A review and comparison of common maternal positions during the second-stage of labor

The second-stage of labor is the most stressful part of childbirth process and the proper maternal position during this period is paramount for women's safe vaginal birth.Midwives play a pivotal role in managing maternal positions during the second-stage of labor.However,there is limited evidence to support an ideal maternal position during the second-stage of labor.Further,the difference between different maternal positions might not be apparent.This paper aims to review and compare the benefits and risks of common maternal positions during the second-stage of labor,thereby to provide midwives evidence-based practical guidelines.

Clinical Effects and Mechanism of Chanlibao in Accelerating Second Stage of Labor

To observe the clinical effects and the mechanism of Chanlibao (CLB, a preparation of Chinese herbal medicine) in accelerating second stage of labor, primiparae were divided into 3 groups at random. CLB or oxytocin (OTC) was given to the CLB group ( n =80) and the OTC group ( n =52) respectively. The third group served as controls ( n =29). The control group consisted of women experiencing natural labor and to whom no drug was given. The time of second stage of labor and prognosis of mother and newborn of different groups were observed and compared. And intrauterine pressure and fetal heart rate were monitored by means of electronic monitoring. Isolated uterine muscular tissue was used to observe the reactivity to CLB. The results showed that the time of second stage of labor and postpartum hemorrhage in the CLB group were less than those in the control group and the average intrauterine pressure in the former was higher than that in latter, so was the contraction strength of isolated uterine muscle, but with no difference as compared with the OTC group. No side effect of CLB was found. It is concluded that CLB could obviously strengthen uterine contraction and accelerate second stage of labor. Moreover, it is inexpensive, convenient and free of side effect. It can be used as a new, safe and effective alternative for improving prognosis of mother and newborn, especially those not indicated for oxytocin or profuse infusion.

Effect of prolonged second stage of labor on maternal and neonatal outcomes

Objective:To discuss the effect of prolonged second stage of labor on maternal and neonatal outcomes.Methods:A total of 101 primiparas with the length of second stage of labor longer than 2 h were selected and pregnant women with the length less than 2 h served as control.The maternal and neonatal outcomes of two groups were observed and compared.Results:A total of 62.1%(18/11) with the length of second stage of labor between 120 min and 180 min,46.7%(28/32) between 181 min and 240 min and 12 longer than 241 min underwent vaginal delivery.The longer the length of second stage of labor,the lower score of Apgar scale for infants in 1 min,and the higher the incidence of asphyxia.But there was no difference in scale in 5 min.As second stage of labor prolonged,the incidences of cesarean section and of postpartum hemorrhage increased. Conclusions:Almost half of puerperas with the length of second stage of labor longer than 2 h underwent vaginal delivery.The prolonged second stage of labor can decrease the score of Apgar scale in 1 min,increase the incidence of asphyxia,but has no effect on scale in 5 min.It still need more evidence from evidence medicine to definition of time and treatment of second stage of labor.

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.

Adapting the Stage of Change model to investigate adolescent behavior related to reducing second hand smoke exposure

Aims: Second hand smoke (SHS) exposure is increasingly recognized as a major public health concern. Assessing adolescents’ motivational level to avoid SHS is vital to promote and reinforce reductions in SHS exposure. Methods: A brief measure based on the Stage of Change model was developed to characterize adolescents’ behavior related to reducing SHS exposure and used to identify potential determinants of SHS stage of change. The sample consisted of 1172 adolescents aged 13 to 15 years who participated in an internet-based cohort study of youth in British Columbia, Canada. Results: Sixty-six percent of the adolescents reported they had consistently made efforts to reduce exposure to SHS for more than 6 months, while 19% did not intend to reduce their exposure to SHS in the next 6 months. Adolescents’ SHS stage of change significantly differed by ethnicity, whether they had tried cigarettes, amount of tobacco smoked in their lifetime, parental and peer smoking statuses, past months’ exposure to SHS, frequent smoking in the home, and home smoking restrictions (all p < 0.05). Active smoking and more frequent exposure to SHS were associated with an increased probability of being in the pre-contemplation stage of change with regard to behavior related to reducing SHS exposure. Conclusion: This brief measure based on the Stage of Change model can be used in future studies to characterize adolescents’ behavior around SHS. Adolescents who smoke or have parents and/or friends who smoke appear to be a population that could benefit from stage-matched interventions designed to raise awareness of the risks associated with SHS for smokers and non-smokers, and ultimately reduce SHS exposure.

Materno-Foetal Morbidity in the Second Stage of Labour: A Cohort Study in Primiparous Women in Yaounde

Introduction: Prolonged Second Stage of Labor (SSL) is known to increase maternal and foetal morbidity. We, therefore, aimed to assess for the occurrence of complications of the SSL in relation to its duration in primiparous women in Yaounde. Methods: It was a cohort study carried out at the Yaounde Gynaeco-Obstetric and Paediatric Hospital over a period of 6 months, from December 19, 2018 through May 3, 2019. We included for the study nulliparous pregnant women with singleton pregnancies and normal uteri. Data collected were analysed using EPI info 7 and SPSS version 2.0 software. Results: Amongst 327 nulliparas, the SSL lasted more than one hour in 120 (36.7%), and more than two hours in 42 (12.8%). The most common maternal complications observed were genital lacerations (23.6%;28/120), instrumental deliveries (20.2%, 24/120), post-partum haemorrhage (8.9%). Foetal complications included caput succedaneum (15.2%;18/120) and perinatal asphyxia (7.5%;9/120). Maternal complications were significantly increased in women with an SSL lasting 1 - 2 hours (44.9% versus 22.7%;p < 0.001) and >2 hours (42.9% versus 22.7%;p = 0.007). Similarly, for foetal complications 23.1% occurred with SSLs between 1 - 2 hours (versus 6.3%;p < 0.001) and 19.0% for SSLs > 2 hours (versus 6.3%;p = 0.007). Conclusion: Maternal and foetal complications increase when the SSL exceeds 1 hour in primiparas. Identifying factors that predispose to a prolonged SSL and indicating appropriate interventions could help prevent morbidity.

Plasma motilin concentration in the second and third trimesters of pregnancy and postpartum

Plasma motilin concentrations were measured in 135 women during the second andthird trimesters of pregnancy and 3～5 d after delivery and the results were compared withthose of 20 healthy nonpregnant women.The mean plasma motilin concentration (323.96±125.10 ng/L) in women during the second trimester of pregnancy was lower than in healthynonpregnant women (366.12±96.23 ng/L) (P【0.05),but that was significantly higher thanin women during the third trimester of pregnancy (121.04±27.00 ng/L) (P【0.01);theplasma motilin concentration in women during 3～5d after delivery (443.05±140.79 ng/L)was significantly higher than that in pregnant women (P【0.01).The results showed thatpregnancy appears to have a profound inhibitory effect on plasma motilin,and this may partlybe responsible for the gastrointestinal hypomotility associated with pregnancy.

Uterotonic drugs use for post partum hemorrhage: An audit of the third stage of labor management

Objectives: Worldwide the use of uterotonic drugs has significantly reduced maternal mortality from postpartum hemorrhage. The objective is to audit the use of uterotonics in the active management of the third and fourth stages of labor. Methods: Personal data, diagnostic clinical information, blood loss and uterotonics administered were extracted from a cohort of 634 consecutive parturient. Trend in Shock Index (Pulse Rate/Systolic Blood Pressure) and 48 hours hematocrit changes were computed and analyzed. Results: There were 422 vagina deliveries and 212 caesarean sections. Primiparous mothers were 141 (34.2%), while grand multiparous mothers were 14 (3.4%). The mean visually estimated postpartum blood loss 165.9 ± 80 ml. There was no significant difference in the mean blood loss between the three parity groups of parturient [P = 0.09]. Fourteen parturient (3.44%) had blood loss ≥500 ml. The value of Shock Index (Pulse Rate/Systolic Blood Pressure) in the study ranged between 0.43 and 1.38. Logistic regression analysis of the variables associated with the switch between the three regimens of uterotonic drugs, showed a significant positive correlation between VEBL and uterotonic drugs administered [Pearson correlation = 0.130, P-value = 0.008]. In addition, there was a significant negative correlation between uterotonic drugs administered and Shock Index at 30 minutes and 2 hours postpartum. The correlation coefficient between VEBL and regimens of uterotonic drugs used was positive and significant (P = 0.019). Conclusion: Visually estimated blood loss, with shock are the main Triggers involved in switching between uterotonic drugs regimens used in active management of PPH. Shock index calculation is vital in management decision. We advocate training of all birth attendants on VEBL.

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.

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.

徒手旋转胎头术在头位难产产妇第二产程分娩中的协助应用观察

目的:分析徒手旋转胎头术在头位难产产妇第二产程分娩中的协助应用效果。方法:回顾性分析2020年1月至2023年12月于本院分娩的56例头位难产产妇资料,依据第二产程是否使用徒手旋转胎头术分为两组,各28例。对照组采取传统第二产程分娩助产护理,观察组采取第二产程徒手旋转胎头术,统计产程总时间、新生儿神经行为评分、分娩结局并进行对比。结果:观察组的第二分娩产程明显短于对照组,观察组产程总时间明显短于对照组(P<0.05),第一和第三产程两组无明显统计差异(P>0.05);观察组新生儿神经行为各项评分均高于对照组(P<0.05);观察组阴道裂伤、新生儿窒息及产后出血率均低于对照组(P<0.05)。结论:第二产程徒手旋转胎头术的运用能够改善头位难产产妇分娩结局、促进新生儿神经行为发育、缩短产程总时间,具有一定的推广使用价值。

家属陪护下温馨助产模式对初产妇分娩结局及产后恢复影响

目的:观察家属陪护下温馨助产模式对初产妇分娩结局及产后恢复的影响.方法:纳入2022年4月-2023年5月本院产科收治的115例初产妇,随机数字表法分为对照组(58例)与观察组(57例),对照组行常规分娩护理,观察组开展家属陪护下温馨助产模式护理干预,对照组脱落2例,观察组脱落1例,比较各组分娩结局、新生儿结局、产妇产后出血量以及分娩疼痛(改良面部表情疼痛评估工具,FPS-R)、产后焦虑(SAS)与抑郁(SDS)自评量表评分、总产程与住院时间、产妇护理满意率.结果:两组顺利阴道分娩率均为100.0%,观察组分娩后并发症率(0)低于对照组(7.1%),新生儿不良事件发生率(0)低于对照组(8.9%),产妇产后出血量(216.2±10.8ml)少于对照组(289.7±15.2 ml),FPS-R评分(7.9±0.4分)低于对照组(8.9±0.5分),SAS(36.5±3.0分)与SDS(34.8±5.2分)评分低于对照组(42.4±3.8分、41.8±4.8分),总产程(516.23±9.76min)与住院时间(2.14±0.22d)均短于对照组(612.34±10.65 min、2.95±0.26d),产妇护理满意率(96.4%)高于对照组(85.7%)(均P<0.05).结论:家属陪护下温馨助产模式可较好缓解产妇心理不良状态,改善分娩结局,促进产后恢复,降低不良分娩结局,产妇较为满意.

英国新工党政府第二代福利制度对单亲家庭的影响

20世纪70年代中期以来,随着经济社会的剧烈变动,英国传统福利模式逐渐陷入难以为继的困境。20世纪90年代初,以托尼·布莱尔为代表的新工党适时提出“第二代福利理论”,并在1997年上台执政后逐步完成其制度建构,这一变革改变了英国政府在单亲家庭问题上的施政传统。第二代福利模式重新定义了单亲家长的角色身份,同时在政府对单亲家庭的责任范围、单亲家庭与公私部门关系等方面作出新的诠释,最终对改善单亲家庭问题产生了积极而有效的影响。

中国式学校体育现代化中的“五育并举”

历经四个发展阶段,党的教育方针从德、智、体“三育全面发展”拓展成德、智、体、美、劳“五育并举”,这是中国教育在新时代面对人才培养的现实主题,是应对新征程中国教育的发展要求而进行的目标拓展和改革举措。研究发现,从中国式学校体育现代化的视角来看,“五育”中的体育是一个极具特殊性的教育和学科,它在功能上与德育、智育、美育及劳动教育有着深刻内在的结构性联系,因此它具有与其他“四育”可以深入融合共育的广泛可能性。鉴于推进“五育并举”过程中会遇到的结构性障碍与困难,分别提出了体育与其他“四育”并举并进的途径与方法,推进体育成为“五育并举”的主渠道、主战场和主力军。

第二产程侧卧位对低危初产妇分娩结局影响的范围综述

目的了解第二产程侧卧位分娩的相关研究现状,明确该领域未来的研究方向,促进临床更合理地应用分娩体位。方法使用澳大利亚JBI更新版范围综述的制作指南和理论框架作为方法学指导,同时采用PRISMA-ScR作为报告清单,检索PubMed、Embase、Web of Science、CINAHL Plus、ProQuest Dissertations&Theses、中国知网、万方数据库、维普中文科技期刊数据库、中国生物医学文献数据库、中国博士/硕士学位论文全文数据库、中国学位论文全文数据库中针对第二产程侧卧位分娩的相关研究,检索时限为建库至2022年11月25日,并对所纳入的文献进行数据提取和分析。结果共纳入45篇文献,各研究第二产程侧卧位分娩的干预措施差距不大,研究结果显示相较于传统体位,该干预措施能改善低危初产妇的母婴结局指标,但需满足更多助产士人力资源及助产护理等要求。结论第二产程侧卧位分娩在改善低危初产妇母婴结局指标上具有优势,可考虑作为一种新型分娩体位应用于临床,但未来仍需要更多的高质量及大样本研究验证该体位在临床中的可行性。

上颌窦内提升术最佳二期修复时间的有限元分析

背景:牙缺失区由于缺乏功能性加载产生的力学刺激,导致牙槽骨萎缩、骨质丢失,致使牙种植体不能有效埋入。因此种植修复时就需要植入骨粉,弥补牙槽骨高度不足对种植体稳定度的影响。目的:借助有限元分析法从生物力学角度得出种植体二期修复的最佳时间点,为临床缩短种植疗程选择正确二期修复时间点提供了生物力学基础。方法:采集1名女性健康志愿者颅面骨拍摄的锥形束CT,建立正常上颌骨模型、16缺失采用常规种植术(模型B)和16缺失采用上颌窦内提升术(模型A)后的上颌骨三维有限元模型。模型A在黏膜与上颌窦底之间以羟基磷灰石骨粉填充,模型B和正常上颌骨模型无需植骨。设置植骨愈合时间为术后的3-9个月,于术后3-5个月施加200 N的力在邻牙上,6-9个月直接施加在种植体上,模拟二期修复对种植体施加载荷。借助种植体及周围的软硬组织对3种模型进行生物力学分析。结果与结论:①种植体直接加载时,模型A上的应力在103 MPa左右、模型B上的应力在95 MPa左右。植骨后会增加种植体的应力值,而不做植骨则能降低种植体和整个系统的应力。随着骨粉强度的增加,牙槽骨上的应力值随之降低。②当愈合时间到术后6-9个月,在种植体或相应的第1磨牙牙位加载时,正常模型中的应力值最小,模型B次之,模型A最大;植入种植体后的上颌骨的应力大于正常上颌骨。③模型整体松质骨应力水平,在6-9个月模型A的松质骨应力略呈下降趋势,模型B应力水平显著低于正常下颌骨模型。④结论:利用原有的牙槽骨进行修复能提高种植体存活率;植骨后在获得足够的牙槽骨高度的情况下,可在6个月后考虑二期修复。临床应用时可根据患者的骨质、生活习惯、年龄等因素综合判定后,在此基础上适当调整二期修复时间。

以第二产程中经会阴超声所测进展角预测分娩方式:Meta分析

目的采用meta分析观察以经会阴超声于第二产程所测进展角(AOP)预测分娩方式的价值。方法检索数据库中2018年1月1日—2023年8月31日收录的有关第二产程超声测量AOP以预测分娩方式的中英文相关文献,由2名研究者根据纳入、排除标准筛选文献并提取资料,评估以经会阴超声于第二产程所测AOP预测分娩方式的价值;以诊断试验质量评价工具-2(QUADAS-2)评价纳入文献的质量。结果最终纳入11篇研究、2315名产妇。meta分析显示,在第二产程中以经会阴超声所测AOP预测分娩方式的合并敏感度(Sen)、合并特异度(Spe)、合并阳性似然比(+LR)、合并阴性似然比(-LR)及合并诊断比值比(DOR)分别为0.80[95%CI(0.76,0.83)]、0.83[95%CI(0.78,0.88)]、4.8[95%CI(3.5,6.6)]、0.24[95%CI(0.20,0.29)]及20[95%CI(13,30)];其汇总受试者工作特征曲线下面积为0.88。结论在第二产程中以经会阴超声所测AOP预测分娩方式的效能较好,可作为能否自然分娩成功的预测指标。

困境与突破:新时代高校劳动教育的创新实践进路

教育与劳动相结合,是马克思主义重要主张。新时代背景下,加强劳动教育工作,强化提升学生劳动素质,对于学生个体成长和国家长远发展意义深远。针对当前高校劳动教育存在的问题和不足,迫切需要结合“德智体美劳”五育方针总体要求,发掘一切可以利用的劳动育人资源,推动高校劳动教育内容、方法、评价体系等要素的优化,重塑高校劳动教育新模式。学生公寓是高校育人的重要载体,依托学生公寓开展劳动教育有助于其落地落实,有效解决劳动教育师资短缺,切实提升学生劳动素养。

第二产程高半卧位体位分娩在硬膜外分娩镇痛中的应用研究

目的:探讨第二产程高半卧位体位在硬膜外镇痛分娩初产妇中应用的有效性及安全性。方法:采用随机数字表法将2021年5月1日至7月30日在杭州市妇产科医院分娩的120例孕妇随机性的分为研究组(n=60)和对照组(n=60)。对照组第二产程采用仰卧位体位用力,研究组在第二产程采用仰卧位体位用力30分钟,未见胎头拨露时改为高半卧位体位用力。比较不同分娩体位对硬膜外镇痛分娩初产妇的第二产程时长、分娩方式、产后出血量、会阴损伤情况、分娩用力经验感受及分娩控制感的影响,比较新生儿窒息的情况。结果:研究组宫口开全至胎头拨露时长、宫口开全至胎头着冠时长、第二产程时长均短于对照组;自然分娩率高于对照组;会阴切开率和会阴Ⅱ级裂伤率低于对照组;产时+产后2小时出血量少于对照组;分娩体验感及分娩控制感分数高于对照组,差异均有统计学意义(P<0.05)。新生儿1分钟Agpar评分与5分钟Agpar评分在两组比较差异无统计学意义(P>0.05)。结论:硬膜外分娩镇痛下高半卧位体位的应用可以促进阴道自然分娩,缩短第二产程时间,减少会阴损伤情况,减少产后出血量,有较正向的分娩用力经验感受,可以增加分娩控制感。

间苯三酚联合缩宫素在单胎足月初产妇阴道试产中应用效果

目的:探究间苯三酚联合缩宫素在单胎足月初产妇阴道试产中的应用效果。方法:采用随机数字表法将2021年1月-2023年1月在本院接受阴道试产且阴道试产期间出现第一产程异常的197例初产妇分为单一组(98例)和联合组(99例),分别予缩宫素及间苯三酚联合缩宫素治疗,比较两组用药后产程进展情况、宫颈水肿发生率、用药后宫缩强度及母婴结局。结果:联合组用药至进入活跃期时间(77.3±35.5min)、活跃期时间(100.3±51.3min)、用药至宫口开全时间(55.4±25.7min)均短于单一组(117.6±51.5min、155.3±71.3min、85.4±43.2min),宫颈水肿比例(2.0%)低于单一组(9.2%),宫缩强度为强比例(76.8%)高于单一组(63.3%),自然分娩率(95.0%)高于单一组(84.7%),产时(150.4±55.4ml)及产后6h(250.5±38.3ml)出血量均低于单一组(200.5±44.3ml、291.4±40.6ml)(均P<0.05);两组产钳助产比例、胎位异常、巨大儿、头盆不称比例无差异(P>0.05),胎儿宫内窘迫比例联合组(0)低于单一组(7.1%)(P<0.05);两组新生儿出生后1min、5minApgar评分及新生儿体重均无差异(P>0.05)。结论:苯三酚联合缩宫素用于阴道试产第一产程异常初产妇,可有效促进产程进展,提升自然分娩率,降低产时及产后出血量。