Prolonged Labor Research Articles

Risk Factors and Outcome of Early Puerperium Following Caesarean Section

Introduction: The postpartum period, or puerperium, typically lasts six weeks following childbirth and is crucial for the reversal of pregnancy-induced anatomical and physiological changes. This period is often divided into three stages: immediate, early, and remote puerperium. Early puerperium, the first week after childbirth, is critical due to the heightened risk of complications, especially following cesarean sections (CS). Objective: This study aims to investigate the prevalence and types of early puerperal complications in women undergoing elective and emergency cesarean sections. Methods: A retrospective observational study was conducted in the Obstetrics and Gynecology department at Enam Medical College Hospital, Savar, Dhaka, Bangladesh. Hospital records from January 2015 to December 2015 were reviewed, including 100 women who had undergone cesarean sections. Data on demographic characteristics, antenatal care, risk factors, and types of early puerperal morbidities were collected and analyzed using SPSS version 20. Results: The study found that 55% of the participants were aged 21-30 years, 70% belonged to poor socioeconomic backgrounds, and 90% were housewives. A significant 70% of the women had not received any antenatal care. The most prevalent risk factors for early puerperal morbidities were obstructed labor (40%) and prolonged labor (30%). Common complications included wound infections (50%), endomyometritis (45%), and urinary tract infections (35%). Conclusion: Early puerperal complications are prevalent among women who undergo cesarean sections, particularly those from low socioeconomic backgrounds with inadequate antenatal care. Addressing these issues through improved prenatal and postnatal care and better access to skilled birth attendants can potentially reduce these complications and enhance maternal health outcomes.

Prediction of Cerebral Palsy and Other Motor Developmental Trajectories in High-Risk Neonate Using the Rapid Neurodevelopmental Assessment (RNDA)

Background: Cerebral Palsy (CP) is a prevalent motor disability affecting children globally, emphasizing the need for early identification and intervention. The Rapid Neurodevelopmental Assessment (RNDA) offers a comprehensive approach to predict CP and other motor developmental trajectories in high-risk neonates. Objective: This longitudinal cohort study aims to evaluate the effectiveness of RNDA in predicting CP and motor developmental trajectories. Method: Seventy term neonates from Dhaka Shishu (Children) Hospital were included, with neurodevelopmental assessments conducted using RNDA. Assessments were performed at 3 months and 6-9 months, with CP evaluation at 12 months using clinical examinations. Results: Prolonged labor (44.3%) and delayed cry after birth (31.4%) were common among the study patients (n=70), with varying modes of delivery including normal vaginal delivery (50.0%), vaginal delivery with complications (12.9%), and lower uterine cesarean section (37.1%). Muscle tone, primitive reflexes, gross and fine motor skills, epilepsy, and microcephaly were evaluated across visits to identify impending CP. Significant associations were found between hypertonicity, primitive reflex impairment, gross motor impairment, and fine motor impairment with impending CP across visits, particularly in the 3rd visit (p<0.05). Sensitivity, specificity, accuracy, and predictive values varied across parameters and visits, with fine motor skills and gross motor skills showing the highest sensitivity in the 3rd visit (86.4% and 100.0%, respectively). Additionally, abnormal EEG, USG of the brain, and MRI findings were significantly associated with impending CP, with USG of the brain demonstrating the highest sensitivity (93.3%) and MRI showing the highest specificity (70.0%). Conclusion: RNDA emerges as a valuable tool for early prediction of CP and motor developmental trajectories in high-risk neonates. Early identification through RNDA facilitates timely interventions, optimizing long-term neurodevelopmental outcomes.

EFEKTIVITAS SENAM HAMIL PADA IBU TRIMESTER III TERHADAP JENIS PERSALINAN

One of the causes of the high number of maternal deaths is prolonged labor. The form of prevention of prolonged labor that can be done is by controlling the five factors of the birth process which include power, passage, passenger psychology and helpers. Power is a very important birth factor, originating from pregnant women which can be controlled with pregnancy exercises. This research aim is to determine the outcomes of maternal exercise in the third trimester during the birth process. This research method is retrospective, with a total sampling technique of 25 and data analysis use Chi Square. The results of this study were that the majority of pregnant women in the third trimester did regular pregnancy exercise, with as 20 respondents (80.0%). Pregnant women in the third trimester who do pregnancy exercises regularly mostly have a normal delivery process, 17 respondents (85%), and the Pearson Chi-Square Test shows that the significant value is p value = 0.035 < a (0.05), so H1 is accepted. Keywords: Labor Process; Pregnancy Exercise Outcomes; Third Trimester

Maternal excessive weight gain as a potential risk factor for prolonged labor in Japanese pregnant women: The Japan Environment and Children's Study.

This study aimed to determine whether excessive maternal weight gain during pregnancy was associated with a higher risk of prolonged labor. We analyzed the data regarding maternal weight gain during pregnancy for the participants of Japan Environment and Children's Study (JECS), which is an ongoing nationwide prospective birth cohort study in Japan. After excluding participants with multiple pregnancies, with deliveries before 37 or beyond 42 weeks of gestation, or who had undergone cesarean section, 71,154 (nulliparous, n = 28,442) Japanese women were included. Prolonged labor was defined by a cutoff ranking at the 95th percentile and consequently defined as labor duration exceeding 12.7 h in multiparous women and exceeding 23.2 h in nulliparous women. These classifications were made according to labor curves established by the Japanese Society of Obstetrics and Gynecology Perinatal Committee developed in June 2021. Considering that no studies have conducted an investigation based on this new guideline, we analyzed the association between excessive maternal weight gain during pregnancy and prolonged labor by parity. The overall incidence of prolonged labor was 10.2% (2,907/28,442) in nulliparous women and 6.1% (2,597/42,712) in multiparous women. Multivariable analysis indicated that excessive maternal weight gain was significantly associated with prolonged labor in nulliparous (adjusted odds ratio, 1.21; 95% confidence interval, 1.10-1.32) and multiparous women (adjusted odds ratio, 1.15; 95% confidence interval, 1.05-1.27). Kaplan-Meier survival analysis showed that as labor progressed, the percentage of women who had not yet delivered was higher among those with excessive maternal weight gain than among those with normal maternal weight gain in both the nulliparous (median labor duration 12.9 h vs 12.2 h, p<0.001) and multiparous (median labor duration 6.2 h vs 5.8 h, p<0.001) groups. Excessive maternal weight gain was significantly associated with prolonged labor in Japanese women.

Clinico-microbiological evaluation of post-cesarean surgical site infections

Objectives: With increasing rates of cesarean section (CS), the incidence of post-operative complications is bound to increase, which includes surgical site infections (SSIs), being one of the common and distressing complication. This study was aimed to evaluate the various determinants of post-CS SSI, their clinical spectrum, prevalent microbiology, and their susceptibility and resistance patterns. Materials and Methods: This was a prospective longitudinal hospital-based study undertaken in Government Medical College and Hospital (GMCH), Chandigarh. Six hundred and eighty-eight patients were included from April, 2021, to September, 2022, and were followed up till 42nd day post-procedure. Results: The incidence of SSI in the study was 3.49%. The risk factors identified were gestational diabetes mellitus (GDM), thrombocytopenia, chorioamnionitis, prolonged labor, multiple per vaginum examinations, prolonged surgery, post-partum hemorrhage, and blood and blood product transfusions. Most patients presented on or after day 8 of surgery with discharge from the wound site being the most common presentation. Staphylococcus aureus emerged as the most prevalent organism and out of five patients having S. aureus, three had methicillin-resistant S. aureus. Linezolid was found to be the most susceptible antibiotic, whereas ciprofloxacin was mostly resistant among the prevalent isolates. Conclusion: Some of these determinants are modifiable such as GDM and thrombocytopenia and if detected and managed early may help in reducing the risk of developing SSI. Linezolid must be used empirically for treatment of SSI until the reporting of culture and sensitivity is done because routine antibiotics used for antibiotic prophylaxis in CS were found to be highly resistant. Periodic analysis of clinical spectrum and culture and sensitivity patterns is imperative for the early diagnosis and appropriate empirical management of SSI.

Safety and Efficacy of Oral Mifepristone for Cervical Ripening and Induction of Labor.

Background Labor induction, a common practice to prevent maternal and fetal complications from prolonged labor, involves stimulating contractions before they begin naturally. This can be achieved through medications, mechanical methods, or surgical interventions. Cervical ripening is crucial for successful delivery. When the cervix is not sufficiently ripe, drugs are often used to augment this process chemically. Objective To evaluate the safety and efficacy of mifepristone for cervical ripening and induction of labor. Method A sample size of 200 was used in this single-blind randomized control trial. Primarily, pregnant women with term pregnancies, Bishop scores <6, and cephalic fetal presentation were included in the study. The study population was randomly divided into test and control groups. The test group (n=100) was administered 200 mg of mifepristone orally, while the control group (n=100) received a placebo. The Bishop score was reassessed 24 hours after mifepristone administration. Patients were taken for labor induction if their Bishop score was >6. For individuals with a Bishop score of <6, 1 mg of dinoprostone gel was administered intracervically once every six hours. Safety and efficacy were assessed by analyzing several parameters associated with labor progression, maternal outcomes, and fetal outcomes. Results The mean age of patients in the test group was 26±4.5 years, while in the control group, it was 26±5 years. The induction-to-delivery interval was notably shorter in the test group (18.8±2.3 hours) than in the control group (19.24±1.8 hours, p<0.0001). After the administration of 200 mg mifepristone, the mean Bishop score in the test group was 5.74±0.8, compared to 5.13±0.76 in the control group. The increase in the Bishop score after mifepristone treatment was significantly higher in the test group than in the control group (p-value=0.013). In the study, 73 (73%) patients in the test group had a normal vaginal delivery (NVD), whereas NVD accounted for 64 (64%) patients in the control group. Instrumental deliveries were less frequent in the test group, accounting for 14 (14%) patients, compared to 16 (16%) patients in the control group. The frequency of lower segment cesarean section (LSCS) was also lower in the mifepristone-treated group at 13 (13%) compared to the control group at 20 (20%). Fetal distress in five (38%) patients and non-progression of labor in 11 (55%) patients were the most frequent indications for LSCS in the test and control groups, respectively. There was no significant difference in neonatal outcomes between the test and control groups. Meconium-stained liquor was the most frequent complication in both the test group(10, 10%) and the control group (5, or 5%). Conclusion Administration of mifepristone effectively increased the Bishopscores and reduced the induction-to-delivery interval compared to controls, highlighting its potential as a cervical ripening agent.

Assisted reproductive technology and prolonged third stage of labour: a multicentre study in Japan

Research questionWhat are the risk factors for a prolonged third stage of labour, closely related to postpartum haemorrhage, and what is the effect of assisted reproductive technology (ART) on the third stage of labour? DesignClinical data of women who delivered vaginally at term at 12 primary maternity hospitals in Japan (2010–2018) (n = 25,336) were obtained; 1148 (4.5%) conceived through ART and 2246 (8.9%) through non-ART treatments. The risk of a prolonged third stage of labour (defined as ≥20 min) was evaluated by univariable and multivariable regression analyses. Adjusted odds ratios (aOR) of a prolonged third stage of labour were evaluated, stratified by the type of ART, with natural conception as a reference. ResultsMultivariable analysis showed that pregnancy achieved through ART (aOR 4.38, 95% CI 3.12 to 6.15), history of spontaneous miscarriage (OR 1.40, 95% CI 1.06 to 1.84) and prolonged labour (OR 1.52, 95% CI 1.09 to 2.12) were identified as independent risk factors. Frozen embryo transfer (FET), FET in a hormone replacement cycle (HRC–FET) and blastocyst-stage embryo transfer were significantly associated with a prolonged third stage of labour (aOR 4.07, 95% CI 2.75 to 6.04, aOR 4.11, 95% CI 2.58 to 6.57 and aOR 2.13, 95% CI 1.15 to 3.95, respectively). No significant difference was observed in the duration of third stage of labour between natural conception and non-ART treatment (P = 0.61). ConclusionPregnancy achieved through ART, particularly FET, HRC–FET and blastocyst-stage embryo transfer, was a significant risk factor for a prolonged third stage of labour.

Education of Birth Ball Training as Therapy to Relieving Labor Pain

Labor pain arises because of the mother's physical and psychological response. Emotions become unstable due to anxiety and fear which worsen the condition of labor pain. The pain experienced by the mother during labor can give rise to fear which makes her anxious and often leads to panic attacks. This condition causes a physiological response that can disrupt the condition of the uterus when it contracts so that the impact of labor will last a long time. Usually, the mother who is about to give birth will find it difficult to adjust to the conditions of labor pain, so that uterine contractions cannot be controlled which causes the first stage to lengthen and the fetus to be disturbed. A prolonged labor process is a type of birth complication that is worrying, complicated, and unpredictable. A non-pharmacological method that can reduce labor pain is birth ball therapy. Research that has been conducted has found that birth ball exercises affect reducing labor pain. PkM is implemented through educational activities where there are 30 PkM participants. The results of the PkM implementation show that the PkM participants have been successfully educated through this PkM activity so that they can apply birth ball exercises to reduce labor pain in mothers. Due to the implementation of this PkM activity, it is hoped that there will be an increase in the knowledge of midwives who play a role in initial level services to provide appropriate steps in dealing with labor pain in mothers using complementary therapy, and birth ball exercises.

Ambulation During Neuraxial Analgesia in Obese Patients: A Pilot Study

Objective: Obese patients are known to have prolonged labors and an increased risk of cesarean delivery in comparison to their normal weight counterparts. Movement has previously been shown to have beneficial effects on the labor process; however, neuraxial analgesia is often recommended in obese women and in common practice limits mobility. The benefits of continuing to ambulate during neuraxial analgesia are not known. As prior studies have postulated a soft tissue dystocia as a potential etiology for prolonged labor among obese patients, ambulation and encouraged movement throughout the labor process may be of particular benefit for these patients. The purpose of this study was to evaluate the feasibility of ambulation with neuraxial analgesia in nulliparous obese patients admitted for labor. Study Design: This is a pilot study conducted at a single tertiary care center. Patients with a BMI of &gt;=35 were approached if they were nulliparous, term, and planned vaginal trial of labor. Patients were excluded if there were contraindications to ambulation, including magnesium administration. Participants were identified at &gt;=34 weeks estimated gestational age through clinic templates and induction of labor schedules, and were approached either in person or with a standard phone consent. Combined spinal-epidural analgesia was initiated per our institution’s policy, with the exception that during the latter portion of the study the test dose was eliminated in order to decrease the immediate motor block from this dose. Following epidural catheter placement, serial blood pressure measurements and motor assessments were completed to ensure safety including a straight leg test and a step stool test. Patients who passed these assessments were enrolled in the trial. Patients were encouraged to ambulate for 20 minutes of every hour while maintained on fetal and uterine telemetry. Ambulation was discouraged after complete dilation. Demographics and delivery outcomes were collected. Results: 105 patients were identified for consent for the trial, of whom 20 were ineligible for the study, 20 were not approached, and 40 declined study participation, leaving 25 patients who were consented. Of those 25, 14 completed the study. Reasons for not completing the study included ineligible by motor assessment, BMI less than 35 at time of delivery admission, preterm delivery, withdrawal, complete dilation at time of epidural without time to ambulate, magnesium administration during labor. A total of 14 participants were enrolled in the pilot trial, of which 11 were able to ambulate. The average BMI of participants was 43 kg/m2. Patients received epidural analgesia at a median cervical dilation of 4 cm and the average time from initiation of epidural analgesia to delivery was 15.4 hours. 65% of patients enrolled had a cesarean delivery. Of the 5 patients with a vaginal delivery, there was 1 shoulder dystocia. The median time spent ambulating was 58.5 minutes, with a range of 20-230 minutes. No patients fell during the trial. While one patient developed a spinal headache, it was not thought to be related to ambulation. Conclusions: A pilot trial of ambulation during neuraxial analgesia demonstrated no safety concerns among an obese nulliparous population. This pilot study was underpowered and is not designed to determine if there is an effect of ambulation with neuraxial analgesia on mode of delivery. Strengths of this study were interdisciplinary collaboration and biologic plausibility of decreased cesarean delivery through ambulation. Limitations included a low enrollment rate and the COVID pandemic, which halted the study as well as limited patients from being able to ambulate in the hallways. A larger study is needed to assess the efficacy of this intervention.

Evaluating a clinical mentorship intervention on maternal and neonatal complications in primary health facilities in Blantyre district, Malawi: A longitudinal analysis of the Global Action in Nursing program

BackgroundWhile Malawi has made great strides increasing the number of facility-based births, maternal and neonatal mortality remains high. An intervention started in 2019 provided short-course training followed by year-long longitudinal bedside mentorship for nurse midwives at seven health facilities in Blantyre district. The intervention was initiated following invitation from the district to improve outcomes for patients during childbirth. This study examined the impact of the intervention on the reporting of obstetric and neonatal complications and related care. MethodsPatient level data were collected from the District Health Information System 2 database from intervention and non-intervention facilities. Bivariate analysis explored the impact of longitudinal bedside mentorship on select District Health Information System 2 variables at six-month intervals. Outcomes were then analyzed using nonlinear quantile mixed models to better account for the impact of time and clustering at the facility level. ResultsSignificant changes were found in the reporting of obstetric and neonatal complications over time at intervention facilities compared to non-intervention facilities. Intervention facilities showed statistically significant increases in the reporting of prolonged labor, pre/eclampsia, fetal distress, retained placenta, and premature labor. There was also a statistically significant decrease in the reporting of no complications in the multivariate model (95%CI: −0.8 to −0.2). In both the bivariate and multivariate models, the reporting of ‘None’ significantly decreased (0.8 % median), while the reporting of prematurity (0.2 % median) and asphyxia (0.3 % median) both significantly increased. The missingness of data at intervention facilities decreased to almost zero compared to non-intervention facilities. DiscussionThe increase in reported maternal and neonatal complications suggests improved early identification of complications at the facility level. The improved accuracy of patient data from intervention facilities shows the impact mentorship has on data quality which is crucial for the allocation of resources. By highlighting the apparent dose–response relationship of longitudinal bedside mentorship, this study will inform the broader use of mentorship in training programs. Future research is needed to explore the impact of longitudinal mentorship on quality of care.

The Partograph: A Practical Guide for Preventing Prolonged Labour

Background: The partograph, a graphic recording of labour and features in the mother and foetus has been used since 1970 to detect labour that is not progressing normally. The partograph serves early warning system and assist in early decision of transfer, augmentation and termination of labour. It also increases the quality and regularity of observing mother and foetus in labour. Objectives: The study aimed to evaluate effect of using partograph on the management and outcome of labour. Materials and Methods: It was a prospective cross-sectional observational study conducted in the Department of Obstetrics and Gynaecology at Sher-E-Bangla Medical College Hospital, Barishal; Bangladesh over one (1) year from January 2017 to December 2017. A total 280 patients were enrolled in this study. Plotting on the partograph was started at cervical dilation of 4 cm on alert line. Results: The mean age of the participants was 23.4 ±4 years and mean gestational age was 38.3 ±1.74 weeks and 45% were primigravida. The mean Apgar score of the newborn after 5 minutes was 9.3 ±0.7. The mean duration for delivery on active labour was 4.3 ±2.5 hours in primigravida and 3.4 ±2.3 hours in multipara.Conclusion: The proper use of partographs and the application of the right decision at the right time can be achieved the best for maternal and neonatal outcomes. KYAMC Journal Volume: 14, No: 04, January 2024: 215-219.

Analysis of Independent Practice Midwifes in West Pasaman District Using Partograph in Normal Delivery Care

The maternal mortality rate (MMR) and infant mortality rate (IMR) are key performance indicators for a nation. For every Indonesian population, MMR and IMR represent one of the parameters of optimal health status. In an effort to lower the MMR, health professionals are urged to use Partograph to track the progress of labor and make appropriate decisions if pathological conditions are discovered. It has been demonstrated that the Partograph works well for both identifying irregularities in labor and preventing prolonged labor. The purpose of the study is to find out how Partograph are used by midwives at the Independent Midwife Practice in the West Pasaman district. Since the informants for this research are independent practice midwives, the qualitative descriptive research method will be used to collect data through focus group discussions (FGD), in-depth interviews, and observations. Data analysis: By deciphering, writing up, and drawing conclusions from in-depth interviews conducted with key informants and two discussion groups. The research's conclusions are based on the findings of two focus groups and two key informant interviews. Specifically, Partograph are used by independent practice midwives to aid in childbirth; some midwives have also used them to track the progression of labor, particularly for patients with birth insurance so they can claim delivery expenses. The Partograph is filled all the way, but occasionally it is filled after delivery. The only reason partography is applied is to obtain Jampersal fees; independent practical midwives are knowledgeable about partography and have a positive attitude toward it. Organizational policies and leadership for IBI are still lacking.

EFFECTIVENESS OF NIPPLE STIMULATION ON LABOR PROGRESS : EVIDENCE BASED CARE REPORT

Introduction: Prolonged labor is labor that lasts more than 24 hours for primigravida and or 18 hours for multigravida. Prolonged labor is one of several causes of maternal and newborn mortality. As labor progresses, contractions become more frequent, longer and stronger in intensity. Adequate contractions are needed so that labor can take place normally. Nipple stimulation is one way that can be used in increasing uterine contractions. Nipple stimulation causes the breasts to become aroused which causes the intensity of uterine contractions due to the stimulation of the receptors to loosen. This action can be stopped if the contractions experienced have become strong and prolonged. This method is a cost beneficial and effective alternative to induction and augmentation of labor. Objectives:To evaluate effectiveness of nipple stimulation on labor Method: Electronic database literature searches, namely Pubmed and Google Scholar. Result: Two articles were selected from the literature search and then critically reviewed. Based on the study of Gulbahtiyar Demirel and Hanan Ibrahim et al, it was found that nipple stimulation is effective in reducing the induction of elective labor and there is an effect of nipple stimulation on the progress of labor in laboring women. Conclusion: In this case, nipple stimulation was effective on the progress of labor in laboring mothers.

OXYTOCIN RELEASED FROM BACK MASSAGE EXTENDS CONTRACTIONS IN THE FIRST STAGE OF LABOR: EVIDENCE-BASED CASE REPORT (EBCR)

Introduction: Maternal health is a key indicator of community welfare as measured by the Maternal Mortality Rate (MMR). One of the problems with maternal mortality is caused by prolonged labor. Non-pharmacological action in the form of back massage is an important consideration in health services that can be utilized more optimally. This evidence-based case report aims to find out the effectiveness of back massage to increase contractions in the active phase of the first stage of labor. Method: Article search using Pubmed and Google Scholar databases. Found 2 articles chosen one according to the inclusion and exclusion criteria and has been screened previously, then reviewed critically. Result: Based on studies by Kursih Sulastriningsih, et al and Adinda Putri Sari Dewi, et al, it was found that back massage is effective in increased contractions in the first stage of labor in the active phase. Conclusion: Back massage will speed up the work of the parasympathetic nerves in stimulating the posterior pituitary to release oxytocin which can have a relaxing effect. The relaxation experienced by the mother stimulates the brain to reduce levels of the hormone adrenaline and increase the production of oxytocin, which is a factor in producing adequate uterine contractions. Having adequate contractions can cause the cervix to flatten and open. Back massage has been suggested as an effective, inexpensive, non-pharmacological way to induce labor and increase contractions to speed up the progress of labor.

The Impact of the Use of e-Partogram on Maternal and Perinatal Outcomes: A Scoping Review.

To overcome shortcomings of the paper partograph, enhance care during labor and delivery, improve record keeping, and help decision-making, several countries have focused on adopting low-cost digital applications. This scoping review highlights the usability and current status of the digital partogram in obstetric care. We conducted a thorough search involving the databases ScienceDirect, PubMed, and Google Scholar for relevant studies from inception till September 2023 by using the keywords "partograph", "electronic", and "obstetric" as well as the Boolean operators "AND" and "OR". Based on the selection criteria, 25 studies exploring the application of electronic partographs (e-partographs) in obstetric care were included in the review. The majority of the studies examined the efficiency and reported the effectiveness of e-partographs in comparison to paper partographs. The e-partograph has also demonstrated a clear benefit in that the healthcare providers filled out the data, and a reminder mechanism was placed, which might help determine whether the labor process was normal or needed more care. Moreover, an e-partograph was simple to adopt and use for obstetric caregivers and had the potential to save time. To sum up, digital partograph produces superior results to paper partograph. The use of an e-partograph can keep deliveries on track while lowering the need for cesarean sections and prolonged labor. The e-partograph provides essential benefits to its users and also provides a warning system with audible and visual cues that might be utilized to detect difficulties during delivery.

The Effect of Auricular Acupressure on Uterine Contractions, Fetal Heart Rate, and Length of Labor in the Active Phase of Primigravida

The still high maternal mortality rate (MMR) in Indonesia, especially in East Java, is caused by indirect causes or other causes such as prolonged labor, so a method is needed to treat cases of prolonged labor such as auricular acupressure. Auricular acupressure (AKAR) is a non-pharmacological method proven effective for uterine contractions, but its side effects on the fetal heart rate (FHR) are unknown. The research aimed to analyze the AKAR method on uterine contractions, FHR, and labor duration in the first stage's active phase. This type of research is truly experimental, with a pretest-posttest control group design. The research subjects were 41 respondents, primigravida active phase first-stage mothers, selected by consecutive sampling and randomly divided into two groups, namely 21 AKAR groups and 20 deep breathing relaxation control groups. The research results of the Friedman test statistical test ρ-value equal 0.000 in the AKAR group and ρ-value equal 0.000 in the control group, meaning that AKAR influences uterine contractions. The Friedman Test findings show that AKAR does not affect FHR (ρ-value equal 0.618). The Independent Sample Test ρ-value equal 0.29 indicates no statistically significant difference between the two groups' labor lengths throughout the first stage's active phase. The AKAR group's average labor time in the first stage of the active phase was 365.40 minutes, with a minimum of 267 minutes and a high of 395 minutes. Conclusion: The auricular acupressure method affects uterine contractions but does not affect the fetal heart rate. There was no difference in the length of labor in the first active phase of labor between the auricular acupressure and deep breathing relaxation groups, so it is recommended that the auricular acupressure method can be used as an alternative complementary care to prevent prolonged labor.

WORKING WITH MIDWIVES TO IMPROVE MATERNAL HEALTH IN RURAL GHANA

This paper describes the implementation and evaluation of a safe motherhood project in rural Ghana. This project included a partograph and emergency skills program for rural midwives, training and monitoring traditional birth attendants (TBAs), a blood bank and an emergency obstetric transport service. The midwives' roles in caring for women in rural health centres, training and monitoring traditional birth attendants (TBAs) and in emergency obstetric transport are described. In this rural area of Ghana TBAs are responsible for approximately 65% of women in the district during birth. It is important to include them in projects to improve maternal health. The results of process evaluation showed that the rural maternal health system was improved by the project activities through a good communication system, better support for rural midwives, better integration of traditional birth attendants into the health care system and more community involvement. Outcomes included an increase in the number of referrals of women with risk factors and complications to the district hospital, no cases of prolonged obstructed labour in the group of mothers cared for by rural midwives and trained TBAs, a comprehensive recording and reporting system for women cared for by TBAs, and a well established emergency obstetric transport service. Integration of the TBAs into the health care system has had positive effects on TBA practice and morale. However, some TBAs had problems receiving remuneration for their work due to cultural beliefs and practices. The authors conclude that community education and participation are key components of safe motherhood projects.

Serum Folate, Red Blood Cell Folate, and Zinc Serum Levels Are Related with Gestational Weight Gain and Offspring's Birth-Weight of Adolescent Mothers.

Gestational weight gain below or above the Institute of Medicine recommendations has been associated with adverse perinatal and neonatal outcomes. Very few studies have evaluated the association between serum and red blood cell folate concentrations and gestational weight gain in adolescents. Additionally, zinc deficiency during pregnancy has been associated with impaired immunity, prolonged labor, preterm and post-term birth, intrauterine growth restriction, low birth weight, and pregnancy-induced hypertension. The purpose of our study is to evaluate the association between serum concentrations of zinc, serum folate, and red blood cell folate, with the increase in gestational weight and the weight and length of the newborn in a group of adolescent mothers from Mexico City. In our study, 406 adolescent-neonate dyads participated. The adolescents' median age was 15.8 years old. The predominant socioeconomic level was middle-low (57.8%), single (57%), 89.9% were engaged in home activities, and 41.3% completed secondary education. Excessive gestational weight gain was observed in 36.7% of cases, while insufficient gestational weight gain was noted in 38.4%. Small for gestational age infants were observed in 20.9% of the sample. Low serum folate (OR 2.1, 95% CI 1.3-3.3), decreased red blood cell folate (OR 1.6, 95% CI 1.0-2.6), and reduced serum zinc concentrations (OR 3.3, 95% CI 2.1-5.2) were associated with insufficient gestational weight gain. Decreased serum zinc levels (OR 1.2, 95% CI 1.2-3.4) were linked to an increased probability of delivering a baby who is small for their gestational age. Low serum folate, red blood cell folate, and serum zinc concentrations were associated with gestational weight gain and having a small gestational age baby. Both excessive and insufficient gestational weight gain, as well as having a small gestational age baby, are frequent among adolescent mothers.

A prospective study on the causes of hyperbilirubinemia and its clinical markers in term and near-term newborns admitted to a tertiary care hospital in Patna, India

This study aimed to investigate the root causes, prognostic factors, and therapeutic strategies for neonatal hyperbilirubinemia among term and near-term infants admitted to the Neonatal Intensive Care Unit (NICU) at IGIMS, Patna. Furthermore, the research aimed to analyze the clinical progression of these infants throughout their NICU stay.Conducted within the NICU at IGIMS, Patna, Bihar, this study encompassed term and late preterm infants admitted with serum bilirubin levels exceeding 12 mg/dl. The primary focus was on identifying risk factors, etiological factors, and the clinical profile of these infants during their NICU tenure.The study examined birth weight distribution and concurrent medical conditions. Parameters included the initiation of phototherapy based on bilirubin levels and treatment methodologies. Out of the 210 infants studied, 27.14% and 47.62% weighed between 2001 and 2500 grams. The most prevalent causes were physiological (129 cases), fetal prematurity (30 cases), birth asphyxia (7 cases), and prolonged labor (18 cases). Idiopathic causes were observed in 28 instances, ABO incompatibility in 7 cases, and Rh incompatibility in 7 cases. G6PD deficiency was identified once. At the commencement of phototherapy, 19.52% had bilirubin levels between 12 and 15 mg/dl, 58.57% between 15.1 and 18 mg/dl, 11.91% above 20 mg/dl, and 10% between 18.1 and 20 mg/dl.Physiological causes emerged as the most frequent contributors to neonatal hyperbilirubinemia, followed by septicemia and idiopathic factors. Infrequent causes included blood group incompatibility. Phototherapy was established as a cost-effective and efficient method for reducing bilirubin levels in neonatal jaundice. Exchange transfusion proved to be a safe therapeutic measure in cases of severe hyperbilirubinemia. Blood group incompatibility was the main determinant requiring exchange transfusion.

KEMAJUAN PERSALINAN DENGAN MENGGUNAKAN BIRTH BALL PADA IBU BERSALIN PRIMIGRAVIDA DI PMB RENNY INDAH SARI

Background: One of the complications of childbirth that contributes to maternal and infant mortality is prolonged labor. The survey results found that prolonged labor can cause emergencies is mothers and babies. Birth ball is a physical therapy ball that helps mothers in labor during the first stage of labor Purpose: To find out the effect of birth balls on the progress of labor in promigravida mothers at PMB in 2023 Method: The research method used is Quasi Experiment. Data collection used total sampling with a sample of 30 mothers giving birth. By using a static group comparison research design or static group comparison where this design applies treatment or intervention (X) followed by a second measurement or observation. The results of the onservations in the control group, which did not receive the intervention Result: The results of this study showed that the average progress of labor in the intervention group was 292.33 minutes, and in the control group the average progress of labor was 419 minutes. Conclusion: The conclusion of this study is that there is an effect of the birth ball on the progress of labor in primigravida mothers in the first active phase as evidenced by the t-test p-value 0,000&lt;0,5.