Does artificial rupturing of membranes in the active phase of labor enhance myometrial electrical activity?

Objective: To determine whether artificial rupture of membranes (AROM) during active phase of labor augments uterine contractility using Electrical Uterine Myography (EUM).

Study design: A prospective study of 31 women with term singleton pregnancy during active phase of labor. Using a non-invasive EUM technique, electrical uterine activity was recorded in the 30?min preceding AROM and in the immediate 30?min thereafter. Augmentation was defined as >5% increase in EUM index between the basal and post-AROM states, representing the mean EUM increase of the entire cohort. Low basal uterine contraction was defined as EUM index of less than the entire cohort median result prior AROM (3.5 micro-Watt-Second (mWS)).

Results: Mean dilatation in which AROM was preformed was 5.5?±?1.8?cm. There was a significant increase in mean EUM measurement in the post-AROM compared to the basal state (3.59?±?0.39 versus 3.42?±?0.47?mWS, p?p?=?0.009 and OR 16.03, 95% CI 1.90–134.69, p?=?0.003, respectively).

Conclusion: Myometrial electrical activity was significantly enhanced following AROM. Augmentation was mostly pronounced in patients with lower BMI and initial lower basal uterine contraction.     

Uterine electrical activity at labor: is there a correlation between labor stages?

Objective: To determine the association between the myometrial electrical activity in the active and second stages of labor at term using electrical uterine myography (EUM).

Methods: A prospective observational study of 47 singleton deliveries at term in a tertiary hospital. All women were assessed using noninvasive 9-channel surface electrodes of the EUM during labor. EUM index (EUMi) was calculated as the mean electrical activity during a 30?min monitoring period and expressed as microjouls (MJ). Mean EUMi of the active and second stages of labor were compared accordingly.

Results: Mean EUMi during the active phase was 3.53?±?0.43?MJ, whereas mean EUMi in the second stage was 3.66?±?0.48?MJ (p?=?0.02). Correlation analysis between mean EUMi of the active and second stages of labor produced r^2?=^?0.68 (p?r^2?=^?0.73, p?Conclusion: A positive correlation of myometrial electrical activity exists between active phase and second stage of labor. However, while EUMi was associated with the duration of the active phase, no correlation was found between EUMi and the duration of the second stage.     

A comparison between electrical uterine monitor,tocodynamometer and intra uterine pressure catheter for uterine activity in labor

Objective: We aimed to evaluate the performance of a non-invasive EMG electrical uterine monitor (EUM) versus tocodynamometry (TOCO) by comparing both to internal uterine pressure catheter (IUPC).

Study design: Prospective observational trial. Uterine activity was recorded continuously and simultaneously, in women during active term labor, with TOCO, EUM and IUPC. Uterine activity tracings were analyzed by three blinded physicians.

Results: Overall, 385 tracings from 43 women were analyzed. A similar rate of interpretable tracings between physicians was demonstrated for EUM (87%; 95% CI 80.9–92.7%) and IUPC (94.8%; 95% CI 83.4–96.3%), with a significantly lower rate for TOCO (67.5%; 95% CI 59.4–76.8%, p?<?0.001). There is a significant difference in the contraction frequency for EUM versus IUPC (0.77?±?2.3) compared to TOCO versus IUPC (?3.34?±?4.97). There is a high variability between the timing of TOCO contractions as compared to IUPC (4.74?±?10.03 seconds), while a gap of 8.46?±?4.24 seconds was detected for EUM. The sensitivity, positive predictive value and false positive rate for individual contraction identification by TOCO and EUM are 54.0%, 84.4%, 15.6% and 94.2%, 87.6%, 12.4%, respectively.

Conclusion: EUM is efficient as IUPC for uterine activity assessment and both techniques are superior in comparison to external tocodynamometry. Our results support the use of non-invasive EMG technology to monitor uterine activity.     

The effect of inflatable obstetric belts in nulliparous pregnant women receiving patient-controlled epidural analgesia during the second stage of labor

Abstract

Objective: The aim of this study was to evaluate the effect of inflatable obstetric belts on uterine fundal pressure in the management of the second stage of labor.

Method: Between July 2009 and December 2010, 188 nulliparous women with a singleton pregnancy at term were enrolled and only one dropped. The participants were randomized to receive either standard care (control group, n?=?91) or uterine fundal pressure by the Labor Assister? (Baidy M-520/Curexo, Inc., Seoul, Korea; active group, n?=?97) during the second stage of labor in addition to standard care. The Labor Assister is an inflatable obstetric belt that is synchronized to apply constant fundal pressure during a uterine contraction. The primary endpoint was duration of the second stage of labor in women who delivered vaginally (control, n?=?80 versus active, n?=?93). It was not analyzed in women who delivered by cesarean section (n?=?14) and delivered precipitously (n?=?1). The secondary outcomes are perinatal outcomes and perineal laceration. Participants received patient-controlled epidural analgesia.

Results: The 93 women in the active group spent less time in the second stage of labor when compared to the 80 women in the control group (46.51?±?28.01?min versus 75.02?±?37.48?min, p?<?0.001). There was no significant difference in perinatal outcomes and perineal laceration between the two groups.

Conclusion: The uterine fundal pressure exerted by the inflatable obstetric belt reduces the duration of the second stage of labor without complications in nulliparous women who receive patient-controlled epidural analgesia.     

Factors affecting uterine electrical activity during the active phase of labor prior to rupture of membranes

Objective: Limited data exist regarding uterine contraction intensity prior to membrane rupture. Using a novel technique of electrical uterine myography (EUM) we aimed to determine which factors affect myometrial activity during active phase of labor.

Methods: EUM was prospectively measured in 37 women with singleton pregnancy at term during the active phase of labor until membranes’ rupture. EUM was measured using non-invasive nine channels recorder with an EMG amplifier and three-dimensional position sensor. Uterine electrical activity was quantified with the EUM-index, defined as the mean electrical activity of the uterine muscle over a period of 10?min and measured in units of micro-Joule (microwatt per second [mW/s]).

Results: The mean EUM-index at the first 10?min of the measurement was 3.3?±?0.6?mW/s. In a stepwise linear regression model accounting potential confounders EUM was significantly affected by cervical dilatation (p?=?0.005), maternal age (p?=?0.04) and previous cesarean delivery status (p?=?0.02). In a repeated measurement assessment of non-parametric Fridman’s test for all subjects who had at least 10 continuouss EUM measurements, there was a significant increase in electrical uterine activity as labor progressed (p?=?0.01).

Conclusion: Electrical uterine activity during the active phase of labor prior to rupture of membranes is affected by maternal age, previous cesarean delivery status and cervical dilatation. Moreover, electrical uterine activity is enhanced throughout labor.     

Assessment of labor using a new type partogram compared to the classical Fisher partogram

Objective: To assess the quality of a new type partogram used to monitor labor.

Methods: We compared efficacy using two types of partograms. The first was the classical WHO partogram (group A) and the second a new type in which we estimated and reported the sub of cervical dilatation and the position of the descending head (group B).

Results: It was noted that there was a statistically significant decrease of the duration between the initiation of active phase of labor and the delivery time (dt1?+?dt2?+?dt3) (p?p?p?Conclusion: The new partogram is more helpful in the recognition of the initiation of the acceleration stage during the active phase of labor and in the timely use of appropriate actions in order to achieve a safer delivery.     

Uterine activity during the two hours after placental delivery among low-risk pregnancies: an observational study

Objective: The purpose of this study was to describe uterine activity within the first two hours after placental delivery among low-risk pregnant women.

Materials and methods: Participants were 17 low-risk pregnant women who had a singleton birth at midwifery birth centers in Japan. Contractile waves of uterine activity were measured by using an external tocodynamometer.

Results: Spontaneous uterine contraction frequency during the first two hours after the placental delivery decreased over time (F_9,?54?=_?19.7, p?<?0.001). The mean contraction intervals were 1.9?±?0.3?min, 2.4?±?0.9?min, 4.2?±?0.7?min and 7.9?±?2.1?min for the second stage, third stage, and the first hour and second hour after placental delivery, respectively. Uterine contraction frequency increased with oxytocin administration and infant suckling; however, an icepack to cool the uterus did not change the contraction waves. No correlations were found between uterine activity and blood loss or pain.

Conclusion: Contraction of the myometrium is the primary mechanism for hemostasis. The uterine contraction intervals became prolonged over time, and blood loss did not increase. The findings provide insight into the role of myometrium contraction as a hemostasis mechanism.     

Effects of combined spinal–epidural analgesia on first stage of labor: a cohort study

Background: Neuraxial anesthesia is considered as the gold standard in the control labor of pain. Its variants are epidural analgesia and combined spinal–epidural analgesia. Few studies, as yet, have investigated the duration of labor as a primary outcome. Some authors have suggested that combined spinal–epidural analgesia may reduce labor duration but at the moment the benefit of shortening labor is uncertain. The main aim of this study was to compare combined spinal–epidural with epidural analgesia in terms of their effect on duration of stage I labor, maternal, and neonatal outcomes.

Methods: A prospective cohort study was conducted. Parturients who requested analgesia at cervical dilatation <6?cm were included. Analgesia was either epidural with low concentration levobupivacaine or combined spinal epidural with subarachnoid sufentanil. The primary outcome was the length of stage I labor. Onset and quality of analgesia, mode of delivery, effects on uterine activity and use of oxytocin, fetal heart rate abnormalities and uterine hyperkinesia, maternal, and neonatal complications were also considered.

Results: We enrolled 400 patients: 176 in the combined spinal–epidural group and 224 in the epidural group. Patients in the two treatment groups were similar with regard to demographic characteristics, parity, and incidence of obstetric comorbidities, labor induction, oxytocin infusion, Bishop score, and Visual Analogue Score (VAS) at analgesia request. Duration of stage I labor did not differ, at 195 (120–300) minutes for both the groups (p?=?.7). Combined spinal–epidural was associated with less reduction in uterine contractility after initial administration: 15.34 versus 39.73%, (p?p?=?.002). Onset of analgesia was quicker for combined spinal–epidural analgesia: 31 versus 20%, with VAS <4 after 5?minutes, (p?Conclusions: Combined spinal–epidural with subarachnoid sufentanil may not reduce the duration of stage I labor, but in our study it appeared to affect uterine contractility less. It also had a more rapid onset and was more effective, without any concomitant increase in maternal or neonatal complications.     

The association between myometrial electrical activity and time to delivery in threatened preterm labor

Objective: To assess the association between myometrial electrical activity and time-to-delivery in preterm labor using uterine electromyography.

Methods: Myometrial electrical activity was measured via the electrical uterine monitor (EUM) device. Data was prospectively collected among women admitted due to suspected preterm labor, prior to 34 weeks of gestation. EUM-Index was defined as the mean electrical activity of the uterine muscle over a period of 10 minutes measured in units of microjoule (μJ, microwatt second). The association between the EUM-Index at admission to time-to-delivery and delivery prior to 34 weeks of gestation was calculated.

Results: Overall, 45 women were included in the study. EUM-Index combined with cervical dilatation, demonstrated significant correlation to time-to-delivery (R^2?=?0.49, p?=?0.005), which was strengthened for women presenting prior to 28 weeks of gestation. EUM-Index above the median (>3.05?MJ) was significantly associated with a shorter latency period for delivery (36.0?±?19.4 vs. 50.2?±?25.9 days, p?=?0.04). For delivery prior to 34 weeks, the EUM-Index showed an AUC?=?0.65 (95% CI 0.48–0.82), and a cutoff of 2.5?MJ provided 91.7% sensitivity and 93.3% negative predictive value.

Conclusion: EUM-Index at time of admission due to suspected preterm labor is inversely correlated with time-to-delivery and may effectively rule out preterm delivery prior to 34 weeks.     

The effect of hyoscine butylbromide on the duration and progress of labor in primigravidae: a randomized controlled trial

Objective: To assess the effect of hyoscine butylbromide (HBB) on duration of the first stage of labor in primigravdae.

Methods: A case–control study conducted on 120 primigravida at term admitted in active labor were divided into three equal groups. A single dose of the drug (placebo or HBB 20?mg or HBB 40?mg) was injected intravenously slowly to groups A, B, and C. The duration of the first stage was calculated from the time of cervical dilatation of three to four centimeters in active labor until a fully dilated cervix was observed.

Results: The duration of first stage was significantly shorter in women receiving 20 and 40?mg of HBB when controlled to control women (187.73?±?20.92, 186.41?±?19.40 versus 231.39?±?33.14?min). There was no significant difference between the three study groups regarding duration of the second stage (36.76?±?9.98, 35.72?±?9.97 and 37.55?±?10.57, respectively, p?>?.05), number of cases delivered by cesarean section (12.5%, 12.5%, and 15%, respectively, p?>?.05) and Apgar score of the neonates (p?>?.05). There was no significant difference between the three study groups regarding occurrence of side effects named dry mouth (7.5%, 12.5%, and 5%, p?>?.05), flushing (2.5%, 5% and 0%, p?>?.05), tachycardia (2.5%, 2.5%, and 2.5%, p?>?.05), or urinary retention (2.5%, 0%, and 0%, p?>?.05).

Conclusion: Intravenous injection of HBB decreases the duration of active phase of labor in primigravidae with no side effects.     

Effect of intravenous hyoscine-N-butyl bromide on active phase of labor progress: a randomized double blind placebo controlled trial

Introduction: Appropriate cervical dilatation and effacement are essential for the progression of labor. With the active management of labor, number of cesarean deliveries reduces and the duration of labor shortens. Cervical dilatation can be facilitated by mechanical, pharmacological and non-pharmacologic methods. Cervix is richly supplied by autonomic nerves, which may play a role in the dilatation of cervix. Hyoscine-N-butylbromide (HBB) is a muscarinic antagonist and acts as a cervical spasmolytic agent. After intravenous administration it is rapidly distributed into the tissues. We aimed to study the effects and safety of a single dose 20?mg HBB injection during the active phase of labor in both primi- and multigravid women.

Materials and method: A randomized, double-blinded, controlled trial, with healthy primigravid and multigravid women in spontaneous labor at term was considered in this study. Once the active phase of labor was achieved, either a single dose of 20?mg (1?mL) of HBB or placebo (1?mL saline) was given intravenously.

Results: The mean duration of the first stage of labor was 191.1?±?43.06?min in the primigravid patients of the HBB group, while it was 248.2?±?66.1?min in the placebo group, a statistically significant difference of 57?min (p?p?Conclusion: A single dose of 20?mg intravenous HBB is effective and safe in shortening the duration of the first stage of labor without any adverse effects on fetus and mother.     

Effects of acupressure at the Sanyinjiao point (SP6) on the process of active phase of labor in nulliparas women

Introduction.?The reduction of the duration and pain of the active phase of labor is a very important issue and therefore always under serious investigation.

Objective.?The purpose of the present study is to evaluate the effect of acupressure at the Sanyinjiao point (SP6) on the duration and pain of the active phase of labor in nulliparas women.

Method.?A single blind randomized clinical trial was performed on 120 eligible nulliparas women who were at the beginning of active phase of labor (3–4?cm dilatation of cervix plus proper uterine contractions). The women were randomly assigned into two groups. The case group (n?=?60), received acupressure at Sanyinjiao point (above the ankle), for 30?min during contractions. In the control group (n?=?60), simply a touch at this point without massage was performed. Two hours later a second pelvic examination was performed and in the absence of good forceful contractions oxytocin in the classical form was infused. Finally, duration of active phase, severity of pain (using the Visual Analogue Scale), the amount of necessary oxytocin and necessity to administer oxytocin and the route of delivery were compared between the two groups and statistical analyses were performed using SPSS 15.

Results.?The mean duration of active phase was shorter in the case group (252.37?±?108.50?min vs. 441.38?±?155.88, p?=?0.0001). Six patients (10%) in the case group and 25 patients (41.7%) in the control group delivered via cesarean section (p?=?0.0001). The severity of pain in the case group was less than the control group (5.87?±?1.77 vs. 6.79?±?1.52, p?=?0.003). Twenty-five women (41.7%) in the case group and 38 women (63.3%) in the control group needed oxytocin (p?=?0.017) The amount of necessary oxytocin in the case group was less than the control group (73.33?±?97.19?ml vs. 126.6?±?97.19?ml, p?=?0.003).

Conclusion.?Acupressure at Sanyinjiao point (SP6) reduced the duration and severity of pain of the active phase of labor, cesarean section rates, and necessity and amount of oxytocin.     

Uterine electrical activity,oxytocin and labor: translating electrical into mechanical

Purpose

Uterine activity plays a crucial role in labor, especially when utero-tonic materials are administered. We aimed to determine the electrical responsiveness of the uterine musculature to labor augmentation with oxytocin using electrical uterine myography (EUM) technology, and to assess whether the kinetics of the EUM device may serve as a predictor for successful vaginal delivery.

Methods

EUM prospectively measured electrical uterine activity in women with singleton gestations at term (≥ 37 + 0 weeks) undergoing labor augmentation by oxytocin administration. The results were reported as the EUM index, which represented the mean electrical activity in 10-min intervals and measured in units of microwatt per second (mW/s). Measurements were performed at least 30 min before oxytocin initiation and until at least four contractions per 10 min were recorded by standard tocodynamometry. The delta EUM index was defined as the difference between the mean EUM index before and after the initiation of oxytocin.

Results

The mean EUM index increased significantly during oxytocin augmentation in all the parturients (P < 0.001). Mean and minimum (but not maximum) uterine electrical activity during oxytocin infusion correlated with the baseline uterine activity. The delta EUM index was not significantly affected by demographic or obstetric parameters. There was no correlation between the delta EUM index and time to delivery or the mean EUM index during oxytocin administration and time to delivery.

Conclusions

Uterine electrical activity as evaluated by EUM is significantly intensified following oxytocin administration, regardless of obstetrical characteristics, and is correlated with the baseline uterine electrical activity prior to oxytocin infusion.

     

Measurement of the fetal occiput-spine angle during the first stage of labor as predictor of the progress and outcome of labor

Background: Fetal head attitude has a substantial impact on labor progress and outcome. Fetal head deflexion is basically diagnosed by digital vaginal examination during labor.

Objectives: To assess the effect of the fetal occiput-spine angle (OSA) measured through transabdominal ultrasound during the first stage of labor on the progress and outcome of labor.

Material and methods: A prospective cohort study conducted on 400 women with term uncomplicated singleton pregnancy with occipitoanterior position during active labor. The angle between two tangential lines to occipital bone and the vertebral body of the first cervical spine was measured during active labor. Follow up till delivery was done. The primary outcome parameter was the labor duration. Secondary outcomes included the mode of delivery, occurrence of maternal and fetal complications.

Results: There was a significant longer duration of both first and second stage of labor among women with OSA <126° when compared to those with OSA ≥126° (6.8?±?2.1 and1.89?±?0.85 versus 4.16?±?1.63 and 0.92?±?0.43, respectively). Women with OSA <126° had higher incidence of CS (46.3 versus 5.7%), perineal tears (10.4 versus 5.1%), vaginal tears (22.4 versus 6.3%), need for oxytocin augmentation (47.8 versus 21.3%) when compared to those with OSA ≥126. OSA at cutoff value of 126° had a sensitivity, specificity, and accuracy of 8264.6 and 78.4% and 93.79 and 92% in prediction of mode of delivery and overall complications, respectively.

Conclusions: There was a significantly longer duration of both first and second stages of labor with higher rates of CS and maternal and fetal complications in women with OSA <126.     

The effect of intrapartum dental support use among nulliparous during the second stage of labor – a randomized controlled study

Objective: We aimed to determine the effect of a dental support device (DSD) use on the course of labor and delivery in nulliparous women.

Methods: A randomized, controlled, open-label study of nulliparous (at 37?+?0/7 and 41?+?3/7 weeks of gestation) in a single tertiary university-affiliated medical center. Exclusion criteria included maternal chronic diseases, multi-fetal gestation and fetal chromosomal or structural anomalies. Outcomes were analyzed according to the actual use of the DSD, and satisfaction questionnaires following delivery.

Results: Overall, 191 women were randomized (93in the study group and 98 in the control group). The median duration of the second stage was similar between the groups (100.0?±?91.0 versus 98.0?±?128.8?min, p?=?0.97) and the maximal VAS score was significantly higher in the DSD group (4.0?±?8.5 versus 3.0?±?6.8, p?=?0.04). The rate of obstetrical interventions such as operative vaginal delivery or cesarean section during the second stage was significantly higher in the control group than in the study group (28.2% versus 12.3% and 6.4% versus 1.2%, respectively, p?=?0.004), mainly due to prolonged second stage of labor (24.5% versus 8.6%, p?=?0.005). Of the DSD group, 50.6% rated the use of the DSD as comfortable, 32.2% rated its effect on pain relief as high, 55.6% would recommend its use to their peers and 51.9% would like to use it in their consecutive delivery.

Conclusion: The use of a DSD among nulliparous women appears to decrease the need for obstetrical intervention due to prolonged second stage of labor, with fair satisfaction of patients.     

A novel modality for intrapartum fetal heart rate monitoring

Background: Intrapartum fetal heart rate (FHR) monitoring is well recommended during labor to assess fetal wellbeing. Though commonly used, the external Doppler and fetal scalp electrode monitor have significant shortcomings. Lately, non-invasive technologies were developed as possible alternatives.

Objective: The objective of this study is to compare the accuracy of FHR trace using novel Electronic Uterine Monitoring (EUM) to that of external Doppler and fetal scalp electrode monitor.

Material and methods: A comparative study conducted in a single tertiary medical center. Intrapartum FHR trace was recorded simultaneously using three different methods: internal fetal scalp electrode, external Doppler, and EUM. The latter, a multichannel electromyogram (EMG) device acquires a uterine signal and maternal and fetal electrocardiograms. FHR traces obtained from all devices during the first and second stages of labor were analyzed. Positive percent of agreement (PPA) and accuracy (by measuring root means square error between observed and predicted values) of EUM and external Doppler were both compared to internal scalp electrode monitoring. A Bland–Altman agreement plot was used to compare the differences in FHR trace between all modalities. For momentary recordings of fetal heart rate <110 bpm or >160 bpm level of agreement, sensitivity, and specificity were also evaluated.

Results: Overall, 712,800 FHR momentary recordings were obtained from 33 parturients. Although both EUM and external Doppler highly correlated with internal scalp electrode monitoring (r²?=?0.98, p?p?160 bpm, the PPA, sensitivity, and specificity of EUM as compared with internal fetal scalp electrode, were significantly greater than those of external Doppler (p?Conclusion: Intrapartum FHR using EUM is both valid and accurate, yielding higher correlations with internal scalp electrode monitoring than external Doppler. As such, it may provide a good framework for non-invasive evaluation of intrapartum FHR.     

Duration of labor by gestational week in nulliparous women

Abstract

Objectives: To assess whether labor length differs by week of gestation.

Methods: In this observational cross-sectional study, we compared duration of labor by gestational age (36?+?0 through 40?+?6 weeks) in primiparous singleton parturients with vertex presentation. Data were acquired for a period of 24 months (2010–2011).

Results: In general, the rate of change in cervical dilatation decreased as gestational week at delivery advanced: 1.8?±?1.0?cm/h, 1.5?±?0.9?cm/h, 1.3?±?0.8?cm/h, 1.6?±?1.5, and 1.3?±?1.0?cm/h at 36th, 37th, 38th, 39th and 40th gestational week, respectively (p?=?0.040). Concurrently, the total labor duration (1st?+?2nd?+?3rd stages) increased as gestational age advanced: 423.6?±?180.9?min, 496.5?±?212.6?min, 545.9?±?247.1?min, 483.8?±?256.3?min, and 568.2?±?273.8?min at 36th, 37th, 38th, 39th and 40th gestational week, respectively (p?=?0.013).

Conclusions: Gestational week of pregnancy may alter the duration of labor, specifically, the length of labor increases as gestational week at delivery advances.     

The clinical research into the application of multifunctional airbag abdominal pressure belt in midwifery and in the prevention of postpartum hemorrhage

Objective: Explore the effect of the multifunctional airbag abdominal pressure belt on midwifery and on the prevention of postpartum hemorrhage.

Methods: Select 363 natural delivery cases of hospitalized primiparae and divide them randomly into two groups. In the observation group, 182 primiparae used the multifunctional airbag abdominal pressure belt during the second and third stages of labor, whereas the control group of 181 did not use the belt. Delivery outcomes of the primiparae and their fetus were then observed.

Results: The average duration for the second stage of labor, from head emergence to delivery, placenta delivery and postpartum hemorrhage were all shorter in the observation group (p?p?>?0.05). No statistical difference was found in primipara signs and no fetal heart rate change of the primiparae under different internal pressures of the belt during the second stage of labor in the observation group (p?>?0.05).

Conclusion: By closely monitoring and appropriately adjusting the internal pressure of the belt, the multifunctional airbag abdominal pressure belt can speed up the second and third stages of labor, prevent postpartum hemorrhage and promote natural delivery.     

Effects of prenatal music stimulation on state/trait anxiety in full-term pregnancy and its influence on childbirth: a randomized controlled trial

Background: Many researchers have pointed out the strong relationship between maternal psychological well-being and fetal welfare during pregnancy. The impact of music interventions during pregnancy should be examined in depth, as they could have an impact on stress reduction, not only during pregnancy but also during the course of delivery, and furthermore induce fetal awareness.

Objective: This study aimed to investigate the effect of music on maternal anxiety, before and after a non-stress test (NST), and the effect of music on the birthing process.

Material and method: The four hundred and nine pregnant women coming for routine prenatal care were randomized in the third trimester to receive either music (n?=?204) or no music (n?=?205) stimulation during an NST. The primary outcome was considered as the maternal state anxiety score before and after the NST, and the secondary outcome was the birthing process.

Results: Before their NST, full-term pregnant women who had received music intervention were found to have a similar state-trait anxiety score to those from the control group, with 38.10?±?8.8 and 38.08?±?8.2, respectively (p?=?.97). After the NST, the mean state-trait anxiety score of each group was recorded, with results of 30.58?±?13.2 for those with music intervention, and 43.11?±?15.0 for those without music intervention (p?p?p?p?p?Conclusions: Prenatal music intervention could be a useful and effective tool to reduce anxiety in full-term pregnant women during an NST and improve the delivery process by reducing the first stage of labor in nulliparous women.     

Sonographic assessment of fetal occiput position during labor for the prediction of labor dystocia and perinatal outcomes

Objectives: To evaluate the effect of the occiput posterior (OP) position on dystocia and perinatal outcomes.

Methods: This was a prospective cohort study of 162 primiparous women. We performed intrapartum sonography, and fetal occiput positions were recorded. The relationships between the position of the occiput and the course of labor and perinatal outcomes were investigated. Statistical analysis was performed using SAS 9.2.

Results: Fifty-six of 162 fetuses were found to be in the OP position during the first stage of labor. Eight (80.0%) of 10 fetuses in the OP position during the second stage were among the 56 that were in OP position during the first stage. The rate of cesarean sections performed in the OP position group during the first stage was significantly higher than the rate in the non-OP position group (37.5% versus 8.5%, p?<?0.0001). The duration of the second stage of labor was longer and neonatal complications occurred more frequently in the OP position group during the second stage than in the non-OP position group (77.9 ± 33.4?min versus 52.2 ±?26.6?min, p?=?0.0104; 50.0% versus 17.2%, p?=?0.0118).

Conclusions: The OP position may be a useful predicator for labor dystocia that can lead to poor neonatal outcomes.