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.

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.

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.

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.

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.

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.

The Practical Path of Labor Curriculum in Compulsory Education in China from the Perspective of Overlapping Influence Domain Theory

Since the new curriculum reform,labor education has gradually shed its marginalized position in the“five educations,”and the labor curriculum has become an independent course officially separated from comprehensive practical activity courses.Exploring the practical path of labor curriculum in compulsory education in China has become the primary task of labor education in China.Based on the practical situation of labor curriculum in compulsory education in China,drawing on the theory of overlapping influence domains,and from the perspective of collaborative education among family,school,and community,this paper proposes a curriculum practical path of“school-led”family-school-community collaboration and a curriculum practical path guided by“student-centered”sentiment,in order to provide references for the practice of labor curriculum in compulsory education in China.

Research on the Evaluation Index System and Prosperity Index System of Labor Relations in Enterprise

The quantitative model for evaluating labor relations in enterprise consists of two index systems. One system,which consists of 6 second level indices and 26 third level indices, deals with quantitative evaluation of the present situation of labor relations in enterprise. And the other system, which consists of 5 indices, deals with quantitative evaluation of the trend of future labor relations development.

Policy options and system supplies on socialization standard management of city agricultural laborers

It is a social system engineering to solve problems of city agricultural laborers, inevitably concerning series of social phenomenon and the social issues of the city and countryside relations, the government function, the city management, the fair efficiency, the population flows, the labor employment, the social security, and so on. Furthermore, it also involves the profoundly political and economic system reforms, the transformation of government functions, the system perfection, legal administration, the social stability in China. The city government, as the direct superintendent of the agricultural laborers, should adopt the conception of the system engineering to construct a new mechanism of the city agricultural laborers socialization standard management, which has a profound theoretical and practical significance.

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.

The Design of the Assistant Decision Support System of Cross-Regional Rural Labor Flow

The framework of the assistant decision support system of cross-regional rural labor flow is established,the system combines the cross-regional rural labor flow with DSS,which provides the leaders with the maximum assistant decision-making function in the regulation and guidance of rural labors as well as in relevant programs.The assistant decision support system functions are discussed,the function modules of this system are introduced from four aspects,including the analysis of labor flow,the prediction of labor flow,the regulation of cross-regional flow and the configuration of decision support system;based on the data base obtained from dynamic tracking of the migrant workers and combining other data sources,the data warehouse model is established,for example,in the analysis of the labor migration times,a star multi-dimensional data model is designed from the time dimension,place dimension,the type of work dimension,accompaniers dimension and so on;the trans-regional flow of rural labor force is analyzed and predicted by using OLAP from the labor's migration times,migration places and other various perspectives.The operation principles of the assistant decision support system of trans-regional labor flow are introduced,it is pointed out that the system serves the policy-makers of the regulation of labor flow and other relevant enterprises,the system will play an important role in the tracking monitoring and cross-regional regulation of the rural labor flow.

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.

Improve Labor Contract System, Safeguard Lawful Rights and Interests of Laborers——An interview with Prof. Guan Huai of Law School of Renmin University of China

EDITOR＇S NOTE： The Draft Labor Contract Law of the People＇s Republic of China has been completed and was published for soliciting comments on March 20. In a short period of one month, 191,849 pieces of comments and opinions were received. Prior to the promulgation of the law, this reporter interviewed Mr. Guan Huai, a noted Chinese expert in labor law, professor of the Law School of the Renmin University of China and law advisor to the All-China Federation of Trade Unions.

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.

A systematic Review of the Safety and Effectiveness of Epidural Analgesia for Labor Analgesia

Objective To re-evaluate the systematic review of the safety and effectiveness of epidural analgesia(EA)for labor analgesia.Methods The Cochrane database,PubMed,EMBASE,EBSCO,Web of Science,ScienceDirect,China Biomedical Literature database,CNKI,Wanfang and VIP databases were searched,and the search time was limited to August 2020.Two researchers screened the literature and extracted data according to the inclusion criteria.AMSTAR was used to evaluate the methodological quality of the included studies.Pain intensity and pain relief satisfaction were used as the main indicators for re-evaluation of the effectiveness.Midwifery rate,cesarean section rate,back pain,fever,nausea and vomiting,umbilical artery pH value,and newborn Apgar score were used as the main indicators to re-evaluate the safety.Results and Conclusion A total of 9 meta-analyses were included.The safety and effectiveness of EA and opioid intravenous analgesia,acupuncture stimulation,inhalation analgesia,no analgesia,and continuous delivery were evaluated separately.The included systematic reviews showed that EA could increase the rate of device-assisted delivery,causing maternal fever,and prolonging the first and second stages of labor.But the incidence of back pain,nausea,and vomiting was lower.Therefore,analgesia had a good effect with better satisfactory degree.Current evidence shows that EA is safe and effective for labor analgesia,but the quality of the reports of current studies is not high.

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.

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.

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.

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.