1
|
Sadler L, Cronin R, Browne E, Harvey A, Hill MG. Obstetrician views on Fetal Pillow® device use and research in Aotearoa New Zealand: A cross-sectional survey. Aust N Z J Obstet Gynaecol 2024. [PMID: 38634663 DOI: 10.1111/ajo.13824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/03/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND There is anecdotal evidence of Fetal Pillow® use, but no formal local information on clinician practices and perspectives. AIMS To assess obstetrician use of the Fetal Pillow®, knowledge of relevant research, and interest in a proposed randomised controlled trial in Aotearoa New Zealand. MATERIALS AND METHODS Anonymous cross-sectional survey of practising obstetricians and obstetric trainees in Aotearoa New Zealand distributed by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. RESULTS Of 136 respondents (69% specialists and 31% trainees), 130 had heard of the Fetal Pillow® device, and 108 had used it at least once (43% more than ten times). The device was available in 17/21 units represented. The 108 users of the device reported this was most commonly on collegial advice (63%) or after personal experience of a difficult delivery (33%) and most (80%) believed it reduced maternal morbidity. Only around one-third of the 130 respondents who had heard of the device agreed there was adequate research demonstrating its efficacy for maternal (36%) and neonatal (30%) morbidity. The majority reported they would change practice in response to a randomised trial, although they were more likely to start use (81% of current non-users) than stop (53% of users). Most (70%) respondents agreed they would encourage patients to participate in a randomised trial. CONCLUSIONS The Fetal Pillow® is available in most maternity units in Aotearoa New Zealand. The majority of obstetric clinicians believe it reduces maternal morbidity, while acknowledging the lack of scientific evidence. Most would support a randomised trial.
Collapse
Affiliation(s)
- Lynn Sadler
- Women's Health, Te Whatu Ora Auckland, Auckland, New Zealand
| | - Robin Cronin
- Te Whatu Ora Counties Manukau, Auckland, New Zealand
| | - Erena Browne
- Women's Health, Te Whatu Ora Auckland, Auckland, New Zealand
| | - Amanda Harvey
- Women's Health, Te Whatu Ora Auckland, Auckland, New Zealand
| | - Meghan G Hill
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| |
Collapse
|
2
|
Adelaiye S, Wanonyi I, Adanikin A, Mairiga A, Kadas A, Morrupa J, Lavin T, Lamara A, Yahaya I, Tukur J, Chama C. Determinants of obstructed labour and associated outcomes in 54 referral hospitals in Nigeria. BJOG 2024. [PMID: 38616567 DOI: 10.1111/1471-0528.17826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/22/2024] [Accepted: 03/24/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To estimate the prevalence of obstructed labour, associated risk factors and outcomes across a network of referral hospitals in Nigeria. DESIGN Retrospective observational study. SETTING A total of 54 referral-level hospitals across the six geopolitical regions of Nigeria. POPULATION Pregnant women who were diagnosed with obstructed labour during childbirth and subsequently underwent an emergency caesarean section between 1 September 2019 and 31 August 2020. METHODS Secondary analysis of routine maternity care data sets. Random-effects multivariable logistic regression was used to ascertain the factors associated with obstructed labour. MAIN OUTCOME MEASURES Risk factors for obstructed labour and related postpartum complications, including intrapartum stillbirth, maternal death, uterine rupture, postpartum haemorrhage and sepsis. RESULTS Obstructed labour was diagnosed in 1186 (1.7%) women. Among these women, 31 (2.6%) cases resulted in maternal death and 199 (16.8%) cases resulted in postpartum complications. Women under 20 years of age (OR 2.03, 95% CI 1.50-2.75), who lacked formal education (OR 1.88, 95% CI 1.55-2.30), were unemployed (OR 1.94, 95% CI 1.57-2.41), were nulliparous (OR 2.11, 95% CI 1.83-2.43), did not receive antenatal care (OR 3.34, 95% CI 2.53-4.41) or received antenatal care in an informal healthcare setting (OR 8.18, 95% CI 4.41-15.14) were more likely to experience obstructed labour. Ineffective referral systems were identified as a major contributor to maternal death. CONCLUSIONS Modifiable factors contributing to the prevalence of obstructed labour and associated adverse outcomes in Nigeria can be addressed through targeted policies and clinical interventions.
Collapse
Affiliation(s)
- Samuel Adelaiye
- Department of Obstetrics and Gynaecology, Federal Medical Centre, Azare, Bauchi State, Nigeria
| | | | - Abiodun Adanikin
- Centre for Healthcare and Communities, Institute of Health and Wellbeing, Coventry University, Coventry, UK
| | - Abdulkarim Mairiga
- University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Abubakar Kadas
- Obstetrics and Gynaecology Department, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Joel Morrupa
- Federal Medical Centre, Yola, Adamawa State, Nigeria
| | - Tina Lavin
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Abubakar Lamara
- Health Information Management Department, Federal Medical Centre, Azare, Bauchi State, Nigeria
| | - Ibrahim Yahaya
- Health Information Management Department, Federal Medical Centre, Azare, Bauchi State, Nigeria
| | - Jamilu Tukur
- Department of Obstetrics and Gynaecology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Calvin Chama
- Obstetrics and Gynaecology Department, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| |
Collapse
|
3
|
MacVicar S, Jordan A, Vu H, Tran HN, Greig Y, Thi Tuyet Nguyen H, Norris G, Martin CR, Hollins Martin CJ. Translation and validation of Vietnamese version of the Birth Satisfaction Scale-Revised (BSS-R). J Reprod Infant Psychol 2024:1-14. [PMID: 38591499 DOI: 10.1080/02646838.2024.2338176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/26/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND The 10-item Birth Satisfaction Scale-Revised (BSS-R) is a quick and easy survey instrument recommended by the International Consortium for Health Outcome Measures as the tool of choice for measuring women's birth satisfaction. AIM To translate and validate a Vietnamese-language version of the BSS-R. METHOD A quantitative cross-sectional method was used to gather data post translation and back-translation of a Vietnamese version of the BSS-R (VN-BSS-R). Data collected were psychometrically evaluated using key indices of validity and reliability. PARTICIPANTS Vietnamese women who were within one month postpartum of birth (N = 383) took part in the study. RESULTS Findings illustrate that a two-factor model offered excellent psychometric properties. With the two-factor VN-BSS-R, five items loaded onto a subscale 'Positive birth experiences' and the other five onto a second subscale 'Negative birth experiences'. This two-factor model offered a fit to data (root mean square error of approximation [RMSEA] = 0.07, 90% confidence interval [CI] [0.05, 0.09], root square mean residual [RMSE] = 0.04 and comparative fit index [CFI] = 0.97). Mean scores for the exploratory factor analysis [EFA]-derived 'positive' and 'negative' sub-scales were 17.12 (SD 2.34) and 8.40 (SD 4.18) respectively. CONCLUSION The translated and validated VN-BSS-R is a psychometrically robust tool for measuring birth satisfaction in Vietnamese postpartum women.The VN-BSS-R is available for use to measure experiences and perceptions of intrapartum care received by Vietnamese women.
Collapse
Affiliation(s)
- Sonya MacVicar
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | | | - Hien Vu
- Head of Social Work department, Phu San Hanoi Hospital, Hanoi, Vietnam
| | - Hai Ngoc Tran
- Specialist medicine, Tu Du hospital, Ho Chi Minh, Vietnam
| | - Yvonne Greig
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | | | - Gail Norris
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Colin R Martin
- Institute for Health and Wellbeing, University of Suffolk, UK
| | | |
Collapse
|
4
|
Warland J, Pollock D, Collier A, Horey D, Boyle F. Parents' descriptions of labouring with an antepartum fetal death: Findings from the Birthing in Grief study. Aust N Z J Obstet Gynaecol 2024; 64:133-140. [PMID: 37833833 DOI: 10.1111/ajo.13759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Evidence to guide intrapartum care when an unborn baby has died is limited. AIMS To explore parents' experiences of care during labour of an antepartum stillbirth. MATERIALS AND METHODS Semi-structured interviews with 18 bereaved parents from across Australia. Content analysis was conducted. FINDINGS Two broad themes were identified: 'explaining every step' and 'helping us feel like parents.' Sub-themes under the first broad theme, 'explaining every step', were 'how and when information was given' and 'what happens next.' 'Like any other parent', 'feeling the pain' and 'everything is clouded' were sub-themes of the second broad theme. These findings mapped to current Australian clinical practice guidelines for bereavement care around stillbirth and neonatal death, ie good communication, recognition of parenthood, shared decision making and effective support. CONCLUSIONS This study on parents' experiences of labour with a fetal death in utero brings an important perspective to intrapartum care for this group. As far as we are aware, this study is the first to focus solely on this aspect of care. Our findings could be readily mapped to the four perinatal bereavement care goals. Parents wanted care providers to facilitate their choices, their sense of control, their autonomy and their agency. They wanted to feel that they had received the 'best' care available.
Collapse
Affiliation(s)
- Jane Warland
- UniSA Clinical and Health Sciences, UniSA, Adelaide, South Australia, Australia
| | - Danielle Pollock
- Evidence-Based Healthcare Research Division, JBI, Adelaide, South Australia, Australia
| | | | - Dell Horey
- Faculty of Science Agriculture Business and Law, University of New England, Armidale, New South Wales, Australia
| | - Frances Boyle
- Institute for Social Science Research, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
5
|
Christoffersen OB, Møller AM, Moestrup LV, Wildgaard K. Parturients feel capable of giving informed consent for epidural analgesia: A qualitative and quantitative analysis. Acta Anaesthesiol Scand 2024; 68:538-545. [PMID: 38151759 DOI: 10.1111/aas.14370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/29/2023] [Accepted: 12/03/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION The patient's right to autonomy confirmed by informed consent is a cornerstone in modern medicine. Epidural analgesia is increasingly popular in obstetric analgesia, but physicians disagree whether labour pain impairs parturient decision-making. We investigated the fraction of parturients feeling capable of giving informed consent including their knowledge of risks. METHODS Bedside survey postpartum women at the Herlev Hospital, Denmark. The inclusion criteria were recipient of epidural analgesia during labour. A power calculation based on the recognition of genuine and false side effects required the inclusion of 50 participants. RESULTS Forty out of fifty (80%) of the participants felt they could make a judicious consent during labour and 46 out of 50 (92%) felt they knew enough about epidural analgesia to give consent to the procedure again if necessary. Participants spontaneously reported a median of two risks associated with epidural analgesia. Additionally, when prompted with a cued list of true and false risks from epidural analgesia, the participants reported on average 5.1 genuine risks compared with 0.4 made-up risks. The difference (4.7) suggests the included women could discern genuine risks from made-up risks. DISCUSSION The majority of participants reported the capacity to give informed consent. Our quantitative results show the participants could clearly distinguish genuine risks of epidural labour analgesia from made-up risks. Our qualitative data likewise suggest that participants understood the information and consequently their informed consent was genuine. Accordingly, parturients are able to give informed consent. This is supported by parturients' ability to identify risks from epidural labour analgesia.
Collapse
Affiliation(s)
- Oliver Bastian Christoffersen
- Herlev Anaesthesia Critical and Emergency Care Science Unit, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Ann Merete Møller
- Herlev Anaesthesia Critical and Emergency Care Science Unit, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Laerke Vinberg Moestrup
- Department of Obstetrics and Gynecology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Kim Wildgaard
- Herlev Anaesthesia Critical and Emergency Care Science Unit, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| |
Collapse
|
6
|
Rahman RA, Mohammed Nawi A, Ishak S, Balaraman K, Abu MA, Abd Azman SH, Kalok AH, Mohamed Ismail NA, Mahdy ZA, Ahmad S. Second twin outcome at birth: retrospective analysis in a single tertiary centre in Malaysia. J Perinat Med 2024; 0:jpm-2023-0449. [PMID: 38511669 DOI: 10.1515/jpm-2023-0449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/15/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVES To investigate factors associated with outcome of second twin during labour. METHODS The study was a retrospective cohort study in a single tertiary centre in Malaysia from 2014 until 2018 involving all twin pregnancies delivered at or more than 24 weeks of gestation. RESULTS Total of 409 twin pregnancies were included. Dichorionic twin comprises of 54.5 % (n=223) and 45.5 % (n=186) are monochorionic. Women with dichorionic pregnancies are significantly older (p<0.001), have more pre-existing medical disorders (p=0.011) and fetal structural anomalies (p=0.009). Monochorionic pregnancies are significantly more amongst Malay (p=0.01) and conceived spontaneously (p<0.001). There are significantly more fetuses both in cephalic presentation (p=0.026), birthweight discrepancy more than 20 % (p=0.038) and shorter mean inter-twin delivery duration (p=0.048) in monochorionic pregnancies. Second twin delivered with Apgar score <7 is significantly more in dichorionic pregnancies (p=0.006). The second twin is associated with lower birthweight, small for gestational age and arterial cord pH<7.25. Within the group of women who delivered both fetuses vaginally, there was significantly more second twins with intertwin delivery duration less than 30 min who were delivered vaginally without instrumentation (p=0.018). There was significantly more second twin with intertwin delivery duration of 30 min and more with arterial cord pH<7.25 (p=0.045). Those who delivered spontaneously had inter-twin delivery duration within 15-29 min. The outcome of second twin is not influenced by type of twin, gestational age at delivery, inter-twin delivery duration, mode of delivery and presentation at birth. CONCLUSIONS The neonatal outcome for the second twin at birth is not influenced by type of twin, gestational age at delivery, inter-twin delivery duration, mode of delivery and presentation at birth in a cohort managed with non-active management of the second twin in Malaysia.
Collapse
Affiliation(s)
- Rahana Abd Rahman
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Azmawati Mohammed Nawi
- Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Shareena Ishak
- Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Kartik Balaraman
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Mohamad Azrai Abu
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Siti Hajar Abd Azman
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Aida Hani Kalok
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Nor Azlin Mohamed Ismail
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Zaleha Abdullah Mahdy
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Shuhaila Ahmad
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
| |
Collapse
|
7
|
Riley J, Mason-Wilkes W. Dark citizen science. Public Underst Sci 2024; 33:142-157. [PMID: 37861108 PMCID: PMC10832315 DOI: 10.1177/09636625231203470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Citizen science is often celebrated. We interrogate this position through exploration of socio-technoscientific phenomena that mirror citizen science yet are disaligned with its ideals. We term this 'Dark Citizen Science'. We identify five conceptual dimensions of citizen science - purpose, process, perceptibility, power and public effect. Dark citizen science mirrors traditional citizen science in purpose and process but diverges in perceptibility, power and public effect. We compare two Internet-based categorisation processes, Citizen Science project Galaxy Zoo and Dark Citizen Science project Google's reCAPTCHA. We highlight that the reader has, likely unknowingly, provided unpaid technoscientific labour to Google. We apply insights from our analysis of dark citizen science to traditional citizen science. Linking citizen science as practice and normative democratic ideal ignores how some science-citizen configurations actively pit practice against ideal. Further, failure to fully consider the implications of citizen science for science and society allows exploitative elements of citizen science to evade the sociological gaze.
Collapse
|
8
|
Ergin A, Aşci Ö, Bal MD, Öztürk GG, Karaçam Z. The use of hydrotherapy in the first stage of labour: A systematic review and meta-analysis. Int J Nurs Pract 2024; 30:e13192. [PMID: 37632390 DOI: 10.1111/ijn.13192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 06/14/2023] [Accepted: 07/31/2023] [Indexed: 08/28/2023]
Abstract
AIM To explore the effect of hydrotherapy applied in the first stage of labour on the health of mother and newborn. METHODS This systematic review and meta-analysis was carried out by following PRISMA. The studies were obtained by scanning EBSCO, PubMed, Science Direct, Ovid, Web of Science and Scopus electronic databases. Twenty studies published between 2013 and 2023 were included. RESULTS The total sample size of the studies was 8254 (hydrotherapy: 2953, control: 5301). Meta-analyses showed that the perception of pain decreased, comfort level and vaginal birth rate were higher and assisted vaginal birth rate and APGAR scores in the first minute were lower in women who underwent hydrotherapy. There was no difference between groups in terms of the duration of the first and second stage of labour, episiotomy, perineal trauma, intrapartum and postpartum bleeding amounts, use of pain medication and labour augmentations, APGAR scores in the fifth minute, positive neonatal bacterial culture and neonatal intensive care unit need. CONCLUSION This study revealed that the results that hydrotherapy decreased the perception of pain and assisted birth, increased the rate of vaginal birth and comfort level and did not adversely affect the health of the mother and baby during the birth process.
Collapse
Affiliation(s)
- Ayla Ergin
- Division of Midwifery, Faculty of Health Sciences, Kocaeli University, Kocaeli, Turkey
| | - Özlem Aşci
- Division of Midwifery, Niğde Zübeyde Hanım School of Health, Niğde Ömer Halisdemir University, Niğde, Turkey
| | - Meltem Demirgöz Bal
- Division of Midwifery, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
| | - Gizem Güneş Öztürk
- Division of Midwifery, Faculty of Health Sciences, Aydın Adnan Menderes University, Aydın, Turkey
| | - Zekiye Karaçam
- Division of Midwifery, Faculty of Health Sciences, Aydın Adnan Menderes University, Aydın, Turkey
| |
Collapse
|
9
|
Yuan J, Jin A, Shen J, Chen Y, Huang Q, Xiang H. Maternal intrapartum fever during epidural labour analgesia: Incidence and influencing factors. Int J Nurs Pract 2024; 30:e13188. [PMID: 37667558 DOI: 10.1111/ijn.13188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 07/14/2023] [Accepted: 07/28/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND The management and nursing care of women's temperature during delivery is an important part of clinical obstetrics. We aimed to evaluate maternal intrapartum fever during epidural labour analgesia to provide evidence for the management and care of women in labour. METHODS This study was conducted and reported according to the STROBE statement. Women in labour undergoing epidural labour analgesia in our hospital from 1 January 2021 to 31 August 2022 were retrospectively selected. The characteristics of women in labour with and without intrapartum fever were compared. Pearson correlation and logistic regression analysis were used to analyse the influencing factors of postpartum fever. RESULTS A total of 196 women in labour were included, the incidence of maternal intrapartum fever in women in labour undergoing epidural analgesia was 27.5%. Pearson correlation analyses showed that BMI, oxytocin use, labour duration, number of vaginal examinations, time from rupture of the foetal membranes to the end of labour and duration of epidural analgesia were all correlated with the occurrence of intrapartum fever (all P < 0.05). Logistic regression analyses indicated that body mass index ≥28 kg/m2 (OR = 1.825), oxytocin use (OR = 2.082), labour duration ≥9.2 h (OR = 2.613), number of vaginal examinations ≥8 (OR = 2.044-3.115), the time from rupture of the foetal membranes to the end of labour ≥250 min (OR = 2.766) and duration of epidural analgesia ≥300 min (OR = 3.106) were risk factors for intrapartum fever in women in labour undergoing epidural analgesia (all P < 0.05). CONCLUSIONS Maternal intrapartum fever in women in labour undergoing epidural analgesia is common and influenced by many factors. Nurses should take early preventive care measures according to these factors during epidural analgesia in labour.
Collapse
Affiliation(s)
- Jinhua Yuan
- Delivery room, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Aiying Jin
- Delivery room, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jie Shen
- Delivery room, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Youguo Chen
- Delivery room, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Qin Huang
- Delivery room, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Haiyan Xiang
- Delivery room, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| |
Collapse
|
10
|
Mabasa SKM, Matsipane MJ, Useh U. Utilisation of partogram at a district in the North West Province, South Africa. Health SA 2024; 29:2175. [PMID: 38322369 PMCID: PMC10839218 DOI: 10.4102/hsag.v29i0.2175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/24/2023] [Indexed: 02/08/2024] Open
Abstract
Background The partogram or partograph is a tool used to monitor the progress of labour and serves as a diagnostic tool for labour-related abnormalities such as prolonged labour, cephalopelvic disproportion (CPD) and obstructed labour. Appropriate utilisation of the partogram aids health caregivers with early diagnosis and facilitates clinical judgement and interventions to prevent complications of abnormal labour. The partogram is thus a mandatory tool to be utilised to monitor the progress of labour for intrapartum care in South Africa. Aim This study aimed to assess and describe the utilisation of the partogram in a district of the North West Province. Setting The study was conducted in the private rooms of facilities rendering maternity services in the district. Methods A quantitative cross-sectional descriptive design was employed. A purposive sampling was used to select healthcare facilities, and simple random sampling was employed to select plotted partograms. Data were collected using a checklist and analysed using Statistical Package for Social Sciences software version 22. Results A total of 279 partograms were analysed. The average partogram utilisation was 20% correct and 80% substandard or not recorded. All files had partogram documents included. Conclusion A large percentage (80%) of the partograms were not completed according to the World Health Organization (WHO) standards. There was a concern about high proportions of unrecorded parameters such as monitoring of foetal and maternal conditions, and the progress of labour. Contribution The findings and recommendations of the study could improve partogram utilisation in maternity care.
Collapse
Affiliation(s)
- Suzan K M Mabasa
- Department of Nursing Science, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Nursing Science, Faculty of Health Sciences, North-West University, Mafikeng, South Africa
| | - Molekodi J Matsipane
- Department of Nursing Science, Faculty of Health Sciences, North-West University, Mafikeng, South Africa
| | - Ushotanefe Useh
- Department of Lifestyle Diseases, Faculty of Health Sciences, North-West University, Mafikeng, South Africa
| |
Collapse
|
11
|
Hamshaw I, Straube A, Stark R, Baxter L, Alam MT, Wever WJ, Yin J, Yue Y, Pinton P, Sen A, Ferguson GD, Blanks AM. PGF 2α induces a pro- labour phenotypical switch in human myometrial cells that can be inhibited with PGF 2α receptor antagonists. Front Pharmacol 2023; 14:1285779. [PMID: 38155905 PMCID: PMC10752971 DOI: 10.3389/fphar.2023.1285779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/21/2023] [Indexed: 12/30/2023] Open
Abstract
Preterm birth is the leading cause of infant morbidity and mortality. There has been an interest in developing prostaglandin F2α (PGF2α) antagonists as a new treatment for preterm birth, although much of the rationale for their use is based on studies in rodents where PGF2α initiates labour by regressing the corpus luteum and reducing systemic progesterone concentrations. How PGF2α antagonism would act in humans who do not have a fall in systemic progesterone remains unclear. One possibility, in addition to an acute stimulation of contractions, is a direct alteration of the myometrial smooth muscle cell state towards a pro-labour phenotype. In this study, we developed an immortalised myometrial cell line, MYLA, derived from myometrial tissue obtained from a pregnant, non-labouring patient, as well as a novel class of PGF2α receptor (FP) antagonist. We verified the functionality of the cell line by stimulation with PGF2α, resulting in Gαq-specific coupling and Ca2+ release, which were inhibited by FP antagonism. Compared to four published FP receptor antagonists, the novel FP antagonist N582707 was the most potent compound [Fmax 7.67 ± 0.63 (IC50 21.26 nM), AUC 7.30 ± 0.32 (IC50 50.43 nM), and frequency of Ca2+ oscillations 7.66 ± 0.41 (IC50 22.15 nM)]. RNA-sequencing of the MYLA cell line at 1, 3, 6, 12, 24, and 48 h post PGF2α treatment revealed a transforming phenotype from a fibroblastic to smooth muscle mRNA profile. PGF2α treatment increased the expression of MYLK, CALD1, and CNN1 as well as the pro-labour genes OXTR, IL6, and IL11, which were inhibited by FP antagonism. Concomitant with the inhibition of a smooth muscle, pro-labour transition, FP antagonism increased the expression of the fibroblast marker genes DCN, FBLN1, and PDGFRA. Our findings suggest that in addition to the well-described acute contractile effect, PGF2α transforms myometrial smooth muscle cells from a myofibroblast to a smooth muscle, pro-labour-like state and that the novel compound N582707 has the potential for prophylactic use in preterm labour management beyond its use as an acute tocolytic drug.
Collapse
Affiliation(s)
- Isabel Hamshaw
- Clinical Science Research Laboratories, Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Anne Straube
- Centre for Mechanochemical Cell Biology, Division of Biomedical Sciences, University of Warwick, Coventry, United Kingdom
| | - Richard Stark
- Bioinformatics RTP, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Laura Baxter
- Bioinformatics RTP, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Mohammad T. Alam
- Bioinformatics RTP, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | | | - Jun Yin
- Ferring Research Institute Inc., San Diego, United Kingdom
| | - Yong Yue
- Ferring Research Institute Inc., San Diego, United Kingdom
| | - Philippe Pinton
- Ferring Research Institute Inc., San Diego, United Kingdom
- Ferring Pharmaceuticals, International PharmaScience Center, Kastrup, Denmark
| | - Aritro Sen
- Ferring Research Institute Inc., San Diego, United Kingdom
| | | | - Andrew M. Blanks
- Clinical Science Research Laboratories, Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Centre for Mechanochemical Cell Biology, Division of Biomedical Sciences, University of Warwick, Coventry, United Kingdom
| |
Collapse
|
12
|
Kharivhe M, Maluleke M, Masutha T, Thabathe T, Manyuma D, Lavhelani N, Nemathaga M, Ramovha M, Netshikweta M, Mulaudzi M. The psychosomatic experiences of women who had intrauterine foetal death in rural South Africa. Curationis 2023; 46:e1-e8. [PMID: 38111992 PMCID: PMC10790572 DOI: 10.4102/curationis.v46i1.2279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 06/28/2022] [Accepted: 07/29/2022] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Intrauterine foetal death (IUFD) is a traumatic event leading to substantial grief reactions with a variety of experiences in an expectant woman. After delivery, these experiences have shown to impact the mother's psychological well-being, where she experiences post-traumatic stress, sadness, anxiety and depression. The psychosomatic experiences before labour commenced are not known. OBJECTIVES This study explored the psychosomatic (mind-body connection) experiences of women who had an IUFD before labour commenced in rural areas of Limpopo province, South Africa. METHOD A qualitative approach with an explorative descriptive design was carried out among all 10 consented participants who were selected using a purposive sampling technique. The sample consisted of women who delivered an IUFD as reflected by the hospital register from the selected hospitals. Data were collected at the participants' homes through in-depth individual interviews guided by one open-ended central question as follows, 'Please share with me your experiences of IUFD before you went into labour', and analysed using Tesch's open coding method. RESULTS Two themes reflecting the psychosomatic (mind-body connection) experiences of women who had an IUFD emerged from the analysis. The themes are danger alerts and emotional responses. CONCLUSION This qualitative study revealed that women could relate a lack of or decreased foetal movement as the danger alert or warning sign that the baby was in danger before labour commenced. Upon noticing that something was wrong with the baby, a message was sent to the women's minds, which equally affected and activated their emotional dimensions. An investigation regarding the kind of support needed by women after being informed of an IUFD is recommended.
Collapse
Affiliation(s)
- Martha Kharivhe
- Department of Advance Nursing, Faculty of Health, University of Venda, Thohoyandou.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Jin S, Munro A, George RB. The association between labour epidural analgesia and postpartum depression in primiparous patients: a historical cohort study. Can J Anaesth 2023; 70:1909-1916. [PMID: 37726496 DOI: 10.1007/s12630-023-02568-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/16/2023] [Accepted: 04/05/2023] [Indexed: 09/21/2023] Open
Abstract
PURPOSE Peripartum pain has been associated with postpartum depression (PPD), and labour epidural analgesia (LEA) may be able to modify this risk. The objective of this historical cohort study was to examine the association between LEA and PPD among primiparous patients. METHODS With institutional research ethics board approval, a provincial perinatal database was searched for primiparous patients who delivered a liveborn singleton infant between 2004 and 2018. Those patients who experienced PPD following their first delivery were identified by a history of PPD in the perinatal records of their second pregnancy. We used logistic regression to compute odds ratios (ORs) for the association between LEA and PPD and performed an adjusted analysis to control for confounding variables. RESULTS A total of 35,437 primiparous patients were identified, 67% (n = 23,599) of whom received LEA. In the cohort, 3.7% (n = 1,296) of patients developed PPD. Patients who received LEA had increased odds of developing PPD compared with patients who did not receive LEA (adjusted OR, 1.29; 95% confidence interval [CI], 1.12 to 1.48). In a multivariable regression model, LEA remained a significant predictor for PPD, as did body mass index, pre-existing anxiety, and maternal antidepressant use. CONCLUSION This historical cohort study found an association between LEA and PPD among primiparous patients who subsequently had a second pregnancy in the same province. The findings call into question the hypothesis that LEA decreases the risk for PPD and further illustrates the complexities of PPD.
Collapse
Affiliation(s)
- Sherry Jin
- Department of Anesthesia, Humber River Hospital, Toronto, ON, Canada
- Department of Women's and Obstetric Anesthesia, IWK Health, Halifax, NS, Canada
| | - Allana Munro
- Department of Women's and Obstetric Anesthesia, IWK Health, Halifax, NS, Canada.
- Department of Anesthesia, Pain Management, and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.
| | - Ronald B George
- Department of Anesthesiology and Pain Management, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
14
|
Ayoub N, Rocher L, Talamon C, Mercier FJ, Soued M. Reversible cerebral vasoconstriction syndrome after neostigmine and atropine administration for postdural puncture headache. Br J Anaesth 2023; 131:e183-e185. [PMID: 37802666 DOI: 10.1016/j.bja.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/31/2023] [Accepted: 09/03/2023] [Indexed: 10/08/2023] Open
Affiliation(s)
- Nouhad Ayoub
- Département d'Anesthésie, Université Paris-Saclay, Clamart, France
| | - Laurence Rocher
- Service de Radiologie, Hôpital Antoine Béclère - AP-HP, Université Paris-Saclay, Clamart, France
| | - Céline Talamon
- Service de Neurologie, Hôpital Kremlin Bicêtre - AP-HP, Université Paris-Saclay, Clamart, France
| | | | - Mickaël Soued
- Département d'Anesthésie, Université Paris-Saclay, Clamart, France; Service d'Anesthésie, Clinique Les Martinets, Groupe Ramsay Santé, Rueil-Malmaison, France
| |
Collapse
|
15
|
John S, Alsweiler J, Wise MR. Barriers and enablers to implementing an induction of labour guideline: A clinician survey. Aust N Z J Obstet Gynaecol 2023; 63:768-773. [PMID: 37317622 DOI: 10.1111/ajo.13718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/26/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Clinical guidelines improve outcomes, but poor compliance with recommendations is common. Insight into perceived barriers and enablers to the implementation of guidelines can engage maternity care providers and inform strategies for effective implementation. AIM To identify the perceived barriers and enablers to implementing the 2020 'Induction of Labour [IOL] in Aotearoa New Zealand; a Clinical Practice Guideline.' MATERIALS AND METHODS Electronic anonymous survey of clinical leaders in midwifery, obstetrics, and neonatology in New Zealand, from August to November 2021. Recruitment of participants was initially through provided lists of national clinical leads, followed by chain sampling. RESULTS There were 32 of 89 surveys returned (36%). The most frequently identified enablers were implementation tools such as 'standardised IOL request form' and 'peer review process,' and administrative support and dedicated time. Six maternity hospitals already had peer review in place, whereby IOL requests that did not adhere to guidelines were reviewed by a multidisciplinary group of senior colleagues or peers, with individual feedback to the referring clinician. Attitudes in the form of 'existing systems, routines and culture' was the most frequently identified barrier, followed by external barriers such as 'lack of human resources.' CONCLUSIONS Overall, few barriers were identified to implementing this guideline, and some of the key enablers were already in place. The identified enablers warrant future research to develop and evaluate effectiveness in improving outcomes.
Collapse
Affiliation(s)
- Savesh John
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jane Alsweiler
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michelle R Wise
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
16
|
Hunter AR, Heiderscheit A, Galbally M, Gravina D, Mutwalli H, Himmerich H. The Effects of Music-Based Interventions for Pain and Anxiety Management during Vaginal Labour and Caesarean Delivery: A Systematic Review and Narrative Synthesis of Randomised Controlled Trials. Int J Environ Res Public Health 2023; 20:7120. [PMID: 38063550 PMCID: PMC10706633 DOI: 10.3390/ijerph20237120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/04/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023]
Abstract
Music-based interventions are not physically invasive, they usually have minimal side effects, and they are increasingly being implemented during the birthing process for pain and anxiety relief. The aim of this systematic review is to summarise and evaluate published, randomised controlled trials (RCTs) assessing the effects of music-based interventions for pain and anxiety management during vaginal labour and caesarean delivery. Following the PRISMA guidelines, a systematic search of the literature was conducted using: PsychInfo (Ovid), PubMed, and Web of Science. Studies were included in the review if they were RCTs that assessed the effects of music on pain and anxiety during vaginal and caesarean delivery by human mothers. A narrative synthesis was conducted on 28 identified studies with a total of 2835 participants. Most, but not all, of the included studies assessing music-based interventions resulted in reduced anxiety and pain during vaginal and caesarean delivery. Music as part of a comprehensive treatment strategy, participant-selected music, music coupled with another therapy, and relaxing/instrumental music was specifically useful for reducing light to moderate pain and anxiety. Music-based interventions show promising effects in mitigating pain and anxiety in women during labour. However, the long-term effects of these interventions are unclear.
Collapse
Affiliation(s)
- Amy Rose Hunter
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
- Mental Health Studies Programme, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AB, UK
| | - Annie Heiderscheit
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge CB1 2LZ, UK
| | - Megan Galbally
- School of Clinical Sciences, Department of Psychiatry, Monash University, Clayton, VIC 3168, Australia
| | - Davide Gravina
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
- Department of Clinical and Experimental Medicine, University of Pisa, 56127 Pisa, Italy
| | - Hiba Mutwalli
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
- Department of Clinical Nutrition, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Hubertus Himmerich
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK
| |
Collapse
|
17
|
Awotunde TA, Ani-Amponsah M, Ajala DE, Ojo SA, Adeleke TO, Awotunde OT, Olaolorun AD. Unveiling contextual influences of maternal satisfaction with labour care services in Nigeria: A qualitative inquiry. Afr J Prim Health Care Fam Med 2023; 15:e1-e7. [PMID: 38044891 PMCID: PMC10696893 DOI: 10.4102/phcfm.v15i1.4173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 10/01/2023] [Accepted: 10/01/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND In light of the rising global effort to lower maternal mortality rates, it is crucial for low- and middle-income countries with poor maternal indices to investigate the problem of maternal satisfaction and the key elements that affect it. To this effect, this study explored the experiences of postnatal women in relation to labour services and investigated the factors that contribute to their overall satisfaction. AIM The study set out to explore factors influencing maternal satisfaction with labour care services in Ogbomoso, Oyo State, Nigeria. This study ultimately seeks to advance our understanding of this phenomenon to impact labour care and policy. SETTING The study was conducted among multiparous women who had their antenatal care and delivery in Ogbomoso, Oyo State, Nigeria. METHODS A qualitative study was performed using in-depth interviews among postnatal women. RESULTS The results revealed a number of variables that could affect the women's satisfaction with labour care, including the choice of health facility, healthcare providers, environment of the facility, assurance of privacy, treating patients with dignity, provision of needed amenities and having a well-planned postnatal care assessment. CONCLUSION The study revealed that the costs of care, the skill of the caregiver, the provision of confidential and dignified care, and the availability of supplies all have an impact on maternal satisfaction. Hospital administration should address these issues to enhance the experience of women and labour care services.Contribution: The study's findings provide insights that will inform strategies to improve the quality of care being provided to parturients in Nigeria.
Collapse
|
18
|
Briley AL, Silverio SA, Shennan AH, Tydeman G. Experiences of Impacted Foetal Head: Findings from a Pragmatic Focus Group Study of Mothers and Midwives. Int J Environ Res Public Health 2023; 20:7009. [PMID: 37947566 PMCID: PMC10647298 DOI: 10.3390/ijerph20217009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/29/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION We aimed to explore the lived experiences of caesarean birth complicated by impaction of the foetal head, for mothers and midwives. METHODS A pragmatic, qualitative, focus group study of mixed-participants was conducted, face-to-face. They were postpartum women (n = 4), midwives (n = 4), and a postpartum midwife (n = 1) who had experience of either providing care for impacted foetal head, and/or had experienced it during their own labour, in Fife, United Kingdom. Data were transcribed and were analysed using template analysis. RESULTS Three main themes emerged through analysis: (i) current knowledge of impacted foetal head; (ii) current management of impacted foetal head; and (iii) experiences and outcomes of impacted foetal head. Each theme was made up of various initial codes when data were analysed inductively. Finally, each theme could be overlaid onto the three core principles of the Tydeman Tube: (1) to improve outcomes for mother and baby in the second stage of labour; (2) to reduce the risk of trauma to mother and baby in complicated births; and (3) to increase respectful care for women in labour; thus allowing for a neat analytic template. CONCLUSION A lack of consensus regarding definition, management, and training were highlighted by the midwives. Women anticipated caesarean birth in late labour as straightforward and were therefore unaware of this potential complication. Women and midwives would welcome any new device to facilitate delivery of the impacted foetal head (IFH) as long as it is fully evaluated prior to widespread introduction. Women were not averse to being part of this evaluation process.
Collapse
Affiliation(s)
- Annette L. Briley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia;
| | - Sergio A. Silverio
- Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London, London SE1 1UL, UK;
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Andrew H. Shennan
- Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London, London SE1 1UL, UK;
| | - Graham Tydeman
- Maternity Services, Victoria Hospital, NHS Fife, Kirkcaldy KY2 5AH, UK;
| |
Collapse
|
19
|
Macena de Almeida ME, Mendes SS, Maria de Vasconcelos Oliveira N, Vasconcelos Neto JA, Lopes LG, Moreira Vasconcelos CT. Peanut Ball Utilization Protocols in Women During Labour and Delivery: An Integrative Review. J Obstet Gynaecol Can 2023; 45:102185. [PMID: 37473916 DOI: 10.1016/j.jogc.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE This review aimed to assess the evidence available in the literature about the protocols for using peanut ball (PB) in women during labour and delivery. DATA SOURCES A systematic search was carried out by 2 independent researchers in the PubMed/MedLine, Web of Science, Embase, Cochrane and Scopus databases, and the reference lists were scanned for additional articles. STUDY SELECTION Search terms employed were selected from MeSH (Medical Subject Headings) and DeCS (Descriptors in Health Sciences) and combined in each database: "Pregnant Women" AND "Peanut Ball", "Peanut Ball" AND "Labor, Obstetric", as well as "Peanut Ball" AND "Parturition". There were no limits regarding the publication period or language. Studies that answered the following question were included: What are the protocols for the use of the PB in women during labour and childbirth described in the literature? Secondary studies were excluded. Disagreements were resolved by a third researcher. DATA EXTRACTION The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement guided this review. The authors prepared a standardized data extraction sheet to extract data and used the Mendeley software to organize the analyzed studies. DATA SYNTHESIS Ten studies made up the final sample of this review. Eight articles presented the protocol for using the PB: 2 studies included it after epidural analgesia and removed it at complete cervical dilation and effacement; 4 addressed the frequency of position changes during labour; and 3 reported data on maternal positions that were adopted. Five studies showed lower rates of cesarean delivery, and 2 reported that PB reduces the length of labour. Only 1 article associated the use of PB with the reduction of instrumental deliveries and perineal lacerations. One study showed a positive evaluation of parturients regarding the use of PB. CONCLUSION PB was associated with a reduction in cesarean and instrumental deliveries, and the length of labour. Despite its benefits, there is no standardized protocol for the use of PB, preventing it from predicting outcomes with its use. PROSPERO ID CRD42023392238.
Collapse
Affiliation(s)
| | | | | | | | - Lia Gomes Lopes
- Nursing Department, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | |
Collapse
|
20
|
Kaur K, Vaishali, Dahiya P, Kaur S, Bhardwaj M, Singhal SK. Assessment of airway parameters in obstetric patients and comparing them at different phases in the perinatal period: A prospective observational study. Indian J Anaesth 2023; 67:S268-S273. [PMID: 38187969 PMCID: PMC10768908 DOI: 10.4103/ija.ija_675_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 01/09/2024] Open
Abstract
Background and Aims Airway changes occur in different stages of pregnancy. We aimed to evaluate the changes in the upper airway in obstetric patients during pregnancy, labour and after delivery using multiple airway indices and identify the predictive factors of these changes. Methods This observational study was conducted on 90 parturients aged >20 years, having monofoetal pregnancy. The patient's weight was noted, airway assessment including Mallampati grading (MPG), and thyromental distance (TMD), sternomental distance (SMD), neck circumference (NC) and Wilson's risk score were measured in the second trimester of pregnancy (T0), between 32 and 34 weeks of gestation (T1), at the time of admission for safe confinement, between 38 and 40 weeks of gestation (T2), 2 h after delivery of baby (T3) and, 24 h after delivery (T4). Unpaired t-test and analysis of variance test were applied. Results Changes in mean (standard deviation [SD]) weight, recorded from T0 to T2, were from 56.96 (10.77) to 65.322 (11.49) kg (P = 0.001). A rise of one or two grades in MPG was detected as the pregnancy progressed, and a decrease of one grade was noted after delivery. A significant decrease in mean (SD) TMD was noted from 6.88 (0.65) to 6.36 (0.62) cm from T0 to T2 (P = 0.001). SMD also decreased in a similar manner as TMD. NC increased from T0 to T3 and then decreased at T4 (P = 0.004). Conclusion Following the second trimester of pregnancy, MPG increased by either one or two grades, with a decrease in TMD and SMD and an increase in NC.
Collapse
Affiliation(s)
- Kiranpreet Kaur
- Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Vaishali
- Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Pushpa Dahiya
- Department of Obstetrics and Gynaecology, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Svareen Kaur
- Dr. Baba Saheb Ambedkar Govt. Medical College, Rohini, Delhi, India
| | - Mamta Bhardwaj
- Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Suresh K. Singhal
- Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| |
Collapse
|
21
|
Pearce G, Bell L, Pezaro S, Reinhold E. Childbearing with Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders: A Large International Survey of Outcomes and Complications. Int J Environ Res Public Health 2023; 20:6957. [PMID: 37887695 PMCID: PMC10606623 DOI: 10.3390/ijerph20206957] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/03/2023] [Accepted: 09/15/2023] [Indexed: 10/28/2023]
Abstract
One in 20 births could be affected by hypermobile Ehlers-Danlos syndrome or Hypermobility Spectrum Disorders (hEDS/HSD); however, these are under-diagnosed and lacking research. This study aimed to examine outcomes and complications in people childbearing with hEDS/HSD. A large online international survey was completed by women with experience in childbearing and a diagnosis of hEDS/HSD (N = 947, total pregnancies = 1338). Data were collected on demographics, pregnancy and birth outcomes and complications. Participants reported pregnancies in the UK (N = 771), USA (N = 364), Australia (N = 106), Canada (N = 60), New Zealand (N = 23) and Ireland (N = 14). Incidences were higher in people with hEDS/HSD than typically found in the general population for pre-eclampsia, eclampsia, pre-term rupture of membranes, pre-term birth, antepartum haemorrhage, postpartum haemorrhage, hyperemesis gravidarum, shoulder dystocia, caesarean wound infection, postpartum psychosis, post-traumatic stress disorder, precipitate labour and being born before arrival at place of birth. This potential for increased risk related to maternal and neonatal outcomes and complications highlights the importance of diagnosis and appropriate care considerations for childbearing people with hEDS/HSD. Recommendations include updating healthcare guidance to include awareness of these possible complications and outcomes and including hEDS/HSD in initial screening questionnaires of perinatal care to ensure appropriate consultation and monitoring can take place from the start.
Collapse
Affiliation(s)
- Gemma Pearce
- Research Centre for Healthcare and Communities, Coventry University, Coventry CV1 5FB, UK; (L.B.); (S.P.)
| | - Lauren Bell
- Research Centre for Healthcare and Communities, Coventry University, Coventry CV1 5FB, UK; (L.B.); (S.P.)
- Coventry City Council, Coventry CV1 2GN, UK
| | - Sally Pezaro
- Research Centre for Healthcare and Communities, Coventry University, Coventry CV1 5FB, UK; (L.B.); (S.P.)
| | - Emma Reinhold
- Patient and Public Involvement and Medical Advisor, Coventry University, Coventry CV1 5FB, UK;
| |
Collapse
|
22
|
Bovill H, Podpadec T. What is Currently Understood About the Impact of Sexual Violence Activism for Higher Education Student Sexual Violence Survivors? Trauma Violence Abuse 2023; 24:2227-2242. [PMID: 35544710 PMCID: PMC10486178 DOI: 10.1177/15248380221093691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: This systematic literature review maps the landscape of higher education and student sexual violence survivors who become involved in sexual violence activism. It was undertaken to understand what drives student sexual violence survivors to become activists, the negative and positive impacts of this activism on the students, how higher education institutions might work with sexual violence activists to foster effective prevention and response, and how activism has been negotiated by and within practice, policy and research. Method: A qualitative evidence synthesis methodology was used to identify research which examines drivers to and consequences of sexual violence activism for student activists. Searches across seven databases were conducted using six keywords combined in various ways, with further inclusion criteria of published in English between 2010 and 2020. Searches of grey literature were also carried out. Results: 28 sources met the inclusion criteria. Thematic analysis, conducted in NVivo, resulted in identification of four themes: survival from harm, community, labour in the personal made public and power between activists and institutions. Conclusions/Recommendations/Limitations: Inadequate institutional response was a key driver of student sexual violence activism. Activism had positive and negative impacts on the activists. Recommendations are that activists, institutions, researchers and policy makers work as coalitions to bring about enduring cultural change. Review limitations were the small number of studies in this field; additionally, they were dominated by US and UK perspectives.
Collapse
|
23
|
Olivia BB, Fiona AW, Mary AJ. Perceptions of midwifery students and their lecturers regarding challenges faced by deaf pregnant women in accessing maternity care. Afr J Reprod Health 2023; 27:43-56. [PMID: 37788343 DOI: 10.29063/ajrh2023/v27i9.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Midwives are central to caring for pregnant women in labour, including Deaf women. It is the midwife's responsibility to communicate and establish a relationship with the pregnant woman in labour, despite the accompanying challenges. Explore fourth-year undergraduate Midwifery Students' and their Lecturers' perceptions of the challenges faced by Deaf pregnant women in accessing maternity health care when in labour. A qualitative content analysis approach with purposive sampling allowed for the invitation of Midwifery lecturers (n=2) and Bachelor of Nursing Degree Midwifery students (n=25). Data were collected through four focus group discussions and two individual interviews. Data analysis was guided by Elo and Kyngäs approach and trustworthiness was achieved. Two categories with four subcategories emerged. All pregnant women, inclusive of the often "inaudible" Deaf pregnant woman, are entitled to equitable, accessible, available person-centred maternal health care.
Collapse
Affiliation(s)
- B Baloyi Olivia
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Al Walters Fiona
- School of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Ann Jarvis Mary
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| |
Collapse
|
24
|
Šanjug J, Kuna K, Goldštajn MŠ, Dunkić LF, Carek A, Negovetić Vranić D. Relationship between COMT Gene Polymorphism, Anxiety, and Pain Perception during Labour. J Clin Med 2023; 12:6298. [PMID: 37834942 PMCID: PMC10573766 DOI: 10.3390/jcm12196298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The COMT gene polymorphism is associated with neurological and psychiatric disorders and pain perception. The present study investigates the existence of anxiety and pain perception in relation to the COMT (catechol-O-methyltransferase) gene polymorphism in labouring women (during "natural" childbirth) with or without inhaled analgesia. METHODS A total of 181 women who chose vaginal birth were enrolled in this study. To present the difference in pain perception, the parturients were divided into one group (n = 90) that chose labour analgesia with inhaled nitrous oxide (50% nitrous oxide and 50% oxygen) and one group (n = 91) without analgesia. The blood samples were taken during the pregnancy as a part of routine pregnancy controls in the hospital. The COMT gene polymorphism was detected with the PCR technique. The pain perception of parturients was self-evaluated two times according to the VAS (Visual Analogue Scale), and anxiety as a personality trait was determined with the STAI-T (State Trait Anxiety Inventory). Pain perception as well as anxiety were compared according to COMT genotypes. RESULTS In the 181 pregnant women, there were 40 women (22%) of wild homozygotes (GG) of COMT, 95 women (53%) of mutant heterozygotes (GA), and 46 women (25%) of mutant homozygotes (AA). A negative association of pain perception with the GA (mutant heterozygote) polymorphism of the COMT gene versus the wild-type (GG polymorphism) was observed. The GA polymorphism of the COMT gene was associated with 0.46 units lower pain perception compared to the wild type (GG). The anxiety trait score in group AA was lower than in groups GA and GG. The difference reached statistical significance only when comparing AA versus GA (p > 0.042). Analgesic efficacy of nitrous oxide was noticed in 22% of labouring women who reported moderate pain (VAS score 4-7). CONCLUSIONS The COMT gene polymorphism was associated with pain perception and anxiety among parturients. The COMT gene polymorphism GA was associated with negative pain perception among labouring women. Nitrous oxide showed statistical significance in anxiolytic efficacy during labour in women with mild anxiety as a personality trait. Anxiolytic efficacy of nitrous oxide has shown better efficacy in parturients with the COMT gene polymorphism AA.
Collapse
Affiliation(s)
- Jadranka Šanjug
- Department of Gynaecology and Obstetrics, General Hospital Zabok and War Veterans’ Hospital, Bračak 8, 49210 Zabok, Croatia
| | - Krunoslav Kuna
- Department of Gynaecology and Obstetrics, Sestre Milosrdnice University Hospital Centre, 10000 Zagreb, Croatia;
| | - Marina Šprem Goldštajn
- Department of Obstetrics and Gynecology, Clinical Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Lidija Fumić Dunkić
- Division of Anesthesiology, Intensive Care and Pain Medicine, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia;
| | - Andreja Carek
- Department of Fixed Prosthodontics, School of Dental Medicine, University of Zagreb, Gunduliceva 5, 10000 Zagreb, Croatia
| | - Dubravka Negovetić Vranić
- Department of Pediatric Dentistry, School of Dental Medicine, University of Zagreb, Gunduliceva 5, 10000 Zagreb, Croatia
| |
Collapse
|
25
|
Amathullah AS, Rishard M, Walpita Y. Impacts of disrespectful care and abusive care practices in maternity units and potential interventions to improve the quality of care in low- and middle-income countries: A narrative review. Int J Gynaecol Obstet 2023; 162:847-859. [PMID: 37118934 DOI: 10.1002/ijgo.14811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 04/30/2023]
Abstract
This review article explored the impacts of disrespectful care and abusive care practices and the potential interventions to eliminate those practices. Respectful maternity care is a fundamental right for all women. It ensures that women are able to exercise their rights in maternity care. However, research studies have shown the recent prevalence of poor-quality care for women in maternity units in low- and middle-income countries. The literature on this topic was searched on PubMed, Medline, Google Scholar, Cochrane, Science Direct/ Elsevier, and SCOPUS. A total of 24 qualitative and quantitative research articles were included. Thematic analysis was conducted by using the six steps. Impacts are coded on topics including psychological impacts due to disrespectful and abusive care practices, impact on the care process, normalization of the absence of care, suppression of knowledge regarding the labor process, and poor obstetric outcomes. Interventions are coded on topics including programs for health professionals to improve care, education and empowerment programs targeting the women and community, enacting policies and guidelines regarding disrespectful and abusive care practices and improving the facilities in the healthcare system. The majority of the evidenced-based interventions were multi-component and tailored to the needs of a particular setting. More research evidence is needed to inform the healthcare authorities and policymakers to transform these potential interventions into practice. Future research should clearly document the effectiveness of various combinations of interventions, feasibility, cost-effectiveness, and outcomes.
Collapse
Affiliation(s)
| | - Mohamed Rishard
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Yasaswi Walpita
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| |
Collapse
|
26
|
Landry I, René C, Demontigny F. Family centered nursing practices towards women and their families in the birthing context: A qualitative systematic review. Nurs Open 2023; 10:5937-5949. [PMID: 37306178 PMCID: PMC10416028 DOI: 10.1002/nop2.1880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 02/13/2023] [Accepted: 05/29/2023] [Indexed: 06/13/2023] Open
Abstract
AIM Synthesize qualitative evidence examining how nurses' attitudes, beliefs, and sense of efficacy and the context surrounding birth facilitate or hinder family-centered nursing practice. DESIGN Thematic synthesis of qualitative studies. METHODS A literature search was conducted in CINAHL, MEDLINE, PsycINFO, SCOPUS, SCIENCE DIRECT, REPÈRES, CAIRN, and ÉRUDIT from October 2020 to June 2021. The PRISMA guidelines were followed, and studies were critically appraised using the Critical Appraisal Skills Programme checklist. Data were extracted by two independent reviewers, and Thomas and Harden's qualitative thematic synthesis method was performed for data analysis. RESULTS Thirteen studies were included. Three analytical themes were generated: (1) sharing power: opposing beliefs, (2) feeling a sense of efficacy in fulfilling one's role, and (3) managing a challenging work environment. PATIENT OR PUBLIC CONTRIBUTION Synthesizing nurses' experience is essential to promote implementation of favourable changes for care that is more focused on the needs of families.
Collapse
Affiliation(s)
- Isabelle Landry
- Centre for Studies and Research on Family Intervention (CERIF), Department of Nursing ScienceUniversité du Québec en OutaouaisGatineauQuebecCanada
| | - Caroline René
- Centre for Studies and Research on Family Intervention (CERIF), Department of Nursing ScienceUniversité du Québec en OutaouaisGatineauQuebecCanada
| | - Francine Demontigny
- Centre for Studies and Research on Family Intervention (CERIF), Research Group on Fatherhood, Family and Society, Department of Nursing ScienceUniversité du Québec en OutaouaisGatineauQuebecCanada
| |
Collapse
|
27
|
Mellado-García E, Díaz-Rodríguez L, Cortés-Martín J, Sánchez-García JC, Piqueras-Sola B, Rodríguez-Blanque R. Safety and Effect of the Use of Hydrotherapy during Labour: A Retrospective Observational Study. J Clin Med 2023; 12:5617. [PMID: 37685684 PMCID: PMC10488940 DOI: 10.3390/jcm12175617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/16/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Hydrotherapy is a technique used for pain management during labour, but its safety for both the mother and foetus remains uncertain. OBJECTIVE The main aim of this study is to determine whether the use of hydrotherapy in the first stage of labour is safe for both the mother and newborn. METHODS A retrospective observational study was conducted to collect data from the partogram, maternal and neonatal history. RESULTS A total of 377 women who gave birth at the Costa del Sol Hospital in Malaga between January 2010 and December 2020 were randomly selected. They were divided into a control group (253 women) and an intervention group (124 women) that used hydrotherapy in the first stage of labour. There were no significant differences between the groups in terms of age, history of previous miscarriages, type of delivery, or newborn weight. The results showed that most women who opted for hydrotherapy were nulliparous, and the use of hydrotherapy during labour was safe for both the mother and foetus. There were no significant differences in the variables of maternal arterial hypotension, postpartum haemorrhage, postpartum maternal fever, foetal complications, neonatal admission, 1 and 5 min Apgar scores, umbilical arterial or venous pH, or foetal cardiotocographic recording. However, there was a significant difference (p = 0.005) in the rate of breastfeeding among mothers who opted for hydrotherapy (96% vs. 85.7%). CONCLUSIONS The use of hydrotherapy during the first stage of labour is safe and is associated with increased breastfeeding rates compared to conventional delivery.
Collapse
Affiliation(s)
- Elena Mellado-García
- Research Group CTS-1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (E.M.-G.); (L.D.-R.); (J.C.-M.); (B.P.-S.); (R.R.-B.)
- Costa del Sol Health District, 29640 Fuengirola, Spain
| | - Lourdes Díaz-Rodríguez
- Research Group CTS-1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (E.M.-G.); (L.D.-R.); (J.C.-M.); (B.P.-S.); (R.R.-B.)
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Jonathan Cortés-Martín
- Research Group CTS-1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (E.M.-G.); (L.D.-R.); (J.C.-M.); (B.P.-S.); (R.R.-B.)
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Juan Carlos Sánchez-García
- Research Group CTS-1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (E.M.-G.); (L.D.-R.); (J.C.-M.); (B.P.-S.); (R.R.-B.)
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Beatriz Piqueras-Sola
- Research Group CTS-1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (E.M.-G.); (L.D.-R.); (J.C.-M.); (B.P.-S.); (R.R.-B.)
- Virgen de las Nieves University Hospital, 18014 Granada, Spain
| | - Raquel Rodríguez-Blanque
- Research Group CTS-1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (E.M.-G.); (L.D.-R.); (J.C.-M.); (B.P.-S.); (R.R.-B.)
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
- San Cecilio University Hospital, 18016 Granada, Spain
| |
Collapse
|
28
|
Moon RJ, D’Angelo S, Crozier SR, Curtis EM, Fernandes M, Kermack AJ, Davies JH, Godfrey KM, Bishop NJ, Kennedy SH, Prentice A, Schoenmakers I, Fraser R, Gandhi SV, Inskip HM, Javaid MK, Papageorghiou AT, Cooper C, Harvey NC. Does antenatal cholecalciferol supplementation affect the mode or timing of delivery? Post hoc analyses of the MAVIDOS randomized controlled trial. J Public Health (Oxf) 2023; 45:738-747. [PMID: 36585903 PMCID: PMC10470377 DOI: 10.1093/pubmed/fdac160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/07/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Observational studies relating maternal 25-hydroxyvitamin D status to timing and mode of delivery have reported inconsistent results. We assessed the effect of antenatal cholecalciferol supplementation on the incidence of preterm birth, delivery mode and post-partum haemorrhage (PPH). METHODS MAVIDOS was a randomized, double-blind, placebo-controlled trial of 1000 IU/day cholecalciferol from 14 weeks' gestation until delivery. Gestational age, mode of delivery [categorized as spontaneous vaginal delivery (SVD), instrumental (including forceps and vacuum extraction) or Caesarean section] and PPH (>500 ml estimated blood loss) were determined from medical records. RESULTS A total of 965 women participated in the study until delivery. Gestation at birth and incidence of preterm birth (cholecalciferol 5.7%, placebo 4.5%, P = 0.43) were similar between the two treatment groups. SVD (versus instrumental or Caesarean delivery) was more likely in women randomized to cholecalciferol [Relative Risk (RR) 1.13, 95% confidence interval (CI) 1.02,1.25] due to lower instrumental (RR 0.68, 95%CI 0.51,0.91) but similar risk of Caesarean delivery (RR 0.94, 95%CI 0.74,1.19). PPH was less common in women randomized to cholecalciferol [32.1% compared with placebo (38.1%, P = 0.054) overall], but similar when stratified by delivery mode. CONCLUSIONS Antenatal cholecalciferol supplementation did not alter timing of birth or prevalence of preterm birth but demonstrated a possible effect on the likelihood of SVD.
Collapse
Affiliation(s)
- Rebecca J Moon
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- Paediatric Endocrinology, University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, UK
| | - Stefania D’Angelo
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Sarah R Crozier
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Elizabeth M Curtis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Michelle Fernandes
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Alexandra J Kermack
- Department of Women’s Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Justin H Davies
- Paediatric Endocrinology, University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, UK
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nicholas J Bishop
- Academic Unit of Child Health, Sheffield Children’s Hospital, University of Sheffield, Sheffield, UK
| | - Stephen H Kennedy
- Nuffield Department of Women’s & Reproductive Health, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Ann Prentice
- MRC Epidemiology Unit, University of Cambridge, previously at MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK
| | - Inez Schoenmakers
- Faculty of Medicine and Health Sciences, Department of Medicine, University of East Anglia, Norwich, UK
| | - Robert Fraser
- Department of Obstetrics and Gynaecology, Sheffield Hospitals NHS Trust, University of Sheffield, Sheffield, UK
| | - Saurabh V Gandhi
- Department of Obstetrics and Gynaecology, Sheffield Hospitals NHS Trust, University of Sheffield, Sheffield, UK
| | - Hazel M Inskip
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Muhammad Kassim Javaid
- National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Aris T Papageorghiou
- Nuffield Department of Women’s & Reproductive Health, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
29
|
Tyagi A, Deep S, Salhotra R, Malhotra R, Singla A. Minimum effective dose of oxytocin bolus during the caesarean section for patients at high vs low risk of uterine atony: A non-randomized, dual-arm, dose-finding prospective trial. Indian J Anaesth 2023; 67:690-696. [PMID: 37693025 PMCID: PMC10488585 DOI: 10.4103/ija.ija_760_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 05/28/2023] [Accepted: 06/07/2023] [Indexed: 09/12/2023] Open
Abstract
Background and Aims There are scanty data for oxytocin dose in patients at high risk of uterine atony. We aimed to compare the effective dose (ED) 90 of oxytocin for adequate uterine tone during the caesarean section in patients at high-risk vs low-risk uterine atony. Methods This dose-finding study was undertaken after ethical approval in non-labouring women aged >18 years with pre-defined risk factors for uterine atony (high-risk group) vs those without such factors (low-risk group) (n = 39 each). Starting dose of oxytocin in the first patient of low-risk and high-risk groups was 1 and 3 IU, respectively. Achieving adequate uterine tone at 3 min of oxytocin bolus was designated 'success', while inadequate tone constituted 'failure'. If the response was 'failure', the dose of oxytocin was increased for the next patient by 0.5 or 0.2 IU (high- and low-risk groups, respectively). In case of a successful response, the dose for the next patient was decreased with a probability of 1/9 using the same dosing intervals or otherwise kept unchanged. Results The ED90 (95% CI) of oxytocin bolus was 4.7 (3.3-6.0) IU for the high-risk group and 2.2 (1.3-3.2) IU for the low-risk group (P = 0.044). Oxytocin-associated tachycardia (P = 0.247) and hypotension (P = 0.675) were clinically greater for the high-risk vs low-risk group but statistically similar. Conclusion Non-labouring patients with high-risk factors for uterine atony require a greater dose of initial oxytocin bolus to achieve adequate uterine tone during the caesarean section compared to those without risk factors.
Collapse
Affiliation(s)
- Asha Tyagi
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Sonali Deep
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Rashmi Salhotra
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Rajeev Malhotra
- Biostatistician, Delhi Cancer Registry, Dr. BRAIRCH, All India Institute of Medical Sciences, Delhi, India
| | - Anshuja Singla
- Department of Obstetrics and Gynecology, University College of Medical Sciences and GTB Hospital, Delhi, India
| |
Collapse
|
30
|
Riaposova L, Kim SH, Hanyaloglu AC, Sykes L, MacIntyre DA, Bennett PR, Terzidou V. Prostaglandin F2α requires activation of calcium-dependent signalling to trigger inflammation in human myometrium. Front Endocrinol (Lausanne) 2023; 14:1150125. [PMID: 37547305 PMCID: PMC10400332 DOI: 10.3389/fendo.2023.1150125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/06/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Preterm birth is one of the major causes of neonatal morbidity and mortality across the world. Both term and preterm labour are preceded by inflammatory activation in uterine tissues. This includes increased leukocyte infiltration, and subsequent increase in chemokine and cytokine levels, activation of pro-inflammatory transcription factors as NF-κB and increased prostaglandin synthesis. Prostaglandin F2α (PGF2α) is one of the myometrial activators and stimulators. Methods Here we investigated the role of PGF2α in pro-inflammatory signalling pathways in human myometrial cells isolated from term non-labouring uterine tissue. Primary myometrial cells were treated with G protein inhibitors, calcium chelators and/or PGF2α. Nuclear extracts were analysed by TranSignal cAMP/Calcium Protein/DNA Array. Whole cell protein lysates were analysed by Western blotting. mRNA levels of target genes were analysed by RT-PCR. Results The results show that PGF2α increases inflammation in myometrial cells through increased activation of NF-κB and MAP kinases and increased expression of COX-2. PGF2α was found to activate several calcium/cAMP-dependent transcription factors, such as CREB and C/EBP-β. mRNA levels of NF-κB-regulated cytokines and chemokines were also elevated with PGF2α stimulation. We have shown that the increase in PGF2α-mediated COX-2 expression in myometrial cells requires coupling of the FP receptor to both Gαq and Gαi proteins. Additionally, PGF2α-induced calcium response was also mediated through Gαq and Gαi coupling. Discussion In summary, our findings suggest that PGF2α-induced inflammation in myometrial cells involves activation of several transcription factors - NF-κB, MAP kinases, CREB and C/EBP-β. Our results indicate that the FP receptor signals via Gαq and Gαi coupling in myometrium. This work provides insight into PGF2α pro-inflammatory signalling in term myometrium prior to the onset of labour and suggests that PGF2α signalling pathways could be a potential target for management of preterm labour.
Collapse
Affiliation(s)
- Lucia Riaposova
- Parturition Research Group, Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- The March of Dimes European Prematurity Research Centre at Imperial College London, London, United Kingdom
| | - Sung Hye Kim
- Parturition Research Group, Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- The March of Dimes European Prematurity Research Centre at Imperial College London, London, United Kingdom
| | - Aylin C. Hanyaloglu
- Parturition Research Group, Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Lynne Sykes
- Parturition Research Group, Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- The March of Dimes European Prematurity Research Centre at Imperial College London, London, United Kingdom
- The Parasol Foundation Centre for Women’s Health and Cancer Research, St Mary’s Hospital, Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
| | - David A. MacIntyre
- Parturition Research Group, Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- The March of Dimes European Prematurity Research Centre at Imperial College London, London, United Kingdom
| | - Phillip R. Bennett
- Parturition Research Group, Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- The March of Dimes European Prematurity Research Centre at Imperial College London, London, United Kingdom
| | - Vasso Terzidou
- Parturition Research Group, Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- The March of Dimes European Prematurity Research Centre at Imperial College London, London, United Kingdom
- Department of Obstetrics & Gynaecology, Chelsea and Westminster Hospital National Health Service (NHS) Trust, London, United Kingdom
| |
Collapse
|
31
|
Chilaka VN, Navti O, Opoku A, Okunoye GO, Babarinsa I, Odukoya OA, Bako A, Sulaiman AKP, Mohan M. Managing Labour in Women with COVID-19. J Clin Med 2023; 12:3980. [PMID: 37373674 DOI: 10.3390/jcm12123980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Since first reported in December 2019 in Wuhan, China, COVID-19 caused by Severe Acute Respiratory Syndrome (SARS) Corona virus2 (SARS CoV-2) quickly spread to become a pandemic that has caused significant morbidity and mortality. The rapidity of the spread of the virus and the high mortality at the outset threatened to overwhelm health systems worldwide, and, indeed, this significantly impacted maternal health, especially since there was minimal experience to draw from. Experience with Covid 19 has grown exponentially as the unique needs of pregnant and labouring women with COVID-19 infection have become more evident. Managing COVID-19 parturients requires a multidisciplinary team consisting of anaesthesiologists, obstetricians, neonatologists, nursing staff, critical care staff, infectious disease and infection control experts. There should be a clear policy on triaging patients depending on the severity of their condition and the stage of labour. Those at high risk of respiratory failure should be managed in a tertiary referral centre with facilities for intensive care and assisted respiration. Staff and patients in delivery suites and operating rooms should be protected by enforcing infection protection principles such as offering dedicated rooms and theatres to SARS CoV-2 positive patients and using personal protective equipment. All hospital staff must be trained in infection control measures which should be updated regularly. Breastfeeding and care of the new-born must be part of the healthcare package offered to COVID-19 parturient mothers.
Collapse
Affiliation(s)
- Victor Ngozi Chilaka
- Hamad Medical Corporation Qatar, Doha 3050, Qatar
- Weill Cornell Medicine Doha, Doha P.O. Box 24811, Qatar
| | - Osric Navti
- Hamad Medical Corporation Qatar, Doha 3050, Qatar
- Weill Cornell Medicine Doha, Doha P.O. Box 24811, Qatar
| | - Albert Opoku
- Hamad Medical Corporation Qatar, Doha 3050, Qatar
- Weill Cornell Medicine Doha, Doha P.O. Box 24811, Qatar
| | - Gbemisola O Okunoye
- Weill Cornell Medicine Doha, Doha P.O. Box 24811, Qatar
- Sidra Medicine Qatar, Doha P.O. Box 26999, Qatar
- University of Health & Allied Sciences, Ho, Ghana
| | - Isaac Babarinsa
- Hamad Medical Corporation Qatar, Doha 3050, Qatar
- Qatar University College of Medicine, Doha P.O. Box 2713, Qatar
| | | | - Abdulmalik Bako
- Hamad Medical Corporation Qatar, Doha 3050, Qatar
- Weill Cornell Medicine Doha, Doha P.O. Box 24811, Qatar
- Qatar University College of Medicine, Doha P.O. Box 2713, Qatar
| | | | | |
Collapse
|
32
|
Riga M, Koursoumi E, Kostopanagiotou GG, Matsota P. Unusual Presentation of Pneumocephalus With Late Onset During Labour Epidural Analgesia. Cureus 2023; 15:e39888. [PMID: 37404401 PMCID: PMC10315179 DOI: 10.7759/cureus.39888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 07/06/2023] Open
Abstract
A 36-year-old woman with no significant medical history was in active labour and requested labour analgesia. While the epidural technique was performed at the L4-L5 interspace, using the loss of resistance to air technique (LORA), inadvertent dural puncture occurred. Since the patient reported no headache or discomfort, the same procedure was repeated at the L3-L4 interspace successfully. Loss of resistance was reported at 3 cm and the epidural catheter was advanced uneventfully at 8 cm. Aspiration was negative for blood or cerebrospinal fluid (CSF) and a test dose of 2 ml lidocaine 2% was administered epidurally. Within five minutes the patient exhibited a mild hypotensive episode successfully treated with 2.5 mg ephedrine IV, a sensory blockade up to T6 level, and a motor blockade up to T10 level. Both the woman's and the baby's vital signs remained stable, no further drugs were administered epidurally and labour progressed painlessly and uncomplicated for 90 minutes with subsequent vaginal delivery of a healthy newborn. During the episiotomy incision repair, the patient complained of light dizziness and nausea. Her vital signs and the arterial blood gases (ABGs) ordered were within normal range, but the neurological examination revealed an isolated Babinski on the right foot. The head CT scan requested indicated a considerable quantity of air within the subarachnoid region. The patient was treated conservatively; symptoms showed steady improvement with total resolution on the sixth day, and the woman was discharged. This case reemphasizes the possibility of pneumocephalus, which may, in reality, occur more frequently than is commonly recognized without a CT confirmation.
Collapse
Affiliation(s)
- Maria Riga
- 2nd Department of Anesthesiology, Attikon University Hospital, Athens, GRC
- School of Medicine, National and Kapodistrian University of Athens, Athens, GRC
| | - Evgenia Koursoumi
- 2nd Department of Anesthesiology, Attikon University Hospital, Athens, GRC
| | | | - Paraskevi Matsota
- 2nd Department of Anesthesiology, Attikon University Hospital, Athens, GRC
- School of Medicine, National and Kapodistrian University of Athens, Athens, GRC
| |
Collapse
|
33
|
Akpor OA, Odewade EB, Ojo EF, Ojo TF, Ojo IO. Childbirth expectations and coping strategies of first-time mothers attending a comprehensive health centre in Ekiti State, Nigeria. Afr J Reprod Health 2023; 27:99-107. [PMID: 37694707 DOI: 10.29063/ajrh2023/v27i6s.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Childbirth is a complex life event for every woman. Women will have positive experiences if their expectations are met during childbirth, unmet expectations can result in negative experience. This study assessed the knowledge, expectations and coping strategies used by first time mothers attending a Comprehensive Health Center in Ekiti State. The study adopted a qualitative research design and twenty individual semi-structured interviews were conducted. Purposive sampling technique was used and the sample size was determined by saturation of data. Interviews were analyzed using qualitative thematic content analysis. Findings revealed limited knowledge about labour as majority of the participants had no knowledge of labour signs and process. Also, almost all the women were not familiar with the various methods for relief from discomfort during labour and first-time mothers expect midwives to care for them throughout the labour process. This study emphasized the need for healthcare professionals to provide suitable comprehensive education on the process and signs of labor as well as the various methods of pain relief. Supportive networks should also be provided for women during prenatal clinics. Also, health care professionals should consider the needs of mothers and try as much as possible to provide holistic support.
Collapse
Affiliation(s)
- Oluwaseyi A Akpor
- Faculty of Nursing Sciences, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria
| | - Elizabeth B Odewade
- Faculty of Nursing Sciences, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria
| | - Elizabeth F Ojo
- Faculty of Nursing Sciences, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria
| | - Tolulope F Ojo
- Department of Public Health, College of Medicine and Health Sciences, Afe Babalola University, Ado- Ekiti, Ekiti State, Nigeria
| | - Ibukun O Ojo
- Department of Dental Surgery, Afe Babalola University Multi-System Hospital, Ado-Ekiti, Ekiti State, Nigeria
| |
Collapse
|
34
|
Karkada SR, Noronha JA, Bhat SK, Bhat P, Nayak BS. Effectiveness of antepartum breathing exercises on the outcome of labour: A randomized controlled trial. F1000Res 2023; 11:159. [PMID: 37483553 PMCID: PMC10359740 DOI: 10.12688/f1000research.75960.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 07/25/2023] Open
Abstract
Background Childbirth is a life-transforming intense event to a woman and her family. Even though a variety of non-pharmacological techniques are readily available to alleviate the distress of women in labour, the majority of women are unaware of its benefits. The objective of the study was to explore the impact of a simple non-pharmacological technique i.e., antepartum breathing exercises on maternal outcomes of labour among primigravid women. Methods A single centre prospective, single-blinded, randomized controlled trial was conducted at the antenatal outpatient clinic of a secondary healthcare institution. Eligible primigravid women were randomized into intervention and standard care groups. Both groups received standard obstetrical care. In addition, the intervention group were taught antepartum breathing exercises and were advised to practise daily and also during the active stage of labour. The primary outcome of the trial was the maternal outcome of labour measured in terms of onset of labour, nature of delivery, duration of labour, and need for augmentation of labour. Data was collected using World Health Organization (WHO) partograph, structured observational record on the outcome of labour. Results A total of 98 (70%) primigravid women who practised antepartum breathing exercises had spontaneous onset of labour. The odds of spontaneous onset of labour after randomization in the intervention group was 2.192 times more when compared to standard care at a (95% confidence interval 1.31-3.36, p<.001). Also, the requirement for augmentation of labour was minimal and there was a reduction in the rate of caesarean deliveries ( p <.05) based on the χ2 test. The overall mean duration of labour was less compared to standard care group F(1)= 133.800, p <.001. Conclusion Antepartum breathing exercises during labour can facilitate spontaneous vaginal birth, shorten the duration of labour, and reduce the need for operative interference.
Collapse
Affiliation(s)
- Sushmitha R Karkada
- Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Judith A Noronha
- Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Shashikala K Bhat
- Melaka Manipal Medical College & Dr. TMA Pai Hospital Udupi,, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Parvati Bhat
- Melaka Manipal Medical College & Dr. TMA Pai Hospital Udupi,, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Baby S Nayak
- Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| |
Collapse
|
35
|
Ji K, Chen L, Wang X, Wen B, Yang F, Deng W, Chen Y, Zhang G, Liu H. Integrating single-cell RNA sequencing with spatial transcriptomics reveals an immune landscape of human myometrium during labour. Clin Transl Med 2023; 13:e1234. [PMID: 37095651 PMCID: PMC10126311 DOI: 10.1002/ctm2.1234] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND The transition of the myometrium from a quiescent to a contractile state during labour is known to involve inflammation, which is characterized by the infiltration of immune cells and the secretion of cytokines. However, the specific cellular mechanisms underlying inflammation in the myometrium during human parturition are not yet fully understood. METHODS Through the analysis of transcriptomics, proteomics, and cytokine arrays, the inflammation in the human myometrium during labour was revealed. By performing single-cell RNA sequencing (scRNA-seq) and spatiotemporal transcriptomic (ST) analyses on human myometrium in term in labour (TIL) and term in non-labour (TNL), we established a comprehensive landscape of immune cells, their transcriptional characteristics, distribution, function and intercellular communications during labour. Histological staining, flow cytometry, and western blotting were applied to validate some results from scRNA-seq and ST. RESULTS Our analysis identified immune cell types, including monocytes, neutrophils, T cells, natural killer (NK) cells and B cells, present in the myometrium. TIL myometrium had a higher proportion of monocytes and neutrophils than TNL myometrium. Furthermore, the scRNA-seq analysis showed an increase in M1 macrophages in TIL myometrium. CXCL8 expression was mainly observed in neutrophils and increased in TIL myometrium. CCL3 and CCL4 were principally expressed in M2 macrophages and neutrophils-6, and decreased during labour; XCL1 and XCL2 were specifically expressed in NK cells, and decreased during labour. Analysis of cytokine receptor expression revealed an increase in IL1R2, which primarily expressed in neutrophils. Finally, we visualized the spatial proximity of representative cytokines, contraction-associated genes, and corresponding receptors in ST to demonstrate their location within the myometrium. CONCLUSIONS Our analysis comprehensively revealed changes in immune cells, cytokines, and cytokine receptors during labour. It provided a valuable resource to detect and characterize inflammatory changes, yielding insights into the immune mechanisms underlying labour.
Collapse
Affiliation(s)
- Kaiyuan Ji
- Guangzhou Key Laboratory of Maternal-Fetal Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Lina Chen
- Guangzhou Key Laboratory of Maternal-Fetal Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Xiaodi Wang
- Guangzhou Key Laboratory of Maternal-Fetal Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Bolun Wen
- Guangzhou Key Laboratory of Maternal-Fetal Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Fan Yang
- Guangzhou Key Laboratory of Maternal-Fetal Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Wenfeng Deng
- Guangzhou Key Laboratory of Maternal-Fetal Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yunshan Chen
- Guangzhou Key Laboratory of Maternal-Fetal Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Guozheng Zhang
- Guangzhou Key Laboratory of Maternal-Fetal Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huishu Liu
- Guangzhou Key Laboratory of Maternal-Fetal Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
| |
Collapse
|
36
|
Abstract
The arts and creative industries are among those most affected by government measures to contain the Covid-19 pandemic. This article discusses a qualitative survey study, open between August and October 2020, with creative arts workers living in Victoria, Australia. The study explored experiences of disruptions to work and broader impacts on daily lives during the pandemic. In this article, we examine how participants discuss their work and circulate pre-existing and create new intensified social imaginaries of a devalued and ignored arts sector in Australia. Our analysis points to how people understand their lives, work and communities amidst a global pandemic in relation to and entangled with particular social imaginaries of the creative arts.
Collapse
Affiliation(s)
- Jacinthe Flore
- Jacinthe Flore, Social and Global Studies
Centre, School of Global, Urban and Social Studies, RMIT University, GPO Box
2476, Melbourne, VIC 3001, Australia.
| | | | - Averyl Gaylor
- RMIT University, Australia
- La Trobe University, Australia
| |
Collapse
|
37
|
Berg P, Granfors M, Riese C, Mantel Ä. Clinical characteristics and predictors of neonatal outcomes in chorioamnionitis at term gestation: A cohort study. BJOG 2023. [PMID: 36808424 DOI: 10.1111/1471-0528.17433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVE To investigate the association between clinical and laboratory characteristics of chorioamnionitis in deliveries at term gestation with adverse neonatal outcomes. DESIGN Retrospective cohort study. SETTING The study is based on data from the Swedish Pregnancy Register, enriched with clinical data extracted from medical charts. SAMPLE A cohort of 500 term singleton deliveries in Stockholm County with registered diagnosis of chorioamnionitis (based on the assessment of the responsible obstetrician) in the Swedish Pregnancy Register between 2014 and 2020. METHODS Logistic regression was used to estimate odds ratios (ORs) as a measurement of the association between clinical and laboratory characteristics and neonatal complications. MAIN OUTCOME MEASURES Neonatal infection and asphyxia-related complications. RESULTS The prevalence of neonatal infection and asphyxia-related complications was 10% and 22%, respectively. First leukocyte count in the second tertile (OR 2.14, 95% CI 1.02-4.49), maximum C-reactive protein (CRP) level in the third tertile (OR 4.01, 95% Cl 1.66-9.68) and positive cervical culture (OR 2.22, 95% Cl 1.10-4.48) were associated with an increased risk of neonatal infection. Maximum level of CRP in the third tertile (OR 1.93, 95% Cl 1.09-3.41) and fetal tachycardia (OR 1.63, 95% Cl 1.01-2.65) were associated with an increased risk of asphyxia-related complications. CONCLUSIONS Elevated inflammatory laboratory markers were associated with both neonatal infection and asphyxia-related complications, and fetal tachycardia was associated with asphyxia-related complications. Based on these findings, the incorporation of maternal CRP in the management of chorioamnionitis should be considered, and a continuous communication between obstetric and neonatal care extending past the delivery time point endorsed.
Collapse
Affiliation(s)
| | - Michaela Granfors
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.,Department of Women's Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotta Riese
- Department of Women's Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - Ängla Mantel
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.,Department of Women's Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
38
|
Bruce BR, Leask J, De Vries BS, Shepherd HL. Midwives' perspectives of intravenous fluid management and fluid balance documentation in labour: A qualitative reflexive thematic analysis study. J Adv Nurs 2023; 79:749-761. [PMID: 36443887 PMCID: PMC10099802 DOI: 10.1111/jan.15518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 10/29/2022] [Accepted: 11/15/2022] [Indexed: 12/02/2022]
Abstract
AIM To describe current practice, examine the influences and explore barriers and facilitators to accurate documentation, for the administration of intravenous fluids during labour. DESIGN A descriptive qualitative study was performed. METHODS Qualitative semi-structured interviews were conducted with Registered Midwives working across Australia. Midwives were recruited via email and social media advertisements. A maximum variation sampling strategy was used to identify potential participants. Interview questions explored four main areas: (i) understanding of indications for IV fluids in labour; (ii) identification of current practice; (iii) barriers to documentation and (iv) benefits and complications of IV fluid administration. Reflexive thematic analysis of recorded-transcribed interviews was conducted. RESULTS Eleven midwives were interviewed. Clinical practice variation across Australia was recognized. Midwives reported a potential risk of harm for women and babies and a current lack of evidence, education and clinical guidance contributing to uncertainty around the use of IV fluids in labour. Overall, eight major themes were identified: (i) A variable clinical practice; (ii) Triggers and habits; (iii) Workplace and professional culture; (iv) Foundational knowledge; (v) Perception of risk; (vi) Professional standards and regulations; (vii) The importance of monitoring maternal fluid balance and (viii) barriers and facilitators to fluid balance documentation. CONCLUSION There was widespread clinical variation identified and midwives reported a potential risk of harm. The major themes identified will inform future quantitative research examining the impact of IV fluids in labour. IMPACT The implications of this research are important and potentially far-reaching. The administration of IV fluids to women in labour is a common clinical intervention. However, there is limited evidence available to guide practice. This study highlights the need for greater education and evidence examining maternal and neonatal outcomes to provide improved clinical guidance.
Collapse
Affiliation(s)
- Belinda R Bruce
- The University of Sydney Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Julie Leask
- The University of Sydney Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Bradley S De Vries
- The National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia.,Sydney Institute for Women, Children and their Families, RPA Women and Babies, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Heather L Shepherd
- The University of Sydney Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| |
Collapse
|
39
|
Seed E, Kearney L, Weaver E, Ryan EG, Nugent R. A prospective cohort study comparing neonatal outcomes of waterbirth and land birth in an Australian tertiary maternity unit. Aust N Z J Obstet Gynaecol 2023; 63:59-65. [PMID: 35796252 DOI: 10.1111/ajo.13555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/14/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Maternal preference for warm water immersion (WWI) and waterbirth is increasing, but adoption into obstetric guidelines and clinical practice remains limited. Concerns regarding safety and a paucity of evidence have been cited as reasons for the limited adoption and uptake. AIM The aim was to investigate maternal and neonatal outcomes after WWI and/or waterbirth compared with land birth. MATERIALS AND METHODS A prospective cohort study was conducted in an Australian public maternity hospital between 2019 and 2020. Maternal and neonatal outcomes for 1665 women who had a vaginal birth were studied. Primary outcome was admission to the neonatal unit (NNU). Secondary outcomes included neonatal antibiotic administration, maternal intrapartum fever, epidural use and perineal injury. Multivariate logistical regression analyses compared the outcomes between three groups: waterbirth, WWI only and land birth. RESULTS NNU admissions for a suspected infectious condition were significantly higher in the land birth group (P = 0.035). After accounting for labour duration, epidural use and previous birth mode, no significant difference was detected between groups in the odds of NNU admission (P = 0.167). No babies were admitted to NNU with water inhalation or drowning. Women birthing on land were more likely to be febrile (2 vs 0%; P = 0.007); obstetric anal sphincter injury and postpartum haemorrhage were similar between groups. Regional analgesia use was significantly lower in the WWI group compared to the land birth group (21.02 vs 38.58%; P = <0.001). There was one cord avulsion in the waterbirth group (0.41%). CONCLUSION Maternal and neonatal outcomes were similar between groups, with no increased risk evident in the waterbirth and WWI groups.
Collapse
Affiliation(s)
- Emma Seed
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Lauren Kearney
- Sunshine Coast Health Institute, Birtinya, Queensland, Australia.,University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Edward Weaver
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Elizabeth G Ryan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Rachael Nugent
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia.,University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| |
Collapse
|
40
|
Larcin L, Karakaya G, Rygaert X, Van Wilder P, Lamy C, Demyttenaere B, Damase-Michel C, Kirakoya-Samadoulougou F. Trends and regional variations in prescriptions dispensed to stimulate uterine contractions at the end of pregnancy in Belgium: A community-based study from 2003 to 2018. Pharmacoepidemiol Drug Saf 2023; 32:216-224. [PMID: 36300999 DOI: 10.1002/pds.5558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 09/29/2022] [Accepted: 10/26/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE To investigate trends and regional variations in uterotonics dispensed around birth between 2003 and 2018 in Belgium. METHODS Data, including outpatient and inpatient prescriptions were extracted from a nationally representative prescription database. The prevalence of uterotonics dispensed during a period including the 7 days before birth, the delivery day and the 7 days after birth was computed over three 4-year-long study periods from 2003 to 2018. The trends between periods and associations between the use of at least one uterotonic and maternal age, region of residence, delivery type and social status were assessed using logistic regression. RESULTS In total, 31 675 pregnancies were included in the study. The proportion of pregnancies exposed to at least one uterotonic decreased significantly from 92.9% (95%CI, 92.3-93.4) in 2003-2006 to 91.4% (95%CI, 90.7-92.0) in 2015-2018 for vaginal births and from 95.5% (95%CI, 94.5-96.4) to 93.7% (95%CI, 92.6-94.7) for caesarean sections. However, for vaginal births, the proportion of oxytocin increased from 84.5% (95%CI, 83.7-85.2) to 89% (95%CI 88.3-89.7). A significant association was found between uterotonic agent use and maternal age, region of residence, and delivery type. The dispensation of some uterotonic agents differed significantly between the regions. CONCLUSIONS The proportion of pregnancies exposed to at least one uterotonic was high across the study period but decreased slightly between 2003 and 2018. Important variations in uterotonic use between regions highlight the need for improved national guidance.
Collapse
Affiliation(s)
- Lionel Larcin
- Centre de RechercheEpidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Güngör Karakaya
- Agence Intermutualiste (IMA), Bruxelles, Belgium.,Département Représentation et Etudes des Mutualités Libres, Bruxelles, Belgium
| | | | - Philippe Van Wilder
- Centre de Recherche en Economie de la Santé, Gestion des Institutions de Soins et Sciences Infirmières, Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Clotilde Lamy
- Service de Gynécologie-Obstétrique, Hôpital Universitaire de Bruxelles, Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Bart Demyttenaere
- Agence Intermutualiste (IMA), Bruxelles, Belgium.,Service études des Mutualités Socialistes, Bruxelles, Belgium
| | - Christine Damase-Michel
- Pharmacologie Médicale, Faculté de Médecine, Université de Toulouse III, Inserm CERPOP, CHU, Toulouse, France
| | - Fati Kirakoya-Samadoulougou
- Centre de RechercheEpidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgium
| |
Collapse
|
41
|
Robinson D, Campbell K, Hobson SR, MacDonald WK, Sawchuck D, Wagner B. Guideline No. 432c: Induction of Labour. J Obstet Gynaecol Can 2023; 45:70-77.e3. [PMID: 36725134 DOI: 10.1016/j.jogc.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES This guideline presents evidence and recommendations for cervical ripening and induction of labour. It aims to provide information to birth attendants and pregnant individuals on optimal perinatal care while avoiding unnecessary obstetrical intervention. TARGET POPULATION All pregnant patients. BENEFITS, RISKS, AND COSTS Consistent interprofessional use of the guideline, appropriate equipment, and trained professional staff enhance safe intrapartum care. Pregnant individuals and their support person(s) should be informed of the benefits and risks of induction of labour. EVIDENCE Literature published to March 2022 was reviewed. PubMed, CINAHL, and the Cochrane Library were used to search for systematic reviews, randomized control trials, and observational studies on cervical ripening and induction labour. Grey (unpublished) literature was identified by searching the websites of health technology assessment and health technology related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE All providers of obstetrical care. SUMMARY STATEMENTS Misoprostol OXYTOCIN: RECOMMENDATIONS.
Collapse
|
42
|
Robinson D, Campbell K, Hobson SR, MacDonald WK, Sawchuck D, Wagner B. Guideline No. 432b: Cervical Ripening. J Obstet Gynaecol Can 2023; 45:56-62.e1. [PMID: 36725131 DOI: 10.1016/j.jogc.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE This guideline presents evidence and recommendations for cervical ripening and induction of labour. It aims to provide information to birth attendants and pregnant individuals on optimal perinatal care while avoiding unnecessary obstetrical intervention. TARGET POPULATION All pregnant patients. BENEFITS, HARMS, AND COSTS Consistent interprofessional use of the guideline, appropriate equipment, and trained professional staff enhance safe intrapartum care. Pregnant individuals and their support person(s) should be informed of the benefits and risks of induction of labour. EVIDENCE Literature published to March 2022 was reviewed. PubMed, CINAHL, and the Cochrane Library were used to search for systematic reviews, randomized controlled trials, and observational studies on cervical ripening and induction of labour. Grey (unpublished) literature was identified by searching the websites of health technology assessment and health technology related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE All providers of obstetrical care. RECOMMANDATIONS
Collapse
|
43
|
Dockree S, O'Sullivan J, Shine B, James T, Vatish M. How should we interpret lactate in labour? A reference study. BJOG 2022; 129:2150-2156. [PMID: 35866444 PMCID: PMC9804290 DOI: 10.1111/1471-0528.17264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To investigate maternal lactate concentrations in labour and the puerperium. DESIGN Reference study. SETTING Tertiary obstetric unit. POPULATION 1279 pregnant women with good perinatal outcomes at term. METHODS Electronic patient records were searched for women who had lactate measured on the day of delivery or in the following 24 hours, but who were subsequently found to have a very low likelihood of sepsis, based on their outcomes. MAIN OUTCOME MEASURES The normative distribution of lactate and C-reactive protein (CRP), differences according to the mode of birth, and the proportion of results above the commonly used cut-offs (≥2 and ≥4 mmol/l). RESULTS Lactate varied between 0.4-5.4 mmol/l (median 1.8 mmol/l, interquartile range [IQR] 1.3-2.5). It was higher in women who had vaginal deliveries than caesarean sections (median 1.9 vs. 1.6 mmol/l, pdiff < 0.001), demonstrating the association with labour (particularly active pushing in the second stage). In contrast, CRP was more elevated in women who had caesarean sections (median 71.8 mg/l) than those who had vaginal deliveries (33.4 mg/l, pdiff < 0.001). In total, 40.8% had a lactate ≥2 mmol/l, but 95.3% were <4 mmol/l. CONCLUSIONS Lactate in labour and the puerperium is commonly elevated above the levels expected in healthy pregnant or non-pregnant women. There is a paucity of evidence to support using lactate or CRP to make decisions about antibiotics around the time of delivery but, as lactate is rarely higher than 4 mmol/l, this upper limit may still represent a useful severity marker for the investigation and management of sepsis in labour.
Collapse
Affiliation(s)
- Samuel Dockree
- Women's CentreJohn Radcliffe HospitalOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Joseph O'Sullivan
- Women's CentreJohn Radcliffe HospitalOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Brian Shine
- Department of Clinical BiochemistryJohn Radcliffe HospitalOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Tim James
- Department of Clinical BiochemistryJohn Radcliffe HospitalOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Manu Vatish
- Women's CentreJohn Radcliffe HospitalOxford University Hospitals NHS Foundation TrustOxfordUK,Women's CentreNuffield Department of Women's and Reproductive HealthJohn Radcliffe HospitalUniversity of OxfordOxfordUK
| |
Collapse
|
44
|
Abstract
Hamman's syndrome is an uncommon complication of labor. Its diagnosis is based on clinical suspicion and CT imaging. It is often a benign and self-limiting condition occurring in healthy patients. The risk factors are nulliparity and a prolonged second stage of labor. Hamman's syndrome has life-threatening implications that underscore the importance of early diagnosis and management to avoid any difficulty. This paper discusses the case of a 21-year-old, healthy female without allergies who was admitted to the hospital in spontaneous labor at 40 weeks of gestation. During the second stage of labor, she developed Hamman's syndrome and presented with subcutaneous emphysema, which led to an emergency C-section. After a chest and cervical CT scan that showed extensive subcutaneous emphysema and a pneumomediastinum, the patient was admitted to the ICU.
Collapse
|
45
|
Østborg TB, Sande RK, Kessler J, Tappert C, von Brandis P, Eggebø TM. Put your weight behind it-Effect of body mass index on the active second stage of labour: A retrospective cohort study. BJOG 2022; 129:2166-2174. [PMID: 35404537 PMCID: PMC9790457 DOI: 10.1111/1471-0528.17186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/16/2022] [Accepted: 03/28/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To explore the duration of the active phase of the second stage of labour in relation to maternal pre-pregnant body mass index (BMI). DESIGN Retrospective cohort study. SETTING Labour wards of three Norwegian university hospitals, 2012-2019. POPULATION Nulliparous and parous women without previous caesarean section with a live singleton fetus in cephalic presentation and spontaneous onset of labour, corresponding to the Ten Group Classification System (TGCS) group 1 and 3. METHODS Women were stratified to BMI groups according to WHO classification, and estimated median duration of the active phase of the second stage of labour was calculated using survival analyses. Caesarean sections and operative vaginal deliveries during the active phase were censored. MAIN OUTCOME MEASURES Estimated median duration of the active phase of second stage of labour. RESULTS In all, 47 942 women were included in the survival analyses. Increasing BMI was associated with shorter estimated median duration of the active second stage in both TGCS groups. In TGCS group 1, the estimated median durations (interquartile range) were 44 (26-75), 43 (25-71), 39 (22-70), 33 (18-63), 34 (19-54) and 29 (16-56) minutes in BMI groups 1-6, respectively. In TGCS group 3, the corresponding values were 11 (6-19), 10 (6-17), 10 (6-16), 9 (5-15), 8 (5-13) and 7 (4-11) minutes. Increasing BMI remained associated with shorter estimated median duration in analyses stratified by oxytocin augmentation and epidural analgesia. CONCLUSION Increasing BMI was associated with shorter estimated median duration of the active second stage of labour.
Collapse
Affiliation(s)
- Tilde Broch Østborg
- Department of Obstetrics and GynaecologyStavanger University HospitalStavangerNorway,Department of Clinical Science, Medical FacultyUniversity of BergenBergenNorway
| | - Ragnar Kvie Sande
- Department of Obstetrics and GynaecologyStavanger University HospitalStavangerNorway,Department of Clinical Science, Medical FacultyUniversity of BergenBergenNorway
| | - Jørg Kessler
- Department of Clinical Science, Medical FacultyUniversity of BergenBergenNorway
| | - Christian Tappert
- Department of Obstetrics and GynaecologyTrondheim University Hospital (St Olavs Hospital)TrondheimNorway
| | - Phillip von Brandis
- Department of Obstetrics and GynaecologyStavanger University HospitalStavangerNorway
| | - Torbjørn Moe Eggebø
- Department of Obstetrics and GynaecologyStavanger University HospitalStavangerNorway,Centre for Fetal MedicineTrondheim University Hospital (St Olavs Hospital)TrondheimNorway,Department of Clinical and Molecular MedicineNorwegian University of Science and TechnologyTrondheimNorway
| |
Collapse
|
46
|
Çalık KY, Küçük E, Beydağ KD. 'Pregnant women voice their concerns and delivery method preferences during the COVID-19 pandemic in Turkey'. J Reprod Infant Psychol 2022; 40:590-601. [PMID: 34191642 DOI: 10.1080/02646838.2021.1931071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate pregnant women's voice their concerns and delivery method preferences during the COVID-19 pandemic in Turkey. Methods: A cross-sectional study is survey based using an online survey platform. Three hundred pregnant women were included between 16 May and 12 June 2020 in Turkey. Sociodemographic features, obstetric features, concerns about COVID-19, delivery method preferences, and Brief Measure of Worry Severity were evaluated. RESULTS It was determined that the concerns of pregnant women about the pandemic were moderate (12.73 ± 6.838) and did not alter their delivery method preferences. However, the concerns of the pregnant women who planned to perform their delivery by caesarean section before COVID-19 and whose delivery method preferences changed during the pandemic process were higher (p < 0.05). Additionally, during the COVID-19 period, pregnant women often harbour concerns such as 'not knowing how it would affect my baby if I have to take medications for COVID-19 (90.3%)' 'getting infected by COVID-19 during my pregnancy (89.7%)' 'not having a healthy pregnancy until birth (89%)'. CONCLUSIONS Delivery method preferences of pregnant women did not change in the COVID-19 pandemic. On the other hand, COVID-19 pandemic is impacting on the pregnant women experiencing moderate concerns about their pregnancy, delivery, postpartum period, and their baby.
Collapse
Affiliation(s)
- Kıymet Yeşilçiçek Çalık
- Faculty of Health Science, Obstetrics and Gynaecology Nursing Department, Karadeniz Technical University, Trabzon, Turkey
| | - Ebru Küçük
- Faculty of Health Science, Obstetrics and Gynaecology Nursing Department, Karadeniz Technical University, Trabzon, Turkey
| | - Kerime Derya Beydağ
- Department of Nursing, Faculty of Health Sciences, Istanbul Okan University, Istanbul, Turkey
| |
Collapse
|
47
|
Kammies JD, De Waard L, Muller CJB, Hall DR. Delivery outcomes in women with morbid obesity, where induction of labour was planned to prevent post-term complications. J OBSTET GYNAECOL 2022; 42:3450-3455. [PMID: 36194089 DOI: 10.1080/01443615.2022.2128730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Abstract
Morbid obesity and prolonged pregnancy are independently associated with adverse delivery and perinatal outcomes. We conducted a retrospective observational study on otherwise uncomplicated women with a body mass index (BMI) ≥ 40 kg/m2 where, having reached term, induction of labour (IOL) was planned, to prevent prolonged pregnancy. The primary aim was to describe delivery outcomes and short-term maternal and perinatal adverse events. Of 117 cases included, 69 (59%) laboured spontaneously before the induction date, while 48 (41%) required an IOL. Of 48 patients that underwent an IOL, 22 (45.8%) achieved vaginal delivery, compared to 55 (79.7%) who laboured spontaneously (p = <.001). Twenty-two (18.8%) of the 117 babies weighed more than 4000 g, with 13 of these delivered vaginally. Overall, term patients with morbid obesity who laboured spontaneously before requiring induction, had a high rate of vaginal delivery. However, when IOL was required, the rate of caesarean delivery rose dramatically.Impact statementWhat is already known on this subject? Morbid obesity and prolonged pregnancy are independently associated with adverse delivery and perinatal outcomes. Induction of labour (IOL) increases the workload in busy units.What do the results of this study add? These results help inform accurate counselling on delivery outcomes, which is integral to respectful care, for the continuously increasing numbers of morbidly obese pregnant women.What the implications are of these findings for clinical practice and/or further research? It is preferable to avoid semi- or urgent caesarean deliveries in morbidly obese women after IOL. The outcomes of earlier induction of labour from 39- or 40-weeks' gestation requires investigation. Earlier induction may reduce the numbers of caesarean deliveries for abnormal cardiotocograph during the process.
Collapse
Affiliation(s)
- J D Kammies
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - L De Waard
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - C J B Muller
- Department of Statistics and Actuarial Science, Stellenbosch University, Stellenbosch, South Africa
| | - D R Hall
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
48
|
Kizilirmak A, Calpbinici P. Investigation of the effect of pregnant women's childbirth-related Internet use on fear of childbirth. J OBSTET GYNAECOL 2022; 42:3007-3013. [PMID: 36149311 DOI: 10.1080/01443615.2022.2125297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This research was carried out to examine the effect of childbirth-related Internet use by pregnant women on fear of childbirth (FOC). The descriptive study was conducted with 350 pregnant women who applied to the Outpatient Polyclinic of Gynaecology and Obstetrics. Of the pregnant women who used the Internet, 72.9% did so to research information about childbirth. The pregnant women used the Internet mostly to obtain information about coping with labour pain (43.4%), the delivery process (46.9%), the needs list at delivery (39.4%), about C-section/epidural analgesia for labour (26.8%), and about the environment of the delivery room (25.7%). It was determined that there was a statistically significant difference (p < .05) between the delivery-related video viewing status of the pregnant women, the mean score of the W-DEQ Version A (p < .05), and the FOC was lower in those who watched videos about delivery.IMPACT STATEMENTWhat is already known on this subject? Previous studies have shown that pregnant women frequently use the Internet as a source of information about childbirth.What do the results of this study add? The findings of this study reveal that watching videos and listening to or reading the narrations significantly affected the FOC.What are the implications of these findings for clinical practice or further research? Nurses who provide preconception and antenatal care should consider Internet use as a risk factor for FOC and should guide pregnant women to reliable sources.
Collapse
Affiliation(s)
- Aynur Kizilirmak
- Department of Obstetrics and Gynecology Nursing, Nevşehir Hacı Bektaş Veli University, Semra and Vefa Küçük Faculty of Health Sciences, Nevsehir, Turkey
| | - Pelin Calpbinici
- Department of Obstetrics and Gynecology Nursing, Nevşehir Hacı Bektaş Veli University, Semra and Vefa Küçük Faculty of Health Sciences, Nevsehir, Turkey
| |
Collapse
|
49
|
Ghulaxe Y, Tayade S, Huse S, Chavada J. Advancement in Partograph: WHO's Labor Care Guide. Cureus 2022; 14:e30238. [PMID: 36381845 PMCID: PMC9652267 DOI: 10.7759/cureus.30238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023] Open
Abstract
Worldwide, the partograph, also known as a partogram, is used as a labor monitoring tool to detect difficulties early, allowing for referral, intervention, or closer observations to follow. Despite widespread support from health experts, there are worries that the partograph has not yet fully realized its potential for enhancing therapeutic results. As a result, the instrument has undergone several changes, and numerous studies have been conducted to examine the obstacles and enablers to its use. Nevertheless, the partograph was widely embraced and has been a component of evaluating labor progress. Earlier it was also used as a standard method for monitoring labor progress. Even though it is widely used, there have been reports of usage and accurate execution rates. The WHO Labor Care Guide (LCG) was created so that medical professionals could keep an eye on the health of pregnant women and their unborn children during labor by conducting routine evaluations to spot any abnormalities. The tool intends to enhance women-centered care and encourage collaborative decision-making between women and healthcare professionals. The LCG is designed to be a tool for ensuring high-quality research centered on health, reducing pointless measures, and offering comfort measures.
Collapse
Affiliation(s)
- Yash Ghulaxe
- Medical Student, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Surekha Tayade
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Shreyash Huse
- Medical Student, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Jay Chavada
- Medical Student, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| |
Collapse
|
50
|
Macdonald L. Gender and Regionalization in North America: From NAFTA to CUSMA and Beyond? Int J 2022; 77:430-448. [PMID: 36911230 PMCID: PMC9989227 DOI: 10.1177/00207020221146492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The literature on world regions is largely gender-blind. This article suggests ways in which the study of regionalism can incorporate gender analysis, based on the case of North America. It argues that this can be done in three ways: through an examination of the gendered impact of regional integration; through an examination of how gender concerns are, or can be, mainstreamed into regional policies; and through research on new forms of feminist-inspired activism that may shape regional outcomes. After applying these perspectives to the case of North America and the new Canada-United States-Mexico Agreement, it argues that despite the failure of the Canadian government to achieve the inclusion of a gender chapter, the inclusion of language around gender discrimination in the labour chapter makes the new agreement a more effective (if still limited) tool for promotion of some forms of gender equality.
Collapse
Affiliation(s)
- Laura Macdonald
- Laura Macdonald, Department of Political Science, Carleton University, 1125 Colonel By Drive, B640 Loeb Building, Ottawa, ON, K1S 5B6, Canada.
| |
Collapse
|