Objective: To evaluate the combined effect of massage and warm compress to the perineum (MassComp) compared with standard "hands-off" in the second stage of labor. Methods:A randomized trial was conducted in a University hospital in Malaysia.Nulliparous women at term who were about to start pushing were randomized to massage during pushing and warm compress to the perineum in between pushes or to standard "hands-off" care. Primary outcome was suturing for perineal injury (episiotomy or tear).Results: A total of 156 participants were analyzed based on intention to treat. Perineal repair rates were 53/79 (67%) for MassComp versus 70/77 (91%) for control (relative risk [RR] 0.72, 95% confidence interval [CI] 0.61-0.98, number needed to treat for an additional beneficial outcome [NNT b ] 5, 95% CI 2.83-8.62, P < 0.001). Of the secondary outcomes, participants' satisfaction with care (visual numerical rating scale 0-10; 8.3 ± 1.2 vs 7.8 ± 1.2, P = 0.014), major perineal injury (second degree or higher) rates 34/79 (43%) versus 51/77 (66%) (RR 0.72, 95% CI 0.58-0.97, NNT b 5, 95% CI 2.61-12.56, P = 0.004), episiotomy rates 28/79 (37%) versus 40/77 (53%) (RR 0.72, 95% CI 0.52-0.98, NNT b 8, 95% CI 3.63-36.46, P = 0.043), intervention to delivery intervals 29.5 ± 13.6 versus 27.9 ± 13.8 minutes (P = 0.472) and spontaneous vaginal delivery rates 63/79 (79.7%) versus 56/77 (72.7%) (RR 1.11, 95% CI 0.92-1.34, P = 0.306) for MassComp versus control, respectively. Conclusion:Massage and warm compress during pushing decreased the perineal suturing, major perineal injury, and episiotomy rates and improved maternal satisfaction.
Background Induction of labour (IOL) in low‐risk nulliparas at 39 weeks reduces caesarean delivery. Multiparas with ripe cervixes typically have vaginal delivery within eight hours. Delivery at night and weekend are associated with higher maternal and neonatal mortality. Aims To evaluate IOL in full‐term multiparas with ripe cervixes to achieve delivery at normal working hours and improve maternal satisfaction. Methods A randomised trial was performed in a tertiary hospital in Malaysia. Low‐risk multiparas with ripe cervixes (Bishop score ≥6) were recruited at 38+4–40+0 weeks, then randomised to planned labour induction at 39+0 weeks or expectant care. Primary outcomes were delivery during ‘normal working hours’ 09:00–17:00 hours, Monday–Friday and patient satisfaction by visual numerical rating scale. Results For IOL (n = 80) vs expectant care (n = 80) arms respectively, primary outcomes of delivery at normal working hours was 27/80 (34%) vs 29/78 (37%), relative risk (RR) 0.9, 95% CI 0.5–1.7, P = 0.41, patient satisfaction was 8.0 ± 1.8 vs 7.8 ± 1.6, P = 0.41; presentation for spontaneous labour or rupture of membranes were 27/80 (34%) vs 70/79 (89%), RR 0.4, 95% CI 0.3–0.5, P < 0.001; and for labour induction 52/80 (65%) vs 15/79 (19%), RR 3.4, 95% CI 2.1–5.5, P < 0.001. Caesarean delivery was 8/80 (10%) vs 4/79 (5%), RR 2.0, 95% CI 0.62–6.3, P = 0.25; and mean birthweight was 3.1 ± 0.3 vs 3.3 ± 0.4 kg, P = 0.06 for IOL vs expectant care, respectively. Conclusion Labour induction in low‐risk multiparas does not increase births during working hours or improve patient satisfaction. Antenatal clinic visits and non‐birth hospitalisation were significantly reduced.
Background There are no obvious thresholds at which the risk of adverse pregnancy outcomes increases as a result of maternal hyperglycemia. HbA1c level which is representative of average blood glucose levels over the last 2–3 months is not as strongly predictive of adverse outcome compared to blood glucose values of oral glucose tolerance test. Data is sparse on the predictive value of HbA1c at term just prior to delivery on adverse outcome. We sought to evaluate HbA1c taken on admission for delivery at term on adverse outcomes of Cesarean delivery and large (≥ 90th centile) for gestational age (LGA) infants. Methods A prospective cross-sectional study was conducted in a university hospital in Malaysia from December 2017-August 2018. 1000 women at term whose deliveries were imminent were enrolled. Blood were drawn and immediately sent for HbA1c analysis at our hospital laboratory. Primary outcomes were Cesarean delivery and LGA. Results On crude analyses, Cesarean births (vs. vaginal births) were associated with significantly higher HbA1c (%) levels 5.4[5.2–5.7] vs. 5.3[5.1–5.6] P = < 0.001 but not for LGA vs. non-LGA 5.4[5.1–5.6] vs. 5.3[5.1–5.6] P = 0.17. After controlling for significant confounders identified on crude analysis (diabetes in pregnancy, parity, ethnicity, body mass index (BMI), previous cesarean, labor induction, Group B streptococcus (GBS) carriage and birth weight), HbA1c is independently predictive of Cesarean birth, adjusted odds ratio (AOR) 1.47 95% CI 1.06–2.06 P = 0.023 per HbA1c 1% increase. Following adjustment for significant confounders (BMI, predelivery anemia [hemoglobin < 11 g/dl] and GBS carriage), the impact of raised HbA1c level on LGA is AOR 1.43 95% CI 0.93–2.18 P = 0.101 per HbA1c 1% increase and non-significant. Conclusion Raised HbA1c level at term births in the general pregnant population is independently predictive of Cesarean delivery after adjustment for potential confounders including diabetes in pregnancy.
BackgroundWomen experience significant sleep disruption throughout pregnancy. Lack of sleep during the last month of pregnancy is associated with longer labor, a higher rate of Cesarean births, gestational diabetes, hypertension, and preterm birth. Eye-mask and earplugs through sensory deprivation increase sleep duration and quality in patients in the intensive care environment but their impact at home or during pregnancy is not known. We sought to evaluate eye-mask and earplugs compared to sham/placebo headbands on night sleep duration in pregnancy. Materials and methodsA randomized trial was performed in a university hospital in Malaysia. Nulliparas between 34 and 36 weeks of gestation with self-reported night sleep of fewer than six hours were randomized to the use of eye-mask and earplugs or "sham" headbands during night sleep (both introduced as sleep aids). Night sleep duration was measured through a wrist actigraphy monitor during non-intervention week one and intervention week two with the allocated sleep aid. ResultsData from 56 participants were analyzed on an intention-to-treat basis. Mean night sleep duration increased in intervention week two compared to non-intervention week one in both trial arms, which were 279 ± 19 vs. 304 ± 19 minutes (mean increase of 25 minutes) p = <0.001 and 286 ± 21 vs. 302 ± 22 minutes (mean increase of 16 minutes) p = <0.001 for eye-masks-earplugs and headband respectively. However, the mean increase in night sleep duration across trial arms (p=0.13) was not significant. A higher proportion of participants in the eye-masks and earplugs arm had their night sleep duration increased by at least 30 minutes, 13/29 (45%) vs. 5/26 (19%), relative risk (RR) 2.3 (95% CI 1.0-5.6) p = 0.04, more likely to agree that they slept better 19/29 (66%) vs. 7/27 (26%), RR 2.2 (95% CI 1.1-4.6) p = 0.03, expressed higher satisfaction score with their sleep aid 7 (7.0-7.5) vs. 6 (5-7), p = 0.003 and had lower induction of labor rates 4/29 (14%) vs. 12/27 (44%), RR 0.3 (95%CI 0.1-0.8) p = 0.02. ConclusionEye masks and earplugs use in nulliparas with short night sleep duration in late pregnancy, lengthen their night sleep duration over baseline. Sleep is reportedly better and maternal satisfaction is higher with eye masks and earplugs use.
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