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Zapata-Caballero CA, Rivera-Medina ER, Cevallos-Bustillos JI, Granados-Martínez V, Gorbea-Chávez V. Incidence of obstetric anal sphincter injuries according to the type of forceps used in the Mexican population. Int J Gynaecol Obstet 2024. [PMID: 39075831 DOI: 10.1002/ijgo.15823] [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: 05/10/2024] [Revised: 07/09/2024] [Accepted: 07/16/2024] [Indexed: 07/31/2024]
Abstract
OBJECTIVE This study describes the frequency of obstetric anal sphincter injuries (OASIS) in patients after instrumental delivery according to the type of forceps used. METHODS A retrospective comparative cohort study was conducted on patients who underwent instrumental delivery from January 2017 to April 2022. The primary outcome was the presence of OASIS following delivery. Patients were categorized into Cohort A if only rotation forceps were used, Cohort B for only traction forceps, and Cohort C if both types were used sequentially. Statistical analysis was performed with SPSS (IBM, New York, NY) with χ2, Fisher's exact, and analysis of variance testing. A P-value <0.05 was considered significant. RESULTS OASIS occurred in 45 of 328 instrumental deliveries. OASIS after rotation forceps occurred in 12.9% (n = 8) of cases, after traction forceps in 13.2% (n = 34), and after sequential use of rotation and traction forceps in 37.5% (n = 3) of cases (p = 0.141). An odds ratio (OR) of 0.91 (95% confidence interval [CI] 0.40-2.08) for OASIS was obtained with the use of rotation forceps, 0.81 (95% CI 0.38-1.70) for traction forceps, and 3.97 (95% CI 0.91-17.2) for the sequential use of rotation and traction forceps. CONCLUSION There were no significant differences in the presence of OASIS comparing traction and rotation forceps. A non-significant trend of higher OASIS following the sequential use of traction and rotation forceps was observed.
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Affiliation(s)
- Carlos Agustín Zapata-Caballero
- Department of Urogynecology, National Institute of Perinatology, Mexico City, Mexico
- Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
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Lau ES, Aggarwal NR, Briller JE, Crousillat DR, Economy KE, Harrington CM, Lindley KJ, Malhamé I, Mattina DJ, Meng ML, Mohammed SF, Quesada O, Scott NS. Recommendations for the Management of High-Risk Cardiac Delivery: ACC Cardiovascular Disease in Women Committee Panel. JACC. ADVANCES 2024; 3:100901. [PMID: 38939671 PMCID: PMC11198580 DOI: 10.1016/j.jacadv.2024.100901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/28/2023] [Accepted: 01/30/2024] [Indexed: 06/29/2024]
Abstract
Maternal mortality is a major public health crisis in the United States. Cardiovascular disease (CVD) is a leading cause of maternal mortality and morbidity. Labor and delivery is a vulnerable time for pregnant individuals with CVD but there is significant heterogeneity in the management of labor and delivery in high-risk patients due in part to paucity of high-quality randomized data. The authors have convened a multidisciplinary panel of cardio-obstetrics experts including cardiologists, obstetricians and maternal fetal medicine physicians, critical care physicians, and anesthesiologists to provide a practical approach to the management of labor and delivery in high-risk individuals with CVD. This expert panel will review key elements of management from mode, timing, and location of delivery to use of invasive monitoring, cardiac devices, and mechanical circulatory support.
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Affiliation(s)
- Emily S. Lau
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Niti R. Aggarwal
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Joan E. Briller
- Division of Cardiology, Department of Medicine, Obstetrics, and Gynecology, University of Illinois Chicago, Chicago, Illinois, USA
| | - Daniela R. Crousillat
- Division of Cardiovascular Sciences, Department of Medicine, Obstetrics, and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Katherine E. Economy
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Colleen M. Harrington
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kathryn J. Lindley
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Isabelle Malhamé
- Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Deirdre J. Mattina
- Division of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marie-Louise Meng
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Selma F. Mohammed
- Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Odayme Quesada
- Women’s Heart Center, The Carl and Edyth Lindner Center for Research & Education, The Christ Hospital Network Heart & Vascular Institute, Cincinnati, Ohio, USA
| | - Nandita S. Scott
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - ACC Cardiovascular Disease in Women Committee
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
- Division of Cardiology, Department of Medicine, Obstetrics, and Gynecology, University of Illinois Chicago, Chicago, Illinois, USA
- Division of Cardiovascular Sciences, Department of Medicine, Obstetrics, and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Division of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA
- Women’s Heart Center, The Carl and Edyth Lindner Center for Research & Education, The Christ Hospital Network Heart & Vascular Institute, Cincinnati, Ohio, USA
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Lorthe E, Severo M, Hamwi S, Rodrigues T, Teixeira C, Barros H. Obstetric Interventions Among Native and Migrant Women: The (Over)use of Episiotomy in Portugal. Int J Public Health 2024; 69:1606296. [PMID: 38577390 PMCID: PMC10991787 DOI: 10.3389/ijph.2024.1606296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 02/28/2024] [Indexed: 04/06/2024] Open
Abstract
Objective: Episiotomy, defined as the incision of the perineum to enlarge the vaginal opening during childbirth, is one of the most commonly performed surgical interventions in the world. We aimed to determine if migrant status is associated with episiotomy, and if individual characteristics mediate this association. Methods: We analyzed data from the Bambino study, a national, prospective cohort of migrant and native women giving birth at a public hospital in mainland Portugal between 2017 and 2019. We included all women with vaginal delivery. The association between migrant status and episiotomy was assessed using multivariable multilevel random-effect logistic regression models. We used path analysis to quantify the direct, indirect and total effects of migrant status on episiotomy. Results: Among 3,583 women with spontaneous delivery, migrant parturients had decreased odds of episiotomy, especially those born in Africa, compared to native Portuguese women. Conversely, with instrumental delivery, migrant women had higher odds of episiotomy. Disparities in episiotomy were largely explained by maternity units' factors, and little by maternal and fetal characteristics. Conclusion: Our results suggest non-medically justified differential episiotomy use during childbirth and highlight the importance of developing evidence-based recommendations for episiotomy use in a country with a high frequency of medical interventions during delivery.
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Affiliation(s)
- Elsa Lorthe
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Unit of Population Epidemiology, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Milton Severo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências de Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Sousan Hamwi
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Teresa Rodrigues
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Department of Gynecology and Obstetrics, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Cristina Teixeira
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Polytechnic Institute of Bragança, Bragança, Portugal
| | - Henrique Barros
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências de Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Hotton EJ, Bale N, Rose C, White P, Wade J, Mottet N, Loose AJ, Elhodaiby M, Lenguerrand E, Draycott TJ, Crofts JF. The OdonAssist inflatable device for assisted vaginal birth-the ASSIST II study (United Kingdom). Am J Obstet Gynecol 2024; 230:S932-S946.e3. [PMID: 38462264 DOI: 10.1016/j.ajog.2023.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 03/12/2024]
Abstract
BACKGROUND Decreasing rates of assisted vaginal birth have been paralleled with increasing rates of cesarean deliveries over the last 40 years. The OdonAssist is a novel device for assisted vaginal birth. Iterative changes to clinical parameters, device design, and technique have been made to improve device efficacy and usability. OBJECTIVE This study aimed to determine if the feasibility, safety, and efficacy of the OdonAssist device were sufficient to justify conducting a future randomized controlled trial. STUDY DESIGN An open-label nonrandomized study of 104 participants having a clinically indicated assisted vaginal birth using the OdonAssist was undertaken at Southmead Hospital, Bristol, United Kingdom. Data were also collected from participants who consented to participate in the study but for whom trained OdonAssist operators were not available, providing a nested cohort. The primary clinical outcome was the proportion of births successfully expedited with the OdonAssist. Secondary outcomes included clinical, patient-reported, operator-reported, device and health care utilization. Neonatal outcome data were reviewed at day 28, and maternal outcomes were investigated up to day 90. Given that the number of successful OdonAssist births was ≥61 out of 104, the hypothesis of a poor rate of 50% was rejected in favor of a good rate of ≥65%. RESULTS Between August 2019 and June 2021, 941 (64%) of the 1471 approached, eligible participants consented to participate. Of these, 104 received the OdonAssist intervention. Birth was assisted in all cephalic vertex fetal positions, at all stations ≥1 cm below the ischial spines (with or without regional analgesia). The OdonAssist was effective in 69 of the 104 (66%) cases, consistent with the hypothesis of a good efficacy rate. There were no serious device-related maternal or neonatal adverse reactions, and there were no serious adverse device effects. Only 4% of neonatal soft tissue bruising in the successful OdonAssist group was considered device-related, as opposed to 20% and 23% in the unsuccessful OdonAssist group and the nested cohort, respectively. Participants reported high birth perception scores. All practitioners found the device use to be straightforward. CONCLUSION Recruitment to an interventional study of a new device for assisted vaginal birth is feasible; 64% of eligible participants were willing to participate. The success rate of the OdonAssist was comparable to that of the Kiwi OmniCup when introduced in the same unit in 2002, meeting the threshold for a randomized controlled trial to compare the OdonAssist with current standard practice. There were no disadvantages of study participation in terms of maternal and neonatal outcomes. There were potential advantages of using the OdonAssist, particularly reduced neonatal soft tissue injury. The same application technique is used for all fetal positions, with all operators deeming the device straightforward to use. This study provides important data to inform future study design.
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Affiliation(s)
- Emily J Hotton
- Women and Children's Research Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom; Translational Health Sciences, University of Bristol, Southmead Hospital, Bristol, United Kingdom.
| | - Nichola Bale
- Women and Children's Research Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Claire Rose
- Women and Children's Research Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Paul White
- Mathematics and Statistics Research Group, University of the West of England, Bristol, United Kingdom
| | - Julia Wade
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Nicolas Mottet
- Pôle Mère-Femme, Department of Obstetrics and Gynecology, University Hospital of Besançon, University of Franche-Comté, Besançon, France; Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comté, Besançon, France
| | - Abi J Loose
- Women and Children's Research Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Mohamed Elhodaiby
- Women and Children's Research Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom; Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Erik Lenguerrand
- Translational Health Sciences, University of Bristol, Southmead Hospital, Bristol, United Kingdom
| | - Tim J Draycott
- Women and Children's Research Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Joanna F Crofts
- Women and Children's Research Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
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Mitta K, Tsakiridis I, Dagklis T, Kalogiannidis I, Mamopoulos A, Michos G, Virgiliou A, Athanasiadis A. Ultrasonographic Evaluation of the Second Stage of Labor according to the Mode of Delivery: A Prospective Study in Greece. J Clin Med 2024; 13:1068. [PMID: 38398380 PMCID: PMC10889379 DOI: 10.3390/jcm13041068] [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: 01/10/2024] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Accurate diagnosis of labor progress is crucial for making well-informed decisions regarding timely and appropriate interventions to optimize outcomes for both the mother and the fetus. The aim of this study was to assess the progress of the second stage of labor using intrapartum ultrasound. MATERIAL AND METHODS This was a prospective study (December 2022-December 2023) conducted at the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece. Maternal-fetal and labor characteristics were recorded, and two ultrasound parameters were measured: the angle of progression (AoP) and the head-perineum distance (HPD). The correlation between the two ultrasonographic values and the maternal-fetal characteristics was investigated. Multinomial regression analysis was also conducted to investigate any potential predictors of the mode of delivery. RESULTS A total of 82 women at the second stage of labor were clinically and sonographically assessed. The mean duration of the second stage of labor differed between vaginal and cesarean deliveries (65.3 vs. 160 min; p-value < 0.001) and between cesarean and operative vaginal deliveries (160 vs. 88.6 min; p-value = 0.015). The occiput anterior position was associated with an increased likelihood of vaginal delivery (OR: 24.167; 95% CI: 3.8-152.5; p-value < 0.001). No significant differences were identified in the AoP among the three different modes of delivery (vaginal: 145.7° vs. operative vaginal: 139.9° vs. cesarean: 132.1°; p-value = 0.289). The mean HPD differed significantly between vaginal and cesarean deliveries (28.6 vs. 41.4 mm; p-value < 0.001) and between cesarean and operative vaginal deliveries (41.4 vs. 26.9 mm; p-value = 0.002); it was correlated significantly with maternal BMI (r = 0.268; p-value = 0.024) and the duration of the second stage of labor (r = 0.256; p-value = 0.031). Low parity (OR: 12.024; 95% CI: 6.320-22.876; p-value < 0.001) and high HPD (OR: 1.23; 95% CI: 1.05-1.43; p-value = 0.007) were found to be significant predictors of cesarean delivery. CONCLUSIONS The use of intrapartum ultrasound as an adjunctive technique to the standard clinical evaluation may enhance the diagnostic approach to an abnormal labor progress and predict the need for operative vaginal or cesarean delivery.
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Affiliation(s)
| | - Ioannis Tsakiridis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (K.M.); (T.D.); (I.K.); (A.M.); (G.M.); (A.V.); (A.A.)
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Brogaard L, Hinshaw K, Kierkegaard O, Manser T, Uldbjerg N, Hvidman L. Developing the TeamOBS-vacuum-assisted delivery checklist to assess clinical performance in a vacuum-assisted delivery: a Delphi study with initial validation. Front Med (Lausanne) 2024; 11:1330443. [PMID: 38371513 PMCID: PMC10869485 DOI: 10.3389/fmed.2024.1330443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/08/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction In Northern Europe, vacuum-assisted delivery (VAD) accounts for 6-15% of all deliveries; VAD is considered safe when conducted by adequately trained personnel. However, failed vacuum extraction can be harmful to both the mother and child. Therefore, the clinical performance in VAD must be assessed to guide learning, determine a performance benchmark, and evaluate the quality to achieve an overall high performance. We were unable to identify a pre-existing tool for evaluating the clinical performance in real-life vacuum-assisted births. Objective We aimed to develop and validate a checklist for assessing the clinical performance in VAD. Methods We conducted a Delphi process, described as an interactive process where experts answer questions until answers converge toward a "joint opinion" (consensus). We invited international experts as Delphi panelists and reached a consensus after four Delphi rounds, described as follows: (1) the panelists were asked to add, remove, or suggest corrections to the preliminary list of items essential for evaluating clinical performance in VAD; (2) the panelists applied weights of clinical importance on a Likert scale of 1-5 for each item; (3) each panelist revised their original scores after reviewing a summary of the other panelists' scores and arguments; and (4) the TeamOBS-VAD was tested using videos of real-life VADs, and the Delphi panel made final adjustments and approved the checklist. Results Twelve Delphi panelists from the UK (n = 3), Norway (n = 2), Sweden (n = 3), Denmark (n = 3), and Iceland (n = 1) were included. After four Delphi rounds, the Delphi panel reached a consensus on the checklist items and scores. The TeamOBS-VAD checklist was tested using 60 videos of real-life vacuum extractions. The inter-rater agreement had an intraclass correlation coefficient (ICC) of 0.73; 95% confidence interval (95% CI) of [0.58, 0.83], and that for the average of two raters was ICC 0.84 95% CI [0.73, 0.91]. The TeamOBS-VAD score was not associated with difficulties in delivery, such as the number of contractions during vacuum extraction delivery, cephalic level, rotation, and position. Failed vacuum extraction occurred in 6% of the video deliveries, but none were associated with the teams with low clinical performance scores. Conclusion The TeamOBS-VAD checklist provides a valid and reliable evaluation of the clinical performance of vaginal-assisted vacuum extraction.
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Affiliation(s)
- Lise Brogaard
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kim Hinshaw
- Department of Obstetrics and Gynecology, Sunderland Royal Hospital, Sunderland, United Kingdom
| | - Ole Kierkegaard
- Department of Obstetrics and Gynecology, Horsens Regional Hospital, Horsens, Denmark
| | - Tanja Manser
- Fachhochschule Nordwestschweiz (FHNW) School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lone Hvidman
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Dagklis T, Akolekar R, Villalain C, Tsakiridis I, Kesrouani A, Tekay A, Plasencia W, Wellmann S, Kusuda S, Jekova N, Prefumo F, Volpe N, Chaveeva P, Allegaert K, Khalil A, Sen C. Management of preterm labor: Clinical practice guideline and recommendation by the WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine Foundation. Eur J Obstet Gynecol Reprod Biol 2023; 291:196-205. [PMID: 37913556 DOI: 10.1016/j.ejogrb.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023]
Abstract
This practice guideline follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation, bringing together groups and individuals throughout the world, with the goal of improving the management of preterm labor. In fact, this document provides further guidance for healthcare practitioners on the appropriate use of examinations with the aim to improve the accuracy in diagnosing preterm labor and allow timely and appropriate administration of tocolytics, antenatal corticosteroids and magnesium sulphate and avoid unnecessary or excessive interventions. Therefore, it is not intended to establish a legal standard of care. This document is based on consensus among perinatal experts throughout the world in the light of scientific literature and serves as a guideline for use in clinical practice.
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Affiliation(s)
- Themistoklis Dagklis
- Third Department of Obstetrics and Gynaecology, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ranjit Akolekar
- Medway Fetal and Maternal Medicine Centre, Medway NHS Foundation Trust, Gillingham, United Kingdom; Institute of Medical Sciences, Canterbury Christ Church University, Chatham, United Kingdom
| | - Cecilia Villalain
- Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, Complutense University of Madrid, Fetal Medicine Unit, Madrid, Spain
| | - Ioannis Tsakiridis
- Third Department of Obstetrics and Gynaecology, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Assaad Kesrouani
- Obstetrics and Gynecology Department, St. Joseph University Hotel-Dieu de France University Hospital, Beirut, Lebanon; Obstetrics and Gynecology Department, Bellevue Medical Center, Beirut, Lebanon
| | - Aydin Tekay
- Department of Obstetrics and Gynaecology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 2, Helsinki 00290, Finland
| | - Walter Plasencia
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario de Canarias, San Cristóbal de La Laguna, Spain
| | - Sven Wellmann
- Department of Neonatology, University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Satoshi Kusuda
- Department of Pediatrics, Kyorin University, Tokyo, Japan
| | - Nelly Jekova
- Department of Neonatology, University Hospital of Obstetrics and Gynecology "Maichin dom", Medical University, Sofia, Bulgaria
| | - Federico Prefumo
- Department of Obstetrics and Gynaecology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Nicola Volpe
- Department of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria di Parma Fetal Medicine Unit, Parma, Italy
| | - Petya Chaveeva
- Department of Fetal Medicine, Shterev Hospital, Sofia 1330, Bulgaria
| | - Karel Allegaert
- KU Leuven, Leuven, Belgium; Hospital Pharmacy, Erasmus MC, Rotterdam, The Netherlands; Department of Development and Regeneration, and Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom
| | - Cihat Sen
- Department of Perinatal Medicine, Obstetrics and Gynecology, Istanbul University-Cerrahpasa, and Perinatal Medicine Foundation, Istanbul, Turkey.
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8
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Ozsvar J, Gissler M, Lavebratt C, Nilsson IAK. Exposures during pregnancy and at birth are associated with the risk of offspring eating disorders. Int J Eat Disord 2023; 56:2232-2249. [PMID: 37646613 DOI: 10.1002/eat.24053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Eating disorders (ED) are severe psychiatric disorders, commonly debuting early. Aberrances in the intrauterine environment and at birth have been associated with risk of ED. Here, we explore if, and at what effect size, a variety of such exposures associate with offspring ED, that is, anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS). METHODS This population-based cohort study, conducted from September 2021 to August 2023, used Finnish national registries of all live births in 1996-2014 (N = 1,097,753). Cox proportional hazards modeling was used to compare ED risk in exposed versus unexposed offspring, adjusting for potential confounders and performing sex-stratified analyses. RESULTS A total of 6614 offspring were diagnosed with an ED; 3668 AN, 666 BN, and 4248 EDNOS. Lower risk of offspring AN was seen with young mothers, continued smoking, and instrumental delivery, while higher risk was seen with older mothers, inflammatory disorders, prematurity, small for gestational age, and low Apgar. Offspring risk of BN was higher with continued smoking and prematurity, while lower with postmature birth. Offspring risk of EDNOS was lower with instrumental delivery, higher for older mothers, polycystic ovary syndrome, insulin-treated pregestational diabetes, antibacterial treatment, prematurity, and small for gestational age. Sex-specific associations were found. CONCLUSIONS Several prenatal and at birth exposures are associated with offspring ED; however, we cannot exclude confounding by maternal BMI. Nevertheless, several exposures selectively associate with risk of either AN, BN, or EDNOS, and some are sex-specific, emphasizing the importance of subtype- and sex-stratified analyses of ED. PUBLIC SIGNIFICANCE We define environmental factors involved in the development of different ED, of importance as preventive measure, but also in order to aid in defining the molecular pathways involved and thus in the longer perspective contribute to the development of pharmacological treatment of ED.
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Affiliation(s)
- Judit Ozsvar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Mika Gissler
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | - Catharina Lavebratt
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ida A K Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
- Centre for Eating Disorders Innovation, Karolinska Institutet, Stockholm, Sweden
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Giouleka S, Tsakiridis I, Mamopoulos A, Kalogiannidis I, Athanasiadis A, Dagklis T. Fetal Growth Restriction: A Comprehensive Review of Major Guidelines. Obstet Gynecol Surv 2023; 78:690-708. [PMID: 38134339 DOI: 10.1097/ogx.0000000000001203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Importance Fetal growth restriction (FGR) is a common pregnancy complication and a significant contributor of fetal and neonatal morbidity and mortality, mainly due to the lack of effective screening, prevention, and management policies. Objective The aim of this study was to review and compare the most recently published influential guidelines on the management of pregnancies complicated by FGR. Evidence Acquisition A descriptive review of guidelines from the American College of Obstetricians and Gynecologists (ACOG), the Society for Maternal-Fetal Medicine, the International Federation of Gynecology and Obstetrics, the International Society of Ultrasound in Obstetrics and Gynecology, the Royal College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada (SOGC), the Perinatal Society of Australia and New Zealand, the Royal College of Physicians of Ireland, the French College of Gynecologists and Obstetricians (FCGO), and the German Society of Gynecology and Obstetrics on FGR was carried out. Results Several discrepancies were identified regarding the definition of FGR and small-for-gestational-age fetuses, the diagnostic criteria, and the need of testing for congenital infections. On the contrary, there is an overall agreement among the reviewed guidelines regarding the importance of early universal risk stratification for FGR to accordingly modify the surveillance protocols. Low-risk pregnancies should unanimously be evaluated by serial symphysis fundal height measurement, whereas the high-risk ones warrant increased sonographic surveillance. Following FGR diagnosis, all medical societies agree that umbilical artery Doppler assessment is required to further guide management, whereas amniotic fluid volume evaluation is also recommended by the ACOG, the SOGC, the Perinatal Society of Australia and New Zealand, the FCGO, and the German Society of Gynecology and Obstetrics. In case of early, severe FGR or FGR accompanied by structural abnormalities, the ACOG, the Society for Maternal-Fetal Medicine, the International Federation of Gynecology and Obstetrics, the Royal College of Obstetricians and Gynecologists, the SOGC, and the FCGO support the performance of prenatal diagnostic testing. Consistent protocols also exist on the optimal timing and mode of delivery, the importance of continuous fetal heart rate monitoring during labor, and the need for histopathological examination of the placenta after delivery. On the other hand, guidelines concerning the frequency of fetal growth and Doppler velocimetry evaluation lack uniformity, although most of the reviewed medical societies recommend an average interval of 2 weeks, reduced to weekly or less when umbilical artery abnormalities are detected. Moreover, there is a discrepancy on the appropriate timing for corticosteroids and magnesium sulfate administration, as well as the administration of aspirin as a preventive measure. Cessation of smoking, alcohol consumption, and illicit drug use are proposed as preventive measures to reduce the incidence of FGR. Conclusions Fetal growth restriction is a clinical entity associated with numerous adverse antenatal and postnatal events, but currently, it has no definitive cure apart from delivery. Thus, the development of uniform international protocols for the early recognition, the adequate surveillance, and the optimal management of growth-restricted fetuses seem of paramount importance to safely guide clinical practice, thereby improving perinatal outcomes of such pregnancies.
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Affiliation(s)
| | | | | | | | | | - Themistoklis Dagklis
- Assistant Professor, Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
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10
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Mitta K, Tsakiridis I, Dagklis T, Grigoriadou R, Mamopoulos A, Athanasiadis A, Kalogiannidis I. Incidence and Risk Factors for Postpartum Hemorrhage: A Case-Control Study in a Tertiary Hospital in Greece. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1151. [PMID: 37374355 DOI: 10.3390/medicina59061151] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/28/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: Postpartum hemorrhage (PPH) is an obstetrical emergency and although the mortality rate from PPH has decreased, it is still considered a challenge in obstetrics. This study aimed to estimate the rate of primary PPH, as well as to investigate the potential risk factors and management options. Material and methods: This was a retrospective case-control study of all cases with PPH (blood loss > 500 mL, irrespective of the mode of delivery) managed in the Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece, from 2015 to 2021. The ratio of cases to controls was estimated to be 1:1. The chi-squared test was used to examine if there was any relationship between several variables and PPH, while subgroup multivariate logistic regression analyses of certain causes of PPH were also conducted. Results: During the study period, from a total of 8545 births, 219 (2.5%) pregnancies were complicated with PPH. A maternal age > 35 years (OR: 2.172; 95% CI: 1.206-3.912; p = 0.010), preterm delivery (<37 weeks) (OR: 5.090; 95% CI: 2.869-9.030; p < 0.001) and parity (OR: 1.701; 95% CI: 1.164-2.487; p = 0.006) were identified as risk factors for PPH. Uterine atony was the main cause of PPH in 54.8% of the women, followed by placental retention in 30.5% of the sample. Regarding management, 57.9% (n = 127) of the women received uterotonic medication, while in 7.3% (n = 16), a cesarean hysterectomy was performed to control PPH. Preterm delivery (OR: 2.162; 95% CI: 1.138-4.106; p = 0.019) and delivery via a cesarean section (OR: 4.279; 95% CI: 1.921-9.531; p < 0.001) were associated with a higher need for multiple treatment modalities. Prematurity (OR: 8.695; 95% CI: 2.324-32.527; p = 0.001) was identified as an independent predictor for an obstetric hysterectomy. From the retrospective analysis of the births complicated by PPH, no maternal death was identified. Conclusions: Most of the cases complicated with PPH were managed with uterotonic medication. An advanced maternal age, prematurity and multiparity had a significant impact on the occurrence of PPH. More research is needed on the risk factors of PPH, while the establishment of validated predictive models would be of value.
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Affiliation(s)
- Kyriaki Mitta
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Ioannis Tsakiridis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Riola Grigoriadou
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Apostolos Mamopoulos
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Apostolos Athanasiadis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Ioannis Kalogiannidis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
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11
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Pauranik N, Dhakad A, Yadav S, Agrawal S. Letter to the Editor: Gynecologic Use of an Obstetrician's Weapon— Ventouse. J Gynecol Surg 2023. [DOI: 10.1089/gyn.2022.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Affiliation(s)
- Neerja Pauranik
- Department of Obstetrics and Gynaecology, Bombay Hospital, Indore, Madhya Pradesh, India
| | - Amita Dhakad
- Department of Obstetrics and Gynaecology, Bombay Hospital, Indore, Madhya Pradesh, India
| | - Shikha Yadav
- Department of Obstetrics and Gynaecology, Bombay Hospital, Indore, Madhya Pradesh, India
| | - Swati Agrawal
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, Delhi, India
- Smt. Sucheta Kriplani Hospital, New Delhi, Delhi, India
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12
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Giouleka S, Tsakiridis I, Koutsouki G, Kostakis N, Mamopoulos A, Kalogiannidis I, Athanasiadis A, Dagklis T. Obesity in Pregnancy: A Comprehensive Review of Influential Guidelines. Obstet Gynecol Surv 2023; 78:50-68. [PMID: 36607201 DOI: 10.1097/ogx.0000000000001091] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Importance Obesity is one of the most common clinical entities complicating pregnancies and is associated with short- and long-term consequences for both the mother and the offspring. Objective The aim of this study were to review and compare the most recently published influential guidelines on the management of maternal obesity in the preconceptional, antenatal, intrapartum, and postpartum period. Evidence Acquisition A descriptive review of guidelines from the American College of Obstetricians and Gynecologists, the International Federation of Gynecology and Obstetrics, the Society of Obstetricians and Gynecologists of Canada, the Royal College of Obstetricians and Gynecologists, and the Royal Australian and New Zealand College of Obstetricians and Gynecologists on obesity in pregnancy was carried out. Results There is an overall agreement among the reviewed guidelines regarding the importance of prepregnancy weight loss with behavioral modification, optimization of gestational weight gain, and screening for comorbidities in improving pregnancy outcomes of obese women. Women with previous bariatric surgery should be screened for nutritional deficiencies and have a closer antenatal surveillance, according to all guidelines. In addition, folic acid supplementation is recommended for 1 to 3 months before conception and during the first trimester, but several discrepancies were identified with regard to other vitamins, iodine, calcium, and iron supplementation. All medical societies recommend early screening for gestational diabetes mellitus and early anesthetic assessment in obese women and suggest the use of aspirin for the prevention of preeclampsia when additional risk factors are present, although the optimal dosage is controversial. The International Federation of Gynecology and Obstetrics, Society of Obstetricians and Gynecologists of Canada, Royal College of Obstetricians and Gynecologists, and Royal Australian and New Zealand College of Obstetricians and Gynecologists point out that specific equipment and adequate resources must be readily available in all health care facilities managing obese pregnant women. Moreover, thromboprophylaxis and prophylactic antibiotics are indicated in case of cesarean delivery, and intrapartum fetal monitoring is justified during active labor in obese patients. However, there are no consistent protocols regarding the fetal surveillance, the monitoring of multiple gestations, the timing and mode of delivery, and the postpartum follow-up, although weight loss and breastfeeding are unanimously supported. Conclusions Obesity in pregnancy is a significant contributor to maternal and perinatal morbidity with a constantly rising global prevalence among reproductive-aged women. Thus, the development of uniform international protocols for the effective management of obese women is of paramount importance to safely guide clinical practice and subsequently improve pregnancy outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | - Themistoklis Dagklis
- Assistant Professor, Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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13
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Postpartum Hemorrhage: A Comprehensive Review of Guidelines. Obstet Gynecol Surv 2022; 77:665-682. [DOI: 10.1097/ogx.0000000000001061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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14
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Shimalis C, Hasen T, Regasa MT, Desalegn Z, Mulisa D, Upashe SP. Complications of instrumental vaginal deliveries and associated factors in hospitals of Western Oromia, Ethiopia. SAGE Open Med 2022; 10:20503121221113091. [PMID: 35898956 PMCID: PMC9310291 DOI: 10.1177/20503121221113091] [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: 11/26/2021] [Accepted: 06/22/2022] [Indexed: 12/02/2022] Open
Abstract
Objective: In developing countries like Ethiopia, there is lack of evidence that shows the magnitude and factors affecting complications of instrumental delivery. Most of the research done in Ethiopia was secondary data and lacks variables like socio-demographic factors, availability of cardiotocograph, number of traction, and who conducted delivery (qualification of health workers). So, this study tried to fill the gaps by conducting primary research with secondary data and adding those variables stated above. Methods: Health facility-based cross-sectional study was conducted from 20 February 20 June 2020 in five public hospitals in East Wollega Zone. Single population proportion formula used to calculate sample size. Systematic random sampling was employed. Interviewer-administered structured questionnaire, checklist, and document review were used to collect data from 282 respondents. Data entered to Epi Data version 3.01 and exported to a statistical package of social sciences version 21 for analysis. Those variables with p < 0.25 in the bivariate analyses were a candidate for multivariable logistic regression and multivariable logistic regression was done to identify factors associated with complications of instrumental vaginal delivery using 95% confidence interval and p < 0.05. Results: Complications of instrumental vaginal delivery were 37.2%. Out of all neonates delivered by operative vaginal delivery, 69 (24.5%) developed complications. Vacuum-assisted delivery (adjusted odd ratio = 0.245, 95% confidence interval 0.092–0.658), 120–160 fetal heartbeats per minute (adjusted odd ratio = 0.298, 95% confidence interval 0.114–0.628), birthweight > 4000 g (adjusted odd ratio = 4.09, 95% confidence interval 1.729–9.499) and outlet instrumentation (adjusted odd ratio = 0.139, 95% confidence interval 0.057–0.339) were associated with complications of instrumental vaginal delivery. Conclusion: Magnitude of complications of instrumental vaginal delivery was high in the study area. So, health professionals should give due attention on instrument selection and application. Instrumental delivery requires a careful assessment of clinical circumstances to identify the indications and contraindications for the application of the instruments.
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Affiliation(s)
- Chaltu Shimalis
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
| | - Tahir Hasen
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
| | - Misganu Teshoma Regasa
- Department of Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
| | - Zelalem Desalegn
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
| | - Diriba Mulisa
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
| | - Shivaleela P Upashe
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia.,Department of Child Health Nursing, Nitte Usha Institute of Nursing Sciences, Nitte (Deemed to be), Mangaluru, India
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Preterm Labor: A Comprehensive Review of Guidelines on Diagnosis, Management, Prediction and Prevention. Obstet Gynecol Surv 2022; 77:302-317. [PMID: 35522432 DOI: 10.1097/ogx.0000000000001023] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Importance Preterm labor (PTL) is one of the most common and serious pregnancy complications associated with significant perinatal morbidity and mortality, as well as long-term neurologic impairment in the offspring. Objective The aim of this study was to review and compare the most recently published major guidelines on diagnosis, management, prediction, and prevention of this severe complication of pregnancy. Evidence Acquisition A descriptive review of guidelines from the National Institute for Health and Care Excellence (NICE), the World Health Organization, the American College of Obstetricians and Gynecologists, the New South Wales Government, and the European Association of Perinatal Medicine (EAPM) on PTL was carried out. Results There is a consensus among the reviewed guidelines that the diagnosis of PTL is based on clinical criteria, physical examination, measurement of cervical length (CL) with transvaginal ultrasound (TVUS) and use of biomarkers, although there is disagreement on the first-line diagnostic test. The NICE and the EAPM are in favor of TVUS CL measurement, whereas the New South Wales Government mentions that fetal fibronectin testing is the mainstay for PTL diagnosis. Moreover, there is consistency among the guidelines regarding the importance of treating PTL up to 34 weeks of gestation, to delay delivery for 48 hours, for the administration of antenatal corticosteroids, magnesium sulfate, and in utero transfer to higher care facility, although several discrepancies exist regarding the tocolytic drugs of choice and the administration of corticosteroids and magnesium sulfate after 34 and 30 gestational weeks, respectively. Routine cesarean delivery in case of PTL is unanimously not recommended. Finally, the NICE, the American College of Obstetricians and Gynecologists, and the EAPM highlight the significance of screening for PTL by TVUS CL measurement between 16 and 24 weeks of gestation and suggest the use of either vaginal progesterone or cervical cerclage for the prevention of PTL, based on specific indications. Cervical pessary is not recommended as a preventive measure. Conclusions Preterm labor is a significant contributor of perinatal morbidity and mortality with a substantial impact on health care systems. Thus, it seems of paramount importance to develop consistent international practice protocols for timely diagnosis and effective management of this major obstetric complication and subsequently improve pregnancy outcomes.
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Maternal and Neonatal Morbidity After Attempted Operative Vaginal Delivery. Obstet Gynecol 2022; 139:833-845. [DOI: 10.1097/aog.0000000000004746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/27/2022] [Indexed: 11/26/2022]
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Vučinić N, Paulsen F, Milinkov M, Nikolić MB, Todorović ST, Knezi N, Nikolić U. A survey of pelvic types on computed tomography images. Ann Anat 2022; 243:151942. [PMID: 35378253 DOI: 10.1016/j.aanat.2022.151942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/07/2022] [Accepted: 03/14/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND In the medical literature several classifications of the pelvis according to its shape can be found. The most common classification distinguishes four general pelvis types: gynecoid, android, anthropoid and platypelloid. Natural childbirth may be significantly prolonged, difficult or even impossible if the pelvis shape is not in proportion to the size of the fetus. The objectives of our study were to calculate major diameters and conjugate diameters of the female bony pelvic ring and to determine the major pelvic types according to their shape. Based on the parameters obtained, we aimed to establish a relationship between some pelvic types and difficult childbirth. METHODS The study was prospective in design and included 54 female subjects of various ages who had been referred for computed tomography of the pelvis, as part of the diagnosis of an underlying condition. In each patient, five most important parameters in two planes were measured and the pelvic type was determined by using the brim index and a special formula for android type. All measurements were performed using the Vue PACS v 12.1.6.1005 program. The description of the pelvic inlet was used to confirm all pelvic types. Data on previous births were taken from the questionnaire filled out by the subjects during the radiological examination. RESULTS Gynecoid pelvic type was the most common in our sample (28 pelvises - 52%), followed by platypelloid type (11 pelvises - 20%), anthropoid type (8 pelvises - 15%) and finally android type (7 pelvises - 13%). There was a statistically significant difference in the diameter bispinous length (p<0.05) between the platypelloid and anthropoid pelvic types. Pathological degree of stenosis was present in seven pelvises (the first degree in six pelvises and the second degree in one pelvis). The frequency of cesarean section was 31.82% and this technique was most frequently used in the subjects with a gynecoid pelvic type. The duration of natural labor ranged from 4 to 18hours. There was no statistically significant difference in the duration of labor between subjects with different pelvic types. CONCLUSIONS Gynecoid pelvic type was present in more than half of our subjects. Although this type is considered ideal for labor, we have not established that it has a great influence on whether the labor will be performed naturally or by cesarean section, neither that it significantly affects the length of birth. The gross narrowing of the pelvic ring is present in non-gynecoid pelvic types. The data obtained will certainly be useful to the obstetrician when planning the labor and considering all the factors that may affect the course of birth.
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Affiliation(s)
- Nikola Vučinić
- Department of Anatomy, Faculty of Medicine, University of Novi Sad, Serbia.
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany.
| | | | - Marijana Basta Nikolić
- Department of Radiology, Faculty of Medicine, University of Novi Sad, Serbia, Radiology Center, Clinical Center of Vojvodina, Novi Sad, Serbia.
| | - Snežana Tomašević Todorović
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Novi Sad, Serbia; Clinic for Medical Rehabilitation, Clinical Center of Vojvodina, Novi Sad, Serbia.
| | - Nikola Knezi
- Department of Anatomy, Faculty of Medicine, University of Novi Sad, Serbia.
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Mendoza HF, Hobson S, Kingdom J, Rojas D. Identification of Eessential Steps in Outlet Forceps-Assisted Vaginal Delivery: A Delphi Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:675-682. [DOI: 10.1016/j.jogc.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/06/2022] [Accepted: 01/06/2022] [Indexed: 11/27/2022]
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Ankarcrona V, Hesselman S, Kopp Kallner H, Brismar Wendel S. Attitudes and knowledge regarding episiotomy use and technique in vacuum extraction: A web-based survey among doctors in Sweden. Eur J Obstet Gynecol Reprod Biol 2021; 269:62-70. [PMID: 34968876 DOI: 10.1016/j.ejogrb.2021.12.017] [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: 09/02/2021] [Revised: 11/19/2021] [Accepted: 12/11/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Correct episiotomy use and technique may prevent obstetric anal sphincter injuries. We aimed to explore the attitudes, use, and technique regarding episiotomy among doctors in Sweden, and their willingness to contribute to a randomized controlled trial of lateral episiotomy or no episiotomy in vacuum extraction in nulliparous women. STUDY DESIGN A web-based survey was sent to members of the Swedish Society of Obstetrics and Gynecology (n = 2140). The survey included 31 questions addressing personal characteristics, use of episiotomy, a two-dimensional picture on which the respondents drew an episiotomy, and questions regarding attitudes towards episiotomy and participation in a randomized controlled trial. We calculated the proportion of supposedly protective episiotomies (fulfilling criteria of a lateral or mediolateral episiotomy and a length ≥ 30 mm). We compared the results between obstetricians, gynecologists, and residents using Chi-square and Kruskal-Wallis tests for differences between groups, and logistic regression to estimate the odds ratio (OR) of drawing a protective episiotomy. RESULTS We received 432 responses. Doctors without a vacuum delivery in the past year were excluded, leaving 384 respondents for further analyses. In all, 222 (57.8%) doctors reported use of episiotomy in<50% of vacuum extractions. We obtained 308 illustrated episiotomies with a median angle of 53°, incision point distance from the midline of 21 mm, and length of 36 mm, corresponding to a lateral episiotomy. Few doctors combined these parameters correctly resulting in 167 (54.2%) incorrectly drawn episiotomies. Residents drew shorter episiotomies than obstetricians and gynecologists. Doctors ranked episiotomy the least important intervention to prevent obstetric anal sphincter injuries in vacuum extraction. Doctors contributing to an ongoing randomized controlled trial of lateral episiotomy or no episiotomy in vacuum extraction were more able to draw a protective episiotomy (OR 3.69, 95% confidence interval 1.94-7.02). CONCLUSIONS Doctors in Sweden reported restrictive use of episiotomy in vacuum extraction and depicted lateral type episiotomies, although the majority were incorrectly drawn. Preventive episiotomy was ranked of low importance. Our results imply a need for education, training, and guidelines to increase uptake of correct episiotomy technique, which could result in improved prevention of obstetric anal sphincter injuries.
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Affiliation(s)
- Victoria Ankarcrona
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet and the Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden.
| | - Susanne Hesselman
- Department of Women's and Children's Health and Centre for Clinical Research Dalarna and Uppsala University, Uppsala, Sweden
| | - Helena Kopp Kallner
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet and the Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
| | - Sophia Brismar Wendel
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet and the Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
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20
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Malm MC, Hesselman S, Brismar Wendel S, Ericson J. Episiotomy or not? Midwives' experiences of recruiting to a randomized controlled trial during pregnancy and labor - A qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 30:100674. [PMID: 34741843 DOI: 10.1016/j.srhc.2021.100674] [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: 04/20/2021] [Revised: 10/10/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The performance of randomized controlled trials (RCTs) is dependent on recruitment. Recruiting women to RCTs regarding interventions during childbirth may be difficult due to time constraints and their vulnerable situation. Midwives play a major role in such recruitment. Few studies have investigated the views and experiences of recruiters. The aim of this study was to describe midwives' experiences of recruiting pregnant women regarding an RCT of lateral episiotomy or no episiotomy in vacuum-assisted delivery. METHODS In this qualitative study, 19 midwives were interviewed regarding their experiences. The midwives worked at antenatal health care centers or labor wards. The transcribed interviews were analyzed using content analysis. RESULTS Four categories appeared during the analysis, including "experiences and perceptions of providing trial information" and "the right timing in providing trial information," which varied among the midwives. Midwives' perceptions of how the women provided consent or declined participation, and the women's views and questions about the randomization and intervention, were summarized as "experiences of how the trial information was received by the women." In the final category, "perceived trial apprehensions and concerns," some midwives described ethical concerns related to the intervention and financial compensation to the staff involved. CONCLUSIONS Midwives as recruiters would benefit from education and training in incorporating basic and advanced details of trial design and research methods, as well as training and support in recruitment. Awareness and management of the variation among potential recruiters is important when designing and performing an RCT.
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Affiliation(s)
| | - Susanne Hesselman
- Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden; Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Sophia Brismar Wendel
- Sweden School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Jenny Ericson
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden; Department of Paediatrics, Falu Hospital, Falun, Sweden; Department of Paediatrics, Falu Hospital, Falun, Sweden
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21
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Gestational Hypertension and Preeclampsia: An Overview of National and International Guidelines. Obstet Gynecol Surv 2021; 76:613-633. [PMID: 34724074 DOI: 10.1097/ogx.0000000000000942] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Importance Gestational hypertension and preeclampsia are leading causes of maternal and perinatal morbidity and mortality worldwide. Τhe lack of effective screening and management policies appears to be one of the main reasons. Objective The aim of this study was to review and compare recommendations from published guidelines on these common pregnancy complications. Evidence Acquisition A descriptive review of guidelines from the National Institute for Health and Care Excellence, the Society of Obstetric Medicine of Australia and New Zealand, the International Society of Hypertension, the International Society for the Study of Hypertension in Pregnancy, the European Society of Cardiology, the International Federation of Gynecology and Obstetrics, the Society of Obstetricians and Gynaecologists of Canada, the American College of Obstetricians and Gynecologists, the International Society of Ultrasound in Obstetrics and Gynecology, the World Health Organization, and the US Preventive Services Task Force on gestational hypertension and preeclampsia was carried out. Results There is an overall agreement that, in case of suspected preeclampsia or new-onset hypertension, blood and urine tests should be carried out, including dipstick test for proteinuria, whereas placental growth factor-based testing is only recommended by the National Institute for Health and Care Excellence and the European Society of Cardiology. In addition, there is a consensus on the recommendations for the medical treatment of severe and nonsevere hypertension, the management of preeclampsia, the appropriate timing of delivery, the optimal method of anesthesia and the mode of delivery, the administration of antenatal corticosteroids and the use of magnesium sulfate for the treatment of eclamptic seizures, the prevention of eclampsia in cases of severe preeclampsia, and the neuroprotection of preterm neonates. The reviewed guidelines also state that, based on maternal risk factors, pregnant women identified to be at high risk for preeclampsia should receive low-dose aspirin starting ideally in the first trimester until labor or 36 to 37 weeks of gestation, although the recommended dose varies between 75 and 162 mg/d. Moreover, most guidelines recommend calcium supplementation for the prevention of preeclampsia and discourage the use of other agents. However, controversy exists regarding the definition and the optimal screening method for preeclampsia, the need for treating mild hypertension, the blood pressure treatment targets, and the postnatal blood pressure monitoring. Conclusions The development and implementation of consistent international protocols will allow clinicians to adopt effective universal screening, as well as preventive and management strategies with the intention of improving maternal and neonatal outcomes.
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22
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Tsakiridis I, Giouleka S, Arvanitaki A, Mamopoulos A, Giannakoulas G, Papazisis G, Athanasiadis A, Dagklis T. Chronic hypertension in pregnancy: synthesis of influential guidelines. J Perinat Med 2021; 49:859-872. [PMID: 33872475 DOI: 10.1515/jpm-2021-0015] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/18/2021] [Indexed: 12/29/2022]
Abstract
Chronic hypertension in pregnancy accounts for a substantial proportion of maternal morbidity and mortality and is associated with adverse perinatal outcomes, most of which can be mitigated by appropriate surveillance and management protocols. The aim of this study was to review and compare recommendations of published guidelines on this condition. Thus, a descriptive review of influential guidelines from the National Institute for Health and Care Excellence, the Society of Obstetric Medicine of Australia and New Zealand, the International Society of Hypertension, the International Society for the Study of Hypertension in Pregnancy, the European Society of Cardiology, the International Federation of Gynecology and Obstetrics, the Society of Obstetricians and Gynaecologists of Canada and the American College of Obstetricians and Gynecologists on chronic hypertension in pregnancy was conducted. All guidelines agree on the definition and medical management, the need for more frequent antenatal care and fetal surveillance and the re-evaluation at 6-8 weeks postpartum. There is also a consensus that the administration of low-dose aspirin is required to prevent preeclampsia, although the optimal dosage remains controversial. No universal agreement has been spotted regarding optimal treatment blood pressure (BP) targets, need for treating mild-to-moderate hypertension and postnatal BP measurements. Additionally, while the necessity of antenatal corticosteroids and magnesium sulfate for preterm delivery is universally recommended, the appropriate timing of delivery is not clearly outlined. Hence, there is a need to adopt consistent practice protocols to optimally manage these pregnancies; i.e. timely detect and treat any potential complications and subsequently reduce the associated morbidity and mortality.
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Affiliation(s)
- Ioannis Tsakiridis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sonia Giouleka
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandra Arvanitaki
- Adult Congenital Heart Centre and National Centre for Pulmonary Arterial Hypertension, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Mamopoulos
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Papazisis
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Athanasiadis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Masturzo B, Zonca M, Germano C, Girlando F, Diacono D, Attini R, Menato G, Benedetto C. Operative vaginal delivery: all you should know. Minerva Obstet Gynecol 2021; 73:45-56. [PMID: 33821598 DOI: 10.23736/s2724-606x.21.04679-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Over the last three decades, the decrease in operative vaginal delivery (OVD) has lead to an increase in the rate of cesarean sections, giving rise to intense debate amongst healthcare providers. As the use of vacuum and forceps requires personnel be adequately trained so as to become familiar with the correct use of instruments, the lack of skilled and experienced instructors may well lead to this technique being discarded in the near future. The aim of this study was to review the literature, compare the recommendations from international OVD guidelines and to illustrate the correct technique of obstetrical vacuum and forceps application to promote OVD among clinicians as a safe way of delivery.
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Affiliation(s)
- Bianca Masturzo
- Sant'Anna University Hospital, Città della Salute e della Scienza, Turin, Italy -
| | - Marina Zonca
- Sant'Anna University Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Chiara Germano
- Department of Surgical Sciences, Sant'Anna University Hospital, Turin, Italy
| | - Flavia Girlando
- Department of Surgical Sciences, Sant'Anna University Hospital, Turin, Italy
| | - Debora Diacono
- Department of Surgical Sciences, Sant'Anna University Hospital, Turin, Italy
| | - Rossella Attini
- Sant'Anna University Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Guido Menato
- Unit of Obstetrics and Gynaecology 2, Department of Surgical Sciences, Sant'Anna University Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Chiara Benedetto
- Unit of Obstetrics and Gynaecology 1, Department of Surgical Sciences, Sant'Anna University Hospital, Città della Salute e della Scienza, Turin, Italy
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Harrison MS, Teshome B, Liyew T, Kirub E, Jimenez-Zambrano A, Muldrow M, Yarinbab T. Prevalence of and characteristics associated with operative vaginal birth at Mizan-Tepi University Teaching Hospital. Int Health 2021; 13:199-204. [PMID: 32478380 PMCID: PMC7902677 DOI: 10.1093/inthealth/ihaa024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/09/2020] [Accepted: 04/22/2020] [Indexed: 11/30/2022] Open
Abstract
Background To observe prevalence, characteristics and outcomes associated with operative vaginal birth (OVB). Methods We compared spontaneous vaginal birth with OVB. Results Of 993 women, 759 (76.4%) experienced vaginal birth; 716 were spontaneous (94.3%), 14 (1.8%) underwent forceps-assisted birth and 29 (3.8%) had vacuum assistance. In a multivariable model of OVB (forceps and vacuum), compared with a midwife, general practitioners (OR 5.6, p = 0.04) and integrated emergency surgical officers (OR 42.8, p = 0.001) were more likely to attend. Women experiencing OVB were more likely to receive local anesthesia (OR 3.0, p = 0.009). Conclusion OVB is used sparingly but safely at Mizan-Tepi University Teaching Hospital.
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Affiliation(s)
- Margo S Harrison
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Biruk Teshome
- Mizan-Tepi University Teaching Hospital, Aman, Bench Maji Zone, Ethiopia
| | - Tewodros Liyew
- Mizan-Tepi University Teaching Hospital, Aman, Bench Maji Zone, Ethiopia
| | - Ephrem Kirub
- Mizan-Tepi University Teaching Hospital, Aman, Bench Maji Zone, Ethiopia
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25
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De Angelis C, Di Stadio A, Vitale S, Saccone G, Angelis MCD, Zizolfi B, Di Spiezio Sardo A. Use of calendula ointment after episiotomy: a randomized clinical trial. J Matern Fetal Neonatal Med 2020; 35:1860-1864. [PMID: 32460565 DOI: 10.1080/14767058.2020.1770219] [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: 12/14/2022]
Abstract
Objective: Episiotomy is associated with an increased risk of postpartum pain, bleeding, and dyspareunia. The hypothesis of this trial was that in women with singleton pregnancy, and spontaneous labor at term, use of calendula ointment would reduce pain after episiotomy.Methods: This was a single-center parallel group randomized trial of women with singleton pregnancies and spontaneous labor at term who were randomized to either use of calendula ointment (i.e. intervention group) or standard care (i.e. control group) after episiotomy. Eligible women were those with singleton gestations in spontaneous labor and vertex presentation at term. Women with premature rupture of membranes were excluded from the study. Women in the intervention group were recommended use of calendula ointment 4 h after the episiotomy and then every 8 h for 10 days. The primary outcome was the pain level. Pain level was self-reported and recorded using the verbal rating scale (VRS). The effect of the calendula ointment was quantified as mean difference (MD) with 95% confidence interval (CI).Results: During the study, 100 women agreed to take part in the study, underwent randomization, and were enrolled in this trial. Of the 100 randomized women, 50 were randomized to the calendula ointment group, and 50 to the control group. No women were excluded after randomization or lost to follow up.Women who received calendula ointment after episiotomy compared to standard care had a significantly lower pain level starting from day two and during all the follow-up. Calendula ointment also improve wound healing in terms of redness and edema.Conclusions: Use of calendula ointment significantly reduce pain after episiotomy.
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Affiliation(s)
- Carlo De Angelis
- Casa di Cura Accreditata Fabia Mater, Rome, Italy.,Department of Obstetrics and Gynecology, Sapienza University of Rome, Roma, Italy
| | | | | | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | | | - Brunella Zizolfi
- Department of Public Health, University of Naples Federico II, Naples, Italy
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Sagi-Dain L, Kreinin-Bleicher I, Bahous R, Gur Arye N, Shema T, Eshel A, Caspin O, Gonen R, Sagi S. Is it time to abandon episiotomy use? A randomized controlled trial (EPITRIAL). Int Urogynecol J 2020; 31:2377-2385. [PMID: 32448935 DOI: 10.1007/s00192-020-04332-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/05/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this trial was to evaluate whether avoidance of episiotomy can decrease the risk of advanced perineal tears. METHODS In this randomized (1:1) parallel-group superiority trial, primiparous women underwent randomization into "avoidance of episiotomy" (the study group in which episiotomy was allowed only in cases of fetal distress) or "standard care." The primary outcome was the incidence of advanced (3rd- and 4th-degree) perineal tears. RESULTS The participants were randomized into "standard care" (n = 337) vs. "no episiotomy" (n = 339) groups, not differing in any demographic or obstetric characteristics. Episiotomy rates were significantly lower in the study group (19.6%) compared with the standard care group (29.8%, p = 0.004). Five (1.5%) advanced tears were diagnosed in the study group vs. ten = 3.0% in the controls, yielding an odds ratio of 0.50 (95% CI 0.17-1.50) in favor of the "no episiotomy" group (p = 0.296). No differences were noted in any secondary outcomes. By per protocol analysis (omitting cases in which episiotomy was performed for indications other than fetal distress in the study group), a trend to decreased risk of advanced tears in the study group was noted (p = 0.0956). By per protocol analyses, no severe tears were noted in the 53 vacuum deliveries in the study group vs. 4/65 (6.2%) tears in the controls (p = 0.126). CONCLUSIONS Since decreased use of episiotomy was not associated with higher rates of severe tears or any other adverse outcomes, we believe this procedure can be avoided in spontaneous as well as vacuum-assisted deliveries. Trial registration no. NCT02356237.
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Affiliation(s)
- Lena Sagi-Dain
- Department of Obstetrics and Gynecology, Carmel Medical Center, 7 Michal St., Haifa, Israel. .,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | | | - Rabia Bahous
- Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Haifa, Israel
| | - Noga Gur Arye
- Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Haifa, Israel
| | - Tamar Shema
- Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Haifa, Israel
| | - Aya Eshel
- Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Haifa, Israel
| | - Orna Caspin
- Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Haifa, Israel
| | - Ron Gonen
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Haifa, Israel
| | - Shlomi Sagi
- Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Haifa, Israel
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