Search

BACKGROUND/OBJECTIVE: To evaluate the association between the duration of the latent phase of labor and subsequent processes and outcomes. METHODS: Secondary analysis of prospectively collected data among 1,189 women with low-risk pregnancies and spontaneous labor. RESULTS: Longer latent phase duration was associated with labor dystocia (eg, nulliparous ≥ mean [compared with < mean] aOR 3.95 [2.70–5.79]; multiparous ≥ mean [compared with < mean] aOR 5.45 [3.43–8.65]), interventions to ameliorate dystocia, and epidurals to cope or rest (eg, oxytocin augmentation: nulliparous > 80th% [compared with < 80th%] aOR 6.39 [4.04–10.12]; multiparous ≥ 80th% [compared with < 80th%] aOR 6.35 [3.79–10.64]). Longer latent phase duration was also associated with longer active phase and second stage. There were no associations between latent phase duration and risk for cesarean delivery or postpartum hemorrhage in a practice setting with relatively low rates of primary cesarean. Newborns born to multiparous women with latent phase of labor durations at and beyond the 80th% were more frequently admitted to the NICU (≥80th% [compared with < 80th%] aOR 2.7 [1.22–5.84]); however, two-thirds of these NICU admissions were likely for observation only. CONCLUSIONS: Longer duration of the spontaneous latent phase of labor among women with low-risk pregnancies may signal longer total labor processes, leading to an increase in diagnosis of dystocia, interventions to manage dystocia, and epidural use. Apart from multiparous neonatal NICU admission, no other maternal or child morbidity outcomes were elevated with longer duration of the latent phase of labor.

Perinatal asphyxia remains a frequent cause of neonatal mortality and long-term neurodevelopmental sequelae, despite the introduction of therapeutic hypothermia. Specific maternal characteristics may predispose asphyxiated newborns treated with hypothermia to worse outcome.To investigate the possible association between specific maternal factors and adverse outcome in asphyxiated newborns treated with hypothermia.We conducted a retrospective review of our database of 215 asphyxiated newborns treated with hypothermia from 2008 to 2015. We collected maternal characteristics including parity and labor duration, and we definedAsphyxiated newborns born to nulliparous mothers had a significantly higher risk of adverse outcome (61%), compared to asphyxiated newborns born from primiparous (19%) and multiparous (20%) mothers (Newborns with evidence of perinatal asphyxia, born to nulliparous mothers, and especially to those in whom the duration of labor has been prolonged, might be at higher risk of death or brain injury despite the use of therapeutic hypothermia.

Der Einfluss der prä- und intrapartalen Faktoren auf die Dauer der Austreibungsperiode, sowie der Einfluss der Dauer der Austreibungsperiode auf die maternale und neonatale Morbidität wurde in dieser retrospektiven unizentrischen Analyse analysiert. Es wurde der Status Quo des geburtshilflichen Managements in der Sektion Geburtshilfe der Klinik für Frauenheilkunde und Geburtshilfe des Universitätsklinikums Ulm erhoben, um mögliche Einflussnahmen ableiten zu können. Die Untersuchung erfolgte im Zeitraum vom 01.01.2014 – 31.12.2017, in welchem aufgrund der Einschlusskriterien (Einlingsschwangerschaft, Geburt ab 37+0 Schwangerschaftswochen, fetale Schädellage und Erreichen der Austreibungsperiode) 6.951 Geburten erfasst wurden. Dabei zeigten sich signifikante und klinisch relevante Zusammenhänge zwischen der Dauer der Austreibungsperiode und den prä- und intrapartalen Faktoren bei der Parität, der Periduralanästhesie, der Gabe von Wehenmittel und der Durchführung einer Fetalblutgasanalyse. Höhere Medianwerte zeigten sich beim Geburtsmodus im Zusammenhang mit einer operativen Geburtsbeendigung: der Medianwert bei einer Spontangeburt befand sich bei 29 min., der Medianwert bei den operativen Geburtsbeendigungen (vaginal-operative Geburtsbeendigung, Kaiserschnitt) bei 157 min. (p < ,001). Bei der maternalen Morbidität wiesen die Parameter der postpartalen Hämorrhagie, der höhergradigen Geburtsverletzungen und der Episiotomie einen statistisch signifikanten und klinisch relevanten Zusammenhang mit der Dauer der Austreibungsperiode auf. Die neonatale Morbidität zeigte statische Zusammenhänge, die jedoch von geringer klinischer Relevanz waren.

Background Labor pain is one of the leading causes of fear of childbirth. Acupressure is a non-pharmacological pain relief method that has shown promising results in relieving this pain. The present study is designed to compare the effects of body acupressure at multiple points and auricular acupressure on the pain and duration of labor. Methods/design In a randomized controlled trial, 90 primigravida women who attend for childbirth will be randomly assigned to one of three groups (intervention groups of either body acupressure or auricular acupressure; control, consisting of routine care). Computer-generated six-block randomization techniques will be used to determine the allocation sequence with a 1:1:1 ratio. To hide the allocation, the type of intervention will be written according to the generated sequence and put in opaque envelopes; these as well as questionnaires will be encoded. The pain score for all participants will be measured at the peak uterine contraction at 4-cm cervical dilation and at 10-cm dilation based on a visual analog scale (VAS). The duration of the active phase of labor in these groups will be recorded too. Data will be imported into SPSS-16 software. First, normality of the data distribution will be investigated. To compare labor duration among the research groups, ANOVA will be used, which will be followed, in case of significance, by the Scheffe post hoc test. Furthermore, Chi-squared test will be used to compare the categorized demographic variables and ANOVA or Kruskal–Wallis tests will be used to compare the quantitative variables in the studied groups. A significance level of 0.05 is considered significant. Discussion In this study the effect of auricular acupressure and body acupressure on pain and duration of first stage of labor will be compared. Trial registration Iranian Registry of Clinical Trials, IRCT20180218038789N1. Registered 2018-03-04; pre result.

Objective To investigate the characteristics of labor in Chinese women who successfully have vaginal birth after cesarean section (VBAC). Methods A retrospective cohort study was conducted in a hospital with 1000 beds between January 1 2015 and December 31 2017. A total 657 parturients with VBAC were selected. Women were divided into two groups according to previous cesarean section with or without trial of labor. Labor curves were analyzed and interval-censored regression was used to estimate the duration of labor. Results The 95th percentile for the first stage of labor in VBAC was 13.03 hours, and labor accelerated after 4 cm of cervical dilation in both groups. The dilation rate in the trial of labor group was superior to that in the non-trial of labor group at 6–10 cm of dilation. After 6 cm, labor accelerated much faster in the trial of labor group than in the non-trial of labor group. Conclusions Management of labor in parturients with VBAC whose cervical dilation is >6 cm should be treated differently according to previous cesarean section with or without trial of labor. If there is trial of labor in a previous delivery, the duration of labor should be shortened.

Background The efficacy of yoga on delivery outcomes remaining controversy. Objectives To evaluate the effects of prenatal yoga on delivery outcomes. Methods The Cochrane Library, PubMed, Embase, Web of Science, CINAHL and Elsevier databases were searched from inception to January 22, 2020, and randomized, quasi-randomized and non-randomized controlled trials evaluating the effect of yoga on the delivery outcomes in pregnant women were included. The methodological quality was assessed by the Cochrane Collaboration's tool. Meta-analysis was performed using Revman 5.3. Results This meta-analysis identified that yoga improved vaginal delivery, decreased premature delivery and birth weight of newborns, shorten the labor duration. Conclusion Prenatal yoga is an effective complementary medicine to improve delivery outcomes and not to increase the risk of fetus, which is worth recommending to pregnant women. But studies involved in this meta-analysis were not all of high quality. The Registration Number in PROSPERO is CRD42019132490.

Background: Normal vaginal delivery is considered a painful process and it is difficult to tolerate the pain. The goal of this study was to compare the effect of injection of sterile distilled water and normal saline on pain intensity in nulliparous women. Materials and Methods: This triple-blind clinical trial was conducted on 164 nulliparous women randomly selected from among those who were hospitalized in Motahari Hospital of Jahrom, Iran, from 1 May 2012 to 1 October 2013. Women with a gestational age of 37–42 weeks, dilatation of 4–6 cm, and delivery 180 min after the intervention were selected. The subjects were randomly allocated to four groups of intracutaneous and subcutaneous sterile water and normal saline injections. Pain severity was measured 5 min before the injection and every 30 min up to 3 h after the injection using a visual analog scale. The data were analyzed using Chi-square, Scheffe, and Spearman's correlation tests in SPSS software. Results: There was no significant difference among the four studied groups concerning gestational age and other demographic characteristics. Chi-square test showed lower pain intensity 120 min after the injection in group 4 (subcutaneous injection of normal saline) (F3 = 14.75, p < 0.001) and 150 min after the injection in group 3 (intracutaneous injection of normal saline) (F3 = 14.75, p < 0.001). Chi-square test showed that the duration of the second stage of labor was shorter in group 4 participants (subcutaneous injection of normal saline) (F3 = −12.23, p < 0.001). Conclusions: The study showed that subcutaneous and intracutaneous injection of normal saline reduced the intensity of pain during childbirth.

Controversy surrounds the impact of the fetal head station on labor duration and mode of delivery. Although an extensive body of evidence has been published evaluating fetal head station in early labor, there is a paucity of data on the impact of fetal head descent during the second stage.This study aimed to explore the association between fetal head station at the diagnosis of the second stage of labor and the second stage duration and the risk of operative delivery.This is a retrospective cohort study of all singleton vertex deliveries in a single tertiary center (2011-2016). Women were grouped according to fetal head station upon the diagnosis of the second stage of labor as follows: above (S0), at the level (S=0), and below (S0) the level of the ischial spine. The duration of the second stage and the risk of operative delivery were compared between the groups and stratified by parity.Overall, 34,334 women met the inclusion criteria. Of these, 18,743 (54.6%) were nulliparous and 15,591 (45.4%) were multiparous. Of the nulliparous women, 8.1%, 35.8%, and 56.1% were diagnosed as having fetal head above, at the level, and below the ischial spine upon second stage diagnosis. Of the multiparous women, 19.7%, 35.6%, and 44.7% were diagnosed as having fetal head above, at the level, and below the ischial spine. Fetal head station upon second stage diagnosis was independently and significantly associated with second stage duration (P.001); however, its contribution was 4.5-fold among nulliparous women compared with multiparous women. In multivariable analysis, after controlling for maternal age, gestational age at delivery, prepregnancy body mass index, epidural anesthesia, and birthweight, the risk of operative delivery was substantially increased in a dose-dependent pattern for both nulliparous and multiparous women.The fetal head station at the first diagnosis of the second stage is significantly and independently associated with the duration of the second stage and correlated with the risk of operative delivery in both nulliparous and multiparous women (P.001).

The aim of this study is to evaluate the influence of duration of calving and obstetric assistance on retained placenta incidence of high milk production Holstein cows. Experimental groups were determined according to the duration of the expulsive phase of calving: 2 h (n = 16), 2-4 h (n = 16) and >4 h (n = 12), and additionally allocated in two sub-groups: spontaneous calving (n = 22) and intervention calving (n = 22). Diagnosis of retained placenta was considered with a threshold of 8 h after the expulsive phase. Cows without obstetric intervention, with labor duration of 2 h, presented reduced time needed for placental release, in comparison to those with obstetric assistance. In the 2-4 h group and >4 h, there was no statistical difference. The 2 h and 2-4 h groups with intervention and the spontaneous >4 h group were considered retained placenta groups. On the other hand, performing obstetric intervention when calving period was superior to 4 h nulled the occurrence of retention of fetal membranes. As a conclusion, obstetric assistance predisposes placental retention to calving with

Thisstudy evaluated the effects of pushing techniques on the second stage of laborduration and maternal and fetal outcomes. The pregnant women were dividedrandomly into Valsalva pushing (n =20) or spontaneous pushing (n =20) groups. The experimental groupreceived spontaneous pushing training in the latent phase. Interventions duringlabor as well as maternal and fetal complications and the duration of thesecond stage of labor were recorded. There was a significant difference infetal Apgar scores and the duration of second labor stage between the twogroups (p0.05). Spontaneous pushing is effective in shortersecond stages of labor and higher Apgar scores. It should be included in maternal hospital protocols.

This study aimed to assess the prevalence and influence of urinary tract infection on the reproductive performance of sows. The animals underwent urine tests using reagent strips and diagnosed as positive or negative. They were then divided into two groups of 30 positive and 30 negative sows for urinary tract infection. Each sow was considered an experimental unit and was followed from labor to weaning. The animals were assessed for their reproductive performance (labor duration, number of live births, mummified piglets, and stillbirths, and postpartum diseases). After weaning, the weaning-estrus interval and rate of return to estrus were assessed. A thermographic camera was used to identify hyperthermia of the mammary system and its relation with the onset of urinary tract infections. The prevalence of urinary tract infection in prepartum sows was 41.1%. Urinary tract infection does not impact labor duration, number of live births, mummified piglets, and stillbirths, number of sows culled, weaning-estrus interval, or return to estrus after insemination. However, it was considered a predisposing factor for the occurrence of postpartum vaginal discharge. There is no correlation between the occurrence of urinary tract infection and mammary system temperature in sows.

Introduction Epidural analgesia may lead to a prolonged second stage, and increased instrumental vaginal deliveries rate in singleton gestations. We aimed to examine the association between epidural and vacuum deliveries rate and second stage duration among twin deliveries. Methods Retrospective study conducted at a single teaching hospital on data between January 1995 and December 2015. All twin pregnancies, >24 weeks that had a trial of labor were included. Twins with major malformations, intrauterine death, or had a caesarean delivery without a trial of labor, were excluded. Women were divided to those who had an epidural analgesia (group 1) and those who did not (group 2). Primary outcome was vacuum delivery rate. Results Of all 1955 twin pregnancies delivered during the study period, 827 (42.3%) were eligible and included; 332 (40.1%) in group 1 and 495 (59.9%) in group 2. Vacuum delivery rate of any twin was 7.5% and 6.3% in groups 1 and 2, respectively (p = 0.48; Relative Risk 1.20; 95% Confidence Interval: 0.72–2.0). Vacuum delivery rate of first twin only or second twin only did not differ significantly as well. After adjusting for variables that differed significantly between the groups in univariate analysis, second stage duration of first and second twins in group 1 was significantly longer than in group 2 (p = 0.001; ratio=1.66; 95% Confidence Interval: 1.42–1.94 and p = 0.001; ratio=1.40; 95% Confidence Interval: 1.24–1.58, respectively). Conclusions Epidural use in twin deliveries did not affect vacuum deliveries rate. Epidural was associated with a prolonged second stage of both twins.

Introduction: Physiological delivery program was implemented in mother-friendly hospitals of Iran after 2008. The aim of present study is to assess the effect of physiological delivery program in a mother-friendly hospital on duration of active phase and second stage of labor.Methods: This study was a clinical trial that was conducted at the Sinaand Ommobaninmotherfriendly hospitals in Ahvaz, Mashhad, Iran, in 2016. The intervention group of 77 women was offered the childbirth preparation classes during pregnancy and physiological delivery program during labor and the control group of 77 women received routine care.Results: The results showed that after controlling the confounding factors, the active phase and second stage of labor were significantly shorter in the intervention group (p

OBJECTIVE: To assess the contribution of a new type of partogram, used in labor monitoring, in caesarean section rates. MATERIAL AND METHODS: The study included term singleton uncomplicated pregnancies divided into two groups. Two types of partogram were used in labor monitoring. In the first group, the classical WHO partogram (A) was used. In the second group, a new type of partogram, in which cervical dilatation and the position of descending head (B) (one line) were estimated and reported, was used. The labor duration and caesarean section rates were calculated and compared in the two groups. RESULTS: A statistically significant decrease in labor duration (from the initiation of the active phase of labor to the delivery time) (dt1+dt2+dt3) (p

Resume Le deroulement du travail « normal » a ete etonnamment peu etudie ces 60 dernieres annees alors qu’il s’agit d’un axe central en obstetrique. Des normes du deroulement du travail ont ete proposees il y a 60 ans par Emmanuel Friedman et adoptees par de nombreux pays pour devenir ensuite, sous l’impulsion de l’ecole de Dublin, des regles conditionnant la prise en charge du travail : rupture des membranes et ocytociques avec, en cas d’echec, cesarienne pour dystocie dynamique. Des donnees recentes ont suggere que la duree du travail s’etait modifiee depuis les annees 1960. La modification des caracteristiques individuelles des femmes et les changements survenus dans la pratique obstetricale avec en particulier la generalisation du travail dirige et la realisation de peridurales ont probablement eu un impact sur le deroulement du travail. Les travaux actuels suggerent qu’il est possible d’accepter une vitesse de dilatation plus lente que ce qui est generalement accepte en France, et ce sans augmentation notable de la morbidite maternelle ou neonatale. Des essais randomises seraient utiles pour verifier les resultats des vastes etudes retrospectives publiees recemment.

Artificial rupture of amniotic membranes (amniotomy) which induces or accelerates labor is the most common obstetrical procedure. There is controversy about the effect of early amniotomy on dystocia and cesarean delivery. The study aim was to determine the effect of early amniotomy on the risk of dystocia and cesarean delivery in nulliparous women. This randomized controlled clinical trial was conducted on 300 nulliparous women. They were randomly assigned into the experimental (early amniotomy; artificial amniotomy at cervical dilation ≤4 cm) and control (routine management) groups (each 150 women). Length of labor, dystocia, cesarean delivery, placental abruption, and umbilical cord prolapse were compared between the groups. Early amniotomy shortened labor duration significantly in experimental group (7.5 ± 0.7 h) compared to control group (9.9 ± 1.0 h) (P

Objective: Delivery is an inflammatory process and Apelin, has a vital role in pro-inflammatory process and uterine contractility. Therefore, this article studied maternal serum apelin-36 before and after cesarean (C/S) and natural vaginal delivery (NVD). Material and Methods: In this study, 166 pregnant, 18-40 years old, were studied during weeks 28-32 of pregnancy until after delivery. They all meet inclusion criteria. To do so, the first blood sample was taken from the participants within third trimester. Twenty-three of these women had to upped elective cesarean and considered as the case group. Then, from the participants who had vaginal delivery, twenty-two were made homogenous concerning demographic characteristics with case group and selected as the control group and the second blood sample in the first 24 h after delivery. Blood samples were measured by means of ELIZA. Data were analyzed by SPSS16. Results: Maternal Apelin-36 concentration in the third trimester of the pregnancy and the first 24 h after delivery were [82.16 ± 99.40 (NM/L)], and [86.49 ± 23.769 (NM/L)] in the C/S group and [101.5 ± 105.65 (NM/L)] and [84.9 ± 63.64 (NM/L)] in the NVD group. A significant difference was seen in NVD group before delivery, compared to after delivery (P=0.029). Furthermore, a statically significant difference was seen in Apelin-36 difference before and after delivery in the NVD group, compared to its difference in the C/S group (P=0,005). A positive relationship was seen between Apelin- 36 concentrations after delivery and during labor (P

Background Use of prenatal acupuncture for labor preparation is common, but there is still conflicting evidence with respect to its objective obstetric benefits. There is little information on women's expectations and subjective experiences with acupuncture treatments. Methods In this retrospective cohort study, a validated questionnaire on women's treatment satisfaction was sent to women who had received prenatal acupuncture at the obstetric clinic of the Medical University of Graz, Austria within the last 3 years. The electronic obstetric database was used to extract detailed clinical and obstetric data of women who received acupuncture and delivered at the hospital. For comparison, obstetric data were matched with a control group of women without prenatal acupuncture, who had given birth at the hospital during the study period. Results The questionnaire was sent to 150 women, out of which 70 (46.7%) completed and returned the questionnaire. Analysis of the questionnaire indicated good overall satisfaction (mean sum score 26.22 ± 4.72) with acupuncture treatment-97.1% indicated that they were very or quite satisfied. Responders did not differ from nonresponders, except for the time between delivery and questionnaire (P = .015). Comparisons between the deliveries after prenatal acupuncture (n = 144) and the matched control deliveries (n = 576) showed no statistical significant differences in the length of labor and use of analgesics. Conclusion Prenatal acupuncture is likely to have positive effects on pregnant women, aside from an objective influence on labor duration and pain.

Cesarean delivery is the most common major abdominal surgery in many parts of the world, and it accounts for nearly one-third of births in the United States. For a patient who requires a C-section, allowing prolonged labor is not recommended because of the increased risk of infection. However, for a patient who is capable of a successful vaginal delivery, performing an unnecessary C-section can have a substantial adverse impact on the patient's future health. We develop two stochastic simulation models of the delivery process for women in labor; and our objectives are (i) to represent the natural progression of labor and thereby gain insights concerning the duration of labor as it depends on the dilation state for induced, augmented, and spontaneous labors; and (ii) to evaluate the Friedman curve and other labor-progression rules, including their impact on the C-section rate and on the rates of maternal and fetal complications. To use a shifted lognormal distribution for modeling the duration of labor in each dilation state and for each type of labor, we formulate a percentile-matching procedure that requires three estimated quantiles of each distribution as reported in the literature. Based on results generated by both simulation models, we concluded that for singleton births by nulliparous women with no prior complications, labor duration longer than two hours (i.e., the time limit for labor arrest based on the Friedman curve) should be allowed in each dilation state; furthermore, the allowed labor duration should be a function of dilation state.

Introduction: The aim of this study was to assess the effect of two-stage warm compress technique on the pain duration of the first and second labor stages and neonatal outcomes. Methods: The clinical trial was done on 150 women (75 subjects in each groups) in Shiraz-affiliated hospitals in 2012 A two-staged warm compress was done for 15-20 minutes in the first and second labor phase (cervical dilatation of 7 and 10 cm with zero status) while the control group received hospital routine care. The duration of labor and Apgar score were evaluated. Results: According to t-test, the average of labor duration was lower in the intervention group compared to the control group at the second stage. However, there was no significant difference for labor duration at the first stage and the first and fifth minute Apgar score. Conclusion: According to the result, this intervention seems a good method for decreasing labor duration at the second stage of parturition.

History of fast labor is currently subjectively defined and inductions for non-medical indications are becoming restricted. We hypothesized that women induced for a history of fast labor do not have faster previous labors and do not deliver more quickly.A retrospective case-control cohort design studied multiparas undergoing elective induction at one high risk center. Outcomes of dyads electively induced for a history of previous fast labor indication (PFast) were compared to controls with a psychosocial indication.A total of 612 elective inductions with 1074 previous deliveries were evaluated: 81 (13%) PFast and 531 (87%) control. PFast had faster previous labors (median 5.5 h, IQR: 4.5-6) versus. control (10 h, IQR: 9-10.5; p 0.001). Subsequent delivery time from start to expulsion was shorter for PFast (median 7 h, IQR: 5-9, p 0.001) than controls with and without a previous labor5.5 h (8.6 h, IQR: 6-14 and 9.5 h, IQR: 7-15, respectively). PFast were less likely to have a serious maternal complication. Neonatal complications were similar.Patients induced for a history of fast labor do have faster previous labors, suggesting a significant history of fast labor can be defined as5.5 h. These women deliver more quickly and with lower morbidity than controls when subsequently induced, therefore the benefit may warrant the risk for a select number of women with a history of a prior labor length5.5 h.

Resume Introduction L’objectif de cette enquete etait de decrire le retentissement de la mobilisation pendant le travail et des variations posturales a l’accouchement sur des parametres obstetricaux tels que la duree du travail, le taux de cesariennes, la satisfaction des couples et des sages-femmes. Patientes et methode Il s’agissait d’une enquete prospective, observationnelle, monocentrique, realisee de mai 2007 a fevrier 2009 au sein de l’unite de salle de naissances d’un centre hospitalier universitaire. Une femme etait dite « mobilisee » si elle avait eu au moins un changement de position en phase de latence et/ou un bain et/ou une deambulation avec au moins trois changements de position en phase active, entre decubitus dorsal ou lateral (amenage ou non), ROSA, quatre pattes, assise amenagee ou non, debout et accroupie suspendue. La duree minimale retenue pour une position etait de 20 minutes. Resultats Huit cent vingt-huit femmes se sont mobilisees parmi les 1906 incluses (43,4 %). Du fait de notre definition de la mobilisation, les femmes « non mobilisees » ont eu un travail significativement plus court de deux heures en moyenne. Le recours a la cesarienne etait moins frequent dans le groupe des femmes « mobilisees » (OR = 0,71 ; IC95 % = [0,51–0,99]), resultat confirme par une analyse multi-variee. La satisfaction des femmes « mobilisees » avait une mediane de 9 sur une echelle de 0 a 10, celle de leur conjoint de 10. La satisfaction des sages-femmes etait plus importante en cas de mobilisation. Conclusion Cette enquete a mis en evidence un lien significatif entre la mobilisation et le recours a la cesarienne, qui necessiterait d’etre valide par un essai randomise. Cette pratique satisfaisait pleinement les couples et les sages-femmes. Cependant, a ce jour, il n’existe aucune reference pouvant servir d’element de comparaison. Il apparait necessaire d’utiliser une definition commune de la mobilisation afin d’aboutir a des recommandations pour la pratique clinique.

Labor pain is one of the most challenging experiences encountered by females during their lives. Neuraxial analgesia is the mainstay analgesic for intrapartum pain relief. However, despite the increasing use and undeniable advantages of neuraxial analgesia for labor, there have been concerns regarding undesirable effects on the progression of labor and outcomes. Recent evidence indicates that neuraxial analgesia does not increase the rate of Cesarean sections, although it may be associated with a prolonged second stage of labor and an increased rate of instrumental vaginal delivery. Even when neuraxial analgesia is administered early in the course of labor, it is not associated with an increased rate of Cesarean section or instrumental vaginal delivery, nor does it prolong the labor duration. These data may help physicians correct misconceptions regarding the adverse effects of neuraxial analgesia on labor outcome, as well as encourage the administration of neuraxial analgesia in response to requests for pain relief.

Objectives: To assess whether labor length differs by week of gestation.Methods: In this observational cross-sectional study, we compared duration of labor by gestational age (36 + 0 through 40 + 6 weeks) in primiparous singleton parturients with vertex presentation. Data were acquired for a period of 24 months (2010–2011).Results: In general, the rate of change in cervical dilatation decreased as gestational week at delivery advanced: 1.8 ± 1.0 cm/h, 1.5 ± 0.9 cm/h, 1.3 ± 0.8 cm/h, 1.6 ± 1.5, and 1.3 ± 1.0 cm/h at 36th, 37th, 38th, 39th and 40th gestational week, respectively (p = 0.040). Concurrently, the total labor duration (1st + 2nd + 3rd stages) increased as gestational age advanced: 423.6 ± 180.9 min, 496.5 ± 212.6 min, 545.9 ± 247.1 min, 483.8 ± 256.3 min, and 568.2 ± 273.8 min at 36th, 37th, 38th, 39th and 40th gestational week, respectively (p = 0.013).Conclusions: Gestational week of pregnancy may alter the duration of labor, specifically, the length of labor increases as gestational w...

To model the timing and sequence of intrapartum interventions and to estimate the association with labor length and delivery mode. A longitudinal multi-center cohort study included data from 3,955 low-risk women who gave birth in hospitals in Lower Saxony, Germany. We analyzed three intrapartum interventions: amniotomy, oxytocin augmentation and epidural analgesia. We divided births into time intervals delineated by these interventions and noted cervical dilation at interval onset. We analyzed the duration of intervals from onset of labor until the first intervention and between intrapartum interventions with Kaplan–Meier’s estimate, regarding the three interventions as competing risks. Further, we analyzed the cervical dilation before an intervention by Kaplan–Meier’s estimate without censoring. 73.2 % of the included 2,082 nulliparae (n = 1,525) and 59.6 % of the included 1,873 multiparae (n = 1,117) received at least one intervention, while 1,313 women (33.2 %) experienced a normal labor without any of these interventions. The intervals from onset of labor until the first intervention and from the first until the second intervention were significantly shorter in multiparae than in nulliparae. The intervention cascade in nulliparae most often started with epidural analgesia in early labor (n = 579, 27.8 %). Oxytocin augmentation most often followed after a short interval (n = 343, 59.2 %, median 1.57 h). In multiparae, amniotomy was most often the first intervention (n = 629, 33.6 %), and spontaneous birth most often followed (n = 503, 80.0 %). Labor duration and operative deliveries increased as interventions increased. The temporal sequence of intrapartum interventions varied in association with parity, cervical dilation, labor duration and mode of birth.

Fournier, D, Feeney, G, and Mathieu, M-E. Outcomes of exercise training following the use of a birthing ball during pregnancy and delivery. J Strength Cond Res 31(7): 1941-1947, 2017- Using a birthing ball (BB) is an exercise form that is growing in popularity. Improved delivery outcomes have been recently reported with as little a 6-8 hours of training per week; however, little is known regarding lower and higher training levels. The aim of this study was to document whether more time spent training with a BB resulted in improved delivery outcomes for the mother and the newborn. This quasi-experimental study was conducted with a sample of women who participated in 1 to 28 supervised exercise classes during pregnancy according to the Ballon Forme program offered in nonclinical settings (http://ballonforme.com), with the option of completing the supervised BB exercises performed at home. Thirty women who gave birth naturally were included in the study. Mean BB training time was 22.3 hours (SD = 16.6 hours). A greater BB training time was significantly associated with shorter labor duration (r = -0.408; p = 0.031) and specific stages of labor (stage 1 [dilatation/active stage] [r = -0.372; p = 0.043] and stage 2 [expulsion] [r = -0.415; p = 0.028]). Increased participation in BB supervised classes was more closely associated with quicker deliveries than those of home based BB exercises. No associations between training time and adverse effects of labor parameters or the baby's health were noted. Greater involvement in BB training seems to lead to quicker deliveries than lower levels of involvement; it also has the benefit of supervised practice.

Type and volume of fluid administered for intrapartum maintenance had been reported to differently affect labor length, delivery mode, and cord artery pH and glucose level. We aimed to compare the effect of three different fluid regimens on labor duration. In a randomized trial, healthy nulliparous in labor were randomized into one of three intravenous fluid regimens: group 1, the reference group, lactated Ringer’s solution infused at a rate of 125 mL/h; group 2, lactated Ringer’s solution infused at a rate of 250 mL/h; group 3, 0.9% saline solution boosted with 5% glucose, infused at a rate of 125 mL/h. The primary outcome was labor length from enrollment until delivery. Between December 2010 and July 2015, 300 women were randomized to one of the three groups. Demographic and baseline obstetric characteristics were comparable between the groups. There was no significant difference in the time from enrollment to delivery (p = 0.62). Furthermore, there were no significant differences in second stage duration (p = 0.73), mode of delivery (p = 0.21), cord artery pH and glucose level between the groups. Increasing the intravenous volume of lactated Ringer’s solution or substituting to fluid containing 5% glucose solution does not affect labor length. ClinicalTrials.gov, http://www.clinicaltrials.gov , NCT01242293.

Purpose The purpose of this study was to evaluate the efficacy of peanut ball use on duration of first stage labor and pushing time in women who were scheduled for elective induction of labor at ≥39 weeks gestation and planning an epidural. Study design and methods In this randomized controlled trial, women having labor induction and planning a labor epidural were assigned (1:1) to one of two groups: one group used a peanut ball and one group did not. Outcome variables were time spent in first stage labor and time spent pushing. Factors included group assignment (peanut ball, no peanut ball), parity (primiparous, multiparous), and race. Age and maximum oxytocin dose served as covariates. Results Among women having elective induction with epidural analgesia, use of a peanut ball reduced first stage labor duration for primiparous patients significantly more than multiparous patients, p = 0.018. There was no significant difference in the reduction of length of first stage labor for multiparous women, p = 0.057 with use of the peanut ball. Peanut ball use did not alter length of pushing time for either group, p > 0.05. Clinical implications Use of peanut balls may reduce total labor time to a greater degree in primiparous patients than multiparous patients having elective induction at ≥39 weeks with epidural analgesia.

The aim of the study was to explore the role of parity, maternal age, medical interventions, and birth weight with respect to labor duration and cervical dilation. A total of 1601 pregnant women who had a singleton term gestation, spontaneous onset of labor, vertex presentation, vaginal delivery, and a normal perinatal outcome were reviewed. The retrospective study was conducted in patients from West China Second University Hospital of Sichuan University during June 2008 to June 2013. There were 1367 nulliparous women and 234 multiparous women analyzed. The first stage (8.3 ± 3.8 vs 5.0 ± 2.6 hours), latent phase (5.1 ± 3.2 vs 3.5 ± 2.4 hours), active phase (3.2 ± 1.8 vs 1.5 ± 1.0 hours), second stage (44 ± 31 vs 18 ± 14 minutes), and total stage of labor (9.1 ± 3.9 vs 5.4 ± 2.6 hours) were all longer in nulliparous than in multipara women (all P

Introduction Laboring women are often admitted to labor units under criteria that are commonly associated with the onset of active-phase labor (i.e., cervical dilatation of 3–5 cm in the presence of regular contractions). Beginning with these criteria through complete dilatation, this systematic review describes labor duration and cervical dilation rates among low-risk, nulliparous women with spontaneous labor onset. Methods Studies published in English (between 1990 and 2008) were identified via MEDLINE and CINAHL searches. Data were abstracted and weighted “active labor” durations (i.e., from 3–5 cm through complete dilatation) and linear dilation rates were calculated. Results Eighteen studies (n = 7009) reported mean “active labor” duration. The weighted mean duration was 6.0 hours, and the calculated dilation rate was 1.2 cm per hour. These findings closely parallel those found at the median. At the statistical limits, the weighted “active labor” duration was 13.4 hours (mean + 2 standard deviations) and the dilation rate was 0.6 cm per hour (mean – 2 standard deviations). Discussion These findings indicate that nulliparous women with spontaneous labor onset have longer “active” labors and therefore slower dilation rates than are traditionally associated with active labor when commonly used criteria are applied as the starting point. Revision of existing active labor expectations and/or criteria used to prospectively identify active phase onset is warranted.

Study Objective To assess the effect of intermittent versus continuous bladder catheterization on labor duration and local anesthetic consumption. Design Randomized, controlled, prospective, single-blind trial. Setting University-affiliated hospital. Patients 209 ASA physical status I and II, primiparous parturients who received patient-controlled epidural analgesia for labor. Interventions Patients were randomly allocated to either the intermittent bladder catheterization group (Group IC; n=109) or the continuous catheterization group (Group CC; n=100). Measurements Duration of the second stage of labor, dose of local anesthetics given, and primary outcomes were compared by group using the t-test for independent samples. Main secondary outcomes were postpartum urinary retention and rate of postpartum urinary tract infection (UTI; asymptomatic bacteruria). Main Results Duration of the second stage of labor was longer in Group CC than Group IC: 105 ± 72 vs. 75 ± 52 min ( P = 0.002). This finding was associated with increased local anesthetic dose requirement in Group CC during both stages of labor (73 ± 25 mL vs. 63 ± 26 mL; P = 0.005). The rate of UTI was similar (30%) in both study groups. Conclusion Intermittent bladder catheterization was associated with shorter second-stage labor and less local anesthetic, but the same frequency of postpartum urinary retention and UTI was seen with both catheterization groups.

To determine the farrowing process and to evaluate the effect of parity on uterine dynamics and reproductive performance, 120 Yorkshire X Landrace hybrid sows, twenty for each parity number from 1 to 6 were used. Frequency, duration and intensity of contractions were monitored as indicators of uterine activity, foetal cardiac frequency (FCF) was monitored to determine fetal distress. Overall, farrowing duration was 189 min, contraction number and intensity were 40.9 and 9.89 mm Hg, respectively. Sixth parity sows had the shortest labor duration. The average number of fetuses with severe bradycardia and distress was 0.5. There was a significant increase (P=0.001) in the number of uterine contractions in gilts and second parity sows. First parity sows showed the highest intensity of contractions (12.30 mm Hg, P=0.001) and the largest number of delayed FCF decelerations, (0.90, P=0.004), which agrees too with a large average number of intra-partum stillbirths (0.90) found. The present study establishes the basic uterine dynamics of eutocic parturitions which may help in swine obstetrics to design uterotonic treatments reducing the stillbirth rate due to asphyxia. These findings emphasize a need for farrowing supervision, especially for first and over fifth parity sows.

BACKGROUND: Prolonged labor may cause poor infant clinical condition. Lengthening uterine involution may cause postpartum hemorrhage. Oxytocin is a hormone secreted by the neurons of the hypothalamus and stored in the posterior pituitary in mammals. Theoretically, oxytocin stimulates contraction of uterine smooth muscle by increasing the sodium permeability of uterine myofibrils. High estrogen concentrations lower the threshold for uterine response to oxytocin. Uterine response to oxytocin increases with the duration of pregnancy. This study aimed to determine effect of oxytocin massage on labor duration and uterine involution. SUBJECT AND METHODS: This was an experimental study, using post test only design with a control group. It was conducted at Independent Midwivery Practice (BPM) Sri Hastutik, Surabaya, East Java. A sample of 32 pregnant mothers was monitored during the delivery and post partum processes. The dependent variables were phase I labor duration and uterine involution. The independent variable was oxytocin massage. The data was analyzed by McNemar test. RESULTS: Pregnant mothers who received intra-partum oxytocin massage were 6.60 times more likely to have rapid labor than those who did not receive oxytocin massage (OR=6.60; 95%CI= 1.40 to 31.05; p=0.013). Pregnant mothers who received intra-partum oxytocin massage were 9.53 times more likely to have rapid uterine involution than those who did not receive oxytocin massage (OR=9.53; 95%CI= 1.85 to 49.20; p=0.004). CONCLUSION: Oxytocin massage is effective to shorten labor duration and uterine involution. Keywords: oxytocin massage, phase I labor duration, uterine involution

Criteria for failed labor induction have not been standardized. The increasing prevalence of labor induction and the lack of a definition for failed induction contribute to unnecessary abdominal deliveries. Labor duration, cervical dilation, and uterine activity necessary to attain the active phase are reviewed. A practical definition of failed induction of labor is suggested.

This study examined the effect of eating during the latent phase of labor on the hospital-estimated labor duration and birth outcomes for the mother and baby. A prospective, comparative trial with concurrent controls compared labor duration and outcomes of 176 low-risk, nulliparous women who birthed at four hospitals in Sydney, Australia. Food was voluntarily consumed by 82 women, whereas 94 consumed clear fluids only. Food intake during the latent phase of the first stage of labor was associated with a longer duration of labor (mean difference = 2.35 hours). No difference was found between eating and noneating groups for the rate of medical interventions, adverse birth outcomes, or vomiting. Results suggest that eating during the latent phase of labor may increase labor duration.

Background Water immersion during the first stage of labor can reduce the length of the first stage and epidural/spinal analgesia use; however, there is limited information regarding other outcomes. Our purpose was to compare maternal and neonatal outcomes of women who underwent water immersion during the first stage of labor with those who underwent conventional labor and delivery. Methods Healthy primipara with singleton pregnancies and cephalic presentation were included in the study. Patients were allowed to choose water immersion during labor or conventional labor and delivery. For water immersion, the water temperature was maintained at 35-38°C and subjects left the tub on complete cervical dilatation. A visual analogue scale (VAS) was used to assess pain during labor. Other outcome measures included duration of labor, type of delivery, blood loss, pelvic floor dysfunction and symptoms of stress urinary incontinence (SUI) at 42 days after delivery, infant Apgar scores, and need for transfer of the infant to the neonatal intensive care unit. Results Thirty eight subjects (mean age, 28.66 ± 3.08 y) received water immersion and 70 (mean age, 27.89 ± 2.99 y) underwent conventional labor and delivery. There were no differences in maternal height, weight, age, gestational age, gravidity, and newborn weight between the groups (all, p>0.05). VAS pain scores were significantly greater in the conventional labor group at 30 min and 60 min after a cervical dilatation of 3 cm (30 min: 10 [9, 10] vs. 6 [5, 8]; 60 min: 10 [10, 10] vs. 7 [6, 8], respectively, both, p0.05). The cesarean section rate was higher in the conventional labor group (32.9% vs. 13.2%, p=0.026). The 1-minute and 5-minute Apgar scores were similar between the groups. Maternal and neonatal culture results were similar between the groups. SUI symptoms at 42 days after delivery was significantly higher in the conventional labor group (25.5% vs. 6.1%, respectively, p=0.035). Conclusions Water immersion can reduce labor pain, and is associated with a lower rate of cesarean delivery and SUI symptoms at 42 days.

Background Ambulatory epidural analgesia (AEA) is a popular choice for labor analgesia because ambulation reportedly increases maternal comfort, increases the intensity of uterine contractions, avoids inferior vena cava compression, facilitates fetal head descent, and relaxes the pelvic musculature, all of which can shorten labor. However, the preponderance of evidence suggests that ambulation during labor is not associated with these benefits. The purpose of this study is to determine whether ambulation with AEA decreases labor duration from the time of epidural insertion to complete cervical dilatation. Methods In this prospective, randomized study, 160 nulliparous women with AFA were randomly assigned to one of two groups: AEA with ambulation and AEA without ambulation. AEA blocks were initiated with 15-20 ml ropivacaine (0.07%) plus 100 microg fentanyl, followed by a continuous infusion of 0.07% ropivacaine plus 2 microg/ml fentanyl at 15-20 ml/h. Maternal measured variables included ambulation time, time from epidural insertion to complete dilatation, stage II duration, pain Visual Analogue Scale scores, and mode of delivery. APGAR scores were recorded at 1 and 5 min. Results are expressed as mean +/- SD or median and analyzed using the t test, chi-square, or the Mann-Whitney test at P < or = 0.05. Results The ambulatory group walked 25.0 +/- 23.3 min, sat upright 40.3 +/- 29.7 min, or both. Time from epidural insertion to complete dilatation was 240.9 +/- 146.1 min in the ambulatory group and 211.9 +/- 133.9 min in the nonambulatory group (P = 0.206). Conclusion Ambulatory epidural analgesia with walking or sitting does not shorten labor duration from the time of epidural insertion to complete cervical dilatation.

BACKGROUND Although maternal choice increasingly influences intrapartum care, little is known about maternal attitudes about many outcomes and interventions, particularly the length of labor. Early amniotomy decreases the length of labor and particularly the frequency of prolonged (> 12 hr) labor but is often avoided by health professionals. The objective of this survey was to assess the attitudes of women in a major Dublin teaching hospital about the length of labor, amniotomy, and epidural analgesia. METHODS An anonymous, structured, self-completed questionnaire was given to 438 women at their booking visit to the hospital antenatal clinic in February 1998. Participants could ring "agree," "disagree," "don't know," or "don't care" to seven different statements. RESULTS The questionnaire was returned by 398 (92%) women; demographic details were similar to those for the overall hospital population. Of these, 73.5 percent of women wanted a quick labor; 82 percent wanted it to last less than 12 hours. Nearly one-half specifically wanted epidural analgesia. Only 13 percent wished to avoid amniotomy; significantly more multiparas disagreed with "avoiding amniotomy." CONCLUSIONS Many women want a quick and painless labor, and do not object to the interventions that help achieve this.