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Pasquale J, Gialdini C, Chamillard M, Diaz V, Rijken MJ, Browne JL, Seto MTY, Cheung KW, Bonet M. Clinical algorithms for the monitoring and management of spontaneous, uncomplicated labour and childbirth. BJOG 2024; 131 Suppl 2:17-27. [PMID: 38986678 DOI: 10.1111/1471-0528.17895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 05/31/2024] [Accepted: 06/10/2024] [Indexed: 07/12/2024]
Abstract
AIM To develop evidence-based clinical algorithms for the assessment and management of spontaneous, uncomplicated labour and vaginal birth. POPULATION Pregnant women at any stage of labour, with singleton, term pregnancies considered to be at low risk of developing complications. SETTING Health facilities in low- and middle-income countries. SEARCH STRATEGY We searched for relevant published algorithms, guidelines, systematic reviews and primary research studies on Cochrane Library, PubMed, and Google on terms related to spontaneous, uncomplicated labour and childbirth up to 01 June 2023. CASE SCENARIOS Three case scenarios were developed to cover assessments and management for spontaneous, uncomplicated first, second and third stage of labour. The algorithms provide pathways for definition, assessments, diagnosis, and links to other algorithms in this series for management of complications. CONCLUSIONS We have developed three clinical algorithms to support evidence-based decision making during spontaneous, uncomplicated labour and vaginal birth. These algorithms may help guide health care staff to institute respectful care, appropriate interventions where needed, and potentially reduce the unnecessary use of interventions during labour and childbirth.
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Affiliation(s)
- Julia Pasquale
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | - Celina Gialdini
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
- Fundacio Blanquerna, Barcelona, Spain
| | | | - Virginia Diaz
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | - Marcus J Rijken
- Department of Global Public Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Joyce L Browne
- Department of Global Public Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Mimi Tin Yan Seto
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Ka Wang Cheung
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Laderas Díaz E, Rodríguez‐Almagro J, Picón Rodríguez R, Martínez Galiano JM, Martínez Rodríguez S, Hernández‐Martínez A. Midwives' approach to the prevention and repair of obstetric perineal trauma in Spain. Nurs Open 2024; 11:e2160. [PMID: 38660722 PMCID: PMC11043828 DOI: 10.1002/nop2.2160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 02/17/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
AIM Different clinical practice guidelines include recommendations on how to prevent and repair obstetric perineal trauma, as well as the use of episiotomy. To evaluate the variability in midwives' professional practices for preventing and repairing perineal trauma, as well as the professional factors that may be associated with the restrictive use of episiotomy. DESIGN Observational cross-sectional study. METHODS Three hundred five midwives completed an anonymous questionnaire developed by the authors and distributed across various midwifery scientific societies. The main outcomes measured were the frequencies of adopting specific practices related to perineal injury prevention and repair, episiotomy technique and restrictive episiotomy use (<10%). Odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals were estimated. RESULTS Intrapartum perineal massage was not normally used by 253 (83%) of midwives, and 186 (61%) applied compresses soaked in warm water to the perineum. Regarding episiotomy, there was a great deal of variability, noting that 129 (42.3%) adopted a restrictive use of this procedure, 125 (41%) performed it between 10% and 20%, while 51 midwives (16.7%) performed it in more than 20% of cases. In addition, 165 (54.1%) midwives followed an incision angle of 60º. Concerning tears, 155 (50.8%) usually sutured first-degree tears and 273 (89.5%) always sutured second-degree tears. Midwives attending home births (aOR = 6.5; 95% CI: 2.69-15.69), working at a teaching hospital (aOR = 3.69; 95% CI: 1.39-9.84), and the ones who recently completed their professional training (aOR = 3.58; 95% CI: 1.46-8.79) were significantly more likely to adopt a restrictive use of episiotomy. CONCLUSIONS There is a significant variability in Spanish midwives' practices for preventing and repairing perineal tears. Moreover, the restrictive use of episiotomy is associated with midwives attending home births, working in teaching hospitals and having recent professional training. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Estíbaliz Laderas Díaz
- Department of Obstetrics & GynecologyLa Mancha Centro General HospitalAlcázar de San Juan, Ciudad RealSpain
| | - Julián Rodríguez‐Almagro
- Department of Nursing, Physiotherapy and Occupational Therapy, Ciudad Real Faculty of NursingUniversity of Castilla‐La ManchaCiudad RealSpain
| | - Rafael Picón Rodríguez
- Department of General and Digestive SurgerySanta Bárbara HospitalPuertollano, Ciudad RealSpain
| | - Juan Miguel Martínez Galiano
- Department of NursingJaen UniversityJaenSpain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain
| | - Sandra Martínez Rodríguez
- Department of Nursing, Physiotherapy and Occupational Therapy, Ciudad Real Faculty of NursingUniversity of Castilla‐La ManchaCiudad RealSpain
| | - Antonio Hernández‐Martínez
- Department of Nursing, Physiotherapy and Occupational Therapy, Ciudad Real Faculty of NursingUniversity of Castilla‐La ManchaCiudad RealSpain
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Stones W, Nair A. Metrics for maternity unit staffing in low resource settings: Scoping review and proposed core indicator. Front Glob Womens Health 2023; 4:1028273. [PMID: 37009093 PMCID: PMC10050730 DOI: 10.3389/fgwh.2023.1028273] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/27/2023] [Indexed: 03/17/2023] Open
Abstract
BackgroundThe lack of usable indicators and benchmarks for staffing of maternity units in health facilities has constrained planning and effective program implementation for emergency obstetric and newborn care (EmONC) globally.ObjectivesTo identify potential indicator(s) and benchmarks for EmONC facility staffing that might be applicable in low resource settings, we undertook a scoping review before proceeding to develop a proposed set of indicators.Eligibility criteriaPopulation: women attending health facilities for care around the time of delivery and their newborns. Concept: reports of mandated norms or actual staffing levels in health facilities.Contextstudies conducted in healthcare facilities of any type that undertake delivery and newborn care and those from any geographic setting in both public and private sector facilities.Sources of evidence and chartingSearches were limited to material published since 2000 in English or French, using Pubmed and a purposive search of national Ministry of Health, non-governmental organization and UN agency websites for relevant documents. A template for data extraction was designed.ResultsData extraction was undertaken from 59 papers and reports including 29 descriptive journal articles, 17 national Ministry of Health documents, 5 Health Care Professional Association (HCPA) documents, two each of journal policy recommendation and comparative studies, one UN Agency document and 3 systematic reviews. Calculation or modelling of staffing ratios was based on delivery, admission or inpatient numbers in 34 reports, with 15 using facility designation as the basis for staffing norms. Other ratios were based on bed numbers or population metrics.ConclusionsTaken together, the findings point to a need for staffing norms for delivery and newborn care that reflect numbers and competencies of staff physically present on each shift. A Core indicator is proposed, “Monthly mean delivery unit staffing ratio” calculated as number of annual births/365/monthly average shift staff census.
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Affiliation(s)
- William Stones
- Centre for Reproductive Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Correspondence: William Stones
| | - Anjali Nair
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, United States
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4
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Bishop A, Dewhurst H. Military provision of maternal care in humanitarian and disaster relief operations. BMJ Mil Health 2022; 168:492-497. [PMID: 35042759 DOI: 10.1136/bmjmilitary-2021-001993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/11/2021] [Indexed: 11/03/2022]
Abstract
With three-quarters of the 80 million people in need of humanitarian assistance being women or children in 2014, maternal care makes up a significant burden of medical care in humanitarian assistance and disaster relief operations. Due to lack of infrastructure and up to 80% of these displaced people being located in developing countries, mothers are often extremely vulnerable to disease, abuse and malnutrition. This can lead to late presentations of severe disease and birthing complications that would usually be easily manageable, but are far more complex due to the physical condition of the mother and lack of available resources. The British Armed Forces are often involved in humanitarian assistance and disaster relief either intentionally or due to the nature of the operations they carry out. However, it is not always possible to predict the requirement of maternal care. This humanitarian special edition article focuses on the factors impacting the maternal patient in a humanitarian environment, also looking at common pathologies and ways of managing these in a Role 1 facility. This is a paper commissioned as a part of the Humanitarian and Disaster Relief Operations special issue of BMJ Military Health.
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Albuquerque RCD, Pereira GMV, Luz AG, Nóbrega MA, Lajos GJ, Brito LGO. Risk factors for mediolateral episiotomy at a tertiary hospital: a cross-sectional study. Rev Assoc Med Bras (1992) 2022; 68:463-469. [DOI: 10.1590/1806-9282.20211251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 11/22/2022] Open
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Blanc-Petitjean P, Saumier S, Meunier G, Sibiude J, Mandelbrot L. Prolongation of active second stage of labor: Associated factors and perinatal outcomes. J Gynecol Obstet Hum Reprod 2021; 50:102205. [PMID: 34391951 DOI: 10.1016/j.jogoh.2021.102205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/09/2021] [Accepted: 08/09/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Current data does not allow to define a reasonable threshold of duration of active second stage (ASS) of labor beyond which a medical intervention should be considered. Primary objective was to analyse perinatal outcomes associated with prolonged ASS beyond 45 min. Secondarily, we analysed associated maternal, gestational, labor and delivery characteristics associated with prolonged ASS. METHODS We performed a monocentric retrospective study among women with vaginal delivery, a term singleton cephalic fetus, without history of cesarean section. We compared women with active second stage of labor longer than 45 min (ASS ≥45 min, group A) and women with instrumental vaginal delivery (IVD) only for failure to progress (FtP) before 45 min of pushing (group B). Primary outcome was postpartum hemorrhage (PPH). Maternal and neonatal outcomes associated with ASS ≥ 45 min were assessed with multivariable logistic regression models. RESULTS Prolonged ASS ≥45 min (group A, N=177) was associated with lower rate of persistent occiput posterior position (1.7 vs 9.5%, p<0.01) and of non-engaged presentation when expulsive efforts started (10.7 vs 27.4%, p<0.01), compared to IVD for FtP <45 min (group B, N=84). In group A, 52% of women had instrumental delivery. Prolonged active second stage was independently associated with lower odds of episiotomy (38.4 vs 61.9%, AOR(95%CI)=0.43[0.24-0.78]) and was not associated with PPH (5.1 vs 5.9%, AOR=1.01[0.28-3.68]), pH<7.20, 5-min Apgar score < 7 (20.2 vs 15.9%, AOR=2.00[0.89-4.48]), lactates > 6 (23.0 vs 24.3, AOR=1.45[0.68-3.07]) or transfer to neonatal intensive care unit (6.2 vs 2.4%, AOR=4.71[0.76-29.08]. DISCUSSION Extending the duration of active second stage of labor beyond 45 min seems reasonable under rigorous surveillance of maternal and fetal wellbeing.
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Affiliation(s)
- Pauline Blanc-Petitjean
- Université de Paris, CRESS, INSERM, INRA, F-75004 Paris, France; AP-HP, Louis Mourier Hospital, Department of Obstetrics and Gynecology, Université de Paris, F-92700, Colombes, France.
| | - Solenne Saumier
- Université de Paris, CRESS, INSERM, INRA, F-75004 Paris, France; Université de Paris, Baudelocque Midwifery school, F-75014, Paris, France
| | | | - Jeanne Sibiude
- AP-HP, Louis Mourier Hospital, Department of Obstetrics and Gynecology, Université de Paris, F-92700, Colombes, France; Université de Paris, IAME, INSERM, F-75018 Paris, France
| | - Laurent Mandelbrot
- AP-HP, Louis Mourier Hospital, Department of Obstetrics and Gynecology, Université de Paris, F-92700, Colombes, France; Université de Paris, IAME, INSERM, F-75018 Paris, France
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Abstract
Normal labor is identified as regular uterine contractions in addition to dilation and effacement of the cervix. It is necessary to define normal labor in order to delineate when a woman's labor pattern diverges from that observed in most women. Labor irregularities are subdivided into protraction disorders and arrest disorders. Identifying abnormal labor patterns and initiating appropriate interventions is essential because prolonged labor is associated with an increase in perinatal morbidity. The aim of this review was to delineate both normal labor progress and also discuss the current evidence-based diagnosis and treatment of protraction and arrest disorders. Many subtleties go into defining the boundaries of the first and second stages of labor. Historically, the Friedman curve established normal limits; but currently Zhang has advanced these definitions by accounting for current demographical characteristics and practice environments. The most significant variables for defining normal progress of labor are parity and regional anesthesia status. The most common causes of labor abnormalities are uterine inactivity, obesity, cephalopelvic disproportion and fetal malposition. Risks of extending the first and/or second stage of labor include postpartum hemorrhage, intraamniotic infection and potentially an increase in neonatal adverse outcomes. The management of labor disorders consists of oxytocin administration, amniotomy, intrauterine pressure catheter use and shared decision-making regarding proceeding with expectant management, operative vaginal delivery or cesarean delivery after weighing the risks and benefits of each option. The decision to extend the duration of labor is personalized for each mother-baby dyad and should be agreed upon depending on individual maternal and fetal circumstances.
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Affiliation(s)
- Alexis C Gimovsky
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital, Warren Alpert School of Medicine of Brown University, Providence, RI, USA -
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Wright A, Nassar AH, Visser G, Ramasauskaite D, Theron G. FIGO good clinical practice paper: management of the second stage of labor. Int J Gynaecol Obstet 2021; 152:172-181. [PMID: 33340411 PMCID: PMC7898872 DOI: 10.1002/ijgo.13552] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/24/2020] [Accepted: 12/17/2020] [Indexed: 11/08/2022]
Abstract
This good clinical practice paper provides an overview of the current evidence around second stage care, highlighting the challenges and the importance of maintaining high-quality, safe, and respectful care in all settings. It includes a series of recommendations based on best available evidence regarding length of second stage, judicious use of episiotomy, and the importance of competent attendants and adequate resource to facilitate all aspects of second stage management, from physiological birth to assisted vaginal delivery and cesarean at full dilatation. The second stage of labor is potentially the most dangerous time for the baby and can have significant consequences for the mother, including death or severe perineal trauma or fistula, especially where there are failures to recognize and repair. This paper sets out principles of care, including the vital role of skilled birth attendants and birth companions, and the importance of obstetricians and midwives working together effectively and speaking with one voice, whether to women or to policy makers. The optimization of high-quality, safe, and personalized care in the second stage of labor for all women globally can only be achieved by appropriate attention to the training of birth attendants, midwives, and obstetricians. FIGO is committed to this aim alongside the WHO, ICM, and all FIGO's 132 member societies.
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Affiliation(s)
- Alison Wright
- Department of Obstetrics and GynaecologyRoyal Free London Teaching HospitalLondonUK
| | - Anwar H. Nassar
- Department of Obstetrics and GynecologyAmerican University of Beirut Medical CenterBeirutLebanon
| | - Gerry Visser
- Department of ObstetricsUniversity Medical CenterUtrechtthe Netherlands
| | - Diana Ramasauskaite
- Center of Obstetrics and GynaecologyVilnius University Faculty of MedicineVilniusLithuania
| | - Gerhard Theron
- Department of Obstetrics and GynaecologyFaculty of Medicine and Health SciencesUniversiteit StellenboschStellenboschSouth Africa
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Nassar AH, Visser GHA. A framework for safe obstetrical practices. Int J Gynaecol Obstet 2021; 152:137-138. [PMID: 33508143 DOI: 10.1002/ijgo.13539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Anwar H Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
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10
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Pérez MLM, Hernández Garre JM, Pérez PE. Analysis of Factors Associated With Variability and Acidosis of the Umbilical Artery pH at Birth. Front Pediatr 2021; 9:650555. [PMID: 34113587 PMCID: PMC8185037 DOI: 10.3389/fped.2021.650555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Perinatal asphyxia is a significant contributing factor for neonatal morbidity and mortality. The aim of this study was to investigate the clinical factors associated with umbilical artery pH variability and fetal acidosis at birth. Methods: This is a single center cross-sectional study in a public regional hospital in southeastern Spain from January to December 2019. The reference population was 1.655 newborns, final sample of 312 experimental units with validated values of umbilical cord blood pH. Results: Factors such as gestational age at term ( X ¯ at - term : 7.26 ± 0.08- X ¯ no -at-term: 7.31 ± 0.05, p: 0.00), primiparity ( X ¯ primiparity : 7.24 ± 0.078- X ¯ multiparity : 7.27 ± 0.08, p: 0.01), induced labor ( X ¯ induced : 7.24 ± 0.07- X ¯ spontaneous : 7.26 ± 0.081, p: 0.02), vaginal delivery ( X ¯ vaginal :7.25 ± 0.08- X ¯ cesarean :7.27 ± 0.07, p: 0.01), and prolonged dilation duration ( X ¯ AboveAverage : 7.22 ± 0.07- X ¯ BelowAverage : 7.27 ± 0.08, p: 0.00), expulsion duration ( X ¯ AboveAverage : 7.23 ± 0.07- X ¯ BelowAverage : 7.26 ± 0.08, p: 0.01), and total labor duration ( X ¯ AboveAverage : 7.23 ± 0.07- X ¯ BelowAverage : 7.27 ± 0.08, p: 0.00) are associated with a decrease in umbilical artery pH at birth. However, only three factors are associated with acidosis pH (<7.20) of the umbilical artery at birth: the induction of labor [OR: 1.74 (95% CI: 0.98-3.10); p: 0.04], vaginal delivery [OR: 2.09 (95% CI: 0.95-4.61); p: 0.04], and total duration of labor [OR: 2.06 (95% CI: 1.18-3.57); p: 0.01]. Conclusions: Although several factors may affect the variability of umbilical artery pH at birth by decreasing their mean values (gestational age, primiparity, induced labor, vaginal delivery and prolonged: dilation duration, expulsion duration and total labor duration), only induction of labor, vaginal delivery and total duration of labor are associated with an acidosis (<7.20) of same.
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Affiliation(s)
- María Luisa Mayol Pérez
- Department of Health Sciences Program, Universidad Católica de Murcia (UCAM), Guadalupe, Murcia, Spain.,Hospital Torrevieja, Torrevieja, Spain
| | - José Manuel Hernández Garre
- Department of Political Sciences, Social Anthropology and Public Finance University of Murcia, Murcia, Spain.,Hospital Rafael Méndez Lorca, Lorca, Spain
| | - Paloma Echevarría Pérez
- Department of Health Sciences Program, Universidad Católica de Murcia (UCAM), Guadalupe, Murcia, Spain
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Fiedler A, Brun R, Randegger D, Balsyte D, Zimmermann R, Haslinger C. Adverse effect of delayed pushing on postpartum blood loss in nulliparous women with epidural analgesia. Int J Gynaecol Obstet 2020; 150:92-97. [PMID: 32364638 DOI: 10.1002/ijgo.13175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/27/2018] [Accepted: 04/16/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To test for an association between blood loss and time until pushing (TUP) after full cervical dilation in nulliparous women with epidural analgesia. METHODS A prospective cohort study was performed at the University Hospital of Zurich between October 2015 and November 2016. Included were 228 nulliparous women with singleton pregnancy, planned vaginal delivery after 36 completed weeks of gestation, epidural analgesia, and guided active pushing. TUP was defined as the interval between full cervical dilation and initiation of active pushing. The primary outcome measure was blood loss, assessed by the postpartum decrease in hemoglobin (ΔHb), estimated blood loss, and rate of ΔHb ≥30 g/L. Associations between TUP and primary and secondary maternal and neonatal delivery outcomes were assessed using Spearman correlation, Mann-Whitney U test, Kruskal-Wallis test, or Fisher exact test, as appropriate. RESULTS Longer TUP correlated significantly with increased ΔHb (ρ=0.142, P=0.033) and higher rates of ΔHb ≥30 g/l (P=0.002). Composite adverse maternal and neonatal outcomes were unaffected. CONCLUSION On the grounds of increased maternal blood loss, and in contrast to the current International Federation of Gynecology and Obstetrics (FIGO) guideline, delayed active pushing is not recommended in nulliparous women with epidural analgesia.
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Affiliation(s)
- Anton Fiedler
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
| | - Romana Brun
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
| | | | - Dalia Balsyte
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
| | - Roland Zimmermann
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
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12
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Wright A, Nassar AH. Correspondence: Adverse effect of delayed pushing on postpartum blood loss in nulliparous women with epidural analgesia. Int J Gynaecol Obstet 2020; 150:134. [PMID: 32365224 DOI: 10.1002/ijgo.13190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Anwar H Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
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13
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Mselle LT, Eustace L. Why do women assume a supine position when giving birth? The perceptions and experiences of postnatal mothers and nurse-midwives in Tanzania. BMC Pregnancy Childbirth 2020; 20:36. [PMID: 31931780 PMCID: PMC6958681 DOI: 10.1186/s12884-020-2726-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/07/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Before the advent of Western medicine in Tanzania, women gave birth in an upright position either by sitting, squatting or kneeling. Birthing women would hold ropes or trees as a way of gaining strength and stability in order to push the baby with sufficient force. Despite the evidence supporting the upright position as beneficial to the woman and her unborn child, healthcare facilities consistently promote the use of the supine position. The purpose of this study was to explore the perceptions and experiences of mothers and nurse-midwives regarding the use of the supine position during labour and delivery. METHODS We used a descriptive qualitative design. We conducted seven semi-structured interviews with nurse-midwives and two focus group discussions with postnatal mothers who were purposively recruited for the study. Qualitative content analysis guided the analysis. RESULTS Four themes emerged from mothers' and midwives' description of their experiences and perceptions of using supine position during childbirth. These were: women adopted the supine position as instructed by midwives; women experience of using alternative birthing positions; midwives commonly decide birthing positions for labouring women and supine position is the best-known birthing position. CONCLUSION Women use the supine position during childbirth because they are instructed to do so by the nurse-midwives. Nurse-midwives believe that the supine position is the universally known and practised birthing position, and prefer it because it provides flexibility for them to continuously monitor the progress of labour and assist delivery most efficiently. Mothers in this study had no other choice than to labour and deliver their babies in the supine position as instructed because they trusted midwives as skilled professionals who knew what was best given the condition of the mother and her baby.
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Affiliation(s)
- Lilian Teddy Mselle
- Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lucia Eustace
- Department of Nursing and Midwifery, Missenyi District Council, Bukoba, Kagera Tanzania
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14
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Xu EH, Mandel V, Huet C, Rampakakis E, Brown RN, Wintermark P. Maternal risk factors for adverse outcome in asphyxiated newborns treated with hypothermia: parity and labor duration matter. J Matern Fetal Neonatal Med 2019; 34:4123-4131. [PMID: 31878805 DOI: 10.1080/14767058.2019.1706472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Perinatal asphyxia remains a frequent cause of neonatal mortality and long-term neurodevelopmental sequelae, despite the introduction of therapeutic hypothermia. Specific maternal characteristics may predispose asphyxiated newborns treated with hypothermia to worse outcome.Objective: To investigate the possible association between specific maternal factors and adverse outcome in asphyxiated newborns treated with hypothermia.Methods: We conducted a retrospective review of our database of 215 asphyxiated newborns treated with hypothermia from 2008 to 2015. We collected maternal characteristics including parity and labor duration, and we defined adverse outcome as death and/or brain injury. We compared the maternal characteristics between the asphyxiated newborns who developed adverse outcome and those who did not.Results: Asphyxiated newborns born to nulliparous mothers had a significantly higher risk of adverse outcome (61%), compared to asphyxiated newborns born from primiparous (19%) and multiparous (20%) mothers (p = .002). Labor duration was longer in nulliparous mothers (p = .04). Among mothers who delivered vaginally, labor duration was significantly longer in newborns developing adverse outcome (p = .04). In multivariable analysis, parity was confirmed as an independent predictor of adverse outcome in all newborns, but labor duration showed a borderline non-significant association with adverse outcome (p = .051) only in newborns born vaginally. Labor duration beyond 12 h of life was associated with maximal sensitivity and specificity in detecting asphyxiated newborns at an increased risk of adverse outcome despite hypothermia treatment (AUC 0.62, p = .044).Conclusions: Newborns with evidence of perinatal asphyxia, born to nulliparous mothers, and especially to those in whom the duration of labor has been prolonged, might be at higher risk of death or brain injury despite the use of therapeutic hypothermia.
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Affiliation(s)
- Eric Hongbo Xu
- Division of Newborn Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Valentine Mandel
- Division of Newborn Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Cloe Huet
- Division of Newborn Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada
| | | | | | - Pia Wintermark
- Division of Newborn Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada
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Franchi M, Parissone F, Lazzari C, Garzon S, Laganà AS, Raffaelli R, Cromi A, Ghezzi F. Selective use of episiotomy: what is the impact on perineal trauma? Results from a retrospective cohort study. Arch Gynecol Obstet 2019; 301:427-435. [PMID: 31823037 DOI: 10.1007/s00404-019-05404-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 12/02/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the effects of selective use of episiotomy on perineal trauma. METHODS We performed a retrospective cohort study on consecutive vaginal deliveries from January 2010 to December 2016. From January 2010 to December 2011 episiotomy was performed liberally, based only on individual midwife/doctor's decision. Since January 2012, a shared selective use of episiotomy policy has been introduced. To evaluate the range of perineal trauma in spontaneous second-degree perineal tears, a sub-classification of second-degree lacerations has been introduced dividing them into two sub-groups: A (smaller than the average episiotomy) and B (spontaneous vaginal tear larger than the average episiotomy). The primary outcomes were the incidence and type of perineal trauma, with the proportion of type A and type B second-degree spontaneous tears under a policy of selective episiotomy. RESULTS Deliveries not exposed to selective use of episiotomy were 1583 (Group 1), those exposed to selective use of episiotomy were 6409 (Group 2). In Group 2 episiotomy rate decreased, and incidence of intact perineum, first- and second-degree lacerations increased. The incidence of third- and fourth-degree lacerations did not change. Spontaneous second-degree lacerations occurred in 19.4% and 36.8% of women in group 1 and 2, respectively. With a selective episiotomy policy, 88.3% of second-degree tears was classified as type A. CONCLUSIONS The selective use of episiotomy is clinically feasible and effective. This policy seems to be associated with a lower delivery-related perineal trauma as showed by the sub-classification, that could be a useful tool to monitor obstetric care.
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Affiliation(s)
- Massimo Franchi
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | - Francesca Parissone
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | - Cecilia Lazzari
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospital, University of Insubria, Piazza Biroldi 1, 21100, Varese, Italy.
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospital, University of Insubria, Piazza Biroldi 1, 21100, Varese, Italy
| | - Ricciarda Raffaelli
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | - Antonella Cromi
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospital, University of Insubria, Piazza Biroldi 1, 21100, Varese, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospital, University of Insubria, Piazza Biroldi 1, 21100, Varese, Italy
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Management of the passive phase of the second stage of labour in nulliparous women—Focus group discussions with Swedish midwives. Midwifery 2019; 75:89-96. [DOI: 10.1016/j.midw.2019.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 04/25/2019] [Accepted: 04/28/2019] [Indexed: 11/21/2022]
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17
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Housseine N, Punt MC, Browne JL, van ‘t Hooft J, Maaløe N, Meguid T, Theron GB, Franx A, Grobbee DE, Visser GH, Rijken MJ. Delphi consensus statement on intrapartum fetal monitoring in low-resource settings. Int J Gynaecol Obstet 2019; 146:8-16. [PMID: 30582153 PMCID: PMC7379246 DOI: 10.1002/ijgo.12724] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/23/2018] [Accepted: 11/26/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine acceptable and achievable strategies of intrapartum fetal monitoring in busy low-resource settings. METHODS Three rounds of online Delphi surveys were conducted between January 1 and October 31, 2017. International experts with experience in low-resource settings scored the importance of intrapartum fetal monitoring methods. RESULTS 71 experts completed all three rounds (28 midwives, 43 obstetricians). Consensus was reached on (1) need for an admission test, (2) handheld Doppler for intrapartum fetal monitoring, (3) intermittent auscultation (IA) every 30 minutes for low-risk pregnancies during the first stage of labor and after every contraction for high-risk pregnancies in the second stage, (4) contraction monitoring hourly for low-risk pregnancies in the first stage, and (5) adjunctive tests. Consensus was not reached on frequency of IA or contraction monitoring for high-risk women in the first stage or low-risk women in the second stage of labor. CONCLUSION There is a gap between international recommendations and what is physically possible in many labor wards in low-resource settings. Research on how to effectively implement the consensus on fetal assessment at admission and use of handheld Doppler during labor and delivery is crucial to support staff in achieving the best possible care in low-resource settings.
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Affiliation(s)
- Natasha Housseine
- Department of Obstetrics and GynaecologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtNetherlands
- Julius Global HealthJulius Centre for Health Sciences and Primary CareUniversity Medical Centre UtrechtUtrecht UniversityUtrechtNetherlands
- Department of Obstetrics and GynaecologyMnazi Mmoja HospitalZanzibarTanzania
| | - Marieke C. Punt
- Department of Obstetrics and GynaecologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtNetherlands
| | - Joyce L. Browne
- Julius Global HealthJulius Centre for Health Sciences and Primary CareUniversity Medical Centre UtrechtUtrecht UniversityUtrechtNetherlands
| | - Janneke van ‘t Hooft
- Department of Obstetrics and GynaecologyAcademic Medical CenterAmsterdamNetherlands
| | - Nanna Maaløe
- Global Health SectionDepartment of Public HealthUniversity of CopenhagenCopenhagenDenmark
| | - Tarek Meguid
- Department of Obstetrics and GynaecologyMnazi Mmoja HospitalZanzibarTanzania
- School of Health and Medical ScienceState University of ZanzibarZanzibarTanzania
| | - Gerhard B. Theron
- Department of Obstetrics and GynecologyFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Arie Franx
- Department of Obstetrics and GynaecologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtNetherlands
| | - Diederick E. Grobbee
- Julius Global HealthJulius Centre for Health Sciences and Primary CareUniversity Medical Centre UtrechtUtrecht UniversityUtrechtNetherlands
| | | | - Marcus J. Rijken
- Department of Obstetrics and GynaecologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtNetherlands
- Julius Global HealthJulius Centre for Health Sciences and Primary CareUniversity Medical Centre UtrechtUtrecht UniversityUtrechtNetherlands
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Stones W, Visser GHA, Theron G. FIGO Statement: Staffing requirements for delivery care, with special reference to low- and middle-income countries. Int J Gynaecol Obstet 2019; 146:3-7. [PMID: 30927443 DOI: 10.1002/ijgo.12815] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 02/24/2019] [Accepted: 03/28/2019] [Indexed: 11/11/2022]
Abstract
International standards for clinical staffing of delivery care in maternity units are currently lacking, with resulting gaps in provision leading to adverse outcomes and very poor experiences of care for women and families. While evidence-informed modelling approaches have been proposed based on population characteristics and estimated rates of complications, their application and outcomes in low-resource settings have not been reported. Here, FIGO's Safe Motherhood and Newborn Health Committee proposes indicative standards for labor wards as a starting point for policy and program development. These standards consider the volume of deliveries, the case mix, and the need to match clinical care requirements with an appropriate mix of professional skills among midwifery and obstetric staff. The role of Shift Leader in busy labor wards is emphasized. Application of the standards can help to assure women and their families of a safe but also positive birthing experience. FIGO calls for investment by partners to test these clinically-informed recommendations for delivery unit staffing at hospital and district level in low- and middle-income country settings.
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Affiliation(s)
- William Stones
- Departments of Obstetrics and Gynecology and Public Health, Malawi College of Medicine, Blantyre, Malawi
| | | | - Gerhard Theron
- Department of Obstetrics and Gynecology, University of Stellenbosch, Cape Town, South Africa
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Zhang M, Wang M, Zhao X, Ren J, Xiang J, Luo B, Yao J. Risk factors for episiotomy during vaginal childbirth: A retrospective cohort study in Western China. J Evid Based Med 2018; 11:233-241. [PMID: 30160052 DOI: 10.1111/jebm.12316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 08/02/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To assess the incidence rates and risk factors for episiotomy during vaginal childbirth in a Western China context. METHODS A retrospective hospital-based cohort study was conducted using computerized data of 3721 singleton vaginal deliveries after 28 weeks of gestation. Women who underwent episiotomy were compared with those who did not. RESULTS The overall prevalence of episiotomy was 44.0% (1636/3721); 52.9% (1458/2756) among primiparas and 18.4% (178/965) among multiparas (P < 0.001). Adjusted risk factors significantly associated with episiotomy included primiparity, prolonged second stage of labor, and labor-management personnel. Risk factors specific to primiparas were increasing maternal age (per year) (OR = 1.04, 95% CI 1.01 to 1.07, P = 0.035), increasing biparietal diameter (per centimeter) (OR = 1.40, 95% CI 1.06 to 1.84, P = 0.017), first stage of labor beyond 10-hour (OR = 1.36, 95% CI 1.10 to 1.68, P = 0.005), and birth weight (per 100 g) (OR = 1.06, 95% CI 1.03 to 1.09, P < 0.001). Birth weight resulted in an adjusted risk increase of 6.1% among primiparas for every 100 additional grams of birth weight. For the analysis stratified by labor-management personnel, moderately experienced midwifery was a risk factor of episiotomy (OR = 1.76, 95% CI 1.21 to 2.56, P = 0.003); midwives with bachelor's degree (OR = 1.47, 95% CI 1.15 to 1.88, P = 0.002), and obstetricians with doctor's degree (OR = 2.00, 95% CI 1.18 to 3.39, P = 0.010) were most likely to perform episiotomy. CONCLUSION Episiotomy is still commonly performed in Western China. A survey of maternity care professionals' knowledge of and attitudes towards episiotomy is urgently required to explore the complex reasons for conducting episiotomy.
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Affiliation(s)
- Mengqin Zhang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, P. R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, P. R. China
| | - Min Wang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, P. R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, P. R. China
| | - Xiufang Zhao
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, P. R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, P. R. China
| | - Jianhua Ren
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, P. R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, P. R. China
| | - Jie Xiang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, P. R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, P. R. China
| | - Biru Luo
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, P. R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, P. R. China
| | - Jianrong Yao
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, P. R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, P. R. China
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20
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Pervin J, Aktar S, Nu UT, Rahman M, Rahman A. Associations between improved care during the second stage of labour and maternal and neonatal health outcomes in a rural hospital in Bangladesh. Midwifery 2018; 66:30-35. [PMID: 30107287 DOI: 10.1016/j.midw.2018.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/08/2018] [Accepted: 07/22/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the efficacy of care in the second stage of labour with a package of interventions that included (1) maintaining the birthing position according to the woman's choice, (2) adopting a spontaneous pushing technique and (3) using a support person, to reduce maternal and neonatal complications. DESIGN Used the data collected from two cohorts- before and after an initiative to improve care during the second stage of labour. SETTING A rural hospital in Bangladesh where 90-100 deliveries are conducted monthly and cesarean section provision is not available. PARTICIPANTS One thousand and fifty-one singleton pregnancies who attended the hospital for giving birth in the first stage of labour before full dilatation of the cervix and with cephalic presentation. MEASUREMENTS AND FINDINGS Data were collected through a structured checklist and questionnaire completed by research assistants; and also retrieved from hospital case record files, and the ongoing demographic surveillance system database. Coverage of adopting the upright or lateral position in the post-intervention period increased to 76% from about 1% in the pre-intervention period, and the spontaneous pushing technique increased to 97% from 77% in the same period. The odds of combined maternal and neonatal complications decreased by 46% between pre- and post-intervention periods (odds ratio: 0.54, 95% confidence interval: 0.43-0.70). Frequency of episiotomy (from 43% to 29%, P < 0.001), cervical tear (3.8% to 1.5%, P = 0.02), and median blood loss (200 ml to 150 ml; P < 0.001) were reduced significantly in the same period. No significant associations were observed in perineal tear or birth asphyxia occurrences. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The study suggests that there is a beneficial effect of care during the second stage of labour with a package of interventions in reducing maternal and neonatal complications, particularly in reducing the frequency of episiotomy, cervical tear, and blood loss during delivery. The preferred choice of posture during giving birth, adopting a spontaneous pushing technique and continuous presence of support person during the second stage of labour may be encouraged for better health outcomes.
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Affiliation(s)
- Jesmin Pervin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b); Mohakhali, Dhaka 1212, Bangladesh.
| | - Shaki Aktar
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b); Mohakhali, Dhaka 1212, Bangladesh
| | - U Tin Nu
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b); Mohakhali, Dhaka 1212, Bangladesh
| | - Monjur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b); Mohakhali, Dhaka 1212, Bangladesh
| | - Anisur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b); Mohakhali, Dhaka 1212, Bangladesh
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21
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Corry EM, Ramphul M, Rowan AM, Segurado R, Mahony RM, Keane DP. Exploring full cervical dilatation caesarean sections–A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2018; 224:188-191. [DOI: 10.1016/j.ejogrb.2018.03.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/16/2018] [Accepted: 03/19/2018] [Indexed: 11/16/2022]
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McLelland G, McKenna L, Morgans A, Smith K. Epidemiology of unplanned out-of-hospital births attended by paramedics. BMC Pregnancy Childbirth 2018; 18:15. [PMID: 29310618 PMCID: PMC5759287 DOI: 10.1186/s12884-017-1638-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 12/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the previous two decades the incidence and number of unplanned out of hospital births Victoria has increased. As the only out of hospital emergency care providers in Victoria, paramedics would provide care for women having birth emergencies in the community. However, there is a lack of research about the involvement of paramedics provide for these women and their newborns. This research reports the clinical profile of a 1-year sample caseload of births attended by a state-wide ambulance service in Australia. METHODS Retrospective data previously collected via Victorian Ambulance Clinical Information System (VACIS ®) an in-field electronic patient care record was provided by Ambulance Victoria. Cases were identified via a comprehensive filter, and analysed using SPSS version 19. RESULTS Over a 12-month period paramedics attended 324 out-of-hospital births including 190 before paramedics' arrival. Most (88.3%) were uncomplicated precipitous term births. However, paramedics documented various obstetric complications including postpartum haemorrhage, breech, cord prolapse, prematurity and neonatal death. Furthermore, nearly one fifth (16.7%) of the women had medical histories that had potential to complicate their clinical management, including taking illicit or prescription drugs. Mothers were more likely to be multiparas. Births were more likely to occur between 2200 and 0600 h. Paramedics performed a range of interventions for both mothers and babies. CONCLUSIONS Paramedics provided emergency care for prehospital out-of-hospital births. Although most were precipitous uneventful births at term, paramedics used complex obstetric assessment and clinical skills. These findings have implications for paramedic clinical practice and education around management of unplanned out of hospital births.
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Affiliation(s)
- Gayle McLelland
- School of Nursing and Midwifery, Monash University, PO Box 527, Frankston, 3199 Australia
| | - Lisa McKenna
- School of Nursing and Midwifery, Monash University, PO Box 527, Frankston, 3199 Australia
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3083 Australia
| | - Amee Morgans
- Department of Primary Health Care, Monash University, Clayton, VIC 3168 Australia
| | - Karen Smith
- Ambulance Victoria, Blackburn North, VIC 3130 Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Clayton, VIC 3168 Australia
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Liu J, Peng C, Zhou QM, Guo L, Liu ZH, Xiong L. Alkaloids and flavonoid glycosides from the aerial parts of Leonurus japonicus and their opposite effects on uterine smooth muscle. PHYTOCHEMISTRY 2018; 145:128-136. [PMID: 29127939 DOI: 10.1016/j.phytochem.2017.11.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 10/20/2017] [Accepted: 11/01/2017] [Indexed: 06/07/2023]
Abstract
The crude extract and some Chinese patented medicines of Leonurus japonicus Houtt. have been proven to affect the uterine smooth muscle. L. japonicus injection is widely used in obstetric departments in China for treating postpartum hemorrhage caused by uterine inertia. Bioassay-guided isolation of the 95% EtOH extract of L. japonicus yielded four cyclopeptides, nine alkaloids, and three flavonoid glycosides, including two previously undescribed cyclopeptides, namely, cycloleonuripeptide G and cycloleonuripeptide H. The structures of the cyclopeptides were elucidated to be cyclo-(L-Phe-L-Phe-Gly-L-Pro-Gly-L-Pro) and cyclo-(L-Phe-L-Ala-L-Pro-L-Ile-L-His-Gly-L-Ala-L-Pro), respectively, via spectroscopic and chemical methods. Cyclopeptides (cycloleonuripeptides C and D) and alkaloids (imperialine-3β-D-glucoside and leonurine) promoted contraction of uterine smooth muscle strips isolated from normal rats. However, it was observed that flavonoid glycosides (spinosin, linarin, and apigenin-7-O-β-D-glucopyranoside) significantly inhibited contraction of the uterine smooth muscle strips.
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Affiliation(s)
- Juan Liu
- State Key Laboratory Breeding Base of Systematic Research, Development and Utilization of Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China; School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Cheng Peng
- State Key Laboratory Breeding Base of Systematic Research, Development and Utilization of Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China; School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China.
| | - Qin-Mei Zhou
- State Key Laboratory Breeding Base of Systematic Research, Development and Utilization of Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China; School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China; Institute of Innovative Medicine Ingredients of Southwest Specialty Medicinal Materials, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Li Guo
- State Key Laboratory Breeding Base of Systematic Research, Development and Utilization of Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China; School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China; Institute of Innovative Medicine Ingredients of Southwest Specialty Medicinal Materials, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Zhao-Hua Liu
- Chengdu No.1 Pharmaceutical Co. Ltd., Chengdu, 610031, China
| | - Liang Xiong
- State Key Laboratory Breeding Base of Systematic Research, Development and Utilization of Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China; School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China; Institute of Innovative Medicine Ingredients of Southwest Specialty Medicinal Materials, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China.
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Relationship between duration of second stage of labour and postpartum anaemia. Women Birth 2017; 31:e318-e324. [PMID: 29221635 DOI: 10.1016/j.wombi.2017.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/20/2017] [Accepted: 11/24/2017] [Indexed: 01/01/2023]
Abstract
AIM To assess the relationship between the duration of the second stage of labour and postpartum anaemia during vaginal birth. METHODS An observational, analytical retrospective cohort study was performed at the "Mancha-Centro Hospital" (Spain) during the 2013-2016 period. Data were collected from 3437 women who had a vaginal birth. Postpartum anaemia was defined as a haemoglobin level below 11g/dL at 24h postpartum. A univariate analysis was used for potential risk factors and a multivariate analysis with binary logistic regression to control for possible confounding factors. FINDINGS The incidence of postpartum anaemia was 42.0%. The risk of postpartum anaemia did not increase in nulliparous women whose duration of the second stage of labour exceeded 4h. Compared with multiparous women who delivered between 0 and 3h, multiparous women with a duration of the second stage of labour beyond 3h were at higher risk of postpartum anaemia (OR=2.43 [1.30-4.52]). CONCLUSION The duration of the second stage of labour beyond 4h is safe for postpartum anaemia in nulliparous women. However in multiparous women, monitoring should increase if the second stage of labour exceeds 3h given the increased risk of postpartum anaemia.
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25
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Boatin AA, Eckert LO, Boulvain M, Grotegut C, Fisher BM, King J, Berg M, Adanu RMK, Reddy U, Waugh JJS, Gupta M, Kochhar S, Kenyon S. Dysfunctional labor: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2017; 35:6538-6545. [PMID: 29150059 PMCID: PMC5710983 DOI: 10.1016/j.vaccine.2017.01.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/13/2017] [Indexed: 01/30/2023]
Affiliation(s)
- Adeline A Boatin
- Department of OB/GYN, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
| | | | | | - Chad Grotegut
- Division of Maternal-Fetal Medicine, Duke University, USA
| | - Barbra M Fisher
- Maternal Fetal Medicine, Northwest Perinatal Centre, Women's Healthcare Associates, LLC, Portland, USA
| | | | - Marie Berg
- Institute of Health Care Science, University of Gothenburg, Gothenburg, Sweden
| | | | - Uma Reddy
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, USA
| | - Jason J S Waugh
- Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | | | - Sonali Kochhar
- Global Healthcare Consulting, India; Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sara Kenyon
- Reader in Evidence Based Maternity Care, Institute for Applied Health Research, University of Birmingham, United Kingdom
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Maaløe N, Housseine N, van Roosmalen J, Bygbjerg IC, Tersbøl BP, Khamis RS, Nielsen BB, Meguid T. Labour management guidelines for a Tanzanian referral hospital: The participatory development process and birth attendants' perceptions. BMC Pregnancy Childbirth 2017; 17:175. [PMID: 28592237 PMCID: PMC5463375 DOI: 10.1186/s12884-017-1360-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While international guidelines for intrapartum care appear to have increased rapidly since 2000, literature suggests that it has only in few instances been matched with reviews of local modifications, use, and impact at the targeted low resource facilities. At a Tanzanian referral hospital, this paper describes the development process of locally achievable, partograph-associated, and peer-reviewed labour management guidelines, and it presents an assessment of professional birth attendants' perceptions. METHODS Part 1: Modification of evidence-based international guidelines through repeated evaluation cycles by local staff and seven external specialists in midwifery/obstetrics. Part 2: Questionnaire evaluation 12 months post-implementation of perceptions and use among professional birth attendants. RESULTS Part 1: After the development process, including three rounds of evaluation by staff and two external peer-review cycles, there were no major concerns with the guidelines internally nor externally. Thereby, international recommendations were condensed to the eight-paged 'PartoMa guidelines ©'. This pocket booklet includes routine assessments, supportive care, and management of common abnormalities in foetal heart rate, labour progress, and maternal condition. It uses colour codes indicating urgency. Compared to international guidelines, reductions were made in frequency of assessments, information load, and ambiguity. Part 2: Response rate of 84% (n = 84). The majority of staff (93%) agreed that the guidelines helped to improve care. They found the guidelines achievable (89%), and the graphics worked well (90%). Doctors more often than nurse-midwives (89% versus 74%) responded to use the guidelines daily. CONCLUSIONS The PartoMa guidelines ensure readily available, locally achievable, and acceptable support for intrapartum surveillance, triage, and management. This is a crucial example of adapting evidence-based international recommendations to local reality. TRIAL REGISTRATION This paper describes the intervention of the PartoMa trial, which is registered on ClinicalTrials.org ( NCT02318420 , 4th November 2014).
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Affiliation(s)
- Nanna Maaløe
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1353 Copenhagen K, Denmark
| | - Natasha Housseine
- Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, the Netherlands
| | - Jos van Roosmalen
- Athena Institute, VU University of Amsterdam, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
| | - Ib Christian Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1353 Copenhagen K, Denmark
| | - Britt Pinkowski Tersbøl
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1353 Copenhagen K, Denmark
| | - Rashid Saleh Khamis
- Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - Birgitte Bruun Nielsen
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Tarek Meguid
- Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania
- School of Health & Medical Sciences, State University of Zanzibar, P.O.Box:146, Zanzibar, Tanzania
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Abstract
BACKGROUND Some clinicians believe that routine episiotomy, a surgical cut of the vagina and perineum, will prevent serious tears during childbirth. On the other hand, an episiotomy guarantees perineal trauma and sutures. OBJECTIVES To assess the effects on mother and baby of a policy of selective episiotomy ('only if needed') compared with a policy of routine episiotomy ('part of routine management') for vaginal births. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (14 September 2016) and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing selective versus routine use of episiotomy, irrespective of parity, setting or surgical type of episiotomy. We included trials where either unassisted or assisted vaginal births were intended. Quasi-RCTs, trials using a cross-over design or those published in abstract form only were not eligible for inclusion in this review. DATA COLLECTION AND ANALYSIS Two authors independently screened studies, extracted data, and assessed risk of bias. A third author mediated where there was no clear consensus. We observed good practice for data analysis and interpretation where trialists were review authors. We used fixed-effect models unless heterogeneity precluded this, expressed results as risk ratios (RR) and 95% confidence intervals (CI), and assessed the certainty of the evidence using GRADE. MAIN RESULTS This updated review includes 12 studies (6177 women), 11 in women in labour for whom a vaginal birth was intended, and one in women where an assisted birth was anticipated. Two were trials each with more than 1000 women (Argentina and the UK), and the rest were smaller (from Canada, Germany, Spain, Ireland, Malaysia, Pakistan, Columbia and Saudi Arabia). Eight trials included primiparous women only, and four trials were in both primiparous and multiparous women. For risk of bias, allocation was adequately concealed and reported in nine trials; sequence generation random and adequately reported in three trials; blinding of outcomes adequate and reported in one trial, blinding of participants and personnel reported in one trial.For women where an unassisted vaginal birth was anticipated, a policy of selective episiotomy may result in 30% fewer women experiencing severe perineal/vaginal trauma (RR 0.70, 95% CI 0.52 to 0.94; 5375 women; eight RCTs; low-certainty evidence). We do not know if there is a difference for blood loss at delivery (an average of 27 mL less with selective episiotomy, 95% CI from 75 mL less to 20 mL more; two trials, 336 women, very low-certainty evidence). Both selective and routine episiotomy have little or no effect on infants with Apgar score less than seven at five minutes (four trials, no events; 3908 women, moderate-certainty evidence); and there may be little or no difference in perineal infection (RR 0.90, 95% CI 0.45 to 1.82, three trials, 1467 participants, low-certainty evidence).For pain, we do not know if selective episiotomy compared with routine results in fewer women with moderate or severe perineal pain (measured on a visual analogue scale) at three days postpartum (RR 0.71, 95% CI 0.48 to 1.05, one trial, 165 participants, very low-certainty evidence). There is probably little or no difference for long-term (six months or more) dyspareunia (RR1.14, 95% CI 0.84 to 1.53, three trials, 1107 participants, moderate-certainty evidence); and there may be little or no difference for long-term (six months or more) urinary incontinence (average RR 0.98, 95% CI 0.67 to 1.44, three trials, 1107 participants, low-certainty evidence). One trial reported genital prolapse at three years postpartum. There was no clear difference between the two groups (RR 0.30, 95% CI 0.06 to 1.41; 365 women; one trial, low certainty evidence). Other outcomes relating to long-term effects were not reported (urinary fistula, rectal fistula, and faecal incontinence). Subgroup analyses by parity (primiparae versus multiparae) and by surgical method (midline versus mediolateral episiotomy) did not identify any modifying effects. Pain was not well assessed, and women's preferences were not reported.One trial examined selective episiotomy compared with routine episiotomy in women where an operative vaginal delivery was intended in 175 women, and did not show clear difference on severe perineal trauma between the restrictive and routine use of episiotomy, but the analysis was underpowered. AUTHORS' CONCLUSIONS In women where no instrumental delivery is intended, selective episiotomy policies result in fewer women with severe perineal/vaginal trauma. Other findings, both in the short or long term, provide no clear evidence that selective episiotomy policies results in harm to mother or baby.The review thus demonstrates that believing that routine episiotomy reduces perineal/vaginal trauma is not justified by current evidence. Further research in women where instrumental delivery is intended may help clarify if routine episiotomy is useful in this particular group. These trials should use better, standardised outcome assessment methods.
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Affiliation(s)
- Hong Jiang
- School of Public Health, Fudan UniversityDepartment of Maternal, Child and Adolescent HealthMailbox 175, No. 138 Yi Xue Yuan RoadShanghaiShanghaiChina200032
| | - Xu Qian
- School of Public Health, Fudan UniversityDepartment of Maternal, Child and Adolescent HealthMailbox 175, No. 138 Yi Xue Yuan RoadShanghaiShanghaiChina200032
| | - Guillermo Carroli
- Centro Rosarino de Estudios Perinatales (CREP)Moreno 878 piso 6RosarioSanta FeArgentina2000
| | - Paul Garner
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesPembroke PlaceLiverpoolMerseysideUKL3 5QA
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Yee LM, Sandoval G, Bailit J, Reddy UM, Wapner RJ, Varner MW, Caritis SN, Prasad M, Tita ATN, Saade G, Sorokin Y, Rouse DJ, Blackwell SC, Tolosa JE. Maternal and Neonatal Outcomes With Early Compared With Delayed Pushing Among Nulliparous Women. Obstet Gynecol 2016; 128:1039-1047. [PMID: 27741203 PMCID: PMC5119640 DOI: 10.1097/aog.0000000000001683] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe factors associated with delayed pushing and evaluate the relationship between delayed pushing and perinatal outcomes in nulliparous women with singleton term gestations. METHODS This was a secondary analysis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Assessment of Perinatal Excellence cohort of 115,502 women and their neonates born in 25 U.S. hospitals from 2008 to 2011. Nulliparous women with singleton, cephalic, nonanomalous term births who achieved 10-cm cervical dilation were included. Women in whom pushing was delayed by 60 minutes or greater (delayed group) were compared with those who initiated pushing within 30 minutes (early group). Multivariable regression analyses were used to assess the independent association of delayed pushing with mode of delivery, length of the second stage, and other maternal and perinatal outcomes (significance defined as P<.05). RESULTS Of 21,034 women in the primary analysis sample, pushing was delayed in 18.4% (n=3,870). Women who were older, privately insured, or non-Hispanic white as well as those who had induction or augmentation of labor, diabetes, or epidural analgesia were more likely to have delayed pushing. Delayed pushing was more common when the second stage began during daytime hours or in hospitals with dedicated 24-hour obstetric anesthesia, although differences were small. After adjusting for differences in baseline and labor characteristics including center, women in the delayed group had longer mean durations of the second stage (191 compared with 84 minutes, P<.001) and of active pushing (86 compared with 76 minutes, P<.001). Delayed pushing was associated with greater rates of cesarean delivery (11.2% compared with 5.1%; adjusted odds ratio [OR] 1.86, 95% confidence interval [CI] 1.63-2.12), operative vaginal delivery (adjusted OR 1.26, 95% CI 1.14-1.40), postpartum hemorrhage (adjusted OR 1.43, 95% CI 1.05-1.95), and blood transfusion (adjusted OR 1.51, 95% CI 1.04-2.17). Delayed pushing was not associated with increased odds of adverse neonatal outcomes compared with early pushing. CONCLUSION In this large birth cohort, delayed pushing was associated with longer second stage duration, increased odds of cesarean delivery, and increased odds of postpartum hemorrhage, but was not associated with neonatal morbidity.
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Affiliation(s)
- Lynn M Yee
- Departments of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois; MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio; Columbia University, New York, New York; the University of Utah Health Sciences Center, Salt Lake City, Utah; the University of Pittsburgh, Pittsburgh, Pennsylvania; The Ohio State University, Columbus, Ohio; the University of Alabama at Birmingham, Birmingham, Alabama; Wayne State University, Detroit, Michigan; Brown University, Providence, Rhode Island; the University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas; Oregon Health & Science University, Portland, Oregon; the George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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Buchmann EJ, Stones W, Thomas N. Preventing deaths from complications of labour and delivery. Best Pract Res Clin Obstet Gynaecol 2016; 36:103-115. [PMID: 27427491 DOI: 10.1016/j.bpobgyn.2016.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 05/24/2016] [Accepted: 05/29/2016] [Indexed: 11/17/2022]
Abstract
The process of labour and delivery remains an unnecessary and preventable cause of death of women and babies around the world. Although the rates of maternal and perinatal death are declining, there are large disparities between rich and poor countries, and sub-Saharan Africa has not seen the scale of decline as seen elsewhere. In many areas, maternity services remain sparse and under-equipped, with insufficient and poorly trained staff. Priorities for reducing the mortality burden are provision of safe caesarean section, prevention of sepsis and appropriate care of women in labour in line with the current best practices, appropriately and affordably delivered. A concern is that large-scale recourse to caesarean delivery has its own dangers and may present new dominant causes for maternal mortality. An area of current neglect is newborn care. However, innovative training methods and appropriate technologies offer opportunities for affordable and effective newborn resuscitation and follow-up management in low-income settings.
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Affiliation(s)
- Eckhart J Buchmann
- Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Academic Hospital, PO Bertsham 2013, Johannesburg, South Africa.
| | - William Stones
- School of Medicine, University of St Andrews and College of Medicine, University of Malawi, Fife KY16 9JT, UK.
| | - Niranjan Thomas
- Department of Neonatology, Christian Medical College, Vellore 632004, India.
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Azaïs H, Bauwens J, Servan-Schreiber E, Deruelle P. [Odon device: A revolution in the field of assisted vaginal delivery?]. ACTA ACUST UNITED AC 2015; 44:884-6. [PMID: 26123015 DOI: 10.1016/j.jgyn.2015.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/11/2015] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
Affiliation(s)
- H Azaïs
- Clinique d'obstétrique, université Lille Nord de France, hôpital Jeanne-de-Flandre, 2, avenue Eugene-Aviné, 59000 Lille, France.
| | - J Bauwens
- Clinique d'obstétrique, université Lille Nord de France, hôpital Jeanne-de-Flandre, 2, avenue Eugene-Aviné, 59000 Lille, France
| | - E Servan-Schreiber
- Clinique d'obstétrique, université Lille Nord de France, hôpital Jeanne-de-Flandre, 2, avenue Eugene-Aviné, 59000 Lille, France
| | - P Deruelle
- Clinique d'obstétrique, université Lille Nord de France, hôpital Jeanne-de-Flandre, 2, avenue Eugene-Aviné, 59000 Lille, France
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Kopas ML. A Review of Evidence-Based Practices for Management of the Second Stage of Labor. J Midwifery Womens Health 2014; 59:264-76. [DOI: 10.1111/jmwh.12199] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Labor down or bear down: a strategy to translate second-stage labor evidence to perinatal practice. J Perinat Neonatal Nurs 2014; 28:117-26. [PMID: 24781770 DOI: 10.1097/jpn.0000000000000023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Scientific evidence supports spontaneous physiologic approaches to second-stage labor care; however, most women in US hospitals continue to receive direction from nurses and birth attendants to use prolonged Valsalva bearing-down efforts as soon as the cervix is completely dilated. Delaying maternal bearing-down efforts during second-stage labor until a woman feels an urge to push (laboring down) results in optimal use of maternal energy, has no detrimental maternal effects, and results in improved fetal oxygenation. Although most commonly used with women who are undergoing epidural anesthesia, laboring down is just one component of physiologic second-stage labor care that can be used to achieve optimal maternal and neonatal outcomes for women with or without an epidural. Prior efforts to translate evidence regarding second-stage labor care to practice have not been successful. In this article, the scientific evidence for second-stage labor care and previous efforts at clinical translation are reviewed. The Ottawa Hospital Second Stage Protocol is presented as a model with potential to allow translation of evidence to practice. Recommendations to enhance widespread adoption of evidence-based practice are provided, including improved collaboration between nurses and birth attendants.
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Tessmer-Tuck JA, Arendt KW, Craigo PA. Update on Maternal Mortality in the Developed World. CURRENT ANESTHESIOLOGY REPORTS 2013. [DOI: 10.1007/s40140-013-0031-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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