Impact of Peanut Ball Device on the Duration of Active Labor: A Randomized Control Trial

Objective To evaluate whether the use of a peanut ball device shortens the duration of active labor in nulliparas. Study Design Single-site, nonblinded randomized trial in nulliparous women admitted for labor or labor induction. English-speaking women > 18 years of age with singleton pregnancies were enrolled. Participants were randomized to the use of peanut ball or usual care upon reaching the active phase of labor (≥ 6 cm cervical dilation) with an epidural. Primary outcome was rate of cervical dilation. Secondary outcomes were rates of cesarean delivery and fetal presentation at time of full dilation or delivery. Results Ninety-six patients enrolled; 63 reached full cervical dilation. There was no statistically significant difference in rates of cervical dilation (0.98cm/h vs. 0.79cm/h, p = 0.27) or length of labor (315 minutes vs. 387 minutes, p = 0.14) between the groups. There was no difference in the rates of cesarean delivery (33% vs. 35%, p = 0.8) or occiput posterior presentation. (28% vs. 9%, p = 0.09). Among the subgroup who had labor arrest, fewer patients using the peanut ball experienced arrest of dilation; this approached but did not reach statistical significance (30% vs. 73% p = 0.05). Conclusion Use of the peanut ball does not significantly increase rates of cervical dilation or decrease time in active labor.

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Impact of Epidural Analgesia at Different Cervical Dilation on the Rate of Cesarean Delivery

Science Insights ◽

10.15354/si.14.or007 ◽

2014 ◽

Vol 7 (2) ◽

pp. 153-166

Author(s):

Xiaofeng Shen

Keyword(s):

Epidural Analgesia ◽

Cesarean Delivery ◽

Controlled Trial ◽

Labor Pain ◽

High Rate ◽

Care Hospital ◽

Cervical Dilation ◽

Maternal Characteristics ◽

Nulliparous Women ◽

Significant Difference

BACKGROUND: Epidural analgesia is the optimal means in controlling labor pain, whereas the correlation between epidural analgesia at different cervix dilation and corresponding risk of operative delivery remains unclear. OBJECTIVE: The aim of this study was to investigate the association between the epidural analgesia at different cervix and the rate of Cesarean in nulliparous women. METHODS: This is a perspective controlled trial conducted in a University affiliated tertiary women’s health care hospital. After approval by the Institutional Ethical Committee, 780 nulliparous women who underwent spontaneous vaginal delivery at term requesting labor analgesia were screened and 596 of them were assigned into interventions. Subjects were allocated into one of four groups received epidural analgesia initiated at different cervical dilation, i.e. from the onset of painful uterine contraction to the cervix 50.0 mm or greater. The primary outcome was the rate of Cesarean delivery. Others included maternal and neonatal outcomes due to epidural analgesia and drug delivery. RESULTS: Five hundred and thirty three subjects completed the study. Significant difference in the rate of Cesarean delivery was observed amongst the four groups (98.9% at cervix <= 10.0mm, 30.2% at cervix 11.0 – 30.0mm, 24.2% at cervix 31.0 – 50.0mm and 18.1% at cervix >= 51.0mm, P < 0.0001). The major reason led to high Cesarean rate at cervix <= 10.0 mm was poor labor progression (75.2%). No significant differences were expressed in variables of non-reassuring fetal status. CONCLUSIONS: Epidural analgesia should be avoided in controlling labor pain at the cervix below 10.0mm due to its influence on the progress of labor resulting in high rate of Cesarean. Maternal characteristics are additional aspects need to be concerned during epidural labor control in nulliparous women. TRIAL REGISTRATION: Epidural Analgesia in Different Cervix Diameter and the Rate of Cesarean Delivery (EACDRCD). ClinicalTrials.gov ID, NCT00677274. http://clinicaltrials.gov/ct2/show/NCT00677274.

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Epidural Analgesia in the Latent Phase of Labor and the Risk of Cesarean Delivery

Anesthesiology ◽

10.1097/aln.0b013e3181b55e65 ◽

2009 ◽

Vol 111 (4) ◽

pp. 871-880 ◽

Cited By ~ 83

Author(s):

FuZhou Wang ◽

XiaoFeng Shen ◽

XiRong Guo ◽

YuZhu Peng ◽

XiaoQi Gu ◽

...

Keyword(s):

Cesarean Section ◽

Epidural Analgesia ◽

Cesarean Delivery ◽

Optimal Timing ◽

Epidural Group ◽

Cervical Dilation ◽

Nulliparous Women ◽

Patient Consent ◽

Significant Difference ◽

Latent Phase

Background The optimal timing of epidural analgesia has been a controversial issue, and how early women can benefit from epidural analgesia is still debated. The objective of this trial was to test the hypothesis that patient-controlled epidural analgesia given at cervical dilation of 1.0 cm or more does not increase the risk of prolonged labor or Cesarean delivery. Methods After institutional review board approval and patient consent, 12,793 nulliparous patients requesting neuraxial analgesia were enrolled and randomized to an early epidural (cervical dilation at least 1.0 cm) or delayed epidural (cervical dilation at least 4.0 cm) group. A 15-ml epidural analgesic mixture consisting of 0.125% (1.25 mg/ml) ropivacaine plus 0.3 microg/ml sufentanil was given in a single bolus, followed by patient-controlled pump with a 10-ml bolus without background infusion. Repeatable meperidine (25 mg) was prescribed as being the rescue analgesic to patients in the delayed epidural group. The primary outcome was the rate of Cesarean section. Results The median diameters of cervical dilation were 1.6 cm and 5.1 cm in the early and delayed epidural groups, respectively (P < 0.0001). The duration of labor from analgesia request to vaginal delivery was equal in both groups (11.3 +/- 4.5 h for early epidural and 11.8 +/- 4.9 h for delayed epidural group women, P = 0.90). No statistically significant difference in the rate of Cesarean section was observed between the two groups on the intention-to-treat analysis (23.2% vs. 22.8% in the early and delayed epidural groups, respectively; P = 0.51). Conclusions Epidural analgesia in the latent phase of labor at cervical dilation of 1.0 cm or more does not prolong the progression of labor and does not increase the rate of Cesarean in nulliparous women compared with the delayed analgesia at the cervical dilation of 4.0 cm or more.

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Effect of Epidural Analgesia on Fundal Dominance during Spontaneous Active-Phase Nulliparous Labor

Anesthesiology ◽

10.1097/00000542-199603000-00008 ◽

1996 ◽

Vol 84 (3) ◽

pp. 540-544 ◽

Cited By ~ 8

Author(s):

Peter E. Nielsen ◽

Ezzat Abouleish ◽

Bruce A. Meyer ◽

Valerie M. Parisi

Keyword(s):

Epidural Analgesia ◽

Active Phase ◽

Lower Uterine Segment ◽

Lower Segment ◽

Nulliparous Women ◽

Active Labor ◽

Before And After ◽

Fundal Pressure

Background The purpose of this investigation was to determine if epidural analgesia, established during active phase labor, results in elimination or reversal of fundal dominance (lower uterine segment pressure equal to or greater than fundal pressure). Methods Upper and lower uterine segment intrauterine pressures were prospectively evaluated for 50 min before and 50 min after epidural analgesia using 0.25% bupivacaine in 11 nulliparous women in spontaneous active labor. A total of 958 contractions were evaluated. Results No significant differences were found in the number of contractions in the interval before epidural analgesia compared to after epidural analgesia. Significantly greater pressure readings were recorded in the upper segment than in the lower segment (consistent with fundal dominance) both before and after epidural analgesia (P<0.01). In addition, fundal dominance increased after epidural analgesia when compared to the preanalgesia period (P<0.01). Conclusions Fundal dominance is present both before and after active phase epidural analgesia and is increased during the immediate 50-min postanalgesia period.

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Effectiveness of a Snoezelen Room on Fear, Anxiety, and Satisfaction of Nulliparous Women: A Randomized Controlled Trial

Iranian Journal of Psychiatry and Behavioral Sciences ◽

10.5812/ijpbs.89168 ◽

2020 ◽

Vol 14 (2) ◽

Author(s):

Mariyam Momeni ◽

Mansoureh Jamshidimanesh ◽

Hadi Ranjbar

Keyword(s):

Repeated Measures ◽

Rating Scale ◽

Controlled Trial ◽

Intervention Group ◽

Active Phase ◽

Control Group ◽

Chi Square ◽

Nulliparous Women ◽

Significant Difference ◽

Interventional Group

Background: Pregnancy and childbirth are natural phenomena in a women’s life, associated with stress and anxiety, leading to adverse effects in the mother and fetus. Using complementary medicine, such as aromatherapy, music, light radiation, and aquariums in an environment that engage a person’s multiple senses can make mothers relax through mental deviations. Objectives: The aim of this study was to evaluate the effects of a Snoezelen room on fear, anxiety, and satisfaction of childbirth’s nulliparous women. Methods: This randomized clinical trial was carried out on 130 eligible women in a selected hospital affiliated to the Iran University of Medical Sciences in Tehran. One hundred thirty women were randomly assigned to the intervention (n = 65) and control (n = 65) groups using six modes blocks using the convenient sampling method. The delivery room was designed to distract women’s minds in the intervention group. Data were collected using a demographic characteristics form, Harman’s Childbirth Attitude questionnaire (CAQ), Visual Analogue scale (VAS) to measure childbirth anxiety, and the Mackey Childbirth Satisfaction Rating scale. Data were analyzed by SPSS version 16 using independent t-test, repeated measures analysis of variance, and Bonferroni and chi-square tests. Results: The results showed a significant reduction in fear in the active phase and postpartum in the intervention group compared with the control group (P < 0.001 and P < 0.001, respectively). Anxiety showed a significant difference and was lower at dilatation of 6 to 7 and 7 to 8 cm, and after childbirth in the interventional group. The satisfaction of childbirth significantly increased in the interventional group (P < 0.001). Conclusions: These results confirmed the importance of a Snoezelen room in the childbirth of nulliparous women, which can promote vaginal childbirth.

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Using Cervical Dilation to Predict Labor Onset: A Tool for Elective Labor Induction Counseling

American Journal of Perinatology ◽

10.1055/s-0039-1677866 ◽

2019 ◽

Vol 36 (14) ◽

pp. 1485-1491 ◽

Cited By ~ 1

Author(s):

Danielle M. Panelli ◽

Julian N. Robinson ◽

Anjali J. Kaimal ◽

Kathryn L. Terry ◽

Jiaxi Yang ◽

...

Keyword(s):

Survival Analysis ◽

Confidence Interval ◽

Retrospective Cohort ◽

Categorical Variables ◽

Cervical Dilation ◽

Nulliparous Women ◽

Elective Induction ◽

Labor Onset ◽

Primary Predictor ◽

Singleton Pregnancies

Objective To evaluate whether cervical dilation predicts the timing and likelihood of spontaneous labor at term. Study Design This was a retrospective cohort of nulliparous women with singleton pregnancies who delivered at term from 2013 to 2015. Outpatient cervical examinations performed after 37 weeks and prior to labor onset were collected. Survival analysis was used to analyze time to spontaneous labor with cervical dilation as the primary predictor, modeled as continuous and categorical variables (<1 cm, 1 cm, >1 cm). Results Our cohort included 726 women; 407 (56%) spontaneously labored, 263 (36%) were induced, and 56 (8%) had an unlabored cesarean delivery. Women with >1-cm dilation were three times more likely to spontaneously labor (adjusted hazard ratio [aHR]: 3.1; 95% confidence interval [CI]: 2.4–4) than those with <1-cm dilation. At 39 weeks, 60% of women with >1-cm dilation went into spontaneous labor as compared with only 28% of those with <1-cm dilation (aHR: 2.9; 95% CI: 2–4.4). Conclusion In our cohort of nulliparous women at term, those with cervical dilation > 1 cm were significantly more likely to go into labor in the following week. This information can aid in counseling about elective induction of labor.

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The effectiveness of delivery ball use versus conventional nursing care during delivery of primiparae

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.3.1440 ◽

2020 ◽

Vol 36 (3) ◽

Author(s):

Jianfang Wang ◽

Xuemei Lu ◽

Chunhong Wang ◽

Xuemei Li

Keyword(s):

Cesarean Delivery ◽

Vaginal Delivery ◽

Nursing Care ◽

Statistical Significance ◽

Control Group ◽

Delivery Mode ◽

Observation Group ◽

Gynecology And Obstetrics ◽

Significant Difference ◽

Free Position

Objective: To analyze the clinical effect of delivery ball and free position delivery nursing in primipara delivery. Methods: Total 110 primipara who were admitted to the department of gynecology and obstetrics of our hospital from August 2017 to August 2018 were included in the study. They were randomly divided into an observation group and a control group, 55 each group. The control group adopted conventional nursing measures, while the observation group adopted delivery ball combined with free position midwifery nursing on the basis of conventional nursing. The pain degree, comfort degree, pregnancy outcome and sense of delivery control were compared between the two groups. Results: The number of puerperae with grade 0 and 3 labor pain in the two groups had no statistically significant difference (P>0.05). The number of puerperae with grade 1 and 2 had significant difference (P<0.05). As to the comparison of the delivery mode between the two groups, there were 9 cases of cesarean delivery and 46 cases of vaginal delivery in the observation group; there were 19 cases of cesarean delivery and 36 cases of vaginal delivery in the control group; the differences had statistical significance (P<0.05). In the comparison of the birth process time of the vaginal delivery puerperae, the time of the first and second stages of labor in the observation group was shorter than that in the control group, and the differences were statistically significant (P<0.05); there was no difference in the time of the third stage of labor between the two groups (P>0.05). The amount of hemorrhage of the observation group 2 hours after labor was 172.50±40.60 mL and that of the control group was 224.45±32.80 mL; the difference between the two groups was statistically significant (P<0.05). The sense of delivery control of the puerperae who suffered vaginal delivery was compared between the two groups using Labor Agentry Scale (LAS); the sense of delivery control of the observation group was stronger than that of the control group, and the differences had statistical significance (P<0.05). Conclusion: In the delivery of primipara, delivery ball combined with free position delivery can help the primipara relieve pain, improve comfort degree, reduce the amount of postpartum hemorrhage, shorten the duration of various stages of labor, and improve the delivery outcome. It has a high clinical promotion value. doi: https://doi.org/10.12669/pjms.36.3.1440 How to cite this:Wang J, Lu X, Wang C, Li X. The effectiveness of delivery ball use versus conventional nursing care during delivery of primiparae. Pak J Med Sci. 2020;36(3):---------. doi: https://doi.org/10.12669/pjms.36.3.1440 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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262 Risk of primary cesarean delivery among non-english speaking nulliparous women

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2020.12.284 ◽

2021 ◽

Vol 224 (2) ◽

pp. S173

Author(s):

Lizelle Comfort ◽

Meaghan Jain ◽

Ellen Marcus ◽

Ruth Eisenberg ◽

Melissa Fazzari ◽

...

Keyword(s):

Cesarean Delivery ◽

Nulliparous Women ◽

English Speaking ◽

Primary Cesarean Delivery

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Considering Criteria for Active Phase Labor Management of Nulliparous Women: A Cost-Effectiveness Analysis

American Journal of Perinatology ◽

10.1055/s-0041-1728836 ◽

2021 ◽

Author(s):

Eleanor M. Schmidt ◽

Alyssa R. Hersh ◽

Methodius Tuuli ◽

Alison G. Cahill ◽

Aaron B. Caughey

Keyword(s):

Sensitivity Analysis ◽

Brachial Plexus Injury ◽

Cost Effective ◽

Active Phase ◽

Neonatal Outcomes ◽

Maternal Outcomes ◽

Cervical Dilation ◽

Cesarean Deliveries ◽

Active Labor ◽

Adverse Neonatal Outcomes

Objective The aim of the study is to evaluate differences in maternal and neonatal outcomes based on updated criteria for defining active labor at 6 cm of cervical dilation and to determine if these recommendations are cost-effective. Study Design A decision-analytic model was built using TreeAge Pro 2020 software. We included maternal outcomes of mode of delivery, endometritis, postpartum hemorrhage requiring transfusion, and death. Neonatal outcomes included rates of shoulder dystocia and permanent brachial plexus injury. Costs and quality-adjusted life years (QALYs) were included from the maternal and infant perspectives. We used a willingness-to-pay threshold of $100,000 per QALY and all model inputs were subjected to sensitivity analysis. Results In a theoretical cohort of 1.4 million women, a threshold of 6 cm to define active labor resulted in 373,668 fewer cesarean deliveries, 33,181 fewer cases of endometritis, 143 fewer postpartum hemorrhages requiring transfusions, and seven fewer maternal deaths when compared with a threshold of 4 cm. However, there were higher rates of adverse neonatal outcomes, including 484 more cases of shoulder dystocia and 17 more instances of permanent brachial plexus injury. Using 6 cm as the threshold resulted in lower costs and greater effectiveness, making it a dominant strategy. Multivariate sensitivity analysis demonstrated the model was robust over a wide range of assumptions. Conclusion In this model, considering 6 cm of cervical dilation as the threshold for the active phase of labor compared with 4 cm was a cost-effective strategy to prevent primary cesarean deliveries, lower costs, and improve maternal outcomes, despite associated increased adverse neonatal outcomes. Key Points

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