Maternal Positions and Pushing Techniques in a Nonprescriptive Environment

There are many non-pharmacological methods for relieving labor pain. The preferable method is certainly the one that is effective and harmless. Therefore, we decided to compare the efficacy of massage therapy and breathing techniques on pain intensity, physiological responses to labor pain, labor type and the outcomes. A quasi-experimental study was conducted in Alzahra Hospital in Tabriz. At first, 4o primigravidas, satisfying the inclusion criteria, were selected and randomly divided into two groups of massage 1 (M1) and breathing 1 (B1). Then, another 42 mothers were selected based on the same criteria and randomly divided into two groups of massage 2 (M2) and breathing 2 (B2). An educated researcher assistant (ERA) provided practical training to (B1 and B2 groups) by holding one educational session. As the labor process started, the ERA, who was present at the labor room, repeated the breathing technique for B1 and B2 groups. The breathing groups employed the techniques during the first or second stage of labor at 4, 6, 8 and 10 centimeter of dilatation for 30 minutes. The intensity of pain was measured by a numerical rating scale (NRS) 30 minutes after determining dilatation. The physiological responses were evaluated at the same time intervals. The ERA performed massaging at the same dilatations for M1 and M2 groups. The data was collected similarly. Labor progression was evaluated by the partograph. Massage at 4 and 6 cm dilatations and breathing at most dilatations decreased pain scores significantly. The mean difference of pain intensity and physiological responses to pain was not significant between the massaging and breathing groups at most dilatations. Based on the findings of this research, providing the possibility of choosing one or both methods for labor pain relief and decreasing cesarean section rate is suggested.

ObjectiveTo develop, implement, and evaluate an educational program to improve nurses’ management of the second stage of labor. DesignEvidence-based practice project guided by the Iowa Model–Revised. SettingAcute care teaching hospital in central California averaging 2,100 births/year with 12 labor, delivery, and recovery rooms and a Level III nursery. ParticipantsEighteen registered nurses participated in the educational intervention. InterventionAn instructional course addressed contemporary labor management guidelines and delayed and open/closed glottis pushing. Assessment/documentation of maternal–fetal status, progress/fetal descent, and nurse/provider communication were discussed. Participants engaged in an interactive experience regarding maternal positions. MeasurementsData collected from the electronic health record included the number of position changes, nurse/provider communication interactions, and minutes from 10 cm to birth and minutes in delayed pushing. ResultsSecond-stage labor outcomes for nulliparous patients at term with a singleton in vertex presentation improved with more position changes and percentage of spontaneous vaginal births. Patients of nurses who participated in the educational intervention (n = 18) had a vaginal birth rate of 87.5% and a surgical birth rate of 6.2%. Patients of nurses who did not participate in the educational intervention (n = 31) had a vaginal birth rate of 81.8% and a surgical birth rate of 9.1%. ConclusionBased on the positive response to the intervention and improved clinical outcomes, regularly scheduled interactive nursing education focused on strategies to improve the second stage of labor may be beneficial.

Maternal Postures to Promote the Rotation of Occiput Posterior Foetal Position During Labour

BACKGROUND/AIMS This study aimed to determine the effect of three different positions of delivery on the postpartum bleeding, perineum status, and some birth outcomes. MATERIALS and METHODS This clinical trial study was performed on 96 primiparous pregnant women who had voluntarily entered the trial and were randomly assigned to one of the following three groups: lithotomy, sitting, and squatting group in the second stage of labor. Bleeding during the first hour after delivery, postpartum status of the perineum, as well as type and degree of tear were measured. The data were analyzed using Statistical Package for the Social Sciences 17 (SPSS Inc.; Chicago, IL, USA). RESULTS and CONCLUSION The mean volume of bleeding in the lithotomy group was significantly lower than those in the other two groups (p=0.016), and there was no significant difference between the sitting and squatting groups. There was no significant difference among the three groups in terms of the perineal status (tear and episiotomy), the height of the uterus, and the neonatal mean Apgar mean scores at 1 and 5 minutes (p>0.05). The use of different delivery positions based on the status of the mother can have different effects on the mother and infant outcomes; further studies are warranted on this subject. Keywords: Childbirth position, episiotomy and laceration, post partum position

IntroductionOne of the major health problems in many countries including India is type 2 diabetes. Yoga is being explored as an alternative therapy for the management of diabetes.MethodsAmong the total of 137 participants who successfully completed the ‘Living Well’ workshop by the Art of Living, 84 with type 2 diabetes were assessed for change in random blood sugar levels, systolic and diastolic blood pressure levels (SBP/DBP), and pulse rate over seven days. In the Living Well workshop, the participants performed a comprehensive Yogic Breathing Program that included yogic movements and postures (Asana), relaxation practice, three-stage Pranayama, Sudarshan Kriya Yoga (SKY), breathing techniques, and discussion of stress relieving principles over those seven days. The parameters were recorded at the time of enrollment and after the completion of seven days of the workshop.ResultsThere was a greater (p<0.05) percent reduction in the mean blood sugar level in diabetics as compared to non-diabetic individuals. However, the reduction in SBP and DBP were similar (p>0.05) in diabetics and non-diabetics. The percent reduction in the pulse rate however was greater (p<0.05) in diabetics than non-diabetics.ConclusionComprehensive yogic breathing practices comprising SKY may be beneficial in patients with type 2 diabetes mellitus.

We hypothesized that the simultaneous use of low concentrations (<6%) of desflurane, nitrous oxide (N(2)O), and fentanyl would allow a laryngeal mask airway (LMA) to be inserted safely with inhalation induction of desflurane, even in nonparalyzed patients. This prospective, observational study was performed to determine the 50% effective concentration (EC(50)) of desflurane for LMA insertion in such patients. Twenty-two adult patients undergoing ambulatory surgical procedures under general anesthesia using an LMA were included in the study. Fentanyl was administered intravenously at 1.5 microg x kg(-1), and anesthesia was induced with desflurane in 50% N(2)O and oxygen, using a normal tidal volume breathing technique. Subsequently, a preselected steady-state end-tidal desflurane concentration was maintained for 10 min before insertion of the LMA. Successful LMA insertion was defined as the absence of adverse airway responses until cuff inflation. Target concentrations of desflurane for LMA insertion were determined using a modified Dixon's up-and-down method (starting dose, 5%; step size, 0.5%). All 22 patients completed the study without adverse events related to airway irritation. The EC(50) of desflurane for insertion of the LMA was determined to be 3.61 +/- 0.31%, and the 95% confidence interval (CI) of the EC(50) obtained using probit analysis was 3.13-3.90. We demonstrated that N(2)O-desflurane inhalation induction with a normal tidal breathing technique after premedication with fentanyl can be used safely without any adverse airway events in nonparalyzed patients. In such patients, the EC(50) of desflurane for successful LMA insertion was 3.61 +/- 0.31% (95% CI, 3.13-3.90).

OBJECTIVE: The objective of this study was to describe the impact of genital tract trauma on the prevalence of perineal pain, urinary (UI) and anal incontinence (AI), and sexual function in a low-risk cohort of women after vaginal birth. METHODS: In this prospective cohort study, women completed validated questionnaires at discharge, 6 weeks and 3 months postpartum. Questionnaires included the Modified McGill pain scale, Incontinence Impact Questionnaire (IIQ-7), Fecal Incontinence Score (FIS), and Intimate Relationship Scale (IRS). Intrapartum events were recorded and trauma was mapped to site (anterior or perineal) and severity (major or minor). Chi-squared analyses were used to compare subgroups. Significance was set at P<0.05. RESULTS: Five hundred thirteen women participated with follow-up rates of 96% postpartum day 1, 63% at 6 weeks, and 57% at 3 months. Mean age was 24.8 ± 5.2 years and 40% were nulliparous. Less than 1% of women underwent episiotomy or operative vaginal delivery or had recognized third- or fourth-degree lacerations. Twenty percent of women delivered without trauma, 34% with anterior (periurethral, periclitoral, or labial), 17% perineal, and 26%with both anterior and perineal trauma. Major trauma (trauma that involved perineal muscles or required suturing) occurred in 19%. At 3 months, few women (1%) had persistent perineal pain. AI (FIS score >0) was reported by 28% of women at 6 weeks and 24% at 3 months. Women with major trauma were more likely to report AI at 3 months (P=0.004), but presence or site of trauma was not related to AI complaints (all P=not significant [NS]). Complaints of UI were common at 28% at 6 weeks and 30% at 3 months. Fewer women reported IIQ-7 scores >0, at 17% and 12%, respectively. UI was not related to the presence or severity of trauma (all P=NS). Women with anterior trauma had fewer UI complaints than women with other sites of trauma (P=0.02). Dyspareunia was reported more often by women with major trauma than women with minor or no trauma (P=0.02). At 6 weeks, UI and AI were positively associated with directed forceful pushing in the second stage (P=0.003 and P=0.02, respectively). At 3 months, AI and UI were not associated with age, race/ethnicity, parity, body mass index, length of second stage, fetal weight, oxytocin or epidural use, or maternal position at delivery. CONCLUSIONS: This is the first prospective cohort study of low-risk healthy women that examines the impact of genital tract trauma on postpartum pelvic floor function. Complaints of pain were rare; AI and UI were reported more commonly. UI was inversely associated with anterior trauma, whereas AI was associated with perineal laceration. Directed forceful pushing in the second stage of labor may place women at risk in the short term for pelvic floor disorders.

Association of Carboxyhemoglobin Levels with Yogic Breathing in Medical Undergraduate Students- An Observational Cross-sectional Study

Routine delirium monitoring is independently associated with a reduction of hospital mortality in critically ill surgical patients: A prospective, observational cohort study

Effectiveness of detection of intrauterine growth retardation by abdominal palpation as screening test in a low risk population: an observational study

Type 1 Gaucher disease is currently categorized as non-neuronopathic, although recent studies suggest peripheral neurological manifestations. We report prevalence and incidence data for peripheral neuropathy and associated conditions from a multinational, prospective, longitudinal, observational cohort study in patients with type 1 Gaucher disease, either untreated or receiving enzyme replacement therapy. The primary outcome parameters were the prevalence and incidence of polyneuropathy, evaluated by standardized assessments of neurological symptoms and signs, and electrophysiological studies. All diagnoses of polyneuropathy were adjudicated centrally. Secondary outcome parameters included the prevalence and incidence of mononeuropathy, other neurological or electrophysiological abnormalities not fulfilling the criteria for a mono- or polyneuropathy and general type 1 Gaucher disease symptoms. Furthermore, a literature search was performed to identify all studies reporting on prevalence and incidence of polyneuropathy in the general population. One hundred and three patients were enrolled [median (range) age: 42 (18-75) years; disease duration: 15 (0-56) years; 52% female]; 14 (13.6%) were untreated and 89 (86.4%) were on enzyme replacement therapy. At baseline, 11 patients [10.7%; 95% confidence interval (CI): 5.9-18.3] were diagnosed with sensory motor axonal polyneuropathy. Two (1.9%; 95% CI: 0.1-7.2) had a mononeuropathy of the ulnar nerve. The 2-year follow-up period revealed another six cases of polyneuropathy (2.9 per 100 person-years; 95% CI: 1.2-6.3). Patients with polyneuropathy were older than those without (P<0.001). Conditions possibly associated with polyneuropathy were identified in four patients only, being monoclonal gammopathy, vitamin B(1) deficiency, folic acid deficiency, type 2 diabetes mellitus, renal insufficiency, alcohol abuse and exposure to toxins related to profession. The 11 cases of polyneuropathy found at baseline were confirmed during follow-up. According to the literature, the prevalence of polyneuropathy in the general population was estimated between 0.09 and 1.3% and the incidence was estimated between 0.0046 and 0.015 per 100 person-years. Thus, we conclude that the prevalence and incidence of polyneuropathy in patients with type 1 Gaucher disease is increased compared with the general population.

Continuous electroencephalography in a mixed non-neurological intensive care population, an observational study

The primary aim was to study the risk of cardiovascular mortality in patients with differentiated thyroid carcinoma (DTC). Secondary aims were to evaluate all-cause mortality and explore the relation between thyroid-stimulating hormone (TSH; also known as thyrotropin) level and these outcome parameters. Subjects from two cohorts were retrospectively compared by Cox regression analyses; 524 patients with DTC and 1,572 sex- and age-matched controls from a large population-based study in the same geographic region. Mean age plus or minus standard deviation was 49 ± 14 years. Median follow-up was 8.5 years (interquartile range [IQR], 4.1 to 15.9 years) for patients with DTC and 10.5 years (IQR, 9.9 to 10.9 years) for controls. One hundred patients with DTC (19.1%) died, 22 (4.2%) as a result of cardiovascular disease, 39 (7.4%) as a result of DTC, and 39 (7.4%) as a result of other/unknown causes. Eighty-five controls (5.4%) died, 24 (1.5%) as a result of cardiovascular disease and 61 (3.9%) as a result of other/unknown causes. Patients with DTC had an increased risk of cardiovascular and all-cause mortality (hazard ratios [HRs], 3.35 [95% CI, 1.66 to 6.74] and 4.40 [95% CI, 3.15 to 6.14], respectively, adjusted for age, sex, and cardiovascular risk factors). Within the DTC group, TSH level was predictive for cardiovascular mortality; the adjusted HR was 3.08 (95% CI, 1.32 to 7.21) for each 10-fold decrease in geometric mean TSH level. The risk of cardiovascular and all-cause mortality is increased in patients with DTC, independent of age, sex, and cardiovascular risk factors. A lower TSH level is associated with increased cardiovascular mortality, supporting the current European Thyroid Association and the American Thyroid Association guidelines of tempering TSH suppression in patients with low risk of cancer recurrence. Furthermore, patients with DTC may benefit from assessment and treatment of cardiovascular risk factors.

Patients enrolled in randomised clinical trials are not representative of critically ill patients in clinical practice: Observational study focus on tigecycline

Introduction: Fetal growth restriction (FGR) is a major obstetric complication associated with an increased risk of adverse perinatal outcomes. Objectives: This study aimed to evaluate the relationship between Doppler parameters, including the cerebroplacental ratio (CPR), umbilicocerebral ratio (UCR), and cerebro-placental-uterine ratio (CPUR), with adverse perinatal outcomes in singleton pregnancies complicated by FGR. Patients and Methods: This was a prospective study of 100 women with a singleton pregnancy 28 and 36.8 weeks of gestation was complicated by FGR and mild abnormalities. Feto-maternal Doppler examinations were conducted by the CPR, UCR, and CPUR parameters. Adverse outcomes were defined as Apgar score &lt;7 at 5 minutes, preterm birth &lt;37-week, neonatal intensive care unit (NICU) admission, fetal distress, and emergency cesarean section. These outcome parameters were checked with the results of the last ultrasound which performed 1-2 weeks before delivery. Results: Mean umbilical artery pulsatility index (UA-PI) (1.18±0.31 versus 1.04±0.21, P=0.010) and mean uterine arteries (UtAs)-PI (1.18±0.45 versus 0.96±0.36, P=0.20) were significantly higher in pregnancies that experienced adverse perinatal outcomes than those that did not experience them. Mean CPUR (1.82±1.03 versus 2.25±0.83, P=0.039) was significantly lower in pregnancies that experienced adverse perinatal outcomes versus those that did not. In binary multivariate logistic regression analysis, CPR, UCR, and CPUR parameters were evaluated with adverse perinatal outcomes. Only CPUR had a significant relationship with adverse perinatal outcomes. CPUR had a substantial relationship with Apgar score &lt;7 at 5 minutes (OR: 0.13; 95% CI: 0.02-0.63; P=0.012). Conclusion: CPUR is a new Doppler ratio associated with adverse perinatal outcomes in FGR pregnancies with minimal abnormalities.