Length Of Labor Research Articles

Impact of labor length and mode of delivery on adverse maternal outcomes among preeclamptic obese patients

Cysts and cavities are common radiologic abnormalities. Pulmonary metastasis comprises a rare entity of thoracic cystic diseases. We reported a case of giant cyst at the left anterior mediastinum that was pathologically confirmed as a lung metastasis from previously resected gastric cancer. The cyst was completely removed with wedge resection of the surrounding lung through a left anterior thoracotomy. One should always keep in mind the possibility of an intrathoracic cyst near or at the mediastinal region that may originate from metastatic lesions to the lungs when patients have previous cancer history.

Peanut ball for decreasing length of labor: A systematic review and meta-analysis of randomized controlled trials

IntroductionProlonged length of labor is associated with increased maternal and neonatal complications. Therefore, great attention has been given to interventions aimed at reducing the length of labor. One such intervention is the peanut ball, a large elongated exercise ball placed between a woman’s legs during labor. ObjectiveThe aim of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to assess the effect of the use of peanut ball in reducing length of labor. Study DesignData sources: MEDLINE, EMBASE, Web of Sciences, Scopus, ClinicalTrial.gov, OVID and Cochrane Library were searched from inception until January 2019. Selection criteria: Selection criteria included RCTs of laboring women with singleton gestations in cephalic presentation at term (≥37weeks) who were randomized to either use of peanut ball or control group (no peanut ball). Data Collection and Analysis: Four trials with 648 nulliparous and multiparous women in spontaneous or induced labor were identified and included. 330 women were randomized to the intervention (peanut ball between the knees during labor) and 318 women to the control. Summary measures were reported as mean difference (MD) with 95% of confidence interval (CI) using the random effects model of DerSimonian and Laird. The primary outcome was total length of labor. PROSPERO Registration Number: CRD42018082438 ResultsTotal length of labor was 79min shorter in the peanut ball group, but this was not significant (MD −79.1 min, 95% CI −204.9, 46.7). Peanut ball use showed trends toward higher incidence of spontaneous vaginal deliveries (RR 1.1, 95% CI 1.0, 1.2) and lower incidence of cesarean deliveries (RR 0.8, 95% CI 0.6, 1.0). ConclusionsPeanut ball use was not associated with a significant decrease in total length of labor. Since there were trends toward reductions in length of labor, an increased incidence in spontaneous vaginal deliveries, and lower incidence of cesarean deliveries, more research is needed.

Effect of Dates Consumption On Bleeding, Duration, And Types of Labor

Dates are a good source of nutrition for the body if consumed regularly both in the form of dried fruit, wet, as well as in the form of palm juice extracts, especially for pregnant and maternal mothers. Pregnant women who are going to give birth are in desperate need of drinks and foods that are rich in sugar, this is because of the many contractions of the uterine muscles when it comes to removing the baby, especially if it takes a long time. Dates contain potuchin hormone which functions to bind the uterus and muscles of the uterus so that it can help reduce postpartum bleeding. Besides, there is the hormone oxytocin which can help stimulate contractions in the muscles of the uterus so as to facilitate labor. The purpose of this study was to determine the effect of consumption of dates on bleeding, length of labor and type of labor. This type of research is a Pre experiment with a post-test Only Control Group Design research design. The population in this study were all pregnant women in the working area of South Klaten Public Health Center with estimated deliveries from July to September 2018. While the sample size was 60 samples consisting of 30 treatment group respondents and 30 control group respondents. The sampling technique used in this study was Quota sampling. Data analysis using Fisher Exact test and Mann-Whitney U test with p-value considered significant is p = 0.05. The results of the study of bleeding showed that there were no significant differences in the estimation of blood loss and during labor and type of delivery between the treatment group and the control group (p-value = 0.5). The results of the study about the length of labor showed that there was an effect of date consumption on the length of labor, with a value of p = 0,000

Manejo no farmacológico del dolor en la atención del parto: experiencia desde las prácticas formativas

Introducción: Describir las percepciones del estudiante de enfermería de una universidad privada, sobre la experiencia en la aplicación de las medidas no farmacológicas para el manejo del dolor en la atención del parto en el componente teórico y práctico. Materiales y Métodos: Investigación cualitativa, con técnica de grupo focal, se utilizó entrevista semiestructurada y se organizaron dos grupos focales en el que participación 16 estudiantes de los cursos de V a VIII semestre matriculados durante el primer periodo del 2018. Resultados: De los participantes, el 62.5% fueron mujeres y el 37.5% fueron hombres, la edad promedio fue 24.4 años (6.6%). Del análisis de las narrativas del grupo focal emergieron 2 categorías y 10 subcategorías definitivas: dentro de las categorías se destaca que los participantes identifican medidas no farmacológicas que se presentan en el componente teórico, pero no todas se logran realizar en los escenarios de práctica formativa, también surge inquietudes respecto a los mínimos insumos requeridos para conformar un kit para la realización de las medidas no farmacológicas para el manejo del dolor. Discusión: A partir de los artículos investigados y el análisis realizado varios autores definen diferentes medidas no farmacológicas que son aplicables a la materna siendo estas efectivas y las cuales los estudiantes de enfermería aplican en su mayoría teniendo como resultado aspectos positivos y a mejorar. Conclusiones: En general todos los participantes reconocen la importancia del uso de las medidas no farmacológicas para el manejo del dolor en la gestante durante la atención del parto, e identifican que estas medidas disminuyen la intensidad del dolor, ayudan disminuir el tiempo del trabajo de parto, y facilita la comunicación entre el personal de enfermería y la gestante.
 Como citar este artículo: Jaimes ML, Pereira D, Pedraza AJ, Carvajal KX, Mejía FJ, Aparicio LA, et al. Manejo no farmacológico del dolor en la atención del parto: experiencia desde las prácticas formativas. Rev Cuid. 2019; 10(3): e667. http://dx.doi.org/10.15649/cuidarte.v10i3.667

Epidural use in labour is not associated with an increased risk of maternal or neonatal morbidity when the second stage is prolonged.

Epidural analgesia increases length of labour and risk of operative delivery (caesarean or instrumental). This study aimed to assess the impact of epidural anaesthesia on maternal and neonatal adverse outcomes when the second stage of labour was prolonged. A retrospective cohort study of women delivering at term at the Mater Mother's Hospital, Brisbane between 2008 and 2017. Intrapartum, maternal and neonatal outcomes were assessed and dichotomised according to the presence of prolonged second stage of labour and further by epidural use. Prolonged second stage of labour was defined as: nulliparous women ≥3h (with epidural) and ≥2h (without); multiparous women ≥2h (with epidural) and ≥1h (without). There were 48352 women who met the inclusion criteria - 43676 without and 4676 with prolonged second stage of labour. The overall epidural rate was 35.9%. Women with epidural had significantly lower odds of achieving a spontaneous vaginal birth and higher odds of an operative birth regardless of length of second stage. While rates of several adverse maternal and neonatal outcomes were higher when the second stage was prolonged, after adjusting for clinically relevant confounders, epidural use was not associated with increased odds of the majority of these adverse outcomes. Indeed, epidural use was associated with a significant reduction in the odds of obstetric anal sphincter injuries and reduced odds of neonatal acidosis in women with prolonged second stage. While epidural increases the risk of operative birth, this is not associated with an increase in adverse maternal or neonatal outcomes.

Second-stage labor: consensus versus science

There has been a recent significant evolution in suggested practices for the management of labor because of the increased national cesarean delivery rate. One of the most significant changes was promulgated by the 2014 Obstetric Care Consensus entitled, "Safe Prevention of Primary Cesarean Delivery," which recommended reconsideration of the upper limits of the length of labor in the second stage as well as the first stage. We previously published a 2016 Clinical Opinion challenging the second-stage practice change. Over the past 2 years, there have been at least 5 reports as well as 2 national organization statements supporting revised management of second-stage labor. We now revisit the second-stage issue because we believe that it is important to carefully clarify the current status resulting from consensus statements as well as the evolving current status of scientific evidence. We structured this Clinical Opinion using questions in an effort to chronicle the story of how obstetric precepts on second-stage labor in use for more than 50 years were being replaced. How did we get here? What is the current evidence? What can be learned from this experience? Should American obstetrics now "fall back" to pre-existing obstetric precepts for the management of second-stage labor after having "sprung forward" an additional hour-namely, lengthening the duration of acceptable second-stage labor to 4 hours as recommended by the Obstetric Care Consensus? We believe that the data published since our 2016 Clinical Opinion buttress our original position that prolongation of the second stage beyond historical precepts is unsafe.

The utility of maternal serum endocan level to predict preterm delivery within seven days in patients with threatened preterm labor

Objective The aim of the current study was to determine serum endocan levels in patients with threatened preterm labor and to assign whether endocan levels in patients with true preterm labor who give birth within 7 days differ from those of false preterm labor and uncomplicated pregnancy. Materials and methods This cross-sectional study was conducted on 58 patients diagnosed with threatened preterm labor and 31 healthy pregnant women matched for gestational age. Patients with threatened preterm labor were divided into two groups; preterm delivery (28) and term delivery (30) groups. Maternal serum endocan levels were measured with the use of an enzyme-linked immunosorbent assay kit. Results The median serum endocan level (pg/mL) in patients with threatened preterm labor was significantly higher than that of women with uncomplicated pregnancies (725, IQR 619–823 versus 310, IQR 218–423; p < .001 Figure 1). Subgroup analysis performed among threatened preterm labor group revealed that median serum endocan level (pg/mL) in preterm delivery group was higher compared with the other two groups (preterm 823, IQR 718–905 versus term 637, IQR 590–729 p < .001 and preterm 823, IQR 718–905 versus control 310, IQR 218–423 p < .001). The threshold value of maternal serum endocan level for predicting delivery within 7 days after admission was calculated 655 pg/mL, (the area under curve was 0.934, 95% CI 0.88–0.98, p < .001) with 85.7% sensitivity and 78.7% specificity. The mean cervical length measurement was significantly higher in the control group (p < .001); there was no significant difference in cervical length between the term and preterm delivery groups. Maternal characteristics including age, BMI, gravidity, gestational age at blood sampling, CRP and Hb levels were not significantly different between groups (p > .05). Conclusions The maternal serum endocan level may be a useful marker to define high risk group for preterm delivery in patients with threatened preterm labor and similar cervical length measures.

Fetal adrenal gland size and the ability to predict spontaneous term labor

ObjectiveThe objective of this study was to evaluate whether ultrasound measured fetal adrenal gland size can be a predictor of spontaneous term labor. Study designThis study was a diagnostic test accuracy study using a prospective cohort design evaluating the ability of 2-dimensional ultrasound measurement of fetal adrenal gland total length, total width, fetal zone length and fetal zone width in women in the third trimester to predict the primary outcome of spontaneous term labor. Secondary outcomes were vaginal delivery, length of labor, and maternal and neonatal morbidities. ResultsOf 43 patients recruited, 3 were excluded. 11 (25.6%) presented in spontaneous labor and 29 (67.4%) underwent induction of labor. Patient demographics were similar for all included except for admission cervical exam and oxytocin use. A receiver operative curve was created to assess test predictability. Weighted width of fetal adrenal gland was the best predictor of spontaneous labor amongst variables measured with an area under the curve of 0.674, p = 0.93. w/W ≥ 0.41 had a sensitivity of 91.0%, specificity of 44.8%, positive predictive value of 38.5% and a negative predictive value of 92.3%. Maternal and neonatal morbidities were not different between the spontaneous labor group and the induction of labor group. ConclusionUltrasound measured fetal w/W was moderately predictive of spontaneous labor.

A Mathematical Model Relating Pitocin Use during Labor with Offspring Autism Development in terms of Oxytocin Receptor Desensitization in the Fetal Brain.

This paper develops a mathematical model describing the potential buildup of high oxytocin concentrations in the maternal circulation during labor in terms of continuous Pitocin infusion rate, half-life, and maternal weight. Oxytocin override of the degradation of oxytocin by placental oxytocinase is introduced to model the potential transfer of oxytocin from the maternal circulation across the placenta into the fetal circulation and from there into the brain of the fetus. The desensitization unit D equal to 1.8E6 (pg·min)/ml is employed to establish a desensitization threshold and by extension, a downregulation threshold as a function of oxytocin override concentration and continuous Pitocin infusion time, that could be a factor in the subsequent development of autism among offspring. Epidemiological studies by Duke University [1], Yale University [2], and Harvard University [3] are discussed regarding Pitocin use and offspring autism development for an explanation of the weak correlations they identified. The findings of the Harvard epidemiological study are reinterpreted regarding Pitocin use and its conclusion questioned. Further evaluations of the findings of these three epidemiological studies are called for to incorporate medical information on quantity of Pitocin used, continuous Pitocin infusion rate, length of labor, and maternal weight to determine if a correlation can be established with offspring autism development above an empirically determined desensitization threshold for Pitocin use. Suggestions for research are discussed, including an alternative to continuous Pitocin infusion, pulsatile infusion of Pitocin during labor induction, which may mitigate possible offspring autism development.

The Effect of Perineal Massage on Perineal Status and Duration of Labor

&lt;pre&gt;Perineal rupture in postpartum mothers causes bleeding, pain, and high dependency on others after the birth. The preliminary study results showed that 68.81% of postpartum mothers experienced perineal rupture. The aim of this study was to determine the effect of perineal massage on perineal status and length of labor. It was quasi-experimental research with control group post-test only design. The population were all expectant mothers in the Yogyakarta Community Health Center. A sample of 60 respondents were divided into control and intervention groups using a random sampling method. The inclusion criteria were 20-35 years old, singleton pregnancy, spontaneous labor, and gestational age of 34-36 weeks. The study instrument used was an observation sheet. Data were analyzed using descriptive, t-test independent, Mann-Whitney’s, and linear regression test. Results. The results showed that perineal massage affects perineal status (p &amp;lt; 0.001) and the duration of stage I and stage II of labor (p &amp;lt; 0.001). Perineal massage affects perineal status and the duration of labor in the Yogyakarta City Community Health Center.&lt;/pre&gt;

The Impact of Birth Ball Exercises on Mode of Delivery and Length of Labor: A Systematic Review and Meta-Analysis

Background & aim: Recently, the use of birth ball in childbirth has been widely considered. This review study aimed to critically evaluate the evidence regarding the effect of using the birth ball on the mode of delivery and length of labor. Methods: For the purpose of the study, the articles related to the subject of interest and published up to August 5th, 2018 were searched in several scientific databases, including Cochrane library, CENTRAL, and PubMed. This review included all randomized control trials evaluating the use of birth ball for giving birth. Two study outcomes were considered in the present study, namely the type of delivery and length of labor stages. Finally, five studies were entered into the systematic review and meta-analysis. The risk of bias was calculated by means of the Cochrane’s tool. Results: The included studies had a different range of quality, mostly lower than the standard level. The results of the reviewed articles revealed that the group who used birth ball had shorter active labor phase, as compared to the control group (P=0.048). However, the use of birth had no statistically significant effect on the length of the second stage of labor (P=0.128). In addition, using birth ball did not increase the chance of vaginal delivery (P=0.922). Conclusion: Given the findings of the present study, it is essential to perform further high-quality studies with more scientific design to provide clinical evidence on the use of birth ball as a maternity service.

The effect of labor epidural analgesia on labor, delivery, and neonatal outcomes: a propensity score-matched analysis in a single Japanese institute

PurposeLumbar epidural analgesia (LEA) is the most widely used method in reducing labor pain. Previous RCTs have shown that LEA does not increase cesarean section rates; however, the results are inconsistent and may vary depending on the different backgrounds. Therefore, we aimed to study whether LEA would affect the course of labor in our institute.MethodsDelivery records from October 2013 to April 2016 were collected. Deliveries at gestational age < 36 weeks and multiple pregnancies were excluded. All cases were divided into the non-epidural labor (NEL) group or the epidural labor (EL) group. We performed a propensity score matching analysis to balance intergroup differences. Our primary outcome was a mode of delivery (spontaneous, assisted vaginal, cesarean). Secondary outcomes were lengths of labor and outcomes of the neonates.ResultsDuring the study period, 2632 cases met the inclusion criteria. All analyses were performed after propensity score matching (218 pairs). The percentage of assisted vaginal delivery increased by the use of LEA (11.5% in NEL group vs 25.7% in EL group; p < 0.001), but the rate of cesarean section was similar (12.8% vs 17.0%; p = 0.23). The durations of the first and second stages of labor were prolonged by the use of LEA in both primipara and multipara women. Outcomes of the neonates were similar in both groups.ConclusionUse of LEA did not increase the rate of cesarean section when analyzed by propensity score-matched analysis in our institute.

Effect of Peanut Ball and Position Changes in Women Laboring With an Epidural

ObjectiveTo examine the effect of a nurse-driven intervention using a peanut ball (PB) with position changes on length of labor and incidence of cesarean birth among women who receive epidural anesthesia. DesignQuasiexperimental comparison group design. Setting/Local ProblemA 407-bed, nonprofit, Magnet-designated, Baby-Friendly Hospital Initiative–designated hospital with 8 labor and delivery suites and an average of 100 births per month. ParticipantsA total of 343 participants were included, with 164 women in the PB group. Intervention/MeasurementsThe PB was placed after epidural administration; women were repositioned a minimum of every 1 to 2 hours, and the PB was removed at second stage of labor; duration was recorded. ResultsOverall, women in the PB group were 50% less likely to have cesarean birth. For women with cervical dilation of 4 cm or less, rates of vaginal birth were 61% with use of the peanut ball. A multivariate analysis of outcomes was used. A multiple linear regression model showed, after adjusting for other variables, that PB placement alone did not shorten labor length (p = .4684). However, a stratified analysis indicated that for women with cervical dilation of 4 cm or less, length of the first stage of labor was affected by parity (p = .0042) and frequency of position change (p < .001). For women with cervical dilation greater than 4 cm, length of the first stage of labor was influenced by frequency of position changes (p = .0130) and effacement (p = .0050). Length of the second state of labor was affected by the frequency of position change (p = .0416). ConclusionThe PB may be an effective intervention to reduce the incidence of cesarean birth. Changing position frequently was associated with reduced length of first and second stages of labor.

Does the implementation of a restrictive episiotomy policy for operative deliveries increase the risk of obstetric anal sphincter injury?

Our main objective was to investigate whether the implementation of a restrictive episiotomy policy in operative deliveries changes the incidence of obstetric anal sphincter injury (OASI). This is an observational study over an 11-year period in Poitiers University Maternity, France. We included women with vaginal operative deliveries after 34 gestational weeks for singleton births in cephalic presentation. We collected data on the mother and operative delivery characteristics: indication, instrument, epidural analgesia, labor length, episiotomy, OASI, and birthweight. We investigated the changes in the mediolateral episiotomy (MLE) and OASI rates and the association between MLE and OASI. The primary outcome was the evolution of the OASI and MLE rates. The secondary outcome was the occurrence of OASI during operative delivery with or without MLE. In total, 2357 operative deliveries were assessed, including 847 vacuum-, 1350 forceps- and 160 spatula-assisted deliveries. Of these, 950 were performed with MLE and 1407 without; 37 OASIs (3.9%) occurred in the MLE group, and 137 (9.7%) in the no-MLE group. Between 2005 and 2015, MLE use decreased from 78.5 to 16.2% and OASI occurrence increased from 3.1 to 12.7%. The increase in OASI occurrence was significant for forceps deliveries, but not for vacuum or spatula deliveries. Operative delivery with MLE was associated with a three times lower OASI occurrence than that without MLE (adjusted OR = 0.29, 95% CI [0.20-0.43]). Implementation of a restrictive MLE policy for operative delivery seems to be associated with an increase in OASI incidence with forceps, but not with vacuum.

Definition and Incidence of Severe Surgical Site Infections After Cesarean Delivery [24B

INTRODUCTION: Surgical site infections (SSI) are common complications following cesarean delivery. As part of a performance improvement project, we recognized the need to differentiate infections based on severity and thus sought to characterize the most severe cases of SSI. METHODS: We performed a retrospective review of women ≥18 years or older who delivered by cesarean in 2016 and 2017 at a Women's Hospital. Using a combination of ICD-10 diagnosis codes, the electronic medical record, and infection control surveillance, we identified cases and confirmed all diagnoses by chart review using CDC definitions for SSI. We defined severe SSI as cases requiring additional treatment (change in antibiotics or additional procedure), readmission, CT imaging, ICU admission, or length of stay ≥7 days. We compared maternal demographics and clinical characteristics between severe and non-severe cases using the Student t-test and Fischer exact test as appropriate. RESULTS: Among 3,507 cesarean deliveries, 141 met criteria for SSI. Of these, there were 53 cases of severe SSI. Women with severe SSI were older (31.9 vs. 30.2 years, p=0.01), had lower gestational ages at delivery (35.8 vs. 37.6 weeks, p<0.01), were more likely to have diabetes (26.4% vs. 10.2%, p=0.02) and less likely to have endometritis only (50.9% vs. 81.8%, p<0.01). There was no difference between groups in BMI, prior cesarean, hypertension, GBS status, length of labor or rupture of membranes, or emergent/urgent deliveries. CONCLUSION: In our cohort, severe SSI was associated with older age, diabetes, and earlier deliveries. Further research is needed to identify modifiable risk factors and guide prevention strategies.

Measuring the quality of maternal and care processes at the time of delivery in sub-Saharan Africa: development and validation of a short index

BackgroundThere is a growing recognition that quality of care must improve in facility-based deliveries to achieve further global reductions in maternal and newborn mortality and morbidity. Better measurement of care quality is needed, but the unpredictable length of labor and delivery hinders the feasibility of observation, the gold standard in quality assessment. This study evaluated whether a measure restricted to actions at or immediately following delivery could provide a valid assessment of the quality of the process of intrapartum and immediate postpartum care (QoPIIPC), including essential newborn care.MethodsThe study used a comprehensive QoPIIPC index developed through a modified Delphi process and validated by delivery observation data as a starting point. A subset of items from this index assessed at or immediately following delivery was identified to create a “delivery-only” index. This delivery-only index was evaluated across content and criterion validation domains using delivery observation data from Kenya, Madagascar, and Tanzania, including Zanzibar.ResultsThe delivery-only index included 13 items and performed well on most validation criteria, including correct classification of poorly and well-performed deliveries. Relative to the comprehensive QoPIIPC index, the delivery-only index had reduced content validity, representing fewer dimensions of QoPIIPC. The delivery-only index was also less strongly associated with overall quality performance in observed deliveries than the comprehensive QoPIIPC index.ConclusionsWhere supervision resources are limited, a measure of the quality of labor and delivery care targeting the time of delivery may mitigate challenges in observation-based assessment. The delivery-only index may enable increased use of observation-based quality assessment within maternal and newborn care programs in low-resource settings.

Reassessing the length of labour in healthy Turkish women: a retrospective and descriptive study

This study aims to use the partograph among Turkish women to (a) assess birth curves, (b) define the phase duration of labour, and (c) identify the factors that affect labour. This study was conducted with 496 women and features a retrospective descriptive analysis and a cross-sectional design. The mean duration for the active phase was 5.75 hours (minimum: 0.92 to maximum: 20.00) in nulliparous women and 3.50 hours (minimum: 0.42 to maximum: 20.00) in multiparous women. The length of the active phase was significantly longer for infants with a length greater than 50 cm according to bivariate analyses. Lastly, according to multivariate analyses, the gestational age was the only covariate that was significantly associated with a prolonged labour (OR: 1.29, 95% CI: 1.03–1.62). This study demonstrated that the duration of the active phase for Turkish women lasted longer than Friedman’s study both for nulliparous and multiparous women. Prospective studies are necessary in order to create the birth curves of Turkish women.Impact statementWhat is already known on this subject? Friedman was the first researcher to describe the curve and phases of labour in 1954. However, the demographic data of women has changed over the past 50 years. Furthermore, it has been reported that race may influence the duration of labour. There is only one previous study that examined the duration of labour among Turkish women. This study’s results suggest a shorter duration of labour in comparison to Friedman’s sample.What do the results of this study add? The mean duration for the active phase was 5.75 hours (minimum: 0.92 – maximum: 20.00) in the nulliparous and 3.50 hours (minimum: 0.42 – maximum: 20.00) in multiparous healthy Turkish women. The duration of the active phase in this study was longer than that observed in Friedman’s study, both for nulliparous and multiparous women. Also, the nulliparous length of the second stage of labour was higher in this study than it was observed to be in Friedman’s study. In addition, the length of the active phase was significantly longer for infants with a length greater than 50 cm according to bivariate analyses. Lastly, according to multivariate analyses, gestational age was the only covariate that can be significantly associated with a prolonged labour (OR: 1.29, 95% CI: 1.03–1.62) in nulliparous women. In other words, a higher gestational age tended to prolong the active phase of labour.What are the implications of these findings for clinical practice and/or further research? The results of this study can be used to reduce the number of unnecessary interventions used in labour management. Further research is needed to confirm the current findings in other races. For instance, additional research should examine the correlation between the labour models and the women’s length of labour.

Outcomes associated with trial of labor after cesarean in women with one versus two prior cesarean deliveries after a change in clinical practice guidelines in an academic hospital*

Objective: In 2010, the American College of Obstetricians & Gynecologists (ACOG) published a new clinical practice guideline on trial of labor after cesarean (TOLAC) that was considered less restrictive. It allowed for offering TOLAC to women with two prior cesarean deliveries, even without a prior vaginal delivery, and for labor induction. As a result, our hospital, a public tertiary care academic center, updated our TOLAC practice guideline to reflect ACOG’s new recommendations. We thus aim to evaluate maternal and neonatal outcomes for women undergoing TOLAC with 1 versus 2 prior cesareans, with and without a prior vaginal delivery, following these clinical practice changes at our hospital.Study design: This was a secondary analysis of a 2-year retrospective cohort following implementation of a hospital guideline in women undergoing TOLAC with a live, cephalic, singleton without lethal anomaly ≥24 0/7 weeks and 1 or 2 prior cesarean deliveries. Maternal and neonatal outcomes in women with one prior cesarean were compared to women with two prior cesareans. The primary outcome was composite maternal morbidity (uterine rupture, uterine dehiscence, hysterectomy, transfusion, postpartum venous thromboembolism, delivery/surgical injury, chorioamnionitis or endometritis, shoulder dystocia, death). Secondary outcomes included neonatal morbidity. The analysis was performed in SAS; p < .05 was considered significant.Results: Seven hundred women with one prior cesarean and 73 women with two prior cesareans underwent TOLAC after the 2011 guideline implementation. Post guideline maternal demographics, labor length, comorbid conditions, simplified Bishop score, and induced labor were similar between groups. Composite maternal morbidity was similar between groups (18.3 versus 23.3%, p = .30 for women with 1 versus 2 prior cesarean deliveries, respectively). The same was true when comparing women with 1 versus 2 prior cesareans who had never had a prior vaginal delivery (25.5 versus 33.3%, p = .28 for 1 versus 2 prior cesarean deliveries, respectively). There were no differences in neonatal outcomes. Vaginal birth after cesarean (VBAC) success rates were similar between groups (78.9% in women with 1 prior cesarean versus 74.0% in women with 2 prior cesareans, p=.33), even when only analyzing women without a prior vaginal delivery (69.4% in women with 1 prior cesarean versus 71.4% in women with 2 prior cesareans, p = .78).Conclusion: Adoption of ACOG’s TOLAC practice changes, specifically offering TOLAC to women with two prior cesareans even without a prior vaginal delivery, and offering induction of labor regardless of cervical favorability, may increase VBAC rates without increasing maternal or neonatal morbidity from TOLAC.

Measuring the benefits of free pregnancy yoga classes

Background Antenatal yoga is known to have many benefits, including increased comfort in labour, decreased pain in labour and decreased length of labour. Aims To identify the impact and benefits of free yoga sessions on women's pregnancy experience and birth outcomes. Methods A structured service evaluation was carried out, consisting of a small-scale audit of birth outcomes of primigravid women who had attended six or more yoga sessions, and a survey of women who had attended. Findings Women found the classes to be beneficial, and reported the breathing and relaxation to be invaluable. The social aspect of the classes enabled women to make friends and build support networks. The birth outcomes audit was small scale and did not account for confounding variables such as demographics or mobility in labour. Of the women audited, 83% had a spontaneous vaginal birth, and the average length of labour was 5 hours and 45 minutes. Conclusion Yoga classes have had multiple benefits for women during pregnancy, labour and birth, and beyond.

782: Length of active labor and risk of adverse maternal and neonatal outcomes

In 2012, contemporary labor curves from the Consortium on Safe Labor (CSL) were created utilizing mathematical modeling and entered clinical practice as NICHD guidelines, replacing older Friedman labor curves. However, the association between length of labor and adverse maternal or neonatal outcomes was not evaluated. We sought to assess the relationship between length of active labor in women undergoing vaginal delivery and the risk of adverse maternal or neonatal outcomes as defined by contemporary labor curves. We performed a secondary analysis of the CSL data, including information from electronic medical records from 19 hospitals across the U.S. from 2002 to 2008. Our inclusion criteria were women with a normal, singleton, term, vertex pregnancy experiencing a vaginal delivery, and having documentation of a cervical exam of 5 or 6cm. Duration of active labor was defined as the time from a cervical exam of 6 cm to 10cm. Forward interpolation was performed to estimate time of the 6cm cervical exam for women with only a 5cm exam documented. Composite adverse maternal and neonatal outcomes were created. Time in active labor was categorized into 5 groups (0-2, >2-4, >4-6, >6-8, >9 hours). Comparisons were made among the groups using multivariable logistic regression, controlling for maternal age, race, parity and body mass index. The CSL data includes 228,438 deliveries. Based on our inclusion criteria, 29,087 were included in our analysis. There is a 1.57 fold higher odds of an adverse neonatal outcome with labor lasting >9 hours compared to the 0-2 hours group (p-value <0.001, 95% CI 1.2-1.9). All groups demonstrated significantly increased odds for adverse maternal outcome compared to 0-2 hours. Any active labor length >4 hours has increased odds of either an adverse maternal or neonatal outcome compared to 0-2 hours. Recent NICHD guidelines regarding labor management utilizing contemporary labor curves have not analyzed risk of adverse perinatal outcomes to date. Therefore, our data uniquely demonstrates that a longer duration of contemporary active labor is associated with adverse maternal and neonatal outcomes. While longer duration of active labor is allowed in current NICHD guidelines with the goal to reduce cesarean delivery, our data suggests that further studies are needed to evaluate safe and effective management of active labor to optimize maternal and neonatal health.