Stage Of Labor Research Articles

Effectiveness of Labor Dance on Duration of the First Active Phase of Labor in Nulliparous Women

Prolonged labor, also known as failure to progress, occurs when the total duration of labor is more than 24 hours and if not handled properly will cause various complications for the mother and baby and even lead to death. This study aimed to determine the effectiveness of labor dance on the duration of the first active phase of labor in nulliparous women. This study was a true experimental randomized controlled trial (single blind) with a posttest only with control group design. This research was conducted from 1 February to 31 March 2023 at the Central General Hospital Prof. dr.I.G.N.G Ngoerah Denpasar and Regional General Hospital Wangaya Denpasar. 42 primigravida mothers were randomly selected according to arrival, with 21 people in the intervention and control groups. Data were analyzed using the Mann Whitney test. The average length of the first stage of labor in the experimental group was 252,62 minutes and in the control group was 355,95 minutes (p-value=0,000); effect size of 1,61 (strong effect) with a percentage of 94,5%. There was a statistically significant difference in the duration of the active phase I stage of labor between the experimental and control groups. It is hoped that health workers, especially midwives, will

Optimizing labor duration with pilates: evidence from a systematic review and meta-analysis of randomized controlled trials

BackgroundPilates has captured interest due to its possible advantages during pregnancy and childbirth. Although research indicates that Pilates may reduce labor duration, alleviate pain, and improve satisfaction with the childbirth experience, consensus on these outcomes remains elusive, underscoring the necessity for additional studies.AimThis systematic review and meta-analysis aimed to assess the impact of Pilates exercises on labor duration among pregnant women.MethodsThe online database was searched to yield the literature using the terms of ‘Pilates’, ‘childbirth’, and ‘labor duration’, and similar terms including PubMed, Clinical Key, Scopus, Web of Science, Embase, and Cochrane Database of Systematic Reviews up to June 25, 2023. Studies were considered eligible if they were randomized or clinical controlled trials (RCTs/CCTs) published in English, focusing on healthy pregnant women without exercise contraindications. The studies needed to include interventions involving Pilates or exercise movement techniques, a comparison group with no exercise, and outcomes related to labor duration, the period of the active phase, and the second stage of delivery.ResultsEleven studies, totalling 1239 participants, were included in the analysis. These studies provided high-quality evidence from exercise only RCTs/CCTs. The findings indicated a significant reduction in the active phase of labor (8 RCTs, n = 1195; Mean Difference [MD] = -56.35, 95% Confidence Interval [CI] [-89.46 to -23.25]) and overall labor duration (8 RCTs, n = 898; MD = -93.93, 95% CI [-138.34 to -49.51]) in pregnant women who engaged in Pilates exercises compared to those who did not but doesn’t affect on the duration of the second stage of labor (7 RCTs, n = 1135; MD = -0.11, 95% CI [-7.21 to 6.99]).ConclusionsWhile this review primarily addresses the effects of Pilates on healthy and low-risk pregnant women, the findings suggest a potential role for Pilates in shortening labor duration. Therefore, engaging in Pilates or similar physical activities is recommended for pregnant women to potentially facilitate a more efficient labor process.

Effectiveness of Zilgrei Method Towards Labor Output Among Primigravida Mother in Indonesia

Aims : the study aimed to test the effectiveness of the zilgrei methode in primigravida mother with second stage labor of long second stage, incidence laceration, infant condition and the scale pain of labor. Methods : The study used a queasy experimental design with a control group, collecting primary data through observation, partographs, APGAR score, and pain scale assessment for 6 months. Result : The result of the bivariate test shows that the mean comparison of the long second stage was different between the two groups (p-value 0,001). No significant difference in the proportion of the incidence laceration (p= 0.370), APGAR score at first, fifth, and ten minutes (p>0.005). There was a significant comparison of pain scale between a group with and without Zilgrei Method (p=0.000). Conclusions : Based on the results of this study Zilgrei method can be applied as an alternative non-pharmacological method to shorten the second stage and reduce pain on labor. For further research, it is necessary to consider controlling the weight of a born baby and maternal risk factors to determine the effect of applying the Zilgrei method optimally to the laceration of the birth canal and the condition of the baby at birth.

The Effect of Effleurage Massage on Reducing the Intensity of Pain in the First Stage of Active Labor

Childbirth is a process of expelling the results of fertilization through a flask from inside the uterus out of the uterus through the vagina spontaneously. Pain is an experience of feeling uncomfortable and unpleasant from a person's sensory and emotional side. The purpose of this study was to determine the effect of Mensage Effinage on reducing the intensity of labor pain in the first active phase. This study used a one-group pre-test post-test design experiment with a sample of 34 respondents. Data was collected using a Verbal Descriptor Scale (VDS) monitoring observation sheet. Data analysis using the normality test on the Wilcoxon Sign Ronk Anamis pararsenic test because the data is not normally distributed or has Wilcoxon status. The results of the study showed that the intensity of pain in the first stage of labor in the active phase can be reduced through effluent massage therapy. This is evidenced by the results of data analysis where p = 0.000 <0.05 so that the Ho result is rejected, H1 is accepted. Effluent Massage Therapy can be used as an alternative that needs to be applied to reduce pregnancy pain in mothers giving birth in the first phase of pregnancy. The conclusion is that massage effluent can reduce the intensity of pain in pregnant women in phase 1.

Kajian Karakteristik pada Anak Yang Terkonfirmasi Positif Covid-19 di Sumatera Barat Pada Periode Juli-Desember 2020

This study employed a pre-experimental method with a one-group pretest-posttest design. The sample size consisted of 30 respondents. The population included all laboring mothers in the first stage of labor with cervical dilation of 6–8 cm, selected through purposive sampling. Data collection was conducted using counterpressure with a birth ball questionnaires and the Numeric Rating Scale (NRS) for pain measurement. Data analysis was performed using the Wilcoxon test and paired t-test. The Wilcoxon test results showed a Z-value of -4.902 with an asymp.sig (2-tailed) value of 0.000 > 0.05, indicating that the data supports the conclusion that there is a significant difference before and after performing counterpressure with a birth ball. Additionally, the paired t-test revealed that the average pain level before the intervention was 8.20, while the average pain level after the intervention was 6.23. This indicates a reduction in pain intensity with a difference of 1.97, and the significance value obtained was 0.000 > 5% (p-value = 0.000 < 0.05). Therefore, the hypothesis (Ha) is accepted, meaning that counterpressure with a birth ball has a significant effect on reducing labor pain during the active phase of the first stage of labor. The study suggests that counterpressure using a birth ball can be used as an alternative non-pharmacological therapy for pain management during the active phase of the first stage of labor.

Hubungan Teknik Couterpressure Massage Dengan Birth Ball Terhadap Penurunan Nyeri Persalinan Kala I Fase Aktif di PMB Wilayah Kelurahan Kembangan Selatan Kota Jakarta Barat Tahun 2023

This study employed a pre-experimental method with a one-group pretest-posttest design. The sample size consisted of 30 respondents. The population included all laboring mothers in the first stage of labor with cervical dilation of 6–8 cm, selected through purposive sampling. Data collection was conducted using counterpressure with a birth ball questionnaires and the Numeric Rating Scale (NRS) for pain measurement. Data analysis was performed using the Wilcoxon test and paired t-test. The Wilcoxon test results showed a Z-value of -4.902 with an asymp.sig (2-tailed) value of 0.000 > 0.05, indicating that the data supports the conclusion that there is a significant difference before and after performing counterpressure with a birth ball. Additionally, the paired t-test revealed that the average pain level before the intervention was 8.20, while the average pain level after the intervention was 6.23. This indicates a reduction in pain intensity with a difference of 1.97, and the significance value obtained was 0.000 > 5% (p-value = 0.000 < 0.05). Therefore, the hypothesis (Ha) is accepted, meaning that counterpressure with a birth ball has a significant effect on reducing labor pain during the active phase of the first stage of labor. The study suggests that counterpressure using a birth ball can be used as an alternative non-pharmacological therapy for pain management during the active phase of the first stage of labor.

Spontaneous vaginal birth after multiple previous caesarean sections: A case report and literature review

Background: Vaginal birth after caesarean section (VBAC) is increasingly recognized as a safe and effective option for women with a history of Caesarean deliveries. However, limited attention has been given to feasibility and safety of VBAC after multiple caesarean sections. Case presentation: A 36-year-old woman with a history of four previous Caesarean sections presented in our centre in third stage of labour. Despite counseling for elective Caesarean section, she had a spontaneous vaginal delivery of a live 2.6 kg female neonate in a vehicle en route to the hospital. On arrival, she was stable but had lost about 500ml of blood. Immediate interventions included active management of third stage of labour and assessment for perineal injuries, with subsequent monitoring and blood transfusion. She had a normal postpartum recovery, was discharged after four days, and had a reassuring 6-week post-natal visit, with a referral to family planning. Conclusion: This case underscores the potential success and safety of vaginal birth after multiple (three or more) Caesarean sections, challenging the notion that a history of repeated C-sections precludes this option. Vaginal birth after CS (VBAC), initially restricted to one previous CS, is now considered in selected cases with two prior abdominal deliveries. However, the acceptance of VBAC after three or more CS remains limited despite available evidences indicating comparable success rates and maternal risks for VBAC after multiple CS when compared to VBAC after one prior CS or elective repeat CS.

PENERAPAN KOMBINASI TERAPI BIRTHBALL DAN TEKNIK RELAKSASI NAFAS DALAM TERHADAP NYERI PERSALINAN

The treatment of non-pharmacological pain management is intended to lessen pain, particularly during the first stage of labor, pain management is more effective than pharmacological methods because it is cheap, simple effective, and without adverse effects. In the early stages, it is important to provide maternal care, which includes teaching relaxing techniques such as breathing and Birth ball therapy. The purpose of this study is to determine the efficacy of birth ball and breathing exercises. This research methodology uses a case study approach and is a form of descriptive research. In order to reduce labor pain during the active phase I of labor, one mother in the sample used deep breathing exercises and a birth ball. Through the use of a numerical rating scale (NRS) on an observation sheet, the pain level was measured. When birth ball therapy and Deep Breath Relaxation Technique are combined, laboring mothers experience a reduction in pain. During the first half hour, the results show a decrease in pain level at pain score 6 (moderate heavy), and after the second half, the results show a decrease in pain level at pain score 4 (moderate mild). In summary During the active phase I of labor, the combination of birth ball and Deep Breath Relaxation Technique effectively reduces labor pain

Temporalities of oxytocin for labour augmentation: a mixed-methods study of time factors shaping labour practices in a busy maternity unit in Tanzania

BackgroundHigh rates of labour augmentation with oxytocin have been found in some low- and lower-middle-income countries, causing potential perinatal harm. It is critical to understand the reasons for this overuse. Aim was to explore factors that shape practices around using oxytocin for labour augmentation in a high-volume labour ward in Dar es Salaam, Tanzania.MethodsMixed-methods data collection was conducted from March 2021 to February 2022, including structured observations of 234 births, 220 h of unstructured labour ward observations and 13 individual in-depth interviews with birth attendants. Thematic network analysis and descriptive statistics were used to analyse data. We used a time-lens to understand practices of oxytocin for labour augmentation in time-pressured labour wards.ResultsBirth attendants constantly had to prioritise certain care practices over others in response to time pressure. This led to overuse of oxytocin for augmentation to ensure faster labour progression and decongestion of the, often overburdened, ward. Simultaneously, birth attendants had little time to monitor foetal and maternal condition. Surprisingly, while oxytocin was used in 146 out of 234 (62.4%) structured labour observations, only 9/234 (4.2%) women had active labour lasting more than 12 h. Correspondingly, 21/48 (43.8%) women who were augmented with oxytocin in the first stage of labour had uncomplicated labour progression at the start of augmentation. While the partograph was often not used for decision-making, timing of starting oxytocin often correlated with natural cycles of ward-rounds and shift-turnovers instead of individual women’s labour progression. This resulted in co-existence of ‘too early’ and ‘too late’ use of oxytocin. Liberal use of oxytocin for labour augmentation was facilitated by an underlying fear of prolonged labour and low alertness of oxytocin-related risks.ConclusionsTime scarcity in the labour ward often made birth attendants deviate from clinical guidelines for labour augmentation with oxytocin. Efforts to navigate time pressure resulted in too many women with uncomplicated labour progression receiving oxytocin with little monitoring of labour. Fear of prolonged labour and low alertness to oxytocin-mediated risks were crucial drivers. These findings call for research into safety and benefits of oxytocin in low-resource settings and interventions to address congestion in labour wards to prevent using oxytocin as a time-management tool.

Effects of Rosa damascena on Labor Pain and Anxiety in Primiparous Women.

This study aimed to investigate the effect of Damask rose aromatherapy on pain and anxiety in primiparas during the incubation and latent periods of the first stage of labor. The study randomly divided participants into aroma, placebo, and control groups. The control group received daily care, while the aroma group received at least 30minutes of aromatherapy. The placebo group received the same aromatherapy device as the aroma group but inhaled saline. Pain, anxiety, and uterine contractions were measured at enrollment and at 30, 60, and 120minutes. Data from 76 participants were analyzed, and the results showed that the aroma group had lower anxiety and pain scores than the placebo and control groups at 60 and 120minutes. Additionally, the effect gradually appeared and was maintained even with increased contractions. Damask rose aromatherapy can be used as a safe and effective adjuvant therapy for reducing the anxiety and pain of women in the latent period of labor.

Pregnancy Exercise Shorten the Duration of the Second Stage of Labor

Background : There are several factors that contribute to duration of labor, which are power, passage, and passenger. Pregnancy exercise is one of many interventions that can be done in favor of increasing power during labor.Aim : The purpose of this study was to investigate the correlation between pregnancy exercise and second stage of labor duration.Material and Methods: This was an analytic observational study using cross sectional design conducted in Al-Irsyad Hospital in Surabaya. The total sample was 48 pregnant women who followed pregnancy exercise program and did not follow pregnancy exercise program that met sample criteria. Medical records data on duration of second stage of labor and pregnancy exercise program data were collected then analyzed by mann-whitney test.Results: The mean second stage of labor in pregnancy exercise group was 25.88±13.21 minutes, while in non-pregnancy group was 11.46±4.77 minutes. The analysis using mann-whitney test showed a significant correlation between pregnancy exercise and second stage of labor (p=0.000).Conclusion: There was a significant correlation between pregnancy exercise and second stage of labor. Pregnancy exercise shorten the duration of second stage of labor.

The Role Of Family Support In Childbirth: Implications For Maternal And Infant Well-Being

Labor is a critical moment in the life of both mother and baby, often accompanied by physical and emotional challenges. Family support, whether emotional, physical, or informational, plays an important role in influencing the quality of the birth experience and health outcomes. This study used a qualitative approach with literature review as the main data collection technique. This study aims to explore the role of family support in the labor process and its implications for maternal and infant well-being. The literature study approach was used to identify and analyze various research, theories, and empirical reports relevant to the topic. The study results show that emotional support from family can reduce maternal anxiety, increase a sense of security, and improve the overall labor experience. Physical support, such as massaging or helping the mother move, contributes to a smoother labor process and minimizes the need for medical intervention. Informational support helps mothers understand the stages of labor and make better decisions regarding health care. In addition, family support improves the quality of care provided to the baby, helps the mother to be more responsive to the baby's needs, and supports a strong emotional bond between mother and baby. The implications of these findings emphasize the importance of family involvement in childbirth and the postpartum period to improve the well-being of mothers and infants. Health workers are advised to encourage family participation and provide adequate education on the role of family support, to ensure that mothers and infants receive optimal support.

Effects of Warm Compresses on the Perineal Area During the Active Phase of Labor: A Quasi-Experimental Study.

Background A perineal tear refers to any injury to the female genitalia during labor, which can occur spontaneously or with the use of instruments. An episiotomy, a surgical procedure, is sometimes performed to enlarge the vaginal orifice to facilitate delivery. Ineffective management of labor pain can result in negative physiological and psychosocial outcomes. Objective This study aims to investigate the effect of warm compresses on the perineal area during active labor. Methods This quasi-experimental study utilized a convenience sample, dividing 80 mothers into intervention and control groups. Participants were randomly assigned to groups after meeting the inclusion criteria and signing consent forms. The inclusion criteria encompassed pregnant women aged 18 years or older with a healthy singleton pregnancy, a cephalic presentation, and a gestational age of 37 weeks or more. The women were in the active phase of the first stage of labor (6-7 cm cervical dilation). In Part I, a data collection tool was developed to gather sociodemographic data, obstetrical history, and initial assessment information. Part II assessed perineal pain using the Visual Analogue Scale. Part III collected data on the perineal status post-delivery, and Part IV gathered information about the newborns. The research was conducted in the labor unit at East Jeddah Hospital, with data collection occurring from November 2022 to February 2023. Results The results of this study revealed that the mean second-stage labor pain score was 9.73 for the control group and 8.68 for the intervention group. In the third stage of labor, the mean pain score was 4.52 for the control group and 2.75 for the intervention group. During the fourth stage of labor, the mean pain score for the control group was 2.90, compared to 1.50 for the intervention group. In terms of perineal outcomes, 17 participants (42.5%) in the intervention group had an intact perineum, compared to 11 participants (27.5%) in the control group. However, there was no significant difference in the episiotomy rate between the two groups. Conclusions The findings of this study indicate that applying a warm compress to the perineal area during active labor can enhance perineal intactness and significantly reduce perineal pain. Future research could explore the challenges nurses encounter when applying warm compresses to the perineum during labor.

Real-Time Imaging as Visual Biofeedback in Active Second Stage of Labor Among Nulliparas: A Randomized Controlled Trial

Real-Time Imaging as Visual Biofeedback in Active Second Stage of Labor Among Nulliparas: A Randomized Controlled Trial

Prevalence of group B Streptococcus colonisation in mother–newborn dyads in low-income and middle-income south Asian and African countries: a prospective, observational study

Rectovaginal group B Streptococcus (GBS) colonisation in pregnant individuals at the time of labour is a major risk factor for invasive GBS disease by age 7days (early-onset disease). We aimed to investigate the prevalence of rectovaginal GBS colonisation at the time of labour among pregnant women and vertical transmission to their newborns across selected low-income and middle-income African and south Asian countries. This prospective, observational study was undertaken at 11maternity and obstetric care facilities based in Ethiopia, Kenya, Mozambique, Nigeria, Mali, South Africa, Bangladesh, India, and Bhutan. HIV-negative pregnant women aged 18-45years who were in the early stages of labour and at least 37weeks' gestation were eligible for inclusion. Lower vaginal and rectal swabs and urine were collected from the women, and swabs of the umbilicus, outer ear, axillary fold, rectum, and throat were obtained from their newborns, for GBS culture. Standardised sampling and culture using direct plating and selective media broth for detection of GBS colonisation was undertaken at the sites. Serotyping of GBS isolates was done in South Africa. The primary outcome was the prevalence of rectovaginal GBS among pregnant women, analysed in participants with available data. This study is registered with the South African National Clinical Trials Register, number DOH-27-0418-4989. 6922pregnant women were enrolled from Jan 10, 2016, to Dec 11, 2018, of whom 6514 (94·1%; 759-892per country) were included in the analysis; data from Bhutan were not included in the study due to issues with specimen collection and processing. Overall, the prevalence of maternal GBS colonisation was 24·1% (95% CI 23·1-25·2; 1572of 6514); it was highest in Mali (41·1% [37·7-44·6]; 314of 764) and lowest in Ethiopia (11·6% [9·5-14·1]; 88of 759). Theoverall rate of vertical transmission of GBS from women with rectovaginal GBS colonisation was 72·3% (70·0-74·4; 1132of 1566); it was highest in Mozambique (79·2% [73·3-84·2]; 168of 212) and lowest in Bangladesh (55·8%, 47·5-63·8; 77of 138). The five most common GBS colonising serotypes were Ia (37·3% [34·9-39·7]; 586of 1572), V(28·5% [26·3-30·8]; 448of 1572), III (25·1% [23·0-27·3]; 394of 1572), II (9·2% [7·8-10·7]; 144of 1572), and Ib(6·5% [5·4-7·8]; 102of 1572). There was geographical variability in serotype proportion distribution; serotype VIIwas the third most common serotype in India (8·6% [5·3-13·7]; 15of 174) and serotype VI was mainly identified in Bangladesh (5·8% [3·0-11·0]; eight of 138) and India (5·7% [3·2-10·3]; ten of 174). Our study reported a high prevalence of GBS colonisation in most settings, with some geographical variability even within African countries. Our findings suggest that serotypes not included in current multivalent capsular-polysaccharide GBS vaccines prevail in some regions, so vaccine efficacy and post-licensure effectiveness studies should assess the effect of vaccination on maternal GBS colonisation given the potential for replacement by non-vaccine serotypes. Bill & Melinda Gates Foundation.

The Effect of Endorphine Massage to Reduce Pain During the First Stage of Labor: Evidence Based Case Report

Background: Labor is a physiological process that every pregnant woman will experience in her reproductive cycle. The changes that occur in the body to prepare for childbirth often cause pain in the mother. Physical changes will also affect the emotional and psychological condition of the birthing mother, such as stress and anxiety. One non-pharmacological methods to reduce pain during labor is endorphine massage. This massage aims to make the mother comfortable and calm by helping to release endorphin hormones which play a role in increased analgesic response during labor. Endorphine massage is performed by giving a light touch to the back area to help release the hormones endorphins and oxytocin during the first stage of labor. Purpose: To determine the effect of endorphin massage on reducing pain in the first stage of labor. Method: Evidence based case report (EBCR) by searching several articles via Google Scholar and Portal Garuda. Result: There was a decrease in pain intensity of first stage of labor from severe to moderate pain after being given endorphins massage for 5 minutes every hour. Conclusion: The results of the case report show that endorphin massage can reduce pain in the first stage of labor.

The Effectiveness of Lavender Aromatherapy on Reducing Pain Intensity in The First Stage of Labor Active

Pregnant woman looks forward to the moment she gives birth in order to experience the joy she longs for. if the baby, placenta, and amniotic membranes leave the mother's uterus at term (after 37 weeks) without complications, the process is considered normal. At TPMB Siti Hapsah, S.Tr.Keb in 2024, the purpose of this study is to determine whether lavender aromatherapy reduces pain intensity during the active phase of first stage labor. The Quasy Experiment research method is used in this quantitative research design. This study used a one-group pretest-posttest design with 32 respondents. The Wilcoxon test was used to analyze the observation sheet data. Lavender aromatherapy was found to be effective at reducing pain intensity during the active phase of first stage labor at TPMB Siti Hapsah, s.Tr.Keb in 2024 because the obtained result had a significance value of 0.000, which was lower than the significance result of 5% (p-value = 0.000 0.05). During the initial active phase of labor, lavender aromatherapy is recommended for use as a complementary therapy.

A deep learning approach to identify the fetal head position using transperineal ultrasound during labor

ObjectivesTo develop a deep learning (DL)-model using convolutional neural networks (CNN) to automatically identify the fetal head position at transperineal ultrasound in the second stage of labor. Material and methodsProspective, multicenter study including singleton, term, cephalic pregnancies in the second stage of labor. We assessed the fetal head position using transabdominal ultrasound and subsequently, obtained an image of the fetal head on the axial plane using transperineal ultrasound and labeled it according to the transabdominal ultrasound findings. The ultrasound images were randomly allocated into the three datasets containing a similar proportion of images of each subtype of fetal head position (occiput anterior, posterior, right and left transverse): the training dataset included 70 %, the validation dataset 15 %, and the testing dataset 15 % of the acquired images. The pre-trained ResNet18 model was employed as a foundational framework for feature extraction and classification. CNN1 was trained to differentiate between occiput anterior (OA) and non-OA positions, CNN2 classified fetal head malpositions into occiput posterior (OP) or occiput transverse (OT) position, and CNN3 classified the remaining images as right or left OT. The DL-model was constructed using three convolutional neural networks (CNN) working simultaneously for the classification of fetal head positions. The performance of the algorithm was evaluated in terms of accuracy, sensitivity, specificity, F1-score and Cohen’s kappa. ResultsBetween February 2018 and May 2023, 2154 transperineal images were included from eligible participants across 16 collaborating centers. The overall performance of the model for the classification of the fetal head position in the axial plane at transperineal ultrasound was excellent, with an of 94.5 % (95 % CI 92.0––97.0), a sensitivity of 95.6 % (95 % CI 96.8–100.0), a specificity of 91.2 % (95 % CI 87.3–95.1), a F1-score of 0.92 and a Cohen’s kappa of 0.90. The best performance was achieved by the CNN1 – OA position vs fetal head malpositions – with an accuracy of 98.3 % (95 % CI 96.9–99.7), followed by CNN2 – OP vs OT positions – with an accuracy of 93.9 % (95 % CI 89.6–98.2), and finally, CNN3 – right vs left OT position – with an accuracy of 91.3 % (95 % CI 83.5–99.1). ConclusionsWe have developed a DL-model capable of assessing fetal head position using transperineal ultrasound during the second stage of labor with an excellent overall accuracy. Future studies should validate our DL model using larger datasets and real-time patients before introducing it into routine clinical practice.

AIDA (Artificial Intelligence Dystocia Algorithm) in Prolonged Dystocic Labor: Focus on Asynclitism Degree.

Asynclitism, a misalignment of the fetal head with respect to the plane of passage through the birth canal, represents a significant obstetric challenge. High degrees of asynclitism are associated with labor dystocia, difficult operative delivery, and cesarean delivery. Despite its clinical relevance, the diagnosis of asynclitism and its influence on the outcome of labor remain matters of debate. This study analyzes the role of the degree of asynclitism (AD) in assessing labor progress and predicting labor outcome, focusing on its ability to predict intrapartum cesarean delivery (ICD) versus non-cesarean delivery. The study also aims to assess the performance of the AIDA (Artificial Intelligence Dystocia Algorithm) algorithm in integrating AD with other ultrasound parameters for predicting labor outcome. This retrospective study involved 135 full-term nulliparous patients with singleton fetuses in cephalic presentation undergoing neuraxial analgesia. Data were collected at three Italian hospitals between January 2014 and December 2020. In addition to routine digital vaginal examination, all patients underwent intrapartum ultrasound (IU) during protracted second stage of labor (greater than three hours). Four geometric parameters were measured using standard 3.5 MHz transabdominal ultrasound probes: head-to-symphysis distance (HSD), degree of asynclitism (AD), angle of progression (AoP), and midline angle (MLA). The AIDA algorithm, a machine learning-based decision support system, was used to classify patients into five classes (from 0 to 4) based on the values of the four geometric parameters and to predict labor outcome (ICD or non-ICD). Six machine learning algorithms were used: MLP (multi-layer perceptron), RF (random forest), SVM (support vector machine), XGBoost, LR (logistic regression), and DT (decision tree). Pearson's correlation was used to investigate the relationship between AD and the other parameters. A degree of asynclitism greater than 70 mm was found to be significantly associated with an increased rate of cesarean deliveries. Pearson's correlation analysis showed a weak to very weak correlation between AD and AoP (PC = 0.36, p < 0.001), AD and HSD (PC = 0.18, p < 0.05), and AD and MLA (PC = 0.14). The AIDA algorithm demonstrated high accuracy in predicting labor outcome, particularly for AIDA classes 0 and 4, with 100% agreement with physician-practiced labor outcome in two cases (RF and SVM algorithms) and slightly lower agreement with MLP. For AIDA class 3, the RF algorithm performed best, with an accuracy of 92%. AD, in combination with HSD, MLA, and AoP, plays a significant role in predicting labor dystocia and labor outcome. The AIDA algorithm, based on these four geometric parameters, has proven to be a promising decision support tool for predicting labor outcome and may help reduce the need for unnecessary cesarean deliveries, while improving maternal-fetal outcomes. Future studies with larger cohorts are needed to further validate these findings and refine the cut-off thresholds for AD and other parameters in the AIDA algorithm.

Tranexamic acid in preventing postpartum blood loss in vaginal delivery: a double-blinded randomized controlled trial

Postpartum hemorrhage (PPH) is an obstetrical emergency that occurs in 1% to 10% of all deliveries and contributes to nearly one-quarter of all maternal deaths worldwide. Tranexamic acid has been established as an adjunct in the treatment of PPH but its role in its prevention of PPH following vaginal delivery has not been widely studied. This study aimed to assess the effect of prophylactic tranexamic acid (1 g) along with active management of the third stage of labor in reducing postpartum blood loss and the incidence of postpartum hemorrhage after vaginal delivery. In this randomized controlled trial, 650 women with singleton pregnancies at ≥34 weeks of gestation who were undergoing vaginal delivery were included. Eligible women were randomly assigned to receive either 1 g of tranexamic acid or placebo intravenously along with active management of the third stage of labor. Calibrated blood collection bags were used to measure postpartum blood loss during the third and fourth stages of labor. Of 886 women approached for the study, 650 who met the inclusion criteria were enrolled, and 320 in group A and 321 in group B were analyzed. The maternal characteristics were similar between the groups. The mean blood loss did not differ significantly between the intervention and placebo groups (378.5±261.2 mL vs 383.0±258.9 mL; P=.93). The incidence of primary postpartum hemorrhage was comparable in both groups (15.9% in group A and 15.3% in group B; P=.814). The median quantitative decreases in hemoglobin levels within 12 to 24 hours after delivery were 0.60 g% (interquartile range, 0.40-0.90) in group A and 0.60 g% (interquartile range, 0.40-0.80) in group B, which were comparable in both groups (P=.95). The most common adverse effect reported was dizziness, and there was no thromboembolic event at 3 months follow-up in either group. The use of tranexamic acid as a prophylactic measure along with active management of the third stage of labor does not provide additional benefit in reducing the postpartum blood loss and incidence of postpartum hemorrhage after vaginal delivery. El resumen está disponible en Español al final del artículo.