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Randomized trial of 105 cesarean deliveries finds underbody warmers with heated IV fluids prevent maternal hypothermia and boost neonatal Apgar scores

AORN journal (PubMed)Nov 1, 2026

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Brief summary

A randomized clinical trial of 105 pregnant patients undergoing cesarean delivery found that combining an underbody warming mattress with heated intravenous fluids significantly preserved maternal core temperature, reduced neonatal stress hormones, improved Apgar scores, and accelerated recovery compared with passive warming.

What NurseJet pulled from the source

Inadvertent perioperative hypothermia occurs frequently during cesarean delivery under neuraxial anesthesia, triggering maternal shivering, coagulopathy, increased blood loss, and neonatal cold stress. In a randomized controlled clinical trial conducted at a university hospital, 105 pregnant patients scheduled for cesarean delivery were randomized 1:1:1 into three intraoperative thermal management cohorts: underbody warmer only, underbody warmer combined with heated intravenous fluids (warmed to body temperature), or passive warming using standard hospital cotton blankets. Primary study endpoints were maternal intraoperative and postoperative core body temperatures and neonatal body temperature immediately following delivery. Secondary maternal outcomes evaluated intraoperative blood loss, postoperative analgesic consumption, and time to first flatus and spontaneous urination. Secondary neonatal outcomes measured umbilical cord blood cortisol and glucose concentrations and 1- and 5-minute Apgar scores. Active warming groups demonstrated significantly higher maternal intraoperative core temperatures and higher neonatal temperatures at birth compared with the passive blanket control group. Neonates in the active warming cohorts had significantly higher Apgar scores and reduced umbilical cord blood cortisol levels, indicating attenuated birth stress. Mothers receiving active warming experienced lower analgesic requirements and significantly faster gastrointestinal and urinary recovery.

Why this matters for nurses

Obstetric and perioperative nurses are directly responsible for thermal comfort, surgical safety, and newborn transition during cesarean births. Spinal anesthesia impairs maternal thermoregulation, and cold intravenous crystalloids rapidly lower maternal core temperature, which directly cools the fetal-placental circulation. Demonstrating that combined underbody warming mattresses and fluid warmers protect both maternal recovery and neonatal transition empowers nurses to champion active thermal protocols in the operating room.

Bedside takeaway

An RCT of 105 cesarean delivery patients found combining an underbody warmer with heated IV fluids maintained maternal core temperature, raised neonatal Apgar scores, and sped recovery.

Key takeaways

Randomized trial enrolled 105 women undergoing cesarean delivery allocated to underbody warmer, underbody warmer + heated IV fluids, or passive blankets.
Active warming significantly preserved maternal intraoperative core temperature and prevented hypothermia under spinal anesthesia.
Neonatal body temperatures at birth and Apgar scores were significantly higher in the active warming cohorts.
Cord blood cortisol levels were significantly lower in neonates whose mothers received active thermal management, indicating reduced cold-stress response.
Active intraoperative warming reduced maternal postoperative analgesic consumption and accelerated time to first flatus and spontaneous urination.

Practice implications

Implement active warming protocols—combining an underbody convective or conductive warmer with in-line fluid warming—for all scheduled cesarean deliveries prior to induction of neuraxial anesthesia. Continuously monitor maternal core temperature intraoperatively and postoperatively. Keep warmed infant blankets ready for immediate delivery, initiate early skin-to-skin contact, and observe for shivering, hemodynamic stability, and prompt return of bowel motility in the post-anesthesia care unit.

Limitations & cautions

Single-center study conducted at one university medical center with a sample size of 105 participants; blinding of operating room staff was unfeasible due to warming equipment; specific surgical blood loss volumes and long-term neonatal developmental outcomes were not detailed in the abstract.
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Citations

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AORN journal (PubMed)

AORN journal (PubMed). The Effect of Using Heated IV Fluids With Underbody Warmers on Maternal and Neonatal Well-Being in Cesarean Delivery Operations: A Randomized Clinical Trial.

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https://pubmed.ncbi.nlm.nih.gov/42949594/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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International journal of nursing studies (PubMed)Aug 10, 2026Systematic Review

A systematic review and meta-analysis of 28 randomized controlled trials with 4,410 participants found that electronic inhaler monitoring coupled with active feedback increased medication adherence by 18.4% and significantly reduced acute asthma exacerbations.

Peds Med-SurgAI summaryReview source

Systematic ReviewResearchPatient EducationWorkflowAI summary · original source linked below

Suboptimal adherence to daily inhaled corticosteroids (ICS) is responsible for approximately 24% of all acute asthma exacerbations and remains a major challenge in pediatric and adolescent respiratory care. This systematic review and meta-analysis synthesized 28 randomized controlled trials encompassing 4,410 patients across six international databases through October 2025, evaluating electronic medication monitoring devices paired with active feedback modalities versus standard care. Study quality was evaluated using Cochrane RoB 2, and evidence certainty was graded using GRADE methodology. Feedback-enhanced electronic monitoring produced a statistically significant 18.43% absolute improvement in inhaler adherence relative to standard care (mean difference [MD]: 18.43%, 95% CI: 13.02% to 23.84%; 21 trials, 2,567 participants; moderate-certainty evidence). Adherence gains were particularly robust among pediatric cohorts (MD: 22.21%), compared with adult cohorts (MD: 14.23%) and mixed populations (MD: 23.18%). Crucially, improved adherence translated into concrete clinical benefits: asthma exacerbation rates fell significantly (MD: -2.65, 95% CI: -4.39 to -0.91; 10 trials, 1,569 participants; low certainty), while the proportion of patients achieving well-controlled asthma increased by 6.67% (MD: 6.67%, 95% CI: 4.47% to 8.86%; 5 trials, 1,709 participants). Health-related quality of life also improved on the Mini Asthma Quality of Life Questionnaire (MD: 0.26, 95% CI: 0.13 to 0.40; moderate certainty). Usability was high (SUS score 69.4 to 80.1) without an increase in adverse events.

Key takeaways

Meta-analysis included 28 randomized controlled trials with 4,410 patients evaluating smart inhalers with active feedback.
Electronic monitoring with feedback increased overall inhaler adherence by 18.43% (95% CI: 13.02%–23.84%; moderate certainty).
Children showed the greatest adherence benefit, experiencing a 22.21% absolute increase compared to standard care.
Acute asthma exacerbation rates decreased significantly (mean difference -2.65, 95% CI: -4.39 to -0.91).
Patients achieved a 6.67% higher rate of asthma disease control alongside improved health-related quality of life.

Why this matters on shift

Pediatric and outpatient nurses routinely provide asthma action plans and inhaler teaching, yet self-reported medication use often masks poor controller compliance until a severe exacerbation requires emergency department care or hospital admission. Demonstrating that Bluetooth sensor-enabled inhalers that deliver proactive app reminders and clinician feedback raise pediatric adherence by over 22% and prevent flare-ups provides strong evidence for integrating digital monitoring into outpatient care management.

Bedside takeaway

A meta-analysis of 28 RCTs and 4,410 patients showed feedback-enhanced electronic inhaler monitoring boosted medication adherence by 18.4% (22.2% in children) and cut exacerbations.

Nursing implications

Review electronic adherence data and dose counters during clinic visits and discharge counseling rather than relying solely on patient recall. Teach children, teens, and caregivers how active smart sensor alerts support routine controller habits. Verify correct spacer technique, discuss digital access barriers, and utilize objective adherence tracking to tailor dosage adjustments before escalating pharmacotherapy.

Limitations & cautions

Exacerbation and control outcomes had low-certainty ratings due to risk of bias and heterogeneity across trial definitions; Asthma Control Test score change did not reach statistical significance; device durability, digital health literacy, and health equity in underserved populations require consideration.
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Citations · exact source links

International journal of nursing studies (PubMed). Feedback-enhanced electronic monitoring for asthma inhaler adherence: A systematic review and meta-analysis of randomized controlled trials.

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Nursing in critical care (PubMed)Nov 1, 2026Research Article

A pragmatic randomized controlled trial in a neonatal intensive care unit found that using the Tomazoni anatomical measurement method for PICC insertion achieved central tip placement in 77.8% of procedures compared with 17.9% using traditional measurement, reducing catheter withdrawal requirements by 81%.

Peds Med-SurgAI summaryReview source

Research ArticleResearchQuality ImprovementAI summary · original source linked below

Accurate peripherally inserted central catheter (PICC) tip placement in neonates is vital for delivering hyperosmolar parenteral nutrition and inotropes while avoiding cardiac tamponade, extravasation, and thrombosis, yet traditional landmark measurement methods frequently result in catheter tip malposition. In a pragmatic, parallel-group randomized clinical trial with stratified block randomization conducted in a Brazilian neonatal intensive care unit (ReBEC RBR-55zwb45) between June 2024 and April 2025, 62 neonatal PICC procedures were randomized, yielding 55 evaluable procedures (27 experimental, 28 control). The experimental group utilized the Tomazoni measurement method to estimate insertion length prior to venipuncture, while the control group used the standard traditional landmark technique. Accurate central tip positioning was confirmed radiographically in 21 of 27 procedures (77.8%) in the Tomazoni group versus only 5 of 28 (17.9%) in the control group (p < 0.001). PICC insertions guided by the Tomazoni method were 4.36 times more likely to achieve central placement (relative risk [RR]: 4.36; 95% CI: 1.91–9.88). Furthermore, post-insertion catheter withdrawal due to over-insertion was required in only 11.1% (3/27) of the Tomazoni cohort compared to 57.1% (16/28) of the control cohort (p = 0.001; RR: 0.19; 95% CI: 0.06–0.59).

Key takeaways

Pragmatic RCT in a NICU analyzed 55 evaluable PICC insertions comparing the Tomazoni measurement method (n = 27) with traditional measurement (n = 28).
Tomazoni measurement achieved accurate central tip positioning in 77.8% (21/27) versus 17.9% (5/28) with standard measurement (p < 0.001).
Procedures using the Tomazoni method were 4.36 times more likely to achieve optimal central tip placement (RR: 4.36, 95% CI: 1.91–9.88).
Need for subsequent catheter withdrawal dropped from 57.1% to 11.1% (RR: 0.19, 95% CI: 0.06–0.59, p = 0.001).
The technique provides a low-cost, reproducible measurement framework that minimizes sterile field disruption and post-procedure catheter manipulation.

Why this matters on shift

Neonatal nurses and vascular access specialists placing PICCs in premature and critically ill infants face significant risks when catheter tips are positioned either intracardiac or peripheral. Repeated catheter manipulation and sterile dressing removal to adjust catheter depth introduce substantial infection and extravasation hazards. Utilizing an anatomical measurement formula that quadruples first-pass central tip accuracy substantially enhances neonatal patient safety.

Bedside takeaway

An RCT of 55 neonatal PICC insertions found the Tomazoni measurement method quadrupled central tip positioning (77.8% vs. 17.9%) and cut catheter withdrawal needs by 81%.

Nursing implications

Incorporate validated anatomical measurement strategies like the Tomazoni technique when measuring neonatal limb landmarks before catheter insertion. Ensure post-placement confirmatory radiographs are verified before infusing vesicants or hypertonic solutions, and recognize that optimizing initial insertion measurement markedly reduces subsequent sterile dressing disruptions and catheter adjustments.

Limitations & cautions

Single-center trial in one NICU in Brazil; sample size of 55 evaluable procedures; did not evaluate long-term catheter longevity, mechanical occlusion, or catheter-related bloodstream infection rates.
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Citations · exact source links

Nursing in critical care (PubMed). Effectiveness of Tomazoni Measurement Method for Central Catheter Tip Positioning in Neonates: A Randomised Controlled Trial.

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The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians (PubMed)Oct 14, 2026Research Article

A secondary analysis of 1,322 patients undergoing standardized term labor induction found that individuals with severe obesity (BMI >= 40 kg/m2) experienced 3.5 hours longer total labor duration, required more misoprostol doses, and had 40% lower odds of vaginal delivery compared to patients with BMI < 40 kg/m2.

L&D / OB Med-SurgAI summaryReview source

Research ArticleResearchMedication SafetyWorkflowAI summary · original source linked below

Maternal obesity is a major contributor to prolonged labor and cesarean birth, but the specific dynamics of prostaglandin cervical ripening in severe obesity remain incompletely defined. This study analyzed data from 1,322 patients at >= 37 weeks gestation with cervical dilation <= 2 cm who received vaginal misoprostol (25 µg every 3 hours for up to 5 doses followed by standardized oxytocin) in a cluster randomized controlled trial conducted between May 2021 and September 2022. Overall, 264 participants (20.0%) had severe obesity (BMI >= 40 kg/m2) and 1,058 (80.0%) had BMI < 40 kg/m2. Patients with severe obesity were significantly more likely to present with a completely closed cervix at induction initiation. After controlling for hospital clustering, initial cervical dilation, chronic hypertension, and diabetes using generalized estimating equations, individuals with severe obesity experienced significantly longer total induction duration (adjusted mean difference: 3.5 hours, 95% CI: 1.9–4.8), longer first stage of labor (adjusted mean difference: 2.2 hours, 95% CI: 0.6–3.8), and extended oxytocin administration (adjusted mean difference: 2.5 hours, 95% CI: 1.1–3.8). Furthermore, patients with BMI >= 40 kg/m2 required more misoprostol doses and had significantly reduced odds of achieving vaginal delivery (adjusted odds ratio: 0.6, 95% CI: 0.4–0.8).

Key takeaways

Analysis evaluated 1,322 term labor inductions using standardized vaginal misoprostol (25 µg q3h up to 5 doses).
264 patients (20.0%) presented with severe obesity (BMI >= 40 kg/m2) and were more likely to begin induction with a closed cervix.
Total induction time was 3.5 hours longer (95% CI: 1.9–4.8) and first stage was 2.2 hours longer (95% CI: 0.6–3.8) in patients with BMI >= 40.
Duration of oxytocin infusion was increased by 2.5 hours (95% CI: 1.1–3.8), with higher total misoprostol requirements.
Severe obesity was associated with 40% lower odds of successful vaginal delivery (aOR 0.6, 95% CI: 0.4–0.8).

Why this matters on shift

Labor and delivery nurses manage complex cervical ripening and oxytocin titration pathways for pregnant individuals across diverse BMI categories. Recognizing that severe obesity independently prolongs induction duration by several hours and increases medication requirements helps bedside nurses set realistic expectations with laboring families, plan for extended electronic fetal monitoring, and avoid premature declarations of failed induction before adequate ripening time has elapsed.

Bedside takeaway

In a trial of 1,322 inductions, severe obesity (BMI >= 40) added 3.5 hours to labor duration and lowered odds of vaginal delivery by 40% under vaginal misoprostol.

Nursing implications

When caring for laboring patients with BMI >= 40 kg/m2 undergoing cervical ripening, anticipate longer progression times through the latent and active phases of labor. Maintain continuous fetal and uterine contraction monitoring, advocate for patience during early ripening per standardized labor guidelines, and monitor closely for oxytocin-related tachysystole.

Limitations & cautions

Secondary observational analysis of a trial cohort limited to vaginal misoprostol and oxytocin; cannot evaluate whether mechanical ripening (e.g., Foley balloon) or alternative pharmacological dosing would alter delivery outcomes in this population.
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Citations · exact source links

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians (PubMed). Characterizing vaginal misoprostol induction in individuals with and without severe obesity.

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Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Meta-analysis of 28 trials finds feedback-enhanced electronic monitoring boosts asthma inhaler adherence by 18% and cuts exacerbations

Randomized trial of 55 neonatal PICC insertions finds Tomazoni measurement method quadruples central tip placement accuracy

Trial of 1,322 term inductions finds severe obesity extends labor by 3.5 hours and reduces odds of vaginal delivery under vaginal misoprostol