Labor Outcomes Research Articles

2D-transperineal ultrasound in delivery room: contribution in assessing labor progress, predicting outcome of labor and recognizing obstetric anal sphincter injuries (OASIS). A systematic review

2D-transperineal ultrasound in delivery room: contribution in assessing labor progress, predicting outcome of labor and recognizing obstetric anal sphincter injuries (OASIS). A systematic review

High- versus Low-dose Oxytocin Regimens for Labor Augmentation: A Systematic Review and Meta-analysis.

To assess whether high- versus low-dose oxytocin regimens for labor augmentation are associated with differential risk for low Apgar score, neonatal acidosis, and other adverse labor outcomes. We searched electronic databases (MEDLINE, EMBASE, the Cochrane Library, CINAHL, Scopus, ClinicalTrials.gov) from inception up to March 2024 using combinations of the following keywords: "oxytocin," "oxytocin regimen," "oxytocin protocol," "oxytocin dosage," "active management," "high dose protocol," "low dose protocol," "augmentation of labor." We included quasi-randomized and randomized controlled trials comparing continuous oxytocin infusion with high-dose regimens (i.e., intervention group) versus low-dose regimens (i.e., control group) in nulliparous or multiparous patients undergoing augmentation of labor. High-dose regimens were defined as starting oxytocin dose of 4 mU/min or higher and increasing by increments of 3-7 mU/min every 15 to 40 minutes. Low-dose regimens were defined as starting oxytocin dose of less than 4 mU/min and increasing by increments of 1-2 mU/min every 15 to 40 minutes (PROSPERO CRD42024500197). The co-primary outcomes were incidence of Apgar score <7 at 5 minutes and umbilical arterial pH <7.00. Secondary outcomes included cesarean delivery and chorioamnionitis. We performed random-effect head-to-head meta-analyses to compare high- versus low-dose strategies, reporting summary risk ratio (RR) with 95% confidence interval (CI). Ten randomized and quasi-randomized controlled trials of 5,508 total pregnancies met inclusion criteria and were included in the meta-analysis. There was no difference in risk for the co-primary outcomes of Apgar score <7 at 5 minutes (relative risk [RR] 0.94, 95% confidence interval [CI] 0.60-1.46) and umbilical arterial pH <7.00 (RR 0.77, 95% CI 0.50-1.20). There was also no difference in risk for cesarean delivery (RR 0.83, 95% CI 0.67-1.02). High-dose oxytocin regimens were associated with significantly lower risk of chorioamnionitis (RR 0.70, 95% CI 0.57-0.84, number needed to treat=25) and higher risk of tachysystole (RR 1.32, 95% CI 1.21, 1.43; p<0.001). When used for labor augmentation, high-dose oxytocin regimens decrease risk for chorioamnionitis compared to low-dose regimens, without affecting risk for low Apgar score, neonatal acidosis, or cesarean delivery.

Effectiveness of Birthing Ball Exercises Therapy in Improving Labor Pain and Labor Outcomes: A Systematic Review

Objective: We must treat every woman with respect and compassion during her childbirth, allowing her to choose how she wants to remember the experience. Midwives and nurses use birthing balls to reduce labor pain and enhance maternal comfort without an epidural. The aim of this systematic review was to critically evaluate the available evidences on the effect of birthing balls on labor pain and labour outcomes. Materials and methods: Studies identified through PubMed, Semantic Scholar, and Mendeley electronic databases to gather evidences with selected keywords. This review incorporated randomised controlled trials and quasi-experimental research studies that met specific, predefined inclusion criteria. The search generated 441 titles and abstracts, which were further filtered down to 29 publications that were possibly relevant. Out of those, eight studies met the inclusion criteria. Performed a quality assessment of the articles using the JBI quality assessment tool. Results: All of the included studies show labor pain on a 10-cm Visual Analogue Scale (VAS), and interventional groups reported significantly less labor pain in delivery compared to the control group without birth ball exercise. On labour outcome findings, the intervention group had a higher mean score of cervical dilation in 2 studies, quicker head descent in 3 studies, lower labor time in 4 studies, mother satisfaction throughout labor in 2 studies, and a preference for vaginal delivery in 2 studies. Conclusion: Clinical implementation of a birthing ball exercise during the process of labor is an effective intervention to reduce labor pain and improve labor outcomes.

Influencing Factor Analysis and Prediction Model of Emergency Caesarean Delivery for Advanced-Age Nulliparous Women at the Time of Hospitalization

Objective: In Japan, the number of nulliparous pregnant women of advanced age, defined as 35 years or older, has increased, and the age range has lengthened towards older age with the increased use of infertility treatments. Given this trend, adverse labour outcomes, such as emergency caesarean delivery (ECD), are expected to increase. Therefore, by focusing mainly on maternal age and infertility treatment history, we aimed to establish a new prediction model for the likelihood of ECD after identifying the influencing factors related to maternal and labour-related characteristics. Materials and methods: The medical records of 1,521 pregnant women who were nulliparous between 2017/4/1 and 2024/3/31 at our hospital were retrospectively reviewed. First, for the 675 women who were aged 30 years old or more, we calculated the rates of ECD in 8 groups classified according to maternal age, infertility treatment, and other variables. Next, we performed multivariate logistic regression analysis to assess the effect of each representative factor and established a prediction model based on the number of factors that were significant in the multivariate analysis. Results: Simple comparisons classified by maternal age revealed a constant increase in the rate of ECD with increasing maternal age, and multivariate analysis revealed 7 significant factors, namely, advanced maternal age, history of using assisted reproductive techniques (ART), small height, high Body mass index (BMI), low Bishop score, late-term delivery, and large infant. In the prediction model constructed with these 7 factors, the rate of ECD increased as the number of these factors increased. Conclusion: The negative impact of advanced maternal age, namely, 40 years or older, and ART history, on labour outcome is clear. A new prediction model has the potential to identify patients with an extremely high probability of needing an ECD. These results may indicate that the management of the labour process will become more difficult in the future.

Prenatal ultrasound scoring in diagnosis and postpartum outcomes prediction for Placenta Accreta Spectrum (PAS): a systematic review

BackgroundPlacenta accreta spectrum (PAS) is one of the most dangerous pregnancy-related conditions. This study aims to conduct a systematic review of current research on the ultrasound scoring systems used in PAS patients with a comprehensive summarization of researches and comparison of prenatal ultrasound scoring in evaluating postpartum outcomes.MethodsThis systematic review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were retrieved from four databases (PubMed, Cochrane Library, Embase and Web of Science) up to December 2023. Original studies involving women diagnosed with PAS using ultrasound scoring for diagnosis or outcome evaluation were screened based on predefined inclusion and exclusion criteria. The primary outcome was the diagnostic performance of ultrasound scoring systems and their effectiveness in predicting labor outcomes. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was utilized to assess the study quality. The study has been registered on the PROSPERO website with the registration number CRD42024507311.ResultsSixteen studies met the inclusion criteria. 3930 patients were included in the review, with 1693 participants in the control group. Included studies had a high risk of bias in patient selection, with a low risk in flow and timing and reference standards. Existing studies have reported several indicators that can be included in ultrasound scoring systems and tested their effectiveness in diagnosis and severity evaluation. The pool sensitivity, specificity, and area under the curve (AUC) of ultrasound scoring system in diagnosing PAS were 0.89 (95% confidence interval [CI]: 0.82–0.94), 0.85(95%CI: 0.80–0.90) and 0.93 (95%CI:0.91–0.95). Ultrasound scores are associated with PAS outcomes including intraoperative haemorrhage, postpartum haemorrhage, hysterectomy, length of hospital stay, and neonatal prognosis. Limitation is that the existing studies are wide-ranging but have low replication and association.ConclusionUltrasound scoring systems play a role in the prenatal diagnosis, management, and prediction of postnatal complications in PAS. Nevertheless, additional research is required to further evaluate the performance between different scoring systems to develop a unified consensus.

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

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

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

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

Impact of Support Person's Presence on Labor Outcomes among Primiparous Mothers in a Selected Hospital in Nadiad, Gujarat, India

Impact of Support Person's Presence on Labor Outcomes among Primiparous Mothers in a Selected Hospital in Nadiad, Gujarat, India

Global Monopsony, Contracting Practices and Labour Outcomes: A Study of Garment GVCs in India

Global Monopsony, Contracting Practices and Labour Outcomes: A Study of Garment GVCs in India

Labor Outcomes After Employer‐Provided Training: Evidence from the Understanding Society Survey

ABSTRACTA simple two‐period model is developed to show that employer‐provided training might increase workers' wages and incentives to work more paid and unpaid hours. These predictions are then tested using the United Kingdom Understanding Society Survey data. The empirical analysis suggests that individuals with at least one employer‐provided training incident work more paid and unpaid overtime compared with individuals without employer‐provided training. Training has significant positive and permanent effects on wages and the odds of workers being in a managerial role after training. Additionally, those with employer‐provided training have higher odds of job satisfaction. The unpaid working hours and job satisfaction effects of job training are not long‐lasting.

The Impact of Providing Training to Young Men on Labour Outcomes and Attitudes towards Migration in Northern Guinea-Bissau

The Impact of Providing Training to Young Men on Labour Outcomes and Attitudes towards Migration in Northern Guinea-Bissau

Job teleworkability and labour outcomes in the time of COVID-19: evidence from Russia

PurposeThis study investigates the effect of teleworkability on labour outcomes across gender, local labour markets, education, marital and parental statuses during COVID-19 in Russia.Design/methodology/approachBased on the Russia Longitudinal Monitoring Survey (RLMS-HSE), three classifications of telework are tested. Telework is associated with (1) work from home, (2) workplace digitalisation and (3) the suitability of professional occupations for telework. The methodology includes a difference-in-differences approach combined with propensity score matching, inverse probability weighted regression adjustment and dose-response function with the generalised propensity score.FindingsWe find a positive effect of teleworkability on working hours for men and employment status for women, especially women with higher education. The effect of teleworkability was more salient in large labour markets, where it manifested in an increase in working hours for both genders. The results indicate that parental status did not remarkably affect the magnitude of the effect of teleworkability for women. However, for fathers, teleworkability was associated with an increase in working hours.Research limitations/implicationsLimited data did not enable an exploration of the effect of teleworkability across industries and professional occupations. We take the use of the Internet for work in 2019 and the suitability of occupation for telework as a measure of teleworkability.Originality/valueThis is the first thorough analysis of the effect of telework on labour outcomes for the Russian economy during the COVID-19 pandemic.

Analysis of the outcomes and factors influencing vaginal trial labor in primiparas at term.

To explore the outcomes and factors influencing vaginal trial labor in primiparas with term singleton fetuses. A retrospective analysis of 9174 first-time mothers who opted for a vaginal trial of labor at Peking University First Hospital from October 2019 to September 2022 was performed. The primary outcomes included the outcome of the trial of labor and influencing factors. Of the total population, the success rate of attempted vaginal delivery was 74.3% (6818/9174). Logistic regression analysis revealed that increasing maternal age (OR = 1.054; 95% CI = 1.239-2.316; p < 0.001), gestational weight gain (OR = 1.033; 95% CI = 1.022-1.045; p < 0.001), neonatal weight (OR = 1.971; 95% CI = 1.724-2.253; p < 0.001), prepregnancy body mass index (BMI) ≥ 24kg/m2 (OR = 1.605; 95% CI = 1.411-1.825; p < 0.001), prenatal BMI ≥ 24kg/m2 (OR = 1.326; 95% CI = 1.137-1.546; p < 0.001), and induced labor (OR = 2.434; 95% CI = 2.187-2.708; p < 0.001) increased the risk of failed vaginal delivery attempts, and labor analgesia reduced the risk of failed vaginal delivery attempts (OR = 0.356; 95% CI = 0.320-0.397; p < 0.001). However, the use of assisted reproductive technology had no significant effect on the outcome of attempted vaginal delivery (p = 0.137). According to the partial regression coefficient, the area under the ROC curve was 0.710 (95% CI = 0.698-0.723), and the model passed the Hosmer-Lemeshow test and had good discrimination and calibration (χ2 = 12.833, p = 0.118). The postpartum hemorrhage (PPH) rate and overall neonatal asphyxia rate differed significantly between women who had different outcomes of vaginal trial labor. There are many factors affecting the occurrence of abnormal delivery in primiparas. These independent factors can be used for prenatal evaluation.

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

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

Swiss Ball Exercise In Active Phase Of Labor: A Review Of Clinical Outcomes

Background: Childbirth is a transformative yet painful experience which impacts the mother physically and psychologically. Managing labor and pain is the crucial for the well-being of the mother and the neonates. There are two ways in which labor pain can be reduced namely pharmacological and non-pharmacological method such as birth ball which has been widely used for the better birthing experience. To evaluate the evidence-based insights of using Swiss ball exercises during the active phase of labor and to reviews its impact on pain intensity, duration of labor, maternal and neonatal outcomes. Materials and Methods: This review encompasses 12 studies conducted between 2011 and 2024, utilizing database like PubMed and Scopus to investigate the effectiveness of Swiss ball exercise during labor. Results: The findings indicated that Swiss ball exercises during labor offers significant benefits for mothers. It helped in alleviating the pain and shortening the first and second stage of labor making the labor less physically and emotionally tiring. It enhanced maternal satisfaction, and it helped in reduction in caesarean section risks and vulvar swelling and reduced the overall complications associated with childbirth. However, the uncertain neonatal outcome highlights a gap in knowledge and the need for further studies. Conclusion: Implementing a standardized Swiss ball exercise during labor has the potential to decrease pain, duration of labor and improved maternal satisfaction but there was no change in neonatal outcomes.

Child labor in artisanal and small-scale mining: Implications for health, development and poverty

This paper investigates the complexities of health-related consequences associated with child labor in artisanal and small-scale mining (ASM). Based on qualitative data from northeast Guinea, our findings reveal pervasive adverse effects on the physical, psychological, and target organ health of affected children, significantly compromising their quality of life. Physical injuries, psychological distress, and exposure to toxic substances are prevalent, underscoring the inadequacy of existing policies and institutional actions to eradicate child labor and ensure the safety of those involved. Drawing from the findings, we have formulated a conceptual framework, the 'Child Labor Poverty Cycle,' to simplify and explain the intricate dynamics and connections among child labor, poor health outcomes, community vulnerability, and persistent poverty. These interrelated outcomes of child labor are detrimental to the socioeconomic wellbeing of communities, necessitating the need for government and stakeholder institutions to improve protection measures against child labor and address rural poverty, which partly drives children into child labor. Decision-makers can adopt the conceptual framework to inform the development of sustainable policies that address the drivers of child labor.

Labor and Delivery Outcomes in Australian Mothers after Kidney Transplantation.

Background: Factors influencing high cesarean section rates among mothers with a kidney transplant remain unclear. Methods: Using linked Australia and New Zealand Dialysis and Transplant Registry (1970-2016) and perinatal datasets (1991-2013), we compared deliveries of women with a functioning kidney transplant to those without kidney replacement therapy (non-KRT). Results: Of 2,946,851 babies (1,627,408 mothers), 211 were born to 137 mothers with a kidney transplant. Overall cesarean sections rates were doubled in transplant cohort (63% versus 26% non-KRT, p&lt;0.001) across all gestational periods compared to non-KRT cohort, and highest in preterm births (≥37 weeks: 48% versus 25%, p&lt;0.001, 33-36 weeks: 77% versus 40%, p&lt;0.001, and &lt;33 weeks: 75% versus 41%, p&lt;0.001). Cesarean section rates remained higher after adjusting for maternal factors (incidence rate ratio: 1.5; 95% CI: 1.3-1.7). In post-transplant women with past pregnancy, 53% with no previous cesarean sections had a cesarean section in the current pregnancy (versus 19% non-KRT, p&lt;0.001). Mothers with a kidney transplant had less spontaneous labor than non-KRT mothers (30% versus 63%, p&lt;0.001) and more planned deliveries (induced or elective cesarean sections) (70% versus 36%, p&lt;0.001). Nearly half of the women with transplantation (45%) delivered by non-labor cesarean sections, mostly occurring preterm (&lt;37 weeks: 70% versus ≥37 weeks: 30%, p=0.002). In the transplant cohort, the main indications for non-labor cesarean sections were hypertensive disorders of pregnancy and breech presentation (&gt;50% versus 18% non-KRT cohort, p&lt;0.001) and were linked to gestational age. Non-labor cesarean sections for fetal distress were higher in women with transplantation (10% versus 4% non-KRT, p=0.029). In the non-KRT cohort, previous cesarean sections were the main indication for non-labor cesarean sections (40% versus 24% transplant; p=0.055). Post-partum hemorrhage (13% vs 7% non-KRT, p=0.003) and fetal distress (18% versus 10% non-KRT, p=0.001) were higher among the transplant cohort. Conclusions: Women with a kidney transplant have higher rates of cesarean sections delivery even after accounting for maternal factors, preterm delivery and past cesarean sections compared to non-KRT cohorts.

A Programmed Labour to Optimize Labour Outcome

Background: A Programmed labour following a protocol teaches the goal of safe motherhood. The present study on programmed labour protocol implemented to shorten the duration of labour, to optimise pain relief during labour, to monitor labour by partograph and to enhance vaginal birth. The prime objective of the study is to evaluate the effect of programmed labour on duration of labour and to assess efficiency of analgesics in reducing severity of labour pain. Materials and methods: Total 100 cases of low risk pregnant women both primi and multipara were included in this study. It was designed to low risk pregnant women with cephalic presentation without evidence of CPD- either with spontaneous onset of labour or waiting for induction of labour at 41+ wks pregnancy. Patient with labour pain allowed to move. Pain relief was done either by pharmacological or nonpharmacological method. Labour was monitored by partograph. Results: The duration were shortened in all stages of labour specially in active phase that was (Mean± SD- 3.08 hr ± 0.83), Significant paint relief in 76% cases (Mean SD of score 2.08 ± 0.62). The rate of vaginal delivery is more in programmed labour which is about 95% in this study. There is also significant reduction of maternal and fetal morbidity and mortality. Conclusion: The programmed labour is simple, easy, cheap and effective method of painless and safe vaginal delivery. Significant reduction of pain by programmed protocol avoid hyperventilation of mother, maintain circulation, thereby increase chance of vaginal delivery. Chatt Maa Shi Hosp Med Coll J; Vol.22 (2); July 2023; Page 72-74

Labor market effects of bounds on domestic outsourcing

In early 2022, Peru enacted regulations to curtail widespread outsourcing, limiting it to activities outside a firm’s core functions. Utilizing quarterly data from Peru’s National Household Surveys (ENAHO) from 2021 to 2022 and yearly data from 2023, this study applies difference-in-differences techniques to assess short-term labor market outcomes. Results show that while outsourcing decreased by 1.7 percentage points, the restrictions had no significant adverse effects on employment, wages, or labor formalization. If anything, employment and labor force participation showed slight, though non-causal, increases. These findings are robust to various tests and alternative specifications, suggesting that the policy primarily impacted outsourcing practices without markedly influencing broader labor outcomes. It did neither destroy jobs nor improve workers’ employment conditions.

Evaluating the effects of back massage during labour on delivery outcomes: A prospective study on primigravida mothers

The labor and delivery process can be stressful for parturient women, especially for primigravida mothers. Birth companions providing massage and emotional support can help make more pleasant birthing experience. This study aimed to assess the impact of back massage by trained birth companions on reducing analgesic use, pain intensity scores, and labor duration. The study was conducted on primigravida women. During antenatal care visits, companions in the intervention group were trained in massage techniques, while no training was imparted to companions in the control group. Data were collected using a pre-tested questionnaire during antenatal clinic visits and delivery A multivariable logistic regression model was used to assess the impact of massage on delivery outcomes while adjusting for significant confounding variables.The study demonstrated a positive impact of back massaging on labor and delivery outcomes. Mothers in the massaged group were 2.27 times less likely to receive analgesics and 3.71 times more likely to experience a reduction in pain intensity scores of &amp;#62; 2 compared to those receiving usual care. Additionally, the massaged group had a 2.24 times higher likelihood of reducing labor duration to &amp;#60; 12 hours compared to the usual care group. Back massaging by trained birth companions is an effective intervention for reducing the use of analgesics, pain intensity scores, and the length of labor in primigravida women.