Stage Of Labor Research Articles

Informed consent to midwifery practices and interventions during the second stage of labor-An observational study within the Oneplus trial.

To study informed consent to midwifery practices and interventions during the second stage of labor and to investigate the association between informed consent and experiences of these practices and interventions and women's experiences of the second stage of labor. This study uses an observational design with data from a follow-up questionnaire sent to women one month after giving birth spontaneously in the Oneplus trial, a study aimed at evaluating collegial midwifery assistance to reduce severe perineal trauma. The trial was conducted between 2018-2020 at five Swedish maternity wards and trial registered at clinicaltrials.gov, no NCT03770962. The follow-up questionnaire contained questions about experiences of the second stage of labor, practices and interventions used and whether the women had provided informed consent. Evaluated practices and interventions were the use of warm compresses held at the perineum, manual perineal protection, vaginal examinations, perineal massage, levator pressure, intermittent catheterization of the bladder, fundal pressure, and episiotomy. Associations between informed consent and women's experiences were assessed by univariate and multivariable logistic regression. Of the 3049 women participating in the trial, 2849 consented to receive the questionnaire. Informed consent was reported by less than one in five women and was associated with feelings of being safe, strong, and in control. Informed consent was further associated with more positive experiences of clinical practices and interventions, and with less discomfort and pain from interventions involving physical penetration of the genital area. The findings indicate that informed consent during the second stage is associated with feelings of safety and of being in control. With less than one in five women reporting informed consent to all practices and interventions performed by midwives, the results emphasize the need for further action to enhance midwives' knowledge and motivation in obtaining informed consent prior to performance of interventions.

Join point trends of instrumental vaginal deliveries and cesarean sections at the Lagos University Teaching Hospital, Lagos, Nigeria (2002-2017).

To determine the trends of instrumental vaginal delivery (IVD) and cesarean section (CS) at the Lagos University Teaching Hospital (LUTH), Nigeria, over 16 years, from 2002 to 2017. A retrospective cross-sectional study. The case records of all women who had IVD and CS during the study period were reviewed. The trends in the IVD and CS rates were evaluated using join point regression modeling. The average annual percent change (AAPC) and annual percent change (APC) with associated 95% confidence interval of segmental trends were calculated. The overall IVD rate was 1.36%. Vacuum delivery rate was higher than forceps (0.79% vs 0.57%). The CS rate was 44.9 per 100 deliveries; the rate increased by about 3.7% per annum. CS rates were 7.1-89.9 times the IVD rates within the study period. The number of IVDs performed in the hospital declined by about 83.02%, from 53 cases in 2002 to nine cases in 2017. Forceps delivery declined at a faster rate than vacuum delivery between 2002 and 2017 (AAPC for forceps: -12.6% [-17.5 to -7.5], P < 0.001 vs AAPC for vacuum: -6.2% [-14.3 to 2.7], P = 0.200). The commonest indication for IVD was prolonged second stage of labor (47/162, 29.01%) and shortening of the second stage of labor for maternal conditions (47/162, 29.01%). IVD rates are low and declining at LUTH. There is need to train accoucheurs on the safe use of IVDs to potentially reduce the CS rate.

Risk factors for neonatal hypoxic ischemic encephalopathy and therapeutic hypothermia: a matched case-control study

BackgroundPeripartum asphyxia is one of the main causes of neonatal morbidity and mortality. In moderate and severe cases of asphyxia, a condition called hypoxic-ischemic encephalopathy (HIE) and associated permanent neurological morbidities may follow. Due to the multifactorial etiology of asphyxia, it may be difficult prevent, but in term neonates, therapeutic cooling can be used to prevent or reduce permanent brain damage. The aim of this study was to assess the significance of different antenatal and delivery related risk factors for moderate and severe HIE and the need for therapeutic hypothermia.MethodsWe conducted a retrospective matched case-control study in Helsinki University area hospitals during 2013–2017. Newborn singletons with moderate or severe HIE and the need for therapeutic hypothermia were included. They were identified from the hospital database using ICD-codes P91.00, P91.01 and P91.02. For every newborn with the need for therapeutic hypothermia the consecutive term singleton newborn matched by gender, fetal presentation, delivery hospital, and the mode of delivery was selected as a control. Odds ratios (OR) between obstetric and delivery risk factors and the development of HIE were calculated.ResultsEighty-eight cases with matched controls met the inclusion criteria during the study period. Maternal and infant characteristics among cases and controls were similar, but smoking was more common among cases (aOR 1.46, CI 1.14–1.64, p = 0.003). The incidence of preeclampsia, diabetes and intrauterine growth restriction in groups was equal. Induction of labour (aOR 3.08, CI 1.18–8.05, p = 0.02) and obstetric emergencies (aOR 3.51, CI 1.28–9.60, p = 0.015) were more common in the case group. No difference was detected in the duration of the second stage of labour or the delivery analgesia.ConclusionsSmoking, induction of labour and any obstetric emergency, especially shoulder dystocia, increase the risk for HIE and need for therapeutic hypothermia. The decisions upon induction of labour need to be carefully weighed, since maternal smoking and obstetric emergencies can hardly be controlled by the clinician.

Pelvic Rocking Exercise on The Length of The First Stage of Labor

Pelvic Rocking Exercise on The Length of The First Stage of Labor

INTRAPARTUM NIPPLE STIMULATION TO INCREASE CONTRACTION IN PRIMIPARITY: EVIDENCE BASED CASE REPORT

Introduction Normal labor process duration varies between 4 to 24 hours since the occurrence of uterine contractions which cause changes in the cervix. Adequate contractions are needed to induce labor to proceed normally. The active phase of the first stage of labor is considered more tiring and painful because uterine activity increases. In this phase, there is often an increase in adrenaline production which has the potential to inhibit contractions and delay the labor process. Nipple stimulation is one method that can be used to increase uterine contractions. This technique can stimulate the formation of natural oxytocin in the mother and channel it to the uterus, thus it increases uterine contractions. Objectives: This study aimed to find analyzed the effect of nipple stimulation on the labor progress and implement the best application of nipple stimulation Method: This EBCR using the Google Scholar database and PubMed. The articles were limited to original article and published from 2017-2022. According to the inclusion criteria and exclusion criteria we have found 2 articles met the criteria. The articles were obtained and critically reviewed using 3 aspects, namely the validity, the importancy, and applicability. Result: in this study the duration of first stage of labor were considered faster after the application of nipple stimulation long first stage in cases. The first stage was 2 hours faster than the average duration of the first stage , which is 1 hour per 1 cm. Conclusion: Nipple stimulation is one od the non pharmacological intervention that can be used an an option to increase the contraction during labor.

The application of DPE, CSEA, and EA in labor analgesia for nulliparous women and their impact on maternal and infant safety.

This work compared the effects of dural puncture epidural (DPE), combined spinal epidural analgesia (CSEA) and epidural analgesia (EA) on labor analgesia for primiparae and their impacts on maternal and infant safety. A total of 204 primiparae in need of labor analgesia for vaginal delivery were allocated to DPE, CSEA and EA groups. At 10 min, 30 min and 1 h after analgesia, the DPE and CSEA groups showed lower VAS scores and quicker onset of action than EA group. There was no significant difference in the duration of analgesia and labor and fetal decelerations among the 3 groups. At 1 min and 5 min after childbirth, the neonatal Apgar scores showed no significant difference between the 3 groups. The Bromage scores of DPE and EA groups were lower than those of CSEA group. The incidence of pruritus, hypotension, and postpartum headache in DPE and EA groups were lower than those in CSEA group. To sum up, the efficacy of DPE in labor analgesia for primiparae is similar to that of CSEA, with no obvious effect on labor stage and neonatal Apgar score, no additional complications and less LLMB, pruritus, hypotension and postpartum headache.

The Effectiveness of Effleurage Massage Accompanied with Consumption of Young Coconut Water (Cocos Nucifera L) to Relieve Pain Intensity in Women First Stage of Labor at the Madani Clinic, Manado City

Childbirth is a process in which repeated contractions occur, which can cause Pain in the mother in labor. The Pain felt during labor can cause anxiety and fear, which will affect the birthing process. This research aims to determine the effectiveness of a combination of effleurage massage and consumption of young coconut water (Cocos Nucifera L) to reduce the intensity of Pain in mothers in the first stage of labor at the Madani Clinic, Manado City. The research design used was Quasi-Experimental. The population studied was all mothers giving birth in the Madani Clinic Working Area, Manado City. A sample of 13 people was obtained using the accidental sampling technique. The research instrument used was a questionnaire sheet. The research results were then analyzed using Man Whitney. The results of the analysis showed that there was no significant effect between the group given the combination intervention and the control group. Based on the research results, it is hoped that the research area will be able to include clinical midwives in acupressure therapy training, especially for women giving birth, so that it can relieve pain and increase comfort for women giving birth.

Analyzing the Expectant Management of Redefined Active Phase of Labor (WHO 2018 Guidelines) in Nulliparous Women: A Randomized Control Trial

BACKGROUND:The World Health Organization (WHO) in their 2018 guidelines favored a noninterventional approach toward the labor process. The active phase of labor will be initiated when the cervix is 5 cm dilated and during obsoleted use of a 1 cm/hour cervical dilation rate as a diagnostic test for abnormal birth outcomes.OBJECTIVES:The aim of the study is to compare an active interventional labor management approach to a noninterventional labor management approach in nulliparous parturient women in terms of need of intervention, mode of birth, and maternofetal outcome.METHODOLOGY:This randomized control study was conducted at a rural tertiary care hospital for a period of 1.5 years. Nulliparous low-risk pregnant women presenting in latent labor were randomly allocated into two groups on the basis of cervical dilation and labor intervention. WHO 2014 guidelines with partograph were followed in group 1, and 2018 WHO guidelines with labor care guide were followed in group 2.RESULT:Both the groups were comparable with age, parity, and Bishop score at the time of admission. The incidence rates of intervention in the active first stage of labor in group 1 and group 2 were 31% and 10% with an odds ratio of 0.192 (95% confidence interval [CI] [0.079, 0.466]), and the rates of lower segment cesarean section in both the groups were 17.6% and 5.8%, respectively. The odds ratio with 95% CI for postpartum hemorrhage and neonatal intensive care unit admission in group 1 compared with group 2 was 0.313 [0.061, 1.610] and 1.057 [0.143, 7.832], respectively.CONCLUSION:This study showed that the shifting of the active first-stage threshold by 1 cm and letting labor progress at its natural pace significantly reduced the need for intervention and affected the fetal and maternal outcome positively.

Effects of perineal massage at different stages on perineal and postpartum pelvic floor function in primiparous women: a systematic review and meta-analysis

BackgroundPerineal massage, as a preventive intervention, has been shown to reduce the risk of perineal injuries and may have a positive impact on pelvic floor function in the early postpartum period. However, there is still debate concerning the best period to apply perineal massage, which is either antenatal or in the second stage of labor, as well as its safety and effectiveness. Meta-analysis was used to evaluate the effect of implementing perineal massage in antenatal versus the second stage of labor on the prevention of perineal injuries during labor and early postpartum pelvic floor function in primiparous women.MethodsWe searched nine different electronic databases from inception to April 16, 2024. The randomized controlled trials (RCTs) we included assessed the effects of antenatal and second-stage labor perineal massage in primiparous women. All data were analyzed with Revman 5.3, Stata Statistical Software, and Risk of Bias 2 was used to assess the risk of bias. Subgroup analyses were performed based on the different periods of perineal massage. The primary outcomes were the incidence of perineal integrity and perineal injury. Secondary outcomes were perineal pain, duration of the second stage of labor, postpartum hemorrhage, urinary incontinence, fecal incontinence, and flatus incontinence.ResultsThis review comprised a total of 10 studies that covered 1057 primigravid women. The results of the analysis showed that perineal massage during the second stage of labor reduced the perineal pain of primigravid women in the immediate postpartum period compared to the antenatal period, with a statistical value of (MD = -2.29, 95% CI [-2.53, -2.05], P < 0.001). Additionally, only the antenatal stage reported that perineal massage reduced fecal incontinence (P = 0.04) and flatus incontinence (P = 0.01) in primiparous women at three months postpartum, but had no significant effect on urinary incontinence in primiparous women at three months postpartum (P = 0.80).ConclusionsReducing perineal injuries in primiparous women can be achieved by providing perineal massage both antenatally and during the second stage of labor. Pelvic floor function is improved in the postnatal phase by perineal massage during the antenatal stage.Trial registrationCRD42023415996 (PROSPERO).

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.

Outcomes and factors influencing the second stage of labour in singleton deliveries

Objective: To define the characteristics of the second stage of labour and the outcomes of labour. Study design: The study includes 725 cases of pregnant monitored during the second stage of labour at the Obstetrics Centers of Hue Central Hospital and the Hue University of Medicine and Pharmacy Hospital from January 2022 to August 2023. Inclusion criteria: Singleton pregnancy, cephalic presentation, gestational age between 37 and 41 weeks 6 days, height ≥ 145 cm. Exclusion criteria: Category 2 and 3 cardiotocography (CTG) during the first stage of labour, refusal to participate in the study. Methodology is a cross-sectional descriptive study with a convenient sample size. Results: The average duration of the second stage was 51.73 ± 22.55 minutes. The mean duration for vaginal deliveries was 46.45 ± 16.27 minutes, instrumental deliveries were 48.89 ± 22.65 minutes, and cesarean sections were 59.86 ± 28.75 minutes (p &lt; 0.05). Vaginal deliveries constituted 87.5%, cesarean sections 10.4%, and instrumental deliveries 2.2%. Non-engagement of the fetal head in the second stage was associated with a 19.5 higher risk of instrumental or cesarean delivery compared to engaged presentations (p &lt; 0.05). Occurrence of transverse or posterior positions had a 6.4 higher intervention rate for instrumental or cesarean deliveries than anterior positions (p &lt; 0.05). Less than 3 contractions during the second stage increased the risk of cesarean or instrumental delivery by 5.5 times compared to those with ≥ 3 contractions (p &lt; 0.05). Key words: Second stage of labour, cesarean delivery, instrumental delivery, fetal presentation.

Early Morbidities of Hypoxia-Ischemic Encephalopathy in Term Neonates With a Resistive Index as a Prognostic Indicator.

Background Acidosis, hypoxemia, and hypercarbia are symptoms of a syndrome known as perinatal asphyxia that occurs during the first and second stages of labor and shortly after delivery due to poor gas exchange. The Doppler technique is a non-invasive way to assess the risk of neurodevelopment damage in hypoxic-ischemic encephalopathy (HIE) that may be done at the patient's bedside without disturbing them. The study aims to evaluate cranial ultrasound findings in HIEand investigate the role of resistive index (RI) values assessed by color Doppler transcranial ultrasonography in predicting early morbidities in neonates with HIE within 72 hours of life. Methodology Prospective observational research was carried out at the north Karnataka region's tertiary newborn critical care unit. The study included 54 infants with HIE in total. The male-to-female ratio was 1.7:1, with 34 (63%) male and 20 (37%) female newborns. Results About 32 instances had grade I HIE, 8 had grade II HIE, and 14 had grade III HIE. In 35 instances (64.81%), the RI was normal; in 19 cases (35.19%), it was abnormal. Increased periventricular density and cerebral parenchyma echo density were common Doppler ultrasonography findings. Roughly 93% of people survived, and 7% of people died from HIE. Seizures (12.96%) and acute renal damage (33.33%) were the most frequent consequences. Conclusion In instances of HIE, the RI was revealed to be a favorable predictive indicator for newborn prognosis. Counselingand educating parents about early morbidities, anticipated long-term consequences, and the need for follow-up will all benefit from it. Additionally, color Doppler is a practical and secure diagnostic method for determining a newborn's level of HIE.

Impact of early versus delayed umbilical cord clamping on term neonates' haemoglobin levels: a randomized controlled trial.

To compare the effects of early and delayed cord clamping on the haemoglobin levels of neonates delivered at term. This randomized controlled trial enrolled pregnant women during the second stage of labour. They were randomized into either the early cord clamping (ECC) group or the delayed cord clamping (DCC) group in the ratio of 1:1. Following delivery of the baby, the umbilical cords of participants in the ECC group were clamped within 30 s of delivery of the neonate while those of participants in the DCC group were clamped after 2 min from the delivery of the neonate. The primary outcome measure was the effect of ECC and DCC on the haemoglobin levels of neonates delivered at term. A total of 270 pregnant women were enrolled in the study. Their baseline sociodemographic and clinical characteristics were similar in both groups. There was no significant difference in the mean haemoglobin level between ECC and DCC groups at birth. The mean haemoglobin level of the neonates at 48 h postpartum was significantly higher in the DCC group than the ECC group. DCC at birth was associated with a significant increase in neonatal haemoglobin levels at 48 h postpartum when compared with ECC.Trial Registration: The trial was registered at Pan African Clinical Trial Registry with approval number PACTR202206735622089.

Effect of Jasmine Oil Back Massage on Pain Intensity among Primigravidae during the First Stage of Labor

Effect of Jasmine Oil Back Massage on Pain Intensity among Primigravidae during the First Stage of Labor

Active Versus Expectant Management of Third Stage of Labor: A Plane of Nursing Action

Active Versus Expectant Management of Third Stage of Labor: A Plane of Nursing Action

Effect of Competency-Based Education on Maternity Nurses' Performance and Quality of Care regarding Management of First Stage of Labor

Effect of Competency-Based Education on Maternity Nurses' Performance and Quality of Care regarding Management of First Stage of Labor

The Effect of the Competency Based Education Model on Nurses' Performance Regarding Active Management of Second Stage labor

The Effect of the Competency Based Education Model on Nurses' Performance Regarding Active Management of Second Stage labor

Analysis of Factors Affecting the Implementation of Uterine Exploration at the Third Stage of Labor

Labor is one of the critical periods for women based on IDHS data up to 2020 shows that bleeding, hypertension in pregnancy, and infection are the causes of maternal death. Observation data was conducted in January-February 2022 at 5 Puskesmas in the city of Tasikmalaya, and it was found that 3 out of 5 women in labor underwent exploratory procedures during the third stage of labor because there were signs of retained placenta. The act of uterus exploration could be a portal of bacterial entry into the cavity and cause infection. This study aimed to look at the factors that affect the implementation of uterine exploration in the third stage of labor. The research method uses a sequential explanatory mix method to analyze the supporting factors for third-stage exploration actions by midwives. The research sample was 43 midwives. Quantitative results showed that there was no influence of characteristic factors on exploration actions (ρ more than 0.05), and there was no influence of self-efficacy on uterus exploration (ρ more than 0.05). Qualitative results showed that there were four main factors supporting exploration, such as visible signs of bleeding and weak contractions, ensuring that there were no remaining placentas and routine actions that were carried out. The research concludes that the exploratory action carried out is the midwife's accumulated experience, which results in the perception of dealing with cases of retained placenta in the third stage of labor, this makes the uterus exploration an additional action to anticipate problems.

Weight Gain During Pregnancy Based on Pre-Pregnancy Body Mass Index with Duration of Labor

Chronic Energy Deficiency and being overweight in pregnancy is a severe problem because it could cause many risks in labor. This study aimed to determine the association between weight gain during pregnancy based on Body Mass Index before pregnancy with the duration of labor. The type of research was analytical observational with a cross-sectional approach. Thirty respondents used the quota sampling technique. The Spearman-rank test showed a significant value of 0,039, so there was a significant relationship between weight gain during pregnancy and the duration of the first stage of labor in the latent phase. The significant value was 0,016, indicating a relationship between weight gain during pregnancy and the duration of the first stage of labor in the active phase. However, a significant value of more than 0,05 in the variable duration of the second, third, and fourth stages of labor. So, it was necessary to monitor weight gain and provide counseling on the impact of excessive weight gain during labor. In addition, women with excessive weight gain should be given more time during the first stage because the duration in the second until the fourth stage of labor would generally run so that it could reduce unnecessary interventions.

Hydrotherapy in Pain Management in Pregnant Women: A Meta-Analysis of Randomized Clinical Trials.

Background: the benefits of water are significant during the birth process. Improved maternal experience of labor, less use of epidurals, better pain management, shorter labor, and a greater sense of control are observed during the birth process. Objective: This report aims to determine the benefits of hydrotherapy in clinical childbirth approaches and its applicability in pain control. Methods: A meta-analysis of randomized clinical trials selected from various databases with no publication date limits was conducted, comparing groups that did not use hydrotherapy with groups that did during labor. Results: Seven articles met the inclusion criteria, with five articles using hot water immersion and two using hot water shower as hydrotherapy treatments. This study identified 840 participants, with the intervention groups including 417 term pregnant women and the control groups including 423 pregnant women. The effect size of hydrotherapy on pain was calculated using the visual analog scale in five articles and analgesic use in the other two articles. Hydrotherapy significantly reduced pain during labor with a mean difference of -0.97 (95% CI: -1.91 to -0.03; I2 = 97.32%, p < 0.001). The duration of the first stage of labor was not significantly affected, with a mean difference of -0.17 h (95% CI: -0.55 to 0.21; I2 = 56.75%, p = 0.059). Additionally, hydrotherapy did not significantly impact the newborns' Apgar scores at 5 min, with a mean difference of 0.18 (95% CI: -0.48 to 0.85; I2 = 2.15%, p = 0.939). Conclusions: Hydrotherapy is beneficial for pain control in the first stage of labor and does not increase its duration or negatively affect the Apgar score of newborns.