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Weckend M, McCullough K, Duffield C, Bayes S, Davison C. Physiological plateaus during normal labor and birth: A novel definition. Birth 2024. [PMID: 38800984 DOI: 10.1111/birt.12843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/24/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Diagnoses of labor dystocia, and subsequent labor augmentation, make one of the biggest contributions to childbirth medicalization, which remains a key challenge in contemporary maternity care. However, labor dystocia is poorly defined, and the antithetical concept of physiological plateaus remains insufficiently explored. AIM To generate a definition of physiological plateaus as a basis for further research. METHODS This qualitative study applied grounded theory methods and comprised interviews with 20 midwives across Australia, conducted between September 2020 and February 2022. Data were coded in a three-phase approach, starting with inductive line-by-line coding, which generated themes and subthemes, and finally, through axial coding. RESULTS Physiological plateaus represent a temporary slowing of one or multiple labor processes and appear to be common during childbirth. They are reported throughout the entire continuum of labor, typically lasting between a few minutes to several hours. Their etiology/function appears to be a self-regulatory mechanism of the mother-infant dyad. Physiological plateaus typically self-resolve and are followed by a self-resumption of labor. Women with physiological plateaus during labor appear to experience positive birth outcomes. DISCUSSION Despite appearing to be common, physiological plateaus are insufficiently recognized in contemporary childbirth discourse. Consequently, there seems to be a significant risk of misinterpretation of physiological plateaus as labor dystocia. While findings are limited by the qualitative design and require validation through further quantitative research, the proposed novel definition provides an important starting point for further investigation. CONCLUSION A better understanding of physiological plateaus holds the potential for a de-medicalization of childbirth through preventing unjustified labor augmentation.
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Affiliation(s)
- Marina Weckend
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Kylie McCullough
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Christine Duffield
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Sara Bayes
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
- Faculty of Health Sciences, School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Clare Davison
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
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Svelato A, Carabaneanu A, Sergiampietri C, Mannella P, D'Avino S, De Luca C, Bartolone M, Angioli R, Ragusa A. "To get the baby out off the hook": a prospective, longitudinal, multicenter, observational study about decision making in vacuum-assisted operative vaginal delivery. BMC Pregnancy Childbirth 2022; 22:128. [PMID: 35172781 PMCID: PMC8848824 DOI: 10.1186/s12884-022-04440-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since operative vaginal delivery may be risky for women and might cause neonatal complications, the aim of this study is to assess appropriateness of the procedure. This is a prospective, longitudinal, multicenter, observational study and it was conducted in three Italian Obstetric Units (Pisa, Massa Carrara and Prato). All term pregnant women, either nulliparous and multiparous, with singleton pregnancy and a cephalic fetus, with spontaneous or induced labour, requiring vacuum-assisted delivery were enrolled. Indications to operative vaginal delivery were grouped as alterations of fetal cardiotocography (CTG) patterns, delay/arrest of second stage of labour or elective shortening of second stage of labour. A board consisting of five among authors evaluated appropriateness of the procedure. RESULTS Overall, 466 women undergoing operative vaginal deliveries were included. Cardiotocography, classified as ACOG category 2 or 3 was the indication for vacuum assisted delivery in 253 patients (54.29%). Among these, 66 women (26.1%) had an operative vaginal delivery which was then considered to be inappropriate, while in 114 cases (45.1%) CTG traces resulted to be unreadable. CONCLUSION Decision making process, which leads clinicians to go for operative vaginal delivery, is often influenced by shortness of time and complexity of the situation. Therefore, clinicians tend to intervene performing vacuum delivery without adopting critical analysis and without adequately considering the clinical situation. Operative vaginal delivery might be a risky procedure and should be performed only when clinically indicated and after adequate critical analysis.
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Affiliation(s)
- Alessandro Svelato
- Department of Obstetrics and Gynecology, San Giovanni Calibita Fatebenefratelli Hospital, Isola Tiberina, Via di Ponte Quattro capi, 39, 00186, Rome, Italy.
| | - Alis Carabaneanu
- Department of Obstetrics and Gynecology, Prato General Hospital, Prato, Italy
| | | | - Paolo Mannella
- Department of Reproductive Medicine and Child Development, University of Pisa, Pisa, Italy
| | - Sara D'Avino
- Department of Obstetrics and Gynecology, San Giovanni Calibita Fatebenefratelli Hospital, Isola Tiberina, Via di Ponte Quattro capi, 39, 00186, Rome, Italy
| | - Caterina De Luca
- Department of Obstetrics and Gynecology, San Giovanni Calibita Fatebenefratelli Hospital, Isola Tiberina, Via di Ponte Quattro capi, 39, 00186, Rome, Italy
| | - Martina Bartolone
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Roberto Angioli
- Department of Gynecology, University Campus Biomedico, Rome, Italy
| | - Antonio Ragusa
- Department of Obstetrics and Gynecology, San Giovanni Calibita Fatebenefratelli Hospital, Isola Tiberina, Via di Ponte Quattro capi, 39, 00186, Rome, Italy
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Too long does not always mean too much. Am J Obstet Gynecol 2021; 224:416. [PMID: 33428876 DOI: 10.1016/j.ajog.2020.12.1216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/29/2020] [Indexed: 12/26/2022]
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Blankenship SA, Raghuraman N, Cahill AG. Awareness of time in labor does not preclude investigation of other factors contributing to maternal and neonatal morbidity. Am J Obstet Gynecol 2021; 224:417. [PMID: 33434553 DOI: 10.1016/j.ajog.2020.12.1217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/28/2020] [Indexed: 11/26/2022]
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Svelato A, Ragusa A, Manfredi P. General methods for measuring and comparing medical interventions in childbirth: a framework. BMC Pregnancy Childbirth 2020; 20:279. [PMID: 32380966 PMCID: PMC7203888 DOI: 10.1186/s12884-020-02945-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 04/14/2020] [Indexed: 02/07/2023] Open
Abstract
Background The continue increase of interventions during labour in low risk population is a controversial issue of the current obstetric literature, given the lack of evidence demonstrating the benefits of unnecessary interventions for women or infants’ health. This makes it important to have approaches to assess the burden of all medical interventions performed. Methods Exploiting the nature of childbirth intervention as a staged process, we proposed graphic representations allowing to generate alternative formulas for the simplest measures of the intervention intensity namely, the overall and type-specific treatment ratios. We applied the approach to quantify the change in interventions following a protocol termed Comprehensive Management (CM), using data from Robson classification, collected in a prospective longitudinal cohort study carried out at the Obstetric Unit of the Cà Granda Niguarda Hospital in Milan, Italy. Results Following CM a substantial reduction was observed in the Overall Treatment Ratio, as well as in the ratios for augmentation (amniotomy and synthetic oxytocin use) and for caesarean section ratio, without any increase in neonatal and maternal adverse outcomes. The key component of this reduction was the dramatic decline in the proportion of women progressing to augmentation, which resulted not only the most practiced intervention, but also the main door towards further treatments. Conclusions The proposed framework, once combined with Robson Classification, provides useful tools to make medical interventions performed during childbirth quantitatively measurable and comparable. The framework allowed to identifying the key components of interventions reduction following CM. In its turn, CM proved useful to reduce the number of medical interventions carried out during childbirth, without worsening neonatal and maternal outcomes.
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Affiliation(s)
- Alessandro Svelato
- Department of Obstetrics and Gynecology, San Giovanni Calibita Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - Antonio Ragusa
- Department of Obstetrics and Gynecology, San Giovanni Calibita Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy.
| | - Piero Manfredi
- Department of Economics and Management, University of Pisa, Pisa, Italy
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Cohen WR, Friedman EA. Guidelines for labor assessment: failure to progress? Am J Obstet Gynecol 2020; 222:342.e1-342.e4. [PMID: 31954702 DOI: 10.1016/j.ajog.2020.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/23/2019] [Accepted: 01/03/2020] [Indexed: 10/25/2022]
Abstract
The ongoing debate about what models of cervical dilatation and fetal descent should guide clinical decision-making has sown uncertainty among obstetric practitioners. We previously argued that the adoption of recently published labor assessment guidelines promoted by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine may have been premature. Before accepting any new clinical approaches as the standard of care, their underlying hypotheses should be thoroughly tested to ensure they are at least equivalent (or, preferably, superior) to existing management paradigms. Some of the apparent urgency to subscribe to new clinical tactics has been fueled by legitimate concerns about the rise in the cesarean delivery rate over the past several decades. A major contributor to this change in practice patterns is that more cesarean deliveries are being done for diagnoses that fall under the rubric of dystocia than ever before. As a consequence, traditional labor curves-fundamental for assessing labor progress-and the practice paradigms associated with them have received intense scrutiny as a possible contributor to this delivery trend. Moreover, the recent proposal of new labor curves and accompanying management guidelines has, understandably, fed the appetite to correct a perceived problem. However, the cesarean delivery rate rose most rapidly during decades when there was no major change in traditional labor curves or in the guidelines for their interpretation. Also, during the years since the new guidelines were first published, there has been no major fall in cesarean delivery frequency. This raises the question of whether there was truly a fundamental flaw in the traditional labor management paradigms or whether their proper interpretation and use had been somehow forgotten, ignored, or corrupted. More important, existing studies have shown that application of the new guidelines often (but not always) results in a modest fall in the cesarean delivery rate, but that this change may be accompanied by significant increases in maternal and neonatal morbidity. These results strongly suggest more caution in the adoption of the American College of Obstetricians and Gynecologists / Society for Maternal-Fetal Medicine labor assessment recommendations. They are based on a hypothesis that has yet to undergo thorough evaluation of its risks and benefits.
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Case report: difficulty in diagnosis of delayed spinal epidural hematoma in puerperal women after combined spinal epidural anaesthesia. BMC Anesthesiol 2019; 19:54. [PMID: 30975081 PMCID: PMC6460545 DOI: 10.1186/s12871-019-0721-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 03/28/2019] [Indexed: 11/18/2022] Open
Abstract
Background Spinal epidural hematoma is a rare but serious complication of epidural anaesthesia and neurological impairment. Epidural hematoma usually becomes evident within a few hours of the procedure. Delayed clinical presentation of spinal epidural hematoma is even rarer and insidious. Case presentation We reported a case of a 44-year-old woman who underwent a caesarean section for a twin pregnancy during which a delayed dorsal spinal epidural hematoma occurred. Symptoms were reported 5 days after surgery and 72 h after removal of the epidural catheter. An MRI scan showed a dorsal epidural hematoma. The patient was moved to the Neurosurgical Department and underwent decompression surgery. Conclusion The possibility of the delayed onset of a spinal epidural hematoma in a pregnant woman who undergoes epidural anaesthesia in labour must always be taken into consideration. In order to achieve the best clinical result, we stress the importance of a timely diagnosis and prompt surgical treatment.
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Parkington HC, Sheehan PM, Coleman HA, Brennecke SP. Mother Nature versus Father Time. J Physiol 2017; 595:1849-1850. [PMID: 28105704 DOI: 10.1113/jp273914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Helena C Parkington
- Department of Physiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, 3800, Australia
| | - Penelope M Sheehan
- Department of Maternal-Fetal Medicine Pregnancy Research Centre, Royal Women's Hospital, Parkville, Victoria, 3052, Australia
| | - Harold A Coleman
- Department of Physiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, 3800, Australia
| | - Shaun P Brennecke
- Department of Maternal-Fetal Medicine Pregnancy Research Centre, Royal Women's Hospital, Parkville, Victoria, 3052, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, 3010, Australia
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Ogunyemi D, McGlynn S, Ronk A, Knudsen P, Andrews-Johnson T, Raczkiewicz A, Jovanovski A, Kaur S, Dykowski M, Redman M, Bahado-Singh R. Using a multifaceted quality improvement initiative to reverse the rising trend of cesarean births. J Matern Fetal Neonatal Med 2017; 31:567-579. [DOI: 10.1080/14767058.2017.1292244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Dotun Ogunyemi
- Division of Maternal-Fetal Medicine, Beaumont Hospital, Royal Oak, MI, USA
- William Beaumont Hospital – Royal Oak, Royal Oak, MI, USA
| | - Sara McGlynn
- Division of Maternal-Fetal Medicine, Beaumont Hospital, Royal Oak, MI, USA
- William Beaumont Hospital – Royal Oak, Royal Oak, MI, USA
| | - Anne Ronk
- Division of Maternal-Fetal Medicine, Beaumont Hospital, Royal Oak, MI, USA
- William Beaumont Hospital – Royal Oak, Royal Oak, MI, USA
| | - Patricia Knudsen
- Division of Maternal-Fetal Medicine, Beaumont Hospital, Royal Oak, MI, USA
- William Beaumont Hospital – Royal Oak, Royal Oak, MI, USA
| | - Tonyie Andrews-Johnson
- Division of Maternal-Fetal Medicine, Beaumont Hospital, Royal Oak, MI, USA
- William Beaumont Hospital – Royal Oak, Royal Oak, MI, USA
| | - Angeline Raczkiewicz
- Division of Maternal-Fetal Medicine, Beaumont Hospital, Royal Oak, MI, USA
- William Beaumont Hospital – Royal Oak, Royal Oak, MI, USA
| | - Andrew Jovanovski
- Division of Maternal-Fetal Medicine, Beaumont Hospital, Royal Oak, MI, USA
- William Beaumont Hospital – Royal Oak, Royal Oak, MI, USA
| | - Sangeeta Kaur
- Division of Maternal-Fetal Medicine, Beaumont Hospital, Royal Oak, MI, USA
- William Beaumont Hospital – Royal Oak, Royal Oak, MI, USA
| | - Mark Dykowski
- Division of Maternal-Fetal Medicine, Beaumont Hospital, Royal Oak, MI, USA
- William Beaumont Hospital – Royal Oak, Royal Oak, MI, USA
| | - Mark Redman
- Division of Maternal-Fetal Medicine, Beaumont Hospital, Royal Oak, MI, USA
- William Beaumont Hospital – Royal Oak, Royal Oak, MI, USA
| | - Ray Bahado-Singh
- William Beaumont Hospital – Royal Oak, Royal Oak, MI, USA
- Department of Obstetrics and Gynecology, Beaumont Health System, Royal Oak, MI, USA
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Blomberg M. Team-led hospital-based care reduced the number of obstetric interventions. Acta Obstet Gynecol Scand 2016; 95:1320. [PMID: 27517500 DOI: 10.1111/aogs.12961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Marie Blomberg
- Department of Obstetrics and Gynecology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
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Svelato A, Di Tommaso M, Spinoso R, Ragusa A. The reduction of first cesarean sections: a cultural issue. Acta Obstet Gynecol Scand 2016; 95:1319. [PMID: 27517646 DOI: 10.1111/aogs.12962] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Alessandro Svelato
- Department of Cardiovascular Pediatrics and Neonatology, G. Monasterio Tuscany Foundation, G. Pasquinucci Heart Hospital, Massa, Italy.
| | | | - Roberta Spinoso
- Department of Obstetrics and Gynecology, Villa Serena Private Hospital, Palermo, Italy
| | - Antonio Ragusa
- Department of Obstetrics and Gynecology, Massa Carrara General Hospital, Massa Carrara, Italy
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