Prevention of primary caesarean delivery: comprehensive management of dystocia in nulliparous patients at term

Ragusa, Antonio; Gizzo, Salvatore; Noventa, Marco; Ferrazzi, E.; Deiana, Serena; Svelato, Alessandro

doi:10.1007/s00404-016-4046-5

Cited by 20 publications

(20 citation statements)

References 38 publications

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“…In this perspective, the hyperbolic curve deriving from cervical dilation /time ratio becomes a screening tool and no longer a diagnostic tool to decide when to intervene with medical procedures (6,19). 11.1% of midwives who would intervene with artificial rupture of membranes at the diagnosis of dystocia, probably, as indicated by a comment on the questionnaire, would do it in accordance with NICE indications, that support rupturing the membranes at the time of delay in cervical dilation after 4 hours of unchanged finding ( figure 3).…”

Section: Discussionmentioning

confidence: 99%

Dystocia in labour: diagnosis, management and culture of Italian midwives

et al. 2021

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Objective. Dystocia in labour is the most common indication for primary caesarean sections. We have investigated how Italian midwives are informed and aware of the diagnosis of dystocia in labour, which strategies they implement and how their culture can affect clinical decisions. Methods. Purpose-built questionnaire using convenience sampling on a voluntary basis. The research was carried out on a population of Italian midwives. The questionnaire was divided into three macro-areas: socio-demographic information; a clinical case with decision questions; operators' knowledge and clinical choices. Results. 300 questionnaires were collected, and 289 were analysed. 60% of midwives would have not diagnosed active labour before 6 cm of dilation and would have adopted conservative management. 81% would adopt methods such as change of maternal posture, movement, and emotional support to solve dystocia rather than oxytocin and artificial rupture of membranes. 76% is aware that there is no single definition of dystocia, 80% do not know the definition of latent phase. The discussion on dystocia is rarely addressed in a context such as an audit. Conclusions. Culture considered as experience, knowledge, and work context, could affect clinical practice. Most midwives showed interest in the subject by tackling it with a view that was mainly physiological. The need for training and structured discussion meetings is, in any case, important.

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Section: Discussionmentioning

confidence: 99%

Dystocia in labour: diagnosis, management and culture of Italian midwives

et al. 2021

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“…Neuraxial techniques are used to provide analgesia for labour [8, 9] and anaesthesia for surgical delivery. Therefore, complications associated with neuraxial techniques are sometimes seen even in pregnant patients.…”

Section: Discussionmentioning

confidence: 99%

Case report: difficulty in diagnosis of delayed spinal epidural hematoma in puerperal women after combined spinal epidural anaesthesia

Svelato

Bertelloni

et al. 2019

BMC Anesthesiol

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Background Spinal epidural hematoma is a rare but serious complication of epidural anaesthesia and neurological impairment. Epidural hematoma usually becomes evident within a few hours of the procedure. Delayed clinical presentation of spinal epidural hematoma is even rarer and insidious. Case presentation We reported a case of a 44-year-old woman who underwent a caesarean section for a twin pregnancy during which a delayed dorsal spinal epidural hematoma occurred. Symptoms were reported 5 days after surgery and 72 h after removal of the epidural catheter. An MRI scan showed a dorsal epidural hematoma. The patient was moved to the Neurosurgical Department and underwent decompression surgery. Conclusion The possibility of the delayed onset of a spinal epidural hematoma in a pregnant woman who undergoes epidural anaesthesia in labour must always be taken into consideration. In order to achieve the best clinical result, we stress the importance of a timely diagnosis and prompt surgical treatment.

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“…Failure to progress in labour is often associated with dysfunctional uterine contraction, and is the most common indication for primary CS, accounting for 50% of CSs in nulliparous women and for the majority of repeat CSs in labour (Ragusa et al . ). It has been suggested that poor uterine contractile function may be responsible for the slow labour, increased need for CS, and increased post‐partum haemorrhage reported in the labour of first‐pregnancy women over 40 years of age (Bianco et al .…”

Section: The Need To Augment Contractions and For Caesarean Delivery mentioning

confidence: 97%

Mother Nature versus Father Time

Parkington

Sheehan

Coleman

et al. 2017

The Journal of Physiology

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Prevention of primary caesarean delivery: comprehensive management of dystocia in nulliparous patients at term

Abstract: Comprehensive management of dystocia enabled us to achieve a reduction in iatrogenic interventions in labor while maintaining good neonatal outcomes.

Cited by 20 publications

References 38 publications

Dystocia in labour: diagnosis, management and culture of Italian midwives

Dystocia in labour: diagnosis, management and culture of Italian midwives

Case report: difficulty in diagnosis of delayed spinal epidural hematoma in puerperal women after combined spinal epidural anaesthesia

Mother Nature versus Father Time

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