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Background In Jordan, there is an overuse of treatments that were originally designed to manage complications of labour and birth. Aim To explore the reasons for the non-application of evidence-based practices in maternal care in a Jordanian governmental hospital from the healthcare professionals' perspective. Methods A descriptive qualitative method was employed in one selected Jordanian governmental hospital. Data were collected by conducting one-to-one, semi-structured interviews with 11 participants, which were subjected to a thematic and content analysis. Findings There were four main themes: limited human, financial, infrastructural resources and hospital environment; midwives are not autonomous; lack of motivation to apply evidence-based practices; and socio-cultural pressures hinder the usage of new evidence-based practices. Conclusion There is a weak application of evidence-based practices in maternal care in a governmental hospital in Jordan. So, it is important to modify maternal healthcare policy to allow greater midwife autonomy, and raise awareness of maternal evidence-based practice.

Term newborn infants without significant medical problems usually transition from fetal to newborn life without medical assistance. Infants requiring therapy often need care in a neonatal intensive care unit as opposed to a well-baby unit. Infants with unclear physiologic status or disease that may require therapies in the immediate newborn period may benefit from a period of observation with close monitoring before admission to a well-baby unit. Whenever possible, providing care for a newborn infant in an area that provides care for the newborn and mother together in the same room facilitates adaptation to normal breastfeeding and family bonding.

Background:It is dynamic and difficult to study midwifery, and is students accepted into the labor wards or not this affects the students learning. Therefore the study aimed to assess the challenges of nursing students regarding their expectations and satisfaction before and after entering delivery room. Method: An exploratory descriptive study design was used Sample: A purposive sample, all technical institute nursing students (91)who were attending the delivery unit during studying maternity and neonatal nursing course at study year 2018-2019,Setting: in General Damietta hospital. Tools: two tools, a self-administered questionnaire of three parts was developed by the researchers, includes questions about the students’ expectations, students' knowledge about labor and satisfaction, and a modified scale was also used. Results: Regarding students' expectations more than two third of students expected to be welcomed from mothers, and around half of students expected that nurses following the principle of infection control, nurses instructed women regarding bearing down and less than two-thirds of them were satisfied with the practical training and a sense of belonging and identity. Conclusion: Nursing students are faced with many challenges in the clinical learning, there were highly statically significant differences found between before and after entrance for many of their expectations, and some ’expectations were achieved. Students were satisfied with their clinical achievements after attending delivery room. Recommendations: Implement Students orientation programs pre attending delivery room include, prepare students, avoid causes of students fears and anxiety, and increase training through simulators, videos and integration of nursing ethics.

The rupture of the membranes in the presence of a mature cervix and strong contractions never prolong labor. The results of a preliminary study of 30 mothers who experienced rupture of the membranes, 16 of them had a long second stage of labor, and 14 mothers experienced a normal second stage of labor. The aim of the study was to determine the description of the duration of the second stage of labor based on amniotomy at RSUD 45 Kuningan. The research method used was descriptive using partograph sheets in a retrospective way taken from secondary data, the number of samples was 140 respondents, the total sampling technique was the total sampling technique, namely all women who gave birth vaginally at RSUD 45 Kuningan Regency in January-June, analysis data using univariate. The results of the analysis, most of the mothers gave birth at RSUD 45 Kuningan, out of 140 respondents, most of whom did not undergo amniotomy as much as 77.1%. All mothers who did not undergo amniotomy for the duration of the second stage of labor were 100% normal. The results of this study were all women who gave birth who did not undergo amniotomy, the duration of the second stage of labor was normal. It is hoped that health workers will improve the quality and competence of themselves in health services, especially midwives in the delivery room in providing delivery care, especially during the second stage in accordance with midwifery care standards.

Fetal distress during intrauterine is related to many factors. Knowing the risk factors will provide an effort to prevent and detect early fetal distress cases. The objective was to determine the risk factors for fetal distress during intrauterine treatment at dr. H. Slamet Martodirdjo Pamekasan. The method used is analytic observational with a cross-sectional method and the sample is simple random sampling. Samples taken were 184 patients in the delivery room dr. H. Slamet Martodirdjo general hospital Pamekasan. Data was taken by observation from patient medical records during 2018. Through this study, 92 patients experienced intrauterine fetal distress. The main risk factors for fetal distress was umbilical cord twists (p: 0.003, OR: 6,857, 95% CI: 1,914-24,572) and protective factors were maternal anemia (p: 0.018, OR: 0.141, 95% CI : 0.028-0.714). There are several risk factors for fetal distress during the intrauterine process at dr. H. Slamet Martodirdjo Pamekasan, the main factor was umbilical cord twisting where pregnant women with umbilical cord twists have a 6 times risk of experiencing fetal distress compared to those who do not.

Objective Current delivery room (DR) resuscitation utilizes pressure-limited devices without tidal volume (TV) measurements. Clinicians use chest expansion as a surrogate, which is a poor indicator of TV. TV in early life can be highly variable due to rapidly changing lung compliance. Our objectives were to assess feasibility of measuring TV in DR, and to report the generated TV in intubated patients. Study design Prospective, observational, feasibility study in infants 6 ml/kg) provided 47.7% of times. Conclusion TV measurement in DR is feasible. It is associated with high intra and inter-patient variability.

Background and objective: Human dignity which is defined as respect to human individu-ality is a highly recommended necessity to be taken into account in medical settings to de-liver high-quality services and raise the patients’ satisfaction. Due to a lack of well-defined provisions and instructions in midwifery practice in the Kurdistan region of Iraq, human dignity is threatened in this field. The present study was an attempt to figure out the meaning of patient dignity, what threatens patients’ dignity, and how to promote patients dignity in midwifery settings in maternity departments and clinics in Erbil, in the Kurdistan region-Iraq. Method: The present qualitative study was conducted on 10 Kurdish registered midwives who were working delivery room of Maternity Teaching Hospital and Dyke Private Hospital located in Erbil, Iraqi Kurdistan. In-depth semi-structured interviews were conducted with the midwives to collect required data. The interviews were recorded and then transcribed verbatim and analyzed using the six methodological activities proposed by Van Manen, and the themes and subthemes were extracted. Results: Analyzing the transcribed interviews resulted in emergence of one main theme, namely “need for holistic support” which had subthemes, namely “need for medical sup-port”, “need for mental support”, and “need for sympathetic support”. Conclusion: Human dignity of pregnant and childbearing mothers in maternity depart-ments and clinics is relatively low due to lack of sufficient equipment and facilities and in-sufficient number of midwives and maternity staff. Therefore, appropriate measures need to be taken in these regards.

In this prospective study, we evaluated postpartum voiding dysfunction stratified by mode of delivery - vaginal delivery versus elective caesarean delivery (CD). We recruited nulliparous women carrying singleton gestation at term admitted to delivery room or elective CD. Pre-labour voiding function was assessed by recording the post-voiding residual volume (PVRV) using a bladder scan. PVRV evaluation was repeated at least 12 hours following delivery and before discharge. PVRVs were considered abnormal if ≥150 mL. PVRVs were compared between vaginal and CD. Overall, 54 women were included. Of them, 34 (63%) delivered vaginally and 20 (37%) had an elective CD. Postpartum mean PVRVs were significantly higher compared to pre-labour PVRVs (215 vs. 133 mL, p

Hintergrund Das deutsche Infektionsschutzgesetz (IfSG) fordert, in Kliniken effektive Maßnahmen zur Vermeidung nosokomialer Infektionen umzusetzen. Die Coronapandemie führt uns vor Augen, wie wichtig adäquate Hygienemaßnahmen bei der Infektionsvermeidung sind. Fragestellung Zusammenstellung gängiger Basis-Hygienemaßnahmen für die klinische Geburtshilfe. Material und Methode Besprechung einschlägiger gültiger deutscher Richtlinien, bezogen auf die Tätigkeit im Kreißsaal. Entwicklung von Empfehlungen zur hygienisch korrekten Betreuung der Geburt. Ergebnisse Empfehlungen zur Flächendesinfektion orientieren sich an definierten Risikobereichen. In Zusammenarbeit mit der Krankenhaushygiene müssen in einrichtungsinternen Hygieneplänen die Häufigkeit von Reinigung und Desinfektion festgelegt werden. Zur Vermeidung einer Selektion desinfektionsmitteltoleranter Keime ist die Beachtung von Wirkspektrum und Einwirkzeit eines jeden Desinfektionsmittels essenziell. Die Händedesinfektion ist die wirksamste Einzelmaßnahme zur Verhinderung nosokomialer Infektionen; eine Herausforderung stellt hier die konsequente Umsetzung der allgemein bekannten Indikationen zur Händedesinfektion im Alltag dar. Für die hygienisch korrekte Durchführung der Wassergeburt und Aufbereitung der Entbindungswanne sollten in jedem Kreißsaal Standards entwickelt werden, deren Effektivität regelmäßig zu überwachen ist. In einer Pandemie ergeben sich zusätzliche Hygieneregeln, abgestimmt auf den jeweiligen Erreger. Schlussfolgerungen Obwohl es an Wissen in Form von Richtlinien und Empfehlungen nicht mangelt, erfordert die Umsetzung der Basishygienemaßnahmen im Kreißsaalalltag Ausdauer und Engagement.

Background Several methods have been developed to improve the episiotomy skills of midwifery students. This study was conducted to determine the effect of episiotomy simulation training on the episiotomy skills of midwifery students and their state anxiety levels. Methods This study is a quasi-experimental randomized controlled trial. Its sample consisted of 68 third-year students in the midwifery department of a university in Turkey. The students were randomly divided into experimental (34) and control (34) groups. The study data were collected using a sociodemographic information form, the State Anxiety Inventory (STAI) and the Episiotomy Skill Assessment Form. All the data collection tools were administered during the fall semester of 2018-2019. Results After the delivery room practice, the simulation group had significantly higher Episiotomy Skill Assessment Form scores (p Conclusion The episiotomy skill performance of the students in the episiotomy suture simulation group was significantly higher than that of the control group, but the use of simulation did not reduce the students’ state anxiety.

ObjectiveTwin vaginal deliveries (VDs) are often performed in the operating room (OR) given the theoretical risk of conversion to cesarean delivery (CD) for the aftercoming twin. We aim to evaluate the cost-effectiveness of performing VDs for twin gestations in the labor and delivery room (LDR) versus OR.Study designWe conducted a cost-effectiveness analysis using a decision-analysis model that compared the costs and effectiveness of two strategies of twin deliveries undergoing a trial of labor: (1) intended delivery in the LDR and 2) delivery in the OR. Sensitivity analyses were performed to assess strength and validity of the model. Primary outcome was incremental cost-effectiveness ratio (ICER) defined as cost needed to gain 1 quality-adjusted life year (QALY).ResultsIn the base-case scenario, where 7% of deliveries resulted in conversion to CD for twin B, attempting to deliver twins in the LDR was the most cost-effective strategy. For every QALY gained by delivering in the OR, 243,335 USD would need to be spent (ICER). In univariate sensitivity analyses, the most cost-effective strategy shifted to delivering in the OR when the following was true: (1) probability of successful VD was less than 86%, (2) probability of neonatal morbidity after emergent CD exceeded 3.5%, (3) cost of VD in an LDR exceeded 10,500 USD, (4) cost of CD was less than 10,000 USD, or (5) probability of neonatal death from emergent CD exceeded 2.8%. Assuming a willingness to pay of 100,000 USD per neonatal QALY gained, attempted VD in the LDR was cost effective in 51% of simulations in the Monte Carlo analysis.ConclusionTwin VDs in the LDR are cost effective based on current neonatal outcome data, taking into account gestational age and associated morbidity. Further investigation is needed to elucidate impact of cost and outcomes on optimal utilization of resources.Key points· Cost effectiveness of twin VDs in the LDR versus OR was assessed.. · Twin VDs in the LDR are cost effective based on current neonatal outcome data.. · Attempted VD in the LDR was cost effective in 51% of simulations in the Monte Carlo analysis..

Background National audit data showed our hospital had one of the highest numbers of term admissions in the region during the period January until June 2017. Methods Authors conducted a quality improvement project aimed at reducing the number of term admissions in our neonatal unit. With retrospective audit during the pre-intervention phase (January until June 2017), we identified hypothermia and hypoglycemia as the two modifiable risk factors for term admissions. During the “intervention phase” from July 2017 until Dec 2017, authors introduced interventions in the delivery room and postnatal ward. Real-time data were collected during the post-intervention phase from January until December 2018. Results We had reduced the number of admissions with a diagnosis of hypoglycemia or hypothermia by 49% during the intervention phase and by 44% during the post-intervention phase. Conclusion This QI project reduced the number of term admissions with a diagnosis of hypoglycemia or hypothermia.

In women who give birth normally, about 90% of mothers feel labor pain Stage 1. Medically, the pain is categorized as sharp and hot or somatic-sharp and burning. The pain typically starts when the head appears in the vagina. The tissue between the vagina and the anus (perineum) is stretched tight due to the head pushing it open. The mother feels pain due to the tearing of the tissue. Labor pain causes anxiety and fear so that the need for oxygen increases, blood pressure increases, muscles become tense, this condition will lead to prolonged labor, and can be a contributing cause in the death of mothers and babies. To determine the factors that contribute to pain during the first stage of labor in the delivery room dr. Derajat Prawiranegara Hospital Serang in 2019. The research design used was descriptive observational research, to see the factors that contribute to the management of Stage 1 labor pain. The statistical analysis indicates a significant relationship between education, family support, and coping mechanisms with the management of period 1 intrapartum pain, with p-value < 0,05%, while the factors that were not related were age, and parity, for the Stage 1 of labor pain, because the P-value > 0.05%.

Aim: Barcelona Hospital Campus Vall D’Hebron (Hospital A) and Hospital Mollet (Hospital B) provide women with humanized maternity care, but there are differences in dimension and complexity. This study describes the obstetrical results and women’s childbirth satisfaction of these two Spanish hospitals. Design: A correlational descriptive study was conducted with 194 postpartum women. Methods: Satisfaction and birth experience were evaluated using the CEQ-E and the MCSRSS questionnaires. A bivariate and discriminant analysis was conducted to evaluate the relationship between satisfaction and the recorded variables. Results: There were significant differences between both hospitals in prenatal class attendance (p = 0.006), same midwife during all process (p = 0.000), and mode of delivery (p = 0.009). Significant association was found among overall satisfaction and immediate breastfeeding in the delivery room (p = 0.050), skin-to-skin contact (p = 0.004), beginning of labour (p = 0.031), and delivery mode (p = 0.011). The total questionnaires scores mean of CEQ-E and MCSRSS were Hospital A 66.97 and 130.64; Hospital B 67.98 and 129.98, respectively. Women at both hospitals were satisfied with different aspects. Conclusion: Despite obtaining similar results in both hospitals, there are better obstetrical outcomes in hospital B with less complexity. However, women’s satisfaction scores are slightly different in certain questionnaires subscales between both hospitals.

Purpose: The purpose of this study was to determine HIV prevalence among participants admitted to the delivery room and recent birth attendants. Materials and Methods: This was a descriptive, cross-sectional, analytical study, with a prospective collection from February 1, 2018 to January 31, 2019 at fousseyni Daou Hospital in Kayes, Mali. Results: During our study period, we recorded 4269 deliveries. HIV-positive patients known before labour accounted for 0.21%. Four hundred and six participants received counselling/testing in the delivery room; of which 36 refused the test: 8.87% and 370 accepted or 91.13%. Thirteen patients tested positive or 3.51%. The 20 - 35 age group was the most represented at 76.92%. Positive patients tested received ARV treatment in the delivery room in 92.31% of cases; and 1 patient or 7.69% did not receive treatment for refusal. Vaginal delivery was the most common at 77%, with caesarean section 23%. Newborns had a good prognosis in their first weeks of life in 85%; fetal lethality was observed in 15% of newborns including 1 case of fresh stillbirth and 1 case of pediatric deaths for neonatal suffering. Conclusion: Counselling and voluntary HIV/AIDS testing during labour and immediate postpartum can detect many pregnant women who escape screening during antenatal consultations.

Background Respiratory distress syndrome (RDS) is the most common cause of respiratory failure in preterm infants. Treatment consists of respiratory support and exogenous surfactant administration. Commonly, surfactant is administered intratracheally. However, this requires airway instrumentation and subsequent fluid instillation which may be harmful. Surfactant nebulization (SN) may offer a safe and effective alternative for surfactant administration, but the clinical efficacy is not yet established. Thus, this systematic review and meta-analysis of randomized controlled trials will summarize the available evidence to determine the effectiveness and safety of SN for the prevention of intubation and subsequent mechanical ventilation at 72 h after birth. Methods A systematic literature search in Medline, Embase, and The Cochrane Library will be performed, and all randomized controlled trials (RCTs) and quasi-RCTs from published articles, presentations, and trial registries will be included in this meta-analysis. Titles and abstracts of all records identified in the search will be screened by two reviewers independently. Data on preterm infants (≤ 37 weeks) receiving nebulized surfactant in the first 72 h after birth for the treatment or prevention of RDS will be evaluated. Primary outcome is the intubation rate by 72 h after birth, and secondary outcomes include peridosing safety effects as well as major neonatal morbidities. Risk of bias will be assessed using the revised Cochrane ROB tool, and subgroup analyses will be performed to evaluate potential confounding factors. Publication bias will be assessed by examining a funnel plot. The meta-analysis will be performed using a fixed-effects model. Discussion This review will provide an evidence-based tool for information about surfactant nebulization, illustrating the current knowledge and hopefully revealing potential novel avenues for researchers and clinicians alike. Systematic review registration This review is registered with the publicly available resource PROSPERO (CRD42020175625).

Aim Following extreme preterm birth, there has traditionally been felt an imperative to rush baby to the neonatal unit for ongoing intensive care. Immediate needs of parents to bond with their babies through direct early physical contact have often been overlooked; many weeks can pass before parents get to hold their babies for the first time. Recognition of the importance of early contact is growing. We aimed to review the safety and value of routinely practising delivery room cuddles for extremely preterm babies. Methods We reviewed delivery room cuddles in babies born

Introduction:Congenital atrioventricular block is diagnosed in uterine life, at birth, or early in life. Atrioventricular blocks can be life threatening immediately at birth so urgent pacemaker implantation techniques are requested. Reasons can be cardiac or non-cardiac, but regardless of the reason, operations are challenging. We aimed to present technical procedure and operative results of pacemaker implantation in neonates.Materials and methods:Between June 2014 and February 2021, 10 neonates who had congenital atrioventricular block underwent surgical operation to implant permanent epicardial pacemaker by using minimally invasive technique. Six of the patients were female and four of them were male. Mean age was 4.3 days (0–11), while three of them were operated on the day of birth. Mean weight was 2533 g (1200–3300).Results:Operations were achieved through subxiphoidal minimally skin incision. Epicardial 25 mm length dual leads were implanted on right ventricular surface and generators were fixed on the right (seven patients) or left (three patients) diaphragmatic surface by incising pleura. There were no complication, morbidity, and mortality related to surgery.Conclusion:Few studies have characterised the surgical outcomes following epicardial permanent pacemaker implantation in neonates. The surgical approach is attractive and compelling among professionals so we aimed to present the techniques and results in patients who required permanent pacemaker implantation in the first month of life.

ObjectiveInformed consent is standard in research. International guidelines allow for research without prior consent in emergent situations, such as neonatal resuscitation. Research without prior consent was incorporated in the Vermont Oxford Network Heat Loss Prevention Trial. We evaluated whether significant differences in outcomes exist based on the consent method.DesignSubgroup analysis of infants enrolled in a randomised controlled trial conducted from 2004 to 2010.SettingA multicentre trial with 38 participating centres.ParticipantsInfants born 24–27 weeks of gestation. 3048 infants assessed, 2231 excluded due to fetal congenital anomalies, failure to obtain consent or gestation less than 24 weeks. 817 randomised, 4 withdrew consent, total of 813 analysed.Main outcome measureThe difference in mortality between consent groups.ResultsNo significant differences were found in mortality at 36 weeks (80.2%, 77.4%, p=0.492) or 6 months corrected gestational age (80.7%, 79.7%, p=0.765). Infants enrolled after informed consent were more likely to have mothers who had received antenatal steroids (95.2%, 84.0%, pConclusions and relevanceResearch without prior consent resulted in the inclusion of infants with different baseline characteristics than those enrolled after informed consent. There were no significant differences in mortality. Significantly higher Apgar scores in the informed consent group suggest that some of the sicker infants would have been excluded from enrolment under informed consent. Research without prior consent should be considered in neonatal resuscitation research.

Establishing effective respiration is vital in the transition from fetal to neonatal life. Respiratory support mainly facilitates and creates functional residual capacity and maintains adequate gas exchange. Sustained inflation (SI) delivers prolonged inflation and rapidly creates and establishes the functional residual capacity. The use of SI in preterm infants in the delivery room is still controversial. The optimum settings of SI remain unknown. Animal studies and clinical reports have demonstrated the advantages and disadvantages of SI. In this article, the current literature was reviewed to examine the efficacy of SI in infants.

Neonatatal mortalite istatistikleri incelendiğinde, önemli bir bölümünün yaşamın ilk günü meydana geldiği görülmektedir. Bu durum yenidoğanın doğum odasındaki bakım ve izleminin ne kadar önemli olduğunu ortaya koymaktadır. Doğum odasında yenidoğanlara yapılan uygulamalar arasında yer alan aspirasyon işlemi yaygın olarak kullanılmaktadır. Aspirasyon işlemine bağlı solunum ve dolaşım sisteminin çalışmasını olumsuz etkileyen birçok komplikasyon gelişebilmektedir. Bu açıdan yenidoğanda dikkatli uygulanması gereken bir girişimdir. Yıllar içerisinde yenidoğanlara doğum odasında yaklaşım uygulamaları değişiklik göstermiştir. Yenidoğan bakımına yön veren Dünya Sağlık Örgütü, Türk Neonatoloji Derneği, Amerikan Kalp Derneği ve Uluslararası Resüsitasyon Komitesi’nin güncel önerileri incelendiğinde, yenidoğanlara rutin aspirasyon işlemi önerilmemektedir. Ebelerin görev ve sorumlulukları arasında yenidoğanın ilk bakım ve muayenesi ve gerektiğinde acil resüsitasyon gerçekleştirmesi de yer almaktadır. Bu durum ebelerin yenidoğanın aspirasyon işleminde anahtar role sahip olduğunu göstermektedir. Bu açıdan ebelerin yenidoğanda aspirasyon ilkeleri hakkında ayrıntılı bilgi sahibi olması ve konuyla ilgili güncel yaklaşımları bilmesi önemli bir konudur. Aspirasyon yenidoğanlara doğum odasında oro-nazofarenks, endotrakeal ve mide içeriği aspirasyonu yöntemlerinde uygulanmakta ve ebelik bakımında önemli yer tutmaktadır. Bu makalede, yenidoğanın doğum odasında aspirasyon ilkelerinde güncel yaklaşımlar ve ebelerin rol ve sorumlulukları literatür bilgisi kapsamında derlenmiştir.

Background Neonatal mortality is a worldwide concern, especially in sub-Sahara Africa. Millions of newborn deaths could be prevented with quality care at birth. Objective To identify immediate newborn care provided by birth attendants and associated outcomes in the delivery room of a district hospital in Kabgayi, Rwanda. Methods This study used a descriptive cross-sectional design and convenience sampling strategy. The sample of 171 newborns and birth attendants were observed in the delivery room using a standardized checklist during April and May 2019. Descriptive statistics were used to analyze data. Results The majority (65.5%) of newborns were female, and at term (93.6%). The majority had mouth and nose cleared (60%), dried thoroughly (75.4%), wet cloth removed (57.3%), delayed umbilical cord clamping (67.3%), and immediate skin-to-skin contact (67.3%). Limited interventions included APGAR evaluation (28%) and breastfeeding within the first hour (36.6%). The majority of 135(78.9%) were stable, and none died. Conclusion The majority of the study population was stable, though all newborns did not benefit from standard immediate newborn care. To reduce neonatal mortality and morbidity in Rwanda, we need to redouble efforts to strengthen the quality of immediate newborn care. Future research is needed to identify effective training to improve newborn outcomes at birth. Rwanda J Med Health Sci 2020;3(2):238-249

To define the effects of attempted external cephalic version (ECV) in a low-risk population for breech delivery in a maternity hospital where breech vaginal delivery is widely practiced. Retrospective exposed—unexposed study including 204 patients presented with a live singleton fetus breech presentation on third-trimester ultrasound and who delivered at Reims University Hospital between January 1st, 2013 and July 1st, 2018. 121 patients received ECV. Cesarean section rate was lower (OR with no adjustment 0.42 [0.24–0.76] p = 0.004) but without significant difference in the exposed patients after adjustment. This difference was significant between exposed and unexposed patients in the subgroup of 51 primiparous (OR = 0.14 [0.04–0.52] p = 0.002) and 51 multiparous (OR = 0.26 [0.08–0.89] p = 0.028) but not in the subgroup of 102 nulliparous. There was no difference in fetal impact other than neonatal management in the delivery room, which is less needed in exposed primiparous women. Attempted ECV significantly decreased the breech rate (72.5 vs 100%, p

In the context of SARS-CoV-2 pandemic, the hospital management of mother-infant pairs poses to obstetricians and neonatologists previously unmet challenges. In Lombardy, Northern Italy, 59 maternity wards networked to organise the medical assistance of mothers and neonates with suspected or confirmed SARS-CoV-2 infection. Six “COVID-19 maternity centres” were identified, the architecture and activity of obstetric and neonatal wards of each centre was reorganised, and common assistance protocols for the management of suspected and proven cases were formulated. Here, we present the key features of this reorganization effort, and our current management of the mother-infant dyad before and after birth, including our approach to rooming-in practice, breastfeeding and neonatal follow-up, based on the currently available scientific evidence. Considered the rapid diffusion of COVID-19 all over the world, we believe that preparedness is fundamental to assist mother-infant dyads, minimising the risk of propagation of the infection through maternity and neonatal wards.

Background: Oxytocin is widely used in perinatal medicine, but it can cause serious side effects. Health professionals should be familiar with the pharmacokinetics, dosing regimen, and fetal effects of oxytocin. This study aims to explore the use of oxytocin by healthcare professionals during labor. Methods: This study was conducted in one medical faculty, one training and research hospital, one maternity hospital, and one private hospital in Adana, Turkey. The sample group included 107 participants. The data were gathered using a survey prepared in line with the literature. The survey was comprised of 30 questions. These questions concern the social demographic information of the participants, the knowledge and actual oxytocin use, and the views of the participants. The data were analyzed using descriptive statistics. Results: The average age of the participants was 36.76 ± 8.70 years, the mean of working experience in the delivery room was 7.79 ± 7.73 years. 85.6% of the participants who answered the question of possible effects of oxytocin as contraction, 57.9% of the possible side effects as fetal distress. 69.2% of the participants stated that they applied oxytocin after dilution in a fluid while 47% stated that they applied it after dilution in fluid with 5% Dextrose. While 40% of the participants responded that they sometimes forgot to administer medication, 39.2% stated that they did not register medication in their survey responses. Conclusion: It was determined that most of the participants answered the questions about the effect of oxytocin correctly, but they could not respond to all the side effects of oxytocin. It was found that most of the participants could not answer the storage conditions that are important for the effectiveness of the drug correctly. In addition, the importance level given to the principles of drug administration by the participants was generally found to be high.

A fin de contribuir al fortalecimiento de la atención integral a los recién nacidos (Neonatos), se realizó este estudio titulado: Factores de riesgos asociados a las sepsis neonatales en el hospital Nuevo Amanecer, durante enero-diciembre 2013. El estudio fue cuali-cuantitaivo, retrospectivo de corte transversal, con resultados más destacados, siendo la edad materna con 66% entre edades de 20-34 años, según la etnia predominan las madres miskitus en un 68%, en el estado civil madres de unión libre fueron mayoritarias con 42%, en cuanto a los factores maternos se destaca como IVU (infecciones de vías urinarias) con 31%, madres que cursaron con pre-eclampsia con 22%, así mismo los factores de riesgo más frecuentes como bajo peso al nacer con 45%, y seguido de prematuro de 29%, en cuanto a los factores de riesgo relacionadas al parto no son relevantes en nuestro medio ya que en la sala de labor y parto se cumple con la normativa de asepsia y antisepsia, y se realiza buena técnica de lavado de la región vulvo perineal, previo a la atención del parto, tomando en cuenta estos resultados se realizó recomendaciones a diferentes niveles como el Hospital Nuevo Amanecer, SILAIS y también a las usuarias de los diferentes servicios de salud.

Objective: It has been suggested that desaturations and bradycardia precede acute life-threatening events (ALTE) and that ALTE is more common in the delivery room than later in life. However, frequency, duration and severity of desaturations in the first hours of life and additional risk factors have not readily been studied. Methods: Term neonates (n = 100) were monitored for the first two hours after birth by pulse oximetry. The impact of maternal and perinatal factors on the frequency and severity of desaturations (Results: Desaturations were detected in 30%, prolonged desaturations in 25% of infants. Desaturations were observed significantly more often in infants born by planned Cesarean section (pCs) compared to other modes of delivery (pCs 20/49; others 10/51; p = .029). Desaturations were also more frequent in infants diagnosed with neonatal infection (NI) or infants born to a mother with gestational diabetes (GDM), although not significantly. No bradycardia Conclusions: In our collective 4% of healthy term neonates had prolonged, clinically relevant desaturations in the first hours after birth. The mode of delivery and maternal risk factors may increase the risk for these events. However, our cohort was too small to detect any ALTE or SIDS and determine potential risk factors for these events. Our data lay ground for a large-scale prospective trial to investigate whether the mode of delivery could be an indication for general pulse oximetry monitoring of newborn in the delivery room.

AIM: Flow Disruptions (FDs) are deviations from the progression of care that compromise safety and efficiency of a specific process. The study aim was to identify the impact of FDs during neonatal resuscitation and determine their association with key process and outcome measures. METHODS: Prospective observational study of video recorded delivery room resuscitations of neonates

Neonatal airway emergencies in the delivery room are associated with significant morbidity and mortality. Etiologies vary, but often predispose the neonate to life threatening airway obstruction. With the recent expansion of fetal medicine programs, pediatric anesthesiologists are increasingly being asked to care for these patients. In this review, we discuss common etiologies of difficult airway at delivery, management tools and techniques, and surgical approaches.

Objective This study aims to determine estradiol levels in mothers who experience postpartum blues. Methods It was a crossectional study conducted in Pertiwi Maternal and Child Hospital Makassar. The population was all mothers who had normal postpartum births on the third day from January to March 2018, and samples were 31 selected accidentally selected. Postpartum blues data was obtained with the Edinburgh Postnatal Depression Scale (EPDS) questionnaire and secondary data obtained from maternal medical records in the delivery room and nursing staff at the hospital. Estradiol levels examined using the enzyme-linked immunosorbent assay (ELISA) technique. Analysis of the data in this study Mann Whitney and data were performed using frequency and mean. Results Estradiol levels between mothers who experienced and those who did not experience postpartum blues were different significantly (p = 0.024, p Conclusion Levels of hormone estradiol are lower in mothers who have postpartum blues. It is needed individual attention to postpartum mothers so that those detected with very low estradiol levels can get treatment and prevention as soon as possible.

Congenital diaphragmatic hernia (CDH) is associated with high mortality rates and significant pulmonary morbidity, mainly due to disrupted lung development related to herniation of abdominal organs into the chest. Pulmonary hypertension is a major contributor to both mortality and morbidity, however, treatment modalities are limited. Novel prenatal and postnatal interventions, such as fetal surgery and medical treatments, are currently under investigation. Until now, the perinatal stabilisation period immediately after birth has been relatively overlooked, although optimising support in these early stages may be vital in improving outcomes. Moreover, physiological parameters obtained from the perinatal stabilisation period could serve as early predictors of adverse outcomes, thereby facilitating both prevention and early treatment of these conditions. In this review, we focus on the perinatal stabilisation period by discussing the current delivery room guidelines in infants born with CDH, the physiological changes occurring during the fetal-to-neonatal transition in CDH, novel delivery room strategies and early predictors of adverse outcomes. The combination of improvements in the perinatal stabilisation period and early prediction of adverse outcomes may mitigate the need for specific postnatal management strategies.

The care of infants born at the lowest extreme of gestation requires dedication, skill, and experience. Most centers apply a selective approach where intensive care at these gestational ages is being offered to a varying proportion of infants depending on the views and experiences of the medical community, the individual physician, and the parents. Consequently, the outcomes differ dramatically with survival rates at 22-23 weeks ranging from 0 to greater than 50%. This paper presents the approach in a center with a long tradition of providing a comprehensive and uniformly active care to all mother-infant dyads from 22+0 weeks of gestation. Important features outlined include prenatal maternal referral and transfer, delivery room management, and initial intensive care.

Introduction Video recording and video evaluation tools have been successfully used to evaluate neonatal resuscitation performance. The objective of our study was to evaluate differences in Neonatal Resuscitation Program (NRP) adherence at time of birth between three temporal resuscitative periods using scored video recordings. Methods This is a retrospective review of in-situ resuscitation video recordings from a level 3 perinatal center between 2017 and 2018. The modified Neonatal Resuscitation Assessment (mNRA) scoring tool was used as a surrogate marker to assess NRP adherence during daytime, evening, and nighttime hours. Results A total of 260 resuscitations, of which 258 were births via Cesarean section, were assessed. mNRA composite scores were 86.2% during daytime hours, 87% during evening hours, and 86.6% during nighttime hours. There were no significant differences in mNRA composite scores between any of the three time periods. Differences remained statistically similar after controlling for complexity of resuscitations with administration of positive pressure ventilation (PPV), intubation, or chest compressions. Conclusion Overall adherence to NRP, as measured by composite mNRA scores as a surrogate marker, was high across all three daily resuscitative periods without significant differences between daytime, evening, and nighttime hours.

Background and Objective: In Ethiopia, birth asphyxia causes ~30% of all neonatal deaths and 11–31% of deaths among neonates delivered in healthcare facilities that have breathing difficulty at birth. This study aimed to examine the impact of low-dose, high-frequency (LDHF) training for introducing a nurse-led neonatal advanced life support (NALS) service in a tertiary care hospital in Ethiopia.Methods: Through a retrospective cohort study, a total of 12,001 neonates born post-implementation of the NALS service (between June 2017 and March 2019) were compared to 2,066 neonates born before its implementation (between June 2016 and September 2016). Based on when the neonates were born, they were divided into six groups (groups A to F). All deliveries occurred in the inpatient Labor and Delivery Unit (LDU) at St. Paul's Hospital Millennium Medical College. The number of neonatal deaths in the LDU, neonatal intensive care unit (NICU) admission rate, and proportion of neonates with normal axillary temperature (36.5–37.5°C) within the first hour of life were evaluated. Data were analyzed using the χ2 test, and p-values < 0.05 were considered statistically significant. Following the implementation of the NALS service, semi-structured interviews with key stakeholders were conducted to evaluate their perception of the service; the interviews were recorded, transcribed, and coded for thematic analysis.Results: There was a decrease in the proportion of neonates who died in the LDU (from 3.5 to 1%) during the immediate post-implementation period, followed by a sustained decrease over the study period (p < 0.001). The change in the NICU admission rate (from 22.8 to 21.2%) was insignificant (p = 0.6) during this initial period. However, this was followed by a significant sustained decrease (7.8% in group E and 9.8% in group F, p < 0.001). The proportion of newborns with normal axillary temperature improved from 46.2% during the initial post-implementation period to 87.8% (p < 0.01); this proportion further increased to 99.8%. The program was perceived positively by NALS team members, NICU care providers, and hospital administrators.Conclusion: In resource-limited settings, LDHF training for neonatal resuscitation improves the neonatal resuscitation skills and management of delivery room attendants.

The third stage of labor begins after delivery of the infant and ends with the completed delivery of the placenta and its attached membranes, being a unique period in the transition from fetal to extrauterine physiology. The care of the newborn during this period needs updated knowledge since while the placenta persists attached coexisting with bidirectional umbilical flow, several changes interact to achieve neonatal circulatory and ventilatory autonomy. Consequently, the healthcare team must find the optimum moment to clamp the cord being important for terms and preterms. An engorged and pulsating cord, a sign of vitality, should be used in the clinical evaluation of the newborn added to other signs of physiological changes as the skin blue to pink during the first minutes of extrauterine life. Other aspects must be considered as transference of iron, cooling prevention, respiratory support as needed, and microbiota. In this sense the setting for maintaining together the mother and the baby needs redesigning the delivery room and the healthcare-team work.

Pregnancy in autoimmune rheumatic diseases remains a real challenge in clinical practice due to complex interplay between disease activity, pregnancy and drugs, and account for potential influence of pregnancy on rheumatic condition and the impact of disease on pregnancy outcomes. Indeed, innovative and successful therapies have dramatically improved the quality of life in immune-mediated rheumatic conditions and, subsequently, allowed more patients of reproductive age to plan a pregnancy/to conceive. The purpose of this chapter is to discuss emerging data about the interaction of pregnancy and systemic erythematosus lupus (SLE) focusing on modulation of the immune system by pregnancy, pregnancy outcomes in women with active lupus, biomarkers of adverse pregnancy outcomes (APO) including predictors of pre-eclampsia, predictors of obstetric complications in SLE, the influence of autoantibodies on fetal health, and, finally, evidence about rheumatologic and obstetric follow-up. There are still unmet needs in this new field of reproductive rheumatology and it becomes crucial that researchers, physicians (rheumatologists, specialists in maternofetal medicine, obstetricians) and midwifes share their knowledge and expertise in counseling women with SLE wishing to conceive, assisting pregnancy and managing different issues related to APO as well as drug optimization in preconception, during pregnancy and postpartum period.

Premature infants born after less than 25 weeks’ gestation are particularly vulnerable at birth and stabilization in the delivery room (DR) is challenging. After birth, infants born after

Introduction:Accurate temperature monitoring of neonates is vital due to the significant morbidities and mortality associated with neonatal hypothermia. Many studies have compared different thermometers in neonates, however, there is a lack of consensus regarding which of the currently available thermometers is most suitable for use in neonates.Objectives:The aim of this review was to identify and compare current methods available for temperature monitoring of neonates beyond the delivery room, including the accuracy, advantages and disadvantages of each.Methods:A recent search and narrative synthesis of relevant studies published between January 1, 1949 and May 5, 2021 on the OVID Medline, PubMed and Google Scholar databases.Results:A total of 160 papers were retrieved for narrative synthesis. The main methods available for temperature monitoring in neonates are human touch and mercury-in-glass, electronic, infrared tympanic and other infrared thermometers. Newer innovations that are also available include liquid crystal thermometers and the BEMPU TempWatch. This paper discusses the current evidence available regarding the utility of these devices, and identifies barriers to valid comparison of different thermometry methods.Conclusion:Many methods for temperature monitoring in neonates are currently available, each with their own advantages and disadvantages. However, the accuracies of different devices are hard to determine due to variable methodologies used in relevant studies and hence, further research that addresses these gaps is needed.

Improving the cardiopulmonary resuscitation quality in the delivery room is one of the most pressing issues in modern neonatology. Despite the fact that in recent years the number of surviving infants with low and extremely low birth weight has been steadily increasing, the nursing outcome is not enough favourable with unsatisfying quality of life. The cardiopulmonary resuscitation protocols have been regularly updated and upgraded (every five years in the last twenty years). This helps to improve resuscitation outcome. In 2015 the American Heart Association and the European Resuscitation Council issued the new edition of the guidelines on basic and advanced cardiopulmonary resuscitation in children, including infants. The guidelines are believed to improve the quality of resuscitation care in the delivery room and to contribute to a better neurological outcome.

Aim: Satisfaction with medical care is an important element of birth experience. The aim of this study was to attempt to assess the effect of location (birth centre and delivery room) on the experiences and opinions of labouring women concerning childbirth. Design: Cross-sectional study. Methods: Two hundred women after childbirth participated in surveys, which were conducted one-four days after childbirth. The research tools used were the authors' own survey questionnaire and a standardised tool: the Inventory to Measure Coping Strategies with Stress - Mini-Cope. Results: Women who gave birth at the birth centre more often considered that the delivery had met their expectations. Both the women who gave birth to children at the birth centre and those who gave birth in the delivery room wanted to have their next childbirth in the same place. Women who underwent childbirth at a birth centre rated the experience more highly than women who experienced childbirth in a delivery room, and also managed stress better during childbirth. Conclusion: Women who chose to have their birth at a birth centre and, thus, to experience it more fully, more often stated that the childbirth had met their expectations. They managed stress better during childbirth and gave significantly better assessments of the experience of childbirth.

We sought to determine if fetuses with prenatally diagnosed congenital heart disease (CHD) were more likely to undergo cesarean delivery in the setting of a non-reassuring fetal heart rate tracing (NRFHT) and to determine if those fetuses were more likely to have a fetal acidosis. A retrospective cohort study of neonates prenatally diagnosed with CHD from August 2010 to July 2016. The control group consisted of gestational age matched controls without CHD. Each group consisted of 143 patients. The most common reason for cesarean delivery was a NRFHT (control 31% vs CHD 35%, p = 0.67). Fetal acidosis was a rare outcome occurring in only five controls (3.5%) and 11 cases (7.7%) (p = 0.12). These findings demonstrate that with multidisciplinary care coordination, fetuses with a prenatal diagnosis of CHD have similar cesarean rates, labor and delivery management, and delivery room compromise as healthy fetuses.

RESUMEN Objetivo: determinar la adherencia global y por componentes a la estrategia minuto de oro en médicos que atienden recién nacidos en una entidad de mediano nivel de complejidad. Materiales y métodos: estudio de corte transversal; se incluyeron recién nacidos vivos de partos vaginales espontáneos atendidos por médicos pediatras, ginecólogos o internos en sala de partos de un hospital universitario de la ciudad de Cali, Colombia, en el 2017. Se excluyeron fetos con mal- formaciones congénitas mayores, gemelares y con menos de 34 semanas de edad gestacional. Muestreo sistemático. Tamaño muestral: 150 recién nacidos. Se evaluaron las características basales de los recién nacidos y sus madres, y la adherencia a la estrategia minuto de oro y sus componentes. Se hizo análisis descriptivo. Resultados: la adherencia al minuto de oro en médicos pediatras fue del 65,6 % (IC 95 %: 53,8-78,4), en ginecobstetras, de 33,33 % (IC 95 %: 4,3-77,7), y en médicos internos, de 75,3 % (IC 95 %: 64,8- 85,1). La menor frecuencia se dio en la colocación del gorro al recién nacido, 64,90 % (IC 95 %: 56,7- 72,4), y poner al bebé piel a piel sobre la madre, 65 % (IC 95 %: 55,9-74,4); la mayor frecuencia se presentó en cubrir al recién nacido con paños calientes, 98,6 % (IC 95 %: 95,3-99,8), y la ventilación con presión positiva en los casos en los que no había respuesta a la estimulación inicial, 100 % (IC 95 %: 30-100). Conclusiones: los resultados obtenidos sobre el grado de adherencia de los profesionales sugieren la necesidad de realizar procesos continuos de educación y evaluación sobre la aplicación de esta estrategia de reconocida efectividad en las institu- ciones que ofrecen el servicio de atención de partos. ABSTRACT Objective: To determine adherence, overall and by components, to the Helping Babies Breathe strategy by physicians caring for neonates in an intermediate complexity institution. Materials and Methods: Cross-sectional study that included live neonates born by spontaneous vaginal delivery and who received care from pediatricians, gynecologists or interns in the delivery room of a university hospital in the city of Cali, Colombia, in 2017. Fetuses with major congenital malformations, twins, and neonates with less than 34 weeks of gestational age were excluded. Sampling was systematic and the sample size was of 150 neonates. Baseline neonatal and maternal characteristics were assessed, as well as adherence to the Helping Babies Breathe strategy and its components. A descriptive analysis was performed. Results: Adherence to the Helping Babies Breathe was 65.6% (95% CI 53.8-78.4) for pediatricians, 33.33% (95% CI: 4,3-77,7) for obstetricians and gynecologists, and 75.3% (95% CI: 64,8-85,1) for interns. The lowest frequency was found for cap placement on the neonate’s head, 64.90% (95% CI: 56.7-72.4), and placement of the baby in contact with the mother’s skin, 65% (95% CI: 55.9-74.4); the highest frequency was found for covering the baby with warm blankets, 98,6% (95% CI: 95.3-99.8), and positive pressure ventilation in those cases of absent response to initial stimulation, 100% (95% CI 30-100). Conclusions: Results pertaining to the degree of adherence on the part of the practitioners suggest the need to implement continuous education and evaluation processes focused on the application of this strategy which has been shown to be effective in institutions offering childbirth care.

Background: Characteristics of neonatal tracheal intubations (TI) may vary between the neonatal intensive care unit (NICU) and delivery room (DR). The impact of the setting on TI outcomes is not well characterized. Objective: The aim of this study was to define variation in neonatal TI practice between settings, and identify the association between setting and TI success and safety outcomes. Design: This was a retrospective cohort study of TIs in the National Emergency Airway Registry for Neonates from October 2014 to September 2017. The setting (NICU vs. DR) was the exposure of interest. The outcomes were first attempt success, course success, success within 4 attempts, adverse TI-associated events, severe desaturation, and bradycardia. We compared TI characteristics and outcomes between settings in univariable analysis. Factors significant in univariable analysis (p < 0.1) were included in a logistic regression model, with adjustment for clustering by center, to identify the independent impact of the setting on TI outcomes. Results: There were 3,145 TI encounters (2279 NICU, 866 DR) in 9 centers. Almost all baseline characteristics significantly varied between settings. First attempt success rates were 48% (NICU) and 46% (DR). In multivariable analysis, the setting was not associated with first attempt success. DR was associated with a higher adjusted OR (aOR) of success within 4 attempts (1.48, 95% CI 1.06–2.08) and a lower aOR for bradycardia (0.43, 95% CI 0.26–0.71). Conclusion: Significant differences in patient, provider, and practice characteristics exist between NICU and DR TIs. There is substantial room for improvement in first attempt success rates. These results suggest interventions to improve safety and success need to be targeted to the distinct setting.

Point of care ultrasound has emerged as useful tool in cardiac arrest situations in adult population. Despite of these, there is not a protocol for cardiopulmonary resuscitation in the delivery room for newborns. We describe two case were ultrasound helped to rule out the cardiopulmonary arrest case and we propose and algorithm were ultrasound is integrated in the newborn resuscitation and may help to diagnose the cardiac arrest cause.

Objective Identify clinical factors, transport characteristics and transport time intervals associated with clinical deterioration during neonatal transport in California. Study design Population-based database was used to evaluate 47,794 infants transported before 7 days after birth from 2007 to 2016. Log binomial regression was used to estimate relative risks. Results 30.8% of infants had clinical deterioration. Clinical deterioration was associated with prematurity, delivery room resuscitation, severe birth defects, emergent transports, transports by helicopter and requests for delivery room attendance. When evaluating transport time intervals, time required for evaluation by the transport team was associated with increased risk of clinical deterioration. Modifiable transport intervals were not associated with increased risk. Conclusion Our results suggest that high-risk infants are more likely to be unstable during transport. Coordination and timing of neonatal transport in California appears to be effective and does not seem to contribute to clinical deterioration despite variation in the duration of these processes.

The assessment of newborns' heart rate (HR) in the delivery room is one of the important steps to ascertain the need for initiation and continuation of resuscitation. At present, ECG is the "gold standard" to monitor neonatal HR in the delivery room. However, various limitations with the use of ECG exist. Furthermore, in developing countries, ECG may not be universally available in delivery rooms.To compare the accuracy and HR acquisition time of portable Doppler ultrasound (PDU) versus electrocardiogram (ECG) in newborns.This multicenter, prospective, observational study across five centers in India between January and September 2017 included neonates more than 34 weeks of gestation (Mean (±SD) gestational age and birthweight were 37.7 (±1.2) weeks and 2954 (±457) g, respectively. The mean (±SD) visible HRPortable Doppler has similar accuracy to ECG and is faster in acquiring the signal.