A randomized comparative study of effect of intramuscular valathemate bromide (epidosin) and intramuscular camylofin dihydrochloride (anafortan) on cervical dilatation in labour

Background: Our aim is to search for a good cervical dilating agent which is not only more efficacious in cervical dilatation but also effective in relieving pain during labour with no or very little harmful effects on mother and foetus.Methods: The type of study was simple randomized comparative study. The present study was conducted in R. N. T. Medical College, Udaipur between October 2019 and December 2020. 118 patients were selected randomly. Two groups were made each consisting of 59 patients. First group received intramuscular camylofin dihydrochloride, second group received intramuscular (IM) valethamate bromide. Patients included in study group were: primigravidae/multigravidae, singleton full term gestation (37-40 weeks) with vertex presentation, cervical dilatation of ≥3 cm and patient excluded from study group with preclampsia, eclampsia, antepartum haemorrhage, any obstetric complications: cephalo pelvic disproportion, abnormal presentations.Results: Mean duration of active phase of first stage of labor was shorter in group I (313.17 minutes) than in group II (356.3 minutes) but not statistically significant. Mean cervical dilatation rate was significantly more in group I (2.02 cm/hour) than group II (1.81 cm/hour). Anafortan was effective in pain relief with mean pain score 5.31±1.06 while mean pain score for epidosin group was 7.37±1.07.Conclusions: In our study we observed that intramuscular camylofin dihydrochloride (anafortan) was more efficacious than IM valethamate bromide (epidosin) in shortening the duration of labor as well as in pain relief.

Labour classified by cervical dilatation & fetal membrane rupture demonstrates differential impact on RNA-seq data for human myometrium tissues

High throughput sequencing has previously identified differentially expressed genes (DEGs) and enriched signalling networks in human myometrium for term (≥37 weeks) gestation labour, when defined as a singular state of activity at comparison to the non-labouring state. However, transcriptome changes that occur during transition from early to established labour (defined as ≤3 and >3 cm cervical dilatation, respectively) and potentially altered by fetal membrane rupture (ROM), when adapting from onset to completion of childbirth, remained to be defined. In the present study, we assessed whether differences for these two clinically observable factors of labour are associated with different myometrial transcriptome profiles. Analysis of our tissue (‘bulk’) RNA-seq data (NCBI Gene Expression Omnibus: GSE80172) with classification of labour into four groups, each compared to the same non-labour group, identified more DEGs for early than established labour; ROM was the strongest up-regulator of DEGs. We propose that lower DEGs frequency for early labour and/or ROM negative myometrium was attributed to bulk RNA-seq limitations associated with tissue heterogeneity, as well as the possibility that processes other than gene transcription are of more importance at labour onset. Integrative analysis with future data from additional samples, which have at least equivalent refined clinical classification for labour status, and alternative omics approaches will help to explain what truly contributes to transcriptomic changes that are critical for labour onset. Lastly, we identified five DEGs common to all labour groupings; two of which (AREG and PER3) were validated by qPCR and not differentially expressed in placenta and choriodecidua.

The Integrated Neurophysiology of Emotions during Labour and Birth: a Feminist Standpoint Exploration of the Women's Perspectives of Labour Progress

<p>Within childbirth there is a common and widely known explanation of labour and birth which describes and defines the birth process as that of stages and phases. The boundaries between the stages and phases have been determined by cervical dilatation with time parameters set to measure progress. The measurement of cervical dilatation is determined by a health professional and has resulted in an apparent inability of women to determine themselves whether they are in labour and their closeness to the impending birth. The aims of this thesis were threefold; the first was to critically examine the knowledge base of labour progress, so that the influences on knowledge development were fully understood. Through exploring the historical and theoretical development I found that the current knowledge has come from a male understanding of female anatomy and observational data constructed within a discourse of male, medical, scientific superiority. The second aim of the thesis was to explore the perspectives of women who had experienced a spontaneous labour and birth in order to determine whether the discourse of labour as stages and phases resonated with them. This leads to the third aim of providing a description of the women’s voices and perspectives based on their experiential knowledge of spontaneous labour and birth. A critical feminist ontology and feminist standpoint methodology guided the research which used in-depth one-to-one interviews with 18 women who had experienced a spontaneous labour and birth. Early thematic analysis was developed further through feedback from the participants supporting a coconstruction of knowledge. Analysis revealed that women considered the stages and phases of labour to be an abstract concept which did not resonate with their experiences of labour and birth. An important aspect of labour was having support during the process, in terms of both emotional and physical support from midwives, partners, family and friends present during the labour and birth. Women’s perceptions were dominated by their feelings and a linear pattern of feelings was discerned consistently amongst the participants. The emotions of labour were an important finding in this research but during the feedback process the women requested a scientific foundation to support the findings. I therefore explored the recent advances in theoretical understanding of the role of emotion, cognition, physiology and behaviour. Contemporary theories define emotions and neurohormones as bi-directional and intricately linked to behaviour change and physiological adaptations. I argue that the feelings women have described give an indication of an underlying hormonal influence and a directing of behaviour, necessary for labour to move towards birth. The hormones involved in labour also support maternal behaviour and attachment to the baby. I suggest a new conceptual understanding of labour as the integration of the mind, body and behaviour in which the feelings and hormones that initiate and sustain labour to birth also support the necessary adaptation and transition to becoming a mother. This integrated neurophysiologic concept will help midwives and other health professionals involved in maternity to recognise emotions as a key to understanding physiological labour and birth. It has also highlighted the importance of emotional and physical support during labour. Further research is necessary to test the hypothesis that women experience a similar range of emotions at similar times during a spontaneous labour and birth and to what extent the described emotions resonate with other women’s experiences.</p>

The Integrated Neurophysiology of Emotions during Labour and Birth: a Feminist Standpoint Exploration of the Women's Perspectives of Labour Progress

<p>Within childbirth there is a common and widely known explanation of labour and birth which describes and defines the birth process as that of stages and phases. The boundaries between the stages and phases have been determined by cervical dilatation with time parameters set to measure progress. The measurement of cervical dilatation is determined by a health professional and has resulted in an apparent inability of women to determine themselves whether they are in labour and their closeness to the impending birth. The aims of this thesis were threefold; the first was to critically examine the knowledge base of labour progress, so that the influences on knowledge development were fully understood. Through exploring the historical and theoretical development I found that the current knowledge has come from a male understanding of female anatomy and observational data constructed within a discourse of male, medical, scientific superiority. The second aim of the thesis was to explore the perspectives of women who had experienced a spontaneous labour and birth in order to determine whether the discourse of labour as stages and phases resonated with them. This leads to the third aim of providing a description of the women’s voices and perspectives based on their experiential knowledge of spontaneous labour and birth. A critical feminist ontology and feminist standpoint methodology guided the research which used in-depth one-to-one interviews with 18 women who had experienced a spontaneous labour and birth. Early thematic analysis was developed further through feedback from the participants supporting a coconstruction of knowledge. Analysis revealed that women considered the stages and phases of labour to be an abstract concept which did not resonate with their experiences of labour and birth. An important aspect of labour was having support during the process, in terms of both emotional and physical support from midwives, partners, family and friends present during the labour and birth. Women’s perceptions were dominated by their feelings and a linear pattern of feelings was discerned consistently amongst the participants. The emotions of labour were an important finding in this research but during the feedback process the women requested a scientific foundation to support the findings. I therefore explored the recent advances in theoretical understanding of the role of emotion, cognition, physiology and behaviour. Contemporary theories define emotions and neurohormones as bi-directional and intricately linked to behaviour change and physiological adaptations. I argue that the feelings women have described give an indication of an underlying hormonal influence and a directing of behaviour, necessary for labour to move towards birth. The hormones involved in labour also support maternal behaviour and attachment to the baby. I suggest a new conceptual understanding of labour as the integration of the mind, body and behaviour in which the feelings and hormones that initiate and sustain labour to birth also support the necessary adaptation and transition to becoming a mother. This integrated neurophysiologic concept will help midwives and other health professionals involved in maternity to recognise emotions as a key to understanding physiological labour and birth. It has also highlighted the importance of emotional and physical support during labour. Further research is necessary to test the hypothesis that women experience a similar range of emotions at similar times during a spontaneous labour and birth and to what extent the described emotions resonate with other women’s experiences.</p>

The effect of Hyoscine Butylbromide on the rate of vaginal delivery in cases of secondary arrest of cervical dilatation: A rondomized controlled clinical trial

Background For decades, health providers have worked to manage labor actively and safely, with the goal of shortening the duration of painful labor. Reduction of cesarean sections and maternal complication is also an important aspect of labor management. Antispasmodic are commonly administrating during labor in both developing and developed countries, although there is a paucity of scientific reports validating this. Hyoscine butylbromide is an effective antispasmodic drug. Therefore, We aim to assess efficacy of Hyoscine butylbromide on rate of vaginal delivery in cases of 2ry arrest of cervical dilatation. Objective To assess whether the intravenous injection of hyoscine butylbromide is effective in progress of labor in which cases with 2ry arrest of cervical dilatation. Patients and Methods The study included 100 pregnant women (PG, P1, P2, P3) conducted at Ain Shams University Maternity Hospital, the inclusion Criteria were: term uncomplicated singleton pregnancy in a spontaneous active labor, with cephalic presentation. The patient must be free from any medical disorder associated with pregnancy and free from any obstetric complication. Cases were subdivided into 2 groups: Study group: 50 patients received 40mg iv Hyoscine Butylbromide (as Buscopan 20mg\mrl) when the cervix &gt;4cm dilated and was &gt;50% effaced. Control group: 50 patients received 2ml saline as placebo. Results Significant increase in vaginal delivery rate (72%) in Hyoscine group; compared to Saline group (52%); with significant statistical difference (p = 0.04). Highly significant decrease in 1st and 2nd stage labor time in Hyoscine group; compared to Saline group; with highly significant statistical difference (p &lt; 0.05 respectively). These results observed without significant difference as regards 3rd stage labor time and postpartum hemorrhage (p &gt; 0.05), APGAR score and NICU admission (p &gt; 0.05). Conclusion From the current study we can conclude that HBB 40 mg is safe and effective in increasing vaginal delivary rate in cases of 2ry arrest of 12 dilatation. It is effective in decreasing first and second stage of labor. It has no maternal or neonatal adverse effect. It is easy and available.

Caesarean section in second stage of labour: a commentary on principles and techniques

Caesarean section done at full cervical dilatation (second stage of labour) has been on the rise globally and comes with its own unique challenges and complications. This commentary highlights the peculiar challenges associated with caesarean section in second stage of labour and gives an overview on various principles to be followed and techniques to employ to reduce fetal and maternal morbidity.