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ABSTRACT BACKGROUND AND OBJECTIVES: Pain is the most frequently reported symptom in the immediate puerperium. The aim of this study was to quantify pain levels and sociodemographic, obstetric, and care characteristics associated with severe pain and inadequate analgesia according to the mode of delivery. METHODS: Observational, descriptive, cross-sectional study conducted between October and December 2020, with a sample of 229 postpartum women considered eligible (baby born alive, weighing > 500 g and/or gestational age > 22 weeks) to answer the study questionnaire. RESULTS: The mean reported pain was 5.34 by Visual Analogue Scale (VAS) and there was a difference (p<0.001) between modes of delivery. Cesarean section was associated with severe pain (p=0.006) and pain above eight on the VAS (p=0.02). Vaginal delivery was associated with the perception of inadequate analgesia (p=0.04). Severe pain reported was associated with the admission of the baby to the ICU (p=0.01) and cases of postpartum hemorrhage (p=0.002). Among women who gave birth vaginally, there was an association between severe pain and instrumental delivery (p=0.05). Reported severe pain was associated with difficulties in self-care (p<0.001) and care of the newborn (p= 0.02), sensation of weakness (p<0.001), and fainting (p=0.002). The perception of inadequate analgesia was associated with vaginal birth (p=0.04) end non-white skin color (p=0,03). CONCLUSION: The average reported pain was moderate. Intense pain and the perception of inadequate analgesia were associated with instrumental delivery, newborns being referred to the NICU, postpartum hemorrhage, and non-white skin color.
RESUMO JUSTIFICATIVA E OBJETIVOS: A dor é o sintoma mais frequentemente relatado no puerpério imediato. O objetivo deste estudo foi quantificar os níveis de dor e as características sociodemográficas, obstétricas e da assistência associadas à dor intensa e à percepção de analgesia inadequada segundo a via de nascimento. MÉTODOS: Estudo observacional, descritivo, transversal, conduzido entre outubro e dezembro de 2020, com uma amostra de 229 puérperas consideradas elegíveis (nativivos com peso > 500g e/ou idade gestacional > 22 semanas) para responder ao questionário do estudo. RESULTADOS: A média de dor relatada foi 5,3 pela Escala Analógica Visual (EAV) e houve diferença (p<0,001) entre as vias de nascimento. A cesariana apresentou associação com dor intensa referida (p=0,006) e dor acima de oito pela EAV (p=0,02). O parto vaginal obteve associação com percepção de analgesia inadequada (p=0,04). Entre as mulheres que referiram dor intensa, houve associação com recém-nascido encaminhado à unidade de terapia intensiva neonatal (UTIN) (p=0,01) e nos casos de hemorragia pós-parto (p=0,002). Entre as mulheres que tiveram parto vaginal, também houve associação entre dor intensa e o parto instrumental (p=0,05). Dor intensa referida teve associação com dificuldades para o autocuidado (p<0,001) e do recém-nascido (p=0,02), sensação de fraqueza (p<0,001) e de desmaio (p= 0,002). A percepção de analgesia inadequada esteve associada a parto vaginal (p=0,04) e cor da pele não branca (p=0,03). CONCLUSÃO: A média de dor relatada foi moderada. Dor intensa e percepção de analgesia inadequada estiveram associadas com parto instrumental, recém-nascido encaminhado à UTIN, hemorragia pós-parto e cor de pele não branca.
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Objective: We aimed to translate and determine cultural validity of the Vaginal Changes Sexual and Body Esteem Scale (VSBE) for Brazilian Portuguese language in postpartum women who underwent vaginal delivery with or without perineal laceration and cesarean section. Methods: A cross-sectional study conducted virtually, with online data collection through a survey with 234 postpartum women of 975 that were invited. Clinical, sociodemographic, and psychometric variables from the VSBE questionnaire were analyzed (content validity index, internal consistency, test-retest reliability, construct/structural and discriminant validity). Multivariate analysis was performed to explore associated factors with the presence of perineal laceration. Results: One-hundred fifty-eight women experienced vaginal delivery, of which 24.79% had an intact perineum, 33.33% had perineal laceration, and 9.4% underwent episiotomy; and 76 participants had cesarean sections. Women with perineal laceration were older, presented dyspareunia and previous surgeries than women without perineal laceration (p<0.05). For VSBE, a high internal consistency (Cronbach's α > 0.7) was observed, but it did not correlate with Body Attractiveness Questionnaire and Female Sexual Function Index; however, it correlated with the presence of women sutured for perineal laceration. Moreover, VSBE presented good structural validity with two loading factors after exploratory factor analysis. VSBE also demonstrated discriminant validity between the presence or absence of perineal laceration. The presence of urinary incontinence (UI) (OR=2.716[1.015-4.667];p=0.046) and a higher VSBE total score (OR=1.056[1.037-1.075];p<0.001) were the only factors associated with perineal laceration. Conclusion: Vaginal Changes Sexual and Body Esteem Scale demonstrated appropriate translation and good internal consistency, discriminant/construct validity and reliability. Vaginal Changes Sexual and Body Esteem Scale total score and presence of UI were associated with women that underwent perineal laceration.
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Humanos , Femenino , Autoimagen , Cesárea , Sexualidad , Periodo PospartoRESUMEN
Background: The hematological values of the new born is amenable to certain changes under the influence of fetal, maternal, and environmental factors. Aims and Objectives: The aims of this study was to study the effect of maternal factors on hemoglobin content and reticulocyte count in umbilical cord blood of newborns of Sikkim. Materials and Methods: A total of 150 cord blood samples from newborns delivered at CRH Hospital and STNM Govt. Hospital, Gangtok, Sikkim were analyzed. Two ml of cord blood was taken in an ethylene diamine tetra acetic acid tube under aseptic condition and within 6 h: Hemoglobin estimation and Reticulocyte count was done. Results: The mean reticulocyte count was 2.48 ± 0.87% in normal vaginal delivery (NVD) and in C/S was 3.06 ± 0.97%. The mean hemoglobin content was 13.9 ± 2.6 g/dL in NVD and in C/S was 16.1 ± 3.4 g/dL. P < 0.05 for cord hemoglobin and reticulocytes in relation to mode of delivery was found to be highly significant. The mean reticulocyte count was 2.85 ± 1.0% in normal pregnancy and in complication of pregnancy was 2.9 ± 0.70%. The mean hemoglobin content was 15.36 ± 3.31 g/dL in normal pregnancy and in complication of pregnancy was 16.1 ± 3.4 g/dL. The reticulocyte count was found to be statistically significant in relation to complication of pregnancy. The mean mother’s hemoglobin was 11.16 ± 1.27 when cord hemoglobin content was <14 g/dL and was 11.88 ± 1.24 g/dL when cord hemoglobin content was >14 g/dL. There was statistical significance between the cord hemoglobin content and the hemoglobin content of the mother. Conclusion: Maternal anemia leads to lower circulating hemoglobin in new born. Cord blood screening is a useful means for identification of anemia in neonatal period. High reticulocyte count in neonates denotes active erythropoiesis which might help to defer transfusion unless there were other special reasons for proceeding.
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Objective:To explore the effect of oral nutritional supplements (ONS) during labor on delivery outcomes in low-risk pregnant women and the risk factors of cesarean section.Methods:A retrospective analysis was conducted in a total of 206 full-term pregnant women with singleton and cephalic presentation at the delivery center in our hospital from March 15th to May 15th, 2022. Standard diet education was given to all those women by midwives. Pregnant women who received the enteral nutrient solution prepared by the Department of Clinical Nutrition during labor were in the ONS group ( n = 110), while those who did not were in the control group ( n = 96). The baseline characteristics and delivery outcomes were compared between the two groups, and the risk factors of cesarean section were also analyzed. Results:There were no significant differences in terms of maternal age, height, baseline weight, baseline body mass index (BMI), weight gain during pregnancy, prenatal BMI, gestational week, intraspinal labor analgesia, oxytocin, gastrointestinal intolerance, neonatal length, and weight between the two groups ( P > 0.05). However, the total oral energy intake during labor in the ONS group was significantly higher than that in the control group ([1 349.99± 569.51] kJ vs [249.59 ± 455.19] kJ, P < 0.01). The rate of vaginal delivery in the ONS group was significantly higher than that in the control group (93.6% vs 81.3%, P = 0.01), and the duration of the first stage of labor ([487.06 ± 232.94] min vs [416.17 ± 191.13] min, P = 0.03) was also significantly longer in the ONS group. There were no significant differences between the two groups in terms of the duration of the second and third stages of labor, perineal laceration, cervical laceration, vaginal laceration, amount of bleeding, hospital stay, and Apgar score after birth ( P > 0.05). Multivariate logistic regression analysis showed that maternal age was a risk factor for changing to cesarean section in women with low-risk pregnancies ( OR 1.20, 95% CI 1.03 to 1.40, P = 0.02), while ONS during labor ( OR 0.31, 95% CI 0.11 to 0.85, P = 0.02) and intraspinal labor analgesia ( OR 0.10, 95% CI 0.04 to 0.26, P < 0.01) were protective factors. Conclusions:ONS during labor can significantly increase the vaginal delivery rate, without increasing the incidence of gastrointestinal intolerance in low-risk pregnant women. Maternal age is a risk factor for cesarean section while ONS during labor and intraspinal labor analgesia are protective factors in women with low-risk pregnancies.
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Objective:To explore the application effects of a new self-designed device for measuring postpartum blood loss in women with postpartum hemorrhage after vaginal delivery, so as to provide a basis for early identification and treatment of postpartum hemorrhage.Methods:The research was a quasi-experiment study. A total of 12 824 women who delivered vaginally in Women's Hospital of Nanjing Medical University from July 2021 to June 2022 were conveniently selected. Among them, the pregnant women enrolled from January to June 2022 were selected as the experimental group, and the pregnant women enrolled from July to December 2021 were included in the control group, with 6 412 cases in each group. The self-designed new postpartum blood loss measuring device was used to evaluate the blood loss in the experimental group, while the traditional blood collecting basin was taken in the control group.The differences between the two groups in the assessment error of 24 hours postpartum blood loss, postpartum blood loss at 2 hours and 24 hours, postpartum hemorrhage rate, severe postpartum hemorrhage rate and midwives′ satisfaction with the assessment of blood loss were compared.Results:The assessment error of 24 hours postpartum blood loss in the experimental group was 180.00 (80.00, 300.00) ml, which was lower than 192.00 (80.00, 310.00) ml in the control group, and the difference was statistically significant ( Z = - 2.04, P<0.05). The postpartum blood loss at 2 hours and 24 hours in the experimental group was 312.00 (290.00, 330.00) ml and 415.00 (385.00, 440.00) ml, respectively, which was higher than 310.00 (280.00, 330.00) ml and 407.00 (380.00, 435.00) ml in the control group, and the differences were statistically significant ( Z = - 9.86, - 5.42, both P<0.001). The rates of postpartum hemorrhage and severe postpartum hemorrhage in the experimental group were 6.50% (417/6 412) and 2.21% (142/6 412), respectively, higher than 4.71% (302/6 412) and 1.59% (102/6 412) in the control group, and the differences were statistically significant ( χ2 = 19.49, 6.69, both P<0.05). Midwives′ satisfaction score with the assessment of blood loss in the experimental group was (18.17 ± 1.02) points, higher than that in the control group (17.78 ± 1.17) points, and the difference was statistically significant ( t = 2.33, P<0.05). Conclusions:The use of a new device for measuring postpartum bleeding during vaginal delivery can reduce errors in evaluating postpartum blood loss within 24 hours, improve the detection rate of postpartum hemorrhage and severe postpartum hemorrhage, and midwives are satisfied with it.
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Objective:To investigate the current status of women′s level of birth experience and lactation initiation time and explore the effect of level of birth experience on lactation initiation time.Methods:This was a cross-sectional study. A convenience sampling method was used to select 622 maternal cases attending the Affiliated Hospital of Jining Medical College from November, 2020 to January, 2021, and the distribution of their labor experience level and lactation initiation time was investigated by questionnaire and follow-up assessment.Results:There were 622 women with transvaginal deliveries who had lactation initiation times of more than 72 h in 241 cases (38.75%). The scores for each dimension of the Childbirth Experience Questionnaire (CEQ) were (49.63 ± 8.58)points, and the scores for each dimension of CEQ were perceived safety, professional support, involvement and self-efficacy in descending order. The results of the correlation analysis showed that there was a negative correlation between the scores on each dimension of CEQ and the total score and lactation initiation time ( r values were -0.436 to -0.146, all P<0.01). Stratified regression analysis showed that after controlling for age, number of births, gestational weeks of labour, illness during pregnancy and labour analgesia as the underlying variables affecting lactation initiation time, the scores for self-efficacy, involvement, perceived safety and professional support in the CEQ all affected lactation initiation time after delivery ( t values were -6.76 to -2.02, all P<0.05). Conclusions:The birth experience and lactation of women who deliver via vaginal birth need to be taken into account. The more negative the birth experience, the longer the lactation initiation time. The women′s involvement in the birth process, their own competence, perceived safety and level of professional support are all valid influencing indicators of lactation initiation time.
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Objective:To evaluate the effectiveness of hands-on training and video demonstration in training of forceps delivery for residents.Methods:Forty nine residents who were rotating in the obstetrics department of Peking Union Medical College Hospital from 2019 to 2021 were enrolled. The residents were randomly divided into two groups: the instructor group ( n=24) was taught by hands-on training of forceps delivery and the video group ( n=25) was instructed by watching video demonstration. All the trainees completed the self-confidence questionnaire survey, and were evaluated by written tests and objective structured assessment of technical skills scoring system. Results:The scores of self-confidence in each item after the simulation training were higher than those before training in both groups; and there were no significant differences between two groups in the increment of scores(mastering knowledge: 1.54±0.98 vs. 1.40±0.71, U=266.68, P=0.480;mastering operation skills: 1.42±0.93 vs.1.80±0.87, U=233.47, P=0.161; mastering forceps structure: 1.63±1.10 vs. 1.88±0.93, U=261.63, P=0.416; confidence in independent operation: 1.13±0.90 vs. 1.00±1.08, U=287.74, P=0.799; evaluation of simulation training: 0.21±0.51 vs. 0.16±0.55, U=288.27, P=0.776). In the written tests, the scores of the instructor group were significantly higher than those of the video group (83.00±7.18 vs.70.56±10.37; t=4.86, P<0.001). In the practical operation, the instructor group significantly outperformed the video group in items of “right blade placement” (0.71±0.46 vs. 0.20±0.41, U=147.54, P<0.001), “objective total score” (6.17±1.46 vs. 4.72±1.65, U=155.49, P=0.003) and “correct traction” (0.85±0.31 vs. 0.56±0.51, U=213.86, P=0.036). Conclusion:Training delivered via hands-on instruction and demonstration was generally more effective than that delivered via video, although both groups show a increased self-confidence in learning and performing forceps delivery.
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Objective To investigate the clinical features and maternal and infant outcomes of super-aged pregnant women.Methods The clinical data of pregnant women who gave birth in Maternity and Child Health Care Hospital Affiliated to Xuzhou Medical University from January 2017 to June 2022 were retrospectively analyzed.According to the age of pregnant women,they were divided into super-aged group(≥40 years old,1822 cases)and age-appropriate group(<35 years old,1827 cases).The general conditions,pregnancy complication and comorbidity,delivery outcomes and neonatal outcomes of two groups were compared.Results The number of pregnancies and number of delivery in super-aged group were significantly higher than those in age-appropriate group,and the gestational week of delivery was earlier than that in age-appropriate group(P<0.01).There was no statistical significance in the proportion of assisted reproduction between two groups(P>0.05).The incidences of gestational hypertension,gestational diabetes mellitus,scarring uterus,placenta previa and preterm delivery in super-aged group were significantly higher than those in age-appropriate group(P<0.05),while the incidences of premature rupture of membranes,placental abruption and fetal distress were lower than those in age-appropriate group(P<0.05).The rate of cesarean section and the proportion of uterine binding in super-aged group were significantly higher than those in age-appropriate group(P<0.05),and the rates of vaginal delivery and lateral perineal resection were significantly lower than those in age-appropriate group(P<0.05).There was no significant difference in the average body weight of newborns between the two groups(P>0.05),but the rates of low birth weight infants,macrosomia and neonatal asphyxia in super-aged group were significantly higher than those in age-appropriate group(P<0.05).Conclusion The incidences of pregnancy complications and comorbidity,cesarean section and neonatal complications increased in super-aged pregnant women.We should attach great importance to the prenatal health care and perinatal management of super-aged pregnant women.
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Objective To propose an integrated management scheme for perineal pain after vaginal delivery.Methods Literature review and Delphi inquiry were conducted to propose the perineal pain management scheme after vaginal delivery from November 2022 to April 2023.A total of 21 experts were consulted with 2 rounds of correspondence.Results Questionnaires collected from the two rounds of correspondence consultations were both at 100.0%.The expert authority coefficients for the two rounds were 0.930 and 0.935,respectively,with the expert coordination coefficients of the two rounds at 0.109(P<0.001)and 0.392(P<0.001),full mark rate 100%.A total of 3 primary items,15 secondary items and 40 tertiary items were summarised for the perineal pain management scheme after vaginal delivery in relation to prenatal prophylaxis,intrapartum protection and postnatal treatment.Conclusions The developed perineal pain management scheme after vaginal delivery is scientific and reliable.It provides a scientific reference for the prevention and treatment of perineal pain after vaginal delivery.
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Abstract Objectives: to evaluate the success rate of labor induction and determinants of successful outcome. Methods: retrospective cohort study of parturients that undergone labor induction between 2006 and 2015. Data was retrieved from the medical records and multivariate logistic regression was used to evaluate the determinants of successful labor induction. Results: the rate of labor induction was 10.9%. Out of the 940 women analysed, six hundred and fifty-six women (69.8%) had successful vaginal delivery. Labor induction at 39-40 weeks (OR=2.70; CI95%=1.17-6.36), 41 weeks (OR=2.44; CI95%=1.14-5.28), estimated fetal weight between 2.5 and 3.4kg (OR=4.27, CI95%=1.96-5.59) and estimated fetal weight of 3.5-3.9kg (OR=5.45; CI95%=2.81-10.60) increased the odds of achieving vaginal delivery. Conclusions: our findings suggest that 39, 40 and 41 weeks are optimal gestational ages for labor induction with respect to successful vaginal delivery. Also, estimated fetal weight between 2.5kg and 3.9kg favours successful vaginal delivery.
Resumo Objetivos: avaliar a taxa de sucesso da indução do trabalho de parto e determinantes de um resultado bem sucedido. Métodos: estudo de coorte retrospectivo de parturientes que submeteram a indução de trabalho de parto entre 2006 e 2015. Os dados foram recuperados dos registros médicos e a regressão logística multivariada foi utilizada para avaliar os determinantes da indução de trabalho de parto bem sucedida. Resultados: a taxa de indução de trabalho de parto foi de 10,9%. Das 940 mulheres analisadas, seiscentas e cinquenta e seis mulheres (69,8%) tiveram um parto vaginal bem sucedido. A indução de trabalho de parto nas 39-40 semanas (OR=2,70; IC95%=1,17-6,36), 41 semanas (OR=2,44; IC95%=1,14-5,28), peso fetal estimado entre 2,5 e 3,4kg OR=4,27; IC95%=1,96-5,59) e peso fetal estimado entre 3,5-3,9kg (OR=5,45; IC95%=2,81-10,60) aumentou as probabilidades de conseguir um parto vaginal. Conclusões: as nossas conclusões sugerem que as 39, 40 e 41 semanas são idades gestacionais ideais para a indução do trabalho de parto no que diz respeito ao sucesso do parto vaginal. Além disso, o peso fetal estimado entre 2,5kg e 3,9kg favorece o parto vaginal bem sucedido.
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Humanos , Femenino , Embarazo , Complicaciones del Embarazo , Edad Gestacional , Trabajo de Parto Inducido/estadística & datos numéricos , Partería , Estudios de Cohortes , Maternidades , NigeriaRESUMEN
Objetivos: determinar la proporción de parto vaginal exitoso en mujeres con cesárea previa, describir las complicaciones maternas y perinatales, y realizar una aproximación a los factores asociados al parto vaginal. Materiales y métodos: estudio de corte transversal descriptivo. Se incluyeron mujeres con antecedente de un parto por cesárea, con edad gestacional mayor a 24 semanas y fetos únicos vivos que tuvieron prueba de parto vaginal, atendidas en una institución pública de alta complejidad en 2019. Se excluyeron aquellas pacientes con antecedente de más de una cesárea o miomectomía. Muestreo consecutivo. Se midieron variables sociodemográficas, obstétricas, vía del parto y complicaciones maternas y perinatales. Se hace análisis descriptivo y un análisis exploratorio multivariado de los factores asociados al parto vaginal exitoso. Resultados: de 286 gestantes incluidas, el porcentaje de éxito de parto vaginal fue del 74,5 %. Se identificaron complicaciones maternas en el 3,2 % de los partos vaginales y en el 6,8 % de las cesáreas. El 1,3 % de los recién nacidos tuvo alguna complicación. Hubo 2 muertes perinatales. Se encontró asociación entre parto vaginal exitoso y tener antecedente de parto vaginal (OR: 2,7; IC 95 %: 1,15-6,29); puntaje de Bishop mayor de 6 (OR: 2,2; IC 95 %: 1,03-4,56); inicio de trabajo de parto espontáneo (OR: 4,5; IC 95 %: 2,07-9,6); y edad materna menor de 30 años (OR: 2,28; IC 95 %: 1,2-4,2). Conclusiones: el parto vaginal es una opción segura para considerar en pacientes con cesárea anterior, especialmente si inician trabajo de parto espontáneo o han tenido un parto vaginal previamente. Se requieren cohortes prospectivas para confirmar estos hallazgos.
Objectives: To determine the proportion of successful vaginal deliveries in women with prior cesarean section; to describe maternal and perinatal complications; and to examine the factors associated with vaginal delivery. Materials and methods: Descriptive cross-sectional study of women with a history of cesarean delivery, gestational age of more than 24 weeks, singleton live fetuses, with prior vaginal delivery who received care in a high complexity public institution in 2019. Patients with a history of more than one cesarean section or myomectomy were excluded. Consecutive sampling was used. Sociodemographic and obstetric variables, delivery route and maternal and perinatal complications were measured. A descriptive analysis as well as a multivariate exploratory analysis of the factors associated with successful vaginal delivery were carried out. Results: Among 286 pregnant women included, the percentage of successful vaginal deliveries was 74.5 %. Maternal complications were identified in 3.2 % of vaginal delivery cases and in 6.8 % of cesarean births. Complications occurred in 1.3 % of all live neonates; there were 2 perinatal deaths. An association was found between successful vaginal delivery and a history of prior vaginal delivery (OR: 2.7; 95 % CI: 1.15-6.29); a Bishop score greater than 6 (OR: 2.2; 95 % CI: 1.03-4.56); spontaneous labor initiation (OR: 4.5; IC 95 % CI: 2.07-9.6); and maternal age under 30 years (OR:2.28; 95 % CI: 1.2-4.2). Conclusions: Vaginal delivery is a safe option to consider in patients with prior cesarean section, in particular in cases of spontaneous labor initiation or prior vaginal delivery. Prospective cohorts are needed in order to confirm these findings.
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Humanos , Femenino , Embarazo , Rotura Uterina , Parto Vaginal Después de Cesárea , Complicaciones del Embarazo , Asociación , Trabajo de Parto , Cesárea , Atención Perinatal , Mujeres EmbarazadasRESUMEN
Introducción: la competencia "asistencia del parto vaginal" se adquiere, parcialmente, mediante simulación en estudiantes de enfermería/obstetricia. Sin embargo, no se ha reportado cuantos partos simulados son necesarios para que estos estudiantes adquieran la mínima competencia. Métodos: estudio cuasi experimental que incluyó a todos los alumnos del internado hospitalario en salud de la mujer, en el segundo semestre del año 2020, excluyendo aquellos que hubieran tenido exposición a la simulación o atención clínica de partos vagina-les. Se evaluó una intervención de práctica simulada en la atención del parto normal en tres etapas: 1) texto, 2) video y 3) simulación. Los estudiantes efectúan tres atenciones simuladas, un evaluador ciego evaluó su rendimiento con una pauta de cotejo (máximo 37 puntos) y se midió la satisfacción con una pauta de evaluación validada. Resultados: el rendimiento de los alumnos mejora significativamente (p < 0.001) con la repetición de la simulación (28,3; 34,3 y 36,7 puntos en 1°, 2° y 3° intento). El porcentaje de estudiantes que logra el umbral de mínima competencia es de 6%, 67% y 100 %, en cada repetición (p < 0.001) Conclusiones: en este grupo de estudiantes, tres repeti-ciones de la simulación/debriefing son suficientes para superar el umbral de mínima competencia. Esta información es útil para definir los recursos necesarios en simulación en atención del parto vaginal en estudiantes de enfermería/obstetricia.
Introduction: Vaginal delivery assistance competence is acquired partially by simulation in nursing/midwifery students. However, it has yet to be reported how many simulated deliveries are necessary for these students to develop the minimum competence. Methods: Quasi-experimental study, all the hospital internship in women>s health students were included in the second semester of 2020, excluding those exposed to the simulation or clinical care of vaginal births. A simulated practice intervention in vaginal delivery care in three stages: 1) text, 2) video, and 3) simulation, was evaluated. The students performed three simulations, a blind observer evaluated their performance with a comparison guideline (maximum 37 points), and their satisfaction was measured with a validated evaluation guideline. Results: The performance of the students improve significantly (p <0.001) with the repetition of the simulation (28.3, 34.3, and 36.7 points in the first, second and third attempts). The percentage of students who achieve the minimum proficiency threshold is 6%, 67%, and 100% in each repetition (p <0.001). Conclusions: In this group of students, three repetitions of the simulation/debriefing are sufficient to exceed the threshold of minimum competence. This information is helpful in defining the necessary resources in simulation in vaginal delivery care in nursing/midwifery students.
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Background: Modern obstetrics has a tremendous issue in inducing full-term labor in women with a viable fetus. When the hazards of prolonging pregnancy outweigh the advantages of birth, induction is undertaken. This study’s objective was to evaluate the efficacy of misoprostol 50µg administered sublingually, orally and vaginally in the process of inducing labor.Material & Methods:Between June 2021 and July 2022, 120 pregnant women admitted in Department of Gynecology and Obstetrics, ShaheedZiaur Rahman Medical College and Hospital, Bogura in Bangladesh were recruited randomly for a randomized control trial as per inclusion criteria. Misoprostol was administered either orally or sublingually to each patient. A maximum of three doses might be administered if necessary. A previous cesarean birth was an exclusion criterion. The number of women who had a vaginal birth during 24 hours of induction was our major metric for success. SPSS 26 was used to analyze the data.Results:The induction to delivery intervals were considerably shorter in the sublingual group (18 hours versus 25.5 hours; mean difference was 6.2 hours; 95 percent confidence interval, 1.5 to 14.6). In the sublingual group, there was just 2% occurrence of uterine hyperstimulation. The two groups did not vary significantly in terms of delivery method, fetal distress, or newborn outcomes. A total of 80% percent and 82.60 percent of patients were satisfied with the oral and sublingual groups, respectively, and only 10% percent believed the sublingual tablets didn’t entirely dissolve.Conclusion:Sublingual misoprostol seems to be a successful method of delivery, although further clinical studies are needed to demonstrate the safety and effectiveness of the sublingual mode.
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Background: When it occurs after a cesarean section or a normal vaginal delivery, postpartum hemorrhage (PPH) is a potentially fatal obstetric emergency. Aims and objectives: The aim of the study was to compare the efficacy and safety of oxytocin against oxytocin plus misoprostol in avoiding PPH during active management of the third stage of labor (AMTSL). Materials and Methods: Using simple randomization, 150 women from the labor ward of the Department of Obstetrics and Gynaecology at the Indore Medical College were recruited and randomly allocated to either test Group A or test Group B. Standard pharmacological treatment, including intramuscular injection of 10 IU of oxytocin and other components of AMTSL criteria, was administered to patients in Group A. In addition to the other components of the AMTSL criteria, Group B patients got the usual pharmacological treatment of 10 IU of oxytocin through the injectable route and 600 g of misoprostol through the oral route. Various characteristics of both groups were compared, including parity, gravida, delivery style, PPH etiology, blood transfusion, and surgical intervention. Results: Mode of delivery was vaginally seen in 85% and 92% and cesarean in 15% and 8%. Etiology was uterine atony in 54% and 64%, retained tissue in 26% and 12%, laceration in 11% and 18%, and coagulopathy in 9% and 6%. Blood transfusion was needed in 27% and 57% and surgical intervention in 82% and 68% in Groups A and B, respectively. A statistically significant difference was observed (P ? 0.05). Conclusion: The results of this study support the use of misoprostol in hospital settings as an adjunct to oxytocin since it reduces the incidence of PPH, eliminates the need for intrusive interventions, and ultimately reduces maternal mortality.
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Resumen Introducción: Tanto a nivel sudamericano como mundial, el incremento de la tasa de cesáreas electivas ha sido abrumante. Esto se considera un problema de salud pública, ya que el parto vaginal es la vía más fisiológica para el nacimiento y trae beneficios de salud para la madre y el recién nacido, tanto inmediatos como a futuro. Objetivo: Evaluar la postura de mujeres nuligestas en edad fértil acerca de las vías del parto a través de sus conocimientos, percepciones y preferencias. Método: Estudio de corte transversal. Se aplicó una encuesta a estudiantes universitarias para la recopilación de datos mediante SPSS, y análisis con prueba de diferencias de proporciones y de χ2. Resultados: 210 mujeres encuestadas. Un 80% de ellas desconoce la menor morbilidad infantil asociada a un parto vaginal, más de la mitad estima una ventaja de la cesárea que evite el dolor y un gran porcentaje desconoce los riesgos médicos asociados a la cesárea. Conclusiones: Existe un alto nivel de desconocimiento respecto a beneficios, riesgos y consecuencias de las diferentes vías del parto.
Abstract Introduction: Both in South America and worldwide, the increase in the rate of elective caesarean sections has been overwhelming. This is considered a public health problem, since vaginal delivery is the most physiological route for birth and brings health benefits for the mother and the newborn, immediately and in the future. Objective: To evaluate the position of nulliparous women of childbearing age regarding the delivery pathways through their knowledge, perceptions, and preferences. Method: Cross-sectional study with an analytical component. A survey was applied to university students for data collection through SPSS, and analysis was made with the difference of proportions and χ2 test. Results: 210 women surveyed; 80% of them are unaware of the lower infant morbidity associated with a vaginal delivery, more than a half estimate an advantage of a cesarean section that it avoids pain, and a large percentage are unaware of the medical risks associated with cesarean sections. Conclusions: There is a high level of ignorance regarding the benefits, risks and consequences of the different delivery routes.
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Humanos , Femenino , Adulto , Adulto Joven , Estudiantes/psicología , Conocimientos, Actitudes y Práctica en Salud , Parto Obstétrico/psicología , Conducta Reproductiva/psicología , Paridad , Percepción , Universidades , Cesárea/psicología , Estudios Transversales , Encuestas y Cuestionarios , Factores de Edad , Parto/psicología , Periodo FértilRESUMEN
Postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality. We focus on two innovations by Indian gynecologists, the Panicker’s vacuum suction cannula and the SR suction cannula. These effective devices are economical and easy-to-use, and help prevent and manage PPH. They can also be used to reduce bleeding in non-PPH indications. These Indian innovations are a matter of pride, and need to be studied extensively in diverse settings. This will help ensure that their benefits can be shared across the world.
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Background:Labour progress in partograph plotting helps to early recognition and prevention of the complication of labour. This helpful in better maternal and perinatal outcome. Aim of the study is to evaluate the maternal and perinatal outcome in primigravida and multigravida by comparing their partograph in labour.Material And Methods:This prospective observational study was carried out in Smt. SCL General Hospital a teaching tertiary care hospital from May-2018 to November-2019. Total 250 cases out of which 125 cases of primigravida and 125 cases of multigravida admitted in labour room were randomly selected and monitored by using modified WHO partograph. All the cases reporting to labour room and fulfilled the inclusion criteria were included in thisstudy. Individual partograph was studied to know the various aspect of course of labour.Result:208 out of 250 cases were before alert line, 34 cases were between alert and action line and 8 cases were beyond action line. Rate of cervical dilatation in most primigravida was between 1.1-2cm/hour and in multigravida was >2.1cm/hour. In Zone A, in primigravida 90.7% had VD and 9.3% had LSCS whereas in multigravida 96.4% had VD and 3.6% had LSCS. In Zone B, in primigravida 47.8% had vaginal delivery and 52.2% had LSCS whereas in multigravida 54.4% had VD and 45.5% LSCS. In Zone C, in primigravida and multigravida there were no VD and 100% had LSCS. Protracted active phase (50%) was presents the most common abnormality of first stage of labour in both group inpresent study and in second stage, arrest of decent (82%) was more common. In both groups, NICU admission were more in Zone C (3.2%) as c ompared to Zone A (2%) and Zone B (1.6%).Conclusion:This study has shown that using the partograph can be highly effective in reducing complications from both mother and neonate. It is also helpful in monitoring of labour and early diagnosis of abnormal labour. It prevents maternal mortality and morbidity.
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Objective:To investigate cases of delayed lactation initiation in women with transvaginal delivery and the influencing factors, in order to provide a basis for effective control of delayed lactation initiation and promotion of breastfeeding.Methods:Inpatients who were admitted to the obstetric ward of Affiliated Hospital of Jining Medical College from November 6, 2020 to January 16, 2021 were selected for the study using convenience sampling method and investigated by general information questionnaire and Chindbirth Experience Questionnaire (CEQ). Binary Logistic regression analysis was used to determine the factors influencing delayed lactation initiation.Results:The incidence of delayed lactation initiation in 622 women with transvaginal delivery was 38.75% (241/622). Binary Logistic regression analysis showed that age 20-35 years, full-term delivery, labor and delivery, use of labor analgesia, and good experience of transvaginal delivery were protective factors for delayed lactation initiation ( OR values were 0.012 to 0.868, all P<0.05); age >35 years, excessive weight gain during pregnancy, presence of pregnancy complications, use of induction of labor during delivery, long labor process, and damage to perineal skin after delivery were risk factors for delayed lactation initiation ( OR values were 1.097 to 13.235, all P<0.05). Conclusions:The high incidence of delayed lactation initiation in women with transvaginal delivery is influenced by a number of factors, which reminds the clinic that lactation in women after transvaginal delivery also needs to be taken into account, with priority assessment and prevention for those who are elderly (age≥35 years), primiparous, have other diseases during pregnancy, have gained too much weight during pregnancy, have preterm delivery, have a long duration of labor, have not received labor analgesia, have had a single or combined induction of labor, have had an episiotomy or perineal laceration during labor, and have a poor transvaginal delivery experience.
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OBJECTIVE@#To evaluate the impact of a history of vaginal delivery on anesthesia management of patients undergoing hysteroscopic surgery under intravenous general anesthesia without tracheal intubation.@*METHODS@#Ninety-nine patients undergoing hysteroscopic surgery under intravenous general anesthesia were enrolled in this study, including 43 patients with (VD group) and 56 patients without a history of vaginal delivery (NVD group). For all the patients, blood pressure, heart rate (HR), blood oxygen saturation (SpO2) and bispectral index (BIS) were recorded before anesthesia (T1), after anesthesia (T2), after cervical dilation (T3), and at 3 min after cervical dilation (T4). Propofol and etomidate doses during anesthesia induction, the total dose of propofol administered, additional intraoperative bolus dose and times of propofol, intraoperative body movement, total operation time and surgeons' satisfaction feedback scores were compared between the two groups. The postoperative awake time, recovery time, VAS score at 30 min after operation, and postoperative nausea and vomiting (PONV) were also compared.@*RESULTS@#There was no significant differences in SBP, DBP, HR, SpO2, or BIS between the two groups at T1 and T2, but at T3 and T4, SBP and DBP were significantly higher in NVD group than in VD group (P < 0.01); HR was significantly higher in NVD group only at T3 (P < 0.01). The application of vasoactive drugs did not differ significantly between the two groups. The total dose of propofol, additional intraoperative dose and times of propofol were all greater in NVD group than in VD group (P < 0.01). More body movements of the patients were observed in NVD group (P < 0.01), which also had lower surgeons' satisfaction score for anesthesia (P < 0.01), higher postoperative VAS score (P < 0.05), and shorter postoperative awake time (P < 0.05) and recovery time (P < 0.01).@*CONCLUSION@#A history of vaginal delivery has a significant impact on anesthesia management of patients undergoing hysteroscopic surgery under intravenous general anesthesia without tracheal intubation in terms of hemodynamic changes, anesthetic medication, and postoperative recovery quality, suggesting the necessity of individualized anesthesia management for these patients.
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Femenino , Humanos , Embarazo , Anestesia General , Anestesia Intravenosa , Anestésicos Intravenosos , Estudios de Cohortes , Parto Obstétrico , Histeroscopía , PropofolRESUMEN
Objective:To provide data support for preventing its occurrence and developing scientific and effective nursing intervention by investigating the situation and risk factors of perineal hematoma in pregnant women undergoing vaginal delivery through retrospective case-control study.Methods:A total of 102 parturients who had perineal hematoma during vaginal delivery in Shanghai Maternity and Infant Hospital Affiliated to Tongji University were selected as the hematoma group, from October 2018 to March 2020, and case control study ( n=204) was performed in the ratio of 1∶2. 24 possible influencing factors were determined by literature review and expert consultation and the data were collected retrospectively by clinicopathology. Single factor analysis, t test, Chi-square test and Multivariate binary Logistic regression analysis were used to identify factors related to perineal hematoma, and to explore potential risk factors of perineal hematoma. Results:From October 2018 to March 2020, there were 18 292 cases of vaginal delivery, including 102 cases of perineal hematoma, with an incidence of 0.56%. Single factor analysis showed 10 risk factors pertinent to perineal hematoma were selected ( t/ χ2 values were -4.51 to 31.79, all P<0.05); and multiple Logistic regression analysis showed the risk factors of perineal hematoma in vaginal delivery were old puerperal ( OR=7.53, P<0.05) and perineal edema ( OR=3.10, P<0.05), and the protective factors were free position delivery ( OR=0.35, P<0.05) and concomitant delivery ( OR=0.31, P<0.05). Conclusions:The incidence of perineal hematoma is relatively high in pregnant women undergoing vaginal delivery, usually occurrs on the right side of the perineal vagina and within 2 hours after delivery. Clinically, it is necessary to actively promote quality nursing services at midwifery to reduce the incidence of perineal hematoma.