Computational protocol: The association between labour variables and primiparous women’s experience of childbirth; a prospective cohort study

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Protocol publication

[…] A prospective observational study called `the dysfunctional labour study´ was performed at Soder Hospital Stockholm, Sweden between April 2010 and January 2012.Healthy, Swedish-speaking, nulliparous women, with a singleton pregnancy and a gestational age between 37–42 weeks, were asked to participate. A number of criteria for inclusion were formulated: labour should have started spontaneously, the foetus should be in a cephalic presentation, the cervical dilation should be at least 3 cm and regular, painful contractions should be present.A group of 25/140 midwives at the Soder Hospital clinic volunteered to assist in data collection and informed the labouring women about the ongoing study. In all, 561 healthy primiparous women in labour, presenting consecutively, were invited to participate in this study as they fulfilled the inclusion criteria. Of these, seven declined to participate and 107 were excluded later due to incomplete ID or an incomplete questionnaire. One woman was excluded due to intrapartum death of the infant. The remaining 446 women constituted our material for the survey. A written informed consent for participation in the study was obtained from all participants. The study was approved by the Karolinska Institute Human Research Ethics Committee (2010/199-31/1).All women included were asked to complete the Wijma Delivery Experience Questionnaire (W-DEQ B) the day after delivery. The W-DEQ B measures the woman´s experience of childbirth after delivery. The questionnaire includes 33 items, each scoring from 0–5. The sum score ranges from 0–165; the higher the score, the worse the woman’s experience. The questionnaire has shown good psychometric properties []. The cut-off between good/moderate and negative experience of childbirth was set at a sum score of 66, which was the 75th percentile in the original study of childbirth experience []. The two groups (W-DEQ < and ≥ 66) were compared with regard to levels of AFL, and labour variables in several parameters.In addition to the W-DEQ, seven questions were added relating to nourishment, sleep, the presence of the midwife during labour and thoughts about a subsequent pregnancy and delivery. In calculating the outcome, the same scale was used as in the original W-DEQ B questionnaire, with a scoring range from 0–5.The questionnaire was collected after delivery but before the woman was discharged from hospital.In order to detect labour dystocia, the WHO-modified partogram was used with an alert line and a two hours displaced action line, as recommended in Sweden at the time of the study. The alert line was passed if the cervical dilation was slower than 1 cm per hour, and the action line was passed if the delay in progress continued beyond two hours.In line with the study guidelines, a sample of amniotic fluid was collected by the midwife at delivery. The level of lactate in AF was used as a sign of the uterine metabolic status at delivery and the analysis was performed immediately by a research midwife, using a lactate measurement device, (LMU061, ObsteCare AB, Sweden) [-]. The test result was blinded to both the midwife and the labouring woman. A cut-off value for a very high AFL level was set at ≥ 12 mmol/L. This is in line with earlier publications where there was an increased frequency of complicated deliveries in the group with a high AFL value [-].Foetal scalp blood sampling was performed in the deliveries where a non-reassuring/pathological CTG (Cardiotoccography) trace was presented. The test was performed with the mother supine and her legs in stirrups. The scalp blood was collected in preheparinized glass capillary tubes, and the lactate analysis was carried out at the bedside.After delivery and before the newborn’s first cry, arterial and venous cord blood samples were drawn from a segment of the cord and analysed within a few minutes for ph. All cord blood analyses were performed using an ABL 800 analyser (Bayer®) available in the labour ward. Socio-demographic and obstetric background data were collected from the antenatal and delivery records.Statistical analyses were performed using SPSS 20.0 (SPSS Inc. Chicago, Illinois, USA) and the Statistica for Windows statistical package, version 10.0 (Stat Soft, Tulsa, Oklahoma, USA). Mean (m) and standard deviation (SD) were used as descriptive measures. The difference between the groups of low/moderate or high W-DEQ (13 h (yes/no), full cervical dilation and non-descent of the foetal head >3 h (yes/no), AFL ≥ 12 mmol/L (yes/no), epidural anaesthesia (yes/no), Apgar < 7 at 1 min (yes/no). Our model strategy was as follows: first, unadjusted associations with each factor were studied in a univariate model. Second, the adjusted association with respect to the risk factors measured was studied in a multivariable model. Before performing the logistic regression, clinically relevant interaction models were constructed (such as high lactate and low Apgar score). No significant interactions were detected. […]

Pipeline specifications

Software tools SPSS, Statistica
Application Miscellaneous
Organisms Homo sapiens
Diseases Dystocia
Chemicals Lactic Acid