Objective: To compare maternal and fetal outcome associated with two methods Reverse breech extraction versus Head pushing to deliver the impacted fetal head in advanced labor requiring emergency Cesarean section. Met...Objective: To compare maternal and fetal outcome associated with two methods Reverse breech extraction versus Head pushing to deliver the impacted fetal head in advanced labor requiring emergency Cesarean section. Method: A prospective comparative study was conducted on 80 pregnant women at term with cephalic presentation in advanced labour, requiring emergency Cesarean Section. Reverse breech extraction technique (pull method) was used in 40 cases (group I) and pushing the head up through the vagina (“push” method) was tried in (group II) 40 cases. The maternal outcome was assessed by extension of the uterine Incision, bladder injury, intra and postoperative blood transfusion, Postpartum hemorrhage, wound infection and duration of hospital stay. Fetal outcome was Apgar score and admission to neonatal intensive care unit. Results: Extension of the uterine incision was significantly lower in women undergoing reverse breech extraction compared to cephalic delivery (20% versus 50%;p = 0.001). The mean operative time (pull group) was lower than that in the (push group) 59.7 ± 4.2, versus 75.2 ± 6.1 p = 0.001 and blood loss was significantly lower in the (pull group) than that in the (push group) 878 ± 67 ml, versus 1321 ± 57 ml, p = 0.001. No significant difference between groups regarding maternal and neonatal outcome. Conclusion: Reverse breech extraction (pull) is safer than pushing head up through vagina (push) for delivery of a deeply impacted fetal head in advanced labour sensitizing emergency Cesarean Section and is associated with the least maternal complications.展开更多
“Locked twins” is a rare event occurring in about 1 in every 1000 twin births. A 21-year-old primigravida with a 31-week twin pregnancy was admitted for delivery. The head of the first twin was locked to the chin of...“Locked twins” is a rare event occurring in about 1 in every 1000 twin births. A 21-year-old primigravida with a 31-week twin pregnancy was admitted for delivery. The head of the first twin was locked to the chin of the second twin at the top of the symphysis pubis. Caesarean section was performed allowing the delivery of both dead twins. Twins gestations with first twin in the breech </span><span style="font-family:Verdana;">presentation raise index of suspicion of potential locked twin. However,</span><span style="font-family:Verdana;"> management of such situation is controversial with most authors and colleges re</span><span style="font-family:Verdana;">commending caesarean section to avoid interlocking heads. We report</span><span style="font-family:Verdana;"> another rare case of interlocking heads and bring up the topic about management of breech-first twin deliveries.展开更多
Introduction: Breech birth has always been a subject of great interest because of its risks of perinatal morbidity and mortality. Aim: The aim of our study was to compare the maternal and perinatal prognosis of breech...Introduction: Breech birth has always been a subject of great interest because of its risks of perinatal morbidity and mortality. Aim: The aim of our study was to compare the maternal and perinatal prognosis of breech delivery with that of vertex delivery. Patients and Method: This was a retrospective case-control analytical study carried out in the obstetrics and gynaecology department of Ségou hospital over a 2-year period from 1 January 2020 to 31 December 2021, involving 242 breech deliveries compared with 484 top deliveries with a live single foetus without foetal malformation of gestational age ≥ 35 SA. The statistical tests used were: chi² (p Results: The frequency of breech delivery was 3.3%, with a predominance of caesarean section for breech presentation (64.88%) compared with 32.85% for vertex (P: 0.00;CI: (0.191 - 0.367). The perinatal prognosis of fetuses with breech presentations was marked by a higher rate of neonatal asphyxia (Apgar score Conclusion: Breech birth is relatively rare in our department. It carries a higher risk of maternal morbidity and neonatal morbidity than breech delivery. However, the vital prognosis for the mother was identical in both groups.展开更多
Over 10%of English Restoration drama engaged its audience through plays that were translated from or imitated the Spanish capa y espada form of theatre.English plays modeled on this form used Spanish locations and a c...Over 10%of English Restoration drama engaged its audience through plays that were translated from or imitated the Spanish capa y espada form of theatre.English plays modeled on this form used Spanish locations and a constructed and rigid idea of honor as a proxy for English society.While dialogue was still important,it performed physical action of this form,including frequent use of breeches roles and female characters sword fighting,allowed for different and effective critiques and models of social behavior for women in England.Particularly important were concerns about women’s behavior and status in English society,and the presence of the actress for the first time on English stages heightened the effectiveness of these plays as an instrument of social discussion.展开更多
Any non-cephalic presentation in a fetus is regarded as malpresentation.The most common malpresentation,breech,contributes to 3%-5%of term pregnancies and is a leading indication for cesarean delivery.Identification o...Any non-cephalic presentation in a fetus is regarded as malpresentation.The most common malpresentation,breech,contributes to 3%-5%of term pregnancies and is a leading indication for cesarean delivery.Identification of risk factors and a proper physical examination are beneficial;however,ultrasound is the gold standard for the diagnosis of malpresentations.External cephalic version(ECV)refers to a procedure aimed to convert a non-cephalic presenting fetus to cephalic presentation.This procedure is performed manually through the mother’s abdomen by a trained health care provider,to reduce the likelihood of a cesarean section.Studies have reported a version success rate of above 50%by ECV.The main objective of this review is to present a broad perspective on fetal malpresentation,ECV,and delivery of a breech fetus.The focus is to elaborate all clinical scenarios of breech and to provide an evidence-based clinical approach for them.After discussing breech prevalence,risk factors,diagnosis,and management,an updated review of ECV is presented.Moreover,ECV indications/contraindications,alternatives,clinical techniques on how to perform ECV and breech vaginal delivery,and obstetrical considerations for the delivery of malpresentations are thoroughly discussed.展开更多
Objective:Various techniques are proposed for changing fetal presentation.We aimed to assess the effect of BL67 point stimulation on correcting breech presentation and natural delivery in women at 36-38 gestational we...Objective:Various techniques are proposed for changing fetal presentation.We aimed to assess the effect of BL67 point stimulation on correcting breech presentation and natural delivery in women at 36-38 gestational weeks.Methods:A parallel single blinded randomized clinical trial was conducted on 72 eligible pregnant women with breech presentation at the 36 weeks of pregnancy.The subjects were divided into two groups-intervention(n=36)and control groups(n=36)by block randomization method.The intervention group stimulated the BL67 point by self-administration for 20 min once a day for 2 weeks.Finally,the appearance of cephalic presentation and rate of vaginal delivery was compared between the groups(n1=n2=32)using the Chi-square test and multivariate logistic regression.Results:The correction of breech to cephalic presentation occurred in 53.1% of patients in the intervention group.The adjusted relative risk(RR)for fetal correction from breech to cephalic was 1.80(RR=1.80,95%confidence interval[CI],1.13-5.17).It was shown that the stimulation of the BL67 point increased the correction of breech to cephalic presentation.In addition,the rate of vaginal delivery increased by>4-fold(RR=4.16,95%CI,2.54-6.82)by correction to cephalic presentation.Moreover,65.6%of mothers in intervention group and 90.6%in the control group underwent cesarean section.Conclusions:The stimulation of the BL67 point is a safe,inexpensive,and effective method that can be self-administered at home for fetal correction from breech to cephalic presentation in women with breech presentations during 36-38 gestational weeks.This promotes uncomplicated natural childbirth.展开更多
目的:通过证据图谱系统描述和评价不同干预措施纠正胎儿臀位的相关研究,为今后开展干预研究提供指导。方法:计算机检索2000年至2024年中国知网、万方数据、维普资讯、中国生物医学数据库、PubMed、Cochrane Library、Web of Science、EM...目的:通过证据图谱系统描述和评价不同干预措施纠正胎儿臀位的相关研究,为今后开展干预研究提供指导。方法:计算机检索2000年至2024年中国知网、万方数据、维普资讯、中国生物医学数据库、PubMed、Cochrane Library、Web of Science、EMBASE等数据库,获取胎儿臀位干预的随机对照试验和系统评价/Meta分析。采用Risk of Bias和AMSTAR-2对纳入的研究进行质量评价,基于护理结局分类系统对结局指标进行分类,对纳入的研究进行数据提取与编码,采用气泡图综合呈现纳入的研究内容。结果:最终纳入30篇文献,包括24篇随机对照试验和6篇系统评价/Meta分析,共涉及4种干预类型和12种干预方法。其中体位管理干预4篇,外倒转术18篇,分娩球运动1篇,艾灸/刺激至阴穴9篇。结局指标主要包括头位转化有效性28篇,分娩方式18篇、疼痛评分13篇,新生儿状况9篇、不良反应、并发症等;有22篇结局效果为有效或可能有效。结论:研究显示宫缩抑制剂或麻醉下行外倒转术对胎儿臀位的干预是有效、成功率高的,但不同麻醉方式存在差异性。针灸、艾灸与体位管理等方法的干预效果尚未得到确凿证据支持。未来可以将关注点放在新技术和大样本实证研究,并注重干预过程中孕妇的舒适度和心理状况。展开更多
目的:探讨应用改良式体位对孕30~34周初产妇臀位矫正及母婴结局的影响。方法:选取2024年1月至12月于中国人民解放军北部战区总医院助产士门诊行臀位矫正的孕30~34周初产妇274例,按照抛硬币法随机分为两组,通过纳入标准、排除标准、剔除...目的:探讨应用改良式体位对孕30~34周初产妇臀位矫正及母婴结局的影响。方法:选取2024年1月至12月于中国人民解放军北部战区总医院助产士门诊行臀位矫正的孕30~34周初产妇274例,按照抛硬币法随机分为两组,通过纳入标准、排除标准、剔除标准,最终筛选入组孕妇为:膝胸卧位组(对照组)126例,改良式体位组(观察组)140例。比较两组孕妇臀位矫正成功率、分娩方式、产程时间、经阴道分娩新生儿1 min和5 min Apgar评分、脐动脉血气、产后恢复、产后抑郁等情况。结果:观察组臀位矫正成功率高于对照组(77.9%vs.58.7%,P<0.05)。孕妇臀位矫正成功后,观察组经阴道分娩率高于对照组(80.7%vs.66.2%),且经阴道分娩产妇中,观察组分娩过程并发症发生率低于对照组(22.7%vs.46.9%),差异有统计学意义(P<0.05)。观察组产妇第一产程(557.7±195.5 min vs.629.6±208.2 min)和第二产程时间(67.7±11.4 min vs.79.6±10.3 min)均低于对照组,差异有统计学意义(P<0.05)。观察组经阴道分娩新生儿脐动脉血气分析pH值高于对照组,差异有统计学意义(7.367±0.028 vs.7.322±0.027,P<0.05)。两组经阴道分娩新生儿1 min和5 min Apgar评分、新生儿脐动脉血气分析碱剩余和乳酸水平差异均无统计学意义(P>0.05)。观察组经阴道分娩产妇产后泌乳初始时间(21.7±4.4 h vs.23.5±4.1 h)、下床时间(8.2±1.2 d vs.9.2±1.4 d)、恶露消退时间(29.6±4.8 d vs.34.1±4.8 d)及产后出血量(298.1±56.1 ml vs.362.9±42.6 ml)均低于对照组,差异有统计学意义(P<0.05)。两组经阴道分娩产妇产后1周和6周抑郁[爱丁堡产后抑郁量表(EPDS)]评分差异无统计学意义(P>0.05)。结论:改良式体位对孕30~34周初产妇臀位矫正成功率高,母婴结局良好,值得临床推广应用。展开更多
目的探讨艾灸联合外倒转术(ECV)矫正胎位异常的应用价值。方法将规律产检的90例臀位孕妇根据干预措施不同分为艾灸组、对照组、艾灸联合ECV组,每组30例。艾灸联合ECV组采用艾灸联合ECV治疗,艾灸组采用艾灸治疗,对照组不采用干预措施。...目的探讨艾灸联合外倒转术(ECV)矫正胎位异常的应用价值。方法将规律产检的90例臀位孕妇根据干预措施不同分为艾灸组、对照组、艾灸联合ECV组,每组30例。艾灸联合ECV组采用艾灸联合ECV治疗,艾灸组采用艾灸治疗,对照组不采用干预措施。比较三组妊娠结局(剖宫产率、非头位分娩率、新生儿出生后1 min Apgar评分<7分的发生率、胎膜早破率、急性胎窘率、死胎率及脐带脱垂率)。结果对照组、艾灸组、艾灸联合ECV组在新生儿出生后1 min Apgar评分<7分的发生率、胎膜早破率、急性胎窘率、死胎率和脐带脱垂率两两比较均无显著差异(P>0.05)。对照组4例孕妇自发过渡到头位,均阴道分娩成功;1例孕妇臀位宫口开全,通过臀位牵引成功经阴道分娩。艾灸组12例孕妇成功转为头位,均阴道分娩成功。艾灸联合ECV组22例孕妇成功转为头位,其中21例经阴道成功分娩,1例因巨大儿行剖宫产。艾灸联合ECV组剖宫产率(30.0%)低于艾灸组(60.0%)、对照组(83.3%),艾灸组剖宫产率低于对照组(P<0.05);艾灸联合ECV组非头位分娩率(26.7%)低于艾灸组(60.0%)、对照组(86.7%),艾灸组非头位分娩率低于对照组(P<0.05)。结论艾灸联合ECV在降低胎位异常孕妇剖宫产率和非头位分娩率方面具有显著优势,且安全性良好,临床价值显著。展开更多
文摘Objective: To compare maternal and fetal outcome associated with two methods Reverse breech extraction versus Head pushing to deliver the impacted fetal head in advanced labor requiring emergency Cesarean section. Method: A prospective comparative study was conducted on 80 pregnant women at term with cephalic presentation in advanced labour, requiring emergency Cesarean Section. Reverse breech extraction technique (pull method) was used in 40 cases (group I) and pushing the head up through the vagina (“push” method) was tried in (group II) 40 cases. The maternal outcome was assessed by extension of the uterine Incision, bladder injury, intra and postoperative blood transfusion, Postpartum hemorrhage, wound infection and duration of hospital stay. Fetal outcome was Apgar score and admission to neonatal intensive care unit. Results: Extension of the uterine incision was significantly lower in women undergoing reverse breech extraction compared to cephalic delivery (20% versus 50%;p = 0.001). The mean operative time (pull group) was lower than that in the (push group) 59.7 ± 4.2, versus 75.2 ± 6.1 p = 0.001 and blood loss was significantly lower in the (pull group) than that in the (push group) 878 ± 67 ml, versus 1321 ± 57 ml, p = 0.001. No significant difference between groups regarding maternal and neonatal outcome. Conclusion: Reverse breech extraction (pull) is safer than pushing head up through vagina (push) for delivery of a deeply impacted fetal head in advanced labour sensitizing emergency Cesarean Section and is associated with the least maternal complications.
文摘“Locked twins” is a rare event occurring in about 1 in every 1000 twin births. A 21-year-old primigravida with a 31-week twin pregnancy was admitted for delivery. The head of the first twin was locked to the chin of the second twin at the top of the symphysis pubis. Caesarean section was performed allowing the delivery of both dead twins. Twins gestations with first twin in the breech </span><span style="font-family:Verdana;">presentation raise index of suspicion of potential locked twin. However,</span><span style="font-family:Verdana;"> management of such situation is controversial with most authors and colleges re</span><span style="font-family:Verdana;">commending caesarean section to avoid interlocking heads. We report</span><span style="font-family:Verdana;"> another rare case of interlocking heads and bring up the topic about management of breech-first twin deliveries.
文摘Introduction: Breech birth has always been a subject of great interest because of its risks of perinatal morbidity and mortality. Aim: The aim of our study was to compare the maternal and perinatal prognosis of breech delivery with that of vertex delivery. Patients and Method: This was a retrospective case-control analytical study carried out in the obstetrics and gynaecology department of Ségou hospital over a 2-year period from 1 January 2020 to 31 December 2021, involving 242 breech deliveries compared with 484 top deliveries with a live single foetus without foetal malformation of gestational age ≥ 35 SA. The statistical tests used were: chi² (p Results: The frequency of breech delivery was 3.3%, with a predominance of caesarean section for breech presentation (64.88%) compared with 32.85% for vertex (P: 0.00;CI: (0.191 - 0.367). The perinatal prognosis of fetuses with breech presentations was marked by a higher rate of neonatal asphyxia (Apgar score Conclusion: Breech birth is relatively rare in our department. It carries a higher risk of maternal morbidity and neonatal morbidity than breech delivery. However, the vital prognosis for the mother was identical in both groups.
文摘Over 10%of English Restoration drama engaged its audience through plays that were translated from or imitated the Spanish capa y espada form of theatre.English plays modeled on this form used Spanish locations and a constructed and rigid idea of honor as a proxy for English society.While dialogue was still important,it performed physical action of this form,including frequent use of breeches roles and female characters sword fighting,allowed for different and effective critiques and models of social behavior for women in England.Particularly important were concerns about women’s behavior and status in English society,and the presence of the actress for the first time on English stages heightened the effectiveness of these plays as an instrument of social discussion.
文摘Any non-cephalic presentation in a fetus is regarded as malpresentation.The most common malpresentation,breech,contributes to 3%-5%of term pregnancies and is a leading indication for cesarean delivery.Identification of risk factors and a proper physical examination are beneficial;however,ultrasound is the gold standard for the diagnosis of malpresentations.External cephalic version(ECV)refers to a procedure aimed to convert a non-cephalic presenting fetus to cephalic presentation.This procedure is performed manually through the mother’s abdomen by a trained health care provider,to reduce the likelihood of a cesarean section.Studies have reported a version success rate of above 50%by ECV.The main objective of this review is to present a broad perspective on fetal malpresentation,ECV,and delivery of a breech fetus.The focus is to elaborate all clinical scenarios of breech and to provide an evidence-based clinical approach for them.After discussing breech prevalence,risk factors,diagnosis,and management,an updated review of ECV is presented.Moreover,ECV indications/contraindications,alternatives,clinical techniques on how to perform ECV and breech vaginal delivery,and obstetrical considerations for the delivery of malpresentations are thoroughly discussed.
基金Qom University of Medical Sciences,Iran by grant number of 96894.
文摘Objective:Various techniques are proposed for changing fetal presentation.We aimed to assess the effect of BL67 point stimulation on correcting breech presentation and natural delivery in women at 36-38 gestational weeks.Methods:A parallel single blinded randomized clinical trial was conducted on 72 eligible pregnant women with breech presentation at the 36 weeks of pregnancy.The subjects were divided into two groups-intervention(n=36)and control groups(n=36)by block randomization method.The intervention group stimulated the BL67 point by self-administration for 20 min once a day for 2 weeks.Finally,the appearance of cephalic presentation and rate of vaginal delivery was compared between the groups(n1=n2=32)using the Chi-square test and multivariate logistic regression.Results:The correction of breech to cephalic presentation occurred in 53.1% of patients in the intervention group.The adjusted relative risk(RR)for fetal correction from breech to cephalic was 1.80(RR=1.80,95%confidence interval[CI],1.13-5.17).It was shown that the stimulation of the BL67 point increased the correction of breech to cephalic presentation.In addition,the rate of vaginal delivery increased by>4-fold(RR=4.16,95%CI,2.54-6.82)by correction to cephalic presentation.Moreover,65.6%of mothers in intervention group and 90.6%in the control group underwent cesarean section.Conclusions:The stimulation of the BL67 point is a safe,inexpensive,and effective method that can be self-administered at home for fetal correction from breech to cephalic presentation in women with breech presentations during 36-38 gestational weeks.This promotes uncomplicated natural childbirth.
文摘目的:通过证据图谱系统描述和评价不同干预措施纠正胎儿臀位的相关研究,为今后开展干预研究提供指导。方法:计算机检索2000年至2024年中国知网、万方数据、维普资讯、中国生物医学数据库、PubMed、Cochrane Library、Web of Science、EMBASE等数据库,获取胎儿臀位干预的随机对照试验和系统评价/Meta分析。采用Risk of Bias和AMSTAR-2对纳入的研究进行质量评价,基于护理结局分类系统对结局指标进行分类,对纳入的研究进行数据提取与编码,采用气泡图综合呈现纳入的研究内容。结果:最终纳入30篇文献,包括24篇随机对照试验和6篇系统评价/Meta分析,共涉及4种干预类型和12种干预方法。其中体位管理干预4篇,外倒转术18篇,分娩球运动1篇,艾灸/刺激至阴穴9篇。结局指标主要包括头位转化有效性28篇,分娩方式18篇、疼痛评分13篇,新生儿状况9篇、不良反应、并发症等;有22篇结局效果为有效或可能有效。结论:研究显示宫缩抑制剂或麻醉下行外倒转术对胎儿臀位的干预是有效、成功率高的,但不同麻醉方式存在差异性。针灸、艾灸与体位管理等方法的干预效果尚未得到确凿证据支持。未来可以将关注点放在新技术和大样本实证研究,并注重干预过程中孕妇的舒适度和心理状况。
文摘目的:探讨应用改良式体位对孕30~34周初产妇臀位矫正及母婴结局的影响。方法:选取2024年1月至12月于中国人民解放军北部战区总医院助产士门诊行臀位矫正的孕30~34周初产妇274例,按照抛硬币法随机分为两组,通过纳入标准、排除标准、剔除标准,最终筛选入组孕妇为:膝胸卧位组(对照组)126例,改良式体位组(观察组)140例。比较两组孕妇臀位矫正成功率、分娩方式、产程时间、经阴道分娩新生儿1 min和5 min Apgar评分、脐动脉血气、产后恢复、产后抑郁等情况。结果:观察组臀位矫正成功率高于对照组(77.9%vs.58.7%,P<0.05)。孕妇臀位矫正成功后,观察组经阴道分娩率高于对照组(80.7%vs.66.2%),且经阴道分娩产妇中,观察组分娩过程并发症发生率低于对照组(22.7%vs.46.9%),差异有统计学意义(P<0.05)。观察组产妇第一产程(557.7±195.5 min vs.629.6±208.2 min)和第二产程时间(67.7±11.4 min vs.79.6±10.3 min)均低于对照组,差异有统计学意义(P<0.05)。观察组经阴道分娩新生儿脐动脉血气分析pH值高于对照组,差异有统计学意义(7.367±0.028 vs.7.322±0.027,P<0.05)。两组经阴道分娩新生儿1 min和5 min Apgar评分、新生儿脐动脉血气分析碱剩余和乳酸水平差异均无统计学意义(P>0.05)。观察组经阴道分娩产妇产后泌乳初始时间(21.7±4.4 h vs.23.5±4.1 h)、下床时间(8.2±1.2 d vs.9.2±1.4 d)、恶露消退时间(29.6±4.8 d vs.34.1±4.8 d)及产后出血量(298.1±56.1 ml vs.362.9±42.6 ml)均低于对照组,差异有统计学意义(P<0.05)。两组经阴道分娩产妇产后1周和6周抑郁[爱丁堡产后抑郁量表(EPDS)]评分差异无统计学意义(P>0.05)。结论:改良式体位对孕30~34周初产妇臀位矫正成功率高,母婴结局良好,值得临床推广应用。
文摘目的探讨艾灸联合外倒转术(ECV)矫正胎位异常的应用价值。方法将规律产检的90例臀位孕妇根据干预措施不同分为艾灸组、对照组、艾灸联合ECV组,每组30例。艾灸联合ECV组采用艾灸联合ECV治疗,艾灸组采用艾灸治疗,对照组不采用干预措施。比较三组妊娠结局(剖宫产率、非头位分娩率、新生儿出生后1 min Apgar评分<7分的发生率、胎膜早破率、急性胎窘率、死胎率及脐带脱垂率)。结果对照组、艾灸组、艾灸联合ECV组在新生儿出生后1 min Apgar评分<7分的发生率、胎膜早破率、急性胎窘率、死胎率和脐带脱垂率两两比较均无显著差异(P>0.05)。对照组4例孕妇自发过渡到头位,均阴道分娩成功;1例孕妇臀位宫口开全,通过臀位牵引成功经阴道分娩。艾灸组12例孕妇成功转为头位,均阴道分娩成功。艾灸联合ECV组22例孕妇成功转为头位,其中21例经阴道成功分娩,1例因巨大儿行剖宫产。艾灸联合ECV组剖宫产率(30.0%)低于艾灸组(60.0%)、对照组(83.3%),艾灸组剖宫产率低于对照组(P<0.05);艾灸联合ECV组非头位分娩率(26.7%)低于艾灸组(60.0%)、对照组(86.7%),艾灸组非头位分娩率低于对照组(P<0.05)。结论艾灸联合ECV在降低胎位异常孕妇剖宫产率和非头位分娩率方面具有显著优势,且安全性良好,临床价值显著。
