Pregnancy and childbirth in women from among the indigenous minorities of the north in the context of urbanization

Data on the health status of the population of the indigenous small-numbered peoples of the North of Khanty and Mansi, who migrated to the city and changed the traditional nomadic way of life, are few and not systematized.The aim of the study was to study the course of pregnancy and childbirth among the indigenous peoples of the north who migrated and live in the city of Khanty-Mansiysk, Khanty-Mansiysk Autonomous Okrug-Yugra. An increase in the frequency of gynecological diseases was revealed: menstrual irregularities (in 38.5%), inflammatory diseases of the cervix (in 42.3%) and inflammatory diseases of the uterus (in 19.2%). Half of the observed women had gastritis (50%), cholecystitis (51.9%), every fourth cystitis (23.1%), anemia was diagnosed in every third in 30.8%. Pregnancy in women of the study cohort was often complicated by early toxicosis, anemia, gestational diabetes mellitus, threatening premature birth. Childbirth in pregnant women from among the indigenous small peoples of the north living in the city was complicated by anomalies in labor, indications for emergency operative delivery. This requires further study of the health status of the indigenous peoples of the north and the development of a health improvement program.Materials and methods. The course of pregnancy, childbirth and the postpartum period was retrospectively analyzed in 168 women selected by the continuous sampling method. Women from the Khanty and Mansi KMNS living in the village of Berezovo, in the camps and in Khanty-Mansiysk were examined. Statistical processing was performed in the software package SPSS, Statistica 8.0, as well as using the Microsoft Excel analysis package.Results. The results of the study showed that the least number of deviations in the state of health were among women from the number of KMNS living in the village and in the camps and leading a traditional nomadic lifestyle. The course of pregnancy rarely had complications and 100% of women ended in spontaneous labor on time.Conclusion. The urbanization of women from among the indigenous small-numbered peoples of the north has an adverse effect on the state of somatic and reproductive health, characterized by a high frequency of gynecological diseases, pregnancy complications, labor anomalies and operative delivery.

Neuraxial analgesia interfered with the circadian rhythm of labor: a propensity score matched cohort study

Objectives To investigate whether neuraxial analgesia and other medical interventions have effects on the circadian rhythm of labor. Methods It was a retrospective propensity score matched cohort study. Parturients were recruited, who delivered term singletons in cephalic position, from seven hospitals in Harvard University Partners Healthcare Systems, 2016–2018. The parturients were divided into two groups, neuraxial analgesia delivery and spontaneous vaginal delivery, the stratification was performed according to labor induction, oxytocin, operative delivery. The parturients in each group were divided into 12 periods in every 2 h based on the birth time of babies. Cosine function fitting was used to verify whether the birth time had the characteristic of circadian rhythm. Results In spontaneous vaginal deliveries, the peak of birth time was at 2:00–4:00, and the nadir was at 14:00–16:00, this showed a circadian rhythm presented by a cosine curve fitting with the formula (y = 0.0847 + 0.01711 × cos(− 0.2138 × x + 0.4471). The labor rhythm of NAD (Neuraxial Analgesia Delivery) group changed completely, inconsistent with the cosine curve fitting of the circadian rhythm. The intervention of induction and oxytocin blurred the circadian rhythm of SVD (Spontaneous Vaginal Delivery) group and increased the amplitude of the fluctuation in NAD (Neuraxial Analgesia Delivery) group. The intervention of operative delivery had changed the distribution curve completely both in the SVD (Spontaneous Vaginal Delivery) group and the NAD (Neuraxial Analgesia Delivery) group. Conclusions Neuraxial analgesia did affect on circadian rhythm of labor, changed the cosine rhythm of labor with spontaneous vaginal delivery, and this trend was aggravated by the use of induction, oxytocin and operative delivery.

The ‘occiput-spine angle’: a new sonographic index of fetal head deflexion during first stage of labor as predictor of course of labor and outcome

Background Labor is a physiologic process during which the products of conception (i.e. the fetus, membranes, umbilical cord, and placenta) are expelled outside of the uterus. Labor is achieved with changes in the biochemical connective tissue and with gradual effacement and dilatation of the uterine cervix as a result of rhythmic uterine contractions of sufficient frequency, intensity, and duration. Labor is divided into three stages that include cervical dilatation, fetal delivery and delivery of the placenta. Objective The aims of this study were to quantify the degree of fetal head deflection via the use of Ultrasound during the first stage of labor and to determine whether a parameter derived from ultrasound examination (the occiput-spine angle) has a relationship with the progress of labor, subsequent effect on maternal, fetal complications and rate of cesarean delivery. Methods This is a prospective cohort study which includes a total of 200 women with gestational age 37-42 weeks were assessed in this study in Ain shams Maternity hospital labor ward by 2 dimensional ultra sound. Examinations were performed after a verbal and written consent from the patient with the patient lying in the dorsal supine position. And exclusion of Occiput-posterior position, multigravida, Indication for cesarean, Medical disorder eg hypertension or diabetes, pre labor rupture of membranes to correlate between the Occiput- spine angle (OSA) and the outcome of labor regarding the progress of labor, incidence of cesarean section, maternal and fetal complications. Results This study demonstrates that the sonographic measurement of the angle formed by the fetal occiput and the spine (occiput-spine angle) is feasible and reproducible, the occiput-spine angle in the first stage of labor is positively correlated with the clinically established station and the risk of obstructed labor requiring an operative delivery ie, Occiput-spine angle have been statistically significantly lower in cases underwent operative delivery. Occiput-spine angle had a statistically significant low diagnostic performance in predicting operative delivery. Conclusion The occiput-spine angle in the first stage of labor correlates significantly with the risk of obstructed labor Compared with spontaneous vaginal deliveries, cases that require obstetric intervention demonstrated a smaller occiput-spine angle at a similar station, suggesting diminished flexion of the fetal head. For occiput anterior fetuses, the greater the degree of fetal head deflexion, the greater risk of operative delivery due to labor arrest.

Possibilities of practicing the skills of operative delivery in the context of simulation training

Caesarean section (CS) is one of the most common surgical procedures in the world, and its frequency continues to rise, especially in high- and middle-income countries. A technically correct CS determines the successful course of the intra- and postoperative period, promotes favorable healing of the postoperative wound.

Investigating the Vacuum Extractors of Biomedical Devices of Different Materials and Pressures on the Fetal Head during Delivery

Operative delivery requires the use of a vacuum extractor; obstetricians can choose the appropriate vacuum extractor to make the delivery process smoother and safer. However, there is no biomechanical literature focused on the imposed effects of a vacuum extractor prepared with different materials and vacuum pressure on the fetal head during the process of delivery. Therefore, we first established and performed the finite element analytical model to explore the influences of vacuum extractors manufactured from different materials on the fetal head under various extractive pressures. The model of the vacuum extractor was designed as a hemispherical shape, and the material of the vacuum extractor was composed of silicone rubber and stainless steel for comparison. Four different vacuum pressures (500 cm H2O, 600 cm H2O, 700 cm H2O, and 800 cm H2O) were applied as the factors for investigation. The reaction force on the fetal head, von Mises stress of vacuum extractor, and von Mises stress on the skull of fetal head were measured and analyzed to evaluate the effects. The results revealed that subtle divergent influences of different vacuum pressures were observed, and the stainless-steel vacuum extractor induced a larger reaction force (358.04–361.37 N), accompanied with stress (13.547–13.675 MPa), on the fetal head than non-metallic or relatively softer materials. The results provide a reliable basis for selecting proper vacuum extractor during operative delivery to avoid obstetrical complications, such as scalp scratch, cephalohematoma and even intracerebral hemorrhage.

Results of Using the Robson Classification in Kazakhstan

BACKGROUND: Over the past few decades, the cesarean section frequency has increased significantly in many countries around the world, especially in the countries with high and medium income. The World Health Organization recommends 10–15% as the optimum cesarean section frequency. In Kazakhstan, the frequency of operative delivery in 2018 was 23.5%. AIM: The article is aimed at analyzing the caesarean section frequency following the Robson classification in Kazakhstan at Level II and III obstetric institutions, identifying the groups that make the greatest contribution to the overall cesarean section frequency, studying the clinical reasons in these groups, and identifying the ways to reduce unneeded cesarean sections. METHODS: A prospective study was performed at the Level II and III obstetric facilities in Almaty. On admission for delivery, all women were assigned following the Robson classification. The indices of cesarean section in each of 10 groups and the absolute and relative contribution to the overall cesarean section frequency were calculated. The patient data were prospectively entered into a computer application and processed in MS Excel and Statistica version 23. The results were presented using the Robson classification. The odds ratios were calculated with a confidence interval of 95%. RESULTS: For the period from January 1, 2019, to December 31, 2019, 12,395 women parturiated at Level II and III obstetric facilities. The main contributors to the overall cesarean section frequency at Level II and III obstetric facilities were Group 5 (multiparous women with uterine scars) – 46.3% (Level II facility) and 37.5% (Level III facility), Group 2 (12.4%) and (12.4%), Group 1 (12%) and (9.6%), and Group 10 (11.4%) at the Level III facility. CONCLUSION: The Robson classification has been used for the 1st time in Kazakhstan which has made it possible to identify the reasons that make the greatest contribution to the overall cesarean section frequency. The use of monitoring for analyzing the cesarean section frequency will make it possible to compare the Kazakhstan data with the foreign data and determine the organizational measures aimed at reducing the frequency of operative delivery. The strategies to reduce unneeded cesarean section should focus on reducing the cesarean section frequency in nulliparous women. In the absence of contraindications, natural delivery should be advised to the women with uterine scars.

Maternal and perinatal outcomes in repeated cesarean section

Aim. To analyze the maternal and perinatal outcomes in repeated caesarean section. The first group included 50 laboring women who received combined endotracheal anesthesia for a repeat cesarean section. The second group included 50 laboring women who received spinal anesthesia during the operative delivery. The condition of 100 newborns born by repeated cesarean section was studied.Results. In postpartum period in the women of first group very often, develop endometritis (24%), in second group – 36%, hematometra in first group we see in 12%, in second – 26%. Tracheobronhitis occur in first group among 30%. Research of the condition and course of early neonatal period in newborns showed, that combined anesthesia initiates pathological course of this period. The main complications were asphyxia (28%), and neurological disorders (22%).Conclusions. Different types of analgesia initiate different types of complications in the postoperative period, but better neonatal outcomes with the use of regional anesthesia techniques qualify them as the anesthesia method of choice for repeat cesarean section.

Possibilities for predicting prelabor rupture of membranes

Prelabor rupture of membranes occurs in 20% of all pregnancies, while in the structure of preterm labor it occurs in 40% of cases. Particular attention to prelabor rupture of membranes is primarily due to the risk of developing septic complications being increased as the duration of the anhydrous interval increases. Currently, there are no effective methods for preventing prelabor rupture of membranes. Therefore, the timeliness of prevention of fetal respiratory distress syndrome depends on the effectiveness of the prognosis of this condition. The aim of this study was to assess the possibilities for predicting prelabor rupture of membranes. This was achieved by using an analytical method including carrying out a detailed systematic analysis of modern domestic and foreign literature on predicting prelabor rupture of membranes. The study used databases such as eLIBRARY.RU, Scopus, PubMed, MEDLINE, ScienceDirect, Cochrane Library and FIPS from the creation until December 2020. An integrated approach to assessing the likelihood of prelabor rupture of membranes will allow optimizing the tactics of pregnancy and labor management, which in the future will reduce not only the incidence of maternal and perinatal morbidity, but also the frequency of operative delivery.