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Elective labour

P Rozenberg
Macrosomic fetuses are at increased risk of obstetric complications, and notably shoulder dystocia, responsible for a severe neonatal morbidity. In case of fetal macrosomia, three options are: (i) the elective cesarean delivery, but this is recommended only when the estimated fetal weight is≥4500g for diabetic women and 5000g for non-diabetic women; (ii) the expectative management, but children with birth weight≥4500 had significantly increased risk of perinatal mortality, neonatal asphyxia, trauma, and cesarean delivery; (iii) the induction of labor which, reducing the possibility of fetal growth, reduce the risk of cesarean delivery for cephalopelvic disproportion and shoulder dystocia...
October 19, 2016: Journal de Gynécologie, Obstétrique et Biologie de la Reproduction
Judith Kikhney, Dinah von Schöning, Ina Steding, Julia Schulze, Annett Petrich, Andreas Hiergeist, Udo Reischl, Annette Moter, Anke Thomas
OBJECTIVES: The aim of this study was to detect microorganisms in foetal membranes and placental tissue in preterm chorioamnionitis by combining FISH with broad range PCR. The combination of the two molecular techniques enables identification and localization of the microorganisms within the tissue, confirming their clinical relevance. METHODS: In a prospective cohort study, we compared 31 patients with preterm premature rupture of membranes or preterm labour and preterm delivery by caesarean section with a control group of 26 participants with elective caesarean section at term...
October 15, 2016: Clinical Microbiology and Infection
Clare Dolman, Ian R Jones, Louise M Howard
BACKGROUND: Women with bipolar disorder are at increased risk of having a severe episode of illness associated with childbirth. AIMS: To explore the factors that influence the decision-making of women with bipolar disorder regarding pregnancy and childbirth. METHOD: Qualitative study with a purposive sample of women with bipolar disorder considering pregnancy, or currently or previously pregnant, supplemented by data from an online forum. Data were analysed using thematic analysis...
September 2016: BJPsych Open
Georgy Joy Eralil
OBJECTIVE: Aim of this audit is to analyse indication and proportion of babies delivered by elective caesarean section at less than 39(+0) weeks of gestation exposed to antenatal corticosteroids performed in a Premier Hospital, Hywel Dda Health University. The second aim was to learn how an audit can be done and used for improving clinical practice. METHODS: Present study involved all patients who underwent elective caesarean delivery before 39 weeks completed period of gestation in August and September 2014...
October 2016: Journal of Obstetrics and Gynaecology of India
Gerson Weiss, Sam Teichman, Dennis Stewart, David Nader, Susan Wood, Peter Breining, Elaine Unemori
BACKGROUND: Nonclinical studies indicate that the hormone relaxin is a good candidate for a safe cervical ripening agent that does not cause uterine contractions. METHODS: This Phase II study (conducted November 2, 2005-October 20, 2006) was a randomised, double blind, placebo controlled trial testing 24-h intravenous infusion of serelaxin (recombinant human relaxin) or placebo for cervical ripening in 72 healthy, primiparous women. Eligible subjects had a singleton pregnancy ≥40 weeks, were planned for elective induction, had vertex presentation of the fetus, intact membranes and a Bishop score at screening ≤4...
2016: BMC Pregnancy and Childbirth
Luciana Cordeiro, Cassia Baldini Soares
The aim of the study is to discuss the emancipatory approach to action research as an appropriate methodology for workers' meaningful implementation of evidence-based health care. Implementation of evidence-based health care using action research is well supported by the literature. There are various approaches to action research, and they are coherent with the objectives and methods elected to develop the investigation. It is not clear which approach of action research is responsible for meaningful worker engagement in changing praxis...
August 2016: International Journal of Nursing Practice
Matthew Cauldwell, Kate Von Klemperer, Anselm Uebing, Lorna Swan, Philip J Steer, Michael Gatzoulis, Mark R Johnson
OBJECTIVE: To examine the duration of the passive and active parts of the second stage (SS) of labour in women with cardiac disease (CD) and to assess the adherence to antenatal care plans regarding timing of assisted delivery. Cardiac parameters were measured in a subset of women to investigate any differences between the passive and active SS of labour. STUDY DESIGN: Cohort study of 73 women with CD, classified into mWHO Class Groups I-IV. Women were matched with an equal number of women controlling for gestational age, maternal age (+/- five years), parity, use of regional anaesthesia, and spontaneous versus assisted delivery...
November 1, 2016: International Journal of Cardiology
Yoshimi Suzuki, Emiko Saito, Minako Sawai, Emiko Kishi, Satori Kakemoto, Harumi Nakada, Chiyo Igarashi, Kiyomi Asahara
Objective To equip public health nurses (PHNs) with higher qualifications, PHN education is shifting from an integrated curriculum for PHNs and registered nurses to a specific elective system of undergraduate or postgraduate programs. Most colleges in the special wards of Tokyo introduced the elective system in 2014 before the remaining areas. The outcomes of this must be evaluated. This study aimed to evaluate the achievement levels and practical experiences of PHN students at seven colleges in the special wards before and after introduction of the PHN course as an elective...
2016: [Nihon Kōshū Eisei Zasshi] Japanese Journal of Public Health
N M Murphy, A S Khashan, D I Broadhurst, O Gilligan, K O'Donoghue, L C Kenny
BACKGROUND: To examine perinatal determinants of the antenatal levels of D-dimers. METHODS: Cross-sectional study of 760 low risk pregnant women recruited into five gestational groups. Variables examined in antenatal groups included maternal age, body mass index, parity, smoking, family history venous thromboembolism (VTE) and previous use of the oral contraceptive pill (OCP). Onset of labour and mode of delivery were also examined in the post-natal group. RESULTS: D-dimer levels in group 4 (38-40 + 6) were significantly lower in the women with a history of taking the OCP when compared to those that had not taken it in the past (P = 0...
June 2016: Obstetric Medicine
Nicla A Varnier, Sarah Chwah, Trent Miller, Franziska Pettit, Mark Brown, David Rees, Amanda Henry
BACKGROUND: Shortness of breath is a common physiological pregnancy presentation, secondary to both hormonal and mechanical effects. Its pathological causes are common (asthma exacerbation or infection); new-onset cardiac pathology is rarely considered. CASE: JC, a 39-year old G4P2T1, presented at 34 weeks' gestation with shortness of breath unrelieved by salbutamol. History included asthma, poly-drug abuse and smoking. Initial presentation was consistent with asthma exacerbation and she was treated as such...
September 2015: Obstetric Medicine
Melek Aksoy Sarı, Semih Küçükgüçlü, Şule Özbilgin, Ferim Sakize Günenç, Sümeyye Mercan, Ayşenur Esen, Büşra Yetim
OBJECTIVE: This study aimed to evaluate the maternal, foetal and neonatal effects of anaesthetic techniques used in caesarean sections (C/S) retrospectively over 6 years at the Hospital of Medical School of Dokuz Eylül University and to compare the results with the literature from Turkey and developed countries. METHODS: After obtaining approval from the ethics committee, anaesthetic and gestational data from all caesarean operations performed over a 6-year period between 2005 and 2010 was retrospectively obtained from hospital archives...
December 2015: Turkish Journal of Anaesthesiology and Reanimation
Nicole Jastrow, Suzanne Demers, Nils Chaillet, Mario Girard, Robert J Gauthier, Jean-Charles Pasquier, Belkacem Abdous, Chantale Vachon-Marceau, Sylvie Marcoux, Olivier Irion, Normand Brassard, Michel Boulvain, Emmanuel Bujold
BACKGROUND: Choice of delivery route after previous cesarean delivery can be difficult because both trial of labor after cesarean delivery and elective repeat cesarean delivery are associated with risks. The major risk that is associated with trial of labor after cesarean delivery is uterine rupture that requires emergency laparotomy. OBJECTIVE: This study aimed to estimate the occurrence of uterine rupture during trial of labor after cesarean delivery when lower uterine segment thickness measurement is included in the decision-making process about the route of delivery...
June 21, 2016: American Journal of Obstetrics and Gynecology
Anke G Posthumus, Gerard J Borsboom, Jashvant Poeran, Eric A P Steegers, Gouke J Bonsel
BACKGROUND: All women in the Netherlands should have equal access to obstetric care. However, utilization of care is shaped by demand and supply factors. Demand is increased in high risk groups (non-Western women, low socio-economic status (SES)), and supply is influenced by availability of hospital facilities (hospital density). To explore the dynamics of obstetric care utilization we investigated the joint association of hospital density and individual characteristics with prototype obstetric interventions...
2016: PloS One
Pei F Lai, Rachel M Tribe, Mark R Johnson
Acute cAMP elevation inhibits myometrial contractility, but the mechanisms responsible are not fully defined and the long-term effects uncertain. These need to be defined in pregnant human myometrium before the therapeutic potential of cAMP-elevating agents in the prevention of preterm labour can be realised. In the present study, we tested the hypotheses that PKA activity is necessary for cAMP-induced myometrial relaxation and prolonged cAMP elevation can prevent myometrial contractions. Myometrial tissues obtained from term, pre-labour elective Caesarean sections were exposed to receptor-independent cAMP agonists to determine the relationship between myometrial contractility (spontaneous and oxytocin-induced), PKA activity, HSP20 phosphorylation and expression of contraction-associated and cAMP signalling proteins...
June 22, 2016: Journal of Physiology
W Rath, P Tsikouras, G-F von Tempelhoff
Venous thromboembolism (VTE) is one of the leading causes of maternal deaths worldwide. Due to the increasing number of pregnant women with risk factors, the incidence of VTE has risen over the past decades. Mortality and morbidity of VTE are potentially preventable, since more than two-thirds of these women have identifiable risk factors and may benefit from appropriate thromboprophylaxis. The cornerstones for prevention of VTE are the individual and careful assessment of preexisting and new-onset/transient risk factors during pregnancy as well as before and after delivery and a risk-stratified pharmacological thromboprophylaxis...
June 2016: Zeitschrift Für Geburtshilfe und Neonatologie
Jacqueline M Wallace, Sohinee Bhattacharya, Doris M Campbell, Graham W Horgan
Women with specific adverse pregnancy outcomes in their first pregnancy may be receptive to inter-pregnancy weight management guidance aimed at preventing these complications reoccurring in subsequent pregnancies. Thus the association between inter-pregnancy weight change and the risk of recurrent pregnancy complications at the second pregnancy was investigated in a retrospective cohort study of 24,520 women with their first-ever and second consecutive deliveries in Aberdeen using logistic regression. Compared with women who were weight stable, weight loss (>2BMI units) between pregnancies was associated with an increased risk of recurrent small for gestational age (SGA) birth and elective Cesarean-section, and was protective against recurrent pre-eclampsia, placental oversize and large for gestational age (LGA) birth...
2016: PloS One
S Bartolo, F Goffinet, B Blondel, C Deneux-Tharaux
OBJECTIVE: To identify the characteristics of women and maternity units associated with elective repeat caesarean delivery (ERCD) in women eligible for trial of labour after caesarean (TOLAC). DESIGN: Cross-sectional study. SETTING: France. POPULATION AND SAMPLE: Using data from the 2010 French National Perinatal Survey, a representative sample of births in France (n = 14 681 women), we studied two groups of women with prior caesarean section: (i) women eligible for TOLAC according to guidelines (n = 1179) and (ii) a subgroup of these women without any medical characteristics that might indicate ERCD (n = 575)...
September 2016: BJOG: An International Journal of Obstetrics and Gynaecology
Mary-Ann Davey, James King
BACKGROUND: The impact of elective induction of labour at term on the increasing caesarean section (CS) rate is unclear. A Cochrane Systematic Review that concluded that elective induction was associated with a reduction in CS was based on trials that mostly reflect outdated obstetric care, or were flawed. The findings of other studies vary widely in the magnitude and direction of the relationship between elective induction and CS. This inconsistency may be due to the heterogeneity in the methods used to induce or augment labour, such that the relationship with CS is not constant across methods...
2016: BMC Pregnancy and Childbirth
Elham M Jalal, Felipe Moretti, Andree Gruslin
BACKGROUND: Non-elective cervical cerclages are associated with significant perinatal complications. There is scant available information about what the predictors of these outcomes are, thus making counselling difficult. OBJECTIVE: To identify which factors predict delivery at or beyond 28, 34, and 37 weeks' gestation in women with emergency/rescue cervical cerclage. METHODS: We conducted a retrospective cohort study of nonelective cerclages over 10 years in our centre...
March 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Misao Fukuda, Kiyomi Fukuda, Takashi Shimizu, Emmanuel Bujold
OBJECTIVES: To evaluate the normal ranges of lower uterine segment (LUS) thickness throughout pregnancy in women without a previous cesarean and to evaluate the relationship between ultrasound and intraoperative LUS thickness. METHODS: We assessed LUS thickness using transabdominal and transperineal longitudinal scan at each week of gestation, during labour, and in the postpartum period in 1000 pregnant women without previous CS. Secondly, we assessed LUS thickness immediately before CS (using ultrasound) and intraoperatively (using ophthalmic calipers) immediately before delivery of the fetus in 35 women with a previous CS and 29 women without previous CS undergoing elective CS before labour...
February 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
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