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Li H, Yang L, Peng J, Cheng W, Ma H, Wu S, Wen J, Zhao Y. Duration time of labor progression for pregnant women of vaginal birth after cesarean in Hubei, China. Ir J Med Sci 2024; 193:1351-1358. [PMID: 38169049 DOI: 10.1007/s11845-023-03600-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE There have been limited reports on the duration of labor progression in pregnant women undergoing vaginal birth after cesarean (VBAC). This study aimed to investigate the duration of labor progression during VBAC in Hubei, China. METHODS A total of 359 pregnant women undergoing VBAC were enrolled as the VBAC group, meeting the following criteria: singleton pregnancy, gestational age ≥ 37 weeks, live birth, history of cesarean delivery, and a willingness to attempt a vaginal delivery. At the same time, 359 primiparas successfully undergoing vaginal delivery were randomly enrolled in the control group at a 1:1 ratio. Subsequently, the durations of the first, second, and third stages of labor were comparatively analyzed between the two groups. RESULTS The duration of the first, second, and total stages of labor in the VBAC group was significantly shorter than that in the control group (p < 0.05). There was no significant difference in the duration of the third stage of labor between the two groups (p > 0.05). The amount of blood loss, the rate of postpartum hemorrhage (PPH), and episiotomy were higher in the VBAC group than in the control group (p < 0.05). The rate of labor analgesia and intrapartum fever in the VBAC group was significantly lower than that in the control group (p < 0.05). CONCLUSION The duration of labor progression of the first, second, and total stages of VBAC is shorter than that in primiparous women in our observation in China.
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Affiliation(s)
- Hao Li
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No. 745, Wuluo Road, Hongshan District, Wuhan, 430070, China
| | - Lijun Yang
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No. 745, Wuluo Road, Hongshan District, Wuhan, 430070, China
| | - Jing Peng
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No. 745, Wuluo Road, Hongshan District, Wuhan, 430070, China
| | - Wenxing Cheng
- Department of Gynaecology and Obstetrics, Wuhan University of Science and Technology, No. 2, Huangjiahu West Road, Hongshan District, Wuhan, 430065, China
| | - Hongwen Ma
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No. 745, Wuluo Road, Hongshan District, Wuhan, 430070, China
| | - Shiyao Wu
- Department of Gynaecology and Obstetrics, Wuhan University of Science and Technology, No. 2, Huangjiahu West Road, Hongshan District, Wuhan, 430065, China
| | - Jiao Wen
- Department of Gynaecology and Obstetrics, Wuhan University of Science and Technology, No. 2, Huangjiahu West Road, Hongshan District, Wuhan, 430065, China
| | - Yun Zhao
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No. 745, Wuluo Road, Hongshan District, Wuhan, 430070, China.
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Baruch Y, Gold R, Eisenberg H, Yogev Y, Groutz A. Is vaginal birth after cesarean section a risk factor for obstetric anal sphincter injury? Int J Gynaecol Obstet 2024. [PMID: 38803102 DOI: 10.1002/ijgo.15698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE To investigate whether women undergoing their first vaginal delivery after a previous cesarean section (secundiparous) are at increased risk for obstetric anal sphincter injury (OASI) compared with primiparous women. METHODS A retrospective cohort study of 85 428 women who delivered vaginally over a 10-year period in a single tertiary medical center. Incidence of OASI, risk factors, and clinical characteristics were compared between primiparous women who delivered vaginally and secundiparous women who underwent their first vaginal birth after cesarean section (VBAC). A multivariable logistic regression analysis was used to study the association between VBAC and OASI. RESULTS Overall, 36 250 primiparous and 1602 secundiparous women were enrolled, 309 of whom had OASI. The rates of OASI were similar among secundiparous women who had VBAC and primiparous women who underwent vaginal delivery (15 [0.94%] vs 294 [0.81%], P = 0.58). The proportions of third- and fourth-degree tears were also similar among secundiparous and primiparous women who experienced OASI (87% vs 91.5%, and 13% vs 8.5%, respectively, P = 0.68). Furthermore, the rates of OASI were similar in both study groups, although secundiparous women who underwent VBAC had higher rates of birth weights exceeding 3500 g (414 [25.8%] vs 8284 [22.8%], P = 0.016), and higher rates of vacuum-assisted deliveries (338 [21%] vs 6224 [17.2%], P < 0.001). A multivariate logistic regression analysis failed to establish a statistically significant association between VBAC and OASI (odds ratio 0.672, 95% confidence interval 0.281-1.61, P = 0.37). CONCLUSIONS No increased risk for OASI was found in secundiparous women who underwent VBAC compared with primiparous women at their first vaginal birth.
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Affiliation(s)
- Yoav Baruch
- Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Ronen Gold
- Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Eisenberg
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Yariv Yogev
- Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Asnat Groutz
- Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
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Karampas G, Witkowski M, Metallinou D, Steinwall M, Matsas A, Panoskaltsis T, Christopoulos P. Delivery Progress, Labor Interventions and Perinatal Outcome in Spontaneous Vaginal Delivery of Singleton Pregnancies between Nulliparous and Primiparous Women with One Previous Elective Cesarean Section: A Retrospective Comparative Study. Life (Basel) 2023; 13:2016. [PMID: 37895398 PMCID: PMC10608638 DOI: 10.3390/life13102016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
Trial of labor after cesarean (TOLAC) is an alternative to repeated cesarean for women with singleton pregnancy and one previous transverse lower segment cesarean section (LSCS), resulting in most cases being a successful vaginal birth after cesarean section (VBAC). The primary objective of this study was to examine if the progress and the duration of the active first stage and the second stage of labor in nulliparous women with singleton pregnancy, spontaneous start of labor and vaginal birth differ from primiparous women succeeding VBAC after one previous elective LSCS in a country with a low cesarean section and high VBAC rate. Secondary objectives were to compare labor interventions and maternal-neonatal outcomes between the two groups. METHODS This is a retrospective comparative study. Data were collected in a four-year period at the departments of Obstetrics and Gynecology at Kristianstad and Ystad hospitals in Sweden. Out of 14,925 deliveries, 106 primipara women with one previous elective LSCS and a spontaneous labor onset in the subsequent singleton pregnancy were identified. Of these women, 94 (88.7%) delivered vaginally and were included in the study (VBAC group). The comparison group included 212 randomly selected nulliparous women that had a normal singleton pregnancy, spontaneous labor onset and delivered vaginally. RESULTS The rate of cervical dilation during the active first stage of labor as well as the duration of the second stage did not differ between the two groups. When adjusting for cervical dilation at admission, there was no significant difference between the two groups regarding the duration of the active phase of the first stage of labor. No significant differences were found in maternal-neonatal outcomes between the two groups except for higher birth weight in the VBAC group. The use of epidural analgesia was associated with slower dilation rhythm over the duration of the active phase and second stage of labor, need for labor augmentation, postpartum bleeding and need for transfusion at higher rates, irrespective of parity when epidural was used. CONCLUSIONS Our study provides evidence that in women with one previous elective LSCS undergoing TOLAC in the subsequent pregnancy resulting in vaginal birth, the progress and duration of labor are not different from those in nulliparous women when labor is spontaneous and the it is a singleton pregnancy. The use of epidural was associated with prolonged labor, need for labor augmentation and higher postpartum bleeding, irrespective of parity. This information may be useful in patient counseling and labor management in TOLAC.
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Affiliation(s)
- Grigorios Karampas
- Department of Obstetrics and Gynecology, Skånes University Hospital, 21428 Malmö-Lund, Sweden
- Second Department of Obstetrics & Gynecology, Medical School, University of Athens “Aretaieion” Hospital, 11528 Athens, Greece
| | - Martin Witkowski
- Department of Obstetrics and Gynecology, Kristianstad/Ystad Community Hospitals, 27133 Ystad, Sweden
| | - Dimitra Metallinou
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
| | - Margareta Steinwall
- Department of Obstetrics and Gynecology, Kristianstad/Ystad Community Hospitals, 27133 Ystad, Sweden
| | - Alkis Matsas
- Second Department of Obstetrics & Gynecology, Medical School, University of Athens “Aretaieion” Hospital, 11528 Athens, Greece
| | - Theodoros Panoskaltsis
- Second Department of Obstetrics & Gynecology, Medical School, University of Athens “Aretaieion” Hospital, 11528 Athens, Greece
| | - Panagiotis Christopoulos
- Second Department of Obstetrics & Gynecology, Medical School, University of Athens “Aretaieion” Hospital, 11528 Athens, Greece
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Tzitiridou-Chatzopoulou M, Orovou E, Skoura R, Eskitzis P, Dagla M, Iliadou M, Palaska E, Antoniou E. Traumatic Birth Experience and Breastfeeding Ineffectiveness - a Literature Review. Mater Sociomed 2023; 35:325-333. [PMID: 38380281 PMCID: PMC10875946 DOI: 10.5455/msm.2023.35.325-333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/15/2023] [Indexed: 02/22/2024] Open
Abstract
Background A traumatic birth experience can affect the breastfeeding process and make it ineffective. The aim of this study was to identify the factors associated with breastfeeding ineffectiveness after birth trauma, through the world literature. There are several factors responsible for a traumatic birth experience, such as obstetric violence, postpartum complications and complications induced by doctors, invasive vaginal deliveries, emergency caesarean sections, admission of a neonate to the Neonatal Intensive Unit, past traumatic life events and mental health problems. Objective The aim of this study was to identify the factors associated with breastfeeding ineffectiveness after birth trauma, through the world literature. Methods An extended search was conducted to identify relevant for breastfeeding and traumatic birth experiences manuscripts for this study. Databases including PubMed, PsycINFO and Google Scholar. The search was limited to articles published in English the last decade. Results Factors that contribute to the ineffectiveness of breastfeeding after a traumatic birth are hormonal, medication, insufficient support from the partner, reliving the traumatic birth experience, past traumatic experiences in the woman's life and her mental state. Conclusion The mental trauma during childbirth is complex and multifactorial. Therefore, it is necessary to take measures on the one hand to prevent mental trauma during childbirth and on the other hand to make interventions to deal with the consequences of the trauma on the mental health of the mother and on breastfeeding which is directly affected.
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Affiliation(s)
| | - Eirini Orovou
- Department of Midwifery, University of Western Macedonia, 0200 Ptolemaida, Greece; (E.O); (M.T-C); (R.S); (P.E)
| | - Rafailia Skoura
- Department of Midwifery, University of Western Macedonia, 0200 Ptolemaida, Greece; (E.O); (M.T-C); (R.S); (P.E)
| | - Panagiotis Eskitzis
- Department of Midwifery, University of Western Macedonia, 0200 Ptolemaida, Greece; (E.O); (M.T-C); (R.S); (P.E)
| | - Maria Dagla
- Department of Midwifery, Egaleo Park Campus, University of West Attica, Ag. Spyridonos Str.,12243 Egaleo, Greece; (M.D); (M.I); (E.P); (E.A)
| | - Maria Iliadou
- Department of Midwifery, Egaleo Park Campus, University of West Attica, Ag. Spyridonos Str.,12243 Egaleo, Greece; (M.D); (M.I); (E.P); (E.A)
| | - Ermioni Palaska
- Department of Midwifery, Egaleo Park Campus, University of West Attica, Ag. Spyridonos Str.,12243 Egaleo, Greece; (M.D); (M.I); (E.P); (E.A)
| | - Evangelia Antoniou
- Department of Midwifery, Egaleo Park Campus, University of West Attica, Ag. Spyridonos Str.,12243 Egaleo, Greece; (M.D); (M.I); (E.P); (E.A)
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Lan Y, Pan S, Chen B, Peng L, Chen R, Hua Y, Ma Y. Labor characteristics and intrapartum interventions in women with vaginal birth after cesarean section. BMC Pregnancy Childbirth 2022; 22:589. [PMID: 35870907 PMCID: PMC9308341 DOI: 10.1186/s12884-022-04919-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
With the development of China’s two-child-policy, vaginal birth after cesarean section (VBAC) has aroused public concern. It is important to understand the labour characteristics and intrapartum management of women attempting VBAC to enhance the rates of successful VBAC. The purpose of our research was to investigate the differences in the characteristics of labor, intervention measures and perinatal outcomes between women who had a VBAC and primiparas or multiparas not undergoing VBAC, providing clinical references of intrapartum management for women who are planning a VBAC.
Material and methods
This observational retrospective study enrolled all women who laboured spontaneously and who had a VBAC (n = 139) at the Second Affiliated Hospital of Wenzhou Medical University in China between 2016 and 2019. They were allocated into VBAC group A (the previous cesarean section was performed before dilation of the cervix) and VBAC group B (the previous cesarean section was performed after dilation of the cervix). The primipara control group included 149 primiparae, and the multipara control group included 155 multiparae with second vaginal birth. Durations of labor, intervention measures and perinatal outcomes were compared among the groups.
Results
The durations of labor, intrapartum interventions and maternal and neonatal outcomes in VBAC group A were similar to those of the VBAC group B. However, all women who had a VBAC and those in VBAC group A had shorter first, second and the total stages of labor than primiparae. All women with VBAC and those in VBAC group B had longer second stage of labor, but shorter third stage of labor than multiparae. Oxytocin, labor analgesia and artificial rupture of membranes were administered less often in women with VBAC than in primiparae, while phloroglucinol was administered more often in women with VBAC than in multiparae. Women who had a VBAC were more likely to receive episiotomy and had higher incidences of postpartum hemorrhage than primipara and multipara women.
Conclusions
Labor characteristics, intrapartum interventions and perinatal outcomes in women who had a VBAC with cervical dilation were similar to those in women who had a VBAC without cervical dilation before the previous cesarean section, but differed significantly from those of multiparae and primiparae who did not undergo VBAC.
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Thorne EPC, Durnea CM, Sedgwick PM, Doumouchtsis S. Influence of previous delivery mode on perineal trauma risk. Int J Gynaecol Obstet 2022; 159:757-763. [PMID: 35426118 PMCID: PMC9790575 DOI: 10.1002/ijgo.14218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 03/31/2022] [Accepted: 04/05/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the impact of a previous pregnancy and delivery on perineal trauma rates in the subsequent vaginal birth. METHODS Retrospective cohort study. The perineal outcomes of secundiparous women with history of previous (first) delivery in one of three categories: failed operative vaginal delivery (FOVD) and second-stage emergency cesarean section (EmCS); elective cesarean section (ElCS), and vaginal delivery (VD) with intact perineum, were compared with a control primiparous group. RESULTS The percentage obstetric anal sphincter injuries (OASIS)at first vaginal delivery was 17.3% (n = 9) after previous FOVD+EmCS, 12.9% (n = 18) after previous ElCS, and 0.6% (n = 9) after previous VD maintaining an intact perineum, compared with 6% (n = 1193) in the control primiparous group of women. Multivariate regression analysis demonstrated that previous FOVD+EmCS and ElCS were associated with a statistically significant increased risk of OASIS of 180% and 110% when compared with control (odds ratio [OR] 2.80; 95% confidence interval [CI] 1.35-5.78 and OR 2.10; 95% CI 1.27-3.48, respectively). Previous VD with intact perineum was associated with a statistically significantly reduced risk of OASIS (OR 0.09; 95% CI 0.04-0.17). CONCLUSIONS Previous FOVD+EmCS and ElCS were associated with increased risk of OASIS in subsequent vaginal delivery compared with control, whereas previous VD with intact perineum was associated with decreased risk.
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Affiliation(s)
| | | | - Philip M. Sedgwick
- Institute of Medical and Biomedical EducationSt George’s, University of LondonLondonUK
| | - Stergios K. Doumouchtsis
- Institute of Medical and Biomedical EducationSt George’s, University of LondonLondonUK,Department of Obstetrics and GynaecologyEpsom and St Helier University Hospitals NHS TrustEpsomUK,Laboratory of Experimental Surgery and Surgical Research N.S. ChristeasNational and Kapodistrian University of Athens, Medical SchoolAthensGreece,American University of the CaribbeanSchool of MedicinePembroke PinesFloridaUSA,School of Medicine, Ross UniversityMiramarFloridaUSA
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Perslev K, Mørch EJ, Jangö H. Increased risk of obstetric anal sphincter injury in women undergoing vaginal delivery after caesarean section: A systematic review and meta-analysis. BJOG 2022; 129:1961-1968. [PMID: 35596697 DOI: 10.1111/1471-0528.17227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/26/2022] [Accepted: 03/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is increased focus on obstetric anal sphincter injury (OASI) and there are several well-established risk factors such as birthweight, instrumental delivery and median episiotomy. Some studies have found increased risk of OASI in women delivering vaginally after a previous caesarean section (VBAC). OBJECTIVE To evaluate whether there is increased prevalence of OASI in VBAC compared with primiparous women. SEARCH STRATEGY Literature search using PubMed, Embase and Cochrane databases. SELECTION CRITERIA All studies with data on both primiparous women and women undergoing VBAC were included. All included studies were evaluated using the "SIGN - methodology checklist" to verify if the quality was acceptable. DATA COLLECTION AND ANALYSIS This systematic review included 23 articles conducted in 11 countries over 19 years. Included studies were analysed using RevMan version 5.4. MAIN RESULTS We found increased prevalence of OASI in the VBAC group; 8.18% (95% confidence interval [CI] 8.07-8.29) compared with 6.59% (95% CI 6.56-6.62) in primiparous women. Correspondingly, the meta-analysis revealed increased prevalence for OASI in the VBAC group (odds ratio 1.27, 95% CI 1.10-1.47). We found a high level of heterogeneity (I2 = 98%). CONCLUSION Women undergoing VBAC had a higher prevalence of OASI compared with primiparous women.
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Affiliation(s)
- Kathrine Perslev
- Department of Obstetrics and Gynaecology, Herlev University Hospital, Herlev, Denmark
| | - Ella-Josephine Mørch
- Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Hanna Jangö
- Department of Obstetrics and Gynaecology, Herlev University Hospital, Herlev, Denmark.,Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
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Wondimu H. A cultural syndicate of society and NGOs challenges to deter child labour manipulation in Addis Ababa. JOURNAL OF MOTHER AND CHILD 2022; 25:285-300. [PMID: 35390235 PMCID: PMC9444199 DOI: 10.34763/jmotherandchild.20212504.d-21-00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/15/2022] [Indexed: 11/18/2022]
Abstract
This study aimed to investigate the existing trends of child labour abuse in Addis Ababa, as well as to examine the sociocultural barriers that impede nongovernmental organizations. This study involves two domestic NGOs (FHIDO and SCFDS) working on child issues. The study used a qualitative approach with 25 participants in in-depth interviews, one focus-group discussion, and six key informants to collect or acquire a full grasp of the issue and to address the study's stated objectives. The finding of this study revealed some psychometric reasons for the children to be engaged in hazardous work activities, including their family background (dynamics), poverty, and self-actualisation arising from contributions to the well-being of the family. Concerning gender-selective norms as a problem, the chosen two organizations are facing a significant task in putting an end to child labour exploitation in the region owing to social gender preference. The cultural and social expectations of men and women make the issue ubiquitous in their communities. Based on the findings of this study, the Winrock International (2008) approach of CIRCLE experience with an awareness-raising plan is recommended.
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Affiliation(s)
- Habtamu Wondimu
- Sociology Department, Wolkite University, WolkiteEthiopia, P.O. Box. O7, Wolkite University, Ethiopia; Tel. +251-985369849
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Paymova L, Svabik K, Neumann A, Kalis V, Ismail KM, Rusavy Z. Vaginal birth after Cesarean section and levator ani avulsion: a case-control study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:303-308. [PMID: 33724564 DOI: 10.1002/uog.23629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The aim of this study was to explore the risk of levator ani muscle (LAM) avulsion and enlargement of the levator hiatus following vaginal birth after Cesarean section (VBAC) in comparison with vaginal delivery in primiparous women. METHODS In this two-center observational case-control study, we identified all women who had a term VBAC for their second delivery at the Departments of Obstetrics and Gynecology at the Faculty of Medicine in Pilsen and the 1st Faculty of Medicine in Prague, Charles University, Czech Republic, between 2012 and 2016. Women with a repeat VBAC, preterm birth or stillbirth were excluded from the study. As a control group, we enrolled a cohort of primiparous women who delivered vaginally during the study period. To increase our control sample, we also invited all primiparous women who delivered vaginally in both participating units between May and June 2019 to participate. All participants were invited for a four-dimensional pelvic floor ultrasound scan to assess LAM trauma. LAM avulsion and the area of the levator hiatus were assessed offline from the stored pelvic floor volumes obtained at rest, during maximum contraction and during Valsalva maneuver. The laterality of the avulsion was also noted. The cohorts were then compared using the χ2 test and Wilcoxon's two-sample test according to the normality of the distribution. P < 0.05 was considered statistically significant. Multivariate regression analysis, controlling for age and body mass index (BMI), was also performed. RESULTS A total of 356 women had a VBAC for their second delivery during the study period. Of these, 152 (42.7%) attended the ultrasound examination and full data were available for statistical analysis for 141 women. The control group comprised 113 primiparous women. A significant difference was observed between the VBAC group and the control group in age (32.7 vs 30.1 years; P < 0.05), BMI (28.4 vs 27.4 kg/m2 ; P < 0.05) and duration of the first and second stages of labor (293.1 vs 345.9 min; P < 0.05 and 27.6 vs 35.3 min; P < 0.05, respectively) at the time of the index birth. The LAM avulsion rate was significantly higher in the VBAC compared with the control group (32.6% vs 18.6%; P = 0.01). The difference between the groups was observed predominantly in the rate of unilateral avulsion and remained significant after controlling for age and BMI (adjusted odds ratio 2.061 (95% CI, 1.103-3.852)). There was no statistically significant difference in the area of the levator hiatus at rest (12.0 vs 12.6 cm2 ; P = 0.28) or on maximum Valsalva maneuver (18.6 vs 18.7 cm2 ; P = 0.55) between the VBAC and control groups. The incidence of levator hiatal ballooning was comparable between the groups (17.7% and 18.6%; P = 0.86). CONCLUSIONS VBAC is associated with a significantly higher rate of LAM avulsion than is vaginal birth in nulliparous women. The difference was significant even after controlling for age and BMI. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L Paymova
- Department of Obstetrics and Gynecology, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic
| | - K Svabik
- Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - A Neumann
- Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - V Kalis
- Department of Obstetrics and Gynecology, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic
- Biomedical Center, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic
| | - K M Ismail
- Department of Obstetrics and Gynecology, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic
- Biomedical Center, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic
| | - Z Rusavy
- Department of Obstetrics and Gynecology, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic
- Biomedical Center, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic
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Fidalgo DS, Pouca MCPV, Oliveira DA, Malanowska E, Myers KM, Jorge RMN, Parente MPL. Mechanical Effects of a Maylard Scar During a Vaginal Birth After a Previous Caesarean. Ann Biomed Eng 2021; 49:3593-3608. [PMID: 34114131 DOI: 10.1007/s10439-021-02805-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/31/2021] [Indexed: 01/12/2023]
Abstract
Caesarean section is one of the most common surgeries worldwide, even though there is no evidence supporting maternal and perinatal long-term benefits. Furthermore, the mechanical behavior of a caesarean scar during a vaginal birth after caesarean (VBAC) is not well understood since there are several questions regarding the uterine wound healing process. The aim of this study is to investigate the biomechanical Maylard fiber reorientation and stiffness influence during a VBAC through computational methods. A biomechanical model comprising a fetus and a uterus was developed, and a chemical-mechanical constitutive model that triggers uterine contractions was used, where some of the parameters were adjusted to account for the matrix and fiber stiffness increase in the caesarean scar. Several mechanical simulations were performed to analyze different scar fibers arrangements, considering different values for the respective matrix and fibers stiffness. The results revealed that a random fiber arrangement in the Maylard scar has a much higher impact on its mechanical behavior during a VBAC than the common fibers arrangement present in the uninjured uterine tissue. An increase of the matrix scar stiffness exhibits a lower impact, while an increase of the fiber's stiffness has no significant influence.
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Affiliation(s)
- D S Fidalgo
- INEGI - Institute of Science and Innovation in Mechanical and Industrial Engineering/DEMec, Faculty of Engineering, University of Porto, Porto, Portugal.
| | - M C P Vila Pouca
- INEGI - Institute of Science and Innovation in Mechanical and Industrial Engineering/DEMec, Faculty of Engineering, University of Porto, Porto, Portugal
| | - D A Oliveira
- INEGI - Institute of Science and Innovation in Mechanical and Industrial Engineering/DEMec, Faculty of Engineering, University of Porto, Porto, Portugal
| | - E Malanowska
- Department of Gynaecology, Endocrinology and Gynaecologic Oncology, Pomeranian Medical University, Szczecin, Poland
| | - K M Myers
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - R M Natal Jorge
- INEGI - Institute of Science and Innovation in Mechanical and Industrial Engineering/DEMec, Faculty of Engineering, University of Porto, Porto, Portugal
| | - M P L Parente
- INEGI - Institute of Science and Innovation in Mechanical and Industrial Engineering/DEMec, Faculty of Engineering, University of Porto, Porto, Portugal
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11
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Knigin D, Ezra Y, Ben-David A, Elami-Suzin M. The continuum of a prolonged labor and a second stage cesarean delivery. J Matern Fetal Neonatal Med 2021; 35:6425-6429. [PMID: 34030598 DOI: 10.1080/14767058.2021.1914577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- David Knigin
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Ein-Kerem, Jerusalem, Israel
| | - Yossef Ezra
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Ein-Kerem, Jerusalem, Israel
| | - Arbel Ben-David
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Mount Scopus, Jerusalem, Israel
| | - Matan Elami-Suzin
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Ein-Kerem, Jerusalem, Israel
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12
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Zheng X, Yan J, Liu Z, Wang X, Xu R, Li L, Lin Z, Zheng L, Liu M, Chen Y. Safety and feasibility of trial of labor in pregnant women with cesarean scar diverticulum. J Int Med Res 2021; 48:300060520954993. [PMID: 32938285 PMCID: PMC7503006 DOI: 10.1177/0300060520954993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Literature on trial of labor after cesarean section (TOLAC) in women with isthmoceles is scarce because of complications associated with the procedure. This study investigated TOLAC's safety and feasibility in patients with isthmoceles. METHODS The study group comprised 34 pregnant women with isthmoceles who vaginally delivered. The control group comprised 102 pregnant women without isthmoceles who vaginally delivered during the same period. Scar diverticula were measured using color Doppler ultrasonography; between-group delivery outcomes were compared. RESULTS Of the study group patients, 27/34 had isthmoceles diagnosed by ultrasound before pregnancy. Nineteen (70.37%) of these patients had mild defects and eight (29.63%) had moderate defects. The scar diverticula's mean length, depth, and width were 1.05 ± 0.62, 0.54 ± 0.28, and 1.20 ± 0.70 cm, respectively. The residual muscle layer's mean thickness was 0.27 ± 0.07 cm. The mean diverticulum depth/residual muscular thickness ratio was 2.39 ± 2.58. The duration of the first stage of labor was significantly shorter and the neonatal weight was significantly lower in the study group than control group. CONCLUSION Successful vaginal delivery is possible for women with mild and moderate isthmoceles. Further large-scale studies are needed to improve TOLAC's safety in pregnant women with isthmoceles.
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Affiliation(s)
- Xiuqiong Zheng
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Jianying Yan
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Zhaozhen Liu
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Xuechun Wang
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Rongli Xu
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Liying Li
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Zhi Lin
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Lianghui Zheng
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Min Liu
- Department of Ultrasound, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Yan Chen
- Department of Ultrasound, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
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13
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Duration of first vaginal birth following cesarean: Is stage of labor at previous cesarean a factor? Eur J Obstet Gynecol Reprod Biol 2020; 252:344-348. [PMID: 32659640 DOI: 10.1016/j.ejogrb.2020.06.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Parturients in second delivery undergoing vaginal birth after cesarean (VBAC) are divided to those who had their cesarean delivery (CD) while in labor as opposed to those who had an elective CD. We aimed to study if the stage of labor that was present during the primary CD is associated with the duration of subsequent spontaneous VBAC. METHODS A retrospective study (2006-2014). Multiparas in second delivery with a history of a CD (P2-VBAC) were sub-grouped based on stage of labor at which the CD was performed in the first delivery; elective, latent, first or second stage of labor, Duration of labor was compared between P2-VBAC (as one group and further as the sub-groups) to primiparas (P1), multiparas in second (P2) and third (P3) vaginal delivery (VD). A Cox regression analysis was performed including maternal age, preterm-delivery, regional anesthesia, oxytocin augmentation, birthweight and neonatal gender. RESULTS A total of 58,028 parturients were included in the study. Mean duration of labor was significantly longer in parturients with a first VD (P1 and P2-VBAC) compared to repeat VD (P2 and P3), 6.0 versus 2.5 h, respectively, (P < 0.001). Analyzing duration of labor by the sub-groups of P2-VBAC revealed that spontaneous VD following a second-stage CD was associated with shorter duration of labor when compared with spontaneous VD following elective, latent and active first stage CD 4.2 versus 6.3, 7.0, 6.9 h respectively, p<0.001. CONCLUSION Second stage CD shortens duration of the following VBAC compared to those who underwent cesarean in earlier stages of labor.
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