Laura Migliaccio

Does a Large Infant Head or a Short Perineal Body Increase the Risk of Obstetrical Perineal Trauma

BACKGROUND Perineal trauma after vaginal delivery can have significant long-term consequences. It is unknown if a larger infant head circumference or smaller maternal perineal anatomy are risk factors for perineal trauma after vaginal delivery. METHODS We conducted a prospective cohort study of low-risk nulliparous women. Data collected included maternal characteristics, antepartum Pelvic Organ Prolapse Quantification measurements of the perineal body and genital hiatus, labor characteristics, perineal trauma, and infant head circumference. Perineal trauma was defined as trauma that extended into the muscles of the perineum (second-degree or deeper). Univariate and multivariate logistic models were created to calculate odds ratios (OR) and 95 percent confidence intervals (CI). RESULTS We observed 448 vaginal births. Multivariate analysis demonstrated a significant association between infant head circumference at birth and perineal trauma: OR 1.22 for each increase of 1 cm in head circumference (95% CI 1.05-1.43). There was no association between perineal body or genital hiatus length and perineal trauma. CONCLUSIONS In nulliparous low-risk women a larger infant head circumference at birth increases the likelihood of perineal trauma, although the effect is modest. Antenatal perineal body and genital hiatus measurements do not predict perineal trauma. These results do not support alteration in mode of delivery or other obstetric practices.

Role development in midwifery education: A place for simulation

OBJECTIVE simulation-based learning is increasingly seen as an effective strategy to develop student nurse-midwives into effective healthcare team members. A gap exists concerning the use of simulation to promote role transition/development of the student midwife. The purpose of this paper is to describe an evolving simulation curriculum aimed at role development of the student midwife as well as technical skills training. SETTING the University of New Mexico, College of Nursing and the Interprofessional Healthcare Simulation Center. PARTICIPANTS this program involves students enrolled in the Masters in Nursing Program, Midwifery Concentration and students enrolled in the pre-licensure Bachelor of Science in Nursing program. FINDINGS simulation allows for an opportunity to focus on communication skills with other team members, practicing the importance of clear delegation of responsibilities in high-stress situations. CONCLUSIONS the value of practicing the necessary communication skills, as well as the opportunity to engage in simulated delegation of tasks, is an important aspect of midwifery role development.

Initiating Intrapartum Nitrous Oxide in an Academic Hospital: Considerations and Challenges

&NA; A 50%‐50% mixture of nitrous oxide and oxygen has long been used for managing pain during labor in many countries, but only recently has this intrapartum analgesic technique become popular in the United States. Nitrous oxide is considered minimal sedation and a safe pain management alternative. Many facilities are now interested in providing laboring women this analgesic option. The process of establishing use of nitrous oxide in a large institution can be complicated and may seem daunting. This brief report describes the challenges that occurred during the process of initiating nitrous oxide for pain management during childbirth at an academic medical center and discusses various committee roles. Nurses at the University of New Mexico Hospital now directly oversee the administration of nitrous oxide to women in labor in accordance to an established guideline. Despite limited available research, the guideline also allows offering nitrous oxide as a pain management technique for women with opioid dependence. Key components of the guideline and specifics related to education, cost, and safety are reviewed.

Impact of Nulliparous Women's Body Mass Index or Excessive Weight Gain in Pregnancy on Genital Tract Trauma at Birth

INTRODUCTION The purpose of this study was to explore the impact of body mass index (BMI) or pregnancy weight gain on the presence, site, and severity of genital tract trauma at childbirth in nulliparous women. METHODS The present study is a subanalysis of a prospective cohort of healthy nulliparous women recruited during pregnancy and followed through birth. Weight gain during pregnancy and prepregnancy BMI were recorded. At birth, women underwent detailed mapping of genital tract trauma. For analyses, women were dichotomized into obese (BMI ≥ 30) versus nonobese (BMI < 30) at baseline as well as into those who gained weight as recommended by the Institute of Medicine (IOM) and those who gained more than the recommended amount to determine the impact of obesity or excessive weight gain on rates of genital tract trauma. RESULTS Data from 445 women were available for analysis. Presence and severity of genital tract trauma did not vary between obese and nonobese women (51% vs 53%, P = .64). Likewise, women who had more than the IOM-recommended weight gain did not have a higher incidence of perineal lacerations (52% versus 53% with perineal lacerations, P = .69). Obese women were more likely to gain in excess of the IOM guidelines during pregnancy (75% vs 50% excessive weight gain in obese vs nonobese women, respectively; P < .001). DISCUSSION A womans BMI or excessive weight gain in pregnancy did not influence her risk of genital tract trauma at birth.