Factors Affecting the Labor : A Review Article

Effect of intrapartum vitamin D levels on labor pain

AIM

Vitamin D has widespread receptor distribution in the body, and therefore it has vital roles in numerous pathophysiological conditions. It also affects pain manifestation through its functions at various stages of the pain pathways. This study aimed to investigate the effects of intrapartum vitamin D levels on pain experienced by women during the first stage of labor.

METHODS

A total of 127 term-nulliparous women at the early stage of labor were included in the study. Serum 25 (OH) vitamin D levels were measured at the beginning of labor to determine intrapartum vitamin D levels. Labor pain was assessed using the Visual Analog Scale at different stages of cervical dilation (VAS₀ , VAS₁ , VAS₂ ). Postpartum pain (VAS_pp ) and women's birth satisfaction score (BSS) were also evaluated during the early postpartum period.

RESULTS

There was a moderate negative correlation between vitamin D and VAS₀ and VAS₁ (r²  = 0.4, p = 0.000; r²  = -0.570, p = 0.000, respectively), and a weak negative correlation between vitamin D and VAS₂ (r²  = -0.373, p = 0.000). No significant correlation was found between vitamin D and BSS and length of labor (p = 0.127, p = 0.126, respectively).

CONCLUSION

In nulliparous women with low vitamin D levels, the first stage of labor and the early postpartum period may be more painful. To facilitate management of labor pain, during the antenatal period vitamin D levels should be monitored, and in cases where the levels are deficient, vitamin D supplementation should be started.

Prospective study of the effect of maternal body mass index on labor progress in nulliparous women in Egypt

OBJECTIVE

To evaluate the impact of maternal body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) on labor progress in nulliparous women.

METHODS

The present prospective cohort study enrolled primigravidae admitted to Kasr Al Ainy hospital, Cairo University, Egypt, during active labor between February 1, 2016, and February 28, 2017. Patients were classified into three equal groups using their BMI at admission: underweight (<18.5), normal weight (18.5-29.9), and obese (≥30). The primary outcome was the rate of cervical dilatation; secondary outcomes included the duration of the second stage of labor, neonatal delivery weight, and the mode of delivery.

RESULTS

Among the 600 primigravidae enrolled (200 in each group), significant differences were recorded in the rates of cervical dilatation (P<0.001), and the duration of the active labor phase (P<0.001) and the whole of labor (P<0.001); in the obese group, the cervical dilatation rate was lowest and the durations of the active phase of labor and the whole of labor were longer. The incidence of intrapartum cesarean delivery (P<0.001) and neonatal delivery weight (P<0.001) also differed between the groups; both were highest in the obese group.

CONCLUSIONS

Patterns in labor progress, including cervical dilatation rate and labor duration, differed among patients with different BMI. ClinicalTrials.gov: NCT02686073.