Download PDF
Z Geburtshilfe Neonatol 2021; 225(03): 251-256
DOI: 10.1055/a-1370-0620
Original Article

The Effects of Water Immersion during First Stage of Labor on Postpartum Systemic Inflammatory Response

Ayçağ Yorgancı 
1   Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Cankaya, Turkey
,
Gul Nihal Buyuk 
1   Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Cankaya, Turkey
,
Mesut Akyol
2   Department of Biostatistics and Medical Informatics, Ankara Yildirim Beyazit University, Ankara, Turkey
,
Özlem Gündüz
1   Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Cankaya, Turkey
,
Banu Seven
1   Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Cankaya, Turkey
,
Yaprak Engin-Ustun
3   Obstetrics and Gynecology, University of Health Sciences, Etlik Zübeyde Hanım Women's Health Education and Research Hospital, Ankara, Turkey
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective The systemic inflammatory response is a cascade of physiologic reactions that arise in response to trauma, infection, burn, or any kind of injury. This study aimed to determine the effects of water immersion during the first stage of labor on the systemic inflammatory indices in the postpartum period.

Materials and methods In this retrospective study, 125 healthy multiparous women with uncomplicated pregnancies between 37 and 41 weeks of gestation who elected for immersion in water during the first stage of labor were compared with multiparous uncomplicated term women who had conventional vaginal births on land (n=125). Age, parity, body mass index (BMI), gestational age, duration of labor, birth weight, Apgar scores, neonatal intensive care unit admissions, and ante- and postpartum whole blood parameters were noted. Antepartum and postpartum neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) were calculated for all patients as systemic inflammatory indices.

Results Demographic characteristics and birth outcomes of both groups were similar except BMI, which was statistically significantly higher in the water immersion group. There were no statistical differences in antepartum NLR, MLR, PLR, and MPV between the 2 groups. However, postpartum NLR, MLR, PLR, and MPV were statistically significantly lower in the water immersion group compared to the controls.

Conclusion Water immersion during the first stage of labor might decrease systemic inflammatory indices in the early postpartum period.

Key words

water immersion - labor - systemic inflammatory response - neutrophil-to-lymphocyte ratio - platelet-to-lymphocyte ratio


Publication History

Received: 26 October 2020

Accepted after revision: 13 January 2021

Article published online:
10 March 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Eberhard J, Stein S, Geissbuehler V. Experience of pain and analgesia with water and land births. J Psychosom Obstet Gynaecol 2005; 26: 127-133
    CrossrefPubMedSearch in Google Scholar
  • 2 Benfield RD, Hortobagyi T, Tanner CJ. et al. The effects of hydrotherapy on anxiety, pain, neuroendocrine responses, and contraction dynamics during labor. Biol Res Nurs 2010; 12: 28-36
    CrossrefPubMedSearch in Google Scholar
  • 3 Otigbah CM, Dhanjal MK, Harmsworth G. et al. A retrospective comparison of water births and conventional vaginal deliveries. Eur J Obstet Gynecol Reprod Biol 2000; 91: 15-20
    CrossrefPubMedSearch in Google Scholar
  • 4 Ulfsdottir H, Saltvedt S, Georgsson S. Waterbirth in Sweden – a comparative study. Acta Obstet Gynecol Scand 2018; 97: 341-348
    CrossrefPubMedSearch in Google Scholar
  • 5 Edlich RF, Towler MA, Goitz RJ. et al. Bioengineering principles of hydrotherapy. J Burn Care Rehabil 1987; 8: 580-584
    CrossrefPubMedSearch in Google Scholar
  • 6 Katz VL, Ryder RM, Cefalo RC. et al. A comparison of bed rest and immersion for treating the edema of pregnancy. Obstet Gynecol 1990; 75: 147-151
    PubMedSearch in Google Scholar
  • 7 Cluett ER, Pickering RM, Getliffe K. et al. Randomised controlled trial of labouring in water compared with standard of augmentation for management of dystocia in first stage of labour. BMJ 2004; 328: 314
    CrossrefPubMedSearch in Google Scholar
  • 8 Maude RM, Foureur MJ. It’s beyond water: stories of women’s experience of using water for labour and birth. Women Birth 2007; 20: 17-24
    CrossrefPubMedSearch in Google Scholar
  • 9 Cluett ER, Burns E, Cuthbert A. Immersion in water during labour and birth. Cochrane Database Syst Rev 2018; 5: CD000111
    CrossrefPubMedSearch in Google Scholar
  • 10 Committee Opinion No. 679: Immersion in Water During Labor and Delivery. Obstet Gynecol 2016; 128: e231-e236
    CrossrefPubMedSearch in Google Scholar
  • 11 Ayala A, Chung CS, Grutkoski PS. et al. Mechanisms of immune resolution. Crit Care Med 2003; 31: S558-S571
    CrossrefPubMedSearch in Google Scholar
  • 12 Dupre A, Malik HZ. Inflammation and cancer: What a surgical oncologist should know. Eur J Surg Oncol 2018; 44: 566-570
    CrossrefPubMedSearch in Google Scholar
  • 13 Bistrian B. Systemic response to inflammation. Nutr Rev 2007; 65: S170-S172
    CrossrefPubMedSearch in Google Scholar
  • 14 Gasparyan AY, Ayvazyan L, Mukanova U. et al. The platelet-to-lymphocyte ratio as an inflammatory marker in rheumatic diseases. Ann Lab Med 2019; 39: 345-357
    CrossrefPubMedSearch in Google Scholar
  • 15 Hwang SY, Shin TG, Jo IJ. et al. Neutrophil-to-lymphocyte ratio as a prognostic marker in critically-ill septic patients. Am J Emerg Med 2017; 35: 234-239
    CrossrefPubMedSearch in Google Scholar
  • 16 Djordjevic D, Rondovic G, Surbatovic M. et al. Neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume-to-platelet count ratio as biomarkers in critically ill and injured patients: which ratio to choose to predict outcome and nature of bacteremia?. Mediators Inflamm 2018; 2018: 3758068
    CrossrefPubMedSearch in Google Scholar
  • 17 Afari ME, Bhat T. Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: an update. Expert Rev Cardiovasc Ther 2016; 14: 573-577
    CrossrefPubMedSearch in Google Scholar
  • 18 Wang Q, Ma J, Jiang Z. et al. Prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in acute pulmonary embolism: a systematic review and meta-analysis. Int Angiol 2018; 37: 4-11
    CrossrefPubMedSearch in Google Scholar
  • 19 Gao XP, Liu YH, Liu ZY. et al. Pretreatment lymphocyte-to-monocyte ratio as a predictor of survival among patients with ovarian cancer: a meta-analysis. Cancer Manag Res 2019; 11: 1907-1920
    CrossrefPubMedSearch in Google Scholar
  • 20 Tan D, Fu Y, Tong W. et al. Prognostic significance of lymphocyte to monocyte ratio in colorectal cancer: A meta-analysis. Int J Surg 2018; 55: 128-138
    CrossrefPubMedSearch in Google Scholar
  • 21 Hu RJ, Liu Q, Ma JY. et al. Preoperative lymphocyte-to-monocyte ratio predicts breast cancer outcome: A meta-analysis. Clin Chim Acta 2018; 484: 1-6
    CrossrefPubMedSearch in Google Scholar
  • 22 Bacigalupo G, Riese S, Rosendahl H. et al. Quantitative relationships between pain intensities during labor and beta-endorphin and cortisol concentrations in plasma. Decline of the hormone concentrations in the early postpartum period. J Perinat Med 1990; 18: 289-296
    PubMedSearch in Google Scholar
  • 23 Alehagen S, Wijma B, Lundberg U. et al. Fear, pain and stress hormones during childbirth. J Psychosom Obstet Gynaecol 2005; 26: 153-165
    CrossrefPubMedSearch in Google Scholar
  • 24 Dhabhar FS, Malarkey WB, Neri E. et al. Stress-induced redistribution of immune cells – from barracks to boulevards to battlefields: a tale of three hormones – Curt Richter Award winner. Psychoneuroendocrinology 2012; 37: 1345-1368
    CrossrefPubMedSearch in Google Scholar
  • 25 O’Connor TM, O’Halloran DJ, Shanahan F. The stress response and the hypothalamic-pituitary-adrenal axis: from molecule to melancholia. QJM 2000; 93: 323-333
    CrossrefPubMedSearch in Google Scholar
  • 26 Swan MP, Hickman DL. Evaluation of the neutrophil-lymphocyte ratio as a measure of distress in rats. Lab Anim (NY) 2014; 43: 276-282
    CrossrefPubMedSearch in Google Scholar
  • 27 Hickman DL. Evaluation of the neutrophil:lymphocyte ratio as an indicator of chronic distress in the laboratory mouse. Lab Anim (NY) 2017; 46: 303-307
    CrossrefPubMedSearch in Google Scholar
  • 28 Du J, Chen S, Shi J. et al. The association between the lymphocyte-monocyte ratio and disease activity in rheumatoid arthritis. Clin Rheumatol 2017; 36: 2689-2695
    CrossrefPubMedSearch in Google Scholar
  • 29 Wang Q, Ma J, Jiang Z. et al. Association of lymphocyte-to-monocyte ratio with in-hospital and long-term major adverse cardiac and cerebrovascular events in patients with ST-elevated myocardial infarction. Medicine (Baltimore) 2017; 96: e7897
    CrossrefPubMedSearch in Google Scholar
  • 30 Ommen SR, Hodge DO, Rodeheffer RJ. et al. Predictive power of the relative lymphocyte concentration in patients with advanced heart failure. Circulation 1998; 97: 19-22
    CrossrefPubMedSearch in Google Scholar
  • 31 Noris P, Melazzini F, Balduini CL. New roles for mean platelet volume measurement in the clinical practice?. Platelets 2016; 27: 607-612
    CrossrefPubMedSearch in Google Scholar
  • 32 Sarikaya Y, Bayraktar C, Karatas M. et al. Increased mean platelet volume in patients with idiopathic subjective tinnitus. Eur Arch Otorhinolaryngol 2016; 273: 3533-3536
    CrossrefPubMedSearch in Google Scholar
  • 33 Kokacya MH, Copoglu US, Kivrak Y. et al. Increased mean platelet volume in patients with panic disorder. Neuropsychiatr Dis Treat 2015; 11: 2629-2633
    CrossrefPubMedSearch in Google Scholar
  • 34 Franzoi M, Simioni P, Luni S. et al. Effect of delivery modalities on the physiologic inhibition system of coagulation of the neonate. Thromb Res 2002; 105: 15-18
    CrossrefPubMedSearch in Google Scholar