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Huang M, Fang C, Zheng X, Wu S, Zhang Z, Zhong L, Wu L. Risk factors analysis and multidisciplinary team first-aid simulation training for umbilical cord prolapse can improve neonatal outcomes. J Matern Fetal Neonatal Med 2024; 37:2352088. [PMID: 38735870 DOI: 10.1080/14767058.2024.2352088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/30/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE In the present study, we sought to identify risk factors for umbilical cord prolapse (UCP) and adapt the multidisciplinary team (MDT) first-aid simulation training for UCP patients. We evaluated the usefulness of the MDT first-aid simulation by comparing delivery outcomes for UCP patients before and after its implementation. MATERIAL AND METHODS A retrospective review was conducted on 149 UCP cases (48 overt and 101 occult) and 298 control deliveries that occurred at the Third Affiliated Hospital of Sun Yat-sen University from January 1998 to December 2022. Patient data were compared between the groups. One-way analysis of variance (ANOVA) was used for means comparison, and the chi-square test was used for categorical data. Univariate and multivariate logistic regression analyses were performed to identify factors significantly associated with UCP. RESULTS Overt UCP was strongly associated with all adverse delivery outcomes. Both univariate and multivariate analyses identified multiparity, breech presentation, polyhydramnios, and low birth weight as independent risk factors for overt UCP (all odds ratios [OR] > 1; all p < 0.05). Preterm labor and abnormal placental cord insertion were identified as independent risk factors for occult UCP (all OR > 1; all p < 0.05). After 2014, when obstetrical staff received MDT first-aid simulation training, patients with overt UCP experienced shorter decision-to-delivery intervals due to more timely cesarean sections. They also had higher Apgar scores at 1, 5, and 10 min, and lower admission rates to the neonatal intensive care unit compared to patients before 2014 (all p < 0.05). CONCLUSION MDT first-aid simulation training for overt UCP can improve neonatal outcomes. However, medical simulation training efforts should initially focus on the early identification of risk factors for both overt and occult UCP.
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Affiliation(s)
- Minli Huang
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Changping Fang
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaojing Zheng
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shuzhen Wu
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zijing Zhang
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Linjia Zhong
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lingling Wu
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Froeliger A, Deneux-Tharaux C, Madar H, Bouchghoul H, Le Ray C, Sentilhes L. Closed- or open-glottis pushing for vaginal delivery: a planned secondary analysis of the TRAnexamic Acid for Preventing postpartum hemorrhage after vaginal delivery study. Am J Obstet Gynecol 2024; 230:S879-S889.e4. [PMID: 37633725 DOI: 10.1016/j.ajog.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND The effect on obstetrical outcomes of closed- or open-glottis pushing is uncertain among both nulliparous and parous women. OBJECTIVE This study aimed to assess the association between open- or closed-glottis pushing and mode of delivery after an attempted singleton vaginal birth at or near term. STUDY DESIGN This was an ancillary planned cohort study of the TRAAP (TRAnexamic Acid for Preventing postpartum hemorrhage after vaginal delivery) randomized controlled trial, conducted in 15 French maternity units from 2015 to 2016 that enrolled women with an attempted singleton vaginal delivery after 35 weeks' gestation. After randomization, characteristics of labor and delivery were prospectively collected, with special attention to active second-stage pushing and a specific planned questionnaire completed immediately after birth by the attending care provider. The exposure was the mode of pushing, classified into 2 groups: closed- or open-glottis. The main endpoint was operative vaginal delivery. Secondary endpoints were items of maternal morbidity, including severe perineal laceration, episiotomy, postpartum hemorrhage, duration of the second stage of labor, and a composite severe neonatal morbidity outcome. We also assessed immediate maternal satisfaction, experience of delivery, and psychological status 2 months after delivery. The associations between mode of pushing and outcome were analyzed by multivariate logistic regression to control for confounding bias, with multilevel mixed-effects analysis, and a random intercept for center. RESULTS Among 3041 women included in our main analysis, 2463 (81.0%) used closed-glottis pushing and 578 (19.0%) open-glottis pushing; their respective operative vaginal delivery rates were 19.1% (n=471; 95% confidence interval, 17.6-20.7) and 12.5% (n=72; 95% confidence interval, 9.9-15.4; P<.001). In an analysis stratified according to parity and after controlling for available confounders, the rate of operative vaginal delivery did not differ between the groups among nulliparous women: 28.7% (n=399) for the closed-glottis and 27.5% (n=64) for the open-glottis group (adjusted odds ratio, 0.93; 95% confidence interval, 0.65-1.33; P=.7). The operative vaginal delivery rate was significantly lower for women using open- compared with closed-glottis pushing in the parous population: 2.3% (n=8) for the open- and 6.7% (n=72) for the closed-glottis groups (adjusted odds ratio, 0.43; 95% confidence interval, 0.19-0.90; P=.03). Other maternal and neonatal outcomes did not differ between the 2 modes of pushing among either the nulliparous or parous groups. CONCLUSION Among nulliparous women with singleton pregnancies at term, the risk of operative vaginal birth did not differ according to mode of pushing. These results will inform shared decision-making about the mode of pushing during the second stage of labor.
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Affiliation(s)
- Alizée Froeliger
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Catherine Deneux-Tharaux
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and Statistics, Institut National de la Sante et de la Recherche Medicale, Université Paris Cité, Paris, France
| | - Hugo Madar
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Hanane Bouchghoul
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Camille Le Ray
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and Statistics, Institut National de la Sante et de la Recherche Medicale, Université Paris Cité, Paris, France; Assistance Publique - Hôpitaux de Paris, Maternity Port Royal, Paris, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France.
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Shani U, Klein L, Greenbaum H, Eisenberg VH. Re-evaluation of modifiable risk factors for obstetric anal sphincter injury in a real-world setting. Int Urogynecol J 2023; 34:2743-2749. [PMID: 37436436 DOI: 10.1007/s00192-023-05602-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/08/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to identify modifiable risk factors for obstetric anal sphincter injury (OASI) in primiparous women. METHODS This was a retrospective cohort study of primiparous women with a singleton vaginal delivery. Main outcome measures were incidence of OASI and odds ratios for possible risk factors: maternal age, body mass index and height, fetal birthweight and head circumference, gestational age, epidural analgesia, mediolateral episiotomy, and instrumental deliveries. Univariate and multivariate logistic regressions were performed using forward methods for variable selection. RESULTS Of 19,786 primiparous women with a singleton vaginal delivery, 369 sustained an OASI (1.9%). Risk factors were identified: vacuum extraction (adjusted OR 2.06, 95% CI, 1.59-2.65, p < 0.001), increased fetal weight (aOR 1.06, 95% CI, 1.02-1.11, p = 0.002, per 100-g increments); head circumference (aOR 1.24, 95% CI, 1.13-1.35, p < 0.001, per 1-cm increments); gestational week (aOR 1.11, 95% CI, 1.02-1.2, p = 0.012, per week). Protective factors: mediolateral episiotomy (aOR 0.75, 95% CI, 0.59-0.94, p = 0.013) particularly in vacuum deliveries (aOR 0.50, 95% CI, 0.29-0.97, p = 0.040); epidural analgesia (aOR 0.64, 95% CI, 0.48-0.84, p = 0.001); maternal height ≥157 cm (aOR 0.97, 95% CI, 0.96-0.98, p = 0.006, risk decreases by 2.6% per 1 cm increase in height). CONCLUSIONS Mediolateral episiotomy was protective against OASI in both spontaneous and instrumental deliveries of primiparae. Increased fetal weight and large fetal head circumference, particularly in short women, were significant risk factors. These findings support the performance of ultrasound to acquire updated fetal measures before admission to the labor ward.
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Affiliation(s)
- Uria Shani
- Sheba Medical Center at Tel Hashomer, Ramat-Gan and Sackler Faculty of Medicine, Tel Aviv University, 5265601, Tel Aviv-Yafo, Israel.
| | - Linor Klein
- Sheba Medical Center at Tel Hashomer, Ramat-Gan and Sackler Faculty of Medicine, Tel Aviv University, 5265601, Tel Aviv-Yafo, Israel
| | - Hila Greenbaum
- Sheba Medical Center at Tel Hashomer, Ramat-Gan and Sackler Faculty of Medicine, Tel Aviv University, 5265601, Tel Aviv-Yafo, Israel
| | - Vered H Eisenberg
- Sheba Medical Center at Tel Hashomer, Ramat-Gan and Sackler Faculty of Medicine, Tel Aviv University, 5265601, Tel Aviv-Yafo, Israel
- Ministry of Health and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
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Zang Y, Huang J, Zhang H, Sun K, Li X, Wang D, Wei T, Xing L, Fu L, Hou R, Lu H. Implementation of the Practice Programme for Upright Positions in the Second Stage of Labour and the birth experience of Chinese women: A qualitative study. Midwifery 2023; 125:103801. [PMID: 37657132 DOI: 10.1016/j.midw.2023.103801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 08/08/2023] [Accepted: 08/25/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Upright positions in the second stage of labour are recommended by many international organizations. However, they have not been widely used worldwide, especially in China. One of the important factors is the absence of a practice programme based on the best available evidence. We thus developed a Practice Programme for Upright Positions in the Second Stage of Labour following the UK Medical Research Council framework. Under the guidance of the programme, whether the use of upright positions can improve the maternal birth experience is a question of great concern. This study aimed to explore the birth experience of Chinese women who adopted upright positions in the second stage of labour. DESIGN This qualitative descriptive study was conducted as part of an implementation study that developed an evidence-based intervention and used strategies to integrate the evidence-based intervention into routine obstetric clinical practice. SETTING The maternity department of a tertiary comprehensive hospital in Hebei Province, China. PARTICIPANTS Semi-structured interviews with twelve eligible women who adopted upright positions in the second stage of labour were conducted between March and April 2022. Qualitative data were analyzed by using conventional content analysis. FINDINGS The average age of included women was 26.5 ± 3.5 years, and ten of them were primiparous women. Eight women adopted epidural analgesia during labour to relieve labour pain. All women gave birth in at least one type of upright position in the passive second stage of labour and adopted the semi-recumbent position in the active second stage of labour. Through conventional content analysis, we found that the use of upright positions in the second stage of labour could possibly promote an overall positive birth experience. Women giving birth in upright positions generally perceived they were more involved in their birthing process, and had greater physical and mental capacity to cope with childbirth. KEY CONCLUSIONS Women have a positive birth experience when using upright positions in the second stage of labour. IMPLICATIONS FOR PRACTICE This study suggests upright positions could improve women's birth experience and have the potential to be widely applied in clinical practice.
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Affiliation(s)
- Yu Zang
- School of Nursing, Hebei Medical University, Shijiazhuang, China
| | - Jing Huang
- School of Nursing, Peking University, Beijing 100191, China
| | - Huixin Zhang
- Department of Obstetrics and Gynaecology, The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Kejuan Sun
- Department of Nursing, The First Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaodan Li
- Department of Nursing, Peking University People's Hospital, Beijing, China
| | - Dehui Wang
- Department of Obstetrics, Beijing Hospital, Beijing, China
| | - Tao Wei
- Department of Obstetrics, Beijing Hospital, Beijing, China
| | - Lili Xing
- Department of Obstetrics, Peking University People's Hospital, Beijing, China
| | - Li Fu
- School of Nursing, Peking University, Beijing 100191, China
| | - Rui Hou
- School of Nursing, Peking University, Beijing 100191, China
| | - Hong Lu
- School of Nursing, Peking University, Beijing 100191, China.
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Wood S, Skiffington J, Brant R, Crawford S, Hicks M, Mohammad K, Mrklas KJ, Tang S, Metcalfe A. The REDUCED trial: a cluster randomized trial for REDucing the utilization of CEsarean delivery for dystocia. Am J Obstet Gynecol 2023; 228:S1095-S1103. [PMID: 37164490 DOI: 10.1016/j.ajog.2022.10.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 03/18/2023]
Abstract
BACKGROUND To reduce cesarean delivery rates in nulliparous women, guidelines for diagnosing nonprogressive labor have been developed by the National Institute of Child Health and Human Development, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine. These are mainly based on data from the Consortium for Safe Labor study. The guidelines have not been tested in a clinical trial, so the efficacy and safety of this new approach is uncertain. OBJECTIVE This study aimed to assess whether adoption of new guidelines for diagnosing nonprogressing labor would reduce cesarean delivery rates. STUDY DESIGN We conducted a cluster randomized controlled trial of a knowledge translation program of the guidelines in 26 Canadian hospitals (13 control sites and 13 intervention sites). The sites included all intrapartum care sites in Alberta that perform cesarean delivery and deliver at least 70 nulliparous women annually. The baseline period started on January 1, 2015. The intervention was initiated at the first intervention site in January 2017. The follow-up period began at the first intervention site in February 2017 and lasted till February 2020. The primary outcome was the rate of cesarean delivery in nulliparous women with vertex presentation in labor at term. The secondary outcomes included spontaneous vaginal birth and maternal and neonatal safety. The main data source for the primary and secondary outcomes was the Alberta Perinatal Health Program database. The cesarean delivery rates were assessed using repeated measures mixed effects logistic regression applied to individual births. RESULTS The analysis was based on 45,193 deliveries at intervention sites and 43,725 deliveries at control sites. There was no evidence of a decrease in the rate of cesarean delivery in association with the intervention (baseline-adjusted odds ratio, 0.94; 95% confidence interval [0.85-1.05]; P=.259). The rate of spontaneous vaginal delivery increased slightly (baseline-adjusted odds ratio, 1.10; 95% confidence interval, [1.01-1.18]; P=.024). We did not observe any differences in adverse maternal or neonatal outcomes. CONCLUSION Cesarean delivery rates in nulliparous women were not reduced by the application of recent guidelines for the diagnosis of nonprogressive labor. Spontaneous vaginal delivery-a secondary outcome-was increased in the intervention group. The intervention appears to be safe.
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Affiliation(s)
- Stephen Wood
- Departments of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada; Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Janice Skiffington
- Departments of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Rollin Brant
- Department of Statistics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Susan Crawford
- Alberta Perinatal Health Program, Alberta Health Services, Calgary, Alberta, Canada
| | - Matthew Hicks
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Khorshid Mohammad
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Kelly J Mrklas
- Strategic Clinical Networks, Provincial Clinical Excellence, Alberta Health Services, Calgary, Alberta, Canada
| | - Selphee Tang
- Department of Obstetrics and Gynecology, Alberta Health Services, Calgary, Alberta, Canada
| | - Amy Metcalfe
- Departments of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada; Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Zang Y, Lu H. Promoting normal childbirth: Research status and application of upright positions in the second stage of labour. Int J Nurs Sci 2022; 10:129-131. [PMID: 36860708 PMCID: PMC9969065 DOI: 10.1016/j.ijnss.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/25/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- Yu Zang
- School of Nursing, Hebei Medical University, Shijiazhuang, China
| | - Hong Lu
- School of Nursing, Peking University, Beijing, China,Corresponding author.
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Zang Y, Fu L, Zhang H, Hou R, Lu H. Practice Programme for Upright Positions in the Second Stage of Labour: the development of a complex intervention based on the Medical Research Council Framework. J Nurs Manag 2022; 30:3608-3617. [PMID: 36121431 DOI: 10.1111/jonm.13805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/14/2022] [Indexed: 11/28/2022]
Abstract
AIMS This study aimed to develop a Practice Programme for Upright Positions in the Second Stage of Labour to provide a reference for midwifery professionals in the standardized implementation of upright positions in clinical practice. BACKGROUND The adoption of upright positions in the second stage of labour is recommended by many international organizations, but upright positions have not been widely used and their implementation varies greatly across studies. METHODS The Practice Programme for Upright Positions in the Second Stage of Labour was developed under the guidance of the Medical Research Council framework for developing and evaluating complex interventions and the World Health Organization handbook for guideline development. Four stages were conducted: (1) establishing the intervention development group; (2) identifying a theoretical basis and forming a content framework; (3) evidence retrieval and synthesis; (4) refining and modelling the practice programme. RESULTS The content framework of the Practice Programme for Upright Positions in the Second Stage of Labour was formed based on the literature review, semi- structured interviews and expert consultation, including indications and contraindications, implementation methods, observations, potential risks and precautions. According to each item, we conducted a series of systematic reviews, and summarized the available best evidence from clinical guidelines, systematic reviews and original studies. Eventually, the Practice Programme for Upright Positions in the Second Stage of Labour was developed, integrating the findings of the iterative evidence reviews and revised by stakeholders. CONCLUSIONS This study firstly reported the development process of the Practice Programme for Upright Positions in the Second Stage of Labour, characterized by evidence-based, iteratively-processed, and highly-rigorous. The implications may guide researchers to embed the intervention normatively into clinical practice for improving maternal and infant outcomes. IMPLICATIONS FOR NURSING MANAGEMENT Facilitate systematic labour position management, and guide midwives in the successful implementation of upright positions.
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Affiliation(s)
- Yu Zang
- School of Nursing, Hebei Medical University, Shijiazhuang, China
| | - Li Fu
- School of Nursing, Peking University, Beijing, China
| | - Huixin Zhang
- Department of Obstetrics and Gynaecology, the Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Rui Hou
- School of Nursing, Peking University, Beijing, China
| | - Hong Lu
- School of Nursing, Peking University, Beijing, China
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Gülümser C, Yassa M. Clinical management of uterine contraction abnormalities; an evidence-based intrapartum care algorithm. BJOG 2022. [PMID: 35415963 DOI: 10.1111/1471-0528.16727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2021] [Indexed: 11/29/2022]
Abstract
AIM To develop algorithms as decision support tools for identifying, managing and monitoring abnormal uterine activity during labour. POPULATION Women with singleton, term (37-42 weeks) pregnancies in active labour at admission. SETTING Institutional birth settings in low- and middle-income countries (the algorithm may be applicable to any health facility). SEARCH STRATEGY PubMed was searched up to January 2020 using keywords. We also searched The Cochrane Library, and international guidelines from World Health Organization (WHO), National Institute for Health and Care Excellence (NICE), American College of Obstetricians and Gynecologists (ACOG) and French College of Gynaecologists and Obstetricians (CNGOF). CASE SCENARIOS Algorithms were developed for two case scenarios: uterine hypoactivity and excessive uterine contractions. Key themes in the algorithm are: diagnosis, identification of probable causes, assessment of maternal and fetal condition and labour progress, monitoring and management. CONCLUSION The algorithms for uterine hypoactivity and excessive uterine contractions have been developed to facilitate safe and effective management of abnormal uterine activity during labour. Research is needed to assess the views of healthcare professionals and women accessing healthcare to explore the feasibility of implementing these algorithms, and impact on labour outcomes. TWEETABLE ABSTRACT An evidence-based algorithm to support clinical management of abnormal uterine activity during labour.
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Affiliation(s)
- C Gülümser
- Department of Obstetrics and Gynaecology, Yuksek Ihtisas University School of Medicine, Ankara, Turkey
| | - M Yassa
- Department of Obstetrics and Gynaecology, Bahcesehir University Medical Park Maltepe Hospital, İstanbul, Turkey
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McDonald SD, Narvey M, Ehman W, Jain V, Cassell K. Guideline No. 424: Umbilical Cord Management in Preterm and Term Infants. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:313-322.e1. [PMID: 35300830 DOI: 10.1016/j.jogc.2022.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the impact of deferred (delayed) cord clamping (DCC) and umbilical cord milking in singleton and twin gestations on maternal and infant mortality and morbidity. TARGET POPULATION People who are pregnant with preterm or term singletons or twins. BENEFITS, HARMS, AND COSTS In preterm singletons, DCC for (ideally) 60 to 120 seconds, but at least for 30 seconds, reduces infant risk of mortality and morbidity. DCC in preterm twins is associated with some benefits. In term singletons, DCC for 60 seconds improves hematological parameters. In very preterm infants, umbilical cord milking increases risk for intraventricular hemorrhage. EVIDENCE Searches of Medline, PubMed, Embase, and the Cochrane Library from inception to March 2020 were undertaken using Medical Subject Heading (MeSH) terms and key words related to deferred cord clamping and umbilical cord milking. This document represents an abstraction of the evidence rather than a methodological review. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED USERS Maternity and newborn care providers. RECOMMENDATIONS
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McDonald SD, Narvey M, Ehman W, Jain V, Cassell K. Directive clinique no 424 : Prise en charge du cordon ombilical chez le nourrisson prématuré ou à terme. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:323-333.e1. [DOI: 10.1016/j.jogc.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Stairs J, Brown MM, Smith A, Woolcott C. Association between second stage of labour length and risk of obstetrical anal sphincter injury in nulliparous women: a population-based retrospective cohort study. Int Urogynecol J 2022; 33:1583-1590. [PMID: 35020035 DOI: 10.1007/s00192-021-05070-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Obstetrical anal sphincter injury (OASIS) is a common consequence of vaginal delivery in nulliparas and carries the risk of short- and long-term morbidity. The objective of this study was to estimate the association between the duration of the second stage of labour and OASIS risk. METHODS A population-based, retrospective cohort of nulliparas delivering singleton, vertex, non-anomalous fetuses at term in Nova Scotia, Canada, from 2005 to 2019, were identified using the Nova Scotia Atlee Perinatal Database. Poisson regression models were used to estimate risk ratios (RR) with robust 95% confidence intervals (CI) adjusting for confounding variables to investigate the association between the length of the second stage and OASIS in the entire cohort and in operative vaginal deliveries. RESULTS Of 36,662 participants, 7.6% sustained an OASIS (6.8% third-degree, 0.8% fourth-degree tear). The proportion of participants who sustained an OASIS increased over the study period. For each 30-min increase in the length of second stage, the OASIS risk increased by 11% (RR 1.11, 95% CI 1.10-1.12). When stratified by mode of delivery, second stage length ≥ 90 min was associated with an increased OASIS risk in spontaneous (RR 1.35, 95% CI 1.15-1.58) and vacuum-assisted vaginal deliveries (RR 1.42, 95% CI 1.11-1.81). In forceps-assisted vaginal deliveries, OASIS risk was increased, with shorter and longer durations of the second stage. CONCLUSION Increasing length of the second stage of labour was associated with increasing risk of OASIS overall, but the association was heterogeneous between modes of delivery. Length of the second stage should be considered in counseling about OASIS risk.
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Affiliation(s)
- Jocelyn Stairs
- Division of Urogynaecology, Department of Obstetrics and Gynaecology, Dalhousie University, 5850/5980 University Avenue, P.O. Box 9700, Halifax, Nova Scotia, B3K 6R8, Canada.
| | - Mary Margaret Brown
- Perinatal Epidemiology Research Unit, Departments of Pediatrics and Obstetrics & Gynaecology, Dalhousie University, Nova Scotia, Canada
| | - Anita Smith
- Division of Urogynaecology, Department of Obstetrics and Gynaecology, Dalhousie University, 5850/5980 University Avenue, P.O. Box 9700, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Christy Woolcott
- Perinatal Epidemiology Research Unit, Departments of Pediatrics and Obstetrics & Gynaecology, Dalhousie University, Nova Scotia, Canada
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Kelly P, Quance M, Snow N, Porr C. Using Institutional Ethnography to Explicate the Everyday Realities of Nurses’ Work in Labor and Delivery. Glob Qual Nurs Res 2022; 9:23333936221137576. [DOI: 10.1177/23333936221137576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 11/27/2022] Open
Abstract
Fetal health surveillance is a significant everyday work responsibility for labor and delivery nurses. Here, nursing care is increasingly focused on technological interventions, particularly with the use of continuous electronic fetal monitoring. Using Institutional Ethnography, we explored how nurses conduct this work and uncovered the ruling relations coordinating how nurses “do” fetal health surveillance. Analysis revealed how these powerful ruling relations associated with the biomedical and medical-legal discourses coordinated nurses’ fetal monitoring work. Forms requiring documentation of biophysical data caused nurses to focus on technological interventions with much less attention given to holistic and supportive care measures. In doing so, nurses inadvertently activated and participated in these powerful ruling discourses. The practice of ensuring the safe birth of the baby through advances in technological surveillance and medical interventions took priority over well-established approaches to holistic nursing care.
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Affiliation(s)
- Paula Kelly
- Memorial University of Newfoundland in St. John’s, Canada
| | | | - Nicole Snow
- Memorial University of Newfoundland in St. John’s, Canada
| | - Caroline Porr
- Memorial University of Newfoundland in St. John’s, Canada
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Management of Placental Transfusion to Neonates After Delivery. Obstet Gynecol 2022; 139:121-137. [PMID: 34856560 DOI: 10.1097/aog.0000000000004625] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/23/2021] [Indexed: 12/19/2022]
Abstract
This review summarizes high-quality evidence supporting delayed umbilical cord clamping to promote placental transfusion to preterm and term neonates. In preterm neonates, delayed cord clamping may decrease mortality and the need for blood transfusions. Although robust data are lacking to guide cord management strategies in many clinical scenarios, emerging literature is reviewed on numerous topics including delivery mode, twin gestations, maternal comorbidities (eg, gestational diabetes, red blood cell alloimmunization, human immunodeficiency virus [HIV] infection, and severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection) and neonatal complications (eg, fetal growth restriction, congenital heart disease, and the depressed neonate). Umbilical cord milking is an alternate method of rapid placental transfusion, but has been associated with severe intraventricular hemorrhage in extremely preterm neonates. Data on long-term outcomes are discussed, as well as potential contraindications to delayed cord clamping. Overall, delayed cord clamping offers potential benefits to the estimated 140 million neonates born globally every year, emphasizing the importance of this simple and no-cost strategy.
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Shazly SA, Shawki AA, Ahmed MM, Monib FA, Radwan AA, Sedik AS, Said AE, Ali SS, Abouzeid MH, Sayed EG, Nassr AA, Eltaweel NA, Hortu I, Hassan RM, Abdelbadie AS. Middle-East OBGYN graduate education (MOGGE) foundation practice guidelines: use of labor charts in management of labor. Practice guideline no. 04-O-21. J Matern Fetal Neonatal Med 2021; 35:7280-7289. [PMID: 34470117 DOI: 10.1080/14767058.2021.1946787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Since the 50 s of the last century, labor charts have been proposed and appraised as a tool to diagnose labor abnormalities and guide decision-making. The partogram, the most widely adopted form of labor charts, has been endorsed by the world health organization (WHO) since 1994. Nevertheless, recent studies and systematic reviews did not support clinical significance of application of the WHO partogram. These results have led to further studies that investigate modifications to the structure of the partogram, or more recently, to reconstruct new labor charts to improve their clinical efficacy. This guideline appraises current evidence on use of labor charts in management of labor specially in low-resource settings.
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Affiliation(s)
- Sherif A Shazly
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Abdelrahman A Shawki
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Manar M Ahmed
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Fatma A Monib
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Ahmad A Radwan
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Ahmed S Sedik
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Aliaa E Said
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Shimaa S Ali
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Mostafa H Abouzeid
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Esraa G Sayed
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Ahmed A Nassr
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Nashwa A Eltaweel
- Department of Obstetrics and Gynecology, University hospitals of Coventry and Warwickshire, UK
| | - Ismet Hortu
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Rana M Hassan
- Department of Obstetrics and Gynecology, Maternity Hospital, Alexandria, Egypt
| | - Amr S Abdelbadie
- Department of Obstetrics and Gynecology, Aswan University, Aswan, Egypt
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Committee Opinion No. 415: Impacted Fetal Head, Second-Stage Cesarean Delivery. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:406-413. [PMID: 33640101 DOI: 10.1016/j.jogc.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To review the most effective clinical approaches to disengage an impacted fetal head during cesarean delivery. TARGET POPULATION Women who undergo cesarean delivery of an infant with a deeply impacted head. OPTIONS The "push" technique (from below) or the "pull" technique (reverse breech extraction). OUTCOMES Proper management of this clinical scenario can reduce maternal and perinatal morbidity and mortality. BENEFITS, HARMS, AND COSTS Using an evidence-informed approach when an impacted fetal head is anticipated has the potential to reduce maternal and fetal complications and short- and long-term harm and their associated costs. Research into the value of simulation learning, regular labour assessments, and team preparedness for possible interventions will help inform quality care. EVIDENCE The following search terms were entered into PubMed/Medline, Google Scholar, and Cochrane for the publication period 2012-2019: • 'Guidelines' 'manual' • 'Caesarean Section' • 'full dilation' • 'operative delivery' • 'impacted head' • 'Caesarean' AND 'full dilation' AND 'impacted head' • 'Caesarean' AND 'second stage of labour' OR 'second stage' AND 'impacted head' • 'Caesarean' OR 'operative delivery' AND 'impacted head' A total of 32 articles were retrieved and 24 were deemed appropriate to include as references. Many of these articles represented expert opinion. Randomized controlled trials had small sample sizes and were conducted in settings that limit the generalizability of their findings to the Canadian population.20 INTENDED USERS: Intrapartum health care providers.
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Garbelli L, Lira V. Maternal positions during labor: Midwives' knowledge and educational needs in northern Italy. Eur J Midwifery 2021; 5:15. [PMID: 34046561 PMCID: PMC8138948 DOI: 10.18332/ejm/136423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Maternal positions and mobility during childbirth can have different and specific effects on labor and affect some birth outcomes. The aim of the survey is to investigate the knowledge and skills regarding maternal positions in labor among midwives and to consider the need of training. METHODS A semi-structured questionnaire was distributed in August and September 2020 among midwives working in eight hospitals of Brescia, Northern Italy. The sample consisted of 115 midwives and data were analyzed using a quantitative, descriptive approach. RESULTS The majority of the sample identified the general and specific benefits of maternal positions. Factors limiting the proposal of maternal positions were the context, the relationships with healthcare providers, the woman features, the fetal heart rate registration, continuous cardiotocography, amniotomy, episiotomy, operative vaginal birth, and epidural analgesia. Vaginal examination, the detection of uterine contractions, intrapartum ultrasounds, and ‘hands-on’ perineum technique were considered irrelevant by the participating midwives. The promoting factors were the presence of the partner, the telemetry, and the partogram with a section dedicated to positions. Nearly the totality of the sample considered appropriate to deepen the topic with training. CONCLUSIONS Post-graduate courses are desirable to improve midwives’ skills. An educational toolkit is proposed to make the promotion of maternal positions more effective and appropriate. In order to improve midwifery intrapartum care, further research addressed to midwives of other settings appears essential to compare different training contexts, to expand the proposed toolkit, and to invest on midwifery practice and education.
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Affiliation(s)
- Laura Garbelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Viviana Lira
- Department of Obstetrics and Gynaecology, ASST Spedali Civili Hospital, Brescia, Italy
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Nadal J, Pierre F, Fernandez A, Boussac E, Loupec T, Desseauve D. Drinking during low-risk labor: monocentric randomized clinical trial on patients' satisfaction, and maternal and neonatal outcomes. J Matern Fetal Neonatal Med 2021; 35:5697-5702. [PMID: 33678098 DOI: 10.1080/14767058.2021.1891219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION This study aimed to assess satisfaction of patients affected by various fluid regimes during uncomplicated labor; to identify factors possibly associated with the level of satisfaction; to compare obstetrical and neonatal outcomes between the intervention groups. METHODS Between October and December 2014, 40 women were included in the study set at the Poitiers University Hospital, France. Women were randomly allocated to two study arms: 20 to strict and 20 to liberal fluid regime group. Women's satisfaction was assessed using visual analog scale. Categorical obstetrical and neonatal outcomes were analyzed using Chi-squared test and Fischer's exact test. The between-group difference was assessed with Mann-Whitney U-test. RESULTS Overall satisfaction was higher among women from the liberal fluid regime than from the strict fluid regime group (median score: 88, interquartile range [IQR]: 21 vs. 72, IQR: 21; p = 0.03). The active phase of the second stage of labor was shorter in the liberal fluid regime than in the strict fluid regime group (median 9 min, IQR: 7 vs. 17 min, IQR: 12; p = 0.02). The length of stay in the delivery room was significantly shorter in liberal fluid regime than in strict fluid regime group (median 190 min, IQR: 128 vs. 340 min, IQR: 195, p = 0.04). There were no significant differences in other obstetrical and neonatal outcomes. CONCLUSION Liberal fluid regime during labor was associated with significantly higher satisfaction of women. The active phase of the second stage of labor and the length of stay in the delivery room were significantly shorter in the liberal fluid regime group.
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Affiliation(s)
- Justine Nadal
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Poitiers University Hospital, Poitiers, France
| | - Fabrice Pierre
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Poitiers University Hospital, Poitiers, France
| | - Anna Fernandez
- Women-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Emilie Boussac
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Poitiers University Hospital, Poitiers, France
| | - Thibaut Loupec
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Poitiers University Hospital, Poitiers, France
| | - David Desseauve
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Poitiers University Hospital, Poitiers, France
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Bloch C, Dore S, Hobson S. Opinion de comité n° 415 : Césarienne au deuxième stade avec enclavement de la tête fœtale. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:414-422. [PMID: 33640102 DOI: 10.1016/j.jogc.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIF Passer en revue les stratégies cliniques les plus efficaces pour désengager une tête fœtale enclavée pendant la césarienne. POPULATION CIBLE Les femmes qui subissent une césarienne lorsque la tête fœtale est fortement enclavée. OPTIONS La technique par poussée (par le bas) ou par traction (grande extraction du siège par voie abdominale). RéSULTATS: La prise en charge adéquate de cette situation clinique peut réduire les risques de morbidité et mortalité maternelle et périnatale. BéNéFICES, RISQUES ET COûTS: Lorsque l'on anticipe un enclavement de la tête fœtale, il est possible de réduire le risque de complications maternelles et fœtales, les atteintes à court et à long terme ainsi que les coûts associés en adoptant une stratégie fondée sur des données probantes. Les recherches sur la valeur de l'apprentissage par simulation, les évaluations régulières pendant le travail et la préparation de l'équipe aux interventions possibles aideront à orienter les soins de qualité. DONNéES PROBANTES: Les termes de recherche suivants ont été utilisés dans les bases de données PubMed-Medline, Google Scholar et Cochrane pour la période de publication de 2012 à 2019 : • "Guidelines" "manual" • "Caesarean Section" • "full dilation" • "operative delivery" • "impacted head" • "Caesarean" AND "full dilation" AND "impacted head" • "Caesarean" AND "second stage of labour" OR "second stage" AND "impacted head" • "Caesarean" OR "operative delivery" AND "impacted head" Au total, 32 articles ont été récupérés et 24 ont été jugés adéquats comme références. Plusieurs de ces articles étaient des opinions d'experts. Les essais cliniques randomisés avaient des échantillons de petite taille et ont été menés dans des contextes qui limitent la généralisabilité de leurs résultats à la population canadienne20. PROFESSIONNELS CIBLES Fournisseurs de soins de santé intrapartum.
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Abstract
Cervical ripening and induction and augmentation of labor are common procedures in labor and birth units. The potential risks and benefits for the procedure should be explained to women so that they can make informed decisions. Clinicians should be knowledgeable about the methods and medications used and be skilled in maternal-fetal assessment. Adequate nurse staffing is required to monitor the mother and fetus to promote the best possible outcomes. This practice monograph includes information on mechanical and pharmacologic methods for cervical ripening; labor induction and augmentation with oxytocin, a high alert drug; and nurse staffing levels and skills needed to provide safe and effective care during cervical ripening and labor induction and augmentation.
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Delpero E, Tannenbaum E, Thomas J. Labour Management in Trial of Labour After Cesarean Delivery (TOLAC): A Gap Analysis and Quality Improvement Initiative. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:967-972. [PMID: 33310163 DOI: 10.1016/j.jogc.2020.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/22/2020] [Accepted: 10/24/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This quality improvement (QI) initiative was designed to identify gaps between evidence-based or hospital recommendations for trial of labour after cesarean delivery (TOLAC) labour management and clinical practice. METHODS Viable, singleton pregnancies from January 1, 2016, to December 31, 2018, undergoing TOLAC were extracted from the electronic medical record. Sixty randomly selected charts were reviewed for (1) consent, (2) induction methods, (3) oxytocin use, (4) continuous fetal monitoring, (5) admission indication, (6) examination regularity, (7) duration of dystocia before decision to perform cesarean delivery (CD), and (8) maternal complications. RESULTS The institutional vaginal birth after cesarean rate was 71%. Documented consent to TOLAC on admission was present in 50% of cases. Oxytocin augmentation was used in 38% of cases, and the median maximum dose was 4 mU/min (interquartile range [IQR] 3-7.5 mU/min). Delays in initiating oxytocin were identified in 47% of those patients. Decisions to deliver by cesarean were made after a median time of 5 hours and 40 minutes (IQR 3 hours and 30 minutes to 6 hours and 35 minutes) of failure to progress despite adequate contractions. After this decision, median time to delivery was 1 hour and 11 minutes (IQR 57 minutes to 2 hours and 16 minutes). Complications included postpartum hemorrhage (5%) and chorioamnionitis (6.7%). Surgical injury occurred in 10% of intrapartum CD. Peripartum complications were associated with delay in oxytocin implementation (χ2 (1) = 9.80; P < 0.001) in secondary analysis. CONCLUSION Areas for QI were identified in (1) consent, (2) duration of dystocia before decision to proceed with CD and delay to CD, and (3) peripartum complications. We recognize the potential use of this as a tool to identify areas for QI and prospective study.
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Affiliation(s)
- Emily Delpero
- Department of Obstetrics and Gynecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON.
| | - Evan Tannenbaum
- Department of Obstetrics and Gynecology, Division of General Obstetrics and Gynecology, Sinai Health System, Toronto, ON
| | - Jacqueline Thomas
- Department of Obstetrics and Gynecology, Division of General Obstetrics and Gynecology, Sinai Health System, Toronto, ON
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Liyanage SK, Ninan K, McDonald SD. Guidelines on Deferred Cord Clamping and Cord Milking: A Systematic Review. Pediatrics 2020; 146:peds.2020-1429. [PMID: 33087551 DOI: 10.1542/peds.2020-1429] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Deferred cord clamping (DCC) saves lives. It reduces extremely preterm infants' mortality by 30%, yet a minority of eligible infants receive it. This may in part be due to lack of awareness or confidence in evidence, or conflicting or vague guidelines. OBJECTIVE To systematically review clinical practice guidelines and other statements on DCC and cord milking. DATA SOURCES Ten academic and guideline databases were searched. STUDY SELECTION Clinical practice guidelines and other statements (position statements and consensus statements) providing at least 1 recommendation on DCC or umbilical cord milking among preterm or term infants were included. DATA EXTRACTION Data from included statements were extracted by 2 independent reviewers, and discrepancies were resolved through consensus. Guideline quality was appraised with modified Appraisal of Guidelines for Research and Evaluation II and Appraisal of Guidelines for Research and Evaluation Recommendation Excellence tools. RESULTS Forty-four statements from 35 organizations were included. All endorsed DCC for uncompromised preterm infants, and 11 cautiously stated that cord milking may be considered when DCC is infeasible. Only half (49%) of the recommendations on the optimal duration of DCC were supported by high-quality evidence. Only 8% of statements cited a mortality benefit of DCC for preterm infants. LIMITATIONS Because systematic reviews of guidelines are relatively novel, there are few tools to inform study execution; however, we used the Appraisal of Guidelines for Research and Evaluation II and the Appraisal of Guidelines for Research and Evaluation Recommendation Excellence to assess quality and were methodologically informed by previous systematic reviews of guidelines. CONCLUSIONS Statements worldwide clearly encouraged DCC. Their implementability would benefit from noting the preterm mortality benefit of DCC and more granularity.
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Affiliation(s)
| | - Kiran Ninan
- Departments of Obstetrics and Gynecology.,Contributed equally as co-first authors
| | - Sarah D McDonald
- Departments of Obstetrics and Gynecology, .,Division of Maternal-Fetal Medicine and.,Health Research Methods, Evidence, and Impact, and.,Radiology, McMaster University, Hamilton, Ontario, Canada
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Maxwell C, Gaudet L, Cassir G, Nowik C, McLeod NL, Jacob CÉ, Walker M. Guideline No. 392-Pregnancy and Maternal Obesity Part 2: Team Planning for Delivery and Postpartum Care. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 41:1660-1675. [PMID: 31640866 DOI: 10.1016/j.jogc.2019.03.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This guideline will review key aspects in the pregnancy care of women with obesity. Part I will focus on Preconception and Pregnancy Care. Part II will focus on Team Planning for Delivery and Postpartum Care. INTENDED USERS All health care providers (obstetricians, family doctors, midwives, nurses, anaesthesiologists) who provide pregnancy-related care to women with obesity. TARGET POPULATION Women with obesity who are pregnant or planning pregnancies. EVIDENCE Literature was retrieved through searches of Statistics Canada, Medline, and The Cochrane Library on the impact of obesity in pregnancy on antepartum and intrapartum care, maternal morbidity and mortality, obstetric anaesthesia, and perinatal morbidity and mortality. Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to September 2018. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALIDATION METHODS The content and recommendations were drafted and agreed upon by the authors. Then the Maternal-Fetal Medicine Committees peer reviewed the content and submitted comments for consideration, and the Board of the Society of Obstetricians and Gynaecologists of Canada (SOGC) approved the final draft for publication. Areas of disagreement were discussed during meetings at which time consensus was reached. The level of evidence and quality of the recommendation made were described using the Evaluation of Evidence criteria of the Canadian Task Force on Preventive Health Care. BENEFITS, HARMS, AND COSTS Implementation of the recommendations in these guidelines may increase obstetrical provider recognition of the issues affecting pregnant individuals with obesity, including clinical prevention strategies, communication between the health care team, the patient and family as well as equipment and human resource planning. It is hoped that regional, provincial and federal agencies will assist in the education and support of coordinated care for pregnant individuals with obesity. GUIDELINE UPDATE SOGC guideline will be automatically reviewed 5 years after publication. However, authors can propose another review date if they feel that 5 years is too short/long based on their expert knowledge of the subject matter. SPONSORS This guideline was developed with resources funded by the SOGC. SUMMARY STATEMENTS RECOMMENDATIONS.
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Abstract
Cervical ripening and induction and augmentation of labor are common procedures in labor and birth units. The potential risks and benefits for the procedure should be explained to women so that they can make informed decisions. Clinicians should be knowledgeable about the methods and medications used and be skilled in maternal-fetal assessment. Adequate nurse staffing is required to monitor the mother and fetus to promote the best possible outcomes. This practice monograph includes information on mechanical and pharmacologic methods for cervical ripening; labor induction and augmentation with oxytocin, a high alert drug; and nurse staffing levels and skills needed to provide safe and effective care during cervical ripening and labor induction and augmentation.
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Gu C, Wang X, Zhang Z, Schwank S, Zhu C, Zhang Z, Qian X. Pregnant women's clinical characteristics, intrapartum interventions, and duration of labour in urban China: a multi-center cross-sectional study. BMC Pregnancy Childbirth 2020; 20:386. [PMID: 32616073 PMCID: PMC7330978 DOI: 10.1186/s12884-020-03072-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/19/2020] [Indexed: 12/19/2022] Open
Abstract
Background There is an increasing global trend towards the widespread over-medicalisation of labour and childbirth. The present study aimed to investigate pregnant women’s clinical characteristics, intrapartum interventions, duration of labour and its associated factors; and to compare the differences of these variables between nulliparas and multiparas in China. Methods A multi-center cross-sectional study was carried out in three tertiary hospitals of Fudan University in Shanghai, China. A total of 1523 participants were approched and assessed for eligibility. Data on women’s sociodemographic characteristics, intrapartum interventions, and duration of labour were measured and collected. Kaplan-Meier survival analysis was performed to present the curves of total duration of labour by parity. After z-transformation of labour duration, multivariable linear regression was used to control for confounding and to identify independent associations between potential associated factors and the primary outcome of labour duration. Results Overall, 1209 eligible women agreed to participate and were investigated. Rates of different intrapartum interventions were 27.4% in use of amniotomy, 37.9% in use of oxytocin, 53.0% in continuous electronic fetal monitoring, and 52.9% in epidural use, respectively. The curve of total duration of labour was significantly different between nulliparas and multiparas (P < .001). Of the 1209 participants, 983 (81.3%) women eventually achieved successful vaginal birth while 226 (18.7%) women ended in intrapartum caesarean section. The median duration of total stage of labour was significantly longer in the nulliparous group [9.38 (6.33,14.10) hours] than that in the multiparous group [5.08 (3.00,7.83) hours] (P < .001). The following factors were independently associated with longer duration of total stage of labour: epidural analgesia (P < .001), primiparity (P < .001), continuous electronic fetal monitoring (P = .035), and increased birth weight (P = .005). Conclusions Intrapartum medical interventions become common obstetric practices in urban China. Multifactorial variables independently associated with longer duration of labour were identified, including epidural analgesia, primiparity, continuous electronic fetal monitoring, and increased birth weight. Further research is required to validate these variables and to determine the modifiable factors for labour management. And models of care with lower intervention rates such as midwife-led models of care should be developed and implemented in China.
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Affiliation(s)
- Chunyi Gu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China.,Department of Nursing, Obstetrics & Gynaecology Hospital of Fudan University, Shanghai, China
| | - Xiaojiao Wang
- Department of Nursing, Obstetrics & Gynaecology Hospital of Fudan University, Shanghai, China
| | - Zhijie Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Simone Schwank
- Department of Women and Children's Health, Reproductive Health, Karolinska Institutet, Stockholm, Sweden
| | - Chunxiang Zhu
- Department of Nursing, Obstetrics & Gynaecology Hospital of Fudan University, Shanghai, China
| | - Zheng Zhang
- Department of Nursing, Obstetrics & Gynaecology Hospital of Fudan University, Shanghai, China
| | - Xu Qian
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China. .,Global Health Institute, Fudan University, Shanghai, China.
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Investigating the association between labour epidural analgesia and postpartum depression. Eur J Anaesthesiol 2020; 37:796-802. [DOI: 10.1097/eja.0000000000001236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Fan HSL, Wong JYH, Fong DYT, Lok KYW, Tarrant M. Association Between Intrapartum Factors and the Time to Breastfeeding Initiation. Breastfeed Med 2020; 15:394-400. [PMID: 32283038 DOI: 10.1089/bfm.2019.0166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background/Objectives: Early breastfeeding initiation is strongly recommended. Reasons for delayed breastfeeding initiation often include intrapartum interventions such as induction of labor, opioid pain medication administration, epidural analgesia, and caesarean birth. The majority of existing studies examining the timeliness of breastfeeding initiation are from low- or middle-income countries. The objective of this study is to examine intrapartum interventions on the time to breastfeeding initiation in a cohort of mothers from a high-income country. Materials and Methods: A cohort of 1,277 new mothers was recruited within 24 hours after birth from 4 hospitals in Hong Kong from 2011 to 2012. Participants completed a self-administered questionnaire immediately after recruitment. The rates of intrapartum interventions and the time to the first breastfeed were collected from participants' hospital record. Results: Among participants, 575 (45.5%) initiated breastfeeding within 1 hour of birth and the median time to the first breastfeed was 1.5 hours. The use of opioid pain medication (adjusted hazard ratio [aHR]: 0.78, 95% confidence interval [CI]: 0.67-0.91), assisted vaginal birth (aHR: 0.74, 95% CI 0.56-0.97), and caesarean section (aHR: 0.30, 95% CI 0.25-0.36) were associated with delayed breastfeeding, whereas epidural analgesia and induction of labor had no effect on breastfeeding initiation. Natural birth (i.e., no intrapartum interventions) was also significantly associated with early breastfeeding initiation (aHR: 1.75, 95% CI 1.54-1.99). Conclusions: Breastfeeding initiation was delayed in participants who had a caesarean birth and who received opioid pain medication. These women may require additional support to initiate breastfeeding soon after birth.
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Affiliation(s)
| | | | | | | | - Marie Tarrant
- School of Nursing, University of British Columbia, Kelowna, Canada
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Faulk KA, Niemczyk NA. Key indicators influencing management of prolonged second stage labour by midwives in freestanding birth centres: Results from an ethnographic interview study. Women Birth 2020; 34:e279-e285. [PMID: 32434683 DOI: 10.1016/j.wombi.2020.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/19/2020] [Accepted: 04/07/2020] [Indexed: 11/26/2022]
Abstract
PROBLEMS Complications for newborns and postpartum clients in the hospital are more frequent after a prolonged second stage of labour. Midwives in community settings have little research to guide management in their settings. AIM We explored how US birth centre midwives identify onset of second stage of labour and determine when to transfer clients to the hospital for prolonged second stage. METHODS Ethnographic interviews of midwives with at least 2 years' experience in birth centres and participant observation of birth centre care. FINDINGS We interviewed 21 midwives (18 CNMs, 3 CPMs/equivalent) from 18 birth centres in 11 US states, 45% with hospital practice privileges. Midwives relied on and engaged in embodied practice in evaluating each labour and making decisions concerning management of labour. Midwives considered time a useful but limited measure as a guiding factor in management. Though ideas of time and progress do play an important role in the decision-making process of midwives, their usefulness is limited due to the continual, multifactorial, and multisensory nature of the assessment. Relationship with the transfer hospital structured midwives' decision-making about transfers. DISCUSSION & CONCLUSION These findings can inform future robust multivariate evaluation of factors, including but not limited to time, in guidelines for management of second stage of labour. Optimal management may require formal consideration of more than just time and parity. Our findings also suggest the need for evaluation of how structural issues involving hospital privileges for midwives and relationships between birth centre and hospital staff affect the well-being of childbearing families.
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Affiliation(s)
| | - Nancy A Niemczyk
- Department of Health Promotion and Development, University of Pittsburgh, School of Nursing, 440 Victoria Building, 3600 Victoria Street, Pittsburgh, PA 15261, USA.
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Cohen WR, Friedman EA. Guidelines for labor assessment: failure to progress? Am J Obstet Gynecol 2020; 222:342.e1-342.e4. [PMID: 31954702 DOI: 10.1016/j.ajog.2020.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/23/2019] [Accepted: 01/03/2020] [Indexed: 10/25/2022]
Abstract
The ongoing debate about what models of cervical dilatation and fetal descent should guide clinical decision-making has sown uncertainty among obstetric practitioners. We previously argued that the adoption of recently published labor assessment guidelines promoted by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine may have been premature. Before accepting any new clinical approaches as the standard of care, their underlying hypotheses should be thoroughly tested to ensure they are at least equivalent (or, preferably, superior) to existing management paradigms. Some of the apparent urgency to subscribe to new clinical tactics has been fueled by legitimate concerns about the rise in the cesarean delivery rate over the past several decades. A major contributor to this change in practice patterns is that more cesarean deliveries are being done for diagnoses that fall under the rubric of dystocia than ever before. As a consequence, traditional labor curves-fundamental for assessing labor progress-and the practice paradigms associated with them have received intense scrutiny as a possible contributor to this delivery trend. Moreover, the recent proposal of new labor curves and accompanying management guidelines has, understandably, fed the appetite to correct a perceived problem. However, the cesarean delivery rate rose most rapidly during decades when there was no major change in traditional labor curves or in the guidelines for their interpretation. Also, during the years since the new guidelines were first published, there has been no major fall in cesarean delivery frequency. This raises the question of whether there was truly a fundamental flaw in the traditional labor management paradigms or whether their proper interpretation and use had been somehow forgotten, ignored, or corrupted. More important, existing studies have shown that application of the new guidelines often (but not always) results in a modest fall in the cesarean delivery rate, but that this change may be accompanied by significant increases in maternal and neonatal morbidity. These results strongly suggest more caution in the adoption of the American College of Obstetricians and Gynecologists / Society for Maternal-Fetal Medicine labor assessment recommendations. They are based on a hypothesis that has yet to undergo thorough evaluation of its risks and benefits.
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Hersh SR, Emeis CL. Mediolateral Episiotomy: Technique, Practice, and Training. J Midwifery Womens Health 2020; 65:404-409. [PMID: 32222098 DOI: 10.1111/jmwh.13096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 01/24/2020] [Accepted: 01/27/2020] [Indexed: 01/29/2023]
Abstract
Episiotomy is one of the most common obstetric procedures. However, restrictive use of episiotomy has led to a decrease in its use in the United States. Historically, mediolateral episiotomy has been performed less often than median episiotomy in the United States, but both have purported advantages and disadvantages. Emerging research on episiotomy and obstetric anal sphincter injuries has led to an examination of the effects of mediolateral episiotomy. This article describes performance of a mediolateral episiotomy in a situation of fetal bradycardia. Technical aspects of the incision and repair are described, and outcome data and knowledge gaps are summarized. Implications for practice, clinical competency, and education are reviewed.
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Affiliation(s)
- Sally Rollow Hersh
- Nurse-Midwifery Education Program, School of Nursing, Oregon Health & Science University, Portland, Oregon
| | - Cathy L Emeis
- Nurse-Midwifery Education Program, School of Nursing, Oregon Health & Science University, Portland, Oregon
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Muraca GM, Joseph KS. The authors respond to "Routine use of episiotomy with forceps should not be encouraged". CMAJ 2020; 192:E191-E192. [PMID: 32094271 PMCID: PMC7043826 DOI: 10.1503/cmaj.74565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Giulia M Muraca
- Postdoctoral fellow, Clinical Epidemiology Unit, Department of Medicine, Solna Karolinska Institutet, Stockholm, Sweden, and Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
| | - K S Joseph
- Professor, Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
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31
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Steer-Massaro C. Neonatal Omphalitis After Lotus Birth. J Midwifery Womens Health 2020; 65:271-275. [PMID: 31944541 DOI: 10.1111/jmwh.13062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 12/17/2022]
Abstract
Lotus birth, or umbilical nonseverance, is the practice wherein the umbilical cord is not separated from the placenta after birth, but allowed instead to dry and fall off on its own. Lotus birth may result in neonatal omphalitis. This article describes the history and rationale for lotus birth as well as the etiology, incidence, clinical presentation, and management of neonatal omphalitis. Recommendations for educating families how to perform lotus birth safely are presented. Additionally, signs and symptoms that warrant newborn assessment and treatment are reviewed.
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Affiliation(s)
- Courtney Steer-Massaro
- Department of Obstetrics and Gynecology, Boston University School of Medicine, The Midwives at Boston Medical Center, Boston, Massachusetts
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32
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Edwards HE, Wynne-Edwards KE. Substrates and Clearance Products of Fetal Adrenal Glucocorticoid Synthesis in Full-Term Human Umbilical Circulation. J Endocr Soc 2019; 4:bvz041. [PMID: 32047871 PMCID: PMC7003984 DOI: 10.1210/jendso/bvz041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/18/2019] [Indexed: 11/19/2022] Open
Abstract
In full-term elective caesarian sections, fetal flow of adrenal substrate steroids to products differs by sex, with males (M) in molar equilibrium whereas females (F) add net molarity and synthesize more cortisol. Using the same sampling design, paired, full-term, arterial, and venous umbilical cord samples and intrapartum chart records were obtained at the time of vaginal delivery (N = 167, 85 male) or emergency C-section (N = 38, 22 male). Eight steroids were quantified by liquid chromatography coupled to tandem mass spectrometry (adrenal glucocorticoids [cortisol, corticosterone], sequential cortisol precursor steroids [17-hydroxyprogesterone, 11-deoxycortisol], cortisol and corticosterone metabolites [cortisone and 11-dehydrocorticosterone], and gonadal steroids [androstenedione, testosterone]). Fetal sex was not significant in any analytic models. Going through both phase 1 and phase 2 labor increased fetal adrenal steroidogenesis and decreased male testosterone relative to emergency C-sections that do not reach stage 2 of labor (ie, head compressions) and elective C-sections with no labor. Sum adrenal steroid molarity arriving in venous serum was almost double the equivalent metric for deliveries without labor. No effects of operative vaginal delivery were noted. Maternal regional anesthetic suppressed venous concentrations, and fetal synthesis replaced that steroid. Approximate molar equivalence between substrate pool depletion and net glucocorticoid synthesis was seen. Paired venous and arterial umbilical cord serum has the potential to identify sex differences that underlie antenatal programming of hypothalamic-pituitary-adrenal axis function in later life. However, stage 2 labor before the collection of serum, and regional anesthetic for the mother, mask those sex differences.
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Affiliation(s)
- Heather E Edwards
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Katherine E Wynne-Edwards
- Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine & Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta
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Maxwell C, Gaudet L, Cassir G, Nowik C, McLeod NL, Jacob CÉ, Walker M. Directive clinique N o 392 - Grossesse et obésité maternelle Partie 2 : Planification en équipe de l'accouchement et soins post-partum. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1676-1693. [PMID: 31640867 DOI: 10.1016/j.jogc.2019.08.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIF La présente directive clinique aborde les aspects essentiels des soins prénataux chez les femmes atteintes d'obésité. La partie 1 porte sur la préconception et les soins prénataux. La partie 2 porte sur la planification en équipe de l'accouchement et les soins post-partum. UTILISATEURS CONCERNéS: Tous les fournisseurs de soins de santé (obstétriciens, médecins de famille, sages-femmes, infirmières, anesthésiologistes) qui prodiguent des soins relatifs à la grossesse auprès de femmes atteintes d'obésité. POPULATION CIBLE Femmes atteintes d'obésité qui sont enceintes ou prévoient le devenir. DONNéES PROBANTES: Des recherches ont été menées en consultant les ressources de Statistique Canada, de Medline et de Cochrane Library en vue d'en tirer la littérature relativement aux effets de l'obésité durant la grossesse sur les soins prénataux et intrapartum, la morbidité et la mortalité maternelles, l'anesthésie obstétricale ainsi que sur la morbidité et la mortalité périnatales. Seuls les résultats de revues systématiques, d'essais cliniques randomisés ou comparatifs et d'études observationnelles ont été retenus. Aucune restriction de date ou de langue n'a été employée. Les recherches ont été mises à jour régulièrement, et les résultats ont été incorporés à la directive clinique jusqu'en septembre 2018. Nous avons également tenu compte de la littérature grise (non publiée) obtenue sur les sites Web d'organismes d'évaluation des technologies de la santé et d'autres organismes pertinents, dans des collections de directives cliniques et des registres d'essais cliniques, et auprès d'associations nationales et internationales de médecins spécialistes. MéTHODES DE VALIDATION: Le contenu et les recommandations ont été rédigés et acceptés par les auteurs. Les membres du comité de médecine fœto-maternelle ont ensuite passé en revue le contenu et formulé des commentaires aux fins d'examen. Enfin, le conseil d'administration de la Société des obstétriciens et gynécologues du Canada (SOGC) a approuvé la publication de la version définitive de la directive. Les points de désaccord ont été abordés lors de réunions pour enfin arriver à un consensus. La qualité des données et des recommandations a été déterminée à l'aide des critères d'évaluation décrits par le Groupe d'étude canadien sur les soins de santé préventifs. AVANTAGES, PRéJUDICE ET COûTS: La mise en place des recommandations des présentes directives peut améliorer la reconnaissance des fournisseurs de soins obstétricaux relativement aux problèmes qui touchent les personnes enceintes atteintes d'obésité, notamment au moyen de stratégies de prévention clinique; de la communication entre l'équipe de soins de santé, la patiente et la famille; et de la planification de l'équipement et des ressources humaines. Il est à espérer que les organismes régionaux, provinciaux et fédéraux participeront à la formation et au soutien en matière de soins coordonnés pour les personnes enceintes atteintes d'obésité. MISE à JOUR DE LA DIRECTIVE CLINIQUE: Les directives de la SOGC sont automatiquement passées en revue 5 ans après leur publication. Les auteurs peuvent toutefois proposer une autre date de réévaluation s'ils croient qu'une période de 5 ans est trop courte ou trop longue en fonction de leurs connaissances du sujet à titre d'experts en la matière. PROMOTEURS La présente directive a été élaborée à l'aide de ressources financées par la SOGC. DéCLARATIONS SOMMAIRES: RECOMMANDATIONS.
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Armson BA, Allan DS, Casper RF. Author Response: Delayed Cord Clamping and Umbilical Cord Blood Collection. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 40:155. [PMID: 29447708 DOI: 10.1016/j.jogc.2017.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- B Anthony Armson
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS
| | - David S Allan
- Blood and Marrow Transplantation, Department of Medicine (Hematology), University of Ottawa, Ottawa, ON
| | - Robert F Casper
- Division of Reproductive Sciences, Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON
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35
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Establishing Expert-Based Recommendations for the Conservative Management of Pregnancy-Related Diastasis Rectus Abdominis: A Delphi Consensus Study. ACTA ACUST UNITED AC 2019. [DOI: 10.1097/jwh.0000000000000130] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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36
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Hernández-Martínez A, Martínez-Galiano JM, Rodríguez-Almagro J, Delgado-Rodríguez M, Gómez-Salgado J. Evidence-based Birth Attendance in Spain: Private versus Public Centers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050894. [PMID: 30871065 PMCID: PMC6427791 DOI: 10.3390/ijerph16050894] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 03/07/2019] [Accepted: 03/09/2019] [Indexed: 12/17/2022]
Abstract
The type of hospital (public or private) has been associated with the type of clinical practice carried out. The purpose of this study was to determine the association between the type of hospital (public or private) and delivery attendance with practices based on the recommendations by the World Health Organization (WHO). A cross-sectional study with puerperal women (n = 2906) was conducted in Spain during 2017. The crude Odds Ratios (OR), adjusted (aOR) and their 95% confidence intervals (CI) were calculated through binary logistic regression. For multiparous women in private centers, a higher rate of induced labor was observed (aOR: 1.49; 95% CI: 1.11⁻2.00), fewer natural methods were used to relieve pain (aOR: 0.51; 95% CI: 0.35⁻0.73), and increased odds of cesarean section (aOR: 2.50; 95% CI: 1.81⁻3.46) were found as compared to public hospitals. For primiparous women in private centers, a greater use of the epidural was observed (aOR: 1.57; 95% CI: 1.03⁻1.40), as well as an increased likelihood of instrumental birth (aOR: 1.53; 95% CI: 1.09⁻2.15) and of cesarean section (aOR: 1.77; 95% CI: 1.33⁻2.37) than in public hospitals. No differences were found in hospitalization times among women giving birth in public and private centers (p > 0.05). The World Health Organization birth attendance recommendations are more strictly followed in public hospitals than in private settings.
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Affiliation(s)
| | - Juan Miguel Martínez-Galiano
- Department of Nursing, University of Jaén, Campus de Las Lagunillas s/n, Building B3 Office 266, 23071 Jaén, Spain.
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain.
| | | | - Miguel Delgado-Rodríguez
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain.
- Division of Preventive Medicine and Public Health, University of Jaen, 23071 Jaen, Spain.
| | - Juan Gómez-Salgado
- Department of Nursing, Faculty of Nursing, University of Huelva, 21071 Huelva, Spain.
- Espíritu Santo University, Guayaquil 092301, Ecuador.
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Hobson SR, Abdelmalek MZ, Farine D. Update on uterine tachysystole. J Perinat Med 2019; 47:152-160. [PMID: 30352043 DOI: 10.1515/jpm-2018-0175] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 09/14/2018] [Indexed: 11/15/2022]
Abstract
Uterine tachysystole (TS) is a potentially significant intrapartum complication seen most commonly in induced or augmented labors but may also occur in women with spontaneous labor. When it occurs, maternal and perinatal complications can arise if not identified and managed promptly by obstetric care providers. Over recent years, new definitions of the condition have facilitated further research into the field, which has been synthesized to inform clinical management guidelines and protocols. We propose a set of recommendations pertaining to TS in line with contemporary evidence and obstetric practice.
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Affiliation(s)
- Sebastian Rupert Hobson
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
| | - Merihan Zarif Abdelmalek
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
| | - Dan Farine
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
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38
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Association between intrapartum epidural use and maternal postpartum depression presenting for medical care: a population-based, matched cohort study. Int J Obstet Anesth 2018; 35:10-16. [DOI: 10.1016/j.ijoa.2018.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/03/2018] [Accepted: 04/15/2018] [Indexed: 11/19/2022]
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Munro A, George RB, Allen VM. The impact of analgesic intervention during the second stage of labour: a retrospective cohort study. Can J Anaesth 2018; 65:1240-1247. [PMID: 29987805 DOI: 10.1007/s12630-018-1184-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 05/25/2018] [Accepted: 05/25/2018] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The incidence of epidural top-ups received in the second stage of labour in nulliparous women and the obstetrical and neonatal implications associated with these boluses are explored in this retrospective observational study. We hypothesized that an epidural top-up in the second stage of labour reduces operative deliveries by resolving inadequate analgesia. METHODS A population-based cohort analysis was performed using perinatal data from 1 January 2013 through 31 December 2014. An anesthesia database provided information to determine the top-up incidence. Women with or without a top-up for second-stage duration were compared for method of delivery and neonatal characteristics using descriptive statistics. Logistic regression identified predictive factors for method of delivery. RESULTS Of the 1,462 women with a second stage of labour > one hour who received epidural analgesia, 105 (7%) required a top-up during the second stage of labour. Women who received a top-up were more likely to have had induction of labour and/or augmentation (89% vs 76%; odds ratio [OR], 2.43; 95% confidence interval [CI], 1.32 to 4.49; P = 0.003), a longer second stage (303 min vs 171 min; mean difference, 132 min; 95% CI, 113 to 151; P < 0.001), and more assisted vaginal (41% vs 17%; OR, 3.35; 95% CI, 2.21 to 5.1; P < 0.001) or Cesarean deliveries (26% vs 11%; OR, 3.04; 95% CI, 1.91 to 4.8; P < 0.001) than women without a top-up. CONCLUSION Most women who received a top-up had a vaginal (spontaneous or assisted) delivery. Compared with women without a top-up, women requiring a top-up had more predictors of difficult labour and higher rates of assisted vaginal delivery and Cesarean delivery.
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Affiliation(s)
- Allana Munro
- Department of Women's & Obstetric Anesthesia, IWK Health Centre, Dalhousie University, Halifax, NS, Canada.
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.
- Department of Women's & Obstetric Anesthesia, IWK Health Centre, 5850/5980 University Avenue, Halifax, NS, B3K 6R8, Canada.
| | - Ronald B George
- Department of Women's & Obstetric Anesthesia, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Victoria M Allen
- Department of Obstetrics and Gynaecology IWK Health Centre, 5850/5980 University Ave., Halifax, NS, Canada
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, NS, Canada
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40
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Green CR, Blake JM, Carson GD, Po L, Brown ARH, Friedman CL. Choosing Wisely: SOGC's Top 10 Recommendations. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:716-722. [PMID: 29861082 DOI: 10.1016/j.jogc.2018.04.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 04/05/2018] [Indexed: 11/26/2022]
Affiliation(s)
| | - Jennifer M Blake
- The Society of Obstetricians and Gynaecologists of Canada; Department of Obstetrics and Gynaecology, The University of Ottawa; Department of Obstetrics and Gynaecology, University of Toronto
| | - George D Carson
- Regina General Hospital at Saskatchewan Health Authority; Department of Obstetrics and Gynecology, University of Saskatchewan, SK
| | - Leslie Po
- Department of Obstetrics and Gynaecology, University of Toronto; Department of Obstetrics & Gynaecology, Division of Minimally Invasive Gynaecologic Surgery, Sunnybrook Health Sciences Centre
| | - Adrian R H Brown
- Department of Obstetrics and Gynaecology, University of Toronto; Department of Obstetrics and Gynaecology, North York General Hospital
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41
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Green CR, Blake JM, Carson GD, Po L, Brown ARH, Friedman CL. Choisir avec soin : les 10 principales recommandations de la SOGC. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:e443-e450. [PMID: 29861086 DOI: 10.1016/j.jogc.2018.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 04/05/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Jennifer M Blake
- The Society of Obstetricians and Gynaecologists of Canada; Department of Obstetrics and Gynaecology, The University of Ottawa; Department of Obstetrics and Gynaecology, University of Toronto
| | - George D Carson
- Regina General Hospital at Saskatchewan Health Authority; Department of Obstetrics and Gynecology, University of Saskatchewan, SK
| | - Leslie Po
- Department of Obstetrics and Gynaecology, University of Toronto; Department of Obstetrics & Gynaecology, Division of Minimally Invasive Gynaecologic Surgery, Sunnybrook Health Sciences Centre
| | - Adrian R H Brown
- Department of Obstetrics and Gynaecology, University of Toronto; Department of Obstetrics and Gynaecology, North York General Hospital
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Bonapace J, Gagné GP, Chaillet N, Gagnon R, Hébert E, Buckley S. N° 355-Fondements physiologiques de la douleur pendant le travail et l'accouchement: approche de soulagement basée sur les données probantes. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:246-266. [DOI: 10.1016/j.jogc.2017.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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43
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Bonapace J, Gagné GP, Chaillet N, Gagnon R, Hébert E, Buckley S. No. 355-Physiologic Basis of Pain in Labour and Delivery: An Evidence-Based Approach to its Management. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:227-245. [DOI: 10.1016/j.jogc.2017.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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44
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Kiely DJ. Management of Spontaneous Labour at Term in Healthy Women. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:220-221. [PMID: 28284514 DOI: 10.1016/j.jogc.2017.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Henrique AJ, Gabrielloni MC, Cavalcanti ACV, Melo PDS, Barbieri M. Hidroterapia e bola suíça no trabalho de parto: ensaio clínico randomizado. ACTA PAUL ENFERM 2016. [DOI: 10.1590/1982-0194201600096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Resumo Objetivo Conhecer a influência do banho quente e exercício perineal com bola suíça, de forma isolada e combinada, sobre a progressão do trabalho de parto. Métodos Ensaio clínico randomizado e controlado, realizado em dois hospitais públicos, no período de 2013 a 2014 com 128 mulheres internadas para assistência ao parto. A randomização aleatória alocou 44 parturientes no Grupo Banho Quente, 45 no Grupo Bola Suíça e 39 no Grupo Banho Quente e Bola Suíça associados. Resultados A pesquisa mostrou aumento estatisticamente significante na frequência da contração uterina com uso isolado (p=0,025) e associado da bola suíça (p<0,001), um aumento também significante na frequência cardíaca fetal com uso isolado e associado do banho quente (p< 0,001). Conclusão Associação do banho quente e bola suíça foi mais efetiva para a progressão do trabalho de parto e desfecho para o parto normal quando comparado com o seu uso isolado.
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