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The article explores the considerations and challenges of administering neuraxial anaesthesia to parturients with intracranial pathology. Topics discussed include the management of obstetric anaesthesia in patients with intracranial hypertension, the potential risks associated with lumbar puncture, and the complexities of using regional anaesthesia in this clinical setting.

As primary carers of children, mothers provide a central role in mediating and negotiating children's digital media use in the home. In parental mediation research, this work is often reported with a gender-neutral tone, implying both parents play an equal role. This study challenges this bias by unmasking the mediation practices and experiences of mothers. Qualitative interviews revealed mediation is bound by maternal desires to protect, guide and educate children in their media use. The intensity of this care role, often conducted in parallel with other unpaid and paid work, also leads mothers to deploy self-satisfying strategies that facilitate repose. The study illustrates how the gendered role and experience of mothering influences the mediation strategies mothers' use and argues for broader recognition of these nuanced practices in parental mediation research. It also discusses the implications and impact of parental mediation on the unpaid digital care work of mothers. [ABSTRACT FROM AUTHOR]

Background: The fear of childbirth (FOC) causes negativities such as increased an need for analgesia and interventions related to labour, prolonged labor, and childbirth dissatisfaction. It has been shown that birth support can be an effective strategy for reducing these negative outcomes. Also, labour support based on a nursing theory can help improve care outcomes. Aim: This study aimed to examine the effects of nursing care structured according to Kolcaba's theory on duration, pain, and comfort of childbirth. Methods: This pilot study was a randomised controlled study. Before the participants were randomized, their FOC levels were determined using the Wijma Delivery Expectancy/Experience Scale A (WDEQ-A). Ninety women who had a FOC (WDEQ-A >66) were randomised into groups. The study was completed with 46 women (21 intervention, 25 control). The intervention group received the labour support based on Kolcaba's Theory of Comfort. The control group received standard care at birth.The data were collected using the Wijma Delivery Expectancy/Experience Scale A and the Comfort Behavior Checklist during pregnancy and labour. They were analysed using non-parametric tests. Results: The women in the intervention group had shorter latent and active phases (p = 0.002), lower pain scores (p = 0.000), and higher levels of birth comfort (p = 0.002). Relevance for the Clinical Practice: Labor support structured according to Kolcaba's Theory of Comfort contributes to increased comfort and decreases childbirth pain. This study can guide healthcare professionals who provide labour support on how to plan, provide, and assess care for woman who are giving birth. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to clarify the maternal and neonatal outcomes based on the presence or absence of a Couvelaire uterus with placental abruption. Methods: This single‐center retrospective study was conducted at a tertiary perinatal center in Japan, including patients diagnosed with acute placental abruption who delivered live births via cesarean section between 2016 and 2023. Patients were divided into two groups based on the presence or absence of a Couvelaire uterus during surgery: the Couvelaire and normal uterus groups. Maternal and neonatal outcomes were assessed. Results: This study included 76 patients: 24 in the Couvelaire group and 52 in the normal uterus group. No patients underwent hysterectomies. The Couvelaire group had significantly higher intraoperative blood loss (median 1152 vs 948 g, P = 0.010), blood transfusion rates (58% vs 31%, P = 0.022), fibrinogen administration rates (38% vs 13%, P = 0.038), intensive care unit/high care unit admission rates (29% vs 7.7%, P = 0.013), and disseminated intravascular coagulation complication rates (25% vs 7.7%, P = 0.038). There were no differences in birth weight, gestational age (median 2387 vs 2065 g, P = 0.082), Apgar score <4 at 5 min (4.2% vs 3.9%, P = 0.95), umbilical artery blood pH <7.1 (25% vs 22%, P = 0.82), and neonatal death (4.2% vs 1.9%, P = 0.57). Conclusion: A Couvelaire uterus indicated adverse maternal outcomes but not neonatal ones. Its presence necessitates preparation for blood transfusions and/or intensive patient follow‐up. Synopsis: The patients with placental abruption who have a Couvelaire uterus have adverse maternal outcomes. [ABSTRACT FROM AUTHOR]

Reverse takotsubo cardiomyopathy is a rare variant of a rare disease characterized by basal ballooning and dysfunction of the left ventricle. While it can render patients profoundly unwell and reliant on intensivist care, it is a transient phenomenon, with the worst symptoms subsiding after 2–3 days. At term, a young woman spontaneously entered labor prior to a planned repeat cesarean section. After experiencing physical and psychological distress during labor and a vacuum extraction, she developed cardiogenic shock from reverse takotsubo cardiomyopathy, quickly diagnosed with transthoracic echocardiogram. She required 2 days of intensive care support and made an excellent recovery. This very rare condition should be considered in systemically unwell women in the peripartum as it can be quickly diagnosed, providing patients with the best appropriate care. Synopsis: A young woman develops a very rare cardiomyopathy in the peripartum, requiring intensive care support. With rapid efforts to diagnose, she makes a good recovery. [ABSTRACT FROM AUTHOR]

• Myotonic dystrophy linked to high miscarriage and preterm birth rates. • Spinal muscular atrophy increases cesarean sections due to preterm labor. • Postpartum worsening of muscle strength noted in Pompe disease. • GNE myopathy shows no significant increase in emergency cesarean rates. Genetic neuromuscular disorders affect muscle function and control by the nervous system, presenting significant clinical challenges, particularly during pregnancy. To systematically review the literature on the obstetric outcomes and complications in women with genetic neuromuscular disorders. We searched PubMed/Medline, Scopus, and CINAHL Ultimate from inception till June 2024 using terms like "pregnancy", "genetic neuromuscular disorder", "myotonic dystrophy", "maternal health" etc. Pregnant women with genetic neuromuscular disorders. Screening, selection, and data extraction were performed independently by two reviewers. A total of 28 studies from 1978 to 2023 examined pregnancy outcomes in women with genetic neuromuscular disorders. The disorders included myotonic dystrophy, spinal muscular atrophy (SMA), Charcot-Marie-Tooth disease (CMT), and others. Common complications were polyhydramnios, preterm labor, miscarriages, and cesarean sections. Myotonic dystrophy type 1 (DM1) showed higher neonatal risks than type 2 (DM2). Women with SMA faced exacerbated muscle weakness, while CMT and limb-girdle muscular dystrophy were associated with preterm labor and cesarean deliveries. Pompe disease exacerbated symptoms, and GNE myopathy showed similar pregnancy outcomes to the general population. Non-dystrophic myotonias had higher fetal distress and postpartum complications. Women with genetic neuromuscular disorders face increased pregnancy complications, including preterm labor, cesarean sections, and disease symptom exacerbation. Multidisciplinary care between neurologists and obstetricians is essential in managing these high-risk pregnancies effectively, ensuring better maternal and neonatal outcomes. Further research is needed to develop standardized care protocols and improve clinical management. [ABSTRACT FROM AUTHOR]

The study aimed to analyze the use of complementary and integrative health practices (CIHPs) during labor and birth in a freestanding birth center. A total of 28 different CIHPs were applied with or used by laboring women. The most adopted CIHPs were mind-body practices (99.9%) and natural products (35.5%), mostly used by primiparous women (P <.05). Adopting CIHPs can increase care quality, increase positive experiences during childbirth, and promote evidence-based choices. [ABSTRACT FROM AUTHOR]

Objectives: Involuntary exit from the labor force can lead to poor health and well-being outcomes. Therefore, the purpose of this research is to better understand the factors that contribute to perceived retirement voluntariness. Methods: We conducted descriptive and multivariable logistic regression analyses using a sample of recent retirees (n = 2080) from the Canadian Longitudinal Study on Aging (CLSA). Results: More than one-quarter (28%) of older workers perceived their retirement to be involuntary. Among 37 possible predictors, 14 directly predicted retirement voluntariness and many more indirectly predicted retirement voluntariness. Only four direct predictors were common to both women and men, retiring because of organizational restructuring/job elimination; disability, health, or stress; financial possibility; and having wanted to stop working. Discussion: Findings suggest the need for employment support, health promotion, work disability prevention, financial education, and support that is sensitive to the differences between women and men to prevent involuntary retirement. [ABSTRACT FROM AUTHOR]

Previous studies have investigated whether inflammatory cytokines in maternal circulation are associated with preterm birth. However, many have reported inconsistent results, and few have investigated cytokine trends through gestation, particularly with respect to subtypes of preterm birth. We explored levels of 15 inflammatory cytokines and growth factors in plasma and serum collected in the second (17–23 weeks, timepoint 1 (T1)) and third (28–32 weeks, timepoint 2 (T2)) trimesters with respect to subtypes of preterm birth: spontaneous preterm labour (sPTL), preterm premature rupture of membranes (PPROM), and medically indicated preterm birth (mPTB). The change in TNFα levels over time (T2/T1) significantly classified mPTB from term birth with an AUC of 0.79. While elevated sICAM-1 levels were significantly associated with sPTL, sICAM-1 was not an effective biomarker for prediction. While statistical differences in some biomarkers, such as TNFα and sICAM-1 were found, these are likely not clinically meaningful for prediction. These results did not reveal a relationship between spontaneous labour and circulating maternal inflammatory biomarkers, however, do suggest distinct inflammatory profiles between subtypes of preterm birth. [ABSTRACT FROM AUTHOR]

To assess the risk of exposure to a medicinal product during pregnancy in an individual case report, the necessary information should be present, complete and clearly described. Previously designed grading tools were not developed for pregnancy pharmacovigilance data. This study aims to identify the elements that are necessary to assess of the quality of information for risk assessment of medicinal products used during pregnancy. This is a first step in the development of a validated method to assess the clinical quality of case reports in pregnancy pharmacovigilance data. Potential information elements were determined by means of an expert focus group discussion and a survey based on its outcome. This provided an overview of possible information elements to be selected. For the final selection of the elements, a second survey and subsequent focus group discussion was used. Twenty-one information elements within seven categories were identified: information related to the association itself, the event, exposure to the medicinal product, maternal factors, pregnancy, labour, and the child. This study identified elements considered necessary in the assessment of quality of information of case reports in pregnancy pharmacovigilance data, via an extensive four-step process. [ABSTRACT FROM AUTHOR]

The objective of this study was to explore the relationship between cervical inflammatory status at term gestation and spontaneous onset of labour. The aim was to search for a cost-effective, readily available, point of care test as predictor for spontaneous onset of labour (SPOL) at term. This prospective observational cohort study was ICMR-STS project. Women who were primigravida with 20–30 years age, term gestation, single-live foetus with cephalic presentation, not in labour, asymptomatic with no evidence of infection and obstetric complications, were included in the study. Cervical mucous samples were subjected to cytological assessment after Giemsa staining and differential count under microscope. Primary outcome measure was the spontaneous onset of labour within 7 days of enrollment; and depending on whether SPOL occurred or not the participants were divided into two groups, Group I and Group II, respectively. Out of 47 participants, 23 went into SPOL and included in Group I. We observed significantly increased mean levels of polymorphs (71.7 ± 29 vs. 55 ± 28; p-value 0.03), and raised PLR (12.72 ± 6.89 vs. 7.01 ± 3.4; p-value 0.0007) in group I before onset of labour. Polymorphs showed good sensitivity (73.9%) and specificity (83.3%); and on ROC polymorphs curve was on the left of the reference line which indicated that it has good predictive value for SPOL. Predominance of polymorphs in the cervical mucous prior to the onset of labour has emerged as a novel, cost-effective, point of care predictor for SPOL. [ABSTRACT FROM AUTHOR]

Aim: The induction of labor before due date has recently been proved to reduce the rate of cesarean sections and is not associated with increased risk of adverse perinatal outcomes as compared to expectant management. Controlled‐release dinoprostone (PGE2) vaginal insert has recently been approved for use in Japan. However, evidence regarding its efficacy in cervical ripening and labor induction before due date remains limited. We aimed to compare the efficacy of PGE2 vaginal inserts and mechanical dilation for labor induction before due date. Methods: This retrospective cohort study included 206 mothers at 37, 38, and 39 weeks' gestation delivered at our institution between January 2021 and October 2022. Perinatal outcomes, including the success rate of vaginal delivery, were compared between the PGE2 (n = 46) and metreurynter/laminaria tent (non‐PGE2) (n = 160) groups. The success rate of vaginal delivery was defined as the proportion of women who delivered vaginally within 48 h of initiating oxytocin augmentation. Results: The success rate of vaginal delivery was significantly higher in the PGE2 group (37/49, 80.4%) than in the non‐PGE2 group (106/177, 66.2%). Emergency cesarean section related to non‐reassuring fetal status was performed with none in the PGE2 group and with eight (5.0%) in the non‐PGE2 group. Conclusions: The rate of vaginal delivery was significantly higher in the PGE2 group for elective labor induction between 37 and 39 weeks. The PGE2 vaginal insert could increase the success rate of vaginal delivery for elective induction of labor at 39 weeks. [ABSTRACT FROM AUTHOR]

Introduction Material and Methods Results Conclusions Vaginal birth after cesarean delivery (VBAC) attempt is promoted to reduce cesarean‐related morbidity, but it carries a risk of uterine rupture, posing significant maternal and neonatal risks. This study evaluated uterine rupture incidence and risk factors in a high VBAC attempt population.This was a 16‐year retrospective multicenter case–control cohort study (2002–2018). Eleven French university hospitals participated. Women were included if they had a complete uterine rupture during a VBAC attempt. Two controls, defined as a VBAC attempt without uterine rupture, were randomly included for each case. We analyzed the risk factors of uterine rupture among the overall population and then among women who had labor induction and those who had spontaneous labor. Logistic regression was used to compute crude odds ratios (ORs) and 95% confidence intervals (CIs) for uterine rupture. Multivariable logistic regression was used to calculate adjusted ORs (aORs) and 95% CIs.Among 48 124 patients with a single prior cesarean section, 31668 (65.8%, 95% CI 65.3–66.2) had a VBAC attempt and 23 086 (72.9% 95% CI 72.4–73.4) had a successful vaginal delivery. The complete uterine rupture frequency was 0.63%. There were 199 cases of complete uterine rupture (0.63%, 95%CI 0.54–0.71) and 396 controls. Among the overall population, the odds of uterine rupture was inversely associated with prior vaginal delivery (adjusted odds ratio [aOR] 0.3, CI 95% 0.2–0.5) and positively with induction of labor (aOR 2.2, 95% CI 1.4–3.4). For women with spontaneous labor, the odds of uterine rupture was positively associated with a Bishop score<6 (aOR 1.8, 95%CI 1.0–3.0), arrest of cervical dilatation of at least 1 hr. (aOR, 1.8 95%CI 1.1–2.9) and oxytocin augmentation (aOR 2.2 95% CI 1.3–3.7). For women undergoing labor induction, no factors were significantly associated with uterine rupture.Uterine rupture frequency was low among women with high rates of VBAC attempt and successful vaginal delivery and was reduced with previous vaginal birth and increased with induction of labor, regardless of the method used. It was associated with any dystocia during spontaneous labor and suspected macrosomia in induced women, which should be managed with caution. [ABSTRACT FROM AUTHOR]

An increasing number of women are conceiving through assisted reproductive technology; however, few studies have investigated their mental health after successful conception. This study investigated the changes in depressive symptoms in women using assisted reproductive technology and the association between the mode of conception and perinatal depressive symptoms. A longitudinal observational study was conducted from 2015 to 2019, 542 pregnant women completed questionnaires on depressive symptoms at eight timepoints during the prepregnancy, pregnancy and first-year postpartum periods. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. A generalized estimating equation regression model was employed for repeated measures. In the assisted reproductive technology group, depressive symptoms were more prevalent during early pregnancy and at 1 month postpartum than before pregnancy, and more prevalent before pregnancy and at 1 month after childbirth than in the spontaneous conception group. No significant association was identified between the mode of conception and depressive symptoms during the antenatal or postnatal period. The lack of full-time employment and prepregnancy depressive symptoms were associated with antenatal depressive symptoms. Primipara status and depressive symptoms during prepregnancy and pregnancy were associated with depressive symptoms during the first-year postpartum. Assisted reproductive technology was not a risk factor for depressive symptoms during the pregnancy and postpartum periods, whereas primipara status, lack of full-time employment and prepregnancy depressive symptoms were negative predictors. Therefore, targeted mental health interventions should address these specific factors to effectively support maternal mental health. [ABSTRACT FROM AUTHOR]

Background: Research has shown caseload midwifery to increase the chance of vaginal birth, but this may not be the case in settings with high vaginal birth rates in standard care. This study investigated the association between caseload midwifery and birth mode, labor interventions, and maternal and neonatal outcomes at a large obstetric unit in Denmark. Methods: Cohort study including medical records on live, singleton births fr om June 2018 until February 2022. Exposure was caseload midwifery care compared with standard midwifery care. The primary outcome was birth mode, and secondary outcomes were other outcomes of labor. Adjusted risk ratios (aRR) with 95% confidence intervals (CI) were estimated by log‐binomial regression. Results: Among 16,110 pregnancies, 3162 pregnancies (19.6%) received caseload midwifery care. Caseload midwifery was associated with fewer planned cesareans (aRR 0.63 [95% CI 0.54–0.74]) and emergency cesareans (aRR 0.86 [95% CI 0.75–0.95]). No differences in labor induction, use of epidural analgesia, oxytocin augmentation, or anal sphincter tears were observed. Caseload midwifery performed more amniotomies (aRR 1.14 [95% CI 1.02–1.27]) and tended to perform more episiotomies (aRR 1.19 [95% CI 0.96–1.48]). Postpartum hemorrhage (aRR 0.90 [95% CI 0.82–0.99]) and low Apgar score were less likely (aRR 0.54 [95% CI 0.37–0.77]), and early discharge more likely (aRR 1.22 [95% CI 1.17–1.28]) in caseload midwifery. Conclusion: In caseload midwifery care, a higher vaginal birth rate was observed with no increase in adverse outcomes, mainly due to a lower likelihood of planned cesarean. Also, fewer children were born with low Apgar scores. [ABSTRACT FROM AUTHOR]

Background: Respectful maternity care includes shared decision‐making (SDM). However, research on SDM is lacking from the intrapartum period and instruments to measure it have only recently been developed. TeamBirth is a quality improvement initiative that uses team huddles to improve SDM during labor and birth. Team huddles are structured meetings including the patient and full care team when the patient's preferences, care plans, and expectations for when the next huddle will occur are reviewed. Methods: We used patient survey data (n = 1253) from a prospective observational study at four U.S. hospitals to examine the relationship between TeamBirth huddles and SDM. We measured SDM using the Mother's Autonomy in Decision‐Making (MADM) scale. Linear regression models were used to assess the association between any exposure to huddles and the MADM score and between the number of huddles and the MADM score. Results: In our multivariable model, experiencing a huddle was significantly associated with a 3.13‐point higher MADM score. When compared with receiving one huddle, experiencing 6+ huddles yielded a 3.64‐point higher MADM score. Discussion: Patients reporting at least one TeamBirth huddle experienced significantly higher SDM, as measured by the MADM scale. Our findings align with prior research that found actively involving the patient in their care by creating structured opportunities to discuss preferences and choices enables SDM. We also demonstrated that MADM is sensitive to hospital‐based quality improvement, suggesting that future labor and birth interventions might adopt MADM as a patient‐reported experience measure. [ABSTRACT FROM AUTHOR]

Introduction: This exploratory review aimed to provide empirical evidence on the definitions of labor, the statistical approaches and measures reported in randomized controlled trials (RCTs) and observational studies measuring the duration of labor. Methods: A systematic electronic literature search was conducted using different databases. An extraction form was designed and used to extract relevant data. English, French, and German studies published between 1999 and 2019 have been included. Only RCTs and observational studies analyzing labor duration (or a phase of labor duration) as a primary outcome have been included. Results: Ninety‐two RCTs and 126 observational studies were eligible. No definition of the onset of labor was provided in 21.7% (n = 20) of the RCTs and 23.8% (n = 30) of the observational studies. Mean was the most frequently applied measure of labor duration in the RCTs (89.1%, n = 82), and median in the observational studies (54.8%, n = 69). Most RCTs (83%, n = 76) and observational studies (70.6%, n = 89) analyzed labor duration using a bivariate method, with the t‐test being the most frequently applied (45.7% and 27%, respectively). Only 10.8% (n = 10) of the RCTs and 52.4% (n = 66) of the observational studies conducted a multivariable regression: 3 (30%; out of 10) RCTs and 37 (56%; out of 66) observational studies used a time‐to‐event adapted model. Conclusion: This survey reports a lack of agreement with respect to how the onset of labor and phases of labor duration are presented. Concerning the statistical approaches, few studies used survival analysis, which is the appropriate statistical framework to analyze time‐to‐event data. [ABSTRACT FROM AUTHOR]

Background: Shoulder dystocia is an unpredictable obstetric condition with potential long‐term neonatal complications. The risk of neonatal injury might be related to the condition itself as well as to the obstetrics maneuvers used for its release. Objectives: To examine the available evidence to assess current management and possible improvement of outcomes. Search Strategy: A comprehensive search of MEDLINE, EMBASE, EMCARE, and The Cochrane Library database was performed, all studies reporting on neonatal outcomes in cases of shoulder dystocia stratified by obstetric maneuvers used for delivery were included. Data abstraction was performed and checked by two independent reviewers. Results: McRoberts maneuver was the least associated with risk of neonatal injury (odds ratio 0.6, 95% confidence interval 0.4–0.9), followed by delivery of posterior arm. Conclusion: Delivery of posterior arm might be prioritized in cases of shoulder dystocia after failed McRoberts. Neonatal hypoxic injury correlates with the duration of dystocia rather than the maneuver used. Synopsis: Neonatal injury in shoulder dystocia can be mechanical or metabolic, but hypoxic injury seems more related to duration than the maneuver used for release. [ABSTRACT FROM AUTHOR]

Objective This study aimed to assess the impact of implementation of an induction of labor (IOL) guideline on IOL length and utilization of evidence-based practices. Study Design We conducted a quality improvement project to increase utilization of three evidence-based IOL practices: combined agent ripening, vaginal misoprostol, and early amniotomy. Singletons with intact membranes and cervical dilation ≤2 cm admitted for IOL were included. Primary outcome was IOL length. Secondary outcomes included cesarean delivery and practice utilization. We compared preimplementation (PRE; November 1, 2021 through January 31, 2022) to postimplementation (POST; March 1, 2022 through April 30, 2022) with sensitivity analyses by self-reported race and ethnicity. Cox proportional hazards models and logistic regression were used to test the association between period and outcomes. Results Among 495 birthing people (PRE, n = 293; POST, n = 202), IOL length was shorter POST (22.0 vs. 18.3 h, p = 0.003), with faster time to delivery (adjusted hazard ratio [aHR] = 1.38, 95% CI: 1.15–1.66), more birthing people delivered within 24 hours (57 vs. 68.8%, adjusted odds ratio [aOR] = 1.90 [95% CI: 1.25–2.89]), and no difference in cesarean. Utilization of combined agent ripening (31.1 vs. 42.6%, p = 0.009), vaginal misoprostol (34.5 vs. 68.3%, p < 0.001), and early amniotomy (19.1 vs. 31.7%, p = 0.001) increased POST. Conclusion Implementation of an evidence-based IOL guideline is associated with shorter induction time. Additional implementation efforts to increase adoption of practices are needed to optimize outcomes after IOL. Key Points Implementation of an IOL guideline is associated with faster time to delivery. Evidence-based induction practices were used more often after guideline implementation. Adoption of evidence-based induction practices is variable even with a guideline. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to explore the correlation between the angle of progression (AOP) and spontaneous vaginal delivery (SVD) for term nulliparous women before the onset of labor. Additionally, it evaluates the diagnostic efficacy of AOP in predicting SVD in term nulliparous women. Methods: In this retrospective observational study, data from nulliparous women without contraindications for vaginal delivery, with a singleton pregnancy ≥37 weeks, and before the onset of labor were included. Transperineal ultrasound was performed to collect AOP. The date and mode of delivery were tracked, to assess the correlation between AOP and SVD in term nulliparous women. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic efficacy of AOP in predicting SVD for term nulliparous women. Results: The SVD‐failure (SVD‐f) group exhibited a significantly lower AOP compared with the SVD group (88.43° vs 95.72°, P <.001). Logistic regression analysis revealed that AOP was associated with SVD in term nulliparous women (OR = 1.051). ROC curve analysis demonstrated that the area under the ROC curve with AOP 84° as the threshold was 0.663, with a sensitivity of 85.25% and specificity of 43.18%. Considering a sensitivity and specificity of 90%, the dual cut‐off values for term nulliparous women for SVD were 81° and 104°, respectively. Conclusions: A positive correlation was identified between AOP and SVD for nulliparous women after 37 weeks and before the onset of labor. Notably, term nulliparous women with AOP exceeding 104° exhibited a higher probability of SVD. [ABSTRACT FROM AUTHOR]

BACKGROUND: Birthing choices play significant roles in maternal outcomes. This article describes the birthing choices made by some women on Mageta Island (hereafter called simply "the Island") of Western Kenya in relation to Universal Health Coverage (UHC) and free maternity services (FMS) policy ideals. Kenya has officially rolled out UHC and has also initiated universal coverage of maternal healthcare services to reduce maternal morbidities and mortalities. In 2016, the government of Kenya expanded FMS, called the Linda Mama (Taking Care of the Mother) initiative, which targets all pregnant women, newborns, and infants by offering free maternal healthcare services. Despite the existence of UHC and FMS in Kenya, women living on the Island have no access to such services. They therefore devise mechanisms for accessing maternal healthcare services. DESIGN: This study is based on an ethnographic design. Data were collected for 5 months using informal conversations, participant observation, and note-taking with mothers at their homes. The study included interviews with six pregnant mothers who were living on the Island at the time of our interviews. DISCUSSION: It emerged that women relied on their agency to find alternatives to biomedical maternal healthcare services, despite the existence of UHC. Such alternatives included having traditional midwives attend their births in their own homes, migrating to the mainland for proper care, and using kin relations as alternatives for birthing beyond the Island. This article highlights how the implementation of the UHC policy might be tailored to specific local contexts, which could help avert maternal mortalities in hard-to-reach areas such as the Island. [ABSTRACT FROM AUTHOR]

Background: There is an unmet need for a large comprehensive population-based dataset documenting national birthing trends in China and a partograph specifically tailored to Chinese women. This study assessed the impact of using the World Health Organization (WHO) partograph or Zhang's guideline to manage labor and delivery in China and inform the development of a partograph that specifically aligns with the progression of labor in Chinese women. Methods: This retrospective analysis included low-risk nulliparous women with a singleton, full-term fetus in cephalic presentation entering spontaneous labor at a specialized obstetric hospital in China between January 2010 and June 2022. Pregnant women were managed according to the WHO partograph (January 2010-August 2014, n = 31,286) or Zhang's guideline (September 2014-June 2022, n = 49,821). Results: Rates of assisted reproduction (4.57% vs. 1.05%; p < 0.0001) and hypertension (7.44% vs. 6.71%; p < 0.0001) were significantly higher for pregnant women managed according to Zhang's guideline compared to the WHO partograph. Rates of labor intervention (35.31% vs. 13.95%; p < 0.0001), including induction of labor by oxytocin, artificial rupture of membranes, lateral episiotomy and conversion to cesarean section (all, p < 0.0001), were significantly higher for pregnant women managed according to the WHO partograph. Rates of forceps assisted vaginal deliveries (12.67% vs. 6.42%; p < 0.0001) and postpartum hemorrhage (10.9% vs. 6.2%; p < 0.0001) were significantly higher, and birth asphyxia (0.15% vs. 0.09%; p = 0.02) was significantly lower, for pregnant women managed according to Zhang's guideline. Conclusions: This study provides valuable insights into the utilization of the WHO partograph and Zhang's guideline in managing labor and delivery among Chinese women. Findings indicate that women managed according to Zhang's guideline had higher rates of assisted reproduction and hypertension, suggesting a potentially different demographic profile or underlying health conditions compared to women managed according to the WHO partograph. Notably, the use of the WHO partograph was linked to a significant increase in labor interventions, while Zhang's guideline resulted in higher rates of forceps-assisted vaginal deliveries and postpartum hemorrhage, yet interestingly, a lower incidence of birth asphyxia. These contrasting outcomes underscore the importance of aligning labor management tools with the specific needs and progression of labor in Chinese women. The results advocate for a tailored partograph that could better reflect the unique characteristics of Chinese women and optimize decision making and maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Background: Ciprofol(HSK3486) is a novel 2,6-disubstituted phenol derivate, a short-acting intravenous sedative, which has similar efficacy characteristics as propofol with less incidence of side effect. Both ciprofol and propofol are often used in outpatient hysteroscopic surgery for sedation. However, the relative potency of these two drugs has not been fully determined in this context. Objective: Our study aimed to investigate the potency-ratio of ciprofol and propofol under procedural sedation and anesthesia in restraining reaction of outpatient hysteroscopy dilatation. Methods: The ED50 (effective dose in 50% of subjects) value for ciprofol and propofol were calculated by Up-and-Down Sequential Allocation Method. 60 healthy patients undergoing daytime hysteroscopy were randomly divided into two groups, which were intravenously injected with ciprofol at an initial dose of 0.4 mg/kg (group C) or propofol at an initial dose of 2 mg/kg (group P) at 2 min after intravenous injection of sufentanil 0.15ug/kg. A successful response is defined as the absence of patient movement in the case of cervical dilation. Conversely, the presence of patient movement is defined as failure. After successful or failed responses, each follow-up patient in the corresponding group was reduced or increased with propofol 0.5 mg/kg or ciprofol 0.1 mg/kg, respectively. Results: The estimated ED50 value for ciprofol and propofol in restraining reaction of hysteroscopy dilatation was 0.444 mg/kg (95% CI, 0.385-0.503 mg/kg) and 1.985 mg/kg (95% CI, 1.801–2.170 mg/kg), respectively. The incidence of respiratory depression, hypoxemia and injection pain in ciprofol was significantly lower than those in propofol. Conclusion: The ED50 of ciprofol and propofol in preventing hysteroscopy dilatation reaction was 0.444 mg/kg (95% CI, 0.385-0.503 mg/kg) and 1.985 mg/kg (95% CI, 1.801–2.170 mg/kg) for outpatient hysteroscopy. The potency-ratio of ciprofol and propofol observed in our study was 1.0:4.5(95%CI,1:3.9-1:5.1). Trial registration: The study was registered at Chinese Clinical Trial Registry http//www.chictr.org.cn/ (Registration date19/11/22 Trial ID ChiCTR2200065954). [ABSTRACT FROM AUTHOR]

Background: In low‐income countries, such as Ethiopia, home birth is the main cause of maternal and neonatal mortality. Several separate studies have been conducted on the prevalence of home birth preference. However, there is no pooled prevalence of home birth preferences. So, this systematic review and meta‐analysis is aimed at assessing the overall preference for home birth and related factors among Ethiopian women. Methods and Materials: The review included only published articles. Medline/PubMed, Web Science, Google Scholar, Scopus, and the Cochrane Library are the main databases. The review includes cross‐sectional studies in English that meet eligibility requirements. The combined prevalence of women's preference for home birth is calculated by random effect models. In addition, Egger's tests and funnel diagrams were used to investigate publication biases. STATA Version 14 is used to perform all statistical analyses. Results: The review included 14 studies with 6631 participants. In Ethiopia, the prevalence of women's preference for home birth was 41.48% (confidence interval (CI): 49.99; 63, 56; I2:98.7%; p ≤ 0.001). In the analysis of the subgroups, the Oromia region had the highest home birth preference rate at 61.40% (55.54%, 67.16), while southern Ethiopia had the lowest value at 20.52% (5.18, 29.75). The probability of preferring home birth was higher for women without education (OR = 0.22, p ≤ 0.001, I2 = 69.7%) and for younger women (ODR = 0.47, p ≤ 0.001, I2 = 84.2%). Conclusion: According to the study, 41% of Ethiopian women prefer home births over institutional births. Age and education of women are statistically important factors in the choice of birthplace. To solve this problem, health professionals and other stakeholders are strongly encouraged to provide women's health education at the community and institutional levels. [ABSTRACT FROM AUTHOR]

Based on fieldwork in maternity wards in Tanzania, I argue that the partograph – a graphical representation of a pregnant woman’s labor – far exceeds its intended role as tracking and surveillance of labor progress. Through surveillance and its concomitant documentation, nurses, especially, also utilize this document to co-create care for themselves and their colleagues. These forms of care proliferate largely unseen by global health systems but are vital for understanding the meeting point of bureaucracy, surveillance, and care and the dynamics of maternity care in this and other lower resource settings. Nurses use the partograph to generate novel forms of surveillance-care. [ABSTRACT FROM AUTHOR]

Background: Fear of childbirth affects women worldwide and can have adverse consequences. Midwives have implemented a number of interventions, autonomously or as part of a professional team. However, midwives have been unable to identify the most appropriate intervention for ensuring the reduction or alleviation of this fear to provide the best perinatal outcomes. Objective: This study aimed to evaluate the effectiveness of a prenatal educational intervention followed by specific support during childbirth, designed and delivered exclusively by midwives for women with a high fear of childbirth. Method: This randomized controlled trial was performed with two arms in two phases: an online prenatal education phase followed by a support phase during childbirth. Participating women with a high fear of childbirth, which was determined using the Wijma Delivery Expectancy Questionnaire A-Spanish version, were assigned to the experimental group or the usual care control group at a 1:1 ratio. Results:Women showed a reduction in fear of childbirth in both phases of the study. According to the intention-to-treat analysis, a significant mean difference was observed in the prenatal stage in favor of the intervention group, and a nonsignificant difference was observed in favor of this same group after delivery. Discussion: The effectiveness of continuous specific prenatal education with preferential support during childbirth by midwives was indicated by improvements in the level of fear of childbirth. [ABSTRACT FROM AUTHOR]

To compare the effectiveness, safety and patient satisfaction of a double balloon catheter (DB) with a synthetic osmotic cervical dilator (OD) for pre-induction cervical ripening in an outpatient setting. This is a prospective, dual-center pilot study including 94 patients with an unripe cervix (Bishop Score <6) near term; 50 patients received the DB and 44 patients the OD. The primary outcomes were the difference in BishopScore (BS) and cervical shortening. Pain perception at insertion and during the cervical ripening period was evaluated by a visual analogue scale and patient satisfaction by a predefined questionnaire. The use of DB was associated with a significantly higher increase in BS (median 3) compared to OD (median 2; p=0.002) and resulted in significantly greater cervical shortening (median −14 mm vs. −9 mm; p=0.003). There were no serious adverse events at placement of devices or during the cervical ripening. There were no significant differences in perinatal outcomes. Pain perception during cervical ripening was significantly higher (p<0.001), and patient satisfaction regarding sleep, relaxing time and performing desired daily activities were significantly lower in patients with DB compared to patients with OD (p<0.001). DB was superior to OD regarding cervical ripening based on BS and on sonographic measurement of the cervical length. Patients with OD experienced less pain during cervical ripening and were more satisfied with the method compared to patients with DB. [ABSTRACT FROM AUTHOR]

Labor management remains a critical issue in obstetrics, with dystocic labor presenting significant challenges in both management and outcomes. Recent advancements in intrapartum ultrasound have facilitated substantial progress in monitoring labor progression. This paper explores the integration of artificial intelligence (AI) into obstetric care, focusing on the Artificial Intelligence Dystocia Algorithm (AIDA) for assessing spatial dystocia during labor. The AIDA utilizes intrapartum ultrasonography to measure four geometric parameters: the angle of progression, the degree of asynclitism, the head–symphysis distance, and the midline angle. These measurements are analyzed using machine learning techniques to predict delivery outcomes and stratify risk. The AIDA classification system categorizes labor events into five classes, providing a nuanced assessment of labor progression. This approach offers several potential advantages, including objective assessment of fetal position, earlier detection of malpositions, and improved risk stratification, placing labor events within a broader context of labor dystocia and obstetric care and discussing their potential impact on clinical practice. This paper serves as a more comprehensive overview and discussion of the AIDA approach, its implications, perspectives, and future directions. However, challenges such as the technological requirements, training needs, and integration with clinical workflows are also addressed. This study emphasizes the necessity for additional validation across diverse populations and careful consideration of its ethical implications. The AIDA represents a significant advancement in applying AI to intrapartum care, potentially enhancing clinical decision-making and improving outcomes in cases of suspected dystocia. This paper explicates the key methodological approaches underpinning the AIDA, illustrating the integration of artificial intelligence and clinical expertise. The innovative framework presented offers a paradigm for similar endeavors in other medical specialties, potentially catalyzing advancements in AI-assisted healthcare beyond obstetrics. [ABSTRACT FROM AUTHOR]

Objective: Acetaminophen (Paracetamol) is the most widely used analgesic. We aimed to determine its efficacy in labour with varying pain intensity, to make labour less painful for women. Methods: This randomized controlled trial was conducted on primigravida's in their active phase of first stage of labour at Pharmacology department of Army Medical College, National University of Medical Sciences in collaboration with Gynecology department of Pak Emirates Military hospital, Rawalpindi. It was a registered trial with trial number of IRCT20220308054220N1. Duration of study was from May 2022 to October 2022. Patients were divided into two groups, Group-I received two doses of I/V 100 ml normal saline whereas Group-II received I/V two doses of 1000 mg acetaminophen in 100 ml normal saline. Calculated sample size was 130, 65 in each group. Visual analogue scale was used as a tool for data measurement. Data was analysed using split plot anova test. Results: Mean VAS in acetaminophen infusion group was found to be less than placebo for 1st dose, but this effect was apparent only one hour after 2nd dose intervention. The difference in means between groups was statistically significant only for 1st dose with p-value of 0.003 (for second dose p-value 0.21). In acetaminophen infusion group, for both doses mean VAS decreased as an immediate effect of drug, but then it increased with time. The difference in VAS between intervals had p-value of <0.001 for 1st dose and 0.005 for 2nd dose. Conclusion: Acetaminophen is an effective non opioid labour analgesic in active phase of first stage of labour. [ABSTRACT FROM AUTHOR]

Objective Our objective was to compare patient perceived control and experience with outpatient versus inpatient cervical ripening. Study Design This is a retrospective mixed-methods analysis of a quality improvement initiative focused on the impact to patients of incorporating outpatient cervical ripening into routine practice. Postpartum inpatients who had elected for outpatient cervical ripening (outpatients) and those who met criteria for outpatient cervical ripening but opted for an inpatient setting (inpatients) were invited to participate in the study. Patients completed the Perceived Control in Childbirth Scale, and scores were compared between outpatient and inpatient groups using Mann–Whitney U test. In addition, semistructured questions elicited feedback prior to hospital discharge, and these qualitative data were analyzed using iterative thematic analysis. Results The study population consisted of 36 outpatients and 38 inpatients. The median score on the Perceived Control in Childbirth Scale was 69 for outpatients and 67 for inpatients (p -value = 0.49), out of a maximum score of 72 (representing the highest level of perceived control). Both groups reported similarly high levels of perceived control, regardless of cervical ripening setting. In the qualitative analysis, pain was the most common theme in both groups. Inpatients reported more distress despite access to stronger pain medications. Outpatients utilized a variety of distraction techniques and expressed gratitude for their setting more than inpatients. Conclusion Outpatient cervical ripening can be a patient-centered solution to obstetric throughput challenges arising from increased numbers of inductions. Those who underwent outpatient cervical ripening had similar perceived control to those who underwent inpatient cervical ripening, suggesting that individual patient preferences are most important in determining the optimal setting for care. The patients' reported experiences identified focus areas for process improvement efforts and future research, including improving patient education regarding expectations and innovating new pain management strategies for cervical ripening. Key Points Patient experiences must inform patient-centered care. Perceived control with cervical ripening was high. Pain with cervical ripening was the most cited theme. [ABSTRACT FROM AUTHOR]

• Limited evidence on best strategy with unfavorable cervix 24 h after first vaginal dinoprostone. • Efficacy, maternal and neonatal morbidity after repeated methods questioned. • Similar vaginal delivery and neonatal morbidity between vaginal dinoprostone and cervical ripening balloon. • Cervical ripening balloon more efficient with more favourable cervix or labor within 24 h. To compare dinoprostone vaginal insert (PG) with cervical ripening balloon (CRB) as second line of cervical ripening in women at term with a persistent unfavorable cervix after first PG. This retrospective cohort study comprised all women with singleton fetus in cephalic presentation who required cervical ripening at term (≥37 weeks) for maternal and/or fetal disease using repeated PG or CRB for a persistent unfavorable cervix (Bishop score <6) 24 h after first PG. Primary outcome was vaginal delivery rate. Secondary outcomes were favorable cervix (Bishop score ≥6) or labor within 24 h after second device placement, postpartum hemorrhage (PPH) and neonatal morbidity. 180 women were analyzed (127 repeated PG (70.6 %) and 53 CRB after first PG (29.4 %)). After second device, 93.3 % of women had a favorable cervix (Bishop score ≥6) or were in labor within 24 h, and the rate was significantly higher after CRB, compared to repeated PG (98.1 % vs. 91.3 %; p = 0.048). Vaginal deliveries were similar between groups (62.2 % after repeated PG vs. 54.7 % after CRB; p = 0.36). PPH was observed in 22.2 % of included women, and no difference was observed between groups (21.3 % vs. 21.4 %; p = 0.63). Neonatal morbidity was similar between groups (13.4 % vs. 9.4 %; p = 0.48). Vaginal delivery rate and neonatal morbidity were similar when using PG or CRB as second line in women at term with a persistent unfavorable cervix after first PG. CRB seemed to be more efficient on the cervix status, compared to repeated PG, in these women. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluated the effects of the Spinning Babies program applied during labor on birth outcomes and satisfaction among pregnant women. Methods: This non-equivalent control group, non-synchronized post-test only design study included 42 participants (22 in the experimental group and 20 in the control group). The Spinning Babies program was conducted four times in the experimental group during the first and second stages of delivery for 50 min per session. The program comprised performing pelvic circles on a birth ball, followed by wide squatting and adopting of open knee-chest and side-lying positions. Results: Compared with those in the control group, pregnant women in the experimental group had a significantly shorter labor time (t = - 6.64, p < .001), a higher success rate for normal vaginal delivery (χ² = 4.86, p = .043), improved Apgar scores of newborns (z² = - 2.18, p = .029), differences in neonatal oxygen therapy use (χ² = 4.86, p = .043), and improved birth satisfaction (t = 11.99, p < .001). Conclusion: The Spinning Babies program improves the birth environment by increasing the normal vaginal delivery success rate, as well as pregnant women's birth satisfaction, and promotes neonatal health. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre 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.)

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre 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/Aim: Our study compares repeat cesarian section with and without labor in progress and evaluates adverse maternal outcomes that could discourage pregnant women in planning labor at term or at least after 39 weeks of gestation as recommended due to benefits in neonatal outcome. Patients and Methods: In this retrospective study, we analyzed 191 patients undergoing third C-section and compared two groups of women of undergoing C-section either before or after the onset of labor. The primary outcome measure was the incidence of maternal morbidity. Values of p≤0.05 were regarded as significant. Results: Comparing the two subgroups, we did not find any significant differences in the occurrence of maternal complications or severe acute morbidity except for incomplete uterine rupture (p=0.04). Conclusion: Undergoing a third C-section after the start of labor has no relevant or adverse impact on maternal outcome. Therefore, elective repeat C-section can be planned in late weeks of gestation aiming at reducing neonatal morbidity. The higher rate of uterine dehiscence was not associated with other issues of severe acute maternal morbidity. [ABSTRACT FROM AUTHOR]

Background/Objectives: Childbirth is a profoundly personal experience that often does not align with expectations. The World Health Organization has established guidelines for best practises; in this sense, it is crucial to understand the childbirth experiences of Portuguese women in comparison with these guidelines. Methods: A quantitative, descriptive, correlational, and cross-sectional study was conducted to achieve this. In total, 615 women completed a sociodemographic questionnaire and the Labour and Childbirth Experience questionnaire, which comprised 39 statements based on the WHO's recommendations. Additionally, the study utilized the Life Satisfaction Scale and gathered insights into participants' overall perception of care during this phase. Results: The results were categorized as follows: (1) practises influencing the labour experience; (2) practises influencing the experience of vaginal birth; (3) practises affecting the experience of caesarean birth; and (4) emotional experience during labour and birth. Conclusions: Notably, the study found that practises discouraged by the WHO are still prevalent, potentially enabling obstetric violence. However, a robust and statistically significant correlation was observed between the childbirth experience and the overall perception of care. [ABSTRACT FROM AUTHOR]

Background: High rates of adverse neonatal outcomes in resource-limited settings are multifactorial, varying by country, region, and institution. In sub-Saharan Africa, the majority of adverse neonatal outcomes are intrapartum related, and studies in Uganda have shown that referral in labor is a major determinant of adverse neonatal outcomes. This study aimed to assess the incidence and factors associated with immediate adverse neonatal outcomes among emergency obstetric referrals in labor at a tertiary hospital in Eastern Uganda. Materials and methods: This was a prospective cohort study involving 265 women who were referred in labor to Jinja Regional Referral Hospital in Uganda with emergency obstetric complications. The exposure of interest was being referred with obstetrical emergency, and the outcome variable was adverse neonatal outcomes. The study was conducted between July 5, 2023, and October 5, 2023. Consecutive sampling was used, and data on sociodemographic and obstetric factors, referral related factors, as well as the primary outcome variable (adverse neonatal outcome) were collected via interviewer-administered questionnaires. The data were then cleaned, coded, and analyzed using STATA version 14. Log-binomial regression determined risk ratios and associations for factors related to adverse neonatal outcomes. Variables with p-values < 0.2 in bivariable analysis were included in the multivariable analysis, where significance was set at p < 0.05. Results: Of the 265 women exposed to emergency obstetrical referrals, 40% experienced adverse neonatal outcomes, a composite measure including neonatal intensive care admission (27.6%), low Apgar score (23.8%), fresh stillbirth (11.3%), early-onset neonatal infection (6.8%), and early neonatal death (2.3%). Factors significantly associated with adverse neonatal outcomes were; maternal age ≥ 35 years (aRR = 1.72, CI:1.194–2.477, p value = 0.004), APH (aRR = 2.48, CI: 1.859–3.311, p-value < 0.001), and non-reassuring fetal status (aRR = 1.90, CI: 1.394–2.584, p-value < 0.001). Conclusions: The study found a high rate of adverse neonatal outcomes among emergency obstetric referrals, with 40% of participants facing issues like ICU admissions, low Apgar scores and fresh stillbirth. Key factors included maternal age over 35, antepartum hemorrhage, and non-reassuring fetal status. These results highlight the urgent need for targeted interventions in emergency obstetric care. Strategies should enhance referral systems, improve facility preparedness, train healthcare providers, and educate communities on timely referrals and managing high-risk pregnancies. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Methods Results Conclusions In subsistence populations, high physical activity is typically maintained throughout pregnancy. Market integration shifts activity patterns to resemble industrialized populations, with more time allocated to sedentary behavior. Daasanach semi‐nomadic pastoralists living in northern Kenya face lifestyle heterogeneity due to the emergence of a market center. We investigate how Daasanach women manage the energetic demands of pregnancy with subsistence labor tasks and how market integration relates to variation in energetic demands, physical activity, and coping strategies.We conducted nine focus group discussions with 72 pregnant women. We also deployed wrist‐worn fitness trackers with 21 pregnant women in two community types: central or peripheral to the market center to capture variation in market integration. Data from focus group discussions were analyzed using thematic analysis. We used multiple linear regression to examine the relationship between gestational age and physical activity.We identified themes of increased fatigue, diet restrictions, and assistance with labor tasks during pregnancy. Gestational age negatively predicted mean daily steps, with a decrease of 1160 ± 437 steps per day with each consecutive pregnancy month. Stratified by community type, gestational age only negatively predicted mean daily steps for peripheral communities, with a decrease of 1443 ± 629 steps per day with each consecutive pregnancy month.Results suggest that physical activity differs with market integration early, but not late, in pregnancy. Daasanach women cope with the energetic demands of pregnancy by reducing physical activity late in pregnancy and receiving assistance with labor tasks from family and neighbors. [ABSTRACT FROM AUTHOR]

Introduction: Newer neuraxial local anesthetic agents which have been used as epidural analgesia have shown to provide reliable pain relief during labor. Ropivacaine and levobupivacaine are newer agents now used for labor analgesia. However, even though few studies have made their comparison with bupivacaine, ropivacaine and levobupivacaine have seldom systematically been compared. Therefore, in this analysis, we aimed to systematically show the impact of epidural ropivacaine versus levobupivacaine for labor analgesia on maternal and fetal outcomes. Methods: http://www.clinicaltrials.gov, Web of Science, MEDLINE, EMBASE, Cochrane database and Google Scholar were searched for studies comparing ropivacaine versus levobupivacaine for labor analgesia. Maternal and fetal outcomes were considered as the endpoints in this analysis. The RevMan software 5.4 was used to analyze data in this study. Risk ratio (RR) with 95% confidence intervals (CI) were used to represent the data post analysis. Results: A total number of 2062 participants were included in this analysis whereby 1054 participants were assigned to ropivacaine and 1008 participants were assigned to levobupivacaine. The main results of this analysis showed that epidural ropivacaine was not associated with significantly higher risk of hypotension (RR: 0.71, 95% CI: 0.43 – 1.17; P = 0.18) and pruritus (RR: 1.12, 95% CI: 0.89 – 1.42; P = 0.34) when compared to levobupivacaine for labor analgesia. However, the risk of nausea and vomiting was significantly higher with ropivacaine (RR: 1.60, 95% CI: 1.05 – 2.44; P = 0.03). Spontaneous vaginal delivery (RR: 0.99, 95% CI: 0.89 – 1.42; P = 0.83), instrumental vaginal delivery (RR: 1.13, 95% CI: 0.89 – 1.45; P = 0.32) and the risk for cesarean section (RR: 0.76, 95% CI: 0.42 – 1.37; P = 0.35) were not significantly different. When fetal outcomes were assessed, Apgar score < 7 at 1 min (RR: 1.01: 95% CI: 0.57 – 1.80; P = 0.97), abnormality of fetal heart rate (RR: 1.45, 95% CI: 0.55 – 3.79; P = 0.45) and neonatal asphyxia (RR: 0.35, 95% CI: 0.10 – 1.18; P = 0.09) were also similarly manifested. Conclusions: To conclude, our analysis showed both epidural ropivacaine and levobupivacaine to be equally effective for labor analgesia in terms of maternal and fetal outcomes. No major adverse maternal and fetal outcome was observed in this analysis. However, considering the several limitations of this analysis, further larger studies should be able to solve and clarify this issue. [ABSTRACT FROM AUTHOR]

Objective To assess the association between use of an oxytocin decision support checklist with oxytocin usage and clinical outcomes. Study Design We conducted a retrospective cohort study of patients with singleton gestations at 37 0/7 weeks or greater who received oxytocin during labor from October 2012 to February 2017 at an integrated community health care system during three exposure periods: (1) prechecklist; (2) after paper checklist implementation; and (3) after checklist integration into the electronic medical record (EMR). The checklist was a clinical decision support tool to standardize the dosing and management of oxytocin. Thus, our primary outcomes included oxytocin infusion rates and cumulative dose. Secondary outcomes included maternal and neonatal outcomes. We controlled for maternal risk factors with multivariable regression analysis and stratified by mode of delivery. Results A total of 34,269 deliveries were included. Unadjusted analyses showed that compared with prechecklist, deliveries during the paper and EMR-integrated periods had a lower cumulative dose (4,670 ± 6,174 vs. 4,318 ± 5,719 and 4,286 ± 5,579 mU, p < 0.001 for both), lower maximal infusion rate (9.9 ± 6.8 vs. 8.7 ± 5.8 and 8.4 ± 5.6 mU/min, p < 0.001 for both), and longer duration of oxytocin use (576 ± 442 vs. 609 ± 476 and 627 ± 488 minutes, p < 0.001 and p = 0.01, respectively). The unadjusted rates of cesarean, 5-minute Apgar <7, mechanical ventilation, and neonatal hospital length of stay were similar between periods. The adjusted mean difference in time from admission to delivery was longer during the EMR-integrated period compared with prechecklist (3.0 [95% confidence interval: 2.7–3.3] hours, p < 0.001). Conclusion Oxytocin checklist use was associated with decreased oxytocin use patterns at the expense of longer labor times. Findings were more pronounced with EMR integration. Key Points An oxytocin decision support checklist is associated with reduced amounts of oxytocin used. However, checklists were associated with longer duration of oxytocin use and of labor. Results were more pronounced in the EMR-integrated checklist compared with paper checklist. [ABSTRACT FROM AUTHOR]

Objective This study aimed to examine the relationship of fetal station in the first stage of labor to labor curves and cesarean delivery rates among women presenting in spontaneous labor. Study Design Labor curves for patients with nonanomalous singletons who presented in spontaneous labor to our hospital's Obstetric Triage Unit with intact membranes from January 1, 2012, to August 31, 2016, were reviewed. Cervical exams and time of exam were obtained for each patient from presentation to triage until delivery. Station for each presentation and cervical dilation was estimated using a random effects model and the slope of cervical station change was calculated to estimate the change in dilation by hour. Perinatal outcomes, including cesarean delivery rates, were examined according to fetal station at initial presentation. Factors known to affect labor curves—epidural analgesia, infant birth weight, maternal habitus, and parity—were also examined. Results There were 8,123 patients presented in spontaneous labor with intact membranes. For patients presenting at 6-cm dilation, the rate of change of labor was significantly different when identified to have a station greater than 0 (+1 and more caudad) when compared with those with −1 and more cephalad station (both p < 0.001). This relationship persisted when analyzed according to epidural analgesia, birth weight, maternal habitus, and parity. The frequency of cesarean delivery was significantly higher for women presenting in spontaneous labor with negative fetal station (p < 0.05). When stratified across all dilation (3–9 cm), this trend remained significant (p < 0.001). Conclusion In the first stage of labor, advanced fetal station was significantly associated with differing rates of labor progression, and positive fetal station was significantly less likely to result in cesarean delivery. Physical examination, including station, remains a critical element in labor management. Key Points Fetal station is important in labor management. Fetal station at initial exam is related to time to delivery. Positive fetal station at initial exam is less likely to result in cesarean delivery. [ABSTRACT FROM AUTHOR]

Background/Objectives: Resources to cope with maternity and women's participation are essential modulators of maternal well-being. Therefore, it is relevant that the psychosocial factors of woman be monitored during maternity to promote adequate healthcare. This study involved the design and the validation of two new tools that identify women's knowledge of healthcare rights (MatCODE) and perception of resource scarcity (MatER) during pregnancy, labor and early postpartum; Methods: The content validity was carried out using the Aiken's V coefficient and the content validity index (CVI-i) based on five experts. In addition, for the face validity, the pilot cohort was considered the INFLESZ scale. Finally, the questionnaires were applied to 185 women, which allowed to assess the construct validation by factorial and Rasch analysis. The divergent validity was also studied with validated psychological questionnaires; Results: MatCODE and MatER questionnaires received CVI-i and Aiken's V > 0.80 values, and the INFLESZ demonstrated acceptable semantic understanding. The analysis confirms the unidimensionality of the questionnaires, with fit values for MatCODE of RMSEA = 0.113 [0.105; 0.122] and for MatER of RMSEA = 0.067 [0.063; 0.072]. The divergent validity showed significant and consistent correlations with the constructs assessed. For MatCODE, ω = 0.95 and α = 0.94, and for MatER, ω = 0.79 and α = 0.78; Conclusions: MatCODE and MatER are useful new tools for monitoring maternal healthcare, with adequate psychometric characteristics in the Spanish context. [ABSTRACT FROM AUTHOR]

Background: There is growing recognition of obstetric violence in health facilities across the globe. With nearly one in three pregnant women living with HIV in South Africa, it is important to consider the influence of HIV status on birth experiences, including potential experience of obstetric violence as defined by the Respectful Maternity Care Charter. This qualitative analysis aims to understand the factors that shape birth experiences of women living with HIV, including experiences at the nexus of HIV status and obstetric violence, and how women react to these factors. Methods: Data were collected in a Midwife Obstetric Unit in Gugulethu, Cape Town, South Africa, through 26 in-depth interviews with women living with HIV at 6–8 weeks postpartum. Interviews included questions about labor and early motherhood, ART adherence, and social contexts. We combined template style thematic analysis and matrix analysis to refine themes and subthemes. Results: Participants described a range of social and structural factors they felt influenced their birth experiences, including lack of resources and institutional policies. While some participants described positive interactions with healthcare providers, several described instances of obstetric violence, including being ignored and denied care. Nearly all participants, even those who described instances of obstetric violence, described themselves as strong and independent during their birth experiences. Participants reacted to birth experiences by shifting their family planning intentions, forming attitudes toward the health facility, and taking responsibility for their own and their babies' safety during birth. Conclusions: Narratives of negative birth experiences among some women living with HIV reveal a constellation of factors that produce obstetric violence, reflective of social hierarchies and networks of power relations. Participant accounts indicate the need for future research explicitly examining how structural vulnerability shapes birth experiences for women living with HIV in South Africa. These birth stories should also guide future intervention and advocacy work, sparking initiatives to advance compassionate maternity care across health facilities in South Africa, with relevance for other comparable settings. Plain language summary: Mistreatment of women during childbirth is a global concern, with known negative impacts on the birthing person and newborn. Women living with HIV are at risk for mistreatment in clinical settings due to persistent stigma and negative perceptions about HIV. Women living with HIV may be further at risk for mistreatment during labor and delivery based on stigma related to HIV status. This qualitative data analysis aims to understand the factors that shape birth experiences of women living with HIV, and how women react to those factors. Data were collected in a Midwife Obstetric Unit in Gugulethu, Cape Town, South Africa, through 26 interviews with women living with HIV at 6-8 weeks postpartum. Interviews included questions about labor and early motherhood experiences. We used a combination of qualitative data analysis techniques to understand and organize participant experiences. While some participants described positive interactions with healthcare providers, several described mistreatment including being ignored, disrespected, denied care, and denied informed consent. Participants also said that lack of healthcare facility resources and infrastructure issues influenced their birth experiences. Nearly all participants, even those who described mistreatment during childbirth, described themselves as strong and independent. These birth stories should guide future research and advocacy in South Africa. [ABSTRACT FROM AUTHOR]

Background: Around 60% of term labours in the UK are continuously monitored using cardiotocography (CTG) to guide clinical labour management. Interpreting the CTG trace is challenging, leading to some babies suffering adverse outcomes and others unnecessary expedited deliveries. A new data driven computerised tool combining multiple clinical risk factors with CTG data (attentive CTG) was developed to help identify term babies at risk of severe compromise during labour. This paper presents an early health economic model exploring its potential cost-effectiveness. Methods: The model compared attentive CTG and usual care with usual care alone and simulated clinical events, healthcare costs, and infant quality-adjusted life years over 18 years. It was populated using data from a cohort of term pregnancies, the literature, and administrative datasets. Attentive CTG effectiveness was projected through improved monitoring sensitivity/specificity and potential reductions in numbers of severely compromised infants. Scenario analyses explored the impact of including litigation costs. Results: Nationally, attentive CTG could potentially avoid 10,000 unnecessary alerts in labour and 2400 emergency C-section deliveries through improved specificity. A reduction of 21 intrapartum stillbirths amongst severely compromised infants was also predicted with improved sensitivity. Attentive CTG could potentially lead to cost savings and health gains with a probability of being cost-effective at £25,000 per QALY ranging from 70 to 95%. Potential exists for further cost savings if litigation costs are included. Conclusions: Attentive CTG could offer a cost-effective use of healthcare resources. Prospective patient-level studies are needed to formally evaluate its effectiveness and economic impact in routine clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Childbirth self-efficacy has repeatedly been shown to raise satisfaction with childbirth, reduce the need for analgesic, and promote the use of different childbirth alternatives. However, the measures to improve the childbirth self-efficacy had rarely been investigated among Egyptian primiparous women. Aim: The aim of this study is to evaluate the effectiveness of childbirth self-efficacy enhancing classes on labor length and outcomes among Egyptian primiparous women. Methods: A quasi-experimental research approach was carried out on prospective, consecutive sample of 148 pregnant women at the end of pregnancy. A prenatal education study group (n = 74) and a control group receiving standard antenatal care (n = 74) make up the first and second groups, respectively. Between October 2021 and October 2022, the study was conducted at the antenatal clinic. The following four tools were employed to fulfill the study's objective: A structured interviewing form, a childbirth self-efficacy inventory, a follow-up checklist for monitoring maternal and neonatal outcomes during labor, and three antenatal education sessions to boost childbirth self-efficacy are all examples of tools that can be used. All statistical analyses were performed using SPSS for windows version 20.0 Results: Approximately 68.9% of women in the experimental group gave birth vaginally, compared to 29.7% of those in the control group with (p =.001), according to the study's findings. In the experimental group, regular labor took an average of 8 to 12 h, but it took more than 12 h in the control group. Birth weight (>3000g) in the experimental group compared to (2000–3000 g) in the control group, as well as the Apgar score at 1 min and 5 min, were highly statistically significance between two groups with (p =.001). The means±SD of the childbirth self-efficacy result scores were better in the study group than in control groups regarding length of delivery and vaginal delivery (248.2 ± 19.4 versus 144.6 ± 21.6 and 250.1 ± 18.2 versus 137.9 ± 21.5, respectively). Conclusion: According to the findings of this study, antenatal education classes have a real chance of assisting primiparous women in increasing their childbirth self-efficacy and improving maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Background: The partograph, one of the vital tools available for the midwife, was originally developed from Friedman's 1954 Cervicograph by Philpott and Castle in 1972. It was later modified and adopted by the WHO as a universal 'gold standard' tool for recording and monitoring progress in labour and providing interventions in cases of abnormal labour. The goal of this study was to assess the level of knowledge of midwives and their utilisation of the modified WHO partograph at the Ga South Municipality in the Greater Accra Region of Ghana. Methodology: An institution-based quantitative cross-sectional study was conducted within the municipality from February to March 2019. One hundred and ten (110) midwives were recruited using the census approach. Data were collected using a structured self-administered questionnaire. STATA statistical software version 14 was used for descriptive analysis and results were reported in the form of percentages and frequencies using charts and tables. Pearson's Chi-Square estimation was also performed to test the association between selected variables with a p value <.05 as the threshold for statistical significance. Results: Of the 110 participants, 105 (95.5%) of the midwives could properly describe the partograph and 104 (94.5%) understood that it was used as a tool for vital decision-making, while 92 (83.6%) indicated that partograph contributes in reducing maternal and new-born deaths. Almost all participants, 109 (99.09%) knew all the parameters of the partograph and were also aware that plotting the partograph begins at a cervical dilation of 4 cm. Also, while a good number of participants 103 (93.64%) knew that cervical dilation on the partograph is carried out every four hours during the active phase of labour, 110 (100%) indicated that progress of labour is assessed by the degree of cervical dilation and descent of the presenting part. Routine usage of the partograph was recorded among the majority of midwives, 102 (92.7%), to record and monitor the progress of labour in expectant women. Bivariate analysis showed a significant association between the use of the modified WHO partograph and the knowledge of midwives on Ghana Health Service (GHS) policies (p =.045). There was, however, no positive association determined among age (p =.66), rank (p =.77), years of professional experience (p = 1.00), place of work (p =.51), work shift and highest qualification (p = 1.00) as far as knowledge and use of the WHO modified partograph are concerned. Conclusion: The findings of the study underscore the desirable level of knowledge and usage of the partograph among study participants. This affirms that the knowledge and usage of the partograph within the facilities in Ga South health facilities hold the prospect of enhancing the safety of expectant mothers. [ABSTRACT FROM AUTHOR]

ABSTRACT: Context: Over-medicalization of normal pregnancy is associated with unnecessary inductions of labor leading to operative deliveries. In a busy outpatient department (OPD) or low-resource setup where ultrasound availability, experience, and cost will be a concern, routine ultrasound at term can be avoided if the clinical estimation of fetal weight is more or less equal to the actual birth weight. Aims: To assess the reliability and validity of fetal weight estimation at term by ultrasound and clinical estimation. Settings and Design: A prospective study of diagnostic accuracy was done over a period of 1.5 years in a tertiary hospital, which included 100 women with term singleton pregnancies admitted in obstetric wards or labor room. Methods and Material: To find out the agreement between actual birthweight and ultrasound fetal weight interclass correlation coefficient (ICC) was used. Mean difference plots (Bland–Altman plots) were done. The mean percentage error was compared with the consultant estimate and registrar estimate across groups. The sensitivity, specificity, and predictive values by clinical and ultrasound estimate were calculated for actual birth weight ≤ 2.5 kg. Results: Both methods of fetal weight estimation have moderate reliability in predicting the actual birth weight. The sensitivity of identifying birthweight < 2.5 kg babies by ultrasound was slightly higher. For birth weight less than 2.5 kg, there was an overestimation of fetal weight by clinical estimation done by postgraduate with mean percentage error being statistically significant as compared with ultrasound estimation. Conclusions: In a developing country like ours where ultrasound is not readily available in all healthcare setups, the clinical method is an easy, cost-effective, simple one that can be used by all medical professionals after adequate training. [ABSTRACT FROM AUTHOR]

Introduction: Expanding access to doula care is a key strategy for improving the perinatal experiences and health outcomes of birthing people of color in the U.S. This study investigates the future of maternal healthcare in the U.S. from the perspective of doulas and highlights emerging technology and other opportunities related to strengthening the doula workforce. Methods: The study recruited community doulas from 12 unique U.S. states, ensuring at least half of the doulas predominantly served communities of color. Doulas (N = 26) participated in semi-structured, futures-oriented interviews that explored their experiences providing care during the COVID-19 pandemic and utilization of technology. A subset of doulas (n = 8) were engaged in interactive workshops where they envisioned alternative futures for doula care and childbirth. Interviews and workshops were analyzed using the Framework Method. Results: The COVID-19 pandemic heightened technology use among doulas and increased client accessibility. Social media serves as a unique space for critical community building and client outreach. Doulas reported opportunities to strengthen and mobilize the future workforce: recognizing doula care as a reimbursable service by health insurers, utilizing doula collectives for community practice to decrease burnout, increasing emotional support for doulas, and instilling a chain of learning through mentorship. Discussion: Futures thinking served as a valuable approach for doulas to illuminate the implications of present-day challenges and empowered doulas to design roadmaps toward better futures for doulas and maternal health. Doulas should be engaged as partners to hold a meaningful decision-making role when discussing policies, employment structures, emerging technology, and other aspects of doulas' positioning within the healthcare system. Significance: Doulas provide information, and emotional and physical support to birthing persons throughout labor, birth, and postpartum. Various studies have shown that doulas help to address gaps in maternal healthcare and reduce racial health disparities. Despite doulas' impactful role in facilitating empowered childbirth experiences, they are often left out of decision-making conversations among maternal health professionals. By gathering doula perspectives on the future of maternal healthcare through blending futures thinking and racial equity, this study provides opportunities around emerging technology and other strategies to mobilize the doula workforce. [ABSTRACT FROM AUTHOR]

Purpose: To compare the success rate of a trial of labor (TOL) in a cohort of patients with pelvic fractures, with and without internal fixation, in order to better counsel patients and avoid unnecessary cesarean section (CS). Methods: A retrospective review of 35 female patients with 28 pelvic ring, five acetabular, and two combined fractures that had subsequent pregnancy; 12 patients had operative fixation and 23 did not. Fracture classification, treatment, type of fixation, mode of deliveries, and reason for CS were documented. Results: The rate of vaginal delivery, unscheduled CS, and scheduled CS across all patients was 80.0% (n = 28), 14.3% (n = 5), and 5.7% (n = 2), respectively, which was similar to institutional rates of 87.0, 12.0, and 1.0%. A TOL was attempted in 91.4% (32/35) and successful in 87.5% (28/32). Patients who failed a TOL were more likely to have Tile B/C pelvic fractures (100.0 vs. 30.4%, observed difference (OD) 69.6%, 95% confidence interval (CI) 16.4, 86.3%; p = 0.01) and more pelvic displacement (6.0 vs. 1.5 mm, OD 4.0, CI 1.0, 18.0; p = 0.01). The fixation and control groups had no observed difference in successful TOL (72.7% vs. 95.2%, OD 22.5%, − 49.7%, 5.5%; p = 0.10). Conclusions: A majority of women had successful vaginal deliveries after pelvic fractures, with or without fixation, suggesting that these patients should consider a TOL. Level of evidence: Diagnostic Level III. [ABSTRACT FROM AUTHOR]