Number Of Vaginal Examinations Research Articles

Routine vaginal examination to assess labour progress at 8 compared to 4 h after early amniotomy following Foley balloon ripening in the labor induction of nulliparas: A randomized trial.

Our objective was to compare the performance of the first vaginal examination at 8 versus 4 h after amniotomy following Foley ripening in nulliparous labor induction. A randomized controlled trial was conducted from June 2021 to January 2022. 210 nulliparas at term for labor induction were randomized: 105 each to first vaginal examination at 8 or 4 h after Foley balloon ripening and amniotomy. Titrated oxytocin infusion was routinely commenced after amniotomy to expedite labor. Primary outcomes were the amniotomy-to-delivery interval (non-inferiority hypothesis) and maternal satisfaction with their allocated labor care (superiority hypothesis) within 24 h after delivery. Analyses performed using t-test, Mann-Whitney U test, and Chi-squared test as appropriate. The amniotomy-to-delivery interval was mean ± standard deviation 8.7 ± 3.4 versus 8.4 ± 3.7, mean difference 0.4 (97.5% CI: -0.7 to 1.5) hours, p = 0.442 within the pre-specified 2-hour non-inferiority margin, and maternal satisfaction score with allocated labor care was median [interquartile range] 8[7.5-10] versus 8[7.0-10], p = 0.248 for 8 versus 4 h arms, respectively. The amniotomy to first vaginal examination intervals was 5.9 ± 2.3 versus 3.6 ± 1.0 h, p < 0.001, and the number of vaginal examinations was 2[1-2.5] versus 3 [2, 3], p < 0.001 for 8 versus 4 h, respectively. The first vaginal examination was less likely to have been performed as scheduled, more likely to be indicated by the urge to bear down, and non-reassuring cardiotocography for the 8 h arm (p < 0.001). Spontaneous vaginal delivery was significantly more likely and instrumental vaginal delivery less likely, but cesarean rate was not significantly different for the 8 h arm (p = 0.017). A routine first vaginal examination at 8 h compared to 4 h is non-inferior for the time to birth but does not increase maternal satisfaction although the number of vaginal examinations is fewer. The increase in spontaneous vaginal delivery and reduction in instrumental vaginal delivery rates warrant further powered primary evaluation.

Routine vaginal examination to assess labor progress at 8 compared to 4 hours after early amniotomy following Foley balloon ripening in the labor induction of multiparas: a randomized trial

BackgroundVaginal examination to monitor progress in labor is recommended at least every 4 hours but it can cause pain and embarrassment to women. Trial data is limited on the best intensity for vaginal examination. Vaginal examination is not needed for oxytocin dose titration after amniotomy has been performed and oxytocin infusion started. The Foley balloon commonly ripens the cervix without strong contractions; amniotomy and oxytocin infusion is usually required to drive labor. ObjectiveTo evaluate the first vaginal examination at 8 vs 4 hours after amniotomy-oxytocin following Foley ripening in multiparous labor induction. MethodsA randomized controlled trial was conducted from October 2021 to September 2022 in University Malaya Medical Center. Multiparas at term were recruited at admission for labor induction. Participants were randomized to a first routine vaginal examination at 8 or 4 hours after Foley balloon ripening and amniotomy. Titrated oxytocin infusion was routinely commenced after amniotomy to initiate contractions. The two primary outcomes were the time from amniotomy to delivery (non-inferiority hypothesis) and maternal satisfaction (superiority hypothesis). Data were analyzed with the Student t-test, Mann-Whitney U test, Chi square test (or Fisher exact test) as suitable for the data. Results204 women were randomized, 102 to each arm. Amniotomy to birth interval was mean±standard deviation 4.97±2.47 vs 5.79±3.17, mean difference -0.82, 97.5% CI (-1.72 to 0.08) hours p=0.041 (Bonferroni correction), which was non-inferior within the pre-specified 2 hour upper margin and maternal satisfaction score with allocated labor care was median[interquartile range] 9[8-9] vs 8[7-9] p=0.814 (11-point 0-10 NRS) for 8 vs 4 hours arms respectively. Oxytocin infusion to birth interval difference was also non-inferior within the 97.5% CI (-1.59 to 0.23) margin of 2 hours. Of the maternal outcomes, amniotomy to first vaginal examination intervals were 3.9±1.8 vs 3.4±1.3hours p=0.026 and number of vaginal examinations was 2[2-3] vs 3[2-3.25] p<0.001 for 8 vs 4 hours arms respectively. For the 8 hours arm, first vaginal examination was less likely to be as scheduled and more likely to be indicated by sensation to bear down (p<0.001) and epidural analgesia rate was lower 13/102 (12.7%) vs 28/102 (27.5%) RR 0.46 95% CI 0.26–0.84 p=0.009. Other outcomes of mode of delivery, indications for cesarean and delivery blood loss were not different. Neonatal outcomes were not different. ConclusionRoutine first vaginal examination at 8 hours compared to 4 hours is non-inferior for the time to birth but does not improve maternal satisfaction.

Particular features of labor activity at the presence of inflammation of the uterine layers and placental membranes

Research objectives: to analyze the association between the various abnormalities of the labor activity and inflammatory changes of the placental, fetal membranes, and uterine layers.Materials and methods. A prospective cohort study of 382 patients with singleton pregnancies at 28–42 weeks' gestation who underwent cesarean section for abnormal uterine contractions and other complications was conducted. The patients were divided into 3 observation groups: 168 women with hypotonic labor (HL), 70 women with hypertonic uterine dysfunction (HUD) and 144 women operated on for various indications (control group). The development of the inflammation of the decidua, myometrium, chorioamniotic membranes and umbilical cord in different types of labor activity abnormalities were studied. Statistical analyses included Mann-Whitney U test, Chi-squared test, and logistic regression. Results. In the control group on the eve of the labor the lower uterine segments' polymorphonuclear leukocytes and macrophages infiltration of mild grade were detected in 73.6 and 59.7% cases accordingly.The strength of the association of uterine layers, placental and fetal membranes inflammation with the HUD was: for the deciduitis – adjusted odds ratio (aOR): 2.6, 95% confidence interval (CI): 1.4–4.8; for the myometritis – aOR: 0.7, 95% CI: 0.3–2.4; for the histological chorioamnionitis (hCAM) – aOR: 4.5, 95% CI: 3.4–12.1; for the funisitis – aOR: 2.9, 95% CI: 1.3–10.6. The main clinical risk factors for hCAM, funisitis, and deciduitis in the HUD group, such as prematurity, nulliparity, group B streptococcus colonization, and duration of ruptured fetal membranes before the cesarean section, indicated the antenatal occurrence of inflammatory process. А decrease of the uterine contractility іn the HL group was associated with grade 2+ deciduitis (aOR: 1.4, 95% CI: 0.6–3.6) and grade II+ myometritis (aOR: 3.9, 95% CI: 1.3–14.7), but no association was found with stage II+ hCAM (aOR: 0.8, 95% CI: 0.3–4.9) and stage 2+ funisitis (aOR: 0.3, 95% CI: 0.6–2.7). Decidual and myometrial inflammation was significantly connected with nulliparity and intrapartum factors such as protracted active first stage of labor with oxytocin augmentation, advanced cervical dilation, and number of vaginal examinations. Inflammation of the myometrium was accompanied by the deciduitis in all cases.Conclusions. Mild inflammation of the decidua and myometrium of the lower segment of the uterus at term pregnancy is a physiological phenomenon that contributes to the initiation of labor. Inflammation of the chorioamniotic membranes and decidua against the background of intact myometrium plays a fundamental role in the occurrence of hypertensive uterine dysfunction, particularly in preterm birth. Marked myometrial inflammation that occurs in prolonged labor is an additional factor aggravating the hypotonic uterine activity.

Normal value and changes in CRP values on maternal and fetal umbilical cord blood with the labor and intrapartum interventions

Introduction: C-reactive protein (CRP) is widely used as an inflammatory marker. Since labour is an inflammatory process, CRP values vary during the intrapartum and postpartum period due to multiple factors.Methods: A descriptive-analytical study was carried out at Castle Street Hospital for Women. Mothers who have term singleton pregnancies with uneventful antenatal periods and have undergone vaginal delivery were recruited for the study. Samples were obtained just after admission to the labour ward (S1), 24 hours after the delivery (S2), and the fetal umbilical cord blood (S3). Reference ranges for S2 and S3 were determined using the interquartile range (IQR).Results: Out of 300 mothers recruited for the study, the mean age was 26.73 years (95% Confidence interval 19.5-36.9). There were 266 samples of S1,177 samples of S2, and 173 samples of S3 were collected. The reference range for S2 is 12.70-150.83 mg/dl, and for S3 is 0.1-8.1 mg/dL. The S2 value is significantly associated with duration of labor (r=0.47, p=0.046), number of vaginal examinations (VEs) (p &lt; 0.001), augmentation of labor (AOL) (p=0.001), method of cervical ripening (p=0.014) and intrapartum intervention (p &lt; 0.001). The number of vaginal examinations (p=0.02) and augmentation of labor (p=0.025) are significantly associated with fetal umbilical cord blood (S3).Conclusion: Early postpartum CRP can be risen up to 151 mg/dL after 24 hours of vaginal delivery. It may be associated with prolonged labor, number of VEs performed, AOL, method of cervical ripening, and episiotomy. Fluctuation of normal CRP values during the periods of antenatal, intrapartum, and postpartum needs to be assessed in the Sri Lankan community.

Factors Influencing Prevalence of Surgical Site Infections among Mothers Undergoing Ceaserean Section in Iganga Hospital, Uganda

Caesarean Section as a mode of delivery is the most commonly done surgical procedure in maternity departments all over the world. Surgical site infection complicates about one-third to two-thirds of caesarean sections in low-income countries which is about 9 times higher compared with the high-resource countries. Surgical Site Infection is associated with increased maternal morbidity, prolonged hospital stay and increased medical costs. The development of post-caesarean surgical site infection is hung on a complex interplay of many factors not limited to wound class, immune status, maternal age, hypertensive disorders, ASA classification, number of vaginal examinations, the virulence of the microorganisms, maternal weight, surgical techniques and premature rupture of membrane. The study employed a descriptive cross-sectional and quantitative approach to study the factors influencing the prevalence of surgical site infections among mothers undergoing caesarean section in Iganga Hospital. A sample size of 288 participants were enrolled using a random sampling technique and close-ended questionnaires were employed to obtain the data from participants. Data analysis was done using SPSS version 20 and statistical significance was set at a P-value less than 0.05 at 95% confidence interval. A total of 288 post-caesarean mothers were studied from October – November 2021 in Iganga Hospital. The majority of the participants were married 255(88.8%) and had a secondary level of education 142(49.3%). The mean age of the participants were 25.6 years with 21 as the modal age. The prevalence of surgical site infection among post-caesarean mothers at Iganga Hospital was 20.5% (59 out of 288) and the factors which were statistically influencing the SSI included early rupture of membranes of more than 18 hours (aOR 23.715 95% C.I 5.976-94.117, P 0000) and postoperative haemoglobin (aOR 15.109 95% C.I 3.494-65.333, P 0.000) There’s a high burden of SSI among post-caesarean mothers in Iganga Hospital. Earlyrupture of membranes more than 18 hours and post-operative haemoglobin less than 11g/dl are key contributory factors. Aggressive prophylactic and post-operative antibiotic therapy should be considered in mothers with early rupture of membranes and post-operative anaemia. Keywords: Caesarean Section, Maternal morbidity, Surgical Site Infection, Post-caesarean mothers, Vagina examination. IN

Maternal intrapartum fever during epidural labour analgesia: Incidence and influencing factors.

The management and nursing care of women's temperature during delivery is an important part of clinical obstetrics. We aimed to evaluate maternal intrapartum fever during epidural labour analgesia to provide evidence for the management and care of women in labour. This study was conducted and reported according to the STROBE statement. Women in labour undergoing epidural labour analgesia in our hospital from 1 January 2021 to 31 August 2022 were retrospectively selected. The characteristics of women in labour with and without intrapartum fever were compared. Pearson correlation and logistic regression analysis were used to analyse the influencing factors of postpartum fever. A total of 196 women in labour were included, the incidence of maternal intrapartum fever in women in labour undergoing epidural analgesia was 27.5%. Pearson correlation analyses showed that BMI, oxytocin use, labour duration, number of vaginal examinations, time from rupture of the foetal membranes to the end of labour and duration of epidural analgesia were all correlated with the occurrence of intrapartum fever (all P < 0.05). Logistic regression analyses indicated that body mass index ≥28 kg/m2 (OR = 1.825), oxytocin use (OR = 2.082), labour duration ≥9.2h (OR = 2.613), number of vaginal examinations ≥8 (OR = 2.044-3.115), the time from rupture of the foetal membranes to the end of labour ≥250 min (OR = 2.766) and duration of epidural analgesia ≥300 min (OR = 3.106) were risk factors for intrapartum fever in women in labour undergoing epidural analgesia (all P < 0.05). Maternal intrapartum fever in women in labour undergoing epidural analgesia is common and influenced by many factors. Nurses should take early preventive care measures according to these factors during epidural analgesia in labour.

Risk factors for mediolateral episiotomy at a tertiary hospital: a cross-sectional study.

The main aim of this study was to assess the associated factors for selective mediolateral episiotomy at a tertiary, academic hospital. A retrospective cohort analysis between 2017 and 2019 was performed. The primary outcome was the prevalence of selective mediolateral episiotomy. Independent variables were maternal, intrapartum, and neonatal characteristics. A significance level of 5% was established, and univariate and multivariate analyses with logistic regression models were performed. From 2,761 vaginal deliveries eligible for inclusion during this period, the prevalence of selective mediolateral episiotomy was 18.7%. Univariate analysis has shown that non-white women were protective factors (OR=0.77 [0.63-0.96]; p=0.02) for episiotomy; primiparity (OR=2.61 [2.12-3.21]; p<0.01), number of vaginal examinations between 6-10 repetitions (OR=3.16 [2.48-4.01]; p<0.01) and 11-20 repetitions (OR=5.40 [3.69-7.90]; p<0.01), longer second stage duration (OR=1.01 [1.00-1.02]; p<0.01), and women with gestational age more than 37 weeks were risk factors. Multivariate analysis reported that second stage duration (AOR=1.01 [1.00-1.03]; p<0.01), primiparity (AOR=2.03 [1.34-3.06]; p<0.01), and number of vaginal examinations between 6-10 repetitions (AOR=2.36 [1.50-3.70]; p<0.01) and 11-20 repetitions (AOR=3.29 [1.74-6.20]; p<0.01) were remained as risk factors for selective mediolateral episiotomy. A higher number of vaginal examinations during labor (over six repetitions), longer duration of second stage labor, and primiparity were risk factors associated with selective mediolateral episiotomy.

Effect of magnetic beads auricular point sticking therapy on intrapartum fever in primipara with epidural labor analgesia

To observe effect of magnetic beads auricular point sticking therapy on intrapartum fever in primipara with epidural labor analgesia and explore its possible mechanism. A total of 160 primipara were randomly divided into an observation group (80 cases, 12 cases dropped off ) and a control group (80 cases, 15 cases dropped off ). The primipara in the control group received epidural labor analgesia. In the observation group, 15 min after epidural labor analgesia was performed, magnetic beads auricular point sticking therapy was given at shenmen (TF4), neishengzhiqi (TF2), neifenmi (CO18) and jiaogan (AH6a), pressing and kneading once every 15 min, 1 min each time, until the end of first stage of labor. The tympanic temperature on Ta (before labor analgesia), Tb (2 h after labor analgesia), Tc (4 h after labor analgesia) and Td (1 h after labor) was recorded, and the intrapartum fever incidence and level of serum cortisol and IL-6 between two groups were compared. The visual analogue scale (VAS) score before and after labor analgesia, the pressing times of patient controlled epidural analgesia (PCEA), and the dosage of sufentanil were observed. The active labor period, the second stage of labor, and the time of analgesia, the use of oxytocin, the number of vaginal examination and the rate of cesarean section were recorded in the two groups. There was no significant difference in tympanic temperature in the observation group at each time point (P>0.05), the tympanic temperature at Tc and Td in the control group was higher than that at Ta (P<0.05); the tympanic temperature at Tc and Td in the observation group was lower than that in the control group (P<0.05). The levels of serum cortisol and IL-6 at Td in the two groups were higher than those at Ta (P<0.05), and those in the observation group were lower than the control group (P<0.05). The second stage of labor in the observation group was shorter than that in the control group (P<0.05), and the pressing times of PCEA, the dosage of sufentanil, intrapartum fever incidence, usage rate and total amount of oxytocin and the number of vaginal examinations were all lower than those in the control group (P<0.05). Magnetic beads auricular point sticking therapy can reduce the amount of anesthetics, decrease the effect of epidural analgesia on primipara's body temperature regulation and labor progress, and lower the incidence of fever during labor analgesia by regulating the level of inflammatory response in the primipara.

The correlation between the number of vaginal examinations during active labor and febrile morbidity, a retrospective cohort study

BackgroundThe association between the number of vaginal examinations (VEs) performed during labor and the risk of infection is unclear. The literature regarding this issue is not consensual, and the available studies are relatively small. Therefore, we aimed to study the association between the number of VEs during labor, and maternal febrile morbidity, in a very large cohort.MethodsThis is a retrospective cohort study. All women who delivered vaginally ≥37 weeks, at our institute, between 2008 and 2017 were included. Patients who underwent cesarean delivery or who were treated with prophylactic antibiotics, or had a fever ≥38.0 °C prior to the first VE were excluded. Cases of intrauterine fetal death, known malformations, or missing data were excluded as well. The cohort was divided according to the number of VEs performed: up to 4 VEs (n = 9716), 5–6 VEs (n = 4624), 7–8 VEs (n = 2999), and 9 or more VEs (n = 4844). The rates of intrapartum febrile morbidity (intrapartum fever and chorioamnionitis), postpartum febrile morbidity (postpartum fever and endometritis), and peripartum febrile morbidity (any of the mentioned complications) were compared.ResultsOverall, 22,183 women were included in the study. On multivariate analysis, we found that performing 5 VEs or more during labor was independently associated with intrapartum febrile morbidity (5–6 VEs: aOR = 1.83, 95% CI (1.29–2.61), 7–8 VEs: aOR = 2.65 95% CI (1.87–3.76), 9 or more VEs aOR = 3.47 95% CI (2.44–4.92)), postpartum febrile morbidity (5–6 VEs: aOR = 1.29, 95% CI (1.09–1.86), 7–8 VEs: aOR = 1.94 95% CI (1.33–2.83), 9 or more VEs aOR = 1.91 95% CI (1.28–2.82)), and peripartum morbidity (5–6 VEs: aOR = 1.48, 95% CI (1.15–1.91), 7–8 VEs: aOR = 2.15 95% CI (1.66–2.78), 9 or more VEs: aOR = 2.57 95% CI (1.97–3.34)).ConclusionThe number of VEs performed during labor is directly correlated with febrile morbidity. Performing five or more VEs during labor is independently associated with febrile morbidity; For intrapartum and peripartum febrile morbidity the risk rises as more VEs are performed.

The association between the number of vaginal examinations during labor and perineal trauma: a retrospective cohort study.

To study the association between the number of vaginal examinations (VEs) performed during labor and subsequent severe perineal trauma. This is a retrospective cohort study. We included all women admitted to the delivery ward between 2008 and 2017, in active labor. Exclusion criteria included preterm deliveries (< 37weeks), Cesarean deliveries and episiotomy during delivery. The primary outcome, severe perineal trauma, was defined as perineal tears grades 3-4. The cohort was divided into 4 groups, based on the number of VEs performed during labor: Group 1-up to two VEs (n = 4588), Group 2-three to four VEs (n = 5815), Group 3-five to six VEs (n = 4687), and Group 4-seven or more VEs (n = 7297). Overall, 22,387 women were included in the study. The rate of severe perineal trauma in groups 1, 2, 3 and 4 was 0.4%, 0.1%, 0.8%, and 0.4%, respectively (p < 0.001). Performing five or more VEs during labor was associated with a higher risk of severe perineal trauma (0.26% vs. 0.53%, p < 0.01), as compared to four VEs or less. Using a logistic regression model, we found that performing five or more VEs during labor (aOR = 1.72 CI 95% (1.21-2.47), p < 0.001) or performing an instrumental delivery (aOR = 2.65 CI 95% (1.72-4.07), p < 0.001) were directly associated with the risk for severe perineal trauma. Applying epidural anesthesia showed an inverse association with severe perineal trauma (aOR = 0.54 CI 95% (0.38-0.77), p < 0.001). Performing five or more VEs during active labor is associated with an increased risk for severe perineal trauma.

Misoprostol administered sublingually at a dose of 12.5\u2009\u03bcg versus vaginally at a dose of 25\u2009\u03bcg for the induction of full-term labor: a randomized controlled trial

BackgroundLabor induction is defined as any procedure that stimulates uterine contractions before labor begins spontaneously. The vaginal and oral routes of administration of misoprostol are those most used for the induction of labor in routine practice, with the recommended dose being 25 μg. Nevertheless, the sublingual route may reduce the number of vaginal examinations required, increasing patient comfort and lowering the risk of maternal and fetal infection. Based on a previous systematic review, the objective of this study was to compare the frequency of tachysystole as the main outcome measure when misoprostol is administered sublingually at the dose of 12.5 μg versus vaginally at a dose of 25 μg to induce labor in a full-term pregnancy with a live fetus.MethodsA randomized, placebo-controlled, triple-blind clinical trial was conducted at two maternity hospitals in northeastern Brazil. Two hundred patients with a full-term pregnancy, a live fetus, Bishop score ≤ 6 and an indication for induction of labor were included. Following randomization, one group received 12.5 μg misoprostol sublingually and a vaginal placebo, while the other group received a sublingual placebo and 25 μg misoprostol vaginally. The primary outcome was the frequency of tachysystole. Student’s t-test, the chi-square test of association and Fisher’s exact test were used, as appropriate. Risk ratios and their 95% confidence intervals were calculated.ResultsThe frequency of tachysystole was lower in the group using 12.5 μg misoprostol sublingually compared to the group using 25 μg misoprostol vaginally (RR = 0.15; 95%CI: 0.02–0.97; p = 0.002). Failure to achieve vaginal delivery within 12 and 24 h was similar in both groups. Sublingual administration was preferred to vaginal administration by women in both groups; however, the difference was not statistically significant.ConclusionThe effectiveness of labor induction with low-dose sublingual misoprostol was similar to that achieved with vaginal administration of the recommended dose; however, the rate of tachysystole was lower in the sublingual group, and this route of administration may prove a safe alternative.Trial registrationRegistration number: NCT01406392, ClinicalTrials.gov. Date of registration: August 1, 2011.

Admitting women in active labour: A randomised controlled trial about the effects of protocol use on childbirth method and interventions

AimTo determine the effects of protocol of admitting women in active labour on childbirth method and interventions during labour and childbirth. MethodsThis single-blind randomised clinical trial was conducted in a public hospital in Mazandaran province (Iran) in 2017. Two hundred nulliparous low-risk women were randomly assigned into intervention and control groups. The participant women were admitted in the intervention group using the admission protocol and to the group control by staff midwives and doctors. The admission criteria of the protocol were: the presence of regular, painful contractions, the cervix at least four cm dilated and at least one of the following cues: cervix effaced, and spontaneous rupture of membranes, or “show”. The primary outcome measure was childbirth method. Data were analyzed in SPSS-22 using Mann–Whitney and Chi–square tests. The level of statistical significance was set as p<0.05. FindingThere were significant differences between the intervention and control groups in the number of caesarian section (CS) (p<0.001). Two groups had a statistically significant difference in amniotomy (p=0.003), augmentation by oxytocin (p<0.001), number of vaginal examinations (p<0.001) and fundal pressure (p<0.001). ConclusionsUsing a protocol for admission of low risk nulliparous women in active labour contributed to reduction of the primary caesarean section rate and interventions during childbirth. A risk assessment and using evidence informed guidelines in admission can contribute to reduce unsafe and harmful practices and support normalisation of birth. This is essential for demedicalisation and a useful strategy for reducing primary CS.

Urinary Pathogens amongst Parturients at the University of Port Harcourt Teaching Hospital, South-South, Nigeria

Aim: To identify the microorganisms in urine before and after delivery. Also, to identify the incidence, risk factors and antibiotic susceptibility pattern in postpartum bacteriuria. &#x0D; Methods: A quasi-interventional study of 50 women who had term vaginal deliveries at the University of Port Harcourt Teaching Hospital (UPTH) Nigeria, between September 1, 2016 and December 31, 2016. Clean catch midstream urine samples collected in sterile containers from parturients before and after delivery were processed. All significant isolates were subjected to antimicrobial susceptibility testing. Socio-demographic data and data regarding labour and risk factors were collected on a pre-designed proforma and entered on a spread sheet. Statistical analysis was done using SPSS version 22.0.&#x0D; Results: Majority 49 (98%) of the parturients were booked (women that received antenatal care). Eight (16%) of the parturients had bacteriuria pre and post-delivery. Four of the parturients who were negative for bacteriuria before delivery had postpartum bacteria, giving an incidence of 8% for postpartum bacteriuria. The commonest micro-organism isolated post-delivery was Escherichia coli (50%). The number of vaginal examinations, vacuum delivery, episiotomy, perineal tear and bladder catheterization did not significantly increase the risk of postpartum bacteriuria.&#x0D; Conclusion: Escherichia coli is the most common urinary pathogens and sensitive to Nalidixic acid. Routine screening of women for bacteriuria after delivery and an understanding of the antimicrobial sensitivity will help in reducing associated morbidities.

Potential excess of vaginal examinations during the management of labor: frequency and associated factors in 13 Peruvian hospitals

BackgroundA high number of vaginal examinations (VEs) may lead to a higher risk of infections, as well as discomfort/dissatisfaction with intrapartum care.ObjectiveTo determine the frequency of potential excess of vaginal examinations (PEVE) during the management of labor and identify its associated factors, in Peruvian hospitals.MethodsSecondary analysis of the data collected in the DisrespEct and abuse during ChIlDbirth in pEru (DECIDE) study, held between April and May 2016. In this study, women hospitalized in Peruvian hospitals right after giving birth were surveyed by trained personnel. PEVE, the main outcome, was considered as five or more vaginal examinations (VEs) performed during the management of labor. Poisson regression models with robust variance were performed to calculate crude and adjusted prevalence ratios (cPR and aPR) as well as their 95% confidence intervals (95% CI).ResultsOne thousand four hundred twenty registries of 13 hospitals from 8 Peruvian cities were evaluated. The number of women studied at each hospital ranged between 100 and 129. The median age was 26 years (interquartile rank: 22–31). The median number of VEs was 3 (interquartile rank: 2–5). The proportion of women who underwent PEVE was 33.9%, this ranged from 0.9 to 69.9% at the studied hospitals. The frequency of PEVE was higher in women who attended > 2 obstetric psychoprophylaxis sessions, compared to those who attended ≤ 2 sessions (aPR: 1.78 95% CI: 1.01–3.12); and among women who gave birth between 18:00 h and 23:59 h, compared to those who did it between 7:00 and 17:59 h (aPR: 1.28 95% CI: 1.04–1.57).ConclusionAround one in three women underwent a PEVE, although this frequency varied widely across the evaluated hospitals. Women with more psychoprophylaxis sessions, and who gave birth between 18:00 h and 23:59 h, had a higher PEVE frequency. Future studies should assess in depth the causes and consequences of this high frequency.

768: The correlation between the number of vaginal examinations during active labor and peripartum complications

We aimed to study the effect of each vaginal examination (VE) performed in active labor (AL) on maternal febrile morbidity and perineal trauma. All women who underwent a trial of labor >24 gestational weeks, in a single tertiary medical center, between 2008- 2017 were included. For each delivery, the number of VEs performed in the first and second stages of AL was retracted from the computerized database. For the purpose of this study, AL was defined as cervical dilatation >4 cm, associated with regular uterine contractions, with or without rupture of the membranes. Data regarding the length of each stage of AL, mode of delivery, and peripartum complications were retracted. Peripartum complications included: intrapartum febrile morbidity (intrapartum fever ≥ 380C and/or culture-proven chorioamnionitis), postpartum febrile morbidity (postpartum fever ≥ 380C, and/or culture-proven endometritis, and/or surgical site infection), and perineal trauma (perineal tears grade 1-4 and/or cervical tears). Overall, 33,292 women were included in the study. The number of VEs performed in the first and second stages of AL and the associated complications in univariate analysis are presented in the table. On multivariate analysis, after controlling for confounders including the length of each stage of AL, we found that each additional VE during the first stage of AL increased the risk of any febrile morbidity by 1.5% (aOR 1.015, 95% CI 1.005-1.03). Each additional VE during the second stage of AL increased the risk of perineal trauma by 10% (aOR 1.10, 95% CI 1.08- 1.12), and the risk of postpartum febrile morbidity by 11% (aOR 1.11, 95% CI 1.06-1.16). The number of VEs during the first stage directly correlated with the risk for postpartum febrile morbidity and any febrile morbidity (p<0.001 for both). The number of VEs during the second stage of AL directly correlated with the risk of perineal trauma, postpartum febrile morbidity, and any febrile morbidity (p<0.001 for all) (figure). The number of VEs performed in AL directly correlates with febrile morbidity and perineal trauma. These data should be taken into consideration by obstetricians in decision making regarding the number of VEs to perform in each stage of AL.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Measuring women’s experience of induction of labor using prostaglandin vaginal gel

ObjectiveTo describe and examine the EXIT (EXperiences of Induction Tool), and report on the experience of women undergoing PGE2 vaginal gel IOL, who were participants in a randomized controlled trial comparing early amniotomy with repeat-PGE2. Study designFollowing an evening dose of PGE2 vaginal gel, 245 women with live singleton term pregnancies were randomized to amniotomy or repeat-PGE2. Women’s experience of IOL was a secondary outcome measure, assessed using the self-report EXIT administered by phone at 7–9days post-partum. The 10-item EXIT assessed women’s experiences in multiple domains using a 5-point agreement scale. Principal components analysis with orthogonal varimax rotation was undertaken to examine the scale structure. Internal consistency, face, content, construct and discriminant validity were also assessed. ResultsThe final 3-component solution comprised 8 of the 10 EXIT items, explained 76.1% of the variance and had a good fit to model (p<0.001). The three resulting components were representative of women’s experience of the time taken to give birth, discomfort with IOL, and subsequent contractions. The items loading to each component showed good internal consistency for time taken to give birth (α=0.88), discomfort with IOL (α=0.78), and experience of subsequent contractions (α=0.87). Women in the repeat-PGE2 group reported a less favorable experience with the time taken to give birth (mean (SD): 3.5 (1.4) vs 3.9 (1.2); p=0.04) and more discomfort with IOL (2.9 (1.1) vs 2.5 (1.0); p=0.04) compared to women in the amniotomy group. At the individual item level, women in the amniotomy group responded more positive about the time taken to have their baby (median (IQR): 4 (3–5) vs 3 (2–5); p<0.01); and less negative to the question about the number of vaginal examinations (2 (1–3) vs 2 (1–4); p=0.05). ConclusionsThe EXIT shows promise as an instrument for assessing women’s experience of IOL. Women undergoing PGE2 vaginal gel IOL reports a more positive experience with an early amniotomy rather than with repeat-PGE2.

Endometritis Puerperal. Incidencia y Factores de Riesgo

OBJETIVO: Determinar la incidencia y factores de riesgo para la presentación de endometritis puerperal. DISEÑO: Estudio prospectivo, longitudinal, comparativo y de observación. LUGAR: Departamento de Obstetricia, Hospital Nacional Edgardo Rebagliati Martins, IPSS. SUJETOS: 3350 gestantes cuyos partos fueron atendidos en el Hospital en referencia. RESULTADOS: La endometritis puerperal se presentó en 26% de las pacientes estudiadas, siendo mayor su incidencia en las primíparas y grandes multíparas. La rotura de membranas mayor de 6 horas se presenta como el factor de riesgo de mayor importancia, seguida por el parto abdominal, trabajo de parto prolongado, parto inducido, preeclampsia, parto pretérmino y anemia. No hubo relación de la endometritis con laparidad, el control prenatal, número de tactos vaginales y la infección de la vía urinaria. El E. Coli fue el microorganismo que mayormente creció en los cultivos. CONCLUSIÓN: Se señala la importancia de la detección precoz de los factores de riesgo, con el fin de evitar la endometritis puerperal.

The diagnostic accuracy of purple line in prediction of labor progress in omolbanin hospital, iran.

Background:Currently, vaginal examination is the gold standard for assessment of labor progress. The World Health Organization emphasizes that the number of vaginal examinations should be limited where it is necessary.Objectives:Therefore, this study aimed to determine the diagnostic accuracy of purple line in the prediction of labor progress.Patients and Methods:In this cross-sectional study, 350 women with a single pregnancy in vertex presentation and gestational age of 38-42 weeks without any medical disorder, admitted to government hospitals of Mashhad, were selected using convenience sampling. Vaginal examination and observation of the line each hour in the active phase of labor were measured. Abnormal progress of labor was defined as cervical dilatation less than 1 centimeter/hour in the active phase for two consecutive hours and fetal head descend less than 1cm/h or duration of more than two hours for nulliparous and one hour for multiparous In the second stage of labor. Data was analyzed by SPSS version 16 using chi -square test.Results:The purple line appeared in 75.3% of women during the active phase of labor. Appearance of the purple line in the prediction of labor progress had 90.2% sensitivity, 45.3% specificity, 88.1% positive predictive value, 51.0% negative predictive value in the first stage of labor and had 87.6% sensitivity, 52.4% specificity, 96.5% positive predictive value, 22.0% negative predictive value in the second stage of labor and has 68.57% sensitivity, 42.66% specificity, 85.32% positive predictive value, and 43.85% negative predictive value for the total labor.Conclusions:According to the appearance of the purple line in most of the cases and its high sensitivity and specificity, we can use it as a non-invasive complementary method for clinical assessment of labor progress.

Related factors of maternal infection for lateral episiotomy and nursing intervention analysis

Objective To investigate the related factors of maternal infection for lateral episiotomy and summarize care interven -tions measures.Methods A total of 75 cases with maternal infection were taken as the observation group and 75 cases without maternal in-fection as control group , and summed up the related factors of maternal infection for lateral episiotomy and summarize care interven -tions.Results Maternal obesity, along with the underlying disease and infection before admission , maternal, premature rupture of mem-branes, prolonged labor , the number of vaginal examinations more than 2 times, catheterization, rectal examination more than 3 times and other relevant factors , there was significant difference between observation group and control group statistically （ P〈0.05 ） .Conclusions Postoperative infection episiotomy is caused by many factors;timely appropriate nursing interventions can reduce the incidence of infection e -pisiotomy. Key words: Episiotomy; Infection; Nursing intervention

Determinants of postpartum infectious complications among HIV uninfected and antiretroviral naïve-HIV infected women following vaginal delivery: A prospective cohort study

Objective To determine the incidence rate of postpartum infectious morbidity among HIV uninfected women compared to antiretroviral naïve-HIV infected women who were eligible for vaginal delivery. Study design A nested study was conducted within a large prospective trial in which HIV infected women eligible for vaginal delivery at term were compared with HIV uninfected women. Women were reviewed within 72 h post delivery, at 1, 2 and 6 weeks for clinical signs of puerperal infection. Results 241 HIV infected women were compared with 427 HIV uninfected controls. Both groups were comparable in terms of baseline parameters. The infectious morbidity rate was similar between the HIV infected and uninfected women ( p = 0.977). Factors which significantly increased puerperal infections in both groups were the presence of an episiotomy, p < 0.001, the number of vaginal examinations after rupture of amniotic membranes, p = 0.026, and a CD4 count of <200 μ/L, p = 0.017 in the HIV infected group. Conclusion There was no difference in postpartum infections amongst HIV infected compared to uninfected women, but an episiotomy was associated with a 2-fold increased risk of infectious morbidity.