Management of the third stage of labour—focus group discussions with Swedish midwives

Objectiveto explore Swedish midwives’ experiences of management of third stage of labour.Designsix focus group discussions were performed and the analysis was based on content analysis.Settingthe midwives worked at six hospitals: three university hospitals and three provincial hospitals located from the south west to the north of Sweden.Participants32 midwives with extensive experience of assisting women in childbirth.Findingsthe analysis generated three categories: ‘bring the process under control’, ‘protect normality and women's birthing experiences’ and ‘maintain midwives’ autonomy’. This study demonstrates that management of the third stage of labour varies greatly. Not all midwives were convinced that administration of prophylactic oxytocin in the third stage of labour was always the best alternative for all women who had a normal birth.Key conclusions and implications for practicethe midwives exhibited self-confidence in evaluating the physiological process, and endeavoured to leave the physiological process undisturbed if no other risks were apparent. Their decisions concerning third stage management were based on a combination of previous experience, hospital guidelines, risk assessment and sensitivity to each woman's needs. This study demonstrates that management of the third stage of labour varies greatly. The findings show the importance of reaching a balance between treating birth as a normal process and as a biomedical event.     

A Meta‐analysis of the Efficacy of Ocular Prophylactic Agents Used for the Prevention of Gonococcal and Chlamydial Ophthalmia Neonatorum

Introduction : Neonatal eye prophylaxis has been routine in North America for more than a century. Contextual changes justify reexamining this practice, and prompted a systematic review of the efficacy of prophylactic agents. Methods : We searched MEDLINE (1966–2008), EMBASE (1980–2008), CINAHL (1982–2008), and the Cochrane library (the first quarter of 2008) for relevant clinical trials and hand‐searched the resulting reference lists. We independently evaluated eligibility and study quality. Meta‐analyses were performed using a random effects model. Results : Each of the eight included studies had substantial methodologic weaknesses. Data to estimate the efficacy of prophylaxis in the prevention of gonococcal ophthalmia neonatorum (GON) were not available. One study found no differences in rates of chlamydial ophthalmia neonatorum (CON) when three agents were compared to no prophylaxis: silver nitrate (relative risk [RR] = 1.06; 95% confidence interval [CI], 0.55–2.02; 2225 newborns), erythromycin (RR = 0.93; 95% CI, 0.48–1.79; 2306 newborns), and tetracycline (RR = 0.82; 95% CI, 0.42–1.63; 2299 newborns). No statistically significant differences were found between agents in the prevention of GON. Erythromycin and povidone‐iodine both decrease the risk of CON when compared to silver nitrate (RR = 0.71; 95% CI, 0.52–0.97; 4514 newborns, and RR = 0.52; 95% CI, 0.38–0.71; 2005 newborns, respectively). Discussion : Failure rates of universal eye prophylaxis support reexamination of this policy where the prevalence of maternal infection is low.     

Acupuncture treatment of pregnant women with low back and pelvic pain – an intervention study

Scand J Caring Sci; 2010; 24; 175–182
Acupuncture treatment of pregnant women with low back and pelvic pain – an intervention study
Objective:  To describe patients' experience of acupuncture treatment in low back and pelvic pain during pregnancy.
Design:  An intervention study carried out between September 2000 and December 2001, involving 40 pregnant women.
Participants:  The study population consisted of healthy pregnant women presenting with low back and pelvic pain at maternity health care centres within a defined area in southern Sweden.
Intervention:  Two groups of women received acupuncture treatment from gestational week 20 (group 1) or week 26 (group 2) respectively, for a period of 6 weeks divided into eight sessions of 30 minutes each.
Measurements:  Pain assessment was carried out using Pain-O-Meter and visual analogue scale (POM-VAS), Short-Form McGill Questionnaire (SF-MPQ), Short-Form-36: Health Survey Questionnaire (SF-36), followed by telephone interviews 2–3 months after delivery.
Findings:  The results of POM-VAS, SF-MPQ and SF-36 showed a relief of pain in both groups. In group 2, an improvement in several SF-36 variables was noted in spite of increased physical restrictions. Telephone interviews confirmed that expectations of treatment were fulfilled. Using content analysis the main category, limitations in daily life , was identified, with subcategories pain , and psychological well-being .
Conclusion:  It may be advantageous to begin acupuncture therapy later in pregnancy to maximise pain relief.     

Organic solvent tolerance of Halobacterium sp. SP1(1) and its extracellular protease

Halophilic archaea belonging to three different genera- Halobacterium, Haloarcula and Haloferax, were isolated from Kandla salt pans. The isolates had an optimum requirement of 25% NaCl for growth. Increase in organic solvent tolerance of isolates was observed at higher NaCl concentrations. Among the three isolates Halobacterium sp. SP1(1) was found to be more tolerant than Haloarcula sp. SP2(2) and Haloferax sp. SP1(2a). The extracellular protease of Halobacterium sp. SP1(1) showed higher solvent tolerance compared to the organism itself. The enzyme was highly tolerant to toluene, xylene, n-decane, n-dodecane and n-undecane, majority of which are frequently used in paints. These findings may help in understanding the mechanism of organic solvent tolerance in halophilic archaea and their application in antifouling coatings. Also, best to our knowledge the present study is the first report on organic solvent tolerance of haloarchaeal extracellular protease.     

Assessment of the elderly: it’s worth covering the risks

Background Comprehensive assessments provide an invaluable opportunity to identify those at risk of adverse health events, enabling timely access to appropriate health care. Aims This study aimed to evaluate the effectiveness of a comprehensive assessment tool, the Adult Patient Assessment Tool (APAT), particularly in relation to early identification of older people at risk of falls, pressure areas, cognitive impairment or delirium, or patients with mental illness or substance abuse. Methods Concurrent mixed methods including an initial retrospective medical record audit and focus groups were used. Results With the introduction of the APAT, assessment of falls risk and mental illness increased. The number of nursing actions relating to pressure areas and falls also increased, indicating a greater awareness of patients’ individual needs. Non-clinical information gathered through the APAT enabled a more holistic approach to patient care. Conclusion The use of electronic medical records would alleviate pressures on nurses’ time, providing an opportunity to store and retrieve comprehensive nursing assessment and benefit patient health care. Implications for nursing management Early assessment results in an increased number of nursing activities related to patient care. Further education relating to mental health and substance abuse screening and cognitive assessment may enhance the completion of these tools.