Assessing the duration of obstetric analgesia and the time elapsed between analgesia and delivery. Observational trial

Introduction: The duration of labor and the immediate puerperium are affected by obstetric and maternal-fetal factors. Interventions to provide obstetric analgesia may prolong the hospital stay. Objective: To characterize the procedure for obstetric analgesia and describe the time elapsed between analgesia and delivery and postpartum surveillance in healthy mothers. Methods: Observational, descriptive trial. The time elapsed between analgesia and delivery, and postpartum surveillance were measured in healthy pregnant women with vaginal delivery and a prescription of a neuraxial analgesia technique. Results: 226 patients were included. The mean time elapsed between analgesia an delivery was 4 hours (IQR 3-7). 50.7 % (n = 114) received early analgesia (neuraxial technique with ≤ 4 centimeters of cervical dilatation), of which 48.2 % (n = 109) experienced a duration of analgesia until delivery longer than expected. The mean cervical dilatation at the time of the neuraxial approach was 4 centimeters (IQR 4-6) and the epidural technique was the most frequently used – 92.9 % (n = 210). The mean postpartum surveillance was 20 hours (IQR 15-27). Conclusions: Half of the patients included received early analgesia and around fifty percent of them took longer than expected in completing delivery. The postpartum surveillance time was consistent with the provisions of the Ministry of Health and with the current trend of a short postpartum surveillance aimed at early hospital discharge and the benefits thereof.

Download Full-text

Laparoscopic cholecystectomy in Jordan

Eastern Mediterranean Health Journal ◽

10.26719/2001.7.4-5.838 ◽

2001 ◽

Vol 7 (4-5) ◽

pp. 838-840

Author(s):

A. Al Raymoony

Keyword(s):

Laparoscopic Cholecystectomy ◽

Postoperative Pain ◽

Return To Work ◽

Hospital Stay ◽

Operative Time ◽

Safe Procedure ◽

Short Hospital Stay ◽

Early Return ◽

The Mean ◽

Mean Time

This study was conducted on 100 patients with symptomatic gallbladder stones, aged 22-81 years with a mean of 51.5 years, who underwent cholecystectomy in Zarqa city, Jordan between July 1998 and July 1999. The success rate was 87% and the procedure was completed using the conventional method in 13 patients. The mean operative time was 60 minutes, complication rate was 5% and there were no deaths. The mean hospital stay was 1 day and mean time to return to work was 10 days. This study showed that laparoscopic cholecystectomy is a safe procedure with reasonable operative time, less postoperative pain, a short hospital stay, early return to work, and a low morbidity and mortality rate.

Download Full-text

Prevalence of Cesarean Section and Analysis of Neonatal Apgar Score and the Mean Time of Second Phase of Labor in Pregnant Women

Medical Archives ◽

10.5455/medarh.2019.73.399-403 ◽

2019 ◽

Vol 73 (6) ◽

pp. 399

Author(s):

Maryam Shokrpour ◽

Parisa Reza ◽

Mehrzad Sharifi ◽

Alireza Kamali

Keyword(s):

Cesarean Section ◽

Pregnant Women ◽

Apgar Score ◽

Second Phase ◽

The Mean ◽

Mean Time

Download Full-text

Clinical predictive factors for vaginal delivery following induction of labour among pregnant women in Jordan

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04151-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Rawan A. Obeidat ◽

Mahmoud Almaaitah ◽

Abeer Ben-Sadon ◽

Dina Istaiti ◽

Hasan Rawashdeh ◽

...

Keyword(s):

Regression Analysis ◽

Pregnant Women ◽

Cesarean Delivery ◽

Vaginal Delivery ◽

Induction Of Labour ◽

Labour Induction ◽

Bishop Score ◽

Nulliparous Women ◽

Multiparous Women ◽

The Mean

Abstract Background Induction of labour (IOL) is an important and common clinical procedure in obstetrics. In the current study, we evaluate predictors of vaginal delivery in both nulliparous and multiparous women in north Jordan who were induced with vaginal prostaglandins. Method A prospective study was conducted on 530 pregnant women at King Abdullah University Hospital (KAUH) in north Jordan. All pregnant mothers with singleton live fetuses, who had induction of labour (IOL) between July 2017 and June 2019, were included in the study. Mode of delivery, whether vaginal or caesarean, was the primary outcome. Several maternal and fetal variables were investigated. The safety and benefit of repeated dosage of vaginal prostaglandin E2 (PGE2) tablets, neonatal outcomes and factors that affect duration of labour were also evaluated. Pearson χ2 test was used to investigate the significance of association between categorical variables, while student’s t-test and ANOVA were applied to examine the mean differences between categorical and numerical variables. Linear regression analysis was utilized to study the relation between two continuous variables. A multivariate regression analysis was then performed. Significance level was considered at alpha less than 0.05. Results Nulliparous women (N = 254) had significantly higher cesarean delivery rate (58.7% vs. 17.8%, p < 0.001) and longer duration of labour (16.1 ± 0.74 h vs. 11.0 ± 0.43 h, p < 0.001) than multiparous women (N = 276). In nulliparous women, the rate of vaginal delivery was significantly higher in women with higher Bishop score; the mean Bishop score was 3.47 ± 0.12 in nulliparous women who had vaginal delivery vs. 3.06 ± 0.10 in women who had cesarean delivery (Adjusted odds ratio (AOR) = 1.2, 95% CI: 1.03–1.28, p = 0.03). In multiparous women, the rate of vaginal delivery was significantly higher in women with higher Bishop scores and lower in women with higher body mass index (BMI). The mean Bishop score was 3.97 ± 0.07 in multiparous women who had vaginal delivery vs. 3.56 ± 0.16 in women who had cesarean delivery (AOR = 1.5, 95% CI: 1.1–2.1, p = 0.01). The mean BMI was 30.24 ± 0.28 kg/m2 in multiparous women who had vaginal delivery vs. 32.36 ± 0.73 kg/m2 in women who had cesarean delivery (AOR = 0.89, 95% CI: 0.84–0.96, p = 0.005). 27% of nulliparous women who received more than two PGE2 tablets and 50% of multiparous women who received more than two PGE2 tablets had vaginal delivery with no significant increase in neonatal morbidity. Conclusion Parity and cervical status are the main predictors of successful labour induction. Further studies are required to investigate the benefit of the use of additional doses of vaginal PGE2 above the recommended dose for IOL.

Download Full-text

Comparison between extra mucosal continuous prolene repair versus interrupted through and through silk repair in colonic anastomosis

International Surgery Journal ◽

10.18203/2349-2902.isj20192978 ◽

2019 ◽

Vol 6 (7) ◽

pp. 2480

Author(s):

Ashok Kumar Nayak ◽

Malaya Krishna Nayak ◽

Dharbind Kumar Jha ◽

Chinmaya Kar ◽

Debashree Maharana

Keyword(s):

Hospital Stay ◽

Postoperative Ileus ◽

Bowel Movement ◽

Colonic Anastomosis ◽

Single Layer ◽

Suture Line ◽

Luminal Narrowing ◽

Ischemic Tissue ◽

The Mean ◽

Mean Time

Background: The traditional double layered colonic anastomosis incorporates large amount of ischemic tissue in the suture line causing luminal narrowing and fistula formations. Single layered anastomosis may be done through continuous extramucosal suturing or by interrupted through and through technique using nonabsorbable materials. The single layer of suture has shown to be safe and causes fewer complications.Methods: The study was conducted in the Department of surgery, VIMSAR, Burla during the period from October 2016 to September 2018. All the patients of colonic anastomosis were included in the study. One group consists of extra mucosal continuous prolene repair and other interrupted though and through silk repair. Both groups were followed up and were compared taking different variables.Results: 146 cases of colonic anastomosis were performed, 110 with interrupted through and through silk repair (75.34%) and 36 with continuous extra mucosal prolene repair (24.66%).The mean time taken for silk repair was more (25.67 min) than prolene (15.5 min). The patients of prolene repair had shorter duration (9 days) of hospital stay than silk (12.4 days). The postoperative ileus was more in silk (16.36%) than prolene (5.56%). Anastomotic leak in prolene is less (2.78%) in comparison to silk (8.18%). The bowel movement appeared earlier with prolene (4.2 days) is less than ssilk (5.3 days).Conclusions: The present study shows single layer monofilament thin diameter prolene for different end to end colonic anastomosis has better prognostic panorama in relation to morbidity and mortality, and had an edge over conventional single or bilayere anastomosis.

Download Full-text

The Impact of Preemptive Perianal Anaesthetic Block in Open Haemorrhoidectomy – a randomised controlled trial

10.53350/pjmhs211592165 ◽

2021 ◽

Vol 15 (9) ◽

pp. 2165-2167

Author(s):

Wajeeha I. Andrabi ◽

M Asadullah Khawaja ◽

K. Fatima ◽

S I. Hussain Andrabi ◽

A. Shafique ◽

...

Keyword(s):

Placebo Group ◽

Hospital Stay ◽

Pain Intensity ◽

P Value ◽

Open Hemorrhoidectomy ◽

Group A ◽

The Mean ◽

Group B ◽

The Impact ◽

Mean Time

Background: the study was conducted to analyze the efficacy of 0.75% ropicaine at perianal block for open haemrrhoidectomy with regards to pain intensity, first demand of analgesia and hospital stay. Method: 50 patients were selected for open haemrrhoidectomy under GA which were divided into two groups.it was a randomized control trial in which sealed envelope method was used for the group delegation in which Group A was designated to the patients having the perianal block with 0.75% ropivacaine while the group B was the placebo group having normal saline injected in the perianal region. The variables compared were the first demand of analgesia, pain intensity and the duration of the hospital stay. In order to make the site of injection more authentic the injections were sited under ultrasound guidance. Results: The pain intensity which was analyzed with the visual analogue score (VAS) had a median of 3.8 (high=6, low=3) in group A while 5.5 (high=8, low=4) in the Group B with the p value of < 0.05. The mean time recorded for the first demand of analgesia was 6.20 ± 1.20 hours in the Group A which had improved from 1.20 ± 1.0 hours in the Placebo Group while the p value was < 0.001, while the mean time of hospital stay got reduced from 22.5±3.30 hours to 12.4 ± 3.10 hours with the significant p value of < 0.002. Conclusion: It was observed that with preemptive analgesia with 0.75% ropivacaine administered led to a substantial reduction in pain perception, request for an analgesic and hospital stay. Therefore it is appropriate to administer it before open hemorrhoidectomy. Keywords: preemptive anaesthesia, local anesthesia, postoperative pain, ropivacaine, open hemorrhoidectomy

Download Full-text

Concurrent administration of oxytocin with Foley catheter versus misoprostol for induction of labor: A systematic review

10.21203/rs.2.20722/v1 ◽

2020 ◽

Author(s):

Mohamed A. Abdel Aziz ◽

Shayeste Jahanfar ◽

Parvin Abedi ◽

Shahla Faal

Keyword(s):

Systematic Review ◽

Cesarean Section ◽

Vaginal Delivery ◽

Foley Catheter ◽

Mode Of Delivery ◽

Labor Induction ◽

Cochrane Central Register ◽

Concurrent Administration ◽

The Mean ◽

Mean Time

Abstract Objectives: Around one- third of pregnancies require labor induction due to issues such as post-term pregnancy, stillbirth, and medical complications. This systematic review aimed to evaluate the effect of concurrent administration of Foley catheter plus oxytocin vs. misoprostol on labor induction. Methods: The search was conducted in April 2019. The following databases were searched: PubMed, SCOPUS, Cochrane Central Register of controlled trials and Web of Science. Primary outcomes included mode of delivery and cesarean section rate. Secondary outcomes were the mean time of induction to delivery and delivery in less than 12 hours from induction. Data were analyzed using RevMan. For binary outcomes, the odds ratio with 95% confidence intervals (CI), and for continuous outcomes, the mean difference (MD) with 95% CI was measured. Results: Four studies were included in this review. The cesarean section and vaginal delivery rate in Foley + oxytocin was not significantly different from misoprostol (OR = 0.95; 95 % CI: 0.70, 1.30) and (OR = 0.92; 95 % CI: 0.66, 1.29) respectively. Foley + oxytocin decreased the mean time of induction to delivery compared to misoprostol (MD = 0.60; 95 % CI: 0.03, 1.16), and increased delivery in less than 12 hours from induction (OR = 2.08; 95 % CI: 1.43, 3.02). Conclusion: Although the rate of cesarean and vaginal delivery was not significant in two groups of Foley catheter + oxytocin and misoprostol, the mean time of induction to delivery reduced and delivery in less than 12 hours from induction increased in the Foley +oxytocin.

Download Full-text

Angles, Traction, and Time after Delivery of Fetal Head: Interobserver Variation of Novel Visual Analogs

American Journal of Perinatology ◽

10.1055/s-0037-1603993 ◽

2017 ◽

Vol 34 (14) ◽

pp. 1424-1429 ◽

Cited By ~ 2

Author(s):

Nana-Ama Ankumah ◽

Vidya Chauhan ◽

Claudia Pedroza ◽

Rodney McLaren ◽

Sean Blackwell ◽

...

Keyword(s):

Vaginal Delivery ◽

Interobserver Agreement ◽

Interobserver Variability ◽

Time Interval ◽

Poor Agreement ◽

Fetal Head ◽

Time Intervals ◽

The Mean ◽

Mean Time ◽

Singleton Pregnancies

Objective The objective was to ascertain interobserver variability for assessment of Angles of fetal head manipulation, Traction exerted on the fetal head, and Time interval from the emergence of the head to the feet (ATT) at vaginal delivery. Materials and Methods Singleton pregnancies of ≥36 weeks with vaginal delivery were included. Visual analogs were created to assess angles and traction, and mobile phone stopwatch was used to assess the time interval. The intraclass coefficient (ICC) was calculated to determine interobserver variability. Results Thirty-seven deliveries were analyzed. For the two observers, the median angle for downward manipulation was –5° vs –20° (interquartile range [IQR], –5 to –5 vs –30 to –10), ICC of 0.09 (poor agreement; 95% confidence interval [CI] –0.09, 0.32), and that for upward manipulation was 10° vs 20° (IQR, 10–15 vs 10–30), ICC of 0.25 (poor agreement; 95% CI –0.05, 0.52). ICC for lateral manipulation could not be calculated as it was not noted in 98% of deliveries. Mean traction was 2.5 versus 5.0, ICC of 0.36 (poor agreement; 95% CI –0.09, 0.72). The mean time intervals were 14.9 versus 14.0 seconds, ICC of 0.94 (excellent agreement, 95% CI 0.88–0.97). Conclusion With exception of time interval, interobserver agreement was poor in estimation of fetal head manipulation and traction.

Download Full-text

HAEMORRHOIDECTOMY;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.01.424 ◽

2017 ◽

Vol 24 (01) ◽

pp. 69-74

Author(s):

Ahsan Nasim ◽

Marriyum Baig ◽

Reem Saad

Keyword(s):

Hospital Stay ◽

Harmonic Scalpel ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Randomized Control ◽

Group B ◽

Mean Time ◽

Surgical Unit ◽

Closed Haemorrhoidectomy

Haemorrhoids are one of the most common anorectal disorders. Internalhaemorrhoids are symptomatic anal cushions and characteristically lie in the 3, 7 and 11 o’clockposition whereas external haemorrhoids relate to venous channels of the inferior haemorrhoidalplexus. Objectives: To compare the outcome of haemorrhoidectomy using harmonic scalpelversus conventional closed haemorrhoidectomy. Study Design: Randomized control trial.Setting: Department of Surgical unit II, Jinnah Hospital, Lahore. Period: Six months from 25thDecember 2014 to 24th June 2015. Methodology: A total of 140 patients were included inthis study. Patients were divided in two groups A & B. In Group A, (70 patients) conventionalhaemorrhoidectomy was performed by the Ferguson Technique (closed technique) whereasin Group B, (70 patients) suture less closed haemorrhoidectomy was performed by using theharmonic scalpel. Results: The mean age of the patients in group A was 43.3±8.2 years andin group B was 42.3±7.3 years. The mean time for surgery in group A was 23.8±4.2 minutesand in group B was 8.5±3.6 minutes. The mean pain score in group A was 5.3±1.8 VAS andin group B was 3.9±1.9 VAS. In group A, less than 1 day postoperative hospital stay was in 62(88.6%) patients and in group B, it was in 66 (94.3%) patients. Conclusions: It is concludedfrom this study that haemorrhoidectomy by harmonic scalpel results in decrease in operationtime and less postoperative pain although there is not much significant difference in less than 1day hospital stay as compared to the conventional closed haemorrhidectomy technique.

Download Full-text

Comparison of Postpartum Hemoglobin and Hematocrit Levels in Conventional and Physiological Delivery in Iran: A Quasi-Experimental Study

Current Women s Health Reviews ◽

10.2174/1573404817999201228110246 ◽

2020 ◽

Vol 17 ◽

Author(s):

Khodayar Oshvandi ◽

Seyedeh Zahra Masoumi ◽

Arezoo Shayan ◽

Seyed Saleh Oliaei ◽

Afshin Mohammadi ◽

...

Keyword(s):

Experimental Study ◽

Pregnant Women ◽

Vaginal Delivery ◽

Postpartum Hemorrhage ◽

Weak Relationship ◽

Confounding Variables ◽

Quasi Experimental ◽

The Mean ◽

Type Of Delivery ◽

D Value

Background: Despite the great importance of controlling and preventing postpartum hemorrhage, no evidence has been provided to reduce postpartum hemorrhage physiologically compared to conventional vaginal delivery. While it is claimed that physiological delivery can be better than conventional delivery, in many ways, there is insufficient available information about the effect of delivery method on postpartum hemoglobin and hematocrit levels. Objective: The current study aimed to compare postpartum hemoglobin and hematocrit levels in conventional and physiological delivery methods in Fatemieh Hospital of Hamedan. Methods: This quasi-experimental study was conducted on 400 pregnant women candidates for physiological delivery and 400 pregnant women for conventional vaginal delivery in 2019. Mothers in the physiological delivery group were provided with necessary training. In the conventional vaginal delivery group, the mother went through the usual procedures upon hospitalization. All mothers' venous blood samples were analyzed for hemoglobin and hematocrit at the time of hospitalization and six hours after delivery. The significance level was considered 0.05. Results: The outcomes indicated that by controlling the confounding variables, the mean of hemoglobin in the physiologic delivery group was significantly higher than conventional vaginal delivery, 11.93 (1.20) and 11.64 (1.20) respectively (P <0.001), but the Cohen's d value of 0.25 indicated a weak relationship between the mean of hemoglobin level six hours after delivery and the type of delivery. The results also indicated that by controlling the effect of confounding variables, the mean of hematocrit in the physiological group was significantly more than conventional vaginal delivery (36.53 (3.33) and 35.50 (3.33) respectively) (p <0.001) but the Cohen's d value of 0.31 indicates a weak relationship between mean hematocrit 6 hours after delivery and the type of delivery. Conclusions: The results indicated that physiologic delivery did not show a valuable/considerable or the expected effect on improving postpartum maternal hemoglobin and hematocrit levels comparing to conventional delivery.

Download Full-text

Effect of Different Methods of Induction on the Mode of Delivery and Fetal Outcome

Bangladesh Journal of Obstetrics & Gynaecology ◽

10.3329/bjog.v26i2.13785 ◽

2013 ◽

Vol 26 (2) ◽

pp. 81-85

Author(s):

Nabila Aminu Buhari ◽

Sumayya Lugman Ahmed ◽

Nastaran Redha Sohrabi ◽

Hidayat Yetunde Ogunsola ◽

Riwana B Shaikh ◽

...

Keyword(s):

Pregnant Women ◽

Vaginal Delivery ◽

Mode Of Delivery ◽

Fetal Outcome ◽

Labor Induction ◽

Induction Of Labor ◽

Normal Vaginal Delivery ◽

College Hospital ◽

Medical College ◽

Mean Time

Objectives: To study various methods of induction of labor and their effect on mode of delivery and fetal outcome.Methods: 104 pregnant women induced in Gulf Medical College hospital from August to November 2009 were included. Mothers were observed from the start of their induction and followed up till they were discharged. The methods of induction compared were the use of prostaglandin, oxytocin, prostaglandin and oxytocin combined and artificial rupture of membranes.Results: Out of 104 pregnant women, 86 (89%) had normal vaginal delivery. Of these, 36 (41.9%) were induced with combination of prostaglandin and oxytocin, 32 (37.2%) with prostaglandin, 14 (16.2%) with oxytocin, and 4 (4.6%) with artificial rupture of membranes. 13 (12.5%) mothers delivered through caesarean section of these, 7 (53.8%) mothers were induced with prostaglandin, 3 (23%) with prostaglandin and oxytocin, 2 (15.3%) with oxytocin alone, and 1 (7.7%) with artificial rupture of membranes. Induction of labor with combination of prostaglandin and oxytocin was found to be the most effective method. Duration of labor between primigravidas and multigravidas were significantly different with primigravidas having longer duration of labor with mean time of 12.47 hours while multigravidas had 9.16 hours.Conclusion: Induction of labor with combination of prostaglandin and oxytocin was found to be the most effective method in this study with very good progressing to normal vaginal delivery. Further research is needed on a larger scale to compare other methods of labor induction on parturient to be able to recommend the most effective method of labor induction. DOI: http://dx.doi.org/10.3329/bjog.v26i2.13785 Bangladesh J Obstet Gynaecol, 2011; Vol. 26(2) : 81-85

Download Full-text