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Objective This study aimed to compare the effectiveness of sustained uterine compression versus uterine massage in reducing blood loos after a vaginal delivery. Study Design This was a prospective randomized trial conducted at the American University of Beirut Medical Center (AUBMC) between October 2015 and October 2017. Inclusion criteria were women with a singleton pregnancy at ≥36 weeks of gestation, with less than three previous deliveries, who were candidates for vaginal delivery. Participants were randomized into two groups, a sustained uterine compression group (group 1) and a uterine massage group (group 2). Incidence of postpartum hemorrhage (blood loss of ≥500 mL) was the primary outcome. We assumed that the incidence of postpartum hemorrhage at our institution is similar to previously published studies. A total of 545 women were required in each arm to detect a reduction from 9.6 to 4.8% in the primary outcome (50% reduction) with a one-sided α of 0.05 and a power of 80%. Factoring in a 10% dropout rate. Secondary outcomes were admission to intensive care unit (ICU), postpartum complications, drop in hemoglobin, duration of hospital stay, maternal pain, use of uterotonics, or of surgical procedure for postpartum hemorrhage. Results A total of 550 pregnant women were recruited, 273 in group 1 and 277 in group 2. There was no statistically significant difference in baseline characteristics between the two groups. Type of anesthesia, rate of episiotomy, lacerations, and mean birth weight were also equal between the groups. Incidence of the primary outcome was not different between the two groups (group 1: 15.5%, group 2: 15.4%; p = 0.98). There was no statistically significant difference in any of the secondary outcomes between the two groups, including drop in hemoglobin (p = 0.79). Conclusion There was no difference in blood loss between sustained uterine compression and uterine massage after vaginal delivery. Key Points Transabdominal uterine compression and uterine massage are appropriate to prevent postpartum hemorrhage. No significant difference in blood loss or maternal discomfort observed between the two techniques. Both methods are equally effective and either one can be used based on provider preference. [ABSTRACT FROM AUTHOR]

The aim of our study was to compare the neonatal outcome of vaginally delivered breech-presenting twins (VD) to those delivered by cesarean (CS). Maternal and neonatal charts of all live, non-anomalous twins delivered at ≥ 25 weeks of gestation, in a single tertiary care center, over an 11-year period were reviewed. Of 517 twins delivered, 130 breech-presenting twins were analyzed. Thirty-five (26.9%) were delivered vaginally and 95 (73.1%) by cesarean. More patients presented in labor with advanced cervical dilation in the VD compared to the CS group. There was no difference in the incidence of respiratory distress syndrome, intraventricular hemorrhage, need for mechanical ventilation, length of nursery stay or neonatal mortality rate when twin A was compared in the two groups. However, one breech-presenting twin in the VD group had a traumatic delivery at 32 weeks of gestation that caused a spine fracture followed by immediate neonatal death. Although there seems to be no compromise in the immediate neonatal outcome of breech-presenting twins delivered vaginally compared to those delivered by cesarean, the case of head entrapment that led to intrapartum death is quite alarming. Based on our study, we cannot advocate normal vaginal delivery when twin A is non-vertex: cesarean seems to be a safer route of delivery. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To study the perinatal outcome of vaginally delivered twins when twin B is more than 250 g larger than twin A. STUDY DESIGN: Maternal and neonatal charts of live-born, nonanomalous twins, >25 weeks' gestation and vaginally delivered over a period of 17 years were reviewed. The results of this review were distributed among two groups: (1) those with twin B more than 250 g larger than twin A (ΔBW>250) and (2) those where the difference was &t;250 g (ΔBW<250). For vaginally delivered twin gestations, the perinatal outcome of twin B in the group ΔBW>250 was compared to that of its co-twin, and to that of twin B in the group ΔBW<250. RESULTS: Of the 679 twin gestations reviewed, 138 (20.6%) were in the group ΔBW>250, of whom 73 (52.9%) delivered vaginally despite malpresentation in 39.7%. The vaginally delivered twin pregnancies in the groups ΔBW>250 (n =73) and ΔBW<250 (n =303) had similar demographics, parity, presentation, gestational age at delivery, and duration of the first stage of labor. Discordant twins were more frequent in the group ΔBW>250 (26.0 versus 9.5%, p =0.001). Twin B in the group ΔBW<250 was smaller, with higher incidence of growth restriction, low 5 min Apgar score, and hyperbilirubinemia compared to twin B in the group ΔBW>250. There was no difference in the incidence of intraventricular hemorrhage, seizures, sepsis, neonatal death, and median nursery stay. Except for a lower median Apgar score at 1 min in twin B and a longer median nursery stay in twin A, twins A and B in the group ΔBW>250 were similar regarding all other neonatal outcome variables. CONCLUSIONS: When twin B is more than 250 g larger than A, and both are delivered vaginally, the perinatal outcome is similar to its co-twin as well as to that of twin B of all other vaginally delivered twins. That twin B is larger than A is not itself a contraindication to attempted... [ABSTRACT FROM AUTHOR]

OBJECTIVE:: To determine perinatal complications in infants =4500?g according to delivery mode. STUDY DESIGN:: Records of 231 mothers and live cephalic infants weighing =4500?g over a 13-year period were retrospectively reviewed. Maternal and perinatal complications were compared in relation to delivery mode. RESULTS:: Vaginal delivery (NVD) was achievable in 168/189 (88.9%) of women allowed to labor, of which 36.9% were operative. The cesarean delivery (CS) rate was 27.3%. The NVD group had a lower incidence of diabetes; however, hypoglycemia and transient tachypnea were more common in the CS group. The frequency of low Apgar scores at 1 and 5?minutes was similar in both groups. A total of 13 (7.7%) major fetal injuries were documented in the NVD group (arm weakness 3, hematoma 3, clavicular fracture 2, and brachial plexus injury 5). Shoulder dystocia was documented in only 7/13 (53.8%). CONCLUSION:: Vaginal delivery is achievable in 88.9% of pregnancies with infants =4500?g allowed to labor, at the expense of a 7.7% risk of perinatal trauma.Journal of Perinatology (2003) 23, 136-141. doi:10.1038/sj.jp.7210877 [ABSTRACT FROM AUTHOR]

Introduction. Osteitis pubis is a poorly understood and uncommon disorder rarely associated with spontaneous delivery. Case report. We present a case consistent with osteitis pubis that followed a normal vaginal delivery and where symptoms developed earlier than ever previously reported. Discussion. The potential benefit of low molecular heparin is discussed. [ABSTRACT FROM AUTHOR]