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Labor and delivery

Jesse J Liu, Jeffrey S Raskin, Fran Hardaway, Katherine Holste, Sarah Brown, Ahmed M Raslan
BACKGROUND: Delivery of higher value healthcare is an ultimate government and public goal. Improving efficiency by standardization of surgical steps can improve patient outcomes, reduce costs, and lead to higher value healthcare. Lean principles and methodology have improved timeliness in perioperative medicine; however, process mapping of surgery itself has not been performed. OBJECTIVE: To apply Plan/Do/Study/Act (PDSA) cycles methodology to lumbar posterior instrumented fusion (PIF) using lean principles to create a standard work flow, identify waste, remove intraoperative variability, and examine feasibility among pilot cases...
March 14, 2018: Operative Neurosurgery (Hagerstown, Md.)
Yu-Ching Lin, Meei-Ling Gau, Ghi-Hwei Kao, Hung-Chang Lee
BACKGROUND: The physical positions that are adopted by women during childbirth significantly impact their childbirth outcomes and experiences. Literature studies have associated using a squatting position with reduced childbirth pain and increased comfort and pushing efficiency. However, the major disadvantage of the squatting position is that women may lack the muscular fitness and stamina necessary to sustain this position for a long period. PURPOSE: The aim of this study was to compare the pushing experiences and birth outcomes of three different pushing positions during the second stage of labor...
March 16, 2018: Journal of Nursing Research: JNR
M Cynthia Logsdon, Deborah Winders Davis, John A Myers, Katlin M Masterson, Jeffrey A Rushton, Adrian P Lauf
PURPOSE: The purpose of this study was to describe new mothers' knowledge related to maternal mortality. STUDY DESIGN AND METHODS: Using a cross-sectional design, new mothers were recruited from a postpartum unit of an academic health sciences center where the population was predominately low-income women. Before hospital discharge, they answered questions on their knowledge of potential postpartum complications that could lead to maternal mortality. Questions were based on recommendations from an expert nursing panel...
March 16, 2018: MCN. the American Journal of Maternal Child Nursing
Carolyn F Weiniger, Sharon Einav, Uriel Elchalal, Vladislav Ozerski, Daniel Shatalin, Alexander Ioscovich, Yehuda Ginosar
BACKGROUND: Care of pregnant women with concurrent medical conditions can be optimized by multidisciplinary antenatal management. In the current study we describe women with concurrent medical conditions who attended our antenatal anesthesia clinic over a 14-year period, 2002-2015 and, based on the findings, we suggest new policies, strategies and practices to improve antenatal care. METHODS: In 2002, an antenatal anesthesia clinic was established in Hadassah Medical Center...
March 19, 2018: Israel Journal of Health Policy Research
Yun Chai, Miaomiao Qu, Meng Jin
This study was designed to evaluate the application effect of single balloon catheters and dinoprostone on promoting cervical ripening of pregnant women in late-term pregnancy and their influences on stress and inflammatory responses. A total of 160 pregnant women with indications of labor induction were included and randomly divided into the control (n=80) and observation (n=80) groups. Patients in the control group received labor induction by administration of dinoprostone at the vaginal vault, while those in the observation group received labor induction by domestic single balloon catheters...
April 2018: Experimental and Therapeutic Medicine
Tiffany Field
The increasing prevalence of postnatal anxiety highlights the need for summarizing the recent research on this condition to inform screening and intervention efforts. This narrative review of the literature was derived from a search on PubMed and PsycINFO for papers published since 2010. The demographic risk factors for postnatal anxiety include being a young mother, having more education and being employed. Childbirth risk factors include being primiparous in one sample and multiparous in another, caesarean delivery, fear of the birth and of death during delivery, lack of control during labor, low self-confidence for the delivery and the delivery staff, and premature delivery...
March 12, 2018: Infant Behavior & Development
Nancy A Scott, Taryn Vian, Jeanette L Kaiser, Thandiwe Ngoma, Kaluba Mataka, Elizabeth G Henry, Godfrey Biemba, Mary Nambao, Davidson H Hamer
BACKGROUND: The WHO recommends maternity waiting homes (MWH) as one intervention to improve maternal and newborn health. However, persistent structural, cultural and financial barriers in their design and implementation have resulted in mixed success in both their uptake and utilization. Guidance is needed on how to design a MWH intervention that is acceptable and sustainable. Using formative research and guided by a sustainability framework for health programs, we systematically collected data from key stakeholders and potential users in order to design a MWH intervention in Zambia that could overcome multi-dimensional barriers to accessing facility delivery, be acceptable to the community and be financially and operationally sustainable...
2018: PloS One
Samin Nobakht, Arash Shirdel, Yasamin Molavi-Taleghani, Mohammad M Doustmohammadi, Hojjat Sheikhbardsiri
INTRODUCTION: Human resource supply is considered as one of the most vital factors in achieving organizational goals, and human resources are the most valuable factor in the production and delivery of services. Labor shortages and surpluses could downgrade the quality of services offered to patients. Considering the seriousness of this issue, this study aimed to investigate the status of human resources in Iran hospitals. METHODS: The narrative review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines...
March 15, 2018: International Journal of Health Planning and Management
Clodoaldo Tentes Côrtes, Sonia Maria Junqueira Vasconcellos de Oliveira, Rafael Cleison Silva Dos Santos, Adriana Amorim Francisco, Maria Luiza Gonzalez Riesco, Gilceria Tochika Shimoda
OBJECTIVE: to evaluate the impact of the implementation of evidence-based practices on normal delivery care. METHOD: quasi-experimental, before-and-after intervention study conducted in a public maternity hospital, Amapá. Forty-two professionals and 280 puerperal women were interviewed and data from 555 medical records were analyzed. The study was developed in three phases: baseline audit (phase 1), educational intervention (phase 2) and post-intervention audit (phase 3)...
March 8, 2018: Revista Latino-americana de Enfermagem
Terhi Tapiainen, Niko Paalanne, Mysore V Tejesvi, Pirjo Riikola M, Katja Korpela, Tytti Pokka, Jarmo Salo, Tuula Kaukola, Anna Maria Pirttilä, Matti Uhari, Marjo Renko
BACKGROUND: Meconium is formed before birth and may reflect the microbiome of the fetus. To test our hypothesis, we investigated whether maternal factors during pregnancy, such as biodiversity of the living environment, influence the microbiome of the first stool more than immediate perinatal factors. METHODS: We recruited 218 consecutive newborn infants from one hospital. Regions of the bacterial 16S rRNA gene were sequenced to characterize the microbiomes of the first-pass meconium samples (N=212)...
March 14, 2018: Pediatric Research
Vanessa Bueno-Lopez, Carmen Fuentelsaz-Gallego, Manel Casellas-Caro, Ana Maria Falgueras-Serrano, Silvia Crespo-Berros, Ana Maria Silvano-Cocinero, Carolina Alcaine-Guisado, Manuela Zamoro Fuentes, Elena Carreras, Carmen Terré-Rull
BACKGROUND: Fetal occiput posterior position in labor is associated with more painful and prolonged labor, and an increase in both maternal and fetal morbidity. The aim of this study is to assess whether the modified Sims position on the side of the fetal spine increases the rotation to occiput anterior position in women with epidural analgesia and a fetus in persistent occiput posterior (POP) position. METHODS: This is an open, randomized controlled, clinical trial...
March 14, 2018: Birth
Marie-Louise Marschalek, Christof Worda, Lorenz Kuessel, Heinz Koelbl, Willi Oberaigner, Hermann Leitner, Julian Marschalek, Heinrich Husslein
BACKGROUND: In view of the reported increase in obstetric anal sphincter injuries, the objective of this study was to evaluate the incidence of such injuries over time and the associated risk and protective factors. METHODS: This was a retrospective cohort study from a national database of 168 137 primiparous women with term, singleton, cephalic, vaginal delivery between 2008 and 2014. The main outcome measure was obstetric anal sphincter injury. A multivariate regression model was used to identify risk and protective factors...
March 14, 2018: Birth
Irene Papanicolas, Liana R Woskie, Ashish K Jha
Importance: Health care spending in the United States is a major concern and is higher than in other high-income countries, but there is little evidence that efforts to reform US health care delivery have had a meaningful influence on controlling health care spending and costs. Objective: To compare potential drivers of spending, such as structural capacity and utilization, in the United States with those of 10 of the highest-income countries (United Kingdom, Canada, Germany, Australia, Japan, Sweden, France, the Netherlands, Switzerland, and Denmark) to gain insight into what the United States can learn from these nations...
March 13, 2018: JAMA: the Journal of the American Medical Association
Annie Dude, Charlotte M Niznik, Emily D Szmuilowicz, Alan M Peaceman, Lynn M Yee
Achieving maternal euglycemia in women with pregestational and gestational diabetes mellitus is critical to decreasing the risk of neonatal hypoglycemia, as maternal blood glucose levels around the time of delivery are directly related to the risk of hypoglycemia in the neonate. Many institutions use continuous insulin and glucose infusions during the intrapartum period, although practices are widely variable. At Northwestern Memorial Hospital, the "Management of the Perinatal Patient with Diabetes" policy and protocol was developed to improve consistency of management while also allowing individualization appropriate for the patient's specific diabetic needs...
March 13, 2018: American Journal of Perinatology
Nancy A Niemczyk, Alison Cutts, Dana B Perlman
INTRODUCTION: In order to increase and diversify the midwifery workforce, admissions criteria for midwifery education programs must not contain unnecessary barriers to entry. Once accepted, students need to successfully complete the program. Many admissions criteria commonly used in midwifery education programs in the United States are not evidence based and could be unnecessary barriers to education. The primary objective of this study was to identify factors known during the admission process that were related to successful completion or failure to complete a midwifery program educating both student nurse-midwives (SNMs) and student midwives (SMs); a secondary objective was to quantify reasons for program noncompletion...
March 13, 2018: Journal of Midwifery & Women's Health
F Bellussi, L Alcamisi, G Guizzardi, D Parma, G Pilu
OBJECTIVES: to investigate the usefulness of visual biofeedback by transperineal ultrasound to improve the pushing coaching during the active second stage of labor in nulliparous women. METHODS: a randomized controlled trial of low risk nulliparous women in the active second stage of labor. Patients were allocated either to coaching aided by visual demonstration of the progress of the fetal head by transperineal ultrasound (sonographic coaching, Group A) or to classical coaching (Group B)...
March 13, 2018: Ultrasound in Obstetrics & Gynecology
Ruben Barakat, Evelia Franco, María Perales, Carmina López, Michelle F Mottola
OBJECTIVE: to examine the influence of an exercise program throughout pregnancy on the duration of labor in healthy pregnant women. STUDY DESIGN: A randomized clinical trial was used (Identifier: NCT02109588). In all, 508 healthy pregnant women were randomly assigned between 9 and 11 weeks of gestation to either a Control Group (CG, N = 253) or an Exercise Group (EG, N = 255). A moderate aerobic exercise program throughout pregnancy (three weekly sessions) was used as the intervention...
March 6, 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Anussara Prayongrat, Kikuo Umegaki, Arjen van der Schaaf, Albert C Koong, Steven H Lin, Thomas Whitaker, Todd McNutt, Naruhiro Matsufuji, Edward Graves, Masahiko Mizuta, Kazuhiko Ogawa, Hiroyuki Date, Kensuke Moriwaki, Yoichi M Ito, Keiji Kobashi, Yasuhiro Dekura, Shinichi Shimizu, Hiroki Shirato
Particle beam therapy (PBT), including proton and carbon ion therapy, is an emerging innovative treatment for cancer patients. Due to the high cost of and limited access to treatment, meticulous selection of patients who would benefit most from PBT, when compared with standard X-ray therapy (XRT), is necessary. Due to the cost and labor involved in randomized controlled trials, the model-based approach (MBA) is used as an alternative means of establishing scientific evidence in medicine, and it can be improved continuously...
February 24, 2018: Journal of Radiation Research
Joshua I Rosenbloom, Methodius G Tuuli, Molly J Stout, Omar M Young, Candice L Woolfolk, Julia D López, George A Macones, Alison G Cahill
OBJECTIVE:  To determine the factors associated with severe maternal morbidity in a modern cohort of women laboring at term and to create a prediction model. STUDY DESIGN:  This is a retrospective cohort study of all term, laboring patients with live births at a single tertiary care center from 2004 to 2014. The primary outcome was composite maternal morbidity including organ failure, amniotic fluid embolism, anesthesia complications, sepsis, shock, thrombotic events, transfusion, or hysterectomy...
February 8, 2018: American Journal of Perinatology
Solina Tith, Garinder Bining, Laurent Bollag
Background : Opioid use during pregnancy is a growing concern in the United States. Buprenorphine has been recommended by "The American College of Obstetrics and Gynecology" as an alternative to methadone to decrease risks associated with the use of illicit opioids during pregnancy. The partial μ-opioid agonists' unique pharmacology, including its long half time and high affinity to the μ-opioid receptor, complicates patient management in a highly kinetic, and often urgent field like obstetric anesthesia...
2018: F1000Research
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