Women In Active Labor Research Articles

EFFICACY OF BREATHING TECHNIQUES FOR MANAGEMENT OF MATERNAL OUTCOMES DURING LABOR

Maternal anxiety during labor can adversely affect both the mother and fetus. Effective management strategies, including non-pharmacological interventions like breathing patterns, are crucial to improving labor outcomes and maternal well-being. Objective: To evaluate the efficacy of breathing patterns for the management of maternal anxiety during the dilation phase of labor. Methods: A prospective study was conducted in the Physiotherapy and Obstetrics and Gynecology Department of DHQ Hospital from April 2023 to April 2024. One hundred fifty pregnant women in active labor with gestational ages of 37-41 weeks were included. The patients were divided into the study group (70 women) and the control group (80 women). The control group followed standard labor procedures, while the study group was guided on breathing patterns according to a specified protocol. The primary endpoint was maternal anxiety, and secondary endpoints included pain, fatigue, satisfaction, labor duration, and delivery mode. The 5-minute Apgar score was also assessed for the fetus. Statistical analysis was performed to compare outcomes between the groups. Results: Baseline maternal outcomes, including pain, fatigue, anxiety, satisfaction, and labor duration, showed no significant differences between the study and control groups. The mean labor duration was 7.70 ± 3.36 hours for the study group and 8.00 ± 2.54 hours for the control group, with a mean difference of 0.30 hours (95% CI 1.35-0.78). Maternal outcomes did not differ between groups after two hours of protocol implementation and sensitivity analysis. The delivery mode was similar in both groups, with a relative risk of 0.10 (95% CI 0.78-1.09) and 0.10 (95% CI 0.77-1.10) for protocol and sensitivity analysis, respectively. The 5-minute Apgar scores also showed no significant differences between the groups. Conclusion: Using breathing patterns during active labor did not significantly impact maternal outcomes, including pain, satisfaction, anxiety, and fatigue.

The burden of critical illness among adults in a Swedish region—a population-based point-prevalence study

BackgroundPatients with critical illness have a high risk of mortality. Key decision-making in the health system affecting the outcomes of critically ill patients requires epidemiological evidence, but the burden of critical illness is largely unknown. This study aimed to estimate the prevalence of critical illness in a Swedish region. Secondary objectives were to estimate the proportion of hospital inpatients who are critically ill and to describe the in-hospital location of critically ill patients.MethodsA prospective, multi-center, population-based, point-prevalence study on specific days in 2017–2018. All adult (> 18 years) in-patients, regardless of admitting specially, in all acute hospitals in Sörmland, and the patients from Sörmland who had been referred to university hospitals, were included. Patients in the operating theatres, with a psychiatric cause of admission, women in active labor and moribund patients, were excluded. All participants were examined by trained data collectors. Critical illness was defined as “a state of ill health with vital organ dysfunction, a high risk of imminent death if care is not provided and a potential for reversibility”. The presence of one or more severely deranged vital signs was used to classify critical illness. The prevalence of critical illness was calculated as the number of critically ill patients divided by the number of adults in the region.ResultsA total of 1269 patients were included in the study. Median age was 74 years and 50% of patients were female. Critical illness was present in 133 patients, resulting in an adult population prevalence of critical illness per 100,000 people of 19.4 (95% CI 16.4–23.0). The proportion of patients in hospital who were critically ill was 10.5% (95% CI 8.8–12.3%). Among the critically ill, 125 [95% CI 94.0% (88.4–97.0%)] were cared for in general wards.ConclusionsThe prevalence of critical illness was higher than previous, indirect estimates. One in ten hospitalized patients were critically ill, the large majority of which were cared for in general wards. This suggests a hidden burden of critical illness of potential public health, health system and hospital management significance.

The Impact of the Active Stage of Labor on Estimate Fetal Weight: A Prospective Cohort Study

Objective: In the literature, there have been few data on ultrasound measurements during the active phase of labor. In this study, it was aimed to compare the accuracy of fetal weight estimation by ultrasound in terms of active phase of labor. Methods: This was a prospective cohort study at the obstetrics clinic of Esenler Gynecology and Children's Hospital in Istanbul. A total of 85 patients in active labor were included in the study. All pregnant women were evaluated for estimated fetal weight (EFW) by ultrasound evaluation, and cervical dilation and effacement measurements by pelvic examination, at most 24 hours before labor. Hadlock-4 formula was used for EFW. EFW and actual birth weight (ABW) and absolute errors of pregnant women in active labor were compared. Results: The mean EFW and ABW of the patients were 3161±482 and 3150±476 g, respectively. In terms of EFW and ABW, a finding in favor of the ultrasound was found. The error and error rates between EFW and ABW were found to be 234±191 g and 7.6±6.2, respectively. No significant difference was found in terms of these parameters (p>0.05). A significant and strong (0.80) correlation was found with estimated fetal weights and actual birth weights. Conclusion: Ultrasound can be used as a safe method to measure estimated fetal weight in the active phase of labor.

Pain Intensity, coping and maternal satisfaction in Low-Risk labouring Women: A prospective descriptive correlational study

ObjectivesThe primary aim of the study was to explore pain intensity (PI) and pain coping (PC) scores and the relationship between them. The secondary aim was to explore the correlation between PI and PC scores with labour progress, parity, labour acceleration, labour augmentation and maternal satisfaction. MethodsA prospective descriptive correlational study was conducted in a maternity hospital in Northern Italy. The sample included 54 low-risk women in active labour at term of pregnancy. A data record sheet was used to collect the relevant variables and the Italian Birth Satisfaction Scale Revised (I-BSS-R) was administered to participants at least 24 h after birth. ResultsIn the first labour stage, the average PI score was 6.99 (SD = 1.95) and the average PC score was 6.5 (SD = 2.22). During the second labour stage, the average PI score was 7.75 (SD = 1.74) and the average PC score was 4.97 (SD = 2.76). The average PI score trend increased with labour progress. The average PC score improved between 4 and 7 cm of cervical dilatation. A significant positive correlation between PI scores and oxytocin augmentation (p < 0.001) and labour progression (p < 0.001) was noted. A significant positive correlation between PC scores and oxytocin augmentation (p = 0.02) was also observed. No significant differences were found for maternal satisfaction in regard to PI and PC scores. Conclusioncoping in labour do not solely depend on PI but also on labour progress and oxytocin augmentation. Additional support to empower women to cope with pain may be required in case of labour augmentation.

On the prediction of premature births in Hispanic labour patients using uterine contractions, heart beat signals and prediction machines.

Preterm birth is a global epidemic affecting millions of mothers across different ethnicities. The cause of the condition remains unknown but has recognised health-based implications, in addition to financial and economic ones. Machine Learning methods have enabled researchers to combine datasetsusinguterine contraction signals with various forms of prediction machines to improve awareness of the likelihood of premature births. This work investigates the feasibility of enhancing these prediction methods using physiological signals including uterine contractions, and foetal and maternal heart rate signals, for a population of south American women in active labour. As part of this work, the use of the Linear Series Decomposition Learner (LSDL) was seen to lead to an improvement in the prediction accuracies of all models, which included supervised and unsupervised learning models. The results from the supervised learning models showed high prediction metrics upon the physiological signals being pre-processed by the LSDL for all variations of the physiological signals. The unsupervised learning models showed good metrics for the partitioning of Preterm/Term labour patients from their uterine contraction signals but produced a comparatively lower set of results for the various kinds of heart rate signals investigated.

Qualitative Study of the Experience of Caring for Women During Labor and Birth During the First Wave of the COVID-19 Pandemic

ObjectiveTo examine the experiences of labor and delivery (L&D) nurses and certified nurse-midwives who cared for women during labor and birth in the United States during the first wave of the COVID-19 pandemic. DesignSubgroup analysis of a larger study with a qualitative descriptive design. SettingTelephone interviews. ParticipantsThe parent study included 100 nurses across various specialty areas who provided patient care during the first wave of COVID-19 in the United States. Our subgroup analysis included 19 participants: L&D nurses (n = 11) and certified nurse-midwives (n = 8). MethodsSemistructured interview guide. ResultsParticipants described their experiences providing patient care in L&D settings during the first wave of the COVID-19 pandemic. We identified five major themes: Separation of COVID-19–Positive Mothers and Newborns, Isolation of Women in Active Labor, Disparities in Access to Care, Barriers to Communication, and Effect on the Mental Health of Members of the Care Team. ConclusionOur findings captured the experiences of maternity care team members who worked during the COVID-19 pandemic when standards of quality maternity care were compromised. The challenges of caring for COVID-19–positive mothers, including isolation during active labor and infant removal from mothers at birth, affected their psychological well-being and their mental health and must now be addressed to prevent burnout and turnover.

Magnetic resonance imaging in late pregnancy to improve labour and delivery outcomes – a systematic literature review

BackgroundMagnetic resonance imaging (MRI) provides excellent soft tissue visualisation which may be useful in late pregnancy to predict labour outcome and maternal/neonatal birth trauma.ObjectiveTo study if MRI in late pregnancy can predict maternal and neonatal outcomes of labour and birth.MethodsSystematic review of studies that performed MRI in late pregnancy or immediately postpartum. Studies were included if they imaged maternal pelvic or neonatal structures and assessed birth outcome. Meta-analysis was not performed due to the heterogeneity of studies.ResultsEighteen studies were selected. Twelve studies explored the value of MRI pelvimetry measurement and its utility to predict cephalopelvic disproportion (CPD) and vaginal breech birth. Four explored cervical imaging in predicting time interval to birth. Two imaged women in active labour and assessed mouldability of the fetal skull. No marker of CPD had both high sensitivity and specificity for predicting labour outcome. The fetal pelvic index yielded sensitivities between 59 and 60%, and specificities between 34 to 64%. Similarly, although the sensitivity of the cephalopelvic disproportion index in predicting labour outcome was high (85%), specificity was only 56%. In women with breech presentation, MRI was demonstrated to reduce the rates of emergency caesarean section from 35 to 19%, and allowed better selection of vaginal breech birth. Live birth studies showed that the fetal head undergoes a substantial degree of moulding and deformation during cephalic vaginal birth, which is not considered during pelvimetry. There are conflicting studies on the role of MRI in cervical imaging and predicting time interval to birth.ConclusionMRI is a promising imaging modality to assess aspects of CPD, yet no current marker of CPD accurately predicts labour outcome. With advances in MRI, it is hoped that novel methods can be developed to better identify individuals at risk of obstructed or pathological labour. Its role in exploring fetal head moulding as a marker of CPD should be further explored.

Cervicovaginal Complement Activation and Microbiota During Pregnancy and in Parturition.

BackgroundVaginal microbiome and the local innate immune defense, including the complement system, contribute to anti- and proinflammatory homeostasis during pregnancy and parturition. The relationship between commensal vaginal bacteria and complement activation during pregnancy and delivery is not known.ObjectiveTo study the association of the cervicovaginal microbiota composition to activation and regulation of the complement system during pregnancy and labor.Study designWe recruited women during late pregnancy (weeks 41 + 5 to 42 + 0, n=48) and women in active labor (weeks 38 + 4 to 42 + 2, n=25). Mucosal swabs were taken from the external cervix and lateral fornix of the vagina. From the same sampling site, microbiota was analyzed with 16S RNA gene amplicon sequencing. A Western blot technique was used to detect complement C3, C4 and factor B activation and presence of complement inhibitors. For semiquantitative analysis, the bands of the electrophoresed proteins in gels were digitized on a flatbed photo scanner and staining intensities were analyzed using ImageJ/Fiji win-64 software. Patient data was collected from medical records and questionnaires.ResultsThe vaginal microbiota was Lactobacillus-dominant in most of the samples (n=60), L. iners and L. crispatus being the dominant species. L. gasseri and L. jensenii were found to be more abundant during pregnancy than active labor. L. jensenii abundance correlated with C4 activation during pregnancy but not in labor. Gardnerella vaginalis was associated with C4 activation both during pregnancy and labor. The amount of L. gasseri correlated with factor B activation during pregnancy but not during labor. Atopobium vaginae was more abundant during pregnancy than labor and correlated with C4 activation during labor and with factor B activation during pregnancy. Activation of the alternative pathway factor B was significantly stronger during pregnancy compared to labor. During labor complement activation may be inhibited by the abundant presence of factor H and FHL1.ConclusionsThese results indicate that bacterial composition of the vaginal microbiota could have a role in the local activation and regulation of complement-mediated inflammation during pregnancy. At the time of parturition complement activation appears to be more strictly regulated than during pregnancy.

Role of intrapartum amnioinfusion in meconium-stained amniotic fluid

Background: Intrapartum amnioinfusion in meconium-stained amniotic fluid has been known to dilute the meconium and prevent meconium aspiration syndrome (MAS). However, the literature available on intrapartum amnioinfusion is varying. Objective: To assess the neonatal outcomes following intrapartum transcervical amnioinfusion in full-term pregnant women. Methods: This case-control study included pregnant women in active labor, divided into case group (n=63) receiving amnioinfusion and control group (n=63) without amnioinfusion. In the case group, 500 mL of warm, normal saline was infused into the uterine cavity. Both groups were compared for liquor quality, mode of delivery, and neonatal outcomes like APGAR score, resuscitation, meconium presence, MAS, neonatal intensive care unit (NICU) admission, and length of NICU stay. Chi-square test was used to analyze the difference between cases and controls. Results: Mode of delivery was spontaneous vaginal delivery in most cases (71%), with only 19% undergoing cesarean section. APGAR score at 1 min was &gt;7 in cases compared to controls, which was significant (12.69% vs 0%, P=0.005). Resuscitation was required less in cases than controls (9.52% vs 50.79%, P&lt;0.001). Presence of meconium below the vocal cord was more in controls (34.92% vs 4.76%, P=0.003). MAS was observed more in controls (26.98% vs 4.76%, P&lt;0.001)

Scaling up context-tailored clinical guidelines and training to improve childbirth care in urban, low-resource maternity units in Tanzania: A protocol for a stepped-wedged cluster randomized trial with embedded qualitative and economic analyses (The PartoMa Scale-Up Study)

ABSTRACT While facility births are increasing in many low-resource settings, quality of care often does not follow suit; maternal and perinatal mortality and morbidity remain unacceptably high. Therefore, realistic, context-tailored clinical support is crucially needed to assist birth attendants in resource-constrained realities to provide best possible evidence-based and respectful care. Our pilot study in Zanzibar suggested that co-created clinical practice guidelines (CPGs) and low-dose, high-frequency training (PartoMa intervention) were associated with improved childbirth care and survival. We now aim to modify, implement, and evaluate this multi-faceted intervention in five high-volume, urban maternity units in Dar es Salaam, Tanzania (approximately 60,000 births annually). This PartoMa Scale-up Study will include four main steps: I. Mixed-methods situational analysis exploring factors affecting care; II. Co-created contextual modifications to the pilot CPGs and training, based on step I; III. Implementation and evaluation of the modified intervention; IV. Development of a framework for co-creation of context-specific CPGs and training, of relevance in comparable fields. The implementation and evaluation design is a theory-based, stepped-wedged cluster-randomised trial with embedded qualitative and economic assessments. Women in active labour and their offspring will be followed until discharge to assess provided and experienced care, intra-hospital perinatal deaths, Apgar scores, and caesarean sections that could potentially be avoided. Birth attendants’ perceptions, intervention use and possible associated learning will be analysed. Moreover, as further detailed in the accompanying article, a qualitative in-depth investigation will explore behavioural, biomedical, and structural elements that might interact with non-linear and multiplying effects to shape health providers’ clinical practices. Finally, the incremental cost-effectiveness of co-creating and implementing the PartoMa intervention is calculated. Such real-world scale-up of context-tailored CPGs and training within an existing health system may enable a comprehensive understanding of how impact is achieved or not, and how it may be translated between contexts and sustained. Trial registration number: NCT04685668

Comparing compliance with commencement and use of two partograph designs for women in active labour: A randomised controlled trial

BackgroundDocumentation and assessment of progress in labour using a partograph is recommended by the World Health Organisation to assist in the timely recognition of labour dystocia. Recent studies have tested new designs of partographs that aim to account for more variable rates of labour progress. However, other studies have suggested that poor compliance in the completion of partographs affects utility. The objective of this study was to compare two types of partographs for compliance in documentation and use for managing labour. MethodsLow-risk nulliparous women in spontaneous labour (n = 228) were randomised to either an Action Line (control) (n = 114) or Dystocia Line partograph (intervention) (n = 114). Primary outcome was compliance with instructions for commencement of the partograph following a multifaceted training strategy. Secondary outcomes included compliance with the accompanying clinical management protocol for each partograph; and labour and birth outcomes. ResultsThe compliance rate for commencing the Action line partograph was 43.2% compared to 67.0% (p = 0.02) for the Dystocia line partograph. Other than a reduction in artificial rupture of membranes in the Dystocia Line group there were no other differences in labour management or birth outcomes. The use of centralised electronic display of labour progress may be a contributing factor. ConclusionsCompliance with the commencement and use of either partograph was low. There was little indication that the partograph was being utilized in the assessment and management of prolonged labour. Further studies are needed to explore the current utility of partographs in labour management and the effect of centralised monitoring of progress in high resource settings

Admission to delivery suites: the importance of antenatal education

This article discusses the challenges in ensuring women have appropriate education to guide their decision on when to present to hospital during labour. Unnecessary admission to the delivery suite can cause overcrowding, which may affect the services provided to women in active labour. Pregnancy is a demanding and sometimes overwhelming experience and women's fears can be compounded if they do not know what to expect from labour. Antenatal education to inform women on the signs and symptoms of the first stage of labour, and how to recognise deviations from normal, is vital in encapsulating holistic antenatal care. Therefore, antenatal education is integral to positive pregnancy outcomes, enhancing women's ability to take control of their pregnancy by undertaking self-management at home prior to the onset of active labour and their confidence in coming to the delivery suite at the appropriate time.

The effect of Zhang's guideline vs the WHO partograph on childbirth experience measured by the Childbirth Experience Questionnaire in the Labor Progression Study (LaPS): A cluster randomized trial.

Childbirth experience is an increasingly recognized and important measure of quality of obstetric care. Previous research has shown that it can be affected by intrapartum care and how labor is followed. A partograph is recommended to follow labor progression by recording cervical dilation over time. There are currently different guidelines in use worldwide to follow labor progression. The two main ones are the partograph recommended by the World Health Organization (WHO) based on the work of Friedman and Philpott and a guideline based on Zhang's research. In our study we assessed the effect of adhering to Zhang's guideline or the WHO partograph on childbirth experience. Zhang's guideline describes expected normal labor progression based on data from contemporary obstetric populations, resulting in an exponential progression curve, compared with the linear WHO partograph. The choice of labor curve affects the intrapartum follow-up of women and this could potentially affect childbirth experience. The Labor Progression Study (LaPS) study was a prospective, cluster randomized controlled trial conducted at 14 birth centers in Norway. Birth centers were randomized to either follow Zhang's guideline or the WHO partograph. Nulliparous women in active labor, with one fetus in cephalic presentation at term and spontaneous labor onset were included. At 4 weeks postpartum, included women received an online login to complete the Childbirth Experience Questionnaire (CEQ). Total score on the CEQ, the four domain scores on the CEQ, and scores on the individual items on the CEQ were compared between the two groups. There were 1855 women in the Zhang group and 1749 women in the WHO partograph group. There was no difference in the total or domain CEQ scores between the two groups. We found statistically significant differences for two individual items; women in the Zhang group scored lower on positive memories and feeling of control. Based on our findings on childbirth experience there is no reason to prefer Zhang's guideline over the WHO partograph.

Body mass index and labor outcome associated with the level of amniotic fluid lactate. A cross-sectional study of women with labor dystocia

Introduction Obesity is a globally growing problem. Labor dystocia is associated with obstetric complications, especially among obese pregnant women. Previous studies have shown an association between the level of lactate produced by uterine myocytes during contractions and the level of lactate in the amniotic fluid (AFL). A relationship between a high level of AFL and labor dystocia has also been demonstrated. However, it is still unknown whether the observation applies to all women with labor dystocia, regardless of body mass index (BMI). Aims: This study investigated whether there was any difference in the level of AFL in the three BMI groups and whether there was a difference in labor outcomes between high and low AFL in the different groups. Materials and Methods This cross-sectional study included 1683 women from three different countries. Healthy nulliparous women in active labor were included, and they were grouped according to BMI as normal weighted (<25), overweight (≥25–29), and obese (≥30), respectively. AFL was categorized as high (≥10.1 mmol/l) and low (<10.1 mmol/l). The main outcome was the frequency of cesarean section. Results No difference in AFL levels was found between the three BMI groups at delivery (mean values of 8.2 vs. 8.3 vs. 8.4 mmol/l, p = .3). Obese women with high AFL had a higher frequency of cesarean section than normal-weighted women (16.2 vs. 20.7 vs. 29.2%). Other risk factors associated with cesarean section varied among the different BMI groups. Conclusions This study showed no difference in the mean level of AFL between women with different BMIs. Further, high AFL was associated with a higher frequency of cesarean section in all three BMI groups, suggesting that the level of AFL can in the future be used as a predictor of labor outcome among women with labor dystocia despite their BMI.

Factors contributing to a positive childbirth experience for women in a hospital setting: an umbrella review protocol.

The objective of this umbrella review is to identify and evaluate the factors that contribute to a positive childbirth experience in laboring women in the hospital setting. Childbirth is a milestone for women. Overall, the experience can positively or negatively affect self-esteem, bonding, future childbirth decisions, and overall health and well-being. Understanding of the mother's perception and expectation of the childbirth event is needed to promote positive experiences and outcomes. This review will consider qualitative systematic reviews that include pregnant women, women in active labor, or women who have recently given birth. This review will consider systematic reviews conducted in a hospital setting in any geographical location reporting on women's positive childbirth experiences, and the factors that led to positive experiences. The search strategy will aim to locate qualitative systematic reviews. Databases to be searched include MEDLINE, CINAHL, Embase, Scopus, JBI Evidence Synthesis, and Cochrane Database of Systematic Reviews. Sources of unpublished reviews and gray literature to be searched include ProQuest Dissertations and Theses Sciences and Engineering Collection and OpenGrey. Systematic reviews published since 2001 in the English language will be included. Data will be extracted from systematic reviews by two independent reviewers and findings from the included reviews, as they relate to the umbrella review question, will be presented in tabular format with a supplemental narrative to ensure interpretability. PROSPERO CRD42021251796.

A Comparison of Tramadol and Pethidine Analgesia on the Duration of Labour

Background: A standard obstetric analgesic should have a good analgesic effect without reducing the intensity of uterine contraction. The present study aimed to evaluate and compare the efficacy of intramuscular tramadol and pethidine on labor pain and duration. Material and Methods: A total of 170 multigravida women in active labor were randomly assigned to two identical groups, so that 85 pregnant women received pethidine (50mg/2ml) and 85 pregnant women received tramadol (100mg/2ml) intramuscularly. Results: The labor duration in the tramadol group was shorter than in the pethidine group. In 1st stage of labor, 64.7% of the participants in the tramadol group received the drug for 120±30 minutes, while 67.1% in the pethidine group received the drug for 180±30 minutes. In the 2nd stage, 44.7% of the participants in the tramadol group received the drug for 15±5 minutes, while 51.8% in the pethidine group received the drug for 25±5 minutes. The Visual Analog Scale (VAS) was used before, and 1 and 3 hours after drug administration. The pethidine group obtained a lower VAS mean score compared to those in the tramadol group at 1 hour after drug administration (4 vs 6; P≤.001). Moreover, there was a significant higher level of vomiting and dizziness among women in the pethidine group (29.4% vs 1.2%; P≤.001). Conclusion: Tramadol appears to lead to a shorter labor duration and cause lower maternal side-effects, although its analgesic efficacy was not as much as pethidine.

Bacterial Colonization of Vagina in Indian Women During Labor and Its Association With Puerperal and Neonatal Sepsis: A Tertiary Hospital Study.

ObjectiveThe aim was to find the prevalence of colonization of vagina with aerobic bacteria among low-risk Indian women in active labor and its association with early-onset neonatal sepsis (EONS) and puerperal sepsis.MethodsThe study was conducted prospectively from October 2018 to March 2020 in a tertiary hospital in New Delhi, India. Low-risk pregnant women (N=920) in active labor with intact membranes were recruited. High vaginal swabs were collected, cultured by standard methods to detect aerobic bacteria. The primary outcomes were the development of puerperal sepsis and EONS.ResultsIn a total of 920 low-risk subjects, vaginal colonization was found in 484 (52.6%), coagulase-negative Staphylococcus being the predominant colonizer (13.2%) followed by Escherichia coli (8.9%). Multigravida women were at 1.4 times higher risk of colonization than primigravida (odds ratio [OR] 1.399; 95% CI 1.064, 1.84). Women whose sample was collected at the first vaginal examination were at 0.34 times lower risk of colonization as compared to women with more than one vaginal examination (OR 0.34; 95% CI 0.241, 0.481). The incidence of colonization increased with progressive vaginal examinations (p<0.001). None of the colonized women and their neonates developed puerperal sepsis or EONS, respectively.ConclusionVaginal colonization of aerobic bacteria in active labor is not associated with an increased risk of puerperal sepsis or EONS.

Effect of variable pre-oxygenation endpoints on safe apnoea time using high flow nasal oxygen for women in labour: a modelling investigation

BackgroundStudies of pulmonary denitrogenation (pre-oxygenation) in obstetric populations have shown high flow nasal oxygen therapy (HFNO) is inferior to facemask techniques. HFNO achieves median end-tidal oxygen fraction (FE′O2) of 0.87 after 3 min. As HFNO prolongs safe apnoea times through apnoeic oxygenation, we postulated that HFNO would still extend safe apnoeic times despite the lower FE′O2 after pre-oxygenation. MethodsThe Interdisciplinary Collaboration in Systems Medicine simulation suite, a highly integrated, high-fidelity model of the human respiratory and cardiovascular systems, was used to study the effect of varying FE′O2 (60%, 70%, 80%, and 90%) on the duration of safe apnoea times using HFNO and facemask techniques (with the airway open and obstructed). The study population consisted of validated models of pregnant women in active labour and not in labour with BMI of 24, 35, 40, 45, and 50 kg m−2. ResultsHFNO provided longer safe apnoeic times in all models, with all FE′O2 values. Labour and increased BMI reduced this effect, in particular a BMI of 50 kg m−2 reduced the improvement in apnoea time to 1.8–8.5 min (depending on the FE′O2), compared with an improvement of more than 60 min in the subject with BMI 24 kg m−2. ConclusionsDespite generating lower FE′O2, HFNO provides longer safe apnoea times in pregnant subjects in labour. Care should be taken when used in patients with BMI ≥50 kg m−2 as the extension of the safe apnoea time is limited.

482 Correlation between maternal hemodynamic changes and CTG findings among women submitted to epidural analgesia

to assess the correlation between maternal hemodynamics and fetal heart rate (FHR) findings among women submitted to epidural analgesia. Prospective observational study including low-risk pregnant women in active labor with normal CTG trace submitted to epidural analgesia. All women underwent serial bedside measurements of the main cardiac parameters including stroke volume (SV), heart rate (HR), cardiac output (CO), mean arterial pressure (MAP) and systemic vascular resistances (SRV).These measurements were obtained using a non-invasive ultrasound system (USCOM-1A) before (T0) and after 5 (T5), 15 (T15) and 30 (T30) minutes from low dose epidural administration. The maternal cardiac parameters were compared between cases with persistently normal CTG trace and those with de novo appearance of FHR anomalies. Given the high individual variability of hemodynamic parameters, the percentage variation from the baseline (T0) measurement was calculated. Overall, 102 pregnant women were enrolled, including 11 (or 10.7%) who presented FHR anomalies after epidural administration (late decelerations in 3 cases, prolonged decelerations in 3 cases, bradycardia in 1 case, reduced variability <5 bpm >30 min in 4 cases). Baseline (T0) maternal hemodynamic findings did not differ between the cases with persistently normal CTG and those with de novo appearance of FHR anomalies. In this latter group a significantly greater fall of SVR at T5, T15 and T30 but no change in the other maternal cardiac parameters was noted (Table 1). The onset of FHR anomalies following epidural seems associated with a greater fall of the SVR without a compensative increase of CO or a significant decrease of maternal blood pressure.

Activation of the Complement System in the Lower Genital Tract During Pregnancy and Delivery

BackgroundHuman pregnancy alters profoundly the immune system. The local involvement and mechanisms of activation of the complement system in the cervicovaginal milieu during pregnancy and delivery remain unexplored.ObjectivesTo determine whether normal pregnancy and delivery are associated with local activation of complement or changes in the immunoglobulin profile in the cervix.Study DesignThis study was designed to assess IgA, IgG, and complement activation in the cervicovaginal area in three groups of patients: i) 49 pregnant women (week 41+3–42+0) not in active labor, ii) 24 women in active labor (38+4–42+2), and iii) a control group of nonpregnant women (n=23) at child-bearing age. We collected mucosal samples from the lateral fornix of the vagina and external cervix during routine visits and delivery. The Western blot technique was used to detect complement C3 and its activation products. For semiquantitative analysis, the bands of the electrophoresed proteins in gels were digitized on a flatbed photo scanner and analyzed. IgA and IgG were analyzed by Western blotting and quantified by ELISA. One-way ANOVA and Tukey’s Multiple Comparison tests were used for statistical comparisons.ResultsA higher abundance but lower activation level of C3 in both the external cervix (P<0.001) and lateral fornix of the vagina (P<0.001) was observed during delivery (58 ± 22, n= 24) in comparison to the groups of nonpregnant (72 ± 13%; mean ± SD, n=23) and pregnant women (78 ± 22%, n=49). Complement activating IgG was detected in higher abundance than IgA in the cervicovaginal secretions of pregnant women. In a small proportion samples also C3-IgG complexes were detected.ConclusionsOur results reveal an unexpectedly strong activation of the complement system and the presence IgG immunoglobulins in the cervicovaginal area during pregnancy, active labor, and among nonpregnant women. In contrast to the higher amounts of C3 in the cervicovaginal secretions during labor, its activation level was lower. Complement activating IgG was detected in higher concentrations than IgA in the mucosal secretions during pregnancy and labor. Taken together our results imply the presence a locally operating humoral immune system in the cervicovaginal mucosa.