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Biomedical subjects

E Hodnett

Publications and source records attributed to E Hodnett.

At least 19 recordsLinked to original sources
PubMed2000

Antenatal education for self-diagnosis of the onset of active labour at term.

BACKGROUND: A specific program designed to teach women to recognise active labour may be beneficial through potentially decreasing the incidence of early admission to hospital, increasing women's confidence and decreasing their anxiety. OBJECTIVES: The objective of this review was to assess the effects of teaching pregnant women specific criteria for self-diagnosis of active labour onset in term pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. SELECTION CRITERIA: Randomised trials comparing a structured antenatal education intervention for the identification of symptoms for self-diagnosis of active labour with usual care. DATA COLLECTION AND ANALYSIS: Trial quality was assessed. MAIN RESULTS: One study involving 245 women was included. Method of randomisation was unclear and 15% of the sample was lost to follow-up in this trial. A specific antenatal education program was associated with a reduction in the mean number of visits to the labour suite before the onset of labour (weighted mean difference -0. 29, 95% confidence interval -0.47 to -0.11). It is unclear whether this resulted in fewer women being sent home because they were not in labour. REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate the use of a specific set of criteria for self-diagnosis of active labour.

Female↗
PubMed2000

Caregivers' use of strict criteria for diagnosing active labour in term pregnancy.

BACKGROUND: Application of specific criteria for diagnosis of active labour as part of a labour assessment program aims to differentiate more accurately between latent and active phases of labour. OBJECTIVES: The objective of this review was to assess the effects of the use of specific criteria by caregivers in diagnosing active labour in term pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. Date of last search: January 1998. SELECTION CRITERIA: Randomised trials comparing caregivers' application of strict diagnostic criteria for active labour with routine care. DATA COLLECTION AND ANALYSIS: Trial quality was assessed. MAIN RESULTS: One study of 209 women was included. The trial was of excellent quality. Women who experienced early labour assessment were less likely to receive intrapartum oxytocics than women who received standard care (odds ratio 0.45, 95% confidence interval 0.25 to 0.80) and analgesia (odds ratio 0.36, 95% confidence interval 0.16 to 0.78). They reported higher levels of control during labour and birth (weighted mean difference 16.00, 95% confidence interval 7.52 to 24.48). There were no differences detected for rate of caesarean section and other important measures of maternal and neonatal outcome. REVIEWER'S CONCLUSIONS: Early labour assessment (which includes use of specific criteria for diagnosis of active labour) may have some positive outcomes for women at term pregnancy.

Caregivers↗
PubMed1998

International multicenter term PROM study: evaluation of predictors of neonatal infection in infants born to patients with premature rupture of membranes at term. Premature Rupture of the Membranes.

OBJECTIVE: Our objective was to determine significant predictors for the development of neonatal infection in infants born to patients with premature rupture of membranes at term. STUDY DESIGN: Multivariate analysis was used to determine the significant predictors of neonatal infection in infants born to women with premature rupture of the membranes who were enrolled in the Term PROM Study. In a randomized, controlled trial, the Term PROM Study recently compared induction of labor with expectant management for premature rupture of membranes at term. RESULTS: The following variables were identified as independent predictors of neonatal infection: clinical chorioamnionitis (odds ratio 5.89, P < .0001), positive maternal group B streptococcal status (vs negative or unknown, odds ratio 3.08, P < .0001), 7 to 8 vaginal digital examinations (vs 0 to 2, odds ratio 2.37, P = .04), 24 to < 48 hours from membrane rupture to active labor (vs < 12 hours, odds ratio 1.97, P = .02), > or = 48 hours from membrane rupture to active labor (vs < 12 hours, odds ratio 2.25, P = .01), and maternal antibiotics before delivery (odds ratio 1.63, P = .05). CONCLUSIONS: Among infants born to patients with premature rupture of membranes at term, clinical chorioamnionitis and maternal colonization with group B streptococci are the most important predictors of subsequent neonatal infection.

Adult↗
PubMed1998

An early labor assessment program: a randomized, controlled trial.

BACKGROUND: Approximately 31 percent of cesarean deliveries in the United States and Canada are performed for dystocia. The aim of this study was to determine the effectiveness of early labor assessment to reduce cesarean birth rates for low-risk nulliparous women. METHODS: Two hundred and nine low-risk nulliparous women were randomly allocated to either the early labor assessment group or the direct admission to hospital group. Women in the early labor assessment group were evaluated and, if found to be in false or latent labor, were encouraged to go home or walk before admission to the labor unit. Those in the direct admission group were admitted to the labor unit without an assessment. Data were collected and analyzed about method of delivery, duration of labor, intrapartum interventions, and neonatal well-being. Women completed an evaluation of their experience in the early postpartum period. RESULTS: Significant decreases occurred in duration of labor, use of epidural analgesia for pain, and use of oxytocin to augment labor in the early labor assessment group. These women evaluated their labor and birth experience more positively than women in the direct admission group. No significant differences were found in the frequency of cesarean section or instrumental vaginal delivery for the two groups. CONCLUSIONS: Early labor assessment has the potential to reduce the number of women receiving oxytocin for augmentation, the rate of epidural analgesia for pain relief, and the duration of the active and second stages of labor, and to improve women's evaluations of their labor and birth experiences.

Adult↗
PubMed1997

Randomized controlled trial of a prenatal vaginal birth after cesarean section education and support program. Childbirth Alternatives Post-Cesarean Study Group.

OBJECTIVE: Our objective was to assess whether, for women with previous cesarean section, a prenatal education and support program promoting vaginal birth after cesarean delivery increases the probability of vaginal delivery. STUDY DESIGN: Women with a single previous cesarean were recruited before 28 weeks' gestation. Women's self-assessed motivation to attempt vaginal birth after a previous cesarean delivery was measured on a 10 cm visual analog scale: stratum I, low motivation; stratum II, high motivation. Women were randomized by stratum to one of two groups. Those in the "Verbal" group participated in an individualized education program. Those in the "Document" group were provided with a pamphlet detailing the benefits of planned vaginal birth after cesarean delivery. RESULTS: Rates of vaginal birth after cesarean section were similar in the verbal and document groups: verbal, 339 of 641 (53%); document, 310 of 634 (49%); relative risk 1.1, 95% confidence interval 1.0 to 1.2. There was no evidence of heterogeneity across motivational strata. Regardless of treatment group, women with low motivation for vaginal birth after cesarean section were more than three times as likely to undergo elective repeat cesarean than were women with high motivation (47% vs 13%). CONCLUSIONS: There was no evidence that an individualized prenatal education and support program, when offered to all women with previous cesarean delivery, results in a clinically significant increase in the rate of vaginal birth after cesarean section.

Adult↗
PubMed1992

Supporting women in labor: a work sampling study of the activities of labor and delivery nurses.

Studies demonstrated that support during labor and birth has a positive impact on childbirth outcomes, and that women reported they received little supportive care from nurses during parturition. This study piloted a work sampling method that was adapted to determine the proportion of time the average intrapartum nurse at a Toronto teaching hospital spends in supportive care activities. Supportive care was operationally defined within four categories of activities: emotional support, physical comfort measures, instruction/information, and advocacy. Work sampling was an effective method of measuring support as a specific aspect of direct intrapartum care. The proportion of time that nurses spent in supportive versus all other activities was 9.9 percent (95% confidence interval 7.5% and 12%), based on a sample of 616 random observations of 18 nurses. Findings are discussed in terms of the social and political factors that affect the meaning and value of the supportive activities of work by obstetric nurses.

Clinical Nursing Research↗
PubMedDate not supplied

Making evidence-based practice a reality in your institution.

There are many barriers to ensuring that nursing practice is based on research evidence. This article provides several resources to help the practicing nurse identify what evidence is available upon which to make practice changes. Additionally, strategies for supporting change are discussed and a case study of one particular evidenced-based change--1:1 support by nurses for women in labor--is examined.

Databases as Topic↗