Severe Variable Decelerations and Fetal Pulse Oximetry during the Second Stage of Labor

Efficacy of five-element music interventions in perinatal mental health and labor pain: A meta-analysis

OBJECTIVE

To systematically review the efficacy of five-element music interventions in perinatal mental health and labor pain. To provide evidence for future research on Chinese Traditional Music Interventions.

METHODS

An electronically search was conducted in Web of Science, PubMed, EMbase, The Cochrane Library, CNKI databases, WanFang Data and VIP Database for Chinese Technical Periodicals from inception to January 07, 2020 to collect randomized controlled trials (RCTs) on five-element music interventions for prenatal, perinatal and postpartum women. Literature screening, data extraction, and the risk of bias assessment of all eligible studies were conducted by two reviewers independently. Then, meta-analysis was performed by RevMan 5.3 software.

RESULTS

A total of 13 RCTs involving 2387 patients were included. The results of meta-analysis showed that five-element music could significantly improve the depression levels (SMD = -2.03, 95%CI: -2.88 to -1.19, P < 0.00001), anxiety levels (SMD = -3.49, 95%CI: -4.47 to -2.24, P < 0.00001) and severe anxiety rate (OR = 0.42, 95%CI: 0.19 to 0.94, P = 0.04) of perinatal women. Additionally, five-element music produced significant effects on labor pain (MD = -0.67, 95%CI: -0.82 to -0.52, P < 0.00001), labor duration (MD = -0.85, 95%CI: -1.07 to -0.63, P < 0.00001), the hemorrhage 2 h after parturition (MD = -19.55, 95%CI: -35.56 to -3.54, P = 0.02) and the Serum DYN expression level (MD = 1.32, 95%CI: 0.23 to 2.40, P = 0.02).

CONCLUSIONS

Five-element music may be efficacious in improving perinatal women' depression, anxiety, labor pain, labor duration, the hemorrhage 2 h after parturition and the Serum DYN expression level. Because of the limitation of quantity and quality of included studies, more high-quality studies were needed to confirm the above conclusion.

Fetal pulse oximetry during labor: theory, clinical use and the future

Fetal pulse oximetry (FPO) has evolved through various phases of technical development and calibration. Clinical studies have addressed the issue of determining threshold action values and how well the technology is accepted by childbearing women and their caregivers. This article considers a variety of situations and factors that commonly occur during labor and that may influence fetal oximetry values. These include uterine contractions, supplemental oxygen and intravenous fluids administered to the mother, maternal position and epidural analgesia. The five randomized, controlled trials that compared the use of FPO in addition to fetal heart-rate monitoring with fetal heart-rate monitoring alone, have been systematically reviewed and subjected to meta-analysis where appropriate. Current clinical practice guidelines do not support the routine use of FPO; however, the recent emergence of robust multiwavelength oximeters may, in the future, offer further clinical applications for FPO.

Intrapartum oximetry of the fetus

Fetal monitoring during labor aims to identify fetal problems which, if uncorrected, may result in morbidity or death. A nonreassuring or abnormal fetal heart rate trace by cardiotocography (CTG) does not necessarily equate with fetal hypoxia and/or acidosis. However, in the absence of more objective data, the use of CTG often results in variable, but inappropriately high, operative delivery rates (forceps, vacuum, or cesarean delivery) for nonreassuring fetal status in many hospitals. The addition of fetal pulse oximetry (FPO) has the potential to improve the assessment of fetal well-being during labor. In this review we consider several aspects of FPO. Several factors, such as sensor to skin contact, uterine contractions, fetal hair, and caput succedaneum, influence the performance and use of FPO. Issues such as clinicians' perspectives of FPO sensor placement, maternal perspectives of FPO during labor, and an economic analysis have all favored FPO. Several randomized controlled trials (RCTs) of FPO reported a reduction in cesarean delivery for nonreassuring fetal status when FPO was added to conventional CTG monitoring, with no difference in overall cesarean delivery rates. One large RCT reported no difference in mode of birth for any indication. Several issues relevant to the future of FPO have been addressed by these RCTs, the major issue being that it makes no difference to cesarean rates. It may be argued that FPO has a valid clinical use in monitoring the fetus with congenital heart block. Additionally, in situations of nonreassuring fetal status and dystocia, FPO may provide the necessary reassurance until adequate resources for cesarean delivery are available.