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1.
Maryam Kashanian Farahroos Javadi 《International journal of gynaecology and obstetrics》2010,109(3):198-200
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. 相似文献2.
Osman Balci Alaa S. Mahmoud Suna Ozdemir Ali Acar 《International journal of gynaecology and obstetrics》2010,110(1):64-67
Objective
To compare the effect of an oxytocin infusion alone or preceded by an intravaginal application of misoprostol for labor induction in women with term pregnancies and a low Bishop score.Methods
This study randomized 100 multiparous women with singleton pregnancies over 38 weeks and a Bishop score less than 6 to receive either a single 50-µg dose of misoprostol intravaginally 3 hours before initiation of the oxytocin infusion or only an oxytocin infusion. The time from induction to delivery, the route of delivery, and maternal and fetal outcomes were analyzed.Results
The mean time from induction to delivery was 9.36 ± 1.97 hours in the misoprostol plus oxytocin group and 11.08 ± 3.23 in the oxytocin alone group (P = 0.002). The rates of vaginal delivery, 1- and 5-minute Agpar scores, placental abruption, and postpartum hemorrhage were similar between the 2 groups, as were the rates of admission to the neonatal intensive care unit. There were no cases of perinatal asphyxia.Conclusion
A 50-µg intravaginal application of misoprostol before starting the oxytocin infusion is a more effective method of labor induction than an oxytocin infusion alone for our study population. 相似文献3.
Gunjan Singh Gita Radhakrishnan Kiran Guleria 《International journal of gynaecology and obstetrics》2009,107(2):130-134
Objective
To compare the efficacy and adverse effects of sublingual misoprostol, intravenous oxytocin, and intravenous methylergometrine in active management of the third stage of labor (AMTSL).Methods
A double-blind randomized trial of 300 women with a healthy singleton pregnancy allocated into 4 groups to receive either: 400 µg or 600 µg of sublingual misoprostol, 5 IU of intravenous oxytocin, or 200 µg of intravenous methylergometrine. The primary outcome measure was blood loss in the third and fourth stage of labor; secondary measures were duration of the third stage of labor, changes in hemoglobin levels, and adverse effects.Results
Patients who received 600 µg of misoprostol had the lowest blood loss (96.05 ± 21.1 mL), followed by 400 µg of misoprostol (126.24 ± 49.3 mL), oxytocin (154.7 ± 45.7 mL), and methylergometrine (223.4 ± 73.7 mL) (P < 0.01). Shortest mean duration of the third stage of labor (5.74 minutes) was with 600 µg of misoprostol, while methylergometrine had the longest (6.83 minutes) (P < 0.05). Pyrexia was observed in the misoprostol groups, and raised blood pressure in the methylergometrine group (P < 0.001). The 24-hour postpartum hemoglobin level was similar among the groups (P > 0.05).Conclusion
Administration of 600 µg of sublingual misoprostol was more effective than 400 µg of misoprostol, intravenous oxytocin, and intravenous methylergometrine for AMTSL. 相似文献4.
Kandil MA Abdel-Sattar MM Abdel-Salam SM Saleh S Khalafallah MM 《European journal of obstetrics, gynecology, and reproductive biology》2012,160(1):18-21
Objective
To determine whether abdominal electromyography can predict the response to tocolysis in pregnant women in preterm labor.Study design
This study was carried out at the Department of Obstetrics and Gynecology, Menofyia University Hospital in Egypt. Fifty pregnant women in preterm labor who fulfilled the inclusion criteria were enrolled. Baseline abdominal electromyography was performed. Tocolysis in the form of hexoprenaline sulphate infusion was started for all women and electromyography was repeated after 24 h in responders but only after 6 h in non responders. The receiver operating characteristics curve was drawn to calculate specificity of the electromyography at 100% sensitivity. Results were tabulated and statistically analyzed.Results
Forty women responded to tocolysis by delaying delivery for more than 48 h. There was a significant reduction in the frequency of uterine contractions after tocolysis (3.76 ± 0.92 versus 2.32 ± 2.05 contractions per 10 min; P < 0.001). Similar significant reductions affected the duration and amplitude of uterine action potentials (25.08 ± 9.74 versus 14.4 ± 17.16 s; P < 0.001, 40.8 ± 25.89 versus 28.32 ± 29.38 mV; P < 0.001). At a sensitivity of 100% and using ROC curve, abdominal electromyography of amplitude of 82 mV lasting for 30 s or more had a specificity of 90%, positive and negative predictive values of 67% and 95%, and a diagnostic accuracy of 88% in predicting preterm labor.Conclusion
Abdominal electromyography may predict the response to tocolysis in preterm labor. 相似文献5.
Rohna Kearney Myra Fitzpatrick Michael Behan Declan Keane John O.L. DeLancey 《International journal of gynaecology and obstetrics》2010,111(1):19-22
Objective
To compare levator ani muscle injury rates in primiparous women who had a forceps delivery owing to fetal distress with women delivered by forceps for second stage arrest; and to compare these injury rates with a historical control group of women who delivered spontaneously.Methods
Primiparous women who delivered by forceps were recruited retrospectively into 2 groups: forceps for fetal distress with short second stage (25 ± 11 minutes; n = 19); and forceps delivery for second stage arrest (137 ± 26 minutes; n = 19). MR images of the levator ani muscles were compared with a historical control group of women from a previous study who had delivered spontaneously (n = 129).Results
Major defect rates were: 42% for forceps and short second stage; 63% for forceps and second stage arrest; and 6% for spontaneous delivery. The odds ratios for major injury were: 11.0 for forceps and short second stage compared with spontaneous delivery; 25.9 for forceps and second stage arrest compared with spontaneous delivery; and 2.3 for forceps and second stage arrest compared with short second stage (P = 0.07).Conclusion
Women delivered by forceps have a higher rate of levator ani injury compared with spontaneous delivery controls; the difference between the forceps groups did not reach significance. 相似文献6.
Ahmed Nasr Ahmed Y. Shahin Ali M. Elsamman Mahmoud S. Zakherah Omar M. Shaaban 《International journal of gynaecology and obstetrics》2009,105(3):244-247
Objective
To assess the effectiveness of 800 μg of rectal misoprostol compared with an intravenous infusion of 5 IU of oxytocin as prophylaxis against postpartum hemorrhage (PPH).Methods
A total of 514 women in labor were randomized into two groups (257 women in each). Within 1 minute of delivery of the anterior shoulder participants in group 1 received 800 μg of rectal misoprostol and 1 ampoule of normal saline in 5 mL lactated Ringer solution intravenously; group 2 received a rectal placebo tablet and 5 IU of oxytocin in 5 mL lactated Ringer solution intravenously.Results
Both groups were comparable regarding the need for uterotonics, blood transfusion, and hematocrit drop of 10% or greater, 24 hours post partum (P = 0.54, P = 0.25, and P = 0.85, respectively). Fever was significantly higher among misoprostol patients (18.7% vs 0.8%, P < 0.001).Conclusions
Routine use of 800 μg of rectal misoprostol was effective in reducing blood loss after delivery. We recommend the regimen for low-resource, busy obstetric settings. 相似文献7.
Emi Kamoshita Yuji Kanai Yasuhiro Ikeda Akihiro Tani Toshiyuki Okutomi Nobuya Unno 《International journal of gynaecology and obstetrics》2010,111(1):23-27
Objective
To examine the effect of the interval between onset of sustained fetal bradycardia and cesarean delivery on long-term neonatal neurologic prognosis.Method
A retrospective observational case-series performed with patients who had sudden-onset and sustained (< 100 beats per minute) fetal bradycardia during labor. Fetal heart rate was monitored closely until cesarean delivery. The effect of the interval between the onset of bradycardia and delivery on neonatal neurologic prognosis was examined.Results
Among 2267 deliveries in 2002-2003 at Kitasato University Hospital, 19 pregnancies met the inclusion criteria. Episodes of fetal bradycardia were due to umbilical cord prolapse (n = 5), placental abruption (n = 4), uterine rupture (n = 3), maternal respiratory failure (n = 1), and other causes (n = 6). Mean onset of fetal bradycardia to delivery interval (BDI) was 20.5 ± 8.9 minutes. Mean decision-to-cesarean delivery interval was 11.4 ± 3.9 minutes. BDI was negatively correlated with umbilical arterial pH at delivery. There were 3 postnatal deaths. Neurologic assessment at the age of 2 years revealed that 15 of 16 children were neurologically normal. When the BDI was less than 25 minutes, all term pregnancies led to normal neonatal neurologic development.Conclusion
In the event of sustained intrapartum fetal bradycardia, delivery by emergency cesarean within 25 minutes improved long-term neonatal neurologic outcome. 相似文献8.
Fernando Althabe Giselle Tomasso Gerardo Vitureira Pierre Buekens 《International journal of gynaecology and obstetrics》2009,107(1):4-7
Objective
To evaluate whether controlled cord traction (CCT) for management of the third stage of labor reduced postpartum blood loss compared with a “hands-off” management protocol.Methods
Women with imminent vaginal delivery were randomly assigned to either a CCT group or a hands-off group. The women received prophylactic oxytocin. The primary outcome was blood loss during the third stage of labor.Results
In total, 103 women were allocated to the CCT group and 101 were allocated to the hands-off group. Median blood loss in the CCT group and the hands-off group was 282.0 mL and 310.2 mL, respectively. The difference in blood loss (- 28.2 mL) was not significant (95% confidence interval, - 92.3 to 35.9; P = 0.126). Blood collection in the hands-off group took 1.2 minutes longer than in the CCT group, which may have contributed to this difference.Conclusion
CCT may reduce postpartum blood loss. The present findings support conducting a large trial to determine whether CCT can prevent postpartum hemorrhage. 相似文献9.
Walid El-Sherbiny Walid Saber Ashraf El-Daly 《International journal of gynaecology and obstetrics》2009,106(3):213-215
Objective
To assess the effect of intraperitoneal instillation of lidocaine on postoperative pain after minor gynecological laparoscopic surgery.Method
A prospective, double-blind, placebo-controlled clinical trial of 75 patients undergoing gynecological laparoscopy randomized to receive intraperitoneal instillation of either 120 mg of lidocaine (n = 60) or normal saline (n = 15) at the end of surgery. Postoperative pain was evaluated by Wong-Baker Faces Pain Rating Scale (WBFS) score at 15 minutes and at 1, 2, 4, 12, and 24 hours postoperatively.Results
The WBFS score was lower for the lidocaine group than for the control group at 1, 2, and 4 hours after surgery (P = 0.023). There was no difference in WBFS scores between the 2 groups at 15 minutes (P = 0.46), 12 hours (P = 0.13), and 24 hours (P = 0.07) after surgery.Conclusion
Intraperitoneal instillation of lidocaine was effective in reducing postoperative pain after minor gynecological laparoscopic procedures. 相似文献10.
Poonam Phusaanantakul 《International journal of gynaecology and obstetrics》2010,110(2):145-148
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. 相似文献11.
Aruna N. Kekre Rupashree Dasgupta 《International journal of gynaecology and obstetrics》2011,112(2):112-115
Objective
To determine the incidence of covert and overt postpartum urinary retention (PUR) after vaginal delivery and to determine obstetric variables contributing to PUR.Methods
In a cross-sectional study, women who delivered vaginally underwent a transabdominal ultrasound scan for estimation of postvoid residual bladder volume and diagnosis of PUR. Patient data, including age, obstetric history, mode of delivery, and duration of labor, were compared between women with and those without PUR.Results
Of the 771 participants recruited, 84 (10. 9%) had PUR: 82 (10.6%) with covert PUR and 2 (0.3%) with overt PUR. Women with instrumental delivery were more prone to develop PUR (P = 0.03), with an odds ratio (OR) of 1.194 (95% confidence interval [CI], 0.56-1.90). A duration of labor of more than 700 minutes was a good predictor of PUR. The area under the receiver operating characteristic (ROC) curve was 0.634 (95% CI, 0.567-0.702; P < 0.001), with an OR of 1.003 (95% CI, 1.001-1.004).Conclusion
Covert retention of urine was significantly associated with parturients who had an instrumental delivery and a duration of labor of more than 700 minutes. 相似文献12.
Objective
To determine the relationship between child labor and sexual assault among girls in Maiduguri, Nigeria.Methods
Face-to-face interview using a validated questionnaire of a randomly selected sample of employed girls.Results
Out of 350 girls, 316 were successfully interviewed for a response rate of 90.3%. Mean age of the girls was 14.9 ± 2.3 years and mean workday was 8.5 ± 3.8 hours/day. In 33.4% of cases the girls had no formal education, and 78.5% were not currently going to school. The sexual assault rate was 77.7%, and in 38.6% of cases the assailant was a customer. Sexual assault was more likely in girls who were younger than 12 years (OR 3.54; 95% CI, 1.38-9.14), had no formal education (OR 4.80; 95% CI, 1.63-14.16), worked for more than 8 hours/day (OR 4.43; 95% CI, 1.60-12.30), or had 2 or more jobs (OR 16.09; 95% CI, 1.20-61.70).Conclusion
To reduce the risk of sexual assault, if girls are employed they should be older, work for limited hours, and not have more than one job at a time. 相似文献13.
Michael J. Turner 《International journal of gynaecology and obstetrics》2011,113(3):175-177
Objective
To examine the use of quality control performance charts to analyze cesarean rates nationally.Methods
Information on cesarean rates was obtained for all 19 Irish maternity hospitals receiving state funding in 2009. All women who underwent cesarean delivery of a live or stillborn infant weighing 500 g or more between January 1 and December 31 were included. Deliveries were classified as elective or emergency. Individual hospitals were not identified in the analysis.Results
The mean rates per hospital of elective and emergency cesarean were 12.9 ± 2.6% (n = 9337) and 13.8 ± 3.0% (n = 9989), respectively—giving an overall mean rate of 26.7 ± 4.2% (n = 19326) per hospital. Cesarean rates were normally distributed. Using a quality control performance chart with a cutoff 2 standard deviations from the mean, 1 hospital was above the normal range for both total and elective cesareans, indicating that its pre-labor obstetric practices warrant clinical review. Another hospital had a mean emergency cesarean rate above the normal range, indicating that its labor ward practices warrant review.Conclusion
Quality control performance charts can be used to analyze cesarean rates nationally and, thus, to identify hospitals at which obstetric practices should be reviewed. 相似文献14.
Jareethum R Suksompong S Petyim S Prechapanich J Laokirkkiat P Choavaratana R 《European journal of obstetrics, gynecology, and reproductive biology》2011,155(2):193-198
Objectives
To evaluate the efficacy and level of satisfaction from mefenamic acid and hyoscine when used for pain relief during saline infusion sonohysterography.Study design
In this double blind randomized controlled trial, 141 nulliparous women were allocated to receive 500 mg of mefenamic acid, 10 mg of hyoscine or a placebo, which was packed in the same outer capsule. Saline infusion sonohysterography (SIS) was performed 30 min later by one operator. Pain and satisfaction scores were evaluated using a 10 cm visual analog scale. Baseline characteristics, pain and satisfaction scores were compared among the three groups. Pain scores were recorded before, after catheter insertion, during, immediately after, and 30 min after the procedure.Results
No statistically significant differences were found in baseline characteristics, pain and satisfaction scores among the three groups. Maximum pain during SIS was 4.40 ± 3.34, 4.67 ± 3.14 and 4.85 ± 3.19 in the mefenamic acid, hyoscine and placebo groups respectively. There was a 31.1% prevalence of intrauterine abnormality and the most frequent finding was endometrial polyp.Conclusion
There is no benefit in using mefenamic acid and hyoscine in the prevention of pain occurring from SIS. 相似文献15.
Maryam Kashanian Shohreh Bahasadri Bita Zolali 《International journal of gynaecology and obstetrics》2011,113(3):192-195
Objective
To compare the effectiveness and adverse effects of nifedipine versus indomethacin in the treatment of preterm labor.Methods
In a randomized clinical trial, 79 women with labor pain at 26-33 weeks of gestation were treated with either oral nifedipine (n = 40) or rectal indomethacin (n = 39).Results
Twenty-three (59%) women in the indomethacin group, and 10 (25%) in the nifedipine group did not respond to treatment (P = 0.002). None of the 16 and 30 women remaining in the indomethacin and nifedipine groups, respectively, delivered during the subsequent 48 hours. Of these remaining women, 1 (6.25%) in the indomethacin group and 4 (13.3%) in the nifedipine group delivered between 48 hours and 7 days (P = 0.162). For the women who responded to treatment, the mean gestational age at time of delivery was 238.5 ± 19.4 days and 246.4 ± 15.4 days in the nifedipine and indomethacin groups, respectively (P = 0.182). Seventeen (42.5%) women in the nifedipine group, and 11 (28.2%) in the indomethacin group showed adverse effects (P = 0.184).Conclusion
Indomethacin was less effective than nifedipine for the fast treatment of preterm labor. For women who responded to treatment within 2 hours, however, the delaying of delivery by indomethacin was similar to that by nifedipine. 相似文献16.
Monika B. Nagpal Chitra Raghunandan 《International journal of gynaecology and obstetrics》2009,106(1):23-26
Objective
To compare the efficacy and safety of oral misoprostol with intracervical prostaglandin E2 (PGE2) gel for the active management of premature rupture of membranes (PROM) at term.Methods
Women with pregnancies between 37 and 42 weeks presenting with PROM at term and a Bishop score of 5 or less were randomly assigned to receive either a 4-hourly oral dose of 50 µg of misoprostol up to a maximum of 3 doses or 2 applications of intracervical PGE2 gel at a 6-hour interval. Oxytocin was given if labor had not started after 12 hours.Results
Twenty women in the misoprostol group (n = 31) delivered within 12 hours compared with 5 in the PGE2 group (n = 30) (P < 0.001). The induction-to-delivery interval in the misoprostol group was shorter than in the PGE2 gel group (615 min vs 1070 min; P < 0.001). The mode of delivery was comparable between the 2 groups (P = 0.821). Abnormalities in uterine contractions and neonatal outcomes were also comparable. The requirement for oxytocin was lower and patient satisfaction was better in the misoprostol group.Conclusion
Oral misoprostol is a safe and efficacious alternative to intracervical PGE2 gel in the active management of PROM at term. 相似文献17.
Adeniran O. Fawole Oladapo S. Sotiloye Augustine C. Umezulike Daniel A. Adekanle Olusoji Adeyanju Adeyemi O. Adekunle Lindeka Mangesi 《International journal of gynaecology and obstetrics》2011,112(2):107-111
Objective
To assess the effects of 400-μg sublingual misoprostol plus routine uterotonics on postpartum hemorrhage.Methods
A double-blind, placebo-controlled, randomized study was performed. After delivery of the child, eligible women received routine uterotonics and were randomly allocated to receive 400-μg misoprostol or placebo sublingually. The primary outcome measure was blood loss of at least 500 mL within 1 hour of taking the trial tablets.Results
In total, 672 women received misoprostol and 673 received placebo. The baseline data were similar for both groups. Misoprostol plus routine uterotonics reduced postpartum blood loss, but the effect was not significant for blood loss of at least 500 mL (relative risk [RR] 0.96; 95% confidence interval [CI], 0.63-1.45) or blood loss of at least 1000 mL (RR 0.50; 95% CI, 0.15-1.66). Misoprostol also reduced the need for non-routine oxytocin, manual removal of the placenta, and hysterectomy, but these differences were not significant either. Misoprostol was associated with pyrexia and moderate/severe shivering. There was no death in either group.Conclusion
Misoprostol plus routine uterotonics resulted in modest reductions of blood loss in the third stage of labor, but the effects did not reach statistical significance. Larger studies are recommended. 相似文献18.
Objective
To determine the best management for women with premature rupture of membranes at term.Method
In 2008, 579 women admitted to Peking University First Hospital for premature rupture of membranes (PROM) at term were allocated to one of 3 groups. Group 1 (n = 292) consisted of those whose labor began spontaneously within 12 hours of PROM; group 2 (n = 234), of those whose labor did not begin within 12 hours of PROM and were induced with oxytocin; and group 3 (n = 53), of those who accepted a cesarean delivery immediately after PROM was diagnosed. The χ2 test was used to compare the rates of intrauterine and neonatal infection in these 3 groups.Results
Compared with the intrauterine and neonatal infection rates for group 1 (3.4% and 13.7%) and group 3 (1.9% and 3.8%), the corresponding rates were higher for group 2 (10.7% and 21.8%) (P < 0.05). In group 2, 76.5% of the women began labor within 24 hours of induction and 92.7% of these within 12 hours.Conclusion
In women at term, induction should be performed immediately after PROM is diagnosed, as it is likely to fail when labor does not begin within 12 hours of oxytocin administration. 相似文献19.
Bjarke Lund Sorensen Vibeke Rasch Siriel Massawe Peter Elsass 《International journal of gynaecology and obstetrics》2010,111(1):8-12
Objective
To evaluate the management of prolonged labor and neonatal care before and after Advanced Life Support in Obstetrics (ALSO) training.Methods
Staff involved in childbirth at Kagera Regional Hospital, Tanzania, attended a 2-day ALSO provider course. In this prospective intervention study conducted between July and November 2008, the management and outcomes of 558 deliveries before and 550 after the training were observed.Results
There was no significant difference in the rate of cesarean deliveries owing to prolonged labor, and vacuum delivery was not practiced after the intervention. During prolonged labor, action was delayed for more than 3 hours in half of the cases. The stillbirth rate, Apgar scores, and frequency of neonatal resuscitation did not change significantly. After the intervention, there was a significant increase in newborns given to their mothers within 10 minutes, from 5.6% to 71.5% (RR 12.71; 95% CI, 9.04-17.88). There was a significant decrease from 6 to 0 neonatal deaths before discharge among those born with an Apgar score after 1 minute of 4 or more (P = 0.03).Conclusion
ALSO training had no effect on the management of prolonged labor. Early contact between newborn and mother was more frequently practiced after ALSO training and the immediate neonatal mortality decreased. 相似文献20.
Suellen Miller Oladosu Ojengbede Imran O. Morhason-Bello David Nsima 《International journal of gynaecology and obstetrics》2009,107(2):121-98