Effect of upright and ambulant positions versus lying down during the active first stage of labor on birth outcomes among nulliparous women:randomized controlled clinical trial

Objective:To examine the effect of upright and ambulant positions versus lying down during the active first stage of labor on birth outcomes for nulliparous women.Methods:This is a randomized controlled clinical trial conducted at the delivery department of Damanhour Educational Institute,El Behira Governorate,Egypt.The study sample involved 150 parturient women equally divided into intervention and control groups using randomization block technique.The researchers used four tools for data collection:Demographic data interview schedule,World Health Organization Partograph,Apgar’s score,to evaluate neonatal outcomes,and visual analogue pain intensity scale.For the study group,the parturient women were encouraged to assume one of the upright positions or ambulating around the bed so as to maintain the pelvis in vertical plane as far as possible for 20-25 min for every 1 h.The control group received routine hospital care,which includes lying down in bed.IBM SPSS 23.0 was used to analyze the data.Results:Significant differences(P<0.05)were observed between the study and control groups in relation to cervical dilation,fetal head descent,uterine contractions interval,and frequency.The duration of the first stage of labor significantly reduced(P=0.018)in the intervention group compared with control group.No significant differences(P>0.05)were observed between both groups in term of emergency cesarean birth rates,oxytocin use,and neonatal outcomes.Conclusions:This study proves that upright and ambulant positions significantly enhance uterine contractility,cervical dilatation,and fetal head descent and reduce the first stage duration.

Manual Uterine Fundal Pressure in the Spontaneous Delivery during the Second Stage of Labor: A Pilot Case-Control Study Following an Analysis of Questionnaire Survey

Background: Recent obstetrical practice tends to avoid the use of manual uterine fundal pressure (MUFP);however, data showed that MUFP is actually employed. We here attempted 1) to determine the obstetricians’ attitudes towards MUFP via questionnaire, and 2) to examine whether MUFP shortens the 2nd stage of labor, with the latter tested as a pilot study. Methods: A questionnaire-based study was carried out (n = 122) at meetings of Obstetrics on May 5, 2017. Then, we conducted a pilot case-control study from August 23 to September 6, 2020. Participants (n = 29) were divided into two groups;women who did and did not want MUFP;i.e., MUFP (n = 14) vs. (Non-MUFP) group (n = 15). Results: Of 122 doctors, 99.18% (121/122) used MUFP at cesarean section. 95.90% (117/122) of institutions used MUFP in spontaneous delivery. 95.08% (116/122) obstetricians considered MUFP effective and helpful. 85.24% (104/122) considered that MUFP should be employed after station +3. In the case control study, MUFP vs. Non-MUFP group showed the second-stage-duration of 58.5 (50.25 - 71.25) vs. 48 (39 - 59) minutes, without statistical significance (P = 0.101). However, importantly, MUFP, compared with Non-MUFP group, showed a significantly shorter duration from head visible on introitus (apparition) to delivery;i.e., 21.26 ± 7.32 vs. 30.13 ± 10.61 minutes (P = 0.014). Conclusions: MUFP is still used widely and MUFP shortened the duration of head apparition to delivery time. Larger-sample studies are needed to confirm the efficacy and safety of MUFP.

Association between Fetal Heart Rate Monitoring during Labor and Neonatal Acidosis in Full-Term Newborns: A Retrospective Multicenter Cohort Study

Introduction: Fetal heart rate monitoring during labor is used to study fetal well-being and predict neonatal acidosis of newborn. Fetal heart rate monitoring is analyzed by the obstetrical team and categorized according to the FIGO guidelines. An important limitation of this diagnostic tool is an inter- and intra-observer variability, leading to subjective cardiotocography interpretation and classification. Our objective was to study the association between the categories of fetal heart rate analysis (according to FIGO classification) and neonatal acidosis of full-term newborns. Study design: This is a multicenter retrospective cohort study conducted between 2014 and 2018 in the Grand-Est region. We searched and included retrospectively children hospitalized in a pediatric intensive care unit in one of the participating hospitals with an ICD-10 coding type “P91.6” corresponding to “Hypoxic Ischemic Encephalopathy”. Maternal, pregnancy, delivery, and newborn characteristics were collected and compared by univariate logistic regression with multiple imputation. Odds Ratio and 95% confidence intervals (CI) were calculated using the model and presented. Multiple imputation with m = 100 imputations was tested, using Rubin rules to combine the results. Results: 55 patients were included in the study. Fetal heart rate tracings classified in Category 3 as “pathological” according to FIGO guidelines were significantly associated with an increased risk of severe neonatal acidosis. Late decelerations and bradycardia during labor were associated with severe neonatal acidosis. Conclusion: Severe neonatal acidosis may be suspected by interpretation of fetal heart rate during labor. Fetal bradycardia and late decelerations are predictive of the severity of neonatal acidosis. This study emphasizes the need to screen severe neonatal acidosis and allows the identification of populations most at risk. Repeated team training and upgrading of fetal heart rate study would further reduce the incidence of neonatal acidosis.

Effect of Acupoint Sanyinjiao(SP6) Moxibustion on the First Stage of Labor and Uterine Contractive Pain in Primiparae

Objective：To observe the effect of acupoint Sanyinjiao（SP6） moxibustion（S-Mox） on the duration of the first labor stage and uterine contractive pain in primiparae.Methods：Sixty primipara women in labor were equally assigned according to their choice to three groups：women in the S-Mox group received bilateral S-Mox for 30 min,women in the non-acupoint group received moxibustion（Mox） applied on non-acupoints for 30 min,and those in the control group did not receive Mox intervention.The duration of the first labor stage was recorded and the degree of labor pain was estimated by a visual analogue scale（VAS） before and after Mox. Results：The duration of the first stage active phase in the S-Mox group was significantly shorter than that in the other two groups（P0.05,P0.01）;the VAS score after Mox was lower in the S-Mox group,showing a statistical difference in comparison with the control group（P0.05）.Conclusions：Applying S-Mox could markedly shorten the active phase of the first stage of labor and lower the VAS score of uterine contractive pain,which means alleviating the pain caused by vaginal delivery.Its mechanism is worthy of further study.