The Effects of Immediate versus Delayed Pushing During the Second Stage of Labor on Fetal Wellbeing: A Randomized Clinical Trial

2.50
Hdl Handle:
http://hdl.handle.net/10755/161226
Type:
Presentation
Title:
The Effects of Immediate versus Delayed Pushing During the Second Stage of Labor on Fetal Wellbeing: A Randomized Clinical Trial
Abstract:
The Effects of Immediate versus Delayed Pushing During the Second Stage of Labor on Fetal Wellbeing: A Randomized Clinical Trial
Conference Sponsor:Midwest Nursing Research Society
Conference Year:2005
Author:Simpson, Kathleen, PhD, RN, FAAN
P.I. Institution Name:St. John's Mercy Medical Center
Title:Clinical Nurse Specialist
Contact Address:Labor and Delivery, 7140 Pershing Ave, St. Louis, MO, 63130, USA
Contact Telephone:314-569-6087
Co-Authors:Dotti C. James, PhD, RN, Associate Professor
Problem: Although there are two methods of nursing care for women with
epidural analgesia during second stage labor (coached closed-glottis
pushing immediately at 10 centimeters cervical dilation or passive fetal
descent and delayed pushing until the woman feels the urge to push), there
are limited data concerning which method is most optimal for fetal
wellbeing. Purpose: To evaluate the effects on fetal wellbeing of two
methods of nursing care during second stage labor. A physiologic framework
was used to guide the study. Methods: Forty-five nulliparous women in the
second stage were randomized to immediate pushing or delayed pushing.
Fetal oxygen saturation (FSpO2) and the fetal heart rate (FHR) were
continuously monitored. FSpO2 values at 10 cm dilation, initiation of
pushing and prior to birth and the amount of time that FSpO2 values were
abnormal (2 or more minutes <30%) were compared between groups. Results:
There was a significant difference between groups in the decrease in FSpO2
over the course of the second stage (immediate M=12.45; delayed M=4.56,
p=.001). Ninety-four percent of the 2 minute epochs of desaturation (FSpO2
<30%) occurred during active pushing. There were more variable FHR
decelerations in the immediate pushing group (immediate M=22.41; delayed
M=15.61, p=.019). Conclusions: The delayed pushing method results in less
of a decrease in FSp02 during the second stage, less periods of FSpO2
below 30%, and less FHR decelerations as compared to the immediate pushing
method, thus delayed pushing is more favorable for fetal wellbeing during
second stage labor. Delayed pushing did not increase risk of operative
vaginal birth or cesarean birth. Second stage nursing care has an impact
on fetal wellbeing and the transition to extrauterine life. Supported by a
Grant from the American Nurses Foundation sponsored by GlaxoSmithKline.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Midwest Nursing Research Society

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleThe Effects of Immediate versus Delayed Pushing During the Second Stage of Labor on Fetal Wellbeing: A Randomized Clinical Trialen_GB
dc.identifier.urihttp://hdl.handle.net/10755/161226-
dc.description.abstract<table><tr><td colspan="2" class="item-title">The Effects of Immediate versus Delayed Pushing During the Second Stage of Labor on Fetal Wellbeing: A Randomized Clinical Trial</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Midwest Nursing Research Society</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2005</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Simpson, Kathleen, PhD, RN, FAAN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">St. John's Mercy Medical Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Clinical Nurse Specialist</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">Labor and Delivery, 7140 Pershing Ave, St. Louis, MO, 63130, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">314-569-6087</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">KRSimpson@prodigy.net</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Dotti C. James, PhD, RN, Associate Professor</td></tr><tr><td colspan="2" class="item-abstract">Problem: Although there are two methods of nursing care for women with <br/> epidural analgesia during second stage labor (coached closed-glottis <br/> pushing immediately at 10 centimeters cervical dilation or passive fetal <br/> descent and delayed pushing until the woman feels the urge to push), there <br/> are limited data concerning which method is most optimal for fetal <br/> wellbeing. Purpose: To evaluate the effects on fetal wellbeing of two <br/> methods of nursing care during second stage labor. A physiologic framework <br/> was used to guide the study. Methods: Forty-five nulliparous women in the <br/> second stage were randomized to immediate pushing or delayed pushing. <br/> Fetal oxygen saturation (FSpO2) and the fetal heart rate (FHR) were <br/> continuously monitored. FSpO2 values at 10 cm dilation, initiation of <br/> pushing and prior to birth and the amount of time that FSpO2 values were <br/> abnormal (2 or more minutes &lt;30%) were compared between groups. Results: <br/> There was a significant difference between groups in the decrease in FSpO2 <br/> over the course of the second stage (immediate M=12.45; delayed M=4.56, <br/> p=.001). Ninety-four percent of the 2 minute epochs of desaturation (FSpO2 <br/> &lt;30%) occurred during active pushing. There were more variable FHR <br/> decelerations in the immediate pushing group (immediate M=22.41; delayed <br/> M=15.61, p=.019). Conclusions: The delayed pushing method results in less <br/> of a decrease in FSp02 during the second stage, less periods of FSpO2 <br/> below 30%, and less FHR decelerations as compared to the immediate pushing <br/> method, thus delayed pushing is more favorable for fetal wellbeing during <br/> second stage labor. Delayed pushing did not increase risk of operative <br/> vaginal birth or cesarean birth. Second stage nursing care has an impact <br/> on fetal wellbeing and the transition to extrauterine life. Supported by a <br/> Grant from the American Nurses Foundation sponsored by GlaxoSmithKline.</td></tr></table>en_GB
dc.date.available2011-10-26T23:17:56Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T23:17:56Z-
dc.description.sponsorshipMidwest Nursing Research Societyen_GB
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