Women In Spontaneous Labor Research Articles

Evidence-based guidelines for intrapartum maternal hydration assessment and management: A scoping review.

Inconsistent practice relating to intrapartum hydration assessment and management is reported, and potential harm exists for laboring women and birthing persons. Labor and birth are physically demanding, and adequate nutrition and hydration are essential for labor progress. A lack of clear consensus on intrapartum hydration assessment and management during labor and birth currently exists. In addition, there is an inconsistent approach to managing hydration, often including a mixture of intravenous and oral fluids that are poorly monitored. The aim of this scoping review was to identify and collate evidence-based guidelines for intrapartum hydration assessment and management of maternal hydration during labor and birth. PubMed, Embase, and CINAHL databases were searched, in addition to professional college association websites. Inclusion criteria were intrapartum clinical guidelines in English, published in the last 10 years. Despite searching all appropriate databases in maternity care, we were unable to identify evidence-based guidelines specific to hydration assessment and management, therefore resulting in an "empty review." A subsequent review of general intrapartum care guidelines was undertaken. Our adapted review identified 12 guidelines, seven of which referenced the assessment and management of maternal hydration during labor and birth. Three guidelines recommend that "low-risk" women in spontaneous labor at term should hold determination over what they ingest in labor. No recommendations with respect to assessment and management of hydration for women undergoing induction of labor were found. Despite the increasing use of intravenous fluid as an adjunct to oral intake to maintain maternal intrapartum hydration, there is limited evidence and, subsequently, guidelines to determine best practice in this area. How hydration is assessed was also largely absent from general intrapartum care guidelines, further perpetuating potential clinical variation in this area. There is an absence of guidelines specific to the assessment and management of maternal hydration during labor and birth, despite its importance in ensuring labor progress and safe care.

Induction or spontaneous labor for pregnant patients on anticoagulants?

There are two approaches to peripartum management for pregnant patients undergoing anticoagulation treatments: spontaneous labor or scheduling an induction. A long interval without anticoagulation is a thrombosis risk factor, while a short interval leads to risks of delivery without epidural analgesia or post partum hemorrhage. Our objective was to evaluate the impact of planned induction versus spontaneous labor on obtaining neuraxial analgesia. A retrospective single-center study was conducted from 2012 to 2020 including all patients on preventive or curative low molecular-weight heparin at the time of delivery, excluding planned cesarean sections. The rates of neuraxial analgesia were compared between two groups: spontaneous labor and induction, as well as the intervals without anticoagulants. 127 patients were included. In the spontaneous labor group, 78% (44/56) received neuraxial analgesia versus 88% (37/42) in the induction group (p=0.29). For curative dose treatment, the rate of neuraxial analgesia was 45,5% in the spontaneous group versus 78,6% (p=0.12). The median time without anticoagulation was 34 h [26-46] in the spontaneous labor group and 43 h [34-54] in the induction group (p=0.01), without an increased incidence of thrombosis. The rate of postpartum hemorrhage did not differ between the two groups. Planned induction tended to increase the rate of neuraxial analgesia, without reaching significance, and most women in spontaneous labor accessed analgesia. Peripartum management should be a shared decision with the patient considering the obstetrical and thrombosis risk context for each patient.

Validating a predictive model for caesarean section in low-risk nulliparous pregnancies

ProblemCaesarean birth (CS) rates are steadily increasing. BackgroundIn 2017 Janssen et al. developed a model which could predict CB in nulliparous healthy woman with 71 % accuracy based on factors measurable on admission to the hospital. AimTo validate the predictive model for risk of caesarean birth among low-risk, nulliparous women in a new setting. MethodsA retrospective chart study in Abbotsford Regional Hospital (British Columbia, Canada) of healthy nulliparous women in spontaneous labour, at term, with a singleton fetus in cephalic position. Sociodemographic, pregnancy and labour-related characteristics were collected and independent predictors of CS were determined using multivariate logistic regression. The Janssen model was tested in the Abbotsford sample and additionally novel predictors were tested in an effort to improve the model. The area under the ROC curve (C-statistic) was computed and model calibration, sensitivity and specificity evaluated for the final model. Findings and discussionOf 348 women, 106 (30.5 %) had a CB. Applying the Janssen predictive model to the Abbotsford data resulted in a C-statistic of 0.77. No new predictors were added to the model. The mean predicted risk score for CS in the cohort was 0.30 ± 0.20. A risk score cut-off of 0.32 was determined resulting in a sensitivity and specificity of 69 %. The model had acceptable calibration. ConclusionA model with variables easily accessible at admission can predict caesarean birth in nulliparous women. The results from this study can guide provision of more intensive care during labour to women at higher risk, with the overall goal of reducing CB rates.

Robson classification of caesarean births: implications for reducing caesarean section rate in a private tertiary hospital in Nigeria

BackgroundCaesarean section (CS) is a potentially lifesaving obstetric procedure. However, there are concerns about the rising CS rate in many countries of the world including Nigeria. The Ten-Group Robson classification system is presently recommended as an effective monitoring tool for comparing CS rates and identifying target groups for intervention aimed at reducing the rates. The aim of this study was to evaluate the cesarean section rate and the groups with the highest risk of CS at the obstetric unit of Babcock University Teaching Hospital (BUTH), using the Robson classification system.MethodsA cross-sectional study involving 447 women who gave birth at the obstetric unit of BUTH between August 2020 and February 2022. Relevant information was retrieved from the delivery records of the study participants. Data were analyzed using the IBM-SPSS Statistics for Windows version 23.0 (IBM Corp., Armonk, NY, USA).ResultsThe overall CS rate was 51.2%. Multiparous women with previous CS, single, cephalic, term (group 5); nulliparous women, single cephalic, term, with induced labour or pre-labour CS (group 2); women with preterm single cephalic, term (group 10); and single cephalic term multiparous women in spontaneous labour (group 3) were the largest contributors to CS rate accounting for 34.5%, 14.0%, 12.6%, and 10.0% respectively. The commonest indication for CS was previous CS (87; 38.0%), followed by poor progress in labour (24; 10.5%).ConclusionsThe CS rate in BUTH is high and Robson groups 5, 2 10 and 3 were the major contributors to this high rate. Interventions directed at reducing the first CS by improving management of spontaneous and induced labours; and strengthening clinical practice around encouraging vaginal birth after CS will have the most significant effect on reducing CS rate.

Admission Cardiotocography: Its Role in Predicting Perinatal Outcome in Term, Uncomplicated (Low Risk) Pregnant Women in Spontaneous Labour

Introduction: Labour admission cardiotocography (CTG) is commonly used non-invasive method of fetal monitoring in Sri Lanka. It may have a potentialto predict perinatal outcome in low-risk term pregnancies. Objectives: Objectives of the study were to determine the perinatal outcomes of normal, suspicious and pathological admission CTGs and role of labour admission cardiotocography as a predictive test for perinatal outcome in low-risk term pregnancies in spontaneous labour. Methods: This study was a prospective observational study done involving 445 low risk, term pregnancies in spontaneous labour. Labour admission CTG was performed in each pregnancy and categorized into normal, suspicious and pathological CTG according to criteria depicted by National Institute of Clinical Excellence (NICE) guideline 2007. Apgar score less than 7 at five minutes, resuscitation at birth, admission to neonatal intensive care unit (NICU), seizure within first 24 hours of birth and meconium-stained amniotic fluid were the primary outcome measures to assess fetal asphyxia. Mode of delivery in each category, nuchal cord at birth were also assessed. Results: Majority of participants were in 25-to-29-year age group and were nulliparous. Frequencies of normal, suspicious and pathological CTG were 74.8%, 18% and 7.2% respectively. Pathological CTG was significantly associated with low Apgar score compared to non-pathological CTG group (p 0.005) while other outcome measures were not significant. Rate of operative delivery was 68% in pathological group and 20.8% in non-pathological CTG group. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of labour admission CTG to detect fetal asphyxia were 51.85%, 95.69%, 43.75% and 96.85% respectively. Conclusions: Incidence of pathological labour admission CTG was 7.2%. Apgar score less than 7 at five minutes of birth was significantly associated with pathological CTG group compared to non-pathological CTG (p 0.05). Worsening of CTG from normal to pathological showed increasing rate of operative delivery. Even though sensitivity and positive predictive values of labour admission CTG were low, specificity and negative predictive values were high for detecting low Apgar score. Therefore, labour admission CTG has a value in excluding adverse perinatal outcomes in low-risk term pregnancies in spontaneous labour.

Retracted: The Effect of Psychological Support Intervention Based on Structure-Process-Result Three-Dimensional Quality Assessment on Maternal Role Adaptation and Pelvic Floor Rehabilitation Exercise Compliance of Women in Spontaneous Labor.

[This retracts the article DOI: 10.1155/2022/8993144.].

Machine Learning Prediction of risk for Cesarean delivery among nulliparous women in spontaneous labor

Machine Learning Prediction of risk for Cesarean delivery among nulliparous women in spontaneous labor

Hands-on vs hands-off technique for the prevention of perineal injury: a randomized clinical trial

Perineal trauma after vaginal delivery is common and is associated with severe morbidity, including incontinence, pelvic pain, and sexual dysfunction. Morbidity is mainly related to third- or fourthdegree lacerations. This study aimed to test the hypothesis that in nulliparous women with singleton pregnancies at term, hands-off technique during spontaneous vaginal delivery could reduce the rate of perineal laceration. This was a parallel-group, nonblinded, randomized clinical trial. Nulliparous women in spontaneous labor with singleton pregnancies and vertex presentation admitted to the labor and delivery room between 37 0/7 and 42 0/7 weeks of gestation were eligible, and were randomized in a 1:1 ratio to receive hands-off technique (intervention group) or hands-on technique during pushing in the second stage of labor. The primary outcome was perineal laceration (any degree). The effect of hands-off technique on each outcome was quantified as relative risk with 95% confidence interval. A total of 70 women were enrolled in the trial. Perineal lacerations (any degree) occurred in 15 of 35 (42.9%) women in the intervention group and 33 of 35 (94.3%) women in the control group (relative risk, 0.45; 95% confidence interval, 0.31-0.67). Hands-off technique was also associated with significantly decreased incidence of episiotomy (relative risk, 0.36; 95% confidence interval, 0.14-0.88), first-degree lacerations (relative risk, 0.41; 95% confidence interval, 0.20-0.87), and second-degree lacerations (relative risk, 0.43; 95% confidence interval, 0.19-0.99). There was no significant between-group difference in third- and fourth-degree lacerations, but the trial was not powered for these outcomes. In nulliparous women with singleton pregnancies at term, hands-off technique reduces the rate of perineal lacerations.

The Effect of Psychological Support Intervention Based on Structure-Process-Result Three-Dimensional Quality Assessment on Maternal Role Adaptation and Pelvic Floor Rehabilitation Exercise Compliance of Women in Spontaneous Labor.

Objective A case-control study was conducted to explore the effect of psychological support intervention based on structure-process-result three-dimensional quality assessment on maternal role adaptation and pelvic floor rehabilitation exercise compliance. Methods 110 parturients who delivered naturally in our hospital from January 2019 to October 2021 were randomly divided into the control group and the study group. Patients in the former group received routine nursing measures, while patients in the latter group received psychological support intervention based on structure-process-outcome three-dimensional quality assessment (intervention group). Psychological intervention measures include health education, cognitive therapy, behavioral therapy, collective psychological intervention, and happiness therapy. The Edinburgh postpartum depression (PPD) scale and general self-efficacy scale were adopted before intervention, on the day of discharge, and 42 days after delivery. Meanwhile, the mother's role adaptation questionnaire was adopted 42 days after delivery. The PPD, the change of self-efficacy, the function of the pelvic floor, the role adaptation of mothers, and the compliance of pelvic floor rehabilitation exercise in the control group and the intervention group were analyzed. Results There was a significant difference in the EPDS score between the two groups at 42 days after delivery. There was a significant difference in the incidence of depression 42 days after delivery between the two groups (P < 0.05). The score of pelvic floor function in the two groups after intervention was higher than that before intervention, and that in the intervention group was higher than that in the control group (P < 0.05). The score of self-efficacy in the two groups after intervention was higher than that before intervention, and that in the intervention group was higher than that in the control group (P < 0.05). The role adaptation of mothers in the intervention group was better than that in the control group (P < 0.05). The compliance rate of pelvic floor rehabilitation exercise in the intervention group was higher than that in the control group (P < 0.05). Conclusion Psychological support intervention based on structure-process-result three-dimensional quality assessment can effectively enhance the sense of self-efficacy, pelvic floor function, maternal role adaptation, and pelvic floor rehabilitation exercise compliance of parturients and can effectively reduce the incidence of PPD and play a positive role in the prevention of PPD.

Neonatal morbidity and mortality for preterm in breech presentation regarding the onset mode of labor.

To assess severe neonatal morbidity and mortality in induced labor in preterm breech deliveries, compared to spontaneous labor. This is a retrospective study conducted in a tertiary university center in France. Women with single live breech pregnancy between 28 + 0 and 36 + 6weeks gestation were included. We excluded situations with medical contraindication to vaginal delivery and fetal malformations. We compared women with an unfavorable cervix, who had an indication for deliver and could receive cervical ripening to induce labor, to women in spontaneous labor. The primary outcome was a composite criterion of severe neonatal morbidity and mortality including perinatal death, traumatic event during delivery, Apgar score at 5-min < 4, moderate or severe encephalopathy, seizures within the first 24h, Intra-Ventricular Hemorrhage grade 3 or 4, necrotizing enterocolitis grade 2 or 3. We included 212 patients: 64 in the induced labor group and 136 in the spontaneous labor group. In the induced labor group, 45.3% of patients delivered vaginally, and 86% in spontaneous labor group. The neonatal morbidity and mortality rate were similar in both groups: 4.7% in the induced labor group, and 5.2% in the spontaneous labor group, p = 0.889, aOR = 1.5 (0.28-8.28). Nearly half of the patient who received induction of labor delivered vaginally. The onset mode of labor does not appear to have an effect on severe neonatal morbidity and mortality in preterm breech fetuses. Induction of labor could be an option for patients in this setting.

Room4Birth – The effect of giving birth in a hospital birthing room designed with person-centred considerations: A Swedish randomised controlled trial

ObjectiveTo evaluate if a birthing room designed with person-centred considerations improves labour and birth outcomes for nulliparous women when compared to regular birthing rooms. MethodsA randomised controlled trial was conducted at a Swedish labour ward between January 2019 and October 2020. Nulliparous women in spontaneous labour were randomised either to a birthing room designed with person-centred considerations (New room) or a Regular room. The primary outcome was a composite of four variables: vaginal non-instrumental birth; no oxytocin augmentation; postpartum blood loss < 1000 ml; and a positive childbirth experience. To detect a difference of 8% between the groups, 1274 study participants were needed, but the trial was terminated early due to consequences of the Covid-19 pandemic. ResultsA total of 406 women were randomised; 204 to the New room and 202 to the Regular room. There was no significant difference in the primary outcome between the groups (42.2% versus 35.1%; odds ratio: 1.35, 95% Confidence Interval 0.90–2.01; p = 0.18). Participants in the New room used epidural analgesia to a lower extent (54.4% versus 65.3%, relative risk: 0.83, 95% Confidence Interval 0.71–0.98; p = 0.03) and reported to a higher degree that the room contributed to a sense of safety, control, and integrity (p=<0.001). ConclusionsThe hypothesis that the New room would improve the primary outcome could not be verified. Considering the early discontinuation of the study, results should be interpreted with caution. Nevertheless, analyses of our secondary outcomes emphasise the experiential value of the built birth environment in improving care for labouring women.

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

Analysis of cesarean section rates and its indications using robson's classification at a tertiary care hospital, Manipur.

The World Health Organization proposed the Robson's classification system as a global standard for assessing and comparing cesarean section (CS) rates within health-care facilities over time and between facilities. This study aims to assess the frequency and indications of CS and to identify the groups within the obstetric population contributing to CS using Robson's classification. A retrospective chart review was conducted in a Tertiary Care Teaching Hospital in Imphal, Manipur. All women who delivered between January and December 2019 were classified using the Robson's Ten Group Classification System. The overall CS rate and the CS rate in each Robson's group were calculated. The indications for CS were also recorded. Descriptive statistics, such as frequency, percentage, mean, and standard deviation, was used. A total of 10,282 births were reported. The overall CS rate was 35.2%. Group 3 (multiparous women without previous CS in spontaneous labor) (27.6%) and Group 1 (nulliparous women in spontaneous labor) (23.7%) contributed to most of the obstetric populations. The majority of CS belonged to the women in Group 5 (multiparous women with previous lower segment CS) (11%), followed by Group 2 (nulliparous women with labor induced or prelabor CS) (8.6%) and Group 4 (multiparous women without previous CS were induced or taken for prelabor CS) (5.5%). The study revealed that Groups 5, 2, and 4 contributed to the high CS rate. Efforts to reduce the overall CS rate should be directed at increasing vaginal births after CS, performing effective pelvic examinations, and encouraging obstetricians to perform versions when indicated.

Outpatient labour induction.

The inexorable rise in induction rates over the past two decades, in parallel with increasing medical costs and pressure to reduce length of stay, has led to marked logistic difficulties for health care workers, managers and planners. Maternity services are being overwhelmed by the need to allocate staff and delivery suite space for the scheduling and undertaking of induction processes, rather than focussing care for women in spontaneous labour. Induction of labour according to the majority of current protocols and guidelines necessitates increased length of stay and relatively aggressive use of oxytocin (to reduce the time expended in the labour ward from artificial rupture of membranes (AROM) to establishment of labour). This increased oxytocin usage requires increased use of continuous electronic foetal monitoring, and may also increase epidural usage, further increasing the complexity of labour for the woman and her health care workers. Outpatient care after cervical priming and even outpatient care after AROM may help to ease these pressures and may reduce the medicalisation of the birth experience when induction is indicated, with a potential to reduce oxytocin use and associated interventions. If the period between cervical priming to AROM is managed as outpatient care, then the woman may be able to find better psychological and social support at home, as well as maintain autonomy and get better rest prior to the onset of labour. Inpatient AROM could also be followed by outpatient care until the pregnant person returns to the hospital, either in spontaneous labour, or for initiation of syntocinon after 12-18h. High-quality research has already demonstrated that outpatient care for cervical ripening is acceptable to mothers and caregivers, has economic benefits and has an acceptable safety profile in appropriately selected low-risk inductions.

Delay in the induction of labour process: a retrospective cohort study and computer simulation of maternity unit workload

ObjectivesDelay in the induction of labour (IOL) process is associated with poor patient experience and adverse perinatal outcome. Our objective was to identify factors associated with delay in the IOL...

Can the Robson 10 Group Classification System help identify which groups of women are driving the high caesarean section rate in major private hospitals in eastern Ethiopia? A cross-sectional study

ObjectiveThe rates of caesarean section (CS) in Ethiopian private hospitals are high compared with those in public facilities, and there are limited descriptions of groups of women contributing to these...

Does giving birth in a "birth environment room" versus a standard birth room lower augmentation of labor? - Results from a randomized controlled trial.

In the last decade, there has been an increased interest in exploring the impact of the physical birth environment on midwifery practice and women's birth experiences. This study is based on the hypothesis that the environment for birth needs greater attention to improve some of the existing challenges in modern obstetric practice, for example the increasing use of augmentation and number of interventions during delivery. A randomized controlled trial was carried out to study the effect of giving birth in a specially designed "birth environment room" on the use of augmentation during labor. The study took place at the Department of Obstetrics and Gynecology, Herning Hospital, Denmark and included 680 nulliparous women in spontaneous labor at term with a fetus in cephalic presentation. Women were randomly allocated to either the "birth environment room" or a standard birth room. The primary outcome was augmentation of labor by use of oxytocin. Secondary outcomes were duration of labor, use of pharmacological pain relief, and mode of birth. Differences were estimated as relative risks (RR) and presented with 95% confidence intervals. No difference was found on the primary outcome, augmentation of labor (29.1% in the "birth environment room" versus 30.6% in the standard room, RR 0.97; 0.89-1.08). More women in the "birth environment room" used the bathtub (60.6% versus 52.4%, RR 1.18; 1.02-1.37), whereas a tendency to lower use of epidural analgesia (22.6% versus 28.2%) did not reach statistical significance (RR 0.87; 0.74-1.02). The chance of an uncomplicated birth was almost similar in the two groups (70.6% in the "birth environment room" versus 72.6% in the standard room, RR 0.97; 0.88-1.07) as were duration of labor (mean 7.9 hours in both groups). Birthing in a specially designed physical birth environment did not lower use of oxytocin for augmentation of labor. Neither did it have any effect on duration of labor, use of pharmacological pain relief, and chance of birthing without complications. We recommend that future trials are conducted in birth units with greater improvement potentials.

47 A Double-Blinded Randomized Controlled Trial on Increased Intravenous Hydration in Nulliparous Women Undergoing Labor Induction

High-dose intravenous fluid (250cc/hr) has been previously demonstrated to shorten the time to delivery in nulliparous women in spontaneous labor. Whether or not this relationship ship exists in women undergoing induction of labor is unknown. Our study aimed to evaluate the effect of high-dose intravenous hydration (compared to standard dose) on time to delivery among nulliparous women undergoing induction of labor. Nulliparous women presenting for induction of labor with a Bishop score of less than or equal to 6 (with and without rupture of membranes) were randomized to receive either 125cc/hr or 250cc/hr of normal saline. The primary outcome was length of labor (defined as time from initiation of study fluids to delivery). Both time to overall delivery and vaginal delivery were evaluated. Secondary outcomes included the lengths of each stage of labor, the percentage of women delivering within 24 hours, and maternal and neonatal outcomes. 180 individuals meeting inclusion criteria were enrolled and randomized. Baseline demographic characteristics were similar between groups, however there was a higher incidence of maternal diabetes in the group receiving 125cc/hr. Average length of labor was similar between groups (27.6hr in 250cc/hr and 27.8hr in 125cc/hr) as was the length of each stage of labor. Cox regression analysis did not demonstrate an effect of fluid rate on time to delivery. Neither admission bishop score, BMI, nor other demographic characteristics impacted time to delivery or vaginal delivery. There were no differences in maternal or neonatal outcomes including overall cesarean rate, clinical iatrogenic intrapartum infection, Apgar scores, need for neonatal phototherapy, or neonatal intensive care unit stay. There are no observed differences in the length of labor or maternal or neonatal outcomes with the administration of an increased rate of intravenous fluids among nulliparous women undergoing induction of labor.

Maternal blood and amnionic oxytocin receptor gene expression and serum oxytocin levels in preterm birth: a case-control study

BACKGROUND: The oxytocin (OXT)-oxytocin receptor (OXTR) system provides promising candidate gene for studies of genetic contributions to prematurity. OBJECTIVE: Quantification and comparison of oxytocin receptor (OXTR) gene expression and serum OXT levels in the blood and amnion of women delivering preterm and evaluation of the correlation between OXTR gene expression in blood and amnion with serum OXT levels in them. METHODS: 70 pregnant women in spontaneous labor delivering vaginally preterm i.e < 37 weeks and equal number of matched controls delivering spontaneously at term (37-42 weeks) were recruited. Maternal serum OXT levels taken in active stage of labor (i.e 4 cm cervical dilatation) were quantified by ELISA. Gene expression studies in the maternal blood and amnion were done by using real time quantitative polymerase chain reaction (RT-qPCR). RESULTS: The mean serum OXT level in PTL was 48.56 +- 6.97 pg/ml; significantly higher than in controls (43.00 +- 3.96 pg/ml), p<0.001. OXTR gene expression both in maternal blood (2.5 times) and amnion (3.5 times) were significantly higher in PTL. A significant positive correlation was observed between serum OXT levels and OXTR gene expression in amnion (r = -0.190, p = 0.025). CONCLUSIONS: The serum OXT levels and OXTR gene expression in amnion surge significantly in active phase of PTL. Thus, amnion probably links OXT-PTGs autocrine paracrine circuit to facilitate PTL. Future studies are needed to devise better OXTR receptor antagonists preferably acting on amnionic OXTRs to prevent PTL. KEYWORDS: Preterm birth, Preterm labor, Oxytocin, Oxytocin receptor, Placenta, Amnion

Do you pay to go private?: a single centre comparison of induction of labour and caesarean section rates in private versus public patients

BackgroundThe aim of this study was to compare rates of induction and subsequent caesarean delivery among nulliparous women with private versus publicly funded health care at a single institution. This is a retrospective cohort study using the electronic booking and delivery records of nulliparous women with singleton pregnancies who delivered between 2010 and 2015 in an Irish Tertiary Maternity Hospital (approx. 9000 deliveries per annum).MethodsData were extracted from the National Maternity Hospital (NMH), Dublin, Patient Administration System (PAS) on all nulliparous women who delivered a liveborn infant at ≥37 weeks gestation during the 6-year period. At NMH, all women in spontaneous labour are managed according to a standardised intrapartum protocol. Twenty-two thousand two hundred thirty-two women met the inclusion criteria. Of these, 2520 (12.8%) were private patients; the remainder (19,712; 87.2%) were public. Mode of and gestational age at delivery, rates of and indications for induction of labour, rates of pre-labour caesarean section, and maternal and neonatal outcomes were examined. Rates of labour intervention and subsequent maternal and neonatal outcomes were compared between those with and without private health cover.ResultsWomen attending privately were more than twice as likely to have a pre-labour caesarean section (12.7% vs. 6.5%, RR = 2.0, [CI 1.8–2.2])); this finding persisted following adjustment for differences in maternal age and body mass index (BMI) (adjusted relative risk 1.74, [CI 1.5–2.0]). Women with private cover were also more likely to have induction of labour and significantly less likely to labour spontaneously. Women who attended privately were significantly more likely to have an operative vaginal delivery, whether labour commenced spontaneously or was induced.ConclusionsThese findings demonstrate significant differences in rates of obstetric intervention between those with private and public health cover. This division is unlikely to be explained by differences in clinical risk factors as no significant difference in outcomes following spontaneous onset of labour were noted. Further research is required to determine the roots of the disparity between private and public decision-making. This should focus on the relative contributions of both mothers and maternity care professionals in clinical decision making, and the potential implications of these choices.