Primary high-risk HPV screening for cervical cancer in post-menopausal women

Objective

The present study was conducted to examine the value of screening for high-risk HPV in post-menopausal women.

Methods

A cohort of post-menopausal women (n = 2113), age range 55-76 years, from Uppsala County, Sweden, were offered testing for both high-risk HPV and a Pap smear in the gynaecological screening during 2008-2010. For the HPV test the cervical smear sample was applied to a filter paper matrix, an indicating FTA elute card and HPV typing performed using a real-time PCR assay. Histological verified CIN2+ lesion was used as an end-point measurement.

Results

High-risk HPV were found in 6.2% (95% CI 5.2-7.3%) of the women (n = 130) and 22% (95% CI 14-32%) (n = 17) of these had CIN2+ lesions based on histology. The Pap smear taken in conjunction with the HPV test was abnormal in 9.7% (95% CI 5.7-16.3%) (n = 12) of HPV positive women. Among HPV positive women with an abnormal Pap smear, the frequency of histology verified CIN2+ lesions was 67% (95% CI 38-86%) (n = 8), as compared to 14% (95% CI 7-24%) (n = 9) in HPV positive women with a normal smear. The prevalence of HPV16 in CIN2+ lesions (29%, 95% CI 22-37%) in post-menopausal women was less than half of previous estimates in pre-menopausal women from this population.

Conclusions

Most histological CIN2+ lesions in post-menopausal women are not recognized by a single Pap smear. A large fraction of pre-invasive cervical cancer cases in post-menopausal women result from infections by HPV types not included in the present vaccine formulas.     

Location of aortic node metastases in locally advanced cervical cancer

Background

To assess the location of aortic node metastasis in patients with locally advanced cervical cancer undergoing extraperitoneal aortic lymphadenectomy to define the extent of the aortic lymphadenectomy.

Material and methods

Between August 2001 and December 2010, 100 consecutive patients with primary locally advanced cervical cancer underwent extraperitoneal laparoscopic aortic and common iliac lymphadenectomy. The location of aortic node metastases, inframesenteric or infrarenal was noted.

Results

The mean number ± standard deviation (SD) of aortic nodes removed was 15.9 ± 7.8 (range 4-62). The mean number ± SD of inframesenteric (including common iliac) nodes removed was 8.8 ± 4.5 (range 2-41) and the mean number ± SD of infrarenal nodes removed was 7.8 ± 4.1 (range 2-21). Positive aortic nodes were observed in 16 patients, and in 5 (31.2%) of them the infrarenal nodes were the only nodes involved, with negative inframesenteric nodes.

Conclusion

Inframesenteric aortic nodes are negative in the presence of positive infrarenal nodes in about one third of patients with locally advanced cervical cancer and aortic metastases.     

HPV16 is associated with younger age in women with cervical intraepithelial neoplasia grade 2 and 3

Objective

To evaluate if women with HPV16 positive CIN2 and CIN3 are diagnosed at a younger age.

Methods

We conducted a population-based cohort study including more than 40,000 women having a liquid based cervical cytology sample taken as part of routine screening. HPV analysis was performed using Hybrid Capture 2 and LiPAv2. The study population was linked to the Danish Pathology Data Bank to retrieve information on subsequent cervical histology. We included HR HPV positive CIN2/3 samples, comprising 173 CIN2 and 467 CIN3 lesions. Due to a high number of multiple concurrent HPV infections, the causative HPV type was assigned to a hierarchically group.

Results

In CIN3, the estimated proportion of lesions positive for HPV16 was 68.1% among women aged 20 years and decreased to 38.9% among women aged 50 years. A decrease in HPV16 positivity with increasing age was also observed in CIN2. In a multinomial logistic regression analysis, young age was strongly associated with HPV16 positivity in CIN3 lesions (OR = 0.46 per 10 year increase in age, 95% CI: 0.32-0.65). The proportion of HPV16 and/or 18 positive lesions among women diagnosed with CIN2 and CIN3 below 30 years of age was 44% and 75%, respectively.

Conclusions

HPV16 positivity was significantly associated with younger age at diagnosis of CIN3. In a population vaccinated against HPV16 and 18, we will experience a shift to older ages in cervical precancerous lesions. These findings may imply that cervical cancer screening programs could start at an older age in HPV vaccinated populations.     

Cryotherapy for HPV clearance in women with biopsy-confirmed cervical low-grade squamous intraepithelial lesions

Objective

To compare the clearance rate of HPV infection among women aged older than 30 years with biopsy-confirmed cervical low-grade squamous intraepithelial lesions (LSIL) 1 year after cryotherapy with the spontaneous clearance rate (observation).

Method

HPV DNA typing by polymerase chain reaction and reverse line blot hybridization were used to identify 14 high-risk types and 23 low-risk types. HPV DNA sequencing was also used for other types.

Result

Between December 2007 and March 2009, 100 women were recruited to the study and 60 cases had positive results on HPV testing. Twenty-nine patients were randomly allocated to the cryotherapy group and 31 to the observation group. At 1 year, 89.7% (26/29; 95% CI, 78.6-100%) of the cryotherapy group and 90.3% (28/31; 95% CI, 79.9-100%) of the observation group had negative results on HPV testing (0.6% difference; 95% CI, -15.8 to 14.6%, P = 0.94).

Conclusion

Cryotherapy failed to increase the clearance of prevalent HPV infections among women with LSIL, although in both arms the clearance rates were above 80%. However, in coupling with visual inspection with acetic acid as a single visit approach, its effect on prevention of HSIL and cervical cancer is still promising. Therefore, cryotherapy should not be withdrawn from such programs. (ClinicalTrials.gov Identifier: NCT00566579).     

Type-specific human papillomavirus DNA testing with the genotyping array: a comparison of cervical and vaginal sampling

Objective

To compare the detection and typing of human papillomavirus (HPV) between vaginal and cervical specimens by using polymerase chain reaction (PCR)-based reverse-blot genotyping arrays.

Study design

Two hundred and fifty-two women were referred to colposcopy clinics because of suspicious or positive results in a community-based cervical cancer-screening program. Genital tract cells were sampled from the cervix and self-collected from the vagina and tested with the HPV Blot kit.

Results

The HPV Blot kit identified HPV infection in 24.7% of vaginal specimens and in 30.2% of cervical collections. Cervical sampling detected significantly more infections compared to vaginal sampling only for HPV type 52; cervical sampling also detected significantly more high-risk HPV infection overall. The sensitivities of detecting histology ≥cervical intraepithelial neoplasia (CIN) grade 3 using the HPV Blot in vaginal and cervical specimens were 75.0% (95% CI, 47.6-92.7%) and 87.5% (95% CI, 61.6-98.4%), respectively (P = 0.48). Both sampling methods were thus statistically effective at detecting high-grade lesions and cervical cancer (P < 0.0001).

Conclusions

The HPV Blot yielded similar results for both vaginal sampling and cervical sampling in the detection of CIN grade 3 or worse. These findings indicate that self-sampling for HPV testing is a viable cervical cancer screening option.     

Effect of isosorbide mononitrate for cervical ripening before surgical termination of pregnancy in the first trimester

Objective

To evaluate the efficacy of isosorbide mononitrate (IMN) for cervical ripening prior to first trimester surgical termination of pregnancy.

Methods

A prospective, double-blind, randomized, placebo-controlled trial. Women scheduled for surgical termination of a nonviable fetus before 12 weeks of gestation from October 2008 to June 2009 were enrolled and randomly assigned to receive either 20 mg vaginally of IMN (n = 24) or a placebo (n = 24) 4 hours before suction evacuation. Cervical dilation before evacuation was assessed with 10-mm Hegar dilators followed by smaller sizes that were measured until the instrument passed freely through the internal os. Cervical dilation, adverse effects, termination complications, and patient satisfaction were the main outcomes.

Results

Mean cervical dilation was not significantly different between the IMN and placebo groups (6.29 ± 0.99 mm vs 5.71 ± 1.04 mm; P = 0.05). Mean operative time did not differ between the groups (16 ± 0.07 min vs 18 ± 0.06 min; P = 0.55), nor did patient satisfaction measured by visual analogue scale (7.04 ± 1.68 vs 6.54 ± 1.22; P = 0.24).

Conclusion

IMN was comparable to placebo in terms of efficacy and patient satisfaction for cervical priming prior to first-trimester termination of pregnancy.     

Prevalence and genotype distribution of human papillomavirus in women with cervical cancer or high-grade precancerous lesions in Chengdu, western China

Objective

To study the prevalence and genotype distribution of human papillomavirus (HPV) among women with cervical cancer or high-grade squamous intraepithelial lesions (HSIL) in western China.

Methods

Cervical cast-off cells from 144 women with cervical cancer and 63 women with HSIL were tested for HPV genotypes using an oligonucleotide microarray.

Results

The overall HPV prevalence was 80.6% in cases of carcinoma and 61.9% in cases of HSIL. The most common genotypes were HPV-16 (carcinoma, 68.1%; HSIL, 34.9%) and HPV-58 (carcinoma, 8.3%; HSIL, 17.5%). Other high-risk types included HPV-18, -31, -33, -35, -45, and -52, with HPV-18 more common in adenocarcinomas than in squamous cell carcinomas (21.4% vs 3.1%; P < 0.02). The HPV prevalence was lower among patients older than 49 years (P < 0.02).

Conclusion

The prevalence of HPV-16 and HPV-58 was high. This finding may help to improve HPV vaccination and cervical cancer prevention programs in western China.     

HPV infection among women in a representative rural and suburban population of the USA

Objective

To study the prevalence of low-risk and high-risk HPV genotypes in a largely suburban, non-Hispanic, white female population of the USA, and to determine the positive predictive value of one-occasion HPV detection and genotyping using high-grade squamous intraepithelial lesion (HSIL) cytology as the endpoint for clinical evaluation.

Methods

HPV DNA present in liquid-based cytology specimens collected by gynecologists in private practice was amplified using nested polymerase chain reaction. HPV DNA was validated by signature DNA sequencing for accurate genotyping.

Results

Of 2633 specimens, 278 were positive for HPV DNA of any genotype. Among 255 single HPV infections, the most prevalent genotype was HPV-16 (n = 50; 19.6%), followed by HPV-52 (n = 24; 9.4%). Only 10 specimens, all positive for a high-risk HPV, were associated with an HSIL cytology result. Among them were 6 of the 50 specimens (12%) tested positive for HPV-16. One novel HPV-39 variant was detected in repeat testing in a patient with persistent HPV infection.

Conclusion

DNA sequencing is a useful method for increasing the specificity of HPV genotyping as an aid to follow persistent high-risk HPV infections to reduce excessive colposcopies in populations with low cancer prevalence.     

Fluoxetine treatment for anxiety in women undergoing in vitro fertilization

Objective

To compare anxiety levels experienced during 4 stressful periods of in vitro fertilization (IVF) and treatment outcomes between women taking fluoxetine and a placebo.

Methods

A prospective, randomized, double-blind, placebo-controlled trial of patients allocated to receive either fluoxetine (FLX) or folic acid (FA). Anxiety state was assessed at the beginning of ovarian stimulation (OS), ovum pick-up, embryo transfer, and on the day of the pregnancy test (DPT) using the State-Trait Anxiety Inventory (STAI).

Results

Baseline STAI-S and STAI-T were normal. From OS to DPT, STAI-S increased from 42.8 ± 10.6 to 44 ± 9.0 in the FLX group and from 40.9 ± 8.1 to 45.3 ± 8.3 in the FA group (P = 0.03 and P = 0.001, respectively). IVF outcome was not affected by the treatment in the two groups.

Conclusions

Caution is needed in prescribing fluoxetine to alleviate anxiety in patients undergoing IVF. Studies are needed to determine whether other selective serotonin reuptake inhibitors or higher fluoxetine doses can relieve emotional distress without affecting IVF outcome.     

Feasibility of laparoscopic extraperitoneal pelvic lymphadenectomy in gynecologic malignancies

Objective

The aim of this study is to evaluate the feasibility of laparoscopic extraperitoneal pelvic lymphadenectomy (LEPL) in gynecologic malignancies.

Methods

Twenty-nine women with cervical, ovarian or endometrial cancer underwent laparoscopic extraperitoneal pelvic lymphadenectomy between July 2008 and December 2010. The operating time, nodal yield, blood loss and complications were recorded.

Results

The number of patients with cervical, ovarian and endometrial carcinoma was 14, 3 and 12, respectively. The median age of patients was 48.9 ± 12.6 years. The median body mass index was 25.6 ± 4.8. Conversion to the transperitoneal laparoscopic approach was necessary in 6 patients for peritoneal tears causing CO₂ gas leakage. Among the remaining 23 patients, the median operating time for laparoscopic extraperitoneal pelvic lymphadenectomy was 69 min (range 50-126 min), and the median estimated blood loss was 20 ml (range 5-105 ml). The median total number of resected nodes was 26 (range 14-42), and complications related to the procedure were rare.

Conclusions

Laparoscopic extraperitoneal pelvic lymphadenectomy is a feasible and safe procedure. It can be used in gynecologic malignancies.     

Uterosacral-cardinal ligament stretching prior to vaginal hysterectomy increases uterine descent: a novel technique

Objective

To examine the effect of uterosacral-cardinal ligament complex stretching prior to vaginal hysterectomy on uterine descent.

Study design

A prospective trial of 25 consecutive women undergoing vaginal hysterectomy. Pre-operative, apical, anterior and posterior wall POP-Q measurements were recorded for each patient before and after uterosacral-cardinal ligament complex stretching during general anesthesia.

Results

Uterosacral-cardinal ligament complex stretching yielded a significant increase in mean stage of uterine and anterior wall descent (2.6 ± 0.6 vs. 3.2 ± 0.6 cm, p < 0.001, and 2.5 ± 0.8 vs. 2.9 ± 0.8 cm, respectively, p < 0.004). There was no significant change in posterior wall prolapse measurements (1.3 ± 0.7 vs. 1.4 ± 0.8 cm, p = 0.05).

Conclusion

Uterosacral-cardinal ligament complex stretching prior to vaginal hysterectomy increase uterine descent.     

Prospective evaluation of longitudinal changes in human papillomavirus genotype and phylogenetic clade associated with cervical disease progression

Objective

Changes in the HPV genotype detected in patients over time could alter cervical disease progression. Identification of patterns in the alteration of HPV genotype should also be related to cytological and histological findings. Thus, we assessed the risk for low-grade squamous intraepithelial lesion (LSIL) or high-grade SIL (HSIL)/squamous cell carcinoma (SCC) associated with alterations in the HPV genotype detected, presence of multiple HPV genotypes, and individual genotyping or HPV clade grouping.

Methods

The 1052 participants were monitored by HPV chip and Pap smear. We calculated odds ratios and applied sequential association analysis (SAA) and decision tree analysis (DTA).

Results

We classified HPV alteration as persistence, regression (spontaneous vs. therapeutic), or metatyping (progressive vs. regressive). Spontaneous regression occurred in 71.9% of patients. Metatyping was strongly associated with progression (RR: 3.9, p = 0.0242), with progressive metatyping showing a higher risk of progression (RR: 31.49, p = 0.00448). Few patients with multiple infections were identified in the initial screen but 30.8% of patients had multiple infections in the final analysis. HPV-16, -35, -52, and -58 were commonly associated with HPV persistence. Univariate analysis determined that final diagnosis significantly associated with HPV type at the endpoint (p < 0.0001), persistence (p = 0.0001), and progressive metatyping (p = 0.0022). SAA determined that HPV-66, -68, and -69 were significantly associated with HSIL, and HPV-16 and -18 persistence significantly association with SCC. DTA indicated an age less than 28 years had a peak in LSIL, and an age between 32 and 48 years had a peak in HSIL. A bimodal peak in SCC for HR-2 at the endpoint was observed in participants less than 32 and greater than 48 years of age.

Conclusions

The alteration patterns of HPV infection detected included persistence, regression, and metatyping. HPV persistence and progressive metatyping are significant signatures of disease progression.     

Cytology versus visual inspection with acetic acid among women treated previously with cryotherapy in a low-resource setting

Objective

To compare visual inspection with acetic acid (VIA) with conventional cervical cytology as a follow-up cervical cancer screening method in women who had been treated previously with cryotherapy.

Methods

Salvadoran women screened with VIA and treated with cryotherapy within 3 years were eligible to participate. Study participants were rescreened with VIA, Pap smear, colposcopy, 4-quandrant biopsy, and endocervical curettage.

Results

Of 147 women enrolled in the study, post-cryotherapy VIA was positive in 39 women (26.5%; 95% CI, 19.6%-34.4%). Of these 39, 1 woman had CIN 1 or higher on biopsy. Post-cryotherapy Pap smear was positive (ASCUS or higher) in 6 women (4.1%; 95% CI, 1.5%-8.7%). Of these 6, 2 women had CIN 1 or higher on biopsy. Post-cryotherapy specificity was significantly higher for Pap compared with VIA (95.8% [138/144]; 95% CI, 91.2%-98.5% vs 73.6% [106/144]; 95% CI, 65.6%-80.6%; P < 0.001).

Conclusion

As the single-visit approach for cervical cancer screening gains popularity, more women will have been treated with cryotherapy. Appropriate follow-up screening is therefore vital. Cytology may be a more suitable screening method than VIA in low-resource settings for women treated previously with cryotherapy.     

Clinical, colposcopic and pathological characteristics of cervical and vaginal high-grade lesions negative for HPV by Hybrid Capture 2

Objective

Less than 5% of women with cervical or vaginal biopsy proven high-grade squamous intraepithelial lesions (HG-SIL) show a negative Hybrid Capture 2 (HC2) result. We analyzed 1) human papillomavirus (HPV) genotypes by PCR in order to determine whether these cases represent infections by common or unusual types, and 2) the clinical, colposcopic and pathological differential characteristics of these patients.

Methods

646 women with a histological diagnosis of HG-SIL and a HC2 test collected within 6 months prior to the diagnosis were identified. Patients with a negative HC2 result were selected. HPV was typed in the biopsy specimen in all by PCR using SPF10 and GP5+/6+ primers, and p16^INK4a immunostaining was performed. The clinical and colposcopy findings of these women were compared with a control group of HG-SIL with positive HC2 result.

Results

20 women (3.1%) with HG-SIL had a negative HC2. All biopsies were positive for p16^INK4. PCR analysis detected HPV types included in HC2 test in 55% of the cases, with an identical percentage of common viruses between women with relative light unit values above or below 0.40 (p = .361). False negative HC2 tests increased with age (p = .002) and were more frequent in patients with non satisfactory colposcopy or small sized lesions (p < .001).

Conclusion

A negative HC2 test is an infrequent event in women with HG-SIL. Common HPV types are identified in over half of the cases. Older women and patients with small lesions or non satisfactory colposcopy have a higher rate of HC2 negative results.     

Knowledge, awareness, and attitudes of female sex workers toward HPV infection, cervical cancer, and cervical smears in Thailand

Objective

To determine the knowledge, attitudes, and awareness of female sex workers (FSWs) regarding cervical cancer and its prevention in Thailand.

Method

From August through November 2008, 402 consecutive FSWs were recruited for interviews.

Results

The mean knowledge score was 4.9 (maximum possible, 15; range, 0-14). Approximately 60% of the FSWs had knowledge scores less than 5. Low education and a lack of health insurance were significant independent predictors of low knowledge scores (adjusted odds ratios, 3.17 and 1.97, respectively). More than half of the FSWs were unaware of being at higher risk for HPV infection or of the possible consequences of HPV infection. The negative attitude regarding cervical screening was caused by the fear of abnormal results (27.9%), experiencing pain (18.4%), and embarrassment (14.7%).

Conclusion

The knowledge and awareness of HPV infection, cervical cancer, and utility of cervical smears is low among FSWs in Thailand. Designing and implementing effective interventions is crucial and merits attention in future research.     

Sexual behavior and knowledge of sexually transmitted infections among university students in Sao Paulo, Brazil

Objective

To investigate the sexual behavior and knowledge about sexually transmitted infections (STIs) among undergraduate students in Sao Paulo, Brazil.

Methods

Self-reported questionnaires were used.

Results

Most of the 447 students in the study were single (97.3%), in their first year of university (87.7%), and the mean ages were 20.4 years (males) and 19.8 years (females). Vaginal intercourse was practiced by 69.7% of males and 48.4% of females, oral sex by 64.5% of males and 43.7% of females, and anal sex by 18.4% of males and 14.1% of females. Use of a condom during vaginal sex was practiced by 80.4% of males and 74.8% of females and during anal sex by 47.8% of males and 30.0% of females. Knowledge of transmission of STIs was greater than 90% for HIV, syphilis, genital herpes, and gonorrhea; 63%-76% for HPV and genital warts; 30%-34% for Trichomonas and only 16% for Chlamydia. Only 25%-34% knew that HIV was transmitted by breastfeeding; 56%-60% knew that HIV was transmitted by anal sex.

Conclusion

Many students engage in high-risk sexual behavior with multiple partners and use condoms inconsistently. Knowledge of the acquisition and modes of sexual and vertical transmission of HIV are strikingly deficient.     

The value of p16ink4a expression by fluorescence in situ hybridization in triage for high risk HPV positive in cervical cancer screening

Objectives

The aim of this study is to evaluate the effect of fluorescence in situ hybridization (FISH) detection for p16ink4a expression as an alternative triage for high risk HPV positive women in cervical cancer screening.

Methods

Totally 191 cervical cell specimens from women with HPV positive were collected. The p16ink4a expression by FISH and liquid-based thin-layer cytology was performed and followed by colposcopy with or without biopsied histologic examination for all participants. The relationship between p16ink4a expression and histologic diagnosis, as well as cytology was analyzed.

Results

The positive rate of p16ink4a was 5.35% in normal or inflammation cases, 56.67% in CIN 1, 83.78% in CIN 2-3, 100.00% in carcinoma, respectively, with a significance between < CIN2 and ≥ CIN 2 (P < 0.001). The p16ink4a expression presented a concordance trend as cytology grading, with a positive rate of 9.28% in NILM, 33.33% in ASCUS, 53.37% in LSIL, 81.25% in ASC-H, and 95% in HSIL, respectively. Compared with cytology, FISH detection for p16ink4a had a higher accuracy (84.8% vs. 74.34%), higher sensitivity (87.75% vs. 52.00%) and similar specificity (83.84% vs. 88.79%) for predicting ≥ CIN 2 lesions.

Conclusions

FISH detection specific to p16ink4a presents a high consistency with cytologic grading and has a higher accuracy for predicting high grade CIN than cytology in high risk HPV positive women. Our findings suggest that FISH detection for p16ink4a is a potential alternative triage for high-risk HPV positive women in cervical cancer screening.     

Overexpression of cystic fibrosis transmembrane conductance regulator (CFTR) is associated with human cervical cancer malignancy, progression and prognosis

Objective

To investigate the correlation of cystic fibrosis transmembrane conductance regulator (CFTR) to cervical cancer progression and prognosis by examining CFTR expression levels in different cervical tissues and cell lines.

Methods

Paraffin-embedded cervical tissue samples (n = 192) were collected for immunohistochemistry (IHC), while fresh cervical tissue samples (n = 165) and human cervical cell lines were collected for protein and mRNA detection by quantitative real-time PCR and western blot, respectively. Correlations between CFTR expression levels to cancer clinicopathologic features and prognosis were statistically analyzed.

Results

Both CFTR mRNA and protein expression gradually increased from normal to precancerous (LSIL, HSIL) and cervical cancer tissues (p < 0.05). Furthermore, CFTR expression level was well-correlated to tumor stage (p < 0.001), histological grades (p < 0.001), lymphatic metastasis (p < 0.001), vascular invasion (p < 0.05), interstitial invasive depth (p < 0.05), tumor size (p < 0.05) and HPV infection (p < 0.05). In vitro, CFTR mRNA and protein were expressed strongly both in SiHa and HeLa, but little was seen in Caski and H8 (p < 0.05). More importantly, overexpression of CFTR conferred significantly poorer survival in cervical carcinoma (Log rank p = 0.028), although it was not an independent predictor for prognosis according to multivariate analysis (p > 0.05).

Conclusions

These results suggest that higher CFTR expression is closely associated with cervical cancer progression, aggressive behaviors and poorer prognosis, indicating that CFTR may function as a novel tumor marker, a prospective prognostic indicator and a potential therapeutic target for cervical cancer.     

Effect of continuous support during labor on duration of labor and rate of cesarean delivery

Objective

To evaluate the effect of continuous support provided by midwives during labor on the duration of the different stages of labor and the rate of cesarean delivery.

Method

A randomized trial of 100 eligible nulliparous women who had not received education classes on childbirth. In the intervention group (n = 50), continuous support during labor was provided; the control group (n = 50) did not receive continuous support.

Results

The two groups did not differ by age, employment, educational level, gestational age, economic status, and neonatal weight. Mean duration of the active phase of labor (167.9 ± 76.3 vs 247.7 ± 101 min, P < 0.001), second stage of labor (34.9 ± 25.4 vs 55.3 ± 33.7 min, P = 0.003), and the number of cesarean deliveries (4 vs 12, P = 0.026) were significantly lower in the intervention group compared with the control group. The rates of oxytocin use and Apgar scores of less than 7 at 5 minutes were similar between the two groups.

Conclusion

Continuous support provided by midwives during labor may reduce the duration of labor and the number of cesarean deliveries; this model of support should be available to all women.