Safety and effectiveness of butorphanol in epidural labor analgesia:A protocol for a systematic review and meta-analysis

BACKGROUND Epidural analgesia is the most effective analgesic method during labor.Butorphanol administered epidurally has been shown to be a successful analgesic method during labor.However,no comprehensive study has examined the safety and efficacy of using butorphanol as an epidural analgesic during labor.AIM To assess butorphanol's safety and efficacy for epidural labor analgesia.METHODS The PubMed,Cochrane Library,EMBASE,Web of Science,China National Knowledge Infrastructure,and Google Scholar databases will be searched from inception.Other types of literature,such as conference abstracts and references to pertinent reviews,will also be reviewed.We will include randomized controlled trials comparing butorphanol with other opioids combined with local anesthetics for epidural analgesia during labor.There will be no language restrictions.The primary outcomes will include the visual analog scale score for the first stage of labor,fetal effects,and Apgar score.Two independent reviewers will evaluate the full texts,extract data,and assess the risk of bias.Publication bias will be evaluated using Egger's or Begg's tests as well as visual analysis of a funnel plot,and heterogeneity will be evaluated using the Cochran Q test,P values,and I2 values.Meta-analysis,subgroup analysis,and sensitivity analysis will be performed using RevMan software version 5.4.This protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)Protocols statement,and the PRISMA statement will be used for the systematic review.RESULTS This study provides reliable information regarding the safety and efficacy of using butorphanol as an epidural analgesic during labor.CONCLUSION To support clinical practice and development,this study provides evidence-based findings regarding the safety and efficacy of using butorphanol as an epidural analgesic during labor.

Association of Squatting Activities of Pregnant Women during the Antenatal Period and Labor Outcomes

Aim: To investigate impact of antenatal squatting activities on labour outcomes. Methods: All eligible primigravida women, with singleton cephalic fetuses, who presented to ward 18 of Colombo South Teaching Hospital, Sri Lanka, during the period 1st of February to 28th of May 2017 were invited into the study. Those who were already in active stage of labor (at least more than two moderate contractions per 10 minutes) on admission were excluded. Demographic data such as age, ethnicity, religion, educational level, occupation, latrine type in use, and booking Body mass index (BMI) were collected via an interviewer administered questionnaire. Data related to labor (modified Bishop score at onset of active labor, labor augmentation, pain relief, labor duration, mode of delivery, episiotomy or tears) and neonatal outcome (birth weight, APGAR score at 1, 5, 10 minutes) were collected from delivery notes. A pre tested interviewer administered questionnaire was used to obtain data regarding routine squatting activities during the previous 6 months. Pain visual analogue scale was used on day after delivery to assess the degree of labour pain. Duration of each squatting activity per day and number of days engaged with the activity per week;were used to calculate total squatting hours per week. In the absence of an accepted threshold for adequate squatting, we employed the sample mean as an operational data-driven threshold to define “more” against “less” squatting activities. Women who did not have squatting activities were considered as the controls. We used chi-square and Fisher’s exact tests to compare characteristics and outcomes between those engaging in more and less levels of squatting activity. We fitted a series of logistic regression models with each dichotomized outcome as the dependent variable, more/less squatting activity as the main independent variable of interest, and age, gestation period, BMI and patient’s occupation as covariates. The resulting adjusted odds ratios (AOR) and their 95% confidence intervals (CI) and statistical significance (p < 0.05) were used to draw conclusions of adjusted associations. Results: We recruited 430 women into this study. Overall, 68% of the women were of 20 - 30 years old, 47% had normal body mass index and 65% were housewives. The most frequent squatting activities were for urination/defecation and clothes washing (146 and 62 minutes/week, respectively). Mean total time was 246 minutes per week, of which more than 147 women (34%) achieved above this level of squatting activities. Those with more squatting activities had a greater modified Bishop Score ≥ 6/10 (92% vs 82%;p < 0.01);labor duration of <6 hours (82% vs 56%;p < 0.01), less likely for labour augmentation (39% vs 51%;p < 0.01) and pain relief (53% vs 65%;p = 0.013). Similar results were obtained after adjustments for maternal age, BMI, gestational age and occupation. However, there were no significant differences in the mode of delivery (normal vaginal vs instrumental vs caesarean), episiotomy rate, birth weight and neonatal Apgar scores. Conclusion: Squatting activities of more than 246 minutes per week may improve labor outcome. Women should be encouraged to increase squatting exercises or incorporate more habitual squatting activities antenatally.

Is Induction of Labor with Early Rupture of Membranes Associated with an Increased Rate of Clinical Chorioamnionitis?

Objective: The objective of this study was to determine if early rupture of membranes (ROM) in women undergoing induction of labor (IOL) at term is associated with an increased rate of clinical chorioamnionitis. Study Design: A retrospective cohort study was performed on women undergoing IOL. Early ROM was defined as ROM at a modified Bishop score less than 5, cervical dilation less than 4 cm, or cervical effacement less than 80%. The rate of clinical chorioamnionitis was compared between women with early and late ROM. Results: The rate of clinical chorioamnionitis was 8.6% (24/279). ROM at an effacement of less than 80% was associated with a rate of clinical chorioamnionitis of 15.4% (12/78) compared to 6.0% (12/201) at an effacement of equal to or greater than 80%, p = 0.017. The rate of cesarean delivery was higher for patients with early ROM by any definition: 32% compared to 17.5% by modified Bishop score (p = 0.031), 32.4% versus 18.2% by cervical dilation (p = 0.049), and 33.3% versus 14.9% by cervical effacement (p = 0.001). Conclusions: In patients undergoing IOL, early ROM may be associated with an increased rate of clinical chorioamnionitis when performed at a cervical effacement of less than 80% and an increased rate of cesarean delivery.

A Study on the Correlation of Body Mass Management During Pregnancy with Adverse Pregnancy Outcomes and Labor Progression

Objective:To investigate the effects of body mass management during pregnancy on adverse pregnancy outcomes,duration of labor,and neonatal birth weight.Methods:472 pregnant women who visited Beijing Anzhen Hospital from January to December 2023 were selected,and the pregnant women were divided into 236 each in the observation group and the control group.Body mass of pregnant women was measured and BMI was calculated in early and late pregnancy respectively,and the pregnant women in the control group were guided by routine management,while the observation group was guided by body mass management during pregnancy.The growth of maternal body mass,mode of delivery,postpartum hemorrhage,neonatal score,neonatal blood glucose at birth,and umbilical artery blood,as well as the comparison of the duration of labor,were observed.Results:The observation group was significantly better than the control group in terms of mode of delivery,postpartum hemorrhage,and body mass growth,with statistically significant differences(P<0.05),and there was no statistical significance in terms of neonatal scores,neonatal blood glucose at birth,and umbilical artery blood(P>0.05);the time of the first stage of labor and the time of the second stage of labor of the mothers in the observation group was significantly better than that of the control group,with statistical differences(P<0.05),and the time of the third stage of labor of the mothers in the observation group was statistically better than that of the control group.There was no statistically significant difference between the time of the third stage of labor in the observation group and the control group(P>0.05),and the time of the total stage of labor in the observation group was statistically better than that in the control group(P<0.05).Conclusion:Body mass management during pregnancy can effectively improve maternal control of weight gain,reduce labor time,and decrease the occurrence of adverse pregnancy outcomes.

Analysis of the Effect of Midwives’ Psychological Care Intervention on the Progress of Labor and Cesarean Rate of Elderly Women in Labor

Objective:To analyze the effect of midwife psychological nursing intervention in the clinical care of elderly women in labor.Methods:According to the order of admission,74 elderly women were divided into the control group and the observation group.In addition to the routine perinatal nursing interventions,the observation group strengthened the implementation of midwives’psychological nursing interventions.The duration of labor,mode of delivery,psychological state,and stress response indexes of the two groups were analyzed and compared.Results:The observation group had a shorter duration of all labor stages and total duration of labor than the control group,a lower cesarean section rate than the control group,and a higher degree of improvement in anxiety,depression,and stress response indexes in the 3-day postpartum period as compared to the control group(P<0.05).Conclusion:The implementation of midwife psychological care intervention in perinatal care of elderly women can further shorten the duration of labor,reduce the cesarean section rate,and improve the psychological state and stress indicators,which is worth promoting.

Research on the Implementation Path of Labor Education in Colleges and Universities from an International Perspective

Universities shoulder the important mission of talent cultivation,scientific research,social service,cultural heritage and innovation,and international exchange and cooperation.International exchange and cooperation have become the fifth major function of universities.Based on the background of the globalization era,undergraduate colleges and universities should pay more attention to the cultivation of students’intercultural communication and understanding ability while cultivating their professional skills,and take expanding students’international vision and enhancing the international competitiveness of China’s education as important tasks.Labor education is an important content of the national education system,which has the comprehensive nurturing value of cultivating morality,increasing intelligence,strengthening physical fitness,and cultivating beauty.Higher education institutions should further optimize the system of labor education,expand students’space and field of thinking in the process of labor education,and broaden students’international perspectives.

Chinese Rural labors Transfer under the Coordination of Urban-Rural Development

The strategic significance of Chinese rural labor transfer is expounded.It is conducive to solving the three agricultural problems concerning agriculture,rural areas,and farmers and coordinating the urban and rural development;promoting the rational distribution of human resources and realizing the growth of national economy;restructuring industrial structure and improving Chinese market competitiveness.The problems in the transfer of Chinese rural labors are analyzed,which include the low overall cultural level of rural labors;imperfect organization developmental;weak management mechanism and imperfect supporting measures.The rational paths for Chinese rural labor transfer are pointed out,including break the urban and rural dual structure and realize the free move of rural labors;strengthen the organization construction to provide high-quality socialized service for rural labor transfer;perfect security system to foster favorable social environment for rural labor transfer;establish scientific management mechanism to realize the sustainable rural labor transfer.

From "Migrant Workers Boom" to "Migrant Workers Scarcity"——Analysis of Institutional Bottleneck of Rural Surplus Labors Transfer in China

Through description of three-steps characteristic of dual economic theory and its practical significance to the process of industrialization and urbanization in China,and making comparative analysis between important criterion of "Lewis turning point" and current situation of rural surplus labors market in China,we can find that there exists a great deal of surplus labors in rural areas in our country,improvement of peasant income is the result of external interference of government,and demographic dividend in our country hasn't finished.These phenomena go against the theory of "Lewis turning point".So it can prove that "Lewis turning point" in China hasn't come yet.The paper points out the major factors of coexistence of "migrant workers scarcity" and labors redundancy in our country.The first one is structure contradiction of labors market;the second one is law of supply-demand of labors market;the third one is institutional barrier which hinders labors in free flow of census register and social guarantee.Therefore,if we want to realize successful transfer of rural surplus labors and the goal of industrialization and urbanization,we must promote upgrading of industrial structure,change the style of economic growth and realize harmonious development of regional economy in macrocosmic level;And in microcosmic level,we should eliminate institutional barrier which hinders transfer of rural surplus labors.

Approaches and countermeasures of the transfer of rural surplus labors in China

The transfer of rural surplus labors concerns the development of agriculture and the national economy in China. On the pivotal period of transforming economy and society, whether the transfer can be accomplished successfully will play an important role in the social stabilization and the sustainable development of economy. In this paper, the authors bring out the characteristics and the main impediment of transfer. At the same time, countermeasures which are more effective have been put forward.

The Research on Determinants of Moving Labors’ Settlement in Urban Area

Based on the analysis of the factors affecting the migration of moving labor and the explanation of becoming permanent urban residents,this research takes migration mode(migration) as the dependent variable,sex(sex) ,age(age) ,monthly income(income) ,education degree(edu) ,working experiences(exp) ,social relation(relation) ,and social security(security) as the independent variables.According to the investigation of China Agricultural University in the year 2009,Logistic Binary Choice Model is used to construct the corresponding econometric model and to measure the effects of influencing factors on the selection of migration mode.Result shows that education degree,personal ability,social relation,and social security are the major influencing factors determining the peasant households becoming permanent urban residents;and human capital and social security construction are of great significance to the improvement of farmers’ income and life quality.

Teaching Practice of Integrating Labor Education into Specialized Courses:A Case Study of Plant Cultivation and Maintenance

Vocational colleges attach great importance to labor education.Specialized courses are an effective way to cultivate students labor quality,and the integration of labor education in specialized courses plays an important role in the overall cultivation of students moral quality and practical ability.Combined with the teaching practice of landscape technology specialty,labor education is integrated into the teaching of Plant Cultivation and Maintenance,and certain results have been achieved.In this paper,the course content"grafting propagation"was analyzed from the aspects of overall teaching design,teaching implementation process,teaching effect and reflection improvement,so as to provide reference for other contents of this major or other majors to carry out integrated teaching.

Initial Labor Market Conditions and Individual Employability

Initial labor market conditions affect how individuals build their human capital and look for jobs and thus can have long-term effects on their income levels,work performance,and career development.Based on data from the Urban Household Survey(UHS)of urban households in China from 1986 to 2009,we perform an empirical test of how initial labor market conditions affect the employability of individuals.Our research shows that people’s future incomes suffer if they start out in an adverse job market.Each percentage point of increase in the unemployment rate at an individual’s entry into the labor market is associated with a two-percentage-point drop in his or her average annual income.Even after looking at different parts of the job market and sample groups,this conclusion still holds.In the context of global economic instability,our findings may assist government policymakers in addressing adverse labor market conditions.

Effects of financial development and capital accumulation on labor productivity in sub‑Saharan Africa:new insight from cross sectional autoregressive lag approach

This study aims to shed light on the effects of financial development and accumula-tion of capital on the productivity of labor in the sub-Sahara African region within the period of 1990–2018.In this work,we used the(dynamic)common correlated effects estimator-mean group and additional techniques such as cross-section autoregressive distributed lag to calibrate the sample into the African subregion to ensure robustness.The findings reveal that financial progress in the region over time leads to an increase in productivity of labor and also the accumulation of capital.Furthermore,financial markets have a progressive impact on the productivity of labor within sub-Saharan African regions.We extend the very limited literature on the nexus between financial development and labor productivity by incorporating capital accumulation into our model which has not been previously studied.

Traditional medicine use during pregnancy and labor in African context:A scoping review

Traditional medicine(TM)has been more popular among pregnant women worldwide and has played a significant part in maternal health-care services in many nations.Herbs,herbal preparations,and finished herbal products all contain active substances that are derived from plant parts or other plant components that are thought to have medicinal advantages.To diagnose,prevent,and treat illnesses as well as to enhance general well-being,about 80%of people use a variety of TM,including herbal remedies.A systematic search of Google Scholar and PubMed was performed utilizing an established scoping review framework by Joanna Briggs Institute from January 2012 to December 2022.A consequent title and abstract review of articles published on TM in the African context were completed.Of over 15,000 published studies identified,15 meeting the inclusion criteria were integrated into the following seven categorical themes:prevalence of TM use,source of information on TM use,reasons for use of TM,route of administration,common herbs used in pregnancy and labor,the effect of herbs used in pregnancy and labor,and predictors of use of TM.The studies reviewed were primarily in the context of an African setting on the use of TM regarding herbal medicine.Of all the articles,the highest number of studies was conducted in Zimbabwe.This review shows increased use of TM by women during pregnancy and labor with a reported prevalence rate varying from 12%to 60%.However,a decrease in use in the third trimester of pregnancy was reported.The most frequent source of information on the use of TM was from family and friends,while age,parity,education,and income were factors affecting use.In conclusion,the participants do not often disclose the use of TM during their antenatal attendance and the reason for use was accessibility and cost.Therefore,there is a need for further study on the safety and efficacy of TM use in pregnancy and labor.

Accessible and low-to zero-cost remedy:Traditional medicine use during pregnancy and labor

Traditional medicine(TM)has played an essential part in maternity services around the world,which has led to increased utilization among pregnant women.Herbs,herbal preparations,and completed herbal products are examples of TMs that contain active substances such as plant parts or other plant components that are thought to have therapeutic advantages.This study review aimed to identify the herbs commonly used,reasons for use,and effect of use,to make adequate recommendations on herbal medicine use as a remedy for pregnancy and labor.Incorporating evidence from reviews,personal correspondence,and diaries,this study demonstrates that about 80%of people used TM such as herbal remedies for sickness diagnosis,prevention,treatment,and promotion of general well‑being.Due to its accessibility,cost,and availability,TM is usually used by expectant mothers.Examples of TM used in pregnancy and labor include honey,aloe,raspberry,jute mallow,and hibiscus leaves.It is important to note that its use in pregnancy and labor can be beneficial or harmful to both mother and child.Lack of standardization,financial risk,lack of safety,and effectiveness are challenges to TM.There is a need of creating awareness of the safe use and effects of TM in pregnancy and labor through the provision of health education programs for women in the community.

An Empirical Analysis of the Impact of the Contract Book of the Civil Code on Labor Dispute Trial Practices:A Study of Four Hundred Judgments

Interpretation(I)of the Supreme People’s Court of Issues Concerning the Application of Law in the Trial of Labor Dispute Cases allows for the application of pertinent laws and regulations,including the Civil Code of the People’s Republic of China(hereinafter referred to as the“Civil Code”),in labor dispute cases.This has resolved the controversy over the relationship between civil law and labor law in academic and practical communities.In view of this development,we examined four hundred judicial documents,analyzing the focal points of disputes,the reasoning behind judgments,applicable laws,and judgment results.Our study identified seven impacts of the Contract Book of the Civil Code on labor dispute trial practices,exploring the underlying logic behind these changes and proposing policy suggestions to promote consistent judgments across jurisdictions,enhance judicial credibility,and encourage employers to govern enterprises in compliance with the law while empowering employees to safeguard their rights in accordance with relevant laws and regulations.

Could Labor Be Considered Outside of a Medical Environment in Africa? Case of the Maternity Hospital in Yopougon Attié/Abidjan/Ivory Coast/West Africa

Introduction: Developing countries are characterized by a high maternal mortality rate, particulary related to the management of childbirth. The author describes in this work 588 childbirth labors that took place without any medical supervision. Method: All patients who reached the hospital with a full cervix dilation were included in the study. The outcomes of those childbirth labors without medical supervision were evaluated at the maternal and neonatal level. Results and Discussion: The average age of the patients was 28.1 ± 13 years with 47% nulliparous and 30% pauciparous. These patients represented 14% of all births;59% of the patients had had three and five prenatal consultations. 71% of them came straight from home and had meconium-stained amniotic fluid. The APGAR score was greater than 6 in 94% of newborns, and 66.7 of them weighed between 2500 and 3500 g. Only 0.9% of patients coming from home needed a caesarean section. Conclusion: Home birth is not yet possible in Africa because it is not supervised by professionals who know the risks of childbirth, its complications and recognize the warning signs;however, the results of this preliminary study show that the issue of home childbirth in Côte d’Ivoire can be reconsidered subject to greater involvement of medical staffs.

Effects of combined spinal-epidural anesthesia on anxiety,labor analgesia and motor blocks in women during natural delivery

BACKGROUND The background of this study was analgesia in natural delivery.The combined spinal-epidural anesthesia has obvious analgesic effect on the parturients in natural labor,and combined spinal-epidural anesthesia has been widely used in anesthesia for various diseases.AIM To study the effects of combined spinal-epidural anesthesia on anxiety,labor analgesia,and motor blocks in parturients during natural delivery.METHODS A total of 120 women who gave birth at Changning District Maternal and Child Health Hospital between December 2021 to December 2022 were included;a random number table approach was employed to divide the women into a control group and a joint group,with each group consisting of 60 women.The control group was given epidural anesthesia,while the joint group was given combined spinal-epidural anesthesia.The visual analog scale(VAS)was used to evaluate the degree of maternal pain.Comparisons were made between the two groups’conditions of childbirth and the duration of labor.Apgar scores were used to evaluate the status of the newborns at birth;Self-rating Anxiety Scale(SAS)and General Self-Efficacy Scale(GSES)scores,umbilical artery blood gas analysis indices and stress indices were compared between the two groups;and the frequencies of motor block and postpartum complications were analyzed.RESULTS In comparison to the control group,in the joint group,the VAS scores for the first,second,and third stages of labor were lower(P<0.05).The rates of conversion to cesarean section and postpartum blood loss in the joint group were lower than those in the control group(P<0.05).No significant differences were observed in the Apgar score,the duration of the first stage of labor,or the total duration of labor between the two groups(P>0.05).The second and third stages of labor in the joint group were shorter than those in the control group(P<0.05).When compared to the control group,the postpartum SAS score of the joint group was lower,while the GSES score was greater(P<0.05).Between the control group and the joint group,the differences observed in pH,arterial carbon dioxide partial pressure,arterial oxygen partial pressure,or arterial hydrogen ion concentration were not significant(P>0.05).Nitric oxide,cortisol,and adrenaline levels were lower in the joint group than in the control group(P<0.05).There were no substantial differences in Bromage grade or rate of complications between the two groups(P>0.05).CONCLUSION For parturients during natural delivery,combined spinal-epidural anesthesia can reduce anxiety,provide labor analgesia,shorten labor time,and reduce postoperative stress levels but did not result in a motor block.

Timing of Elective Repeat Cesarean Delivery at 38 Weeks versus 39 Weeks: Rate of Spontaneous Onset of Labor before Planned Cesarean Section and Impact on Maternal Outcome: A Retrospective Cohort Study

Background: The timing of elective repeat cesarean delivery at 38 weeks versus 39 weeks is still a debatable subject, both regarding maternal and neonatal outcomes. In the Saudi context, there is lack of local data to aid decision-making regarding the timing of elective repeat cesarean delivery. Objectives: To estimate the rate of spontaneous onset of labor before the planned gestational age for repeat cesarean section in women who were booked at gestational age of (39 0/7 - 39 6/7) weeks (W39) versus (38 0/7 - 38 6/7) weeks (W38) and to compare the rate of maternal composite outcome between these groups. Design: Retrospective cohort. Setting: This study was conducted at King Abdulaziz Medical City, Jeddah, KSA. Method: Delivery registry books were reviewed to identify all deliveries from 1 January 2014 to 31 December 2016 (3 years). All low-risk pregnant women who had 2 or more cesarean deliveries and who met the inclusion criteria were included. Results: A total of 440 women were included of whom 318 (72.3%) were planned for elective cesarean section at W38 gestational age and 122 women at W39 gestational age. Mothers planned at W39 had higher rate of emergency cesarean deliveries versus those planned at W38 (18.0% versus 10.4%, p = 0.030;RR = 13.06), most frequently due to early onset of contractions (16.4% versus 8.2%, p = 0.012;RR = 12.17) or cervical dilatation (11.6% versus 5.4%, p = 0.024, RR = 16.15). No difference in the incidence of individual or composite maternal complications was noted between the two groups. Mother’s age (OR 0.93, p = 0.018) and schedule date at W39 (OR = 1.94, p = 0.028) were independently associated with spontaneous onset of labor before the scheduled gestational age, while no association was found with parity, previous number of spontaneous vaginal deliveries, number of previous cesarean deliveries or interval from last cesarean delivery. Conclusion: Elective cesarean section scheduled at 39 weeks of gestation or beyond carries a higher risk of emergency cesarean section, with no significant increase in maternal complications. The identification of factors associated with spontaneous onset of labor before the planned gestational age should be carefully identified to determine the optimal timing.