Pushing Technique Research Articles

Antegrade horizontal stenting for endovascular coiling of wide-neck aneurysms in the basilar tip: Two case reports.

Endovascular coil embolization for wide-neck intracranial aneurysms is technically challenging and requires supporting devices. Intracranial stents are widely used as a buttress for compact coil filling and preventing coil protrusion into the parent artery. Horizontal stenting has been developed to maximize coil insertion and reduce the risk of thromboembolism. An anterograde route for horizontal stenting could be attempted for basilar tip aneurysms if the posterior communicating artery is not accessible. Here, we report 2 cases of antegrade horizontal stenting (AHS) for wide-neck aneurysm (WNA) in the basilar tip. This approach aims to maximize coil insertion and achieve complete aneurysm occlusion. Both patients were admitted for the treatment of cerebral aneurysms, which were incidentally detected during routine health checkups. Both patients were diagnosed with WNAs at the basilar tip and hypoplastic communicating arteries. The patients underwent stent-assisted coil embolization for WNA in the basilar tip using the catheter jailing technique. After positioning a pre-jailed microcatheter within a basilar aneurysm, AHS was performed using the Neuroform Atlas stent, with the proximal part of the stent deployed across the neck of the basilar tip aneurysm. In both cases, the preselected microcatheter tip shifted either to the anterior or posterior side of the aneurysm immediately after AHS using the pushing technique. The coils inserted into the aneurysm did not reach the opposite side of the microcatheter placement, necessitating additional catheterization. Complete occlusion was achieved by inserting additional coils through the repositioned microcatheter. Horizontal stenting via an antegrade route may be an effective strategy for achieving compact coil embolization in selected patients with WNAs at the basilar tip. The Neuroform Atlas stent appears to be a promising tool for AHS owing to its hybrid-cell design. However, the shifting phenomenon of a jailed microcatheter after AHS warrants attention, as it may present potential challenges that require further catheterization.

The effect of a pushing technique with normal saline on peripheral intravenous catheter placement success in paediatric haematology and oncology: A randomized controlled trial

PurposeThe aim of the present study is to determine the effect of the pushing technique with saline on the success of peripheral IV catheter placement in a paediatric haematology and oncology sample. MethodsThe randomized controlled trial was conducted among 60 paediatric haematology and oncology patients aged between 0 and 17. The participants were randomly assigned to two peripheral intravenous catheter placement groups (intervention group, n:30, control group, n:30). Each patient was evaluated with the Difficult Intravenous Access (DIVA) score before being included in the study. Each patient was assessed using the Personal Information Form for Children and Catheter Registration Form. ResultsThe average age of the children was 86.4 months (SD = 60.0); 36.7% were female. The pushing technique with saline significantly increased the success of placing a peripheral IV catheter on the first attempt in the intervention group compared to the control group (F = 42.391, p = 0.000). The number of attempts during peripheral IV catheter placement significantly decreased in the intervention group compared with the control group (t = −5.676, p = 0.000). Complications were less in the intervention group compared with the control group (χ2 = 24.438, p = 0.000). The procedure time was significantly shorter in the intervention group compared with the control group (t = −4.026, p = 0.000). ConclusionThe pushing technique with saline is an effective method to increase the first attempt success rate, decrease the number of attempts, reduce the procedure time, and reduce the complications during peripheral intravenous catheter placement procedures in paediatric haematology and oncology patients with difficult intravenous access. Trial RegistrationThis study was registered at ClinicalTrials.gov (NCT05685290 & date of first recruitment: January 3, 2023) https://clinicaltrials.gov/ct2/show/NCT05685290.

Feasibility Study on Using Syringes to Separate Human Peripheral Blood for Preparing Platelet-Rich Plasma (PRP)

This paper focuses on exploring new methods for preparing platelet-rich plasma (PRP) to improve its clinical application and popularization. As a natural growth factor, PRP has significant advantages in promoting tissue repair and alleviating inflammation, but limitations in preparation methods hinder its widespread use. The study uses clinical medical syringes as the centrifuge container for PRP preparation. Without disrupting the stratification of the blood, the method employs a pushing technique to move the density gradient centrifuged blood through a medical three-way valve, separating the different blood components to obtain the target PRP layer. This method is simple to operate, has a higher recovery efficiency, and ensures the blood is handled in a closed environment throughout the process, reducing environmental contamination. It can be performed in ordinary settings. The authors seek a feasible, easy-to-operate, environmentally low-requirement, and low-cost separation method to facilitate the clinical popularization of PRP.

Effectiveness of Spontaneous Pushing versus Valsalva Pushing in the Second Stage of Labor on Maternal and Neonatal Outcomes: A Systematic Review and Meta-analysis

Vaginal birth is a natural process, but maternal pushing is an essential factor in the mechanism and process of delivery. This systematic review examined the evidence comparing the effectiveness of two methods of pushing techniques (spontaneous push­ing versus Valsalva pushing) on maternal and neonatal outcomes in the second stage of labor. A literature search of Scopus, PubMed, ScienceDirect, CINAHL, PsycINFO, and ThaiJo for articles published between 2012 and 2023 revealed 12 studies with a focus on maternal pushing during the second stage, but four with neonatal outcomes (APGAR scores) and maternal outcomes (fatigue and duration of labor). Meta-analysis of the four studies did not support the benefit of spontaneous pushing in reducing the duration of labor but did support spontaneous pushing in lessening maternal fatigue two hours postpartum. Spontaneous pushing did not directly benefit the neonatal APGAR scores at 1 or 5 minutes postpartum. The result that spontaneous pushing did not shorten labor was unexpected; this is contrary to other studies that have reported a shorter labor duration. The small number of studies makes it difficult to conclude the effectiveness of either pushing technique. Further evidence is necessary to include possible confounding variables postpartum, including women’s choice, advanced assessments of neonatal outcomes, and maternal recovery beyond the immediate postpartum period.

Faktor-Faktor yang Berhubungan dengan Lama Penyembuhan Laserasi Perineum Ibu Nifas Di Puskesmas Singotrunan-Banyuwangi

Perineal wound at the puerperium can be caused by episiotomy and lacerations during childbirth at the first labour or more. Factors that cause perineal lacerations are parity, birth spacing, breathing and pushing technique at giving birth, maternal age. fetal presentation and weight. The classification of wound healing perineum laceration is divided into 3 phases, firts is inflammatory phase (24 hours-48 hours), poliferation phase (48 hours-5 days), and the maturation phase (5 days and more). The purpose of this study was to analyze the factors associated with the healing time of perineal laceration wounds in puerperal mothers. This research method is quantitative with a cross sectional design of 34 respondents with total sampling techniques.This research was conducted at desember 2022-Januari 2023 at Singotrunuan Village, Subdistric Banyuwangi. Independent variables are patterns of nutritional fulfillment, personal hygiene, and early mobilization. The dependent variable is the healing of perineal laceration wounds. The collection data is using questionaire and analyzed using Chi Square statistical test. The results of the study found that there was a correlation between personal hyegiene, early mobilization, and nutritional fulfillment patterns with the duration of healing of perineal laceration wounds at the puerperal mother with p sig value of <0.005.It is hoped that this study can add insight and knowledge to postpartum mothers with perineal laceration wounds about factors that affect the healing time of perineal laceration wounds.

Stent-screw assisted internal fixation with apex pushing technique for kyphosing thoracolumbar fractures (SAIFAP)

Stent-screw assisted internal fixation with apex pushing technique for kyphosing thoracolumbar fractures (SAIFAP)

Desempenho do diagrama de desvio fonatório no monitoramento da qualidade vocal pré e pós exercício vocal em indivíduos com Doença de Parkinson

ABSTRACT Purpose To assess the performance of the phonatory deviation diagram and its measurements in monitoring voice quality before and after voice exercise in individuals with Parkinson's Disease. Methods Retrospective and documentary study. A sample of 30 subjects was used, 50% male, with a mean age of 62.13 ± 9.05 years. The results of the phonatory deviation diagram were analyzed, in the moments before and after vocal exercise with the pushing technique associated with plosive sounds, considering the area, density, shape and location of the diagram in the quadrants. For comparison purposes, the acoustic parameters of jitter, shimmer, glottal to noise excitation ratio and results of the auditory-perceptual analysis, carried out in previous research, were also considered, in the pre- and post-technical moments. Results Despite the fact that there was no difference in the distribution of samples in the diagram, after performing the vocal technique, a change in the displacement of the diagram towards the area of normality was identified in the visual qualitative analysis, and there was an association between the general degree of vocal deviation in the analysis auditory perception and the area of the diagram. There was an improvement in the shimmer values after the vocal technique. Conclusion The displacement of the phonatory deviation diagram towards the area of normality corroborated the results in relation to the general degree of dysphonia, evaluated by the auditory-perceptual analysis and the shimmer results, after the vocal technique. Thus, the diagram shows good performance in monitoring voice quality of individuals with Parkinson’s.

Stent-screw assisted internal fixation with APEX pushing technique for kyphosing thoracolumbar fractures (SAIFAP)

Stent-screw assisted internal fixation with APEX pushing technique for kyphosing thoracolumbar fractures (SAIFAP)

Endoexpression technique of nucleus delivery in manual small-incision cataract surgery.

Manual small-incision cataract surgery (MSICS) is a cost-effective alternative to phacoemulsification and extracapsular cataract extraction (ECCE) for cataract surgery. The surgical technique in MSICS is heterogeneous, and the maximum variation exists in incision and nucleus delivery techniques. Many studies on various incisions are available, and most of them are dedicated to surgically induced astigmatism (SIA), utility, and visual outcomes. The nucleus delivery techniques have less-extensive literature available. They can be divided into "pulling" techniques like phacosandwich technique, fish hook technique, and vectis delivery and "pushing" techniques like viscoexpression or hydroexpression with irrigating vectis/Blumenthal's MiniNuc technique. Postoperative surgical-induced astigmatism is comparable in all techniques. The authors describe a pushing technique which does not raise the pressure of the anterior chamber and can be utilized with variable-sized and irregularly shaped nuclear fragments. It has universal application, especially when the size of the incision is getting smaller in MSICS and phacofragmentation is being used as an adjunct to reduce the incision size. It can be used in situations like posterior polar cataracts, where pressure variations in the anterior chamber can be dangerous.

On the management of maternal pushing during the second stage of labor: a biomechanical study considering passive tissue fatigue damage accumulation

During the second stage of labor, the maternal pelvic floor muscles undergo repetitive stretch loading as uterine contractions and strenuous maternal pushes combined to expel the fetus, and it is not uncommon that these muscles sustain a partial or complete rupture. It has recently been demonstrated that soft tissues, including the anterior cruciate ligament and connective tissue in sheep pelvic floor muscle, can accumulate damage under repetitive physiological (submaximal) loads. It is well known to material scientists that this damage accumulation can not only decrease tissue resistance to stretch but also result in a partial or complete structural failure. Thus, we wondered whether certain maternal pushing patterns (in terms of frequency and duration of each push) could increase the risk of excessive damage accumulation in the pelvic floor tissue, thereby inadvertently contributing to the development of pelvic floor muscle injury. This study aimed to determine which labor management practices (spontaneous vs directed pushing) are less prone to accumulate damage in the pelvic floor muscles during the second stage of labor and find the optimum approach in terms of minimizing the risk of pelvic floor muscle injury. We developed a biomechanical model for the expulsive phase of the second stage of labor that includes the ability to measure the damage accumulation because of repetitive physiological submaximal loads. We performed 4 simulations of the second stage of labor, reflecting a directed pushing technique and 3 alternatives for spontaneous pushing. The finite element model predicted that the origin of the pubovisceral muscle accumulates the most damage and so it is the most likely place for a tear to develop. This result was independent of the pushing pattern. Performing 3 maternal pushes per contraction, with each push lasting 5 seconds, caused less damage and seemed the best approach. The directed pushing technique (3 pushes per contraction, with each push lasting 10 seconds) did not reduce the duration of the second stage of labor and caused higher damage accumulation. The frequency and duration of the maternal pushes influenced the damage accumulation in the passive tissues of the pelvic floor muscles, indicating that it can influence the prevalence of pelvic floor muscle injuries. Our results suggested that the maternal pushes should not last longer than 5 seconds and that the duration of active pushing is a better measurement than the total duration of the second stage of labor. Hopefully, this research will help to shed new light on the best practices needed to improve the experience of labor for women.

Application of exposure enhancement technique combined with femoral condyle pushing technique in repairing the posterior horn of the medial meniscus under knee arthroscopy.

Objectives:To investigate the clinical efficacy of exposure enhancement technique and femoral condyle pushing technique applying in the posterior horn of the medial meniscus of the knee.Methods:From January 2016 to June 2019, 52 patients with injury in the medial meniscus treated in our department were selected. The horizontal tear of the posterior horn of the medial meniscus was repaired by exposure enhancement technique and femoral condyle pushing technique using the meniscus suture system. Postoperatively, the efficacy was evaluated using the Lysholm scoring system.Results:These 52 patients were all followed up for 3~18 months, with an average of 12.5 ± 7.3 months. The pain and activity of all patients were significantly improved compared with those before surgery.Conclusion:Exposure enhancement technique and femoral condyle pushing technique in the repair of the posterior horn of the medial meniscus presents satisfactory efficacy. It can improve the pain and activity of the knee, and enhance the stability of residual meniscus. Therefore, it is worth promoting.

EFEKTIFITAS TEKNIK MENERAN TERHADAP KEJADIAN RUPTURE PERINEUM PADA IBU BERSALIN

Mechanical menerant is an influence on the incidence of perineal rupture in normal delivery that causes postpartum hemorrhage. Bleeding is the main cause of maternal death in Indonesia. The results of a survey conducted that the incidence of perineal rupture was caused by a pressing technique error. This study aims to determine the effectiveness of the pressing technique on the incidence of perineal rupture at the Batam City OW Clinic in 2020. This type of research is an analytical survey. The data collection technique used is primary data using observation sheets. The sample in this study were all normal mothers who gave birth at the Batam City OW Clinic, totaling 47 people. Based on the results of research conducted from 47 respondents, there were 15 respondents (31.9%) who pushed correctly, it was found that 13 respondents (72.2%) had no perineal rupture. while 32 respondents (68.1%) who said incorrectly, 27 respondents (93.1%) experienced perineal rupture after statistical tests (chi-square test) obtained a P-value of 0.000. This means that Ho is rejected and Ha is accepted, so it can be concluded that the pushing technique is really effective against the incidence of perineal tears in maternity mothers.

Comparing the accuracy and complications of peripherally inserted central catheter (PICC) placement using fluoroscopic and the blind pushing technique.

IntroductionPeripherally inserted central catheters (PICCs) offer a convenient long‐term intravenous access option. Different methods exist for insertion including the use of continuous fluoroscopy for guidance, or bedside insertion techniques. The blind pushing technique is a bedside approach which involves advancing a PICC through the access sheath without imaging guidance, before taking a mobile chest radiograph to confirm tip position. Obtaining optimal position is a critical aim of PICC placement as malpositioned lines have been associated with higher complications including death. We aimed to assess the accuracy of PICC placement by comparing the tip position and complications for lines placed under fluoroscopic guidance to those placed without fluoroscopic guidance.MethodsThe Radiology Information System was used to identify 100 continuous PICC insertions in each group (fluoroscopic and blind pushing) between 1 January and 12 May 2019. Patients were excluded if there was a known history of central venous occlusion/stenosis.ResultsIn the fluoroscopic‐guided group, 0% of the lines were malpositioned compared with 60% of the lines placed using the blind pushing technique, P < 0.001.Fluoroscopic‐guided PICC insertions were in place for a total of 2446 days and demonstrated 6 complications (2.45 complications per 1000 catheter days). This compared with blind pushing technique PICC insertions which were in place for a total of 1521 days and demonstrated 18 complications (11.83 complications per 1000 catheter days), P = 0.004.ConclusionThe use of fluoroscopy for PICC placement leads to significant improvements in tip accuracy than for PICCs placed using the blind pushing technique. While the use of these imaging resources incurs cost and time, these factors should be balanced in order to offer patients the safest and most accurate method of line insertion.

Spontaneous Versus Directed Pushing Technique: Maternal and Neonatal Outcomes: A Comparative Study in Northern Upper Egypt

Background: Maternal pushing during the 2nd stage of labor is indispensable and important contributor to the involuntary expulsive force developed by uterine contraction results to influence on the mother and fetus. Aim: the study was conducted to compare spontaneous versus Valsalva (directed) pushing techniques at the second stage of labor on maternal and fetal outcomes. Methods: Setting: Delivery Unit of El-Fayoum General and University Hospitals. Design: A quasi-experimental comparative study. Subjects: A purposive sample of a total of 100 primiparous women; 50 in the Valsalva (directed) pushing group &amp; 50 in the spontaneous pushing group. Tools: four tools were used; structured interviewing questionnaire sheet, Apgar score, Visual analog scale, and women satisfaction questionnaire. Results: The duration of the second stage of labor was shorter (5-10 min) in a spontaneous pushing (54.0%) group compared to the direct pushing group (2.0%). Oxygen wasn't used at all in spontaneous pushing group compared to 74.0% of directed pushing group. Postpartum hemorrhage was too little in spontaneous pushing group (96.0%) compared to 36.0% of the directed pushing group. Also, all women in the spontaneous pushing group experienced mild perineal pain compared to 32.0% in the directed pushing group (p&lt;0.001). The individual items of the VAS were significantly higher in the directed pushing group than those in the spontaneous pushing group. According to Apgar's score, there was a significant difference between the two groups during both the first and fifth minutes of birth. In the directed pushing group, a higher proportion of babies are admitted to ICU than those in the spontaneous pushing group (18.0 percent versus 10.0 percent). Conclusion; spontaneous pushing during the 2nd stage of labor enhanced neonatal and maternal outcomes; whilst directed pushing was associated with an increased duration of the 2nd stage of labor and risk of adverse neonatal outcomes. Recommendations: It may be recommended that spontaneous pushing during the second stage of childbirth be included in the procedure for maternal hospitals.

Scattering or Pushing for Object Singulation in Cluttered Environment: Case Study with Soma Cube

This paper proposes a hybrid singulation approach combining dynamic scattering and pushing techniques. Using the impulse-based dynamic model, a guideline is provided to decide whether scattering or pushing is conducted for object singulation. The Soma cube consisting of seven blocks is used as the test example. The target is to singulate all the blocks. The dynamic scattering technique was initially applied to separate blocks in the formation. However, scattering alone does not provide target singulation in all the cases. So we combine the quasi-static pushing technique to complete the singulation of all the blocks. In pushing, image segmentation based on principal component analysis (PCA) algorithm was employed to singulate multiple blocks in clutter and prehensile manipulation was used to remove isolated blocks. Several 2-D formations of the Soma cube are used as the test cases. To validate the effectiveness of our approach, we have conducted comparative analysis which clearly shows that the hybrid singulation achieves singulation in much less time as compared to the pure pushing approach.

The immediate effect of vocal technique associated with virtual reality game in people with Parkinsons disease

Abstract Introduction People with Parkinson’s Disease (PD) have difficult motor hearing calibration, which affects the monitoring of vocal production. Therefore, employing visual stimulus associated with vocal therapy may benefit the voice of this population. For this purpose, some techniques favour the competence of the glottis, such as pushing, which consists of movements of the arms with a simultaneous effort to phonation and, associated with virtual reality games, provide playful therapeutic intervention through the simulation of experiences that can foster glottal adjustments and generate changes in the voice. Objectives To determine the immediate effect of the technique of pushing with plosive sounds associated with the use of a virtual reality game in the voice of people with Parkinson's disease. Methodology The participants were 17 men and 14 women, mean age of 62.61 (± 11.24) years, meantime of diagnosis 6.93 years, distributed in stages I (32.5%), II (22.59%), III (45.16%) of Hoehn and Yahr. scale. The vocal evaluation pre and post pushing technique with plosive sounds associated with virtual reality game consisted of analysing vocal, acoustic parameters from the record of the issuance of the vowel /ε/. The parameters extracted were Jitter, Shimmer, corresponding to signs of disturbance of the sound source and Glottal-to Noise Excitation (GNE), corresponding to the energy of the glottis on the noise. The satisfaction questionnaire on the implementation of this technique associated with virtual reality was used. Results The values of disturbance of the sound wave decreased, and the glottal energy on the noise increased, respectively, Jitter (p = 0.0075); Shimmer (p = 0.0048); GNE (p = 0.0008). Regarding the satisfaction questionnaire, 74.20% of them felt very satisfied and 25.80%, satisfied. Conclusion The vocal technique associated with virtual reality game improved the acoustic parameters of the participants' voice and the majority felt great satisfaction with the intervention.

Intuitive human interface to a scanning tunnelling microscope: observation of parity oscillations for a single atomic chain.

A new way to control individual molecules and monoatomic chains is devised by preparing a human–machine augmented system in which the operator and the machine are connected by a real-time simulation. Here, a 3D motion control system is integrated with an ultra-high vacuum (UHV) low-temperature scanning tunnelling microscope (STM). Moreover, we coupled a real-time molecular dynamics (MD) simulation to the motion control system that provides a continuous visual feedback to the operator during atomic manipulation. This allows the operator to become a part of the experiment and to make any adaptable tip trajectory that could be useful for atomic manipulation in three dimensions. The strength of this system is demonstrated by preparing and lifting a monoatomic chain of gold atoms from a Au(111) surface in a well-controlled manner. We have demonstrated the existence of Fabry–Pérot-type electronic oscillations in such a monoatomic chain of gold atoms and determined its phase, which was difficult to ascertain previously. We also show here a new geometric procedure to infer the adatom positions and therefore information about the substrate atoms, which are not easily visible on clean metallic surfaces such as gold. This method enables a new controlled atom manipulation technique, which we will refer to as point contact pushing (PCP) technique.

Learning the negotiation dance between regionally integrated states: theoretical propositions inspired by the European Union

Much can be learned from the interstate negotiations in the European Union as the most elaborated system of regional integration. When negotiating to adopt a decision jointly, EU member states usually manage to dance together in harmony, sometimes less so. But some dance better; they get more attention, satisfaction, and control over the others. The article investigates what factors may explain their better performance in interstate negotiations. It builds on these findings to offer six propositions on the success factors in negotiations taking place between states integrated economically and/or politically, beyond simply the EU. The article wonders also what happens when the states are forced to dance faster, and tensions between the states jeopardize the harmony between partners. It submits six more propositions to cope effectively with the effects of crises on customary negotiations. All findings and propositions rely on theory as well as research on negotiation and crisis bargaining. The twelve propositions submitted in total for ordinary and crisis negotiations include notably the strategy building of a chess master; the relational influence of a diplomat on a drunken counterpart; as well as the pushing and pulling technique of a martial art master.

On the effect of labour durations using an anisotropic visco-hyperelastic-damage approach to simulate vaginal deliveries

Injuries sustained by the pelvic floor muscles during childbirth are one of the major risk factors for the development of pelvic floor dysfunctions. The ability to predict the loss of the tissue integrity and the most affected regions prior to the childbirth would represent a compelling difference in choosing the appropriate management of labour.Previous biomechanical studies, using the finite element method, were able to simulate a vaginal delivery and analyse the mechanical effects on the pelvic floor muscles during the passage of the foetus. Complementing these studies, the aim of this work is to improve the characterization of the pelvic floor muscles, by using an anisotropic visco-hyperelastic constitutive model, including a continuum mechanics damage model. Viscoelasticity is a key feature to obtain more realistic results since biological tissues present relaxation effects that allow larger deformations without damage. This work analyses the reaction forces and the loss of tissue integrity sustained by the pelvic floor and evaluates the effects of different durations of labour. A delaying pushing technique of rest and descend is also studied in this work.The results obtained showed that the reaction forces vary with the duration of labour, with higher force levels associated with higher stretch rates. The pubovisceral muscle is the most affected of the levator ani, presenting an affected region of approximately 30%. The relaxation properties of the tissue contribute to diminish the damage levels, supporting the theory of delayed pushing applied in the second stage of labour.

Associations between improved care during the second stage of labour and maternal and neonatal health outcomes in a rural hospital in Bangladesh

ObjectiveTo evaluate the efficacy of care in the second stage of labour with a package of interventions that included (1) maintaining the birthing position according to the woman's choice, (2) adopting a spontaneous pushing technique and (3) using a support person, to reduce maternal and neonatal complications. DesignUsed the data collected from two cohorts- before and after an initiative to improve care during the second stage of labour. SettingA rural hospital in Bangladesh where 90–100 deliveries are conducted monthly and cesarean section provision is not available. ParticipantsOne thousand and fifty-one singleton pregnancies who attended the hospital for giving birth in the first stage of labour before full dilatation of the cervix and with cephalic presentation. Measurements and findingsData were collected through a structured checklist and questionnaire completed by research assistants; and also retrieved from hospital case record files, and the ongoing demographic surveillance system database. Coverage of adopting the upright or lateral position in the post-intervention period increased to 76% from about 1% in the pre-intervention period, and the spontaneous pushing technique increased to 97% from 77% in the same period. The odds of combined maternal and neonatal complications decreased by 46% between pre- and post-intervention periods (odds ratio: 0.54, 95% confidence interval: 0.43–0.70). Frequency of episiotomy (from 43% to 29%, P < 0.001), cervical tear (3.8% to 1.5%, P = 0.02), and median blood loss (200 ml to 150 ml; P < 0.001) were reduced significantly in the same period. No significant associations were observed in perineal tear or birth asphyxia occurrences. Key conclusions and implications for practiceThe study suggests that there is a beneficial effect of care during the second stage of labour with a package of interventions in reducing maternal and neonatal complications, particularly in reducing the frequency of episiotomy, cervical tear, and blood loss during delivery. The preferred choice of posture during giving birth, adopting a spontaneous pushing technique and continuous presence of support person during the second stage of labour may be encouraged for better health outcomes.