Background: Prolonged pregnancy influences different aspects of maternal and neonatal health. Although it is accepted that drug intervention is necessary before Labor in Prolonged pregnancy but there is debate about the termination time of the pregnancy. Considering the importance and prevalence of this entity we studied the Labor indices in the hospitalized women with Prolonged pregnancy in Kashan, in 1382-1383.Material and Methods: This descriptive study carried out on 450 women with gestational age of more than 40 weeks (based on their LMP or sonography before30 weeks) admitted for termination of pregnancy by induction. They had no medical or obstetrical problem. Labor indices including dilatation and effacement at the time of admission, number of inductions, duration of hospitalization, dystocia and type of delivery, as well as mother's age, history of Prolonged pregnancy, and number of parturitions were recorded and then on the base of gestational age categorized in 4 following groups: 40w to 41w and 3days, 40w and 4 days to 41w, 41w and 1 days to 41 w and 3 days and 41w, 4 days or more.Results: Data showed that 131 women(%29.1) have terminated in 40 to 40w and 3 days of gestation and 130 women (%28.9) in 40w and 4days to 41w, 150 women (%33.3) in 41w and 1 days to 41w and 3 days and only 39 women(%8.7) after 41w and 3 day; 12(2.7%) of which were more than 42 weeks. There wasn't significant difference between women in dilatation and effacement on admission, dystocia and type of delivery; but there was significant difference in the number of induction and duration of hospitalization.Termination of pregnancy in lower gestational age causes increased number of inductions and duration of hospitalization. The most frequent reason for cesarean section was lack of response to drug interventions and induction in lower gestational age.Conclusion: We recommend no intervention for termination of delayed pregnancy up to 41.5 weeks in women with out problem.

Unfavorable cervix is a major problem in termination of Prolonged pregnancies. It is one cauese of increased cesarean section rate in these pregnancies. Prosta glandines are used for cevical ripening. In this randomized controlled trial, two groups with post term pregnancy and unfavorable cervix each included 50 patients underwent induction of Labor with oxytocin. In the case group, prostaglandin suppository was used intravaginally 8 hours before induction. In this group Bishop score increased (0.75±0.69 vs 2.39±0.84) (P<0.005) and the time from beginning of induction to delivery was shorter than control group 574.8±280.1 vs 843.04±412.8min) (P<0.005). C/S rate was the same in two groups. The only side effect of PGE2 was nausea. It can be concluded that PGE2 vaginal suppoditory is useful for ripening of cervix and decreasing the duration of induction without serious side effects.

Background and aim: The early diagnosis of abnormal progress of labour and prevention of long term delivery are the main keys to reduce fetal mortality rate due to hypoxia and tissue ischemia. One of the WHO’s proposed methods for prevention of abnormal delivery is using partogram. Therefore, this survey was conducted to evaluate WHO's partogram alert line for APGAR score at the first minute after birth.Methods: This descriptive–analytical study was performed on 140 pregnant women under partogram in Shahrood Fatemieh hospital. Using the partogram alert line, the progress of labour, mother's and infant's condition started to be controled from 3 cm dilation of the cervix. Decision for resuscitation was made based on respiration, heart rate and skin color of the infant 20 to 30 seconds after the birth. Tools of this research were a questionnaire, inspection form consisted of WHO's partogram and step by step resuscitation form. χ2, t–test and analytical methods of sensitivity, specificity and negative and positive values were used for data analysis.Results: The results showed that 68.8% of the subject's cervical dilatation remained on or to the left side of the alert line and 28.6% was on the right side and 2.9% was on or to the right side of the active line.According to χ2 test, there was a significant relationship between the first minute APGAR score after delivery and the location of cervical dilation. The value of alert line for surveying of APGAR score at the first minute after birth had a sensitivity of 25%, specificity of 96.87%, negative and positive predictive value of 75.6% and 76.92%, respectively.Conclusion: Our results showed that using WHO's partogram prevents long term delivery, helps for on time diagnosis of fetal distress and reduction in stillbirth and fetal mortality. So, partogram should be a part and parcel of fetal and maternal health care.

Introduction: Since duration of Labor is an effective factor on outcome of pregnancy, the study was conducted to evaluate the effect of oral propranolol and oxytocin with oxytocin alone on duration of Labor and type of delivery in nulliparous women with Prolonged pregnancy.Methods: A double blind randomized controlled trial was performed on 146 nulliparous women with gestational age 40-42 weeks, cephalic presentation, bishop score³5, normal body mass index, intact of membrane, estimated fetal weight£4kg who referred to Khomeyni hospital of Ilam in 2009.Participants were classified into two groups, case group (propranolol and oxytocin) and control group (oxytocin alone). Before induction, the case group received 20 mg propranolol and control group received placebo with similar capsules orally TDS. Then induction was started initially with 2 mIU/min oxytocin in both groups and increased until obtain well contractions (3 contractions per 10 min) or 30 mIU/min. Data analyzes using SPSS software version 16, t-test and x2 test. p<0.05 was considered significant.Results: All participants were matched for factors affecting duration of Labor. Mean±SD duration of active phase and second stages of Labor in first and second days after induction was significantly shorter in case group than control group. Cesarean rate had significantly decreased in the control group but no significant difference of third stage and Apgar was found between both groups (p=0.987).Conclusion: Propranolol decreases the Labor duration and the number of cesarean delivery.

Introduction: Poor progress of Labor is the most common leading cause of cesarean section. Oral intake during Labor is one of the strategies to prevent dystocia among low-risk nulliparous women. To date, little is known about the influence of oral intake on Labor progress and the most appropriate foodstuff during Labor. The purpose of this study was to determine the effect of oral honey date syrup during on Labor progress in nulliparous women.Methods: In a double-blind randomized clinical trial, 90 low-risk nulliparous women aged 18-35, between 37-42 week gestation, singleton fetus, vertex presentation and spontaneous beginning of uterine contractions were enrolled at Sajad hospital in Shahriyar Tehran in 2007 .They were randomized to the intervention, placebo or usual care groups. At Labor, after a cervical dilatation of 4 cm to delivery, women in the intervention and placebo groups received honey-date syrup and placebo; respectively. The women in the usual care group were restricted to small quantities of water as desired. Labor progress was compared among the groups using ANOVA, Kruskal Wallis and Chi-Square tests.Results: Normal Labor progression rate was higher among honey-date group than two other groups (96.7% vs. 66.7% in placebo and 60.0% in usual care group p<0.002). Labor duration was also shorter in the group taking honey date syrup than two other groups (351.0 minutes vs. 484.2 in placebo and 475.7 in usual care groups, p<0.001).Conclusion: In our study oral honey-date syrup induced high rate of normal Labor progress. It may be used during Labor to prevent Prolonged Labors but more research is warranted to clarify these associations.

2Background: The success of Labor induction depends on the condition of the cervix at the time of delivery. This study examines the effect of Labor induction with an intra-cervical Foley catheter and oxytocin compared to a Foley catheter and misoprostol on cervical preparation and delivery rate in the first 24 hours after induction. Methods: In a randomized clinical study, pregnant women with a singleton pregnancy and a gestational age of more than 40 weeks, with a Bishop score less than 4 and an intact amniotic sac referred to Umm al-Binin Hospital in Mashhad from 2017 to 2018 were included in the study. They were randomly divided into two groups of Foley catheter and oxytocin (1) or Foley catheter and misoprostol (2). In the first group, immediately after placing the Foley catheter; Oxytocin was started with a dose of 2 milliunits per minute, and every 20 minutes, 2 milliunits were added to reach the maximum dose of 30 milliunits per minute (induction method with a low dose). In the second group, after Foley catheter insertion, sublingual misoprostol was prescribed at a dose of 25 micrograms every 4 hours up to a maximum of 6 doses. Results: 74 pregnant women were randomly evaluated in two groups of 37 people. There is no statistically significant difference in the demographic variables in the two groups. There was a significant difference in the Labor rate in the first 24 hours, and it was higher in the oxytocin group (P=0.009). Bishop's score after 24 hours of induction was not significantly different in the two groups. Reaching the active phase was significantly shorter in the oxytocin group. (P=0.01). The time of catheter removal in both groups and the rate of cesarean section and the occurrence of complications were the same in both groups. Conclusion: The use of oxytocin with a Foley catheter inside the cervix can accelerate the preparation of the cervix and increase the chance of Labor in the first 24 hours, but it does not affect Labor complications.

Objective (s): Pre-term and post-term Labor were among the major problems in the health system during the covid-19 pandemic in developing countries. In the epidemic of infectious diseases, including the Covid-19 pandemic, pregnant women and their fetuses are among the high-risk population. This study was conducted to investigate and compare the prevalence and factors affecting pre-term and post-term Labors in the 6 months before and after the (beginning) of the covid-19 pandemic. Methods: This comparative study was conducted on 36914 pregnant mothers in the 6 months before the covid-19 pandemic and 6039 pregnant mothers in the 6 months after the covid-19 pandemic. The information was obtained from the integrated system of the Ministry of Health. The data were analyzed using SPSS 22 software. Results: The prevalence of pre-term and post-term Labor in the 6 months before the covid-19 pandemic was 8.5% and 0.7%, respectively, and in the 6 months after the covid-19 pandemic began for the first time, it was 5.6% and 1.4%, respectively. In the 6 months before and after the (beginning) of the covid-19 pandemic, age, parity, gravidity, high body mass index, abortion and pregnancy interval were found to be factors affecting preterm Labor (P<0.05). Parity, level of education in both periods were related to post-term Labor (P<0.05). Based on the multiple regression, by controlling for possible confounders of preterm and post-term Labor in the covid-19 pandemic, the prevalence of pre-term Labor was decreased [OR=1.665, 95% CI: 1.395-1.988], while the prevalence of post-term Labor was increased [OR=0.373, 95% CI: 0.267–0.52]. Conclusion: The findings showed that the COVID-19 pandemic had an effect on pre-term and post-term Labor over a short period of 6 months compared to the previous period, reducing pre-term Labor and increasing post-term Labor.

Introduction: Childbirth is one of the most unique moments of women's life, however, if it's natural process is Prolonged, then leads to intolerable phenomenon in mother, so that it is associated with undesirable maternal and fetal complications. Therefore, this study was performed with aim to evaluate the effect of abdominal massage along with breathing techniques on duration of uterine contractions in primiparous women.Methods: This randomized control trial was performed on 64 pregnant primiparous women referred to Tehran Lolagar hospital in 2010. The subjects were divided into experiment and control groups through systematic random assignment. In experimental group (n=32), effleurage abdominal massage with breathing techniques was performed during 30 minutes of early active and transferal phase, and control group (n=32) received routine care. Features of uterine contractions and duration of childbirth stages were examined in both groups. Data was analyzed by SPSS software (version 17), and using Chi-square, Fisher, and independent t tests. P£0.05 was considered significant.Results: Based on the results, mean duration of first stage of childbirth after the intervention (70±254.74 vs. 311±63.05 min) was significantly less in experimental group than control group (P=0.002). Duration of second (p=0.952) and third (p=0.672) stages of childbirth was not significantly different between two groups. Mean number of uterine contractions was significantly higher in experimental group (P<0.001). No statistically significant difference was found between two groups in terms of the rate of C/S, placental abruption, uterine hypertonic, episiotomy, postpartum hemorrhage and low Apgar score (p>0.05).Conclusion: Abdominal massage along with breathing technics increases the number of uterine contractions in Labor while has no adverse effect on the delivery outcomes. Therefore, it is recommended this non-drug approach be used instead of drug-based methods which strengthen uterine contractions such as oxytocin.