Assessment Of Fetal Well-being Research Articles

The Value of Middle Cerebral Artery and Umbilical Artery Doppler Indices in Assessment of Fetal Wellbeing and Prediction of Neonatal Outcome in Preeclampsia

To evaluate the value of middle cerebral artery and umbilical artery Doppler indices in assessment of fetal wellbeing and prediction of neonatal outcome in pregnant women with preeclampsia.

The Value of Middle Cerebral Artery and Umbilical Artery Doppler Indices in Assessment of Fetal Wellbeing and Prediction of Neonatal Outcome in Preeclampsia

Aim of The Study: To evaluate the value of middle cerebral artery and umbilical artery Doppler indices in assessment of fetal wellbeing and prediction of neonatal outcome in pregnant women with preeclampsia. Patients and Methods: This study included 100 pregnant women with preeclampsia, 50 women with uneventful pregnancies, Ultrasound and Doppler studies were carried out to estimate fetal weight, fetal biophysical profile and resistance indices of the middle cerebral and umbilical arteries. C/U RI <1.0 was considered abnormal. Adverse neonatal outcome was diagnosed when Apgar score <6 at 5 minutes, C.S for fetal distress, stained meconium, abnormal BPP, perinatal death and/or neonatal admission to neonatal intensive care unit. Results: adverse neonatal outcome in groups A, B and C was significantly correlated to UA-RI and UA-PI. Between the normal and adverse neonatal outcome, in group A, there was a significant difference in UA-RI (P-value = 0.021); in group B, there was a significant difference in UA-RI and UA-PI (P-value <0.001 and P-value <0.001 respectively); and in group C, there was a significant difference in UA-RI and UA-PI (P-value <0.001 and P-value =0.004 respectively). In our study, both absent and reversed diastolic flows were significantly correlated with bad neonatal outcome in the study group (P value <0.001, r-value = 0.428). Conclusions: MCA and UA Doppler indices are good utilities for the assessment of fetal wellbeing and prediction of neonatal outcome in pregnant women with preeclampsia.

Effectiveness of vascular symptom management package on vascular symptoms, quality of life, and perinatal outcome among pregnant women with pregnancy-induced hypertension - A pilot investigation

Background: Pregnancy-Induced Hypertension (PIH) is a high-risk condition which implies a threat to pregnancy, either by means of the mother’s health or the health of the fetus. In PIH, the underlying basic pathology is endothelial dysfunction and intense vasospasm affecting almost all the vessels, particularly those of uterus, kidney, placental bed, and brain result the symptoms called vascular symptoms. Thus, PIH affects QOL of pregnant women and perinatal outcome. Objectives: The aim of this study was to assess the effect of Vascular Symptom Management Package (VSMP) on vascular symptoms, QOL of pregnant women with PIH & perinatal outcome. Materials and Methods: Quantitative approach with true experimental design was adopted. Ten pregnant women with PIH were selected for the study using purposive sampling technique. Subjects were randomly assigned to the experimental and control group using Sequentially Numbered, Opaque Sealed Envelopes (SNOSE) (5 in the experimental group and 5 in the control group). VSMP includes two sessions: 1-Instructions on strategies to manage each vascular symptoms, fetal well-being assessment, sleep health behavior education, warning signs of complications, and importance of compliance to interventions. 2- Demonstration on Systematic muscle relaxation techniques, Diaphramatic breathing and muscle stretching exercises. The tools used to collect the data were as follows: (1) Demographic questionnaire, (2) vascular symptom assessment scale, (3) Women’s Health Initiative Insomnia Rating Scale (WHIIRS), (4) Edinburg Postnatal Depression Scale (EPDS), (5) WHOQOL–BREF, and (6) perinatal outcome questionnaire. Informed written consent was taken from each participant. Baseline assessment was done on the 1st day and the first session of intervention was implemented on the same day. The second session of intervention was implemented after 1 week. Post-assessment was done after 4 weeks. Mothers were followed till immediate puerperium and perinatal outcome was assessed. Phone calls & weekly meeting were done to make the mother to adhere in practice. The data analyzed using descriptive and inferential statistics. Results: The post-test mean rank of vascular symptoms of the experimental group was lower (P ≤ 0.05) than that of the control group. The mean post-QOL score of the experimental groups was higher (P ≤ 0.05) than that of mean post-QOL score of the control group. The mean rank of all parameters of perinatal outcome in the experimental group was lower (P ≤ 0.05) than that of the control group. Hence, it can be interpreted that VSMP is effective to improve the reduce the vascular symptoms, improve the QOL & perinatal outcome. Conclusion: PIH is a life-threatening condition. The findings of this study show that the effectiveness of VSMP improves the QOL. Hence, VSMP is a nurse-led intervention which can be implemented to effectively reduce the vascular symptoms and improve the QOL of pregnant women with PIH.

Cardiotocographic Signal Feature Extraction Through CEEMDAN and Time-Varying Autoregressive Spectral-Based Analysis for Fetal Welfare Assessment

Cardiotocograph (CTG) is a widely used tool for fetal surveillance during labor, which provides the joint recording of fetal heart rate (FHR) and uterine contraction data. Unfortunately, the CTG interpretation is difficult because it involves a visual analysis of highly complex signals. Recent clinical research indicates that a correct CTG assessment requires a good understanding of the fetal compensatory mechanisms modulated by the autonomic nervous system. Certainly, this modulation reflects variations in the FHR, whose characteristics can involve significant information about the fetal condition. The main contribution of this work is to investigate these characteristics by a new approach combining two signal processing methods: the complete ensemble empirical mode decomposition with adaptive noise (CEEMDAN) and time-varying autoregressive (TV-AR) modeling. The idea is to study the CEEMDAN intrinsic mode functions (IMFs) in both the time-domain and the spectral-domain in order to extract information that can help to assess the fetal condition. For this purpose, first, the FHR signal is decomposed, and then for each IMF, the TV-AR spectrum is computed in order to study their spectral dynamics over time. In this paper, we first explain the foundations of our proposed features. Then, we evaluate their performance in CTG classification by using three machine learning classifiers. The proposed approach has been evaluated on real CTG data extracted from the CTU-UHB database. Results show that by using only conventional FHR features, the classification performance achieved 78, 0%. Then, by including the proposed CEEMDAN spectral-based features, it increased to 81, 7%.

Introduction of a new fetal examination protocol for on-field and clinical equine practice

Prepartum fetal surveillance techniques have been widely used in both human and veterinary obstetrics, although these tests differ in their sensitivity for the assessment of fetal well-being. In equine reproduction, the ‘gold standard’ examination technique is the equine biophysical profile (EBP) described by Virginia Reef in 1995. Although this fetal assessment has many benefits, its accuracy, sensitivity and specificity have not been evaluated so far. In this study, 129 late-term pregnant mares were scanned twice in their last month of gestation using two different protocols (the EBP and a new, rapid examination protocol, REP) in order to determine the accuracy of these tests. The REP included the determination of fetal heart rate, fetal aortic diameter and the combined thickness of the uteroplacental unit. Twenty-seven fetuses proved to be compromised and 102 mares had healthy asymptomatic foals. Statistical analyses showed slight differences in test sensitivity (81.48% and 85.19%), specificity (83.3% and 87.25%) and accuracy (82.95% and 86.82%) for EBP and REP, respectively. Furthermore, a statistically significant interchangeability could be demonstrated between the two methods. It is concluded that, depending on the prevalence of the disease (here: compromised state), both methods are useful for the diagnosis of fetal abnormalities and make it possible to provide satisfactory care for broodmares and their fetuses.

Trans-abdominal in vivo placental vessel occlusion using High Intensity Focused Ultrasound

Pre-clinically, High Intensity Focused Ultrasound (HIFU) has been shown to safely and effectively occlude placental blood vessels in the acute setting, when applied through the uterus. However, further development of the technique to overcome the technical challenges of targeting and occluding blood vessels through intact skin remains essential to translation into human studies. So too does the assessment of fetal wellbeing following this procedure, and demonstration of the persistence of vascular occlusion. At 115 ± 10 d gestational age (term~147 days) 12 pregnant sheep were exposed to HIFU (n = 6), or to a sham (n = 6) therapy through intact abdominal skin (1.66 MHz, 5 s duration, in situ ISPTA 1.3–4.4 kW.cm−2). Treatment success was defined as undetectable colour Doppler signal in the target placental vessel following HIFU exposures. Pregnancies were monitored for 21 days using diagnostic ultrasound from one day before HIFU exposure until term, when post-mortem examination was performed. Placental vessels were examined histologically for evidence of persistent vascular occlusion. HIFU occluded 31/34 (91%) of placental vessels targeted, with persistent vascular occlusion evident on histological examination 20 days after treatment. The mean diameter of occluded vessels was 1.4 mm (range 0.3–3.3 mm). All pregnancies survived until post mortem without evidence of significant maternal or fetal iatrogenic harm, preterm labour, maternal or fetal haemorrhage or infection. Three of six ewes exposed to HIFU experienced abdominal skin burns, which healed without intervention within 21 days. Mean fetal weight, fetal growth velocity and other measures of fetal biometry were not affected by exposure to HIFU. Fetal Doppler studies indicated a transient increase in the umbilical artery pulsatility index (PI) and a decrease in middle cerebral artery PI as a result of general anaesthesia, which was not different between sham and treatment groups. We report the first successful application of fully non-invasive HIFU for occlusion of placental blood flow in a pregnant sheep model, with a low risk of significant complications. This proof of concept study demonstrates the potential of this technique for clinical translation.

Sparse learning for Intrapartum fetal heart rate analysis

Fetal Heart Rate (FHR) monitoring is used during delivery for fetal well-being assessment. Classically based on the visual evaluation of FIGO criteria, FHR characterization remains a challenging task that continuously receives intensive research efforts. Intrapartum FHR analysis is further complicated by the two different stages of labor (dilation and active pushing). Research works aimed at devising automated acidosis prediction procedures are either based on designing new advanced signal processing analyses or on efficiently combining a large number of features proposed in the literature. Such multi-feature procedures either rely on a prior feature selection step or end up with decision rules involving long lists of features. This many-feature outcome rule does not permit to easily interpret the decision and is hence not well suited for clinical practice. Machine-learning-based decision-rule assessment is often impaired by the use of different, proprietary and small databases, preventing meaningful comparisons of results reported in the literature. Here, sparse learning is promoted as a way to perform jointly feature selection and acidosis prediction, hence producing an optimal decision rule based on as few features as possible. Making use of a set of 20 features (gathering ‘FIGO-like’ features, classical spectral features and recently proposed scale-free features), applied to two large-size (respectively ≃1800 and ≃500 subjects), well-documented databases, collected independently in French and Czech hospitals, the benefits of sparse learning are quantified in terms of: (i) accounting for class imbalance (few acidotic subjects), (ii) producing simple and interpretable decision rules, (iii) evidences for differences between the temporal dynamics of active pushing and dilation stages, and (iv) of validity/generalizability of decision rules learned on one database and applied to the other one.

Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment of fetal wellbeing: an updated systematic review

Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment of fetal wellbeing: an updated systematic review

Значимость кардиотокографии и лактат-теста в оценке состояния плода во время родов

Значимость кардиотокографии и лактат-теста в оценке состояния плода во время родов

Comparison of umbilical artery Doppler and non-stress test in assessment of fetal well-being in gestational diabetes mellitus: A prospective cohort study.

BackgroundGestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy and is related to poor perinatal outcomes. Reduction of neonatal complications of GDM is feasible by assessment of fetal well-being. Both fetal Doppler and NST are used for the screening of high-risk pregnancies.ObjectiveWe aimed to compare the non-stress test (NST) and umbilical artery (UA) Doppler assessments for evaluation of the adverse perinatal outcomes in GDM.MethodsWe conducted a prospective cohort study on 50 pregnant women with GDM in Jame Zanan Hospital, Tehran, Iran, from Oct 2014 to Sep 2015. A convenient sampling method was used for patient recruitment. Inclusion criteria were women with GDM, singleton pregnancies, and gestational age>32 weeks who had neither medical conditions nor fetal anomalies. Adverse perinatal outcomes were defined as Apgar scores at 1-min and 5-min <7, hypoglycemia (blood glucose <45 mg/dl), neonatal acidosis (PH<7.2), hypocalcemia (Ca<8 mg/dl), admission to the NICU for more than 24 hours, and perinatal death. Statistical analyses were performed with SPSS version 16 using Chi-square, Fisher’s exact test, and independent-samples t-test. The significance level was considered at 0.05.ResultsTotally, 22% and 12% of women had an abnormal UA Doppler and a non-reactive NST respectively. Poor outcomes were detected in 13 women. The most frequent poor outcomes were hypoglycemia (n=9), Apgar 1-min <7 (n=8), neonate admitted in NICU (n=6), and respiratory distress syndrome (n=6). Poor outcome was more prevalent in women with non-reactive NST (p<0.001), abnormal UA Doppler (p=0.033), and those with infant birth weight >4000 gram (p=0.033). Sensitivity and specificity of the NST in predicting different poor outcomes were 76.9% and 97.3% respectively. Sensitivity and specificity of UA Doppler in predicting different poor outcomes were 30.8% and 94.6% respectively.ConclusionNST is a better predictor of adverse perinatal outcomes in GDM patients.

Intrapartum assessment of fetal well-being

Intrapartum assessment of fetal well-being

Cardiotocography versus intermittent auscultation of foetal heart on admission to labour ward for assessment of foetal wellbeing.

Cardiotocography versus intermittent auscultation of foetal heart on admission to labour ward for assessment of foetal wellbeing.

Gender-specific evolution of fetal heart rate variability throughout gestation: A study of 8823 cases

BackgroundFetal heart rate (FHR) variability throughout gestation reflects aspects of fetal development, and its analysis has been used for the assessment of fetal well-being. AimThe objective of this study was to provide a gender-specific analysis of the evolution of FHR variability indices throughout gestation, using linear time-domain, spectral and nonlinear FHR indices. Study designA large retrospective study was carried out using antepartum FHR recordings obtained from 4713 male and 4110 female fetuses, with normal pregnancy outcome, between 2004 and 2013, with gestational ages ranging between 25 and 40weeks. Outcome measuresFHR variability was analysed through linear time-domain methods, as well as using spectral analysis and entropy indices. Evolution of FHR indices throughout gestation was analysed through Spearman correlation coefficient. Comparison between male and female fetuses was performed using nonparametric bootstrap 95% confidence intervals for the median. ResultsMean FHR decreased significantly throughout gestation, whereas most variability indices increased. Sympatho-vagal balance measured by spectral analysis exhibited two local maxima at 29–30 and 34–35weeks and decreased afterwards. Entropy indices increased until around the 34th week, slightly decreasing after the 37th week. Female fetuses presented higher mean FHR and entropy from the 34th week afterwards, and lower short-term variability and sympatho-vagal balance in the same period. ConclusionsSpectral and entropy analysis should be considered as a complement to conventional FHR variability analysis, aiming at a better characterization and follow-up of fetal development/maturation throughout gestation. Additionally, gestational age needs to be considered when defining reference ranges for FHR indices in systems of computerized analysis.

Investigating pH based evaluation of fetal heart rate (FHR) recordings

Cardiotocography (CTG) is a standard tool for the assessment of fetal well-being during pregnancy and delivery. However, its interpretation is associated with high inter- and intra-observer variability. Since its introduction there have been numerous attempts to develop computerized systems assisting the evaluation of the CTG recording. Nevertheless these systems are still hardly used in a delivery ward. Two main approaches to computerized evaluation are encountered in the literature; the first one emulates existing guidelines, while the second one is more of a data-driven approach using signal processing and computational methods. The latter employs preprocessing, feature extraction/selection and a classifier that discriminates between two or more classes/conditions. These classes are often formed using the umbilical cord artery pH value measured after delivery. In this work an approach to Fetal Heart Rate (FHR) classification using pH is presented that could serve as a benchmark for reporting results on the unique open-access CTU-UHB CTG database, the largest and the only freely available database of this kind. The overall results using a very small number of features and a Least Squares Support Vector Machine (LS-SVM) classifier, are in accordance to the ones encountered in the literature and outperform the results of a baseline classification scheme proving the utility of using advanced data processing methods. Therefore the achieved results can be used as a benchmark for future research involving more informative features and/or better classification algorithms.

Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment of fetal wellbeing.

The admission cardiotocograph (CTG) is a commonly used screening test consisting of a short (usually 20 minutes) recording of the fetal heart rate (FHR) and uterine activity performed on the mother's admission to the labour ward. This is an update of a review published in 2012. To compare the effects of admission cardiotocography with intermittent auscultation of the FHR on maternal and infant outcomes for pregnant women without risk factors on their admission to the labour ward. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register to 30 November 2016 and we planned to review the reference list of retrieved papers All randomised and quasi-randomised trials comparing admission CTG with intermittent auscultation of the FHR for pregnant women between 37 and 42 completed weeks of pregnancy and considered to be at low risk of intrapartum fetal hypoxia and of developing complications during labour. Two authors independently assessed trial eligibility and quality, and extracted data. Data were checked for accuracy. We included no new trials in this update. We included four trials involving more than 13,000 women which were conducted in the UK and Ireland and included women in labour. Three trials were funded by the hospitals where the trials took place and one trial was funded by the Scottish government. No declarations of interest were made in two trials; the remaining two trials did not mention declarations of interest. Overall, the studies were assessed as low risk of bias. Results reported in the 2012 review remain unchanged.Although not statistically significant using a strict P < 0.05 criterion, data were consistent with women allocated to admission CTG having, on average, a higher probability of an increase in incidence of caesarean section than women allocated to intermittent auscultation (risk ratio (RR) 1.20, 95% confidence interval (CI) 1.00 to 1.44, 4 trials, 11,338 women, I² = 0%, moderate quality evidence). There was no clear difference in the average treatment effect across included trials between women allocated to admission CTG and women allocated to intermittent auscultation in instrumental vaginal birth (RR 1.10, 95% CI 0.95 to 1.27, 4 trials, 11,338 women, I² = 38%, low quality evidence) and perinatal mortality rate (RR 1.01, 95% CI 0.30 to 3.47, 4 trials, 11,339 infants, I² = 0%, moderate quality evidence).Women allocated to admission CTG had, on average, higher rates of continuous electronic fetal monitoring during labour (RR 1.30, 95% CI 1.14 to 1.48, 3 trials, 10,753 women, I² = 79%, low quality evidence) and fetal blood sampling (RR 1.28, 95% CI 1.13 to 1.45, 3 trials, 10,757 women, I² = 0%) than women allocated to intermittent auscultation. There were no differences between groups in other secondary outcome measures including incidence and severity of hypoxic ischaemic encephalopathy (incidence only reported) (RR 1.19, 95% CI 0.37 to 3.90; 2367 infants; 1 trial; very low quality evidence) and incidence of seizures in the neonatal period (RR 0.72, 95% CI 0.32 to 1.61; 8056 infants; 1 trial; low quality evidence). There were no data reported for severe neurodevelopmental disability assessed at greater than, or equal to, 12 months of age. Contrary to continued use in some clinical areas, we found no evidence of benefit for the use of the admission CTG for low-risk women on admission in labour.Furthermore, the probability is that admission CTG increases the caesarean section rate by approximately 20%. The data lacked power to detect possible important differences in perinatal mortality. However, it is unlikely that any trial, or meta-analysis, will be adequately powered to detect such differences. The findings of this review support recommendations that the admission CTG not be used for women who are low risk on admission in labour. Women should be informed that admission CTG is likely associated with an increase in the incidence of caesarean section without evidence of benefit.Evidence quality ranged from moderate to very low, with downgrading decisions based on imprecision, inconsistency and a lack of blinding for participants and personnel. All four included trials were conducted in developed Western European countries. One additional study is ongoing.The usefulness of the findings of this review for developing countries will depend on FHR monitoring practices. However, an absence of benefit and likely harm associated with admission CTG will have relevance for countries where questions are being asked about the role of the admission CTG.Future studies evaluating the effects of the admission CTG should consider including women admitted with signs of labour and before a formal diagnosis of labour. This would include a cohort of women currently having admission CTGs and not included in current trials.

Developing Nursing Management Protocol for Maternity Nurses Regarding Emergency Obstetric Care

The aim of the study was to develop nursing management protocol for maternity nurses regarding obstetric emergencies. An intervention (quasi experimental) study design was used. The study was conducted in the Obstetrics and Gynecology Emergencies Department at Benha University Hospital. A convenient sample of all nurses working in Obstetrics and Gynecology emergencies department at Benha University Hospital (40 nurse). Two tools were used for data collection; I) A structured interviewing questionnaire: include two parts; Part 1: Socio demographic characteristics of the study nurses: included (Age, educational level, years of experience, previous training program). Part 2: Assessment of nurses’ knowledge regarding obstetric emergencies such as definition, causes, basic priorities and preparations for emergency obstetrics care. II) Observational checklist for evaluating nursing management regarding obstetric emergencies such as resuscitation, nursing management of preeclampsia, eclampsia, infection, trauma & shock and assessment of fetal wellbeing. The study results showed that 88.7% of nurses had poor knowledge before intervention of the protocol. However, 75.7% of them had good knowledge after intervention respectively. As well as, 77.5% of them had unsatisfactory practices toward emergency obstetrics care before intervention of the protocol. Meanwhile, after intervention 82.3% had satisfactory practices respectively. The study concluded that Nurses’ management protocol has appositive effect on nurse’s knowledge and practices regarding obstetric emergencies. There was a highly statistically significant difference before / after protocol of the studied nurses’ knowledge and practice regarding obstetrics emergencies (P ≤ 0.001). The study recommended that Simple guidelines regarding emergency obstetrical nursing care can be attributed to nurses in the emergency obstetrics department. Continuous refreshment courses and follows up programs for nurses regarding emergency obstetrics care.

Comparison of Amniotic Fluid Index at Different Gestational Age in Normal Pregnancy

Sonographic assessment of amniotic fluid has formed an integral and important component of pregnancy assessment of fetal wellbeing. Changes in amniotic fluid volume are associated with variable outcome of the fetus. Amniotic fluid index which is an objective means of assessing adequacy of amniotic fluid volume does not only vary with gestational age but also differs from population to population. The study determined the reference values of amniotic fluid index and compared the values with the established ranges throughout gestation in uncomplicated singleton pregnancies among women attending our antenatal care facility. This was a longitudinal prospective assessment of amniotic fluid index in eighty six healthy pregnant women with singleton pregnancies recruited at 20 to 22 weeks of gestation and followed up to 41 weeks and 3 days. The patients recruited at 20 weeks had amniotic fluid measurements at recruitment and 4 weeks apart until 40 weeks gestation. Those recruited at 22 weeks had it also at recruitment and 4 weekly with the last estimation at 41 weeks +3 days. These measurements were plotted against their respective gestational ages. The graph was then analyzed using statistical and graphical packages of SPSS version 21. The study populations mean, 5th and 95th percentiles was documented and discussed appropriately. A total of 414 readings were obtained from 81 subjects who underwent more than 3 measurements. Analysis of the data obtained shows a rising AFI with a mean 28 weeks and, thereafter gradually fell till term. The mean age obtained in the study group compared with that of Caucasians showed statistically significant difference (P=0.014). Also, comparison with Chama et al. showed obvious statistical difference at the lower limit (5th percentile; P=0.007, 50th percentile; P=0.006) but no differences at the upper limit (95th percentile; P=0.726). Amniotic fluid index values appear to be differing in different population. The reference range of AFI used in clinical practice should therefore be based on data obtained from local population.

214: Cpr 2 as a new doppler parameter for assessment of wellbeing in fetal growth restricted fetuses

214: Cpr 2 as a new doppler parameter for assessment of wellbeing in fetal growth restricted fetuses

Durations of second stage of labor and pushing, and adverse neonatal outcomes: a population-based cohort study

Objective:The associations between duration of second stage of labor, pushing time and risk of adverse neonatal outcomes are not fully established. Therefore, we aimed to examine such relationships.Study design:A population-based cohort study including 42 539 nulliparous women with singleton infants born in cephalic presentation at ⩾37 gestational weeks, using the Stockholm-Gotland Obstetric Cohort, Sweden, and the Swedish Neonatal Quality Register, 2008 to 2013. Poisson regression was used to analyze estimated adjusted relative risks (RRs), with 95% confidence intervals (CIs). Outcome measures were umbilical artery acidosis (pH <7.05 and base excess <−12), birth asphyxia-related complications (including any of the following conditions: hypoxic ischemic encephalopathy, hypothermia treatment, neonatal seizures, meconium aspiration syndrome or advanced resuscitation after birth) and admission to neonatal intensive care unit (NICU).Results:Overall rates of umbilical artery acidosis, birth asphyxia-related complications and admission to NICU were 1.08, 0.63 and 6.42%, respectively. Rate of birth asphyxia-related complications gradually increased with duration of second stage: from 0.42% at <1 h to 1.29% at ≥4 h (adjusted RR 2.46 (95% CI 1.66 to 3.66)). For admission to NICU, corresponding rates were 4.97 and 9.45%, and adjusted RR (95% CI) was 1.80 (95% CI 1.58 to 2.04). Compared with duration of pushing <15 min, a duration of pushing ⩾60 min increased rates of acidosis from 0.57 to 1.69% (adjusted RR 2.55 (95% CI 1.51 to 4.30)).Conclusion:Prolonged durations of second stage of labor and pushing are associated with increased RRs of adverse neonatal outcomes. Clinical assessment of fetal well-being is essential when durations of second stage and pushing increases.

A Model Practice Template for Hydrotherapy in Labor and Birth.

A Model Practice Template for Hydrotherapy in Labor and Birth.