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Julie Bonapace,1 Nils Chaillet,2 Isabelle Gaumond,3,4 Émilie Paul-Savoie,5 Serge Marchand3,41Département des Sciences de l'Éducation, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Québec, 2Centre de Recherche de l'Hôpital Sainte-Justine, Université de Montréal, Montréal, Québec, 3Département de chirurgie, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, 4Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Québec, 5École des sciences infirmières, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, CanadaObjective: As pain during childbirth is very intense, several educational programs exist to help women prepare for the event. This study evaluates the efficacy of a specific pain management program, the Bonapace Method (BM), to reduce the perception of pain during childbirth. The BM involves the father, or a significant partner, in the use of several pain control techniques based on three neurophysiological pain modulation models: (1) controlling the central nervous system through breathing, relaxation, and cognitive structuring; (2) using non-painful stimuli as described in the Gate Control Theory; and (3) recruiting descending inhibition by hyperstimulation of acupressure trigger points.Methods: A multicenter case control study in Quebec on pain perception during labor and delivery compared traditional childbirth training programs (TCTPs) and the BM. Visual analog scales were used to measure pain perception during labor. In all, 25 women (TCTP: n = 12; BM: n = 13) successfully reported their perceptions of pain intensity and unpleasantness every 15 minutes.Results: A positive correlation between the progression of labor and pain was found (pain intensity: P < 0.01; pain unpleasantness: P < 0.01). When compared to TCTP, the BM showed an overall significant lower pain perception for both intensity (45%; P < 0.01) and unpleasantness (46%; P < 0.01).Conclusion: These significant differences in pain perception between TCTP and the BM suggest that the emphasis on pain modulation models and techniques during labor combined with the active participation of a partner in BM are important variables to be added to the traditional childbirth training programs for childbirth pain management.Keywords: labor pain, yoga, perinatal care, DNIC, gate control theory, cognitive structuring, massage, father

In the frame of Thermodynamics of irreversible process, a model describing the thermomagneto-mechanical behavior of a single crystal of Ni-Mn-Ga is built. The choice of internal variables is linked to the physics of the problem (fraction of martensite variants, fraction of Weiss domains, magnetization angle). The simulations permit to describe the paths in the space (stress, temperature, magnetic field) in agreement with experimental tests. A special attention will be devoted to the control laws required to use these functional materials as sensors or actuators.

This article discusses the role of lower uterine segment thickness (LUST) in predicting uterine rupture during trial of labor after Caesarean (TOLAC). The study analyzed data from the PRISMA randomized trial and found that LUST is highly associated with the risk of uterine rupture. The best approach for predicting uterine rupture is a combination of vaginal and abdominal ultrasound. A LUST measurement below 3.0mm should be considered a risk factor for uterine rupture during TOLAC. It is important to note that no uterine ruptures were observed among high-risk women who attempted TOLAC after being informed of their risk based on LUST measurement. [Extracted from the article]

Background: Rates of cesarean delivery are continuously increasing in industrialized countries, with repeated cesarean accounting for about a third of all cesareans. Women who have undergone a first cesarean are facing a difficult choice for their next pregnancy, i.e.: (1) to plan for a second cesarean delivery, associated with higher risk of maternal complications than vaginal delivery; or (b) to have a trial of labor (TOL) with the aim to achieve a vaginal birth after cesarean (VBAC) and to accept a significant, but rare, risk of uterine rupture and its related maternal and neonatal complications. The objective of this trial is to assess whether a multifaceted intervention would reduce the rate of major perinatal morbidity among women with one prior cesarean.Methods/design: The study is a stratified, non-blinded, cluster-randomized, parallel-group trial of a multifaceted intervention. Hospitals in Quebec are the units of randomization and women are the units of analysis. As depicted in Figure 1, the study includes a 1-year pre-intervention period (baseline), a 5-month implementation period, and a 2-year intervention period. At the end of the baseline period, 20 hospitals will be allocated to the intervention group and 20 to the control group, using a randomization stratified by level of care. Medical records will be used to collect data before and during the intervention period. Primary outcome is the rate of a composite of major perinatal morbidities measured during the intervention period. Secondary outcomes include major and minor maternal morbidity; minor perinatal morbidity; and TOL and VBAC rate. The effect of the intervention will be assessed using the multivariable generalized-estimating-equations extension of logistic regression. The evaluation will include subgroup analyses for preterm and term birth, and a cost-effectiveness analysis.Discussion: The intervention is designed to facilitate: (1) women's decision-making process, using a decision analysis tool (DAT), (2) an estimate of uterine rupture risk during TOL using ultrasound evaluation of low-uterine segment thickness, (3) an estimate of chance of TOL success, using a validated prediction tool, and (4) the implementation of best practices for intrapartum management.Trial Registration: Current Controlled Trials, ID: ISRCTN15346559 . Registered on 20 August 2015. [ABSTRACT FROM AUTHOR]

Objective: To assess the risks of uterine rupture, maternal and perinatal outcomes associated with a trial of labour (TOL) after one previous caesarean were compared with having an elective repeated caesarean section (ERCS) without labour in low-resource settings.Design: A prospective 4-year observational study.Setting: Senegal and Mali.Sample: A cohort of 9712 women with one previous caesarean delivery.Methods: Maternal and perinatal outcomes were compared between 8083 women who underwent a TOL and 1629 women who had an ERCS. Perinatal and maternal outcomes were then stratified according to the presence or absence of risk factors associated with vaginal birth after caesarean section. These outcomes were adjusted on maternal, perinatal and institutional characteristics.Main Outcome Measures: The risks of uterine rupture, maternal complication and perinatal mortality associated with TOL after one previous caesarean as compared with ERCS, RESULTS: The risks of hospital-based maternal complication [adjusted odds ratio (OR) 1.52; 95% CI 1.09-2.13; P = 0.013] and perinatal mortality (adjusted OR 4.53; 95% CI 2.30-9.92; P < 0.001) were significantly higher in women with a TOL compared with women who had an ERCS. However, when restricted to low-risk women, these differences were not significant (adjusted OR 0.90, 95% CI 0.55-1.46, P = 0.68, and adjusted OR 1.13; 95% CI 0.75-1.86; P = 0.53, for each outcome, respectively). Uterine rupture occurred in 25 (0.64%) of 3885 low-risk women compared with 70 (1.66%) of 4198 women with unfavourable risk factors.Conclusion: Low-risk women have no increased risk of maternal complications or perinatal mortality compared with women with one or more unfavourable factors.Tweetable Abstract: Low-risk women have a lower risk of maternal complications or perinatal mortality compared with high-risk women. [ABSTRACT FROM AUTHOR]