Examination Of Labour Research Articles

Puerperal Pyrexia: A Review. Part I

Puerperal pyrexia and sepsis are among the leading causes of preventable maternal morbidity and mortality not only in developing countries but in developed countries as well. Most postpartum infections take place after hospital discharge, which is usually 24 hours after delivery. In the absence of postnatal follow-up, as is the case in many developing countries, many cases of puerperal infections can go undiagnosed and unreported. Besides endometritis (endomyometritis or endomyoparametritis), wound infection, mastitis, urinary tract infection, and septic thrombophlebitis are the chief causes of puerperal infections. The predisposing factors leading to the development of sepsis include home birth in unhygienic conditions, low socioeconomic status, poor nutrition, primiparity, anemia, prolonged rupture of membranes, prolonged labor, multiple vaginal examinations in labor, cesarean section, obstetrical maneuvers, retained secundines within the uterus and postpartum hemorrhage. Maternal complications include septicemia, endotoxic shock, peritonitis or abscess formation leading to surgery and compromised future fertility. The transmissions of infecting organisms are typically categorized into nosocomial, exogenous, and endogenous. Nosocomial infections are acquired in hospitals or other health facilities and may come from the hospital environment or from the patient's own flora. Exogenous infections come from external contamination, especially when deliveries take place under unhygienic conditions. Endogenous organisms, consisting of mixed flora colonizing the woman's own genital tract, are also a source of infection in puerperal sepsis. Aseptic precautions, advances in investigative tools and the use of antibiotics have played a major role in reducing the incidence of puerperal infections. Part I of this review provides background information and definitions, discusses the incidence and risk factors, explains the microbiology and pathophysiology of various infections, and delineates the signs and symptoms of major puerperal infection. Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader should be able to recall that world wide puerperal sepsis is a leading cause of maternal mortality, state that many of the predisposing factors are preventable, explain that both nosocomial infections as well as exogenous infections are serious factors, and relate that septic techniques and antibiotics can play a major role in reducing the incidence of puerperal infections.

‘I'm just going to wash you down’: sanitizing the vaginal examination

This paper reports findings from an ongoing study exploring the qualitative experiences of midwives and women in relation to vaginal examination in labour, focusing on how vaginal examination is discussed and on the wash-down procedure used by some midwives. The body is a source of considerable ambivalence in sociological terms. Women's bodies, in particular, have been viewed as problematic and as a potential source of dirt and pollution. It has been suggested that vaginal examinations during labour are used, at least in part, as a ritual procedure by which healthcare professionals demonstrate that they are in control of both the labouring woman and the process of labour itself. Methods. In-depth interviews were undertaken during 2003 with six childbearing women and 10 midwives who had been involved in these women's care. Non-participant observation was also carried out of each woman's labour and birth. During interviews, when discussing vaginal examination, midwives persistently used abbreviations or euphemisms as a means of distancing themselves from the realities of the procedure. Some midwives were observed washing women's genitals in a highly ritualized manner prior to vaginal examination, apparently as a strategy for establishing power differentials. Midwives commonly state that they are advocates for woman-centred care but their behaviour in relation to vaginal examination belies this and suggests that they regard women's bodies as contaminated and polluting. Healthcare students need to be taught specific communication skills to enable them to discuss vaginal examination more fully with women so that they feel less need to resort to euphemisms and abbreviations when discussing the procedure. It is also important to carry out vaginal examination in a way that is not demeaning and does not reinforce notions that women's bodies are dirty.

Women's experiences of vaginal examinations in labour

To investigate women's perceptions of their experiences of vaginal examinations in labour. A prospective, analytic survey design using anonymised, self-completion, postal questionnaires. A multi-centre study conducted in 2002 in three midwifery units in Cambridgeshire, England. An unselected, consecutive sample of 104 primiparae expected to deliver their first baby in hospital after an uneventful pregnancy at 37 weeks or over, with the fetal head presenting, of whom 73 finally took part; the response rate was 70%. On the basis of a 20-item Likert-type scale, a notional satisfaction index score of 74% was calculated. This was based on 1435 items of ordinal data, suggesting an encouraging measure of contentment with the privacy, dignity, sensitivity, support and frequency with which vaginal examinations in labour were managed. However, there was some scope for improvement in areas such as associated pain, opportunities to refuse examinations and more detailed information-giving. No statistically significant differences in women's perceptions could be demonstrated in the three midwifery units in relation to the numbers of vaginal examinations carried out in labour or the women's perceptions of their care by health professionals. Evidence based on the women's perceptions indicates that 53% of women were more than satisfied with the conduct of their vaginal examinations in labour; a further 44% were satisfied; and the remaining 3% were less than satisfied.

Informing women during vaginal examinations

In a small, multi-centre study conducted in three maternity units in Cambridgeshire, England, a prospective, analytical survey design employing postal questionnaires was used to investigate women's experiences of vaginal examinations in labour. An unselected, consecutive, random sample of 104 primiparae participated in the research of whom 73 returned completed questionnaires, a response rate of 70%. Regarding information-giving during vaginal examination in labour, approximately two thirds of women rated the information provided by midwives as good or very good, the equivalent figure for doctors being one third. A Likert scale addressing ten broad elements of information-giving generated a total of 715 responses of which 63% were positive, 18% were negative and 19% were in between. These findings suggested, on average, that while three fifths of women reported positive experiences of information giving, almost a fifth had negative experiences overall and a further fifth also had, mediocre communication experiences related to their vaginal examinations in labour.

Hong Kong Chinese women's experiences of vaginal examinations in labour

Objective: to explore women's experiences during vaginal examinations in labour. Design: qualitative with phenomenological approach. Data were collected by tape-recorded open-ended interviews during the early postnatal period. Data analysis: phenomenological hermeneutic analysis based upon Riceour's interpretation theory. Participants: a purposive sample of eight women post-delivery who had given birth vaginally and were able to speak and read Chinese. Setting: a maternity unit of a University affiliated District General Hospital in Hong Kong. Key findings: women accepted the necessity for vaginal examinations, but expressed the need to be able to trust that the examiner would respect them as individuals and try to maintain their dignity, perform the examination skillfully and communicate the findings to them. Pain and embarrassment were frequently experienced during vaginal examination. Women wanted to be supported during the examination by someone they knew and trusted; they appreciated practitioners who tried to minimise their physical and psychological discomfort. Some women felt embarrassed when examined by a male doctor, but the attitude and approach of the examiner was generally found to be more important than gender. Implications for practice: practitioners should be continuously aware of the need to show respect and consideration for the dignity of a woman undergoing vaginal examination in labour. Although this seems an obvious statement to make it is reiterated because some practitioners display insensitivity in this regard. Each woman should be treated with courtesy and respect, and her modesty protected by minimal exposure and examiners/examinations. Findings from the examination should be discussed with her. Practitioners should be aware of the cultural influences that may lead a woman to hide her pain during examination and should be alert for signs of this.

A structured examination in labour improves documentation

A structured sticker for examination of women in labour was introduced at Arrowe Park Hospital in 1998 to improve documentation of examination findings. This study was undertaken to assess whether the use of the sticker improved documentation of examination findings and second, compliance of sticker use. A retrospective analysis was performed on 64 cases randomised by random number generated on Arcus Quickstat from 470 women who were induced by prostaglandin during 1 January 1998 to 31 December 1998 at Arrowe Park Hospital. Women were induced by prostaglandin were chosen as the study population to obtain data from early labour. A total of 229 examinations were performed in these areas. Statistical analysis was undertaken on Arcus Quickstat, and χ2 and Fisher’s exact tests were applied to check for statistical significance.

Can sonography represent a marker of dystocia in epidural analgesia? A prospective randomized study

Purpose: An association between epidural analgesia and dystocia in the second stage of labor remains controversial. To compare severe labor pain and dystocia at the time of epidural placement for predicting cesarean section (c.s.) risk. We hypothesized, the dystocia causes severe labor pain, such that more epidural medication is required to maintain comfort.Methods: We examined the relationship between labor outcome and severe labor pain defined by the number of supplemental anesthetic boluses, by cervical dilatation, clinical evaluation of pelvic dimension, sonographic fetal weight and ultrasonographic examination of fetal axis in cephalic presenting deliveries. This prospective study included 375 women in labor with have singleton fetuses at term in vertex presentations. We excluded women with pre‐eclampsia, placenta previa, repeat c.s.Results: Seventy‐nine of the 375 patients receiving early epidural analgesia were delivered by c.s. (68 due to dystocia, 11 due to fetal distress). A multiple logistic regression model evaluated demographic and labor‐related variables associations with cesarean risk. By using multivariate analysis, the odds ratio of c.s. among patients who required at least three boluses was 2.4 compared with those who required two boluses or less (P < 0.001). Variables that proved to be statistically significant in increasing the likelihood of c.s. were station at time epidural placement (P < 0.01) and severe labor pain associated with dystocia (P < 0.01). The relationship between severe labor pain‐dystocia and labor arrest (persistent occipito‐posterior or occipito‐transverse position in labor progress) we confirmed with sonography examination during the first and second stage of labor (82% of cases) (P < 0.01).Conclusions: This is a prospective study demonstrating an association between severe labor pain and c.s. The abnormality of fetal axis exists and it can affect the progress of epidural analgesia labors. The sonographic examination in labor reducing the time of labor failure, the possibility of fetal and maternal complications. Furthermore it reduces forensis implications because of the possibility to give evidence of the intrapartum head fetal axis.

Puerperal sepsis: a preventable post-partum complication.

Patients with puerperal sepsis following delivery at Ife State Hospital (ISH) of Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) Ile-Ife over a 10-year period spanning January 1986 to December 1995 were reviewed. One hundred and forty-six patients were diagnosed as having puerperal sepsis and there were 8428 deliveries giving an incidence of 1.7%. The incidence was higher among the unbooked patients 71.2%. Predisposing factors were: anaemia in pregnancy, 69.2%; prolonged labour (labour lasting up to 12 h or more), 65.7%; frequent vaginal examinations in labour (more than five), 50.7%; premature rupture of membranes, 31.5%; and non-adherence to asepsis during delivery. The case mortality rate was 4.1%. Antenatal care and supervised hospital delivery should be encouraged in order to prevent or reduce this serious post-partum morbidity.

A brief overview of South Africa's mineral industry: world context and changing local circumstances

An examination of the important South African mineral resources clearly demonstrates that, omitting hydrocarbon fuels, South Africa (RSA) contains the greatest value of mineral wealth per square kilometre of surface area on Earth. The reserves of all these commodities are examined in a global context, comparing also their production and exports (1985–1994), as well as new events that have influenced their holdings situation and their exploitation over the last ten years up to 1994 or beyond. The mineral industry's current input to state revenue is also examined, along with continuing discussions to bring about the necessary alterations in the mineral and mining laws and policies in the RSA, in the post-apartheid environment. Mineral wealth is greatly dependant on secure land-tenure, so that this and the environmental aspects of mineral exploration and exploitation are also appraised. The brief examination of labour and industrial relations is also very pertinent at this stage of the political and economic development in the RSA. Finally, the future outlook for the RSA mining industry is reviewed.

David Willetts, Blair's Gurus: An Examination of Labour's Rhetoric, Centre for Policy Studies, London, 1996, 73 pp. paper £7.50.

David Willetts, Blair's Gurus: An Examination of Labour's Rhetoric, Centre for Policy Studies, London, 1996, 73 pp. paper £7.50.

Management of Prelabour Rupture of the Membranes in Term Primigravidae

GRANT, JOHN M.; SERLE, ELISABETH; MAHMOOD, TAHIR; SARMANDAL, PURNIMA; CONWAY, DAVID I. Author Information

A Randomized Controlled Trial of a Nursery Ritual: Wearing Cover Gowns to Care for Healthy Newborns

The routine wearing of individual cover gowns by nurses and visitors for direct care of healthy newborns was usual practice on the maternity ward of a regional referral center. We conducted a randomized trial in which cover gowns were not provided for care of infants in the experimental group (n = 222), but were maintained for control infants (n = 230). The principal outcome measured was Staphylococcus aureus colonization of the newborn nares or umbilicus on day 3 or day of discharge. Twenty percent (n = 51) of the experimental group (no gown) had a positive culture compared with 21 percent (n = 47) of the controls. Of the infants with positive cultures, two in each group exhibited symptoms of overt S. aureus infection. Experimental infants were similar to controls with respect to feeding method, route of delivery, amount of time spent rooming-in, and average number of visitors per day. In the group of positively cultured infants, the mothers experienced longer labor, and more vaginal examinations in labor, and the number of males undergoing circumcision was higher. We concluded that routine use of cover gowns was unwarranted, and we have altered the ward policy accordingly. This also has had a positive economic effect.

Maternal considerations in the use of pelvic examinations in labour

In a randomised controlled trial involving 307 women maternal discomfort associated with a policy of rectal examinations for routine management in labour was compared with that associated with an alternative policy of using vaginal examinations. The women, irrespective of parity showed a clear preference for the vaginal examination policy: 28% in the rectal examination group compared with only 11% in the vaginal examination group described their examinations as ‘very uncomfortable’. Furthermore, there was no evidence that the vaginal examination policy was associated with an increased risk of maternal or neonatal morbidity. The continuing use of routine rectal examinations in labour should be reassessed and greater consideration given to maternal feelings.

Trial of labor after previous cesarean section: Prognostic indicators of outcome

A cross-sectional analytic survey of 92 patients permitted to attempt vaginal delivery after previous lower segment cesarean section ("trial of scar") is reported. Variables which may predict mode of delivery were assessed. Fifty patients (54.3%) were delivered vaginally; 42 patients (45.7%) had repeat cesarean sections in labor. There were three cases of scar dehiscence (3.2%). There were no maternal or fetal mortality. When the cervix was less than 3 cm dilated at initial examination in labor, 10 of 37 patients (27%) were delivered vaginally, compared to 38 of 55 patients (69%) who were delivered vaginally when the cervix was greater than 3 cm dilated. Assessment of cervical dilatation on admission in labor proved to be the most significant prognostic factor at the onset of labor, with regard to successful vaginal delivery in a patient with a lower segment cesarean section scar.

Is vaginal examination in labour a significant cause of genital tract infection?

Acta Obstetricia et Gynecologica ScandinavicaVolume 39, Issue 2 p. 316-322 Is Vaginal Examination in Labour a Significant Cause of Genital Tract Infection? Teit Kærn, Teit Kærn The Department of Obstetrics (Teit Kœrn, M.D.), St. Joseph's Hospital, Copenhagen, DenmarkSearch for more papers by this authorJørgen Glenert, Jørgen Glenert The Department of Obstetrics (Teit Kœrn, M.D.), St. Joseph's Hospital, Copenhagen, DenmarkSearch for more papers by this author Teit Kærn, Teit Kærn The Department of Obstetrics (Teit Kœrn, M.D.), St. Joseph's Hospital, Copenhagen, DenmarkSearch for more papers by this authorJørgen Glenert, Jørgen Glenert The Department of Obstetrics (Teit Kœrn, M.D.), St. Joseph's Hospital, Copenhagen, DenmarkSearch for more papers by this author First published: January 1960 https://doi.org/10.3109/00016346009159928AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume39, Issue2January 1960Pages 316-322 RelatedInformation

Errors of presentation

Errors of presentation during labor result in increased maternal and fetal morbidity and mortality and therefore deserve attention. For the purpose of this study, breech presentation is not included, and the errors discussed will include face, brow, compound, and shoulder presentations. When these problems are promptly diagnosed and properly managed, better results for mother and baby are obtained.A summary of the important etiological factors concerned in the study of the group includes such maternal factors as pelvic contraction, large pelvis, multiparity, lax abdominal wall, congenital anomalies of the uterus, placenta previa, and pelvic tumor. Fetal factors include prematurity, large infant, macerated fetus, multiple pregnancy, abnormality of the fetal neck, nuchal cord, and congenital anomalies. It is important to realize that upon diagnosing an error of presentation, possible etiological factors must immediately be investigated. Consideration of these factors may prevent errors in management and resultant tragedy.Early diagnosis is important since it determines management. Failure to make a prompt diagnosis of an error of presentation may predispose to uterine inertia which could result in prolonged labor with increased maternal and fetal morbidity. The usual means of diagnosis are abdominal, rectal, vaginal, and x-ray examinations. Despite careful abdominal examination during pregnancy, few errors except shoulder presentation are detected before labor starts.The most valuable diagnostic method is a careful vaginal examination in labor. It is frequently desirable to confirm a clinical diagnosis of an error of presentation radiologically, and, at the same time, to obtain additional information as to pelvic capacity, placental position, and possible fetal anomaly. However, abnormal presentation is often first diagnosed on x-ray in the presence of polyhydramnios or multiple pregnancy.The method of treatment depends on the type of error that is diagnosed, the etiological factor or factors involved, the condition of the mother and infant at the time the diagnosis is made, the experience of the operator, and the facilities at hand.

X-ray pelvimetry

1.1. Two hundred and forty-two cases of x-ray pelvimetry reported by eighteen different radiologists are reviewed on the basis of the prognostic accuracy of the reporting physician.2.2. Three out of four were reported correctly, but almost all of these were in the adequate pelvis with an average-sized baby.3.3. The radiologist has no method of measuring the fetal head adequately, and was in error most frequently in the cases where the obstetrician needed help—the cases of cephalopelvic disproportion, due either to the borderline pelvis, or to the unsuspected larger baby in an average pelvis.4.4. It is suggested that the roentgenologist does not usually have sufficient information or the obstetrical background to make a clinical prognosis and should cease predicting the outcome of delivery. Furthermore, by his predictions, he places the obstetrician in an untenable position medicolegally.5.5. X-ray pelvimetry was never intended to take the place of an adequate pelvic examination in labor, and a trial of labor. It is a laboratory aid at best and should be used as such.6.6. The indications for x-ray pelvimetry should be limited to two situations: (1) malpresentation, and (2) lack of adequate clinical progress in labor. Further, it is our opinion that x-rays should be taken only while the patient is in labor for maximum information.7.7. Since all radiation is harmful, it is our belief that all routines as to the number of plates should be discarded. A specific minimum number of views should be ordered by the obstetrician for the individual case.

Is the Danger of Vaginal Examination in Labor Overestimated?: Case Report

Is the Danger of Vaginal Examination in Labor Overestimated?: Case Report

RECTAL EXAMINATION IN LABOUR.

RECTAL EXAMINATION IN LABOUR.

The status of rectal examinations in labor: A survey of the literature and an analysis of one thousand cases

The status of rectal examinations in labor: A survey of the literature and an analysis of one thousand cases