Women with Severe Anemia in Labor: Fetomaternal Outcomes

Background: Anaemia in pregnancy is the leading medical disorder in developing countries like India. Women with severe anemia in labor is a challenging situation for the obstetrician with increased maternal and perinatal morbidity and mortality. It has multifactorial etiology, Main cause of anemia in obstetrics is iron deficiency. There are specific risks for the mother like preterm labour pain, IUGR baby, preeclampsia, antepartum haemorrhage, sepsis etc and the fetus such as prematurity, lowbirth weight, birth asphyxia etc. Aim and Objectives: To determine the socio-demographic variables and also the maternal and perinatal outcomes of pregnant women admitted to labour room with severe anemia (Hb <7gm%) late in pregnancy. Results: It was seen that out of 50 severely anemic women, 82% had Hb between 4-7 gm% and 18% had Hb < 4gm%. Severe anemia is seen in 82% unbooked patients and only in 18% booked patients. There was increased incidence of preterm delivery, PPH, preeclampsia, eclampsia, mortality in anemic group as compared to non anemic group. Among the adverse fetal outcomes, there was increased incidence of intrauterine deaths, intrauterine growth restriction, NICU admission, low birth weight among the anemic group as compared to non anemic group. Conclusions: Severely anemic women reporting in labor had significantly high maternal and perinatal morbidity and mortality. Even a minor blood loss is much devastating for such patients. Extrapolating our observations, it can be said that a close vigilance, anticipation of complications and appropriate care and interventions during labor and puerperium will help in improving outcomes in these severely anemic women. Awareness and education on early antenatal bookings, regular iron intake and continuous antenatal care should be the goal in tackling anemia in pregnancy. Key words: Anaemia, Iron deficiency, Intrauterine growth retardation, prematurity, maternal outcome, neonatal outcome.

Literature Review : Penerapan Metode Kompres Hangat Dalam Menurunkan Intensitas Nyeri Ibu Bersalin Kala 1 Fase Aktif

The unproper handied labour pain may ancrease blood pressure as well as oxygen demand, and decrease uterine contraction. Warm compress is a method that can be applied to reduce the intensity of pain during labour. this scientific report was written to describe the application of warm compresses to reduce the intensity of maternal pain during the first active phase of labour based on a literature review. this literature review was constructed by analyzing 3 articles takeen from Google Scholar with "labour pain", "firts active phase" and "warm compresses" the keywords, in the form of fulltext articles, and published during 2011 - 2021. From 78 respondent, 66.6% of them aged >25 years old, 58% were multipara, and 60.4% finished secondary education. The result showed that the average pain scale before the intervention was 5,3. Therefore, it can be concluded that warm compresses can reduce labour pain during the firts active phse. hence, health workers are suggested to give warm compresses to reduce the intensity of labour pain during the firts active phase.Keywords: Labour Pain; Warm Compresses; Stage 1 Active Phase AbstrakNyeri persalinan yang tidak ditangani dengan tepat dapat menyebabkan peningkatan tekanan darah, peningkatan kebutuhan oksigen dan penurunan kotraksi uterus. Metode kompres hangat merupakan salah satu intevensi yang dapat menurunkan intensitas nyeri pada ibu bersalin. Penulisan karya tulis ilmiah ini bertujuan untuk mengambarkan penerapan kompres hangat terhadap intensitas nyeri ibu bersalin kala 1 fase aktif berdasarkan literature review. Desain karya tulis ilmiah ini adalah Literature Review, dengan menganalisis 3 artikel yang diambil dari laman google scholar dengan kata kunci “nyeri persalinan”, “kala 1 fase aktif” dan “kompres hangat”, berupa artikel fulltext artikel terbit pada tahun 2011-2021 . Hasil analisa karakteristik responden berjumlah 78, 66,6% responden berusia >25 tahun, 58% paritas Multipara, dan 60,4% pendidikan menegah. Rata-rata skala nyeri sebelum intervensi 7,9 dan setelah intervensi 5,3. Kesimpulanya adalah kompres hangat dapat menurunkan nyeri pada ibu bersalin kala 1 fase aktif. Saran bagi tenaga kesehatan adalah memberikan kompres hangat untuk menggurangi intensitas nyeri bersalin kala 1 fase aktif.Kata kunci: Nyeri Persalinan; Kompres hangat; Kala 1 Fase Aktif

Literature Review : Tentang Massage Effleurage Terhadap Respon Nyeri Pada Ibu Bersalin Kala I

Contraction during labour can be painful. The pain due to labour process can be reduced by performing non-pharmacological treatment of Effleurage. Effelurage is a serries of massage which is done in the abdominal area aiming to reduce pain that arises during the labour process. The purpose of this study was to find out whether Effleurage could reduce pain response of mothers in the first phase labour. The study was a literature review of three articles taken from Google Scholar with the keyword “Effleurage”, “labour pain” and “first phase” in the form of fulltext articles, published in 2019. The respondents of the thre articles 63 mothers who gave birth. The average value of pain response showed by the respondents before and after being treated with Effleurage decreased from 5.883 to 3.576. Therefore, it was concluded that effleurage could be given to mothers to reduce the pain response in the labour process. Moreover, health providers are expected to treat mothers with Effleurage to reduce their pain to the labour process.Keywords: First phase, labour pain, Massage effleurage AbstrakKontraksi selama persalinan dapat menimbulkan rasa nyeri. Rasa nyeri yang dirasakan pada proses persalinan tersebut dapat dikurangi dengan melakukan tindakan non-farmakologis salah satunya berupa pemberianmassage effleurage. Massage effleurage yang dilakukan di area perut untuk membantu mengurangi rasa nyeri yang muncul pada proses persalinan. Tujuan karya tulis ilmiah ini untuk mengetahui apakah massage effleurage dapat menurunkan respon nyeri pada ibu bersalin kala I berdasarkan literatur review. Desain karya tulis ilmiah berupa literatur review dengan jumlah artikel tiga yang diambil dari laman jurnal google scholar dengan kata kunci “massage effleurage”. “nyeri persalinan” dan “kala I” berupa artikel fulltext, terbit tahun 2019. Jumlah responden dari tiga artikel tersebut adalah 63 ibu bersalin. Nilai rata-rata respon nyeri sebelum dilakukan massage effleurage 5,883, dan nilai rata-rata respon nyeri setelah dilakukan massage effleurage 3,576. Simpulannya adalah tindakan massage effleurage dapat membantu menurunkan respon nyeri pada proses persalinan. Saran bagi pelayanan kesehatan agar dapat menerapkan teknik massage effleurage untuk mengurangi nyeri pada proses persalinan.Kata kunci: Massage effleurage,nyeri persalinan, kala I

A Protocol on Comparative Evaluation of Epidural and Spinal Technique of Labour Analgesia in Rural Women of Central India and their Perceptions Regarding Pain Relief in Labour

Background: Labour pain while giving birth is one of the most excruciatingly painful and emotionally stressful experience for a woman that has piqued the interest of several academicians. Labour pain is induced due to the uterine ischemia, expansion of vagina and birth canal, muscle contractions, and pressure on the bladder. To relieve the severe pain during labour, analgesia is required, which offers pain relief without the loss of consciousness. Regional analgesia (Epidural and spinal) are most commonly used for offering pain relief to women. Aim: To evaluate whether low dose spinal analgesia is a better alternative to lumbar epidural analgesia for pain relief in labour. Objectives - Primary objective is to evaluate efficacy of lumbar epidural and spinal analgesia for pain relief in labour. Secondary objective is to evaluate the perceptions of women towards the use of labour analgesia, to evaluate the maternal and fetal outcome and to evaluate the barriers affecting the use of lumbar epidural and spinal analgesia for women during labour. Methods: In this randomized control trial study, where 60 patients are present in each group. Patients in GROUP E, epidural analgesia will be given using 18-gauge Touhy epidural needle by a loss of resistance to air technique, and after confirmation of space, an epidural catheter will be inserted cranially in L3 - L4 or L4-L5 interspace, and a dose of 15ml of 0.125% bupivacaine with 25µg of fentanyl would be given slowly. Group S patients will receive subarachnoid block using 25-gauge needle inserted and directed to reach the intrathecal space between L3 - L4 or L4 - L5 intervertebral space. After a successful Dural puncture with acceptable CSF flow, 0.1% bupivacaine 2ml with 25µg fentanyl will be given via spinal needle. Throughout the duration of delivery, hemodynamic monitoring including SPO2, ECG, heart rate and blood pressure of mother and fetal heart rate would be monitored under the guidance of obstetrician and anesthesiologists. Patient will be assessed every 5min for the first 15 min, and then every 15 minutes until additional analgesia was requested. The severity of labour pain would be assessed using visual analogue scale. (0 = no pain; 10 = severe pain). Within the first 24 - 48 hours postpartum patient will fill the self-administered questionnaires. Results: The groups are expected to be similar. However, Low dose spinal analgesia may be a better alternative to lumbar epidural analgesia in providing effective pain relief for women in labour in terms of cost effectiveness. There are no results found as it is just a protocol. Results are yet to come. Conclusions: The study would offer new insights and knowledge into the use of epidural and spinal analgesia in India, particularly Wardha. The perceptions of women, towards labour analgesia, its consequences or side effects, and the myths associated with its use will be comprehended.

Giving Birth on a Beach Women's Experiences of Using Virtual Reality in Labour A Pragmatic Mixed Methods Approach

<p><b>Birth is a normal physiological process, and many women want a natural birth. However, there is worldwide concern over the increasing use of epidural analgesia and other pharmacological pain relief methods for women in labour. This tendency renders birth non-physiological by increasing the use of obstetric interventions with associated risks. Women use a range of non-pharmacological pain relief methods to reduce labour pain intensity, to help manage labour pain and to induce relaxation. The purpose of this study was to explore the experiences of women using virtual reality (VR) as a non-pharmacological method of pain relief in labour and to determine whether there was an effect on labour pain intensity. Virtual reality has been shown to be an effective distraction technique in other acute pain settings and also reduces anxiety.</b></p> <p>This study used a pragmatic mixed method approach with a sequential exploratory design, combining in-depth antenatal and postnatal interviews with an intervention study in labour in a cross-over within-subjects trial. Thematic analysis was used to analyse the qualitative data.</p> <p>Twenty-six pregnant women were recruited to the study. Fourteen participants reported their pain and had their heart rate and blood pressure measured during active labour while using and not using VR. There were significantly lower reported pain scores (6.14 compared to 7.61, p =<.001) and maternal heart rate (79.86 beats per minute compared to 85.57, p = .033) and mean arterial pressure (88.78 mmHg compared to 92.61 mmHg, p = .022) were lower when using VR during active labour. These differences were all statistically significant. Findings from qualitative postnatal interviews indicated a positive response to the use of VR in labour. Several themes were identified in the data. The first theme, Impact of VR on Labour, described the impact of VR on labour in terms of distraction, relaxation, enjoyment and a positive birth experience. The second theme, Managing the Pain, describes how VR was used by the women to manage their labour pain using breathing techniques and gaining a sense of control. In the third theme, The Challenges and Surprises of Using VR in Labour, women’s narratives recounted the various challenges of using the VR technology. Despite these challenges, ninety-four percent of women reported that they would use VR in labour again and would recommend it to a pregnant friend.</p> <p>This study provides a unique and original contribution to the field of VR in labour and birth. It is consistent with other recent findings of reduced pain with the use of VR, and links decreased pain scales to heart rate and blood pressure, the physiological markers of pain. It also identifies VR as an acceptable and positive experience in the management of labour pain. Results from this study have the potential to inform design for future labour specific VR environments and expand its application in the field of biomedical technology.</p>

Giving Birth on a Beach Women's Experiences of Using Virtual Reality in Labour A Pragmatic Mixed Methods Approach

<p><b>Birth is a normal physiological process, and many women want a natural birth. However, there is worldwide concern over the increasing use of epidural analgesia and other pharmacological pain relief methods for women in labour. This tendency renders birth non-physiological by increasing the use of obstetric interventions with associated risks. Women use a range of non-pharmacological pain relief methods to reduce labour pain intensity, to help manage labour pain and to induce relaxation. The purpose of this study was to explore the experiences of women using virtual reality (VR) as a non-pharmacological method of pain relief in labour and to determine whether there was an effect on labour pain intensity. Virtual reality has been shown to be an effective distraction technique in other acute pain settings and also reduces anxiety.</b></p> <p>This study used a pragmatic mixed method approach with a sequential exploratory design, combining in-depth antenatal and postnatal interviews with an intervention study in labour in a cross-over within-subjects trial. Thematic analysis was used to analyse the qualitative data.</p> <p>Twenty-six pregnant women were recruited to the study. Fourteen participants reported their pain and had their heart rate and blood pressure measured during active labour while using and not using VR. There were significantly lower reported pain scores (6.14 compared to 7.61, p =<.001) and maternal heart rate (79.86 beats per minute compared to 85.57, p = .033) and mean arterial pressure (88.78 mmHg compared to 92.61 mmHg, p = .022) were lower when using VR during active labour. These differences were all statistically significant. Findings from qualitative postnatal interviews indicated a positive response to the use of VR in labour. Several themes were identified in the data. The first theme, Impact of VR on Labour, described the impact of VR on labour in terms of distraction, relaxation, enjoyment and a positive birth experience. The second theme, Managing the Pain, describes how VR was used by the women to manage their labour pain using breathing techniques and gaining a sense of control. In the third theme, The Challenges and Surprises of Using VR in Labour, women’s narratives recounted the various challenges of using the VR technology. Despite these challenges, ninety-four percent of women reported that they would use VR in labour again and would recommend it to a pregnant friend.</p> <p>This study provides a unique and original contribution to the field of VR in labour and birth. It is consistent with other recent findings of reduced pain with the use of VR, and links decreased pain scales to heart rate and blood pressure, the physiological markers of pain. It also identifies VR as an acceptable and positive experience in the management of labour pain. Results from this study have the potential to inform design for future labour specific VR environments and expand its application in the field of biomedical technology.</p>

To Assess the Effectiveness of Breathing Exercise on Labour Pain and Behavioral Response of Primi Gravida Mothers during First Stage of Labour, at Selected Maternity Hospitals

Background of the Study: Labour is tough and headaches occur, however mother's our bodies are designed to supply birth. The shape of the pelvis, hormones, effective muscle mass and further all paintings collectively that may help mother to convey her child into the globe - before, within the course of and after childbirth. Objectives: 1. To assess pain intensity level among the Primi gravida mothers during first stage of labour in experimental and control group.2. To assess the behavioral response of primi gravid mothers during 1st stage of labour in control and Experimental group. 3. To determine the effectiveness of breathing exercise on labour pain among primi gravida mothers during first stage of labour.4. To determine the effectiveness of breathing exercise on behavioral response among primi gravida mothers during first stage of labour. 5. To determine the association between selected demographic variables and pain of primi gravida mothers during first stage of labour.6. To determine the association between selected demographic variables and behavioral response of prim gravid mothers during first stage of labour. Material and Methods: The design of this research study was based on a True Experimental research design with a pre-test and post-test control group. A total of 400 mothers were included in the study (200 in experimental group and 200 in control group). The samples were chosen using the probability simple random sampling technique. The data will be gathered using Baseline Proforma and an observational check list. Expected Results: At selected Maternity hospitals, this study will assess the effects of respiratory exercise on Childbirth pain and behavioral responses of primi gravida moms during the early stage of childbirth. After intervention, the degree of discomfort in primi gravida women should be reduced, and their behavioral reaction should improve. Conclusion: Final conclusion is drawn from the ultimate results of the statistical review.

Effectivity of Large Intestine 4 Point Accupressure on Labour Pain Stage-I Active Phase

Background: Law of the Republic of Indonesia No. 36 of 2009 concerning traditional health services (Yankestrad), namely articles 1, 48, 59, 60 and 61. Acupressure is included in Yankestrad skills that are easy, cheap, simple, effective, and without any side effects. harmful. Acupressure at the Large Intestine 4 Point (LI4) based on the literature is able to reduce labor pain in the first stage of the active phase. Methods: This type of research is quasi-experimental with a pre-test and post-test research design. The samples were divided into two groups, the treatment group and the control group. Results: Based on the results of the research that has been carried out, it can be concluded as follows: Active phase I labour pain before being given Acupressure Therapy for primigravida mothers in PMB Aceh Besar District averaged 7.35. Active phase I labour pain after being given Acupressure Therapy to primigravida mothers in PMB Aceh Besar District decreased by an average of 5.47. Conclusions: There are differences in labour pain in the stage-I of active phase in the Acupressure therapy group with the Routine care group for the stage-I of labour for primigravida mothers in PMB Aceh Besar District.

Outcome of Preterm Labour in SSMC Mitford Hospital, Dhaka.

Introduction: : Preterm birth as a consequence of preterm labour is the major clinical problem associated with perinatal mortality, serious neonatal morbidity and moderate to severe childhood disability and two-thirds of all perinatal deaths. Moreover, preterm labour comprises a large number of low birth weight babies. Global incidence of preterm labour is 5-10% of all births. The aim of this study was to determine the clinical profile and to find out pregnancy outcomes of preterm labour. Materials & Methods: This cross-sectional study was conducted in Sir Salimullah Medical College Mitford Hospital, Dhaka from January 2005 to December 2005. A total 103 gravid women who got admitted with established premature labour pain were included as study patients. Preterm labour associated with severe pre-eclampsia, eclampsia, antepartum haemorrhage and intrauterine fetal death were excluded. Data were collected in a pre-designed questionnaire and analyzed by SPSS software. Results: Incidence of preterm labour was found 6.3%. Among maternal morbidities, puerperal sepsis found to be highest (14.56%) followed by UTI (7.77%), PPH (6.80%), wound infection (5.83%) and retained placenta (3.88%). This study found perinatal mortality 32.0% and morbidity 49.5% of which RDS contributed highest (24.27%) followed by neonatal jaundice (11.65%), septicemia (8.73%), neonatal convulsion (2.91%) and umbilical sepsis (1.94%). Conclusion: Preterm labor followed by preterm birth significantly contributes to maternal morbidity and perinatal morbidity and mortality. Medicine Today 2021 Vol.33(2): 143-146