Dynamic ultrasonographic imaging of the third stage of labor: New perspectives into third-stage mechanisms

Herman, Arie; Weinraub, Z.; Bukovsky, Ian; Arieli, Shlomo; Zabow, P.; Caspi, Eliahu; Ron-El, Raphaël

doi:10.1016/s0002-9378(11)90788-1

Cited by 72 publications

(57 citation statements)

References 10 publications

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“…(3) Pathological condition of the third stage of labor constitutes a frequent and significant component of maternal complications in labor, thus providing scope for devising better management protocols to decrease maternal morbidity. (1) Adequate retraction of uterus in the third stage is essential for placental separation and thus in controlling postpartum hemorrhage. Postpartum hemorrhage occurs in women with risk factors like multiplepregnancy, fetal macrosmia,prolonged third stage and it also occurs in women with no known risk factors thus necessitating need for a physician's preparedness in dealing with it.…”

Section: Discussionmentioning

confidence: 99%

“…Better understanding of third stage and its mechanisms may contribute to improved medical treatment and diminished maternal morbidity. (1) Complications can occur unexpectedly at this stage and unless prompt action is taken, serious maternal morbidity and sometimes mortality can occur. The most common complication is postpartum haemorrhage, which remains a leading cause of maternal mortality (25%) especially in developing countries.…”

Section: Introductionmentioning

confidence: 99%

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A Randomized Controlled Study of Prophylactic Use of Umbilical Vein Oxytocin in The Management of Third Stage of Labor.

Manhas¹

2012

IOSR-JDMS

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Randomized Controlled Study of Prophylactic Use of Umbilical Vein Oxytocin in The Management of Third Stage of Labor.

Manhas¹

2012

IOSR-JDMS

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“…Herman et al ultrasonographically demonstrated that a retro-placental myometrial contraction is mandatory to produce shearing forces on the interface between the placenta and the myometrium to supply placental separation (28). Contractions occurring prior to delivery are insufficient to cause placental separation since, in the presence of the fetus, the myometrium is unable to achieve the necessary strain for placental separation (5,28).…”

Section: Data Presented As Mean ± Standard Deviation or Median With Mmentioning

confidence: 99%

Placental Blood Drainage Shortens Duration of the Third Stage of Labor in Women Slowly Administered 20 IU Oxytocin

Kaba

Üstün

Eyı

et al. 2017

Gynecol Obstet Reprod Med

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OBJECTIVE: Prolongation of the third stage of labor may cause serious postpartum complications. Thus, timely expulsion of the placenta is essential for preventing complications of the third stage of labor. We conducted a prospective cohort study to determine the effect of placental cord drainage on the duration of the TSL in women administered intravenous oxytocin during this stage. STUDY DESIGN:This was a prospective cohort study in which 112 low risk pregnant women were allocated to the study. There were 53 women in the placental cord drainage group, and 59 women in the cord clamping group without drainage. Immediately after fetal delivery, intravenous infusion of 20 IU oxytocin in 500 mL Ringers' Lactate was started and infused within 2 hours in women in both groups. Outcome measures were the third stage duration and hemoglobin differences between admission and the postpartum sixth hour. RESULTS:There were no significant differences between the two groups with regard to duration of stages 1 and 2 of labor, hemoglobin level on admission, and at the postpartum sixth hour, and hemoglobin differences between admission and the postpartum sixth hour. The median third stage duration in the study group was 3.40 (range: 0.35-16.20) minutes, and 5.10 (range: 2.30-11.00) minutes in the control group. This difference between the groups was statistically significant (p<0.01). CONCLUSION:Placental cord drainage reduces the third stage duration following vaginal deliveries in patients receiving intravenous oxytocin. Placental cord drainage is simple, does not require additional cost, and is applicable for every delivery.Keywords: Third stage of labor, Active management of the third stage, Placental cord drainage,

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“…8 In 1993 Herman et al evaluated 25 normal deliveries compared to five with a prolonged third stage of labor. 23 Normal third-stage labor could be split into four phases: the latent form, qualified by a thick, placenta-free wall and thin, placenta-site wall; the contraction stage, with a thickening of the placenta site wall (from <1cm to >2 cm); the withdrawal phase, when the placenta completes its separation and detaches; and the expulsion phase, which involves a sliding motion of the placenta. 23 Routinely used uterotonic agents had surprisingly little impact on the findings.…”

Section: Examination Of Third Stage Labor With Intrapartum Ultrasoundmentioning

confidence: 99%

“…23 Normal third-stage labor could be split into four phases: the latent form, qualified by a thick, placenta-free wall and thin, placenta-site wall; the contraction stage, with a thickening of the placenta site wall (from <1cm to >2 cm); the withdrawal phase, when the placenta completes its separation and detaches; and the expulsion phase, which involves a sliding motion of the placenta. 23 Routinely used uterotonic agents had surprisingly little impact on the findings. In another study aimed at characterization of normal and abnormal third stage placental separation, gray scale and color Doppler sonography was used to define the three sonographic phases of separation, namely the interval between delivery of the fetus and the beginning of placental separation (latent phase), monophasic or multiphasic shearing off of the placenta (detachment phase), and the interval between completing placental separation and vaginal delivery of the placenta (expulsion phase).…”

Section: Examination Of Third Stage Labor With Intrapartum Ultrasoundmentioning

confidence: 99%

Intrapartum Ultrasonography for Prediction of Vaginal Delivery: Review

Eser¹,

Köşüş²,

Köşüş³

2016

Turkiye Klinikleri J Gynecol Obst

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A AB BS S T TR RA AC CT T Intrapartum ultrasound imaging is gaining popularity, with increased application due to its relative ease of use and direct on-site accessibility. Though its use was initially restricted to esoteric indications and routinely applied antepartum, sonography is now increasingly being used for more mundane intrapartum indications, for example illustration of the precise fetal head position, assessment of fetal head engagement and estimation of the fetal weight. Advance evaluation of the complex physiology of childbirth is now possible with intrapartum ultrasonography, including Doppler flow velocimetry. It is not, however, in current use for the purposes of pure clinical management, i.e. development of labor or the lack thereof. The increased rate of cesarean delivery is a worldwide problem. Medico-legal problems, however, can arise from difficult vaginal deliveries. Internationally, finding ways to reduce cesarean delivery rates is a clinical priority. This includes development of new techniques for encouraging normal vaginal delivery. Appropriate use of intrapartum sonography could contribute to reduction of cesarean delivery rates and help to protect patients and doctors from possible complications of difficult vaginal delivery. Detection of advancing cervical dilatation and descent of the fetal head, however, are two important aspects currently beyond the clinical scope of intrapartum ultrasound imaging. Determination of the descent of the fetal head will be the ultimate challenge of clinical applicability of intrapartum ultrasound imaging. The hope is that imaging ultrasound will ultimately permit us to assess these two vital clinical parameters, which have up until now proven indefinable. K Ke ey y W Wo or rd ds s: : Parturition; ultrasonography; labor, obstetric Ö ÖZ ZE ET T İntrapartum ultrasonografik görüntülemenin, uygulama kolaylığı, direkt erişilebilirliği ve artan uygulama alanları ile popülerliği artmaktadır. Sonografinin ilk uygulama alanları yalnızca özel bilgisi olanlar tarafından anlaşılabilen endikasyonlar ve antepartum uygulamalar ile sınırlı olsa da, son zamanlarda olağan intrapartum endikasyonlar için de kullanılmaktadır. Bu uygulamalar, fetal baş pozisyonunun gösterimi, fetal baş angajmanının değerlendirmesi ve fetal ağırlık tahminini içermektedir. Günümüzde intrapartum ultrasonografi ile doğumun karmaşık fizyolojisinin (doppler akım çalışmalarını içeren) ileri değerlendirmesi mümkün olmaktadır. Klinik yö-netimin tamamında kullanılmamakla birlikte doğum seyrini (veya olamayacağını) tahminde yardımcıdır. Artan sezaryenle doğum oranları dünya genelinde bir problemdir. Bir başka problem ise zor vajinal doğumdan kaynaklanan mediko-legal olayların artıyor olmasıdır. Tüm dünya ülkeleri sezaryen doğum oranlarını azaltmanın yollarını aramaktadır. Normal vajinal doğumu teşvik edecek yeni yöntemler geliştirmenin arayışı içindedirler. Intrapartum sonografi tekniği, sezaryen doğum oranını azaltmanın yanısıra hastaları ve doktorları zor vajinal doğumda oluşabilecek komplikasyonlar...

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Dynamic ultrasonographic imaging of the third stage of labor: New perspectives into third-stage mechanisms

Cited by 72 publications

References 10 publications

A Randomized Controlled Study of Prophylactic Use of Umbilical Vein Oxytocin in The Management of Third Stage of Labor.

A Randomized Controlled Study of Prophylactic Use of Umbilical Vein Oxytocin in The Management of Third Stage of Labor.

Placental Blood Drainage Shortens Duration of the Third Stage of Labor in Women Slowly Administered 20 IU Oxytocin

Intrapartum Ultrasonography for Prediction of Vaginal Delivery: Review

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