Maternal outcomes associated with interventions in labor for low-risk nulliparous women
DOI:
https://doi.org/10.21527/2176-7114.2024.48.13932Keywords:
Maternal Health, Obstetrics, Obstetric Nursing, Labor of Childbirth, Childbirth Assistance, Humanized birthAbstract
This study aimed to analyze maternal outcomes associated with interventions performed during low-risk nulliparous women labor. This is a cross-sectional study, with 534 nulliparous pregnant women. Gamma and logistic regression models were used for the p<0.05 significance level. The use of partogram, venoclysis, non-pharmacological methods for pain relief, neuraxial analgesia and Valsalva maneuver are associated with a reduction in the expulsive period duration. Cardiotography on admission (OR=0.20), oxytocin (OR=0.22) and fasting (OR=0.15) during labor decreased the chances of vaginal delivery, whereas partogram (OR=11.00) and non-pharmacological pain relief methods increased the chances (OR=2.12).. The study revealed no association between the interventions and the degree of perineal laceration. The use of oxytocin (OR=3.04) and the Kristeller maneuver (OR=9.03) were shown to increase the chances of complications after childbirth, with a prevalence of postpartum hemorrhage. It is concluded that interventions during labor of nulliparous women must be individualized and minimized, in order to be implemented to obtain favorable outcomes for parturients and their fetuses.
References
Leal M do C, Bittencourt S de A, Esteves-Pereira AP, Ayres BV da S, Silva LBRA de A, Thomaz EBAF, et al. Progress in childbirth care in Brazil: preliminary results of two evaluation studies. Cad Saúde Pública [Internet]. 2019 Jul. 22 [cited 2022 Nov 29];35. Disponível em: http://www.scielo.br/j/csp/a/grzf9kCgwKLFx8SV5DvPyJx/?lang=en
Silva F, Nucci M, Nakano AR, Teixeira L. “Ideal childbirth”: medicalization and construction of a hospital delivery assistance script in Brazil in mid-20th century. Saúde E Soc [Internet]. 2019 Oct. 7 [cited 2023 Jan. 10];28:171-84. Disponível em: http://www.scielo.br/j/sausoc/a/ZBMXtHgcSpYZJrXfsBF87Nt/abstract/?lang=en
Committee on Obstetric Practice (ACOG). Committee Opinion No. 687: Approaches to Limit Intervention During Labor and Birth. Obstetrics and gynecology. 2017;129(2):e20.
World Health Organization. WHO recomendations on intrapartum care for a positive childbirth experience. World Health Organization. 2018.
Ashwal E, Livne MY, Benichou JIC, Unger R, Hiersch L, Aviram A, et al. Contemporary patterns of labor in nulliparous and multiparous women. Am J Obstet Gynecol. 2020 Mar.;222(3):267.e1-267.e9.
Abalos E, Oladapo OT, Chamillard M, Díaz V, Pasquale J, Bonet M, et al. Duration of spontaneous labour in “low-risk” women with “normal” perinatal outcomes: A systematic review. Eur J Obstet Gynecol Reprod Biol. 2018 Apr.;223:123-132.
Dalbye R, Blix E, Frøslie KF, Zhang J, Eggebø TM, Olsen IC, et al. The Labour Progression Study (LaPS): Duration of labour following Zhang’s guideline and the WHO partograph – A cluster randomised trial. Midwifery. 2020 Feb.;81:102578.
Kahrs BH, Usman S, Ghi T, Youssef A, Torkildsen EA, Lindtjørn E, et al. Descent of fetal head during active pushing: secondary analysis of prospective cohort study investigating ultrasound examination before operative vaginal delivery. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2019 Oct.;54(4):524-529.
Cavalcanti ACV, Henrique AJ, Brasil CM, Gabrielloni MC, Barbieri M. Complementary therapies in labor: randomized clinical trial. Rev Gaúcha Enferm [Internet]. 2019 Sep. 23 [cited 2023 Jan. 10];40. Disponível em: http://www.scielo.br/j/rgenf/a/PMRKWGm6pwNvFwCtZDz88bh/?lang=en
Kumar N, Yadav M. Role of admission cardiotocography in predicting the obstetric outcome in term antenatal women: A prospective observational study. J Mother Child. 2022 Nov. 2.
Smith V, Begley C, Newell J, Higgins S, Murphy DJ, White MJ, et al. Admission cardiotocography versus intermittent auscultation of the fetal heart in low-risk pregnancy during evaluation for possible labour admission – a multicentre randomised trial: the ADCAR trial. BJOG Int J Obstet Gynaecol. 2019 Jan.;126(1):114-121.
Neal JL, Lowe NK, Caughey AB, Bennett KA, Tilden EL, Carlson NS, et al. Applying a physiologic partograph to Consortium on Safe Labor data to identify opportunities for safely decreasing cesarean births among nulliparous women. Birth Berkeley Calif. 2018 Dec.;45(4):358-367.
Lavender T, Cuthbert A, Smyth RM. Effect of partograph use on outcomes for women in spontaneous labour at term and their babies. Cochrane Database Syst Rev [Internet]. 2018 Aug 6 [cited 2023 Jan. 10];2018(8):CD005461. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6513424/
Vogel JP, Comrie‐Thomson L, Pingray V, Gadama L, Galadanci H, Goudar S, et al. Usability, acceptability, and feasibility of the World Health Organization Labour Care Guide: A mixed‐methods, multicountry evaluation. Birth Berkeley Calif [Internet]. 2021 Mar. [cited 2023 Jan 10];48(1):66-75. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8246537/
Lucena TS de, Morais RJL de, Santos AAP dos. Analysis of partogram completion as good obstetric practice in the monitoring of labor/Análise do preenchimento do partograma como boa prática obstétrica na monitorização do trabalho de parto. Rev Pesqui Cuid É Fundam On-line [Internet]. 2019 Jan. 1 [cited 2023 Jan 10];11(1):222-227. Disponível em: http://seer.unirio.br/cuidadofundamental/article/view/7003
Alhafez L, Berghella V. Evidence-based labor management: first stage of labor (part 3). Am J Obstet Gynecol MFM. 2020 Nov.;2(4):100185.
Shea-Lewis A, Eckardt P, Stapleton D. CE: Original Research: An Investigation into the Safety of Oral Intake During Labor. Am J Nurs. 2018 Mar.;118(3):24-31.
Espada-Trespalacios X, Ojeda F, Perez-Botella M, Milà Villarroel R, Bach Martinez M, Figuls Soler H, et al. Oxytocin Administration in Low-Risk Women, a Retrospective Analysis of Birth and Neonatal Outcomes. Int J Environ Res Public Health. 2021 Apr. 20;18(8):4.375.
Foley A, Gunter A, Nunes KJ, Shahul S, Scavone BM. Patients Undergoing Cesarean Delivery After Exposure to Oxytocin During Labor Require Higher Postpartum Oxytocin Doses. Anesth Analg. 2018 Mar.;126(3):920-924.
Farrington E, Connolly M, Phung L, Wilson AN, Comrie-Thomson L, Bohren MA, et al. The prevalence of uterine fundal pressure during the second stage of labour for women giving birth in health facilities: a systematic review and meta-analysis. Reprod Health [Internet]. 2021 May 18 [cited 2023 Jan. 10];18:98. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8132352/
Erickson EN, Lee CS, Carlson NS. Predicting Postpartum Hemorrhage After Vaginal Birth by Labor Phenotype. J Midwifery Womens Health. 2020 Sep.;65(5):609-620.
Bączek G, Rzońca E, Sys D, Rychlewicz S, Durka A, Rzońca P, et al. Spontaneous Perineal Trauma during Non-Operative Childbirth – Retrospective Analysis of Perineal Laceration Risk Factors. Int J Environ Res Public Health [Internet]. 2022 Jun. 23 [cited 2023 Jan. 10];19(13):7.653. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9266119/
Gaudernack LC, Michelsen TM, Egeland T, Voldner N, Lukasse M. Does prolonged labor affect the birth experience and subsequent wish for cesarean section among first-time mothers? A quantitative and qualitative analysis of a survey from Norway. BMC Pregnancy Childbirth [Internet]. 2020 Oct. 8 [cited 2023 Jan. 10];20:605. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7542692/
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Revista Contexto & Saúde
This work is licensed under a Creative Commons Attribution 4.0 International License.
Autores que publicam na Revista Contexto & Saúde concordam com os seguintes termos:
a) A submissão de trabalho(s) científico(s) original(is) pelos autores, na qualidade de titulares do direito de autor do(s) texto(s) enviado(s) ao periódico, nos termos da Lei 9.610/98, implica na cessão de direitos autorais de publicação na Revista Contexto e Saúde do(s) artigo(s) aceitos para publicação à Universidade Regional do Noroeste do Estado do Rio Grande do Sul, autorizando-se, ainda, que o(s) trabalho(s) científico(s) aprovado(s) seja(m) divulgado(s) gratuitamente, sem qualquer tipo de ressarcimento a título de direitos autorais, por meio do site da revista e suas bases de dados de indexação e repositórios, para fins de leitura, impressão e/ou download do arquivo do texto, a partir da data de aceitação para fins de publicação. Isto significa que, ao procederem a submissão do(s) artigo(s) à Revista Contexto e Saúde e, por conseguinte, a cessão gratuita dos direitos autorais relacionados ao trabalho científico enviado, os autores têm plena ciência de que não serão remunerados pela publicação do(s) artigo(s) no periódico.
b). Autores mantém os direitos autorais e concedem à revista o direito de primeira publicação, com o trabalho simultaneamente licenciado sob a Licença Creative Commons Attribution que permite o compartilhamento do trabalho com reconhecimento da autoria e publicação inicial nesta revista.
c). Autores têm autorização para assumir contratos adicionais separadamente, para distribuição não-exclusiva da versão do trabalho publicada nesta revista (ex.: publicar em repositório institucional ou como capítulo de livro), com reconhecimento de autoria e publicação inicial nesta revista.
d). Autores têm permissão e são estimulados a publicar e distribuir seu trabalho online (ex.: em repositórios institucionais ou na sua página pessoal) a qualquer ponto antes ou durante o processo editorial, já que isso pode gerar alterações produtivas, bem como aumentar o impacto e a citação do trabalho publicado (Veja O Efeito do Acesso Livre).
