Mothers' experiences of labor support: exploration of qualitative research

OBJECTIVE: To review and synthesize qualitative research studies of women's perceptions of professional labor support. DATA SOURCES: Journal articles dated from 1990 to 2001. Search terms included labor support, labor and delivery, childbirth, birth, and caring during labor. Qualitative studies and combined quantitative/qualitative studies with open-ended questions were included. STUDY SELECTION: The focus of the 17 studies was laboring women's rather than nurses' perceptions of labor support or care during labor. DATA EXTRACTION: Data describing methods, samples, and findings were extracted from study reports. DATA SYNTHESIS: Similarities reported in the study findings were synthesized using a model of labor support. Synthesis of the study findings was reported using exemplary statements in the words of women who experienced labor support. Categories included expectations of labor support, physical comfort, caring and emotional support, interpersonal communication style, communication of information and instructions, advocacy, and competence of the professional. CONCLUSIONS: There were a limited number of qualitative studies of labor support. Professional labor support was influenced by the interpersonal communication style of the caregiver. Cultural differences existed in caregiver actions considered supportive.     

Randomized controlled trial of 50 and 100 mcg of misoprostol for induction of labor at term

To compare the safety and efficacy of two different regimens of misoprostol for labor induction at term, we conducted a randomized controlled trial on women presenting for induction of labor at >37 weeks’ gestation. Eligible women were randomized to receive intra-vaginal misoprostol 50 μg every 4 h or 100 μg every 6 h until any of the following: 1) adequate contraction pattern (3 contractions/10 min); 2) dilatation >3 cm; 3) artificial rupture of membranes; or 4) signs of uterine hyperstimulation. Use of oxytocin during labor was at the discretion of the managing clinician. The main outcome variable considered for analysis was cesarean section rate. Secondary outcome measures were induction to delivery interval and neonatal outcome (Apgar scores, meconium staining, and umbilical artery pH). A total of 58 women were randomized to receive either misoprostol 100 μg (n=26) or 50 μg (n=32). The 100 and 50 μg groups had similar mean Bishop’s scores at induction (4.0±2.3 vs 4.1±2.2, p=0.87), rates of nulliparity, use of epidural anesthesia, and oxytocin augmentation. The number of doses of misoprostol used was similar in the two groups (1.4±0.6 vs 1.8±1.2). The mean±standard deviation time to delivery (hours) (11.9± 7.3 vs 14.3±9.6 h, p=0.30) and cesarean section rate (35% vs 19%, p=0.30, relative risk: 1.8, 95% confidence interval 0.7–5.4) were not different in the 100 vs 50 μg group. Power analysis demonstrated that 132 women would be required in each group to achieve statistical significance in the primary outcome measure (α=0.05, β=0.80). Similarly, rates of 5-minute Apgar scores <7 (4% vs 3%, p=1.0), and of meconium passage (17% vs 25%, p=0.73) were not significantly different between the two groups. Received: 20 January 2001 / Accepted: 7 March 2001     

利多卡因宫颈涂抹促进产程进展520例临床分析

目的 观察利多卡因宫颈涂抹在产程中的应用。方法 分析我院自2003年5月～2005年2月住院分娩的初产妇，在产程观察中，采用利多卡因应用520例，同时不用药者520例与之对照。对两组的宫颈口扩张速度、羊水污染、胎儿宫内窘迫、新生儿窒息情况及剖腹产率等方面进行分析讨论。结果 产程中用利多卡因涂抹的病例可加速宫颈扩张，缩短产程效果肯定（P＜0．01），剖宫产率降低（P＜0．05）。结论 利多卡因有明显扩张宫颈作用，且无明显的毒副作用，值得临床推广。     

The health care system for female workers and its current status in Japan

In this paper we describe female workers' health care, the women's and maternal protection system within the Japanese legal system, the current status of female workers in Japan, and problems regarding methods of advancing health care and the women's or maternal protection system. Motherhood is respected in the workplace in Japan, and in order to provide an environment in which women can work and still bear and rear children with a sense of security, laws concerning maternal protection of female workers, and revisions in terms of the system have been made, and a new system has been in effect since the fiscal year of 1998. Nevertheless, gender discrimination against women and the disparagement of women, rooted in gender role stereotypes concerning the division of labor, remain firmly planted in the social environment and in long-established custom. Received: 20 February 2000 / Accepted: 10 June 2000     

罗比卡因和布比卡因用于自控硬膜外分娩镇痛的临床效果对比研究

目的 :比较罗比卡因和布比卡因联合芬太尼用于自控硬膜外分娩镇痛 (PCEA)的效果及运动神经阻滞情况。方法 :将 6 0例健康、单胎、足月的初产妇随机分为两组 ,接受 0 .1%罗比卡因加 1μg/ml芬太尼 (RF组 )或 0 .0 75 %布比卡因加 1μg/ml芬太尼 (BF组 )自控硬膜外分娩镇痛。两组进行视觉模拟镇痛评分 (VAS)和下肢运动神经阻滞评分(MBS)。记录两组产程时间、分娩方式、阴道流血量及新生儿Apgar评分。结果 :两组产妇均有较可靠的镇痛效果 ,差异无显著性 (P >0 .0 5 ) ;RF组可下床活动者为 96 .6 7% ,而BF组为 33.33% ,两组差异有显著性 (P <0 .0 5 ) ;两组产程时间和分娩方式差异无显著性 (P >0 .0 5 ) ;两组新生儿Apgar评分差异无显著性 (P >0 .0 5 )。结论 :低浓度罗比卡因或布比卡因联合小剂量芬太尼用于PCEA均可产生可靠的镇痛效果。产程中罗比卡因极少引起运动阻滞 ,产妇有下床活动能力 ,其效果优于布比卡因     

口服灭滴灵及红霉素对细菌性阴道病孕妇早产的预防效果

目的　确定在孕２０ ～２８ 周治疗细菌性阴道病（ＢＶ） 能否降低有早产史孕妇早产发生率。　方法　在产前门诊对有早产史孕妇进行ＢＶ 筛查,对检出的患者随机分为应用灭滴灵和红霉素治疗及未加治疗组,随诊妊娠结局。　结果　在１７０ 例有早产史孕妇中,共检出ＢＶ８１ 例、检出率４７．６％ 。４１ 例患者接受灭滴灵及红霉素口服治疗;另４０ 例未予治疗。治疗组孕妇胎膜早破、早产及低出生体重儿发生率分别为２４ ％ 、２０ ％ 及１７ ％ ,低于未治疗组（ 分别为４８ ％ 、４０ ％ 及３５ ％ ）。　结论　中孕期筛查和口服灭滴灵及红霉素治疗细菌性阴道病可降低有早产史孕妇早产及胎膜早破发生率。     

中期妊娠引产的有效性和安全性

全世界每年有较多的非意愿性妊娠流产发生,而中期妊娠流产造成2/3的重大流产并发症。医生的经验和技术水平以及妊娠妇女的知情选择,使目前常用终止中期妊娠的药物和手术方法均是安全和有效的。大部分妇女采用米非司酮配伍米索前列醇引产时不需行常规的清宫术。在某些缺乏米非司酮的     

Factors associated with higher oxytocin requirements in labor

Objective: To identify clinical characteristics associated with high maximum oxytocin doses in women who achieve complete cervical dilation.

Methods: A retrospective nested case-control study was performed within a cohort of all term women at a single center between 2004 and 2008 who reached the second stage of labor. Cases were defined as women who had a maximum oxytocin dose during labor >20?mu/min, while women in the control group had a maximum oxytocin dose during labor of ≤20?mu/min. Exclusion criteria included no oxytocin administration during labor, multiple gestations, major fetal anomalies, nonvertex presentation, and prior cesarean delivery. Multiple maternal, fetal, and labor factors were evaluated with univariable analysis and multivariable logistic regression.

Results: Maximum oxytocin doses >20?mu/min were administered to 108 women (3.6%), while 2864 women received doses ≤20?mu/min. Factors associated with higher maximum oxytocin dose after adjusting for relevant confounders included maternal diabetes, birthweight >4000?g, intrapartum fever, administration of magnesium, and induction of labor.

Conclusions: Few women who achieve complete cervical dilation require high doses of oxytocin. We identified maternal, fetal and labor factors that characterize this group of parturients.     

Intravenous Paracetamol Infusion Versus Intramuscular Tramadol as an Intrapartum Labor Analgesic

Objectives

To compare intravenous paracetamol and intramuscular tramadol as labor analgesics.

Methods

This prospective-randomized study conducted in 200 primigravidae in active labor, distributed into two groups of 100 women each with one receiving intravenous 1,000 mg Paracetamol and other 100 mg intramuscular tramadol. Pain intensity is recorded by McGills scale before, one and 3 h after drug administration. Perinatal outcome is recorded.

Results

No difference in pain intensity is seen before drug administration. After 1 h of drug administration, in paracetamol group, 4 % women had horrible pain, and 29 % had distressing pain, while in tramadol group, 30 % women had horrible pain, and 60 % had distressing pain. After 3 h of drug administration, in paracetamol group, 26 % had distressing pain, while in tramadol group, 51 % women had horrible pain, and 35 % had distressing pain. Labor duration in paracetamol and tramadol group was 4.3 and 5.9 h, respectively. In paracetamol group, nausea is seen in 2.2 % and vomiting in 1.1 %, while in tramadol group, nausea is seen in 6.4 % and vomiting in 4.3 %.

Conclusions

Intravenous paracetamol is more effective labor analgesic with fewer maternal adverse effects and shortens labor as compared to intramuscular tramadol.