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Asha Kamath - One of the best experts on this subject based on the ideXlab platform.
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Fetal Head Position during the First Stage of Labor: Comparison between Vaginal Examination and Transabdominal Ultrasound.
ISRN obstetrics and gynecology, 2014Co-Authors: Jyothi Shetty, Vinod Aahir, Deeksha Pandey, Prashanth Adiga, Asha KamathAbstract:Introduction. Recent evidence indicates that clinical examination, for determination of Fetal Head position, is subjective and inaccurate. Present study was aimed to compare transabdominal ultrasound for Fetal Head position with vaginal examination during first stage of labor. Material and Methods. This prospective study was performed at a tertiary center during a two-year period. Before or after clinically indicated vaginal examinations, transverse suprapubic transabdominal real-time ultrasound Fetal Head position assessment was done. Frequencies of various ultrasound depicted Fetal Head positions were compared with position determined at vaginal examination. Results. In only 31.5% of patients, Fetal Head position determinations by vaginal examinations were consistent with those obtained by ultrasound. Cohen's Kappa test of concordance indicated a poor concordance of 0.15. Accuracy of vaginal examination increased to 66% when Fetal Head position at vaginal examination was recorded correct if reported within +45° of the ultrasound assessment. Rate of agreement between the two assessment methods for consultants versus residents was 36% and 26%, respectively (P = 0.17). Conclusion. We found that vaginal examination was associated with a high error rate in Fetal Head position determination. Data supports the idea that intrapartum transabdominal ultrasound enhances correct determination of Fetal Head position during first stage of labor.
Agnaldo L. Silva-filho - One of the best experts on this subject based on the ideXlab platform.
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Computational modeling approach to study the effects of Fetal Head flexion during vaginal delivery
American Journal of Obstetrics and Gynecology, 2010Co-Authors: Marco Parente, Renato Natal Jorge, T. Mascarenhas, António Fernandes, Agnaldo L. Silva-filhoAbstract:Objective The purpose of this study was to investigate the influence of Fetal Head flexion during vaginal delivery with a 3-dimensional computational finite element model. Study Design A finite element model of the pelvic skeletal structure, pelvic floor, and fetus was developed. The movements of the fetus during birth were simulated in engagement, descent, flexion, internal rotation, and extension of the Fetal Head. The opposite forces against the Fetal descendent and the stress of the pelvic floor muscles were obtained on simulations with different degrees of Head flexion. Results The simulated increase in Fetal Head flexion is associated with lower values of opposite forces against the Fetal descent. The descending fetus with abnormal Head flexion also meets resistance in later stations. Lower stress on the pelvic floor was demonstrated with simulated increase in Fetal Head flexion during vaginal delivery. Conclusion This analytic evidence suggests that the Fetal Head flexion during vaginal delivery may facilitate birth and protect the pelvic floor.
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Computational modeling approach to study the effects of Fetal Head flexion during vaginal delivery.
American journal of obstetrics and gynecology, 2010Co-Authors: Marco P Parente, Teresa Mascarenhas, Renato M Natal Jorge, António A Fernandes, Agnaldo L. Silva-filhoAbstract:The purpose of this study was to investigate the influence of Fetal Head flexion during vaginal delivery with a 3-dimensional computational finite element model. A finite element model of the pelvic skeletal structure, pelvic floor, and fetus was developed. The movements of the fetus during birth were simulated in engagement, descent, flexion, internal rotation, and extension of the Fetal Head. The opposite forces against the Fetal descendent and the stress of the pelvic floor muscles were obtained on simulations with different degrees of Head flexion. The simulated increase in Fetal Head flexion is associated with lower values of opposite forces against the Fetal descent. The descending fetus with abnormal Head flexion also meets resistance in later stations. Lower stress on the pelvic floor was demonstrated with simulated increase in Fetal Head flexion during vaginal delivery. This analytic evidence suggests that the Fetal Head flexion during vaginal delivery may facilitate birth and protect the pelvic floor. Copyright 2010 Mosby, Inc. All rights reserved.
Sigi Rotmensch - One of the best experts on this subject based on the ideXlab platform.
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Comparison of transvaginal sonography with digital examination and transabdominal sonography for the determination of Fetal Head position in the second stage of labor
American journal of obstetrics and gynecology, 2005Co-Authors: Neriman Zahalka, Oscar Sadan, Marek Glezerman, Gustav Malinger, Marco Liberati, Mona Boaz, Sigi RotmenschAbstract:Objective Precise determination of Fetal Head position in labor is a prerequisite for safe instrumental deliveries, and essential for the assessment of labor progress. Recent studies have cast serious doubts on the accuracy of the time-honored digital vaginal examination (DVE) in comparison to transabdominal ultrasound scans (TUS). However, transabdominal imaging is technically difficult with a deeply engaged Fetal Head in the second stage of labor. We examined the accuracy and time requirements of transvaginal scans (TVS) in the second stage of labor for determination of Fetal Head position. Study design Sixty laboring women in the second stage of labor with a deeply engaged Fetal Head were examined by experienced nurse midwives and senior residents. Fetal Head position was recorded as "time on a 12-hour clock." Subsequently, TUS and TVS were independently performed by a skilled sonographer. Accuracy and time requirements for all 3 examinations were recorded. Results Fetal Head position could be determined in all cases by TVS, but not in 7 cases and 9 cases by DVE and TUS, respectively ( P P P P P Conclusion Transvaginal sonography was the most successful and accurate method for determination of Fetal Head position in the second stage of labor, and required the least time for performance. We believe that TVS should be routinely performed in the labor room setting for the determination of Fetal Head position.
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Clinical significance of the floating Fetal Head in nulliparous women in labor.
The Journal of reproductive medicine, 2003Co-Authors: A. Debby, Sigi Rotmensch, Ofer Girtler, Oscar Sadan, Abraham Golan, Marek GlezermanAbstract:OBJECTIVE To examine the course of labor in nulliparous women in active labor with a floating Fetal Head. STUDY DESIGN A prospective, cohort study of nulliparous women presenting in active labor at term with a floating Fetal Head (station > or = -3, n = 108) or engaged Fetal Head (n = 241). All patients were examined by a senior physician. Assignment to the study or control group was noted in the investigator's records. However, management of labor was at the discretion of the labor ward team on duty. RESULTS Cesarean section rates for failure to progress were significantly higher in the study group (17.1% versus 4.2%, P < .0001), and the second stage of labor was prolonged (65.3 +/- 27.1 versus 54.9 +/- 30.2 minutes, P < .03). None of the women who had a persistently floating Fetal Head at 7 cm of cervical dilation delivered vaginally. Birth weights were larger (P < .03) and Apgar scores lower (P < .0001) in the study group. The lengths of the active phase and instrumental delivery rates were similar in the two groups. CONCLUSION Nulliparous women presenting in active labor at term with a floating Head are at substantially increased risk of cesarean section for abnormal progress of labor. However, the majority of patients will still deliver vaginally. A persistently floating Head with advanced cervical dilation (7 cm) should prompt consideration of cesarean section since little is to be gained by waiting.
Donald E. Wasserman - One of the best experts on this subject based on the ideXlab platform.
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Acceleration of Fetal Head induced by vibration of maternal abdominal wall in sheep
American journal of obstetrics and gynecology, 1996Co-Authors: Aemil J.m. Petersa, Robert M. Abrams, Kenneth J. Gerhardt, Donald E. WassermanAbstract:Abstract OBJECTIVE: The human body is often exposed to significant vibration stress in the workplace, at home, and during recreational activities. The current study was designed to evaluate whether low- to midfrequency vibrations present at the extraabdominal wall would be attenuated across this wall and what the levels of exposure would be once these vibrations reached the Fetal Head. STUDY DESIGN: Four pregnant sheep were instrumented with acceleration transducers to obtain acceleration levels at the extraabdominal and intraabdominal walls and at the Fetal Head. Sine-wave vibration stimulation was applied over a frequency range of 3 to 150 Hz at a constant acceleration level of 2.5 m/sec 2 (root-mean-square). RESULTS: Vibration of the extraabdominal wall resulted in a frequency-dependent rise in vibration levels at the intraabdominal wall, from 4% to 140% of the input level. At the Fetal Head a broad peak in response was noted between 6 and 12 Hz, but the overall levels never exceeded 4% of the input level. CONCLUSION: Fetal exposure to localized vibratory stimulation of the maternal abdomen is maximal in the range of 6 to 12 Hz. (AM J OBSTET GYNECOL 1996;174:552-6.)
Jyothi Shetty - One of the best experts on this subject based on the ideXlab platform.
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Fetal Head Position during the First Stage of Labor: Comparison between Vaginal Examination and Transabdominal Ultrasound.
ISRN obstetrics and gynecology, 2014Co-Authors: Jyothi Shetty, Vinod Aahir, Deeksha Pandey, Prashanth Adiga, Asha KamathAbstract:Introduction. Recent evidence indicates that clinical examination, for determination of Fetal Head position, is subjective and inaccurate. Present study was aimed to compare transabdominal ultrasound for Fetal Head position with vaginal examination during first stage of labor. Material and Methods. This prospective study was performed at a tertiary center during a two-year period. Before or after clinically indicated vaginal examinations, transverse suprapubic transabdominal real-time ultrasound Fetal Head position assessment was done. Frequencies of various ultrasound depicted Fetal Head positions were compared with position determined at vaginal examination. Results. In only 31.5% of patients, Fetal Head position determinations by vaginal examinations were consistent with those obtained by ultrasound. Cohen's Kappa test of concordance indicated a poor concordance of 0.15. Accuracy of vaginal examination increased to 66% when Fetal Head position at vaginal examination was recorded correct if reported within +45° of the ultrasound assessment. Rate of agreement between the two assessment methods for consultants versus residents was 36% and 26%, respectively (P = 0.17). Conclusion. We found that vaginal examination was associated with a high error rate in Fetal Head position determination. Data supports the idea that intrapartum transabdominal ultrasound enhances correct determination of Fetal Head position during first stage of labor.