Women In Labor Research Articles

The Effectiveness of an Integrated Symptom-related Fatigue Management Program (ISFMP) on Pain, Anxiety, Fatigue Score and Lactate Levels in Low-risk Pregnant Women During Childbirth

Background: Fatigue accumulates throughout the labor period and often occurs in conjunction with pain and anxiety during childbirth, resulting in negative effects on laboring women. Objective: The purpose of this study is to investigate the effectiveness of an integrated symptom-related fatigue management program (ISFMP) on pain, anxiety, fatigue score and lactate levels in a low-risk pregnant woman during childbirth. Method: This quasi-experimental study was conducted from August of 2021 to March of 2022 at Prachuap Khiri Khan Hospital. Sixty-five low-risk pregnant women with 32–41+6 weeks gestation were selected by the stratified random-sampling and matching techniques. They were then randomly assigned to either comparison or intervention groups. Data were collected using a demographic questionnaire and a visual analogue scale for pain, anxiety and fatigue. Lactate Pro 2 was used to evaluate lactate levels. Data were analyzed through statistical software (SPSS-26) using independent t-test, chi-square, repeated measure ANOVA and repeated measure multivariate analysis of variance (MANOVA). The significance level was set at p <.05. Results: The participants in the comparison and experimental groups had varying pain, anxiety, fatigue scores and lactate levels throughout their progression of labor. Pain, anxiety and fatigue in the experimental group were significantly lower than in the comparison group (p < .001). There were no statistically significant differences in lactate levels between the two groups. Conclusion: The ISFMP was shown to be effective in lowering the symptoms of pain, anxiety and fatigue in women in labor. Midwives should apply the ISFMP in their clinical practice when caring for low-risk pregnant women.

On the prediction of premature births in Hispanic labour patients using uterine contractions, heart beat signals and prediction machines.

Preterm birth is a global epidemic affecting millions of mothers across different ethnicities. The cause of the condition remains unknown but has recognised health-based implications, in addition to financial and economic ones. Machine Learning methods have enabled researchers to combine datasetsusinguterine contraction signals with various forms of prediction machines to improve awareness of the likelihood of premature births. This work investigates the feasibility of enhancing these prediction methods using physiological signals including uterine contractions, and foetal and maternal heart rate signals, for a population of south American women in active labour. As part of this work, the use of the Linear Series Decomposition Learner (LSDL) was seen to lead to an improvement in the prediction accuracies of all models, which included supervised and unsupervised learning models. The results from the supervised learning models showed high prediction metrics upon the physiological signals being pre-processed by the LSDL for all variations of the physiological signals. The unsupervised learning models showed good metrics for the partitioning of Preterm/Term labour patients from their uterine contraction signals but produced a comparatively lower set of results for the various kinds of heart rate signals investigated.

Intersectionality Matters: Black Women, Labor, and Households in Black Suburbia

The number of Black suburbs has expanded since the 1960s, however, research on gender and how Black women contribute to their formation is understudied. Grounded in an intersectional framework, this article places women at the center of the analysis of Black suburban life. Using a multisite ethnography conducted during the Great Recession, I make a case for a Black diasporic suburb model and analyze the labor and household practices Black women use to sustain their families’ suburban lives. This article generates new insights into the heterogeneity of and Black suburbs in general, and the dynamic culture and economies of Black suburban women, in particular. Thus it contributes to new thought in Black feminist geography and the sociology of suburbs.

Indian Time: Temporality, Gender, Mobility

Indian Time: Temporality, Gender, Mobility

Study the Role of Congenital Toxoplasmosis with Preterm Labor, and Low Birth Weight

The study included 100 samples of blood from women who suffer from premature birth and low fetal weight, and a hundred samples from women who do not suffer from any injury. This study extends from February 1, 2019 to November 1, 2019, where the study included collecting blood samples from all women who entered the study, in addition to collecting information regarding age, weight, height, and history of infection with parasites, if any, to investigate the parasite’s DNA in blood samples collected from patients. These samples were examined using the standard methods provided by the company in which the tests were conducted. The study included the molecular detection by PCR of toxoplasma genes, where EDTA blood samples were collected from all preterm and term pregnant women in the study. Using laboratory kit for Toxoplasma DNA extraction, samples were extracted and kept in separate sterile tubes using DAN extraction kit (Zymogene, Japan), then the DNA was detected by real-time PCR which was done according to the protocols designed by the manufacturer of the diagnostic kit. The study showed no significant relationship between the two groups regarding mean of ages. But regular contractions, reduced length of cervix and decreased weight of babies was highly related with women presented with preterm birth. The study showed that 87.5% of preterm delivery women with +ve DNA detection of T. gondii have regular contraction comparing with 12.5% of cases with negative T. gondii infection (P<0.001). The study showed the lowest mean of baby weight at birth was recorded in pregnant women with preterm labor women who infected with T. gondii as compared with cases who were negative to T. gondii infection (P<0.001). The study demonstrated that majority of women with +ve T gondii infection were had positive history of abortion.

Frequency of Successful Vaginal Delivery after Induction of Labour in Obese Pregnant Women Presenting at Tertiary Care Hospital Peshawar

Introduction: The incidence of induction of labour is 20% of all deliveries and is considered as the most common techniques in modern obstetrics. But both medically indicated and elective inductions are thought to increase the risk of instrumental and cesarean deliveries. Objective: Aim of this study was to determine the frequency of successful vaginal delivery after induction of labour in obese women. Methodology: This study was descriptive study carried out at Gynecology and Obstetrics Department, Hayatabad Medical Complex, Peshawar. The duration of study was Six months (from 1/2/2021 to 1/8/2021). Detail history, clinical examination, routine investigation were performed for the confirmation of obese pregnant women. All the data i.e. age, gestational age, parity, gravidity, number of induction, duration of labour, previous history of C section was recorded in pre design performa. All the recorded information on performa was entered in statistical software SPSS ver 23. Results: Our study shows that among 149 patients mean maternal age was 29 years with standard deviation ± 5.91. Among 149 patients successful vaginal delivery was observed in 86(58%) patients while 63(42%) patients were observed with un-successful vaginal delivery. Conclusion: Our study concludes that the frequency of successful vaginal delivery was 58% after induction of labour in obese pregnant women presenting at tertiary care hospital Peshawar. Keywords: Successful vaginal delivery, Induction of labour, obese pregnant women

A critical interpretive synthesis of power and mistreatment of women in maternity care.

Labouring women may be subjected to physical and verbal abuse that reflects dynamics of power, described as Mistreatment of Women (MoW). This Critical Interpretive Synthesis on power and MoW consolidates current research and advances theory and practice through inter-disciplinary literature exploration. The review was undertaken in 3 phases. Phase 1 consisted of topic scoping; phase 2 entailed exploration of key power-related drivers emerging from the topic scoping; and phase 3 entailed data synthesis and analysis, with a particular focus on interventions. We identified 63 papers for inclusion in Phase 1. These papers utilized a variety of methods and approaches and represented a wide range of geographic regions. The power-related drivers of mistreatment in these articles span multiple levels of the social ecological model, including intrapersonal (e.g. lack of knowledge about one's rights), interpersonal (e.g. patient-provider hierarchy), community (e.g. widespread discrimination against indigenous women), organizational (e.g. pressure to achieve performance goals), and law/policy (e.g. lack of accountability for rights violations). Most papers addressed more than one level of the social-ecological model, though a significant minority were focused just on interpersonal factors. During Phase 1, we identified priority themes relating to under-explored power-related drivers of MoW for exploration in Phase 2, including lack of conscientization and normalization of MoW; perceptions of fitness for motherhood; geopolitical and ethnopolitical projects related to fertility; and pressure to achieve quantifiable performance goals. We ultimately included 104 papers in Phase 2. The wide-ranging findings from Phase 3 (synthesis and analysis) coalesce in several key meta-themes, each with their own evidence-base for action. Consistent with the notion that research on power can point us to "drivers of the drivers," the paper includes some intervention-relevant insights for further exploration, including as relating to broader social norms, health systems design, and the utility of multi-level strategies.

Mode of delivery and birth outcomes in relation to the duration of the passive second stage of labour: A retrospective cohort study of nulliparous women.

To investigate the mode of delivery and birth outcomes in relation to the duration of the passive second stage of labour in nulliparous women. A retrospective cohort study of all nulliparous women (n = 1131) at two delivery units in Sweden. Maternal and obstetric data were obtained from electronic medical records during 2019. The passive second stage was defined as the complete dilation of the cervix until the start of the active second stage. The duration of the passive second stage was categorized into three groups: 0 to 119 min (0 to <2 h), 120-239 min (2- <4h) and ≥240 min (≥4h). Differences between the groups were examined using t-test and Chi2-tests and regression analyses were used to analyse adjusted odds ratio with 95% confidence intervals. The primary outcome was mode of delivery in relation to the duration of the passive second stage and the secondary outcomes covered a series of adverse maternal and neonatal birth outcomes. The rates of instrumental and caesarean deliveries increased as the duration of the passive second stage increased. A ≥4-hour duration of the passive second stage was associated with a nine-times increased risk of caesarean section, and a four-times risk of instrumental delivery compared to a duration of <2 hours in the adjusted analyses. No differences were found in the maternal birth outcomes. The risk of a 5-minute Apgar score <7 was increased in the 2-<4h group. A longer passive second stage was not associated with an increased risk of negative birth experience. Our study demonstrates an increased risk of operative delivery for a longer duration (>2h) of the passive second stage in nulliparous women, although most of the women gave birth by spontaneous vaginal delivery even after ≥4 hours. There was no evidence of an increased risk of adverse maternal outcomes in a longer duration of the passive second stage but there were indications of increased adverse neonatal outcomes. Assessment of fetal well-being is important when the duration of the passive phase is prolonged.

Perbandingan Pemberian Aromaterapi Lavender Dan Lemon Terhadap Nyeri Persalinan Kala I Pada Ibu Bersalin Di Wilayah Puskesmas Cimanggu Pandeglang Banten Tahun 2022

Introduction: Pain during labor is unique and different for each individual, this is because the pain is influenced by fear or anxiety about childbirth. Excessive and prolonged labor pain will cause anxiety and psychological pressure, and it can affect the physical condition of the birthing mother, such as increased blood pressure, respiratory rate, and heart rate. There are many methods for dealing with labor pain. Methods: The research method was quasi-experimental with two group pre-test and post-test design. The number of samples was 30 respondents, and the sampling technique used purposive sampling and data analysis using Independent T-test. Results: The level of labor pain in the first stage of labor before and after giving lavender aromatherapy obtained an average value of 6,00; and after being given lavender aromatherapy, an average of 3,20 with an average difference of 2,80. The level of labor pain in the first stage of labor before and after giving lemon aromatherapy obtained an average value of 6,47; and after being given lemon aromatherapy, an average of 1,73 with an average difference of 4,74. There is a difference between giving lavender aromatherapy and lemon aromatherapy to the level of labor pain in the first stage of labor, with a significance level of 0,002. Discussion: The research concludes that there is a difference between giving lavender aromatherapy and lemon aromatherapy to the level of labor pain in the first stage of labor in women. Giving lemon and lavender aromatherapy can be applied thoroughly in Indonesian health services.

Reliability and Reproducibility of Analyzing 3D Transperineal Ultrasound Volumes Obtained in the First Phase of Labor - A Pilot Study.

The aim of this study was to investigate the reliability and reproducibility of transperineal ultrasound (TPUS) in the initial phase of labor. As TPUS is a common method, it could supplement vaginal palpation and even replace it in certain situations. In addition, we used a 4-dimensional method for the assessment of cervical effacement. 54 women in labor were included and underwent TPUS. The resulting images from the acquired 4D volumes were evaluated after the examination for the first time and a second time after 21 days. The measured values were cervical length, dilatation and effacement, the angle of progression (AoP), and head-perineum distance. 54 patients were examined. TPUS images were unable to be evaluated in 12 patients because of cervical dilatation of more than 5 cm or poor image quality. Thus, 42 measurements were included. The concordance correlation coefficients according to Lin are satisfactory overall, with one exception for cervical effacement. The accuracy component of cervical length (CCCLin: 0.93; accuracy: 1.00), dilatation (CCCLin: 0.93; accuracy: 1.00), and AoP (CCCLin: 0.87; accuracy: 1.00) is excellent and still high for the head-perineum distance (CCCLin: 0.89; accuracy: 0.96) and cervical effacement (CCCLin: 0.77; accuracy: 0.97). TPUS is a valuable noninvasive tool with good diagnostic accuracy for the AoP, cervical length, and dilatation. Our study provides support for the use of TPUS to complement a vaginal examination. It should not replace a digital examination but should serve as a suitable alternative method for monitoring labor progression in the future.

Physical and Mental Effects of Foot Baths Among Women in Labor: Protocol for a Pre-Post Test Experimental Design

Foot baths are used in complementary and alternative therapy to improve the duration and quality of sleep and reduce tension, anxiety, fatigue, and confusion. They are also known to improve the frequency of labor contractions and to increase their duration in women; thus, they are commonly used by midwives in clinical settings in Japan. However, the physical and mental effects of foot baths during labor are unknown. This study aims to assess the physical and mental effects of foot baths based on biomarker levels and self-administered questionnaires. A single-arm pre-post test trial design is being used in this study, and the study is being conducted at a general hospital in Tochigi Prefecture, Japan. The target study population is women in the first stage of labor, the phase when the uterus starts to contract and when the cervix dilates to 10 cm, or those undergoing labor induction. Participants who meet the eligibility criteria are recruited, and written informed consent is obtained from them. They are asked to answer the questionnaire and to collect 1.5 mL of saliva in 2 microtubes each, before and after the intervention. The intervention is foot baths for 15-20 minutes using a foot bath device. Data on delivery, such as gestational age, gravidity, parity, diagnosis following the last vaginal examination, and presence or absence of membrane rupture, are retrieved from the medical records. The primary outcomes are salivary cortisol levels before and after the foot baths. The secondary outcomes are levels of relaxation and comfort, labor pain, body warmth, vital signs, and interval of labor pain before and after the foot baths, which are assessed using a numerical rating scale. A paired t test or Wilcoxon signed-rank test will be performed to compare the data for salivary cortisol levels and numerical rating scale scores. Data collection started on April 1, 2022. As of October 2022, we had enrolled 10 participants. Because of the COVID-19 pandemic in Japan, it is difficult for medical personnel to freely interact with women in labor until the results of the COVID-19 polymerase chain reaction test are available in the research facility, complicating the recruitment process. This is the first prospective study to assess the effects of foot baths using a biomarker during the first stage of labor. The findings on the effects of foot baths on women in labor will provide novel insights that may improve the outcomes of delivery. A randomized controlled trial to investigate the effects of foot baths to obtain robust evidence should be conducted in the future. University Hospital Medical Information Network-Clinical Trial Registry UMIN000046539; https://tinyurl.com/2wwj7dns. DERR1-10.2196/39985.

Maternal position during the second stage of labor and maternal-neonatal outcomes in nulliparous women: a retrospective cohort study

The existing evidence is insufficient to draw conclusions about the association between maternal position in labor and obstetrical outcomes. This study aimed to evaluate the effects of different maternal positions during the second stage of labor among women with and those without epidural analgesia on important obstetrical outcomes including perineal damage. In this retrospective cohort study, we collected data of women who delivered vaginally over a 2-year period. The associations between maternal and gestational characteristics and several obstetrical outcomes were analyzed. We considered perineal damage as the primary outcome. Secondary outcomes were the incidence of operative vaginal births, duration of fetal descent, intrapartum blood loss, and 1-minute and 5-minutes Apgar scores. A total of 2240 nulliparous, at-term pregnancies were included. Of those, 76.9% gave birth in a supine position and 23.1% gave birth in alternative positions. The results showed that regardless of the use of epidural analgesia, nonsupine positions in the second stage of labor are associated with a significant reduction in the risk of both episiotomy and perineal damage to any degree (P<.0001) and to a reduction in the duration of fetal descent (Spearman rho, 9.17; confidence interval, 3.07-15.32; P=.003). No statistically significant differences were found in the 1-minute and 5-minutes Apgar score between the 2 groups. Our results show that nonsupine positions in the second stage of labor and at the time of birth are associated with a significant increase in having an intact perineum and a reduction in any perineal trauma and in the need for an episiotomy regardless of the use of epidural analgesia.

Risk Factors for Uterine Atony in Postpartum Hemorrhage Patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Background: Uterine atony can be life-threatening for a pregnant woman in labor and bleeding after delivery. It is important to explore the risk factors that can cause uterine atony in order to detect it early and take preventive measures. This study aimed to explore the risk factors for causing uterine atony in postpartum hemorrhage patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.&#x0D; Methods: This study was an analytic observational study with a case-control approach. A total of 52 subjects (13 case group subjects and 39 control group subjects) participated in this study. Risk factor analysis was carried out with the help of SPSS version 25 in univariate and bivariate.&#x0D; Results: Maternal age at delivery is associated with the risk of uterine atony in postpartum hemorrhage patients. Mothers aged less than 20 years or more than 35 years are at risk of experiencing uterine atony by 5.8 times more at risk than mothers aged 20-35 years. The risk factors for parity, prolonged labor, macrosomia, gemelli, hydramnios, induction of labor, history of postpartum hemorrhage, and type of delivery were not associated with uterine atony in postpartum hemorrhage patients, p&gt;0.05.&#x0D; Conclusion: The age of delivery of mothers who are less than 20 years or more than 35 years is a risk factor for uterine atony in postpartum hemorrhage patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.

Uterine activity modifies the response of the fetal autonomic nervous system at preterm active labor.

The autonomic nervous system of preterm fetuses has a different level of maturity than term fetuses. Thus, their autonomic response to transient hypoxemia caused by uterine contractions in labor may differ. This study aims to compare the behavior of the fetal autonomic response to uterine contractions between preterm and term active labor using a novel time-frequency analysis of fetal heart rate variability (FHRV). We performed a case-control study using fetal R-R and uterine activity time series obtained by abdominal electrical recordings from 18 women in active preterm labor (32-36 weeks of gestation) and 19 in active term labor (39-40 weeks of gestation). We analyzed 20 minutes of the fetal R-R time series by applying a Continuous Wavelet Transform (CWT) to obtain frequency (HF, 0.2-1Hz; LF, 0.05-0.2Hz) and time-frequency (Flux0, Flux90, and Flux45) domain features. Time domain FHRV features (SDNN, RMSSD, meanNN) were also calculated. In addition, ultra-short FHRV analysis was performed by segmenting the fetal R-R time series according to episodes of the uterine contraction and quiescent periods. No significant differences between preterm and term labor were found for FHRV features when calculated over 20 minutes. However, we found significant differences when segmenting between uterine contraction and quiescent periods. In the preterm group, the LF, Flux0, and Flux45 were higher during the average contraction episode compared with the average quiescent period (p<0.01), while in term fetuses, vagally mediated FHRV features (HF and RMSSD) were higher during the average contraction episode (p<0.05). The meanNN was lower during the strongest contraction in preterm fetuses compared to their consecutive quiescent period (p=0.008). The average autonomic response to contractions in preterm fetuses shows sympathetic predominance, while term fetuses respond through parasympathetic activity. Comparison between groups during the strongest contraction showed a diminished fetal autonomic response in the preterm group. Thus, separating contraction and quiescent periods during labor allows for identifying differences in the autonomic nervous system cardiac regulation between preterm and term fetuses.

Fetal scalp stimulation for assessing fetal well-being during labour.

Continuous fetal heart rate monitoring by cardiotocography (CTG) is used in labour for women with complicated pregnancies. Fetal heart rate abnormalities are common and may result in the decision to expedite delivery by caesarean section. Fetal scalp stimulation (FSS) is a second-line test of fetal well-being that may provide reassurance that the labour can continue. To evaluate methods of FSS as second-line tests of intrapartum fetal well-being in cases of non-reassuring CTG. FSS and CTG were compared to CTG alone, and to CTG with fetal blood sampling (FBS). We searched Cochrane Pregnancy and Childbirth's Trials Register (which includes trials from CENTRAL, MEDLINE, Embase, CINAHL, the WHO ICTRP and conference proceedings), ClinicalTrials.gov (18 October 2022), and reference lists of retrieved studies. Eligible studies were randomised controlled trials (RCTs) that compared any form of FSS to assess fetal well-being in labour. Quasi-RCTs, cluster-RCTs and studies published in abstract form were also eligible for inclusion, but none were identified. Two review authors independently assessed studies for inclusion and risk of bias, extracted data and checked them for accuracy. We assessed the certainty of the evidence using the GRADE approach. Two trials, involving 377 women, met the inclusion criteria for this review. Both trials were conducted in hospital settings and included women with singleton, term (37+0 weeks or more) pregnancies, a cephalic presentation, and abnormal CTG. Follow-up was until hospital discharge after the birth. A pilot trial of 50 women in a high-income country (Ireland) compared CTG and digital fetal scalp stimulation (dFSS) with CTG and fetal blood sampling (FBS). A single-centre trial of 327 women in a lower middle-income country (India) compared CTG and manual fetal stimulation (abdominal or vaginal scalp stimulation) with CTG alone. The two included studies were at moderate or unclear risk of bias. Both trials provided clear information on allocation concealment but it was not possible to blind participants or health professionals in relation to the intervention. Although objective outcome measures were reported, outcome assessment was not blinded or blinding was unclear. dFSS and CTG versus FBS and CTG There were no perinatal deaths and data were not reported for neurodevelopmental disability at >/= 12 months. The risk of caesarean section (CS) may be lower with dFSS compared to FBS (risk ratio (RR) 0.38, 95% confidence interval (CI) 0.16 to 0.92; 1 pilot trial, 50 women; very low-certainty evidence) but the evidence is very uncertain. There were no cases of neonatal encephalopathy reported. The evidence was also very uncertain between dFSS and FBS for assisted vaginal birth (RR 1.44, 95% CI 0.76 to 2.75; very low-certainty evidence) and for the spontaneous vaginal birth rate (RR 2.33, 95% CI 0.68 to 8.01, very low-certainty evidence). Maternal acceptability of the procedures was not reported. FSS and CTG versus CTG alone Manual stimulation of the fetus was performed either abdominally (92/164) or vaginally (72/164). There were no perinatal deaths and data were not reported for neurodevelopmental disability at >/= 12 months. There may be little differences in the risk of CS on comparing manual fetal stimulation and CTG with CTG alone (RR 0.83, 95% CI 0.59 to 1.18; 1 trial, 327 women; very low-certainty evidence), but again the evidence was very uncertain. There were no cases of neonatal encephalopathy reported. There may be no differences in the risk of assisted vaginal birth (RR 1.43, 95% CI 0.78 to 2.60; very low-certainty evidence) or in the rates of spontaneous vaginal birth (RR 1.01, 95% CI 0.85 to 1.21, very low-certainty evidence), but again the evidence is very uncertain. Maternal acceptability of abdominal stimulation/FSS was not reported although 13 women withdrew consent after randomisation due to concerns about fetal well-being. There is very low-certainty evidence available which makes it unclear whether stimulating the fetal scalp is a safe and effective way to confirm fetal well-being in labour. Evidence was downgraded based on limitations in study design and imprecision. Further high-quality studies of adequate sample size are required to evaluate this research question. In order to be generalisable, these trials should be conducted in different settings, including broad clinical criteria at both preterm and term gestational ages, and standardising the method of stimulation. There is an ongoing study (FIRSST) that will be incorporated into this review in a subsequent update.

The gestational membrane microbiome in the presence or absence of intraamniotic infection

Data regarding the microbiome of the gestational membranes are emerging and conflicting. Shifts in the microbial communities in the setting of labor, rupture of membranes, and intraamniotic infection are yet to be understood. This study aimed to characterize the microbiome of the gestational membranes of women in labor or with ruptured membranes, including those with and without intraamniotic infection. Women with a singleton pregnancy at ≥28 weeks' gestation undergoing unscheduled cesarean delivery in the setting of labor or rupture of membranes were included. Demographic and clinical variables were collected. We defined suspected intraamniotic infection by standard clinical criteria; placentae and gestational membranes were also reviewed for histologic evidence of infection. Sterile swabs were collected from membranes at the time of delivery. Bacteria were cultured from the swabs, and the isolates were sequenced. DNA extraction and 16S sequencing of the swabs were also performed. Bacterial taxonomy was assigned to each sequence. Alpha diversity indices and beta-diversity metrics were calculated to test for differences in microbial community diversity and composition between uninfected and infected groups. Differential abundance of bacteria between infected and uninfected groups was tested at the class, family, and genus level. Samples were collected from 34 participants. Clinical intraamniotic infection was diagnosed in 38% of participants, although 50% of placentae and membranes demonstrated histologic signs of infection. Of all samples, 68% grew bacteria on culture; this included 62% of the uninfected samples and 77% of the infected samples (P=.83). Multiple measures of alpha diversity were not significantly different between uninfected and infected groups. Similarly, analysis of beta diversity revealed that the microbial community was not significantly different between the uninfected and infected group. Several bacteria traditionally characterized as pathogenic, including Actinomyces and Streptococcus agalactiae, were identified in both infected and uninfected samples. The pathogenesis and clinical implications of intraamniotic infection remain poorly understood. Diverse bacteria are present in both infected and uninfected gestational membranes. A unique microbiologic signature may exist among the gestational membranes following labor or rupture of membranes, and further characterization of the pathogens specifically implicated in intraamniotic infection may allow for targeted therapy.

Ritodrine-induced rhabdomyolysis and psychiatric symptoms: a case report and literature review

BackgroundRitodrine hydrochloride, a β2-adrenergic agonist, has been widely used in Asia and Europe to treat preterm labor in pregnant women. It has some typical side effects, such as palpitations, pulmonary edema, and hypokalemia. Here, we report a case of rhabdomyolysis and psychiatric symptoms might be associated with intravenous ritodrine.Case presentationA 32-year-old Chinese primigravida woman who was pregnant with twins by in vitro fertilization-embryo transfer was diagnosed with placenta previa and threatened abortion at 21 gestational weeks (GW). The patient was then treated with ritodrine hydrochloride. The initial dose of ritodrine was 150 μg/min, gradually increasing to 360 μg/min at 235/7 GW and 400 μg/min at 271/7 GW. Magnesium sulfate was added to the ritodrine regimen at 215/7 GW in dosage of 1-2 g/h. Psychiatric symptoms appeared at 245/7, 265/7, and 273/7 GW, manifesting as depression, anxiety, and suicidal tendencies. Severe muscle pain in her limbs and general weakness appeared after six weeks of ritodrine administration, which might have been a sign of rhabdomyolysis resulting from ritodrine administration. After ceasing the administration of ritodrine, the muscle pain and relevant data from laboratory tests on the patient were significantly improved, and her mood was stable. It is worth noting that this is the first time to report psychiatric symptoms may associated with the administration of ritodrine. In addition, we reviewed and analyzed six reported cases of rhabdomyolysis caused by ritodrine.ConclusionOur results suggest that we should pay more attention to the risk of rhabdomyolysis and psychiatric symptoms induced by intravenous ritodrine hydrochloride, especially in patients with a history of neuromuscular disorder, or concomitant use of magnesium sulfate.

Learning Obstetrical Cervical Exam Skills : Development of a Novel Model to Demystify Blind Procedures.

Obstetric care is a core element in family medicine education. New interns typically learn the sterile cervical exam on the job by examining women in labor. This can be uncomfortable for patients and may increase the risk of infection. Simulated training could minimize these challenges, but manufactured models are expensive and not widely available in residency programs. We soughtto evaluate a simple, homemade sewn model using stretchy fabric and pipe cleaners that could improve teaching and acquisition of cervical examination skills and common obstetrical procedures. We used the model to teach cervical examination skills to students and new interns and assessed participant satisfaction. We evaluated examination accuracy by grading practice exams on the model before and after a workshop teaching obstetrical procedures including the sterile vaginal exam. We calculated satisfaction using summary statistics. We evaluated pre- and postscores for exam accuracy using pairedttests. Interns demonstrated a significant improvement in cervical exam skills using the model, and participants reported very high satisfaction with the workshop utilizing the model. We developed a simple, low-cost cervical exam model that was shown to be well-regarded by trainees and could be duplicated by other residency programs. This approach provides a unique and accessible way to offer hands-on simulation during obstetrical training. The model may improve trainees' understanding of the procedures which would lead to better experiences for obstetrical patients.

Effect of Date Fruit Consumption in Later Pregnancy on Length of Gestation, Labour and Delivery of Nulliparous Women

Objective: To assess the effect of date fruit consumption in late pregnancy on the onset and progress of labour, the need for induction and augmentation, and delivery outcomes.&#x0D; Study Design: Randomized controlled trial (NCT05105893).&#x0D; Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Jun 2021.&#x0D; Methodology: One hundred and forty women were randomized into equal-strength Experimental and Control Groups (70 in each Group). The Experimental-Group included those pregnant females who were advised to consume seven dates per day from 35 weeks onwards till the spontaneous onset of labour. In contrast, the Control-Group comprised primigravidae who did not consume dates in later pregnancy.&#x0D; Results: Spontaneous onset of labour was reported in 59(84.2%) pregnant women of the Experimental-Group compared to 43(61.4%) of Control-Group. 55(78.5%) pregnant women who consumed date fruit had a spontaneous vaginal delivery,4(5.7%) required instrumental delivery, and 11(15%) ended up having a caesarean section, whereas 43 out of 70(61.4%) women of the Control-Group had a spontaneous vaginal delivery, 6(8.5%) had an instrumental vaginal delivery, and 21(30%) underwent a cesarean section.&#x0D; Conclusion: The patients who had consumed date fruit in later pregnancy had an improved Bishop score at the onset of labour, a shorter duration of labour, a lesser need for induction and augmentation of labour and more spontaneous vaginal deliveries.

Hardly working: eliding remunerative labour in recent Irish women’s fiction

ABSTRACT This article examines Sara Baume’s Seven Steeples (2020), Naoise Dolan’s Exciting Times, and Caoilinn Hughes’ Orchid and the Wasp (2018) and The Wild Laughter (2020) as reactions against the capitalist expectation that human worth can be measured by an individual’s contribution towards remunerative labour. These texts are all recent novels by young Irish women writers in which the protagonists seek a form of work which elides participation in the neoliberal economic system – either as profit-making or salaried workers, or in the traditionally female role of providing domestic labour to a profit-making or salaried male partner. The article explores the fraught relationship between these novels’ protagonists and a globalised labour market which is simultaneously scarred by, and in continued denial about, the existential shock it faced in the 2008–9 financial crash, with a particular focus on the Republic of Ireland’s role as a key site of late capitalist deregulation, where the effects of the crash were particularly severely felt.