Objective This study was undertaken to examine the relationship betwe en labor abnormalities and shoulder dystocia in nulliparous women. Study design Nulliparo us women whose delivery was complicated by shoulder dysto...Objective This study was undertaken to examine the relationship betwe en labor abnormalities and shoulder dystocia in nulliparous women. Study design Nulliparo us women whose delivery was complicated by shoulder dystocia were studied and co mpared with a control group selected based on the best possible match for race, labor type (spontaneous or induced), and birth weight. The duration of first and second stage of labor, as well as the rates of labor progress, were calculated and compared between groups. Results During this 4-year study period, there wer e 8010 nulliparous singleton deliveries of which 65 (0.8%) were complicated by shoulder dystocia. Compared with controls, there was no difference in the rate o f cervical dilation in the active phase of the first stage of labor. In the shou lder dystocia group, more patients had a second stage of labor greater than 2 ho urs (22%vs 3%; P < .05) and had operative vaginal deliveries (26%vs 1.5%; P < .001). In shoulder dystocia cases with birth weight greater than 4000 g, 33%h ad a second stage of labor greater than 2 hours. Conclusion In our population, t he combination of fetal macrosomia, second stage of labor longer than 2 hours an d the use of operative vaginal delivery were associated with shoulder dystocia i n nulliparous women.展开更多
Objective This study was undertaken to determine the effect of advanc ed ultras ound equipment on the ability to visualize fetal cardiac structures in obese gra vid women. Study design Singleton pregnancies undergoing...Objective This study was undertaken to determine the effect of advanc ed ultras ound equipment on the ability to visualize fetal cardiac structures in obese gra vid women. Study design Singleton pregnancies undergoing initial ultrasound exam ination between 14 weeks and 23 weeks 6 days were included. Patients were classi fied by body mass index (BMI) (nonobese <BMI < 30 kg/m2] and obese <BMI ≥30 kg/ m2]). The rate of suboptimal ultrasound visualization (SUV) of the fetal heart ( cardiac axis, cardiac position, 4-chamber, and outflow tracts views) was compar ed between patients examined by standard (HDI 3000) or advanced ultrasound equip ment (HDI 5000)-(ATL, Philips Medical Systems, Bothell, Wash). Results Over a 5 -year period, 7029 singleton gestations met inclusion criteria; 2498 (35.5%) w ere clinically obese. There was no difference in gestational age, rate of low am niotic fluid volume, anterior placenta, or vertex fetal presentation between the groups. When the advanced ultrasound equipment was used, SUV of the fetal heart was lower in the nonobese population (20.8%vs 16.4%; P< .001), but not in the obese gravid women (38.1%vs 35.5%; P=.27). However, obese patients who were e xamined by advanced ultrasound equipment after 18 weeks had less SUV of the outf low tracts (28.5%vs 23.1%, P=.04) but not of the 4-chamber view. Conclusion D espite advanced ultrasound equipment,maternal obesity significantly limits visua lization of the fetal heart. However, the advanced ultrasound equipment may some what benefit obese gravid women examined after 18 weeksgestation.展开更多
Objectives The purpose of this study was to evaluate the association between preinduction modified Bishops score and obstetric outcome, including successful vaginal birth after prior cesarean (VBAC) and uterine rupt...Objectives The purpose of this study was to evaluate the association between preinduction modified Bishops score and obstetric outcome, including successful vaginal birth after prior cesarean (VBAC) and uterine rupture in patients with a previous cesarean undergoing induction of labor. Study design Medical records of all patients who had an induction of labor after a previous cesarean in our institution between 1988 and 2002 were reviewed. Patients were divided into 4 groups according to the modified Bishops score (0 to 2, 3 to 5, 6 to 8, and 9 to 12). The rates of successful VBAC, symptomatic uterine rupture, and other obstetric outcomes were evaluated in each group. Multivariate regression analyses were performed to adjust for confounding factors. Results Out of 685 women included in the study, 187 (27.3%) had a modified Bishops score <2, 276 (40.3%) of 3 to 5, 189 (27.6%) of 6 to 8, and 33 (4.8%) of 9 to 12. The rate of successful VBAC significantly correlated with the modified Bishops score (57.5%, 64.5%, 82.5%, and 97.0%, respectively, P <.001). However, the rate of uterine rupture was not statistically significant between the groups (2.1%, 1.8%, 0.5%, 0.0%, P=.48). After adjusting for confounding variables, a modified Bishops score ≥6 remained associated with successful VBAC (odds ratio [OR] 2.07, 95%CI 1.28-3.35, P <..001). Conclusion The modified Bishops score before induction of labor is an independent factor associated with successful VBAC.展开更多
文摘Objective This study was undertaken to examine the relationship betwe en labor abnormalities and shoulder dystocia in nulliparous women. Study design Nulliparo us women whose delivery was complicated by shoulder dystocia were studied and co mpared with a control group selected based on the best possible match for race, labor type (spontaneous or induced), and birth weight. The duration of first and second stage of labor, as well as the rates of labor progress, were calculated and compared between groups. Results During this 4-year study period, there wer e 8010 nulliparous singleton deliveries of which 65 (0.8%) were complicated by shoulder dystocia. Compared with controls, there was no difference in the rate o f cervical dilation in the active phase of the first stage of labor. In the shou lder dystocia group, more patients had a second stage of labor greater than 2 ho urs (22%vs 3%; P < .05) and had operative vaginal deliveries (26%vs 1.5%; P < .001). In shoulder dystocia cases with birth weight greater than 4000 g, 33%h ad a second stage of labor greater than 2 hours. Conclusion In our population, t he combination of fetal macrosomia, second stage of labor longer than 2 hours an d the use of operative vaginal delivery were associated with shoulder dystocia i n nulliparous women.
文摘Objective This study was undertaken to determine the effect of advanc ed ultras ound equipment on the ability to visualize fetal cardiac structures in obese gra vid women. Study design Singleton pregnancies undergoing initial ultrasound exam ination between 14 weeks and 23 weeks 6 days were included. Patients were classi fied by body mass index (BMI) (nonobese <BMI < 30 kg/m2] and obese <BMI ≥30 kg/ m2]). The rate of suboptimal ultrasound visualization (SUV) of the fetal heart ( cardiac axis, cardiac position, 4-chamber, and outflow tracts views) was compar ed between patients examined by standard (HDI 3000) or advanced ultrasound equip ment (HDI 5000)-(ATL, Philips Medical Systems, Bothell, Wash). Results Over a 5 -year period, 7029 singleton gestations met inclusion criteria; 2498 (35.5%) w ere clinically obese. There was no difference in gestational age, rate of low am niotic fluid volume, anterior placenta, or vertex fetal presentation between the groups. When the advanced ultrasound equipment was used, SUV of the fetal heart was lower in the nonobese population (20.8%vs 16.4%; P< .001), but not in the obese gravid women (38.1%vs 35.5%; P=.27). However, obese patients who were e xamined by advanced ultrasound equipment after 18 weeks had less SUV of the outf low tracts (28.5%vs 23.1%, P=.04) but not of the 4-chamber view. Conclusion D espite advanced ultrasound equipment,maternal obesity significantly limits visua lization of the fetal heart. However, the advanced ultrasound equipment may some what benefit obese gravid women examined after 18 weeksgestation.
文摘Objectives The purpose of this study was to evaluate the association between preinduction modified Bishops score and obstetric outcome, including successful vaginal birth after prior cesarean (VBAC) and uterine rupture in patients with a previous cesarean undergoing induction of labor. Study design Medical records of all patients who had an induction of labor after a previous cesarean in our institution between 1988 and 2002 were reviewed. Patients were divided into 4 groups according to the modified Bishops score (0 to 2, 3 to 5, 6 to 8, and 9 to 12). The rates of successful VBAC, symptomatic uterine rupture, and other obstetric outcomes were evaluated in each group. Multivariate regression analyses were performed to adjust for confounding factors. Results Out of 685 women included in the study, 187 (27.3%) had a modified Bishops score <2, 276 (40.3%) of 3 to 5, 189 (27.6%) of 6 to 8, and 33 (4.8%) of 9 to 12. The rate of successful VBAC significantly correlated with the modified Bishops score (57.5%, 64.5%, 82.5%, and 97.0%, respectively, P <.001). However, the rate of uterine rupture was not statistically significant between the groups (2.1%, 1.8%, 0.5%, 0.0%, P=.48). After adjusting for confounding variables, a modified Bishops score ≥6 remained associated with successful VBAC (odds ratio [OR] 2.07, 95%CI 1.28-3.35, P <..001). Conclusion The modified Bishops score before induction of labor is an independent factor associated with successful VBAC.
