ABSTRACT
INTRODUCTION: Fetal occiput posterior (OP) positions account for 15 to 20% of cephalic presentations and are associated with poorer maternal and neonatal outcomes than occiput anterior (OA) positions. The aim of this study was to identify maternal, neonatal and obstetric factors associated with rotation from OP to OA position during the first stage of labor. MATERIAL AND METHODS: This secondary analysis of a multicenter randomized controlled trial (EVADELA) included 285 laboring women with ruptured membranes and a term fetus in OP position. After excluding women with cesarean deliveries before full dilatation, we compared two groups according to fetal head position at the end of the first stage of labor: those with and without rotation from OP to OA position. Factors associated with rotation were assessed with univariate and multivariate analyses using multilevel logistic regression models. RESULTS: The rate of anterior rotation during the first stage was 49.1%. Rotation of the fetal head was negatively associated with excessive gestational weight gain (adjusted odds ratio [aOR]: 0.37, 95% confidence interval [CI]: 0.17-0.80), macrosomia (aOR: 0.35, 95% CI: 0.14-0.90), direct OP position (aOR: 0.24, 95% CI: 0.09-0.65), and prelabor rupture of membranes (aOR: 0.40, 95% CI: 0.19-0.86). Oxytocin administration was the only factor positively associated with fetal head rotation (aOR: 2.17, 95% CI: 1.20-3.91). DISCUSSION: Oxytocin administration may affect rotation of OP positions during the first stage of labor. Further studies should be performed to assess the risks and benefits of its utilization for managing labor with a fetus in OP position.
Subject(s)
Delivery, Obstetric/methods , Labor Presentation , Labor, Obstetric , Obstetric Labor Complications/therapy , Oxytocics/pharmacology , Oxytocin/pharmacology , Adult , Female , Humans , Labor, Obstetric/drug effects , Obstetric Labor Complications/drug therapy , Oxytocics/administration & dosage , Oxytocin/administration & dosage , Pregnancy , RotationABSTRACT
INTRODUCTION: The aim of this study was to describe the potential impact of an active birth on classical obstetrical outcomes, as labor duration, cesarean section rate, couples and team satisfactions. MATERIAL AND METHODS: This observational study was prospective, monocentric and took place between May 2007 and February 2009 at the maternity ward of the University Hospital of Caen, France. An "active birth" was defined as an active latent-phase (having a change in position and/or a bath and/or a walk) followed by at least three changes in position during the active phase. The suggested positions were: lateral or dorsal decubitus, ROSA, on all fours, seated, standing and crouch. A position must have lasted at least 20 minutes to be considered. RESULTS: Out of the 1906 women included, 828 had an active birth (43.4%). Due to our definition of an "active birth", a "non-active birth" was significantly associated with a quicker labor. An "active birth" was associated with a decreased rate of cesarean section (OR=0.71; IC95%=[0.51-0.99]). The parturients satisfaction median was 9 on a scale of 0 to 10, the spouses'one was 10. Midwives were more satisfied when it was an "active birth". CONCLUSION: Significant associations with active births were highlighted, which would require to be validated by a randomised study. This practise plenty satisfied couples and midwives. In fact, no litterature exists to date. A consensus about the definition of an active birth is still necessary in order to lead to guidelines.
Subject(s)
Delivery, Obstetric/methods , Labor, Obstetric , Patient Positioning , Adult , Female , Humans , Patient Satisfaction , Pregnancy , Pregnancy Outcome , Prospective Studies , Surveys and QuestionnairesABSTRACT
The new training reference guide related to state registered degree has been applied since 31 July 2009. Training and valuation projects developed by nurse training institutes have been amended to comply with learning concept: understanding-action-transfer. Validation of grade 4.4 S4 is part of competence 4 validation "implementation of actions related to diagnostic and therapy". The requirement for all students to ratify simulated transfusion lead teachers to update their knowledge and to be more committed to knowledge acquisition. To complete its work, the research and quality control department of the French Transfusion Company regarding the result of the national 2011 inquiry, proposes in relation with the National Transfusion Institute to provide the professional network with tools and supports making knowledge exchanges and experience sharing easier. The reference transfusional teaching guide updating intended to training institutes is being carried out and considered as a priority.
