The Experts below are selected from a list of 3036 Experts worldwide ranked by ideXlab platform
Elena Libhaber - One of the best experts on this subject based on the ideXlab platform.
-
Sagittal suture overlap in Cephalopelvic Disproportion: blinded and non-participant assessment.
Acta obstetricia et gynecologica Scandinavica, 2008Co-Authors: Eckhart Buchmann, Elena LibhaberAbstract:Objective. To determine the role of assessment of overlap of fetal skull bones (molding) in intrapartum prediction of Cephalopelvic Disproportion (CPD). Design. Prospective cross-sectional study. Setting. South African high-risk obstetric unit that receives referrals from other facilities. Population. Women of at least 37 weeks’ gestation in the active phase of labor, with singleton vertex presentations and live fetuses, and without previous cesarean sections. Method. The researcher was blinded to parity and previous clinical information on the women, and not involved in their obstetric care. The researcher performed clinical assessments, including estimation of level of head, cervical dilatation, head flexion, position, overlap of fetal skull bones, caput succedaneum and asynclitism. A single assessment was done on each woman. Main outcome measure. CPD, defined as cesarean section for poor progress in labor. Results. The author examined 504 women, and CPD occurred in 113 (22.4%). In multivariate logistic...
-
Sagittal Suture Overlap in Cephalopelvic Disproportion : Blinded and Non-Participant Assessment
Obstetrical & Gynecological Survey, 2008Co-Authors: Eckhart Buchmann, Elena LibhaberAbstract:Perinatal death and morbidity occur with Cephalopelvic Disproportion (CPD) as a consequence of the complications of obstructed labor. It is unclear whether overlap of fetal skull bones (molding) is a sign of normal labor, or is associated with and predictive of CPD. CPD is common in sub-Saharan Africans, who are considered to be at greater risk for CPD than Caucasians. A previous prospective study in the 1970s involving African women showed that overlap of skull bones at the sagittal suture and to a lesser degree at the lambdoid suture were associated with CPD and could be predictive. However, these findings were questioned for possible bias because of the absence of investigator blinding. In addition, the study lacked statistical analysis to adjust for confounding. In this prospective blinded cross-sectional study, the authors examined 505 women of at least 37 weeks' gestation in the active phase of labor with singleton live fetuses and vertex presentations, and no history of cesarean delivery. The authors defined CPD as cesarean section for poor progress in labor in the presence of adequate uterine activity; CPD occurred in 113 of the 505 women (22%). The investigators had no prior knowledge of the parity of the index women or previous clinical findings, and did not participate in their obstetric care. Multivariate logistic regression analysis revealed that sagittal suture overlap was independently associated with CPD. Lambdoid suture overlap could be determined in only 66.5% of examinations primarily because of frequent head deflexion, and intrapartum assessment of the Lambdoid suture was not predictive of CPD. The findings were not affected by parity. The authors conclude that overlap at the sagittal suture, although not necessarily diagnostic, is useful for prediction of CPD. Lambdoid suture overlap appears to be a normal intrapartum phenomenon and of little predictive value.
Vivien D Tsu - One of the best experts on this subject based on the ideXlab platform.
-
Antenatal screening: its use in assessing obstetric risk factors in Zimbabwe.
Journal of epidemiology and community health, 1994Co-Authors: Vivien D TsuAbstract:STUDY OBJECTIVE--To assess the predictive utility of obstetric risk factors for identifying before the onset of labour those women at high risk of obstetric complications in a developing world setting, where home deliveries predominate and emergency transport is scarce. DESIGN--Risk factors derived from two population based, case-control studies (one of Cephalopelvic Disproportion and one of post partum haemorrhage), carried out in Zimbabwe were used to construct weighted and unweighted scores, a variety of screening algorithms, and sets of probabilities estimated from logistic regression models. These screening tests were evaluated for sensitivity, specificity, positive predictive value, and "cost" (the proportion of the population testing positive). Each complication was evaluated separately and the two were then pooled. PARTICIPANTS--All were Harare residents with singleton, vertex deliveries and spontaneous onset of labour. A total of 201 experienced Cephalopelvic Disproportion, 150 had post partum haemorrhage, and 299 had normal, unassisted deliveries. MEASUREMENTS AND MAIN RESULTS--Largely because of the very low incidence of the two complications studied (1% or less), positive predictive values were low (less than 7%). Holding "cost" constant at 10%, a screening test for Cephalopelvic Disproportion could predict 42.3% of cases compared with only 35.0% of those with post partum haemorrhage. Weighted scores had little advantage over unweighted ones, and probabilities from the logistic regression models did not differentiate cases from controls very well. CONCLUSIONS--With simple algorithms based on maternal height, parity, and obstetric history, more than one third of women at risk for potentially fatal complications could be identified at relatively small cost to themselves or the health care system.
-
Maternal Height and Age: Risk Factors for Cephalopelvic Disproportion in Zimbabwe
International journal of epidemiology, 1992Co-Authors: Vivien D TsuAbstract:In the Greater Harare area of Zimbabwe a researcher compared data on 203 women who suffered from Cephalopelvic Disproportion (CPD) and underwent a cesarean section with data on 299 facility matched controls to determine the effects of maternal height and age and their significance for CPD. All the women delivered either at the municipal hospital or its clinics. When the researcher controlled for parity young age ( 35-year old mothers were at 2.1 times the risk for CPD than were 20.34 year olds after controlling for parity and at 2.7 times the risk after controlling for demographic and other obstetric factors. Women at a height of 160 cm. Potential biases in this study included the possibility that women with prior cesarean section were underrepresented especially if they were selected for cesarean section for their short stature and questionable quality of the data in the medical records. This study was the 1st to document advanced maternal age as a risk factor for CPD but did not verify maternal youth as a risk factor. These results suggested that even though short stature is a risk factor for CPD there is a need to determine local cutoff points for screening purposes. Screening for CPD risk factors can reduce the likelihood of mothers having to endure prolonged labor.
Eckhart Buchmann - One of the best experts on this subject based on the ideXlab platform.
-
Sagittal suture overlap in Cephalopelvic Disproportion: blinded and non-participant assessment.
Acta obstetricia et gynecologica Scandinavica, 2008Co-Authors: Eckhart Buchmann, Elena LibhaberAbstract:Objective. To determine the role of assessment of overlap of fetal skull bones (molding) in intrapartum prediction of Cephalopelvic Disproportion (CPD). Design. Prospective cross-sectional study. Setting. South African high-risk obstetric unit that receives referrals from other facilities. Population. Women of at least 37 weeks’ gestation in the active phase of labor, with singleton vertex presentations and live fetuses, and without previous cesarean sections. Method. The researcher was blinded to parity and previous clinical information on the women, and not involved in their obstetric care. The researcher performed clinical assessments, including estimation of level of head, cervical dilatation, head flexion, position, overlap of fetal skull bones, caput succedaneum and asynclitism. A single assessment was done on each woman. Main outcome measure. CPD, defined as cesarean section for poor progress in labor. Results. The author examined 504 women, and CPD occurred in 113 (22.4%). In multivariate logistic...
-
Sagittal Suture Overlap in Cephalopelvic Disproportion : Blinded and Non-Participant Assessment
Obstetrical & Gynecological Survey, 2008Co-Authors: Eckhart Buchmann, Elena LibhaberAbstract:Perinatal death and morbidity occur with Cephalopelvic Disproportion (CPD) as a consequence of the complications of obstructed labor. It is unclear whether overlap of fetal skull bones (molding) is a sign of normal labor, or is associated with and predictive of CPD. CPD is common in sub-Saharan Africans, who are considered to be at greater risk for CPD than Caucasians. A previous prospective study in the 1970s involving African women showed that overlap of skull bones at the sagittal suture and to a lesser degree at the lambdoid suture were associated with CPD and could be predictive. However, these findings were questioned for possible bias because of the absence of investigator blinding. In addition, the study lacked statistical analysis to adjust for confounding. In this prospective blinded cross-sectional study, the authors examined 505 women of at least 37 weeks' gestation in the active phase of labor with singleton live fetuses and vertex presentations, and no history of cesarean delivery. The authors defined CPD as cesarean section for poor progress in labor in the presence of adequate uterine activity; CPD occurred in 113 of the 505 women (22%). The investigators had no prior knowledge of the parity of the index women or previous clinical findings, and did not participate in their obstetric care. Multivariate logistic regression analysis revealed that sagittal suture overlap was independently associated with CPD. Lambdoid suture overlap could be determined in only 66.5% of examinations primarily because of frequent head deflexion, and intrapartum assessment of the Lambdoid suture was not predictive of CPD. The findings were not affected by parity. The authors conclude that overlap at the sagittal suture, although not necessarily diagnostic, is useful for prediction of CPD. Lambdoid suture overlap appears to be a normal intrapartum phenomenon and of little predictive value.
Uwe Hasbargen - One of the best experts on this subject based on the ideXlab platform.
-
Pelvimetry revisited: Analyzing Cephalopelvic Disproportion
European Journal of Radiology, 2010Co-Authors: Miriam Lenhard, Thorsten R. C. Johnson, Sabine Weckbach, Konstantin Nikolaou, Klaus Friese, Uwe HasbargenAbstract:Abstract The objective of this study was to assess the clinical value of pelvimetry to predict dystocia due to Cephalopelvic Disproportion. 63 patients who had received an abdominal CT scan postpartum were included. Pelvimetry was performed retrospectively with these datasets on a 3D workstation; there were no CT examinations performed solely for pelvimetry, and there was no radiation exposure for study purposes. Patients were divided into three groups by the course of birth, i.e. normal vaginal delivery (A), dystocia due to Cephalopelvic Disproportion (B) and other patients (C). Previously described methods were evaluated for their accuracy in diagnosing Cephalopelvic Disproportion. The pelvimetric parameters did not show significant differences between groups A ( n = 20) and B ( n = 20) except for the sagittal mid-pelvic diameter ( q ) with 12.7 ± 0.6 cm vs. 11.9 ± 0.6 cm ( p = 0.0001). The ROC analysis of the previously described methods showed areas under the curve between 0.50 and 0.67. The ROC curves for q had an area of 0.88, providing 85% sensitivity with 85% specificity. In conclusion, the sagittal mid-pelvic diameter shows potential to detect Cephalopelvic Disproportion with acceptable accuracy. With the information gained on the CT data, a prospective trial based on MR imaging can be set up to validate the diagnostic accuracy.
George A. Macones - One of the best experts on this subject based on the ideXlab platform.
-
Vaginal birth after cesarean for Cephalopelvic Disproportion: effect of birth weight difference on success.
Obstetrics & Gynecology, 2011Co-Authors: Lorie M. Harper, David Stamilio, Anthony Odibo, Jeffrey F. Peipert, George A. MaconesAbstract:OBJECTIVE:To estimate the effect of birth weight difference between the current and index pregnancy on vaginal birth after cesarean (VBAC) failure in patients whose prior cesarean was for Cephalopelvic Disproportion (CPD).METHODS:This was a retrospective cohort study of women with one cesarean for C
-
Vaginal birth after cesarean for Cephalopelvic Disproportion: effect of birth weight difference on success.
Obstetrics and gynecology, 2011Co-Authors: Lorie M. Harper, David Stamilio, Anthony Odibo, Jeffrey F. Peipert, George A. MaconesAbstract:To estimate the effect of birth weight difference between the current and index pregnancy on vaginal birth after cesarean (VBAC) failure in patients whose prior cesarean was for Cephalopelvic Disproportion (CPD). This was a retrospective cohort study of women with one cesarean for CPD, comparing the rate of VBAC failure in women whose infant was smaller, the same, or larger in the VBAC attempt compared with cesarean. The primary outcome was VBAC attempt failure, defined as a patient who attempted VBAC but subsequently required a cesarean delivery for any indication. Univariable, stratified, and multivariable analyses were used. Of 13,706 patients attempting VBAC, 1,511 had one prior cesarean delivery for CPD. Compared with patients with the same birth weight, a lower birth weight was associated with fewer failed VBAC attempts (29.6% compared with 37.8%, adjusted odds ratio [OR] 0.7, 95% confidence interval [CI] 0.5-1.0) and a higher birth weight was associated with more failed VBAC attempts (54.5% compared with 37.8%, adjusted OR 2.0, 95% CI 1.5-2.8). Birth weight difference has a moderate effect on the rate of VBAC success in patients whose prior cesarean delivery was for CPD. II.