The effect of hyoscine n- butylbromide on labor progress: A systematic review.

BACKGROUND: The objective of this systematic review and meta-analysis was to assess the effectiveness of hyoscine n-butylbromide in labor progress. METHODS: The databases including PubMed, the Cochrane Library, Science-Direct, Scopus and Web of Science were searched for studies published up to December 2019. Articles that published as randomized controlled trials (RCTs), and full-text articles published in English or other languages were included and participants were primi or multigravida women who were in active phase of labor. The intervention included HBB compared to placebo (normal saline) that was used during active phase of labor. Pooled estimates were measured using the fixed or random effect model, while the overall effect was reported in a mean difference (MD). All data were analyzed using Review Manager 5.3. RESULTS: Twenty studies involving 3108 women were included in meta-analysis. Based on subgroup analysis by parity, use of HBB significantly reduced the duration of the first stage of labor in primigravida women (MD = - 57.73; 95% CI: [- 61.48, - 53.60]) and in multigravida women (MD = - 90.74; 95% CI: [- 97.24, - 84.24]). Administering HBB could reduce the second stages of labor in primigravidas and multigravidas about 6 min and 4 min respectively. Also, HBB reduced the duration of the third stage of labor in multigravidas about 3 min. APGAR score at one and 5 min after birth was not affected. The main maternal adverse effect was tachycardia and dry mouth. Labor duration in studies in which the participants were primi-and multigravida was not presented based on separate parities except for four papers, and the route of HBB administration was not the same across all studies. CONCLUSIONS: Although, the effect of HBB was minimal when multigravidas and primigravidas women were considered together, the HBB was clinically effective in primigravida and multigravida women for shortening the first and the second stages of labor. Also, HBB could reduce the length of the third stage of labor in multigravidas.

Change in the Caries Status of Pregnant Women in Southeast Hungary and Its Background.

PURPOSE: To examine the caries status of pregnant women in southeast Hungary and compare the results with a similar study completed in the same region ten years earlier to determine whether any improvement has taken place in the past decade. Another objective was to assess the effects of age, socioeconomic status and number of pregnancies on oral health. MATERIALS AND METHODS: The dental examination of 130 pregnant women was carried out at the Dental Clinic of University of Szeged, Faculty of Dentistry in 2011-2013 (group 1). Caries status was examined according to WHO guidelines. In order to compare demographic and socioeconomic factors with DMF indices, find the decisive influencing factors and compare the results with the results of the previous study (group 2), two-way ANOVA and regression analyses were conducted. RESULTS: The number of highly educated, professional, urban participants included in the present group (group 1) was greater compared with that of group 2. Despite the higher age of the pregnant women in present study, statistically significantly lower DMFT (10.05 vs 12.57, p = 0.008) and DMFS (19.41 vs 26.26, p = 0.001) scores were found than ten years ago. In both studies, the regression analyses showed that women's age was the main contributing factor to caries status. CONCLUSION: The lower DMFT and DMFS values and the participants' willingness to participate in the dental screening in the present study group were probably the result of their higher educational background and that they worked as professionals.

Knowledge of dental decay and associated factors among pregnant women: a study from rural India.

PURPOSE: To assess the knowledge of dental decay among pregnant women and its relationship with sociodemographic characteristics and caries experience in rural India. MATERIALS AND METHODS: A cross-sectional study was conducted among 381 pregnant women in southern India. Variables and knowledge of dental decay were recorded using a structured self-administered questionnaire. Dental caries was recorded by a calibrated examiner as per WHO guidelines. RESULTS: The majority of the respondents were under 30 years of age (91.6%), utilised a public health-care delivery system (57.2%), were primigravid (63%), had a pre-universtiy diploma (64.8%) and were in the 3rd trimester (63%). Overall, poor knowledge was expressed by 12% to 37% of the women. The mean (±SD) DT (decayed teeth), MT (missing teeth), FT (filled teeth) and DMFT (decayed, missing and filled teeth) were 3.08 (±2.6), 0.93 (±2.23), 0.39 (±1.14) and 4.4 (±3.56), respectively. There were no significant differences in the responses to the knowledge of caries with respect to age and trimester. Educational status, health-care delivery system and number of pregnancies had a significant association with knowledge of caries. CONCLUSION: This study highlighted the limited knowledge of dental decay among pregnant, rural, southern Indian women. Preventive programmes for pregnant women should be designed based upon a thorough interview including an informative session on the specific risks during this period, in order to motivate the patient towards oral health and implement the needed prophylactic measures.

Vaginal cleansing before cesarean delivery to reduce postoperative infectious morbidity: a randomized, controlled trial.

OBJECTIVE: The objective of the study was to determine whether vaginal preparation with povidone iodine before cesarean delivery decreased the risk of postoperative maternal morbidities. STUDY DESIGN: The design of the study was a randomized, controlled trial in women undergoing cesarean delivery with subjects assigned to have a preoperative vaginal cleansing with povidone iodine or to a standard care group (no vaginal wash). The primary outcome was a composite of postoperative fever, endometritis, sepsis, readmission, wound infection, or complication. RESULTS: There were 155 vaginal cleansing subjects and 145 control subjects. Overall, 9.0% developed the composite outcome, with fewer women in the cleansing group (6.5%) compared with the control group (11.7%), although the difference was not statistically significant (relative risk, 0.55; 95% confidence interval, 0.26-1.11; P = .11). Length of surgery, being in labor, and having a dilated cervix were all associated with the composite morbidity outcome. CONCLUSION: Vaginal cleansing with povidone iodine before cesarean delivery may decrease postoperative morbidities, although the reduction is not statistically significant.

Fear of birth-A prospective cohort study of primigravida in the UK.

OBJECTIVE: An increase in the number of women who have fear of birth [FOB] has been reported globally; yet, how these women are identified varies. This study aimed to identify the most effective way of measuring FOB in clinical practice. DESIGN: This paper reports on a prospective cohort study; a core element of an explanatory mixed-methods study. This element explored the appropriateness of measures of anxiety (biomarkers and validated questionnaires) and observed any relationship between anxiety levels and clinical outcomes. PARTICIPANTS: A purposive sampling strategy was used. One hundred and forty-eight primigravida, during the 1st trimester, in two tertiary maternity units in England were included. METHODS: Demographic and baseline data were collected from participants in the first trimester of pregnancy along with FOB scores, and a saliva sample to measure cortisol level. In the third trimester, a second FOBS score, and saliva sample were collected, and the Personal Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) were administered to measure depression and anxiety respectively. FINDINGS: The FOBS was completed by 148 women in the first trimester and 80 in the third. Using a cut-off of 54, 30/148 (20%) women had a FOB in the first trimester; 21/80 (26%) had a FOB in the third trimester, 15 (19%) of whom also had a FOB in the first. Compared with the first trimester, 51/80 women showed an increase in FOBS score, with 14 scores increasing above and 8 scores decreasing below the cut-off of 54. FOBS scores were not correlated with salivary cortisol in either trimester (first trimester Spearman's ρ=0.08, p = 0.354, n = 144; third trimester ρ=0.12, p = 0.309, n = 71) but they were correlated with PHQ-9 and GAD-7 scores in the third trimester (PHQ-9 ρ=0.53, p = 0.010, n = 23; GAD-7 ρ=0.45, p = 0.033, n = 23) although not sufficiently high enough to demonstrate convergent validity against those measures of depression and anxiety. They were also associated with a previous history of depression but only in the first trimester (p = 0.011). FOBS scores showed considerable variability and a high measurement error, indicating a need for further refinement and psychometric testing. CONCLUSION: The FOBS is a potentially effective way of measuring FOB in clinical practice and research, but it requires refining. Scores are not related to salivary cortisol levels but are correlated with validated scores for anxiety and depression. An enhanced version of the FOBS could be used in clinical practice to measure FOB.

The effect of hyoscine butylbromide on the duration and progress of labor in primigravidae: a randomized controlled trial.

OBJECTIVE: To assess the effect of hyoscine butylbromide (HBB) on duration of the first stage of labor in primigravdae. METHODS: A case-control study conducted on 120 primigravida at term admitted in active labor were divided into three equal groups. A single dose of the drug (placebo or HBB 20 mg or HBB 40 mg) was injected intravenously slowly to groups A, B, and C. The duration of the first stage was calculated from the time of cervical dilatation of three to four centimeters in active labor until a fully dilated cervix was observed. RESULTS: The duration of first stage was significantly shorter in women receiving 20 and 40 mg of HBB when controlled to control women (187.73 ± 20.92, 186.41 ± 19.40 versus 231.39 ± 33.14 min). There was no significant difference between the three study groups regarding duration of the second stage (36.76 ± 9.98, 35.72 ± 9.97 and 37.55 ± 10.57, respectively, p > .05), number of cases delivered by cesarean section (12.5%, 12.5%, and 15%, respectively, p > .05) and Apgar score of the neonates (p > .05). There was no significant difference between the three study groups regarding occurrence of side effects named dry mouth (7.5%, 12.5%, and 5%, p > .05), flushing (2.5%, 5% and 0%, p > .05), tachycardia (2.5%, 2.5%, and 2.5%, p > .05), or urinary retention (2.5%, 0%, and 0%, p > .05). CONCLUSION: Intravenous injection of HBB decreases the duration of active phase of labor in primigravidae with no side effects.

Periodontal disease awareness among pregnant women in the central and eastern regions of Saudi Arabia.

AIM: The purpose of this study was to assess the knowledge and awareness regarding periodontal disease and its effects on pregnancy among pregnant women in the central and eastern regions of Saudi Arabia. METHODS: In this cross-sectional survey, self-administered, structured questionnaires were distributed to 300 pregnant women who were chosen randomly from attendees of maternity health care centers in the central and eastern regions of Saudi Arabia. The questions were developed from literature reviews of articles. The questionnaire addressed personal and sociodemographic variables, periodontal health awareness, and knowledge of pregnant women. The questionnaire was translated into Arabic and was pretested during the pilot study on a random sample of 50 pregnant women. Data were analyzed by χ(2) -tests, with the level of significance set at P < 0.05. RESULTS: An overall response rate of 81% was obtained. Approximately 53% had a higher level of education, but only 21% knew how to define dental plaque and 30% knew its harmful effects. Almost 73% stated that gum disease could be prevented through toothbrushing and flossing. Approximately 97% of the respondents knew the negative effect of smoking, while only 12% knew there was a possible relationship between periodontal disease and adverse pregnancy outcomes. CONCLUSION: The results of this cross-sectional study found that there is limited knowledge and awareness about periodontal disease and its possible effects on pregnancy among pregnant women attending maternal health care centers in the central and eastern regions of Saudi Arabia.

[Adamantiades-Behcet's syndrome and pregnancy: a case report]. / Sindrom na Adamantiadi-Bekhchet i bremennost predstaviane na edin sluchai.

Is introducing a case study on a 20 year old female first time pregnant who presents with rare case of Adamantiadis-Bechet syndrome. These symptoms first appeared at the age of 9. The patient refers that from this age she has suffered from recurrent relapses of ulcerations of the mouth and genital organs, vescicular exanthema of the upper and lower extremities and severe headaches that would not subside with analgetic therapy. The patient upon the first trimester presented with a relapse of the disease and significant improvement during the remainder of the pregnancy. She delivered on the 39th week of her pregnancy a neonate male, alive and weighing 3640 gr. The Apgar--score 9 and 10 the 1st and 5th minute. Mother and neonate were discharged from the clinic on the 3rd postpartum day in good health. This case is also being discussed in international bibliography. Adamantiadis-Behcet syndrome constitutes systemic angiitis of unknown etiology that is characterized mainly by recurrent ulcers of the mouth and genital organs, serum negative arthritis, central nervous system disorders as well as ulcerations of the epidermis, nodular erythema, thrombophlebitis and vision disorders. It usually affects people in early adulthood, more often those in their 30s. Geographically it is seen more often in Japan, Korea, Turkey, Israel and other Mediterranean countries. Familial prevalence is also common.

Periodontal disease and pregnancy hypertension: a clinical correlation.

BACKGROUND: Periodontal disease is thought to be associated with increased risk of systemic diseases and adverse pregnancy outcomes, including pregnancy hypertension (PH). The aim of the present study is to find the prevalence of periodontal disease in females with PH in a rural-based medical institute. METHODS: The present case control study was performed with 200 females, 100 with PH and 100 without PH. Antenatal periodontal screening was performed within 72 hours of their hospital admission for delivery. The periodontal parameters assessed were oral hygiene index-simplified, gingival index, mean probing depth, and loss of attachment. RESULTS: Prevalence of periodontal disease was 65.5% and was significantly higher (P <0.0001) in females with hypertension (relative risk = 1.5; 95% confidence interval [CI] = 1.3 to 1.9). Socioeconomic status, education, occupation, and body mass index did not appear to influence the relationship between periodontal disease and PH on bivariate multiple logistic regression analysis. Nulliparous females were at higher odds to develop periodontal disease and PH (odds ratio = 1.7; 95% CI = 0.5 to 6.1). As the severity of periodontal disease increased from moderate to severe, the severity of hypertension also increased (r(2) = 0.8 and 0.5 for moderate and severe periodontal disease, respectively). CONCLUSION: Periodontal disease is more prevalent in females with PH.

Oral health literacy and knowledge among patients who are pregnant for the first time.

BACKGROUND: The authors conducted an observational cohort study to determine the levels of and examine the associations of oral health literacy (OHL) and oral health knowledge in low-income patients who were pregnant for the first time. METHODS: An analytic sample of 119 low-income patients who were pregnant for the first time completed a structured 30-minute, in-person interview conducted by two trained interviewers in seven counties in North Carolina. The authors measured OHL by means of a dental word recognition test and assessed oral health knowledge by administering a six-item knowledge survey. RESULTS: The authors found that OHL scores were distributed normally (mean [standard deviation], 16.4 [5.0]). The percentage of correct responses for each oral health knowledge item ranged from 45 to 98 percent. The results of bivariate analyses showed that there was a positive correlation between OHL and oral health knowledge (P < .01). Higher OHL levels were associated with correct responses to two of the knowledge items (P < .01). CONCLUSIONS: OHL was low in the study sample. There was a significant association between OHL and oral health knowledge. CLINICAL IMPLICATIONS: Low OHL levels and, thereby, low levels of oral health knowledge, might affect health outcomes for both the mother and child. Tailoring messages to appropriate OHL levels might improve knowledge.

Periodontal therapy and low birth weight: preliminary results from an alternative methodologic strategy.

BACKGROUND: The purpose of this study is to present the use of a non-randomized experimental design with multiple controls, with emphasis on a historical control group, as an alternative methodologic resource for studies on the association between periodontal disease and prematurity/low birth weight. METHODS: The sample consisted of 234 pregnant women: 54 in the Test Group (treatment of periodontal disease); 68 in Control Group I (without periodontal disease); and 112 in Control Group II (historical control group, with untreated periodontal disease). The diagnosis of periodontal disease was established by means of a complete clinical examination, using measurements of probing depth, gingival recession, clinical attachment loss, and bleeding index. The women in the Test Group were treated for periodontitis and followed-up with periodontal support therapy throughout their pregnancies. After delivery, they were reevaluated regarding their periodontal condition, and information on the newborn's birth weight was obtained. This was also done for Control Groups I and II. Descriptive analyses on the study variables were performed using the χ(2) and Fisher exact tests. Association measurements (relative risk) were obtained using a significance level of 5%. RESULTS: The frequency of low birth weight among the Test Group was similar to Control Group I and lower than Control Group II. CONCLUSION: The results suggest that successful periodontal therapy in pregnant women suffering from periodontitis is a protective factor promoting the birth of children with normal weight.

Obstetrician-assessed maternal health at pregnancy predicts offspring future health.

BACKGROUND: We aimed to examine the association between obstetrician assessment of maternal physical health at the time of pregnancy and offspring cardiovascular disease risk. METHODS AND PRINCIPAL FINDINGS: We examined this association in a birth cohort of 11,106 individuals, with 245,000 person years of follow-up. We were concerned that any associations might be explained by residual confounding, particularly by family socioeconomic position. In order to explore this we used multivariable regression models in which we adjusted for a range of indicators of socioeconomic position and we explored the specificity of the association. Specificity of association was explored by examining associations with other health related outcomes. Maternal physical health was associated with cardiovascular disease: adjusted (socioeconomic position, complications of pregnancy, birthweight and childhood growth at mean age 5) hazard ratio comparing those described as having poor or very poor health at the time of pregnancy to those with good or very good health was 1.55 (95%CI: 1.05, 2.28) for coronary heart disease, 1.91 (95%CI: 0.99, 3.67) for stroke and 1.57 (95%CI: 1.13, 2.18) for either coronary heart disease or stroke. However, this association was not specific. There were strong associations for other outcomes that are known to be related to socioeconomic position (3.61 (95%CI: 1.04, 12.55) for lung cancer and 1.28 (95%CI:1.03, 1.58) for unintentional injury), but not for breast cancer (1.10 (95%CI:0.48, 2.53)). CONCLUSIONS AND SIGNIFICANCE: These findings demonstrate that a simple assessment of physical health (based on the appearance of eyes, skin, hair and teeth) of mothers at the time of pregnancy is a strong indicator of the future health risk of their offspring for common conditions that are associated with poor socioeconomic position and unhealthy behaviours. They do not support a specific biological link between maternal health across her life course and future risk of cardiovascular disease in her offspring.

Oral hygiene practices, periodontal conditions, dentition status and self-reported bad mouth breath among young mothers, Tanzania.

OBJECTIVES: To determine the oral hygiene practices, periodontal conditions, dentition status and self-reported bad mouth breath (S-BMB) among young mothers. STUDY PARTICIPANTS AND METHODS: This was a cross-sectional descriptive study conducted at Muhimbili National Hospital, Dar es Salaam, Tanzania. A total of 302 postpartum mothers, aged 14-44 years, were interviewed on oral hygiene practices and S-BMB using structured questionnaire. Oral hygiene, dentition and periodontal status were assessed using the Community Periodontal Index probe and gingival recessions (GR) using Williams Periodontal probe. RESULTS: Tooth brushing practice was 99%; tongue brushing (95%), plastic toothbrush users (96%), chewing stick (1%), wooden toothpicks (76%), dental floss (<1%); and toothpaste (93%). The prevalence of plaque and gingival bleeding on probing was 100%, gum bleeding during tooth brushing (33%), calculus (99%), probing periodontal pocket depth (PPD) 4-5 mm (27%), PPD 6+ mm (3%), GR 1+ mm (27%) and tooth decay (55%). The prevalence of S-BMB was 14%; the S-BMB had higher mean number of sites with plaque compared to the no S-BMB group (P=0.04). Factors associated with S-BMB were gum bleeding on tooth brushing (OR=2.4) and PPD 6+ mm (OR=5.4). CONCLUSION: Self-reported bad mouth breath is a cause of concern among young mothers, and associated significant factors were gum bleeding on tooth brushing and deep periodontal pockets of 6+ mm. Further research involving clinical diagnosis of bad mouth breath and intervention through oral health promotion and periodontal therapy are recommended. CLINICAL RELEVANCE: This study provides baseline information on oral health status and the complaint on bad mouth breath which necessitates in the future need for objective assessment, diagnosis and management of bad mouth breath for enhanced social and professional interaction without embarrassment.

Periodontal disease awareness among pregnant women and its relationship with socio-demographic variables.

Certain conditions may have an affect on gingival status and may aggravate pre-existing disease, especially in persons with poor oral hygiene. Pregnancy is one of these conditions. In addition, there is evidence in the literature suggesting an association between periodontal diseases in pregnant women and giving birth to premature, low-birth infants. The purpose of this study was to evaluate the degree of periodontal health knowledge, and awareness, among pregnant women in Jordan. This was carried out by cross-sectional survey using self-administered, structured questionnaires distributed at six maternity care centres in Irbid City. Questionnaire items addressed personal and socio-demographic variables and periodontal health awareness and knowledge of pregnant women. Women (n = 300) were randomly chosen from attendants to these centres. Of the 300 questionnaires distributed, only 275 pregnant women ages 16-45 years with a mean of 29 year responded and were included in the study. Data were analysed by chi-squared test with the level of significance set at (P < 0.05). About one-third of the participants had secondary level of education; it appeared that a minority of the pregnant women had knowledge or ability to identify dental plaque (16.4%) and its harmful effects (22.5%), while most of them (88%) were aware that bleeding gums indicated the presence of periodontal disease. The differences in the responses to knowledge questions were only significant for question number one (What is plaque?) among different educational levels and groups. This study revealed that (71.6%) of the pregnant women knew the main cause of gum disease; however 56% of them do not believe that frequency of teeth brushing should be increased during pregnancy and only 5.1% believed there might be a relationship between gum diseases and premature labour. Knowledge and awareness for pregnant women about their teeth and gingival condition is generally poor. Pregnant women need accurate information about their teeth and oral health. Simple educational preventive programmes on oral self-care and disease prevention before and during pregnancy should be provided to improve oral health.

[Effect of occlusal interference on fluctuation of body's gravity center].

OBJECTIVE: To study if the occlusal interference affects the fluctuation of body's gravity center. METHODS: An artificial occlusal interference was separately applied on 14 volunteers (7 males and 7 females, mean age 23.2 years). Fluctuations of body's gravity center were measured before wearing the occlusal interference appliance, at 30 minutes and 24 hours after wearing the appliance. RESULTS: The length and area of fluctuation of body's gravity center with the interference appliance were greater than that without it. The length of fluctuation of gravity center was 40.22 cm, 41.66 cm and 43.21 cm in eye-opening conditions and 56.96 cm2, 61.93 cm2, 66.9 cm2 in eye-closing condition. The area of fluctuation of gravity center was 3.3 cm2, 3.43 cm2, 3.61 cm2 in eye-opening condition and 4.63 cm2, 5.00 cm2, 6.47 cm2 in eye-closing condition. The female volunteers showed more changes than the male ones. CONCLUSION: Occlusal interference does affect the fluctuation of body's gravity center.