Labor epidural analgesia (LEA) effectively relieves the labor pain, but it is still not available consistently for multiparous women in many institutions because of their obviously shortened labor length.
A total of 811 multiprous women were retrospective enrolled and firstly divided into two groups: LEA group or non-LEA group. And then they were divided into seven subgroups and analyzed according to the use of LEA and cervical dilation. The primary outcomes (time intervals, blood loss and Apgar scores) and secondary outcomes (maternal demographic characteristics and birth weight) were collected by checking electronic medical records.
The prevalence of using LEA in multiprous women was 54.5 %. Using LEA significantly lengthened the duration of labor stage by 56 min (P < 0.001), increased the blood loss (P < 0.001) and lowered Apgar scores (P = 0.001). In the comparison of sub-group analysis, using LEA can obviously prolong the duration of first-second stage in women with 2 cm cervical dilation (P < 0.001) and 3 cm cervical dilation (P = 0.014), while there was no significant difference with 4 cm or more cervical dilation (P = 0.69). Using LEA can significantly increased the blood loss when the initiation of LEA in the women with 2 cm cervical dilation (P < 0.001) and 3 cm cervical dilation (P = 0.035), meanwhile there were no significantly differences in the women with 4 cm or more cervical dilation (P = 0.524). Using LEA can significantly lower the Apgar scores when the initiation of LEA in the women with 2 cm cervical dilation (P = 0.001) and 4 cm or more cervical dilation (P = 0.025), while there were no significantly differences in the women with 3 cm cervical dilation (P = 0.839).
Labor epidural analgesia for the multiparous woman may alter progress of labor, increase postpartum blood loss and lower Apgar scores. Early or late initiation of LEA should be defined as with cervical dilatation of less or more than 3 cm and the different effect should be understand.
ChiCTR2100042746. Registered 27 January 2021-Prospectively registered, http://www.chictr.org.cn .

BACKGROUND: Labour dystocia (LD) is associated with maternal and foeto-neonatal complications and increased rate of caesarean section. There are scant studies on predictive factors of labour dystocia in Iran, as well as in other countries. Therefore, this study aimed to identify the predictive factors of LD using an integrated and collaborative pre- and during- labour factors to help formulate more effective intervention strategies for prevention and management of LD.
METHODS: In this case-control study, 350 women with and 350 women without LD, matched individually in terms of parity and hospital, were compared. The participants were in active labor, had singleton pregnancy, live foetus with a cephalic presentation, gestational age of 37+ 0-41+ 6 weeks, and were hospitalized for vaginal birth in two teaching hospitals in Tabriz, Iran. Data related to the socio-demographic characteristics, anxiety status (using the Spielberger State Anxiety Inventory), and woman dehydration were collected at cervical dilatation between 4 and 6 cm (before dystocia detection) and the other data at different phases of labour, and after birth (before discharge). The multivariate logistic regression was used to determine the predictors.
RESULTS: The predictors of LD were severe [OR 58.0 (95% CI 26.9 to 125.1)] and moderate [8.6 (4.2 to 17.4)] anxiety, woman dehydration > 3 h [18.67 (4.0 to 87.3)] and ≤ 3 h [2.8 (1.7 to 4.8], insufficient support by the medical staff in the delivery room [5.8 (1.9 to 17.9)], remifentanil administration [3.1 (1.5 to 6.2)], labour induction [4.2 (2.5 to 7.2], low income [2.0 (1.2 to 3.3)], woman\'s height < 160 cm [2.0 (1.1 to 3.3)], and woman age of 16-20 y [0.3 (0.2 to 0.6)]. The proportion of the variance explained by all these factors was 74%.
CONCLUSIONS: The controllable predictors, such as woman anxiety and dehydration, and insufficient support from medical staff during labour were strongly associated with the risk of LD. Therefore, it seems that responding to woman physical, psychological, and supportive needs during labour can play a significant role in LD prevention and control.
UNASSIGNED: IR.TBZMED.REC.1397.624.

OBJECTIVE: To identify additional risk factors for placenta praevia in women with prior caesarean section.
METHODS: A retrospective case-control study of 53 cases and 157 controls was performed. Information was obtained from the National Women\'s database between 2004 and 2009. Cases were defined as women with diagnosed placenta praevia over 20 weeks\' gestation and having had one or more prior caesarean sections. Risk factors assessed from the prior caesarean section were (i) type of suture used for hysterotomy closure; (ii) stage of labour; (iii) type of primary surgeon; and (iv) model of funding. Univariate and logistical regression analyses were performed.
RESULTS: Use of monofilament suture for hysterotomy closure in prior caesarean section significantly reduced the chance of having placenta praevia in the index pregnancy (adjusted odds ratio 0.26, 95% confidence interval 0.08-0.80), as did prior caesarean being performed in the first stage of labour (aOR 0.36, 95% CI 0.14-0.92). Type of primary surgeon (specialist vs trainee junior doctor), nor model of funding of prior caesarean section (public vs private), was associated with risk of placenta praevia (privately funded specialist aOR 4.75, 95% CI 0.89-25.23 and trainee junior doctor aOR 3.18, 95% CI 0.59-17.28, respectively).
CONCLUSIONS: A prior caesarean section performed in first stage, and monofilament suture for hysterotomy closure, reduced the chance of having placenta praevia in the index pregnancy.

OBJECTIVE: Recently, a non-invasive fetal electrocardiogram monitor has been approved for clinical usage in labour and delivery. To determine the fetal signal quality of vaginal breech deliveries in comparison with a case-controlled cephalic group during labour.
METHODS: This case-control study was carried out at the Department of Obstetrics and Gynecology of the University Hospital Frankfurt between 1st July 2012 and 30th September 2012. A total of seven breech deliveries were evaluated. A case-controlled cephalic group with same gestational age and parity were selected from a previous trial.
RESULTS: During first stage of labour, vaginal breech and cephalic delivery had no significant different fetal signal success rates (mean 87.8 vs. 85.7 %; p > 0.05). There was a trend of higher fetal signal success rates in the vaginal breech delivery group during second stage of labour (78.4 vs. 55.4 %; p = 0.08).
CONCLUSIONS: Similar fetal signal success rates in vaginal breech delivery in comparison to cephalic presentation were demonstrated using the new commercially available non-invasive abdominal fECG device (the Monica AN24(TM)).

The use of fundal pressure to assist a woman in labor is a controversial procedure. Its benefits are yet to be scientifically confirmed and it is associated with complications such as perineal lacerations, uterine rupture and uterine inversion. A case is reported of a 28year old Gravida 5 Para ?? (3 Alive) who presented to Aminu Kano Teaching Hospital, (AKTH) Kano, Nigeria with uterine prolapse following fundal pressure done in the first stage of labor in a peripheral hospital. She was delivered by Cesarean section and the prolapse successfully reduced under general anesthesia. Health workers need education on the risks associated with fundal pressure. Alternative methods of aiding women in labor should be promoted.

OBJECTIVE: The purpose of this study was to identify risk factors for second trimester premature preterm rupture of membranes or advanced cervical dilation in a high-risk population.
METHODS: A retrospective case control study was performed that compared women with premature preterm rupture of membranes or advanced cervical dilation to term control subjects. The cases included all singleton pregnancies between 14 and 24 weeks of gestation with premature preterm rupture of membranes or advanced cervical dilation between 1996 and 2000. The next 2 term deliveries were chosen as control subjects. The variables compared between cases and control subjects included pregnancy history, infectious and medical histories, cervical/uterine procedures, and habits. This study had institutional review board approval.
RESULTS: There were 102 women with premature preterm rupture of membranes, 56 women with advanced cervical dilation, and 316 control subjects. The mean gestational ages for premature preterm rupture of membranes or advanced cervical dilation were 20 +/- 2.6 and 19.9 +/- 2.6 weeks. Tobacco use, history of or current cervical incompetence, previous second trimester delivery, previous termination at <20 weeks of gestation, and previous premature preterm rupture of membranes were associated significantly with premature preterm rupture of membranes or advanced cervical dilation compared with term control subjects. When controlled for parity, age, marital status, and race, these variables remained significant. Bacterial vaginosis in current pregnancy was associated significantly with only advanced cervical dilation but not premature preterm rupture of membranes compared with control subjects. A history of Chlamydia was most common in the term control subjects (19.6%).
CONCLUSIONS: In a high-risk population of inner city women, only pregnancy history and tobacco use distinguished women with second trimester premature preterm rupture of membranes or advanced cervical dilation from term control subjects. No infectious risk factors distinguished control women from women with premature preterm rupture of membranes. The only modifiable risk identified was tobacco use.

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Between January 1, 1994 and December 31, 1997 a total of 76 low-risk multiparas of 40 years and older with spontaneous onset of labour were delivered and were compared with 152 younger (25-30 years-old) low-risk multiparas of similar parity in a case-control study. The labour and perinatal outcomes of the 2 groups were compared. The duration of the first stage of labour was longer (233 minutes versus 149 minutes, p<0.0005) in the older women. Significantly more labours of older multiparas were complicated by intrapartum fetal distress (6.6% versus 1.3%, p<0.05); received intramuscular analgesia (11.8% versus 2.6%, p<0.01); and had operative deliveries (17.1% versus 4.6%, p<0.01). The incidence of instrumental delivery (11.8% versus 3.9%, p<0.05) and Caesarean section (5.3% versus 0.7%, p<0.05) were higher among older multiparas. The incidences of Syntocinon augmentation of labour, prolonged second stage, episiotomy and third stage complications such as perineal tear, primary postpartum haemorrhage, and retained placenta were similar in both groups. Both groups had similar perinatal outcomes. These women should be treated as others with high-risk pregnancies with appropriate careful attention during labour such as continuous fetal heart rate monitoring. They should be counselled to be made aware of the increased risks during labour.

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In a case-control study on 79 cone biopsy treated women under 35 yr of age the subsequent pregnancies were followed. The women of the control group were matched to maternal age, parity and the time of delivery. There were more \'abnormal\' deliveries in the surgical treated group such as more bleedings, more cervical insufficiencies and a faster descent-time curve of the presenting part of the fetus. The premature frequency was 13.2% in the conized group and only 3.8% in the control group. The study gives support to a primarily more conservative policy in young women with positive smears.