Volume 28, Issue 4 (Fall 2020)                   Avicenna J Nurs Midwifery Care 2020, 28(4): 9-19 | Back to browse issues page


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Oshvandi K, Masoumi S Z, Kazemi F, Shayan A, Oliaei S S, Mohammadi A. Comparison of Maternal Anemia and Their Infant Apgar Scores in Conventional Vaginal Delivery with Physiological Delivery. Avicenna J Nurs Midwifery Care 2020; 28 (4) :9-19
URL: http://nmj.umsha.ac.ir/article-1-2177-en.html
1- Professor, Hamadan University of Medical Sciences, Hamadan, Iran
2- Associated professor, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
3- Lecturer, Hamadan University of Medical Sciences, Hamadan, Iran
4- Lecturer, Hamadan University of Medical Sciences, Hamadan, Iran , arezoo.shayan2012@yahoo.com
5- Research Center of Iranian Blood Transfusion Organization, Hamadan Blood Center, Hamadan, Iran
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✅ The results showed that at 6 hours postpartum, the mean of hemoglobin and hematocrit in the physiological delivery group was significantly higher than conventional vaginal delivery (P<0.001). Comparison of neonatal Apgar scores of the two groups in minute 1 and minute 5 also showed that the amount of Apgar score in physiological delivery group was higher than conventional vaginal delivery (P<0.05).


Extended Abstract:   (456 Views)
Introduction

Postpartum hemorrhage is one of the leading causes of maternal death worldwide, especially in developing countries, and is responsible for 13% of maternal deaths as well as nosocomial complications [2-6]. In addition, one of the concerns of the first 24 hours after delivery is a decrease in hemoglobin; so routine measurement of postpartum hemoglobin and obstetric and gynecological surgeries is common [7]. Every year, 14 million women suffer from postpartum hemorrhage, of which about 140,000 die. [8] Primary postpartum hemorrhage is the most common form of major obstetric hemorrhage, which involves the loss of 500 mL or more of blood from the genital tract within the first 24 hours after delivery [9]. This is a clinical estimate, and the loss of 500 mL of blood can be life-threatening due to the prevalence of anemia in many parts of the world.
So far, studies have shown that natural childbirth leads to cesarean section due to medical interventions and the use of physiological childbirth. Due to the lack of available information about the effects of delivery method on postpartum hemorrhage and hemoglobin loss and the special importance of mothers, the present study aimed to compare some maternal blood parameters and their neonatal Apgar scores in both conventional and physiological vaginal delivery methods in Fatemieh hospital, in Hamadan, Iran.


 

Materials and Methods

This semi-experimental study was performed in 2018 with the participation of 400 pregnant women candidates for physiological childbirth and 400 pregnant women candidates for conventional vaginal delivery, using the available sampling method. Mothers in the physiological delivery group were those who did not receive any major labor intervention, and during the labor, training was given on how to breathe, pelvic rotation, delivery ball, hot shower, and massage. In the common vaginal delivery group, the mother went through the usual steps as soon as she was hospitalized. All mothers' intravenous blood samples were examined in two groups to measure the amount of hemoglobin and hematocrit at the time of hospitalization and 6 hours after delivery and the Apgar score of the first and fifth minutes of infancy in both groups. Data were analyzed using SPSS version 16 (SPSS Inc., Chicago, Ill., USA). Kolmogorov-Smirnov test was used to investigate the distribution of quantitative variables. Independent t-test was used to compare demographic and quantitative variables and Chi-square test was used for qualitative variables. Independent t-test, paired t-test and ANOVA were used to compare the mean of hemoglobin and hematocrit in two groups and Fisher’s exact test was used to compare the Apgar scores of minutes 1 and 5. Significance level was considered 0.05.

 

Results
The mean age of Hemoglobin and Hematocrit in the conventional vaginal delivery group was27.37 (5.75) years and in the physiological delivery group was 27.70 (5.73) years. The results showed that at the time of hospitalization, the mean hemoglobin in the physiological delivery group was significantly higher than the conventional vaginal delivery 11.64 (1.20) and 11.93 (1.20), respectively (P<0.001). The results showed that at the time of hospitalization, the mean hematocrit in the physiological delivery group was significantly higher than conventional vaginal delivery 36.53 (3.33) and 35.50 (3.33), respectively (P<0.001). Comparison of the Apgar scores of the newborns in two groups in the 1st and 5th minutes also showed that the Apgar score in the physiological delivery group was higher than the conventional vaginal delivery (P<0.05).

Table 1. Comparison of demographic and midwifery variables classified by participants
Variable Natural delivery
Mean (SD)
N=400
Physiological delivery
Mean (SD)
N=400
Test statistics P *
Gravida  
1 (33.5) 134 (32.3) 129 0.74 0.68
2 (39.8) 159 (38.3) 153
3 (26.8) 107 (29.5) 118
Number of deliveries        
0 (33.5) 134 (32.3) 129 0.39 0.82
1 (37.2) 149 (36.5) 146
2 (29.3) 117 (31.2) 125
History of abortion  
Had (10.3) 41 (18.3) 73 10.47 0.001
Didn’t have (89.8) 359 (81.8) 327
Cervical dilatation at hospitalization (cm)        
< 4 (61.3) 245 (51.8) 207 7.34 0.007
4 (38.8) 155 (48.3) 193
 
Table 2. Comparison of mean hemoglobin before and after delivery between the two groups
Hemoglobin measurement stage Natural delivery
Mean (SD)
N=400
Physiological delivery
Mean (SD)
N=400
T *P
Before childbirth (1.04) 12.78 (1.20) 12.49 3.63 0.001>
6 hours after delivery (1.38) 11.72 (1.34) 11.85 1.35- 0.17
  T=14.45
**P>0.001
T=12.46
**P>0.001
 
 
Table 3. Comparison of hemoglobin 6 hours after delivery in two groups, with control of intervention factors
  Adjusted mean (SD) *Cohen’s d 95% CI F **P
Natural childbirth group (1.20) 11.64 (0.39&0.11) 0.25 11.95 0.001>
Physiological delivery group (1.20) 11.93
 
Table 4. Comparison of mean hematocrit before delivery and 6 hours after delivery between the two groups
Hematocrit measurement stage Natural childbirth group
Mean (SD)
N=400
Physiological delivery group Mean (SD)
N=400
T P *
Before childbirth (2.79) 38.13 (3.30) 37.46 3.10 0.002
6 hours after delivery (3.96) 35.71 (3.65) 36.32 2.27- 0.02
T=11.72
*P>0.001
T=8.68
*P>0.001
* Independent t-test, ** Paired t-test
 
 
Table 5. Comparison of hematocrit 6 hours after delivery in two groups with control of intervention factors
Group Adjusted mean (SD) *Cohen’s d 95% CI F **P
Natural childbirth (3.33) 35.50 (0.45&0.17) 0.31 18.53 0.001>
Physiological delivery (3.33) 36.53
* 0.2-0.4: effect size low, 0.5-0.7: medium, 0.8: strong
** ANCOVA test and control for prenatal hematocrit, gestational age, history of abortion and cervical dilatation at hospitalization
 
Table 6. Comparison of Apgar scores between normal and physiological delivery groups
Apgar scores Natural childbirth group
(400=n)
n (%)
Physiological delivery group Mean
(400=n)
n (%)
P *
Fisher’s exact test
First min 7 (0.2) 1 (0.0) 0 0.01
8 (5.8) 23 (2.3) 9
9 (94.0) 376 (97.7) 391
Fifth min 8 (0.2) 1 (0.0) 0 0.03
9 (5.0) 20 (2.3) 9
10 (94.8) 379 (97.7) 391
 ​​​​​ 


 
Discussion


In the present study, according to the hospital's policies in the prevention of postpartum uterine atony, synthetic oxytocin is used for all mothers, and since the third stage is not physiologically managed in mothers who give birth physiologically, the amount of blood loss expected in the two groups can be similar and this has caused a slight difference in maternal hemoglobin and hematocrit between the two groups.
Also in the present study, the comparison of Apgar scores in minutes 1 and 5 between the two groups showed that the condition of newborns in deliveries performed by physiological methods is better than conventional delivery methods. The results of the present study are consistent with the results of the study of Jahdi et al. as well as Rahimikian et al. The results of these studies showed that Apgar scores 1 and 5 in the physiological delivery group were better than normal delivery [12, 24].
Due to the fact that in physiological childbirth, the least interventions are made on the mother, and on the other hand, due to the reduction of unnecessary interventions, the mother's hormonal system is balanced and the adrenaline level is at the lowest level, resulting in reduced fear and anxiety. The consequences of infancy can and should be expected to be better for mothers who give birth physiologically than for mothers who give birth naturally.


 

Conclusion

The results showed that at 6 hours postpartum, the mean of hemoglobin and hematocrit in the physiological delivery group was significantly higher than conventional vaginal delivery (P<0.001). Comparison of neonatal Apgar scores of the two groups in minute 1 and minute 5 also showed that the amount of Apgar score in physiological delivery group was higher than conventional vaginal delivery (P<0.05).

 

Acknowledgments

The present study is the result of the faculty research project with ethics code IR.UMSHA.REC.1397.39 and design code (970218782), approved by the Vice Chancellor for Research and Technology of Hamadan University of Medical Sciences. We would like to thank the esteemed staff of Fatemieh Hospital and the mothers who participated in the project, as well as the Deputy of Research and Technology of Hamadan Medical Sciences, who helped us in the implementation of the project.

 

Conflicts of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

 

Type of Study: Original Research | Subject: Midwifery
Received: 2020/04/5 | Accepted: 2020/08/27 | Published: 2020/11/23

References
1. Abbaspoor Z, Vaziri L, Emam J. Sensitivity and specificity collector bag for the measurement of post-partum hemorrhage. J Guilan Univ Med Sci. 2012; 21(83):58-64.
2. Osmundson SS, Ou-Yang RJ, Grobman WA. Elective induction compared with expectant management in nulliparous women with a favorable cervix. Obst Gynecol. 2010; 116(3):601-5. [DOI:10.1097/AOG.0b013e3181eb6e9b] [PMID]
3. Miller S, Tudor C, Thorsten V, Quzong K, Dekyi T, Hartwell T, et al. Randomized double masked trial of Zhi Byed 11, a Tibetan traditional medicine, versus misoprostol to prevent postpartum hemorrhage in Lhasa, Tibet. J Midwifery Women Health. 2009; 54(2):133-41. [DOI:10.1016/j.jmwh.2008.09.010] [PMID] [PMCID]
4. Samimi M, Moravveji SA, Heidari-Shirazi F. The effect of tranexamic acid on pregnancy outcome and vaginal post-parturition hemodynamics. Feyz J Kashan Univ Med Sci. 2013; 17(2):114-22.
5. Nama V, Chandraharan E. Massive obstetric haemorrhage. In E. Chandraharan, & S. Arulkumaran editors. Obstetric and Intrapartum Emergencies: A Practical Guide to Management. Cambridge: Cambridge University Press; 2012.
6. Shakur H, Elbourne D, Gülmezoglu M, Alfirevic Z, Ronsmans C, Allen E, et al. The WOMAN Trial (World Maternal Antifibrinolytic Trial): tranexamic acid for the treatment of postpartum haemorrhage: an international randomised, double blind placebo controlled trial. Trials. 2010; 11(1):40. [DOI:10.1186/1745-6215-11-40] [PMID] [PMCID]
7. Nasohi J, Falakaflaki B. The Magnitude of Hemoglobin-Drop in Obstetrics and Gynecologic Operations (Is Routine Hb Check Necessary?). Sci J Hamadan Univ Med Sci. 2004; 10(4):43-6.
8. Samimi M, Abedzadeh Kalahroudi M, Imani A. Comparison of the Effect of Rectal Misoprostol and IM Syntometrin in the Prevention of Post Partum Hemorrhage. Sci J Hamadan Univ Med Sci. 2011; 18(2):38-44.
9. Shirazi M. The mangement of post partum haemorrhage. Iran J Obs Gynecol Infert. 2010; 5(3):14-29.
10. Cunningham FG, Bloom SL, Hauth JC, Rouse DJ, Spong CY, et al. Conduct of normal labor and delivery. New York: McGraw-Hill; 2010.
11. Gibbs RS, Karlyn BY, Haney AF, Nygaard I. Danforth's obstetrics and gynecology. Philadelphia: Wolters Kluwer Health Adis (ESP); 2012.
12. Rahimikian F, Talebi F, Golian Tehrani S, Mehran A. Comparison of the effect of physiological birth and routine normal delivery on some of maternal and fetus outcomes. J Ardabil Univ Med Sci. 2013; 13(4):398-405.
13. Sagiry M, Tabrizy N, Pezeshky Z. Comparison severity pain with use entonox and outcome neonatal in primary gravity. J Ardabil Univ Med Sci. 2008; 1(8):62-7.
14. Ghalandari S, Kariman N, Sheikhan Z, Shahrahmani H, Asadi N. Systematic review on variety of effective treatment methods for postpartum hemorrhage in Iran and world. Iran J Obst Gynec Infert. 2016; 19(15):16-38.
15. Jafari E, Mohebbi P, Rastegari L, Mazloomzadeh S. The comparison of physiologic and routine method of delivery in mother's satisfaction level in Ayatollah Mosavai Hospital, Zanjan, Iran, 2012. Iran J Obst Gynec Infert. 2013; 16(73):9-18.
16. Zibad HA, Moghadam KB, Moghadam MB, Binabaj NB, Rafat E. The Correlation between Type of Delivery and Umbilical Cord Blood Hemoglobin and Hematocrit in Full-Term Neonates. J Isfahan Med School. 2012; 29(163):1298-305.
17. Supporting Healthy and Normal Physiologic Childbirth: A Consensus Statement by ACNM, MANA, and NACPM. J Perinat Educ. 2013; 22(1):14-8. [DOI:10.1891/1058-1243.22.1.14] [PMID] [PMCID]
18. Kazemi S, Ghojazadeh M. Relationship between length of delivery stages and mode of delivery for nulliparus women in labor in two groups of physiological and tradithional delivery. Iran J Obst Gync infert. 2014; 17(117):17-25.
19. Biguzzi E, Franchi F, Ambrogi F, Ibrahim B, Bucciarelli P, Acaia B, et al. Risk factors for postpartum hemorrhage in a cohort of 6011 Italian women. Thromb Res. 2012; 129(4):e1-e7. [DOI:10.1016/j.thromres.2011.09.010] [PMID]
20. Buzaglo N, Harlev A, Sergienko R, Sheiner E. Risk factors for early postpartum hemorrhage (PPH) in the first vaginal delivery, and obstetrical outcomes in subsequent pregnancy. J Matern-Fet Neonat Med. 2015; 28(8):932-7. [DOI:10.3109/14767058.2014.937698] [PMID]
21. Sheiner E, Sarid L, Levy A, Seidman DS, Hallak M. Obstetric risk factors and outcome of pregnancies complicated with early postpartum hemorrhage: a population-based study. J Matern-Fet Neonat Med. 2005; 18(3):149-54. [DOI:10.1080/14767050500170088] [PMID]
22. Van Gemund N, Hardeman A, Scherjon S, Kanhai H. Intervention rates after elective induction of labor compared to labor with a spontaneous onset. Gynecol Obs Invest. 2003; 56(3):133-8. [DOI:10.1159/000073771] [PMID]
23. Dolatian M, Shademani N, Sharafi SA, Valaei N. Efficacy of Syntometrine, Syntocinon and the Physiologic Approach in the Management of the Third Stage of Labor. Pejouhesh dar Pezeshki (Res Med). 2003; 27(3):191-6.
24. Jahdi F, Shanazari Avag M, Kashanian M, Ashgehi Farahani M, Hagani H. The effect of physiological birth in outcomes of delivery [dissertation]. Tehran university. 2009.
25. Cheng YW, Delaney SS, Hopkins LM, Caughey AB. The association between the length of first stage of labor, mode of delivery, and perinatal outcomes in women undergoing induction of labor. America J Obst Gynec. 2009; 201(5):477. [DOI:10.1016/j.ajog.2009.05.024] [PMID]
26. Moghimi-Hanjani S , Mehdizadeh-Tourzani Z , Shoghi M.The Effect of Foot Reflexology on Anxiety, Pain, and Outcomes of the Labor in Primigravida Women. Acta Med Iran. 2015; 53(8):507-11.
27. Weinberger B, Anwar M, Hegyi T, Hiatt M, Koons A, Paneth N. Antecedents and neonatal consequences of low Apgar scores in preterm newborns: a population study. Arch Pediat Adol Med. 2000; 154(3):294-300. [DOI:10.1001/archpedi.154.3.294] [PMID]

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