Factors hindering midwives' utilisation of alternative birth positions during labour in a selected public hospital

Background: An evidence-based practice suggests that the birth position adopted by women during labour has a significant impact on the maternal and neonatal birth outcomes. The birth positions are endorsed by guidelines of maternity care in South Africa, which documented that women in labour should be allowed to select the birth position of their choice, preferably alternative birth positions (including upright, kneeling, squatting and lateral positions) during labour. Thus, the lithotomy birth position should be avoided. However, despite available literature, midwives routinely position women in the lithotomy position during normal vertex births, which causes several adverse maternal outcomes (namely prolonged labour, postpartum haemorrhage) and adverse neonatal outcomes (such as foetal asphyxia and respiratory compromise). Aim: The aim was to explore and describe factors hindering midwives' utilisation of alternative birth positions during labour in a selected public hospital. Setting: A public hospital in the Tshwane district, Pretoria were used in the study. Methods: This study used the qualitative, exploratory and descriptive research design. This design gathered quality information on factors hindering midwives' utilisation of alternative birth positions during labour in a selected public hospital. Results: The study revealed the following themes: (1) midwives' perceptions on alternative use of birth positions and (2) barriers to utilisation of alternative birth positions. The themes were discussed and validated through the use of a literature review. Conclusion: The lack of skills and training during the midwifery undergraduate and postgraduate programme contributes to the midwives being incompetent to utilise alternative birth positions during clinical practice

Determinants of preterm delivery in the central zone of Tigray, northern Ethiopia: a case-control study

Background. Preterm birth remains one of the most serious problems in obstetrics care globally. In Ethiopia preterm delivery is a direct cause of 28% newborn deaths. However, little is known about the risk factors of preterm birth.Objective. To determine risk factors of preterm birth in Tigray, Ethiopia.Methods. A hospital-based, unmatched case-control study was conducted among 288 respondents (cases=96; controls=192). Data were collected during individual interviews and through a chart review. Statistical analysis included descriptive statistics and bivariate and multivariate binary logistic regression analysis (significance level p<0.05). Results. The response rate was 100%. The mean (standard deviation) age of the respondents was 26.1 (5.9) years. Urban residence (adjusted odds ratio (aOR) 3.11; 95% confidence interval (CI) 1.181 - 8.168)), gynaecological problems (aOR 8.9; 95% CI 1.580 - 50.252), hard physical work during pregnancy (aOR 3.85; 95% CI 1.622 - 9.144), being younger than 18 (aOR 4.56; 95% CI 1.702 - 12.215) and being a first-time mother (aOR 4.66; 95% CI 1.635 - 13.254) were identified as statiscally significant risk factors of preterm delivery. Micronutrient supplementation (aOR 0.26; 95% CI 0.008 - 0.084) and nutritional counselling during pregnancy (aOR 0.24; 95% CI 0.067 - 0.862) were identified as protective factors against preterm birth. Conclusion. The study identified various factors associated with an increased risk of preterm birth and also some protective factors against preterm birth. Programmes to improve maternal and newborn healthcare are recommended to reduce the incidence of preterm births in this region

A comparison of orally administered misoprostol and membrane sweeping for labour induction in uncomplicated singleton post-term pregnancies

Objectives. This study assessed the efficacy of the two outpatient processes of single-dose 50 µg oral misoprostol (OM) and membrane sweeping (MS) on the outcome of labour induction and the possibility of reducing the need for hospital admission for cervical ripening/labour induction in uncomplicated post-term singleton pregnancies at a tertiary health institution in south-western Nigeria. Methods. A total of 100 patients were equally randomised into the two groups between April 2007 and March 2010. Primary outcome measures were delivery within 48 hours after the start of induction and route of delivery. Secondary outcome measures were time interval from induction to onset of labour (latency period), time interval from start of induction to delivery (duration of labour), need for oxytocin augmentation, labour complications, Apgar scores at 1 and 5 minutes, and need for neonatal intensive care unit (NICU) admission. Results. Both groups were similar at the baseline with regard to age, parity and days beyond 40 weeks' gestation. There was a significantly shorter induction to onset of labour (latency) interval in the OM group, with a mean of 17.0 hours compared with 31.9 hours in the MS group (p=0.005), with 82.0% of the patients in the OM group in spontaneous labour within the latency period of 18 hours as opposed to 32.6% of the MS group (p<0.005). Forty-two patients in the OM group and 40 in the MS group had a vaginal delivery (84.0% v. 87.0%, p=0.361), with 12 and 20 patients in the OM and MS groups, respectively, requiring oxytocin augmentation (p=0.023). The duration of labour was significantly shorter in the OM group, in which 78.6% of those who had a vaginal delivery achieved it within 9 hours, compared with 57.5% in the MS group (p=0.036). Overall, neonatal outcomes and need for NICU admission were similar and comparable in the two groups. On a preference scale, 43% of the women in the MS group felt positive about the intervention, compared with 92% of the women in the OM group. Conclusion. The study demonstrated a shorter latency period, less need for oxytocin augmentation and shorter duration of labour in patients who received OM. The two induction agents were similar with regard to neonatal outcomes and need for NICU admission. Both showed good safety profiles for outpatient care, although further assessment of the safety profile with larger studies will be needed. More patients felt positive about the intervention in the OM group than in the MS group

Methods of Induction of Labour at the University of Maiduguri Teaching Hospital, Maiduguri: A 4-Year Review

Background: Induction of labour is an important intervention in obstetrics. Misoprostol is increasingly being used for induction of labour in many obstetric units and it may replace the traditional Foleys catheter/oxytocin protocol. Method: This was a retrospective study of the 3 methods of induction of labour used at the University of Maiduguri Teaching Hospital (UMTH). A total of 468 women had induction of labour during the study period. Two hundred and twenty eight of them had induction with 50?g of misoprostol; 57 women had 100?g of misoprostol while 183 women had extra-amniotic Foleys catheter with oxytocin infusion. Result: Induction of labour constituted 6.6(468/7086) of all deliveries during the study period. The commonest indication for induction of labour was prolonged pregnancy in 46.8; followed by pregnancy induced hypertension in 33.5. There was no difference in the achievement of vaginal delivery between the 3 methods of induction of labour (x2=1.13; p=0.57). The mean induction delivery time was shortest for those induced with 100?g of misoprostol (6.38+2.25 hours); followed by 8.16+3.58 hours in those induced with 50ug of misoprostol and 9.73+4.32.43 hours in those induced with Foleys catheter/oxytocin (p

Declenchement artificiel du travail d'accouchement sur foetus vivant a la maternite du CHU de Treichville : etude descriptive et retrospective

OBJECTIFS : Ce travail avait pour objectifs : -D'apprecier la pratique du declenchement artificiel du travail d'accouchement ; -De determiner la frequence du declenchement dans le service ; -De rapporter les resultats. PATIENTES ET METHODE : Il s'agissait d'une etude retrospective descriptive s'etendant sur 12 mois. Il a ete retenu 50 dossiers selon les criteres de selection precis. Et nous avons etudie les caracteristiques epidemiologiques des patientes; puis les parametres lies au declenchement et enfin les resultats des declenchement. RESULTATS : *le profil de la gestante beneficiant d'un declenchement. L'age moyen de nos patientes etait 28 ans. Ces gestantes etaient paucigestes (46pour cent) et paucipares (48pour cent). Dans la majorite des cas elles etaient adressees par un medecin du service (64pour cent). Dans 66pour cent des cas la grossesse etaient a terme. *La frequence du declenchement etait de 1;52pour cent ; *Les indictions son dominees par les declenchement de necessite (80pour cent) ; represente surtout par la rupture premature des membranes (40pour cent) et le depassement de terme (40pour cent) ; *Les resultas sont marques par : un taux de cesarienne de 22pour cent ; des indications de cesarienne representees par la souffrance foetale dans 72;7pour cent ; 92pour cent des nouveau-nes avec un bon indice d'APGAR ; Un enfant mort-ne ; Des suites de couche simples

Accouchement assisté par ventouse : à propos de 147 cas à la maternité du CHU de Cocody

Notre travail est une etude retrospective et descriptive realisee du 1er janvier 2003 au 31 decembre 2004. Son but est d'evaluer les accouchements assistes par ventouse dans le service de Gynecologie et Obstetrique du C.H.U. de Cocody. Il ressort de notre etude que la frequence de la pratique de la ventouse est de 1;72pour cent. Elle est realisee chez des patientes ayant en moyenne 24 ans d'age; nullipares (79;59pour cent) et evacuees des formations sanitaires peripheriques (71;43pour cent). Les indications des extractions par ventouse sont a predominance maternelles (78;23pour cent); dominees par les mauvais efforts expulsifs (70;07pour cent). Les indications foetales (21;77pour cent) se resument essentiellement a la souffrance foetale aigue (13;61pour cent). Les ventouses ont; dans la quasi-totalite des cas; ete posees par des medecins-CES et la variete de presentation n'a pas ete precisee. Le pronostic foetal est marque est marque par un taux de mortalite de 14;29pour cent; lie en grande partie a la souffrance foetale preexistante. L'indice d'APGAR est satisfaisant dans 50;34pour cent des cas a 5 minutes. Les lesions traumatiques sont dominees par la bosse sero-sanguine (29;93pour cent). Concernant le pronostic maternel; les lesions sont representees par les dechirures cervicales (2;04pour cent) et les dechirures perineales (1 ;36pour cent). Cependant les faibles taux de complications graves plaident en faveur d'une utilisation croissante de la ventouse donc de son enseignement rigoureux