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1.
Afr J Reprod Health ; 28(2): 96-106, 2024 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-38425232

RESUMO

The aim of this study was to investigate the factors affecting mothers' satisfaction with birth and the supportive care given to them during labor. The tools used to collect the data were the Scale for Measuring Maternal Satisfaction in Birth and Bryanton Adaptation of the Nursing Support in Labor Questionnaire. The study sample consisted of 352 mothers. In this study, it was determined that 64.2% of mothers were satisfied with the support given during their birth. There is a significant relationship between age, number of pregnancies, number of births and Nursing Support Scale total score and mothers' satisfaction with birth. Mothers' satisfaction levels with birth are affected by these variables. It has been determined that as the birth support mothers receive during labor increases, their satisfaction level with birth increases. For this reason, it is recommended to increase care and support during labor and conduct other studies to determine other factors affecting satisfaction at birth.


Le but des cette étude était d'étudier les facteurs affectant la satisfaction des mères à l'égard de l'accouchement et les soins de soutien qui leur sont prodigués pendant le travail. Les outils utilisés pour collecter les données étaient l'échelle de mesure de la satisfaction maternelle à la naissance et l'adaptation de Bryanton du questionnaire sur le soutien infirmier au travail. L'échantillon de l'étude était composé de 352 mères. Dans cette étude, il a été déterminé que 64,2% des mères étaient satisfaites du soutien apporté lors de leur accouchement. Il existe une relation significative entre l'âge, le nombre de grossesses, le nombre de naissances, le score total de l'échelle de soutien infirmier et la satisfaction des mères à l'égard de l'accouchement. Les niveaux de satisfaction des mères à l'égard de la naissance sont affectés par ces variables. Il a été déterminé qu'à mesure que le soutien à l'accouchement que les mères reçoivent pendant le travail augmente, leur niveau de satisfaction à l'égard de l'accouchement augmente. Pour cette raison, il est recommandé d'augmenter les soins et le soutien pendant le travail et de mener d'autres études pour déterminer d'autres facteurs affectant la satisfaction à la naissance.


Assuntos
Trabalho de Parto , Satisfação do Paciente , Gravidez , Feminino , Recém-Nascido , Humanos , Mães , Parto Obstétrico , Satisfação Pessoal
2.
BMC Pregnancy Childbirth ; 24(1): 197, 2024 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-38481196

RESUMO

BACKGROUND: Preterm labor is caused by multiple etiologies, including intra-amniotic infection and/or intra-amniotic inflammation, vascular disorders, cervical disease, decidual senescence, and breakdown of maternal-fetal tolerance. Accumulating evidence in vivo and in vitro has shown that an allergic reaction, including anaphylaxis, can induce preterm uterine contractions. This report describes a case of a pregnant woman who developed anaphylaxis and regular uterine contractions after the ingestion of a strawberry-coated biscuit. We also review the mechanism of allergic reaction (hypersensitivity)-induced preterm labor. Case presentation A 31-year-old woman (gravida 1, para 0) at 30+2 weeks of gestation was admitted to the labor and delivery unit with regular uterine contractions and anaphylactic symptoms after she ingested a strawberry-coated biscuit as a snack. The uterine contractions resolved after the treatment of anaphylaxis by administering antihistamines and epinephrine. The patient subsequently delivered at 39+3 weeks of gestation. The amniotic fluid profile showed no infection or inflammation. A postpartum skin-prick test confirmed a positive type 1 hypersensitivity reaction to the strawberry-coated biscuit. CONCLUSIONS: We report a case of anaphylaxis-induced uterine contractility in which uterine contractions subsided after the treatment of anaphylaxis. The absence of intra-amniotic infection and/or intra-amniotic inflammation and the cause of the anaphylaxis were confirmed. Our findings indicate that maternal allergic reactions may be one of the mechanisms of preterm labor.


Assuntos
Anafilaxia , Corioamnionite , Trabalho de Parto , Trabalho de Parto Prematuro , Nascimento Prematuro , Feminino , Recém-Nascido , Gravidez , Humanos , Adulto , Anafilaxia/induzido quimicamente , Anafilaxia/complicações , Trabalho de Parto Prematuro/diagnóstico , Contração Uterina , Líquido Amniótico/metabolismo , Inflamação , Corioamnionite/metabolismo
3.
Nutrients ; 16(5)2024 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-38474818

RESUMO

Numerous factors concerning early breastfeeding abandonment have been described, including health literacy (HL). This study's objective was to analyze factors related to early breastfeeding abandonment (<6 months). This prospective multicentric study examined the duration of breastfeeding at 6 months postpartum and was conducted in four different regions of Spain from January 2021 to January 2023. A total of 275 women participated in this study, which focused on maternal HL and obstetric practices. A decrease in the breastfeeding rate was observed from hospital discharge (n = 224, 81.5%) to the sixth month postpartum (n = 117, 42.5%). A Cox regression analysis revealed that inadequate HL levels, lack of mobilization during labour, and induced labour were significantly associated with early breastfeeding cessation (p = 0.022, p = 0.019, and p = 0.010, respectively). The results highlight that women with adequate HL had a 32% lower risk of early breastfeeding abandonment. In comparison, mobilization during labour and induction of labour were linked to a 32.4% reduction and a 53.8% increase in this risk, respectively. These findings emphasize the importance of considering obstetric and HL factors when addressing the breastfeeding duration, indicating opportunities for educational and perinatal care interventions.


Assuntos
Letramento em Saúde , Trabalho de Parto , Gravidez , Feminino , Humanos , Aleitamento Materno , Estudos Prospectivos , Período Pós-Parto , Mães
5.
PLoS One ; 19(3): e0295440, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38489288

RESUMO

Click-through rate (CTR) prediction is a term used to predict the probability of a user clicking on an ad or item and has become a popular research area in advertising. As the volume of Internet data increases, the labor costs of traditional feature engineering continue to rise. To reduce the dependence on feature interactions, this paper proposes a fusion model that combines explicit and implicit feature interactions, called the Two-Tower Multi-Head Attention Neural Network (TMH) approach. The model integrates multiple components such as multi-head attention, residual network, and deep neural networks into an end-to-end model that automatically obtains vector-level combinations of explicit and implicit features to predict click-through rates through higher-order explicit and implicit interactions. We evaluated the effectiveness of TMH in CTR prediction through numerous experiments using three real datasets. The results demonstrate that our proposed method not only outperforms existing prediction methods but also offers good interpretability.


Assuntos
Publicidade , Trabalho de Parto , Gravidez , Feminino , Humanos , Engenharia , Internet , Redes Neurais de Computação
7.
J Matern Fetal Neonatal Med ; 37(1): 2326301, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38485519

RESUMO

OBJECTIVE: Cesarean section (CS) rates have been on the rise globally, leading to an increasing number of women facing the decision between a Trial of Labor after two Cesarean Sections (TOLAC-2) or opting for an Elective Repeat Cesarean Section (ERCS). This study evaluates and compares safety outcomes of TOLAC and ERCS in women with a history of two previous CS deliveries. METHODS: PubMed, MEDLINE, EMbase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for studies published until 30 June 2023. Eligible studies were included based on predetermined criteria, and a random-effects model was employed to pool data for maternal and neonatal outcomes. RESULTS: Thirteen studies with a combined sample size of 101,011 women who had two prior CS were included. TOLAC-2 was associated with significantly higher maternal mortality (odds ratio (OR)=1.50, 95% confidence interval (CI)= 1.25-1.81) and higher chance of uterine rupture (OR = 7.15, 95% CI = 3.44-14.87) compared to ERCS. However, no correlation was found for other maternal outcomes, including blood transfusion, hysterectomy, or post-partum hemorrhage. Furthermore, neonatal outcomes, such as Apgar scores, NICU admissions, and neonatal mortality, were comparable in the TOLAC-2 and ERCS groups. CONCLUSION: Our findings suggest an increased risk of uterine rupture and maternal mortality with TOLAC-2, emphasizing the need for personalized risk assessment and shared decision-making by healthcare professionals. Additional studies are needed to refine our understanding of these outcomes in the context of TOLAC-2.


Assuntos
Trabalho de Parto , Ruptura Uterina , Nascimento Vaginal Após Cesárea , Recém-Nascido , Humanos , Gravidez , Feminino , Cesárea/efeitos adversos , Prova de Trabalho de Parto , Ruptura Uterina/epidemiologia , Ruptura Uterina/etiologia , Nascimento Vaginal Após Cesárea/efeitos adversos , Recesariana/efeitos adversos , Estudos Retrospectivos
8.
PLoS One ; 19(3): e0298046, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38517902

RESUMO

OBJECTIVES: This systematic scoping review was conducted to 1) identify and describe labor curves that illustrate cervical dilatation over time; 2) map any evidence for, as well as outcomes used to evaluate the accuracy and effectiveness of the curves; and 3) identify areas in research that require further investigation. METHODS: A three-step systematic literature search was conducted for publications up to May 2023. We searched the Medline, Maternity & Infant Care, Embase, Cochrane Library, Epistemonikos, CINAHL, Scopus, and African Index Medicus databases for studies describing labor curves, assessing their effectiveness in improving birth outcomes, or assessing their accuracy as screening or diagnostic tools. Original research articles and systematic reviews were included. We excluded studies investigating adverse birth outcomes retrospectively, and those investigating the effect of analgesia-related interventions on labor progression. Study eligibility was assessed, and data were extracted from included studies using a piloted charting form. The findings are presented according to descriptive summaries created for the included studies. RESULTS AND IMPLICATIONS FOR RESEARCH: Of 26,073 potentially eligible studies, 108 studies were included. Seventy-three studies described labor curves, of which ten of the thirteen largest were based mainly on the United States Consortium on Safe Labor cohort. Labor curve endpoints were 10 cm cervical dilatation in 69 studies and vaginal birth in 4 studies. Labor curve accuracy was assessed in 26 studies, of which all 15 published after 1986 were from low- and middle-income countries. Recent studies of labor curve accuracy in high-income countries are lacking. The effectiveness of labor curves was assessed in 13 studies, which failed to prove the superiority of any curve. Patient-reported health and well-being is an underrepresented outcome in evaluations of labor curves. The usefulness of labor curves is still a matter of debate, as studies have failed to prove their accuracy or effectiveness.


Assuntos
Primeira Fase do Trabalho de Parto , Trabalho de Parto , Gravidez , Feminino , Humanos , Estudos Retrospectivos
9.
Sci Rep ; 14(1): 6906, 2024 03 22.
Artigo em Inglês | MEDLINE | ID: mdl-38519648

RESUMO

Social support has been proposed as an important determinant of women's physical and emotional well-being during pregnancy and after childbirth. Our study aimed to examine the association between the risk of postpartum depression (PPD) and perceived social support during pregnancy. A web-based prospective study survey was conducted among Polish women. The level of social support was measured with the Berlin Social Support Scales during pregnancy. Four weeks after the birth the risk of PPD was assessed using the Edinburgh Postpartum Depression Scale. Data from 932 mothers aged 19-43 (mean 30.95; SD 3.83) were analyzed using multinomial logistic regression. Higher perceived available support (emotional and instrumental), currently received support (emotional, instrumental and informational), satisfaction with the support, and sum of score were all associated with lower risk of PPD, after controlling for selected covariates (woman's age, socioeconomic status, parity status, place of residency, education, child's Apgar score, type of delivery, complications during birth, kin assisting the labor, breastfeeding). Our results suggest that the more social support the pregnant woman receives, the lower is her risk of PPD. Since humans evolved as cooperative breeders, they are inherently reliant on social support to raise children and such allomaternal help could improve maternal well-being.


Assuntos
Depressão Pós-Parto , Trabalho de Parto , Humanos , Gravidez , Criança , Feminino , Estudos Prospectivos , Depressão Pós-Parto/psicologia , Polônia/epidemiologia , Apoio Social , Fatores de Risco , Período Pós-Parto
10.
PLoS One ; 19(3): e0298519, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38512995

RESUMO

Neonatal birth trauma, although it has steadily decreased in industrialized nations, constitutes a significant health burden in low-resource settings. Keeping with this, we sought to determine the pooled cumulative incidence (incidence proportion) of birth trauma and identify potential contributing factors in low and middle-income countries. Besides, we aimed to describe the temporal trend, clinical pattern, and immediate adverse neonatal outcomes of birth trauma. We searched articles published in the English language in the Excerpta Medica database, PubMed, Web of Science, Google, African Journals Online, Google Scholar, Scopus, and in the reference list of retrieved articles. Literature search strategies were developed using medical subject headings and text words related to the outcomes of the study. The Joana Briggs Institute quality assessment tool was employed and articles with appraisal scores of seven or more were deemed suitable to be included in the meta-analysis. Data were analyzed using the random-effect Dersimonian-Laird model. The full search identified a total of 827 articles about neonatal birth trauma. Of these, 37 articles involving 365,547 participants met the inclusion criteria. The weighted pooled cumulative incidence of birth trauma was estimated at 34 per 1,000 live births (95% confidence interval (CI) 30.5 to 38.5) with the highest incidence observed in Africa at 52.9 per 1,000 live births (95% CI 46.5 to 59.4). Being born to a mother from rural areas (odds ratio (OR), 1.61; 95% CI1.18 to 2.21); prolonged labor (OR, 5.45; 95% CI 2.30, 9.91); fetal malpresentation at delivery (OR, 4.70; 95% CI1.75 to 12.26); shoulder dystocia (OR, 6.11; 95% CI3.84 to 9.74); operative vaginal delivery (assisted vacuum or forceps extraction) (OR, 3.19; 95% CI 1.92 to 5.31); and macrosomia (OR, 5.06; 95% CI 2.76 to 9.29) were factors associated with neonatal birth trauma. In conclusion, we found a considerably high incidence proportion of neonatal birth trauma in low and middle-income countries. Therefore, early identification of risk factors and prompt decisions on the mode of delivery can potentially contribute to the decreased magnitude and impacts of neonatal birth trauma and promote the newborn's health.


Assuntos
Traumatismos do Nascimento , Doenças do Recém-Nascido , Trabalho de Parto , Gravidez , Recém-Nascido , Feminino , Humanos , Países em Desenvolvimento , Parto Obstétrico
11.
BMJ Case Rep ; 17(3)2024 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-38508596

RESUMO

We report a case of a mid-20s primigravida at 37 weeks' gestation who presented with severe headache and acute neurological deterioration. The CT brain scan showed hydrocephalus caused by a colloid cyst in the third ventricle. The patient underwent emergency placement of an external ventricular drain for decompression of acute hydrocephalus. Four hours later, labour commenced spontaneously, and in view of her neurological status, a decision was taken to perform a caesarean section under general anaesthetics. Four days postpartum, the patient underwent an endoscopic removal of the cyst. Intracranial emergencies during pregnancy are rare and challenging to manage. The mortality rate can be significant. Diagnostic and surgical intervention should not be delayed because of pregnancy. An individualised treatment approach is required with multidisciplinary input. The collaborative efforts of our multidisciplinary team resulted in prompt diagnosis and surgical treatment in this case that resulted in both a healthy mother and child.


Assuntos
Cistos Coloides , Hidrocefalia , Trabalho de Parto , Terceiro Ventrículo , Criança , Humanos , Gravidez , Feminino , Cesárea , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Terceiro Ventrículo/cirurgia
12.
BMC Pregnancy Childbirth ; 24(1): 210, 2024 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-38509483

RESUMO

BACKGROUND: Instrumental vaginal birth, a very common intervention in obstetrics, concerns nearly one in eight women in France. Instrumentally assisted vaginal childbirth can be for maternal and/or fetal indications. Although it reduces recourse to caesarean section, it is subject to risks. Practices concerning instrumental birth are disparate, varying among different practitioners, maternity units and countries, and it is essential to be able to evaluate them. Our objective was to create a classification tool of women requiring instrumental birth to facilitate the analysis of practices within our maternity unit as well as to enable temporal and geographical comparisons. MATERIALS AND METHODS: We propose a simple and robust classification based on the same principles as Robson's classification. It is made up of seven totally inclusive and mutually exclusive groups. Our classification was refined and validated using the Delphi method by a panel of 14 experts from throughout France, and tested in our maternity unit using data from throughout 2021. RESULTS: The seven clinically relevant groups are based on five obstetric criteria (multiplicity, presentation, gestational age, previous type of birth, induction of labor). To classify each woman in a group, five successive questions are posed in a predefined order. The classification has been validated by the experts with highly satisfactory overall agreement. CONCLUSION: In order to improve the quality of care, we propose a tool to standardize the evaluation of instrumental vaginal birth practice (called the "Isère classification", after the county where we work in south-eastern France). It will also facilitate the comparison the practices among different maternity units in a network, a country or even among different countries.


Assuntos
Trabalho de Parto , Obstetrícia , Gravidez , Feminino , Humanos , Cesárea , Parto Obstétrico/métodos , Cuidado Pré-Natal
13.
Int Tinnitus J ; 27(2): 191-197, 2024 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-38507634

RESUMO

INTRODUCTION: Labor pain is often severe and its lack of relief can have a bad effect on the mother's physiological condition. Accurate measurement and appropriate treatment of pain is an important problem. There are several choices for the control of labor pain, however, each method has its own risks and benefits regarding its efficiency and availability; therefore, the aim of this study was to compare the rate of cesarean section and newborn Apgar in two types of physiological delivery and facilitated delivery among mothers with first delivery. MATERIALS AND METHODS: This case-control study was conducted on mothers aged 18-35 who went to the hospital to give birth. In the present study, 8 sessions (90 minutes each session) were held to prepare mothers from 20 to 37 weeks of pregnancy. Candidate mothers for physiological labor were hospitalized without intervention and in the active phase of labor, and their labor stages were planned physiologically. The pain intensity of mothers was asked using a scale (VAS) during labor every half hour (according to the pain scale from 0 to 10). The average score of pain during the first and second stages, type of delivery, amount of postpartum bleeding, length of the stage of delivery, infection, and fever after delivery, Apgar score of the baby, perineal status, mother's satisfaction and the rate of hospitalization of the baby in NICU were recorded. Furthermore, the level of satisfaction with childbirth was evaluated with the help of Mackey's standard satisfaction questionnaire. RESULTS: The average age of the physiological delivery and facilitated delivery groups was 26.37 ± 5.23 years and 26.58 ± 5.79 years, respectively. Physiological delivery significantly required less conversion to cesarean section. The most common etiology was caesarean section in the physiologic labor group, and a drop in NST was reported in the facilitated group. The analysis of the results demonstrated no significant difference between the etiology of cesarean section and the study groups. The Apgar score in the physiological group was significantly better than the facilitated group. There is no significant relationship between the study group and the amount of bleeding during delivery. Furthermore, there was no significant relationship between the study group and the incidence of postpartum infection. The rate of NICU admission in the facilitated group was found to be significantly higher than physiological delivery. CONCLUSION: The results of this study revealed that the rate of caesarean section, the rate of need for NICU, newborns' Apgar score, and the rate of mothers' satisfaction in physiological delivery group were significantly different from the other groups, but the rate of wound infection and the amount of postpartum bleeding in the two groups showed a significant difference.


Assuntos
Dor do Parto , Trabalho de Parto , Gravidez , Recém-Nascido , Feminino , Humanos , Adulto Jovem , Adulto , Cesárea , Mães , Índice de Apgar , Estudos de Casos e Controles , Trabalho de Parto/fisiologia
14.
Methods Mol Biol ; 2781: 27-37, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38502440

RESUMO

Leukocyte infiltration into the maternal-fetal interface is a consequence of the robust inflammation in the gestational tissues during term labor and preterm labor with or without infection. During pregnancy, the fetal membranes act as a physical barrier that isolates the fetus into the amniotic cavity, keeping it in an optimal environment for its development. In addition, the fetal membranes possess immunological competencies such as the secretion of cytokines and chemokines in response to different stimuli. Clinical and experimental evidence indicates that these tissues are involved in the extensive chemotaxis of immune cells in normal or pathological conditions.Few studies have evaluated the chemotactic capacities of the fetal membranes considering that this tissue is composed of two adjacent tissues, the amnion and the chorion, which have different characteristics. Although these tissues function as a unit, their response is complex since there is an interaction between them, where each tissue contributes differently. The protocol described here allows us to evaluate the in vitro chemotactic capacities of fetal membranes in response to various applied stimuli, considering the contribution of each of their components (amnion and choriodecidua) using a Boyden chamber assay and phenotyping the chemo-attracted leukocytes by flow cytometry.


Assuntos
Membranas Extraembrionárias , Trabalho de Parto , Gravidez , Recém-Nascido , Feminino , Humanos , Âmnio , Córion , Quimiotaxia de Leucócito
15.
PLoS One ; 19(3): e0299046, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38446799

RESUMO

The agglomeration effect significantly influences firms' site selection. Manufacturing firms often exhibit intricate spatial co-location patterns that are indicative of agglomerations due to their reliance on material input and product output across various subdivisions of manufacture. In this study, we present an analytical approach employing the Q statistic and additive color mixing visualization to assess co-location patterns of manufacturing firms. We identified frequent pairs and triplets of manufacturing divisions, mapping them to reveal distinct categories: labor-intensive clusters, upstream/downstream industrial chains, and technology-spillover clusters. These agglomeration categories concentrate in different regions of the city. Policy implications are proposed to promote the upgrade of labor-intensive divisions, enhance the operational efficiency of upstream/downstream industrial chains, and reinforce the spillover effects of technology-intensive divisions.


Assuntos
Comércio , Trabalho de Parto , Gravidez , Feminino , Humanos , Indústrias , Políticas , Tecnologia
16.
Rev Bras Enferm ; 77Suppl 3(Suppl 3): e20230290, 2024.
Artigo em Inglês, Português | MEDLINE | ID: mdl-38477816

RESUMO

OBJECTIVE: To understand the meaning attributed by women with physical disabilities to the health care received and expected during labor and delivery. METHODS: Qualitative study, based on Social Network Theory, conducted through an online workshop in April 2022, with the participation of six women with physical disabilities. Data, collected through the focus group technique, underwent thematic content analysis with the assistance of the IRaMuTeQ tool. RESULTS: Three thematic categories emerged: Challenges experienced during pregnancy; The experience within the maternity ward; and, The importance of social networks. The assistance provided by healthcare professionals sometimes differed between what was expected and what was received by women with physical disabilities during labor and delivery. FINAL CONSIDERATIONS: Experiences were predominantly negative, resulting from inappropriate professional conduct due to ableist attitudes. Support from members of social networks is crucial for preventing stressors.


Assuntos
Trabalho de Parto , Gravidez , Humanos , Feminino , Grupos Focais , Instalações de Saúde , Pessoal de Saúde , Hospitais
17.
Am J Obstet Gynecol ; 230(3S): S1046-S1060.e1, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38462248

RESUMO

The third stage of labor is defined as the time period between delivery of the fetus through delivery of the placenta. During a normal third stage, uterine contractions lead to separation and expulsion of the placenta from the uterus. Postpartum hemorrhage is a relatively common complication of the third stage of labor. Strategies have been studied to mitigate the risk of postpartum hemorrhage, leading to the widespread implementation of active management of the third stage of labor. Initially, active management of the third stage of labor consisted of a bundle of interventions including administration of a uterotonic agent, early cord clamping, controlled cord traction, and external uterine massage. However, the effectiveness of these interventions as a bundle has been questioned, leading to abandonment of some components in recent years. Despite this, upon review of selected international guidelines, we found that the term "active management of the third stage of labor" was still used, but recommendations for and against individual interventions were variable and not necessarily supported by current evidence. In this review, we: (1) examine the physiology of the third stage of labor, (2) present evidence related to interventions that prevent postpartum hemorrhage and promote maternal and neonatal health, (3) review current global guidelines and recommendations for practice, and (4) propose future areas of investigation. The interventions in this review include pharmacologic agents to prevent postpartum hemorrhage, cord clamping, cord milking, cord traction, cord drainage, early skin-to-skin contact, and nipple stimulation. Treatment of complications of the third stage of labor is outside of the scope of this review. We conclude that current evidence supports the use of effective pharmacologic postpartum hemorrhage prophylaxis, delayed cord clamping, early skin-to-skin contact, and controlled cord traction at delivery when feasible. The most effective uterotonic regimens for preventing postpartum hemorrhage after vaginal delivery include oxytocin plus ergometrine; oxytocin plus misoprostol; or carbetocin. After cesarean delivery, carbetocin or oxytocin as a bolus are the most effective regimens. There is inconsistent evidence regarding the use of tranexamic acid in addition to a uterotonic compared with a uterotonic alone for postpartum hemorrhage prevention after all deliveries. Because of differences in patient comorbidities, costs, and availability of resources and staff, decisions to use specific prevention strategies are dependent on patient- and system-level factors. We recommend that the term "active management of the third stage of labor" as a combined intervention no longer be used. Instead, we recommend that "third stage care" be adopted, which promotes the implementation of evidence-based interventions that incorporate practices that are safe and beneficial for both the woman and neonate.


Assuntos
Trabalho de Parto , Ocitócicos , Hemorragia Pós-Parto , Gravidez , Feminino , Recém-Nascido , Humanos , Hemorragia Pós-Parto/induzido quimicamente , Ocitocina/uso terapêutico , Ocitócicos/uso terapêutico , Prática Clínica Baseada em Evidências
18.
Am J Obstet Gynecol ; 230(3S): S740-S758, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38462255

RESUMO

Oxytocin is a reproductive hormone implicated in the process of parturition and widely used during labor. Oxytocin is produced within the supraoptic nucleus and paraventricular nucleus of the hypothalamus and released from the posterior pituitary lobe into the circulation. Oxytocin is released in pulses with increasing frequency and amplitude in the first and second stages of labor, with a few pulses released in the third stage of labor. During labor, the fetus exerts pressure on the cervix of the uterus, which activates a feedforward reflex-the Ferguson reflex-which releases oxytocin. When myometrial contractions activate sympathetic nerves, it decreases oxytocin release. When oxytocin binds to specific myometrial oxytocin receptors, it induces myometrial contractions. High levels of circulating estrogen at term make the receptors more sensitive. In addition, oxytocin stimulates prostaglandin synthesis and release in the decidua and chorioamniotic membranes by activating a specific type of oxytocin receptor. Prostaglandins contribute to cervical ripening and uterine contractility in labor. The oxytocin system in the brain has been implicated in decreasing maternal levels of fear, pain, and stress, and oxytocin release and function during labor are stimulated by a social support. Moreover, studies suggest, but have not yet proven, that labor may be associated with long-term, behavioral and physiological adaptations in the mother and infant, possibly involving epigenetic modulation of oxytocin production and release and the oxytocin receptor. In addition, infusions of synthetic oxytocin are used to induce and augment labor. Oxytocin may be administered according to different dose regimens at increasing rates from 1 to 3 mIU/min to a maximal rate of 36 mIU/min at 15- to 40-minute intervals. The total amount of synthetic oxytocin given during labor can be 5 to 10 IU, but lower and higher amounts of oxytocin may also be given. High-dose infusions of oxytocin may shorten the duration of labor by up to 2 hours compared with no infusion of oxytocin; however, it does not lower the frequency of cesarean delivery. When synthetic oxytocin is administered, the plasma concentration of oxytocin increases in a dose-dependent way: at infusion rates of 20 to 30 mIU/min, plasma oxytocin concentration increases approximately 2- to 3-fold above the basal level. Synthetic oxytocin administered at recommended dose levels is not likely to cross the placenta or maternal blood-brain barrier. Synthetic oxytocin should be administered with caution as high levels may induce tachystole and uterine overstimulation, with potentially negative consequences for the fetus and possibly the mother. Of note, 5 to 10 IU of synthetic oxytocin is often routinely given as an intravenous or intramuscular bolus administration after delivery to induce uterine contractility, which, in turn, induces uterine separation of the placenta and prevents postpartum hemorrhage. Furthermore, it promotes the expulsion of the placenta.


Assuntos
Trabalho de Parto , Ocitócicos , Gravidez , Feminino , Humanos , Ocitocina/farmacologia , Receptores de Ocitocina , Período Periparto , Trabalho de Parto/fisiologia , Ocitócicos/farmacologia , Trabalho de Parto Induzido
19.
Am J Obstet Gynecol ; 230(3S): S653-S661, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38462251

RESUMO

Childbirth is a defining moment in anyone's life, and it occurs 140 million times per year. Largely a physiologic process, parturition does come with risks; one mother dies every two minutes. These deaths occur mostly among healthy women, and many are considered preventable. For each death, 20 to 30 mothers experience complications that compromise their short- and long-term health. The risk of birth extends to the newborn, and, in 2020, 2.4 million neonates died, 25% in the first day of life. Hence, intrapartum care is an important priority for society. The American Journal of Obstetrics & Gynecology has devoted two special Supplements in 2023 and 2024 to the clinical aspects of labor at term. This article describes the content of the Supplements and highlights new developments in the induction of labor (a comparison of methods, definition of failed induction, new pharmacologic agents), management of the second stage, the value of intrapartum sonography, new concepts on soft tissue dystocia, optimal care during the third stage, and common complications that account for maternal death, such as infection, hemorrhage, and uterine rupture. All articles are available to subscribers and non-subscribers and have supporting video content to enhance dissemination and improve intrapartum care. Our hope is that no mother suffers because of lack of information.


Assuntos
Trabalho de Parto , Ruptura Uterina , Gravidez , Recém-Nascido , Feminino , Humanos , Ruptura Uterina/etiologia , Parto Obstétrico , Trabalho de Parto Induzido/métodos , Parto
20.
Am J Obstet Gynecol ; 230(3S): S841-S855, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38462258

RESUMO

It seems puzzling why humans have evolved such a small and rigid birth canal that entails a relatively complex process of labor compared with the birth canal of our closest relatives, the great apes. This study reviewed insights into the evolution of the human birth canal from recent theoretical and empirical studies and discussed connections to obstetrics, gynecology, and orthopedics. Originating from the evolution of bipedality and the large human brain million years ago, the evolution of the human birth canal has been characterized by complex trade-off dynamics among multiple biological, environmental, and sociocultural factors. The long-held notion that a wider pelvis has not evolved because it would be disadvantageous for bipedal locomotion has not yet been empirically verified. However, recent clinical and biomechanical studies suggest that a larger birth canal would compromise pelvic floor stability and increase the risk of incontinence and pelvic organ prolapse. Several mammals have neonates that are equally large or even larger than human neonates compared to the size of the maternal birth canal. In these species, the pubic symphysis opens widely to allow successful delivery. Biomechanical and developmental constraints imposed by bipedality have hindered this evolutionary solution in humans and led to the comparatively rigid pelvic girdle in pregnant women. Mathematical models have shown why the evolutionary compromise to these antagonistic selective factors inevitably involves a certain rate of fetopelvic disproportion. In addition, these models predict that cesarean deliveries have disrupted the evolutionary equilibrium and led to new and ongoing evolutionary changes. Different forms of assisted birth have existed since the stone age and have become an integral part of human reproduction. Paradoxically, by buffering selection, they may also have hindered the evolution of a larger birth canal. Many of the biological, environmental, and sociocultural factors that have influenced the evolution of the human birth canal vary globally and are subject to ongoing transitions. These differences may have contributed to the global variation in the form of the birth canal and the difficulty of labor, and they likely continue to change human reproductive anatomy.


Assuntos
Hominidae , Trabalho de Parto , Animais , Recém-Nascido , Humanos , Gravidez , Feminino , Evolução Biológica , Pelve/anatomia & histologia , Cesárea , Diafragma da Pelve , Mamíferos
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