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Background: Approximately 15% of births worldwide result in life-threatening complications during pregnancy, delivery, or postpartum. Comprehensive Emergency Management of Obstetric and Newborn Care (CEmONC) is intended as one of the measures for maternal healthcare services to reduce the high burden with regard to childbirth complications. However, its state of implementation fidelity has not been well investigated. Therefore, this study aimed to evaluate the implementation fidelity of CEmONC services at University of Gondar Comprehensive Specialized Hospital, Ethiopia. Method: A case-study design with an embedded mixed method was employed. Adherence, quality of delivery, and participant responsiveness dimensions from Carroll's conceptual framework were used in this evaluation. Four hundred four exit interviews, 423 retrospective document reviews and 10 key informants were conducted. Moreover, a binary logistic regression model was fitted. The qualitative data were transcribed, translated, coded, and analysed using a thematic analysis approach. The overall implementation fidelity of the CEmONC was judged based on the pre-seated judgmental criteria. Results: Overall the implementation fidelity of the CEmONC service was 75.5%. Quality of delivery, participant responsiveness and adherence were 72.7%, 76.6% and 77.2% respectively. Signal functions like parenteral antibiotics and removal of retained products were insufficiently performed against the recommended protocols which was also evidenced by the key informant interviews. Healthcare providers' respect for the clients was less. Age ≥ 35 years (AOR = 0.48, 95% CI: 0.24,0.98), educational status of college and above (AOR = 2.61, 95% CI: 1.46,4.66), being government employed (AOR = 1.85, 95% CI: 1.08,3.18), having ANC follow-up (AOR = 5.50, 95% CI: 1.83, 16.47) and grand multigravida (AOR = 2.17, 95% CI: 1.08, 4.38) were factors significantly associated with participant responsiveness towards the services. Conclusions: The overall implementation fidelity of the CEmONC services was implemented in good fidelity. Moreover, the quality of delivery was judged as implemented in fair fidelity. Parenteral antibiotics and removal of retained products were not found to be sufficiently performed. Respect for the clients was insufficiently delivered. Therefore, it is recommended that parenteral antibiotics drugs be adequately provided and training for healthcare providers regarding compassionate and respectful care shall be facilitated. Moreover, healthcare providers are strongly recommended to adhere to the recommended guidelines. [ABSTRACT FROM AUTHOR]

Background: Birth preparedness and complication readiness is a holistic approach that empowers mothers and families with the knowledge, attitude, and resources to alleviate potential challenges during childbirth. Despite its benefits, husbands' participation in maternal care differs significantly between countries and regions. There is a lack of previous studies that look at husbands' responses to birth preparedness and complication readiness in the research area. Thus, the primary goal of this study is to find out how husbands who have wives with infants under 12 months old feel about birth preparation, readiness for problems, and its associated factors. Methods: A community-based cross-sectional study design was conducted from May 30 to July 29, 2022. Simple random sampling was employed to select 499 husbands. An interviewer-administered, structured, and pretested questionnaire was used to collect the data. Data entry and analysis were performed using Epi Data version 4.6 and SPSS version 25, respectively. We used multivariable logistic regression to find statistically significant factors. P-values less than 0.05, 95% confidence intervals, and adjusted odds ratios are used to declare statistical significance. The findings were shown in figures, tables, and text. Results: The study found that 55.9% (95% CI: 51.4 to 61.4%) of husbands responded to birth preparedness and complication readiness. This response was significantly associated with being employed (AOR = 3.7, 95% CI: 2.27–5.95), engaging in self-business (AOR = 5.3, 95% CI: 2.34–12.01), having wives who delivered in health facilities (AOR = 7.1, 95% CI: 3.92–12.86), accompanying wives for antenatal care (AOR = 2.2, 95% CI: 1.39–3.56), possessing good knowledge of danger signs during labor (AOR = 2.0, 95% CI: 1.08–3.74) and the postnatal period (AOR = 7.1, 95% CI: 3.14–16.01). Interestingly, residents living near a health facility (AOR = 0.6, 95% CI: 0.39–0.97) were less likely to respond. Conclusion: The present study found that nearly 6 out of 10 husbands actively responded in terms of birth preparedness and complication readiness. While husbands in this study showed some involvement in birth preparedness and complications, it is good when compared to studies carried out nationally. To improve this, educating husbands by focusing on the danger signs and their role in childbirth is recommended. [ABSTRACT FROM AUTHOR]

Objective: To explore the clinical feasibility of different treatment methods for persistent occipitotransverse position and the influence on maternal and infant complications. Method: During the trial of vaginal delivery from April 2020 to March 2023 in our hospital, the cervix was fully dilated and the presentation was located at +2 station. Ninety‐six pregnant women with fetal presentation at +4 station, occipitotransverse fetal position, maternal complications, abnormalities in the second stage of labor, and or fetal distress were divided into two groups: 65 patients with Kielland forceps vaginal delivery and 31 patients underwent emergency cesarean section. The delivery time, vaginal laceration rate, postpartum blood loss volume, puerperal infection rate, neonatal birth injury rate, and neonatal 1 min Apgar scores were analyzed. Results: The delivery outcomes and maternal and neonatal complications of 96 pregnant women were analyzed: the application of Kielland forceps delivery time was shorter, while the vaginal laceration rate, postpartum hemorrhage, puerperal infection rate were significantly lower than that of patients undergoing emergency cesarean section and the neonatal 1 min Apgar score was higher than that of emergency cesarean section group (p < 0.05). Conclusion: It was clinically appropriate to use Kielland forceps in vaginal delivery when the persistent occipitotransverse position was present and delivery needed to be expediated. Use of Kielland forceps can shorten the delivery time, improve the success rate of vaginal delivery and reduce the complications of mothers and infants. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine maternal and neonatal factors in cesarean deliveries due to dystocia, including cephalopelvic disproportion, latent‐phase prolongation, and fetal malposition or malpresentation. Additionally, we sought to compare the differences between the dystocia subgroups. Method and Materials: This retrospective case–control study included women who delivered between January 2010 and June 2021 after 37 weeks of pregnancy and underwent abdominal‐pelvic CT scans within 5 years before and after delivery. Neonatal factors were extracted from medical charts immediately after delivery. Results: Among the 292 women studied, those with cesarean deliveries for dystocia were older (mean ± SD, 34.2 ± 4.27 vs. 32.2 ± 3.8, p‐value = 0.002), had higher pre‐pregnancy BMI (22.7 ± 3.67 vs. 21.4 ± 3.48, p‐value = 0.012) and term‐BMI (27.4 ± 3.72 vs. 25.9 ± 3.66, p‐value = 0.010), shorter interspinous distance (ISD, the distance between ischial spine) (10.8 ± 0.76 vs. 11.2 ± 0.85 cm, p‐value = 0.003), and longer head circumference (HC) (35 ± 1.47 vs. 34.4 ± 1.36 cm, p‐value = 0.003) compared to those who had vaginal deliveries. Univariate logistic regression for dystocia revealed associations between HC/maternal height and HC/ISD ratios (OR, 2.02 [95% confidence interval, CI, 1.4 ~ 2.92], 12.13 [3.2 ~ 46.04], respectively). Multivariate logistic analysis indicated that maternal age, ISD, and HC were significant factors for dystocia (OR, 1.11 [95% CI, 1.01 ~ 1.21], 0.49 [0.26 ~ 0.91], 1.53 [1.07 ~ 2.19], respectively). The subgroup with latent‐phase prolongation exhibited the lowest birthweight/term‐BMI ratio (124 ± 18.8 vs. 113 ± 10.3 vs. 134 ± 19.1, p‐value = 0.013). Conclusion: The HC/ISD ratio emerged as a crucial predictor of dystocia, suggesting that reducing term‐BMI could potentially mitigate latent‐phase prolongation. Further research assessing the maternal mid‐pelvis during pregnancy and labor is warranted, along with efforts to reduce BMI during pregnancy. [ABSTRACT FROM AUTHOR]

Introduction: Peripartum hysterectomy is a rare emergency obstetric surgery, usually performed in emergency situations such as massive obstetric hemorrhage. Emergency peripartum hysterectomy (EPH) can follow a vaginal delivery or a cesarean section. Materials and methods: Our study is retrospective. It is done at the Department of Obstetrics and Gynaecology, Bangalore Medical College and Research Institute (Tertiary care teaching hospital in South India) from January 2018 to December 2023. Results: Out of 90,956 deliveries, EPH was performed in 162 cases. 0.178% is the incidence of EPH or it is about 1.8 per 1,000 deliveries. The commonest reason for EPH was abnormal placentation (43.8%). Atonic uterus (22.8%) and rupture uterus (20.3%) mostly secondary to scar rupture were the 2nd and 3rd most common causes of EPH. Discussion: Uncontrollable hemorrhage secondary to atonicity, ruptured uterus, and sepsis were once considered the principal risk factors for EPH. However, presently risk factors have changed and it is the abnormal placentation that considered to be the main indication for EPH. In this study, the most common indications of EPH were abnormal placentation, atonic uterus, ruptured uterus, and abruption. There were 13 maternal deaths (8.02%) in our study. A relatively low perinatal mortality rate (21.6%) is found in this study. Conclusion: Reducing the number of unnecessary cesarean deliveries, particularly repeat cesarean deliveries, in light of the evidence linking placental pathology with cesarean delivery, will help mitigate the number of EPH. [ABSTRACT FROM AUTHOR]

Aim and background: It is imperative to achieve precise diagnosis of prelabor rupture of membranes (PROM) and preterm prelabor rupture of membranes (PPROM) by recognizing specific amniotic fluid indicators in vaginal environment. The study included assessment of creatinine levels in vaginal fluid along with determining its cut-off value to diagnose PROM/PPROM. Methods: Sixty women with singleton pregnancy of 28 weeks or more period of gestation, were enrolled in the study to be categorized in two equal groups of 30 each. Study group comprised of patients having confirmed PROM and control group included pregnant women with intact membranes. Vaginal fluid samples were collected in a sterile syringe in study patients. In controls, 5 mL of normal (0.9%) saline was instilled into vaginal cavity, and 3 mL of vaginal fluid was collected to be sent for creatinine estimation. Results: The mean value of levels of creatinine in vaginal fluid in study groups was (1.15 ± 0.55 mg/dL) and control groups was (0.15 ± 0.16 mg/dL) showing a significant difference (p < 0.001). The value of creatinine in vaginal fluid to detect PROM/PPROM was 0.7 mg/dL, with sensitivity of 86.67% and specificity of 100%. The positive predictive value (PPV) was 100% and negative predictive value (NPV) was 88.24% with an accuracy of 93.33%. Conclusion: Creatinine estimation in vaginal fluid is an easy, reliable, as well as readily available method to diagnose PROM/PPROM. Clinical significance: Accurate diagnosis of PROM/PPROM, using an easily available and reliable method is important to guide the clinical management in high-risk pregnancy. [ABSTRACT FROM AUTHOR]

Obesity is an important risk factor for the development of pregnancy complications. We investigated the effects of pregestational overweight and obesity on maternal lipidome during pregnancy and on newborns' characteristics. The study encompassed 131 pregnant women, 99 with pre-pregnancy body mass index (BMI) < 25 kg/m2 and 32 with BMI ≥ 25 kg/m2. Maternal lipid status parameters, plasma markers of cholesterol synthesis and absorption and sphingolipids were determined in each trimester. Data on neonatal height, weight and APGAR scores were assessed. The results showed a higher prevalence (p < 0.05) of pregnancy and childbirth complications among the participants with elevated pregestational BMI. Levels of total cholesterol, HDL-cholesterol (p < 0.05) and LDL-cholesterol (p < 0.01) were significantly lower, and concentrations of triglycerides were higher (p < 0.05) in women with increased pre-gestational BMI. Lower concentrations of the cholesterol synthesis marker, desmosterol, in the 2nd trimester (p < 0.01) and the cholesterol absorption marker, campesterol, in each trimester (p < 0.01, p < 0.05, p < 0.01, respectively) were also found in this group. Markers of maternal cholesterol synthesis were in positive correlation with neonatal APGAR scores in the group of mothers with healthy pre-pregnancy weight but in negative correlation in the overweight/obese group. Our results indicate that gestational adaptations of maternal lipidome depend on her pregestational nutritional status and that such changes may affect neonatal outcomes. [ABSTRACT FROM AUTHOR]

To compare characteristics of labor, cardiotocography traces, and maternal and neonatal outcomes, in a cohort of pregnancies at term complicated by maternal intrapartum pyrexia, with or without a histologic diagnosis of chorioamnionitis. This is a retrospective case-control study including pregnancies at term with detection of maternal intrapartum pyrexia, delivered between January 2020 and June 2021. Cardiotocography traces were entirely evaluated, since admission till delivery, and classified according to the International Federation of Obstetrics and Gynecology (FIGO) guideline. Maternal and neonatal outcomes were also recorded as secondary outcomes. Placentas have been studied according to the Amniotic Fluid Infection Nosology Committee. Forty four patients met the inclusion criteria and were included in the study cohort. There was a significant association between the use of oxytocin augmentation in labor and the histologic diagnosis of chorioamnionitis. A significative recurrence of loss and/or absence of accelerations at the point of pyrexia was also documented in women with histological chorioamnionitis compared to the others. Chorioamnionitis appears to be associated with myometrial disfunction, as suggested by the increased use of oxytocin augmentation during active labor of women at term with intrapartum pyrexia and histologic diagnosis of chorioamnionitis. [ABSTRACT FROM AUTHOR]

Background: The evaluation of patients with first-trimester vaginal bleeding and concern for early pregnancy loss (EPL) frequently occurs in the emergency department (ED), accounting for approximately 1.6% of all ED visits.¹ Unfortunately, these patients consistently report negative experiences with ED care.2–8 In addition to environmental concerns, such as long wait times, patients often describe negative interactions with staff, including a perceived lack of empathy, the use of insensitive language, and inadequate counseling.2,3 These patients and their partners often view EPL as a traumatic loss of life and commonly experience prolonged grief reactions, including anxiety and depression.9–11 Poor satisfaction with care has been associated with worse mental health outcomes.12 These complaints represent an important opportunity for improvement in emergency medicine (EM) training.13 While no published literature to date describes the performance of EM residents in managing patients presenting with EPL, studies suggest that even obstetrics and gynecology (OB/GYN) residents find these interactions challenging.14,15 Simulation- and didactic-based training has been shown to be beneficial in improving OB/GYN resident EPL counseling and has been associated with improved patient outcomes.16 To our knowledge, this has yet to be replicated in EM residency training. Objectives: We aimed to develop and evaluate a simulation-based educational intervention to improve EM resident management of patients presenting with EPL. [ABSTRACT FROM AUTHOR]

Background: Sexual violence remains a persistent and devastating issue in eastern Democratic Republic of Congo (DRC). Aim: To elucidate the sociodemographic, sexual, and obstetrical characteristics associated with the experiences of victims of sexual violence (VSV) among women in the region. Materials and Methods: A cross‐sectional study was conducted involving 625 women from eastern DRC. Participants provided self‐reported data, collected through interviews conducted by trained female interviewers in secure environments. Associations between VSV and various sociodemographic and reproductive health factors were examined. Results: Of the respondents, 26.1% reported experiences of sexual violence. VSV were predominantly younger, with 56.44% aged between 15 and 24 years. Single women comprised 57.67% of VSV, and 37.42% identified as farmers. There were 33.13% of VSV who were illiterate, and 81.60% belonged to the low socio‐economic stratum. Early physiological and reproductive milestones characterised VSV: 52.15% experienced menarche at or before 13 years, 34.97% initiated sexual intercourse before age 15, and 18.70% reported their first pregnancy before age 15. Higher nulliparity was observed in VSV (29.45%) compared to non‐VSV (9.31%). A lower prevalence of HIV infection was found among VSV (11.04%) relative to non‐VSV (25.76%). Conclusion: Sexual violence in the eastern DRC exhibits multifactorial associations. Younger women, those in certain occupations, and those with specific reproductive histories appear more vulnerable. The findings underscore the urgency for targeted interventions, enhanced access to education, and improved reproductive health services. Addressing these pressing issues should remain a primary focus in both societal and public health spheres. [ABSTRACT FROM AUTHOR]

Introduction: Women with polycystic ovary syndrome (PCOS) have more pregnancy complications like gestational diabetes, hypertension, and preterm labor than other women. Metformin has been used in an attempt to improve pregnancy outcomes. Our study aims to explore childbirth experiences in women with PCOS compared with a reference population. It also explores the potential influence of metformin, obesity, pregnancy complications, and the duration and mode of birth on childbirth experiences. Material and methods: This study is a cohort study combining data from two randomized trials conducted in Norway, Sweden and Iceland. The PregMet2 study (ClinicalTrials.gov, NCT01587378) investigated the use of metformin vs. placebo in pregnant women with PCOS. The Labour Progression Study (ClinicalTrials.gov, NCT02221427) compared the WHO partograph to Zhang's guidelines for progression of labor and were used as the reference population. A total of 365 women with PCOS and 3604 reference women were included. Both studies used the Childbirth Experience Questionnaire (CEQ). Main outcome measures were total CEQ score and four domain scores. The CEQ scores were compared using Mann–Whitney U test for women in Robson group 1 with PCOS (n = 131) and reference women (n = 3604). CEQ scores were also compared between metformin‐treated (n = 180) and placebo‐treated (n = 185) women with PCOS, and for different subgroups of women with PCOS. Results: There was no difference in total CEQ score between women with PCOS and reference women—Wilcoxon–Mann–Whitney (WMW)‐odds 0.96 (95% confidence interval [CI] 0.78–1.17). We detected no difference in CEQ scores between the metformin‐ and placebo‐treated women with PCOS (WMW‐odds 1.13, 95% CI 0.89–1.43). Complications in pregnancy did not affect CEQ (WMW‐odds 1, 95% CI 0.76–1.31). Higher body mass index (WMW‐odds 0.75, 95% CI 0.58–0.96), longer duration of labor (WMW‐odds 0.69, 95% CI 0.49–0.96), and cesarean section (WMW‐odds 0.29, 95% CI 0.2–0.42) were associated with lower CEQ scores in women with PCOS. Conclusions: Women with PCOS experience childbirth similarly to the reference women. Metformin did not influence childbirth experience in women with PCOS, neither did pregnancy complications. Obesity, long duration of labor or cesarean section had a negative impact on childbirth experience. [ABSTRACT FROM AUTHOR]

Background: The amount of tissue trauma within second‐degree perineal tears varies widely. Therefore, subcategorization of second‐degree tears and a better understanding of their occurrence and risk factors are needed. The aim of this study was to assess the occurrence of perineal tears when second‐degree tears were subcategorized. Furthermore, we aimed to assess the association between variables related to perineal anatomy and other potential risk factors, with second‐degree tear subcategories. Methods: This prospective cohort study included 880 primiparous and multiparous women giving birth to one child vaginally. Perineal tears were categorized using the classification system recommended by the Royal College of Obstetricians and Gynaecologists. In addition, second‐degree tears were subcategorized as 2A, 2B, or 2C according to the percentage of damage to the perineal body. Selected variables related to perineal anatomy were as follows: length of genital hiatus; perineal body length; and previous perineal trauma. Risk factors for second‐degree tear subcategories were analyzed using a multinominal regression model. Results: Perineal tears occurred as follows: first‐degree: 35.6% (n = 313), 2A: 16.3% (n = 143), 2B: 9.1% (n = 80), 2C: 6.6% (n = 58), and third‐ or fourth‐degree: 1.6% (n = 14). In total, 169/880 participants underwent an episiotomy. When episiotomies were excluded, the risk for 2B, or 2C tears increased with smaller genital hiatus, larger perineal body, previous perineal trauma, primiparity, higher gestational age, instrumental vaginal delivery and fetal presentation other than occiput anterior. Conclusion: The occurrence of second‐degree tear subcategories was 16.3% for 2A tears, 9.1% for 2B tears, and 6.6% for 2C tears. Factors related to perineal anatomy increased the odds for experiencing a second‐degree tear in a more severe subcategory. [ABSTRACT FROM AUTHOR]

Background: Globally, disrespectful, and abusive childbirth practices negatively impact women's health, create barriers to accessing health facilities, and contribute to poor birth experiences and adverse outcomes for both mothers and newborns. However, the degree to which disrespectful maternity care is associated with complications during childbirth is poorly understood, particularly in Ethiopia. Aim: To determine the extent to which disrespectful maternity care is associated with maternal and neonatal-related complications in central Ethiopia. Methods: A multicentre cross-sectional study was conducted in the West Shewa Zone of Oromia, Ethiopia. The sample size was determined using the single population proportion formula. Participants (n = 440) were selected with a simple random sampling technique using computer-generated random numbers. Data were collected through face-to-face interviews with a pretested questionnaire and were entered into Epidata and subsequently exported to STATA version 17 for the final analysis. Analyses included descriptive statistics and binary logistic regression, with a 95% confidence interval (CI) and an odds ratio (OR) of 0.05. Co-founders were controlled by adjusting for maternal sociodemographic characteristics. The primary exposure was disrespectful maternity care; the main outcomes were maternal and neonatal-related complications. Results: Disrespectful maternity care was reported by 344 women (78.2%) [95% CI: 74–82]. Complications were recorded in one-third of mothers (33.4%) and neonates (30%). Disrespectful maternity care was significantly associated with maternal (AOR = 2.22, 95% CI: 1.29, 3.8) and neonatal-related complications (AOR = 2.78, 95% CI: 1.54, 5.04). Conclusion: The World Health Organization advocates respectful maternal care during facility-based childbirth to improve the quality of care and outcomes. However, the findings of this study indicated high mistreatment and abuse during childbirth in central Ethiopia and a significant association between such mistreatment and the occurrence of both maternal and neonatal complications during childbirth. Therefore, healthcare professionals ought to prioritise respectful maternity care to achieve improved birth outcomes and alleviate mistreatment and abuse within the healthcare sector. [ABSTRACT FROM AUTHOR]

Introduction and objectives: Ninety percent of maternal deaths are attributed to postpartum hemorrhage, with 50% being preventable. Annually, University of Mississippi Medical Center staff have more than 20,000 obstetrical encounters and deliver thousands of infants, with ∼75% being high-risk. The mother/baby unit, 3 Wiser, experienced two postpartum hemorrhages in August 2022. Post-event debriefings revealed opportunities for improvement. This project aimed to promote evidence-based practices regarding the prevention and management of postpartum hemorrhage in 3 Wiser. Methods: The project was guided by the JBI Model of Evidence-Based Healthcare and used the JBI Practical Application of Clinical Evidence System together with the Getting Research into Practice audit and feedback strategy. Four evidence-based practices were selected as audit criteria. After baseline audits were conducted, strategies to improve compliance with evidence-based practices were implemented. Finally, a follow-up audit was conducted, and the results of both audits were compared. Results: The baseline audits revealed 84% average compliance with the four evidence-based practices. Strategies to improve compliance included a simulation for nursing staff with a review of postpartum hemorrhage policies and skills. The post-implementation audit revealed 98% average compliance with the four evidence-based practices, a 14% increase from the baseline audit. Conclusions: This evidence implementation project utilized a clinical audit process, which led to improvements in practice related to the prevention and management of postpartum hemorrhage in the inpatient postpartum unit. [ABSTRACT FROM AUTHOR]

Pregnancy that continues beyond 42 weeks of gestation (post-term) confers increased antepartum and intrapartum fetal risk. Maternal risk may also be associated with post-term pregnancy, for example increased likelihood of delivery via emergency Caesarean section. The increased likelihood of adverse perinatal outcomes associated with post-term pregnancy derives mainly from increasing fetal size and placental ageing. The key intervention currently available to manage the risks associated with prolonged pregnancy is to offer delivery. In the UK, induction of labour is routinely offered at 41 weeks. Although offering induction of labour to manage post-term pregnancy is intended to minimize risk, women should feel supported by healthcare professionals if they opt for expectant management or decline induction of labour. [ABSTRACT FROM AUTHOR]

Premature spontaneous cervical dilatation can happen among pregnant women leading to miscarriage, preterm labor, or premature delivery. We present a case of twin pregnancy with spontaneous cervical dilatation and membranes bulging into the vagina at 8-week gestation. A 34-year-old primigravida presented to our clinic with complaints of cramping pain in the lower abdomen. Her per speculum pelvic examination showed evidence of dilated cervical os and amniotic membranes bulging through the cervix into the vagina. Her sonogram suggested a dichorionic diamniotic pregnancy of 8-week gestation. Her TVS examination revealed that the internal os was dilated. Both fetuses were alive with regular fetal heart rate. Rescue cervical cerclage by modified Shirodkar's technique was done under general anesthesia. She was administered prophylactic antibiotics and tocolytic. She was closely followed up at regular intervals and observed for signs of chorioamnionitis. She delivered at 35 weeks of gestation with two female children with birth weights 2.3 kg and 2.1 kg, respectively. [ABSTRACT FROM AUTHOR]

Introduction: Surgical repair of obstetric fistula aims to restore the anatomical and functional integrity of the urinary tract, enabling affected women to regain their dignity and quality of life. However, such repairs can end in a failure. The aim of this study is to develop a predictive score to identify factors influencing failure of surgical repair of obstetric vesico-vaginal fistula (FSROVVF) in the Democratic Republic of the Congo. Methods: This was an analytical cross-sectional study of 318 women with obstetric vesico-vaginal fistula (OVVF) who had undergone surgical management. A bivariate and then a multivariate analysis were performed. Score discrimination was assessed using the ROC curve and C-index, and score calibration using the Hosmer–Lemeshow test. Results: Surgical repair of OVVF was unsuccessful in 16.98% of cases (54/318). After logistic modeling, six criteria emerged as predictive factors for FSROVVF: the presence of fibrosis (AOR = 5.01; 95% CI:1.73–14.49), the presence of 2 or more fistulas (AOR = 9.04; 95% CI:3.01–27.13), the association of OVVF with another anatomoclinical entity of fistula (AOR = 3.16; 95% CI:1.09–9.13), the fistula size > 3 cm (AOR = 3.65; 95% CI:1.36–9.76), the peri-operative hemorrhage (AOR = 7.01; 95% CI:2.33–21.03), and the post-operative infection (AOR = 178.89; 95% CI:26.09–1226.64). A score ranging from 0 to 13 points was obtained, of which a value ≤ 5 points defines a low risk of FSROVVF, a value between 6 and 8 points defines a moderate risk and value ≥ 9 points corresponds to a high risk of FSROVVF. The area under the ROC curve of the score is 0.925 with a sensitivity of 61.11%, a specificity of 96.59%, a positive predictive value of 78.57% and a negative predictive value of 92.39%. Conclusion: This study demonstrated that the number of fistulas ≥ 2, fistula size > 3 cm, fibrosis, association of OVVF with other types of fistulas, peri-operative hemorrhage, and post-operative infection are factors predictive of FSROVVF. These six factors are key contributors to the score used to predict FSROVVF. Once validated, this score will inform and enable preoperative counseling regarding the prognosis and the chances of a successful outcome of surgical repair of OVVF. [ABSTRACT FROM AUTHOR]

Background: Worldwide, there are regional and demographic differences in the prevalence of pelvic floor complications (PFCs) during childbirth. Pelvic floor complications have been found to occur more frequently in some studies than others, despite some studies reporting a low incidence. This systematic review and meta-analysis sought to identify which types of PFCs were seen to occur most frequently in the studies chosen, as well as to provide an updated and thorough summary of the incidence and risk factors associated with various types of PFCs during childbirth. Methods: Search terms derived from free text words and medical topic headings (MeSH) were used to comb through a number of significant web databases. The first stage in the study selection strategy involved a search using keywords related to "pelvic floor," "childbirth," "complications," and "risk factors," which originally produced 759 papers. Results: 10 studies relevant to our objectives were ultimately selected for the investigation. In majority of the studies, urinary incontinence (UIT) and anal incontinence (AIT) were found to be the most commonly occurring PFCs, with stress urinary incontinence (SUT), overactive bladder syndrome (OAB), pelvic organ prolapse (POP) being incidental in decreasing order. The meta-analysis also reported the effects of UIT to be of significant impact in the studies in which it occurred. Although one study did report the occurrence of certain depressive symptoms following childbirth, the inference obtained was not very significant. Conclusion: The findings highlight the need for further research on the prevention and management of pelvic floor complications during childbirth, particularly in relation to UIT and AIT. Clinicians should be aware of the high prevalence of these conditions and their associated risk factors (especially psychosocial and psychological health) to provide appropriate care for affected women. [ABSTRACT FROM AUTHOR]

Objective The cesarean delivery rate in the United States is 31.9%. One of the leading indications for primary cesarean delivery is labor arrest. A modern understanding of the labor curve supports more time prior to the diagnosis of labor arrest. We conducted this study to examine the impact of adherence to the modern criteria for labor arrest and failed induction on rates of primary cesarean delivery and to identify predictors of meeting these criteria. Study Design We analyzed rates of primary cesarean deliveries overall and primary cesarean deliveries occurring due to arrest of dilation, arrest of descent, and failed induction among the 17,877 live births at a large academic center from 2010 through 2013. Multiple logistic regression modeling identified predictors of meeting the new criteria for these indications based on guidelines published by the 2012 National Institute of Child Health and Human Development. Results The primary cesarean delivery rate decreased from 23.5 to 21.1% (p = 0.026) from 2010 to 2013. Primary cesarean delivery rate for labor arrest and failed induction decreased from 8.5 to 6.7% (p = 0.005). The percentage of primary cesarean deliveries meeting the 2012 criteria for labor arrest increased from 18.8 to 34.9% (p = 0.002), and the rate of primary cesarean deliveries due to arrest of dilation decreased from 5.1 to 3.4% (p < 0.0005). The percentage of cases meeting the 2012 criteria for arrest of descent increased from 57.8 to 71.0% (p < 0.007), while primary cesarean delivery rate due to arrest of descent remained relatively unchanged, 3.1 to 2.6% (p = 0.330). Conclusion A decrease in the primary cesarean rate was attributable to a decrease in cesarean for arrest of dilation in the setting of a significant increase in meeting the 2012 criteria for arrest of dilation. At the end of the study period, 65.2% of cesareans still did not meet the criteria for arrest of dilation. Greater rates of adherence to these guidelines may yield further reductions in the cesarean rate. Key Points Primary cesarean delivery for labor arrest was decreased. Meeting criteria for labor arrest increased. A hospitalist provider increased odds of meeting criteria. [ABSTRACT FROM AUTHOR]

Aim: Different clinical practice guidelines include recommendations on how to prevent and repair obstetric perineal trauma, as well as the use of episiotomy. To evaluate the variability in midwives' professional practices for preventing and repairing perineal trauma, as well as the professional factors that may be associated with the restrictive use of episiotomy. Design: Observational cross‐sectional study. Methods: Three hundred five midwives completed an anonymous questionnaire developed by the authors and distributed across various midwifery scientific societies. The main outcomes measured were the frequencies of adopting specific practices related to perineal injury prevention and repair, episiotomy technique and restrictive episiotomy use (<10%). Odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals were estimated. Results: Intrapartum perineal massage was not normally used by 253 (83%) of midwives, and 186 (61%) applied compresses soaked in warm water to the perineum. Regarding episiotomy, there was a great deal of variability, noting that 129 (42.3%) adopted a restrictive use of this procedure, 125 (41%) performed it between 10% and 20%, while 51 midwives (16.7%) performed it in more than 20% of cases. In addition, 165 (54.1%) midwives followed an incision angle of 60º. Concerning tears, 155 (50.8%) usually sutured first‐degree tears and 273 (89.5%) always sutured second‐degree tears. Midwives attending home births (aOR = 6.5; 95% CI: 2.69–15.69), working at a teaching hospital (aOR = 3.69; 95% CI: 1.39–9.84), and the ones who recently completed their professional training (aOR = 3.58; 95% CI: 1.46–8.79) were significantly more likely to adopt a restrictive use of episiotomy. Conclusions: There is a significant variability in Spanish midwives' practices for preventing and repairing perineal tears. Moreover, the restrictive use of episiotomy is associated with midwives attending home births, working in teaching hospitals and having recent professional training. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Introduction: Adolescent pregnancy is defined as pregnancy at the age of 19 or below. Pregnancy and childbirth complications are the most significant cause of death among 15–19-year-old girls. Several studies have indicated that inequitable gender norms can increase the vulnerability of adolescent girls, including violence exposure, early marriage, and adolescent pregnancy. To address these disparities, gender transformative approaches aim to challenge and transform restrictive gender norms, roles, and relations through targeted interventions, promoting progressive changes. This realist review aims to synthesise existing evidence from a broad range of data sources to understand how, why, for whom, and in what contexts gender transformative approaches succeed in reducing adolescent pregnancy in low- and middle-income countries. Method and analysis: We employ a five-step realist synthesis approach: (1) clarify the scope of review and assessment of published literature, (2) development of initial programme theories, (3) systematic search for evidence, (4) development of refined programme theories, and (5) expert feedback and dissemination of results. This protocol presents the results of the first three steps and provides details of the next steps. We extracted data from 18 studies and outlined eight initial programme theories on how gender transformative approaches targeting adolescent pregnancy work in the first three steps. These steps were guided by experts in the field of sexual and reproductive health, implementation science, and realist methodology. As a next step, we will systematically search evidence from electronic databases and grey literature to identify additional studies eligible to refine the initial programme theories. Finally, we will propose refined programme theories that explain how gender transformative approaches work, why, for whom, and under which circumstances. Ethics and dissemination: Ethics approval is not required because the included studies are published articles and other policy and intervention reports. Key results will be shared with the broader audience via academic papers in open-access journals, conferences, and policy recommendations. The protocol for this realist review is registered in PROSPERO (CRD42023398293). [ABSTRACT FROM AUTHOR]

Abnormally Invasive Placenta is an obstetric condition resulting in significant physical complications and shown to increase the likelihood of developing Post Traumatic Stress Disorder. Dissatisfaction with the care experienced increases the likelihood of Post Traumatic Stress Disorder. Psychological flexibility has been shown to reduce the severity of Post Traumatic Stress Disorder, but there is no research regarding either of these in women with Abnormally Invasive Placenta. To investigate if there is a relationship between trauma experience in women with a diagnosis of Abnormally Invasive Placenta, psychological flexibility, and birth satisfaction. Using a retrospective questionnaire, 126 participants age range 18–45, comprising the Birth Satisfaction Scale Revised Indicator (BSS-RI), Impact of Events Scale Revised (IES-R) and Acceptance and Action Questionnaire (AAQ-2) was completed. A hierarchical regression assessed the predictive relationship of Psychological Flexibility and Birth Satisfaction on Trauma symptoms The relationship between Birth Satisfaction measured using the BSS-RI and likelihood of Post Traumatic Stress Disorder (IES-R) was not supported (r (124) = −.08, p =.36). Results did show that Psychological Flexibility (AAQ-2) correlated with Trauma Score (IES-R) (r (124) =.68, p <.001) in women who had experienced Abnormally Invasive Placenta and explained 45.3% of the variance. The results suggest that Post Traumatic Stress Disorder in those with Abnormally Invasive Placenta is as high as 1 in 2 and can be mediated by psychological flexibility. In turn, this suggests that interventions to increase Psychological Flexibility in those with the diagnosis may reduce trauma symptom severity.Abbreviations: AAQ-2 - Acceptance and Action QuestionnaireAIP - Abnormally Invasive PlacentaBAME – Black Asian or other Minority EthnicitiesBSS-RI Birth Satisfaction Scale Revised IndicatorEPH – EPH Gestosis (Pre eclampsia/Eclampsia)DSM – Diagnostic Statical ManualIES-R - Impact of Events Scale RevisedPAS - Placenta Accreta SpectrumPTSD – Post Traumatic Stress Disorder [ABSTRACT FROM AUTHOR]

Background: In order to reduce the complications of perineal damage and the pain caused by it for the mother, this study was conducted to determine the effect of warm perineal compress on perineal trauma (1st-, 2nd-, 3rd-, and 4th-degree perineal tears), postpartum pain, intact perineum (primary outcomes), episiotomy, length of the second stage, and APGAR score at 1 and 5 min after childbirth (secondary outcome). Methods: PubMed, Scopus, Cochrane Central Register of Controlled Trials, Google Scholar, Web of Science, SID, Magiran, and ClinicalTrials.gov were searched to identify the relevant articles from inception to November 1, 2022, with language restriction (only English and Persian). A manual search was also performed. Risk of bias 2 (RoB2) and ROBIN-I were employed to evaluate the quality of the included papers. Meta-analysis was conducted using RevMan 5.3. Heterogeneity was assessed using I2. In cases with high heterogeneity, subgroup analysis was utilized based on the parity and ethnicity, and time of pain measurement after delivery also a random-effects model was used instead of a fixed-effects model. Trial sequential analysis (TSA) was performed for the primary outcomes. The certainty of evidence was assessed using the GRADE approach. Results: A total number of 228 articles were found in databases. Of these articles, eighty-six were screened by title, 27 by abstract, and 21 by full text. Finally, 14 articles were included, of which ten were RCT and four were non-RCT. Meta-analysis results revealed that warm perineal compress significantly reduced perineal pain (RR 0.23, 95% CI 0.08–0.66; P = 0.0006), average pain (SMD − 0.73, 95% CI 1.23 to − 0.23; P = 0.004), second-degree perineal tear (RR 0.65, 95% CI 0.54–0.79; P˂0.00001), third-degree perineal tear (RR 0.32, 95% CI 0.15–0.67; P = 0.003), fourth-degree perineal tear (RR 0.11, 95% CI 0.01–0.87; P = 0.04), episiotomy (RR 0.63, 95% CI 0.46–0.86; P = 0.004), and intact perineum significantly increased (RR 3.06, 95% CI 1.79–5.22; P < 0.0001) compared to the control group. However, there was no statistically significant difference in terms of first-degree tear (RR 1.04, 95% CI 0.86–1.25; P = 0.72), length of the second stage of labor (MD − 0.60, 95% CI − 2.43 to 1.22; P = 0.52), the first minute (MD − 0.03, 95% CI − 0.07 to 0.02; P = 0.24) and the fifth minute Apgar score (MD − 0.02, 95% CI − 0.07 to 0.03; P = 0.46) between the two groups. Conclusion: Warm perineal compress administered during the second stage of labor reduce postpartum pain, second and third-degree perineal tears, and episiotomy rate while it increases the incidence of intact perineum compared to the control group. [ABSTRACT FROM AUTHOR]

Background: Because the cause of increasing rates of postpartum hemorrhage (PPH) and manual placental removal (MROP) is still unknown, we described trends in PPH, MROP, and childbirth interventions and examined factors associated with changes in rates of PPH and MROP. Methods: This nationwide cohort study used national perinatal registry data from 2000 to 2014 (n = 2,332,005). We included births of women who gave birth to a term singleton child in obstetrician‐led care or midwife‐led care. Multivariable logistic regression analyses were used to examine associations between characteristics and interventions, and PPH ≥ 1000 mL and MROP. Results: PPH rates increased from 4.3% to 6.6% in obstetrician‐led care and from 2.5% to 4.8% in midwife‐led care. MROP rates increased from 2.4% to 3.4% and from 1.0% to 1.4%, respectively. A rising trend was found for rates of induction and augmentation of labor, pain medication, and cesarean section, while rates of episiotomy and assisted vaginal birth declined. Adjustments for characteristics and childbirth interventions did not result in large changes in the trends of PPH and MROP. After adjustments for childbirth interventions, in obstetrician‐led care, the odds ratio (OR) of PPH in 2014 compared with the reference year 2000 changed from 1.66 (95% CI 1.57–1.76) to 1.64 (1.55–1.73) among nulliparous women and from 1.56 (1.47–1.66) to 1.52 (1.44–1.62) among multiparous women. For MROP, the ORs changed from 1.51 (1.38–1.64) to 1.36 (1.25–1.49) and from 1.56 (1.42–1.71) to 1.45 (1.33–1.59), respectively. Conclusions: Rising PPH trends were not associated with changes in population characteristics and rising childbirth intervention rates. The rising MROP was to some extent associated with rising intervention rates. [ABSTRACT FROM AUTHOR]

The prevalence and clinical significance of heterozygous factor XIII (FXIII) deficiency has long been debated, with controversial reports emerging since 1988. In the absence of large epidemiologic studies, but based on a few studies, a prevalence of 1 per 1,000 to 5,000 is estimated. In southeastern Iran, a hotspot area for the disorder, a study of more than 3,500 individuals found an incidence of 3.5%. Between 1988 and 2023, a total of 308 individuals were found with heterozygous FXIII deficiency, of which molecular, laboratory, and clinical presentations were available for 207 individuals. A total of 49 variants were found in the F13A gene, most of which were missense (61.2%), followed by nonsense (12.2%) and small deletions (12.2%), most occurring in the catalytic domain (52.1%) of the FXIII-A protein and most frequently in exon 4 (17%) of the F13A gene. This pattern is relatively similar to homozygous (severe) FXIII deficiency. In general, heterozygous FXIII deficiency is an asymptomatic condition without spontaneous bleeding tendency, but it can lead to hemorrhagic complications in hemostatic challenges such as trauma, surgery, childbirth, and pregnancy. Postoperative bleeding, postpartum hemorrhage, and miscarriage are the most common clinical manifestations, while impaired wound healing has been rarely reported. Although some of these clinical manifestations can also be observed in the general population, they are more common in heterozygous FXIII deficiency. While studies of heterozygous FXIII deficiency conducted over the past 35 years have shed light on some of the ambiguities of this condition, further studies on a large number of heterozygotes are needed to answer the major questions related to heterozygous FXIII deficiency. [ABSTRACT FROM AUTHOR]

Sudden unexpected postnatal collapse (SUPC) of healthy newborns is a catastrophic event caused by cardiorespiratory collapse in a healthy newborn. The most common cause of SUPC is poor positioning of the newborn during skin-to-skin contact or breastfeeding when the newborn is not being observed by a health professional, attentive parent, or caretaker. Maternal/newborn health care professionals need to know about the essential information, definitions, incidence, risk factors, clinical presentation, outcomes, and prevention and management strategies to minimize the occurrence and impact of SUPC. A sample SUPC hospital policy is included in the manuscript. [ABSTRACT FROM AUTHOR]

Obstetric perineal trauma is a common pathology that complicates up to 90% of vaginal deliveries. The true incidence of injuries (and their severity) is usually underestimated and higher than reported. Obstetric perineal injuries have a serious impact on a woman’s well-being and have medical, emotional, social and psychological aspects. Their negative consequences can persist for many years after childbirth and have a potentially devastating impact on a woman’s quality of life, lead to severe morbidity due to persistent pain, pelvic floor dysfunction, urinary and faecal incontinence, sexual problems, high risk of reinjury during future childbirth, etc. The article presents an overview of existing national guidelines for the prevention and treatment of perineal injuries. The data on the frequency and risk factors of perineal tears are systematized, and a modern classification is presented. Particular attention is paid to obstetric anal sphincter injuries (OASIS) for a better understanding of this pathology by partitional doctors. Training and awareness of obstetricians about OASIS should help to identify patients at risk, more accurately diagnose and choose the right tactics. The article also describes the main preventive interventions during pregnancy and childbirth, discussing the advantages and disadvantages of each. Given the high frequency of episiotomy for the prevention of OASIS, the advantages and disadvantages of various options, as well as the correct 45-60˚ technique, are presented. The emphasis is placed on the fact that it is necessary to perform selective episiotomy rather than routine episiotomy in the presence of clear indications according to the national standard. Reducing the frequency of episiotomies should lead to a decreased number of iatrogenic perineal injuries. The general principles of surgical treatment of perineal injuries, various suturing techniques, suture material characteristics, postoperative management of patients and counselling for future births are also presented. The use of these recommendations by obstetricians will be useful for their practice and will help improve the quality of medical care. [ABSTRACT FROM AUTHOR]

BACKGROUND: Even though a cesarean section (CS) performed greater than 15% has no significant association with a reduction in maternal and neonatal mortality, repeat elective CS contributes to unnecessary CS worldwide. Trial of labor after cesarean (TOLAC) is one of the strategies to reduce the rate of CS. However, the selection of candidates for a TOLAC is not an easy task without evidence. This study was conducted to determine the incidence of successful vaginal birth after one CS and the associated factors in public health facilities in southern Ethiopia. METHODS: An institutional-based cross-sectional study was conducted from June 10, 2020, to December 10, 2021, on laboring women, and the data were collected using a pretested interviewer-administered questionnaire and a data extraction sheet. A binary logistic regression model was used to assess the factors associated with successful vaginal birth after cesarean (VBAC) section using SPSS version 25. Bivariate and multivariate analyses were performed, and independent variables with p <.05 along with an odd ratio and 95% confidence interval (CI) declare the associated factors. RESULTS: A total of 417 women participated in this study with a response rate of 98.8%. The incidence of vaginal births after cesarean was 51.1% (CI, 46%–56%). The likelihood of successful VBAC was observed in women with a history of vaginal delivery before CS (AOR, 3.7, CI = 1.06, 13.19), favorable Bishop score at admission (AOR, 19.1, CI = 2.69, 134.98), greater than 4 cm cervical dilatation at admission (AOR, 171.3, CI = 1.8, 16,722), and clear color of amniotic fluid (AOR,.096, CI =.02,.38). CONCLUSION: The incidence of VBAC in this study was slightly greater than half of all women who had a TOLAC. There were complications such as uterine rupture, whole blood transfusions, neonatal death (1 in 40 deliveries), and an emergency cesarean section rate of 48.9%. Therefore, health professionals need to be well-versed in these potential complications and obtain informed consent from properly identified potential TOLAC candidates. In choosing a woman for the TOLAC, health professionals might need to pay attention to intrapartum variables, such as cervical dilatation, Bishop score, and color of the amniotic fluid. [ABSTRACT FROM AUTHOR]

Epidural analgesia (EA) provides the most effective labor analgesia, however, it significantly affects the process of childbirth, so finding out the true frequency of adverse outcomes in the case of EA during vaginal birth is relevant. The objective: to establish the frequency of use of EA in maternity healthcare institutions of Ukraine, to determine the relationship between the development of adverse perinatal outcomes in women with vaginal births and use of EA, and the introduction of alternative methods of analgesia for vaginal births. Materials and methods. The frequency of adverse outcomes was analyzed in the group of women who had a vaginal birth and who did not use EA (n=27 503) and in the group of women who had a vaginal birth with EA (n=22 214). The frequency of EA use in vaginal births in 2023 was studied during premature births at 22–25 weeks of pregnancy, 26–32 weeks and 32–37 weeks, pregnancies with preeclampsia, diabetes, breech presentation of the fetus, and the presence of a uterine scar. The data of the medical records of the electronic health care system of women who had vaginal births during 2023 served as the information base. Bibliosemantic, analytical, epidemiological, statistical and conceptual research methods were used. Results. The use of EA is a common method of analgesia for childbirth in Ukraine. EA during childbirth significantly increases the chances of a woman having a prolonged labor (odds ratio (OR) 4.71; p<0.001), weakness of labor (OR 3.52; p<0.001), stimulation of labor (OR 2.36; p< 0.001), instrumental vaginal births (OR 2.76; p<0.001), rupture of the perineum of the 2nd degree (OR 1.24; p<0.001), cervical rupture (OR 1.15; p=0.011), vaginal rupture (OR 1.17; p<0.001), episiotomy (OR 1.71; p<0.001), delayed separation of the placenta (OR 1.32; p<0.001) and fetal distress (OR 1.8; p<0.001). An alternative to EA can be effective non-pharmacological pain management (NРPM), which has numerous advantages in terms of the absence of complications. Effective implementation of NPPM in practice requires the development of a comprehensive approach, including improved education and support for women, availability of resources, and promotion of dissemination of knowledge about NPPM among health care providers. Conclusions. In the study, reliable results were obtained regarding a higher frequency of adverse outcomes in women who received EA compared to women who did not receive EA, namely: prolonged labor, weakness of labor, stimulation of labor, instrumental vaginal delivery, second-degree perineal rupture, cervical rupture, vaginal rupture, episiotomy, delayed separation of the placenta, and fetal distress. These results indicate the need for a balanced approach to the use of EA, based on the benefits and risks for the woman and the fetus. The use of NPPM is a promising alternative that potentially improves the birth experience, reduces adverse effects, and improves outcomes for both mothers and newborns. These methods use the natural pain-relief mechanisms of the organism and promote relaxation, comfort, reduced anxiety, and increased labor satisfaction. In addition, their use has a minimal number of side effects and risks, which makes them an attractive option for most women. [ABSTRACT FROM AUTHOR]

Objective The aim of the study is to estimate the association between arcuate uterus and pregnancy outcomes using controls selected from a similarly high-risk cohort. Study Design This is a retrospective cohort study of women with an arcuate uterus cared for by a single maternal–fetal medicine practice from 2005 to 2020. We included all women with a singleton pregnancy ≥20 weeks and diagnosis of arcuate uterus and randomly selected (3:1) patients with a singleton pregnancy and no uterine anomaly from the same practice as controls. Baseline characteristics and pregnancy outcomes were compared between the two groups. Chi-square, Fisher's exact, and independent samples t -test were used for data analysis, as indicated. Results A total of 37 women with an arcuate uterus (55 independent singleton pregnancies) and 165 controls were included. There were no differences in baseline characteristics. Women with an arcuate uterus had a significantly higher rate of spontaneous preterm birth less than 37 weeks (10.9 vs. 3.0%, p = 0.031) and were more likely to require vaginal progesterone (5.5 vs. 0.6%, p = 0.049) and administration of antenatal corticosteroids (16.4 vs. 5.5%, p = 0.020). Arcuate uterus was also associated with lower birthweight (3,028.1 ± 528.0 vs. 3257.2 ± 579.9 g, p = 0.010) and higher incidence of intrauterine fetal growth restriction (20.0 vs. 7.3%, p = 0.008), despite similar starting body mass index (BMI) and weight gain throughout pregnancy. There were no differences in preeclampsia, malpresentation, cesarean delivery, blood transfusion, retained placenta, or morbidly adherent placenta. Conclusion Arcuate uterus is associated with a significantly increased risk of spontaneous preterm birth (<37 weeks), need for vaginal progesterone for short cervix and antenatal corticosteroids, fetal growth restriction, and lower mean birthweight. These findings suggest that arcuate uterus is not just a normal variant of uterine anatomy but rather a risk factor for poor fetal growth, short cervix, and a higher risk pregnancy. Key Points Arcuate uterus is associated with increased risk of preterm birth and fetal growth restriction. Women with arcuate uteri had higher rates of vaginal progesterone use during pregnancy. Arcuate uterus should be treated as a true finding rather than a normal anatomical variant. [ABSTRACT FROM AUTHOR]

This study aims to document the cultural significance of vertical birthing positions and knowledge of easing complicated deliveries among the Porja hilly tribal group, Visakhapatnam district, Andhra Pradesh, India. With the purposive sampling method, 31 postpartum mothers were selected on the inclusion criteria of having been given childbirth in the last six months. The socio-demographic profile of the respondents was presented to understand the socio-cultural living conditions. The qualitative data collection involved 31 face-to-face in-depth interviews with postpartum women and two focus group discussions involving six to eight traditional birth attendants (TBAs) on the cultural efficacy of upright positions. Handwritten transcripts of the interviews and conversations were transcribed and coded into themes and categories. Qualitative themes reveal that the pregnant women with anaemia and morbidity conditions had been exposed to maternal distress and foetal distress (breathing problems and loss of consciousness) but had managed by adopting immediate alternative vertical birthing positions with the suggestion of TBAs. The findings suggest that vertical birth positions are age-old childbirth customs which have been adopted as as a priority option by labouring women, especially in socio-economically disadvantaged societies where medical facilities are unavailable. [ABSTRACT FROM AUTHOR]

Background: Childbirth is a transformative process. Modern healthcare offers pharmacological and non-pharmacological interventions for safe and improved childbirth experience. Studies have found that maternal mobility during the first stage of labour has a significant effect on maternal and child outcomes. A pilot study was done to find the effect of mobility during the first stage of labour on maternal satisfaction and foetal outcome. Method: An experimental study was done with 60 primigravida women with uncomplicated antenatal history reporting to the labour room of a tertiary care government hospital in Delhi chosen as study participants. Validated and reliable tools were used to measure labour, maternal and neonatal outcomes within 24 h post-delivery. Results: The results showed that there was an impact on mobility intervention during the first stage of labour on parturition (p =.03) and significant maternal satisfaction (p =.001). However, the neonatal outcome of both groups was not significant. Conclusion: Mobility was an effective non-pharmacological intervention for enhancing parturition and maternal satisfaction. Mobility during the first stage of labour can be recommended for practice guidelines for all midwives in the labour room as a protocol. [ABSTRACT FROM AUTHOR]

Background: Fetal distress (FD) is one of the most frequent causes of emergency cesarean section (CS) due to the insufficient uteroplacental blood supply during labor. There is a theory that Sildenafil citrate (SC) may improve the uteroplacental blood supply and decrease fetal hypoxia and FD. Methods: In a randomized double-blinded clinical trial, a total of 208 low-risk subjects who met our stringent inclusion criteria were randomly assigned into two groups: the Sildenafil citrate group (n=104) and the placebo group (n=104). These participants were referred to our referral gynecology and obstetrics department for delivery between July 2022 to September 2022. The SC group received oral SC at a dose of 50 mg every 6 hr, up to a maximum of three times. The final maternal-fetal-neonatal results were recorded and all data were analyzed using SPSS version 23. Results: The mean age of mothers was 28.98±5.6 years and 120 cases were primigravid (57.7%). Out of a total of 208 pregnant subjects, 168 subjects delivered through normal vaginal delivery (80.8%) and 40 cases underwent emergency CS (19.2%). The number of NVD in Sildenafil group was significantly more than placebo group (87.5% vs. 74%) and SC decreased the rate of emergency CS to 87.5% (RR=2.46%, 95%CI 1.19-5.08). Also, SC decreased the rate of FD to 53.8% (RR= 2.83%, 95%CI of 1-8.24). Conclusion: The results showed that SC can effectively decrease the rate of emergency CS and FD during labor. [ABSTRACT FROM AUTHOR]

Gastrointestinal system (GIS) cancer in pregnancy is a rare disease. Our aim was to evaluate the association between this type of cancer and pregnancy, delivery and neonatal outcomes. We conducted a retrospective population-based cohort study using the Healthcare Cost and Utilization Project, Nation-wide Inpatient Sample (HCUP-NIS). We included all women who delivered or had a maternal death in the US between 2004 and 2014. We compared women with an ICD-9 diagnosis of GIS cancer to those without. Pregnancy, delivery, and neonatal outcomes were compared between the two groups. A total of 9,096,788 women met inclusion criteria. Amongst them, 194 women (2/100,000) had a diagnosis of GIS cancer during pregnancy. Women with GIS cancer, compared to those without, were more likely to be Caucasian, older than 35 years of age, and to suffer from obesity, chronic hypertension, pregestational diabetes and thyroid disease. The cancer group had a lower rate of spontaneous vaginal delivery (aOR 0.2, 95 % CI 0.13–0.27, p<0.001), and a higher rate of preterm delivery (aOR 1.85, 95 % CI 1.21–2.82, p=0.04), and of maternal complications such as blood transfusion (aOR 24.7, 95 % CI 17.11–35.66, p<0.001), disseminated intravascular coagulation (aOR 14.56, 95 % CI 3.56–59.55, p<0.001), venous thromboembolism (aOR 9.4, 95 % CI 2.3–38.42, p=0.002) and maternal death (aOR 8.02, 95 % CI 2.55–25.34, p<0.001). Neonatal outcomes were comparable between the two groups. Women with a diagnosis of GIS cancer in pregnancy have a higher incidence of maternal complications including maternal death, without any differences in neonatal outcomes. [ABSTRACT FROM AUTHOR]

How much do active pelvic movements on a Swiss ball during labour affect maternal and neonatal outcomes? A randomised trial with concealed allocation, blinded assessors and intention-to-treat analysis. Two-hundred parturient women. The experimental group performed pelvic anteversion and retroversion, lateral pelvic tilts and circular hip movements according to individual obstetric evaluation (foetal station and position, cervical dilatation and the presence of early pushing urge) on a Swiss ball. The control group received usual care. Both groups were permitted to walk and shower. The primary outcome was the duration of the first stage of labour. The secondary outcomes were the duration of the second stage of labour, pain intensity, delivery mode, medication use, local swelling, fatigue, anxiety, satisfaction and neonatal outcomes. The experimental intervention reduced the duration of labour by 179 minutes (95% CI 146 to 213) in stage one and 19 minutes (95% CI 13 to 25) in stage two. It decreased pain by approximately 2 points (95% CI 2 to 2) on a 0-to-10 scale at 30, 60 and 90 minutes. It reduced the risk of a caesarean section (ARR 0.14, 95% CI 0.03 to 0.25; NNT 7, 95% CI 4 to 32) and vulvar swelling (ARR 0.11, 95% CI 0.03 to 0.19; NNT 9, 95% CI 5 to 31). It reduced fatigue by 18 points (95% CI 16 to 21) on a 15-to-75-point scale and anxiety by 9 points (95% CI 8 to 11) on an 18-to-72-point scale. Other effects were negligible or unclear. Active pelvic movements on a Swiss ball during labour reduced the duration of labour, pain intensity, and maternal fatigue and anxiety; they also lowered the risk of caesarean section and vulvar swelling. Several effects exceeded the smallest worthwhile effect. NCT04124835. [ABSTRACT FROM AUTHOR]

Background/Aim: There is insufficient information about how long fetal well-being will last after a negative oxytocin challenge test (OCT) and the factors affecting this process. We aim to evaluate maternal and perinatal outcomes in high-risk patients who had negative OCTs and to investigate the effects of methods of induction on the development of fetal distress. Methods: The study was designed as a retrospective cohort study. Data of patients who were hospitalized in the perinatal intensive care unit due to high-risk pregnancies between January 2016 and December 2016 were reviewed retrospectively. The patient's gestational age, gravidity, parity, and body mass index (BMI), risk factors leading to the OCT, labor induction methods used following a negative OCT, time from negative OCT to delivery, mode of delivery, and indications for cesarean section were recorded. In addition, data regarding fetal sex, birth weight, birth height, labor complications, Apgar scores at minutes 1 and 5, admission to the neonatal intensive care unit (NICU), indications for NICU admission, length of NICU stay, and stillbirth were also recorded. Results: OCT was performed on 551 patients and was negative in 447 patients. Among patients with a negative OCT, labor induction was preferred in 427 (95.5%) patients. When fetal distress development was assessed according to the induction method used following a negative OCT, fetal distress developed in 9.1% of 427 patients who underwent labor induction. Conclusion: When outcomes were considered in pregnant women with a negative OCT, it was observed that there were no fetal deaths and a limited number of newborns with low Apgar scores. Further randomized studies are needed to draw definitive conclusions. [ABSTRACT FROM AUTHOR]

The 10-point pain scale was developed to avoid undertreated pain in the hospital setting. Developed in a Veterans Administration hospital for medical–surgical patients in 2003, the 10-point pain scale was adopted in health care as part of the "pain as the fifth vital sign" initiative. The pain scale was implemented in maternity care as part of a general hospital initiative. Assessing coping is more appropriate to the labor process than focusing on pain or its avoidance. The Farver–Campos Labor Coping Scale is evidence-based and promotes vaginal birth and personal labor care by guiding nurses and laboring women through a number of coping options. The scale is an appropriate tool to replace the 10-point pain scale in the maternity care setting. [ABSTRACT FROM AUTHOR]

Proposing hysteroscopic morcellation (HM) as a surgical-therapeutic approach in the treatment of retained products of conception (RPOC) to prevent intrauterine adhesions (IUAs). Prospective analysis. A teaching and university hospital. Women with RPOC. Office -HM with 'Truclear 5 C'. Twenty-two consecutive patients presenting with trophoblastic residue retention after miscarriage and interruption of pregnancy or placenta remnants after cesarean section or delivery were enrolled. These women underwent office-HM with 'Truclear 5 C'. Primary outcomes were median time and rate of hospitalization. The quality of the specimen was also analyzed. A hysteroscopic second look for IUAs was performed. Mean procedure time was six minutes (SD ± 5). Tissue samples had a mean collection size 2.5 cm3+0.9. 38% of the samples had spotting or abnormal vaginal discharge. Dilatation of the cervical canal was not performed in any case. Second-look hysteroscopy did not show any de novo IUAs in any of the enrolled patients. In the hysteroscopic treatment of RPOC, HM is a valid choice in an office setting without the use of cervical dilatation. Removal of RPOC was uneventful in all cases, simple and carried out faster without any adverse outcomes. [ABSTRACT FROM AUTHOR]

Background: As maternal mortality remains unacceptably high with about 830 women dying from pregnancy and childbirth related complications over the aging rates world everyday (WHO). Majority 99 % occur in developing countries. Therefore, we conducted a retrospective cross-sectional study to know the Fetomaternal outcome of high-risk obstetrics cases in our region. The objective is to know the Fetomaternal outcome of high-risk obstetrics cases in an upcoming new medical college of Kumaon region. Material and Methods: It is a retrospective cross-sectional study done at a new tertiary care center, from the records of a year i.e from 1/1/2022 to 31/12/2022. 140 high risk obstetrics cases after 32 weeks of pregnancy, according to Pradhan Mantra Surakshit Matritva Abhiyan, were included and their maternal and fetal outcome was observed. Results: Among 140 ANC cases reviewed, majority belonged to unbooked cases (62.85%), majority were between 20-25 yrs of age(52.85%), mostly were multigravida(58.5%) and term(53.5%), majority high risk were pre-eclampsia (20%), previous cesarean (18.57%), severe anemia (12.14%), APH (11.42%). 68.5% underwent emergency LSCS, 32.14 % needed ICU admission,40% required BT,29.28% experienced PPH for which 23.55 % required conservative surgical management for PPH whereas 5.71 % required emergency hysterectomy. In case of fetal outcome, only 17.11% were <1.5 kg, NICU required in 25.36%, 1.42% had SB. Conclusion: Early detection of high risk pregnancy, emphasis on correction of anemia and timely referral from the periphery should be given importance to improve feto maternal outcome. [ABSTRACT FROM AUTHOR]

Objective: To describe our individualized management protocol for women with an antenatal diagnosis of vasa previa (VP) and to report maternal and neonatal outcomes in patients managed according to our protocol. Methods: A retrospective study of prospectively collected data of antenatally diagnosed VP managed at our hospital between 2014 and 2021. Obstetric and neonatal outcomes were reviewed and analyzed. Results: Fourteen cases of antenatally diagnosed VP in 5150 total deliveries were analyzed (0.3%) Five cases (36%) of VP were diagnosed during the routine fetal morphological ultrasound screening, and nine cases (64%) were referred to our hospital due to perinatal complications. There were nine cases that required hospitalization (due to fetal growth restriction [FGR] [1], preterm labor [3], patients' request [5]). The other five were asymptomatic. Eight patients were delivered by scheduled cesarean section at around 36 weeks and only three neonates were admitted to NICU with transient tachypnea of newborn. However, six patients required CS before the scheduled dates because of other complications (preterm labor [3], abnormal cardiotocogram patterns [1], FGR [1] and twin pregnancy [1]). Four neonates born by CS before their scheduled dates were admitted to NICU. No cases required prolonged hospitalization and there were no serious neonatal complications. Conclusion: Individualized management may lead to favorable outcomes with VP. Outpatient management may be considered in patients without risk factors. However, maternal hospitalization and earlier scheduled CS should be considered in symptomatic patients or those at risk for preterm delivery. [ABSTRACT FROM AUTHOR]

Two major complications of monochorionic diamniotic (MCDA) twin pregnancies are twin to twin transfusion syndrome (TTTS) and birthweight discordance. The current screening ultrasound test for these pathologies combines the detection of nuchal translucency discrepancy and abnormal ductus venosus in at least one twin, in the first trimester. We aim to determine whether combining the presence of velamentous cord insertion in at least one twin increases screening efficiency. This was a retrospective cohort with a sample of 136 MCDA twin pregnancies followed at Centro Hospitalar Universitário São João, during a 16-year period. The combination of abnormal ductus venosus in at least one twin and nuchal translucency discrepancy is associated with the development of TTTS with an OR of 10.455, but not with birthweight discordance. The combination of these first trimester markers with velamentous cord insertion is not associated with the development of either outcome. The presence of velamentous cord insertion in MCDA pregnancies is not associated to TTTS development. Therefore, the addition of this marker to the first trimester screening would not effectively predict the development of birthweight discordance or TTTS. However, a positive currently used screening test increases the risk of developing TTTS by about ten times. [ABSTRACT FROM AUTHOR]

A malpresentation is diagnosed when any part of the baby is presenting to the maternal pelvis other than the vertex of the fetal head. A malposition is diagnosed when the fetal head is in any position other than occipito-anterior (OA) flexed vertex. Both malpresentation and malposition are associated with prolonged or obstructed labour, fetal and maternal morbidity, and potential mortality, if not managed in labour effectively. Malpresentations can be further classified by the lie of the fetus, be it normal or abnormal. The most common fetal malpresentation in longitudinal lie is breech presentation which itself can be further subdivided into subtypes. Other malpresentations in longitudinal lie include face, brow and compound. The fetus in non-longitudinal lie may be oblique or transverse, with shoulder, arm or cord presentations. Malpositions, such as occipito-posterior (OP) and occipito-transverse (OT), can be further described by the degree of deflexion and asynclitism. This practical review considers the potential fetal abnormal presentations and positions, their risk factors, and how these should be managed during labour. [ABSTRACT FROM AUTHOR]

Guillain-Barré syndrome is a rare neurological complication that presents in pregnancy and postpartum. We present a case of a 23-year-old Gravida 2 Para 1 Living 1 with 39 weeks of gestation and previous lower (uterine) segment cesarean section (LSCS) who presented with nonspecific symptoms in the antenatal period and progressed to develop symmetrical progressive ascending paralysis in the postpartum period with no antecedent history of infection. The patient was managed by a multidisciplinary team and treated with plasma exchange, with complete recovery at follow-up. We are reporting this case because of the rarity of Guillain-Barre syndrome in pregnancy and postpartum and the nonspecific initial presentation with an unexpected diagnosis in the immediate postpartum. [ABSTRACT FROM AUTHOR]

Objective: Rare disease. Background: Spontaneous pneumomediastinum and subcutaneous emphysema (Hamman's syndrome) presents with sudden and life-threatening symptoms. Clinical signs include crackles that synchronize with the heartbeat on chest auscultation (Hamman's sign). This report describes the case of a 29-year-old woman with a protracted second stage of labor at 40 weeks of pregnancy with postpartum dyspnea, acute chest pain, and surgical emphysema due to pneumomediastinum (Hamman's syndrome). Case Report: This case report describes the case of a 29-year-old primigravida admitted to the hospital ward for spontaneous labor at 40 weeks of pregnancy. Due to a protracted second stage of labor, the delivery was assisted by Thierry's spatulas. Shortly after delivery, the patient developed dyspnea associated with subcutaneous emphysema in the inferior part of the face, neck, and anterior chest wall. As the clinical evaluation showed no signs of severity, we performed a chest X-ray, which confirmed the diagnosis of pneumomediastinum (Hamman's syndrome), excluded any other life-threatening condition, and led to a conservative treatment approach. Conclusions: This report presents a rare association between protracted labor and Hamman's syndrome and highlights the importance of rapid diagnosis and management. In this case, the postpartum presentation was distinguished from pulmonary embolism, and emergency life-saving management was initiated. [ABSTRACT FROM AUTHOR]

Problem: Research so far has evaluated the effect of antenatal classes, but few studies have investigated its usefulness from the perspective of mothers after birth. Background: Antenatal classes evolved from pain management to a mother-centred approach, including birth plans and parenting education. Evaluating the perception of the usefulness of these classes is important to meet mother's needs. However, so far, research on the mothers' perception of the usefulness of these classes is sparse, particularly when measured after childbirth. Given that antenatal classes are considered as adult education, it is necessary to carry out this evaluation after mothers have had an opportunity to apply some of the competences they acquired during the antenatal classes during their childbirth. Aim: This study investigated mothers' satisfaction and perceived usefulness of antenatal classes provided within a university hospital in Switzerland, as assessed in the postpartum period. Methods: Primiparous mothers who gave birth at a Swiss university hospital from January 2018 to September 2020 were contacted. Those who had attended the hospital's antenatal classes were invited to complete a questionnaire consisting of a quantitative and qualitative part about usefulness and satisfaction about antenatal classes. Quantitative data were analysed using both descriptive and inferential statistics. Qualitative data were analysed using thematic analysis. Findings: Among the 259 mothers who answered, 61% (n = 158) were globally satisfied with the antenatal classes and 56.2% (n = 145) found the sessions useful in general. However, looking at the utility score of each theme, none of them achieved a score of usefulness above 44%. The timing of some of these sessions was questioned. Some mothers regretted the lack of accurate information, especially on labour complications and postnatal care. Discussion: Antenatal classes were valued for their peer support. However, in their salutogenic vision of empowerment, they did not address the complications of childbirth, even though this was what some mothers needed. Furthermore, these classes could also be more oriented towards the postpartum period, as requested by some mothers. Conclusion: Revising antenatal classes to fit mothers' needs could lead to greater satisfaction and thus a better impact on the well-being of mothers and their families. [ABSTRACT FROM AUTHOR]

Having a negative childbirth experience is a known risk-factor for developing postpartum depression (PPD). Alterations of the hypothalamus-pituitary-adrenal (HPA)-axis have been discussed as a potential underlying mechanism. However, research on the association between negative birth experiences and long-term integrated glucocorticoids (GCs) is lacking. This study aimed to examine whether objective and subjective birth experience predicted long-term GCs and PPD symptoms. Measures of objective and subjective birth experience, PPD symptoms, and hair strands for the assessment of hair cortisol concentrations (HairF), hair cortisone concentrations (HairE), and HairF/HairE ratio, were provided eight weeks after childbirth by 235 mothers participating in the study DREAM HAIR. A negative objective birth experience predicted a higher HairF/HairE ratio but was not associated with HairF or HairE. The subjective birth experience did not explain additional variance in hair GCs but was a significant predictor for PPD symptoms. A higher HairF/HairE ratio predicted PPD symptoms when controlling for prepartum depressive symptoms and number of lifetime traumatic events. Analyses were based on a relatively homogeneous sample and women reported in general positive birth experiences and low levels of depressive symptoms. Therefore, results should be applied to the broader population with caution. Our results suggest that negative objective birth experience is associated with an altered HairF/HairE ratio, which in turn, seems to be a promising biomarker to identify women at risk for developing PPD. A negative subjective birth experience may be less critical for alterations of the HPA-axis but remains an essential risk factor for PPD. • Childbirth complications were associated with a higher cortisol/cortisone ratio. • A higher cortisol/cortisone ratio predicted higher postpartum depressive symptoms. • A negative subjective birth experience was not linked to glucocorticoid levels. • A negative subjective birth experience predicted postpartum depressive symptoms. [ABSTRACT FROM AUTHOR]

Background: The most common cause of post partum hemorrhage after a cesarean section is uterine atony. Aims & Objective: The main aim of this study was to examine the outcomes of the B-Lynch procedure in patients who experienced primary PPH after cesarean section. Methods: This study spanned one year, from August 2020 to August 2021, at Ayub Teaching Hospital. Patients who developed post-partum hemorrhage after a cesarean section were enrolled in this study and a thorough review of their records was conducted to identify those who received B-Lynch sutures and assess the resulting outcomes. Results: Out of the 87 patients who experienced PPH, 24 (27.6%) patients received the B-Lynch procedure. Among these 24 patients, only two (8.3%) needed hysterectomy, while the remaining 22 successfully recovered after receiving the B-Lynch procedure. Conclusion: The B-Lynch technique proves to be a safe, effective, and easily applicable method for stopping hemorrhage in patients who experienced significant initial postpartum hemorrhage due to uterine atony. [ABSTRACT FROM AUTHOR]