General methods for measuring and comparing medical interventions in childbirth: a framework

Maternal Birth Satisfaction Relating to Intraoperative and Early Postpartum Skin-to-Skin Contact with the Neonate During Caesarean Birth: An Integrative Review

Background: Mothers and their newborns experiencing caesarean birth often receive delayed or interrupted skin-to-skin care (SSC) despite the intervention being well recognised as beneficial to both mother and baby, with no associated risk for increased morbidity or mortality. Maternal birth satisfaction is recognised as an indicator of quality maternity care; however, most of the research has focused on early intraoperative SSC initiation and breastfeeding outcomes. Objectives: To collate and synthesise evidence for maternal satisfaction of intraoperative and early postpartum SSC during and immediately following caesarean birth. To identify timelines of implementation, barriers, and facilitators of SSC. Methods: An integrative review was conducted guided by the 5-stage Wittemore and Knalf's framework. Four electronic databases (CINAHL, Medline, PsycINFO, Web of Science) were searched. Key terms were 'Caesarean birth', 'skin-to-skin care', 'maternal satisfaction'. Studies published from 2014 to 5 September 2024 in English language were included. A hand search of potential inclusion articles was also searched to undertake a comprehensive review. The JBI critical appraisal checklist was used to assess the quality of inclusion studies. Results: 17 studies met the selection criteria and were included in this review. Intraoperative and early SSC during caesarean birth is associated with positive maternal birth satisfaction and contributes to improved birth experience for mothers with no negative implications. Conclusions: Increased access to intraoperative SSC will likely contribute to increased maternal satisfaction and positive birthing experience. Compliance with policy recommendations regarding SSC may improve with access to a flow chart tool identifying expectations of women's intraoperative and postoperative care for caesarean birth.

Fire dragon cupping in treating a parturient woman with gastrointestinal dysfunction after cesarean section: A case report

RATIONALE

The postoperative gastrointestinal dysfunction after cesarean section is commonly presented as uncomfortable symptoms such as abdominal pain and distension. As a novel traditional Chinese medicine characteristic therapy, the fire dragon cupping can effectively enhance intestinal peristalsis and improve the gastrointestinal discomforts by using the manipulation and moxibustion heat to stimulate acupuncture points. The purpose of this report is to provide a new approach and new ideas for rapid rehabilitation of gastrointestinal dysfunction after cesarean section.

PATIENT CONCERNS

A parturient woman, 39 years old, pregnancy 4, delivery 2, underwent lower uterine segment cesarean section under intrathecal anesthesia due to scarred uterus. On the 3rd day after cesarean section, the anus still did not exhaust and defecate, so this parturient woman complained of obvious abdominal pain, abdominal distension, nausea, and vomiting.

DIAGNOSES

The measured abdominal circumference was 96 cm, and the bowel sounds weakened on auscultation; the plain abdominal radiograph indicated a small amount of pneumomediastinum, thus the incomplete intestinal obstruction was considered.

INTERVENTIONS

The parturient woman was treated with fire dragon cupping treatment in her back and abdomen once a day, each time about 30 to 40 minutes, 3 consecutive days of treatment.

OUTCOMES

On the 4th day after cesarean section, the parturient woman naturally had anal exhaust and defecated watery stools twice, without complaint of abdominal pain distension.

LESSONS

Under the guidance of the concept of rapid rehabilitation nursing in obstetrics, according to the principle of making gradual and orderly progress, risk management of gastrointestinal dysfunction after cesarean section is carried out in the early stage, the fire dragon cupping and individualized rehabilitation scheme are implemented, and the parturient women with gastrointestinal dysfunction after cesarean section are actively treated.

Cohort Study Summary of the Effects of Carboprost Tromethamine Combined with Oxytocin on Infant Outcome, Postpartum Hemorrhage and Uterine Involution of Parturients Undergoing Cesarean Section

Background

Carboprost tromethamine injection has a high safety factor in clinical application and has a good effect on uterine smooth muscle and vasoconstriction. Carboprost aminobutyriol combined with oxytocin may be beneficial to infant outcome and uterine involution after cesarean section.

Objective

To investigate the effects of carboprost tromethamine combined with oxytocin on infant outcome, postpartum hemorrhage, and uterine involution in parturients undergoing cesarean section.

Methods

A total of 120 parturients undergone cesarean section in our hospital from February 2019 to April 2021 were selected as the object of study. The parturients were randomly divided into control group (n = 60) and research group (n = 60). The control group was treated with oxytocin, and the research group was treated with carboprost aminobutyriol combined with oxytocin. The amount of maternal bleeding, uterine floor decline index, the end of lochia, poor rate of uterine involution, infant outcome, and the incidence of adverse drug reactions were compared between the two groups.

Results

The amount of bleeding in the research group was significantly lower than that in the control group (P < 0.05). The position of the last uterine floor and the index of uterine floor downward movement in the research group were significantly higher than those in the control group (P < 0.05). The disappearance time of bloody lochia and serous lochia in the research group was significantly shorter than that in the control group (P < 0.05). The end time of lochia in the research group was higher than that in the control group, and the rate of uterine involution in the research group was lower than that in the control group (P < 0.05). The neonatal weight and Apgar score in the research group were higher than those in the control group, and the hospitalization rate of neonatal ICU in the research group was significantly lower than that in the control group. The incidence of adverse reactions in the research group was significantly lower than that in the control group (P < 0.05).

Conclusion

Carboprost aminobutyriol combined with carbestatin can effectively prevent the occurrence of bleeding after cesarean section, improve uterine involution, and improve neonatal birth quality, which is worth popularizing.

Cesarean section rate changes after audit and feedback with the Ten Group Classification System in a French perinatal network: A retrospective pre-post study

INTRODUCTION

The rise in the number of cesarean sections (CS) is a major health public problem which concerns nearly all countries. It is suggested that the Ten Group Classification System be adapted to a procedure of audit/feedback cycles, which could have an effect on CS practice. Therefore, we aimed to study changes in CS rates between maternity wards in a perinatal network after implementation of the Ten Group Classification System in an audit with feedback.

MATERIAL AND METHODS

This was a retrospective pre-post study of all births from 1 January 2012 to 31 December 2018, in a French perinatal network of 10 maternity wards in the Yvelines district of France. All live births occurring at a gestational age ≥24 weeks in the network were included. During the pre-period (1 January 2012 to 31 December 2014), the audit and feedback provided only overall CS rates. During the post-period (1 January 2015 to 31 December 2018), CS rates for each Robson Ten Group Classification System group were provided. Regression models, adjusted for maternal characteristics and maternity ward, were used to compare CS rates globally and for each group of the system. Variability of CS rates between maternity wards was analyzed using the coefficients of variation.

RESULTS

There were 51 082 women who delivered during the pre-period and 63 964 during the post-period. The overall CS rate did not decrease (24.5% during the pre-period vs 25.1% during the post-period). There were no significant differences in CS rates for any group of the Ten Group Classification System after adjustment for maternity, maternal age and sociodemographic characteristics, nor did audit implementation decrease CS rate variability between maternity wards or within groups of the system.

CONCLUSIONS

Implementation of an audit-and-feedback cycle using the Ten Group Classification System did not decrease either CS rates or variability between maternity wards.

"To get the baby out off the hook": a prospective, longitudinal, multicenter, observational study about decision making in vacuum-assisted operative vaginal delivery

BACKGROUND

Since operative vaginal delivery may be risky for women and might cause neonatal complications, the aim of this study is to assess appropriateness of the procedure. This is a prospective, longitudinal, multicenter, observational study and it was conducted in three Italian Obstetric Units (Pisa, Massa Carrara and Prato). All term pregnant women, either nulliparous and multiparous, with singleton pregnancy and a cephalic fetus, with spontaneous or induced labour, requiring vacuum-assisted delivery were enrolled. Indications to operative vaginal delivery were grouped as alterations of fetal cardiotocography (CTG) patterns, delay/arrest of second stage of labour or elective shortening of second stage of labour. A board consisting of five among authors evaluated appropriateness of the procedure.

RESULTS

Overall, 466 women undergoing operative vaginal deliveries were included. Cardiotocography, classified as ACOG category 2 or 3 was the indication for vacuum assisted delivery in 253 patients (54.29%). Among these, 66 women (26.1%) had an operative vaginal delivery which was then considered to be inappropriate, while in 114 cases (45.1%) CTG traces resulted to be unreadable.

CONCLUSION

Decision making process, which leads clinicians to go for operative vaginal delivery, is often influenced by shortness of time and complexity of the situation. Therefore, clinicians tend to intervene performing vacuum delivery without adopting critical analysis and without adequately considering the clinical situation. Operative vaginal delivery might be a risky procedure and should be performed only when clinically indicated and after adequate critical analysis.

Effect of Low-Frequency Electric Pulse Technique Combined with Carboprost Methylate Suppositories on Recovery of Gastrointestinal Function and Postoperative Complications of Patients with Scarred Uterus Undergoing Secondary Cesarean Section

The study aims to explore the effect of low-frequency electric pulse technique combined with carboprost methylate suppositories on recovery of gastrointestinal function and postoperative complications of patients with scarred uterus undergoing secondary cesarean section (C-section). The clinical data of 120 patients with scarred uterus undergoing secondary C-section treated in our hospital from February 2019 to February 2020 were retrospectively analyzed, and the patients were equally divided into experimental and control groups according to their admission order, where each group included 60 patients. After the operation, patients in the control group received routine nursing and conducted breastfeeding, and carboprost methylate suppositories were used for postoperative hemostasis. Those in the experimental group received low-frequency electric pulse technique for comprehensive treatment to compare their coagulation function indicators, recovery of gastrointestinal function, incidence rates of postoperative complications, and involution of uterus. No significant between-group differences in patients' general information such as gestational weeks, gravidity, and number of times receiving C-section were observed (P > 0.05). Compared with the control group after the operation, patients in the experimental group obtained significantly better coagulation function indicators (P < 0.001) and presented better gastrointestinal function recovery (P < 0.001), significantly lower incidence rates of postpartum hemorrhage, retention of urine, deep venous thrombosis of lower limb, rupture of uterus, and endometrial cavity fluid (P < 0.05), and significantly better involution of uterus (P < 0.001). In conclusion, combining low-frequency electric pulse technique with carboprost methylate suppositories can lower the incidence rates of postoperative complications for patients with scarred uterus undergoing secondary C-section, improve their coagulation function, promote the recovery of gastrointestinal function, and present the desirable involution of uterus, which should be promoted in practice.