Progress Of Labor Research Articles

391. Analysis of spontaneous labor progression of breech presentation at term

Introduction: Cervical dilatation curves are widely used to describe normal and abnormal labor progression for cephalic presentation. Labor curves for breech presentations have never been described. The aim of this study was to examine the pattern of labor progression in parturient with a breech presentation and to determine if the type of breech or parity could influence the speed of cervical dilatation. Study design: We analyzed labor data from 349 women with a term, singleton, and breech fetus after spontaneous onset of labor in 2010 – 2018.

50 The labour progression study (LaPS): duration of labour following zhangs’s guideline and the who partograph – A cluster randomised trial

Introduction and aim: Traditionally, the progress of labour is measured by cervical dilatation. However, the expected progression varies between countries and there is no consensus regarding which guideline is best suited for clinical use. The applicability of stages, phases and time limits in labour is challenging, mainly because of variations in defining the onset of labour and transition of phases and stages. One concern is that women may undergo unnecessary interventions because slow progress of labour is poorly defined.

Revaluation of Paperless Partograph in the Management of Labor

Background: The paperless partograph refers to monitoring progress of labor and reaching to an accurate decision for intervention to ensure safe delivery. It needs no graph paper, no extra time to do in comparison to routine partograph. Aim: to reevaluate effect of using paperless partograph on the management and outcome of labor at to prevent prolonged labor and its complications and improving quality of labor in Labor ward at women health hospital Assiut university. Subjects and Methods: The study was conducted from 1st March 2018 to last February 2019 on Women Health Hospital, Assiut University, Egypt, at reception (emergency) unit and it was prospective observational analytical study.Sample of 800 women who met the criteria of; gestational age from 37 to 42 weeks, singleton pregnancy and with cephalic presentation. The data were collected by using the paperless partograph model. Results: Mean age of the participants was 25.6 years and mean of gestational age 39.1weeks and 87% were multipara. Mean duration for delivery after Alert ETD was 3.5 ±2.1 hours in primigravida and 3.3 ±2.1 hours in multipara. Mean Apgar score of the new-born after 5 minutes was 9.4. Conclusion: Paperless partograph was found to be effective positively on the management and the outcome of labor.

Are levator hiatal dimensions in mid-pregnancy associated with mode of delivery?

Introduction and hypothesisSlow progress of labour is a risk for operative delivery. Smaller levator hiatal dimensions are possible risk factors for slow progress and operative delivery. Our aim was to explore associations between hiatal dimensions antenatally, duration of second stage of labour and mode of delivery.MethodsProspective cohort study of 65 nullipara examined at 20 weeks gestation and 6 months postpartum. Levator hiatal anteroposterior diameter and area were measured using 2D/3D transperineal ultrasound and compared between women with normal vaginal delivery and operative delivery (vacuum or caesarean) using t-test and with Spearman’s rank to explore correlations with duration of second stage. ROC analysis established a cut-off for high risk of operative delivery.ResultsTwo-dimensional anteroposterior diameter and 3D hiatal area at rest were smaller in women with operative delivery than with normal delivery, 5.0 cm vs. 5.7 cm, p = 0.007 and 18.5 cm2 vs. 14.9 cm2, p < 0.001. From the ROC curve for 2D anteroposterior diameter, a cut-off of 5.6 cm, (sensitivity = 0.94, specificity = 0.63) and for 3D hiatal area a cut-off of 17.6 cm2 (sensitivity = 0.94, specificity = 0.65) predicted operative delivery. We found inverse correlations between second stage of labour and anteroposterior diameter at rest, r = −0.330, contraction, r = −0.365, area at rest, r = −0.324, and contraction, r = −0.521, all p < 0.05.ConclusionsSmaller hiatal dimensions at 20 weeks gestation were associated with longer second stage of labour and increased risk of operative delivery in nullipara. A 2D anteroposterior hiatal diameter < 5.6 cm and 3D hiatal area < 17.6 cm2 at rest imply increased risk of operative delivery.

EFFECT OF PLACENTAL CORD DRAINAGE ON THE THIRD STAGE OF LABOR

Placental cord drainage is unclamping the maternal side of the umbilical cord, thereby permitting the blood from the placenta to drain freely into a vessel immediately after the clamping and cutting of the umbilical cord. The aim was to study observe the Effects of Placental Cord Drainage on the third stage of labor progress. This study was an observational study carried out in the department of Obstetrics and Gynecology, who undergo spontaneous vaginal delivery over a period of six months were included in the study. This study population have been divided into two groups. In Group 1(30 women-unclamped), Group 2(30 women-clamped). The amount of blood loss and the time duration taken for the separation of placenta was noted in both groups. The mean duration of the third stage of labour was 6.36 ± 1.47 mins in Group 1 and 25.30 ± 4.98 mins in Group 2. The average amount of blood loss was 191.53 ± 37.51 ml in Group 1 and 359.63 ± 61.11 ml in Group 2. There was no retained placenta in the study. One patient in Group 2 had PPH. None of the women required blood transfusion. Placental cord drainage is simple, safe and non-invasive method.

Does an Empirical Economic Relation Have a Life?

Does an Empirical Economic Relation Have a Life?

Uterine rupture: A rare complication of repeated cervical cerclage

Uterine rupture is an obstetric crisis with potentially catastrophic fetal and maternal consequences. Uterine rupture in contemporary practice correlates with increased rates of cesarean section, with scarred uteri now being the most common etiology. We encountered a multigravida parturient with a cervical cerclage repeated in three consecutive pregnancies. She presented in early labor and removal of the cervical stitch with spontaneous progress of labor led to an unexpected cascade of events that included maternal tachycardia, fetal distress and regression of station at full dilatation. An urgent laparotomy with cesarean delivery was performed and intraoperatively we found there was hemoperitoneum and complete uterine tear extending from the cervix to the lower segment of the uterus on the left side. Repair of the tear and immediate management resulted in an uneventful postpartum recovery for both the mother and the baby. A literature search turned up just three such reported cases, a testimony to the rarity of this condition. This case highlights an unexpected side effect of a simple procedure that is often taken for granted. It also reiterates the need for medical and paramedical staff to think, anticipate and act promptly even in the most dreadful situations like this of a rupture in an unscarred uterus.

Refining the Clinical Definition of Active Phase Arrest of Dilation in Nulliparous Women to Consider Degree of Cervical Dilation as Well as Duration of Arrest

(Abstracted from Am J Obstet Gynecol 2021;225:294.e1–294.e14) In the United States, the progression of labor has been substantially slower than reported previously, according to a retrospective observational study by the Consortium on Safe Labor. Yet, the optimal threshold for arrest of dilation that balances the likelihood of vaginal delivery with the risk of adverse maternal and neonatal outcomes is unknown.

Purple line Alteration in prediction of labor progress

Purple line Alteration in prediction of labor progress

Manipulative Reduction for Abnormal Uterine Inclination in Vaginal Delivery.

Objective To investigate the manipulative reduction in abnormal uterine inclination in vaginal delivery. Methods With the independently developed uterine inclination surveyor, 40 primiparas with abnormal uterine inclination were randomly divided into two groups: treatment group (Group A, 20 cases) and control group (Group B, 20 cases). The general condition of the primipara, the labor stages, the changes in uterine inclination after treatment, postpartum hemorrhage at 2 hours, and the general condition of fetuses were observed to study the therapeutic value of manual reduction in abnormal uterine inclination. Result In the control group, one uterine inclination was not corrected with the change in labor process, and the pregnancy was terminated due to stagnation of the active phase. In the first stage of labor, the time spent in the treatment group (393.4 ± 31.3 mins) was significantly lower than that in the control group (440.7 ± 34.9 mins) (P = 0.001). Compared with the control group (49.8 ± 6.5 mins), the treatment group (42.6 ± 7.2 mins) also exhibited a significantly shortened second stage of labor (P = 0.02). Sixteen cases (16/20) in the treatment group returned to normal after manual reduction, and 9 cases (9/20) in the control group returned to normal with the progression of natural labor. Manual reduction could be used as an option to treat abnormal uterine inclination (P = 0.01). There was no significant difference in the third stage of labor (P = 0.2), 2-hour postpartum hemorrhage (P = 0.35), Apgar score (P = 0.64), or body weight (P = 0.76) between the two groups. Conclusion Manual reduction in the treatment of abnormal uterine inclination has obvious effects, shortens the birth process, and is safe for the fetus.

Spontaneous labor patterns among women attempting vaginal birth after cesarean delivery

Objective This study evaluated spontaneous labor patterns among women achieving a vaginal birth after cesarean (VBAC), without a previous vaginal delivery in relation to nulliparous women. Methods This historical cohort study included 422 women attempting VBAC and 150 nulliparas. We examined time intervals for each centimeter of cervical dilation and compared labor progression in 321 women who achieved spontaneous VBAC and 147 nulliparous women achieving a spontaneous vaginal delivery. Epidural anesthesia use, delivery mode, cord arterial pH and 5-minute Apgar score were also compared. Findings Women in the VBAC group compared to nulliparous women had similar durations of first (4–10 cm: 4:22 (00:54–13:10) h vs. 4:47 (1:10–15:10) h, p = .61), second (1:07 (8:00–3:21), vs. 1:34 (10:00–3:40), p = .124) and third stages of labor (10:00 (2:00–22:00) vs. 08:00 (3:24–22:12), p = .788). When comparing women who had epidural analgesia to those who did not, no differences were found between the groups regarding durations of first and second stages of labor. Interestingly, among parturients without epidural anesthesia only, the VBAC group had shorter second stage compared to the nulliparous (00:19 (0:04–1:59) vs. 00:47 (0:08–2:09), p = .023). Conclusion Labor patterns among women achieving spontaneous VBAC are similar to those of nulliparous women with spontaneous vaginal deliveries.

Collagenase Activity of Vaginal Microbes Associated with Preterm Labour

Collagens in the cervix (type I) and chorioamniotic membranes (type I, IV) play important biomechanical roles in maintaining healthy pregnancy and undergo significant modulation during natural labour progression. However, timing is key: inappropriate remodeling of collagens can trigger premature cervical dilation, chorioamniotic membrane rupture and preterm labour. While up to 40% of preterm labour cases arise from microbial infection, the mechanisms underlying this process are not understood. Notably, select members of the vaginal microbiome have been significantly associated with preterm labour including Sneathia, Prevotella and Porphyromonas species.

Ecografía transperineal intraparto en la progresión del trabajo de parto

Objective: To determine the usefulness of intrapartum transperineal ultrasound in the progression of labor in patients admitted to the Concepción Palacios Maternity Parting Room Service, in the period May-August 2019. Methods: Prospective, descriptive and longitudinal study involving 98 patients. Transperineal ultrasound was performed every two hours during labor, evaluating cervical characteristics and changes in fetal head position and decline variety, linking them to clinical findings. Results: 219 ultrasounds were performed. At the begin, the ultrasound mean of the dilation was 5.94 x 1.70 cm and by clinic was 5.96 x 1.80 cm (p-0.717). At two hours, it was 8.14 x 1.92 cm and 8.15 x 2.07 cm, respectively (p-0.849). At the third control, it was 8.35 x 1.70 cm per ultrasound and by clinic it was 8.43 x 1.97 (p.0.604). With regard to erasure, among the 4 patients with grade 3 (the least erasure), 1 (25%) neck erased 40% - 50% and 3 (75%), 60% - 70%; 116 (100%) patients ultrasound as grade 0 (the maximum erasure), had a neck erased by more than 80%. There was an association between Hodge’s plane with the head-to-perineum distance (p-0.001) and the mid-line angle (p-0.001). There was no association with head-symphysis distance. Satisfaction was 100%. Conclusion: Intrapartum transperineal ultrasound is useful in evaluating the progression of labor. Keywords: Transperineal, Position variety, Fetal head descent.

Intrapartum nipple stimulation therapy for labor induction: a randomized controlled external pilot study of acceptability and feasibility

BACKGROUNDNipple stimulation is purported as a natural and inexpensive method for inducing labor, but its use is understudied. OBJECTIVEWe aimed to assess whether conducting a large randomized controlled trial comparing intrapartum nipple stimulation therapy with oxytocin infusion is feasible and acceptable to patients and obstetrical care providers. STUDY DESIGNThis single-center parallel-group randomized controlled external pilot study (ClinicalTrials.gov Identifier NCT04756089) included women at ≥36 weeks of gestation who were planned to receive exogenous oxytocin for their labor induction. Women who were <18 years old, non-English speaking, or with fetuses at increased risk of neonatal intensive care were excluded. Stratified by parity, women were randomized 3:1 to intrapartum nipple stimulation therapy or immediate receipt of oxytocin. Women assigned to nipple stimulation therapy were asked to stimulate with an electric breast pump or by hand for periods of at least 30 minutes, with breaks as needed for up to 15 minutes at a time, for at least a cumulative 2 hours before considering initiation of oxytocin, and to complete intrapartum diaries. Labor characteristics and outcomes were examined. Validated questionnaires were used to assess the participants’ pain level during the intervention, their sense of control during childbirth, and their breastfeeding success. Primary outcome measures were recruitment, adherence to study protocol and follow-up, and crossover rates. RESULTSA total of 620 women underwent labor induction from March 13, 2021 to June 23, 2021. Of 557 potentially eligible women, 53 were approached by available research staff. Of the 53 women, 24 (45%) consented and enrolled: 18 randomized to nipple stimulation and 6 randomized to oxytocin. Moreover, 1 woman assigned to nipple stimulation withdrew because of delay of clinical care and received oxytocin (crossover rate of 1/24 [4%]), and 1 woman assigned to oxytocin did not receive it because of spontaneous labor progress. All other participants followed their assigned intervention. The 17 women who performed nipple stimulation stimulated for a median duration of 198 (interquartile range, 125–291) minutes and required a median of 69 (interquartile range, 21–80) minutes of stimulation before achieving at least 3 contractions in a 10-minute window, averaged >30 minutes (also known as “adequate” contractions). Among those assigned to nipple stimulation therapy, 15 of 17 women (88%) later received oxytocin infusion before delivery. The median times from intervention start to delivery were 16.4 (interquartile range, 0.6–28.2) hours for women assigned to nipple stimulation and 20.6 (interquartile range, 14.2–23.4) hours for women assigned to oxytocin infusion. Of note, 12 women (50%) completed their postpartum study questionnaires. CONCLUSIONRandom assignment to either intrapartum nipple stimulation therapy or oxytocin infusion for labor induction was feasible and acceptable to patients and obstetrical care providers.

Ultrasonographic foetal head circumference and cheek-to-cheek diameter at term as predictors of labour outcomes.

The clinical uses of ultrasonography have varied and increased over time, especially the ability of ultrasonographic measured parameters to predict the outcomes of labour. The proper understanding of the association between these ultrasonographic parameters, mode of delivery, adverse maternal and foetal outcomes will further improve patient counselling as well as the planning of intrapartum care. The study explored the ultrasonographic measurement of foetal head circumference (HC) and cheek-to-cheek diameter (CCD) at term as predictors of labour outcomes. Eligible pregnant women at term were recruited from the antenatal clinic and had obstetric ultrasound scans done with HC and CCD measured. Maternal and foetal outcomes were measured and included progress in labour, obstetric lacerations, mode of delivery and suspected foetal distress. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 20. One hundred and thirty-two patients were recruited into the study. Foetal HC measurements ≥35 cm were closely associated with caesarean delivery odds ratio - 2.40 (95% confidence interval - 1.02-5.66. P = 0.046). Neither CCD nor CCD/HC ratio was predictive of the modes of delivery. The occurrence of perineal lacerations and poor progress of labour were observed more frequently with increasing HC and CCD. HC performed well in predicting caesarean delivery as well as perinatal outcomes among parturients. The ultrasonographic measured HC (≥35 cm) is associated with a higher incidence of both obstetric interventions for poor progress of labour and adverse perinatal outcomes in comparison to CCD. The association between HC and labour dystocia was found to be linear. The CCD did not perform well as a predictor of the mode of delivery.

ОСОБЛИВОСТІ УПРАВЛІННЯ ПЕРСОНАЛОМ ІЗ ВРАХУВАННЯМ ПРАВОВОГО АСПЕКТУ

The search for internal reserves of economic growth of industrial enterprises requires an improved approach to efficiency of personnel management, and new conditions of competitive environment, including intellectualization and informatization of labor, rapid scientific and technological progress confirm the important role of synthesized capital (human, intellectual and social capital). In view of this, the issues of organizational and economic support for the effectiveness of personnel management, which need to be urgently addressed, are becoming especially important. The main purpose of the personnel management system is to create an effective motivation to provide the company with highly qualified personnel, its productive use, professional and social development. The essence of personnel management, including employees, employers and other business owners, is to establish organizational, economic, socio-psychological and legal relations of the subject and object of management. These relations are based on the principles, methods and forms of influencing the behavior and activities of employees in order to maximize benefits. The tasks of legal support of personnel management system include: legal regulation of labor relations between employers and employees, protection of rights and legitimate interests labor relations The article considers the concept of personnel management and its features. These indicators have a significant impact on the effectiveness of personnel management. The approaches to work with the personnel in the western companies are resulted. The importance of the regulatory framework for personnel management is highlighted and the legal framework for personnel accounting in Ukraine is presented. The issues of competence of HR managers of companies are identified. The issue of preventive mediation is considered. The list of the main tasks of the legal support of the personnel management system is determined. The dynamics of claims under labor legislation in Ukraine for 2018-2020 in general and in the following areas: resumption of work, non-payment of wages, compensation for material damage caused by employees to state enterprises and institutions. Recommended ways to avoid lawsuits with employees.

Association between Intrapartum Cardiotocography and Umbilical Cord Blood pH in Term Pregnancies: A Cross-sectional Study in a Tertiary Care Centre, Kolkata, India

Introduction: Labour, a physiological process for majority of foetuses, often acts as a challenge to foetal reserves causing foetal hypoxia. Foetal monitoring with intrapartum cardiotocography is an important tool to enable timely intervention to reduce adverse neonatal outcomes like postnatal cerebral palsy. Aim: To determine an association between cardiotocography tracing and umbilical artery cord blood pH in term pregnancies in labour where the influence of drugs and the presence of other comorbid medical/obstetric adverse outcomes have been ruled out. Materials and Methods: This cross-sectional, hospital-based, observational study involved singleton uncomplicated term pregnancies with a normal baseline cardiotocography and spontaneous labour onset and progression admitted to the labour ward of R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India. Intrapartum continuous cardiotocography traces were recorded and those showing abnormal traces were documented and delivery expedited within two hours. Total of 90 such consecutive women were included in the study and umbilical arterial cord blood sample was taken for all these pregnancies immediate postpartum. Cardiotocography traces were then statistically compared with cord blood parameters and the findings were computed using Statistical Package for the Social Sciences (SPSS) software version 22.0. Results: Out of 90 participants the mean age was 24.21±3.43 years, most (43, 47.8%) of them were in between 21 to 25 years. Of the abnormal traces, 51 (56.7%) were NICE Category II (Suspicious) and 39 (43.3%) were NICE category III (pathological). Cord blood analysis revealed that 40% had a pH&lt;7, 44.4% had blood lactate levels above 6 mmol/L and another 47.7% had a base deficit ≥12 mmol/L. On crosstabulation and Chi-square analysis, these were all found to be statistically significant (p-value &lt;0.05). Abnormalities of Foetal Heart Rate (FHR) and baseline variability had higher Odds ratio of predicting umbilical artery acidemia with Odd’s ratio for baseline variability abnormality as high as 2.768. Conclusion: Although there has been a rising trend towards operative deliveries, the overall incidence of neonatal morbidity due to cerebral palsy is still on the rise. Cardiotocography can be a very important tool to identify neonatal acidosis in “at risk” foetuses and helps in timely intervention giving long term best outcomes.

EFFECT OF INDUCTION WITH OXYTOCIN DRIP ON INCIDENCE OF POSTPARTUM HEMORRHAGE IN BUNDA ASY SYIFA MOTHER AND CHILD HOSPITAL BANDAR LAMPUNG

Background: Postpartum hemorrhage is an important problem because it is related to maternal health and can cause death. The definition of postpartum hemorrhage is bleeding of 500 ml or more that occurs after the baby is born. In 2013, the highest maternal mortality rate in Indonesia was caused by postpartum hemorrhage, which was 30.3%. The most common etiology of postpartum hemorrhage was uterine atony (60%) and placental complications (36%), the largest factor (4%) was a history of previous postpartum hemorrhage, anticoagulant drugs, anemia, severe preeclampsia or HELLP syndrome, uterine fibroma, multiple pregnancies. The most common side effects of oxytocin are nausea, vomiting, and the worst side effects are allergic reactions, blood clotting problems, heart arrhythmias, heavy or continued bleeding after delivery, increased blood loss, and blood clots in the pelvis. Objective: The purpose of this study was to determine the effect of oxytocin drip induction on the incidence of postpartum hemorrhage at RSIA Bunda Asy Syifa Bandar Lampung in 2020. Methods: This study used an analytic observational method through aapproach case controlwith a sample size of 254 samples. Sampling used a total random sampling method using secondary data taken in 2021. Bivariate analysis was carried out with Chi-Square. Results: The results showed that mothers who were given oxytocin drip induction experienced postpartum hemorrhage as much as 57%. The results of thestatistical test chi square showed that the induction of oxytocin drip with the incidence of postpartum hemorrhage had a significant relationship with the incidence of postpartum hemorrhage with p value = 0.000 (p <0.005). Conclusion: Mothers who were given oxytocin drip induction were 8.4 times more likely to experience postpartum hemorrhage. Health workers carry out regular monitoring and recording of the progress of labor on the partograph as a preventive measure against risk factors for postpartum hemorrhage.

Effect of metoclopramide in shorting the length of labor: a randomized controlled trial

ObjectiveTo establish whether metoclopramide plays a role in shorting the length of labor.BackgroundThe actual role of metoclopramide concerning cervical dilatation to improve labor progress is still controversial.Patients and methodsA prospective randomized control study was conducted on 100 pregnant women who were admitted to Etay-Elbaroud Hospital. They were divided into two equal groups; each included 50 pregnant women. Each group received a prefilled syringe with either metoclopramide or saline.ResultsThe results indicated that there were statistically significant differences between the two studied groups regarding cervical dilation at 2, 4, 6, 8, and 10 h, as P values were 0.018, 0.001, more than 0.001, more than 0.001, and 0.043, respectively. Regarding full cervical dilatation, there were statistically significant differences between the two studied groups regarding cervical dilation at 6, 8, and 10 h, as P values were 0.037, 0.001, more than 0.001, and more than 0.001, respectively. Kaplan–Meier survival analysis showed a significant difference in the probability of faster delivery among women who were treated with metoclopramide and others who were treated with placebo (P = 0.036).ConclusionMetoclopramide usage in the first stage of labor significantly enhances cervical dilatation, which subsequently may shorten the duration of labor.

LITERATURE REVIEW : EFEKTIFITAS PELVIC ROCKING EXERCISE MENGGUNAKAN BIRTHING BALL TERHADAP KEMAJUAN PERSALINAN PADA IBU PRIMIPARA

Indonesia's Health Profile in 2019 in general, there was a decrease in maternal mortality during the period 1991-2015 from 390 to 305 per 100,000 live births, if it is associated with the 2015 Millennium Development Goals (MDGs), namely reducing the maternal mortality rate (MMR) to 102/100,000 live births. the maternal mortality rate did not reach the MDGs target. Physiological efforts are made to prevent prolonged labor, such as pelvic rocking exercise using the birthing ball technique. This is also a method that really helps respond to pain in an active way and reduces the length of the first stage of labor in the active phase. This study aims to determine the effectiveness of the implementation of pelvic rocking with a birthing ball on the progress of labor in primiparous women in 2020. This study uses Systematic Literature Reviews (SLR), which is a synthesis of systematic, clear, comprehensive literature studies, by identifying, analyzing , evaluating through the collection of existing data with an explicit search method and involving a critical review process in the selection of studies. In 6 journals, all journals perform pelvic rocking exercise techniques using the birthing ball technique when the mother enters the first stage of the active phase. The conclusion in this study is that all journals reviewed by researchers can be ascertained that all of these journals get the same results, namely stating that using the Pelvic Rocking Exercise technique with the help of a birthing ball can make delivery times for mothers go faster