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Perry JD, Maples JM, Deisher HN, Trimble H, van Nes JV, Morton K, Zite NB. A Novel Approach to Teaching the Cervical Exam: A Versatile, Low-Cost Simulation for Labor and Delivery Learners. Cureus 2021; 13:e20235. [PMID: 35004050 PMCID: PMC8730796 DOI: 10.7759/cureus.20235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 11/05/2022] Open
Abstract
This technical report describes the making of cervical exam models that can be used to teach cervical dilation and effacement, with the versatility to teach additional obstetrical skills including artificial rupture of membranes (AROM) and fetal scalp electrode (FSE) placement. These models, primarily constructed from materials that are low cost and/or easily accessible within a healthcare setting, can be used to educate nurses, medical students, residents, and other healthcare professionals to improve the evaluation of the labor progress.
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Affiliation(s)
- Jamie D Perry
- Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, USA
| | - Jill M Maples
- Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, USA
| | - Heather N Deisher
- Brookwood Women's Health PC, Brookwood Baptist Medical Center, Birmingham, USA
| | - Hayley Trimble
- Obstetrics and Gynecology, Pikeville Medical Center, Pikeville, USA
| | - Jaclyn V van Nes
- Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, USA
| | - Kaitlin Morton
- Kinesiology, Recreation, and Sport, University of Tennessee, Knoxville, USA
| | - Nikki B Zite
- Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, USA
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Battarbee AN, Sandoval G, Grobman WA, Reddy UM, Tita AT, Silver RM, El-Sayed YY, Wapner RJ, Rouse DJ, Saade GR, Chauhan SP, Iams JD, Chien EK, Casey BM, Gibbs RS, Srinivas SK, Swamy GK, Simhan HN. Maternal and Neonatal Outcomes Associated with Amniotomy among Nulliparous Women Undergoing Labor Induction at Term. Am J Perinatol 2021; 38:e239-e248. [PMID: 32299106 PMCID: PMC7572589 DOI: 10.1055/s-0040-1709464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of the study is to evaluate the association between amniotomy at various time points during labor induction and maternal and neonatal outcomes among term, nulliparous women. STUDY DESIGN Secondary analysis of a randomized trial of term labor induction versus expectant management in low-risk, nulliparous women (2014-2017) was conducted. Women met inclusion criteria if they underwent induction ≥38 weeks' gestation using oxytocin with documented time and type of membrane rupture. Women with antepartum stillbirth or fetal anomaly were excluded. The primary outcome was cesarean delivery. Secondary outcomes included maternal and neonatal complications. Maternal and neonatal outcomes were compared among women with amniotomy versus women with intact membranes and no amniotomy at six 2-hour time intervals: before oxytocin initiation, 0 to <2 hours after oxytocin, 2 to <4 hours after, 4 to <6 hours after, 6 to <8 hours after, and 8 to <10 hours after. Multivariable logistic regression adjusted for maternal age, body mass index, race/ethnicity, modified Bishop score on admission, treatment group, and hospital (as a random effect). RESULTS Of 6,106 women in the parent trial, 2,854 (46.7%) women met inclusion criteria. Of these 2,340 (82.0%) underwent amniotomy, and majority of the women had amniotomy performed between 2 and <6 hours after oxytocin. Cesarean delivery was less frequent among women with amniotomy 6 to <8 hours after oxytocin compared with women without amniotomy (21.9 vs. 29.7%; adjusted odds ratio 0.61, 95% confidence interval 0.42-0.89). Amniotomy at time intervals ≥4 hours after oxytocin was associated with lower odds of labor duration >24 hours. Amniotomy at time intervals ≥2 hours and <8 hours after oxytocin was associated with lower odds of maternal hospitalization >3 days. Amniotomy was not associated with postpartum or neonatal complications. CONCLUSION Among a contemporary cohort of nulliparous women undergoing term labor induction, amniotomy was associated with either lower or similar odds of cesarean delivery and other adverse outcomes, compared with no amniotomy.
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Affiliation(s)
- Ashley N. Battarbee
- Department of Obstetrics and Gynecology of University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Grecio Sandoval
- Department of Obstetrics and Gynecology the George Washington University Biostatistics Center, Washington, DC
| | - William A. Grobman
- Department of Obstetrics and Gynecology of Northwestern University, Chicago, IL
| | - Uma M. Reddy
- Departments of Obstetrics and Gynecology of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Alan T.N. Tita
- Department of Obstetrics and Gynecology of University of Alabama at Birmingham, Birmingham, AL
| | - Robert M. Silver
- Department of Obstetrics and Gynecology of University of Utah Health Sciences Center, Salt Lake City, UT
| | - Yasser Y. El-Sayed
- Department of Obstetrics and Gynecology of Stanford University, Stanford, CA
| | - Ronald J. Wapner
- Department of Obstetrics and Gynecology of Columbia University, New York, NY
| | - Dwight J. Rouse
- Department of Obstetrics and Gynecology of Brown University, Providence, RI
| | - George R. Saade
- Department of Obstetrics and Gynecology of University of Texas Medical Branch, Galveston, TX
| | - Suneet P. Chauhan
- Department of Obstetrics and Gynecology of University of Texas Health Science Center at Houston-Children’s Memorial Hermann Hospital, Houston, TX
| | - Jay D. Iams
- Department of Obstetrics and Gynecology of The Ohio State University, Columbus, OH
| | - Edward K. Chien
- Department of Obstetrics and Gynecology of MetroHealth Medical Center-Case Western Reserve University, Cleveland, OH
| | - Brian M. Casey
- Department of Obstetrics and Gynecology of University of Texas Southwestern Medical Center, Dallas, TX
| | - Ronald S. Gibbs
- Department of Obstetrics and Gynecology of University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
| | - Sindhu K. Srinivas
- Department of Obstetrics and Gynecology of University of Pennsylvania, Philadelphia, PA
| | - Geeta K. Swamy
- Department of Obstetrics and Gynecology of Duke University, Durham, NC
| | - Hyagriv N. Simhan
- Department of Obstetrics and Gynecology of University of Pittsburgh, Pittsburgh, PA
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Battarbee AN, Glover AV, Stamilio DM. Association between early amniotomy in labour induction and severe maternal and neonatal morbidity. Aust N Z J Obstet Gynaecol 2019; 60:108-114. [PMID: 31292948 DOI: 10.1111/ajo.13031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/06/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Amniotomy is a commonly used, inexpensive method of labour induction; however, the optimal timing of amniotomy during labour induction is debated. AIMS To investigate whether artificial rupture of membranes <4 cm dilation is associated with caesarean, severe maternal and neonatal morbidity, and labour induction duration. MATERIALS AND METHODS Retrospective cohort study of 228 438 deliveries at 19 US hospitals. Women with a viable, singleton gestation undergoing induction ≥37 weeks with cervical dilation <4 cm were included. Women were excluded if membranes spontaneously ruptured <4 cm. Women were compared by early amniotomy (<4 cm dilation) versus not early. The primary outcome was caesarean. Secondary outcomes included severe maternal and neonatal morbidity, and labour duration. Logistic and Cox proportional hazard regression estimated the association between early amniotomy and study outcomes. RESULTS Of 15 525 eligible women, 10 421 (67%) had early amniotomy. Early amniotomy was associated with higher adjusted odds of caesarean and severe maternal morbidity, but not neonatal morbidity. After accounting for interaction, early amniotomy was associated with increasingly higher odds of caesarean as body mass index increased. Early amniotomy was associated with lower odds of severe maternal morbidity among multiparas with mechanical ripening. Median labour induction was 2.5 h shorter with early amniotomy, significant in hazard regression. CONCLUSIONS Early amniotomy was associated with increased odds of caesarean among obese women. The association between early amniotomy and severe maternal morbidity varied by maternal characteristics, but early amniotomy was not associated with neonatal morbidity. Early amniotomy in labour induction may be advantageous in certain populations, particularly non-obese women requiring mechanical ripening.
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Affiliation(s)
- Ashley N Battarbee
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina School of Medicine and University of North Carolina Health Care, Chapel Hill, North Carolina, USA
| | - Angelica V Glover
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina School of Medicine and University of North Carolina Health Care, Chapel Hill, North Carolina, USA
| | - David M Stamilio
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina School of Medicine and University of North Carolina Health Care, Chapel Hill, North Carolina, USA
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Ganer Herman H, Tamayev L, Houli R, Miremberg H, Bar J, Kovo M. Risk factors for nonreassuring fetal heart rate tracings after artificial rupture of membranes in spontaneous labor. Birth 2018; 45:393-398. [PMID: 29687488 DOI: 10.1111/birt.12350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 03/01/2018] [Accepted: 03/01/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND We aimed to characterize factors associated with nonreassuring fetal heart (FHR) tracings after artificial rupture of membranes (AROM), during the active phase of labor. METHODS Delivery charts of patients who presented in spontaneous labor, at term, between 2015 and 2016 were reviewed. We identified cases in which AROM was performed during the active stage of labor. We compared deliveries with a normal FHR and those who developed nonreassuring FHR. Nonreassuring FHR was defined as fetal tracing that necessitated intrauterine resuscitation, which included: oxytocin withheld, amnioinfusion, or immediate instrumental or cesarean birth. RESULTS Of 664 deliveries, nonreassuring FHR occurred in 141 (21.2%) and normal FHR in 523 (78.7%). Both groups were notable for similar maternal characteristics and a similar gestational age. Epidural block was significantly more common in the nonreassuring FHR group (P < .001), as was meconium during delivery (P = .01). Deliveries in the nonreassuring FHR group were characterized by significantly lower Bishop scores at AROM. Mean birthweight was significantly lower in the nonreassuring FHR group (3201 ± 418 vs 3342 ± 376 g, P < .001), yet, neonatal outcome did not differ between the groups. In a multivariate logistic regression model, nulliparity, AROM at a station lower than -2, and increased birthweight were all significantly associated with a decreased rate of nonreassuring FHR, while prolonged duration from AROM to delivery and oxytocin augmentation significantly increased the risk for nonreassuring FHR. DISCUSSION Nonreassuring FHR after AROM during delivery is associated with parity, fetal station at AROM, birthweight, and oxytocin augmentation.
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Affiliation(s)
- Hadas Ganer Herman
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
| | - Liliya Tamayev
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
| | - Rotem Houli
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
| | - Hadas Miremberg
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
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Abstract
Objective The aim of the study was to examine the association between cervical exam at the time of artificial rupture of membranes (AROM) and cord prolapse. Study Design We conducted a retrospective cohort study using the data from the Consortium on Safe Labor. We included women with cephalic presentation and singleton pregnancies at ≥ 23 weeks' gestation who underwent AROM during the course of labor. Multivariable logistic regression was used to calculate the adjusted odds ratio (aOR) with 95% confidence interval (95% CI), controlling for prespecified covariates. Results Of 57,204 women who underwent AROM, cord prolapse occurred in 113 (0.2%). Compared with dilation 6 to 10 cm + station ≥ 0 at the time of AROM, <6 cm + any station and 6-10 cm + station ≤ -3 were associated with increased risks of cord prolapse (<6 cm + station ≤ -3 [aOR, 2.29; 95% CI, 1.02-5.40]; <6 cm + station -2.5 to -0.5 [aOR, 2.34; 95% CI, 1.23-4.97]; <6 cm + station ≥ 0 [aOR, 3.31; 95% CI, 1.39-8.09]; and 6-10 cm + station ≤ -3 [aOR, 5.47; 95% CI, 1.35-17.48]). Conclusion Cervical dilation < 6 cm with any station and 6 to 10 cm with station ≤ -3 were associated with a higher risk of cord prolapse.
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Affiliation(s)
- Tetsuya Kawakita
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Chun-Chih Huang
- Department of Biostatistics and Epidemiology, MedStar Health Research Institute, Hyattsville, Maryland.,Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, District of Columbia
| | - Helain J Landy
- Department of Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington, District of Columbia
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Pascuzzi LA. An Account of Labor and Birth Following a High-Risk Pregnancy That Ended in Induction of Labor at 37 Weeks: An Acknowledgment of When Option B Can Still Lead to a Positive Birth Experience. J Perinat Educ 2018; 27:66-8. [PMID: 30863003 DOI: 10.1891/1058-1243.27.2.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
After two textbook pregnancies, I was not expecting my third to be any different. However, despite feeling well and exercising regularly, at 29 weeks, I was diagnosed with gestational diabetes. After taking insulin, I developed pregnancy-induced hypertension and oligohydramnios. Having studied to become a Lamaze Certified Childbirth Educator in 2017, I was keen to utilize all my learning and follow the six Healthy Birth Practices to avoid repeating the birth experiences I had had in 2012 and 2014. This is an account of when option B is presented as the best option for the safest end to pregnancy and the ways I tried to gain control of what I could the Lamaze way.
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Abstract
This updated edition of Care Practice Paper #4 presents the evidence for risks of routinely intervening in normal physiologic labor and birth. The authors review evidence related to the routine use of restrictions on oral intake, intravenous lines, continuous electronic fetal monitoring, artificial rupture of membranes, pharmacologic augmentation of labor, epidural analgesia, and episiotomy. Medical indications for each intervention are listed. Women are encouraged to avoid routine interventions in labor unless interventions are medically indicated.
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Affiliation(s)
- Judith A Lothian
- JUDITH LOTHIAN is a childbirth educator in Brooklyn, New York, a member of the Lamaze International Board of Directors, and the associate editor of The Journal of Perinatal Education. She is also an associate professor in the College of Nursing at Seton Hall University in South Orange, New Jersey
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