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Background: Present study attempts to assess the skills of staff including Doctors and nurses posted in labour room and maternity OTs based on OSCE (Objective Structured Clinical Examination) as mentioned in LaQshya guidelines in selected areas of Indore and Ujjain district (M.P) regarding the management of normal labour, the active management of third stage of labour, Newborn Resuscitation, management of PPH due to atonic uterus and management of eclampsia. Even in these parameters many sub-parameters were studied. Materials and Methods: Pre designed semi structured Observation checklist for Health care providers regarding skill assessment of the staff based on OSCE guideline was used to assess Health care providers including Doctors, Staff nurses/ANMs, who are providing MCH services in LR (Labour room) and maternity OT of the selected hospitals of Indore and Ujjain district. Results: Most of the manoeuvres were better performed by staff nurses posted in CHCs rather than those posted in PHCs. Breathing assessment of baby was lacking among staff nurses of both CHCs and PHCs and needed to be tackled with by a reorientation training of paramedical staff in critical care. Decision to transfer (is usually after Consultation with the in charge, hence it is usually the Medical officers prerogative) and bimanual compression/ aortic compression/condom tamponade to control bleeding was done exclusively by MOs. Conclusion: OSCE helped to assess the skills of the staff of maternity wing in a comprehensive manner and was well appreciated by the staff. Such OSCE modules should be developed and regularly used and updated to assess the clinical skill of the staff in the maternity wing of any health centre or hospital. [ABSTRACT FROM AUTHOR]

Copyright of Sportis: Scientific Journal of School Sport, Physical Education & Psychomotricity is the property of Sportis: Scientific Journal of School Sport, Physical Education & Psychomotricity and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Fear of giving birth is the primary factor that has reduced the preference for natural birth. The sudden rise in the percentage of C-sections has harmed women's pregnancy and new-born health. Purpose: To evaluate the effectiveness of peanut ball exercise on reducing fear among primigravida mothers. Materials and Methods: Thirty participants were randomly assigned to experimental (peanut ball exercise, antenatal exercise, antenatal education) and conventional (Antenatal exercises) groups. The fear of childbirth questionnaire (FCQ) was used to evaluate the pre-test the same test used to determine post-treatment values after 12 weeks of the treatment. Results: A significant difference was observed between the experimental and control groups (P =0.0001). peanut ball exercise and antenatal education were effective in mothers with a fear of childbirth. Conclusion: Peanut ball training is effective in mothers with a fear of childbirth. [ABSTRACT FROM AUTHOR]

Though the rationalisation of health care has been well documented, less is known about its impacts on mental health social workers. Drawing on qualitative data collected from 120 interviews and the qualitative comments on a Canadian four-province survey, the article explores the shifting labour process through profession-linked and organisational care strategies. The article argues that power is shifted from mental health social workers to management through stratagems including managerialism, biomedical hegemony and team-based care. These processes are complex and dynamic, travelling along professional divisions and logics, appearing neutral and scientific rather than as conduits reinforcing neoliberalised approaches to health care provision. Social workers' resistance to these models of care is similarly complex and professionally based, though with strong elements of gendered altruism and social justice themes. Though this article draws on Canadian data, the analysis is likely highly applicable to other managerialised contexts including the UK. The article contributes to the intersection of Labour Process Theory and moral economy theory by highlighting the operation of a unique form of engagement referred to here as resistance-as-engagement. Overall, mental health social workers revealed strong oppositional narratives and identities pivoting on their marginalised position within team-based care, medical professional hierarchies and narrow, neoliberal approaches. [ABSTRACT FROM AUTHOR]

Background & Objective: Inducing labor is a common practice in obstetrics to prevent maternal and fetal complications. There are several methods of labor induction, including pharmacological and mechanical approaches. The objective of this study was to determine the most effective approach for labor induction. Materials & Methods: A cross-sectional study at Al-Kadhimiya Teaching Hospital compared labor induction in pregnant females at their third trimester using Misoprostol & Foley Catheter (group A) and Misoprostol alone (group B). The study collected data on maternal age, gestational age, BMI, time frames, mode of delivery, and neonatal outcomes such as Apgar scores and ICU admissions. Results: In a cross-sectional study comparing labor induction with Misoprostol & Foley Catheter (group A) vs. Misoprostol alone (group B), most females in both groups had no cesarean section inductions, normal vaginal deliveries, and no complications. The study found significant differences in BMI, time frame, and time for ripening between the two groups, with group A having lower values for these variables. Conclusion: Foley's with vaginal misoprostol results in a shortened time between induction and delivery than misoprostol alone. [ABSTRACT FROM AUTHOR]

Copyright of Fenerbahce University Journal of Health Sciences (FBU-JOSH) / Fenerbahçe Üniversitesi Sağlık Bilimleri Dergisi is the property of Fenerbahce University Journal of Health Sciences (FBU-JOSH) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Losing blood in the labour’s 3rd stage is the primary factor that impacts maternal health. Immediate breastfeeding could be considered a saving factor in the life of mothers. Since it could naturally spread the oxytocin to stimulate the uterine contraction, dislodging the placenta by such contractions would be easier, reducing bleeding in the labour’s 3rd stage. Objectives: To determine the relationship of breastfeeding early initiation on the extent of vaginal bleeding in the labour's 3rd stage. Methodology: A quasi-experimental study was conducted at the Maternity Teaching Hospital in Sulaimaniyah/ Iraq. Participants were Three hundred pregnant women in 3rd stage of labour in the labour ward who were divided equally into an experimental group that applied early initiation of breastfeeding and a control group that followed routine hospital care and was under investigation for more than five months from 26th February 2020 to 30th July 2021. The probability simple randomization technique was used to ensure that all participants had an equal chance of being selected to participate in the study by the record sheet of structured observation, in which the measure of vaginal bleeding of women in 2 groups was assessed. Descriptive and inferential statistics were used for data analysis. Results: Based on the vaginal bleeding measure in the groups of control and experimental, it is revealed that the extent of vaginal bleeding in the control group was significantly higher than in the experimental group. Conclusion: Breastfeeding immediately following birth is beneficial for reducing the measure of vaginal blood loss. [ABSTRACT FROM AUTHOR]

Introduction: Epidural anesthesia along with an experienced anaesthetist, a dedicated obstetrician and a trained midwife has ability to convert the painful and extensively stressful labour labour event into a less stressful event. The purpose of this study was to compare feto-maternal outcome of labour with epidural analgesia to those without epidural analgesia. Methodology: The prospective, comparative and interventional study was conducted among primigravida with full term pregnancy admitted to maternity ward. Study group were given epidural analgesia which was compared with control group who did not give any labour analgesia. Maternal and foetal outcome were assessed. Results: Difference in mean duration of first stage and second stage of labour was statistically non-significant between two groups (p>0.05). Before the analgesia (basal) mean VAS was 8.45 and 8.32 in women who received epidural anesthesia and cases who didn't receive epidural anesthesia respectively. The mean VAS was significantly less in women who received epidural anesthesia (p<0.001). Conclusion: Use of epidural analgesia during the later stage of labour, when cervical dilatation was more than 4 cm, provides better analgesic effect with minimal side effect and almost equivalent duration of labour. Epidural analgesia doesn't unnecessarily increase operative delivery rate and had no adverse effect on APGAR score of newborns. [ABSTRACT FROM AUTHOR]

Purpose: The conversion of epidural labor analgesia (ELA) to epidural surgical anesthesia (ESA) for intrapartum cesarean section (CS) often encounters failures. This study aimed to develop a nomogram for predicting the failure rate of this conversion.Patients and Methods: A retrospective analysis was conducted on data from the Fujian Maternity and Child Health Hospital. Pregnant women (n=214) who underwent cesarean section after receiving labor analgesia. We performed correlation heat map and Lasso regression in terms of exclusion confounding factors and screening independent variables. A nomogram was developed to predict the occurrence.Results: The developed nomogram incorporated variables such as pregnant history, weight, premature rupture of membranes (PROM), dural puncture epidural (DPE), anesthesiologist level of cesarean section (ALOCS), and Anesthesiologist level of labor analgesia (ALOLA). The model demonstrated good predictive performance, providing a practical tool for assessing the risk of failure in converting labor analgesia to cesarean section anesthesia.Conclusion: The nomogram can aid anesthesiologists in making informed decisions and optimizing patient care. By utilizing the nomogram, clinicians can estimate the probability of conversion failure based on individual patient characteristics and clinical factors. [ABSTRACT FROM AUTHOR]

Copyright of Revista Família, Ciclos de Vida e Saúde no Contexto Social (REFACS) is the property of Universidade Federal do Triangulo Mineiro, Instituto de Ciencias da Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Outcomes of trial of scar (TOS) correlate well with predictions provided by vaginal birth after cesarean scoring systems. In Cameroon, there is limited data on the implementation and effectiveness of these scoring systems, as well as the materno-fetal outcomes of TOS. Objectives: The objective was to utilize the Flamm score in predicting the success of TOS, and to evaluate the maternal and fetal outcomes observed following TOS in Yaounde and Douala Gyneco-Obstetric and Pediatric Hospitals from 2017 to 2021. Material and Methods: We included files of 310 parturient women with single transverse lower uterine segment cesarean section, who had TOS. Data on sociodemographic, reproductive health, Flamm scoring, and labor outcomes were documented using a structured data extraction form and analyzed using the Statistical Package for the Social Sciences version 25. Results: Of the 310 patients, 73.9% had successful vaginal deliveries (VDs) and 26.1% had repeated emergency cesarean. Flamm score predictions were associated with TOS outcomes (P = 0.0001), with mean score of 5.87 ± 0.01 for successful VD compared to 3.72 ± 0.126 for repeat cesarean. Probability of successful VD increased with Flamm score, ranging from 0% for scores of two to 100% for scores > 7, with a cutoff score of 4.5 (Se = 75.0%, Sp = 75.3%). The main maternal complication was one uterine rupture (0.32%) and neonatal complications were three stillbirths (0.98%) and one early neonatal death (0.32%) after repeat cesarean. Conclusions: TOS is associated with high success rates in tertiary hospitals in Cameroon. Applying Flamm score will improve the chances of a successful VD following TOS, and should be encouraged. [ABSTRACT FROM AUTHOR]

Summary: Coronary arteriovenous fistulas are an abnormal conduit between a coronary artery and another cardiovascular lumen, without an intervening capillary bed. The reported prevalence is 0.002–0.3%. Physiologic consequences such as congestive heart failure, coronary steal phenomenon and fistula aneurysm formation and rupture are possible. There are limited reports of symptomatic coronary arteriovenous fistulas in association with pregnancy. We describe a 19‐year‐old woman with symptomatic left circumflex artery to coronary sinus fistula, terminating into a large exophytic varix in the right atrium, presenting for an elective caesarean section at 37 weeks gestational age. Our anaesthetic management strategy aimed to optimise myocardial perfusion, maintain euvolemia, avoid right ventricular obstruction from exophytic varix and avoid sympathetic stimulation or sudden increases in pulmonary vascular resistance. A slowly titrated epidural was used as the primary anaesthetic. Our patient tolerated the procedure well and was discharged home on postoperative day two. Understanding of the potential physiologic consequence of coronary arteriovenous fistulas, and interaction with the physiologic changes of pregnancy and delivery, are essential for the management of these cases. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to compare the efficacy and safety of intravenous paracetamol (1000mg) and intramuscular tramadol (100mg) as labor analgesic. Methods: A prospective randomized study was conducted on 120 women in active labor at NIMS Hospital, Jaipur, between January and September 2023. Patients were divided into two groups: Group A received intravenous paracetamol, and Group B received intramuscular tramadol. Labor progression, pain intensity (according to McGills scale), perinatal outcomes, and maternal side effects were monitored. Results: Paracetamol was found to be more effective in pain relief than tramadol. After 1 and 3 hours, paracetamol demonstrated superior pain relief. After 3 hours, 70% cases of Group A had significant pain relief as compared to 40% cases of Group B. The total duration of labor from the active phase of first stage of labor was 4.55 hours in Group A and 6.46 hours in Group B. Both drugs showed no significant difference in neonatal outcomes. Nausea and vomiting were the primary maternal adverse effects, with tramadol displaying a slightly higher incidence, though the difference was not statistically significant. Conclusion: In conclusion, intravenous paracetamol is a more effective and safer labor analgesic compared to intramuscular tramadol. It offers superior pain relief, shortens the duration of labor, and has fewer maternal side effects. These findings suggest that intravenous paracetamol can be a valuable option for labor analgesia in low-resource healthcare settings in developing countries, contributing to a more positive childbirth experience for mothers. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic disrupted work and family life around the world. For parents, this upending meant a potential re-negotiation of the 'status quo' in the gendered division of labour. A comparative lens provides extended understandings of changes in fathers' domestic work based in socio-cultural context – in assessing the size and consequences of change in domestic labour in relation to the type of work-care regime. Using novel harmonized data from four countries (the United States, Canada, the United Kingdom, and the Netherlands) and a work-care regime framework, this study examines cross-national changes in fathers' shares of domestic labour during the early months of the pandemic and whether these changes are associated with parents' satisfaction with the division of labour. Results indicate that fathers' shares of housework and childcare increased early in the pandemic in all countries, with fathers' increased shares of housework being particularly pronounced in the US. Results also show an association between fathers' increased shares of domestic labour and mothers' increased satisfaction with the division of domestic labour in the US, Canada, and the UK. Such comparative work promises to be generative for understanding the pandemic's imprint on gender relations far into the future. [ABSTRACT FROM AUTHOR]

Objectives The aim of the study was to identify the characteristics associated with spontaneous labor onset in pregnant patients undergoing expectant management at greater than 39 weeks' gestation and delineate perinatal outcomes associated with spontaneous labor compared with labor induction. Study Design This was a retrospective cohort study of singleton pregnancies at ≥39 0/7 weeks' gestation delivered at a single center in 2013. The exclusion criteria were elective induction, cesarean delivery or presence of a medical indication for delivery at 39 weeks, more than one prior cesarean delivery, and fetal anomaly or demise. We evaluated prenatally available maternal characteristics as potential predictors of the primary outcome-spontaneous labor onset. Multivariable logistic regression was used to generate two parsimonious models: one with and one without third trimester cervical dilation. We also performed sensitivity analysis by parity and timing of cervical examination, and compared the mode of delivery and other secondary outcomes between patients who went into spontaneous labor and those who did not. Results Of 707 eligible patients, 536 (75.8%) attained spontaneous labor and 171 (24.2%) did not. In the first model, maternal body mass index (BMI), parity, and substance use were identified as the most predictive factors. Overall, the model did not predict spontaneous labor (area under the curve [AUC]: 0.65; 95% confidence interval [CI]: 0.61–0.70) with high accuracy. The addition of third trimester cervical dilation in the second model did not significantly improve labor prediction (AUC: 0.66; 95% CI: 0.61–0.70; p = 0.76). These results did not differ by timing of cervical examination or parity. Patients admitted in spontaneous labor had lower odds of cesarean delivery (odds ratio [OR]: 0.33; 95% CI: 0.21–0.53) and neonatal intensive care unit (NICU) admission (OR: 0.38; 95% CI: 0.15–0.94). Other perinatal outcomes were similar between the groups. Conclusion Maternal characteristics did not predict spontaneous labor onset at ≥39 weeks' gestation with high accuracy. Patients should be counseled on the challenges of labor prediction regardless of parity and cervical examination, outcomes if spontaneous labor does not occur, and benefits of labor induction. Key Points Majority of patients will attain spontaneous labor at ≥39 weeks. Maternal characteristics do not predict labor at ≥39 weeks. Spontaneous labor has associated lower perinatal risks. A shared decision model should be utilized in counseling patients who may choose expectant management. [ABSTRACT FROM AUTHOR]

Background: Millions of women give birth annually without the support of a trained birth attendant. Generally and globally, countries provide maternal health services for their citizens but there is a coverage gap for undocumented migrant women who often can't access the same care due to their legal status. The objective of this investigation is to explore undocumented migrants' experiences and perceptions of maternal healthcare accessibility. Methods: We held focus groups discussions with 64 pregnant women at 3 migrant health clinics on the Thailand–Myanmar border and asked how they learned about the clinic, their health care options, travel and past experiences with birth services. In this context undocumented women could sign up for migrant health insurance at the clinic that would allow them to be referred for tertiary care at government hospitals if needed. Results: Women learned about care options through a network approach often relying on information from community members and trusted care providers. For many, choice of alternate care was limited by lack of antenatal care services close to their homes, limited knowledge of other services and inability to pay fees associated with hospital care. Women travelled up to 4 h to get to the clinic by foot, bicycle, tractor, motorcycle or car, sometimes using multiple modes of transport. Journeys from the Myanmar side of the border were sometimes complicated by nighttime border crossing closures, limited transport and heavy rain. Conclusions: Undocumented migrant women in our study experienced a type of conditional or variable accessibility where time of day, transport and weather needed to align with the onset of labour to ensure that they could get to the migrant clinic on time to give birth. We anticipate that undocumented migrants in other countries may also experience conditional accessibility to birth care, especially where travel is necessary due to limited local services. Care providers may improve opportunities for undocumented pregnant women to access maternal care by disseminating information on available services through informal networks and addressing travel barriers through mobile services and other travel supports. Trial registration The research project was approved by Research Ethics Committee at the Faculty of Medicine, Chiang Mai University (FAM-2560-05204), and the Department of Community Medicine and Global Health at the University of Oslo—Norwegian Centre for Research Data (58542). Plain Language Summary: Undocumented pregnant migrants have difficulties and limitations in accessing maternal health care services. Although the governments have tried to provide maternal health care services to all, there is still a gap in coverage among this population. This study explores how undocumented pregnant migrants perceive their ability to access maternal health care and share their experiences when utilizing it. We used focus groups to interview 64 pregnant women at three migrant health clinics on the Thailand–Myanmar border. We asked how they learned about the clinic, their health care options, travel, and past experiences with birth services. The results showed that they usually knew about care options from community members and trusted care providers. The limitations for the choice of alternate care were due to a lack of services close to their homes, limited knowledge of other services, inability to pay hospital fees, and difficulty traveling from their residence to the clinic. Therefore, we anticipate that undocumented migrants in other countries may also experience difficulties in accessibility to birth care, especially where travel is necessary due to limited local services. Care providers may improve opportunities for these migrants to access maternal care by disseminating information on available services through informal networks and addressing travel barriers through mobile services and other travel supports. [ABSTRACT FROM AUTHOR]

Context: Women, transgender men, and gender non‐binary individuals who gave birth during the first year of the COVID‐19 pandemic experienced strict visitor restrictions that significantly disrupted their support networks. This study sought to examine women's perceptions and experiences of solitary support, particularly from male partners, during labor and delivery. Methods: From April 2020 through August 2021, I conducted in‐depth interviews with women who had given birth in the previous 12 months in the state of Ohio. I used a multi‐modal recruitment strategy and conducted all interviews virtually. I analyzed transcripts to identify themes using inductive and deductive techniques. Results: I interviewed 12 women who gave birth after the onset of the COVID‐19 pandemic and all opted to have their male partner as their solitary support person. Most women reported putting pressure on their male partners to "step up" in the absence of other sources of support, such as doulas. Couples engaged in intensive communication and planning prior to the delivery, which contributed to increased feelings of emotional closeness. Participants reported mixed feelings about birthing with a solitary support person including having a sense of increased privacy and an ability to focus while also feeling afraid and isolated. Conclusions: Women who gave birth in the first year of the COVID‐19 pandemic and prior to the widespread availability of vaccines were particularly vulnerable to adverse perinatal outcomes, including stillbirth and postpartum depression. Understanding the impact of solitary support from male partners can help inform future person‐centered and equitable maternity care visitor policies. [ABSTRACT FROM AUTHOR]

Childbirth is a remarkable, life-changing process and is frequently regarded as an excruciating, physically and emotionally demanding experience that women endure. Labor pain management poses a significant challenge for obstetricians and expectant mothers. Although pharmacological pain management is the gold standard, it still imposes risks on the mother and baby. Recently, non-pharmacological pain management (NPPM) has emerged as a safe, effective option. Six databases were searched for articles published up to 2023 using specific related keywords and defined inclusion and exclusion criteria. The extraction and gathering of data was made so as to be categorized into physical, psychological, and complementary NPPM techniques. In light of the enormous development and diversity of NPPM techniques, the present review aims to examine contemporary NPPM knowledge and application, discussing efficacy, advantages, limitations, and potential adverse effects, with a specific focus on women's individual requirements, to strengthen obstetricians' knowledge in guiding decision-making for women in childbirth. [ABSTRACT FROM AUTHOR]

Objectives: To characterize pregnant women admitted to Irene Neto Maternity Hospital, Lubango city, Huíla province, and their pregnancy outcomes. Methods: We conducted a descriptive cross-sectional facility-based survey between October 2016 and September 2017, involving 500 pregnant women, followed from admission in labor until the end of delivery. Mean (SD) was computed for quantitative variables, while relative and absolute frequencies were determined for categorical variables. Additionally, confidence intervals were estimated. Results: Among pregnant women 18.3% were adolescents (≤ 19 years) and 14.5% had advanced maternal age (≥ 35 years). Illiteracy was reported by 8.2%. One in three (33.6%) had a short stature (< 1.55 m). Malaria was the most frequent infection during pregnancy (16.3%). Upon admission, 18.1% were anemic (Hb < 11 g/dl) and 36.0% had hypertension (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg), contrasting with the few cases reported of chronic hypertension and pregnancy-induced hypertension. There were 15 twin pregnancies. Cesarean section was performed in 25.2% of the women, although there was no medical indication for 23.0% of women having cesareans. Two maternal deaths occurred in our sample. Among live births from singleton pregnancies (97.1%), birth asphyxia (Apgar < 7 at 5 min) was observed in 22.7% and 10.3% had low birth weight (< 2.5 kg). Conclusions: There are very few studies reporting pregnancy outcomes in Angola. This analysis presents data from Huíla province, the second most populous province. We identified characteristics for higher risk of adverse pregnancy outcomes: adolescence, illiteracy, and short stature. Among newborn outcomes, birth asphyxia and low birth weight demand special attention. Further research is needed to explore the non-medical indications for cesarean section and to better understand the twinning rate in Lubango. Significance: The significance of this paper is that it is one of the very few reports contributing for the knowledge of detailed maternal, obstetric and newborn outcomes in Angolan women. Although our study only addresses the outcomes descriptively, it can be used as a first step in monitoring and improving outcomes of Angolan women. Maternal and child health is a key issue to address sustainable development in Angola. [ABSTRACT FROM AUTHOR]

Background: Labor after cesarean (LAC) remains an optional delivery method among healthy pregnant individuals. Exploring women's attitudes, preferences, reasons for previous cesarean delivery, and the incentives underlying pregnant individuals' preferences could help us understand their choice of delivery mode. In this study we evaluated the preferences and attitudes of eligible pregnant women regarding participation in a LAC in Foshan, China. Methods: A cross‐sectional survey was conducted among 438 pregnant individuals with one prior cesarean delivery (CD) who attended their antenatal examination at a tertiary hospital in southern China, between November 1, 2018, and October 31, 2019. Information on demographic characteristics, obstetric data, preferences for LAC, and incentives for LAC were analyzed. Results: Overall, 85.4% (374/438) of women preferred LAC if they did not have contraindications before delivery, whereas 12.3% (54/438) refused and 2.3% (10/438) were unsure. Participants reported that the most important factors affecting their willingness to undergo LAC were safety indicators (i.e., "ability of hospitals to perform emergency cesarean delivery" [score of 9.28 ± 1.86]), followed by accessibility indicators (i.e., "priority bed arrangements" [score of 9.17 ± 1.84]). Logistic regression analysis indicated that neonatal wellbeing with the prior CD was an independent influencing factor (OR = 2.235 [95%CI: 1.115–4.845], p = 0.024) affecting willingness to access LAC in the subsequent pregnancy. Conclusions: We found a high preference for LAC among pregnant individuals without contraindications before delivery in southern China. Healthcare providers need to ensure access to LAC and increase pregnant individuals' LAC willingness through high‐quality shared decsision‐making in alignment with patient preferences. [ABSTRACT FROM AUTHOR]

Background: Shared decision‐making is an important component of a patient‐centered healthcare system. We assessed the prevalence of parturients with preferences for their labor and childbirth, expressed verbally in the birthing room or as a written birth plan, and studied maternal, obstetric, and organizational factors associated with their expression. Methods: Data came from the 2016 National Perinatal Survey, a cross‐sectional nationwide population‐based survey conducted in France. Preferences for labor and childbirth were studied in three categories: expressed verbally, in writing (birth plan), or unexpressed or nonexistent. Analyses used multinomial multilevel logistic regression. Results: The analysis included 11,633 parturients: 3.7% had written a birth plan, 17.3% expressed their preferences verbally, and 79.0% either did not have or did not express any preferences. Compared with the latter group, written or verbal preferences were both significantly associated with prenatal care by independent midwives (respectively, adjusted odds ratio (aOR) 2.19; 95% confidence interval (CI), [1.59–3.03], and aOR 1.43; 95% CI [1.19–1.71]) and with attendance at childbirth education classes (respectively, aOR 4.99; 95% CI [3.49–7.15], and aOR 2.27; 95% CI [1.98–2.62]). As years in traditional schooling increased, so did its association with preferences. Conversely, parturients from African countries were significantly less likely than French mothers to express preferences. A written birth plan was also associated with characteristics of maternity unit organization. Conclusion: Only one in five parturients reported having expressed preferences for labor and childbirth to healthcare professionals in the birthing room. This expression of preferences was associated with maternal characteristics and the organization of care. [ABSTRACT FROM AUTHOR]

Background: Immigrant women are in a vulnerable position during labour and birth due to language barriers. Communication with women who do not master the host country's language is difficult for midwives, but there are few studies about midwives' experiences. Aim: To explore Norwegian midwives' experiences of encountering immigrant women during labour and birth who do not master the native language. Method: A hermeneutic lifeworld approach. Interviews with eight midwives working at specialist clinics and hospital maternity wards in Norway. Results: The findings were interpreted based on four concepts in the theory "Birth territory: A theory for midwifery practice" by Fahy and Parrat presented in five themes: language barriers can cause disharmony and prevent participation, language barriers can lead to midwifery domination and poorer care, midwives strive for harmony and to be a guardian, medicalisd birth due to language barriers, and disharmony can lead to crossing boundaries. The main interpretation shows that it is midwifery domination and disintegrative power that are prominent. However, the midwives strived to use their integrative power and be guardians, but in doing so they encountered challenges. Conclusion: Midwives need strategies for better communication with immigrant women involving the women and for avoiding a medicalised birth. To be able to meet immigrant women's needs and to establish a good relationship with them, challenges in maternity care need to be addressed. There are needs of care that focus on cultural aspects, leadership teams that support midwives, and both theoretical and organisational care models that support immigrant women. [ABSTRACT FROM AUTHOR]

• All three models (Grobman 2007, Grobman 2021 and Zhang model 2020) were observed to have a fair discriminative capacity. • Poor agreement between observed and predicted probability of successful TOLAC limits its usefulness in the study setting. • A population-specific model, including intrapartum factors, may aid in predicting the outcome among women undergoing TOLAC. To externally validate three predictive models (the Grobman model (2007), the Zhang model (2020), and the Grobman model (2021)) for identifying women with increased chances of a successful trial of labour after caesarean section (TOLAC). This retrospective observational cohort study was conducted in a tertiary teaching hospital from 2018 to 2021. Individual probabilities were calculated for women with previous one caesarean section who underwent TOLAC at term, using the predicted probabilities from the logistic regression models. The primary outcome of this study was vaginal delivery following attempted TOLAC. The predictive ability of the models was assessed using the area under the receiver operative characteristics curves (AUC) and a calibration graph. Of 1515 eligible women who underwent TOLAC, we found an overall rate of successful TOLAC of 60.3 %. No significant difference was noticed in adverse scar outcome and neonatal morbidity while comparing successful and failed TOLAC. The discriminative ability of Grobman-2007 and Grobman-2021 and the Zhang model were fair to poor with the AUC of 0.54(95 % CI 0.51–0.57), 0.62(95 % CI 0.59–0.65) and 0.66(95 % CI 0.63–0.69) respectively. The agreement between the observed rates of TOLAC success and the predicted probabilities for all three models was poor. The performance of all three models predicting success after TOLAC was poor in the study population. A population-specific model may be needed, with the addition of factors influencing the labour, such as the methods of induction, which may aid in predicting the outcome. [ABSTRACT FROM AUTHOR]

The optimal gestational age for delivery of twin gestations balances the risk to the mother with the risks to the fetus and newborn. Primary considerations should include chorionicity and the presence or absence of other obstetrical complications such as fetal growth restriction or hypertensive disorders of pregnancy. More than half of twin gestations will deliver preterm, and a significant portion will be due to spontaneous labor or medical indications, such that the timing of delivery for twins is typically less determined by the provider discretion. Future studies are needed to assist in clarifying the optimal timing for delivery of twin pregnancies. [ABSTRACT FROM AUTHOR]

First-trimester abortion is a common and safe procedure. A focused history and physical examination are essential for providing this care. Laboratory assessment can include Rh typing, hemoglobin, and cervicitis testing as indicated by a patient's risk factors. Procedural abortion in the first trimester includes cervical dilation with or without cervical preparation, and uterine evacuation utilizing a manual vacuum aspirator or electric vacuum aspirator. Complications occur rarely and are often easily managed at the time of diagnosis. [ABSTRACT FROM AUTHOR]

Oxytocin is effective in reducing labour duration but can be associated with fetal and maternal complications that could potentially be reduced by discontinuing the treatment during labour. We aimed to assess the impact of discontinuing oxytocin during active labour on neonatal morbidity. STOPOXY was a multicentre, randomised, open-label, controlled, superiority trial conducted in 21 maternity units in France. Participants who received oxytocin before 4 cm dilation were randomly assigned 1:1 to either discontinuous oxytocin (oxytocin infusion stopped beyond a cervical dilation equal to or greater than 6 cm) or continuous oxytocin (administration of oxytocin continued until delivery). Randomisation was stratified by centre and parity. The primary outcome, neonatal morbidity, was assessed at birth using a composite variable defined by an umbilical arterial pH at birth less than 7·10, a base excess greater than 10 mmol/L, umbilical arterial lactates greater than 7 mmol/L, a 5-min Apgar score less than 7, or admission to the neonatal intensive care unit. Efficacy and safety was assessed in participants who were randomly assigned (excluding those who withdrew consent or were deemed ineligible after randomisation) and had reached a cervical dilation of at least 6 cm. This trial is registered with ClinicalTrials.gov , NCT03991091. Of 2459 participants randomly assigned between Jan 13, 2020, and Jan 24, 2022, 2170 were eligible to receive the intervention and were included in the final modified intention-to-treat analysis. The primary outcome occurred for 102 (9·6%) of 1067 participants (95% CI 7·9 to 11·5) in the discontinuous oxytocin group and for 101 (9·2%) of 1103 participants (7·6 to 11·0) in the continuous oxytocin group; absolute difference 0·4% (95% CI –2·1 to 2·9); relative risk 1·0 (95% CI 0·8 to 1·4). There were no clinically significant differences in adverse events between the two groups of the safety population. Among participants receiving oxytocin in early labour, discontinuing oxytocin when the active phase is reached does not clinically or statistically significantly reduce neonatal morbidity compared with continuous oxytocin. French Ministry of Health and the Département de la Recherche Clinique et du Développement de l'Assistance Publique–Hôpitaux de Paris. [ABSTRACT FROM AUTHOR]

We evaluated quantitative cervicovaginal foetal-fibronectin as a predictor of cervical ripening and labour duration in late-term pregnant women with an unfavourable cervix. This was an analytical cross-sectional study wherein 152 women, with late-term pregnancy and unfavourable cervix, at 41weeks3days gestational age, had pre-induction quantitative cervicovaginal foetal-fibronectin determined using ELISA. Data were compared in nulliparas and multiparas at a significance level < 0.05. The mean age of late-term pregnant women was 30.4 ± 4.3 years. Median cervicovaginal foetal-fibronectin levels in nulliparous and multiparous women were 45.35 ng/ml and 46.93 ng/ml respectively(p = 0.289). The correlation between foetal-fibronectin levels and cervical ripening duration was poor in nulliparous(r = 0.014) and multiparous(r = 0.024) women. The Youden's foetal-fibronectin cut-off level had a sensitivity of 53.5% and specificity of 71.6% in predicting cervical ripening duration of > 12 hours in late-term pregnancy with an area under the ROC curve of 0.634. Quantitative cervicovaginal foetal-fibronectin is a poor correlate and predictor of cervical ripening and induced labour duration in late-term pregnancy. What is already known on this subject? Cervicovaginal foetal fibronectin is useful in the prediction of preterm delivery but its role in prolonged pregnancy is unclear. What the results of this study add? Cervicovaginal foetal fibronectin is a poor correlate and predictor of cervical ripening and induced labour duration in late-term pregnancy What the implications are of these findings for clinical practice and/or further research? Cervicovaginal fibronectin should not be used to predict ease and success of cervical ripening and induction of labour in women with late-term pregnancy. [ABSTRACT FROM AUTHOR]

To establish and verify a model for labour dystocia occurring in the active phase, this study retrospectively analysed the clinical data of primiparas with singleton cephalic full-term foetuses, who had delivered after a trial of labour. The Chi-square test, t-test, Mann–Whitney U test and multivariate logistic regression analysis were used for statistical analysis. Based on the model a nomogram was established using the R programming language. Multivariate logistic regression analysis showed that the foetal abdominal circumference, premature rupture of membranes (PROM), prolonged latent phase, foetal station and foetal position at the early stage of the active phase were independent factors influencing labour dystocia occurring in the active phase. The established model could effectively and accurately support clinicians in the early identification of labour dystocia to improve maternal and infant outcomes. What is already known on this subject? Labour dystocia occurring during the active phase of the first stage, is the most commonly diagnosed as labour aberration. Previous studies have suggested that maternal age, body mass index, macrosomia and abnormal foetal position are the independent risk factors for labour dystocia. However, only the risk factors were reported, and few prediction models were established. What do the results of this study add? This study uses data in the real world to establish a prediction model of full-term singleton primipara with labour dystocia occurring in the active phase by logistic regression analysis. Foetal abdomen circumference, PROM, prolonged latent phase, the foetal station and foetal position at the early stage of the active phase are independent factors influencing labour dystocia that occurs in the active phase. In addition, a nomogram is established as a visual graph to predict the probability of it. What are the implications of these findings for clinical practice and/or further research? The nomogram based on the predictive model discarded complicated calculations and presented an easy visual graph-based method to predict the probability of labour dystocia occurring in the active phase. It helps to introduce interventions that could reduce the CS rate and occurrence of adverse maternal and foetal outcomes to ensure the safety of mothers and infants. [ABSTRACT FROM AUTHOR]

Objective: Childbirth is a complex process with various dimensions including physical, psychological, emotional, social, and cultural aspects. The study intended to assess the effectiveness of Nurse led FALCI (Fear and Apprehension related to Labour or Childbirth Improving) Intervention in reducing childbirth fear among pregnant women. Materials and methods: A quasi-experimental study was conducted among 115 pregnant women (selected through purposive sampling) at antenatal OPD of tertiary care hospital of Bhopal. Data was collected using Wijma Delivery Expectancy Questionnaire (DEQ) and self-structured questionnaire on socio-demographic and clinical variables. The intervention (FALCI) was carried out in two phases, each lasting for 30 minutes conducted at week 3-4 and week 5-6 and information booklet was provided for reinforcement. The data was analysed using two-way repeated measures mixed ANOVA (within group and between groups). Results: Findings revealed that most of the pregnant women in both experimental (68.5%) and control (90.2%) group had high level of childbirth fear. Post-intervention data revealed mean of pretest, posttest 1 and posttest 2 were 73.85, 46.94 and 37.90 in experimental group and the mean of pretest, posttest 1 and posttest 2 were 75.49, 72.59 and 72.67 in control group respectively and found that there is significant difference in childbirth fear (within group, F value=114.69, p<0.001 in experimental group and F =0.575, p=0.564 in control group) and between groups (F value= 81.52, p value <0.001). However, no significant association was found between childbirth fear and sociodemographic/clinical variables. Conclusion: The study findings revealed that Nurse led FALCI intervention was effective in reducing childbirth fear among the pregnant women and it is recommended that such intervention must be planned at all levels and implemented as routine protocol in maternity services. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To compare the labor curve between individuals with induced labor and those undergoing spontaneous labor. METHODS: This was a secondary analysis of the Consortium on Safe Labor database, including nulliparous and multiparous individuals with singleton vertex pregnancy who delivered vaginally after spontaneous labor or induction of labor at term. Labor that resulted in uterine rupture and neonates with a 5-minute Apgar scores less than 7, birth injury, or neonatal intensive care unit admission was excluded. We modeled the course of cervical dilation using repeated-measures analysis with a polynomial function. We compared traverse time, defined as the elapsed time between two given dilation measures, between induced and spontaneous labor using interval-censored regression. RESULTS: Of 46,835 nulliparous individuals, 18,576 and 28,259 underwent induced and spontaneous labor, respectively. Of 77,503 multiparous individuals, 29,684 and 47,819 underwent induced and spontaneous labor, respectively. The start of the active phase on the labor curve was 6 cm in induced labor, regardless of parity. In nulliparous individuals, induced labor compared with spontaneous labor had a significantly shorter traverse time from 6 to 10 cm (median 1.8 hours [5th–95th percentile 0.4–8.6 hours] vs 2.3 hours [5th–95th percentile 0.6–9.4 hours]; P<.01). In multiparous individuals, induced labor compared with spontaneous labor had a significantly shorter traverse time from 6 to 10 cm (median 0.9 hours [5th–95th percentile 0.1–6.0 hours] vs 1.4 hours [5th–95th percentile 0.3–7.9 hours]; P<.01). CONCLUSION: Similar to spontaneous labor, the start of the active phase of induced labor was at 6 cm of dilation. Comparatively, induced labor had a shorter active phase than spontaneous labor. These findings suggest that the current criteria for active phase arrest provided by the American College of Obstetricians and Gynecologists do not need to be lengthened for individuals in induced labor. [ABSTRACT FROM AUTHOR]

Ectopic decidua is a rare benign condition, believed to be associated with excessive progesterone stimulation such as in multiple gestations as in our case, it's usually asymptomatic and found incidentally during caesarean section. The lesions involute spontaneously in the postpartum period; therefore it usually doesn't require any therapeutic interventions. This condition could induce anxiety to surgeons intra-operatively, because of resemblance of more sinister lesions such as: carcinomatosis and granulomas. We report a clinical case of diffuse peritoneal deciduosis, identified during an emergency caesarean section, performed at 33 weeks of gestation, for a transverse lie, twins DCDA pregnancy in active labor. [ABSTRACT FROM AUTHOR]

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BACKGROUND: Childbirth is a significant event with a great impact on maternal physical and psychological health. Childbirth abuse has been reported in different countries with variable rates. This study aims to determine the prevalence of childbirth abuse during labor in a governmental hospital in Egypt. METHODS: This cross-sectional study was conducted from March 2020 to December 2021. We recruited 190 women. Patients were asked to fill in the Arabic-validated childbirth verbal abuse and neglect questionnaire immediately after delivery. The questionnaire consisted of four parts enquiring about personal data and childbirth history, the occurrence of physical violence, and other elements of satisfaction. RESULTS: Fifty (26.3%) patients were neglected during childbirth. Verbal abuse was reported by 25.8%. Two women (1.1%) were slapped (physical abuse) during childbirth. Women reported being satisfied and strongly satisfied at 57.9% and 37.9%, respectively. Multiparity (p-value .02), patient ignorance about the childbirth process (p-value .004), their rights (p-value .0001), and lack of participation in decision-making (p-value .0001) were associated with exposure to neglect. Verbal abuse was associated with the delivery time in addition (p-value .004). CONCLUSION: Neglect and abuse occurred significantly at the current facility. [ABSTRACT FROM AUTHOR]

Background: Induction is the stimulation of uterine contractions to aid childbirth. Meanwhile, the prevalence of obesity is predicted to grow by 33% worldwide by the year 2030. Genetic, environmental, behavioral, and social elements all have a role in the development of obesity. The prevalence of obesity is highly associated with both ancestry and ethnicity. Numerous illnesses and malignancies are only a few of the many that can be exacerbated by obesity. Menstrual irregularities, infertility, and premature birth are just a few of the ways that obesity negatively affects a woman's ability to have healthy, natural children. Longer labors and more cesarean sections are directly related to the rising prevalence of maternal obesity, which also correlates with an increase in the use of labor induction. The present study aims to evaluate the effect of maternal body mass index on the duration of induction of labor. Methods: A prospective cohort study was conducted at Al-Zahraa Teaching Hospital from December 2022 to June 2023. It included 100 pregnant women divided into overweight/obese and non-obese groups. Prim and multi gravida term pregnant women with unfavorable cervix and not in labor were included. The collected data included demographical, menstrual, medical, and surgical history, and assessment of labor duration and success. Labor was induced by using PGE1 and oxytocin. Failed induction was defined as cervical dilatation >4 cm not achieved after 12 ± 3 h of labor or ending with a cesarean section. Results: The study examined 100 women undergoing labor induction, finding a success rate of 80% for vaginal delivery and 20% ending in caesarean sections. Notably, failed inductions were associated with larger gestational age and higher Body Mass Index (BMI). In fact, 90% of those who had a failed induction of labor were obese (BMI >30 kg/m²). Despite these findings, there were no significant variations in maternal age, gravidity, parity, and miscarriage rates between the successful and failed induction groups. Conclusion: Higher BMI increases the likelihood of failed labor induction but its impact on the duration of induction is not clearly established from the current data which may need further study with increasing sample size. [ABSTRACT FROM AUTHOR]

Background: As caesarean delivery rates continue to increase globally, so are the number of second-stage caesarean deliveries. Second-stage caesareans may carry additional risk of complications for both the mother and fetus owing to fetal head impaction into the maternal pelvis and manipulations required for delivery. So far, data on this procedure's outcomes from low resource countries are limited. Objectives: To compare adverse maternal and perinatal outcomes between second-stage and first-stage of labour intrapartum primary caesarean deliveries over 12 months at a tertiary referral obstetric hospital in Kenya. Methods: In a hospital-based cohort study, 222 women with singleton, cephalic presenting fetuses at term gestation who had intrapartum primary caesarean delivery during active labour were recruited post-partum. Second-stage caesarean deliveries (73) were compared to 149 first-stage caesarean deliveries. The proportion of caesarean deliveries in the second-stage of labour was estimated and the adverse maternal and perinatal outcomes were compared. The study was conducted from August 2021 to July 2022 at the Moi Teaching and Referral Hospital, Eldoret. Results: The proportion of second-stage caesarean deliveries among intrapartum primary caesarean deliveries was 4.3% [95% CI: 2.9% - 4.7%]. Compared to first-stage caesarean deliveries, second-stage caesarean deliveries had a significantly higher risk of adverse maternal outcomes (RR 3.272, 95% CI 2.28–4.71, P < 0.001), including intraoperative trauma, atony, blood transfusion, and a postoperative hospital stay of more than three days. Additionally, there was a higher risk of adverse perinatal outcomes (RR 2.748, 95% CI 2.45–4.50, P < 0.001), including increased risk of a 5-min APGAR ≤3, admission to NBU, and neonatal death. Conclusions: An increased risk of adverse maternal and perinatal outcomes is associated with primary second-stage caesarean deliveries compared to primary first-stage caesarean deliveries. [ABSTRACT FROM AUTHOR]

Background: The study was designed to investigate effects of single intravenous injection of esketamine on the incidence of postpartum depression (PPD) after labor analgesia and explore the potential mechanisms. Methods: A total of 120 women who underwent labor analgesia by epidural analgesia pump were enrolled and divided into two groups randomly. Esketamine at a dose of 0.2 mg/kg was intravenously injected after fetal disengagement in the test group and placebo was administered in the control group. The occurrence of PPD and side effects after delivery were recorded. Some indicators related to stress and inflammation were measured before labor analgesia and at 24 h, 1 week, and 6 weeks after delivery in this study. Data were analyzed by independent t-test, repeated measures analysis of variance and Chi-square test in SPSS software (version 25.0). It was considered statistically significant since a p value less than 0.05. Results: The incidence of PPD was significantly decreased both for one week and six weeks after delivery by using of esketamine (3.4% vs. 15.3%, p = 0.004 and 5.2% vs. 18.6%, p = 0.006, respectively). There were also significant differences between the stress and inflammation-related indicators in different time points in this study, while the side effects for 48 h after delivery were similar between the two groups. Conclusions: Single intravenous injection of esketamine after delivery in participants underwent labor analgesia can decrease the occurrence of postpartum depression for one week and six weeks after delivery, while the side effects were not increased. The antidepressant effects of esketamine may be related to the reduction of stress response and inflammation. Trial registration: The trial was registered at the Chinese Clinical Trial Registry on 5/30/2022 (CTRI registration number—ChiCTR2200060387). URL of registry: https://www.chictr.org.cn/bin/home. [ABSTRACT FROM AUTHOR]

Introduction: Maternal healthcare utilization, particularly the institutional delivery, is disproportionately low in rural Ethiopia. This study aimed to evaluate the effectiveness of an integrated package of community-based interventions on the improved knowledge of obstetric danger signs, birth preparedness, and institutional delivery services utilization in rural areas of Gamo zone, southern Ethiopia. Methods: We conducted cluster-randomized controlled trial (NCT05385380) from 2019 to 2021 at the Arba Minch Health and Demographic Surveillance System site. We randomly assigned the 10 kebele clusters to intervention and control arm. We used a package of interventions, which included providing information on safe motherhood via video and/or audio with a birth preparedness card for pregnant women, training for community volunteers and health extension workers, and improving maternity waiting home services. Women in the control arm received routine services only. We used generalized mixed-effects logistic regression models to evaluate the effectiveness of the intervention on the outcome variables. Results: The study enrolled 727 pregnant women across the 10 clusters, with a 617 (84.9%) successful follow-up rate. The proportion of institutional delivery in the intervention arm was increased by 16.1% from 36.4% (174/478) at the baseline to 52.5% (224/427) at the endline (Adjusted odds ratio [AOR] for McNemar's Test = 1.5; 95% confidence interval [CI]: 1.1 to 2; p < 0.001). In the control arm, however, there was a 10.3% fall in the proportion of institutional delivery (from 164/249 to 105/190). Pregnant women who received the intervention were significantly more likely to give birth in a health institution than those who did not (AOR 2.8; 95% CI: 1.2, 6.4). Conclusion: The study demonstrates that an integrated community-based intervention package that included video-based storytelling and upgrading maternity waiting homes increased institutional delivery care utilization among rural women. We recommend that audio-visual storytelling, starting during pregnancy and continuing postpartum, be incorporated into routine maternal healthcare services to address access to care inequalities in rural settings. Trial registration: The study protocol was registered in the clinicaltrials.gov with registry number NCT05385380. Plain English summary: Many women in developing nations, including Ethiopia, are dying due to problems related to pregnancy and childbirth. One of the interventions to prevent maternal illness and deaths is promoting and ensuring the timely use of maternal health care services. This study aimed to evaluate the effectiveness of an integrated package of community-based interventions on the improved institutional birth rate in rural Ethiopia. We conducted a trial at the Arba Minch HDSS site. The package provided information on safe motherhood via videos and audiocassettes for pregnant women, a birth preparedness card for women, community volunteers and extension workers training, and maternity waiting home services upgrading. In the control arm, women received routine services only. From the 10 Arba Minch HDSS kebele clusters, six kebele clusters were randomly assigned to the intervention and an additional four were assigned to the control. Different statistical techniques were used to evaluate the effectiveness of the intervention on the institutional birth rate. At the baseline, 727 pregnant women had enrolled across all 10 clusters, with a 617 (84.9%) successful follow-up rate. The intervention arm had a higher proportion of institutional birth (224/427 [52.5%]) at the endline than the baseline (174/478 [36.4%). Furthermore, the study showed a significant association between intervention status and institutional birth rate. Therefore, stimulating demand for existing services to ensure the timely use of care can improve maternal health service utilization, particularly the institutional birth rate. [ABSTRACT FROM AUTHOR]

Background and objectives: To ascertain the prevalence of obstructed labour and to research numerous risk variables that affect obstructed labour To research the problems related to pregnancy and birth and, investigate about maternal and perinatal deaths in addition to the numerous variables that contribute to these losses. To Discuss methods for reducing obstructed labour with the available resources. Methods: A prospective study was carried out for a full year, from January 2020 to December 2020, in the Obstetrics and Gynaecology Department at Kurnool Medical College, Kurnool, Andhra Pradesh, India, in which all term pregnant women with obstructed labour who attend labour room emergency referred from outlying health care facilities were included. Results: In the present study, 69% of the cases were 21 to 30 years old, followed by 19% aged 21 and 12% aged 31 and older. Mean height was 142.7+ 4.0 cm. 59.5% of the pregnant women were primigravida, followed by second (16.7%) and third (11.9%) gravidas. 14.7% of cases with a labour duration of 24 hours had PPH and 62.5% of cases with a labour duration >24 hours had PPH. 11.8% of cases with a duration of labour 24 hours and 50% of cases with a duration of labour >24 hours had APGAR of 0, and 50% of cases with a duration of labour 24 hours and 0% of cases with a duration of labour >24 hours had APGAR of 10. Conclusion: Even though obstructed labour is preventable, it still significantly increases mother and infant morbidity in our country. As a result, prevention is better than treatment. Enhancing remote healthcare can reduce incidence. [ABSTRACT FROM AUTHOR]

Imaging can aid in determining potential causes of coccygeal pain and therefore guide clinicians to carry out individualized treatment. We represent a case of postpartum coccydynia treated by platelet-rich plasma (PRP) which was assessed and followed by MRI. A primipara with uncomplicated labor developed coccygeal pain after delivery that significantly limited her postpartum recovery. On the first MR scan, recorded 6 months after delivery, there were edematous changes of the vertebral endplates of Co1-4 level (Modic type I) with the presence of pronounced precoccygeal venous drainage. Degenerative changes with signs of edema in the area of the pubic symphysis were recorded. The sacroiliac joints had regular morphological features. Since the patient was breastfeeding, PRP therapy was applied with a total of three injections in the area of the coccyx subcutaneously, once every 3 months. The subjective feeling of pain reduction after each injection was about 30%, with the complete withdrawal of pain after one year and still pain-free at the two-year follow-up. One year after the initial MR imaging, a follow-up MR examination was performed, where almost complete resolution of edematous changes in the previously present zones was observed, with residual minor edema of the vertebral endplates at the Co2-3 level. Edema of the pubic bones in the area of the pubic symphysis also subsided. A case of labor-induced coccydynia that was represented as Modic type I changes without neither fracture or luxation was successfully treated with PRP with complete resolution of symptoms. [ABSTRACT FROM AUTHOR]

Background: During the reproductive period among pregnant women, the worst pain a woman can experience is labour pain. Untreated labour pain has many detrimental effects on the mother and the fetus. Then, the inadequate levels of awareness and attitudes toward labour analgesia among pregnant women are considered a serious concern that influences no-healthy results for both the mother and the baby. Therefore, this research aimed to define the degree of Awareness, Attitude, and intent to use labour analgesia among pregnant women in Syria. Methods: We conducted a cross-sectional study from 7 September to 23 October 2022, in which we included Pregnant Syrian women aged 18 and above. The questionnaire was based on a prior study that included verified and validated scales, which consisted of 23 questions separated into four sections. The sample size was calculated using Fisher's formula; however, our study included 638 participants. The data was analyzed using IBM SPSS Version 28.0, using descriptive and binary logistic regression methods. Results: Among those who had previous deliveries, 39.4% performed a caesarian delivery, and only 1.9% had a delivery at home. Nearly half of the study participants (50.4%) reported adequate knowledge about analgesia for obstetric pain. The inquired pregnant women who had children had more odds of knowledge than participants who had not. Respondents who were childbearing at the health center were more likely to have a good attitude (Adjusted Odds ratio = 4.728, P-value < 0.05, 95%CI: 1.035–21.589) than those who were childbearing at a national referral hospital. Also, the respondents above 31 years were less likely to desire labour analgesia than those aged 18–24. Conclusion: Our results revealed that Syrian pregnant women have a moderated awareness, attitudes, and desire regarding labour analgesia, indicating a serious health problem among this population group. It is recommended that local and global health organizations address the current condition relevant to this issue by implementing healthy educational programmes for Syrian women through coordination with obstetric and gynaecological professionals. [ABSTRACT FROM AUTHOR]

Purpose: To search for maternal, labor-related and fetal variables associated with low Apgar in the fifth minute in term pregnancy. Methods: A retrospective case–control study with term births was conducted in a public teaching hospital from 2013 to 2020. Cases were term births with Apgar score less than 7 in the fifth minute, and controls, the next one or two births following a case, with Apgar of 7 or more. Non-cephalic presentations, multiples and malformations were excluded. We accessed 100 cases and 190 controls. We considered significant values of p < 0.05. Results: Were accessed 27 variables which could be risk factors, from which 12 were associated with the outcome. We found a protective effect of prelabor cesarean for the outcome, odds ratio (OR) 0.38, p = 0.013. Consequently, we conducted two sets of analyses: in the whole group and in the group of laboring women. The values of OR were in general greater in the group of laboring women, compared with the whole group. We conducted multivariate analysis within the group of women in labor. The variables which fitted best in the model were nulliparity, male sex of the fetus, less than six prenatal visits and abnormal cardiotocography; all remained significant. An association of rupture of membranes more than 360 min with the outcome, even after controlling fpr duration of labor, was found; adjusted OR 2.45, p = 0.023. Conclusion: Twelve variables were associated with the outcome. Prelabor cesarean had a protective effect. The time of ruptured membranes was associated with low Apgar. [ABSTRACT FROM AUTHOR]

Background: The maternal mortality rate in Pakistan is high, which has been attributed partly to delays in accessing healthcare for women who are pregnant and in labour. This study aimed to explore the community's perspectives of delays to use of health services in pregnancy and labour, using the 'three delays' model and the framework for determinants of maternal mortality. Methods: An explorative-descriptive approach was used, with purposeful sampling of 382 participants selected from across Pakistan. Four groups of participants were selected: married women, married men, adolescent girls and adolescent boys. Results: Several factors led to delays seeking healthcare. Women were unable to decide for themselves whether to attend a healthcare facility, there were issues reaching a facility in time and at the facility, either the resources or healthcare workers were lacking. Conclusions: Women must be given education and access to healthcare in order to reduce maternal mortality and morbidity. [ABSTRACT FROM AUTHOR]

Background: The utility of procalcitonin to identify obstetric sepsis is unknown. Objective: To calculate the mean (range) procalcitonin in pregnancy among healthy women not in labor (group 1), healthy women in labor (group 2), and women with preterm prelabor rupture of membranes (PPROM) without clinical chorioamnionitis (group 3). Search Strategy: NLM PubMed, Elsevier Embase, and Wiley Cochrane Central Register of Controlled Trials from inception to February 21, 2022. Selection Criteria: Ten or more pregnant women with procalcitonin reported at more than 20 weeks of pregnancy, with information on labor, PPROM, and infection. Exclusions were major medical comorbidities. Data Collection and Analysis: Each abstract and full‐text review was independently reviewed by the same two authors. Quality was reviewed using the Newcastle‐Ottawa Scale. A meta‐analysis was performed using a random effects model. Main Results: The systematic review included 25 studies: 10 (40%) of good quality and 15 (60%) of poor quality. The meta‐analysis included 21 studies. Mean procalcitonin in group 1 was 0.092 ng/mL (range 0.036–0.049 ng/mL), in group 2 it was 0.130 ng/mL (range 0.049–0.259 ng/mL), and in group 3 it was 0.345 ng/mL (range 0.005–1.292 ng/mL). Conclusions: Among healthy pregnant women not in labor, procalcitonin levels are comparable to those in non‐pregnant adults and may be useful in identifying infection. Procalcitonin levels in other groups overlap abnormal values of procalcitonin in non‐pregnant adults, and may not discriminate infection among women in labor or with obstetric comorbidities. Prospero: CRD42020157376, registered 4/28/2020. Synopsis: Although limited data are published, procalcitonin levels in healthy pregnant women without complications are comparable with those in non‐pregnant adults. [ABSTRACT FROM AUTHOR]

Context • After the age of 35, women’s fertility and physical function gradually decline, and this can significantly increase the risks of postpartum hemorrhage (PPH) after delivery. Sufficient exploration of prenatal indicators of PPH for older pregnant women are still lacking. Objective • The study intended to examine the factors influencing postpartum hemorrhage (PPH) in natural delivery for pregnant women ≥35 years of age and to establish a reliable risk-prediction model. Design • The research team performed a retrospective study. Setting • The study took place at Suzhou Ninth People’s Hospital in Suzhou, Jiangsu Province, China. Participants • Participants were 351 pregnant women who had undergone a prenatal examination and vaginal delivery at the hospital between January 2019 and October 2022. Groups • The research team divided participants into two groups: (1) a PPH group, with 52 participants who experienced PPH, and (2) a non-PPH group, with 299 participants who had no PPH. Outcome Measures • The research team: (1) conducted single-factor analysis of the two groups’ demographic and clinical characteristics; (2) performed multivariate logistic regression analysis to find the factors influencing PPH; (3) built a risk-prediction model based on the results; and (4) analyzed the model’s identification ability, proofreading ability, and clinical applicability using a goodness-of-fit test, a receiver operating characteristic (ROC) curve, a calibration curve, and a decision curve. The team used the SPSS 22.0 and R software for statistical analysis. Results • The incidence of PPH was 14.81%, for the 52 out of 351 participants. The PPH group’s age (P < .001), rate of pregnancy-induced hypertension (P = .008), length of the third stage of labor (P = .001), and newborn’s birth weight (P < .001) were significantly greater and its FIB before delivery was significantly lower than those of the nonPPH group. The high expression of fibrinogen (FIB) before delivery indicates it may be a protective factor against PPH. The multivariate analysis indicated that a greater age (P = .013), pregnancy-induced hypertension (P = .002), a low FIB level (P < .001), a long third stage of labor (P = .012), and a low birth weight for the newborn (P = .006) were all significantly related to PPH. The research team validated the risk-prediction model, which indicated that the model had good recognition ability (AUC = 0.873). The optimal critical value was 34%, and the sensitivity and specificity were 0.869 and 0.826, respectively. In the comparison of the PPH value that the model predicted and the participants’ actual PPH incidence (U = -0.006, Brier = 0.089), the deviation of the model wasn’t statistically significant (χ² = 5.964, P = .651). The analysis of the decision curve found that the net benefits for pregnant women ≥35 years of age were higher than those of the other two extreme curves, showing that the model was clinically effective. Conclusions • The PPH risk-prediction model for vaginal delivery for pregnant women ≥35 years of age showed that a greater age, pregnancy-induced hypertension, a lower prelabor FIB, a longer third stage of labor, and a higher birth weight for the newborn were significantly related to the incidence of PPH and that its use could be clinically helpful. [ABSTRACT FROM AUTHOR]

Objective • To investigate the effects of systematic pregnancy management on labor and maternal and infant outcomes in gestational diabetes mellitus patients (GDM). Methods • From February 2020 to December 2021, 116 patients who were diagnosed with GDM at the first hospital of Hebei medical university were enrolled in this prospective study. According to the random number table, patients were divided into the control group (n = 58, routine nursing) and the intervention group (n = 58, systematic pregnancy management). Results • After treatment, the blood glucose levels of both groups decreased compared to that measured before treatment, and the blood glucose levels in the intervention group were lower than those in the control group (P<.05). After treatment, the lipid profile cholesterol levels of both groups decreased compared to those measured before treatment. However, the lipid profile cholesterol levels were lower in the intervention group than those in the control group (P<.05). The first, second, and third stages of labor and total labor time in the intervention group were lower than those in the control group (P < .05). The rate of natural delivery in the intervention group was higher than that in the control group, while the rate of cesarean section was lower than that in the control group (P<.05). Conclusion • Systematic pregnancy management can reduce the level of blood glucose and improve lipid metabolism in patients with GDM. [ABSTRACT FROM AUTHOR]

Though there are multitudes of analgesic techniques available to relieve labor pain, epidural analgesia is considered as most effective against labor pain. Many studies have investigated whether and how the epidural analgesia may have an impact on the first and second stage of labor, maternal and neonatal outcomes and birth experience but the results are still controversial. There was an interest to analyze on delivery outcomes of Bloom Life Hospital at Chennai, on the delivery outcomes (maternal and fetal) on using Epidural analgesia (0.2% ropivacaine + 50 mic Fentanyl). Data was accessed from bloom Life Hospital (N= 223 parturients) administered with Epidural analgesia between April 2015 to October 2021. The obtained data was coded and the preliminary analysis was performed descriptively analyzed. The descriptive analysis revealed that among 223 parturients who received EA 89% (N=174) had Normal Vaginal delivery. Only 28 among the study participants (12.5%) had ins/outlet forceps delivery. Neonatal outcomes revealed that 138 among 224 babies did not require NICU admission. The study data has clearly revealed that Epidural Analgesia did not increase the rates of CSection. In Future, prospective study has been planned to know the impact of EA on labor, delivery, maternal and fetal outcomes. [ABSTRACT FROM AUTHOR]

Background: Cervical dilatation is an essential aspect of active labour, which is necessary for the progress of delivery. Delayed or inadequate cervical dilatation can lead to prolonged labour, fetal distress, and the need for instrumental delivery. Pharmacological agents, such as Drotaverine Hydrochloride and Valethamate Bromide, are commonly used to promote cervical dilatation and facilitate delivery. Aim: To Observe the effectiveness of Drotaverine Hydrochloride and Valethamate Bromide in Promoting Cervical Dilatation during Active Labour. Methodology: This was a randomized, observational study conducted at a tertiary care hospital. A total of 100 women in active labour, with a cervical dilatation of less than 4 cm, were included in the study. They were randomly divided into two groups, with 50 women in each group. The first group received Drotaverine Hydrochloride, while the second group received Valethamate Bromide. The drugs were administered intravenously as per the standard protocol. The rate of cervical dilatation was monitored in both groups for a period of 6 hours. Results: The mean rate of cervical dilatation in the Drotaverine Hydrochloride group was 1.7 cm/hour, while in the Valethamate Bromide group it was 1.2 cm/hour. The difference was statistically significant (p<0.05). The mean time for cervical dilatation of 4 cm was 2.5 hours in the Drotaverine Hydrochloride group, while in the Valethamate Bromide group it was 3.5 hours. The difference was statistically significant (p<0.05). The adverse effects observed in both groups were similar and mild. Conclusion: In this observational study, Drotaverine Hydrochloride was found to be more effective in promoting cervical dilatation during active labour as compared to Valethamate Bromide. However, further studies are needed to validate these findings and to explore the long-term effects of these drugs on maternal and fetal outcomes. [ABSTRACT FROM AUTHOR]

Background: Early recognition and prompt intervention for overt postpartum urinary retention (PUR) takes on a critical significance when a woman chooses labor epidural analgesia for pain relief. However, there have been rare fewer reports on the incidence and factors influencing overt PUR in women after vaginal delivery with labor epidural analgesia in China. Therefore, this study aimed to investigate the incidence and factors correlated with overt urinary retention in postpartum women undergoing vaginal delivery with labor epidural analgesia.Methods: In total, 462 Chinese postpartum women with labor epidural analgesia and vaginal delivery were recruited in one tertiary hospital in Beijing from Dec. 2020 to Nov. 2021. Factors associated with overt PUR for these women were identified through multivariate logistic regression analysis.Results: The incidence of overt PUR was obtained as 10.2% among these women after vaginal delivery with labor epidural analgesia. As indicated by the result of univariate analysis, forceps-assisted delivery, lateral episiotomy, perineal pain, and fluid administration in the delivery room were correlated with PUR. The result of the multivariate logistic regression suggested that forceps-assisted delivery (odds ratio [OR]=2.46, 95% confidence interval [CI]: 1.14– 5.32, P=0.022), lateral episiotomy (OR=4.55, 95% CI: 1.91– 10.80, P=0.001), and perineal pain (OR=4.23, 95% CI: 2.05– 8.73, P< 0.001) were factors affecting overt PUR for these women.Conclusion: Postpartum women undergoing vaginal delivery with labor epidural analgesia showed a high incidence of overt PUR, and health-care providers should pay more attention to their postpartum urination status in clinical practice. Effective and timely intervention is strongly recommended to reduce the occurrence of overt PUR for these kinds of postpartum women undergoing vaginal delivery with labor epidural analgesia, such as ones experienced forceps-assisted delivery, lateral episiotomy, and more severe perineal pain. [ABSTRACT FROM AUTHOR]

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Purpose: To compare the effect of Dural puncture epidural (DPE) and conventional epidural (EP), in conjunction with programmed intermittent epidural bolus (PIEB) and low-concentration ropivacaine strategy.Methods: After written informed consent was obtained, healthy nulliparous women with singleton pregnancies, vertex presentation at 38– 42 weeks' gestation, cervical dilation of 3– 5 cm, and a desire for pain relief were randomly assigned to DPE or EP group. Dural matter was puncture with 25G Whitacre needle in DPE group. Analgesia was initiated with 15 mL of 0.1% ropivacaine over 5 minutes and was maintained by PIEB (8 mL of 0.08% ropivacaine with 2 μg/mL fentanyl every 40 min). Primary outcome was the percentage of adequate analgesia, defined as NRPS ≤ 1, at 30 minutes after the initiation of the epidural bolus.Results: Out of 130 enrolled parturients, 127 were included in final analysis (64 in DPE group, 63 in EP group). No significant difference was found in percentage of adequate analgesia at 30 minutes (risk ratio: 1.09; 95% confidence interval: 0.90– 1.31; P = 0.366). At 8, 12, 14, and 16 minutes, percentage of adequate analgesia was higher in DPE group (P = 0.023, 0.027, 0.016 and 0.033, respectively). NPRS scores in DPE group decreased more dramatically within the first 30 min. The incidence of S2 sensory blocks at 20 and 30 min in DPE group was higher (P = 0.010 and 0.006, respectively). There were no differences in patient satisfaction, delivery mode, adverse effects, fetal bradycardia, and Apgar scores at 1 and 5 minutes.Conclusion: The combination of the use of DPE technique with 25G spinal needle and PIEB technique for labor analgesia appears to enhance the quality of labor analgesia by accelerating onset and providing improved sacral blockade, without increasing adverse effects. [ABSTRACT FROM AUTHOR]