embryos was transferred to the patient, one of which survived. At 30−2/7 and 32−3/7 weeks of gestation, respectively, she was hospitalised for risk of premature labour and treated with tocolytic therapy. At 36−2/7 weeks of gestation, she presented with preterm pre-labour rupture of membranes and underwent a low transverse caesarean delivery after a failed trial of labour. She delivered a viable male neonate weighing 2670 g with Apgar scores of 10, 10 and 10 at 1, 5 and 10 min, respectively. The newborn did not exhibit any congenital anomalies or neonatal complications. Three months after a caesarean section, still in the lactation period, she presented to our department for re-examination and the levels of hormonal profile were tested (Table 1). Transvaginal pelvic ultrasonography showed a solid mass echoic pattern on her bilateral ovaries.
Influence of maternal factors and mode of induction on labour outcomes: a pragmatic retrospective cohort study
Published in Journal of Obstetrics and Gynaecology, 2018
A total of 1971 deliveries were included in the analyses; no maternal or foetal deaths occurred in this cohort. Table 2 summarises the demographics and obstetric medical history for the patients included. Furthermore, the extent to which each variable is associated with vaginal delivery is determined by a multinominal regression analysis. Likewise, the primary reason for the induction is summarised in Table 3, with the odds of vaginal delivery again assessed through use of the multinominal regressional analysis. The most common reasons for the induction of labour in this cohort were post-term (i.e. >41 weeks; 18.8%), small for gestational age (SGA; 14.4%) and a pre-labour membrane rupture (12.6%) respectively. The mean average maternal age was 30 years (min. 13 to max. 46 years) and median gravida and parity were 2 and 1, respectively. The mean weight of the newborn child was 3384 grams; the median blood loss was 300 ml. In terms of the vaginal deliveries, 1342 (68.1%) of these were unaided, in 238 (12.1%) cases an extraction technique such as the forceps or vacuum had to be applied, and a caesarean section was required in 391 (19.8%) cases. This compares favourably compared to the overall caesarean section rates of 26% in the United Kingdom in 2013–2014.
Prediction model for labour dystocia occurring in the active phase
Published in Journal of Obstetrics and Gynaecology, 2023
Yanqing Liu, Qingquan Gong, Yuhong Yuan, Qi Shi
Labour dystocia often occurs in the active phase, in which case CS is required to end delivery. Although CS is convenient and not time intensive, it would negatively impact the mother and foetus if not handled properly. Therefore, understanding the related factors causing labour dystocia, which occurs in the active phase, is necessary to promote natural childbirth and reduce the rate of CS and the incidence of maternal and foetal loss in the perinatal period. In this study, by integrating the factors of pre-labour and during labour, we found premature rupture of membranes, foetal abdominal circumference, prolonged latent phase and foetal position and station at the early stage of the active phase as the risk factors causing labour dystocia occurring in the active phase.