TAILIEUCHUNG - Ebook Williams obstetrics (24th edition): Part 2

(BQ) Part 2 book "Williams obstetrics" presents the following contents: Delivery, the newborn, the puerperium, obstetrical complications, medical and surgical complications. | SECTION 8 DELIVERY 536 CHAPTER 27 Vaginal Delivery ROUTE OF DELIVERY. 536 PREPARATION FOR DELIVERY. 536 OCCIPUT ANTERIOR POSITION. 537 PERSISTENT OCCIPUT POSTERIOR POSITION. 539 OCCIPUT TRANSVERSE POSITION. 540 SHOULDER DYSTOCIA. 541 SPECIAL POPULATIONS. 545 THIRD STAGE OF LABOR. 546 FOURTH STAGE OF LABOR. 548 EPISIOTOMY. 550 The natural culmination of second-stage labor is controlled vaginal delivery of a healthy neonate with minimal trauma to the mother. Vaginal delivery is the preferred route of delivery for most fetuses although certain clinical settings may favor cesarean delivery. Spontaneous vaginal delivery is typical however maternal or fetal complications may warrant operative vaginal delivery as described in Chapter 29. Last a mal-presenting fetus or multifetal gestation in many cases may be delivered vaginally but requires special techniques. These are describedinChapters28 Breech Deliveryand45 Multifetal Pregnancy. ROUTE OF DELIVERY In general spontaneous vaginal vertex delivery poses the lowest risk of most maternal and fetal comorbidity. Compared with cesarean delivery spontaneous vaginal delivery has lower associated rates of maternal infection hemorrhage anesthesia complications and peripartum hysterectomy among others. In contrast for women undergoing spontaneous vaginal delivery compared with cesarean delivery pelvic floor disorders may be increased Handa 2011 Rortveit 2003 . Longitudinal studies however suggest that initial pelvic floor protection advantages gained from cesarean delivery are lost as women age Dolan 2010 Glazener 2013 Rortveit 2001 . During their State-of-the-Science Conference the National Institutes of Health panel 2006 summarized that stress urinary incontinence rates after elective cesarean delivery are lower than those following vaginal delivery. However the duration of this protection is unclear particularly in older and multiparous populations. This same conference considered the evidence implicating vaginal delivery in .

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