Association between fetal position at onset of labor and mode of delivery: a prospective cohort study.

OBJECTIVES: To determine the association between fetal position at onset of labor and mode of delivery, specifically left occipito-anterior (LOA) fetal position and spontaneous vaginal delivery (SVD). METHODS: All nulliparous women who were booked at the Birmingham Women's NHS Foundation Trust over an 18-month period from April 2007 to September 2008 with a singleton live fetus without structural anomalies at term gestation were invited to take part in the study. Women recruited to the study underwent a transabdominal ultrasound scan to determine fetal occiput position at the onset of labor. They were then followed up until birth to determine outcome. The primary outcome measure was mode of delivery, categorized into SVD, instrumental delivery and Cesarean section. RESULTS: Of 1647 eligible women, 1250 had valid scans at onset of labor; 155 of the 1250 (12.4%) had fetuses in the LOA position. Analysis showed no evidence of difference in odds ratio (OR) of SVD for fetuses in the LOA position compared with all other positions (OR 0.864 (95% CI, 0.617-1.209); P = 0.394). No difference remained with adjustment for confounding effects of variables known to influence mode of delivery (OR 0.837 (95% CI, 0.551-1.272); P = 0.405). No other occipital position showed significant association with SVD. There was no evidence of the LOA position being associated with Cesarean section, ventouse or forceps delivery. CONCLUSION: There is no evidence of an association between the fetal LOA position at onset of labor and SVD. This finding challenges the conventional theory that LOA is the optimum fetal position at onset of labor, and suggests that antenatal practices encouraging adoption of the LOA position through maternal posturing are unnecessary.

Valuing authority/responsibility relationships. The essence of professional practice.

Central to the practice of professional nursing are the elements of accountability, autonomy, direct communication, and authority. The value that nursing work groups place on authority affects their level of acceptance of responsibility and accountability for clinical decision making. The authors examined the value that nurse managers and staff nurses on primary nursing and total patient care units place on authority/responsibility relationships. Results indicated that nurse managers and staff nurses on primary nursing units valued accountability, authority, and autonomy more than the nurse managers and staff nurses on total patient care units, a finding consistent with the professional practice model of primary nursing.

Toward the development of a potent, nonsedating, oral analgesic.

The separate and combined analgesic effects of 10 mg of oral amphetamine sulfate and 25 mg of oral anileridine dihydrochloride were studied in 24 healthy, adult, male volunteers. Tolerance of progressively increasing pain produced by the Submaximum Effort Tourniquet Technique was tested four times in each subject: after amphetamine, after anileridine, after the combination, and after a matching placebo. Treatments were administered double blind and in counterbalanced order. Elapsed time to report of slight, moderately distressing, very distressing, and unbearable pain was recorded on each trial. The four oral treatments differed significantly for very distressing and for unbearable pain. At each of the three upper pain levels, the mean tolerance times for anileridine and amphetamine were similar; each was longer than placebo but shorter than the combination; and the effect of the combination was approximately the sum of the effects of the two components.