Optimal continuous support accompanying labor - the midwives' and laboring women's point of view.

BACKGROUND: Women who have continuous intrapartum support are more likely to have a shorter labor and spontaneous vaginal birth, and are less likely to need intrapartum analgesia than women who receive usual care without support. We aimed to determine what women in labor and midwives regard as the optimal number of labor supporters and whether they should be present during medical interventions. METHODS: A questionnaire was distributed to midwives participating in a national midwifery conference in June 2015. In addition, an anonymized questionnaire concerning the preferred number and type of supporters was distributed to laboring women at the beginning of labor and repeated post-partum in the maternity unit of a single tertiary medical center between March 2017 and January 2018. RESULTS: Of 124 midwives from 18 hospitals throughout Israel attending the conference, 92 (74%) completed the questionnaire. Eighty-three percent of the midwives who responded felt that more than two supporters interferes with their work. Eighty percent of the midwives work in obstetrical units that allow up to two labor supporters, and 82% of them felt that one or two supporters is optimal. Similarly, of the 140 laboring women surveyed, 84% preferred one or two supporters. There was no difference in the preferred number of supporters between the maternal pre- and post-partum questionnaires. The laboring women and midwives had differing opinions regarding supporter presence during vacuum extraction and perineal suture. Sixty-four percent of the midwives preferred that the supporter not be present during vacuum extraction, and 45% of them preferred that the supporter not be present during perineal suture. In contrast, among the laboring women, 78% preferred supporter presence during vacuum extraction, 76% during perineal suture and 74% during vaginal examination. Interestingly, even among the midwives, 82% preferred that the supporter remain during vaginal examination and 84% preferred the supporter remain during medical rounds. CONCLUSIONS: Serious consideration should be given to restricting the number of labor supporters to two, as both laboring woman and midwives consider that to be the optimal number. In light of the difference of opinion regarding presence of supporters during certain medical procedures, additional surveys concerning the points of view of obstetricians and laboring women in additional hospitals should be considered before establishing a national policy.

Colposcopy in Evaluating Bleeding During the Second and Third Trimesters: Short-Term and Postpartum Implications.

BACKGROUND: The etiology of vaginal bleeding during pregnancy may be obstetric or non-obstetric. Though colposcopy is generally not part of the routine evaluation of 2nd- or 3rd-trimester vaginal bleeding without obvious obstetrical cause, our department does perform colposcopy and cervical cytology testing in these patients. This study assessed the need and possible contribution of colposcopy in diagnosing the etiology of 2nd- and 3rd-trimester bleeding. METHODS: Retrospective analysis of colposcopy findings from 2012-2015 in patients with 2nd- or 3rd-trimester bleeding where an obstetrical cause was not found. Data collected included demographics, obstetric data, bleeding characteristics, colposcopy results, cervical cytology testing, a sonogram directed at the placenta, and birth details. RESULTS: Of the 168 patients who underwent colposcopy, 29 (17.3%) complained of postcoital bleeding (PCB). The following were the colposcopy results: 5 (3%) had abnormal colposcopy findings, 14 (8.3%) ectropion, 4 (2.4%) polyps, and 1 (0.6%) vaginal varices. Postpartum follow-up of women with PCB or pathologic cervical cytology testing diagnosed 1(0.6%) patient with high-grade cervical intraepithelial neoplasia 2-3, human papillomavirus 18 and 45 positive. CONCLUSIONS: Colposcopy diagnosed the origin of bleeding in 24 cases (13.7%). These findings support the use of colposcopy in evaluating vaginal bleeding of undetermined obstetric origin during pregnancy.