Skip to search form Skip to main content You are currently offline. Some features of the site may not work correctly. Obstetric Psychoprophylaxis OPP , recognized as a prevention tool in obstetric care has a positive impact on maternal and perinatal health. In a globalized world, it is necessary and desirable to standardize criteria, in order that staff integrates the program can work better under the same concepts, understanding the very meaning and objectives of the OPP, for a team work with quality and there by achieve the maximum benefit for mothers, babies and their environment. View PDF.

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We'd like to understand how you use our websites in order to improve them. Register your interest. To determine the frequency of potential excess of vaginal examinations PEVE during the management of labor and identify its associated factors, in Peruvian hospitals.

In this study, women hospitalized in Peruvian hospitals right after giving birth were surveyed by trained personnel. PEVE, the main outcome, was considered as five or more vaginal examinations VEs performed during the management of labor. One thousand four hundred twenty registries of 13 hospitals from 8 Peruvian cities were evaluated. The number of women studied at each hospital ranged between and The median number of VEs was 3 interquartile rank: 2—5. The proportion of women who underwent PEVE was Around one in three women underwent a PEVE, although this frequency varied widely across the evaluated hospitals.

Future studies should assess in depth the causes and consequences of this high frequency. Peer Review reports. We aimed to evaluate how frequent the potential excess of vaginal examinations PEVE was during management of labor and identify its associated factors in Peruvian hospitals. This study included women hospitalized right after giving birth.

We included women. In conclusion, the proportion of women who underwent PEVE was large and varied among the evaluated hospitals. Thus, there is a need to evaluate the application of guidelines regarding the frequency of VE conducted during labor, and the number of VEs needs to be evaluated relative to duration of labor.

Vaginal examination VE is a procedure used frequently during the management of labor [ 1 , 2 ], especially to assess its beginning and to evaluate its progress [ 3 , 4 ]. However, the use of VE during labor has not shown to be useful for improving outcomes of interest like length of labor, maternal or infant mortality and morbidity [ 5 ]. Moreover, recent studies have found that assessment of labor could be performed more accurately using ultrasound [ 6 , 7 ]. Although a higher number of VE has not been clearly associated with an increased risk of infection or fever [ 5 , 8 , 9 , 10 ], it has been associated with pain, discomfort, embarrassment [ 3 , 11 ], dissatisfaction with intrapartum care [ 12 ], and posttraumatic stress syndrome [ 13 , 14 ].

Therefore, according to the recommendations provided by the World Health Organization WHO , the number of VE performed during labor should be limited to what is strictly necessary and should be performed to confirm the beginning of labor and every 4 hrs to identify prolonged labor [ 15 ]. The excessive number of VE during labor has been assessed in previous studies.

However, few of them have taken place in Latin America [ 9 , 16 , 17 , 18 ] and Peru [ 19 ]. Moreover, few studies have evaluated the associated factors to the excessive number of VE during labor [ 3 , 4 , 20 ], which is important to design interventions assessing subgroups of women in a higher risk of being subjected to an excessive number of VE.

Due to the importance of the subject for adequate childbirth care, and to the limited number of studies conducted in Latin America and Peru, the present study aimed to determine the potential excess of vaginal examinations PEVE performed during the management of labor and to identify its associated factors in Peruvian hospitals.

The primary study collected information from puerperal women who were hospitalized in the maternity wards of 14 hospitals in nine cities of Peru: two from the coast, five from the highlands, and two from the jungle.

Those who did not wish to participate in the study were not able to respond to the survey, or whose babies had died were not included in the study. For the present study, records from one of the hospitals included in the primary study were excluded from the analysis since surveys took there did not include certain covariates of interest for the present analysis.

In addition, those records of women who did not provide information on the number of VEs performed during labor and records containing inconsistent data were excluded. Facilities included in this study belong to the public and social security health systems, which give coverage to Public system provides care for the informal workers, independent workers, and unemployed; whereas social security system provides health insurance for the formal workers, independent workers who pay a minimum fee, retired, and their families [ 23 ].

Interviewers from nine Peruvian cities were recruited, and permissions for the main study were asked in all hospitals located in each city, and 14 of these hospitals granted their authorization. Interviewers attended to the hospital with a daily to 3 times a week frequency until reaching at least respondents.

Frequency varied within hospitals due to the interviewer possibilities. Women signed an informed consent form before their participation and were conducted to a private environment for the survey application. The collection of VEs data was done through an interview in which the postpartum women were asked about the number of VEs performed in total during labor.

VE was defined as the introduction of one or more fingers into the vagina for evaluation means. PEVE was defined as the performance of five or more VE during labor, in accordance with the national guideline for childbirth care that applies to all health facilities in Peru, in which 4 is considered the maximum number of expected VEs in normal labor [ 24 ].

This cut-off has been also used in two previous studies [ 3 , 25 ]. In order to carry out our analysis, we considered three socio-demographic variables: age in tertiles , educational level without education, complete primary, complete secondary, or complete higher education , region where the hospital is located coast, highlands, or jungle , and hospital health system public or social security. The number of obstetric psychoprophylaxis sessions during pregnancy was also collected.

Psychoprophylaxis can be defined as the integral, theoretical, physical, and psycho-affective preparation provided during pregnancy, with the objective of preparing women for future obstetric care [ 26 ]. Absolute and relative frequencies were calculated for categorical variables. Medians, interquartile ranks IQR , means, and standard deviations, were calculated for quantitative variables. The adjusted model included the following variables: age, educational level, region, health system, number of deliveries considering the recent one, number of prenatal controls, number of psychoprophylaxis sessions, referral, type of delivery, day of delivery, and time of delivery.

For the adjusted model hospitals were entered as clusters. Informed consent form for the participants included the purpose of the study. Participation was anonymous and voluntary, and the confidentiality of the data was ensured. Of these, 99 surveys of one hospital were excluded because they did not have complete variables of interest. In addition, 5 records were excluded for not having information about the number of VEs performed during labor, and other 4 records were excluded because they lacked other variables of interest.

Finally, data from puerperal women These women were attended in 13 hospitals of eight cities in Peru. Data from postpartum women were analyzed. Of these, Regarding the number of deliveries, Regarding current delivery, We evaluated 13 hospitals in eight Peruvian cities. The mean number of VEs performed during labor in our study was 3. The hospital with the lowest mean of VEs had 2. Other studies also showed great variability in the number of VEs, with 2. Although the Peruvian and the WHO guidelines establish that VEs should be performed every 4 hrs to evaluate the progress of labor [ 15 , 24 ], we found a great variability among Peruvian hospitals.

We propose four features that could explain this variability. First, it is possible that health personnel in each hospital tend to mainly follow indications of professionals with more experience, considered as experts in the area [ 27 , 28 ]. Thus, regarding VEs, such opinions may be different from the guideline recommendations.

Second, there are some procedures that are usually performed accompanied by VE such as intrapartum analgesia, artificial rupture of membranes, or placement of fetal electrodes [ 20 , 29 , 30 ]. Thus, it is possible that these procedures are overused in certain hospitals. Third, in hospitals with higher amount and diversity of health personnel performing the assessment of the progress of labor including gynecologists, midwives, residents, interns, medical students, and obstetrics students , each health personnel could register his findings on different documents and carry out parallel VE [ 31 ].

Accordingly, the number of health professionals involved in labor management has found to increase the number of VEs [ 3 ]. Fourth, the staff in training could be performing unnecessary VE just for training reasons, or necessary VE that later will be corroborated by more experienced personnel.

These features should be studied in depth to prevent an excessive number of VEs. In addition, it is necessary to generate local evidence regarding number or frequency of VEs associated to discomfort, embarrassment, or dissatisfaction with intrapartum care in Peruvian women, in order to correctly generate cut-off points for VE. One of the goals of these sessions is for pregnant women to recognize the beginning of labor and the timing in which they should go to the health center [ 32 ].

Therefore, the higher frequency of PEVE associated with a greater number of psychoprophylaxis sessions could be explained by the fact that women who have been trained in recognizing the onset of labor attend earlier to health facilities and are exposed more time to health care.

Conversely, in a study conducted in a hospital in Palestine, no differences were found in the frequency of PEVE according to the time of delivery [ 3 ]. The incoming team has usually been working all morning, so it is understandable that they try to reduce their workload by reducing the number of patients they have in charge.

In order to achieve this, they may opt for more active management of labor which includes rupture of membranes and stimulation with oxytocin, procedures which are usually preceded by VE [ 33 , 34 ].

Our study had some limitations: 1 Postpartum women may have been intimidated by the hospital environment, which could have influenced their response to the number of VE. Nevertheless, in order to reduce this bias the anonymity of the survey was emphasized, and surveys were performed without the presence of health professionals in the room.

Thus, efforts were made to survey women just few hours after their birth, assess them in a quiet environment, and give them enough time to remember the characteristics of their birth. Also, to minimize these limitations, further studies should corroborate the information collected through the revision of the hospital registries.

In order to have a more accurate approximation of excess of VE, some studies have opted to calculate the expected number of VE by dividing the number of hours the in-patient was in labor in four [ 4 , 28 ]. Unfortunately, we had no information about the length of labor spent in the hospital. However, we were not able to collect these situations, so we had no clinical information to evaluate if extra VEs were or were not necessary for labor management.

Nevertheless, we expect to compensate this limitation, at least partially, by using the mean of expected VEs. Despite these limitations, our results are important as they show wide differences among different hospitals, as well as a temporal variation in the number of VE, which may reflect differences in the intensity of management of labor according to the time of birth.

Induction of labour. J Obstet Gynaecol. Williams Obstetricia. Google Scholar. Reproductive Health. Shepherd A, Cheyne H. The frequency and reasons for vaginal examinations in labour. Women Birth. Routine vaginal examinations for assessing progress of labour to improve outcomes for women and babies at term.

Cochrane Database Syst Rev. Trasperineal ultrasonography for labor management: accuracy and reliability. Acta Obstet Gynecol Scand. Hoon K, Oh M-J.


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