Management of the second stage of labor

,

doi:10.1016/j.ijgo.2012.08.002

Cited by 41 publications

(12 citation statements)

References 27 publications

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“…During first stage of active labour, the international benchmark of 30 min intervals was often hard to achieve, and 1 h was included as a minimum acceptable interval. For second stage, due to high numbers of intrapartum stillbirths, and known risks of pushing on the foetus’ oxygen supply, the importance of close monitoring was stressed (Additional file 2, page 1) [12, 32]. …”

Section: Resultsmentioning

confidence: 99%

“…Second, because severe obstetric complications are often preceeded by delays in basic care, we found it crucial to integrate routine and emergency obstetric care [12]. Third, we emphasized partograph use as an integrated early warning tool to assess FHR, labour progress, and maternal condition throughout latent and active phase of labour, including the often forgotten second stage [32]. …”

Section: Discussionmentioning

confidence: 99%

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Labour management guidelines for a Tanzanian referral hospital: The participatory development process and birth attendants’ perceptions

Maaløe

Housseine

Roosmalen

et al. 2017

BMC Pregnancy Childbirth

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BackgroundWhile international guidelines for intrapartum care appear to have increased rapidly since 2000, literature suggests that it has only in few instances been matched with reviews of local modifications, use, and impact at the targeted low resource facilities. At a Tanzanian referral hospital, this paper describes the development process of locally achievable, partograph-associated, and peer-reviewed labour management guidelines, and it presents an assessment of professional birth attendants’ perceptions.MethodsPart 1: Modification of evidence-based international guidelines through repeated evaluation cycles by local staff and seven external specialists in midwifery/obstetrics. Part 2: Questionnaire evaluation 12 months post-implementation of perceptions and use among professional birth attendants.ResultsPart 1: After the development process, including three rounds of evaluation by staff and two external peer-review cycles, there were no major concerns with the guidelines internally nor externally. Thereby, international recommendations were condensed to the eight-paged ‘PartoMa guidelines ©’. This pocket booklet includes routine assessments, supportive care, and management of common abnormalities in foetal heart rate, labour progress, and maternal condition. It uses colour codes indicating urgency. Compared to international guidelines, reductions were made in frequency of assessments, information load, and ambiguity. Part 2: Response rate of 84% (n = 84). The majority of staff (93%) agreed that the guidelines helped to improve care. They found the guidelines achievable (89%), and the graphics worked well (90%). Doctors more often than nurse-midwives (89% versus 74%) responded to use the guidelines daily.ConclusionsThe PartoMa guidelines ensure readily available, locally achievable, and acceptable support for intrapartum surveillance, triage, and management. This is a crucial example of adapting evidence-based international recommendations to local reality.Trial registrationThis paper describes the intervention of the PartoMa trial, which is registered on ClinicalTrials.org (NCT02318420, 4th November 2014).Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1360-2) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Labour management guidelines for a Tanzanian referral hospital: The participatory development process and birth attendants’ perceptions

Maaløe

Housseine

Roosmalen

et al. 2017

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

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“…Thirteen babies (4%) were recorded with APGAR scores less than three, with four babies (1.2%) receiving full neonatal resuscitation which is well above the national reported in-hospital rate [ 28 ]. Nearly one third of women were given analgesia including Methoxyflurane, Morphine and Fentanyl whilst in paramedics’ care, which are not recommended immediately prior to the birth of a baby due to increased risk of neonatal respiratory depression [ 29 , 30 ]. In the immediate period after birth paramedics suctioned the airways of and administered oxygen to more babies than required resuscitation, again highlighting the need for paramedics to keep abreast of current evidence underpinning neonatal resuscitation [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of unplanned out-of-hospital births attended by paramedics

McLelland

McKenna

Morgans

et al. 2018

BMC Pregnancy Childbirth

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BackgroundOver the previous two decades the incidence and number of unplanned out of hospital births Victoria has increased. As the only out of hospital emergency care providers in Victoria, paramedics would provide care for women having birth emergencies in the community. However, there is a lack of research about the involvement of paramedics provide for these women and their newborns. This research reports the clinical profile of a 1-year sample caseload of births attended by a state-wide ambulance service in Australia.MethodsRetrospective data previously collected via Victorian Ambulance Clinical Information System (VACIS ®) an in-field electronic patient care record was provided by Ambulance Victoria. Cases were identified via a comprehensive filter, and analysed using SPSS version 19.ResultsOver a 12-month period paramedics attended 324 out-of-hospital births including 190 before paramedics’ arrival. Most (88.3%) were uncomplicated precipitous term births. However, paramedics documented various obstetric complications including postpartum haemorrhage, breech, cord prolapse, prematurity and neonatal death. Furthermore, nearly one fifth (16.7%) of the women had medical histories that had potential to complicate their clinical management, including taking illicit or prescription drugs. Mothers were more likely to be multiparas. Births were more likely to occur between 2200 and 0600 h. Paramedics performed a range of interventions for both mothers and babies.ConclusionsParamedics provided emergency care for prehospital out-of-hospital births. Although most were precipitous uneventful births at term, paramedics used complex obstetric assessment and clinical skills. These findings have implications for paramedic clinical practice and education around management of unplanned out of hospital births.

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“…Finally, an association between fetal acidosis and increased duration of dilation (49,50), duration of expulsion (51,52), and total duration of delivery (49, 51) has also been observed.…”

Section: Discussionmentioning

confidence: 86%

Analysis of Factors Associated With Variability and Acidosis of the Umbilical Artery pH at Birth

2021

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Background: Perinatal asphyxia is a significant contributing factor for neonatal morbidity and mortality. The aim of this study was to investigate the clinical factors associated with umbilical artery pH variability and fetal acidosis at birth.Methods: This is a single center cross-sectional study in a public regional hospital in southeastern Spain from January to December 2019. The reference population was 1.655 newborns, final sample of 312 experimental units with validated values of umbilical cord blood pH.Results: Factors such as gestational age at term (X̄at-term: 7.26 ± 0.08-X̄no-at−term: 7.31 ± 0.05, p: 0.00), primiparity (X̄primiparity: 7.24 ± 0.078-X̄multiparity: 7.27 ± 0.08, p: 0.01), induced labor (X̄induced: 7.24 ± 0.07-X̄spontaneous: 7.26 ± 0.081, p: 0.02), vaginal delivery (X̄vaginal:7.25 ± 0.08-X̄cesarean:7.27 ± 0.07, p: 0.01), and prolonged dilation duration (X̄AboveAverage: 7.22 ± 0.07-X̄BelowAverage: 7.27 ± 0.08, p: 0.00), expulsion duration (X̄AboveAverage: 7.23 ± 0.07-X̄BelowAverage: 7.26 ± 0.08, p: 0.01), and total labor duration (X̄AboveAverage: 7.23 ± 0.07-X̄BelowAverage: 7.27 ± 0.08, p: 0.00) are associated with a decrease in umbilical artery pH at birth. However, only three factors are associated with acidosis pH (<7.20) of the umbilical artery at birth: the induction of labor [OR: 1.74 (95% CI: 0.98–3.10); p: 0.04], vaginal delivery [OR: 2.09 (95% CI: 0.95–4.61); p: 0.04], and total duration of labor [OR: 2.06 (95% CI: 1.18–3.57); p: 0.01].Conclusions: Although several factors may affect the variability of umbilical artery pH at birth by decreasing their mean values (gestational age, primiparity, induced labor, vaginal delivery and prolonged: dilation duration, expulsion duration and total labor duration), only induction of labor, vaginal delivery and total duration of labor are associated with an acidosis (<7.20) of same.

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Management of the second stage of labor

Cited by 41 publications

References 27 publications

Labour management guidelines for a Tanzanian referral hospital: The participatory development process and birth attendants’ perceptions

Labour management guidelines for a Tanzanian referral hospital: The participatory development process and birth attendants’ perceptions

Epidemiology of unplanned out-of-hospital births attended by paramedics

Analysis of Factors Associated With Variability and Acidosis of the Umbilical Artery pH at Birth

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