Machine learning model based on RCA-PDCA nursing methods and differentiating factors to predict hypotension during cesarean section surgery.

BACKGROUND: Intraoperative hypotension during cesarean section has become a serious complication for maternal and fetal healthy. It is commonly encountered by subarachnoid anesthesia. However, currently used control methods have varying degrees of side effects, such as drugs. The Root Cause Analysis (RCA) - Plan, Do, Check, Act (PDCA) is a new model of care that identifies the root causes of problems. The study aimed to demonstrate the usefulness of RCA-PDCA nursing methods in preventing intraoperative hypotension during cesarean section and to predict the occurrence of intraoperative hypotension through a machine learning model. METHODS: Patients who underwent cesarean section at Traditional Chinese Medicine of Southwest Medical University from January 2023 to December 2023 were retrospectively screened, and the data of their gestational times, age, height, weight, history of allergies, intraoperative vital signs, fetal condition, operative time, fluid out and in, adverse effects, use of vasopressor drugs, anxiety-depression-pain scores, and satisfaction were collected and analyzed. The statistically different features were screened and five machine learning models were used as predictive models to assess the usefulness of the RCA-PDCA model of care. RESULTS: (1) Compared with the general nursing model, the RCA-PDCA nursing model significantly reduces the incidence of intraoperative hypotension and postoperative complications in cesarean delivery, and the patient experience is comfortable and satisfactory. (2) Among the five machine learning models, the RF model has the best predictive performance, and the accuracy of the random forest model in preventing intraoperative hypotension is as high as 90%. CONCLUSION: Through computer machine learning model analysis, we prove the importance of the RCA-PDCA nursing method in the prevention of intraoperative hypotension during cesarean section, especially the Random Forest model which performed well and promoted the application of artificial intelligence computer learning methods in the field of medical analysis.

Timing of induction of labor in suspected macrosomia: retrospective cohort study, systematic review and meta-analysis.

OBJECTIVE: Large-for-gestational-age (LGA) is associated with several adverse maternal and neonatal outcomes. Although many studies have found that early induction of labor (eIOL) in LGA reduces the incidence of shoulder dystocia (SD), no current guidelines recommend this particular strategy, due to concerns about increased rates of cesarean delivery (CD) and neonatal complications. The purpose of this study was to assess whether the timing of IOL in LGA fetuses affects maternal and neonatal outcomes in a single center; and to combine these results with the evidence reported in the literature. METHODS: This study comprised two parts. The first was a retrospective cohort study that included: consecutive patients with singleton pregnancy, an estimated fetal weight (EFW) ≥90th percentile on ultrasound (US) between 35+0 and 39+0 weeks of gestation (WG), who were eligible for normal vaginal delivery. The second part was a systematic review of literature and meta-analysis that included the results of the first part as well as all previously reported studies that have compared IOL to expectant management in patients with LGA. The perinatal outcomes were CD, operative vaginal delivery (OVD), SD, brachial plexus palsy, anal sphincter injury, postpartum hemorrhage (PPH), APGAR score, umbilical arterial pH, neonatal intensive care unit (NICU) admission, use of continuous positive airway pressure (CPAP), intracranial hemorrhage (ICH), phototherapy, and bone fracture. RESULTS: Retrospective cohort: of the 547 patients, 329 (60.1%) were induced and 218 (39.9%) entered spontaneous labor. Following covariate balancing, CD was significantly higher in the IOL group in comparison to the spontaneous labor group. This difference only became apparent beyond 40WG (hazard ratio: 1.9, p=0.030). The difference between both groups for shoulder dystocia was not statistically significant. Systematic review and metanalysis: 17 studies were included in addition to our own results giving a total sample size of 111,300 participants. When IOL was performed <40+0WG, the risk for SD was significantly lower in the IOL group (OR: 0.64, 95%CI: 0.42-0.98, I2 =19%). There was no significant difference in CD rate between IOL and expectant management after pooling the results of these 17 studies. However, when removing the studies in which IOL was done exclusively before 40+0WG, the risk for CD in the remaining studies (IOL not exclusively <40+0WG) was significantly higher in the IOL group (odds ratio [OR]: 1.46, 95% confidence interval [95%CI]: 1.02-2.09, I2 =56%). There were no statistically significant differences between IOL and expectant management for the remaining perinatal outcomes. Nulliparity, history of CD, and low Bishop score but not methods of induction were independent risk factors for intrapartum CD in patients who were induced for LGA. CONCLUSION: Timing of IOL in patients with suspected macrosomia significantly impacts perinatal adverse outcomes. IOL has no impact on rates of SD but does increase CD when considered irrespective of gestational age, but it may decrease the risk of SD without increasing the risk of other adverse maternal outcomes, in particular cesarean section when performed before 40+0 WG. (GRADE: Low/Very low). This article is protected by copyright. All rights reserved.

Effect of Reflexology on Pain, Fatigue, Sleep Quality, and Lactation in Postpartum Primiparous Women After Cesarean Delivery: A Randomized Controlled Trial.

BACKGROUND: Mothers commonly experience pain, fatigue, sleep disruption, and breastfeeding problems after cesarean delivery. To date, no follow-up study has examined all of these variables to evaluate the utility of reflexology in reducing these problems and supporting breastfeeding. RESEARCH AIM: This study aimed to determine the effect of foot reflexology performed in the postpartum period on pain, fatigue, sleep quality, and lactation in primiparous women who underwent cesarean delivery. METHODS: This is a two-arm, parallel-group randomized controlled trial. Data were collected between January 1, 2020, and January 31, 2021, with a sample of 80 women who were randomly assigned to the reflexology (n = 40) and control (n = 40) groups. The reflexology group received 40 minutes of foot reflexology once a week for 8 weeks. The primary outcomes of the study were pain, fatigue, sleep quality, and breastfeeding efficacy. RESULTS: Pain scores in the reflexology group decreased by 90.9% in week 1, 90.2% in week 2, and 59.8% in week 3 compared to the control group. Pain resolved at week 4 in the reflexology group and week 7 in the control group. The reflexology group showed a 36.9% decrease in fatigue level, a 48.0% increase in energy level, a 70.7% increase in sleep quality, and a 20.2% increase in breastfeeding efficacy compared to the control group (p < 0.05). CONCLUSIONS: Foot reflexology reduces postpartum symptoms and positively affects breastfeeding and can be used safely in postnatal care practices.

Is enhanced recovery after surgery essential?

BACKGROUND: The enhanced recovery after surgery (ERAS) method is designed for the patient to recover quickly, have less pain and have a more comfortable period after the surgery; that includes preoperative, intra and postoperative processes. ERAS has been started to be applied in cesarean section surgeries as the patients need to recover quickly. In the literature, there is no study about the results of ERAS in cesarean section about pain scores and complications. OBJECTIVES: It is aimed to compare the results of cesarean section patients using the ERAS method completely in patients who have had cesarean section without meeting some of the postoperative conditions of the ERAS criteria. STUDY DESIGN: It is a prospective study designed as postoperative metoclopramide, enema and routine opioids in group 1, enema and metoclopramide in group 2, metoclopramide only in group 3 and nothing in group 4. Postoperative pain scoring was done by using visual analog scale (VAS). Analysis of variance tests and t tests were used for results. RESULTS: There was no difference between groups according to age, parity, and birth weight. As a result, although there was no difference between the groups in terms of discharge time and complications, the VAS score used in pain scoring was found to be significantly lower in group 3 compared to the other groups (p: 0.000). Only metoclopramide group (group 3) had lowest VAS score. CONCLUSION: It has been revealed that the ERAS procedure does not need to be so detailed in the postoperative period, and the addition of metoclopramide may be sufficient. Since pain can be a subjective factor, other randomized studies are needed in terms of other criteria.

The effect of progressive relaxation exercises and transcutaneous electrical neural stimulation administered to women delivering via cesarean delivery on pain, breastfeeding success, and comfort levels: A randomized controlled study.

OBJECTIVE: This study aimed to determine the effect of progressive relaxation exercises (PRE) and transcutaneous electrical nerve stimulation administered to women delivering via cesarean delivery on acute pain, breastfeeding success, and comfort levels. METHODS: This is a single-blind, randomized controlled study. This study was carried out in the obstetrics and gynecology clinic of a university hospital affiliated with the Ministry of Health in Turkey between August 20, 2018 and April 15, 2019. A total of 120 participants were randomly assigned to one of four groups, which included a transcutaneous electrical neural stimulation (TENS) group, a PRE group, a combined intervention group, and a control group. Data were collected with a Data Collection Form, The Visual Analogue Scale, The LATCH Breastfeeding Diagnostic Tool, and The Postpartum Comfort Scale. RESULTS: According to the findings of the study, it was determined that pain significantly decreased and comfort increased after having a cesarean delivery in all three intervention groups compared to the control group (p < 0.05). Regarding the breastfeeding success, while there was no statistically significant change in this behavior in the TENS group, it was significantly better in the PRE group and the combined intervention group, where TENS and PRE were administered together (p < 0.05). CONCLUSIONS: According to our study results, we recommend that TENS and PRE should be employed together after a cesarean delivery as safe non-pharmacological methods in pain management, eliminating breastfeeding problems, and increasing comfort.

Delayed cord clamping versus cord milking in vigorous neonates ≥35 weeks gestation born via cesarean: A Randomized clinical trial.

BACKGROUND: Delayed cord clamping (DCC) is the recommended strategy in neonates not requiring resuscitation, but umbilical cord milking (UCM) can also be used in term babies. DCC has been found to offer advantages more than just placental transfusion. OBJECTIVE: To compare the neonatal outcomes of DCC and UCM at birth in vigorous neonates ≥35 weeks born via cesarean section. METHODS: We included all vigorous neonates born ≥35 weeks of gestation through the cesarean section in this open-label randomized controlled trial. They were randomized into Group-A (DCC-cord was clamped 60 s after birth) or Group B(UCM). For neonates in Group B, the intact cord was milked at 25 cm from the stump 3 times towards the neonate and then clamped. The primary outcome was hematocrit at 72 h of life. Secondary outcomes were serum ferritin between 6 and 10 weeks of life, serum bilirubin at 72 h of life, need and duration of phototherapy, respiratory distress, hypoglycemia, hypotension, and sepsis. RESULTS: Baseline characteristics were similar in both the groups. The mean hematocrit at 72 h was more in the DCC group compared to the UCM group [(55.60±4.50) vs (53.89±4.44), MD (95% CI) = 1.71 (0.26, 3.16); p = 0.021]. There was no significant difference in median serum ferritin between the groups [102.88(84.67-173.24) vs 137.93(85.15-230.40); p = 0.173]. There was no significant difference in clinical outcomes. CONCLUSION: In neonates born via cesarean section, DCC resulted in improved hematocrit levels by 72 hours compared to UCM. DCC results in better placental transfusion.

Prophylactic effect of chamomile on post-dural puncture headache in women undergoing elective cesarean section: A randomized, double blind, placebo-controlled clinical trial.

BACKGROUND: Post-dural puncture headache (PDPH) is a common complication after spinal anesthesia, affecting patient recovery. This study evaluated the prophylactic effect of topical chamomile ointment on PDPH in women undergoing elective cesarean section. METHODS: In a randomized, double-blind, placebo-controlled clinical trial 148 pregnant women were randomized into two parallel groups and received 3cc of the chamomile or the placebo ointment on the forehead of the participants 20 minutes before the start of spinal anesthesia, and then 2 and 4 hours after that. The primary outcomes were the incidence rate of headache, and its severity assessed by a numeric rating scale (NRS), while secondary outcomes included analgesic consumption, frequency of nausea/vomiting, and adverse events. RESULTS: Chamomile ointment exhibited significant preventive effects on PDPH incidence compared to placebo. The chamomile group demonstrated lower rates of PDPH at 6 hours (3.5% vs. 7.18%, p = 0.021) and 12 hours (7.6% vs. 20%, p = 0.028) after spinal anesthesia. Analgesic consumption, frequency of nausea/vomiting, and adverse events were comparable between the groups. CONCLUSION: Topical chamomile ointment demonstrated significant preventive effects on PDPH incidence compared to placebo. Chamomile ointment could be a promising adjunctive approach to prevent PDPH, enhancing patient comfort and potentially reducing the need for analgesics. Further investigation is needed to explore its mechanisms and broader applications.

Mothers' Perceptions About Childbirth Preparation Classes: A Qualitative Study.

Background: Childbirth preparation classes are designed for better adaptation of couples to physiological and psychological changes related to pregnancy and childbirth. Therefore, we aimed to explore the mothers' perceptions about childbirth preparation classes. Methods: A qualitative study was conducted using the conventional qualitative content analysis method from May to August 2022. Eighteen women who had given birth in the last six months in one of the hospitals in Tehran and at least 20 days had passed since their delivery were included in the study; also, five husbands, two midwives, and two obstetricians were interviewed. The participants were purposefully selected according to the inclusion criteria. Sampling continued until data saturation. Data were collected through individual, in-depth, and semi-structured interviews and analyzed by the MAXQDA version 10 software. Results: Mothers' age ranged from 17 to 37 years. 128 primary codes, 7 sub-sub themes, 3 sub-themes, and one theme were extracted. The sub-themes included satisfaction from the choice (perception forming for better choices, common consent), making the wait pleasant (dignity-oriented professional care, adaptation to change, feeling of empowerment), and good termination (free and conscious choice for birth mode, self-control during delivery process). Finally, a theme called "making motherhood pleasant" was extracted. Conclusion: Making motherhood pleasant can be a meaningful achievement of childbirth preparation classes. Paying more attention to improving the quality of these classes can help improve family health. Therefore, policymakers should implement strategies to facilitate women's access to these classes.

A Systematic Review of Interventions for Prevention and Treatment of Post-Traumatic Stress Disorder Following Childbirth.

Objective: Postpartum women can develop post-traumatic stress disorder (PTSD) in response to complicated, traumatic childbirth; prevalence of these events remains high in the U.S. Currently, there is no recommended treatment approach in routine peripartum care for preventing maternal childbirth-related PTSD (CB-PTSD) and lessening its severity. Here, we provide a systematic review of available clinical trials testing interventions for the prevention and indication of CB-PTSD. Data Sources: We conducted a systematic review of PsycInfo, PsycArticles, PubMed (MEDLINE), ClinicalTrials.gov, CINAHL, ProQuest, Sociological Abstracts, Google Scholar, Embase, Web of Science, ScienceDirect, and Scopus through December 2022 to identify clinical trials involving CB-PTSD prevention and treatment. Study Eligibility Criteria: Trials were included if they were interventional, evaluated CB-PTSD preventive strategies or treatments, and reported outcomes assessing CB-PTSD symptoms. Duplicate studies, case reports, protocols, active clinical trials, and studies of CB-PTSD following stillbirth were excluded. Study Appraisal and Synthesis Methods: Two independent coders evaluated trials using a modified Downs and Black methodological quality assessment checklist. Sample characteristics and related intervention information were extracted via an Excel-based form. Results: A total of 33 studies, including 25 randomized controlled trials (RCTs) and 8 non-RCTs, were included. Trial quality ranged from Poor to Excellent. Trials tested psychological therapies most often delivered as secondary prevention against CB-PTSD onset (n=21); some examined primary (n=3) and tertiary (n=9) therapies. Positive treatment effects were found for early interventions employing conventional trauma-focused therapies, psychological counseling, and mother-infant dyadic focused strategies. Therapies' utility to aid women with severe acute traumatic stress symptoms or reduce incidence of CB-PTSD diagnosis is unclear, as is whether they are effective as tertiary intervention. Educational birth plan-focused interventions during pregnancy may improve maternal health outcomes, but studies remain scarce. Conclusions: An array of early psychological therapies delivered in response to traumatic childbirth, rather than universally, in the first postpartum days and weeks, may potentially buffer CB-PTSD development. Rather than one treatment being suitable for all, effective therapy should consider individual-specific factors. As additional RCTs generate critical information and guide recommendations for first-line preventive treatments for CB-PTSD, the psychiatric consequences associated with traumatic childbirth could be lessened.

Antenatal steroid as an independent risk factor for vitamin K2 deficiency in newborns: A Chinese single-center, retrospective study.

OBJECTIVES: To identified vitamin K2 deficiency rate and risk factors among newborns in China and assess the importance of high-risk maternal intakes of vitamin K2. METHODS: This retrospective study was performed at the Neonatology Department, the Affiliated Hospital of Guangdong Medical University, China. Routinely collected mother-neonate hospitalization data from July 2020 to January 2021 were analyzed. In total, data from 200 neonates who had completed vitamin K2 tests were utilized to assess the prevalence of vitamin K2 deficiency and identify the potential risk factors. According to the vitamin K2 level, the neonates were divided into 2 groups: cases (vitamin K2 deficiency) and controls (no vitamin K2 deficiency). The potential risk factors for vitamin K2 deficiency were evaluated by univariate and multivariate logistic regression. RESULTS: The vitamin K2 level in 24 of the 200 neonates was undetectable (<0.05 ng/mL). The prevalence of low serum vitamin K2 (<0.1 ng/ml) was 33%. Study subjects with antenatal corticosteroids use had an approximately 5-fold greater risk of developing vitamin K2 deficiency. In the univariate analyses, small-for-gestational-age (SGA), caesarean section, maternal gestational diabetes and premature rupture of the membranes were risk factors for vitamin K2 deficiency. In the multivariate logistic regression analysis, high antenatal corticosteroids use, cesarean section, and SGA were independently associated with vitamin K2 deficiency. CONCLUSION: The present study demonstrated that antenatal corticosteroids use is independently associated with vitamin K2 deficiency. This finding highlights the importance of routine vitamin K2 supplementation in late-stage pregnant women and neonates in China.

Evaluation of photobiomodulation effect on cesarean-sectioned wound healing: a clinical study.

The effects of low-level laser on the wound healing and burn injuries have been previously examined to demonstrate some satisfactory results. Despite there are a few articles available to study photobiomodulation (PBM) effects on the pain relief of cesarean sectioned wound, however no systematic examination has been carried out so far regarding its healing. Here, the aim of this clinical study was to evaluate PBM effect on the cesarean-sectioned wound healing. PBM effects of semiconductor lasers are investigated at 658 and 660 nm with 100, 150 and 350 mW output powers on 40 patients. Due to the global increasing number of cesarean sections, we have decided to investigate the effect of laser as a reliable technique to recover the wounds fast. We considered women as the target group who had their first delivery giving the birth of their children by cesarean section. We selected patients are who treated by laser therapy using indium gallium aluminum phosphide (InGaAlP) semiconductor linear scanning type with beam cross section of 12 cm2 and the output power of 100 mW at 658 nm exposing a therapeutic dose of 2 J/cm2. The purpose is to accelerate the healing process of the wounds after delivery as an intervention group against the people who chose the conventional methods (using ointments, pills, etc.) to heal their cesarean sectioned wounds as the control group. Regarding the wounds of these two groups, the questionnaires were filled by patients to assess the severity of pain from visual analogue scale (VAS) based on the healing of wounds from redness, edema, ecchymosis, discharge, and distance between the two edges of the wound (REEDA) scale in the early hours after surgery and the post-treatment follow-up on the third, seventh, and the tenth days. The data collected by these questionnaires were analyzed using statistical package for social science)SPSS( as a statistical software to give out the comparative histograms. This study reports a clinical examination of PBM under intervention group of 40 patients ranging 18-40 years old with body mass index (BMI) of 29-36, during post-cesarean surgery to elucidate successful healing of the wounds and scars against conventional methods which considered as control group. Comparison of mean REEDA scores on the third day (p = 0.035), seventh day (p = 0.03), and tenth day (p = 0.02) after delivery exhibits that the two groups benefit a statistically significant difference with each other. For instance, the mean wound healing score in the intervention group was almost half of the mean wound healing score on the tenth day in the control group (1.09 ± 0.586 vs. 2.25 ± 0.422). The post-cesarean follow-up indicates that the patients treated by the laser therapy (intervention group) encounter better recovery than the control group.

[Effects of auricular thumbtack needle on lactation function and TDP-43/Btn1A1/XDH pathway in primiparous women with cesarean section].

OBJECTIVE: To observe the effects of auricular thumbtack needle on breast feeding and lactation function in primiparous women with cesarean section, and to explore its mechanism of action from the perspective of lactation-related gene expression. METHODS: One hundred cases of primiparous women with cesarean section were randomly divided into an observation group (50 cases, 3 cases dropped off) and a control group (50 cases, 2 cases were eliminated). The patients in the control group were treated with routine obstetric care. Based on the treatment of the control group, the patients in the observation group were treated with auricular thumbtack needle at Neifenmi (CO18), Xiong (AH10), Xiongzhui (AH11), Shenmen (TF4), and Jiaogan (AH6a), etc., with one side of auricular point selected, only once for a total of 3 d. The lactation initiation time, lactation adequacy rate at postpartum 72 h, exclusive breastfeeding rate at postpartum 42 d, and breastfeeding score after treatment were compared between the two groups. Real-time quantitative PCR and Western blot method were used to detect the mRNA and protein expression levels of TDP-43, Btn1A1 and XDH. RESULTS: After treatment, the lactation initiation time in the observation group was earlier than that in the control group (P<0.01), and breastfeeding score in the observation group was higher than that in the control group (P<0.01). The lactation adequacy rate at postpartum 72 h was 63.8% (30/47) in the observation group, which was higher than 41.7% (20/48) in the control group (P<0.05). The exclusive breastfeeding rate at postpartum 42 d was 72.3% (34/47) in the observation group, which was higher than 47.9% (23/48) in the control group (P<0.05). The mRNA and protein expression levels of TDP-43 and Btn1A1 in breast milk in the observation group were higher than those in the control group (P<0.01), while there was no statistically significant difference in mRNA and protein expression of XDH in breast milk between the two groups (P>0.05). CONCLUSION: The auricular thumbtack needle in addition to routine care could promote lactation initiation, improve lactation adequacy rate and exclusive breastfeeding rate in primiparous women with cesarean section, and the action mechanism may be related to up-regulation of TDP-43 and Btn1A1 expression.

Knowledge and experience of midwives and gynecologists about manual rotation of persistent occiput posterior position.

BACKGROUND: management of persistent occiput posterior position has always been controversial. Manual rotation by a delivery operator can reduce instrumental delivery and cesarean section. AIM: This study aims to determine the knowledge and experience of midwives and gynecologists about manual rotation of persistent occiput posterior position. METHODS: This descriptive cross-sectional study was performed in 2022. The questionnaire link was sent to 300 participating midwives and gynecologists via WhatsApp Messenger. Two hundred sixty-two participants completed the questionnaire. Data analysis was performed using SPSS22 statistical software and descriptive statistics. RESULTS: 189 people (73.3%) had limited information about this technique, and 240 (93%) had never performed it. If this technique is recognized as a safe intervention and is included in the national protocol, 239 people (92.6%) want to learn, and 212 (82.2%) are willing to do it. CONCLUSION: According to the results, the knowledge and skills of midwives and gynecologists need to be trained and improved for manual rotation of persistent occiput posterior position.

Aromatherapy with oil of Lavandula angustifolia for pain in women: scoping review / Aromaterapia com óleo essencial de Lavandula angustifolia para dor em mulheres: revisão de escopo

ABSTRACT BACKGROUND AND OBJECTIVES: Aromatherapy with lavender essential oil has been used to reduce pain, anxiety, nausea and vomiting, among others. As the painful experience is unique, responses to therapeutic approaches may vary among individuals and there are specific conditions related to women's health that deserve to be examined. The objective of this study was to analyze the uses of aromatherapy with essential oil of lavender (Lavandula angustifolia), by nurses, for pain control in women. CONTENTS: This is a scoping literature review. The search was carried out in the following portals and/or databases: BVS, Pubmed, Cochrane, on June 3, 2022, and was updated on June 9, 2023. The sample consisted of four controlled clinical trials addressing aromatherapy with lavender essential oil in the "inhalation" and "massage" modalities, to treat acute labor pain and dysmenorrhea. In all studies, the intervention provided a reduction in pain without unwanted effects (p<0.05) and the nurse participated as a member of the multidisciplinary team. CONCLUSION: Aromatherapy with lavender essential oil during labor and dysmenorrhea proved to be effective in reducing pain in the analyzed sample.

RESUMO JUSTIFICATIVA E OBJETIVOS: A aromaterapia com óleo essencial de lavanda tem sido utilizada para redução de dor, ansiedade, náuseas e vômitos, dentre outros. Assim como a experiência dolorosa é única, as respostas às abordagens terapêuticas podem variar entre os indivíduos e há condições específicas relacionadas à saúde da mulher que merecem ser examinadas. O objetivo deste estudo foi analisar os usos da aromaterapia com óleo essencial de lavanda (Lavandula angustifolia), por enfermeiros, no controle da dor em mulheres. CONTEÚDO: Esta é uma revisão de escopo da literatura. A busca foi realizada nos seguintes portais e/ou bases de dados: BVS, Pubmed, Cochrane, em 03 junho de 2022, sendo atualizada em 09 de junho de 2023. A amostra foi composta de quatro ensaios clínicos controlados abordando aromaterapia com óleo essencial de lavanda nas modalidades "inalação" e "massagem", para tratar dor aguda do parto e da dismenorreia. Em todos os estudos a intervenção proporcionou redução na dor sem efeitos adversos (p<0,05) e o enfermeiro participou como integrante da equipe multidisciplinar. CONCLUSÃO: A aromaterapia com óleo essencial de lavanda no trabalho de parto e dismenorreia mostrou-se eficaz para a redução da dor na amostra analisada.

Effect of chamomile aromatherapy with and without oxygen on pain of women in post cesarean section with spinal anesthesia: A randomized clinical trial.

Background: Pain is the most common side effect in cesarean section with spinal anesthesia. It seems that oxygen therapy and chamomile aromatherapy may diminish pain. The present study was conducted to examine and compare the effect of chamomile aromatherapy with and without oxygen on the severity of pain of women following cesarean section surgery with spinal anesthesia. Methods: The present randomized clinical trial study was carried out on 136 women undergoing cesarean section surgery with spinal anesthesia at Imam Sajad Hospital, Yasuj, Iran in 2020. The eligible women were assigned into four 34-member groups including oxygen therapy plus aromatherapy, oxygen therapy, aromatherapy, and control via block randomization. Each of these interventions were performed 6, 6.30 and 7 h post operation. In the first intervention group, one drop of chamomile essential oil with distilled water was poured into a small nebulizer using a simple mask connected to 6 L of oxygen. The second intervention group received oxygen without chamomile aromatherapy at similar times, and the third intervention group received chamomile aromatherapy without oxygen. The control group received only routine interventions. The instrument used in the research was visual analog scale which was completed by the researcher 6, 12, 18 h after cesarean section. The data were analyzed by the SPSS software version 20. Results: There was a significant difference in the intensity of pain of patients between the various groups of study following the interventions (P < 0.001). Pain intensity reduced significantly in the group receiving combined intervention of chamomile aromatherapy plus oxygen compared to the other three groups. Moreover, the pain intensity diminished more in the groups undergoing each of these interventions alone as compared to the control group (P < 0.05). Conclusions: The combined intervention of chamomile aromatherapy with oxygen was more effective than each of the chamomile aromatherapy and oxygen interventions alone in reducing the pain of cesarean section patients though each intervention alone was still effective in lowering pain post-operation.

Preoperative anemia and associated factors in women undergoing cesarean section at a comprehensive specialized referral hospital in Ethiopia.

Background: Anemia is a common public health burden during pregnancy. Severe maternal and fetal complications have been associated with anemia. Despite many studies on anemia during pregnancy have been conducted in Ethiopia at any time of antenatal care visits, the prevalence of preoperative anemia among women awaiting cesarean delivery and its contributing factors have not been determined. The aim of this study was to determine the prevalence and associated factors of preoperative anemia in women awaiting cesarean section at a comprehensive specialized hospital in Ethiopia. Methods: An institution-based cross-sectional study was done from April to June 2022 to determine preoperative anemia in women undergoing cesarean delivery. Data were obtained using a standardized questionnaire that included the women's background characteristics. Bi-variable and multi-variable logistic regression analyses were performed to identify variables related to preoperative anemia. With a 95% confidence level, the estimated crude odds ratio and adjusted odds ratio were calculated. In a multivariate analysis, variables were considered statistically significant if their p-value was less than 0.05. Results: A total of 424 pregnant women with a 100% response rate were included in this study. The prevalence of preoperative anemia among women awaiting cesarean delivery was 28.3% (95% CI: 23.8-32.5%). Previous history of abortion, lack of iron supplementation, human immunodeficiency virus infection, previous cesarean section, and American Society of Anesthesiology class III were significantly associated with preoperative anemia among women awaiting cesarean section. Conclusion and recommendation: Preoperative anemia was diagnosed in a significant proportion of women awaiting cesarean-delivery. Anemia was linked to a lack of iron supplementation, American Society of Anesthesiology class III, previous history of abortion, human immunodeficiency virus infection, and previous cesarean section. Therefore, early detection of high-risk pregnancies, iron supplementation, prevention of HIV infection and due attention to people living with HIV/AIDs are paramount.

Midwifery Workforce Density Moderates the Association Between Independent Practice and Pregnancy Outcomes.

INTRODUCTION: Studies comparing pregnancy outcomes before and after state transition to independent midwifery practice have found little change in primary cesarean birth and preterm birth rates. One reason may be the failure to control for midwife density. The objective was to test if the local midwife density moderates the association between state independent midwifery practice and pregnancy outcomes. METHODS: Birth records were abstracted from the State Inpatient Databases for 6 states. The Area Health Resource File provided county variables. Midwife density was operationalized as no midwives, low midwife density (<4.5 per 1000 births), and high midwife density (≥4.5 midwives per 1000 births). Multivariate logistic regression models compared primary cesarean birth and preterm birth, controlling for maternal and county characteristics. Moderation was tested by including an interaction term (independent practice × density) to the regression models. The magnitude of association for the interaction was measured by stratifying the models. RESULTS: The study included 875,156 women; most (79.7%) resided in a county with low midwife density. Restricted midwifery practice was associated with increased odds of both primary cesarean birth and preterm birth. The interaction term was significant for both preterm birth and primary cesarean, indicating moderation. The largest magnitude of difference was the increased odds of preterm birth in counties with a high midwife density and restricted practice (odds ratio, 3.50; 95% CI, 2.43-5.06) compared with those with high midwife density and independent practice. DISCUSSION: Midwife density moderates the association between independent midwifery practice and primary cesarean birth and preterm birth. Moderation may explain why prior studies found small or no changes in outcomes when states adopted independent practice. Moderation models can improve testing for associations with independent practice. Both midwife independent practice and increasing midwifery workforce size can be strategies to improve state pregnancy outcomes.

Effectiveness of various methods of manual scar therapy.

BACKGROUND: The skin is a protective barrier of the body against external factors, and its damage leads to a loss of integrity. Normal wound healing results in a correct, flat, bright, and flexible scar. Initial skin damage and patient specific factors in wound healing contribute that many of these scars may progress into widespread or pathologic hypertrophic and keloid scars. The changes in cosmetic appearance, continuing pain, and loss of movement due to contracture or adhesion and persistent pruritis can significantly affect an individual's quality of life and psychological recovery post injury. Many different treatment methods can reduce the trauma and surgical scars. Manual scar treatment includes various techniques of therapy. The most effectiveness is a combined therapy, which has a multidirectional impact. Clinical observations show an effectiveness of manual scar therapy. MATERIAL AND METHODS: The aim of this work was to evaluate effectiveness of the scar manual therapy combined with complementary methods on the postoperative scars. Treatment protocol included two therapies during 30 min per week for 8 weeks. Therapy included manual scar manipulation, massage, cupping, dry needling, and taping. RESULTS: Treatment had a significant positive effect to influence pain, pigmentation, pliability, pruritus, surface area, and scar stiffness. Improvement of skin parameters (scar elasticity, thickness, regularity, color) was also noticed. CONCLUSION: To investigate the most effective manual therapy strategy, further studies are needed, evaluating comparisons of different individual and combined scar therapy modalities.

A cultura da cesariana e as práticas obstétricas em um hospital de ensino / The cesarean culture and obstetric practices in a teaching hospital / La cultura de la cesárea y las prácticas obstetricas en un hospital de enseñanza

Objetivo: Delimitar o perfil de atendimento prestado às parturientes, bem como as práticas obstétricas desenvolvidas no Centro Obstétrico do Hospital da Região Leste no período de janeiro a dezembro do ano de 2019. Métodos: Consiste em uma pesquisa de método quantitativo, transversal, retrospectivo, de caráter observacional e descritivo. Resultados: Observados altos índices de cesarianas no serviço (40%). Baixo índice de uso do partograma nos atendimentos. De acordo com a Classificação de Robson, a maioria das parturientes (88%) se encaixa entre os grupos de um a cinco, e 12% entre os grupos de seis à dez. Conclusão: Taxas de cesariana acima do recomendado pela Organização Mundial de Saúde devido à um conjunto de fatores. O baixo índice de uso do partograma pode indicar insegurança ou desconhecimento do profissional, falta de protocolos, objeções ao seu uso, ou desatualização e falta de credibilidade do instrumento. Estudos nacionais e internacionais têm mostrado um alto índice de mulheres entre os grupos um à cinco sendo encaminhadas para cesariana devido à falta de incentivo às boas práticas e ao uso de métodos não farmacológicos e à falha no uso dos instrumentos recomendados (partograma). (AU)

Objective: Delimit parturient service profile and the OBGYN practices developed in the West Region Hospital between January and December of 2019. Methods: Consists of a quantitative transversal, retrospective, observational and descriptive research. Results: High rates of cesarean sections in the service (40%). Low rate of use of the partograph in care. According to the Robson Classification, most parturients (88%) fit between groups one to five, and 12% between groups six to ten. Conclusion: Cesarean rates higher than recommended by the World Health Organization due to a number of factors. The low rate of use of the partograph may indicate insecurity or lack of knowledge by professionals, lack of protocols, objections to its use, or outdated and lack of credibility of the instrument. National and international studies have shown a high rate of women between groups one to five being referred for cesarean section due to the lack of encouragement to good practices and the use of non-pharmacological methods and the failure to use the recommended instruments (partograph). (AU)

Objetivo: Delimitar el perfil de la atención brindada a las parturientas, así como las prácticas obstétricas desarrolladas en el Centro de Obstetricia del Hospital da Região Leste de enero a diciembre de 2019. Métodos: Consiste en una investigación cuantitativa, transversal, retrospectiva, observacional y descriptiva. Resultados: Se observaron altas tasas de cesáreas en el servicio (40%). Baja tasa de uso del partograma en el cuidado. Según la Clasificación de Robson, la mayoría de las parturientas (88%) encajan entre los grupos del uno al cinco y 12% entre los grupos del seis al diez. Conclusión: Tasas de cesáreas superiores a las recomendadas por la Organización Mundial de la Salud debido a una serie de factores. La baja tasa de uso del partograma puede indicar inseguridad o desconocimiento del profesional, falta de protocolos, objeciones a su uso o desactualización y falta de credibilidad del instrumento. Estudios nacionales e internacionales han demostrado una alta tasa de mujeres entre los grupos uno a cinco que son derivadas para cesárea debido a la falta de estímulo a las buenas prácticas y al uso de métodos no farmacológicos y al no uso de los instrumentos recomendados (partograma). (AU)

[Effect of thumb-tack needle on gastrointestinal function recovery after cesarean section under the concept of enhanced recovery after surgery].

OBJECTIVE: To observe the synergistic effect and safety of combined use of houpo paiqi mixture and thumb-tack needle on promoting gastrointestinal function recovery after cesarean section. METHODS: Parturients receiving cesarean section were randomly divided into the control group (29 cases), the traditional Chinese medicine (TCM) group (30 cases) and needle+TCM group (30 cases). The control group received only routine postoperative treatment. Besides the treatment as the control group, parturients in the TCM group were given 50 mL houpo paiqi mixture 6 h and 10 h after cesarean section respectively. Besides the treatment as the TCM group, parturients in the needle+TCM group received thumb-tack needle treatment at bilateral Zusanli(ST36), Tianshu(ST25), Shangjuxu(ST37) and Sanyinjiao(SP6), Zhongwan(CV12), Qihai(CV6), with auricular pressure at bilateral otopoints Zigong(Uterus), Wei(Stomach) and Dachang(Large intestine), within 1 h after the parturients returned to the ward after the operation. Each acupoint was pressed for 10 s and performed acupressure every 4 h (except sleeping hours), continuously for 3 d. The time of bowel sound recovery, the time to the first postoperative exhaust and defecation, the time of postoperative semi-fluid diet recovery, incidence of postoperative nausea and vomiting (PONV) and abdominal distention, and abdominal pain VAS score were recorded and analyzed. The safety of the treatments was also evaluated. RESULTS: Compared with the control group, the time of bowel sounds recovery, the time to the first postoperative exhaust and the time of postoperative semi-fluid diet recovery were significantly shortened in the TCM and needle+TCM groups (P<0.01); the time to the first postoperative defecation were significantly shortened (P<0.01), incidence of both abdominal distention and PONV were significantly decreased in the needle+TCM group (P<0.05, P<0.01); incidence of abdominal distention were significantly decreased in TCM group (P<0.05). Compared with the TCM group, the time of bowel sounds recovery, the time to the first postoperative exhaust and defecation, and the time of postoperative semi-fluid diet recovery were significantly shortened (P<0.01), and incidence of both abdominal distention and PONV were significantly decreased in the needle+TCM group (P<0.05). VAS scores of the three groups decreased gradually over time (P<0.01). Compared with the control and TCM groups, VAS scores of the needle+TCM group significantly decreased at 24 h, 48 h and 72 h after operation (P<0.01). No treatment-related adverse reactions were observed during the whole trial. CONCLUSION: On the base of the treatment with houpo paiqi mixture, the addition of thumb-tack needle treatment exerted positive synergistic effect on gastrointestinal function recovery after cesarean section, with high safety, which is worthy of clinical application.