Intra-uterine pressure and the active management of labour

Byrne, Bridgette; Keane, Declan; Boylan, Peter; Stronge, J. M.

doi:10.3109/01443619309151732

Cited by 4 publications

(2 citation statements)

References 10 publications

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“…Conventionally the causes for second stage arrest were categorized as the '3 Ps': passages; power; and passenger. 2 To reduce surgical intervention in these cases, active management of labor was first introduced in 1969. 3 Since then there has been no significant change in the management of arrest of descent in the second stage of labor.…”

Section: Introductionmentioning

confidence: 99%

Prediction of caesarean section for arrest of descent during the second stage of labour

Samal

Rathod

2017

Int J Reprod Contracept Obstet Gynecol

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Background: Friedman described the normal progress of labor in different curves for nulliparous and multiparous women in 1954. Any deviation from these curves during the second stage of labor is considered as failure to progress in the second stage of labor. The aim of the study is to define obstetrical risk factors for arrest of descent during the second stage of labour.Methods: All singleton, vertex, term deliveries with an unscarred uterus, between December 2013 to November 2016 (3 years) were included. Univariable and multivariable analysis were performed to investigate independent risk factors associated with arrest of descent during the second stage of labor.Results: The study included 7260 deliveries, of these 163 (3.3%) were complicated with arrest of descent during the second stage of labor. Using a multivariable analysis, the following obstetric risk factors were found to be significantly associated with arrest of descent: primigravida (RR=7.8, 95% CI=6.9-8.7, p<0.001), obesity (RR=1.8, 95% CI=1.6-2.0, p<0.001), short stature (RR=2.3, 95% CI=1.9-2.8, p<0.001), hypertensive disorders(RR=1.5, 95% CI=1.3-1.8,p<0.001), gestational diabetes(RR=1.5, 95% CI=1.2-1.8, p<0.001), free floating head before labour(RR=3.4, 95%CI=2.5-4.1, p<0.001), Occipito-posterior position(RR=3.3, 95% CI=2.1-4.5, p<0.002), Prelabour rupture of membrane (PROM) (RR=1.3, 95% CI=1.0-1.6, p<0.02), induction of labour (RR=2.2, 95% CI=1.0-3.4, p<0.03) and birth weight>3.5 kg (RR=2.2, 95% CI=2.0-2.4, p<0.001). Deliveries complicated by arrest of descent resulted in cesarean section in 67% and 34% vaginal delivery.Conclusions: In this era of increased public awareness and medicolegal events it is very crucial to assess and evaluate every woman in labor and to identify in advance the possibility of arrest in advanced labor so that a timely obstetric intervention possibly Cesarean section can prevent unnecessary maternal- fetal complications.

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Section: Introductionmentioning

confidence: 99%

Prediction of caesarean section for arrest of descent during the second stage of labour

Samal

Rathod

2017

Int J Reprod Contracept Obstet Gynecol

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“…Labour is a balance between the forces required to expel the infant and the resistance of the cervix to deliver (Olah & Nielson 1994). Failure to progress in labour is thought to occur from an abnormality in the passages, the powers and the passenger (Byrne et al 1993). It is unlikely that any intervention applied in isolation will affect the remorselessly increasing caesarean section rate (Hunter 1993).…”

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confidence: 99%

Failure to progress in the management of labour

Sarkar

1995

BJOG

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CORRESPONDENCE 265based on all available data, should be employed. Lilford (1989) has highlighted the confusion which has arisen from failure to distinguish between these different types of classification system. Although we did allude to this point in our discussion, it should have been made with greater clarity.In our paper we did not suggest that nonproteinuric preeclampsia does not progress to proteinuric pre-eclampsia, and we are surprised at this interpretation of our data. We made the point that the origins of pre-eclampsia are in early pregnancy and that proteinuria is a late manifestation of the condition, and that there will inevitably be a proportion of women with mild or slowly progressive disease who do not develop the full syndrome (i.e., women with hypertension but without proteinuria). We have shown that obstetric outcome is poor in these women relative to normotensive women. We do not accept that this outcome data from postnatally classified women are "of limited value". Indeed, it provides clear evidence which supports the use of the blood pressure threshold and increment suggested by Redman and Jefferies in developing a final classification system for pre-eclampsia. Cancer associated human papillomavirus perinatal transmission and persistence Sir,We have read with interest the paper by Pakarian et al. (Vol 101, June 1994) regarding the perinatal transmission and persistence of human papillomaviruses. Whilst this was an interesting and worthwhile study, we feel obliged to make some comments regarding their conclusions.While performing the polymerase chain reaction (PCR) analysis, the authors took into account the inherent problem of false positivity and also ensured against a false negative result caused by a lack of target DNA by using P-globulin (Saiki et al. 1986). Those working regularly with the PCR system concede that by far the most common problem is a false positive rather than a false negative result, yet Pakarian and his colleagues attribute their inability to detect HPV DNA in the mother when the newborn was positive for the genome at 24 hours (buccal swab) and at six weeks (one buccal, one vulval) to a false negative result rather than the more likely false positive result. The other main reason for a false negative result is that there are negative inhibitors in the reaction, and insufficient PCR amplification. There appears to be no attempt to elucidate further if such situations have arisen either by the use of nested primers (Sahu 1989), a second round PCR with nested primers (Thien 1989; Innis et al. 1990) or use of a known amount of target DNA and repeating the PCR.Furthermore, only six of the newborns had genital infection detected at 24 hours, and none of these persisted by the six week assessment. The one newborn with genital wart virus infection at the six week assessment did not have the virus detected at 24 hours. The authors postulate that the virus may be present higher up the genital tract as the samples were taken from the vulva, yet to out knowledge HPV DNA has...

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