Changes in symphysis pubis width during labor

We studied changes in the width of the symphysis pubis in 32 women examined serially by ultrasound during labor. Measurements were made at the superior border of the symphysis and at its narrowest breadth in the latent phase, the active phase, and the second stage of labor. There was a significant increase in the width of the symphysis between the first and second stages of labor at both measured levels. Widening was observed in 94% at the superior symphyseal breadth and in 59% at the narrowest. Of those cases in which the width of the symphysis increased, there was a large spectrum of change, ranging from 9 to 98% of the original width at the narrowest measurement site and from 2 to 139% at the superior breadth. There was a strong inverse correlation between maternal age and the degree of symphyseal widening in nulliparas, but not in multiparas. We conclude that labor is associated with a substantial widening of the symphysis pubis in most, but not all women.Peer Reviewe

A randomized trial of planned cesarean or vaginal delivery for twin pregnancy

Background: Twin birth is associated with a higher risk of adverse perinatal outcomes than singleton birth. It is unclear whether planned cesarean section results in a lower risk of adverse outcomes than planned vaginal delivery in twin pregnancy.\ud \ud Methods: We randomly assigned women between 32 weeks 0 days and 38 weeks 6 days of gestation with twin pregnancy and with the first twin in the cephalic presentation to planned cesarean section or planned vaginal delivery with cesarean only if indicated. Elective delivery was planned between 37 weeks 5 days and 38 weeks 6 days of gestation. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity, with the fetus or infant as the unit of analysis for the statistical comparison.\ud \ud Results: A total of 1398 women (2795 fetuses) were randomly assigned to planned cesarean delivery and 1406 women (2812 fetuses) to planned vaginal delivery. The rate of cesarean delivery was 90.7% in the planned-cesarean-delivery group and 43.8% in the planned-vaginal-delivery group. Women in the planned-cesarean-delivery group delivered earlier than did those in the planned-vaginal-delivery group (mean number of days from randomization to delivery, 12.4 vs. 13.3; P = 0.04). There was no significant difference in the composite primary outcome between the planned-cesarean-delivery group and the planned-vaginal-delivery group (2.2% and 1.9%, respectively; odds ratio with planned cesarean delivery, 1.16; 95% confidence interval, 0.77 to 1.74; P = 0.49).\ud \ud Conclusion: In twin pregnancy between 32 weeks 0 days and 38 weeks 6 days of gestation, with the first twin in the cephalic presentation, planned cesarean delivery did not significantly decrease or increase the risk of fetal or neonatal death or serious neonatal morbidity, as compared with planned vaginal delivery