Search

Background: To compare the effectiveness of 550 mg naproxen sodium versus 6 mL 2%-lidocaine intracervical block in pain lowering at the 52-mg levonorgestrel-releasing intrauterine system (LNG-IUS) placement in young women.Methods: In this randomized controlled trial, 100 women aged 15-24 years were block-randomized to receive either 6 mL 2%-lidocaine intracervical block 5 min before the LNG-IUS insertion or 550 mg naproxen 30 min before the procedure. Forty-nine women received 550 mg naproxen and 51 received intracervical block. The primary outcome was pain at LNG-IUS insertion. Secondary outcomes were ease of insertion, insertion failures, and correct IUS positioning. Neither participants nor doctors were blinded. Pain at insertion was assessed by using a Visual Analog Scale (VAS).Results: Women randomized to lidocaine intracervical block presented lower mean pain score at insertion, when compared to women who received naproxen (5.4 vs. 7.3, respectively; p < 0.001). Parous women had a 90.1% lower chance of experiencing severe pain (p = 0.004). There was a 49.8% reduction in the chance of severe pain for every 1-cm increase in the hysterometry (p = 0.002). The only complication observed during insertion was vasovagal-like reactions (7%). The insertion was performed without difficulty in 82% of the women. Participants in the intracervical block group presented higher proportion of malpositioned IUS on transvaginal ultrasound examination compared to women in naproxen group. Nevertheless, all the malpositioned IUS were inserted by resident physicians.Conclusion: Lidocaine intracervical block was found to be more effective than naproxen in reducing LNG-IUS insertion pain.Trial Registration Number: RBR-68mmbp, Brazilian Registry of Clinical Trials, Retrospectively registered (August 4, 2020), URL of trial registry record: https://ensaiosclinicos.gov.br/rg/RBR-68mmbp/ . [ABSTRACT FROM AUTHOR]

Objective: In the prospective multicenter Genesis study, we developed a prediction model for Cesarean delivery (CD) in term nulliparous women. The objective of this secondary analysis was to determine whether the Genesis model has the potential to predict maternal and neonatal morbidity associated with vaginal delivery.Study Design: The national prospective Genesis trial recruited 2,336 nulliparous women with a vertex presentation between 39 + 0- and 40 + 6-weeks' gestation from seven tertiary centers. The prediction model used five parameters to assess the risk of CD: maternal age, maternal height, body mass index, fetal head circumference and fetal abdominal circumference. Simple and multiple logistic regression analyses were used to develop the Genesis model. The risk score calculated using this model were correlated with maternal and neonatal morbidity in women who delivered vaginally: postpartum hemorrhage (PPH), obstetric anal sphincter injury (OASI), shoulder dystocia, one- and five-minute Apgar score ≤ 7, neonatal intensive care (NICU) admission, cephalohematoma, fetal laceration, nerve palsy and fractures. The morbidities associated with spontaneous vaginal delivery were compared with those associated with operative vaginal delivery (OVD). The likelihood ratios for composite morbidity and the morbidity associated with OVD based on the Genesis risk scores were also calculated.Results: A total of 1,845 (79%) nulliparous women had a vaginal delivery. A trend of increasing intervention and morbidity was observed with increasing Genesis risk score, including OVD (p < 0.001), PPH (p < 0.008), NICU admission (p < 0.001), low Apgar score at one-minute (p < 0.001) and OASI (p = 0.009). The morbidity associated with OVD was significantly higher compared to spontaneous vaginal delivery, including NICU admission (p < 0.001), PPH (p = 0.022), birth injury (p < 0.001), shoulder dystocia (p = 0.002) and Apgar score of<7 at one-minute (p < 0.001). The positive likelihood ratios for composite outcomes (where the OVD was excluded) increases with increasing risk score from 1.005 at risk score of 5% to 2.507 for risk score of>50%.Conclusion: In women who ultimately achieved a vaginal birth, we have shown more maternal and neonatal morbidity in the setting of a Genesis nomogram-determined high-risk score for intrapartum CD. Therefore, the Genesis prediction tool also has the potential to predict a more morbid vaginal delivery. [ABSTRACT FROM AUTHOR]

Uterine sarcoma is a rare verity of smooth muscle tumor, accounting for 2 to 6% of uterine malignancies. Leiomyosarcoma (LMS) represents ~1% of overall uterine tumors and ~25 to 36% of uterine sarcomas. Here we present a case of uterine LMS in a 34-year-old nulliparous woman presented with huge distension of abdomen which was confused to be an ovarian malignancy. She underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. The diagnosis of LMS is made by histopathological examination after surgery. Surgery is the only treatment and role of adjuvant therapy has not been clearly defined. [ABSTRACT FROM AUTHOR]

Abstract Objective This study aimed to identify factors associated with meeting the Obstetric Care Consensus (OCC) guidelines for nulliparous, term, singleton, and vertex (NTSV) cesarean births. Materials and methods This was a retrospective case control study of women with NTSV cesarean births between January 2014 and December 2017 at single tertiary care center. Demographics and clinical characteristics were compared between women with NTSV cesarean births which did or did not meet OCC guidelines. A multivariable logistic regression model was used to evaluate the effect of each variable on the odds of meeting OCC guidelines. Results There were 1,834 women with NTSV cesarean births of which 744 (40.6%) met OCC guidelines for delivery and 1,090 (59.4%) did not. After controlling for confounding factors, the odds of meeting OCC guidelines were increased for in-house providers managing with residents (adjusted odds ratio [aOR] = 2.03, 95% confidence interval [CI]: 1.44–2.87) and without residents (aOR = 1.66, 95% CI: 1.30–2.12), compared with non-in-house providers managing without residents. There was no significant difference in the odds of meeting OCC guidelines for in-house providers managing with or without residents (aOR = 1.23, 95% CI: 0.84–1.79). Conclusion After adjusting for confounding factors, in-house provider coverage, regardless of resident involvement, is associated with increased odds of NTSV cesarean births meeting OCC guidelines. Key Points Frequency of adherence to OCC guidelines for NTSV cesarean births was 40.6%. Neither patient demographics nor comorbidities was associated with the odds of meeting OCC guidelines. In-house providers are associated with increased odds of meeting OCC guidelines.

Objective  The aim of the study is to evaluate the association between amniotomy at various time points during labor induction and maternal and neonatal outcomes among term, nulliparous women. Study Design  Secondary analysis of a randomized trial of term labor induction versus expectant management in low-risk, nulliparous women (2014–2017) was conducted. Women met inclusion criteria if they underwent induction ≥38 weeks' gestation using oxytocin with documented time and type of membrane rupture. Women with antepartum stillbirth or fetal anomaly were excluded. The primary outcome was cesarean delivery. Secondary outcomes included maternal and neonatal complications. Maternal and neonatal outcomes were compared among women with amniotomy versus women with intact membranes and no amniotomy at six 2-hour time intervals: before oxytocin initiation, 0 to <2 hours after oxytocin, 2 to <4 hours after, 4 to <6 hours after, 6 to <8 hours after, and 8 to <10 hours after. Multivariable logistic regression adjusted for maternal age, body mass index, race/ethnicity, modified Bishop score on admission, treatment group, and hospital (as a random effect). Results  Of 6,106 women in the parent trial, 2,854 (46.7%) women met inclusion criteria. Of these 2,340 (82.0%) underwent amniotomy, and majority of the women had amniotomy performed between 2 and <6 hours after oxytocin. Cesarean delivery was less frequent among women with amniotomy 6 to <8 hours after oxytocin compared with women without amniotomy (21.9 vs. 29.7%; adjusted odds ratio 0.61, 95% confidence interval 0.42–0.89). Amniotomy at time intervals ≥4 hours after oxytocin was associated with lower odds of labor duration >24 hours. Amniotomy at time intervals ≥2 hours and <8 hours after oxytocin was associated with lower odds of maternal hospitalization >3 days. Amniotomy was not associated with postpartum or neonatal complications. Conclusion  Among a contemporary cohort of nulliparous women undergoing term labor induction, amniotomy was associated with either lower or similar odds of cesarean delivery and other adverse outcomes, compared with no amniotomy. [ABSTRACT FROM AUTHOR]

Objective  Nulliparous obese women are at increased risk of labor induction and cesarean delivery (CD). We sought to determine whether the combination of a transvaginal Foley balloon plus misoprostol prostaglandin E1 (PGE1) is superior to misoprostol alone in reducing the risk for CD. Study Design  We undertook a multicenter, open-label, comparative-effectiveness randomized clinical trial of nulliparous obese women with unfavorable cervix (Bishop's score ≤ 6) undergoing labor induction from January 2016 to June 2018 at three tertiary centers. Those at <32 weeks' gestation, premature rupture of membranes, stillbirth, and major fetal anomalies were excluded. Women were randomized 1:1 to either a combination of Foley balloon and misoprostol or misoprostol alone. Once Bishop's score was >6, further management was deferred to treating physicians. Primary outcome was the rate of CD. Secondary maternal outcomes included duration of induction-to-delivery interval, occurrence of tachysystole, clinical chorioamnionitis, need for operative vaginal delivery, as well as a composite of maternal morbidity (postpartum endometritis, surgical-site infection, venous thromboembolism, need for transfusion, intensive care unit admission, and maternal death). Secondary neonatal outcomes included need for neonatal intensive care unit admission, transient tachypnea of the newborn, respiratory distress syndrome, meconium aspiration syndrome, culture-proven sepsis, neonatal seizures, and a composite of neonatal morbidity (Apgar's score ≤7 at 5 minutes, umbilical artery cord pH ≤7.10, birth injury, perinatal death). With the rate of CD rate being 53% at Children's Memorial Herman Hospital among nulliparous obese women who underwent induction of labor at ≥32 weeks and met our inclusion criteria; 250 women (125 women per group) were required to answer the study question. All analyses were by intention to treat. Results  Of the 236 women randomized, 113 (48%) were allocated to group 1 (combined Foley and PGE1) and 123 (52%) to group 2 (PGE1 alone). The rate of CD was similar between the groups (45 vs. 43%, p  = 0.84, relative risk [RR]: 1.03, 95% CI: 0.75–1.42). There was no difference in the occurrence of tachysystole that resulted in fetal heart rate abnormalities between the groups (8.8 vs. 16.2%, p  = 0.09, RR: 0.54, 95% CI: 0.27–1.11). The total duration of the induction-to-delivery interval was also similar between the groups (24.8 ± 13.8 vs. 24.5 ± 14.0 hours, p  = 0.87) regardless of the mode of delivery. No differences were seen in the indications for CD and secondary maternal or neonatal outcomes. Conclusion  In this trial of nulliparous obese women undergoing labor induction, cervical ripening with combined Foley balloon and PGE1 resulted in similar CD rates than ripening with vaginal PGE1 alone. Key Points Nulliparous obese women are at increased risk for cesarean delivery. Combined intravaginal misoprostol-Foley balloon versus misoprostol alone resulted in similar rates of cesarean delivery. Further research is warranted to determine the optimal cervical ripening strategy in this population. [ABSTRACT FROM AUTHOR]

Objective: To assess the effects of aspirin in pregnancy for the prevention of adverse outcomes in low risk, nulliparous women with singleton pregnancies.Study Design: Medline, Embase, CINAHL, the Cochrane library, Web of Science and clinicaltrials.gov were searched from inception until February 2020. Randomised controlled trials were eligible for inclusion where women were nulliparous, had singleton pregnancies and no other risk factors for pre-eclampsia such as diabetes or pre-existing hypertension. Primary outcomes were pre-eclampsia, gestational hypertension and eclampsia. Secondary outcomes included; pre-term birth, postpartum haemorrhage, antepartum haemorrhage, miscarriage, small for gestational age (SGA), fetal growth restriction (FGR), birthweight and further markers of maternal and neonatal morbidity and mortality. The results were combined into meta-analysis where appropriate.Results: Ten studies were eligible for inclusion involving 23,162 women. Two studies (involving 214 women) used aspirin doses of 100 mg, with the remainder using smaller doses. There was no significant difference found in the risk of developing pre-eclampsia between women receiving aspirin compared to no aspirin (relative risk [RR] 0.70, 95 % confidence interval [CI] 0.47-1.05, p = 0.08). Women receiving aspirin had a reduced risk of having a preterm birth <34 weeks (RR 0.50, 95 % CI 0.26-0.96, p = 0.04), and reduced risk of having a SGA neonate (RR 0.94, 95 % CI 0.89-1.00, p = 0.04). An increase in birthweight was seen when aspirin was received (mean difference 105.17 g, 95 % CI 12.38 g-197.96 g, p = 0.03) and there was no increase in risk of postpartum or antepartum haemorrhage in those receiving aspirin (RR 1.24, 95 % CI 0.90-1.71, p = 0.19 and RR 1.06, 95 % CI 0.66-1.70, p = 0.81 respectively).Conclusion: The results did not demonstrate a significant difference amongst low risk nulliparous women in the risks of pre-eclampsia or gestational hypertensive disorders with aspirin administration. Although we found significantly improved fetal growth parameters and prevention of preterm birth in women receiving aspirin, there were few eligible studies, with those included generally providing low quality evidence and many studies using aspirin doses ≤100 mg, commenced late in pregnancy. More research in the form of a high quality randomised controlled trial is needed before recommendations can be made. [ABSTRACT FROM AUTHOR]

Objective: To establish the prevalence and risk factors of urinary and anal incontinence in nulliparous women.Study Design: Thirty-one catholic convents were sent a validated questionnaire to determine the prevalence and severity of urinary incontinence, and a similarly structured questionnaire to assess anal incontinence. Multivariable regression models were used to determine independent risk factors associated with the likelihood of urinary incontinence or anal incontinence.Main Outcome Measures: Urine/faecal/flatal incontinence and symptom severity.Results: Of 202 nuns, 167 (83%) returned the questionnaire. Twenty-two women were excluded due to history of childbirth. Of 145 nulliparous women, 56.2% reported urinary incontinence and 53.8% reported anal incontinence. Women aged 66-76 years had significantly increased odds of experiencing urinary incontinence in comparison to women aged 40-65 years: OR: 2.35 (95% CI: 1.02-5.45) (p = 0.04). The risk of urinary incontinence was increased in women with a body mass index ≥ 30 in comparison to those with a body mass index < 19: OR: 6.25 (95% CI: 1.03-38.08) (p = 0.04). With regards to anal incontinence, although none of the differences with age and body mass index groups reached statistical significance, there was a trend towards women in higher body mass index groups having an increased prevalence of anal incontinence. Current/previous hormonal replacement therapy was also associated with significantly increased odds of experiencing urinary incontinence: OR: 2.53 (95% CI: 1.01-6.36), (p = 0.04). However, when adjusting for age and body mass index, there was no significant association with urinary incontinence.Conclusions: This study highlights that while childbirth is an important risk factor, urinary incontinence and anal incontinence also occur in over 50% of nulliparous women. Additional studies are required to identify other risk factors that may be associated with incontinence in this population. [ABSTRACT FROM AUTHOR]

Introduction: Episiotomy is of common surgical procedures in midwifery and is followed by complications including inflammation, edema, approximation of the wound and perineal pain. In past, Myrtus communis plant has been used to treat wounds and relieve pain. This study was performed with aim to investigate the effect of M. communis cream on wound healing and episiotomy pain severity. Methods: This double-blind clinical trial was conducted on 100 nulliparous women in Zabol Amiralmomenin Ali Hospital from July to November 2018. The participants randomly received Myrtus Communis cream or placebo and used the encoded creams 2 times a day for 10 days. Demographic and obstetrics questionnaire, health status form, analgesic used, Numeric pain rating scale, Reeda scale and drug side effects table were used to assess the individuals. Then, the pain severity and recovery rate were examined on the first 2 hours, fifth and tenth day after delivery. Data were analyzed by SPSS software (version 23) and Mann-Whitney, independent-t, and Chi-square tests. P0.05). The mean difference of pain severity on the fifth (p=0.009) and tenth day (p=0.012) after delivery was significant in M. communis cream and placebo cream groups, and the severity of pain was less pain in M. communis cream group. The mean of Reeda score group on the 5th day after delivery was 1.70 ± 1.09 in the M. communis cream group and 2.94 ± 1.51 in the placebo cream group (p

Introduction: Effacement and dilatation are important factors affecting the progress and duration of labor. Impairment in their progression can disrupt the normal progress of labor and lead to maternal and neonatal complications. For many years, topical magnesium sulfate has been used experimentally for labor progression in Iran. Therefore, this study was performed with aim to determine the effects of topical magnesium sulfate on progression of effacement, dilatation and duration of labor in nulliparous women. Methods: This double-blind randomized clinical trial was conducted on 72 nulliparous women with term pregnancy that had referred to Tehran Mahdieh hospital for delivery from March 2016 to September 2017. The participants were randomly divided into two groups of magnesium sulfate and placebo (n=36 in each group). In the magnesium sulfate group (intervention), 10 cc of magnesium sulfate 50%, and in the control group, 10 cc of distilled water was poured on the cervix in the beginning of the active phase, and the labor progress was assessed in two groups. Data were analyzed by SPSS software (version 17) and using independent t-test, Mann-Whitney, Chi-square and Fisher's exact tests. P0.05). Conclusion: The use of topical magnesium sulfate on the cervix in the active phase improves effacement and dilatation and shortens the duration of labor. Since there are very few studies on this subject, performing further studies are recommended.

Introduction: Causes of prolonged labor have been extensively studied. It has been previously proved that glucose is the main energy substrate for pregnant uterus. It is assumed that intravenous dextrose may shorten the length of labor; however there is no enough evidence in this regard. This study was performed with aim to compare labor duration and maternal-neonatal short-term outcomes in nulliparous women with vaginal delivery receiving intravenous normal saline or dextrose. Methods: In this double-blind randomized clinical trial, 300 nulliparous, singleton women in active phase of vaginal delivery were studied in Tabriz Alzahra educational center in 2013. The women were simple randomly divided into three similar groups: receiving intravenous normal saline 125 ml/h, receiving intravenous dextrose 5% 125 ml/h and control. Data were collected by maternal- pregnancy characteristics questionnaire (based on examination and mother's file) and fetal-neonatal outcomes questionnaire (based on examination and neonate's file). Data were analyzed using SPSS software (version 15), and one way ANOVA, Tukey post hoc test, Chi-square or Fisher exact test. P12h) was significantly more common in control group (39%) than in dextrose group (5%) and normal saline group (10%) (p0.05). Conclusion: Total duration of labor in nulliparous term women with active vaginal labor is reduced by intravenous injection of 125 ml/h dextrose 5%.

Introduction: Childbirth is a physiologic but stressful event in women's life. Anxiety during labor can affect pregnancy outcomes and causes pain and fear of childbirth. So, reduction of anxiety during labor was strictly recommended in various studies. Acupressure, against pharmacological methods, is a simple and cost-effective method which is limitedly investigated in childbirth. This study was performed with aim to investigate the effects of acupressure at LI4, He7, SP6 and Neima points on anxiety during labor in nulliparous women. Methods: This randomized clinical trial was conducted on 130 mothers who were hospitalized in delivery wards of Qazvin Razi hospital in 2018. They were randomly assigned to intervention and control groups. In the intervention group, stimulation of SP6 and Neima points was started in cervical dilatation of 4 cm and continued for 30 minutes, then in cervical dilatation of 8 cm, stimulation of LI4 and H7 continued by TENS until the end of delivery. Control group received routine obstetrics cares. Spielberger’s State-Trait Anxiety Inventory (STAI) was completed at the time of admission to delivery room and one hour after delivery. Data was analyzed by SPSS software (version 24) and Chi-square, independent t-test, Paired t-test. PResults: Acupressure had a significant influence on mean score of state anxiety in experimental (33.7 ± 9.5) compared to control group (40.1 ± 9.9) (P = 0.001). Difference in mean score of trait anxiety in experimental (35.5 ± 8.2) compared to control group (39.08 ± 7.7) was statically significant (p=0.04). Conclusion: Stimulation of LI4, H7, SP6 and Neima points is effective in decreasing state and trait anxiety in nulliparous women and is recommended as one of the methods for treatment of anxiety in pregnancy and childbirth.

Yaël Zimmermann,1 Manuela Viviano,2 Michal Yaron21Faculty of Medicine, University of Geneva, Geneva, Switzerland; 2Department of Obstetrics and Gynecology, Geneva University Hospitals, Geneva, SwitzerlandObjective: The aim of this study was to 1) evaluate the Swiss physicians’ attitudes and beliefs on intrauterine device (IUD) use in multiparous and nulliparous women and 2) determine whether the woman’s parity was a factor influencing the gynecologists’ IUD practice.Material and methods: The Global Survey questionnaire investigating IUD use was modified and adapted to the Swiss guidelines. A link to the online questionnaire was sent to gynecologists practicing in the French- and German-speaking parts of Switzerland. We defined IUD use as frequent whenever it was prescribed by gynecologists for 25% or more out of all women consulting for contraception.Results: A total of 299/1,696 gynecologists completed the online questionnaire (17.6%). Frequent IUD prescription was found in 72.9% of multiparous and in 11.8% of nulliparous women. The most frequently reported barriers to IUD use in nulliparous women were as follows: concern over a painful insertion, difficulty of insertion, higher risk of perforation, pelvic inflammatory disease, changes in bleeding pattern, high cost, and risk of extrauterine pregnancy. The presence of such perceived obstacles was associated with less frequent IUD insertion in nulliparous women.Conclusion: The results of this study provide a valuable insight into the attitudes and opinions of Switzerland’s gynecologists on the use of IUDs in nulliparous and multiparous women, showing that the women’s parity is a factor influencing the physicians’ attitudes and opinions. Further health education might help minimize the physicians’ attitude discrepancies in IUD prescription to nulliparous and multiparous women. Keywords: intrauterine device, IUD, nulliparous, multiparous, gynecologists, LARC, contraception

Abstract Background The aim of this study was to evaluate the reproductive performance of a new artificial insemination (AI) device specifically designed for gilts (Deep cervical AI, Dp-CAI) by means of which the sperm is deposited deeply in the cervix (8 cm more cranial than in traditional cervical insemination-CAI). New AI techniques have arisen in recent decades in the porcine industry, such as post-cervical artificial insemination (PCAI), which involves depositing the sperm in the body of the uterus [through a catheter (outer tube)-cannula (inner tube)] rather than by CAI. Although the PCAI method has been successfully applied in farm conditions to reduce sperm doses without impairing the reproductive performance, this technique has limitations in gilts mainly because of the difficulty involved in introducing the inner cannula through the cranial part of the cervix. For this reason, the Dp-CAI method described herein may be considered as an alternative to CAI and PCAI methods in gilts. Results Gilts were divided in two experimental groups: 1) Dp-CAI: gilts (n = 1166) inseminated using 1.5 × 109 sperm/45 mL; 2) CAI (as a control group): gilts (n = 130) inseminated using 2.5 × 109 sperm/85 mL. The Dp-CAI method was successfully applied in 88.90% of the gilts, with no differences detected between gilts with 1 or 2 previous oestrus cycles, although the catheter could be introduced more deeply in 2 oestrus gilts (P

Background: Preterm birth is a major worldwide public health concern, being the leading cause of infant mortality. Understanding of risk factors remains limited, and early identification of women at high risk of preterm birth is an open challenge. Objective: The aim of the study was to develop and validate a novel pre-pregnancy score for preterm delivery in nulliparous women using information from Italian healthcare utilization databases. Study Design: Twenty-six variables independently able to predict preterm delivery were selected, using a LASSO logistic regression, from a large number of features collected in the 4 years prior to conception, related to clinical history and socio-demographic characteristics of 126,839 nulliparous women from Lombardy region who gave birth between 2012 and 2017. A weight proportional to the coefficient estimated by the model was assigned to each of the selected variables, which contributed to the Preterm Birth Score. Discrimination and calibration of the Preterm Birth Score were assessed using an internal validation set (i.e., other 54,359 deliveries from Lombardy) and two external validation sets (i.e., 14,703 and 62,131 deliveries from Marche and Sicily, respectively). Results: The occurrence of preterm delivery increased with increasing the Preterm Birth Score value in all regions in the study. Almost ideal calibration plots were obtained for the internal validation set and Marche, while expected and observed probabilities differed slightly in Sicily for high Preterm Birth Score values. The area under the receiver operating characteristic curve was 60%, 61% and 56% for the internal validation set, Marche and Sicily, respectively. Conclusions: Despite the limited discriminatory power, the Preterm Birth Score is able to stratify women according to their risk of preterm birth, allowing the early identification of mothers who are more likely to have a preterm delivery.

Here we revise circumstances of non-infectious causes in which the uterus may be associated with pregnancy loss during the late embryo/early fetal period (following a positive pregnancy diagnosis in lactating dairy cows). As the uterine size increases with parity and pregnant heifers with no detrimental effects of a previous parturition, a primigravid uterus is proposed as a reference for identifying risk factors that negatively influence pregnancy in lactating cows. Cows suffering placenta retention or with a large uterus at insemination were selected as topics for this revision. Retained placenta, that occurs around parturition, has a long-lasting influence on subsequent pregnancy loss. Although retained placenta is a particularly predisposing factor for uterine infection, farm conditions along with cow factors of non-infectious cause and their interactions have been identified as main factors favoring this disorder. A large uterus (cervix and uterine horns lying outside the pelvic cavity) with no detectable abnormalities has been associated with low fertility and with a greater incidence of pregnancy loss. A large reproductive tract may well derive from an inadequate uterine involution. Therefore, peripartum management and strategies to reduce the incidence of uterine disorders should reduce their associated financial losses in the herds.

ABSTRACT: The application of the intrauterine artificial insemination (IUAI) technique allows optimization of a swine production system due to the reductions in volume and number of sperm cells in the insemination dose, and by reducing the time taken to perform the insemination. However, IUAI is not recommended for gilts due to the difficulty of intrauterine cannula passage through the cervix. This difficulty is associated mainly with the fact that the reproductive tract is smaller in gilts than in pluriparous females. However, few studies have evaluated the application of IUAI in gilts. In these studies, there are variations in approach concerning the definition of the success rate for cannula passage through the cervix, the type of cannula and the body characteristics of the gilts used, making it difficult to extrapolate the recommendation for the use of IUAI in gilts. Considering the evidence that such characteristics influence or even determine the success of the application of IUAI, there is a necessity for an understanding of the influence of these factors in the improvement and later application of the technique. Gilts represent about 15-20% of the breeding group, and the use of IUAI could optimize the processes of insemination on farms. The approach used in this review highlights the aspects that could aid in structuring further studies for improving IUAI in gilts, allowing its use on commercial farms.

The application of the intrauterine artificial insemination (IUAI) technique allows optimization of a swine production system due to the reductions in volume and number of sperm cells in the insemination dose, and by reducing the time taken to perform the insemination. However, IUAI is not recommended for gilts due to the difficulty of intrauterine cannula passage through the cervix. This difficulty is associated mainly with the fact that the reproductive tract is smaller in gilts than in pluriparous females. However, few studies have evaluated the application of IUAI in gilts. In these studies, there are variations in approach concerning the definition of the success rate for cannula passage through the cervix, the type of cannula and the body characteristics of the gilts used, making it difficult to extrapolate the recommendation for the use of IUAI in gilts. Considering the evidence that such characteristics influence or even determine the success of the application of IUAI, there is a necessity for an understanding of the influence of these factors in the improvement and later application of the technique. Gilts represent about 15–20% of the breeding group, and the use of IUAI could optimize the processes of insemination on farms. The approach used in this review highlights the aspects that could aid in structuring further studies for improving IUAI in gilts, allowing its use on commercial farms. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the need of using eCG on short-term estrus synchronization protocol in nulliparous (NUL) and multiparous (MULT) dairy goats during the breeding season. Alpine (n = 20), Nubian (n = 20), and Saanen (n = 16) goats received 60 mg medroxyprogesterone acetate intravaginal sponges for 6 days plus 30 μg d-cloprostenol and 200 IU eCG (G-eCG, n = 28) or saline (G-Control, n = 28) 24 h before sponge removal. The NUL and MULT goats of each breed were equally assigned into the two treatments. Transrectal ultrasonography was used to evaluate ovulatory parameters, and teaser goats were used for estrus detection every 12 h from sponge removal to ovulation. eCG did not affect (P > 0.05) estrus response (~86%), diameter of ovulatory follicles (~6.8 mm), and number of ovulations (~1.6). Nevertheless, eCG led to earlier (P < 0.05) ovulation (G-eCG = 65.1 and G-Control = 73.2 h) and increased (P < 0.05) the ovulation rate (G-eCG = 96.4% and G-Control = 67.9%). In the absence of eCG, no differences regarding reproductive parameters (P > 0.05) were found between parity orders. Alpine MULT goats underwent a superior (P < 0.05) number of ovulations (2.2) in comparison to NUL goats (1.3). In conclusion, the exclusion of eCG from short-term estrus synchronization protocol did not interfere with estrus response but decreased the ovulation rate. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluated whether episiotomy during vacuum-assisted delivery leads to fewer third- and fourth-degree tears. Methods: This was a retrospective cohort study of all nulliparas who underwent a singleton, soft cup, vacuum-assisted vaginal delivery in one institution, from January 2014 to August 2019. Failed vacuum deliveries were excluded. Based on power analysis calculation, a sample size of 500 women in each group was sufficient to detect an advantage of episiotomy, if present. Primary outcome was third- or fourth-degree perineal tear. Secondary outcomes were other maternal complications, and low neonatal cord pH and Apgar scores. Outcomes were compared between women with and without episiotomy. Results: During the study period, 2370 nulliparas had a vacuum-assisted vaginal delivery using soft vacuum cup and met the study inclusion criteria. Episiotomy was performed in 1868 (79%) women, and 502 (21%) delivered without episiotomy. Background characteristics were similar in both groups. There were no significant differences in the rates of third and fourth grade perineal lacerations between the two groups. Episiotomy was associated with higher rate of postpartum hemorrhage (p < 0.01) Conclusions: Using selective episiotomy for patients delivering vaginally with the assistance of soft cap vacuum does not increase third- or fourth-degree perineal tears. [ABSTRACT FROM AUTHOR]

Objective  This study aimed to develop a validated model to predict intrapartum cesarean in nulliparous women and to use it to adjust for case-mix when comparing institutional laboring cesarean birth (CB) rates. Study Design  This multicenter retrospective study used chart-abstracted data on nulliparous, singleton, term births over a 7-year period. Prelabor cesareans were excluded. Logistic regression was used to predict the probability of CB for individual pregnancies. Thirty-five potential predictive variables were evaluated including maternal demographics, prepregnancy health, pregnancy characteristics, and newborn weight and gender. Models were trained on 21,017 births during 2011 to 2015 (training cohort), and accuracy assessed by prediction on 15,045 births during 2016 to 2017 (test cohort). Results  Six variables delivered predictive success equivalent to the full set of 35 variables: maternal weight, height, and age, gestation at birth, medically-indicated induction, and birth weight. Internal validation within the training cohort gave a receiver operator curve with area under the curve (ROC-AUC) of 0.722. External validation using the test cohort gave ROC-AUC of 0.722 (0.713–0.731 confidence interval). When comparing observed and predicted CB rates at 16 institutions in the test cohort, five had significantly lower than predicted rates and three had significantly higher than predicted rates. Conclusion  Six routine clinical variables used to adjust for case-mix can identify outliers when comparing institutional CB rates. [ABSTRACT FROM AUTHOR]

Introduction: This study investigates associations between maternal body mass index (BMI) early in pregnancy and obstetric interventions, maternal and neonatal outcomes.Material and Methods: This is a cohort study of nulliparous women originally included in a cluster randomized controlled trial carried out at 14 Norwegian obstetric units between 2014 and 2017. The sample included 7189 nulliparous women with a singleton fetus, cephalic presentation and spontaneous onset of labor at term, denoted as group 1 in the Ten-Group Classification System. The women were grouped according to the World Health Organization BMI classifications: underweight (BMI <18.5), normal weight (BMI 18.5-24.9), pre-obesity (BMI 25.0-29.9), obesity class I (BMI 30.0-34.9), and obesity classes II and III (BMI ≥35.0). We used binary logistic regression to estimate crude and adjusted odds ratios (ORs) of the interventions and outcomes, with associated 95% confidence intervals (CIs), comparing women in different BMI groups with women of normal weight.Results: We found an increased risk of intrapartum cesarean section in women of obesity class I and obesity classes II and III, with adjusted OR of 1.70 (95% CI 1.21-2.38) and 2.31 (95% CI 1.41-3.77), respectively. Women in obesity groups had a gradient of risk of epidural analgesia and use of continuous CTG (including STAN), with adjusted OR of 2.39 (95% CI 1.69-3.38) and 3.28 (95% CI 1.97-5.48), respectively. Women in obesity classes II and III had higher risk of amniotomy (adjusted OR = 1.42, 95% CI 1.02-1.96), oxytocin augmentation (adjusted OR = 1.54, 95% CI 1.11-2.15), obstetric anal sphincter injuries (adjusted OR = 2.21, 95% CI 1.01-4.85) and postpartum hemorrhage ≥1000 mL (adjusted OR = 2.20, 95% CI 1.29-3.78). We found a reduced likelihood of spontaneous vaginal delivery for pre-obese women (adjusted OR = 0.85, 95% CI 0.74-0.97) and no associations between maternal BMI and neonatal outcomes.Conclusions: Obese women in Ten-Group Classification System group 1 had increased risks of obstetric interventions and maternal complications. There was a gradient of risk for intrapartum cesarean section, with the highest risk for women in obesity classes II and III. No associations between maternal BMI and neonatal outcomes were observed. [ABSTRACT FROM AUTHOR]

Objective: To compare two pain management strategies: oral tramadol or a verbal analgesia technique during insertion of an intrauterine device (IUD) among nulliparous women.Study Design: In this randomized, controlled trial, 54 nulliparous women undergoing insertion of a levonorgestrel-releasing intrauterine device (IUD), from December 2015 to December 2018 were randomized to receive oral tramadol for analgesia or verbal analgesia prior to IUD insertion. Demographic data, clinical symptoms, visual analogue scale (VAS) and complications were reviewed from patient records.Results: There was no difference between the two groups regarding gravidity, age, smoking or body mass index. No significant differences were detected between the groups regarding the procedure, including ease of insertion (p = .415), number of insertion attempts (p = .514) and complications during the insertion (p = .150). Mean pain level by VAS was 4.5 ± 1.6 (range 2-8) for the tramadol group and 4.8 ± 2.4 (0-10) for the verbal analgesia group (p = .610). There was no spontaneous ejection of the IUD in either group, and no endometritis or discomfort that resulted in IUD removal.Conclusion: There was no benefit in using oral tramadol for analgesia prior to IUD insertion among nulliparous women. Verbal analgesia can be a suitable technique for this process and clinicians should become more familiar with its use. [ABSTRACT FROM AUTHOR]

This study was a multicenter retrospective cohort study of term nulliparous women who underwent labor, and was conducted to develop an automated machine learning model for prediction of emergent cesarean section (CS) before onset of labor. Nine machine learning methods of logistic regression, random forest, Support Vector Machine (SVM), gradient boosting, extreme gradient boosting (XGBoost), light gradient boosting machine (LGBM), k-nearest neighbors (KNN), Voting, and Stacking were applied and compared for prediction of emergent CS during active labor. External validation was performed using a nationwide multicenter dataset for Korean fetal growth. A total of 6549 term nulliparous women was included in the analysis, and the emergent CS rate was 16.1%. The C-statistics values for KNN, Voting, XGBoost, Stacking, gradient boosting, random forest, LGBM, logistic regression, and SVM were 0.6, 0.69, 0.64, 0.59, 0.66, 0.68, 0.68, 0.7, and 0.69, respectively. The logistic regression model showed the best predictive performance with an accuracy of 0.78. The machine learning model identified nine significant variables of maternal age, height, weight at pre-pregnancy, pregnancy-associated hypertension, gestational age, and fetal sonographic findings. The C-statistic value for the logistic regression machine learning model in the external validation set (1391 term nulliparous women) was 0.69, with an overall accuracy of 0.68, a specificity of 0.83, and a sensitivity of 0.41. Machine learning algorithms with clinical and sonographic parameters at near term could be useful tools to predict individual risk of emergent CS during active labor in nulliparous women.

PurposeTo describe the intrauterine contraception (IUC) adoption process among nulliparous adolescents and to identify the role of the medical provider in this trajectory.MethodsWe conducted semistructured interviews with a clinic-based sample of 20 nulliparous adolescents (aged 15-24 years) with a history of IUC use. Interviews were analyzed using modified grounded theory and cross-case analysis to reveal a process model for IUC adoption, with a focus on the role of the medical provider.ResultsThe model includes the following stages: first awareness, initial reaction, information gathering, adoption, and adjustment and reassessment. It is influenced by personal preferences and experiences, friends, family, sexual partner(s), and medical providers. Interactions with medical providers that study participants found helpful in navigating the adoption process included the use of visuals; tailored counseling to address specific contraceptive needs; assurance that IUC discontinuation was an option; information on a wide range of side effects; medical provider self-disclosure regarding use of IUC; and addressing and validating concerns, both before and after IUC insertion.ConclusionsNulliparous adolescents in this study described a complex IUC adoption process in which the medical provider plays a substantial supportive role. Findings from this study may be used to counsel and support future nulliparous adolescents regarding IUC use.

This study aimed to investigate the role of prolonged second stage of labour and second stage caesarean section on the risk of spontaneous preterm birth (sPTB) in a subsequent pregnancy. This was a retrospective cohort study of nulliparous women with two consecutive singleton deliveries between 2014 and 2017 at a tertiary centre. In the vaginal delivery cohort, subsequent pregnancy outcomes for women with a prolonged second stage (>2 h) were compared with those with a normal second stage (≤2 h). In the caesarean delivery cohort, women with a first stage or a second stage were compared with the vaginal delivery cohort. The primary outcome was subsequent sPTB. A total of 821 women met inclusion criteria, of which 74.8% (614/821) delivered vaginally and 25.2% (207/821) delivered by caesarean section. There was no association between a prolonged second stage in the index pregnancy and subsequent sPTB (aOR 0.70, 95% CI 0.13–3.83, p=0.7). The risk of subsequent sPTB was threefold for those with a second stage caesarean section; however this did not reach statistical significance. A prolonged second stage of labour in the index pregnancy is not associated with an increased risk of subsequent sPTB. A second stage caesarean section in the index pregnancy may be associated with an increased risk of subsequent sPTB, however there was no statistically significant difference. These findings are important for counseling and suggest that the effects of these factors are not clinically significant to justify additional interventions in the subsequent pregnancy. [ABSTRACT FROM AUTHOR]

Intrauterine devices (IUDs) are highly effective at preventing pregnancy. Levonorgestrel (LNG) IUDs also have beneficial effects on menstrual bleeding and abdominal and pelvic pain. Although there are increasing data on use of IUDs for contraception in adolescents and for medical indications in adults, there are extremely limited data on LNG IUD use for medical indications in adolescents. Our objective is to describe the characteristics and experiences of LNG IUD use in nulliparous adolescents and young women using IUDs for medical indications. We conducted a retrospective chart review of all nulliparous patients aged 22 years and younger who underwent LNG IUD insertion at a tertiary care children's hospital between July 1, 2004 and June 30, 2014 primarily for noncontraceptive indications. Descriptive statistical analysis was performed. We identified 231 LNG IUDs placed in 219 nulliparous women for medical indications during this time period. Mean patient age was 16.8 years (±2.2). Only 41% reported ever being sexually active. IUD continuation rate at 1 year was 86%. The amenorrhea rate at 1 year was 51%. Approximately 80% of women reported improvements in menstrual bleeding and abdominal and pelvic pain. Side effects and complications were low. This study provides evidence that LNG IUDs are effective, well-tolerated, and safe menstrual management options in young nulliparous women, including younger adolescents and those who have never been sexually active. This method is an excellent first-line therapy option for adolescents and young women for both contraceptive and noncontraceptive indications, regardless of age, parity, or sexual activity. [ABSTRACT FROM AUTHOR]

This study evaluated the applicability of intrauterine artificial insemination (IUAI) in gilts and the impact of age at insemination and different body characteristics of gilts on the success rate for cannula insertion. Additionally, reproductive performance was evaluated for IUAI and cervical artificial insemination (CAI), considering different semen dose sizes. A total of 636 gilts were assigned in a 2 × 2 factorial design: two artificial insemination techniques (CAI and IUAI) and two semen dose sizes (1.5 × 109 sperm cells/50 mL or 2.5 × 109 sperm cells/80 mL). In those gilts assigned to IUAI (n = 319) the success rate for intrauterine cannula insertion was evaluated according to weight at first detected estrus, body condition score (BCS), and age at insemination. Reproductive performance, occurrence of bleeding, and semen backflow during all inseminations were compared among groups (2 × 2). Two subgroups were evaluated regarding the time expended to perform insemination (n = 380), and the semen backflow collected during 1 h after insemination (n = 114). The success rate for intrauterine cannula insertion, based on a successful insertion in all inseminations performed during estrus, was 58.9%. Additionally, greater possibility (>60%; P ≤ 0.04) of cannula insertion was observed in heavier gilts (≥124 kg), as well as in older gilts (≥225 d) and those with greater BCS (>3). There were no differences among the groups in pregnancy rate (≥95.3%; P = 0.23), farrowing rate (≥93.7%; P = 0.54), total piglets born (≥14.5; P = 0.45), as well as, bleeding (P = 0.48) and backflow (P = 0.48) during insemination. However, the percentage of semen backflow volume and percentage of sperm cells in the backflow were lower in gilts inseminated by CAI with 1.5 billion sperm cells/50 mL (P < 0.01) than in the other groups. There was no expressive reduction in time expended to perform IUAI compared to CAI. However, gilts inseminated with 1.5 billion sperm cells/50 mL showed a lower total time to inseminate than all other groups (P < 0.01). In conclusion, higher weight, BCS, and age increased the success rate for cannula insertion. However, IUAI did not optimize the insemination procedure, and remains limited for gilts due to the low success rate for cannula insertion. Reproductive performance was not affected by IUAI or CAI using 1.5 or 2.5 billion sperm cells in 50 or 80 mL, respectively, suggesting the possibility of using CAI with 1.5 billion sperm cells/50 mL in gilts. • Older and heavier gilts had a higher percentage of IUAI cannula insertion. • Time to perform insemination was not optimized with IUAI in gilts. • Semen doses with 1.5 or 2.5 billion sperm cells did not affect performance of gilts. • Reproductive performance was not affected by cervical or intrauterine insemination. [ABSTRACT FROM AUTHOR]

Objective: To elucidate the efficacy and safety of attempting a vaginal birth and to understand the factors that contribute to the increased risk of operative delivery in women aged 40 years or older.Methods: A database of the Japanese Red Cross Nagoya Daiichi Hospital was reviewed to identify women aged 40 years or older with singleton, vertex, and vital pregnancies who attempted vaginal delivery at and after 37 + 0 gestational weeks between January 2011 and December 2016.Results: A total of 415 women met the criteria for inclusion in this study, including 372 and 43 women who gave birth by vaginal delivery and by intrapartum cesarean section (CS), respectively. Vaginal delivery was observed in 84.1% (201/239) and 97.2% (171/176) of nulliparous and multiparous women, respectively. In a logistic regression model, nulliparity [odds ratio (OR), 5.18; 95% confidence interval (CI), 1.91-14.00], assisted reproductive technology (OR, 2.83; 95% CI, 1.42-5.62), and admission for induction of childbirth (OR, 2.68; 95% CI, 1.08-6.67) were associated with a higher likelihood of intrapartum CS. Of 372 women who delivered vaginally, 62 women needed operative delivery. Operative delivery was necessary for 25.4% (51/201) and 6.4% (11/171) of nulliparous and multiparous women, respectively. A logistic regression model identified nulliparity (OR, 3.91; 95% CI, 1.89-8.08) and administration of ecbolic (OR, 2.49; 95% CI, 1.21-5.10) as being independent factors associated with vacuum extraction.Conclusions: Maternal age 40 years or older should not be a barrier for attempting a vaginal delivery, and those women should be encouraged to attempt a vaginal delivery. [ABSTRACT FROM AUTHOR]

This study was to evaluate the clinical presentation and management of fibroid uterus. Study Design: Retrospective Descriptive study. Setting: Independent University Hospital Faisalabad, which is a Tertiary Care Hospital providing health care facilities to poor socioeconomic group. Period: 1st May 2015 to 30th April 2017. Material & Methods: All patients with fibroid uterus who were admitted in gynae ward and operated. Patients having fibroid uterus with pregnancy and patients on medical management were excluded. Results: 56 patients of various ages included in study. The age distribution of patients was 20-70 years with a mean age of 45 years. Parity of patients range from 0-8, 58% were multiparous and 21% were nulliparous. The most common complaints of patients were menorrhagia 83% with anemia and dysmenorrheal 25%. Regarding management total abdominal hysterectomy was performed in 67% of patients preferably in with multiparity and myomectomy in 32% of total patients. Conclusion: Fibroid uterus is the most common benign tumor of reproductive age influencing fertility outcomes and general health of females. This study reinforces the fact that large number of patients requires surgical management because of its varied clinical presentations and often with failure of medical treatment. [ABSTRACT FROM AUTHOR]

Background: Nipple inversion in nulliparous women is often encountered and is a surgical challenge. The challenge lies in the correction of deformity with minimal marks and also in not damaging the lactiferous ducts, which will interfere with future breastfeeding. Aim: To provide a relatively simple technique, which can be easily performed as an outpatient procedure with minimal complications. Materials and Methods: A total of 11 patients were treated with this technique of which 5 patients had bilateral inverted nipples. Results: We had no recurrence and the follow-up period was of minimal of 1 year. One patient had mild stitch infection, which healed conservatively with antibiotics. Conclusion: The pursestring technique described offers a simple surgical option for the treatment of nulliparous women with nipple inversion. [ABSTRACT FROM AUTHOR]

Purpose: Evaluation of simplified Bishop score and ultrasound cervicometry in the assessment of labor induction success in nulliparous women. Methods: Prospective cohort study included 146 nulliparous women with singleton pregnancy and indications for labor induction. Prior to labor induction, cervicometry and Bishop score were determined. Upon delivery, patients were classified as those delivered vaginally and by cesarean section (CS) after unsuccessful labor induction. Results: Bishop score >5 was found in 47.95% of vaginally delivered women and 12.33% of patients delivered by CS (p <.01). Cervicometry had appropriate findings in 34.2% of vaginally delivered women and 75.3% of those delivered by CS (p <.01). Bishop score (>5 versus ≤5) had lower sensitivity (52.05%) and specificity (12.33%) than cervicometry (good versus unfavorable findings) (sensitivity 65.75%, specificity 75.34%) for prediction of labor induction success. If Bishop score was ≤5, cervicometry had 50.0% sensitivity and 78.13% specificity, while if Bishop score was >5, 82.86% sensitivity and 55.56% specificity. Obtained model for predicting labor induction outcome in nulliparous women based on their clinical and ultrasonographical characteristics identified the Bishop score as the most important predictor. Conclusions: Study confirmed the usefulness of simplified Bishop score and ultrasound cervicometry in the assessment of labor induction success in nulliparous women. [ABSTRACT FROM AUTHOR]

The present study was conducted to examine the effect of conventional the Ovsynch protocol (OVS) and a modified Ovsynch synchronization (GPGMH) protocol on the follicular dynamics, estrus, ovulation, and pregnancy in nulliparous and multiparous crossbred (swamp × riverine) buffaloes during different seasons. GPGMH or OVS protocols were used to synchronize nulliparous (n = 128; GPGMH = 94, OVS = 34) and multiparous (n = 154; GPGMH = 122, OVS = 32) buffaloes during the peak (n = 186; GPGMH = 143, OVS = 43) and low breeding (n = 96; GPGMH = 73, OVS = 23) seasons. Buffaloes were monitored for follicular dynamics, estrus response, ovulation, and pregnancy rates. The results showed that protocol, parity, and season had significant effects on estrus, ovulation, and pregnancy variables, and interactions among parity and protocol, season and protocol, and season and parity were observed for few of reproductive indices in the crossbred buffaloes. There were no significant (p > 0.05) interaction for protocol, parity and season. In multiparous buffaloes, the application of the GPGMH protocol significantly (p < 0.05) increased the interaction to the interval to estrus onset after the second GnRH, estrus response, ovulation rate, and pregnancy rate, and lowered (p < 0.05) the silent estrus when compared with the conventional OVS protocol. During the peak breeding season, the application of the GPGMH protocol significantly (p < 0.05) improved the interaction to the estrus response, ovulation rate, and pregnancy rate, while it lowered (p < 0.05) the silent estrus incidence when compared to the conventional OVS protocol. In conclusion, the GPGMH protocol, in comparison to the OVS protocol, improves the follicular dynamics, estrus response, ovulation, and pregnancy rates in crossbred multiparous buffaloes during the peak breeding seasons.

Introduction: Consecutive pregnancies with an of interval less than two years is associated with adverse consequences for the mother and child. Education and support of women during breastfeeding is one of strategies that have been used for appropriate spacing between pregnancies. This study aimed to investigate the effect of peer support on the incidence of pregnancy during breastfeeding and the use of family planning methods in Ilam, Iran. Materials & Methods: This interventional study was conducted in birth and health centers of Ilam between 2010 and 2012 among 240 nulliparous women who were randomly divided into case and control groups. The control group received the standard educational programs, while the case group received both the standard education and peer support from 30 consultants for six months after delivery. One hundred fifty-four participants (79 subjects in the case group and 74 in the control group) completed the questionnaires.. The collected data were analyzed using decriptive statistics such as mean and percentage and chi-square test and Fisher's exact test in SPSS, version 16. Findings: The results showed that 24 months after delivery, pregnancy rate during breastfeeding in the control group was significantly higher than the case group (20% v.s 1.5%; P=0.004). The time of pregnancy in the control group was significantly earlier than the case group(9.6±3.56 months postpartum vs. 18.26±1.25; p=0.01). The two groups were statistically different in terms of onset of use of contraceptive methods (72.71±61.35 vs. 10.02±36.71 days post-partum; P=0.001). Discussion & Conclusions: Appropriate education and consultation programs for young and inexperienced women can prevent pregnancies during breastfeeding.

Abstract Background Rising rates of caesarean section (CS) are a concern in many countries, yet Sweden has managed to maintain low CS rates. Exploring the multifactorial and complex reasons behind the rising trend in CS has become an important goal for health professionals. The aim of the study was to explore Swedish obstetricians’ and midwives’ perceptions of the factors influencing decision-making for CS in nulliparous women in Sweden. Methods A qualitative design was chosen to gain in-depth understanding of the factors influencing the decision-making process for CS. Purposive sampling was used to select the participants. Four audio-recorded focus group interviews (FGIs), using an interview guide with open ended questions, were conducted with eleven midwives and five obstetricians from two selected Swedish maternity hospitals after obtaining written consent from each participant. Data were managed using NVivo© and thematically analysed. Ethical approval was granted by Trinity College Dublin. Results The thematic analysis resulted in three main themes; ‘Belief in normal birth – a cultural perspective’; ‘Clarity and consistency – a system perspective’ and ‘Obstetrician makes the final decision, but...’, and each theme contained a number of subthemes. However, ‘Belief in normal birth’ emerged as the core central theme, overarching the other two themes. Conclusion Findings suggest that believing that normal birth offers women and babies the best possible outcome contributes to having and maintaining a low CS rate. Both midwives and obstetricians agreed that having a shared belief (in normal birth), a common goal (of achieving normal birth) and providing mainly midwife-led care within a ‘team approach’ helped them achieve their goal and keep their CS rate low.

Introduction: Anxiety is a common problem among pregnant women, which has a negative impact on mother and neonate. Midwives are responsible for providing advice and giving care to mothers during pregnancy, delivery, and postpartum. This study was conducted to evaluate the effect of individual counseling program by a midwife on anxiety during pregnancy in nulliparous women. Materials and Methods: This clinical trial was conducted among 90 primiparous women with the gestational ages of 28 to 30 weeks referred to healthcare centers of Mashhad, Iran, during 2015-2016. The participants were randomly assigned into two groups of intervention and control (45 individuals per group). The subjects in the intervention group received three sessions (once every two weeks) of the individual counseling program based on the content of the consultation model in the Gamble's study, and the control group got routine care. Data were collected using the Beck Anxiety Inventory and demographic characteristics form. The level of anxiety was measured at pre-intervention phase during the gestational ages of 34 to 36 weeks. Data analysis was performed using Chi-squared test and t-test with the help of SPSS software, version 16. P-value less than 0.05 was considered statistically significant. Results: The mean scores of anxiety in the intervention and control groups were 6.355±3.960 and 9.822±5.420 during the gestational ages of 34-36 weeks, respectively, which represented a significant difference between the groups (P

Introduction: The best way to deliver a term breech infant is still a much discussed topic among obstetricians. The question whether nulliparity should be considered an exclusion criterion for an intended vaginal breech delivery is not fully answered.Objective: We compared maternal and neonatal outcome of intended vaginal breech deliveries of nulliparous versus multiparous women at term.Study Design: We conducted a prospective case-control study between January 2004 and December 2016. 1046 women expecting singletons at term with favorable pelvic measurements were enrolled in the study.Results: Neonatal morbidity and mortality was not significantly different in deliveries of nulliparous (n = 647) versus multiparous (n = 399) women. Nulliparous women had a significantly higher rate of a cesarean section during labor than multiparous women. Maternal birth-injury rates and the use of epidural anesthesia were significantly higher comparing vaginal births of nulliparous (n = 384) versus multiparous (n = 331) women.Conclusion: Nulliparity seems not be an exclusion criterion for intended vaginal breech birth at term. It is still important to inform the women of an increased risk of a cesarean section during labor. A clinical management built on this evidence might reduce negative implications for future pregnancies. [ABSTRACT FROM AUTHOR]

Background: Although intrauterine contraceptive device is highly effective, safe, long term and reversible method of contraception, the general population and physicians refuse. IUDs for nulliparous women due to persistent rumors about its side effects and complications. The aim of this study was to assess the acceptability of IUD use in nulliparous women by both women and health care providers in Egypt.Methods: Five hundred thirty nulliparous women and 200 physicians were interviewed in 10 family planning clinics in Suez and Minia cities - Egypt. The knowledge and attitudes of women and health care providers towards IUD use in nulliparous women were assessed through a well designed questionnaire over 2 years. Those women who accepted using IUD were then followed up for 6 months.Results: Most of nulliparous women sought for contraception reported a negative impression of IUD method (96.2%). 82.5% of physicians had the same attitude. The reasons for refusing IUD among nulliparous women are fear of side effects including infection (52.8%), and bleeding (37.7%).Also, fear of subsequent infertility 51.9% of women. Regarding the providers, increased pelvic inflammatory disease (PID) represented the highest percentage (70%) for non acceptability, followed by difficult insertion (52.5%). Ninety women who accepted use IUD were followed up 6 months later, 94.4% were still using the method and77.8% were happy with the results.Conclusion: The main barriers that hinder the use of IUD in nulliparous women are the women insufficient knowledge and attitude of their physicians. Good client counseling. Good training for physician to improve their experience would help increase the use of such effective and safe method. [ABSTRACT FROM AUTHOR]

Background: Prolonged latent phase of labour often results in a traumatic birth experience. Prolonged labour is associated with more operative deliveries, haemorrhage, fetal asphyxia and poor birth experience. Women with prolonged labour in a former pregnancy more often demand caesarean section in the next, due to their negative birth experience. "Proactive support of labour" is an alternative method, developed to counteract prolonged labour. There are little research and no randomized controlled study that compare proactive to standard labour support.Methods/design: A prospective, non-blinded, randomized, single-centre, clinical trial where we compare proactive support to standard support of labour in a university hospital setting.Inclusion Criteria: latent phase of labour, non-pathologic pregnancy. Robson group 1, with painful contractions, and fully effaced cervix, with 1-3 cm dilatation.Exclusion Criteria: induction of labour, breech presentation, twin pregnancy, multi-parity, conditions that require extended surveillance before and/or during labour.Primary Outcome: spontaneous, uncomplicated vaginal delivery. After inclusion, women randomized to proactive support of labour will stay at the hospital and have one-to-one midwife support. If no progression during the next 1-2 hours, amniotomy and/or oxytocin stimulation will be started. The control group will adhere to the standard procedures for labour support: expectance until established regular contractions and 4-5 cm cervical dilatation, and then one-to-one midwife support.Discussion: The idea of proactive support of labour is to initiate early intervention when there are signs of slow progress in order to avoid protracted labour with exhaustion of the mother, the uterus and prolonged stress of the foetus. Proactive support of labour may represent a useful method to improve labour support in nulliparous women. However, evidence based on randomized controlled trials are needed in order to know whether proactive support of labour is comparable or superior to standard care. A randomized, controlled trial is described; challenges and possible clinical implications are discussed.Trial Registration: The Proactive Support of Labor Study (PAF) ClinicalTrials, NCT03056313. Registered on February 17, 2017. [ABSTRACT FROM AUTHOR]

Purpose: Currently there are no existing data regarding the maternal and neonatal outcomes for nulliparous women delivering neonates with birthweight above 4500 g. We aim to evaluate birth outcome among these subset of parturients.Methods: A retrospective study of nulliparous delivering a singleton fetus weighing  ≥ 4500 g in two tertiary medical centers between 2007 and 2018. Women who chose to undergo a trial of labor (TOL) were compared to those who underwent elective cesarean delivery (CD).Results: Overall, 121 women were included. Seventy eight (65.4%) women elected a TOL while 43 (34.6%) had elective CD. Of women who chose TOL, 46 (59%) delivered with unassisted vaginal delivery, 28 (36%) by intrapartum CD, and 4 (5%) by assisted vaginal delivery, reaching TOL success rate of 64% (50/78). The rates of shoulder dystocia and anal sphincter injury in vaginal deliveries were 5/50 (10%) and 2/50 (4%) respectively. Successful TOL was negatively associated with the presence of gestational diabetes [5 (18%) vs. 0 (0%), OR 0.8 (95% CI 0.7-0.9), p = 0.005], and was positively associated with maternal height (median 170 cm vs. 165 cm, p = 0.002), epidural analgesia [42 (84%) vs. 16 (57%), OR 3.5 (95% CI 1.2-9.8), p = 0.009] and spontaneous onset of labor (38 (76%) vs. 10 (36%), OR 5.7 (95% CI 2.1-15.6), p = 0.001. Neonates born after TOL were more commonly complicated by meconium aspiration syndrome as compared to no TOL (9 (11%) vs. 0 (0%), OR 1.1 (95% CI 1.04-1.22, p = 0.02). Only maternal height was independently associated with successful TOL (aOR 6.9 (95% CI 1.03-46.3, p = 0.04). Maternal and neonatal adverse composite outcomes were associated with gestational hypertensive disorders (10 (50%) vs. 5 (5%). OR 19.2 (5.5-67.4), p < 0.001) and with delivery before 40 weeks (9 (57%) vs, 86 (82%), OR 3.5 (95% CI 1.2-10.6, p = 0.02), respectively.Conclusions: Trial of vaginal delivery in nulliparous with fetuses ≥ 4500 g was associated with a high failure rate, with only two thirds of parturients achieving successful vaginal delivery. Nevertheless, neonatal outcomes mostly did not differ according to the mode of delivery. Maternal height was the only factor associated with successful vaginal delivery. [ABSTRACT FROM AUTHOR]

Objective: To assess if delayed amniotomy during labor induction is associated with adverse delivery outcomes.Study Design: Retrospective cohort study of women with a viable, singleton gestation who underwent labor induction at a tertiary-care hospital (4/2014-3/2017). Women were excluded if oxytocin was not used or if spontaneous rupture of membranes (ROM) occurred ≤8 h after oxytocin initiation. The primary outcome was cesarean delivery, and secondary outcomes included postpartum hemorrhage, maternal infectious morbidity, neonatal 5-min Apgar score <7, and neonatal intensive care unit admission. Women were compared by timing of amniotomy: delayed (ROM > 8 h after oxytocin initiation) versus not delayed. Multivariable logistic regression was used to estimate the association between delayed amniotomy and study outcomes.Results: Of 2081 women who met inclusion criteria, 1125 (before 54%) had delayed amniotomy. Women with delayed amniotomy had ROM 12.7 h (IQR 10.0, 17.9) after oxytocin versus 5.0 h (IQR 3.7, 6.5) without delayed amniotomy. In multivariable regression, delayed amniotomy was associated with increasingly higher odds of cesarean as maternal obesity severity increased (aOR 1.58, 95 %CI 1.24-2.03 at BMI 30 kg/m2; aOR 2.15, 95 %CI 1.45-3.21 at BMI 40 kg/m2; aOR 2.93, 95 %CI 1.54-5.57 at BMI 50 kg/m2).Conclusion: Delayed amniotomy >8 h after starting oxytocin for labor induction was associated with higher odds of cesarean delivery. Significant delay in ROM should be avoided during labor induction. [ABSTRACT FROM AUTHOR]

Background: Spontaneous preterm birth (sPTB) has a detrimental impact on perinatal outcome, as well as on the resources of health systems in high-income countries. Thus, the objective of the current study was to determine the incidence of modifiable risk factors in pregnancy and their impact on the rate of sPTB. Methods: All nulliparous pregnant women, in singleton pregnancies, with free medical and obstetric history, were eligible to participate in this study. The primary outcome of interest was the incidence of specific modifiable risk factors for sPTB. The correlations between these risk factors and sPTB were also investigated. Results: Overall, 2027 women were eligible for the study and agreed to participate. The incidence of sPTB was 4.9%; 25.5% (n = 518) of the participants were in extreme maternal age (<20 or >35 years), 34.5% (n = 701) had an abnormal body mass index (BMI) (<18.5 or ≥25 kg/m2), 4.4% (n = 89) reported use of assisted reproductive technology (ART) and 10.9% (n = 220) reported themselves as smokers in pregnancy. In the multivariate analysis, sPTB was significantly correlated with ART conception [odds ratio (OR): 2.494, 95% confidence interval (CI): 1.196–5.199]. Conclusion: Approximately one in 20 primiparous pregnant women in the study had a sPTB. The study population included a high percentage of women of advanced maternal age, with abnormal BMI and smokers, but these characteristics did not affect the incidence of sPTB. On the other hand, conception following ART increased two-fold the risk of sPTB. [ABSTRACT FROM AUTHOR]

Background and objectives: Childbirth consists of a three-stage period beginning with uterine contractions and ending in the expulsion of the placenta. The present study was conducted to compare the effects of Ringer's solution, dextrose solution 5%, and oral intake on the duration of total labor and labor stages (primary outcome) and the frequency of oxytocin administration and prolonged labor (secondary outcome) in nulliparous women with spontaneous vaginal delivery.Materials and methods: The present randomized clinical trial was conducted on 201 nulliparous women in labor assigned with a randomized block design to three groups, each receiving either Ringer's solution plus oral fluids, dextrose solution 5% solution plus oral fluids or oral fluids alone. The solutions were intravenously administered at a rate of 125 ml/h in the groups receiving the solutions and the subjects in the oral fluids group could consume liquids of their choice (water, orange juice, and apple juice). The duration of total labor and labor stages (the active stage, the second, and third stages of labor) were recorded by the researcher in minutes. Furthermore, the frequency of oxytocin administration and prolonged labor were recorded by the researcher by using a checklist. Data were analyzed using the Kruskal-Wallis test, Mann-Whitney's U-test, chi- square test and Fisher exact test.Results: The mean (±SD) duration of total labor was 301.2 (±50.0) minutes in the Ringer group, 171.9 (±36.4) in the dextrose 5% group, and 524.8 (±103.4) in the oral fluids group, suggesting a statistically significant intergroup difference (p < .001). The mean (±SD) duration of the active stage of labor was 276.7 (±91.3) minutes in the Ringer group, 150.6 (±78.5) in the dextrose 5% group, and 302.4 (±136.8) in the oral fluids group, suggesting a statistically significant intergroup difference (p < .001). A significant difference was also observed between the three groups in terms of the duration of the third stage of labor (p < .001); however, no significant differences were observed in terms of the duration of the second stage of labor (p = .058). Furthermore, a significant difference was observed between the three groups in terms of the need for oxytocin administration (p ≤ .001) and the frequency of prolonged labor (p = .001).Conclusion: The results suggest that the consumption of dextrose solution by nulliparous women reduces the duration of labor, the need for oxytocin administration and the frequency of prolonged labor compared to when Ringer's solution and oral fluids are used. [ABSTRACT FROM AUTHOR]

Purpose: Most professional guidelines advise against routine episiotomy during vaginal delivery, although mounting evidence supports its protective role regarding obstetric anal sphincter injury (OASI). We aimed to study the effect of lateral and mediolateral episiotomies on the rate of OASI in relation to birthweight among nulliparous women undergoing vaginal delivery.Methods: A historical cohort study was conducted of all nulliparous women who delivered vaginally at term between 2011 and 2019 at a tertiary university hospital. Women were allocated into two groups: (1) with OASI and (2) without OASI. Episiotomy performance and birthweight groups were analyzed.Results: Overall, 22,250 deliveries were analyzed for inclusion: 18,533 (83.3%) spontaneous vaginal deliveries (SVD), 3222 (14.5%) vacuum-assisted deliveries (VAD) and 495 (2.2%) forceps deliveries. Total episiotomy and OASI rate was 48.2% and 1.7%, respectively. Episiotomy rate was lower in the OASI group as compared to the no OASI group (158 (41.3%) vs. 10,568 (48.3%), OR 0.75, 0.61-0.92, p = 0.006). Median birthweight was higher for OASI group neonates (3355 vs. 3160, p < 0.001). In SVDs, episiotomy decreased the rate of OASI in neonatal birthweight groups of 3000-3499, 3500-3999 and > 4000 g (OR 0.56, 0.38-0.82, p = 0.003; 0.66, 0.45-0.99, p = 0.04 and 0.24, 0.07-0.78, p = 0.01, respectively). In VADs, episiotomy decreased the rate of OASI in the neonatal weight groups of 2500-2999 and 3000-3499 g (OR 0.36, 0.14-0.89, p = 0.02 and OR 0.38, 0.19-0.75, p = 0.004, respectively).Conclusions: Lateral and mediolateral episiotomies are independent modifiable predictors of OASI, protective against OASI in SVDs when neonates weigh > 3000 g and 2500-3499 g in VADs. [ABSTRACT FROM AUTHOR]

Background: Cesarean delivery (CD) in primiparas with a term singleton vertex fetus (PTSV) is a sentinel event for the future mode of delivery and determinant of repeat CD risk. We aimed to evaluate the risk factors for primary CD in a population with a decade of sustained low rate of intrapartum CD. Methods: This was a retrospective single-center cohort study between 2005 and 2014. The primary outcome of the study was the mode of delivery. PTSV who attempted vaginal delivery were identified and categorized according to the mode of delivery: vaginal delivery vs. CD. Risk factors for intrapartum CD adjusted odds ratio (aOR) [95% confidence interval (CI)] in multivariate analysis were reported. Results: During the study, 121,483 deliveries were registered; 26,301 (21.6%) PTSV were admitted in labor, of which 1944 (7.4%) had an intrapartum CD. Significantly in multivariate analysis, this group had a unique risk profile as compared to those who delivered vaginally; non modifiable risks included advanced maternal age: 3.06 (2.16–4.33), P < 0.001; prior multiple (≥3) miscarriages: 1.94 (1.04–3.62), P = 0.04; low (<6) modified admission cervical score: 2.41 (2.07–2.82), P < 0.001; low birth weight (BW): 1.42 (1.00–2.01), P = 0.05 or macrosomia: 2.38 (1.77–3.21), P < 0.001; modifiable risks included induction of labor: 1.79 (1.51–2.13), P < 0.001 and oxytocin labor augmentation: 8.36 (6.84–10.22), P < 0.001. Conclusion: In a population of PTSV with a sustained low risk for intrapartum cesarean maintained by a strict labor management, induction of labor remains a significant and sole potentially modifiable risk factor for CD. [ABSTRACT FROM AUTHOR]

Abstract Objective Malaria vectors control interventions are designed to cause immediate killing or shorten mosquito lives, therefore does not allow enough time for the development of the parasites to infective stage. The wall lining is new malaria vectors control intervention in Tanzania where its impact on age structure is not well known. Therefore this study aimed at determining the impact of non-pyrethroid durable wall lining on the age structure of malaria vectors. Results Higher proportions of An. gambiae sensu lato (57.1%, z = 2.66, P = 0.0077) and An. funestus (64.8%, z = 3.38, P = 0.001) were collected in the control clusters. Unexpectedly, significantly higher proportion of parous An. gambiae s. l. were collected in the intervention clusters (z = − 2.78, P = 0.0054). The wall lining intervention has demonstrated low impact on age structure of An. gambiae s. l., this call for further studies on the efficacy of the intervention.

Purpose: In this study, the frequency of presentation of nulliparous and multiparous women to prenatal visit during their term period and the importance of educational level in the frequency of presentation were compared. Materials and Methods: 341 patients giving birth with cesarean section or/and spontaneous vaginal delivery in Gülhane Military Medical Academy, Gynecology and Obstetrics department between December 2015 – May 2016, were included in the study. 205 of them were nulliparous while the rest was multiparous. Results: When the number of term period visits of nulliparous and multiparous women were compared, a significant difference between two groups was determined. This significance was detected as in support of nulliparous women. When the number of term period visits were compared with according to the educational level was not statistically significant for women, while it was detected that the frequency of paternal visits with high school degree was significant. Conclusion: Increasing the educational level of society, raising the awareness of parents in terms of the importance of prenatal visit and its frequency will increase the effectiveness of prenatal care. [ABSTRACT FROM AUTHOR]

A focused ethnography was conducted, based on Kleinman's (1981) anthropology of health care, to identify cognitive constructions about birth held by nulliparous urban African-American women in the Southwestern United States, and reconciliation of constructions with birth during postpartum. Semi-structured prenatal interviews of eleven low risk women and four postpartum interviews were completed. Atlas, ti assisted in thematic analysis and organization. Cognitive constructions grew from their mothers' ideas, and included "birth ispainful", followed by "birth damages you and/or the baby" and "birth changes you." Prenatally, women acknowledged birth as unknown beyond these themes. Women evaluated personal birth experiences using these maternal themes. [ABSTRACT FROM AUTHOR]