Potential Impact of Guidelines for the Prevention of Cesarean Deliveries in a Contemporary Canadian Population

ObjectiveThis study sought to describe how the implementation of recent labour guidelines may affect the cesarean delivery rate in a population in Alberta.MethodsThis retrospective study was conducted on primiparous women who were in labour with singleton term fetuses with cephalic presentation in Alberta from 2007 to 2016 (n = 181 738), and it used data from a perinatal database. Modelled cesarean delivery rates were calculated to determine the potential impact of the recent guidelines on the cesarean delivery rate by using the percentage of cesarean deliveries that occurred outside the threshold of the recent labour guidelines.ResultsA total of 21.7% of the cesarean deliveries for dystocia occurred outside of the guidelines related to the first stage of labour arrest for spontaneous labour (n = 9282), and 45.4% occurred outside of the guidelines related to the first stage of labour arrest for induced labours (n = 11 712). A total of 69.0% of the cesarean deliveries for dystocia occurred outside of the failed induction of labour guidelines (n = 4921), and 55.4% occurred outside of the second stage labour arrest guidelines (n = 6632). Assuming that the labour arrest guidelines are effective at reducing the cesarean delivery rate 25% of the time, the cesarean delivery rate for primiparous women in labour would be reduced from 22.5% to 20.7%. Assuming a 75% adherence/effectiveness rate, the cesarean delivery rate would be reduced to 17.1%.ConclusionThe recent labour guidelines have the potential to have a substantial impact on the intrapartum cesarean delivery rate in primiparous women with singleton fetuses with cephalic presentation at term if the guidelines are put into practice.     

分娩镇痛对初产妇产程的影响

目的:探讨分娩镇痛对初产妇产程的影响。方法:回顾性分析2008年6月至2013年6月在四川大学华西第二医院经阴道分娩的1367例自然临产的初产妇资料。按是否实施分娩镇痛,分为镇痛组和非镇痛组,比较组间产程时限及宫口扩张等指标的差异,并进行分层分析以排除待产过程中其他干预措施(人工破膜及缩宫素使用)对产程的影响。结果:1367例自然临产初产妇,各产程的平均值及上限值分别为第一产程8.3小时和16.0小时,第二产程44分钟和106分钟、总产程9.1小时和16.9小时;宫口扩张至6 cm时产程加速,产程曲线呈平滑上升趋势,无明显减速期。镇痛组第一产程(潜伏期、活跃期)、第二产程、总产程的平均时间均较非镇痛组显著延长(P0.05);镇痛组、非镇痛组分别于宫口扩张至6 cm、5 cm时产程加速。分层分析显示,产程干预组及非干预组中,分娩镇痛均可延长第一产(潜伏期、活跃期),但对第二产程、第三产程的影响不一致。结论:实施分娩镇痛会减慢宫口的扩张,并延长第一产程。自然分娩产妇的产程曲线呈平滑上升趋势,无明显减速期。     

Labor Pattern Among Primigravida in Local Population

Objectives

In this study, we tried to make the customized labor curve by studying the labor pattern among the primigravidas and we compared the cervicograph with Zhang’s and Suzuki’s curves. This study may be a motivator for future research to create own labor norms for our Indian population which may help in reducing the cesarean section rates, principally in primigravidas.

Materials and Methods

It was a prospective observational study, which included 156 primigravidas with uncomplicated term singleton pregnancy with spontaneous onset and progression of labor, who had normal vaginal delivery with good maternal and neonatal outcome.

Results

The shape of the labor curve of this study was similar to Zhang’ and Suzuki–Horiuchi’s curves which had slower progression. The active phase started from 5 to 6 cm of cervical dilatation onwards which was similar to Suzuki–Horiuchi’s curve. In the present study, the mean rate of cervical dilatation in the active phase was 1.5 cm/hour in contrast to Friedman’s study which had a mean rate of cervical dilatation of 3 cm/hour with lower limit of 1.2 cm/hour as 5th centile.

Conclusion

In the present study the mean rate of cervical dilatation in active phase in Indian women was approximately equivalent to the lowest acceptable rate of cervical dilatation in Friedman’s study. If we continued to follow Friedman’s labor norms, it could result in increasing c-sections. Hence, it would be prudent to create a customized labor curve for the local population served based on their individual characteristics features.

     

Quantitative Description of the Patient Population in a Labor and Delivery Unit

Realistic efforts should be made to quantitatively determine patient care given by labor and delivery nursing personnel. In an effort to accurately evaluate staffing requirements, the total patient population utilizing the labor and delivery room was analyzed. Of the 1,281 patients receiving treatment or evaluation, 453 were nondelivered patients (36%) who were not recorded in the average census. These nondelivered patients were analyzed according to their diagnoses. Suggestions are given on which more realistic nursing staffing can be based.     

The Impact of Parity on the Incidence of HELLP Syndrome and Small for Gestational Age Infants in Hypertensive Pregnant Women

Objectives: To determine whether maternal and fetal complications such as HELLP hemolysis, elevated liver enzymes, low platelets) syndrome and the incidence of small for gestational age infants in women with preeclampsia and gestational hypertension differ with both gravidity and parity.Study Design: The charts of 441 hypertensive women, 182 with preeclampsia and 259 with gestational hypertension, presenting for delivery at B.C. Women’s Hospital were retrospectively reviewed. Multiple clinical parameters, including gestational age at presentation the incidence of small for gestational age SGA infants, HELLP syndrome, and the severity of preeclampsia, were compared among three groups of women: (A) primigravid primiparous, (B) multigravid primiparous, and (C) multiparous. Mean values between the groups were compared using analysis of variance with pair-wise comparison using the Tukey test.Results: The incidence of HELLP syndrome among the women with preeclampsia was similar in groups A and B 35% and 50%, respectively), but significantly lower (p < 0.012) in group C (19%). The incidence of small for gestational age infants among the women with preeclampsia was similar for groups A, B, and C (27%, 31% and 19%) respectively). In the gestational hypertensive group the incidence of SGA infants was similar for groups A, B, and C (14%, 11%, and 12% respectively).Conclusions: The preeclamptic primigravid primiparous and multigravid primiparous groups behaved similarly in their clinical expression of hypertensive complications but differed from the multiparous group by having a higher incidence of HELLP syndrome. The incidence of complications in hypertensive pregnant women varied by parity but not by gravidity. The gestational hypertensive groups did not differ in their clinical expression of hypertensive complications.     

产程中饮食对足月分娩孕妇产程及分娩结局的影响

【摘 要】 目的：观察产程中饮食对足月分娩孕妇产程及分娩结局的影响。方法：选取2015年11月-2016年6月于郑州大学第三附属医院住院待产的足月孕妇338例,根据饮食意愿不同分为流质饮食组162例（对照组）和自愿饮食组176例（观察组）,观察2组孕妇第一及第二产程持续时间、产程中呕吐、酮症的发生率及分娩结局。结果：①观察组第一产程和第二产程持续时间均长于对照组,差异均有统计学意义（P＜0.05）。②2组孕妇呕吐发生率比较,差异无统计学意义（P＞0.05）;观察组孕妇酮症的发生率低于对照组,差异有统计学意义（P＜0.05）。③2组孕妇产程中催产素使用情况、会阴侧切率及中转剖宫产率比较,差异均无统计学意义（P＞0.05）,2组孕妇分娩过程中均未使用器械助产。④2组新生儿1 min、5 min Apgar评分及新生儿转入新生儿重症监护病房（NICU）的入住率比较,差异均无统计学意义（P＞0.05）,2组新生儿均未出现窒息等严重并发症。结论：分娩过程中自愿饮食的孕妇虽相对增加第一、第二产程持续时间,但自愿饮食可降低孕妇酮症的发生率、不增加产程干预,且不影响母儿结局,也不增加孕妇呕吐的发生率。     

The Duration of Labor in Adolescents

Study ObjectivesTo determine the lengths of the first and second stages of labor in a group of Canadian adolescents; to compare this timeline to the estimates from a general population, and to a heterogeneous group of adolescents from a previous study.DesignRetrospective chart review.SettingKingston General Hospital, Kingston, Ontario, Canada.ParticipantsThis study included women 19 years old and under at the time of delivery, having had spontaneous labor and a term singleton cephalic vaginal delivery between 2000 and 2005.Main Outcome MeasuresThe primary outcome is the length of the first and second stages of labor. Impact of epidural use will be determined.ResultsIn adolescents undergoing spontaneous labor at term (n = 177), the median duration of the first stage was 6.8 and 3.2 hours for nulliparous and multiparous teens respectively, compared to 10.0 and 5.9 hours in a mostly adult population. The duration of the second stage, in term spontaneous vaginal deliveries, was 54 minutes for nulliparous and 10 minutes for multiparous adolescents, similar to the teens in Greenberg's 2007 study. Comparatively, median lengths of second stage for the general population were 92 minutes and 20 minutes for nulliparous and multiparous women respectively. Epidural analgesia had a significant influence on lengthening the second stage in adolescents, however second stages in teens were still shorter, when controlling for regional analgesia, than in a general population.ConclusionsAdolescents do have shorter both first and second stages when compared to a general group. These differences demonstrate the importance of determining a distinct timeline for evaluating the course of labor in teens.     

分娩疼痛机制与常用分娩镇痛方法

分娩疼痛是妇女分娩过程中产生的一种复杂的生理心理活动,疼痛级别高、持续时间长,对分娩会造成极为不利的影响。用以应对的办法是分娩镇痛,即设法使分娩时的疼痛减轻或消失,其包括药物性镇痛和非药物性镇痛。药物性镇痛是指应用麻醉药或镇痛、镇静药来达到镇痛效果,是分娩镇痛的主要措施;非药物性镇痛则是通过心理支持、物理治疗等方法缓解疼痛,是分娩镇痛的研究热点。理想的分娩镇痛方法可明显减轻产妇疼痛程度,并确保母婴安全。综述分娩疼痛的机制及其对分娩造成的影响、常用的分娩镇痛方法及其利弊,了解分娩镇痛特点,以探索高效且易于被接受的分娩镇痛措施。     

Parity and perinatal mortality amongst diabetics in a Nigerian Teaching Hospital

The parity and the perinatal mortality of 226 married Nigerian female diabetics, aged 20 to 76 years (mean 47.1 years), and 226 married female nondiabetics matched for age and educational level with the diabetics were studied. There was no statistically significant difference between the diabetics and nondiabetics in terms of primary infertility, irrespective of age of onset of diabetes. In the group with one to four deliveries, the nondiabetics significantly outnumbered the diabetics (P less than 0.001) irrespective of age of onset of diabetes. In the group with seven to nine deliveries, only the diabetics of child-bearing age (P less than 0.01); and in the group with 10 or more deliveries, diabetics significantly outnumbered the nondiabetics irrespective of age of onset of diabetes (P less than 0.01). There was a statistically significant difference between the diabetics and nondiabetics in terms of the overall perinatal mortality (P less than 0.001). However, this difference was not significant in diabetics of childbearing age. In Nigeria, where large families are common and children often born in rapid succession, high parity appears not only to increase the chances of a woman developing diabetes in late life but also in early life. Effective birth control practice may thus help in reducing the incidence of diabetes amongst Nigerian women. Additionally, a programme extending to the rural areas aimed at early detection of diabetes and proper management of the pregnant diabetic by a team of medical personnel with special interest in diabetes will help in reducing the perinatal mortality in Nigerian diabetics.     

Prenatal Education in a High-Risk Population: The Effect on Birth Outcomes

ABSTRACT: This case-control investigation examined the relationship between absence of specific educational content during prenatal care and risk of adverse birth outcomes. A total of 1484 women from three regions with high rates of low birthweight and infant mortality participated in structured postpartum interviews. Analyses were performed for both the full sample and three regional subsamples. For the full sample an adjusted risk ratio of 2.87 (95% CI = 1.75, 4.71) was noted between risk of preterm low birthweight and lack of advice to call the health provider if preterm labor were suspected. For one subsample an adjusted risk ratio of 2.50 (95% CI = 1.11, 5.60) was noted between the risk of preterm low birthweight and lack of education on the signs and symptoms of preterm labor. This study reinforces a body of literature that stresses the importance of appropriate prenatal care in preventing preterm low birthweight. It further suggests that adequacy measures of prenatal care should reflect quality and content as well as timing and number of prenatal visits.     

Effects of Labor Support from Close Female Relative on Labor and Maternal Satisfaction in a Thai Setting

ObjectiveTo evaluate the efficacy of a close female relative providing emotional and physical support during active labor and birth.DesignRandomized, two‐group controlled clinical trial.SettingRegional teaching hospital in the eastern part of Thailand with 782 beds.ParticipantsPrimiparous women (N = 120) whose gestational ages were ≥ 36 weeks and who had uncomplicated pregnancies.MethodsParticipants were randomly assigned to receive usual care and support from a chosen close female relative from admission until 2 hours after birth or usual care only. Within 24 hours of birth, labor outcomes (length of labor & type of birth) and levels of maternal satisfaction were assessed.ResultsThose in the experimental group had a significantly shorter duration of active labor and were more satisfied with their childbirth experiences than those in the control group. Differences between groups with respect to incidence of spontaneous delivery were not found.ConclusionsA close female relative was effective in providing supportive care during labor and delivery. The integration of this nursing intervention for women and their families at public hospitals in Thailand is supported.     

The Psychosocial Impact of a High-risk Pregnancy on the Family

A conceptual model for guiding the nurse in assessing the psychosocial impact of a high-risk pregnancy on and planning care for the family is described. The model depicts four major concepts that the nurse must consider in determining how the family is integrating, interpreting, and adapting to the high-risk pregnancy: health status of the pregnancy, the family's perception of the high-risk pregnancy, support available to the family, and the family's adaptation to a high-risk pregnancy are discussed.