Effects of Relaxation-Focused Nursing Care in Women in Preterm Labor.

BACKGROUND: Threatened preterm labor is a common problem that causes women to be hospitalized. During this period, physical problems such as a decrease in muscle functions, edema and pain, and psychological problems such as anxiety and stress may develop. OBJECTIVE: This study aimed to investigate the effect of relaxation-focused nursing care state anxiety, cortisol, contraction severity, nursing care satisfaction, knowledge, and birth weeks on threatened preterm labor. METHOD: This study was a pre-post single-blind randomized controlled trial. The study was conducted with 66 women in the threatened preterm labor process, 33 in the intervention group and 33 in the control group. The intervention group received relaxation-focused nursing care, which comprises a 2-day program in four stages. The data were collected before and after the relaxation-focused nursing care, and after the birth. RESULTS: In the intervention group, state anxiety, cortisol level, and contraction severity were lower than those in the control group (p < .05). The knowledge level about threatened preterm labor, satisfaction from nursing care, and birth weeks were higher in the intervention group (p < .05). CONCLUSION: Relaxation-focused nursing care was found to reduce the state anxiety in women, improve the knowledge level about threatened preterm labor and birth weeks, and decrease the level of cortisol. Therefore, it is recommended to use relaxation-focused nursing care in threatened preterm labor.

A comparison between electrical uterine monitor, tocodynamometer and intra uterine pressure catheter for uterine activity in labor.

OBJECTIVE: We aimed to evaluate the performance of a non-invasive EMG electrical uterine monitor (EUM) versus tocodynamometry (TOCO) by comparing both to internal uterine pressure catheter (IUPC). STUDY DESIGN: Prospective observational trial. Uterine activity was recorded continuously and simultaneously, in women during active term labor, with TOCO, EUM and IUPC. Uterine activity tracings were analyzed by three blinded physicians. RESULTS: Overall, 385 tracings from 43 women were analyzed. A similar rate of interpretable tracings between physicians was demonstrated for EUM (87%; 95% CI 80.9-92.7%) and IUPC (94.8%; 95% CI 83.4-96.3%), with a significantly lower rate for TOCO (67.5%; 95% CI 59.4-76.8%, p < 0.001). There is a significant difference in the contraction frequency for EUM versus IUPC (0.77 ± 2.3) compared to TOCO versus IUPC (-3.34 ± 4.97). There is a high variability between the timing of TOCO contractions as compared to IUPC (4.74 ± 10.03 seconds), while a gap of 8.46 ± 4.24 seconds was detected for EUM. The sensitivity, positive predictive value and false positive rate for individual contraction identification by TOCO and EUM are 54.0%, 84.4%, 15.6% and 94.2%, 87.6%, 12.4%, respectively. CONCLUSION: EUM is efficient as IUPC for uterine activity assessment and both techniques are superior in comparison to external tocodynamometry. Our results support the use of non-invasive EMG technology to monitor uterine activity.

Living with uncertainty: a Swedish qualitative interview study of women at home on sick leave due to premature labour.

OBJECTIVE: to highlight the experiences of pregnant women, experiencing preterm labour, being on sick leave at home and how they handled their daily life. DESIGN: qualitative, descriptive using open interviews. SETTING: 10 antenatal clinics in the south of Sweden. PARTICIPANTS: 15 pregnant women who were on sick leave for premature labour. FINDINGS: four categories were identified: how to interpret unpredictable contractions in the uterus? Having concern regarding premature labour of their child, handling the new situation and finding a balance, and from work to sick leave. KEY CONCLUSIONS: to be on sick leave for premature contractions can be compared with enduring a situation of inactivity. The woman finds herself in a stressful situation which she must learn to handle this and find a balance. IMPLICATIONS FOR PRACTICE: it appears that supportive information offers the women in premature labour the opportunity of increased participation and responsibility which thereby positively affects her well-being.

Pregnancy complications in women with childhood sexual abuse experiences.

OBJECTIVE: Childhood sexual abuse (CSA) has an estimated prevalence of 20% and has a constantly growing list of known long-term consequences on physical as well as psychological health which may also influence obstetrical care attributed to it. However, scientific data on the association of CSA and pregnancy are sparse. Therefore, the study investigated pregnancy complications in women exposed to CSA. METHODS: The study was designed as a cohort study comparing 85 women exposed to CSA with 170 matched unexposed women. CSA was identified by interview using modified questions from Wyatt [Child Abuse Negl 9 (1985) 507-519]. Data on pregnancy complications were collected by questionnaire and based on entries in a booklet (Mutterpass) in which all relevant data on pregnancy are documented at each prenatal consultation for any women attending prenatal care in Germany. Statistical analysis was performed with chi square, Fisher's Exact Test, and multiple logistic regression analysis to control the association between CSA and pregnancy complications for confounders significant in univariate analysis, i.e., physical abuse, other adverse experiences during childhood, abuse during pregnancy, substance abuse, and occupation. RESULTS: Women exposed to CSA were significantly more often hospitalized during pregnancy (41.2%/19.4%; OR 2.91, CI 1.64-5.17). They presented more often complications such as premature contractions (38.8%/20%; OR 2.54 CI 1.43-4.51), cervical insufficiency (25.9%/9.4%; OR 3.36, CI 1.65-6.82), and premature birth (18.8%/8.2%; OR 2.58, CI 1.19-5.59). CONCLUSION: Therefore, health care providers should adapt prenatal care to the specific needs of women exposed to CSA.

Exploring the effect of hospital admission on contraction patterns and labour outcomes using women's perceptions of events.

OBJECTIVE: this study investigated the phenomenon of spontaneous labour contractions becoming less frequent on admission to hospital, which is observed anecdotally but is not evident in the literature. Anxiety in response to hospitalisation has been proposed to be responsible by initiating the biochemical response termed 'fight or flight'. DESIGN: A non-experimental prospective design and a combination of quantitative and qualitative analysis. Data were collected using self-report labour diaries, postnatal questionnaires and hospital records of labour. Univariate analysis using t-test and chi(2)-test was performed to examine relationships between variables, and content analysis was undertaken on qualitative data regarding reactions to hospitalisation. SETTING: hospital and community maternity services provided by a National Health Service hospital in Southern England in 1997. PARTICIPANTS: about 87 women at least 37-week gestation, uncomplicated singleton pregnancy anticipating spontaneous labour with a live fetus. MEASUREMENTS AND FINDINGS: labour diaries were analysed from 26 births. In three home births and 11 hospital births, labour contractions became more frequent, but in the remaining 12 labours, contractions decreased after admission to hospital. Women whose contractions slowed were not more anxious, but they rarely had cervical dilatation over 5cm and usually assumed a recumbent position in hospital. Artificial rupture of membranes was performed more frequently in these women, they used more pain relief and had a higher incidence of complicated childbirth; however, these differences were not statistically significant. KEY CONCLUSIONS: labour contractions can increase or decrease in frequency following admission to hospital, and the change of frequency may be associated with stage of cervical dilatation and posture rather than anxiety. IMPLICATIONS FOR PRACTICE: routine intervention to speed up labour on the basis of admission observations is called into question, and women should be made aware that slowing of contractions can occur as a normal part of changing the labour environment. Further research is needed to determine the physiological parameters of spontaneous labour and the role of posture in labour progress is needed.

Every labor is unique: but "call when your contractions are 3 minutes apart".

PURPOSE: To explore women's perceptions of transitioning to the birth facility when in labor. DESIGN: Qualitative. METHODS: Twenty-four nulliparous women were interviewed following their birth experiences. RESULTS: Pain was identified as the primary reason for transitioning to the hospital. Once arriving at the hospital, women often felt pressure to "get it right" and not make multiple trips. Three themes were identified: (a) Don't trust your body, trust us; (b) This is not right; and (c) This is too labor! CLINICAL IMPLICATIONS: The implications for nursing involve increased recognition of the range of normal experiences and acknowledgment that pain is a primary basis for women coming to the hospital as opposed to cervical dilation. Reevaluating the instruction the healthcare providers give to women is warranted.

From Braxton Hicks to preterm labour: the constitution of risk in pregnancy.

With the recent introduction of preterm birth prevention programs there has been a shift in our understanding of what the presence of contractions during pregnancy means and a reconstituting of risk in ways that position increasing numbers of women at risk for preterm birth. This paper highlights the findings of a study exploring the influences of risk discourses on women's experiences of preterm labour. The primary goals of this institutional ethnographic study were to describe the effects of societal discourses, institutional structures, and nursing work processes on the everyday lives of childbearing women experiencing preterm labour. The findings suggest that risk discourses exert social control over pregnant women and result in fear, guilt, feelings of being judged or punished, and an overwhelming sense of personal responsibility for preventing preterm birth. The study also exposes ways in which biomedical constructions of risk and preterm labour affect the organization of health services, including nursing practice.

[Effect of diumancal, foridon, nifedipine, and verapamil on the myometrium potentials in pregnant rats]. / Vliianie diumankala, foridona, nifedipina i verapamila na biopotentsialy miometriia beremennykh krys.

All the preparations under study were i.v. administered to pregnant Wistar rats in the doses adequate to therapeutic those on pregnant woman basis. Within 10 minutes, a drop both in the amplitude and in the rate of the myometrium potentials were found.