Lubricant for Reducing Perineal Trauma: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Background Different techniques have been reported to prevent perineal lacerations, but the effects of the use of lubricant have been unclear and is still subject of debate. Objective To assess the effect of lubricants on reducing perineal trauma during vaginal delivery. Search strategy PubMed, Embase, the Cochrane Library, CINAHL, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), WanFang databases, ClinicalTrials.gov in 25 June 2021. Selection criteria Randomized controlled trials published in English or Chinese that compared the vaginal application of lubricant with standard care in women with cephalic presentation at vaginal delivery were included . Data collection and analysis Two independent reviewers selected eligible trials and extracted data on perineal trauma, duration of the second-stage labor, postpartum hemorrhage and Apgar score for meta-analysis. Main results Nineteen trials enrolling 5445 pregnant women were included. Compared with standard care, women using lubricants had a lower incidence of perineal trauma (RR 0.84, 95%CI 0.76 to 0.93), second-degree perineal laceration (RR 0.72, 95%CI 0.64 to 0.82) and episiotomy (RR 0.77, 95%CI 0.62 to 0.96), had a shorter duration of the second-stage labor (MD -13.72 minutes, 95%CI -22.68 to -4.77). Subgroup analysis indicated that women with obstetric gel had a shorter duration of the second-stage (MD -16.9 minutes, 95%CI -27.03 to -6.78 vs MD -8.38 minutes, 95%CI -11.11 to -5.65; P interaction=0.02) when compared with liquid wax. Conclusions Compared with standard care, lubricants could reduce the incidence of perineal trauma, especially second-degree perineal laceration, and shorten the duration of the second-stage labor.

Recent trends in labor productivity

PurposeUsing the example of Russia, this paper studied and analyzed productivity of the labor force in agriculture as an important industry for ensuring the sustainable development of the country.Design/methodology/approachAt the first examination stage, the time series of data on labor productivity and real wages in agri-food companies were examined as modern works on the matter tend to highlight the relationship between productivity and remuneration insufficiently. At the second stage, labor productivity was assessed through the rate of change in the share of wages in the gross domestic product. At the last stage, an applied model of the relationship between labor productivity in agriculture and various impact factors was developed.FindingsIt showed that the efficiency of the labor force in the considered area depends greatly on technical equipment and crop yield. Besides, the study findings revealed that the traditional economic relationship between productivity and wages is invalid in the examined regions of Russia. There is a significant reserve for increasing labor productivity by providing additional motivation for employees.Originality/valueThe successful development of agricultural production can be achieved by implementing innovations, facilitating digitalization, attracting investments, increasing the level of interest of those employed in labor results and producing high-quality goods.

Effect of Labor Camera on the Duration of the Second Stage Labor in Primipara

Fear and anxiety due to severe labor pains could also lead to prolonged labor. The efforts made to accelerate the second stage labor process are by providing emotional support with the support of a labor camera. The mother is allowed to observe the development state of her baby's head through video on a tablet or laptop screen. Furthermore, the mother's emotional level becomes more provoked and motivated to strain the labor process faster. This study aims to determine the effect of the labor cameras on the second state duration in primiparous. The design of this study was a posttest-only control group design experiment with a total sample of 30 primiparous of the second stage at independent midwife practice in Bengkulu city in November–December 2020. Each group consisted of 15 for treatment (with labor cameras) and 15 for control (without labor cameras)—the assessment of the labor duration by counting the labor time in seconds during the second state. The statistical results using the t test and chi-square test analysis showed that the intervention group's labor duration (1,393.3 seconds) was shorter than the control group's (2,340.6 seconds). The mean difference in the delivery time was 947.3 seconds or 15.7 minutes faster in the intervention group than in the control group. In conclusion, using a labor camera on the labor duration of the second stage in primiparous mothers is an effect of using a labor camera. PENGARUH KAMERA PERSALINAN TERHADAP DURASI PERSALINAN KALA II PADA PRIMIPARARasa takut dan cemas akibat nyeri persalinan yang berat juga dapat menyebabkan partus lama. Salah satu upaya yang dilakukan untuk mempercepat proses kala II persalinan adalah memberikan dukungan emosional dengan bantuan kamera persalinan. Ibu diberi kesempatan untuk melihat perkembangan pengeluaran kepala bayinya melalui video pada layar tablet atau laptop sehingga tingkat emosional ibu menjadi lebih terbangun dan termotivasi untuk mempercepat proses persalinan. Penelitian ini bertujuan mengetahui pengaruh kamera persalinan terhadap durasi persalinan kala II pada primipara. Desain penelitian adalah eksperimen posttest-only control group design dengan jumlah sampel 30 primipara kala II di bidan praktik mandiri Kota Bengkulu pada November–Desember 2020. Tiap-tiap kelompok berjumlah 15 untuk kelompok perlakuan (menggunakan kamera persalinan) dan 15 untuk kontrol (tidak menggunakan kamera persalinan). Penilaian durasi persalinan dengan menghitung detik selama kala II berlangsung. Pengujian statistik menggunakan analisis uji t dan uji chi-square menunjukkan bahwa durasi persalinan kelompok perlakuan (1.393,3 detik) lebih singkat daripada kelompok kontrol (2.340,6 detik). Selisih perbedaan waktu persalinan rerata selama 947,3 detik atau 15,7 menit lebih cepat pada kelompok intervensi dibanding dengan kelompok kontrol. Simpulan, terdapat pengaruh penggunaan kamera persalinan terhadap durasi persalinan kala II pada ibu primipara.

Hubungan Faktor Maternal terhadap Posisi pada Waktu Persalinan Kala II dengan Kejadian Ruptur Perineum

erineal rupture needs attention because it can cause dysfunction of the female reproductive organs, as a source of bleeding, a source, or a way in and out of infection, then it can cause death due to bleeding or sepsis. About 85% of Women who delivery vaginally experience perineal rupture, in the age group 25-30 years 24%, while in maternal age 32-39 years by 62%. In Asia, perineal rupture is also a problem in society, 50 % of the world's occurrence is in Asia. The study aims to determine the relationship of maternal factors to the position of the second stage labor and perineal rupture occurrence. This research applied a descriptive-analytic method using a cross-sectional research design. The research sample was 102 respondents, accidental random sampling, which was all labor with perineal rupture in July to November 2018. Statistical tests used chi-square. The results of perineal rupture with maternal age was p-value 0.042 (p <0.05), perineal rupture with maternal parity was p-value 0.01 (p <0.05). Suggestions for various maternal positions in maternity and ANC classes to prevent perineal rupture.

A Quality Improvement Project Utilizing a Clinical Practice Guideline in Women During Second-Stage Labor

Second-stage labor is the most challenging stage of labor, as it requires increasing exertion of the birthing woman. Variances in nursing interventions in second-stage labor have an influence on outcomes. There is disparity in nursing care during second-stage labor. The purpose of this project was to evaluate a clinical practice guideline in second-stage labor with respect to positioning, timing of pushing, type of pushing effort, and the effect on birth method and perineal trauma. Spontaneous vaginal birth increased, vacuum extraction birth decreased, and vaginal birth after cesarean doubled. The rate of episiotomy decreased, the rate of multiple types of lacerations decreased, the rate of vaginal wall tears decreased, and the need for wound suturing of birth acquired lacerations decreased.

Redefining Second Stage of Labor: Number of Pushing Contractions

Introduction Despite time standards for second stage labor, “delayed pushing,” uterine contraction frequency, and alternate contraction pushing may alter the effective maternal effort. We sought to quantify the number of pushing contractions needed for a spontaneous vaginal delivery (SVD) among primipara and multipara patients. Methods Deliveries at Harbor-UCLA Medical Center in 2017 were selected for SVD of singleton, term newborns. The first 100 primipara and 100 multipara deliveries were analyzed and monitor tracings quantified for pushing contractions. Results Significantly more pushing contractions were required by primiparas versus multiparas (17.3 ± 1.7 vs. 5.5 ± 0.7; p < 0.001) in accord with a longer second stage (86.7 ± 7.8 vs. 27.2 ± 4.9 min; p < 0.001) and epidural was associated with greater number of pushing contractions among both primipara (18.5 ± 1.8 vs. 10.8 ± 0.8) and multipara women (6.1 ± 0.8 vs. 4.1 ± 0.3). Newborn weight (<3000, 3000–3500, >3500 g) demonstrated a trend for increased pushing contractions among primipara (16.9, 16.5, 19.8 pushes, respectively) though not multiparas. Conclusion Although correlated with the absolute duration of the second stage, the number of pushing contractions eliminates ambiguities of “delayed pushing,” pushing every-other, and frequency of contractions. Examination of larger databases and patients with second stage “arrest disorders” may provide pushing contraction criteria predictive of SVD and prevention of morbidity.

Hubungan Faktor Maternal terhadap Posisi pada Waktu Persalinan Kala II terhadap Kejadian Ruptur Perineum

Perineal rupture needs attention because it can cause dysfunction of the female reproductive organs, as a source of bleeding, a source, or a way in and out of infection, then it can cause death due to bleeding or sepsis. About 85% of Women who delivery vaginally experience perineal rupture, in the age group 25-30 years 24%, while in maternal age 32-39 years by 62%. In Asia, perineal rupture is also a problem in society; 50 % of the world's occurrence is in Asia. The study aims to determine the relationship of maternal factors to the position of the second stage labor and perineal rupture occurrence. This research applied a descriptive-analytic method using a cross-sectional research design. The research sample was 102 respondents, accidental random sampling, which was all labor with perineal rupture in July to November 2018. Statistical tests used chi-square. The results of perineal rupture with maternal age was p-value 0.042 (p <0.05), perineal rupture with maternal parity was p-value 0.01 (p <0.05). Suggestions for various maternal positions in maternity and ANC classes to prevent perineal rupture.

Analisis Perbedaan Posisi Meneran Miring Kiri dan Setengah Duduk Pada Ibu Bersalin Dengan Lama Kala II Di RSUD Dr. H. Moch Anshari Saleh Banjarmasin

Latar Belakang: Lama Kala II dalam persalinan yaitu jangka waktu mulai dari serviks berdilatasi penuh sampai dengan kelahiran bayi tidak boleh melebihi 2 jam pada primigravidan dan 1 jam pada multigravida. Pemilihan posisi melahirkan sangat dianjurkan untuk memberikan rasa nyaman pada ibu, posisi dapat membantu penurunan janin ke dasar panggul dan mempercepat proses persalinan. Dari data yang diperoleh bulan Januari 2018 jumlah persalinan kala II lama sebanyak 0,30% dari 240 persalinan normal.Tujuan: Menganalisis Perbedaan Posisi Meneran Miring Kiri dan Setengah Duduk Pada Ibu Bersalin Dengan Lama Kala II.Metode: Jenis penelitian ini adalah Analisis kuantitatif. Rancangan penelitian menggunakan quasi eksperiment. Populasi penelitian semua ibu bersalin di RSUD Dr. H. Moch Anshari Saleh Banjarmasin. Pengambilan sebanyak 30 responden. Pengambilan data dilakukan dengan menggunakan ceklist. Analisa data yang dilakukan adalah Analisa Univariat dan Analisa Bivariat dengan uji Fisher Exact Test.Hasil: Responden yang menggunakan posisi meneran miring kiri 15 orang (50%) dan setengah duduk sebanyak 15 orang (50%). Jumlah responden primipara yang mengalami persalinan kala II 60 menit sebanyak 12 orang (40,0%), primipara yang mengalami kala II 60 menit sebanyak 2 orang (6,7%) dan responden multipara yang mengalami kala II 30 menit sebanyak 16 orang (53,3%), multipara yang mengalami kala II 30 menit sebanyak 0 orang (0%) dari hasil uji Fisher Exact Test dengan nilai p sebesar 0,483.Simpulan: Tidak ada perbedaan posisi miring kiri dengan posisi setengah duduk terhadap kemajuan persalinan kala II di RSUD Dr. H. Moch. Anshari Saleh Banjarmasin. Kata Kunci: Lama Kala II, Persalinan, Posisi Meneran. Analysis of Different Left and Half Posisition Straining on Mother with Second Duration of Labour In RSUD Dr. H. Moch Anshari Saleh BanjarmasinABSTRACT Background: The duration of second stage of labor is the period from the full dilated cervix to the birth of the baby should not exceed 2 hours in primigravida and 1 hour in multigravida. Position selection is very beneficial for giving comfort to the mother, the position can help lower the fetus to the pelvic floor and improve labor. From the data obtained in January 2018 the number of prolonged second stage deliveries was 0.30% of 240 normal deliveries.Objective: Analyze the Differences in Position Meniring Left and Half Seated at the Maternity with Long Time II.Method: This type of research is quantitative analysis. The study design used quasi experiment. The study population of all mothers giving birth at Dr. RSUD H. Moch Anshari Saleh Banjarmasin. Taking as many as 30 respondents. Data retrieval is done using a checklist. Data analysis performed was Univariate Analysis and Bivariate Analysis with Fisher Exact Test.Results: Respondents who used the left oblique piercing position were 15 people (50%) and half sat as many as 15 people (50%). The number of primiparous respondents who increased labor at second time 60 minutes was 12 people (40.0%), primipara who added second stage 60 minutes as many as 2 people (6.7%) and multiparous respondents who used second time 30 minutes as many as 16 people (53.3%), multiparas who replaced time II 30 minutes as many as 0 people (0%) from the results of the Fisher Exact Test with a p value of 0.483.Conclusion: There was no difference in left oblique position with sitting position towards the progress of second stage labor in Dr. Hospital. H. Moch. Ansari Saleh Banjarmasin. Keywords : Second Duration, Labour, Straining Position