Third Stage Of Labor Research Articles

To evaluate the predisposing factors of uterovaginal prolapse in women admitted in gynaecology ward

: Uterovaginal prolapse is an abnormal protrusion or herniation of pelvic organs from its normal position in the pelvis, due to failure of anatomical support. The prevalence of uterovaginal prolapse is difficult to be determined because many women are asymptomatic and many are hesitant to discuss with family. It can be considered a silent epidemic. The cause of uterovaginal prolapse is multifactorial. The parity, mode of delivery, postmenopausal status, obesity are some of the factors affecting the severity. The condition is preventive and by counseling and care during antenatal and postnatal period, the prevalence of this condition can be curtailed and quality of life can be improved.To evaluate the predisposing factors of uterovaginal prolapse in women admitted to the gynaecology ward.: A retrospective study was done for a period of 2 years from January 2019 to January 2021 at Integral Institute of Medical Sciences and Research, a tertiary care hospital and medical college, Kursi Road, Dasauli, Lucknow. The women admitted in gynaecology ward with symptoms of mass per vagina were included in the study. The data was retrieved from medical records of the department. The case file as per inclusion and exclusion criteria was identified and included in the study. The information of risk factors was collected using patient proforma. The pelvic organ prolapse quantification system (POPQ) approved by international continence society was used for categorizing uterovaginal prolapse. Data was analysed using SPSS version 20. Frequencies, percentage and mean computed to describe the variables of the study. The Chi-square test was used to compare variables. The statistical significance P<0.05 was considered significant.: The period of study was from January 2019 to January 2021. During this period 11256 patients were seen at the gynaecological clinic, out of which 206 patients had uterovaginal prolapse. The prevalence was 1.8%. The multiparity, prolonged and difficult deliveries, delivery by untrained personnel, mismanaged third stage of labour involving injury to sphincters and vaginal tears are determinants of prolapse uterus. Further postmenopausal condition causing hypoestrogenic state causes weaking of ligaments, collagen and aggravates the condition. Hence, preventive measures like institutional delivery, delivery by trained personnel, menopausal clinics may help the target population.

Binational confidential enquiry of maternal deaths due to postpartum hemorrhage in France and the Netherlands: Lessons learned through the perspective of a different contextof care.

To learn lessons for maternity care by scrutinizing postpartum hemorrhage management (PPH) in cases of PPH-related maternal deaths in France and the Netherlands. In this binational Confidential Enquiry into Maternal Deaths (CEMD), 14 PPH-related maternal deaths were reviewed by six experts from the French and Dutch national maternal death review committees regarding cause and preventability of death, clinical care and healthcare organization. Improvable care factors and lessons learned were identified. CEMD practices and PPH guidelines in France and the Netherlands were compared in the process. For France, new insights were primarily related to organization of healthcare, with lessons learned focusing on medical leadership and implementation of (surgical) checklists. For the Netherlands, insights were mainly related to clinical care, emphasizing hemostatic surgery earlier in the course of PPH and reducing the third stage of labor by prompter manual removal of the placenta. Experts recommended extending PPH guidelines with specific guidance for women refusing blood products and systematic evaluation of risk factors. The quality of CEMD was presumed to benefit from enhanced case finding, also through non-obstetric sources, and electronic reporting of maternal deaths to reduce the administrative burden. A binational CEMD revealed opportunities for improvement of care beyond lessons learned at the national level.

Effect of Nano Zinc Supplementation on Reproductive Performance of Assam Hill Goat

Background: Interaction between nutrition and reproduction has been established to play an important role in reproductive performance of animals. Zinc is considered to be an essential element required for reproduction. The present study was conducted to evaluate the efficiency of nano zinc (NZn) as feed supplementation on reproductive performance of Assam Hill goats. Methods: A total of twenty-four numbers of 7 days post kidding doe maintained at Goat Research Station, Assam Agricultural University, Burnihat were randomly selected and divided into 4 groups comprising 6 animals in each group. The control group animals were fed with basal diet without zinc supplementation however, all the animals of the treatment groups received 25 mg NZn, 35 mg NZn and 50 mg NZn/kg concentrate mixture with basal diet for a period of three months. Does were bred naturally at 24 hours from the onset of oestrus and confirmed for pregnancy after two months. Parturition behaviour was observed closely from two days before the expected date of kidding upto the period of placental expulsion. Result: Supplementation of 50 mg NZn to the basal diet of postpartum Assam Hill Goat significantly improved the reproductive performance by decreasing postpartum oestrus interval and increasing conception rate (83.33%).

The Effect of the Rebozo and Effleurage Techniques on Reducing Contraction Pain During Labor at TPMB Lina Maryati in 2022

Pain that lasts from the first stage to the third stage of labor is referred to as labor pain. Apart from being a subjective experience, labor pain is also the result of physical sensations caused by uterine contractions, cervical dilatation and effacement, and fetal descent. Purpose of Writing: to determine the Effectiveness of the Rebozo and Effleurage Techniques in Reducing Contraction Pain During Labor at TPMB Lina Maryati in 2022. Research Methods: In this study it was experimental (quasi-experimental) with a control group design and an experimental group with a quantitative approach. Sampling in this study was a total sampling of 15 people. The sample technique used was accidental sampling. Research results: between using the rebozo and effleurage techniques before and after the mean rank was 8.00 and the sum rank was 120.00. A value of 15 means that this result indicates a decrease (reduction) from the value before and after meaning that all respondents who experienced contraction pain during labor had a reduction in contraction pain using rebozo and effleurage so that it was concluded that there was a significant difference in the pain scale of contractions before and after the rebozo technique was carried out and effleurage, thus it can be concluded that the rebozo and effleurage techniques are effective in reducing contraction pain or in other words, there is effectiveness of the rebozo and effleurage techniques in reducing contraction pain during labor. Conclusions and Suggestions: can be a guideline for health workers, especially midwives in applying this technique to mothers in labor in an effort to reduce or eliminate pain experienced by mothers during contractions.

A STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE AMONG NURSES ON ACTIVE MANAGEMENT OF THIRD STAGE OF LABOUR WORKING IN OBSTETRICS AND GYNAECOLOGY DEPARTMENT IN SELECTED HOSPITALS OF KAMRUP (M), ASSAM.

Background: Active Management of Third Stage of Labour consists of interventions designed to speed the delivery of the placenta by increasing uterine contractions and prevent post-partum hemorrhage by an averting uterine atony. The Objective: objective of the study was to assess the Knowledge and Practice among Nurses on Active Management of Third Stage of Labour in selected hospitals of Kamrup (M), Assam. Methods: The study was conducted using Descriptive Survey design in Gauhati Medical College Hospital and Maternity & Child Welfare Hospital under Kamrup (M), Assam with a total of 82 Nurses by convenience sampling technique. Self - administered structured questionnaire was used to assess the knowledge and practice on Active Management of Third Stage of Labour. Data was analysed by using the software package named SPSS 20 Version. The nding of the study revealed that only 15.8% of the total Nurses have ade Result: quate level of knowledge 17.1% have good practice on Active Management of Third Stage of Labour. Karl Pearson's correlation coefcient was found to be r=0.565** .Thus there is highly signicant positive correlation between the two variables i.e. Knowledge and Practice of Nurses on Active Management of Third Stage of Labour. There was a signicant association between Knowledge on Active Management of Third Stage of Labour with their Professional Qualication and Exposure to any information on Active Management of Third Stage of Labour .The association of Practice was found signicant with their Years of Working Experience in Obstetrics and Gynaecology Department and Exposure to any information on Active Management of Third Stage of Labour. Conclusion: Knowledge and Practice among Nurses on Active Management of Third stage of Labour in the selected hospitals was low

PHYSIOLOGICAL BASED CORD CLAMPING- AN ARCHAIC STEP RELEARNED CLINICAL STUDY AT A TERTIARY CARE CENTRE.

Objective: To study maternal and perinatal outcomes in physiological based cord clamping in third stage of labour. Method: We conducted prospective observational study, in the Department of Obstetrics and Gynecology of Govt. Medical college & hospital, Aurangabad for 2 years to study physiological based cord clamping which is a method of deferred cord clamping until natural delivery of placenta. The placenta was allowed to deliver physiologically without any cord traction or cord pull, encouraging mothers own uterine contractions and taking help of gravity. Oxytocin was given intramuscularly to the mother only after complete placental delivery. Results: Out of 200 women most of them belong to age group 21-25 years (41.5%) with mean age of 24.78 ± 6.72 years. 47.5% were from upper lower class, 53.5% were G2 followed by 26.5% were primigravida's. About 72% women's GA was ranging between 37-40 weeks. In 89.5% women the time required for 3rd stage of labour ranged between 5-10 minutes while in 99% women's placenta expelled in <15 minutes. In our study 75% of women had outstanding experience after PCC. Among 200 neonates who delivered vaginally, had birth weight 2.5-3 kg (71%). majority of neonates had APGAR score ≥7 at 1 min were 97.50%, at 5 minute (100%) and 10 minute (100%) had Apgar score ≥7. It was observed that majority of neonates had heart rate 121-140 bpm at 1 minute (91.5%) and 5 minutes. (96%). Also, it was observed that mean temperature at 5 minutes was 98.32 ±1.08 F. Only 1.5% required NICU admission for neonatal jaundice. No case of hypothermia seen.

Postpartum Hemorrhage Prevention Quality Improvement Initiatives and Blood Transfusion Utilization [ID: 1378079

INTRODUCTION: The universal implementation of active management of the third stage of labor, quantitative assessment of blood loss, and hemorrhage risk assessment on admission is recommended to reduce the incidence and morbidity of postpartum hemorrhage. We evaluated the effect of these quality improvement (QI) initiatives, in addition to an active management protocol for iron deficiency anemia antepartum, on the use of blood transfusion during delivery hospitalization. METHODS: We obtained blood transfusion data for the obstetric service at a tertiary care university hospital from January 1, 2017 to July 13, 2022, as well as data for every delivery during that time period (N=11,101). Institutional review board approval was obtained for the study. Patients whose transfusions were administered for nonobstetric indications were excluded. We compared the frequency of blood transfusions and number of units transfused per patient before and after the implementation of QI initiatives. RESULTS: There was a significant downward trend in the frequency of blood transfusions (P=.003) and the number of units transfused per patient (P=.000006) during the study period. The transfusion rate was 3.3% in the year prior to any intervention and 1.78% after implementation of all QI initiatives. No differences were observed in the characteristics of the patient population relevant to hemorrhage risk during the study period. CONCLUSION: This study provides evidence that in addition to reducing postpartum hemorrhage and its morbidity, these QI initiatives also help reduce blood transfusion utilization.

Marine derived Ca-Mg complex supplementation basal diet during four subsequent parities improved longevity and performance of sows and their litters.

The aim of the present study was to evaluate the effects of dietary supplementation of Ca-Mg complex on the longevity and reproductive performance of sows. In total, seventy-two gilts ([Yorkshire × Landrace] × Duroc, average body weight 181 kg) were randomly allocated to 1 of 3 treatments during 4 successive parity in a 4 × 3 factorial arrangement. Treatments consisted of CON (basal diet), CM1 (basal diet -MgO - 0.3% limestone + 0.4% Ca-Mg complex), and CM2 (basal diet - MgO - 0.7% limestone + 0.4% Ca-Mg complex). A higher (p < 0.05) number of totals born and live piglets, and sows increased feed intake during gestation and lactation, increased backfat thickness, and increased estrus interval were observed (p < 0.05) during their third and fourth parity than during their first and second parity. Ca-Mg complex supplementation improved (p < 0.05) the number of total piglets during the first and second parity as well as live-born piglets during the first to third parity, reduction (p < 0.05) in backfat thickness during the third and fourth parity, a higher (p < 0.05) initial and final number of suckling piglets as well as higher weaning weight compared with sows fed CON diet during the first, second, and third parity. The average daily gain (ADG) was higher (p < 0.05) in piglets born to CM1 and CM2 sows regardless of parity. The treatment diets fed to sows lowered (p < 0.05) the duration of first to last piglet birth and placenta expulsion time compared with CON sows. A significant interactive effect (p = 0.042) between parities and treatment diets was observed for the first to last piglet birth. Thus, Ca-Mg complex supplementation by partially replacing limestone in the basal diet enhanced sow performance, specifically during their third and fourth parity, thereby improving sow longevity.

Active management of the third stage of labour in Ethiopia: A systematic review and meta-analysis.

Post-partum haemorrhage occurs in over 10% of all births and is the leading cause of maternal mortality, accounting for 25% of all maternal deaths worldwide. Active management of the third stage of labor is the most important intervention for reducing maternal morbidity and mortality by preventing postpartum hemorrhage. Previously, documented primary studies had been great discrepancy, inconsistent results, and there is a lack of comprehensive study. Hence, this systematic review and meta-analysis were intended to assess the prevalence and associated factors of the practice of active management of the third stage of labour among obstetric care providers in Ethiopia. Cross-sectional studies were systematically searched from January 01, 2010, to December 24, 2020, using PubMed, Google Scholar, HINARI, Cochrane Library, and grey literature. The pooled prevalence of active management of the third stage of labour practice and associated factors was estimated using DerSemonial-Laird Random Effect Model. Stata (version 16.0) was used to analyze the data. The I-squared statistic was used to assess the studies' heterogeneity. A funnel plot and Egger's test were used to check for publication bias. A subgroup analysis was performed to minimize the underline heterogeneity depending on the study years and the sample sizes. Seven hundred fifty articles were extracted. The final ten studies were included in this systematic review, including 2438 participants. The pooled prevalence of practices of active management of the third stage of labour among obstetric care providers in Ethiopia was 39.65% (30.86, 48.45%). Educational status (OR = 6.11, 95%CI, 1.51-10.72), obstetric care training (OR = 3.56, 95% CI: 2.66, 4.45), work experience (OR = 2.17, 95%CI, 0.47, 3.87) and knowledge of active management of the third stage of labour (OR = 4.5, 95% CI: 2.71, 6.28) were significantly associated with active management of the third stage of labour practices. The practice of active management of the third stage of labour in Ethiopia was low. This study showed that educational status, taking obstetric care training, knowledge of AMTSL, and work experience of obstetric care providers were associated with of practices of active management of the third stage of labour. Therefore, obstetric care professionals should improve their academic level, knowledge, and skills in order to provide useful service to AMTSL and save mothers' lives. All obstetric care providers should get obstetric care training. Furthermore, the government should increase obstetric care professionals' educational level.

Value of inferior vena cava diameter and inferior vena cava collapse index in the evaluation of peripartum volume: A prospective cohort study

ObjectiveThe maternal intravascular volume status assessed during and after gestation is valuable but challenging due to the influence of the substantial adaptive cardiovascular changes during pregnancy. The present study aimed to investigate the changes in the size of inferior vena cava (IVC) diameter and collapse index (IVC-CI) during perinatal delivery and whether it is affected by the change in intravascular volume during delivery. Study designA total of 31 full-term, singleton, and cephalic delivery women delivered by vagina with an estimated blood loss of >500 mL measured longitudinally between September 2019 and September 2020 in the Department of Obstetrics and Gynecology of The Third Hospital in China. The end-expiratory (IVCe) and end-inspiratory (IVCi) diameters of the inferior vena cava were measured at the first, second, and third stages of labor (T1, T2, and T3, respectively) and postpartum haemorrhage ≥500 mL (T4 and after rapid rehydration 500 mL (T5). The collapse index of IVC was calculated, and blood pressure and heart rate were measured. ResultsIVCe and IVC-CI changed significantly in a volume-dependent manner during the perinatal period (T1–T5; P < 0.05). IVCe narrowed significantly with volume reduction (after postpartum hemorrhage) and widened significantly with volume increase (after volume resuscitation). IVC-CI increases significantly with decreased capacity and decreases significantly with increased capacity. ConclusionThe width and collapse index of IVC reflect the circulatory volume changes during the parturient’s perinatal period with postpartum hemorrhage.

Effect of new Maternal and Child Health Book on Iron Supplementation Obedience and Labour Outcome in Pregnant Women, Pringsewu District, Lampung Province, Indonesia

The 2020 edition of the Maternal and Child Health (MCH) book can facilitate pregnant women in monitoring supplementation obedience and labour outcome. There are still few studies that discuss the effectiveness of the MCH book with regard to labour outcomes. This study aimed to determine the effectiveness of the new edition MCH book on obedience to iron supplementation and labour outcomes. The study used a quasi-experimental, non-equivalent control group design. The subjects were pregnant women in the second trimester until labour. The sample of this study comprised 60 people in the intervention group and 61 people in the control group. Research analysis was done using T-test and chi-square tests. The results showed that supplementation obedience increased haemoglobin levels, affected duration of labour in the first and second stages and the amount of blood loss during labour, and the APGAR scores were significantly different in the two groups (p-value &gt;0.05). However, the intake of protein and iron-rich food, placental membrane integrity, duration of the third stage of labour, uterine contractions, APGAR score in the first five minutes, and birth weight did not show a significant difference in the two groups (p-value &gt;0.05). The study concluded that the self-monitoring sheet for iron supplementation in the MCH book could improve obedience and haemoglobin, and thus improve labour outcomes, but it does not increase maternal food intake.

Engaging pregnant individuals and healthcare professionals in an international mixed methods study to develop a core outcome set for studies on placenta accreta spectrum disorder (COPAS): a study protocol

IntroductionPlacenta accreta spectrum (PAS) disorder is a life-threatening condition that may result in serious maternal complications, including mortality. The placenta which is pathologically adherent to the uterine wall, places individuals...

The Relationship Between Mother's Age and Duration Of Placental Devotion in the 3rd Stage Of Delivery in Midwife Practices Yulis Aktriani,S.Tr,Keb

The Maternal Mortality Rate (MMR) in Indonesia is still the highest in Southeast Asia and is still far from the global target of the SDGs (Sustainable Development Goals). One of the highest contributors to death is bleeding during childbirth. Stage III is a stage of labor that has a relatively short duration, can endanger the mother's life because of the increased risk of bleeding and lead to maternal death. This study aims to determine the relationship between maternal age and the duration of placental separation in the third stage of labor. This research method uses a correlational study research design with a retrospective approach. The sample of this study was 138 mothers who met the inclusion criteria. Using a purposive sampling technique. The data collection method used secondary data from medical records and partograph sheets, then the data were analyzed using Chi Square. The results of this study were almost all (77.5 percent) of the mother's age were 20 until 35 years old, while almost all of the time (82.6 percent) of the placenta was detached was not long. Statistical test chi square obtained a value of p more than 0.05 that H0 is rejected, meaning that there is a relationship between maternal age and the incidence of prolonged placental detachment in the third stage with an OR of 5.7, the maternal age at risk will cause the incidence of prolonged placental detachment 5 , 7 times more than the age of mothers who are not at risk. It is hoped that mothers, especially mothers who are at risk of age, understand the importance of planning for childbirth so as to prevent complications during delivery, especially the problem of the length of time the placenta is released.

EVALUATION OF THE EFFECTIVENESS OF ORAL AND VAGINAL MISOPROSTOL FOR INTRAUTERINE FETAL DEATH AND FETAL ANOMALY IN SECOND TRIMESTER PREGNANCY TERMINATION: A RANDOMIZED CLINICAL TRIAL

Background: which method of the expulsion of intrauterine fetal death and fetal anomaly in second trimester is effective, safe, and suitable for pregnant women. Objectives: to evaluate the effectiveness of oral misoprostol and vaginal misoprostol for intrauterine fetal death and fetal anomaly in second trimester pregnancy termination. Materials and Methods: a clinical trial in 108 women experiencing intrauterine fetal death and fetal anomaly during the second trimester in the obstetric department, Can Tho central general hospital in 2014. Excluded criteria: multiple pregnancies, uterus cesarean section scar, and misoprostol contraindication. Intervention: randomized division into two groups: group 1: misoprostol oral, group 2: vaginal misoprostol; dosage as recommended by FIGO. Success was defined as a complete and natural fetal and placenta expulsion without dilation and curettage or other treatment; and healthy hospital discharge. Results: the success rate of group 1 was 75.9%; group 2 was 83.3%. The success rates for fetal conditions of intrauterine fetal death were 74.6%, and the fetal anomaly was 86.7%. In group 1, the success rate in intrauterine fetal death was 63%, fetal anomaly was 88.9%. In group 2, the success rate in intrauterine fetal death was 81.3% and fetal anomaly was 86.4%. The rate of expulsion in the first 24 hours was 78.1% in group 1; 88.9% in group 2, which was not different statistically. Some side effects encountered in the study such as headache, nausea, diarrhea, fever/chills, rash were mainly seen in the oral misoprostol group; all side effects and complications were mild and transient. Related factors to complete expulsion in both groups were gestational age, parity, and fetal conditions. Conclusion: vaginal misoprostol has the same effectiveness and fewer complications than oral misoprostol.

High Dosage of Patient-Controlled Epidural Analgesia (PCEA) with Low Background Infusion during Labor: A Randomized Controlled Trial.

Patient-controlled epidural analgesia (PCEA) is well documented; however, it is unclear whether a high dosage of PCEA with a low dosage of background infusion during labor can be a safe and effective application. Group LH was administered a continuous infusion (CI) of 0.084 mL/kg/h with PCEA of 5 mL every 40 min. Group HL was given a CI of 0.028 mL/kg/h and PCEA of 10 mL every 40 min; Group HH was given a CI of 0.084 mL/kg/h and PCEA of 10 mL every 40 min. The primary outcomes were VAS pain score, the number of supplemental boluses, incidence of pain outbreaks, drug dose for pain outbreaks, PCA times, effective PCA times, anesthetic consumption, duration of analgesia, duration of labor and delivery outcome. Secondary outcomes included adverse reactions such as itching, nausea and vomiting during analgesia and neonatal Apgar scores 1 min and 5 min after birth. A total of 180 patients, 60 in each group were randomly assigned to one of three groups included group LH, group HL or group HH. The VAS scores were obviously decreased in HL group and HH group in comparison with LL group at 2 h after analgesia and the time point of full cervical dilation and delivery of baby. The time for third stage of labor in HH group was increased compared with LH group and HL group. Incidence of pain outbreaks in LH group was obviously increased compared with HL and HH group. The effective PCA times in HL group and HH group were remarkably reduced compared with those in LH group. High dose of PCEA with a low background infusion can reduce effective PCA times, incidence of outbreak pain and the total amount of anesthetics without diminishing analgesia effects. However, high dose of PCEA with a high background infusion can enhance analgesia effect but increase the third stage of labor, instrumental delivery ratio and the total amount of anesthetics.

Effects of epidural analgesia at 1 cm cervical dilatation on labor interventions in full-term primigravida: A retrospective cohort study.

This study aimed to investigate the effects of epidural analgesia administered as early as cervical dilatation of 1 cm on labor interventions and maternal and neonatal outcomes. This retrospective research recruited 1007 full-term primigravidas, who were distributed to two separate cohorts for eligibility: epidural analgesia 1 (cervical dilatation = 1 cm) and epidural analgesia 2 (cervical dilatation >1 cm). Labor interventions (artificial rupture of membranes and oxytocin administration) and duration of labor were the primary outcomes. The effect of initiation timing of epidural analgesia on artificial membrane rupture was not statistically significant (adjusted odds ratio [OR]: 0.85 [0.58-1.24], p > 0.05). Less oxytocin was used in the epidural analgesia 2 group compared with the epidural analgesia 1 group (the adjusted OR: 0.68 [0.49-0.95], p < 0.05). There were no significant differences in the median time to latent phase of labor, active phase of labor, second, and third stages of labor (p > 0.05). There were no significant differences in maternal and neonatal outcomes between the epidural analgesia 1 group and the epidural analgesia 2 group. Epidural analgesia could be administered at cervical dilatation = 1 cm.

The Management of Third Stage of Labor

Doğum eylemi ve doğumun evrelerinde uygulanan çeşitli uygulamalar geçmişten günümüze kadar tartışılmaktadır ve bu konu halen popülaritesini korumaktadır. Anne ve bebeğin iyilik halinin sağlanması ve sürdürülebilmesi için doğumda yapılan her uygulamanın kanıt temelli olması gerekmektedir. Bu çerçevede doğum eyleminin üçüncü evresinde uygulanan umblikal kordun klemplenme zamanı, uterotonik ajan kullanımı, umblikal kordun traksiyonu, uterin masaj gibi uygulamalar literatür çalışmalarıyla incelenmektedir. Bu uygulamaların etkinliğini bilmek, doğumda birincil rol oynayan ebelerin gereksiz uygulamalardan kaçınmasını sağlayacak ve var olan bilgilerini yeni bilgilerle bütünleştirecektir. Bu derlemede, doğum eyleminin üçüncü evresinin yönetiminde kullanılan uygulamalar ve kanıta dayalı yaklaşımlar literatür bilgisiyle sunulmaktadır.

Autonomic nervous system balance in parturient mares: Spontaneous vs induced delivery.

Delivery is not easily predictable in horses and the consequences of dystocia can be serious for both the mare and foal. An induction protocol with low doses of oxytocin has been reported as a safe procedure. This study investigates the effect of induced delivery on at-term mares' sympathetic-vagal balance. Fourteen mares were included and divided into two groups, one subjected to spontaneous delivery (SD), and one to induced delivery (ID). In both groups, an ECG was recorded using an elastic belt with integrated smart textile electrodes. The recording started before the delivery (Basal), continued close to delivery (Pre-delivery) and during delivery (Delivery), and ended after parturition (Placental expulsion). From the ECGs, Heart Rate Variability (HRV) parameters relating to time and frequency domains and non-linear analysis were extrapolated. The HRV analysis was performed both within the same group (IntraGA) and between the two groups (InterGA). In the present study, spontaneous and induced delivery did not appear to differ in autonomic nervous system functioning. In IntraGA analysis, both for SD and ID mares, delivery and placental expulsion periods were parasympathetic dominated since vagal-related HRV parameters increased. Moreover, no differences were found in InterGA comparison between SD and ID mares, except for the pre-delivery period of ID mares, during which both branches of the autonomic nervous system were activated. These results are in line with the literature on parasympathetic dominance during parturition and no change in Heart Rate Variability following exogenous oxytocin administration in parturient mares.

A Comparison of Two Dosing Regimens of Misoprostol in Labour Induction: A Randomised Controlled Trial

Objective: To compare the effectiveness and safety of 50μg of sublingual misoprostol administered six (6) hourly to that of 50μg of vaginal misoprostol administered four (4) hourly. Methodology: A non-blinded, randomized controlled trial conducted from Sept 1, 2014, to Nov 31, 2014, at a tertiary hospital in Ghana. Hundred and sixty women with medical or obstetric indications for labour induction were randomized into two groups. Results: The rate of vaginal delivery, caesarean section, uterine tachysystole and uterine hyperstimulation were similar in both groups. Sixty-three (78.8%) and 66 (82.5%) mothers in the vaginal and sublingual groups delivered vaginally. More (10.0%) mothers in the vagina group required emergency caesarean for foetal distress. Six (vaginal group) and 8 (sublingual group) of the mothers required emergency caesarean for cephalopelvic disproportion. Three mothers from each group had an emergency caesarean section due to failed labour induction. Almost the same number of mothers had uterine tachysystole in both groups. More (3.8%) mothers in the vaginal group had uterine hyperstimulation. Differences in the mean induction delivery interval and the need for oxytocin augmentation were not significant. No differences were found in the intrapartum passage of meconium, blood loss in the third stage of labour, 5-minute Apgar score &lt;7, and neonatal intensive care unit admissions. Conclusion: The sublingual regimen was as effective and safe as the vaginal regimen in achieving vaginal delivery.

Evaluation of the effect of dinoprostone vaginal ovule for cervical maturation and labor induction in term pregnancies on the duration of the third stage of labor and amount of postpartum bleeding

Background/Aim: Postpartum bleeding is a leading preventable cause of maternal death. Prolonged 3rd stage duration of labor and induction agents can increase postpartum bleeding. This study evaluated the effect of using a dinoprostone (PGE2) vaginal insert, a cervical ripening and labor induction agent, on the 3rd stage duration of labor and the amount of postpartum bleeding. Methods: This prospective cross-sectional study involved 301 patients with vaginal delivery between 01.10.2020 and 30.06.2021. Patients were separated into two groups: PGE2+oxytocin (Group A) and only oxytocin (Group B). They were compared in terms of prepartum and postpartum data, 3rd stage duration of labor, and the amount of blood loss in the first 18 h postpartum. Results: The median 3rd stage duration of labor was 8 min in Group A and 7 min in Group B (P=0.009). No significant differences were found between the groups in the amount of postpartum blood loss, percentage changes in hemoglobin and hematocrit values, or when patients were analyzed based on 3rd stage duration of labor (≤10 vs. &gt;10 min). Severe postpartum hemorrhage (≥1000 ml) was associated with decreased gravida, increased body mass index, longer oxytocin use, and prolonged 3rd stage duration of labor in all patients. In Group A, severe postpartum hemorrhage was associated with decreased gravida, increased body mass index, and longer duration of PGE2 use. Conclusion: PGE2 prolonged the 3rd stage duration of labor, but this did not increase postpartum bleeding compared to oxytocin. However, an increase in the duration of PGE2 use was associated with postpartum hemorrhage. Therefore, shortening the duration may be considered in patients with additional risk for postpartum hemorrhage.