Maternal age and body mass index and risk of labor dystocia after spontaneous labor onset among nulliparous women: A clinical prediction model.

INTRODUCTION: Obstetrics research has predominantly focused on the management and identification of factors associated with labor dystocia. Despite these efforts, clinicians currently lack the necessary tools to effectively predict a woman's risk of experiencing labor dystocia. Therefore, the objective of this study was to create a predictive model for labor dystocia. MATERIAL AND METHODS: The study population included nulliparous women with a single baby in the cephalic presentation in spontaneous labor at term. With a cohort-based registry design utilizing data from the Copenhagen Pregnancy Cohort and the Danish Medical Birth Registry, we included women who had given birth from 2014 to 2020 at Copenhagen University Hospital-Rigshospitalet, Denmark. Logistic regression analysis, augmented by a super learner algorithm, was employed to construct the prediction model with candidate predictors pre-selected based on clinical reasoning and existing evidence. These predictors included maternal age, pre-pregnancy body mass index, height, gestational age, physical activity, self-reported medical condition, WHO-5 score, and fertility treatment. Model performance was evaluated using the area under the receiver operating characteristics curve (AUC) for discriminative capacity and Brier score for model calibration. RESULTS: A total of 12,445 women involving 5,525 events of labor dystocia (44%) were included. All candidate predictors were retained in the final model, which demonstrated discriminative ability with an AUC of 62.3% (95% CI:60.7-64.0) and Brier score of 0.24. CONCLUSIONS: Our model represents an initial advancement in the prediction of labor dystocia utilizing readily available information obtainable upon admission in active labor. As a next step further model development and external testing across other populations is warranted. With time a well-performing model may be a step towards facilitating risk stratification and the development of a user-friendly online tool for clinicians.

Spatial Activation of Autophagy in Human Placenta-Related Tissue During Labor: A Possible Mechanism for Labor Onset.

INTRODUCTION: To explore the mechanisms of labor by investigating the autophagy of placental and fetal membranes tissue in normal pregnant women. METHODS: Placenta and fetal membranes were collected from women with singleton pregnancies without any medical complications and from women who delivered vaginally (labor-initiated group; L group) or by caesarean section (labor-noninitiated group; NL group). Autophagosomes were observed by transmission electron microscopy (TEM). Immunofluorescence and western blotting (WB) were used to detect protein levels of the autophagy markers LC3A and LC3B. TEM, immunohistochemistry (IHC), and WB were used to compare autophagy in different parts of the placenta and fetal membranes in the L and NL groups. The expression of LC3B/LC3A, ROCK1, and ROCK2 in the placenta of nonpregnant and pregnant rats was detected by WB and IHC. RESULTS: TEM and IHC results showed an increase in the number of autophagosomes and autophagic lysosomes in the L group, and WB results indicated an increase in the LC3B/A ratio between the placenta and fetal membranes in the L group. Autophagy was significantly increased on the maternal side of the placenta in the L group, and the level of autophagy became higher near rupture in the fetal membranes and near the point where the umbilical cord joins the placenta in the L group. The LC3B/A ratio increased and ROCK1 and ROCK2 levels decreased in postnatal rats. DISCUSSION: Autophagy can occur in the placenta and fetal membranes and its activity is higher at the onset of labor, suggesting a role in labor.

A proposed model of a clock that governs the length of human pregnancy.

In Brief: The mechanisms that determine the length of pregnancy remain undetermined. Here, we review what has been previously published on the topic and incorporate new data to describe a molecular model in which placental stress and fetal signaling ultimately lead to labor onset in uncomplicated pregnancies. Abstract: The mechanisms that govern the length of human pregnancy have not been determined, while preterm birth remains the leading cause of death and disability in newborns worldwide. Here, we review recent data to generate a novel hypothesis about how the pregnancy clock may function to initiate human labor in uncomplicated pregnancies. In this model, placental stress induced by the growing fetus drives placental production of NFKB, which is then activated by exosomes containing platelet-activating factor and complement 4-binding protein-A from the mature fetus, to drive pro-labor genes in the placenta. A better understanding of the clock that triggers labor may lead to new, more effective therapies to prevent spontaneous preterm birth.

Changes of serum cortisol during pregnancy and labor initiation: an onsite cross-sectional study.

Background: Increased maternal cortisol secretion has been observed during pregnancy and labor. However, due to the limitations in diagnostic methods, the dynamic change of cortisol during the short period between threatened labor and labor is unknown. In this study, we aim to evaluate the changes in serum cortisol during late pregnancy and full-term labor initiation, verifying if cortisol could serve as a biomarker for the diagnosis of labor initiation from threatened labor. Methods: This cross-sectional onsite study involved 564 participants of 6 different gestational stages (C: Control; T1: Trimester 1; T3: Trimester 3; E: expectant; TL: threatened labor; L: labor), all patients in the E, TL, and L groups were at full term. The serum cortisol concentration was quantified with a point-of-care test (POCT), and the gestation, age, parity, and BMI of participants were documented. Morning serum cortisol was collected between 8:00 and 10:00 a.m., except for the TL and L group women who were tested upon arrival or during latent labor. With cortisol levels or all five variables, L was distinguished from TL using machine learning algorithms. Results: Significant elevation of cortisol concentration was observed between T1 and T3, or TL and L group (P< 0.001). Women belonging to the E and TL group showed similar gestation week and cortisol levels. Diagnosis of labor initiation using cortisol levels (cutoff = 21.46 µg/dL) yielded sensitivity, specificity, and AUC of 86.50%, 88.60%, and 0.934. With additional variables, a higher specificity (89.29%) was achieved. The diagnostic accuracy of all methods ranged from 85.93% to 87.90%. Conclusion: Serum cortisol could serve as a potential biomarker for diagnosis of L form TL. The rapid onsite detection of serum cortisol with POCT could facilitate medical decision-making for admission and special treatments, either as an additional parameter or when other technical platforms are not available.

The purple line and its association with cervical dilatation in labour: A systematic review and meta-analysis.

BACKGROUND: There is a growing body of evidence that the presence and length of the purple line could represent a non-invasive method of estimating and determining labour progress. OBJECTIVES: The primary outcome was to provide a systematic review and meta-analysis on the association between the purple line length and cervical dilatation in active labour. The secondary outcome was to determine the association between the purple line length and the fetal head descent, and to calculate the pooled mean length of the purple line at a cervical dilatation of 3-4 cm and at a cervical dilatation of 9-10 cm. SEARCH STRATEGY: We searched the Medline, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), Clinical Trials.gov and Cochrane Pregnancy and Childbirth's Trials Register databases from inception till March 25, 2023. SELECTION CRITERIA: We included observational studies of pregnant women in active first stage of labour who had their labour progress assessed with the use of regular vaginal examinations and who had the occurrence recorded and length of the purple line measured at the same time. DATA COLLECTION AND ANALYSIS: Two reviewers independently evaluated study eligibility. We used the random effects and fixed effects model for meta-analysis. MAIN RESULTS: There were six eligible studies included in the systematic review that reported on 982 women in total with the purple line appearing in 760 (77.3%) of cases. We found a moderate positive pooled correlation between the purple line length with cervical dilatation (r = +0.64; 95%CI: 0.41-0.87) and fetal head descent (r = +0.50; 95%CI: 0.32-0.68). For women either in spontaneous or induced labour, the pooled mean length of the purple line was more than 9.4 cm when the cervical dilatation was 9-10 cm, whereas it was more than 7.3 cm when the cervical dilatation was 3-4 cm. CONCLUSIONS: The purple line is a non-invasive method that may potentially be used as an adjunct in labour progress assessment.

Describing the transition from late pregnancy into early labour - A prospective cohort study.

OBJECTIVE: The time between self-assessed first symptoms and clinical confirmation of labour onset is marked by uncertainty, particularly for primiparas. Accordingly, primiparas often seek professional care to confirm their perceptions of labour onset. This paper describes the transition into early labour among primiparas considering their level of certainty in labour onset and their perception of labour onset symptoms prior to birth. METHODS: A prospective exploratory cohort study was conducted in Germany between July 2020 - March 2021 among a convenience sample of 69 primiparas. Respondents recorded in a non-validated questionnaire their perceptions of nine symptoms and degree of certainty about labour onset every day from 37 weeks gestation. Descriptive analysis included certainty in labour onset and dedicated symptoms in relation to days before birth. RESULTS: The participants (n=69) reported a little certainty of labour onset up to 32 days before birth and most of them became certain up to four days before birth. Associated symptoms were regular and irregular pain, symptoms of vaginal loss and emotional symptoms. Gastrointestinal symptoms and nausea were not indicated by a majority. Uncertainty of labour onset, however, was indicated up until the day of birth. CONCLUSION: Although interpretation is based on a small sample size, primiparas are able to self-diagnose labour onset and report connected symptoms up to four days before birth. We suggest calling this time between self-diagnosis of labour onset and confirmed labour onset based on clinical parameters the transition into early labour.

Changes in Salivary Oxytocin Level of Term Pregnant Women after Aromatherapy Footbath for Spontaneous Labor Onset: A Non-Randomized Experimental Study.

BACKGROUND: Aromatherapy is usually used to stimulate labor. However, its specific physiological effects have been scarcely examined. We evaluated whether an aromatherapy footbath increases oxytocin levels in term pregnant women. METHODS: In this quasi-experimental study, low-risk term pregnant women in Japan underwent aromatherapy using a footbath (1) infused with clary sage and lavender essential oils, (2) infused with jasmine oil, or (3) with no infused oils (control group). The primary outcome was the salivary oxytocin level. The secondary outcomes were uterine contractions and cortisol levels. RESULTS: In the clary sage and lavender group (n = 28), the oxytocin level increased significantly after the footbath (p = 0.035). The jasmine group (n = 27) and control group (n = 27) exhibited trends toward a respective increase and decrease in the oxytocin level; however, the changes in the oxytocin levels between the clary sage and lavender group and the control group showed no significance difference. There were no significant differences in the changes in the uterine contractions and cortisol levels between the experiment and control groups. CONCLUSIONS: The changes in the oxytocin levels in the clary sage and lavender group did not differ significantly with those in the control group, possibly because of the small sample size. Further studies are required to examine the effects of repeated aromatherapy footbaths to stimulate labor.

A vivência da mulher durante o trabalho de parto no período pandémico covid-19 numa amostra da população portuguesa / Women's experience during labor in the covid-19 pandemic period in a sample of the Portuguese population

Enquadramento: A presente investigação surge de um acontecimento que influenciou a vida/saúde de todos (pandemia provocada pelo vírus SARS-Cov 2), alterando por completo o dia a dia da população e das diversas sociedades a nível mundial. A informação científica existente no contexto de gravidez era ainda escassa no primeiro semestre de início da pandemia. Essa mesma ausência de conhecimento, abriu portas para a incerteza, provocando ansiedade e receio a todos os que lidam com esta nova pandemia e por vezes, o excesso de zelo acabou por prejudicar os cuidados de saúde, colocando muitas vezes em causa os direitos da pessoa, e neste caso em particular da mulher durante o parto. Assim, na primeira parte do presente trabalho será efetuada uma reflexão sobre as aprendizagens efetuadas em contexto de estágio e, por sua vez, na segunda parte será descrita a componente investigativa deste percurso formativo. Objetivos: Refletir sobre as competências do enfermeiro especialista em saúde materna e obstétrica adquiridas ao longo da componente de estágio. Na componente investigativa: descrever a vivência da mulher na fase final da gravidez, como preparatória para o trabalho de parto no período pandémico Covid-19, numa amostra da população portuguesa. Descrever a vivência da mulher durante o trabalho de parto no período pandémico Covid-19, numa amostra da população portuguesa. Metodologia: A presente investigação apresenta-se como um estudo de nível 1 de natureza qualitativa e do tipo exploratório-descritivo de Amostragem do tipo não probabilística em bola de neve, constituídas por 24 mães com experiência de parto no período pandémico Covid-19. A recolha de dados foi efetuada através de uma entrevista semi-estruturada e do preenchimento de um formulário com dados relativos à caracterização sociodemográfica e dados relativos ao decurso da gravidez e do parto. No final os dados resultantes das entrevistas foram tratados de acordo com Análise de Conteúdo de Bardin. Resultados: Da análise de resultados emergiram quatro (4) categorias e quatorze (14) subcategorias, que se apresentam como: a ?procura do conhecimento sobre a pandemia Covid-19?, as ?expectativas de um momento positivo?, os ?medos e receios? e a ?experiência de parto? vivenciada pelas mães no decurso do seu processo de trabalho de parto. Conclusão: Da componente de estágio faz-se um balanço rico e extremamente positivo. Da componente investigativa. Relativamente à componente investigativa, foi possível compreender qual a origem do conhecimento (relativo à pandemia Covid-19) que as primíparas possuíam, quais as suas expectativas em relação ao parto, quais os seus medos e receios e a experiência efetiva de parto. Importa referir que um número significativo de mães, não puderam vivenciar o trabalho de parto, tal como tinham previsto e idealizado, sendo que a presença de acompanhante/familiar de referência e o contacto direto com o bebé ficou bastante comprometido. Foi de igual forma possível compreender o papel, a importância e a necessidade de intervenção do Enfermeiro Especialista de Enfermagem de Saúde Materna e Obstétrica no período do trabalho de parto e parto perante a situação pandémica por Covid-19.

Alterations in maternal sFlt-1 and PlGF: Time to labor onset in term-/late-term pregnancies with and without placental dysfunction.

OBJECTIVES: To investigate the placenta-associated biomarkers placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) longitudinally in late third trimester extending to late-term pregnancies, and their correlation with time to labor onset in pregnancies with and without placental syndromes (ie preeclampsia and/or fetal growth restriction). Also, to compare whether time to labor onset after induction differ between these groups. STUDY DESIGN: Pregnant women (n = 338, of which 75 had a placental syndrome) with serial blood samples from gestational week ≥37 until labor onset were included. Maternal serum PlGF and sFlt-1 concentrations were analyzed by immunoassay postpartum. MAIN OUTCOME MEASURES: Rate of alteration in sFlt-1, PlGF and the sFlt-1/PlGF ratio prior to labor onset. Secondary outcome was rates of delivery within 48 h of labor induction. RESULTS: In placental syndrome pregnancies, sFlt-1 and sFlt-1/PlGF ratio increased more rapidly between the two last samples prior to labor onset compared to uncomplicated pregnancies (both p < 0.01), but there was no difference in the PlGF decrease (p = 0.513). Time to labor onset was significantly shorter in pregnancies with placental syndromes compared to those without (p = 0.001). In the induced deliveries, there was no difference in delivery within 48 h between the two groups. CONCLUSIONS: An increase in sFlt-1 and sFlt-1/PlGF ratio at term prior to labor onset is more rapid in pregnancies with placental syndromes. This more rapid antiangiogenic shift might indicate a pregnancy more prone to acute placental failure and more inflammatory prepared for labor onset. Effect of labor induction was not impacted by placental dysfunction.

Effectiveness and safety of membrane sweeping in the prevention of post-term pregnancy: a randomised controlled trial.

There is a rising concern with increasing rates of pharmacologically induced labour and its complications. Membrane sweeping is a simple and less invasive means of initiating spontaneous labour onset. We compared the safety and efficacy of membrane sweeping. A total of 186 women (62 in each arm) were recruited at the antenatal clinic at 39 weeks. The intervention groups had membrane sweeping once and twice weekly respectively while the control arm had no membrane sweeping. They were all monitored and followed up till delivery. The trial was registered with the South Africa registry www.pactr.org (PACTR202112841108933) The incidence of prolonged pregnancy was 32.3%, 19.4% and 11.7% among the control, once-weekly, and twice-weekly groups respectively. The sweeping to the delivery interval was significantly shorter for the twice-weekly group (7.4 days) compared to once weekly (8.8 days) and the control group (10.6 days). There were significantly higher odds of spontaneous labour onset in the twice-weekly group (HR 1.53, p = .029) compared to the control group (HR 0.65, p = .033) and the once-weekly group using once weekly as reference. Membrane sweeping is a safe and effective means of preventing prolonged pregnancy. Twice-weekly sweeping of foetal membranes is more effective than once-weekly or no sweeping without added adverse feto-maternal outcomes.IMPACT STATEMENTWhat is already known about the subject? There is no evidence supporting any increase in maternal or foetal morbidity suggesting that membrane sweeping is a safe procedure to offer to all low-risk pregnant women so as to initiate spontaneous labour onset.What do the results of the study add? Membrane sweeping twice weekly after 39weeks for low-risk pregnant women is more effective than once weekly or no sweep with no added adverse maternal or perinatal risks.What are the implications of these findings for clinical practice and or further research? Twice-weekly membrane sweeping is encouraged in selected patients to reduce the risks associated with post-term pregnancy.

O uso de óleos essenciais e aromaterapia no trabalho de parto / The use of essential oils and aromatherapy in labor

Introdução: a aromaterapia consiste na utilização de óleos essenciais na prevenção ou no tratamento de diversas afecções humanas. No trabalho de parto, pode ser aplicada para o alívio da dor e ansiedade. Objetivo: identificar na literatura científica sobre o uso da aromaterapia e dos óleos essenciais no manejo do trabalho de parto; e elaborar um protocolo hospitalar, a partir dos achados nas publicações, sobre aromaterapia e aplicação de óleos essenciais no trabalho de parto. Materiais e métodos: trata-se de revisão integrativa da literatura desenvolvida nas bases de dados LILACS, Cochrane Library e Pubmed. Incluíram-se artigos científicos originais publicados no período de 2000 a 2019. O material coletado foi analisado com base na análise temática de conteúdo de Laurence Bardin. Resultados: treze artigos integraram o corpus desta pesquisa. Deles emergiram quatro categorias de análise: 1- Aromaterapia como estratégia para o alívio da dor na fase de dilatação do trabalho de parto; 2- Aromaterapia como estratégia para a redução de ansiedade no trabalho de parto; 3- Métodos de administração dos óleos essenciais no trabalho de parto; e 4- O uso de óleos essenciais para o manejo de sintomas desagradáveis e da progressão do trabalho de parto. Discussão: a partir dos resultados, elaborou-se um protocolo hospitalar sobre o uso de aromaterapia no trabalho de parto. Conclusão: a aromaterapia é uma ferramenta adequada para o cuidado humanizado no manejo da dor e da ansiedade no trabalho de parto, sem efeitos adversos documentados na literatura levantada.

Introduction: aromatherapy consists of the use of essential oils in the prevention or treatment of various human conditions. In labor, it can be applied to relieve pain and anxiety. Objetive: identify in the scientific literature on the use of aromatherapy and essential oils in the management of labor; and to elaborate a hospital protocol, based on the findings in the publications, on aromatherapy and application of essential oils in labor. Materials and Methods: this is an integrative literature review developed in the LILACS, Cochrane Library and Pubmed databases. Original scientific articles published between 2000 and 2019 were included. The material collected was analyzed based on Laurence Bardin's thematic content analysis. Results: thirteen articles integrated the corpus of this research. From them, four categories of analysis emerged: 1- Aromatherapy as a strategy for pain relief in the dilatation phase of labor; 2- Aromatherapy as a strategy to reduce anxiety in labor; 3- Methods of administering essential oils in labor; and 4- The use of essential oils for the management of unpleasant symptoms and the progression of labor. Discussion:based on the results, a hospital protocol was developed on the use of aromatherapy in labor. Conclusions: aromatherapy is an adequate tool for humanized care in the management of pain and anxiety in labor, with no adverse effects documented in the literature surveyed.

Introducción: la aromaterapia consiste en el uso de aceites esenciales en la prevención o tratamiento de diversas afecciones humanas. En el trabajo de parto, se puede aplicar para aliviar el dolor y la ansiedad. Objetivo: identificar en la literatura científica sobre el uso de la aromaterapia y los aceites esenciales en el manejo del parto; y elaborar un protocolo hospitalario, basado en los hallazgos de las publicaciones, sobre aromaterapia y aplicación de aceites esenciales en el trabajo de parto. Materiales y métodos: se trata de una revisión integrativa de la literatura desarrollada en las bases de datos LILACS, Cochrane Library y Pubmed. Se incluyeron artículos científicos originales publicados entre 2000 y 2019. El material recolectado fue analizado con base en el análisis de contenido temático de Laurence Bardin. Resultados: trece artículos integraron el corpus de esta investigación. De ellos surgieron cuatro categorías de análisis: 1- La aromaterapia como estrategia para el alivio del dolor en la fase de dilatación del trabajo de parto; 2- La aromaterapia como estrategia para reducir la ansiedad en el parto; 3- Métodos de administración de aceites esenciales en el trabajo de parto; y 4- El uso de aceites esenciales para el manejo de síntomas desagradables y la progresión del trabajo de parto. Discusión: a partir de los resultados se elaboró un protocolo hospitalario sobre el uso de la aromaterapia en el trabajo de parto. Conclusión: la aromaterapia es una herramienta adecuada para el cuidado humanizado en el manejo del dolor y la ansiedad en el trabajo de parto, sin efectos adversos documentados en la literatura investigada.

Is there a maternal blood biomarker that can predict spontaneous preterm birth prior to labour onset? A systematic review.

INTRODUCTION: The ability to predict spontaneous preterm birth (sPTB) prior to labour onset is a challenge, and it is currently unclear which biomarker(s), may be potentially predictive of sPTB, and whether their predictive power has any utility. A systematic review was conducted to identify maternal blood biomarkers of sPTB. METHODS: This study was conducted according to PRISMA protocol for systematic reviews. Four databases (MEDLINE, EMBASE, CINAHL, Scopus) were searched up to September 2021 using search terms: "preterm labor", "biomarker" and "blood OR serum OR plasma". Studies assessing blood biomarkers prior to labour onset against the outcome sPTB were eligible for inclusion. Risk of bias was assessed based on the Newcastle Ottawa scale. Increased odds of sPTB associated with maternal blood biomarkers, as reported by odds ratios (OR), or predictive scores were synthesized. This review was not prospectively registered. RESULTS: Seventy-seven primary research articles met the inclusion criteria, reporting 278 unique markers significantly associated with and/or predictive of sPTB in at least one study. The most frequently investigated biomarkers were those measured during maternal serum screen tests for aneuploidy, or inflammatory cytokines, though no single biomarker was clearly predictive of sPTB based on the synthesized evidence. Immune and signaling pathways were enriched within the set of biomarkers and both at the level of protein and gene expression. CONCLUSION: There is currently no known predictive biomarker for sPTB. Inflammatory and immune biomarkers show promise, but positive reporting bias limits the utility of results. The biomarkers identified may be more predictive in multi-marker models instead of as single predictors. Omics-style studies provide promising avenues for the identification of novel (and multiple) biomarkers. This will require larger studies with adequate power, with consideration of gestational age and the heterogeneity of sPTB to identify a set of biomarkers predictive of sPTB.

Nulliparous women with an unfavourable cervix at 41 weeks: Which women go into spontaneous labor during the expectant period?

CONTEXT: After 41 weeks, the labor induction term varies according to countries and obstetrical teams. The French recommendations are not to exceed 41 weeks 6 days. However, there are no data on the percentage of nulliparous women with an unfavorable cervix at 41 weeks going into spontaneous labor within five or six days. OBJECTIVE: The objective was to establish the rate of spontaneous labor within five days amongst nulliparous women with an unfavorable cervix at 41 weeks, and to identify the maternal and obstetrical factors associated with this spontaneous labor. MATERIALS AND METHODS: Retrospective study in a University Hospital Maternity between January 1st and December 31st 2017. All nulliparous women with a cephalic fetal presentation and unfavorable cervix at 41 weeks (Bishop ≤ 3) were included. The maximum term for induced labor was set at 41 weeks 5 days. The population was divided into two groups: spontaneous labor and induced labor (induction between 41 weeks and 41 weeks 4 days for medical indications or maternal wish and induction at 41 weeks 5 days for full term). The maternal and obstetrical characteristics of the two groups at 41 weeks were compared as well as the maternal and neonatal outcomes. RESULTS: The rate of spontaneous labor among the 269 women included was 38.3% (n = 103/269). At 41 weeks, the presence of painful uterine contractions and a Bishop score of 3 were associated with spontaneous labor within five days (p < 0.01). The Bishop score criteria most associated with spontaneous labor were cervical dilation and fetal station. The cesarean delivery rate was 20.4% in the group of women with spontaneous labor versus 41.0% in the group of induced labor (p < 0.01). There were no differences between the two groups in terms of neonatal outcome. CONCLUSION: Among nulliparous women with an unfavorable cervix at 41 weeks, almost 40 % will have a spontaneous onset of labor within five days. The only factors found to be associated with this onset of labor are the presence of painful uterine contractions and a higher Bishop score at 41 weeks.

Can assessing the angle of progression before labor onset assist to predict vaginal birth after cesarean?: A prospective cohort observational study.

OBJECTIVE: To assess whether pre-labor measurement of the angle of progression (AOP) can assist in predicting a successful vaginal birth after cesarean in women without a previous vaginal birth. METHODS: A prospective observational cohort study performed in a single tertiary center including women at term with a single previous cesarean delivery (CD), without prior vaginal births, who desire a trial of labor. Transperineal ultrasound was used to measure the AOP before the onset of labor. The managing staff in the delivery suite was blinded to the ultrasound measurements. Clinical data and delivery outcome were retrieved from medical records. The study was approved by the institutional ethics committee (KMC 0117-10). RESULTS: Of the 111 women included in the study, 67 (60.4%) had a successful vaginal birth after CD. Women were sonographically assessed at a median of 3 days [interquartile range (IQR) 1-3 days] prior to delivery. The median AOP was significantly narrower in women who eventually underwent a CD than in those who delivered vaginally (88°, IQR 78-96° vs. 99°, IQR 89-107°, respectively; p < .001). An AOP >98° (derived from a receiver operating characteristic curve) was associated with a successful vaginal birth after CD in 87.5% of women. Multivariable regression analysis demonstrated that each additional 1° in the AOP increases the chance for a successful vaginal birth after CD by 6%. CONCLUSIONS: Pre-labor AOP may be a useful sonographic tool for predicting vaginal birth after CD and can assist in consulting primiparous women with a prior CD opting for a trial of labor.

Educational technology for primigravidae: a quasi-experimental study / Tecnología educacional para primigestas: estudio casi experimental / Tecnologia educacional para primigestas: estudo quase experimental

ABSTRACT Objective: To analyze the influence of an educational technology on the knowledge of primigravidae about the signs of labor and obstetric risk. Method: A quasi-experimental, before-and-after, non-randomized and non-concurrent study carried out with 90 primigravidae. For data analysis, descriptive statistics was applied,McNemarandStudent's t test. The project was submitted and approved by the Research Ethics Committee in 2020. Results: The profile of the pregnant women corresponded to women with an average age of 23 years, brown, living in a common-law marriage, and with an average of 10 years of education. Half of the pregnant women were in the third trimester of pregnancy and were undergoing usual-risk prenatal care. Only 12.22% of the participants reported having access to information on the subject. Data analysis showed a significant difference in the number of correct answers for the questions, before and after viewing the animated video, especially in questions related to signs of labor, bag of waters, and fetal movement test. Conclusion: Educational technology has a positive influence on primigravidae's knowledge about signs of labor and obstetric risk.

RESUMEN Objetivo: Analizar la influencia de una tecnología educacional sobre el conocimiento de primigestas acerca de las señales de trabajo de parto y de riesgo obstétrico. Método: Estudio casi experimental del tipo antes y después, no randomizado y no concurrente, realizado con 90 primigestas. Para análisis de los datos fue aplicada estadística descriptiva,McNemaryt Student. El proyecto fue sometido y aprobado por el Comité de Ética en 2020. Resultados: El perfil de las gestantes correspondió a mujeres con edad media de 23 años, pardas, que están en una unión estable y con media de 10 años de escolaridad. Mitad de las embarazadas estaban en el tercer trimestre gestacional y realizaban el preembarazo de riesgo habitual. Solamente el 12,22% de las participantes relataron tener acceso a informaciones sobre la temática. El análisis de los datos evidenció diferencia significativa en el número de aciertos de las cuestiones, antes y después de la visualización del vídeo animado, principalmente en las preguntas relacionadas a las señales del trabajo de parto, bolsa de aguas y conteo de movimientos fetales. Conclusión: La tecnología educacional tiene influencia positiva sobre el conocimiento de las primigestas acerca de las señales de parto y de riesgo obstétrico.

RESUMO Objetivo: Analisar a influência de uma tecnologia educacional sobre o conhecimento de primigestas acerca dos sinais de trabalho de parto e de risco obstétrico. Método: Estudo quase experimental do tipo antes e depois, não randomizado e não concorrente, realizado com 90 primigestas. Para análise dos dados foi aplicada estatística descritiva, McNemar e t Student. O projeto foi submetido e aprovado pelo Comitê de Ética em Pesquisa em 2020. Resultados: O perfil das gestantes correspondeu a mulheres com idade média de 23 anos, pardas, que vivenciam uma união estável e com média de 10 anos de escolaridade. Metade das gestantes estavam no terceiro trimestre gestacional e realizavam o pré-natal de risco habitual. Apenas 12,22% das participantes relataram ter acesso a informações sobre a temática. A análise dos dados evidenciou diferença significativa no número de acertos das questões, antes e depois da visualização do vídeo animado, principalmente nas perguntas relacionadas aos sinais de trabalho de parto, bolsa d'águas e mobilograma. Conclusão: A tecnologia educacional tem influência positiva sobre o conhecimento das primigestas acerca dos sinais de trabalho de parto e de risco obstétrico.

Партограмма ВОЗ: руководство для пользователя

Данное руководство разработано для содействия эффективному использованию партограммы работниками здравоохранения, оказывающими помощь роженицам в ходе родов и родоразрешения. Основной целевой аудиторией данного пособия являются квалифицированные медицинские работники, непосредственно занятые в процессе оказания помощи в родах и родоразрешении во всех учреждениях. К их числу относятся акушерки, медицинские сестры, врачи общей практики и врачи акушеры. Кроме того, пособие будет полезным для сотрудников, занимающихся подготовкой медицинского персонала, руководителей медицинских учреждений, исполнителей и руководителей программ в области охраны здоровья матери и ребенка, неправительственных организаций (НПО) и профессиональных обществ, участвующих в планировании и управлении услугами в области охраны здоровья матери и ребенка.

Prostaglandins in biofluids in pregnancy and labour: A systematic review.

Prostaglandins are thought to be important mediators in the initiation of human labour, however the evidence supporting this is not entirely clear. Determining how, and which, prostaglandins change during pregnancy and labour may provide insight into mechanisms governing labour initiation and the potential to predict timing of labour onset. The current study systematically searched the existing scientific literature to determine how biofluid levels of prostaglandins change throughout pregnancy before and during labour, and whether prostaglandins and/or their metabolites may be useful for prediction of labour. The databases EMBASE and MEDLINE were searched for English-language articles on prostaglandins measured in plasma, serum, amniotic fluid, or urine during pregnancy and/or spontaneous labour. Studies were assessed for quality and risk of bias and a qualitative summary of included studies was generated. Our review identified 83 studies published between 1968-2021 that met the inclusion criteria. As measured in amniotic fluid, levels of PGE2, along with PGF2α and its metabolite 13,14-dihydro-15-keto-PGF2α were reported higher in labour compared to non-labour. In blood, only 13,14-dihydro-15-keto-PGF2α was reported higher in labour. Additionally, PGF2α, PGF1α, and PGE2 were reported to increase in amniotic fluid as pregnancy progressed, though this pattern was not consistent in plasma. Overall, the evidence supporting changes in prostaglandin levels in these biofluids remains unclear. An important limitation is the lack of data on the complexity of the prostaglandin pathway outside of the PGE and PGF families. Future studies using new methodologies capable of co-assessing multiple prostaglandins and metabolites, in large, well-defined populations, will help provide more insight as to the identification of exactly which prostaglandins and/or metabolites consistently change with labour. Revisiting and revising our understanding of the prostaglandins may provide better targets for clinical monitoring of pregnancies. This study was supported by the Canadian Institutes of Health Research.

Prospective assessment of vacuum deliveries from midpelvic station in a tertiary care university hospital: Frequency, failure rates, labor characteristics and maternal and neonatal complications.

BACKGROUND: Midpelvic vacuum extractions are controversial due to reports of increased risk of maternal and perinatal morbidity and high failure rates. Prospective studies of attempted midpelvic vacuum outcomes are scarce. Our main aims were to assess frequency, failure rates, labor characteristics, maternal and neonatal complications of attempted midpelvic vacuum deliveries, and to compare labor characteristics and complications between successful and failed midpelvic vacuum deliveries. STUDY DESIGN: Clinical data were obtained prospectively from all attempted vacuum deliveries (n = 891) over a one-year period with a total of 6903 births (overall cesarean section rate 18.2% (n = 1258). Student's t-test, Mann-Whitney U-test or Chi-square test for group differences were used as appropriate. Odds ratios and 95% confidence intervals are given as indicated. The uni- and multivariable analysis were conducted both as a complete case analysis and with a multiple imputation approach. A p-value of <0.05 was considered statistically significant. RESULTS: Attempted vacuum extractions from midpelvic station constituted 36.7% (n = 319) of all attempted vacuum extractions (12.9% (n = 891) of all births). Of these 319 midpelvic vacuum extractions, 11.3% (n = 36) failed and final delivery mode was cesarean section in 86.1% (n = 31) and forceps in the remaining 13.9% (n = 5). Successful completion of midpelvic vacuum by 3 pulls or fewer was achieved in 67.1%. There were 3.9% third-degree and no fourth-degree perineal tears. Cup detachments were associated with a significantly increased failure rate (adjusted OR 6.13, 95% CI 2.41-15.56, p< 0.001). CONCLUSION: In our study, attempted midpelvic vacuum deliveries had relatively low failure rate, the majority was successfully completed within three pulls and they proved safe to perform as reflected by a low rate of third-degree perineal tears. We provide data for nuanced counseling of women on vacuum extraction as a second stage delivery option in comparable obstetric management settings with relatively high vacuum delivery rates and low cesarean section rates.

Labour classified by cervical dilatation & fetal membrane rupture demonstrates differential impact on RNA-seq data for human myometrium tissues.

High throughput sequencing has previously identified differentially expressed genes (DEGs) and enriched signalling networks in human myometrium for term (≥37 weeks) gestation labour, when defined as a singular state of activity at comparison to the non-labouring state. However, transcriptome changes that occur during transition from early to established labour (defined as ≤3 and >3 cm cervical dilatation, respectively) and potentially altered by fetal membrane rupture (ROM), when adapting from onset to completion of childbirth, remained to be defined. In the present study, we assessed whether differences for these two clinically observable factors of labour are associated with different myometrial transcriptome profiles. Analysis of our tissue ('bulk') RNA-seq data (NCBI Gene Expression Omnibus: GSE80172) with classification of labour into four groups, each compared to the same non-labour group, identified more DEGs for early than established labour; ROM was the strongest up-regulator of DEGs. We propose that lower DEGs frequency for early labour and/or ROM negative myometrium was attributed to bulk RNA-seq limitations associated with tissue heterogeneity, as well as the possibility that processes other than gene transcription are of more importance at labour onset. Integrative analysis with future data from additional samples, which have at least equivalent refined clinical classification for labour status, and alternative omics approaches will help to explain what truly contributes to transcriptomic changes that are critical for labour onset. Lastly, we identified five DEGs common to all labour groupings; two of which (AREG and PER3) were validated by qPCR and not differentially expressed in placenta and choriodecidua.