First Stage Of Labor Research Articles

Successful post-term pregnancy in scared bicornuate uterus: case report

Pregnancies in the bicornuate uterus are usually considered high-risk because of their association with poor reproductive outcomes such as recurrent pregnancy loss, cervical insufficiency, low birthweight, preterm birth, malpresentation, cesarean delivery, and uterine rupture. The objective of the report was to show that patients with a scared bicornuate uterus at post-term could have successful pregnancy outcomes. We are presenting a 28-year-old gravida III para II lady with a bicornuate scared uterus at post-term. She has a history of early third-trimester pregnancy loss, and her second pregnancy was delivered via cesarean section. In her first pregnancy, the patient's uterus was not identified as bicornuate. However, an ultrasound during her second pregnancy revealed that she had a bicornuate uterus, which led to the diagnosis. At term, the lady had a successful cesarean section. Lastly, for the current post-term pregnancy she had no prenatal check-up. Even though this, she was coming at the latent first stage of labor and an emergency cesarean section was done.Conclusion Successful outcomes could be achieved in patients with the bicornuate uterus at post-term gestation.

Differences of First Stage Labor with Lemon and Lavender Aromateraphy in Panongan Health Centre Tangerang Regency

Background: Severe pain during labor can cause fatigue in the mother so that there is a risk of prolonged labor which can endanger the mother and fetus. Panongan Community Health Center, Tangerang Regency, Banten in January-March 2022 there were 142 deliveries, 11 mothers (7.8%) of whom delivered SC at the mother's request because they could not stand the pain of labor. Purpose: To determine the differences in labor pain in the first stage of labor for mothers who were given lavender aromatherapy and lemon aromatherapy at the Panongan Health Center, Tangerang Regency, in 2022. Methods: Quasy experimental design study with two group pre-post test design. The sample in this study was 30 respondents using a purposive sampling technique. Data were analyzed using paired sample t-test and Independent T-Test which were previously tested for normality and homogeneity. Results: Pain in the first stage of labor in women giving birth before giving lavender aromatherapy averaged 6.00 and after being given lavender aromatherapy an average of 3.20 with an average difference of 2.80. Pain in the first stage of labor in women giving birth before giving lemon aromatherapy averaged 6.47 and after being given lemon aromatherapy averaged 1.73 with an average difference of 4.74. The results of bivariate analysis with paired sample t-test giving lavender aromatherapy a value of 0.000 and lemon aromatherapy a p value of 0.000. Independent T-Test results posttest p value 0.002. Conclusion: there are differences between lavender aromatherapy and lemon aromatherapy on first stage labor pain among mothers. It is hoped that giving lemon and lavender aromatherapy can be applied thoroughly in Indonesian health services.

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

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

Effect of Distraction Therapy on Reducing Pain Levels

Severe pain during labor causes the mother to experience psychological disorders. Therefore, interventions to reduce labor pain are needed in order to reduce complications for the mother and fetus during the process and after delivery. according to research suggests that 7-54% of mothers give birth without experiencing pain if distraction therapy is done. It turns out that through this distraction or relaxation therapy the smoothness of the birthing process naturally increases. This therapy is also very useful for creating a beautiful birthing experience for mothers giving birth. This study aims to determine the effect of distraction therapy on reducing pain perceived by mothers in the first stage of labor in the BPS Dewi delivery room, Jambi City in 2022. This study was an experimental study with a pre and post design. The research location was conducted at BPS Dewi, Jambi City. The population of this study were all mothers giving birth at BPS Dewi as many as 20 people, and all populations were used as samples. Based on the results of the analysis of the data obtained before the distraction therapy was carried out, the pain scale was obtained with a mean = 4.90 and after the distraction therapy was carried out, the mean = 3.45. So it can be seen that there is a decrease as a result of giving distraction therapy. After recapitulation, there was a mean difference between before and after giving distraction therapy 4.90 to 3.45 with a p value of .000, meaning the effect of distraction therapy on reducing pain levels. It is hoped that this research for health services can improve the quality of services for women giving birth through distraction therapy for mothers who are useful for expediting the delivery process.

Comparison of labor duration of induced labor with dinoprostone insert vs spontaneous labor.

Labor induction is one of the most common procedures in modern obstetrics. One in five pregnant women and 30-40% of women delivering vaginally undergo this procedure. If the cervical status is unfavorable, a ripening process is used prior to induction to shorten the duration of oxytocin administration and maximize the possibility of vaginal birth. The aim of this study was to compare the duration of labor induced with dinoprostone vaginal insert to spontaneous labor. It was a retrospective study conducted between May 2019 and February 2021 in the tertiary reference center, the Obstetrics and Perinatology Department of the Jagiellonian University Hospital in Krakow. The research group involved 182 patients in singleton pregnancy at term, qualified for cervical ripening procedure. The control group consisted of 178 patients that were delivering spontaneously and admitted to the delivery ward in the first stage of labor. Statistical analysis was performed to compare the duration of labor between groups. To find factors affecting the procedure we compared different models consisting of maternal and fetal characteristics. Successful vaginal delivery in the dinoprostone group was achieved in the group of 88% of patients. There was no significant difference in labor duration between the groups: 315 minutes in the study group and 300 min in the control group. Only being primipara was a factor related to longer labor in both groups. Pre-induction with dinoprostone insert and additional foley catheter, if indicated, does not make labor longer in comparison with spontaneous labor.

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

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

Effectiveness of Music Therapy on the Level of Anxiety during First Stage of Labour among Pregnant Woman in Selected Hospitals

Effectiveness of Music Therapy on the Level of Anxiety during First Stage of Labour among Pregnant Woman in Selected Hospitals

Level of agreement between midwives and obstetricians performing ultrasound examination during labor.

To evaluate the level of agreement between ultrasound measurements to evaluate fetal head position and progress of labor by attending midwives and obstetricians after appropriate training. In this prospective study, women in the first stage of labor giving birth to a single baby in cephalic presentation at our Obstetric Unit between March 2018 and December 2019 were invited to participate; 109 women agreed. Transperineal and transabdominal ultrasound was independently performed by a trained midwife and an obstetrician. Two paired measurements were available for comparisons in 107 cases for the angle of progression (AoP), in 106 cases for the head-to-perineum distance (HPD), in 97 cases for the cervical dilatation (CD), and in 79 cases for the fetal head position. We found a good correlation between the AoP measured by obstetricians and midwives (intra-class correlation coefficient [ICC] = 0.85; 95% confidence interval [CI] 0.80-0.89). There was a moderate correlation between the HPD (ICC = 0.75; 95% CI 0.68-0.82). There was a very good correlation between the CD measured (ICC = 0.94; 95% CI 0.91-0.96). There was a very good level of agreement in the classification of the fetal head position (Cohen's κ = 0.89; 95% CI 0.80-0.98). Ultrasound assessment of fetal head position and progress of labor can effectively be performed by attending midwives without previous experience in ultrasound.

The effectiveness of obstetric gel application in shortening labor duration and preserving vaginal perineal integrity: prospective observational study

Aim: The aim of this study to determine the effects of obstetric gel application on labor outcomes.&#x0D; Materials and Method: This nonrandomized controlled study was carried out between January 2019 and June 2019 in a tertiary-care hospital. Nulliparous pregnant women with low risk, vertex position, between the ages of 16-40 years, with an estimated fetal weight of 2500-4000 grams and a gestational week between 37-41 weeks were included in the study. Using an applicator, 3-5 ml of a hydroxyethyl cellulose gel was applied to the vaginal canal of the study group (n=142) at the first stage of labor (before 5 cm cervical opening). The procedure was repeated every two hours until the birth of the baby. The control group (n=191) received standard antenatal care. &#x0D; Results: The need for episiotomy was significantly lower in the study group compared to the control group (n=72 (50.7%) vs. n=175 (91.6%)) (Z=18.902, p

Remifentanil at a Relatively Elevated Dose in Active Phase is Safe and More Suitable Than Fixed Lower Dose for Intravenous Labor Analgesia.

Intravenous labor analgesia is recommended as an alternative for parturients who have contraindications to epidural analgesia. There are several opioid analgesics and different administering regimens used in the clinic. This study aimed to compare the effectiveness and safety of two intravenous remifentanil dosage regimens in the first labor stage. One hundred and fifteen parturients with a contraindication to epidural analgesia but were willing to receive systemic labor analgesia were randomized into group A received a fixed dose of remifentanil throughout the first stage of labor, and group B received an elevated dose of remifentanil during the active phase of the first stage both by patient-controlled analgesia (PCA). Maternal numerical rating scale (NRS) pain score and oxygen desaturation, sedation efficacy, satisfaction, as well as maternal and fetal adverse reactions were recorded and compared. The mean NRS pain scores before analgesia and in the latent phase showed no statistically significant difference between the two groups (P > 0.05). However, during the active phase, group B demonstrated significantly lower mean NRS pain scores and lowest pain score compared to group A (P < 0.05). Furthermore, group B exhibited higher overall sedation scores and satisfaction scores in comparison to group A (P < 0.05). The incidence of adverse reactions between the two groups was similar (P > 0.05). Relatively elevated intravenous dosage of remifentanil with PCA during the active phase in the first stage of labor is safe and more effective than a fixed-dosage regimen for labor analgesia. This study was registered with ChiCTR on 24/08/2021 with trial identification number: ChiCTR2100050247. First participant was recruited on 31/08/2021. The last patient was recruited on 12/08/2022.

Effect of warm compress on pain perception during first stage of labour among primigravida mothers

Effect of warm compress on pain perception during first stage of labour among primigravida mothers

Effect of Birthing Balls on the Length of First Stage Labor among Primigravidas at the Barokah Main Clinic Bandung City in 2021

Background: Labor and birth are physiological events and normal. Delivery is said to be normal if the process is full term (37-42 weeks) without any complications. Birth ball is a technique to help progress labor that can be used during the first stage of labour. Until now, not much is known and not familiar with birth balls, even though birth balls are very effective in speeding up the delivery process. The advantage of using this birth ball is that it increases blood flow to the uterus, placenta and baby, relieves pressure and can increase the output of the pelvis by as much as 30%, provides comfort for the knees and ankles, provides counter-pressure on the perineum and erect thighs.&#x0D; Objective: To determine the average duration of the first stage of labor in primigravidas using a birth ball and without using a birth ball and to determine the effect of a birthing ball on the duration of the first stage of labor in primigravidas&#x0D; Methodology: This study used a quasi-experimental method with a Randomized Two-Group, Posttest only design. Held at the Barokah Main Clinic in Bandung City. The time of the research was carried out from June to July 2021. The research sample was primigravida in the first stage of the birth of 30 respondents with data analysis using the Mann Whitney test and independent sample t-test. Results: Based on the results of the study using the Mann Whitney test and the independent t-test, the p value &lt;0.05 was obtained.&#x0D; Conclusion: There is a difference in the average duration of the first stage of labor in primigravidas using a birth ball and without using a birth ball. It is expected that women in labor can know the function of the birth ball so that they can maximize the use of the birth ball in the delivery process.&#x0D;

Prevention of prolonged labour in term nulliparas with oxytocin alone versus with oxytocin and an antispasmodic

Background: Poor progress of labour is a common problem with nulliparous deliveries. It occurs when the cervical dilatation rate in the active phase of the first stage of labour is &lt;1cm/hr, and is mainly due to poor uterine contractions or slow cervical dilatation. Without interventions, poor progress could degenerate into prolonged labour which is associated with increased maternal and perinatal morbidity and mortality. Augmentation of labour with oxytocin is the traditional management for poor progress as it enhances uterine contractions. At times, despite adequate uterine contractions poor progress will persist due to cervical smooth muscle spasms. Antispasmodics can relieve smooth muscle spasms. Aim/objective: This study compared the duration of labour in term nulliparous parturients with poor progress following augmentation with oxytocin alone versus with oxytocin and an antispasmodic (drotaverine). Methods: The study was a single-blinded randomized controlled trial involving 156 term nulliparous parturients with poor progress of labour, that were randomized into two groups in eight months. Each group had 78 parturients which were augmented with either oxytocin with placebo or oxytocin with drotaverine. They were monitored until delivery and the duration of labour in both groups after the intervention was compared. Data obtained were analysed using SPSS version 23 software. The level of significance was set at 0.05. Results: The two groups were similar in their sociodemographic characteristics, and the mean pre-intervention duration of labour was also similar (6.02 ±2.04 vs. 6.09± 2.07hr p=0.23). In this study 135(86.5%) parturients had vaginal delivery while 21(13.5%) had emergency caesarean section. Among those who had a vaginal delivery, the mean duration of labour following augmentation was significantly shorter in the oxytocin-drotaverine group than in the oxytocin-placebo group (6.20 ±0.40hrs vs. 6.64±0.34hrs, MD- 26.4minutes, p&lt;0.01). There was no difference in the duration of the second stage of labour in both groups. Conclusion: The use of drotaverine with oxytocin in managing poor progress of labour in term nulliparous women leads to a significantly shorter duration of the first stage of labour than oxytocin alone.

Neonatal outcomes after water birth: A retrospective cohort study

ObjectiveTo compare neonatal outcomes between water births, births with immersion only during labour, and births in which immersion was never used. MethodsA retrospective cohort study was performed including mother-baby dyads attended between 2009 and 2019 at the Hospital do Salnés regional hospital (Pontevedra, Spain). These women were categorised into 3 groups: water birth; immersion only during dilation; and women who never used immersion. Several sociodemographic-obstetric variables were studied and the main outcome was the admission of the neonate to the intensive care unit (NICU). Permission was obtained from the responsible provincial ethics committee. Descriptive statistics were used and between-group comparisons were performed using variance for continuous variables and chi-square for categorical variables. Multivariate analysis was performed with backward stepwise logistic regression and incidence risk ratios with 95%CI were calculated for each independent variable. Data were analysed using IBM SPSS® statistical software. ResultsA total of 1191 cases were included. 404 births without immersions; 397 immersions only during the first stage of labor; and 390 waterbirths were included. No differences were found in the need to transfer new-borns to a NICU (p = .735). In the waterbirth cohort, neonatal resuscitation (p < .001, OR: 0,1), as well as respiratory distress (p = .005, OR: 0,2) or neonatal problems during admission (p < .001, OR: 0,2), were lower. In the immersion only during labor cohort, less neonatal resuscitation (p = .003; OR: 0,4) and respiratory distress (p = .019; OR: 0,4) were found. The probability of not breastfeeding upon discharge was higher for the land birth cohort (p < .001, OR: 0,4). ConclusionsThe results of this study indicated that water birth did not influence the need for NICU admission, but was associated with fewer adverse neonatal outcomes, such as resuscitation, respiratory distress, or problems during admission.

Особливості управління болем у вагітних та породіль

Purpose - to evaluate the efficacy and adverse side effects (if any) of intravenous infusion of 1000 mg paracetamol as a method of pain relief in labour during the active phase of labour and in the postoperative period after caesarean section. Materials and methods. 43 pregnant women in the first stage of labor with active labor were studied. The selection criteria were healthy low-risk first-term mothers; aged 18-35 years; with spontaneous onset of labor at 37-40 weeks of pregnancy; the first period of labor with the opening of the cervix by 3-5 cm; one live fruit; main presentation Infulgan inf. solution was chosen as a paracetamol preparation 10 mg/ml per 100 ml. Multimodal anesthesia with a combination of the drugs Infulgan (paracetamol) and Keydex (dexketoprofen) was performed for postoperative analgesia. The pain intensity indicator was determined using the visual analog scale (VAS) - a method of subjective pain assessment. The patient marked a point on a non-graduated ruler 10 cm long, which corresponds to the degree of severity of pain. During the dynamic evaluation of changes in pain intensity, they were considered objective and significant if the true VAS value differed from the previous one by more than 1.3 cm. The comparison group consisted of 20 pregnant women in the 1st stage of labor who did not receive anesthesia at their own request. Also, a study of the effectiveness of complex multimodal anesthesia (Infulgan (paracetamol) and Keydex (dexketoprofen)) was conducted in 5 (11.6%) women in labor after delivery by caesarean section. Results. The use of intravenous paracetamol injection for analgesia during labor is an effective analgesia. There was an initial but significant decrease in the VAS score 30 minutes after Infulgan administration and a statistically significant decrease in pain after 2, 3 and 4 hours compared with the VAS score before treatment. In the group of women who did not undergo analgesia, the intensity of the pain syndrome steadily increased. In the postoperative period, after caesarean section, women underwent combined analgesia with the use of Infulgan (paracetamol) drugs as the basic component of multimodal analgesia and Keydex (dexketoprofen) as a necessary step of multimodal analgesia. The above-mentioned combination of drugs allows for Step-Up analgesia - step-by-step pain therapy. Infulgan was administered in 1 vial (1000 mg) every 6 hours by intravenous injection, and Keydex - in 1 ampoule every 8 hours by intramuscular injection. The addition of Keydex (dexketoprofen) to the analgesia provided an adequate analgesic effect and did not require the administration of opioid analgesics in the postoperative period. Conclusions. Intravenous paracetamol is an effective non-opioid drug for the relief of labor pain without any significant side effects for mother and fetus. The absence of any maternal side effects (sedation, respiratory depression, delayed gastric emptying, nausea and vomiting) or neonatal side effects (respiratory depression and decreased Apgar scores) associated with opioids allows us to recommend Infulgan for the relief of labor pain. The step-by-step Step-Up pain therapy in the postoperative period allows you to reduce the doses of each of the analgesics and reduce the frequency and side effects of the drugs. The use of Infulgan and Keydex as a method of pain management by means of Step-Up analgesia in the postoperative period in parturient women showed high efficiency, adequate tolerability and patient’s satisfaction. 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 all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Intrapartum electronic fetal monitoring features associated with a clinical diagnosis of nonreassuring fetal status

Nonreassuring fetal status detected by continuous electronic fetal monitoring accounts for almost 1 in 4 primary cesarean deliveries. However, given the subjective nature of the diagnosis, there is a need to identify the electronic fetal monitoring patterns that are clinically considered nonreassuring. This study aimed to describe which electronic fetal monitoring features are most commonly associated with first-stage cesarean delivery for nonreassuring fetal status, and to evaluate the risk of neonatal acidemia following cesarean delivery for nonreassuring fetal status. This was a nested case-control study in a prospectively collected cohort of patients with singleton pregnancies at ≥37 weeks' gestation, admitted in spontaneous labor or for induction of labor from 2010 to 2014 at a single tertiary care center. Patients with preterm pregnancies, multiple gestations, planned cesarean delivery, or nonreassuring fetal status in the second stage of labor were excluded. Cases were identified as having nonreassuring fetal status on the basis of what was documented in the operative note by the delivering physician. Controls were patients without nonreassuring fetal status within 1 hour of delivery. Cases were matched to controls in a 1:2 ratio by parity, obesity, and history of cesarean delivery. Electronic fetal monitoring data were abstracted by credentialed obstetrical research nurses for the 60 minutes before delivery. The primary exposure of interest was the incidence of high-risk category II electronic fetal monitoring features in the 60 minutes before delivery; in particular, the incidence of minimal variability, recurrent late decelerations, recurrent variable decelerations, tachycardia, and >1 prolonged deceleration were compared between groups. We also compared neonatal outcomes between cases and controls, including fetal acidemia (umbilical artery pH <7.1), other umbilical artery gas analytes, and neonatal and maternal outcomes. Of the 8580 patients in the parent study, 714 (8.3%) underwent cesarean delivery for nonreassuring fetal status in the first stage of labor. Patients diagnosed with nonreassuring fetal status requiring cesarean delivery were more likely to have recurrent late decelerations, >1 prolonged deceleration, and recurrent variable decelerations compared with controls. More than 1 prolonged deceleration was associated with 6 times increased rate of nonreassuring fetal status diagnosis resulting in cesarean delivery (adjusted odds ratio, 6.73 [95% confidence interval, 2.47-8.33]). Rates of fetal tachycardia were similar between groups. Minimal variability was less common in the nonreassuring fetal status group compared with controls (adjusted odds ratio, 0.36 [95% confidence interval, 0.25-0.54]). Compared with control deliveries, cesarean delivery for nonreassuring fetal status was associated with nearly 7 times higher risk of neonatal acidemia (7.2% vs 1.1%; adjusted odds ratio, 6.93 [95% confidence interval, 3.83-12.54]). Composite neonatal morbidity and composite maternal morbidity were more likely among patients delivered for nonreassuring fetal status in the first stage (3.9% vs 1.1%; adjusted odds ratio, 5.70 [2.60-12.49]; and 13.3% vs 8.0%; adjusted odds ratio, 1.99 [1.41-2.80]). Although multiple category II electronic fetal monitoring features have been traditionally linked to acidemia, the presence of recurrent late decelerations, recurrent variable decelerations, and prolonged decelerations seemed to concern obstetricians enough to surgically intervene for nonreassuring fetal status. A clinical intrapartum diagnosis of nonreassuring fetal status in the setting of these electronic fetal monitoring features is also associated with increased risk of acidemia, suggesting clinical validity to the diagnosis of nonreassuring fetal status.

Oxycodone does not affect placental circulatory physiology during the early first stage of labor-A randomized trial.

Opioids are used for pain relief during the first stage of labor. Oxycodone can cause maternal hypotension that may modify utero- and fetoplacental circulatory physiology. We hypothesized that maternal intravenous (i.v.) oxycodone has no detrimental effect on utero- and fetoplacental hemodynamics during the early first stage of labor. Twenty-two parturients requiring pain relief during the first stage of labor were randomized in a double-blinded and placebo-controlled study. By Doppler ultrasonography, both uterine artery (Ut) and umbilical vein (UV) volume blood flows (Q), Ut pulsatility index (PI), and Ut vascular resistance (RUt) were calculated. Blood flow velocity waveforms were obtained between uterine contractions. After baseline measurements, women received oxycodone 0.05 mg/kg or a placebo intravenous. Doppler ultrasonography was repeated up to 120 min after the first drug administration. The second dose of oxycodone 0.05 mg/kg was allowed at 60 min to all parturients with contraction pain ≥5/10. Maternal plasma samples were collected at each study phase and after delivery with umbilical cord plasma samples, to measure oxycodone concentrations. gov identifier (NCT no. NCT02573831). At baseline, mean QUt and QUV did not differ significantly between the placebo-first (478 mL/min and 57 mL/min/kg) and the oxycodone-first (561 mL/min and 71 mL/min/kg) groups. In addition, RUt and Ut PI were comparable between the groups. Following oxycodone at 60 min, mean QUt and QUV (714 mL/min and 52 mL/min/kg) were similar to the placebo-first (520 mL/min and 55 mL/min/kg) group. Furthermore, all the measured parameters were comparable to the baseline values. At 60 min after the first study drug administration, all the parturients in the placebo-first group needed intravenous oxycodone 0.05 mg/kg. At 120 min, we found no statistically significant change in any of the measured parameters. No significant correlation was found between maternal oxycodone concentration and QUt or QUV. Furthermore, newborn oxycodone concentration did not correlate with QUV. Oxycodone did not have any detrimental effect on either utero- or fetoplacental circulatory physiology during the early first stage of labor. Maternal plasma oxycodone did not correlate with utero- and fetoplacental hemodynamics. No correlation was found between newborn oxycodone concentration and fetoplacental hemodynamics.

The Impact of Cervical Effacement at Time of Amniotomy in Patients Undergoing Induction of Labor.

There is evidence to suggest that early amniotomy during induction of labor is advantageous. However, following cervical ripening balloon removal, the cervix remains less effaced and the utility of amniotomy in this setting is less clear. We investigated whether cervical effacement at the time of amniotomy impacts outcomes among nulliparas undergoing induction of labor. This was a secondary analysis of a prospective cohort of singleton, term, nulliparous patients at a tertiary care center undergoing induction of labor and amniotomy. The primary outcome was completion of the first stage of labor. Secondary outcomes were vaginal delivery and postpartum hemorrhage. Outcomes were compared between patients with cervical effacement ≤50% (low effacement) and >50% (high effacement) at time of amniotomy. Multivariable logistic regression was used calculate risk ratios (RR) to adjust for confounders including cervical dilation. Stratified analysis was performed in patients with cervical ripening balloon use. A post hoc sensitivity analysis was performed to further control for cervical dilation. Of 1,256 patients, 365 (29%) underwent amniotomy at low effacement. Amniotomy at low effacement was associated with reduced likelihood of completing the first stage (aRR: 0.87 [95% confidence interval, CI: 0.78-0.95]) and vaginal delivery (aRR: 0.87 [95% CI: 0.77-0.96]). Although amniotomy at low effacement was associated with lower likelihood of completing the first stage in all-comers, those who had amniotomy performed at low effacement following cervical ripening balloon expulsion were at the highest risk (aRR: 0.84 [95% CI: 0.69-0.98], p for interaction = 0.04) In the post hoc sensitivity analysis, including patients who underwent amniotomy at 3- or 4-cm dilation, low cervical effacement remained associated with a lower likelihood of completing the first stage of labor. Low cervical effacement at time of amniotomy, particularly following cervical ripening balloon expulsion, is associated with a lower likelihood of successful induction. · Low cervical effacement at amniotomy was associated with lower rates of complete dilation.. · Effacement at amniotomy is especially important for patients who had a cervical ripening balloon.. · Providers should consider cervical effacement when timing amniotomy for nulliparous term patients..

Resultados neonatales tras parto en el agua: Estudio de cohortes retrospectivo

ObjectiveTo compare neonatal outcomes between water births, births with immersion only during labour, and births in which immersion was never used. MethodsA retrospective cohort study was performed including mother-baby dyads attended between 2009 and 2019 at the Hospital do Salnés regional hospital (Pontevedra, Spain). These women were categorised into 3 groups: water birth; immersion only during dilation; and women who never used immersion. Several sociodemographic-obstetric variables were studied and the main outcome was the admission of the neonate to the intensive care unit (NICU). Permission was obtained from the responsible provincial ethics committee. Descriptive statistics were used and between-group comparisons were performed using variance for continuous variables and chi-square for categorical variables. Multivariate analysis was performed with backward stepwise logistic regression and incidence risk ratios with 95%CI were calculated for each independent variable. Data were analysed using IBM SPSS® statistical software. ResultsA total of 1,191 cases were included. 404 births without immersions; 397 immersions only during the first stage of labor; and 390 waterbirths were included. No differences were found in the need to transfer new-borns to a NICU (P = .735). In the waterbirth cohort, neonatal resuscitation (P < .001, OR: 0,1), as well as respiratory distress (P = .005 OR: 0,2) or neonatal problems during admission (P < .001, OR: 0,2), were lower. In the immersion only during labor cohort, less neonatal resuscitation (P =.003; OR: 0,4) and respiratory distress (P = .019; OR: 0,4) were found. The probability of not breastfeeding upon discharge was higher for the land birth cohort (P < .001, OR: 0,4;). ConclusionsThe results of this study indicated that water birth did not influence the need for NICU admission, but was associated with fewer adverse neonatal outcomes, such as resuscitation, respiratory distress, or problems during admission.

Effect of continuous spinal anesthesia on the hemodynamics of labor analgesia in hypertensive pregnant women: a comparative, randomized clinical trial

BackgroundTo observe the changes in hemodynamic, stress and inflammatory responses during labor and their labor outcomes after continuous spinal anesthesia labor analgesia for hypertensive pregnant women, and to evaluate whether the continuous spinal anesthesia had any advantages compared to continuous epidural analgesia for hypertensive pregnant women and their newborns.MethodsA total of 160 hypertensive pregnant women were selected and randomly divided into continuous spinal anesthesia analgesia group (CSA group) and continuous epidural analgesia group (EA group). Participant age, height, weight and gestational week were recorded; MAP, VAS score, CO and SVR were recorded after the onset of regular uterine contractions (T0), 10 min after analgesia (T1), 30 min (T2), 60 min (T3), when the uterine opening was complete (T4) and when the fetus was delivered (T5); the duration of the first stage of labor and the second stage of labor were recorded; the number of cases of treatment with oxytocin and antihypertensive therapy, mode of delivery, eclampsia and postpartum hemorrhage were counted; pregnant women Bromage scores were recorded at T2. We also recorded neonatal weight, Apgar scores at 1, 5 and 10 min after birth; arterial blood gas analysis of the umbilical cord was performed in newborns; finally, TNF-α, IL-6, and cortisol in pregnant women venous blood were measured at T0, T5, and 24 h after delivery (T7). The number of successful compressions and the total drug dosage administered by the analgesic pump were recorded for both groups.ResultsThe first stage of labor in CSA was longer than EA (P < 0.05); the MAP, VAS and SVR value in CSA were lower than EA group at T1, T3 and T4 (P < 0.05); in contrast, the CO in CSA at T3 and T4 was higher than in EA (P < 0.05). The oxytocin was more often used whereas the antihypertensive drugs were less used in CSA as compared to EA. The level of TNF-α, IL-6, Cor in the CSA at T5 was lower than the EA group (P < 0.05), and the level of TNF-α in the CSA group at T7 was lower than the EA group (P < 0.05).ConclusionFor pregnant women with hypertension during pregnancy, continuous spinal anesthesia labor analgesia has no significant effect on the final mode of delivery, but shows precise analgesic effect and stabilizes circulatory system, it is recommended to perform continuous spinal anesthesia early in labor for hypertensive pregnant women, which can effectively reduce the stress reaction.Trial registrationChiCTR-INR-17012659.Date of registration: 13/09/2017.