Normal Range of Head-to-body Delivery Interval by Two-step Delivery

Background： The one-step method was routine practices in China, scientific evidence to support this intervention is scarce. The purpose of this study was to observe the natural process of head-to-body delivery interval by waiting for at least one contraction （two-step） after head delivered in normal birth. Methods： From March 1 to March 30 in 2015 at Haikou Maternal and Child Hospital in China, normal vaginal birth with normal baby condition were recorded by video. Videotapes were transferred to computer then replayed and observed. Results： Ninety-two cases were enrolled in this study. The average head-to-body delivery interval by two-step delivery was 71.04± 61.02 s, （mean ＋ 2 standard deviation - 193.07 s, 95% confidence interval [15.65-229.15] s）. Fifty-one patients （51/92, 55.43%） were 〈60 s, 41 patients （41/92, 44.57%） were over 60 s. Shoulders delivered at the first contraction were 96.74% （89/92）, 3.26% （3/92） had delivered by the second contraction. Shoulders emerged from perineum were 71.73% （66/92）, 15.21% （14/92） transversely, and 13.04% （12/92） emerged from under pubic arch. Babies cried before the shoulder were 31.52% （29/92）, cried after birth 52.17% （48/92）, and 16.30% （15/92） did not cry after birth. Baby activities included as making faces, sucking, and bubbled from mouth and noses, and the lighter blue color of skin with good perfusion. Conclusions： The average time of head-to-body delivery interval was longer than 60 s by two-step delivery. Majority shoulders were delivered at the first contraction. Majority shoulders emerged from perineum rather from under pubic arch. The routine one-step method of shoulder delivery where the downward force applied is not necessary and is not the right direction. Baby＇s breath, making faces, sucking, bubble from noses and mouth, and the light blue color of the faces, all those signs during shoulder delivery indicated a normal live birth.

Previable Premature Rupture of Membranes in Dichorionic Diamniotic Twin Gestation, Loss of Leading Twin, Emergency Cervical Cerclage and Ceaserean Delivery at Term

Introduction: Multiple pregnancies have a higher risk of premature delivery and a weakened cervix has been associated with it. In most cases, emergency cerclage has proved to be beneficial as the birth of the first twin is usually followed by the unavoidable delivery of the second twin and most fetus dies shortly after delivery. Studies have noted that delayed delivery of the second fetus in a twin pregnancy is an effective management choice and the use of cervical cerclage after the first delivery is associated with a longer inter-delivery interval. We present a case of previable premature rupture of membrane of a dichorionic diamniotic twin gestation leading to the loss of the leading twin and subsequently having emergency cervical cerclage for the second twin and caesarean delivery at term. Case Presentation: She was a case of a 29 years old, G6P1+4 with 1 living child at a gestational age of 17 weeks plus 5 days who initially was diagnosed with dichorionic diamniotic twin gestation following an early ultrasound but presented with a history of bleeding and passage of liquor per vaginam. Ultrasound done on admission showed cervical funneling and a stable state of the second twin. She subsequently had emergency cervical cerclage after stabilization on account of previable premature rupture of membrane of a dichorionic diamniotic twin gestation with the loss of the leading twin. A repeat ultrasound done prior to discharge showed closed cervical os and a good state of the fetus. She then had elective caesarean delivery at term with a good feto-maternal outcome. Conclusion: Emergency cervical cerclage should be part of the options of management after stabilization in cases of previable premature rupture of membrane in a dichorionic or multichoronic gestation so as to save the viable once.