Duration Of Labor Research Articles

Development and early validation of questionnaires to assess system level factors affecting male partners’ attendance at childbirth in LMICs

BackgroundThere is evidence that a woman who receives continuous labour support from a chosen companion can have shorter labour duration, is more likely to give birth without medical interventions, and report a satisfying childbirth experience. These outcomes result from the beneficial effects of emotional and practical support from the woman’s chosen companion, and care provided by health providers. When a woman’s chosen companion is her male partner, in addition to the above benefits, his presence can promote his bonding with the baby, and shared parenthood. However, there may be healthcare system barriers, including organisational, management and individual (staff) factors, that inhibit or restrict women’s choice of companion. There are currently no suitable survey tools that can be used to assess the system level factors affecting the implementation of male partners’ attendance at childbirth in low- and middle- income countries (LMICs).MethodsWe designed two questionnaires to help to address that gap: the Male Partners’ Attendance at Childbirth-Questionnaire for Heads of Maternity Units (MPAC-QHMUs); and the Male Partners’ Attendance at Childbirth-Questionnaire for Maternity Staff (MPAC-QMS). We carried out an extensive review to generate initial items of the two questionnaires. We assessed the content and face validity of the two questionnaires in a three-round modified Delphi study.ResultsThe Male Partners’ Attendance at Childbirth-Questionnaire for Heads of Maternity Units (MPAC-QHMUs) focused on organisational and management factors. The Male Partners’ Attendance at Childbirth-Questionnaire of Maternity Staff (MPAC-QMS) focused on individual staff factors. The final MPAC-QHMUs and MPAC-QMS included items which garnered over 80% content relevance according to the experts’ rating. After all three consensus rounds of the Delphi study, 43 items were retained for the MPAC-QHMUs and 61 items were retained for the MPAC-QMS.ConclusionsThe MPAC-QHMUs and the MPAC-QMS may help understanding of barriers affecting male partners’ attendance at childbirth in LMICs in order to devise implementation strategies to enable wider availability and to maximize women’s choices during labour and childbirth. The MPAC-QHMUs and the MPAC-QMS as newly-developed questionnaires require further validation of their acceptability and feasibility in different cultural contexts, and languages.

Effect of new Maternal and Child Health Book on Iron Supplementation Obedience and Labour Outcome in Pregnant Women, Pringsewu District, Lampung Province, Indonesia

The 2020 edition of the Maternal and Child Health (MCH) book can facilitate pregnant women in monitoring supplementation obedience and labour outcome. There are still few studies that discuss the effectiveness of the MCH book with regard to labour outcomes. This study aimed to determine the effectiveness of the new edition MCH book on obedience to iron supplementation and labour outcomes. The study used a quasi-experimental, non-equivalent control group design. The subjects were pregnant women in the second trimester until labour. The sample of this study comprised 60 people in the intervention group and 61 people in the control group. Research analysis was done using T-test and chi-square tests. The results showed that supplementation obedience increased haemoglobin levels, affected duration of labour in the first and second stages and the amount of blood loss during labour, and the APGAR scores were significantly different in the two groups (p-value >0.05). However, the intake of protein and iron-rich food, placental membrane integrity, duration of the third stage of labour, uterine contractions, APGAR score in the first five minutes, and birth weight did not show a significant difference in the two groups (p-value >0.05). The study concluded that the self-monitoring sheet for iron supplementation in the MCH book could improve obedience and haemoglobin, and thus improve labour outcomes, but it does not increase maternal food intake.

The impact of epidural analgesia on delivery mode in Robson class 1 women: a retrospective cohort study

The use of epidural analgesia represents the gold standard for pain management during labor, but the influence of the use of epidural analgesia on delivery mode is not fully understood. This study aimed to analyze the impact of epidural analgesia on the delivery mode, namely, cesarean delivery, vaginal delivery, and operative vaginal delivery rates, in Robson class 1 women. A retrospective cohort study was conducted on all Robson class 1 women who delivered from January 1, 2019, to December 31, 2019, in the University Hospital of Modena. The primary outcome was the delivery mode (cesarean delivery, vaginal delivery, and operative vaginal delivery rates), and the secondary outcomes were maternal, anesthesiologic, and neonatal effects of epidural analgesia (duration of labor, duration of the second stage of labor, Apgar score, and neonatal intensive care unit admission). A total of 744 women were included in the final analysis, of which 198 (26.6%) underwent epidural analgesia on request and 546 (73.4%) did not. In women with and without epidural analgesia, the cesarean delivery rate was 8.1% vs 7%, the vaginal delivery rate was 79.3% vs 81.1%, and the operative vaginal delivery rate was 12.6% vs 11.9%, respectively. A significant increase in both the first stage of labor (66.3±38.5 vs 43.8±38.8 minutes; P<.0001) and total duration of labor (328.0±206.7 vs 201.7±168.3 minutes; P<.0001) was found in women receiving epidural analgesia. No change was recorded in the second stage of labor. A shorter duration of labor was observed (P<.0001) when epidural analgesia was started earlier (dilation: 2-4 cm vs >4 cm). No significant difference in Apgar score and neonatal intensive care unit admission was found. The use of epidural analgesia was not associated with an increased risk of cesarean delivery or operative vaginal delivery in Robson class 1 women. Further investigations are needed to evaluate its impact on the duration of labor, namely the duration of the first stage of labor, and on the possible advantages of starting epidural analgesia at an early stage.

Comparison of Efficacy and Safety of Different Doses of Dexmedetomidine for Epidural Labor Analgesia.

To explore the efficacy and safety of different doses of dexmedetomidine (DEX) for epidural labor analgesia (ELA). From June 2021 to June 2022, 147 parturients who underwent ELA in our hospital were selected and divided into low- (0.5 μg/kg DEX), medium- (0.75 μg/kg DEX), and high-dose (1.0 μg/kg DEX) groups (n = 49 for each) according to the random number table method. The analgesic effect was assessed using the Ramsay sedation score and Visual Analogue Scale (VAS), and the labor duration, mean arterial pressure (MAP), and heart rate (HR) before and after analgesia, vaginal bleeding within 2 h postpartum, and delivery outcomes (the cesarean section conversion rate and the neonatal Apgar score) were statistically analyzed. Furthermore, the incidence of adverse reactions was calculated, and maternal satisfaction with delivery was investigated. After analgesia, the the Ramsay and labor duration were higher in the high-dose group than those in the low- and medium-dose groups, and the VAS scores was lowerin the high-dose group than those in the low- and medium-dose groups(P < 0.05), while no difference was identified among the three groups in terms of the cesarean section conversion rate and the neonatal Apgar score (P > 0.05). The high-dose group had the greatest fluctuations in MAP and HR levels before and after analgesia than the other two groups, with a higher incidence of adverse reactions (P < 0.05). Finally, the survey of delivery satisfaction showed no significant difference in delivery satisfaction among the three groups (P > 0.05). DEX has excellent performance in ELA, which can effectively relieve the pain of puerperae and shorten the labor process. Among them, low-dose DEX has higher safety and is recommended as the first choice. Trial Registrations. This trial is registered with ML2021073.

Factors associated with intrapartum stillbirth in a tertiary teaching hospital in Burkina Faso.

Intrapartum stillbirth is an indicator of health and community development. To identify the risk factors associated with intrapartum stillbirth in a tertiary teaching hospital in Burkina Faso. A case-control study conducted from January 1 to August 30, 2019. Cases were defined as patients admitted to Yalgado Ouedraogo teaching hospital (YOTH) with a live fetus of at least 28 weeks' gestation and who gave birth to an intrapartum stillborn, a fetus delivered without any signs of life in the first minute postpartum. Controls were defined as patients who delivered a live newborn. Study controls were gradually recruited and matched to cases. For each case, two controls were recruited and matched according to criteria such as delivery route and day of delivery. Data were cleaned in Epidata and exported to Stata for analysis. Variables with a p < 0.05 significance level in the multivariable regression were retained. Odds ratio (OR) and 95% confidence intervals are reported. Eighty-three intrapartum stillbirths were documented among a total of 4,122 deliveries, a stillbirth rate of 20.1 per 1,000 births. There was a statistically significant association between intrapartum stillbirth and prior caesarean section (p = 0.045), multiparity (p = 0.03), the receipt of antenatal care (ANC) by a nurse (p = 0.005) and the disuse of the partogram (p = 0.004). We did not find a significant association between the number of ANC consultations performed (p = 0.3), whether membranes were ruptured at admission (p = 0.6), the duration of labor (p = 0.6) and intrapartum fetal death. Multivariate analysis showed that patient referral to another heath facility (OR: 3.33; 95% IC: 1.56, 7.10), no obstetric ultrasound performed (OR: 3.16; 95% IC: 2.11, 4.73), birth weight less than 2,500 g (OR: 7.49; 95% IC: 6.40, 8.76) were significantly associated with intrapartum stillbirth. Specific interventions must be taken to identify these risk factors of intrapartum stillbirth in order to ensure better and appropriate management.

SYSTEMATIC REVIEW ON MATERNAL POSITION AND MOBILITY DURING FIRST STAGE OF LABOR

This systematic review is the product of 10 top published journals. The search engines adopted in this study were PubMed, Medline, Cochrane Library, Google Scholar, and Research gate. The inclusion criteria were:1. Papers published between 2004-2020, 2. Top tier journal articles (High quality), 3. Term Mobility and rst stage of labor, duration of labor, Maternal and neonatal outcome. The present highlight is that the active phase of labor enhances the effect of gravity that helps the fetus to descend comfortably as there is adequate space to move downwards as the diameter of the pelvis expands to its maximum. The pressure on the nerve in the spine during labor is reduced and thus reducing and relieving pain. If the membranes are intact, the woman is allowed to walk about. This attitude prevents vena cava compression and encourages descent of the head. Ambulation can reduce the duration of labor, need for analgesia and improve maternal comfort. Mobilization improves frequency, strength and length of contractions, decreases the use of oxytocin to augment labor and improves oxygen supply to the fetus. It improves alignment of pelvic bones and the shape and capacity of pelvis, and optimizes the good t between fetus and pelvis. This paper shows the research gaps from different studies in the review of the literature. In this present study of systematic review, 10 recent multiple interventions based on RCTs and Non RCTs studies between 2004 to 2020 were systematically reviewed using the keywords search method. The ndings are discussed and research gaps are listed accordingly Systematic review on Mobility/Ambulation during the First Stage of Labor:

Predictors of surgical site infection among women following cesarean delivery in eastern Ethiopia: a prospective cohort study.

The authors conducted a prospective cohort study in eastern Ethiopia. The women were serially enrolled until the desired sample size was reached. A structured questionnaire was used to collect data. Women were followed at the hospital during their weekly visits. Culture-based microbiological methods were used to identify causal agents. A binary logistic regression model was used to identify the predictors of SSI after CS. Among serially enrolled women, 336 were followed for 30 days. The incidence of SSI was 7.74% (95% CI: 7.68-7.80). Rupture of the membrane before operation [adjusted odds ratio (AOR)=3.75, 95% CI: 1.85-16.6], labor duration greater than 24h (AOR=4.04, 95% CI: 1.52-10.79), and postoperative hemoglobin less than 11g/dl (AOR=3.42, 95% CI: 1.32-8.87) were all significantly associated with SSI. The most common isolated pathogen was Staphylococcus aureus, followed by Escherichia coli. Nearly one-tenth of the women developed SSIs. Factors such as rupture of the membrane before the operation, absence of antenatal care, labor duration greater than 24h, a midline skin incision, and postoperative hemoglobin less than 11g/dl were the predictors of SSI. To reduce the incidence of SSI, policymakers should consider the importance of high-quality antenatal care, shorten the duration of labor, and maintain women's hemodynamics in future SSI prevention bundles.

Echtzeitanalyse des Geburtsablaufes bei Hündinnen einer mittelgroßen Rasse

Observation of the birth processes in healthy bitches under controlled conditions. The primary aim was to gain more insight into the natural birth process. Additional goal was to determine under which circumstances caregivers seek veterinary assistance. Data regarding length of gestation, the course of the parturition process, litter size, as well as neonatal characteristics were collected from 345 Boxer bitches. A real-time evaluation supplied the data concerning the birth process itself. Statistical analysis included single- and multi-factor variance analyses, as well as correlation, regression, and rank correlation analyses. Mother dogs with fewer fetuses were gravid for a significantly longer period than those with a high number (p=0.0012). The proportion of live neonates decreased significantly from the 5th litter onwards (p=0.0072). Female neonates exhibited a lower birth weight than male neonates (p<0.0001). Diurnal influences on the onset of stage II were not found. Birth processes could be divided into 3 groups based on the recorded progression: group 1 - eutocia (54.6%), group II - eutocia with prophylactic measures by the caregiver (20.5%), and group III - dystocia (24.9%). Bitches of group 1 were slightly younger than those of groups 2 and 3. In groups 2 and 3, the proportion of older primiparae (≥4 years) was significantly higher than in group 1 (p<0.05). The total duration of labor differed significantly between groups 1 and 2 (p<0.0001). Significant differences were seen between the groups in labor activity. In group 3, the proportion of bitches with a type I (=primary) weakness in labor was strikingly high (45.2%). In 83.8% of the births (groups 1 and 2), one or more pauses in labor (>60 min) occurred during the expulsive phase. This was correlated with litter size (p=0.0025), but not with age or birth number. The rate of stillbirth was positively correlated with duration of the birth process. Reasons for veterinary intervention primarily pertained to conditions of type II and III labor weakness (inadequate contractions of the uterus during parturition). The average time span between identification of a birth disorder and presentation of the bitch to a practice/clinic was 4.8±3.3 hours. In pre-partum-counselling, special attention should be paid to conditions of hyperfetia (>20% above the mean) as well as uniparous and biparous gravidity and these dams should be classified as risk patients with regard to the course of parturition. In the case of birth complications, rapid veterinary intervention is warranted in order to minimize the development of maternal inanition and fetal vitality depression.

Cervical dilatation at diagnosis of active phase of labour determines the mode of delivery and peripartum outcomes: a retrospective study in a single tertiary centre in Malaysia

BackgroundThere is an increasing trend of Caesarean section rate in Malaysia. Limited evidence demonstrated the benefits of changing the demarcation of the active phase of labour.MethodsThis was a retrospective study of 3980 singletons, term pregnancy, spontaneous labouring women between 2015 and 2019 comparing outcomes between those with cervical dilation of 4 versus 6 cm at diagnosis of the active phase of labour.ResultsA total of 3403 (85.5%) women had cervical dilatation of 4 cm, and 577 (14.5%) at 6 cm upon diagnosis of the active phase of labour. Women in 4 cm group were significantly heavier at delivery (p = 0.015) but significantly more multiparous women were in 6 cm group (p < 0.001). There were significantly fewer women in the 6 cm group who needed oxytocin infusion (p < 0.001) and epidural analgesia (p < 0.001) with significantly lower caesarean section rate (p < 0.001) done for fetal distress and poor progress (p < 0.001 both). The mean duration from diagnosis of the active phase of labour until delivery was significantly shorter in the 6 cm group (p < 0.001) with lighter mean birth weight (p = 0.019) and fewer neonates with arterial cord pH < 7.20 (p = 0.047) requiring neonatal intensive care unit admissions (p = 0.01). Multiparity (AOR = 0.488, p < 0.001), oxytocin augmentation (AOR = 0.487, p < 0.001) and active phase of labour diagnosed at 6 cm (AOR = 0.337, p < 0.001) reduced the risk of caesarean delivery. Caesarean delivery increased the risk of neonatal intensive care admission by 27% (AOR = 1.73, p < 0.001).ConclusionsActive phase of labour at 6 cm cervical dilatation is associated with reduced primary caesarean delivery rate, labour intervention, shorter labour duration and fewer neonatal complications.

Intervention of Kusuma Milk-Shake Drink on Cervical Dilatation and Duration of Labor: Experience from Bengkulu, Indonesia

Background: Labor processes require energy consumption regulated by a complex nervous system and hormonal response. Thus, the intensity of maternal nutritional intake since pregnancy should be highly considered for physiological delivery. Nutrients that are high in energy and provide fast-decomposing glucose intake should be chosen by the mothers. Kusuma is a kind of drink made from dates, milk, and honey. This study aimed to analyze the effect of Kusuma milk-shake drink implementations on cervical dilatation and duration of labor.Methods: An experimental study was conducted by post-test only with a controlled group design, including 34 mothers with term pregnancy, which was intervention groups and controls. A completely randomized design in two different places was conducted. Data were analyzed using Shapiro-wilk, independent sample T-test, and Mann-Whitney. Results: There was a significant effect of Kusuma milk-shake implementation on cervical dilatation (p=0.000). The dilatation process was found to be 5.5 times faster, and the duration of labor (p=0.000) was observed to be 9.7 hours faster than the control group.Conclusions: Implementation of the Kusuma milk-shake has a significant effect on the acceleration of cervical dilation and the duration of labor. This research is expected to improve the quality of midwifery services as an effort to realize the concept of a Continuum of Obstetric Care.

Impact of medication correction of labor weakness on obstetrical complications and newborn status

Objectives: To analyze the impact of medical correction of labor weakness with oxytocin on obstetric and newborn complications.Materials and methods. 100 cases of childbirth with weakness of labor activity and medical correction with oxytocin (main group) and 50 cases of childbirth without weakness of labor activity (control group) were analyzed. The analysis included pregnancy and childbirth histories of mothers aged 20–32 years with a gestation period of 37– 41 weeks with uncomplicated pregnancies, without significant somatic and obstetric-gynecological pathology, who gave birth in the Perinatal Center of Kyiv during the last 3 years.Depending on the method of delivery, the women of the main group were divided into 3 subgroups: Iа – natural vaginal, spontaneous delivery (n = 60), Ib – operative vaginal delivery using a vacuum extractor (n = 22), Іc – delivery by cesarean section (n = 18).The following factors were studied in each group: assessment of newborns status according to the Apgar scale at the 1st and 5th minutes, pH level of the umbilical cord blood, frequency of fetal distress based on cardiotocography (Fischer score &lt; 6 points), duration of labor induction, color of the amniotic fluid.Results. The average duration of labor was the largest in the subgroup of spontaneous vaginal deliveries, the smallest in the subgroup of cesarean section. In subgroup Ib in 14 (63.6%) cases indications for the vacuum extractor were signs of fetal distress and only in 8 (36.4%) cases – weakness of labor activity.In subgroup Ia compared to subgroup Ic, there was a longer average duration of labor and higher percentage of deliveries with meconium-stained waters (28.3%), higher frequency of neonatal acidemia (16.7%) and the birth of children with an Apgar score at the 5th minute ≤ 6 points (8.4%). In subgroup Ic compared to subgroup Ia, there was a higher value of cases of Fischer score &lt; 6 points (50%), the duration of labor reinforcement for more than 4 hours (44.5%), more cases of asphyxia (44.5%), and the birth of children with an Apgar score at the 1st minute ≤ 6 points (38.9%). Indications for caesarean section in subgroup Ic in 50% of cases were signs of fetal distress, in 38.9% – weakness of labor activity which was not associated with medication, in 11.1% – a clinically narrow pelvis.In all groups there was a relationship between the duration of labor induction and the condition of the newborn (the frequency of asphyxia of newborns was higher when the infusion of oxytocin lasted more than 4 hours).In subgroup Ib fetal distress was the indication for urgent delivery in 63.6% of cases, and in subgroup Iс it was 50%. This indicates signs of a mediated negative effect of exogenous oxytocin on the fetus during childbirth. The newborns condition, according to the studied criteria, was worse in the groups with labor reinforcement compared to the control group, regardless of the method of delivery.Conclusions. The use of oxytocin during childbirth can have a negative effect on the fetus, which increases the frequency of operative vaginal deliveries and cesarean sections and, as a result, is a risk factor for complications in the postpartum period. There is a correlation between duration of oxytocin injection and condition of the newborn.

Effectiveness of Intracervical Foley’s Catheter with PGE2 Versus PGE2 Alone for Induction of Labour at Term Pregnancy

Objective: To compare the effectiveness of intracervical foley’s catheter with prostaglandin E2(PGE2) and PGE2 alone in achieving vaginal delivery in a patient having full-term pregnancy and its impact on maternal and fetal outcome. Study design and setting: This Comparative cross sectional study was conducted in the Department of Obs &amp; Gynae, in January-December 2021. Methodology: A detailed history of the patients was obtained, and a physical examination was performed. Patients were randomly allocated into two groups A (cervical Foleys and PGE2) and group B (PGE2 alone). Results: In Group A, 176 (90.7%) patients showed effective results in achieving vaginal delivery out of which 68.0% were spontaneous and 22.7% instrumental, while in Group B, 172 (88.7%) patients delivered vaginally out of which 48.5% spontaneous and 40.2% instrumental with P&lt;0.01. Conclusion: This study demonstrated that intracervical foley’s catheter with PGE2 yielded significantly better and more effective results in terms of improved maternal and fetal outcomes as compared to PGE2 alone in terms of achieving vaginal delivery and duration of active phase labour.

High Dosage of Patient-Controlled Epidural Analgesia (PCEA) with Low Background Infusion during Labor: A Randomized Controlled Trial.

Patient-controlled epidural analgesia (PCEA) is well documented; however, it is unclear whether a high dosage of PCEA with a low dosage of background infusion during labor can be a safe and effective application. Group LH was administered a continuous infusion (CI) of 0.084 mL/kg/h with PCEA of 5 mL every 40 min. Group HL was given a CI of 0.028 mL/kg/h and PCEA of 10 mL every 40 min; Group HH was given a CI of 0.084 mL/kg/h and PCEA of 10 mL every 40 min. The primary outcomes were VAS pain score, the number of supplemental boluses, incidence of pain outbreaks, drug dose for pain outbreaks, PCA times, effective PCA times, anesthetic consumption, duration of analgesia, duration of labor and delivery outcome. Secondary outcomes included adverse reactions such as itching, nausea and vomiting during analgesia and neonatal Apgar scores 1 min and 5 min after birth. A total of 180 patients, 60 in each group were randomly assigned to one of three groups included group LH, group HL or group HH. The VAS scores were obviously decreased in HL group and HH group in comparison with LL group at 2 h after analgesia and the time point of full cervical dilation and delivery of baby. The time for third stage of labor in HH group was increased compared with LH group and HL group. Incidence of pain outbreaks in LH group was obviously increased compared with HL and HH group. The effective PCA times in HL group and HH group were remarkably reduced compared with those in LH group. High dose of PCEA with a low background infusion can reduce effective PCA times, incidence of outbreak pain and the total amount of anesthetics without diminishing analgesia effects. However, high dose of PCEA with a high background infusion can enhance analgesia effect but increase the third stage of labor, instrumental delivery ratio and the total amount of anesthetics.

Effects of epidural analgesia at 1 cm cervical dilatation on labor interventions in full-term primigravida: A retrospective cohort study.

This study aimed to investigate the effects of epidural analgesia administered as early as cervical dilatation of 1 cm on labor interventions and maternal and neonatal outcomes. This retrospective research recruited 1007 full-term primigravidas, who were distributed to two separate cohorts for eligibility: epidural analgesia 1 (cervical dilatation = 1 cm) and epidural analgesia 2 (cervical dilatation >1 cm). Labor interventions (artificial rupture of membranes and oxytocin administration) and duration of labor were the primary outcomes. The effect of initiation timing of epidural analgesia on artificial membrane rupture was not statistically significant (adjusted odds ratio [OR]: 0.85 [0.58-1.24], p > 0.05). Less oxytocin was used in the epidural analgesia 2 group compared with the epidural analgesia 1 group (the adjusted OR: 0.68 [0.49-0.95], p < 0.05). There were no significant differences in the median time to latent phase of labor, active phase of labor, second, and third stages of labor (p > 0.05). There were no significant differences in maternal and neonatal outcomes between the epidural analgesia 1 group and the epidural analgesia 2 group. Epidural analgesia could be administered at cervical dilatation = 1 cm.

Influence of gestational diabetes mellitus on outcomes of preinduced labour with dinoprostone vaginal insert.

The aim of this study was to evaluate the effectiveness of labour preinduction using a dinoprostone vaginal insert in patients with gestational diabetes mellitus versus patients undergoing labour induction for other causes. The second aim of the study was to compare perinatal outcomes in both groups. The study has a retrospective character, conducted in 2019-2021 in a tertiary reference hospital. The following endpoints were assumed for the analysis: natural childbirth, birth occurring within 12 hours of dinoprostone administration and neonatal outcomes. Furthermore, indications of a Caesarean section were analysed. The percentage of natural childbirths was similar in both groups. Furthermore, in both groups, over 80% of patients gave birth within less than 12 hours following dinoprostone administration. Neonatal outcomes (body weight, Apgar score) did not differ statistically. Analysing indications for a Caesarean section, failure in the progress of labour was an indication in 39.5% of cases in the control group, 29.4% of cases in gestational diabetes mellitus (GDM), and 50% of cases in diabetes mellitus (DM). The risk of foetal asphyxia was an indication in 55.8% of cases in the control group, 35.3% of cases in GDM and 50% of cases in DM. Ineffective labour induction - no induction of the contractile function was an indication for a C-section in 4.7% of cases in the control group and 35.3% of cases in GDM; no cases were noted in DM (p = 0.024). The study demonstrated that patients undergoing labour induction due to GDM using a dinoprostone vaginal insert did not differ in terms of labour duration, oxytocin administration compared to patients undergoing labour induction for other causes. Furthermore, the same rate of Caesarean sections was found in the study group; however, these groups differ in terms of indications, including risk of foetal asphyxia (35.3% vs 55.8%), failure in the progress of labour (29.4% vs 39.5%), and no active labour (1.8% vs 1.5%). The neonatal Apgar score at 1.5 and 10 minutes after birth was similar in both groups.

Effect of sterile vs clean gloves for cervical checks in labor on maternal infection at term: a randomized trial

Intrapartum infection usually warrants immediate delivery and impacts 5-12% of term pregnancies, with the most commonly identified pathogenic organism being of the Ureaplasma genus. When performing cervical examinations during labor, providers in the United States commonly use sterile gloves, although there are no data currently to support that this practice reduces rates of infection. Furthermore, in nearly all other settings of Gynecologic care, aside from surgery in an operating room, nonsterile gloves are used. Even though the uterus could be sterile in normal pregnancies, the provider performing the cervical examination must traverse the milieu of vaginal bacteria in order to reach the cervix to perform the exam, introducing vaginal microbiota into the uterus regardless of the type of glove used. This prospective randomized controlled study examines whether the type of glove used (sterile vs clean) impacts the rates of intrapartum infection in patients receiving cervical examinations during labor or induction of labor at term.. This study aimed to evaluate if the glove type (sterile vs clean) used for cervical examinations during labor affects the rates of intrapartum and postpartum infection. This randomized controlled trial assigned eligible and consenting participants to receive cervical examinations during labor with either sterile powder-free polyvinyl chloride examination gloves (current routine practice, control group) or clean powder-free nitrile examination gloves (nonsterile, experimental group). The primary outcome was rates of intrapartum infection (chorioamnionitis). Sample size calculations estimated that 300 participants would be needed with a rate of infection of 10% in the control group and 20% in the experimental group to demonstrate difference between the groups; however, the rates of infection were much lower than expected, at 5.4% and 4.4% in the sterile and clean glove group, respectively. At this point, it was determined futile to continue the study because a sample size of >29,000 participants would be needed, which would not be achievable at a single tertiary care referral center with approximately 3500 deliveries per year. The study was approved by the Eastern Virginia Medical School Institutional Review Board (IRB 21-09-FB-0206), and was registered at ClinicalTrials.gov (identifier NCT05603624; https://clinicaltrials.gov/ct2/show/NCT05603624). A total of 163 participants with singleton pregnancies completed the study; 74 (45%) were randomized to the sterile glove group, and 89 (55%) were randomized to the clean glove group. In the sterile glove group, 4 (5.4%) developed intrapartum infection (chorioamnionitis) and 1 (1.3%) developed postpartum infection (endometritis). In the clean glove group, 4 (4.4%) developed intrapartum infection and 2 (2.2%) developed postpartum infection. There was no significant difference in rates of intrapartum infection (P=1.0) or postpartum infection (P=1.0), or combined rates of infection (including both chorioamnionitis and endometritis; P=.99) between the sterile and the clean glove group. When comparing the participants from both groups who had any intrapartum or postpartum infection (n=11) with those who had no infection (n=152), the former were more likely to be nulliparous (P=.01), have lower gravidity (P<.01) and parity (P<.01), have longer times from first cervical examination to delivery (P=.02), have longer times from rupture of membranes to delivery (P=.0001), undergo cesarean delivery (P=.0002), and experience postpartum hemorrhage (P=.001). Although participants who were in labor for a longer time also likely had more cervical examinations, these data could suggest that duration of labor (P=.02) is more closely associated with infectious morbidity compared with the number of cervical examinations (P=.15). Using clean gloves for cervical examinations during labor is unlikely to increase risk of infection, and could reduce cost by up to 92.4% at our institution, saving over $25,000 annually.

Video Instruction for Pushing in the Second Stage: a randomized controlled trial

The second stage of labor requires active patient engagement. Previous studies suggest that coaching can influence the second stage of labor duration. However, a standardized education tool has not been established, and patients face many barriers to accessing childbirth education before delivery. This study aimed to investigate the effect of an intrapartum video pushing education tool on the second stage of labor duration. This was a randomized controlled trial of nulliparous patients with singleton pregnancies ≥37 weeks of gestation admitted for induction of labor or spontaneous labor with neuraxial anesthesia. Patients were consented on admission and block randomized in active labor to 1 of 2 arms in a 1:1 ratio. The study arm viewed a 4-minute video before the second stage of labor on what to anticipate in the second stage of labor and pushing techniques. The control arm received the standard of care: bedside coaching at 10 cm dilation from a nurse or physician. The primary outcome was second stage of labor duration. The secondary outcomes were birth satisfaction (using the Modified Mackey Childbirth Satisfaction Rating Scale), mode of delivery, postpartum hemorrhage, clinical chorioamnionitis, neonatal intensive care unit admission, and umbilical artery gases. Of note, 156 patients were needed to detect a 20% decrease in the second stage of labor duration with 80% power, 2-sided alpha level of .05, and 10% loss after randomization. Funding was provided by the Lucy Anarcha Betsy award from the division of clinical research at Washington University. Of 161 patients, 81 were randomized to standard of care, and 80 were randomized to intrapartum video education. Among these patients, 149 progressed to the second stage of labor and were included in the intention-to-treat analysis: 69 in the video group and 78 in the control group. Maternal demographics and labor characteristics were similar between groups. The second stage of labor duration was statistically similar between the video arm (61 minutes [interquartile range, 20-140]) and the control arm (49 minutes [interquartile range, 27-131]) (P=.77). There was no difference in mode of delivery, postpartum hemorrhage, clinical chorioamnionitis, neonatal intensive care unit admission, or umbilical artery gases between groups. Although the overall birth satisfaction score on the Modified Mackey Childbirth Satisfaction Rating Scale was similar between groups, patients in the video group rated their "level of comfort during birth" and "attitude of the doctors in birth" significantly higher or more positively than patients in the control group (P<.05 for both). Intrapartum video education was not associated with a shorter second stage of labor duration. However, patients who received video education reported a higher level of comfort and a more favorable perception of their physician, suggesting that video education may be a helpful tool to improve the birth experience.

Effect of Entonox on Duration of First Stage and Cervical Dilatation in Women During Labour

Introduction: Labour pain is one of the most severe types of pain ever to be experienced. Entonox is a nitrous oxide (N2O), a self administered patient controlled inhalational analgesia. Our research is focused to study about this aspect of Entonox that is reduction in the duration of labour by making cervical dilatation faster. The aims and objectives of our study was to determine the effect of entonox on duration of first stage of labour and to determine the effect of entonox on rate of cervical dilatation. Methodology: A prospective observational study was carried out Pushpagiri Institute of Medical Sciences and Research Centre in Kerala, India, for a period of 6 months consecutive sampling: sample size obtained is 20 per group, grouped them into two groups depending upon the analgesic of choice. The study tool was a Performa and variables entered into Microsoft excel spreadsheet and analysed SPSS 18.0 software package. Results presented as frequency and percentages for categorical data and descriptive statistics for continuous data. The duration of labour was presented as mean and SD and cervical dilatation rate is calculated as cm in dilatation divided by duration of first stage and this also was presented as mean and SD. These two outcome variables was compared between entonox and control Mann-Whitney U Test. Results: There was 20 study participants each in the two groups. 10 primigravidas and 10 multigravidas, with mean age was 28.15 ± 2.66 years and majority of them belong to normal BMI. Although there was no difference with respect to the cervical dilatation at the onset of usage of Entonox, it was observed that there was significant reduction in the duration of labour and usage of Entonox as there was a increase in cervical dilatation rate when compared to women who chose other analgesics. All these factors also found to be statistically significant. Conclusion: A part from analgesic effect nitrous oxide also is shown to decrease the duration of active phase of labour by making cervical dilatation faster and lowering the duration of usage of labour analgesics, which makes labour a pleasant experience for woman.

STUDY THE FREQUENCY AND RISK FACTORS OF MECONIUM ASPIRATION SYNDROME IN NEWBORN

Background: Meconium is the rst faeces of a newborn. The incidence of meconium stained liquor is 10- 15% of deliveries; out of which 5% develop meconium syndrome. It is regarded as a sign of fetal compromise. Objectives: To study the frequency and risk factors of Meconium Aspiration Syndrome in newborn Method: It is a hospital based, prospective, cohort study comprising of neonates. Setting Neonatal intensive care unit (NICU) of the Department of Paediatrics and Post Natal ward. Sample size - 4pq/e2 = 81. Inclusion criteria: In born neonates born to mothers with meconium stained amniotic uid. Out born neonates who present in the NICU within one hour of birth with history of MSAF along with staining of skin, nails and umbilical cord. Results: There were 847 deliveries during the study period. Frequency of babies born with meconium stained amniotic uid (MSAF) was 9.6%. The frequency of meconium aspiration syndrome (MAS) out of total MSAF deliveries was (7.4%). Conclusion: Meconium aspiration syndrome is one of the most common problems in the newborn and contributes signicantly to the neonatal morbidity and mortality.MAS was signicantly associated with maternal risk factors like preeclampsia, oligohydroamnios and birth factors like prolonged duration of labour, low Apgar score of 1 and 5 min

COMPARATIVE STUDY OF MATERNAL AND NEONATAL OUTCOMES OF LABOUR INDUCTION AT 40 WEEKS VERSUS EXPECTANT MANAGEMENT FROM 40 WEEKS TILL 40 WEEKS 6 DAYS IN TERM NULLIPAROUS WOMEN

Background:The goal of obstetrics is a pregnancy that results in a healthy infant and a healthy mother.Much of the art of good obstetric care involves the delicate balance of avoiding caesarean delivery with all its attendant complications Methods :A Prospective randomized control study conducted at PESIMSR, KUPPAM, Comparing maternal and neonatal outcomes of labour induction at 40 weeks versus expectant management from 40 weeks till 40 weeks 6 days in term nulliparous women. The study protocol was approved by the institutional ethics board.Written informed consent was obtained from all study subjects. The women were categorized into group A and group B by computer-generated randomization each containing 64 nulliparous pregnant women. The primary outcome was maternal and neonatal outcomes in nulliparous women with labour induction at 40 weeks versus expectant management at 40 weeks till 40 weeks 6 days. Results: 128 nulliparous pregnant women who met the inclusion criteria was taken into the study after obtaining consent.The mean age of patients in induction group was 23.12 +/- 2.805 and in expectant group was 22.62 +/- 2.547 years.The mean period of gestation in expectant group was 40 weeks 4 days.42.19% of participants in group A had a cesarean section, 1.56% had instrumental delivery and 56.25% had a normal vaginal delivery.Where as in group B, 23.43% had a cesarean section,3.13% had instrumental delivery,and 73.44% had a normal vaginal delivery.There was no statistical significance between the mode of delivery in Group A and Group B (p=0.074).A longer duration of labour was noted in induction group compared to expectant group. P value 0.043, which is statistically significant. NICU admissions were high in an expectantly managed group compared to the induction group.But when APGAR scores were compared in both groups,no statistical significance was seen at 1 minute and 5 minutes.Conclusion:Labor induction at 40 weeks appears to be a safe alternative to expectant management for spontaneous labor beyond 40 weeks to deliver with no mortality and minimum morbidity to safeguard the mother and neonate,with precautions and evidence-based protocols to identify the risks and challenges to initiate the natural labor process.