The continuum of a prolonged labor and a second stage cesarean delivery

OBJECTIVE

To investigate the association of the timing of primary cesarean delivery with the progress of labor and the operative delivery rate at the subsequent successful trial of labor.

METHODS

A retrospective study of women with a primary cesarean and subsequent term cephalic vaginal delivery in two medical centers. Cesarean deliveries were classified as planned, intrapartum first stage or intrapartum second stage. The second stage duration and the operative delivery rate, adjusted to epidural analgesia and oxytocin use, were compared between the groups. χ² and Kruskal-Wallis tests were used for analysis of categorical and continuous variables, respectively.

RESULTS

The study population included 1166 women. The second stage of labor was longer when the previous cesarean delivery occurred during the second stage compared to planned or first stage (1.7 h vs 1.3 h vs 1.3 h, p = 0.005). The proportion of operative deliveries was greater among women with previous cesarean in the second stage of labor (39.6%), compared to planned (26.9%) or first stage (28.8%), p = 0.006.

CONCLUSION

Cesarean delivery at the second stage of labor is associated with a longer second stage and an increased operative delivery rate at the subsequent vaginal birth. Our findings attest to the delicate passenger-passage relations that can exist in some parent-couples.

Practising with an obstetric box and a dummy improves students' confidence in performing obstetric procedures involving large animals

BACKGROUND

Usually, the teaching process of eutocia and dystocia on large animals is supported by the use of photographs, videos, animations and texts with descriptions of the births and the difficulties of delivery, being not enough to provide an effective experiential learning process in veterinary obstetrics. This study aimed to evaluate the learning and the student's perception of the impact of using an obstetric box and an articulated dummy as a teaching resource in a dynamic game methodology on learning obstetric diagnoses and procedures.

METHODS

Veterinary students attended a theoretical class about foetal disposition and obstetrics manoeuvres and later attended a practical class about the same topic using an obstetric box and an articulated foal dummy. All students were evaluated by questionnaires and tests after each class addressing the topics of the objectives of this study.

RESULTS

The teaching methodologies facilitated students' understanding of how to perform obstetric manoeuvres and significantly increased their test scores and their confidence to execute obstetric procedures in a real professional situation in the future.

CONCLUSION

The use of obstetric box and dummy combined with a dynamic game methodology in practical classes stimulated the students' learning process and helped graduate more confident professionals.

Caesarean section followed by ovariohysterectomy in a Bangladeshi domestic cat: A surgical intervention for management of dystocia due to partial primary uterine inertia

Background

The incidence of dystocia in cats is relatively low compared to that in other pet and farm animals. However, when dystocia occurs in cats, manual, medicinal or surgical intervention is required.

Objectives

Here, we report a caesarean section (C‐section) in a Bangladeshi domestic cat that suffered from dystocia due to partial primary uterine inertia.

Methods

A Bangladeshi domestic queen cat was presented to the Veterinary Teaching Hospital (VTH) with signs of dystocia. The queen had given birth to one kitten 36 hr earlier; however, newborn died 30 min after birth. She was unable to deliver the remaining fetuses. The cat had gone off feed, appeared depressed, had a severely enlarged abdomen and showed no straining efforts. On palpation, bony‐like structures were felt in both sides of the abdomen. Ultrasonographic (USG) examination was carried out, which confirmed the presence of two fetuses, one fetus in each uterine horn. No fetal movements could be detected. The cat was diagnosed with dystocia due to partial primary uterine inertia.

Results

A C‐section was performed, and two emphysematous, putrefied and large dead kittens were removed. The uterus was found to be severely decomposed and foul smelling; therefore, an ovariohysterectomy was carried out to prevent development of maternal toxaemia and septicaemia. The queen recovered fully.

Conclusion

To the best of our knowledge, we report here, for the first time, a successful C‐section followed by an ovariohysterectomy in a Bangladeshi domestic cat, suffering from severe dystocia due to partial primary uterine inertia for >36 hr.

COMPLICATIONS ASSOCIATED WITH PREGNANCY AND PARTURITION IN AFRICAN WHITE-BELLIED PANGOLINS (PHATAGINUS TRICUSPIS)

There are no studies to date on the normal reproductive physiology of African white-bellied pangolins (Phataginus tricuspis). As a reclusive species, little is known about normal gestation, successful parturition, and potential complications during pregnancy. Ten female P. tricuspis were diagnosed as pregnant and monitored under professional care. Five developed complications during pregnancies or during parturition and are detailed in this case series. Dystocia occurred in two dams each, with malposition of a singleton fetus. Both dams were successfully treated with surgical intervention by caesarian section. Of the two individuals, one fetus was nonviable, but the other neonate survived and was reared by the dam to weaning. A third pregnant female died during pregnancy from septicemia resulting in death of the preterm fetus. The two additional dams of the five gave birth to full-term neonates. One fetus was stillborn with evidence of fetal distress, and the other died immediately after birth (perinatal death) with undetermined etiology. Based on this case series, complications associated with pregnancy occur in P. tricuspis, indicating the need for further study and close monitoring during impending parturition.

REVIEW OF VETERINARY INTERVENTION IN REPRODUCTION OF CAPTIVE WESTERN LOWLAND GORILLAS (GORILLA GORILLA GORILLA) FROM 1996 TO 2016

In order to gain an understanding of the frequency of veterinary intervention during the periparturient period of western lowland gorillas (Gorilla gorilla gorilla) in captivity between 1996 and 2016, a survey was sent to institutions associated with the Association of Zoos and Aquariums' Gorilla Species Survival Plan^®. A total of 193 births were reported during the survey period, from 51/53 institutions. There were six incidences of prolonged labor (longer than 6 hr; 3%), six cases of cesarean section (3%), and three incidences of veterinary intervention that did not involve a cesarean section (2%). Fifty-one gorilla neonates (26%) were assist-reared (required intervention lasting longer than 24 hr). Out of 51 attempts to reintroduce neonates to dams or surrogates, 42 were accepted (82%), while nine attempts (18%) were deemed failures. The age group with the highest rate of maternal or surrogate acceptance after reintroduction was between 6 and 12 mo of age. Compared to data from a 1981 survey, the percentage of assist-reared gorillas decreased from 64% to 26%. Results show that veterinary intervention in the periparturient period is low, and there is a high rate of acceptance of neonates by either the dam or a surrogate after intervention. Advances in captive husbandry and veterinary knowledge have led to a reduced risk of veterinary intervention during gorilla parturition; however, the long-term effects on behavioral development of the neonate should be considered before removal of the infant from the dam for any period of time.

Administration of ketoprofen affects post-partum lying behaviours of Holstein dairy cows regardless of whether parturition is assisted

BACKGROUND

Assistance at parturition in cattle is common. Although analgesia is commonly provided, its value in terms of welfare improvement is not known. Few previous studies include both parturition assistance and analgesic treatment status as well as appropriate control groups in a factorial design.

METHODS

Seventy-two Holstein cattle (37 assisted and 35 unassisted) were randomly allocated to receive a single dose of the NSAID ketoprofen or a saline placebo within 3 h of parturition. Detailed behavioural observations allowed a time budget to be constructed for each cow for 48 h post-partum.

RESULTS

Cows experiencing assisted parturition spent more time in lateral recumbency (overall and with the head rested) (p < 0.05) - an infrequently adopted posture suggestive of illness or pain. Cows treated with ketoprofen spent less time in lateral recumbency (p < 0.05) (overall and with the head rested); this was independent of assistance status, and lateral recumbency was not affected by the interaction between assistance and treatment status. Additionally, cows treated with ketoprofen spent more time with the head rested when in sternal recumbency (p = 0.009) - a behaviour associated with comfortable resting.

CONCLUSION

These differences in lying postures exhibited by cows receiving ketoprofen analgesia suggest that, regardless of whether parturition is assisted, a single dose of ketoprofen in the immediate post-partum period has the potential to improve cow comfort in the first 48 h post-partum.

Dynamic External Pelvimetry Test in Third Trimester Pregnant Women: Shifting Positions Affect Pelvic Biomechanics and Create More Room in Obstetric Diameters

Dystocia in labor is still a clinical challenge. The "contracted pelvis" is the absence of pelvic mobility, which leads to fetal-pelvic disproportion, obstructed labor, and operative delivery. Maternal pelvis biomechanics studies by high technological techniques have shown that maternal shifting positions during pregnancy and labor can create more room in the pelvis for safe delivery. The external and internal pelvic diameters are related. The present study aims to evaluate the external obstetric pelvic diameters in shifting positions using a clinical technique suitable for daily practice in every clinical setting: the dynamic external pelvimetry test (DEP test). Seventy pregnant women were recruited, and the obstetric external pelvic diameters were measured, moving the position from kneeling standing to "hands-and-knees" to kneeling squat position. Results showed modification of the pelvic diameters in shifting position: the transverse and longitudinal diameters of Michaelis sacral area, the inter-tuberosities diameter, the bi-trochanters diameter, and the external conjugate widened; the bi-crestal iliac diameter, the bi-spinous iliac diameter, and the base of the Trillat's triangle decreased. The test showed good reproducibility and reliability. Linear correlations were found between diameters and between the range of motion of the diameters. The maternal pelvis is confirmed to modify the diameters changing its tridimensional shape. The pelvic inlet edge's inclination is inferred to be modified, facilitating the fetal descend. The pelvic outlet enlarged the transverse diameter, facilitating birth. The DEP test estimates the pelvic diameters' modification with postural changes, as magnetic resonance (MR) and computational biomechanics studies have demonstrated.

Sensitivity and specificity of a tail-activity measuring device for calving prediction in dairy cattle

Efficient calving surveillance is essential for avoiding stillbirth due to unattended dystocia. Calving sensors can help detect the onset of parturition and thus ensure timely calving assistance if necessary. Tail-raising is an indicator of imminent calving. The objective of this study was to evaluate a tail-mounted inclinometer sensor (Moocall Ltd., Dublin, Ireland) and to monitor skin integrity after sensor attachment. Cows (n = 157) and heifers (n = 23) were enrolled at 275 d post insemination, and a sensor was attached to each cow's tail. Investigators checked for signs indicating the onset of stage II of parturition, verified the position of the sensor, and evaluated the skin integrity of the tail above and below the sensor hourly for 24 h/d. We used 5 different intervals (i.e., 1, 2, 4, 12, and 24 h until calving) to calculate sensitivity and specificity. Sensors continuously remained on the tail (i.e., within 3 cm of the initial attachment position) after initial attachment until the onset of calving in only 13.9% of animals (n = 25). Sensors were reattached until a calving event occurred (51.6%) or the animal was excluded for other reasons (34.4%). In 31 animals the sensor was removed because the tail was swollen or painful. Heifers were significantly less likely than cows to lose a sensor but more likely to experience tail swelling or pain. Depending on the interval preceding the onset of parturition, sensitivity varied from 19 to 75% and specificity from 63 to 96%.

Ggps1 deficiency in the uterus results in dystocia by disrupting uterine contraction

Dystocia is a serious problem for pregnant women, and it increases the cesarean section rate. Although uterine dysfunction has an unknown etiology, it is responsible for cesarean delivery and clinical dystocia, resulting in neonatal morbidity and mortality; thus, there is an urgent need for novel therapeutic agents. Previous studies indicated that statins, which inhibit the mevalonate (MVA) pathway of cholesterol synthesis, can reduce the incidence of preterm birth, but the safety of statins for pregnant women has not been thoroughly evaluated. Therefore, to unambiguously examine the function of the MVA pathway in pregnancy and delivery, we employed a genetic approach by using myometrial cell-specific deletion of geranylgeranyl pyrophosphate synthase (Ggps1) mice. We found that Ggps1 deficiency in myometrial cells caused impaired uterine contractions, resulting in disrupted embryonic placing and dystocia. Studies of the underlying mechanism suggested that Ggps1 is required for uterine contractions to ensure successful parturition by regulating RhoA prenylation to activate the RhoA/Rock2/p-MLC pathway. Our work indicates that perturbing the MVA pathway might result in problems during delivery for pregnant females, but modifying protein prenylation with supplementary farnesyl pyrophosphate or geranylgeranyl pyrophosphate might be a strategy to avoid side effects.

Factors associated with ewe and lamb survival, and subsequent reproductive performance of sheep undergoing emergency caesarean section

Clinical records of all 212 ewes undergoing emergency caesarean surgery at a veterinary teaching hospital between January 2008 and December 2019 were evaluated retrospectively. Their age ranged from 1 to 10 years (median = 4 years), with German merino the predominant breed (48.1% of cases). The most frequently diagnosed indications were insufficient cervical dilatation (n = 94, 44.3%), uterine torsion (n = 50, 23.6%), foetopelvic disproportion (n = 31, 14.6%) and vaginal prolapse intra partum (n = 11, 5.2%). Fifty-four (25.5%) of the 212 ewes additionally suffered from one or more concurrent, pre-existing conditions. Overall ewe mortality until hospital discharge was 10.8% (23/212), and 3.8% (n = 6) for the 158 ewes without a history of concurrent disorders. Mortality during hospitalization increased to 31.5% (17/54) for those with pre-existing conditions. Total lamb mortality was 49.1% (173/352) until hospital discharge. Pre-existing conditions (p = .001) and the presence of post-surgical complications (p = .025) were identified as significant factors influencing dam mortality, while delayed presentation for veterinary attention with an observed duration of labour of >12 hr was identified as the most influential factor on total lamb mortality (p = .010). The presence of dead or emphysematous foetuses was not significant for ewe mortality. Follow-up information on further outcomes was available for 156 (82.5%) of the 189 discharged ewes. Eighty-nine animals (57.1%) were re-bred in the following season and achieved a 93.3% (83/89) pregnancy rate, while the remainder had either been slaughtered (n = 56, 35.9%), sold (n = 5, 3.2%) or had died of unknown causes (n = 3, 1.9%). The subsequent incidence of dystocia was 15.6% (n = 12) in the 77 ewes with available information on lambing ease. Adequate management of underlying conditions and timely intervention are important factors for best possible short-term outcomes. In the long term, the subsequent pregnancy rate was good and the incidence of subsequent dystocia was within the normal range.

Dystocia after Unwanted Mating as One of the Risk Factors in Non-Spayed Bitches-A Retrospective Study

Simple Summary

This is an article presenting the clinical data on the incidence of difficult labour in dogs being mated without owners’ intentions (accidental mating, unplanned breeding). Despite the widespread availability of spaying and its safety, unplanned and unwanted pregnancies in dogs are still a frequent concern. Unfortunately, in 8.3% (76/914) of cases, they result in difficult labour and deadly complications for the dam and her litter. Better owners’ education about the importance of neutering their pets and understanding of the benefits of early spaying by animal shelter managements and by breeders selling pets might improve the situation in the future. On the other hand, in such cases, it seems to be justified to advise the termination of pregnancy through spaying or the use of abortifacient drugs, despite the ethical concerns, because waiting for natural delivery could cause unnecessary suffering both to the bitch and her unborn puppies.

Abstract

This article presents a retrospective study on dystocia cases in bitches that were unintentionally mated and carried an unwanted pregnancy in the last 39 years. The evaluated medical records include 76 cases of difficult labour, which is 8.3% of 914 dystocia cases recorded during the period. Of these bitches, 38.2% (29/76) were 8 years, and 18.4% (14/76) were younger than 12 months. In 67/76 cases (88.2%), conservative (pharmacological and manual) obstetrical assistance proved to be unsuccessful, and caesarian section (CS) had to be performed, in contrast to the remaining recorded cases of dystocia (in which the pregnancy was intended and expected) when CS was performed significantly less often, in 71.5% (599/838) of cases. In unplanned pregnancies, 46.6% (110/236) of delivered pups were dead compared to only 26.4% (864/3273) dead pups in planned pregnancies. p value < 0.05 was considered significant. Despite the widespread availability of the spaying procedure nowadays and its safety, unplanned and unwanted pregnancies in dogs are still a concern in clinical practice. However, throughout the years investigated here, we observed an apparent decrease in the occurrence of dystocia after unintended mating, with much less recorded cases from year 2004 (71 vs. 5). Most probably, this is due to the increasing popularity of surgical castration in both females and males, and rising societal awareness of its importance, giving hope that some improvement in the welfare of dogs has already been achieved.

Comparison of the Mean Minimum Dose of Bolus Oxytocin for Proper Uterine Contraction during Cesarean Section

BACKGROUND

Cesarean section is the most common midwifery operation. The aim of this study is to determine the mean minimum dose of bolus oxytocin for proper uterine contraction during cesarean section.

METHODS

Patients were divided into two groups: elective cesarean section (n=41) and cesarean section due to difficulty in labor (n=42 patients). Patients underwent spinal anesthesia and oxytocin infusion was begun at 30 drops per minute (20 units of oxytocin per 1000 cc serum), and was also administered as a half-dose in cc to achieve effective contraction of the uterus. Meanwhile, the information of patients including systolic and diastolic blood pressure (SBP and DBP), heart rate and amount of bleeding during the operation was recorded in a questionnaire.

RESULTS

In the elective cesarean section group, the average SBP was about 117.10mmHg, average DBP 70.50 mmHg, the amount of bleeding during surgery was 623.63mL, and heart rate was 88.88bpm. In the cesarean section group due to difficulty in labor progress, SBP was 113.5 mmHg, DBP 62.69 mmHg, and bleeding was 573.81mL. In addition, 9 patients in the elective group and 3 patients in the lack of progress group, did not require bolus oxytocin. In the lack of a progress group, 8 patients needed more than 5 doses of oxytocin. In addition, about 10 (12%) of all patients had no side effects, and hypotension.

CONCLUSION

Given that, the minimum effective dose of oxytocin in the elective cesarean section was 1IU, and in those in labor progress was 1-1.5IU, less oxytocin administration represents lesser side effects. It is recommended that patients who are candidates of cesarean section should be administered 1.5IU of oxytocin in the form of bolus.

Quantifying the Forces Applied During Manually and Mechanically Assisted Calvings in Beef Cattle

Dystocia is a leading cause of calf mortality, yet there is little available information quantifying the duration and forces applied to assisted deliveries. Objectives of this study were to: (1) develop a method to measure the magnitude and duration of various forces applied to a calf during calving assistance, and (2) quantify the forces applied to beef calves during manual or mechanical calving assistance. Twenty-five primiparous dams requiring calving assistance were enrolled. Calvings were assisted by manual (1 or 2 people pulling) or mechanical (calf extractor) delivery. A set of modified obstetric chains with integrated force measuring devices (Calving Assistance Force Logger; CAF-Log) were applied to the calf for delivery. The CAF-Log system was calibrated using known masses ranging from 25 to 200 kg in increasing increments of 25 kg. Duration of the assisted delivery and force parameters (peak force applied to one leg, peak force applied to both legs, cumulative force, and maximum jerk force) were described and assessed for their associations with method of delivery and ranch. Median duration was 112.6 s (IQR: 88.4–149.7) for manual and 312.6 s (IQR: 221.6–462.3) for mechanical deliveries. Mean peak force applied to one leg was 56.9 kg (SD: 22.9) for manual and 126.8 kg (SD: 48.2) for mechanical deliveries. Mean peak force applied to both legs was 95.4 kg (SD: 34.1) for manual and 188.6 kg (SD: 83.9) for mechanical deliveries. Median cumulative force was 178.3 kg min (IQR: 21.1–38.8) for manual and 380.6 kg min (IQR: 252.1–581.3) for mechanical deliveries. The maximum jerk force for manual deliveries was 36.6 kg/s (IQR: 21.1–38.8) and 77.2 kg/s (IQR: 60.9–97.1) for mechanical deliveries. An interaction occurred between ranch and method of delivery for peak force applied to one leg, peak force applied to both legs, and cumulative force. The CAF-Log system demonstrated that significantly greater forces were applied to mechanically delivered calves compared to manually delivered calves and could be used in future studies to investigate forces applied to a calf during calving assistance and their impacts on cow and calf well-being.

Evidence-based labor management: first stage of labor (part 3)

There are several interventions during the first stage of labor that have been studied. Vaginal disinfection with chlorhexidine cannot be recommended. Intrapartum antibiotic prophylaxis is recommended for group B streptococcus-positive women. Antibiotic therapy can be considered in women with term prelabor rupture of membranes whose latency is expected to be >12 hours. Aromatherapy with essential oils through inhalation or back massage can be considered. Immersion in water can be considered. Oral restriction of fluid or solid food is not recommended. In the setting of oral restriction, intravenous fluid containing dextrose at a rate of 250 mL/h is recommended. Upright positions and ambulation are recommended in women without regional anesthesia, and women with regional anesthesia can adopt whatever position they find most comfortable and choose to ambulate or not ambulate. Continuous bladder catheterization cannot be recommended. There is no recommended frequency of cervical examinations or sweeping of membranes. The use of a partogram cannot be recommended as a routine intervention. Routine use of the peanut ball cannot be recommended. Antispasmodic agents cannot be recommended. Routine amniotomy alone in normally progressing spontaneous first stage of labor cannot be recommended. Oxytocin augmentation is recommended to shorten the time to delivery for women making slow progress in spontaneous labor, and higher doses of oxytocin can be considered. Early intervention with oxytocin and amniotomy for the prevention and treatment of dysfunctional or slow labor is recommended. Routine use of intrauterine pressure catheter and ultrasound cannot be recommended. Cesarean delivery for arrest should not be performed unless labor has arrested for a minimum of 4 hours with adequate uterine activity or 6 hours with inadequate uterine activity in a woman with rupture of membranes, adequate oxytocin, and ≥6 cm cervical dilation.

Colostral and foal serum immunoglobulin G levels and associations with perinatal abnormalities in heavy draft horses in Japan

The purpose of this study was to elucidate the colostral and foal serum immunoglobulin G (IgG) concentration values in heavy draft horses in Japan and to examine the effects of peripartum mare condition on colostral immunity. Colostrum was obtained 1 hr after foaling (pre-suckling; n=178). Blood was collected from the jugular vein of the foals (n=147) at 24 to 48 hr after birth. The foaling statuses of 73 mares were recorded. The average colostral IgG concentration was 10,540 ± 3,190 mg/dl (median=10,928; range 1,434−17,514 mg/dl). The average serum IgG concentration obtained from neonatal foals 24 to 48 hr after birth was 1,750 ± 919 mg/dl (median=1,890; range 0−3,510 mg/dl). Although colostral IgG did not differ between the normal foaling mare (n=59) and dystocial mare (n=14), foal serum IgG was lower in foals born in dystocia than in foals in normal foaling (P<0.05). This study demonstrates reference values for colostral and foal serum IgG specific to heavy draft horses in Japan and suggests that dystocia may interfere with the acquisition of colostral immunity in neonatal foals.

Usefulness of pathological examinations of the central nervous system for monitoring and controlling perinatal lamb mortality

Correct diagnosis of cause of death is necessary to suggest the most effective management interventions to reduce perinatal lamb mortality. Haemorrhage on the surface of the brain has been used as a field diagnostic tool to allocate lambs to a cause of death category, but the usefulness of this method was unclear. This study aimed to evaluate whether gross pathology was related to neuronal death and whether haemorrhage of the central nervous system (CNS) was distinct between differing causes of death, enabling indicators to be used in field diagnoses. Lambs dying from natural causes (n = 64) and from euthanasia (n = 7) underwent postmortem examination, then the brain and spinal cord were extracted and examined histologically. Histological changes consistent with neuronal death were not detected in any lamb. Haemorrhage of the meninges and/or parenchyma of the CNS occurred in all lambs. The age of the haemorrhage indicated that it occurred near the time of death in most lambs. Dilation of blood vessels varied in severity but appeared to be unrelated to causal diagnosis, severity of subcutaneous oedema, breathing or milk status. Moderate or severe dilation of blood vessels and haemorrhage of the CNS did not occur in all lambs with alternative clear indicators of dystocia and occurred in all death classifications, so it could not be used as diagnostic indicators for classification of cause of death. Dilation and haemorrhage were unrelated to neuronal damage and may have been artefactual. In conclusion, haemorrhage of the CNS was not indicative of neuronal damage and could not be used to distinguish between lambs with clear indicators of differing causes of death, so it is not recommended as a field diagnostic tool.

Percloacal Ovocentesis in the Treatment of Avian Egg Binding: Review of 20 Cases

Egg binding is one of the most commonly diagnosed reproductive disorders in avian medicine. Often, egg binding is caused by multiple factors, including inappropriate diet and husbandry, reproductive tract pathology, and/or systemic disease. Treatment of egg binding can include medical management or egg removal either percloacal or through surgical means. Percloacal ovocentesis is a commonly described technique in avian practice. The aim of this study was to consider the signalment, success of facilitating egg removal, associated complications, and outcome when percloacal ovocentesis was performed. Data were obtained from an avian first-opinion and referral center in the United Kingdom over a 10-year period. Of the 20 cases that met the inclusion criteria, the following orders were represented (Psittaciformes (n = 15; 75%), Anseriformes (n = 1; 5%), Accipitriformes (n = 2; 10%), and Strigiformes (n = 2; 10%) were represented. Patient age ranged from 2 to 26 years, with an average age of 9.4 years. Percloacal ovocentesis successfully facilitated egg removal in 16 of 20 cases (80%) with no complications observed in 14 of 20 cases (70%). Percloacal ovocentesis is not without potential complications; eggs fragmented in 2 of 20 (10%) cases, with coelomic penetration and coelomitis suspected in a single case (5%). Careful risk assessment and case selection should be performed before the use of this technique. In cases that are refractory to medical management, and in which surgical intervention is high risk or not a feasible option, percloacal ovocentesis can facilitate successful resolution of egg binding in an avian patient and should be considered as a viable treatment option.

Obstetric Paralysis: Who is to blame? A systematic literature review

Obstetric palsy is classically defined as the brachial plexus injury due to shoulder dystocia or to maneuvers performed on difficult childbirths. In the last 2 decades, several studies have shown that half of the cases of Obstetric palsy are not associated with shoulder dystocia and have raised other possible etiologies for Obstetric palsy. The purpose of the present study is to collect data from literature reviews, classic articles, sentries, and evidence-based medicine to better understand the events involved in the occurrence of Obstetric palsy. A literature review was conducted in the search engine PubMed (MeSH - Medical Subject Headings) with the following keywords: shoulder dystocia and obstetric palsy , completely open, boundless regarding language or date. Later, the inclusion criterion was defined as revisions. A total of 21 review articles associated with the themes described were found until March 8, 2018. Faced with the best available evidence to date, it is well-demonstrated that Obstetric palsy occurs in uncomplicated deliveries and in cesarean deliveries, and there are multiple factors that can cause it, relativizing the responsibility of obstetricians, nurses, and midwives. The present study aims to break the paradigms that associate Obstetric palsy compulsorily with shoulder dystocia, and that its occurrence necessarily implies negligence, malpractice or recklessness of the team involved.

Clinical utility of plasma progesterone and blood and plasma glucose concentrations in predicting parturition in Holstein cows

An accurate, practical, and low-cost method for predicting parturition is urgently needed in the dairy industry. The objective of this study was to evaluate changes in plasma progesterone concentration ([prog]) and glucose concentration in whole blood ([gluc]_b) and plasma ([gluc]_p) as predictors of parturition within 6, 12, and 24 h in primiparous and multiparous Holstein cows. Blood samples were obtained daily at approximately 0900 h from 34 primiparous and 72 multiparous Holstein cows in late gestation and the time of calving recorded to the nearest hour. Plasma [prog] was measured using an ELISA, and [gluc]_b and [gluc]_p using a low-cost point-of-care glucose meter. The optimal cut-point for predicting parturition was determined using binomial logistic regression with general estimating equations, because the data set consisted of repeated measures for each cow. Diagnostic test performance was evaluated by comparing the area under the receiver operating characteristic curve (AUC) and calculating the sensitivity, specificity, and κ at the optimal cut-point for predicting parturition. Plasma [prog] was the most accurate predictor of parturition within 24 h (AUC = 0.96) and 12 h (AUC = 0.93), whereas [gluc]_b was the most accurate predictor of parturition within 6 h (primiparous, AUC = 0.96; multiparous, AUC = 0.86). We conclude that a decrease in plasma [prog] is currently the most accurate test for predicting calving within 24 h. Measurement of [gluc]_b is a promising new test for the cow-side prediction of parturition in dairy cows due to its accuracy, practicality, and low cost.

Estimating the Mobility of the Michaelis Sacral Rhombus in Pregnant Women

Pelvic mobility is the cornerstone of an adequate birth canal for safe childbirth, and midwives invite pregnant women to assume loading positions to facilitate delivery. Biomechanics asserts that pelvic space changes in shifting positions from erect to the squat position. The current standard practice in obstetrics and osteopathy provides a qualitative observational assessment of the dimension of Michaelis sacral rhombus in shifting positions; a previous report presented a clinical method and instrument to estimate the pelvic range of motion through finger contact on bone landmarks. The present study aims to match the measurement of the diameters of the sacral area of Michaelis from skin marks with the amount from bone landmarks. Methods estimate the sacral area from 100 pregnant women in the late trimester, considering the dimension of the diameters, the range of motion, and the patterns of mobility. Differences resulted in the methods: measuring the skin marks in shifting positions revealed a not significant difference between starting position and squat position. The measurements through the finger contact on the bone landmarks seem to be adequate to estimate pelvic mobility fulfilling the expectation from biomechanics literature.

Secular changes in body height predict global rates of caesarean section

The massive global variation in caesarean-section (C-section) rate is usually attributed to socio-economic, medical and cultural heterogeneity. Here, we show that a third of the global variance in current national C-section rate can be explained by the trends of adult body height from the 1970s to the 1990s. In many countries, living conditions have continually improved during the last century, which has led to an increase in both fetal and adult average body size. As the fetus is one generation ahead of the mother, the fetus is likely to experience better environmental conditions during development than the mother did, causing a disproportionately large fetus and an increased risk of obstructed labour. A structural equation model revealed that socio-economic development and access to healthcare affect C-section rate via multiple causal pathways, but the strongest direct effect on C-section rate was body height change. These results indicate that the historical trajectory of socio-economic development affects-via its influence on pre- and postnatal growth-the intergenerational relationship between maternal and fetal dimensions and thus the difficulty of labour. This sheds new light on historic and prehistoric transitions of childbirth and questions the World Health Organization (WHO) suggestion for a global 'ideal' C-section rate.

Potential Impact of Guidelines for the Prevention of Cesarean Deliveries in a Contemporary Canadian Population

OBJECTIVE

This study sought to describe how the implementation of recent labour guidelines may affect the cesarean delivery rate in a population in Alberta.

METHODS

This retrospective study was conducted on primiparous women who were in labour with singleton term fetuses with cephalic presentation in Alberta from 2007 to 2016 (n = 181 738), and it used data from a perinatal database. Modelled cesarean delivery rates were calculated to determine the potential impact of the recent guidelines on the cesarean delivery rate by using the percentage of cesarean deliveries that occurred outside the threshold of the recent labour guidelines.

RESULTS

A total of 21.7% of the cesarean deliveries for dystocia occurred outside of the guidelines related to the first stage of labour arrest for spontaneous labour (n = 9282), and 45.4% occurred outside of the guidelines related to the first stage of labour arrest for induced labours (n = 11 712). A total of 69.0% of the cesarean deliveries for dystocia occurred outside of the failed induction of labour guidelines (n = 4921), and 55.4% occurred outside of the second stage labour arrest guidelines (n = 6632). Assuming that the labour arrest guidelines are effective at reducing the cesarean delivery rate 25% of the time, the cesarean delivery rate for primiparous women in labour would be reduced from 22.5% to 20.7%. Assuming a 75% adherence/effectiveness rate, the cesarean delivery rate would be reduced to 17.1%.

CONCLUSION

The recent labour guidelines have the potential to have a substantial impact on the intrapartum cesarean delivery rate in primiparous women with singleton fetuses with cephalic presentation at term if the guidelines are put into practice.

A retrospective review of facility-level obstetric complications and stillbirths in southern Haiti, 2013 - 2016

Objective.

To assess the incidence of obstetric complications—eclampsia, dystocia, cesarean section, postpartum hemorrhage, and stillbirths—in hospitals in southern Haiti in 2013 – 2016 and to discuss implications for improvements to the surveillance of birth outcomes.

Methods.

This was a cross-sectional, retrospective study of data for 32 442 deliveries recorded in 2013 – 2016 by the Integrated Monitoring, Evaluation, and Surveillance System for facilities across three departments and one high-volume hospital in southern Haiti. Annual incidence rates of eclampsia, dystocia, cesarean section, postpartum hemorrhage, and stillbirths (both macerated and fresh) were calculated.

Results.

The incidence of eclampsia in the study sample was 2% – 3% and of dystocia approximately 5%, comparable to elsewhere in Haiti and other low-income countries. Cesarean delivery rates averaged about 15% annually. Postpartum hemorrhage rates were lower than published data from similar settings. Stillbirth rates ranged from 30 – 62 per 1 000 births at all facilities, higher than previously recorded by the country’s population surveys. The rates of macerated stillbirths were remarkably high, close to 50% of total stillbirths, indicating severe delays in seeking or receiving emergency obstetric care.

Conclusions.

This study provides important benchmarks for the current burden of preventable labor- and delivery-related complications in Haiti. Surveillance data suggest an urgent need for the management of hypertensive disorders during pregnancy, timely cesarean sections for dystocia, and management and treatment of postpartum hemorrhage in Haiti. Frequent data reviews may help address facility-specific bottlenecks.

A Postural Approach to the Pelvic Diameters of Obstetrics: The Dynamic External Pelvimetry Test

In recent years, there has been a renewed interest in internal and external pelvimetry, in relation to the diagnosis of dystocia from a "contracted pelvis." Dystocia is still one of the causes of maternal-fetal morbidity and mortality in the world. The main cause is the fetal-pelvic disproportion, of which mechanical dystocia and contracted pelvis are most probably involved. Clinical pelvimetry was the diagnostic method of "contracted pelvis" and still seems to have its place in the clinical obstetric routine. Studies have been conducted in order to measure anatomical diameters and correlate them with operative or vaginal delivery. Some studies have been published regarding the diameters' variation with the shifting of the patient's posture. The positions used in the research for the analysis of changes in pelvis measurements are the same as those used for centuries to assist and promote childbirth.

This technical report is to define a method of measuring changes in classical pelvimetric external diameters in relation to the postural change of the subjects, taking into consideration the needs of the operators, the postural difficulties of pregnant women and the evidence acquired from instrumental research. It aims to propose a dynamic postural method suited to daily practice, according to the directives and principles of the classical external obstetric pelvimetry.

Myoma praevia and pregnancy

The association of myoma and pregnancy is becoming more frequent due to the increasing age of first pregnancy. It may affect the outcome of fertility, pregnancy, labor and peripartum course. A 37 years old patient was referred to our unit for discovering uterine leiomyoma at 37 weeks of pregnancy. Ultrasound screening showed a praevia isthmic leiomyoma measuring 16cm. A caesarean delivery was scheduled and a large interstitial isthmic uterine myoma measuring 25cm was found. Hysterectomy was corporeal. The post-operative and puerperium course was normal.