Active Stage Of Labor Research Articles

The effect of dill (Anethum graveolens) seeds on labor pain and progress: A systematic review and meta-analysis

BackgroundIn recent years, there has been growing interest in exploring the potential benefits of dill (Anethum graveolens) seeds in managing labor pain and promoting labor progress. This systematic review and meta-analysis aimed to gather and analyze all available evidence on the efficacy of dill seeds in reducing labor pain and facilitating labor progress. MethodsThe databases of PubMed/MEDLINE, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and ScienceDirect have been searched since their inception until June 20, 2023. The risk of bias for clinical trials was evaluated using the Cochrane tool and the National Institutes of Health (NIH) quality assessment tool was used for the evaluation of cohort studies. Meta-analysis was performed on the extracted data. Heterogeneity was assessed using the Chi2 and I2 index. Meta-analyses of all the data were done using RevMan 5.4. ResultsA total of 341 studies were identified through the primary search and after data reduction, finally, five articles remained for assessment. The results showed that the duration of the first stage (MD = −1.71, 95 % CI −2.94--0.48, P = 0.006), second stage (MD = −9.90, 95 % CI −15.51--4.29, p = 0.0005), and third stage (MD = −1.34, 95 % CI −2.14--0.54, p = 0.001) of labor were statistically shorter in the dill seed group, compared with that in the control group. Also, regarding pain intensity during the active stage of labor, the results indicated a favorable outcome for dill seed both overall and in the subgroup analyses of cohort and RCT studies. However, the significant finding was present only in the cohort subgroup (p < 0.00001). ConclusionUsing dill seeds in the active phase of labor in low-risk childbearing women could be an effective and low-cost intervention to reduce labor pain and accelerate labor progress. However, more high-quality clinical trials are needed to provide stronger scientific evidence.

The Effect of Effleurage Massage on Reducing the Intensity of Pain in the First Stage of Active Labor

Childbirth is a process of expelling the results of fertilization through a flask from inside the uterus out of the uterus through the vagina spontaneously. Pain is an experience of feeling uncomfortable and unpleasant from a person's sensory and emotional side. The purpose of this study was to determine the effect of Mensage Effinage on reducing the intensity of labor pain in the first active phase. This study used a one-group pre-test post-test design experiment with a sample of 34 respondents. Data was collected using a Verbal Descriptor Scale (VDS) monitoring observation sheet. Data analysis using the normality test on the Wilcoxon Sign Ronk Anamis pararsenic test because the data is not normally distributed or has Wilcoxon status. The results of the study showed that the intensity of pain in the first stage of labor in the active phase can be reduced through effluent massage therapy. This is evidenced by the results of data analysis where p = 0.000 &lt;0.05 so that the Ho result is rejected, H1 is accepted. Effluent Massage Therapy can be used as an alternative that needs to be applied to reduce pregnancy pain in mothers giving birth in the first phase of pregnancy. The conclusion is that massage effluent can reduce the intensity of pain in pregnant women in phase 1.

Snoezelen therapy for pain, labor outcome and maternal satisfaction among parturient at tertiary hospital, South India

IntroductionLabor is a physiological process that causes severe discomfort, leading to maternal dissatisfaction. Snoezelen therapy, a multisensory complementary therapy, promotes comfort and relaxation by releasing endorphins, thereby improving satisfaction during the labor process. ObjectiveTo assess the effectiveness of Snoezelen therapy on pain perception, labor outcomes, and maternal satisfaction among parturients. MethodsAn experimental pretest-posttest control design was conducted among 74 parturient selected using consecutive sampling techniques in South India. Baseline observations were obtained at the beginning of the active stage, after which the study group parturient were subjected to Snoezelen therapy until reaching 10cm of cervical dilatation. Hourly assessments of pain, using a numerical pain scale, were performed. Labor outcomes were measured in terms of labor duration and mode of delivery. Maternal satisfaction with the birth experience and satisfaction with Snoezelen therapy components were collected 24 h after delivery. Descriptive and inferential statistics were used for data analysis. ResultsA statistically significant decrease in pain perception (p < 0.001) and an increase in maternal satisfaction (p < 0.001) were noted among parturient who underwent Snoezelen therapy. Parturient expressed high satisfaction with the use of aroma, music, and massage. There was no statistical significance in the duration of delivery and mode of delivery between the study and control groups. ConclusionSnoezelen therapy reduces pain perception and increases maternal satisfaction during the active stage of labor. Thus, Snoezelen therapy can be implemented as part of nursing care during the labor process.

The Influence of Sehat Jiwa Education on the First Active Phase of Labor in Community Health Centers across Makassar City

During pregnancy, women commonly experience both psychological and emotional changes, leading to concerns about childbirth and potential labor complications. Therefore, education programs became essential for preparing mothers mentally for delivery with the engagement of health workers and families. This study aimed to assess the effectiveness of Sehat Jiwa education on the length of the first active stage of labor. Using a Quasi-experimental design with a two-group control approach, the sample comprised 64 respondents (34 in the intervention group and 30 in the control group). The instruments adopted were the Sehat Jiwa (English: Soul Health) education module, questionnaires, and partograph sheets. The results showed that there was no significant difference in the length of the first active phase between the intervention and control groups, with a p-value of 0.061 &gt; 0.05. However, the average duration for the intervention group (5.88 hours) was slightly shorter than the control group (6.40 hours). Emphasizing Sehat Jiwa-based education for pregnant women was crucial, fostering smoother delivery processes and reducing the likelihood of increased labor complications.&#x0D;

Endorphin Massage on Intensity of Pain in the First Stage of Active Labour

Most maternity mothers feel pain during labor; the causes of pain in Indonesia is 16% because they experience complications, and 63% because they did not get information on childbirth preparation. Pain arises due to increased activity of the sympathetic nervous system and results in blood pressure and pulse. A midwife cannot provide analgetic in reducing pain, so complementary treatments are very helpful, one of which is endorphins massage. Massage therapy can systematically affect the skin surface, soft tissues, muscles, and ligaments. It can release of endorphin hormone that can cause muscle relaxation. This study aims to determine endorphin massage's effect on pain intensity in the first stage of active labor at Public Health Center Mampang Prapatan District, South Jakarta. This study used a quasi-experimental design with a pretest-posttest type of control group. This type involved two groups of subjects, one was treated (experimental group) with 15 samples, and the other was not treated (control group) with 15 samples. The total sample is 30 respondents. The research instrument used an observation sheet to measure pain intensity using the FLACC scale (Face, Legs, Activity, Cry, Consolability). Data analysis used the Wilcoxon signed rank test and the Mann-Whitney test. Based on the results of the Mann-Whitney test, it shows that the Assign value sig. (2-tailed) of 0.000. This means that 0,000 &lt; 0,05, there is a significant difference between the pain intensity of the experimental group that was given endorphin massage and the control group that was not treated. There is a difference between the pain intensity in the first stage of active labor at Public Health Center Mampang Prapatan, South Jakarta. It is recommended that services apply non-pharmacological pain control methods of endorphin massage in labor.

Spiritual Guidance Has an Effect on Decreasing The Level of Anxiety in Mothers During The First Stage of Labor

The birth process is a physiological event. Every mother who will give birth will experience pain as a manifestation of the baby's birth process. The effects of pain experienced by the mother will cause anxiety which often has a negative impact on birth outcomes. Many ways to deal with anxiety during labor are related to reducing pain, but only a few have researched the effect of spiritual guidance on reducing this pain. This study aims to assess the effect of spiritual guidance on the level of anxiety in mothers in the first stage of active labor. This study used a one-group pretest and post-test pre-experimental design on 71 mothers in the first active phase of labor. Anxiety levels were measured using the Hamilton Rating Scale for Anxiety (HSRA). The statistical analysis used is Wilcoxon. The results of the study found that there was a decrease in anxiety from before and after being given spiritual support to mothers in the first stage of labor. It is very important to provide childbirth support such as spiritual guidance to birth mothers in reducing their anxiety levels

Alternative to Intensive Management of the Active Phase of the Second Stage of Labor: A Multicenter Randomized Trial (Phase Active du Second STade Trial) Among Nulliparous Women With an Epidural

ABSTRACT The optimal management of second stage of labor, with its passive and active phases, remains controversial. In France, delayed pushing during the active phase is recommended because of the belief that, based on older data, the fetus is at higher risk during the active phase. It is possible that uterine contractions combined with maternal pushing can lead to cord compression and reduce placental perfusion and oxygenation, which can induce acidosis and fetal heart rate abnormalities, resulting in the need for medical intervention, such as operative vaginal delivery (OVD) or episiotomy. In countries where the active phase is limited, women are encouraged to push as strongly as possible to speed delivery. However, if the active second stage of labor is prolonged, this intensive management may increase fetal hypoxia. The aim of this study was to examine the effect of moderate pushing versus intensive pushing in the second stage of labor on the risk of neonatal morbidity. This was a multicenter, randomized controlled trial at 13 French maternity units between January 2017 and May 2020. Included were nulliparous, adult women who had spontaneous or induced, uncomplicated delivery of a singleton fetus at ≥37 weeks of gestation. Excluded were women with a psychiatric condition, a disease contraindicating intensive expulsive efforts, or any uterine surgical scar, as well as those with a fetus that was small for gestational age, had congenital abnormalities, or had abnormal heart rate. Eligible women were randomized into 2 groups: the intervention group was instructed to push moderately only during the active phase of the second stage of labor, and the control group was instructed to push intensively during the same phase following French recommendations. Midwives asked the intervention group to push 2 times during each contraction and to take a break with no pushing in 1 of 5 contractions. No limit was set on pushing duration. The control group was asked to push 3 times per contraction without breaks. After 30 minutes of pushing, the midwife contacted an obstetrician to consider operative delivery. The primary outcome was a composite of neonatal acidosis, a 5-minute Apgar score &lt;7, and/or severe neonatal trauma. Secondary neonatal outcomes were transfer to the neonatology unit or intensive care unit need for resuscitation at birth and need for hypothermia. Secondary maternal outcomes were mode of delivery, postpartum hemorrhage (PPH), and severe PPH. The trial was stopped prematurely because of difficulties obtaining an adequate sample size. Of the 3380 women initially planned, 1710 (50.6%) were included. Ultimately, the intention-to-treat analysis included 809 women in each group. The neonatal morbidity rates for the intervention group and control group were 18.9% and 20.6%, respectively (risk ratio [RR] 0.92; 95% confident interval [CI], 0.75–1.12; P = 0.38). No significant differences were observed for neonatal transfer or need for resuscitation. All but 16 women delivered vaginally. The intervention or moderate pushing group had a longer pushing duration than the control or intensive pushing group (38.8 ± 26.4 vs 28.6 ± 17.0 minutes; P &lt; 0.001) and lower episiotomy rate (13.5% vs 17.8%; RR, 0.76; 95% CI, 0.60–0.95; P = 0.02). The rates of OVD were 21.1% in the intervention group and 24.8% in the control group (RR, 0.85; 95% CI, 0.71–1.02; P = 0.08). No significant differences were observed for PPH or severe PPH. During the active stage of labor, encouraging women to push moderately versus intensively was not associated with decreased neonatal morbidity. Although the pushing duration was longer among women instructed to push moderately, the rate of episiotomy was lower.

Efektivitas Pemberian Metode Pijat Oksitosin Dan Pijat Akupresur Terhadap Lama Persalinan Kala I Fase Aktif

Introduction: In Banten, in 2019 the cause of maternal death was recorded at 22,5% caused by other causes, one of which was due to prolonged labor, as well as Cimanggu Health Center in 2021 found 1 case of maternal death caused by bleeding the cause was due to prolonged parturition. One way to speed up the progress of labor is by giving oxytocin massage and acupressure massage. The purpose of the study was to determine the effectiveness of giving oxytocin massage and acupressure massage for the duration of the active phase of the first stage of labor at the Cimanggu Health Center, Pandeglang Regency, Banten in 2022. Methods: The research method was a quasi-experimental design with a post-test-only design with control groups, the number of samples was 60 respondents, the sampling technique was purposive sampling, and data analysis using the Independent T-test. Result: The results of the study showed that the duration of the first stage of active labor in the oxytocin massage group obtained an average of = 6,84 hours, the duration of the active phase of the first stage of labor in the acupressure massage group obtained an average of 5,34 hours. The results of the bivariate analysis showed that there was an average difference between oxytocin massage and acupressure massage on the duration of the active phase of the first stage of labor with a p-value of 0,000. Discussion: The conclusion of the study was that there was an average difference between oxytocin massage and acupressure massage on the duration of the active phase of the first stage of labor. Suggestions are expected for health workers, are expected to always be updated, especially in helping mothers give birth to meet the mother's need for comfort in non-pharmacological pain control, one of which is using acupressure or oxytocin massage techniques.

Effectiveness of antepartum breathing exercises on the outcome of labour: A randomized controlled trial

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&lt;.001). Also, the requirement for augmentation of labour was minimal and there was a reduction in the rate of caesarean deliveries (p &lt;.05) based on the χ2 test. The overall mean duration of labour was less compared to standard care group F(1)= 133.800, p &lt;.001. Conclusion Antepartum breathing exercises during labour can facilitate spontaneous vaginal birth, shorten the duration of labour, and reduce the need for operative interference.

Effects of vaginal lichen planus on pregnancy

Introduction: Lichen planus is an inflammatory condition that can affect the vulva and vagina. Although more common in women over 50 years of age, lichen planus can affect younger women and complicate pregnancy. During pregnancy, lichen planus can cause vaginal irritation, antepartum bleeding, and postpartum hemorrhages. It is imperative to maintain good control of the disease during pregnancy with topical corticosteroids. Case Report: A 35-year-old female with a history of vaginal lichen planus, on vaginal hydrocortisone, presented to the labor and delivery ward in the active stage of labor. She proceeds with a vaginal delivery that is followed by a postpartum hemorrhage requiring a blood transfusion. The postpartum hemorrhage was secondary to bleeding from the vaginal mucosa that was intolerant to sutures. Bleeding was then controlled with topical hemostatic agents as well as vaginal packing. Conclusion: Uncontrolled vaginal lichen planus can be associated with postpartum hemorrhage at the time of delivery. Some providers may recommend a cesarean section to prevent these outcomes; however, instead it is recommended to focus on adequate control of the disease prior to delivery and to proceed with a vaginal delivery. Standard regimens of topical corticosteroids can be safe and effective at preventing flares of lichen planus in pregnancy. In the event of a postpartum hemorrhage secondary to lichen planus, topical hemostatic agents and vaginal packing should be implemented as means to minimize blood loss.

Continued versus discontinued oxytocin after the active phase of labor: An updated systematic review and meta-analysis.

To systematically assess the effect of discontinued vs continued oxytocin after active stage of labour is established. Pubmed, Embase, and the Cochrane Library were systematically searched to 18 April 2021. The risk ratio or mean difference with corresponding 95% confidence interval were computed to investigate the effect of intervention or control on maternal and fetus outcomes. This review was registered in the International Prospective Register of Systematic Reviews: CRD42021249635. Discontinuing oxytocin when the active labour was established might decrease the risk of cesarean delivery [RR (95% CI): 0.84 (0.72-0.98), P = 0.02]. However, when we restricted our analysis to women who performed cesarean section after the active phase was reached, the difference was no longer significant [RR (95% CI): 0.82 (0.60-1.10), P = 0.19]. The incidence of uterine tachysystole [RR (95% CI): 0.36 (0.27-0.49)], postpartum hemorrhage [RR (95% CI): 0.78 (0.65-0.93)], and non-reassuring fetal heart rate [RR (95% CI): 0.66 (0.58-0.76)] were significantly lower in the oxytocin discontinuation group. We also found a possible decrease in the risk of chorioamnionitis in discontinued oxytocin group [RR (95% CI): 2.77 (1.02-5.08)]. An increased duration of active [MD (95% CI): 2.28 (2.86-41.71)] and second [MD (95% CI): 5.36 (3.18-7.54)] phase of labour was observed in discontinued oxytocin group, while the total delivery time was not significantly different [MD (95% CI): 20.17 (-24.92-65.26)]. After the active labor is reached, discontinuation of oxytocin could be considered a new recommendation for the improved maternal and fetal outcomes without delaying labour.

Effectiveness of Belly Dance in Reducing Women's Pain in Labor through Coupling Style

One alternative that pregnant women usually use is belly dance. This exercise has provided a high sense of self-confidence for pregnant women. This research will be carried out to see the relationship between belly dance and labor pain in the first stage of the active phase. The design of this research is cross-sectional. The results of this study then found a relationship between coping styles and the active phase I labor pain scale. There is no relationship between belly dance and the labor pain scale of the active phase I. Pregnant women who participate in belly dance will reduce pain in the first stage of active labor after controlling for coping style variables. Then it was also found that belly dance can be used as an alternative movement in pregnancy exercise.

Pengaruh Metode Birth Ball Terhadap Intensitas Nyeri Persalinan Kala I Fase Aktif di Praktek Mandiri Bidan (PMB) Fifi Maryoni

Labor is a natural process and causes pain caused by contractions when the mother is about to give birth. One of the non-pharmacological methods that can be used is the birth ball method, which is a method of using a rubber ball filled with air to reduce back pain during pregnancy and childbirth which is safe to use. The purpose of this study was to determine the effect of this type of research, a quasi-experimental design with a pretest-postets group design, by measuring the intensity of labor pain in the first stage of the active phase before and after being given treatment in the group given the birth ball method. The population of this study were all mothers who gave birth normally at PMB Fifi Maryoni from November 2020 to February 2021, the study sample consisted of 30 people in the treatment group. The intensity of labor pain in the active phase of the first stage was measured and recorded directly on the observation sheet provided. Data analysis was carried out bivariate with computerization using the SPSS program. The statistical test used was T - test dependent with a 95% confidence degree (α = 0.05). The results showed that there was a decrease in the intensity of labor pain in the active phase of the first stage after the birth ball method was used. The results showed that there was an effect of the birth ball method on decreasing the intensity of labor pain in the first stage of the active phase before and after being given the birth ball method with p value = 0.000. It is recommended to PMB Fifi Maryoni to be able to provide the birth ball method as one of the non-pharmacological methods in reducing the intensity of labor pain in the first stage of active labor so that the mother can overcome pain during labor.

Effectiveness of antepartum breathing exercises on the outcome of labour: A randomized controlled trial

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&lt;.001). Also, the requirement for augmentation of labour was minimal and there was a reduction in the rate of caesarean deliveries (p &lt;.05) based on the χ2 test. The overall mean duration of labour was less compared to standard care group F(1)= 133.800, p &lt;.001. Conclusion Antepartum breathing exercises during labour can facilitate spontaneous vaginal birth, shorten the duration of labour, and reduce the need for operative interference.

Labour epidural practice in a tertiary training centre

Dear Editor, Labour analgesia provided through the central neuraxial approach is offered for parturients who are in their active stage of labour, usually after 2–4cm of cervical dilatation. Lumbar epidural, the gold standard for labour analgesia, is recently recommended over other alternative methods of analgesia such as pressurised gaseous nitrous oxide, to minimise aerosol-related risks

Effects of the addition of transcutaneous electrical stimulation to non-pharmacological measures in labor pain: study protocol for a randomized controlled trial

BackgroundLabor, although natural and physiological, is a period that can be marked by stress, pain, anxiety, suffering, fear, and anguish for a woman. Thus, non-pharmacological methods that reduce pain during labor are important to allow a better experience without the use of medications. Therefore, the aim of this study is to evaluate the effects of non-pharmacological pain relief methods, added or not to the application of transcutaneous electrical stimulation (TENS), on pain, satisfaction with the childbirth, duration of labor, and newborn conditions.MethodsThis is a randomized controlled clinical trial, with a non-probabilistic convenience sample, composed of women in the first active stage of labor, admitted to a public institution. The parturients will be divided into 3 groups: group 1 (n = 36) composed of parturients who will have continuous support and will be encouraged to walk, adopting different positions with the use of the Swiss ball and receiving back massage for 30 min; group 2 (n = 36) composed of parturients who will also have continuous support and will be encouraged to walk, adopt different positions using the Swiss ball, and will receive the application of TENS for 30 min; and group 3 (n = 36) composed of parturients who will have continuous support and will be encouraged to walk, adopting different positions with the use of the Swiss ball, and will receive placebo TENS application for 30 min. The outcomes evaluated in the study will be pain intensity assessed by the visual analog scale of pain applied before, immediately after, and 30 min and 1 h after the interventions; Experience and Satisfaction with Childbirth Questionnaire (QESP) applied 12 to 24 h after delivery; and data regarding delivery (type of delivery, total duration of labor, and possible obstetric complications) and neonate (weight, height, possible complications, Apgar score in the first and fifth minutes).DiscussionWith this research, it is expected to understand the effects of the intervention through TENS electrostimulation added to other non-pharmacological methods for pain management during labor.Trial registrationBrazilian Registry of Clinical Trials (REBEC) RBR-68kh6j. Registered on March 17, 2020

Meta-Analysis: Are Acupressure and Birthing Ball Exercise Associated with Labor Pain?

Background: Management of pain in labor is identified as one of the most important topics related to pregnancy and childbirth. Acupressure and birthing ball exercise are one of the non-pharmacological methods of managing labor pain to help mothers cope with the labor process. This management can relieve pain sensations by increasing the woman's well-being, comfort, and sense of control in labor. This study aims to estimate the effect of acupressure and birthing ball exercise on labor pain. Subjects and Method: This was a systematic review and meta-analysis conducted using PRISMA flow diagrams. Search articles through journal databases including: PubMed, Science Direct, Google Schoolar and SpingerLink by selecting articles published in 2010-2021. The key­words used are (“labor pain” OR labor pain) “AND (“acupressure” OR “acupressure hegu”) AND (“birthing ball” OR “birthing ball exercise”) AND “randomized controlled trial”. Inclusion criteria were full paper articles with Randomized Controlled Trial (RCT) research methods, the size of the relation­ship used with Mean SD, the intervention given was acupressure and birthing ball exer­cise, research subjects were mothers in the first stage of active labor. Eligible articles were ana­lyzed using the Revman 5.3 application. Results: Meta-analysis of 16 articles showed results for acupressure (SMD -1.29; 95% CI= -2.35 to 0.24; p=0.02) and birthing ball exercise (SMD -0.73; 95% CI= -1.56 to 0.11; p=0.09). Conclusion: Acupressure and birthing ball exercise each have an effect on reducing labor pain.

Role of Occiput Spinal Angle-A Novel Sonographic Index to predict the outcome of labour

Introduction: The attitude (relationship of head of a fetus to the cervical spine) in the first stage of labour has a significant impact on the outcome of labour. Deflexion of the fetal head is determined by digital vaginal examination during labour. However, different ultra-sonographic indexes have been developed to predict labour outcomes. Occiput spine angle (OSA) is a novel ultra-sonographic marker which can be used to predict operative delivery.&#x0D; Objective: To determine the effect of the occipital spinal angle measured through transabdominal ultrasound during the first stage of labour on the labour outcome.&#x0D; Materials and Methods: This prospective cross-sectional study was carried out at Department of Obstetrics and Gynecology Unit 2, Holy Family Hospital, Rawalpindi from June 2020 to Dec 2020 which included 380 low-risk pregnant women in the first active stage of labour. Occipital-spine angle (OSA) was defined as the angle formed by the fetal occiput and the cervical spine on the sagittal plane at the transabdominal ultrasound. For each case, the angle was calculated twice and independently by the 2 radiologists who were unaware of labour outcome to minimize intra and inter-observer error. Data were analyzed using SPSS version 23.0. P-value ≤ 0.05 was considered significant.&#x0D; Results: Incidence of operative delivery was 17.2%. A cut-off value of 1260125.50 of OSA had a sensitivity of 92.3% and specificity of 98.1% to predict operative delivery. Binary Logistic Regression showed that gestational age, OSA, and Head station are significant with the OR= 1.15, 0.711, and 0.32 respectively.&#x0D; Conclusion: OSA is a good predictor of operative delivery at a cut-off value of 1260. It should be determined at routine ultrasound booking during pregnancy. More studies should be conducted to highlight its importance.&#x0D;

Prospective Evaluation of the Ultrasound Signs Proposed for the Description of Uterine Niche in Nonpregnant Women.

To evaluate the new ultrasound-based signs for the diagnosis of post-cesarean section uterine niche in nonpregnant women. We investigated prospectively a cohort of 160 consecutive women with one previous term cesarean delivery (CD) between December 2019 and 2020. All women were separated into two subgroups according to different stages of labor at the time of their CD: subgroup A (n= 109; 68.1%) for elective CD and CD performed in latent labor at a cervical dilatation (≤4 cm) and subgroup B (n= 51; 31.9%); for CD performed during the active stage of labor (>4 cm). Overall, the incidence of a uterine niche was significantly (P< .001) higher in women who had an elective (20/45; 44.4%) compared with those who had an emergent (21/115; 18.3%) CD. Compared with subgroup B, subgroup A presented with a significantly (P= .012) higher incidence of uterine niche located above the vesicovaginal fold and with a significantly (P= .0002) lower proportion of cesarean scar positioned below the vesicovaginal fold. There was a significantly (P< .001) higher proportion of women with a residual myometrial thickness (RMT) > 3 mm in subgroup A than in subgroup B and a significant negative relationship was found between the RMT and the cervical dilatation at CD (r= -0.22; P= .008). Sonographic cesarean section scar assessment indicates that the type of CD and the stage of labor at which the hysterotomy is performed have an impact on the location of the scar and the scarification process including the niche formation and RMT.

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.