Birthing balls to decrease labor pain and peanut balls to decrease length of labor: what is the evidence?

Birthing balls and peanut balls have been used for decades by nurses and midwives as a nonpharmacologic adjunct to labor management based on anecdotal evidence. This article aimed to review the evidence regarding their safety and efficacy based on randomized controlled trials. Birthing balls are round exercise balls that a laboring individual can use for sitting, rocking, and pelvic rotation. The use of the birthing balls has been thought to increase maternal comfort and mimic upright positioning to widen the pelvic outlet for those laboring without an epidural. A recent meta-analysis showed that the use of the birthing ball in labor significantly reduces maternal pain in labor by 1.7 points on a standard visual analog scale of 1 to 10 (mean difference, -1.70 points; 95% confidence interval, -2.20 to -1.20). The use of the birthing ball does not significantly affect the mode of delivery or the rate of other obstetrical complications. This suggests that its use is safe and can offer subjective improvement in maternal pain experienced during labor. The peanut ball is a peanut-shaped plastic ball placed between the knees of a person laboring in the lateral recumbent position, a position common in those laboring with an epidural. Traditionally, its use has been thought to allow for bent-knee positioning that can mimic a squatting position and facilitate frequent and optimal position changes during labor. Data regarding the effects of the peanut ball are mixed. A recent systematic review and meta-analysis found that the use of the peanut ball compared with no peanut ball is associated with a significantly decreased first stage of labor (mean difference, -87.42 minutes; 95% confidence interval, -94.49 to -80.34) and an 11% higher relative risk of vaginal delivery (relative risk, 1.11; 95% confidence interval, 1.02-1.22; n=669). The use of the peanut ball is not associated with increased incidences of obstetrical complications. As such, it is reasonable to offer to individuals in labor. There has been no reported risk of the use of either the birthing ball or the peanut ball. As such, both interventions can be offered to individuals in labor as an adjunct to labor management techniques based on moderate quality evidence.

[Immunohistochemical characterization of acute leukemia. Study of 31 bone marrow biopsies]. / Caractérisation immunohistochimique des leucémies aiguës. Etude de 31 biopsies ostéo-médullaires.

An immunohistochemical study by avidin-biotin-peroxidase was performed on paraffin-embedded and decalcified bone marrow biopsies in 31 acute leukemias (19 myeloid and 12 lymphoblastic). The Ulex Europaeus lectin and 14 antibodies (anti-CD45, -CD34, -myeloperoxidase, -lysozyme, -CD15, -CD68, -carcinoembryonic antigen, -factor VIII-related antigen, BNH9, anti-CD45RO, -CD3, -CD20, DBB42 and DBA44) were tested. All acute myeloid leukemias from M0 to M5 type were stained by either the anti-myeloperoxidase or anti-lysozyme antibodies. CD68, CD15 and the carcinoembryonic antigen were respectively expressed in 80%, 40% and 20% of myeloid leukemias from M1 to M5 type. The Ulex Europaeus lectin and the anti-factor VIII-related antigen antibody stained only the M7 leukemia and the anti-CD3 antibody stained only the T acute lymphoblastic leukemia. DBB42 was expressed by 63% of B-lineage lymphoblastic leukemias and CD20 by 36%. No leukemia was stained by DBA44. Immunohistochemistry on bone marrow biopsy can assess the lineage of most acute leukemias with the use of a panel of antibodies such as the anti-myeloperoxidase, -lysozyme, -CD68, -CD20, DBB42, -CD3, BNH9, anti-factor VIII-related antigen antibodies and the Ulex Europaeus lectin.