Distocia em tigre d'água-de-orelha-vermelha, Trachemys scripta elegans, wied (1839): relato de caso / Dystocia in red-eared slider, Trachemys scripta elegans, wied (1839): case report / Distocia en tortuga de orejas rojas, Trachemys scripta elegans, wied (1839): reporte de caso

Atualmente muitos répteis se tornaram animais de companhia e são mantidos como pet's exóticos. A espécie Trachemys scripta elegans, Wied (1839) é um animal exótico da América do Norte, sua identificação é realizada pelas marcas avermelhadas encontradas lateralmente a sua cabeça. Na rotina clínica as principais enfermidades que acometem os quelônios são as de origem reprodutiva, como a estase folicular e distocia. O objetivo deste trabalho foi relatar um caso recorrente de distocia em um tigre d'água fêmea, para isso, a anamnese, o histórico da paciente, e seus sinais clínicos, em conjunto com os exames complementares de imagem foram essenciais para se obter diagnóstico definitivo. O tratamento foi realizado com a indução medicamentosa utilizando borogluconato de cálcio, seguida da aplicação de ocitocina, esta trouxe resultados positivos para a eliminação dos ovos. Porém devido ao histórico do paciente, optou-se pela intervenção cirúrgica de ovariossalpingectomia, sendo está a maneira permanente de resolução da patologia. O protocolo terapêutico escolhido proporcionou um resultado satisfatório e bem estar ao animal.(AU)

Currently, many reptiles have become companion animals and are kept as exotic pets. The species Trachemys scripta elegans, Wied (1839) is an exotic animal from North America, and its identification is based on the reddish markings found laterally on its head. In routine clinical practice, the main diseases that affect chelonians are those of reproductive origin, such as follicular stasis and dystocia. The aim of this study was to report a recurrent case of dystocia in a female red-eared slider turtle. For this purpose, the patient's anamnesis, history, and clinical signs, along with complementary imaging exams, were essential to obtain a definitive diagnosis. The treatment involved medical induction using calcium borogluconate, followed by the administration of oxytocin, which yielded positive results in egg elimination. However, due to the patient's history, surgical intervention in the form of ovariosalpingectomy was chosen as the permanent solution to the pathology. The chosen therapeutic protocol provided a satisfactory outcome and improved the animal's well-being.(AU)

Actualmente muchos reptiles se han convertido en animales de compañía y se mantienen como mascotas exóticas. La especie Trachemys scripta elegans, Wied (1839) es un animal exótico de América del Norte, su identificación se realiza por las marcas rojizas que se encuentran lateralmente a su cabeza. En la rutina clínica, las principales enfermedades que afectan a los quelonios son las de origen reproductivo, como la estasis folicular y la distocia. El objetivo de este trabajo fue reportar un caso recurrente de distocia en una hembra de tigre de agua, para ello la anamnesis, la historia de la paciente y sus signos clínicos, junto con los exámenes imagenológicos complementarios fueron fundamentales para obtener un diagnóstico definitivo. El tratamiento se realizó con inducción farmacológica con borogluconato de calcio, seguido de la aplicación de oxitocina, que arrojó resultados positivos con la eliminación de huevos. Sin embargo, debido a los antecedentes de la paciente, se optó por la intervención quirúrgica de ovarialpingectomía, que es la forma definitiva de resolución de la patología. El protocolo terapéutico elegido proporcionó un resultado satisfactorio y bienestar al animal.(AU)

Association of a green tea extract with serum immunoglobulin G status and neonatal vitality in newborn dairy calves.

Poor vigor at birth has been associated with reduced IgG absorption from colostrum and a reduced vitality in neonatal dairy calves. Some natural compounds, such as green tea extract, may improve vitality in compromised calves. The objective of this randomized controlled trial was to evaluate the potential of supplementing a green tea extract (15 mL) to calves to improve vigor and activity behavior for the first 72 h postnatal. Also, this study aimed to investigate the influence of green tea extract supplementation on calf serum IgG concentration and the apparent efficiency of absorption (AEA) of colostral IgG. Holstein calves (n = 24) weighing 42.49 ± 1.07 kg postnatal received a complete random assignment at 3 h of one 15-mL dose of green tea extract (Calf Perk, TechMix) or distilled water orally before tube feeding colostrum replacer (Premolac Plus IgG, Zinpro) at 4 h postnatal. Two observers assessed for calving time and dystocia by live video stream to retrieve all calves within 2 h postnatal. One veterinarian performed a baseline vigor assessment based on heart rate and response to stimuli on all calves at 2.5 h, before colostrum feeding at 3.75 h, as well as at 24, 48, and 72 h postnatal. Calf blood samples were taken to assess total IgG by radial immunodiffusion assay at 2.5, 6, 12, 24, 48, and 72 h. Calf vitality was also observed continuously by video for all calves to determine whether treatment was associated with attempts to stand, lying time, and exploration of their pen environment for the first 24 h. We used an ordinal logistic model to evaluate the odds of green tea extract improving a calf's vigor category from 2.5 h postnatal to 72 h of age. Vigor score was categorized as abnormal (≤4), average (5), or alert (≥6), with hour as a fixed effect. We also ran mixed linear models to evaluate the effect of extract on total IgG and AEA, with time and dystocia as fixed effects. Five dystocia calves were enrolled (2 control, 3 extract), but assistance was minor (e.g., manual assistance and all were assisted within 1 h). Baseline vigor scores and baseline total IgG were not different between groups. Vigor score category was not associated with green tea extract supplementation (odds ratio 1.17; 95% CI: 0.43-3.15) but increased with time compared with controls. We observed no association of treatment with total IgG or AEA in the calves, suggesting green tea extract does not compromise IgG absorption. Calf vitality, lying behavior, and exploratory behavior were not associated with green tea extract treatment. Our findings suggest that green tea extract supplementation does not affect AEA and serum IgG concentration in calves. Future research should evaluate whether green tea extract improves vitality in calves experiencing severe dystocia.

Patterns and levels of serum electrolyte imbalance among women with obstructed labor in Uganda: A cross-sectional study.

OBJECTIVE: To determine the patterns and levels of imbalance in sodium, potassium, and chloride electrolytes, and the factors associated with each electrolyte imbalance among women with obstructed labor. DESIGN: In this cross-sectional study, we collected data on personal and obstetric factors using a structured questionnaire. We drew 3 mls of blood from the antecubital vein and analyzed for sodium, potassium, and chloride ions using Cobas Integra 400. Multivariable logistic regression was employed to analyze factors independently associated with each electrolyte imbalance. SETTING: Obstetrics and Gynaecology Unit, Mulago National Referral Hospital, Kampala, Uganda. PARTICIPANTS: Women with obstructed labor. MEASUREMENTS: Imbalance in sodium, potassium, and chloride electrolytes, measured on a binary scale using the normal third-trimester pregnancy electrolyte values: 130-148 mmol/Litre for sodium, 3.3-5.1 mmol/Litre for potassium, and 97-109 mmol/Litre for chloride. Women with electrolyte values outside the respective normal ranges were regarded as having an imbalance. FINDINGS: We studied 299 women and found 22/299 (7.4%) had sodium imbalance, 254/299 (84.9%) had potassium imbalance, and 284/299 (95.0%) had chloride imbalance. In multivariable logistic regression analysis, herbal medicine use was associated with sodium imbalance (adjusted odds ratio (aOR), 2.72; 95% confidence interval (CI), 1.11-6.95). KEY CONCLUSIONS: Potassium and chloride imbalances were more prevalent among women with obstructed labor relative to sodium imbalance. Herbal medicine use during pregnancy is associated with a higher likelihood of sodium electrolyte imbalance. IMPLICATIONS FOR PRACTICE: There is a need to routinely monitor women with obstructed labor for electrolyte imbalance.

Effects of high fidelity simulation model on midwives' shoulder dystocia management skills: An educational Intervention study.

Background: Shoulder dystocia is an emergency and risky situation that most likely directly involves midwives. Aim: The aim of this study is to determine the effects of simulation training with a high fidelity mannequin on midwives' shoulder dystocia management. Subjects and Methods: This study utilized a quantitative, quasi-experimental research design. No sample selection was made. The study included all midwives (n:16) working in the maternity unit of Manisa Province Hospital, Turkey. Management of shoulder dystocia was lectured both theoretically and practically, using a high fidelity simulation. Midwives' shoulder dystocia management skills and knowledge were evaluated before and after training using shoulder dystocia knowledge form and management skill checklist. Results: There was a statistically significant increase in their shoulder dystocia management knowledge scores and management skills after simulation-based shoulder dystocia training (P < 0.05). Before the training, the midwives (62.5%) mostly used the McRoberts maneuver and suprapubic pressure as the primary interventions in shoulder dystocia management. After training, all the midwives were able to apply secondary maneuvers (Wood's or Rubin's maneuvres or posterior arm delivery) along with the primary maneuvers, in accordance with the shoulder dystocia management algorithm. Conclusion: Using a high fidelity simulation model in training increased midwives' shoulder dystocia management skills and knowledge.

Manipulative Reduction for Abnormal Uterine Inclination in Vaginal Delivery.

OBJECTIVE: To investigate the manipulative reduction in abnormal uterine inclination in vaginal delivery. METHODS: With the independently developed uterine inclination surveyor, 40 primiparas with abnormal uterine inclination were randomly divided into two groups: treatment group (Group A, 20 cases) and control group (Group B, 20 cases). The general condition of the primipara, the labor stages, the changes in uterine inclination after treatment, postpartum hemorrhage at 2 hours, and the general condition of fetuses were observed to study the therapeutic value of manual reduction in abnormal uterine inclination. RESULT: In the control group, one uterine inclination was not corrected with the change in labor process, and the pregnancy was terminated due to stagnation of the active phase. In the first stage of labor, the time spent in the treatment group (393.4 ± 31.3 mins) was significantly lower than that in the control group (440.7 ± 34.9 mins) (P = 0.001). Compared with the control group (49.8 ± 6.5 mins), the treatment group (42.6 ± 7.2 mins) also exhibited a significantly shortened second stage of labor (P = 0.02). Sixteen cases (16/20) in the treatment group returned to normal after manual reduction, and 9 cases (9/20) in the control group returned to normal with the progression of natural labor. Manual reduction could be used as an option to treat abnormal uterine inclination (P = 0.01). There was no significant difference in the third stage of labor (P = 0.2), 2-hour postpartum hemorrhage (P = 0.35), Apgar score (P = 0.64), or body weight (P = 0.76) between the two groups. CONCLUSION: Manual reduction in the treatment of abnormal uterine inclination has obvious effects, shortens the birth process, and is safe for the fetus.

The association between longer durations of the latent phase of labor and subsequent perinatal processes and outcomes among midwifery patients.

BACKGROUND/OBJECTIVE: To evaluate the association between the duration of the latent phase of labor and subsequent processes and outcomes. METHODS: Secondary analysis of prospectively collected data among 1,189 women with low-risk pregnancies and spontaneous labor. RESULTS: Longer latent phase duration was associated with labor dystocia (eg, nulliparous ≥ mean [compared with < mean] aOR 3.95 [2.70-5.79]; multiparous ≥ mean [compared with < mean] aOR 5.45 [3.43-8.65]), interventions to ameliorate dystocia, and epidurals to cope or rest (eg, oxytocin augmentation: nulliparous > 80th% [compared with < 80th%] aOR 6.39 [4.04-10.12]; multiparous ≥ 80th% [compared with < 80th%] aOR 6.35 [3.79-10.64]). Longer latent phase duration was also associated with longer active phase and second stage. There were no associations between latent phase duration and risk for cesarean delivery or postpartum hemorrhage in a practice setting with relatively low rates of primary cesarean. Newborns born to multiparous women with latent phase of labor durations at and beyond the 80th% were more frequently admitted to the NICU (≥80th% [compared with < 80th%] aOR 2.7 [1.22-5.84]); however, two-thirds of these NICU admissions were likely for observation only. CONCLUSIONS: Longer duration of the spontaneous latent phase of labor among women with low-risk pregnancies may signal longer total labor processes, leading to an increase in diagnosis of dystocia, interventions to manage dystocia, and epidural use. Apart from multiparous neonatal NICU admission, no other maternal or child morbidity outcomes were elevated with longer duration of the latent phase of labor.

Effects of mineral supplementation on reproductive performance of pregnant cross-breed Bonsmara cows: An experimental study.

Minerals in animal feed occur in variable structures, most of which determine the uptake and usage in biological processes in the body. Effective chemical breakdown of minerals may ensure efficient utilization in metabolism. The aim this study was to evaluate the effects of mineral supplementation on reproduction in cows. A farm was selected for the experiment due to the fact that it previously experienced different reproductive conditions in the farm. The farm comprises cross-breed cows with Bonsmara dominating in the farm. Twelve pregnant primiparous and multiparous cows of different ages, parity and weight, that had previously experienced reproductive conditions, were randomly selected for this study. The cows were then randomly sub-divided into two groups (experimental and control group) of six. The experimental group was injected with MULTIMIN™ + Se + Cu at a dosage of 1 ml/45 kg BW and Calci 50 p.i. at a dosage of 100-150 ml/500 kg BW at an interval of 6 weeks (from June to October 2017). Blood samples were collected before every injection date. The t test was used to relate the mean weight gain and serum metabolite between the experimental and control groups. The body weight gain was significantly higher in the experimental group compared to the non-supplemented group. Supplemented cows had significantly (p < .05) high levels of triglycerides and creatinine kinase. A case of retained placenta and dystocia among non-supplemented cows were noted. Thus, mineral supplementation can be used to improve productivity and reproductive well-being.

Uterine Inertia due to Severe Selenium Deficiency in a Parturient Mare.

A 12-year-old, multiparous, parturient show jumper embryo-recipient mare presented at a veterinary hospital, seven days past her due date and with a dilated cervix, for evaluation of mild colic. Gastrointestinal or metabolic abnormalities and fetal maldispositions were excluded as causes of dystocia, and a diagnosis of uterine inertia was made. There was no uterine response to oxytocin treatment. A live filly was delivered via C-section, and severe selenium deficiency was eventually confirmed in the mare, her offspring, and in the herd of origin. The filly was born with severe white muscle disease and required intensive treatment. This report suggests that selenium deficiency is an underlying cause of equine uterine inertia in the absence of other causes of dystocia.

Peanut ball for decreasing length of labor: A systematic review and meta-analysis of randomized controlled trials.

INTRODUCTION: Prolonged length of labor is associated with increased maternal and neonatal complications. Therefore, great attention has been given to interventions aimed at reducing the length of labor. One such intervention is the peanut ball, a large elongated exercise ball placed between a woman's legs during labor. OBJECTIVE: The aim of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to assess the effect of the use of peanut ball in reducing length of labor. STUDY DESIGN: Data sources: MEDLINE, EMBASE, Web of Sciences, Scopus, ClinicalTrial.gov, OVID and Cochrane Library were searched from inception until January 2019. SELECTION CRITERIA: Selection criteria included RCTs of laboring women with singleton gestations in cephalic presentation at term (≥37weeks) who were randomized to either use of peanut ball or control group (no peanut ball). DATA COLLECTION AND ANALYSIS: Four trials with 648 nulliparous and multiparous women in spontaneous or induced labor were identified and included. 330 women were randomized to the intervention (peanut ball between the knees during labor) and 318 women to the control. Summary measures were reported as mean difference (MD) with 95% of confidence interval (CI) using the random effects model of DerSimonian and Laird. The primary outcome was total length of labor. PROSPERO Registration Number: CRD42018082438 RESULTS: Total length of labor was 79min shorter in the peanut ball group, but this was not significant (MD -79.1 min, 95% CI -204.9, 46.7). Peanut ball use showed trends toward higher incidence of spontaneous vaginal deliveries (RR 1.1, 95% CI 1.0, 1.2) and lower incidence of cesarean deliveries (RR 0.8, 95% CI 0.6, 1.0). CONCLUSIONS: Peanut ball use was not associated with a significant decrease in total length of labor. Since there were trends toward reductions in length of labor, an increased incidence in spontaneous vaginal deliveries, and lower incidence of cesarean deliveries, more research is needed.

Impact of sow energy status during farrowing on farrowing kinetics, frequency of stillborn piglets, and farrowing assistance.

Farrowing duration is rather long in sows most likely due to selection for large litters, and we hypothesized that prolonged farrowings would compromise sow energy status during farrowing and in turn the farrowing process. Two studies were performed as follows: 1) to evaluate whether sow energy status during farrowing compromise the farrowing kinetics (FK, i.e., farrowing duration and birth intervals) and 2) to study the underlying mechanisms potentially affecting stillbirth rate and farrowing assistance. In study-1, parameters affecting FK were characterized based on data from a total of 166 farrowings from 7 feeding trials focused on sow colostrum production. The data were screened for associations with FK using the CORR procedure of SAS. Traits that were correlated with the FK at P < 0.05 were included in a multivariate regression model. Time since last meal until the onset of farrowing greatly affected the farrowing duration (r = 0.76; n = 166; P < 0.001) and a broken-line model was fitted to describe that relationship. According to the model, farrowing duration was constant (3.8 ± 1.5 h) if the farrowing started before the breakpoint (3.13 ± 0.34 h after the last meal), whereas farrowing duration increased to 9.3 h if the farrowing started 8 h after the last meal. Subsequently, sows were divided into 3 categories based on that trait (≤3, 3 to 6, and >6 h) to evaluate the impact on birth intervals, farrowing assistance, and stillbirth rate. Birth intervals (P < 0.001), odds for farrowing assistance (P < 0.001), and odds for stillbirth (P = 0.02) were low, intermediate, and high when time since last meal was ≤3, 3 to 6, and >6 h, respectively. In study-2, blood samples were collected once or twice each week in late gestation and each hour during farrowing to measure arterial concentrations and uterine extractions of plasma metabolites. Time since last meal was strongly negatively correlated with arterial glucose 1 h after the onset of farrowing (r= -0.96; n = 9; P < 0.001). Glucose appeared to be the key energy metabolite for oxidative metabolism of gravid uterus. In conclusion, the present study strongly suggests that a substantial proportion of sows suffer from low-energy status at the onset farrowing and that this negatively affects the farrowing process. Transferring this knowledge into practice, the results suggest that sows should be fed at least 3 daily meals in late gestation.

Evaluation of the McMahon Competence Assessment Instrument for Use with Midwifery Students During a Simulated Shoulder Dystocia.

INTRODUCTION: Intrapartum emergencies occur infrequently but require a prompt and competent response from the midwife to prevent morbidity and mortality of the woman, fetus, and newborn. Simulation provides the opportunity for student midwives to develop competence in a safe environment. The purpose of this study was to determine the inter-rater reliability of the McMahon Competence Assessment Instrument (MCAI) for use with student midwives during a simulated shoulder dystocia scenario. METHODS: A pilot study using a nonprobability convenience sample was used to evaluate the MCAI. Content validity indices were calculated for the individual items and the overall instrument using data from a panel of expert reviewers. Fourteen student midwives consented to be video recorded while participating in a simulated shoulder dystocia scenario. Three faculty raters used the MCAI to evaluate the student performance. These quantitative data were used to determine the inter-rater reliability of the MCAI. RESULTS: The intraclass correlation coefficient (ICC) was used to assess the inter-rater reliability of MCAI scores between 2 or more raters. The ICC was 0.86 (95% confidence interval, 0.60-0.96). Fleiss's kappa was calculated to determine the inter-rater reliability for individual items. Twenty-three of the 42 items corresponded to excellent strength of agreement. DISCUSSION: This study demonstrates a method to determine the inter-rater reliability of a competence assessment instrument to be used with student midwives. Data produced by this study were used to revise and improve the instrument. Additional research will further document the inter-rater reliability and can be used to determine changes in student competence. Valid and reliable methods of assessment will encourage the use of simulation to efficiently develop the competence of student midwives.

De-medicalization of birth by reducing the use of oxytocin for augmentation among first-time mothers - a prospective intervention study.

BACKGROUND: The use of synthetic oxytocin for augmentation of labor is rapidly increasing worldwide. Hyper-stimulation is the most significant side effect, which may cause fetal distress and operative delivery. We performed an intervention consisting of an educational program and modified guidelines to achieve a more appropriate use of oxytocin. METHODS: This prospective intervention study included 431 first-time mothers at term with spontaneous onset of labor before (October 2012 to May 2013), and 664 after the intervention (April 2014 to April 2015). Our outcomes were prevalence and duration of oxytocin treatment, mode of delivery, indication for operative delivery, episiotomy, anal sphincter tears, bleeding, labor duration, pain relief and the effect of oxytocin on mode of delivery. RESULTS: After the intervention, 52.9% were diagnosed with dystocia, compared with 68.9% before (p < 0.001). Oxytocin was not always used in accordance with the guidelines, but a significant reduction in oxytocin rates from 63.3% to 54.1% (p < 0.001) was obtained. More women without dystocia according to the existing guidelines were augmented after the intervention (18.9% vs 8.4%, p < 0.001). Assessing all labors, the median duration of oxytocin treatment was reduced by 72% (from 90 to 25 min) without increasing the median duration of labor (385 min in both groups). There was a moderate reduction in operative vaginal deliveries from 26.9 to 21.5% (p = 0.04), and dystocia as an indication for these deliveries increased (p = 0.01). There was a moderate increase in caesarean sections from 6.7 to 10.2% (p = 0.05), but no increase in dystocia as an indication for these deliveries. Women receiving oxytocin were more likely to have an operative vaginal birth, even after adjusting for birth weight, epidural analgesia and labor duration, OR: 2.1 (CI 1.1-4.0) before and OR 2.7 (CI 1.6-4.5) after the intervention. CONCLUSIONS: Our intervention led to a significant reduction in the use of oxytocin. However, more than half of the women remained diagnosed with dystocia. Operative vaginal births seem to be associated with oxytocin treatment. Therefore, augmentation with oxytocin should be used with caution and only when medically indicated. Even more modified guidelines for augmentation than the ones applied in this study might be appropriate.

Effect of the use of a video tutorial in addition to simulation in learning the maneuvers for shoulder dystocia.

The development of video tutorials is flourishing and may make it possible to maintain knowledge learned during instruction with simulation. The aim of this study was to assess the effect of adding a video tutorial to a lecture and simulation for learning the maneuvers and protocol for the management of shoulder dystocia. Student midwives and medical students attended a lecture class including instruction about maneuvers and a presentation of an algorithm for the management of shoulder dystocia. They were randomized into two groups. The video group was reminded every two weeks to watch a short tutorial. The control group was reminded to consult the slide show. At the end of two months, they were evaluated by graders. The practice, theory, and global scores of the students in the video group were significantly higher than those of the students in the control group (14.8 vs. 10.4; 5.6 vs. 3.4; and 9.3 vs. 7.0, P<0.001). The scores for the video group improved at the second simulation session, compared with the first (14.8 vs. 9.9; 5.6 vs. 2.9; and 9.3 vs. 7, P<0.001). The addition of a video tutorial improved learning compared to a standard lecture and simulation session alone.

Comparing Different Partograph Designs for Use in Standard Labor Care: A Pilot Randomized Trial.

Backgound Partographs are used in many labour settings to provide a pictorial overview of a woman's cervical dilation pattern in the first stage of labor and to alert clinicians to slow progress possibly requiring intervention. Recent reviews called for large trials to establish the efficacy of partographs to improve birth outcomes whilst highlighting issues of clinician compliance with use. Previous studies have also reported issues with participant recruitment related to concerns regarding the possibility of a longer labour. Objectives We sought to compare a standard partograph with an action line, to a newly designed partograph with a stepped line, to determine the feasibility of recruitment to a larger clinical trial. Methods A pragmatic, single-blind randomised trial wherein low-risk, nulliparous women in spontaneous labour at term were randomized to an action-line or stepped-line partograph. First stage labour management was guided by the allocated partograph. Primary outcomes included the proportion of eligible women recruited, reasons for failed recruitment and compliance with partograph use. Secondary outcomes included rates of intervention, mode of birth, maternal and neonatal outcomes. Results Of the 384 potentially eligible participants, 38% (149/384) were approached. Of these 77% (116/149) consented, with 85% (99/116) randomized, only nine women approached (6%) declined to participate. A further 9% (14/149) who were consented antenatally were not eligible at onset of labor and 7% (10/149) of women approached in the birth suite but did not meet the inclusion criteria. Compliance with partograph completion was 65% (action) versus 84% (dystocia line). Conclusions for Practice Participant recruitment to a larger randomized controlled trial comparing new labour management guidelines to standard care is feasible. Effective strategies to improve partograph completion compliance would be required to maintain trial fidelity.

[Fight against maternal mortality in rural areas: decentralization of emergency obstetric cares in Burkina Faso]. / Lutte contre la mortalité maternelle en milieu rural: décentralisation de l'offre des soins obstétricaux d'urgence au Burkina Faso.

INTRODUCTION: In order to cover the shortage of midwives (MWs) in the health district of Tougan, Burkina Faso, a strategy for the decentralization of emergency obstetric cares, based on ad hoc interventions undertaken by MW to manage obstetric complications in health centers (HCs), has been developed in rural areas. This study aimed to describe this experience and to analyze the achieved results. METHODS: We conducted a cross-sectional, analytical, intervention study based on a review of routine data from all the parturients treated from 2013 to 2015. Data collection took place from 5 to 20 January 2016. Chi-square Test, odds ratios (ORs) and their 95% confidence intervals were calculated. RESULTS: A total of 416 parturients with obstetric complications were treated by zonal MW. The average age of patients was 26.4 years. The median distance travelled to treat parturients was 15 km, with an average intervention period of 21.1 minutes (standard deviation = 7.13 minutes). Dystocias accounted for half (50.7%, CI95%= 45.8-55.6) of treated complications followed by hemorrhage (26.4%, CI95%= 22.3%-31.0%). More than 77% of interventions resulted in local resolution of obstetric complications. Finally, the intervention outcome was subject to the pathology treated (OR=5.88; p < 0.001). CONCLUSION: This strategy was an answer to the shortage of MWs in the perypheral HCs in the health district of Tougan. In this particular context, this intervention could provide an alternative solution to the shortage of human resources for health in rural areas.

Análisis y evaluación de la efectividad de la analgesia epidural y su relación con el parto eutócico o distócico / Analysis and evaluation of the effectiveness of epidural analgesia and its relationship with eutocic or dystocic delivery

Objetivo. Numerosos estudios han demostrado mayor puntuación en la escala verbal nominal del dolor en relación con el parto distócico y la inducción médica del parto, de manera que el parto distócico y la macrosomía fetal se han relacionado con una mayor sensación de dolor durante el parto, sobre todo en el primer estadio. Incluso la analgesia epidural se ha vinculado al parto instrumentado y a la cesárea. El objetivo del estudio fue analizar y evaluar la efectividad de la analgesia epidural en el parto distócico frente al parto eutócico. Pacientes y métodos. Se diseñó un estudio observacional, analítico, longitudinal y prospectivo, en el Área Obstétrica del Hospital Universitario Dexeus. Se incluyeron 180 gestantes. Fueron incluidas todas las nulíparas o multíparas con edad gestacional superior a 36 semanas, más allá de 3cm de dilatación cervical y en trabajo de parto espontáneo o inducido. Todas las pacientes recibieron la analgesia epidural según protocolo. Resultados. Para el análisis estadístico univariante de la muestra se emplearon los métodos descriptivos básicos y para la comparación de medias entre 2 grupos, el test U de Mann-Whitney. Las correlaciones entre variables se estudiaron mediante el coeficiente de correlación de Spearman. Las diferencias consideradas estadísticamente significativas fueron aquellas cuya p<0,05. Conclusión. En nuestra población, no hubo diferencias estadísticamente significativas en la efectividad de la analgesia epidural en el parto eutócico frente al distócico. Las pacientes que recibieron la epidural que tuvieron partos distócicos presentaron la misma puntuación en la escala verbal nominal del dolor que aquellas que presentaron parto eutócico (p>0,05) (AU)

Objective. Numerous studies have demonstrated the difference in the verbal rating scale with regard to obstructed labour and induced labour, so that obstructed labour and foetal macrosomia have been related to a greater sensation of pain during labour, particularly in the first stage. Even the epidural analgesia is linked to the need for instrumented or caesarean section due to foetal obstruction. The goal of the study is to analyze and evaluate the effectiveness of epidural analgesia in normal versus obstructed labour. Patients and methods. One hundred and eighty pregnant women were included in an observational, analytical, longitudinal and prospective study, that was performed in the Obstetrics Department of the Hospital Universitario Dexeus. All the nulliparous or multiparous over 36 weeks of pregnancy, after 3cm of cervical dilatation in spontaneous or induced labor were included. All the patients were given epidural analgesia according to protocol. Results. The basic descriptive methods were used for the univariate statistical analysis of the sample and the Mann-Whitney U test was used for the comparison of means between both groups. The correlations between variables were studied by means of the Spearman coefficient of correlation. The differences regarded as statistically significant are those whose P<.05. Conclusion. In our population there were no statistically significant differences in the effectiveness of epidural analgesia in normal versus obstructed labour. Patients who got epidural analgesia and had obstructed labors have the same degree of verbal rating scale as patients that do not had obstructed labors (P>.05) (AU)

Implementation of a multicenter shoulder dystocia injury prevention program.

Although the evidence for supporting the effectiveness of many patient safety practices has increased in recent years, the ability to implement programs to positively impact clinical outcomes across multiple institutions is lagging. Shoulder dystocia simulation has been shown to reduce avoidable patient harm. Neonatal injury from shoulder dystocia contributes to a significant percentage of liability claims. We describe the development and the process of implementation of a shoulder dystocia simulation program across five academic medical centers and their affiliated hospitals united by a common insurance carrier. Key factors in successful roll out of this program included the following: involvement of physician and nursing leadership from each academic medical center; administrative and logistic support from the insurer; development of consensus on curriculum components of the program; conduct of gap and barrier analysis; financial support from insurer to close necessary gaps and mitigate barriers; and creation of dashboards and tracking performance of the program.

Modification of Obstetric Emergency Simulation Scenarios for Realism in a Home-Birth Setting.

INTRODUCTION: Clinical competency and clear communication are essential for intrapartum care providers who encounter high-stakes, low-frequency emergencies. The challenge for these providers is to maintain infrequently used skills. The challenge is even more significant for midwives who manage births at home and who, due to low practice volume and low-risk clientele, may rarely encounter an emergency. In addition, access to team simulation may be limited for home-birth midwives. This project modified existing validated obstetric simulation scenarios for a home-birth setting. METHODS: Twelve certified professional midwives (CPMs) in active home-birth practice participated in shoulder dystocia and postpartum hemorrhage simulations. The simulations were staged to resemble home-birth settings, supplies, and personnel. Fidelity (realism) of the simulations was assessed with the Simulation Design Scale, and satisfaction and self-confidence were assessed with the Student Satisfaction and Self-Confidence in Learning Scale. Both utilized a 5-point Likert scale, with higher scores suggesting greater levels of fidelity, participant satisfaction, and self-confidence. RESULTS: Simulation Design Scale scores indicated participants agreed fidelity was achieved for the home-birth setting, while scores on the Student Satisfaction and Self-Confidence in Learning indicated high levels of participant satisfaction and self-confidence. DISCUSSION: If offered without modification, simulation scenarios designed for use in hospitals may lose fidelity for home-birth midwives, particularly in the environmental and psychological components. Simulation is standard of care in most settings, an excellent vehicle for maintaining skills, and some evidence suggests it results in improved perinatal outcomes. Additional study is needed in this area to support home-birth providers in maintaining skills. This pilot study suggests that simulation scenarios intended for hospital use can be successfully adapted to the home-birth setting.