Applying Tension to the Transcervical Foley Balloon and Delivery Times in Term Nulliparous Women Undergoing Induction of Labor: A Randomized Controlled Trial.

OBJECTIVE: To investigate the effects of applying tension to a transcervical Foley balloon on delivery time in term nulliparous patients undergoing labor induction. METHODS: This cluster randomized clinical trial included 279 term nulliparous women presenting for labor induction with a plan for cervical ripening through transcervical Foley balloon placement. Participants were assigned to either the tension group (n=138) or the no-tension group (n=141) on the basis of randomized, weekly clusters (26 total clusters). The primary outcome measured was the time from initial Foley balloon insertion to delivery. Secondary outcomes included cesarean delivery rates, peripartum infection, and neonatal intensive care unit (NICU) admission. Our prior data suggested that delivery time in the tension group would be about 1,053 minutes. We estimated a sample size of 260 (130 per group, 26 clusters) on the basis of a 25% difference, power of 80%, and two-sided α of 0.05. RESULTS: A total of 279 term nulliparous patients were included in the analysis. The median time from Foley placement to delivery was 1,596 minutes (range 430-3,438 minutes) for the tension group and 1,621 minutes (range 488-3,323 minutes) for the no-tension group ( P =.8); similar results were noted for time to vaginal delivery. No significant differences were observed in the secondary outcomes, including the rates of cesarean delivery (34.1% vs 29.8%, P =.7), peripartum infection, and NICU admission, between the two groups. CONCLUSION: Applying tension to a transcervical Foley balloon in term nulliparous women undergoing labor induction did not significantly reduce delivery time or improve secondary outcomes. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov , NCT05404776.

Reproducibility of the Edinburgh Postnatal Depression Scale during the Postpartum Period.

OBJECTIVE: This study was aimed to evaluate the efficacy of the Edinburgh Postnatal Depression Scale (EPDS) in the immediate postpartum period, which we defined as between 3 and 24 hours postpartum for the purpose of this research. This is such that if it can predict scores obtained at the postpartum visit, it will be an opportunity to access psychiatric services for the patient that may otherwise be more difficult to access in the outpatient setting. STUDY DESIGN: Longitudinal observational study, which included an analysis of 848 consecutive participants screened with the EPDS in the hospital and at the 6-week postpartum visit. RESULTS: Receiver-operating characteristic (ROC) curve suggested >3 at delivery as a more optimal score to predict depression at the postpartum visit with sensitivity 76.5% and specificity 65.9%. The commonly accepted EPDS cut-off value of >9 was far less sensitive at 28.8% but reasonably specific at 93.2% for predicting elevated scores (>9) 6 weeks postpartum. In subgroup analysis, only a prior mental health disorder was found to be predictive of elevated scores at the postpartum visit (relative risk: 1.97, 95% confidence interval: 1.17-3.32, p = 0.01). CONCLUSION: The EPDS, originally designed to screen for postpartum depression (PPD) in the outpatient setting, does not predict the development of PPD, as determined by the EPDS (validated at the 6-week postpartum time interval) when administered during hospitalization shortly after delivery. KEY POINTS: · EPDS is a validated screening tool for PPD that is validated in the outpatient setting, but various guidelines are presently unclear on the exact timing for PPD screening.. · EPDS scores from 3 to 24 hours postpartum does not reliably predict elevated scores 6 weeks later.. · EPDS scores >3 from 3 to 24 hours postpartum may identify need to "rule out" PPD 6 weeks later..

Hemodynamic function during finger force production tasks in healthy adults.

INTRODUCTION: Near-infrared spectroscopy (NIRS) is a noninvasive technique used to measure muscle hemodynamics. The focus of this study was to evaluate changes in muscle oxygenation during sustained maximal force production in young, healthy control individuals to establish baseline function in an ideal population. METHODS: NIRS was used to monitor reduced hemoglobin (HbR) and oxygenated hemoglobin (HbO) in forearm muscles. Hemodynamic responses during force production tasks were monitored in real time. RESULTS: During handgrip exercises, maximal force production declined significantly. Increased HbR was found while HbO remained constant. The correlation between force production and HbO was positive (r = 0.18), while the correlation between force and HbR was negative (r = -0.48). The application of NIRS to monitor the correlation between force production and hemodynamic measures in the forearm was successful. These data set the foundation for future use of NIRS as a diagnostic tool for individuals with peripheral vascular disease: Muscle Nerve 56: 472-478, 2017.