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1.
Medicine (Baltimore) ; 100(4): e23920, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530192

RESUMO

BACKGROUND: Lamaze breathing has been widely used as a breathing training method. Nursing intervention including postural nursing, delivery ball, doula nursing, massage and psychological nursing is usually provided by nurses during labor. A number of clinical studies have investigated the effect of Lamaze breathing training combined with nursing intervention on maternal pain relief and outcomes improvement. But there were some scholars who were against it. METHODS: Randomized controlled trials from January 2000 to November 2019 in PubMed, Cochrance Library, Medline, Web of Science, Embase, Chinese Academic Journals, Chinese Biomedical Literature Database, VIP Database, Wanfang Database were searched. Two researchers independently screened the literature according to the criteria. After extracting the data, the researchers used Cochrane system to evaluate the literature quality. Statistical analyses were performed by using Comprehensive Meta Analysis V2 software. RESULTS: Twenty-two randomized controlled trials conducted on 7035 primiparas were eligible. The results revealed that Lamaze breathing training combined with nursing intervention increased the rate of natural delivery (relative risk [RR] = 2.97, 95% confidence interval [CI] [2.48, 3.56]), shortened the length of labor (-2.604, 95% CI [-3.120, -2.087]), alleviated labor pain (RR = 0.194, 95% CI [0.115, 0.325]) and reduced postpartum bleeding (-2.966, 95% CI [-4.056, -1.877]). CONCLUSIONS: Lamaze breathing training combined with nursing intervention was effective for ameliorating the process and outcomes of childbirth in primiparae and deserves to be promoted and applied in clinical practice.


Assuntos
Trabalho de Parto/fisiologia , Parto Normal/métodos , Parto Normal/enfermagem , Parto/fisiologia , Feminino , Humanos , Dor do Parto/terapia , Paridade , Hemorragia Pós-Parto/prevenção & controle , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo
2.
PLoS One ; 15(7): e0230992, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32722725

RESUMO

BACKGROUND: Psychological aspects of labor and birth have received little attention within maternity care service planning or clinical practice. The aim of this paper is to propose a model demonstrating how neurohormonal processes, in particular oxytocinergic mechanisms, not only control the physiological aspects of labor and birth, but also contribute to the subjective psychological experiences of birth. In addition, sensory information from the uterus as well as the external environment might influence these neurohormonal processes thereby influencing the progress of labor and the experience of birth. METHODOLOGY: In this new model of childbirth, we integrated the findings from two previous systematic reviews, one on maternal plasma levels of oxytocin during physiological childbirth and one meta-synthesis of women´s subjective experiences of physiological childbirth. FINDINGS: The neurobiological processes induced by the release of endogenous oxytocin during birth influence maternal behaviour and feelings in connection with birth in order to facilitate birth. The psychological experiences during birth may promote an optimal transition to motherhood. The spontaneous altered state of consciousness, that some women experience, may well be a hallmark of physiological childbirth in humans. The data also highlights the crucial role of one-to-one support during labor and birth. The physiological importance of social support to reduce labor stress and pain necessitates a reconsideration of many aspects of modern maternity care. CONCLUSION: By listening to women's experiences and by observing women during childbirth, factors that contribute to an optimized process of labor, such as the mothers' wellbeing and feelings of safety, may be identified. These observations support the integrative role of endogenous oxytocin in coordinating the neuroendocrine, psychological and physiological aspects of labor and birth, including oxytocin mediated. decrease of pain, fear and stress, support the need for midwifery one-to-one support in labour as well as the need for maternity care that optimizes the function of these neuroendocrine processes even when birth interventions are used. Women and their partners would benefit from understanding the crucial role that endogenous oxytocin plays in the psychological and neuroendocrinological process of labor.


Assuntos
Trabalho de Parto/fisiologia , Trabalho de Parto/psicologia , Ocitocina/sangue , Parto/fisiologia , Parto/psicologia , Feminino , Humanos , Comportamento Materno , Serviços de Saúde Materna , Tocologia , Modelos Biológicos , Período Pós-Parto/fisiologia , Período Pós-Parto/psicologia , Gravidez , Apoio Social , Estresse Fisiológico
3.
PLoS One ; 15(5): e0230704, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32357152

RESUMO

BACKGROUND: Cortisol has been used to capture psychophysiological stress during childbirth and postpartum wellbeing. We explored the effect of a brief antenatal training course in self-hypnosis on salivary cortisol during childbirth and 6 weeks postpartum. METHODS: In a randomized, controlled trial conducted at Aarhus University Hospital Skejby Denmark during the period January 2010 until October 2010, a total of 349 healthy nulliparous women were included. They were randomly allocated to a hypnosis group (n = 136) receiving three one-hour lessons in self-hypnosis with additional audio-recordings, a relaxation group (n = 134) receiving three one-hour lessons in various relaxation methods with audio-recordings for additional training, and a usual care group (n = 79) receiving ordinary antenatal care only. Salivary cortisol samples were collected during childbirth (at the beginning of the pushing state, 30 minutes, and 2 hours after childbirth), and 6 weeks postpartum (at wake up, 30 minutes after wake up, and evening). Cortisol concentrations were compared using a linear mixed-effects model. Correlations between cortisol concentrations and length of birth, experienced pain and calmness during birth were examined by a Spearman rank correlation test. FINDINGS: During childbirth, week correlations were found between cortisol concentrations 30 minutes after childbirth and length of birth. In the beginning of the pushing state and 2 hours after childbirth, we found a tendency towards higher cortisol concentrations in the hypnosis group compared to the other two groups (hypnosis versus relaxation p = 0.02 and 0.03, hypnosis versus usual care p = 0.08 and 0.05). No differences were observed in cortisol concentrations between the groups 30 minutes after childbirth (hypnosis versus relaxation p = 0.08, hypnosis versus usual care 0.10) or 6 weeks postpartum (hypnosis versus relaxation: p = 0.85, 0.51, and 0.68, hypnosis versus usual care: p = 0.85, 0.93, and 0.96). CONCLUSION: Antenatal hypnosis training may increase the release of cortisol during childbirth with no long-term consequences. Further research is needed to help interpret these findings.


Assuntos
Hipnose/métodos , Dor do Parto/terapia , Parto/metabolismo , Terapia de Relaxamento , Adulto , Analgesia Obstétrica/efeitos adversos , Parto Obstétrico , Feminino , Humanos , Hidrocortisona/metabolismo , Dor do Parto/metabolismo , Dor do Parto/fisiopatologia , Trabalho de Parto/fisiologia , Parto/fisiologia , Satisfação do Paciente , Período Pós-Parto/metabolismo , Período Pós-Parto/fisiologia , Gravidez , Cuidado Pré-Natal , Saliva/metabolismo
4.
Arch Gynecol Obstet ; 302(1): 93-99, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32415469

RESUMO

PURPOSE: To describe patterns of physiological and psychological stress during induced labor and their correlation to obstetrical and neonatal outcomes. METHODS: This prospective, observational study included 167 women, with low-risk, singleton pregnancies, who delivered at term, at a tertiary academic center from 2015 through 2018. Among them, 72 (43%) underwent induction and 95 (57%) had spontaneous labor onset. Physiological stress was evaluated by salivary cortisol measurements and emotional stress by questionnaires (visual analogue stress scale 0-10) during latent phase, active phase and full dilation stages of labor, as well as 2 min and 2 h postpartum. Cord blood cortisol and pH were obtained. Stress patterns were compared between parturients who did or did not undergo induction. Modes of delivery, labor and delivery complications, and early neonatal outcomes were compared. Mothers completed the Hospital Anxiety and Depression Scale. RESULTS: Induced women had lower cortisol concentrations during the latent phase compared to spontaneous onset of labor (p = 0.003), with no differences during active (p = 0.237), full dilation (0.668), 2 min and 2 h after delivery (p = 0.666). Stress scale and Hospital Anxiety and Depression Scale scores were similar between groups. Cord cortisol (p = 0.294), 1-min Apgar score ≤ 7 (p = 0.502) and 5-min Apgar score ≤ 7 (p = 0.37) were similar. All had cord pH > 7. CONCLUSIONS: Induction does not increase stress during labor. Moreover, it might have a positive effect on reducing cortisol during the latent phase. These findings might reassure women who are concerned about induction of labor.


Assuntos
Hidrocortisona/análise , Trabalho de Parto Induzido/psicologia , Trabalho de Parto/psicologia , Angústia Psicológica , Saliva/química , Adulto , Feminino , Humanos , Trabalho de Parto/fisiologia , Período Pós-Parto , Gravidez , Estudos Prospectivos , Estresse Fisiológico , Estresse Psicológico/complicações , Inquéritos e Questionários
5.
Artigo em Inglês | MEDLINE | ID: mdl-32321672

RESUMO

The partograph (sometimes called partogram) is a labour monitoring tool that is used in countries worldwide to enable early detection of complications, so that referral, action or closer observations can ensue. While the partograph has received global support, from health professionals, there are concerns that it has not reached its full potential in improving clinical outcomes. This has resulted in several variations of the tool and a plethora of studies aimed at exploring the barriers and facilitators to its use. In this chapter, we will discuss the history of the partograph, outlining how it has evolved over time. We will also suggest reasons why the tool may not be meeting the needs of all practitioners. In particular, we will explore partograph use as a complex intervention, suggesting that its success is likely to be dependent on multiple contextual factors.


Assuntos
Parto Obstétrico/métodos , Trabalho de Parto/fisiologia , Nascimento a Termo/fisiologia , Técnicas de Apoio para a Decisão , Feminino , Humanos , Gravidez , Resultado da Gravidez , Monitorização Uterina/métodos
6.
Artigo em Inglês | MEDLINE | ID: mdl-32247770

RESUMO

This chapter reviews and compiles the most recent published evidence assessing the overall labour duration and patterns of progression for both nulliparous and parous women, as well as the accuracy of the alert and action lines in the World Health Organization (WHO) partograph for the identification of women at risk of birth complications. Systematic reviews of observational studies reporting on the duration of the first and the second stages of labour, and on cervical dilatation patterns for women with low risk of complications with 'normal' perinatal outcomes were identified and updated. The accuracy of the alert (1 cm/h) and action lines of the cervicograph in the partogram to predict adverse birth outcomes among women in first stage of labour was also reviewed, questioning the appropriateness of considering cervical dilatation over time as an isolated indicator to define labour progression or arrest.


Assuntos
Primeira Fase do Trabalho de Parto/fisiologia , Trabalho de Parto/fisiologia , Parto Obstétrico , Feminino , Humanos , Paridade , Gravidez , Resultado da Gravidez
7.
PLoS One ; 15(4): e0231461, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32298307

RESUMO

Although being the golden standard for intrapartum fetal surveillance, cardiotocography (CTG) has been shown to have poor specificity for detecting fetal acidosis. Non-invasive near-infrared-spectroscopy (NIRS) monitoring of placental oxygenation during labour has not been studied yet. The objective of the study was to determine whether changes in placental NIRS values during labour could identify intrapartum fetal hypoxia and resulting acidosis. We included 43 healthy women in active stage of labour at term. CTG and NIRS parameters in groups with vs. without neonatal umbilical artery pH ≤ 7.20 were compared using Mann-Whitney-U. Receiver-operating-characteristics (ROC) curves were used to estimate predictive value of CTG and NIRS parameters for neonatal pH ≤ 7.20. A computer-based statistical classification was also performed to further evaluate predictive values of CTG and NIRS for neonatal acidosis. Ten (23%) neonates were born with umbilical artery pH ≤ 7.20. Compared to group with pH > 7.20, fetal acidosis was associated with more episodes of placental NIRS deoxygenation (9 (range 2-37) vs. 2 (range 0-65); p<0.001), higher velocity of placental NIRS deoxygenation (2.31 (range 0-22) vs. 1 (range 0-49) %/s; p = 0.03), more decelerations on CTG (25 (range 3-91) vs. 10 (range 10-60); p = 0.02), and more prolonged decelerations on CTG (2 (range 0-4) vs. 1 (range 0-3); p = 0.04). Number of placental deoxygenations had the highest prognostic value for fetal/neonatal acidosis (area under the ROC curve 0.85 (95% confidence interval 0.70-0.99). Computer-based classification also identified number of placental deoxygenations as the most accurate classifier, with 25% false positive and 93% true positive rate in the training dataset, with 100% accuracy when applied to the testing dataset. Placental deoxygenations during labour measured by NIRS are associated with fetal/neonatal acidosis. Predictive value of placental NIRS for neonatal acidosis was superior to that of CTG.


Assuntos
Cardiotocografia/métodos , Feto/irrigação sanguínea , Trabalho de Parto , Placenta/fisiologia , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Adolescente , Adulto , Feminino , Humanos , Trabalho de Parto/fisiologia , Pessoa de Meia-Idade , Oxigênio/metabolismo , Placenta/metabolismo , Gravidez , Adulto Jovem
8.
Artigo em Inglês | MEDLINE | ID: mdl-32220530

RESUMO

Little is known about the physiology of labour onset at term, and there is a debate about what signs and symptoms should be used to define it. In low resource settings, particularly for remote and rural communities, delay in recognising labour onset may mean a delay in seeking a skilled birth attendant. This chapter presents the most recent evidence about the physiology of labour onset, including the complex neuro-hormonal, biophysical, psychological and emotional factors that contribute. The symptoms of labour onset are explored from the perspective of both pregnant women and service providers in a range of sociocultural contexts. Early labour presents challenges for pregnant women, their families, communities and health care professionals. The chapter discusses how maternity care services should be designed, and delivered to ensure that women get the optimum advice and care at the beginning of labour.


Assuntos
Início do Trabalho de Parto/fisiologia , Trabalho de Parto/fisiologia , Serviços de Saúde Materna , Feminino , Humanos , Gravidez , Gestantes
9.
Taiwan J Obstet Gynecol ; 59(1): 34-38, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32039797

RESUMO

OBJECTIVE: To determine the effect of obesity on the onset of spontaneous labor, scheduled delivery rates and perinatal outcomes in term pregnancies. MATERIAL AND METHODS: 242 obese and 244 non-obese pregnant women ≥37 gestational weeks were compared in terms of the onset of spontaneous labor, scheduled delivery rates and perinatal outcomes. RESULTS: Obese pregnant women had statistically significantly lower onset of spontaneous labor and higher rates of scheduled delivery. No difference was determined in respect of the type of delivery, 1st and 5th minutes APGAR scores and the need for intensive care. Higher values of birth weight, large for gestational age, macrosomia, gestational diabetes mellitus and preeclampsia were determined in obese women. CONCLUSION: The onset of spontaneous labor rates in term obese pregnancies were lower and scheduled delivery rates were higher than in the non-obese pregnancies. However, more extensive studies are needed to better understand this relationship.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Trabalho de Parto/fisiologia , Obesidade/fisiopatologia , Complicações na Gravidez/fisiopatologia , Nascimento a Termo/fisiologia , Adulto , Índice de Apgar , Peso ao Nascer , Estudos de Casos e Controles , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Fatores de Risco
10.
J Nepal Health Res Counc ; 17(4): 491-494, 2020 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-32001854

RESUMO

BACKGROUND: Aims of this study was to assess the caesarean section rate and identify the indications contributing to the same using the Robson's Ten Group Classification System at Kathmandu Model Hospital. METHODS: This was a retrospective study conducted at Kathmandu Model Hospital among women who underwent caesarean section from 1 January to 31 December, 2018 and were grouped according to Ten Group Classification System. The overall caesarean section rate and the contribution of each group was calculated. RESULTS: The overall caesarean section rate was 66.1% (494 among 747 total deliveries) in 2018. Nullipara, singleton cephalic, >= 37 weeks, spontaneous labor (Group 1) was the major (24.2%) contributor to the overall caesarean section rate followed by previous caesarean section, singleton cephalic, >=37 weeks (Group 5, 22.6%) and nullipara, singleton cephalic, >=37 weeks, induced or caesarean section before labor (Group 2, 18.8%). Also, the caesarean section rate was 49.5% in nullipara, thus increasing the trend of caesarean section for previous caesarean section in future. CONCLUSIONS: Efforts must be focused more on Group 1, 2 and 5 to decrease the increasing trend of caesarean section Promoting vaginal delivery in nullipara and facilitating vaginal birth after caesarean are the most relevant areas of intervention.


Assuntos
Cesárea/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Trabalho de Parto/fisiologia , Nepal/epidemiologia , Paridade , Gravidez , Estudos Retrospectivos , Adulto Jovem
12.
Glob Health Action ; 13(1): 1711618, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31955672

RESUMO

Background: In Uganda, perinatal mortality is 38 per 1000 pregnancies. One-third of these deaths are due to birth asphyxia. Adequate fetal heart rate (FHR) monitoring during labor may detect birth asphyxia but little is known about monitoring practices in low resource settings.Objective: To explore FHR monitoring practices among health workers at a public hospital in Northern Uganda.Methods: A sequential explanatory mixed methods study was conducted by reviewing 251 maternal records and conducting 11 interviews and two focus group discussions with health workers complemented by observations of 42 women in labor until delivery. Quantitative data were summarized using frequencies and percentages. Content analysis was used for qualitative data.Results: FHR was assessed in 235/251 (93.6%) of records at admission. Health workers documented the FHR at least once in 175/228 (76.8%) of cases during the first stage of labor compared to observed 17/25 (68.0%) cases. Median intervals between FHR monitoring were 30 (IQR 30-120) minutes in patients' records versus 139 (IQR 87-662) minutes according to observations. Observations suggested no monitoring of FHR during the second stage of labor but records indicated monitoring in 3.2% of cases. Reported barriers to adequate FHR monitoring were inadequate number of staff and monitoring devices, institutional challenges such as few beds, documentation problems and perceived non-compliant women not reporting for repeated checks during the first stage of labor. Health workers demonstrated knowledge of national FHR monitoring guidelines and acknowledged that practice was different.Conclusions: When compared to national and international guidelines, FHR monitoring is sub-optimal in the studied setting. Approximately one in four women was not monitored during the first stage of labor. Barriers to appropriate FHR monitoring included shortage of staff and devices, institutional challenges and mother's negative attitudes. These barriers need to be addressed in order to reduce neonatal mortality.


Assuntos
Monitorização Fetal/normas , Mão de Obra em Saúde/estatística & dados numéricos , Frequência Cardíaca Fetal/fisiologia , Hospitais Públicos/estatística & dados numéricos , Trabalho de Parto/fisiologia , Feminino , Fidelidade a Diretrizes , Pessoal de Saúde , Humanos , Lactente , Recém-Nascido , Entrevistas como Assunto , Guias de Prática Clínica como Assunto , Gravidez , Uganda
13.
BJOG ; 127(7): 820-827, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31943696

RESUMO

OBJECTIVE: The aim of this study was to establish rotational thromboelastometry (ROTEM® ) baseline parameters in labouring women at term gestation. The secondary aim was to compare these reference ranges with those from previous studies on labouring women and from the manufacturer. DESIGN: A prospective, observational study. SETTING: Tertiary referral hospital. PARTICIPANTS: Healthy women in labour. METHODS: Ethics approval was granted for an opt-out recruitment approach. ROTEM® testing was performed in labouring women at term gestation. Women with any condition affecting coagulation were excluded. ROTEM® Delta reference ranges were derived by calculating the 2.5% and 97.5% centiles for INTEM/EXTEM/FIBTEM parameters including amplitude at 5 minutes (A5), coagulation time (CT) and maximum clot firmness (MCF). MAIN OUTCOME MEASURES: ROTEM® parameters were measured in labouring women before delivery. The following tests were performed: FIBTEM, EXTEM and INTEM. RESULTS: One hundred and twenty-one women met the inclusion criteria, with a mean (± SD) age of 29.6 ± 5.4 years and median (interquartile range) gestation of 39.4 weeks (37.4-40.4 weeks). Seventy-five (62.0%) women were nulliparous and 71 (58.7%) delivered vaginally. The median and interquartile ranges for selected ROTEM® parameters were: FIBTEM A5, 21 mm (IQR 18-23 mm); EXTEM A5, 55 mm (52-58 mm); and EXTEM CT, 52 seconds (48-56 seconds). CONCLUSIONS: The FIBTEM/EXTEM/INTEM amplitudes were higher than the manufacturer's reference ranges for non-obstetric patients. The FIBTEM MCF upper and lower limits were higher and the EXTEM/INTEM CT was shorter and narrower in range. This study provides reference ranges for ROTEM® values in healthy labouring women at term gestation with uncomplicated pregnancies. TWEETABLE ABSTRACT: This is the first study to report on ROTEM® reference ranges with over 120 healthy labouring women of normal weight at term gestation.


Assuntos
Trabalho de Parto/fisiologia , Diagnóstico Pré-Natal/estatística & dados numéricos , Tromboelastografia/estatística & dados numéricos , Adulto , Feminino , Voluntários Saudáveis , Humanos , Gravidez , Diagnóstico Pré-Natal/métodos , Estudos Prospectivos , Valores de Referência , Tromboelastografia/métodos
14.
BMC Pregnancy Childbirth ; 20(1): 36, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31931780

RESUMO

BACKGROUND: Before the advent of Western medicine in Tanzania, women gave birth in an upright position either by sitting, squatting or kneeling. Birthing women would hold ropes or trees as a way of gaining strength and stability in order to push the baby with sufficient force. Despite the evidence supporting the upright position as beneficial to the woman and her unborn child, healthcare facilities consistently promote the use of the supine position. The purpose of this study was to explore the perceptions and experiences of mothers and nurse-midwives regarding the use of the supine position during labour and delivery. METHODS: We used a descriptive qualitative design. We conducted seven semi-structured interviews with nurse-midwives and two focus group discussions with postnatal mothers who were purposively recruited for the study. Qualitative content analysis guided the analysis. RESULTS: Four themes emerged from mothers' and midwives' description of their experiences and perceptions of using supine position during childbirth. These were: women adopted the supine position as instructed by midwives; women experience of using alternative birthing positions; midwives commonly decide birthing positions for labouring women and supine position is the best-known birthing position. CONCLUSION: Women use the supine position during childbirth because they are instructed to do so by the nurse-midwives. Nurse-midwives believe that the supine position is the universally known and practised birthing position, and prefer it because it provides flexibility for them to continuously monitor the progress of labour and assist delivery most efficiently. Mothers in this study had no other choice than to labour and deliver their babies in the supine position as instructed because they trusted midwives as skilled professionals who knew what was best given the condition of the mother and her baby.


Assuntos
Parto Obstétrico/enfermagem , Parto Obstétrico/psicologia , Tocologia/métodos , Relações Enfermeiro-Paciente , Decúbito Dorsal , Adulto , Feminino , Humanos , Trabalho de Parto/fisiologia , Trabalho de Parto/psicologia , Mães , Enfermeiras Obstétricas , Parto/fisiologia , Postura , Gravidez , Pesquisa Qualitativa , Tanzânia
16.
BMC Pregnancy Childbirth ; 20(1): 49, 2020 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-31964349

RESUMO

BACKGROUND: Partograph is cost effective and affordable tool designed to provide a continuous pictorial overview and labour progress used to prevent prolonged and obstructed labour. It consists of key information about progress of labour, fetal condition and maternal condition. Its role is to improve outcomes and predict the progress of labour. The aim of this study was to assess utilization of partograph and its predictors among midwives working in public health facilities, Addis Ababa city administration, Ethiopia, 2017. METHODS: An institution based cross-sectional study design was conducted in Addis Ababa, Ethiopia from 15/10/2017-15/12/2017.Simple random sampling under multistage sampling technique was applied to select a total of 605 midwives working in maternity unit of selected public health facilities. Data were collected using structured self-administered questionnaire. Checklist based direct observations were made to all midwife participants to determine the actual practical use of partograph. Data first entered in to EpiInfo version 3.5.1 and transported to SPSS Version 21.Descriptive statistics such as frequency, percentage, mean, and median were calculated. Biviriate and multivariable logistic regression analysis were applied. Any personal identification of the study participants was not recorded during data collection to ensure confidentiality of information. RESULTS: In this study, the utilization of partograph was 409(69%) out of 594 study participants. Being mentored(AOR = 3.1; 95% CI: 1.7, 5.3),received training (AOR = 2.4; 95% CI:1.5,3.6),being knowledgeable about partograph (AOR = 1.6; 95% CI: 1.1, 2.5), health center workers(AOR = 12.6; 95% CI:5.1,31.6),supportive supervision 4 times per year (AOR = 18.6; 95% CI: 6.6,25),supportive supervision twice per a year (AOR = 4.7; 95% CI: 1.9, 11.3),supportive supervision once per year (AOR =3.8;95% CI:1.7,8.8) were positive predictors of partograph utilization. Two midwives per shift (AOR = 0.101; 95% CI: 0.05, 0.65), and 4 per shift (AOR = 0.105, 95% CI: 0.03, 0.40) were protective predictors of partograph utilization. CONCLUSIONS: More than half of the respondents utilized partograph. All public health institutions avail partograph in their laboring room but didn't utilize it according to WHO recommended standard. Working facility, supportive supervision, mentoring, training on partograph, number of midwives working per shift, and knowledge were factors affecting partograph utilization. Encouraging interventions are recommended to the response of the above significantly associated factors.


Assuntos
Competência Clínica , Técnicas de Diagnóstico Obstétrico e Ginecológico/enfermagem , Conhecimentos, Atitudes e Prática em Saúde , Tocologia/métodos , Adulto , Estudos Transversais , Etiópia , Feminino , Humanos , Trabalho de Parto/fisiologia , Complicações do Trabalho de Parto/prevenção & controle , Gravidez , Monitorização Uterina/enfermagem , Adulto Jovem
17.
BMC Pregnancy Childbirth ; 20(1): 56, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-31996150

RESUMO

BACKGROUND: Women with spinal cord injuries (SCI) represent a high risk population during pregnancy with comparatively few studies in the literature regarding their management and pregnancy outcomes, due to the relative rarity of the condition. Our objective was to assess pregnancy outcomes in women with spinal cord injury. METHODS: We performed a retrospective observational study of pregnancy outcomes by reviewing maternity records of all pregnant women with SCI attending the National Spinal Injury Centre at Buckinghamshire NHS Trust between 1991 and 2016. The outcome measures were Maternal demographic data, antenatal complications, method of anaesthetic, intrapartum data (gestation at delivery, onset of labour, mode of delivery, indication for obstetric intervention) and neonatal outcomes (low birth weight, stillbirth, neonatal death). RESULTS: Fifty women with a total of 68 pregnancies were identified. Five patients sustained SCI during pregnancy and the remaining 63 pregnancies were conceived at least 1 year after SCI, of which 45 pregnancies had a SCI at T10 or above (73%) and 23 pregnancies at T11 or below (27%). The most common antenatal complications in SCI patients were worsening of spasms (38%) and urinary tract infection (24%). Preterm delivery occurred in 18% of women. Vaginal delivery was achieved in 77% of pregnancies, including 14% instrumental delivery rate and 23% Caesarean delivery rate. CONCLUSIONS: Our findings support the current evidence that pregnancy outcomes are generally successful and that vaginal delivery can be safely achieved in the majority of women, independent of the level of SCI.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Trabalho de Parto/fisiologia , Complicações do Trabalho de Parto/etiologia , Resultado da Gravidez/epidemiologia , Traumatismos da Medula Espinal/complicações , Adulto , Parto Obstétrico/métodos , Feminino , Humanos , Recém-Nascido , Complicações do Trabalho de Parto/prevenção & controle , Gravidez , Estudos Retrospectivos , Adulto Jovem
18.
J Perinat Neonatal Nurs ; 34(1): 38-45, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31996643

RESUMO

Comfort is a fundamental human need to seek relief, ease, and transcendence. Comfort is relevant to women in labor who experience intense pain and mixed emotions. The subjective meaning of comfort in labor for women is not fully understood. This work was part of a phenomenological study of the experience of childbirth, in which the dynamic of keeping-it-together-falling-apart was identified as an essential quality of women's perceptions of childbirth. Comfort was a salient element of keeping-it-together-falling-apart. In this report, the concept of comfort is explored in greater depth, using qualitative descriptive analysis. Eight participants, aged 23 to 38 years, with spontaneous vaginal births, were each interviewed twice about the childbirth experience. Comfort was a holistic experience of relaxation and relief, where the needs of the body and the person were being met. Comfort and pain coexisted with each other, and relief of pain did not always provide comfort. Women had an innate knowledge of comfort, but their capacity for choice was at times restricted by caregivers in the hospital. There are aspects of labor care that do not support comfort, particularly as it relates to mobility and choice. Prioritizing comfort as well as pain relief may contribute to a more holistic, satisfying birth experience for women.


Assuntos
Parto Obstétrico , Saúde Holística/ética , Dor do Parto , Trabalho de Parto , Parto/psicologia , Conforto do Paciente , Adaptação Psicológica , Adulto , Parto Obstétrico/ética , Parto Obstétrico/métodos , Parto Obstétrico/psicologia , Feminino , Humanos , Dor do Parto/fisiopatologia , Dor do Parto/psicologia , Dor do Parto/terapia , Trabalho de Parto/fisiologia , Trabalho de Parto/psicologia , Acontecimentos que Mudam a Vida , Manejo da Dor , Gravidez , Pesquisa Qualitativa
19.
Midwifery ; 83: 102626, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31954296

RESUMO

OBJECTIVE: To explore and synthesise evidence of women's information needs, decision-making and experiences of membrane sweeping to promote spontaneous labour. DESIGN: A systematic review following the Joanna Briggs Institute (JBI) meta-aggregative approach to qualitative evidence synthesis. Relevant databases were searched for literature published in English between 2000-19. Study quality was assessed using the JBI quality assessment tool for qualitative studies. SETTING: Qualitative research conducted in OECD countries describing women's information needs, decision-making and/or experiences of membrane sweeping to promote spontaneous labour. FINDINGS: One article met the criteria for inclusion. This article describes the experience of a membrane sweep given without consent. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: There is a lack of evidence around women's information needs, decision-making and experiences of membrane sweeping. This is concerning, especially in the context of rising rates of formal induction of labour. Further research is needed to investigate how women are being offered membrane sweeping and what information women need to make informed choices about membrane sweeping to promote spontaneous labour.


Assuntos
Tomada de Decisões , Comportamento de Busca de Informação , Trabalho de Parto/psicologia , Gestantes/psicologia , Adulto , Feminino , Humanos , Trabalho de Parto/fisiologia , Gravidez , Pesquisa Qualitativa
20.
Biol Res Nurs ; 22(2): 157-168, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31983215

RESUMO

OBJECTIVES: The purpose of this study was to evaluate differences in the metabolic pathways activated in late-pregnancy serum samples among African American women who went on to have term (≥37 weeks) labor induction requiring high total oxytocin doses to complete first-stage labor compared to those in similar women with low-oxytocin labor inductions. STUDY DESIGN: Case-control study (N = 27 women with labor induction with successful cervical ripening: 13 requiring the highest total doses of synthetic oxytocin to progress from 4- to 10-cm cervical dilation and 14 requiring the lowest total doses) with groups balanced on parity and gestational age. Serum samples obtained between 24 and 30 weeks' gestation were analyzed using ultra-high-resolution metabolomics. Differentially expressed metabolites between high-oxytocin induction cases and low-oxytocin induction comparison subjects were evaluated using linear regression with xmsPANDA. Metabolic pathways analysis was conducted using Mummichog Version 2.0, with discriminating metabolites annotated using xMSannotator Version 1.3. RESULTS: Labor processes were similar by group with the exception that cases received over 6 times more oxytocin between 4- and 10-cm cervical dilation than comparison women. Induction requiring high total doses of synthetic oxytocin was associated with late-pregnancy serum levels of metabolites from the linoleate and fatty acid activation pathways in term, African American women. CONCLUSION: Serum levels of several lipid metabolites predicted more complicated labor induction involving higher doses of synthetic oxytocin to complete first-stage labor. Further investigation in larger, more diverse cohorts of women is needed to identify potential targets to prevent failed labor induction.


Assuntos
Afro-Americanos/estatística & dados numéricos , Trabalho de Parto Induzido , Trabalho de Parto/fisiologia , Redes e Vias Metabólicas/efeitos dos fármacos , Redes e Vias Metabólicas/fisiologia , Ocitocina/efeitos adversos , Ocitocina/uso terapêutico , Adulto , Estudos de Casos e Controles , Relação Dose-Resposta a Droga , Feminino , Humanos , Ocitócicos/efeitos adversos , Ocitócicos/uso terapêutico , Gravidez , Gestantes , Estados Unidos , Adulto Jovem
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