Labor In Nulliparous Women Research Articles

Delivery outcome after trial of labor in nulliparous women 40 years or older-A nationwide population-based study.

The number of women postponing childbirth until an advanced age is increasing. Our aim was to study the outcome of labor in nulliparous women ≥40years, compared with women 25-29years, after both spontaneous onset and induction of labor. The nationwide population-based Swedish Medical Birth Register was used to study the perinatal outcome in nulliparous women with a singleton, term (gestational weeks 37-44), live fetus in cephalic presentation and a planned vaginal delivery from 1992 to 2011. We included 7796 nulliparous women ≥40years and 264262 nulliparous women 25-29years. Prevalence and risk of intrapartum cesarean section, operative vaginal delivery, obstetric anal sphincter injury and a 5-minute Apgar score <7 were calculated for women ≥40years stratified for spontaneous onset and induction of labor, using women 25-29years as the reference in both strata. Crude and adjusted odds ratios (aOR) were calculated by unconditional logistic regression and presented with 95% confidence intervals (CI). Overall, 79% of women ≥40years with a trial of labor reached a vaginal delivery. After spontaneous onset, intrapartum cesarean section was performed in 15.4% of women ≥40years compared with 5.4% of women 25-29years (aOR 3.07, 95% CI 2.81-3.35). Operative vaginal delivery was performed in 22.3% of women ≥40years compared with 14.2% of women 25-29years (aOR 1.71, 95% CI 1.59-1.85). After induction of labor, an intrapartum cesarean section was performed in 37.2% women ≥40years compared with 20.2% women 25-29years (aOR 2.51, 95% CI 2.24-2.81). Operative vaginal delivery was performed in 22.6% of women ≥40years compared with 18.4% women 25-29years (aOR 1.45, 95% CI 1.28-1.65). The risk of obstetric anal sphincter injury or a 5-minute Apgar score <7 was not increased in women ≥40years, regardless of onset of labor. Trial of labor ended in vaginal delivery in 79% of nulliparous women ≥40years. The risks of intrapartum cesarean section and operative vaginal delivery were higher in women ≥40years compared with women 25-29years, after both spontaneous onset and induction of labor. The risk of obstetric anal sphincter injury or a 5-minute Apgar score <7 was not increased.

Intrapartum sonography of fetal head in second stage of labor with neuraxial analgesia: a literature review and possible medicolegal aftermath.

Intrapartum ultrasound (IU) is a valid support to obstetric management of fetal head progression in the second stage of labor in nulliparous with neuraxial labor analgesia (NLA). Nulliparous with NLA may have a prolonged the second stage of labor. The aim of this literature review was to evaluate the mode of delivery, as well as maternal and fetal morbidities associated with missed progression of fetal head detected with IU in the second stage of labor in nulliparous women with NLA. The literature review was performed using PubMed, Cochrane, Medline, EMBASE, Scopus, Google Scholar and book chapters searches to identify relevant articles from 2001 to 2019, evaluating the mode of delivery and morbidities of the second stage of labor. Search terms used were "Intrapartum ultrasound", "dystocia", "prolonged labor", "neuraxial analgesia", "persistent occiput posterior position", "asynclitism", "second stage of labor", "medico-legal aftermath". Prolonged second stage was defined as three hours and more. Retrospective case series of women with prolonged second stage of labor with NLA were identified. The primary outcome was the incidence of operative vaginal delivery (OVD) and cesarean delivery (CS). The use of NLA may determine a prolonged second stage of labor (PSSL). IU when compared to the traditional vaginal digital examination (VDE) demonstrated the highest degree of diagnostic accuracy. The use of IU during NLA can aid in the diagnosis of fetal head progression, station or malposition and malrotation, alerts obstetrician on the possibility of dystocic labor, indicating to stop the drug administration in NLA and shift to OVD or CS. Extending the second stage of labor beyond current American College of Obstetricians and Gynecologists (ACOG) recommendations is beneficial. The ISUOG guidelines recommended the clinical application of IU to diagnose the persistent occiput posterior position (POPP) and asynclitism (A) in dystocic labor and produce photographic evidence of the case. Maternal and neonatal complications, medicolegal consequences and litigation can decrease if the IU device is used as good practice.

Effects of Phoenix dactylifera Syrup Consumption on the Severity of Labor Pain and Length of the Active Phase of Labor in Nulliparous Women

Effects of Phoenix dactylifera Syrup Consumption on the Severity of Labor Pain and Length of the Active Phase of Labor in Nulliparous Women

Risk factors for cesarean delivery after induction of labour in nulliparous women at 41 weeks of gestation

Introduction: Nulliparous women are more likely to undergo labour induction and also at a higher risk of cesarean delivery. It has been reported that maternal and obstetrical factors may enhance this risk.

The Correlation of the Level of Anxiety of Nulliparous Women to the Length of First Stage of Spontaneous Labor at Private Maternity Clinics in the Working Area of Delitua Puskesmas, Deli Serdang District in 2013

Abnormal length of first stage of labor in nulliparous women (first pregnancy) can be related by severe anxiety during labor. Based on the preliminary survey in several private maternity clinics at the working area of Delitua Puskesmas, Deli Serdang District, it was found that there was a prolonged first stage of labor (27.65%) in nulliparous women. The purpose of this study was to analyze the influence of anxiety level to the lenght of first stage of labor. The type of this study was an analytic survey with explanatory research type. The samples comprised 40 childbearing women in private maternity clinics of Kasih Ibu,Kurnia,Tanjung,Wanda,and Mayana which were located in the working area of Delitua Puskesmas , Deli Serdang District,using accidental sampling technique. The data were gathered by using questionnaires and analyzed in univariet analysis by using frequency distribution form, and bivariate analysis using Chi Square test. The result of this study showed that the level of anxiety (p = 0.001) significantly related the lenght of first stage of labor in which mothers who had severe anxiety. It is recomended that health providers should provide standardized services to childbearing women, especially to nulliparous women, so that their level of anxiety can be decreased facing the first stage of labor process. It is also recommended that the husbands should support their wives by positive behaviors so they will not think about bad things on their babies and on themselves.

Outcomes of induction of labour in nulliparous women at 38 to 39weeks pregnancy by clinical indication: An observational study.

Knowledge of the outcomes of induction of labour for different indications is sparse. To describe the mode of birth and other outcomes for nulliparous women induced at 38-39weeks gestational age by indication for induction of labour. This was a retrospective observational study in a tertiary referral hospital, and a metropolitan teaching hospital in Sydney. The study population was nulliparous women with induction of labour at 38 or 39 completed weeks of pregnancy and a singleton, cephalic presenting baby planning a vaginal birth, from 2009 to 2016. The indication for induction of labour was classified into 12 groups. Mode of birth and other maternal and perinatal outcomes were described in each group, for women who spontaneously laboured at 38 or 39weeks, and for women who gave birth from 40 completed weeks onward. The main outcome measure was mode of birth. There were 3330 women with induction of labour at 38 or 39weeks gestation. Rates of vaginal birth varied widely, ranging from 54% when the indication for induction was suspected large fetus, to 82% when the indication was suspected fetal compromise, and was 74% overall. Indications for caesarean delivery also varied by indication for induction. Among women giving birth ≥40weeks gestational age, 75% had a vaginal birth. In nulliparous women, rates of vaginal birth following induction of labour at 38 or 39weeks gestation vary widely according to the indication for induction. These data are useful for antenatal counselling.

787: Early versus late active-phase labor arrest: a retrospective comparison of outcomes

The contemporary labor curve describes a difference in duration of labor in nulliparous women at varying centimeters of cervical dilation. However, current labor dystocia guidelines do not discriminate between varying degrees of cervical dilation when defining active-phase labor arrest. We sought to compare the prospect of vaginal delivery for patients who have cervical dilation of 6-7cm versus 8-9cm for greater than 6 hours. This is a retrospective cohort study of 970 NTSV patients delivering from January 2013-May 2018 at an academic, community hospital. We then identified patients with active-phase arrest, defined as ≥ 6 cm for at least 6 hours with unchanged cervical dilation. Patients were then stratified into two cervical dilation groups: early (6-7 cm dilated) and late (8-9 cm dilated). The primary outcome between these two groups was vaginal delivery rate. Secondary outcomes were maternal and neonatal complications. Fifty-eight patients were identified as having active-phase arrest. There was no difference in vaginal delivery rates between those patients with arrest in early versus late active-phase labor (48.7% [n=41] vs. 47% [n=17], respectively) (Table 1). There were no differences between rates of maternal or neonatal outcomes (Table 2).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Although the anticipated duration of labor should be shorter for nulliparous women with 8-9 cm cervical dilation compared to 6-7 cm cervical dilation, application of the same definition of arrest of active-phase labor to both groups was not associated with a difference in vaginal delivery rate, maternal complications, or neonatal complications. A significant proportion of patients in active-phase labor who remain at the same cervical dilation for greater than 6 hours go on to achieve vaginal delivery.

91: Pushing the bounds of second stage: when should we abandon the ambition of SVD?

To develop a prediction model for spontaneous vaginal delivery per hour during the second stage of labor in nulliparous women with epidural anesthesia. This was a secondary analysis of the Consortium for Safe Labor database. Primary outcome was delivery type per hour of second stage: spontaneous vs operative (operative vaginal and cesarean delivery). Inclusion criteria: term, nulliparas, singleton gestations, vertex presentation, epidural anesthesia who reached 10 centimeters cervical dilation. Exclusion criteria: intrauterine fetal demise, planned cesarean delivery and major congenital anomalies. Univariate comparisons were made to identify variables that were independently associated with spontaneous vaginal delivery. An optimal decision tree was used to create a prediction model. A test set was withheld from the dataset to perform validation. A risk calculator tool was developed for prediction of spontaneous vaginal birth as well as adverse perinatal outcomes per hour. Adverse maternal outcomes were a composite of postpartum hemorrhage, transfusion, endometritis, 3rd/4th degree laceration. Adverse neonatal outcomes were a composite of neonatal intensive care unit admission, hypoxic ischemic encephalopathy, respiratory distress, seizures, apnea, asphyxia and shoulder dystocia. The study population included 228438 deliveries, 26796 patients met inclusion and exclusion criteria. After removing cases with incomplete data the study population consisted of 22299 women, of which 16593 women had a spontaneous vaginal delivery (74.4%). Number deliveries at a given hospital/year, fetal position, cervical dilation on admission, chorioamnionitis, augmentation of labor, maternal age and length of second stage were associated with the odds of spontaneous vaginal delivery. Using the predictors identified, a risk predictor calculator was created. An ROC curve was developed to assess the calculator; AUC was 0.74 for the validation set: This calculator is available at: https://www.interpretable.ai/CSL_study/questionnaire.html Spontaneous vaginal delivery for women with term, cephalic, singleton gestations with epidural anesthesia was associated with several variables. This calculator tool will help facilitate provider decision making and patient counseling about the value of continuing the second stage of labor based on changing rates of success and risks of maternal and neonatal morbidity with time.

Factors affecting labor duration in Chinese pregnant women.

The aim of the study was to explore the role of parity, maternal age, medical interventions, and birth weight with respect to labor duration and cervical dilation.A total of 1601 pregnant women who had a singleton term gestation, spontaneous onset of labor, vertex presentation, vaginal delivery, and a normal perinatal outcome were reviewed. The retrospective study was conducted in patients from West China Second University Hospital of Sichuan University during June 2008 to June 2013.There were 1367 nulliparous women and 234 multiparous women analyzed. The first stage (8.3 ± 3.8 vs 5.0 ± 2.6 hours), latent phase (5.1 ± 3.2 vs 3.5 ± 2.4 hours), active phase (3.2 ± 1.8 vs 1.5 ± 1.0 hours), second stage (44 ± 31 vs 18 ± 14 minutes), and total stage of labor (9.1 ± 3.9 vs 5.4 ± 2.6 hours) were all longer in nulliparous than in multipara women (all P < .05); but no significant difference in the third stage of labor (both 7 ± 4 minutes). In nulliparous women, the average time of first stage of labor increased by 58.257, 171.443, and 56.581 minutes due to artificial rupture of membranes, labor analgesia, and birth weight increased by 1 kg, respectively, but it decreased to 63.592 minutes by oxytocin usage, and the difference was significant. The average time of first stage of labor in nulliparous women aged from 26 to 30 years increased by 2.356 minutes compared to one in 20 to 26 years, but it increased by 1.802 minutes to the one in 30 to 39 years, compared to 20 to 26 years and the difference was not significant. The results were basically similar after multipara women were included.Labor was significantly shorter in multiparous women than that in nulliparous women. Increased birth weight significantly increased in the length of the active phase and the second stage among nulliparous women. The increase of age, artificial rupture of membranes, labor analgesia, and the increase of birth weight tends to increase the time of first stage of labor and total labor duration, whereas oxytocin could shorten it.

Contraction of the levator ani muscle during Valsalva maneuver (coactivation) is associated with a longer active second stage of labor in nulliparous women undergoing induction of labor

The Valsalva maneuver is normally accompanied by relaxation of the levator ani muscle, which stretches around the presenting part, but in some women the maneuver is accompanied by levator ani muscle contraction, which is referred to as levator ani muscle coactivation. The effect of such coactivation on labor outcome in women undergoing induction of labor has not been previously assessed. The aim of the study was to assess the effect of levator ani muscle coactivation on labor outcome, in particular on the duration of the second and active second stage of labor, in nulliparous women undergoing induction of labor. Transperineal ultrasound was used to measure the anteroposterior diameter of the levator hiatus, both at rest and at maximum Valsalva maneuver, in a group of nulliparous women undergoing induction of labor in 2 tertiary-level university hospitals. The correlation between anteroposterior diameter of the levator hiatus values and levator ani muscle coactivation with the mode of delivery and various labor durations was assessed. In total, 138 women were included in the analysis. Larger anteroposterior diameter of the levator hiatus at Valsalva was associated with a shorter second stage (r= -0.230, P= .021) and active second stage (r= -0.338, P= .001) of labor. Women with levator ani muscle coactivation had a significantly longer active second stage duration (60 ± 56 vs 28 ± 16 minutes, P < .001). Cox regression analysis, adjusted for maternal age and epidural analgesia, demonstrated an independent significant correlation between levator ani muscle coactivation and a longer active second stage of labor (hazard ratio, 2.085; 95% confidence interval, 1.158-3.752; P= .014). There was no significant difference between women who underwent operative delivery (n= 46) when compared with the spontaneous vaginal delivery group (n= 92) as regards anteroposterior diameter of the levator hiatus at rest and at Valsalva maneuver, nor in the prevalence of levator ani muscle coactivation (10/46 vs 15/92; P= .49). Levator ani coactivation is associated with a longer active second stage of labor.

Effect of valethamate bromide in accelerating labor: a prospective randomized controlled trial

Objective: This prospective randomized study aimed to investigate the effect of valethamate bromide on the length of labor. Materials and Methods: A total of 200 pregnant women, who were in the 37-41 weeks of gestation, and in the active phase of labor with cervical dilatation of 6-7 cm, were included in the study. Twenty-four pregnant women that underwent cesarean section and 33 pregnant women that required oxytocin were not included in the final statistical analysis. Finally, 71 nulliparous and 72 multiparous women were randomized to four groups according to whether they received valethamate bromide or not. Groups 1 and 2 consisted of 35 nulliparous and 37 multiparous women, respectively receiving 16 mg of valethamate bromide, whereas groups 3 and 4 consisted of 36 nulliparous and 35 multiparous women, respectively, not receiving any medication, and both groups were considered as the control group. Results: There was no statistically significant difference between the groups in terms of mean maternal age and gestational age (p > 0.05). Evaluating the groups in terms of drug side effects such as maternal tachycardia, dry mouth, flushing, headache, nausea, and vomiting, no statistically significant difference was determined between the valethamate bromide groups (groups 1 and 2) and the controls (p > 0.05). There was no statistically significant difference between the study groups (group 1 vs. 3 and groups 2 vs. 4) in terms of the time from the rupture of the membranes to the second stage of labor (p > 0.05). Contrarily, the median length of the second stage of labor was 35 (5-70) minutes and 42.5 (10-70) minutes for groups 1 and 3, respectively, in the nulliparous women and the difference between the groups was considered statistically significant (p = 0.045). For the multiparous women, the median length of the second stage of labor was 12 (5-30) minutes in group 2 and 15 (5-40) minutes in group 4 and no statistically significant difference was determined between the groups (p > 0.05). The median time from the rupture of the membranes to the delivery was 100 (10-235) minutes and 87.5 (20-395) minutes in groups 1 and 3, respectively, and 50 (25-365) minutes and 50 (10-390) minutes in groups 2 and 4, respectively. No statistically significant difference was determined between the groups (p > 0.05). Conclusion: Valethamate bromide significantly shortens the second stage of labor in nulliparous women.

The Influence of Fetal Head Circumference and Fetal Weight Measurement Assessed By Intrapartum Ultrasound on Labor Outcome

Background: labor is a clinical diagnosis characterized by regular, painful uterine that increase in frequency and intensity is associated with progressive cervical effacement or dilatation. More specifically, it is associated with a change in the myometrial contractility pattern from irregular contractures (long-lasting, low-frequency activity) to regular contractions (high-intensity, high frequency activity). Aim of the work: it was to determine if fetal head circumference and fetal weight could predict the rate of caesarian section and operative vaginal deliveries in nulliparous women in labor. Patients and Methods: this study was carried out at Al Alamein Hospital from January 2017 to January 2018 on two hundred (200) primigravida women; their ages ranged from 20 to 30 years and the gestational ages ranged from 38-40 weeks with normal singleton pregnancy with cephalic presentation in labor. Results: there were highly statistically significant relations between mode of delivery and fetal head circumference and estimated fetal weight as p value (0.001).it was found that large fetal head circumference relative to maternal pelvic diameter is the main cause of prolonged labor and therefor increased risk of primary caesarian section. Conclusion: the numerical data have a significant relation between intra partum head circumference and fetal weight and the incidence of primary caesarian section, maternal and fetal complications. Recommendations: according to numerical results obtained from this study. The study recommends strict labor monitoring by partogram in cases where fetal head circumference is more than 35cm or fetal weight is more than 3950gms.

Head progression distance during the first stage of labor as a predictor for delivery outcome

Objectives: To assess if measurement of the head progression distance (PD) during the first stage of labor in nulliparous women can predict the delivery method.Methods: A prospective study was conducted on consecutive nulliparous women beyond 37 week’s gestation during the first stage of labor. Transperineal ultrasound was performed to assess the PD. Analysis was performed on the relationships between PD during rest and during voluntary pushing and the fetal and maternal characteristics, delivery mode, and immediate postnatal outcomes.Results: Eighty seven suitable nulliparous women were suitable for analysis. PD was found to be significantly longer in women who delivered vaginally (VD) compared to those who underwent a cesarean section (CS) for obstructed labor: PD at rest was 2.51 ± 1.71 cm in women who delivered vaginally compared to 1.48 ± 1.9 cm in women who delivered by CS (p = .01). The PD during pushing was 3.43 ± 1.8 cm for a VD compared to 1.5 ± 2.1 cm for CS (p = .015). Logistic regression and receiver-operating characteristics curve analysis demonstrated a moderate predictive value of PD with respect to the mode of delivery (area under the curve was 0.67 during both resting and pushing period).Conclusion: PD measurements during the first stage of labor among nulliparous women differ significantly both in rest and during pushing between patients who delivered vaginally compared to CS and can therefore assist in predicting the mode of delivery.

The effects of intravenous dextrose 5%, Ringer’s solution, and oral intake on the duration of labor stages in nulliparous women: a double-blind, randomized, controlled trial

Background and objectives: Childbirth consists of a three-stage period beginning with uterine contractions and ending in the expulsion of the placenta. The present study was conducted to compare the effects of Ringer’s solution, dextrose solution 5%, and oral intake on the duration of total labor and labor stages (primary outcome) and the frequency of oxytocin administration and prolonged labor (secondary outcome) in nulliparous women with spontaneous vaginal delivery. Materials and methods: The present randomized clinical trial was conducted on 201 nulliparous women in labor assigned with a randomized block design to three groups, each receiving either Ringer’s solution plus oral fluids, dextrose solution 5% solution plus oral fluids or oral fluids alone. The solutions were intravenously administered at a rate of 125 ml/h in the groups receiving the solutions and the subjects in the oral fluids group could consume liquids of their choice (water, orange juice, and apple juice). The duration of total labor and labor stages (the active stage, the second, and third stages of labor) were recorded by the researcher in minutes. Furthermore, the frequency of oxytocin administration and prolonged labor were recorded by the researcher by using a checklist. Data were analyzed using the Kruskal–Wallis test, Mann–Whitney’s U-test, chi- square test and Fisher exact test. Results: The mean (±SD) duration of total labor was 301.2 (±50.0) minutes in the Ringer group, 171.9 (±36.4) in the dextrose 5% group, and 524.8 (±103.4) in the oral fluids group, suggesting a statistically significant intergroup difference (p < .001). The mean (±SD) duration of the active stage of labor was 276.7 (±91.3) minutes in the Ringer group, 150.6 (±78.5) in the dextrose 5% group, and 302.4 (±136.8) in the oral fluids group, suggesting a statistically significant intergroup difference (p < .001). A significant difference was also observed between the three groups in terms of the duration of the third stage of labor (p < .001); however, no significant differences were observed in terms of the duration of the second stage of labor (p = .058). Furthermore, a significant difference was observed between the three groups in terms of the need for oxytocin administration (p ≤ .001) and the frequency of prolonged labor (p = .001). Conclusion: The results suggest that the consumption of dextrose solution by nulliparous women reduces the duration of labor, the need for oxytocin administration and the frequency of prolonged labor compared to when Ringer’s solution and oral fluids are used.

Upright Versus Lying Down Position in Second Stage of Labor in Nulliparous Women With Low Dose Epidural: BUMPES Randomized Controlled Trial

(BMJ 2017;359:j4471) Epidural analgesia is the most effective and preferred form of pain relief in labor for many woman. However, some studies have reported an association between epidural analgesia and a prolongation of the second stage of labor and an increased risk of instrumental vaginal delivery. The concentration of local anesthetic used in many of these studies was greater than is commonly used today, though, resulting in a denser block than that experienced by most women receiving epidural labor analgesia in current practice. Other studies have shown that maternal position during the second stage of labor could also affect the risk of instrumental vaginal delivery. The current study, Birth in the Upright Maternal Position with Epidural in Second Stage (BUMPES) trial, aimed to determine whether being upright during the second stage of labor in nulliparous women receiving low dose epidural analgesia increased the rate of spontaneous vaginal birth compared with women who were lying down.

Retracted: Delivery outcome after trial of labor in nulliparous women over 40 years of age - a population-based study.

Delivery outcome after trial of labor in nulliparous women over 40years of age - a population-based study by Victoria Ankarcrona, Daniel Altman, Anna-Karin Wikström, Bo Jacobsson & Sophia Brismar Wendel (https://doi.org/10.1111/aogs.13379). The above article from Acta Obstetricia et Gynecologica Scandinavica, published online on 17 May 2018 in Wiley Online Library (http://wileyonlinelibrary.com) has been withdrawn by agreement between the authors, the Journal Editor-in-Chief, Ganesh Acharya and John Wiley & Sons Ltd. The withdrawal has been agreed at the request of the authors, since an error in the classification of parity was discovered in the dataset used to produce this report, making the conclusions invalid.

Can uterocervical angles successfully predict induction of labor in nulliparous women?

PurposeInduction of labor is a common practice in obstetrics. In recent years, a newer ultrasonographic parameter called the uterocervical angle (UCA) has been identified as a predictive tool for births. Our purpose is to investigate the role of UCA in predicting successful induction of labor. MethodsThe nulliparous term pregnancies (n:150) were grouped into successful/failed inductions of labor based on their progress into the active phase of labor after the administration of prostaglandin E2 (dinoprostone). The pre-induction cervical length (CL) and UCA were compared in the two groups. The study population was further grouped according to their modes of delivery and pre-induction UCAs were compared among the subgroups. ResultsThe mean UCAs were not significant among the successful induction and failed induction groups (105.46 ± 20.54 degrees in the successful group and 110.57 ± 13.46 degrees in the failed group). However, UCAs significantly varied among the modes of delivery subgroups. The median UCA was significantly higher in patients who delivered vaginally after a successful induction of labor than in patients who delivered via cesarean section. The median UCA value was lowest in patients who had a successful induction of labor but ended up having a cesarean section (Fig. 2). Further, the duration of the active phase of labor negatively correlated with the UCA but not the CL (rho=-0.23, p = 0.02). There was also a negative correlation between the CL and the UCA in patients who delivered vaginally after successful induction of labor (rho= −0.21, p = 0.03). ConclusionThe UCA is a promising ultrasonographic marker in obstetrics. Although the pre-induction UCA did not predict the outcome of labor induction, patients with broader pre-induction UCAs were prone to have a shorter duration of active phase. The pre-induction CL and UCA are inversely corraleted in nulliparous women who delivered vaginally after a successful induction of labor.

Intrapartum ultrasound: viewpoint of midwives and parturient women and reproducibility.

IntroductionVaginal examination (VE) is known to be subjective in interpretation and is considered uncomfortable by many women. Intrapartum ultrasound aims to be more objective and less invasive. The purpose of this study was to evaluate the acceptability of introducing intrapartum ultrasound to both midwives and parturients. Furthermore, we wanted to evaluate the reproducibility of different measurements when introduced de novo among operators without prior ultrasound experience.Subjects and methodsThis study determined intra- and interobserver variability of intrapartum ultrasound in nulliparous women in labor. Ultrasound examinations were performed independently by a midwife and a gynecologist. The symphysis–head distance (SHD) and the angle of progression (AOP) were measured by translabial ultrasound. Structured questionnaires were given to midwives and parturients. Intraclass correlation coefficient (ICC) and limits of agreement (LA) were calculated to evaluate variability.ResultsA total of 33 patients were included; of whom, 28 filled in the questionnaire. A total of 19 midwives working on a delivery ward were asked to respond to the questionnaire, and 13 returned the forms. Midwives clearly continued to prefer VE over ultrasound, the majority evaluated translabial ultrasound as easy to use, but some declared to be unable to use it. The majority of patients, 71%, preferred ultrasound over VE. Reproducibility of intrapartum trans-labial ultrasound was good; ICC for interobserver variability was 0.603 (p=0.001) for SHD, and ICC for intraobserver variability was 0.844 (p<0.001) and 0.914 (p<0.001) for SHD and AOP, respectively.ConclusionPatients prefer ultrasound over VE; midwives tend to stick to trusted VE. Reproducibility of intrapartum ultrasound in non-experienced operators is good.

Traditionally vs sonographically coached pushing in second stage of labor: a pilot randomized controlled trial

To investigate the usefulness of visual biofeedback using transperineal ultrasound to improve coached pushing during the active second stage of labor in nulliparous women. This was a randomized controlled trial of low-risk nulliparous women in the active second stage of labor. Patients were allocated to either coached pushing aided by visual demonstration on transperineal ultrasound of the progress of the fetal head (sonographic coaching) or traditional coaching. Patients in both groups were coached by an obstetrician for the first 20 min of the active second stage of labor and, subsequently, the labor was supervised by a midwife. Primary outcomes were duration of the active second stage and increase in the angle of progression at the end of the coaching process. Secondary outcomes included the incidence of operative delivery and complications of labor. Forty women were recruited into the study. Those who received sonographic coaching had a shorter active phase of the second stage (30 min (interquartile range (IQR), 24-42 min) vs 45 min (IQR, 39-55 min); P = 0.01) and a greater increase in the angle of progression (13.5° (IQR, 9-20°) vs 5° (IQR, 3-9.5°); P = 0.01) in the first 20 min of the active second stage of labor than did those who had traditional coaching. No differences were found in the secondary outcomes between the two groups. Our preliminary data suggest that transperineal ultrasound may be a useful adjunct to coached pushing during the active second stage of labor. Further studies are required to confirm these findings and better define the benefits of this approach. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Does Early Term Induction of Labour in Nulliparous Women Prevent Caesarean Section for Slow Progress or for ‘Fetal Distress’?

Does Early Term Induction of Labour in Nulliparous Women Prevent Caesarean Section for Slow Progress or for ‘Fetal Distress’?