The comparison of dinoprostone and vagiprost for induction of lobar in post t...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Placental Elastography in Intrauterine Growth Restriction: A Case–control Studyasclepiuspdfs
Background: Intrauterine growth restriction (IUGR) is related to poor fetal outcome. Though, various tools are available for evaluation of IUGR they are notreliable inearly diagnosis of IUGR. Shear wave elastography (SWE) can be used to study the change in mechanical properties of various disease which can be a potential technique for early diagnosis of IUGR. Objective: The objective of the study was to compare the differences in SWE values of placentas between IUGR and normal pregnancies. Methodology: Normal second- and third-trimester pregnancies and IUGR pregnancies between 24 and 42 weeks period of gestation (POG), meeting the inclusion criteria were matched for age group and POG. SWE of placenta was performed in supine position during quiet respiration. The SWE of placenta was measured by placing the region of interest in relatively homogeneous area. The placental elasticity values obtained in pregnancies complicated by IUGR were compared with that of normal controls. Umbilical artery (UA) and fetal middle cerebral artery (MCA) Doppler findings were correlated with placental elasticity value of IUGR pregnancies.
AN ANALYSIS OF OUTCOMES IN TWIN PREGNANCIES WITH ACTIVE FETAL SURVEILLANCE AN...Apollo Hospitals
The incidence of multiple gestations is increasing with
increasing maternal age and use of assisted reproduction
techniques. Selective fetal reduction of multifetal pregnancies is now widely practiced to reduce the higher order multiples to twins based on evidence from nonrandomised studies which suggests that this will improve the perinatal outcome. The proportion of twin pregnancies with unique fetal and maternal problems is therefore increasing. Optimising maternal, fetal and perinatal outcomes in twin pregnancies continues to be a formidable challenge in the present day clinical practice.
The comparison of dinoprostone and vagiprost for induction of lobar in post t...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Placental Elastography in Intrauterine Growth Restriction: A Case–control Studyasclepiuspdfs
Background: Intrauterine growth restriction (IUGR) is related to poor fetal outcome. Though, various tools are available for evaluation of IUGR they are notreliable inearly diagnosis of IUGR. Shear wave elastography (SWE) can be used to study the change in mechanical properties of various disease which can be a potential technique for early diagnosis of IUGR. Objective: The objective of the study was to compare the differences in SWE values of placentas between IUGR and normal pregnancies. Methodology: Normal second- and third-trimester pregnancies and IUGR pregnancies between 24 and 42 weeks period of gestation (POG), meeting the inclusion criteria were matched for age group and POG. SWE of placenta was performed in supine position during quiet respiration. The SWE of placenta was measured by placing the region of interest in relatively homogeneous area. The placental elasticity values obtained in pregnancies complicated by IUGR were compared with that of normal controls. Umbilical artery (UA) and fetal middle cerebral artery (MCA) Doppler findings were correlated with placental elasticity value of IUGR pregnancies.
AN ANALYSIS OF OUTCOMES IN TWIN PREGNANCIES WITH ACTIVE FETAL SURVEILLANCE AN...Apollo Hospitals
The incidence of multiple gestations is increasing with
increasing maternal age and use of assisted reproduction
techniques. Selective fetal reduction of multifetal pregnancies is now widely practiced to reduce the higher order multiples to twins based on evidence from nonrandomised studies which suggests that this will improve the perinatal outcome. The proportion of twin pregnancies with unique fetal and maternal problems is therefore increasing. Optimising maternal, fetal and perinatal outcomes in twin pregnancies continues to be a formidable challenge in the present day clinical practice.
Neonatal and Obstetric Risk Assessment (NORA) Pregnancy Cohort Study in Singa...Premier Publishers
The Neonatal and Obstetric Risk Assessment (NORA) pregnancy cohort study was set up to assess clinical, biochemical and biophysical markers for risk assessment and prediction of the outcomes early in pregnancy. A total of 3271 patients who were in KK Women’s and Children’s Hospital between September 2010 and October 2014 were screened and 1013 patients consented to participate in the study. Women were followed at 18 to 22 weeks, 28 to 32 weeks and 34 weeks and above, till their postnatal discharge from the hospital. Finally, 926 patients remained for studying the outcome. In NORA study, we established locally derived and gestational age-specific reference intervals for the five thyroid hormone parameters. Higher serum progesterone levels at 28–32 weeks of pregnancy were observed in women who had preterm deliveries compared with women with term deliveries in the cohort. We also found that extracellular vesicle (EV) biomarkers enhanced the predictive robustness of an existing pre-eclampsia (PE) biomarker sufficiently to justify PE screening in a low-risk general obstetric population. We plan to further conduct a range of serial assessments from the biosamples which will provide a comprehensive and valuable information of the dynamics of maternal conditions and fetal development during pregnancy.
— This study was conducted to find out if AFI ≤ 5 cms has any clinical significance in identifying the subsequent fetal distress & associated maternal & perinatal outcomes, in pregnancies beyond 37 weeks. Methodology: This is a prospective case control study done from July 2010 to July 2012 (24 months) at Dr Vasantrao Pawar Medical College, Hospital and Research Center. Adgaon, Nashik. It study the pregnancy outcome comparison of 58 Anenatal Cases(ANCs)as Study Group with diangosis of oligohydramnios (AFI ≤ 5 cms) by ultrasound after 37 completed weeks of gestation w e r e compared with 58 ANCs (Control Group) with no oligohydramnios (AFI > 5 cms). These two groups were matched for other variables like age, parity, gestational age and any pregnancy complication. Results: There was significant difference between two groups. Hypertension and Preeclampsia were found significantly more in ANCs with oligohydramnios. FHR deceleration was also significantly higher in women with oligohydramnios. Women require LSCS were also significantly more in women with oligohydramnios. Newborn borned by women with oligohydramnios had significantly more chances to admit in NICU than in newborn born by women without oligohydramnios. Conclusion: It can be concluded from this study that women with oligohydramnios poor pregancy outcomes. Determination of AFI can be used as an adjunct to other fetal surveillance methods. Determination of AFI can be used as valuable screening test for predicting fetal distress in labour, requiring caesarean section.
Abstract— Cervical ripening is an essential factor for initiation of normal labour for vaginal delivery. Prior to onset of spontaneous labour the cervix undergoes a gradual process of ripening. But in certain cases it does not occur spontaneously at term and sometimes induction of labour is required. Then cervical ripening means high bishop score in essential for successful induction of labour. This comparative study was conducted at Bikaner to compare induction of labour by vaginal prostaglandin E1 tablet (tablet Misoprostol 25 µg 4 hourly) and Intra cervical Dinoprostone gel 0.5 mg. For this purpose 100 clients were given vaginal prostaglandin E1 tablet (tablet Misoprostol 25 µg 4 hourly) and 100 clients were given Intra cervical Dinoprostone gel 0.5 mg. It was observed in this study that Dinoprostone gel is more efficacious for cervical ripening and labour induction in cases of nulliparous & primiparous at term with unfavourable cervix with intact membranes, as compared to misoprostol in terms of shorter total duration of labour, shorter mean induction delivery interval, more spontaneous vaginal deliveries, and reduced incidence of LSCS as well as instrumental deliveries.
Longitudinal hemodynamics in acute phase of treatment with labetalol in hypertensive pregnant women to predict need for vasodilatory therapy
D. Stott, M. Bolten, D. Paraschiv, I. Papastefanou, J.B. Chambers and N.A. Kametas
Volume 49, Issue 1, Date: January (pages 85–94)
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.17335/full
Serial hemodynamic monitoring to guide treatment of maternal hypertension leads to reduction in severe hypertension
D. Stott, I. Papastefanou, D. Paraschiv, K. Clark and N.A. Kametas
Volume 49, Issue 1, Date: January (pages 95–103)
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.17341/full
Slides prepared by Dr Katherine Goetzinger (UOG Editor for Trainees)
The Detection of a Salivary Ferning Pattern Using the Knowhen Ovulation Monit...KNOWHEN
The ability to detect the period of potential monthly fertility is of great importance to a large segment of the female population in their reproductive years, both in terms of contraception as well as conception. In the current study, the KNOWHEN® ovulation monitoring system was used by a group of women who tested their saliva on a daily
basis for the presence of a ferning pattern, a known biologic marker of impending ovulation. Transvaginal ultrasound examination, which is the “gold standard” for the detection of ovulation, was employed to visually determine if the cycle was ovulatory, either by demonstrating the presence of a dominant ovarian follicle or a corpus luteum found at the site of follicular rupture. If neither were observed, the cycle was determined to be anovulatory. The presence or absence of a ferning pattern in saliva was correlated with the actual documentation of ovulation with transvaginal ultrasound examination. Twenty two (22) women were studied for a total of 41 menstrual cycles. Salivary ferning was observed in 29 of 30 ovulatory cycles. False positive results in which ferning was present in an anovulatory cycle, occurred twice in 10 anovulatory menstrual cycles. Our findings indicate a strong correlation between the presence of salivary ferning and ovulation, as detected by the Knowhen ovulation microscope (Log Odds ratio 7.64, P<0.01, CI 4.26 to 11.02), thus validating its use. Age and weight did not appear to affect ferning, alone or together (P: NS).
http://knowhen.com/
Cervical length screening for prevention of preterm birth in singleton pregnancy with threatened preterm labor: systematic review and meta-analysis of randomized controlled trials using individual patient-level data
V. Berghella, M. Palacio, A. Ness, Z. Alfirevic, K. H. Nicolaides and G. Saccone
Volume 49, Issue 3, Date: March (pages 322–329)
Slides prepared by Dr Shireen Meher (UOG Editors-for-Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.17388/full
Pediatric Nurses’ Knowledge and Practices Regarding Nursing Management of Pre...paperpublications3
Abstract: Prematurity used to be a major cause of infant deaths. The premature babies need improved medical and nursing techniques by highly competence nursing team.
Material and Methods: This descriptive hospital based study was conducted at Soba university hospital, Khartoum state in the period from January to March 2014. The study aimed at assessing the knowledge and practices of pediatric nurses in neonatal intensive care unit concerning nursing management of preterm babies. The sample size compromised of 50 nurses that constituted the total coverage of study population during the period of the study. Data were collected using structured interview questionnaire and observation check list designed f or the study. The data was analyzed using statistical package for social sciences (SPSS). Results:The results obtained that the majority of nurses were knowledgeable about the characteristics of preterm babies, causes of prematurity, immediate nursing care of preterm, signs of hypothermia were adequate (100%, 92%, 100%,100% respectively). Half of them (50%) identify the breathing pattern of preterm baby. The nurses clinical performance were inadequate where 70% of them recorded pulse rate only when recorded the baby pulse.100% did not wear mask, 80% find a difficulty on selecting appropriate vein for sampling . Also 48% of nurses gave feeding incorrect and 60% of them did not aspirate gastric contents before feeding.
Conclusion: The study concluded that the majority of pediatric nurses had adequate knowledge about prematurity, but they were lacking in their clinical skills to manage the preterm baby. So the study recommended continuous training programs for the nurses to refresh their knowledge and practices towards management of preterm babies to ideal standards.Keywords: Pediatric Nurses’ Knowledge, Practices Regarding Nursing Management, Premature Babies.
Title: Pediatric Nurses’ Knowledge and Practices Regarding Nursing Management of Premature Babies in Neonatal Intensive Care Unit at Soba University Hospital, Khartoum State, Sudan
Author: Widad Ibrahim A/gadir A/moula, Ietimad Ibrahim Abd Elrahman kambal
ISSN 2349-7823
International Journal of Recent Research in Life Sciences (IJRRLS)
Paper Publications
Study of Incidence and Etiology of Prolapse at Rural Based Teaching Hospitaltheijes
In our country as large number of woman deliver at home, usually conducted by untrained dias, incidence of prolapse is higher. The etiology of prolapse was discussed by ARETAEUS, a Greek physician who believed procedentiato be result of weakness of ligaments of the uterus. There are multiple etiological factors in the developed of prolapse. Diagnosis of prolapse at the earliest will help to reduce the complications of prolapse as well as continue child bearing function of the young woman.
Magnesium Prevents the Cerebral Palsy Precursor in Premature InfantsRoss Finesmith M.D.
To determine if magnesium sulfate has an effect on the development of cystic
periventricular leukomalacia in preterm infants, this retrospective case control study
was conducted. There were 23,382 infants born at three teaching hospitals in the metropolitan New York area from January 1992 to December 1994. Four hundred ninety-two infants met our entrance criteria. Criteria included a birth weight less than 750 g, survival to at least 7 days of life and at least one cranial ultrasound after 7 days of life.
Infants exposed to magnesium sulfate in utero were less likely to develop periventricular
leukomalacia. Two of 18 (11%) infants with periventricular leukomalacia were
exposed to magnesium sulfate in-utero compared to 14 of 36 controls (39%) (p =
0.035) (OR = 0.196, 95% Cl = 0.039-0.988). Pre-eclampsia as an independent factor
was not associated with a reduced risk (p = 0.251) (OR = 0.294, 95% Cl =
0.033-2.65). Preterm infants exposed to antenatal magnesium sulfate were found to
have a reduced risk of developing cystic periventricular leukomalacia.
Neonatal and Obstetric Risk Assessment (NORA) Pregnancy Cohort Study in Singa...Premier Publishers
The Neonatal and Obstetric Risk Assessment (NORA) pregnancy cohort study was set up to assess clinical, biochemical and biophysical markers for risk assessment and prediction of the outcomes early in pregnancy. A total of 3271 patients who were in KK Women’s and Children’s Hospital between September 2010 and October 2014 were screened and 1013 patients consented to participate in the study. Women were followed at 18 to 22 weeks, 28 to 32 weeks and 34 weeks and above, till their postnatal discharge from the hospital. Finally, 926 patients remained for studying the outcome. In NORA study, we established locally derived and gestational age-specific reference intervals for the five thyroid hormone parameters. Higher serum progesterone levels at 28–32 weeks of pregnancy were observed in women who had preterm deliveries compared with women with term deliveries in the cohort. We also found that extracellular vesicle (EV) biomarkers enhanced the predictive robustness of an existing pre-eclampsia (PE) biomarker sufficiently to justify PE screening in a low-risk general obstetric population. We plan to further conduct a range of serial assessments from the biosamples which will provide a comprehensive and valuable information of the dynamics of maternal conditions and fetal development during pregnancy.
— This study was conducted to find out if AFI ≤ 5 cms has any clinical significance in identifying the subsequent fetal distress & associated maternal & perinatal outcomes, in pregnancies beyond 37 weeks. Methodology: This is a prospective case control study done from July 2010 to July 2012 (24 months) at Dr Vasantrao Pawar Medical College, Hospital and Research Center. Adgaon, Nashik. It study the pregnancy outcome comparison of 58 Anenatal Cases(ANCs)as Study Group with diangosis of oligohydramnios (AFI ≤ 5 cms) by ultrasound after 37 completed weeks of gestation w e r e compared with 58 ANCs (Control Group) with no oligohydramnios (AFI > 5 cms). These two groups were matched for other variables like age, parity, gestational age and any pregnancy complication. Results: There was significant difference between two groups. Hypertension and Preeclampsia were found significantly more in ANCs with oligohydramnios. FHR deceleration was also significantly higher in women with oligohydramnios. Women require LSCS were also significantly more in women with oligohydramnios. Newborn borned by women with oligohydramnios had significantly more chances to admit in NICU than in newborn born by women without oligohydramnios. Conclusion: It can be concluded from this study that women with oligohydramnios poor pregancy outcomes. Determination of AFI can be used as an adjunct to other fetal surveillance methods. Determination of AFI can be used as valuable screening test for predicting fetal distress in labour, requiring caesarean section.
Abstract— Cervical ripening is an essential factor for initiation of normal labour for vaginal delivery. Prior to onset of spontaneous labour the cervix undergoes a gradual process of ripening. But in certain cases it does not occur spontaneously at term and sometimes induction of labour is required. Then cervical ripening means high bishop score in essential for successful induction of labour. This comparative study was conducted at Bikaner to compare induction of labour by vaginal prostaglandin E1 tablet (tablet Misoprostol 25 µg 4 hourly) and Intra cervical Dinoprostone gel 0.5 mg. For this purpose 100 clients were given vaginal prostaglandin E1 tablet (tablet Misoprostol 25 µg 4 hourly) and 100 clients were given Intra cervical Dinoprostone gel 0.5 mg. It was observed in this study that Dinoprostone gel is more efficacious for cervical ripening and labour induction in cases of nulliparous & primiparous at term with unfavourable cervix with intact membranes, as compared to misoprostol in terms of shorter total duration of labour, shorter mean induction delivery interval, more spontaneous vaginal deliveries, and reduced incidence of LSCS as well as instrumental deliveries.
Longitudinal hemodynamics in acute phase of treatment with labetalol in hypertensive pregnant women to predict need for vasodilatory therapy
D. Stott, M. Bolten, D. Paraschiv, I. Papastefanou, J.B. Chambers and N.A. Kametas
Volume 49, Issue 1, Date: January (pages 85–94)
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.17335/full
Serial hemodynamic monitoring to guide treatment of maternal hypertension leads to reduction in severe hypertension
D. Stott, I. Papastefanou, D. Paraschiv, K. Clark and N.A. Kametas
Volume 49, Issue 1, Date: January (pages 95–103)
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.17341/full
Slides prepared by Dr Katherine Goetzinger (UOG Editor for Trainees)
The Detection of a Salivary Ferning Pattern Using the Knowhen Ovulation Monit...KNOWHEN
The ability to detect the period of potential monthly fertility is of great importance to a large segment of the female population in their reproductive years, both in terms of contraception as well as conception. In the current study, the KNOWHEN® ovulation monitoring system was used by a group of women who tested their saliva on a daily
basis for the presence of a ferning pattern, a known biologic marker of impending ovulation. Transvaginal ultrasound examination, which is the “gold standard” for the detection of ovulation, was employed to visually determine if the cycle was ovulatory, either by demonstrating the presence of a dominant ovarian follicle or a corpus luteum found at the site of follicular rupture. If neither were observed, the cycle was determined to be anovulatory. The presence or absence of a ferning pattern in saliva was correlated with the actual documentation of ovulation with transvaginal ultrasound examination. Twenty two (22) women were studied for a total of 41 menstrual cycles. Salivary ferning was observed in 29 of 30 ovulatory cycles. False positive results in which ferning was present in an anovulatory cycle, occurred twice in 10 anovulatory menstrual cycles. Our findings indicate a strong correlation between the presence of salivary ferning and ovulation, as detected by the Knowhen ovulation microscope (Log Odds ratio 7.64, P<0.01, CI 4.26 to 11.02), thus validating its use. Age and weight did not appear to affect ferning, alone or together (P: NS).
http://knowhen.com/
Cervical length screening for prevention of preterm birth in singleton pregnancy with threatened preterm labor: systematic review and meta-analysis of randomized controlled trials using individual patient-level data
V. Berghella, M. Palacio, A. Ness, Z. Alfirevic, K. H. Nicolaides and G. Saccone
Volume 49, Issue 3, Date: March (pages 322–329)
Slides prepared by Dr Shireen Meher (UOG Editors-for-Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.17388/full
Pediatric Nurses’ Knowledge and Practices Regarding Nursing Management of Pre...paperpublications3
Abstract: Prematurity used to be a major cause of infant deaths. The premature babies need improved medical and nursing techniques by highly competence nursing team.
Material and Methods: This descriptive hospital based study was conducted at Soba university hospital, Khartoum state in the period from January to March 2014. The study aimed at assessing the knowledge and practices of pediatric nurses in neonatal intensive care unit concerning nursing management of preterm babies. The sample size compromised of 50 nurses that constituted the total coverage of study population during the period of the study. Data were collected using structured interview questionnaire and observation check list designed f or the study. The data was analyzed using statistical package for social sciences (SPSS). Results:The results obtained that the majority of nurses were knowledgeable about the characteristics of preterm babies, causes of prematurity, immediate nursing care of preterm, signs of hypothermia were adequate (100%, 92%, 100%,100% respectively). Half of them (50%) identify the breathing pattern of preterm baby. The nurses clinical performance were inadequate where 70% of them recorded pulse rate only when recorded the baby pulse.100% did not wear mask, 80% find a difficulty on selecting appropriate vein for sampling . Also 48% of nurses gave feeding incorrect and 60% of them did not aspirate gastric contents before feeding.
Conclusion: The study concluded that the majority of pediatric nurses had adequate knowledge about prematurity, but they were lacking in their clinical skills to manage the preterm baby. So the study recommended continuous training programs for the nurses to refresh their knowledge and practices towards management of preterm babies to ideal standards.Keywords: Pediatric Nurses’ Knowledge, Practices Regarding Nursing Management, Premature Babies.
Title: Pediatric Nurses’ Knowledge and Practices Regarding Nursing Management of Premature Babies in Neonatal Intensive Care Unit at Soba University Hospital, Khartoum State, Sudan
Author: Widad Ibrahim A/gadir A/moula, Ietimad Ibrahim Abd Elrahman kambal
ISSN 2349-7823
International Journal of Recent Research in Life Sciences (IJRRLS)
Paper Publications
Study of Incidence and Etiology of Prolapse at Rural Based Teaching Hospitaltheijes
In our country as large number of woman deliver at home, usually conducted by untrained dias, incidence of prolapse is higher. The etiology of prolapse was discussed by ARETAEUS, a Greek physician who believed procedentiato be result of weakness of ligaments of the uterus. There are multiple etiological factors in the developed of prolapse. Diagnosis of prolapse at the earliest will help to reduce the complications of prolapse as well as continue child bearing function of the young woman.
Magnesium Prevents the Cerebral Palsy Precursor in Premature InfantsRoss Finesmith M.D.
To determine if magnesium sulfate has an effect on the development of cystic
periventricular leukomalacia in preterm infants, this retrospective case control study
was conducted. There were 23,382 infants born at three teaching hospitals in the metropolitan New York area from January 1992 to December 1994. Four hundred ninety-two infants met our entrance criteria. Criteria included a birth weight less than 750 g, survival to at least 7 days of life and at least one cranial ultrasound after 7 days of life.
Infants exposed to magnesium sulfate in utero were less likely to develop periventricular
leukomalacia. Two of 18 (11%) infants with periventricular leukomalacia were
exposed to magnesium sulfate in-utero compared to 14 of 36 controls (39%) (p =
0.035) (OR = 0.196, 95% Cl = 0.039-0.988). Pre-eclampsia as an independent factor
was not associated with a reduced risk (p = 0.251) (OR = 0.294, 95% Cl =
0.033-2.65). Preterm infants exposed to antenatal magnesium sulfate were found to
have a reduced risk of developing cystic periventricular leukomalacia.
— Pregnancy is highly precious for every couple but presence of risk factors that cause prematurity, post maturity and various other conditions that complicate the pregnancy have adverse effects. Gross examination of the placenta may provide useful information about the etiology of newborn and maternal complications. Hence it is important to study relationships between placental abnormalities, gestational age and occurrence of adverse outcome. So, this study aims to compare the macroscopic morphology of human placenta in preterm, term and post-term pregnancy. A hospital based comparative observational study conducted on placentae of 40 pre-term, 40 term and 40 post-term. Shape, weight, diameter, thickness, mode of insertion of umbilical cord, number of cotyledons and arrangement of chorionic vessels was observed of each placenta included in the study. These variables of palcentae were compared as per pre-term, term and post-term. Significance of difference was determined by Chi-square test. This study revealed that most of the placentae were discoidal in shape. And the weight as well as diameter of the term placentae were significantly more from preterm placentae. Likewise weight and diameter both of the post term placentae were significantly more form term placentae. Regarding thickness of placentae, term placentae thickness were more from preterm placentae and post-term placentae were more from term placentae but it was found significant in term to preterm not in term to post-term. So it can be concluded from this study that as gestational period increases weight, diameter and thickness of placenta increases. Observing the facts, more studies are suggested to explore the other variables related to placenta and its relation to pregnancy outcomes.
Characterization and the Kinetics of drying at the drying oven and with micro...Open Access Research Paper
The objective of this work is to contribute to valorization de Nephelium lappaceum by the characterization of kinetics of drying of seeds of Nephelium lappaceum. The seeds were dehydrated until a constant mass respectively in a drying oven and a microwawe oven. The temperatures and the powers of drying are respectively: 50, 60 and 70°C and 140, 280 and 420 W. The results show that the curves of drying of seeds of Nephelium lappaceum do not present a phase of constant kinetics. The coefficients of diffusion vary between 2.09.10-8 to 2.98. 10-8m-2/s in the interval of 50°C at 70°C and between 4.83×10-07 at 9.04×10-07 m-8/s for the powers going of 140 W with 420 W the relation between Arrhenius and a value of energy of activation of 16.49 kJ. mol-1 expressed the effect of the temperature on effective diffusivity.
Accuracy of cervico vaginal fetal fibronectin test in predicting risk of spon...Open Access Research Paper
Preterm delivery is the leading cause of neonatal mortality. One of the best predictors to assess the risk of preterm labour (PTB) is by measuring fetal fibronectin (fFN) in cervico vaginal secretion after 26 weeks of pregnancy. The aim is to evaluate the diagnostic accuracy of qualitative cervico vaginal fFN in symptomatic women and asymptomatic high risk women during antenatal care. Prospective study which was conducted in Basrah Maternity and Child Hospital. It included 106 pregnant women at gestational age more than 26 weeks who had uterine contraction with or without pervious risk factors for PTB. Cervico vaginal fluid sampling was undertaken from all women included in the study after the age of 26 weeks of gestation and qualitative fFN assessment was done with 50ng/ml is the cut off point for positivity. As regard qualitative fFN assessment for predicting of PTB sensitivity, specificity, PPV, NPV, were 71%, 87%, 40.50%, 94% respectively in symptomatic women. While in asymptomatic women with previous high risk had 26% sensitivity, 84% specificity, 32% PPV, and 87% NPV. Qualitative assessment of fFN in cervico vaginal fluid is good predictive marker in detecting of PTB.
LESSON 12 Paying for Care and Health Information LEA.docxSHIVA101531
LESSON 12
Paying for Care and Health Information
LEARNING OUTCOMES
______________________________________________________________________________
In this lesson, you will do the following:
Describe how coding, reimbursement, and billing are impacted by health information systems.
READINGS
The following reading assignments are for Lessons 9 through 12:
Gartee Text:
Chapter 4, pp. 74 - 95
Chapter 5, pp. 98 - 126
Chapter 6, pp. 127 - 151
Chapter 9, pp. 208 - 236
Chapter 10, pp. 237 - 259
ACTIVITIES / ASSESSMENTS
The following activities/assessments are for Lessons 9 through 12:
1. Read the assigned pages from the Gartee text.
2. Review the Lecture Notes, Unit 3 PowerPoint, and Voice Pod.
3. Participate in the weekly discussion question.
4. Complete the written assignment.
WRITTEN ASSIGNMENTS
Hospital Medicare Payment System - DRGs:
Research how large hospitals are paid by a Medicare fee for service reimbursements (DRG’s).
Include a brief history and relate how health information supports the request for a payment.
PLEASE NOTE: All graded assignments for the lessons in this unit should be grouped together
and submitted as ONE document using the Assignment Submission form accessed from your
course homepage or http://www.sjcme.edu/gps/assignments.
All activities/assignments for this unit should be as follows:
1. Should include a cover sheet for each assignment stating the following:
Course (HA 214)
Your Name
Unit and Lesson Number
Date Submitted
2. Each individual assignment number and copy of the assignment directions should be
included in the submission as the starting header of each lesson.
3. Carefully check grammar and spelling.
4. Use APA format for any research or sources that are being used or quoted.
5. Email the instructor if you have questions regarding the assignments.
http://www.sjcme.edu/gps/assignments
g
Research www.AJOG.org
O B S T E T R I C S
Preterm premature rupture of membranes >32 weeks’
estation: impact of revised practice guidelines
Arij Faksh, DO; Joseph R. Wax, MD; F. Lee Lucas, PhD; Angelina Cartin; Michael G. Pinette, MD
OBJECTIVE: The purpose of this study was to determine the perinatal
impact of the 2007 American College of Obstetricians and Gynecolo-
gists Practice Bulletin on preterm premature membrane rupture.
STUDY DESIGN: Perinatal outcomes were compared in women who
had experienced preterm membrane rupture in the 3 years before the
2007 Practice Bulletin to similar women who experienced preterm pre-
mature rupture of membranes in the 3 years after the issue and imple-
mentation of the guideline.
RESULTS: After adjustment for gestational age at membrane rupture
and steroids, composite severe morbidity (death, respiratory distress
Obstet Gynecol 2011;205:340.e1-5.
p
remained uncertain, p
doi: 10.1016/j.ajog.2011.05.036
340.e1 American Journal of Obstetrics & Gynecology OCTOB ...
Similar to The Natural History Of The Normal First Stage Of 6[1] (20)
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. diseases such as cerebral palsy. Abnormal progress of study. We restricted our analysis to term pregnancies
labor was one of the factors of interest. Women who (37– 42 weeks, n 40,973) with a spontaneous onset of
sought prenatal care at 12 hospitals in the United labor (n 36,402). We also restricted to pregnancies
States were recruited prospectively from 1959 to with vertex fetal presentation at admission (excluding
1965.4 At entry, detailed demographic, socioeco- face, brow, or chin position, n 35,318). Further ex-
nomic, and behavioral data were collected through cluded were cases of placenta previa, severe hyperten-
in-person interviews. Medical history, physical exam- sion in pregnancy, cord prolapse, and uterine rupture
ination, and blood sample also were obtained. In the (n 34,250). To examine the labor pattern in parturients
ensuing prenatal visits, women were interviewed re- with normal perinatal outcomes, we restricted our anal-
peatedly and physical findings were recorded. When the ysis to births of neonates with 5-minute Apgar scores of
woman was admitted to the hospital for labor and at least 7 (n 30,872). Finally, we excluded women who
delivery, her physical status was reevaluated and all had fewer than two values of cervical dilation in the first
labor and delivery events were recorded in detail by a stage (n 27,801) or never reached 10 cm, leaving
trained observer. However, no particular labor protocol 26,838 women for analysis.
was used, and the number and timing of pelvic exams Rectal exams to measure cervical dilation were
were not standardized. A summary of the labor and performed quite commonly in that era. Among
delivery was completed by the obstetrician responsible 262,262 pelvic exams in the National Collaborative
for the patient’s care.5 Children were observed up to 7 Perinatal Project data, 45% were vaginal, 45% were
years of age. A comprehensive battery of physical rectal, and 10% were unknown. We compared two
exams and psychological and neurodevelopmental tests types of measurements in terms of degree of error and
were conducted.6 effect on labor curves and found no clinically signifi-
The current study uses information on maternal cant differences (results not shown). Thus, we used
baseline characteristics, physical findings at admission both types of measurements in our analysis.
to labor and delivery, repeated measures of cervical We first grouped the participants according to
dilation, and delivery information. Friedman et al5 their parity (0, 1, 2 ) and compared baseline charac-
conducted a detailed validation study on errors of the teristics. We used the 2 test for categorical variables,
labor data in the National Collaborative Perinatal analysis of variance for continuous variables with
Project. A sample of 667 gravidas was selected for normal distribution, and nonparametric rank-sum test
whom there were suspicious labor data entry errors for continuous variables with skewed distribution to
on cervical dilation, fetal station, or date and time of examine statistical significance. We then used a re-
the exams because the labor progress was unusually peated-measures analysis7 with an eighth-degree poly-
rapid or dilatation regressed. A total of 17,916 data nomial model to construct average labor curves by
items from these cases were verified against hardcopy parity. In this analysis, the starting point was set at the
records. The authors found that the overall error rate first time when the dilation reached 10 cm (time 0)
was about 1% with the error rate of 0.96%, 0.87%, and the time was calculated backwards (eg, 60 min-
1.11% and 1.24% for date, time, cervical dilation and utes before the complete dilation, -60 minutes). After
fetal station, respectively. Conversely, they selected the labor curve models had been computed, the X
1,764 dilation values, 1,925 station values, 1,901 time axis (time) was reverted to a positive value, ie, instead
values and 1,901 date values that were not suspected of being -12 3 0 hours, it became 0 3 12 hours.
of being problematic in any way. The error rates were Labor progression data are interval censored, eg,
1.25%, 1.19%, 1.26% and 0%, respectively. Therefore, one only knows that the cervix dilated from 4 to 5 cm
it was concluded that the National Collaborative between two pelvic exams but does not know exactly
Perinatal Project labor data were reasonably complete when it happened. Thus, we used an interval cen-
and accurate. During our own data preparation for sored regression8 to estimate the distribution of times
the current analysis, we identified a problem related for progression from one integer centimeter of dila-
to time. In one hospital, the clock in the delivery tion to the next (called traverse time) with an assump-
room was not correctly adjusted for daylight savings tion that the labor data are log-normally distributed.9
time, which resulted in discrepancies in time between The median and 95th percentiles were calculated. A
labor and delivery records. A total of 2,718 records total of 6.6% of women with parity of two or more
were affected by this error and, therefore, fixed by contributed more than one pregnancy data to that
adding 1 hour to the delivery time in these cases. group (P2 ). We therefore used a parametric frailty
A total of 54,304 singleton pregnancies who were model to account for the repeated measures in these
delivered at 20 weeks or later were included in the women.10 Because multiparous women tended to be
706 Zhang et al The First Stage of Labor OBSTETRICS & GYNECOLOGY
3. admitted at a more advanced stage labor than nullip- PROC LIFEREG for interval censored regression and
arous women, many multiparous women did not have PROC NLMIXED for interval censored regression with
information on cervical dilation before 3.5 cm. There- repeated measures). Because the National Collaborative
fore, the labor curves and traverse time for multipa- Perinatal Project data are publicly available, our study
rous women started at 3.5 cm (or 4 cm) rather than at was exempted from institutional review board review.
3 cm as for nulliparous women.
Finally, to address the clinical experience where a RESULTS
woman is first observed at a given dilation and then In National Collaborative Perinatal Project, the over-
measured periodically, we calculated cumulative dura- all rate of cesarean delivery was 5.6%; in women who
tion of labor from admission to any given dilation up to had trial of labor, the cesarean rate was 2.6% and the
the first 10 cm in nulliparas. The same interval censored induction rate was 7.1%. Table 1 presents the mater-
regression approach was used. We provide the estimates nal characteristics of the selected study population by
according to the dilation at admission (2.0 or 2.5 cm, 3.0 parity. Approximately half of the women were white,
or 3.5 cm, 4.0 or 4.5 cm, 5.0 or 5.5 cm) because women 40% were African American, and 8% were other,
admitted at different dilation levels may have different mainly Hispanic. The socioeconomic status index (com-
patterns of labor progression. All statistical analyses bination of education, occupation and household in-
were performed using SAS 9.1 (SAS Institute Inc., Cary, come) suggests that the majority of women were be-
NC; PROC MIXED for the repeated-measures analysis, tween the 20th and 80th percentiles based on 1960 U.S.
Table 1. Characteristics of the Parturients by Parity, National Collaborative Perinatal Project, 1959 –1966
Parity 0 Parity 1 Parity 2
(n 8,690) (n 6,373) (n 11,765)
Maternal race
White 53 55 45
African American 39 38 48
Other 8 7 7
Socioeconomic status index (percentile)
Less than 20th 8 5 7
20th–39th 24 26 34
40th–59th 28 32 33
60th–79th 23 24 19
80th or higher 17 13 7
Maternal age (y) 20.3 3.9 22.7 4.4 27.4 5.5
2
Prepregnancy BMI (kg/m ) 21.5 3.2 22.2 3.8 23.5 4.5
Weight gain (kg) 10.9 4.5 10.3 4.4 10.3 4.9
BMI at delivery (kg/m2) 25.4 3.5 25.9 3.9 27.1 4.5
Cervical dilation at admission (cm) 3 (1, 6) 3.5 (2, 7) 3.5 (1.5, 6.5)
Station at admission 0 ( 2, 1) 0 ( 2, 1) 1 ( 3, 1)
Effacement at admission (%) 85 (50, 100) 80 (45, 100) 75 (30, 100)
Rupture of the membranes at admission 29 26 27
Oxytocin for augmentation 20 12 12
Regional analgesia (caudal, sacral, epidural, peridural) 8 11 8
Total number of pelvic exams in first stage 6 (3, 11) 5 (2, 9) 5 (2, 9)
Forceps delivery
None 27 55 76
Outlet 33 17 9
Low 27 16 8
Mid/high 13 12 7
Cesarean delivery at second stage 0.24 0.02 0.05
Gestational age at delivery (wk) 39.8 1.4 39.8 1.4 39.8 1.4
Birth weight (g) 3,185 434 3,259 443 3,301 483
White 3,290 431 3,337 446 3,390 487
African American 3,060 409 3,155 424 3,220 467
Other 3,118 403 3,225 402 3,295 477
BMI, body mass index.
Data are %, mean standard deviation, or median (10th, 90th percentile).
All differences among the three groups were statistically significant at P .01 except for gestational age at delivery, where P .02.
VOL. 115, NO. 4, APRIL 2010 Zhang et al The First Stage of Labor 707
4. census.11 The mean maternal age was 20, 23, and 27 Table 2. Duration of Labor (in Hours) by Parity,
years for parity 0, 1, 2 , respectively. Women were National Collaborative Perinatal Project,
lean; gained 10 kg, on average, during pregnancy. 1959 –1966
The median cervical dilation at admission was 3 Cervical
cm for nulliparas and 3.5 cm for multiparas. 20% Dilation (cm) Parity 0 Parity 1 Parity 2
nulliparas and 12% multiparas received oxytocin for
From 3 to 4 1.2 (6.6)
augmentation. 8 - 11% of women used regional anal- From 4 to 5 0.9 (4.5) 0.7 (3.3) 0.7 (3.5)
gesia for labor pain (approximately half used caudal From 5 to 6 0.6 (2.6) 0.4 (1.6) 0.4 (1.6)
and sacral analgesia and half used epidural and From 6 to 7 0.5 (1.8) 0.4 (1.2) 0.3 (1.2)
peridural analgesia). Virtually all of them were deliv- From 7 to 8 0.4 (1.4) 0.3 (0.8) 0.3 (0.7)
ered vaginally (cesarean deliveries at the first stage From 8 to 9 0.4 (1.3) 0.3 (0.7) 0.2 (0.6)
From 9 to 10 0.4 (1.2) 0.2 (0.5) 0.2 (0.5)
were excluded). The mean gestational age was 39.8 From 4 to 10 3.7 (16.7) 2.4 (13.8) 2.2 (14.2)
weeks for both nulliparas and multiparas. The mean
Data are median (95th percentile).
birth weight increased with parity in all races.
Figure 1 depicts the average labor curves for the
three parity groups. Nulliparous women had the spontaneous onset of labor was admitted at 3 cm, the
longest and most gradual labor curve; multiparous median time from admission to 6 cm was approximately
women of different parities had very similar curves. 2.7 hours and the 95th percentile was 12.3 hours. If a
The division between latent and active phases was woman was admitted at 4 cm, her median and 95th
more obvious in multiparas than in nulliparas. The percentile of the duration of labor from admission to 6
inflection point appeared to have occurred earlier in cm were approximately 1.4 and 7.8 hours, respectively.
parity 2 (at 5 cm) than in parity 1 (at 5.5 cm). The
nulliparous curve did not have a clear inflection point. DISCUSSION
Table 2 provides a more detailed analysis on Labor progression was first studied systematically and
labor progression. The median time needed to extensively by Dr. Friedman for four decades (from
progress from one centimeter to the next became the 1950s to the 1980s). A number of his highly
shorter as the labor advanced. The 95th percentiles influential articles and books established the land-
suggest that, in nulliparous women, labor may be slow scape of this field.5,12–14 Perhaps because labor is often
before 6 cm but that it still can result in a vaginal considered unpredictable and the methodology re-
delivery with a normal perinatal outcome. quired to study labor is complex, the pace of research
Table 3 presents the median and 95th percentiles of on this topic has been painstakingly slow. Only in
the duration of labor in nulliparous women whose first more recent years has it regained some traction as
cervical examination was at 2, 3, 4, or 5 cm of dilation, cesarean delivery became pandemic. Unfortunately,
respectively. For example, if a nulliparous woman with because a large proportion of pregnancies now are
delivered by cesarean, either before or during labor,
10 selection bias (ie, who is left to have a vaginal
P0
delivery?) can have a serious effect on findings in any
9 P2+ P1
contemporary studies. The high frequency of obstet-
Cervical dilation (cm)
8
ric intervention (eg, induction of labor) further com-
7 plicates the data, which makes a natural history study
6 P1 and P2+ difficult. It thus becomes more challenging to conduct
start at 3.5 cm statistical analyses that will yield unbiased results. We,
5
therefore, based our analysis on the old National
4
Collaborative Perinatal Project cohort where cesarean
3 delivery was uncommon and the rate of labor induc-
0 1 2 3 4 5 6 7 8 9 10 11
tion relatively low. We describe the labor progression
Time (hours)
in the first stage only, as forceps were frequently used
Fig. 1. The average labor curves by parity in women with in the second stage of labor, particularly in nulliparas
singleton term pregnancies with spontaneous onset of labor (33%, 27%, and 13% for outlet, low, and mid/high
and vertex presentation who completed the first stage of
labor and whose newborns had 5-minute Apgar scores of at forceps, respectively), which could have affected the
least 7. The National Collaborative Perinatal Project, 1959 – course of the second stage.
1966. P0, nulliparas; P1, parity 1; P2 , parity 2 or higher. One of the interesting findings of our study is that
Zhang. The First Stage of Labor. Obstet Gynecol 2010. the inflection point on the average labor curves of the
708 Zhang et al The First Stage of Labor OBSTETRICS & GYNECOLOGY
5. Table 3. Duration of Labor (in Hours) in Nulliparas Based on Cervical Dilation at Admission, National
Collaborative Perinatal Project, 1959 –1966
Admitted at 2 Admitted at 3 Admitted at 4 Admitted at 5
Cervical Dilation (cm) or 2.5 cm or 3.5 cm or 4.5 cm or 5.5 cm
Adm. to 3 1.0 (8.5)
Adm. to 4 2.3 (12.6) 0.7 (6.5)
Adm. to 5 3.6 (15.3) 1.9 (10.5) 0.5 (5.4)
Adm. to 6 4.5 (17.0) 2.7 (12.4) 1.3 (8.4) 0.4 (3.4)
Adm. to 7 5.1 (18.0) 3.3 (13.3) 2.0 (10.1) 0.9 (5.5)
Adm. to 8 5.5 (18.8) 3.7 (14.1) 2.4 (11.4) 1.3 (6.6)
Adm. to 9 5.9 (19.8) 4.1 (15.2) 2.8 (12.7) 1.7 (8.2)
Adm. to 10 6.3 (20.7) 4.5 (16.2) 3.2 (14.1) 2.1 (9.3)
Adm., admission.
Data are median (95th percentile).
multiparas was more obvious and emerged much phase of labor was defined as time when the cervix
sooner than that of the nulliparas. After the inflection dilated faster than 1.2 cm/h in nulliparas and 1.5
point, the cervix dilated precipitously to 10 cm. The cm/h in multiparas. They found that among women
inflection point appears slightly sooner in parity 2 who had no active phase arrest, 50% of them entered
than in parity 1. On the other hand, the nulliparas had active phase by 4 cm dilation; 74% by 5 cm and 89%
a quite different average labor curve. The inflection by 6 cm. Unfortunately, mixing women with various
point was unclear and appeared quite late in labor. parities makes the application of their findings to
Interpretation of the average labor curve requires nulliparas as well as multiparas difficult.
caution. First, duration of labor expressed in the curves These observations raise an important question:
is the mean rather than the median. The mean and how should the active phase be defined? Hendricks et
median may not match. For example, the duration of al16 define it as “Pains plus Progress,” “which usually
labor from 4 to 10 cm was 4.4 hours on the nulliparous means that contractions are coming at intervals of five
labor curve (the mean) but 3.7 hours according to minutes or less, are associated with discomfort for the
traverse time (the median). Furthermore, the shape of patient, and with observable progress in cervical dilata-
the average labor curve is determined by the shape and tion.” Based on the Friedman curve in primigravid,13,17
variability of the underlying individual curves. For in- the transition from the latent to active phase appeared to
stance, if parturients have diverse speeds of cervical occur between 3 and 4 cm. A more commonly used
dilation in the latent and active phases and enter the definition is that the active phase starts at 4 cm dila-
active phase at various time (measured by cervical tion.18,19 However, if the observations by Peisner and
dilation), the average labor curve will tend to look flat Rosen15 and our study are true, there are a large number
and the inflection point will be unclear. From the of women who are not in the active phase at 4 cm,
average labor curves (Fig. 1), one may deduce that the particularly in nulliparas. As Peisner and Rosen15 con-
variation of multiparous curves is smaller than that of clude, “a patient who is not progressing in labor at 4 cm
nulliparous curves; and women of parity 2 may enter cervical dilation is not necessarily abnormal.” Our anal-
the active phase of labor slightly sooner than parity 1. ysis shows that it may take more than 4 hours for
The speed of cervical dilation in active phase is slower in nulliparas to progress from 4 to 5 cm (Table 2).
nulliparas than in multiparas. Rouse et al20,21 subsequently proposed a new defi-
More importantly, the inflection point on the mul- nition of the active phase (4-cm dilatation and at least
tiparous curve is at 5 cm or 5.5 cm. Although we cannot 90% effacement or 5-cm dilatation regardless of efface-
be certain that all multiparas enter the active phase at ment) and asserted that this definition would capture the
5 cm, we may acknowledge that by 5 cm, the vast majority of women who have entered the active phase
majority of multiparous women have entered the during labor induction.20 It is yet to be tested whether
active phase. Further, if the latest starting point of the this definition applies to spontaneous labor and whether
active labor is 5 cm for multiparas, the inflection point it works equally well in nulliparas and multiparas.
for nulliparas is likely to be later than 5 cm. Another important difference between Friedman
Peisner and Rosen15 examined 1,699 labors with curve13 and ours is the deceleration phase. Our study as
approximately two thirds nulliparas and one third well as previous studies16 do not show a clear decelera-
multiparas. The transition from the latent to active tion phase in late active phase although we used an
VOL. 115, NO. 4, APRIL 2010 Zhang et al The First Stage of Labor 709
6. eighth-degree polynomial model with a very large sam- REFERENCES
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710 Zhang et al The First Stage of Labor OBSTETRICS & GYNECOLOGY