Childbirth

Time perception in shoulder dystocia management; a secondary analysis of the prospective cohort simulation SAFE study (2025)

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Type of publication:

Journal article

Author(s):

*Papoutsis D.; Klazoglou P.; Valasoulis G.; Tzavara C.;

Citation:

European Journal of Obstetrics and Gynecology and Reproductive Biology. 311 (no pagination), 2025. Article Number: 114016. Date of Publication: 01 Jul 2025.

Abstract:

Objective: The aim of this study was to explore and quantify the potential improvement and retention of time perception in a simulated childbirth complicated by shoulder dystocia with use of high-fidelity simulation. Method(s): This was a secondary analysis of the previously conducted prospective cohort SAFE study. Registered midwives and final year Midwifery students were invited to attend a one-day workshop in 6-monthly intervals at the University of Western Macedonia in Greece between October 2021-November 2022. There was a 30-minute initial assessment, a 30-minute theoretical and hands-on training, and a 30-minute post-training assessment on shoulder dystocia management. We identified the actual-time and the self-reported perceived-time of delivery at the start and end of each workshop and measured the difference between them to determine if there was any improvement and retention of time perception through consecutive workshops. Result(s): The baseline workshop recruited 101 participants with mean age of 26.7 +/- 9.8 years (range:20-59), of which 53 participated at the 6 month and 33 at the 12 month workshop. There was a significant improvement in time perception by approximately 34.8 % at the end of the baseline workshop, which was retained after 6 and 12 months. 80.2 % of participants experienced a 'time-distortion effect' towards the same direction and felt that the simulated delivery lasted longer than the actual time recorded by the birthing simulator. Those who were more competent at the start of the baseline workshop demonstrated a better time perception. Conclusion(s): The skill of time perception in shoulder dystocia can be improved and retained through simulation training.

DOI: 10.1016/j.ejogrb.2025.114016

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Are term breech babies who undergo successful external cephalic version still at increased risk of developmental dysplasia of the hip? (2024)

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Type of publication:
Journal article

Author(s):
*Stock, Joanne; *Deshpande, Sanjeev A.

Citation:
Archives of Disease in Childhood. 109(4):351-353, 2024 Mar 19.

Abstract:

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The purple line and its association with cervical dilatation in labour: A systematic review and meta-analysis (2023)

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Type of publication:
Systematic Review

Author(s):
*Papoutsis, Dimitrios; Antonakou, Angeliki; *Gornall, Adam; Tzavara, Chara

Citation:
European Journal of Obstetrics, Gynecology, & Reproductive Biology. 289:91-99, 2023 Aug 25.

Abstract:
BACKGROUND: There is a growing body of evidence that the presence and length of the purple line could represent a non-invasive method of estimating and determining labour progress. OBJECTIVES: The primary outcome was to provide a systematic review and meta-analysis on the association between the purple line length and cervical dilatation in active labour. The secondary outcome was to determine the association between the purple line length and the fetal head descent, and to calculate the pooled mean length of the purple line at a cervical dilatation of 3-4 cm and at a cervical dilatation of 9-10 cm. SEARCH STRATEGY: We searched the Medline, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), Clinical Trials.gov and Cochrane Pregnancy and Childbirth's Trials Register databases from inception till March 25, 2023. SELECTION CRITERIA: We included observational studies of pregnant women in active first stage of labour who had their labour progress assessed with the use of regular vaginal examinations and who had the occurrence recorded and length of the purple line measured at the same time. DATA COLLECTION AND ANALYSIS: Two reviewers independently evaluated study eligibility. We used the random effects and fixed effects model for meta-analysis. MAIN RESULTS: There were six eligible studies included in the systematic review that reported on 982 women in total with the purple line appearing in 760 (77.3%) of cases. We found a moderate positive pooled correlation between the purple line length with cervical dilatation (r = +0.64; 95%CI: 0.41-0.87) and fetal head descent (r = +0.50; 95%CI: 0.32-0.68). For women either in spontaneous or induced labour, the pooled mean length of the purple line was more than 9.4 cm when the cervical dilatation was 9-10 cm, whereas it was more than 7.3 cm when the cervical dilatation was 3-4 cm. CONCLUSIONS: The purple line is a non-invasive method that may potentially be used as an adjunct in labour progress assessment.

Childbirth-related pelvic floor trauma in women at-risk: A survey of the current obstetric management of short stature primigravid women (2019)

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Type of publication:
Conference abstract

Author(s):
*Rachaneni S.; Freeman R.

Citation:
International Urogynecology Journal; September 2019; vol. 30 (no. 1 Supplement)

Abstract:
Objective: To assess the antenatal and intrapartum management of short statured primigravid women in relation to the awareness of the increased risk of long-term pelvic floor morbidity from childbirth, by Obstetricians and Gynaecologists in the UK. Method(s):We carried out a questionnaire survey with 15 questions about the antenatal and intrapartum management of short statured primigravid women with a clinically large fetus, their timing and mode of delivery and discussion with the women about their risk of long-term pelvic floor morbidity following spontaneous and instrumental vaginal deliveries, their choice of instruments and episiotomy. Result(s): The survey was completed by 424 Members and Fellows of Royal College of Obstetricians and Gynaecologists (UK). We created a scenario of a short stature primigravid woman who presented with a clinically large baby around 38 weeks gestation. Sixty five percent of the responders stated that they would scan for estimated fetal weight, 48% would offer induction of labo-r at 40 weeks gestation and 13% would offer an elective caesarean section at 39-40 weeks. Only 59% of the responders said that would discuss the risks of obstructed labo-r, shoulder dystocia, instrumental delivery and Obstetric anal sphincter injury. Seventy percent of the responders said they would not discuss the long term risks of urinary, fecal incontinence and prolapse during antenatal or intrapartum management. For intrapartum management with failure to progress in the second stage of labo-r, 69% would attempt a rotational instrumental delivery, and only 5% would offer an emergency caesarean section. Manual rotation followed by 'straight' forceps application (59%) was the most frequent rotational delivery offered followed by Ventouse (40%) and Keillands forceps rotation. Thirty four percent stated that do not routinely perform an episiotomy in this scenario. The choice of instrument was not based on the long-term risk of pelvic floor dysfunction in 73% of the responses. Conclusion(s): The survey reveals a poor level of counselling of primigravid women of short stature who are known to be at higher risk of long-term pelvic floor trauma and consequent incontinence and prolapse.

Childbirth-related pelvic floor trauma in women at-risk: A survey of the current obstetric management of short stature primigravid women (2019)

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Type of publication:
Conference abstract

Author(s):
*Rachaneni S.; Freeman R.

Citation:
Female Pelvic Medicine and Reconstructive Surgery; 2019; vol. 25 (no. 5)

Abstract:
Objective: To assess the antenatal and intrapartum management of short statured primigravid women in relation to the awareness of the increased risk of long-term pelvic floor morbidity from childbirth, by Obstetricians and Gynaecologists in the UK.
Method(s): We carried out a questionnaire survey with 15 questions about the antenatal and intrapartum management of short statured primigravid women with a clinically large fetus, their timing and mode of delivery and discussion with the women about their risk of long-term pelvic floor morbidity following spontaneous and instrumental vaginal deliveries, their choice of instruments and episiotomy.
Result(s): The survey was completed by 424 Members and Fellows of Royal College of Obstetricians and Gynaecologists (UK). We created a scenario of a short stature primigravid woman who presented with a clinically large baby around 38 weeks gestation. Sixty five percent of the responders stated that they would scan for estimated fetal weight, 48% would offer induction of labo-r at 40 weeks gestation and 13% would offer an elective caesarean section at 39-40 weeks. Only 59% of the responders said that would discuss the risks of obstructed labo-r, shoulder dystocia, instrumental delivery and Obstetric anal sphincter injury. Seventy percent of the responders said they would not discuss the long term risks of urinary, fecal incontinence and prolapse during antenatal or intrapartum management. For intrapartum management with failure to progress in the second stage of labo-r, 69% would attempt a rotational instrumental delivery, and only 5% would offer an emergency caesarean section. Manual rotation followed by 'straight' forceps application (59%) was the most frequent rotational delivery offered followed by Ventouse (40%) and Keillands forceps rotation. Thirty four percent stated that do not routinely perform an episiotomy in this scenario. The choice of instrument was not based on the long-term risk of pelvic floor dysfunction in 73% of the responses.
Conclusion(s): The survey reveals a poor level of counselling of primigravid women of short stature who are known to be at higher risk of long- term pelvic floor trauma and consequent incontinence and prolapse.

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