Course Of Labor Research Articles

Accuracy of Spanish and English-generated ChatGPT responses to commonly asked patient questions about labor epidurals: A survey-based study among bilingual obstetric anesthesia experts

BackgroundLarge language models (LLMs), of which ChatGPT is the most wellknown, are now available to patients to seek medical advice in various languages. However, the accuracy of the information utilized to train these models remains unknown. MethodsTen commonly asked questions regarding labor epidurals were translated from English to Spanish, and all twenty questions were entered into ChatGPT version 3.5. The answers were transcribed. A survey was then sent to ten fellowship-trained obstetric anesthesiologists to assess the accuracy of these answers utilizing a 5-point Likert scale. ResultsOverall, the accuracy scores for the ChatGPT-generated answersin Spanish were lower than for the English answerswith a median score (IQR) of 34 (33–36.5) versus40.5 (39–44.3), respectively (P value = 0.02). Answers to twoquestions were sored significantly lower: “Do epidurals prolong labor?” (2 (IQR 2–2.5) versus 4 (IQR 4–4.5), P value 0.03) and “Do epidurals increase the risk of needing cesarean delivery?” (3(IQR 2–4) versus 4 (IQR 4–5); P value 0.03). There was a strong agreement that answers to the question “Do epidurals cause autism” were accurate in both Spanish and English. ConclusionChatGPT-generated answers in Spanish to ten questions about labor epidurals scored lowerfor accuracythananswers generated in English, particularly regarding the effect of labor epidurals on labor course and mode of delivery. This disparity in ChatGPT-generated information may extend already-known health inequities among non-English-speaking patients and perpetuate misinformation.

Formation of adaptive potential and level of physical condition in disabled people during the course of labor

А person with a disability that has begun to work is forced to pay the "physiological price of adaptation". Materials and methods: The monitoring of the level of physical condition (LPC) by E.A. Pirogova and the adaptive potential (AP) by R.M. Baevsky was carried out on 130 disabled people during their work hours. Their working period lasted 2 weeks. Results: An increase in LPC and a decrease in AP were revealed in people with childhood and psycho-neurological disabilities. In movement disabled people, the indicators of LPC decreased after the end of their work period. Conclusions: Monitoring of indicators has determined a favorable impact of labor on people with childhood disabilities and low reserves of adaptive potential in movement disabled people. The determinative factors of LPC and AP in disabled people during the course of work have been established.

Natural childbirth and cesarean section - descriptive analysis of queries in Google search engine.

The use of internet-based search engines for health information is very popular and common. The Internet has become an important source of health information and has a considerable impact on patient's decision making process. Knowledge of pregnant women about childbirth comes from health professionals and personal experiences described by friends or family members. There is a growing interest in digital sources used by pregnant women. Analysis of queries related to regarding to natural childbirth and cesarean section in the Google search engine. In this infodemiology, descriptive study tool "AlsoAsked" was used. This is a tool for analyzing data appearing in Google search results. "AlsoAsked" search was conducted on April 19, 2023. Search phrases "natural childbirth" and "cesarean section" in polish language were used. Questions that were typed into the Google search engine, ranked according to popularity (volume) and thematic connections have been discussed. The most frequently asked questions were related to the course and duration of labor as well as the preparation for labor and cesarean section (CS). Comparison between a natural labour and CS in the context of safety and pain received a great deal of attention. The most popular questions regarding CS were related to elective CS and indications for it. Some questions concerned the connection between labor and clinical state of a newborn.

Patient Decision Making Surrounding Epidural Use in Labor

Introduction/Objectives: Labor is thought to be one of the most painful experiences in a woman’s life, similar to pain caused by complex regional pain syndromes. Epidural analgesia has been proven to provide excellent pain relief, and many women in the United States choose this during their labor course. The decision to use, or not to use, neuraxial analgesia is complex and multifactorial, and has historically generated debate amongst patients and obstetric providers. In addition, many patients will also change their minds about desiring an epidural in labor during their admission to Labor & Delivery based on various factors encountered. This study aimed to determine the number of patients who change their mind about epidural in labor. We also aimed to characterize the factors involved in patients’ decision about epidural analgesia during labor and to determine if these factors change throughout the labor and delivery course. Methods: This study was a single-center, non-randomized, cross-sectional study that was performed at Loyola University Medical Center in the Labor & Delivery unit. The study population included all full-term nulliparous patients that were admitted to Labor & Delivery for full term labor or induction of labor. Patients were eligible if they were 18 years of age or older, and able to read, speak, and complete the study questionnaire in English. Exclusion criteria included previous vaginal delivery, contraindication to vaginal delivery, no plan to deliver during admission, and contraindication to epidural analgesia. The patients completed one questionnaire about preferences for epidural and influencing factors prior to delivery, and one questionnaire after delivery with similar questions. Demographics were collected, as well as data about complications and details of their labor and delivery course. Results: A total of 199 patients completed the study. The epidural rate was higher in patients who planned to receive it (n = 141/144 or 97.9%) than in patients who did not plan to receive an epidural (n = 49/55 or 89.1%). Further, there was significant discordance between patients’ plans for an epidural and receipt of the medication. That is, only three (1.5%) patients who planned to receive an epidural did not receive one. Conversely, 49 (24.6%) patients who did not plan to receive an epidural received one. Compared to patients who did not plan to receive an epidural, those who planned to receive the medication reported that their OBGYN physician (OR = 3.31, 95% CI: 1.80 – 6.06; p < .001), Anesthesiology physician (OR = 2.73, 95% CI: 1.50 – 4.96; p = .001), and labor nurse (OR = 2.50, 95% CI: 1.38 – 4.53; p =.002) were more important sources of information. Further, when compared to patients who did not plan to receive an epidural, those who planned to receive the medication reported they wanted to be more comfortable during the course of labor (OR = 4.84, 95% CI: 2.50 – 9.39; p < .001), that receiving an epidural would make their labor experience more enjoyable (OR = 27.17, 95% CI: 11.72 – 63.00; p < .001), and that getting an epidural was safe (OR = 5.91, 95% CI: 2.96 – 11.80; p < .001). Conclusions: In conclusion, this study found that the majority of patients in our study population chose to receive an epidural in labor, regardless of their plans at the start of their admission. The most important factors in the decision were discussions with the OBGYN and Anesthesiology physicians. Patients who decided to receive an epidural, despite planning not to, reported that they wanted to be more comfortable during their labor course and that receiving an epidural would make their labor experience more enjoyable.

Neutrophil to Lymphocyte Ratio Values in Late Preterm and Term Patients with Evidence of Chorioamnionitis on Placental Histopathology: A Retrospective Cohort Study

Introduction: Neutrophil to lymphocyte ratio (NLR) is an inexpensive biomarker that may aid in the prediction of adverse pregnancy outcomes, though data remains sparse at this time. Previously published research regarding chorioamnionitis almost exclusively focuses on preterm labor and preterm prelabor rupture of membranes before 34 weeks of gestation and suggests an increase in NLR in those patients with chorioamnionitis identified on placental histopathologic examination. However, chorioamnionitis in the late preterm and term timeframe also represents a significant source of maternal and neonatal morbidity. Therefore, the primary aims of the study were to: 1) compare obstetric admission NLR values among those with and without evidence of histopathologic chorioamnionitis 2) evaluate the efficacy of NLR in identifying histopathologic chorioamnionitis and 3) compare NLR values pre- and postdelivery in the setting of a placental histopathologic chorioamnionitis diagnosis in patients beyond 34 weeks of gestation. Methods: A retrospective electronic chart review was performed at an American urban safety net hospital. Institutional review board approval was obtained (UMKC #2093657), and patient consent was waived due to the retrospective nature of the review. Obstetric encounters were included if a complete blood count (CBC) with differential was performed on admission and postpartum, the subject underwent a trial of labor, a placental histopathologic examination was performed, and delivery occurred beyond 34 0/7 weeks of gestation. Subjects were excluded if an extrauterine infection was present during the hospitalization or the subject received corticosteroids within two weeks of delivery. Postdelivery placentas were examined by the University’s pathology department. Statistical analyses were performed with receiver operator curves, Mann-Whitney U test, and Wilcoxon Signed-Rank Test where applicable, with a significance level p < 0.05. Results: Three hundred seventy-nine patient encounters were reviewed, with only 30.1% of all encounters with placental histopathology available. A total of 58 subjects met the inclusion criteria and 14 additional subjects were excluded due to extrauterine infection (n=1), SARS-CoV-2 diagnosis (n=5), and late preterm steroids administration (n=8). There was no difference between those subjects with and without histopathologic chorioamnionitis in median gestational age at the time of delivery (39 0/7 versus 39 1/7 weeks of gestational, p=0.960), median time of admission CBC collection to delivery (0.98 versus 0.98 days, p=0.340), and timing of collection of postpartum CBC (1.0 versus 1.0 days postpartum, p=0.631). Predelivery neutrophil to lymphocyte ratio values were compared in subjects with and without histopathologic chorioamnionitis and there was no significant difference in median values (4.11 versus 4.52, p=0.683). The predelivery NLR predicted the presence of chorioamnionitis poorly (AUC 0.518, 95% CI [0.326, 0.711], p=0.843). The postdelivery NLR was a slightly better predictor of chorioamnionitis (AUC 0.634, 95% CI [0.454, 0.815], p=0.147), but did not reach statistical significance. Although there was no significant difference in postpartum NLR values in those with and without chorioamnionitis on final histopathology (6.73 versus 4.63, p=0.147), the value was notably higher in the former. When the antepartum and postpartum NLR were compared across individual subjects in a paired fashion, there was a significantly higher postpartum NLR in those subjects both with and without chorioamnionitis on final histopathology (with chorioamnionitis: antepartum median 4.52 versus postpartum 6.73, p=0.012, n=15; without chorioamnionitis: antepartum median 4.11 versus postpartum 4.63, p=0.043, n=29). Conclusion: Though predelivery NLR is a poor predictor of chorioamnionitis, significantly higher postpartum NLR values in the sample population suggest an increase in NLR for all laboring patients, but a more pronounced increase occurs in those with inflammatory placental findings. While the study is limited by a heterogeneous sample population, nonparametric evaluation, and small sample sizes, the data does add to the paucity of preexisting literature that seeks to utilize NLR in the prediction of chorioamnionitis during the labor course. Larger longitudinal studies may help better characterize the rising NLR values over the course of labor and delivery as seen in our study. Neutrophil to lymphocyte ratio values across the spectrum of disease states and gestational ages in pregnancy may help isolate other inflammatory processes that impact perinatal outcomes.

Perinatal Outcomes and Level of Labour Difficulty in Deliveries with Right and Left Foetal Position-A Preliminary Study.

Many studies have shown the negative influence of the foetus's occiput posterior position during birth on the final perinatal outcome. This study aims to add to the discussion on the impact of foetus positioning on the course of labour and subjective assessment of the level of labour difficulty. The cross-sectional study took place from February 2020 to September 2021, and consisted of filling out observation forms and the assessment by the midwives and women of the level of labour difficulty. This study is based on the observation of 152 labours in low-risk women. When compared to left foetal positioning, labours in which the foetus was in the right position were longer and more frequently failed to progress (in 11.3% vs. 37.5%), and epidural was more frequently administrated (in 30.4% vs. 52.7%). Both women and midwives subjectively evaluated deliveries with a foetus in the right position as more difficult. The right positioning of the foetus was related to greater labour difficulty and worse perinatal outcomes. The position of the foetus' head in relation to the pelvis should be considered as an indicator of the difficulty of labour and a support plan for the woman should be offered accordingly.

Neonatal Outcomes in Labor After Intravenous Remifentanil Analgesia vs. Epidural Analgesia: A Retrospective Observational Study.

Background Some evidence indicates that maternal analgesia during labor may have adverse effects on neonates due to exposure to specific drugs or the potential effects of analgesia on the course of labor. We assessed the clinical outcome of term neonates born to mothers who received epidural analgesia (E) or systemic analgesia with remifentanil (R) during labor. Methods Data was collected retrospectively over one year. We have evaluated the medical records of 247 full-term neonates; 208 were born to mothers who received E and 39 to mothers who received R. Data on Apgar scores and neonatal complications(perinatal asphyxia, respiratory distress, infection, hyperbilirubinemia, and birth injuries), and average hospital stay were collected. Mann-Whitney U test, chi-square test, and logistic regression analysis were used where appropriate. Results The values of the mean Apgar scores between E and R at 1 and 5 minutes were similar (8.83 vs. 8.97,p= 0.252; 9.81 vs. 9.87,p= 0.762, respectively). The average length of neonatal hospitalization did not differ between groups (4.19 vs. 4;p= 0.557). The percentages of neonates with any complication were similar between groups (28.3% vs. 32.5%,p= 0.598). Neonates born by cesarean delivery (CD) had significantly worse outcomes than those born vaginally (p= 0.008, OR 2.8, 95% CI [1.30, 6.17]). Conclusion We did not find a statistically significant difference in mean Apgar scores and neonatal complications between neonates who received epidural vs. remifentanil analgesia. An increased rate of complications in neonates born via CD was found. Future studies should have a larger sample size and be powered to detect associations in these findings.

Does the combination of four OGTT values enhance the prediction of adverse pregnancy outcomes? Insights from a retrospective cohort study.

To explore the correlation between a singular value of additive OGTT scores and adverse maternal and neonatal outcomes. We postulated that a higher additive OGTT score would predict poorer maternal and neonatal outcomes. In this retrospective cohort study, data were collected from all women with a documented complete OGTT result and subsequent diagnosis of GDM. The additive OGTT score was calculated by adding each individual hourly glucose measurement. Maternal demographics, pregnancy and labor characteristics, and neonatal outcomes were compared between the lower-sum and higher-sum OGTT groups. A multivariate regression analysis was performed to identify confounders associated with adverse outcomes. In this study, a total of 1497 patients were assessed. The group with higher-sum OGTT scores was characterized by increased rates of GDMA2 (p = 0.008), higher insulin doses (p = 0.009), and higher rates of composite maternal and neonatal adverse outcomes (p = 0.021 and p = 0.030, respectively) compared to the lower-sum OGTT group. The additive OGTT score may aid in predicting the need for insulin treatment, labor course, and neonatal outcomes in GDM patients.

Is it time to end the use of base deficit for fetal well-being assessment?

Authors have expressed reservations regarding the use of base deficit measured in umbilical artery blood samples to assess fetal well-being during the course of labor and to predict neonatal neurologic morbidity. Despite its integration into clinical practice for more than 50 years, obstetricians and maternal-fetal medicine specialists may not realize that this marker has significant limitations in accurately identifying neonatal metabolic acidosis as a proxy for fetal well-being. In brief, there are 2 large families of base deficit, namely whole blood and extracellular fluid. Both rely on equations that use normal adult acid-base characteristics (pH 7.40 and partial CO2 pressure of 40 mm Hg) that overlook the specificity of the normal in utero acid-base status of pH 7.27 and partial CO2 pressure of 54 mm Hg. In addition, it ignores the unique characteristic of the in utero fetal response to acute hypoxia. The dependence on placental circulation for CO2 elimination may lead to extremely high values (up to 130 to 150 mm Hg) during hypoxic events, a phenomenon that is absent in adults with acute metabolic acidosis who can hyperventilate. The dispute over if to include a correction for high partial CO2 pressure in the bicarbonate estimation, as presented in the Great Trans-Atlantic Debates, remains unresolved. The key constants computed for adult acid-base physiology in the current base deficit algorithms, without accounting for the impact of high partial CO2 pressure or other fetal characteristics of buffering capacity (eg, differences in body water content composition, plasma protein, and hemoglobin attributes), may lead to an overestimation of metabolic acidosis, especially in newborns who are experiencing hypercarbia during the early stages of the hypoxic response. These unrecognized limitations impact the base deficit results and may mislead clinicians on fetal well-being assessments when discussing the management of fetal heart rate monitoring and neonatal outcomes. Based on our arguments, we believe that it is prudent to consider an alternative to base deficit for drawing conclusions regarding fetal well-being during the course of birth management. We propose a marker specifically related to the newborn acid-base physiology--the neonatal eucapnic pH correction. This marker can be added to arterial cord blood gas analysis, and we have described how to interpret it as a marker of neonatal metabolic acidosis.

Establishment of Labor Epidural Analgesia Service and its Assessment: An Experience in a Hospital of a Middle-Income Country.

Even though the idea of painless birth is more than 100 years old, it is still underrepresented in some parts of the world despite progress in science, education, anesthesia, spinal and epidural needles, development of catheters, new drugs, and infusion pumps. Maternal care should basically be the safety of the patient (in this case two patients) and also provide all kinds of protection in the form of a multidisciplinary team with an anesthesiologist, especially when it comes to pain therapy and anesthesia for women in labor. In this direction, our hospital departments with low or moderate volume of annual births made the decision to educate ourselves for painless childbirth and contribute more to the care of women in labor. The enthusiasm and dedication of our clinical team prevailed and today we have a high standard of labor epidural service. The aim of this study was to evaluate the establishment of the epidural labor service by comparing the effects of epidural analgesia on labor pain and the course of labor. The secondary objectives were to compare satisfaction with epidural analgesia and the impact of epidural analgesia on the delivery mode. This was a prospective observational hospital-based study conducted on100 patients after the establishment of epidural service. Parturients who were signed to receive epidural analgesia formed Group A and parturients who did not request epidural analgesia formed Group B. All parturients are induced in the delivery room with a Bishop score of 5 or higher. Pain intensity measured through the visual analog scale of pain (VAS score) was significantly lower in Group A (n = 46) compared to Group B (n = 50) at measured points of time (p<0.001). There was a fall in the mean VAS score in Group A from 7.94 to 3.86 within 20 minutes of the bolus dose and starting a continuous infusion.Labor progress according to the Bishop score and till the end of the second stage of labor, or to the transfer to the operating theatre, according to the monitored time in Group A was 176 minutes and it was lower in Group B with 155 minutes; however, by test of linearity we do not gain significance(p = 0.2). There were eight parturients in each group(17% vs 16%) who were indicated for surgical delivery. According to Pearson's correlation test for the outcome of labor between parturients receiving epidural analgesia and parturients without epidural analgesia (p = 0.8), we cannot say that epidural analgesia in labor is correlated with the outcome of surgical delivery. Establishing a new hospital procedure such as an epidural painless service for childbirth in low or moderate-volume settings of annual births is very challenging. By evaluating epidural labor services in our hospital, we created the best environment for continuous improvement and long-term efficacy and safety of our analgesic techniques aimed at providing excellent care to mothers and their babies.

Pelaksanaan Pelvic Rocking dengan Birth Ball terhadap Kemajuan Persalinan

The aim of this study was to determine the effect of implementing pelvic rocking with a birth ball on the progress of labor. The method used was pre-experimental using a static group comparison design with accidental sampling technique. Two groups were selected from the sample, the intervention group performed pelvic rocking movements while monitoring the progress of labor in the control group. The research was conducted in November and December 2023. The sample consisted of 60 respondents. Independent Sample Test was used in data analysis. Research findings show that pelvic rocking with a birth ball has an impact on the course of labor, with a p-value of 0.000 &lt; 0.05 and a confidence level of 95%. In short, pelvic rocking with a Birth ball makes it easier to rotate the baby into an optimal position so that the mother in labor can shorten the first stage, providing a feeling of comfort and relaxation, thereby helping the mother psychologically in processing pain. Keywords: Birth ball, Labor progress, Pelvic rocking

Особливості перебігу вагітності та пологів у жінок із запальними захворюваннями кишечника

The problem of pregnancy management in women with inflammatory bowel diseases is becoming more urgent, due to the prevalence of such pathologies as Crohn's disease and ulcerative colitis in the age group of women 20-40 years old, during which reproductive function is mainly being realized. Purpose - to investigate the course of pregnancy and labour in women whose pregnancy occurred on the background of the existing Crohn’s disease and ulcerative colitis. Materials and methods. The main group (the Group I) included women with chronic inflammatory bowel diseases - Crohn’s disease (the Group I-A; n=27) and ulcerative colitis (the Group I-B; n=52); the control group (n=20) consisted of women without severe somatic pathology. Retrospective clinical and statistical analysis was performed using data from medical documentation. Obtained results were statistically processed in specialized programs. Results. A statistically higher frequency of pregnancy complications was found in women with inflammatory bowel diseases, such as anemia (59.3% in the Group I-A and 69.2% in the Group I-B versus 30% in the control group); threatening abortion (40.7% in the Group I-A and 53.8% in the Group I-B against 15% in the control group); hyperemesis gravidarum (44.4% in the Group I-A and 67.3% in the Group I-B against 25% in the control group); preeclampsia (37% in the Group I-A and 44.2% in the Group I-B against 10% in the control group); premature rupture of fetal membranes (37% in the Group I-A and 21.1% in the Group I-B against 10% in the control group). At the same time, women of the main group had an earlier development of spontaneous labor and a slightly smaller mass of newborns. Conclusions. Received results indicate presence of Crohn's disease and ulcerative colitis influence on the course of pregnancy in women, which requires joint management of such women with gastroenterologists. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Easy of calving cows for dairy pro- ductivity

Data are presented on the dependence of the ease of calving on the duration of the dry period, gender, the number of gestated fetuses and its influence on the frequency of occurrence of specific pathologies of childbirth and the postpartum period and the frequency of insemination in dairy cows of productivity in the conditions of Sibirskaya Niva LLC, Novosibirsk region. More often, childbirth proceeded normally (easy), without outside intervention - 91.36 %, mild and moderate pathology was observed in 3.35 and 4.41 % of cows, and in rare cases, calving was accompanied by severe pathology - 0.87 %. The severity of the birth process increased with a decrease in the duration of the dry period. Thus, in animals with easy labour, the dry period was 54.73 ± 0.27 days; in animals with severe pathology, it was three days less - 51.74 ± 1.33 days. In cows with mild labour, the birth of one calf was more often observed; the number of twins did not exceed 8.95 %. The severity of labour was accompanied by an increase in the number of twins; in the group of animals with arduous labour, it reached 84.21 %. With a problematic labour process, the frequency of stillbirths in groups increases by 4.41 %. Animals with difficult births have an increased risk of obstetric and gynaecological pathology. Thus, in cows with a severe course of the birth process, in 26.32 % of cases, pathology of the third stage of labour was observed, accompanied by retention of the placenta. In the postpartum period, postpartum paresis was often recorded - 42.11 % and various types of metritis - 21.05 %. In contrast, with a mild course of labour, all the pathologies we studied were recorded in aggregate only in 29.35 % of cows. In animals with arduous labour, 1.05 more doses of semen were spent on fertile insemination than in animals with normal labour.

Research on the optimization of teaching content for cloud computing technology in secondary school labor education curriculum

Abstract Labor education is an important educational course for secondary school students to learn and grow comprehensively. This paper first collects the current improvement direction of secondary school labor education through relevant questionnaires and then introduces cloud computing technology to design an online learning platform for secondary school labor education courses, which assists teachers in completing the labor teaching process. The design of the platform adopts MVC development mode, AJAX asynchronous refresh technology, and other key technologies, analyzes the requirements from three aspects of objectives, performance, and functions, and finally realizes five major modules, including user management, course management, and evaluation management. To address the problem of insufficient evaluation of labor courses, this paper constructs a model of students’ online learning behavior based on the K-means algorithm in the application process of the platform and evaluates the behavior of students’ online participation in labor education courses. By standardizing students’ platform learning information data and analyzing and calculating the learning behaviors of 300 students can be divided into 4 categories, accounting for 16.0%, 34.3%, 23.0%, and 26.7%, respectively, and the teachers of the labor courses can formulate personalized teaching plans for each type of labor learning behavior.

ГИПОТОНИЧЕСКАЯ ДИСФУНКЦИЯ МАТКИ: НЕКОТОРЫЕ БИОХИМИЧЕСКИЕ МАРКЕРЫ

We examined 70 postpartum women with postpartum subinvolution of the uterus and hypotonic contractile dysfunction of the uterus in 2022–2024. The comparison group consisted of 19 postpartum women with a physiological course of labor and the postpartum period. The content of oxytocin, nitric oxide, monoamine oxidase, potassium and calcium in blood serum was studied. In postpartum women with impaired contractile function of the uterus, the calcium content was slightly reduced (1.15 times) compared to healthy women (p = 0.0467), but the values of oxytocin and potassium did not differ significantly from the control group. In postpartum women with uterine subinvolution, an increase in monoamine oxidase was observed in comparison with the parameters of healthy women by 1.92 times (p = 0.021) and serum cholinesterase by 2.0 times compared with physiological labor (p = 0.001). Thus, the severity of clinical symptoms of uterine subinvolution and its hypotonic dysfunction is associated with the intensity of neurohumoral regulation of the uterus.

Efficacy of Foley Catheter Bulb with Intracervical Dinoprostone Gel versus Dinoprostone Gel Alone for Cervical Ripening and Induction of Labour: An Observational Study

Introduction: One of the most common obstetrical interventions is the induction of labour. Cervical ripening drugs are typically used before conventional methods of induction since they are linked to an increased risk of protracted labour, chorioamnionitis, and Caesarean Sections (CS) during labour induction when an unfavourable cervix is present. The two major techniques for cervical ripening are mechanical interventions, such as the insertion of balloon catheters, and the application of pharmacologic agents, such as prostaglandins. It is widely accepted that the induction of labour, which ultimately leads to vaginal delivery, is largely dependent on the condition of the uterus’ cervix. Aim: To compare the efficacy of a combination of Foley bulb catheter and intracervical Dinoprostone and intracervical Dinoprostone alone for the induction of labour. Materials and Methods: A prospective observational study was performed over 150 pregnant mothers from May 2018 to April 2019. in the labour room of North Bengal Medical College and Hospital, a tertiary care institution in Darjeeling, West Bengal, India. The pregnant women were divided into two groups: intracervical Dinoprostone gel alone (Group-1) and a combination of intracervical Foley catheter and intracervical Dinoprostone gel (Group-2) with n=75 patients in each group. Group-1 received intracervical Dinoprostone gel 0.5 mg, which was repeated every 6 hours, a maximum of three doses, or until she went into active labour, whichever occurred earlier. In Group-2, a 16 F Foley catheter was inserted into the cervix, inflated, and a single dose of intracervical Dinoprostone gel 0.5 mg was given alongside it. Participant demographic characteristics, medical and pregnancy history, indication for labour induction, labour course, and outcomes were collected. The collected data were analysed with the mean and standard deviation for numerical variables and counts and percentages for categorical variables. Odds ratio was calculated where deemed relevant. Results: The induction to delivery time was considered the primary outcome and was shorter in Group-2 by 28 minutes (p=0.342). Among the secondary outcomes, the duration of the latent phase of labour was shorter in Group-2 by 57 minutes, and the proportion of patients delivering within 12 hours was also higher (28%) but statistically insignificant (p&gt;0.05). The rates of CS were unaffected by the mode of induction. None of the two methods were found to be inferior to the other in respect to neonatal outcomes or complications of labour like chorioamnionitis and postpartum haemorrhage. Conclusion: The combination of Foley catheter with intracervical Dinoprostone gel did not prove to be more efficient than intracervical Dinoprostone alone for labour induction in the current study

Влияние новой коронавирусной инфекции на течение беременности и родов у женщин

Currently, there are contradictory views of scientists on the impact of a novel coronavirus infection on the health of women of reproductive age, pregnancy and labor, in particular, against the background of changes in the homeostasis system. This issue requires the study and analysis of clinical observations of patients who have undergone COVID-19 in the unified system of mother-placenta-fetus-newborn for timely correction of the detected disorders and optimization of medical care. Objective. To determine the possible risks of complications of pregnancy and delivery in pregnant women who had a new coronavirus infection before and during pregnancy. Patients and Methods. We examined 485 women, 156 of whom had SARS-CoV-2-associated viral infection during pregnancy, 139 women before the onset of pregnancy, and 190 pregnant women without COVID-19. Data on the somatic health of the patients, the course of pregnancy and labor were obtained from the individual medical records of pregnant and postpartum women (Form No 111/u-20 and No 096/1u-20). The duration of follow-up ranged from 4 to 8 months. Pregnant women were examined within the decreed time frame, according to the Clinical Recommendations of the Russian Society of Obstetricians and Gynecologists supported by the Scientific and Practical Council of the Ministry of Health of the Russian Federation 2020–2023, with informed consent. The results of the study were processed using the application program package TIBCO STATISTICA (USA) for personal computer. When analyzing conjugation tables, Pearson's χ2 test was used to assess the statistical significance of differences between two relative indices. Data in groups were considered statistically significant at p &lt; 0.05 or statistically highly significant at p &lt; 0.001. Results. Iron deficiency, allergic diseases, and gastrointestinal pathology were the most frequent in the observed women, with statistically significantly fewer COVID-19-uninfected women. Pregnant women with new coronavirus infection in the 3rd trimester had a high incidence of pre-eclampsia, threatened abortion, and prescription of hormonal medications (p &lt; 0.001). Pregnant women who underwent COVID-19 in the 2nd trimester had fetal growth retardation and threatened abortion (p &lt; 0.05). The frequency of high D-dimer values in 3rd trimester pregnant women who had a new coronavirus infection was statistically significantly different compared to uninfected women (p &lt; 0.05). Conclusion. The development of a complex of pregravidar preparation, including timely diagnosis of different strains of this infection in non-pregnant and pregnant women, dynamic observation for timely correction of detected homeostasis disorders and optimization of care in the unified system of mother-placenta-fetus-newborn. Key words: pregnant women, novel coronavirus infection, COVID-19

Effect of cognitive behavior therapy training and psychological nursing on the midwifery process in the delivery room.

The severe physical and psychological impact of pain on the physical and mental health of women during labor leads to increased risks and complications during childbirth, presenting a major public health concern. Some studies have shown that cognitive behavioral therapy (CBT) has a positive effect on maternal psychology during delivery, reducing stress and shortening labor time. Thus, CBT training for mothers and delivery room staff may be beneficial in minimizing complications and adverse effects during natural birth. To investigate the clinical effects of CBT training and psychological care during delivery, and their therapeutic effects on women in labor. This study used a retrospective analysis and included 140 mothers admitted to the maternity ward between January 2021 and January 2023. The study subjects were randomized into two groups: control (n = 70) and observation (n = 70). Routine care, CBT training, and psychological care were provided to mothers in both groups. Psychological status scores, delivery time, and satisfaction with care pre- and post-delivery were compared, and the incidence of complications after receiving care was analyzed between the two groups. Although the psychological state of both groups improved significantly in the late stages of labor, the psychological state scores of the mothers in the observation group were significantly lower than those of the mothers in the control group (P < 0.05). The duration of labor and incidence of complications in the observation group were significantly lower than those in the control group (P < 0.05). The mothers in the observation group were significantly more satisfied with nursing care during the course of labor than those in the control group (P < 0.05). CBT training and psychological care for mothers in the midwifery process can effectively improve anxiety and depression, shorten labor duration, reduce postnatal complications, and improve nursing satisfaction and nurse-patient relationships. Its clinical application is effective and has popularization value, providing a new way to protect maternal mental health.

Sleep Deficiency in Pregnancy.

Sleep is a critical aspect of one's daily life for overall health, with a recommended 7 to 9 hours in adulthood (ages 26-64). Up to a third of women do not sleep sufficiently, and pregnant women are at an increased risk for sleep deficiency. Throughout pregnancy, sleep is affected in differing ways. For example, in the first trimester, hormones affect sleep cycles, but by the third trimester, physical complaints such as increasing frequent urination and fetal movement create frequent awakenings. Associations between sleep deficiency and gestational diabetes, hypertensive disorders, depression, and some evidence regarding preterm birth exist. A woman's labor course and perception of delivery are also negatively affected by short sleep duration.

Comparison of the effect of vaginal misoprostol alone and in combination with evening primrose capsules on the course of labor in pregnant women candidates for termination of pregnancy

Background: Induction of labor at any time before the spontaneous onset of labor is indicated when the benefits of termination of pregnancy for the mother and fetus outweigh the benefits of continued pregnancy. The aim of this study was to compare the effect of vaginal misoprostol alone and in combination with evening primrose capsule on the course of labor in pregnant women candidates for termination of pregnancy. Methods: In this double-blind randomized clinical trial, 30 pregnant women were candidates for termination of pregnancy. At the time of referral, the examination was performed to calculate the bishop score (primary outcome) and the partograph was recorded and plotted once every hour until the end of labor. Length of active phase of labor (from dilatation 3-6 cm to birth), type of labor, Apgar score of the first and fifth minute of the baby and volume of postpartum hemorrhage and pain intensity every 30 minutes was recorded in two groups for up to 2 hours using a ruler. Results: The mean length of the latent labor phase in the misoprostol and evening primrose groups was 9.07±0.96 and in the misoprostol group was 10.13±0.83 hours and this difference was significant. There was no significant difference in bishop score between the two groups at the beginning of the study but after the intervention was significant. Conclusions: Our study showed that using evening primrose oil capsule instead of misoprostol is effective in induction of labor.