BACKGROUND: Longer duration of active pushing during labor is associated with a higher rate of operative delivery and an increased risk of maternal and neonatal complications. Although immediate pushing at complete dilatation is associated with lower rates of chorioamnionitis and postpartum hemorrhage, it is also associated with a longer duration of pushing. OBJECTIVE: This study aimed to evaluate whether fetal head station and position, as assessed by ultrasound at the beginning of the pushing process, can predict the mode of delivery and duration of pushing in nulliparous women. STUDY DESIGN: This prospective observational study included nulliparous women with neuraxial analgesia and complete cervical dilatation. The following sonographic parameters were assessed just before the beginning of the pushing process, at rest, and while pushing during contraction: head position, angle of progression, head-perineum distance, and head-symphysis distance. The change between rest and pushing was designated as delta angle of progression, delta head-perineum distance, and delta headsymphysis distance. The sonographic measurements and fetal head station assessed by vaginal examination were compared between women who had a spontaneous vaginal delivery to those who underwent an operative delivery, and between those who pushed for more or less than 1 hour. RESULTS: Of the 197 women included in this study, 166 (84.3%) had a spontaneous vaginal delivery, 31 (15.7%) had an operative delivery, 23 (11.6%) had a vacuum delivery, and 8 (4.0%) had a cesarean delivery. Spontaneous vaginal delivery and shorter duration of pushing (less than an hour) were significantly more common with a nonocciput posterior position (10.6% vs 47.3%; P<.005), a wider angle of progression, a shorter head-perineum distance and headsymphysis distance (both during rest and while pushing), and a lower fetal head station as assessed by digital vaginal examination. However, a logistic regression model revealed that only the angle of progression at rest and the delta angle of progression were independently associated with a spontaneous vaginal delivery with an area under the curve of 0.82 (95% confidence interval, 0.76e0.87; P<.0001) and 0.75 (95% confidence interval, 0.67e0.79; P<.0001), respectively. CONCLUSION: Ultrasound performed at the beginning of the active second stage of labor can assist in predicting the mode of delivery and duration of pushing and perform better than the traditional digital examination, with the angle of progression at rest and delta angle of progression being the best predictors.
Background Cigarette smoking is a main cause of preventable morbidity and mortality. Many young adults begin smoking in the military, with smoking rates higher among soldiers than in the general population. Among other health effects, smoking impairs performance among soldiers. Smoking cessation programs in the military are challenging due to the unique settings and low access to smoking cessation resources. Studies have shown that text-messaging smoking cessation programs are feasible and effective, but there is a lack of studies on soldiers. Objective To evaluate the feasibility of a text-messaging smoking cessation program tailored for soldiers. Methods We recruited 81 soldiers who smoked, 76.5% of whom were male. Following enrollment, participants filled out a baseline survey and were given a text messaging program for 6 months. Participants could send predetermined keywords and immediately receive a response from a list of messages that were constructed as a response to the specific keyword. Participants filled out a follow-up survey at 1 month. Additionally, we retrieved and analyzed program usage data, including keywords sent and received, for the entire program period. Based on the follow-up survey and the program usage data, we assessed feasibility of the recruitment methods, participants’ engagement and satisfaction and technical usability of the program. Results At 1 month, 20.6% reported that they had not smoked in the past week. A high percentage of the participants were engaged in the program, with 82.5% sending at least one valid keyword. The lowest self-efficacy group had higher chances of leaving the program (50.0%) while for the highest group there were much lower chances (4.8%). Most of the soldiers (96.8%) found the program easy to use and would recommend it to a friend (84.1%). Conclusions The study demonstrates that a text-messaging smoking cessation program is feasible in a military setting. Further development and evaluation of digital smoking cessation tools tailored for soldiers are warranted.
Conclusions: The prevalence of UVPT in a general gynecology population was 3.0%. Several demographic and clinical factors were found to be associated with UVPT, which could help to identify women at risk of this condition and facilitate its early detection. This would provide a basis to assess the natural history and clinical significance of this novel clinical finding, and the development of an optimal management approach. OC12.06 Hysteroscopic removal of asymptomatic endometrial polyps in postmenopause should be considered a primary prevention procedure for endometrial cancer as a result of a 20-year follow-up study
Oral communication abstracts Results: Of the 150 women enrolled, 76 were randomised to the US group and 74 to the control group. The median number of digital exams was significantly lower in the US group (5, range 2-11) than in the control group (8, range 2-18, p < 0.01). Likewise, the median number of digital exams per hour in the US group was significantly lower than in the control group (0.22 vs. 0.37, p < 0.01). Moreover, compared to the control group, the US group had a significantly lower incidence of intrapartum fever (9.2% vs. 25.7%, p < 0.01) as well as a significantly lower incidence of chorioamnionitis (2.6% vs. 14.9%, p = 0.02). The groups did not differ significantly in induction rate, time from admission to delivery, mode of delivery, Apgar at 5 min and NICU admission. Conclusions: The use of TPUS during labour can reduce the number of digital exams and consequently also the incidence of intrapartum fever and chorioamnionitis. No adverse effects on labour progression, maternal or neonatal outcomes were noted. These encouraging results need validation in a larger scale study. OC13.03 Intrapartum ultrasound at the initiation of the active second stage of labour predicts spontaneous vaginal delivery in nulliparous women
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.