Avaliação da dilatação cervical em simuladores de dilatação / Evaluación de la dilatación cervical en simuladores de dilatación / Cervical dilation assessment in dilation simulators

Resumo Objetivo Comparar o número de acertos dos estudantes na avaliação da dilatação cervical em simuladores de dilatação com e sem o uso de uma validação visual direta. Métodos Estudo transversal com 40 alunos de graduação em Obstetrícia de uma Universidade Pública de São Paulo, que avaliaram as dilatações cervicais em simuladores de dilatação às cegas, em três etapas: na primeira, estimaram as dilatações nos simuladores, na segunda, compararam sequencialmente os achados nos simuladores com uma ferramenta de validação visual direta usando a mão dominante e depois a mão não dominante, e na terceira etapa, compararam simultaneamente as estimativas encontradas nos simuladores com a validação visual direta com a mão dominante e não dominante. O desfecho foi o acerto da dilatação cervical nos simuladores de dilatação ou não acerto, com valor de p ≤ 0,05 considerado estatisticamente significativo. Resultados Foram analisadas 240 avaliações e computados os acertos dos estudantes relacionados a avaliação da dilatação cervical dos simuladores. Houve aumento da taxa de acerto de 47,1% com o uso da validação visual direta (OR= 4,689; IC95%: 2,601-8,452; p<0,001). Conclusão O uso de uma validação visual direta aumenta a probabilidade de acertos dos alunos na avaliação da dilatação cervical em simuladores de dilatação.

Resumen Objetivo Comparar el número de aciertos de los estudiantes en la evaluación de la dilatación cervical en simuladores de dilatación con y sin uso de una validación visual directa. Métodos Estudio transversal con 40 alumnos de la carrera de Obstetricia de una universidad pública de São Paulo, quienes evaluaron las dilataciones cervicales en simuladores de dilatación a ciegas, en tres etapas: en la primera, estimaron las dilataciones en los simuladores; en la segunda, compararon secuencialmente los resultados en los simuladores con una herramienta de validación visual directa usando la mano dominante y después la mano no dominante; y en la tercera etapa, compararon simultáneamente las estimativas encontradas en los simuladores con la validación visual directa con la mano dominante y no dominante. El criterio de valoración fue el acierto de la dilatación cervical en los simuladores de dilatación o el no acierto, con un valor de p ≤ 0,05 considerado estadísticamente significativo. Resultados Se analizaron 240 evaluaciones y se computaron los aciertos de los estudiantes relacionados con la evaluación de la dilatación cervical de los simuladores. Hubo un aumento del índice de acierto del 47,1 % con el uso de la validación visual directa (OR= 4,689; IC 95 %: 2,601-8,452; p<0,001). Conclusión El uso de una validación visual directa aumenta la probabilidad de aciertos de los alumnos en la evaluación de la dilatación cervical en simuladores de dilatación.

Abstract Objective To compare the number of hits of students in cervical dilation assessment in dilation simulators with and without the use of direct visual validation. Methods This is a cross-sectional study with 40 undergraduate obstetrics students from a public university in São Paulo, who assessed cervical dilatations in blind dilatation simulators, in three stages: in the first, they estimated dilations in the simulators; in the second, they sequentially compared the findings in simulators with a direct visual validation tool using the dominant hand and then the non-dominant hand; and in the third step, they simultaneously compared the estimates found in simulators with direct visual validation with the dominant and non-dominant hands. The outcome was the success of cervical dilation in dilation simulators or not, with a p-value ≤ 0.05 considered statistically significant. Results We analyzed 240 assessments and computed the hits of students related to cervical dilatation assessment of simulators. There was an increase in the hit rate of 47.1% with the use of direct visual validation (OR= 4.689; 95%CI: 2.601-8.452; p<0.001). Conclusion The use of direct visual validation increases the probability of hits by students in cervical dilation assessment in dilation simulators.

Application effects of unprotected perineal delivery technique in low-risk nulliparous women during natural delivery / 中国基层医药

Objective:To investigate the application effects of unprotected perineal delivery technique in low-risk nulliparous women during natural delivery.Methods:Seventy low-risk nulliparous women who delivered in January to December 2017 in Huaibei People's Hospital were included in this study. They were randomly assigned to undergo delivery with either conventional technology (control group, n = 35) or unprotected perineal delivery technique (observation group, n = 35). Lateral episiotomy rate, incidence of perineal tears, labor process time and Visual Analogue Scale score as well as the degree of postpartum perineal pain were compared between two groups. Results:Lateral episiotomy rate in the observation group was significantly lower than that in the control group [8.57% (3/35) vs. (45.71% (16/35), χ2 = 10.402, P < 0.001). The incidence rates of complete perineum, grade I perineal injury and grade II perineal injury in the observation group were 34.29% (12/35), 57.14% (20/35) and 8.57% (3/35), respectively, and those in the control group were 11.43% (4/35), 28.57% (10/35) and 60.00% (21/35) respectively ( χ2 = 4.732, 4.725, 18.324, all P < 0.05). The Visual Analogue Scale score in the observation group was significantly lower than that in the control group [(3.08 ± 0.42) points vs. (5.13 ± 0.58) points, t = 16.936, P < 0.001]. There were no significant differences in the time of first-stage, second-stage and third-stage labors between the two groups (all P > 0.05). Conclusion:Application of unprotected perineal delivery technique for low-risk primipara delivery can reduce maternal injury during delivery, which is worthy of application.

[Analysis of labor progression characteristics of 1 089 nulliparas managed by the new partogram].

Objective: To analyze labor progression characteristics among nulliparas and provide reference to labor progress management. Methods: A retrospective study was conducted on 1 089 women who went for vaginal delivery at the First Affiliated Hospital, Sun Yet-San University from January 1st, 2015 to May 31th, 2016. The duration of cervical dilation from 1.0 cm to the next and the process of initial cervical dilation (2.0 cm or 3.0 cm) to full cervical dilation of nulliparas were analyzed. Results: The cervical dilation speed was accelerating with the progress of labor. The rate of cervical dilation changed fastest between 5.0-6.0 cm dilation, which was more than 3.0 cm/hour. With regard to labor curves, at admission of 2.0 cm cervical dilation, it rose dramatically from 5.0 cm dilation. At admission of 3.0 cm dilation, it presented approximately linear rising before 5.5 cm dilation, then became steeper. Conclusions: The cervical dilation speed is fast. Both labor curves of initial cervical dilation (2.0 cm or 3.0 cm) to full cervical dilation show obvious acceleration stage with steep slope.

Epidural analgesia in latent phase of labor for preeclamptic women attempting vaginal delivery / 中华围产医学杂志

Objective To evaluate the efficacy of epidural analgesia in latent phase of labor for preeclamptic women undergoing vaginal delivery.Methods A prospective study was conducted on 80 nulliparae of singleton pregnancy with preeclampsia and cephalic presentation in Tianjin Central Hospital of Gynecology Obstetrics from August 2016 to July 2017.All subjects were randomly divided into two groups including labor analgesia in active phase group (labor analgesia was commenced at cervical dilation over ≥ 4 cm,n=40,group 1) and the whole labor analgesia in latent phase group (labor analgesia was comenced at the onset of labor,n=40,group 2).Visual analogue score (VAS) was used to evaluate pain intensity at different time points.Maternal venous blood samples were collected at the time of parturient and fetal delivery to determine the serum concentrations of cortisol (Cor) and adrenocorticotropic hormone (ACTH) by enzyme-linked immunosorbent assay (ELISA).Clinical data was statistically analyzed using t-test or Chisquare test.Results (1) Compared with group 1,the duration of the first stage of labor [(521.3±103.5) vs (570.3 ±116.2) min,t=0.366,P＜0.05],the VAS scores immediately after analgesic administration and at cervical dilation of 2 and 3 cm [4.1±1.1 vs 7.3±1.2,3.5±0.9 vs 7.6±1.7,3.7±0.7 vs 8.1±1.4;t=4.387,9.652,5.321;all P＜0.05],the mean arterial pressure at cervical dilation of 2 and 3 cm [(98.3±9.1) vs (125.3±10.6) mmHg (1 mmHg=0.133 kPa),(98.6±10.4) vs (127.5±9.6) mmHg;t=8.014,5.496;both P＜0.05] and the cesarean delivery rate [15.0％ (6/40) vs 27.5％ (11/40),x2=4.012,P＜0.05] were all lower in group 2.(2) The serum levels of Cor [(565±76) vs (231 ±64) nmol/L,(457±79) vs (233±55) nmol/L;t=6.028,5.126;both P＜0.05] and ACTH [(81 ± 14) vs (38±11) pg/ml,(71 ± 16) vs (39±10) pg/ml,t=5.984,6.028;both P＜0.05]in group 1 and group 2 were both increased significantly after delivery as compared with those at the time of parturient,and they also showed significant differences between the two groups after delivery (t=5.009,3.862;both P＜0.05).Conclusions Epidural analgesia in latent phase of labor can be implemented in preeclamptic women attempting vaginal delivery through alleviating labor pain as sooner and earlier as possible,reducing their stress responses and maintain hemodynamic stability.

Using quantile regression to re-evaluate the epidural labor analgesia under new partogram: a prospective cohort study / 中华围产医学杂志

Objective To investigate the influence of epidural analgesia on labor duration under the new partogram recommendations using quantile regression.Methods In this study,we recruited 300 nulliparous women at full term who were hospitalized in Department of Obstetrics and Gynecology,Tongji Medical College,Huazhong University of Science and Technology from May to September,2018.The participants who were willing to receive epidural analgesia during labor were assigned to the epidural group (n=150),and those who were not to the control group (n=150).Labor duration and delivery outcomes were analyzed by Student's t test,Mann-Whitney U test,Chi-square test and Fisher's exact test.Quantile regression models were also used to investigate the effect of epidural analgesia on labor duration.Results The median durations of first-and second-stage labor in the epidural group were 600(400-840) and 66(45-98) min,respectively,which were significantly longer than those of the control group [420(320-610) and 52(33-87) min] (Z=-4.273,P＜0.001;Z=-3.210,P=0.001).Quantile regression analysis showed that,for the first stage of labor,epidural analgesia was associated with labor prolongation,and had significant effects on all the percentiles (all P＜0.05).The regression coefficients increased (95.630-285.000) correspondingly as the percentiles of the labor duration (from 10th to 90th percentiles) increased.For the second stage of labor,epidural analgesia showed a significant impact on prolongation only between the 25th and 75th percentiles (coefficients:10.000～18.143;all P＜0.05).Although the epidural group had a significant higher episiotomy rate [46.8％(65/139) vs 33.3％(48/144),x2=5.318,P=0.021],more times of urine catheterization during labor [1(0-1) vs 0(0-1),Z=-0.974,P=0.001]and higher rate of oxytocin administration during labor [48.7％(73/150) vs 30.0％(45/150),x2=10.952,P=0.001],when compared with the control group,there was no significant difference in cesarean section rate,assisted vaginal delivery rate and neonatal outcomes between the two groups (all P＞0.05).Conclusions Epidural analgesia may associated with the prolongation of the first and second stage of labor,especially with the first stage of labor,but has no adverse effects on maternal and neonatal outcomes.

Differences in starting points of active phase and labor duration between preterm and full-term primiparae / 中华围产医学杂志

Objective To compare the starting points of the active phase of labor and labor duration between preterm and full-term primiparae and to provide evidence for appropriate labor management. Methods From January 2013 to December 2016, 925 preterm primiparae (preterm group, 28 to 36+6 weeks) and equal number of full-term primiparae (full-term group, 37 to 41+6 weeks) who delivered in Tianjin Central Hospital of Gynecology Obstetrics were recruited. The starting point of the active labor was defined as the cervical dilatation at the turning point on the cervical dilatation curve where changing from almost flat to the biggest slope. Differences in the starting points and labor duration between the two groups were compared. Statistical analysis was performed using two independent sample t-test, one way analysis of variance and rank-sum test. Results The duration of the first and second stages [(5.7±2.5) vs (6.8±5.2) h, t=－5.835; (29.9±16.8) vs (34.2± 17.2) min, t=－12.637; both P<0.001] and the active phase [M (P95): 1.0 (3.2) vs 1.0 (4.5) h, Z=2.017, P=0.047] of the preterm primiparae were all significantly shorter than those of the full-term primiparae, and the average cervical dilatation rate was significantly accelerated during the active period [M (P5): 6.7 (1.8) vs 5.1 (1.6) cm/h, Z=－2.676, P<0.001]. In the preterm group, women whose starting points of the active phase were at 1 cm, 2 cm, 3 cm, 4 cm, 5 cm and ≥ 6 cm of cervical dilatation were 25 (2.7%), 275 (29.7%), 258 (27.9%), 203 (21.9%), 109 (11.8%) and 55 (5.9%), respectively. While in the full-term group, women whose starting points of the active phase were at 2 cm, 3 cm, 4 cm, 5 cm, 6 cm and >6 cm of cervical dilatation were 74 (8.0%), 208 (22.5%), 287 (31.0%), 168 (18.2%), 127 (13.7%) and 61(6.6%), respectively. In the preterm group, the starting points of the active phase at cervical dilatation≤3 cm, ≤4 cm and ≤5 cm accounted for 60.3% (558/925), 82.3% (761/925) and 94.1% (870/925), respectively. In the full-term group, the percentages of the active phase starting at cervical dilatation≤4 cm, ≤5 cm and ≤6 cm were 61.5% (569/925), 79.7% (737/925) and 93.4% (864/925), respectively. Conclusions Preterm primiparae may experience shorter labor duration and an earlier start of the active phase than full-term primiparae. The routine labor progression model for full-term primiparae should not be applied to preterm primiparae.

Differences in starting points of active phase and labor duration between preterm and full-term primiparae / 中华围产医学杂志

Objective@#To compare the starting points of the active phase of labor and labor duration between preterm and full-term primiparae and to provide evidence for appropriate labor management.@*Methods@#From January 2013 to December 2016, 925 preterm primiparae (preterm group, 28 to 36+6 weeks) and equal number of full-term primiparae (full-term group, 37 to 41+6 weeks) who delivered in Tianjin Central Hospital of Gynecology Obstetrics were recruited. The starting point of the active labor was defined as the cervical dilatation at the turning point on the cervical dilatation curve where changing from almost flat to the biggest slope. Differences in the starting points and labor duration between the two groups were compared. Statistical analysis was performed using two independent sample t-test, one way analysis of variance and rank-sum test.@*Results@#The duration of the first and second stages [(5.7±2.5) vs (6.8±5.2) h, t=-5.835; (29.9±16.8) vs (34.2±17.2) min, t=-12.637; both P<0.001] and the active phase [M (P95): 1.0 (3.2) vs 1.0 (4.5) h, Z=2.017, P=0.047] of the preterm primiparae were all significantly shorter than those of the full-term primiparae, and the average cervical dilatation rate was significantly accelerated during the active period [M (P5): 6.7 (1.8) vs 5.1 (1.6) cm/h, Z=-2.676, P<0.001]. In the preterm group, women whose starting points of the active phase were at 1 cm, 2 cm, 3 cm, 4 cm, 5 cm and ≥6 cm of cervical dilatation were 25 (2.7%), 275 (29.7%), 258 (27.9%), 203 (21.9%),109 (11.8%) and 55 (5.9%), respectively. While in the full-term group, women whose starting points of the active phase were at 2 cm, 3 cm, 4 cm, 5 cm, 6 cm and >6 cm of cervical dilatation were 74 (8.0%), 208 (22.5%), 287 (31.0%), 168 (18.2%), 127 (13.7%) and 61(6.6%), respectively. In the preterm group, the starting points of the active phase at cervical dilatation≤3 cm, ≤4 cm and ≤5 cm accounted for 60.3% (558/925), 82.3% (761/925) and 94.1% (870/925), respectively. In the full-term group, the percentages of the active phase starting at cervical dilatation≤4 cm, ≤5 cm and ≤6 cm were 61.5% (569/925), 79.7% (737/925) and 93.4% (864/925), respectively.@*Conclusions@#Preterm primiparae may experience shorter labor duration and an earlier start of the active phase than full-term primiparae. The routine labor progression model for full-term primiparae should not be applied to preterm primiparae.

Likelihood of cesarean birth among parous women after applying leading active labor diagnostic guidelines.

OBJECTIVES: Hospital admission during early labor may increase women's risk for medical and surgical interventions. However, it is unclear which diagnostic guideline is best suited for identifying the active phase of labor among parous women. Dr. Emanuel Friedman, the United Kingdom's National Institute for Health and Care Excellence (NICE), and the American College of Obstetricians and Gynecologists/Society for Maternal-Fetal Medicine (ACOG/SMFM) support different active labor diagnostic guidelines. Our aims were (1) to determine the proportions of parous women admitted to the hospital before or in active labor per these leading guidelines and (2) to compare associations of labor status at admission (i.e., early labor or active labor) with oxytocin augmentation, cesarean birth, and adverse birth outcomes when using the different active labor diagnostic guidelines. DESIGN: Active labor diagnostic guidelines were applied retrospectively to cervical examination data. Binomial logistic regression was used to assess associations of labor status at admission (i.e., early labor relative to active labor) and outcomes. SETTING: A large, academic, tertiary medical center in the Midwestern United States. PARTICIPANTS: Parous women with spontaneous labor onset who gave birth to a single, cephalic-presenting fetus at term gestation between 2006 and 2010 (n = 3,219). FINDINGS: At admission, 28.8%, 71.9%, and 24.4% of parous women were in active labor per Friedman, NICE, and ACOG/SMFM diagnostic guidelines, respectively. Oxytocin augmentation was more likely among women admitted in early labor, regardless of the diagnostic strategy used (p < 0.001 for each guideline). Cesarean birth was also more likely among women admitted before versus in active labor according to all guidelines (Friedman: adjusted odds ratio [AOR] 3.63 [95% CI 1.46-9.03]), NICE: AOR 2.71 [95% CI 1.47-4.99]), and ACOG/SMFM: AOR 2.11 [95% CI 1.02-4.34]). There were no differences in a composite measure of adverse outcomes within active labor diagnostic guidelines after adjusting for covariates. KEY CONCLUSIONS: Many parous women with spontaneous labor onset are admitted to the hospital before active labor. These women are more likely to receive oxytocin augmentation during labor and are more likely to have a cesarean birth. IMPLICATIONS FOR PRACTICE: Diagnosing active labor prior to admission or prior to intervention aimed at speeding labor after admission may decrease likelihoods for primary cesarean births. The NICE dilation-rate based active labor diagnostic guideline is more inclusive than Friedman or ACOG/SMFM guidelines and its use may be the most clinically-useful for improving the likelihood of vaginal birth among parous women.

Determination of a cutoff value for pelvic floor distensibility using the Epi-no balloon to predict perineal integrity in vaginal delivery: ROC curve analysis. Prospective observational single cohort study / Determinação de um valor de ponto de corte para a extensibilidade do assoalho pélvico pelo balão Epi-no para predizer integridade perineal no parto vaginal: análise pela curva ROC. Estudo prospectivo observacional de coorte única

CONTEXT AND OBJECTIVE: Several risk factors are involved in perineal lacerations during vaginal delivery. However, little is known about the influence of perineal distensibility as a protective factor. The aim here was to determine a cutoff value for pelvic floor distensibility measured using the Epi-no balloon, which could be used as a predictive factor for perineal integrity in vaginal delivery. DESIGN AND SETTING: Prospective observational single cohort study conducted in a maternity hospital. METHODS: A convenience sample of 227 consecutive at-term parturients was used. All women had a single fetus in the vertex presentation, with up to 9.0 cm of dilation. The maximum dilation of the Epi-no balloon was measured using a tape measure after it had been inflated inside the vagina up to the parturients' maximum tolerance. The receiver operating characteristic (ROC) curve was used to obtain the Epi-no circumference measurement with best sensitivity and specificity. RESULTS: Among the 161 patients who were included in the study, 50.9% underwent episiotomy, 21.8% presented lacerations and 27.3% retained an intact perineum. Age > 25.9 years; number of pregnancies > 3.4; number of deliveries > 2.2 and circumference measured by Epi-no > 21.4 cm were all directly correlated with an intact perineum. Circumference measurements using the Epi-no balloon that were greater than 20.8 cm showed sensitivity and specificity of 70.5% and 66.7% (area under curve = 0.713), respectively, as a predictive factor for an intact perineum in vaginal delivery. CONCLUSION: Circumferences greater than 20.8 cm achieved using the Epi-no balloon are a predictive factor for perineal integrity in parturients.

CONTEXTO E OBJETIVO: Diversos fatores de risco estão envolvidos nas lacerações do períneo durante o parto vaginal, contudo, pouco se sabe sobre a influência da extensibilidade perineal como um fator protetor. O objetivo foi avaliar o ponto de corte da extensibilidade do assoalho pélvico medido pelo balão Epi-no, o qual poderia ser usado como fator preditor de integridade perineal no parto vaginal. TIPO DE ESTUDO E LOCAL: Estudo prospectivo observacional de coorte única conduzido em maternidade. MÉTODOS: Uma amostra de conveniência de 277 parturientes consecutivas no termo foi utilizada. Todas as mulheres tinham feto único com apresentação cefálica fletida, com até 9,0 cm de dilatação. A máxima dilatação do balão Epi-no foi medida com fita métrica após a sua insuflação dentro da vagina até a tolerância máxima da parturiente. Uma curva característica de operação do receptor (ROC) foi utilizada para obter a medida da circunferência com a melhor sensibilidade e especificidade. RESULTADOS: Dentre as 161 pacientes que foram incluídas no estudo, 50,9% sofreram episiotomia, 21,8% lacerações e 27,3% tiveram o períneo intacto. Idade > 25,9 anos; número de gestações > 3,4; número de partos > 2,2; e medida do perímetro do Epi-no > 21,4 cm foram todos diretamente correlacionados com períneo intacto. Os valores do perímetro com o balão Epi-no que estavam acima de 20,8 cm mostraram sensibilidade e especificidade de 70,5% e 66,7% (área sob a curva = 0,713), respectivamente, como fator preditor de períneo intacto no parto vaginal. CONCLUSÃO: Circunferência medida pelo balão Epi-no maior que 20,8 cm é fator preditor de integridade perineal em parturientes.

Labor Dystocia: A Common Approach to Diagnosis.

Contemporary labor and birth population norms should be the basis for evaluating labor progression and determining slow progress that may benefit from intervention. The aim of this article is to present guidelines for a common, evidence-based approach for determination of active labor onset and diagnosis of labor dystocia based on a synthesis of existing professional guidelines and relevant contemporary publications. A 3-point approach for diagnosing active labor onset and classifying labor dystocia-related labor aberrations into well-defined, mutually exclusive categories that can be used clinically and validated by researchers is proposed. The approach comprises identification of 1) an objective point that strictly defines active labor onset (point of active labor determination); 2) an objective point that identifies when labor progress becomes atypical, beyond which interventions aimed at correcting labor dystocia may be justified (point of protraction diagnosis); and 3) an objective point that identifies when interventions aimed at correcting labor dystocia, if used, can first be determined to be unsuccessful, beyond which assisted vaginal or cesarean birth may be justified (earliest point of arrest diagnosis). Widespread adoption of a common approach for diagnosing labor dystocia will facilitate consistent evaluation of labor progress, improve communications between clinicians and laboring women, indicate when intervention aimed at speeding labor progress or facilitating birth may be appropriate, and allow for more efficient translation of safe and effective management strategies into clinical practice. Correct application of the diagnosis of labor dystocia may lead to a decrease in the rate of cesarean birth, decreased health care costs, and improved health of childbearing women and neonates.

Stopping Oxytocin in Active Labor Rather Than Continuing it until Delivery: A Viable Option for the Induction of Labor.

OBJECTIVE: Induction of labor (IOL), using intravenous oxytocin, is the artificial initiation of labor before its spontaneous onset for the purpose of delivery of the fetoplacental unit. Although there are various studies looking at dosages of oxytocin, only a few have addressed the issue of discontinuation of oxytocin in the active stage of labor. Thus, our study was conducted to evaluate the need for continuation versus discontinuation of oxytocin during active labor. METHODS: This prospective, randomized controlled trial included 106 women who needed IOL. Oxytocin infusion was initiated at a rate of 3mIU/min and was incremental until 4-6cm cervical dilation. At this point the patients were randomly assigned into one of two groups. In group one, oxytocin was discontinued, and infusion was continued with 0.9% sodium chloride solution. In group two, oxytocin was continued at the same dose until delivery. RESULTS: The duration of oxytocin infusion was 5.5 hours in the oxytocin discontinuation group and 11.0 hours in oxytocin continuation group (p<0.001). The total dose of oxytocin was significantly higher in group two (6.1 units vs. 16.5 units; p=<0.001). The induction-delivery interval was significantly less in group one (9.1 and 11.2 hours in group one and group two, respectively; p=0.023). CONCLUSION: Oxytocin discontinuation in the active stage of labor did not prolong the active stage. The total duration of labor and total oxytocin dose were significantly less in the oxytocin discontinuation group. Our results suggest that oxytocin discontinuation is an alternative and viable option particularly in resource poor and economically challenged settings. It not only reduces the need for intense monitoring and prolonged oxytocin use-associated dangers but reduces the total cost of labor management.

A randomized controlled trial on early induction compared to expectant management of nulliparous women with prolonged latent phases.

OBJECTIVE: To compare early induction and expectant management regarding delivery outcomes and the experience of delivery in nulliparous women with prolonged latent phases. DESIGN: Randomized controlled trial. SETTING: One delivery unit in a Swedish hospital. POPULATION: Nulliparous women at term experiencing continuous contractions impeding rest (women's report) and exceeding 18 h, a cervical dilation of less than 4 cm, intact membranes and with a singleton fetus in cephalic presentation. METHODS: The women were randomly allocated to either early induction (n = 65) or expectant management (n = 64). All participants received medication for therapeutic rest. The early induction group was induced five hours after medication, and the expectant group awaited spontaneous onset of labor. The Wijma Delivery Experience Questionnaire (W-DEQ version B) was filled in after delivery. MAIN OUTCOME MEASURES: The primary outcome was mode of delivery. Secondary outcomes included birth experience, duration of labor, postpartum hemorrhage, and neonatal outcomes. RESULTS: The cesarean section rate was 15 of 65 (23.1%) in the early induction group and 24 of 64 (37.5%) in the expectant group (p = 0.076, OR 2.00, 95% CI 0.93-4.31). No significant differences were shown regarding delivery, neonatal outcomes or birth experience. CONCLUSIONS: No significant differences were shown between the two groups in the rate of cesarean sections or the experience of delivery. According to the actual results, the power to detect a difference was only 45%. The cesarean section rate was high in both groups, regardless of intervention.

Influence of acupuncture on parturition process / 中国基层医药

Objective To observe the influence of acupuncture treatment on parturition process.Methods 545 pregnant women delivered in our hospital were selected,excluding those with cesarean section indication.On voluntary principle and randomized principle,primipara aged from 22 to 30 who agreed with natural labor were divided into two groups:observation group and control group.Pregnant women in observation group were received acupuncture treatment during latent phase.The following indexes of the two groups were recorded and compared:labor time of the first stage and the second stage,the case for inertia of uterus,cesarean sections,postpartum hemorrhage amount and Apgar score of new-born.Results The labor time of the first stage and the second stage of the control group were (178.55 ± 56.87) min and (130.70 ± 77.22) min,and which of the observation group were (53.87 ±22.33) min and (33.25 ± 15.55) min,there was significant differenec between the two groups(t =3.97,4.11,all P ＜0.05).The differences in the pilot failed to cesarean section rate(14.2％ and 13.6％),postpartum hemorrhage and the perinatal outcome were not significant between the two groups.Conclusion Acupuncture and moxibustion can accelerate labor.

O papel da equipe de saúde no cuidado e conforto no trabalho de parto e parto: opinião de puérperas / El papel del equipo de salud en el cuidado y confort durante el trabajo del parto y el parto: la opinión de las puérperas / The healt team's role in providing care and comfort during labor and childbirth: the puerperae's opinion

Trata-se de um recorte qualitativo de uma pesquisa multicênctrica quali-quantitativa, desenvolvida com suporte teórico dos Componentes de Cuidado de Carraro. Tem como objetivo apresentar o papel da equipe de saúde, segundo a opinião das mulheres, quanto aos métodos utilizados para seu cuidado e conforto durante trabalho de parto e parto. As entrevistas foram realizadas com 30 puérperas internadas em três instituições públicas da região sul do Brasil, no período de agosto a dezembro de 2006, sendo analisados por meio de análise de conteúdo. Como resultados, surgiram as categorias: apoio emocional da equipe de saúde; orientação; e des-cuidado, que aparece nos momentos de solidão e abandono mencionados pelas puérperas. O estudo aponta a enfermeira, juntamente com a equipe de saúde, tomando posição quanto à sua responsabilidade ética, legal e moral, e não apenas técnica e científica, despertando a mulher para a realidade de conhecer seu corpo e limites.

This is a qualitative fragment of a multi-centric study with qualitative and quantitative approaches developed in three public health institutions in the Southern region of Brazil, involving 30 inpatient pregnant women. The study uses Carraro's Components of Care as theoretical support and aims to present the health team's role, according to the methods applied for women's care and comfort during labor and childbirth. The interviews took place between August and December of 2006 and were analyzed through content analysis. As a result, the following categories emerged: emotional support provided by the health team; orientation; and care-lessness, which appeared in moments of loneliness and abandonment mentioned by the interviewed women. The study points out the nurse together with the health team taking a stand on their ethical, legal, and moral responsibility, going beyond technical and scientific responsibility, awakening women to the reality of knowing her body and her limitations.

Se trata de una investigación cualitativa y cuantitativa, multicéntrica, con base teórica en los Componentes del Cuidado de Carraro, cuyo objetivo fue presentar el papel del equipo de salud, según la opinión de las mujeres, en relación a los métodos utilizados para su cuidado y confort durante el trabajo de parto y el parto. Las entrevistas fueron realizadas con 30 puérperas internadas en tres instituciones públicas de la región sur de Brasil, en el periodo de agosto a diciembre de 2006, siendo analizados los datos por medio del análisis de contenido. Como resultados, surgieron las siguientes categorías: apoyo emocional del equipo de salud; orientación; y falta de cuidado, el cual aparece en los momentos de soledad y abandono mencionados por las puérperas. El estudio indica a la enfermera, juntamente con el equipo de salud, tomando posición en relación a su responsabilidad ética, legal y moral, y no apenas técnica y científica, despertando la mujer para la realidad de conocer su cuerpo y sus límites.

Clinical obstration on promoting the first stage of the multigravidae by using of 654-2 / 中国基层医药

Objective To explore the clinical effect by using of 654-2 to multigravidae.Methods Among 60 multigravidaes deliverying,30 were treated with 654-2 and oxytocin,the other 30 multigravidaes were treated with oxytocin only for control.The time of dilatation of the cervix,the rate of fetal distress and neonatal asphyxia,the rate of operative delivery and postpartum hemorrhage were observed.Results The time of dilatation of the cervix and the rate of operative delivery were shorter than the control.It was significantly different between the two groups(P0.05).Conclusion 654-2 can promote the first stage of the multigravidae.It can reduce the rate of operative delivery.It is safety by using of 654-2 to short the first stage to multigravidae.

Effect of cervical injected Phloroglucinol on the progress of labor during latent phase / 中华围产医学杂志

Objective To observe the effects of phlorohlucinol on cervical dilatation. Methods Totaling 250 normal parturients were randomized into four study groups (50 in each group) and control group (n=50). Phloroglucinol was given in the study groups(group1,2,3 and 4)at the dose of 40 mg to the cervix and/or 160 mg and 200 mg intravenously during the latent phase. The control group (group1) received only atropine (0.5 mg) intravenously. Results The overall speed of cervical dilatation in the study group was (2.82?1.82) cm/h and (1.78?1.01) cm/h in the control group. The mean time of the first stage of labor was (14.23?1.11) h and (17.71?2.23) h in the study and control group, respectively (P

Effects of Diazepam (Valium) Injected to Cervix During the Latent Phase of the First Stage of Labor / 中华围产医学杂志

Objective To observe the effects of diazepam on the cervix in relieving spasm, eliminating edema and improving dilation during the latent phase of labor. Methods One hundred normal parturients were randomly devided into study group ( n =50) and control group ( n =50). The study group was injected diazepam 10 mg in the cervix during the latent phase. The control group was given 10 mg of diazepam by intravenous injection. Results The dilating speed of cervix in study group was 2.81?1.92 cm/h. The mean time of the first stage of labor was 11.13?1.21 h, while the control group was 1.98?0.92 cm/h and 13.34?0.44 h respectively. The differences between two groups were statistically significant ( P