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Trial of labour

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https://www.readbyqxmd.com/read/29338142/patient-controlled-epidural-analgesia-with-and-without-basal-infusion-using-ropivacaine-0-15-and-fentanyl-2%C3%AE-ml-for-labour-analgesia-a-prospective-comparative-randomised-trial
#1
Paraskevi K Matsota, Kalliopi H Drachtidi, Chrysanthi Z Batistaki, Agathi V Karakosta, Ioanna C Koukopoulou, Eugenia I Koursoumi, Georgia G Kostopanagiotou
BACKGROUND: Patient-Controlled Epidural Analgesia (PCEA) is a common practice for labour pain relief. This study aimed to compare two different settings of a PCEA device using the same solution to obtain labour analgesia. METHODS: Fifty two parturients were randomly allocated to receive ropivacaine 0.15% and fentanyl 2γ/mL via a PCEA device either as a background infusion of 5mL/h plus 5mL demand bolus doses with 10 min lockout (group B/D, n=26) or as only demand bolus doses of 5mL with 10 min lockout (group D, n=26)...
January 16, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29320553/undiagnosed-abnormal-postpartum-blood-loss-incidence-and-risk-factors
#2
Aude Girault, Catherine Deneux-Tharaux, Loic Sentilhes, Françoise Maillard, François Goffinet
BACKGROUND: We aimed to evaluate the incidence of undiagnosed abnormal postpartum blood loss (UPPBL) after vaginal delivery, identify the risk factors and compare them to those of postpartum haemorrhage (PPH). METHOD: The study population included women who participated in a randomized controlled trial of women with singleton low-risk pregnancy who delivered vaginally after 35 weeks' gestation (n = 3917). Clinical PPH was defined as postpartum blood loss ≥ 500 mL measured by using a collector bag and UPPBL was defined by a peripartum change in haemoglobin ≥ 2 g/dL in the absence of clinical PPH...
2018: PloS One
https://www.readbyqxmd.com/read/29303230/planned-birth-at-or-near-term-for-improving-health-outcomes-for-pregnant-women-with-gestational-diabetes-and-their-infants
#3
REVIEW
Linda M Biesty, Aoife M Egan, Fidelma Dunne, Eugene Dempsey, Pauline Meskell, Valerie Smith, G Meabh Ni Bhuinneain, Declan Devane
BACKGROUND: Gestational diabetes is a type of diabetes that occurs during pregnancy. Women with gestational diabetes are more likely to experience adverse health outcomes such as pre-eclampsia or polyhydramnios (excess amniotic fluid). Their babies are also more likely to have health complications such as macrosomia (birthweight > 4000 g) and being large-for-gestational age (birthweight above the 90th percentile for gestational age). Current clinical guidelines support elective birth, at or near term in women with gestational diabetes to minimise perinatal complications, especially those related to macrosomia...
January 5, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29289579/sequential-application-of-non-pharmacological-interventions-reduces-the-severity-of-labour-pain-delays-use-of-pharmacological-analgesia-and-improves-some-obstetric-outcomes-a-randomised-trial
#4
Rubneide Barreto Silva Gallo, Licia Santos Santana, Alessandra Cristina Marcolin, Geraldo Duarte, Silvana Maria Quintana
QUESTION: Among women in labour, does sequential application of non-pharmacological interventions relieve labour pain, shorten labour, and delay pharmacological analgesia use? DESIGN: Randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS: Eighty women admitted in labour at the end of a low-risk pregnancy. INTERVENTION: Participants in the experimental group received three interventions for up to 40minutes each in particular stages of labour: exercise on a Swiss ball at 4 to 5cm of cervical dilation; lumbosacral massage at 5 to 6cm dilation; and a warm shower at >7cm dilation...
December 27, 2017: Journal of Physiotherapy
https://www.readbyqxmd.com/read/29284453/a-pilot-exploratory-investigation-on-pregnant-women-s-views-regarding-stan-fetal-monitoring-technology
#5
Kate Bryson, Chris Wilkinson, Sabrina Kuah, Geoff Matthews, Deborah Turnbull
BACKGROUND: Women's views are critical for informing the planning and delivery of maternity care services. ST segment analysis (STan) is a promising method to more accurately detect when unborn babies are at risk of brain damage or death during labour that is being trialled for the first time in Australia. This is the first study to examine women's views about STan monitoring in this context. METHODS: Semi-structured interviews were conducted with pregnant women recruited across a range of clinical locations at the study hospital...
December 29, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/29282015/does-azithromycin-given-to-women-in-labour-decrease-ocular-bacterial-infection-in-neonates-a-double-blind-randomized-trial
#6
Sarah E Burr, Bully Camara, Claire Oluwalana, Ebrima Bojang, Christian Bottomley, Abdoulie Bojang, Robin L Bailey, Umberto D'Alessandro, Anna Roca
BACKGROUND: Vertical transmission can result in neonatal infection and disease. Reducing the transmission of bacterial pathogens from mother to infant may be an effective means of preventing neonatal infection, including bacterial conjunctivitis. METHODS: In a double-blind, randomized trial, we assessed the effect of administering a single dose of oral azithromycin to women in labour on bacterial colonization of the neonate. A reduction in purulent neonatal conjunctivitis was a secondary objective of the trial...
December 28, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/29276166/accelerated-titration-of-oxytocin-in-nulliparous-women-with-labour-dystocia-results-of-the-action-pilot-randomized-controlled-trial
#7
Jessica Dy, Jenna Rainey, Mark C Walker, William Fraser, Graeme N Smith, Ruth Rennicks White, Patti Waddell, Ghayath Janoudi, Daniel J Corsi, Shu Qin Wei
OBJECTIVE: The primary objective was to determine the feasibility of a large RCT assessing the effectiveness of an accelerated oxytocin titration (AOT) protocol compared with a standard gradual oxytocin titration (GOT) in reducing the risk of CS in nulliparous women diagnosed with dystocia in the first stage of labour. The secondary objective was to obtain preliminary data on the safety and efficacy of the foregoing AOT protocol. METHODS: This was a multicentre, double-masked, parallel-group pilot RCT...
December 21, 2017: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
https://www.readbyqxmd.com/read/29276165/caesarean-delivery-surgical-site-infection-what-are-expected-rates-and-potentially-modifiable-risk-factors
#8
Ziad A Haidar, Susan Hosseini Nasab, Hind N Moussa, Baha M Sibai, Sean C Blackwell
OBJECTIVE: This study sought to determine baseline Caesarean delivery (CD) surgical site infection (SSI) rates in various patient subgroups and to identify potentially modifiable and non-modifiable risk factors for SSI. METHODS: This is a secondary analysis of a multicentre CD registry. Women who underwent CD were divided into SSI versus no SSI. SSI was defined as an infection that occurred in the part of the body where the surgery took place, within 30 days of surgery...
December 21, 2017: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
https://www.readbyqxmd.com/read/29244103/gender-dynamics-affecting-maternal-health-and-health-care-access-and-use-in-uganda
#9
Rosemary Morgan, Moses Tetui, Rornald Muhumuza Kananura, Elizabeth Ekirapa-Kiracho, A S George
Despite its reduction over the last decade, the maternal mortality rate in Uganda remains high, due to in part a lack of access to maternal health care. In an effort to increase access to care, a quasi-experimental trial using vouchers was implemented in Eastern Uganda between 2009 and 2011. Findings from the trial reported a dramatic increase in pregnant women's access to institutional delivery. Sustainability of such interventions, however, is an important challenge. While such interventions are able to successfully address immediate access barriers, such as lack of financial resources and transportation, they are reliant on external resources to sustain them and are not designed to address the underlying causes contributing to women's lack of access, including those related to gender...
December 1, 2017: Health Policy and Planning
https://www.readbyqxmd.com/read/29211328/safety-of-the-balloon-catheter-for-cervical-ripening-in-outpatient-care-complications-during-the-period-from-insertion-to-expulsion-of-a-balloon-catheter-in-the-process-of-labour-induction-a-systematic-review
#10
M Diederen, J S M Gommers, C Wilkinson, D Turnbull, B W J Mol
BACKGROUND: It has been suggested that cervical ripening with a balloon catheter for labour induction can be done in an outpatient setting in low-risk pregnancies. Introduction of such an approach needs to be accompanied with monitoring of potential complications. Therefore the existence and frequency of any associated adverse event during cervical ripening needs to be established. OBJECTIVE: To assess the complication rate during cervical ripening with balloon induction...
December 6, 2017: BJOG: An International Journal of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/29210462/vocational-rehabilitation-for-enhancing-return-to-work-in-workers-with-traumatic-upper-limb-injuries
#11
REVIEW
Wen-Hsuan Hou, Ching-Chi Chi, Heng-Lien Lo, Yun-Yun Chou, Ken N Kuo, Hung-Yi Chuang
BACKGROUND: Traumatic upper limb injury is a leading cause of work-related disability. After return-to-work (RTW), many survivors of injuries are able to regain a quality of life (QoL) comparable with the normal population. Since RTW plays an important role in economic productivity and regaining health-related QoL, enhancing RTW in workers with traumatic limb injuries is the primary goal of rehabilitation. Vocational rehabilitation has been commonly employed in the field of occupational safety and health to increase the number of injured people returning to the labour market, prevent illness, increase well-being, and reduce disability...
December 6, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29197839/rupture-of-the-posterior-cul-de-sac-during-trial-of-labour-after-caesarean-section
#12
Lysanne D C Graafmans, Marja G K Dijksterhuis, Louwerens D Vos, Jeroen van Bavel
Rupture of the vaginal wall in unobstructed labour is a rare entity in the developed world. This case report describes rupture of the posterior cul-de-sac in a healthy 34-year-old multiparous woman attempting trial of labour after caesarean section. The woman presented to the labour ward at term with spontaneous onset of contractions. In the second stage of labour, the woman experienced sudden severe abdominal pain, different in character from the contraction pain. Therefore, the baby was delivered by ventouse extraction...
December 2, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29197080/determination-of-the-optimal-programmed-intermittent-epidural-bolus-volume-of-bupivacaine-0-0625-with-fentanyl-2-%C3%AE-g-ml-1-at-a-fixed-interval-of-forty-minutes-a-biased-coin-up-and-down-sequential-allocation-trial
#13
P Zakus, C Arzola, R Bittencourt, K Downey, X Y Ye, J C Carvalho
The optimum time interval for 10 ml boluses of bupivacaine 0.0625% + fentanyl 2 μg.ml-1 as part of a programmed intermittent epidural bolus regimen has been found to be 40 min. This regimen was shown to be effective without the use of supplementary patient-controlled epidural analgesia boluses in 90% of women during the first stage of labour, although with a rate of sensory block to ice above T6 in 34% of women. We aimed to determine the optimum programmed intermittent epidural bolus volume at a 40 min interval to provide effective analgesia in 90% of women (EV90 ) during the first stage of labour, without the use of patient-controlled epidural analgesia...
December 2, 2017: Anaesthesia
https://www.readbyqxmd.com/read/29187156/lack-of-controlled-studies-investigating-the-risk-of-postpartum-haemorrhage-in-cesarean-delivery-after-prior-use-of-oxytocin-a-scoping-review
#14
Karin Bischoff, Monika Nothacker, Cornelius Lehane, Britta Lang, Joerg Meerpohl, Christine Schmucker
BACKGROUND: Postpartum haemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide. Experimental and clinical studies indicate that prolonged oxytocin exposure in the first or second stage of labour may be associated with impaired uterine contractility and an increased risk of atonic PPH. Therefore, particularly labouring women requiring cesarean delivery constitute a subset of patients that may exhibit an unpredictable response to oxytocin. We mapped the evidence for comparative studies investigating the hypothesis whether the risk for PPH is increased in women requiring cesarean section after induction or augmentation of labour...
November 29, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/29181841/epidural-therapy-for-the-treatment-of-severe-pre-eclampsia-in-non-labouring-women
#15
REVIEW
Amita Ray, Sujoy Ray
BACKGROUND: Pre-eclampsia is a pregnancy-specific multi-organ disorder, which is characterised by hypertension and multisystem organ involvement and which has significant maternal and fetal morbidity and mortality. Failure of the placental vascular remodelling and reduced uteroplacental flow form the etiopathological basis of pre-eclampsia. There are several established therapies for pre-eclampsia including antihypertensives and anticonvulsants. Most of these therapies aim at controlling the blood pressure or preventing complications of elevated blood pressure, or both...
November 28, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29154779/letrozole-pre-treatment-prior-to-medical-termination-of-pregnancy-a-systematic-review
#16
Christopher M Nash, Lauren Philp, Prakesh Shah, Kellie E Murphy
OBJECTIVE(S): The purpose of this systematic review was to evaluate the efficacy of pretreatment with letrozole prior to either a first or second trimester medical termination of pregnancy. STUDY DESIGN: We searched letrozole, femara, aromatase inhibitors, abortifacient agents, termination of pregnancy, and labour induction in MEDLINE, EMBASE, Cochrane Database, Google Scholar, and PubMed from inception of each database until September 2015 with no language limitation...
November 14, 2017: Contraception
https://www.readbyqxmd.com/read/29141679/intramuscular-oxytocin-versus-intravenous-oxytocin-to-prevent-postpartum-haemorrhage-at-vaginal-delivery-labor-trial-study-protocol-for-a-randomised-controlled-trial
#17
Nita Adnan, Fiona Boland, Deirdre J Murphy
BACKGROUND: Primary postpartum haemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality worldwide. The most common cause of primary PPH is uterine atony. Atonic PPH rates are increasing in developed countries despite routine active management of the third stage of labour. In less-developed countries, primary PPH remains the leading cause of maternal death. Although the value of routine oxytocics in the third stage of labour has been well established, there is inconsistent practice in the choice of agent and route of administration...
November 15, 2017: Trials
https://www.readbyqxmd.com/read/29139110/unconditional-cash-transfers-for-reducing-poverty-and-vulnerabilities-effect-on-use-of-health-services-and-health-outcomes-in-low-and-middle-income-countries
#18
REVIEW
Frank Pega, Sze Yan Liu, Stefan Walter, Roman Pabayo, Ruhi Saith, Stefan K Lhachimi
BACKGROUND: Unconditional cash transfers (UCTs; provided without obligation) for reducing poverty and vulnerabilities (e.g. orphanhood, old age or HIV infection) are a type of social protection intervention that addresses a key social determinant of health (income) in low- and middle-income countries (LMICs). The relative effectiveness of UCTs compared with conditional cash transfers (CCTs; provided so long as the recipient engages in prescribed behaviours such as using a health service or attending school) is unknown...
November 15, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29136026/operative-technique-at-caesarean-delivery-and-risk-of-complete-uterine-rupture-in-a-subsequent-trial-of-labour-at-term-a-registry-case-control-study
#19
Dorthe L A Thisted, Laust H Mortensen, Lone Hvidman, Lone Krebs
OBJECTIVE: To estimate the relation of single-layer closure at previous caesarean delivery, and other pre-labour and intra-partum risk factors for complete uterine rupture in trial of vaginal birth after a caesarean (TOLAC) at term. STUDY DESIGN: Population-based case-control study. We identified all women (n = 39 742) recorded in the Danish Medical Birth Registry (DMBR) during a 12-year period (1997-2008) with a singleton pregnancy at term and TOLAC. Among these, all women with a complete uterine rupture were identified (cases)...
2017: PloS One
https://www.readbyqxmd.com/read/29136007/perinatal-mortality-associated-with-induction-of-labour-versus-expectant-management-in-nulliparous-women-aged-35-years-or-over-an-english-national-cohort-study
#20
Hannah E Knight, David A Cromwell, Ipek Gurol-Urganci, Katie Harron, Jan H van der Meulen, Gordon C S Smith
BACKGROUND: A recent randomised controlled trial (RCT) demonstrated that induction of labour at 39 weeks of gestational age has no short-term adverse effect on the mother or infant among nulliparous women aged ≥35 years. However, the trial was underpowered to address the effect of routine induction of labour on the risk of perinatal death. We aimed to determine the association between induction of labour at ≥39 weeks and the risk of perinatal mortality among nulliparous women aged ≥35 years...
November 2017: PLoS Medicine
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