Active First Stage Of Labor Research Articles

A Study to Assess the Effectiveness of Music Therapy and Aromatherapy on Faetomaternal Parameters among Parturient in the Active First Stage of Labour in a Selected Hospital, Bangalore, India

A Study to Assess the Effectiveness of Music Therapy and Aromatherapy on Faetomaternal Parameters among Parturient in the Active First Stage of Labour in a Selected Hospital, Bangalore, India

Analyzing the Expectant Management of Redefined Active Phase of Labor (WHO 2018 Guidelines) in Nulliparous Women: A Randomized Control Trial

BACKGROUND:The World Health Organization (WHO) in their 2018 guidelines favored a noninterventional approach toward the labor process. The active phase of labor will be initiated when the cervix is 5 cm dilated and during obsoleted use of a 1 cm/hour cervical dilation rate as a diagnostic test for abnormal birth outcomes.OBJECTIVES:The aim of the study is to compare an active interventional labor management approach to a noninterventional labor management approach in nulliparous parturient women in terms of need of intervention, mode of birth, and maternofetal outcome.METHODOLOGY:This randomized control study was conducted at a rural tertiary care hospital for a period of 1.5 years. Nulliparous low-risk pregnant women presenting in latent labor were randomly allocated into two groups on the basis of cervical dilation and labor intervention. WHO 2014 guidelines with partograph were followed in group 1, and 2018 WHO guidelines with labor care guide were followed in group 2.RESULT:Both the groups were comparable with age, parity, and Bishop score at the time of admission. The incidence rates of intervention in the active first stage of labor in group 1 and group 2 were 31% and 10% with an odds ratio of 0.192 (95% confidence interval [CI] [0.079, 0.466]), and the rates of lower segment cesarean section in both the groups were 17.6% and 5.8%, respectively. The odds ratio with 95% CI for postpartum hemorrhage and neonatal intensive care unit admission in group 1 compared with group 2 was 0.313 [0.061, 1.610] and 1.057 [0.143, 7.832], respectively.CONCLUSION:This study showed that the shifting of the active first-stage threshold by 1 cm and letting labor progress at its natural pace significantly reduced the need for intervention and affected the fetal and maternal outcome positively.

Duration of labor in consecutive deliveries: a retrospective data analysis

PurposeLabor is shorter in multiparous women. However, there are no individualized data on differences in duration of labor for consecutive deliveries in the same parturient.MethodsWe conducted a retrospective data analysis from 2004 to 2021 at the University Hospital of Zurich and included all women with 2 or more vaginal deliveries of a singleton child in cephalic position, between 22 and 42 weeks of gestation. Descriptive statistics were performed with SPSS version 25.0 (IBM, SPSS Inc., USA). The primary endpoint was the ratio between durations of labor stages in consecutive deliveries of the same parturient.ResultsA total of 3344 women with 7066 births (2601 first [P0], 2987 s [P1], 1176 third [P2], and 302 fourth [P3]) were included. The ratio of duration of the active first stage of labor between P1 and P0 was 0.49 (95% CI 0.47–0.51, p < 0.001) meaning that the active first stage of labor was 51% shorter. The second stage of labor with a ratio of 0.26 (95% CI 0.24–0.27, p < 0.001) was 74% shorter in P1 compared to P0. Higher birthweight of the first child led to an even greater decrease in duration of the second stage of labor in P1 compared to P0 (p = 0.003). Neuraxial anesthesia was an independent risk factor for a longer duration of labor, irrespective of parity (p < 0.001). Birthweight and HC of the neonates did not significantly differ between the children born by the same women. However, higher birthweight in of the first child significantly augmented the rate of second stage of labor between P0 and P1 (p = 0.003).DiscussionUp to the third delivery, duration of labor decreased with each consecutive delivery of the same parturient. An individualized assessment of the expected duration of labor in multiparous women should be encouraged.

Particular features of labor activity at the presence of inflammation of the uterine layers and placental membranes

Research objectives: to analyze the association between the various abnormalities of the labor activity and inflammatory changes of the placental, fetal membranes, and uterine layers.Materials and methods. A prospective cohort study of 382 patients with singleton pregnancies at 28–42 weeks' gestation who underwent cesarean section for abnormal uterine contractions and other complications was conducted. The patients were divided into 3 observation groups: 168 women with hypotonic labor (HL), 70 women with hypertonic uterine dysfunction (HUD) and 144 women operated on for various indications (control group). The development of the inflammation of the decidua, myometrium, chorioamniotic membranes and umbilical cord in different types of labor activity abnormalities were studied. Statistical analyses included Mann-Whitney U test, Chi-squared test, and logistic regression. Results. In the control group on the eve of the labor the lower uterine segments' polymorphonuclear leukocytes and macrophages infiltration of mild grade were detected in 73.6 and 59.7% cases accordingly.The strength of the association of uterine layers, placental and fetal membranes inflammation with the HUD was: for the deciduitis – adjusted odds ratio (aOR): 2.6, 95% confidence interval (CI): 1.4–4.8; for the myometritis – aOR: 0.7, 95% CI: 0.3–2.4; for the histological chorioamnionitis (hCAM) – aOR: 4.5, 95% CI: 3.4–12.1; for the funisitis – aOR: 2.9, 95% CI: 1.3–10.6. The main clinical risk factors for hCAM, funisitis, and deciduitis in the HUD group, such as prematurity, nulliparity, group B streptococcus colonization, and duration of ruptured fetal membranes before the cesarean section, indicated the antenatal occurrence of inflammatory process. А decrease of the uterine contractility іn the HL group was associated with grade 2+ deciduitis (aOR: 1.4, 95% CI: 0.6–3.6) and grade II+ myometritis (aOR: 3.9, 95% CI: 1.3–14.7), but no association was found with stage II+ hCAM (aOR: 0.8, 95% CI: 0.3–4.9) and stage 2+ funisitis (aOR: 0.3, 95% CI: 0.6–2.7). Decidual and myometrial inflammation was significantly connected with nulliparity and intrapartum factors such as protracted active first stage of labor with oxytocin augmentation, advanced cervical dilation, and number of vaginal examinations. Inflammation of the myometrium was accompanied by the deciduitis in all cases.Conclusions. Mild inflammation of the decidua and myometrium of the lower segment of the uterus at term pregnancy is a physiological phenomenon that contributes to the initiation of labor. Inflammation of the chorioamniotic membranes and decidua against the background of intact myometrium plays a fundamental role in the occurrence of hypertensive uterine dysfunction, particularly in preterm birth. Marked myometrial inflammation that occurs in prolonged labor is an additional factor aggravating the hypotonic uterine activity.

Duration of the active first stage of labour and severe perineal lacerations and maternal postpartum complications: a population-based cohort study.

The impact of first stage labour duration on maternal outcomes is sparsely investigated. We aimed to study the association between a longer active first stage and maternal complications in the early postpartum period. A population-based cohort study. Regions of Stockholm and Gotland, Sweden, 2008-2020. A cohort of 159 459 term, singleton, vertex pregnancies, stratified by parity groups. The exposure was active first stage duration, categorised in percentiles. Poisson regression analysis was performed to estimate the adjusted relative risk (aRR) and the 95% confidence interval (95% CI). To investigate the effect of second stage duration on the outcome, mediation analysis was performed. Severe perineal lacerations (third or fourth degree), postpartum infection, urinary retention and haematoma in the birth canal or ruptured sutures. The risks of severe perineal laceration, postpartum infection and urinary retention increased with a longer active first stage, both overall and stratified by parity group. The aRR increased with a longer active first stage, using duration of <50th percentile as the reference. In the ≥90th percentile category, the aRR for postpartum infection was 1.64 (95% CI 1.46-1.84) in primiparous women, 2.43 (95% CI 1.98-2.98) in parous women with no previous caesarean delivery (CD) and 2.33 (95% CI 1.65-3.28) in parous women with a previous CD. The proportion mediated by second stage duration was 33.4% to 36.9% for the different outcomes in primiparous women. The risk of haematoma or ruptured sutures did not increased with a longer active first stage. Increasing active first stage duration is associated with maternal complications in the early postpartum period.

Delivery Progress, Labor Interventions and Perinatal Outcome in Spontaneous Vaginal Delivery of Singleton Pregnancies between Nulliparous and Primiparous Women with One Previous Elective Cesarean Section: A Retrospective Comparative Study.

This is a retrospective comparative study. Data were collected in a four-year period at the departments of Obstetrics and Gynecology at Kristianstad and Ystad hospitals in Sweden. Out of 14,925 deliveries, 106 primipara women with one previous elective LSCS and a spontaneous labor onset in the subsequent singleton pregnancy were identified. Of these women, 94 (88.7%) delivered vaginally and were included in the study (VBAC group). The comparison group included 212 randomly selected nulliparous women that had a normal singleton pregnancy, spontaneous labor onset and delivered vaginally. The rate of cervical dilation during the active first stage of labor as well as the duration of the second stage did not differ between the two groups. When adjusting for cervical dilation at admission, there was no significant difference between the two groups regarding the duration of the active phase of the first stage of labor. No significant differences were found in maternal-neonatal outcomes between the two groups except for higher birth weight in the VBAC group. The use of epidural analgesia was associated with slower dilation rhythm over the duration of the active phase and second stage of labor, need for labor augmentation, postpartum bleeding and need for transfusion at higher rates, irrespective of parity when epidural was used. Our study provides evidence that in women with one previous elective LSCS undergoing TOLAC in the subsequent pregnancy resulting in vaginal birth, the progress and duration of labor are not different from those in nulliparous women when labor is spontaneous and the it is a singleton pregnancy. The use of epidural was associated with prolonged labor, need for labor augmentation and higher postpartum bleeding, irrespective of parity. This information may be useful in patient counseling and labor management in TOLAC.

First stage of labour duration and associated risk of adverse neonatal outcomes

Prior evidence evaluating the benefits and harms of expectant labour duration during active first stage is inconclusive regarding potential consequences for the neonate. Population-based cohort study in Stockholm-Gotland region, Sweden, including 46,040 women (Robson 1), between October 1st, 2008 and June 15th, 2020. Modified Poisson regression was used for the association between active first stage of labour duration and adverse neonatal outcomes. 94.2% experienced a delivery with normal neonatal outcomes. Absolute risk for severe outcomes increased from 1.9 to 3.0%, moderate outcomes increased from 2.8 to 6.2% (> 10.1 h). Compared to the reference, (< 5.1 h; median), the adjusted relative risk (aRR) of severe neonatal outcome significantly increased beyond 10.1 h (> 90th percentile) (aRR 1.53, 95% CI 1.26, 1.87), for moderate neonatal outcome the aRR began to slowly increase beyond 5.1 h (≥ 50 percentile; aRR 1.40, 95% CI 1.24, 1.58). Mediation analysis indicate that most of the association was due to a longer active first stage of labour, 13% (severe neonatal outcomes) and 20% (moderate neonatal outcomes) of the risk was mediated (indirect effect) by longer second stage of labour duration. We report an association between increasing active first stage duration and increased risk of adverse neonatal outcomes. We did not observe a clear labour duration risk threshold.

Ultrasound examination of the pelvic floor during active labor: A longitudinal cohort study.

There is limited evidence about changes in the pelvic floor during active labor. We aimed to investigate changes in hiatal dimensions during the active first stage of labor and associations with fetal descent and head position. We conducted a longitudinal, prospective cohort study at the National University Hospital of Iceland, from 2016 to 2018. Nulliparous women with spontaneous onset of labor, a single fetus in cephalic presentation, and gestational age ≥37 weeks were eligible. Fetal position was assessed with transabdominal ultrasound and fetal descent was measured with transperineal ultrasound. Three-dimensional volumes were acquired from transperineal scanning at the start of the active phase of labor and in late first stage or early second stage. The largest transverse hiatal diameter was measured in the plane of minimal hiatal dimensions. The levator urethral gap was measured as the distance between the center of the urethra and the levator insertion using tomographic ultrasound imaging. Measurements of the levator urethral gap were made in the plane of minimal hiatal dimensions and 2.5 and 5 mm cranial to this. The final study population comprised 78 women. The mean transverse hiatal diameter increased 12.4% between the two examinations, from 39.4 ± 4.1 mm (±standard deviation) at the first examination to 44.3 ± 5.8 mm at the last examination (p < 0.01). We found a moderate correlation between the transverse hiatal diameter and fetal station at the last examination (r = 0.44, r2 = 0.19; p < 0.01; regression equation y = 2.71 + 0.014x), and a weak correlation between the change in transverse hiatal diameter and change in fetal station (r = 0.29; r2 = 0.08; p = 0.01; regression equation y = 0.24 + 0.012x). Levator urethral gap increased significantly in all three planes on both the left and right sides. Head position was not associated with hiatal measurements after adjusting for fetal station. We found a significant, but only modest, increase of the hiatal dimensions during the first stage of labor. The risk of levator ani trauma will therefore be low during this stage. The change in transverse hiatal diameter was associated with fetal descent but not with head position.

Effect of fetal malposition, primiparous, and premature rupture of membrane on Neonatal Near miss mediated by grade three meconium-stained amniotic fluids and duration of the active first stage of labor: Mediation analysis.

In many low-income countries, including Ethiopia, neonatal mortality remains a major concern. For every newborn that dies, many more neonates survived (near-miss neonates) the first 28 days after birth from life-threatening conditions. The generation of evidence on neonatal near-miss determinants could be a critical step in reducing neonatal mortality rates. However, studies causal pathway determinants are limited in Ethiopia. This study aimed to investigate the Neonatal Near-miss determinants in public health hospitals in Amhara Regional State, northwest Ethiopia. A cross-sectional study was conducted on 1277 mother-newborn pairs at six hospitals between July 2021 and January 2022. A validated interviewer-administered questionnaire and a review of medical records were used to collect data. Data were entered into Epi-Info version 7.1.2 and exported to STATA version 16 in California, America for analysis. The paths from exposure variables to Neonatal Near-Miss via mediators were examined using multiple logistic regression analysis. The adjusted odds ratio (AOR) and ß-coefficients were calculated and reported with a 95% confidence interval and a p-value of 0.05. The proportion of neonatal near-misses was 28.6% (365/1277) (95% CI: 26-31%). Women who could not read and write (AOR = 1.67,95%CI:1.14-2.47), being primiparous (AOR = 2.48,95% CI:1.63-3.79), pregnancy-induced hypertension (AOR = 2.10,95% CI:1.49-2.95),being referred from other health facilities (AOR = 2.28,95% CI:1.88-3.29), premature rupture of membrane (AOR = 1.47,95% CI:1.09-1.98), and fetal malposition (AOR = 1.89,95% CI:1.14-3.16) were associated with Neonatal Near-miss. Grade III meconium stained amniotic fluid partially mediated the relationship between primiparous (ß = 0.517), fetal malposition (ß = 0.526), pregnant women referred from other health facilities (ß = 0.948) and Neonatal Near-Miss at P-value < 0.01. Duration of the active first stage of labour partially mediated the relationship between primiparous (ß = -0.345), fetal malposition (ß = -0.656), premature rupture of membranes (ß = -0.550) and Neonatal Near-Miss at P- value <0.01.It had also a significant indirect effect (ß = 0.581, P<0.001) on NNM with variables (primiparous, fetal malposition, and premature rupture of membranes). The relationship between fetal malposition, primiparous, referred from other health facilities, premature rupture of membrane, and Neonatal Near miss were partially mediated by grade III meconium stained amniotic fluid and duration of the active first stage of labour. Early diagnosis of these potential danger signs and appropriate intervention could be of supreme importance in reducing NNM.

A Study to Assess the Effectiveness of Lamaze Method in terms of Labour Pain Perception, Anxiety and Progress of Labour among Primi Mothers in active first stage of Labour

Background: Natural childbirth is a beautiful experience. Women dream of the perfect birth with less pain. But severe pain is a phenomenon embedded in the very nature of human existence. Though experiencing pain during labour is a universal feature of childbirth, the degree of pain perception can be reduced using many simple, effective, low cost non-pharmacological methods which also helps in improving labour progress and patient satisfaction. The concept of painless child birth gave rise to many scientific discoveries and research findings. Among that Lamaze method is one, which prepares mother for child birth and to tackle Labour pain. Objective: The objective of this study are to evaluate the effectiveness of Lamaze method in terms of pain perception, anxiety and progress of labour among primi mothers in first stage of labour admitted at Christian fellowship Hospital, Oddanchatram. Method: The research design used for the study was quasi experimental nonequivalent control group posttest only design. The sample size was 60 samples. Out of which 30 were in experimental group and 30 were in control group. The Samples were selected by using Non probability purposive sampling technique. Primi mothers at their term was selected and was given antenatal teaching on “Normal labor process and non-pharmacological labour pain management” in antenatal OPD for about 30 minutes. The same primi mothers who attended teaching were selected for experimental group during their labour period. During the first hour of active first stage of labour Lamaze intervention of visual stimuli was provided by showing natural sceneries during each contraction for the second hour auditory stimuli was provided by making the mother to listen to light music by using ear phone. During the 3rd hour of active first stage of labour abdominal effleurage stroke was done during each painful contractions. Followed by that hot water bag application on the sacral region was provided and was continued till delivery. Primi gravid mothers who did not undergo Lamaze teaching and interventions were selected for control group. Posttest was done on both experimental and control group after four hours of active stage of labor to assess the level of labor pain perception, the level of anxiety and progress of labor by using Universal pain assessment scale, modified Max Hamilton anxiety rating scale and Labor progress assessment scale. The level of satisfaction on Lamaze method among experimental group was assessed by using Likert scale on satisfaction of Lamaze method. Total time taken to perform posttest in both groups was 30 minutes. The gathered data were analyzed by using descriptive and inferential statistics. Results: Results: Independent “t” value for level of pain perception was 16.08(table value=2.001) which was significant at P&lt;0.05 level. The independent “t” value for level of anxiety was 5.08(table value=2.001) which was significant at P&lt;0.05 level. The independent “t” value for progress of labour was 9.86 (table value=2.001) which was significant at P&lt;0.05 level. Regarding the level of satisfaction on Lamaze method of experimental group all 30(100%) primi mothers were adequately satisfied. There was no significant association existing between pain perception, anxiety and progress of labour with demographic variables such as age, education, occupation, monthly income and residence except for pain perception and demographic variables such as religion (χ2 = 45.44) and family type (χ2 = 4.33) among experimental group. The study findings revealed that Lamaze method was effective in reducing labor pain perception, anxiety and promote labour progress among primi mothers in active first stage of labour.

The effectiveness of roll-on aromatherapy of calamansi orange peel essential oil (Citrofortunella microcarpa) on reducing anxiety and pain in labor

Purpose: To determine the effectiveness of calamansi orange peel aromatherapy in reducing pain and anxiety in the active first stage of labor. Patients and methods: This research is a quasi-experimental pre-posttest control group design. The number of samples was 60 people, 30 mothers for each intervention and control group. Samples were obtained by accidental sampling from 10 independent Privat Midwifery Clinics in Bengkulu and divided into 2 groups randomly. Pain level was assessed by VAS, and anxiety level was measured by HARS. Data were collected before the intervention (pre-test and after the intervention (post-test) 1 (dilatation 4), post-test 2 (dilatation 7-8 cm), and post-test 3 (dilatation 9-10). Meanwhile, the level of anxiety was only measured 2 times during the pre-test and post-test (dilatation 4). The results were analyzed using the Wilcoxon signed rank test and the Mann-Whitney U test. Results: The results showed that in the intervention group, it was known that there was an effect of giving calamansi orange peel aromatherapy on pain (0.001) and anxiety (0.001) in mothers in the active phase of the first stage of labor. In the control group given orange aromatherapy, the results also showed an effect on pain (0.005) and anxiety (0.046). The results of the Mann-Whitney U test showed that there was a significant difference between the intervention and control groups in post-test 1 (0.000) and post-test 2 (0.004), but there was no significant difference in post-test 3 (0.121). Meanwhile, for the level of anxiety, it is known that there is a difference between the intervention and control groups (0.042). Conclusion: Using aromatherapy of calamansi orange peel essential oil as a complementary therapy effectively reduces the level of pain and anxiety in mothers during the active phase of the first stage of labor.

Quality of fetal heart rate monitoring with transabdominal fetal ECG during maternal movement in labor: A prospective study.

Transabdominal electrocardiographic (TAfECG) acquisition of fetal heart rate (FHR) signals has recently been introduced into leading commercial cardiotocographic (CTG) monitors. Continuous wireless transmission of signals has raised the possibility of the technology being used during maternal mobilization in labor. This study aims to evaluate signal quality and accuracy of TAfECG acquisition of FHR signals during static and active maternal positions in labor when compared with Doppler signals and with the gold-standard method of fetal scalp electrode (FSE). A total of 76 women with singleton term pregnancies in the active first stage of labor had simultaneously acquired FHR with TAfECG, Doppler, and FSE. Participants were asked to complete a supervised mobilization scheme, comprising five sequential 10-min periods of lying down, standing, sitting, walking, and rocking on the birthing ball. The three FHR signals were compared, defining signal loss as the percentage of signals under 20 bpm or exceeding 250 bpm and accuracy as the difference with FSE values. Computer analysis was used to quantify variability, accelerations, and decelerations. Static labor positions (lying down, standing, and sitting) were compared with active labor positions (walking and rocking on the birthing ball). Average signal loss was 5.3% with TAfECG (3.2% in static and 7.4% in active positions) and 15.5% with Doppler (8.3% in static and 30.7% in active positions). Average accuracy was 3.5bpm with TAfECG (1.9bpm in static and 5.04 bpm in active positions) and 13.9bpm with Doppler (3.2bpm in static and 24.7bpm in active positions). Average variability was similar with TAfECG and FSE in static positions but significantly higher with TAfECG in active positions (23.6 vs. 13.5 bpm, p < 0.001). In static labor positions, TAfECG provides a low signal loss, similar to that obtained with FSE, and a good signal accuracy, so the technique can be considered reliable when the mother is lying down, standing, or sitting. During maternal movement, TAfECG causes an artificial increase in FHR variability, which can cause false reassurance regarding fetal oxygenation. Doppler signals are unreliable during maternal movements.

The duration of spontaneous active and pushing phases of labour among 75,243 US women when intervention is minimal: A prospective, observational cohort study

SummaryBackgroundFriedman's curve, despite acknowledged limitations, has greatly influenced labour management. Interventions to hasten birth are now ubiquitous, challenging the contemporary study of normal labour. Our primary purpose was to characterise normal active labour and pushing durations in a large, contemporary sample experiencing minimal intervention, stratified by parity, age, and body mass index (BMI).MethodsThis is a secondary analysis of the national, validated Midwives Alliance of North America 4·0 (MANA Stats) data registry (n = 75,243), prospectively collected between Jan 1, 2012 and Dec 31, 2018 to describe labour and birth in home and birth center settings where common obstetric interventions [i.e., oxytocin, planned cesarean] are not available. The MANA Stats cohort includes pregnant people who intended birth in these settings and prospectively collects labour and birth processes and outcomes regardless of where birth or postpartum care ultimately occurs. Survival curves were calculated to estimate labour duration percentiles (e.g. 10th, 50th, 90th, and others of interest), by parity and sub-stratified by age and BMI.FindingsCompared to multiparous women (n = 32,882), nulliparous women (n = 15,331) had significantly longer active labour [e.g., median 7.5 vs. 3.3 h; 95th percentile 34.8 vs. 12.0 h] and significantly longer pushing phase [e.g., median 1.1 vs. 0.2 h; 95th percentile 5.5 vs. 1.1 h]. Among nulliparous women, maternal age >35 was associated with longer active first stage of labour and longer pushing phase, and BMI >30 kg/m² was associated with a longer active first stage of labour but a shorter pushing phase. Patterns among multiparous women were different, with those >35 years of age experiencing a slightly more rapid active labour and no difference in pushing duration, and those with BMI >30 kg/m² experiencing a slightly longer active labour but, similarly, no difference in pushing duration.InterpretationNulliparous women had significantly longer active first stage and pushing phase durations than multiparous women, with further variation noted by age and by BMI. Contemporary US women with low-risk pregnancies who intended birth in settings absent common obstetric interventions and in spontaneous labour with a live, vertex, term, singleton, non-anomalous fetus experienced labour durations that were often longer than prior characterizations, particularly among nulliparous women. Results overcome prior and current sampling limitations to refine understanding of normal labour durations and time thresholds signaling ‘labour dystocia’.FundingOHSU Nursing Innovation and OHSU University Shared Resources.

Uterovaginal prolapse in a primigravida presenting in active first stage of labor: a case report

BackgroundUterovaginal prolapse is the descent of the uterus and vagina down the birth canal toward the introitus. The occurrence of uterovaginal prolapse in a primigravida is very rare. It can cause preterm labor, fetal demise, spontaneous abortion, postpartum hemorrhage, maternal urinary complications, sepsis, and death. This case report presents the rare occurrence of uterovaginal prolapse in a primigravida woman with no major risk factors identified for prolapse, who presented in active first stage of labor and delivered vaginally.Case presentationA 30-year-old Oromo primigravida woman who did not remember her last normal menstrual period but claimed amenorrhea of 9 months duration presented with the urge to bear down of 12 hours duration and passage of liquor of 8 hours duration. She was referred from the local health center to Jimma Medical Center with a diagnosis of prolonged labor. At presentation, she was in active first stage of labor with cervix 5–6 cm and fetal heartbeat was negative. She was followed for the progress of labor, and 4 hours after admission to the labor ward, she delivered a freshly dead male neonate weighing 3000 g. Her postpartum period was uneventful, and she was discharged on her third postpartum day and referred after 6 weeks to the outpatient department.ConclusionUterovaginal prolapse occurring in primigravida and during labor at first recognition is very rare, with congenital weakness being a possible underlying pathology. Management of uterovaginal prolapse during labor should be individualized on the basis of fetal condition and the severity of prolapse. For a patient with pelvic organ prolapse in labor, expectant management is a good option when there is no severe edema resulting in obstructed labor, as in our case, where the patient delivered vaginally and the prolapse resolved postpartum.

Association between first and second stage of labour duration and mode of delivery: A population-based cohort study.

Active first stage of labour duration can widely vary between women. However, the nature of the relationship between the active first stage and second stage of labour duration is sparsely studied. To determine whether active first stage of labour duration (i) influences second stage of labour duration; and (ii) is associated with mode of delivery. A population-based cohort study of 13,379 women primiparous women, with spontaneous start in Stockholm-Gotland Region, Sweden, between 2008 and 2014. Duration of the active first stage of labour was examined in relation to second-stage duration using univariate and multivariable quantile regressions, with the first quartile (first stage duration) as the reference. Nonlinearity of associations was tested by restricted cubic splines. Association between active first-stage duration with mode of delivery was estimated using a multinomial logistic regression based on adjusted odds ratios. Longer active first stage of labour duration was linearly associated with longer second stage of labour duration until approximately 12h of active first stage of labour duration. After 12h, a non-linear trend is seen, demonstrated by a plateau in the second-stage duration. In addition, longer active first stage of labour duration was associated with increased occurrence of operative vaginal delivery (adjusted odds ratio 3.36, 95% confidence interval [CI] 2.89, 3.89) and caesarean delivery (adjusted odds ratio 4.75, 95% CI 3.85, 5.80). Among primiparous women with spontaneous onset of labour, longer active first stage of labour duration was associated with both longer second stage of labour duration and higher odds of operative delivery. This study contributes with findings, which may inform future discussions regarding how to properly account for second-stage duration, with applications in obstetric and perinatal epidemiology.

The Assessment of Intrapartum Transperineal Ultrasonographic Parameters for their Effectiveness in Evaluation of Progress of Labor and Prediction of Mode of Delivery in Egyptian Women

Introduction: High fetal head station has been associated with prolonged labor and delivery outcomes. Although clinical assessment of fetal head station is both subjective and unreliable, women with prolonged labor are subjected to multiple digital vaginal examinations. The use of ultrasound has been proposed to aid in the management of labor since 1990s. Ultrasound examination is more accurate and reproducible than clinical examination in the diagnosis of fetal head station and in the prediction of arrest of labor. Ultrasound examination can, to some extent, distinguish those women destined for spontaneous vaginal delivery and those destined for operative delivery and may predict the outcome of instrumental vaginal delivery. Such a technique has the potential to reduce the frequency of intrusive internal examinations and associated infection and could be useful in allowing the assessment of women in whom digital VE is traumatic or contra-indicated. Intrapartum ultrasound not only provides objective and quantitative data in labor, but also helps to make more reliable clinical decisions aiming to improve obstetric outcomes of both the mother and fetus as a supplementary tool for active management.&#x0D; Aim of the work: This study aims at assessing the value of intrapartum transperineal ultrasonography as a quantitative and objective tool in the evaluation of progress of labor and prediction of mode of delivery.&#x0D; Subjects: This study was a prospective observational study conducted on 600 primiparous women in active first stage of labor admitted to Kasr Al Ainy maternity hospital from January 2017 to June 2018. The studied population was divided into two groups. Group A of 300 women with normal progress of labor and group B of 300 women with prolonged 1st stage of labor.&#x0D; Methods: Fetal head station(FHS) was assessed clinically by digital vaginal examination (dVE) and sonographically by transperineal ultrasound measurement of head perineal distance (HPD) and angle of progression (AOP). Intrapartum care of the patient continued as normal based only on digital vaginal examinations using the modified WHO partogram. (1). Statistical analysis was targeted towards assessing the potential of the intrapartum ultrasonography in the evaluation of progress of labor and prediction of mode of delivery.&#x0D; Results: All studied parameters for assessment of FHS (dVE, HPD, and AOP) significantly corelated with each other and with both progress of labor and mode of delivery with P value (&lt;0.001). The highest sensitivity for prediction of progress of labor is observed using dVE (83%), the highest specificity is observed using AOP (78.3%). The highest sensitivity for prediction mode of delivery is for combined HPD &amp; AOP (97.7%) while the highest specificity is for AOP (81%). When combining both HPD and AOP for prediction of mode of delivery, the assessment of both parameters was found to have a high sensitivity of 97.7% and a high positive predictive value of 86.63%.&#x0D; Conclusion: Intrapartum ultrasound examination is a valuable tool in the prediction of progress of labor and mode of delivery. The assessment of fetal head station by transperineal ultrasound measurement of HPD and AOP is much more informative of the progress of labor and the mode of delivery than digital assessment of fetal head station.&#x0D; Keywords: Labor, intrapartum ultrasound, Angle of progression, Head perineal distance, fetal head station, digital vaginal examination.

Effect of Prolonged Upright Position during First Stage of Labour on Labour Outcome in Low Risk Term Nulliparous Women

Background: For positive childbirth experience, WHO recommends that women with low risk pregnancy should be encouraged to be ambulatory and assume upright position during labour. The aim of present study was to compare the effect of prolonged upright position during active first stage of labour with ambulation as per choice of the women, on the labour outcome. Methods: This was an interventional study conducted on 60 low risk nulliparous women. 30 women were assigned to upright position and motivated to remain in sitting, standing or walking position for atleast 60% of the duration of active first stage of labour and women in the control group were allowed to assume the position of their choice. Duration of labour, need for augmentation and mode of delivery in both groups were compared. Conclusion: In low risk nulliparous women, upright position during active first stage of labour is associated with frequent and stronger contractions in first 3 hours of active labour but does not have any significant impact on duration of labour, need for augmentation and mode of delivery. Therefore, nulliparous women during active first stage of labour can be allowed to be in position of their choice rather than imposing prolonged upright position.

311 Development of a prediction model for cesarean delivery among term women with presumed intraamniotic infection

To identify factors associated with cesarean delivery (CD) among term laboring women who develop an intrapartum fever due to presumed intraamniotic infection and to develop a predictive model for CD to assist in patient counseling. We performed a multi-center, retrospective cohort study among febrile, term laboring women between January 1, 2015 and December 31, 2017. We excluded women who had a documented non-obstetric source of infection, received antibiotics on admission for other indications, used immunosuppressant medication chronically, or had an intrauterine fetal demise. The medical record was reviewed, and sociodemographic, labor, and clinical characteristics were extracted. We identified the factors associated with CD and built our predictive model using backward stepwise regression. The final model was shown through the area under the receiver operating characteristic curve (AUC). The cohort consisted of 850 febrile laboring women, of whom 295 (34.7%) had a CD. Indications for Cesarean delivery included 34.6% for failure to progress, 33.6% for non-reassuring fetal heart tracing, 29.8% for arrest of descent, and 2.0% for failed operative delivery due to maternal exhaustion. The final model included stage of labor stratified by cervical exam dilation (less than 6 cm of dilation in latent labor, 6 cm to 9.5 cm in active first stage of labor, and 10 cm dilation in second stage of labor), duration of rupture of membranes (in hours), and if labor was induced. Our final model had an AUC of 0.74 (95% CI 0.71-0.78) with a Hosmer-Lemeshow test P=0.07. Using a predicted probability cutoff of 0.47, the model’s sensitivity was 54.7%, specificity was 80.7% with a positive predictive value of 60.1% and negative predictive value of 77.0% to predict CD. Information available at the time of development of an intrapartum fever may be used to counsel patients regarding the likelihood of CD. Our study was limited by unavailable electronic fetal monitoring data which also heavily influences CD risk.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Comparison of efficacy of the deep back massage method with and without Al-Fatihah for pain management in primigravida during active first stage of labor

Background: Labor pain is a common physiological condition experienced by women during childbirth. Labor pain can have a negative effect on the process of labor if not treated properly. One of the methods of reducing labor pain is deep back massage and distraction. The recitation of Surah Al-Fatihah is believed to reduce pain during childbirth. Aim and Objective: The objective of research was to determine the difference in the effectiveness of the deep back massage method with Al-Fatihah and without Al-Fatihah in reducing pain intensity in primigravidas during active first stage of labor at BPM Bunda, Bukittinggi, in 2016. Materials and Methods: This study used a quasi-experimental design. The population of this research was primigravidas during the active stage of labor. A sample of 20 women was taken using purposive sampling technique. Ten respondents were given deep back massage method without Al-Fatihah recitation and the other 10 with Al-Fatihah recitation. The data were collected through interviews and observations, and analyzed using the paired t-test. Results: The results of the analysis showed that there was a significant relationship between the deep back massage method without Al-Fatihah recitation and a reduction in labor pain, with P = 0.001 and a mean difference between before and after experiments. Analysis of the deep back massage method with Al-Fatihah recitation showed a reduction in labor pain with P = 0.000 and a mean difference between before and after experiments. Conclusions: Deep back massage method with Al-Fatihah recitation is more effective in reducing pain intensity in pregnant women during active first stage of labor.

Body stalk anomaly presenting as an emergency in Ethiopia: a case report

BackgroundBody stalk anomaly is a generally lethal malformation of the thorax and/or abdomen. It is often associated with limb defects. The intrathoracic and abdominal organs lie outside the abdominal cavity. These are contained within a sac composed of amnioperitoneal membrane attached directly to the placenta. The umbilical cord may be totally absent or extremely shortened. Severe kyphoscoliosis is often present. This case is reported to highlight this rare malformation and its clinical presentation.Case presentationWe present a case of a 27-year-old primigravida Oromo woman who had been amenorrheic for 9 months. She presented with an urge to bear down of 10 hours and passage of liquor of the same duration. The patient was referred from a district primary hospital with a diagnosis of preterm labor and hand prolapse. A lower uterine segment cesarean section was performed at Jimma University Medical Center for an indication of active first stage of labor with nonreassuring fetal heart rate pattern (fetal bradycardia) and hand prolapse to effect an anomalous fetus that had only a rudimentary right lower extremity and liver and intestine found outside the abdominal cavity contained within a sac composed of transparent membrane attached directly to the placenta. The umbilical cord was very short, measuring about 7 cm. The fetus had severe scoliosis. It also had a heartbeat upon extraction, which stopped after 5 minutes of delivery. The placenta and fetal body parts together weighed 2400 g.ConclusionTermination of pregnancy is usually offered because this abnormality is generally considered lethal. If the pregnancy is continued undetected as in our patient’s case, vaginal delivery is recommended, given the highly lethal nature of this anomaly. Good prenatal screening and counseling are recommended for early detection and management.