Swedish midwives' experiences and views of amniotomy: An interview study

Observation of non-recommended (harmful) intrapartum practices among obstetric care providers in public hospitals in southern Ethiopia, 2023

The majority of developing countries do not follow the WHO's emphasis on replacing harmful and ineffective traditional practices with evidence-based clinical treatment. In these countries, harmful or ineffective practices are routinely used as part of routine care during labor and delivery, while beneficial procedures are not used for the majority of laboring mothers. However, it is critical to use evidence-based practices while giving therapy since they improve care quality, save costs, increase patient and family happiness, and promote professional progress. To assess the magnitude of non-recommended (harmful) intrapartum practices among obstetric care providers in public hospitals in southern Ethiopia, 2023. An institution-based cross-sectional study was conducted from January 30, 2023, to February 30, 2023, in public hospitals in the Gamo and Gofa zones. An observational checklist and a self-administered questionnaire were used to gather data. Using odds ratio of 95% C, bivariate and multivariable logistic regression was used to discover factors related with the outcome variable during data analysis using SPSS version 27. A P-value of less than 0.05 and I were regarded as statistically significant. The magnitude of harmful intrapartum practice was 60.6% (95% CI: 53.25-68.5). Lack of internet access (AOR = 10.1, 95% CI: 4.93-21.1), a few years of work experience (AOR = 6.21, 95% CI: 3.1-12.5), and not being trained on evidence-based intrapartum practices (AOR = 4.01, 95% CI: 1.94-7.95) were statistically significant with harmful intrapartum practices. Evidence-based practice can be improved by promptly providing obstetric care providers with ongoing training and standards for intrapartum care.

Perceptions of healthcare professionals regarding labour induction and augmentation: A qualitative systematic review

BACKGROUND

Labour induction and augmentation procedures are commonly used in maternity units with or without medical indications. Research shows that healthcare professionals play a significant role in women's childbirth decisions.

AIM

To consolidate healthcare professionals' perceptions about labour induction and augmentation.

METHODS

Seven electronic databases were searched from their inception dates till January 2023: PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus, ProQuest Dissertations, and Theses Global. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis and Sandelowski and Barroso's guidelines guided this review. Included studies' quality was appraised by the Critical Appraisal Skills Program tool. Data were thematically synthesised. Review findings were assessed using the Grading of Recommendations Assessment, Development, and Evaluation-Confidence in the Evidence from Reviews of Qualitative research approach.

FINDINGS

Three main themes were identified from the 17 included studies: 1) Making sense of the phenomenon, 2) Two sides of the coin, and 3) The enlightened path ahead.

DISCUSSION

Healthcare professionals' labour induction and augmentation decisions were affected by personal (knowledge and moral philosophies), and external factors (women, community members, colleagues, and healthcare institutions). Some clinicians were unfamiliar with the proper labour induction/augmentation procedures, while others were worried about their decisions and outcomes.

CONCLUSION

Suggestions for improvement include conducting labour induction/augmentation training for clinicians, having sufficient resources in facilities, and developing appropriate labour induction/augmentation clinical guidelines. Women and their partners, community members, and traditional healers could benefit from receiving labour induction/augmentation education. To improve health outcomes, healthcare professionals could deliver woman-centred care and collaborate.

Incidence and risk factors for umbilical cord prolapse in labor when amniotomy is used and with spontaneous rupture of membranes: A Swedish nationwide register study

INTRODUCTION

Umbilical cord prolapse (UCP) is a rare but severe obstetric complication in the presence of a rupture of the membranes. Although it is not possible to prevent a spontaneous rupture of the membranes (SROM), it is possible to prevent an amniotomy, which is a commonly used intervention in labor. This study aimed to explore the incidence and risk factors that are associated with UCP in labor when amniotomy is used vs SROM.

MATERIAL AND METHODS

A retrospective nationwide register study was conducted of all births in Sweden from January 2014 to June 2020 that were included in the Swedish Pregnancy Register (n = 717 336). The main outcome, UCP, was identified in the data by the International Classification of Diseases (ICD-10) diagnosis code O69.0. Multiple binary logistic regression analysis was used to identify the risk factors.

RESULTS

Amniotomy was performed in 230 699 (43.6%) of all pregnancies. A UCP occurred in 293 (0.13%) of these cases. SROM occurred in 298 192 (56.4%) of all cases, of which 352 (0.12%) were complicated by UCP. Risk factors that increased the odds of UCP for both amniotomy and SROM were: higher parity, non-cephalic presentation and an induction of labor. Greater gestational age reduced the odds of UCP. Risk factors associated with only amniotomy were previous cesarean section and the presence of polyhydramnios. Identified risk factors for UCP in labor with SROM were a higher maternal age and maternal origin outside of the EU.

CONCLUSIONS

UCP is a rare complication in Sweden. Beyond confirming the previously recognized risk factors, this study found induction of labor and previous cesarean section to be risk factors in labor when amniotomy is used.

The Correct Indication to Induce Labour in a Swiss Cantonal Hospital

BACKGROUND

Induction of labour (IOL) is a way to stimulate the onset of labour using mechanical and pharmacological methods. IOL is one of the most frequently performed obstetric procedures worldwide. We aimed to determine compliance with guidelines and to investigate factors associated with the success of labour.

METHODS

In this retrospective, observational study, we analysed all induced deliveries in a Swiss hospital between January 2020 and December 2022.

RESULTS

Out of 1705 deliveries, 349 women underwent IOL, and 278 were included in this study, with an average age of 32 years (range 19-44 years). Most of the women were induced for missed deadlines (20.1%), the premature rupture of membranes (16.5%), and gestational diabetes mellitus (9.3%), and there was a good adherence to the guideline, especially with the indication and IOL monitoring (100%). However, an improvement needs to be made in measuring and documenting the Bishop score (41%). The success of labour was associated with multiparity (81.8% vs. 62.4% p = 0.001) and maternal non-obesity (73.4 vs. 54.1% p = 0.026).

CONCLUSIONS

An improvement is needed in the measurement and documentation of the Bishop score. Further research is needed to confirm the found associations between parity, obesity, and the success of IOL.

Prevalence of amniotomy in Sweden: a nationwide register study

BACKGROUND

Amniotomy is a commonly used labor intervention with uncertain evidence, and there are complications connected to the intervention. Yet, the Swedish prevalence of amniotomy is unknown. The aim of the study was therefore to describe the prevalence of amniotomy in Sweden.

METHODS

This nationwide register-based study included 330,913 women giving birth in 2017-2020. Data were collected from the Swedish Pregnancy Register in which the majority of data is collected via direct transfer from medical records. Prevalence of amniotomy was described for all births, for nulliparous and multiparous women with spontaneous onset of labour, and at the hospital level. Descriptive statistics and chi-square test were used to analyse the data.

RESULTS

For all births, the prevalence of amniotomy was 40.6%. More amniotomies were performed in Robson group 1 compared to Robson group 3; 41.1% vs 32.3% (p < 0.001). The prevalence for all births remained the same during the study period; however, a decrease from 37.5 to 34.1%, was seen in Robson group 1 and Robson group 3 (p < 0.001). Variations in the prevalence between hospitals were reported. The hospitals with the fewest number of births annually had the highest prevalence of amniotomy (45.0%), and the lowest prevalence was reported at the University hospitals (40.4%) (p < 0.001).

CONCLUSIONS

Amniotomy is a common labor intervention in Sweden, given that almost half of the laboring women underwent the intervention. Our results, regarding variations in the prevalence between hospitals, could imply a potential for fewer amniotomies in Swedish childbirth care.