View on the problem of managing of medical care quality

The Effect of Pethidine Analgesia on Labor Duration and Maternal-Fetal Outcomes

Background and Aim:

Opioid analgesics had been used from time to time for treating labor pain. However, their use have been concerning. The aim of this study is to evaluate the effect of pethidine on duration of active phase of labor, labor pain and maternal-neonatal outcomes.

Methods:

In the present case-control study, the study group received a 50 mg pethidine intramuscular injection upon the start of active phase of labor, and the control group consisted of patients who receive placebo injeciton. In both groups, vital signs were measured before, and at 0, 5, 15, 30, 45 and 60 minutes after the injection. Pain intensity was evaluated with Visual Analogue Scale (VAS) prior to, and 1 hour and 2 hours after injection. Data regarding labor phase durations, maternal side effects, newborn APGAR scores and fetal respiratory problems were recorded.

Results:

102 patients in Pethidine group and 92 patients in control group, were included into the study. Labor pain VAS-scores were significantly lower in the study group (p<0.001). Moreover, active phase of labor duration was significantly shorter in the study group (p<0.001). Maternal pulse significantly decreased, and maternal nausea-vomiting was frequent in the study groups. However, the groups were similar in terms of other side effects and neonatal outcomes.

Conclusions:

Pethidine significantly reduces active phase of labor duration, has a favorable analgesic effect in treating labor pain and is not associated with serious maternal or neonatal complications. It is therefore considered an acceptable agent for use during active phase of labor. (www.actabiomedica.it)

Effectiveness of the educational interventions on improvement of the performance of burning ward nurses

Introduction — Burning is one of the most accidents with a higher rate of morbidity and mortality. The aim of this study was to investigate the status of nursing cares in the burning ward to improve the quality of nursing service following the education. Methods — An after-before intervention-educational audit study was conducted on burning ward nurses in Iran. The data were collected using a researcher-made checklist based on the Ministry of Health standards with “Yes/No” questions. The data were analyzed using SPSS software version.16 through descriptive statistics and Mc-Nemar nonparametric metric test. Results — The population consisted of 20 nurses working in the burning ward of the Sina Hospital in Tabriz/Iran. Presentation of nursing services was good in terms of the primary care (80.5%) and during hospitalization (83.4%); and it was weak in terms of the secondary care (42.5%). A significant improvement was observed following the educational intervention according to the results of the Mc-Nemar test performed before and after intervention (P<0.001). Conclusion — Audit education improved the nursing secondary cares and follow- up care after patients discharge. It is necessary to hold educational workshops for improving the nurses̓ performance in the other fields.

The effect of intravenous fentanyl on pain and duration of the active phase of first stage labor

OBJECTIVES

Opioids are most widely used for pain relief during childbirth. An alternative opioid, fentanyl, has been shown to be a good option for pain management and has fewer side-effects on both mother and fetus. Therefore, the purpose of this study is to determine the effect of fentanyl on pain as well as the duration of the active phase of labor.

METHODS

This clinical trial was conducted on 70 multiparous parturients having labor from May to July 2006 at Tamin Ejtemai Hospital. They were selected by convenience sampling at the beginning of the active phase of labor. The samples were then randomly divided into the case and control groups. The case group received fentanyl 50 micrograms in two doses, one hour apart after being diluted (0 and 60 mins). Vital signs were recorded pre-administration and 5, 15, 30, 45, 60 minutes post-administration. Pain intensity was estimated by visual pain scale (0-10) four times (before and 1, 2, 3 hours after the intervention). Data analysis was done using the student t-test, repeated measure ANOVA and chi-square tests via SPSS 11.5 software.

RESULTS

The results showed a significant reduction in pain (p=0.002) and HR (p=0.001) in the case group. The mean pain score also decreased from 8±1 to 5±1. There was a significant difference in terms of the duration of the active phase between the two groups (p=0.001). However, there were no significant differences in terms of systolic blood pressure and diastolic blood pressure between the two groups.

CONCLUSION

Fentanyl provides good analgesic effect for pain management during labor by considerably reducing the duration of the active phase, and can therefore be used as an acceptable analgesic agent during labor.