Progress Of Labor Research Articles

Monocytes and cervical ripening: a narrative review of prolonged labor pathophysiology

Prolonged labor, a major obstetric complication, is often linked to inadequate cervical ripening, which hinders labor progression. The process of cervical ripening is governed by complex hormonal and immune-mediated mechanisms, with monocytes playing a central role. These immune cells infiltrate the cervix and differentiate into macrophages, releasing cytokines and proteases that are essential for extracellular matrix remodeling, cervical softening, and dilation. However, in prolonged labor, an imbalance in monocyte activity may impede normal cervical ripening, contributing to stalled labor and increased risk of maternal and neonatal complications. Monocytes are critical to the inflammatory response that initiates cervical remodeling during labor. Upon recruitment to the cervix, monocytes release inflammatory cytokines like IL-1, IL-6, and TNF-α, which activate matrix metalloproteinases (MMPs) to degrade collagen and extracellular matrix proteins, facilitating cervical effacement and dilation. Dysregulated monocyte recruitment and prolonged inflammation, however, may lead to ineffective cervix remodeling, preventing labor from progressing efficiently. Furthermore, these immune responses can influence uterine contractility, either promoting or inhibiting uterine contractions, which further complicates the pathophysiology of prolonged labor.

Serial intrapartum ultrasound to predict vaginal delivery using angle of progression and head- progression distance in term nulliparous women.

Over the past decade, intrapartum ultrasound (ITU) has been in the global limelight for labour monitoring. The use of the same in clinical settings of low- and middle-income countries (LMIC's) however, is limited. Till date, angle of progression (AOP) stands as the most studied parameter. Very few studies, most from developed countries, have shown that other ITU measurements could also hold relevance to labour and delivery. In recent times, serial ITU has also garnered some attention and could possibly be a better predictor of labour outcome. This study aimed to compare the predictive accuracies of AOP and head PD for vaginal delivery and to investigate whether the rate of change of serially measured AOP and head PD in the first stage is predictive of vaginal delivery. A prospective observational study was conducted on 90 nulliparous women between April 2023 and July 2024 at a tertiary teaching hospital in South India. Participants had singleton pregnancies in cephalic presentation between 37-40weeks with regular contractions, and cervical dilation≥3 cm. Exclusion criteria included prior LSCS and abnormal cardiotocography. Intrapartum ultrasound was performed twice, once at recruitment and 3-5h apart, to measure AOP and PD. Statistical analysis included ROC curve plotting for diagnostic accuracy of AOP and PD in predicting vaginal delivery. Of the 90 participants, 71 (78.9%) delivered vaginally and 19 (21.1%) had caesarean sections. AOP≥120° and PD≥2.7cm at≥6 cm cervical dilation showed a strong correlation with vaginal delivery, with sensitivity and specificity of 70.4% and 94.7%, and 63.4% and 89.5% respectively. Change (delta) in AOP>10° had the highest diagnostic accuracy (81%), with a positive predictive value of 92.2%. ITU offers valuable insights into labour progression. AOP and PD, particularly at cervical dilation of≥6 cm, are predictive of vaginal delivery. Delta AOP serves as the most accurate predictor. Incorporating ITU into routine labour management enhances clinical decision-making, helping reduce unnecessary interventions and caesarean deliveries.

The role of intrapartum ultrasound combined with free position delivery in the management of abnormal fetal positions during labor

ObjectiveTo investigate the effectiveness of combining intrapartum ultrasound with free maternal positions in managing abnormal labor, specifically focusing on its impact on delivery outcomes.MethodsA retrospective cohort study was conducted on 176 cases of abnormal labor progression in women who attempted vaginal delivery at our hospital from June 2021 to May 2022. Among these, 88 cases were diagnosed with abnormal fetal positions using a combination of intrapartum ultrasound and vaginal examination, and these patients were guided to adopt free maternal positions (experimental group). The control group comprised 88 cases diagnosed with abnormal fetal positions through vaginal examination alone, without any intervention to correct positioning. Maternal and neonatal outcomes, including the duration of the first and second stages of labor, total labor time, cesarean section rates due to failed progression, postpartum hemorrhage, and length of hospital stay, were compared between the two groups.ResultsThe experimental group demonstrated significantly reduced durations of the first and second stages of labor, as well as total labor time, compared to the control group. Furthermore, the rate of cesarean sections due to failed progression was significantly lower in the experimental group. Additionally, the experimental group experienced lower rates of postpartum hemorrhage and shorter hospital stays, with statistically significant differences observed.ConclusionCombining intrapartum ultrasound with free maternal positions shows promise in improving delivery outcomes for women with abnormal fetal positions during labor. These findings highlight the potential benefits of this approach in enhancing the quality of delivery.

‘You Can Really See the Pain in Their Eyes’: Stressors and Supports Affecting the Well-being of Homelessness Services Staff in Ireland During COVID-19

Despite their crucial roles, the well-being narratives of those working in homelessness services have frequently been overlooked in research and policy. This paper addresses that gap, presenting qualitative evidence from interviews with homelessness service workers in Cork, Ireland, during 2021 and 2022. We explore the multidimensional, layered character of service staff members’ well-being narratives, showing they are intimately connected to relationships with their own families, commitment to service users, fears about COVID-19, and their motivation to the social mission of their work: to support vulnerable people with multiple, interlinking needs. Our data reveals that stressors encountered in pre-COVID times, relating to burnout, emotional labour, inter-agency working, and career progression, were exacerbated due to government restrictions and new challenges encountered by service users. We focus on the period covering pandemic-related lockdowns in 2020 and 2021, and the immediate aftermath, to consider how those delivering crucial services coped, the informal and formal support they accessed, and the value of this support in their lives. Significantly, our analysis reflects upon the longer-term implications of these findings, contextualised against the backdrop of the housing crisis in Ireland, changing demographics of persons accessing homelessness services, and increased systemic and social pressures.

Comparison of Labour Progression between Nulliparous Pregnant Women of Advanced Maternal Age and Young Nulliparous Women with Spontaneous Vaginal Delivery: A Retrospective Study in a Regional Core Hospital

Background: The number of nulliparous pregnant women of advanced maternal age, defined as 35 years or older, has increased in Japan, but there has not been a study comparing labour progression between pregnant women of advanced maternal age and young pregnant women. Therefore, we aimed to evaluate roughly whether labour progression times differed according to maternal age, with cervical dilation and foetal station used as the endpoints. Methods: We retrospectively reviewed the medical records of 1573 nulliparous women who had spontaneous vaginal delivery (929 patients), were administered an intravenous uterotonic agent (372 patients) or underwent emergency caesarean section (272 patients) at Kinan Hospital. We collected data on the patient characteristics and reviewed vaginal examination data for comparisons of labour progression. The endpoints were cervical dilation of 10 cm (full dilation) and foetal station of 2 cm, as these metrics are sufficient for vacuum-assisted vaginal delivery (sufficient descent). Data on the elapsed time between the recorded time of each stage of labour and the endpoint were obtained from two groups, namely, pregnant women of advanced maternal age and young pregnant women, and compared. Results: The percentages of women of advanced maternal age were higher among those who underwent emergency caesarean section and intravenous uterotonic agent administration. When the characteristics of the pregnant women of advanced maternal age were compared to those of the young pregnant women among the 929 patients with spontaneous vaginal delivery, differences in “blood loss amount” and “vacuum delivery status” were detected. However, regarding labour progression, there was almost no difference in any of the stages when the elapsed times between each stage and full dilation or sufficient descent were compared. Conclusions: We did not detect a clear impact of maternal age on labour progression in the groups of nulliparous women who had spontaneous vaginal delivery after women who underwent emergency caesarean section or intravenous uterotonic agent administration were excluded; however, further studies with larger sample sizes of women of advanced maternal age may be needed.

Myometrial shortening stimulates contractility: a biomechanical hypothesis for labor onset and progression.

The mechanisms responsible for the onset and progression of labor remain uncertain. Myometrial contractile activity gradually increases until labor onset as a result of a number of intrinsic and hormonal changes, and this a believed to be the essential process responsible for labor. At the same time, the cervix slowly effaces and dilates throughout pregnancy, and these are the only physiologic parameters predictive labor onset. It is feasible that an interaction exists between increasing contractile activity and cervical softening that is responsible for labor onset and progression. The novel biomedical hypothesis presented here is that labor onset and progression rely on a positive feedback loop involving uterine contractility, myometrial shortening, and shortening-related myometrial prostaglandin F2α production, which occurs when contractile force exceeds the resistance to myometrial shortening. Immediately before labor onset and during early labor, first cervical effacement and then dilation allows the cervix to be pulled up over the presenting part, thus permitting myometrium to assume a decreasing percentage of uterine circumference, which enables myometrium to shorten with each uterine contraction. After complete dilation, further shortening is allowed by decreasing uterine volume resulting from fetal egress from the uterus and complete uterine emptying at delivery. Since contractile activity can shorten myometrium and shortening has been shown to increase myometrial prostaglandin F2α production, the ability of myometrial shortening to stimulate contractile activity results in a positive feedback loop that plays an important role in both labor onset and progression. Premature labor occurs whenever this positive feedback loop develops prior to term because of pathologically increased contractile activity or decreased resistance to shortening. Details of this hypothesis and the mechanisms that either resist or allow myometrial shortening are presented, followed by a review of the laboratory and clinical evidence that either supports or appears to contradict this hypothesis.

Obstetric Factors Contributing to the Rising Trend of Cesarean Deliveries at Sheikh Khalifa Bin Zaid Hospital, Rawlakot

The study aimed to assess the rate of cesarean section and to analyse the risk factors contributing to C-sections to introduce measures to check unwanted, non-medical reasons to go for a C-section. The study was retrospectively conducted at Sheikh Khalifa Bin Zaid Hospital Rawlakot Azad Kashmir on 5226 normal deliveries and 1604 C-sections. The rate was found to be 30.6%, more than the recommended rate by WHO (10-15 %). The major contributing factor was the previous scar (41.6%). The most prevalent indications were foetal distress (14%), older age more than 35 years (6 %), obstructed labour (1.9 %), failed IOL (1.6 %), failure of progress of labour (1.8 %), multiple pregnancies (1.74 %), PIH (0.99 %), meconium aspiration (1.62 %), placental problems (1.8 %), only one patient (0.06 %) requested for elective caesarean and other risk factors were also seen (18 %) in aggregate. The study concluded that at SKBZ hospital C-sections were overused. The study was conducted with a limited sample size only in one high-standard hospital in Rawalakot Azad Jammu and Kashmir, where the demographic characteristics of the patients were almost similar. Yet, it will be better to repeat the same kind of study in other hospitals of the AJK with larger sample sizes and with varying population characteristics and facilities, including populations from both the urban as well as from rural areas to get a clear understanding based on these differences to and generalize the results. The findings of this study will contribute to theory and practice and will be helpful to the government functionaries in healthcare planning.

Electric therapy is used to reduce pain in a mother giving birth

<p><strong><em>Background:</em></strong><em>Pain during labor is a physiological response but can result in an increase in catecholamines which result in disrupting uterine contractions which can cause uterine inertia, prolonged labor, inadequate oxygenation to the fetus and fetal distress, as well as death of the mother and/or fetus if labor pain is not treated. According to (Utami & Putri, 2020) Severe pain can affect the increase in heart rate, respiratory system, increase in blood pressure and can cause stress, thereby inhibiting the release of the hormone oxytocin which results in inadequate contractions and disruption of cervical dilatation. Uterine contractions cause complaints of labor pain which can cause anxiety and fatigue in the mother during labor and have a negative influence on the progress of labor and the well-being of the fetus.Non-pharmacological pain management includes administering electrical therapy (TENS). Transcutaneous electrical nerve stimulation (TENS) is a therapy that uses electric current to treat pain due to various conditions, ranging from nerve disorders, disorders, to pain due to childbirth. </em></p><p><strong><em>Objectives</em></strong><em> of this research is to find out how much influence electrical therapy has in reducing pain in mothers giving birth. </em></p><p><strong><em>Methods </em></strong><em>The quasi-experimental research design uses a one group pretest-posttest design. The research population was mothers in the first stage of labor in the Sukoharjo Independent Midwife Practice area. The sampling technique was total sampling with a sample size of 20 people. </em></p><p><strong><em>Results </em></strong><em>obtained a reduction value of 1.55 (mean diff.) or a reduction of 23.2% and p=<0.001 (p<0.05) which means there is a significant difference in the pain scale before and after electrical therapy. therapeutic treatment. </em></p><p><strong><em>Conlusions</em></strong><em>, electrical therapy is effective in reducing pain in mothers giving birth.</em></p><em>Key words: electrical therapy, labor pain, mother giving birth.</em>

Assessment of the Impact of Assisted Reproductive Technology on the Incidence of Vacuum-Assisted Delivery

Background: In Japan, the rising number of nulliparous women of advanced maternal age (AMA) conceiving via assisted reproductive technology (ART) is anticipated to lead to an increase in adverse labor outcomes, even when the progression of labor appears to be favorable. Therefore, by examining the likelihood of vacuum-assisted delivery (VaD), our aim was to confirm the potential adverse impact of AMA and a history of ART treatment on labor outcomes. Methods: In this retrospective cohort study, the medical records of 542 nulliparous pregnant women aged 30 years or older who delivered at our hospital between April 1, 2017 and March 31, 2024, were reviewed with the approval of the institutional review board. First, we compared the characteristics, including labor conditions and delivery outcomes, of 417 patients who underwent spontaneous vaginal delivery (SVD) with those of 125 patients who underwent VaD. Next, we performed multivariate analysis to assess the effect of various representative factor, including AMA and a history of ART treatment, in order to confirm their actual impact on the likelihood of VaD. Results: In the simple comparison, maternal age, history of ART treatment, the amount of blood loss, and Apgar scores differed significantly between the two groups. However, in the multivariate analysis, only two factors, including history of ART treatment and uterine leiomyoma status, were found to significantly affect the likelihood of VaD. Conclusions: We detected a clear effect of both uterine leiomyoma status and a history of ART treatment on the likelihood of VaD, while AMA did not emerge as a significant factor. Further studies are needed to confirm the adverse impact of a history of ART treatment on labor progression.

The Impact of Prenatal Birthing Ball Exercises on First Stage Labor Progression

Background: Labor is a significant physiological event in a woman’s life, and its progression can vary greatly across individuals. Factors such as maternal health, fetal positioning, and interventions can influence the pace of labor. Among the strategies to support labor progression, prenatal birthing ball exercises have been increasingly used, with claims of enhancing pelvic flexibility, promoting better fetal positioning, and facilitating cervical dilation, potentially leading to smoother labor and delivery. Objective: This study aims to evaluate the impact of prenatal birthing ball exercises on the progression of the first stage of labor. Methods: This prospective study was conducted at Ahsania Mission Medical College and Cancer & General Hospital over one year, with 47 participants selected based on inclusion criteria. Participants received 3-6 birthing ball exercise sessions between 36-40 weeks of gestation. Data were collected on demographics, obstetric history, labor progression, pain assessment, and delivery outcomes. Statistical analysis, including t-tests, ANOVA, and chi-square tests, was used to analyze the data. Results: The majority of participants were young (18-29 years old), with most having secondary education and residing in urban areas. A significant portion was primigravida (64%), and 100% of participants performed birthing ball exercises. Pain experiences during labor varied, with most participants reporting moderate pain. Labor progression was mostly normal, with 66% experiencing vaginal deliveries. All participants showed normal fetal molding, and 88% had clear amniotic fluid. Conclusion: Prenatal birthing ball exercises appear to have a positive impact on labor outcomes, contributing to normal fetal molding and a higher rate of vaginal deliveries. The study suggests that these exercises may aid in labor progression and maternal comfort, though further research with larger sample sizes is needed to confirm these findings.

Current concepts on the use of the partogram to monitor labor progression.

The partogram is a graphic tool used to monitor labor progression. This article reviews the recent literature on the use of the partogram, aiming to evaluate whether its implementation reduces cesarean section rates and to determine which model is more appropriate. Studies that compared using the partogram with not using it were analyzed, as well as studies that contrasted different partogram models. The results indicate that partogram use is not associated with a significant reduction in cesarean section rate, particularly in countries with low cesarean section rates. However, the modified World Health Organization partogram, which eliminates the latent phase, appears to have advantages over the classic 1994 model, with significantly lower cesarean section rates. Although the partogram has not shown significant benefits in reducing cesarean sections, it is still a useful tool for graphically documenting the progress of labor, which could improve clinical decision-making. In Chile, the high cesarean section rates, close to 45%, suggest that implementing the WHO 2000 partogram could be beneficial. However, local studies are needed to confirm the potential benefits of reducing cesarean sections.

The association among fetal head position, fetal head rotation and descent during the progress of labor: a clinical study of an ultrasound-based longitudinal cohort study in nulliparous women.

To elucidate the effects of the timing of fetal head rotation on the labor progress and outcomes. A paired ultrasound measurement was performed at each of the three stages of labor: latency stage, active stage, and full-cervical-dilatation stage. The measurements included fetal head position, head-perineum distance (HPD) and the angle of progression (AOP). A total of 46 pregnancy women were included and a total of 102 effective measurements were collected. The cases in occipital anterior position were all eutocia. The rate of cesarean section in the left transverse occipital group was the highest (15.7 %, 3/19). There were 13 cases (37.1 %) with fetal head rotation occur during active phase, changing from occipital transverse to anterior. Ten cases (28.6 %) rotated in the second stage of labor. The average rotation degree of occipital transverse to anterior position was 62.6°. When AoP <95°, 100 % of the women were occipital transverse; When AoP≥125°, 66.7 % was occipital anterior. The rate of oxytocin utilization and epidural analgesia in the occipital posterior group was higher than that in the other groups (71.4 and 85.7 %, respectively). Occipital transverse is the most common fetal head position in the early stage of labor and fetal head rotation occurs mostly in the active phase and the second stage of labor. Sufficient time should be given in labor management for women that who tried vaginal delivery without contraindications.

Maternal positions in childbirth - A cohort study of labouring women's movements and body positions the last 24hours before birth.

Maternal position plays an essential role in achieving labour progress as it supports the physiological mechanisms of labour. Evidence supports that adopting upright positions may facilitate physiological childbirth. To describe the use of various positionsamong nulliparous pregnant women in the last 24h before birth and describe physical positions in relation to maternal and neonatal outcomes at time of birth. Cohort study of 105 nulliparous women with an uncomplicated singleton pregnancy. Body position was measured by two triaxial accelerometers (SENS motion®), and maternal and neonatal outcomes at time of birth were obtained from medical records. Positions were described for the total population and further stratified into two groups based on time spent in sacrum non-flexible (lying, sitting) and sacrum flexible (standing, walking) positions.Descriptive analyses of maternal position in relation to birth outcomes and comparisons between the two groups were made. Lying down was the mostfrequent position adapted, with a median time of 659 (78;1208) minutes, equivalent to 11.0hours. Women spent 1152 (687;1369) minutes in sacrum non-flexible positions, equivalent to 19.2hours or 80% of the last 24hours before childbirth. More than 90% gave birth in a sacrum non-flexible position. Women spending more time in sacrum non-flexible positions had more epidural analgesia than women spending more time in sacrum flexible positions (42.6% and 21.3%, p=0.03). Women spent 80% of their time in sacrum non-flexible positions during the last 24hours before childbirth. At birth, more than 90% gave birth in sacrum non-flexible positions.

Use of the WHO partograph and Zhang’s guideline for labor and delivery in China: implications for clinical practice

BackgroundThere is an unmet need for a large comprehensive population-based dataset documenting national birthing trends in China and a partograph specifically tailored to Chinese women. This study assessed the impact of using the World Health Organization (WHO) partograph or Zhang’s guideline to manage labor and delivery in China and inform the development of a partograph that specifically aligns with the progression of labor in Chinese women.MethodsThis retrospective analysis included low-risk nulliparous women with a singleton, full-term fetus in cephalic presentation entering spontaneous labor at a specialized obstetric hospital in China between January 2010 and June 2022. Pregnant women were managed according to the WHO partograph (January 2010-August 2014, n = 31,286) or Zhang’s guideline (September 2014-June 2022, n = 49,821).ResultsRates of assisted reproduction (4.57% vs. 1.05%; p < 0.0001) and hypertension (7.44% vs. 6.71%; p < 0.0001) were significantly higher for pregnant women managed according to Zhang’s guideline compared to the WHO partograph. Rates of labor intervention (35.31% vs. 13.95%; p < 0.0001), including induction of labor by oxytocin, artificial rupture of membranes, lateral episiotomy and conversion to cesarean section (all, p < 0.0001), were significantly higher for pregnant women managed according to the WHO partograph. Rates of forceps assisted vaginal deliveries (12.67% vs. 6.42%; p < 0.0001) and postpartum hemorrhage (10.9% vs. 6.2%; p < 0.0001) were significantly higher, and birth asphyxia (0.15% vs. 0.09%; p = 0.02) was significantly lower, for pregnant women managed according to Zhang’s guideline.ConclusionsThis study provides valuable insights into the utilization of the WHO partograph and Zhang’s guideline in managing labor and delivery among Chinese women. Findings indicate that women managed according to Zhang’s guideline had higher rates of assisted reproduction and hypertension, suggesting a potentially different demographic profile or underlying health conditions compared to women managed according to the WHO partograph. Notably, the use of the WHO partograph was linked to a significant increase in labor interventions, while Zhang’s guideline resulted in higher rates of forceps-assisted vaginal deliveries and postpartum hemorrhage, yet interestingly, a lower incidence of birth asphyxia. These contrasting outcomes underscore the importance of aligning labor management tools with the specific needs and progression of labor in Chinese women. The results advocate for a tailored partograph that could better reflect the unique characteristics of Chinese women and optimize decision making and maternal and neonatal outcomes.

Using the Robson’s Classification System to Analyze the Trend of Cesarean Section in a Tertiary Care Hospital: An Observational Study from Bangladesh

Introduction: A caesarean section (CS) is an obstetric procedure often performed when it is determined that vaginal delivery could be harmful to either mother or the baby. There is a growing concern about the increasing percentage of CS globally and this is particularly dramatic in many middle- and high-income countries, but at a lower degree in low-income countries. Hence, this study aimed to analyze the trends in cesarean section rates at a tertiary care hospital in Bangladesh using the Robson’s classification system. Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Islami Bank Hospital, Dhaka, Bangladesh from January 2023 to September 2024. Our study included 486 pregnant women who underwent a caesarean section under the Department of Obstetrics and Gynaecology of our hospital during the study period. Result: In this study, we found that group 5 (multiparous with previous CS, single cephalic, ≥37 weeks- with one previous CS and two or more CS) had the highest frequency with 220 cases (45.27%). Most of our patients (68.72%) were aged between 18-30 years and the majority (95.47%) of the deliveries occurred at gestational ages &gt;37 weeks. Out of 229 caesarean sections, 67.08% were elective, and 32.92% were emergency cases. The most common indication for CS was PCS (45.27%), followed by poor progress in labour (21.60%) and foetal distress (13.37%). Conclusion: Our study found that the use of the Robson’s classification of CS is increasing, and Robson group 5 is the main contributor to the overall CS rate.

Partograph adherence trends in various healthcare services: A Systematic Review

A partograph is a tool used to monitor the progress of labor and identify potential complications. However, evidence shows that many countries still need to improve partograph adherence. This study aims to review the adherence to using partographs in health services. Literature is identified through PubMed, Scopus, and Google Scholar with the keywords “Partograph,” “Adherence,” AND “Health Care.” In total, 12 studies were identified and analyzed. The results showed that partograph adherence in developing countries ranged from 20% to 80%. Factors associated with low adherence include a lack of training and knowledge of partographs among healthcare workers, lack of resources, and traditional childbirth culture. Compliance with partographs still needs to improve in health services.

Interaction between time-of-day and oxytocin efficacy in mice and humans with and without gestational diabetes.

Management of labor in women with diabetes is challenging due to the high risk of peri- and postpartum complications. To avoid cesarean section and assist with labor progression, Pitocin, a synthetic oxytocin, is frequently used to induce and augment labor. However, the efficacy of Pitocin is often compromised in diabetic pregnancies, leading to increased cesarian delivery. As diabetes deregulates the body's circadian timekeeping system and the time-of-day of the first Pitocin administration contributes to labor duration, our objective was to determine how the time of day and the circadian clock gene, Bmal1, gates oxytocin efficacy. Our studies in mice show that, compared to the rest phase of the day (lights on), the uterotonic efficacy of oxytocin is significantly increased during the active phase (lights off). Using in vitro studies, a myometrium-specific Bmal1 conditional knockout mouse model, and a mouse model of food-induced gestational diabetes, we find that Bmal1 is crucial for maintaining oxytocin receptor expression and response in the myometrium in mice. These findings also translate to humans, where oxytocin-induced human myometrial cell contraction is time-of-day dependent, and retrospective clinical data suggest that administration of Pitocin in the morning should be considered for pregnant women with gestational diabetes.

Neutrophil phenotypes in prolonged labor: Implications for therapeutic strategies.

Prolonged labor, defined as labor extending beyond 20 hours for nulliparas and 14 hours for multiparas, poses significant risks to both maternal and neonatal health. The inflammatory response plays a crucial role in the pathophysiology of prolonged labor, with neutrophils being key players in this process. Neutrophils, the most abundant leukocytes, exhibit diverse phenotypes and functions in response to prolonged labor, influencing both the onset and progression of labor through their inflammatory actions. Classical neutrophils (N1) are involved in acute inflammatory responses, aiding in tissue remodeling and labor onset, but their prolonged activation can lead to tissue damage. Regulatory neutrophils (N2), which produce anti-inflammatory cytokines, help resolve inflammation and facilitate labor progression. Low-density granulocytes and aged neutrophils, associated with chronic inflammation and impaired function respectively, contribute to labor complications. The balance among these neutrophil phenotypes is crucial for maintaining a controlled inflammatory response during labor. Therapeutic strategies targeting neutrophil recruitment, NETosis, and cytokine production hold promise for managing prolonged labor. Modulating chemokine pathways, regulating NET formation, and balancing cytokine profiles may reduce inflammation and improve labor outcomes. Further research into the mechanisms of neutrophil regulation and the development of targeted therapies is essential for mitigating the adverse effects of prolonged labor and enhancing maternal and neonatal health.

Should we restrict food intake during labor? A randomized controlled trial.

To evaluate whether consuming food during labor influences its outcomes. This randomized controlled study included healthy, laboring patients at 37-41weeks of gestation. After epidural anesthesia, patients were randomized into groups of eating at will versus drinking clear fluids only. The primary composite outcome included unplanned cesarean delivery, the need for general anesthesia, asphyxia, postpartum fever, and prolonged postpartum admission (more than 5days). Secondary outcomes included the need for oxytocin, length of the second stage of labor, postpartum analgesia requirements, and early maternal and neonatal outcomes. Sample size analysis indicated that 126 patients needed to be randomized to detect a statistically significance difference between the groups. A total of 129 patients were randomized: 58 to the fluids-only group and 71 to the food group. The groups had similar basic characteristics. The composite outcome of complications attributed to eating during labor and delivery was comparable between groups. Labor progression and the need for oxytocin augmentation were similar in both groups. The groups had comparable fetal heart rate tracings, modes of delivery, maternal and neonatal outcomes, and complications. None of the patients in the study experienced aspiration or an indication for general anesthesia. While our data suggest that eating during labor does not adversely affect labor progression or outcomes, we recommend a cautious approach, allowing patients autonomy while considering individual risk factors. The study has been registered in the primary clinical trial registry on 02/12/2023. ISRCTN trial number ISRCTN11794106, registration number 44513. https://www.isrctn.com/ISRCTN11794106 .

Assessment of Midwives’ Knowledge and Application of the Modified WHO Partograph at Ga South Public Health Facilities, Greater Accra, Ghana

Background The partograph, one of the vital tools available for the midwife, was originally developed from Friedman’s 1954 Cervicograph by Philpott and Castle in 1972. It was later modified and adopted by the WHO as a universal ‘gold standard’ tool for recording and monitoring progress in labour and providing interventions in cases of abnormal labour. The goal of this study was to assess the level of knowledge of midwives and their utilisation of the modified WHO partograph at the Ga South Municipality in the Greater Accra Region of Ghana. Methodology An institution-based quantitative cross-sectional study was conducted within the municipality from February to March 2019. One hundred and ten (110) midwives were recruited using the census approach. Data were collected using a structured self-administered questionnaire. STATA statistical software version 14 was used for descriptive analysis and results were reported in the form of percentages and frequencies using charts and tables. Pearson’s Chi-Square estimation was also performed to test the association between selected variables with a p value &lt;.05 as the threshold for statistical significance. Results Of the 110 participants, 105 (95.5%) of the midwives could properly describe the partograph and 104 (94.5%) understood that it was used as a tool for vital decision-making, while 92 (83.6%) indicated that partograph contributes in reducing maternal and new-born deaths. Almost all participants, 109 (99.09%) knew all the parameters of the partograph and were also aware that plotting the partograph begins at a cervical dilation of 4 cm. Also, while a good number of participants 103 (93.64%) knew that cervical dilation on the partograph is carried out every four hours during the active phase of labour, 110 (100%) indicated that progress of labour is assessed by the degree of cervical dilation and descent of the presenting part. Routine usage of the partograph was recorded among the majority of midwives, 102 (92.7%), to record and monitor the progress of labour in expectant women. Bivariate analysis showed a significant association between the use of the modified WHO partograph and the knowledge of midwives on Ghana Health Service (GHS) policies ( p = .045). There was, however, no positive association determined among age ( p = .66), rank ( p = .77), years of professional experience ( p = 1.00), place of work ( p = .51), work shift and highest qualification ( p = 1.00) as far as knowledge and use of the WHO modified partograph are concerned. Conclusion The findings of the study underscore the desirable level of knowledge and usage of the partograph among study participants. This affirms that the knowledge and usage of the partograph within the facilities in Ga South health facilities hold the prospect of enhancing the safety of expectant mothers.