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.

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.

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.

Review of Women’s Employment in Greece in the 20th and Early 21st Centuries

In the early 20th century,the role of Greek women in the working environment was considered complementary,and the type of work they would do should fit their Review of Women’s Employment in Greece in the 20th and Early 21st Centuries gender stereotypes.Therefore,they were low-paid workers and employees,and they were the first to be laid off.Despite the fact that the number of Greek women participating in the labor market has increased,many of them were obliged to work due to the high rate of men’s unemployment since there was no other way to sustain the living level of the household(Alpha Bank,2018).Greek women’s participation in the labor market was accompanied by an increase in flexible types of employment along with the pay gap between men and women,which remained persistent due to the existence of discrimination.

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.

A Study of the Effects of Employee Engagement on Job Satisfaction:Mediating Effect of Labor Relations Climate

With the rapid advancement of new technologies and the transformation of the economic model on a global scale,enterprises are facing unprecedented changes in the external environment and more diversified demands from employees.Therefore,it is essential for enterprises to bolster employee engagement by enhancing employees’job satisfaction,building a stable and harmonious internal climate,and adapting to the dynamic,complex external environment.This study analyzes the positive effects of employee engagement on job satisfaction,explores the mediating effect of labor relations climate in the relationship between the two,and proposes corresponding practical countermeasures and suggestions.

Effect of Resistance Training,Aerobic Exercise Before Doula-Assisted Delivery on the Psychological Well-Being and Labor Duration of Parturients

Objective:To investigate the impact of resistance training and aerobic exercise before doula-assisted delivery on the psychological well-being and labor duration of parturients.Methods:105 cases of parturients who gave birth in our hospital from February 2021 to April 2023 were included in this study.The patients were divided into a control group of 52 cases and an observation group of 53 cases.The patients in the control group received no particular intervention before delivery and only received doula assistance.The patients in the observation group received resistance training,aerobic exercise,and doula assistance prior to giving birth.After delivery,the mothers were observed for 2 hours in the delivery room and then returned to the maternal and infant ward.The observation indicators of the two groups were compared.Results:In comparison to the control group,the observation group exhibited shorter durations in the first,second,and third stages of labor,as well as the total delivery time.Additionally,the amount of postpartum blood loss at 2 hours was smaller in the observation group.The rate of cesarean section was lower,and the rate of vaginal natural delivery was higher in the observation group.Following the intervention,both groups of postpartum women showed decreased SAS and SDS scores compared to before the intervention.Moreover,the observation group had lower scores than the control group.These differences were all statistically significant(P<0.05).Conclusion:Resistance training and aerobic exercise before doula-assisted delivery can effectively improve the psychological state of parturients,shorten labor duration,increase the rate of natural vaginal delivery,and reduce pain and postpartum hemorrhage.

Research on the Reform Strategy of Integrating Labor Education into Landscape Design Curriculum

With the development of the new era,the concept of three-whole education has put forward a requisite where teaching must begin from the current state of student labor,integrate labor education into subject teaching,and cultivate and improve students’awareness of labor through practice and guidance.In this paper,the importance of integrating labor education into landscape design courses and the current state of integration are discussed.On this basis,the reform strategy of integrating labor education into landscape design curriculum is explored,laying a foundation for a better implementation of labor education.

Innovative Research on Funding and Educating People in Applied Colleges and Universities Under the Perspective of Labor Education

As an important part of the“Five Education,”labor education is a practical activity for cultivating labor values,labor skills,and labor spirit(also named craftsman spirit).This article points out the importance of integrating labor education into the process of“funding and educating people”in applied colleges and universities.It also explores the role of labor education as a starting point from the three aspects of labor values,labor skills,and labor spirit.It provides an innovative path for applied colleges to fund and educate people.

The Efficacy and Safety of Dinoprostone Vaginal Insert for Labor Induction Following Optimization of Standard Operating Procedure: A Retrospective Study in China

Background:The study aimed to assess the efficacy and safety of dinoprostone vaginal insert in labor induction following optimization of standard operating procedure(SOP)and to discover independent predictors of vaginal delivery.Methods:This study comprised 551 pregnant women who required cervical ripening with dinoprostone before induction of labor.Using univariate and multivariate analyses,independent predictors of vaginal delivery were identified.Results:443 of the 551 women(80.4%)gave birth vaginally.Vaginal delivery was predicted by maternal age(24-30 vs.<24,P<0.001;30-35 vs.<24,P=0.03),gestational age(P=0.005),birth weight(P<0.001),parity(P=0.001),pre-pregnancy BMI(P<0.001),premature rupture of membranes(P=0.001),meconium-stained amniotic fluid(P<0.001),fundal height(P<0.001)and the Bishop score(P<0.001).None of the women exhibited severe postpartum hemorrhage.Conclusions:The maternal age,gestational age,birth weight,parity,body mass index,premature membrane rupture,amniotic fluid contamination,fundal height,and the Bishop score were independent predictors of vaginal delivery.These may guide the clinical use of dinoprostone for induction of labor.

Research on Practical Pathways of Strengthening Labor Education for College and University Students in the New Era

Labor education is an essential component of college and university education that can help students to develop a strong work ethic,acquire practical skills,and better understand the value of work.Strengthening labor education for college and university students is an urgent need of the high-quality development of the society and the internal requirement of promoting the all-round development of individuals.This study analyzes the importance of strengthening labor education for college and university students in the new era and proposes four practical pathways which draw on labor courses and campus activities,social practices,scientific research projects,and internships.After implementing these pathways,a survey of 967 students showed that students’understanding and awareness of labor was deepened,their hands-on skills and interests in science and labor practices were improved,and they became more cordially respectful to the working class.Taken together,the exploration and practice of these pathways helps college and university students to recognize their abilities,strengths,and interests,and guides them to form good labor habits that permeate all aspects of their studies and lives.

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.

Labor Pain through the Eyes of Brazilian Women and Delivery Nurses

Objective: Understanding the perception of women who have recently given birth in a Brazilian hospital regarding labor pain and nursing involvement in the labor process. Methodology: exploratory, descriptive and qualitative study carried out in a Maternity part of the supplementary health system in the Federal District (DF). Data were collected between May and July 2015 through interviews using a semi-structured questionnaire. The sample consisted of 16 mothers and data analysis followed Bardin methodology in three phases. Results: The pain experienced during labor is surrounded by feelings and expectations. Both positive and negative feelings experienced by mothers were identified in the interviews and unanimous opinion was the fact that the second stage is the most painful period as continuous pain is experienced. Some of the participants compared pain with strong menstrual cramps, renal colic and back pain;others, said labor pain was the strongest ever experienced. The immediate contact with the newborn was referred to as a reward for coping with breast pain and suffering. Other factors such as the importance of follow-up, support and coping with the pain and care provided by health staff were also highlighted. Conclusion: empowerment of the mother and family through knowledge is considered an important tool to fight pain and cope with the birth process in a positive and physiological way, which in the long run promotes a cultural change in the population regarding the importance of vaginal birth.

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.

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.