Duration of low-risk, spontaneous active labor and second stage with minimal medical intervention

Background The aim of this study was to assess the effect of an external nasal dilator on several variables characterizing labor in both mother and fetus. Methods One hundred and fifty primigravida women in active labor were randomized to wear, throughout labor, either a dilator spring-loaded nasal strip or a placebo device. Data were obtained during labor and compared between the groups. After delivery, the satisfaction rate was assessed. Results No differences were found between the study and the control group regarding rate of induction or augmentation of labor as well as Montevideo units reached, frequency of rupture of membranes, duration of the active phase and second stage of labor, usage of epidural analgesia, normal fetal heart pattern, meconium-stained amniotic fluid, and neonatal well being. Length of maternal and neonatal hospitalization also did not differ between the groups. Satisfaction rate was significantly higher in parturient women wearing nasal strips with a dilator spring than in parturient women wearing a placebo spring (P < 0.0001). Conclusion Nasal strips do not change the course but ameliorate the quality of labor by improving the ease of breathing. Nasal dilators sustain the respiratory effort associated with the long process of labor and may control the switch from nasal to oronasal breathing during delivery.

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Normal labour: second stage

10.1093/med/9780198754787.003.0017 ◽

2017 ◽

Author(s):

Janet Medforth ◽

Linda Ball ◽

Angela Walker ◽

Sue Battersby ◽

Sarah Stables

Keyword(s):

Female Genital Mutilation ◽

Evidence Base ◽

Low Risk ◽

Current Evidence ◽

Genital Mutilation ◽

Second Stage ◽

Second Stage Of Labour ◽

Current Evidence Base ◽

Low Risk Women ◽

Female Genital

This chapter covers the second stage of labour, from onset through to latent and active phases. It describes the physiology and diagnosis of the second stage of labour for low-risk women. It considers the mechanism of normal labour which underpins the principles of care and conduct of a normal vaginal birth. The care of the perineum in line with the current evidence base is also described. Categorization of perineal trauma is given and the performance of an episiotomy described. The incidence and management of female genital mutilation are discussed.

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Maternal and neonatal outcome of births in alongside midwifery units: A cohort study from a tertiary center in Germany

10.21203/rs.2.15294/v1 ◽

2019 ◽

Author(s):

Waltraut Maria Merz ◽

Laura Tascon-Padron ◽

Marie-Therese Puth ◽

Andrea Heep ◽

Sophia L. Tietjen ◽

...

Keyword(s):

Primary Outcome ◽

Neonatal Outcome ◽

Obstetric Care ◽

Models Of Care ◽

Low Risk ◽

Control Group ◽

Study Group ◽

Second Stage Of Labor ◽

Second Stage ◽

Low Risk Women

Abstract Background For healthy women entering birth after uneventful pregnancy, midwife-led models of care have the potential to reduce interventions and increase the vaginal birth rate without compromising the maternal or health of the neonate. In Germany, 98.4% of women are giving birth in consultant-led obstetric units. Alongside midwifery units (AMU) have been established in 2003. We compared the outcome of all births in the AMU at our hospital from 2010 to 2017 with a matched group of low-risk women who gave birth during the same period of time in standard obstetric care. Methods We used a retrospective cohort study design. The study group consists of all women admitted to labor ward who had registered for birth in AMU. For the control group, low-risk women were selected; additionally, matching was performed for parity. Mode of birth, postpartum hemorrhage, and obstetric injury was chosen as primary outcome parameter for the mother. For the neonate, a composite primary outcome (5-minute Apgar <7 or umbilical cord arterial pH < 7.20 or transfer to specialist neonatal care) was defined. Secondary outcomes included epidural analgesia, duration of the second stage of labor, and episiotomy rate. Non-inferiority was assessed, and multiple logistic regression analysis was performed. Results 612 women were admitted for labor in AMU, the control group consisted of 612 women giving birth in standard obstetric care. Women in the study group were on average older and had a higher BMI; birthweight was on average 95 g higher. Except for birth injuries, non-inferiority could be established for the primary outcomes. Secondary outcomes occurred less common in the study group, including a shorter duration of the second stage of labor. Overall, 50.3% of women were transferred to standard obstetric care. Regression analysis revealed effects of parity, age and birthweight on the chance of transfer. Conclusion Our investigation confirms comparable maternal and neonatal outcome with less interventions for women giving birth in AMU at our institution. Currently, obstetric services in Germany are almost exclusively provided by consultant-led units. Our results support the integration of AMU as complementary models of care for low-risk women.

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BLATCHFORD SCORE IN PROGNOSIS OF GASTROINTESTINAL BLEEDING PATIENTS CAUSED BY PEPTIC ULCER

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2014.3.11 ◽

2014 ◽

pp. 77-85

Author(s):

Trong Thang Hoang ◽

Phuong Thuy Hoang

Keyword(s):

Gastrointestinal Bleeding ◽

Risk Group ◽

Medical Intervention ◽

High Risk Group ◽

Low Risk ◽

Gastroduodenal Disease ◽

Rockall Score ◽

Ulcerative Lesions ◽

Bleeding Score ◽

Higher Sensitivity

Background: Gastrointestinal bleeding in general and gastrointestinal bleeding from peptic ulcer is the most common internal medical emergency especially in digestive diseases. The evaluation of rebleeding is important problems in treatment and prognosis. Thereby improving the quality of treatment and reduce the dead rate for patients, the Blatchford score is a screening tool to evaluate patients gastrointestinal bleeding that help for the medical intervention such as blood transfusion, endoscopic therapy or surgical hemostasis or not. Objectives: 1. Investigating the mean value of Blatchford score according to the location, the causes and the severity of bleeding and the type of lesions by the Forrest’s classification. 2 Comparising the value of Blatchford score with Rockall score in prognosis of the upper gastrointestinal bleeding due to. Subjects and Methods: Prospective cohort study of 101 patients with gastrointestinal bleeding due to gastroduodenal disease treated at Hue Central Hospital from 12/ 2011 to April 2013. The data were processed by SPSS ver 19.0. Results: The average Blatchford patient group 7.91 ± 3.81 research, medical interventions accounted for 60.40 %. Lesions in the stomach Blatchford average 7.37 ± 4.12, duodenum 9.13 ± 4.16, lesions both gastroduodenal 8.52 ± 2.23. Blatchford point average of group causes ulcers 8.48 ± 3.74, ulcerative colitis with a 8.46 ± 3.13, inflammation 5.83 ± 4.20. Blatchford point average of group severe hemorrhagic 10.20 ± 2.10 points, just 8.04 ± 3.67 hemorrhage, minor hemorrhage 3.37 ± 2.48, Blatchford point average of at risk groups Forrest high point of 10.08 ± 3.57, 7.59 ± Forrest low risk of 3.76 points, - Percentage of patients Blatchford score > 6 / patient Blatchford score ≤ 6, in both gastric lesions and duodenal lesions is higher than a position or in the stomach or duodenum) and in duodenum were higher in the stomach (10.49/1 from 3/1 and 1.82/1); Blatchford score of ulcerative lesions was higher than that of purely inflammatory lesions; Level Blatchford bleeding score as high as heavy. The difference is statistically significant with p < 0.01; Forrest high risk group Blatchford score higher than low risk - Blatchford scoring higher sensitivity Rockall score (91.80% against 77.05%). The positive predictive value of Blatchford score higher than Rockall score (76.71% compared with 73.44%). Conclusion: The average Blatchford's research group patients 7.91±3.81; Ulcerative lesions with higher points Blatchford merely inflammatory lesions; Level Blatchford bleeding score higher the more severe; Forrest high risk group Blatchford score higher than low risk; Rockall and Blatchford scoring system is valuable in prognostic evaluation requires medical intervention. Blatchford scoring higher sensitivity Rockall score. Keywords: Gastroduodenal disease, Blatchford score, gastrointestinal bleeding

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Unattended Home Labor until Complete Cervical Dilatation Ending with Hospital Delivery: Analysis of 238 Pregnancies

Obstetrics and Gynecology International ◽

10.1155/2013/196709 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Ozlem Gun Eryilmaz ◽

Nasuh Utku Dogan ◽

Cavidan Gulerman ◽

Leyla Mollamahmutoglu ◽

Nedim Cicek ◽

...

Keyword(s):

Neonatal Intensive Care ◽

Hospital Setting ◽

Current Data ◽

Low Risk ◽

Neonatal Outcomes ◽

Study Group ◽

Hospital Delivery ◽

Active Labor ◽

Maternal And Neonatal Outcomes ◽

At Home

Objectives. Hospital fear and avoidance of the routine hospital obstetrical interventions cause some women with low-risk pregnancies to spend most of the active labor period at home, and subsequently they present to the hospital for delivery. Our aim was to analyze the maternal and neonatal outcomes of pregnancies with a planned hospital birth, yet spending the first stage of labor at home without a health provider and completing the delivery in the hospital setting.Methods. We retrospectively compared 238 pregnancies having home labor plus hospital delivery (study group) with 476 pregnancies that had spent the whole labor in the hospital setting, considering various maternal and neonatal outcomes.Results. Cesarean and episiotomy rates were lower (P<0.0001andP<0.001, resp.), but neonatal intensive care unit admissions of the infants were more prevalent (P<0.01) in the study group. Other maternal and neonatal outcomes including neonatal mortality were comparable.Conclusion. Although our preliminary data generally do support the safety of home active labor plus hospital delivery for low-risk pregnancies, the clinical implications of current data warrant further prospective trials.

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Perineal Trauma in a Low-risk Maternity with High Prevalence of Upright Position during the Second Stage of Labor

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0038-1666810 ◽

2018 ◽

Vol 40 (07) ◽

pp. 379-383

Author(s):

Mariana Peppe ◽

Juliana Stefanello ◽

Bruna Infante ◽

Mauricio Kobayashi ◽

Claudia Baraldi ◽

...

Keyword(s):

Upright Position ◽

Low Risk ◽

Perineal Trauma ◽

Fourth Degree ◽

Second Stage Of Labor ◽

Second Stage ◽

Perineal Tears ◽

Nulliparous Women ◽

Risk Pregnancy ◽

Severe Perineal Trauma

Objective Perineal trauma is a negative outcome during labor, and until now it is unclear if the maternal position during the second stage of labor may influence the risk of acquiring severe perineal trauma. We have aimed to determine the prevalence of perineal trauma and its risk factors in a low-risk maternity with a high incidence of upright position during the second stage of labor. Methods A retrospective cohort study of 264 singleton pregnancies during labor was performed at a low-risk pregnancy maternity during a 6-month period. Perineal trauma was classified according to the Royal College of Obstetricians and Gynecologists (RCOG), and perineal integrity was divided into three categories: no tears; first/second-degree tears + episiotomy; and third and fourth-degree tears. A multinomial analysis was performed to search for associated factors of perineal trauma. Results From a total of 264 women, there were 2 cases (0.75%) of severe perineal trauma, which occurred in nulliparous women younger than 25 years old. Approximately 46% (121) of the women had no tears, and 7.95% (21) performed mediolateral episiotomies. Perineal trauma was not associated with maternal position (p = 0.285), health professional (obstetricians or midwives; p = 0.231), newborns with 4 kilos or more (p = 0.672), and labor analgesia (p = 0.319). The multinomial analysis showed that white and nulliparous presented, respectively, 3.90 and 2.90 times more risk of presenting perineal tears. Conclusion The incidence of severe perineal trauma was low. The prevalence of upright position during the second stage of labor was 42%. White and nulliparous women were more prone to develop perineal tears.

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Epidurals and the Modern Labor Curve: How Epidural Timing Impacts Fetal Station during Active Labor

American Journal of Perinatology ◽

10.1055/s-0037-1617457 ◽

2017 ◽

Vol 35 (05) ◽

pp. 421-426

Author(s):

Methodius Tuuli ◽

Molly Stout ◽

Candice Woolfolk ◽

Kimberly Roehl ◽

George Macones ◽

...

Keyword(s):

Odds Ratio ◽

Primary Outcome ◽

Secondary Analysis ◽

Single Institution ◽

Second Stage Of Labor ◽

Second Stage ◽

Increased Risk ◽

Active Labor ◽

Secondary Outcomes ◽

Singleton Pregnancies

Objective The objective of this study was to estimate epidural timing's impact on fetal station during active labor. Study Design This secondary analysis of a single-institution prospective cohort study included all term singleton pregnancies, stratified by parity. Those with early epidurals (placed at <6 cm) were compared with those with late epidurals (placed at ≥6 cm). The primary outcome was median fetal station from 6 to 10 cm. Secondary outcomes included rate of prolonged first or second stage of labor (>95%). Multivariable logistic regression adjusted for labor type. Results Among 7,647 women, 3,434 were nulliparous (2,983 with early epidurals and 451 with late epidurals) and 4,213 multiparous (3,141 with early epidurals and 1,072 with late epidurals). Interquartile ranges (IQRs) suggested fetal station at 6 cm was likely lower among those with early epidurals (nulliparous: median head station −1 [IQR: −1 to 0] for early epidural vs. −1 [IQR: −2 to 0] for late epidural, p < 0.01; multiparous: −1 (IQR: −2 to 0] for early epidural vs. −1 [IQR: −3 to −1] for late epidural, p < 0.01). Early epidurals were not associated with increased risk of prolonged first stage, but among nulliparous were associated with decreased risk of prolonged second stage (adjusted odds ratio: 0.66 [95% confidence interval: 0.44–0.99]). Conclusion Early epidurals were associated with lower fetal station in active labor but not prolonged first stage.

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