Early amniotomy after cervical ripening for induction of labor: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE DATA: Timing of artificial rupture of membranes (ie, amniotomy) in induction of labor is controversial, because it has been associated not only with shorter labors, but also with fetal nonreassuring testing, at times necessitating cesarean delivery. The aim of this systematic review and metaanalysis of randomized trials was to evaluate the effectiveness of early amniotomy vs late amniotomy or spontaneous rupture of membranes after cervical ripening. STUDY: The search was conducted with the use of electronic databases from inception of each database through February 2019. Review of articles included the abstracts of all references that were retrieved from the search. STUDY APPRAISAL AND SYNTHESIS METHODS: Selection criteria included randomized clinical trials that compared early amniotomy vs control (ie, late amniotomy or spontaneous rupture of membranes) after cervical ripening with either Foley catheter or prostaglandins at any dose. The primary outcome was the incidence of cesarean delivery. The summary measures were reported as summary relative risk with 95% of confidence interval with the use of the random effects model of DerSimonian and Laird. RESULTS: Four trials that included 1273 women who underwent cervical ripening with either Foley catheter or prostaglandins and then were assigned randomly to either early amniotomy, late amniotomy, or spontaneous rupture of membranes (control subjects) were included in the review. Women who were assigned randomly to early amniotomy had a similar risk of cesarean delivery (31.1% vs 30.9%; relative risk, 1.05; 95% confidence interval, 0.71-1.56) compared with control subjects and had a shorter interval from induction to delivery of approximately 5 hours (mean difference, -4.95 hours; 95% confidence interval, -8.12 to -1.78). Spontaneous vaginal delivery was also reduced in the early amniotomy group, but only 1 of the included trials reported this outcome (67.5% vs 69.1%; relative risk, 0.78; 95% confidence interval, 0.66-0.93). No between-group differences were reported in the other obstetrics or perinatal outcomes. CONCLUSION: After cervical ripening, routine early amniotomy does not increase the risk of cesarean delivery and reduces the interval from induction to delivery

“They turn to you first for everything”: insights into midwives’ perspectives of providing physical activity advice and guidance to pregnant women.

Background: The antenatal period is associated with a decline in physical activity among women. Midwives are viewed central to the dissemination of information during pregnancy, however, there is little research relating to their promotion of physical activity. The purpose of this study was to gain insight into midwives’ perspectives of providing physical activity advice and guidance to pregnant women. Methods: Community midwives (N = 10) from ten randomly selected antenatal clinics in England took part in semi-structured interviews which were audio recorded, transcribed and analysed thematically. Results: In relation to perceived role and responsibilities in providing physical activity advice and guidance, midwives emphasised the extent to which their profession has evolved, the perceived burden of responsibility, and the tick box approach to physical activity discussion. Midwives identified a lack of training, knowledge, confidence, time, resources, and perceptions of vulnerability as barriers to effective physical activity promotion. Despite these issues midwives proposed eight opportunities to facilitate pregnant women’s physical activity engagement: (1) recognising and addressing barriers in the uptake and maintenance of physical activities, (2) professional development, (3) inter-professional collaboration, (4) communicating effectively through simple, reliable resources, (5) improved access, availability, and awareness of suitable activities in the local community, (6) encouraging a support network, (7) “selling” physical activity by challenging misconceptions and focusing on benefits, and (8) suitable motivation, incentives and reward. Conclusions: These opportunities identified by midwives provide foundations from which improvements in practice can result. Whilst midwives are ideally placed to promote physical activity as part of a healthy pregnancy, this is likely to be most effective as part of a wider network of practitioners that share consistent and confident messages regarding physical activity engagement. This notion has far reaching implications for practice, policy, research and the normalisation of active pregnancies in the wider population

New teaching resource for promoting physical activity in pregnancy

Christ Church academics have been working on updating physical activity teaching resources, launched today by the Council of Deans of Health and Exercise Works!, to enable healthcare professionals to provide consistent messaging on physical activity during pregnancy. The resource forms part of a series of teaching guides for the #MovementforMovement campaign, which supports teaching on undergraduate health and medicine programmes across the UK, and aims to help healthcare graduates effectively promote physical activity for the prevention, treatment and management of disease, and in the promotion of good health. Dr Marlize De Vivo and Dr Hayley Mills, from the School of Human and Life Sciences, were commissioned to update the teaching resources relating to physical activity during pregnancy. This follows the release of the Department of Health’s new guidelines for physical activity during pregnancy earlier this year. Drs De Vivo and Mills stated that: “Pregnancy is considered by many healthcare policymakers as a unique opportunity to promote healthy lifestyle behaviours. However, messaging relating to various health behaviours during pregnancy has often been ambiguous and at times contradictory. Historically, there has been a tendency to view physical activity as a potential risk during pregnancy, and on that basis even active women have reduced their engagement with physical activities. However, data increasingly suggests health and wellbeing benefits for both mother and baby. The new Department of Health guidelines bring those for physical activity during pregnancy in line with those for the general population that is, accumulating 150 minutes of moderate intensity of activity per week. Some pregnancy considerations and adaptations are noted in the guidelines, however, they support the maintenance of physical activity among previously active women whilst encouraging those not previously engaged to start gradually. The updated “Movement for Movement” resources enable these same consistent messages to be taught directly to students in the healthcare professions. Teaching and disseminating the updated guidance allows for a confident delivery of consistent evidence-based physical activity messages to expectant mums. This in turn, paves the way in normalising physical activity during pregnancy in the wider society.” Drs De Vivo and Mills will be presenting further work focusing on the psychology of physical activity and Pregnancy behaviour at the British Association of Sport and Exercise Sciences – European Federation for Sport Psychology (BASES-FEPSAC) conference on November 28th 2017. /Ends • The #MovementForMovement aims to build capacity in delivering physical activity interventions by all future health care workers through working as a community of practice both professionally and educationally. The resources are available for free to all universities with health programmes. • The #MovementForMovement resources are available to all undergraduate schools of medicine and health that train health care students (such as doctors, nurses, midwives, dentists, pharmacists and allied health professionals as defined by the NHS). • Exercise Works! promotes the use of physical activity in preventing and treating disease. For further details, http://www.exercise-works.org/ • The Council of Deans of Health is the voice of the deans and heads of UK university faculties for nursing, midwifery and the allied health professions. For further information about the work of the Council of Deans of Health please see councilofdeans.org.uk. Canterbury Christ Church University Canterbury Christ Church University is a modern university with a particular strength in higher education for the public services. With 17,000 students across Kent and Medway, its courses span a wide range of academic and professional subject areas. • Over 94% of our UK undergraduates were in employment or further studies six months after completing their studies*. • We are one of the South East’s largest providers of education, training and skills leading to public service careers. *2015/16 Destinations of Leavers from Higher Education survey Media contact Jeanette Earl Media Relations Manager Canterbury Christ Church University 01227 78239

“Already tired – do I need to be more tired?!” Eliciting the modal salient exercise beliefs of pregnant women in East Kent (United Kingdom).

Objective: The theory of planned behaviour (TPB) posits that the cognitive foundation for behaviour is rooted in three subjective probabilities: (1) behavioural, (2) normative, and (3) control beliefs. The purpose of this study was therefore to conduct an elicitation study to determine the modal salient exercise beliefs held by pregnant women in East Kent. Design: Consistent with TPB guidelines, participants (n = 18) were asked to describe their beliefs using open-ended questions. Method: A modal set of beliefs were compiled following content analyses. Specifically, beliefs were selected based on their frequency of emission until 75% of all responses listed were accounted for. Results: The main advantages of exercise during pregnancy were keeping fit and being healthy whilst fatigue was the main disadvantage. Expectant mothers believed that health professionals in particular would approve of them exercising during their pregnancy. The primary normative referents identified were those who already enjoy an active lifestyle whilst those with health issues were least likely to be physically active. Accessibility of suitable exercise opportunities and having time available were two of the main factors that would make it easy or enable women to exercise during their pregnancy. Conversely, health issues, not having enough time and fatigue were identified as factors that would hinder participation. Conclusion: Elicitation studies provide valuable information regarding people’s beliefs about a particular behaviour. Such insight has important implications for behavioural interventions as it allows researchers and practitioners to tailor interventions to meet the specific needs of the population under investigation

Random Matrix approach to collective behavior and bulk universality in protein dynamics

Covariance matrices of amino acid displacements, commonly used to characterize the large-scale movements of proteins, are investigated through the prism of Random Matrix Theory. Bulk universality is detected in the local spacing statistics of noise-dressed eigenmodes, which is well described by a Brody distribution with parameter $\beta\simeq 0.8$. This finding, supported by other consistent indicators, implies a novel quantitative criterion to single out the collective degrees of freedom of the protein from the majority of high-energy, localized vibrations.Comment: 4 pages, 7 figure

Kardar-Parisi-Zhang asymptotics for the two-dimensional noisy Kuramoto-Sivashinsky equation

We study numerically the Kuramoto-Sivashinsky (KS) equation forced by external white noise in two space dimensions, that is a generic model for e.g. surface kinetic roughening in the presence of morphological instabilities. Large scale simulations using a pseudospectral numerical scheme allow us to retrieve Kardar-Parisi-Zhang (KPZ) scaling as the asymptotic state of the system, as in the 1D case. However, this is only the case for sufficiently large values of the coupling and/or system size, so that previous conclusions on non-KPZ asymptotics are demonstrated as finite size effects. Crossover effects are comparatively stronger for the 2D case than for the 1D system.Comment: 5 pages, 3 figures; supplemental material available at journal web page and/or on reques

Examining the effectiveness of the theory of planned behaviour in explaining exercise intention and behaviour during pregnancy: a meta-analysis

Background: Several studies have supported the efficacy and predictive utility of the Theory of Planned Behaviour (TPB; Ajzen 1991) in explaining a variety of behaviours including physical activity. However, the relative contribution of the theory’s components in describing intention and behaviour may differ depending on the context, time and population being studied. Such evidence is necessary to inform exercise advice and interventions aimed at pregnant women. Purpose: The purpose of this study was therefore to review the existing literature surrounding the application of the TPB in explaining exercise intentions and behaviour during pregnancy and to evaluate the magnitude of relationships between TPB constructs within this context. Method: Multiple search strategies yielded 99 potentially relevant studies of which 47 were assessed against the inclusion criteria. Finally, 7 studies, involving 777 pregnant women, were included in the analysis. Relationships identified among TPB constructs were subjected to a random-effects meta-analytic review using the Comprehensive Meta-Analysis (version 3.0) computer software package. Results: Results confirmed the existence of a medium to strong relationship between intention and behaviour (r = 0.44, P < 0.05, R2 = 19.36) and also supported the existence of a direct relationship between behaviour and perceived behavioural control (PBC; r = 0.45, P < 0.05, R2 = 20.25). Pregnant women’s attitude (r = 0.48, P < 0.05, R2 = 23.04) had the strongest association with their intention to be physically active. However, both PBC (r = 0.47, P < 0.05, R2 = 22.09) and subjective norm (r = 0.42, P < 0.05, R2 = 17.64) revealed similar relationships with intention. Conclusion: The study supports the TPB as a relevant conceptual framework for the investigation of exercise intentions and behaviours during pregnancy. PBC carried slightly more weight in explaining behaviour than did intention thereby suggesting that exercise during pregnancy is not a behaviour that is under women’s complete volitional control. Intention to exercise was influenced primarily by expectant mothers’ beliefs about the positive and negative consequences of doing so. Contrary to previous meta-analytic reports in the exercise domain, this study supported the relevance of subjective norm as a construct to investigate exercise intentions and behaviour in a pregnant population. The perceived social pressure to conform to other people’s opinion about physical activity during pregnancy may well be an important consideration for pregnant women. These findings present both researchers and practitioners with an opportunity for intervention and further research