Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Gynecology and Obstetrics

Objective: The primary purpose of this study is to compare the effects of two different methods of care during the second stage of labor for nulliparous women (coached versus uncoached pushing) on the length of the second stage and how this may affect maternal and neonatal outcome. Background: Valsalva pushing efforts sustained for longer than 5 to 6 seconds lead to alterations in maternal and fetal hemodynamics, such as a lowering of maternal blood pressure and blood flow to the placenta, and lower apgar scores. The fetal response to valsalva bearing-down efforts has also been studied scientifically. In spontaneous pushing, there is synchrony between the woman{u2019}s respiratory and uterine function that may allow spontaneous bearing-down efforts to take advantage of the force generated by abdominal muscle action. Women who use spontaneous bearing down have been observed to wait for the contraction to build to a uterine pressure of at least 30 mm Hg before they begin pushing. Study designe: This is a prospective randomized controlled trial. Setting: The study was conducted at Kasr Elainy teaching maternity hospital for labor. Sample size: 200 Nulliparous, full term, cephalic, singleton births. Main outcome measure: Duration of the second Stage

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