Bladder stone: uncommon cause of mechanical dystocia

Bladder stone can exceptionally cause an obstetrical dystocia. A combined procedure of cesarean section with a cystolithotomy is the most advocated attitude. The authors reported a rare case of mechanical dystocia caused by a bladder stone in a 27 year-old multiparous women. The diagnosis was suspected during labor and a vaginal examination revealed a large firm mass in the anterior vagina wall. This mass was responsible for an obstruction of the pelvis requiring a cesarean section. A cystotomy was performed intraoperatively and a bladder stone weighing 130 g and measuring 8 × 6 × 4 cm³ was extracted. The postoperative course was uneventful.     

胎膜早破与分娩关系探讨

目的 :探讨胎膜早破与分娩结局的相互关系。方法 :用回顾性调查方法对 1 86例胎膜早破孕妇进行统计分析。结果 :胎膜早破孕妇难产率及产褥病率均较对照组照高 ,且新生儿感染亦较对照组明显增加 ,差异均有显著性(P<0 .0 5)。结论 :胎膜早破使难产增加 ,其产褥病率及新生儿病率也明显增高。     

Maternal factors associated with labor dystocia in low-risk nulliparous women. A systematic review and meta-analysis

ObjectiveTo identify maternal factors associated with labor dystocia in low-risk nulliparous women.MethodsMEDLINE, Embase, ClinicalTrials.gov, Cochrane, and CINAHL were searched for intervention studies and observational studies published from January 2000 to January 2022. Low-risk was defined as nulliparous women with a singleton, cephalic birth in spontaneous labor at term. Labor dystocia was defined by national or international criteria or treatment. Countries were restricted to OECD members. Two authors independently screened 11,374 titles and abstracts, extracted data, and assessed risk of bias using the Newcastle-Ottawa Scale. Results were presented narratively and by meta-analysis when compatible.ResultsSeven cohort studies were included. Overall, the certainty of the evidence was moderate. Three studies found that higher maternal age was associated with an increased frequency of labor dystocia (relative risk 1.68; 95% CI 1.43–1.98). Further three studies found that higher maternal BMI was associated with increased frequency of labor dystocia (relative risk 1.20; 95% CI 1.01–1.43). Maternal short stature, fear of childbirth, and high caffeine intake were also associated with an increased frequency of labor dystocia, while maternal physical activity was associated with a decreased frequency.ConclusionMaternal factors associated with an increased frequency of labor dystocia were mainly maternal age, physical characteristics, and fear of childbirth. Maternal physical activity was associated with a decreased frequency. Intervention studies targeting these maternal factors would need to be initiated before or early in pregnancy to test the causality of the identified factors and labor dystocia.