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Second Stage Of Labor
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
If there are no signs of infection (maternal or fetal), no maternal exhaustion, and reassuring fetal testing, labor can be allowed to continue beyond current limits (Table 9.2) as long as some progress has been made. This is supported by the AHRQ recommendations [63]. Nevertheless, even if contractions are adequate, the chance of vaginal delivery decreases progressively after 3–5 hours of pushing in the second stage [64].
Shoulder dystocia
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Randall C. Floyd, James S. Smeltzer
If the above maneuvers fail or cannot be performed, the fetal head can be replaced in the pelvis, with or without relaxing the uterus (with terbutaline, nitroglycerine, magnesium sulfate, or inhalation anesthetics). Replacement is accomplished by depressing the perineum and reversing the fetal head extension. Delivery can be completed by cesarean section, at a time indicated by fetal monitoring. This usually results in an intact infant, but possibilities of hypoxic ischemic encephalopathy or stillbirth and permanent brachial plexus injury still exist (13). The risks may be comparable with those associated with forceful vaginal delivery.
Practice exam 2: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
Factors: on HAART and detectable viral load.Elective caesarean section or not at 38 weeks.If vaginal delivery, special considerations during labour.
Pre-induction cervical ripening with different initial doses of intravaginal misoprostol: time to delivery and peri-natal outcomes
Published in Journal of Obstetrics and Gynaecology, 2022
M. Porras Lucena, J. Duro Gómez, A. J. De la Torre Gonzalez, C. Castelo-Branco
Although, our results show that first dose 50 µg of misoprostol reduces time to delivery, it does not represent an increment of delivery rate within 24 hours. These observations were similar to some randomised clinical trials conducted by Adeniyi et al. (2014) and Azubuike et al. (2015). Both authors found a decrease in time to delivery and no statistical differences in vaginal delivery rate within 24 hours. In contrast, Kreft et al. (2014) carried out a retrospective study where significant differences in time to delivery and in vaginal delivery rate within 24 hours were observed. These differences could be due to the greater number of patients included, a total of 1435 women. More oxytocin was used in group II. Adeniyi et al. (2015) and Kreft et al. (2014) obtained similar results, but Azubuike et al. (2015) did not observe differences.
Predictors of adverse perinatal outcome up to 34 weeks, a multivariable analysis study
Published in Journal of Obstetrics and Gynaecology, 2022
José Morales-Roselló, Alberto Galindo, Elisa Scarinci, Ignacio Herraiz, Silvia Buongiorno, Gabriela Loscalzo, Paula Isabel Gómez Arriaga, Antonio José Cañada Martínez, Paolo Rosati, Antonio Lanzone, Alfredo Perales Marín
Gestational characteristics including parity, number of gestations and maternal ethnicity, age, pre-pregnancy weight, and height, were collected at examination. In addition, labour outcome data including BW, mode of delivery, Apgar score, cord arterial pH, and admission to the neonatal care unit were collected after birth to evaluate APO. This was considered when the outcome was adverse for any of these components: abnormal intrapartum foetal heart rate (according to the intrapartum foetal monitoring guidelines of the FIGO) (Ayres-de-Campos et al. 2015), or intrapartum foetal scalp pH <7.20 requiring expedite delivery by the fastest route, neonatal umbilical cord pH <7.10, 5 minute Apgar score <7, and postpartum admission to the neonatal intensive care unit or special care baby unit. As per local protocol, all foetuses were initially aimed to reach a vaginal delivery but were subsequently managed according to their progression in labour. Doppler examinations did not influence the management of labours, which were performed by different obstetricians. Finally, cases with abnormal intrapartum foetal heart rate ending with instrumental delivery were not included as APO if foetal scalp pH or neonatal pH were within normal limits.
Impact of pregnancy on voice: a prospective observational study
Published in Logopedics Phoniatrics Vocology, 2022
Burak Ulkumen, Burcu Artunc-Ulkumen, Onur Celik
Seventy-eight pregnant women who had term delivery between April 2019 and March 2020 were invited to participate in the study. The inclusion criterion was determined to be pregnant women aged between 20 and 40 years. Exclusion criteria were determined as follows: preeclampsia, gestational diabetes, history of polycystic ovary syndrome, history of voice pathology, history of gastroesophageal reflux disease, and delivery by cesarean. Demographic data of all cases including age, type of delivery, history of voice abuse, and gastroesophageal reflux were obtained. Type of delivery was defined as cesarean and vaginal delivery. According to the exclusion criteria, a total of 29 cases (23 women who underwent cesarean delivery and six women who were suffering from hearth burn or regurgitation) were excluded. The remaining 49 cases composed the final sample.